Background and purpose:Literature report of treatment and prognosis in gastrointestinal stromal tumors(GIST) with hepatic metastasis and recur rent metastasis was rare, This study was to discuss the clinicopathological characteristics and the situation of treatment and prognosis in GIST with hepatic metastasis and recurrent again metastasis. Methods:We reviewed two cases of GIST with hepatic metastasis reported from our hospital, and comprehensively analysed the related literature. Results:Two cases of GIST with hepatic metastasis in our hospital were analysed: one case of primary intestinel tumor,13 years after the treatment of the patient was diagnosed with hepatic metastasis. After operation, the patient accepts imatinib mesylate therapy for 400 mg per day and gave up one and a half month later because of serious side reactions. 1 year 10 months later, the patient was diagnosed with liver, kidney, peritoneum and diaphragm metastasis again, after excised lesions the patient continued to accept Imatinib therapy, and persisted takes about 8 months until now. The primary tumor of recowd case came from greater omentum, 2.5 years later after primary tumor excised hepatic metastasis occured, after operation the patient accepted Imatinib therapy for 400 mg per day, until now 15 months. Two cases followed respectively until now was 2.5 and 1.5 years, without recurrence or metastasis again, all are surviving. Conclusions:The patients of GIST with hepatic metastasis and recurrence again, by suitably lengthened Imatinib therapy cycle after the excision of the lesions, it is still to be possible to obtain the good curative effect .

Objective To compare the efficacy of three solutions used in the patients who suffered chronic obstructive pulmonary diseases (COPD ) when combined with oral fungal infection,and to find the most suitable one. Methods Using randomized controlled trial method, 98 patients who suffered COPD complicated with fungal infection were randomly divided into three groups. Method 1, using 0.5% povidone for the oral care. Method 2, making 200 million U of nystatin powder dissolved in 2.5% NaHCO3 for the oral care.Method 3, gave oral care with 2.5% NaHCO3 first, then put 200 million U of nystatin powder into 20 ml glycerol and covered the oral spots with them. Three groups were observed in the effect of oral fungal infection and the feedback from patients and nurses. Results In the analysis of the white spots sharply disappeared or pharyngeal swab smear turned negative, method 1 and method 3 had no statistical difference, P>0.05, but method 2 and method 3 had statistical significance, t=3.892, P <0.01; the three groups had no significant difference of feedback from the patients’ oral comfort, P >0.05. The time made solution of method 1 occupied 41.7% of method 3, and the time made solution of method 2 occupied 54.4%of method 3, while there was no statistical significance in total time of three groups (P>0.05). Conclusions The oral care with 0.5% povidone had good effect on the patients who suffered COPD complicated with oral fungal infection,with good comfort,and most nurses saving time. Nystatin powder dissolved in 2.5% NaHCO3 worked later than nystatin powder dissolved in glycerol.

Objective To explore the effects of teaching method of concept-map orientation on cultivating intern nursing students' autonomous learning competencies. Methods 120 volunteers were randomly divided into the experimental group and the control group with 60 students in each group. The students from the experimental group participated in the training activities, in which concept-map orientation and clinical case served as a vehicle. While the students from the control group attended lectures held by nursing department. All the students fulfilled the Measure Scale of Autonomous Learning Competencies of Nursing Undergraduates before and after this study. Results There was significant difference between before and after the study, and significant difference was also seen in total score and score of each dimension between the experimental group and the control one. Conclusions The teaching method of conceptmap orientation can cultivate nursing students' autonomous learning competencies.

ObjectiveTo investigate the effect of follow-ups on medical compliance behaviors and quality of life of patients with gastroesophageal reflux disease (GERD).Methods One hundred GERD patients who were hospitalized in our department from June 2012 to June 2013 were divided into intervention group (n=50) and control group (n=50) according to the random number table. Both groups received the same drug treatment and conventional nursing during hospitalization.The control group received periodically outpatient follow-ups,while the intervention group received professional follow-ups by trained nurses after discharge from hospital. The compliance behaviors and quality of life in these patients were assessed and statistically analyzed after 6 months nursing intervention or outpatient follow-up.Results With the implement of follow-up in patients with GERD,the intervention group was better than the control group in compliance behaviors,including the decrement of smoking and drinking,strong tea,coffee,having midnight snack and spicy food (P<0.05),but there was no difference in the behavior of staying-up between the two groups.Concerning the quality of life,the intervention group was significantly better than the control group in the 6 items excluding the physical and physiological functions (P<0.05).Conclusion Professional follow-ups can improve compliance behavior and quality of life of GERD patients.

Objective To explore the common problems that facing the nursing trainees and seek the way to solving them. Methods The established Internet forum for nursing eases which was divided into six areas,such as clinical decision,ethical problems,nursing skills, the relationship between teachers and students,the relationship between nurses and patients,vocational prevention;77 nursing stuedents who were from three junior colleges of Jiangxi province participated in this study voluntarily.Nursing cases that happened during practical period were sent to the forum by volunteers and were discussed by nursing students and tutors. Results The cases sent by the nursing students were listed as the following order:relationship between teachers and students, relationship between nurses and patients, vocational prevention, clinical decision, ethical problem, and nursing skills. Conclusions During practical period, the main problems which the nursing students focused on stemod from the relationship between teachers and students, the relationship between nurses and patients and vocational prevention. Nursing educators should put emphases on the related knowledge and skills in order to improve the students'ability of coping with these problems.

