Many trauma victims occur in China every year, with a notably high mortality rate among those who suffered from multiple traumas such as severe traffic trauma. One of the main reasons is the defect of current trauma emergency system, in which the full-time trauma physician often lacks. It has therefore become urgent to establish a well-organized trauma emergency system with full-time physicians.
Accidents, Traffic ; statistics & numerical data ; China ; Emergency Service, Hospital ; manpower ; organization & administration ; standards ; Humans ; Multiple Trauma ; epidemiology ; Physicians ; supply & distribution

Objective to investigate the application of the whole course case tracking method in continuous improvement of nursing quality of out-patient operation unit. Methods Administration frames were established for this project,such as monitoring group and executive group. the medi-cal treatment procedure and patients′experience were followed by referees. the results were quantified for statistical analysis. the problems were rec-ognized by priorities and rectification was correspondingly performed. Afterward,another group of patients were traced to evaluate the results of the rectification. We focus on those items of lower scores and undertook rectifications accordingly. Particularly,we optimized signs in outpatient unit, made pamphlets to clarify the procedures,and were cautious to provide more easy-to-understand informs. Results By the second round evaluate, these scores were effectively improved. Especially,the item of“clear informed consent”was statistically significant(P = 0.003). Meanwhile,the team of outpatient operation unit became more cohesion,with enhanced service consciousness,and was initiative to improve the work. Conclusion the whole course case tracking method is feasible for short-range medical service evaluation such as outpatient surgery. the evaluation results clarify the direction for quality improvement,thus set the starting point of quality management aiming at continuously improvement of the patients′ experi-ence and quality of nursing service.

BACKGROUND:Lumbar disc herniation is the most common cause of lumbago in clinic, which seriously affect the patient's daily life, study and work. Therefore, studies on biomechanics of lumbar intervertebral disk benefit to prevent and treat the diseases associated with lumbar intervertebral disk. OBJECTIVE: To summarize the biomechanical progress of lumbar intervertebral disk. METHODS: The first author retrieved China National Knowledge Infrastructure and PubMed database for literatures published from 2009 to 2014. The key words were intervertebral disc, nucleus pulposus, biomechanics, fibrosis annulus, cartilage in Chinese and English, respectively. Articles regarding biomechanical characteristics of lumbar intervertebral disk, nucleus pulposus, fibrosis annulus and cartilage were included, and repetitive studies were excluded. Totaly 5 072 articles were retrieved initialy. In accordance with inclusion and exclusion criteria, 41 articles were included in result analysis. RESULTS AND CONCLUSION:We can fuly understand the pathogenesis, development and adverse consequences of diseases related to the lumbar intervertebral disk by summarizing the structural features and internal pressure of lumbar intervertebral disk and the effect of different loads, biomechanical characteristics of lumbar intervertebral disk with degenerative changes and establishment of mechanical model of lumbar intervertebral disk. It is of directive significance for daily health care of the lumbar intervertebral disk and how to better use force, a physical factor, to solve the lumbar intervertebral disk problems.

Objective Gastrointestinal stromal tumor( GIST) is a rare mesenchymal tumor from gastroin-testinal tract,and surgery remains the only curative treatment.In order to improve the outcome of surgical treat-ment,reduce the risk of surgery,and increase the quality of life,preoperative imatinib( IM) treatment for GIST is investigated.Methods We retrospectively studied the multidisciplinary team model treatments for 8 GIST cases receiving preoperative IM treatment.The cases were prescribed IM of 400 mg daily for 12 to 40 weeks and exten-sively followed until surgery was considered feasibleg.The clinical significance and safety profile were analyzed. Results Partial responsive rate was 62.5% in this study.There was no intolerable sever adverse effects by IM preoperative treatment.All the cases received R0 dissection,with no intraoperative tumor rupture.The postopera-tive recovery was satisfied.Conclusion IM preoperative treatment brings significant clinical benefit to large stomach GISTs and cardiac region GISTs.The preoperative treatment should be monitored carefully under a multi-disciplinary team.Preoperative IM treatment is an evocative treatment strategy for high risk GIST.

AIM:To research the effects of Kanglaite(KLT)injection on antitumor and expression of epidermal growth factor receptor(EGFR)in Lewis lung carcinoma(LLC).METHODS:A total of 40 C57BL/6 mice were randomly divided into four groups,including model group,KLT 6.25,12.5,25 mL/kg groups.All the mice were injected with 2?106 LLC cells at 1st day.At the next day,mice in the KLT groups were peritoneally injected with KLT for 14 days.And at the 16th day,all the mice were sacrificed and the tumors were harvested.The tumor weight was measured and the tumor growth inhibition rate was analyzed.The expression of EGFR was detected by westernblot.RESULTS:The growth of LLC was significantly inhibited by KLT,the changes of tumor appearance and histology were affected and the expression level of EGFR was decreased.CONCLUSION:KLT injection could obviously inhibit the growth of LLC,whose mechanism maybe related to the inhibition of EGFR expression.

