Objective To construct simulation medical care comprehensive training and cultivate stu-dents'nursing professional competence.Methods By setting medical simulation scenarios,comprehensive training of medical care based on admission,hospitalization,discharge and re-admission process for chronic medical patients was constructed.Self-designed questionnaire was adopted to investigate and evaluate the effect of teaching by systematic sampling from students and teachers in two dimensions.Results Compared with the control group,students'nursing skills,clinical comprehensive thinking,self-learning ability,communication skills and other professional competence of the experimental group were significantly increased.Conclusions Construction and implementation of comprehensive medical care with simulated clin-ical scenarios training and inpatient demand-oriented in vocational nursing students achieves a seamless con-nection on teaching and clinic and the nursing professional ability of students can also be improved.

From the beginning of 1980 to the end of 1992, 125 patients with Cushing disease were undergone transsphenoidal microsurgery. 41 patients were operated by selective adenoma resection and 62 patients by radical surgery. 103 cases were available to be analyzed. The results of a long-term follow-up showed: (1) The cure rates were 63. 1% and 48.1% with positive and negative pathological study, respectively. (2) The cure rates were 72.6% and 41. 5% with radical and selective surgery respectively. In cured patients the plasma cortisol level dropped to normal or subnormal within 48 hours after the surgery. However, in uncured patients, it was still above the normal. After operation, 1. 6% of cases (1/60) had secondary hypothyroidism and 62.5 % of cases (30/48) who had abnormal menstruation preoperatively restored normal menstrual cycle. The recurrent rate was 11.4%. Conclusion: (1) The outcome of radical surgery is better than the selective adenoma resection; (2) The pathological study and the analysis of the plasma cortisol level within 48 hours after the surgery may have predictive value for efficacy of the surgery.

BACKGROUND: Coronary artery disease (CAD) risk in type Ⅱ diabetics is one of the hot topics in clinical research.OBJECTIVE: By using electron-beam tomography(EBT) technology, heart scans were performed to investigate coronary artery lesion in type Ⅱ diabetics and their CAD risks were evaluated as well.DESIGN: Comparative study based on type Ⅱ diabetics complicated with coronary artery lesion.SETTING: Gerontology department in a hospital affiliated to a military medical university of Chinese PLA.PARTICIPANTS: From January 2002 to June 2004, 93 inpatients between the ages of 36 and 78 in the Gerontology Department of Xijing Hospital, an affiliation to the Fourth Military Medical University of Chinese PLA, were selected(male 80, female 13) . Totally 25 of all the patients proved normal by physical examinations were set as normal control(male 22, female 3) group; other inpatients were divided into the abnormal blood glucose group and the coronary heart disease (CHD) group respectively according to their examination results. Of the 57 patients in the abnormal blood glucose group,49 were male and 8 were female. This group was divided into two subgroups:the impaired glucose tolerance group(IGT) containing 29 patients and the diabetes group containing 28 patients. In this group, 44 patients have had heart symptom of different extent. Of the 11 patients in the CHD group, 9 were male and 2 were female. Inclusion criteria: patients with type Ⅱ diabetes were defined by American Diabetes Association in 1979; patients with CHD were defined in the report of the Joint International Society and Federation of Cardiology/World Health Organization Task Force on the standardization of clinical nomenclature and criteria for diagnosis of ischemic heart disease in 1979, and they were all confirmed by coronary angiography. Exclusion criteeases.METHODS: Both plain EBT heart scanning and contrast-enhanced heart scanning were performed on the 93 patients to evaluate the occurrence of coronary artery calcification(CAC), the number of stenosed coronary arterie,and the number of soft plaques. Additionally, other examination results including blood glucose, blood HbA1c and blood lipid were also collected for comparison between the conditions of coronary artery and assessment of the CHD risk among groups.MAIN OUTCOME MEASUREMENTS: In all the groups, the occurrence of CAC, the number of stenosed coronary arteries and the number of plaques were compared, and the CHD risk was analyzed.RESULTS: The occurrence of coronary artery calcification was significantly increased in all the study groups as compared with the control group(x2 = 18.88, P < 0. 01 ). Increasing trend was also observed in the study groups when calculating the number of branches with coronary stenosis and plaques ( F = 10. 758, P < 0. 01; F = 9. 991, P < 0.01 ). CHD risk in diabetes was estimated to be 7. 514 (95% confidence interval, 1. 885 -63. 778).CONCLUSION: Coronary artery lesion can be easily observed in type Ⅱ diabetics,and high CHD risk is predicted in this population. Early diagnosis of CAD and early rehabilitation intervention in grade 2 are extremely important in improving the quality of life and reducing the disability ratio of type Ⅱ diabetics.Huang C, Gao JY, Wong XM, Li R, Yang AL, Zheng MW, Xue FB. Risk analysis of coronary artery disease in type Ⅱ diabetics.