Objective To explore the impact of duration of catheter on incidences of PUR,UTI and reinserting catheter following LAVH,in order to determine the best time for withdrawing catheter.Methods 139 patients in keeping with the selected criteria were randomly divided into the non-catheter group,indwelling one-day and two-day group.The incidences of PUR,UTI and reinserting catheter were analyzed.Results There was significant difference in PUR and UTI among the three groups,and no difference was seen in reinserting catheter among them.Conclusions The catheter should be withdrawn as early as possible to prevent UTI.

Objective To explore the effects of the integrated teaching," teaching,studying and doing",which designed according to the nurse's core competency. Methods The integrated teaching of "teaching,studying and doing" was applied to the experimental class. The basal portions of the integrated teaching were as follows:searching for the Internet information,Sharing information between groups,per-forming cleaning care for the elders living in welfare agency according to nursing process,writing Nursing History or reflections. Results Comparison of mean scores between the experimental class and the con-trol one predicted significant differcences on theoretical and practical test,and the former was better than the Last. Conclusions The integrated teaching designed according to the nurse's core competency was more effective than the traditional teaching method,since the students from the experimental class valued the knowledge and skills immanently,and were involved in applying,reviewing them in time.

Objective To understand and analyze the situation of orthopedic nursing manpower resources in grade- Ⅲ general hospital in Shanghai and provide empirical evidence for appropriate allocation and exploitation of nursing manpower resources. Methods Data were collected by questionnaire and then underwent analysis. Results In 2009,the number of authorized beds was 1866,the actual number of open beds was 2007.The number of nurses was 595 (2 male).The ratio of ward bed and nurse were 1:0.319 and 1:0.296, calculated by the authorized beds and authorized beds, respectively.The average age of head nurses was (37.53±6.11 ) years old, average working life span was (17.87 ± 6.16) years; college degree or above accounted for 95.56%; middle professional titles accounted for 62.22%. College degree or above accounted for 75.13% in nurses, junior professional titles accounted for 92.1%; age group is mostly concentrated in the 20 to 29 years of age, accounted for 67.06%; working life span concentrated within 10 years, accounted foi 73.11%. The education level mainly is primary school in the care workers (carer), accounted for 45.83%; concentrated in the 40 to 49 years of age, accounted for 60.42%; working life span concentrated in more than 6 years, accounted for 55.21%. Conclusions There are shortage of orthopedic nursing manpower resources, unreasonable allocated structure, lack of male nurses in grade- Ⅲ general hospital in Shanghai. The management of the care workers should be standardized.

[ ABSTRACT] AIM: To observe the effect of microRNA-19a ( miR-19a) on the lipid catabolism of hepatocyte LO2, and to explore the potential mechanism.METHODS: miR-19a was over-expressed or silenced by transfection of miR-19a mimics or miR-19a inhibitor into LO2 cells, then the mRNA level of miR-19a was detected by real-time PCR.The potential target of miR-19a was found by the method of bioinformatics through internet website.The effect of miR-19a on the 3’ UTR of peroxisome proliferator-activated receptorα(PPARα) was measured by dual luciferase reporter assay, and the protein level of PPARαand its 2 major downstream rate-limiting enzymes involved in lipid catabolism, acyl-coenzyme a dehydrogenase (ACADM) and carnitine palmitoyltransferase 1A ( CPT1A), were detected by Western blotting.Mean-while, the effect of miR-19a on the generation of ketone body was measured by beta-hydroxybutyric acid (β-OHB) detec-tion assay.RESULTS:The mRNA level of miR-19a was dramatically elevated by the transfection of miR-19a mimics, and sharply decreased by the transfection of miR-19a inhibitor (P<0.05).PPARαwas found as a potential target of miR-19a, and dual luciferase reporter assay and Western blotting confirmed the regulatory effect of miR-19a on the expression of PPARα, with the protein level changes of ACADM and CPT1A.miR-19a mimics down-regulated, while miR-19a inhibitor up-regulated the concentration ofβ-OHB in LO2 cells (P<0.05).CONCLUSION:miR-19a regulates the lipid catabo-lism of hepatocytes by targeting the PPARαand its 2 downstream rate-limiting enzymes.

Objective To analyze the learning curve of microendoscopic lumbar discectomy (MED) and summarize the operative experience. Methods From July 2010 to March 2012, the first 100 patients with single level lumbar disc herniation managed with MED were divided into chronological groups (A, B, C and D), 30 patients in group A, B, C and 10 patients in group D. The comparsons were conducted in terms of operative time , estimated blood loss , number of cases with transition from MED to open surgey or for reoperation , rate of complications and postoperative efficacy. Results The mean operative time and the mean estimated blood loss in each group was valuated respectively. In group A , the operative time and estimated blood loss were significantly decreased as compared with those in group B, C and D respectively (P < 0.05), but those in group B were not significantly different from those in group C and D (P > 0.05). There were 6 complications in group A, 1 complication in group B and C respectively and no complication in group D. The leg pain visual analogue scale and Oswestry disability index at the first month and the twelfth month postoperatively were all improved respectively as compared with those preoperatively (P < 0.01). Conclusion The learning curve of microendoscopic lumbar discectomy generally may reach the plateau when about 30 cases are operated on. The key procedure to pass over the learning curve includes puncture and location , flavectomy , anatomy mark identification, and precaution of damage in dural sac.