Objective To identify the influencing factors for pediatric nursese' reporting of adverse events at 3A hospitals in Beijing. Methods Adopting the random sampling of ten 3A hospitals with pediatric wards in Beijing and conducting an questionnaire survey of some nurses in those hospitals. Results The possibility of adverse events reporting increased with the awareness of adverse events which was related with their severity. Except for title, educational background, length of service, position and past experiences were not associated with the barriers. The major perceived barrier was fear of colleague relationship brokenup and some other undesirable consequence. Conclusions Better training of awareness of adverse events and changes of the punitive culture by the roots as well as some regulation or policy were the major solutions to improve incident reporting.

Objective To explore the clinical value of using heparin in DIC caused by Tsutsugamushi.Methods 27 cases of Tsutsugamushi with DIC were divided into two groups. The heparin treatment group(n = 15) and non-heparin treatment group(n = 12). The two groups were compared and analyzed. All the cases were diagnosed definitely depended on the "Tsutsugamushi-Disease-Diagnosis Standard".Results The group which use heparin improved in rectifying shock,terminating heorrhage,restoring the time of lab index of DIC,rating of MOF and death. Compared with the control group, the difference had statistical significance(P

Desmoid tumor of abdominal wall was also known as fibronmatosis of abdominal wall.It is a rare benign fibroblastic tumor, which is characterized by non-enveloped,strong local infiltration, with high recurrence rate after surgery.In December 2011, one patient with huge desmoid tumor of abdominal wall with intestinal tube received surgical resection with single-stage patch repair for the large defect in abdominal wall at the 210th Hospital of PLA, and the result was satisfactory.

Objective To evaluate the diagnostic accuracy of two dimensional echocardiography combining with enhanced flow (e-flow) imaging for fetal heart malformation.Methods 1580 cases were screened for fetal heart malformation.The diagnostic accuracy was evaluated by comparing the results fetal echocardiography with those of postpartum echocardiography,surgery or autopsy.Results Antepartum and postpartum data were obtained in 1286 of the 1580 fetuses (81.39％).Among the 1286 cases,the sensitivity,specificity,mistake diagnostic rate,omission diagnostic rate was 98.0 ％,99.3 ％,2.0 ％,0.7％,respectively.The consistency evaluation of fetal heart malformation by two dimensional echocardiography combining with e-flow concluded that the valve of Kappa was 0.970 (P =0.000).Conclusions Two dimensional echocardiography combining with e-flow is an accurate and reliable method for diagnosing fetal heart malformation,it has a high sensitivity and specificity.

Objective To investigate the strategies of surgical approaches,indications and surgical techniques of local resection for mid-lower rectal tumors and pelvic floor neoplasia.Methods Clinical data of 122 patients underwent local resection for mid-lower rectal tumors pelvic floor neoplasia between July 2004 and July 2008 were analyzed retrospectively.Results Transanal,transsacral,transsphincteric local resection was respectively performed in 45,and 32,and 45 patients.Pathological examination proved that benign tumors were account for 81 cases,pelvic floor neoplasia 16 cases,malignant tumors 25 cases.The masses were 5.6 cm(0 to 12 cm) apart from the anal border,and the mean tumors' diameter was 4.2 cm (0.5 to 11 cm).No case was diagnosed with positive margins upon final pathology of resected specimens.The rate of postoperative complications of transanal,transsacral,transsphincteric approaches was 8.9％ (4/45),18.8％ (6/32),20.0％ (9/45),respectively.The recurrence of transanal,transsacral,transsphincteric approaches was 6.7％ (3/45),9.4％ (3/32),4.4％ (2/45),respectively.Conclusions The three approaches for patients suffering from mid-lower rectal tumors and pelvic floor neoplasia have respectively advantages.Transsphincteric approach is the most useful methods,but with more postoperative complications,so it need more surgical techniques.

Objective To report the curative effect of the epitympanoplasty with cartilage obliteration in the treatment of middle ear cholesteatoma .Methods This study retrospectively analysed 123 cases ,with middle ear cholesteatoma treated in our department from November 2009 to July 2012 .The operation included mastoidectomy with posterior canal wall preserved ,lateral wall of attic resected ,facial recess opened to the epitympanum ,epitym-panum obliterated with cartilage and mastoid cavity blocked with bone dust .All cases were followed up on complica-tions and hearing improvement .Results All cases were followed up 6~38 months .In 123 cases ,there were 2 ca-ses had cholesteatoma recurrence in the middle ear cavity ,6 cases had infection of post auricular incision after opera-tion ,3 cases had residual marginal tympanic membrane perforation ,2 cases had ossicular replacement prosthesis ex-clusion ,and 6 cases had canal wall skin swelling or defect .The rest cases acquired full -recovery after 2 or 3 wound dressing changes .Out of 123 cases ,83 cases had the whole hearing document ,the average AB gap at 0 .5 ,1 ,2 kHz reduced from 32 .2 ± 11 .2 dB pre-operation to 20 .7 ± 12 .4 dB post -operation .The AB gap of pre - and post -operation had significant difference (P<0 .001) .Conclusion The mastoidectomy with posterior canal wall preserved greatly shortened the healing time .The resection of lateral wall of epitympanum can exposed operating field more completely and remove lesions thoroughly .The cartilage obliteration in the attic can prevent the retraction pocket formation effectively .This technique provides alternative in treating middle ear cholesteatoma .

