Objective to analyze the influence obstetric factors of the small for gestational age(SGA)in twins,so as to direct the clinical prenatal supervision in clinic. Methods A retrospective study of the SGA was performed,the general data of 1 514 patients admitted in obstetrics and gyne-cology of Shengjing Hospital during 2001 to 2014 were analyzed by Logistic regression analysis. Results the incidence of the SGA in twins was 10.89%. the protective factors were male fetus,assisted reproductive technology(ARt)and gestational diabetes mellitus(GDM). the risk factors were the female fetus and hypertensive disorders in pregnancy. Conclusion the gender of fetus,assisted reproductive technology(ARt),gestation-al diabetes mellitus(GDM),hypertensive disorder complicating pregnancy are the influential factors of the SGA in twins. We recommend a further pre-pregnancy and pregnancy care which is of significance for the prevention of SGA.

Objective To investigate the histological changes and collagen phenotype of a semitendinosus autograft after reconstruction of posterior cruciate ligament(PCL) in rabbits. Methods Twenty skeletally mature New Zealand white rabbits were divided into two groups. In group 1, the PCL of the right knees of 18 mature New Zealand white rabbits were resected and immediaterly reconstructed with double-band semitendinosus antograft. Then the rabbits were respectively killed at 3, 6, 12, 26 and 52 weeks after the operation, to obtain the the semitendinosus autografts. Group 2 consisting of the other 2 rabbits was served as control group, and semitendinosus tendons and PCL were obtained. All specimens were staining with hematoxylin and eosin, toluidine blue and immunohistochemical methods of type Ⅰ, Ⅲ collagens to analyze the histological changes and collagen phenotype of a semitendinosus autograft, and compare those with normal semitendinosus tendons and PCL. Results Histological results demonstrated that there was obvious difference at the cell formation between normal semitendinosus tendon and PCL. After postoperative 52 weeks the graft was similar to the normal PCL, while the alignment of graft was still different from that of normal PCL through necrosis, cell growing in, collagen formation and remolding. Immunohistochemistry result demonstrated: the staining of type Ⅰ collagen in graft was low at first, then increased gradually; the staining of type Ⅲ collagen was low at first, increased quickly, then decreased, at 52 weeks it was present in local areas. But positive reactions for type Ⅰ collagen were localized in collagen fibers, and those for type Ⅲ collagen were localized in synovium in normal PCL. Conclusion The study showed the semitendinosus autograft was still different in cell formation from normal PCL at 52 weeks after PCL reconstruction with semitendinosus.

Traditionally the cultivation mechanisms of pathological postgraduates can not fully adapt to the demand of research and society in China,to some extent,which impedes the development of pathology.Combining our practical conditions with overseas experiences,we try to make the beneficial thinking and adjustment on the existing cultivation mechanisms.

[Objective] To investigate X-ray and CT manifestations of tobereulosis of ankle joint and to discuss the differentiation with other diseases.[Method]The X-ray and CT findings in 5 cases with pathalogically proved tuberculosis of ankle joint were retrospectively analyzed.The differentiation with other diseases was discussed.[Result]The lesions involved entire right ankle joint in all 5 cases,The typical signs were as follows:(1)indistlnct and erosive joint surface,insect bitten-like of bony destruction ofjotht surface,digging-like shape of cancellous bone's destruction;(2)narrowed or irregular widened joint space;(3)ostooporosis of diseased region and surrounding;(4)extensive periostoal reaction of distal fibia and fibula;(5)to form cold abscess and sinus tract.[Conclusion]The tuberculosis of ankle joint earyies certain characteristic X-ray and CT signs,CT is better than X-ray in diagnosis.Highly alert of ankle joint tuberculosis is the key of early correct diagnosis.

Relative deficiency of serum insulin and insulin resistance of tissues are the main causes of postburn hypercatabolism.In order to evaluate the clinical effects of tolbutamide to improve postburn hypermetabolism,9 burn patients were given tolbutamide and observed for 10 days after the drug had gone through animal experiments.It was found that tolbutamide could improve postburn hyper-metabolism through following ways:1.To stimulate the secretion of insulin and enhance the effect of insulin.2.To reduce the insulin resistance of tissues and promote glucose utilization of skeletal muscles.3.To inhibit the secretion of glucagon.

The rate of resting energy expenditure (REE) was determined in 75 cases of burn patients with different total areas of burned wounds.Itwas found that.1.The rate of REE increased with the increase of the total area of burned wounds.2.When the total burned body surface area was equal,the rate of ERE increased more signficantly in the case with more extensive third degree burns.3.In the period immediately after the healing of the burned wounds,the rate of REE remained significantly higher than in the normal subjects.

