Objective To investigate the risk factors of vagus nerve invasion of advanced adenocarcinoma of esophagogastric junction (AEG).Methods The specimens from 98 patients with advanced AEG who underwent radical total gastrectomy and esophagogastric Roux-en-Y anastomosis from January 2011 to August 2012 at the First Affiliated Hospital of Anhui Medical University were collected.Serial section cutting was done and the upper and bottom incisional edges of every section were marked.The specimens were stained by hematoxylin-eosin solution,S-100 and CK immunohistochemistry.Vagus nerve invasion could be affirmed if cancer cells were observed in the peripheral space of vagus nerve and vagus nerve parenchyma or cancer cells infiltrated along the peripheral space of vagus nerve.Relationship between nerve invasion and clinicopathological factors was analyzed using chi-square test or Fisher exact probability.Factors related to vagus nerve invasion were analyzed using one-way analysis of variance and multi-factor logistic regression analysis.Results The incidence of vagus nerve invasion was 28.6％ (28/98),and the tumor only invaded the vagus nerve which had the same altitude as the upper incisional edge.The results of one-way analysis of variance showed that Siewert classification,intravascular cancer emboli,lymph node metastasis,the degree of lymph node metastasis,clinical staging,the degree of tumor differentiation were correlated with the vagus nerve invasion (x2 =14.156,14.552,5.454,10.706,6.919,14.767,P ＜ 0.05).The results of multi-factor logistic regression analysis showed that Siewert classification,intravascular cancer emboli and degree of tumor differentiation were the independent influencing factors of vague nerve invasion (OR =3.667,10.368,0.249,P ＜ 0.05).Conclusion Vagus nerve invasion is correlated with Siewert classification,intravascular cancer emboli and degree of tumor differentiation.The range of vagus nerve invasion is restricted under the upper incisional edge of tumor section.

In the present experiment the high dose of LRH-A was injected into pregnant rats on Day 9 of pregnancy. Morphology and histochemistry of corpus luteum were studied. It was found that 24 hours after injection LRH-A could effectively cause the corpus luteum to degenarate. A great many large lipid droplets occured in the luteal cells, and the activity of 3?-HSD and of SDH of these cells decreased. At the same time the activity of AcP increased in a few of luteal cells. 48 hours after injection the effects outlined above became more distinct, and the activity of G-6-PD also began to decrease. The activity of 20 ?-HSD in both control and experimental groups was negative 24 hours after injection, while the activity of the AIP increased distinctly in endothelium of the capillary network of corpus luteum. These changes indicated that the high dose of LRH-A had damaged corpus luteum and reduced its synthetic and secretory function of progesterone which, we believe, plays a main role in terminating pregnancy.

The specific anti-rat LH in the peroxidase anti-peroxidase (PAP) immunohistochemical method was used to demonstrate the pituitary gonadotropic cells in the pregnant rats, and then the morphometric analysis method was used to study the change of the number, size and nucleo-cytoplasmic ratio parameters of the gonadotropic cells in pregnant rats after being injected by a high dose of LHRH-A.It was observed that on 24h after injection the number of gonadotropic cells decreased, their size became smaller and their nucleo-cytoplasmic ratio larger: the cell number per mm~3 pituitary tissue was from (4.25?0.21)?10~4 to (2.49?0.14)?10~4; the cell size from 1295?35?m~3 to 895?31?m~3; the nucleo-cytoplasmic ratio from 0.144?0.005 to 0.229?0.010. On 48h after injection these changes were in the process of recovery. On 168h after injection all parameters were recovered.Our observations suggest that after being injected by a high dose of LHRH-A the change of gonadotropic cells in pregnant rats results from the exogenous high dose of LHRH-A which has stimulated gonadotropic cells to release a great amount of LH. It is believed, however, that the changes of gonadotropic cells caused by a high dose of LHRH-A can still return to normal.

Ten pregnant rats randomly chosen from the total twenty rats on day 9 ofprognancy were injected a high dosage of LRH-A.The other ten were used ascontrol group.After one day and two days the ultrastructure of the luteal cell wasobserved by transmission electron microscope.Compared with the control group,theexperimental group showed an increase of lipid droplets,and a lot of large lipiddroplets appeared.The smooth endoplasmic reticulum decreased,dissolved and lostits regular array.Mitochondria degenerated,Autophagocytic vacuole,lysosome,myelin figure,multivesicular body as well as residual body increased.Golgi appa-ratus swelled in the first day after injection,and then shrank.Microvilli on thesurface of the cell decreased.The above results all suggest that with the injection of high dosage of LRH-Ainto the pregnant rats,luteal cell shows morphologic regression and decrease insecretive function.

