Using high-energy proton to image the region of interest can directly obtain the accurate estimation of the proton stopping power of the lesions,which is of great significance to reduce the range uncertainty in proton therapy.As a fundamental function of proton computed tomography(CT),radiographic imaging plays a crucial role in assisting clinical positioning.The study develops a compact proton CT detector based on an active array pixel CMOS chip in Monte-Carlo simulation toolkit Geant4,and evaluates the radiographic imaging capability of the system using 180 MeV protons.The angles of tracks are successfully reconstructed.CTP404,CTP528,and the CTP515 of specific materials are used for simulation,obtaining the spatial and density resolutions,and measuring the proton relative stopping power(RSP).The image signal-to-noise ratio is improved when using 2° proton scattering angle cut-off value.The spatial resolution is 3-4 lp/cm measured using CTP528 module.The density resolution is better than 0.05 g/cm3,and the RSP resolution is within 5%when CTP404 module is used.Through the imaging of CTP515 phantom of specific material,it is demonstrated that the system has potential for imaging common human tissues.

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【Objective】 To explore the effects of early application of erythropoietin (EPO) in patients with anemia after renal transplantation. 【Methods】 Patients who underwent renal transplantation in the First Affiliated Hospital of Soochow University were retrospectively analyzed. According to whether EPO was applied after operation, the patients were divided into EPO group and routine group. Patients with delayed renal function recovery were excluded, and the remaining patients were further analyzed. The general, laboratory and follow-up data of the two groups were compared, and adverse drug reactions were observed. 【Results】 The hemoglobin (P=0.026), red blood cell count (P=0.038) and hematocrit (P=0.011) in EPO group were higher than those in the routine group 2 weeks after operation, while the postoperative serum creatinine level was lower (P=0.001). Since the first week after operation, the reticulocyte count in EPO group was significantly higher than that in routine group (P<0.01). There was a negative correlation between hemoglobin and serum creatinine in EPO group at week 1 (r=-0.375, P=0.010) and week 2 (r=-0.386, P=0.008). During the treatment, 6 patients showed transient elevation of serum potassium, which returned to normal after symptomatic treatment, and no obvious adverse drug reactions were observed. 【Conclusion】 Continuous application of erythropoietin in the early stage after renal transplantation can significantly improve anemia in renal transplant patients and promote the recovery of renal function.

Objective:To estimate in-hospital mortality after knee replacement (KR) and to assess its trend and risk factors in China.Methods:We included patients undergoing KR in the Hospital Quality Monitoring System in China (2013-2019) to estimate in-hospital mortality after KR and assessed relation of patient's and hospital's characteristics (year of surgery, age, gender, marital status, primary indication, Charlson comorbidity index, geographic location, hospital type, hospital volume of KR, and surgery type) to in-hospital mortality using multivariable Poisson regression.Results:The annual amount of KR has increased from 20 307 in 2013 to 35 757 in 2019, and has maintained an upward trend for 7 years. The mean age of patients having KR increased from 64.9 years in 2013 to 66.6 years in 2019. Of the total 218 923 KRs, 63 deaths (0.29‰) occurred within 30 days before discharging. Older age was associated with higher in-hospital mortality ( P for trend <0.001). Male gender had higher incidence of in-hospital mortality compared with female [relative risk (RR), 2.5; 95% CI: 1.5, 4.1]. Single marital status was associated with higher, albeit non-statistically significant, in-hospital mortality than married patients (RR, 2.1; 95% CI: 0.9, 4.6). Higher Charlson comorbidity index was associated with increased risk of in-hospital mortality ( P for trend <0.001). Risk of in-hospital mortality decreased with more hospital-year knee replacement surgeries ( P for trend <0.001). In-hospital mortality varied by geographic regions, with the lowest mortality in East region (0.16‰), followed by South-West (0.31‰), South-Central (0.31‰), North region (0.33‰), North-West (0.54‰) and North-East (0.59‰). Conclusion:In-hospital mortality after KR in China was relatively low. Older age, male gender, higher Charlson comorbidity index and lower hospital-year knee replacement surgeries were risk factors for in-hospital mortality. The mortality varied greatly according to the geographic location of hospital.

OBJECTIVES: We assessed the role of social support in presenteeism by examining organizational commitment among Chinese healthcare workers. METHODS: One thousand four hundred thirty-four healthcare workers from 6 hospitals in 4 Chinese cities completed a questionnaire measuring presenteeism, social support, and organizational commitment. With organizational commitment as the mediator, regression analyses and structural equation modeling were used to test the model. RESULTS: Organizational commitment was directly inversely associated with presenteeism (β = - 0.42, p < 0.001). Coworker support was moderately but significantly inversely associated with presenteeism (β = - 0.15, p < 0.001), but the path from supervisor support to presenteeism was not significant (β = 0.05, p > 0.05). The correlation between supervisor support and coworker support was significant (β = 0.71, p <0.001). Supervisor support and coworker support were significantly positively associated with organizational commitment (β = 0.41, p < 0.001, and β = 0.14, p < 0.001, respectively). CONCLUSIONS Supervisor support was more important in promoting organizational commitment, while coworker support was more effective in reducing presenteeism. The mediating effect of organizational commitment was significant.

