Objective To explore the effective procedures and practices to solve the ethical dilemma of nursing, and to building nursing ethics decision path. Methods Using inductive-deductive method, summarize predecessors′ research on nursing ethics mode and decision-making process, and establish nursing ethical decisions paths, then display the application based on clinical case. Results Six-steps-Nursing ethics decision path was established, and tested. Conclusions Pay attention to strengthen the cultivation of nurses nursing ethics accomplishment and ability of the decision.

Objective:To compare the immunizing efficiency in mice with recombinant adenovirus inoculated by intranasal, intramuscular or oral routes.Methods:BALB/c mice were immunized with 108 PFU recombinant adenovirus expressing rotavirus VP4 antigen intranasally, intramuscularly or orally.The mice were boosted twice with the same dose by the same route. Serum, stool and intestine specimens were collected to detect rotavirus VP4 specific antibodies by ELISA. Mice were mock treated with adenoviral vector and PBS as the blank control.Results:Inoculation with the recombinant adenovirus by these 3 routes elicted rotavirus VP4 specific serum and intestinal antibodies(P

BACKGROUNDTo study the diagnostic value of detection of p16 methylation of sputum exfoliated cells for peripheral lung cancer.

METHODSBefore operation, p16 methylation of the sputum exfoliated cells was detected in 20 normal persons and 50 patients with peripheral pulmonary nodi by p16 methylation-specific PCR (MSP) for judging the nature of the nodi. The results were compared with pathological reports after operation.

RESULTSThe p16 MSP positive rate of sputum exfoliated cells of peripheral lung cancer patients (27/44, 61.4%) was much higher than that of benign pulmonary nodi (1/6, 16.7%) and normal persons (3/20, 15.0%)(Chi-Square=4.281 and 11.869 respectively, both P < 0.05). No significant difference of p16 MSP positive rate of sputum exfoliated cells was found between benign pulmonary nodi and normal persons (Chi-Square= 0.136, P > 0.05). No significant difference of p16 MSP positive rate of sputum exfoliated cells was found between squamous cell carcinoma (13/18, 72.2%) and adenocarcinoma (8/19, 42.1%) (Chi-Square=3.416, P > 0.05 ). If the positive p16 MSP of sputum was chosen as criterion for peripheral lung cancer, its positive predictive value, negative predictive value, sensitivity and specificity were 96.4%, 22.7%, 61.4% and 83.0% respectively.

CONCLUSIONSThe detection of p16 methylation of sputum exfoliated cells is contributable to the diagnosis of lung cancer.

Objective:To investigate the factors related to the occurrence of submacular fluid (SMF) after pars plana vitrectomy (PPV) in the treatment of rhegmatogenous retinal detachment (RRD).Methods:A retrospective case series observational study was performed.A total of 103 patients (103 eyes) with RRD who underwent 23G vitrectomy combined with silicone oil tamponade in The First Affiliated Hospital of Zhengzhou University from May 2017 to August 2019 were included.There were 55 males and 48 females, aged from 17 to 77, with an average of (48.65±15.80) years.The macular morphology was observed by optical coherence tomography (OCT) before surgery and 1 month and 3 months after surgery.The patients were divided into SMF group and no SMF group according to OCT results at 1 month after surgery.Clinical data were compared and analyzed, including age, gender, duration of symptoms, axial length, the preoperative status of macula (on or off), retinal detachment caused by inferior retinal break or not, the way to drain subretinal fluid intraoperative, best corrected visual acuity (BCVA). FFA was performed in 3 eyes and microperimeter examination in 2 eyes with SMF according to patients' willingness.A multivariate binary Logistic regression was used to analyze the risk factors of SMF after vitrectomy in RRD patients.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2020-KY-334). Written informed consent was obtained from each subject prior to surgery.Results:Postoperative optical fundus examination and ocular ultrasound indicated that retinas of all eyes were completely anatomically reattached.There were 10.7% (11/103) of eyes developed SMF.The microperimeter examination results of 2 patients showed that their visual functions were worse at 3 months than those at 1 month after operation.The BCVA of patients with SMF at 1 month and 3 months after operation were worse than those without SMF, and the differences were statistically significant (both at P<0.05). Logistic regression analysis showed that macula-off RD before surgery and RD caused by inferior break of retina were risk factors for the occurrence of SMF (OR=6.401, P=0.041; OR=19.819, P=0.005), while the increasing age and the drainage of subretinal fluid through draining hole were protective factors (OR=0.939, P=0.016; OR=0.123, P=0.040).Conclusions:Macula-off RD before surgery, and RD caused by inferior break of retina may be the risk factors of SMF after PPV combined with silicone oil tamponade for RRD.Nevertheless, the increasing age and the drainage of subretinal fluid through draining hole may decrease the occurrence of SMF.And SMF after PPV may delay visual recovery.

