Objective To investigate the value of measurement of cardiac output in children by bio-reactance versus echocardiography.Methods Pediatric patients admitted in pediatric department of Peking University First Hospital from September to December 2012 who needed hemodynamic monitoring were enrolled prospectively.Cardiac index(CI)and stroke volume(SV)were measured by echocardiography and non-invasive cardiac output measurement(NICOM)and compared by Spearman correlation and Bland-Alt-man analysis.Results Thirty patients were included.The median age was 7.25 years.CI[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated significantly[3.42(2.28,4.92)L /(min?m2 ) vs.3.51 (2.94,4.85 )L/(min?m2 ),R =0.385,P =0.035 ].Bland-Altman analysis revealed a bias of-0.22 L/(min?m2 )(P =0.051 ),limits of agreement of -1.40 to 0.95 L/(min?m2 ).SV[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated more significantly [36.3 (12.6,87.8 )ml vs.39.4(14.7,86.9)ml,R =0.768,P ﹤0.001 ].Bland-Altman analysis revealed a bias of -3.1 ml(P =0.176),limits of agreement of -27.4 to 21.2 ml.Conclusion There is no significant difference between NICOM and echocardiography for the measurement of CI and SV in pediatric patients.Further validation studies need to be conducted before routine clinical use.

In this review, we have briefly described the concept, status quo and relevant variables of worldwide nurses′ professional identity. Moreover, there has been a detailed summary of promotion strategies on foreign nurses. The introduction mentioned above aims at exploring more effective and comprehensive promotion strategy, which might provide the theoretical basis for Chinese nursing identity studies.

Objective To explore the pathological changes by CT scan on localized thermochemotherapy dur- ing and after the operation of human gliomas.Methods Retrospective analysis was given to the CT scan of 37 pa- tients receiving thermochemotherapy during and after the operation,and the relation of the tumorous cells and mi- crovessels and CT density by EM were analyzed.Changes of tumorous cells and microvessels after localized ther- mochemotherapy on C_6 gliomas in rat were analyzed.Results When the tumor was low dense on CT pattern,less cellular number with increasing the amount of fluid between the cells was demonstrated pathologically.On EM,a lower cellular electron density was observed.The amount of fluid in cytoplasm was increased,the cytoplasm was porous,swelling denaturation was chiefly seen in organelle.If the tumor had mixed density on CT,cellular number was more,the amount of fluid was less.On EM,cellular electron density increased correspondingly,the fluid in cyto- plasm decreased,organdie was aggregated.After thermochemotherapy,the tumor reduced,liquefied,and vanished by CT scan.It could be observed that the tumorous cell become smaller,concentrated and cataclased,finally formed apoprotic bodies and separated from the cell in C_6 gliomas in EM.The tumorous vessels was less,smaller and thinker. Some vessels only could see the base membrane and no endothelioid cells.Conclusion The remaining tumors is van- ished by CT scan.The mechanisms of tumors disappearance proposes to explain that thermochemotherapy can dam- age C_6 glioma cells and microvessels,decrease microvessels density and induce tumor ceils apoptosis.That inhibits tu- morous angiogenesis and proliferation.

Background and purpose: Thyroid carcinoma cells spread mainly through lymph node metastasis, and lymphangiogenesis plays an important role during the lymph node metastasis, but it is not very clear to understand the formation mechanism. This study was to investigate the correlative expressions of HPSE, VEGF-C, D2-40 and lymphangiogenesis in thyroid carcinoma. Methods: Immunohistochemistry SP method was used to detect the expressions of HPSE, VEGF-C and D2-40 in 77 patients with thyroid carcinoma including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC),medullary thyroid carcinoma (MTC), 32 of them with lymph node metastasis was enrolled into the study, D2-40 stained the lymphatic vessels, and lymphatic vessel density (LVD) was scanned under the light-microscope, and the correlation among the above indexes in different thyroid carcinoma types were analyzed respectively. Results: The expressions of HPSE, VEGF-C and D2-40 were observed to have a different degree in thyroid carcinoma, and the highest expression of the protein could be seen in the patients with papillary carcinoma (P<0.05),The expression ratios of HPSE,VEGF-C and D2-40 in different carcinoma types were 54.9%, 68.6%, 12.8±5.7 for PTC, 37.5%, 50%, 8.6±1.7 for FTC, 20% and 20%, 4.9±0.8 for MTC, respectively. There were significant different expressions of HPSE, VEGF-C and D2-40 between the patients with lymph node-positive group and node-negative group (P=0.014, P=0.048, respectively). In addition, the expressions of them were positively correlated (P<0.001, r=0.616). Conclusion: HPSE, VEGF-C and D2-40 have a close relationship with lymph node metastasis, HPSE and VEGF-C are related to the lymphangiogenesis.

