OBJECTIVE:To provide reference for the medication safety in elderly patients with chronic diseases. METHODS:Elderly inpatients with chronic diseases and nursing staff in affiliated hospital of shaoyang medical college,from Mar. 2014 to May 2015 were randomly selected for a questionnaire survey to analyze the influential factors of drug safety and health education de-mand,and the difficulty sources of nursing staff in developing health education was explored. RESULTS:Totally 500 questionnaire was sent out to elderly patients with chronic diseases,500 were effectively received with effective recovery of 100%;and totally 200 were sent out to nursing staff,200 were effectively received with effective recovery of 100%. In the 500 surveyed patients, 193 had ADR,which was affected by age,educational background,monthly income,disease course,whether received health edu-cation,etc.(P<0.05),patients with older age,lower educational background and monthly income,longer disease course and no receiving health education showed higher incidence of ADR;the influential factors for health education demands included education-al background,occupational status,disease course,quality evaluation of nursing staff,etc.(P<0.05),patients with higher educa-tional background,lower disease course,higher occupational status and quality evaluation of nursing staff showed stronger health education demands. The difficulty sources of surveyed nursing staff in developing health education were busy work,being afraid of misunderstanding,embarrassing,cognitive and skill deficits. CONCLUSIONS:The drug safety of elderly patients with chronic dis-eases is related to many influential factors,as well as the health education demands. Nursing staff should continuously improve their ability and quality,combined with the above influential factors,carry out health education with physicians and pharmacists to ensure the medication safety.

Objective To explore the diagnostic value of axial diffusion tensor imaging(DTI) for gliomas grading at 3 .0T MRI , analyze the characteristics of different grades gliomas of axial DTI in order to improve diagnostic accuracy .Methods A retrospec‐tive analysis was performed involving a group of 37 cases of high grade glioma and 26 cases of low grade glioma confirmed by the pathological results in affiliated hospital of Luzhou medical college ,observation analysis was obtained in axial DTI ,peritumoral neu‐rofibrillary was divided into three types :displacement ,interruption and neurofibrillary tangles(NFT) .Results among the 26 cases of low grade glioma ,there were 18 cases of displacement ;8 cases of interruption ,no NFT ;among the 37 cases of high grade glio‐mas ,there were 9 cases of displacement ,21 cases of interruption ,and 7 cases of NFT (1 case of frontal lobe ,6 cases of temporal lobe);ordinal variables rank sum test in two independent samples between high grade glioma group and low grade glioma showed significant differences(Z= -3 .756 ,P<0 .05);χ2 test showed no significant difference(P>0 .05) ,frontal lobe appeared NFT in 1 case ,accounting for 2 .7% (1/37) ,temporal lobe appeared NFT in 6 cases ,accounting for 16 .2% (6/37) .Conclusion Peritumoral neurofibrillary of the low grade gliomas more performed displacement ,the high grade gliomas show more interrupts and NFT at 3 .0T MRI ,NFT in high grade gliomas is often seen in the temporal and frontal lobe .

Ten dogs were divided into 2 groups and absolute ethanol was injected into the renal artery and its branches respectively. The kidneys injected were resected by stages and examined pathologically. The results showed that coagulative necrosis developed in the renal artery and kidney itself. In the group whose branches of the renal artery were injected there was a clear demarcation line between the necro-tic and the normal areas. The thrombus formed secondary to necrosis might worsen the blockage of the renal artery. The clinical observations on the renal artery injected with absolute ethanol in 15 cases showed that the method of absolute ethanol injection was better than any other methods or drugs for the renal artery. The injection was safe, convenient and more favourable to the prevention of the spread of cancer cells.

