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 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 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 explore the effect of comprehensive intervention on constipation caused by antipsychotic drugs.Methods Ninty patients with antipsychotic drug induced constipation who were admitted to our hospital from June 2012 to October 2013 were enrolled in this investigation and randomly assigned to the comprehensive intervention group(CIG,n=46) and the routine care group(RCG,n=44).The subjects of the RCG received routine diet and medication therapy; and those of CIG received comprehensive intervention of life style,psychological ability,cognition,nursing and traditional chinese medicine(TCM) for 3 months.Constipation symptoms scale and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) were assessed before and after the intervention.Results CIG showed significant improvement in defecation difficulty,defecation force,defecation duration,frequency,abdominal distension,total symptom score,PAC-QOL,physical discomfort,psycho-social discomfort,anxiety and treatment satisfaction were(2.8±2.1),(2.2±1.6),(2.4±1.3),(2.1±1.7),(1.5±0.9),(14.0±8.1)respectively (t values were 2.629,3.818,2.328,2.593,2.578,2.913,7.499,2.570,5.012,2.249 and 12.259,respectively; all P＜0.05).Conclusion Comprehensive intervention may be an effective therapy against psychiatric drug induced constipation.

Objective To research the effects of transcutaneous electrical stimulation (TES) on the expression of neurotrophin-3 (NT-3) and tumor necrosis factor-α (TNF-a) in the ventral horn of rats' spinal cords and in the injured region after spinal cord injury (SCI),and to explore the effects of TES on neuron reconstruction and functional recovery and their mechanisms. Methods Forty-eight Wistar rats were selected and divided using stochastic methods into a model group and a TES group.Using Allen's method,a complete SCI model was created at T9.Rats of the TES group were given TES treatment.Basso-Beattie-Brasnahan ( BBB ) ratings were used to evaluate locomotor function.Both groups were sampled at 1,3,5 and 7 days after the operation.Immunohistochemical techniques were used to detect the expression of NT-3 and TNF-α in the rats' spinal cords at the different time points. Results The post-operative BBB ratings of both groups showed an increasing trend.In the TES group the improvement was significantly better at 5 and 7 days than in the model group.The expression of NT-3 immuno-positive cells increased in both groups,peaking at 5 days post-operation,then declining at day 7.The expression of NT-3 positive cells at days 5 and 7 had increased significantly more in the TES group than in the model group.TNF-α immuno-positive expression increased with time in both groups,but in the TES group the expression increased substantially less than in the model group.At days 5 and 7 post-operation,the expression was significantly lower than in the model group. Conclusions TES can promote NT-3 expression in rats with SCI,inhibit the increase in TNF-α expression,and aid repair and reconstruction of neurons and related functional recovery.

ObjectiveTo investigate the value of serum procalcitonin (PCT) in diagnosing lower respiratory tract infection (LRTI) in adult.MethodsIn a retrospective study,97 patients were enrolled,who admitted into Peking University People's Hospital with suspected LRTI from July to December 2008.During analysis,the subjects are categorized into groups of LRTI with sepsis,hospital-acquired pneumonia(HAP),community-acquired pneumonia(CAP),acute exacerbation of chronic obstructive lung disease (AECOPD),other LRTI and non-infectious diseases.In these cases,the following parameters were assessed regularly,such as white blood cell count,erythrocyte sedimentation rate( ESR),C-reactive protein (CRP),PCT,bacterial culture of both sputum and blood,and Acute Physiology and Chronic Health Evaluation (APACHE)Ⅱ score.PCT levels were determined using antibody-coated tubes as a complete diagnostic-kit (LUMI test Pro-Calcitonin) in a Luminometer.ResultsMean PCT levels in groups of LRTI with sepsis, hospital-acquired pneumonia ( HAP ), community-acquired pneumonia ( CAP ), acute exacerbation of chronic obstructive lung disease( AECOPD),other LRTI,non-infectious diseases were 10.1 (0.7 -37.0),0.3(0.1 -0.8),0.2(0.1 -0.9),0.2(0.1 -0.4),0.3(0.1 -0.5),0.1 (0.1 -0.2) mg/L,respectively.There were statistical differences between these groups (H =19.898,P ＜ 0.01 ).And the PCT levels in groups of LRTI with sepsis,HAP,CAP,AECOPD,other LRTI were higher than group of non-infectious diseases ( U values were 0,18.000,81.000,20.000,all P ＜ 0.01 ).Patients with sepsis exhibited strongly higher PCT levels than patients with other lung diseases ( U values were 11.000,45.000,3.000,4.500,all P ＜ 0.01 ).Pearson correlation analysis of PCT levels with positive bacterial cultures and APACHE Ⅱ score was performed ( r =0.449).ROC analysis revealed that optimal discrimination between LRTI and non-infectious diseases could be performed at the cut-off point of 0.5 mg/L with a sensitivity of 32.6％ and specificity of 100％,while at a suggested cut-off point of 0.235 mg/L with a sensitivity of 53.9％ and specificity of 100％.Conclusions PCT is a more useful parameter for diagnosing lower respiratory tract infections( especially for those with sepsis) than other infectious markers such as CRP,ESR and white blood cell count.The sensitivity of PCT could be elevated with a reduction of the cut-off level.

Base Sequence ; Child, Preschool ; Humans ; Male ; Point Mutation ; Polymerase Chain Reaction ; Puberty, Precocious ; genetics ; Receptors, LHRH ; genetics ; Sequence Analysis, DNA ; Testosterone ; blood