Bile leak is a commonly complication after biliary tract surgery.In the past,operation was considered priorly to deal with bile leak besides putting a drainage tube in advance.Minimally invasive surgery has gradually become a primary management of bile leak,with the development of minimally invasive surgery such as abdominoscope in the 20th century.

Objective To explore the self efficacy of newly-contracted nurses in a tumor hospital in Guangzhou and to find out the related factors. Methods By convenience, cluster sampling method, 333 newly-contracted nurses from a tumor hospital in Guangzhou were recruited in the study. The general self-efficacy scale (GSES) and a self-designed demographic questionnaire were used to look into their self-efficacy and explore the related factors. Results The average score of self efficacy was (2.67 ± 0.41). The level of self-efficacy was related to education and the type of hospital for internship. Nurse with bachalor degree and graduated from comprehensive hospital had higher self-efficacy. Conclusions The self efficacy of the newly contracted nurses is intermediate. The education level and the type of hospital for internship both influence the level of self efficacy. The special hospitals should strengthen the teaching and training of students and lay stress on developing their capacity to prepare them for the job.

To explore the effects and mechanisms of combining astragaloside IV (the effective component of Astragalus membranaceus) with notoginsenoside R1, ginsenoside Rb1 and ginsenoside Rg1 (the effective components of Panax notoginseng) against oxidative injury in PC12 cells induced by cobalt chloride (CoCl₂).

Objective To establish a HPLC method for determination of geniposide content in Qingkailing Capsule. Methods HPLC with Gracesmart C18 was used and detection wavelength was 238 nm with acetonitrile-water (15∶85) as mobile phase. The flow rate was 1.0 mL/min. Results The standard curve was linear over the range of 0.060 4～0.302 0 ?g (r=0.999 8). The average recovery was 98.73%, and RSD was 1.61%. Conclusion This method is reliable, accurate and suitable for the determination of geniposide in Qingkailing Capsule.

Objective To determine the median effective doae (ED50) for motor block after intrathecal ropivacaine and bupivacaine. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 18-64, weighing 46-75 kg, undergoing elective urological surgery under combined spinal-epidural anesthesia, were randomized into 2 groups ( n = 30each) receiving intrathecal 0.5% ropivacaine and 0.5% bupivacaine respectively. The ED50 was determined by up-down sequential allocation. The initial dose was 4 mg. Each time the dose increased/decreased by 1 mg. Efficacy was determined by the occurrence of any motor block in either lower extremity (modified Bromage scale > 0)within 5 or 10 min after the spinal injection. Results The intrathecal ED50 for motor block was 6.68 mg for ropivacaine (95% confidence interval 6.27-7.13 mg) and 4.07 mg for bupivacaine (95% confidence interval 3.56-4.47mg) . The relative motor blocking potency ratio was ropivacaine/bupivacaine 0.61. Conclusion The potency of intrathecal ropivacaine is lower than that of bupivacaine for motor block.

Objective To construct the competency model of emergency and critical care clinical nurses and provide a reference for allocation and selection of the emergency and critical care clinical nurses. Methods Twenty emergency and critical care clinical nurses were interviewed by using behavioral event interview method. The optimal competency elements were screened by comparing the difference in their competency in different performance levels, so the competency model was constructed. Results Two distinctive competencies and nine threshold competencies were comprised in the competency model. The category agreement of the competency model was 0.790 and the coding reliability coefficient was 0.882. Conclusions The competency model of emergency and critical care clinical nurses is of high reliability. The model provides a scientific basis for allocation and selection of appropriate emergency and critical care clinical nurses and develops human resources from newly graduated nurses.

Objective: To explore the effect of salvianolate combined with the conventional therapy on acute ischemic stroke and observe the influence on serum inflammatory cytokines of interleukin-6(IL-6).Methods: According to the random number table, 70 patients were randomly divided into the observation group (n =35) and the control group (n =35), and both were given the conventional therapy for acute ischemic stroke.The observation group was given intravenous injection of 200mg salvianolate in 250ml normal saline once a day additionally.The treatment course was 2 weeks.Another 30 persons with physical examination were in the healthy control group.The neurologic damage deficiency score (NIHSS score) was evaluated after the 3-, 7-,10-and 14-day treatment in the groups, the serum IL-6 in 24 h after onset, and after the 3-, 7-,10-and 14-day treatment was detected and compared with that in the healthy control group.Results: After the 7-day treatment, NIHSS score in the observation group decreased significantly when compared with that on admission (P＜0.05), and remained the decreasing trend.After the 10-day treatment, NIHSS score in the control group decreased significantly when compared with that on admission (P＜0.05).After the 7-day treatment, NIHSS score in the observation group was lower than that in the control group (P＜0.05).Compared with that in the healthy control group, the serum level of IL-6 in the observation group and the control group was higher in 24 h of admission (P＜0.05).The serum level of IL-6 in the observation group decreased after the 7-day treatment, and was similar to that in the healthy control group after the 14-day treatment (P＞0.05).The serum level of IL-6 in the control group decreased after the 10-day treatment, while was higher than that in the healthy control group during the whole study period (P＜0.05).The serum level of IL-6 in the observation group was lower than that in the control group after the 7-day treatment (P＜0.05), and the peak value in the observation group was notably lower than that in the control group (P＜0.05).Conclusion: Salvianolate combined with the conventional therapy can effectively decrease the NIHSS score and the content of IL-6 in the patients with acute ischemic stroke, which shows better effect than the conventional therapy alone.

