Advance medical directive is a statement made by a patient ,which indicates patient′s acceptable or unacceptable treatments , when he or she is not competent to make a medical decision .There are two types of ad-vance directive , which are living will and durable power of attorney for healthcare .The paper will briefly introduce advance directive′s history and analyse its controversies throughout the world .In China , most people don′t own an advance directive .When these patients are faced with medical emergency , their desires can not be known by their relatives, and not to mention let their relatives respect their desires .Cultural barrier and the lack of regulation and propaganda on advance directive are the main reasons cause the current situation of advance directive in china . Based on the analyses above , the paper offers a suggestion that it is necessary to widely promote advance directive in China .During the process of promoting advance directive , should pay attention to guide and respect traditional culture .

Objective To explore the molecular targets and mechanisms that could influence the sensitivity of triple negative breast cancer (TNBC) to chemotherapy,to provide important references for the chemotherapy based on gene detection.Methods The gene expression dataset GSE43502 was downloaded from the Gene Expression Omnibus in National Center for Biotechnology Information (NCBI).Gene expression data preprocessing was conducted by R Programming.The differentially expressed genes in the TNBC patients that relapsed after chemotherapy compared with the non-relapsed ones were obtained.Besides,the Database for Annotation Visualization and Integrated analysis (DAVID) was used for functional analysis of those genes.The microRNA (miRNA) that might regulate the differentially expressed genes was obtained from the starBase database.Furthermore,Cytoscape was used for the construction of miRNA-gene regulation network.Results Three hundred and twelve differentially expressed genes were obtained.Some biological process related to cell membrane,metal ion homeostasis and pathways involved in immune and inflammatory were found to be enriched in those genes.Furthermore,171 miRNA that might regulate the differentially expressed genes were obtained and 553 miRNA-gene regulation pairs were formed.Conclusions hsa-miR-30d-5p,SIX4,etc.might influence the sensitivity of TNBC to chemotherapy through cell structure or immune system.

Objective To observe the effect of"one-to-one"full-course Doula accompanied delivery on the outcome of puerperants in obstetric departments.Methods Totally 2120 normal full-term puerperants were taken as the observation group.The puerperants in the observation group were accompanied one-to-one for the full course by a maternity nurse who offered services on physiology,psychology and emotion,social adaptative ability,etc.to the puerperants.Totally 2132 normal full-term puerperants were taken as the control group.Results In the observation group,the psychological state was relatively stable,the painful degree Was mild,the incidence rate of postpartum hemorrhage Was low,the rate of uterine-incision delivery Was low,the delivery course was short,the Apgar score of neonates was high,the apnoea is less(P＜0.05),and the satisfactory degree of the puerperants was high.Conclusion The service mode of"one-to-one"full-course Doula accompanied dehvery in obstetric departments is helpful for the health of both mothers and infants,and is good for improving the entire nursing quality and for improving the satisfactory degree.The"one-to-one"full-course Doula accompanied delivery is a good service mode.

Objective To explore advantage of RNA guiding activity in vitro cleavage assay and intracellular antivi-ral effects for hepatitis C, basing on one external guide sequence (EGS)sequence of the conserved region of 5′UTR of HCV genome .Methods We analyzed the sequence and structure of the conserved region of 5′UTR of HCV ge-nome with computer software and designed one EGS which was direct at the potential targeting site ( C67-G68 ) .We tested the gene expression of HCV in Northern blot and Western blot and its antiviral activity by fluorescence quan -titative PCR in the Huh7.5.1 cell which was transfected by EGS-C67 .Results EGS-C67 had obvious advantage of RNA guiding activity in vitro cleavage assay .EGS-C67 obviously inhibited the gene expression of HCV and inhibit the proliferation of HCV and down-regulate the titer of HCV about 150 times( P<0.01 ) .Conclusions EGS-C67 , the new antiviral RNA has notably antiviral activity in cultured cells , thus could provide a new promising approach for development of anti-HCV strategy .

Objective To investigate and analyze the characteristics and stratified influencing factors of self-directed learning of nursing college students.Methods In November 2016,a total of 304 students from three nursing colleges in Sichuan province were investigated with self-rating scale of self-directedness learning (SRSSDL).304 copies of the questionnaires were issued and recovered.Using SPSS 13.0,the independent sample t test and variance analysis were used to compare the differences between groups.Pearson correlation test and multiple linear regression were used to analyze the influencing factors.Results The average SRSSDL score of key undergraduate students of nursing college was (220.27 ± 30.16),the score of general undergraduate students was (212.37 ± 25.01),the score of Junior college students was (205.26 ± 29.84),The score difference has statistical significance (F=6.191,P=0.002).Students from key undergraduate had the highest self-directed learning ability,and students from general undergraduate and Junior college had the medium self-directed learning ability.The factors such as different levels,whether the one-child,self-study time every day,team learning experience affect students' self-directed learning ability.Conclusions We should create conditions for students to study independently,cultivate professional identity and independent spirit under the premise of clear educational objectives to improve their SDL ability.

In order to meet the need of limb rehabilitation, the control system that takes programmable logic controller (PLC) as the core was studied based on analysis of mechanical structure and working principle for the rehabilitation training device. The function and characteristics of hardware are analyzed for control system, overall hardware scheme design is completed. Then different training modes of software are developed, in which touch screen as a host computer, is responsible for human-computer interaction, control instructions transmission and information display; PLC as lower machine, receives control instructions and acquires data from sensor, controls torque and speed of the motor. Patients can choose training mode according to their specific situations. Experimental results show that control system is stable and reliable in performance.