Objective To investigate the association of sleep quality with prevalence of irritable bowel syndrome (IBS) in communities of Shanghai.Methods A survey on prevalence of IBS in communities of Jiangqiao County,Jiading District of Shanghai was conducted using a stratified,randomized cluster-sampling method.A total of 11 569 questionnaires was collected.The IBS was diagnosed according to Rome Ⅲ criteria,and Athens Insomnia Scale (ALS) was used for selfassessment.The relationship between sleep quality and IBS was analyzed.Results The prevalence of insomnia was 21.00% in community groups,33.02% in IBS patients and 18.74% in non-IBS patients.The incidence of insomnia was significant higher in IBS group than non-IBS group (P =0.004,OR = 2.14,95 % CI:1.92- 2.39).Among IBS patients,the incidence of insomnia was higher in females than in males (37.24% vs 28.41%,P = 0.000).A logistic analysis for psychological contributing factors in IBS revealed that insomnia might be one of the risk factors for IBS (OR= 2.11,95% CI:1.89-2.36).Conclusion IBS patients have poor sleep quality,especially in females.

Objective To explore the effects of problem-based learning (PBL) on improving intern doctors' clinical thinking and problem-solving capacities in clinical practice teaching.Methods PBL teaching courses were designed and used among 72 intern doctors come from 2010 grade clinical medical major (experiment group)and traditional teaching model was applied in 55 intern doctors come from 2009 grade clinical medical major ( control group).The PBL teaching effectiveness was evaluated through expert comment,exam and questionnaire survey.Test was conducted concerning the score of objective theoretical test on clinical thinking and the quality of case report writing.Results There were differences between experiment group and control group in theoretical test score and case report writing quality ( P ＜ 0.01 ).According to the results of questionnaire survey,teachers and students thought that the PBL teaching mode was better than traditional teaching mode in cultivating students' clinical thinking ability and problem solving ability.Conclusion The teaching effect of PBL in clinical practice is satisfactory.PBL teaching can effectively develop the students' clinical thinking and problem-solving capacities and play an active role in improving education quality and promoting education reform.

Objective To study the clinical presentations,radiologic features,prognosis,and possible causes of liver injury associated umbilical venous catheter (UVC ).Methods We reviewed database of our NICU from December 2012 to November 2015 and identified preterm infants with liver injury while UVC in place.The gestational age,birth weight,gender,days of UVC in place prior to liver injury, the depth of UVC (cm),UVC tip position,ultrasound findings of liver injury,laboratory tests,treatment and outcomes were collected.Results During study period,322 infants received UVC insertion.Ten cases (3.1 %)of liver injury associated with UVC were diagnosed.Of the ten infants,nine were diagnosed as extravasation of fluid to liver parenchyma,and one was diagnosed as liver hematoma.The mean birth weight was (1184 ±207)g,mean gestational age was (28.5 ±1.7)weeks.The UVC tip was at thoracic (T) vertebrae T 9 to T 11 level,nine UVC tips were below the right diaphragm level.All UVCs were used for total parenteral nutrition before liver injury was diagnosed.Six infants had clinical manifestations,and four infants were free of clinical manifestations.The most prominent clinical signs were abdominal distension (n =5),weak bowel sounds (n =5)and hepatomegaly (n =4).One infant who was diagnosed with liver hematoma also had progressive hemoglobin decline (minimum 34 g/L)and shock.Abdominal ultrasound showed well-limited,irregular,hyperechoic rimmed lesions with heterogeneously hypoechoic centers or anechoic liquid dark space.Extravasation of fluid to liver parenchyma will restorate within one week after the UVC was remove.One baby who was diagnosed as liver hematoma passed away at 9 days of life.Liver ultrasound of eight returned to normal in 52 days to 3.5 months,and one had calcified lesions at 9 months of age.Conclusions Liver injury is an unusual complication of UVC insertion and usage.Proper positioning of the UVC tip may help to avoid this complication.Early recognition,prompt diagnosis with liver ultrasound examination and timely treatment can lead to better outcome in newborns with extravasation of fluid to liver parenchyma.

