Objective To study the probability safety assessment to analyze and evaluate radiation error risk in the external beam radiotherapy,so as to establish and strengthen the control and management of the radiotherapy process,continuous improvement of quality control and quality management.Methods To build the whole of radiotherapy flow chart and process tree,using the decision tree model to determine critical control points in the whole process,making risk assessment chart and analyzing 4 patients with potential safety hazards error.Results The whole process is divided into 22 missions in 3 functional areas,the entire cover 15 branches and 59 key and 11 key control point.The enumeration of error as risks and critical control points has certain correlation.Conclusions Probabilistic safety assessment method have strengthened manage,analyze and control to risk,and all these provide the basis for developing and improving radiotherapy process control management.Radiotherapy quality management for future multidisciplinary and high-level management personnel who take up provides a prospective study.

【Objective】 To identify the main factor or factors w hich contribute to recurrent early spontaneous abortion for clinical diagnosis a nd treatment. 【Methods】 69 cases received the screening examination including inherent, endocrine, anatomical, infective, immunological and contamination hist ory poison metabolic factors, then analyses all factors. 【Results】 Analysing the single factor effecting th e recurrent early spontaneous abortion in the above 7 factors, we found the immun ological factor was 86.2%. Furthermore the immunological factor had significant difference in the various aged groups. 【Conclusion】 Immunological factor is a main factor in recurrent early spontaneous abortion. The immunological factor b ecomes significantly important as the times of spontaneous abortion increasing.

Objective To investigate the effect of sufentanil postconditioning on cardiomyocyte apoptosis during myocardial ischemia-reperfusion (I/R) in rats.Methods Thirty-six male Sprague-Dawley rats weighing 250-280 g were randomly divided into 3 groups ( n =12 each):sham operation group (group S),I/R group and sufentanil postconditioning group (group SP).Myocardial I/R was induced by occlusion of the left coronary artery for 30 min followed by 120 min reperfusion.Sufentanil 3.0μg/kg was injected iv at the beginning of reperfusion in group SP.HR and MAP were recorded during I/R.The rats were sacrificed at 120 min of reperfusion and their hearts were removed for determination of infarct size,number of apoptotic cardiomyocytes,and the expression of Bax mRNA and Bcl-2 mRNA,and apoptotic index was caculated.Results There was no significant difference in HR among the 3 groups ( P ＞ 0.05 ).Compared with group S,MAP and Bcl-2 mRNA expression were significantly decreased,apoptotic index and Bax mRNA expression increased in group I/R,and apoptotic index,and the expression of Bax mRNA and Bcl-2 mRNA were increased in group SP (P ＜ 0.05).Compared with group I/R,the infarct size,apoptotic index and Bax mRNA expression were decreased,and Bcl-2 mRNA expression was increased in group SP (P ＜ 0.05).Conclusion Sufentanil postconditioning can attenuate myocardial I/R injury in rats by up-regulating Bcl-2 expression,down-regulating Bax expression and inhibitting cardiomyocyte apoptosis.

Objective To evaluate obstetrics and gynecology training quality by analysis of clinical knowledge and clinical skills scores for long-term graduates.Methods A retrospective analysis of clinical knowledge and clinical skills scores was performed in obstetrics and gynecology training for 134 long-term graduates.Results The clinical knowledge and clinical skills scores of obstetrics and gynecology training were 82.27?7.68,87.69?7.24.There was no,P﹥0.05.Only the scores of clinical skills judged by one teacher in interview was correlated with clinical knowledge scores,while there were no correlation between clinical knowledge judged by other five teachers and scores of clinical skills.Conclusion There was no correlation between clinical knowledge and the scores of clinical skills scores.Culturing students’practical ability and communication ability is worth strengthening,while the consistency of teachers’evaluation standard should be improved.

Objective To provide the nurse care evidence of nutritional intervention in patients with lung cancer during radiotherapy and chemotherapy by analyzing the nutritional status of these patients.Methods 55 patients with lung cancer who received chemotherapy and radiotherapy were selected.The nutritional status of these patients were evaluated by laboratory examination data at the time of hospitalized,ongoing and the end of radiotherapy. Results The hemoglobin(Hb),albumin(ALB),body mass and body mass index(BMI)were (130.50 ±17.80)g/L, (41.02 ±5.68)g/L,(61.29 ±8.75)kg,(22.36 ±2.78)kg/m2 respectively at admission;(115.90 ±19.00)g/L, (37.94 ±5.55)g/L,(59.95 ±9.05 )kg,(21.86 ±2.86)kg/m2 respectively during the course of radiotherapy;(110.40 ±19.40)g/L,(36.91 ±5.30)g/L,(58.91 ±9.30)kg,(21.48 ±2.99)kg/m2 respectively at the end of radiotherapy.At different stages of radiotherapy,the nutritional index gradually decreased,the Hb was lower in the middle of the radiotherapy than on admission,the difference was significant(t =8.611,P <0.05).The Hb in the late stage of radiotherapy was lower than the middle,the difference was significant(t =2.492,P <0.05).Although the ALB in the latter stage of radiotherapy was lower than the middle,but the difference was not statistically significant (t =1.464,P >0.05),and the difference was significant compared with on admission(t =4.815,P <0.05).The weight of the patients in the middle period of radiotherapy was less than the time of admission,but the difference was not statistically significant(t =0.781,P >0.05).The weight of patients in the late stage of radiotherapy was lower than the medium term,but the difference was not statistically significant as well(t =0.601,P >0.05),and there was no significant difference compared with on admission(t =1.382,P >0.05).The BMI of the patients with radiotherapy was lower than that at the time of admission,the difference was not statistically significant(t =0.091,P >0.05).The BMI of patients with radiotherapy was lower than that in the medium term,whereas the difference was not statistically significant(t =0.690,P >0.05),and the difference was not statistically significant compared with on admission(t =1.599,P >0.05).The Hb (F =16.643,P =0.000)and ALB(F =7.736,P =0.001)decreased significantly in particular.Conclusion The risk of malnutrition in patients with lung cancer is exist during radiotherapy and chemo-therapy,and it is obvious in the middle -late stage,the changes of physical and biochemical indexes have been appeared,and among them,Hb and ALB are the most obvious,so should be monitored and managed cause these data varied significantly.

