Objective To investigate the effect of using root cause analysis(RCA)on the improvement of disinfection and isolation.Methods A RCA group was established to find out the problems in disinfection and isolation.Then the related personnel were organized to study relevant knowledge,quality control was performed and disinfection management system was strictly executed. The managements of ultraviolet lamp,hand hygiene,use of disinfectants as well as the biological tests on air and hand were all compared between pre-and post-implementation of RCA.Results After implementing RCA,the use of ultraviolet lamp disinfection and hand hygiene were both improved than before implication(P < 0.05).But use of disinfectant for disinfection before the RCA implementation was not significantly better than that after the implementation(P>0.05).Conclusion The implementation of RCA may notably improve the quality of disinfection and isolation.

Objective To explore the diagnosis value of ultrasound-guided COre needle biopsy(CNB)and frozen sectionin breast cancer.Methods There were 41 cases of breast tumor which were suspicious with ultrasonography,and using Bard automatic biopsy device was applied for percutaneous puncture by ultrasound-guided in breast neoplasms.Tissue samples were harvested for frozen soetion pathologic examination.compared with 42 clinical cases of the turnour which suspicious with ultrasonography were excised in operation room(B group)during the same time.Results The outcome of frozen sections were finished in 30～40 miutes.Thirty-nine cases were diagnosed to be malignant,36 cases were infiltrated ductal carcino and 3cases were infiltrated lobular carcinoma,two cases were severely non-type hyperplasia the sensitivity of sonographically guided CNB for the diagnosis of breast cancer was 95.1%.one operation was finished in 60 to 120 minutes,the average is 68.19±12.41 minutes.In group B,sensitivity of diagnosis of breast cancer was 97.6%(P＜0.05).One operation was finished in 120 to 200 minutes,the average was127.88±11.50 minutes(P＜0.05).Conclusion It can achieved higHy diagnostic rate,and have benefit of setting down the operations program and the operating time was curtailed when breast cancer was utrasound-guided by CNB and examinede with frozen section.

Objective To investigate the effect of macrophage FRβ expression on bleomycin induced pulmonary fibrosis(PF) in mice.Methods The rats were divided into the normal group,control group and experimental group,6 cases in each group.The mice were performed the PF induction.The experimental group was treated with immunotoxin,the control group was given the contrast protein and the normal group was not treated.The mouse left lung was used for histological analysis,and the right lung was used for hydroxyproline analysi s.The effect of macrophage FRβ expression on bleomycin induced pulmonary fibrosis in mice and the pulmonary macrophage FRβ expression in the patients with idiopathic pulmonary fibrosis(UIP) were detected.Results The macrophage FRβ expression mainly existed in the patients with UIP and pulmonary fibrosis area of PF mice induced by bleomycin;the survival rate was significantly increased by giving the mice immunotoxin with nose(P=0.003),and the level of total hydroxyproline and fibrosis of PF mice induced by bleomycin was decreased(P=0.009,0.014);immunohistochemistry results showed that immunotoxin could reduce the cells number of lung tumor necrosis factor(TNF)-α,chemotactic CCL2 and CCL12 cells inPF mice induced by bleomycin(P=0.000).Conclusion The FRβ expression of macrophages plays a pathogenic role in IPF,and the targeted therapy of FRβ expression in macrophages may be an effective method for the treatment of IPF.

OBJECTIVETo compare the CT image of gastrointestinal schwannomas (GIS) and gastrointestinal stromal tumors(GIST), and to find the CT features to be helpful for differentiation of GIS from GIST.

METHODSClinical and iconography data of 15 GIS patients and 50 GIST patients who underwent stomach CT scan with postoperatively confirmed histopathology between January 2000 and July 2014 in our department were collected retrospectively. CT findings of these two tumors were compared. Then the ROC curve was drawn based on the significant CT findings and area under the curve (AUC) was calculated to assess the sensibility and specificity for the differential diagnosis of GIS and GIST.

RESULTCT findings, such as the tumor size, shape, cystic change, perilesional lymph nodes, vessel seeding, enhancement pattern and degree, absolute and standardized CT value were significantly different between GIS and GIST(all P<0.05). Among the CT findings, tumor size, cystic change, perilesional lymph nodes, enhancement pattern and arterial phase standardized CT value (Sa) were better differential than others (all AUC>0.7). Tumor size showed the highest sensibility(90%), and cystic change and Sa showed the highest specificity(87%).