Objective To investigate the relationship between hepatitis B virus reactivation and the level of blood T-lymphocyte subsets.Methods T lymphocyte subsets ( CD3,CD4,CDs ),CD4/CDs level of 40 patients with chronic carriers of hepatitis B virus and 35 patients with hepatitis B virus re-activation were detected by Flow cytometry(Epics XL).Results The hepatitis B virus reactivation in patients with CD3,CD4 and CD4/CDs levels were significantly lower than the chronic hepatitis B virus carriers,The difference between the two groups patients was significant[(71.31 ±5.20)％ vs (68.57 ±6.10)％,(37.82 ±4.90)％ vs (32.12 ±5.93)％,(1.37 ±0.28) vs (1.18 ±0.43 ),all P ＜ 0.05].Conclusion The levels of CD3,CD4 and CD4/CD8 ratio were significantly declined,it may be the one important reason of hepatitis B virus reactivation.

BACKGROUND: It is a new tendency to treat central nervous system injury or tumor therapy using the combination of seed cells and gene therapy.OBJECTIVE: To observe the dose-relationship between transfection and expression of rabbit bone marrow mesenchymal stem cell (BMSCs) with adenovirus vector carrying green fluorescent protein (Ad-GFP), and to study its effects on cell biological properties, in addition, to explore the feasibility of using Ad-GFP vector to construct gene modified BMSCs.DESIGN, TIME AND SETTING: A randomized grouping, contrast observation. The experiment was performed at the Southern Medical University between August 2008 and March 2009.MATERIALS: New Zealand white rabbits, irrespective of genders, weighing 2.0-3.0 kg, were selected.METHODS: BMSCs were separated and cultured in vitro, and then the cell immunophenotypes were detected by flow cytometry.The adenovirus was obtained by packaging 293 cells and was used to transfect BMSCs with various liters (1 ×-10~3-1×10~(10) PFU/mL).Cytometry was used to analyze the transfection efficiency.MAIN OUTCOME MEASURES: Cell morphological changes were detected under an invert microscope. The cell proliferation was detected by CCK8 kits. BMSCs transfected with Ad-GFP were induced differentiating into neuron-like cells by adding of β-mercaptoethanol.RESULTS: The surface markers of 3-6-generation BMSCs were negative to CD34 and CD45, but positive for CD29 and CD44.When the virus titers were 1 ×10~7 PFU/mL, the transfection rate was 55%, which were 85% when the virus titers were 1 ×10~9 and1×10~(10) PFU/mL. However, cell pathology phenomenon occurred when the virus titer was 1 ×10~(10) PFU/mL. The fluorescence was strongest expressed at day 7, and it still can be seen at day 28. The BMSCs trasfected with Ad-GFP could differentiate into neuron-like cells under induction of p-mercaptoethanol, with positive neuron-specific enolase.CONCLUSION: Ad-GFP with suitable titers can infect BMSCs effectively with little influence on the biology property or differentiation function. BMSCs can serve as seeds cell in gene therapy field when utilizing ad-GFP vector system.

Objective To explore the changes ofT lymphocyte subsets CD3+,CD4+,CD8+ in hepatitis B reactivation after chemotherapy.Methods Flow cytometry was used to detect T lymphocyte subsets of 32 patients with hepatitis B reactivation before and after chemotherapy.In addition,25 patients without hepatitis B reactivition were chosen as control group.Results After chemotherapy,the percentage of CD3+ and CD4+ T lymphocytes and the ratio of CD4+/CDs+ were significantly reduced than those before chemotherapy (P ＜ 0.05).However,the percentage of CD8+ T lymphocytes was not significantly changed(P ＞ 0.05).Conclusion The chemotherapy can change the number and ratio of T lymphocyte subsets,the inhibition of the cellular immune function is one of the reason of hepatitis B virus reactivation.