Objective To discuss the detail design of medical linear accelerator room to optimize the layout of radiation shield.Methods According to the optimization principle for medical exposure protection and national radiation protection related documents,the influence of detail design on room quality was analyzed.Optimization design was executed from theaspects of spatial layout,protection,shielding wall,decorating materials,labyrinth,control cabin,protective door,occupancy factor,purification ventilation,tennperature humidity control and etc.Results The design and layout of the roomwere optimized to eliminate hidden risksand reduce the design flaws to prevent adverse consequences due to design errors.Conclusion Detail design contributes to stable operation,enhanced quality and efficiency of medical linear accelerator room.

Objective To investigate the significance of monitoring P(c-a)CO2 (the gradients between transcutaneous PCO2 and arterial PCO2) in patients with septic shock.Method 31 patients with early septic shock were enrolled as the study group and 20 patients with stable hemodynamics as the control group from Fab.2013 to Sept.2014 in our Intensive Care Unit (ICU).The patients with septic shock were treated guided by early goal directed therapy (EGDT) within 6 hours since hospitalization.The differences of baseline P(c-a) CO2 levels and other index as arterial lactate (LAC) concentration between two groups and the variations of these indexes after EGDT in the study group were compared respectively.Results The baseline levels of P(c-a)CO2 and LAC in patients with septic shock were significantly higher than in patients of control group: (21.2 ± 10.1) mmHg vs.(7.5 ±4.6), P =0.000, and (4.0±2.4) mmol/ Lvs.(1.6 ± 0.5), P =0.000.The areas under receiver operator characteristic (ROC) curve (AUC) for baselineP(c-a)CO2 and LAC were 0.918 (95％ CI: 0.843-0.992) and 0.840 (95％ CI: 0.719-0.962) respectively.A threshold of 14.0 mmHg for P(c-a)CO2 and 2.1 mmol/L for LAC discriminated patients with septic shock from without shock with the same sensibility of 83.9％ and the same specificity of 90.0％, respectively.With regard to prognosis (Day 28), AUC for baseline P(c-a)CO2 and LAC were 0.739 (95％ CI: 0.562-0.917) and0.702 (95％ CI: 0.514-0.889) respectively.A threshold of 21.5 mmHg for P(c-a) CO2 and 3.9 mmol/L for LAC discriminated survivors from nonsurvivors with the same sensibility of 71.4％ and the same specificity of 70.6％ respectively.31 patients in the study group completed EGDT within 6 hours after the admission, 16 (51.6％) passed EGDT and 13 (81.3％) survived, 15 (48.4％) failed EGDT and 4 (26.7％) survived, and survival rates were significantly different, F =9.314, P =0.004.After EGDT, P(c-a) CO2 (18.8 ± 9.4) mmHg and LAC (3.3 ± 2.4) mmol/Lreduced significantly compared with the baselines, all P =0.000.AUC then for P(c-a) CO2 and LAC were 0.742 (95％ CI: 0.562-0.921) and 0.769 (95％ CI: 0.593-0.945), respectively.A threshold of 18.3 mmHg for P(c-a)CO2 and 3.1 mmol/L for LAC discriminated survivors from nonsurvivors with the same sensibility of 71.4％ and the specificity of 71.4％ and of 76.5％ respectively.P(c-a) CO2 and LAC of patients passed EGDT reduced significantly compared with those failed EGDT: (14.8 ± 7.5) mmHgvs.(23.6±9.6) mmHg (P=0.012)、 (2.5±1.5) mmol/L vs.(4.3±2.9) mmol/L (P=0.038), and so did with their baseline : (14.8±7.5) mmHgvs.(18.0±8.1) mmHg, (P=0.042)、 (2.5±1.5) mmol/Lvs.(3.2±1.8) mmol/L, P=0.043.In patients failed EGDT, P(c-a)CO2 and LAC changed little after EGDT, from (24.6 ± 9.2) to (23.6 ± 9.6) mmHg (P =0.238) and from (4.8 ± 2.5) mmol/L to (4.3 ± 2.9) mmol/L (P =0.629).When baseline levels were compared between patients passed EGDT with those failed EGDT, P(c-a) CO2 was (18.0 ±8.1) mmHg vs.(24.6 ± 9.2) mmHg (P =0.042), LAC was (3.2 ± 1.8) mmol/L vs.(4.8 ± 2.5) mmol/L (P =0.050).Conclusions P(c-a) CO2 ＞ 14.0 mmHg could play a role in recognizing early septic shock.EGDT was an effective therapy for the disease and P(c-a)CO2 level could reflect the efficacy of EGDT.P(c-a)CO2 ＞ 21.5mmHg before EGDT and P(c-a) CO2 ＞ 19.3 mmHg after EGDT both could predict the prognosis of patients with septic shock.All above correlated well with LAC and represented a new efficient technique to assess tissue microperfusion.

