Objective To evaluate the dosimetric errors of organs-at-risk (OARs) induced by the optimal auto-segmentation using Mim Maestro based on dose calculation and measurement.Methods The Mim atlas library composed of 240 nasopharyngeal carcinoma,breast cancer,and rectal cancer patients that were retrospectively selected was used for the auto-segmentation of OARs on the CT images of corresponding regions in 76 patients.Relative to the manual contouring,one optimal case was selected from each site based on conformity index (CI),mean distance to conformity (MDC),relative volume difference (Dv％),DICE,sensitivity index (Se.Idx),and inclusion index (Inc.Idx).Treatment plans were made to satisfy the DVH constraints of OARs based on auto-contours,and then the dose errors to the actual organs were evaluated in terms of calculation and measurement.The paired t-test (normal distribution) or rank sum test (non-normal distribution).Results Significant differences were observed in the 76 patients between the manual and automated segmentation (P＜0.05).For the optimal cases,the DICE index of various OARs ranged from 0.43 to O.98,and 73％(16/22) of DICE values were higher than 0.70.The calculated dose errors to various OARs were (-1.15±15.94)％(95％ CI:-8.21％ to 5.92％) (mean dose) and (-6.53±21.13)％ (95％ CI:-15.90％ to 2.84％) (maximum dose).The measured dose errors were (-2.43± 24.52)％ (95％ CI:-13.30％ to 8.44％)(mean dose) and (-3.38±20.87)％(95％ CI:-12.63％ to 5.87％)(maximum dose).Conclusion Without human interference,even the optimal auto-segmentation results are not clinically acceptable for treatment planning.

Objective To summarize the manifestation of solid pseudopapillary tumor of the pancreas (SPTP) on ultrasound and contrast-enhanced ultrasound (CEUS) and to investigate the diagnostic value of CEUS. Methods The ultrasound and CEUS images of six patients with SPTP confirmed by pathology were reviewed. According to CEUS record,the enhanced and wash-out time,enhanced speed and degree of tumor were analyzed. Results On ultrasound, SPTP presented as solid, well-circumscribed masses, usually heterogeneous in echo texture, and some of them contained macro-calcification. On CEUS, the tumor enhanced simultaneously or slightly late compared with normal pancreatic tissues. The contrast agent washed out quickly in all tumors than in normal pancreatic tissues. The enhanced degrees were equal to or less than that of the normal pancreatic tissues. Some tumors showed capsule and septum enhancement. Conclusions The manifestation of SPTP on CEUS had some features and may be helpful for differentiation diagnosis combine with ultrasound.

Objective To explore the manifestation of pancreatic metastases (PM)using contrast‐enhanced ultrasound (CEUS). Methods Eleven patients with PM confirmed by pathology or CT/MRI combined with clinical data were analyzed retrospectively. The manifestation on conventional ultrasound and the enhancement appearance on CEUS were analyzed. Results The primary malignant tumors included lung cancer(n=6), breast cancer(n=1), renal clear cell carcinoma(n=1), gastric cancer(n=1), rectal cancer(n=1)and leiomyosarcoma of uterus(n=1). Eight patients had one lesion and three were multiple. The maximum lesion diameter was 2. 0-5. 0cm. Eight of the 11 patients showed hypoechoic on conventional US. Three patients were diagnosed as probably PM, one probably malignant and 7 undetermined by US. In the early stage of CEUS, two patients showed hyper‐enhancement, six showed iso‐enhancement and 3 showed hypo‐enhancement I.n the late stage of CEUS, nine patients (9/11) showed hypo‐enhancement. Seven patients showed homogeneous enhancement S.ix patients were diagnosed as PM, three malignant, one neuroendocrine tumor and one undetermined by CEUS. Conclusions PM showed certain characteristics on CEUS. The hyper‐or iso‐enhancement at the early stage of CEUS and history of primary cancer is helpful for diagnosis of PM.

