Ventilator is broadly used in the hospital all over the world,The paper describes three case of common troubles in clinical practice for Bird-brand ventilator and its troubleshooting.

The construction of traditional theory of Chinese herbalism cannot do without the accumulated understanding of herb effect in clinical practice.Meanwhile,it closely relates to the natural history of using different theories of herb property to explain effect and mechanism at different stages.The compilation of Inner Canon of Yellow Emperor 《(黄帝内经》) and Shennong Bencao Jing 《神农本草经》) represent the initial formation of traditional herbalism in Chinese medicine.These two books have a relatively complete description of property and effects of herbs,but with different focus of concerning.After Shennong Bencao Jing,explaining the effect from property of herbs gradually become the developing trend and basic characteristics of herbalism.During the Ming-Qing Dynasties,publication of a large number of herbal annotation works further highlights this feature.

Objective To construct a yeast two-hybrid recombinant bait plasmid of human programmed cell death ligand 1(PD-L1)immunoglobulin variable region(IgV)domain gene,detect its expression in yeast and detect the cytotoxicity and self-activation of PD-L1 IgV protein as well as the interaction between PD-L1 IgV and human thioredoxin(hTrx).Methods Human PD-L1 was analyzed by bioinformatics method,and primers were designed to amplify PD-L1 IgV domain based on the coding region of PD-L1 gene registered in NCBI GenBank database. PCR amplification was carried out with pENTERPD-L1 plasmid as template,and then cloned into yeast two-hybrid bait vector pGBKT7. The recombinant bait plasmid and pGBKT7 empty vector were transformed into Y2HGold yeast cells respectively,and the PD-L1 IgV gene and its expression were detected by PCR and Western blot;Meanwhile,the protein toxicity and self-activation of PD-L1 IgV were detected,and the interaction between PD-L1 IgV and hTrx was detected by drip plate method.Results The bioinformatics analysis results of PD-L1 were consistent with related reports. The recombinant bait plasmid pGBKT7-PD-L1 IgV was correctly constructed,and Y2HGold positive clone was obtained,in which PD-L1 IgV was stably expressed. The empty vector pGBKT7 and recombinant bait plasmid pGBKT7-PD-L1 IgV grew well on SD/-Trp and SD/-Trp/X-α-Gal plates with the same colony size and number and white colony,but they did not grow on SD/-Trp/X-α-Gal/AbA plates,which indicated that PD-L1 IgV protein had no toxicity and no self-activation effect on yeast. The results of drip plates test showed that all experimental groups grew well on SD/-Trp/-Leu plate,while only positive control group grew on SD/-Trp/-Leu/X-α-Gal/AbA plate and showed blue color,which indicated that bait protein PD-L1 IgV and hTrx did not self-activate,and there was no interaction between them.Conclusion Recombinant human PD-L1 IgV bait plasmid was successfully constructed. PD-L1 IgV protein showed no toxicity and self-activation effect on yeast cells,and there was no interaction between PD-L1 IgV and hTrx. Subsequently,hTrx can be used to construct a peptide aptamer library,from which peptide aptamers that specifically bind to PD-L1 IgV can be screened.

BACKGROUND:In the treatment of primary knee osteoarthritis, total knee arthroplasty is a common treatment, but there are some shortcomings in the traditional operation, which maylead to early failure of the prosthesis.
OBJECTIVE:To explore the difference of computer-assisted total knee arthroplasty by vastus medialis approach from the traditional total knee arthroplasty.
METHODS:A total of 79 patients with primary knee osteoarthritis were randomly divided into control group (41 cases) and observation group (38 cases), which underwent conventional total knee arthroplasty and computer-assisted total knee arthroplasty by vastus medialis approach. Surgical incision, operation time, total blood loss and drainage volume were recorded and compared in both groups. In 12 months of folow-up, Hospital for Special Surgery knee score was evaluated, and the complications were recorded and compared between the two groups.
RESULTS AND CONCLUSION:(1) Operative incision was significantly less in the observation group than in the control group. Operation time was significantly shorter in the observation group than in the control group. Total blood loss and drainage volume were significantly lessin the observation group than in the control group (alP< 0.05). (2) Patients in both groups were folowed up for 12 months. Index score and total score of knee function were significantly higher in the observation group than in the control group (al P< 0.05). (3) No adverse events such as infection, prosthesis loosening or fracture appeared in the observation group. In the control group, four cases affected prosthesis loosening. One case suffered from wound infection. Above events were improved obviously after active treatment. No serious complications occurred. The incidence of complications was significantly lower in the observation group than in the control group (P< 0.05). (4) The results show that, compared with the traditional operation, the choice of the femoral medial approach and the use of computer aided design technology can simulate the knee replacement process, set the cutting position, improve the accuracy and success rate of surgery, have less trauma, and effectively improve knee function, and reduce the incidence of postoperative complications.

