Objective:To analyze human factors in radiotherapy safety incidents and identify their correction for the purpose of mining the latent incident chains.Methods:A total of 60 radiotherapy safety incidents were included in the Radiation Oncology Incident Learning System (ROILS) for cause identification and frequency statistics using the Human Factors Analysis and Classification System (HFACS). Latent class analysis (LCA) was performed for the result to correlate the incident causes.Results:Incidents in the protocol design stage were the most common, accounting for 35%. Adverse organizational climate, inadequate supervision, and personnel factors were the primary causes of incidents at each level of the HFACS, accounting for 4.66%, 15.68%, and 16.20%, respectively. Three latent incident chains were identified through LCA, comprising two originating from organizational climate issues and one from organizational process issues, which were passed down via various human factors or " loopholes"Conclusions:HFACS assists in tracing the human factors at all levels that lead to radiotherapy safety incidents. The high-frequency causes and three latent chains of radiotherapy incidents found in this study can provide a guide for the development of targeted safety and defense measures.

Objective To investigate the clinical effect of tenofovir alafenamide fumarate (TAF) on chronic hepatitis B (CHB) patients with low-level viremia (LLV) after entecavir (ETV) treatment. Methods A total of 160 CHB patients who received ETV antiviral therapy in Wuhan Jinyintan Hospital from March 2019 to October 2020 were enrolled and divided into experimental group and control group by propensity score matching, with 80 patients in each group. The patients in the experimental group were given TAF antiviral therapy, and those in the control group were given ETV treatment; the course of treatment was 24 weeks for both groups. The two groups were compared in terms of HBV-DNA clearance rate, HBeAg clearance rate, alanine aminotransferase (ALT) level, estimated glomerular filtration rate (eGFR), FIB-4 value, liver stiffness measurement, and adverse drug reactions after treatment. The t -test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Results After 24 weeks of treatment, compared with the control group, the experimental group had significantly higher HBV DNA clearance rate (96.25% vs 16.25%, χ 2 =104.03, P < 0.001) and HBeAg clearance rate (34.78% vs 11.90%, χ 2 =6.32, P < 0.05). Compared with the control group, the experimental group had varying degrees of improvement in ALT, eGFR, FIB-4, and liver stiffness measurement ( t =5.77, 4.21, 8.45, and 4.58, all P < 0.05), and there was no significant difference in the incidence rate of adverse drug reactions between the control group and the experimental group during treatment (7.50% vs 8.75%, P > 0.05). Conclusion For CHB patients with LLV after ETV treatment, the change to TAF antiviral therapy can effectively increase their HBV DNA clearance rate and HBeAg clearance rate, improve liver and renal function, and reduce the degree of liver fibrosis, with good safety.

Objective:To explore any effect of training assisted by a pelvic rehabilitation robot on trunk control and walking after cerebral infarction.Methods:Forty cerebral infarction survivors with hemiplegia were randomly divided into an experimental group and a control group, each of 20. Both groups were given routine neurological medication and rehabilitation training, while the experimental group was additionally provided with 20 minutes of robot-assisted gait training daily, five times a week, for 4 weeks. Before and after the intervention, the motor function, walking function, trunk control and pelvic movement were assessed using a simplified version of the Fugl-Meyer assessment (FMA-LL), functional ambulation categories (FAC) and the trunk control test (TCT).Results:After the treatment, significant improvement was observed in all of the above measurements in both groups. The average FMA-LL, FAC and TCT results of the experimental group as well as their average pelvic lateral displacement, height displacement, rotation angle and roll angle were all significantly superior to the control group′s averages.Conclusions:Robot-assisted training can effectively improve lower limb motor functioning, trunk control, walking and pelvic motion after cerebral infarction, with better curative effect than routine rehabilitation training alone.

Objective:To explore the effect of robot-assisted training and repetitive transcranial magnetic stimulation (rTMS) on the lower limb function of hemiplegic stroke survivors.Methods:Forty hemiplegic stroke patients were randomly divided into a treatment group ( n=20) and a control group ( n=20). Both groups were given routine rehabilitation training and robot-assisted walking training, but the treatment group was additionally treated with rTMS at 1Hz applied to the primary motor cortex M1 area at an intensity of 80% of the resting motor threshold. The stimulation time was 5 seconds at 5-second intervals, 600 pulses each time, five times a week for 8 weeks. Lower limb motor function, balance and walking function were assessed before and after the intervention using the Fugl-Meyer assessment for the lower extremities, the Berg balance scale and the Holden walking function scale. Results:There was no significant difference between the two groups in any measurement before the training, but after the intervention all of the measurements had improved significantly in both groups, with the average Fugl-Meyer score, Berg score and Holden grading significantly better in the treatment group.Conclusion:Repetitive transcranial magnetic stimulation can improve the effectiveness of robot-assisted walking training in improving lower limb motor function, balance and walking after a stroke.

