Guided by the study theory of constructivism,we utilize informational environment and resource to design the teaching of “nursing of mental disorders who abuse psychoactive substances”,change teaching methods divorced from reality,advocate situation teaching,recommend student' s initiative and cooperative study and improve the students' practical and innovative ability.

For many reasons,the size of jointed implement for central oxygen supply are different in some small and mediate hospitals,and some equipments can not used in other departments.In order to share mutual resource and make good use of all important equipments,we design a fast jointed implement for respirator joint.In the application of 24 cases,it shows convenient and effective for saving patients.

Objective: To clone the Fab gene of a monoclonal antibody (mAb) BDI against human bladder cancer and its expression in E. coli. Methods: Fd and K genes of mAb BDI were cloned by RT-PCR and inserted into an Fab expression vector. Phage displaying Fab and soluble Fab were expressed in E. coli. The N-terminal sequence of VH region was corrected by PCR mediated mutagenesis. The antigen-binding characteristics of the Fab were tested by ELISA and immu-nohistochemistry. Results: Fd and K genes were cloned into the expressing vector p3MH and the phage displaying antibody and soluble Fab were expressed in E. coli, which showed weak binding activity to bladder cancer cells. Correction of the N-terminal sequence of the VHimproved the biding activity dramatically. The feasibility of the application of the Fab in phage antibody library screening was confirmed by a simulated panning procedure. Conclusion: The Fab gene of an anti-human bladder cancer mAb was expressed in E. coli. The importance of the N-terminal sequence on antibody binding activity was suggested.

Objective To establish the assay method of hydroxyproline(HYP) level in rat lung tissue for evaluating the lung fi-brosis degree .Methods The impact of different acid hydrolyzable time ,oxidative time ,developing time on the assay results of the HYP level in rat lung tissue was studied .On this basis ,the assay method for determining the HYP level was established and prelim-inarily applied in the detection of the HYP level in rat lung tissue .Results The optimal condition for the HYP level detection in rat lung tissue was as follows :7 .50 mol HCL was hydrolyzed for 16 h at 110 ℃ ,oxidized for 10 min at room temperature and devel-oped for 25min at 60℃ .The sensitivity of this method was 0 .067μg/mL .The recovery rate and the average CV of this method were 88 .85% -110 .88% and 4 .70% -6 .60% ,respectively .In the study of bleomycin induced rat lung fibrosis ,the HYP level of the model group was obviously higher than that of the control group .Conclusion This method has high sensitivity ,high recovery rate and good reproducibility ,and may be used as a reliable quantitative method to judge the lung fibrosis level in clinic .

Objective: To find out effects of the service unit floating payment system under the total budget control of the medical institution, and explore feasible solution. Methods: Through interpretation of the policy, compare with simple service unit floating payment system to find out the characteristics of the new policy. Results: Through the total budget pre-control system, the new policy can effectively restrain the trend of fast growing on medical expenses. Time of doctor and number of patient ratio indicators are introduced to effectively prevent the medical institution decompose the time of doctor. Conclusion: To achieve the steady growth of medical business, medical institutions need to enhance the management of expense control, develop new business to attract new patients , optimize the medical charge structure.

Objective:To explore the methods and condition in which calcium ionorphore(CI) induces the CML cells to differentiate into dendritic cells(DCs).Methods:Mononuclear cells were separated from peripheral blood or bone marrow of CML patients whose WBC counts were more than 30?30~9 L~ -1 when samples were collected,then lymphocytes and monocytes were discarded by pouring out supernatant twice at different culture time point. Slightly adherent cells were cultured in RPMI1640 containing 10%FCS(Fetal calf serum),with or without CI(375 ng/ml) and GM-CSF(200 ng/ml) at 37℃,5%CO_2 humidified atmosphere for 96 h. To evaluate the effect of CI on inducing CML cells to differentiate into DCs,the phenotype of these cells were analyzed by flow cytometry and the morphology change was observed under inverted microscope and electron microscope. Better condition was also explored for DCs differentiation from CML cells under the effect of CI.Results:After 96 h of culture with CI and GM-CSF,the CML cells acquired morphology of mature DCs and significantly up-regulation of CD80,CD86,CD40,CD86 and HLA-DR.Conclusion:CML cells might acquire typical morphology and immunological phenotype of mature DCs when being cultured with CI and GM-CSF.

