Objective To observe the reproducibility of radiomics feature(RF)extracted from virtual monoenergetic image(VMI)of rabbit VX2 hepatoma models obtained with 3 different dual-energy CT(DECT)systems,and to explore relationship of reproducibility and diagnostic performance of RF.Methods Fifteen rabbits with VX2 hepatoma were randomly divided into 3 groups(each n=5).Contrast-enhanced abdominal CT scanning under volume CT dose index(CTDIvol)levels of 6,9 and 12 mGy were performed with dual-source DECT(dsDECT),rapid kV switching DECT(rsDECT)and dual-layer detector DECT(dlDECT),respectively.VMI were reconstructed at 10 keV increments from 40 to 140 keV.RF were extracted from VMI,the reproducibility was assessed using intra-class correlation coefficient(ICC),and those with ICC≥0.8 were considered as reproducible RF.The percentage of reproducible features(denoted by R)were compared among different scanner pairings and different CTDIvol levels.Within each CTDIvol group,the reconstruction energy levels yielding the maximum number(denoted by N)of common RF across different scanner pairings were identified.The receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated,and the diagnostic efficacies of reproducible RF and other RF were compared under optimal reproducible conditions.Spearman correlation coefficient between ICC and the corresponding AUC of RF were calculated.Results RrsDECT-dsDECT(6.45％,95％CI[2.36％,8.87％])was higher than RdlDECT-dsDECT(0.72％,95％CI[0.15％,1.79％])and RrsDECT-dlDECT(1.43％,95％CI[0.60％,4.06％])(all adjusted P＜0.05),R9mGy(3.70％,95％CI[1.31％,5.73％])and R12mGy(2.63％,95％CI[0.60％,6.69％])were higher than R6mGy(1.31％,95％CI[0.12％,1.55％])(all adjusted P＜0.05).The optimal reproducible reconstruction energy levels of RF under CTDIvol of 6,9 and 12 mGy concentrated at 50-70 keV.AUC of reproducible RFs were higher than of other RF(all adjusted P＜0.05)and had certain correlation with the reproducibility(rs=0.102-0.516,P＜0.05).Conclusion The reproducibility of RF extracted from contrast-enhanced VMI CT images of rabbit VX2 hepatoma models associated with DECT scanner,CTDIvol level and reconstruction energy level.RF with higher reproducibility might have better diagnostic performance.

Objective:To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge.Methods:At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station.Results:There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission.Conclusions:To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.

Objective:To investigate the diagnostic value of Flt3 ligand (Flt3L) and growth arrest specific protein 6 (Gas6) in post-chemotherapy infection of patients with non-Hodgkin′s lymphoma.Methods:A total of 94 NHL patients admitted to Wuhan No.1 Hospital for chemotherapy from July 2019 to October 2020 were collected, and divided into infection group ( n=40) and non-infection group ( n=54). Fifty healthy subjects at the same period were selected as the control group to analyze the expression levels of Flt3L, Gas6 and general inflammatory indicators among the three groups. The relationship between Flt3L, Gas6 and general inflammatory indicators were analyzed. The predictive value of Flt3L and Gas6 for post-chemotherapy infection in NHL patients was analyzed by ROC curve. Kaplan-Meier curve was used to analyze the infection status of NHL chemotherapy patients with serum Flt3L and Gas6 levels. Results:The levels of serum Flt3L [807.80(215.10-1 232.00) pg/ml] and Gas6 [20.04(13.14-27.52) ng/ml] in the infection group were higher than those in the non-infection group and the control group, and the differences were statistically significant (all P<0.05);The levels of serum Flt3L[887.3(321.60-1 367.00) pg/ml] and Gas6[25.24(17.61-42.86) ng/ml] in the severely infection group were higher than those in the mildly infection group, and the differences were statistically significant (all P<0.05). serum Flt3L was negatively correlated with WBC and positively correlated with IL-6;serum Gas6 was negatively correlated with WBC.ROC curve analysis showed that the AUC and 95% CI of Flt3L and Gas6 were 0.814 (0.718-0.909) and 0.644 (0.523-0.765), respectively. The combined application of serum Flt3L with hsCRP, PCT and IL-6 significantly improved the diagnostic efficiency, and the area under the curve was 0.956, 0.923 and 0.865, respectively. Kaplan-Meier curve analysis showed that when serum Flt3L≥649.80 pg/ml and serum Gas6≥21.50 ng/ml in NHL chemotherapy patients, the infection rate was significantly increased ( P all<0.05). Conclusion:Serum Flt3L and Gas6 levels in post chemotherapy-infection of NHL patients were significantly increased and correlated with the severity of infection. Early detection of serum Flt3L levels is helpful to predict the diagnosis of infection in NHL patients after chemotherapy.