In 4 602 subjects for routine check-up,blood uric acid,total cholesterol,triglyceride,high density lipoprotein-cholesterol,and low density lipoprotein-cholesterol were determined.Results showed that the overall prevalence of hyperuricemia in Nanning,Guangxi was 19.8％ (28.8％ in male,9.4％ in female).Blood uric acid and lipids in hyperuricemia group were higher than those in normal uric acid group(all P＜0.01).Serum uric acid had a positive correlation with total cholesterol,triglyceride,low density lipoprotein-cholesterol,but it was negatively correlated with serum high density lipoprotein-cholesterol.The prevalence of hypercholesterolemia was 30.8％,and that of hypertriglyceridemia was 22.2％.Logistic multi-factor regression analysis showed that men,high total cholesterol,triglyceride,and low density lipoprotein-cholesterol could be independent risk factors for hyperuricemia,and that high density lipoprotein-cholesterol was a protective factor.The prevalence of hyperuricemia in population of Nanning,Guangxi during health examination is high.Hyperuricemia is closely associated with dyslipidemia.Timely intervention of hyperuricemia can reduce the related diseases effectively.

Objective To investigate the effects of prostaglandin E1(PGEl)in improving proteinuria and albuminuria in the elderly people with diabetic nephropathy(DN). Methods Patients including stage Ⅲ,stage Ⅳ and stage Ⅴ were divided into four groups:conventional therapy group,PGE1 group,PGE1+ACEI group and ACEI group.Proteinuria and albuminuria were measured before and after treatment for 15 days,3 months,6 months. Results (1)In the DN patients in stage Ⅲ and stage Ⅳ (proteinuria＜2.5 g/d),the proteinuria and albuminuria descended markedly in PGE1+ACEI and PGEl group(P＜0.01).It was better than that in eonventionaI therapy and ACEI group.(2)In the DN patients in stage Ⅳ(proteinuria＞2.5 g/d),proteinuria and albuminuria were not changed significantly after 3 months and 6 months in PGE1+ACEI and PGE1 group,but they were increased in conventional group(P＜0.05).(3)In the DN patients in stage Ⅴ,the proteinuria and albuminuria were not changed much after 1 5 days,3 months and 6 months(P＜0.05).The proteinuria and albuminuria were increased by more than 10 percent(P＜0.01)in the conventional group after 3 and 6 months. Conclusions The therapeutic effects of PGE1 are obvious.Early treatment of nephropathy will get a better improvement in patients with diabetic nephropathy.

Objective To evaluate the value of evoked potentials (EP) in diagnoses of minimal hepatic encephalopathy (MHE) for liver cirrhotic patients without overt hepatic encephalopathy (OHE). Methods A blind and self control study was conducted in 114 liver cirrhotic patients without OHE. All patients were tested for MHE by the number connection test-A(NCT-A), digit symbol test (DST), visual evoked potentials (VEP), brain-stem auditoru evoked potentials (BAEP), short latency somatosensory evoked potentials (SSEP), P300 auditory event-related potentials (P300ERP). MHE was identified when the NCT-A or/and DST was abnormal. The positive rate was compared among VEP, BAEP, SSEP and P300ERP for their reliability and validity in diagnosis of MHE. Results Of 114 patients, 60 patients were found with MHE (52. 6%), which was positively correlated with Child-Pugh classifications (r=0. 278, P = 0. 003). The positive rate was found 17.5% in VEP, 29.8% in BAEP, 38. 6% in SSEP and 57. 0% in P300ERP. There was no significant difference in diagnosis of MHE between P300ERP and NCT-A+DST (X2 =0. 432,P = 0. 511). The sensitivity of VEP, BAEP, SSEP or P300ERP for diagnosis of MHE was 13. 3%, 41. 7%, 46. 7% or 73. 3%, respectively, whereas the specificity was 77. 8%, 83. 3%, 70. 4% or 61. 1 %, respectively. The receiver operating characteristic curve revealed that the best sensitivity and specificity for the diagnosis of MHE was P300EERP (area under the curve was 0. 672, 95%CI 0. 572 * 0. 773). The agreement of NCT-A+DST with VEP, BAEP, SSEP or P300ERP was 43. 9%, 61. 4%, 57. 9% or 67. 5%. Conclusions P300ERP is a sensitive and specific method for the diagnosis of MHE. which can serve as a supplement but not instead of NCT-A+DST.

Objective To investigate the expression of TLR2 and HIF-1α in pancreatic cancer and explore the relationship between TLR2 or HIF-1α protein and the clinical or pathological changes in pancreatic cancer. Methods The mRNA of TLR2 and HIF-1α in 30 cases of pancreatic cancer and its adjacent tissues were detected with real-time PCR and with immunohistochemical methods in 65 cases of pancreatic cancer and 38 cases of corresponding adjacent tissues. The relationship between TLR2 or HIF-1α and pathologic features of pancreatic cancer was analyzed. The correlation between TLR2 and HIF-1α in pancreatic cancer was also assessed. Kaplan-Meier method was used to assess the impact of TLR2 or HIF1αexpression on survival. Results The relative quantification of TLR2 mRNA and HIF-1α mRNA in pancreatic cancer tissues was 0.84±0.17 and 0.87±0.11, respectively, which was significantly higher than that in adjacent tissues 0.70±0.13 and 0.68±0.13 respectively,P＜0.05. The protein expression of TLR2 and HIF-1α in pancreatic cancer tissues was 63. 10% and 70.8%, respectively, significantly higher than that in adjacent tissues (34.20% and 36.8%, respectively). There was no significant correlation between the expression of TLR2 or HIF-1α protein and the age, gender, tumor location, the degree of differentiation in patients with pancreatic cancer (P＞0.05). However, there was significant correlation between the expression of TLR2 or HIF-1α protein and tumor size, lymph node metastasis, venous invasion and clinical staging. TLR2 and HIF-1α had a significant impact on survival. Conclusion TLR2 and HIF-1α overexpressed in pancreatic cancer and TLR2 signaling pathway may promote development of the pancreatic cancer with HIF-1α together.