Objective:To analyze the correlation between thymus dose-volume parameters and lymphopenia in patients with early-stage breast cancer (BC) receiving adjuvant radiotherapy (RT).Methods:Medical records of 54 patients with early-stage BC who received postoperative adjuvant RT in the Second Affiliated Hospital of Soochow University from January to December 2019 were retrospectively analyzed. Absolute lymphocyte counts (ALC) were collected at 1 month before (baseline) and weekly during RT. Lymphopenia was graded based according to the common terminology criteria for adverse events version 5.0 and nadir/baseline ALC was calculated. The thymus was delineated according to anatomical boundaries in the original RT planning system. Dosimetric parameters were obtained from the dose volume histograms. Stepwise multiple linear regression analysis was used to explore the factors associated with nadir/baseline ALC. The cutoff values of dosimetric parameters for predicting ≥grade 3 lymphopenia were obtained using the receiver operating characteristic (ROC) curve.Results:The proportion of 54 patients experiencing ≥ grade 3 lymphopenia was 38.9%. The median value of thymus volume, mean dose, V 5 Gy, V 10 Gy were 14.02 cm 3, 4.95 Gy, 36.18%, and 6.61%, respectively. Stepwise multiple linear regression analysis revealed that baseline ALC ( P=0.005), quadrant location ( P=0.005) and mean thymus dose ( P<0.001) were significantly associated with nadir/baseline ALC. ROC curve analysis indicated that the cutoff values of thymus mean dose, V 5 Gy and V 10 Gy for predicting ≥ grade 3 lymphopenia were 6.12 Gy, 35.2%, and 7.4%, respectively. Conclusions:Lymphopenia in early-stage BC patients is significantly correlated with high dosimetric parameters of the thymus during postoperative adjuvant RT. Thymus may be considered as an organ at risk during RT.

Objective:To analyze the correlation between thymus dose-volume parameters and lymphopenia in patients with early-stage breast cancer (BC) receiving adjuvant radiotherapy (RT).Methods:Medical records of 54 patients with early-stage BC who received postoperative adjuvant RT in the Second Affiliated Hospital of Soochow University from January to December 2019 were retrospectively analyzed. Absolute lymphocyte counts (ALC) were collected at 1 month before (baseline) and weekly during RT. Lymphopenia was graded based according to the common terminology criteria for adverse events version 5.0 and nadir/baseline ALC was calculated. The thymus was delineated according to anatomical boundaries in the original RT planning system. Dosimetric parameters were obtained from the dose volume histograms. Stepwise multiple linear regression analysis was used to explore the factors associated with nadir/baseline ALC. The cutoff values of dosimetric parameters for predicting ≥grade 3 lymphopenia were obtained using the receiver operating characteristic (ROC) curve.Results:The proportion of 54 patients experiencing ≥ grade 3 lymphopenia was 38.9%. The median value of thymus volume, mean dose, V 5 Gy, V 10 Gy were 14.02 cm 3, 4.95 Gy, 36.18%, and 6.61%, respectively. Stepwise multiple linear regression analysis revealed that baseline ALC ( P=0.005), quadrant location ( P=0.005) and mean thymus dose ( P<0.001) were significantly associated with nadir/baseline ALC. ROC curve analysis indicated that the cutoff values of thymus mean dose, V 5 Gy and V 10 Gy for predicting ≥ grade 3 lymphopenia were 6.12 Gy, 35.2%, and 7.4%, respectively. Conclusions:Lymphopenia in early-stage BC patients is significantly correlated with high dosimetric parameters of the thymus during postoperative adjuvant RT. Thymus may be considered as an organ at risk during RT.

Objective To understand the prevalence of Salmonella and the characteristics of drug resistance genes in General Hospital of People's Liberation Army, and to provide evidence for the prevention and treatment of Salmonella infection. Methods A retrospective study was conducted to collect 78 clinical isolates of Salmonella from 2015 to 2017. The age of the patients was 49 ± 21 years old. The infected patients were mainly young and middle-aged. The clinical samples mainly came from feces and venous blood, accounting for 44.87％(35/78) and 33.33％(26/78), respectively. After serotype identification, drug sensitivity test and whole genome sequencing, multilocus sequence typing and drug resistance genotyping were performed. Cluster of Cefotaxime or Ciprofloxacin resistant Salmonella was analyzed. Results Salmonella group D (53.85％) and Salmonella group C (21.79％) were dominant Salmonella serotype. ST11 was mainly ST type. Drug sensitivity test showed that the multidrug resistance rate of Salmonella was 64.11％ (50/78). The sensitivity to all antimicrobial agents' rate was 25.64 (20/78). The resistance rate of Salmonella to nalidixic acid was 65.38％(51/78). The most common drug resistance gene of Salmonella was extended-spectrum β-lactam drug resistance gene, accounting for 78.21％ (61/78). Conclusions The ST-type and carrying resistance genes of Salmonella in this hospital were diverse. Most pathogens were multi-drug resistant to antimicrobial agents. Molecular typing and drug resistance gene analysis of Salmonella and construction of resistant strains to determine the inheritance of Salmonella relationships have a certain clinical significance.

Objective To explore the recognition of perioperative needs of elderly lung cancer patients from the perspective of doctors and nurses and provide evidence for improving perioperative nursing measures in elderly patients with lung cancer. Methods Totally 17 doctors and nurses were selected by purposive sampling and received face-to-face semi-structural interview during June to September 2016. The data were analyzed with NVivo 8.0 according to Colaizzi's seven-step analysis method to refine the topic. Results The recognition of perioperative needs of elderly patients with lung cancer from the perspective of doctors and nurses could boil down to four topics: the urgent need for the patient's social support system, the need for perioperative nutrition screening, the need for self-care and assistance, and the need for improving doctor-patient communication skills. Conclusions Nursing managers should pay attention to meet the perioperative needs of elderly patients with lung cancer from the perspective of medical workers and put forward appropriate interventions based on their needs in order to improve the perioperative nursing quality of elderly patients with lung cancer.

OBJECTIVE: To provide reference for the implementation of essential drug system. METHODS: Relevance system allocation theory of institutional economics was applied to analyze essential drug system in China. RESULTS & CONCLUSION: Only coupling among internal systems of essential drug system form, can the gap of system be eliminated to realize the target of essential drug system.