Objective To investigate the efficacy and safety of tiotropium bromide aerosol combined with salmeterol in the treatment of ACOS. Methods 76 patients with ACOS were enrolled in this study from October 2014 to November 2016. They were divided into experimental group and control group according to the random number table method. The test group was given tiotropium bromide combined with salmeterol Casson aerosol treatment, the control group was given salmeterol tacrolone aerosol treatment, compared the two groups of patients with clinical efficacy and adverse reactions. Results The total effective rate was 92.11% in the experimental group and 73.68% in the control group, the difference was statistically significant (Z = 4.547, P<0.05). The ACT score of the test group was higher than that of the control group, the CAT score was lower than that of the control group, the difference was statistically significant (P<0.05); The incidence of adverse reactions in the test group was 10.53%, the incidence of adverse reactions in the control group was 13.16%,the difference was not statistically significant (χ2 = 0.126). Conclusion Tiotropium powder combined with salmeterol tegon aerosol in the treatment of bronchial asthma-chronic obstructive pulmonary syndrome is reliable and worthy of clinical practice.

Objective: Design of intelligent safety control system in hospital, in order to effectively safeguard patient’s items or the safety of personnel, improve the management level of hospital. Methods: By RFID (radio-frequency identification), System to realize the real-time monitoring of the patient position and tracking through electronic tag worn by the patient and hospital to install signal receiving device, and monitoring violations by informatization and promptly report to the police. Results: The design of the system in the interests of the parties, prevent the happening of the accident in patients with use of mature information technology. Conclusion: The design of intelligent safety control system in hospital enhances the administrative level of informatization of hospital, the design of the software system has promotion value.

Objective To investigate the change of dendritic cells (DCs) in rats with hepatic carcinoma treated by radiofrequency ablation (RFA),and to explore the mechanisms of anti-tumor immune response to RFA. Methods Forty healthy SD rats with established animal model of hepatic carcinoma were randomly divided into control group (n = 10) ,RFA 7 d group (n = 16) and RFA 14 d group (n = 14). The rats of control group were killed without treatment. The other rats were killed in 7 d and 14 d after RFA treatment respectively. Peripheral blood, liver tissue around the ablation area and spleen were taken out. The OX62,OX6,CD86 of DCs were analyzed with flowcytometry. Results ①OX62 cells accounted for (0.45 ± 0.19)% of mononuelear cells in peripheral blood in control group. The account of OX62 cells increased to (0.78 ± 0.30)% and (1.53 % 0.80)% in RFA 7 d and 14 d groups respectively. There were significant differences between control and RFA 7 d group, control and RFA 14 d group (P<0.05). ②OX62 cells accounted for (18.91 ± 4.58)% of mononuclear cells in liver tissue around the tumor in control group. The account of OX62 cells increased to (24.49 ± 4.59)% in RFA 7 d group (P<0.05). The expression of OX6 on DCs in liver tissue was (15.29 ± 4.59)% and increased to (34.2 ± 11.62)% and (39.18 ± 9.14)% in RFA 7 d and RFA 14 d group respectively (P<0.05). ③OX62 cells accounted for (11.69 ± 4.39)% of mononuclear cells in spleen in control group which increased to (15.10±2.37)% in RFA 14 d group (P<0.05). Conclusions The precursor DCs in peripheral blood and DCs in liver and spleen increased significantly after RFA. The expressions of OX6 on DCs in liver and spleen increased after RFA. RFA can promote the differentiation and maturation of DC. The increased function of antigen presenting may contribute to the anti-tumor responses after RFA.

Objective To investigate the changes of chemokines related to dendritic cells in liver and spleen in rats with hepatic carcinoma treated by radiofrequency ablation (RFA),and to explore the mechanism of anti-tumor responses to RFA.Methods Forty healthy SD rats with established animal model of hepatic carcinoma were randomly divided into control group (n=10),RFA 7d group (n=16) and RFA 14d group (n=14).The rats of control group were killed without treatment.The other rats were killed in 7d and 14d after RFA treatment respectively.Spleen and liver tissue around the ablation area or around the tumor were taken out.The expressions of macrophage inflammatory protein (MIP)-1a in liver tissue and MIP-3β in spleen were analyzed by ELISA.Results The expression of MIP-1a in liver tissue was (232.92±54.5B)ng/L in control group,which enhanced to (499.38±15.14)ng/L and (495.90±9.94)ng/L in RFA 7d and 14d groups respectively.There were significant differences between control and RFA 7d group,control and RFA 14d group(P＜0.05).The expression of MIP-3βin spleen was (70.08±2.67) ng/L in control group,which enhanced to (151.57±48.48)ng/L and (154.57±18.25)ng/L in RFA 7 d and 14 d groups respectively.There were significant differences between control and RFA 7 d group,control and RFA 14 d group (P＜0.05).Conclusions The expressions of MIP-1a in liver tissue and MIP-3β in spleen increase significantly after RFA.These changes will promote recruitment and migration of dendritic cells and may contribute to the anti-tumor responses after RFA.

