Objective In order to evaluate nursing students' clinical nursing knowledge and ability objectively, we tested a clinical nursing examination system which is based on the computer technology. Methods The proposed project used the whole group of sampling methods. Data were collected via class unit. All the 620 subjects recruited from seven classes of grade 2007 (280 students )and eight classes of grade 2008 (340 students). Results Students of grade two without clinical practice had lower scores when answering clinical nursing case problems compared with grade one students who went through clinical practice. Conclusions The computer simulated clinical nursing testing system has better validity and reliability in evaluating students' clinical nursing ability.

Objective To investigate the effects of blocking gastrin receptor on the proliferation,apoptosis and expression of key proteins in the related pathway in gastric cancer cell lines.Methods In the experimental group,the gastric cancer cell lines SGC-7901 and AGS cells were treated with 5 mmol/L proglumide,a kind of a gastrin receptor antagonist.And the normal cultured gastric cancer cells SGC-7901 and AGS were used in control group.The growth of each group was detected by MTT assay;the cell growth curve was drawn by flow cytometry;the cell cycle of each group was detected by flow cytometry.Annexin V-FITC/PI double staining was used to detect the cell growth of apoptosis.The relative mRNA expression of β-catenin,nuclear factor-P65,mammalian target of rapamycin and glycogen synthase kinase 3 beta in Wnt,NF-κB and PI3K-AKT-MTOR pathways were detected by RT-qPCR.The expression of β-catenin protein was detected by Western blotting.Results After treatment with proglumide,the growth of the cells in the experimental group was lower than that in the control group;and the proportion of S phase cells in the cell cycle was also lower than that in the control group,but the proportion of cells in G0/G1 phase was higher than that in the control group(P<0.05).The percentage of apoptotic cells was also increased after treatment with proglumide(P<0.05).Furthermore,proglumide treatment significantly reduced the expression of β-catenin at both mRNA and protein levels(P<0.05).Conclusion Blocking gastrin receptor can down-regulate the expression of β-catenin,inhibit the cell proliferation and promote the cell apoptosis in gastric cancer cells.

Objective To investigate the clinical and laboratorial characteristics of patients with myelodysplastic syndrome ( MDS) and erythroid hyperplasia.Methods MDS patients whose bone marrow was hypercellular with erythroid lineage more than 50% and blasts account for less than 20% of non-erythroid cells were enrolled in this study.The ratio of mature erythrocytes to nucleated erythrocytes was no more than 20, namely MDS patients with erythroid hyperplasia ( MDS-E ).The retrospective analysis comprised 102 patients with MDS-E from the First Affiliated Hospital of Suzhou University.Clinical characteristics , karyotype , and the prognostic significance of erythroid hyperplasia were evaluated.Results A total of 48 MDS-E patients (47.1%) presented a variety of cytogenetic abnormalities.The most frequently involved chromosomes were chromosome 8 (39.5%of all abnormal karyotypes ), chromosome 7 (22.9%), followed by chromosome 5 ( 18.8%) , chromosome 1 ( 16.7%) and chromosome 20 ( 16.7%) .Hemoglobin ( Hb) level affected the prognosis by survival analysis.The overall survival ( OS) of MDS-E patients with Hb equal or more than 70 g/L was longer than that of patients less than 70 g/L ( P<0.001).Allogeneic hematopoietic stem cell transplantation (HSCT) significantly improved the OS compared with best supportive care (P<0.001) and chemotherapy (P<0.001).The extent of erythroid hyperplasia in bone marrow did not impact on prognosis ( P=0.187 ).Conclusions Compared with previous reports of MDS patients, MDS-E patients have higher level of erythroid hyperplasia , more common erythroid dyshematopoiesis , more frequent 8 and 1 chromosome abnormalities .The degree of erythroid hyperplasia is not correlated with prognosis.Allogeneic hematopoietic stem cell transplantation improves the prognosis.

