Objective To summarize our experiences in the long-term continuous maintenance of the peripherally inserted central catheter (PICC) in a patient with intestinal fistula.Method The systematic holistic nursing care has been provided according to the nursing practices to a patient with intestinal fistula since 2006,during which eitht PICCs were used successively.Results The eight PICCs were placed for 3-14 months.The 1 st,3rd,5th,and 7th cathers were retained for 12,13,11,and 14 months.The second catheter was retained for 6 months,and then removed due to increased body temperature (38.7℃).The 4th cather was retained for 3 months,then catheter-related bloodstream infection was suspected due to high body temperature (39℃) ; culture for fungi at the tip showed positive results.The 6th catheter was retained for 7 months,inserting from jugular vein to the superior vena cava; however,it was removed due to puncture point local purulent changes at the puncture site.The 8th catheter was applied for 8 months,but was rmoved due to tube occlusion,which responded poorly to urokinase.Conclusion The application of PICC in patients with fistula can relieve the pain and improve the quality of life.

Colonic neoplasms is the third most commonly diagnosed cancer in men and second most commonlv diagnosed cancer in women worldwide.The morbidity of Colonic neoplasms is increasing year by year.Despite the fact that surgery is still the main treatment for patients with colon cancer,surgery alone hasn't improved the treatment effectiveness.The current management of colon cancer has come to multidisciplinary team (MDT) modality.MDT modality could offer the optimal treatment option and the internal communication.Under the pattern of MDT which integrates the surgery,chemotherapy,radiotherapy,interventional therapy,targeted therapy and immune therapy,there has been a big progress in the diagnosis and treatment of colon cancer.Patients with metastatic colon cancer should undergo a discussion by a multidisciplinary team before the initial treatment.

Objective To understand the actual psychological conditions of pregnant patients with gynecologic malignancies during chemotherapy so as to instruct the nurses to provide individualized psychological care to the patients and their relatives. Method The in-depth interviews were conducted to 7 patients by implementing the phenomenological approach of qualitative study. The acquired data were analyzed. Result The patients experienced four psychological conditions: pessimism about prognosis, anxiety to know more about the chemotherapy and guilty to their family and hope for treatment effect. Conclusion Nurses should pay attention to the psychological conditions of pregnant patients with gynecologic malignancies and help them successfully live through the treatment.

Objective To evaluate the effects of dexmedetomidine on action potential in isolated rabbit sinoatrial node cells.Methods Twenty-four healthy New Zealand rabbits of both sexes,weighing 1.5-2.5 kg,were sacrificed.Their hearts were removed and sinoatrial nodes were dissected and placed in Tyrode solution.Sixty isolated sinoatrial nodes were randomly divided into 6 groups (n =10 each):control group (group C),0.5 ng/ml dexmedetomedine group (group D1),5.0 ng/ml dexmedetomedine group (group D2),dexmedetomidine 5.0 ng/ml + yohimbine 1 μmol/L (alpha 2-adrenoreceptor antagonist) group (group D2 + Y),dexmedetomidine 5.0 ng/ml + 2 mmol/L CsCl (blocker of pacemaker current) group (group D2 + C),and dexmedetomidine 50.0 ng/ml group (group D3).After perfusion with the Tyrode' s solution for 60 min,C group was perfused with Tyrode' s solution for another 40 min,D1-3 groups were perfused with Tyrode's solution cont(a)ining dexmedetomedine 0.5,5.0 and 50.0 ng/ml,respectively,for40 min,and D2 + Y and D2 + C groups were perfused with Tyrode' s solution containing 1 μmol/L yohimbine and 2 mmol/L CsCl,respectively,for 20 min,and then 5.0 ng/ml dexmedetomedine was added and sinoatrial nodes were perfused for 20 min.Maximal rate of depolarization (Vmax),amplitude of action potential (APA),action potential duration at 50％ and 90％ repolarization (APDso and APD90),velocity of diastolic (phase 4) depolarization (VDD),and rate of pacemaker firing (RPF) were recorded at 60 min of perfusion with Tyrode' s solution (T1),20 min of perfusion with yohimbine or CsCl (T2) and termination of perfusion with dexmedetomedine (T3).Results Compared with group C,APA,VDD and RPF were gradually decreased at T2,3 in groups D1-3 (P ＜ 0.05),and there was no significant difference in Vmax,APD50 and APD9o among C and D1-3 groups (P ＞ 0.05).VDD and RPF at T2 in group D2 + C and APA,VDD and RPF at T3 in groups D2 + Y and D2 + C were significantly lower than those at T1 (P ＜ 0.05).APA,VDD and RPF in group D2 + Y and APA in group D2 + C were significantly lower at T3 than at T2 (P ＜ 0.05).Conclusion Dexmedetomidine can decrease the sinoatrial node autorhythmicity in a concentration-dependent manner in rabbits,and the mechanism may be related to the inhibition of pacemaker current,but not alpha 2-adrenoreceptor.

