BACKGROUND:Medical risks are al unsafe events or that damage to the patient during medical services. Present medical risk management is mainly qualitative experience, and lacks of regular failure analysis and risk assessment for established medical treatment.
OBJECTIVE:To construct models of medical process failure analysis and risk assessment, find possible risks during medical treatment, and propose effective measures to eliminate or decrease above risks.
METHODS:Failure mode and effects analysis during reliability engineering were used in production. That was, risk assessment was conducted in the possible technical failure modes, causes and al impacts on the product during each process. Improvement measures were made for weak link during the process. The risk could reach an acceptable level. In accordance with failure mode and effects analysis during production, the procedure of medical process failure analysis and risk assessment could be made to analyze the potential failures during medical treatment. Moreover, the improvement measures were proposed for weak link with high risks so as to prevent the occurrence of risk of significant adverse effects on patients.
RESULTS AND CONCLUSION:The methods and basic procedures of medical process failure analysis and risk assessment were established by using the experience of failure mode and effects analysis. Taking the rescue process of myocardial infarction in the emergency of a hospital as an example, the analysis of failures, reasons and impacts was performed taking“chewing 300 mg aspirin”in the rescue steps as a key. The improvement measures and suggestions were proposed for unacceptable failures and reasons. Seen from the analysis results, proposed improvement measures and suggestions can obviously decrease the risks of failures caused by this step to patients. Therefore, the application of failure mode and effects analysis in medical treatment has a strong practical value.

Huang Ti's "Nei Ching Su Wen" is the earliest classical work on medical science in ancient China. It summed up the results of observations made in long years through practice by the ancient Chinese labouring people, accumulating thereby lots of valuable knowledge and experience in different lines of medicine.Some two thousand years ago, Chinese medical scientists in the Chou and the Chin Dynasties already conceived the advanced idea of laying special emphasis on prophylactic measures, and began to adopt diet therapy as a means of medical treatment. Principles of preparing complete diet were worked out by them. And in this connection, it is mentioned in the book "Nei Ching Su Wen" that "five kinds of cereals are the means of subsistence, five kinds of cattle provide beneficial food in the form of meat, five kinds of vegetables can be used for food enrichment, and five kinds of fruits may serve as supplement." These principles point out the necessary sorts of food to constitute a complete diet and their respective positions in it. That is to say, cereals including beans and peas are the staple food and animal meat is of secondary importance, with vegetables to enrich and fruits to supplement the first two. A diet thus prepared will not only consist of all the nutritive elements needed by the human body but also represent an appropriate arrangement of the different kinds of nutrients. Such a diet is, no doubt, in accord with the dietetic theory of modern science.

Objective: To investigate the effect of dimethyl dicarboxylate biphenyl ( DDB) on the proliferation, apoptosis and PPARγ expression of hepatic stellate cells. Methods: HSC-T6 cells were cultured in 96-well plates and 6-well plates, and after the 24-hour drug treatment, the influence of DDB on the proliferation and apoptosis of HSC-T6 were detected respectively by CCK-8 kit and flow cytometry. Quantitative real-time-PCR ( Q-PCR) and Western blotting were adopted to determine the effect of DDB on the PPARγmRNA level and the protein expression in HSC-T6 cells. Results:DDB obviously inhibited the proliferation of HSC-T6 (P<0. 05) and significantly promoted the apoptosis of HSC-T6 (P<0. 05) at the experimental concentration (8-64 μmol·L-1) when compared with the control group (0 μmol·L-1). The expression of PPARγ in drug-treated HSC-T6 was notably improved. Conclusion: DDB can inhibit the proliferation and promote the apoptosis of HSC-T6 cells by up-regulating the expression of PPARγ.