Objective To investigate the value of protective transverse colostomy in decreasing postoperative anastomotic leakage and stricture after laparoscopic resection for rectal cancer.Methods The clinical data of 128 patients with rectal cancer who were admitted to the Jinhua Hospital of Zhejiang University from March 2008 to February 2012 were retrospectively analyzed.All the patients received laparoscopic anterior resection of rectal cancer after neoadjuvant chemoradiotherapy.Sixty-one patients received protective transverse colostomy (colostomy group) and 67 patients did not receive protective transverse colostomy (non-colostomy group).The incidences of postoperative anastomotic leakage and stricture,condition of the patients and the prognosis of the patients in the 2 groups were compared.Patients were followed up via out-patient examination,in-patient chemotherapy or phone call till May 2013.All data were analyzed using the t test,chi-square test or Fisher exact probability.Results The overall incidence of postoperative anastomotic leakage was 7.03％ (9/128).The incidences of postoperative anastomotic leakage in the colostomy group and non-colostomy group were 6.56％ (4/61) and 7.46％ (5/67),with no significant difference between the 2 groups (x2 =0.000,P ＞ 0.05).The systemic condition of 4 patients who were complicated with anastomotic leakage in the colostomy group was comparatively better,and all of them were cured by conservative treatment.The condition of 5 patients who were complicated with anastomotic leakage in the non-colostomy group was severe,and 4 of them received reoperation,with the reoperation rate of 4/5 ; the other patient received conservative treatment.There was significant difference in the reoperation rate between the 2 groups (P ＜0.05).The overall incidence of postoperative anastomotic stricture was 13.28％ (17/128).The incidences of postoperative anastomotic stricture in the colostomy group and the non-colostomy group were 19.67％ (12/61) and 7.46％ (5/67),with significant difference between the 2 groups (x2=4.133,P ＜ 0.05).The incidences of severe anastomotic stricture of the colostomy group and the non-colostomy group were 8.20 (5/61) and 0,respectively.Conclusion Protective transverse colostomy could not reduce the incidence of postoperative anastomotic leakage,but could mitigate the symptoms followed anastomotic leakage and reduce the reoperation rate.Protective transverse colostomy may improve the incidence of anastomotic stricture,therefore it should be applied cautiously.

Objective To verify the dose delivery accuracy of volumetric-modulated arc therapy plan by log-file analysis of linear accelerator that can be created when a dynamic delivery occurs.Methods Accelerator log file in binary format recorded the accelerator execution plan for each control point corresponding to the gantry angle,multi-leaf collimator leave position,cumulative machine monitor units ( MU).These information were read from the accelerator log file with Matlab7.1,then the original control points in the plan file replaced the corresponding information for the log,which generated a new plan.New plan was exported into the planning system to reculculate the dose.The volume dose histogram (DVH) and dose distribution was contrasted to determine the accuracy of the accelerator plan of implementation between two plans.Results Compared with the original plan,antry angle difference over ± 1° accounted for about 35％ of the entire arc of control points in 4 of 12 arcs and the percentage of the leave error of ±0.5 mm was about 95％.MU error of a single control point was larger,but the cumulative MU for each are was small which was located between-0.09％ to 0.11％ in the selected 12 arcs.Between the targets,the maximum dose,minimum dose,the mean dose differences were from-0.07％ to 0.42％,-0.38％ to 0.40％,0.03％ to 0.08％,respectively.The maximum dose and mean dose differences of organs at risks were located from-1.16％ to 2.51％,-1.21％ to 3.12％,respectively.Conclusions Accelerator log-file analysis to verify the VMAT plan nan be supplyed to the experimental method supplement.

Objective To discuss the utility of lean management in the informationalization of health check-up.Methods A total of 2125 matched adults who received health check-up from April to July 2008 (n =1001) or 2012 (n =1124) were enrolled by using random sampling.Time of health check-up registration and laboratory sheet filling,preparation of final report,consumption of labor force,and integrity of data collection were compared before and after the conduction of lean management.Results Since lean management startup,time of registration was decreased from (250.0 ± 7.7) to (7.8 ± 0.9) min/100persons,time of sheet filling was reduced from (137.0 ± 10.6) to (26.0 ± 2.9) min/100 persons,preparation of final report was less time-consuming ((702.0 ± 11.7) vs.(300.0 ± 12.6) min/100persons).The integrity and accuracy of health check-up reports were significantly improved (67.0％ vs.99.2％).Newer health check-up receivers were increased from 17.8％ to 29.4％ (x2 =461.944,P ＜0.05).Conclusion Lean management may be feasible and effective in the informationalization of health check-up.

