ObjectiveTo understand the distribution of enrofloxacin (ENR) residues in freshwater fish, to evaluate the dietary exposure risk to ENR for consumers through the consumption of different freshwater fish in Shanghai, and to provide a reference for controlling antibiotic residues in freshwater fish. MethodsGrass carp, Wuchang bream, pond loach, and Asian swamp eels were purchased from the markets in Shanghai. After being fed with ENR, the fish were divided into 42 batches according to their species and weight, and thereafter ENR residues in the muscles and skin of the fish were measured. In addition, a total of 44 batches of Wuchang bream, pond loach, Asian swamp eels were purchased from the markets, and the ENR residues in the muscles with or without the fish skin were measured, and the exposure risk was evaluated. ResultsThe average residues of ENR in skin of the freshwater fish after being fed with drugs in the 42 groups were higher than those in muscles (M=659.38 μg·kg^-1, M=460.83 μg·kg^-1; z=-2.212, P=0.027). The over-standard rates of ENR residues in the muscles with or without skin 44 batches of freshwater fish of sold in Shanghai were 36.36% and 29.55%, respectively. The median exposure, P₉₅ exposure, and maximum exposure to ENR through the consumption of the muscles with the skin for adults and children in Shanghai were higher than those through the consumption of muscles without the skin. For children, the margin of safety (MOS) for the max exposure to ENR by consuming the muscles with the skin was more than 1, while the MOS was less than 1 in all other cases for both children and adults. ConclusionThe ENR residues in the skin of freshwater fish are generally higher than those in the muscles. The risk of ENR residues in freshwater fish sold in Shanghai is within a controllable range. However, there might be a certain risk of acute exposure to ENR for children by consuming muscles with the skin of freshwater fish.

Objective The objective of this study is to investigate whether there is a correlation between a high TyG index(serum triglyceride glucose index)and higher mortality rates among patients undergoing peritoneal dialysis(PD).Methods This study utilized a single-center retrospective cohort as the basis for its methods..From January 1,2007 to December 31,2015,a total of 519 PD patients kept under observation until December 31,2018.There searchers employed the Kaplan-Meier method and Cox proportional hazards modelsto examine the cor-relation between TyG index levels and mortality.Results Over a period of 40.5 months,104(20.0%)individuals with Parkinson's disease passed away,with 55(52.9%)of these deaths attributed to cardiovascular disease(CVD).The serum median TyG index at baseline was 8.44(6.48,11.94).Through Cox regression analysis subject to the adjustments of such parameters as gender,age,body mass index(BMI),presence of cardiovascular disease,hypertension,diabetes mellitus,hemoglobin,serum albumin,serum Ferritin,total cholesterol,renal residual function(RRF),An increased risk of all-cause mortality(HR = 2.22,95%CI:1.43～3.44,P＜0.001)and CVD mortality(HR = 2.50,95%CI:1.34～4.65,P = 0.004)was observed with a higher baseline TyG index(8.44).A comparable impact was observed in the correlation between the average TyG index over time(TA-TyG index)and both all-cause mortality and CVD mortality.(HR = 1.90,95%CI:1.25～2.90,P = 0.003;HR = 2.05,95%CI:1.14～3.70,P = 0.017,respectively).Conclusion PD patients with a higher serum TyG index have a greater risk of all-cause mortality and mortality related to cardiovascular disease.

ObjectiveTo understand the concentration of heavy metal cadmium and cadmium in portunus and mantis shrimp， and to timely identify food safety problems and potential hazards. MethodsPortunus and mantis shrimp samples from different provinces were collected and categorized based on different regions and locations， and some samples were made from tissue parts. Graphite furnace atomic absorption spectrometry was used to detect cadmium items， the cadmium exposure of portunus and mantis shrimp was evaluated simultaneously ResultsThe detection rate of cadmium in 124 batches of portunus sold in Shanghai was 100% （124/124）， the detection rate of cadmium in 63 batches of mantis shrimp sold in the market was also 100% （63/63）. The cadmium content varied in different tissue parts， and the cadmium enrichment in hepatopancreas was the highest in the edible parts of portunus and mantis shrimp. The average detection value， 50th percentile value， 95th percentile value of cadmium in the hepatopancreas of portunus accounted for 52.64%， 49.28% and 98.65% of the PTMI， respectively. The average detection value， 50th percentile value and 95th percentile value of cadmium in the hepatopancreas of mantis shrimp accounted for 30.76%， 32.04% and 46.16% of the PTMI， respectively. ConclusionThe average residual levels of heavy metal cadmium in portunus and mantis shrimp are within the safe range.

