Objective To evaluate the diagnostic value of serum cardiac fatty acid binding protein (H-FABP), high sensitivity C-reactive protein (hs-CRP) and cardiac troponin T (cTnT) in the diagnosis of myocardial infarction. Methods From August 2015 to July 2016, 50 patients with myocardial infarction were treated as group A, and 48 patients with chest pain caused by other factors were treated as group B, and 53 patients were selected in our hospital physical examination of patients without chest pain as C group. The levels of H-FABP, hs-CRP and cTnT were compared between the three groups. The levels of H-FABP, hs-CRP and cTnT in patients with myocardial infarction at 5 h, 10 h, 24 h and 3 d after admission were compared . Results The positive rate of serum H-FABP, hs-CRP and cTnT in group A was significantly higher than that in group B, group C[(82.00％, 41.00), 68.00％ (34/50), 76.00％ (38/50) VS 8.33％(4/48), 14.58％(7/48),10.42％(5/48) VS 0.00％(0/53),0.00％(0/53),0.00％(0/53)], and the difference was statistically significant (P<0.05). The positive rate of H-FABP and hs-CRP was higher than that of admission at 10 h, 24 h and 3 d at 5 h after admission. The positive rate of cTnT was higher than that at 5 h, 24 h and 3 d at admission (P<0.05). The positive rate of H-FABP was significantly higher than that of the control group (P<0.05). Conclusion Combined detection of serum H-FABP, hs-CRP and cTnT can improve the diagnostic value of myocardial infarction and reduce the misdiagnosis rate.

Objective To investigate the diagnostic value of tumor marker measurement in biliary juice obtained during endoscopic retrograde cholangiopancreatography (ERCP) in differential diagnosis of suspected biliary-pancrentic diseases.Methods ERCP was performed in patients with suspected biliarypancreatic lesions that could not be diagnosed by routine methods including ultrasonography,MRCP,blood biochemistry and serum tumor marker test,and biliary juice was obtained to measure tumor markers including CEA and CA199.A total of 29 patients with definitive diagnosis were recruited and divided into benign and malignant groups.Serum biochemical findings and tumor markers were compared between 2 groups.The diagnostic value of uhrasonography,EUS,MRCP,ERCP and ERCP combined with biliary tumor markers were also compared.Results There was no significant difference in serum biochemical findings,serum CEA,serum CA19-9 or biliary CA19-9 between 2 groups,while the average biliary CEA in malignant group was significandy higher than that in benign group (P＜0.001).The accuracy of ERCP combined with biliary tumor markers in diagnosing suspected biliary-pancreatic diseases was 69.0%,which was higher than that of ultrasonography (6.9%),MRCP (37.9%) and ERCP (41.4%),respectively.Conclusion The diagnostic accuracy of suspected biliary-pancreatic diseases can be improved through ERCP combined with biliary CEA test,which is helpful in differential diagnosis between benign and malignant lesions.

Objective To observe the feasibility and safety of dexmedetomidine used in motor evoked potentials(MEP)monitoring in patients undergoing neurosurgery.Methods Thirty ASA Ⅰ orⅡ patients,male 1 5 cases,female 1 5 cases,aged 20-60 years,weighing 40-80 kg undergoing neuro-surgery receiving MEP monitoring were randomly divided into 2 groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In group D,dexmedetomidine 0.5 μg/kg was in-fused over 10 minutes before anesthesia induction,and then was infused at a rate of 0.5 μg·kg-1 · h-1 toward the end of operation.Group C received the equal volume of normal saline.HR,MAP and BIS were recorded at admission to the operating room (T0 ),skin incision (T1 ),when the muscle re-laxants were stopped (T2 )and 50 minutes later (T3 ).The current intensity and the time when first MEP was induced after muscle relaxant was stopped,the amplitudes and latencies of MEP on thenar muscle at T3 ,the total consumption of anesthetics,and development of adverse effects were also re-corded.Results Compared with T0 ,HR in group C at T1 ,T3 and MAP in group C at T1-T3 was in-creased,HR in group D was decreased at T2-T3 (P <0.05).Compared with group C,HR and MAP were decreased at T1-T3 in group D(P <0.05).The amount of propofol consumed and the current in-tensity inducing MEP were lower in group D than in group C (P <0.05).The amplitude of MEP at T3 was higher in group D than in group C (P <0.05).Compared with group C,the incidences of hy-pertension and tachycardia were decreased in group D,and the incidence of bradycardia was increased (P <0.05).Conclusion Dexmedetomidine used in MEP monitoring in patients undergoing neurosur-gery can meet the operation requirements,maintain hemodynamic stability,reduce the incidences of adverse reactions,and improve monitoring quality of MEP.It is a safe and feasible anesthesia method.

