Objective To establish a safety culture evaluation model to conduct empirical research with regard to the assessment of both the radiation safety culture and management at different levels of health institutions.Methods Delphi method is used to develop a model to define the effectiveness and operational practice of safety culture system in hospitals.Results The research had achieved good reliability assessment,with Cronbach coefficient α of all indicators higher than 0.60.There were 16 hospitals with scores less than 75 (61.54％),at the primary stage of radiation safety culture,and 9 hospitals among 75-95 (34.62％),at the middle stage,only 1 hospital with score of 95.48 (3.85％),at the high grade stage.Conclusions At present,the level of radiation safety culture in medical institutions is lower as a whole.The evaluation model established in the present research is practicable to some extent and can provide reference for strengthening radiation safety management.

Objective To explore the clinical value of double collagenase injection in treating patients with lumbar disc herniation. Methods Thirty one patients with lumbar disc herniation to whom DCI had been applied were analyzed with 15 to 31 months follow-up. Results The therapeutic effects were excellent in 27, good in 3, fail in 1. The total effective rate was 96.7%.Conclusions DCI is a good method in treating lumbar disc herniation with high effectiveness, extensive indications, low complications and profitable clinical application prospectively.

Objective To investigate the variation of plasma mitochondrial coupling factor -6 and explore the significance in neonatal sepsis.Methods The study of 88 cases of pediatric inpatients in our hospital were divided into non-sepsis group (46 cases)and sepsis group (42 cases).CF-6 concentration in venous blood of all study subjects was determined by enzyme linked immunosorbent assay (ELISA).Re-sults The plasma CF-6 concentrations in peripheral venous blood of the patients with sepsis were signifi-cantly higher than those in non sepsis group(107.65 ±50.38)pg/ml vs (38.96 ±29.87)pg/ml,The con-centrations of CF-6 in the infected group were higher than those in the normal control group(P <0.05). Conclusions The concentration of mitochondrial coupling factor -6 in neonatal sepsis was significantly higher,and has a certain pathological and physiological significance in the pathogenesis of neonatal sepsis.

Objective To explore the influence of middle cerebral artery blood flow on mechanical ventilation in very low birth weight premature after using Budesonide(BUD) mixed with pulmonary surfactant(PS),and to explore the protection mechanism of cerebral injury.Methods Forty premature infants (gestational age ＜ 34 weeks,birth weight ＜ 1 500 g) with respiratory distress syndrome(RDS) were randomly assigned into study group and control group in Nanjing Maternal and Child Health Hospital from Aug.2010 to Mar.2012.PS and BUD mixture was used in study group (Per 70 mg PS adding BUD 0.25 mg),PS dose of 70 mg/kg,BUD dose of 0.25 mg/kg.Control group was only administered with PS,dose 70 mg/kg.It was administered intratracheally after 30 to 60 minutes of birth in both groups.The index of blood flow rate and blood vessel elasticity of arteria cerebri media [including systolic velocity (Vs),diastolic velocity (Vd),mean velocity (Vm),resistant index (RI) and elasticity index (PI)] were monitored by using transcranial Doppler.Results The Vs increased steadily in study group,but instability in control group,and there were of statistical differences on the 4 d,5 d,6 d and 7 d (t =3.21,2.95,3.12,3.43,all P ＜ 0.05).The Vd increased steadily in study group,but unsteadily in control group,and there were statistical differences on the 4 d,5 d,6 d and 7 d (t =4.21,3.10,3.98,4.56,all P ＜0.05).The Vm of study group was higher than that in the PS group,and there were statistical differences on the 4 d,5 d,6 d and 7 d (t =2.68,2.98,3.98,3.57,all P ＜ 0.05).The RI of study group was higher than that in the control group,and there were statistical differences in the 5 d,6 d and 7 d(t =3.10,3.98,4.06,all P ＜ 0.05).PI steadily in study group,but instability in control group,and there were statistical differences in the 5 d,6 d and 7 d (t =4.18,3.23,3.02,all P ＜ 0.05).The overall incidence of periventricular/intraventricular hemorrhage showed no significant difference,but severe periventricular/intraventricular hemorrhage (grade Ⅲ,Ⅳ) of study group was less than that in the control group (x2 =4.80,P ＜ 0.05).The incidence of periventricular leukomalacia was reduced in the study group compared with that in the control group (x2 =3.31,P ＜ 0.05).Conclusion The very low birth weight infants treated with mechanical ventilation show steady cerebral blood flow and lower incidence of brain injury after using BUD mixed with pulmonary surfactant.

