Objective To investigate the dosimetric effect of multi-leaf collimator (MLC)transmission on intensity-modulated radiation therapy (IMRT).Methods MLC transmission through theleaves and rounded ends were measured with ion chamber for Varian Trilogy linear accelerator with the X-ray of 6 MV and 10 MV.The intraleaf and interleaf transmission were also measured with the electronic portal imaging device of aS1000.10 tumor patients treated with IMRT were used to evaluate the MLC parameters modeling in the Eclipse treatment planning system.Results The average transmissions of Millennium MLC were 1.6％ and 1.8％ for 6 MV and 10 MV X-rays.The transmission increased with the field size and depth of measurement.The transmissions at off axis position were a little lower than those on the central axis.The intraleaf transmissions measured with aS1000 were 0.8％-1.2％ and 1.1％-1.6％,the interleaf transmission were 1.3％-1.9％ and 1.6％-2.5％ for 6 MV and 10 MV X-rays respectively.Modeling with the measured MLC parameters,the Eclipse treatment planning system could calculate the dose distribution accurately.The γ pass rate at 3％ 3 mm was above 95％,except for two patients with nasopharyngeal cancer with the pass rate of 93.6％ and 94.5％.Conclusions The transmissions through the MLC leaves and the leaf ends contribute to the dose throughout the target significantly for IMRT.MLC transmission varied with the field size,depth of measurement and off axis position.

This paper introduced the design and application of the performance appraisal scheme for the interventional operation platform.The comparison of interventional operations before and after the means of performance management in place, presented the effective role of performance management in interventional operation platform, and analyzed the motivation effect of performance management on the enthusiasm of interventional operators.The authors recommend performance appraisal and incentive compensation mechanism to motivate the clinical use of the platform, and greater application of such a common platform, for perfection of surgery performance management.

in view of the emphasis on disease management and clinical research, the authors introduced the evaluation and construction methods of the departments based on disease management. Introduction to the selection process of the evaluation and construction methods of such departments, the authors expounded the construction thought of clinical research evaluation system. This paper analyzed the important role of clinical scientific research in the formation of hospital characteristic advantage and leading position, then suggested that hospitals should take research-type diseases as the basis, promote steady breakthroughs in their medical services and scientific research level, and fully reflect the responsibilities of tertiary hospitals.

Objective:To investigate clinical efficacy of tunneled subcutaneous pedicle flaps in the repair of ipsilateral nasal alar defects.Methods:A total of 20 patients with nasal alar defects after excision of basal cell carcinoma, which were repaired with ipsilateral tunneled subcutaneous pedicle flaps, were retrospectively collected from January 2018 to January 2020. There were 11 male patients and 9 female patients, with an average age of 60.6 years (range, 48 - 76 years) . According to clinical manifestations, the basal cell carcinoma lesions could be classified into 3 types: nodular-ulcerative type (13 cases) , superficial type (4 cases) and pigmented type (3 cases) , and the skin lesions varied from 0.4 cm × 0.5 cm to 0.9 cm × 1.1 cm in size. All the patients received extended surgical resection of basal cell carcinoma, and nasal alar defects were repaired with tunneled subcutaneous pedicle flaps, with the size of flaps ranging from 0.7 cm × 0.8 cm to 1.2 cm × 1.4 cm.Results:All flaps survived successfully, the nasal alar defects were completely repaired, and all wounds healed primarily. During the postoperative follow-up of 6 - 24 months, neither recurrence of tumors nor obvious scar hyperplasia occurred on the nasal ala, and nasal morphology and appearance were favorable.Conclusion:The tunneled subcutaneous pedicle flap can be used for the repair of ipsilateral nasal alar defects following excision of tumors or other lesions, resulting in favorable therapeutic outcomes and aesthetic appearance.

