Objective　To explore the effect of the psychological intervention on the treatment of dental anxiety (DA).Methods Measured with Corah's dental anxiety scale , 316DA patients were selected from department of dentistry and were divided into two groups: the intervention group and the control group . The psychological intervention as well as regular dental therapeutics were applied to the patients in the intervention group , whereas only regular dental therapeutics were used to those in the control group.Results　The patients had a lower clinical dental anxiety in the intervention group , significantly different from that of the control group ( P＜ 0.01). After the treatment , more patients in the intervention group had a slower pulse than those in the control group and fewer had a faster pulse .The results also showed that the psychological intervention had a better curative effect on male patients than female ( P＜0.05). Conclusion　The psychological intervention was efficient to patients with dental anxiety.

Multiple chromosomal aberrations, nucleotide substitutions, and epigenetic modifications may occur in human cancer cells, which drive malignant transformation. The Cancer Genome Atlas (TCGA) project aims to promote large-scale multi-dimensional analysis of these molecular characteristics in human cancer and rapidly provide data to researchers. In this study, we introduce four flow paths of the production of TCGA data, the collections of various cancer types, the data category and level, and the standardized pipeline of data analysis, as well as several existing data analytical tools. We used ovarian cancer as an example to introduce the application of the TCGA data in the analyses of mutation, copy number, analysis, and expression. We summarized the important findings of glioblasto-ma by TCGA teams.

BACKGROUND:Great saphenous vein is the most common vascular material in coronary artery bypass grafting, however, the graft neointimal hyperplasia and subsequent atherosclerosis result in angiostegnosis, which affect the long-term efficacy. OBJECTIVE: To analyze the pathophysiology and mechanism of the angiostenosis, additionally, to construct smooth muscle cell specific SM22a promoter and SMHC enhancer. METHODS: The database of PubMed, HighWire and CNKI were retrieved with key words of "SM22α promoter, SMHC enhancer, stenosis, Pi3k and RNAi/RNA interference". The language was confined to English and Chinese. The literatures correlated with angiostenosis, VSMC-specific SM22α promoter and enhancer were selected. The reviews and overlapped researches were excluded. In vascular smooth muscle cell proliferation and apoptosis of graft neointimal hyperplasia, as well as the extent of graft thrombosis were considered as evaluation index. RESULTS AND CONCLUSION: More than 8 730 literatures were searched by the computer. According to inclusion and exclusion criteria, the SM22α promoter and angiostenosis were analyzed. The neointimal hyperplasia and thrombosis had a strong impact on prospective efficacy after coronary artery bypass grafting. The PI3K-Akt-mTOR pathway was a crucial signal passage which regulated cell proliferation and migration. RNA interference targeting Pik3cb can efficiently suppress the neointimal hyperplasia through down regulating the PI3K-Akt-mTOR pathway. The shRNA eukaryon expression plasmid vectors targeting rat Pik3cb were constructed using VSMC-specific SM22α promoter. On the one hand, it can suppress the neointimal hyperplasia, and on the other, it can prevent the occurrence of thrombosis.SM22a is a specific gene in vascular smooth muscle cell. The studies that applied VSMC-specific SM22α promoter/enhancer to vascular grafting provide a new strategy to prevent angiostenosis and thrombosis.

Objective To demonstrate clinical value of surgical repair combined with collateral embolization for tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs).Methods The clinical catheterization and surgical data of 8 such patients from October 2004 to May 2008 were analyzed retrospectively.All 8 patients underwent completely surgical repair combined with MAPCAs occlusion.Of 25 collateral arteries,20 were occluded before surgical procedure and 5 small ones were left.Corrective repairs were accomplished under moderate hypothermic cardiopulmonary bypass.Ventricular septal defect was closed with Dacron patch,and all patients underwent non-valved autologous right ventricular outflow tract reconstruction.Results No complications were observed,only 1 patient got hypoxemia.Blood returned to left atrium from lung was decreased.During 6 months follow-up,7 cases were in NYHA class Ⅰ,another was in NYHA class Ⅱ.Conclusions In selective patients with dual pulmonary blood supply by both MAPCAs and native pulmonary arteries,this combined therapy of collateral embolization and surgical repair simplifies copmpleling surgical procedure,improves surgical results and achieves higher rate of one-stage repair.

Objective To explore the effect of three shifts on sleep status of nurses in order to supply evidence for improving the nurses' sleeping quality. Methods 111 three shifts nurses and 117 traditional shifts nurses of 3 grade three A hospitals in Guangzhou were investigated for their sleep condition with self-rating scale of sleep (SRSS), and later the results underwentχ2 test and t test. Results There were 55 three shifts nurses with sleeping factor scores of SRSS≥23 (49.5 %), while there were 72 traditional shifts nurses with sleeping factor scores of SRSS≥23 (61.5 %). Compared with traditional shifts nurses, the total mean scores and factor score of three shifts nurses were better except sleeping time and lack of awakening. It is discovered that great sleeping status differences were found among three shifts nurses and traditional shifts nurses between the age of 20 to 30. Conclusions Three shifts can release the pressure of nurses and can improve the nurses' sleeping status to some degree, especially to the juniority nurses' sleeping status,then the nursing safety can be insured.

