The fluctuation of medical staff thoughts and hospital rapid action during SARS epidemic, we name it "hospital phenomenon during SARS", has its specific characteristics. We analyzed this phenomenon from the following points: the conflict between panic response and the duty of the profession, the contradiction between the need to control infection and the available conditions, the special following phenomenon post - diagnosis of SARS and the hospital routine activity and SARS prevention and cure. We conclude that at least three fields should be improved, that is to strength education of duty morals, to normalize the medical procedure, and to build the dual system of hospital' s routine run and rapid action, in order to constructing hospital credit ethic.

This article analyzed the ethical situation in hospitals. The author pointed out the defect of confidence between doctor and patient is the primary cause that leaded to the deterioration of doctor-patient relation, and the retardation of medical service management is the important factor that affected the confidence construction. According to all this above, the author proposed the suggestion of strengthening the understanding and communication between doctor and patient, transforming the medical service concept, enhancing the medical service quality, completing the supervising system, increasing the hospital ability of realizing medical service defect and improving the five thoughts of follow up confidence system to direct the hospital confidence ethical construction.

Objective To discuss the predictable factors for the occurrence of intraoperative aneurysm rupture(IAR) of anterior circulation aneurysm treated by clipping.Methods The clinical data of 96 patients with 115 aneurysms treated by clipping were retrospectively analyzed.The univariate analysis and Logistic regression analysis was performed for the risk factors of IAR such as history of hypertension,pre-operative Hunt-Hess scale,aneurysm location,aneurysm sac,aneurysm dome/neck ratio,aneurysm direction,and operation time.Results Twenty-one patients occurred IAR [18.3 ％ (21/115) of aneurysms,21.9％ (21/96) of patients] during the operation,2 patients died and 94 patients were estimated by Rank scale:0 score was for 66 patients,2 scores was for 10 patients,3 scores was for 6 patients,4 scores was for 4 patients,5 scores was for 6 patients and 6 scores was for 2 patients at 6 months after surgery.Statistic analysis revealed that history of hypertension (P =0.037),pre-operative Hunt-Hess scale (P =0.040),aneurysm direction (P =0.009),aneurysm sac (P =0.010),operation time (P =0.001) and aneurysm dome/neck ratio (P =0.029) were the predictable factors for the occurrence of IAR,while aneurysm location was not included (P =0.198).Conclusion The history of hypertension,pre-operative Hunt-Hess scale,aneurysm direction,aneurysm sac,operation time and aneurysm dome/neck ratio 1.78-2.89 are the predictable factors for the occurrence of IAR and the combination of various factors lead to the occurrence of IAR.

Objective To introduce the preliminary experience of using rigid neuroendoscope in repair of spinal meningocele or myelomeningocele. Methods 3 infantile patients aging between 13 months and 22 months underwent the resection and repair of spinal meningocele or myelomeningocele in May, 2013. The operations were performed under the direct visualization of the rigid neuroendoscope in the aid of the intraoperative electrophysiological monitoring. All the surgical manipulations were accomplished outside the sheath of the endoscope. Results The surgical procedures were smooth. All the patients recovered satisfactorily. There was no postoperative complication. At the one-year follow-up, they were developing normally. Conclusions The rigid neuroendoscope is useful to the resection and repair of spinal meningocele and myelomeningocele. It could simplify the surgical procedures.

Objective The aim of this work is to compare the performances of EDR2 film dosimetry with two-dimensional ion chamber array (2DICA) in quality assurance (QA) procedures and to investigate the origin of possible discrepancies between the two methods.Methods A 2DICA, I′mRT MatriXX and MULTICube equivalent solid water phantom from IBA Company were used to verify the dose distribution of 15 tomotherapy plan cases.The combined phantom which includes EDR2 film on the array was set up to measure the dose distribution from coronal and sagittal orientations.After the irradiation, the dose distributions of 2DICA and film were compared with those calculated in the planning system for verification.The results and efficiency were evaluated independently in the two methods.Results The mean number of points satifying γ parameter ≤1 in the coronal and sagittal planes was 97.00%±1.56%& 95.98%±2.52%(t=-2.22,P=0.043) and 98.28%±1.55%& 95.42%±1.99%(t=0.75,P=0.464) of the 15 cases respectively for 2DICA and EDR2 film.The ratio of more than 90% and 95% were 93.3% and 66.7%.The results we presented show a very good agreement between the two methods when used to assess the dose distribution between calculated and measured doses,and a certain degree of correlation (r=0.14,P=0.001).Conclusions The 2DICA may effectively replace both film and ion chamber dosimetry in routine IMRT QA.The good agreement between 2DICA and EDR2 film may give a possible check regularly just as a gold standard.

Objective To reduce immunogenicity of porcine skin by removingα-Gal epitopes expressed in cell surface and extracellular matrix using recombinant α-galactosidase produced by Bacteroides fragilis.Methods The porcine skin was harvested from healthy 2-month-old pigs without any skin disorders before being sterilized by iodine and 75%alcohol, respectively.Enzymatic removal of α-Gal antigen was followed by washing with PBS.The α-Gal antigen in the prepared porcine skin was measured with immunofluorostaining of cryosections and the residual enzyme was measured with a double-antibody sandwich ELISA method.Enzymatic removal procedures were optimized by detecting residual enzyme and the effi-cacy ofα-Gal removal under different enzymatic and washing conditions.Results Efficient enzymatic and washing methods were established to removeα-Gal antigen.Theα-Gal removal efficacy was above 90% and residual enzyme was undetect-able (αprescribed minimum ofα-galactosidase detection with indirect ELISA was 1 ng/ml) .Conclusion It is feasible to efficiently removeα-Gal antigen under these enzymatic and washing conditions, and a method of producing low-immunoge-nicity pig skin dressing for burn is established.

