Objective To assess inter-observer variations(IOV)in the delineation of target volumes and organs-at-risk(OAR)for intensity-modulated radiotherapy(IMRT)of nasopharyngeal carcinoma(NPC)among physicians from different levels of cancer centers,thereby providing a reference for quality control in multi-center clinical trials.Methods Twelve patients with NPC of different TMN stages were randomly selected.Three physicians from the same municipal cancer center manually delineated the target volume(GTVnx)and OAR for each patient.The manually modified and confirmed target volume(GTVnx)and OAR delineation structures by radiotherapy experts from the regional cancer center were used as the standard delineation.The absolute volume difference ratio(△V_diff),maximum/minimum volume ratio(MMR),coefficient of variation(CV),and Dice similarity coefficient(DSC)were used to compare the differences in organ delineation among physicians from different levels of cancer centers and among the 3 physicians from the same municipal cancer center.Furthermore,the IOV of GTVnx and OAR among physicians from different levels cancer centers were compared across different TMN stages.Results Significant differences in the delineation of GTVnx were observed among physicians from different levels of cancer centers.Among the 3 physicians,the maximum values of △V_diff,MMR,and CV were 97.23%±83.45%,2.19±0.75,and 0.31±0.14,respectively,with an average DSC of less than 0.7.Additionally,there were considerable differences in the delineation of small-volume OAR such as the left and right optic nerves,chiasm,and pituitary,with average MMR>2.8,CV>0.37,and DSC<0.51.However,relatively smaller differences were observed in the delineation of large-volume OAR such as the brainstem,spinal cord,left and right eyeballs,and left and right mandible,with average△V_diff<42%,MMR<1.55,and DSC>0.7.Compared with the differences among physicians from different levels cancer centers,the differences among the 3 physicians from the municipal cancer center were slightly reduced.Furthermore,there were also differences in the delineation of target volumes for NPC among physicians from different levels cancer centers,depending on the staging of the disease.Compared with the delineation of target volumes for earlier stage patients(stages I or II),the differences among physicians in the delineation of target volumes for advanced stage patients(stages III or IV)were smaller,with average △V_diff and DSC of 98.31%±67.36%vs 69.38%±72.61%(P<0.05)and 0.55±0.08 vs 0.72±0.12(P<0.05),respectively.Conclusion There are differences in the delineation of GTVnx and OAR in radiation therapy for NPC among physicians from different levels of cancer centers,especially in the delineation of target volume(GTVnx)and small-volume OAR for early-stage patients.To ensure the accuracy of multicenter clinical trials,it is recommended to provide unified training to physicians from different levels of cancer centers and review their delineation results to reduce the effect of differences on treatment outcomes.

Objective:To explore the application effect of electronic Bowie&Dick test technology and to provide a scientific basis for ensuring the accuracy,sensitivity,convenience and sterilization safety of Bowie&Dick test results of pulsation pre-vacuum steam sterilizer.Methods:From July and October of 2023,Bowie&Dick test were performed on pulsating pre-vacuum steam sterilizers No.6 and No.7 using an electronic Bowie&Dick tester and three disposable chemical Bowie&Dick test kits.The test results of different Bowie&Dick tests for the same sterilizer and the same Bowie&Dick test type on two sterilizers were analyzed,the test temperature data and usage efficiency of electronic Bowie&Dick test equipment were analyzed.Results:The unqualified rate of sterilizer No.6 in the electronic Bowie&Dick test was compared with the unqualified rate of chemical Bowie&Dick test 1,test 2 and test 3,and the difference was statistically significant(x2=16.68,22.20,0.27,P<0.05).There was no significant difference in the test results of chemical Bowie&Dick test 1 and test 3 between the two sterilizers(x2=0.55,0.00,P>0.05).The temperature difference between inside and outside of the two sterilizers electronic Bowie&Dick testers was compared,and the difference was statistically significant(t=45.44,P<0.05).The display time of electronic Bowie&Dick test results and the storage time of test data were shorter than those of chemical BD test,and the differences were statistically significant(t=-29.80,t=-37.12,P<0.05).The physical parameter monitoring records of the two sterilizers were all qualified.Conclusion:The sensitivity and convenience of electronic Bowie&Dick testing are better than those of traditional chemical Bowie&Dick testing,which can increase the safety and reliability of sterilization,improve work efficiency,improve the safety of traceability information storage and the convenience of searching,which is a new trend of Bowie&Dick testing.

