OBJECTIVE: To evaluate the feasibility and accuracy of cone-beam CT (CBCT) images for radiotherapy dose calculation in pelvic tumors. METHODS: An improved volumetric density coverage method was used to establish CT value-relative electron density (RED) curves for CBCT images. The planning CT plans were transferred to the CBCT images, and the constructed density curves were applied to calculate doses for CBCT plans while maintaining the optimization parameters unchanged. Dose calculation deviations between the two plans were analyzed. RESULTS: The mean differences in dosimetric parameters for the target volume and organs at risk (OAR) between the two plans were less than 1% and 1.5%, respectively. The target conformity index (CI), homogeneity index (HI), and gamma passing rates were highly consistent, with no statistically significant differences. CONCLUSION CBCT images corrected by this method can be used for dose calculation in pelvic tumor radiotherapy planning.
Cone-Beam Computed Tomography/methods* ; Humans ; Radiotherapy Planning, Computer-Assisted/methods* ; Radiotherapy Dosage ; Pelvic Neoplasms/diagnostic imaging*

Objective To explore the effectiveness of building block assembly games in the upper limb functional exercise of school-aged children with peripherally inserted central catheter catheterization.Methods Using convenience sampling,90 catheterized children who met the inclusion criteria in the pediatric ward of a tertiary hospital in Henan Province from November 2022 to April 2023 were selected as research subjects.They were randomly divided into an experimental group and a control group,with 45 cases in each group.The experimental group participated in building block assembly games in addition to conventional ball-gripping exercises,while the control group engaged solely in conventional ball-gripping exercises.The compliance rates of upper limb exercises,time average peak flow rate of axillary vein of the catheterization side,and the incidence of catheter-related complications were compared between the 2 groups.Results During the study,2 cases in the experimental group and 3 in the control group dropped out,resulting in 43 cases in the experimental group and 42 in the control group.The compliance rate of upper limb exercises in the experimental group during hospitalization was 93.03％,significantly higher than 64.29％in the control group(P＜0.001).On the third day after catheterization,the time average peak flow rate of axillary vein of the catheterization side was(5.58±1.24)cm/s and(5.37±1.24)cm/s on the seventh day in the experimental group,compared to(3.87±1.06)cm/s and(3.56±0.81)cm/s,respectively,in the control group.These differences were statistically significant(P＜0.001).The incidence of catheter-related thrombosis in the experimental group was 4.65％,significantly lower than 21.43％in the control group(P=0.021).The rates of bleeding at the puncture site and catheter displacement in the experimental group were both 4.65％,compared to 7.14％and 4.76％,respectively,in the control group.These differences were not statistically significant(both P＞0.05).Conclusion Incorporating building block assembly games into routine ball-gripping exercises can improve the compliance of upper limb exercises in children with PICC placement,improve the blood flow velocity in the axillary vein of the catheterization upper limb,and reduce the incidence of catheter-related thrombosis,without increasing the risk of bleeding at the puncture site or catheter displacement.

The cross regional loose medical alliance is an important carrier in the current integrated development process of medical services in the Yangtze River Delta region. Smith policy implementation process model was used to analyze the development difficulties of cross regional loose medical alliances from idealized policies, policy implementation institutions, policy target groups, and policy implementation environment. Such medical alliances were formed under the background of integrated development in the Yangtze River Delta, with Shanghai′s tertiary public hospitals as leading units and medical institutions in Jiangsu, Zhejiang, and Anhui provinces as member units. Analysis showed that the policies for such medical alliances development had not yet clearly defined the organizational management mode, operational mechanism, and implementation path, and the corporate governance structure of medical alliance was immature; The policy implementation agencies were relatively lagging behind in the support of special funds and the formulation of related supporting policies; Participation of policy target groups was insufficient and their incentive mechanisms was imperfect; There were problems in the policy implementation environment, namely inconsistent medical and health service regulations and systems in different regions, different health financing capabilities of local governments, insufficient coordination of medical institution management concepts, and a lack of unified standards in information systems. Based on the above difficulties, this study proposed to strengthen the development planning and layout of cross regional loose medical alliances, and improve the corporate governance structure; To strengthen the government′s main responsibility and improving policy implementation capabilities; To improve the internal cooperation and operation mechanism of cross regional loose medical alliances, and enhance the sense of identity of the target group; To optimize the policy implementation environment and implement various support measures, so as to provide references for further promoting the coordinated development of high-quality medical resources in the Yangtze River Delta region.

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.

Based on the requirement of the ongoing healthcare reform on the performance appraisal for public hospitals, Shanghai Tenth People′s Hospital explored the performance appraisal system oriented by clinical ability and cost control from the perspective of medical administration and finance. Performance appraisal programs were made from five aspects: clinical development ability, key efficacy indicators, clinical path, disease-entity structure, cost control, aiming to highlight the functional positioning of tertiary hospitals, change doctors′ behaviors of diagnosis and treatment, lead clinical improvement and maintain healthy economy development.

Objective: To analyze evolution and research hot sports of sports intervention on youth health promotion, and to provide the theoretical data for the researchers to make sure their future research directions. Methods: The Web of Science was searched through with core collection database to obtain original articles in this domain on November 10th 2018, and 1 242 articles were selected as research samples. Citespace was used to analyze the following data, including co-word, cited-reference, cite-author and so on. Results: Research on this domain was performed in 43 countries. The leading 5 countries of publishing papers were as follows: USA,Australia,England, Canada and Holland, accounting for 1 017 articles published, occupying 81.9% of the published papers. The most productive organizations were in USA and Australia. The team of Luban DR and Pate RR was most representative in this domain. Recently more and more researchers were paying attention to sport intervention of adolescents. The leading issues were about: application of intelligent electronic products in intervening adolescents’ health, the positive effect of sports environment on adolescents’ participation in sports and the sport intervention of adolescent’s brain. Conclusion We must recognize that the field in sports intervention among adolescents is still in its infancy and shows huge potential for further improvement. Scientists from the United States and Australia are leading the world in this field. It’s important for China to participate and refer to their cutting-edge researches, and to invest in specific sports intervention strategies paving the road to good health among adolescents.

OBJECTIVETo analyze clinical manifestations and genetic mutation in a child with severe short stature and other malformations.

METHODSThe child has undergone history taking and physical examination. Genome DNA was extracted from peripheral blood samples of the proband and her family members. Candidate genes were captured with Agilent SureSelect and sequenced on an Illumina platform. Suspected mutation was verified by Sanger sequencing.

RESULTSThe patient, a six-year-and-10-month old girl, presented with non-symmetrical short stature, dysmorphism, abnormalities of limbs and spine, amblyopia of left eye, and cataract of right eye, in addition with frequent respiratory infection and micturition. Laboratory testing suggested 25-hydroxy vitamin D deficiency (18.9 ng/mL). Spine X-ray showed multiple malformations with centrums. Her mother also featured short stature (138 cm). Her aunt had short stature (130 cm) and limb-length discrepancy. Her little brother was 2.5 years old, and his height was 81 cm (-3.4 SD). Exome sequencing revealed a heterozygous mutation c.184C to T (p.Arg62Trp) in the proband and her mother. The same mutation was not found in her father and brother.

CONCLUSIONThe patient was diagnosed with X-linked chondrodysplasia punctata 2. Mutation of the EBP gene probably underlied the disease in this family.

