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Radiation skin injury can be induced by medical exposure, occupational exposure, and emergency exposure. Many relevant studies focused on the prevention and treatment of radiation-induced skin injury, but the underlying molecular mechanisms have not been fully clarified. It has been demonstrated that radiation-induced premature cellular senescence is involved in radiation skin injury. To discuss the relationship between radiation-induced premature cellular senescence and radiation-induced skin injury, this paper reviewed the mechanism of radiation-induced skin injury, the promotion of premature cellular senescence and related signal pathways, and the role of premature cellular senescence in wound healing.
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Objetivo Analizar información bibliográfica relacionada con las principales lesiones ocasionadas por los adhesivos tisulares, y el manejo de los dispositivos médicos. Metodología Revisión documental durante los meses de mayo, junio y julio de 2018 búsqueda exhaustiva de 68 artículos en diferentes bases de datos como PubMed, Scielo, Elsevier, Scient Direct, FECYT, Embase, Ovid Nursing y Medline. Con criterios de búsqueda como lesiones cutáneas y lesiones por dispositivos médicos de los cuales se tomaron 50 artículos teniendo en cuenta como método de inclusión el año (no mayor a 6 años de publicado) y la pertinencia en el tema de lesiones en piel por adhesivos y dispositivos clínicos. Resultados Las lesiones cutáneas más comunes son: reacciones alérgicas y las lesiones derivadas de los actos inseguros que alteran seguridad y bienestar del paciente, derivados de las prácticas por parte del personal médico y de enfermería. Conclusiones El uso de adhesivos tisulares y dispositivos de uso clínico prevé una problemática, que debe ser tratada con educación y estrategias de prevención.
Objective To analyze bibliographic information related to the main injuries caused by tissue adhesives, and the management of medical devices. Methodology Documentary review during the months of May, June and July of 2018 exhaustive search of 68 articles in different databases such as PubMed, Scielo, elsevier, Direct, FECYT, Embase, Ovid Nursing and Medline, with search criteria such as skin lesions and injuries by medical devices of which 50 were taken into account as inclusion method the year (no more than 6 years of publication) and the pertinence in the topic of skin lesions by adhesives and clinical devices. Results The most common skin lesions are: allergic reactions and injuries derived from unsafe acts that alter the safety and well-being of the patient, derived from the practices by medical and nursing staff. Conclusions the use of tissue adhesives and devices for clinical use, foresees a problem that must be treated with education and prevention strategies.
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Humains , Pancreas DivisumRésumé
Skin is the first organ of contact with ionizing radiation. Radiation-induced skin injury is common because the basal cell layer and capillaries of the skin are very sensitive to radiation. Acute radiation-induced skin injury primarily involves cellular alterations and inflammation in the epidermis and dermis, and late skin injury is mainly related to the effect of radiation on blood vessels. Clinical manifestations of radiation-induced skin injury include erythema, dry desquamation, moist desquamation, and ulceration in the skin mucosa, and the severity is related to the type and dose of radiation. Currently, the underlying mechanisms of radiation-induced skin injury are largely unknown, and the gold standard for the treatment of radiation injury has not been established. The known mechanisms of radiation-induced skin injury can be roughly divided into three pathways: oxidative stress injury caused by excessive production of reactive oxygen species, inflammation triggered by transcriptional activation of cytokines, and immune response evoked by bone marrow-derived cells. This paper reviews the three major pathways of mechanisms of radiation-induced skin injury, giving a reference for further mechanism study and preventive treatment of radiation-induced skin injury.