Objective To compare the difference of the left ventricular structure and diastolic func-tion in normotensive offspring with or without a family history of hypertension. Methods One hundred nor-motensive offspring were assessed. Fifty had a family history of hypertension (experimental group) and 50 had no family hi.history of hypertension (control group). By eehocardiography and Doppler tissue imaging, the following parameters of left ventricular structure and diastolic function were examined: interventricular septal thickness (IVST), left ventrieular posterior wall thickness (LVPWT), left ventricular internal dimension (LVIDed), left ventrieular mass index(LVMI) and E/A. Results Compared with control group, experimen-tal group had higher IVST, LVPWT and LVMI, lower peak velocity of the early diastolic wave (e) of mitral annulus, and lower e/a (P<0.05). No differences in LVIDed, left atrial diameter (LA),aortic dimension(AOD), E,A and E/A were found between the two groups. Conclusion The results indicate that genetic factor of parental hypertension influence left ventrieular structure and diastolic function in normotensive offspring, which may precede the elevation of blood pressure.

Objective To explore the clinical significance of lymph node micrometastases in stage Ⅱ rectal cancer patients. Methods Forty-two patients with rectal cancer underwent total mesorectal exci-sion between January 2000 and August 2001 were included, 484 lymph nodes were studied in paraffin blocks that had previously been considered free by conventional histopathological examination. These lymph nodes were submitted to immunohistochemical analysis using cytokeratin 20 (CK20) monoclonal antibodies to identify micrometastases. Five-year follow-up information was obtained on these patients. Observed survival rates and assessed respectively in the patients with and without micrometastases. Results Micrometastases were detected in 33 lymph nodes (6.8% ,33/484) of 15 cases (35.7%, 15/42). The five-year survival rate was 40.0% in the patients with micrometastases, whereas in the patients without micrometastases, the survival rate was 92.6%(P = 0.000,by the Log-rank test). By multivariate Cox regression analysis, lymph node mi-cromctastases was closely correlated with post-operative recurrence or metastases, the value of RR was 11.435. Conclusions Detection of micrometastases is an important prognostic tool in stage Ⅱ rectal can-cer. In this study, lymph nodes micrometastases is an independent prognostic factor for overall survival. These patients maybe get benefit from adjuvant chemotherapy.

