Objective:To explore the efficacy and adverse reactions of image-guided hypofractionated intensity-modulated radiotherapy (Ig-HypoRT) conbined with contralateral esophageal protection in treatment of patients with unresectable stage Ⅲ non-small cell lung cancer (NSCLC).Methods:The clinical data of 45 patients with unresectable stage Ⅲ NSCLC who were admitted to Xuzhou Cancer Hospital from January 2016 to January 2019 were retrospectively analyzed. Patients received induction chemotherapy with a platinum-based dual-drug combination regimen, followed by Ig-HypoRT with a total dose of tumor of 60-63 Gy/12- 18 times at 3.5-5.0 Gy/time. Contralateral esophagus was delineated as an organ at risk during radiotherapy, limiting V 45 Gy≤1.8 cc and V 55 Gy ≤0.4 cc. Patients' efficacy, survival and the occurrence of adverse reactions were observed. Results:Among 45 patients, there were 9 cases of complete remission, 31 cases of partial remission, 4 cases of stable disease and 1 case of disease progression, and the effective rate was 88.8% (40/45). The median follow-up time was 34 months, 45 patients had a median overall survival (OS) time of 25.0 months (95% CI 21.7-28.8 months), with 1-, 2-, and 3-year OS rates of 78.9%, 56.8% and 47.7%, respectively; the median progression-free survival (PFS) time was 18.5 months (95% CI 15.0-22.0 months), with 1-, 2- and 3-year PFS rates of 59.8%, 32.6% and 18.6%, respectively. The 3-year local recurrence rate was 9% (4/45). The incidence of grade 1-2 radioactive esophagitis was 80% (36/45); the incidence of grade 1-2 chest pain was 20% (9/45). The incidence of grade 3-4 adverse reactions were 13% (6/45), including 7% (3/45) of grade 3 pulmonary atelectasis, 4% (2/45) of grade 3 radioactive pneumonia, and 2% (1/45) of grade 4 hemoptysis. Conclusions:Ig-HypoRT combined with contralateral esophageal protection for unresectable stage Ⅲ NSCLC can improve survival rate and reduce esophageal adverse reactions of patients.

Objective:To explore the effects of psychological intervention based on resourcefulness theory on the management of aggression and violence attitude and resilience of emergency nurses.Methods:Totally 60 nurses who worked in the Emergency Department of the 904 Hospital, the People's Liberation Army Joint Logistic Support Force from January 2020 to December 2021 were selected by convenience sampling. According to the enrollment time, the nurses enrolled from January to December 2020 were included as the control group, and the nurses enrolled from January to December 2021 were included as the intervention group, with 30 nurses in each group. Nurses in the control group received routine psychological training, while nurses in the intervention group was trained with a psychological intervention program based on resourcefulness theory based on the training provided to the control group. The nurses were surveyed and the intervention effect was evaluated by Resourcefulness Scale, Management of Aggression and Violence Attitude Scale (MAVAS), Medical Professionals Resilience Scale (MeRS), and Nurses' Work Alienation Questionnaire (NWAQ) .Results:After intervention, the scores of Resourcefulness Scale, MAVAS and MeRS of nurses in the intervention group were higher than those in the control group, and the scores of NWAQ were lower than those in the control group, with statistical significance between the two groups ( P<0.05) . Conclusions:Psychological intervention based on resourcefulness theory can enhance the resourcefulness of emergency nurses, improve their management of aggression and violence attitudes, strengthen their deep understanding of work violence and their level of resilience, reduce their sense of alienation at work, and alleviate negative psychological emotions. Therefore, it is worth promoting in clinical practice.

Objective:To analyze the role of wechat combined with SBAR communication in emergency nursing management.Methods:From December 2019 to December 2020, 100 cases of patients in the emergency department of No.904 Hospital, Joint Logistics Support Force of PLA were randomly selected and divided into two groups according to the computer random table method, 50 cases in the control group were treated with routine nursing management, 50 cases in the study group were treated with Wechat combined with SBAR communication mode for management. The goal achievement, nursing service quality and nursing satisfaction of the two groups were compared.Results:The score of Nurse′s Performancefor Goal Attainment (NPGA) in the study group was 196.32 ± 20.36, which was higher than (165.24 ± 18.14) of the control group ( t=8.06, P<0.05), and the score of Servqual evaluation questionnaire (94.32 ± 3.36) was higher than (89.24 ± 3.14) of the control group ( t= 7.81, P<0.05). The difference of nursing satisfaction between the two groups was significant, the study group (92.00%, 46/50) was higher than (64.00%, 32/50) of the control group ( χ2=11.42, P<0.05). Conclusions:In the emergency nursing work, using wechat combined with SBAR communication management can effectively improve the quality of nursing service, improve work efficiency, and increase patients′ recognition of nursing staff.

