This article analyses and summarizes the clinical maintenance work of Elekta Precise Linac in five years.Afer the further research on its performances and errors,a better way is found to solve the main problem of clinical electronic linac,i.e.the way to reduce the Stop Rate of Linac in Radiotherapy.

Schwannomas of the vagus nerve (SVN) and schwannomas of the cervical sympathetic nerve (SSN) are the two most common schwannomas in the carotid space. Because schwannomas are asymptomatic, moreover, the vagus nerve and the cervical sympathetic nerve have adjacent anatomical location, it is diffcult to differentiate SVN or SSN. In addition, the current surgical treatment of schwannomas still remains controversial. This article summarized the studies on SVN and SSN, and meanwhile discussed the advances in the diagnosis and management of the disease.

Objective:To analyze the indicators and resistance rate of antibacterial drugs for special use in our hospital before and after the implementation of network online approval process to provide reference for the management and rational use of antibacterial drugs for special use. Methods:A retrospective analysis was performed, and the consumption amount, sales amount, utilization ratio, AUD, submission rate of microbial specimen and resistance rates for the main pathogenic bacteria of antibacterial drugs and ones for special use were investigated during 2012 and 2015 in our hospital. Results:The approval process of antibacterial drugs for special use developed from handwork to network online. The consumption amount of antibacterial drugs increased slightly year by year from 2012 to 2015 in our hospital, the mean expense of antibacterial drugs for the inpatients increased from 1602. 85 yuan to 1888. 63 yuan,and AUD increased from 54. 50 DDDs/(100 persons × d) to 65. 47 DDDs/(100 persons × d). The sales amount proportion of antibacterial drugs for special use (13. 90%) was the lowest in 2013, and the highest (17. 34%) in 2015, and AUD increased from 4. 85 DDDs/(100 person × d)to 6. 37 DDDs/(100 person × d), and the submission rate of microbial specimen before the treatment increased from 85. 5% to 90. 0%. The main pathogenic bacteria were Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa and Acinetobacter baumannii,and their ratio had slight change. Except Staphylococcus aureus, the resistance rate of the other four pathogenic bacteria kept increasing, and the resistance rates of Acinetobacter baumannii to cefepime and carbapenems were over 50%. Conclusion:The approval process management of antibacterial drugs for special use must be strengthened in order to truly a-chieve reasonable use of antibacterial drugs for special use.

Objective To establish a rabbit model of hypoglycemia and evaluate the accuracy and timeliness of hypoglycemia monitoring by continuous glucose monitoring system (CGMS).Methods Sixteen female New Zealand white rabbits were randomly divided into 4 groups, with 4 rabbits in each group.The rabbits in the control group were given intravenous infusion of saline.The animals in the experimental group were infused with insulin continuously, which were divided into 0.1 U/kg/h insulin group (RI=0.1 U group), 0.2 U/kg/h insulin (RI=0.2 U group) group and 0.4 U/kg/h insulin group (RI=0.4 U group) accordingly.During the experiment, CGMS was monitored for 240 min.Blood samples were collected at a 30-minute interval and the blood glucose level was measured by a hand glucose meter.Results A total of 1296 CGMS monitoring data were obtained during the study period, and 136 BG monitoring data matched with CGMS time were obtained.After the insulin administration, BG and CGMS were significantly decreased.The reduction rates of BG and CGMS were 0.016 and 0.017 mmol/L/min in the RI=0.1 U insulin group, 0.04 and 0.027 mmol/L/min in the RI=0.2U insulin group, and 0.049 and 0.032 mmol/L/min in the RI=0.4 U group.According to whether BG monitoring value was lower than 4.4 mmol/L, the BG-CGMS paring data were divided into hypoglycemia and normoglycemia.In hypoglycemia, the average deviation of BG-CGMS was 0.55 mmol/L (the upper and lower limits were-0.98 and 2.08 mmol/L, respectively) and the absolute difference percentage (RAD) was 40.2% ± 45.2%.The mean deviation of BG-CGMS in normal blood glucose was-0.19 mmol/L (upper and lower limits were-1.38 and 1.00 mmol/L, respectively) and 5.8% ± 5.3% in RAD.The error grid analysis (EGA) showed that the proportion of zone A was 93.4%, 0.7% in zone B, and 5.9% in zone D, and the zone D was distributed in area of low BG and high CGMS.Conclusions The results of this study indicate that CGMS has a significant hysteresis phenomenon when blood glucose is reduced rapidly.When the blood glucose levels fall below 4.4 mmol/L, CGMS may have a risk of overestimating blood glucose.Such risk should be fully considered during CGMS clinical application.