Objective:To investigate clinical efficacy of nail removal in combination with periungual dermis-fat flap tamponade in the treatment of bilateral severe curved ingrown nails.Methods:A retrospective analysis was conducted on clinical data collected from 7 patients with bilateral severe curved ingrown nails visiting the hospital between January 2018 and January 2020. There were 3 males and 4 females, aged 25-49 years (average: 35 years) . All patients were treated with nail removal in combination with periungual dermis-fat flap tamponade at outpatient clinics.Results:All the 7 patients experienced primary healing of incisions without infections, and achieved pain relief 1-2 weeks after surgery. During the follow-up of 12 to 24 months, new nail plates grew back without curling deformity, no erythematous swelling occurred in the nail grooves, and no recurrence of paronychia was observed. All patients were satisfied with the clinical efficacy.Conclusion:Nail removal in combination with periungual dermis-fat flap tamponade is effective for the treatment of bilateral severe curved ingrown nails.

This paper introduced the performance appraisal scheme for digestive endoscopy centers featuring centralized management. A comparison of the operations before and after the use of such performance management, proves the efficiency improvement of such centers, and the supplementary effect on centralized management of digestive endoscopies. Thus the authors propose that performance management is conducive to centralized management of the equipment for reference in designing performance management of departments.

Objective:To investigate clinical and genetic characteristics of a family with hereditary hemorrhagic telangiectasia complicated by aortic sinus aneurysm, and to analyze causative genes.Methods:Clinical data and peripheral blood samples were collected from the proband and her relatives, and genomic DNA was extracted. Causative genes were screened by whole-exome sequencing, and then verified by Sanger sequencing.Results:A heterozygous mutation c.137G>A was identified at position 137 in exon 3 of the ACVRL1 gene in the proband, her daughter, grandson and granddaughter, which led to the substitution of cysteine by tyrosine at amino acid position 46 (p.C46Y) . The mutation was not found in any of the other 5 family members without clinical symptoms.Conclusion:A causative mutation c.137G>A (p.C46Y) in the ACVRL1 gene was identified in the family with hereditary hemorrhagic telangiectasia type 2 complicated by aortic sinus aneurysm, which had not been previously reported in Asian populations.

Objective:To investigate the clinical efficacy of subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture in surgical treatment of benign pigmented facial lesions in infants and preschoolers.Methods:Totally, 100 infants and preschoolers with pigmented facial lesions were enrolled from the Department of Dermatology, Hanzhong Central Hospital and the Second Affiliated Hospital of Xi′an Jiaotong University from January 2018 to January 2019, and their clinical data were analyzed retrospectively. Among these patients, there were 59 males and 41 females, and their age ranged from 3 months to 5 years, with an average age of 15 months. All patients underwent outpatient surgery under local anesthesia, and sedative drugs were used before operation. The skin lesions were excised once or in stages according to their areas, and incisions were closed by using a subcutaneous asymmetric suture-based tension reduction technique, followed by dermal buried angular mattress sutures. After surgery, medical silicone gels and tension reduction devices were used for 6 months to 1 year, and postoperative follow-up was performed.Results:All patients were followed up for more than 1 year after surgery. Four patients showed suture rejection reaction within two months after surgery, and the incisions completely healed after the suture knots were discharged; cat′s ear-shaped scars were formed at the upper and lower ends of the incisions in 3 cases when the sutures were removed 1 week after surgery, no treatment was given, and the cat′s ear-shaped scars gradually became flat after 1 year of follow-up; fat liquefaction occurred in 1 case 4 days after surgery, re-suturing of the incision was done 1 week after the removal of internal sutures and drainage, and the incision healed well; 1 case developed infection 3 days after surgery, and then received the removal of internal sutures, drainage, and anti-infection treatment, re-suturing was performed after complete regression of the incision swelling, and the incisions healed well; scar hyperplasia occurred in 4 cases 3 to 6 months after surgery, and the scars became flat after the local injection of triamcinolone acetonide. In the remaining children, fine white linear scars were formed after the healing of incisions, the depressions and ridges at both ends of the incisions became flat, and there was no obvious pulling sensation in facial organs or formation of cat′s ear-shaped scars.Conclusions:Subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture can effectively reduce tension twice during delicate facial surgery in infants and preschoolers, and help to avoid incision widening and scar hyperplasia. The follow-up showed favorable long-term efficacy and aesthetic effect.