Objective To establish a set of teaching evaluation index system for clinical practice which can embody education cocept of modern nursing,accord with reform direction of nursing education, and is scientific,reasonable and easy to operate. Methods Teaching evaluation index system for clinical practice was preliminarily established using literature data, theoretical analysis, expert evaluation,collective argument by evaluator and who were evaluated. Results 32 first-order indices,169 second-order indices and value assignment of weight were confirmed after establishment of teaching evaluation index system, which was satisfying to the evaluator, who were evaluated and nursing students. Conclusions The evalu-ation index satisfy the requirement of teaching quality evaluation for practice,the degree of approval, coordi-nation and reliability is relatively high, so it can be used for teaching quality evaluation for nursing practice.

Objective: To investigate the clinical effect of total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer. Methods: Total cystectomy and W-shaped orthotopic ileal neobladder were performed on 29 male patients and 3 female patients. Atfer the cystectomy, 35-40 cm terminal ileal segment was isolated to make W-shaped orthotopic ileal neobladder. Bilateral uretero-ileal anastomoses were constructed by nipple technique, urethral stump was sutured to the lowest portion of the ileal pouch. Results: All surgeries were completed successfully. Patients were able to void by increasing the abdominal pressure, daytime continence rate was 87.5% and nighttime continence rate was 78.1%. The mean neobladder capacity was 410.6 mL and the mean postvoid residual urine was22.7 mL at 6 months. After the surgery, ileal neobladder leakage occurred in 3 (9.4%) patients, mild ileus occurred in 2 (6.3%) patients, ileo-urethral anastomosis stricture developed in 1(3.1%) patient, and dysuria occurred in 3 (9.4%) patients because of the mucus.HTe complications were treated properly and satisfactory results were obtained. Erection was preserved in 5 of the 9 male patients with normal erectile function, and normal sexual function was preserved in 1 female patient who underwent uterus-sparing cystectomy. HTe mean follow-up was 15 months.One patient died of distant metastasis and pneumonia, while other patients survived without tumor. Conclusion: Total cystectomy and W-shaped orthotopic ileal neobladder have the advantages of voiding through the native urethra, satisfactory continence, low complication rates of upper urinary tract damage and electrolyte imbalance. W-shaped orthotopic ileal neobladder may be considered as the ifrst option of urinary diversion atfer cystectomy. Postoperative management should focus on complications and follow-up.

Objective To afford the basis for the application of Sinomenine(SIN) in the proposal for organ transplantation, the expression of TGF-? 1 was explored in inborn WistarSK kidney transplantation model. Methods Forty-eight recipients were divided into 4 groups at random:group 1 being used as control and treated with 0 9% natrii chloride(3ml?kg -1 ?d -1 ,ip), group 2 treated with SIN(30mg?kg -1 ?d -1 ,ip),group 3 treated with CsA(2 5mg?kg -1 ?d -1 ,ip),group 4 treated with SIN(30mg?kg -1 ?d -1 ,ip) combined with CsA(2 5mg?kg -1 ?d -1 ,ip).Allografts of 6 recipients from each group were harvested at day 6 before end stage rejection for histological studies. The synergistic effects of SIN combined with CsA were assessed by COX proportional hazards model. The quantitative methods of immunohistochemistry were used for analysis on expression of TGF-? 1.Results Control recipients rejected their allografs at day 9 post-operation, the average life time was 7 83?9 75 days. Treated with either SIN(30mg?kg -1 ?d -1 ,ip) or subtherapeutic doses of CsA(2 5mg?kg -1 ?d -1 ,ip) allografts survival was mininally prolonged. Combined treatment with SIN and subtherapeutic doses of CsA led to a significant prolongation of graft survival(group 4), more than 18 days. The expression of TGF-? 1 was enhanced significantly in group 2 and group 3.No synergistic effect of SIN combined with CsA on expression of TGF-? 1 was observed. Conclusion The therapeutic value of SIN in rat kidney allograft model suggests that this safe chinese medicine has remarkable efficacy of anti-acute rejection in rat kidney transplantation. It shows significant synergistic effect with sub-therapeutic CsA. The immunosuppressive efficacy of SIN is probably based on enhancing express of TGF-? 1. No synergistic effect of SIN and CsA on expression of TGF-? 1 indicates low danger of fibrosis of allografts. SIN will be a hopeful chinese medicine for immunosuppressive treatment in organ transplantation.

Objective:To present our initial experience with robot-assisted laparoscopic prostatectomy (RALP) for complicated cases.Methods:Clinical and pathological data from 4 complicated prostate cancer cases,who underwent RALP from October to November in 2015,were analyzed retrospectively.All the cases were conducted transurethral plasmakinetic enucleation of prostate and hormonal therapy before RALP.Results:All surgeries were done successfully.The age,baseline prostatic special antigen,clinical tumor stage,operation time and estimated blood loss were 58-70 years,6.04-70.15 ng/mL,T2bT3b,210-360 min and 50-250 mL,respectively.No blood transfusion was needed.All surgical margin were negative.Conclusion:Although previous transurethral surgeries and hormonal therapies may increase the difficulty for operations,RALP is still appropriate for the complicated cases of prostate cancer.

