Objective: To explore the predictive value of high-sensitivity C-reactive protein (hs-CRP) levels in patients with persistent atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). Methods: A total of 77 patients of persistent AF as the first diagnosis with initial RFCA in our hospital were studied. The patients were divided into 2 groups: Recurrent group, n=27 and Non recurrent group, n=50. Basic clinical conditions were studied by Cox model analysis to screen the risk factors for AF recurrence, receiver operating characteristic (ROC) curve was conducted to assess the predictive value of hs-CRP level on AF recurrence. Results: AF recurrence was related tothe age (HR=1.126, 95% CI 1.044-1.215, P=0.002), body mass index (HR=1.297, 95% CI 1.077-1.563, P=0.006), hypertension at stage II (HR=4.142, 95% CI 1.047-16.390, P=0.043), hypertension at stage III (HR=8.595, 95%CI 1.913-38.610, P=0.005), left atrial size (HR=1.438, 95% CI 1.212-1.707, P=0.000) and hs-CRP (HR=2.026, 95% CI 1.010-4.061,P=0.047). The area under ROC curve of hs-CRP level was 0.693,P=0.005 with the cut-off point at 0.355 mg/dl. Conclusion: Persistent AF recurrence after RFCA was related to pre-operative inflammatory status; actively control pre-operative condition may reduceAF recurrence, improve prognosis and decrease adverse cardiovascular event in relevant patients.

Objective To evaluate the factors influencing prognosis and to explore the pathological mechanism in which herpes simplex virus encephalitis(HSE) was one of the severe types of acute viral encephalitis in children and had poor prognosis.Methods Twenty-one children with HSE were diagnosed by the clinical syndrome of focal encephalitis and HSV DNA-PCR positive in cerebrospinal fluid(CSF) from Jan.2012 to Oct.2013,among whom,19 patients were treated with intravenous Acyclovir,30 mg/(kg · d) 48 hours after onset and were followed up for 6 to 24 months.Clinical data were collected including Glasgow Coma Score,the brain magnetic resonance imaging(MRI),and electroencephalography(EEG).All MRI examinations including plain scan and contrast enhancement were carried out at the beginning of admission and 1 month after the onset of symptoms.The clinical outcomes were divided into two levels accoming to the severity of the neurological deficit,then the data were analyzed by using Logistic regression and Fisher's exact probability method.The OR value was calculated.Results Eighteen children survived,of whom 5 cases had no neurological deficit(27.8％),3 cases were left with mild impairment(16.7％),and the above 8 cases were thought to have better outcome.Six cases had moderate impairment (33.3％) and 4 cases had severe impairment(22.2％) and 1 child died,and these 11 cases were thought to have worse outcome.Patients aged between 1 month and 10 years,average (2.03 ± 2.23) years old.The mean GCS score was (9.68 ± 2.65) scores,the GCS of the patients were more than 7except for one death child with 3 scores.The multiple factor analysis showed that EEG,age,GCS and the range and character in MRI were significantly correlative to the prognosis(P ＜ 0.05).The single factor analysis illustrated that age 1-4 years old(OR =30,95％ CI 2.066-366.510,P =0.002),GCS ≤ 10 scores(OR =27.518,95％ C1 2.066-366.510,P =0.004)and the wide necrosis existence involving diffuse white matter or deep nuclei of MRI findings (OR =12,95 ％ CI 1.294-111.323,P =0.017) indicated the worse outcome.Conclusions Age,GCS score,nature and damage degree of MRI lesions are the main important factors affecting the prognosis of children's HSE.HSE in children is apt to involve the cortex such as frontal lobe,parietal lobe even diffuse white matter or deep nuclei,which indicates the poor prognosis.

Objective To investigate the distribution and antimicrobial resistance of pathogens from lower respira-tory tract in patients in intensive care unit (ICU),so as to provide reference for clinical treatment.Methods Distri-bution and antimicrobial susceptibility of pathogens isolated from ICU patients’sputum obtained through fiberbron-choscope between 2011 and 2014 were analyzed retrospectively.Results A total of 3 454 pathogenic strains were isolated between January 1 ,2011 and December 31 ,2014,the percentage of gram-negative bacteria,gram-positive bacteria,and fungi were 84.11 %,14.50%,and 1 .39% respectively.The detection rates of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp .in 2011 -2014 were 38.46% -73.33% and 26.95% -37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%);resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa ,both had low resistance rates to amikacin(3.32%-37.16%);vancomycin-and linezolid-resistant strains were not found among Staphylo-coccus .In 2011 - 2014,detection rates of methicillin-resistant Staphylococcus aureus (MRSA)were 42.86% -61 .22%,methicillin-resistant coagulase-negative staphylococcus (MRCNS)were 86.96% - 91 .67%;resistance rates of Enterococcus faecium was higher than Enterococcus faecalis ,vancomycin-resistant strains were not found among Enterococcus faecalis and Enterococcus faecium ;the major fungus was Candida albicans .Conclusion Anti-microbial resistance of pathogens isolated from lower respiratory tract is getting more serious,clinicians should pay attention to non-antimicrobial infection control strategies in addition to rational use of antimicrobial agents.

Objective To study the effect of the quality control circle in reducing not using needed security signs of emergency nursing. Methods A panel for quality control circle was set up to implement quality control circle activities in order to promote the use of drug signs, anti-accident signs, hospital infection signs and nursing security signs. The un-qualified rate of the sign uses were compared between pre-and post-implication of quality control circle. Result The un-qaulified rate of drug sign uses was significantly decreased after the implementation (P<0.01). Conclusion The quality control circle can be effective for improving the rate of using nursing signs and thus enhancing nursing quality.