Objective To discuss the change of serum TGF-β1 and IL-10 in peripheral blood of rats with liver tumor treated by RFA.Methods Thirty experimental liver tumor model of SD rats were prepared by implantation of tumor particles.These rats were randomly divided equally into three groups including 1 week after RFA,2 week after RFA and control group.Peripheral blood of control group,group 1 week after RFA and group 2 week after RFA was taken out respectively without RFA,1 week and 2 week after RFA.The mononuclear cells of peripheral blood were separated by Ficoll density gradient centrifugation.The expression level of IL-10 in peripheral blood was analyzed with flowcytometry.Serum TGF-β1 were dectected by ELISA.Results The serum expression level of TGF-β1 of control group was(6.61±0.12)μg/L,and that of group 1 week and 2 week after RFA were respectively(5.63±0.46)μg/L and(5.53±0.56)μg/L.There was statistical significance for the difference between control group and group 1 week or group 2 week after RFA.The serum expression level of IL-10 of control gorup was 95.92±2.31,and that of group 1 week and 2 week after RFA were respectively 89.71±5.44 and 87.67±11.11.There was statistical significance for the difference between control group and group 1 week after RFA.Conclusions RFA can destroy the tumor tissues in situ and relief immune suppression by IL-10,TGF-β1 secreted by tumor tissue.RFA can improve differentiation and maturation of dendritic cell in local area of tumor and promate ability of antigen-presentation of body.

Objective To study changes in the expression levels of OX-62, OX-6 and CD86 of mononuclear cells and the related chemotatic factor macrophage inflammatory protein-1α (MIP-1α) in the livers of rats with Walker-256 tumors treated with radiofrequency ablation (RFA) and to elucidate the influence of RFA on differentiation and migration of liver dendritic cells(DCs).Methods Walker-256 liver tumors were induced in 60 SpragueDawley rats by implanting tumor particles. These rats were randomly divided equally into three groups from which liver tissue around the local area of the tumor was sampled at 7 d and 14 d after RFA. The mononuclear liver cells were separated with Ficoll density gradient centrifugation. The expression levels of OX-62, OX-6 and CD86 in the mononuclear cells were analyzed with flow cytometry. The expression level of MIP-1α in the liver tissue was detected by enzyme-linked immunosorbent assay (ELISA). Results The average expression of OX-6 in the control rats was 15.29 ±4.59% and those 7 d and 14 d after RFA were 34.20±11.62% and 39.18±9.14% respectively. The difference between the two RFA groups and the control group was statistically significant. The average expression rate of OX-62 in the control rats was 18.91±4.58% and those 7 d and 14 d after RFA were 24.49±4.45% and 22.77 ± 3.50% respectively. The difference between the 7 d group and the control group was significant. The average expression rate of CD86 in the control rats was 66.29±17.69% and those 7 d and 14 d after RFA were 55.29±10.69% and 55.93±12.64% respectively. These differences between both RFA groups and the controls group were not significant. The average expression level of MIP-1 α around the tumors was 232.92±54.58 pg/ml in the controls and 499.38±15.14 pg/ml and 495.90±9.94 pg/ml 7d and 14 d after RFA respectively. These differences from the controls were both statistically significant. Conclusion The expression of MIP-1α around the tumors was elevated after RFA, which could promote the migration of DCs. The changes in the expression of OX-62, OX-6 and CD86 also could reflect increased DC differentiation, which could improve local antigen-presenting capacity to a certain extent and recovery of host anti-tumor immune response.

Objective To use clustering analysis to help physicians detect abnormal parameters in radiotherapy treatment plans and improve the efficiency of plan verification. Methods From 2010 to 2015, 835 breast cancer treatment plans for using 4?field hybrid intensity?modulated radiotherapy from MOSAIQ were collectted. Fractional dose, beam angle, and monitor unit were used as featured parameters of a treatment plan to generate a dataset. The K?means clustering algorithm based on principal component analysis was used to perform a clustering analysis of the dataset and divide the dataset into different clusters. The outliers of clusters were automatically detected based on the distance threshold. The outlier?contained treatment plans were manually verified by physicians to determine the accuracy of clustering analysis in detection of abnormal plans. Results In the clustering analysis, the sample space composed by parameters of treatment plans for breast cancer was divided into 4 clusters, 3 of which had outliers detected. In the targeted treatment plans, 3 plans became outliers because of special target volume and the other 4 plans needed improvement. Conclusions Clustering analysis is effective to help physicians to independently verify treatment plans.