Objective To investigate the effect of percutaneous nephrostolithotomy (PCNL) on patients with different body mass index.Methods The clinical data of 84 patients with kidney stones who were treated with PCNL surgical treatment were enrolled in this study,and they were divided into different groups according to body mass index (BMI),including 16 cases of BMI ＜ 18.5 kg/m2(low BMI group),36 cases of 18.5 kg/m2≤BMI ＜24.0 kg/m2 (normal BMI group),32 cases of BMI≥24.0 kg/m2 (high BMI group),and the curative effect was evaluated.Results Three groups' operation time,multichannel gravel rate,stones clearance,length of hospital stay,blood transfusion rate had no significant difference (P ＞0.05),the incidence of complications in low BMI group [31.25％ (5/16)] was obviously higher than that in normal BMI group [5.56％(2/36)] and high BMI group [9.38％(3/32)],there was significant difference (P ＜ 0.05).Conclusion BMI of PCNL surgery influences on certain effect,low BMI will affect patients with surgery tolerance,cause complications increase,obesity wifl increase the difficulty of the operation.

With the aging of population, the incidence of osteoporosis and intervertebral disc degeneration increased remarkably.As a consisting part of spine, vertebrae play important roles in spinal diseases.The microstructure of vertebrae is closely associated with not only its biomechanical properties, but also its adjacent intervertebral discs.A detailed understanding of vertebrae's microstructure can help us understand the initial mechanism, progression and prognosis of vertebrae and its adjacent discs' diseases.On the other hand, traditional examinations are less effective in detecting vertebrae's microstructure.Being a noninvasive, high-resolution and bony-sensitive neo-technology, Micro-CT has obvious advantages in detecting vertebrae's microstructure.Many researches have reported the usage of Micro-CT in reveling microstructures while they also raised problems.Thus, herein we searched the related information of vertebrae's microstructure scanning with Micro-CT, explained its basic mechanism, reviewed its progress in technology and arithmetic, and concluded the latest developments.Depending on the microstructure revealed by Micro-CT, achievements in biomechanical properties of vertebrae and intervertebral disc degeneration have been made,and related problems have been summarized.Also, new applications of Micro-CT in spinal diseases are discussed for acquiring reasonable clinical data in the future.

Objective To explore the effect of training course based on the model of practical performance which was designed to improve the humanistic caring ability of nursing postgraduates. Methods After conceived, designed and trained the nursing postgraduates, we combined quantitative research method and qualitative research method to understand the effect and the true feelings of the students after taking the training. Results “Humanistic Caring Ability of Nursing Undergraduates Assessment scale (HCANU)“was used before and after 22 nursing postgraduates accepted the training. After training, their total score (86.06±5.16) was higher than before (67.70±5.00) (t=2.665, P<0.01) and 8 dimensions scores were respectively higher than before(P<0.01 or 0.05). The course has improved the humanistic caring ability of nursing postgraduates, enhanced their empathy of nursing objects and promote self-reflection. Conclusions This training course based on the model of practical performance helps to improve the humanistic caring ability of nursing postgraduates and cultivate their humantistic quality.

Objective To investigate the team-based learning(TBL) combined with microteaching method in the teaching of undergraduate first aid courses. Methods Totally72 undergraduate nursing students randomly divided into the observation group and control group each including 36 cases by lottery. Nursing students in the observation group received TBL combined with microteaching, while nursing students in the control group received conventional teaching. Results The average score of objective structured clinical examination (OSCE) in observation group was (86.66±5.09) points and the control group was (84.47 ± 5.78) points, the difference was statistically significant (t=3.38, P<0.05). After training,the total score of Critical Thinking Disposition Inventory Chinese Version (CTDI-CV) and 5 dimensions′were (329.39 ± 25.56), (49.33 ± 4.42), (45.11 ± 6.08), (48.17 ± 6.14), (51.08 ± 6.55), (45.06 ± 5.19) points in observation group, and (325.17±27.26), (48.19±4.97),(44.42±6.30), (47.47±6.27), (50.36±7.12), (44.56± 5.13) points before training, the differences were statistically significant (t=2.11- 4.95, P<0.05). Conclusions TBL combined with microteaching method in first aid training course can improve the undergraduate nursing students′first aid ability, critical thinking ability.

