Objective To understand the individual dose monitoring of occupational external exposure for radiation workers in Wuhan City and analyze the dose change trend, and to provide a scientific basis for radiation protection management of radiation workers. Methods The data on the monitoring results of occupational external exposure of radiation workers in Wuhan City from 2017 to 2021 were collected through the National Personal Dose Registration System, and the individual dose levels of different years, different occupational categories, and different levels of hospitals were analyzed. Results A total of 9 134 radiation workers were investigated, with an average annual effective dose per capita of 0.20 mSv/a. The overall personal annual effective dose from 2017 to 2021 showed a decreasing trend (P<0.001). The per capita annual effective dose in medical applications was higher than that in industrial applications (0.22 mSv vs 0.14 mSv; P<0.001). Among medical applications, diagnostic radiologists had the highest average annual effective dose (0.27 mSv), and among industrial applications, industrial irradiators had the highest average annual effective dose (0.29 mSv). The proportion of personnel with personal annual effective doses exceeding 1 mSv was higher in interventional radiology and industrial nondestructive testing (4.90% and 1.90%). The annual effective dose per capita in Class I and unrated hospitals was higher (0.35 mSv). Conclusion The average annual effective dose of radiation workers in Wuhan City has decreased year by year and has not exceeded the national standard limit (20 mSv). Radiation protection management still needs to focus on personnel with personal annual effective doses exceeding 1mSv in interventional radiology and industrial nondestructive testing, and supervision over primary healthcare institutions and industrial radiation should be strengthened.

Objective To investigate the effect of left ventricular assist device (LVAD) and aortic graft angle on hemodynamics of aortic valve. Methods Three models of aorta and aortic valve with 45°, 60° and 90° anastomosis angles between LVAD and aorta were constructed, and an in vitro pulsating table was built for in vitro experiments. Using particle image velocimetry (PIV) system, three moments in the cardiac cycle ( T1 systolic peak, T rapid closure, T3 diastolic peak), were selected to study the hemodynamic state of aortic valve. Results Velocity vector, vorticity and viscous shear stress were used to evaluate the effect of LVAD anastomosis angle on hemodynamics of aortic valve. During the period of rapid valve closure, with the increase of graft angle, the blood flow velocity near the valve wall, the average vorticity and the maximum viscous shear stress all increased. Conclusions When the graft angle is lower, the impact velocity of blood on the valve is smaller, and the shear force on the valve decreases, so that the valve is in a better hemodynamic environment. This study provides references for the selection of anastomotic angles in clinical operations.

Objective:To attain comprehensive insight into the diagnostic X-ray equipment and examination frequency in radiological diagnosis and treatment institutions in Wuhan, with the purpose of assisting the health administration department in formulating medical exposure protection strategies and efficiently allocating radiological diagnosis and treatment resources.Methods:Using the census method, questionnaires on the basic information on diagnostic X-ray equipment and the annual number of examinations filled out in 2022 by the 1 030 radiological diagnosis and treatment institutions (excluding military and armed police hospitals) were collected through the Wuhan Prevention and Treatment Information Management Platform for Occupational Diseases. To obtain the data on number and frequency of diagnostic X-ray examinations, the different types of diagnostic X-ray examinations were divided by the total number of permanent residents by the end of 2021 in Wuhan.Results:In Wuhan, 1 030 radiological diagnosis and treatment institutions had 7 062 radiation workers and 2 540 diagnostic X-ray units of various types. 37.76% of units and 75.01% of radiation workers were concentrated in tertiary hospitals. The number of diagnostic X-ray units per million population was 186.10, with the top two being 48.65 DR machines per million population and 31.21 intraoral dental machines per million population. The total number of diagnostic X-ray examinations was 11 884 582, with plain radiographs and computed tomography (CT) examinations accounting for 43.61% and 43.59% of the total, respectively. The annual frequency of examinations was 379.75 and 379.52 per 1 000 population, respectively. Radiodiagnosis and treatment resources were higher in central urban areas than that in remote urban areas.Conclusions:The development of diagnostic X-ray equipment in Wuhan was experiencing rapid growth, with potential for further expansion, and the frequency has not yet recovered to the level before the COVID-19 pandemic. The allocation of radiodiagnosis and treatment resources between central urban areas and remote urban areas needs to be coordinated and the management of medical radiation protection should be continuously strengthened, so as to promote the sustainable development of inter-regional radiodiagnosis and treatment, and ensure the health and safety of examinaed patients and indivuduals.

