Objective To explore the effective and systematic clinical nursing methods,in order to improve the successful rate of preservation of laryngeal function in hypopharyngeal carcinoma,promote laryngeal function recovery,and improve the life quality of patients.Methods 103 patients with hypopharyngeal carcinoma underwent the operation with preservation of laryngeal function were selected.Detailed psychological nursing and health education were given before the operations,while multi mode communication,intensifying the nursing of respiratory tract,diet nursing,observation of complications,rehabilitation guidance and the hospital discharge guidance after operations were given.And the nursing effects were observed.Results 94 patients got healing by first intention(91.26％).Laryngeal functions were completely restored in 70 patients (67.96％) and partially restored in 33 patients (32.04％).About the postoperative complications,21 cases got stress ulceration,6 cases got pharyngeal fistula,5 cases got cardiac arrhythmia,1 case got ARDS and 1 case got pneumothorax.Conclusions The strict and systematic nursing method can improve the successful rate of surgery,reduce the postoperative complications,reduce the economic burden of the patients,promote laryngeal function recovery and improve the life quality of patients.

Objective To investigate the role of blood motilin and anorectal function in the pathogenesis of functional outlet obstructive constipation (OOC), and study if motilin and its receptor agonist are effective to treat OOC. [WTHZ]Methods Patients with OOC were selected according to colonic transit time and transit index. Twenty healthy subjects were also selected as control group. Anorectal manometry was performed, and blood motilin level was measured in patients with OOC and healthy subjects. Correlation between blood motilin level and anorectal function was analyzed. [WTHZ]Results Compared with healthy subjects, OOC patients had higher anal resting pressure, lower defecating pressure difference,larger minimum relaxation volume to elicit anorectal inhibitory reflex, and higher rectal sensation threshold. The plasma level of motilin was positively correlated with anal resting pressure, maximum squeeze pressure and anal defecating pressure, but was negatively correlated with defecating pressure difference between rectum and anal canal. Conclusion OOC patients had anal sphincter dysfunction in relaxtion, discoordination of annorectum during defecation, and Low sensitivity of rectum. OCC patients with the normal level of blood motilin may have more severe outlet obstructive tendency, and motilin and its receptor agonist are not suitable for treating OOC patients.

Objective To evaluate the impact of standardized health management and treatment on asthma control and the quality of life of the patients.Methods One hundred asthma patients were recruited in our hospital and were assigned to the health management (n=50) or the control group (n=50).The control group subjects were treated with conventional therapy,while those of the heahh management group received standardized asthma management and health education.The control of asthma and the quality of life were evaluated at baseline and six months after the intervention.Student's t test and Chisquare test were used for data analysis.Results At 6 months treatment,the rate of effective control of asthma of the health management group (56％) was higher than that of the control group (22％) (x2=12.15,P＜0.05).In the control group,the activity limitation,asthma symptoms,mentality asthma,the stimulus response,the personal health concerns and the total score of Quality of life were (47.4±5.8),(35.3±6.2),(28.2±4.3),(22.7±3.5),(17.6±3.9),(151.2±14.7),and they were (38.2±4.5),(27.1±4.8),(23.1±5.7),(18.3±4.3),(13.7±4.2),(121.4± 12.6) in the control group,they were all significantly higher in the management group than that of control group(t values were 6.17,4.42,4.98,5.76,5.43 and 6.35,all P＜0.05).Conclusion The standardized health management and the health education can effectively control asthma and significantly improve the quality of the patient's life.

Objective To explore the efficacy of trazodone replacement treatment on benzodiazepine drugs dependence and effect of cognitive function on senile patients.Methods 51 senile patients with benzodiazepine drugs dependence were assigned with dosage tacho-decrement and replaced by trazodone.The patients were discontinuanced taking benzodiazepine in 14 days and taken at a draught of trazodone before retiring about 6 months.Clinical effect and side effects were assessed with the Pittsburgh sleep quality index (PSQJ) and treatment emergent symptom scale(TESS) before and after treatment.Cognitive function was evaluated with Wechsler intelligence scale for adult-Chinese revised (WAIS-RC) and Wechsler mermory scale for adult-Chinese revised ( WMS-RC ) once before and after treatment.Results The scores total PSQJ( ( 13.17 ± 3.70),( 11.05 ± 3.48 ) ),the sleep quality( (2.36 ± 0.33 ),( 1.91 ± 0.29 ) ),daily function disorder,sleep disorder were significantly lower than before treatment while the other factor scores were not significantly changed.Trazodone wes effective without severe side effects and dependence.The study group showed significantly lower scores in learning,calculation,the signs of figure,wood puzzles,long-term memory,short-term memory,immediate memory,memory quotient in the assessment of cognitive function than after treatmemt (P ＜ 0.05 ).Conclusion Trazodone is an ideal medicine to senile insomnia.