24 cases of human placentas were obtained from rivanol-induced abortion, and 6 cases from cesarean section, curettage, and water saccule-induced abortion were chosen for comparative study. All the specimens were proccessed under the same histological and histochemical procedures.In all the specimens from rivanol-induced abortion we observed a reduction in the activity of the ?~5-3?-hydroxysteroid dehydrogenase and of the number of fine lipid droplets in the syncytiotrophoblasts, and in these cells we also observed an increased activity in acid phosphatase in most of the specimens and a decrease of RNA content in a few specimens. A large number of decidual cells and a few trophoblasts showed necrotic changes. The chorionic plate also showed necrosis and distinct inflammatory reactions, and on the fetal surface of the placenta the blood circulation showed disturbance. These changes indicated that rivanol had demaged the placenta and reduced its synthetic function of progesterone which we believed played a rote in terminating pregnancy and caused abortion eventually. It was suggested that the intraamniotic injection of rivanol is preferable to extraamniotic injection.

The specific anti-rat LH, anti-rat FSH and anti-hCG sera were used in the peroxidase antiperoxidase (PAP) immunohistochemical method to observe the change of pituitary gonadotropic cells in pregnant rats after being injected by a high dosage of LHRH-A. It was observed that 24 hrs after injection the immunohistochemical reaction of gonadotropic cells weakened strikingly; 48 hrs after injection the immunohistochemical reaction began to recover; and 168 hrs after injection, the recovery was still in progress. The number of LH cells of different immunoreactive intensity and their percentage in total LH cells of the control and experimental groups were calculated and tested by statistical method. It was found that the results were the same as the above. Our observations support the view that the high dosage of LHRH-A can stimulate gonadotropic cells in rat to release a great amount of LH rapidly. It inhibits the synthesis of progesterone in the ovary of pregnant rat and results in termination of pregnancy. Moreover it is believed that the effect of high dosage of LHRH-A on the secretory function of gonadotropic cells can recover themseleves.

Objective To evaluate the comprehensive clinical ability of new nurses in hospital of traditional Chinese medicine by the application of obstructive structured clinical examination.Methods New nurses of Nanjing hospital of traditional Chinese medicine (TCM) of the grade 2012 and 2013 were assessed.The examination consisted of four parts including standard patient station,the capacity of the case,the basic nursing skills of medicine and TCM.The scores of the theoretical knowledges and nursing skills were assessed.Results The average score of the nurses was (76.32±6.31)points,complying to the normal distribution;The degree of difficulty of the examination was 0.70-0.85 and the degree of distinguish was 0.28-0.48;The score of the theoretical test was lower than that of nursing skills and there was significant difference between them (P＜0.05).Conclusions The design of the examination is reasonable and the clinical ability of new nurses majored in TCM can be well assessed.

Objective To investigate the clinical effect of botulinum toxin type A (BTX-A) injections guided by electromyography in combination with electrical stimulation in the treatment of upper limb spasticity poststroke.Methods Forty-five patients with upper limb spasticity following stroke were recruited.They received multiple intra-muscular BTX-A injections guided by electromyography and electrical stimulation.Rehabilitation training was administered after the BTX-A injections.The results were assessed using the modified Ashworth scale (MAS),the Fugl-Meyer upper limb assessment (FMA),active range of movement (AROM) and the modified Barthel index (MBI).All the assessments were performed at the baseline,and then 1 week,2 weeks,1 month,and 3 months after the injections.Results Compared with the baseline scores the MAS,FMA,AROM and MBI results had all obviously improved by 2 weeks after the BTX-A injections.Compared with 2 weeks after the injections,the FMA and AROM scores at 1 month were significantly higher and there were further significant improvements at 3 months.No patient demonstrated obvious side effects from the therapy.Conclusion BTX-A injection guided by electromyography and electrical stimulation is safe and has definite beneficial effects on upper limb spasticity after stroke.

OBJECTIVEThe exact mechanisms of defect closure in patients with perimembranous ventricular septal defect (PMVSD) remain unknown. We hypothesized that the expression of urokinase type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) may mediate extracellular matrix (ECM) remodeling in aneurysms.