Objective:To explore application and effect evaluation of group prenatal care model in primiparas.Methods:A total of primiparas were recruited from December 2019 to May 2020 in the department of Obstetric clinic. Group prenatal care was carried out in the intervention group and the routine nursing was implemented in the control group. Positive capital Questionnaire and pregnancy outcome were used to evaluate the effects of intervention.Results:The scores of pre-intervention, intervention for one month and post-intervention of PPQ was (123.87±18.86), (130.70±13.41) and (142.23±8.37) respectively. Higher level of natural childbirth rate([86.7%] versus [63.3%]; χ2=4.356; P=0.037<0.05) and lower rate of perineal injury([16.7%] versus [43.3%]; χ2=5.079; P=0.024<0.05). The rate of exclusive breastfeeding during hospitalization ([90.0%] versus [66.7%]; χ2=4.812; P=0.028<0.05) after intervention as compared with those who received routine care. Conclusion:Group prenatal care intervention model can improve the level of positive psychological capital and pregnancy outcome.

Objective:To summarize the anesthesia management of living small bowel transplantation.Methods:Severn patients undergoing living and allogeneic small bowel transplantation for the first time were selected.The intraoperative hemodynamics, indexes of blood gas analysis, body temperature and blood transfusion and volume of liquid infused were analyzed.Postoperative outcomes were tracked.Results:Six cases survived and were successfully discharged from hospital successfully, and one patient died.In the operation room, 71% patients were successfully extubated after surgery.Compared with the values during anatomical separation period, Hb during vascular anastomosis and intestinal reconstruction periods and concentration of Ca 2+ during intestinal reconstruction period were significantly decreased, and the blood glucose concentration during vascular anastomosis period were increased ( P<0.05 or 0.01). Compared with the values during vascular anastomosis period, the blood glucose concentration was increased significantly during intestinal reconstruction period ( P<0.05). Crystalloid solution (57±30) ml/kg and colloid solution which mainly containing 20% albumin (15±13) ml/kg were infused mainly during anatomical separation and vascular anastomosis periods in all the patients. Conclusion:The condition of successful living small bowel transplantation is fully evaluation and preparation before surgery.Intravenous-inhalational anesthesia combined with transverses abdominis plane block and rational infusion of colloid solution with vasoactive drugs to maintain hemodynamics stability and monitor blood gas, body temperature, active adjustment of electrolytes and internal environment and stable body temperature can be helpful in maintaining perioperative stable vital signs during the perioperative period, removing the tracheal tube early at the end of surgery, and reducing the development of postoperative complications in patients undergoing living small bowel transplantation.

OBJECTIVE： To provide reference for optimizing the structure of family doctor team and improving rational drug use in primary medical institutions of China. METHODS： Combined with relevant literatures and author’s work experience， the situation of rational drug use in primary medical institution and the development of family doctors team were reviewed. The problems existing in the rational drug use service provided by family doctor team were analyzed to put forward relevant suggestions. RESULTS & CONCLUSIONS： There are some problems in primary medical institutions， such as blind selection or abuse of antibiotics， high frequency of injection use. Provinces and municipalities that implement the family doctor model in China have gradually formed five kinds of family doctor contract service modes， such as “1+1+1” contract service mode， “basic package+personality package” contract service mode. The existing family doctors team have problems in the development of rational drug use services， such as lack of pharmaceutical service personnel， low business ability， limited pharmacy knowledge of team members， and insufficient participation of pharmacists. A reasonable family doctor team should pay attention to the cultivation of pharmacy service pharmacists， strengthen pharmacy professional knowledge training of medical staff， and build a corresponding “pharmaceutical joint” platform by means of the medical association platform if necessary so as to promote rational drug use in primary medical institutions.

Objective To investigate the effect of ultrasound-guided serratus anterior plane (SAP) block on postoperative pain in patients undergoing breast prosthesis implantation. Methods Fifty patients scheduled for breast prosthesis implantation under general anesthesia, aged 18-40 years, BMI 18-24 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n = 25 each) : SAP block group (group N) and control group (group C). Ultrasound-guided bilateral SAP block was performed before induction of anesthesia, and 0.375％ ropivacaine 20 ml was injected bilaterally in group N, while the equal volume of normal saline was used instead in group C. The visual analogue scale (VAS) in resting state was evaluated at 2, 6, 12 and 24 h after surgery. Also, the perioperative opioid consumption, the numbers of PCIA pressing attempts and rescue analgesia, adverse effects and patients′ satisfaction degree within 24 h postoperatively were recorded. Results Compared to group C, the scores of VAS at postoperative 2, 6, 12 and 24 hand the perioperative consumption of opioid were significantly lower, the numbers of PCIA pressing attempts and rescue analgesia were decreased, while patients′ satisfaction degree was increased in group N (P ＜ 0.05).There were no significant differences in adverse reactions between these two groups. Conclusion Ultrasound-guided SAP block reduces the postoperative pain in patients undergoing breast prosthesis implantation.