Objective To explore the diagnostic value of contrast enhanced ultrasound (CEUS) by comparison with enhanced MRI.Methods Thirty-two cases with pancreatic cystic lesions confirmed by surgery or biopsy were enrolled.Ultrasound,CEUS and MRI were applied respectively for the diagnosis of 32 cases.The diagnostic ability of different imaging methods were compared according to pathological results as the gold standard.Results The 32 cases include 8 cases of serous cystadenoma,6 cases of mucinous cystic neoplasm,3 cases of intraductal papillary mucinous neoplasm,4 cases of solid pseudopapillary tumor,3 cases of neuroendocrine tumor,6 cases of pancreatic carcinoma,1 case of cyst and 1 case of inflammatory myofibroblastic tumor.The diagnostic accuracies of ultrasound,CEUS and MRI were 46.88％ (15/32),75.00％ (24/32) and 78.13％ (25/32) respectively.There was no significant difference between the diagnostic accuracies of CEUS and MRI (P =0.768).The diagnostic accuracies of CEUS and MRI were higher than that of ultrasound (P ＜0.05).Conclusions CEUS has obvious superiority over ultrasound in the diagnostic accuracy of pancreatic cystic lesions.The diagnostic ability of CEUS is similar to that of MRI.

OBJECTIVETo investigate the risk factors of surgical site infection (SSI) in definitive surgery of intestinal fistulas.

METHODSPatients with gastrointestinal fistula undergoing definitive operation during November 2011 to November 2013 in Jinling Hospital were prospectively enrolled in the study. Risk factors of SSI were analyzed. Patients' characteristics, surgery-related data and fistula-related data were prospectively collected. Risk factors of SSI were analyzed.

RESULTSA total of 191 cases were enrolled and 51 cases developed SSI. Univariate analysis showed that patients with risk index category (RIC)≥2, length of abdominal incisions>15 cm, and duration of drainage tubes>10 days had significantly higher incidence of SSI (P<0.05). Multivariate Logistics analysis demonstrated that RIC and duration of drainage tube were independent risk factors for SSI (P=0.02, P=0.01, respectively).

CONCLUSIONSRIC≥2 and duration of drainage tubes>10 days are independent risk factors for development of SSI.

OBJECTIVE:To study the rational use of antibacterials in inpatients.METHODS:A discussion was made on the use of antibacterials for 4 948 inpatients in 2004 and 5 476 inpatients in 2005 in our hospital,managed in accordance with the requirements for hospital management by level and the Guidelines for Clinical Use of Antibacterials.RESULTS & CONCL- USIONS:The inpatient use of antibacterials in our hospital has been made basically rational through implementation of systematic management,enactment of antibacterials management by level,monitoring on usage of antibacterials and enforcement of warning system for overusing.

Objective To detect the expression of Beclin1 and Bcl2 in invasive pituitary adenomas and to explore the relationship of Beclin1 and Bci2 in invasive pituitary adenomas and the relativity between the 2 genes.Methods 61 specimens were classified into invasive group (32 cases) and non-invasive group (29 cases) according to the comprehensive evaluation of invasive pituitary adenomas.lmmunofluorescence analysis and RT-PCR were adopted respectively to detect the protein and mRNA expressions of Beclinl and Bcl2.The difference and relativity of Beclin1 and Bcl2 expression in invasive group and non-invasive group were analyzed.Results 32 specimens of pituitary adenoma were invasive and 29 were non-invasive.Beclin1 protein and mRNA expressions were lower in the invasive group than in the non-invasive group (P ＜0.01 ).Bcl2 protein and mRNA expressions were higher in the invasive group than in the non-invasive group (P ＜0.01 ).Pearson related analysis showed that Beclin1 mRNA expression was negtively correlated with Bcl2 mRNA expression in the invasive group ( r =-0.42,P =0.028 ).Conclusions Beclinl expression is decreased in invasive pituitary adenomas.The invasiveness of pituitary adenoma is closely related to the high expression of Bcl2 protein and mRNA,and the low expression of Beclin1 protein and mRNA.The inhibition of the autophagy may lead to the enhancement of the invasiveness of pituitary adenomas and that inhibition may come from the interaction of Beclin1 and Bcl2.