Objective To introduce an ideal method of repairing of finger volar skin defect. Methods Thirty-five patients whose finger was repaired by second digit lateral shank flap through free transplantation of lateral defect were selected. Twenty-four cases were male and 11 cases were female, with age of 21 to 45 years old. Cutting injury was in 7 cases, crush injury was in 16 cases, degloving injury was in 9 cases, and firearm injury was in 3 cases. Skin defect area was 2.0 cm × 1.5 cm-4.0 cm ×2.5 cm. The course was 1 h to 5 d. Donor area was repaired by thick skin flap. Results The postoperative wound of 35 cases all healed in stage Ⅰ, and skin flap transplantation and the donor skin grafts survived. Twenty-nine cases received follow-up for 5-26 (14.5±5.0) months. The skin flap had good appearance and good texture, with two points discrimination of 5-8 (6.7±1.1) mm. According to the Chinese medical association upper part of the function evaluation trial standard: excellent was in 19 fingers, good was in 8 fingers, and the excellent and good rate was 93.1% (27/29). Walk, run, jump functions of donor foot were normal. Conclusions Repairing finger with the second digit lateral shank flap through free transplantation of lateral defect has small area damage, and damage to the area around the organization is small. The effect of repairing is good, and can achieve the aim of the palm side repairing.

The amount-based restriction of negotiation in private when resolving medical disputes is quite com-mon in much local legislation.This kind of provision is legitimate in general, because the rights and interests it pro-tects overweigh those it limits, and the measures it takes are proper.However, there are several flaws.Firstly, as a provision which impairs the rights of citizen, the level of legislation and legal effect need to be upgraded.Secondly, the set of the amount of limitation is arbitrary.Thirdly, differential treatment of public and non-public medical insti-tution in the provision cannot be justified;it actually shows confliction between different government functions.Last-ly, blindly limitation of negotiation in private has neglect something important, that is the self-government functions behind autonomous disputes settlement mechanism.Based on these flaws, several improvement suggestions are pro-vided.

This paper discussed the development of hospice care in our country form five respects , detailed e-laborated our country the main manifestations of lacking hospice medical service policy : relevant policies render fragments;relevant policy interoperability is not strong;Relevant policy lack of financial support;the lack of pub-licity related policy .On this basis , put forward the hospice career development needs of related policies , inclu-ding:set up complete medical security system;establish perfect hospice service classification management mecha-nism;establish and perfect the government funds allocated for hospice care medical services .

Objective To explore the mechanism of diabetic hepatic fibrosis by observing effects of high glucose and insulin on expressions of transforming growth factor beta 1 (TGF-β1) and tissue inhibitor of metalloproteinase (TIMP-1) mRNAs of hepatic stellate cell (HSC) in rat.Methods Hepatic stellate cell lines in vitro were administrated by different dose of glucose without insulin and glucose with insulin for 72 h,and mannitol was chosen as hyperosmosis control group.Real time fluorescent quantitation polymerase chain reaction (RT-FQ-PCR) was used to determine expressions of TGF-β1 and TIMP-1 mRNAs of HSC in each group.Results Expressions of TGF-β1 and TIMP-1 mRNAs of HSC in each group could be detected and showed no significant difference among groups (P ＞ 0.05).However,in general,expression of TGF-β1 mRNA in glucose with insulin group decreased and TIMP-1 mRNA increased.Conclusions The mRNA expressions of TGF-β1 and TIMP-1 in HSC could not be induced by high glucose alone,high dose of insulin may increase expressions of HSC TIMP-1 and reduce TGF-β1 expression.The main mechanisms of diabetic hepatic fibrosis may not be TGF-β1 pathway but be closely related to TIMP-1 pathway.

OBJECTIVE:To observe the efficacy and safety of amikacin different administrations in the treatment of ventila-tor-associated pneumonia. METHODS:Data of 109 patients with ventilator-associated pneumonia were divided into observation group (58 cases) and control group (51 cases) based on different administrations. All patients received 3.0 g Ceftriaxone sodium for injection,adding into 100 ml 0.9% Sodium chloride injection,intravenously,once every 12 h. Based on it,control group re-ceived 7.5 mg/kg Amikacin sulfate injection,once a day. Observation group received 7.5 mg/kg Amikacin sulfate injection,adding into 20 ml 0.45% Sodium chloride injection,aerosol inhalation,twice a day. The treatment course for both groups was 7 d. Clini-cal pulmonary infection score (CPIS),alanine aminotransferase (ALT),serum creatinine (Cr),oxygenation index (PaO2/FiO2), IL-10,IL-6,C-reactive protein(CRP),tumor necrosis factor(TNF)-α,cumulative mortality after 3 months of treatment and the incidence of adverse reactions before and after treatment in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the CPIS score,ALT,Cr,PaO2/FiO2,IL-10,IL-6,CRP and TNF-α levels in 2 groups(P>0.05). After treatment,CPIS score,TNF-α,IL-6 and CRP levels in 2 groups were significantly lower than before,observation group was low-er than control group,the difference was statistically significant(P<0.05),and there was no significant difference in IL-10 before and after treatment in 2 groups(P>0.05). PaO2/FiO2 in observation group and ALT,Cr and PaO2/FiO2 in control group were signif-icantly higher than before,PaO2/FiO2 in observation group was higher than control group,ALT and Cr were significantly lower than control group,the differences were statistically significant(P<0.05). The cumulative mortality after 3 months of treatment in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). And there were no severe adverse reactions during treatment. CONCLUSIONS:The efficacy of amikacin by aerosol inhalation is superior to by in-travenous infusion in the treatment of ventilator-associated pneumonia,it can effectively reduce inflammatory cytokine levels and mortality rate,do not increase the incidence of adverse reactions.