Objective To construct clinical thinking competence index system for undergraduate nursing students.Methods The study established the Clinical Thinking Competence Evaluation Index System through Delphi method.Results The evaluation index system included 5 level-1 dimensions and 28 level-2 Index connotations.Conclusions Through quantitative research methods,Clinical Thinking Competence evaluation index system is established for undergraduate nursing students,which provides an objective standard for cultivation and evaluation of undergraduate nursing students.

Objective To investigate long-term care needs and its influencing factors among old people with chronic diseases in nursing homes in rural area of Liaoning. Methods A total of 502 elderly with chronic diseases were recruited using convenience sampling method from eight nursing homes in rural area of Liaoning, and were investigated with the general information questionnaire, Short Form 36-item Health Survey (SF-36) and long-term care needs questionnaire from March 2015 to January 2016. Results Logistic regression analyses were used to identify that age (P=0.000), old patients′ disease condition (P=0.008), marriage (P=0.013) and quality of life (P=0.000) were major factors affecting long-term care needs. The top three highest percentage services were seeing the doctor 85.26% (428/502), assisting with taking the medicine 80.28% (403/502), assisting with bathing 70.32% (353/502). Conclusions This study suggests that we should improve the quality of services of long-term care needs based on the demands of old people with chronic diseases in nursing homes in rural area.

Objectives To investigate the role of angiogenic T cells (Tang) and endothelial progenitor cells (EPC) in the pathogenesis of preeclampsia. To explore the relationship between Tang and EPC. Methods From Mar 2013 to Aug 2014, 40 patients diagnosed preeclampsia (PE) and delivered in Hunan Provincial People′s Hospital. A total of 20 of them were defined as the mild preeclampsia group and the other 20 cases were recruited as the severe preeclampsia group. And 24 healthy pregnant women wererecruited as the control group. The percentage of Tang and EPC in peripheral blood mononuclear cells (PBMC) were determinated by flow cytometry between 28 and 40 gestational weeks. Results (1) There was no significant difference in the age, pre-pregnancy body mass index(Pre-BMI) or gestational age among the three groups (P>0.05). The differences of blood pressure among the three groups were statistically significant (P<0.05). The gestational week at delivery, the birthweight of the neonates and the 1 minute Apgar score in the severe preeclampsia group were lower than those in the mild preeclampsia group and the control group, with statistically significant differences (P<0.05). The morbidity of neonatal asphyxia in the severe preeclampsia group was 35%(7/20);and in the mild preeclampsia group it was 5%(1/20), with statistically significant difference( P<0.05). (2) The percentage of Tang in maternal peripheral blood was(52.7 ± 8.0)%, (47.5 ± 8.8)% and (45.5 ± 8.7)% in the control group, the mild preeclampsia group and the severe preeclampsia group, respectively. The difference among the three groups was significant (F=4.248,P<0.05), and SNK q analysis showed there was significant difference between the control group and the severe preeclampsia group(P<0.05).While there was no statistically significant difference between the mild and the severe preeclampsia group, nor between the control group and the mild preeclampsia group(P>0.05). (3) The percentage of EPC in maternal peripheral blood was (0.16±0.07)%, (0.09±0.07)%and (0.08±0.05)%in the control group, the mild and the severe preeclampsia group, respectively. Analysis of variance showed that difference among the three groups was significant (F=9.351, P<0.05). The percentage of EPC in the mild or the severe preeclampsia group was significantly higher than that of the control group(P<0.05). (4) There was no statistically significant correlation between the Tang level and the EPC level in the control group ( r=-0.325, P>0.05). In the preeclampsia group (including mild and severe cases), there was positive correlation between the Tang level and EPC level (r=0.667, P<0.01). The positive correlation between Tang level and EPC level were proved respectively in the mild preeclampsia group (r=0.803, P<0.01) and the severe preeclampsia group (r= 0.520, P<0.05). Conclusions The number of Tang had some correlation with the pathogenesis of preeclampsia. The percentage of Tang had positive correlation with the level of EPC in women with preeclampsia. Tang might have some influence on the change of EPC′ level. Tang together with EPC were likely to contribute to the angiogenesis in preeclampsia.

