Practice of Cultivating Humanistic Literacy in Public Hospitals Based on Patient Experience Improvement / 中国医学伦理学

Patient experience is an important window for modern hospital management and medical service quality, and also an important point for humanistic hospital construction. Improving patient experience is of great significance for constructing harmonious doctor-patient relationship and improving patients’ satisfaction and sense of gain. Based on the perspective of patient experience improvement, this paper analyzed the core value of "patient demand first" of Mayo Clinic and the operational experience of Cleveland Medical Center Patient Experience Office, and applied them to the cultivation of humanistic hospital culture in the First Affiliated Hospital of Xi’an Jiaotong University. Based on the concept of "strengthening patient demand orientation", with the goal of "building a high-quality patient service system and significantly improving patient satisfaction", through building education platforms for medical ethics and medical humanism, exploring the medical humanism dissemination mode for medical staff, and carrying out the humanism literacy cultivation practice in the training camp for improving hospital service efficiency, the humanistic cultural atmosphere of the hospital has been further enhanced, and the patient satisfaction has been steadily improved. It provides reference for the cultivation of humanistic literacy and the construction of new culture in public hospitals in the context of high-quality development.

Meta-analysis of the efficacy and adverse reactions of fractionated high dose rate brachytherapy as monotherapy for localized prostate cancer / 中华放射肿瘤学杂志

Objective:To conduct a meta-analysis to analyze the efficacy and adverse reactions of fractionated high dose rate brachytherapy (HDR-BT) as monotherapy for localized prostate cancer.Methods:Relevant databases were searched to collect the clinical trials on HDR-BT as monotherapy in patients with localized prostate cancer. Included studies were limited to full-text publications of fractionated HDR-BT as monotherapy with a median follow-up of at least 5 years, and adequate reporting of treatment outcomes and adverse reactions data. Stata 12.0 was used for data analysis.Results:According to the inclusion and exclusion criteria, a total of 11 clinical trials involving 2 683 patients with prostate cancer were included in this meta-analysis. The results of the meta-analysis showed that 5-year biochemical recurrence-free survival (bRFS) rate and overall survival (OS) rate were 94% (95% CI: 93% - 96%) and 96% (95% CI: 94% - 98%), respectively. Long-term (≥5 years) cancer-specific survival (CSS) rate and distant metastasis-free survival (DMFS) rate were 99% (95% CI: 98% - 100%) and 98% (95% CI: 98% - 99%), respectively. Long-term (≥5 years) late grade ≥3 grade gastrointestinal and genitourinary adverse reactions rates were 2% (95% CI: 1% - 3%) and 9% (95% CI: 6% - 13%), respectively. Conclusions:Fractionated HDR-BT as monotherapy is an effective treatment for patients with localized prostate cancer. Its long-term efficacy is encouraging, and the treatment is well tolerated and safe.

Application of 192Ir brachytherapy in locally recurrent non-small cell lung cancer / 中华放射肿瘤学杂志

Objective:To evaluate the clinical efficacy and adverse events of 192Ir high-dose rate brachytherapy (HDR-BT) in the treatment of locally recurrent non-small cell lung cancer (NSCLC). Methods:Clinical data of 22 cases of recurrent NSCLC after radiotherapy admitted to our hospital from September 2013 to March 2018 were retrospectively analyzed. 192Ir HDR-BT was adopted for reradiotherapy. The prescription dose was 30Gy for 1 fraction. CT scan was reviewed every 1 month in the first 3 months after treatment and every 3 months after 3 months. Local control rate and adverse events were evaluated. The 1-and 2-year overall survival (OS) rates of re-treatment after relapse were calculated. Results:All the 22 patients completed the treatment successfully. The 1-, 3-and 6-month complete response (CR) rates were 9%, 14% and 14%, 82%, 82% and 82% for the partial response (PR) rates, 5%, 0% and 0% for the stable disease (SD) rates, 5%, 5% and 5% for the progressive disease (PD) rates, 91%, 96% and 96% for the objective response rates (ORR), respectively. The 1-and 2-year OS rates of re-treatment after relapse were 59% and 27%. Five patients (23%) experienced acute radiation-induced pneumonitis (3 cases of grade 1 and 2 cases of grade Ⅱ), 4 cases (18%) of radiation-induced bone marrow suppression (3 cases of grade I leukopenia and 1 case of grade I thrombocytopenia) and 1 case of postoperative pneumothorax. All these adverse events were mitigated after symptomatic treatment.Conclusion:192Ir HDR-BT is an efficacious and safe treatment of locally recurrent NSCLC.

