Objective To investigate the influence of PBL combined with CBS education on reporting cognition and reporting intention of adverse events.Methods Using convenience sampling method,66 registered nurses working for over 6 months were extracted as the study object.The training group was set up and the training files were established,PBL combined with CBS mode were implemented for 6 months from March to August 2013,once a month,2 hours per time.Training cases were designed and written,teaching staff was organized to carry out the training,problems were raised in class and discussed on site.Training staff looked up relevant data,collected information,organized another focused discussion and summarized the results.The Adverse Event Reporting Cognitive Questionnaire and Adverse Nursing Event Reporting Intention Questionnaire were adopted to evaluate reporting cognition and reporting intention before and after the training.Results After the implementation of PBL combined with CBS education,cognition of nurses for adverse events scored (7.23±1.20),higher than that before the intervention,(6.48±1.49),t=3.17,P ＜ 0.01.The numbers of nurses to report adverse events such as potential vulnerabilities and not doing any harm were 42 and 45 before the intervention,while 53 and 56 after the intervention.Conclusions Using PBL combined with CBS model to implement educational interventions can improve reporting cognition and report intention on nursing adverse events of nurses.

Objective To summarize the pathological and imaging features and treatment of retroperitoneal bronchogenic cyst.Methods The clinical data of 2 cases treated from October 2001 to November 2009 were summarized.The first patient was a 55-year-old woman with the chief complaint of lumbago in the left flank for 10 d.B-ultrasound showed mixed solid and cystic mass in spleen space with a diameter of 3.9 cm with thin wall and without rich blood supply.CT showed the lesion in the left adrenal gland region measured about 4 cm ×4 cm with low density with CT value of 10 HU,and enhanced scan was not obvious with CT value of 20 HU.It was diagnosed as left adrenal tumor and tumor resection was performed.The second case was a 17-year-old young man with the chief complaint of gross hematuria for 3 weeks after strenuous exercise.Ultrasonography found a 8.4 cm × 7.7 cm × 9.0 cm anechoic area surrounding the bladder.CT showed about 9.0 cm × 7.2 cm × 9.0 cm cystic lesion with thin wall,and the center density was uniformity in presacral space with CT value of8 HU.IVU showed visible semi-circular lower edge on the right edge of the bladder.The patient was diagnosed of presacral cyst and cystectomy was performed successfully.Results The pathology report of the first case:organizing wall with fibrous connective tissue,with most of the lining overlying pseudostratified ciliated columnar epithelium,goblet cells and subepithelial basement membrane.Pathological diagnosis was bronchogenic cyst,and the patient was followed up for 9 months without recurrence.The pathology report of the second case:pathological tissue fibers false wall tissue lining ciliated columnar epithelium,goblet cells seen in epithelium,fibrous tissue in the visible structure of mixed glands,a small amount of cartilage and muscle tissue.The diagnosis was bronchogenic cyst,and the patient was followed up for 2 years without recurrence.Conclusions Retroperitoneal bronchogenic cyst is rare and easily misdiagnosed.Radiology imaging can identify cystic features,while a few may be with high density without specificity.Surgical removal of retroperitoneal bronchogenic cyst with symptoms has good prognosis and may prevent malignant transformation and secondary infection.

Objective To evaluate the anesthetic efficacy of different doses of dexmedetomidine combined with ketamine in the pediatric patients undergoing closure of ventricular septal defect.Methods Ninety pediatric patients with ventricular septal defect requiring interventional treatment,aged 4-11 yr,weighing 12-47 kg,of ASA physical status Ⅰ or Ⅱ,were randomly divided into D1-3 groups (n =30 each) using a random number table.After admission to operating room,anesthesia was induced with iv atropine 0.02 mg/kg and ketamine 1.0 mg/kg,followed by administration of a loading dose of dexmedetonidine 0.5 μg/kg which was infused over 10 min.In D1,D2 and D3 groups,dexmedetomidine 0.7,1.0 and 1.2 μg· kg 1 · h-1 were infused intravenously,respectively,until the end of operation.After the pediatric patients lost consciousness,the femoral artery was punctured to perform interventional treatment.Additional ketamine 0.5 mg/kg was given when the depth of anesthesia was inadequate.BIS,BP,HR and SpO2 were recorded after admission to the operating room (T0),at 1 and 5 min after ketamine administration (T1,2),at the end of loading dose of dexmedetomidine infusion (T3),at 15 min after maintenance dose of dexmedetomidine infusion (T4),immediately after operation (T5),and immediately after emergence (T6).The total consumption of ketamine,cases who needed additional ketamine and atropine,operation time,emergence time and development of adverse effects such as respiratory depression and postoperative agitation were recorded.Results Compared with the baseline value at T0,BIS value was significantly decreased at T4,5 in the three groups,HR was decreased at T4,5 in D2,3 groups,and no significant change was found in BP and SpO2 at each time point in the three groups.Compared with D1 group,the requirement for additional atropine was significantly increased,the total consumption of ketamine was reduced,and the requirement for additional ketamine and incidence of respiratory depression were decreased in D2 and D3 groups.No patients needed additional ketamine in D2 and D3 groups.The requirement for additional atropine was significantly higher in D3 group than in D2 group.There was no significant difference in the operation time and emergence time among the three groups.No pediatric patients developed agitation during emergence from anesthesia.Conclusion Ketamine 1.0 mg/kg (for induction of anesthesia) combined with a loading dose of dexmedetomidine 0.5 μg/kg and maintenance dose of dexmedetomidine 1.0 μg·kg-1 · h-1 (for maintenance of anesthesia) can produce good anesthetic efficacy,which is an optimum combination of anesthesia in pediatric patients undergoing closure of ventricular septal defect.

Objective To elucidate whether and how injection site diversity influences on the sodium hyaluronate (HA) distribution on cartilage surface of the knee joint.Methods From September 2014 to December 2014, 32 human cadaveric knees were sorted from small to large based on femoral condyle width (FCW) and divided into group Ⅰ (n=16, odd number, the patella medial approach) and group Ⅱ (n=16, even number, injected through the medial joint line approach).Knees of both groups were interfused with a 5％ (mg: ml) methylene blue tracer.Each specimen was then simulated a 5°-45° alternating walking for 2 h in the Electro Force platform.Afterwards, all the knee cavities were cut open to examine the range of HA distribution.Based on the eight-zoning classification law for the knee cartilage surface, the coverage area of HA in each zone was scored and the characteristics of HA distribution was depicted, as well as HA zonal distribution diversity between groups were statistically analyzed.Results HA of both patella medial and medial joint line subgroups showed analogical distribution in all zones except the lateral tibial plateau at the time of FCW ≤ 7.0 cm.However, HA coverage through the patella medial approach showed significantly higher distribution scores in the patella zone and the femoral trochlear zone, but significant lower distribution scores in the antero-lateral/postero-lateral femoral condyle, the medial posterior femoral condyle zone and the lateral tibial plateau zone compared with medial joint line approach at the time of FCW ＞ 7.0 cm.Conclusion When delivered through different injection approaches, HA showed analogical distribution characteristics in most zones of the knee cavity in population with a small bodily shape (FCW ≤ 7.0cm), but significant diverse distribution characteristics in population with a big bodily shape (FCW ＞7.0 cm).When FCW ＞ 7.0cm, HA injected through the medial-patellar approach tended to be distributed mainly over the patella-femoral articulation and the anterior knee cavity, while HA injected through the joint line approach tended to be distributed mainly over the tibio-femoral articulation and the posterior knee cavity.