Objective To evaluate the differences of the thinnest-point corneal thickness (TCT) decrease after three different corneal crosslinking (CXL) protocols for progressive keratoconus.Methyds Retrospective clinical case study.From August 2010 to November 2015,consecutive 85 patients (110 eyes) with progressive keratoconus were enrolled and treated with CXL in Department of Opthalmology,Navy General Hospital.21 patients of 25 eyes underwent standard epithelium-off corneal crosslinking (S-CXL),14 patients of 22 eyes underwent 1 g · L-1 riboflavin-sodium lactate Ringer's solution iontophoresis-assisted CXL (I-CXLa),and 50 patients of 63 eyes underwent 0.1％ riboflavin-distilled water solution I-CXLb.Preoperative and postoperative TCT were measured by ALLEGRO oculyzer.The differences of TCT decrease after treatment were compared among the three CXL protocols.Results The differences of TCT from baseline after 3 months,6 months and 12 months in the S-CXL group were (-14.93 ±27.16) μm,(-31.94 ±22.89) μm,(-27.71 ±26.01) μm,respectively,the I-CXLa group were (-20.14 ± 19.09) μm,(-10.10 ± 24.28) μm,(-7.11 ± 22.26)μm,respectively,the I-CXLb group were (-28.08 ± 26.14) μm,(-21.08 ± 25.62) μm,(-15.91 ± 19.19)μm,respectively.Three months after treatment,the differences of TCT decrease in the three groups was not statistically significant (P =0.188);Six and 12 months after treatment,the differences between S-CXL and I-CXLa were statistically significant (all P ＜0.05),but the differences between S-CXL and I-CXLb,between I-CXLb and I-CXLa showed no significant difference (all P ＞ 0.05).Conclusion Six and 12 months after treatment,TCT decrease is related to the CXL protocol.TCT decrease degree may reflect the intensity of crossinking.TCT decrease in I-CXLb is smaller than that in S-CXL,but there is no statistical difference.

Objective To study the expression and clinical significance of CD34 and smooth muscle actin (SMA) in stroma of breast tissues and lesions. Methods Seventy cases of breast tissues and lesions, including 20 fibroadenomas, 10 sclerosing adnoses, 30 invasive ductal carcinomas and 10 invasive lobular carcinomas were investigated, and 10 normal breast tissues were served as controls. Immunohistochemical staining was applied to compare the distribution of CD34+ fibrocytes and SMA-reactive myofibroblasts. Results The stroma of normal breast tissue contained CD34+ fibrocytes, whereas SMA-reactive myofibroblasts were absent (100% for both). All benign breast lesions exhibited astromal CD34+ fibrobytes, and fibroadenomas showed SMA-reactive myofibroblasts as well. In invasive ductal and lobular carcinoma the stroma was devoid of CD34+ fibrocytes, but a varying number of stromal SMA-reactive myofibroblasts were detectable (100%). Conclusion In breast carcer, immunohistochemical staining used in detecting expressions of CD34 and SMA is helpful in distinguishing benign lesions from malignancies.

BACKGROUND: During spinal orthopedic repair, the main difficulty is to maximize the correction of the deformity, simultaneously, to reduce the incidence of trauma and complications, especial y to avoid the corresponding spinal nerve injury. OBJECTIVE: To evaluate the curative effect of one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation in the treatment of rigid angular kyphosis of thoracolumbar spine. METHODS: We retrospectively analyzed the data of 42 cases of rigid angular kyphosis of thoracolumbar spine that were treated by one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation. Al patients received detailed imaging examination before and after operation. Kyphosis angle, Frankel grading and perioperative complications were recorded in al patients. X-ray films or CT films showed the bone graft fusion during fol ow-up. RESULTS AND CONCLUSION: Patients were fol owed up for 10-36 months after treatment. The average time of bone graft fusion was 5.1 months. Cobb’s angle of kyphosis was corrected from 78.4° (38°-110°) preoperatively to 7°(-8°-24°) at 10 days after treatment. The correction rate was 90%. The average angle during final fol ow-up was 7.9°, with an average loss of 0.9°. In 16 paresis patients, Frankel grading results showed grade B in 0 case, grade C in 3 cases, grade D in 5 cases, and grade E in 8 cases during final fol ow-up, showing significant improvement as compared with that pre-treatment (P < 0.05). Among 42 patients, 5 cases had complications. At 7 months after treatment, there were screw and titanium rod loosening at the distal end of the fusion segment in 1 case, cerebrospinal fluid leakage in 2 cases, transient double lower limb weakness in 1 case, pain in one side of lower limb in 1 case, and no severe complications appeared. These results verified that one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation could achieve satisfactory clinical outcomes in rigid angular kyphosis of thoracolumbar spine. The internal fixation was stable and with a high fusion rate and few complications. The medium-term effect was satisfactory.

Objective To observe the safety and clinic effect of umbilical blood stem cell transplantation for the patients with chronic liver failure (CLF).Methods 44 patients with CLF were included in the research and divided into two groups,22 in control group received internal medicine treatment,the other 22 in treatment group received umbilical blood stem cell transplantation in addition to internal medicine treatment.The biochemical index,MELD scores,clinical symptoms,survival situation and adverse reaction of the patients were observed within 2,4,12 and 24 weeks.Results Albumin and prothrombin activity of treatment group were higher than those of control group,the MELD scores of the treatment group was lower than that of control group,the survival rate was higher than the control group,and the difference is significant between the two groups (P ＜ 0.05).There was no significant difference between the two groups in terms of alanine aminotransferase and total bilirubin (P ＞ 0.05).After 4 weeks treatment,fatigue,inappetite,abdominal distention and ascitic fluid of the treatment group were better than that of control group,the difference was statistically significant (P ＜ 0.05).Besides,the patients of the both groups did not have any adverse reaction or hepatocellular carcinoma.Conclusion Umbilical blood stem cell transplantation is safe and effective for the patients with CLF and can improve the survival rate of the patients.

