Objective To explore the concordance of nursing grades which are ordered by the nurses and the standards of nursing grade and the inpatients' needs. Methods 120 inpatients were rated using the three methods respectively, which were the nurses' order, the standards of musing grade and Bartbel index, and then compare the concordance of the nursing grades rated by the three. Results Then nurses' order was of well concordance with the standards of nursing grade and Barthel index,and the Kappa value was 0.862,0.611,P<0.01,respectively. Conclusions The nurses' order accords with the standards of nursing grade and the patients' needs, is helpful to develop the clinical work, and should be spreaded and exploited.

Objective To analyze the diagnostic value of diffusion tensor imaging(DTI)and diffusion tensor tractography(DTT) in viral encephalitis at 3.0T magneton. Methods 25 patients with viral encephalitis confirmed by clinic and 25 age-match healthy patients were examined by conventional MRI and DTI. The average diffusion coefficient (ADC) map, fractional anisotropy (FA) map and diffusion tensor tractography (DTT) was acquired through image post processing technique. The ADC value, FA value of lesions and normal tissues were measured by region of interest (ROI) with the same standard and the results were statistically analyzed.Results In the acute stage of viral encephalitis: The ADC values were significantly lower than that in normal tissues of control group (P<0.01), FA values of lesions were higher than that of control group and had no statistical significance (P＞0.05). In the subacute and chronic stage of viral encephalitis: The ADC values were higher than that of control group and had statistical significance(P＜0.01), FA values of lesions were significantly lower than that of control group(P<0.05). DTT imaging showed infiltrative changes of white matter fibers in the lesion areas.Conclusion DTI and DTT technique may provide some complementally informations and clinical diagnostic value for viral encephalitis.

Objective To observe the effect of electronic colonoscopy on heart rate,blood pressure,arterial hemoglobin oxygen saturation and electrocardiography in elderly patients.Methods 60 patients were divided into two groups,elderly group (over 60 years old,n=30) and non-elderly group (＜ 60 years old,n =30).The changes in heart rate,blood pressure,arterial hemoglobin oxygen saturation and electrocardiography before and during colonoscopy were compared between the two groups.The increased heart rate was observed in both groups(the non-elderly group:t=10.746,P＜0.001; the elderly group:t=4.892,P＜0.001),and the increment of heart rate was higher in non-elderly group than in elderly group [(6.9±3.7) /min vs.(4.0±3.8) /min,t=2.88,P＜ 0.01].Results Systolic and diastolic pressures were increased in both groups during colonoscopy as compared with pre-colonoscopy(t=3.88,5.88,6.55 and 7.43,respectively,P＜0.01 or 0.001),but there were no significant differences in the increment between the two groups(t=0.31 and 0.32,bothP＞0.05).Arterial hemoglobin oxygen saturation was decreased in both groups during colonoscopy as compared with pre-colonoscopy(t=3.05 and 2.98,P＜0.05 or 0.01),and there was no significant difference in the decrease between the two groups(t=-0.13,P＞0.05).Abnormal ECG can be detected in both groups,but had no statistical significance between the two groups (20.0％ vs.16.7％,x2 =0.11,P＞ 0.05).Conclusions Electronic colonoscopy can be performed relatively safely in the elderly.

Objective To develop a new instrument to assess swallowing function which will be suitable for nurses to screen dysphagia in the patients with stroke.MethodsItems closely related to symptoms and signs of dysphagia were found with literature review, forming a preliminary instrument. All items retrieved were selected and modified by experts interview and a pilot study in patients with stroke. Then, a clinical nursing swallowing assessment tool (CNSAT) was formulated.ResultsTotally, seven items of symptoms and signs related to dysphagia in patients with stroke were found with literature review. All the seven items retrieved were selected again by experts interview and finally a CNSAT was formed with six modified items by a pilot study in 10 patients with stroke, each item with four choice based on its severity of their symptoms and signs.ConclusionCNSAT is a simple, convenient and safe instrument and suitable for nurses to assess swallowing function of patients with stroke.

Objective To explore the effects of signaling pathways inducing activation of DC-SIGN promoter on the activity of HIV-1 5'LTR.Methods The sequences of DC-SIGN promoter and HIV-1 5'LTR were amplified by PCR and then cloned into pGL-3/Basic plasmid to constructluciferase reporter plasmids for DC-SIGN promoter and HIV-1 5'LTR.Differentiated THP-1 cells stimulated by PMA (phorbol myristate acetate) were used as the in vitro model of DCs.The activaties of DC-SIGN promoter and HIV-1 5'LTR induced by IL-4 in differentiated THP-1 cells were studied using luciferase reporter plasmids.The signaling pathways were identified by using specific inhibitors.Results IL-4 induced signaling pathways could increase the activities of HIV-1 5'LTR and DC-SIGN promoter for more than two times in THP-1 cells transfected with luciferase reporter plasmids.However,the activity of HIV-1 5'LTR was weaker than that of DCSIGN promoter.ERK/JAK-STAT/NF-κB signal pathway blockers could inhibit the luciferase activity driven by DC-SIGN promoter,of which ERKI/2 blocker showed the strongest inhibitory effect that almost completely blocked IL-4 induction.NF-κB blocker had a significant inhibitory effect on HIV-1 5'LTR activity at a rate of 52.32％,followed by the ERK blocker at a rate of 43.31％.Conclusion This study suggested that IL-4-induced signaling pathways mediate the activation of DC-SIGN promoter and HIV-1 5'LTR through NFκB and ERK.

