Objective To investigate the effect and underlying mechanism of radioactive 125I seed implantation on the angiogenesis of transplanted human lung adenocarcinoma in nude mice.Methods An animal model of transplantd human lung adenocarcinoma was established by subcutaneous implanting A549 cells into nude mice.Twenty four tumor-bearing nude mice were randomly divided into 4 groups with different irradiation doses of blank control (without any treatment) and 0 MBq,22.2 MBq,29.6 MBq and by embedding radioactive 125I seeds with an 18 G implant needle.Tumor volumes were measured every 4 days until all mice were terminated 30 d later and the tumor growth curve was drawn.The microvessel density (MVD) in the tumor tissue was detected by immunohistochemistry S-P assay.The mRNA and protein levels of VEGF and HIF-1α of each group were detected by RT-PCR and Western blot,respectively.Results After embedding of 125I seeds,the tumor volumes of 22.2 MBq group (886 ± 97) and 29.6 MBq group (590 ± 107) were significantly smaller than those of control group (2 297 ± 149) at 54 d after administration (q =14.117,17.075,P ＜ 0.05),but there were no significant differences among 0 MBq group and control group,22.2 MBq and 29.6 MBq groups (P ＞ 0.05).The immunohistochemical CD34-positive staining demonstrated that MVD in 22.2 MBq group (522 ± 119) and 29.6 MBq group (491 ± 121) were decreased significantly compared with control group (922 ± 260) (q =4.826,5.197,P ＜0.05),but there were no significant differences among 0 MBq and control groups,22.2 MBq and 29.6 MBq groups(P ＞0.05).The mRNA expressions of VEGF and HIF-1α in 22.2 MBq group (0.279±0.0659,0.370 ±0.0857) and 29.6 MBq group (0.215 ±0.0620,0.278 ±0.0651) were significantly lower than those in the control group (q VEGFmRNA =18.881,17.211,q HIF-1αmRNA =15.376,14.733,P ＜0.05),but there were no significant differences among 0 MBq and control groups,22.2 MBq and 29.6 MBq groups(P ＞0.05).At the same time,the expression levels of VEGF and HIF-1α protein after 125I seed implantation were also obviously decreased in 22.2 MBq and 29.6 MBq groups (qvEGr =5.848,6.263,q HIF-1α =6.560,7.576,P ＜ 0.05),and no significant difference between 0 MBq and control groups(P ＞ 0.05) and between 22.2 MBq and 29.6 MBq groups (P ＞ 0.05).Conclusions Interstitial implantation with 125I seeds may potently inhibit angiogenesis in human lung adenocarcinoma xenografts of nude mice.

Objective To explore the clinical outcome of HLA haploidentical vs HLA-matcbed peripheral blood hematopoietic stem cell transplantation (PBSCT) without in vitro T-cell depletion for malignant hematological diseases. Methods 111 patients with malignant hematological diseases underwent PBSCT without in vitro T-cell depletion between May 2004 and February 2009, including 51 patients with HLA-haploidentical and 60 patients with HLA-matched. All patients have received myeloablative conditioning regimen. A two-agent based graft-versus-host disease (GVHD) prophylaxis was used as cyclosporine A and a short course of methotrexate. Mycophenolate mofetile was added for the patients with one locus mismatch. Mycophenolate mofetile, antithymocyte globulin and CD25 monoclonal antibody were added for the patients with 2-3 loci mismatch. The grafts were granulocyte colony-stimulating factor-mobilized peripheral blood stem cells without in vitro T-cell depletion. Results 111 patients achieved sustained and full donor-type engraftment. The median time to reach an absolute neutrophil count above 0.5×10~9/L was 14 days and that to a platelet count exceeding 20×10~9/L was 15 days in 51 HLA-haploidentical patients, and that was 12 days and 13 days in 60 HLA-matched patients, respectively. In 51 HLA-haploidentical patients, 25 patients developed aGVHD, including 20 cases of grade Ⅰ aGVHD, and 5 cases of grade Ⅱ. Thirty-three patients developed cGVHD with limited in 30 and extensive in 3. The 4-year cumulative incidence of cGVHD was 70.4 %. The 3-year probabilities of leukemia-free survival (LFS) were 74.5% (77.3 % for standard risk patients and 68.2 % for high risk patients respectively). Seven patients had recurrence. In 60 HLA-matched patients, 14 patients developed aGVHD, including 10 cases of grade Ⅰ, 2 cases of grade Ⅱ and 2 cases of grade Ⅲ. Thirty-seven patients developed cGVHD with limited in 32 and extensive in 5. The 4-year cumulative incidence of cGVHD was 58.1%. The 3-year probabilities of LFS were 72.1% (77.6 % for standard risk patients and 52.7 % for high risk patients respectively). Ten patients had recurrence. The incidence of aGVHD in HLA-haploidentical cohort was significantly higher than in HLA-matched cohort (P<0.05). There was no significant difference in incidence of cGVHD, incidence of relapse and LFS between HLA-haploidentical and HLA-matched cohorts (P>0.05). Conclusion Haploidentical PBSCT is feasible and safe for malignant hematological diseases to use myeloablative conditioning regimen in combination with intensive immunosuppressants without in vitro T cell depletion.

