Objective To discuss the influence of health education pathway on detaining time of thoracic drainage tube and standardize the nursing procedure for postoperative patients.Methods Forty five patients after thoracotomy from March to December in 2006 were set as the control group.Fifty patients of the same kind from January to September in 2007 were named the test group.The control group received conventional nursing education.The test group received health education on the day of operation,the first,second,third and fourth day after operation from specified nurses according to health education pathway.The contents included psychological nursing,pain management,respiratory function and physical training and enhancement of drainage efficacy.The average indwelling time of thoracic drainage tube was recorded.Results The average indwelling time of thoracic drainage tube in the test group and the control group was(74.40±8.88)h and(91.68±10.08)h respectively,which showed statistical difference,P＜0.01.Conclusions Application of health education pathway effectively shortened indwelling time of thoracic drainage tube as well as reduced pain and medical costs of patients.

Informed consent is one of the basic ethical rules for living related kidney transplantation.Doctors have obligations of informing before kidney transplantation.The advantages and disadvantages of each treatment should be introduced to uremic patients and their relatives to let them know that kidney transplantation is not the only choice for treating uremia.Both donors and recipients of living kidney transplantation should be informed of the clinical effects,all kinds of complications and their risks,and the importance of treatment compliance after operation.Donors should be notified with the interests,complications and risks in period of donating operation and long-term after operation,and should be notified with the interests and risks in some special conditions for exchanging donation.Voluntary donation should fulfill that donators make the decision of donation under a fully understanding of the risks of living kidney transplantation and being fully assessed by themselves,and cheating,luring and sealing kidneys for economic interests are ruled out in making consent.Persons with incapability can not be donors even if they had made the consents of donation.In order to make sure that the decision of donation is made under the condition that living donors and recipients have known the fact thoroughly,ethics committee should inspect the "consent of kidney transplantation of living donation" and "consent of operation" offered to donors and recipients by hospital to make sure that donors and recipients have been fully notified with the current situation,clinical effects and possible complications of living kidney transplantation by doctors.This measure can make sure that donors and recipients make the decision based on knowing the fact thoroughly and sign the consent personally.

Objective To investigate the expression of inducible nitric oxide synthase(iNOS) in the cochlear stria vascularis(SV) of guinea pigs after streptomycin(SM).Methods Auditory brainstem response(ABR) was used as measurement index,and combining with transmission electron microscope(TEM),immunohistochemical staining and image quantitative analysis technique, to detect iNOS expression in the cochlea stria vascularis of guinea pigs and the change of morphology after SM.Results 10 days after adminitration, ABR threshold of SM group increased more significantly than that of the control group(P

To improve the diagnostic level of CT and MRI in intracranial angioreticuloma. 75 cases of intracranial angioreticuloma were examined by CT, and 19 of them were re examined with MRI. The tumor was located in the cerebellum in 67, frontal lobe in 2, temporal lobe in 1, cerebellum with involvement of medulla, great occipital foramen, vertebral canal, spinal cord and cerebropontial angle in 1, respectively. CT displayed cystic low density accompanied by tumor wall nodules (midcystic tumor) in 35, cystic low density in 18, circular cystic wall in 11, parenchymatous high density in 4, and mixed density in 6. Long T 1 and T 2 signals with tumor wall nodules were displayed in MRI in all of 12 patients. Postoperative pathology: 47 were cystic tumors with tumor wall nodules in the size of 0 1～3 0cm in diameter. The tumor was solitary in 71 cases, and multiple is 3, and the mixed tumor of glioblastoma multiforme and multiple angioreticuloma was located in the temporal lobe in 1 patient, which was rare. The tumor should be diagnosed as angioreticuloma when it was located in the cerebellar hemisphere or vermis without the feature of midcystic tumor or parenchymatous tumor in CT and MRI profiles, with the features of obvious reinforcement or paramagnetic vascular empty in tumor, and a short history.

OBJECTIVE:To study the incidence of adverse drug reactions(ADRs) and the rational use of Durogesic in in-patients METHODS:37 in-patients treated with Durogesic in Department of Oncology in our hospital were prospectively observed,and its analgesic efficacy and incidence,severity and the outcome of ADRs were evaluated RESULTS:The alleviating effect of Durogesic on carcinomatous pain was 100% Of 37 patients,ADRs were found in 4 cases with a ADR rate of 10 8% CONCLUSION:Durogesic is effective in clinical use,but attention should be paid to monitoring ADRs and avoiding irrational use of drug

Objective To analyze the method of self-management education on the health status of patients with gastric carcinoma during chemotherapy. Methods Patients with gastric carcinoma (60 cases) were divided into the test group and the control group with 30 cases in each group. The two groups both received chemotherapy of complete cycle and general health education. The test group adopted self-management education based upon the above treatment, including collective education, group discussion and individual instruction. The treatment effect was appraised and compared by senior primary nurses. Results The recent total effective rate of chemotherapy in the test group was 76.7%, which was higher than that of the control group (50.0%). The level of life quality of the test group was also better than that of the control group (P<0.05). Conclusion Patients-centered self-management education could improve the health status of patients with gastric carcinoma during chemotherapy.