BACKGROUND:How to make more transplanted bone marrow stem cel s stay and differentiate in the liver is an important issue, which is also crucial for treatment of liver cirrhosis via the hepatic artery.
OBJECTIVE:To investigate the therapeutic effect of autologous bone marrow stem cel transplantation via the hepatic artery on liver cirrhosis.
METHODS:Thirty New Zealand white rabbits were equivalently randomized into normal control, stem cel transplantation and model groups. Animal models of liver cirrhosis were made in the latter two groups. Then, model rabbits in the stem cel transplantation group were subjected to autologous bone marrow stem cel transplantation via the hepatic artery. Liver function of rabbits was detected in 1, 2, 4, 8, 10 weeks after cel transplantation, and pathological detection of the liver was performed in the 10th week.
RESULTS AND CONCLUSION:At 10 weeks after cel transplantation, the liver function of the rabbits was improved significantly compared with the model group, including reduced activities of serum alanine aminotransferase, total bilirubin and aspartate aminotransferase, shortened activated partial thromboplastin time, and increased albumin level (P<0.05). Pathological examination of the liver showed that the liver cel s in the stem cel transplantation group were intact with no obvious edema and stil had the structure of the pseudolobule, and compared with the model group, the degree of liver fibrosis was significantly reduced in the stem cel transplantation group. Our experimental results show that the transplantation of autologous bone marrow stem cel s via the hepatic artery has a certain therapeutic effect on liver cirrhosis by increasing the body albumin content in a short time and improving the liver function.

Objective To measure the expression of CD80 and CD86 in renal tissue of lupus nephritis (LN) and explore its mechanism in the development of LN.Methods Forty-nine patients with active LN and 9 patients with minor glomerular abnormalities tissues as controls were studied.The expression of CD80, and CD86 in renal tissues was detected by immunohistochemical methods.Results CD86 was expressed extensively in glomerulus, periglomerular area, tubular epithelial cells and peritubular interstitium, while CD80 was expressed only in tubular epithelial cells and peritubular interstitium.Moreover, the percentage of CD+80 and CD+86 cells in tubular epithelial cells and peritubular interstitium showed a tendency to increase with tubulointerstitial damage.The expression of CD80 and CD86 in renal tissue correlated with the systemic lupus erythematosus (SLE) disease activity index score, the degree of proteinuria, creatinine clearance and anti- dsDNA antibody.Conclusions This study shows that increased CD80 and CD86 expression with the progression of tubulointerstitial lesion might play an important role in the development of lupus nephropathy, and the tubulointerstitial expression of CD80 and CD86 could potentially serve as a surrogate marker of SLE disease activity.The co-stimulatory molecules CDg, and CD86 might play an important role in the pathogenesis of LN.

OBJECTIVETo evaluate the outcome of Titanium elastic intramedullary nailing (TEN) for the treatment of displaced midclavicular fractures.

METHODSBetween February 2010 and February 2013, 62 patients with displaced midclavicular fractures were treated by TEN, including 27 males and 35 females with an average age of 37.6 years old ranging from 15 to 67 years. The course of disease was from 1 to 9 days (means 2.7 days). Thirty-nine cases were treated by closed reduction and 23 cases by assistant small incision. Based on OTA (the Orthopaedic Trauma Association classification) classification, 31 cases of simple fractures involved 5 cases of 06-A1,15 cases of 06-A2,11 cases of 06-A3; 31 cases of wedge fractures involved 4 cases of 06-B1,12 cases of 06-B2,15 cases of 06-B3. Postoperative pain relief were evaluated by VAS score,and operation time,fracture healing time were recorded. After 6 weeks and after removing internal fixation shoulder joint function was evaluated by Constant score, and shoulder joint function were assessed by Herscovici score after 6 weeks.

RESULTSExcept 2 cases were lost to follow-up, 2 cases did not remove internal fixation, 3 cases' fractures were nonunion, the remaining 55 patients received follow-up for an average time of 11.4 months. The average preoperative VAS score was 5.20±0.71, and it turned to be 1.550.59 at 3 days after operation. The average operative duration was 40 min (15 to 65 min). The average bone healing time was (2.71±0.54) months (2 to 5 months). No difference about bone healing time was found between simple fractures and wedge fractures,and between the patients treated by closed reduction and assistant small incision. According to Herscovici standard, the shoulder function was excellent in 49 cases, good in 4, fair in 1, and poor in 1. Simple fractures achieved better Constant score than wedge fractures at 6 weeks postoperatively, whereas no difference was found at 4 weeks after fixation removal.

CONCLUSIONTitanium elastic nails (TEN) for treatment of displaced midclavicular fractures has advantages of good clinical effect,rapid pain relief,fast recovery of shoulder joint function. For OTA classification type B patients with comminuted fracture can replace steel to achieve very good effect, but to grasp the appropriate.

Adolescent ; Adult ; Clavicle ; injuries ; surgery ; Female ; Fracture Fixation, Intramedullary ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged