The ethics committee of organ transplantation technology and clinical application in a hospital has encountered some difficulties and typical cases in its review work and practice for many years. Sometimes, it is difficult to make a decision in these dilemmas. Based on the previous experience of the hospital in the ethical review of organ donation and transplantation, combined with two typical cases, this paper discussed and analyzed two review points of whether the voluntary unpaid donation and the principle of informed consent were met, and whether the risk-benefit ratio was reasonable, and put forward relevant ethical and legal countermeasure for further research by institutional ethics committees and other parties, in order to provide reference for discussing the practical problems and ethical confusion of ethical review of organ donation and transplantation.

Objective To construct the competency and professional activities of pediatric rehabilitation therapists in China based on World Health Organization rehabilitation competency framework(RCF). Methods Competencies,activities,and tasks in the field of pediatric rehabilitation were collected through literature,offi-cial websites and interviews with key informants using RCF.Competency requirements suitable for pediatric re-habilitation therapists were selected,competency dimensions and activities were adjusted based on the context of pediatric rehabilitation therapy.Similar content was integrated through thematic framework analysis and content analysis.Competencies were matched with typical professional activities.A competency framework and profes-sional activities for Chinese pediatric rehabilitation therapists were developed,and the Delphi method was used to survey 22 experts,ultimately confirming competency dimensions and activity content. Results The enthusiasm coefficient of experts was 88.00%,the authority coefficient was 0.84,and the expert opinions were more focused on importance.The CV values of all competency dimensions and activities were≤0.25,and the W test was statistically significant(P<0.05),indicating a high degree of coordination among experts.A com-petency framework for pediatric rehabilitation therapists in China,included 17 competency dimensions and 17 professional activities. Conclusion To explore the competency of typical professions through RCF may enhance the application of research re-sults in the field of rehabilitation,which provides a reference for clarifying the job content and cultivating the competency of Chinese pediatric rehabilitation therapists.

Objective:To explore the value of monoenergetic imaging on dual-layer spectral detector CT combined with individual injection protocol of contrast medium in brain CT angiography (CTA).Methods:Seventy-six patients who underwent brain CTA on the Philips IQon dual-layer spectral detector CT and individual injection protocol of contrast medium in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from August to November 2020 were retrospectively analyzed. Objective and subjective evaluation of image quality was performed in conventional energetic images (conventional group) which derived from 120 kVp hybrid iterative reconstruction algorithm and 50 keV virtual monoenergetic images (test group) which derived from spectral reconstruction algorithm. The objective evaluation content included CT values, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of internal carotid artery and middle cerebral artery, CT values and standard deviation (SD) of brain parenchyma. The subjective evaluation was completed by two senior radiologists according to the 5-point scale, and the inter-agreement between two radiologists was evaluated by Kappa test. Paired t test or Wilcoxon rank test was used for analysis between two groups. Results:The SNR and CNR of both internal carotid artery and middle cerebral artery, as well as CT values of internal carotid artery, middle cerebral artery and brain parenchyma, were significantly higher in test group than that in conventional group (all P<0.001). The subjective scores of two radiologists for test group were both 5 (5, 5) points, and the subjective scores for conventional group were both 4 (4, 4) points. The subjective scores of the radiologists were in good agreement, and the Kappa values were 0.74 and 0.84 respectively. The subjective scores of test group were significantly higher than that of conventional group ( Z=-11.15, P<0.001). Conclusion:Monoenergetic imaging on dual-layer spectral detector CT combined with individual injection protocol of contrast medium can improve SNR, CNR and the image quality of brain CTA.

The ethics committee of organ transplantation technology and clinical application in a hospital has encountered some difficulties and typical cases in its review work and practice for many years. Sometimes, it is difficult to make a decision in these dilemmas. Based on the previous experience of the hospital in the ethical review of organ donation and transplantation, combined with two typical cases, this paper discussed and analyzed two review points of whether the voluntary unpaid donation and the principle of informed consent were met, and whether the risk-benefit ratio was reasonable, and put forward relevant ethical and legal countermeasure for further research by institutional ethics committees and other parties, in order to provide reference for discussing the practical problems and ethical confusion of ethical review of organ donation and transplantation.