Objective To develop a vulnerable plaque targeting ultrasound contrast agent (UCA) and to evaluate its affinity and imaging performance in vitro.Methods E-selectin receptor-targeting UCA,which conjugated with monoclonal antibody of E-selectin,was prepared with filming-rehydration method and biotin-avidin linkage.The size and distribution of UCA were measured with particle size analyzer,the connectivity condition of microbubbles with E-selectin antibody was also detected with fluorescence analysis.The cytotoxicity from microbubble and ultrasound irradiation was evaluated through cell counting kit-8 (CCK8) assay.The adhesion effect of UCA was assessed after co-incubated with activated mouse endothelial cells (bEnd.3) and compared with that of free antibody intervention group and control group.The imaging performance of UCA at different time points was observed on an ultrasound equipment with a high-frequency transducer.Two-sample t test and one-way analysis of variance were performed to analyze the data.Results E-selectin receptor-targeting UCA was successfully prepared.The cytotoxicity result with CCK8 assay demonstrated the favorable biocompatibility of UCA.The connection amount of UCA on activated bEnd.3 cells ((6.23 ± 0.45) bubbles/cell) was significantly higher than that of the free antibody intervention group ((1.57±0.34) bubbles/cell) and control group ((0.07±0.03) bubbles/cell;F=291.43,P＜0.01).The performance of in vitro ultrasonography at the same time points showed no obvious difference between targeting UCA and control UCA (all t＜0.51,all P＞0.05).Conclusions The prepared E-selectin receptor-targeting UCA has favorable targeting and imaging capabilities.It might be a potentially ultrasound molecular imaging agent for early detection and prognosis evaluation of vulnerable plaque.

Objective To investigate the effects of medicine androgen deprivation therapy(ADT)on quality of life in patients with prostate cancer.Methods A total of 42 consecutive advanced prostate cancer patients without any other anti-androgen medications after ADT[A subcutaneous depot injection of LHRH-agonist(Zoladex) was instituted every 28 days]were enrolled.Levels of serum testosterone and prostatic specific antigen(PSA)were obtained just prior to ADT and after ADT.The general and disease-specific health-related quality of life were assessed.Results The average testosterone level was less than 50 mg/L after medical ADT in 3 weeks.And PSA level declined dramatically in one month.Although there were no significant differences on physical discomfort and limitations to daily activities.Urinary obstruction symptoms after ADT were disappeared and the size of prostate were reduced after one month.The appetite and vigor were worsened.Overall health status and sexual function were significantly reduced.Conclusion The ADT could make serum testosterone and PSA decline dramatically in short time,and worsen some general health-related quality of life.

Objective The purpose of this study was to explore the risk factors of recurrence of atrial fibrillation (AF) after surgical radiofrequency ablation in patients undergoing cardiac valve surgery.Metbods Retrospective analysis was made in 255 cardiac valve patients undergoing concomitant radiofrequency modified Maze operation from April 2010 to December 2012 in Nanjing Drum Tower Hospital.Multivariate logistic regression analysis was used to screen independent risk factors for predicting recurrence of AF.Results Excluding 8 patients died after surgery,11 cases who were junctional rhythm after ablation or received pacemaker implantation and 60 lost case,176 patients were finished follow-up.107 cases maintained stable sinus rhythm (SR),whereas other 69 cases developed AF recurrence.Multivariate logistic regression analysis found larger left atrial size,higher B-type natriuretic peptide,lower preoperative heart rate and postoperative AF rhythm before discharge were independent risk factors for predicting AF recurrence.Conclusion Larger left atrial size,higher B-type natriuretic peptide and lower preoperative heart rate before surgery can impact outcome of surgical radiofrequency ablation in patients undergoing cardiac valve surgery after following 12(4-38)months.They can be used in clinical practice to choose more suitable cardiac valve patients with AF for surgical ablation.Postoperative appearance of AF rhythm before discharge indicated a poor prognosis,which should be interfered with drugs or electrical cardioversion.

Objective To evaluate the diabetes self-management program based on Chinese local patients in Nanjing community. Methods From April 2014 to June 2014, diabetes patients were recruited through health records system screening in the community health service centers, letter invitation, poster announcements at communities, and telephone notification. A total of 53 self-management groups were established. Nanjing diabetes self-management program included six 1-1.5 hours sessions scheduled on consecutive weeks, based on the blueprint of Shanghai Chronic Disease Self-Management Program (CDSMP) developed at Stanford University. Baseline and three-month later interviews were conducted respectively. Results A total of 636 patients were recruited and agreed to enter CDSMP; 603 completed the 6-session activities, with the response rate being 94.8%. Compared to baseline, nine of the patients' the awareness rate of diabetes-related knowledge, six of self-management behaviors, the scores of quality of life in physical component summary [(47.51 ± 9.47) vs. (49.10 ± 8.27) points, t=6.170, P=0.000] and mental component summary [(47.09±11.95) vs. (49.13±10.74) points, t=5.157, P=0.000] were all higher after three months (all P values<0.05). Three months after implementation, the level of systolic blood pressure, diastolic blood pressure, fasting plasma glucose and total cholesterol decreased respectively by (1.42±0.52) mmHg (1 mmHg=0.133 kPa), (0.98 ± 0.34) mmHg, (0.66 ± 0.16) mmol/L, (0.15 ± 0.56) mmol/L,the differences were statistically significant (tpaired values were 3.935, 2.030, 4.889, 4.899, all P values<0.05). Conclusion The diabetes self-management program based on Chinese local patients for Nanjing may improve patients' awareness rate of diabetes-related knowledge, self-management behavior, the quality of life, and health status. CDSMP could be applied effectively in Nanjing.