Objective To evaluate the feasibility,safety,post-operative short and long-term outcomes of laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric carcinoma without serosal invasion.Method From May 2007 to May 2013,54 cases of advanced gastric antral cancer without serosal invasion underwent laparoscopic-assisted D2 radical distal gastrectomy (laparoscopic group),54 demographically and pathologically-matched cases undergoing open surgery served as control.The surgical risk,post-operative recovery and follow-up results were compared.Result Surgery was successful in all patients.The mean operation time in laparoscopic group and open group was (168 ± 31) mins and (157 ±20) min respectively,the difference was significant (t =2.237,P =0.027) ; Intra-operative blood loss was (151 ± 56) ml and (213 ± 86) ml (t =4.45,P =0) ; Post-operative intestinal function recovery time was (2.7 ± 0.7) d and (3.4 ± 0.5) d (t =5.4,P =0) ; Lymph node dissection number was (26.4 ± 4.2) and (24.8 ±5.2) (t =1.769,P=0.08).Post-operative complication rate was 4％ and 11％ (P =0.142).There was no perioperative mortality in either group.Post-operative pathological stage of Ⅰ B,Ⅱ A,Ⅱ B,ⅢA was 8,17,24,5 cases in laparoscopic group and 9,14,23,8 cases in open surgery group.108 cases were followed up from 7 to 79 months.In laparoscopic group,8 cases had local recurrence or distal mestastasis,and 4 cases died from tumor; In open group,9 cases had local recurrence or distal mestastasis,and 6 cases died from tumor.Conclusions Laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric cancer without serosal invasion is feasible,safe and advantageous in minimal invasion and rapid recovery,with good short and long-term outcomes.

Objective To discuss the feasibility of constructing the system of traditional Chinese medicine nursing diagnosis.Methods Based on the theoretical analysis and status quo analysis,the feasibility of constructing the system of TCM nursing diagnosis was discussed,and the achievements and problems waiting for settlement were also narrated.Resuts It has the foundation of constructing the system of TCM nursing diagnosis,but some problems still need to be solved.Conclusions It is feasible for building TCM nursing diagnosis system,and the TCM nursing diagnosis system does not conflict with NANDA-I.

AIM To study the effects of propofol on membrane fluidity and intracellular free Ca 2+ concentration ([Ca 2+ ] i ) in PC12 cells and discuss its relevant mechanism. METHODS PC12 cell lines were divided into seven groups: control, solvent and propofols(1,3,10,30,100 mg?L -1 ). Fluorescence depolarization method was used to measure dynamically microviscosity in PC12 cells and [Ca 2+ ] i was detected using calcium fluorescentprobe Fluo 3/AM and a laser scanning confocal microscope. RESULTS ①Acute administration of various doses of propofol induced a significant decrease of microviscosity in PC12 cells dose dependenty. ② Solvent, propofol at dose of 10 mg?L -1 had no effect on [Ca 2+ ] i in PC12 cells, however, after 30 and 100 mg?L -1 administration, [Ca 2+ ] i increased markedly at 20～30 seconds (increase percentage were 119% and 140% respectively) and then recovered to their pre administration levels within 50 seconds. CONCLUSION The propofol can significantly increase membrane fluidity in PC12 cells in a dose dependent manner and elevate [Ca 2+ ] i in PC12 cells at doses of 30 and 100 mg?L -1 . These changes are consistent with each other and related closely with anesthetic effect of propofol.

Objective To compare nursing students' adaptation in clinical practice who are under two different curriculum systems in order to guide our college's curriculum reform. Methods ROY adaptation model was used as the theoretical basis to design the questionnaire. 48 students in the reform class and 80 students in the parallel class were surveyed by questionnaire. Results The reform class and the parallel class of students were both unadaptable in clinical practice, but the reform class's adaptation was better than the parallel class. Conclusions Curriculum reform has some positive effect in clinical practice, nursing educators should take appropriate approaches to promote students to adapt the clinical practice.

AIM:To investigate the effects of P34H gene silencing on the expression of P34H and activity of hyaluronidase (HYD) in mouse sperm.METHODS:The recombinant plasmid series of P34H targeted short hairpin RNA (shRNA) were constructed by GV248 plasmids vector.These recombinant plasmids were transformed into DH 5αcompetent cells, and the plasmids were taken from DNA sequencing analysis .The HEK293T cells were co-transfected with shRNA and lentiviral packaging plasmids .The 3 kinds of recombinant lentiviruses and negative control lentiviruses were used to in -ject into the mouse epididymis and the expression of P 34H at mRNA and protein levels was detected by real-time PCR and Western blot, respectively.The location of P34H protein on the mouse spermatozoa was determined by indirect immunofluo-rescent staining using P34H antibody.The positive rate and activity intensity of HYD was detected by modified sodium hya-luronate-gelatin membrane.RESULTS:DNA sequencing analysis confirmed that the 3 P34H-shRNA sequences were suc-cessfully inserted into the lentiviral vectors .P34H expression in epididymis tissue was significantly decreased at both mR-NA and protein levels compared with those of the non-transfected and normal control vectors (P<0.05).The GV-P34H-shRNA-1 played a significant role in reducing the percentage of P 34H positive rate and the activity of HYD in mouse sperm.The silencing effect did not significantly differ between the non-transfected and normal control vectors .CONCLU-SION:Silencing of P34H significantly inhibits the percentage of P 34H positive rate and the activity of hyaluronidase in mouse sperm.