【Objective】 To evaluate the clinical characteristics and risk factors of adverse transfusion reactions (ATR) in Chinese adults, and to provide evidence-based medical evidence for early prevention. 【Methods】 The controlled trial (CT) of risk factors for ATR in Chinese adults were collected through PubMed, Embase, Cochrane Library, CNKI, CMB, VIP and Wanfang database, and the retrieval time was from the establishment of those databases to January 31, 2021 Literature was selected and extracted by 2 researchers according to inclusion and exclusion criteria. Meta-analysis was performed by RevMan5.3 software. 【Results】 A total of 28 049 patients in 12 literature were included, 1 190 patients were included into the ART group and 26 859 into the non-ART group. Meta-analysis results showed that the incidence of ART was 1.63% (410/24 361), mainly allergic reaction (43.90%, 188/410) and non-hemolytic fever (40%, 164/410). Primary hematologic disease (OR=27.11, 95%CI=21.64~33.96, P<0.01), allergy history(OR=15.52, 95% CI=2.20~109.38, P<0.01), transfusion history(OR=9.36, 95% CI=7.77 ~11.28, P<0.01), numbers of blood transfusion > 2 (OR=7.06, 95% CI=5.64~8.84, P<0.01), >30 min interval between blood issuing and transfusion (OR=3.40, 95% CI=2.88~4.00, P<0.01), transfusion of plasma (OR=2.67, 95%CI=2.20~3.25, P<0.01) and cryoprecipitate (OR=1.43, 95%CI=1.21~1.68, P<0.01) were risk factors for ART, while the transfusion of red blood cells/white blood cells/platelets (OR=0.29, 95% CI=0.24~0.35, P<0.01) was the protective factor. Sensitivity analysis showed that the results were stable. 【Conclusion】 According to the correlation intensity, the risk factors for ART in Chinese adults from high to low are primary blood disease, history of allergy, transfusion history, numbers of blood transfusion >2, >30 min interval between blood issuing and transfusion, transfusion of plasma and cryoprecipitates, while transfusion of red blood cells/white blood cells/platelets was the protective factor.

Objective:To investigate the value of the size-specific dose estimate (SSDE) on dose estimations of children's head CT scans.Methods:A retrospective study was conducted on plain head CT scans of 252 patients with the 64-row detector CT device of Discovery 750HD in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to September in 2019. The volume CT dose index (CTDI vol)values were recorded. The head circumference (HC), area, and CT value were measured using a self-developed computer program, and the water equivalent diameter (WED), size-specific conversion factors ( f293 and f220), and absorbed dose (SSDE 293 and SSDE 220) were calculated according to the AAPM reports 293 and 220.The patients were divided into three groups by the quartering meth odaccording to their HC(<47.8 cm, 47.8-52.7 cm, >52.7 cm)and four groups based on their ages(0-2, 3-6, 7-10 and 11-14 years old). The difference between parameters ( f220 and f293, SSDE 220 and SSDE 293、SSDE 293 and CTDI vol) were compared for different groups, and the correlation of HC with f293 and SSDE 293 was analyzed. Results:There was an overestimation of f220 by 11.11% ( t=252.61, P<0.05) compared with f293. SSDE 220 was overestimated by 10.31% ( t=228.21, P<0.05) compared with SSDE 293, and SSDE 293 was underestimated by 9.60% ( t=-31.34, P<0.05)compared with CTDI vol. For the three HC groups, SSDE 220 was overestimated by 8.54%, 10.37%, and 11.57% ( t=73.73, 438.58, 275.52, P<0.05)compared with SSDE 293, and SSDE 293 was underestimated by 1.30%, 9.79%, and 14.61% ( t=-1.91, -60.95, -47.64, P<0.05)compared with CTDI vol. For the four age groups SSDE 220 was overestimated by 8.45%, 10.00%, 10.57%, and 11.36% ( t=63.58, 232.29, 247.84, 302.95, P< 0.05)compared with SSDE 293, and SSDE 293 was underestimated by 1.49%, 8.27%, 10.63%, and 13.78% ( t=-1.83, -28.27, -37.30, -49.80, P< 0.05)compared with CTDI vol. Furthermore, HC was highly correlated with f293 and SSDE 293 ( r2=0.88 and 0.76, respectively, P< 0.05). Conclusions:The radiation dose in children′s head CT scanning can be more accurately estimated according to the AAPM Report 293, while it can be overestimated by CTDI vol. Meanwhile, the CT radiation dose can be patently overestimated with the AAPM Report 220 compared with Report 293.HC is closely correlated with f293 and SSDE 293 and it can be used to estimatee more accurately for SSDE and the radiation dose received by children during head CT scanning.