Objective To investigate the differences between Monte Carlo (MC) calculated doseto-water (Dw) and dose-to-medium (Dm) for lung cancers treated with intensity-modulated radiotherapy (IMRT).Methods A total of 10 lung carcinoma patients with 5-field IMRT treatment plans were stratified sampling randomly selected for this study,which were performed on Monaco treatment planning system (TPS) with MC algorithm.Using the patients' own CT images as quality assurance (QA) phantoms,two kinds of QA plan were calculated,one was the Dm,and another was the Dw plan.Dose volume histogram (DVH) parameters and the subtraction of two plans were used to evaluate the spatial distribution of the difference between the Dm and Dw.Results Differences between dose-volume indices computed with Dm and Dw for the PTV65 and PTV50 doses (D50％,D98％ and D2％) were-0.3％,-0.2％,0.3％ and 0.1％,-0.6％,0.4％,respectively,of which the D50％ of PTV65 and D98％ of PTV50 had statistical difference (t =-2.536,-3.776,P ＜ 0.05).For normal tissues,spinal cord,heart,lung and esophagus,the D50％ differences between Dm and Dw were 0.3％,1.1％,-0.2％ and -0.1％,of which the Dm of spinal cord and heart were slightly lower than the Dw (t =2.535,3.254,P ＜ 0.05).For the D2％ of the normal tissues,the differences were 0.3％,-0.6％,-0.7％ and 0.6％,the differences were statistically significant (t =2.311,-4.105,-3.878,6.214,P＜0.05).All the differences were within 2％.Meanwhile planned subtraction analysis showed the differences between the Dm and Dw varied very much with the other body parts of the patient,especially for bone tissues,and the two doses were significant difference (＞ 5％).Conclusion In the course of clinical application,the relative differences between Dm and Dw for lung cancers MC calculations should be noted when considering the dose limitations of bone tissue.

Objective:To explore the influence of the selection of statistical uncertainty of control points in Monaco planning system on the dose distribution of nasopharyngeal carcinoma (NPC), aiming to provide the statistical uncertainty of single control point in Monte Carlo calculation which satisfies clinical needs.Methods:First, nine 10 cm×10 cm square fields with an equal interval of gantry angle were designed and five cases of 9-field intensity-modulated radiotherapy (IMRT) and five cases of single-arc volumetric-modulated arc therapy (VMAT) plans were randomly selected, Then, quality assurance (QA) verification plan using patient CT as QA phantom was created. Second, the grid spacing was selected as 3 mm during the calculation of dose distribution of QA plan. The statistical uncertainties of single control point were selected as 1%, 2%, 3%, 4% and 5%, respectively. Last, the deviation of dose distribution between different statistical uncertainties and 1% statistical uncertainty was analyzed.Results:For a square field and single IMRT field, the dose deviation of center point was almost 7% while the statistical uncertainty was selected 4%. For 9-field IMRT and single-arc VMAT, the dose deviation of center point was ≤ 1.5% and the average dose deviation of PTV was ≤ 0.3% when the statistical uncertainty of control points was changed from 1% to 5%. The percentage of the point dose deviation of the coronary plane of ≤ 1% was greater than 99% when the statistical uncertainty was ≤ 3% for 9-filed IMRT and 4% for single-arc VMAT.Conclusions:For the Monaco treatment planning system based on Monte Carlo calculation, the changes in the statistical uncertainty of control point from 1% to 5% exert significant effect upon the single field. In clinical application, the statistical uncertainty of control point should be ≤ 3% for 9-field IMRT and ≤ 4% for single-arc VMAT.

Objective To study the impact of the resolution of reference dose distribution and evaluated dose distribution to Gamma rate in the verification of IMRT. Methods Designed four fields, the resolution of dose distribution calculated in water phantom and exported from TPS are 1 ,2,3 ,4,5,6 mm. To calculate Gamma index by IBA's OmniPro-I'mRT software in different sampling resolution. Results When the resolution of evaluated dose distribution was fixed, the change of reference dose distribution's resolution has little effect on Gamma rate (5％ to IMRT field) ;When the resolution of reference dose distribution was fixed , the Gamma rate increased as the evaluated dose distribution's resolution ( ＞ 1 mm) raise ( the Gamma rate increase ( 15. 2 ±6. 2) ％ ( t = 11. 99 ,P < 0. 01 ) and ( 14. 9 ± 5. 5) ％ ( t = 13. 24 , P ＜ 0. 01 ) while the resolution of evaluated dose distribution changed from 6 mm t0 3 mm and from 3 mm to 1 mm　respectively) .Conclusions To use Camma method for verification of IMRT, the measured data can be as a reference dose distribution without　interpolation;the computed data by TPS can be as a evaluated dose distribution and it is more appropriate for the resolution of 1 mm.

