Objective:To evaluate the effectiveness of a mobile extracorporeal cardiopulmonary resuscitation (ECPR) team in treating cardiac arrest (CA) in the mountainous regions of southwest Zhejiang Province, and to provide clinical insights for ECPR in patients with prolonged low blood flow time in such areas.Methods:A retrospective analysis was conducted on 55 CA patients treated with ECPR at Lishui People's Hospital from June 2020 to June 2024. These patients were compared with 55 CA patients treated with ECPR in urban areas during the same period. The mobile team from our center established ECMO support at county-level hospitals before transferring patients to our hospital's ECMO treatment center for further care. General patient data and blood gas analysis results before and 2 hours after ECPR were collected. Clinical data differences between the two groups were compared, and factors influencing patient prognosis were analyzed using univariate and multivariate Cox regression analyses.Results:The average age of the patients was (52.45 ± 15.66) years, with an average low blood flow time of 151.42 ± 49.31 minutes. The 30-day survival rate was 23.64%, and the rate of good neurological recovery was 18.18%. Although the survival rate and good neurological function rate were lower than those of ECPR patients in urban areas, the differences were not statistically significant ( P > 0.05). Univariate Cox analysis revealed that defibrillation rhythm, low blood flow time, pH before and after ECMO, blood lactate levels before and after ECMO, and hemoglobin significantly influenced the prognosis of ECPR patients ( P < 0.05). Multivariate Cox analysis identified post-ECMO pH ( HR = 0.037) and post-ECMO blood lactate levels ( HR = 1.078) as independent prognostic factors for ECPR patients ( P < 0.05). Conclusions:Despite the longer low blood flow time in CA patients from mountainous areas, the mobile ECPR team can effectively enhance the treatment success rate of these patients through ECPR.

Objective:To compare the effects of two methods of marking surface landmarks on the patient’s positional stability when using a multifunctional body board in combination with thermoplastics to fix the abdominal and pelvic areas for radiotherapy patients.Methods:50 subjects who underwent positional fixation using a multifunctional body board in combination with thermoplastics from August 2022 to January 2023. The subjects were divided into two groups, A and B, with 25 cases each, according to the different methods of body surface marking. In group A, landmarks were marked on the body surface on the top edge of the thermoplastics. In group B, three sets of surface landmarks were marked on the patient’s body according to the laser line on the projection of the patient’s body surface when the thermoplastics were completed. Manual registration is performed using L3 to L5 as the main registration targets. The pre-treatment CBCT image is used to analyze the first-time positioning pass rate, setup errors in the x-, y-, and z-axis directions, and the distribution of positive and negative setup errors in both groups of patients. Results:The pass rates of the first-time positioning of patients in Groups A and B were 76.9% and 86.1%, respectively, which met the clinical requirements. Group B had a better first-time positioning pass rate than group A, and the difference between the two groups was statistically significant ( P < 0.05). The pendulum errors of group B were smaller than those of group A in both the x-axis and y-axis (all P < 0.05), and the difference between the two groups in terms of the pendulum errors in the z-axis direction was not statistically significant (all P > 0.05). The difference in the frequency distribution of the pendulum error in the positive and negative directions of the x- and z-axis between the two groups was not statistically significant (all P > 0.05). The difference in the frequency of distribution of the pendulum error in the positive and negative directions of the y-axis between the two groups was statistically significant ( P < 0.05). Conclusions:The proposed two methods of surface landmark marking are generally in line with the positioning requirements for conventional fractionation radiotherapy for abdominal and pelvic patients. Using a laser line on the projection of the patient’s body surface for three sets of surface landmark markings produces smaller setup errors and is better than using the top edge of the thermoplastics for surface landmark markings, improving the positional stability of abdominal and pelvic patients.

