Based on the conception and character of core competency, this paper analyzed the core competency in rehabilitation organization and suggested some strategy.

Objective To explore the dose rate response characterization of four kinds of dosimeters for clinical application.Methods Within the range of 100-600 cGy/min,the dose rate responses of the PTW 0.6 cm3 ion chamber,0.015 cm3 ion chamber,Matrixx Evolution 2D diode array and MapCHECK 2D diode array under the same measuring conditions were measured.The dose rate response of the PTW 0.6 cm3 ion chamber under different energy and working voltage were analyzed.Results All ionization chambe.r types of measured equipment showed certain dose rate dependence for 6 MV X-rays.All the differences were below 1％.The dose rate dependence disappeared for 15 MV X-rays.The 2D diode array had strong dose rate dependence and the response difference was about 2％.Conclusions It is necessary to test and analyze the dose rate response of the measured equipment in treatment technology with dose rate varying,in order to ensure the precision of daily calibration and dose verification.

Objective To investigate the inhibitory mechanism of rabeprazole on acid secretion of parietal cells in rats. Methods Seventy two Spraque-Dawley rats were divided into control group(normal saline), low dose of rabeprazole group (rabeprazole 10 mg/kg) and high dose of rabeprazole group (rabeprazole 20 mg/kg) with 24 each. Four rats in each group were treated at 1 h, 2 h, 4 h, 6 h, 12 h and 24 h, respectively, pH value and activity of H+-K+-ATPase were tested by NaOH titrimetric method and chromatometry, respectively. The changes of ultrastructure of parietal cells were observed by electron microscope. Results Compared with control group(1.97±0.30), pH value in low (3.37± 0.97)and high (5.96±0.26)dose groups were significantly increased(P<0.01), and the activity of H+-K+-ATPase was inhibited obviously at 1 h after administration(3.28±0. 41 vs 1.47±0.27 and 0.92±0.07, P<0.05). Those differences could be found even at 12 h(P<0.01). The ultrastructural changes of parietal cells were consistent with the increase of pH value and decreased activity of H+-K+-ATPase. The significant difference was found in acid depression and excellent time between low and high dose of rabeprazole groups. Conclnsions The uhrastructural changes of parietal cells and the activity of H+-K+-ATPase can accurately reflect the acid secretion in rats. Rabeprazole has powerful and rapid effects in inhibiting acid secretion which correlates with the dosage.

ObjectiveTo explore the effects of different flushing and scanning processing on optical density (A) responding and set up the clinic quality assurance protocol based on silver halide emulsions radiographic films.MethodsSetting different flushing temperature and choosing different batch's film and developer and fixer or fixer in the same batch with different analyzing dose were performed to analyze the effect on A value; The effect of light uniform,the stabilize work time and the noise of different scanning resolution were discussed.ResultsThe A value at the same dose level would enhance as the temperature increased;the responding curve of dose and A value with different batches of films varied a lot;the responding curve of dose and A value with different batches of films and developer and fixer solution had marked variations;the responding of dose and A with the same batches would show some low.The heterogeneity of the scanner would achieve 0.03 ; the A value of the same dose would gradually steady while the time ofscanning was more than 10 minutes:the affect of noise would increase as the dose and resolution ratio increased.ConclusionsThe best processing temperature is 29-31 ℃.Different batches of film couldn't be confounded.A new calibration must be obtained when the film dosimetry to evaluate dose distribution is used.A 5 - 10 min warm up for stabilize work and the best setting resolution/depth lever are 72 dpi/16 bit for scanning films are determined.

Objective To analyze the related rules and prognosis analysis for lymphatic metastasis in patients for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Methods This study retrospectively reviewed 65 patients who underwent radical surgery for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction in Beijing Friendship Hospital between July 2013 and March 2017.The primary indicators were sex,age,tumor site,tumor size,macroscopic type,histological type,depth of invasion,operation,tumor emboli and carcinoma nodes.The clinical characteristics and pathological features were analyzed by using Logistic regression and Kaplan-Meier survival analysis.Follow-tup using outpatient examination and telephone interview was performed to detect patients' diseases and postoperative survival up to April 2017.Results Lymph node metastasis was observed in 41 of 65 patients (63.1％).Lymph node metastasis frequency was found in No.1,No.2,No.3,No.7,No.11 and No.110 lymph nodes.The incidences of those lymph node metastasis were 45.3％,32.5％,28.8％,22.5％,19.4％ and 8.2％.The metastasis rate of the tumors with diameter over 2 cm was higher than the tumors which were less than 2 cm (71.9％ vs 0;P =0.000);The observed rate of lymph node metastasis was 0,12.5％,69％,95.2％ in early cancer (T1) and advanced cancer (T2-T4) (P=0.000) respectively.The metastasis rate of highly differentiated Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction was 45.2％ lower than poorly differentiated tumors 79.4％ (P =0.009).Thirty-three cases were found with lymphatic embolus,28 of them (84.8％) were found to be combined with lymph node metastasis among them (P =0.001).All the differences were statistically significant (P ＜ 0.05).The results of multivariable analyzed by binary logistic regression analysis revealed that neoplasms histologic type and lymphatic embolus were independent risk factors for lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Sixty-five patients were followed up for 1-45 months,with a median time of 18.81 months.Although there was no statistically significant difference,3 years-overall survival rate showed tumor without lymph node metastasis has better prognosis than with lymph node metastasis and early stage tumor also has better prognosis than advanced tumor.Conclusions Lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction is related with histological type of tumor and lymphatic embolus.For Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction,the incidence of lymphatic metastasis were higher appear in abdominal cavity,which included No.1,No.2,No.3,No.7 and No.11;Meanwhile,the metastasis of mediastinal lymph node is given priority to No.110 lymph node.Therefore,radical total gastrectomy combined with standard D2 lymphadenectomy and No.110 lymphadenectomy are performed in order to improving the prognosis.For patients with lymph node metastasis and tumor in advanced stage,long-term prognosis remains to be further study.