BACKGROUND:Primary culture in vitro of neurons plays an important role in the development, regeneration, signal transduction mechanisms, neuropharmacology and gene expressions of the nervous system.
OBJECTIVE:To establish a simple method for primary culture of high-purity cortical neurons in neonatal Sprague-Dawley rats.
METHODS:Cortical tissues were acquired from neonatal Sprague-Dawley rats born 1 day. In traditional experimental group, the whole cortex was removed;in improved experimental group, the cortical tissues, 2-3 mm thick on the brain surface were removed. Single cel suspensions were prepared after papain digestion and centrifugation and were then seeded onto 24-wel culture plates containing neuron solutions for primary culture (1×105 per wel ). Cel s were identified by neuronal specific markers MAP-2 and Tuj1 after 3-day culture. The number of neurons and neurite length were observed under inverted phase contrast microscope and recorded at 6, 24, 48 and 72 hours, 5 and 7 days of culture, resprctively.
RESULTS AND CONCLUSION:The cultured cel s expressing MAP-2 and Tuj1 were neurons that could be used in the fol owing experiments. The purity of neurons in the improved experimental group was 92%at 3 days, while only 51%in the traditional experimental group. Cel s in both two groups had attached to the wal presenting with smal processes at 6 hours, and a simple neural network formed at the 3rd day until dense neural networks could be found at the 5th day. To conclude, our culture method herein is simple and convenient, and can be used to produce neurons with high purity, which wil be helpful for the experimental studies on cortical neurons from Sprague-Dawley rats.

Objective To study the skills and effects of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis .Methods We enrolled 21 patients with suspected acute appendicitis who then underwent emergent ERAT between October 2014 and January 2015 .The data of treatment were collected and the operative skills and effects of ERAT were analyzed . Results ERAT was completed successfully in all the patients ,resulting in a success rate of 100% .Mean operation time of ERAT was (49 .7 ± 18 .2) min and mean hospital stay was (3 .3 ± 1 .6)d .Cannulation of the appendix lumen was the most critical step of ERAT ,and cannulation time [(5 .7 ± 4 .9)min , P< 0 .05] was shortened significantly by the use of LoopTip guidewire . Fourteen patients with intraluminal appendicoliths (7 of massive appendicoliths , 4 of sand‐like appendicoliths and 3 of sand‐like appendicoliths with luminal stenosis ) underwent endoscopic lithotomy successfully with balloon or basket ,with the success rate of 100% .One patient who presented perforation after appendicolith removal by basket was cured with conservative treatment .Appendix stent was inserted ,then pulled out after 1 week in 9 patients ,while no complaint or complication of the stent was observed .Operation time of ERAT shortened with the increase of case number .Conclusion ERAT is an effective and safe therapy for treating patients with uncomplicated acute appendicitis .The high success rate and safety of ERAT will be achieved by selecting suitable instruments for cannulation and appendicolith removal ,deciding suitable indications for stenting ,and accumulating of operative cases .

Objective To study the effect and safety of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis. Methods Patients with uncomplicated acute appendicitis were enrolled and divided into ERAT group and LA group received laparoscopic appendectomy. Then compare treat-ment condition, complications and follow-up of the two groups. Results ERAT were completed successfully in all the patients in ERAT group, while one patient underwent a reversion to open appendectomy for technical difficulties in LA group. Mean operative time was (49.7 ± 18.2) min for ERAT group and (68.9 ± 25.9) min for LA group (P <0.05). Fever relief time (1.3 ± 0.5) d, WBC normalization time (2.0 ± 0.9) d, mean bed time (0.1 ± 0.2) d and mean hospital stay (3.3 ± 1.6) d for ERAT group were significantly lower than LA group (P <0.05). 14 patients with intra-luminal appendicoliths (7 of massive appendicoliths, 4 of broken appendicoliths and 3 of broken appendicoliths with luminal stenosis) underwent endoscopic lithotomy successfully in ERAT group, resulting in a success rate of 100.00%. One patient presented perforation after ERAT was cured with conservative treatment. During the follow-up of at least 1/2 year, the rate of recurrence was 10.00% in ERAT group. 1 patient (5.00%) underwent LA at the 5th month after ERAT during the follow-up. Conclusion ERAT is an effective and safe therapy in treating patients with uncomplicated acute appendicitis with advantages of minimal invasiveness and quick recovery. Uncomplicated acute appendicitis with appendicoliths and/or luminal stenosis are the most suitable indications for ERAT.

This study was aimed to observe the clinical effect of Ping-Ai GranulesⅠin the treatment of HIV/AIDS . A total of 107 AIDS cases were divided into Ping-Ai GranulesⅠgroup and Ping-Ai GranulesⅠunited with HAART group. The results showed that there was significant difference between Ping-Ai GranulesⅠgroup and Ping-Ai GranulesⅠunited with HAART group in aspects of symptoms, physical signs, Karnovsky Score and changes of CD4+ T lymphocyte . It was concluded that Ping-Ai GranulesⅠhad the function of improving patient's symptom and increasing patient's immunity and living quality .