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Objective:To evaluate the skin development and repair process of X-ray radiation damage in rat with non-invasive two-photon excitation fluorescence (TPEF) imaging technology in vivo. Methods:Totally 24 SD rats were randomly divided into four groups including X-ray irradiated group (25, 35 and 45 Gy) and non-irradiation control group. At different times after irradiation, the degree of skin injury was evaluated, and the pathological changes of nicotinamide adenine dinucleotide (phosphate) [NAD(P)H] and collagen fiber fluorescence signals in epidermal cells were detected in vivo by TPEF imaging technology. Results:At 10 d post-irradiation, the skin of irradiation groups showed erythema and desquamation. At 15-20 d post-irradiation, the skin of radiation groups developed progressive exudation, edema and ulcers with increasing radiation dose. On day 25, the skin began to repair in the 25 Gy group, however, the skin of other groups still had exudation and ulcers. On day 10, NAD(P)H fluorescence signal in epidermal cells of irradiation groups decreased and the fluorescence signal of collagen fibers in papillary layer and reticular layer of irradiation groups reduced, which were significantly lower than that of normal control group ( t=24.145, 28.303, 26.989, 6.654, 7.510, 7.997, P<0.05). On day 30, fluorescence signal of NAD(P)H and collagen fibers in epidermal cells and dermis began to repair, the cell from stratum granulosum, stratum spinosum, and stratum basale in the 25 Gy group showed fluorescence signal, the other groups did not show. The fluorescence signal of collagen fibers in the 25 Gy group were gradually increased in papillary layer and reticular layer, however, they were significantly lower than normal control group ( t=115.133, 17.431, P<0.05), the skin of 45 Gy group did not show fluorescence signal of collagen fibers. Conclusions:The damage and repair process of epidermal cells and dermal collagen fiber can be detected noninvasively by TPEF imaging technology after X-ray irradiation in vivo.
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Objective:To evaluate biological dose and retrospective biodosimetry of a case of large area back skin injury caused by suspected interventional procedure.Methods:Peripheral blood from the patient was collected at about 7 months after interventional procedure, and the chromosomal aberrations in peripheral blood cells were analyzed to evaluate the retrospective biodosimetry using the correction factor of dose estimation, Dolphin′s model and Qdr method, respectively. Results:Based on the amounts of semi-automated dic and manually detected dic plus ring, the whole-body average absorbed dose of the victim was estimated to be 0.68-0.95 Gy by four different dose response curves. Over dispersion of dic or dic plus ring was also detected, and the efficiency of dose assessment was obviously increased using dic semi-automatic detection. Based on three different retrospective biodosimetry models, the estimated average absorbed dose was further corrected to be between 1.80-2.86 Gy, which was consistent with clinical diagnosis of degree Ⅳ radiation skin injury.Conclusions:A case of suspected radiation skin injury was confirmed by chromosomal aberration analysis and it’s biodosimetry was reconstructed, suggesting that the unstable chromosomal aberration analysis may be applicable to assess the retrospective biodosimetry of non-uniform local radiation exposure.
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Objective:To carry out investigation and analysis of an extensive skin radiation injury to the back accidentally caused by interventional procedure and to explore the problems faced in the event with emphasis on avoiding the reoccurance of similar events in the future.Methods:The data were collected by consulting the patient′s detailed medical history, collecting and analyzing clinical diagnosis and treatment data, tracking and observing their clinical manifestations and signs. The patient′s peripheral blood samples were also collected, together with the biological dose estimated and the equipment data collected on the site of the interventional treatment hospital.Results:The whole body dose to the patient was estimated to be 0.95 Gy. The typical values of kerma rate of radiation incident on the body surface due to fluoroscopic procedures were 373.5 mGy/min in subtraction modality and 47.8 mGy/min in fluoroscopy modality, respectively. The annual effective dose to the interventional radiologist was 20.51 mSv due to his operation in long-time radiation exposure conditions, higher than 3.09 mSv for other interventional radiologists with similar workload in the same department. The whole body and local clinical manifestations of the patients were in line with radiation injury. No clear diagnosis has been obtained in several hospitals, nor can obvious treatment outcomes be obsevered.Conclusion:Combined with the biological dose estimation result and clinical manifestations, the case was diagnosed as degree Ⅳ skin radiation injury. Radiation injury is closely related to whether the operation is conducted according to the standard and the output dose of X-ray machine. Non-specialized hospitals should strengthen clinical diagnosis and treatment of radiation injury.
