Objective The objective of this study was to study the dosimetric characteristics and advantages of Non-coplanar IMRT techniques stereotactic body radiation therapy(SBRT)in the early stage of NSCLC.Methods Ten patients were selected with early stage of NSCLC.Treatment planning designed 9 fields coplanar IMRT and 9 fields Non-coplanar IMRT,respectively.Non-coplanar plans include five coplanar fields and four non-coplanar fields.Two group patients' plans compared V2.5,V5,V20,V25 of the whole lung,the average exposure doses of the whole lung,and the average exposure doses of the contralateral lung.The comparison of the other OARs include:spinal cord Dmax,heart Dmax,esophagus Dmax,trachea Dmax,chest wall Dmax and V30 of chest wall.At the meantime,we compared the conformal index of PTV(CI)and the homogenization index of PTV(HI).Results Non-coplanar plans reduced V20 of the whole lung(P=0.001),the average exposure dose of the contralateral lung(P=0.001),but V5 of the whole lung non-coplanar plans were increased than that in coplanar plans(P=0.002).Non-coplanar technology reduce max dose of spinal cord,esophagus,trachea,chest wall and V30 of chest wall(P=0.026,0.001,0.026,0.008,0.016).Heart Dmax of the non-coplanar plans was high in coplanar plans with no statistical significance difference(P=0.296).The conformal index of PTV of the non-coplanar plans was better(P=0.036),there was no difference in the homogenization index of PTV(P=0.254).Conclusion The stereotactic body radiation therapy of the early stage of NSCLC,the non-coplanar technology can effectively reduce exposure doses of the lung tissue and the other most OARs,also improve the conformal index of the PTV.The non-coplanar technology have possibility in reducing complications when compared with the coplanar technology and therefore has certain dosimetry advantage.

ObjectiveTo develop a new formula to estimate macrosomia weight and compared with published 25 formulas.Methods1153 fetuses including 239 macrosomia within one week of delivery were considered.Two-dimensional ultrasound measurements of the fetal biparietal diameter (BPD),head circumference (HC),abdominal circumference (AC) and femur length (FL) were performed and recorded by experienced sonographers.The birth weight were measured after the babies born.The formula finding group,1034 fetuses including 914 fetuses weighting less than 4000g and 120 macrosomia,were utilized to generate an overall regression formula by stepwise linear regression.120 macrosomia were used to established the formula for estimating macrosomic weight.As the training group,other 119 macrosomia were used to test the new formula and compared with other 25 existing formulas.ResultsThe new formula for whole weight was:lgBW =0.180 (HC) + 0.00628 (AC) - 0.00318 (HC)2 + 0.00173 (AC) (FL) +0.0000430(BPD)(HC)2.The new formula for macromia was:lgBW =0.730(BPD) -0.0375 (BPD)2 +0.000264(AC) (FL).The new method gave ( - 87.89 ± 230.95)g of estimation error and (4.4 ± 3.9) ％ of absolute percentage error,while the best existing formula provided (115.61± 345.09)g and (6.8 ± 5.4)％.With the new method,89.1％ of estimates fell within ± 10％ of the actual birth weight,while the best existing formula gave 75.6％.ConclusionsThe new formula was based on typical Chinese Han women,the error was lower and more suitable than those developed formulas for Chinese populations,especially for macrosomia fetuses.

Objective Summarize the clinical nursing keys and experiences for tranplantation of leg island flap. Methods Follow- up 111 patients with transplantation of leg island flap. Results There were 109 patients had accepted survival of island flap, their function of wounded limb were recoveried satisfactory by one- year follow up. There were 2 amputation patients because of disturbance of blood circulation of distal wounded limb. Conclusions Careful perioperative nursing and observation are the keys of survival for tranplantation of leg island flap. Proper rehabilitaiton education can guarantee the satisfactory prognosis.

