Objective: To evaluate the long-term result after bioprosthesis replacement, and analyse the risk factors of the late deaths. Methods: From September 1984 to March 1988, 90 patients underwent bioprosthesis replacement in our hospital. There were 39 males (43%) and 51 females (57%) with an average age of 36.1 years. 78 patients had rheumatic disease, 8 degenerative disease, 3 congenital mitral valve anomaly and 1 Ebstein's anomaly. The preoperatively heart function (NYHA) was grade II in 15, grade III in 54, and grade IV in 21. C/T was 0.51～0.90 (average 0.65?0.10). Results: The operative mortality rate was 7。8%. All survived patients were followed up. The mean follow-up time was 7.8 years (range from 3 months to 15.7 years. 35 patients died during the follow-up period. The causes of death cardiac related deaths in 33 patients (88.6%), noncardiac related death in 3 (8.6%), and unknown in 1 (2.8%). Reoperation was performed in 20patients. At 1, 5 and 10 years after operation, the actuarial survival rate of patients were 92.7%, 80.7% and 57.8%, respectively. Multiple regression analysis showed that preoperatively cardiac function, C/T ratio and EF were risk factors for late deaths. Conclusion: The long-term results with bioprosthesis replacement appear satisfactory.

Objective To discuss the ability of nursing major undergraduate students in disaster response in order to construct undergraduate's disaster response ability evaluation system.Methods Delphi method was used to draw the evaluation system framework on the basis of consulting literature material and analyzing theories.35 related experts attended it.The choice was evaluated according to the 5 classification Likert evaluation method.Results Consensus was reached after two rounds inst.Questionnaire recovery rate was 100％.Construct undergraduate's disaster response ability evaluation system with 3 first-level indexes,12 second-level indexes,37 third-level indexes.Conclusions The undergraduate's disaster response ability evaluation system based on Delphi experts method is reliable.It can provide reference for the nursing major undergraduate student's disaster response training and research.

Objective To investigate the effect of virtual simulation teaching method in the comprehensive experimental teaching.Methods In experimental teaching of nursing,simulation medical records were compiled,plans were implemented,experiment guidance materials were preliminarily formed and teaching effect was evaluated.Results The application of virtual simulation teaching in nursing comprehensive experiments reflected the comprehensiveness of teaching content,and the comprehensiveness of knowledge,ability and capacity.It could train students creative ability,exploring spirit,enhance the sense of professional and humane care consciousness,train the communication skills and strain capacity,make active teaching atmosphere,improve the quality of teaching.Conclusions This teaching method can make students achieve mastery through a comprehensive multi-disciplinary knowledge,improve the ability of solving practical problems,help nurses to develop the comprehensive professional quality.

Objective:To investigate Cinnamic aldehyde effects on expression of E-cadherin and MMP-9 and proliferation of lung adenocarcinoma A549 cells,and explore the possible mechanism of Sonic Hedgehog (SHH) signaling transduction.Methods:After co-cultured with Cinnamic aldehyde at the concentration of 0,10,20 and 40 μg/ml for 24 h,48 h and 72 h respectively,A549 cells were tested for their proliferation by MTT assay;E-cadherin and MMP-9 level in the supernatant by ELISA;expression of E-cadherin and MMP-9 mRNA by realtime-PCR with SYBR GreenⅠ;and protein expression by Western blot.Results: ①Cinnamic adehyde with concentration at 10 μg/ml would inhibited proliferation of A 549 cells after 24 hours′treatment;with concentration at 10, 20 and 40μg/ml can affect the proliferation significantly ( P<0.05 );with concentration of 40μg/ml cinnamic adehyde for 72 h,the re-markably inhibition of proliferation in A 549 cells was observed , the highest inhibitory rate was ( 93.782 ±5.036 )%.②Cinnamic aldehyde also increased migration rate of A 549 cells.③Expression of components on Hedgehog signaling pathway in A 549 was higher than that in human HBE cells.Cinnamic aldehyde could increase further upregulate of components expression in Hedgehog signaling pathway of A549 cells.④Secretion level of E-cadherin,mRNA and protein were decreased in A549 cells co-cultured with Cinnamic al-dehyde,while secretion level of MMP-9,mRNA and protein level in A549 cells co-cultured with cinnamic aldehyde were increased.Pre-treatment with 2 nmol/ml cyclopamine,an increasing of secretion level of E-cadherin ,mRNA and protein level in A549 cells was observed,decreasing of secretion level of E-cadhein,mRNA and protein level was also observed in A 549 cells.Conclusion:Cinnamic aldehyde inhibits the proliferation in a time-and dose-dependent manner and effected expression of E-cadherin and MMP-9 through sonic hedgehog signaling pathway in lung adenocarcinoma A 549 cells.