Objective To investigate the distribution and changes of pathogens in intensive care unit of our hospital from 2010 to 2015,and provide treatment suggestions for infection.Methods The data of pathogens and multi-drug resistant organisms(MDROs)in ICU from 2010 to 2015 were analyzed retrospectively by WHONET5.6,Microsoft Office Excel2007 and SPSS19.0.Results The numbers of pathogens in ICU were increasing year by year while the top six were Acinetobacter baumanni,Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,Staphylococcus aureus and Candida albicans.The dominant MDROs were multi-drug resistant Acinetobacter baumanni,multi-drug resistant Pseudomonas aeruginosa,extended spectrum β lactamase producing Escherichia coli and Klebsiella pneumonia,methicillin-resistant coagulase negative Staph-ylococcus and methicillin-resistant Staphylococcus aureus,etc.There were statistically dramatic significant differences of most MDROs during the six years(P<0.01).Conclusion The pathogens of ICU were mainly bacteria related to the healthcare associated infection,and the multi-drug resistance was obviously in dynamic change as well as most pathogens.As a suggestion,antibiotic agents should be used rationally according to the antimicrobial susceptibility results for treating the MDROs.

Objective: To compare the differences and caused of patients' utilization of Traditional Chinese Medicine service under three basic medical insurance systems.Methods: Using self-developed questionnaire,random sample survey was conducted among the basic medical insurance outpatients in five hospitals in Nanjing and Lanzhou.The survey content included the basic information of the patients,the utilization of Traditional Chinese Medicine outpatient clinics,the utilization of Traditional Chinese Medicine service items,and the suggestions for the Traditional Chinese Medicine service.Results:①The utilization rate of the Traditional Chinese Medicine out-patient clinics in new rural cooperative medical system patients was much lower than that in urban basic medical in-surance patients.②The utilization rate of Traditional Chinese Medicine service projects in patients under basic medical insurance for urban employees was higher than those under medical insurance for urban residents and new rural cooperative medical system patients.In all Traditional Chinese Medicine service projects,the utilization rate of cupping project was the highest(48.3％).③ The gap between urban and rural areas made the utilization rate of Traditional Chinese Medicine service projects different among patients participating in basic medical insurances.④ The most expected suggestion of patients was the improvement of the efficacy of Traditional Chinese Medicine(68.5％),followed by the improvement of medical insurance-related reimbursement ratio(65.2％)and the in-crease of reimbursement items(64.3％).Conclusion: The government should increase the financial input in new rural cooperative medical system and improve the basic medical insurance system.Traditional Chinese Medicine medical institutions should improve the quality of services in order to achieve the fairness in the provision of health services.

Objective The aim of this study was to investigate the anti-tumor effect on sequential injection of heterogeneic lymphocyte(HL)and autogeneic lymphocyte(AL). Methods The HL was prepared by using CC3HF1 mice as feeders. CB6F1 mice were used as recipients,and Hepa1-6 cells were inoculated into the recepients′groin subcutis. A cryoprecipitate was extracted from mouse plasma by freeze-thaw method to prepare fibrin Glue(FG);FG was combined with HL or AL to be FG-HL or FG-AL. The experimental treatment consisted of two stages. At first stage(15 d),FG-HL were injected on the surface of the tumor-bearing tissue of the recipients as the experimental group,and FG-phosphate buffer saline(FG-PBS)were injected on the surface of the tumor-bearing tissue of the rest recipients as the control group. The immunological factors such as tumor cell killing rate of the spleen lym-phocytes and numbers of lymphocytes,CD8 +T and NK in the two groups were detected,respectively. At later stage(10 d),a part of mice were randomly selected from the experimental and control groups,and the lymphocytes( AL) were used to form FG-AL,which were injected on the surface of tumor-bearing tissues in the rest of mice. Tumors in mice of the two groups were compared for tumor volume and tumor inhibition rate. Results The tumor cell killing rate of AL in the experimental group(26. 70 ± 7. 22) was signifi-cantly higher than that in the control group(5. 70 ± 2. 68)(P<0. 01). Numbers of mouse spleen lymphocytes,CD8 +T cells and NK cells were significantly higher than the corresponding values of the control group(P<0. 05). After the two-stage treatment,the aver-age tumor volume of the experimental group[(1.20 ±0.33)cm3]was significantly smaller than that of control group[(2.05 ±0.37) cm3](P<0. 01). The tumor inhibition rate in the experiment group was 41. 5% when compared to the control group. Conclusion Local injections of FG-HL followed by FG-AL can significantly inhibit the growth of transplanted tumor in mice;it is expected to become an anti-tumor biological therapy.