Adherence refers to the extent to which a patient′s behavior coincides with medical advice without missing a dose or overdosing and taking drugs at the right time. Good adherence could assure the effect of the therapy and reduce neoplasm metastasis and recurrence as well. In this article, status of oral chemotherapy adherence in cancer patients, impact factors and measurement tools had been reviewed. Adherence of oral chemotherapy in cancer patients and measurement tools of oral chemotherapy adherence needed further study. Besides, nursing should also focus on impact factors of the adherence of cancer patients during the oral chemotherapy, and take effective interventions to improve the adherence, so as to ensure the effect of chemotherapy, and improve the survival rate of cancer patients.

Objective To understand hand hygiene(HH) among health care workers(HCWs) in primary medical institutions in Shijiazhuang,and evaluate HH compliance,so as to formulate the strategy for HH management.Methods In 2015,one county-level comprehensive medical institution and two township medical institutions from each of seven counties of Shijiazhuang city were randomly selected,HH qualified rates of HCWs in all divisions of internal medicine before clinical procedures and after HH were analyzed statistically.Results 118 HCWs before clinical procedures and 130 HCWs after HH were monitored.The qualified rate of HH of physicians and nurses before clinical procedures were 44.26％ (27/61) and 40.35％ (23/57) respectively;HH qualified rate of nurses in township hospitals before clinical procedures were higher than county-level hospitals(x2 =6.447,P =0.011);the qualified rate of HH of physicians and nurses after HH were 98.41 ％ (62/63) and 98.51 ％ (66/67) respectively;there were significant differences in the qualified rates before clinical procedures as well as after HH in HCWs at different levels and types of medical institutions(all P＜0.05).Conclusion The qualified rate of HH among HCWs in primary medical institutions in Shijiazhuang before clinical procedures is low,medical institutions should improve the HH compliance among HCWs from various aspects.

OBJECTIVE:To standardize the writing of outpatient prescriptions and set up monitoring mechanism on rational use of antibiotics and drug costs.METHODS:A total of 400 prescriptions collected from 8 departments(50 from each department)of our hospital in the fourth quarter of 2005(before the examination)and from first to fourth quarter in 2006(after the examination)were examined statistically according to Inspection Items and Writing Requirements of Clinical Prescriptions,Guiding Principle of Rational Application of Antibiotics in Hospital,Principles of Classified Management of Antibiotics which were formulated by our hospital.RESULTS:Before prescription examination,the qualified rate of prescriptions was only 57.5%,but rose to an average of 85.6% after the examination.CONCLUSION:To include the standardized writing of prescriptions and reasonable application of antibiotics in the assessment of hospital comprehensive goals was proved to be an effective management method.

Objective To measure the erythrocyte dielectric response variation of patients with KaschinBeck disease,to explore the pathogenesis of Kaschin-Beck disease and seek more effective means for evaluating the effectiveness of early diagnosis and control measures against Kaschin-Beck disease.Methods According to the principle of dielectrophoresis and cell dielectric response phenomena,dielectrophoretic pool was manufactured and dielectrophoretic detection and separation system was established.Patients with Kaschin-Beck disease (438) were selected in Kaschin-Beck disease areas of Aba County,Sichuan.At the same time,healthy persons (480) in KaschinBeck disease areas and non-Kaschin-Beck disease areas in Aba County were selected.Anticoagulant blood samples from patients with Kaschin-Beck disease and healthy persons were collected,erythrocytes were separated,cell suspension (10s cells/ml) was prepared and 200 μl cell suspension was added to the dielectrophoretic pool to measure erythrocyte dielectric response rate.Results Erythrocyte dielectric response rates were significantly different between patients living in Kaschin-Beck disease areas with Kaschin-Beck disease [(75.87 ± 5.89)％] and healthy persons living in Kaschin-Beck disease areas and non-Kaschin-Beck disease areas [(92.43 ± 4.45)％,(92.81 ±5.01)％,F =1.843,P ＜ 0.01).Erythrocyte dielectric response rate was significantly reduced in patients with Kaschin-Beck disease compared with that of healthy persons (all P ＜ 0.01);erythrocyte dielectric response rate of adult patients with Kaschin-Beck disease was lower [(69.57 ± 6.87)％] than that of pediatric patients with Kaschin-Beck disease [(82.17 ± 4.91)％,P ＜ 0.01].Erythrocyte dielectric response rates were significantly different in patients with different degrees of Kaschin-Beck disease (F =1.647,P ＜ 0.01).Erythrocyte dielectric response rate of patients with Kaschin-Beck disease was negatively correlated with prevalence of the disease (r =-0.87,P ＜ 0.01).Conclusions Erythrocytes of patients with Kaschin-Beck disease have some degree of pathological damage.The more severe the disease,the more serious the damage of red blood cell.The change of erythrocyte dielectric response properties may be used as an index to judge the prevalence of Kaschin-Beck disease and for early diagnosis.