Objective To evaluate the effects of real-time continuous glucose monitoring (RT-CGM) system on oxidative stress and mortality in critically ill patients and to explore the correlation between glucose index,oxidative stress and mortality.Methods Selected 123 cases of critically ill patients were enrolled in this prospective randomized controlled study.They were randomly divided into the RT-CGM group(n =61) and blood glucose meter group (GM group,n =62).The following parameters were compared between the two groups:mean amplitude of glucose excursions (MAGE),hypoglycemia incidence,low blood glucose index (LBGI),high blood glucose index (HBGI),28-day mortality and plasma level of 8-iso-PGF2α (8-iso) at 48 hours (R2),72 hours (R3) and 96 hours(R4) after admission to ICU.The correlation between glucose index and plasma level of 8-iso-PGF2α were analyzed.The correlation between glucose index,plasma 8-iso level and 28-day death were analyzed.Results The parameters of MAGE,hypoglycemia incidence,LBGI and HBG1 in the RT-CGM group and the GM group were (3.73 ±1.09) mmol/Land (4.19±1.11)mmol/L(P=0.02),3.28％ and 14.52％(P=0.03),0.0011 and 0.0119 (P ＜ 0.01) and 0.2258 and 0.3697 (P ＜ 0.01),respectively.The plasma levels of 8-iso at R2,R3,R4 in the RT-CGM group and the GM group were (111.44 ± 16.99) ng/L and (114.03 ± 14.64) ng/L(P=0.37),(94.53 ±14.92)ng/L and (110.31 ±13.42) ng/L(P＜0.01) and (57.84±12.22) ng/L and (84.41 ± 14.16)ng/L(P ＜0.01),respectively.The r values between MAGE,LBGI,HBGI and the plasma level of 8-iso were 0.69,0.71 and 0.67,respectively (all P values ＜ 0.01).Multivariate stepwise regression analysis showed MAGE,LBGI,HBGI entered final models (corrected R2 =0.61,P ＜ 0.01) with β values of 0.64,0.65 and 0.6 respectively(all P values ＜0.01).The 28-day mortality in the RT-CGM group and the GM group was 9.84％ and 30.65％ (P ＜0.01).The OR values of MAGE,hypoglycemia incidence,LBGI,HBGI and the plasma level of 8-iso for 28-day death were 2.14 (0.98-4.35),3.43 (1.12-5.82),2.67 (1.01-5.14),1.32 (0.24-2.96) and 1.89 (0.67-3.44),respectively.Conclusion RT-CGM can optimize the care in critically ill patients by improving hypoglycemia,hyperglycemia,glucose variability and oxidative stress and bring more detailed concern in the process,and to reduce the mortality.

Objective　To explore the effects of hypoxia on the syntheses and secretion of adrenomedullin (AM), calcitonin gene related peptide (CGRP) and c-type natriuretic peptide (CNP) and the relationship between these peptides. Methods　Rat models were established with hypoxia for 10, 20 and 30 d respectively and rats under normal altitude were served as control. Pulmonary artery pressure and the maximum increasing speed of right ventricle (RVdp/dtmax) were measured in every group. The dynamic changes of AM, CGRP and CNP concentrations in plasma were studied with radioimmunoassay. Results　During hypoxia, pulmonary artery pressure and RVdp/dtmax were enhanced. Plasma AM and CNP concentrations were increased while CGRP was decreased significantly. The plasma level of AM had positive correlation with that of CNP, but negatively correlated with that of CGRP. Conclusion　Results indicate that hypoxia may cause pulmonary artery pressure change and right ventricle has compensatory reaction to hypoxic pulmonary hypertension. Dynamic changes of plasma AM, CGRP and CNP concentrations can be regarded as indexes for condition of illness.