CONCLUSIONSGIS seems to show a homogeneous tumor more frequently, presenting light and moderate enhancement pattern and obvious enhancement of perilesional lymph nodes, while GIST seems to reveal malignant features, such as abundant blood supply, larger volume, frequent necrosis and cystic change. Cystic change and Sa value possess the better differential ability in diagnosis of these two tumors.

The protection effect of flash-radiotherapy(Flash-RT)with super-high dose on normal tissue has obtained wide attention in therapeutic radiology since it was found in 2014 year.The increasing research demand of Flash-RT with super-high dose-rate proposed new challenge for the existing radiotherapy equipment.Based on the demands of FLASH-RT research and clinical application,this review analyzed the proposed new requirement of Flash-RT for equipment,and introduce current scientific facilities with the experimental ability of X-ray FLASH-RT,as well as the situation of the specialized FLASH-RT equipment which were developing.The research of Flash-RT mechanism need the existing equipment with high-energy X-ray source develop toward high power,while the clinical application of Flash-RT demand these transient high-power devices should possess a series of radiotherapy techniques such as multi angle irradiation,conformal radiotherapy and others.Currently,China's X-ray FLASH-RT research is at the forefront of the world,which is expected to achieve the first breakthrough of high-end medical equipment in the X-ray Flash RT field.

Objective To compare the CT image of gastrointestinal schwannomas ﹙GIS) and gastrointestinal stromal tumors ﹙GIST), and to find the CT features to be helpful for differentiation of GIS from GIST. Methods Clinical and iconography data of 15 GIS patients and 50 GIST patients who underwent stomach CT scan with postoperatively confirmed histopathology between January 2000 and July 2014 in our department were collected retrospectively. CT findings of these two tumors were compared. Then the ROC curve was drawn based on the significant CT findings and area under the curve ﹙AUC) was calculated to assess the sensibility and specificity for the differential diagnosis of GIS and GIST. Result CT findings, such as the tumor size, shape, cystic change, perilesional lymph nodes, vessel seeding, enhancement pattern and degree, absolute and standardized CT value were significantly different between GIS and GIST ﹙all P<0.05). Among the CT findings, tumor size, cystic change, perilesional lymph nodes, enhancement pattern and arterial phase standardized CT value ﹙Sa) were better differential than others ﹙all AUC>0.7). Tumor size showed the highest sensibility ﹙90%), and cystic change and Sa showed the highest specificity ﹙87%). Conclusions GIS seems to show a homogeneous tumor more frequently, presenting light and moderate enhancement pattern and obvious enhancement of perilesional lymph nodes, while GIST seems to reveal malignant features, such as abundant blood supply, larger volume, frequent necrosis and cystic change. Cystic change and Sa value possess the better differential ability in diagnosis of these two tumors.

Objective To compare the CT image of gastrointestinal schwannomas ﹙GIS) and gastrointestinal stromal tumors ﹙GIST), and to find the CT features to be helpful for differentiation of GIS from GIST. Methods Clinical and iconography data of 15 GIS patients and 50 GIST patients who underwent stomach CT scan with postoperatively confirmed histopathology between January 2000 and July 2014 in our department were collected retrospectively. CT findings of these two tumors were compared. Then the ROC curve was drawn based on the significant CT findings and area under the curve ﹙AUC) was calculated to assess the sensibility and specificity for the differential diagnosis of GIS and GIST. Result CT findings, such as the tumor size, shape, cystic change, perilesional lymph nodes, vessel seeding, enhancement pattern and degree, absolute and standardized CT value were significantly different between GIS and GIST ﹙all P<0.05). Among the CT findings, tumor size, cystic change, perilesional lymph nodes, enhancement pattern and arterial phase standardized CT value ﹙Sa) were better differential than others ﹙all AUC>0.7). Tumor size showed the highest sensibility ﹙90%), and cystic change and Sa showed the highest specificity ﹙87%). Conclusions GIS seems to show a homogeneous tumor more frequently, presenting light and moderate enhancement pattern and obvious enhancement of perilesional lymph nodes, while GIST seems to reveal malignant features, such as abundant blood supply, larger volume, frequent necrosis and cystic change. Cystic change and Sa value possess the better differential ability in diagnosis of these two tumors.

