As varus posteromedial rotatory instability (VPMRI) is not common, its injury mechanisms are complex and presents no obvious dislocation on X-ray, it may be considered as a simple coronoid fracture, likely leading to a missed diagnosis or misdiagnosis. Moreover, the treatment of VPMRI is also controversial. Conservative treatment or improper treatment can cause serious complications. Therefore, this review expounds on the injury mechanisms, anatomical structure, O'Driscoll classification, imaging examination, treatment and postoperative rehabilitation of this complicated elbow injury which is rare and difficult to treat clinically.

Objective To explore the effects of application and management of the standardized training system for newly graduated registered nurses. Methods A total of 238 newly graduated nurses in Peking University First Hospital were selected by purposive sampling method. The 138 nurses who were enrolled in August 2015 were assigned into control group, adopting the traditional training program for new nurses. The 100 newly enrolled nurses in August 2016 were assigned into observation group, adopting the new standardized training program for new nurses. After training, the nurses of both groups were evaluated with the Transition Shock of Newly Graduated Nurses Scale (TSNGNS), the New Nurse Standardized Training Satisfaction Questionnaire, and the comprehensive examination paper. Results The total scores of TSNGNS, physical dimension, psychological dimension, social culture and development of nurses in the observation group were lower than those in the control group after training, and the differences were statistically significant (P＜0.01). After training, the total score and each dimension score of nurse satisfaction questionnaire in the observation group were higher than those in the control group, and the differences were statistically significant (P＜0.05). After the training, the comprehensive examination score of the nurses in the observation group was higher than that in the control group, and the difference was statistically significant (P＜ 0.01). Conclusions The implementation of the new training scheme can effectively relieve the new nurses' transition shock and improve their satisfaction and comprehensive evaluation score during training.

Objective:To investigate the clinical efficacy of a medial support plate and a row of screws in the treatment of Schatzker type Ⅳ tibial plateau fracture involving the postero-lateral condyle.Methods:A retrospective analysis was performed of the data of 26 patients who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University for Schatzker type Ⅳ tibial plateau fracture involving the postero-lateral condyle from December 2015 to December 2020. There were 17 males and 9 females, aged from 19 to 51 years (average, 36.1 years). All their fracture lines involved the postero-lateral condyle and all fractures were fixated with a medial support plate and a row of screws via one medial and one lateral incisions. Recorded were the operation time, hospital stay, blood loss, incision length, fracture healing, complications, quality of knee joint reduction and knee joint function at the last follow-up.Results:The length of hospital stay ranged from 8 to 16 days, averaging 10.4 days. The 26 patients were followed up for 8 to 18 months, with an average of 14.3 months. All the fractures got united after 11 to 17 weeks (average, 13.7 weeks). During the follow-up, no reduction loss, internal fixation failure or surgical complications were observed. Rasmussen radiographic scores at the last follow-up ranged from 11 to 18 points, averaging 16.1 points. The range of motion of the knee joint ranged from 0° to 140°, averaging 120.8°. The Rasmussen scores of the knee function ranged from 14 to 28 points, averaging 24.4 points.Conclusion:In the treatment of Schatzker type Ⅳ tibial plateau fracture involving the postero-lateral condyle, the use of a medial support plate and a row of screws can achieve satisfactory clinical results.

Objective:To analyze the incidence and characteristics of neonatal abnormal hemoglobinopathy in Wuhan and its surrounding areas.Methods:Dry blood spot samples of newborns (born from January 2020 to June 2021) sent to Hubei Neonatal Disease Screening Center were tested by hemoglobin capillary electrophoresis, and the newborns with abnormal hemoglobin bands were further tested for gene and statistically analyzed.Results:A total of 51 348 samples of neonatal dry blood spots were collected. According to electrophoresis analysis, abnormal bands were detected in 127 cases, and 78 cases were recalled for genetic test, the recall rate was 61.42%. Among them, 42 cases were diagnosed as abnormal hemoglobinopathy. Calculated according to the recall ratio, the detection rate of abnormal hemoglobinopathy was 0.13%. There were 11 cases of α-globin chain structural variation, most often were 3 cases of Hb Queens (27.27%) and 2 cases of Hb I (18.18%); moreover, there were 31 cases of β-globin chain structural variation, among which 11 cases of Hb J-Bangkok (35.48%), 8 cases of Hb E (25.81%) and 7 cases of Hb New York (22.58%) appeared more frequently. Among the 13 kinds of abnormal hemoglobins found, Hb I was located in N13/N(Bart) zone; Hb J-Bangkok and Hb J-Meerut were located in N12 zone; Hb New York and Hb Shenyang were located in N11 zone; Hb G-Coushatta, Hb G-Taipei and Hb Port Phillip were located in N5/N(D/G/K) zone; Hb Queens, Hb G-Honolulu and Hb Ottawa were located in N4/N(S) zone; Hb Montgomery and Hb E were located in N3/N (E) zone.Conclusion:The incidence of neonatal abnormal hemoglobinopathy in Wuhan and its surrounding areas is low, and main type of abnormal hemoglobin is β-globin chain structural variation.