Objective To discuss the difference of handwriting characteristics of schizophrenia,neurosis and healthy people according to the gender,the age and the level of educated.Methods The handwriting data were obtained under the standard condition of handwriting,then the 24 Chinese characters handwriting image information were transformed into digital data using the quantitative characteristics of Chinese characters handwriting recognition system (CCQAS4.0),finally the data of 99 patients with schizophrenia and 131 patients with neurosis were analyzed.Results Many significant differences had been found in schizophrenia,neurosis and norm group (P ＜0.05,P＜0.01),such as footer space((198.33±26.50) mm,(180.31±39.31)mm,(192.39±35.08) mm),average line spacing ((4.02 ± 1.68) mm,(5.34 ± 2.20) mm,(4.76 ± 2.00) mm) etc ; and there were also some important differences between the schizophrenia patient and the neurosis patient from different gender,age and education level in the 24 handwriting characteristics (P＜0.05,P＜0.01).Conclusions (1) Significant handwriting characteristic differences have surely been found among the schizophrenia/neurosis patient and normal people.(2) Gender,age and education level have impact on the characteristic in the schizophrenia patient and the neurosis patient.

Objective:To observe the relationship between the occurrence of symptomatic hypocalcemia (SH) and various potential influencing factors in patients after thyroidectomy, stratify according to the scope of thyroidectomy, and explore the predictive value of intact parathyroid hormone (iPTH) for postoperative SH.Methods:Among 3 379 patients with thyroidectomy who admitted into the First Affiliated Hospital of Zhengzhou University from January 2020 to February 2021, 122 patients with SH after thyroidectomy were collected retrospectively and set as SH group. 100 patients of the remaining 3 200 patients who did not suffer from SH in the same year were selected by systematic sampling method and set as control group. Pearson correlation analysis was used to analyze the potential influencing factors such as age, preoperative calcium, postoperative calcium, preoperative iPTH, postoperative iPTH, central lymph node number, blood loss, operation duration, gender, lymph node dissection method, thyroidectomy range, postoperative pathological type and other. Among them, the measurement data of normal distribution were expressed by mean±standard deviation( Mean± SD), t-test was used for the comparison between the two groups, and Chi-square test was used for count data. By drawing the receiver operating characteristic curve (ROC), the iPTH levels in patients with and without SH before/after operation (different surgical methods) were studied, and the diagnostic threshold, sensitivity and specificity of iPTH were predicted. Results:Among 3 379 patients, 122 patients suffered from SH after thyroidectomy, with the incidence rate of 3.6%. There were significant differences in gender (8 males and 114 females in SH group; 27 males and 73 females in control group), whether lateral area dissection was performed (58 cases with dissection and 64 cases without dissection in SH group; 7 cases with dissection and 93 cases without dissection in control group), thyroidectomy range (14 cases with one side and 108 cases with both sides in SH group; 73 cases with one side and 27 cases with both sides in control group), age (40.1 years old vs 43.2 years old), dissection number of central lymph nodes (8.6 vs 4.6), dissection number of cervical lymph nodes (12.3 vs 0.7), blood loss (22.8 mL vs 11.0 mL), operation duration (1.7 h vs 0.8 h), postoperative iPTH (16.4 pg/mL vs 41.9 pg/mL), preoperative iPTH (39.4 pg/mL vs 47.8 pg/mL) in SH group; and postoperative calcium level (1.9 mmol/L vs 2.2 mmol/L). There was significant differences between the two groups ( P<0.05). However, there was no significant differences between them with postoperative pathological type (4 cases with toxic goiter, 3 cases with medullary thyroid carcinoma, 1 case with thyroid follicular carcinoma, 114 cases with papillary thyroid carcinoma in SH group; 1 case with medullary thyroid carcinoma, 1 case of thyroid follicular carcinoma, 98 cases with papillary thyroid carcinoma in control group, P=0.25) and preoperative calcium (2.3 mmol/L vs 2.3 mmol/L, P=0.10). For patients with bilateral thyroidectomy, SH was easy to occur when postoperative iPTH < 20.08 pg/mL, and its sensitivity and specificity were 74.07% and 96.30%; however, for patients with unilateral thyroidectomy, SH was easy to occur when iPTH < 24.00 pg/mL after operation. Conclusions:Gender, age, postoperative calcium, preoperative iPTH, postoperative iPTH, central lymph node number, blood loss, operation duration, lymph node dissection method and thyroidectomy range are important factors affecting the occurrence of SH after thyroidectomy. With the expansion of surgical range, the postoperative iPTH level gradually decreases, which predicts the occurrence of symptomatic hypocalcemia. In order to avoid the occurrence of symptomatic hypocalcemia after operation, it is necessary to supplement calcium in time according to the range of operation and postoperative iPTH level.

