With the rapid development of computer technology and informatization of the society,hospital network security and reliability becomes more and more important.According to HIS maintenance in our hospital,this paper discusses security measures in hospital from such aspects as system security,data security,network security,and security management.

Objective To investigate the value of X-ray Knife in the stereotaxis radiotherapy of lung cancer.Methods 52 cases with pulmonary carcinoma were treated with X-ray knife,before and after that,general radiotherapy was applied.After whole radiotherapy,2 or 3 months later,all patients were followed by CT scan.The changes of tumor and clinical appearances were compared before and after therapy.The curative effect was estimated according to clinical appearances and CT findings.Results 6 patients were complete response(11.5%) ,29 patients were partial response(55.8%) and 13 patients were no changes or reduced less than 50%.The total responsive rate was 92.3%.Conclusion The treatment of lung cancer with X-ray Knife can give tumor accuracy high dosage irradiation.The short term therapeutic effectiveness is significant and safe on clinical.

Objective To introduce the construction and application of clinical microbiology laboratory data management expert system.Methods Firstly, the process management was introduced to clinical microbiology laboratory. Then the characteristics of data on each node of work process were analyzed, and SQL Server data table was created as the knowledge base of the expert system.Finally, VB6.0 was used to compile the knowledge acquisition module, reasoning desktop module and input/output interface procedures to finally construct the expert system.Rates of defect report, errors in bacterial identification and drug sensitivity test, delay in culture results reporting and average delayed days were compared before and after the application of the expert system.Results The expert system could be used for data management in process nodes like sample reception, information collection and input, bacteria culture medium selection, bacterial identification and drug sensitive test, interpretation of drug sensitivity results, comprehensive evaluation in bacterial identification and drug sensitivity results, report of negative result, report of positive result, blood culture, Mycoplasma culture, time limit of detection, and nosocomial infection indicators.No defect report was found after the application of expert system; rate of errors in selection of drug sensitivity test medium was reduced from 0.81% ( 31/3 836 ) in 2012 to 0.02%(1/5 433) in 2014;rate of delay in culture results reporting was reduced from 1.78% (320/17 983) to 1.18%(232/19 692), and the average delayed days was also reduced (3.8 d vs.3.2 d).Conclusion Clinical microbiology laboratory data management expert system can improve work efficiency and reduce errors, which can enhance the overall management of laboratory and the quality of clinical service.

Objective To analyze the impact of parotid's position and volume changing on radiation dose for head and neck cancer treated with TomoTherapy.Methods Totally 12 patients with head and neck cancer were treated with TomoTherapy.Before the treatment,the dose distribution was recalculated with MVCT images,which would obtain the parameters of position,volume and actual radiation dose for parotids.Results The volume of parotids in Plan2 was significantly lower than in Plan1,and the percentage reduction was 29.06％ and 31.78％ for left and right parotid,respectively (Z =6.77,3.06,P ＜ 0.05).Distance between the COM (center of mass) of parotids and the midline of body was significantly smaller in Plan2 than in Plan1,and the percentage reduction was 6.72％ and 6.19％ (t =5.14,5.80,P ＜ 0.05) at left and right side,respectively.Average dose and V26 for both parotids were higher than those in Plan1,increasing by an average of 37.74％,25.08％ (Z =-6.03,-5.31,P ＜ 0.05) for left parotid and 30.45％,19.33％ (Z =-5.43,-3.26,P ＜0.05) for right parotid,respectively.Conclusions The actual radiation dose to parotids was significantly increased during the radiation therapy for patients with head and neck cancer.There was a linear correlation between the decrease of distance between the COM of parotids and the midline of body and the percentage increase of parotids' radiation dose.No correlation between the reduction of parotids' volume and dose to parotids.In order to reduce the parotids' radiation dose,modification of treatment plan at the appropriate time is essential.

