Objective To describe the structure and the level of the stress of nursing students in clinic practice,and supply reference for reform of clinical teaching method.Methods Totally 100 undergraduate nursing students in clinic practice,who would graduate from nursing school and begin to work in 2013,were interviewed and investigated.Results The main stress sources were divided into five aspects:recognition,clinical nursing ability,career development,field response and exhaustion of body and mind.Conclusions The structure and level of the stress of nursing students changed a lot.Some new appropriate reform should be introduced into clinic education,in order to help nursing students to complete psychological change and role adaptation.

ObjectiveTo analyze the distribution and antibiotic resistance of bacteria isolated from cerebrospinal fluid. Methods569 cerebrospinal fluild specimens were analyzed. ResultsPathogens were isolated from 93 specimens (16.3%), in which 52 were Gram positive bacteria and 38 were negative, 3 were fungi. All the Gram positive cocci were sensitive to vancomycin and linezolid, while the Gram negative bacteria were resistant to routine antibiotics such as cefotaxime and ceftriaxone, but sensitive to carbapenems. ConclusionThe prevailing pathogens in intracranial infection are Gram positive cocci, especially Staphylococcus epidermidis and Staphylococcus aureu.

Objective To compare various CT signs of pancreatic carcinoma (PC) and inflammatory pancreatic mass (IPM), and to study the diagnostic value of these signs for distinguishing two diseases. Methods Eigty-five patients with PC and IPM were proved by surgery, fine needle aspiration or other comprehensive methods. These patients underwent non-enhanced and enhanced CT scans. CT findings were analyzed retrospectively. The occurrance rates of various CT signs in these two diseases were analyzed with Fisher test and were compared with the corresponding clinical and operational results as welL Results Among the 85 patients, 66 patients were proved to have PC, and 19 were proved to have IPM. In PC group,58 were corerectly diagnosed with CT, 3 (4. 5% ) were misdiagnosed, and 5 (7.6%) were omitted. In IPM group, 9 were correctly diagnosed with CT and 10 (52. 6% ) were misdiagnosed. The CT findings were as follows: (1) Pancreatic mass with liver metastases, lymph node metastases, encased celiac arteries, and cancer emboli in portal veins just occurred in PC group. (2) The occurrence rates of mass over 3 cm in diameter, clear boundary, low-density area within the mass, pseudocysts, peripancreatie infiltration, ascites, and slight and moderate pancreatic-bile duct dilation in PC group were 90. 91% (60/66), 15.15% ( 10/66), 54. 55% ( 36/66 ), 10. 61% ( 7/66 ), 4. 55% ( 3/66 ), 22. 73% ( 15/66 ), 24. 24% ( 16/66 ), 45.45% (30/66), and 27. 27% (18/66) respectively, the occurrence rates in IPM group were 94. 74% ( 18/19), 15.79% ( 3/19 ), 52. 63% ( 10/19 ), 15.79% ( 3/19 ), 15. 79% ( 3/19 ), 21.05% (4/19), 31.58% (6/19) ,21.05% (4/19), and 5.26% (1/19) respectively. There was no statistical difference for these CT findings between two groups(P >0. 05). (3) Pancreatic head mass with atrophy of pancreatic body and tail, mass calcification, pancreatic duct-penetrating sign, pancreatic head mass with hypertrophy of pancreatic body and tail, biliary stones with inflammation , and thickening of pre-kidney fascia in PC group were 48.48% ( 32/66 ), 3.03% ( 2/66 ), 1.52% ( 1/66 ), 10. 61% ( 7/66 ), 6. 06% ( 4/66 ) and 3.03% (2/66) respectively, the occurrence rates of those in IPM group were 5. 26% (1/19),47.37% (9/19), 15.79% ( 3/19 ), 84. 21% ( 16/19 ), 36. 84% ( 7/19 ) and 21.05% ( 4/19 ) respectively. There was statistical difference for these CT findings between two groups ( P < 0. 05 ) . Conclusion Accurate evaluation of various CT signs in PC and IPM is of great importance in the diagnosis of the two diseases.