Objective To investigate the effects of enteral ecological nutrition on intestinal immune function and Hh protein expression in intestinal mucosa of rats with small intestinal injury and explore the mechanism. Methods Thirty male clean grade Wistar rats were selected as study subjects. The rats were randomly divided into a model group and an enteral ecotrophic group with 15 rats in each group. The small intestinal injury model was prepared by trauma method. After successful modeling, Six hours after successful establishment of the model, the rats in the two groups were fed with 753.12 kJ·kg-1·d-1 energy, 3 times a day. The rats in the model group were fed with conventional diet, while the rats in the enteral ecotrophic group were fed with enteral nutrition emulsion +Lactobacillus, bifidobacterium triple viable bacteria by intragastric administration of 1×107 cfu/d. After 10 days, the rats were killed, the small intestine of the two groups was dissected and stained with hematoxylin-eosin (HE) staining, and the morphological changes of small intestinal mucosa (villus height, glandular recess depth, mucosal thickness) were observed in the two groups; the expressions of CD3+, CD4+, CD8+ positive T cells in small intestinal mucosa were evaluated by immunohistochemistry; the expression of Hh protein in small intestinal mucosa was detected by Western Blot in the two groups. Results On the first day after the establishment of the model, the weight of rats in both groups was lower than that before the modeling [model group (g): 118.0±4.2 vs. 121.7±5.2, enteral ecotrophic group (g):117.5±4.7 vs. 120.8±5.0, P > 0.05], from the fifth day after the modeling, the weight of the rats in the enteral ecotrophic group was significantly higher than that of the model group (g: 127.1±5.0 vs. 123.2±4.2, P < 0.05), continued to 10 days (g: 142.5±6.6 vs. 135.3±6.2, P < 0.05). After the establishment of the model for 10 days, the small intestinal villus height, glandular recess depth, mucosal thickness and percentages of CD3+, CD4+ and CD8+ positive T cells in enteral ecotrophic group were significantly higher than those in model group [villus height (μm): 221.7±25.0 vs. 159.5±20.8, glandular recess depth (μm): 79.39±12.65 vs. 67.87±7.79, mucosal thickness (μm): 254.7±51.8 vs. 209.0±27.2, CD3+: 0.193±0.035 vs. 0.125±0.031, CD4+: 0.130±0.027 vs. 0.104±0.015, CD8+: 0.165±0.026 vs. 0.137±0.027, all P < 0.05]. The expression of Hh protein in the enteral ecotrophic group was obviously higher than that in model group (Hh/β-actin: 0.16±0.04 vs. 0.04±0.02, P <0.05). Conclusion Enteral ecological nutrition may promote the repair of intestinal mucosa and the improvement of immune function level by enhancing the expression of Hh protein in small intestinal mucosa of rats with small intestinal injury.

OBJECTIVE:To explore the effect and mechanism of ulinastatin on blood coagulation dysfunction of ICU sepsis pa-tients. METHODS:64 ICU sepsis patients were randomly divided into treatment and control groups,with 32 cases in each group. Control group received routine treatment,while treatment group was additionally given Ulinastatin injection on the basis of control group,100 000 u dissolved in 500 ml 15% Glucose injection or Sodium chloride injection intraveously,3 times/d,for consecutive 7 days. The mechanical ventilation time,ICU length of stay and survival rate within 30 d were analyzed statistically in 2 groups. The platelet count (PLT),prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),D-dimer (D-D), white blood cell count (WBC) and IL-6 were detected before treatment and on first,third and seventh day after treatment. RE-SULTS:After treatment,mechanical ventilation and ICU length of stay in treatment group were significantly shorter than in control group,and survival rate was significantly higher than control group,with statistical significance (P<0.05). The peripheral blood WBC and IL-6 level of treatment group were significantly lower than those of control group,with statistical significance(P<0.05). There was a significant difference in blood coagulation indicators between treatment group after 7 days of treatment and before treat-ment,control group after treatment(P<0.05). The blood coagulation indicators recovered to normal level after 7 days of treatment. CONCLUSIONS:Ulinastatin can improve blood coagulation of ICU sepsis patients by a mechanism of inhibiting the release of in-flammatory cytokines and corresponding blood coagulation factor function.

This article describes the physical, technical, and dosimetric aspects of total body irradiation (TBI) that was carried out by using 6MV X-Ray from Varian 2300 C/D Linear Accelerator at a distance of 450 cm from target to the treatment table and at a gantry angle of 270°.The dose to lung tissue was limit by setting the individual lead compensators customized before, and using DPD-510 to monitor the absorbed dose of the reference point the absorbed dose in depth of half of body will be (Din+Dout)/2 after taking treatment in both AP position and PA position.