Objective To detect p27 expression in rectal carcinoma and serum transforming growth factor ? 1 (TGF ? 1) level in these patients, and to elucidate the modulatory effect of serum TGF ?1 on p27 expression in rectal carcinoma. Methods Expression of p27 was measured in 37 cases of rectal carcinoma, 22 of rectal adenoma and 19 of normal control specimens by immunohistochemical staining using antibodies to p27. Serum level of TGF ?1 was measured in these patients by enzyme linked immunosorbent assay (ELISA) method. Results p27 protein was expressed in normal rectal tissue, rectal adenoma and rectal carcinoma, and the positive rate was 89.47%, 90.91% and 64.87%, respectively. The positive rate of p27 in rectal carcinoma was significantly lower than that of normal rectal tissue and rectal adenoma ( P =0.025). p27 was mainly located in nucleolus of normal rectal tissue and rectal adenoma, and the positive rate of p27 in cytoplasm of rectal carcinoma was higher than that of normal and rectal adenoma. The positives rates of serum TGF ?1 in normal group, rectal adenoma group and rectal carcinoma group were 21.05%, 27.27% and 51.35%( P =0.045),respectively. The expression of p27 related to histological differentiation, lymph node metastasis and infiltration depth. Serum level of TGF ?1 related to lymph node metastasis, infiltrated depth and CEA level. The positive rate of p27 in TGF ?1 negative group and positive group was 88.89% and 42.11%(Mantel Haenszel ? 2=6.755, P =0.009), respectively. Conclusion TGF ?1 may be useful in assessment of malignance and prognosis of rectal carcinoma. TGF ?1 can down regulate p27 expression in rectal carcinoma.

BACKGROUND:Deep vein thrombosis occurred during waiting period before operation affects the prognosis of calcaneal fractures. Therefore, it has important clinical significance for its accurate diagnosis. The staging of thrombosis during waiting period before operation for calcaneal fractures is rarely reported. OBJECTIVE:To detect the incidence and risk factors of deep vein thrombosis in patients with calcaneal fracture by ultrasound elastography imaging after staging diagnosis of thrombosis. METHODS:Al objects were included in the study from patients with calcaneal fractures waiting for surgery in the Qinghai University Affiliated Hospital between 2008 and 2015. Patients received preoperative duplex ultrasonography. Those with thrombosis received ultrasound elastography. The incidence of thrombosis was calculated. According to medical records, age, sex, body mass index and history of smoking were col ected. The correlation between thrombosis and above factors was analyzed by multiple Logistic regression analysis. RESULTS AND CONCLUSION:(1) One hundred and forty-nine patients were final y included. Of these, 22 (14.8%) were found to affect deep vein thrombosis in the lower limb. The incidence of acute thrombosis was 9.4%. (2) Multiple Logistic regression analysis suggested that age (P=0.009, OR=1.063, 95%confidence interval (CI) 1.010–1.117), body mass index (P=0.019, OR=1.302, 95%CI 1.124–1.430), history of smoking (P=0.017, OR=5.124, 95%CI 1.347-18.359), and operation waiting time (P=0.000, OR=5.190, 95%CI 1.396–19.266) were risk factors of acute lower extremity deep venous thrombosis. (3) These results suggest that the incidences of preoperative deep vein thrombosis and acute deep vein thrombosis are very high. The risk assessment of acute deep vein thrombosis should be taken according to the patient’s age, smoking history, body mass index, as wel as the time waiting for surgery. The corresponding diagnosis and treatment program should be given to patients with thrombosis.