Background and purpose:Drug resistance is a major cause of failure in lung cancer chemotherapy. This study aimed to investigate the effect of YAP on doxorubicin resistance in lung cancer and its underlying mechanism. Methods:Doxorubicin resistant lung cancer cell clones were established from parental sensitive cancer PC9 cell line via in vitroinduction, and the expression of YAP was analyzed. YAP was down-regulated via shRNA to different levels. MTS assay was employed to determine cell proliferation and drug sensitivity. Flow cytometry was used to determine cell cycle distribution, apoptosis and uptake of Rh-123. Western blot and quantitative real-time polymerase chain reaction (QRT-PCR) assay were used to determine the expression of ABCB1, ABCC1, p53, Runx2, ITGB2 and ErbB4. The phosphory-lation of serine/threonine kinase (AKT) was determined as well.Results:Doxorubicin resistant PC9/Adr cell clone was obtained with over-expressed YAP. Expression of YAP in PC9/Adr cells was down-regulated to different levels via shR-NA. After YAP silencing, cell proliferation was reduced, while sensitivity to doxorubicin was increased. The cell cycle was significantly halted by G0/G1 phase. Doxorubicin induced-apoptotic rate and cellular uptake of Rh-123 were increased,with positive correlation to YAP silencing level. Western blot and QRT-PCR results showed that after YAP silencing, ABCB1, ABCC1, Runx2, ITGB2, and ErbB4 proteins were down-regulated, while the expression of p53 was up-regulated. Phosphorylation of AKT was inhibited as well.Conclusion:Over-expression of YAP is involved in doxorubicin resistance in PC9/Adr cell line. Silencing of YAP could restore doxorubicin sensitivity. The mechanism involves regulation of drug resistance-related genes and promotion of apoptosis.

Objective:To explore the relationship between anxiety and mental resilience of caregivers for community-dwelling dementia patients.Methods:Patients in four communities who met the diagnostic criteria for Alzheimer's disease(AD)were randomly selected and their caregivers served as study subjects.General characteristics, anxiety and resilience of caregivers(n=592)were investigated with a questionnaire developed by ourselves, the Generalized Anxiety Disorder-7 Scale(GAD-7), and the Conner-Davidson Resilience Scale(CDRISC).Results:There were 592 subjects in the study, with 185 cases(31.3%)having anxiety.Differences in manifestations of anxiety existed between caregivers for AD patients in different age groups( P<0.01). Anxiety levels were also influenced by AD patient caregivers' gender, educational level and blood relationship to the patient( P<0.05). The differences were reflected in tenacity( F=72.58), strength( F=82.19), optimism( F=12.57)and the total elasticity score( F=162.88). The Spearman correlation was used to analyze the association of caregiver anxiety with caregivers' general characteristics and domains of psychological resilience.The results showed that anxiety was negatively correlated with gender( r=-0.09, P<0.05), education level( r=-0.112, P<0.01), blood relationship( r=-0.122, P<0.01), psychoelasticity and three other domains( r=-0.457, -0.495, -0.208, -0.60, all P<0.01), but was positively correlated with age( r=0.127, P<0.01). Logistic regression analysis showed that psychoelasticity was a protective factor for anxiety in caregivers for community-dwelling AD patients( β=-0.323, P<0.05). Conclusions:While treating Alzheimer's patients, clinicians can consider psychotherapy measures to improve the psychological resilience of their caregivers.