Objective To study the compliance of forbidden depasturing livestock on the marshland with Oncomelania snails in schistosomiasis endemic areas. Methods According to 3 levels of human infection rates as > 10% ,5%-10% and <5% , 2 204 residents selected randomly from the schistosomiasis endemic villages were sampled with the stratified cluster sampling method in Hunan, Hubei, Jiangxi, Anhui, Jiangsu, Sichuan and Yunnan provinces, and investigated by questionnaire. The contents of the questionnaire included the recognition and implementation of forbidden depasturing livestock on marshland with Oncomelania snails and breeding livestock in bam. Results A total of 78.4% residents agreed forbidden depasturing livestock on marshland with snails, but 3. 7% residents disagreed it. A total of 83. 9% residents considered the relationship between breeding livestock in bam and schistosomiasis control, but 3. 1% residents thought that it was no relationship. The main reasons of depasturing livestock on marshland with Oncomelania snails were the high cost of breeding livestock in bam (36. 2% ) , unaccustomed (26.4% ) and no room for breeding livestock in bam (25.4% ). Conclusion Forbidden depasturing livestock on the marshland with Oncomelania snails should be strengthened according to the local economic, nature environment, agriculture, residents'culture degree and agriculture habit.

Background and objective Subsequent chemotherapy were needed in patients with advanced pul-monary adenocarcinoma experiencing disease progression atfer epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) treatment. hTe study is to explore factors potentially inlfuencing effcacy of subsequent chemotherapy. Meth-ods One hundred and ninety-one patients with advanced lung adenocarcinoma, who were resistant from EGFR-TKIs and then received subsequent chemotherapy, were identified. Data of patient’s characteristics, responses to chemotherapy and survival time were analyzed retrospectively. Results hTe overall response rate of the pemetrexed-based chemotherapy (9.3%) was higher than non-pemetrexed-based regimen (1.1%), P=0.011. Furthermore, the response in the second-line was more ob-visous [objective response rate (ORR) 14.3%vs 3.7%, P=0.041]. hTe patients who achieved response of partial response (PR) showed longer progression-free survival (PFS) than those who achieved non-PR (PFS 10.1 months and 2.3 months, P=0.012). hTe patients treated with platinum-based chemotherapy had longer PFS and OS than those with non-platinum-based che-motherapy, therefore platinum-based regimen was independent prognosis factors for PFS and OS (PFS:RR=0.634, 95%CI:0.466-0.832, P=0.004;OS:RR=0.666, 95%CI:0.460-0.960, P=0.030), especially the pateients who were aquired EGFR-TKIs resistance and who got drmatic progression from EGFR-TKIs treatment might got more beneifts from platinum-based chemo-therapy. However there was no signiifcant difference in ORR, PFS or OS between patients with TKIs primary resistance and acquired resistance, or between dramtic progression and gradual/local progression. Conclusion hTe patients with advanced lung adenocarcinoma might get beneifts from pemetrexed-based or platinum-based chemotherapy atfer they were EGFR-TKIs resistace.

Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer, most NSCLC patients are at advanced stage at the time of diagnosis. For patients without sensitive driven-oncogene mutations, chemotherapy is still the main treatment at present, the overall prognosis is poor. Improving outcomes and obtaining long-term survival are the most urgent needs of patients with advanced NSCLC. In recent years, immunotherapy has developed rapidly. Immune checkpoint inhibitors (ICIs), especially targeting programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1), have made a breakthrough in the treatment of NSCLC, beneficial to patients' survival and changed the treatment pattern for NSCLC. It shows more and more important role in the treatment of NSCLC. Led by NSCLC expert committee of Chinese society of clinical oncology (CSCO), relevant experts in this field were organized. On the basis of referring to domestic and foreign literature, systematically evaluating the results of Chinese and foreign clinical trials, and combining the experiences of the experts, the experts group reached an agreement to develop this consensus. It will guide domestic counterparts for better application of ICIs to treat NSCLC.