Steroid-restant nephrotic syndrome (SRNS) is often continuously relapsed, and even develops into end-stage renal di-sease. It has been a great difficulty in the treatment of nephritic syndrome in children. In recent years, many researchers of children SRNS on diagnosis, pathology, treatment have been carried on domestically and in abroad. This paper reviews the latest update on the di-agnosis and treatment of SRNS in children.

Objective To investigate the clinical features,treatment,medication and abnormal metabolism control status in elderly benign prostatic hyperplasia (BPH) with metabolic syndrome (MS).Methods The 397 patients with BPH aged ＞60 years (294 with MS) were retrospectively analyzed.The clinical features,treatment and control status were analyzed.Results Body mass index,waist circumference (BMI),2 hPBG,systolic pressure,diastolic pressure,TG and uric acid,urinary albumin/creatinine ratio,urinary albumin were higher and HDL-C was lower in BPH with MS than without MS (P＜0.05).Prostate volume,PSA level,IPSS score,quality of life score were higher in BPH patients with MS than without MS (P＜0.05).Treatment modality analysis showed that lower urinary tract symptoms was mild,watchful waiting accounted for 22.3％,urinary retention or obstruction related operation treatment for 8.7％,moderate to severe symptoms related oral drugs treatments for 67％,the oral drug treatment was still the main mode of BPH.In the patients with abnormal levels of glucose metabolism,the target arrival rate (TAR) on FBG,2 hPBG and HbAlc were 49.6％,34.9％ and 37.5％,TAR on all the three was 19.1％.In the hypertensive population,TAR on systolic and diastolic pressure were 44.1％ and 82.5％,TAR on both two was 41.7％.TG,TC,LDL-C and HDL-C were 31.3％,35.4％,48.2％ and 64.9％,on all the four was 29.9％.Conclusions The ratio of elderly BPH with MS is high,but the target arrival rate on control of urinary tract symptoms and abnormal metabolism component is not optimistic in spite of a positive drug administration.

Objective To explore the effect of transport procedure adopted on intra-hospital transport of critically ill patients. Methods Three hundred and fifteen critically ill patients(control group)were intra-hospital transported adopting traditional method,while 309 ones(experimental group)adopting transport procedure. The occurrence rate of accidents of both groups and satisfactory rate of nurses in which the patients were admitted.Result The occurrence rate of accidents in experiment group was lower than that in control group and the satisfactory rate of nurses on transport procedure was higher than that on traditional method with statistical difference(P<0.01).Conclusion The application of transport procedure can effectively minimize the risk of critically ill patients during intra-hospital transport and increase satisfactory rate of medical staffs.

Objective Exploration of best effect on washing medical instrument between automatic cleaning sterilizer and ultrasonic cleaners.Methods Suppose washing method A and method B.A:directly put medical instrument into automatic cleaning sterilizer,wash,sterilize and dry it step by step.B:place medical instrument into ultrasonic cleaners,wash with ultra sonic,shower with cool water,sterilize and dry with hot water.Results By comparison,after washing method A,there remains 0.33‰ residue on the medical instrument while after B there are 0.03‰ remains.It has an evident difference between result of the two methods(?~2=46.546,P=0.000).Especially on the cleaning result of saw-shaped medical instrument:A method has 0.52‰ residue while method B is 0.04‰,which is of great significance.But there exists no significant difference of washing result on non saw-shaped instrument(?~2=2.667,P=0.102).Conclusion Ultrasonic cleaners can reach the optimum washing effect on saw-shaped medical instrument,with a great decline on residue after cleaning.And automatic cleaning sterilizer can wash large quantity of non saw-shaped,saving labor and enhancing efficiency by automation cleaning process.Therefore,adpoting different equipment to wash different instrument can efficiently improve cleaning effect and ensure safe and qualified stelization.