Objective To explore the effect of health education and comprehensive nursing intervention on quality of patients with lung cancer.Methods One hundred lung cancer patients who were treated with chemotherapy from February 2010 to February 2013 in our hospital were selected and assigned to the intervention group (n=50) and the control group (n=50).The participants in the control group received conventional anti-cancer drug and routine primary care,however those of the intervention group additionally obtained health education and comprehensive nursing intervention.The Zung Anxiety Scale (SAS),Depression Rating Scale (SDS) and the core quality of life questionnaire (QLQ-C30) were used to evaluate the quality of life of the patients.Paired samples t test and ANOVA were used for data analysis.Results Differences of age,gender,disease duration,SAS,SDS score and EORTC QLQ-C30 score were not statistically significant between the two groups (all P＞0.05).After the intervention,SAS and SDS scores of the control subjects were 58.8±7.6 and 49.5±10.1 respectively,and SAS and SDS scores of the intervention group were 46.5±7.8 and 37.4±9.2 respectively (t velues were 5.347 and 6.215,respectively; both P＜0.05).Quality of life scores in the intervention group were as followed:general condition 57.2± 18.3,physical fitness 63.0±25.9,mutual affection 67.3±23.3,cognitive score 75.4±28.2,social role 67.7±24.8 and function scores 58.5±22.3.Quality of life scores in the control group were as followed:general condition 47.3±23.0,physical fitness 54.9±26.6,mutual affection 60.4±19.1,cognitive score 66.2±25.8,social role 54.1±26.2 and function scores 49.4±21.5 (t values were 5.725,6.144,5.021,5.702,7.137 and 6.357,respectively; all P＜ 0.05).Conclusion Health education and comprehensive nursing intervention for lung cancer patients may reduce their anxiety and depression symptoms and improve the quality of life.

Objective To explore the effective evaluation methods of case-based learning (CBL) in critical disease teaching.Methods Totally 53 undergraduate students in department of clinical medicine of Shanghai Jiao Tong University,who practiced in our hospital from 2010 to 2012,were divided into the traditional teaching group and CBL teaching group.We used traditional teaching combining with CBL teaching in CBL group.Common cases of critical illness(severe acute pancreatitis and multiple trauma)in intensive care unit (ICU) were selected for CBL cases.The evaluation of theoretical knowledge,mini-clinical evaluation exercise(Mini-CEX)and direct observation of procedural skills (DOPS) were continued after teaching and practice.Results These was no significant difference in the theoretical knowledge examination between the two groups. In Mini-CEX,the students in CBL group were better concerning the medical interview capacity (P=0.000),humanistic care (P=0.013),clinical diagnosis(P=0.035),counseling(P=0.009) and the overall clinical competence (P=0.008) than those in traditional teaching group.The DOPS scores of endotracheal intubation (P=0.016)and central venous catheterization (P=0.001)discussed in CBL teaching were significantly higher in CBL group.Conclusion Traditional theoretical knowledge examination has little significance in the assessment of CBL teaching,but Mini-CEX and DOPS can reflect the advantages of CBL teaching better in the assessment of clinical abilities and skills.

Objective To evaluate the outcomes and prognostic factors of distant metastasis in patients with advanced cervical squamous cell carcinoma treated with concurrent chemoradiotherapy (CCRT). Methods A total of 118 patients with International Federation of Gynecology and Obstetrics (FIGO, 2009 version) stageⅡb-Ⅳa cervical squamous cell carcinoma treated with CCRT between 2006 and 2010 in the Second Affiliated Hospital of Dalian Medical University were analyzed. Their median age was 48 years (range, 23-70 years). FIGO stages were as follows:Ⅱb stage 56 cases,Ⅲa stage 6 cases,Ⅲb stage 52 cases, andⅣa stage 4 cases. Of the all patients, 55 cases showed bulkly tumor (tumor size>4 cm) and 35 cases were pelvic lymph node positive. Forty patients had pretreatment hemoglobin (Hb) levels no greater than 110 g/L. Patients with elevated squamous cell carcinoma antigen (SCC-Ag) >1.5 μg/L before CCRT and at one month after CCRT were 91 cases and 34 cases, respectively. Kaplan-Meier method was used to estimate survival. For the analysis of prognostic factors affecting distant metastasis, log-rank test was used for univariate analysis, and Cox proportional hazard model was used for multivariate analysis. Results Thirty-seven patients were diagnosed with recurrence, 19 cases of whom developed distant metastasis, 13 cases developed loco-regional recurrence and 5 cases had both distant and loco-regional recurrence. The 5-year overall survival rates and distant disease-free survival of all patients were 64.0% and 78.8%, respectively. Two patients had grade 3 acute gastrointestinal toxicity (mainly diarrhea) and 20 cases had grade 3 to 4 hematologic toxicity. Seven patients experienced grade 3 to 4 late toxicity, 5 cases of them were gastrointestinal and 2 cases were genitourinary toxicity. Univariate analysis showed that FIGO stages, SCC-Ag level at one month after treatment, pretreatment hemoglobin level, and pelvic lymph node metastasis were significantly correlated with distant metastasis (all P<0.05). Multivariate analysis showed that FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis were independent prognostic factors for distant metastasis (all P<0.05). Conclusions For stageⅡb-Ⅳa cervical squamous cell carcinoma, the regimen of CCRT was efficacious and safe. The predictive factors for distant metastasis in patients withⅡb-Ⅳa stage squamous cell carcinoma of cervix treated with CCRT included FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis. New treatment strategies should be considered to control distant metastasis for these patients.

