By using the procedures of the routinization of risk assessment - implementation - evaluation of result-modification to the risk management and carring out the feasibility exploretion on the application and effect of the ward nursing management, so that care defects, nursing errors and the number of cases of occurrence of accidents has significantly reduced, the patients satisfactory degree has rised from 92.5% to 98.5%, improved the quality of care and ensured the safety of patients, fully enhanced the quality of nursing services.

Objective To evaluate the effects of different concentrations of dexmedetomidine on large-con-ductance Ca2+-activated K+ (BKca) channels in the rat mesenteric arterial smooth muscle (MASM) cells.Methods Sprague-Dawley rats of both sexes,weighing 180-220 g,were used in this study.Single MASM cell was freshly isolated from mesenteric arteries in two steps.Ten cells were chosen and studied.When holding potential was 40 mV and the concentration of free calcium ions was 10-7 mol/L,inside-out patch-clamp technique was used to record the single BKCa channel current before and after application of different concentrations of dexmedetomidine (0,10-9,10-8,10-7,10-6,10-5 mol/L).Total open probability (NPo),amplitude (Am),mean open time (To) and mean close time (To) of single BKca channel were observed and recorded.Results Compared with the baseline value,dexmedetomidine 10-7,10-6 and 10-5 mol/L increased NPo in a concentration-dependent man-ner,and dexmedetomidine 10-9,10-8,10-7,10-6,10-5mol/L shortened Tc (P ＜0.05 or 0.01).Compared with the value obtained when the concentration of dexmedetomidine was 10-9 mol/L,Tc was significantly shortened when the concentration of dexmedetomidine was 10-8 mol/L (P ＜ 0.05),and no significant change was found in Am and To obtained when different concentrations of dexmedetomidine were applied (P ＞ 0.05).Conclusion Dexmedetomidine 10-7,10-6 and 10-5 mol/L activate BKca channels in rat MASM cells in a concentration-depen-dent manner,which is one of the mechanisms of decrease in blood pressure by dexmedetomidine.

Objective To investigate the effect of hydromorphone postconditioning on ischemiareperfusion (I/R) injury in isolated rat hearts and the role of mitochondial permeability transition pore (mPTP).Methods Male Sprague-Dawley rats, aged 2-3 months, weighing 250-320 g, were used in the study.The rats were heparinized and anesthetized with intraperitoneal 10％ chloral hydrate 350 mg/kg.The hearts were excised, and perfused in a Langendorff apparatus with K-H solution saturated with 95％ O2-5％ CO2 at 36.5-37.5 ℃.Forty isolated rat hearts were randomly divided into 4 groups (n=10 each)using a random number table: control group (group C), group I/R, hydromorphone postconditioning group (group H), and hydromorphone postconditioning + mPTP opener lonidamine group (group HL).Group C was continuously perfused with K-H solution for 120 min.Group I/R was perfused with K-H solution for 30 min, the perfusion was then suspended for 30 min, and group I/R was perfused with K-H solution for another 30 min.Group H was perfused with K-H solution for 30 min, the perfusion was then suspended for 30 min, and group H was perfused with K-H solution containing 0.3 μmol/L hydromorphone for 10 min, and then with K-H solution for 50 min.Group HL was perfused with K-H solution for 30 min, the perfusion was then suspended for 30 min, and group HL was perfused with K-H solution containing 0.3 μmol/L hydromorphone and 30 μmol/L lonidamine for 10 min, and then with K-H solution for 50 min.At 30 min of equilibration (T0), and 30 and 60 min of reperfusion (T2,3), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), left ventricular developed pressure (LVDP) , ±dp/dtmax, heart rate (HR), and coronary flow (CF) were measured.The concentrations of lactic dehydrogenase (LDH), creatine kinase-MB (CK-MB) , and troponin-T (Tn-T) in the coronary effluent were determined at T0 and T3.The coronary effluent was collected at T0 and 15 min of reperfusion (T1),nicotinamide-adenine dinucleotide (NAD+) concentrations were measured using enzyme-linked immunosorbent assay to reflect the degree of mPTP opening.The myocardial infarct size was determined at T3 by TTC staining.Results Compared with group C, LVDP, HR, ±dp/dtmax and CF were significantly decreased, and LVEDP was increased at T2,3, and the concentrations of LDH, CK-MB and Tn-T in the coronary effluent, myocardial infarct size at T3, and NAD+ concentrations in the coronary effluent at T1 were increased in group I/R (P＜0.05).Compared with I/R and HL groups, LVDP, ±dp/dt CF and HR were significantly increased, and LVEDP was decreased at T2,3, and the concentrations of LDH, CK-MB and Tn-T in the coronary effluent, myocardial infarct size at T3, and NAD+ concentrations in the coronary effluent at T1 were decreased in group H (P＜0.05).Conclusion Hydromorphone postconditioning can reduce myocardial I/R injury in isolated rat hearts, and the mechanism is related to inhibition of mPTP opening.

