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Objective:According to 2013 updated consensus guidelines of neck node levels, the distribution characteristics of cervical lymph nodes of nasopharyngeal carcinoma (NPC) were analyzed, aiming to provide preliminary reference for the clinical target volume (CTV) delineation of level Ⅴ in NPC.Methods:A total of 1110 patients pathologically diagnosed with NPC from 2012 to 2020 were retrospectively recruited for further analysis. All patients’ MRI and contrast-enhanced CT simulation scan imageswere retrospectively reviewed, metastatic lymph nodes were mapped using the 2013 International Consensus Guidelines. Then, the correlation between Ⅴa, Ⅴb and Ⅴc metastatic lymph nodes and other lymph nodes was analyzed. An NPC case diagnosed with T 1N 0M 0 was selected as the baseline standard for the normal anatomical structure and proportion of Ⅴc area. The metastatic lymph nodes in Vc were delineated on the CT simulation scan image of sample case, and the distribution characteristics of the metastatic lymph nodes inⅤc were analyzed. Results:Among the 1110 patients, 1004(90.5%) patients had lymph node metastases. The most common area of metastatic lymph node levels were level Ⅶa (74.7%) and level Ⅱb(70.7%), and the skip metastasis of lymph nodes was rare (1.0%). The multivariate analysis showed lymph node metastasis in level Va was correlated with levels Ⅱb, Ⅲ, Ⅳa, Ⅴb, and Ⅷ region ( P=0.010, 0.001, 0.001, 0.001, 0.037). Lymph node metastasis in level Ⅴb was correlated with levels Ⅲ, Ⅳa, Ⅴa and Ⅴc region ( P=0.006, 0.001, 0.001, 0.001). Lymph node metastasis in level Ⅴc was correlated with levels Ⅳb and Ⅴb region ( P=0.008, 0.001). There were 28 cases of lymph node metastasis in levelⅤc. A total of 38 metastatic lymph nodes were counted in level Vc. Among them, 33(86.8%) lymph nodes were located in the medial of the omohyoid muscle (Ⅴc-1 region), and 5(13.2%) were located in the lateral of the omohyoid muscle (Ⅴc-2 region). Conclusions:This study reflects the principle of individualized CTV delineation, which is based on the levels of nodal spread in NPC patients. When correlation is observed among different level V, V should be delineated as the moderate risk lymphatic drainage (CTV n2). It is recommended to individualized delineate level Vc when the CTV n2 covers Vc. The Ⅴc-2 region should be delineated as CTV n2 only when there is nodal spread in the ipsilateral Ⅴc-1 region.
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【Objective】 To evaluate the application of computer-aided personal interviewing (CAPI) and computer-assisted telephone interview (CATI) in the satisfaction survey among blood donors. 【Methods】 Voluntary blood donors from stationary and mobile blood collecting sites of Zhejiang Blood Center from Jan 2018 to Dec 2020 were surveyed according to the principle of random sampling. The satisfactory degree of totally 21 items involving pre-donation, in-donation, and post-donation were surveyed. The outcomes were categorized and subsequently analyzed by SPSS23.0, and the differences in demography and blood types between different years were analyzed. 【Results】 5 534 voluntary blood donors were investigated via CAPI and CATI, which contributed to the reflection of real needs of blood donors. The results showed that the comprehensive satisfactory degree of blood donors increased from 95.4% in 2018 to 95.8% in 2020. Significant difference has been found in the eight indexes in Zhejiang (P<0.05) as blood donation publicity, environment of blood donation, service and professional skills of healthcare physicians, skills of phlebotomist before donation, service of pre-donation testing physicians, service and skills of phlebotomist during donation. 【Conclusion】 The combination of CAPI and CATI methods used in the survey of blood donor satisfactory degree, which has presented credible results, is more objective, convenient and time saving, therefore worth popularizing.
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Objective:To assess the impact of zero makeup policy for drug and medical supplies on hospitals. Methods:Descrip-tive statistics and comparative analysis were used to analyze the related indicators, profit and loss calculation and the cost of patients from April 2014 to March 2017.Results:After the policy was implemented, the number of outpatients and the number of outpatients choosing general doctors decreased. The average length of hospitalization was 8.88 days, and the proportion of drug consumption was 34.10%. The number of outpatients choosing medical experts, the number of inpatients and the proportion of surgical treatment in-creased. Although the policy benefited patients,the average medical expenditure still increased. There was policy loss in the hospital. Conclusion:The reform promotes the implementation of hierarchical medical system, optimizes the hospital income structure and re-duces drug proportion significantly,which achieves the original intentions of the policy to some extent.
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Objective To explore clinical effect of the stellate ganglion block combined buflomedil in the treatment of vertebral artery type of cervical syndrome (CSA).Methods One hundred and twenty cases of CSA were included in the study,and randomly divided into two groups.Study group (60 cases)patients were treated by stellate ganglion block therapy combined with buflomedil intravenous;the controlled group (60 cases)was treated with buflomedil intravenous therapy only.In the treatment,vertebral-basi-lar artery mean flow velocity (Vm)was measured before and after treatment and comparison of Vm difference was the clinical ba-sis.According to the CSA standard of clinical cure,the clinical curative effect was observed.Results After treatment,the total ef-fective rate of study group was 95.00%,total effective rate of control group was 71.67%,the difference statistically significant (χ2 =24.474,P <0.05).vertebral artery blood flow velocity of the two groups after treatment increased more obvious than that of before treatment,the difference was statistically significant (P <0.05),vertebral artery blood flow velocity after treatment of study group (38.44±2.20)cm/s was significantly higher than that of the control group (34.36±3.50)cm/s,the difference was statisti-cally significant (t=7.645,P <0.05).basilar artery blood flow velocity of the two groups after treatment increased more obvious than that of before treatment,the difference was statistically significant (P <0.05),basilar artery blood flow velocity after treat-ment of study group(56.34±4.10)cm/s was significantly higher than that of the control group (47.69±3.90)cm/s,the differ-ence was statistically significant (t= 11.841,P <0.05).Conclusion The clinical efficacy of stellate ganglion block combined bu-flomedil in treatment of vertebral artery type of cervical syndrome is obvious.The cure rate with respect to the drug treatment has significant advantages and the therapy is worthy of further promotion.