Objective To study the clinicopathological characteristics of complicated Kaposi's sarcoma after renal transplantation.Methods Five cases of complicated Kaposi's sarcoma after kidney transplantation were studied by histopathological immunohistochemical and ultrastructural observations.Results Of the 5 Kaposi's sarcoma patients,2 had multiple amaranthine dermal plaques starting on the legs,one had lymph node hypertrophy all over the body,and others had inguinal lymph node and adenoid hypertrophy. Histopathologically,these angiomatous lesions had characteristic areas of spindle cells within which erythrocytes were enmeshed.Admixed in these lesions were hyaline bodies and hemosider-laden,phagocytic cells.Immunohistochemical and ultrastructural studies revealed that this tumor was derived from vasofomative mesenchyme with multipotential capabilities.It was found that the epithelia and spindle cells were positive for Vimentin,CD-31,CD-34 and Ⅷ-RAg.Conclusion Complicated Kaposi's sarcoma after kidney transplantation can be diagnosed by combination of clinical manifestations and histopathological examinations with immunohistochemical and ultrastructural observations.

ObjectiveTo evaluate the efficacy of intravenous and intra-arterial thrombolysis with urokinase for acute cerebral infarction.Methods Fifty patients with acute cerebral infarction occurred within 6 hours were divided into two groups by random digits table method with 25 cases each:intravenous and intra-arterial thrombolysis group and intravenous thrombolysis group.The patients in intravenous and intra-arterial thrombolysis group were given 200 000 U urokinase by intravenous infusion for 30 minutes immediately after being hospitalized,and arterial thrombolysis was prepared at the same time.With cerebrovascular angiography,the thrombolytic therapy was carried out in the target vessel blocking points through micro-catheter.Urokinase dissolved in 0.9％ sodium chloride was infused at the rate of 10 000 U per minute,the total volume would not be more than 1 000 000 U.The patients in intravenous thrombolysis group were given 1 000 000 U urokinase in 100 ml 0.9％ sodium chloride by intravenous infusion within 60 minutes.The clinical efficacy after thrombolysis was assessed according to the National Institutes of Health stroke scale (NIHSS) score,the quality of life was judged by Barthel index (BI) score and the prognosis was evaluated by modified Rankin scale (mRS) score of 90 days after thrombolysis.ResultsThere was no significant difference between two groups before thrombolysis according to the NIHSS score (P ＞ 0.05).After thrombolysis,NIHSS scores in two groups showed a downward trend,but they were obviously lower in intravenous and intra-arterial thrombolysis group after 24 h,7 d and 14 d than those in intravenous thrombolysis group [(8.97±4.56) scores vs.(11.01±3.65) scores,(6.88±2.31) scores vs.(8.34±3.05) scores,( 4.06±3.02 ) scores vs.( 6.73±2.15 ) scores ] ( P ＜ 0.05 or ＜ 0.01 ).BI scores before thrombolysis between two groups had no significant difference(P ＞0.05),while BI score of 90 days after thrombolysis in intravenous and intra-arterial thrombolysis group [(79.55±19.64) scores] was higher than that in intravenous thrombolysis group [(69.31±21.35) scores](P=0.0162).The rate of mRS score 0-2 (good efficscy) in intravenous and intra-arterial thrombolysis group [72.0％(18/25) ] was obviously higher than that in intravenous thrombolysis group [ 52.0％ ( 13/25 ) ] (P =0.0198 ).ConclusionsIt is significantly effective to treat acute cerebral infarction by superselective intravenous and intra-arterial thrombolysis.Therefore,it is supposed to be an optimal option for treating acute cerebral infarction in the future.

