Objective To explore the efficacy of the case and scenario teaching method in the neurosurgery practice teaching.Methods By cluster sampling,153 nursing students underwent rotary practice in neurosurgery department in People's Hospital of Three Gorges University from September 2011 to July 2012 were trained with the case and scenario teaching method.Scenario simulation training combined with case playback teaching was used in practice teaching.At the end of the internship,nursing students' satisfaction was investigated and their operational capacity was evaluated.Self-designed questionnaire was adopted to evaluate satisfaction.Operational capacity evaluation scores of nursing students were divided into several parts:basic operation examination (30％),specialized operation (30％),professional theory (30％) and teacher evaluation (10％).Data were analyzed using Excel spreadsheet for entry.Countif and Count function formula were used to calculate eligibility and the passing rate.Results Nursing students had high evaluation on case playback teaching methods.By this method,153(100％) nursing students considered that the learning initiative was improved.At the end of the internship,passing rates of basic operation examination,specialized operation,professional theory were 98.69％ (151/153),96.73 ％ (148/153) and 100％ while the total passing rate was 100％.Conclusion The case and scenario teaching method could develop the study positivity and practice ability of nursing students and can enhance the internship efficacy.

Objective To investigate the clinical significance of myasthenia gravis (MG) associated autoantibodies.Methods Titin,ryanodine receptor (RyR)and acetylcholine receptor (AChR) antibodies were examined in the sera of 74 myasthenia gravies patients by ELISA.Results AChR,Titin, RyR antibodies were detected in 77.0% (57/74),39.2% (29/74) and 32.4% (24/74) of the MG patients,respectively.For thymoma MG,AChR,Titin and RyR antibodies were detected in 76.2% (16/21),71.4% (15/21) and 52.4% (11/21) respectively.For late onset MG,Titin and RyR antibodies were detected in 77.3% (17/22) and 50.0% (11/22) respectively.With respect to the modified Osserman classification,the positve rate for Titin and RyR antibodies is much higher in more severe patients (X~2= 16.094,P=0.001;X~2=11.226,P=0.011).Titin antibodies was significantly related with RyR antibodies (r=0.380,P=0.001).Conclusions Titin and RyR antibodies show high sensitivity for thymoma MG,and the combination of serological and radiological testing can increase both sensitivity and specificity in diagnosis of thymoma MG.The levels of the two antibodies may serve as important prognosis markers in MG.The induction of the immune response against Titin and RyR and the possible pathogenic effects of the two antibodies will be further studied.

Objective To study the clinical and electrophysiological features of myasthenia gravis (MG)accompanied by myogenic lesion.Methods The data of the patients who were diagnosed MG accompanied by myogenic lesion from 1998 to 2006 were collected in EMG Room, Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and were retrospectively analyzed.Results In this group of 53 patients, myogenic lesion was found more often in patients with early-onset MG than those with late-onset(69.81% vs 30.20%), and among the early-onset patients the frequency of female was significantly higher than male(26 vs 11,X~2=5.281, P

Background The pathological change of the anterior uveitis is the disruption of blood-aqueous barrier.Slit lamp examination appears to be limited for the evaluation of inflammatory response,and fluorescine angiography is an objective approach.However,there are few relative studies up to now in China.Objective Aim of this study was to observe the characteristics and assess the clinical applications of iris fluorescein angiography (IFA)in Chinese uveitis with brown iris.Methods Forty eyes of 40 normal subjects and 21 eyes of 13 patients with the anterior uveitis were collected in this study.IFA,slit-lamp examination and iris photograph were performed on the subjects.All individuals were informed consented at the initiation of this study.Results In normal eyes,fluorescence in iris vessels was blocked by the melanin pigment,but peripupillary weak fluorescent leakage was seen in the normal eyes with the age of ＞60 years old.The multiple patterns of fluorescence leakage were found in the patients suffered from uveitis of various etiologies although the negative slit-lamp finding,including the leakage of fluorescein around the pupillary margin and radial iris vessels in the eyes with mild diseases,transmitted fluorescence of regular iris vessels in the eyes with diffuse and local iris atrophy,and vascular tufts of the pupillary margin with coiled interwind tight clusters of thin vessels at the early phase in the eyes with dilated capillaries,microvascular anomalies and new vessel formation.The hyperfluorescence remained throughout the IFA duration.Conclusions IFA findings in uveitis vary depending on the topography,type and severity of inflammation.IFA has a good clinical applying value because of its objective assessment ability of the degree of the blood-aqueous barrier breakdown and iris neovascularization breakdown.It can exhibit the unvisible lesion under the slit-lamp and monitor the efficacy of medical theraphy in patients with active or quiescent uveitis.

