Objective To investigate the nursing knowledge of rural patients with rectal carcinoma after permanent colostomy.Methods Data were collected on 54 patients with rectal carcinoma after permanent colostomy using the self-designed questionnaire and analyzed by statistical methods.Results The rural patients with permanent colostomy showed low level of nursing knowledge.Scores of patients with different sexes and family income showed significant difference.Conclusions Medical security system and medical staff should provide with more welfare policy and specialty support for the patients in rural areas to promote their knowledge of self-care.

Objective: To explore the contents of hypericin from different parts of Hypericum sampsonii. Methods : The hypericin in Hypericum sampsonii and H. Officinalis were measured by HPLC with Novapak C 18 column, mobile phase(methanol∶ethanol∶0.1mol?L -1 NaH 2SO 4=200∶300∶100), flow rate 1.0mol?L -1 , column temperature at 30 ?C , wavelength at 588nm. Results:Contents of H. Sampsonii in flower and flower itself were equal content to H. officinalis. Conclusion:It is possible to sift out the plant of H. Sampsonii with more Hypericin.

Objective To investigate the expression of indoleamine 2,3-dioxygenase(IDO)in renal tissues of crescent nephritis and its correlation with cell proliferation and pathologic tubulointerstitial lesion.Methods Immunohistochemistry was used to detect IDO expression in renal tissues of crescent nephritis and normal renal tissues.The correlation between IDO expression and the number of proliferating cell nuclear antigen(PCNA)positive cells or pathologic tubulointerstitial lesion were analyzed.Results IDO expression was found in the renal tubular epithelial cells of crescent nephritis,while that in the normal renal tissues was negative by immunohistochemical staining.The expression of IDO protein in tubular epithelial cells showed a significantly negative correlation with the number of PCNA positive cells or tubulointerstitial lesion of crescent nephritis.Conclusion IDO may participate in the pathogenesis of crescent nephritis by inhibiting the cell proliferation.

Objective To investigate and evaluate the pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy. Methods 282 cases of triplets who received multi-fetal pregnancy reduction (MFPR) at Shandong Provincial Hospital affiliated to Shandong University were recruited from Sep 2001 to Mar 2014. According to the remaining fetal number after MFPR, 231 cases were opted to reduce to twins (twins group) while 51 cases were opted to singleton pregnancy (singleton group).The indication of the former group was fetal abnormalities under ultrasound or on patients′ demand; while the indication for the later group included dichorionic triamniotic (DCTA) triplets or patients′ aspiration. Potassium chloride was injected into the targeted fetal heart until cardiac standstill was obtained. The pregnancy outcomes, gestational age at delivery, birth weight of newborns of the two groups were recorded. Successful pregnancy was defined as take-home at least one baby. Results (1)The overall rate of successful pregnancy was 91.5%(258/282).There were 413 neonates in the twins group, including 4 neonatal deaths and 409 live babies, with the successful rate of 90.5%(209/231). There were 49 neonates in the singleton group, including 2 cases of fetal loss. Thus the successful rate was 96.1%(49/51). There was no difference of successful pregnancy rate between the two groups(P>0.05).(2)The mean gestational age at operation for the twins group and singleton group were(16.5±3.5)weeks and (14.2±2.0) weeks, respectively. Each group was divided into three periods,11-13+6 weeks, 14-16+6 weeks and≥17 weeks.In the twins group, the cases in each time period were129(55.8%,129/231), 50(21.6%,50/231)and 52(22.5%,52/231), respectively. While in the singleton group, the cases in each time period were 27(53%,27/51), 16(31%, 16/51)and 8(16%,8/51).There was no difference between the two groups at each time period(P>0.05). (3)The fetal loss rate in the twins group were 7%(9/129), 12%(6/50), 10%(5/52) at each time period, respectively. While for the singleton group they were 4%(1/27), 0(0/16)and 1/8, respectively. There was no significant difference between the two groups at each time period(P>0.05).(4)The mean birth weight of the twins group was lower than the singleton group [(2 555±447) g vs (3 084±550) g, respectively, P<0.05].The rates of low birth weight infants(<2 499 g)in the twins group and the singleton group were 45.5%(188/413)and 8%(4/49), respectively(P<0.05).The rate of very low birth weight infants(≤1 499 g) was 3.9%(16/413)in the twins group compared with 0(0/49)in the singleton group(P>0.05).(5)The gestational age at delivery of the twins group was earlier than the singleton group [(36.2 ± 2.4) weeks vs(38.3 ± 2.2)weeks, respectively,P<0.05]. The labor rate of the two groups was significantly different for both 34-36+6 weeks and≥37 weeks(P<0.05).The full-term delivery rate in the twins group was 47.6%(110/231), and was 88.2%(45/51)in the singleton group(P<0.05). The fetal loss rate before 28 weeks did not differ between the two groups[8.7%(20/231)vs 3.9%(2/51), P>0.05].Conclusions Reduction to one fetus led to significantly better outcome than two fetuses, with no significant difference in fetal loss rate. It is better to advise patients with triplets reduce to singleton pregnancy.

