Objective:To explore the clinical effect of high quality nursing service in department of neurosur-gery.Methods:The patient and family's satisfaction degree , number of nursing errors , medical disputes , family ac-company rate and so forth were compared before and after the implementation of high quality nursing service in de-partment of neurosurgery .ResultsAfter the implementation of high quality nursing , the satisfaction degree of pa-tients and their families was improved and the nursing errors , medical disputes and family members accompany rate were reduced .Conclusions:High quality nursing service mode could improve the nursing quality and patient satis-faction in department of neurosurgery .

Two unusual cases of coexistence of Hashimoto′s thyroiditis and subacute thyroiditis were reported. The diagnosis was based on the comprehensive analysis of clinical symptoms, laboratory data and histological findings. If patients with confirmed evidence of subacute thyroiditis were accompanied with markedly and persistently elevated titers of thyroid autoantibodies, coexistence of both diseases should be suspected.

Background Alkali burn-induced corneal neovascularization(CNV) usually leads to blindness.Recently,study determined that vascular endothelial growth factor(VEGF) and basic fibroblast growth factor(bFGF) were the main regulating factors inducing angiogenesis,and canstatin proteins can inhibit the growth of VEGF and bFGF and thereby inhibit CNV growth.Objective The present study was to investigate the effect of recombinant canstatin protein on mouse CNV induced by alkali burn and its mechanism.Methods CNV models were induced in the right eyes of 40 female BALB/c mice by sticking the 2.0 mm filtering paper with 1 mol/L NaOH at the central cornea for 10 seconds.The animals then were randomized into two groups.Recombinant canstatin protein drops(5 mg/L) was topically administered 4 times daily in the mice of the experimental group,and normal saline solution was used at the same way in the control group.Corneas of the mice were examined under the slit lamp to calculate the CNV area 1 day,3,7,14 days after modeling.The mice were sacrificed at above time points and corneas were obtained.The expressions of VEGF protein and bFGF protein in cornea were detected by Western blot,and the results were analyzed by enhanced chemiluminescence(ECL).The use of the experimental animals complied with the Instructive Notions with Respect to Caring for Laboratory Animals by State Ministry of Science and Technology.Results In 3,7 and 14 days after establishment of models,the area of CNV was (1.98-0.31) mm2,(6.21 ±0.44) mm2 and (9.83±0.72) mm2 in the experimental group,and that in the control group was (2.92 ± 0.41) mm2,(8.04 ± 0.56) mm2 and (11.78 ±0.84) mm2,showing significant reduce in the mice treated with recombinant canstatin protein(t3d =4.332,P=0.005 ;t7 d =11.729,P =0.000 ;t14 d =14.562,P =0.000).Western blot analysis showed that there was significant increase in the gray scale of VEGF protein 1 day,3,7,14 days following alkali burn in the experimental group compared with the control group(t1 d =-3.980,P＜0.001 ;t3d =-10.020,P＜0.001 ;t7d =-4.355,P＜0.001 ;t14 d =-8.156,P＜0.001),and the gray scale of bFGF was significantly ascent at various time points in the the experimental in comparison with the control groups (t1 d =-3.488,P＜0.001 ; t3 d =-2.124,P =0.013; t7 d =-1.977,P =0.028; t14 d =-4.542,P＜0.001).Conclusions Topical application of recombinant canstatin protein drops inhibits CNV growth induced by alkali burn by down-regulating the expressions of VEGF and bFGF proteins.

Clinical education for undergraduates in China can be divided into three phases:preclinical phase,clinical clerkship phase,clinical practice phase,and each phase has its own features and different teaching tasks.Currently there are four teaching methods mostly applied in clinical education:lecture-based Learning (LBL),team-based learning (TBL),case-based learning (CBL) and problem-based learning (PBL).LBL is a teacher-centered.teaching method,which focuses on making knowledge accurate,systematic and comprehensive;TBL,CBL and PBL are student-centered teaching methods,which can improve students' enthusiasm and subject initiative.Each teaching method has advantages and dis-advantages.According to the different characteristics of three stages of medical education,this paper analyzes the reasonable application of different medical teaching methods in three stages of undergraduate medical education:in preclinical stage,combining LBL with TBL teaching methods;in clinical clerkship phase,combining the teaching methods of LBL,TBL and CBL;in clinical practice stage,combining CBL with PBL teaching methods.

Objective To investigate the role and prognostic impact of E-cadherin( E-cad)on in-vasion and metastasis of gastric carcinoma by analyzing E-cadherin expression at DNA,RNA and protein levels. Methods RNA and protein expression of E-cad were tested in 60 cases of gastric carcinoma and adjacent tissues by streptavidin peroxidase( SP )immunohistochemistry and in situ hybridization. DNA methylation of E-cad was tested with methylation-specific polymerase chain reaction( MSP). Results The positive rates of E-cadherin protein and mRNA in gastric carcinoma were significantly lower than those in adjacent tissues. DNA methylation of E-cad negatively correlated with the E-cad protein and RNA expres-sion in gastric carcinoma respectively(r= -0. 355,r = -0. 271). DNA methylation of E-cad negatively correlated with the 5-year survival rate of gastric carcinoma(r = -0. 381,P ﹤0. 01). However,E-cad protein positively correlated with the 5-year survival rate of gastric carcinoma(r=0. 378,P﹤0. 01). Con-clusion The decreased expression of E-cad is one of the most important biological features in gastric car-cinoma. Methylation of E-cad DNA may be an important agent causing low expression of E-cad protein and mRNA and it can be used as an important indicator in predicting invasion and metastasis of gastric cancer.

