Objective To review the clinical experience of diagnosis and treatment of the congenital diaphragmatic hernia in newborn infants. Methods Thirty-three neonates were diagnosed having congenital diaphragmatic hernia in our hospital from Jan. 1,2004 to Sept. 30, 2009. The clinical data was retrospectively reviewed. Results 21 cases were treated surgically and 17 survived, while 4 cases died. The main cause of death was congenital pulmonary dysplasia. Another 12 cases refused to accept surgical treatment and they all died, one died shortly after he was born. Four cases who had been diagnosed by prenatal ultrasonography were survived. Conclusion The mortality of congenital diaphragmatic hernia in neonates was still high. Prenatal diagnosis of the congenital diaphragmatic hernia is very important and the cooperation between the obstetrics, neonatology and cardiothoracic surgery will improve the survival rate of congenital diaphragmatic hernia in newborn infants.

Objective To investigate the efficacy of preoperative transcatheter artery chemoembolization (TACE) correlates with outcome after orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC). Methods Sixty-seven patients with HCC underwent TACE before OLT. In all the patients, there were 52 males and 15 females with age ranging from 34 to 67 years old (average 48). Sixty-one patients met the Milan' standard, and 6 patients exceeded Milan' standard. Classic OLT was done in 62 patients and pigyback liver transplantation was done in 5 patients. Immunosuppression regimen after operation included Tacrolimus (or Ciclosporin,Sirolimus), mycophynolate, steroid hormone. The efficacy of TACE was assessed according to histological findings after OLT. Tumor recurrence rate of 1-and 2-year tumor recurrence rate, and 1-and 2-year survival rate in different groups with different responses to preoperative TACE were compared. Results Tumor necrosis rate was greater than 50% in 50 patients and new tumor nodi occurred in 2 patients. Tumor necrosis rate after TACE was 73. 77%. Tumor necrosis rate was less than 50% in 17 patients and new tumor nodi occurred in 7 patients. Forty-eight patients had satisfactory efficacy after TACE and no new tumor nodi occurred, 1-and 2-year tumor recurrence rate was 2. 08/ (1/48) and 6. 25% (3/48) respectively, and 1- and 2-year survival rate was 97. 92% (47/48) and 95. 83% (46/48) respectively. Nineteen patients had worse efficacy after TACE and new nodi occurred, 1- and 2-year tumor recurrence rate was 36. 84% (7/19) and 57. 89% (11/19), and 1-and 2-year survival rate was 73.68% (14/19) and 47. 37% (9/19) respectively. There were statistically significant difference between the two groups (P＜0.05). Conclusion TACE provides good local control in preoperatively diagnosed HCC, but its impact is limited in lesions not detected preoperatively. Patients with satisfactory efficacy after TACE before OLT had a good prognosis. The response to preoperative TACE may predict long-term outcome after LT.

selenomethionine.Although the structure of selenomethionine and methionine are similar,the electron supply ability of selenomethionine is lower than that of methionine.Conclusion Methionine as electrons provider could accelerate the photolysis of VB2 to generate ?O 2,but selenocystine,selenomethionine and cystine could directily scavenge ?O 2 generated by VB2.

Objective To develop training program of evidence implementation(EI) based on PARIHS model and to evaluate the effectiveness on clinical nurses for evidence-based nursing knowledge,attitudes and ability,and to understand the evaluation of participants about the methodological training.Methods A quasi-experiment design was conducted.A 6-month comprehensive evidence implementation training program was developed including methodological lecture,group discussion,EI case analysis,EI project development and implementation,and was carried out among 44 clinical nurses from 11 tertiary hospitals in Shanghai.The participants' EBN knowledge,attitudes and ability were measured by EBN knowledge,attitudes and ability questionnaire at 3 months and 6 months after training.Results Participants' EBN knowledge and ability were significantly improved at 3 months and 6 months after training(P＜0.05),and participants' EBN attitude had no significant difference before and after training (P＞0.05).The level of training satisfaction among participants was higher than 80.0％,and participants had finished 22 evidence implementation programs.Conclusion Evidence implementation training based on PARIHS can enhance clinical nurses' EBN knowledge and ability.Participants' EBN attitude hasn't been significantly improved.Participants have high satisfaction towards methodological training.

Objective To investigate the imaging features and laboratory detection characteristics of tuberculous meningitis (TBM ) for achieving the purpose of early diagnosis and treatment.Methods Seventy-four patients with TBM in First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to December 2015 were selected as the experimental group and 80 patients of non-TBM as the control group.All cases were performed ADA ,TB-DNA and acid-fast bacilli smear detection in cerebrospinal fluid ,and at the same time ,which was combined with tuberculous infection T-SPOT.TB test and compared with the results of ima-ging examination.Then the application values of various examinations were compared.Results The sensitivity of ADA ,TB-DNA , acid-fast bacilli smear ,T-SPOT.TB and the imaging examination for 74 patients with TBM were respectively 64.86% (48/74) , 33.78% (25/74) ,75.68% (56/74) ,10.81% (8/74) and 54.05% (40/74).The specificity were respectively 75.00% (60/80) , 100.00% (80/80) ,58.75% (47/80) ,100.00% (80/80) and 91.25% (73/80).Conclusion The difference in imaging and laboratory test indicators has a certain guiding significance for TBM clinical diagnosis.Except for clinical routine detection ,other detections should be perfected as far as possible ,conducting the comprehensive analysis can improve the accuracy of diagnosis.