MicroRNAs (miRNAs)are involved in the pathological and physiological process of life activities,and some of them exist stably and abundantly in serum,plasma,and other body fluids.Previous studies have indicated that there are significant differences in the expres-sion patterns of circulating miRNAs between patients with viral hepatitis,liver fibrosis,liver cirrhosis,hepatocellular carcinoma,drug-in-duced hepatitis,and other hepatobiliary diseases at different disease stages.Among these circulating miRNAs,some can act as novel nonin-vasive biomarkers for the early diagnosis,disease progression,and prognostic evaluation of related diseases.The latest research advances in circulating miRNAs for the diagnosis of hepatobiliary diseases are reviewed.

Objective To analyze the existing problems in the management of outpatient, to change the traditional manage-ment mode and to provide convenience for outpatient medical care.Methods By adopting the establishment of outpatient manage-ment by walking -around team, making the inspection content and quality standards of walking -around management and implemen-ting three class patrol management, We realized the transformation of the traditional outpatient management mode .Results After im-plementing the management by walking around, outpatients'satisfaction were improved and complaints reduced.Conclusion Man-agement by walking around has great effect on meeting the medical needs of patients, improving the quality of clinic service, optimi-zing the management process, and improving the hospital's reputation.

Objective　To evaluation the application value of two-phase enhanced spiral CT in pancreatic adenocarcinoma. Methods　Two-phase enhanced spiral CT was performed in 27 cases of pancreatic adenocarcinoma. After plain CT examination, performed arterial phase（25s after infusion）and portal venous phase（60～70s after infusion）with a 150ml bolus injection of contrast material at 3ml/s. CT attenuation values of tumor and normal pancreas in all scanning phase were obtained and the tumor-pancreas contrast was calculated. Results　Mean tumor enhancement were 48±8 HU（arterial phase）and 72±6 HU（portal venous phase）, normal pancreas enhancement were 125±18 HU、98±11 HU, mean tumor-pancreas contrast was significantly differenced on arterial phase （73±21 HU）and portal venous phase （25±12 HU）. Conclusion　Excellent tumor-pancreas contrast is obtained with arterial phase scans, as such it is of significance reference value for diagnosis pancreatic adenocarcinoma.

Objective: The FDA regulation requirements for medical device software are relatively mature and systematic, and the research on the FDA regulation thinking of medical device software helps to promote the regulation work of the medical device software in our country. Methods:Based on the comparison of the 1998 edition and 2005 edition FDA software submission guidance, the trend of the FDA regulation requirements for medical device software was analyzed, and then its regulation thinking was discussed according to other current effective software-related guidance. Results:FDA integrally improves the submission requirements for all medical device software, especially for the minor Level of Concern software, and simplifies the requirements for design specification, verification and validation, but strengthens the requirements for traceability analysis and revision history. Conclusion: The regulation work of the medical device software in our country needs to fully consider the particularity of the medical device software, strengthen the audit of software quality management system, implement the software traceability analysis, and determine the regulation requirements for software change.

Objective To explore the clinical significance of plasma D-dimer and fibrinogen level in cervical carcinoma . Methods Sxity-two patients with cervical cancer pathologically proved ,34 cases of benign uterine tumors and 42 cases of CIN were detected plasma DD and Fib levels preoperative , compared with normal control group .Results DD and Fib levels in patients with cervical cancer group were significantly higher than those of control group;With the lesions of cervical cancer malignant degree of plas-ma DD and Fib levels increased;DD and Fib increased cervical cancer occur more frequently in patients with lymph node and distant metastasis .Conclusions Along with the increase of the malignant degree of tumor ,Micro thrombosis or thromboembolism risk increa-ses,In clinical,they can be used as auxiliary index to predict clinical cancer staging and transfer .

Objective To investigate the methods for the detection of serum samples with low-concentration HBsAg and its clin-ical value.Methods Serum samples with HBsAg weak positive were measured by ELISA or using Roch cobas e601 were collected from the clinical laboratory.The samples with low-concentration HBsAg were confirmed by neutralization assay by using Lizhu ELISA reagent Kit or Roch cobas e601 analyzer.at the same time,ALT/AST concentrations and HBV DNA copies were also deter-mined.Results Among 53 samples that showed weak positive reaction by using Kehua reagent kit,37 samples were positive in neu-tralization test,while the other 16 samples were negative.Among 18 samples that showed weak positive reaction tested by using Roch cobas e601 analyzer,13 samples showed positive in neutralization test,and the other 5 samples showed negative.Conclusion The results of HBsAg test varies in different detection System.The clinical significance of samples with low-concentration HBsAg needs further study.