Objective To investigate the imaging manifestations and clinical features of hepatic and renal angiomyolipoma. Meth-ods The clinical data and imaging findings of hepatic and renal angiomyolipoma in a 51-year-old woman was retrospectively ana-lyzed with literature review. Results CT scan showed a large polymorphous hypodense mass in the right lobe of liver. After contrast -enhanced CT scan, the mass was enhanced gradually from periphery to ceritre. Bilateral kidneys obviously enlarged and appeared as alveolate appearance mixed density with spotty and stripped fat structures. At contrast-enhanced scan, the normal structures of cor-tex and medulla were disappeared, the alveolate walls were enhanced obviously. The arteries and veins of bilateral kidneys were com-pressed and displaced. Conclusion The imaging features of liver and kidney are of certain characteristic compared with other benign and malignant masses,but the final diagnosis of it is still depending on pathology mostly.

Objective To explore therapeutic effects of combinative artificial kidney treatment on renal osteopathy.Methods HD + HP Group composed by 30 urinaemia was treated with hemodialysis and hemoperfusion,and the HD Group was treated only with hemodialysis.Clinical symptoms and lab indicators including osteodynia,itch of skin,blood pressure,appetite,sleep,as well as BUN,SCr,Hb,BPC,Ca,P and iPTH,were compared between the two groups.Results Osteodynia decreased by 67.7% (21/31),and itch of skin by 71.0% (22/31)in HD group.Osteodynia decreased by 96.7% (29/30) ,and itch of skin by 96.7% (29/30) in HD + HP group (P ＜0.01 ).iPTH were (65.5 ± 34.4) pmol/L before treatment and (57.1 ± 21.4) pmol/L after treatment in HD group,and (73.5 ± 44.4)pmol/L and (19.1 ± 17.4)pmol/L in HD + HP group.HD Group eliminated less iPTH (P ＞0.05).HD + HP Group removed more serum poison molecules than HD Group ( P ＜ 0.05 ).Conclusions For patients in maintenance-dialysis stage but with higher iPTH,hemodialysis combined with hemoperfusion removes more poison molecules,consequently decreases incidence of renal osteopathy.

Objective This paper studies on feasibility of low dose CT scanning in lung cancer patients simulated localisation.Methods 62 patients cases of lung cancer are selected.Scan parameter:scan twice by 20/100 mA,the other parameter remain unchanged as voltage of 120 kV,thickness of 5 mm,pitch of 1:1 and scan time of 1 s.After scan,picture quality was evaluated according to excellent,good,bad under different condition.Volume of target was determined by treatment planning system.Data such as dose index value of single helical scan,z-axis scan range,dose length product value and etc.are recorded in order to evaluate radiation dose of patients.Picture quality and the difference of radiation dose were statistically analyzed using Fisher's and pair t-test.Results Picture quality of low dose scanning was a little bit lower than that of normal dose,however,picture quality difference of difference dose scanning was statistically meaningless (number of patients according to excellent,good,bad were 46,13,3 and 50,11,1,P =0.541).There is no obvious difference of target volume under different dose scanning in the same (36.78 cm3,40.35 cm3,t =2.57,P =0.189).Radiation dose of low dose scanning group is far less than that of high dose scanning group and the difference is obvious (133.05 mGy,941.25 mGy,t =-41.24,P =0.000).Conclusions Low dose scanning of 20 mA current during CT simulated localisation tremendously reduces harm that may happen to patients during CT scan,while tumor target delineation and scanned picture quality is guaranteed.

