Growth Regularity of Pulmonary Ground Glass Nodules Based on 3D Reconstruction Technology / 中国肺癌杂志

BACKGROUND@#Since the popularization of computed tomography (CT) technology, the detection rate of pulmonary ground glass nodules (GGNs) with imaging follow-up as the main management method has increased significantly. The purpose of this study is to quantitatively analyze the changes of pulmonary GGNs during the follow-up process with three-dimensional reconstruction technology, explore the natural progression of pulmonary GGNs, and provide effective basis for clinical guidance for patients to conduct reasonable management of nodules.@*METHODS@#A total of 115 cases of pulmonary GGNs with regular follow-up in the Combined Outpatient Department of Zhoushan Hospital from March 2015 to November 2022 were enrolled. Quantitative imaging features of nodules were extracted by semi-automatic segmentation of 3D Slicer software to evaluate the growth of nodules and clinical intervention during follow-up.@*RESULTS@#The average baseline age of the patients was (56.9±10.1) yr. The mean follow-up time was (48.8±18.9) months. The two-dimensional diameter of baseline CT scan was (7.9±2.9) mm, and the maximum three-dimensional diameter was (10.1±3.4) mm. The two-dimensional diameter of the last CT scan was (9.9±4.7) mm, and the maximum three-dimensional diameter was (11.4±5.1) mm. A total of 27 cases (23.5%) showed an increase during follow-up, with a median volume doubling time of 822 days and a median mass doubling time of 1,007 days. 32 cases were surgically resected, including 6 cases of invasive adenocarcinoma (IAC), 16 cases of minimally invasive adenocarcinoma (MIA), 8 cases of adenocarcinoma in situ (AIS) and 2 cases of atypical adenomatous hyperplasia (AAH). Five nodules underwent surgical intervention due to the progression of two-dimensional diameter, which was pathologically confirmed as pre-invasive lesions, but their three-dimensional maximum diameter showed no significant change. Nodular morphology, lobulated sign, spiculated sign and vacuole signs all promoted the growth of nodules in univariate analysis. There were significant differences in age, baseline diameter, mean CT value, median CT value, 10% and 90% percentile CT number between the growth group and the stable group (P<0.05). Multivariate Logistic regression analysis showed that age and average CT value were risk factors for nodule growth (P<0.05). Receiver-operating characteristic (ROC) curve analysis results indicated that the age ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU were more likely to accelerate the growth of GGNs. The maximum three-dimensional diameter ≥14.4 mm and the average CT value ≥-495.7 HU may be a higher malignant probability.@*CONCLUSIONS@#GGNs show an inert growth process, and the use of three-dimensional measurements during follow-up is of greater significance. For persistent glass grinding nodules ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU are more likely to increase. However, most nodules still have good prognosis after progression, and long-term follow-up is safe.

The indicators of selecting patients with breast cancer undergoing postoperative radiotherapy for deep inspiration breath hold technique / 中华放射肿瘤学杂志

Cardiotoxicity caused by postoperative radiotherapy can increase the risk of cardiovascular adverse events in patients with breast cancer, especially those with left breast cancer, which is proportional to the dose of radiation to the heart. It has been proved that deep inspiration breath-hold (DIBH) technique can significantly reduce the cardiac dose in patients with left breast cancer, but the benefits of this technique vary greatly among different patients, and its implementation requires additional equipment, time, manpower and other resources. Hence, it is necessary to select patients who are suitable for this technique in advance. In addition to comprehensive analysis of general factors before simulation positioning that affect DIBH selection, this review also systematically summarized relevant indicators of CT simulation positioning images. These anatomical indicators included the measurement of the cardiac contact distances in parasagittal (CCD ps) plane, the lateral heart-to-chest distance (HCD), the product of maximum heart width (HW max) and the maximum heart depth (HD max) during CT simulation positioning, and the maximum heart distance, heart volume in the irradiation field (HVIF), the difference of lung volume and heart volume between free breathing (FB) and DIBH measured after CT localization. All of them showed some instructive significance for evaluating whether DIBH should be applied in tangent field based radiotherapy planning. The automatic planning (rapid plan) function in the treatment planning system could quickly predict the benefit of DIBH for breast cancer patients. The purpose of this article is to help clinicians select patients who are suitable for DIBH technique, guaranteeing that DIBH technique resources can be used reasonably.

