Objectives By survey the head nurses or nursing instructors,to know the one year professional performance of nurses graduated from Sino-Australia cooperation program of Jinhua Polytechnic,which can help us to make the educational plan and further cultivation.MethodSelf-composed questionnaire is provided to 32 head nurses or nursing instructors from secondary and tertiary hospitals of Zhejiang province.SPSS 18 is applied for data analysis.ResultThe nurses' performance is generally consistent to the objectives ofthe Sino-Australia nursing program and the rating scores are normally distributed. There is no significant difference in the average performance of nurses comparing to a test value of 71,P≤0.08.The scores of professional quality,nursing competency,English ability,humanitarian caring,active learning,team work and adaptability to clinical responsibilities were especially well rated.ConclusionResults indicated that the school should appropriately adjust the direction for students＇ employment,consider to localize the nursing courses introduced from foreign countries.It is necessary for the hospitals to ponder on how to further cultivate and utilize the English competency of the nurses,and use the individualized strategies to retain the nurses who are proficient in English.

Objective To investigate the methods and strategies of therapeutic ERCP in patients with duodenum stricture.Methods Endoscopic procedure,success rate and complications in patients with duodenum stricture who underwent ERCP were retrospectively analyzed.Results In 7276 patients who underwent therapeutic ERCP,duodenum stricture was found in 158 (2.17％),patients with malignant tumor infiltration in 120 and benign stricture in 38.The total success rate of ERCP and biliary drainage was 84.2％,with posture change or guidewire leading method in 96 patients,stylolitic water sac dilation in 33and duodenum metal stent placement before biliary drainage in 4.The procedure was failed in 25 patients.Minor bleeding occurred in 5 patients and no major complication including massive bleeding or perforation was observed.Conclusion ERCP is safe,effective and feasible for patients with duodenum stricture,which can be performed by posture change or guidewire leading method in mild stricture,and stylolitic water sac dilation or duodenum metal stent placement in severe stricture.

Objective Feedback of 35 graduates from a Sino-Australia cooperation program was investigated at 1 -year fulfillment of clinical practice,and reflect some of the issues in the process of cultivation and utilization of nursing talents from the program. Methods 32 nursing talents from a Sino-Australia cooperation program at 1 -year fulfillment of clinical practice was selected as research object.Self made questionnaires baaed on the goal of the program were used,which included both open and close questions.The investigation results were analyzed. Results The nursing talents considered that the main advantages of the program were as followed:cultivation of their ability in active communication,improving English level,broaden international vision,and internationalization of courses. Conclusions Stratified and individualized teaching strategies need to be implemented.English study and nursing specialty study are to be appropriately combined.Routes of employment should be broadened.In addition,imported courses are to be adjusted according to domestic situation.While attaching importance in teaching,faculty should also emphasize advising.Finally,it is not to be ignored for the hospitals that they are responsible for greater utilization and cultivation of the nurses with both nursing and English ability.

Objective To intelligently adjust the driving force of a remote-controlled drug delivery capsule based on the postural information in intestines,so as to achieve the control of speed and dosage of drug delivery and reduce the energy consuming.Methods A six-axis sensor MPU6050 was used,and its Z axis was coincident with the central axis of the drug delivery capsule so as to made the medicine discharge port pointing to the Z direction.The angular velocities and accelerations of X,Y,Z axes were monitored,transformed to quaternion with built-in digital motion processor,and then converted to Euler angle form.The intelligence adjustment of driving force could be achieved by accessing the real-time attitude angle of the capsule.Results The results of experiments showed that the error between the actual and the attitude angle measured by the sensor was less 1°.Conclusions The intelligent adjustment scheme of driving force of a gastrointestinal remote-controlled drug delivery capsule was designed.The real-time attitude angles of the capsule could be obtained with high spped and precision.This study can provide the theoretical and experimental basis for the intelligent adjustment of the driving force.

Objective To evaluate the value of acoustic radiation force impulse imaging (ARFI) technique in differential diagnosis of renal tumors.Methods Totally 86 patients with 86 renal tumors underwent conventional ultrasound and ultrasound with ARFI technique.The shear wave velocity (SWV),virtual touch tissue imaging (VTI) score between tumors and the surrounding renal parenchyma,benign and malignant tumors were compared.Results In 86 patients with renal tumors,32 cases were renal benign tumors and all them were angiomyolipomas (AML),54 cases were renal malignant tumors,inculding 26 cases of renal clear cell carcinoma (ccRCC),8 cases of renal color cell carcinoma (cRCC),5 cases of renal papillary carcinoma (pRCC),15 cases of invasive urothelial carcinoma (IUC).The difference of SWV and VTI scores between lesions and the surrounding renal parenchyma were statistically significant (both P＜0.05).The SWV and VTI score renal benign tumors were lower than those of malignant tumors (both P＜0.05).The area under the ROC curve with SWV＞1.37 m/s or VTI score＞3.83 to distinguish benign and malignant renal tumors were 0.898,0.847,sensitivity were 88.9％,83.3％,specificity were 84.4％,78.1％,respectively (P＜0.05).Among renal malignant tumors,SWV and VTI score of ccRCC significantly higher than those of other malignant tumors,and the area under the ROC curve with SWV＞2.06 m/s or VTI score＞4.31 to distinguish ccRCC and other renal malignant renal tumors were 0.766,0.729,sensitivity were 65.4％,57.7％,specificity was 82.1％,78.6％,respectively (P＜0.05).Conclusion ARFI has important value in differential diagnosis of renal tumors,and can help to distinguish ccRCC with other renal malignant tumors.

Objective To explore the potential mechanism of Fasudil hydrochloride pharmacologic postconditioning that alleviated acute myocardial ischemia/reperfusion injury (MI/RI) in rats,narrowed the scope of infacted myocardium,and inhibited cell apoptosis.Methods Ninety rats were randomly and averagely divided into 5 groups:sham group,ischemia/reperfusion (I/R) group,ischemic postconditioning (IPost) group,fasudil hydrochloride (FH) group,and FH and PI3K inhibitor (LY294002) (FH + I) group.The expressions of Rho associated coiled-coil forming protein kinase-1 (ROCK-1),Bcl-2,Bax,Caspase-3,Akt,and P-Akt in rat myocardial cells were determined.Results Compared to I/R group (ROCK1:2.94 ± 0.13),ROCK1 expression was not changed in IPost group (ROCK1:2.79 ± 0.11),FH group (ROCK1:2.83 ± 0.10),and FH + I group (ROCK1:2.85 ± 0.26).Compared to I/R group (Bcl-2:1.11 ± 0.12,P-Akt:1.09 ± 0.06,Bax:1.74 ± 0.06,and caspase-3:1.32 ± 0.12),the expressions of Bcl-2 and P-Akt in FH group (Bcl-2:1.76 ± 0.08,and P-Akt:1.73 ± 0.05) and IPost group (Bcl-2:1.74 ± 0.06,and P-Akt:1.37 ± 0.05) were all significantly higher than those in I/R group (P ＜ 0.05),while the expressions of Bax and caspase-3 in FH group (Bax:0.98 ±0.14,and caspase-3:0.97 ±0.06) and IPost group (Bax:0.97 ±0.11,and caspase-3:1.07 ±0.08) were all significantly lower than those in I/R group (P ＜0.05).Compared to FH group,the expressions of Bcl-2 and P-Akt in FH + I group (Bcl2:1.05 ±0.12,and P-Akt:1.21 ±0.06) were decreased (P ＜0.05),while the levels of Bax and caspase-3 (Bax:1.61 ±0.11,and caspase-3:1.42 ± 0.11) were increased (P ＜ 0.05).Conclusions The mechanism of FH postconditioning was associated with the inhibition of ROCK activity,and the activation of PI3K-Akt pathway.

