Objective To explore the adjustment and posttraumatic growth of people with spinal cord injury from the community. Meth-ods From January 2013 to May 2015, Semi-structured in-depth interviews were used to interview 12 participants with spinal cord injury from Sunshine Rehibilation Center. Interviews were recorded on audio-tape with participants' permission and then transcribed verbatim. The transcribed interviews were analyzed according to interpretative phenomenological analysis. Results 3 superordinate themes emerged includ-ing struggling in despair, disentangling from the shadow of disability and continuing with life as normal, facing challenge and achieving pos-itive growth. Conclusion It is necessary to explore the process of adjustment and posttraumatic growth of people with spinal cord injury, which contribute to understand their psychological experience, psychological feature, and coping strategies, promote their physical and psy-chological recovery, and provide theory and practice guidance for family and society re-integration.

Objective To explore the effect of health management on compliance and complication in postpartum reexamination.Methods According to the admission time, 2,217 parturients were assigned into control group and another 2,216 into experiment group.The latter was managed with health management including establishment of health records, telephone follow-up and follow-up by visits and the former received routine nursing care.The two groups were compared in respect of maternal postpartum reexamination and health status.Result The compliance rate in the experimental group was higher than that in the control group and the incidence of complications was lower than that in the control group(P<0.05).Conclusion The implementation of health management can improve postpartum compliance in reexamination and reduce postpartum complications.

With the continuous improvement of various imaging techniques, the morbidity of polypoid lesions in gallbladder is increasing year by year. However, owing to the lack of effective means of diagnosis before undergoing the surgery, there is a large number of patients who do not have definite indications of surgery for prophylactic cholecystectomy. Therefore, this text will carry out a comprehensive narration of the imaging features, epidemiological characteristics and pathological types about the polypoid lesions in gallbladder, summarizing the experience of diagnosis and treatment of the disease, helping the option in clinical treatments.

Aim To investigate the influence of intranasal delivery of calcitonin gene-related peptide(CGRP)on cerebral blood supply and expression of vascular endothelial growth factor(VEGF)following experimental subarachnoid hemorrhage(SAH).Methods Wistar rats were divided into normal control group,SAH group,intranasal normal saline(NS)+SAH group and intranasal CGRP+SAH group.SAH models were produced by double injection of autologous arterial blood into cisterna magna.CGRP and NS were given by intranasal perfusion.Dynamic observations of regional cerebral blood flow(rCBF)of cerebral cortex were made using a laser Doppler flowmeter probe.On the third day after the second cisternal injection,the expression of VEGF protein in cerebral cortex was observed by immunofluorescence method combined with laser confocal microscopic observation.Results Anatomic observation revealed that SAH models were successfully manufactured.In SAH and intranasal NS+SAH groups,a drastic and persistent drop in rCBF was noted during the observed periods.The decrease of rCBF in intranasal CGRP+SAH group was slighter as compared with that in SAH and intranasal NS+SAH groups.In SAH and intranasal NS+SAH groups,increased expression of VEGF protein in cerebral cortex was observed on the third day after second cisternal injection as compared with that in normal control group.The expression of VEGF in intranasal CGRP+SAH group was more obvious than that in intranasal NS+SAH group.Conclusion Intranasal delivery of CGRP improves cerebral blood supply and promotes angiogenesis by enhancing the expression of VEGF after SAH.

Objective To observe the effects of CoC12 treatment on the expression of Hypoxia-inducible factor-1(HIF-1α) in mice hippocampus at different time point.Methods Balb/c mice were injected with CoCl2 and the change of HIF-1 α was detected by western blot and immunofluorescence and confocal laser scanning microscope at different time point(0h,1h,2h,3h,4h,5h and 6h) after injection.Results The relative protein level of HIF-1α was 0.135 ±0.01,0.572 ±0.01,0.595 ±0.03,1.09 ±0.03,1.30 +0.04,1.275 ±0.03,0.947 ±0.03respectively at different time point after the injection.The HIF-1α protein level reached its peak value at 4 h and decreased at 5h and 6h.Fluorescence intensity of HIF-1α was 13.33 ± 3.42,30.95 ± 7.86,46.50 ± 9.65,61.50± 10.02,88.30 + 15.69,71.39 ± 11.28,67.41 ± 10.78 respectively at different time point after the injection.The HIF-1α fluorescence intensity also reached its peak value at 4 h and decreased at 5h and 6h.Conclusion Time dependent HIF-1α accumulation was in close correlation with the CoCl2.