Objective:To explore the effect of a pelvis-assisting rehabilitation robot on lower limb function and knee proprioception after cerebral infarction.Methods:Forty hemiplegic cerebral infarction survivors were randomly divided into an experimental group and a control group, each of 20. Both groups were given routine neurological medication and rehabilitation training, while the experimental group was additionally provided with 20 minutes of robot-assisted gait training daily, five times a week for four weeks. Before and after the intervention, motor function, balance, walking function and knee joint proprioception were assessed using the simplified Fugl-Meyer lower limb assessment, the Berg balance scale, functional ambulation categorization and the Humac Norm isokinetic tester.Results:After the treatment, significant improvement was observed in all of the above measurements in both groups, but the improvements were significantly greater in the experimental group.Conclusions:Robotic pelvic assistance can effectively improve lower limb motor function, balance, knee proprioception and walking after cerebral infarction.

Objective To observe the effects of adiponectin (APN) on anxiety-and depression-like behaviors occurred in APP/PS1/tau triple transgenic Alzheimer's disease (3xTg-AD) model mice and investigate the possible mechanism.Methods The 9-month-old 3xTg-AD mice and wild type (WT) mice were randomly divided into four groups (n=8 for each group):WT+Saline,WT+APN,3xTg-AD+Saline and 3xTg-AD+APN groups.The mouse was chronically intracerebroventricular injection of APN or saline under free moving condition.Elevated plus maze task was used to evaluate the anxiety-like behaviors.Sucrose preference test and tail suspension test were used to evaluate the depression-like behaviors.Western blot was used to detect the protein expression levels of p-AMPK,AMPK,p-GSK-3β (Ser9),GSK-3β and SIRT1 in the hippocampus of each mouse.Results In the elevated plus maze test,the time percentage spent in open arms of 3xTg-AD+Saline mice was ((4.2±2.7) ％),which significantly lower than that in WT+Saline group ((10.1±4.1)％) (q=4.349,P＜0.01) and in 3xTg-AD+APN group ((9.7±3.3)％) (q=4.065,P＜0.01).In the sucrose preference test,the sucrose preference percentage in 3xTg-AD+Saline group((48.8±5.3) ％) was lower than that in WT+Saline group ((60.9±6.7) ％) (q=4.522,P＜0.01) and in 3xTg-AD+APN group ((59.3±6.2)％) (q=3.911,P＜0.05).As for tail suspension test,the immobility time percentage in 3xTg-AD+Saline group((40.7±9.9)％) was higher than that in WT+Saline group ((27.1±4.8)％) (q=5.257,P＜0.001) and in 3xTg-AD+APN group ((31.4±6.0)％) (q=3.624,P＜0.05).The result of Western blot showed that there was no significant difference in expression level of AMPK and GSK-3β among four groups.However,compared with that in WT+Saline group,the expression levels of p-AMPK (q=3.586,P＜0.05),p-GSK-3β (Ser9) (q=3.125,P＜0.05),and SIRT1 (q=3.044,P＜0.05) in 3xTg-AD+Saline group were significantly decreased.In addition,compared with that in 3xTg-AD+Saline group,the expression levels of p-AMPK (q=3.374,P＜0.05) and p-GSK-3β (Ser9) (q=3.063,P＜0.05) in 3xTg-AD+APN group were obviously up-regulated without affecting the SIRT1.Conclusion Adiponectin can effectively alleviate the anxiety-and depression-like behaviors of 9-month-old 3xTg-AD mice by up-regulating the protein expression of p-AMPK and p-GSK-3β (Ser9) in the hippocampus.

OBJECTIVE： To prepare Jinlei capsule and evaluate its quality. METHODS： Wet granulation was adopted. The molding technology of Jinlei capsule content granule was optimized with drug-excipient ratio， excipient ratio and ethanol volume fraction as factors， using comprehensive score of particle forming rate， moisture content and fluidity as the evaluation index. According to 2015 edition of Chinese Pharmacopoeia （part Ⅳ）， the characters， moisture， volume difference， disintegration time limit were checked. Qualitative identification of Gentianopsis paludosa and Lysimachia christinale were analysed by TLC， and quantitative analysis of luteolin and kaempferol were analysed by HPLC. RESULTS： The optimal molding technology of Jinlei capsule content granule was that the maltodextrin and the micro-silica gel are mixed as a mixed auxiliary material according to 10 ∶ 1 and then mixed with the drug powder by 1 ∶ 0.5， using the wet granulation method with 90％ ethanol as wetting agent. The characters， moisture， volume difference and disintegration time limit of Jinlei capsule were in line with Chinese Pharmacopoeia. TLC showed the same color spots on the corresponding positions of the reference chromatogram. The linear range of luteolin and kaempferol were 4.4-88.0 μg/mL and 9.6-96.0 μg/mL （all r＝0.999 9）. RSD of precision （n＝6）， reproducibility （n＝6） and stability （18 h， n＝7） tests were all lower than 2.5％. The average recoveries were 95.74％ and 99.77％ （RSD＝1.50％， 2.72％， n＝6）； the content of them were 2.52， 0.34 mg/g. CONCLUSIONS： The optimal molding technology of Jinlei capsule is stable and feasible； prepared Jinlei capsule in controllable in quality.

Objective To explore the effect of robot assistance on the gait kinematics of hemiplegic persons after a stroke.Methods Forty hemiplegic stroke patients were randomly divided into an experimental group and a control group,each of 20.Both groups were given routine neurological medication and rehabilitation training,while the experimental group was additionally provided with 20 minutes of robot-assisted gait training daily,six times a week,for 8 weeks.Before and after the intervention,both groups' motor function,balance,step length and pace were evaluated,as well as their pelvic rotation angles,side inclination,vertical displacement and lateral displacement.The Fugl-Meyer assessment for the lower extremities (FMA-LE) was used along with the Berg balance scale (BBS),the gait analysis system of Biodex Gait Trainer-2 equipment.Results After the treatment,the average FMA-LE score,BBS score,pace and step length of the experimental group were all significantly better than the before the treatment and significantly better than the control group's averages after the treatment.The improvements observed in the pelvic rotation angle,side inclination,vertical displacement and lateral displacement were all significant.Conclusion Robot assistance can usefully supplement routine rehabilitation training after stroke.It can improve control of the pelvis,enhance walking and balance and generally improve the motor function of the lower extremities.

Objective To analyze the correlation between the clinical characteristics and the incidence of postoperative hepatic encephalopathy in patients with cirrhosis who received transjugular intrahepatic portosystemic shunt ( TIPS) . Methods The clinical data of 80 patients with liver cirrhosis hospitalized in the Fifth Medical Center of PLA General Hospital from March 2015 to March 2017 were retrospectively analyzed. The related factors of hepatic encephalopathy complications after TIPS treatment were analyzed. Results The cumulative incidence of hepatic encephalopathy was about 23. 75%(19／80) in one year after TIPS operation. Through single factor analysis and multi factor Logistic regression analysis,it was found that the two factors of preoperative platelet level and the location of tips blood shunt were closely related to the occurrence of hepatic encephalopathy after TIPS operation. The ROC curve suggested that the AUC of preoperative platelet level and the location of tips blood shunt were 0. 657 and 0. 668, respectively. The sensitivity and specificity of the former were 70. 0%,52. 6% and the cutoff value was 51 ×109／L, respectively, while those of the latter were 70. 5% and 63. 2%, respectively. Conclusion Preoperative platelets level＞51×109／L or shunting of the left branches of the portal vein may indicate a lower incidence of hepatic encephalopathy.

Objective: To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns. Methods: 218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8±10.7) years and 170 were male(78.0%). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22.0%). Clinical data were compared between two groups and risk factors for short- and long-term mortality identified using Cox regression. Results: Patients with renal malperfusion showed significantly higher incidences of short-term mortality(22.9% vs 8.3%, P=0.023), long-term mortality(87.0% vs 72.9%, P=0.003) and postoperative acute kidney failure(20.8% vs 4.1%, P<0.001). Renal malperfusion was the risk factor for short-term mortality(OR 2.92, 95%CI 1.31-6.63, P=0.009) and long-term mortality(OR 2.56, 95%CI 1.32-4.94, P=0.005). Conclusion Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD.