Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU.

Objective To summarize our experience in the management of cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA) during aortic arch surgery.Methods From March 2007 to May 2010,58 consecutive patients,including 24 urgent and 34 selective operations underwent aortic arch surgery.Thirty-nine hemiarch and 19 total aortic arch replacement operations were performed.CPB was established by perfusion through femoral artery (42 cases) and right subclavian artery (RSA) ( 16 cases),of which 4 cases were carried out with antegrade cerebral perfusion (ACP).Results The mean CPB time was ( 208.88 ± 136.45 ) min.The mean cerebral circulation arrest was ( 27.36 ± 11.50 ) min.Nasopharyngeal and rectal temperature were ( 16.01 ±2.67)℃ and ( 19.72 ±2.13)℃ respectively before DHCA was initiated.The mean times for cooling and rewarming were ( 50.91 ± 16.89) min and ( 88.97 ± 43.68 ) min.The mean time of intubation was (56.70 ± 45.19 ) h.The time in ICU was ( 5.68 ± 5.31 ) d,and the time of hospitalization was (30.11 ± 22.27 ) d.Acute renal failure,hypoxemia,and paraplegia occurred post-operatively in 4,19,and 2 patients,respectively.Four patients died post-operatively with a mortality of 6.90％.Compared with those received hemiarch replacement operation,the patients received total aortic arch replacement had statistically longer time of CPB([262.16 ±219.97]min vs [182.92 ±53.81] min,t =2.14,P ＜0.05),cerebral circulatory arrest ( [30.47 ± 15.86 ] win vs [25.85 ± 8.48 ] min,t =2.40,P ＜ 0.05 ),rewarming ( [110.00 ± 68.66 ] min vs [78.72 ± 17.31 ] min,t =2.69,P ＜ 0.05 ),and intubation ( [93.95 ± 131.89 ] h vs [38.08 ± 30.70 ] h,t =2.50,P ＜ 0.05 ).There was no significant difference in the times of these procedures between emergency surgery group and elective surgery group,between RSA and femoral artery cannulation groups.Conclusion It is crucial that the cooling and re-warming procedures during aortic arch surgery should be carried out slowly,gradually,and completely when DHCA was adopted alone.conclusion through right axillary artery or RSA was preferred for ACP,in order to accomplish the body circulation arrest at a relative high temperature,to shorten the CPB time,and to alleviate potential harmful effects of hypothermia.Meticulous management of CPB is one of the most important measures to improve the patients' outcome.

Objective To summarize our experience in endovascular repair of 83 cases with type B aortic dissection.Methods A retrospective analysis was performed in 83 cases of type B aortic dissections who were treated in our hospital.Results The surgical procedure was successful for all the patients.Two patients died peri-operatively.One case encountered a coma,but no post-operative paraplegia occurred.Conclusion Endovascular repair for type B aortic dissection is a micro-invasive,safe and effective technique.Long-term follow-up is required to give a comprehensive evaluation.

Objective To describe the treatment experience of post-operative complications after total arch replacement for acute type A aortic dissection in 34 cases.Methods The subjects were 34 consecutive patients (Twenty-eight males and 6 females,age 34.0 -60.0 yrs) who received total arch replacement for acute Stanford type A aortic dissection from Jan.2005 to Oct.2010 in our hospital.The duration from the onset of the symptoms to the hospitalization ranged from 4 - 18 hrs.Pre-operative 2-D Echo revealed aortic valve regurgitation in 8 patients and mitral valve regurgitation in 1 patient.Results Three patients died after operation ( mortality 8.8％ ).Severe complications included acute kidney injury in 13 cases,respiratory dysfunction in 12 cases,paraplegia in 1 case,mental disorder in 10 cases and excessive post-operative bleeding in 2 cases.Conclusion The incidence of the complications after total arch replacement is still high and severe.Intensive care should be stressed peri-operatively and early diagnosis and treatment for post-operative complications are important procedures.

Objective To describe the follow-up data of 34 patients receiving total arch replacement with an open stent graft for acute type Ⅰ aortic dissection.Methods The subjects were 34 consecutive patients with type Ⅰ acute aortic dissection ( Twenty-eight males and 6 females,aged 34.0 - 46.0 yrs) who received total arch replacement with an open stent graft in our hospital from Jan.2005 to Oct.2010.Thirty of the 34 patients were followed up for 2 - 70 months.CT scanning was performed at the 3 and 12 months and then yearly after operation to detect the thrombus formation,absorption of thrombus,and obliteration of the false lumen after its exclusion by the stent graft.Results Three patients died peri-operatively with the mortality of 8.8％.One patient died during the follow-up period.Obliteration was recognized in all the patients at the distal side of the stent graft during the follow-up period.The false lumen remained in 10 patients at the distal part of descending aorta,but the diameter of the false lumen was not enlarged.Conclusion In patients with acute type Ⅰ aortic dissection,it is relative safe to perform extensive primary repair of the thoracic aorta by stent grafting.This method may enhance the obliteration of the false lumen and reduce the possibility for further operations to manage a residual false lumen.