Objective To investigate the prevalence and resistance mechanisms of Proteus mirabilis in the ward of neurology de‐partment of our hospital .Methods For a total of 20 clinic isolates of Proteus mirabilis ,PCR were used for the detection of AmpC , ESBLs ,KPC and MBLs and then DNA sequencing was performed .The integrons were also detected by using PCR and then sequen‐cing was carried out .The genetic relationship between isolates were detected and analysed by pulsed‐field gel electrophoresis(PF‐GE) .The results of drug sensitivity tests were analysed .Results TEM‐1 and CTX‐M‐14 gene were found in all the 20 isolates ,the 10 isolates of Proteus mirabilis were also found carrying CMY‐2 gene .Class Ⅰ integrons were amplified from 19 strains carrying gene cassettes aacA4+cmlA1,dfrA12+orfF+aadA2and dfrA32+ereA+aadA2 respectively .PFGE analysis revealed that the 20 isolates were grouped into 11 PFGE types P1-P11 ,the 12 isolates of P1-P3 were same clones .The sensitive rates of the i‐solates to Meropenem ,Amikacin ,Aztreonam ,Ceftazidime and Tazocin were high .Conclusion Nosocomial transmission of the same clone of Proteus mirabilis was appeared in the ward of neurology department of our hospital .The predominance drug‐resistance genes were CTX‐M‐14 andCMY‐2 .The incidence of carrying class Ⅰ integrons was high ,and the major gene cassettes wereaacA4+cmlA1and dfrA12+orfF+aadA2.The 20 isolates were all sensitive to Meropenem ,Amikacin and Aztreonam .Other Clinical departments should also pay attention to the nosocomial infection caused by Proteus mirabilis and strengthen the infection control measures .

Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is an extremely rare, indolent skin malignancy that can be difficult to distinguish from autoimmune disease-associated panniculitides. Here, we describe a 12-year-old boy who was diagnosed at age 7 years with dermatomyositis with classical manifestations, including poikiloderma, Gottron’s sign, and symmetric muscle weakness. Recently, the boy presented multiple subcutaneous nodules and fever. Histopathological examination and immunohistochemical staining revealed coexistence of SPTL. To our knowledge, this is the first case of dermatomyositis accompanied with SPTL. This case alert clinical physicians of the possibility of SPTL should be considered when a patient with dermatomyositis has new lesions presenting as nodules and unknown fever.

Objective:To explore methods and effects of training and rotation of newly recruited nurses in ClassⅢ hospitals of traditional Chinese medicine (TCM) so as to provide references for improving the clinical nursing service ability of newly recruited nurses in hospitals of traditional Chinese medicine and providing practical TCM nursing talents for clinical practice.Methods:According to the requirements of the"Standardized Training Outline for Newly Recruited Nurses (Trial)""Systematic and Standardized Training Program for Newly Recruited Nurses in ClassⅢ Hospitals of Traditional Chinese Medicine"was formulated. Using the convenience sampling method, 95 nurses from the First Affiliated Hospital of Zhejiang University of Chinese Medicine were selected as the research objects. A total of 95 newly recruited undergraduate nurses who graduated in 2016 were given pre-job training for 3 weeks and specialist rotation training for 24 months. After 3 weeks of training, theoretical test and nursing skills assessment of traditional Chinese medicine and western medicine were conducted to evaluate the comprehensive ability of clinical practice after 1 year and 2 years of rotation.Results:After 3 weeks of training, the average scores of theoretical test, western medicine nursing operation and TCM nursing operation of 95 newly recruited nurses were respectively (88.63±4.74) , (95.57±0.75) and (93.18±1.63) . The score of comprehensive ability of clinical practice after 1 year of rotation was (84.05±4.96) , and that after 2 years of rotation was (90.62±2.38) . The differences in scores were statistically significant ( P<0.05) . During the rotation phase, none of 95 newly recruited nurses had patient complaints or serious errors. Conclusions:Through training and rotation, newly recruited nurses can quickly complete the role transformation of nurses, consolidate the basic theoretical knowledge and skills related to TCM nursing and improve the comprehensive ability of clinical nursing practice to ensure the quality of nursing.