Objective:To investigate the correlation between serum phosphorus levels and outcomes of weaning from mechanical ventilation in elderly chronic obstructive pulmonary disease(COPD)patients with type Ⅱ respiratory failure.Methods:A total of 142 hospitalized elderly COPD patients with type Ⅱ respiratory failure receiving mechanical ventilation in our hospital from August 2016 to December 2018 were retrospectively enrolled.Patients were divided into the successful weaning group(n=101)and the unsuccessful weaning group(n=41)based on weaning outcomes.General data, blood phosphorus levels on admission and before spontaneous breathing trials(SBT)and the incidence of hypophosphatemia were compared between the two groups.The logistic regression equation was used to analyze the related factors for the unsuccessful weaning, and the receiver operating characteristics(ROC)curve was drawn to analyze the value of serum phosphorus levels in predicting the failure of weaning.Methods:Compared with the successful weaning group, Acute Physiology and Chronic Health evaluation Ⅱ(APACHEⅡ)scores, rapid shallow breathing index(RSBI), and serum creatinine(Cr), C-reactive protein(CRP)levels were higher, while the oxygenation index(PaO 2/FiO 2), serum albumin(ALB)and magnesium levels were lower in the unsuccessful weaning group than in the successful weaning group( P<0.05). The incidences of hypophosphatemia on admission and before SBT were higher in the unsuccessful weaning group than in the successful weaning group(34.2% or 34/41 vs.17.8% or 18/101, 46.3% or 19/41 vs.25.7% or 26/101, χ2=4.452 and 5.716, P<0.05). Serum phosphorus levels on admission and before SBT were lower in the unsuccessful weaning group than in the successful weaning group[(0.82±0.21) mmol/L vs.(1.05±0.23) mmol/L, (0.71±0.19) mmol/L vs.(1.02±0.22) mmol/L, t=5.171 and 7.646, P<0.05)]. Multivariate logistic regression analysis showed that hypophosphatemia on admission or before SBT was an independent risk factor for unsuccessful weaning in elderly COPD patients with type Ⅱ respiratory failure( P<0.05). The areas under the ROC curve(AUC)of hypophosphatemia on admission and before SBT for predicting the failure of weaning was 0.657 and 0.776, respectively, and with 0.84 mmol/L and 0.76 mmol/L as the respective optimal threshold values, the sensitivity and specificity were 67.3% and 68.3% for AUC on admission and 76.5% and 85.6% for AUC before SBT, respectively.AUC of the serum phosphorus level was higher before SBT than on admission( Z=3.142, P<0.05). Conclusions:The decrease of blood phosphorus levels is common in elderly COPD patients with type Ⅱ respiratory failure, and hypophosphatemia has a high incidence and may be an independent risk factor for the failure of weaning.Blood phosphorus levels should be closely monitored in order to guide clinical weaning.

Avermectins can affect biological processes of multiple tumor, including tumor cell proliferation and metastasis, cell cycle arrest, induction of apoptosis and autophagy, regulation of tumor microenvironment and tumor stem cells. Avermectins can be administered alone or combined with chemotherapeutic drugs to reverse multidrug resistance. To further explore the anti-tumor mechanism of avermectins will provide reliable experimental and theoretical guidance for future clinical application.

Objective To assess the association between killer cell immunoglobulin-like receptor (KIR) gene polymorphisms and the risk of hypertension in autoimmune mechanism.Methods We conducted a case-control study including 205 hypertensives and 205 controls matched with sex and age,from a community-based population.KIR genes of all subjects were genotyped by polymerase chain reaction with sequence-specific primers (PCR-SSP).Conditional logistic regression model and generalized multifactor dimensionality reduction (GMDR) method were used to estimate the association among KIR gene polymorphisms and the risk of hypertension.Results The genotypic frequencies of KIRs were not significantly different between the hypertensives and the control groups (P＞0.05).Among all the models of GMDR concerning the association between interactions of KIR genes and essential hypertension,the testing accuracy of the interaction between K/R2DS2 and KIR2DS3 was the highest (55.13％),with cross-validation consistency as 10/10 (P=0.054).Results from the conditional logistic regression showed that individuals with KIR2DS2 +:KIR2DS3-were significantly associated with an increased risk on hypertension (OR=2.555,95％CI:1.203-5.429,P=0.015).However,individuals with KIR2DS2 +:KIR2DS3 + were significantly associated with a reduced risk of hypertension (0R=0.268,95％ CI:0.088-0.815,P=0.020).Individuals with KIR2DS2-KIR2DS3 + did not seem to be associated with the risk of hypertension (0R=1.602,95％ C I:0.785-3.266,P=0.195),when compared to the KIR2DS2-KIR2DS3-group.Interactions between KIR2DS2 and KIR2DS3 were significantly associated with the risk of hypertension,after adjusted for BMI,smoking,drinking and family history of hypertension (OR=0.065,95％CI:0.013-0.317,P=0.001).Conclusion Individuals with KIR2DS2 and no KIR2DS3 were associated with the increased risk of hypertension.KIR2DS2 that coexisted with KIR2DS3 were associated with the reduced risk of hypertension.Antagonism between KIR2DS2 and KIR2DS3 might serve as a protect factor for hypertension.