Hyperthermia is a means of adjuvant therapy, which have a sensitizing effect to radiotherapy and chemotherapy. In recent years, the molecular biology, cell and animal experimental research of tumor thermochemotherapy progressed very quickly, which provide theoretical foundation and guidance for us to further develop hyperthermia combined with chemotherapy in clinical trials. In this paper, the studies with the mechanism of thermo-chemotherapy treatment of tumor, different ways of thermochemotherapy and commonly used drugs in thermochemotherapy are reviewed.

ABC-ELISA established by ourselves was used to detect the tiansferrin receptors (TfR) on peripheral blood mononuclear cells. It was found that the TfR quantity in the leukenie kukemk group was higher than that in the complete remission leukemia group (P0.05). We also found that the TfR quantity was higher in 6 cases of leukemia when blasts appeared in perpheral Hood than they disappeared(P

Objective To summarize experience of concomitant endovascular aneurysm aortic repair(EVAR) and coronary artery bypass grafting(CABG) for patients of severe coronary artery disease(CAD) complicated with infra-renal abdominal aortic aneurysm(AAA) or infra-renal abdominal penetrating aortic ulcer(PAU).Methods Between January 2013 and December 2016,13 patients with severe CAD and infra-renal AAA/PAU who underwent CABG and EVAR were enrolled in this study.12 patients (92.3 ％) were male and 1 patient was female (7.7 ％),the mean age of(63.7 ± 7.3) years.11 patients with CAD related symptoms,2 patients with AAA/PAU related symptoms,abdominal aortic lesions include:AAA in 3cases,PAU in 10 cases,2 patients combined with PAU of the thoracic aorta.CABG and EVAR manipulations were performed according to the routine protocol,patients who were combined with thoracic aorta PAU were treated with thoracic endovascular aortic repair (TEVAR) simultaneously.Results 7 patients received EVAR followed by CABG;6 patients received CABG followed by EVAR,TEVAR were performed in 2 patients.For all the patients,there were 11 cases of CABG were performed under the cardiopulmonary bypass(CPB) (ON-PUMP) and 2 others cases were performed without CPB(OFF-PUMP).On the average(2.5 ± 0.7)grafts were performed.The time of aortic clamp and CPB averaged were(50.7 ± 16.5)min and (58.0 ± 11.2)min respectively for the ON-PUMP CABG patients.Totally 30 thoracic aorta and abdominal aorta stent grafts were implanted in 13 patients.The duration of postoperative mechanical ventilation time was (17.8 ± 7.0) hours,Median intensive care stay was (2.7 ± 1.9) days,while hospital stay was(8.1 ± 2.4)days.All the patients was discharged.1 patient suffered wound unhealing 2 days after discharging,followed by sternal infection,he was re-admitted and received pectoralis major myocutaneous flap transfer operation,29 days after this operation,he suffered sudden cardiac arrest and eventually dead.The other 12 surviving patients was followed up for 1 ～ 36 months,The results showed that the patency of the grafts in all patients was good,no EVAR related secondary interventions were required.Conclusion For the patients with surgical indications,the procedure of one stage CABG and EVAR completed by one surgical team was safe and feasible.Comparing with the traditional one stage or staged surgical repair,this strategy showed less surgical trauma,shorter operation time,lower perioperative risks,more efficacy and more conducive to the overall management of patients.

The principal goal of opening the course of Medical Communication is to develop medical students'basic communication skills which involve three aspects:the proper use of language tools,communication and problem-solving skills in the course of general interper-sonal relationships,information communication skills between doctors and patients in the process of making a diagnosis or treatment,public communication skills on medical education and communication skills in dealing with a medical dispute or crisis between doctors and patients. This paper presents clearly the connotation of medical communication and puts forward specific programs on the organization and implementation of the course.