Objective To investigate the effect of Kanglaite injection (KLT) on immunological function of rat models with Lewis lung carcinoma. Methods Forty C57BL/6 mice were used to establish Lewis lung carcinoma models and divided randomly into the high dose(25 mL/kg), middle dose (12.5 mL/kg) and low dose (6.25 mL/kg) of KLT groups and model group(n=10). The mice in the KLT groups were sacrificed after injecting corresponding dose of KLT with intraperitoneal injection for 14 d. No treatment was performed on the rats in model group. The body weight, tumor and spleen weight was weighed, then the ratio of tumor restriction and the index of spleen was calculated. MTT colorimetric method and ELISA were used to detected activity of T cell proliferation and expression of IL-2 in spleen. The expression of NF-κB and IκBα protein was detected by Western blot. Results The ratio of tumor restriction in the high, middle, low dose of KLT groups decreased gradually. The indexes of spleen of the high and middle dose of KLT groups were higher than those in the model group (P<0.05 or P<0.01).Compared with the model group, the activity of T cell proliferation in the high, middle, low dose of KLT groups and the expression of IL-2 in the high and middle dose of KLT groups was increased significantly (P<0.05 or P<0.01). The expression of NF-κB protein in the nuclei of high, middle, low dose of KLT groups increased dose-dependently, and the expression of NF-κB and IκBα protein in the cytoplasm decreased dose-dependently. ConclusionKLT could enhance immunological function by effecting T cell proliferation, expression of IL-2, NF-κB and IκBα, while restricting tumor growth in Lewis lung carcinoma models.

Objective To compare the differences and characteristics of the dose distribution of the two optimization methods in the three dimensional brachytherapy,and provide the basis for clinieal treatment.Methods Excel 2007 was used to generate random number.And a total of 21 patients of cervical cancer were selected from those who have completed the treatment.Inverse simulated annealing optimization (IPSA) plans were designed for graphical optimization (GO) plans.The dose volume histogram (DVH) parameters of the targets (V100％,V150％) and the organs (D1 cm3,D2cm3) of the two methods were analyzed.Results The targets dose of both plans could meet the prescription requirements.There was no statistically significant difference in the dose parameters of all targets (P ＞ 0.05).The closes of D1 cm3 and D2cm3 in the bladder of IPSA plan were significantly lower than that of the GO plan (t =3.596,3.490,P ＜ 0.05).There was no statistically significant difference in the dose parameters of rectum (P ＞ 0.05).Conclusions For cervix brachytherapy,the GO and IPSA have no effect on targets dose,but IPSA optimization can reduce the maximum dose of bladder.

Objective To study the impacts of different applicators on dose distribution in 192 Ir brachytherapy. Methods The inner tubes of two cylinder applicators from Nucletron,#101?001 and#084?350, were made of plastic and stainless steel, respectively. The cylinder parts of them were made of plastic, and had four different radiuses:1?00 cm, 1?25 cm, 1?50 cm, and 1?75 cm. EGSnrc program was used to simulate dose distribution when applicators were present in a phantom, and the results calculated by the treatment planning system were compared with the results of EGSnrc. The impacts of applicators on dose distribution were analyzed with different materials, thickness, and numbers of resident source. Results There was no significant relationship between dose deviation and the radius for the two applicators. When an applicator was present, the actual dose delivered to a patient was smaller than the planned dose. The dose deviation of the applicator#101?001 was no more than 1%, while the dose deviation of the applicator#084?350 was close to 3%. The dose deviation remained the same when the number of resident source changed. Conclusions The plastic applicator, if possible, is the best choice for brachytherapy right now. In a long term, in order to promote the accuracy of brachytherapy, current dosimetry algorithm should be improved, and the impacts of the applicator made of metal, such as stainless steel, on dose distribution should be taken into account.

Objective To explore the mechanisms of individual, social and environmental factors influencing physical activity and the relationships among the factors in patients with type 2 diabetes. Methods A survey was conducted from January to July 2015 among 225 patients with type 2 diabetes using convenience sampling. The questionnaire included 9- item Patient Health Questionnaire, the International Physical Activity Questionnaire,Perceived Social Support Scale, Chinese Walkable Environment Scale, Bandura′s Exercise Self- efficacy Scale. Results The effective questionnaire recovery rate was 98.7%(222/225). Exercise self- efficacy was a mediator of factors influencing physical activity. Exercise self- efficacy and physical activity were positively correlated (β=0.24, P<0.05). Walkable environment only affected physical activity indirectly medicated by exercise self- efficacy (β=-0.26, P<0.05). Perceived social support directly associated with physical activity (β=0.14, P<0.05). Depression not only affected physical activity directly (β=-0.28, P<0.05), but also associated with physical activity indirectly medicated by exercise self-efficacy (β=-0.32, P<0.05). Conclusions Interventions should be taken to increase the perceived social support, improve depression and walkable environment, especially to enhance exercise self- efficacy, so as to improve the physical activity level of patients with type 2 diabetes.

Objective To analyze the status and influencing factors of physical activity in patients with diabetes.Methods A survey was conducted in patients with diabetes from one hospital in Tianjin city using the International Physical Activity Questionnaire, Exercise Self-efficacy Scale, 9-item Patient Health Questionnaire,Perceived Social Support Scale, Chinese Walkable Environment Scale, Visual Analogue Scale.The cumulative logits model was used to explore the influencing factors of physical activity in diabetic patients.Results The average of sitting time for diabetic patients was 6.1 hours per day.41.2％ of patients with diabetes were at high level of physical activity ,42.7％ were at moderate level of physical activity, and 16.1％ were at low level of physical activity.The cumulative logits model showed that perceived social support (β=0.029, OR=1.03, P=0.039,95％ CI=0.001-0.057) ,exercise self-efficacy (β=0.014, OR=1.01, P=0.001,95％ CI=0.005-0.023),and beautiful neighborhood surroundings(β=-0.366, OR=0.69, P=0.008,95％ CI=-0.635--0.096) were protective factors of physical activity, and depression(β=-0.093, OR=0.91, P=0.020,95％ CI=-0.172--0.015) was a risk factor of physical activity.Conclusion The physical activity status of diabetic patients are not ideal.Measures should be taken to improve the exercise self-efficacy, perceived social support and environment of surroundings, to reduce the symptoms of depression, so as to promote regular physical activities in patients with diabetes mellitus.