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 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.

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.

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.

This paper analyzed current problems and challenges facing hospitals in alarm management both abroad and at home. Based on a survey conducted on alarm management in hospitals, plus an analysis on different kinds of data interfaces and data exchange protocols of the medical equipment used in ICUs, a solution of alarm management is put forwarded which is based on alarm information integration and processing. It aims at improving medical equipment alarm management and reducing relevant adverse events.
Automatic Data Processing ; Clinical Alarms ; Intensive Care Units

Objective To evaluate the technical points and security of CT-guided in percutaneous gold seed fiducials implantation for 132 solid tumors before cyberknife radiosurgery treatment. Methods 132 solid tumors were implanted with gold seed fiducials guided by CT before cyberknife radiosurgery treatment.The complications were analyzed. The methods for the prevention and treatment of the complications were suggested. Results Of 132 cases, the achievement rate of puncture was 99.2%(131/132), including 16 (12.1%) cases of pain in the location of puncture, 10(7.6%) cases of tachycardia, and 6 (4.5%) cases of hypertension. Among the 68 cases of lung cancer, there were 3(4.4%) cases of slight pneumothorax, 3(4.4%)cases of generous pneumothorax. Among the 50 cases of liver cancer, there were 1 (2.0%) case of gold seed fiducials transmigration, 2 (4.0%) cases of small amount bleeding from needle channel. Conclusion Percutaneous gold seed fiducials implantation in CT-guided for solid tumors before cyberknife radiosurgery treatment is a slight trauma and safe method.

Objective To explore the clinical value of combined detection of CA15-3, TSGF, OPN and CA125 in the diagnosis and treatment of breast cancer. Methods The serum specimens from 187 patients with breast cancer (cancer group) were collected, tumor markers CA15-3 and CA125 were detected with electrochemiluminescence method, TSGF was detected with chemocolorimetry, and OPN was detected with enzyme-linked immunosorbent assay. Compared with 50 cases of patients with benign breast disease (control group), The relationship between these marker and clinical stage, recurrence and metastasis of breast cancer were analyzed. Results The serum levels of CA15-3, CA125, TSGF and OPN in cancer group were significantly higher than those in control group (P ＜0.05). Four markers in high clinical stage(Ⅲ and Ⅳ stage)[(83.21±28.67), (89.13±32.34), (278.66±137.23) U/ml and (97.4±11.7) ng/ml, respectively] were higher than those in low stage( Ⅰ and Ⅱ stage) [(60.03±19.35), (58.21±17.56), (155.79±113.11) U/ml and (77.5±10.81) ng/ml,respectively] (P ＜0.05), and those in lymphnode metastasis patients and in recurrence patients were significantly higher than those in corresponding groups (P ＜0.05). The sensitivity and specificity of the combined detection of four tumor markers were 96.3 % (180/187) and 80.0 % (40/50), respectively. The average time of combined detection of serum tumor markers was 2 months ahead of the mammographic features in the recurrence patients with breast cancer. Conclusion The dynamic combined detection of CA15-3, TSGF, OPN and CA125 are better markers for monitoring recurrence and metastasis of breast cancer,which are benefit to early diagnosis and interference.

Objective To investigate acquired carbapenemases and prevalence of carbapenem- resistant gram-negative bacill.Methods The antimicrobial susceptibility was determined by agar dilution method.Metallo-B-lactamase(MBLs)were screened by EDTA-disk synergy tesL The encoding genes of MBLs were amplified by PCR followed by sequencing.Strain homology Was investigated by pulsed-field gel electronphoresis(PFGE).Results In 141 carbapenem-resistant Pseudomonas aeruginosa(P.aeruginosa), there were three resistant patterns which were imipenem(IMP)-resistant+meropenem(MEM)-resistant (66.7%),IMP-resistant+MEM-sensitive(32.6%),and IMP-resistant+MEM-sensitive(0.7%).AⅡthe carbapenem-resistan Acinetobacter baumannii(A.baumannii),Acinetobacter lwoffi(A.lwoffi),Citrobactor freundii(C.freundii),Klebsielta pneumoniac(K.pneumoniac)and Serratia were resistant to imipenem and meropenem.Four strains of 141 P.aeruginosa were positive by EDTA-disk synergy test,and they produced VIM-2-type Metallo-B-1actamase.Of 34 carbapenem-resistan A.baumannii,30 strains produced OXA-tllrpe.Among them, OXA23, OXA24 and OXA66 accounted for 79.4%,38.2% and 67.6%,respectively.And 22 of 34 strains(64.7%)produced multiple OXA-carbapenemases.All 7 strains A.lwoffi produced OXA-23-type carbapenemases.A11 11 strains C.freundii,5 strains k pneumoniac and 1 strains Serratia produced KPC-2-type carbapencmases.And 6 of 11 strains C.freundii produced new subtype IMP-8.Of 15 PFGE type in 34 strains A.baumannii,14 strains belonged to A-type,7 strains belonged to B-type.Seven A.lwoffi strains distilbuted in difierent PFGE type.Four strains of P.aeruginosa producing VIM-2.type Metallo-8-lactamase did not have the same PFGE type.Eleven C.freundii strains had the same PFGE type.Five k pneumoniae strains had the sanle PFGE type.Conclusions Drug resistance to 12 common antibiotics in carbapenem-resistant gram-negative bacill was higher than non-carbapenem-resistant gram-negative.The former produced many kinds of carbaponemases and the strains prducing carbapenemases were prevalent in the C.freundii, A.baumanii, and k pneumoniae.