[ ABSTRACT] AIM:To investigate the effect of oxidized low-density lipoprotein ( ox-LDL) on autophagy in mac-rophages and the underlying molecular mechanisms.METHODS:RAW264.7 macrophages were pretreated with 2 mg/L anti-CD36 monoclonal antibody (anti-CD36 mAb), 5 μmol/L diphenyleneiodonium (DPI), 3 mmol/L 3-methyladenine (3-MA) or 1μmol/L rapamycin for 1 h and then treated with ox-LDL (100 mg/L) for 12 h.The viability of the cells was measured by MTT assay.The activities of lactic dehydrogenase ( LDH) in the medium and nicotinamide adenine dinucleoti-de phosphate ( NADPH) oxidase, superoxide dismutase ( SOD) in the cells as well as the levels of intracellular reactive ox-ygen species ( ROS) and malondialdehyde ( MDA) were determined to characterize the membrane integrity and the oxida-tive stress, respectively.The protein levels of beclin-1 and microtubule-associated protein 1 light chain 3-II ( LC3-II) , 2 important molecular markers of autophagy, were examined by Western blotting.RESULTS:ox-LDL induced autophagy in
RAW264.7 macrophages as assessed by upregulation of beclin-1 and LC3-II.Similar to 3-MA, an autophagy inhibitor, an-ti-CD36 mAb significantly inhibited the ox-LDL-induced upregulation of beclin-1 and LC3-II.Anti-CD36 mAb suppressed the ox-LDL-induced oxidative stress as revealed by decreased NADPH oxidase activation, ROS and MDA generation as well as increased SOD activity.Similar results were observed in the cells pretreated with DPI, a NADPH oxidase inhibitor.Mo-reover, DPI significantly inhibited the ox-LDL-induced upregulation of beclin-1 and LC3-II.Inaddition, the decrease in the cell viability and increase in LDH release induced by ox-LDL were promoted by 3-MA and blocked by rapamycin ( an auto-phagy inducer).CONCLUSION: ox-LDL induces autophagy in RAW264.7 macrophages, which may be involved in CD36-mediated ox-LDL uptake and subsequent activation of oxidative stress, and moderate activation of autophagy may pro-tect macrophages from ox-LDL-induced injury.

Objective To explore the efficiency of continuous glucose monitoring system(CGMS) and blood glucose self-monitoring (SMBG)in evaluating blood glucose excursion in type 1 diabetes mellitus (T1DM) complicated with pregnancy. Methods Twenty-five patients having suffered from T1DM complicated with pregnancy were selected randomly during June 2012 to July 2015. All subjects underwent blood glucose monitoring by CGMS and SMBG for 72 h, including the data of blood glucose before meal, 2 h post-meal blood glucose (2hBG) and blood glucose at 2:00 AM. Results The level of the highest blood glucose in CGMS was significantly higher than that in SMBG:(10.60 ± 2.11) mmol/L vs. (7.50 ± 1.18) mmol/L, P<0.01. The level of the lowest blood glucose in CGMS was significantly lower than that in SMBG:(3.60 ± 1.06) mmol/L vs. (4.50 ± 1.15) mmol/L, P<0.01. The level of mean blood glucose in CGMS and SMBG had no significant difference:(7.20 ± 1.18) mmol/L vs. (7.30 ± 1.15) mmol/L, P>0.05. The rate of hypoglycemia(blood glucose<3.3 mmol/L) in CGMS was 4.6%, and in SMBG was 1.9%. Through adjusting the treatment by CGMS, the blood glucose before meal, 2hBG and blood glucose at 2:00 AM at 49-72 h were significantly lower than that at 0-24 h (P<0.05). Conclusions Compared with SMBG, CGMS has a relatively larger blood glucose monitoring range and can sensitively evaluate blood glucose excursion, CGMS provides a scientific basis to develop a more rational and effective strategies for controlling diabetes.

Objective To evaluate the value of ultrasound elastography score and strain ratio index in the differential diagnosis of thyroid solid nodules. Methods Eighty-six thyroid solid nodules of 69 patients were divided into 2 groups based on their pathologic results: benign nodules group and malignant nodules group.Compared with pathological results, each thyroid solid nodules' elastographic scores and strain ratio index were respectively analyzed. The sensitivity, specificity and accuracy of elasticity score and strain ratio index were calctlated.The receiver operator characteristic (ROC) curves were drawn according to the results, to choose the best cut-off value.Results There were 67 nodules in benign nodules group and 19 nodules in malignant nodules group. The diameter of benign nodules was (2.05 ± 0.21)cm, malignant nodules was (1.62 ± 0.12)cm. There were no significant differences in the elasticity score and strain ratio index between benign and malignant nodules(t= - 1.736, P ＞ 0.05). Malignant lesions had a higher score and strain ratio index(median 3, 3.97, respectively) than benign ones(median 2, 1.66,respectively, Z = - 5.290, - 5.450, all P ＜ 0.05). If the cut-off value of the elastographic scores was equal or more than 3, the sensitivity, specificity and accuracy were 84.2%(16/19) ,86.6%(58/67) and 86.0%(74/86), respectively,with an area under ROC curve of 0.854. If the cut-off value of the strain ratio index was equal or more than 2.50,the sensitivity, specificity and accuracy were 89.4%(17/19),86.6%(58/67) and 87.2%(75/86), respectively, with an area under ROC curve of 0.911. Conclusion Elasticity score and strain ratio index are helpful in differentiating benign and malignant lesions of thyroid with high clinical value.