The purpose of the present study was to investigate the effect of chronic intermittent hypobaric hypoxia (CIHH) on α(1)-adrenergic receptors and the role of alpha(1)-adrenergic receptors in the protection of CIHH against ischemic injury of myocardium. Sixty-six adult male Sprague-Dawley rats were randomly divided into four groups: control group (Con), 14-day CIHH treatment group (CIHH14), 28-day CIHH treatment group (CIHH28) and 42-day CIHH treatment group (CIHH42). CIHH rats were exposed to hypoxia mimicking 5 000 m altitude (p(B)=404 mmHg, p(O(2))=84 mmHg) in a hypobaric chamber, 6 h daily for 14, 28 and 42 d, respectively. Control animals lived in the same environment as CIHH animals except hypoxia exposure. After anesthesia with sodium pentobarbital (3.0-3.5 mL/kg body weight, i.p.), papillary muscle was taken from the right ventricle of rat and perfused with modified Tyrode's solution continuously, at constant temperature (37 °C) and perfusion speed (12 mL/min). Muscle contraction was evoked by electric stimuli. Different concentrations (1x10(-7), 1x10(-6) and 1x10(-5) mol/L) of phenylephrine (PE), an alpha(1)-adrenergic receptor agonist, were applied cumulatively to investigate the effect of PE on the mechanic contraction of right ventricular papillary muscles of rats in Con, CIHH14, CIHH28 and CIHH42 groups. Also, prazosin (1x10(-6) mol/L), an α(1)-adrenergic receptor antagonist, was used to investigate the role of α(1)-adrenergic receptor in the protective effect of CIHH on papillary muscle. The results showed: (1) PE increased the maximal isometric tension (P(max)) and maximal velocity of tension development (P(dT/dt)) of muscle contraction in a dose-dependent manner (P<0.05), and the increase of the muscle contraction was much greater in CIHH28 and CIHH42 rats than that in Con rats (P<0.05). Under 1x10(-5) mol/L of PE, the increases of P(max) and P(dT/dt) over the baseline were 51.2% and 44.5% in CIHH28 group, 48.6% and 44.5% in CIHH42 group, and 28.7% and 24.5% in Con group, respectively; (2) The contraction of papillary muscle decreased during simulated ischemia, but the decrease was slighter in CIHH rats than that in Con rats (P<0.05). The decreases in P(max) and P(dT/dt) were 59.6% and 53.6% in CIHH28 group, 60.4% and 49.9% in CIHH42 group, and 74.4% and 64.7% in Con group, respectively; (3) The protective effect of CIHH on ischemic papillary muscle was abolished by prazosin (1x10(-6) mol/L). The results of the present study suggest that CIHH increases the activity of α(1)-adrenergic receptor, which is possibly one of the mechanisms for the cardioprotection of CIHH.
Altitude ; Animals ; Heart Ventricles ; physiopathology ; Hypoxia ; metabolism ; Male ; Muscle Contraction ; Myocardium ; metabolism ; Papillary Muscles ; metabolism ; Rats ; Rats, Sprague-Dawley ; Receptors, Adrenergic, alpha-1 ; metabolism

Objective To investigate the current status about personal mastery in paediatric nurses in a tertiary hospital in Changchun and to analyse the influencing factors.Methods A total of 340 paediatric nurses in the hospital were enrolled in the investigation with the methods of general data questionnaire,personal mastery scale(PMS),nurses'perceived professional benefits scale(NPPBS)and practice environment scale(PES).Results 321 paediatric nurses complete the research.The total score of personal mastery among the paediatric nurses was found at(27.63±1.99)and was at a middle-high level.Multiple linear regression analysis showed the overall independent factors that affected the overall personal mastery of the paediatric nurses included type of job contract,average monthly income,working experience,number of night shifts per month,the perceived professional benefits and practice environment of the nurses(P<0.05).Conclusion Personal mastery among the paediatric nurses is at a middle-high level.Nursing managers should take targeted and pertinent measures to the identified influencing factors in order to improve the personal mastery,relieve work related pressures,reduce job burnout,enhance professional identity and thereby promote the stability and development the workforce in paediatric nursing.

BACKGROUNDSingle-fiber electromyography (SFEMG) abnormality in the extensor digitorum communis (EDC) was reported in ocular myasthenia gravis (OMG), which indicated subclinical involvement beyond extraocular muscles in OMG patients. The relationship between the abnormal findings of SFEMG in EDC and the probability for OMG to develop generalized myasthenia gravis (GMG) is unknown. This retrospective study aimed to determine the predictive value of abnormality of SFEMG in EDC of OMG patients.

METHODSOne-hundred and two OMG patients underwent standard clinical diagnosis process and SFEMG test in EDC muscle when diagnosed and were clinically followed up for 5 years. The SFEMG data were compared between different clinical groups according to thymus status, onset age, and different outcome of OMG developing. Chances of progressing to GMG were compared between two different groups according to SFEMG and repetitive nerve stimulation (RNS) results, acetylcholine receptor antibody (AchRAb) titer, thymus status, and onset age.