Objective To study the best position for children to transfusing mannitol by venous, and then reduce the incidence rate of complication. Method Divided children into 3 groups according to the injection point. There were 69 cases in the A group, the injection points included cephalic vein, basilic vein, median cubital vein and the external jugular vein. There were 46 cases in the B group, the injection points included vein of forehead, superficial temporal vein and the posterior auricular vein. There were 63 cases in the C group, the injection points included dorsal vein. Results The condition of transfusing mannitol by venous in the A group were significant better than those of in the B and C group,P

Objective To evaluate the levels of plasma coupling factor 6(CF6) and cytochrome C(Cyt-c) in neonatal sepsis,and to explore the clinical significance in neonatal sepsis.Methods A total of 88 neonates admitted to Hunan Children's Hospital from January 2015 to April 2015 were collected.Neonates were divided into non-sepsis group(n=42) and sepsis group(n=46).According to the severity of infection,the non-sepsis group was further divided into non-infection group(n=20) and common infection group(n=22);the sepsis group was further divided into general sepsis group (31 cases,no organ failure) and severe sepsis group (15 cases,combined with multiple organ failure).Femoral venous blood was collected in all patients before the use of antibiotics after admission.The levels of Cyt-c and CF6 in plasma were measured by ELISA,and the levels of C-reactive protein(CRP),procalcitonin (PCT) were measured.The changes of CF6 and Cyt-c between these groups were compared,and the sensitivity and specificity with the traditional sepsis index (CRP,PCT) were analyzed.The correlation between the levels of CF6,Cyt-c and neonatal critical illness score was analyzed.Results (1)In sepsis group,the levels of CF6 and Cyt-c[(109.7±8.9)pg/ml and (44.5±4.9)ng/ml] were significantly higher than those in the non-sepsis group[(46.3±6.0)pg/ml,(31.8±6.7)ng/ml,P<0.01,respectively].(2) In the non-infection group,common infection group,general sepsis group and severe sepsis group,the levels of CF6 were (32.1±8.9)pg/ml,(59.3±7.2)pg/ml,(79.3±5.9)pg/ml,and (172.6±6.1)pg/ml,respectively;the levels of Cyt-c were (29.3±8.6)ng/ml,(35.4±4.1) ng/ml,(43.1±5.9) ng/ml,and (44.5±5.9)ng/ml,respectively.The differences between these groups were significant(P<0.01).(3)The receiver operating characteristic curve showed that the sensitivity and specificity of CF6 were 0.761,0.732,and the Cyt-c were 0.739,0.714.(4)Cyt-C and CF6 were negatively correlated with the neonatal critical illness score(r=-0.599,P<0.001;r=-0.337,P<0.01).Conclusion The levels of CF6 and Cyt-c increase in neonatal sepsis.The damage of mitochondria may be one of the pathological mechanisms in neonatal sepsis.The levels of CF6 and Cyt-c were closely related to the severity of neonatal sepsis.

Objective To analysis the clinical outcome at discharge and its risk factors of extremely preterm infants.Method To retrospectively analysis the clinical outcome at discharge and it's risk factors of extremely preterm infants (less than 28 weeks gestation) admitted from September 2008 to August 2014 in our Hospital.Result A total of 179 cases were enrolled.Survival rate was 59.2％ (106/179).Unfavorable outcome rate was 74.3％ (133/179),among them 73 cases died.The top five causes of death were severe bronchopulmonary dysplasia (BPD) (28 cases),Ⅲ ～ Ⅳ o intraventricular hemorrhage (IVH) (19 cases),sepsis (16 cases) and necrotizing enterocolitis (NEC) (6 cases).Among the 60 survivals with unfavorable outcomes,35 cases had either severe neurologic or ophthalmological sequela,and 25 cases had severe pulmonary sequela.Univariate analysis showed that,comparing with improved group,unfavorable outcome group had higher rates of not receiving prenatal steroids,placental abruption,male,small for gestation age,resuscitation with chest compression,admission age older than 72 hour,severe respiratory distress syndrome (RDS),without pulmonary surfactant (PS) usage,mechanical ventilation beyond 2 weeks and sepsis (P ＜ 0.05).Logistic regression analysis showed that those without prenatal steroids (OR =9.402,P =0.002),small for gestational age (OR =8.271,P =0.018),resuscitation with chest compression (OR =6.325,P =0.023),admission age older than 72 hour (OR =4.174,P =0.028) were independent risk factors for unfavorable outcome of extremely premature at discharge.Conclusion Extremely preterm infants have a higher rate of unfavorable outcome at discharge.Avoid small for gestational age,transfer properly and in time both in utero and after birth,and conduct prenatal steroids could improve their clinical outcome at discharge.

