Objective To explore the common problems that facing the nursing trainees and seek the way to solving them. Methods The established Internet forum for nursing eases which was divided into six areas,such as clinical decision,ethical problems,nursing skills, the relationship between teachers and students,the relationship between nurses and patients,vocational prevention;77 nursing stuedents who were from three junior colleges of Jiangxi province participated in this study voluntarily.Nursing cases that happened during practical period were sent to the forum by volunteers and were discussed by nursing students and tutors. Results The cases sent by the nursing students were listed as the following order:relationship between teachers and students, relationship between nurses and patients, vocational prevention, clinical decision, ethical problem, and nursing skills. Conclusions During practical period, the main problems which the nursing students focused on stemod from the relationship between teachers and students, the relationship between nurses and patients and vocational prevention. Nursing educators should put emphases on the related knowledge and skills in order to improve the students'ability of coping with these problems.

Objective To analyze the correlations between pediatric intersive cave unit (PICU) nurses′job satisfaction and their perception of job characteristics. Method One hundred and thirty-six PICU nurses from a women and children′s hospital of Guangzhou participated in the study and the job diagnostic survey (JDS) and Minnesota satisfaction questionnaire short-form (MSQ20) were used to investigate the relationship between the job characteristics and job satisfaction. Results The average score on general satisfaction was (3.57 ± 0.41). The dimensions like skill variety, task integrity, feedback from job and feedback from others, had a significant positive impact on general satisfaction (all P<0.05). Conclusion Nurses generally have a relatively middle level of job satisfaction and measures should be taken to improve their job satisfaction as well as the quality of nursing.

Objective To evaluate the relationship of clinical symptom to plasmic levels of D-dimer, activated factorⅦ (FⅦa) and tissue factor pathway inhibitor (TFPI)/X a in patients with urticaria. Methods A total of 27 patients with chronic urticaria (CU), 27 patients with acute urticaria (AU) and 26 normal human controls were included in this study. Symptom score was determined and disease course was surveyed in these patients. ELISA was used to detect the plasma levels of D-dimer, FⅦa and (TFPI)/Xa in patients and controls. The relation of clinical symptom and disease course to plasma levels of these parameters was assessed. Results In patients with AU and normal controls, the plasma level of D-dimer was 450.57± 242.13 ng/mL and 266.81±40.68 ng/mL, respectively, the level of FⅦa, 2.23± 0.74 ng/mL and 5.23±1.35 ng/mL, respectively, and the level of TFPI/Xa 0.87±0.13 nmol/L and 0.88 ~ 0.12 nmol/L, respectively. There was a significant difference in the level of both D-dimer and FⅦa (both P < 0.01 ), whereas no differ-ence was observed in that of TFPI/X a (P > 0.05) between patients with AU and normal controls. In addi-tion, increased level of D-dimer and decreased level of FⅦa were noticed in patients with CU compared with those in normal controls (593.80±294.04 ng/mL vs 266.81±40.68 ng/mL, 3.98±0.35 ng/mL vs 5.23± 1.35 ng/mL, both P < 0.01 ), but there was no significant difference in the plasma level of TFPI/Xa (0.87± 0.16 nmol/L vs 0.88±0.12 nmol/L, P > 0.05). Significant difference was observed in the plasma level of D-dimer and FⅦa between patients with AU and CU (450.57±242.13 ng/mL vs 593.80 ±294.04 ng/mL, P < 0.05; 2.23± 0.74 ng/mL vs 3.98± 0.35 ng/mL, P<0.01 ). The plasma level of D-dimer positively corre-lated to the symptom score of patients with CU and those with AU (r= 0.68, P< 0.01; r= 0.82, P< 0.01),but was independent of discase course (P> 0.05). Neither the level of FⅦa nor that of TFPI/Xa correlated to symptom score or disease course of patients (all P > 0.05). Conclusions There is an overactivation of coagulation cascade, consumption of blood coagulation factors and secondary fibrinolysis in patients with urticaria, suggesting that plasma D-dimer and FⅦa may be associated with the clinical symptoms of urticaria.