Objective To analyze the sites of CT scan and radiation dose to children, and to compare the dose difference between children and others aged above 14 years with the dose-monitoring software in a single scan. Methods A total of 125147 cases undergoing CT scans were selected from Jan 1 to Dec 31, 2016, including 542 in children group and 124605 in patients group aged above 14 years. Based on the self-designed CT dose of real-time detection and management software, the scan sites and the composition of the scanning dose were recorded and compared between children and patients aged above 14 years in a single scan. Results Head (39. 67%) and extremities (36. 90%) were the primary CT scan sites in children. Abdominal (20. 77%) and limbs (48. 87%) constituted the main part of effective dose to children. In children group, the average single DLP gradually increased with age ( Z =21. 42, P <0. 05). The mean DLP was (567. 38 ± 433. 03) mGy·cm and average effective dose (5. 58 ± 5. 45) mSv in children group, significantly lower than that in patients aged above[14 years (737. 75 ± 172. 40) mGy· cm and (11. 07 ± 2. 59) mSv, Z= -3. 74,-4. 12, P<0. 05]. DLPs in patients aged above 14 years were higher than or equal to those in children group, with a few exceptions of neck and limbs with higher values(Z= -2. 04、 -3. 97, P<0. 05). Effective doses in children were higher than or equal to those in the group aged above 14 years(Z= -3. 03, -3. 11, -4. 12,P<0. 05), with an exception of chest with higher value. Conclusions Although the parameters of CT scan and dose control were optimized to some extent in children, radiation protection on children still needs to be paid attention for due to the radiosensitivity of children. CT scanning on children should be more careful.

Objective:To compare the application effects of totally implantable access port (TIAP) and peripherally inserted central catheter (PICC) in adult patients with hematological tumor undergoing chemotherapy.Methods:PubMed, Embase, Cochrane Library, CNKI, Wanfang Database and VIP database were searched by computer for all randomized controlled trials of TIAP and PICC in patients receiving chemotherapy for hematological tumors, and the search time was from the establishment of the databases to March 1, 2021. Statistical software STATA 15.0 was used for Meta-analysis. The success rate of one-time catheterization, the incidence of unplanned extubation, the maintenance time of the tubes, incidence of complications and quality of life scores were compared between the two groups.Results:A total of 11 studies were included, including adult patients with hematological tumor undergoing chemotherapy (371 in the TIAP group and 383 in the PICC group) . The success rate of one-time catheterization ( RR=1.11, 95% CI 1.03-1.20) , the incidence of unplanned extubation ( RR=0.37, 95% CI 0.16-0.88) , pipeline maintenance time ( WMD=-3.89, 95% CI -4.95--2.83) , complication rate ( RR=0.25, 95% CI 0.16-0.40) , quality of life score ( WMD=4.82, 95% CI 2.14-7.50) of the TIAP group were better than those of the PICC group, and the differences were statistically significant ( P<0.05) . Conclusions:TIAP catheterization success rate, pipeline maintenance time, complication rate, and quality of life all show advantages, but due to the small sample size of some indicators, further research is needed.

bjective? To explore the proportion between peripherally inserted central catheter (PICC) vein and catheter on hemorrhage and plugging among hematologic tumor patients. Methods? From February 2016 to February 2018, we selected 105 patients of department of hematology in Wuxi Second People's Hospital of Nanjing Medical University as subjects. Before PICC, vein diameter was measured with the portable color doppler ultrasound system to obtain the proportion between catheterization vein and catheter diameter. Among 105 PICC catheterization cases of hematologic tumor patients, proportions between catheterization vein and catheter diameter were divided into three groups including ＜2,2 to 3,＞3,35 cases in each group. We observed the incidences of hemorrhage and plugging at different proportions of catheterization. Results? There was no statistical difference in the amount of bleeding of hematologic tumor patients among three groups after catheter (P＞0.05). There was a statistical difference in the incidence of plugging (P＜0.05). Conclusions? The incidence of hemorrhage and plugging of hematologic tumor patients after PICC cannot be ignored. The proportion between catheterization vein and catheter diameter has no obvious effect on hemorrhage after catheter, but it can affect the incidence of catheter plugging. Therefore, we should apply visual assessment instrument to exactly measure the internal diameter of vein and select appropriate catheter to reduce the complications after catheterization.