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BACKGROUND: Nowadays, the ray types, animal species, irradiation modes and sites used in the establishment of animal models of radioactive skin injury in China are not consistent. Meanwhile, there is no uniform standard for the prevention and treatment of radioactive skin injury in clinical practice. OBJECTIVE: To establish an ideal rat model of acute radioactive skin injury. METHODS: Sixty Wistar rats were randomly divided into 32, 38, 45 Gy X-ray groups (n=18) and non-irradiated group (n=6). Three X-ray irradiated groups (32, 38, 45 Gy) received single irradiation of the right posterior buttock, 300 cGy/min, 100 cm between the skin and irradiated source, for 10.67, 12.67, and 15 minutes respectively. No irradiation was given in the non-irradiated group. The study protocol was approved by the Animal Ethic Committee of Shanxi Cancer Hospital (approval No. GDY2018001). RESULTS AND CONCLUSION: There was no accidental death after irradiation. The body mass of the rats decreased within 3 days after irradiation, and then increased. Irradiated wound was severest at about 15 days after irradiation, and the body mass dropped again, and returned to normal 2 days later. Two weeks after radiation, with the increase of X-ray dose, the structures of rat’s skin appendages were destroyed and a large number of inflammatory cells were infiltrated, indicating that the acute radiation skin injury was dose-dependent within a certain range. On the other hand, with the increase of irradiation time, the skin wound in the 38 and 45 Gy groups gradually deepened. At the same dose, the severity of acute radiation skin injury was also positively correlated with the irradiation time. After 6 hours to 15 days of 38 Gy irradiation on the rat skin, macrophages were activated, and the expression of Nod-like receptor pyrin domain-containing protein 3 was enhanced, indicating obvious inflammatory response, and thereby verifying the reliability of the model. To conclude, it is an ideal animal model of acute X-ray skin injury model made by the X-ray linear accelerator, which is easily observed and obtained, with obvious skin inflammation expression. This model is also of high safety and strong tolerance.
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Mesenchymal stem cells (MSCs) are pluripotent stem cells with high self-proliferation and multidirectional differentiation potential. They also have other functions including immune regulation, paracrine and so on, playing an important role in repairing injured tissues. In recent years, a lot of research has been done on how MSCs promote skin injury repair, and a lot of progress has been made. Compared with direct injection of MSCs in the wound area, some special treatments or transplantation methods could enhance the ability of MSCs to repair skin injury. This paper mainly discusses the role of MSCs in skin injury repair and technical ways to improve its repairing capacity, and discusses the existing problems in this field and prospects for future research directions.
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Différenciation cellulaire , Transplantation de cellules souches mésenchymateuses , Cellules souches mésenchymateuses , PeauRésumé
Radiation skin injury is a common and severe adverse event of radiotherapy in patients with head and neck cancer or nasopharyngeal carcinoma, which not only limits the radiation dose of the tumor, but also seriously affects the follow-up treatment and quality of life of the patients. It has become a bottleneck to improve the curative effect of tumor. The occurrence of radiation skin injury is a complex process of the interaction of many factors, which is closely related to the patient's own factors, radiotherapy technology, radiotherapy dose segmentation scheme and the combined regimens of radiotherapy and chemotherapy. Different regimens of radiotherapy and chemotherapy with drugs have effects on the occurrence and development of acute skin injury. There is still a lack of effective prevention and treatment of radiation-induced skin injury. Therefore, it is of great significance to explore its mechanism and radiation skin damage caused by different radiotherapy and chemotherapy regimens. This paper mainly reviews the combined application of concurrent chemoradiotherapy, induction and adjuvant chemotherapy to aggravate skin injury and its related mechanisms.
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Objective@#To evaluate the parabiotic tissue protection concept in the repairment of acute radiation-induced skin injury.@*Methods@#Seven patients(3 males and 4 females) with acute radiation injury treated in the Department of Plastic Surgery of the Second Affiliated Hospital of Soochow University from February 2014 to January 2018. The ages of patients ranged from 45 to 76 years. The wound areas include perineum and buttock (n=3), chest(n=2), and thigh(n=2). In the early stage, subregional " sandwich" surgical dressing was used to protect the probiotic tissue. Two months later, the necrotic tissue was clearly demarcated, the debridement was underwent, and the parabiotic tissue was preserved as far as possible. Vacuum sealing drainage(VSD)was applied to cover and soak wound with normal saline to moisturize the wound and promote the benign transformation of ecological tissue. Ten days later, the granulation grown well, and the skin flaps and myocutaneous flaps with good blood supply were designed to repair the wounds. The VSD device was continued to be used, to drain effusion under flap and promote the growth of cystic cavity granulation, with the purpose to promote blood supply of the skin flap, perform the final biological cleaning effect on the parabiotic tissue of the wound surface, promote the benign transformation of parabiotic tissue, and reduce the further necrosis.@*Results@#Seven patients with Ⅳ degree acute radiation-induced injury wounds were treated 6-10 weeks for surgery preparation, and 2-4 weeks for VSD-application after debridement. Except for part of flap was necrotized on 10th day after the first operation in one patient, all the other patients achieved satisfied outcome in a surgery. There was no further radiation-induced ulcer occurred during the 0.5-3 years of follow-up.@*Conclusions@#The concept of parabiotic tissue protection during preoperative, intraoperative and postoperative recovery phase can promote parabiotic tissue transformed to a good result after acute radiation injury, and reduce the size and depth of soft tissue necrosis, which can provide a good foundation for the secondary repair with flap and reduce complications.