Objective To investigate the efficacy of pancreatic duct guidewire pre-occupying in ERCP with difficult biliary cannulation.Methods During a four-year study period from June 2008 to June 2012,a total of 3505 patients were included in this retrospective analysis.Initial biliary cannulation method consisted of single-guidewire technique for up to 5 attempts,followed by double-guidewire technique when repeated unintentional pancreatic duct cannulation had taken place.Pre-cut papillotomy technique was reserved for when double-guidewire technique had failed or no pancreatic duct cannulation had been previously achieved.Biliary cannulation success and post-ERCP complication rate were compared.Results Single-guidewire technique was characterized by statistically significant higher success rate (93.4％),compared with the double-guidewire technique (54.8％,P ＜0.001),pre-cut failed double-guidewire technique (81.3％,P ＜0.001) or precut as first step method (84.6％,P =0.011).Pre-cut failed double-guidewire technique and pre-cut as first step method offered a statistically significantly more favorable outcome compared with the double-guidewire technique (both P ＜ 0.001).The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner among the four methods.Numbers of patients who got bleeding in pre-cut papillotomy technique and sphincterotomy after successful single-guidewire technique were 5 and 2 respectively.One case of perforation was recorded using pre-cut papillotomy technique.There was no procedure-related mortality within 30 days.Conclusion Although double-guidewire technique success rate proved not to be superior to singleguidewire technique or pre-cut papillotomy,it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Female ; Humans ; Lymphoma ; diagnosis ; Pregnancy ; Pregnancy Complications, Neoplastic ; diagnosis

Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent (ARMS) for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duct underwent endoscopic retrograde cholangiopancreatography (ERCP) and ARMs placement. The success rate, early complications, stent patency and patients' survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents (SEMs). In 22 patients completing the follow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in-growth in 1, overgrowth in 2, and stent dislodgement in 3. Other patients were free of biliary symptoms until death or at the end of follow-up. The average stent patency of ARMs was 14 months. Patency rates at 3, 6, and 12 months were 95%, 74% and 56%, respectively. The mean patient survival was 7. 9 months ( 1-14 months).Postoperative survival rates at 3,6 and 12 months were 91.0%, 81.3% and 17. 2%, respectively. Conclusion Endoscopic placement of novel ARMs in patients with extra-hepatic biliary tumors is feasible,safe and effective.

Objective To investigate the efficiency and safety of endoscopic large balloon dilation following small sphincterotomy (ESBD) for treatment of common bile duct (CBD) stones, and to prospectively compare it with traditional sphincterotomy (ES). Methods Patients with single or multiple calculi in extra-hepatic bile ducts and with the diameter of CBD larger than 13 mm, were randomized into 2 groups to receive maximal sphincterotomy (ES group), or partial sphincterotomy plus sphincteroplasty with 15mm-balloon (ESBD group), respectively, followed by conventional stones removal and/or lithotripsy. The success rate of stone clearance, operation time and related complications were observed. Results A total of 86 patients were enrolled in 2 endoscopy centers, with 2 excluded because of papillary pre-cut in 1 and non-compliance with the protocol in the other, and were randomly divided into groups ES and ESBD, with 42 patients in each. The clinical characteristics, including average diameter of CBD, size and quantity of calculi, and incidences of peri-ampullary diverticulum, of patients in both groups were all similar. Stones clearance with single session in 2 groups were 88% and 93%, respectively (P =0. 531 ). The operation time were (25.76 ± 12. 74) min and (26. 38 ± 12. 86) min ( P = 0. 825 ). The rate of mechanical lithotripsy was 36% and 25%, respectively (P=0. 363). Complications occurred in 5 cases in ES group (3 mild, 2 medium), and 2 mild complications occurred in ESBD group (no statistical difference). No death happened in any group.Conclusion ESBD is an effective method for clearance of extra-hepatic bile duct stones with the similar safety, compared with traditional sphincterotomy. It could be an optimal alternative for those with large stones or difficult sphincterotomy.