Objective To investigate the effectiveness of 360-degree assessment method in clinical teaching for nursing students.Methods Forty-six nursing interns in our hospital from May 2012 to March 2013 were assigned as the observation group,and another 44 from May 2011 to March 2012 as the control group. The observation group was assessed in respect of nursing theory,nursing techniques,examinations,nursing ethics using the 360-degree assessment,while the interns in the control group in the traditional methods.The quality of comprehensive clinical evaluation over the interns in the two groups was compared.Result The nursing interns in the experiment group were significantly better than those in the control group in terms of nursing theory,nursing techniques, examinations,evaluation of nursing students on teaching quality of department and the satisfaction degree of patients,teachers and students with their nursing work (allP<0.05).Conclusions 360-degree assessment method can reflect the information of clinical nursing students from different prospective. It helps improve the ability of the nursing trainees in clinical comprehensive career ability and build up their correct professional attitude of “patient-centered”.

Objective To investigate the relationship between inflammatory response and depth of propofol sedation during cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty patients undergoing cardiac valve replacement with CPB were randomly divided into low Bispectral index (BIS)group(30≤BIS<45)and high BIS group(45≤BIS≤60).Each group had 25 cases.The induction of anesthesia in the two groups was in the same way.Anesthesia was maintained in the fol‐lowing way :low BIS group and high BIS group received intravenous infusion of 7 mg/(kg · h) and 3 mg/(kg · h) propofol ,re‐spectively.In operation ,the propofol infusion rate was adjusted to maintain each group in the corresponding BIS value range.Before induction of anesthesia(T0 ) ,at the end of the CPB(T1 ) ,the end of operation(T2 )and 1 h after operation(T3 ) ,re‐spectively ,6 mL of jugular vein blood samples were collected.The concentrations of IL‐6 ,TNF‐αand S100βprotein in the serum were detected by ELISA method.At T0 ,T1 and T2 ,respectively ,arterial blood was collected ,the pH of blood and the concentra‐tions of blood glucose and lactate were determined.Results At T1 ,T2 and T3 ,the concentrations of IL‐6 and TNF‐αin serum in low BIS group were all lower than those in the high BIS group(all P<0.05).At T2 and T3 ,the S100βprotein concentrations in serum in the low BIS group were all lower than those in the high BIS group (both P< 0.05).Compared with the high BIS group ,the concentrations of blood glucose and lactate in low group at T 1 and T2 were all lower(all P<0.05).Conclusion Ap‐propriately enhancing the depth of sedation could help relieve the inflammatory reaction of patients during cardiac valve replace‐ment with CPB.It can help protect brain tissue and reduce the incidence of brain injury.

BACKGROUND: Most of the displaced fractures of calcaneus reed operation treatment. Because early postoperative dirigation is sometimes ignored,most patients receive only good anatomic reduction but less pleased functional reduction.OBJECTIVE: To compare the effect of different starting time of the postoperative dirigation on the functional recovery of the joint of the foot after the operation of the fracture of calcaneus with joint surface displacement.DESIGN: Non-randomized and concurrently controlled retrospective analysis with blind evaluation.SETTING: Orthopedic Department of Renji Hospital of Shanghai Second Medical University.PARTICIPANTS: Cases with the fracture of the calcaneus with joint surface displacement, in the Orthopedic Department of Renji Hospital of Shanghai Second Medical University were chosen from October 2000 to June 2003. There were totally 64 cases(72 sides), male 40 sides and female 32sides, whose ages varied from 22 to 68 years old. According to the starting time of the postoperative dirigation, the cases were divided into two groups,the 1-week dirigation group with 34 cases(38 sides), male 20 sides and female 18 sides, and the 6-week dirigation group with 30 cases(34 sides), male 20 sides and female 14 sides.METHODS: Totally 64 cases were involved in the result analysis. In the two groups, the same operative therapeutic methods and postoperative dirigation were taken except the starting time of the dirigation. The dirigation was started respectively 1 or 6 weeks after the operation and lasted for 6weeks. Six months later, follow-ups were done according to the Maryland Grade(excellent 90-100, good 75 -89, moderate 50 -74, poor ＜ 50) to evaluate the activity of the talocrural joint and the stability of the anterior half of the foot and the gait as well.MAIN OUTCOME MEASURES: Primary results: the postoperative function of the injured foot of the two groups. Secondary results: the adverse events and side effect.Maryland Grade: In the 34 cases(38 sides) of the 1-week dirigation group,the average mark was 87. 8, and in the 30 cases(34 sides) of the 6-week dirigation group, the average mark was 73.2, and the difference had signifigroup, 3 cases had poor healing of the incision, and achieved the healing after 2-week medication. And 2 cases had injury of the lateral dorsal cutaneous nerve of the foot. In the 6-week dirigation group 2 cases had poor healing of the incision and achieved the healing after 2-week medication, and 1 case had injury of the lateral dorsal cutaneous nerve of the foot. There was no significant difference between the two groups.CONCLUSION: After the operation of the fracture of calcaneus with joint surface displacement, early application of dirigation is beneficial to the functional recovery of the foot and talocrural joint without unsafety.