RESULTSAbnormal SFEMG results were observed in 84 (82.4%) patients. The mean jitter, percentage of jitter >55 μs (%), and blocking were higher in OMG patients than in healthy volunteers. There were no statistical differences in jitter analysis between thymoma group and non-thymoma group (P = 0.65), or between the later OMG group and the later GMG group (P = 0.31), including mean jitter, percentage of jitter >55 μs (%), and blocking. Elderly group (≥45 years old) had a higher mean jitter than younger group (t = 2.235, P = 0.028). Total 55 OMG developed GMG, including 47 in abnormal SFEMG group while 8 in normal SFEMG group. There was no statistical difference in the conversion rates between the two groups (χ2 = 0.790, P = 0.140). RNS abnormality, AchRab titer, or onset age had no correlation with OMG prognosis (P = 0.150, 0.070, 0.120, respectively) while thymoma did (χ2 = 0.510, P = 0.020).

CONCLUSIONSFEMG test in the EDC showed high abnormality in OMG, suggesting subclinical involvement other than extraocular muscles. Nevertheless, the abnormal jitter analysis did not predict the prognosis of OMG according to clinical follow-up.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Electromyography ; methods ; Humans ; Middle Aged ; Myasthenia Gravis ; metabolism ; pathology ; physiopathology ; Prognosis ; Receptors, Cholinergic ; metabolism ; Retrospective Studies ; Young Adult

OBJECTIVETo analyze the relationship between tumor necrosis factor-alpha (TNFalpha) gene promoter -308 polymorphism and myasthenia gravis (MG) in Chinese and analyze secretion of TNFalpha in peripheral blood mononuclear cells (PBMC) in MG patients.

METHODSA biallelic polymorphism at position -308 in the promoter of TNFalpha gene was screened by PCR amplification and NcoI recognition site. One hundred and twenty-three MG cases and 115 healthy controls were included in this study. MG patients were classified to different groups according to clinical type, age at onset, and sex respectively. PBMC were isolated from 20 patients and 20 healthy controls, and then cultured in the presence or absence of phytohemagglutinin (PHA) and acetycholine receptors (AchR). The supernatants were harvested after incubation and stored until TNFalpha was assayed by enzyme-linked immunosorbent assay.

RESULTSThe frequency of TNFalpha-308 allele 2 (A) was found significantly increase in MG patients and showed a trend especially in late onset (> or =40 years) and male patients (P < 0.05). The allele A had no relationship with thymic pathogenesis in MG patients. But frequency of allele A was significantly higher in general type than in ocular type (P < 0.05). MG patients had a higher inducible level of TNFalpha by PHA and AchR, and could be down regulated after treatment.

CONCLUSIONPolymorphism in TNFalpha gene promoter -308 is associated with onset of MG. The microsatellite allele TNFalpha2 confer risk for the development of MG in Chinese patients. MG patients have a higher inducible level of TNFalpha.

Adolescent ; Adult ; Aged ; Cells, Cultured ; Child ; Child, Preschool ; Female ; Gene Frequency ; Genotype ; Humans ; Immunosuppressive Agents ; therapeutic use ; Leukocytes, Mononuclear ; pathology ; secretion ; Male ; Middle Aged ; Myasthenia Gravis ; drug therapy ; genetics ; metabolism ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Tumor Necrosis Factor-alpha ; genetics ; secretion

Encephalitis ; diagnosis ; epidemiology ; etiology ; therapy ; Hashimoto Disease ; diagnosis ; epidemiology ; etiology ; therapy ; Humans

BACKGROUNDSingle-fiber electromyography (SFEMG) has been suggested as a quantitative method for supporting chronic partial denervation in amyotrophic lateral sclerosis (ALS) by the revised EI Escorial criteria. Although concentric needle (CN) electrodes have been used to assess jitter in myasthenia gravis patients and healthy controls, there are few reports using CN electrodes to assess motor unit instability and denervation in neurogenic diseases. The aim of this study was to determine whether quantitative changes in jitter and spike number using CN electrodes could be used for ALS studies.

METHODSTwenty-seven healthy controls and 23 ALS patients were studied using both CN and single-fiber needle (SFN) electrodes on the extensor digitorum communis muscle with an SFEMG program. The SFN-jitter and SFN-fiber density data were measured using SFN electrodes. The CN-jitter and spike number were measured using CN electrodes.

RESULTSThe mean CN-jitter was significantly increased in ALS patients (47.3 ± 17.0 μs) than in healthy controls (27.4 ± 3.3 μs) (P < 0.001). Besides, the mean spike number was significantly increased in ALS patients (2.5 ± 0.5) than in healthy controls (1.7 ± 0.3) (P < 0.001). The sensitivity and specificity in the diagnosis of ALS were 82.6% and 92.6% for CN-jitter (cut-off value: 32 μs), and 91.3% and 96.3% for the spike number (cut-off value: 2.0), respectively. There was no significant difference between the SFN-jitter and CN-jitter in ALS patients; meanwhile, there was no significant difference between the SFN-jitter and CN-jitter in healthy controls.

CONCLUSIONCN-jitter and spike number could be used to quantitatively evaluate changes due to denervation-reinnervation in ALS.

Amyotrophic Lateral Sclerosis ; physiopathology ; Electrodes ; Electromyography ; Humans ; Middle Aged ; Needles ; ROC Curve