Comparison of three fixed-field IMRT plans for nasal cavity and paranasal sinus tumors / 中华放射医学与防护杂志

Objective:To compare three fixed-field intensity-modulated radiotherapy (IMRT) plans for nasal cavity and paranasal sinus tumors, including the coplanar IMRT (C-IMRT) plan and the non-coplanar IMRT(NC-IMRT) plan which were based on a conventional C-arm LINAC (Trilogy), and the coplanar IMRT (H-IMRT) plan based on an O-ring LINAC (Halcyon).Methods:Based on the data of 10 patients in the Ningbo First Hospital from December 2018 to December 2021 with nasal cavity and paranasal sinus tumors who underwent postoperative radiotherapy, this study redesigned three IMRT plans with the same prescribed doses and optimization objectives. Then, this study compared the doses of target volumes and organ at risks(OARs), the validation pass rates, and the execution time of these plans. Friedman test was employed in this study, and multiple comparisons were further made in cases of different results.Results:The differences in the conformal index (CI) of PTV and PTV boost of the three plans were statistically significant ( χ2 = 7.51, 9.69, P < 0.05). The multiple comparisons showed that the median CI of the H-IMRT plan was higher than that of the NC-IMRT plan ( Z = 2.53, 2.68, P < 0.05). The differences in other parameters of target volumes were not statistically significant. Compared with the C-IMRT plan, the H-IMRT plan reduced the Dmax of bilateral lenses, bilateral corneas, ipsilateral optic nerve, and ipsilateral eyeball ( Z = 2.80, 2.80, 2.80, 2.80, 2.81, 2.09, P < 0.05). Compared with the C-IMRT plan, the NC-IMRT reduced the Dmax of bilateral lenses, corneas, and eyeballs and contralateral optic nerve ( Z = 2.80, 2.66, 2.80, 2.70, 2.29, 2.29, 2.65, P < 0.05) and reduced the Dmean of bilateral eyeballs ( Z = 2.80, 2.80, P < 0.05). Compared with the NC-IMRT plan, the H-IMRT plan reduced the Dmax of the ipsilateral lens and cornea ( Z = 2.50, 2.08, P < 0.05), but increased the Dmax of the contralateral optic nerve and the Dmean of bilateral eyeballs ( Z = 2.80, 2.80, 2.80, P < 0.05). The validation pass rate of the three plans met the institutional standards, and the differences were not statistically significant. Moreover, the H-IMRT plan had the shortest median execution time (172.00 s), followed by the C-IMRT plan (337.50 s), and the NC-IMRT plan (388.00 s). Conclusions:The verification pass rate of the three plans can achieve the requirements of treatment implementation. The three plans had similar dosimetric differences in target volumes. However, the H-IMRT and NC-IMRT plans can protect the normal tissues (especially optical organs) more effectively than the C-IMRT plan, which is conducive to reducing the toxicity after radiotherapy and provides space for local dose increase or the radiotherapy for the treatment of tumor recurrence. The execution efficiency of the three plans is in the order of H-IMRT > C-IMRT > NC-IMRT. It is necessary to select appropriate radiotherapy equipment and technology according to actual situations.

Practice and discussion of the development of pre-hospital emergency standard in Dezhou city / 中华医院管理杂志

The paper covered in brief the process and achievements of the pre-hospital emergency service standardization in Dezhou. It is held that such development provides the emergency service with a scientific service management appraisal system, and contributes to efficient implementation of such emergency service, making it an effective means for rational resources deployment. The authors recommended to build an effective and standardized operational mechanism and a mechanism for appraisal and supervision, to elevate primary level pre-hospital emergency capability and promote the use standardized tools extensively as well as the formulation and enforcement of such standards at provincial level.

Investigation of the Development of Clinical Pharmacy in 28 Hospitals of Jiangsu Province / 中国药房

