Objective To investigate the anxiety in the relatives of patients with severe brain injury at acute period and discuss the effective solving pathway.MethodsA questionnaire-based survey was conducted in 120 relatires of patients with severe brain injury during March 2006 to March 2007 by using state-trait anxiety inventory (STAI).Results Comparison of anxiety score between relatives of patients and normals,the scores of state anxiety and trait anxiety in the relatives of patients[(52,40±8.42),(46.73±7.56)]were significantly higher than those in normal people[(38.97±8.45),(41.31±7.54),P＜0,01].And between relatives of man and woman,the Scores of state anxiety and trait anxiety in the relatives of patients in female were significantly higher than those in male ones(P＜0.01).The scores of state anxiety and trait amv,iety in the 51～65 old group were significantly higher than ihosein 31～50 old group and 17～30 old group(P＜0.01).The scores of state anxiety and trait anxiety in the little educated group were significantly higher than that higher educated group(P＜0.05,P＜0.01),and higher in those having self-medical service than in those having public medical service.The scores for,mate is signkfigantly higher than that other roles(all is P＜0.05).Conclusion The relatives of patients with severe brain injury have anxiety of different degrees.Medical staff should pay attention to the relatives anxiety,and so to better the relationship of medical staff and patient

Objective To evaluate the usefulness of cytologic examinations in the diagnosis of pancreatic neoplasms using nasopancreatic drainage and pancreatic duct brushing during ERCP.Methods In 47 patients with pancreatic diseases,cytologic examinations of pancreatic duct brushing and nasopancreatic drainage during ERCP were performed.Results The rate of accuracy,sensitivity,and specificity of brush cytologic examination were 70\^4%,65\^2% and 100%,respectively,and that of pancreatic juice cytologic examinations was 45%,8\^3% and 100%,respectively.Conclusion Our results confirm the value,safety,and utility of obtaining cytologic specimens at the time of ERCP for the early diagnosis of pancreatic neoplasms.

Objective To evaluate the usefulness of cytologic examinations of pancreatic duct brushing obstained during ERCP in diagnosis of pancreatic neoplasms. Methods In 27 patients with suspected manlignancy, cytologic examinations of pancreatic duct brushing during ERCP were performed. Results The positive rate of brush cytology was 55.6%.The results were affected by the location of lesion, correct cytodiagnoses of cancer were 69.2% in cancer at the head of the pancreas and 60% in cancer of the body. The accuracy rate of ERCP was 77.8%.However, by combining these 2 methods, the accuracy rate rose to 100%. Conclusion Our results confirm the significance,safety,and usefulness of the cytologic specimens obtained at the time of ERCP for the diagnosis of pancreatic neoplasms.

Objective To study the characteristics of MR imaging and proton MR spectrscopy(~1H MRS)of stroke-like lesions in MELAS.Methods Clinical,MR imaging and proton spectroscopic findings of stroke-like lesions in 7 patients with confirmed MELAS were analyzed retrospectively.Results A total of 12 MR investigations had been performed in 7 patients.Stroke-like lesions showed by MR imaging included superacute in 12,acute in 12,subacute in 10 and chronic stage in 6.Early stroke-like lesions were demonstrated as focal edematous foci mainly involved cortex/subcotical areas of occipital,temporal and parietal lobes.At MR diffusion imaging,stroke-like lesions in the superacute(＜3 days)stage were showed as well-circumscribed lesions with high signal intensities for cytotoxic edema.During the acute(4～7 days),sub-acute(2～4 weeks)and chronic(＞4 weeks)stages,the lesions gradually expanded,and became blur,and presented with vasogenic edema mainly.Proton spectroscopy showed a prominently elevated lactate,varied decrease of NAA concentration and other brain motabolites in the stroke-like lesions early after onset,and depicted gradual decrease of lactate level and partial recovery of NAA concentration subsequently.Conclusion Stroke-like lesions in MELAS mainly involve the cerebral cortex and subcortical areas,in which cytotoxic edema appears early but for a short period.In ~1H MRS,the lesions are characterized by a double lactate peak with decrease of NAA concentration.