Objective To summarize the onset and the management of serious responsiveness during the tilt table test (TTT), and the prevention measures. Methods Thirty six elderly patients (26 males and 10 females, aged between 60 70) were tested with a tilt angle of 70 degrees for a maximum of 45 minutes and then processed with isoproterenol provocative tilt testing. ECG and blood pressure were monitored during the test and the peripheral intravenous cannula were maintained for all patients with normal saline. Results Twenty one of the 36 patients were defined as positive including 10 showing serious responsiveness. Of the 10 patients, 3 had a history of atherosclerosis involving internal carotid arteries; among the 3 with bradycardia, 2 were associated with II? A V block, and another one was with chronic atrial fibrillation. The serious reponsiveness included asystole for more than 5 seconds(3 cases) , serious bradycardia for more than 1 minute(3 cases) , and serious hypotension for more than 1 minute (4 case), respectively. Those with serious responsiveness were managed with returning to supine position, or intraveneous atropine, or CPR (2 cases), or oxygen given(4 cases). Only 2 hypotensive patients recovered gradually in 10 minute emergent management while others recovered rapidly and with no complication. Conclusions TTT may result in serious responsiveness especially in elderly patients though it is non invasive method. Therefore, proper patient selection according to the indications, control of isoproterenal infusion and close observation of vital signs are important for a safe consequence.

After a description of the application of education game in literature retrieval teaching and the practical activities of information literacy education game in our library, suggestions were put forward for the problems that need to be concerned in performing information literacy education game, namely pursuing the benefits and avoi-ding the hazards, making entertainment a medium of education, rational application of small game in classroom teaching, taking immediate action, and leaving it undone as it is small.

Objective To compare clinical efficacy of inverse less invasive stabilization system (LISS) and Gamma nail in treating unstable femoral intertrochanteric fractures combined with lateral wall fractures.Methods Fifty-two patients with intertrochanteric fractures associated with lateral wall fractures followed up for at least 12 months after surgical treatment between June 2010 and June 2013 were included in this retrospective cohort study.According to the different internal fixation,the patients were assigned to inverse LISS group [16 males and 8 females;(62.5 ± 12.4)years] and Gamma nail group [17 males and 11 females;(60.4 ± 18.6)years].According to the AO classification,there were 6 patients with A2.2 type,5 A2.3 type,5 A3.1 type,6 A3.2 type and 2 A3.3 type in inverse LISS group,and there were 4 patients with A2.2 type,7 A2.3 type,9 A3.1 type,5 A3.2 type and 3 A3.3 type in Gamma nail group.Opcration time,total blood loss (intraoperaive plus occult blood loss),hospital length of stay,bone healing,time of commencing full weight-beating and complication incidence were compared between the two groups.Harris hip score was recorded postoperatively.Results All patients were followed up for 24-36 months (mean,30.2 months).Operation time in Gamma nail group was shorter than that in inverse LISS group (P ＜ 0.05),while relatively more blood loss was found in Gamma nail group(P ＜0.05).There were no significant differences in hospital length of stay and bone healing timebetween the two groups (P ＞ 0.05).Patients in Gamma nail groups started earlier full weight-bearing than inverse LISS group (P ＜0.05).Harris score was (86.1-± 12.4)points in inverse LISS group one year after operation,not significantly different from (83.3 ± 11.2) points in Gamma nail group (P ＞ 0.05).Complication of one patient with coxa vara and one bone nonunion in inverse LISS,showing no significant from one patient with screw breakage and one femoral head osteonecrosis in Gamma nail group (P ＞ 0.05).Conclusions Both techniques are effective in treatment of intertrochanteric fractures combined with lateral wall fractures and achieve similar results in function recovery.But inverse LISS is eccentric fixation,so too early weight-bearing should not be over-emphasized.