Objective To summarize the perioperative nursing care of the elderly patients with hip fracture.Methods There were 95 elderly patients with hip fractures admitted to hospital and received the fixation of artificial joint replacement and preoperative and postoperative nursing care from June 2010 to September 2013.Results Ninety-five patients were recovered and discharged from the hospital. They had stayed the hospital for 11 to 28 days and the average time was(17.5±2.5)d.One patient had developed pneumonia after surgery and one patient had incision infection.After treatment both patients were cured.Conclusions When the elderly patients with hip fracture stayed in the hospital,the nurses should give them good care.The nurses should provide them with mental care based on their psychological and physiological characteristics,help the patients to prevent the complications,guide the patients through rehabilitation training,enhance daily living and promote the patients’health as soon as possible.

ObjectiveTo evaluate the probability of the fetal heart scanning in first trimester(11 -14+6 week) by transabdominal ultrasonography.MethodsBy using advanced ultrasound machine with high resolution transabdominal probe,249 fetal hearts were scanned.Four chamber view,left and right outflow view,three vessels view were obtained.The successful observation rates of these views under different gestational age were recorded.For 18 pregnant women with suboptimal transabdominal scanning condition,transvaginal scan were supplemented.ResultsAmong 249 singleton fetuses with low risk of congenital heart disease,four chamber view was successfully visualized in 227 (91.2％),left outflow view in 125(50.2％),right outflow view in 102(40.9％),three vessels view in 98(39.4％).The successful observation rate of these four views increased with gestational ages.The successful observation rate of each view in successive gestational age showed remarkable difference (P ＜ 0.05).The four chamber view had the highest successful observation rate with 95％ after 12 weeks.After 13 weeks,left and right outflow views visualizing rate was above 85％.Transvaginal scanning can increase the four chamber view successful observation rate.For observation of other views,transvaginal scanning,however,showed no superior than transabdomial scanning.ConclusionsHigh resolution transabdominal probe can be used to perform the fetal hearts scanning in early trimester.It will benefit to find the fetal heart malformation.

Objective To evaluate the clinical value of endobrochial ultrasound (EBUS) examination,a new ultrasound technique.Method 15 patients with space occupying lesions in lung or doubted obstructive pneumonia or atelectasis were examined by EBUS.The procedure was performed with ultrasound catheters,which were introduced into bronchi through the operating channel of fiberoptic bronchoscope and a full 360℃ cross-sectional image was obtained.Result The bronchial wall was highly echogenic and laminated.The lung parenchyma appeared echo rich and patchy.Pulmonary vessels can be identified by the echo free lumen and the pulsatile changes.Echo poor bronchial carcinomas proved in pathology destructed bronchial wall in different extent were detected in 10 patients.1 patient with nodule in right apical segment who had intact bronchial wall was with tuberculosis proved by operation.1 patient with pleural effusion and atelectasis was detected by EBUS and found no abnormal echo,showing that the reason for atelectasis was compression instead of obstruction.Among the 3 patients who were suspected to have obstructive pneumonia,in 1 case ultrasound scanning showed enlarged lymph node outside the bronchus compressing the wall caused the channel mild narrow;as to the other 2 cases,because bronchial wall was complete and no tumor like echo were found,the obstructive factor was excluded.The ultrasound examination had no particular risk and caused little discomfort.Conclusion Endobronchial ultrasound scan can clearly demonstrate the adjacent extraluminal lesion or structure within the brochial wall itself,which is safe and effective.