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

Objective To investigate the effects ofShipi-Gushen-Huayu Recipe on the expressions of collagen I, laminin(LN), transforming growth factor-β1(TGF-β1)andα-smooth muscle actin(α-SMA)in adriamycin-induced renal fibrosis in rats.Methods A total of male SD rats were randomly divided into four groups, with 10 rats in each group: a normal group, a model group, a treatment group and a fosinopril sodium group. Except the rats in the normal group, the rest rats were subjected to renal fibrosisvia tail intravenous injection of adriamycin(4 mg/kg). Two weeks after modeling, the rats in the rreatment group and in the fosinopril sodium group were intragastrically administrated daily withShipi-Gushen-Huayu Recipe extract(43 g/kg)and fosinopril solution(2 mg/kg), respectively,both in the normal group and model group with saline. After 30 days, 24-hours urine protein were determined, and the expressions of collagen I, LN, TGF-β1 andα-SMA in kidney tissue were detected with immunohistochemistry staining.Results The expressions of collagen I(24.64±0.67vs. 32.86±0.88), LN(18.71±0.72vs. 28.35±0.87), TGF-β1(14.71±0.68vs. 18.35±0.96)andα-SMA(17.64±0.74vs. 25.86±0.85)in the treatment group were significantly lower than those in the model group(allP<0.01). The expressions of collagen I, LN, TGF-β1 andα-SMA in the fosinopril sodium group were 27.33±0.73, 20.44±0.81, 15.44±0.85 and 19.33±0.77, respectively. There was no statistically significant difference between the expressions of collagen I, LN, TGF-β1 andα-SMA in the treatment group and in the fosinopril sodium group.ConclusionShipi-Gushen-Huayu Recipe can significantly down regulate the expressions of collagen I, LN, TGF-β1 andα-SMA in adriamycin-induced renal fibrosis in rats.

Objective To investigate the set-up error of CR in total body irradiation localization and lung shielding.Methods TOR 18FG software was employed to measure the image quality of images at kV and MV levels.The clinical processes were established and the positioning error was analyzed.Results The low contrast resolution and spatial resolution of MV level images were much worse than those at kV level in the condition of total body irradiation,but the image at MV level could be used to identify the high contrast tissues and employed in total body irradiation.The longitudinal errors were (0.50 ± 1.65) cm for left lung and (1.16 ± 1.56)cm for right lung in A P direction,while (1.12 ± 2.22)cm and (0.41 ± 2.16)cm respectively in PA direction.The errors of lateral were (0.81 ± 1.19)cm for left lung and (0.43 ±1.20)cm for right lung in AP direction,while (0.31 ± 1.64)cm and (0.55 ± 1.49)cm respectively in PA direction.Conclusions Application of CR in total body irradiation could make positioning in treatment much easily and reduce the localization errors.

Objective To study the expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in preeclampsia placenta and the relation with preeclampsia attacks.Methods Forty-four samples from pregnant women with preeclampsia (preeclampsia group),38 samples from pregnant women with eclampsia,and 49 samples from normal pregnancies (control group) were obtained.We detected the expression of EMMPRIN in placenta by immunohistochemistry and the expression of EMMPRIN mRNA by RT-PCR,Results (1) EMMPRIN positive expression:in preeclampsia group,the moderate expression rate was 18% (8/44) and the strong positive rate was 9% (4/44);in eclampsia group moderate positive rate was 21% (8/38) and strong positive rate 13% (5/38).The difference of the two groups was insignificant (P＞0.05).In control group the moderate positive rate was 12% (6/49) and strong positive rate 82% (40/49),the difference from the preeclampsia and the eclampsia groups was significant (P＜0.001).(2)EMMPRIN mRNA expression:in preeclampsia group EMMPRIN mRNA expression in term placenta (37-40 gestational weeks) was 0.342?0.002,and in eclampsia group 0.344?0.023;the difference between the two groups was insignificant (P＞0.05).In control group EMMPRIN mRNA expression in term placenta (37-40 gestational weeks) was 0.872?0.094,the differences between the control group and preeclampsia and eclampsia groups were both significant (P＜0.001).Conclusion The decrease in the expression of EMMPRIN in placenta is an important cause of preeclampsia onset;expression rate of EMMPRIN may serve as an indicator in predicting preeclampsia.

Objective:To investigate the expression and regulation of the platelet-activating factor receptor(PAF-R)in human keratinocytes.Methods:The expression of PAF-R in skin tissues and HaCaT cells was examined by immunohis-tochemistry.The expression of PAF-R in HaCaT cell mRNA level was detected by RT-PCR.The expression and regulation of PAF-R were measured by flow cytometry in HaCaT cells treated with various stimuli.Results:The expression level of PAF- R was very high in human keratinocytes,mainly located on cell membranes and cytoplasma.PAF-R also expressed on HaCaT cells transcription levels,and the tissue-type PAF-R mRNA was more than that of leucocyte-type PAF-R mRNA.PAF-R ex-pressed on both membrane and intracellar part of HaCaT cell,and the intracellular expression was about4.82times that of membrane expression.IFN-?and retinoic acid upregulated the membrane expression of PAF-R in HaCaT cell.Conclusion:Human keratinocytes can highly express PAF-R at cell,protein and transcription levels,and the expression characteristic can be regulated by some inflammatory factors,which indicates the PAF system may play an important role in the skin inflamma-tion. [