Objective:To observe the effects of cervical region Ⅱ and oral target area optimization on therapeutic efficacy, salivary gland function and oral mucosal response during intensity modulated radiation therapy (IMRT) for oropharyngeal cancer.Methods:A total of 50 patients with oropharyngeal squamous cell carcinoma in Xuzhou Cancer Hospital from January 2012 to May 2017 were collected. According to the random number table, they were divided into normal radiotherapy group (the control group), oral and cervical target area optimization group (the observation group), 25 cases in each group. Both groups were treated with IMRT and platinum-chemotherapy. The control group received bilateral cervical region Ⅱ-Ⅳ lymphatic drainage area irradiation (the positive side of the cervical lymph node included Ⅰ B region), and bilateral cervical region Ⅱ was given a tumor dose of 60 Gy (positive lymph nodes were given intensified irradiation); the observation group was optimized for the target area, and the contralateral cervical region Ⅱ B (the side with no positive lymph node) was given a tumor dose of 50 Gy; the observation group's oral structure was delineated as an organ at risk and the average radiation dose (D mean) was limited to <32 Gy. The differences in radiation dose of parotid gland, acute oral mucosal reaction and long-term xerostomia (6 months after the end of radiotherapy), objective remission rate (ORR), local recurrence rate (LRR), 3-year overall survival (OS) were compared between the two groups. Results:In the control group, the contralateral parotid gland D mean was (29±4) Gy, the proportion of irradiation volume exposed to 34 Gy (V 34) was (48±5)%; in the observation group, contralateral parotid gland D mean was (23±3) Gy, V 34 was (41±5)%, and there are statistically significant differences between the two groups ( t values were 6.14, 4.98, all P < 0.05). In the control group, oral D mean was (35±6) Gy, the proportion of volume exposed to 30 Gy (V 30) was (36±5)%; in the observation group oral D mean was (29±4) Gy, V 30 was (28±4)%, and there were statistically significant differences between the two groups ( t values were 4.11, 5.98, all P < 0.05). The incidence of ≥ grade Ⅱ acute oral mucosal adverse reaction and the duration time of oral mucosal ≥ 2 weeks was 64% (16/25) and 76% (19/25), respectively in the control group, 36% (9/25) and 40% (10/25), respectively in the observation group; and the differences were statistically significant ( χ2 values were 3.92, 6.65; P values were 0.048, 0.009). The incidence of ≥ grade Ⅱ long-term xerostomia reaction was 72% (18/25) and 44% (11/25), respectively in the control group and the observation group, and the difference between the two groups was statistically significant ( χ2 = 4.02, P = 0.044). The ORR, LRR, and 3-year OS rates were 80%, 28%, 48% in the control group, and 76%, 24%, 44% in the observation group. There was no statistically significant difference in the OS between the two groups ( χ2 = 0.04, P = 0.849). Conclusions:Optimization of the target area of the oral and cervical region Ⅱ during IMRT for oropharyngeal carcinoma can improve the function of salivary glands, thereby reducing dry mouth and oral mucosal reactions, improving the quality of life of patients; and it does not affect the efficacy of tumor treatment.

Objective: To explore the relationship among cognitive flexibility, depression and eating attitude of adolescents and the influencing factors of eating attitude. Methods: A total of 1 231 subjects were assessed using general information questionnaire, Kutcher Adolescent Depression Scale 11 item(KADS-11), Cognitive Flexibility Inventory(CFI), Eating Attitude Test 26(EAT-26). Data were analyzed by independent sample t-test, univariate linear regression, spearman correlation analysis and Logistic regression. Results: There were significant differences in EAT 26 among adolescents between genders and between those with or without depression(P<0.01). Statistically significant differences were observed in CFI, flexible control and KADS 11 among adolescents with or without eating disorders(P<0.01). The scores of EAT 26 was negatively correlated with CFI (r=-0.19, P<0.01) and flexible control(r=-0.23, P<0.01). And there was a significant positive correlation between EAT 26 and KADS 11(r=0.23, P<0.01). Female(OR=2.40, 95%CI=1.87-3.23), depression (OR=1.76, 95%CI=1.35-2.29) and poor flexible control (OR=1.94, 95%CI=1.48-2.54) were risk factors for eating disorders. Conclusion Female, individuals with depressive symptoms or with poor flexible control ability are more likely to have eating disorders which need more attention.