Objective To investigate of the accuracy and feasibility of independent check for intensity-modulated radiotherapy (IMRT).Methods Inputing the linear accelerator Varian 600C/D physical data to IMsure ( a independent checking software) and constructing a calculation model.Use of IMsure to calculate the point dose and fluence of 25 cases IMRT treatment plans which have been calculated by Eclipse treatment planning system (TPS),and do a actual measurement of these plans by Matrixx at the same time.IMsure,TPS calculation results and measurement results of Matrixx were compared.Results Select Matrixx's center probe as a reference point,to TPS calculated results as the standard,then the average difference of the IMsure calculation and Matrixx measurement were ( -0.13 + 1.24)％ (t =0.20,P =0.840 ) and ( - 0.18 ± 1.45 ) ％ ( t =0.86,P =0.400 ),respectively.Compared IMsure with 3 mm/3 ％and 2 mm/2％ standard respectively,the average γ rate of TPS were (98.7 ±2.8)％ and (94.9 ±7.2)％ ;compared matrixx measurement results,the average γ rate of TPS were ( 99.0 + 2.0 ) ％ and ( 93.2 ±6.9) ％.The results show that the difference of the point dose and the γ rate of dose distribution by Matrixx measurement and IMsure calculation was no statistically significant difference ( t =1.54,P =0.126 ).Conclusions Independent checking software can be used in the treatment planning system to acceptance and initial clinical tests.In routine,a independent checking software as IMsure may do a pre-verificaton of IMRT treatment plan,or even partially replace of the actual measurement if the adequate conventional quality assurance do well,thus reducing the daily measurements.

Objective:To evaluate the preliminary clinical efficacy and safety of stereotactic body radiation therapy (SBRT) in combination with targeted therapy for metastatic renal cell carcinoma (mRCC).Methods:Clinical data of 58 patients with mRCC who were treated with SBRT in combination with targeted therapy in Sun Yat-sen University Cancer Center from June 2013 to December 2018 were retrospectively analyzed. Among them, 79.3% patients were classified as intermediate or high risk according to International Metastatic Renal Cell Carcinoma Database Consortium Criteria. The median biologically equivalent dose (BED) was 147 Gy (67 to 238 Gy).Results:Overall, 32, 13, 7, 5 and 1 patients received SBRT for 1, 2, 3, 4 and 6 metastatic sites (105 lesions) and 71.4% of them were bone lesions. Targeted therapy was continued during SBRT. With a median follow-up of 9.4 months (range 2.7 to 40.1 months), 18 patients died. The 1-year local control rate was 97.4%. The 1-year progression-free survival was 50.3%. The 1-and 2-year overall survival was 72% and 53%. Approximately 85% patients experienced pain relief after SBRT. Patients who achieved complete or partial response after SBRT obtained better overall survival than those with stable disease or disease progression (1-year overall survival: 83% vs. 48%, P=0.021). In the whole cohort, 6 cases developed Grade Ⅲ adverse events, 4 of which were Grade Ⅲ myelosuppression, 1 case of Grade Ⅲ neuropathy and 1 case of radiation-induced skin injury. Conclusion:Preliminary study reveals that combined use of targeted therapy and SBRT is an efficacious and safe treatment of advanced mRCC.

Dissolving pulp consists of high purity cellulose and is widely used to as raw materials for the production of regenerated cellulose fiber, cellulose ester and cellulose ether. The characteristic of dissolving pulp affects greatly the production and processing performance of subsequent products. The α-cellulose content, hemicellulose content, pulp viscosity, ash, transition metal ion content, fiber morphology, molecular weight distribution of cellulose and the reactivity are the important properties. Because of its green, mild and high efficiency, the application of enzymes in improving the properties of dissolving pulp has a promising application prospect and has been researched significantly. In this review, the main properties of dissolving pulp are presented first, followed by a recommendation of the enzymes to improve these properties. The application and current research of cellulase and xylanase in improving the properties of dissolving pulp are emphasized. The main problems and the future research areas in improving the properties of dissolving pulp by enzymes are revealed. Finally, the technology prospects in this field are proposed.
Cellulase ; Molecular Weight ; Viscosity ; Wood