With the development of economy and society, the change of heath concept and increased demands for health care , the cultivation of postgraduates majoring in clinical medicine is facing a lot of problems which seriously affects the quality of culti-vation.The article analyzed the problems and reasons in the clinical medicine postgraduate cultivation.We stated the competency of clinical medicine postgraduates according to the transition of health demands, global medical development and practical requirements for clinical personnel in China.We elaborated the required post competence for clinical medicine postgraduates on the basis of its con-tent and characteristics.We proposed to strengthen the cultivation of clinical medicine postgraduates by the reform and support of the government, enhanced construction of teachers, improved course plan and cultivation process, perfected assessment system in order to make the students competent to their posts.

Objective To assess the diagnostic value of capsule endoscopy (CE) and CT virtual endoscopy (CTVE) for small intestinal diseases.Methods The data of 31 patients with suspected small bowel diseases who were examined by both CTVE and CE were collected.The diagnostic rates of CE and CTVE was compared by paired data McNemar test,using the diagnosis confirmed by surgery or follow-up as the golden standard.Results The confirmed diagnosis of 31 patients were small intestinal tumor in 16,nontumorous lesion in 10 and no abnormal lesion in 5.CE identified positive findings in 24 patients,including 14 cases of tumorous lesion (with mis-location in 2 and failure in definite diagnosis in 7) and 10 cases of non-tumorous lesion.CTVE identified positive findings in 17 patients,including 14 cases of tumorous lesion (with mis-location in 1 and failure in definite diagnosis in 4) and 3 cases of non-tumorous lesion.The combination of CE and CTVE could identified positive findings in 26 patients,including 16 tumorous and 10 nontumorous lesions.The diagnostic rates of CE and CTVE for tumorous lesions were both 87.5％ (14/16).The overall diagnostic rate of combined CE and CTVE was 83.9％ (26/31),which was significantly higher than that of CTVE alone (54.8％,17/31) but similar to that of CE alone (77.4％,24/31).Conclusion Both CE and CTVE are effective in diagnosis of small intestinal lesions and the combined use of 2 methods can increase diagnosis yield.

Objective To evaluate effect and safety of first-line chemotherapy regimen combined with rh-endostatin for osteosarcoma of the extremities.Methods Sixty three patients with osteosarcoma were randomly divided into experiment group and control group.There were 32 patients in experiment group,and 31 patients in control group.Nine patients 9 were rejected because they did not meet the standard.Finally,54 patients were enrolled in this study,including 29 patients in experiment group,and 25 patients in control group.In the experiment group,the patients were treated with rh-endostatin combined with MTX,IFO,DDP,and ADM,while patients in control group were treated with MTX,IFO,DDP,and ADM.Several indexes including median progression-free survival time,clinical benefit rate,progression-free survival rate,limb salvage rate,and survival rate were used to assess clinical effect.The safety of rh-endostatin was evaluated by comparing incidence of adverse events in the two groups.Results The median progression-free survival time of experiment group and control group was 18.9 months and 13.1 months,respectively; there was no significant difference.In the experiment group,the clinical benefit rate,progression-free survival rate,survival rate and limb salvage rate were 89.7％,37.9％,65.5％,and 89.7％,respectively; while in the control group,the clinical benefit rate,progression-free survival rate,survival rate,and limb salvage rate were 88.0％,36.0％,68.0％,and 96.0％,respectively.There was no significant difference in 4 indexes mentioned above between two groups.Conclusion After being combined with first-line chemotherapy regimen,rh-endostatin doesn't show significant advantage in controlling tumour progression and improving survival rate.No more toxicity and new side effects are found after using rh-endostatin.

Objective: To investigate the effect of overexpression of Notch intracellular domain (NICD) on proliferation and osteogenic differentiation of human periodontal ligament stem cells (hPDLSC). Methods: The third generation hPDLSC with stable overexpressing of NICD were assigned as experimental group, normal hPDLSC were as negative control group and hPDLSC transfected with empty vector were as blank control group. The effect of overexpressing NICD on proliferation ability of hPDLSC was detected by using cell counting kit-8 (CCK-8). Alizarin Red staining and real-time quantitative PCR (qPCR) were used to detect the effects of NICD on cementum attachment proteins (CAP), osteocalcin (OCN), Runt-related transcription factor 2 (RUNX2) and Notch signal pathway receptor Notch1. The effect of overexpressing NICD on hPDLSC osteogenic protein RUNX2 and flag marker protein (used to label NICD) were detected by using Western blotting. Results: CCK-8 results showed that there were no significant differences in A values amongst the three groups for 1-2 days (P>0.05). The number of cells in the experimental group was significantly increase than that of the two control groups from the third to seventh days (A values were 0.203±0.016, 0.364±0.014, 0.449±0.020, 0.549±0.020 and 0.570±0.020, respectively) (P<0.05). Alizarin red staining showed that compared with the blank control group and negative control group, the mineralized nodules in the experimental group had smaller formation range and lighter color, and the differences were statistically significant (P<0.05). The expressions of CAP gene (0.751±0.058, 0.887±0.025), osteocalcin gene (0.592±0.051, 0.670±0.045) and RUNX2 gene (0.319±0.038, 0.684±0.055) at 14 and 21 days in the experimental group were significantly lower than those in the negative control group respectively (P<0.05). However, the expression levels of Notch1 gene at 14 and 21 days (2.507±0.047, 4.041±0.219) were significantly higher than those of negative and blank control groups (P<0.05). The results of Western blotting showed that the expressions of flag marker protein (0.167±0.007, 0.204±0.010) at 14 and 21 days in the experimental group were significantly higher than those in the negative and blank control groups (P<0.05). However, the expressions of RUNX2 protein (0.075±0.006, 0.074±0.013) at 14 and 21 days were significantly lower than that in the negative control group (0.092±0.003, 0.118±0.008) and blank control group (0.174±0.006, 0.212±0.008) (P<0.05). Conclusions Overexpression of NICD can promote the proliferation capacity of hPDLSC and inhibit its osteogenic differentiation.

Objective:To retrospectively analyze the relationship between patterns of local recurrence and radiotherapy target dose after adjuvant radiotherapy for the pancreatic ductal adenocarcinoma(PDAC), aiming to provide reference for exploring reasonable target and dosage.Methods:Clinical data of 138 patients with T 1-4N 0-2M 0 PDAC who underwent adjuvant radiotherapy after radical resection from April 2012 to December 2020 were analyzed retrospectively. The influencing factors of local recurrence and the correlation between local recurrence site and radiotherapy target dose were analyzed. Results:The median follow-up time was 37.2 months. The median overall survival (mOS) was 29.9 months. The 5-year OS rate was 27.4%. And the median progression-free survival (mPFS) was 13.9 months. There were 24 cases of local recurrence (17.4%), and 10 cases of local recurrence complicated with distant metastasis (7.2%). The correlation between local recurrence site and radiotherapy target dose could be evaluated in 19 patients with complete clinical data. The first local recurrence occurred near the para-aortic (Ao), the celiac axis (CA) and the superior mesenteric artery (SMA) were 8, 5 and 4 cases, respectively. The radiotherapy doses of 8 patients with local recurrence only in the PTV field were above 45 Gy. There were 8 cases of local recurrence both in and out of the PTV field, including 3 cases with dose line between 40 and 52 Gy, 2 cases with dose line between 20 and 47.5 Gy, and 3 cases with dose line between 0.5 and 52.5 Gy. There were 3 cases of local recurrence out of the PTV field, and the dose line ranged from 0 to 20 Gy.Conclusions:The local recurrence rate of PDAC after radical surgery combined with postoperative radiotherapy is low, but a small number of patients have recurrence in the high-dose range of radiation field and regional recurrence out of the field. For these patients, it may be necessary to explore a more appropriate target dose and range for adjuvant radiotherapy.

Informed consent is an important ethical symbol in clinical research,and researchers have the responsibility to fully inform participants of the research information before conducting clinical research.However,it is difficult to obtain complete informed consent form participants or their guardians within a narrow treatment time period in clinical research conducted in emergency situations.Currently,in addition to traditional general informed consent,there are also reality-accepted informed consent,including exemption of informed consent,broad informed consent,and deferred informed consent.By introducing the origin and development process of deferred informed consent in clinical research,this paper sorted out the current application status of deferred informed consent,proposed the prerequisites for applying deferred informed consent in emergency situations,and explored the issues that need to be noted during the application process of deferred informed consent.It is hoped to provide an ethical defense and ethical procedure for the application of deferred informed consent in clinical research in emergency situations.