Objective: To investigate the effect of clopidogrel on antiplatelet therapy in patients with coronary artery disease (CAD) combining chronic kidney disease (CKD) in order to provide a medication reference in clinical practice. Methods: We retrospectively investigated 423 CAD patients with coronary angiography (CAG) conifrmed diagnosis in our hospital from 2014-01 to 2014-09. According to the value of eGFR, the patients were classiifed into 2 groups:CAD+ CKD- group,n=257 patients with eGFR ≥ 90 ml/(min?1.73 m2), including 182 male and 75 female at the mean age of (60.39 ± 11.09) years, and CAD+CKD+ group,n=166 patients with eGFR < 90 ml/(min?1.73 m2), including 107 male and 59 female at the mean age of (65.80 ± 10.84) years. The patients were treated either by aspirin 0.1 g/d with clopidogrel 75 mg/d for at least 7 days, or by PCI operation with the load of aspirin 0.3g and clopidogrel 300 mg. The thrombelastography was conducted to examine and compare the inhibitory rates of ADP receptor and arachidonic acid (AA) pathway in platelet between 2 groups. Results: The inhibitory rate of platelet ADP receptor in CAD+CKD- group (64.9 ± 27.2) % was higher than that in CAD+CKD+ group (56.6 ± 27.4) %,P=0.039. Based on clinical standard of platelet’s ADP and AA inhibitory rates, in CAD+CKD- group, there were 24/257 (9.4%) of patients only insensitive to clopidogrel, in comparison with 25 (9.7%) of patients only insensitive to aspirin,P=0.99. While in CAD+CKD+ group, there were 21/166 (12.7%) of patients only insensitive to clopidogrel, in comparison with 11 (6.6%) of patients only insensitive to aspirin,P= 0.045. Conclusion: Clopidogrel has decreased effect on anti-platelet therapy in CAD patients combining with CKD, such patients have reduced sensitivity to relevant medication.

Objective To investigate the repair effects of co-expression of the VEGF and BMP genes via an adeno-as-sociated viral vector on early steroid-induced avascular necrosis of the femoral head in rabbits. Methords To construct ani-mal model of early SANFH and screen by MRI. The SANFH animal were divided into rAAV-IRES-hrGFP(AAV-GFP), rAAV-hVEGF165-IRES-hrGFP(AAV-VEGF), rAAV-hBMP-7-IRES-hrGFP(AAV-BMP)and rAAV-hVEGF165-IRES-hBMP-7(AAV-VEGF/BMP)groups. The four group virus vectors were injected into core decompression region at the dose of 25μl/site after core decompression operation directly. Repair effects of rAAV vector on early SANFH in rabbits were evaluated by Western blot assay, HE staining, immunohistochemical staining, MRI, radionuclide bone scan, blood vessel counting detected by ink perfusion and fro-zen section, Micro-CT and biomechanical strength detection on the 12th week post-injection. Results Model success ratio was 73.33%. rAAV-hVEGF165-IRES-hBMP-7 virus vector efficiently expressed hVEGF165 and hBMP-7 genes on the 12th week after rAAV injection. hVEGF165 protein secreted in vivo promoted metabolism in core decompression region by increasing the quantity of new vessels and improving the blood supply;hBMP-7 protein secreted in vivo promoted new bone formation in core decompres-sion region by increasing bone mineral density and improving bone biomechanical strength. The AAV-VEGF/BMP group can pro-mote repair effects more effectively than AAV-VEGF group or AAV-BMP group. Conclusion The adeno-associated viral vectors co-expressing hVEGF165 and hBMP-7 can promote repair effects on early SANFH in rabbits by increasing the blood supply and strengthening the bone quality of femoral head.

