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Objective:To investigate the implementation procedures and dosimetric verification of the first patient treated with total body irradiation (TBI) based on volumetric modulated arc therapy (VMAT).Methods:Two sets of CT images were acquired under the head-in first and foot-in first to contour the planning target volume (PTV) of the cranial and caudal segments to accomplish the treatment of the whole body length, on which two interrelated plans of 5 subsequent isocenters with a total of 15 VMAT fields were performed to cover all PTVs. The plans were prescribed to ensure 90% PTV dose coverage with a total dose of 12 Gy in 6 fractions. Firstly, a dose optimization was performed on the caudal CT images, then the cranial CT images were optimized based on the dose distribution of the caudal CT images. The evaluation of the final treatment plan was carried out based on a plan sum of both two sets of images. The parameters of PTV and organs at risk (OARs) were measured by dose volume histograms from the accumulated plan. The quality assurance comprised the verification of the VMAT plans for each individual isocenter via Delta4 phantom. The dose distribution in the overlapped region between two adjacent central fields was verified with EBT3 film. The absolute dose at the overlapped region between two images was measured via Pinpoint chamber. In vivo dosimetry on the patient′s skin was monitored by MOSFET dosimeters. The results of planning parameters and treatment duration were analyzed. Results:The mean doses of two segments of PTVs were 12.45 Gy and 12.37 Gy. The mean dose for the lung was 10.8 Gy. The machine unit (MU) and mean treatment delivery time were 2 883 MU and 24.3 min, and the mean total time per fraction was 121 min. The mean 3%/3 mmγ-analysis pass rate for each isocenter VMAT plan was (99.74±0.42)%, and the mean 5%/5 mmγ-analysis pass rate for the overlapped region was (90.11±2.72)%. The average deviation of absolute dose in the overlap region of the caudal and cranial images was (3.6±0.4)%. In vivo measurement of 8 points on the patient showed that the dose of each region was ranged from 1.57 Gy to 2.04 Gy. Conclusion:According to the results of dosimetric verification, TBI based on multi-isocenter VMAT can be applied in clinical practice, which remains to be improved in terms of dose distribution, measurement results and clinical efficiency.
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Objective:To analyze the application value of health education based on knowledge, attitude and practice (KAP) in patients before gastrointestinal endoscopy in the Department of Gastroenterology.Methods:Three hundred and fifty patients underwent gastrointestinal endoscopy in the Department of Gastroenterology of Jingqiao Health Center of Nanjing Lishui District from January 2019 to October 2020 were selected and divided into the control group ( n=175) and the observation group ( n=175) according to the random number table method. Patients in the control group chose regular health education, and patients in the observation group adopted health education in the KAP model. The gastrointestinal cleanliness before the examination, the Self-rating Anxiety Scale (SAS) score before and after the examination, the awareness rate of medical knowledge, the examination compliance rate, the diet compliance rate and the nursing satisfaction rate were compared between the two groups of patients. Results:Patients of gastrointestinal cleanliness level 1, 2, 3, and 4 in the observation group accounted for 83.43% (146/175), 13.14% (23/175), 3.43% (6/175) and 0, respectively, and those in the control group were 49.71% (87/175), 35.43% (62/175), 9.14% (17/175) and 4.57% (8/175) ( Z value was 6.743, P<0.001). The SAS scores of the observation group after the examination was 42.30±4.77, and 50.17±5.12 in the control group. There was significant difference between the two groups after the examination ( t value was 14.878, P<0.05). The medical-related knowledge awareness rate, the inspection compliance rate, and the diet compliance rate of the observation group were 100.00%(175/175), 98.29% (172/175) and 97.71%(171/175), and those rates of the control group were 90.29%(158/175), 83.43% (146/175), and 79.43%(139/175), respectively ( χ2 value was 17.867, 23.250, 28.903, all P<0.05). Conclusions:The knowledge-attitude-practice model-based health education can reduce the preoperative anxiety of patients undergoing gastrointestinal endoscopy, and improve their compliance and satisfaction with nursing.
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<p><b>OBJECTIVE</b>To explore the polymorphism in circumsporozoite protein of Plasmodium vivax before malaria was eliminated in Hainan island.</p><p><b>METHODS</b>PCR amplification, sequencing, and alignment methodologies were conducted and phylogenetic tree constructed.</p><p><b>RESULTS</b>From all the cases, 19 of them belonged to two types, with 18 as VK210 type and 1 as VK247 type. VK210 type could be divided into seven kinds of subtypes but VK247 had only one type. Ratio of tropical strain with temperate stain in VK210 type was explored between the two stages:control or elimination. Phylogenetic tree was constructed by amino acid sequencing which clearly manifested that VK210 type and VK247 type belonged to different clusters.</p><p><b>CONCLUSION</b>Compared the proportion of two types in the control stage, there was no significant difference seen in the stage of elimination.</p>