Objective: To evaluate the long-term efficacy and prognostic factors of childhood acute lymphoblastic leukemia (ALL) enrolled in Shanghai Children's Medical Center-Acute Lymphoblastic Leukemia-2005(SCMC-ALL-2005) multicenter study. Methods: Between May 2005 and December 2014, 1 497 newly diagnosed ALL patients were enrolled and treated in 5 hospitals of SCMC-ALL-2005 study group, using risk-stratified SCMC-ALL-2005 protocol. Risk group classification and treatment intensity were based on clinical features, genetic abnormalities, early response to treatment and levels of minimal residual disease (MRD). Kaplan-Meier method was used to generate overall survival (OS) and event-free survival(EFS) curves. Cox proportional hazards models were used for multivariate analyses. Results: The patients were followed up to December 31, 2016, the median follow-up time was 69 months (24-141 months). The 5-year and 10-year OS rates were (80.0±1.0)% and (76.0±2.0)%. The 5-year and 10-year EFS rates were (69.0±1.0)% and (66.0±2.0)%. The 5-year and 10-year relapse rates were (23.0±1.0)% and (25.0±2.0)%. The 5-year OS and EFS for low risk (LR), intermediate risk (IR) and high risk (HR) were (91.1±1.4)% and (83.3±1.8)%, (79.2±1.5)% and (68.9±1.7)%, (52.9±4.4)% and (30.0±3.8)%, respectively. MRD negative status (<0.01%) on day 55 was seen in 792 patients (82.8%) and positive MRD on day 55 was associated with poor prognosis (OR=1.9, 95%CI: 1.3-2.7, P=0.001). Twenty-four HR patients received allogeneic hematopoietic stem cell transplantation and 17(70.8%) of them were alive and in remission. A total of 164 severe adverse events occurred, 46 of them died, treatment-related mortality was 3.1%. Conclusions In this large sample research, the overall outcome for multi-center SCMC-ALL-2005 study was favorable. This helps to promote the standardized treatment of childhood ALL to the whole country. MRD results on day 55 of induction therapy have important prognostic and therapeutic implications.

Objective To explore the relationship between fractional anisotropy (FA) of corticospinal tract (CST) and motor function in stroke patients using diffusion tensor imaging (DTI). Methods From January, 2013 to October, 2016, 36 stroke patients were evaluated with Fugl-Meyer Assessment (FMA), Japan Upper Limb Function Test and DTI before and eight weeks after rehabilitation. FA in posterior limb of internal capsule, cerebral peduncle and pons were obtained, including ipsilesional and contralesional CST. Results The FA values within three sections of CST were significantly lower in the ipsilesional side than in the contralesional side both before and after rehabilitation (t>5.330, P<0.001). In posterior limb of internal capsule, the FA value increased after rehabilitation (t=-3.415, P<0.05), and no significant dif-ference was found in the other two sections (t<1.653, P>0.05) in the ipsilesional side, as well as in all the sections in the contralesional side (t<1.021, P>0.05). The FA values were positively correlated with the scores of FMA and Japan Upper Limb Function Test in all the sections both before and after rehabilitation (r>0.43, P<0.05), especially the relationship between the FA value and the score of Japan Upper Limb Function Test in the posterior limb of internal capsule (r=0.67). Conclusion DTI can be used to evaluate CST injury and the relationship be-tween CST injury and motor function.

Objective To evaluate the clinical application value of three-dimensional medical image guided ultrasound in the chemotherapy of huge hepatic hemangioma.Methods Seventy-six cases were enrolled in a randomized control study.All cases were randomly divided into two groups (group A and group B).In group A,all cases underwent treatment based on the traditional two-dimensional medical images.Under the assistance of three-dimensional medical image information,preoperative treatment planning was performed in group B.After puncture treatment,therapeutic efficacy was evaluated by color ultrasound during follow-up.Results For treating huge hepatic hemangioma (tumor diameter ≥ 10.0 cm),the insertion number and pingyangmycin dosage in the group B were less than those in the group A [(6.2± 0.5)times vs (9.3±0.6) times,t=24.467,P=0.035;(99.2±8.0) mg vs (148.8±9.6) mg,t=34.613,P=0.029].The success rate of first treatment in the group B was higher than that in group A [73.6％(28/38) vs 100％(38/38),x2=131.91,P=0.032].Conclusion For huge hepatic hemangioma,the three-dimensional medical image information can be applied to reduce the insertion number and anesthetics dosage,improving the success rate of first treatment and therapeutic effect.