Objective To study the expression of adiponectin in the peripheral blood of patients with rheumatoid arthritis (RA),and discuss its role in the pathogenesis of RA.Methods Fifty-three patients with RA and 31 healthy controls were enrolled in the study.The level of adiponectin in the peripheral blood were detected using enzyme-linked immunosorbent assay (ELISA) method and the relation with clinical and laboratory parameters were analyzed.The stastistical analysis was carried out with independent t-test,one-way ANOVA and Spearman correlation analysis.Results The level of the adiponectin in rheumatoid arthritis patients [(12±8) μg/ml] was higher than control group [(8±4) μg/ml],with statistically significant difference (t=3.694,P=0.002).The level of adiponectin of the experimental group was negatively correlated with rheumatoid factor (RF),anti-cyclic centrullinated peptides (anti-CCP) (r=-0.301,r=-0.290,P＜0.05) and positively correlated with the levels of globulin (GLO),IgA and IgM (r=0.492,r=0.431,r=0.485,P＜0.05),while no significant correlation (P＞0.05) with erythrocyte sedimentation rate (ESR),C reactive protein (CRP),disease activity score in 28 joints (DAS28),Body mass index (BMI),anti streptolysin O (ASO),IgG,liver and kidney function,triglyceride (TG) and cholesterol (TC),C3,C4 levels and prothrombin time (PT) series.The level of adiponectin of the whole experimental group was not significantly correlated with BMI (r=0.142,P＞0.05),but negatively correlated with BMI (r=0.197,P＜0.05) in patients with 10-15 years courses of disease.Conclusion Related to RF and CCP,adiponectin may be involved in the pathogenesis of chronic inflammation of RA.

Objective:To investigate the effect of miR-154 on the apoptosis of hepatic stellate cells (HSC-T6). Methods:Hepat-ic stellate cells (HSC-T6) were transfected with miR-154 mimics and miR-154 inhibitor, and the cells were trandfected with mimics NC and inhibitor NC as the negative control. The effects of miR-154 on the proliferation of HSC-T6 were detected at different time points by CCK-8. A flow cytometry with double staining of Annexin and PI was used to detect the cell cycle and apoptosis rate of HSC-T6. Results:The proliferation ability of the cells was increased,the apoptosis rate was decreased significantly, and the proportion of cells in G0/G1 phase were decreased, and those in G2/M phase were increased significantly after transfected with miR-154 mimics. The proliferation ability of the cells was decreased,the apoptosis rate was increased significantly, and the proportion of cells in G0/G1 phase were increased, and those in G2/M phase were decreased significantly after transfected with miR-154 inhibitor. Conclusion:MiR-154 can promote the proliferation of HSC-T6 and inhibit the apoptosis of HSC-T6.

Objective:To summarize the single nucleotide polymorphisms ( SNPs) in ABCC2 and the effect on clinical drug appli-cation. Methods:According to the related articles published in domestic and abroad, the correlation between the single nucleotide pol-ymorphisms in ABCC2 and drug responses was classified and summarized. Results:ABCC2 translocator played an important role in the transmembrane transport of many physiological compounds and exogenous compounds. Numerous studies have demonstrated that the single nucleotide polymorphisms in ABCC2 possibly affected the expression or activity of ABCC2, which leading to the variation in the absorption, distribution and excretion of certain drugs and toxicants. However, the limitation and controversy were still emerged in the results. Conclusion:The influence of ABCC2 single nucleotide polymorphisms on clinical drug application shows significantly referen-tial value for the guidance of medication and the evaluation of efficacy, however, it can not be used as the only indicator yet.

Objective To establish the quality standard for Haijinhuwei powder. Methods Corydalis Rhizoma, Angelicae Dahuricae Radix, Angelicae Sinensis Radix were identified by TLC. The content of tetrahydropalmatine was determined by HPLC. Results TLC spots were clear and specific.There was a good linear relationship between peak area and concentration of tetrahydropalmatine at the range of 10.78-107.8μg.mL-1(r=0.999 9).The average recovery rate was 96.57% and RSD was 1.40%(n=6). Conclusion All these results indicated that the developed TLC-HPLC method was proved to be reliable, accurate and specific, which could be used for the quality control of Haijinhuwei powder.

