Objective To use three different methods in attempt to estimate the biological dose of the patient partially exposed to 192Ir source at5.7 accident in Nanjing,so as to provide dosimetric information for clinical remedy of exposed patients in the emergency of a nuclear accident.Methods Peripheral blood samples were collected on days 5 after exposure.The biological dose was estimated by the yields of dicentrics plus rings ( dic + r),cytokinesis-block micronuclei (CBMN) assay and nucleoplasmic bridge plus FHC (NPB + FHC).The homogeneity of radiation exposure was examined by Poisson distribution of dicentrics.Results By using three different methods,the whole body equivalent dose was dic + r estimated to be 1.51 Gy (95％ CI 1.40-1.61),1.47 Gy (95％ CI 1.36-1.60) by CBMN and 1.30 Gy (95％ CI 1.00-1.60) by NPB + FHC,respectively.A non-poisson distribution was also detected,suggesting partial body radiation exposure.Conclusions The estimated whole body equivalent dose ot a non-uniform radiation exposure was consistent with clinical diagnosis,suggesting that the yields ofdic + r,CBMN,as well as NPB + FHC,are efficient approaches to the estimation of biological doses.

Objective To explore the natural attenuation pattern of three biological dose estimation indexes in vivo by investigating the effect on biological dosimetry of peripheral blood sampling at different time points from the victim partially exposed to 192Ir radiation source at5.7 accident in Nanjing.Methods Peripheral blood of the patient was collected on days 5,40 and 280 after exposure,respectively.The yields of dicentrics plus rings chromosomes (dic + r),cytokinesis-block micronuclei (CBMN) and nucleoplasmic bridge + fusion + horse shoe + circular(NPB + FHC) were analyzed.The dynamic reduction and dose estimation were both observed using the biomarkers mentioned above after exposure.Results Compared to the estimates on days 5 after exposure,the dose values estimated on days 40 and 280 decreased by 34％ and 49％ fordic + r method,48％ and 79％ for the CBMN assay,and 48％ and 75％ for NPN + FHC method,respectively.Conclusions Three biological dose estimation indexes show a progressive decrease in vivo,with the half-life of dic + r/cell being 40 days.The doses estimated using these three indexes on days 40 after exposure showed a relative deviation more than 20％ compared with those on days 5 after exposure.

Objective To investigate a dose response curve based on a genetic workstation with automatic analysis system of dicentric chromosome assay (DCA) for establishing a high speed dose estimation method.Methods Peripheral blood from three healthy volunteers was irradiated in vitro using 60Co γ-rays,and then lymphocytes were cultured and fixed on slides using the standard protocol for DCA.Dicentric chromosome in metaphase cells was analyzed automatically with the genetic workstation and confirmed manually,and the dose response curve of automated dicentric chromosome was fitted.Dicentric chromosome of another peripheral blood sample irradiated with different doses was manually analyzed to verify the accuracy of the above automated DCA.Results The yield of automated DCA was well fitted by an equation Y =0.018 06D2 + 0.012 79D + 0.000 489 1 with a correlation coefficient R2 =0.961.The biological dose of radiation could be accurately estimated by this dose response curve within a few minutes.Conclusions We had successfully established a new dosimetry method by analyzing dicentric chromesome automatically,which can save a lot of manual analysis time and hence has important significance for emergency rescue in nuclear accidents.

This study was aimed to improve the transfer rate of sinomenine in the intermediate product of Caulis Sinomenii in order to optimize the purification process of intermediate product ofCaulis Sinomenii fromTong-An (TA) injection. The transfer rate of sinomenine and the stability of fingerprints in the intermediate product of Caulis Sinomenii were used as indexes for the investigation on the impact from different pH ofCaulis Sinomenii extract before extraction. The transfer rate of sinomenine was used as an index for the investigation on the impact by different pH of hydrochloric acid created to dry extract solution. The transfer rate of sinomenine was used as an index for the investigation of four separation ways, which included the vacuum filtration, plate and frame filters, high-speed tube separator, and flat direct centrifuge, on the liquid separation of sinomenium acutum acid. The results showed that the pH ofCaulis Sinomenii extract before extraction was 10-11; the transfer rate of sinomenine was the highest in the extraction process and the fingerprints of TA injection was stable. The pH of hydrochloric acid was 2.0-2.5; and the highest transfer rate of sinomenine in acid dissolution process was 92.94%. The high-speed tube separator had the best separation to sinomenium acutum acid-dissolving liquid. The highest transfer rate of sinomenine was 93.34%. It was concluded that the optimized process can effectively improve the transfer rate of sinomenine in the intermediate product ofCaulis Sinomenii. Meanwhile, fingerprints of the product were stable. The process was simple with good repeatability.