Objective:To summarize the experience in diagnosis and treatment of primary cardiac tumors in pediatric patients.Methods:Retrospectively analyzing 7 pediatric patients who were suspected as primary cardiac tumors and diagnosed and treated in Department of Heart Center, Children′s Hospital of Dalian Medical University from August 2013 to February 2019.All patients underwent echocardiography and other examinations, so as to confirm the diagnosis and the treatment plan was chosen based on the size and location of the tumor.All patients were followed up after discharge.Results:A total of 7 patients were diagnosed as primary cardiac tumors by echocardiography, among which 5 cases underwent surgical treatment, and 2 cases were diagnosed with tuberous sclerosis without surgery.In children undergoing surgery, 1 patient underwent autologous heart transplantation to remove the tumor, 1 patient had arrhythmia, 1 patient had mitral regurgitation after surgery, and the mitral regurgitation was corrected again.The remaining children had no adverse complications and were discharged successfully.Histologic examination revealed rhabdomyoma in 4 patients, and fibroma in 1 patient.The patients were followed up for 2-66 months after discharge, and no tumor recurrence was observed in the children who performed surgery.There was a trend of spontaneously regress of cardiac tumor in 2 patients without surgery.Conclusions:Echocardiography is the first choice for the diagnosis of primary cardiac tumors in Pediatric patients.Rhabdomyoma is the most prevalent histologic type of primary cardiac tumors, and tuberous sclerosis should be excluded during the diagnosis process.Patients with tuberous sclerosis selected conservative treatment, and surgical treatment was selected for children with obvious symptoms.According to the location and size of lesion, therapy strategies should be chosen and autologous heart transplantation can be adopted to remove the tumor for children with large tumors.Autologous heart transplantation to remove the tumor is a good surgical treatment.

Objective To investigate the differences of handwriting characteristics among different genders,educational backgrounds and ages. Methods The ESP1020 was used to collect 1 474 handwriting samples throughout the country,and the collected handwriting samples were quantized by the self-developed" HCAS" software. The system could automatically extract 36 objective handwriting features,such as the aver-age character area,at the same time,4 subjective handwriting features such as the overall beauty are quanti-fied by the " overall impression evaluation method" . Finally,forty handwriting characteristics data were intro-duced into SPSS23. 0 for statistical analysis. Results There were statistically significant differences in 11 handwriting characteristics between male and female,such as average Chinese characters height ((6. 960± 1. 843) mm,(6. 757±1. 762) mm,t=2. 16,P<0. 05). There were statistically significant differences in 21 handwriting characteristics between the groups with different educational backgrounds,including the average Chinese characters area in primary school and junior high school((52. 175 6± 33. 989 5) mm2 ),in senior high school and technical secondary school(( 64. 320 7 ± 63. 123 5) mm2 ) and in junior college or above ((63. 815 3±58. 147 4)mm2)(t=5. 42,P<0. 01). There were statistically significant differences in 28 hand-writing characteristics in different age groups,such as writing time,pen pressure and Chinese characters area (P<0. 05,P<0. 01). Conclusions Demographic variables such as gender,education background and age have different effects on different aspects of handwriting characteristics.

Objective: To report the method and clinical effect of reconstruction of proximal thumb plane with iliac bone, combined with the same pedicled toenail and dorsum pedis flaps. Methods: From June 2010 to May 2017, 7 patients with various degrees of proximal thumb defect were treated in the Hand Surgery Department of Ruihua Affiliated Hospital of Soochow University. Among them, there were 3 males and 4 females, aged from 18 to 50 years, with an average age of 29 years. There were 5 cases of proximal thumb defect and 2 cases of distal thumb defect. The thumb reconstruction contained 3 steps: iliac bone graft was used to repair bone defect, toenail skin flap to repair dorsal thumb wound, and dorsum pedis flap to cover volar wound. Full thickness skin graft was used to repair donor site. Results: All the reconstructed fingers survived. The area of toenail skin flap was 3.0 cm×2.5 cm to 5.0 cm×3.0 cm in size. The area of dorsum pedis skin flap was 3.0 cm×3.0 cm to 6.0 cm×3.5 cm in size. The length of iliac bone graft was 2.5-5.0 cm. The follow-up time was 5-28 months, with an average of 10 months. All reconstructed finger pulp was full. The nails grew well. The appearance of fingers was satisfied, and the skin sensation of finger belly was restored to S2 to S3+ . Dorsum finger′s protective sensation of all cases were recovered, and the functions of finger joint were close to normal. The donor area on foot healed well. The scar was not obvious. The walking function was completely normal. Conclusions It is a good method to reconstruct proximal thumb with iliac bone combined with the same pedicled toenail and dorsum pedis flaps without sacrificing toes.

