Objective To explore the correlation between caring behavior and critical thinking of nursing students in clinical practice. Methods Totally 203 nursing students in clinical practice were investigated with Critical Thinking Disposition Inventory- Chinese Version (CTDI- CV) and Caring Behavior Scale (CBS). Results The structural model obtained a good fit. Critical thinking and caring behavior were positively correlated with each other(β=0.46,P<0.01). Conclusions Nursing students′caring behavior could improve their critical thinking. With the cultivation of critical thinking of nursing students, nursing educators should pay attention to improving their caring behavior.

Objective To explore the correlation between ponticulus of atlas and abnormal morphology of V3 segment of vertebral artery. Methods All patients included in this study were underwent CTA and 3D reconstruction examination of intracranial ponticulus and cervical in our workstation, as well as the site, shape of petals and its relationship with vertebral artery was observed. The diameter, shape and trail of vertebral V3 segment were measured and analyzed. The results were analyzed byχ2 test. Results A total of 195 sides (157 cases) ponticulus were detected in 613 cases (1 226 sides), the abnormal morphology of V3 segment of vertebral artery were 103 sides and combined with ponticulus 69 sides among them, including (according to side): the collectivity was 8.4% (103/1 226), combination ponticulus was 35.4% (69/195), uncombination ponticulus was 3.3%(34/1 031), and the risk with ponticulus was increased compared with no ponticulus, and showed statistical significance by Chi-square test(χ2=215.679,P=0.001). The difference of abnormality of vertebral artery was performanced in number, site and shape of ponticulus, we found that the ponticulus composite was 57.1%(12/21) and higher than ponticulus simple 32.8%(57/174)(χ2=4.873,P=0.027), the ponticulus borderl was 68.8%(11/16) which was also higher than ponticulus posticus(27.2%) and ponticulus lateralis(36.4%)in the ponticulus simple(χ2=11.357,P=0.030), the sharp ones (64.2%) were higher than the blunt(14.6%)in the tip of bony processes of the incomplete type ponticulus(χ2=26.813, P=0.001),the smaller ones were higher than the larger in the distance of the gap between the two tips of bony processes in the incomplete type ponticulus(χ2=9.212,P=0.010), and the smallerones(87.5%)were also higher than the larger(28.6%)in the diameter of the hole of complete type ponticulus(χ2=18.193,P=0.001), all of the above ones showed statistical significance among all groups by Chi-square test (P<0.05). Conclusions Ponticulus of atlas can significantly increase the risk of abnormal morphology of V3 segment of vertebral artery, and the differences of abnormality of vertebral artery were performed in number, site and shape of ponticulus, which included the ponticulus composite, ponticulus borderland, the shape tip of bony processes, the moderate distance between the two lip of bony processes, and the smaller diameter of complete type Ponticulus.

Objective To expand MSCT obseration and cognition in the ponticulus of atlas,and to improve the diagnosis for it. Methods 263 cases were collected among the patients undergone the examine of MSCT angiography in intracranial and cervical and volume rendering technique(VRT)with unenhance images,and observation and analysis was focused on the posterior arch of atlas. Results 69 cases(97 sides)were detected ponticulus in this group,including unilateral in 41 cases,bilateral in 28 cases.The simple type ponticulus were 82 sides,including the ponticulus posterior (PP)were 60 sides,the ponticulus lateralis (PL)were 1 5 sides,the ponticulus borderland (PB)were 5 sides,The ponticulus middle (PM)were 2 sides.According to the shape of the ponticulus:simple root in 43 sides,opposite beaked in 21 sides,complete type in 18 sides.The ponticulus compound (PC)were 1 5 sides.Conclusion The images of MSCT VRT can showed accurately the ponticulus of atlas,and it can provide reliable imaging evidence on its diagnosis and classification,and it can be used as an unearthly method for its examination.