Objective:To summarize the atypical manifestations and treatment strategies of serous microcystic neoplasm of the pancreas.Methods:Review the case data of 11 cases of pancreatic serous microcystic adenoma with atypical preoperative clinical imaging findings admitted to Peking Union Medical College Hospital from July 2008 to October 2019, and summarize their clinical manifestations, CT/MRI features, and preoperative clinical diagnosis, surgical methods, postoperative conditions.Results:The median age of the 11 patients was 50 (46-66) years old, 7 females, and 4 males. There were 8 cases with back pain and 6 cases with weight loss. The preoperative imaging examination found that the lesion was located in the head and neck in 8 cases, with pancreaticobiliary duct dilatation in 7 cases, suspected vascular invasion in 3 cases, and pancreatic parenchymal atrophy in 2 cases, 3 cases showed rich blood supply and solid space, and 2 cases were connected to the pancreatic duct. Preoperative diagnosis of pancreatic malignant tumors accounted for 4 cases, neuroendocrine tumors in 3 cases, solid pseudopapillary tumors in 3 cases, and intraductal papillary mucinous tumors in 1 case. All patients underwent surgical treatment, 3 cases of distal pancreatectomy (2 cases of using Kimura method to protect the spleen), 3 cases of pancreaticoduodenectomy, 1 case of total pancreatectomy, 2 cases of pancreatic head resection with duodenum preservation, 2 cases of local resection. All patients had no early postoperative deaths. There were 2 cases of grade B pancreatic fistula, 2 cases of biochemical leakage, 1 case of postoperative abdominal hemorrhage, and 2 cases of delayed gastric emptying, all of which were cured after active treatment. The median postoperative hospital stay was 18 (7-63) days.Conclusions:Pancreatic serous microcystic neoplasm could be accompanied by atypical features such as pancreatic/bile duct dilation, parenchyma atrophy, or even present vessel invasion. Understanding the atypical clinic and image features would help improving differential diagnosis and treatment. For those with invasive features, surgical exploration should be recommended.

Objective:The hvKP phenotype strains were screened from the sensitive and multi-drug resistant Klebsiella pneumoniae, and the distribution and homology of their clinical infection characteristics were compared. Methods:A total of 158 Klebsiella pneumoniae strains isolated from clinical infection specimens in the Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2018 were retrospectively collected. The string test (ST) was used to screen the hvKP infection, and a total of 65 were screened. The number of patients included 51 males and 14 females, with an average age of 56 years. The composition ratio of Klebsiellapneumoniae was analyzed for clinical infection related information. Matrix assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) was used to identify the hypervirulent Klebsiella pneumoniae and establish a new database, and bio-tree cluster analysis and principal component analysis were carried out for all strains that met the experimental conditions by using analysis software and the homology of protein level was obtained. Results:A total of 65 strains hvKP were screened, 62 of which were susceptible strains and 3 were multi-drug resistant strains. The main diseases of infected patients were diagnosed as hepatobiliary disease, encephalopathy and liver abscess. The basic diseases of the population were mainly diabetes and hypertension. Dendrogram cluster analysis divided hvKP into 3 groups at a distance of 550 from the horizontal line; principal component analysis found that some strains were closely related, and the Kc group with the largest proportion was mainly related to hepatobiliary diseases. Ka group was mainly related to infection after surgery.Conclusions:HvKP was highly invasive and the clinical manifestations of infection were diverse. The infected patients were mostly elderly patients with weakened immunity. The rapid homology analysis of MALDI-TOF MS mass spectrometry has important clinical significance for the rapid screening of hvKP infection.