Palliative and hospice care for patients suffering severe or end-stage illness with projected short life expectancy.Such services aim to improve patients' quality of life through prognosticating,prevention and treatment of their ailment.The main components include evaluation and treatment of symptoms,pain control,family care,alleviating and treating patients' psychological burden and depression,and offering comfort and dignity.Hospice and palliative care are different from euthanasia,because they neither hasten nor delay the dying process.Instead,they focus on patients'physical and psychological needs and helping patients to maintain their independence and make their own choice.As a new medical subspecialty,palliative and hospice care are considered one of the important frontier in modern medicine.They employ a multi-disciplinary team approach,and the team members require special skill sets including those in communication and symptom management.

Objective To investigate the changes of serum homocysteine ( Hcy),C-reactive protein ( hsCRP) levels in acute cerebral infarction patients and its significance.Methods 64 patients with acute cerebral infarction were selected as research group,and 60 healthy volunteers were selected as control group.Detected the acute cerebral infarction patients after 1d,the first 7d,14d Hcy,hs-CRP,total cholesterol,triglycerides,high density lipoprotein,low density lipoprotein levels and the control group the level of these indicators.Results Of total cholesterol,triglycerides,low density lipoprotein of the study group was higher than those of the control group of high-density lipoprotein(t =3.073,2.874,2.015,all P ＜0.05);after admission ld,treatment of the first 7d,14d showed no significant difference between the two groups ( t =2.223,2.268,all P ＜ 0.05 ).Conclusion Hcy,hs-CRP and the occurrence of acute cerebralinfarction was closely related to the development,and testing to determine the severity of the disease for the guide had important clinical significance.

BACKGROUND:Recently, the effects of lumbar facet joint morphology on the onset of degenerative lumbar spondylolisthesis have been a discussion point. However, the discussion mainly concerned CT manifestations of joint angle and osteoarthritis. Studies have shown that the changes in cross-sectional area of paraspinal muscle were considered as the essential marker for the pathological diagnosis of degenerative lumbar spondylolisthesis. However, previous studies limited the accuracy of the conclusion due to smal sample size, young age, and measurement.
OBJECTIVE:To observe changes in MRI images of bilateral paraspinal muscles after degenerative lumbar spondylolisthesis.
METHODS:This study adopted the method of retrospective study, selected 80 cases of degenerative lumbar spondylolisthesis as lumbar spondylolisthesis group, and 80 healthy persons as control group. Image J software was utilized to measure cross-sectional areas of bilateral erector spinae and psoas major muscle on the L 3-5 vertebral endplate levels using T2-weighted MRI in both groups. The ratio of relevant data was calculated.
RESULTS AND CONCLUSION:Compared with the control group, the ratio of cross-sectional area of paraspinal muscle was increased on the same side and the same level in the lumbar spondylolisthesis group (P<0.05), and the mean value of cross-sectional area of bilateral psoas major muscle was decreased on the same level (P<0.05). No significant difference in the mean value of cross-sectional area of left and right erector spinae was detected on the same level (P>0.05). Results indicated that the changes in cross-sectional area of paraspinal muscle could induce degenerative lumbar spondylolisthesis, and could be considered as a diagnostic standard for degenerative lumbar spondylolisthesis.

Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWMRI) in gross tumor volume definition and localregional recurrence/distant metastasis prediction in nasopharyngeal carcinoma ( NPC). Methods From Jun. 2008 to Feb. 2011, each of 36 patients with or without Iocalregional recurrence and/or distant metastasis treated by intensity-modulated radiotherapy in our hospital was matched in this study. The difference of apparent diffusion coefficient ( ADC) values between these two groups was compared by t-test method. The conventional MRI and DWMRI before treatment were centrally reviewed to evaluated whether DWMRI would benefit to the definition of gross tumor volume.Results The mean ADC value were (0. 753 ±0. 091) x 10 -3 mm2/s and (0. 793 ±0. 094) x10-3 mm2/s in treatment failure group and control group, respectively ( t = - 1. 79 ,P = 0. 078) . The extension of gross tumor volume were much more outstanding in DWMRI when compared to conventional MRI. DWMRI predicted localregional recurrence more accuracy than conventional MRI in one patient . Conclusions DWMRI is help to definition of gross tumor volume. The ADC value before radiotherapy can not predict the localregional recurrence and/or distant metastasis for nasopharyngeal carcinoma.

Kasabach-Merritt syndrome(KMS) is a massive haemangioma with thrombocytopenia and consumptive coagulopathy. The histopathology of KMS is thrombocytopenia and disseminated intravascular coagulation associated with massive haemangioma.A standard treatment regimen for KMS has not been established. Therapy includes surgery, embolism and medicine(steroids,α-interferon , immunosuppressant , etc).