Postpartum visit are maternal and child health services provided by primary care workers at the homes of postpartum women within one week after hospital discharge. However, China currently lacks detailed work guidelines and standardized protocols for such services, making it difficult to effectively assess the competency of postpartum visitors and improve service quality. This study reviewed 24 Chinese and English articles retrieved using a combination of subject and free terms, selected based on inclusion and exclusion criteria. The key components of postpartum visit competency were summarized into 3 dimensions: Health assessment, health education, and communication/coordination. While home visitors were generally capable of performing basic physical examinations and providing health education for mothers and newborns, they often lacked the ability to deliver more specialized maternal and infant care. Factors affecting the effectiveness of postpartum visit services included the personal characteristics, technical skills, and training of the visitors. Strategies to improve competencies involve reforming training methods, enhancing home visit skills, and standardizing procedures. Currently, there is a lack of comprehensive tools to assess postpartum visit competency.
Humans ; Female ; Postnatal Care/standards* ; House Calls ; China ; Postpartum Period ; Infant, Newborn ; Pregnancy

Objective:To investigate the current status of knowledge, attitude and practice of palliative care among nurses in 10 general hospitals in Beijing and explore its influencing factors, so as to provide a reference for further training and management of palliative care.Methods:From March to April 2020, convenience sampling was used to select nurses from 10 general hospitals in Beijing for investigation with three questionnaires on knowledge, attitude and behavior of palliative care in Chinese. A total of 850 questionnaires were returned and 833 valid questionnaires were collected, with a valid rate of 98.00%. Multiple linear regression analysis was used to analyze the influencing factors of knowledge, attitude and behavior of palliative care among nurses.Results:The overall score for palliative care of nursing staff in 10 general hospitals in Beijing was (82.16±8.73) , with a score rate of 68.47%. The knowledge score was (12.36±4.14) with a score rate of 61.80%, and the attitude score was (36.85±3.97) with a score rate of 61.42%, and the behavior score was (32.95±5.84) with a score rate of 82.37%. Multiple linear regression analysis showed that participation in palliative care training, gender, job title, knowledge and attitude, and monthly income were the main influencing factors of nurses' knowledge, attitude and behavior on palliative care ( P<0.05) . Conclusions:The current status of palliative care awareness among nurses in Beijing general hospitals is at an intermediate level and needs to be further improved. Nursing managers should strengthen the training and education of nursing staff, improve relevant knowledge, palliative care attitudes and professional enthusiasm, so as to promote behavioral changes and improve the quality of clinical nursing.

OBJECTIVE: To explore the genetic cause for a child featuring growth and mental retardation. METHODS: Following conventional karyotyping analysis of the trio family, next generation sequencing (NGS) was carried out to explore the origin of the supernumerary marker chromosome. Fluorescence in situ hybridization (FISH) was used to confirm the result. RESULTS: The karyotypes of both parents were normal, while the proband was found to be 47,XX,+mar. NGS showed that the supernumerary marker has originated from chromosome 9p13.1p24.3 with a size of 39.77 Mb. FISH has confirmed the above finding. CONCLUSION The 9p13.1-p24.3 trisomy probably underlies the abnormal phenotypes of the child. Cytogenetic analysis combined with NGS and FISH can provide accurate diagnosis for such disorders.
Child ; Chromosomes, Human, Pair 9 ; genetics ; Cytogenetic Analysis ; High-Throughput Nucleotide Sequencing ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Trisomy

OBJECTIVETo assess the value of next generation sequencing (NGS) for the analysis of spontaneous abortion samples.

METHODSThe NGS analysis was carried out on 85 chorionic villi samples (taken between 42 days to 12 weeks of gestation) for which conventional cell culture has failed or chromosomal karyotyping has yielded normal or uncertain result.

RESULTSAmong 68 samples with a normal karyotype, the NGS analysis has identified 2 copy number variations (CNVs) and 2 chimeras. For 16 cases with failed cell culture, the NGS has identified 4 chromosomal abnormalities including 1 copy number variation and 3 numerical chromosomal aberrations. For 1 remaining case with uncertain karyotyping result, the NGS analysis has verified it as 46,XX,del(4) (p15.1p16.3).seq[GRCh37/hg19] (57 549 - 32 371 364)×1.

CONCLUSIONThe NGS analysis is capable of identifying novel CNVs in samples for which conventional cell culture may fail or karyotyping analysis may yield a normal result.