Objective The study aimed to construct one severity of illness scoring system specially for children with complex congenital heart diseases and analyzed the applicability of this new score,which will be helpful to assist the medical workers in evaluating children's condition.Methods A total of 1284children patients with complex congenital heart diseases in Shanghai Children's Medical Center Affiliated to School of Medicine of Shanghai Jiaotong University.The general information and clinical data were collected.Logistic regression,method of percentiles and expert opinions were used to construct the new severity of illness scoring system.Area under ROC curve,Hosmer-Lemeshow,goodness of fit test were used to evaluate the performance and applicability of the new score.Results A total of 1284 children with complex congenital heart diseases split into construction group (1138 cases) and verification group (146 cases).The new score included seven indexes (systolic blood pressure,blood oxygen saturation,lactic acid,potassium,potential of hydrogen,glucose,positive inotropic drug score).The range of the score was 0-57 and the cut-off point was 10.The discriminatory power was sufficient (area under the curve ＞ 0.75),and the calibration capability of the score was tolerable (P ＞ 0.05).Conclusions The applicability of the new score is well and it is easy to use,which will not increase the workload for the medical workers while assisting them in the clinical environment.

Objective To investigate the correlation of rCBV with vascular endothelial growth factor (VEGF) protein expression and microvessel density (MVD) in gliomas Methods MR examinations were performed preoperatively in 46 patients with suspected supratentorial gliomas All the 46 cases were proved by operation and pathology Immunohistochemical stain methods were used to demonstrate the situation of VEGF protein expression and quantitatively measure the MVD in gliomas The procedures of MR examinations included plain MR scan, PWI and routine contrast enhanced MR scan The pulse sequence of PWI was single shot GRE EPI T  2WI The CBV maps were calculated from the original data of perfusion images and the maximum rCBV of gliomas was acquired from CBV maps through measurement on the region of interest (ROI) According to the situation of VEGF protein expression, all the 46 cases were divided into two groupsincluding positive VEGF protein expression group and negative VEGF protein expression group Mann Whitney U test was used for comparing the difference between the two groups Spearman′s rho correlation analysis was used for observing the correlation between maximum rCBV and MVD in gliomas Results Of the 46 cases; 12 cases were astrocytomas, 3 were oligodendrogliomas, 1 was mixed glioma, 14 were anaplastic astrocytomas, and 16 were glioblastomas multiforme The maximum rCBV value in VEGF(-) group ( n =14) and VEGF(+) group ( n =32) ranged from 0 33～6 63 and 1 03～10 68, with median of 3 08 and 5 95, respectively The difference in maximum rCBV between the two groups was statistically significant ( Mann Whitney U test | z| =2 638, P

Objective To investigate the therapeutic effect of CTLA4Ig gene on experimental autoimmune thyroiditis (EAT) by the use of portable synthetic costimulatory molecules of cytotoxic T lymphocyte antigen 4 (CTLA-4) antagonist (CTLA4Ig) eukaryotic expression vector.Methods Thirty C57BL/6J female mice were divided into three groups,named EAT model group (EAT,n =10),CTLA4Ig-treatment group (CTLA4Ig-EAT,n =10) and control group(n =10).At 28 day after first immunization,plasmids mixture with pCI or pCI/CTLA4Ig were injected into thyroid tissues of EAT and CTLA4Ig-EAT by surgery,respectively.Serum,thyroid tissues and spleens were collected as samples.Thyroid autoantibody and expression of interleukin (Th)1,Th2 related cytokinesby were measured by real-time quantitative PCR and ELISA.Results Compared with EAT group,the expression of CTLA-4 in thyroid of CTLA4Ig-EAT group was elevated double folds (P =0.038),and the expression of Th1 cytokine interferon γ and intercellular adhesion molecule-1 decreased significantly (P =0.016,0.042).Meanwhile,Th2 cytokine IL-4 was increased after CTLA4Ig treatment (P =0.044).The same changes were seen in spleen tissues and serum.There was no significant difference in terms of TPOAb between EAT and treated group.Conclusion Local thyroid injection of CTLA4Ig gene shows the therapeutic effect to same degree on EAT through adjusting the underlying Th1/Th2 imbalance.

Objective To investigate the risk factors,management and prophylaxis of dangerous placenta previa.Methods The clinical data of 407 cases of placenta previa were reviewed,36 cases of them with dangerous placenta previa.Comparison was made between group A (dangerous placenta previa,36 cases) and group B (non dangerous placenta previa,371 cases) in terms of age,number of pregnancy and number of ceasarean delivery.Results The incidence rates of pregnant women in group A age ≥ 35years,number of pregnancy ≥3times,and cesarean delivery≥2times were 55.6％,61.1％,25.0％,which were significantly higher than those of group B (25.6％,27.7％,2.4％),the differences were statistically significant (x2 =7.71,8.99,21.97,all P ＜ 0.01).Among the 36 cases of dangerous placenta previa,12 cases were diagnosed with concomitant placenta increta.The specificity and sensitivity for detection of placenta increta were 90.5％ (19/21) and 83.9％ (10/12) of ultrasonography respectively,and those were 100.0％ (3/3) and 87.5％ (7/8) of MRI.Of the 36 dangerous placenta previa patients,two patients were treated with induced labour due to unexpected pregnancy under 28 weeks,while the others were refer to surgical operation.5 surgical patients experienced uncontrollable postpartum haemorrhage which necessitated histectomy,while the other 31 cases received conservative operation.Rate of histectomy was 13.9(5/36).Conclusion Dangerous placenta previa is associated with advanced age,multiple pregnancy and multiple cesarean delivery.Accurate preoperational evaluation of the placenta previa should be acquired with ultrasonography and MRI to detect placenta increta,provide information for treatment selection,and prevent postpartum haemorrhage.