Thirty-two adult patients with burn wounds over 50% TBSA were randomized into the nutritioal and the control group.Energy supplement Ifor the patients of the nutritional group was given according to the burn nutrition formula of the Third Military Medical College as follows,Energy (kJ) /day=4184 (1000 cal)?body surface area (m2) +105 (25 cal)?burn surface area (%)glucose,fat:protein=55~60:20~30:15~20calorie (cal):nitrogen (g)=150~170:1The patients of the control were prescribed to eat the hospital diet freely.All the patients of the 2 groups were observed for 28 days postburn with their burn wounds similarly and properly treated.It was found that most of the nutritional indices observed were better in the nutritional group than in the control.

The resting energy expenditure (REE) and the relative ratio of carbohydrate,fat and protein were investigated on the 1st to the 28th dqy postburn in 75 adult burn victims with burn area ranged between 5~98% TBSA.It was found that there was high catabolism of fat and protein but relatively low consumption of carbohydrate after burns.The more severe the burn injury,the more marked the above changes.On the basis of the metabolic characteristics of burn patients and on the traditional dietary habits of Chinese,a reasonable relative ratio among carbohydrate,fat and protein,the 3 main nutritional elements,in the diet of burn patients was suggested,viz,carbohydrate:fat:protein=55~60:20~30:15~20.

Objective To know the nursing scientific research status in recent years,and to reveal the differences between Chinese nursing scientific researches and foreign nursing scientific researches,in order to promote the rapid development of nursing cause in China.Methods Five Chinese journals of nursing and four foreign nursing journals were analyzed covered China National Knowledge Infrastructure (CNKI),PubMed and Google data ranged from 2008 to 2013.By adopting bibliometrics method,regional distribution,the number of people participation,the cooperation between units,the source of financial funding,research content and nature of Chinese nursing research papers were analyzed,and also compared to research content and nature of foreign nursing journals.Results The amounts of published papers were 1 527 pieces.The geographical distribution of research papers were all spread over 28 provinces,autonomous regions sand municipalities directly under the central government,most of which was Guangdong province [12.64％ (193/1 527)];The majority of research papers were completed by single unit and more than five people,which about [68.4％(1 045/1 527)],[38.6％(589/1 527)],respectively;Provincial level of research papers were more than national level [81.4％(1 243/1 527) vs.18.6％(284/1 527)];The papers focused on the clinical nursing research [37.8％(577/1 527)] and clinical basic nursing research [34.6％(529/1 527)].Almost researches were descriptive research,while 40.7％(622/1527) of which were clinical analysis.Foreign nursing scientific researches paid more attention to psychological research and nursing profession which were related to humanities and investigation was major method used;Compared with the foreign nursing papers at the same time,the number of Chinese nursing research papers increased rapidly (P ＜ 0.05);Papers were completed more than five units rapidly increased compared with the pre-upgrade,as well as the national subjects,the difference was statistically significant (P ＜ 0.05).Conclusions The number of nursing research programs tended to increase year by year and the enthusiasm of nurses participating in scientific research was higher than before.Different units needed to further strengthen cooperation in scientific research.The research content and direction were diversity,which had not yet formed central tendency.The research method was still limited to descriptive studies,and the creativity of the research methods was needed,especially laboratory research.

Objective To evaluate the efficacy of modification and care improvement in endotracheal tubes (ETTs) to prevent ventilator associated pneumonia (VAP) in patients receiving mechanical ventilation (MV).Methods PubMed,China National Knowledge Infrastructure (CNKI) were searched,literature information was extracted and classified according to the inclusion criteria,the data were statistically analyzed.Results Totally 46 clinical research articles and 6 laboratory research articles were involved,the data showed that polyurethane (PU) cuff [23.809％ (35/147)],silver-coated ETTs [4.830％ (37/766)],subglottic drainage duct [19.492％ (759/3 894)],discontinuous subglottic drainage[13.603％ (256/1 882)] were associated with a decreased incidence of VAP compared with polyvinyl (PVC) cuff [40.179％ (45/112)],non-silver-coated ETTs [7.537％ (56/743)],conventional ETTs[45.733％ (1 088/2 379)],continuous subglottic drainage [25.000％ (503/2 012)],the differences in the incidence of VAP were statistically significant,respectively,P＜ 0.05.The incidence of VAP in cylindrical PU cuff was 25.000％ (8/32),the tapered PU cuff was 21.875％ (7/32),the difference in the incidence of VAP was not statistically significant.Conclusions The modification of the ETTs and the care improvement can effectively reduce the incidence of VAP.