Objective To evaluate the short-term efficacy of combination of 125 I seed brachytherapy and cetuximab in postoperation recurrent rectum cancer.Methods From July 2014 to June 2018,at Affiliated Hospital of Shandong Academy of Medical Sciences,57 patients with postoperation recurrent rectal cancer were recruited.According to therapy the patients were divided into two groups:the radiotherapy group (30 cases) treated with radioactive 125I seeds alone and the combination treatment group (27 cases) treated with combination of radioactive 125I seeds and cetuximab.The tumor size,pain relief and adverse reactions were observed in both groups.Chi-square test were performed for statistical analysis.Results After treatment for six months,the total efficacy rate and local control rate of combination treatment group were 54.2％ (13/24) and 87.5％ (21/24),respectively;and which were higher than those of radiotherapy group (17.9％,5/28 and 39.3％,11/28),and the differences were statistically significant (x2 =15.01 and 2.55,both P ＜ 0.05).At one month after treatment,the pain relief rate of radiotherapy group and combination treatment group was 70.0％ (21/30) and 85.2％ (23/27),respectively,and there was no statistically significant difference between the two groups (P ＞ 0.05).After treatment for six months,the rates of adverse reactions of radiotherapy group and combination treatment group were 46.7 ％ (14/30) and 63.0％ (17/27),respectively,there was no statistically significant difference between the two groups (P ＞ 0.05).The symptoms of patients with radiation injury significantly improved after symptomatic treatment.Conclusion The short-term efficacy of combination of 125 I seed brachytherapy and cetuximab is better than that of 125 I seed brachytherapy alone in patients with postoperation recurrent rectum cancer.

Objective To investigate the clinical value of the transluminal radiofrequency catheter ablation (RFCA) for malignant esophageal obstruction.Methods The retrospective cross-sectional descriptive study was conducted.The clinicopathological data of 52 patients with malignant esophageal obstruction who underwent transluminal RFCA at the Affiliated Hospital of Shandong Academy of Medical Science between March 2013 and March 2016 were collected.Patients received the bipolar radiofrequency ablation (RFA) under dualchannel endoscopy and X-ray.Observation indicators:(1) intra-and post-operative situations:operation situations,operation time,time of RFA,postoperative complications and duration of postoperative hospital stay,(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the subsequent treatment,survival of patients and recurrence of esophageal obstruction up to June 2016.Measurement data with normal distribution were represented as average (range).Results (1) Intra-and post-operative situations:52 patients underwent successful RFCA,without the occurrence of aspiration,asphyxia,hemorrhage and perforation.Esophageal obstruction was disappeared after treatment,X-ray findings showed a smooth esophagus.Average operation time and time of RFCA were respectively 58 minutes (range,20-71 minutes) and 23 minutes (range,8-42 minutes).Patients took liquid food at postoperative day 2 and normal food at postoperative day 3,without the sensations of esophageal obstruction.Of 52 patients,1 with postoperative hypotension returned to normal level through rehydration and increasing blood volume.Five patients with postoperative substernal pain were improved after 2-day symptomatic treatment.And other 46 patients didn't have postoperative complications.Average duration of postoperative hospital stay was 3 days (range,1-5 days).(2)Follow-up:52 patients were followed up for 3-24 months,with a median time of 13 months.Of 52 patients,17 underwent single intravascular interventional therapy,15 underwent intravascular interventional therapy combined with single systemic chemotherapy,14 underwent single systemic chemotherapy and other 6 didn't undergo antineoplastic therapy.During the follow-up,9 patients didn't have esophageal obstruction and 26 were complicated with esophageal obstruction again.Esophageal obstruction of 26 patients was respectively occurred at 3-8 months postoperatively,20 patients were improved after bipolar transluminal RFCA under dual-channel endoscopy and X-ray and 6 received parenteral nutrition support therapy due to extreme exhaustion.Seventeen patients died of cachexia caused by terminal malignant tumors.Conclusion Transluminal RFCA is safe and effective for malignant esophageal obstruction,with a good short-term outcome.