Objective:To investigate the performance of optical surface imaging (OSI) in the postmastectomy radiotherapy setup and to assess the effects of 3D printed silicone bolus on OSI detection precision.Methods:A retrospective analysis was conducted for 16 patients treated with left-sided postmastectomy radiotherapy (PMRT) in West China Hopital, Sichuan University from January to April, 2021. The setup errors of 16 patients without bolus detected using OSI (OSI no-bolus, OSI n) were obtained before error correction was conducted using cone-beam CT (CBCT). The correlation between OSI n and CBCT was analyzed, and then the diagnostic efficacy of OSI was assessed using the receiver operating characteristic (ROC) curves. The setup errors of six patients with 3D printed silicone bolus detected using OSI (OSI bolus, OSI b) were obtained through off-line image registration, and then the detection precision of OSI n and OSI b in the translational directions was compared. Results:The setup errors in the case of OSI n were highly correlated with CBCT in the translational direction ( r ≥ 0.80), but were weakly correlated in the rotation direction ( r < 0.40). In the ROC analysis, the area under the curve (AUC) in the y direction was the lowest and was in the order of AUC 5 mm ≥AUC 3 mm > 0.75 for any translational direction. The difference in the detection precision between OSI n and OSI b was not statistically significant in the x and z directions ( P > 0.05), but was statistically significant in the y direction ( Z = -2.56, P = 0.01). In the y direction, the systematic error of detection precision in the case of OSI b was 3.11 mm higher than that in the case of OSI n, and the random error of detection precision in the case of OSI b was 1.9 mm higher than that in the case of OSI n. Conclusions:OSI cannot yet substitute CBCT in the postmastectomy radiotherapy setup, but its detection error is still within the clinically acceptable range. The performance of OSI-assisted setup is expected to be further improved by mitigating the interference of factors such as bolus in the imaging path through operational training.

Objective:To investigate the dosimetric effects of complex cardiac-respiratory motion in cardiac stereotactic body radiotherapy (CSBRT).Methods:A cardiac motion phantom was employed to simulate patient-specific cardiac-respiratory motion in 10 cases. The measured doses obtained under the phantom motion state were compared with the calculated doses in radiotherapy treatment planning for clinical patients. Moreover, 18 groups of design-based cardiac-respiratory motion were simulated. The radiation doses under the phantom motion state were measured using radiochromic films and compared with those under the resting state.Results:In the patient-specific cardiac-respiratory motion group, the gamma passing rate (GPR) under the 3%/2 mm standard between the measured and the calculated doses was 90.0% ± 7.0%. The correlation coefficient of the respiratory motion amplitude in the superior-inferior (SI) dimension with the GPR was -0.86 ( P=0.01). In the design-based cardiac-respiratory motion groups, the increase in the amplitude of cardiac-respiratory motion reduced the consistency between the dynamic dose and the static reference dose. Especially, the increase in the respiratory motion amplitude produced the most pronounced effect, reducing the width of the 90% isodose line in the respiratory motion direction, with a mean slope of -1.6. Additionally, the increase in the penumbra corresponds to a mean slope of 1.4. Conclusions:The respiratory motion amplitude serves as a primary factor influencing the dose accuracy of CBSRT. The characteristics and dosimetric effects of cardiac-respiratory motion are patient-specific, thus necessitating the assessment of cardiac-respiratory motion characteristics before CBSRT to individualize the application of motion management techniques for enhanced treatment accuracy.

Objective:To analyze human factors in radiotherapy safety incidents and identify their correction for the purpose of mining the latent incident chains.Methods:A total of 60 radiotherapy safety incidents were included in the Radiation Oncology Incident Learning System (ROILS) for cause identification and frequency statistics using the Human Factors Analysis and Classification System (HFACS). Latent class analysis (LCA) was performed for the result to correlate the incident causes.Results:Incidents in the protocol design stage were the most common, accounting for 35%. Adverse organizational climate, inadequate supervision, and personnel factors were the primary causes of incidents at each level of the HFACS, accounting for 4.66%, 15.68%, and 16.20%, respectively. Three latent incident chains were identified through LCA, comprising two originating from organizational climate issues and one from organizational process issues, which were passed down via various human factors or " loopholes"Conclusions:HFACS assists in tracing the human factors at all levels that lead to radiotherapy safety incidents. The high-frequency causes and three latent chains of radiotherapy incidents found in this study can provide a guide for the development of targeted safety and defense measures.

OBJECTIVE To provide a reference for strengthening the post-admission management of drugs on the medicare formulary in China. METHODS The basic situation， implementation process and effect of post-market reviews （PMR） were introduced after marketing approval of the Australian pharmaceutical benefits scheme （PBS） subsidized medicines. The suggestions were put forward for post-admission management of medicare formulary drugs in China. RESULTS & CONCLUSIONS PMR system exemplified Australia’s concept of life-cycle management of medicines on the PBS catalogue； as a mechanism for managing the admission and adjustment of PBS medicines， it provided a continuous evaluation of medicines in the PBS catalogue； the process mainly included two types： the pre-initiation process of PBS drug review and the PBS drug review process， involving steps such as drug selection， determination of review scope， and implementation management. Through PMR， Australia had completed the review of multiple medicines in nine treatment areas including diabetes， childhood asthma and Alzheimer’s disease in the PBS catalogue. The author suggests that China can improve the post-admission review of medicines at the institutional level （clarifying the selection criteria and methods of the review object， main procedures and responsible parties， and ensuring the transparency of the review process）； specify the National Healthcare Security Administration or the third-party organization until a special technical organization is established to take charge of this work； at the same time， further improve the construction of data collection and monitoring systems.