Objective To evaluate the therapeutic effect of percutaneous endoscopic necrosectomy (PEN) in treating infectious pancreatic necrosis (IPN).Methods A retrospective review of clinical data of 6 patients with IPN who received PEN in Changhai Hospital, Second Military Medical University from Dec 2015 to Sep 2016 was performed.Clinical parameters were recorded, including basic information, severity evaluation and therapeutic methods and times.In addition, vital sign parameters and inflammatory marks before and after PEN treatment were compared.Results There were 4 patients with severe acute pancreatitis (SAP) and 2 patients with moderately severe acute pancreatitis (MSAP) in these 6 patients with IPN.Mean APACHEⅡ score was 12 (10~15), and mean MCTSI scores was 9.3(8~10).All 6 patients received a total of 13 times PEN treatments, with a mean of 2.2(1~3) times.Each patient was treated with a mean of 2.5(1~4) drainage tubes placed in the peripancreatic abscess after PEN treatment, and the mean time for drainage was 139 d(106~183 d).Besides, the mean hospitalization time was 116 d (48~223 d).All the patients′ condition was improved significantly after PEN treatment, including reduced heart rate, body temperature and inflammatory markers, without bleeding or other serious complications.Only 1 patient had pancreatic fistula after treatment, and no patients needed open abdominal drainage surgery.Patients with higher MCTSI scores likely required more times of PEN and more drainage catheters, longer length of drainage and hospital stay.Conclusions PEN was safe and effective for treating patient with IPN, but those with higher MCTSI scores were associated with more PEN treatments, more drainage tubes, and longer time of drainage and hospitalization.

At present, there is still a lack of comprehensive diagnosis and treatment criteria for pancreatic exocrine insufficiency around the world. Pancreatic surgeons often ignore or misjudge pancreatic exocrine insufficiency secondary to pancreatic cancer, and as a result, pancreatic exocrine insufficiency is not adequately treated, which greatly affects the quality of life of patients with pancreatic cancer. This article summarizes the latest research advances in the pathogenesis, typical symptoms, and diagnostic methods of pancreatic exocrine insufficiency, as well as pancreatic enzyme replacement therapy in different stages of pancreatic cancer. It is pointed out that pancreatic enzyme replacement therapy can significantly improve the quality of life of patients with different stages of pancreatic cancer.

Objective:To retrospectively analyze the data of patients undergoing extracorporeal membrane oxygenation (ECMO) during perioperative period of cardiac transplantation and provide objective and reliable evidence for further clinical promotion.Methods:Collect the clinical data of patients undergoing heart transplantation and ECMO support in Fuwai Hospital, analyze the duration of ECMO support, combined use of aortic balloon counterpulsation (IABP), and complications during the supporting period. All statistical analyses were processed by SPSS 23.0 software. Independent sample Student's test was employed for normal distribution and Mann-Whitney U test for abormal distribution. χ2 or Fisher exact test was utilized for comparinge the classification data between groups. Results:All ECMO support models were intravenous-arterial ECMO (V-A ECMO). Eight patients successfully bridging heart transplantation through VA-ECMO. Sixty-one patients (89.7%) who had undergone cardiac transplantation were successfully weaned from ECMO while 48 patients (70.5%) survived and discharged. The most common complications during circulation support are bleeding, acute renal insufficiency, and pulmonary infection. Patients with ECMO support in the operating room had a better rate of survival and weaning off(95.6%, 84.4%) than those with ECMO at the bedside of ICU(72.2%, 27.8%).Conclusions:ECMO can provide adequate circulation and respiratory function support for heart transplant patients, and it is an indispensable treatment for patients to go through the perioperative period of heart transplant surgery smoothly. It is advocated to use IABP combined with ECMO in the early stage and at the same time to increase the perfusion of vital organs, improve the prognosis of patients and obtain good outcomes.

