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.

Accidents, Traffic ; prevention & control ; Global Health ; Humans ; World Health Organization

Benzylisoquinolines ; therapeutic use ; Calcium Channel Blockers ; therapeutic use ; Combined Modality Therapy ; Humans ; Pneumoconiosis ; drug therapy ; Tablets

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.

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 correlation between thrombelastograph (TEG) indexes and serological indexes in patients with acute cerebral infarction (ACI) .Methods :A total of 116 ACI patients treated in our hospital were se‐lected as ACI group ,another 98 cases without ACI , who underwent routine physical examination were regarded as healthy control group .According to severity of neurological function defect during acute phase ,ACI group was fur‐ther divided into mild ACI group (n=51) ,moderate ACI group (n=32) and severe ACI group (n=33) .TEG inde‐xes and serum indexes of platelet activation were measured and compared among above group ,and the correlation a‐mong TEG indexes and serum levels of platelet activation indexes were analyzed .Results:Compared with healthy control group ,there were significant reductions in R value [ (6.17 ± 1.38) min vs .(5.26 ± 0.77) min] and K value [ (2.39 ± 0.53) min vs .(1.71 ± 0.58) min] ,significant rise in α angle [ (63.27 ± 9.23) deg vs .(77.45 ± 12.08) deg] ,MA value [ (55.09 ± 6.38) mm vs .(77.13 ± 13.25) mm] of TEG ;clot index [CI ,(1.68 ± 0.53) vs .(2.56 ± 0.87)] ,D-dimer level [(0.24 ± 0.07) mg/L vs .(0.38 ± 0.09) mg/L] and platelet aggregation rate [PAR ,(56.12 ± 6.75)% vs .(69.17 ± 9.33)% ] in ACI group after treatment ,P<0.05 all .Among ACI subgroups with different severity ,the more severe neurological function defect was ,the lower R and K values were ,the higherαangle ,MA value ,CI ,D-dimer level and PAR were ,there were significant difference in pairwise comparisons ( P<0.05 or <0.01) .Linear regression analysis indicated that PAR was significant inversely correlated with R (B= -2.254) and K values (B= -2.286) ,and significant positively correlated with αangle (B=2.536) ,MA (B=2.537) and CI (B=2.352) ,P<0.05 or <0.01 ;D-dimer level was significant inversely correlated with R (B= -2.276) and K val‐ues (B= -2.259) ,and significant positively correlated with α angle (B=2.621) ,MA (B= 2.462) and CI (B=2.647) , P<0.05 or <0.01. Conclusion:TEG indexes are significantly correlated with platelet activity in ACI pa‐tients .TEG possesses good practical value in diagnosis ,severity judgment and therapeutic guidance for these pa‐tients .

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.

An innovative approach,named associating liver partition and portal vein ligation for staged hepatectomy (ALPPS),has made possible a marked increase in future liver remnant (FLR) over a short period of time,and has challenged the concept of unresectability.To date,ALPPS has been employed for a variety of primary and metastatic liver tumors from many centers across the world.Many technical variations of ALPPS have been described.However,much controversy has surrounded this procedure,and many problems remain to be solved,such as the reasons for rapid hypertrophy,the technical feasibility,safety and long-term oncologic outcomes,and the result compared with the conventional two-stage hepatectomy.These aspects are needed to be evaluated further in large-scale studies.We believe that the ALPPS procedure will has much room for further development.

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 investigate the change rule of common coagulation indicators and platelet parameters in the patients with chronic viral hepatitis,liver cirrhosis and liver failure.Methods One hundrend and twenty patients with liver diseases in our hospital from January 2015 to June 2016 were selected and divided into chronic viral hepatitis group (46 cases),liver cirrhosis group (Child-Pugh class A,B,C,44 cases) and liver failure group (30 cases).Contemporaneous 30 persons undergoing healthy physical examination served as the healthy control group.The coagulation indicators (PT,PTA,APTT,TT, Fg,D-D) and platelet parameters (PLT,MPV,PDW, PCT) were detected in all subjects.Results Except TT,Fg and D-D had no statistical difference between the healthy control group and chronic viral hepatitis group (P>0.05),PT,APTT and TT in the chronic viral hepatitis group,liver cirrhosis group (Child-Pugh class A,B,C) and liver failure group were gradually extended,PTA and Fg were decreased and D-D value was increased,the difference in pairwise comparison was statistically significant (P<0.05).The PLT value in the chronic viral hepatitis group,liver cirrhosis group (Child-Pugh class A,B,C) and liver failure group was decreased gradually,while the MPV and PDW values were gradually increased,showing significantlystatistically significant difference (P<0.05),the PCT value in the liver cirrhosis group and liver failure group was lower than that in the chronic viral hepatitis group(P<0.05).Conclusion The regularity change of coagulation indicators and platelet parameters occurs in different periods of chronic liver disease progression,which provides some reference for clinical diagnosis,treatment and prognosis judgment.