OBJECTIVE:To study the anti-oxidative effects of spirulina kinase (SPK) in vitro. METHODS:The methods of phenanthroine-Fe2+ oxidation method,DPPH and auto-oxidation of pyrogallol were used to measure the effects of different concen-trations of SPK on scavenging hydroxyl (OH-) free radical,DPPH free radical and superoxide anion (O2-) free radical;IC50 of SPK was calculated. Prussian blue reaction was used to determine total reducing ability(by absorbance)of different concentrations of SPK to Fe3+. Vitamin C(VC)was used as positive control in above trials. RESULTS:SPK could eliminate the OH-free radical, DPPH free radical and O2- free radical in concentration-dependant manner,and the maximum elimination rate of SPK to OH- free radical and DPPH free radical were 86.82% and 78.98%(IC50 were 54.31,0.636 g/L),which were higher than VC (64.77%, 73.49%). The maximum elimination rate of SPK to O2- free radical was 78.31%(IC50 was 3.918 g/L),which was lower than VC (94.14%). In reducing ability test,SPK improved absorbance in reducing ability test system,and maximum absorbance was simi-lar to VC in concentration-dependant manner. CONCLUSIONS:SPK has obvious anti-oxidant activities in vitro.

Objective To compare the clinical effect of 2D and 3D laparoscopic radical prostectomy and summarize surgical experience of laparoscopic radical prostectomy of early prostate cancer.MethodsThe clinical data of 34 cases of prostate cancer treated in our institute from November 2015 to April 2016 were collected and analyzed retrospectively. The patients in observation group (11 cases) were treated by 3D laparoscopic radical prostectomy, while those in control group (23 cases) were given 2D laparoscopic radical prostectomy. The operation time, intraoperative bleeding volume, postoperative drainage time, quantity of drainage fluid within 24 hours postoperatively, indwelling catheter time, hospital time, positive surgical margin rate, potence rate, 30d-urinary continence rate and complications were compared between the two groups.Results All operations were successfully performed. There were no signiifcant differences in operation time, intraoperative bleeding volume, postoperative drainage time, quantity of drainage lfuid within 24 hours postoperatively, indwelling catheter time, hospital time, positive surgical margin rate, potence rate, 30d-urinary continence rate and complications between the two groups (P > 0.05). In observation group, the operation time was (153.52 ± 30.47) min and the potence rate was 50.0 %, 4 cases with uroclepsia (36.4 %), 1 case with urine leakage (9.1 %), no patient had urethral stricture or positive surgical margin, the 30d-urinary continence rate was 72.7 %. In control group, the operation time was (164.73 ± 28.65) min and the potence rate was 38.9 %, 13 cases with uroclepsia (56.5 %), 4 cases with urine leakage (17.4 %), 1 case with urethral stricture (4.3 %), 2 cases with positive surgical margin (8.7 %), 30d-urinary continence rate was 60.9 %.ConclusionLaparoscopic radical prostectomy is a safe, effective and less invasive method for treating early prostate cancer patients. Also 3D laparoscopic radical prostectomy play the similar functional results compared with 2D laparoscopic radical prostectomy, but 3D laparoscopic has the advantage in three dimensions space sense and accurate operation, it is worthy of promoting clinical application.

OBJECTIVETo investigate the clinical and genetics characteristics of patients with monosomal karyotype acute myeloid leukemia (MK-AML).

METHODSThe karyotypes of 3743 patients with newly-diagnosed de novo AML were analyzed, which had identified 153 cases with MK-AML, for whom the clinical and genetics characteristics were analyzed.

RESULTSThere were 2056 patients (54.9%) among all patients. A total of 153 patients fulfilling the criteria for MK-AML were identified, which comprised 93 males and 60 females, with a median age of 54. The median white blood cell count on presentation was 4.4×10 (9)/L. One hundred and forty-five cases (94.8%) have fulfilled the criteria for complex karyotype (≥ 3 chromosomal abnormalities). Although the monosomy could be found with all autosomes, chromosome 7 has been most frequently involved (38.56%, 59/153).

CONCLUSIONMK-AML is a distinct cytogenetic subtype of AML. Monosomy 7 is frequently detected among MK-AML patients. The monosomal karyotype is common among elder patients with AML.

