Radiotherapy is one of the main treatment methods for malignant tumors, which can cause the radiation damage to normal tissues. Radiation-induced skin injury (RISI) is one of the main adverse reactions caused by radiotherapy. The main clinical manifestations of RISI are dermatitis, ulcer, erosion and necrosis, which seriously affect the quality of life and treatment effect of tumor radiotherapy patients, and even affect the overall survival of patients. The pathological mechanism of RISI is still unclear. Some studies have shown that inflammation and oxidative stress are the main causes of RISI. RISI can be divided into acute and chronic RISI according to the different onset time, and different treatment strategies can be formulated according to the severity of the injury. In this article, clinical manifestations, classification, pathogenesis, prevention and treatment of RISI are comprehensively summarized.

The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.

ObjectiveTo explore the psychological defense styles and family environment among male prisoners of different terms of imprisonment， and to analyse the relationship between their psychological defense styles and family environment. MethodsA total of 200 male prisoners in a prison in Guangdong were randomly selected from April to June 2015， and they were classified into less than 5 years of imprisonment group （n=108） and 5 years or more imprisonment group （n=92）. Their defense style and family environment were evaluated by Defense Style Questionnaire （DSQ） and Family Environment Scale-Chinese Version （FES-CV）. Pearson correlation analysis was used to test the correlation between each scale score. ResultsThe factor scores of immature defense mechanism and intermediate defense mechanism of DSQ in the group with less than 5 years of imprisonment were lower than those in the group with 5 years or more imprisonment， with statistically significant differences （t=4.198， 1.137， P<0.01）. The scores of FES-CV family intimacy， emotional expression and organizational factors in less than 5 years of imprisonment group were higher than those in 5 years or more imprisonment group （t=3.122， 2.993， 2.203， P<0.01）， and the scores of contradiction factors were lower than those in 5 years or more imprisonment group （t=-3.682， P<0.01）. The scores of DSQ immature， intermediate defense mechanism and concealment factor of male prisoners were negatively correlated with the scores of FES-CV family intimacy and emotional expression factor （r=-0.428~-0.172， P<0.05 or 0.01）， and the scores of 4 factors in DSQ were all positively correlated with the scores of contradiction factor in FES-CV （r=0.175~0.384， P<0.05 or 0.01）. ConclusionCompared with male prisoners with less than 5 years of imprisonment， those with 5 years or more are prone to adopt immature and intermediate defense mechanisms， and their family environments are characterized by apparent contradiction and a lack of family intimacy， emotional expression and organization. Furthermore， the defects of psychological defense mechanism of prisoners are related to their family environment.

【Objective】 To compare the platelet apheresis donation rate via telephone and WeChat appointment in Shijiazhuang area during the COVID-19 epidemic, so as to give suggestions for optimizing blood donation appointment in major public events. 【Methods】 The number and appointment type of apheresis donors from January to March 2019(the control) vs January to March 2020(study group 1) vs January to March 2021(study group2) in Shijiazhuang area were collected. A total of 1 204 and 1 305 questionnaires were distributed to two study groups to analyze their acceptance of telephone and WeChat appointment. 【Results】 More turnout donors preferred WeChat appointment, relative to telephone calls, during January to March 2020 and 2021. But some inactive donors preferred appointment given by telephone calls. 【Conclusion】 Different appointment methods should be adopted to recruit blood donors according to the targets of blood centers, in the event of national or local COVID-19 epidemic.

Autologous fat grafting has been widely used in clinical surgeries in recent years, while the low survival rate of the graft is an important limitation. Platelet-rich plasma (PRP) is one of the strategies to improve the survival rate of the graft. PRP may promote the survival of the graft by stimulating the vascularization of transplanted fat, enhancing the proliferation and differentiation ability of adipose stem cells, and regulating inflammation. Many clinical studies have been carried out using PRP together with autologous fat grafting, revealing that PRP may promote angiogenesis and fat graft retention, but the effectiveness remains controversial. To provide reference and basis for improving the effectiveness of PRP in autologous fat grafting, we introduced the autologous fat grafting and the mechanism of PRP, analyzed clinical trials of PRP combined with autologous fat grafting in this article.

Autologous fat grafting has been widely used in clinical surgeries in recent years, while the low survival rate of the graft is an important limitation. Platelet-rich plasma (PRP) is one of the strategies to improve the survival rate of the graft. PRP may promote the survival of the graft by stimulating the vascularization of transplanted fat, enhancing the proliferation and differentiation ability of adipose stem cells, and regulating inflammation. Many clinical studies have been carried out using PRP together with autologous fat grafting, revealing that PRP may promote angiogenesis and fat graft retention, but the effectiveness remains controversial. To provide reference and basis for improving the effectiveness of PRP in autologous fat grafting, we introduced the autologous fat grafting and the mechanism of PRP, analyzed clinical trials of PRP combined with autologous fat grafting in this article.