Objective To explore the expression of 11-β hydroxysteroid dehydrogenase 2 (11-β HSD2) gene in placenta of pregnancy induced hypertension (PIH) complicated by intrauterine growth retardation (IUGR) and the relationship between different expression of 11-β HSD2 in placenta and newborn's birth weight or placental weight. Methods Thirteen cases of term pregnancy mothers with PIH complicated by IUGR were served as PIH complicated by IUGR group, 22 cases of term pregnancy mothers complicated by PHI with appropriate for gestational age (AGA) infant as PIH with AGA group and 36 cases of normal controls as control group. The mRNA expression level of 11-β HSD2 gene in placenta was evaluated by RT-PCR. The level of cord serum cortisol was detected by the method of chemiluminescence. Results The 11-β HSD2 gene mRNA was expressed in placenta. The mRNA expression level of 11-β HSD2 gene in PIH complicated by IUGR group's placenta was significantly lower (0.26±0.09) than that in PIH with AGA group (0.64±0.19) and control group (0.66±0.20). The level of cord serum cortisol in PIH complicated by IUGR group was significantly higher [(71.60±20.20)μg/L] than that in PIH with AGA group [(51.00±13.80)μg/L] and control group [(49.10±14.40)μg/L]. The newborn's birth weight and placental weight in PIH complicated by IUGR group was significantly lower than those in PIH with AGA group and control group. The mRNA expression level of 11-β HSD2 gene in placenta was positively correlated with the birth weight of their newborns and placental weight. Conclusion The lower mRNA expression level of 11-β HSD2 gene in placenta may contribute to the higher cortisol level in fetal of PIH complicated by IUGR and has a negative role on the fetal development.

Objective To explore the changes and significance of serum visfatin (VF) levels in patients with preeclampsia (PE). Methods Eighty-one cases of PE were served as observed group, 39 cases of mild PE (mild PE group) and 42 cases of severe PE(severe PE group), 45 cases of normal pregnant women as control group. Fasting plasma glucose (FPG), fasting insulin (FINS), total cholesterol (TC) and triglyceride (TG) were measured and the homeostasis model assessment insulin resistance (HOMA-IR) were evaluated in these cases. The levels of serum VF were determined by enzyme-linked immunosorbent assay. Results There were no significant difference in the levels of FPG, FINS, HOMA-IR among three groups (P > 0.05). The levels of TG, TC were significantly increased in severe PE group compared with mild PE group or control group (P < 0.05). The level of serum VF in severe PE group [(22.45 ± 4.18) μ g/L]was significantly higher than that in control group [(14.52 ± 3.25) μg/L]and mild PE group [(18.75 ± 3.96) μ g/L](P < 0.05). The level of serum VF had no relationship with the levels of FPG, FINS (r = 0.21,0.24, P > 0.05), the positively correlation was found between the level of serum VF and HOMA-IR, TC, TG (r = 0.42,0.36,0.41, P < 0.05) in patients with PE. Conclusion VF elevates in the patients with preeclampsia and closely relates with the severity of PE, insulin resistance and lipid metabolism.

Objective To prepare the Elderly Functional Constipation(FC) Health Education Scale, and verify its reliability and validity. Methods The Elderly FC Health Education Scale was prepared by qualitative interviews, literature review, and Delphi method. The elderly patients who were over 60 years old and at Chinese PLA 181st Hospital were recruited by the purposive sampling method from January 2013 to August 2015.The diagnostic criteria of RomanⅢwas used to diagnose FC, the data of preliminary investigation and large sample test was used to form the formal scale, and its reliability and validity were further verified. Results The Elderly FC Health Education Scale was compiled with 6 dimensions and 28 items, and the Cronbach alpha coefficient which was the internal consistency reliability of the 6 factor was 0.965; the correlation coefficient analysis of equality reliability Kendall tau-b rank and various index variables score were positive correlation significantly. Both item level content validity index and scale level content validity index of the content validity were as a result of 1. The structure validity of the cumulated variance contribution ratio of the 6 factors were 60.15%. All factor loading coefficients between the items were more than 0.5, which indicated the fitting was good. Conclusions The reliability and validity of the Elderly FC Health Education Scale are good, and the scale may be used as a tool to prevent the elderly FC health education, and also be applied to the elderly FC patients in self-management and continue nursing after leaving hospital.