Objective To investigate the effect of di-(2-ethylhexyl) phthalate (DEHP) on the postnatal lung development in newborn rats.Methods A total of 60 newborn Sprague-Dawley rats (weighing 5.0-8.0 g) in five age groups were studied in the first experiment.The rats were divided based on the different postnatal ages:postnatal day (PND)I,PND4,PND7 and PND14.A total of 45 newborn Sprague-Dawley rats (weighing 5.0-8.0 g) were randomly divided into three groups according to the dosage of DEHP administered in the second experiment.The newborn rats were administered DEHP through intraperitoneal injection at 10 (low-dose subgroup),100 (medium-dose subgroup) or 750 (high-dose subgroup) mg/kg daily from PND1 to PND13.The rats were sacrificed on PND14.Pups were sacrificed with lethal dose injection of pentobarbital sodium.The lung was removed.The right middle lobes were used for analysis.The tissue was processed for histology and lung sections were stained with HE for light microscopic (LM) morphometric measurement.The analysis was performed by means of a digital image analysis system,including pulmonary interstitial area ratio (IAR) and total length density of all segments.One-way ANOVA,LSD and Dunnet T3 methods were used for statistical analysis.Results In the normal controls,IAR decreased significantly by (31.97±5.03) ％,(30.05±3.57)％,(25.33± 1.83)％ and(22.01 ±2.19)％,respectively,from PND1 to PND14 (P＜0.05 or P＜0.01).IAR in medium-and high-dose subgroups increased significantly by (24.11 ±2.78)％ and (26.53± 3.42)％,respectively on PND 14.The total length density of all segments in unit area lung volume increased significantly by 0.047 8±0.003 7,0.050 0±0.002 9,0.071 2±0.003 0 and 0.084 4±0.004 3,respectively from PND1 to PND14 (P＜0.01).In the DEHP treated animals,when compared with the control group,IAR was significantly higher on PND14 (P＜0.05 or P＜0.01),while the total length density of all segments in unit area lung volume was significantly decreased (P＜0.05 or P＜0.01).Length density in medium-and high-dose subgroups were higher than that of low-dose subgroup by 0.082 9±0.001 8,0.077 2±0.002 0 and 0.071 3±0.003 7,respectively on PND14 (P＜0.05 or P＜0.01).Conclusions Medium-and high-dose DEHP affect the postnatal lung development in rats in a dose-dependent mode.

Objective To evaluate extended criteria donor liver in adult cadaveric liver transplant.Methods 126 liver transplantations were performed from January 2003 to June 2009,of them,74 patients received standard criteria donor livers,52 patients received extended criteria donor livers.These 52 donor livers could be divided into two groups:E1 group (a graft with 1 to 2 risk factors) and E2 group(a graft with 3 to 4 risk factors).Results There was no significant difference in half a year and 1 year survival rates between patients received E1 group extended criteria donor livers and those received standard criteria donor livers(respectively x2 =2.55,3.64,all P ＞0.05).But 2 year survival rate of patients received E1 group extended criteria donor livers was lower than those receiving standard criteria donor livers (x2 =4.9,P ＜0.05).Half a year,1 year and 2 year survival rates in patients receiving E2 group extended criteria donor livers were less than those receiving standard criteria donor livers (respectively x2 =3.91,8.67,11.34,all P ＜ 0.05).The half a year,1 year,and 2 year survival rates of patients received extended criteria donor livers with MELD score more than 20 was less than those with MELD score ＜ 20 (respectively x2 =0.16,0.16,0.07,all P ＜ 0.05).Conclusions Extended criteria donor livers can be used safely if the risk factor of donor liver was less than 3,or when recipient's MELD score was ＜20.

Objective:To compare the ability of Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol in rapid assessment of patients with chest pain.Methods:Patients with chest pain suggestive of acute coronary syndrome were recruited from January 2017 to February 2017 in Emergency Department of Tianjin Medical University General Hospital. Patients were stratified into various risk groups with Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol. The end point was acute myocardial infarction (AMI) within 30 days.Results:A total of 134 patients were enrolled. Fifty-seven patients were preliminary classified as a low risk for suitable discharge by Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol, and one of them had AMI within 30 days. The sensitivity of stratifying low-risk patient was 83.3%, the specificity was 43.8%, and the negative predictive value was 98.2%. Fifty-one patients were preliminary classified as a low risk for suitable discharge by Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 39.8%, and the negative predictive value was 100%. Twenty-four patients were preliminary classified as a low risk for suitable discharge by Vancouver chest pain rule, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 18.8%, and the negative predictive value was 100%.Conclusions:Using accelerated diagnostic protocols to stratify emergency department patients with chest pain achieved early and safe emergency department discharge. The Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol stratified more than 30% of low-risk patient, with a sensitivity of no less than 98% and a specificity of no less than 99.5%.

Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.

Truth disclosure of cancer patients is becoming more and more recognized in the world.Truth disclosure is usually regarded as the doctor's responsibility.However,the nurse has become an active participant in the truth disclosure of cancer patients both intentionally and inadvertently.This article systematically reviewed the role of nurses at home and abroad in informing patients with cancer the truth so as to provide guidance for the clinical practice.In April 2017,we retrieved articles in Pubmed,Chinese CNKI,Wanfang database,VIP database,and retrieval time is not restricted.A total of 92 literatures were retrieved and 8 articles were retrieved by manual searching.Finally,23 articles were included.Through systematic review of the literature,nurses are found to play an important role in informing cancer patients the truth.Compared with physicians,nurses have a more positive attitude for truth disclosure.Nurses have the most contact with patients and family members,if the nurses have plans to communicate with the families on telling the truth to cancer patients,there will be a positive impact on the truth disclosure attitude of family members.It is necessary to explore the strategy of truth disclosure for cancer patients with integrated medical staff in the future.