OBJECTIVE:To know the status quo of clinical pharmacy in main hospitals of Jiangsu province primarily,and to provide reference for promoting the construction of clinical pharmacist system and playing active role of clinical pharmacists on rational drug use and pharmaceustical care.METHODS:A mailed questionnaire investigation was conducted among 28 committee members (coming from 28 hospitals) of the Clinical Pharmacy Branch of the Medical Association in Jiangsu Province regarding the status quo of the clinical pharmacy practice,and the correlated data and results were summarized to statistical analysis.RESULTS:A total of 28 questionnaires were distributed and 28 valid questionnaires were collected,with recovery rate of 100％.Among 28 hospitals,there were 25 general hospitals and 26 third grade class A hospitals.There were 312 full-time and part-time clinical pharmacists;there were 7.32 full-time clinical pharmacists and 3.82 part-time clinical pharmacists in each visited hospital;the proportion of full-time clinical pharmacists with master's degree and intermediate title was significantly higher than that of part-time clinical pharmacists (P＜0.05).There were 144 full-time clinical pharmacists who had been trained to obtain clinical pharmacists qualifications (70.24％).In 13 hospitals with the qualification of clinical pharmacist training base of National Health and Family Planning Commission (NHFPC),the average number of teachers was 3.77;in 5 hospitals with the qualification of provincial clinical pharmacist training base,the average number of teachers was 5.80;in a hospital with the qualification of clinical pharmacist training base of NHFPC,the number of teachers was 5.The surveyed hospital had the highest proportion of clinical pharmacy related work to participate in daily physician rounds,doctor's advice and prescription review,special review of antibiotics,drug record writing,pharmaceutical information service,outpatient drug consultation and ADR monitoring,all being 100％.Expert consultation clinic occupied the lowest proportion of clinical pharmacy work (10.71％).Setting up pharmacy for operation and anaesthesia department (28.57％),community pharmaceutical care (57.14％),pharmacogenomic testing (46.43％) and participating in the management of drug clinical trials (53.57％) occupied the lower proportion of clinical pharmacy related work.The proportion of clinical pharmacy work in training base hospital was higher than that non-training base hospital.Compared to surveyed hospitals,there was statistical significance in the proportion of special review for antineoplastic drugs,hormone drugs and blood products,expert consultation,setting up pharmacy for operation and anaesthesia department,community pharmaceutical care,pharmacogenomic testing and participating in the management of drug clinical trials in provincial clinical pharmacist training base (P＜0.05).There was statistical significance in the number of specialist consultation,case analysis,inpatient injection medical orders,check pharmacy intravenous admixture medical orders and checked outpatient prescriptions,varieties and number of monitored therapeutic drugs as well as case number of pharmacogenomic testing (P＜0.05).CONCLUSIONS:It is suggested to strengthen the construction of clinical pharmacist team in third grade class A hospital in Jiangsu province,accelerate the transition of part-time clinical pharmacists,at the same time,further improve the development of clinical pharmacy related work.

Effect of periopusside administration of ambroxol combined with psychological intervention on patients with lung cancer after thoracoscopic lobectomy / 中国生化药物杂志

Objective To investigate the effect of perindox administration combined with psychological intervention on patients with lung cancer after thoracoscopic lobectomy.Methods Fifty patients with lung cancer underwent thoracoscopic lobectomy from November 2015 to November 2016 in our hospital were randomly divided into experimental group and experimental group according to the time of hospitalization.Control group, 25 cases.The rats in the experimental group were treated with ambroxol hydrochloride(600 mg/d)from the day of operation to the postoperative 3d administration.The control group was treated with the same volume of saline.At the same time, the experimental group was treated with psychological intervention and the necessary psychological guidance was carried out.The data were collected and compared with the two groups before and after the general information, intraoperative conditions, lung function before and after surgery and blood gas analysis Results , mechanical ventilation time, early postoperative complications, postoperative hospital stay and treatment costs.ResultsThere were no cases of death in the perioperative period.Compared with the control group, the total incidence of postoperative complications was not significant, but the pulmonary complications were significantly reduced, only 1 case and 9 cases in the control group The In addition, the postoperative mechanical ventilation, ICU time, postoperative hospital stay, total treatment costs, the difference between the two groups was significant, the data were statistically significant(P<0.05).Conclusion The patients with lung cancer underwent thoracoscopic lobectomy with high dose intravenous ambroxol hydrochloride in the perioperative period can greatly improve the postoperative pulmonary function and reduce the postoperative complications, and effectively reduce the postoperative hospitalization Time, the material pressure on the patient is further reduced.

Development of swine Salmonella vaccine / 中国人兽共患病学报

Salmonella is an important zoonosis.China is the largest pork consumer.Contaminated pork is the main source of Salmonella disease at home and abroad.There are many swine Salmonella vaccine in use in Europe.Now the current swine Salmonella vaccine is a live attenuated vaccine,Salmonella can reduce colonization in pigs,and can induce immune response efficiently after the two immunizations.The control effect is poor,at this stage of swine vaccine cross protection research,type of Salmonella and vaccine antigen are not the same.This paper reviews the research progress of swine Salmonella vaccine.