Objective To explore the effect of support with total parenteral nutrition(TPN)or early enteral and parenteral nutrition(EN+PN)on immune function of critically ill neurosurgical patients.Methods In this prospective control study,patients were divided inte TPN group and EN+PN group based on the timing of admission.The changes of immunological indicators including CD3,CD4,CD8,CD4/CD8,CD3/CD25,IgA,IgG,IgM,and serum protein before and after nutritional support were compared.Results The percentage of T lymphocyte subsets CD3,CD4,and CD8,the ratio of CD3+/CD25+,the plasma leveh of IgA,IgM,and IgG,and the serum protein were significantly increased after nutrifional supports(P<0.05,P<0.01).However,compared with the TPN group,the percentages of T lymphocyte subsets(CD3,CD4,and CD8),the ratio of CD4+/CD8+,the plasma levels of IgA,IgM,and IgG,and the serum protein were significantly higher in EN+PN group(P<0.05,P<0.01).Conclusions Both TPN and EN+PN can promote the recovery of immune function,while EN+PN is superior to TPN.Early nutritional support should be provided to critically ill neurosurgical patients.

[Objective] To explore the clinical pathological characteristics and treatment of pancreatic careinoid. [Methods] Eight patients with pancreatic careinoid were recruited between January in 1997 and December in 2007 for retrospective analysis which involved tumor markers, inanunohistostaining, accompanied with other tumors, misdiagnosis, metastasis, in-hospital mortality rate, and so on. The relevant literatures were simultaneously reviewed to comprehend the clinical pathological characteristics of pancreatic carcinoid. [Results] Tumor markers CEA, CA199, CA125, and CA72-4 in pancreatic carcinoid were 0%, 25%, 12.5%, and 0%, respectively. Specimen immanohistostaining Syn, CgA, NSE, and CK in pancreatic carcinoid were 25%, 62.5%, 75%, and 75%, respectively. Two pancreatic carcinoids were accompanied by other tumors in 8 cases. The misdiagnosis rate of pancreatic carcinoid (7/8) was markedly high. Pancreatic carcinoid possessed high metastasis (50%), high in-hospital mortality rate (37.5%) and low radical operation undergone (62.5%). [Conclusions] Pancrcatic carcinoid was accompanied with high misdiagnosis rate and poor prognosis. Routine sero-markers did not help discover pancreatic carcinoid early. The final diagnosis depended on specimen immunohistostaining with Syn, CgA, NSE, and CK.

Objective To summarize the placement, maintenance, and safety of a high-pressure resistant peripherally inserted central catheter. Methods Ten patients were peripherally placed with this catheter (included 4Fr-single lumen, 5Fr-dual lumen, and 6Fr-three lumen) using ultrasound-guided Seldinger technique in Peking Union Medical College Hospital in August 2010. The therapeutic effectiveness and safety were evaluated. Result Ten catheters were inserted successfully into the upper arms, with few complications noted during routine maintenance. Conclusions This peripherally inserted central catheter can be used for high-pressure injection, central venous pressure monitoring, and fast flow-speed transfusion. Therefore, it can be successfully applied for contrast-enhanced CT angiography and massive fluid infusion.

Objective To investigate the knowledge and attitude of nurses on prevention and intervention of common complications among bedridden patients in Chinese hospitals and to explore the influential factors.Methods It was a cross-sectional study.A total of 3 903 nurses from 6 tertiary hospitals,11 secondary hospitals and 8 primary hospitals from 6 provinces and cities were recruited by convenience sampling and surveyed using selfdesigned questionnaires.Results Nurses' average scoring rate of knowledge and attitude were 73.46％ and 85.02％.Level of hospitals,whether in ICU or not,age,working time,educational background,job title,position,employment form were influential factors for nurses' knowledge (P＜0.05).Meanwhile,level of hospitals,educational background,position,employment form were influential factors for nurses' attitude (P＜0.05).Conclusion Nurses took a positive attitude for prevention and intervention of common complications among bedridden patients,while the level of nurses' knowledge should be improved.

Objective To construct an evaluation index system of ward management,which can evaluate the efficiency of ward management fairly, and make the ward management more scientific and standardized.Methods Delphi method was used in semi-structured interview of 31 experts and 74 experts were subject to questionnaire consultation, so as to establish the index system.Results The index system of ward management so built consisted of three level-1 indexes of safety and quality, teamwork and patient satisfaction, six level-2 indexes of daily monitoring, service environment, adverse events, doctor-nurse cooperation, evaluation of administrators and patient satisfaction, and 25 level-3 indexes.Practice of this system in the past two years reduced adverse events and elevated quality of care.Conclusions This system as used clinically proves its operability and objectivity.