Objective To investigate the role of psychological intervention in the prevention of the temporomandibular joint disease (TMD) , through the observation of the relative changes in the rat TMJ under psychological stress after psychological intervention. Methods The rat model of communication box was built to exert the psychological stress. The antianxiety agent was applied before stress, and the stressor was removed after stress. The expression of the proinflammatory cytokines IL-1 and TNF-α in the mandibular condylar chondrocytes in rat TMJ was detected by ELISA and RT-PCR. Results The RT-PCR results showed that the expression of IL-1 mR-NA increased into the peak in the 1st week, weakened in the 3rd week, and returned to normal in the 5th week, while the TNF-αmRNA peaked in the 1st week, returned to normal in the 3rd week. The ELISA results showed that there was no significant difference of the OD value of the serum IL-1 and TNF-α(0. 095 ±0. 006,0. 077 ± 0.007,0.069 ±0.009 ;0.079 ±0.010,0.075 ±0. 009,0.079 ± 0.012) in the antianxiety agent group (0. 107 ± 0.024,0. 101 ±0.005,0.088 ±0.010)and the stressor removal group(0. 090 ±0.016,0. 088 ±0.005,0.089 ± 0.011) , compared with the control group(0.087 ±0.004,0.090 ±0.009,0.089 ±0.010;0.074 ±0.008,0.069 ±0.015,0.068 ±0.011) (P>0.05), while significant differences were observed when compared with the psychological stress group(0.282 ±0.045,0.226 ±0.021,0.092 ±0.002;0. 164 ±0.009,0.123 ±0.013,0.091 ± 0.006) (P<0.05 ). Conclusion Application of the antianxiety agent and stressor removal could effectively counter the influence of psychological stress to TMJ, which provides good experience for the clinical prevention of TMD.

Objective To study the influence of hydrogen sulfide (H2 S)on the mitochondrial function of pulmonary artery smooth muscle cells of the rats with high pulmonary blood flow pulmonary hypertension, and to clarify the function and its mechanism in the occurrence of high pulmonary blood flow pulmonary hypertension.Methods A total of 27 rats were randomly divided sham operation group,operation group,and operation+sodium hydrosulfide (NaHS)group (n=9).The pulmonary hypertension rat model was built by left lung resection.After fed for 35 d, the mean pulmonary artery pressure (mPAP),ratio of right ventricle/body weight (RV/BW),and ratio of right ventricle/(left ventricle+septum)[RV/(LV + S)]of the rats in three groups were measured.The plasma H2 S levels and the CSE activities in pulmonary artery tissue of the rats were detected;the activities of total mitochondrial ATP enzyme,superoxide dismutase (SOD),glutathione peroxidase (GSH-Px)and malondialdehyde (MDA)levels were determined;the ultrastructure of pulmonary artery smooth muscle mitochondria was observed through transmission electron microscope.Results Compared with sham operation group,the plasma H2 S level and the CSE activity in pulmonary artery tissue of the rats in operation group were decreased(P<0.01);the mitochondrial membrane of pulmonary tissue was swelling, and the mitochondrial activity was decreased (P<0.01);the mitochondrial ATP enzyme,SOD and GSH-Px activities were significantly decreased,and the MDA level was significantly increased (P<0.01).Compared with operation group,the H2S level in plasma and the activity of CSE in pulmonary tissue of the rats in operation + NaHS group were increased (P<0.01 );the mitochondrial membrane swelling was reduced, and the vitality was restored;the ATP enzyme, GSH-Px, and SOD level in pulmonary tissue were significantly increased (P<0.01),and the MDA level was significantly reduced (P<0.01).Conclusion H2 S can enhance the activities of mitochondrial ATP enzyme,GSH-Px,and SOD,and decrease the mitochondrial lipid peroxidation level,thus it plays a protective effect on rat pulmonary artery smooth muscle.

Objective To analyze the risk factors for traumatic cerebral venous sinus occlusion (CVSO)and to investigate the strategies of early diagnosis of traumatic CVSO. Methods The clinical data of 212 patients with moderate to severe closed traumatic brain injury from January 2012 to December 2015 were analyzed retrospectively. Logistic regression analysis was used to evaluate the risk factors for traumatic CVSO. Results Of the 212 patients with traumatic brain injury, 16.5%(35/212) patients had CVSO. Ten patients had CVSO of thrombotic type (typeⅠ), 16 patients had CVSO of compression type (typeⅡ), and 9 patients had CVSO of mixed type (typeⅢ). Logistic regression analysis showed that skull fracture (OR = 8.141; 95%CI: 3.224-20.840) and epidural hematoma of crossing venous sinus (OR = 3.179; 95%CI: 1.470-7.037) were the risk factors for CVSO, and the former was more significantly correlated with CVSO. Female gender was the risk factor for CVSO typeⅠ(OR =10.425; 95%CI: 1.831-30.053), epidural hematoma of crossing venous sinus was the risk factor for CVSO typeⅡ(OR = 5.766; 95%CI: 1.885-18.197), and skull fracture, epidural hematoma of crossing venous sinus, and the previous history of vein thrombosis was the risk factors for CVSO type Ⅲ(OR =18.005, 4.596, 11.394; 95%CI: 2.021-58.836, 1.144-19.525, 1.436-46.558). Conclusions In the early diagnosis of traumatic CVSO, the crossing venous sinus fracture line and epidural hematoma should be given attention. Attention should be paid to the history of venous thrombosis. MR venography and CT venography contributes to early diagnosis of CVSO.