Objective:To optimize the scheme and process of chest CT scanning and control the dose level to the examined individuals by establishing the diagnostic reference level (DRL) and warning dose value from chest CT examinations in our hospital.Methods:The medical records for 205 511 examined individuals, who had undergone chest CT scans in the Second Affiliated Hospital of Zhejiang University Medical College from January 1, 2018 to December 31, 2019, were reviewed consecutively. For the two-year examination periods, these examined individuals were divided into two groups, one for 2018 totalling 90 507 and another for 2019 with a total of 115 004. The mean value of doses from chest CT scans in 2018 was set as the DRL for the hospital, with the 75th and 25th percentiles as the upper and lower limits of diagnostic reference range (DRR) and the 97.5th percentiles as the warning dose values. The doses above the upper limit of DRR were considered to be relatively-high whearas the ones exceeding the warning dose value to be over-high. Based on the analysis of the over high dose in 2018, the scanning scheme and inspection process of the chest CT scans were improved in 2019. The number of examinations were estimated for the 2018 period for chest plain CT scans, chest enhancement CT scans, lung cancer screening low-dose CT scans, and relatively-high and over-high dose CT scans, as well as the single scanning doses to the examined in the two groups. The number of examinations resulting in high dose to the examined due to different reasons before and after the improvement were studied. The various parameters on the examined in the two groups were compared statistically.Results:After the improvement, the average dose from chest plain CT scans decreased by 8.67 %, with the statistically significant difference as compared with before improvement ( t=55.71, P<0.05). The average dose from low-dose chest CT scans fell by 20.13% with statistically significant difference ( t=81.99, P<0.05). The fraction of the examinations with slightly-high doses arising from chest plain CT scans and low dose chest CT scans dropped by 3.66% and 17.15%, respectively. The fraction of the examinations with slightly-high dose from chest enhanced CT increased by 1.7%. The fraction of the examinations with over-high dose from chest plain CT scans, enhanced CT scans and low-dose CT scans decreased by 0.55%, 1.06% and 1.74%, respectively. After improvement, the optimized fraction of the examinations with over-high dose, dropped by 4.72%, 31.49% and 19.18% respectively. Conclusions:The establishment of the DRL and the warming dose value of for chest CT examinations in our hospital is helpful to find out the cause of high dose scanning, promote the optimization of dose, reduce the average dose to the examinedes, and avoid using excessive dose during scanning.

Objective:To explore the application effect of defect scenario simulation combined with joint review action in the training of blood-borne occupational exposure of nursing assistants.Methods:From February 1, 2020 to February 1, 2021, a total of 97 nursing assistants from Central District of Provincial Hospital Affiliated to Shandong First Medical University, were selected as the experimental group and 89 nursing assistants from the Eastern District were selected as the control group. The control group received routine training, while the observation group received defect scenario simulation combined with action training. After 1 year of training, the incidence of blood-borne occupational exposure and blood-borne occupational exposure knowledge scores of nursing assistants in the two groups were compared.Results:During the intervention period, 1 nursing assistant in the experimental group resigned, 2 nursing assistants asked for leave twice or more, and 94 nursing assistants were finally enrolled. In the control group, 2 nursing assistants resigned and 3 nursing assistants asked for leave twice or more, and 84 nursing assistants were eventually enrolled. The incidence of blood-borne occupational exposure of nursing assistants in the experimental group was lower than that in the control group and the score of blood-borne occupational exposure knowledge was higher than that in the control group, and the differences were all statistically significant ( P<0.05) . Conclusions:Defect scenario simulation combined with joint review action has a good effect in blood-borne occupational exposure training of nursing assistants, which can reduce the incidence of blood-borne occupational exposure and improve their blood-borne occupational exposure knowledge scores. It is worthy of clinical promotion.

