Objective To study the surgical techniques with keyhole operation for treatment of the huge intracranial meningioma located in the frontal skull.Methods 39 cases of huge intracranial meningioma were removed by microsurgery with supra-eyebrow approach keyhole operation.Results 39 cases of meningioma were totally removed.There was no associated morbidity,mortality or exacebation in all cases.Conclusion It suggests that keyhole microsurgery may provide maximum efficiency to remove the huge intracranial tumor located in the frontal skull and minimum invasiveness.However,it is very important to choose indication properly,to prepare sufficienctly before operation,and to operate with proficient skill of microsurgery.

Objective To explore the risk factors of hip fracture in elderly patients from Yongkang.Methods From August 2014 to August 2016,468 elderly patients with hip fracture admitted to Department of Orthopedics, Orthopedics Hospital of Yongkang were prospectively collected as study group,and 150 elderly people admitted to Orthopedics Hospital of Yongkang and Community Health Service Center for health examination were randomly selected as control group.The complications,daily living habits,bone density and menstruation of the female were observed between the two groups.Results Compared with the control group,the incidence rate of diabetes in the study group increased significantly(28.63% vs.12.67%,χ2 =15.544,P =0.000),the rate of height decreased more than 3cm increased significantly (16.88% vs.8.00%,χ2 =7.134,P =0.008),the proportion of long -term use of hormone significantly increased (18.59% vs.10.00%,χ2 =6.082,P =0.014),the rate of physical exercise decreased signif-icantly (14.32% vs.22.67%,χ2 =5.793,P =0.016),the rate of bed ridden increased significantly (5.34% vs 1.33%,χ2 =4.369,P =0.037),the bone density of femoral neck decreased significantly[(0.99 ±0.12)g/cm2 vs. (1.10 ±0.12)g/cm2 ,t =10.139,P =0.000].When it came to the females,the rate of menopause before the age of 45 years in the study group was higher than that in the control group (33.23% vs.22.22%,χ2 =4.299,P =0.038).Conclusion Diabetes,height decrease >3 cm,long -term use of hormones,lack of physical exercise,bed ridden and bone density decrease are risk factors of hip fracture in elderly people from Yongkang,and menopause before the age of 45 is a risk factor for hip fracture in elderly women.

Objective To reduce the radiation dose to children from CT scanning through proper adjustment to milliamps (mAs) and scan lengths with a view to learning the relationship between scanning condition and radiation dose.Methods To compare the differences in main scanning parameters used for head,chest and abdomen at multi-detector CT examination of paediatric patients (＜ 1 year old,1-5 years old,6-10 years old,11-15 years old) at seven hospitals in Jiangsu province.CT dose index (CTDI) and dose-length-product (DLP) were gained by using standard children dose model (diameter 16 cm) under the same scanning conditions.Effective doses (E) at different parts of the body from children CT scanning were estimated after modification by empirical weighting factor.Statistical analyses of mAs,scan lengths and DLP were performed with SPSS 16.0 software.The differences in radiation dose due to the choice of condition of scanning were compared between two typical hospitals.Results The mean values of effective doses to paediatric patients during head,chest and abdomen CT scanning were 2.46,5.69,11.86 mSv,respectively.DLP was correlated positively with mAs and scan length (head,chest and abdomen examination,r =0.81,0.81,0.92,P ＜0.05).Due to higher mAs used,the effective dose from chest and abdomen CT examination among all age groups was higher than that in Germany Galanski research.Due to larger scanning length in abdominal examination among all age groups,effective doses in hospital were the highest.Conclusions Reasonablely reducing the scan length and mAs during CT scanning could lower children's CT radiation risk,while clinical diagnosis is not affected.

Objective To evaluate the neuroprotective benefits of histone deacetylases (HDAC)inhibitor MS-275 in rats with moderate traumatic brain injury (TBI).Methods Sixty-eight adult male SD rats were assigned to sham injury + placebo treatment (control group),TBI + placebo treatment (injury group),TBI + MS-275 (15 mg/kg) treatment (treatment group Ⅰ) and TBI + MS-275 (45 mg/kg)treatment (treatment group Ⅱ) according to the random number table.An experimental model of moderate TBI in the rat was induced using a lateral fluid percussion device.MS-275 was dissolved in DMSO and administered (15 and 45 mg/kg) intraperitoneally in seven consecutive days(once a day).The first administration was done in 30 minutes postinjury.Alteration in body weight of rats in each group was recorded after injury.Spatial learning and memory retention in rats was assessed using the Morris Water Maze in days 10-14 after TBI.Brain tissues were sectioned to measure acetyl-histone H3 and neuronal survivals in the hippocampus CA2-3 region using immunohistochemistry and cresyl-violet staining techniques.Results TBI rats showed significant body weight loss in 3 days postinjury as compared with the controls (P ＜0.05) and then gradually gained the body weight in 4-5 days postinjury.No significant difference in actual body weight loss after injury was found among injury group and treatment groups (F =0.149,P ＞0.05).Behavioral result revealed that the animals in treatment groups had significant improvement in cognitive performance as compared with injury group (P ＜ 0.01).Immunohistochemical results presented a markedly increased level of acetyl-histone H3 in both treatment groups,with no significant difference as compared with control group and a trend of increase in the survived neurons in the CA2-3 hippocampus in 14 days postinjury (P ＞ 0.05).Conclusions MS-275 achieves visible improvement of acetyl-histone H3 level and cognitive performance in the acute phase of TBI.Simultaneously,this treatment has an ameliorative effect on pathological changes associated with TBI as well and provides a neuroprotective effect against TBI.