Objective To investigate the effects of paired associative stimulation (PAS) on the recovery of upper limb motor function in stroke patients,and to analyze the relationship between the change of motor cortex excitability in the contralesional hemisphere and the recovery of motor function in the affected upper limb.Methods Thirty hemiplegic stroke patients were divided randomly into a treatment group and a control group.Both groups were given routine rehabilitation therapy,but the treatment group also received PAS consisting of transcranial magnetic stimulation (TMS) of the intact motor cortex and electrical stimulation (ES) of the median nerve at the wrist of the intact arm with an interval of 10 ms between the TMS and ES (PAS10).The PAS10 was delivered at a frequency of 0.05 Hz and an intensity of 120％ the resting motor threshold (RMT),once daily for 30 minutes,five times a week for 4 weeks.Corticospinal excitability was measured using motor evoked potentials (MEP) and the RMT.The FuglMeyer upper limb assessment (FMA),Brunnstrom staging and the modified Barthel index (MBI) were also applied before and at the end of the 4 weeks of treatment.Correlation was sought between any changes in MEP amplitude,the RMT of the contralesional hemisphere and changes in the FMA results.Results Before the intervention there were no significant differences between the two groups in terms of any of the assessments.After 4 weeks of treatment,all the assessments had changed significantly compared to those before the treatment,but there were still no significant differences between the two groups in terms of any the assessments.After 4 weeks of treatment,the differences in MEP amplitude from the contra-lesional hemisphere and the differences in FMA scores were positively and significantly correlated with a correlation coefficient of r =0.431.The lesioned hemisphere was also positively correlated with the differences in FMA scores with a significant correlation coefficient of r =0.608.Conclusion PAS10 can facilitate the recovery of upper limb motor function.The change in motor cortex excitability of the contra-lesional hemisphere significantly correlates with functional recovery in the upper limb.

Objective To determine the clinical value of the multi-slice spiral CT virtual endoscopy (CTVE) for the detection of biliary pancreatic junction lesions. Method MSCT and virtual endoscopic reconstruction were performed in 30 healthy volunteers, 18 cases of common bile duct stones and 7 cases of ampullary carcinoma to observe patterns of duodenal papilla and measure its size.Results Reconstructed image of CTVE showed that the normal duodenal papilla was nodular in 16,shaped like "V" in 8 "Y-shaped" in 6 of the healthy volunteers. Its diameter was (0.84±0.17)cm. In the patients with common bile duct stones, it was nodular and its diameter (1.72±0.32)cm. In the patients with ampullary cancer, it was of irregular protruded type and its diameter (2.30±0.85)cm.There was significant difference among the 3 groups in the overall mean values (P＜0.01). Conclusion CTVE is a convenient, non-invasive and precise clinical examination to observe the shape of duodenal papilla and determine its size.

Objective To investigate the level of compassion fatigue and its influencing factors among ICU nurses.Methods A total of 1 530 ICU nurses in 2 third-grade hospitals in Wuwei city were investigated by using convenience sampling method,general questionnaire and Paramedics Compassion Fatigue Scale Questionnaire.Results The average original score of 7 items of compassion satisfaction was (2.73±0.39),and the item of emotional indifference got the highest score (3.31±0.26),the item of physical and mental exhaustion got the lowest score (2.13±0.22).It could be show that the age,intrinsic satisfaction,extrinsic satisfaction were the main influencing factors of compassion fatigue after multiple regression analysis.Conclusions To give regular psychological intervention and sharing the experience of nurses in different departments were an effective way to relieve nurses compassion fatigue and to reduce the nurses' psychological pressure.

Objective To compare the effects of paired associative stimulation (PAS) and repetitive transcranial magnetic stimulation (rTMS) on motor cortex excitability.Methods The baseline corticospinal excitability of the left hemispheres of 10 healthy subjects was measured in terms of resting motor threshold (RMT) and other indicators of motor evoked potentials (MEP).On the following day they received PAS composed of trascranial magnetic stimulation (TMS) to the motor cortex of the left hemisphere and electric stimulation (ES) of the median nerve contralateral to the motor cortex,with an interval of 10ms between the TMS and ES (termed PAS10).The PAS10 was delivered at a frequency of 0.05 Hz and an intensity of 120％ of the RMT,for a total of 90 pulses.The MEP amplitude,MEP latency and RMT were evaluated one minute after the stimulation.After the PAS intervention,an interval of one week was allowed to eliminate any effect of PAS on motor cortex excitability.Then rTMS was delivered to the subjects' left motor cortex at the same time of day at a frequency of 1 Hz and an intensity of 120％ of the RMT,for a total of 1000 pulses.MEP amplitude,MEP latency and RMT were evaluated one minute after the stimulation.The two interventions were compared in terms of MEP amplitude,MEP latency and RMT.Results The average MEP amplitude,MEP latency and RMT at baseline were (2.93 ± 0.99) mV,(20.97 ± 1.67) ms,and (46.06 ±5.32) ％,respectively.One minute after PAS10,the MEP amplitude,MEP latency and RMT were (1.14 ± 0.76) mV,(21.87 ± 1.09) ms and (52.06 ±4.20) ％,respectively.One minute after rTMS,the MEP amplitude and latency and the RMT were (2.24 ± 0.79) mV,(20.88 ± 1.94) ms,and (49.00 ± 4.54) ％,respectively.The differences in MEP amplitude,MEP latency and RMT pre-and post-intervention were (0.69 ± 0.10) mV,(0.09 ±0.05) ms and (3.94 ± 0.93) ％,respectively for rTMS.For PAS10 they were (1.83 ± 0.14) mV,(0.90 ± 0.26)ms and (6.00 ± 1.13)％,respectively.The differences in MEP amplitude decrease and MEP latency lengthening between the two stimulation protocols were significant,but the difference in RMT elevation was not.Conclusion Both PAS10 and low frequency rTMS suppressed motor cortex excitability,but the suppressive effect of PAS10 is more significant.