Objective: To investigate the effects and mechanism of Holothurian Glycosaminoglycan (hGAG) alone in combination with cisplatin (DDP) on apoptosis of pulmonary adenocarcinoma cell A549. Methods: A549 cells were separately treated with blank, hGAG, DDP and hGAG combined with DDP (hGAG + DDP). The cell morphology in 4 groups was observed using light microscope. CCK8 assay was used to determine the cell viability. Flow cytometry by Hoechst 33258 and AnnexinV-FITC/PI staining was applied to detect cell apoptosis. Western blot was then used to detect the protein expression of Bax, Bcl-2, survivin and caspase-3. Results: After treatment for 24 h, the inhibitory rates of A549 cells in control, hGAG, DDP and hGAG + DDP groups were 0, (19.74±5.39)%, (42.01±2.57)% and (53.89±4.58)%, respectively. Moreover, after treatment for 48 h and 72 h, the inhibitory rates in each group were 0, (23.17±4.78)% and (29.17±4.21 )%, (54.00±7.64)% and (59.35±7.31)%, as well as (77.58±4.26)% and (79.94±4.58)%, respectively. The cell viability was significantly lower in drug treatment groups compared with those in control group at the same time point (P<0.05). Hochest 33258 staining showed that no obvious apoptotic cells were detected in the control group, while apoptotic cells were visible in hGAG, cisplatin and combination groups. Flow cytometry showed that cell apoptotic rates were (2.38±0.59)%, (12.59±4.22)%, (16.36±3.63)% and (44.60±5.45)% in the control, hGAG, DDP and hGAG + DDP groups, respectively. The cell apoptosis was significantly lower in drug treatment groups compared with those in control group at the same time point (P<0.05). Furthermore, western blot results showed that the expression of Bax and caspase-3 protein was increased (P<0.05), whereas Bcl-2 and survivin was decreased (P<0.05) in the hGAG+ DDP group compared with cisplatin alone (P<0.05). Conclusions HGAG can inhibit the proliferation and promote the apoptosis of human lung adenocarcinoma A549 cells. Meanwhile, it can strengthen the chemosensitivity of A549 cells to DDP via up-regulation of Bax, caspase-3 and down-regulation of Bcl-2 and survivin.

Objective: To investigate the efficacy and safety of IA regimen which contains idarubicin (IDA) 8 mg/m², 10 mg/m² or 12 mg/m² as induction chemotherapy for adult patients with de-novo acute myeloid leukemia (AML) . Methods: A total of 1 215 newly diagnosed adult AML patients, ranging from May 2011 to March 2015 in the First Affiliated Hospital of Soochow University and other 36 clinical blood centers in China were enrolled in the multicenter, single-blind, non-randomized, clinical controlled study. To compare the response rate of complete remission (CR) , adverse events between different dose idarubicin combined with cytarabine (100 mg/m²) as induction chemotherapy in newly diagnosed patients of adult AML. Results: Of 1 207 evaluable AML patients were assigned to this analysis of CR rate. The CR rates of IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 73.6% (215/292) , 84.1% (662/787) and 86.7% (111/128) , respectively (P<0.001) . After adjusted for age, blast ratio of bone marrow, FAB classification and risk stratification, the odds ratios (95% CI) of IDA 10 mg/m² group and IDA 12 mg/m² group were 0.49 (0.34-0.70) and 0.36 (0.18-0.71) , as compared with the IDA 8 mg/m² group (P<0.001, P=0.003) . In the intermediate and favorable groups, CR rates was 76.5% (163/213) , 86.9% (506/582) and 86.1% (68/79) in different doses of IDA (P=0.007) . Interestingly, IA regimen with IDA 10 mg/m² was the only beneficial factor affecting CR in this group after adjusted for age, blast ratio of bone marrow and FAB classification[OR=0.47 (95% CI 0.31-0.71) , P<0.001]. CR rates in adverse group was 50.0% (18/36) , 60.6% (43/71) and 81.8% (18/22) respectively (P=0.089) . However, the odds ratios (95% CI) of IDA 12 mg/m² when compared with the IDA 8 mg/m² was 0.22 (0.06-0.80) , after adjusted for age, blast ratio of bone marrow and FAB classification. The median time (days) of neutrophil count less than 0.5×10⁹/L in IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 14 (11-18) , 15 (11-20) and 18 (14-22) , respectively (P=0.012) and of platelet count lower than 20×10⁹/L were 14 (7-17) , 15 (11-20) and 17 (15-21) , respectively (P=0.001) . The incidences of lung infection in the three groups were 9.8%, 13.5% and 25.2%, respectively (P<0.001) . Conclusions For young adult patients (aged 18-60 years) with AML in China, intensifying induction therapy with idarubicin 10 mg/m² is clinically superior to IDA 8 mg/m² and IDA 12 mg/m² in favorable intermediate AML subgroup. However, idarubicin 12 mg/m² is more suitable to adverse AML subgroup.