Objective To evaluate the MRA by measuring the diameter of the stenosis artery and the contralateral normal vertebral artery with unilateral stenosis. Methods Seventeen-six patients were divided into normal group and vertebral arterial type of cervical spondylosis group.Among 26 vertebral arterial type of cervical spondylosis cases,13 cases appeared as vertebral arterial type with unilateral stenosis of ≤1.6 mm in diameter .Statistics assessment of MRA in stenosis and contralateral artery was engaged. Results The unilateral artery stenosis diameter measured

Objective To investigate the relationship between 4G/5G polymorphism in the promotor of plasminogen activator inhibitor-1 (PAI-1) gene and pulmonary thromboembolism (PTE). And to detect whether it plays an important role in the pathogenesis of PTE. Methods The 76 patients with PTE, 74 gender and age matched healthy controls were recruited in this study. Genome DNA was extracted from whole blood using phenol-chloroform. Subjects were genotyped for the 4G/ 5G polymorphism of PAI-1 gene using polymerase chain reaction and restriction fragment length polymorphism analysis. Results Significant difference was found in the frequency of 4G/4G genotype between PTE group and control group (50.0% vs.24.3%,P<0.01). And there were no significant differences in 4G/5G and 5G/5G genotype between the two groups. The 4G allele frequency was higher in PTE group than in control group (72.4% vs. 55.4% , P<0.01) . The recessive allele model was informative and the odd ratio of 4G/4G genotype was much higher than of other two genotypes (OR=3.40, P<0.01). Further stratification showed 4G/4G genotype was associated with high risk of PTE for those individuals without traditional environment risk factors. Conclusions The 4G/5G polymorphism of PAI-1 gene is associated with PTE and 4G allele is recessive. 4G/4G genotype increases the risk of PTE for individuals who have no traditional risk factors of PTE.

Objective To investigate the causes and risk factors of postpartum hemorrhage (PPH) in hepatitis B virus (HBV) infected parturient.Methods Retrospective analysis was performed on the 1021 HBV infected parturient from Shanghai Public Health Clinical Center from July 2005 to June 2011.The comparisons were done by chi-square test.Results Among 1021 cases of HBV infected parturient,868 (85.01％) were asymptomatic and the PPH rate was 2.76％ (24/868) ;the remaining 153 cases (14.99％) were chronic active hepatitis B and the PPH rate was 16.99％(26/153).The difference between two groups was statistically significant (x2 =56.541,P＜0.01).The total incidence rate of PPH was 4.89％ (50/1021) and 17 cases (34.00％) were postpartum hemorrhage＞1000mL.The causes of PPH included uterine inertia (30/50,60.00％),abnormal placenta (11/50,22.00％),dysfunction of coagulation (5/50,10.00％) and lesion of birth canal (4/50,8.00％).The risk factors of PPH included delivery mode (x2 =6.528,P=0.038),abortion times (x2 =16.269,P=0.000),delivery times (x2 =6.990,P=0.008),ALT levels (x2=56.541,P=0.000) and HBV DNA (x2 =64.706,P=0.000).Conclusions The main causes of PPH in HBV infected parturient include uterine inertia,abnormal placenta,lesion of birth canal and dysfunction of blood coagulation.PPH is correlated with abortion times,delivery times,delivery mode,liver function and HBV DNA.The incidence of PPH in parturient with chronic active hepatitis B is higher than asymptomatic parturient.

Objective To investigate the effect of electroacupuncture on the expressions of in-terleukin(IL)-33 and ST2 in spinal cord and dorsal root ganglion in rats with neuropathic pain. Methods Forty adult female SD rats were randomly divided into sham operation group (group Sham),model group (group MC),ipsilateral electroacupuncture group (group SE)and contralateral electroacupuncture group (group VE).Each group had 10.The sciatic nerve injury models were es-tablished.The rats in group SE and group VE were respectively accepted electrical acupuncture treat-ment in Yanglingquan and Zusanli in the right and left limbs.Respectively,before treatment (T0 ), treated for 7 d (T1 ),3 d (T2 )and 7 d (T3 )after treatment,the MWT and TWL of rats in the four groups were measured.At T3 ,the expressions of IL-33 in spinal cord and dorsal root ganglion in rats were detected by using quantitative PCR.Results Compared with T0 ,MWT and TWL in group MC, group SE and group VE at T1-T3 were decreased significantly (P < 0.05).Compared with sham group,MWT in group SE and group VE,TWL in group MC,group SE and group VE at T1-T3 were decreased significantly (P <0.05).Compared with group MC,MWT and TWL in group SE and group VE at T2 ,T3 were increased significantly (P <0.05).Compared with sham group,the relative expression levels of IL-33 mRNA and ST2 mRNA in spinal cord and dorsal root ganglion in the group MC,group SE and group VE were elevated,the differences were statistically significant (P <0.05). Compared with group MC,the relative expression levels of IL-33 mRNA and ST2 mRNA in spinal cord and dorsal root ganglion group SE and group VE were decreased,the differences were statistical-ly significant (P <0.05).Conclusion The electroacupuncture treatment could significantly reduce the pain symptoms of neuropathic pain in rats,possibly via inhibiting the expressions of IL-33 and ST2 in spinal cord and dorsal root ganglion and blocking the IL-33/ST2 mediated inflammatory to play role.