Preliminary application of 192Ir high-dose rate brachytherapy in postoperative recurrent colorectal cancer with intrapulmonary oligometastases / 中华放射医学与防护杂志

Objective@#To investigate the efficacy and feasibility of 192Ir high-dose rate brachytherapy for recurrent intrapulmonary oligometastasis after colorectal cancer surgery.@*Methods@#Patients from May 2013 to October 2017 with intrapulmonary oligometastasisafter colorectal cancer surgery in Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were enrolled. A total of 15 lesions were obtained from 10 patients, which were treated with CT-guided high dose rate of 192Ir. The implant needles were inserted into the tumor and were adjusted to appropriate positions under the guidance of CT. Then the images after transplanting were uploaded to the planning system to delineate the target area and the organ at risk volume. Patients underwent a single radiation dose of 20 Gy.@*Results@#All 10 patients were successfully treated. Grade 1 adverse events were observed for 30% of patients. Of the 10 patients, one patient had a mild cough, and two had bloody sputum. There was no serious adverse events occurred. The local control rate (LC) of the patients at 1 year after treatment was achieved in 93.3%. Only one developed local advancement after six months, who received the secondary brachytherapy. The median progression-free survival(PFS) was 8.5 months and the median overall survival(OS) was 14.7 months.@*Conclusions@#High dose rate brachytherapy is effective in terms of recurrent lung metastases after surgery for colorectal cancer, with a moderate rate of adverse reactions and a favorable local tumor control rate.

Construction and management practice of morphologic experimental center in medical university / 中华医学教育探索杂志

Based on the construction and management practice of the morphologic experimental center in Xi'an Medical University, the achievements in laboratory daily operation and institutional man-agement were summarized in the area of lab rules and regulations, instrument and equipment, experiment teaching, lab environment and safety, lab staff administration and so on. The management work has been refined using the practice model of resource sharing, system administration, individual responsibility, and unified staff supervision. The lab rules and responsibilities were also effectively implemented on specific person. Taking the opportunity in teaching evaluation at the experimental center, the lab connotation con-struction was further strengthened. The evaluation system was thoroughly examined in order to look for gaps and promote the lab construction. Further work could be carried out on the laboratory software and hard-ware, such as instrument and equipment update, experimental teaching system reformation in morphology, promotion on multidisciplinary integration and unified management of lab staff.

Study on the Relationship of MiR-2 5 Targeting FBXO3 3 with Cell Apoptosis and Prognosis in Renal Cell Carcinoma / 现代检验医学杂志

Objective To explore the correlation between miR-25 and FBXO33 in renal cell carcinoma (RCC),and to analyze the relationship with apoptosis and prognosis of renal cell carcinoma.Methods The 511 RCC chip results,from 1998 to 2013,were downloaded from the Cancer Genome Atlas (TCGA)database,and were analyzed for the correlation between miR-25 and FBXO33 by Pearson test.The expression of fluorescein were detected with the FBXO33 3’UTR wild-type,mu-tant and blank control luciferase reporter gene treated by miR-25.The viability of cells transient translated by the miR-25 mimic,siRNA and the controls were detected by CCK8 method.The apoptosis of cells transient translated by the miR-25 mimic,siRNA and the controls were detected by flow cytometry.58 cases with follow-up data were screened from TCGA by expression of FBXO33 negative correlation miR-25.The survival was analyzed between low expression of miR-25 combined with FBXO33 high expression group (n=34)with high expression of miR-25 combined with FBXO33 low expression group (n=24),using Log-rank test and Gehan-Breslow-Wilcoxon test.Results FBXO33 was negatively correlated with miR-25 in RCC tissue (r=-0.161 1,Pearson test).Compared with the control group,miR-25 could reduce the RLU of wild type group to 80.2%±2.6%,the difference was statistically significant (t=6.539,P=0.006).The RLU of mutation group was 103.5%±8.4% compared with that of blank control group,the difference was not statistically significant (t=0.041 3,P=0.968 4),compared with the blank group in 72h for the cell varibility,miR-25 siRNA group were elevated by 32.7%± 3.5%,the difference was statistically significant (P<0.05).The miR-25 mimic group were reduced by 23.3%±1.7%,the difference was statistically significant (P<0.05),and compared with the control group,the early apoptosis rate was de-creased in mimic-miR-25-3p group (8.83 ± 0.09 vs 12.83 ± 0.14),while the difference was statistically significant (t=42.17,P=0.005).The late apoptosis rate was slightly escalated (0.41±0.10 vs 0.33±0.15),while the difference was not statistically significant (t=0.75,P=0.639).Compared with the control group,the early apoptosis rate was increased in siR-NA-miR-25-3p group (19.05 ± 1.64 vs 13.68 ± 0.78),while the difference was statistically significant (t=5.12,P=0.006).But the late apoptosis rate was reduced (0.56±0.10 vs 0.62±0.08),while the difference was not statistically sig-nificant (t=0.83,P=0.376).The survival rate was higher in patients with low expression of miR-25 combined with high expression of FBXO33 (n=34)than that of miR-25 high expression combined with low expression of FBXO33 (n=24),the difference was statistically significant (Log-rank test P=0.025 2,Gehan-Breslow-Wilcoxon test P=0.004 9).Conclusion MiR-25 can inhibite FBXO33 in renal cell carcinoma,improve the cell activity,inhibit apoptosis and reduce the prognosis.