Objective To explore the effect of the island flap application on repairing large scale defects on the face.Methods Based on the defect size,shape and location,preauricula narrow stem side geny-neck flap,submental island flap,angular artery flap,eyelid musculus orbicularis flap and nasolabial groove island flap were used to repair the large scale defects of the face in a one-stage operation.Results All flaps survived well without any obvious complications.35 patients were followed up for 1 to 36 months.Repaired tissues were well matched with the surrounding tissue.Resulting facial contour and appearance were good,and cosmetic results overall were satisfactory.Conclusion The application of island flaps to repair the large scale defects on the face in a one-stage operation is a better method that can achieve good contour and satisfactory cosmetic results.

Objective In the treatment of tumor with high intensity focused ultrasound (HIFU),the acoustic pressure distribution determines the safety and reliability of HIFU.It is necessary to predict the acoustic field produced by HIFU transducer.Methods To analyze the acoustic pressure distribution of HIFU generated by different excitation frequency and variable incentive power,comparison was made between the acoustic pressure simulated by finite difference time domain (FDTD) method and the ones measured by experiments.ResultsThe resultsshowed that the pressureat focalpoint increasedwiththe increasing of excitation power,while the change in the focal length was negligible.The focal point moved towards the transducer with the frequency increasing until the maximum sound pressure was gained at the resonant frequency (RF).Conclusion The simulation results are consistent with the experiment results,indicating that the acoustic fields can be predicted by simulation.

To explore the roles of astrocytes in the epileptogenesis, astrocytes and neurons were isolated, purified and cultured in vitro from cerebral cortex of rats. The astrocytes were activated by ciliary neurotrophic factor (CNTF) and astrocytic conditioned medium (ACM) was collected to treat neurons for 4, 8 and 12 h. By using Western blot, the expression of calmodulin dependent protein kinase II (CaMK II), inducible nitric oxide synthase (iNOS) and adenylate cyclase (AC) was detected in neurons. The results showed that the expression of CaMK II, iNOS and AC was increased significantly in the neurons treated with ACM from 4 h to 12 h (P<0.05), and that of iNOS and AC peaked at 8 h and 12 h respectively. It was suggested that there might be some epileptogenic factors in the ACM and such signal pathways as NOS-NO-cGMP, Ca2+/CaM-CaMK II and AC-cAMP-PKA might take part in the signal transduction of epileptogenesis.

Objective To analysis the diagnostic values and characteristics of ultrasound and ultrasound guided fine needle aspiration cytology (FNAC) in patients with papillary thyroid carcinoma (PTC) before operation. Methods The data of ultrasound and ultrasound guided FNAC in 129 patients (including 148 PTC nodules) with PTC were collected from January 2014 to February 2017, and the diagnostic reports and feature descriptions of ultrasound and ultrasound guided FNAC were analyzed retrospectively. Results Among the 148 PTC nodules, the ultrasonographic imaging showed that 84.5% (125/148) with low echo-level solid nodules, 61.5% (91/148) with echo heterogenicity, 77.7% (115/148) with a ratio ≥ 1 in longitudinal/breadth, 69.6 % (103/148) with fuzzy boundary, 75.0% (111/148) with microcalcification in nodules, 97.3% (144/148) without or with incomplete aureole, 64.9% (96/148) with rich blood flow and 7.0% (9/129) with enlargement of cervical lymph nodes. The FNAC diagnosis showed that 78.4% (116/148) was diagnosed with suspected papillary carcinoma, 1.4% (2/148) was diagnosed with malignent tumor, 11.5% (17/148) was diagnosed with atypia of undetermined significance (AUS), 1.4% (2/148) was diagnosed with benign lesion, 0.7% (1/148) was diagnosed with follicular neoplasm and 6.7% (10/148) could not be diagnosed. If the suspected papillary carcinoma and malignent tumor were defined as cytodiagnosis, the diagnostic accordance rate with intraoperative pathology was 79.7%. Conclusion The preoperative accuracy rates of ultrasound diagnosis and ultrasound guided FNAC diagnosis for patients with PTC are high, and the characteristics of the both are also typical. The two examinations before operation are helpful for early diagnosis and treatment formulation for patients with PTC.

Spinal muscular atrophy (SMA) is a group of neuromuscular disorders, caused by degeneration of the motor neurons in the anterior horn of the spinal cord, with prevalence of about 1 in 6000 to 1 in 10000 in newborn. The gene carrying frequency is about 1 in 40 to 1 in 50 all over the world. SMA is one of the most common autosomal recessive diseases causing infant death. SMA mainly refers to SMN1 dependent caused by SMN1 gene mutations. Noninvasiveness and specificity make genetic testing a recommended method for diagnosis of SMA. In addition to conventional methods such as neural nutrition, muscle exercise, etc., there is no specific treatment for SMA up to now. Nevertheless, HDAC inhibitors deserve attention as they are the only drugs completed Phase Ⅲ clinical trials to date. Furthermore, other ways as small-molecule SMN enhancers, induced pluripotent stem cell (iPSC), antisense oligonucleotides to correct SMN2 splicing, etc, were still on the way of in vitro stage at present.

Objective To explore the effect of PDCA circulation on the training of clinical nursing teachers.Methods PDCA circulation was applied to the training of clinical nursing teachers byPP(planning),D(doing),C(Checking),A(acting). The results of theoretical exams,teaching skills of teachers and the student’s satisfaction with clinical teaching were compared.Result The application of PDCA circulation in clinical nursing teachers training significantly improved the theoretical exam results and teaching skills of the teachers, increased student’s satisfaction with the ways and the skills of teaching,compared to the results before its use(P<0.05).Conclusions The application of PDCA circulation in training clinical nursing teachers can effectively improve the ability of clinical teachers and increase the student’s satisfaction with teachers,thus improve the quality of nursing teaching.