Objective To investigate the impact of the initial fluid resuscitation with different ratio of crystalloid and colloid on the prognosis of patients with moderate severe acute pancreatitis (MSAP).Methods A retrospective analysis was made by reviewing the clinical data of 72 patients with the diagnosis of MSAP from January 2015 to July 2017 in Shanghai Changhai Hospital.According to crystalloid-colloid ratio,which was the total volume of crystalloid fluid versus colloid fluid in the first 7d at admission,patients were randomly divided into low crystalloid-colloid ratio group (＜ 4.5),middle crystalloid-colloid ratio group (4.5-7.5),and high crystalloid-colloid ratio group (＞ 7.5).The parameters of the fluid resuscitation,the cases progressing into severe acute pancreatitis (SAP),the incidence of multiple organs dysfunction syndrome (MODS) and mechanical ventilation,pancreatic necrosis and infection rate,30-day mortality,the duration of systemic inflammatory response syndrome(SIRS) and the time reaching full amount of enteral nutrition were analyzed.Results There was no statistically significant difference in gender,age,etiology and APACHE Ⅱ score within 24 h at admission in each group,which were comparable.Within the first 7 d,there were no statistic difference in the total volume of fluid infusion and the speed of resuscitation in the three groups.While the total fluid volume in the first 24 h and 72 h [(3 095 ± 1 253) ml vs (2 524 ± 751) ml,(8 005 ± 7 269) ml vs (6 667 ± 1 498)ml],the total volume of crystalloid fluid in the first 7 d [(14 485 ± 3 917) ml vs (11 544 ±2 639) ml],crystalloid-colloid ratio (12.7 ± 4.9 vs 6.0 ± 1.0),the cases of SAP (12 vs 4),MODS (41.7 ％vs 16.0％) in high ratio group were significantly higher than those in middle ratio group,but the total volume of colloid fluid was significantly lower [(996 ± 528) ml vs (1 968 ± 574) ml].In addition,the duration of SIRS [(16.5 ± 15.2) d vs (8.2 ± 6.4) d],and the time reaching full amount of enteral nutrition [(7.2 ±3.6) d vs (4.8 ± 2.4) d] in high crystalloid-colloid ratio group were higher than those in middle crystalloid-colloid ratio group (all P ＜ 0.05).Comparing with middle crystalloid-colloid ratio group,there were no significant difference in the mechanical ventilation rate,pancreatic necrosis and infection rate and 30-day mortality in high ratio group.The total volume of colloid fluid was significantly higher [(3 680 ± 1 310) vs (1 968 ±574)] and the crystalloid-colloid ratio was significantly lower [(3.2 ±0.9) vs (6.0 ± 1.0)] in low ratio group than that in middle ratio group,and there were no statistical differences on other parameters.Conclusions For the patients with MSAP,early fluid resuscitation with the crystatloid-colloid ratio of (4.5-7.5) can decrease the incidence of SAP and MODS,shorten the duration of SIRS,and promote the recovery of intestinal mucosal barrier function.

Objective: To understand the influence of post-abortion care (PAC) on the reproductive health of unmarried female college students,and to provide scientific basis for reproductive health education. Methods: A total of 486 unmarried female college students who received artificial abortion voluntarily due to unwanted pregnancy and had complete follow-up data were investigated by questionnaires before and six months after the operation from July 2017 to June 2018 in the Tongde hospital of Zhejiang Province. Results: There were 248 patients with abortion history, including 15 patients with abortion frequency ≥3 times.72 cases of high-risk abortion, the high-risk factors were re-abortion within half a year and the number of abortion ≥3 times; After PAC intervention, the awareness rate on menstruation and ovulation knowledge, scientific contraceptive knowledge, prevention of sexually transmitted diseases knowledge(types of diseases,raltes of transmission and preventive measures), and the harm of abortion knowledge(short-term and longterm complications), was higher than before(χ2=21.42, 69.65, 71.09, 52.80, 63.25, 187.59, 356.02, P<0.05). Before intervention, only 53.7% (261/486) of female college students used medium and low efficiency contraceptive measures, only 0.4% (2/486) were high-efficiency contraceptive measures. After intervention, all of them used contraceptive measures, The rate of effective contraceptive measures in the immediate and six months after operation was 85.4% (415/486) and 68.3% (332/486) respectively, which was significantly higher than before(χ2=786.10, P<0.05). Conclusion PAC service for female college students can improve awareness rate of sexual and reproductive health, enhance effective contraceptive measures, reduce the risk of repeated abortion.