Application and Exploration of PDCA Cycle Management in Hospital Social Evaluation / 中国医学伦理学

The First Hospital Affiliated to Xi'an Jiaotong University adopted PDCA cycle management tool and used planning,implementing,inspection,processing and other links in the specific application of promoting hospital social evaluation.After a certain stage,we summed up the work and changed the chaotic work status of social evaluation management.Comparing with the existing literature,this paper concluded that the application of this tool can promote the research of hospital quality and service management,promote the practice of building harmonious doctor -patient relationship.It is worth to promote the application of PDCA cycle management in hospital social evaluation.

Influence of transarterial chemoembolization on biological behavior of residual hepatocellular carcinoma / 中华肝胆外科杂志

Transarterial chemoembolization (TACE) is the standard treatment of unresectable hepatocellular carcinoma (HCC).However,high incidence of metastasis following TACE has much negative influence on patient survival.In this article,we reviewed negative influence of TACE on biological behavior of residual HCC cells to provide evidence for further application of TACE.

Pathological morphological characteristics of experimental rats with acute light and heavy pancreatitis / 重庆医学

Objective The aim of this study is to demonstrate the pathological characteristics about two types of pancreati‐tis ,providing new thinking about the mechanism of severe acute pancreatitis .Methods Thirty male Sprague‐Dawley rats were ran‐domly divided into three equal groups :sham‐operated (SO ,n=10) group ,mild acute pancreatitis (MAP ,n=10)) group and severe acute pancreatitis (SAP ,n=10) group ,all the rats were killed after 12 h of building model .Under the microscope ,we detected the pathological changes of pancreas ,liver ,lung and small intestine .The ultrastructure of pancreas ,liver ,lung and small intestine tissue were observed by transmission electron microscope .Results In SAP group ,congestion ,edema ,inflammatory cell infiltration ,lea‐king of blood componedts ,vascular endothelial injury and thrombosis of microcirculation were obviously observed .There is no ap‐parent pathological changes in the MAP group except the edema of pancreas .Conclusion Hemorrhage and necrosis are the main pathological characteristics in SAP rats ,has essential difference with MAP .These pathological characteristics provides us a new thinking for further study about the mechanism of SAP .

Ethical Analysis on Iatrogenic Factors for Current Tense Doctor-patient Relationship / 中国医学伦理学

Objective:To investigate the reasons of the tension of doctor-patient relationship and the medical violence from the perspective of the doctors, in order to provide a reference for finding a viable solution. Methods:Questionnaires survey were conducted about doctors' working conditions in 45 hospitals of 9 provinces. Results:On-ly 3. 6% medical staff had a harmonious doctor-patient relationship, the causes for the tense doctor-patient rela-tionship were poor communication with patients (75%), medical limitations (46. 2%);From the patients perspec-tive, the patients 'unpleasant caused by overtreatment due to complex illness accounted for 54. 2%;Institutional health-related reasons accounted for 82 . 6%. Conclusions:In the past five years after the new health care re-form, the tense doctor-patient relationship has not been released. So, should focus on training to enhance the com-munication skills of medical personnel and medical humanities education while the implementation of the national health care reform, in order to reduce iatrogenic conflicts.

Establishment of medical morality and behavior appraisal system and research on its application / 中国医学伦理学

The establishment of medical morality and behavior appraisal system and research on its application developed in comprehensive hospitals were clarified.Several aspects related to the medical morality and behavior appraisal,such as index,standard,approach,method,record and the result,were investigated and practiced,and the establishment of a scientific and reasonable medical morality and behavior appraisal system was investigated in the aspects of consummating the organization management of medical morality appraisal,subdividing the medical morality appraisal system,quantifying the medical morality appraisal standard,operating and performing the medical morality appraisal and establishing the electronic archives of medical morality appraisal to construct an efficient incentive and restraint mechanism,and moreover,to promote the establishment of hospital convention and the enhancement of the overall management level.