Objective To investigate the application prospect of Biolog automatic analyzer for microbes in the identification of common dermatophytes. Methods Clinical isolates of dermatophyte were identified to species level based on phenotypes and DNA sequence. The strains of Trichophyton rubrum, Trichophyton mentagrophyte, Trichophyton tonsurans, Microsporum canis, Microsporum gypseum and Epidermophyton floccosum were inoculated into FF microplates, and the utilization of 95 different carbon sources were recorded.The growth and reaction spectrum of these strains were described and identification database was set up. Results There was a great difference in the utilization of carbon sources among different fungal species. The utilization of raffinose could differentiate Trichophyton mentagrophyte and Trichophyton tonsurans from the other four Trichophyton. Sebacic acid could differentiate Trichophyton mentagrophyte from Trichophyton tonsurans.Meanwhile, Trichophyton rubrum could be differentiated from Microsporum gypseum, Epidermophyton floccosum and Microsporum canis by utilization of fumarate and succinate. Microsporum gypseum could be identified by use of alanine and phenylalanine. The utilization of dextrin could distinguish Epidermophyton floccosum from Microsporum canis. Conclusion The Biolog automatic analyzer for microbes has the ability to identify common dermatophytes to species level based on their specific phenotype.

Objective To elucidate the prevalence of vitamin D insufficiency and deficiency in chronic kidney diseases (CKD) patients and provide the evidence for treatment of these patients. Methods Clinical data of 358 inpatients with CKD from stage 1 to stage 5 were analyzed retrospectively. Level of 25 (OH)D3 in these inpatients, as well as the levels of intact parathyroid hormone (iPTH), hemoglobin (Hb), serum creatinine (Scr), urea nitrogen (BUN), carbon dioxide combining power (CO2CP), alhumin (Alb), serum calcium (Ca) and blood serum (P) were examined. Correlation between 25 (OH)D3 and parameters was analyzed. Results The mean level of 25 (OH)D3 in these CKD patients was (18.58±11.7) μg/L, which was significantly lower than that of normal reference (P<0.01). The 25(OH )D3 levels of CKD patients from stage 1 to stage 5 were (25.84±9.71) μg/L, (20.76±6.99) μg/L, (20.40±17.02) μg/L, (19.49±11.29) μg/L, and (14.16±7.98) μg/L respectively. The prevalence of vitamin D defieiency was 39.66%, and from CKD stage 1 to stage 5 was 5.00%, 17.50%, 37.21%, 42.37% and 57.14%. The prevalence of vitamin D insufficiency was 44.97%, and from CKD stage 1 to stage 5 was 72,50%, 47.50%, 45.35%, 33.90% and 40.60%. The prevalence of decreased vitamin D level was 84.63%, and from CKD stage 1 to stage 5 was 77.50%, 65.00%, 82.56%, 76.27% and 97.74%. Single factor correlation analysis showed 25 (OH)D3 was correlated with Hb, Alb, Scr, eGRF and iPTH. Regression analysis indicated that 25 (OH)D3 was negatively correlated with iPTH and Scr, and positively correlated with Alb. According to K/DOQI, percentage of CKD patients from stage 3 to stage 5 who were consistent with vitamin D treatment was 87.20%, 83.05% and 26.31% based on 25 (OH)3 and iPTH levels, but such percentage was 16.28%, 35.59% and 26.31% based on iPTH level only. Conclusions The prevalence of vitamin D insufficiency and deficiency in patients with CKD is quite high. Alia, iPTH and Scr are key factors influencing vitamin D level. Vitamin D level should be measured among CKD patients in order to carry out corresponding treatment.

ObjectiveToinvestigate the prevalence, awareness and risk factors of chronic kidney disease (CKD) among community adult population in Shanghai, China, in order to provide early diagnosis and treatment of CKD, and informations for national health policy makers.MethodsTwo thousand five hundred and ninety six residents (≥ 18 years old) were randomly selected from community population in Changning district of Shanghai, China. They were interviewed and tested for albuminuria -morning spot urine albumin to creatinine ratio [ACR, abnormal: ≥ 17 mg/g (male), ≥25 mg/g (female)], reduced renal function-estimated GFR by abbreviated MDRD equation [abnormal: <60 ml ·rain-1 (1.73 m2)-1] and hematuria-morning spot urine dipstick confirmed by urine microscopy. The associations among demographic characteristics, healthy characteristics (e.g. diabetes and hypertension) and indicators of kidney damage were examined. The investigators and neighborhood committee were well trained. Those who had semiquantitative positive were detected again by albuminuria-morniag spot urine albumin to creatinine ratio after three months. ResultsTwo thousand five hundred and fifty four residents with complete data were enrolled in the study. Albuminuria was detected in 6.3% of subjects, reduced renal function in 5.8%, hematuria in 1.2%. Approximately 11.8% of these subjects had at least one indicator of kidney damage. The awareness rate of CKD was 8.2%. The Logistic regression model showed that hyperuricemia, nephrolithiasis, anemia, diabetes, central obesity, hypertension and age contributed to the development of CKD. ConclusionsThe prevalence of CKD in community adult population in Shanghai is 11.8%, And the awareness rate of CKD is 8.2%. Hyperuricemia, nephrolithiasis, anemia, diabetes, central obesity, hypertension and age are risk factors of CKD.