Objective To analyze and compare the capacity and efficiency of county-level hospitals′medical service by using the diagnosis related groups ( DRGs ) method. Methods The homepage data of discharged inpatients from seven county-level hospitals in Wenzhou region in 2013 - 2015 period were analyzed, for measurement of the medical service capacity changes of such hospitals using the number of DRGs, total multiplicity of weight, and CMI value, and that of their medical service efficiency changes using expense consumption index and time consumption index. Results The study found in the seven hospitals 8. 49% increase of the total number of DRGs, 17. 34% increase of total multiplicity of weight, and 5. 06%increase of CMI value, with unchanged expense consumption index and 9. 82% decrease of the time consumption index. These facts evidenced enhancements of these hospitals in both service capacity and service efficiency in general. Conclusions DRGs as tools prove useful objectively and scientifically. Policies of Two emphases at primary ends and two enhancements have been implemented desirably.

The paper reviewed the history of drug price addition system and its impact on hospital management. Based on such facts,authors stated that the significance of abolishing drug price addition helped hospital management not to run their hospitals as a business, helped medical practitioners to make their clinical decisions based on medical needs, and to make the health care service deserve the professionals′value and contributions. Following the abolishment, the hospitals need to reform their internal operating mechanisms before they can achieve better performance.

The authors reviewed the practice of integrated health care delivery system( IDS) at home and abroad, and based on experiences of collaborations between medical service institutions in Zhejiang province,proposed the strategic positioning,responsibilities and service innovation of urban public hospitals in a regional medical service system. It is held that the direction of China′s health care reform should move towards IDS in the future,and such hospitals should play an active role in the process via integration of its own resource and provide multi-level,diversified services for the regional health care system.

Objective To assess the radiography change of lumbar spinal stenosis (LSS) treated with the implantation of Coflex interspinous device retrospectively.Methods Sixty patients (34 male and 26 female) with LSS who underwent the decompression and Coflex device implanted surgery from January 2010 to December 2013 were followed up.The mean age of the patients was 59.4 years.There were 33 cases underwent Coflex surgery and 27 cases underwent Topping-off surgery.The Coflex segment ranged from L1/2 to L4/5 (L1-2:1,L2_3:5,L3_4:19,L4_5:35).The foraminal height,foraminal width and intervertebral space height change of the Coflex segment as well as its adjacent segment were recorded pre-/post-operatively and at last follow-up.Meanwhile,the Oswestry Disability Index (ODI) and Visual Analog Scale(VAS) were measured in all patient pre-/post-operatively and at last follow-up.The measurement data was recorded as ~ ± s.And the independent and paired samples t-test was used to conduct the statistical analysis.Results The foraminal height(FH) increased from (19.82 ± 2.38) mm to (22.28 ± 2.95) mm (P ＜ 0.05) post-operatively,and the FH decreased to (19.31 ± 3.32) mm at the last follow up(P ＞ 0.05,compared to the post-operation).The average foraminal width (FW) was 11.2 mm,11.58 mm and 11.12 mm at pre-/post-operation and follow up,which had no significant different change(P ＞0.05).The post-operative intervertebral space height (ISH) increased from (7.84 ± 1.56) mm to (10.05 ±2.39) mm (P ＜0.05),and the ISH decreased to (7.91 ± 1.77) mm at the last follow up(P ＞0.05,compared to the post-operation).The amount of the decreased FH and ISH had no significant difference when comparing the Coflex segment with its adjacent (Coflex ± 1) segments (P ＞ 0.05).The lumbar lordosis (LL) was 43.13° ± 15.93°,38.41° ± 10.82° and 43.10° ± 13.21° at pre-/post-operation and follow up,there was no significant difference between pre-and post-operation (P ＞ 0.05).All patients showed statistically significant improvement(P ＜ 0.05) in the clinical outcome assessed in the VAS and ODI at the time of follow up compared to the pre-operation.The ODI score decreased from 65.12 ± 13.56 to 9.89 ± 1.77; the VAS score decreased from 8.02 ± 1.81 to 1.66 ± 0.51.Conclusions Coflex device could temporarily improve the FH and ISH after operation.However,it could not maintain the improvement as the follow-up time extended.The surgical decompression is the responsible factor for the good clinical outcome but not the improvement of FH.