Objective To learn the satisfaction and influencing factors of medical insurance for urban residents in Taiyuan city.Methods The multi-stage random sampling method was used to survey the satisfaction of medical insurance for urban residents so covered in 4 districts of Taiyuan city. The questionnaire covered basic personal information, and comments of the residents on the three dimensions of medical insurance regarding the stakeholders. The data solicited were subject to descriptive analysis, Kruskal-Wallis test and ordered multi-class logistic regression analysis. Results The rate of overall satisfaction of urban residents′ medical insurance in Taiyuan city was 44.6% , that of average satisfaction was 48.3% , and that of dissatisfaction was 7.1%.For residents of different family size and physical health status, the differences of their satisfaction were statistically different(P<0.05).Ordered multi-class logistic regression analysis showed that the proportion of reimbursement, the scope of drug treatment and the efficiency of treatment were top factors affecting their satisfaction ( OR > 1 ). Conclusions The rate of overall satisfaction of medical insurance by urban residents in Taiyuan city is low. To improve their satisfaction, it is important to increase the proportion of reimbursement, expand the scope of reimbursement for diagnosis and treatment along with drugs, simplify the reimbursement procedures, and improve the service attitude of the service agencies.

OBJECTIVETo investigate the association of mutations in the hepatitis B virus (HBV) X gene (HBX, encoding the HBx protein) and development of hepatocellular carcinoma (HCC).

METHODSForty-four patients with HBV-related HCC participated in the study, along with 76 patients with chronic HBV infection who assessed as controls. All patients had serum HBV DNA levels that were higher than 10(3) copies/ml. Extracted HBV DNA was subjected to nested PCR to amplify the HBX gene, followed by direct sequencing. All sequencing data were compared to the consensus HBV sequence to identify mutations. The sequencing data were analyzed by Chromas and SeqMan software.

RESULTSMutations of G1467C, G/C1479A, C1485T and C1653T in the X region were found, but did not show any significant difference in occurrence between the HCC group and the chronic HBV infection group (P>0.05). The T1674C mutation in the X region, however, occurred more frequently in the HCC group (29.27% vs.6.67%, P<0.05). Prevalence of the T1753C mutation and the A1762T/G1764A double mutation in the BCP region was significantly higher in the HCC group than in the chronic HBV infection group (P<0.05) and in the group of patients with hepatitis B e antigen (HBeAg)-negative status compared to the patients with HBeAg-positive status (P<0.05).

CONCLUSIONIncidence of the T1674C mutation in the X region and of the T1753C mutation and the A1762T/G1764A double mutation in the BCP region was higher for patients with HBV-related HCC; the T1753C mutation and the A1762T/G1764A double mutation may inhibit the formation of HBeAg.

Carcinoma, Hepatocellular ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Incidence ; Liver Neoplasms ; Mutation ; Polymerase Chain Reaction

Objective To explore the feasibility to set the breast board support plate angle to 0° for breast cancer patient in the intensity modulated radiation therapy. Methods A total of 60 patients with breast cancer who received the simultaneous integrated boost intensity-modulated radiation therapy ( SIB-IMRT) after breast-conserving surgery were enrolled form Oct 2015 to Feb 2017. They were randomly divided into three groups that the angle of the breast board support plate was 12°, 7° and 0° respectively. The ipsilateral lung V20 , V5 , Dmean , the heart V10 , V30 , Dmean and the collimator angle were compared among three groups. In addition, the distribution of the setup error was analyzed and the group system error and random error were calculated. Results There were no statistically significant differences in the ipsilateral lung V20, V5, Dmean and the heart V10, V30, Dmean among the three groups(P >0. 05). The sum of the collimator angle and the angle of the support plate was about 13. 4° for each group. Only the setup error of z (vertical) direction was statistically different (χ2 =78. 32, P<0. 001) and the median of the 0° group was closest to the value 0 and the quartile spacing was the smallest. The absolute error of y ( longitudinal) , z directions was statistically different (χ2 =7. 63, 22. 61,P<0. 05). In the z direction, the absolute error was reduced as the angle of the support plate decreased and 0°group was the smallest. In the y direction, the absolute error at 12° was the smallest, but had little difference with that at 0°. Among three groups, the smallest system error of the x(lateral) direction and y direction was at 0°, while that of the z direction was at 12°. Conclusions To set the breast board support plate 0° is feasible. The angle of the support plate can be replaced by the collimator angle, while the setup error of z direction could be significantly reduced.