Adult ; Aged ; Chromosomes, Human, Pair 7 ; genetics ; Female ; Humans ; Karyotype ; Leukemia, Myeloid, Acute ; genetics ; Male ; Middle Aged ; Monosomy ; Young Adult

Objective: To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP. Methods: We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan′an hospital affiliated to Kunming medical university retrospectively. The patients' age ranged from 58 to 75 years, with an average of 64.3 years. The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month, with an average of 3.5 months. 5 cases were urethral stricture at penis segment, 11 cases were urethral stricture at the junction of penis and scrotum, and the length of the narrow urethra was 2-5 cm, with an average of 3.4cm. The average maximum uroflowmetry in preoperative was (5.3±2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months, 5 cases were treated with intraurethral incision combined with urethral dilatation(1 or 2 times). 16 cases were not effective after receiving the above treatment, so that all cases were treated with dorsal mosaic surgery with penis free flap. Subarachnoid anesthesia combined with epidural anesthesia, the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator. Incision from the ventral side of the urethra. The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body. The length of the incision was extended 0.5 cm to the normal urethral mucosa. The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea, and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse, the full thickness of the penis flap was taken, and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra), the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side, Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra, the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine, and the fascia and skin were sutured layer by layer. The 5-0 absorbable thread sutures the wound after the foreskin was taken. Results: The operations were successfully completed. The operation time was 90-120 min, with an average of 102.3 min. The intraoperative blood loss was 10-30 ml. The symptoms of dysuria were relieved in all patients after removal of the catheter at 3 weeks postoperative. 4 weeks after surgery, no signs of urethral stricture were observed in urethrography. And the maximum flow rate was >15 ml/s in 13 cases, while 3 cases was 10-15 ml/s. The mean maximum flow rate in postoperative was [(20.4±7.3) ml/s], which was significantly higher than that in preoperative (t=7.7602, P<0.05). B-ultrasound showed 13 cases without residual urine and 3 cases of residual urine volume <30 ml. All patients had no serious complications such as urinary fistula, urethral diverticulum and extravasation of urine. After 1 year of follow-up, 1 patient was lost to follow up, and none of the remaining15 cases had urethral obstruction due to re-stricture. Conclusion Dorsal mosaic surgery with penis free flap could be an effective method and had no obvious complications for the treatment of anterior urethral stricture after TURP.