Objective To discuss the clinical effects of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot.Methods From November,2014 to June,2017,16 cases of skin and soft tissue defect in ankle or dorsal foot had been repaired,which were 11 males and 5 females,aged from 25to 58 years old(average,32.5 years).The rotation points were on proximal 5 cm of the lateral malleolus in 11 cases and on the level of tarsal sinus in 5 cases.The largest flap was 10.0 cm×18.0 cm and the smallest flap was 6.0 cm×4.0 cm.The color,thickness,texture,sensation,appearance,donor site shape and functional were followed-up after operation.Results All the 16 patients were followed-up from 1 to 24 months.The distal flap appeared dark in 1 case 2 days after operation,and blood supply was improved after stitches;One case was superficial necrosis and healed after dressing.All the flaps had good appearance and texture,no pigmentation,scar contracture,and so on.Conclusion The forward lateral malleolus perforator flaps have perforator constantly and the color,thickness are similar with the receiving areas,the rotation point could on proximal 5 cm of the lateral malleolus and on the level of tarsal sinus,which is a good method to repair skin and soft tissue defect of ankle or dorsal foot.

Objective: To evaluate theresult of Screwless Scarf osteotomy for the treatment of moderate to severe hallux valgus. Methods: From January 2016 to May 2017, 13 patients with 15 feet underwent Screwless (without internal fixation) Scarf osteotomy for the treatment of moderate to severe hallux valgus.The hallux valgus angle (HVA) and intermetatarsal angle(IMA) were compared before and after surgery.Clinical outcomes were assessed by American Orthopedic Foot and Ankle Society (AOFAS) scoring. Results: The mean follow-up was 6 months in all the patients(range, 2-12 months). HVA was decreased by 25.7°(form 38.8°preoperative to 13.1°postoperative). IMA was decreased by 9.6°(form 18.3°preoperative to 8.7°postoperative). AOFAS sore was increase by 39.7 points (45.7 points preoperative to 85.4 points). The incidence of excellence was 86.7%. Conclusions Satisfactory clinical outcomes can be achieved by screwless Scarf osteotomy for moderate or severe hallux valgus.However, strict indications and sufficient surgical skills are crucial.

OBJECTIVE: To compare the safety and efficacy of prone and modified recumbent positions on minimal invasive percutaneous nephrolithotomy. METHODS: A total of 62 patients with upper urinary calculi were grouped into two groups, one of which consisted of 27 patients who underwent the minimal invasive percutaneous nephrolithotomy with modified recumbent position, and the other 35 patients with prone position. There was no significant statistical difference in the age, gender and complications between the two groups before surgery (P>0.05). Duration of and blood loss during surgery, complications in the perioperative period, and the length of postoperative hospital stay were all recorded. The data were analyzed by SPSS 13.0. RESULTS: Surgery was successful in all cases. There was no failure to puncture nor need to resort to open surgery. Average operation duration for the modified recumbent position group was (85.1± 25.3) min vs (97.2±30.6) min for the prone position group. Mean blood loss during the operation was (117.5± 49.7) mL vs (149.3±53.1) mL. There were no severe complications during and after surgery in the modified recumbent position group. In the prone position group, s one patient suffered pneumothorax during the operation and two suffered selective renal artery embolization because of massive hemorrhaging following the operation. There were significant differences in blood loss during surgery, in complications during the perioperative period, and in length of postoperative stay in hospital (P<0.05) between the two groups. CONCLUSION The patients are safer and more easily tolerate the minimal invasive percutaneous nephrolithotomy in the modified recumbent position than in the prone position, though the treatment efficacy of these two kinds of operation is similar. It is recommended that the modified recumbent position should be used generally in the percutaneous nephrolithotomy.
Adult ; Aged ; Female ; Humans ; Kidney Calculi ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Nephrostomy, Percutaneous ; methods ; Posture ; Prone Position ; Supine Position ; Ureteral Calculi ; surgery

Objective:To study the spatiotemporal heterogeneity of the incidence rate of pulmonary tuberculosis and its macro influencing factors in China, so as to provide a reference for the relevant departments to formulate prevention and control policies.Methods:In virtue of the complexity of influencing factors, a new method combining principal component analysis (PCA) with geographically and temporally weighted regression (GTWR) was proposed to analyze the spatiotemporal heterogeneity of influencing factors for pulmonary tuberculosis. Using the data of incidence rate of pulmonary tuberculosis and gross regional product (secondary indicators) of 31 provinces (excluding Hong Kong, Macao, and Taiwan) in China from 2010 to 2019, a macro influencing factor indicator system was established by the PCA scores of 21 secondary indicators quantified to determine four primary indicators: comprehensive economy, medical security, cultural and educational transportation, and resources and environment. Based on the indicator system, PCA-ordinary least squares (PCA-OLS) model, PCA-geographically weighted regression (PCA-GWR) model, and PCA-GTWR model were constructed.Results:Three models passed F-test with F-values of 58.74, 196.62, and 1 202.90 respectively (all P < 0.05), indicating that the impact of the primary indicators on the incidence of tuberculosis is statistically significant. The mean squared error (0.01), the mean absolute error (0.08), the mean absolute percentage error (0.02), and the corrected Akaike information criterion (-358.76) of PCA-GTWR were lower than those of PCA-OLS (0.13, 0.28, 0.07, 258.38) and PCA-GWR (0.06, 0.15, 0.03, 23.41). Meanwhile, the determination coefficient (0.95) of PCA-GTWR was higher than that of PCA-OLS (0.44) and PCA-GWR (0.77), indicating the goodness of fit of the model is the best. And the PCA-GTWR model showed that the comprehensive economy, medical security, cultural and educational transportation, and resources and environment had significant spatiotemporal heterogeneity on the incidence rate of pulmonary tuberculosis according to the distribution of regression coefficients. Conclusion:It is necessary to comprehensively consider various factors and formulate detailed and overall prevention and control measures for pulmonary tuberculosis according to local conditions.