METHODSeven normal heart tricuspid septal leaflet and 33 aneurysms were collected in Shanghai Renji Hospital and Shanghai Children's Medical Center from January 2008 to June 2010. Immunohistochemical expression of uPA and PAI-1 in 4 normal heart valvular tissues and 15 aneurysms was detected with immunohistochemical methods. The expression of uPA and PAI-1 mRNA in 3 normal heart valvular tissues and 7 aneurysms was studied by real time fluorescent PCR; the protein expression of uPA and PAI-1 in 4 normal heart valvular tissues and 11 aneurysms was tested with Western blotting.

RESULTThe surface of the aneurysms were completely covered by endothelial cells. Two types of granulation tissue, myxoid and fibrous, were associated with the aneurismal formation. uPA were recognized predominantly in valvar interstitial cells (VICs) which located mainly in regions adjacent to the endothelium and smooth muscle cells of blood vessels. PAI-1 was found in both VICs which located mainly in granulation tissue and endothelial cells. Nine aneurysms expressed a higher uPA activity than 4 normal valvular tissues ((74.6±11.8)% vs. (49.5±7.4)%; t = 3.87, P = 0.003) and six aneurysms expressed a low uPA activity ((10.3±3.1)% vs. (49.5±7.4)%; t=11.78, P=0.000) and a high PAI-1 activity ((55.2±1.7)% vs. (50.8±3.8)%; t=2.55, P=0.034) using immunohistochemical methods. uPA / PAI-1 ratio of protein expression tested by Western blot was 0.88±0.22 in four normal heart vavular tissues; five aneurysms expressed high uPA activity and low PAI-1 activity and uPA/PAI-1 ratio was 4.26±2.04; while the other 6 cases expressed low uPA activity and high PAI-1 activity and uPA/PAI-1 ratio was 0.30±0.07; the difference among the three groups was statistically significant (P<0.05). The rate of uPA/PAI-1 in relative copy of mRNA expression among normal heart valvular tissue, high uPA expressed aneurysms and low uPA expressed aneurysms are also significantly different (2.14±0.17 vs. 0.45±0.04; 2.14±0.17 vs. 4.38±1.41, P<0.05) respectively.

CONCLUSIONThe expression of uPA and PAI-1 in VICs suggests that interactions among these molecules contribute to the aneurysm formation and development. This provides a potential mechanism for defect closure in patients with PMVSD.

Aneurysm ; pathology ; Blotting, Western ; China ; Endothelial Cells ; cytology ; Extracellular Matrix ; metabolism ; Granulation Tissue ; pathology ; Heart Septal Defects, Ventricular ; pathology ; Humans ; Immunohistochemistry ; Plasminogen Activator Inhibitor 1 ; metabolism ; RNA, Messenger ; Urokinase-Type Plasminogen Activator ; metabolism

Objective:To construct a health education program for patients with permanent enterostomy based on the information motivation behavioral skills model, and to test its effectiveness in improving patient readiness for discharge and reducing the incidence of early ostomy complications after discharge.Methods:From February 2021 to January 2022, convenience sampling was used to select 68 patients with low rectal cancer who were diagnosed by the Colorectal Surgery Department at the First Affiliated Hospital of Wenzhou Medical University and underwent abdominal perineal combined radical resection of rectal cancer (Miles) as research subjects. Randomized number series were generated using the digital table method, and the subjects were randomly divided into control group (33 cases) and intervention group (35 cases) using the envelope method. The control group was housed in the first ward, while the intervention group was housed in the second ward. The control group implemented the conventional health education, while the intervention group carried out the health education based on the information motivation behavioral skills model. The discharge readiness scores, ostomy self-efficacy and ostomy complications were compared between the two groups on the day of discharge and one month after discharge.Results:Patients in the intervention group had higher discharge readiness scores and higher discharge readiness levels than those in the control group, with statistical differences ( P<0.01) . The intervention group had higher levels of ostomy self-efficacy than the control group one month after discharge, with statistically significant difference ( P<0.01) . At the time of discharge for one month, the overall incidence of ostomy complications in the intervention group was 11.43% (4/35) , lower than 42.42% (14/33) in the control group, with a statistically significant difference ( P<0.01) . Conclusions:The health education program based on the information motivation behavioral skills model can effectively increase the readiness of patients with permanent enterostomy for discharge, reduce the incidence of complications of the ostomy and surrounding skin, improve the ostomy self-efficacy and promote patient rehabilitation.