Objective To observe the clinical efficacy of large fraction intensity modulated radiation therapy combined with apatinib in the treatment of elderly patients with non-small cell lung cancer and superior vena cava syndrome. Methods A retrospective analysis was made on 46 elderly patients with non-small cell lung cancer and superior vena cava syndrome who were admitted to Xuzhou Cancer Hospital Affiliated to Jiangsu University from February 2015 to December 2017. The patients were divided into observation group and control group with 23 cases in each group. The control group received radiation therapy only. Apatinib was enrolled in the observation group on the first day synchronously. The remission time of symptoms, short-term efficacy, occurrence of adverse reactions and 1-year overall survival rate were observed and compared between the two groups. Results The complete remission rate was 78.3％ (18/23) in the observation group and 43.3％ (10/23) in the control group, and the difference between the two groups was statistically significant (χ 2 = 4.60, P < 0.05). The effective response rate was 86.9％ (21/23) in the observation group and 65.2％ (15/23) in the control group, and the difference between the two groups was statistically significant (χ 2 = 4.294, P < 0.05). The main adverse reactions in the two groups were radioactive esophagitis, radiation pneumonitis and leukopenia, and most of them were grade Ⅰ-Ⅱ, there was no significant difference between the two groups (all P > 0.05). The 1-year overall survival rate was 56％ in the observation group and 40％ in the control group, and the difference between the two groups was statistically significant (P = 0.009). Conclusion Large fraction intensity modulated radiation therapy combined with apatinib is effective in the treatment of elderly patients with non-small cell lung cancer and superior vena cava syndrome, and theadverse reactions are well tolerated.

Objective To observe the clinical effect of intensity modulated radiation therapy (IMRT) combined with apapatinib mesylate in the treatment of elderly patients with locally advanced cardia adenocarcinoma and its effect on vascular endothelial growth factor receptor (VEGFR). Methods Forty-six elderly patients with locally advanced cardia cancer who were unwilling to accept surgery or couldn't get complete removal of cancers in Xuzhou Hospital Affiliated to Jiangsu University between January 2015 and April 2016 were collected. All the patients were randomly divided into the control group (23 cases) and the observation group (23 cases) according to the random number table method. The control group received radiotherapy alone. In the observation group, oral apatinib (500 mg/d) was taken in the first day of radiotherapy after breakfast until the disease progress or death occurred. Results The total effective rate was 92 % (19/23) in the observation group and 60 % (10/23) in the control group. There was a significant difference between the two groups(χ2=5.86,P <0.05). After treatment, the average level of VEGFR in both groups was decreased[(76.3±4.9)vs.(55.0±2.3)pg/ml],and there was a significant difference between the two groups (t = 3.93, P < 0.05). The common adverse reactions were blood adverse reactions and gastrointestinal reactions. The incidence rate of gastrointestinal reaction was both 83 %, and the blood adverse reaction was 100 %, and there was no significant difference between the two groups (both P > 0.05). Hypertension, proteinuria and rash response in the observation group were increased compared with the control group,but noⅣ grade of adverse reactions occurred. The median progression-free survival time was 10 months in the observation group and 8 months in the control group respectively (P = 0.01). Conclusion IMRT combined with apatinib in the treatment of elderly patients with locally advanced gastric cardia has a favorable efficacy and tolerance.