For making a improving of cytological study doctors in the short term in the basic operated techniques and the level of diagnosis of cytology,the experience of teaching practice in the past fifteen years were reviewed.Flexible teaching ways were appearanced that such as,the reasonable teaching plan and target were maked,promotting self-learning strategies in the work,and special topic lectures and difficult cases discussion were performed with multi-media teaching,and so on.Finally, the activeness and initiative of study doctors were mobilized,and may be passably has the obtaineding in the satisfactory teaching effect.

Objective To investigate the relationships among distal contractile integral (DCI), ineffective esophageal motility (IEM)and gastroesophageal reflux through high resolution manometry (HRM)in patients with gastroesophageal reflux disease (GERD).Methods A total of 69 patients with GERD were enrolled.All patients received HRM and 24 hour pH and impedance monitoring examination. Pearson correlation analysis was performed to analyze the correlation between DCI,number of invalid swallowing and DeMeester score.All the patients were divided into three groups according to the number of invalid swallowing in 10 times of 5 mL liquid swallowing test.Patients with 5 to 10 invalid swallowing was in IEM group (n=21),one to four was in abnormal motility group (n=19),and zero was in normal motility group (n=29).The t test was performed for comparison of average DCI,average DCI of residual effective swallowing,DeMeester score,acid reflux time,bolus exposure time and proximal reflux times
among the three groups.Results Among the 69 patients with GERD,there was negative correlation between DCI and DeMeester score (r=-0.363,P =0.003)in 10 times of 5 mL liquid swallowing test;the number of invalid swallowing was positively correlated with DeMeester score (r=0.374,P =0.002). The mean DCI in 10 times of 5 mL liquid swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96±545 .10),(986.48 ±577.50)and (288.50 ±167.25 )mmHg·s·cm, respectively,and that of IEM group was lower than normal motility group and abnormal motility group (t =-11 .42 and -2.12,both P <0.05).The average DCI of residual effective swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96 ± 545 .10 ),(1 187.90 ± 669.40)and (450.78 ±350.73 )mmHg ·s ·cm,respectively,and that of IEM group was also lower than normal motility group and abnormal motility group (t = -8.05 and -5 .27,both P <0.01 ).The DeMeester score of IEM group (15 .42±8.79)was higher than that of normal motility group (6.34±3.45),and the difference was statistically significant (t=2.43,P <0.05).The acid reflux time and bolus exposure time of IEM group were (54.93 ± 37.07 )min and (0.64 ±0.49 )%,respectively,which were longer than abnormal motility group ((37.37±22.66)min,(0.52 ±0.24)%)and normal motility group ((21 .22 ± 13.98)min,(0.39 ±0.14)%),and the differences were statistically significant (t =2.36,2.17,2.60 and 2.54,all P <0.05).The total number of reflux of IEM group and abnormal motility group were 67.10± 32.94 and 57.26±38.90,which were both more than that of normal motility group (44.61 ±23.84),and the differences were statistically significant (t =2.48 and 2.17,both P <0.05 ).Conclusions DCI and the number of invalid swallowing can predict reflux condition of GERD patients in a certain degree.The contraction strength of esophageal body was the weakest and esophageal clearance was the worst in IEM group.

Objective To summarize the clinical symptoms of patients with non-erosive reflux disease(NERD) and reflux esophagitis(RE),which is helpful to the differential diagnosis.Methods Outpatients who met the criteria of NERD or RE according to the Montreal definition in Gastroenterology Department Wuhan Union Hospital from 2010-2014 were enrolled in our study.Clinical data were comprehensively collected.Incidence of disease,severity,frequency of esophageal and extraesophageal symptoms,and the rates of overlapping with functional dyspepsia (FD) or irritable bowel syndrome (IBS) were all studied.Results Totally 446 subjects were recruited,including 225 patients with NERD and 221patients with RE.The occurrence rates of esophageal symptoms including heartburn [76.0％ (171/225) vs 52.0％ (115/221),P ＜ 0.01] and acid regurgitation [74.7％ (168/225) vs 54.3％ (120/221),P ＜0.05] in NERD group were significantly higher than those in RE patients,with more severe and frequent (P ＜ 0.05).Despite the rates of food regurgitation were similar,NERD patients behaved more severely and frequently (P ＜ 0.05).Extraesophageal symptoms including throat burning and foreign body sensation in NERD group [40.9％ (92/225) vs 27.6％ (61/221),42.2％ (95/225) vs 31.7％ (70/221),all P ＜0.05] were also higher than those in RE group,the degree of which was more severe too (P ＜ 0.05).RE patients claimed a higher proportion of chronic cough.The incidences of overlapping with IBS in two groups were similar.But there were more patients with FD in NERD group [72.0％ (162/225) vs 62.9％ (139/221),P ＜ 0.05] than in RE group.Conclusions The menifestations and degree of esophageal and extraesophageal symptoms in patients with NERD or RE are different,as well as comorbidities such as FD and IBS.These results suggest that NERD and RE are independent diseases.

