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.

The importance of software version in the medical device software supervision does not cause enough attention at present. First of all, the effect of software version in the medical device software supervision is discussed, and then the necessity of software version in the medical device software supervision is analyzed based on the discussion of the misunderstanding of software version. Finally the concrete suggestions on software version naming rules, software version supervision for the software in medical devices, and software version supervision scheme are proposed.
Equipment and Supplies ; Software

Objective To summarize the clinical features of Budd-Chiari syndrome.Methods A total of 151 Budd-Chiari syndrome admitted in Peking University People's Hospital from 1996 to 2012 were analyzed retrospectively.Results Abdominal distension was the most common complaint,with 62.9％ (95/151)of lower extremity edema,53.0％ (80/151)of typical bottom-up flow of the abdominal wall longitudinal varicose veins and 60.9％ (92/151) with ascites.Laboratory tests results showed median of alanine aminotransferase (ALT) was 21.5 (15.0,30.0) U/L,aspartate aminotransferase (AST) was 30.0 (23.8,42.0) U/L,total bilirubin was 31.1 (23.3,47.8) μmol/L,blood albumin 37.5 was (31.8,41.5) g/L,prothrombin activity was 71％ (61％,84％).WBC was 5.2 (3.5,7.5) × 109/L,hemoglobin concentration was 126.5 (108.8,144.2) g/L,and platelet count was 117.0 (85.5,155.5) × 109/L.Abdominal B-ultrasound examination showed hepatomegaly existed in 68.9％ (104/151) patients.Intraoperative angiography and surgical exploration showed that 41.1％ (62/151) patients were simple inferior vena cava obstruction or stenosis,15.9％ (24/151)were simple hepatic vein obstruction or stenosis and 43.0％ (65/151) suffered from the inferior vena cava combined with hepatic vein stenosis or obstruction.Surgically confirmation of the lesions showed that inferior vena cava membrane-like structure combined with thrombosis was in 59.6％ (90/151) cases.Conclusions Liver congestion,inferior vena cava congestion and portal hypertension are the main clinical manifestations of Budd-Chiari syndrome.With slightly liver function injury,liver dysfunction of Budd-Chiari syndrome isn't parallel with its portal hypertension.

Some techniques deserving consideration in purchase of direct digital photography machines in children's hospital are discussed as reference for doctors who purchase machines and decision-makers in hospital. It is emphasized that the dose of the machine in using should be the all-important factor to be considered for the health of not only the patients but the doctors and technicians. High quality images should not be based on the sacrifice of children's health.

Objective To explore a layered nursing intervention based on risk assessment strategies application effect in elderly patients with hip replacement. Methods Chosen during January 2013 to December 2014 rows of orthopaedic trauma treated 224 patients of senile hip replacement as the research objectto divide into observation group and control group 112 caseseach according to admission time.Observation group applied based on risk assessment strategy stratification nursing intervention, the control group used conventional care. Compared two groups of patients with postoperative pain degree, hip function, complications, and patient satisfaction. Results For 24 h, 48 h, 72 h after the operation, Visual Analog Scale (VAS) scores of observation groupwere 2.25 ± 0.35, 2.01 ± 0.31, 1.92 ± 0.23, which were significantly lower than 3.53 ± 0.51, 2.84±0.45, 2.70±0.35 of the control group (t=21.900, 16.075, 21.900, P<0.01);3 months and 12 months after the surgery, the index of the Harris hip score observation group was 71.32 ± 7.45, 93.44 ± 9.65, which were obviously higher than 60.47 ± 6.65, 83.75 ± 9.21 of control group (t=11.498, 7.688, P<0.01);8.04%(9/112) incidence of complications such as infection of incision, increase of observation group was obviously lower than 20.54%(23/112) of the control group(χ2=7.146, P<0.05);97.32%(109/112) satisfaction was significantly higher than 78.57% (88/112) of the control group (χ2= 18.572, P < 0.05). Conclusions Stratified nursing intervention based on risk assessment strategy can help to alleviate the degreeof pain, improve hip function, reduce postoperative complications and improve patient satisfaction.

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.