Objective To study the dosimetry distribution of 125Ⅰ seed chains with different radians in different curvatures of bile ducts. Methods The outlines were drawn on the papers, which are the seed chain models with different radians. Radians formula (radian length=2πr × angle/360) was used to calculate the corresponding 0°, 30°, 60°, 90°, 120°, 150° and 180° models with a radian length at 45 mm, for the total length of seed chain model was 45 mm, and the seeds, had no interval or linear arrangements. The image was transmitted to the Brachytherapy planning system for seeds implantation( TPS) to simulate the seed chains with different radians. Using TPS to delineate the tumor target area, of which the activity was set as 1. 85 × 107 Bq, and the prescription dose was 60 Gy. It was prescribed to simulate the bile duct ( diameter at 8 mm) . TPS were used to calculate the D90 and V100 of the simulated bile duct with the diameter at 8 mm, and explore dosimetry of the points at the centripetal and centrifugal sides with 5 mm vertical distance which from two endpoints and center of seed chains with different radians. Results When the radian of seed chain was 30°, the D90and the V100 were the highest (the D90 was 132 Gy; the V100 was 100%). While the radian was 60°, the D90 and the V100 were the lowest (the D90 was 45 Gy, the V100 was 68%). As the radian was 30°, the highest dose was in the center ( dose in the centripetal side was 165 Gy, and centrifugal side dose was 142 Gy) . The center has the lowest dose as the radian up to 180°(dose in the centripetal side was 90 Gy, and centrifugal side dose was 50 Gy) . Among all radians, dose in the centripetal side was always higher than centrifugal side in the center. Between two endpoints, dose in the centrifugal side was higher than centripetal. Conclusions Distribution of seed chain dosage also changed along with the change of radian. When the radian of seed chain was 30°, the D90 and the V100 were the highest. The centripetal dose was higher than that of the centrifugal side.

Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 107 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.

[Summary] Malignant obstructive jaundice is the bile obstruction caused by the invasion of cholangiocarcinoma , pancreatic cancer or ampulla cancer .Due to lack of effective treatment , the prognosis is poor .In recent years , with the rapid development of medical technology and imaging technology , dual interventional treatment technology , such as percutaneous transhepatic cholangial drainage ( PTCD) or biliary stenting combined with radioactive seed implantation , ablation catheter lumen combined with biliary stent implantation , is applied in the treatment of malignant obstructive jaundice .This article is the summary of the clinical application of PTCD combined with radioactive seed implantation , biliary stent combined with radioactive seed implantation and intraluminal catheter radiofrequency ablation combined with biliary stent implantation technique .

Objective To explore the effect of nursing management mode in the new normal on maintenance of medical equipment in operation room, to improve the qualified rate and service satisfaction .Methods We used nursing management mode in the new normal to formulate specific rules of nursing management and improve the implementation effect between January 2013 and December 2014 .Results After using nursing management mode in the new normal for 2 years, the qualified rate of medical equipment in operation room increased from 51.67%~68.89% to 70.00% ~93.75%, the differences were statistically significant (P <0.05).The patients′satisfaction increased from 66.25% to 86.25%, the difference was statistically significant (χ2 =8.835, P<0.01).The satisfaction of medical staff in operation room increased from 63.33%to 90.00%, the difference was statistically significant (χ2 =5.963, P<0.05).Conclusions Nursing management mode in the new normal can improve the maintenance of medical equipment in operation room continuously and make it more systematic and standardized .

Objective To explore the clinical efficacy of image-guided 125I radioactive seed interstitial implantation therapy for unresectable pancreatic cancer.Methods 25 patients with unresectable pancreatic cancer evaluated by retrospective follow-up were enrolled in this study,13 patients received radioactive seeds implantation while 12 patients were given non-surgical treatment.We observe and compare the clinical benefits,objective curative effect,complications,adverse reaction,survival between the two groups of patients.Results Compared with the non-surgical treatment group,the clinical benefit rate in the radiotherapy seed implantation group was 92％ (12/13) while that of the non-surgical group was 42％ (5/12),the difference was of statistically significance.The numbers of cases evaluated as effective were 6 (46％) and 4 (33 ％) respectively,the difference was not statistical significant (x2 =0.427,P ＞ 0.05);The radioactive seed implantation group had no serious postoperative complications;3 cases who received subsequent chemotherapy in radioactive seed implantation group(23％,3/13) and 3 cases in non-surgical treatment group(25％,3/12)suffered from serious adverse reactions,the difference was of no statistical significance(x2 =0.013,P ＞0.05);Comparing the survival rate between the two groups,x2 =0.001,P =0.969,the difference was of no statistical significance.Conclusions The therapy of 125I radioactive seed implantation for unresectable pancreatic cancer significantly relieves cancer caused pain and improves quality of life.