Objective:The hvKP phenotype strains were screened from the sensitive and multi-drug resistant Klebsiella pneumoniae, and the distribution and homology of their clinical infection characteristics were compared. Methods:A total of 158 Klebsiella pneumoniae strains isolated from clinical infection specimens in the Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2018 were retrospectively collected. The string test (ST) was used to screen the hvKP infection, and a total of 65 were screened. The number of patients included 51 males and 14 females, with an average age of 56 years. The composition ratio of Klebsiellapneumoniae was analyzed for clinical infection related information. Matrix assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) was used to identify the hypervirulent Klebsiella pneumoniae and establish a new database, and bio-tree cluster analysis and principal component analysis were carried out for all strains that met the experimental conditions by using analysis software and the homology of protein level was obtained. Results:A total of 65 strains hvKP were screened, 62 of which were susceptible strains and 3 were multi-drug resistant strains. The main diseases of infected patients were diagnosed as hepatobiliary disease, encephalopathy and liver abscess. The basic diseases of the population were mainly diabetes and hypertension. Dendrogram cluster analysis divided hvKP into 3 groups at a distance of 550 from the horizontal line; principal component analysis found that some strains were closely related, and the Kc group with the largest proportion was mainly related to hepatobiliary diseases. Ka group was mainly related to infection after surgery.Conclusions:HvKP was highly invasive and the clinical manifestations of infection were diverse. The infected patients were mostly elderly patients with weakened immunity. The rapid homology analysis of MALDI-TOF MS mass spectrometry has important clinical significance for the rapid screening of hvKP infection.

Objective: To explore the treatment technique, occurrence and development patterns of such radiation injuries as in a major radiological accident in which a victim suffered mild bone marrow radiation sickness combined grade degree Ⅲ acute radiation induced skin injury, based on his dose estimation, clinical manifestations and disease treatments. Methods: History inquiry in detail, earlier physical dose estimation and biological dose estimation were conducted in conjunction with analyzing the chromosome aberration of peripheral blood lymphocytes. The physical dose was estimated by Monte Carlo method.The systematic laboratory and imaging examination was performed to evaluate the condition. The comprehensive analysis was conducted to determine the diagnosis and treatment plan. Results: At 3d after the exposure, "Ren" felt mild pain and discomfortable on the skin of the right index finger. The body of the right hand index finger was covered with blister at 21 d after exposure.The estimation of biological dose was 0.43 Gy (95%CI: 0.31-0.58 Gy), and the physical dose was estimated to be 36-164 Gy for each part of the right hand finger. The hematopoietic system, immune system and endocrine system were normal. The liver function index value was transiently increased. The liver damage resulted from the use of antibiotic-induced combined with the patient′s past medical history and admission examination result, and the relevant antibiotics were discontinued. The liver function returned to normal after liver protection treatment. At 22 d after irradiation, a right finger incision and decompression surgery were performed. The stem cells were extracted and implanted into the right index finger. After 59 days of hospitalization, there was no obvious discomfort in the body, and the right index finger recovered well, as well as the pain significantly relieved, and the knuckle activity was basically normal. Conclusions The patient with excessive radiation and grade Ⅲ acute radiation skin injury was successfully treated, and local application of autologous adipose-derived stem cell transplantation achieved good result .

Based on the ideas of management systemization, system standardization, process specialisation, post accountability, duty formalization, form informatization, information digitization and digital intelligence, the smart, mobile and paperless bedside billing service was developed which incorporated both functional and financial prospects. The innovation was realized by Internet+ bedside billing and an integrated information platform, so that the inter-hospital billing system could be connected to the medical insurance system, electrical receive system and commercial insurance system. This saved manpower and equipment deployment, and improved service quality. The bedside intelligent mobile billing system of a hospital was launched in January 2021, and the average discharge billing time of inpatients in 2020 and 2021 was 44.36 min and 30.59 min, respectively, and the online billing fee time was significantly shorter than offline billing in 2021, and the differences were all significant( P<0.01).

To solve the problems of long waiting time for outpatients, difficulty on implementation of one patient one room initiative, backward appointment method on examination, and imperfect instruction and guidance, a series of fine management measures have been taken place in a tertiary hospital which included dividing the patient waiting queue reasonably, establishing the patient secondary consultation system, improving the outpatient order of two-way management between doctors and patients, establishing one key appointment system for examinations, building hospital intelligent navigation system, and implementing outpatient payment and self-service drug delivery.The results showed, the waiting time of outpatients was significantly shortened ( P<0.001), and the satisfaction of patients in waiting time, hospital guidance and appointment registration was significantly improved ( P<0.05). Fine management mode combining online and offline can effectively increase the efficiency of outpatient service, improve clinical experience, and facilitate the high-quality development of medical services.