Objective To construct a recombinant lentiviral expression vector containing NIS and EGFP gene,and to explore the feasibility of NIS gene for monitoring the bone marrow derived mesenchymal stem cells (BMSCs) migration to the intracranial glioma.Methods The NIS and EGFP gene fragments were subcloned into lentiviral vector pLVX-puro,then packaged and amplified in HEK293T cells to obtain recombinant lentivirus pLVX-CMV-NIS-EGFP.pLVX-CMV-0-EGFP was constructed as control.BMSCs were isolated,cultured,and transfected by lentivirus.The antibiotic-resistant transfected BMSCs (BMSCs-NIS-EGFP and BMSCs-EGFP) were selected.The expression of NIS gene was examined by Western blot.Functional NIS activity was confirmed by the uptake of 125I and the inhibition effect of NaClO4.The nude mice intracranial glioma models were established.MicroSPECT was performed at 24 h post BMSCs-NIS-EGFP injection via the tail vein.Results pLVX-CMV-NIS-EGFP and pLVX-CMV-0-EGFP were successfully constructed and packaged.BMSCs were successfully isolated and cultured.Stable cell lines BMSCs-NIS-EGFP and BMSCs-EGFP were constructed after lentivirus transfection and puromycin selection.The expression of NIS gene was detected by Western blot in BMSCs-NIS-EGFP,but not in BMSCs-EGFP.BMSCs-NIS-EGFP showed significantly more uptake of 125I (nearly 10 times than the uptake in BMSCs-EGFP) and the uptake could be significantly inhibited by NaClO4.The nude mice intracranial glioma models were successfully established and the BMSCs-NIS-EGFP in glioma foci could be visualized by microSPECT imaging at 24 h post injection.Conclusions A recombinant lentivirus containing NIS gene could be successfully constructed for monitoring BMSCs migration towards intracranial glioma.It might provide evidence on the research of BMSCs and NIS gene mediated therapy for glioma.

Objective:To study the expression of caspase-3 and free radical injury in hypoxic-ischemic brain damage ( HIBD) of neonatal rats.Methods:All seven-day-old Wistar rats were randomly divided into HIBD group and sham operation group.Brains was obtained at time of 6 h,12 h,24 h,48 h,72 h,96 h after HIBD.Neuronal cell apoptosis was detected by terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end labeling ( TUNEL).The expression level of caspase-3 protein was detected by immunohisto-chemistry.The level of malondialdehyde ( MDA) and supemxide dismutase ( SOD) were measured by thiobarbitic acid colorimetry and xanthin oxidase,respectively.Results:The number of neuronal cell apoptosis and the expression of caspase-3 protein began to increase at 6 h and reached the peak at 48 h in HIBD group,they were both significantly higher than those in the sham operation group at each time point (P<0.05).The level of MDA began to increase at 6 h and reached the peak at 24 h in HIBD group,it was significantly higher than the sham operation group at each time point (P<0.05).The level of SOD began to decrease at 6 h and reached the lowest level at 24 h in HIBD group,it was significantly lower than the sham operation group at each time point ( P<0.05 ) .The number of neuronal cell apoptosis and the expression of caspase-3 protein were positively correlated with the level of MDA, but they were negatively correlated with the level of SOD.Conclusion: Free radical injury promotes the expression of caspase-3 and neuronal cell apoptosis in HIBD.

Objective To quantitatively measure the perfusion parameters of placenta in different stage of pregnant rats using contrast-enhanced ultrasonography (CEUS) with contrast pulsed sequencing (CPS), and to analyze the relationship between perfusion parameters and changes of placental vascular bed. Methods Sixty healthy pregnant rats in according to the requirements of the experiment was divided into three groups: 15 days, 17 days and 20 days of gestation with 20 animals in each group. One blous injection of SonoVue (Sonovue 1.0 ml/kg) via a tail vein was administered to each rat, and the time-intensity curves (TIC) of placenta and uterine muscle wall were drawn with ACQ using CPS technique with MI 0.20, and the perfusion parameters were calculated. Then 4 μm vertical placenta sections were cut and stained with hematoxylin and eosin. Surface area densities of placental maternal blood space was measured with image analysis software. Results The peak intensity (PI) of 17 days and 20 days was higher than that of 15 days pregnant rats (P＜0.05). There was no difference in PI between 17 days and 20 days (P＞0.05), and nor of arrivel time (AT) and time-to-peak (TTP) (P＞0.05) among the three groups. There was significant difference of surface area densities of placental maternal blood space among the three groups (P＜0.05). PI was positively correlated to the surface area densites of placenta (P＜0.05). Conclusion There is close relationship between peak intensity and area densities of placental maternal blood space. CPS technique can sensitivly detect changes of the placenta vascular bed in different stage of pregnant rats.