AIM: To elucidate the effect of ginsenoside Rb1 (Gs-Rb1) on the glucose metabolism to improve the viability of the cardiomyocytes under hypoxia, and whether hypoxia-inducible factor 1α(HIF-1α) and/or AMPKαare involved in the process.METHODS: The neonatal rat cardiomyocytes were cultured, and randomly divided into control group, hypoxia (1% O2 , 94% N2 and 5% CO2 ) group, Gs-Rb1 (200 μmol/L) group, Ara-A (500 μmol/L) group, Gs-Rb1 +Ara-A group, YC-1 (5 μmol/L) group, Gs-Rb1 +YC-1 group, Ara-A +YC-1 group and Gs-Rb1 +YC-1 +Ara-A group.After the intervention for 8 h, the cell viability was analyzed by MTT assay.The protein levels of AMPK, HIF-1αand glucose transporter-4 (GLUT-4) were determined by Western blot.The activities of heterophosphatase (HK), phos-phofructokinase (PFK) and lactic dehydrogenase (LDH) were measured by ELISA.RESULTS: Gs-Rb1 significantly im-proved the viability of hypoxic cardiomyocytes, which was significantly inhibited by YC-1 and Ara-A.In addition, YC-1 and Ara-A had a synergistic effect.Gs-Rb1 increased the protein levels of AMPK and HIF-1αin the hypoxic cardiomyo-cytes, which was significantly inhibited by Ara-A and YC-1.Gs-Rb1 significantly increased the expression of GLUT-4 on the cytomembrane of hypoxic cardiomyocytes, which was significantly inhibited by YC-1 or Ara-A, especially Ara-A +YC-1.Gs-Rb1 significantly increased the activities of HK, PFK and LDH, all those were significantly inhibited by YC-1 or Ara-A.Besides, YC-1 and Ara-A had a synergistic effect.CONCLUSION: Gs-Rb1 improves the viability of hypoxic car-diomyocytes, which may be related to the regulation of glucose uptake and enhancement of glycolysis by synergy of both
HIF-1αand AMPK.

Objective To evaluate the risk clinic factors of severe community-acquired pneumonia in older adults,and to provide examples for its clinic application.Methods Sixty-four case patients who were admitted for a diagnosis of severe community-acquired pneumonia in older adults in Beijing Haidian Hospital from January 2013 to July 2015 were selected as observation group.One hundred cases patients also admitted for a diagnosis of community-acquired pneumonia were selected as control group.Within 24 h of admission,the clinical data were collected,medical history were collected,and the serum biochemistry,coagulation index fibrin degradation product,D-dimer and inflammatory factor procalcitonin were detected.The data were analyzed by univariate analysis,and logistic regression analysis was used to analyze the variables with significant difference in single factor analysis.Results Single factor analysis showed that the percentage of severe pneumonia with central nervous system disorders,severe pneumonia with aspiration,severe pneumonia with two or more comorbidities,aspiration and severe pneumonia with bedridden patient in observation group were obviously higher than the control group,the difference between two groups have remarkable statistical significance((82.21％ (53/64) vs.32％(32/100),60.93％(39/64) vs.1％(1/100),(84.37％,54/64) vs.54％(54/100),90.62％(58/ 64) vs.28％ (28/100),59.37％ (38/64) vs.11％ (11/100);P＜0.01 or P＜0.05).The mortality of observation group was higher than the control group,the difference between two groups have remarkable statistical significance(56.62％ (36/64)] vs.3％ (3/100),P=0.001).Albumin of severe pneumonia was obviously lower than the control group,the difference between two groups have remarkable statistical significance ((27.79 ±8.53) g/L vs.(33.66±9.63) g/L,P=0.011).Fibrin degradation product of severe pneumonia was obviously lower than the control group,the difference between two groups have remarkable statistical significance ((i0.98 ± ± 1.32) ng/L vs.(3.61±0.98) ng/L,P=0.002).D-dimer of severe pneumonia was obviously higher than the control group,the difference between two groups have remarkable statistical significance ((2.68± 0.56) mg/L vs.(0.42±0.12) mg/L,P=0.001).Procalcitonin of severe pneumonia was obviously higher than the control group,the difference between two groups have remarkable statistical significance ((1.63±0.32) ng/L vs.(0.13 ± ±0.21) ng/L,P =0.015).The result of multiple factors logistic regression analysis showed the aspiration,hypoproteinemia,D-dimer were severe community-acquired pneumonia in older adults's independent risks (OR =1.782,1.208,1.356,P＜0.05).Conclusion Aspiration,hypoproteinemia,D-dimer are the factors of risking suffering severe community-acquired pneumonia in older adults.D-dimer could be the detection index of severe community-acquired pneumonia in older adults.