Objective:To investigate the application value of third-generation dual-source CT(3-G DSCT) low-dose scan mode combined with iterative reconstruction technology in the screening of COVID-19 and to evaluate the radiation dose.Methods:One hundred and twenty patients suspected of COVID-19 from December 2019 to February 2020 were retrospectively analysed and randomly divided into two groups (test group and conventional group, 60 patients in each). The parameters for test group included 3-G DSCT, Turbo Flash scan mode, CARE kV, with reference 90 kV, pitch 2.0, and ADMIRE algorithm, while those parameters for conventional group included the 128-slice CT, conventional spiral scan mode, 120 kV, pitch 1.2, and FBP algorithm. The CT values of aorta, spinal posterior muscle, and subcutaneous fat, the aortic noise, signal-to-noise ratio (SNR), and contrast noise ratio (CNR) were compared to evaluate the image quality between two groups. Two experienced doctors scored the image quality using a double-blind method, and compared the CT dose index volume (CTDI vol), dose-length product (DLP), and effective dose ( E) of the two groups. Results:The CT value of the aorta and spinal posterior muscle and the aortic SNR in the test group were (45.38±4.77), (53.41±8.44) HU, and 2.82±0.59, and significantly higher than those in the conventional group [(39.68±6.26), (42.66±6.32) HU, 2.58±0.61, t=5.608, 7.897, 2.162, P<0.05]. The aortic noise, CNR and subjective scores between the two groups had no significant difference( P>0.05). The CTDI vol, DLP, and E in the test group were (3.09±1.02) mGy, (107.57±32.81) mGy·cm, (1.51±0.46) mSv, significantly lower than those in the conventional group [(7.00±1.80) mGy, (261.65±73.93) mGy·cm, (3.66±1.03) mSv; t=-14.680, -14.756, -14.756, P<0.05]. Conclusions:In the screening of COVID-19, using low-dose scanning mode of 3-G DSCT combined with iterative reconstruction technology would provide diagnostic quality images and meanwhile effectively reduce the radiation dose and improve the SNR of the image.

Objective:To explore a low dose CT scanning method on novel coronavirus (COVID-19) pneumonia based on infection prevention and control.Methods:A total of 140 patients with confirmed novel coronavirus pneumonia in Xiehe hospital from January 20, 2020 to February 28, 2020 were undertaken CT scan and divided into low dose group and conventional dose group. The patients in low dose group(120 kV, 31 mAs) consisted of mild type(51), severe type(15) and critically ill type(4); and those in conventional dose group(120 kv, adaptive milliampere second) consisted of mild type(48), severe type(17) and critically ill type(5). The effective radiation dose, SNR and CNR of CT scan were compared between two groups. A senior and a middle radiologist made the image subjective quality scores, respectively.Results:The effective dose in low dose group was lower than that of conventional dose group( t=-48.343, P<0.05). There was no significant difference in SNR and CNR between two groups( P>0.05). For severe and critically ill patients, the score in low dose group was significantly lower than that in conventional dose group( t=-2.781, P<0.05). There was no significant difference in scores between two groups for mild patients( P>0.05). Conclusions:Low-dose CT scanning could meet the image quality needs for patients with COVID-19 and meanwhile significantly reduce the radiation dose.

Since February 9th, 2020, the mobile CT in Jianghan mobile cabin hospital had begun to be used for scanning patients with COVID-19.The mobile CT has played an irreplaceable role in clinical diagnosis with its unique advantages. During CT scanning, the technicians should not only ensure that the patients receive the radiation dose as low as possible, but also be aware of the importance of the infection prevention and control. Meanwhile, we need concern the technicians about the psychological problems and should take effective action when they occured.

Objective:To understand the provision of preventive medicine curriculum system in the training programs of clinical medicine in the era of Healthy China.Methods:A total of 36 training programs of clinical medicine were selected from different areas of China for a statistical analysis on their basic information, involvement of concept of preventive medicine in program objectives, and provision of preventive medicine curriculum system.Results:Of all the 36 training programs of clinical medicine, 22(61%) have no mentions of prevention medicine in their program objectives; only one university’s training program states preventive medicine together with basic medicine and clinical medicine as one of the three main disciplines. The total class hours for the core courses of preventive medicine (hygiene, medical statistics, epidemiology, evidence-based medicine, and social medicine) range from 80 to 252, with an average of (156.7±43.2) hours. The average percentage of class hours for preventive medicine courses among the total class hours is 4.3%±1.1% (range: 2.5%-7.5%), and obvious differences exist among universities.Conclusions:In current training programs of clinical medicine, the proportion of prevention medicine curriculum is insufficient, the percentage of hours for preventive medicine course is very low, and the differences among various universities are obvious. It is urgently needed to strengthen preventive medicine curriculum in training programs for clinical medical students in new era. It is suggested to further promote the concept of putting prevention first, improve the curriculum system of clinical medicine, intensify the integrated development preventive medicine and clinical medicine and pay attention to clinical research ability enhancement for the further improvement of training program of clinical medicine.