【Objective】 To investigate the expressions of NLRP1 and NLRP3 in the colon of ulcerative colitis (UC) patients and analyze the correlation of the expressions with severity of UC, endoscopic manifestations and related laboratory indicators. 【Methods】 We collected biopsical specimens obtained with colonoscopy in 46 patients with UC (22 mild cases and 24 moderate to severe cases) and 20 cases of normal control group. We used the disease activity index to evaluate the Mayo UC inflammatory activity and immunohistochemical method to detect the protein expression levels of intestinal mucosal NLRP1 and NLRP3 in the tissue. RT-PCR was used to detect the expressions of NLRP1 and NLRP3 mRNA in intestinal mucosal tissues. Meanwhile, the colonoscopy, serum uric acid, C-reactive protein, serum sedimentation rate, platelet count, low-density lipoprotein, and cholesterol of UC patients were also counted to further analyze the relationship between NLRP1 and NLRP3. 【Results】 The expressions of NLRP1 and NLRP3 protein and mRNA in colonic mucosal tissues of UC patients were significantly higher than those of normal controls (P<0.05). Compared with that in mild UC, the expression of NLRP1 in colonic mucosal tissues of moderate and severe UC patients was significantly increased (P<0.05). There was no significant difference in the expressions of NLRP1 and NLRP3 in colonic mucosal tissues of UC patients with different lesion ranges. NLRP1 expression was positively correlated with Mayo overall score, Mayo endoscopic score, erythrocyte sedimentation rate, and C-reactive protein (P<0.05), NLRP3 expression was positively correlated with C-reactive protein (P<0.05), but not correlated with Mayo overall score, Mayo endoscopic score, or erythrocyte sedimentation rate. NLRP1 expression was positively correlated with low-density lipoprotein and platelet (P<0.05), but not with uric acid or cholesterol. NLRP3 was positively correlated with low-density lipoprotein, uric acid and cholesterol (P<0.05), but not with platelet. 【Conclusion】 NLRP1 and NLRP3 may be involved in the pathogenesis of UC and related to disease activity. Therefore, they can be used as molecular targets for targeted therapy, and NLRP1 can be used as a predictor of mucosal healing.

Objective:To explore the application effect of high quality nursing resources sinking in primary hospitals nursing quality management under the model of overall trusteeship.Methods:In January 2017, through the establishment of a nursing custody assistance team, high-quality nursing resources were integrated to sink to the primary hospitals (Ningbo Daxie Development Zone Hospital) , improving the nursing management system and nursing quality control three-level system, strengthening nursing quality supervision, performance assessment and diversified training of nursing talents. The quality of care, nurse bedside comprehensive ability, nurse job satisfaction, professional identity, and patient satisfaction before and after trusteeship for 2 years were observed and compared.Results:After 2 years of trusteeship, the scores of nursing quality in all dimensions and total score were significantly higher than those before the trusteeship, and the differences were statistically significant ( P<0.05) . After 2 years of trusteeship, nurse bedside comprehensive ability and job satisfaction of the nurses were significantly higher than those before the trusteeship (χ 2=16.97, 40.08; P<0.01) . After 2 years of trusteeship, the scores of professional identity in all dimensions and total score were higher than those before the trusteeship, and the differences were statistically significant ( P<0.01) . After 2 years of trusteeship, the patient satisfaction was higher than that before the trusteeship, and the difference was statistically significant (χ 2=30.40, P<0.01) . Conclusions:Under the overall trusteeship mode, high-quality nursing resources are sunk into primary hospitals, and scientific nursing management and talent training innovation mode are implemented, which effectively improve the nursing quality of the trusteeship hospital, improve the job satisfaction of nurses and patients' satisfaction, and promote the sustainable development of the trusteeship hospital.

Objective:To explore the influencing factors of fatigue after stent implantation in patients with airway stenosis.Methods:Totally 104 patients with airway stenosis hospitalized in a hospital from July 2016 to June 2019 were selected, and all the patients were planned to received stent implantation. The patients were evaluated with Identity-Consequence Fatigue Scale (ICFS) postoperatively, and divided into the fatigue group and the non-fatigue group according to the evaluate results. The data of the two groups were consulted, and their gender, age, primary tumor, combined underlying disease, postoperative physical activity, pathological staging, history of radical surgery before stenting, preoperative radiotherapy and chemotherapy, degree of stenosis, type of stenosis, infiltration juga, stent placement site, and re-intervention after stenting were analyzed. Univariate and Logistic regression analysis were performed over the above influencing factors.Results:All the 104 patients with airway stenosis completed postoperative fatigue evaluation. The total score of ICFS was (82.16±8.07) . The scores of postoperative fatigue, attention, vitality, energy, daily activities and the total score were higher than those before operation, and the differences were statistically significant ( P<0.01) . Among the 104 patients with airway stenosis, 28 developed postoperative fatigue, with an incidence of 26.92%. Univariate and multivariate Logistic analysis revealed that postoperative physical activity, pathological staging, infiltrating and re-intervention after stenting were the main influencing factors to fatigue after stent implantation in patients with airway stenosis ( P<0.05) . Conclusions:Patients with airway stenosis have a high incidence of fatigue after stent implantation, which is affected by many factors. Effective intervention measures should be formulated according to the risk factors in order to reduce the incidence of postoperative fatigue.