Objective To explore the method of demonstrating main operative section of facial recess approach with multi-slice CT by using double oblique muttiplanar reconstruction.MethodsSimilarly as surgical procedure of facial recess approach,30 (60 eras) normal temporal bones in cadavers were reconstructed to observe main operative sections and anatomical marks.Main images of operative section of facial recess approach were reconstructed using double oblique multiplanar reconstruction on multislice CT.With the reference of operative anatomical marks,the ratios of visibility of anatomical marks on the transverse plane,coronal plane,sagittal plane and double oblique were calculated and compared.The degree,of which major anatomical landmarks were displayed on the same plane ( axial,coronal,sagittal,or doubleoblique sagittal plane),was classified using the following criteria: level 4: 100％ of anatomical landmarks were presented in the same plane; level 3: 90％ to 99％ of anatomical landmarks were presented in the same plane; level 2: 80％ to 89％ of anatomical landmarks were presented in the same plane; level 1: 70％ to 79％ of anatomical landmarks were presented in the same plane ; level 0: ＜ 70％ of anatomical landmarks were presented in the same plane.Classification data were tested by chi-square test.Results Four key operative section were involved in facial recess approach,which were of oblique sagittal orientation.The central mark of the first key operative section was semicircular canal by using double oblique multi-planar reformation.On reconstructed images of the first key operative section,horizontal reference line was short process of incus,and the angle adjusting the reference line on the transverse plane was 22.15° ±5.22°.On the reconstructed images of the first key operative section,coronal reference line was tympanic segment of facial canal,and the angle adjusting the reference line on the coronal plane was 14.35° ± 4.02°.On the reconstructed images of the second key operative section,the central mark was fossa incudis,the horizontal reference line was short process of incus and the angle was 20.15° ± 5.52°,while the coronal reference line was tympanic segment of facial cana,and the angle was 13.15° ± 3.33°.On the reconstructed operative images of the third key section,the central mark was pyramidal eminence,the horizontal reference line was the horizontal portion of the facial nerve and the angle was 32.53° ±5.22°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.05° ± 4.43°.On the fourth reconstructed images of the key operative section,the central mark was the posterior border of round window,the horizontal reference line was the superior border of oval window,and the angle was 50.15° ± 8.02°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.25° ± 4.12°.For the four planes (double-oblique sagittal,axial,coronal,or sagittal plane),the results of the degree to which they could include the major anatomical landmarks in the same layer of the first section were: level 4 in 60 sides,level 2 in 12 sides and level 3 in 48 sides,level 2 in 15 sides and level 3 in 45 sides,level 3 in 10 sides and level 4 in 50 sides,respectively.The results of the second section were: level 4 in 60 sides,level 2 in 11 sides and level 3 in 49 sides,level 2 in 13 sides and level 3 in 47 sides,level 3 in 11 sides and level 4 in 49 sides,respectively.The results of the third section were: level 4 in 60 sides,level 2 in 10 sides and level 3 in 50 sides,level 2 in 11 sides and level 3 in 49 sides,level 3 in 9 sides and level 4 in 51 sides,respectively.The results of the fourth section were: level 4 in 60 sides,level 2 in 9 sides and level 3 in 51 sides,level 2 in 8 sides and level 3 in 52 sides,level 3 in 5 sides and level 4 in 55 sides,respectively.The four planes differed significantly in the degree to which they could include the major anatomical landmarks in the same layer ( x2 =123.3200,121.4231,122.4011,125.4213,all,P ＜ 0.05 ).The visibility ratio of every section is 100％ (60/60).Conclusion Double oblique multi-planar reformation is a new method to demonstrate landmarks of operative section of facial recess approach in one slice.The reconstructive images of operative section with double oblique multi-planer reconstruction may provide valuable information for operation.

Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.