Objective To investigate the changes of zinc in maternal plasma and MMP-9,collagen Ⅳ levels in serum and matrix metalloproteinases-9 (MMP-9) level in amniotic fluid in patients with premature rupture of membranes at term(TPROM).Methods Thirty cases who were diagnosed as PROM at term during Nov.2012 to Mar.2013 were enrolled as case group,and 30 cases delivered during the same time without PROM were enrolled as control group.Maternal blood and ammiotic fluid were collected from all the cases.The level of zinc in maternal plasma was measured by atomic absorption method and the levels of MMP-9 in serum and amniotic fluid were detected by enzyme linked immunosorbent assay(ELISA),while the level of collagen Ⅳ in serum was measured by up-conversion luminescence method.The relationship among them was analyzed.Results Compared to control group,there were statistically significant difference between TPROM and control groups in terms of the level of zinc,collagen Ⅳ,MMP-9 in serum and MMP-9 in amniotic fluid (zinc:(109.10 ± 16.07) μmol/L vs.(90.54 ± 10.99) μmol/L; t =-5.22,P ＜ 0.001 ; collagen Ⅳ:(56.86 ±41.26) μg/L vs.(88.61 ±44.87) μg/L;t =2.852,P =0.006;MMP-9 in serum:(1 463.25 ±483.6) μg/L vs.(1 196.9 ± 357.43) μg/L,t =-2.426,P =0.018 ; MMP-9 in amniotic fluid:(125.48 ± 67.18) μg/L vs.(72.64 ± 60.74) μg/L,t =-2.873,P =0.006).Zinc level in maternal plasma and collagen Ⅳ in serum had a negative relationship in TPROM (r =-0.261,P =0.044).Zinc level in maternal plasma and MMP-9 level in serum had a positive relationship in TPROM (r =0.274,P =0.034).MMP-9 levels in serum and amniotic fluid had a positive relationship in TPROM (r =0.264,P =0.047).There were no significant relationship between zinc level in maternal plasma,MMP-9 level in amniotic fluid,collagen Ⅳ and MMP-9 levels in serum,collagen Ⅳ in serum and MMP-9 in amniotic fluid (r =0.215,-0.172,-0.172 ; P ＞ 0.05).Conclusion The level of zinc in maternal plasma and increase of MMP-9 in serum and amniotic fluid of women and decrease of the level of collagen Ⅳ in serum are related to the occurrence of TPROM.

objective To investigate the clinical signiifcance of the changes of angiotensionⅡ(AngⅡ) in children with IgA nephropathy (IgAN). Methods Thirty children diagnosed as primary IgA nephropathy by renal biopsy (IgAN group) and 30 healthy children (control group) were recruited from May 2008 to December 2012. The serum and urine AngⅡwere measured by ELISA and compared between IgAN group and control group. The AngⅡexpression in the renal tissue of IgAN group was detected by immuno-histochemical method, and was correlated with other clinical data.. Results Urine AngⅡwas signiifcantly higher in the primary IgAN group than that of control group (P<0.05);AngⅡexpression in the urine is positively correlated with proteinuria (r=0.37, P=0.046), and is associated with the severity of clinical presentation; AngⅡexpression in kidney tissue increased with the severity of the renal histopathologic grading (r=0.69, 0.79, P=0.000), while AngⅡin blood and proteinuria, AngⅡexpression in kidney tissue were not signiifcantly correlated with the number of crescents. Conclusions Urine AngⅡin children with IgAN is signiifcantly correlated with the severity of the pathologic stage and the level of proteinuria. Urine AngⅡdetection may be useful to assess the progress and prognosis of chronic kidney disease.