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Infection plays an important role in the pediatric intensive care unit. Severe skin damage caused by bacterial infection often causes acute onset and high mortality,which should be paid attention to by clinicians. In this paper,the diagnosis,differential diagnosis and treatment of Staphylococcus aureus scalding syndrome and ecthyma gangrenosum caused by Pseudomonas aeruginosa infection were reviewed.
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An 87-year-old woman was referred for the extraction of residual teeth and removal of tori prior to prosthetic treatment. After surgery under general anesthesia, the surgical tape was removed to detach the bispectral index sensor and the hair cover. After the surgical tape was removed, skin injury occurred on the left side of her face. After epidermis repositioning and ointment application, a dressing was placed over the injury. Her wound was found to have healed completely on follow-up examination. Medical adhesive related skin injury (MARSI) is a complication that can occur after surgery and subjects at the extremes of age with fragile skin are at a higher risk for such injuries. Careful assessment of the risk factors associated with MARSI is an absolute necessity.
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Sujet âgé de 80 ans ou plus , Femelle , Humains , Adhésifs , Anesthésie générale , Bandages , Épiderme , Études de suivi , Poils , Facteurs de risque , Peau , Ruban chirurgical , Dent , Plaies et blessuresRésumé
Objective To investigate and analyze the prevalence of pressure ulcer and other skin injuries, and the implementation of pressure ulcer prevention measures among inpatients in Class ⅢGrade A hospitals in Hainan province. To provide basis for fomulating bundle of care model to prevent and intervent pressure ulcer, and establishing early warning management model on nosocomial pressure ulcer in ClassⅢGrade A hospitals in Hainan province. Methods A cross-sectional survey was conducted on inpatients from 7 ClassⅢGrade A hospitals in Hainan province. A investigation was performed by a self-designed inpatients'questionnaire and qualified tools on pressure ulcer and other skin injuries. Statistical analysis of data using by SPSS19.0 software. Results The content validity index of the self-designed inpatients'questionnaire and qualified tools on pressure ulcer and other skin injuries was 0.91, Cronbach α coefficient was 0.93. The prevalence of pressure sores was 2.28% (165/7 248), of which 66.06% (109/ 165) was family involvement, 30.30% (50/165) was hospital acquired, 3.03% (5/165) was community involvement,and 0.61% (1/165) was both from family and hospital acquired. Medical instrument related pressure ulcer accounted for 18.18%(30/165) of the total number of pressure ulcer. The most common site of pressure ulcer was the sacrococcygeal region, accounting for 47.94% (93/194). The proportion of pressure ulcer in stageⅡwas the highest (35.57% , 69/194). 52.01% (647/1 244) of patients at risk of pressure ulcer did not use the anti-pressure devices,and 81.40% (1 013/1 244) of patients' main compression sites were not covered by dressings.35.50%(442/1 244) of patients did not according to plans or regularly turn over, only 56.19% (699/1 244) patients turned over every 2 hours. 61.57% (442/1 244) patients who have pressure ulcer did not have anti-pressure ulcer signs. Among other skin injuries: the prevalence of incontinence related dermatitis was 0.88%(64/7 248), and the prevalence of avulsion skin injury was 0.37%(27/7 248). Conclusions The incidence of acquired pressure ulcer in ClassⅢGrade A hospitals in our province is slightly higher than other domestic investigation results. The reasons may be that anti-pressure devices in hospital configuration are not enough, lack of the tailored bundle of prevention measures of pressure ulcer, and failure to establish an effective early warning management model on pressure ulcer etc. So prevention and treatment of pressure ulcer should have a further standard management. Instrument related pressure ulcer and incontinence related dermatitis should also attract the attention of clinical nurses and managers.
