DSA同室操作辐射工作人员的剂量预测

通过理论预测和分析,计算了使用DSA时第一术者位和第二术者位的泄漏辐射剂量率和散射辐射剂量率,计算了经床侧和个人防护用品屏蔽后第一术者位和第二术者位的剂量率,并计算了DSA同室操作辐射工作人员的外照射剂量、手部剂量和眼睛体剂量。文章提供了一种预测分析DSA术者位剂量率,预测分析同室操作辐射工作人员外照射剂量、手部剂量和眼睛体剂量的方法,为政府部门的审批提供了相关依据。

Central venous port placement in advanced breast cancer patients:comparison of the anatomic- landmark and ultrasound-guided techniques

Objective： The aim of this study was to compare the anatomic-landmark and ultrasound-guided techniques in the placement of an internal jugular vein port in patients with advanced breast cancer. Methods： Between March 2010 and October 2010, 60 patients with advanced breast cancer underwent central venous port placement for the delivery of chemotherapy, preferably through the internal jugular vein. Patients were randomly assigned to either the anatomic-landmark or the ultrasound-guided group. Failure on first attempt, number of attempts until successful catheterization, time to successful placement, the accordance of the two placement approaches, and the demographics of each patient were recorded. Results： The consistency of the direction of two lines drawn using the anatomic-landmark and ultrasound-guided techniques or of the diameter of the internal jugular vein as determined by the two approaches was 85% （51/60）. The rate of successful place- ment at first attempt was higher in the ultrasound group than in the anatomic-landmark group （P 〈 0.05）. A greater number of attempts and longer time to successful port placement were needed in the latter （P 〈 0.05）. Conclusion： The findings of this study indicate that, in the placement of an internal jugular vein port, the ultrasound （US）-guJded technique has several advantages over the anatomic-landmark technique.

Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.

Advertise With Social Discourse, as a Brand Positioning Technique： The Focuse on Consumers Advertising

This study examines the nature of the social discourse of advertising used as a brand positioning discourse. The focus is on consumer advertising, which is directed toward the promotion of some product or service to the general public. This paper aimed at analyzing some different commercial advertisements [product/non-product ads] to investigate the intentions and techniques of consumer product companies to reach more consumers and sell more products. Norman Fairclough＇s 3-D model and Kress and Van Leeuwen＇s grammar of visual design were used to analyze the data for professionals, but we are pointed on using stereotypes. When we consider gender stereotypes, we look at notions about the supposedly traditional behaviors of men and women and the characteristics and standards of these behaviors, as grounded in our culture and society. In addition, this study provides analyses of some ads, using different ways of interpretations. All materials are taken from Latvian media.

Evaluation of nephron sparing surgery for renal tumors:a single institution experience

Objective:The aim of the study was to report the experience of National Cancer Institute(NCI),Cairo University,Egypt,in managing various benign and malignant renal tumors with nephron sparing surgery(NSS),and to assess its safety and feasibility.Methods:Reviewing the literature for NSS,and records of patients who underwent NSS in the period from January 2000 to December 2009 at National Cancer Institute,Cairo University regarding the patient and tumor related characteristics,the indication for NSS,operative technique,postoperative complications,full histopathological data,and follow up results.Results:The total number of patients was 17.Mean age at surgery was 30.7 years(range 1.5-65 years).Five patients had bilateral tumors during surgery.The mean tumor size was 4.5 cm(range 1-9 cm).All patients had normal preoperative kidney functions.Seven patients had an absolute indication for NSS,6 patients had a relative indication,and 4 patients had an elective indication.All the 5 patients with bilateral tumors underwent bilateral simultaneous surgery.Cold ischemia was used in 8 patients,1 patient was exposed to warm ischemia,manual compression was used in 2 patients,and no vascular control was applied in 6 patients.Complications were encountered in 2 patients,one of them had urinary leakage which needed reoperation,and the other had subcutaneous hematoma which was treated conservatively.Histopathological analysis revealed Wilm's tumor(8 patients),angiomyolipoma(4 patients),renal cell carcinoma(4 patients),and hydatid cyst(1 patient).All patients had negative surgical margin.For patients with Wilm's tumor,the mean follow up was 21.4 months(range 0-94 months),2 patients had local recurrence,and 1 patient had distant metastasis.For patients with RCC,the mean follow up was 15.3 months(5-33 months),no patients had local recurrence or distant metastasis.All patients had normal kidney functions during postoperative and follow up periods.Conclusion:NSS is a feasible safe procedure that can be done with acceptable complications rate and it provides a good solution for patients with bilateral tumors,early localized renal cell carcinoma,and benign tumors.