Objective To investigate the in vitro destructive effect of chlorogenic acid (CRA)/isochlorogenic acid (IRC)on Aspergillus fumigatus biofilm in a model of biofilm formation.Methods The in vitro biofilm model was established using clinical isolates of A.fumigatus.The minimum inhibitory concentrations (MIC)of antimicrobial agents against A.fumigatus were determined by microdilution method.Scanning electron microscope (SEM)and laser confocal scanning microscope (CLSM)were used to characterize the biofilm.Crystal violet staining method was used for biofilm quantitation.Results After reaction with CRA/IRC for 24 h or 48 h,observation of biofilm showed that A.fumigatus extracellular matrix was thinner than the control group.Biofilm quantitation showed that the optical densities were 1.05±0.19,1.14±0.26,0.99±0.14 for CRA group (1 024 mg/L,512 mg/L,256 mg/L);1.39±0.06,1.41±0.06,1.60±0.04 for IRC group (1 000 mg/L,500 mg/L,250 mg/L)at 24 h,and 1.91±0.17 for control group (P<0.05).The quantitation of biofilm showed that the optical densities were 2.25±0.05,2.27±0.05,2.31±0.03 for CRA group,2.26 ± 0.02,2.27±0.02,2.29±0.04 for IRC group at 48 h,and 2.36±0.01 for control group (P<0.05).Conclusions CRA/IRC has some inhibitory effect on the formation of A.fumigatus biofilm.

Objective To explore the correlation between adipocyte factors(adiponectin and visfatin)and fetus intrauterine growth.Methods Enzyme immunoassay was used to measure the adiponeetin and visfatin levels in maternal and umbilical serum from 14 women with fetal growth restriction (FGR group),14 women with maerosomia(macrosomia group)and 14 normal pregnant women(control group).The correlations of cord serum adiponectin and visfatin with matemal serum adiponectin and visfatin were analyzed.Results (1)Serum visfatin levels in FGR mothers[(41.4±5.5)]μg/L were significantly higher than that in control women[(34.7±4.9)μg/L and macrosomia mothers[(37.3±4.4)μg/L;P<0.01,P<0.05].Serum adiponectin levels in maerosomia mothers [(4.1±1.3)mg/L]were significantly lower than that in control women [(6.6±1.5)mg/L]and FGR mothers[(6.4±1.3)mg/L;P<0.01].(2)Serum visfatinin levels in FGR babies[(58.1±7.6)μg/L] were significantly increased than that in control newborns[(42.6±7.8)μg/L]and macrosomia babies[(48.5±9.1)μg/L;P<0.01,P<0.05].Serum adiponeetin levels in macrosomia babies[(6.5±1.3)mg/L]were significantly decreased than that in control newborns[(7.7±1.5)mg/L]and FGR babies[(7.7±1.0)mg/L;P<0.05,P<0.05].(3)Maternal serum visfatin levels were positively correlated with umbilical serum visfatin levels(r=0.720.P<0.01).Umbilical serum adiponectin levels were higher than that in maternal serum,but there were no relationship between them(r=0.301,P>0.05).Conclusion The changes of visfatin and adiponeetin levels may be related to the oceurrenee of FGR and fetal macrosomia.

Objective To evaluate the correlation between the expression of Survivin、VEGF and MMP 2 and the prognosis of patients with hepatocellular carcinoma Methods Expressions of Survivin、 VEGF and MMP 2 were detected by immunohistochemical S P method in 67 postoperative HCC cases Twelve candidate factors associated with long term survival were analyzed by Kaplan Meier Log rank estimation A multivariative Survival analysis of these individual variables was undertaken using the cumulative survival rate by the COX proportional hazards model Results A multivariative analysis determined three independent significant factors influencing overall cumulative survival including Survivin, VEGF, liver function (Child grade) The three prognostic factors predicted an increased risk of death from HCC Conclusion Survivin, VEGF, liver function, particularly the Child Pugh classification are the most significant prognostic factors for HCC patients undergoing hepatic resection

To study the effect of practice while watching (PWW) teaching method in cardiopul-monary resuscitation training of standardized training residents. 196 standardized training residents were selected, and PWW teaching method was used to carry out cardiopulmonary resuscitation training and as-sessment. The results were significantly higher than that before the training, and the satisfaction rate of the residents to the PWW teaching method was 100%.PWW teaching method could improve the effect of stan-dardized training resident doctors in cardiopulmonary resuscitation,and increase the interest in learning.