Objective To explore the regional reference intervals of biomarkers in umbilical blood for diagnosis of early onset bacterial infection in the healthy term newborns .Methods The umbilical blood samples were collected from 1 476 term newborns in our hospital during January 2012 to October 2013 ,of which 1 191 were healthy infants and enrolled in this study .Then the levels of high sensitive c‐reaction protein(hs‐CRP) ,procalcitonin(PCT) ,interleukin(IL)‐6 ,IL‐8 ,platelet(PLT) as well as white blood cell (WBC) were detected in the umbilical blood .These values were analyzed by SAS 9 .0 ,data were described through upper or lower limits or upper limits respectively .Differences among different subgroups were judged through analysis of Kruskal‐Wallis t test or Mann‐Whitney test respectively .Results The upper limits for hs‐CRP was 3 .1 mg/L ,for PCT was 0 .18 ng/mL ,while the refer‐ence interval for IL‐6 was 56 .6(11 .9-133 .2)ng/L ,and IL 8 was 976 .0(111 .7-2 507 .1)ng/L ,PLT was 242 .0(120 .0-339 .0)× 109/L and for WBC was 12 .9(7 .6-19 .3 )× 10 9/L ,and the value of PLT varied from vaginal delivery group to caesarean section group(230 vs .254 ,Z= 4 .301 ,P< 0 .05);no significant differences were found in these biomarkers among different gestational week specific groups (P>0 .05) .Otherwise ,compared with the regional reference intervals ,CRP and PCT in early onset neonatal sepsis group increased(P<0 .05) ,no significant difference was found for IL‐6 ,IL‐8 ,WBC and PLT (P>0 .05) .Conclusion The reference intervals of biomarkers in umbilical blood for diagnosis of early onset bacterial infection were established which may make great contribution for early diagnosis of bacterial infection for the newborns .

Objective to investigate therapeutic methods and effect of X-knife for on intracranial diseases. Method Recent effect of 44pqtients with cranial diseases by X-knife was observed. Radiological follow-up was performed on 40 cases with mean 5.65 months of followup time. Result 92.5% of tumors were controlled locally, stability and recovery rate was 90.0%. The local control of metastatic tumors of brain was higher, but most patients with metastatic tumors died of primary lesion. New metastatic lesions appeared in patients without panencephalic radiotherapy in 1～5months. Tumors of pineal region were sensitive to X-knife. Conclusion X-knife has a definite effect on intracranial diseases. For patients with tumors of pineal region complicated by serious hydrocephalus, shunting should be conducted before X-knife treatment. For patients with mild or morderate hydrocephalus, X-knife chould be utilized only under correct interventions such as dehydration. The local control rate of intracranial metastatic tumors was high, but survival time postoperation depended on panencephalic radiotherapy or control of primafry lision. For tumors with diameter＞ 3cm, pituitary tumors, brains stem tumors and tumors in cerebellopontine angle region repeated X-knife were suggested, which could improve cure rate and decrease complications.

Objective To investigate the influence of the biofeedback electrostimulation against the pelvic floor muscles to cure female pelvic floor dysfunction disease (PFD). Method Fifty-four female PFD patients treated with the biofeedback electrostimulation against the pelvic floor muscles by applying with different frequency and pulse width for different patients. Results The cure rate of the pelvic organ prolapse (POP) patients was 10.0%(1/10) and the cure rate of the post partum pelvic floor injury patients was 100.0%(32/32) except the stress urinary incontinence(SUI) patients. But the SUI patients improved efficacy rate was 91.7%(11/12) and the POP patients improved efficacy rate was 70.0%(7/10). The total efficacy rate was 94.4%(51/54). Conclusions It shows that the biofeedback electrostimulation against the pelvic floor muscles could cure the female PFD,reduce the disease morbidity of the PFD and improve the quality of female patient's lfie. As a result, the curing method could have clinical application prospect extensively.