Objective To investigate the anti-hyperuricemia effects of Bixie deacidification fang on hyperuricemia mice and its mechanism of renal protein transport. Methods The effects of Bixie deacidification fang were investigated on hyperuricemia mice induced by potassium oxonate. Bixie deacidification fang was administered to hyperuricemia mice daily at doses of 220, 440 and 880 mg/kg for 10 days, and allopurinol (5mg/kg) was given as positive control. Serum and urine levels of uric acid and creatinine were determined by colorimetric method. Simultaneously, protein levels of urate transporter 1 (URAT1) and organic anion transporter 1 (OAT1) in the kidney were analyzed by Western blot. Results Compared with the model group, high-dose of Bixie deacidification fang inhibited xanthine oxidase (XOD) activities in serum (18.12±1.33 u/L) and that in liver (70.15±5.20 u/g protein) (P<0.05), decrease levels of serum uric acid (2.04 ± 0.64mg/L) (P<0.05) and serum creatinine (0.35±0.18µmol/L) and blood urea nitrogen (BUN)(8.83±0.71mmol/L) (P<0.05), ncreased levels of urine uric acid (38.34±8.23mg/L), urine creatinine (34.38±1.98mmol/L), down-regulated of URAT1 and up-regulated of OAT1 protein expressions (P<0.05) in the renal tissue of hyperuricemia mice. Conclusion Bixie deacidification fang recipe may promote the excretion of uric acid in the kidney by up-regulating the expression of OAT1 protein to promote the excretion of uric acid, and down-regulating the expression of URAT1 protein to inhibit the reabsorption of uric acid.

Objective To explore the safety and therapeutic effect of transesophageal echocardiography(TEE)-guided transthoracic minimally invasive intervention for congenital heart disease complicated with compound heart ab-normalities in children.Methods From September 2013 to January 2018,32 children with congenital heart disease complicated with compound heart abnormalities were collected,who undergoing TEE-guided transthoracic minimally invasive intervention at the Department of Cardiothoracic Surgery,Dalian Children's Hospital were collected.There were 6 cases of ventricular septal defect (VSD)combined with atrial septal defect (ASD),11 cases of VSD combined with patent ductus arteriosus (PDA),9 cases of ASD combined with PDA,3 cases of VSD combined with pulmonary stenosis (PS),and 3 cases of ASD combined with PS.TEE-guided transcatheter closure was performed within a minimally in-vasive transthoracic minimal incision (1 -2 cm)under non-cardiopulmonary bypass.The efficacy of the procedure was evaluated by TEE.The transthoracic echocardiography,chest film and cardiogram after post-procedure examina-tions were followed.Results TEE-guided transthoracic minimally invasive perventricular intervention was successfully performed in all the sick children.The mean duration of operation,intensive care unit monitoring and ventilation were (54.2 ± 21.8)min,(14.3 ± 8.7)h and (3.7 ± 2.9)h,respectively.No patient received diuretic drugs,sedation drugs,blood transfusion or conventional surgical repair. The follow - up period for all the patients lasted 12 -48 months.No arrhythmias,residual shunts or occluder detachments,or thrombosis,hemorrhage,or new valve regurgitation occurred.Conclusions TEE -guided transthoracic minimally invasive intervention is feasible and has a promising prognosis for young children with congenital heart disease combined with compound heart abnormalities.

Clinical data of 23 children with atrial septal defect and pulmonary valvular stenosis admitted in Dalian Children′s Hospital during March 2015 to March 2018 were retrospectively analyzed. Twenty patients were treated with percutaneous closure of atrial septal defect through femoral vein first, then transthoracic echocardiography-guided balloon pulmonary valvuloplasty was performed; while 3 patients had no balloon pulmonary valvuloplasty after percutaneous closure of atrial septal defect. Patients were followed up by transthoracic echocardiography and all were doing well. The transvalvular pressure fell under 35 mmHg (1 mmHg=0.133 kPa) [(19.5±1.9)mmHg] in all patients, which was significantly lower than that before treatment [(62.0±7.8 mmHg)] (t=28.92, P<0.01). During follow-up, no residual shunt of atrial septal defect was found; and mild pulmonary regurgitation occurred in 3 cases. The study indicates that combined percutaneous treatment with transthoracic echocardiography guidance is effective and safe for children with atrial septal defect and pulmonary valvular stenosis. The pulmonary artery stenosis of some patients can be alleviated, after closuring of the atrial septal defect.