Objective:To evaluate the effect of radical image-guided radiotherapy (IGRT) on the target dose in cervical cancer and investigate the appropriate application mode.Methods:Twenty patients with cervical cancer treated with helical tomotherapy (HT) in Seventh Medical Center of PLA General Hospital from 2012 to 2016 were selected. A megavoltage CT (MVCT) scan was performed before each treatment. The obtained MVCT images were used for dose parameter in the adaptive module of HT to obtain the actual dose (Plan 1) and the non-image-guided dose parameter was simulated (Plan 2). Each single dose distribution and the corresponding fused CT images were transferred to the software Mimvista 6.5 to obtain the total radiation dose parameter by dose superposition.Results:The motion of CTV, uterus and GTV in Plan 2 was significantly larger than that of Plan 1(all P<0.05), and the largest changes were seen in the ventrodorsal and uterine direction. The V 45Gy, V 50Gy, D 98% and D mean of CTV and uterus and V 50Gy of GTV in Plan 2 were significantly decreased compared with those in Plan 1(all P<0.05). The left-right motion of Plan 1 was negatively correlated with D 2% and D 98% of CTV and uterus (both P<0.05). The head-foot motion was negatively associated with V 45Gy and V 50Gy of GTV (both P<0.05). The ventrodorsal motion was negatively correlated with D 98% of uterus ( P<0.05). The left-right motion of Plan 2 was negatively correlated with D 2% of CTV and V 50Gy of uterus (both P<0.05). The head-foot motion was negatively associated with D 98% of CTV, and D 98%, D mean, V 45Gy and V 50Gy of uterus (all P<0.05). The ventrodorsal motion was negatively correlated with D 98% of CTV, D 98%, D mean, V 45Gy and V 50Gy of uterus, and D mean and V 45Gy of GTV (all P<0.05). Conclusions:In intensity-modulated radiotherapy for cervical cancer, the uterine body displacement is large and the low CTV area is mainly located in the uterine body. IGRT can significantly reduce the dosimetric deviation induced by organ movement.

Objective To analyze the changes in volume and the planning volume of the bladder and rectum during helical tomotherapy (HT) treatment for cervical cancer,and to evaluate the impacts of bladder and rectum filling on their dosimetric parameters.Methods Twenty patients with cervical cancer who received HT in our hospital from 2012 to 2016 were enrolled as subjects.Before treatment,megavolt computed tomography (MVCT) and registration of planning CT images were preformed to recalculate the dose distribution,delineate the target volume,and measure the volume and position of the bladder and the rectum.Each MVCT image and the corresponding single dose were obtained by dose reconstruction using the Planned Adaptive module in HT planning workstation.The fused MVCT images and the corresponding single dose for each MVCT were loaded to MIM Maestro software 6.0 for dose stacking.The obtained total radiation dose was compared with that obtained by kilovolt CT.Between-group comparison was made by paired t-test or analysis of variance.Results If the volume change in the bladder was more than 400 ml or the rate of volume change was higher than 60％,the displacements of the bladder centroid toward the foot and dorsal sides were significantly increased;the Dmean and V50 were significantly increased (P＜0.05).If the volume change in the rectum was more than 30 ml or the rate of volume change was higher than 30％,the displacements of the rectum centroid toward the head and ventral sides were significantly increased;the V45 and V50 for the rectum were significantly increased (P＜0.05).Conclusions Although the bladder filling status has little effect on the radiation dose to the bladder,the volume change or the rate of volume change should be no more than 400 ml or 60％,respectively.Moderately filled bladder is recommended for positioning and treatment,which achieves satisfactory repeatability of the treatment.A volume change of more than 30 ml or a rate of volume change of higher than 30％ can result in an increase in the dose to the rectum.Empty rectum can effectively reduce the dose to the rectum.

Objective To investigate the effect of BIS-guided closed-loop target-controlled infusion on perioperative Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy under different anesthesia and sedation depths. Methods We applied random number table method to divide 73 elderly patients undergoing elective laparoscopic radical gastrectomy into BIS closed-loop target-controlled infusion group with BIS value of 55(group H, n=36) and BIS value of 45(group L, n=37).Intravenous blood samples were collected immediately before surgery (T1), 2h after surgery (T2), 24h after surgery (T3) and 72h after surgery (T4).IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ were determined by flow cytometry microsphere array.We compared operation duration, postoperative PACU stay time and postoperative hospitalization time between two groups. Results Compared with T1, IL-6 and IL-10 concentration in group H at T2, T3 and T4 significantly increased (P < 0.05), IL-4 and TNF-α in group H at T4 were significantly increased (P < 0.05), IL-2 and IFN-γ in group H at T2 and T4 were significantly increased (P < 0.05), the concentration of IL-6 and IL-10 in group L at T2, T3 and T4 were increased (P < 0.05), IL-2 in group L at T4 was decreased (P < 0.05), and IFN-γ/IL-6 in two groups were decreased at T2, T3 and T4(P < 0.05).Compared with group L, IL-6 and IL-10 in group H were significantly increased at T2(P < 0.05), IFN-γ/IL-6 in group H was significantly decreased (P < 0.05), IL-2 and IL-10 in group H were significantly increased at T4(P < 0.05).Operation duration, postoperative PACU stay time and postoperative hospitalization time had no statistical significance between two groups (P > 0.05). Conclusion The anesthesia and sedation depth of BIS-guided closed-loop target-controlled infusion set at 45 is better than 55 in maintaining Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy, but it has no obvious effect on long-term prognosis.