Objective To investigate the expressions of PI3K, AKT and MRP protein in pancreatic carcinoma and to determine the clinicopathological significance and the correlation among three protein expressions. Methods The immunohistochemical method was used to detect the expressions of PI3K, AKT and MRP in forty three pancreatic carcinoma, nine chronic pancreatitis and eight normal pancreatic tissue samples. Results The positive expression rates of PI3K, AKT and MRP were 46.51%, 55.81% and 39.53%, respectively in pancreatic carcinoma, which were remarkably higher than those in normal pancreatic tissue and in chronic pancreatitis (P<0.01 and P<0.05, respectively). The aberrant expression of PI3K, AKT and MRP were associated with lymph node metastasis and TNM stages (P<0.05). The abnormal expression rate in both MRP and PI3K was 32.56%, the normal expression rate of both MRP and PI3K was 46.51%, and there was positive correlation between the expression of MRP and PI3K(r=0.581, P<0.01). The abnormal expression rate of both MRP and AKT was 32.56%, the normal expression rate was 37.21%, and there was a positive correlation between MRP and PI3K (r=0.432,P<0.05). The abnormal expression rate of both MRP and PI3K was 37.21%, the normal expression rate of both MRP and PI3K was 32.56%, there was also a positive correlation between MRP and PI3K (r=0.306,P<0.05). Conclusions The expressions of PI3K, AKT and MRP were up-regulated in pancreatic carcinoma. The expressions of PI3K and AKT may be related to the lymph node metastasis and TNM staging.

Objective:To study the combined use of endoscopic balloon dilation with endoscopic biliary brushings in diagnosis of bile duct strictures.Methods:A prospective single center study was conducted at the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology. All patients with suspected malignant bile duct strictures shown on CT or MRI imaging from January 2018 to January 2020 were reviewed. All patients gave informed consent to the endascopic retrograde cholangiopancreatography procedures. Their clinical and follow-up data were analyzed. All patients underwent endoscopic balloon dilation of bile duct strictures. Before and after balloon dilation, biliary brush cytology was performed, and the results were used to classify the patients into the control group and the experimental group. Pathological examination of the brush cytology samples was carried out by a single chief pathologist. Presence of cancer cells or significant heterogeneous cells indicated a positive brush cytology test. Negative patients who still highly consider cholangiocarcinoma and agree to surgery and whose gross specimen is confirmed to be malignant after surgery should be considered as false negative by brush examination; it is difficult to judge that patients with cholangiocarcinoma have progress after 2 months of follow-up should be considered as false negative by brush examination. Any progression of disease indicated that the brush test was wrong and the test was again classified as false negative. Only when there was no progression of strictures was the possibility of a benign biliary stricture being considered. The advantage test (McNemar test) was used to analyze the difference between the two diagnostic methods.Results:Of 39 patients who were included in this study, there were 26 males and 13 females, with an age of (68.0 ± 5.2) years. Cholangiocarcinoma was diagnosed by histopathology, surgery or at 2 months follow-up in 35 patients. In the control group, 17 patients had a positive brush test (sensitivity rate was 48.6%, 17/35). In the experimental group, 26 patients had a positive brush test (sensitivity rate was 74.2%, 26/35). In addition, 2 patients in the control group had a positive brush test, while in the experimental group, a negative brush test. A total of 28 patients were positive in the two groups. The sensitivity rate of the brush test was 80.0% (28/35). There were significant differences between the two groups ( P<0.05). Conclusion:Endoscopic balloon dilation combined with endoscopic biliary brushings improved the sensitivity of pathological diagnosis of cholangiocarcinoma, and endoscopic biliary brushings before and after balloon dilation improved the sensitivity of diagnosis.