Objective To evaluate the effects of peer-assisted learning (PAL) combined with peer feedback in the teaching of operating room nursing. Methods 80 undergraduate nursing students in grade 2012 were assigned to the experimental group (n=40) and control group (n=40) by random number table method. The content of this training is operating room nursing skills. Nursing students in the experimental group received peer-assisted learning combined with peer feedback teaching,while nursing students in the control group received conventional teaching. Results The students′examination scores of the experimental group was (92.25 ± 3.43) obviously higher than that of the control group (89.20 ± 3.55) U=609.500, (P < 0.05), the students' evaluation of the new teaching method was higher than that of the control group (t=-2.76--2.27, P<0.05 or 0.01). Conclusions Peer-assisted learning combined with peer feedback can improve the operational capability of the students in operating room, is helpful to stimulate students′subjective initiative and improve the teaching quality of nursing.

Objective To explore the effect of different temperature of the forced- air warming system on the prevention of hypothermia during laparotomy of infants. Methods A total of 60 infants undergoing laparotomy under general anesthesia were recruited and divided into three groups by random digits table method with 20 cases each according to admitting time; when used the force- air warming system intraoperatively, the three groups were respectively setting on 45℃(automatic adjustment for 43 ℃ after 45 minutes), 43 ℃ and 38 ℃.The core temperature were respectively recorded before anesthesia and 15, 30, 45, 60 minutes after anesthesia (every 30 minutes after 1 hour).The hypothermia incidence and anesthesia recovery conditions were recorded simultaneously. Results There was no significant difference on the core temperature among three groups before anesthesia (P > 0.05). 30 minutes after the anesthetic, the core temperature of 45 ℃ group was (36.31±0.20) ℃,43 ℃ group was (36.32±0.24) ℃ and 38 ℃ group was (36.08±0.21) ℃.The differences among three groups was statistically significant (F=8.12, P < 0.01), but there was no significant difference between 45 ℃ group and 43 ℃ group (P > 0.05). 60 minutes after the anesthetic, the core temperature of 45 ℃ group was (36.39±0.26) ℃,43 ℃ group was (36.19±0.22) ℃ and 38 ℃ group was (35.92±0.15) ℃. The differences among three groups was statistically significant(F=25.19, P<0.01).The hypothermia incidence of 45℃group, 43℃ group,38℃ group was 10.0%(2/20), 25.0%(5/20), 50.0%(10/20)respectively and the differences among three groups was statistically significant( χ2=8.04, P<0.05). The time to complete consciousness of 45 ℃ group was (15.40±5.09) minutes,43 ℃ group was (19.80±4.10) minutes and 38 ℃ group was (22.00±4.36) minutes. The differences among three groups was statistically significant (F=10.96, P<0.01). The time to tracheal extubation of 45 ℃ group was (18.10±5.97) minutes, 43 ℃ group was (21.85±4.02) minutes and 38 ℃ group was (24.90±5.54) minutes.The differences among three groups was statistically significant (F=9.83, P<0.01). Conclusions The forced-air warming system can increase the infants′peripheral tissue heat content and reduce the heat losing.So that it will help decrease the intraoperative hypothermia incidence and shorten the anesthesia recovery period.Meanwhile the higher temperature of the forced-air warming system is setted ,the better effect it is.

Objective To study the characteristic and management method of steroidogenic diabetes in patients with rheumatic disease. Methods The follow-up data of steroidogenic diabetes in 38 patients with rheumatic disease were analyzed retrospectively. Results The nosogenesis of steroidogenic diabetes and fast blood sugar level was related with steroid dosage, using time, age, obesity and hypertipoidemia. The blood-fasting sugar level was not so obviously increased. Blood sugar at bedtime was (24.40±5.92)mmol/L,before breakfast was (9.52±3.64)mmol/L, after breakfast was (20.38±7.19)mmol/L, before lunch was(10.69±3.23)mmol/L, after lunch was (21.81±6.92) mmol/L, before dinner was (12.17±3.63)mmol/L. There was significant difference between blood sugar at bedtime and that in others (P<0.01 or<0.05). Most patients needed insulin to control blood sugar. Decreasing the daily dosage of steroid might be beneficial to the reduction of corticosteroid induced diabetes. Most patients could stop insulin injection when the daily dosage of steroid decreased to a certain level. Conclusions The prescription of corticesteroid in rheumatic diseases can cause temporal increase of blood sugar. Intensive follow-up aad blood sugar monitor is important for the diagnosis of steroidogenic diabetes. Promptly administration of insulin is required for blood sugar control.