Objective To analyze the quality control data of linear accelerator detected by Daily QA3 and to evaluate this quality control process using statistical process control.Methods After the calibrations of the accelerator and Daily QA3,Daily QA3 device was used to perform daily quality control by technicians and physicists and 100 groups and 30 groups of daily quality control data were collected.After the accelerator and Daily QA3 were re-calibrated,Daily QA3 device was utilized to perform daily quality control by technicians and 100 groups of the daily quality control data were repeatedly collected.The variations of normalized signal-to-noise ratio of quality control data collected after two calibrations were analyzed.The first 30 groups of daily quality control data measured by technicians and physicists were adopted to calculate the I-MR control chartsand compare the location of CL and the range of UCL and LCL.The process capability indices were calculated for three different quality control processes bytechnicians and physicists,respectively.Results For twice calibrations,normalized signal-to-noise ratio of quality control data significantly changed before 6 weeks,became stable between 6 and 8 weeks,and the changes became smaller after 8 weeks.For dose output measured by physicists,the rang of UCL and LCL was more narrow.In terms of flatness and symmetry,the location of CL was closer to zero.Regarding dose output and flatness,the process capability indices of three different quality control process were all satisfied ≥ 1,whereas unsatisfied for transverse symmetry.Conclusions The first 30-40 data points should be adopted to delineate I-MR control chart of the linear accelerator in daily quality control process.The quality control process should be completed by a fixed and small group of personnel and an optimal tolerance level should be customized.

It is necessary to place bolus on skin to increase the surface dose when using high-energy rays to treat superficial lesions because of its build-up effect. It is well known that the set-up reproducibility of hand-made bolus is poor, and the main concern of commercialized bolus is the inadvertent air gap between the bolus and irregular skin. Owing to the advantage of making individualized and complex-shaped bolus, 3D-printing technology is playing an important role in making the bolus. The aim of this review is to summarize the current research status of hand-made, commercialized and 3D-printed bolus materials and future development trend of the bolus, providing reference for clinical application.

OBJECTIVE:To reduce the incidence of irrational medical orders for parenteral nutrition,and promote the rational use of parenteral nutrition. METHODS:The medical orders for parenteral nutrition of the first quarter of 2016 in general surgery de-partment of our hospital were collected,and the number and types of its irrational medical orders were summed up. Then FO-CUS-PDCA(Find-organize-clarify-understand-select-plan-do-check-act)cycle management was adopted to analyze and improve the existing problems in issuing medical orders for parenteral nutrition. The improved(the third quarter of 2016)medical orders for par-enteral nutrition were collected,the number and types of its irrational medical orders were summed up,and management effect was evaluated. RESULTS:Establishing nutrition support group,strengthening the training and communication of medical staff,adding prescription evaluation module for parenteral nutrition in hospital information system and a number of measures had made the inci-dence of irrational medical orders for parenteral nutrition in general surgery department declined from 48.25%(1433/2970)before improvement to 5.67%(120/2118)after improvement. The incidences of cation excess,inappropriate selection of drugs and inap-propriate compatibility in irrational types were 0. CONCLUSIONS:FOCUS-PDCA cycle management can reduce the irrational rate of medical orders for parenteral nutrition and promote the rational use of parenteral nutrition in hospital.

Objective To investigate the safety,feasibility and clinical application effect of upper arm totally implantable venous access port (TIVAP) inserted by the combination of oncologists and nurses in patients with tumor.Methods A total of 34 patients,who needed long-term transfusion treatment,were included in this study with upper arm TIVAP from March 2017 and December 2017.There were 20 males and 14 females.The median age was 63 (35 ～ 83) years.Upper arm TIVAP was implanted by both doctors and nurses into the patients with tumor,and the TIVAP related success rate,complications and patients satisfaction were recorded.Results 34 patients all succeeded in TIVAP implantation with the operation success rate of 100％.The average operation time was about 40 minutes (30 to 60 minutes) from the disinfecting cloth to the end of the suture.The operations of all patients were successful.After the operation two patients died of cancer progression,one patient had soft tissue infection around capsular bag,None of the patients had other complications such as blocked infusion,catheter shift,port reversal,and so on,and the incidence of complication was 2.94％ (1/34).Conclusions Upper arm TIVAP has the advantages of safe puncture,shorter operation time,few intra-operative and post-operative complications and higher feasibility for operation by both oncologist and nurse,which can supplement the limitations and deficiencies of the chest wall port and PICC in a certain extent,therefore is a good choice for clinical application.