Objective To explore the expression of RIP2 in colorectal cancer(CRC)tissues,and the inva-sion and migration was observed after RIP2 was increased in CRC cell line.Methods 48 cases of CRC paraf-fin-embedded specimens and 56 cases of tumor-adjacent tissues were collected,and expressions of RIP2 was tested by immunohistochemistry(IHC).pEGFP-RIP2 plasmid and JetPRIME were employed to increase the RIP2 in SW480 cells,and variety of invasion and migration was tested in SW480 cells.Results It was showed that expressions of RIP2 was lower in CRC tumors than in tumor-adjacent tissues(P<0.05).After RIP2 in-creased,migration ability of SW480 cells weakened.Conclusion The expression of RIP2 was decreased in CRC tissues,and it was closely related to tumor cell's invasion and metastasis.

Objective To evaluate the factors that may have impact on se-rum digoxin concentration ( SDC ) as well as its drug -drug interaction.Methods Using systematic method , gathering the inpatients′SDC of Peking university first hospital from January to December , 2014.Using retrospective method , statistics and analysis of the influence factors inclu-ding dosage, age, gender, therapeutic drug monitoring value ( TDM), creatinine clearance ( CrCl ) , electrolyte and co -administration of pa-tients in cardiovascular department were carried out.Results There are 49.8%of the patients with their SDCs below 0.5 ng · mL-1 , 24.1%of the SDCs in the range of 0.5-0.8 ng · mL-1 , 25.7% of the SDCs in the range of 0.8 -2.0 ng· mL-1 , 4.2% of the SDCs are over 2.0 ng· mL-1.The significant factors which influence SDC are age , CrCl and co -administration with antibiotics and nitrates ( P <0.05 ).Conclusion The usage of digoxin in Peking university first hospital is fairly reasonable , however the SDC is a bit of low for a large proportion of the patience.Digoxin dosage should be adjusted individually especially based on the patients ’ age , CrCl and drug combination in order to meet the future goal for achieving personalized medicine.

Objective To analyze the predictive value of combination of endoscopic ultrasound (EUS)and 64-slice dual-source computed tomography(DSCT)in regional clinical staging and peritoneal metastases of gastric cancer.Methods From July 2011 to May 2017,365 patients with gastric cancer diagnosed by endoscopic biopsy were enrolled.The patients received EUS and DSCT examination with the gold standard of postoperative pathological diagnosis,the accuracies of EUS alone,DSCT alone and the combination of EUS and DSCT were evaluated in original gastric tumor,regional lymph nodes and peritoneal metastases.The accuracy,sensitivity,specificity,the positive predictive value,the negative predictive value,consistency(the value of K ap pa)and area under curve(AUC)of receiver operating characteristic(ROC)curve were calculated.Results A total of 263 patients were enrolled into the study on the depth of tumor invasion and clinical staging of regional lymph nodes and 289 patients were recruited into the clinical prediction study on peritoneal metastasis.The accuracy of EUS in clinical staging of the depth of tumor invasion was 75.29% and the sensitivity,specificity,the value of Kappaand AUC of EUS in clinical staging of regional lymph nodes were 86.26%,81.81%,0.681 and 0.840,respectively.The sensitivity,specificity,the value of Kappaand AUC of DSCT in clinical staging of regional lymph nodes were 74.81%,87.12%,0.620 and 0.813,respectively.The sensitivity,specificity,the value of Kappa and AUC of EUS in the prediction of peritoneal metastases were 38.24%,97.25%,0.432 and 0.668, respectively.The sensitivity,specificity,the value of Kappa and AUC of DSCT in the prediction of peritoneal metastases were 41.18%,100.00%,0.553 and 0.706,respectively.The accuracy and the value of Kappaof the combination of EUS and DSCT in clinical staging of the depth of tumor invasion were 75.29% and 0.639;the sensitivity,specificity,positive predictive value,negative predictive value, Kappa,AUC in clinical staging of regional lymph nodes were 93.13%,87.88%,88.41%,92.80%, 0.810 and 0.905,respectively;and the sensitivity,specificity,positive predictive value,negative predictive value,Kappa,AUC in the prediction of peritoneal metastases were 58.82%,97.25%, 74.07%,94.66%,0.616 and 0.774,respectively.Conclusions The combination of EUS and DSCT which is superior to single examination is very helpful in the depth of gastric cancer invasion and regional lymph nodes,and is helpful in the prediction of peritoneal metastasis. The combination of two complementary examinations can improve the accuracy of the depth of gastric cancer invasion,clinical staging of regional lymph nodes,and the prediction of peritoneal metastasis.