Objective To investigate the clinical isolation situation and drug resistance features of enterococcal bacteria in order to provide reference for the clinical rational use of antibacterial agents and infection control. Methods A total of 1220 strains of enterococcal bacteria that induced hospital infection were analyzed retrospectively. Walk Away 96 automated microbial analyzer was used for strain identification and drug sensitive test. MIC was used for screening high-level aminoglycoside resistant strains. WHONET 5.6 was used for data analysis. Results A total of 1220 strains of enterococci were detected, including 675 strains of enterococci faecalis, accounting for 55.3%, and 445 strains of ente-rococci faecium, accounting for 36.5%. Enterococcal bacteria mainly distributed in clinical urine specimens, accounting for 57.5%. The total drug resistance rate of enterococci faecalis was high and the drug resistance rates to penicillin, ampicillin, ciprofloxacin and levofloxacin were all higher than 90%, which were significantly higher than those of the enterococci faecium (<17%). The drug resistance rate of enterococci faecalis to quinupristin/dalfopristin was 100.0%and that of enterococci faecium was 12.6%. For both types of bacteria, no strain resistant to vancomycin was found, but 3 strains of enterococci faecalis were resistant to linezolid. The screening rates of enterococci faecalis for high-level gentamicin drug resistant strains and high-level streptomycin resistant strains were 54.1% and 27.3% respectively while those of enterococci faecium were 58.2% and 56.9% respectively. Conclusion The drug resistance situation of enterococcal bacteria to common antibacterial drugs is not optimistic, and the monitoring of clinical distribution and drug resistance situation of enterococcal bacteria is of important guiding significance to the clinical treatment of entero-coccal bacterial infection.

Objective:To assess the feasibility ,safety and short‐term outcome of simultaneous integrated boost‐intensity modulated radiation therapy(SIB‐IMRT) with concurrent capecitabine chemotherpay for anal cancer .Methods:A total of 10 hospitalized patients with anal cancer during Sep .2009 and Feb .2014 were treated with SIB‐IMRT .A total dosage of 57 .6 Gy was given to the primary lesion and macroscopical lymph nodes in 32 fractions ,with 1 .8 Gy in each fraction .And a total dosage of 48 Gy was given to the bilateral iliac vessels and inguinal lymphatic drainage region in 32 fractions ,with 1 .5 Gy in each fraction .And capecitabine was concurrently administered at the oral dose of 625 mg/m2 ,twice daily ,5 days per week . Two patients received a sequential radiation boost dose of 2 × 1 .8 Gy due to macroscopic residual lesion at week 5 of treatment . Acute and late adverse reaction was assessed according to the Common Terminology Criteria for Adverse Events version 4 .0 . Results:All patients completed radio‐chemotherapy without any treatment break .The incidence rate of grade 3 skin adverse reaction was 50% (5/10) .No grade 4 adverse reaction was observed .Mean follow‐up was 20 months(range 6‐60 months) .The 2‐year‐local control ,colostomy‐free survival ,distant metastases‐free survival and overall survival rates were 100% (10/10) ,90%(9/10) ,90% (9/10) ,and 90% (9/10) ,respectively .Conclusions:SIB‐IMRT with concurrent capecitabine chemotherapy :an acceptable safe regimen ,however ,more samples and a longer follow‐up are required to assess its potential superiority .

Objective:To evaluate the safety and clinical efficacy of hypofractionated radiotherapy (HFRT) at 36.5 Gy in 10 fractions for the chest wall and reginal lymph nodes following modified radical mastectomy for breast cancer.Methods:This was a prospective, single-arm, phase Ⅱ clinical study. A total of 85 patients who received HFRT at 36.5 Gy in 10 fractions to the chest wall ± supraclavicular region following modified radical mastectomy for locally advanced breast cancer from March 2014 to December 2015 were included. The primary endpoint was radiotherapy toxicities. The secondary endpoints were locoregional failure-free survival (LRFFS), disease-free survival (DFS), and overall survival (OS).Results:The median follow-up period was 98 (94.0-109.0) months. Radiotherapy toxicities were mild. The incidence rates of grade 1 acute cutaneous and pulmonary toxicities were 52.9% and 40%, and those of grade 1 late cutaneous, pulmonary, and cardiac toxicities and upper extremity edema were 10.6%, 29.4%, 2.4%, and 21.2%, respectively. Only 1 (1.2%) patient suffered from grade 2 radiation-induced brachial plexus injury. Of the 85 patients, one patient had regional recurrence (supraclavicular lymph nodes), six patients had distant metastasis, and six patients died of breast cancer. The 9-year LRFFS, DFS, and OS were 97.7%, 91.8%, and 92.8%, respectively.Conclusions:HFRT at 36.5 Gy in 10 fractions following modified radical mastectomy for breast cancer is associated with mild toxicities. A phase Ⅲ study is necessary for validating HFRT's clinical efficacy.