Clinical medicine is a comprehensive discipline integrating natural science and hu-manities and social science. Lemology is closely related with basic medicine and medical microbiology and medical immunology are the basis of lemology. Therefore, in the process of cultivating postgradu-ates of lemology, we should not only should attach importance to the cultivation of basic medical knowl-edge and clinical professional quality, but also pay more attention to the development of the intelligence factors and non-intelligence factors. Meanwhile education on humanity, social sciences and relevant laws and regulations should be enhanced to cultivate doctors' professional quality. Reverse thinking and lateral thinking in the clinical diagnosis should be strengthened to achieve the training objectives of cultivating international medical talents.

Animals ; Hypoxia ; classification ; metabolism ; Male ; Oxygen Consumption ; Rats ; Rats, Sprague-Dawley

ObjectiveTo study the expression of insulin-like growth factor Ⅱ mRNA-binding protein 3 ( IMP3 ) and its clinicopathological significance in breast cancer.MethodsThe Maxvision immunohistochemistry was used to detect the expression of IMP3 protein in 103 cases of breast cancer and the adjacent normal breast tissues.Stem-loop real-time RT-PCR was used to detect the expression level of IMP3 mRNA in 30 cases of breast cancer and the matched non-tumor adjacent tissues.The relationship between the expression of IMP3 and the clinicopathological features of breast cancer was analyzed.Results62 cases were infiltrative ductal carcinoma,3cases were invasive lobular carcinoma,9 cases were microinfiltrative intraductal carcinoma,and 29 cases were special type of carcinoma.The difference of IMP3 expression between breast cancer group and normal breast tissue group had statistical significance( t =19.630,P =0.000)by t test.For infiltrative ductal carcinoma patients,IMP3 expression had no significant relation with age,tumor size,lymph node metastasis,histological grade,pTNM stage,ER,PR,or HER-2 ( P ＞ 0.05 ).IMP3 mRNA expression level of was significantly higher in tumor tissues than in the adjacent normal tissues (P ＜ 0.05 ).No significant association was found between the expression of IMP3 and the histological grade,tumor size,lymph node metastasis ( P ＞ 0.05 ).ConclusionIt is possible that IMP3 plays an important role in the generation,progression,invasion and metastasis of breast cancer.

The paper analyzes the difference of higher stomatological education in China and abroad and the weakness in the teaching system of China,and proposes some reform consideration based on our real situation.

Objective To investigate the clinicopathology and immunophenotype of primary non- Hodgkin lymphoma(NHL)of the female genital system,and to analyze the prognosis of such tumors. Methods Clinicopathologic features of 43 cases of primary NHL of the female genital system were studied retrospectively,with the histological classification based on the Classification of Haematopoietic and Lymphoid Tumors(WHO,2001).Immunochemistry technique,in-situ-hybridization and polymerase chain reaction methods were used to detect the immunophenotype,epstein barrvirus(EB)virus infection status and immunoglobulin heavy chain gene rearrangement,respectively.Results(1)Primary lesions:there were 24 cases of lymphoma originating in the ovary,3 cases in the endometrium,10 cases in the cervix,2 cases in the vagina and 4 cases in the vulva.(2)Staging:12 cases(28%)were in stage Ⅰ,9 cases (21%)in stage Ⅱ,and 22 cases(51%)in stage Ⅲ.(3)Histological classification:37 cases(86%)were diffuse large B cell lymphoma(DLBCL),3 cases were Burkitt lymphoma and the remaining 3 cases were unspecified peripheral T-cell lymphoma according to biopsy,immunophenotype analysis,in-situ- hybridization technique and IgH gene rearrangement detection.(4)Prognosis analysis:increase in the level of lactic acid dehydrogenase,stage Ⅲ,DLBCL and single operation suggest poor prognosis.Conclusions Establishment of the diagnosis of primary NHL of the female genital system is based on biopsy, immunophenotype analysis,in-situ-hybridization technique and IgH gene rearrangement detection,which play important roles in diagnosis and differential diagnosis of the tumor.Combined therapy is the first choice of therapeutic regimens.