Objective To observe the expression of survivin and Aurora B in human pancreatic cancer BXPC3 cells after the treatment of sulindac and to explore the potential mechanism. Methods MTr assay was used to determine the effect of sulindac on the proliferation of the BXPC3 cells. RT-PCR was used to detect the expression of mRNA level of survivin and Aurora B, western blot was used to detect protein expression of survivin and Aurora B Thr-232. Cell cycle and apoptosis were detected by flow eytometry (FCM). Results The BXPC3 cells were inhibited by sulindac in a dose and time-dependent manner; the expression of mRNA of survivin and Aurora B were both significantly decreased from 1.5644 and 0.6554 to 0. 4372 and 0.1132 (P< 0.01), the expression of survivin protein and the phosphorylation of Aurora B Thr-232 were also decreased from 1.2735 and 0.4680 to 0.2126 and 0.2546 (P<0.01); the proportion of cells in the G0/G1 phase was increased from (56.65±1.93)% to (70.58±3.21)% (P<0.01). Conclusions Sulindac had inhibitory effects on the growth of BXPC3 cells, the possible mechanism was via decreasing the expression of survivin which depressed the activity of Aurora B, then the CPC was influenced. The most of the cells were blocked in the G0/G1 phase, and the cells' mitosis was inhibited.

Objective To investigate the effect of genistein on Notch-1, SHH and HHIP gene expression and on the cell cycle and proliferation of of BxPC3 cells. Methods Human pancreatic cancer cell line BxPC3 was cultured. The BxPC3 cells were treated with genistein and then the total RNA and protein were extracted. RT-PCR was used to detect the expression of Notch-1 mRNA, SHH mRNA and HHIP mRNA. Noteh-1 and SHH protein was determined by western blotting. MTT assay was used to detect proliferation of BxPC3 cells. The cell cycle of BxPC3 cells was measured by Propidium iodide (PI) and flow cytometry. Results The inhibiting rate was 67.17%±2.32% when BxPC3 cell lines were treated by 20μg/ml genistein for 48 hours. Notch-1 mRNA was down-regulated from 2.454±0.068 to 1.304±O.169 ; SHH mRNA was down-regulated from 0.959±0.023 to O.472±0.077 ; HHIP mRNA was up-regulated from 0.625±O.158 to 1.761±0.121. Notch-1 protein expression was down-regulated from 1.361±0.109 to 0.760±0.114; SHH protein expression was down-regulated from 0.265±0.018 to 0.129±0.013. (52.77±9.47)% cells were hindered in G2/M stage. Conclusions Genistein could down-regulate Notch-1 expression and inactivate Hedgehog signaling pathway and inhibit the proliferation of pancreatic cancer cells.

Objective To investigate the effect of Octreotide on pancreatic head carcinoma patients with obstructive jaundice who underwent endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent placement.Methods Niney-nine patients hospitalized in Department of Gastroenterology of Wuhan Central Hospital from Jan 2006 to Dec 2011 were included in this study.All the patients were diagnosed as pancreatic head carcinoma with obstructive jaundice.The patients were randomly divided into the Octreotide treatment group and the control group.Both groups underwent ERCP with pancreatic duct stent placement for malignant biliary obstruction.The patients in Octreotide treatment group were injected with subcutaneous Octreotide at a dose of 0.1 mg twice per day for more than 90 day till death.The changes of serum total bilirubin before and after treatment were compared.The improvement of symptoms of nausea,vomiting,abdominal pain,diarrhea and anorexia was compared.The complication rates and survival were also determined.Results Postoperative recurrence of jaundice was observed in six patients in control group,and the cause may be stent occlusion,and 3 of the 6 patients underwent a second ERCP and stent placement,then jaundice was relieved,the other 3 patients did not receive a second ERCP.The serum bilirubin level in the remaining 45 patients returned to basically normal value (below 2 times of the normal value).The prevalence of nausea,vomiting,abdominal pain,diarrhea and anorexia in the 2 groups was not statistically different before treatment,and after treatment the prevalence of symptoms in the 2 groups was significantly decreased except for diarrhea.The decrease in Octreotide treatment group was more obvious than that in control group,and the difference between the two groups was statistically significant (P ＜ 0.01).In the control group,post-ERCP pancreatitis occurred in three patients,and all were cured after treatment.There was no post-ERCP pancreatitis occurred in the Octreotide treatment group.Minor pain at the injection site was noted in three patients in the Octreotide treatment group.Pain was relieved after changing the injection site.The survival was significantly longer in the Octreotide group than that in control group [(14.4 ± 8.7) months vs (7.3 ± 5.3) months,P ＜ 0.05),and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Octreotide can improve the quality of life and increase the survival of patients with pancreatic head carcinoma who undergo ERCP with pancreatic duct stent placement.

