Objective To investigate the effects of the thickness of the chest wall compensation film and the patient's body characteristics on the setup errors and radiation dose of breast cancer patients receiving intensity-modulated radiotherapy following surgery.Methods A total of 103 patients with breast cancer who were treated in the Tumor Radiotherapy Center of Fuyang Cancer Hospital from January 2021 to June 2023 were selected for a prospective study.All patients received cone-beam CT scan.The effects of body mass index(BMI),tumor location,chest circumference,and the affected breast volume on the setup errors were analyzed;and the effects of different compensation film thicknesses on the radiation doses to the planning target volume(PTV),lung,heart,and spinal cord were explored.Results The left-right setup errors didn't differ significantly in breast cancer patients with different BMI and affected sides(P>0.05);but the patients with chest circumference≥89.0 cm and affected breast volume≥650 cm3 had greater left-right setup errors than the other patients(chest circumference<89.0 cm and affected breast volume<650 cm3)(P<0.05).The difference in the superior-inferior setup errors was trivial in breast cancer patients with different affected sides(P>0.05),but the superior-inferior setup errors were greater in patients with BMI≥23.1 kg/m2,chest circumference≥89.0 cm,and breast volume on the affected side≥650 cm3 than the others(BMI<23.1 kg/m2,chest circumference<89.0 cm,and breast volume on the affected side<650 cm3)(P<0.05).There was no significant difference in the anterior-posterior setup errors in breast cancer patients with different BMI,chest circumferences,breast volumes,and affected sides(P>0.05).For left-sided breast cancer,the measured values of D95%and D5%of PTV,V20%of left lung,V30%and Dmean of heart,Dmax of spinal cord,MU,and HI in patients with 0.5 and 1.0 cm compensation films were close(P>0.05);while lower CI was found in patients with 0.5 cm compensation film than those with 1.0 cm compensation film(P<0.05).For right-sided breast cancer,the measured values of D95%and D5%of PTV,V20%of right lung,Dmax of spinal cord,MU,CI,and HI didn't differ significantly between patients using 0.5 and 1.0 cm compensation films(P>0.05).Conclusion The BMI,chest circumference,and breast volume on the affected side in breast cancer patients undergoing intensity-modulated radiotherapy are all associated with the setup errors.Both 0.5 and 1.0 cm chest wall compensation films can be used for postoperative radiotherapy,which has little effect on the dosimetry and accelerator MU.

Objective:To construct a scientific and systematic comprehensive evaluation index system for general practice teachers at grassroot practice bases, and to provide references for their selection, evaluation, and examination.Methods:On the basis of literature research, expert consultation, and group discussion, the original index system of general practice teachers at grassroot practice bases was preliminarily constructed. A total of 32 experts with intermediate or above professional titles and who had long been engaged in medical education management, general practice and teaching, and grassroot medical services and management were selected for two rounds of Delphi expert letter consultations. Through the statistical analysis of the consultation results, the comprehensive evaluation indicators of general practice teachers at grassroot practice bases were determined. Analytic hierarchy process was used to calculate the weight of each indicator and consistency test was performed. Data were imported and processed using the Yaahp software.Results:A comprehensive evaluation index system for general practice teachers at grassroot practice bases was constructed, including 3 first-level indicators, 12 second-level indicators, and 61 third-level indicators. The three first-class indicators were the criterion of teacher selection and inclusion, the criterion of teaching ability evaluation, and the criterion of teacher examination, with weights of 0.334, 0.525, and 0.142, respectively.Conclusion:The index system constructed in this study is scientific and systematic, which provides a theoretical basis for further strengthening the construction and management of the general practice teachers at grassroot practice bases and improving the quality of training resident general practitioners.