Objective To observe the clinical features of acute macular neuroretinopathy (AMN).Methods Six patients (11 eyes) with AMN were included in this study,with every 2-week follow-ups till six months.Among them,five had preceding dengue fever (83.3％),one had history of head trauma (16.7％).All patients received routine examination,fundus photography,infrared reflectance (IR) imaging,spectral-domain optical coherence tomography (SD-OCT) scanning and fluorescein fundus angiography (FFA) initially,and fundus photography,IR,SD-OCT during follow-up.Results Sudden onset of central/paracentral scotoma in one eye or both eyes was the main visual symptom.There were 1 eye with normal fundus,2 eyes with wedge-shape lesions,8 eyes with yellow-white or brown sheet lesion.IR imaging demonstrated localized areas of hypo-reflection in the macula.SD-OCT scanning through these areas revealed hyper-reflection in the photoreceptor layer and disruption of its normal reflective structures.Subsequent SD-OCT demonstrated that the hyper-reflection of the photoreceptor layer regressed gradually,followed by thinning of the outer nuclear layer.The external limiting membrane and ellipsoid zone became continuous;however,the interdigitation zone was not restored.There was no remarkable findings of the AMN lesions on FFA.The scotomas persisted in all 6 patients (11 eyes) by the last visit.Conclusions IR imaging demonstrated localized areas of hypo-reflection in the macula.SD-OCT revealed hyper-reflection in the photoreceptor layer in acute stage and the interdigitation zone was not restored in late stage.AMN has a relative poor prognosis with persistent scotomas through at least 6 months.

Objective To explore CT and MR manifestations and its diagnostic value of liver cystic lesions.Methods The clinical and imaging data of 78 cases with liver cystic lesions were collected,including 21 cases of inflammatory cystic lesions,30 cases of tumor cystic degeneration and 27 cass of congenital growth cysts.Results The detected rate of liver cystic lesions with CT and MRI was all 100%.For inflammatory cystic lesions,tumor cystic degeneration and growth cyst,CT diagnostic accurate rate was 76%,90% and 93%,respectively,and MR was 83%,93% and 100% respectively.CT and MR manifestations:Of all inflammatory cystic lesions,hepatic abscess and liver echinococcosis cyst appeared as cystic occupying lesion,the cysts were of tension,low-density band on CT or water-like signal intensity on MR around the lesions in hepatic abscesses.Liver echinococcosis cysts were of big cyst with small cyst sign and enhanced moderately in cystic wall post contrast-enhanced scan.The metastasis cystic tumors showed single or multiple cystic lesions and mild or moderate circular enhancement.The primary liver tumor's cystc degenerative lesions showed cyst-solid lesions on CT and MR,and were of enhanced manifestations of the primary tumors.Growth cysts were single or multiple low-density or water-like signal intensity,generally there was not enhanced.Conclusion CT and MR have great diagnostic value for the location and nature of cystic lesions.

Objective To evaluate the clinical diagnostic value of magnetic resonance cholangiopancreatography ( MRCP ).Methods MPCP data of 42 cases with pancreatic and bile duct lesion proved by operation and pathology were analyzed retrospectively.MRCP was performed using single-shot-radio SE sequence (SSH/RAD). Of all cases included bile duct lithiasis in 19 , inflammation in 3,congenital cyst in 6 , carcinoma in 12,jaundice caused by diverticulitis of duodenum in 1 and Mirizzi syndrome in 1 .Results MRCP was succeeded at one time in all cases . On MRCP , the visual rate of intrinsic and extrinsic hepatic bile duct was 100% and that of common pancreas duct was 80.58%.The localized and qualitative diagnosis of lesions were up to 100%,88.2% respectively.Conclusion SSH/MRCP/RAD plays an important role in diagnosis of the pancreatic and bile duct lesion in clinical practice.

Objective To analyse the CT features of hepatic abscess in different stages of pathology so that to improve the accuracy of CT diagnosis.Methods The plain CT and triphase contrast-enhanced CT findings of hepatic abscesses in 50 cases proved by surgery or other clinical methods were retrospectively analysed and compared with CT findings of hepatic carcinoma,hepatic metastases and hepatic hemangiomas.Results CT features of hepatic abscesses were divided into three types according to different stages of pathology.Early pyogenic hepatic abscess(10 cases)had two types:small cavitation(9 cases)and mass(1 case).Typical pyogenic hepatic abscess(38 cases)and granulomatous hepatic abscess(2 cases).Conclusion CT findings of liver abscesses are different in different stage of pathologic changes,triphase contrast-enhanced CT is specific in diagnosing hepatic abscess.