Objective To explore the Reading man flap for the treatment of soft tissue defects in distal fin-gers. Methods From May, 2014 to June, 2017, Reading man flaps were transferred in the emergency room to repair soft tissue defects in distal fingers in 46 patients. There were 28 cases of finger pulp defects, 6 cases of dorsal defects and 12 cases of finger stump defects with the size of soft tissue defects ranged from 1.0 cm×0.9 cm to 2.2 cm×2.0 cm (average, 1.2 cm×1.3 cm).The volar, dorsal and hybrid flaps were 28, 6 and 12 cases respectively.The average size of the major flap and minor flap were 1.8 cm×1.2 cm and 1.4 cm×0.8 cm, respectively. All donor sites were sutured di-rectly.All patients were followed-up by review in the outpatient department. Results The consumed operative time was 35-48 min, with an average of 37.8 min. Prophylactic antibiotics and wound dressing were conducted postopera-tively. The tip of the minor flaps occurred inflammation and small blister in 2 cases and eased by removal of the tip sutures.Traumatic neuralgia occurred in 1 case and self-healed after 3 months.Twenty-six cases were followed-up at least 11 months, which were 16 cases of finger pulp defects, 3 of dorsal defects and 7 of finger stump defects. On an average of 10.5 (9-27) months followed-up, all flaps survived. Except 4 cases with slim hook nail deformity, the re-maining flaps were observed with satisfactory texture and appearance, the bulky deformity and scar contracture did not occur.Two points distinguishment on the major and minor flaps were 3.3-6.2 (average, 4.5)mm and 5.5-9.8(average, 7.1)mm respectively. According to the Trial Standard for Evaluation of Upper Limb Function of Chinese Society of Hand Surgery, it was excellent in 28 cases, good in 11 cases and moderate in 7 cases, with the overall excellent and good rate of 84.8%. Conclusion The Reading man flap is a good option for treatment of the small size soft tissu de-fect in distal fingers with the advantages of simple procedure, high success rate, good appearance and sensory recovery.

Objective:To explore the possible mechanism of astragaloside involved in the mouse podocytes injury induced by TGF-β1 in vitro.Methods:Mouse podocytes were cultured in vitro and then all cell were divided into 5 groups:normal control group , TGF-β1 treatment group ,TGF-β1 treatment +astragaloside low dose group ,TGF-β1 treatment +astragaloside middle dose group and TGF-β1 treatment +astragaloside high dose group.The proliferation rate of each group was investigated by MTT assay ,the expression of TRPC6 protein and mRNA were measured by Western blot and RT-PCR respectively after 48 hours.Results:TGF-β1 can significantly inhibit the proliferation of podocytes ( P<0.05) ,fusions of foot processes or even effaced of podocytes were observed .TGF-β1 could also increase the expression of TRPC6.Astragaloside could reduce the inhibition of TGF-β1 to the proliferain of podocytes significantly ,make the cell shape tend to be normal,and reduce the expression of TRPC6 mRNA and protein with dose-effect relation.Conclusion:TRPC6 play an impor-tant role in the TGF-β1 induecd podocytes injury .Astragaloside can alleviate podocytes injury by reduce the expression of TRPC 6.

AIM: To explore the effect of pyrrolidine dithiocarbamate (PDTC), an NF-κB inhibitor, on the proliferation and apoptosis of human multiple myeloma U266 cells and its mechanisms.METHODS: The U266 cells were treated with PDTC at different concentrations (0, 25, 50, 100 and 200 μmol/L) in vitro.The growth inhibitory rate of the U266 cells was detected by CCK-8 assay and cell counting.The cell cycle of the U266 cells was determined by flow cyto-metry, and the apoptosis was examined by flow cytometry with Annexin V-FITC/PI staining.The effect of PDTC on the expression of DNA methyltransferase 1 (DNMT1) at mRNA and protein levels was measured by RT-qPCR and Western blot, respectively.The effects of PDTC on the protein levels of NF-κB (P65), DNMT1, Bcl-2, cyclin D1, cleaved caspase-3 and cleaved caspase-8 were determined by Western blot.RESULTS: The protein level of NF-κB (P65) was decreased after treatment with PDTC for 48 h or 72 h.PDTC inhibited the proliferation of U266 cells in both dose-and time-dependent manners.After treatment with PDTC for 48 h, the percentage of U266 cells in G2 phase increased compared with control group (P<0.05).PDTC induced the apoptosis of U266 cells in a dose-dependent manner.The expression of DNMT1 at mRNA and protein levels decreased (P<0.05).The results of Western blot showed that the expression of Bcl-2 in PDTC groups decreased, while the protein levels of cyclin D1, cleaved caspase-3 and cleaved caspase-8 were higher than those in control group (P<0.05).CONCLUSION: The NF-κB inhibitor PDTC inhibits the proliferation of U266 cells by inducing cell apoptosis.It may be related to the down-regulated expression of DNMT1, cell cycle arrest and activation of the apoptotic pathways.