Objective]To clarify the meaning of the phase“without high fever”in ShangHan Lun. [Method]To sort out the explanation of “without high fever”of interpreters from past to nowadays,then to analyse the scriptures of ShangHanLun and Sypnosis of Golden Chamber that involve“without high fever”,to re-define the exact meaning of the phase. [Result] Two main opinions are found about the explanation of“without high fever”in the past literature:one is “heat is in interior not exterior”,while the other is“exterior syndrome is passed”,Both are not accorded with Zhong Jing’s word expression and the real clinical situation. If “high fever”is explained as“the fever characteristics of Yang-ming disease”,the scripture involved and the meaning of“without high fever”can be thoroughly understood.[Conclusion] “Without high fever”is the phase Zhang-zhong-jing used to differentiate the disease in scripture from Yang-ming visceral substantial syndrome .Clarifying the phase“without high fever”helps us to better understand the meaning of related scriptures.

Objective To explore the relationship between self- management and DOSE index for patients with chronic obstructive pulmonary disease (COPD). Methods The convenient sampling and Pearson correlation analysis was used in the study,a total of 81 patients was investigated with Self- Management Scale (SMS) for COPD patients and DOSE index. Results The relationship of symptom management and DOSE index for COPD patients was a positive correlation (r=0.259, P<0.05);with self- efficacy was a negative correlation(r=-0.288, P<0.05).But self- management, daily life management, emotion management and information management with DOSE index were no correlation (P>0.05). Conclusions Through health education, nurses should strengthen to effectively help patients manage symptoms, enhance self- efficacy, improve the patients′quality of life.

Objectives:The objective of this study is to make suggestions for the internet medical development. Methods:Based on the field survey, this paper analyzes three kinds of internet medical mode in China, and sums up the pros and cons. Results:The internet medical has the ability of technically providing healthcare by internet, and meeting the patients’ essential health care requirements. The problems mainly include health insurance, regional dis-tribution, electronic prescription audit, electronic medical record and safekeeping the record files, operation supervi-sion etc. The corresponding countermeasures include elaborating laws, gradually completing the internet medical and health insurance cooperation, the government’s regional division handling, setting up a special supervision department in the hospitals etc. Conclusion:It is important to clear the internet medical related problems and develop a model which is suitable for healthcare institutions.

Through analyzing the ethical status quo in reproductive medicine treatment unit, this article dis-cussed the social ethical issues brought by ART technology development related to the reproductive medical treat-ment unit. Then it put forward the measures to solve those ethical problems: strengthening the ethical principles and ethical committee construction, sharing data information, fully informed consent, and suggestions to improving ethics education.

Emergency practice is an important part of clinical study.At present,the emergency teaching content of general practice is so wide that the teaching time is not enough,We do not pay enough attention to the cultivation of clinical thinking,pre-hospital care,two-way referral,and first aid skills training and so on.In this paper,the development of community emergency oriented teaching content,cultivation of de-escalation clinical thinking,and the pre-hospital emergency training and other aspects are studied for the students' teaching in emergency practice in order to improve the clinical practice teaching level of general medicine sttdents.

Objective To observe the effects of Lipopolysaccharide (LPS) in different concentrations on expression of Robo4 in human umbilical vein endothelial cells (HUVECs). Methods HUVECs were cultured in vitro and randomly divided into 3 groups: control group, low dose LPS group (10 μg/mL) and high dose LPS group (100 μg/mL). Robo4 protein level was detected by immunofluorescence staining and western blot , and Robo4 mRNA level was measured by real-time PCR. Results Robo4 protein and Robo4 mRNA in high dose LPS group were 0.49 ± 0.08 and 0.23 ± 0.08 respectively , which were significantly decreased than those (1.35 ± 0.15 and 0.97 ± 0.17) in control group(P < 0.05). However, there were no significant difference between the low dose (1.23 ± 0.13 and 0.94 ± 0.14) group and the control group (P > 0.05). Conclusion High dose LPS (100 μg/mL) could down-regulate expression of Robo4 in HUVECs.