Objective To investigate the distribution of human papillomavirus(HPV) subtypes in condyloma acuminatum(CA) patients in Shenzhen People's Hospital and assess the association between HPV subtypes and cervix neoplasm.Methods Type specific prevalence and extent of multiple infection were assessed in the genital tract CA samples collected from 352 patients visiting Departments of dermatology or gynecology of Shenzhen People's Hospital during 2003-2004.PCR using MY09/11 as primer and reverse dot blot hybridization for the genotyping of 9-20 HPV subtypes.Results HPV type diversity was broad in the investigated CA patients.The low risk HPV type(HPV subtype 11,6) was dominant and multiple HPV infections occurred in 37% of HPV-positive samples.High risk HPV type was dominant in CA from cervix,especially in the high grade cervical intraepithelial neoplasia(CIN Ⅱ+),and multiple high risk HPV(HR-HPV) infection was found in 87% of HPV positive samples.Conclusion HPV subtypes 6 and 11 were dominant in the patients visiting Shenzhen People's Hospital.HPV subtypes 16 and 18 may be the main causes of malignant changes of cervix.

Objective To summarize the imaging features of computed tomography (CT)and magnetic resonance imaging (MRI) combined with multi-technology imaging and compare its effects in the preoperative evaluation of malignant perihilar biliary obstruction.Methods The clinical data of 20 patients receiving CT and MRI who were diagnosed with malignant perihilar biliary obstruction by pathological examination at the Wuxi Second People's Hospital between January 2008 and April 2014 were retrospectively analyzed.Patients receiving CT combined with negative-contrast CT cholangiopancreatography (nCTCP) and computed tomography angiography (CTA) were allocated into the CT group,and patients receiving MRI combined with magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance angiography (MRA) were allocated into the MRI group.The images of the 2 groups were analyzed by 2 independent reviewers.The classification of malignant perihilar biliary obstruction,hepatic artery and portal vein invasions and lymph node and organ metastases were evaluated respectively,and then the results of evaluation were compared with the results of surgery and pathological examinations.The comparison between the accuracy of imaging examination in the 2 groups and accuracy of perihilar biliary obstruction classification were analyzed by the chi-square test.The comparison of evaluating accuracy (sensitivity and specificity) among vascular invasion and lymph node and organ metastases were done by the receiver operating characteristic (ROC) curve analysis,and the comparison of its accuracy were done by the z-score test.Results The imagings of bile duct involvement of the 2 groups showed that there were irregular thickening bile duct wall combined with retrograde intrahepatic bile duct dilatation.The symptoms of vascular invasion included the stricture and occlusion of blood vessels or more than half of vascular contact surface with tumor.The symptoms of lymph node metastasis included the enlarging short-axis or round-like circular enhanced lesions.The symptoms of organ involvement included the unclear boundary of lesions or low-density necrotic foci within organ.All the 20 patients underwent the surgical treatment,including 13 patients with hilar cholangiocarcinoma and 7 patients with gallbladder carcinoma.Hepatic artery invasions were detected in 5 patients,portal vein invasions in 10 patients,lymph node metastases in 10 patients and organ metastases in 4 patients.The cases of classification of perihilar biliary obstruction,hepatic artery invasion,portal vein invasion,lymph node metastasis and organ metastasis which were evaluated respectively by reviewer 1 and 2 were 18/18,19/18,18/18,17/16 and 18/19 in the CT group and 17/16,14/13,17/16,15/14 and 19/18 in the MRI group.The imaging of the 2 groups were compared with the evaluating accuracies of classification of malignant hilar biliary obstruction,hepatic artery and portal vein invasions,lymph node and organ metastases in the 2 groups,showing no significant differences (x2=12.593,8.889,z=1.823,1.956,0.462,0.817,0.977,0.751,0.233,1.403,P＞0.05).Conclusion CT and MRI for malignant hilar biliary obstruction had the same imaging features,meanwhile,they can provide an equivalent performance in the classification of malignant hilar biliary obstruction,hepatic artery and portal vein invasions and lymph node and organ metastases.