Objective To explore the effects of modified herringbone-Trendelenburg position during gynecological laparoscopic operation of the elderly. Methods A total of 60 elderly patients undergoing gynecological laparoscopic operation under general anesthesia were recruited and assigned to the observation group (30 cases) and control group (30 cases) by random digits table method with 30 cases each according to admitting time;Patients in the control group were placed in conventional Trendelenburg position, while the patients in the observation group were positioned in modified herringbone-Trendelenburg position .Intraocular pressure (IOP) were measured in the patients at anesthesia induction (T1),5 minutes after general anesthesia in supine position (T2) , and 5 minutes after pneumoperitoneum while in the operation position (T3) , every 30 minutes (times 4 to 11), while supine at the end of pneumoperitoneum (time 12) and before awakening (time 13);Patients were followed up at 24 h and 48 h after surgery, researcher investigate and record the scores of the Operation Position Comfort Questionnaire, the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results There was no statistically significant difference (t=-1.098,-0.772,-0.656, P>0.05) of the IOP at T1, T2, T13. The IOP in the observation group had statistically significant difference compared with the control group at T3 to T12 (t=6.523-19.866, P<0.01). The incidence rate of the postoperative complications of the lower limbs in the observation group was 6.7%(2/30) lower than 26.7%(8/30) of the control group (χ2=4.320, P<0.05) and the VAS scores of the patients in the two groups was statistically significant (t=2.471, P<0.05). The incidence rate of the postoperative shoulder pain in the observation group was 10.0%(3/30) lower than 43.3%(13/30) of the control group (χ2=8.523, P<0.01), and the Visual Analogue Scale scores of the patients in the two groups was statistically significant (t=3.575, P<0.05).The scores of the Operation Position Comfort Questionnaire in the observation group was higher than the control group (t=-2.319, P<0.05). Conclusions Modified herringbone- Trendelenburg position can reduce the elevation of intraocular pressure in elderly patients without affecting the operation ,and effectively improve the comfort of the operation position of the patients, reduce the incidence rate of the shoulder pain and postoperative complications of the lower limbs, is conducive to the operation safety of elderly patients.

Objective To study the prevalence and characteristics of gastroesophageal reflux disease (GERD) in patients with idiopathic pulmonary fibrosis(IPF).Methods A total of 48 patients with diffuse parenchymal lung disease(DPLD) including 25 IPF and 23 other DPLD were enrolled from Department of Respiratory Disease in the First Affiliated Hospital of China Medical University.All patients were subjected to 24-hour esophageal pH monitoring.Pulmonary function test and HRCT of lung were performed at the same time.Results The prevalence of GERD in IPF patients was 64.0％,which was significantly higher than that in other DPLD patients.DeMeester scores were significantly higher in IPF patients than those in non-IPF group[(22.8 ± 21.5) score vs (15.7 ± 14.0) score respectively P ＜ 0.05].Numbers of reflux longer than 5 minutes [(3.8 ± 4.1) time vs (2.1 ± 2.1) time respectively) and reflux index (1.8 ± 1.7 vs 1.3 ± 1.2) in IPF group were higher than those in non-IPF group,yet without statistical significance.Patients with IPF had significantly higher values of following parameters than those in non-IPF patients including percentage of total reflux time(pH ＜ 4.0) (9.2 ± 5.1) ％,percentage of upright reflux time (8.5 ± 5.2) ％,percentage of supine reflux time (10.8 ± 10.7) ％,numbers of reflux (54.2 ± 22.7) time,numbers of regurgitation longer than 5 minutes (6.3 ± 4.2) time,thelongest reflux time (14.5 ± 15.3) min,reflux index 2.5 ± 1.7 and DeMeester scores (34.9 ± 20.3) time (P ＜ 0.05).DeMeester score was positively correlated with gastroesophageal reflux diseases questionnaire (GerdQ) score (r =0.667,P ＜ 0.01).The prevalence of typical GERD sympotoms in the IPF-GERD patients was higher (heartburn 7/16,regurgitation 6/16) than that in IPF patients without GERD (heartburn 2/9,regurgitation 1/9).Conclusion Patients with IPF have a high prevalence of GERD,but usually without typical GERD symptoms.In the hospitals 24-hour esophageal pH monitoring not available,GerdQ can be used to identify GERD in IPF patients.

Objective To investigate the involvement of sympathetic nerve system in the transmission of nociceptive information related to vascular headache. Methods Fos expression in the midbrain periaqueductal grey (PAG) induced by electrical stimulation of dural matter near the superior sagittal sinus (SSS) of the rat was determined before and after the extirpation of the superior cervical ganglion (SCG) using standard avidin-biotin immunohistochemistry. Results Fos immunoreactive positive neurons were detected in the ventrolateral PAG, and were bilateral symmetry. Fos expression was (133.3±12.5) in SCG extirpated group, and higher than that in sham-operated group (76.0±11.3). Conclusion The sympathetic system may be involved in the transmission of nociceptive information through PAG, associated with vascular headache such as migraine.