Objective To verify the methodology for auditing dosimetric parameters in reference and non-reference conditions with thermoluminescent dosimeters (TLDs).Methods Under reference and non-reference conditions,the established TLD methods were used to observe the absorbed dose variations with depth,SSD,field size and 45 wedges for 10 photon beams at 5 hospitals.Dosimetric parameters,including doses at Dmax points in axis,on 5 electron beams of 9 MeV were measured.The measurement results were compared between the TLDs and plane parallel ionization chambers.Results For 6 MV photon beams,the relative deviation of between finger ionization chamber method and TLD chips was in the range of-1.7％ to 5.4％ under on-axis non-reference conditions,and-6.3％ to-0.6％ under off-axis non-reference conditions,respectively,all within the range of ≤ ± 7％ as required by the IAEA.The relative deviation between plane parallel chamber and TLD method was-2.3％ to 3.7％,within ± 5％ as required by the IAEA.Conclusions It is convenient and feasible to use TLD method for quality audits of dosimetric parameters in radiotherapy.

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Objective To explore the dosimetric verification method for absorbed dose and twodimensional dose distribution generated through multi-leaf collimator in radiotherapy.Methods A total of 8 medical accelerators were selected in Jiangsu province.Under 6 MV X-rays with a 5 cm × 5 cm field,the thermoluminescent dosimeter (TLD) and EBT3 radiochromic film (RCF) were used to audit the values calculated by treatment planning system (TPS).RCF was used to verify two-dimensional dose distribution under the 6 MV MLC beams for intensity modulated radiation therapy (IMRT).Results The relative dose deviation was from-1.4％ to 6.8％ for TLD and from-1.8％ to 7.8％ for RCF,with 7 accelerators meeting with the IAEA deviation requirement of ± 5％.The passing rates of two-dimensional dose distribution were between 73.7％ and 97.0％,with 7 accelerators greater than 90％.Conclusions TLD and RCF are feasible and suitable for large-scale verification of IMRT TPS absorbed dose and twodimensional dose distribution.

X-ray imaging is an important method for the diagnosis of corona virus disease(COVID-19), but there is a risk of nosocomial infection during X-ray imaging diagnosis. By analyzing the process of X-ray imaging diagnosis and the possible infection factors in hospital, Jiangsu province took the lead in issuing the Guideline for the nosocomial infection prevention and control of X-ray imaging diagnosis of COVID-19. This guideline clarifies the basic requirements for controlling infections during X-ray imaging diagnosis, the specific measures for staff protection, disinfection of personnel and places, and the protection and disinfection of subjects, which is instructive for field work. It is worth noting that while focusing on controlling infections, the principle of optimal protection for medical exposure cannot be ignored.

Objective To survey the frequency of medical X-ray diagnosis and estimate the medical exposure levels of Jiangsu province in 2016,so as to be able to improve effectively the protection against medical radiation exposure.Methods All medical institutions in the province were covered in the survey for their basic medical information by means of census method.Frequencies of diagnostic medical X-ray examination were studied using random sampling method in 31 medical institutions.A linear model was established by number of outpatients number of inpatients,number of staff and number of radiation workers to evaluate the medical examination frequency.Results A total of 9 248 pieces of medical X-ray diagnostic equipment by the end of 2016 in Jiangsu province,including 1 110 CT scanners.The total frequencies of diagnostic medical X-ray examination were estimated to be 911.45 examinations per 1 000 population,covering 239.25 per 1 000 for CT scanning.The number of medical X-ray diagnostic equipment increased by a factor of 0.8 while CT scanners by a factor of 3.6 compared to 1999.Medical X-ray diagnostic frequency raised by a factor of 3.2 while CT frequency by a factor of 15.1 compared with previous data.Conclusions The medical X-ray diagnostic frequencies in Jiangsu province was 1.9 times the value given in the UNSCEAR 2008 Report,close to those in some developed European countries.Compared with the study in 2015,the present study has made greater improvement in sampling technique for selection of hospitals and equipment,frequency estimation method and acquisition of influence factors.Estimates of medical X-ray diagnosis frequency are closer to actual level.Further improvement will be needed for the future survey,so as to further study medical exposure levels and to provide basic information for better patient protection.

X-ray imaging is an important method for the diagnosis of corona virus disease(COVID-19), but there is a risk of nosocomial infection during X-ray imaging and diagnosis. By analyzing the process of X-ray imaging & diagnosis and the possible exposure factors in hospital, Jiangsu province took the lead in issuing the guideline for the nosocomial infection prevention and control of COVID-19 during X-ray imaging and diagnosis. This guideline clarifies the basic requirements for controlling infections during X-ray imaging and diagnosis, the specific measures for staff protection, disinfection of personnel and sites, and the protection and disinfection of subjects, which is instructive for on-site work. It is worth noting that while focusing on controlling infections, the principle of optimal protection for medical exposure cannot be ignored.