Objective To investigate the expression and significance of myeloid cell leukemia-1 (Mcl-1 )gene and protein in Hepatocellular Carcinoma(HCC).Methods The expression of Mcl-1 was detected respectively by Reverse Transcription-Polymerase Chain Reaction (RT-PCR),Western blot and ENVISION immunohistochemistry in 20 HCC specimens,19 liver cirrhosis(LC)specimens,and 12 control ones.Their relationship with clinical and pathological characteristics of HCC was investigated.Results The expression of Mcl-1 mRNA in the control group,LC group and HCC group was 0.52±0.17, 3.46±1.7,3.65±2.93,respectively.The level in HCC and LC group was statistically different compared with the control group,respectively (t=7.925,5.334,P<0.05).The relative expression of Mcl-1 protein in LC group (0.51±0.35)and HCC group (0.75±0.36)were significantly higher than that in the control group (0.21±0.19)(t=5.526,6.355,P<0.05).The positive expression rate of Mcl-1 in HCC group was 55.00% (11/20),significantly higher than that in the con-trol group 33.33% (4/12)(t=7.835,P<0.05).The positive expression of Mcl-1 was related to tumor necrosis and TNM staging (χ2=4.201,P<0.05).Conclusion Mcl-1 gene and protein are differentially expressed in HCC,LC and the control, which may be involved in the occurrence,development and malignant transformation of HCC.

Objective To investigate the feasibility and efficacy of tunica vaginalis flap cover in treatment of recurrent urethrocutaneous fistula (UCF).Methods We reviewed the clinical datas of 25 cases of UCF after urethroplasty of hypospadias from January 2011 to January 2015.The mean age of the patients was 6.2 years(range 1.6-14.0 years).All patients had undergone previous hypospadias repair and at least one previous failed attempt to close the urethrocutaneous fistulae.There were 5 cases of fistula in the coronary sulcus,6 cases of fistula in the penile body and 14 cases of fistula at the junction of penis and scrotum.The diameter of urethrocutaneous fistulae were 3-10 mm.Single fistula was present in all patients.16 cases had undergone UCF repair for two times, 9 cases had undergone UCF repair for more than two times.After closing the fistula with inverting running stitch, a tunica vaginalis flap was mobilized to cover the repair site through a subcutaneous tunnel and the skin closed.Results The mean follow-up time was 2.1 years(range 0.5-4 years).The overall success rate was 96％ (24/25).Penile cosmesis was excellent.There was no evidence of recurrent fistulas or urethral strictures.All parents reported a straight penis when erected, and one patient in whom there was leak from the fistula site because of local wound infection.No postoperative complication was encountered in the testis.The testis was of normal size and position, and the ultrasound findings were normal.Conclusions Repairment of recurrent urethrocutaneous fistulas with a tunica vaginalis flap could be effective regardless of fistula location.The technique is simple to improve the success rate of the repair of UCF effectively and reduce the occurrence of postoperative complications.

Objective To compare the operative cooperation of da Vinci robotic surgery and traditional laparoscopic surgery, so as to provide evidence to qualify the operative cooperation of minimally invasive operation. Methods Comparison of the operative cooperation with related experiences and literature was made between the two kinds of surgeries. Results More requirements were put forward during the da Vinci robotic surgery on nurses′ service quality and training methods, ethics & law knowledge and humanistic care, equipment installation and preparation, complicated nursing performance content, system error handling and postoperative management, etc.. Conclusions It is suggested that the operative cooperation of the precise minimally invasive operation should be improved as follows:strengthen the nurses′ special training and continuing education; establish related operation process and management standards;do patients′explanation work and surgical team cooperation.