Objective To investigate the effect of hydrogen-rich saline postconditioning on the expression of vascular endothelial growth factor receptor-1 (VEGFR1) during myocardial ischemiareperfusion (I/R) injury in rats.Methods Thirty-six adult male Sprague-Dawley rats,weighing 250-280 g,were randomly divided into 3 groups (n=12 each) using a random number table:sham operation group (group S),group I/R and hydrogen-rich saline group (group H2).Myocardial I/R was induced by 30 min ligation of anterior descending branch of the left coronary artery followed by 2 h reperfusion.In group H2,hydrogen-rich saline 5 ml/kg was injected intravenously at 5 min before reperfusion,while the equal volume of normal saline was given in group I/R.Left ventricular systolic pressure (LVSP),left ventricular enddiastolic pressure (LVEDP) and ± dp/dtmax were measured and recorded during reperfusion and at 120 min of reperfusion.The rats were sacrificed at 120 min of reperfusion,and myocardial specimens were obtained for determination of myocardial infarct size,contents of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) (using ELISA),and expression of VEGFR1 (by Western blot).At 120 min of reperfusion,blood samples were collected from the common carotid artery to measure cardiac troponin I (cTnI) concentrations in serum.Results Compared with group S,LVSP and ± dp/dtmax were significantly decreased,LVEDP was increased,the myocardial infarct size was enlarged,cTnI concentrations in serum and contents of IL-6 and TNF-α were increased,and the expression of VEGFR1 was down-regulated at 120 min of reperfusion in H2 and I/R groups.Compared with group I/R,LVSP and ± dp/dtmax were significantly increased,LVEDP and myocardial infarct size were decreased,cTnI concentrations in serum and contents of IL-6 and TNF-α were decreased,and the expression of VEGFR1 was up-regulated at 120 min of reperfusion in group H2.Conclusion Hydrogen-rich saline postconditioning can reduce myocardial I/R injury possibly by upregulating myocardial VEGFR1 expression and inhibiting inflammatory responses in the myocardium of rats.

Objective To explore the belongingness,name and clinical significance of a sort of osteal structure variation (OSV) posterior,outboard and superior to the ditch of vertebral artery of atlas.Methods 23 cases of OSV were collected among 426 patients underwent MSCT intracranial and cervical angiography with volume rendering technique (VRT)to notice the pier point,shape and direction of protuberance,and the relation and influence to the vertebral artery.Results The incidence of OSV was 5.40%(23/426) in which 31 sides were detected,and 1 5 cases in unilateral and 8 cases in bilateral.Simple type was showed at 1 9 sides,compound type at 12 sides with other ponticulus.According to the shape of the ponticulus,simple root was seen at 1 7 sides(13 inferior root and 4 lat-erial root),opposite beaked at 5 sides,complete type at 9 sides.OSV was located at posterior,outbord and superior to the ditch of vertebral artery of atlas and closed to the vertebral artery.The vertebral artery was influenced by OSV as following:in simple OSV vertebral artery stenosis was seen at 4 sides in which unite convulsion was showed at one side;in compound OSV vertebral artery ste-nosis was seen at 5 sides,in which unite convulsion was showed at 2 sides.Conclusion OSV is similar to ponticulus posticus(PP)and ponticulus lateralis(PL),and has similarly importance clinical significance,and should belong to the ponticulus of atlas,and to be named as ponticulus borderland(PB).