Objective To investigate the factors affecting non-neoplasma touch technology operation by operation room nurses for malignant tumor patients.Methods The qualitative methods was used in the study to interview 15 operation room nurses phenomenologically using semi-structured interviews.Colaizzi principles were used for data analysis and summarization of themes.Result The themes brought out from the data included lack of knowledge of no-neoplasma touch technology operation,huge workload,less importance attached to the management,over-consideration of medical costs.Conclusions It is a need to improve the level of knowledge of operating room nurses on non-neoplasma technology operations.The importance should be attached to management of the technology operation.The training on the operation should be strengthened so as to improve their operation of the technology.

Shenzhen implemented the health reform on the separation of drug prescribing and dispensing.This policy abolished the drug price addition system,which interrupted the interest chain between hospitals and pharmaceutical enterprises,and curbed the over-medication and use of expensive drugs.Such a reform has lowered the average cost of diagnose and treatment,the out-of-pocket payment by those covered by social insurance,outpatient infusion and the utilization of antibiotics.To further strengthen these outcomes and maintain the momentum of this policy,Shenzhen will further improve the compensation system for public hospitals,encourage the medical staffs' work enthusiasm and implement the reform measures actively.

This articles introduced the development of the four systems and eight mechanisms in Shenzhen's health reform,and described the implementing measures of the public hospitals reform and major mechanisms reform.It also reviewed the major achievements and challenges met in the health reform and made an outlook of the future steps in the reform.

BACKGROUND:Clinicaly, patients with constipation often have depression and depression is often associated with symptoms of constipation, but the mechanisms remain unclear. OBJECTIVE:To observe the relation between constipation and depression by establishing animal models. METHODS:A total of 60 specific-pathogen-free rats were divided randomly into three groups: normal group, chronic stress-induced depression model group and slow transit constipation model group. Slow transit constipation model was created by giving the solution of compound diphenoxlate 8 mg/kg daily, for 120 consecutive days. On day 100, chronic stress model rats were subjected to successive unforeseen stimulus for 21 days. Rats in the normal group were regularly housed. Fecal number, dry weight of feces and body weight were recorded once a week. After successful model establishment, fecal number, dry weight of feces, time of first dark stools defecation, sucrose preference, open-field behavior score and forced swim time were detected in each group, and statisticaly analyzed. RESULTS AND CONCLUSION:Fecal number was less in the chronic stress-induced depression model group than in the normal group (P = 0.00), and time of first dark stools defecation was longer (P = 0.00). Fecal number was more in the chronic stress-induced depression model group than in the slow transit constipation model group (P = 0.00), but time of first dark stools defecation was shorter (P = 0.00). No significant difference in fluid consumption, sucrose preference, horizontal and vertical scores of open-field test, and forced swim time was detected between slow transit constipation model group and normal group (P > 0.05). However, above indexes were higher in the slow transit constipation model group than in the chronic stress-induced depression model group (P < 0.01). Results verified that constipation was observed in chronic stress-induced rat model, but depression was not observed in slow transit constipation rat model, suggesting that depression can induce constipation, but constipation does not necessarily lead to depression.

Objective To discuss the effect of quick freezer equipment and quick freezing time on the preparation of cryoprecipitate.Methods The cryoprecipitate,already prepared,was placed into the MBF21 freezer and minus 30℃ SANYO refrigerator for 30-minute and 50-minute storage.The activity of coagulation factor VⅧ,and the content of fibrinogen in different equipment were detected by automatic coagulation analyzer,in order to make sure whether it met the quality requirements.Results The content of fibrinogen in the cryoprecipitates from both of the equipment after 30-minute storage met the requirement,with the qualification rate of 100％.As to the activity determination of coagulation FⅧ,low temperature refrigerator showed a qualification rate of 62.5％,which was significantly lower than that of quick freezer with a qualification rate of 97.5％ (P＜0.01).The cryoprecipitates from both of the equipment after 50-minute storage,with part of fibrin precipitation,had a qualification rate of fibrinogen content lower than 50％ (P＞0.05).The qualification rate of quick freezer and low temperature refrigerator was 35％ and 12.5％,respectively,with significant difference.Conclusion Quick freezer can make the cryoprecipitate quick-frozen,which can ensure the quality.The coagulation factor VⅧ is unstable,whose activity decreased with the increase of temperature.We should try our best to shorten the time off the cold chain.

ObjectiveTo establish a prognostic score model based on preoperative neutrophillymphocyte ratio (NLR) to predict recurrence of hepatocellular carcinoma (HCC) following liver transplantation.MethodsThe clinical data of 76 HCC patients undergoing liver transplantation were retrospectively analyzed.An NLR≥2.5 was considered to be elevated.A preoperative recurrence score was established by using three preoperative factors which significantly increased the risk of tumour recurrence after liver transplantation on multivariate analysis,namely,vascular invasion,tumour number＞3,and NLR≥2.5.We then evaluated the scoring system in predicting tumour recurrence of HCC after liver transplantation.ResultsArea under the receiver operating characteristic curve of preoperative recurrence score was 0.758,with scores of 2 and 3 having hazard ratios of 10.038 and 59.773,respectively.All ten patients with a score of 3 developed tumour recurrence in less than 6 months.The 1-,3- and 5-year tumour-free survival rates for patients with a score of 0,1 and 2 were 95.0％,78.4％,and 78.4％ vs.76.9％,66.9％,and 63.2％ vs.51.9％,8.7％,and 8.7％,respectively.Of 55 patients who had no gross vascular invasion,5 patients with both tumour number＞3 and NLR≥2.5 developed recurrence in less than 31 months.ConclusionsPatients with both preoperative NLR≥2.5 and tumour number more than 3 were at a high risk of tumour recurrence after liver transplantation for HCC.The preoperative recurrence score model strongly correlated with tumour recurrence,and may aid in the selection of patients with HCC for liver transplantation.

ObjectiveTo study the role of micafungin in the treatment of invasive fungal infection after liver transplantation.MethodsWe retrospectively studied the clinical data of 32 patients who developed invasive fungal infection after liver transplantation treated in our center between December 2008 and June 2010.The therapeutic effect,adverse effect,and the blood concentration/dose ratio of tacrolimus (tacrolimus concentration per dose.kg-1) before and after micafungin treatment were analysed.ResultsThe curative rate was 93.7％.There were no obvious toxicity and sideeffect.The blood concentration/dose ratio in the triazoles treatment group [(1031± 634.2) ng·ml-1/mg · kg-1] was markably higher than the micafungin treatment group [(172.6±39.45) ng·ml-1/mg · kg-1] and the control group (ceasing antifungal agents) [(183.8±47.08) ng· ml-1/mg · kg-1] (P＜0.05).However,there was no significant difference in the blood concentration/dose ratio between the micafungin treatment group and the control group (P＞0.05).ConclusionsMicafungin did not significantly affect the blood concentration/dose ratio of tacrolimus,and effectively treated invasive fungal infection in patients after liver transplantation.

ObjectiveTo investigate the optimal reconstruction windows for coronary angiography using 320-detector row dynamic volume CT (DVCT) and evaluate their effects on image quality,radiation dose and diagnostic accuracy.MethodsFrom 77 patients [mean heart rate (70 + 13) bpm,range:46-102 bmp] were scanned with retrospective ECG-gating 320-detector row DVCT.The relationship between heart rate and optimal reconstruction windows was analyzed.From 53 patients [mean heart rate ( 75 ±11 ) bpm,range:57-114 bpm] were scanned with prospective ECG-gating 320-detector row DVCT.The effects of prospective ECG-gating on image quality,radiation dose and diagnostic accuracy were evaluated.Friedman test was performed for image quality scores in random groups.Linear regression and Spearman correlation were performed to test bivariate data.ResultsThe proportion of systolic duration in the cardiac cycle increased significantly with higher heart rate (r =0.78,P ＜0.01 ).The image quality in systolic and diastolic phases were significantly influenced by heart rate ( r =0.38,0.82 ; P ＜ 0.01 ).According to the regression analysis of image quality score in different heart rate groups,the optimal reconstruction windows were determined as followed:when heart rate was ＜ 70 bpm,the optimal reconstruction windows should be preset at 65％-80％ ; 70 to 80 bpm,70％-85％ ; 81 to 90 bpm,70％-90％ ; ＞90 bpm,35％-50％.Compared with retrospective ECG-gating,prospective ECG-gating which preset reconstruction windows according to the phases mentioned above,could decrease radiation dose [(6.1 ± 3.8 )vs (12.4 ± 7.0) mSv],without deteriorating the image quality (t =6.5,P ＜ 0.01 ).However,in higher heart rate,the radiation dose of prospective ECG-gating DVCT was still higher ( r =0.64,P ＜ 0.01 ).ConclusionsDVCT can provide high image quality in a wide range of heart rate with prospective ECG gating.It is still recommended to control heart rate strictly since the radiation dose increases significantly in high heart rate.

ObjectiveTo investigate the choice of graft,and transfusion and immunosuppressant regimen of a RhD negative recipient in liver transplantation.MethodsOne RhD negative patient with hepatocellular carcinoma who received a liver graft from a RhD positive donor was retrospectively studied,and related references were reviewed.During the operation,the patient received five units of RhD negative/O RBC,3000 ml positive/O plasma and 30 units cryoprecipitate.Tacrolimus and prednisone were used to prevent rejection,and prednisone was withdrawn 30d post transplant.Results The patient's liver function recovered smoothly,without any acute rejection or hemolytic reaction.Anti-D antibody was not detected.The patient suffered from cancer recurrence 9 months and died of brain metastasis 13 months after transplantation.ConclusionsA RhD negative recipient can receive a graft from a RhD positive donor in liver transplantation.The selection of RBC and platelet from RhD negative or positive donors should be based on the result of anti-D antibody test.Plasma and cryoprecipitate can be transfused regardless of Rh type.Enhanced immunosuppressant regimen was unnecessary for these patients.

Objective To investigate the effect of median nerve electrical stimulation on the activity, speech and quality of life in patients after severe traumatic brain injury. Methods 60 patients with severe traumatic brain injury were divided into 2 groups: the control group (A) and the treated group (B). The patients in Group A were treated with the routine medicine and rehabilitation. Based on the routine therapy, the patients in Group B were treated with the right median nerve electrical stimulation. Their outcome, activity, speech and quality of life were assessed. Results The scores of Glasgow Outcome Scale (GOS), speech assessment, and the quality of life in Group B improved compared with that in Group A (P<0.05), the activity seemed to improve, but not significantly. Conclusion The right median nerve electrical stimulation is effective to promote the recovery of neurological function and improve the quality of life in patients with severe traumatic brain injury.