Objective:To investigate specificity of neurovascular compression in patients with primary trigeminal neuralgia (PTN) by three-dimension reconstruction and computational fluid dynamics.Methods:Clinical characteristics and preoperative magnetic resonance imaging (MRI) data of 20 patients with both PTN and single artery compression (PTN group) and 10 patients without PTN but having neurovascular contact in MRI images (control group) in the Second Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were collected and analyzed. After three-dimension reconstruction of the MRI images, curvature of the arterial loop, angle between the plane of arterial loop and the trigeminal nerve and location of the compression were observed. Then bidirectional structure-fluid coupling based on the optimized stereolithography models of arterial loop and nerve were processed by ANSYS 19.2 software. In the location of the compression of contact, equivalent stress (ES) of arterial loop on the nerve, shearing stress (SS) of the blood flow and local deformation of the nerve were iteratively computed. All parameters were analyzed and compared between the PTN group and the control group, and the correlation analysis was proceeded between the anatomical parameters and hemodynamical parameters.Results:The curvature of arterial loop [0.21(0.12) mm -1vs 0.13(0.07) mm -1, U=34.00, P<0.05], the angle between vascular loop and nerve [69.70(30.67)° vs 43.40(37.21)°, U=38.00, P<0.05] in the PTN group were significantly greater than those in the control group, and the location of compression was significantly closer to the root of nerve in the PTN group [PTN group: (4.23±1.29) mm vs control group: (5.54±1.85) mm, t=-2.26, P<0.05]. The average SS [15 952.48(5 365.56) Pa vs 12 501.97(6 355.26) Pa, U=53.00, P<0.05], ES [24 965.65(7 693.22) Pa vs 14 992.99(9 824.08) Pa, U=32.00, P<0.05] in the PTN group were significantly greater than those in the control group. The curvature of arterial loop was positively correlated with the SS ( r=0.931, P<0.05) and ES ( r=0.962, P<0.05), and the latter two ( r=0.787, P<0.05; r=0.853, P<0.05) were positively correlated with the local neural deformation. Conclusions:In patients with PTN, offending artery compresses the root of nerve by greater arterial curvature and angle between the arterial loop and nerve. These anatomical differences will cause significantly greater SS, ES and local neural deformation.

Objective:To explore the effect of mobile phone application support on medication compliance of stroke patients.Methods:China National Knowledge Infrastructure (CNKI) , Wanfang, VIP Database, PubMed, Cochrane Library, Embase were searched by computer to select randomized controlled trial studies on the effect of mobile application support on medication compliance of stroke patients. According to the inclusion and exclusion criteria, researchers selected the literature, extracted data and evaluated the quality. RevMan 5.3 software was used for Meta-analysis and the retrieval time was from the establishment of databases until August 31, 2019.Results:A total of 10 randomized controlled trials (RCTs) were included. In terms of improving medication compliance, the results of subgroup analysis showed that mobile phone application support could improve medication compliance of stroke patients [ SMD=0.70, 95% CI (0.34-1.06) , P<0.000 01]. In terms of blood pressure control, mobile phone application support was effective in controlling systolic blood pressure [ MD=-8.11, 95% CI (-15.82--0.40) , P=0.04], but there was no statistically significant difference in its effect on diastolic blood pressure control ( P=0.34) . Conclusions:Mobile phone application support is effective in improving medication compliance and controlling systolic blood pressure in stroke patients. It can effectively control blood pressure fluctuations and improve prognosis of the disease. However, it is still uncertain whether diastolic blood pressure can be effectively controlled and a large number of multi-center, large-sample clinical randomized controlled trials are still needed to confirm its effects.

Vertigo is one of the most common symptoms in general practice. During the standardized training in theory and practice of vertigo diagnosis and treatment, researchers from group of vertigo subspe-cialty of department of neurology analyzed the epidemiological characteristics of vertigo disease and the present teaching situation of theory and practice teaching. They put forward and adopted the "Three Steps"(laying firm foundation, consolidating and strengthening, and improving skills) which is based on multidis-cipline and conforming to trainees' understanding of the disease. It helped general practitioners tofamiliarize themselves with the etiology, diagnosis, and treatment of vertigo, to perfect their multidisciplinary knowl-edge structure, to establish scientific clinical thinking, and to improve their levels of the diagnosis and treatment of diseases relating to vertigo, which has produced good effects and has been playing an important role in improving the prognosis for vertigo patients.

The purpose is to establish an emergency medical system that covers a certain region, responds quickly, operates efficiently, functions perfectly and develops sustainably. Such a system leverages the potential social functions of research disciplines, and is guided by the concept of " expanding the emergency system of comprehensive emergency medicine". The authors identified the problems and shortcomings of the existing system and proposed to build a regional emergency medical system led by research disciplines. The path, system layout and functions are stated explicitly, while the system construction strategy is proposed by taking emergency treatment of myocardial infarction patients as an example. The system will be the pivotal support for integrating effectively regional emergency medical resources, improving the ability and level of emergency and first aid in medical institutions at various levels and of different types, promoting the formation of a new pattern of regional emergency medical service and achieving homogenized emergency medical services that everyone enjoy.