Abortion, Spontaneous ; genetics ; Adolescent ; Adult ; Cells, Cultured ; DNA Copy Number Variations ; Female ; High-Throughput Nucleotide Sequencing ; methods ; Humans ; Karyotyping ; Middle Aged ; Pregnancy ; Young Adult

Objective To systematically evaluate the efficacy and safety of amlodipine (A)/hydrochlorothiazide(H) versus val‐sartan(V)/hydrochlorothiazide(H) in treatment of essential hypertension .Methods Literature was retrieved online in Cochrane Li‐brary ,PubMed ,OVID ,MEDLINE ,EMBASE ,CBM ,CNKI ,VIP and Wan fang database up to November 2013 .Relevant magazines were retrieved manually .Quality of the included studies was assessed and Meta‐analysis was performed with RevMan 5 .2 software . Results Seven randomized controlled trials(RCTs) were finally included .Meta‐analyses showed that :in terms of lowering ABP ,V/H group was more effective than A/H group ,the difference was statistically significant (P<0 .05);there was no significant differ‐ence in the decreased value of clinic BP and the control rate of blood pressure between A /H group and V/H group(P>0 .05) .Ad‐verse events occurred less frequently with V/H group compared with A/H group ,the difference was statistically significant (P<0 .05) .Conclusion A/H treatment of essential hypertension is inferior to V/H ,and has more adverse events .

OBJECTIVETo investigate the status and risk factors for hematogenous occupational exposure in medical staff in an infectious disease hospital, and to provide a scientific basis for targeted preventive and control measures.

METHODSThe occupational exposure of 395 medical workers in our hospital was monitored from January 2012 to December 2014, among whom 79 individuals with occupational exposure were subjected to intervention and the risk factors for occupational exposure were analyzed.

RESULTSThe high-risk group was mainly the nursing staff (69.6%). The incidence of hematogenous occupational exposure was high in medical personnel with a working age under 3 years, aged under 25 years, and at the infection ward, accounting for 63.3%, 72.1%, and 72.2%, respectively. Hepatitis B virus, hepatitis C virus, Treponema pallidum, and human immunodeficiency virus were the primary exposure sources. Sharp injury was the major way of injury (91.1%), with needle stick injury accounting for the highest proportion (86.1%). Injury occurred on the hand most frequently (91.1%). The high-risk links were improper disposal during or after pulling the needle, re-capturing the needle, and processing waste, accounting for 46.8%, 17.7%, and 12.7%, respectively. Seventy-nine professionals with occupational exposure were not infected.

CONCLUSIONThe main risk factor for hematogenous occupational exposure in medical staff in the infectious disease hospital is needle stick injury. Strengthening the occupational protection education in medical staff in infectious disease hospital, implementing protective measures, standardizing operating procedures in high-risk links, and enhancing the supervision mechanism can reduce the incidence of occupational exposure and infection after exposure.

Hospitals ; Humans ; Incidence ; Infectious Disease Transmission, Patient-to-Professional ; prevention & control ; Medical Staff, Hospital ; Needlestick Injuries ; epidemiology ; Occupational Diseases ; prevention & control ; Occupational Exposure ; prevention & control ; Risk Factors

Objective To introduce small group learning in the course of introduction to gen-eral practice to cultivate students' ability of active learning and innovation. Methods Totally 221 students of 2008 grade A and B classes were enrolled as teaching objects and were divided into 20 groups. Introduction to general practice was used as learning materials. One week before the class, teacher gave students learning task and A and B classes carried on class discussion respectively. Re-view speaking was conducted by the representatives of groups. Effectiveness was evaluated through the observation,interview,questionnaire survey and answer scoring points. Results Overall support per-centage to small group learning was 91%. Percentages of students who believed that small group learn-ing was beneficial to cultivating the ability of active learning and innovation were 88% and 73% re-spectively. Conclusions Introducing small group learning in the course of introduction to general practice is effective and conductive to training students' ability to study and innovate.

This paper analyzes the recently epidemic status of schistosomiasis,the change of natural and social factors,and field survey and evaluation data of schistosomiasis in Ya’an City after Lushan Earthquake on April 20,2013,and proposes that it is necessary to strengthen the conventional schistosomiasis control measures,the control of exogenous infection sources,the con-trol of Oncomelania hupensis snails and health education for ensuring no major epidemics after the disaster. This paper also recom-mends the direction and suggestions for future schistosomiasis control in Ya’an City.