Tumor necrosis factor receptor-associated protein 1 (TRAP1),as one of the main members of the heat shock protein 90 family, resists oxidative stress-induced apoptosis as well as predominantly maintains the integrity of mitochondria and cellu-lar homeostasis. Abnormal expression of TRAP1 was herein closely related to the onset and progression of a wide variety of tumors. As a key regulatory factor mediating energy metabolism within tumor cells, TRAP1 may be able to kill them by interfer-ing with such metabolism. More importantly, the abnormal ex-pression of TRAP1 played a less important role in normal cells, allowing TRAP1 to be a particularly attractive target as it can be used in tumor treatment or interference. The relationship be-tween abnormal expression of TRAP1 protein and tumor onset was reviewed. Besides, the mechanism by which disordered TRAP1 protein expression induced tumor formation was postula-ted, which may provide references for future research and clini-cal treatment.

Objective To evaluate the survival and adverse effects of adjuvant concurrent temozolomid (TMZ) combined with radiochemotherapy in postoperative patients with high grade intracranial glioma.Methods 84 postoperative patients with high grade intracranial glioma were randomly divided into the observation group (42 cases including 25 grade Ⅲ cases and 17 grade Ⅳ cases) and the control group (42 cases including 23 grade Ⅲ cases and 19 grade Ⅳ cases).All patients were treated with concurrent radiochemotherapy after surgical operations,the total radiation dose was 60-66 Gy.The patients in observation group were given daily oral TMZ 75 mg/m2 during radiotherapy.4 weeks after radiotherapy,all of the patients received 6 cycles of TMZ,each cycle lasted 5 days with 28 days interval between each cycles.150 mg/m2 of TMZ was given for the first cycle for 5 days,followed by 200 mg/m2 of drug for the rest of the cycles if no significant drug related toxicities were observed.Results The overall response rates (CR+ PR) were 71.7 ％ (33/46) in the observation group,and 32.6 ％ (15/46) in the control group,and with significant difference between the two groups (P ＜ 0.001).The 1,2 and 3 year survival rates of patients in the observation group were 71.7 ％,47.8 ％,36.9 ％,and 56.5 ％,26.1％,15.2 ％ in the control group.The significant differences were found in 2-year and 3-year survival rates between the two groups (P =0.031,0.018).The median recurrent period in the observation group were 22 and 12 months in the control group,and with singnificant difference (P =0.015).The main side effects were limited to grade Ⅰ or Ⅱ.Conclusions Concurrent TMZ combined with radiotherapy in the treatment of high grade gliomas has better clinical efficacy,and can improve the 2-year and 3-year survival rates.Patients tolerate the strategy well and no severe toxicities are observed.

ObjectiveTo assess the efficacy of herpes virus entry mediator (HVEM) gene modifled dendritic cells (DCs) in protecting against myosin induced myocarditis,and to investigate the involving mechanism.MethodsWe treated experimental autoimmune myocarditis (EAM) mice with myosin-pulsed DCs which were transfected with HVEM-expressing adenovirus (Ad-HVEM) or control vectors,then evaluated myocarditis,plasm cTn [ and autoantibody by histopathology,fluoroimmunoassay,and ELISA,respectively.ResultsWe found that DCs transfected with Ad-HVEM (DC-Ad-HVEM) could protect against EAM.Further study showed DC-Ad-HVEM could produce regulatory cytokine IL-10,and IL-10 promoted the production of a key regulatory T cell subset which is important in peripheral tolerance.The T cells mediated protection against EAM.ConclusionThis study suggest that myosin-DC-Ad-HVEM cell gene therapy is a safe and effective way for inhibiting the development of EAM,and the signal net mediated by HVEM plays different roles in different cells.

Objective: In acute pancreatitis, traditional treatment insists fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. The aim of our study was to evaluate the efficacy and feasibility of early oral feeding as compared to traditional fasting in patients with mild acute pancreatitis.Methods: Seventy-two patients were randomized to the two treatment groups, fasting or early oral feeding. The inclusion criteria were pancreas amylase≥3times above normal, onset of abdominal pain within 48h, acute physiological and chronic health evaluation-II score<8 and C-reactive protein(CRP)<150 mg/L. Measures were amylase, systemic inflammatory response, length of hospital stay. Results: The groups were comparable with respect to age, sex, etiology, APACHE II, time from onset of pain and amylase at admission. No significant differences were seen between the groups concerning levels of amylase, CRP, leukocytes, abdominal pain or number of gastrointestinal symptoms. The length of hospital stay time was significantly shorter in the oral feeding group (13 vs. 17 days; P<0.05).Conclusion: Early oral feeding would not exacerbate disease process. The differences between treatment groups for amylase or systemic inflammatory response were not obvious. In mild acute pancreatitis, early oral feeding was feasible and safe and may accelerate recovery.

This thesis analyzed the inevitability of medical negligence according to the nature of medical behavior,particularity of medical profession and psychological factors of medical staff.How to control the occurrence of medical errors is an important social problem which is the whole community has been looking forward to solve.This thesis proposed methods to reduce medical negligence from the aspects of service concept,medical education and healthy psychology.