Objective To analyze the distribution and drug resistance situation of pathogens in the respiratory department during the recent 9 years to provide the basis for rational use of antibacterial drugs in clinic .Methods All pathogens isolated from the respiratory depeartment from January 2003 to December 2011 and the drug susceptibility test results were retrospectively and statistically analyzed .Results A total of 5 714 strains of pathogenic bacteria were isolated ,which mainly distributed in the sputum (90 .1% ) ,excrement (4 .2% ) and urine (3 .6% );among them ,2 943 strains (51 .5% ) were Gram‐negative bacteria ,596 strains (10 .4% ) were Gram‐positive bacteria and 2 175 strains (38 .1% ) were fungi .The top six of isolated bacteria were Candida albi‐cans ,Pseudomonas aeruginosa ,Acinetobacter baumannii ,Klebsiella pneumoniae ,Candida tropicalis and Escherichia coli .The isola‐tion rates of A .baumannii and C .albicans were increased year by year ,while the isolation rate of E .coli was decreased .A .baumannii and P .aeruginosa had a high resistant to all antibacterial drugs ,whereas the resistant rate of A .baumannii was increased year by year and that of P .aeruginosa showed some fluctuation .K .pneumoniae had a high susceptibility to imipenem and meropenem ,and the sensitivity to other antimicrobial agents had a gradually increasing tendency .The sensitive rate of C .albicans to amphotericin B was almost 100% ,and they had a high susceptible to other antifungal agents .Conclusion Drug resistance of the pathogens is com‐mon in the respiratory department .It is of importance to emphasize the pathologic examination ,carry out the surveillance of drug re‐sistance of pathogenic bacteria ,and use the antibacterial drugs rationally in clinical anti‐infective therapy .

Objective: To investigate the ictal epileptic activation using simultaneous electroencephalogram functional MRI(EEG-fMRI),and to study the neural mechanism and the roles of the cerebral cortex and subcortical structures in the generation and propagation of the epileptic activity.Methods: A patient with partial epilepsy was retrospectively found to have slight seizures during the simultaneous EEG-fMRI examination.Two sessions of the ictal functional MRI data were processed and analyzed using the general-linear model.Results: Consistent activation patterns were obtained from the two sessions of data.The positive activation was found over the bilateral parietal lobes,insula cortex,bilateral striatum,thalamus and some nuclei of the brain stem,as well as over the vermis and right cerebellar hemisphere.The maximum intensity point was in the left parietal lobe.Conclusion: The seizure activation is originated from the cerebral cortex,and then propagates through the reciprocal circuits made up of the cortex and the subcortical structures.The cerebral cortex and the brain stem reticular formation are the main structures that propagate the seizure to contralateral hemisphere.The subcortical structures play important roles in the seizure propagation and seizure manifestation.

Objective To analyze clinical features,surgical treatment efficacy and prognostic factors of bone metastasis patients after liver transplantation for hepatocellular carcinoma.Methods A retrospective clinical data of 20 bone metastasis patients after liver transplantation for hepatocellular carcinoma from July 2000 to January 2010 were received.The effect of surgery aimed at bone metastasis was evaluated.Univariate and multivariate prognostic risk factors were analyzed.Results The median survival time of these patients was 7.5 months and 1-year survival rate was only 20％.Surgical treatment could relieve pain and promote patients' peformance status significantly.Univariate and multivariate analysis found that tumor microvascular invasion within the removed recipient liver was the only prognostic risk factor.Conclusions Patients of bone metastasis after liver transplantation for HCC had poor prognosis.Surgical treatment helps improve patient's quality of life.Tumor microvascular invasion is the risk factor of surgical prognosis.