This experiment was aimed to mainly observe the effect of Anshen navel plaster on autonomic activities and to compare neurotransmitter gamma-aminobutyric acid (GABA) and monoamine neurotransmitter (5-HT) contents change of insomnia rats.The rats were treated by P-chlorophenylalanine (PCPA),which can make healthy rats lose sleep.The rat model of insomnia was prepared by intraperitoneal injection of PCPA.The healthy SD rats were randomly divided into the blank control group,model control group,low dosage of Anshen navel plaster group,high dosage of Anshen navel plaster group and Tongren Anshen pill group according to the random number table.EthoVision were used to record the rat's autonomic activities.Content changes of 5-HT and GABA of rats in each group were measured by enzyme-linked immunosorbent assay (ELISA).The results showed that rat's autonomic activities were decreased in the Anshen navel plaster group and Tongren Anshen pill group,which indicated that the Anshen navel plaster had a good sedative effect.Intraperitoneal injection of PCPA can remarkably change rat's serum neurotransmitter expression levels,especially GABA and 5-HT.After the intervention of experimental drugs,compared with the model group,the expression levels of GABA and 5-HT were increased significantly.It was concluded that Anshen navel plaster has obvious sedative effect.It can regulate the contents of sleep factors such as GABA and 5-HT.

Objective To investigate the status of health-promoting lifestyle for primary nurses in traditional Chinese medicine ( TCM) hospitals and analyze its influencing factors. Methods Nurses′ health-promoting lifestyle scale and self-designed questionnaire were used to investigate 527 primary nurses in three TCM hospitals affiliated to Zhejiang Chinese Medical University. Results The score of primary nurses′ health-promoting lifestyle was (60.38±17.71) points. The score of 5 dimensions from high to low were: occupational safety (68. 14%), self-actualization (62.77%), Interpersonal support development (60.99%), balanced diet (58. 70%), exercise and health care (34.32%). Regression analysis showed that age and health condition were the most important influencing factors for nurses′ health-promoting lifestyle(P<0.05).Conclusions Health-promoting lifestyle of primary nurses in TCM hospitals is not good, and there is a big space for improvement. Hospital managers should attach great importance to the improvement of primary nurses′ health-promoting lifestyle, and improve nurses′health-promoting lifestyle by targeted intervention, in order to improve the general nursing quality.

Objective:To explore the application effect of coaching technique in respiratory function exercise of patients with chronic obstructive pulmonary disease (COPD) in stable stage.Methods:Using the convenient sampling method, a total of 40 COPD patients in stable stage who were treated in Geriatric and Respiratory Departments of 3 provincial hospitals in Hangzhou were selected as the research objects from August 2018 to June 2019. They were given a six-month breathing intervention based on coaching techniques by trained health coaches. COPD Self-Efficacy Scale (CSES) and COPD Assessment Test (CAT) were used to evaluate self-efficacy and quality of life of patients before and after intervention. The awareness and implementation of respiratory function exercise were compared before and after intervention.Results:After6 months of intervention, compared with those before intervention, the score of awareness and implementation of respiratory function exercise of patients increased, and the differences were statistically significant ( P<0.05) . After the intervention, the score of CSES increased and the scores of CAT decreased, and the differences were statistically significant compared with those before the intervention ( P<0.05) . Conclusions:The application of coaching technique in the respiratory function exercise of COPD patients in stable period has a certain effect, which can improve the awareness and implementation of patients with respiratory function exercise and improve their sense of self-efficacy and quality of life.

In order to improve the professional competence of in-service general practitioners and improve the effectiveness of standardized residency training, it is necessary to carry out training with the specific problems encountered in the practice. Taking Gaobeidian Community Health Service Center as an example, the characteristics, process and precautions of the general practice case discussion model based on the real scene of the community health institutions are introduced in the article. It would provide reference for improving the teaching effectiveness and efficiency in the training base of general practice.