Objective: To observe the cellular damage of low-dose combined exposure to Hg, Pb and Cd on hippocampal neurons in rat. Methods: SH-SY5Y cells were randomly divided into 8 groups by 2×2×2 factorial design: control group, Pb exposure group, Hg exposure group, Pb+Hg exposure group, Pb+Cd exposure group, Hg+Cd exposure group and Pb+Cd+Hg exposure group. And the cell viabilities were measured. On this basis, an animal model was established. Twenty eight-week-old SD pregnant rats were randomly divided into four groups by random number table, and five in each group: the control group(distilled water), 1-fold metal mixture exposure group (1×MM, poisoning solution containing mercury chloride 0.15 mg/L, lead acetate trihydrate 25 mg/L, cadmium chloride 7.5 mg/L), 5-fold metal mixture exposure group (5×MM, poisoning solution containing mercury chloride 0.75 mg/L, lead acetate trihydrate 125.00 mg/L, cadmium chloride 37.50 mg/L), 10-fold metal mixture exposure group (10×MM, poisoning solution containing mercury chloride 1.50 mg/L, lead acetate trihydrate 250.00 mg/L, cadmium chloride 75.00 mg/L). Pregnant rats drank water until delivery. Twenty male pups were selected and exposed to these metals through breast milk until weaned. The heavy metals dose of poisoning water was adjusted, and then the weaned rats were exposed to heavy metals via drinking poisoning water until adulthood (postnatal day 83). The blood samples and brain hippocampus samples were collected to observe the ultrastructural changes of hippocampus, and to determine the levels of Hg, Pb and Cd in blood. In addition, apoptosis rate and fluorescence intensity of reactive oxygen species and intracellular free calcium concentration ([Ca²⁺]_i) in hippocampal neurons were measured. Results: Cellular factorial design analysis showed that Hg+Pb+Cd (at no observed adverse effect level, 1.0, 0.5 and 0.1 μmol/L, respectively)had a interaction on cell viability after 48 or 72 hours of combined exposure (P<0.05). The results of ultrastructure showed that mitochondria decreased, ridges and matrixes gradually dissolved in rat hippocampal neurons of 5×MM group; nuclear chromatin aggregated, more ridges and matrixes dissolved and the mitochondria also decreased in rat hippocampal neurons of 10×MM group. The concentration of Hg, Pb and Cd in the blood of 1×MM group, 5×MM group and 10×MM group were higher than those in the control group, and the differences were statistically significant (P<0.001). There was no significant difference in apoptosis rate between the 1×MM group and the control group. The apoptosis rate of 5×MM group and 10×MM group was higher than that in the control group, and the differences were statistically significant (P<0.001). There was no statistically significant difference in the fluorescence intensity of reactive oxygen species in hippocampal neurons of the 1×MM group and the control group. The fluorescence intensity of reactive oxygen species in the 5×MM group and the 10×MM group was higher than that in the control group, the difference was statistically significant (P<0.05). There was no significant difference in the fluorescence intensity of [Ca²⁺]_i between the 1×MM group and the control group. The fluorescence intensity values of [Ca²⁺]_i in the 5×MM group and the 10×MM group were higher than the control group, the differences were statistically significant (P<0.001). Conclusion Low-level combined exposure to Hg, Pb, and Cd caused synergistic neurotoxic damage, and the process may be related to the changes of neuronal apoptosis, reactive oxide species, and [Ca²⁺]_i levels.

Under the situation of national demand for cardiopulmonary resuscitation (CPR) skills, it is very important to develop a scientific and feasible education and training program to popularize CPR skills, and improve first-aid ability. This study illustrated the significance and feasibility of setting up car-diopulmonary resuscitation courses in colleges and universities. On this basis, specific suggestions and countermeasures were put forward to improve teaching organization and leadership, teaching material de-velopment, curriculum design, teaching faculty development, teacher training and laboratory construction. This study proposed to strengthen the legislation, and the implementation of first-aid qualification examina-tion in colleges and universities, making the students become the preferred educational group of CPR skills, which is of great significance to improve public popularity rate of CPR.

Objective To preliminarily develop a scale to measure the proactive socialization behavior of new nurses and test validity and reliability of the scale, to explore the impact of proactive socialization behavior on turnover intention. Methods Using a questionnaire survey method to investigate 696 new nurses who had worked within three years in nursing organization, structural equation model and hierarchical line regression methods were performed to analyze the data. Results Proactive socialization behavior scale included eight items under one dimension;the consistency coefficient of scale was 0.858;new scale had a good convergent and predictive validity;the proactive socialization behavior of new nurses was significantly negative related to turnover intention (β=-0.236,P<0.01). Conclusions The proactive socialization behavior scale has a good reliability, convergent and predictive validity. Meanwhile, new nurses with higher level of proactive socialization behavior have lower turnover intention. Because they can quickly fit the new environment, role definition and organizational culture, which in turn organization embeddedness is promoted.

Objective To explore the effective procedures and practices to solve the ethical dilemma of nursing, and to building nursing ethics decision path. Methods Using inductive-deductive method, summarize predecessors′ research on nursing ethics mode and decision-making process, and establish nursing ethical decisions paths, then display the application based on clinical case. Results Six-steps-Nursing ethics decision path was established, and tested. Conclusions Pay attention to strengthen the cultivation of nurses nursing ethics accomplishment and ability of the decision.