Objective To establish a method of quantiying trace α-galactosidase from Bacteroides fragilis in enzymatic conversion of blood group B to O red blood cells ( B-ECO RBCs) .Methods BALB/c mice were immunized with purified recombinant B.fragilisα-galactosidase ( the purity>90%) to prepare monoclonal antibodies.The ascites were prepared using hybridoma cell lines stably secreting antibody and purified by HiTrap rProtein A column.The antibody titer and spe-cificity were detected by ELISA and Western blotting, respectively.Purified monoclonal antibody and rabbit polyclonal an-tibody were applied to detect residual enzyme in B-ECO RBCs and the washing solution was analyzed by indirect ELISA. Results A high titer and purity antibody was obtained.Western blotting showed that the antibody specifically reacted with B.fragilisα-galactosidase.Moreover, indirect ELISA was sensitive enough to detect the minimal amount of residualα-gal-actosidase at the concentration of 1 ng/ml.After four repeat washing cycles with 1∶4 ( v/v) phosphate-buffered saline, the amount of residual enzyme in B-ECO RBCs was less than 10 ng/ml.Conclusion An effective method of detecting the min-imal amount of residual α-galactosidase in blood conversion is established for safety evaluation of universal RBCs prepara-tion by enzymatic treatment.

To investigate the patient-specific dose verification method using ArcCHECK for total marrow irradiation (TMI) with Volumetric Modulated Arc Therapy (VMAT) and Helical Tomotherapy (HT). The kVCT images collected from 8 patients were respectively designed for RapidArc and Tomotherapy plans in total marrow irradiation. ArcCHECK was used for dose verification for the head-neck, chest-abdomen and pelvic. The merging function of ArcCHECK was used in VMAT and the method of double plans (reference and delivery plans) were used in HT. The γ-analysis passing rates for the head-neck, chest-abdomen, pelvic were 98.9% ± 1.9%, 98.4% ± 1.8%, 97.4% ± 2.1% for VMAT plans and 94.3% ± 1.5%, 96.5 ± 1.2%, 94.1% ± 1.9% for HT plans. The results show that using the merging function of ArcCHECK can achieve the dose verification well for VMAT plans with TMI. The method of double plans was done for the dose verification of HT plans with TMI as well as the plans with the targets keeping away from the set-up center.
Bone Marrow ; radiation effects ; Humans ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

Objective: Quality assurance (QA) of intensity modulated radiotherapy (IMRT) dosimetry is a laborious task. The goal of this work is to evaluate the dosimetric characteristics of a new 2D diode array and assess the role it can play in routine MRT QA. Methods: A diode array, MapCHECK~(TM) and MapPHAN phantom from Sun Nuclear corporation (USC) were used for verifying the dose distribution of 10 tomotherapy IMRT plan cases. The combined phantom was set up to measure the dose distribution from coronal and sagittal orientations. After MVCT registration, the measured dose distributions of the coronal and sagittal planes were compared with those from calculation in the planning system. The results were evaluated by the absolute doses. The feasibility of the different measuring methods were studied. Results: The dose distribution measured by the MapCHECK~(TM) 2D array was well consistent with that calculated by tomotherapy planning system. In the comparison of the MapCHECK~(TM) measured versus planning system calculated using the 3mm/3% and 4mm/4% γ criteria, the number of detectors with γ parameter ≤ 1 was 96.8%/99.38% and 96.99%/99.49% average of the 10 cases respectively, for coronal and sagittal orientations. The acceptance criteria which is the combined 3mm/3% analysis would be introduced. And the number of points required to pass was generally 90%. Conclusions: MapCHECK~(TM) with MapPHAN phantom has been successfully tested for HT dose verification, and offers users an accurate and convenient rotational dosimetry solution.

Objective To compare the dosimetric characteristics of helical tomotherapy(HT)and step-and-shoot intensity modulated radiotherapy(IMRT)for post-operative cervix cancer patients. Methods Ten patients with post-operative cervix cancer were enrolled in this study.HT and IMRT plans were developed for each patient.The dose distributions of the targets,organs at risk(OARs),CI and HI were analyzed and compared.The prescribed dose was 60 Gy/25 f for CTV1,50 Gy/25 f for CTV2.The iso-dose line of 50 Gy was used.Results The homogeneity indexes(HI)(0.94±0.03),conformity index(C1)(1.28±0.02)in HT group were better than in IMRT group(0.85±0.01 and 1.36±0.03),respectively(t=5.12,-6.34,P<0.001).The Dmean of PTV in HT group(51.77 Gy)was lower than that in IMRT group(54.53 Gy)(t=-8.01,P<0.05).The Dmax ,Dmean,V30,V40 and V50 of bladder、rectum and small bowel were lower in HT group than those in IM RT group.The Dmax,Dmean,V30 and V40 of right and left femoral head were lower in HT group than those in IMRT group.Conclusion Helical tomotherapy treatment plan has a better homogeneity,steeper dose gradient,and a better protection for organs at risk.