OBJECTIVE: This study was designed to develop a rating scale of quality of life (QOL) which fits laryngeal cancer patients after laryngectomy. METHOD: The item pool was developed on the definition of QOL from WHO and the principles and procedures of ddveloping a rating scale. Five methods had been used in the item selection including, such as subjective evaluation methods, discrete tendency, correlation coefficient method, stepwise regression analysis, and factor analysis. The survey was conducted in 126 laryngeal cancer patients after laryngectomy in order to assess the reliability and validity of the rating scale. RESULT: (1) A rating scale of QOL which fits laryngeal cancer patients after laryngectomy including six domains and 27 items is was developed. (2) The split-half reliability coefficient of the scale is 0.802, and the Cronbach' α coefficient is 0.794. (3) It is inferred from the correlation analysis that there are strong correlation between items and their own domains; conversely there are weak correlation between items and other domains. Correlation coefficient is 0.731 between total score and self-rating score. CONCLUSION The reliability and validity of the rating scale is proved to work well.
Aged ; Factor Analysis, Statistical ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; Male ; Middle Aged ; Postoperative Period ; Quality of Life ; Regression Analysis ; Reproducibility of Results

Objective To investigate the effects of quetiapine on serum levels of brain-derived neurotrophic factors ( BDNF) and the correlation between BDNF and psychiatric symptoms and cognitive function in patients with first-episode schizophrenia. Methods Eighty patients with first-episode schizophrenia ( treatment group) were treated with quetiapine orally for 4 weeks,at initial dose of 100 mg·d-1 and average dose of (580±120) mg·d-1 . The psychiatric symptoms were evaluated by using the positive and negative syndrome scale ( PANSS) . The cognitive function was assessed by using Wisconsin cards sort test ( WCST) . The serum BDNF level was detected with enzyme-linked immunosorbent assay ( ELISA) . Results The serum level of BDNF was markedly lower in schizophrenic patients before[(13. 72±8. 79) ng·mL-1,P<0. 01] and after treatment[(18. 02±9.06) ng·mL-1,P<0.05]in comparison with normal controls(23. 67±10. 13) ng·mL-1]. After treatment,the PANSS total scores and subscale scores decreased,WCST number of categories and the number of correct answers increased,and the number of wrong answers reduced. There was a positive correlation between the serum BDNF and negative symptoms ( SANS) ( r= 0. 54, P=0. 032),and the number of correct answers. Conclusion The quetiapine significantly increases serum level of BDNF in schizophrenia patients,which correlates positively with improvements in symptoms and cognitive function.

Objective To discuss the imaging features of pulmonary lophomonas blattarum infecfiom Methods Seventeen patients with renal homotransplantations presented fever without congh.dyspnea and shortness of breath in 1-4 months after the transplantation were included.Chest X-ray abnormalities were comfirmed as pulmonary lophomonag blattarum infection through fiberoptic bronchoscopy (FOB)and bronchoalveolar lavage(BAL).The X-ray and CT films were reviewed and the imaging features were summarized.Results X-ray appearances:Bilateral pulmonary shadows were seen in 16 patients.of which 9 cases presented patchy and cord shadows,and 7 cases presented large area of pathy shadows.Lung marking increase Wag seen in 1 case.CT appearances:CT abnormalities presented bilaterally and involved more than two lobes in all 16 patients.15 eases displayed ground-glass opacity.11 cases displayed patchy consolidation,14 cases displayed bandlike attenuation,and 8 cases displayed nodular opacity.Ground-glass opacity,consolidation and bandlike attenuation were seen simultaneously in 11 cases.Lymph node enlargement in mediastinum Wag presented in 10 cages.Conclusion Pulmonary lophomonas blattarum infection should be suspected in immunosuppressed patients combining the CT appearances and clinical information.