Objective To analyze the clinical efficacy and prognosis of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases.Methods Medical records of 104 patients with SBRT for pulmonary oligometastases in our hospital between 2012 and 2018 were retrospectively reviewed.SBRT was performed by intensity modulated radiation therapy (IMRT) technique before December 2015,and by helical tomotherapy (HT) technique in others.The local control (LC),progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.Cox-regression was used for univariate analyses and multivariate analyses.The radiotherapy-related adverse events were evaluated by NCICTCAE V4.0.Results The 1-,2-and 3-year LC rates were 86.6％,75.9％ and 72.3％,respectively.The 1-,2-and 3-year PFS rates were 40.9％,28.4％ and 22.1％,respectively.The 1-,2-and 3-year OS rates were 75.9％,53.2％ and 43.53％,respectively.The median OS time was 26.6 months.Multivariate analyses showed that the pathologic type of primary tumor,the volume of lung oligometastases and the carcino-embryonic antigen (CEA) level before SBRT were the independent prognostic factors of LC (x2 =28.66,P＜0.05).The way of tumor progression after SBRT was the independent prognostic factor of OS (x2=40.01,P＜0.05).Meanwhile,there were no significant differences in the LC and OS between HTSBRT and IMRT-SBRT.Radiation pneumonitis was the major adverse event of SBRT (n =25,24.04％).Less than 7％ patients experienced grade 2 and above radiation pneumonitis.Conclusions SBRT shows high local control rates and tolerable adverse events in the treatment of pulmonary oligometastases.There were no significant differences in the clinical efficacy and adverse events between HT-SBRT and IMRT-SBRT,which means they are all suitable for clinical application.

Objective To evaluate the clinic effect of transcatheter arterial chemoembolization (TACE) by using arsenic trioxide (ATO) drug-bearing CalliSpheres beads (CB) in treating BCLC stage B hepatocellular carcinoma (HCC) . Methods The clinical data of 13 patients with advanced HCC, who received TACE by using CB loaded with ATO (CBATO) during the period from January 2017 to September 2017, were retrospectively analyzed. The clinical data, imaging materials, laboratory examinations, interventional complications, prognosis, etc., were summarized and evaluated. Results The patients were followed up for9-15 months, with a median period of 11 months. The survival rate was 100％. One, 3, 6 and 9 months after treatment, the disease remission (CR+PR) rates were 76.9％, 76.9％, 69.2％ and 61.5％ respectively, and the disease control rates were 92.3％, 92.3％, 92.3％ and 84.6％ respectively. In all 13 patients, no severe complications such as hepatic failure, renal insufficiency, bone marrow suppression, liver abscess, bile leakage complicated by infection and gastrointestinal bleeding occurred. Conclusion For the treatment of BCLC stage B HCC, TACE by using CBATO is safe and effective with reliable short-term effect.

Objective To compare the efficacy of partial splenic embolization (PSE)with 150－350 μm and 350－560 μm polyvinyl alcohol (PVA).Methods A total of 24 patients were analyzed retrospectively in this study.Among them,9 patients underwent PSE with PVA of 1 50－350 μm (group A)and 1 5 patients with PVA of 350－560 μm (group B).Hematological parameters including white blood cell and platelet counts before and 1 week after surgery were compared between the two groups,as well as postoperative complications. Results The white blood cell and platelet counts were both significantly increased after 1 week of surgery compared with that before surgery (both P＜0.05).Furthermore,group A had obvious advantage over group B in increasing platelets (P＝0.05).The incidences of postoperative complications were 100% (9/9)in group A and 87% (13/15)in group B,respectively,but the incidence and severity of complications between two groups were comparable.Conclusion PSE with PVA of 1 50－3 50 μm has advantage in postoperative platelet improvement over PVA of 350－560 μm.

Target delineation is the key and difficult point in radiation oncology teaching. Combined with the teaching experience in department of cancer radio-chemotherapy, Zhongnan hospital of Wuhan university, this study focused on target delineation to explore the teaching mode and method of radiation oncology. Self-directed learning was combined with teacher's lecturing and guiding. By enhancing tumor imaging teaching and basic theory of tumor radiotherapy, students can grasp the essence and detail of target delineation and build individualized and precise radiotherapy. Finally, a new teaching mode combining students' autonomous learning with teachers' teaching and guide is established. Taking the radiation therapy of breast cancer as an example, We briefly described the concrete application of this teaching system.