Objective To explore the feasibility and safety of flexible ureteroscope with tubeless in the treatment of middle or upper calyx renal calculi.Methods The clinical data of 107 patients with renal calculi treated from January 2015 to October 2018 were analyzed retrospectively.Age ranged from 18 to 55 years,with mean of (32.1 ± 5.2) years.Calculi was single,locating in the middle or upper calyx,with the diameter less than 2.0 cm,the CT value ≤ 800 HU,and mild renal hydronephrosis.All patients were routinely indwelling double-J tube using cystoscopy 2 weeks preoperatively,and ureteroscopic lithotripsy was performed.Fifty patients in group A were received tubeless treatment,and 57 patients in group B were given routinely indwelling double-J tube.The 50 patients in group A were (30.4 ± 5.9) years of age,including 33 males and 17 females,28 cases on the left and 22 cases on the right,24 cases locating in the upper calyx and 26 cases locating in the middle calyx,and calculi diameter of (1.3 ± 0.5) cm.The 57 patients in group B were (31.3 ± 5.4) years of age,including 35 males and 22 females,26 cases on the left and 31 cases on the right,27 cases locating in the upper calyx and 30 cases locating in the middle calyx,and diameter of (1.4 ± 0.4) cm.There were no significant difference in the demographics between the two groups (P ＞ 0.05).Results There were no obvious ureteral malformations,stenosis,polyps or tumors in the 107 cases intraoperatively,and the flexible ureteroscope sheath was placed smoothly.The operation time in group A [(48.2 ± 9.7) min] was significantly lower than that in group B [(51.7 ± 7.8) min,P ＜ 0.05].There was no significant difference in the calculi clearance rate between the two groups on the first day [92.0％ (46/50) vs.91.2％ (52/57)] and two weeks[96.0％ (48/50) vs.98.2％ (56/57)] after operation(P ＞ 0.05),and the calculi clearance rate reached 100％ at 1 month after operation.The incidence of hematuria in group A [24.0％ (12/50)] was significantly lower than that in group B [54.4％ (31/57),P =0.001].The incidence of bladder irritative symptoms in group A [14.0％ (7/50)] was significantly lower than that in group B [36.8％ (21/57),P =0.007].The incidence of lumbar and abdominal pain at 1 week,2 weeks and 1 month after operation was significantly lower in group A [32.0％ (16/50),8.0％ (4/50),2.0％ (1/50)] than that in group B [57.9％ (33/57),49.1％ (28/57),33.3％ (19/57),P ＜ 0.05].There was no significant difference between the two groups about the incidence of lumbar and abdominal pain at first day after operation [86.0％ (43/50) vs.84.2％ (48/57),P ＞ 0.05].Conclusions It was feasibility and safety to perform flexible ureteroscope with tubeless for the patients with renal primary and single calculi,ideal ureteral conditions (no malformations,stenosis,polyps or tumors),mild renal hydronephrosis,calculi,diameter ＜ 2.0 cm,CT value ≤ 800 HU,locating in the middle or upper calyx,and no history of urinary calculi.This procedure had not only similar calculi clearance rate compared with routinely indwelling double-J tube,but also has a lower incidence of complications (hematuria,bladder irritative symptoms,lumbar or abdominal pain).

Aggressive angiomyxoma (AAM) is a rare clinical entity. A case of AAM was reported in this paper. The patient presented with severe hydronephrosis of the left kidney and was diagnosed with a pelvic mass compressing the ureter. The patient underwent laparoscopic resection of the pelvic mass. The postoperative pathology and immunohistochemistry confirmed the diagnosis of AAM. The patient had no recurrence and metastasis after 9 months of follow-up.

Objective： ：To study the effect of silencing DKK1 (Dickkopf1) gene on the proliferation, cell cycle and apoptosis of gastric cancer AGS cells and the action mechanism. Methods： ：The DKK1-shRNA vector was constructed and transfected into AGS cells. The stably transfected cell lines were screened. The total protein and RNAof the transfected cells were extracted and the mRNAand protein expressions of DKK1 were detected by qPCR and WB, respectively. The experiment was divided into blank control group (Control), negative control group (shNC) and DKK1 silence group (DKK1-shRNA). CCK8 assay was used to detect the proliferation ofAGS cells of each group cultured for 0, 24, 48, 72, 96, 120 and 144 h, and flow cytometry was used to analyze the cell cycle and apoptosis in each group. The relationship between DKK1 and clinicopathological features of gastric cancer was analyzed after searching HPA database. Results：The gastric cancer AGS cells with stable DKK1 gene knockdown was successfully established, and it was confirmed that the mRNA and proteinexpressions of DKK1 in DKK1-shRNA group decreased by 72% and 47%, respectively, compared to shNC group (all P<0.05). The cell proliferation curve showed that, the cell proliferation in DKKl-shRNAgroup significantly decreased after 72 hour of culture compared with that in control and shNC groups (P<0.05). The cell number of S phase decreased from 32.06% to 25.87%, while the number of G2/M phase increased from 8.49% to 21.26% compared with shNC group (all P<0.05). The number of apoptotic cells also statistically increased from 10.34% to 20.65% (all P<0.05). The data of HPAdatabase showed that DKK1 mRNAlevel in gastric cancer tissues was significantly higher than that in normal tissues, and the high expression of DKK1 mRNAwas negatively correlat ed with the survival rate of gastric cancer patients. Conclusion: : Silencing DKK1 gene can inhibit the proliferation of gastric cancer cells, arrest cells in G2/M phase and promote cell apoptosis. DKK1 plays a pro-carcinogenic effect in gastric cancer.