Dosimetric evaluation of RapidPlan model on different Radiotherapy devices / 中华放射肿瘤学杂志

Objective To evaluate the dosimetric differences of one RapidPlan Model on different Radiotherapy devices.Methods A RapidPlan Model was built based on 30 reoptimization IMRT plans of cervical cancer patients on typeA LA.Dosimetric differences of automatic optimized IMRT plans using this model on 4 different type LAs,named respectivelyA,B,C andD,were compared with 12 test cervical cancer cases.These four LAs were well commissioned in the treatment planning system (TPS).Student t test was applied for statistical analysis on dosimetric differences.Results Dosimetric differences between A vs.B,C and D were observed on Dmean,HI,CI of PTV50 and PTV45,as well as on V50,V40,V30 of rectum and bladder.Significant dosimetric differences were observed between A and D (P<0.05).Conclusions Automatic planning with RapidPlan model may result in dosimetric differences on different Radiotherapy devices.These differences should be aware of with caution in its clinical application.

Total Laparoscopic Hysterectomy Versus Total Abdominal Hysterectomy:a Retrospective Comparison of Clinical Effects and Sexual Functions / 中国微创外科杂志

Objective To investigate two different hysterectomy ( total abdominal hysterectomy and total laparoscopic hysterectomy ) on short-term efficacy and influence on sexual functions . Methods The retrospective records of 100 cases of total laparoscopic hysterectomy ( TLH) and 100 cases of total abdominal hysterectomy ( TAH) from January 2009 to December 2012 were reviewed.The operation time, intraoperative blood loss, postoperative hospital stay, and sexual satisfaction at 12 months postoperatively were compared between the two groups . Results The operation time was longer in the TLH Group than that in the TAH Group [(128 ±11) min vs.(87 ±33) min, t=-11.787, P=0.000].The intraoperative blood loss was less in the TLH Group than that in the TAH Group [(108 ±37) ml vs.(155 ±28) ml, t=-10.129, P=0.000].The hospital stay was shorter in the TLH Group than that in the TAH Group [(5.5 ±1.9) d vs.(8.2 ±1.6) d, t =-10.870, P =0.000].There were no significant differences between the two groups in sexual frequency (Z=-1.300, P=0.193), libido (Z=-0.564, P=0.573), achievement of orgasm (Z =-1.591, P=0.112), sexual intercourse disorder (Z =-0.478, P =0.633), and the overall satisfaction (Z=-0.083, P=0.934).Extent of dyspareunia was worse in the TLH Group than in the TAH Group (Z=-3.752, P=0.000). Conclusions TLH has less blood loss and shorter hospitalization time than TAH .Hysterectomy has a certain influence on sex functions .Differences in the sexual satisfaction are not statistically significant between the two procedures .

Prevalence and rate of missed diagnosis study of COPD in presurgical patients / 中国实用内科杂志

Objective To invest the prevalence and the missed diagnosis rate of COPD in presurgical patients and their relationship with high risk factors.Methods Epidemic study was carried out in presurgical patients who received pulmonary function test in PFT laboratory of Zhongshan Hospital.Totally 339 patients were selected and their general conditions,exposure history and PFT results were analyzed.Results The prevalence of COPD was 21.8%,and the missed diagnosis rate was 83.8%.About 53.1% subjects had positive exposure history,among which 43.1% had smoking history and 18.6% had occupational exposure history,with the prevalence of 34.2% and 36.5%,between which no statistical significance was revealed.The prevalence of COPD in subjects with negative exposure history was 8.8%,and the missed diagnosis rate was 71.4%.The prevalence of COPD with and without exposure history above the age of 50 years was 38.0% and 10.0%,the former being significantly higher.The prevalence of COPD of men was 25.1%,which was significantly higher than that of women(15.2%)(P=0.04).Logistic regression analysis showed that the prevalence had little relation with gender(OR=0.80,95% CI:0.42～1.51),but had relation with exposure history(OR=4.22,95% CI:2.35～8.34).The severity classification of 62 COPD patients who were newly diagnosed after this PFT:stage Ⅰ 30.6%,stage Ⅱ 56.5%,stage Ⅲ 11.3%,stage Ⅳ 1.9%.Conclusion Most presurgical patients have the risk factors of COPD,like smoking and occupational exposure,and the latter is especially higher in our country.The prevalence and the rate of missed diagnosis of COPD is very high and the classification of severity of most missed diagnosed patients is stage Ⅱ or even more severe.