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Objective To access the clinical effect of medical radiation protective ointment compared with trolamine cream to prevent acute radiation-induced skin injury in breast cancer patients undergoing radiotherapy after modified radical mastectomy. Methods Between February 2017 and February 2018,a total of 120 stage T1-4 N1-3 M0 eligible patients received intensity modulated radiation therapy were enrolled and matches into two groups:study group (60 cases) was administered medical radiation protective ointment from the first irradiation fraction,and control group (60 cases) received trolamine cream. When 3 grade reaction was observed,patients in control group start to administer medical radiation protective ointment until a month after radiation. Results The occurrence rate of acute breast dermal radiation reaction was 100％.Most patients in study group only underwent 1 grade radiation reaction (82％),while 2 and 3 grade radiation reaction (47％ and 13％) in control group were common ( P= 0. 000). Both pruritic degree and pain degree were higher in control group compared with study group (both P= 0. 000).In study group,the occurrence of 2 grade acute radiation-induced skin injury was obviously later than in control group with significant difference (P= 0. 000).Patients observed with 3 grade reaction relieved to certain reaction after administering medical radiation protective ointment. Conclusions Medical radiation protective ointment can effectively both alleviate and delay acute radiation-induced skin injury compared with trolamine cream. It also has therapeutic effect on 3 grade radiation reaction.
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Objective To analyze prevalence and determinants of medical adhesive-related skin injury (MARSI) in peripherally inserted central catheter implanted patients with lung cancer,to create evidence for improved clinical care.Methods A cross-sectional observational study design was adopted.Skin pictures and electronic medical records of 200 lung cancer patients who visited Shanghai Chest Hospital for PICC between June 2017 and September 2017 were analyzed to calculate prevalence of MARSI and identify related factors.Results The prevalence of MARSI was 31.5％ (63/200),and mechanical trauma accounted for 50.8％ of all cases (32/63).Age,diabetes and anaphylaxis were significantly related to MARSI.Conclusion Analysis of MARSI in PICC implanted patients with lung cancer provided evidence for improved clinical care of such patients.
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Objective To investigate the current status analysis the risk factors of medical adhesive related skin injury(MARSI) in neonates in NICU, in order to provide guidance in prevention and nursing of the skin injury. Methods Convenience sampling five NICU in Shenyang, prospective investigate the incidence of MARSI of neonates during the NICU stay, and analysis the incidence , injury type distribution and risk factors. Results The incidence of MARSI in neonates in NICU was 12.8%(53/413);the major injury type of MARSI was epidermal stripping(47.2%,25/53)and skin tear(35.8%,19/53) in mechanical injury;Logistic analysis showed that the independent risk factors of MARSI were the use of stomach tube, dehydrate skin and blue light therapy (χ2=5.953, 9.806 and 7.568, P<0.05). Conclusions MARSI is frequency interrupted in neonates during the NICU stay, correct selection of medical adhesive products, application of suitable paste and remove skills are helpful to reduce the incidence of MARSI in neonates during the NICU stay.
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Objective To measure the prevalence and analyzed associated factors of medical adhesive-related skin injuries (MARSI) at PICC insertion site in patients with hematologic malignancies. Methods A cross- sectional observational study lasting two weeks was carried out in Department of Hematology. Skin assessment data and photographs of skin were collected during PICC maintenances by the same investigator. The related information was got out from the medical record. The observed skin injuries were classified by the dermatologist and PICC specialized nurse together. MARSI prevalence was calculated. The associated factors were analyzed statistically. Results All of the 153 patients with hematologic malignancies were included. The prevalence of total MARSI at PICC insertion site was 33.99%(52/153), including mechanical skin injury (22.87%,35/153), contact dermatitis (CD) ( 9.80%,15/153), moisture-associated skin damage (0.65%,1/153), folliculitis(0.65%,1/153), respectively. Multivariate analysis identified two independent risk factors for mechanical skin injury including age≥50 years old, P=0.016, odds ratio (OR)=5.919, 95%CI 1.389-25.220 and non-specialist nurses in PICC maintenance, P=0.013, OR=8.333,95%CI 1.566-44.360. History of skin allergies (P=0.000,OR=12.333,95%CI 3.669-41.454) and arsenic trioxide infusion through PICC(P=0.003,OR=4.565,95%CI 1.661-12.547) were associated with CD. Conclusions MARSI at PICC insertion site is a prevalent event in the patients with hematologic malignancies. Epidemiological data and independent risk factors are presented in our study, which provide a basis for future study in this area.
