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.

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 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.

To evaluate multi-slice computer tomography (MSCT) in mediastinal lymph node metastasis of T1 and T2 non-small cell lung cancer (NSCLC). Methods:A total of 32 patients with T1 and T2 NSCLC from February 2004 to October 2012 were selected. Preoperative MSCT assessment of mediastinal lymph nodes was performed on basis of the pathological results. Results:Lymph nodes with diameters of≥10 mm were evaluated, and the sensitivity and specificity of the MSCT mediastinal lymph node me-tastases were 82.4%and 92.4%, respectively. Lymph node size, primary tumor location, and visceral pleural invasion showed statistical significance in forecasting mediastinal lymph node metastases (P<0.05). Conclusion:MSCT can be used for the effective evaluation of mediastinal lymph node metastasis, lymph node size, and position of primary tumor. and visceral pleural invasion of the tumor had a higher risk of mediastinal lymph node metastasis.

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 .

BACKGROUND: The expression of Fas antigen and P53 protein in colorectal cancer could reflect the biological character and the prognosis of the tumor.OBJECTIVE: To investigate the relationship between the expression of Fas antigen and P53 protein in coloreetal cancer and the tumor-related biological characters.DESIGN: A controlled experiment by introducing pathological specimens as subjects.SETTING: The study was conducted in the Department of Pathology of Xijing Hospital Affiliated with the Fourth Military Medical University of Chinese PLA.PARTICIPANT S: Totally 32 pathological specimens of colorectal cancer were randomly selected from the Department of Surgery of Xijing Hospital between January 1995 and October 1998. Sixteen normal large intestine tissues were selected form the cadaver of pathology department.METHODS: The expression of Fas antigen and P53 protein in 32 colorectal cancer tissue and 16 normal intestine tissue were tested and compared with immunohistochemical method.MAIN OUTCOME MEASURES: Fas antigen and P53 protein expression in coloreetal cancer and normal intestine, and the clinical indicators of patients with colorectal cancer.RESULTS: The expression of Fas antigen was positive in normal large intestine tissue while the expression of P53 protein was negative. The positive rate of Fas antigen expression in colorectal cancer was 41% (13/32), while the positive rate of P53 expression in colorectal caner was 53% (17/32). Fas antigen significantly decreased in colorectal cancer tissues. The expression of Fas antigen was correlated with the histological type of colorectal cancer and its liver metastasis( P ＜ 0.05) . And the expression of P53 protein was correlated with the liver metastasis of colorectal cancer( P ＜ 0. 05).CONCLUSION: The expression of Fas antigen significantly decreases in colorectal cancer. The higher the malignance is, the more significant less the expression is. Fas antigen does not express in liver metastasis patients. P53protein had positive expression in colorectal cancer tissues, especially in patients with liver metastasis. The reduction and deletion of Fas antigen expression and the excessive expression of P53 protein indicate poor prognosis.

Objective To investigate the effect of a single dose of propofol at the end of surgery on pediatric anesthesia emergence delirium undergoing adenotonsillectomy during sevoflurane anesthesia.Methods Sixty pediatric patients for adenotonsillectomy were randomly divided into propofol group and control group (30 cases in each group), they were undergoing sevoflurane induction and maintaince. The pediatric patients in propofol group were received 1 mg/kg 10% of the propofol intravenous injection at the end of surgery,while the pediatric patients in control group were received the same volume physiological sailine intravenous injection. Duration of surgery, sevoflurane administration, anesthesia time, extubation time were recorded. The highest PAED score after extubation in 30 min were recorded. The time spent in PACU and the FLACC pain score were recorded. Results The PAED score in propofol group was significantly lower than that in control group [(7.5 ± 3.9) scores vs (10.9 ±4.5) scores, P＜0.05]. The incidence rate of postoperative delirium in propofol group was significantly lower than that in control group [20.0% (6/30) vs 46.7% (14/30), P ＜ 0.05 ] . Duration of extubation in propofol group was slightly longer than that in control group[(10.2 ± 1.1 ) min vs (9.1 ± 1 .5 ) min, P ＜ 0.05].There was no statistical significant difference in duration of anesthesia, the time spent in PACU and the FLACC pain score (P ＞0.05).Conclusions The administration a single dose of 1 mg/kg propofol at the end of surgery can effectively reduce pediatric anesthesia emergence delirium undergoing adenotonsillectomy during sevoflurane anesthesia, while can't extend the duration of anesthesia and the time spent in PACU. It has some clinical value.