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Peripherally inserted central catheter (PICC) has become internationally widespread in various healthcare settings (hospital, clinics ,homecare, et al), mainly used for administration of chemotherapy drugs, hypertonic parenteral nutrition solution and infusion therapy in two extreme age patients (neonates, especially in premature infants;elderly), which provides necessary vascular access for medium to longer term transfusion therapy. The risks of complications related with PICC are still existed, and PICC site with impaired skin integrity is prevalent, but described by only paucity of literature. International evidence-based guidelines provide little strategy. Our study was to review PICC site with skin injury in order to better understand the etiology, evolution and familiar with the international nursing dynamics, and identify directions for future research in this field, promote to overcome the nursing conundrum, and provide a basis for construction of guidelines for the skin management of PICC.
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Objective To provide nutritional supportive scheme for patients with radiation injury through the treatment of the one exposed to Nanjing 192Ir source accident.Methods The reasonable nutrition treatment scheme was made on the basis of dietary survey and nutritional index monitoring during clinical stages of the patient,including body weight,body mass index(BMI),biochemical indexes,electrolyte,etc.,as well as metabolic cart determination of resting energy expenditure (REE).Results Patient on admission (days 5 post-irradiated) weighing 42.5 kg,172 days after the first irradiated (the first skin grafting) fell to a minimum of 36 kg,then gradually rise,hen rose back to normal range on days 383 before discharge.Normal admission hemoglobin was 135 g/L,172 d after irradiated to a minimum of 54 g/L,normal discharge;when lymphocytes admission low as 0.5 × 109/L,58 days back to normal after exposure,172 days after irradiated down to 0.4 × 109/L.Serum albumin was normal admission 41.2 g/L,172 days after irradiated down to 25.3 g/L.The normal level of serum prealbumin was 0.22 g/L,248 days to a minimum of 0.04 g/L,the basic return to normal at discharge was 0.17 g/L.Admission normal liver function,bilirubin index slightly higher,the all in one parenteral nutrition after about 2.5 months later,bilirubin and liver function indicators were gradually increased,the adjusted treatment and nutrition liver and gallbladder and other gradually returned to normal after treatment.REE and the body weight were determined by metabolic cart on days 294,308 and 342 for the energy requirements.Conclusions For patient with radiation injury,appropriate nutrition therapy is a key method for the clinical treatment and rehabilitation,which can maintain the nutritional status of patients and improve clinical treatment.
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Objective To find a safer and more effective facial care method,reduce the incidence rate of facial skin injury,and improve patients' comfort level,as well as work efficiency of nursing.Methods 90 patients with orotracheal intubation were divided into the control group,transparent dressing group and skin protecting membrane group by random number table method.The control group was conducted with basic facial nursing;the transparent dressing group was applied with protective transparent dressing on the basis of basic facial nursing;the skin protecting membrane group was applied with skin protecting membrane on the basis of basic facial nursing.This research was conducted by observing and recording the incidence rate of skin injury,severity of skin injury,patients' comfort level,duration of skin care and the results.Results The incidence rate of facial skin injury was as follows:skin protecting membrane group 6.89％ (2/29)and transparent dressing group 15.15％(5/33)were better than the control group 50.00％(14/28),statistical significance was found among the three groups (X2=16.75,P ＜ 0.05);The times of facial skin nursing was as follows:the skin protecting membrane group (4.28±0.53) times was less than transparent dressing group (4.52±0.76) times and the control group (6.04±1.35) times,statistical significance was found among the three groups (Hc=32.65,P ＜ 0.05).Patients' comfort level comparison were as follows:the skin protecting membrane group was better than transparent dressing group and the control group,statistical significance was found among the three groups (Hc=22.42,P ＜ 0.05);Duration of skin care were as follows:skin protecting membrane group (10.40±1.35) minutes was less than transparent dressing group (14.09±1.27) minutes and the control group (12.35±1.28) minutes,statistical significance was found among the three groups (F=85.87,P＜ 0.05).Conclusions Skin protective membrane can effectively reduce the incidence and severity of facial skin injury on patients with orotracheal incubation,improve patients' comfort level,and greatly reduce operation time for nurses through its easer operation and less time consumption.