Objective To explore the feasibility and advantage of the small figure-L unilateral transternal incision for the treatment of anteri or mediastinal tumor. Methods Twenty-four patients with anteri or mediastinal tumor were enrolled in the study. Under general anesthesia, after a 6 to 10 cm midline skin incision was made, a unilateral figure-L partial ste rnotomy on the side occupied by the tumor was made in the second or third interc ostals space, taking into account the tumor size and location. Tumors were resec ted with excellent exposure. Results All tumors were completely resected during the operation. In 8 cases, tumors encroached on the adjacent lu ng tissue, and lung tissue was partially resected. In 6 cases, tumors invaded th e pericardium, and the pericardium was partially removed. Mean operating time wa s 106 minutes (80~125 minutes). The mean time of hospital stay was 5 days after the operation, and there was no complication. All patients were alive with a mea n follow-up period of 14 months (3~24 months). Conclusion The figure-L unilateral mini-sternotomy is considered as an effective and useful mi nimally invasive approach for anterior mediastinal tumors.

Objective To explore the lived study feeling and experience of nursing upgrade students during blended learning model so as to provide the evidence of reforming teaching model of nursing educators.Methods Phenomenological research of qualitative research was used.Four focus groups,25 upgrade nursing students were interviewed in-depth.Results Six themes were sublimated:relief the contradiction between work and study,promote communication in double interaction,improve self-learning ability,improve selfconfidence as learning controllability,online courses lack a sense of belonging,lack of skills support.Conclusions Blended learning model meets students,needs,provides students with personalized learning and improves comprehensive quality.However,the development of blended learning model in China is in the primary stage,we should combine conditions and reference foreign experience to develop it.

Objective To explore the measures and methods to cope with the early stage epidemic struck of H7N9 avian influenza,as the head nurses of the department of infectious diseases.Methods The main work focus of the head nurses of the department of infectious diseases were analyzed during the early stage of H7N9 epidemic struck systematically by reference to the domestic literatures.Results At the early stage of H7N9 epidemic struck,the main work focus of the head nurses of the department of infectious diseases was to draw up every emergency plans,prepare necessary protective medical supplies,train medical staff,and be ready to the preview and triage.Conclusions The head nurses of the department of infectious diseases should pay close attention to the progress of H7N9 epidemic struck,and get ready for all related work in order to ensure smooth treatment during early stage of the epidemic struck.

80mg, P7 days, P 0.05) .The immunopotentiators could increase the morbidity of psychotic reactions .CONCLUSION: Overdose and long - course of glucocorticoid therapy may increase the morbidity of the psychotic adverse effects.

Objective To examine the relationship between CCT 5 ,γδ T cell and autoimmune diseases .Methods Recombinant CCT5 protein was cloned , expressed and purified in E.coli.Three peptides of CCT5 protein were used to prepare for anti-CCT5 monoclonal antibodies .Purified CCT5 protein was used to expand γδT cells from pe-ripheral blood mononuclear cells (PBMC).Plasma level of CCT5 in healthy donors, patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) were detected by ELISA assays .The correlation analysis between plasma CCT5 concentration and the percentage of different subtypes of γδT cells measured by flow cytometry was made . Results The CCT5 gene was amplified by PCR and the length of the target fragment was 1 750 bp.The expressed 65 ku CCT5 protein was purified and validated by SDS-PAGE.Two paired monoclonal anti-CCT5 antibodies were screened to detect CCT5 protein in plasma.Immobilized recombinant CCT5 protein was able to induce specific sig-nificant amplification of peripheral γδT cells.Correlation analysis of 10 healthy donors indicated significant corre-lation between the plasma CCT 5 concentration and the proportion of Vγ9 and Vδ2 γδ T cells.The plasma CCT5 concentration significantly decreased in autoimmune diseases patients , including RA and SLE .Conclusions These data suggest that CCT 5 could be a novel Vγ9δ2 γδT cell-related factor in autoimmune diseases , which deepen the understanding of Vγ9δ2 γδT cell function in autoimmune diseases .

[ ABSTRACT] AIM:To investigate the effect of phycocyanin on the apoptosis of human laryngeal cancer HEP-2 cells and to explore the inhibitory mechanism of phycocyanin to tumor.METHODS:Highly purified phycocyanin was ex-tracted from spirulina.The effects of phycocyanin at different concentrations on the growth of human laryngeal cancer HEP-2 cells were detected by MTT assay.In addition, the cell structures were observed under electron microscope.The cell ap-optosis was analyzed by flow cytometry.The production of reactive oxygen species ( ROS) was measured by flow cytometry. Enzymatic activities of caspase-3,-8 and-9 were measured by chemical colorimatry.The expression of Bax, Bcl-2, Fas, P53, caspase-3 and caspase-9 at mRNA and protein levels was determined by RT-PCR and Western blot.RESULTS:MTT test confirmed that phycocyanin inhibited the cell activity of HEP-2 cells with time and dose dependent manners.The result of electron microscope observation and flow cytometry indicated that phycocyanin induced the apoptosis of HEP-2 cells.The intracellular content of ROS was increased.The activities of caspase-3, -8 and -9 were increased.RT-PCR showed that the mRNA expression of Bax, Fas, P53, caspase-3, caspase-9 was increased and Bcl-2 was decreased.The results of Western blot were consistent with the results of RT-PCR.CONCLUSION:Phycocyanin might induce apoptosis of HEP-2 cells by down-regulating Bcl-2, up-regulating Bax, Fas and P53, and the transduction of apoptotic signals in the human laryngeal cancer cells.

AIM: To investigate the effect of diltiazem on mean pulmonary arterial pressure(mPAP) and nitric oxide synthase(NOS) in arterioles in chronic hypoxic hypercapnic rats. METHODS: Twenty-four rats were randomly divided into three groups: control group(A),hypoxic hypercapnic group(B), hypoxic hypercapnia+ diltiazem group (C), constitutive endothelial NOS(ceNOS) were observed in arterioles of rats using the technique of immunohistochemistry,ceNOS mRNA were observed by the technique of in situ hybridization . RESULTS: (1)mPAP was significantly higher in rats of B group than that of A and C group( P 0 05),but mCAP was lower in rats of C group than that in B group.(2)Light microscopy showed WA/TA (vessel wall area/total area) was significantly lower in rats of C group than that of B group ( P

Objective Toanalyzeclinicalandimagingmanifestationsofaggressiveangiomyxoma(AAM)inthepelvisandperineuminorder tomakeafurtherunderstandingofthisdisease.Methods ThemedicalrecordsofpatientswithAAMinthepelvisandperineum were reviewedfromtheelectronicmedicalrecordsystem.PubMedandChinesebiomedicaldatabaseswerealsosearchedcarefully.Theclinicaland imagingfeaturesofcaseswereanalyzedtogether.Results Accordingtoinclusionandexclusioncriteria,23referenceswereincluded. 62cases(4malesand58females)ofAAMinthepelvisandabdomenwereincluded,with1inourhospitaland61casesintheliterature.The averageagewas39.0±1.2 (range:20-75years).Thetumorslocatedinthepelviccavityfor25cases,intheperineumfor11cases, inthescrotumfor1case,inthepelviccavityandperineumfor25cases.CTimagesshowedtumorswithcysticandsolidcomponents in9cases,nodularenhancementin6cases,andswirlingstrandsorlayeringinternalpatternin21cases;whileMRIimagesshoweda slightlyhyper-intensitylesiononT1andaslightlyhyper-intensitylesiononT2.Lesionsshowedswirlingstrandsorlayeringinternalpatternon MRIenhancementin41cases.Conclusion Theswirlingstrandsorlayeringinternalpatternhaveveryimportantimagingvalueinthediagnosisandthe detectionofrecurrentlesions.

Objective To study the effects of serum C-type natriuretic peptide (CNP) ,insulin-like growth factor II (IGF-Ⅱ ) , endothelin (ET) ,neuron-specific enolase (NSE) and S100B protein(S100B) on the prognosis of the patients with traumatic brain injury .Methods A total of 110 patients with craniocerebral trauma admitted in our hospital from January 2016 to January 2017 se-lected as the craniocerebral trauma group and further divided into the mild ,moderate and severe craniocerebral trauma groups ac-cording to the Glasgow Coma Scale (GCS) .Then the levels of serum CNP ,IGF-Ⅱ ,ET ,NSE and S100B in all cases were analyzed by enzyme-linked immunosorbent assay (ELISA) .Their influence on the prognosis of the patients with craniocerebral trauma and the correlation among various indicators were analyzed .Results The levels of CNP and IGF-Ⅱat admission in the craniocerebral trauma group were significantly decreased ,while the levels of ET ,NSE and S100B were significantly increased ,the difference com-pared with the control group was statistically significant (P<0 .05) .Serum CNP and IGF-Ⅱlevels in the death group ,plant survival group and disabled group were significantly decreased .The difference was statistically significant (P<0 .01) .Serum CNP and IGF-Ⅱlevels in the moderate and severe craniocerebral trauma groups were gradually increased with the disease course progress ,while serum ET ,NSE and S100B levels were gradually decreased with the disease course progress ,the difference was statistically signifi-cant(P<0 .05) .In the patients with craniocerebral trauma ,the positive correlation existed between CNP and IGF-Ⅱ ,between ET and S100B ,between ET and NSE ,and between NSE and S100B(P<0 .01) ,while the negative correlation existed between IGF-Ⅱand ET ,between IGF-Ⅱ and S100B ,between CNP and ET ,and between IGF-Ⅱand NSE (P<0 .01) .Conclusion Serum CNP , IGF-Ⅱ ,ET ,NSE and S100B are correlated to the severity of craniocerebral trauma ,which has a higher clinical application value for judging the disease condition ,evaluating the prognosis in cradiocerebral trauma .

Objective To study the impact of sucrose analgesia on pain response and salivary cortisol levels in preterm infants.Method Preterm infants admitted to our hospital between January 2014 and October 2016 with gestational age ＜ 34 weeks,birth weight ＜ 2 000 grams,and length of hospital stay ≥ 14 days were prospectively assigned into two groups.The intervention group received 0.3 ～ 0.5 ml of 12％ sucrose solution two minutes before each painful procedure,while the control group received none.At time of discharge and at 8 months of corrected age (CA),pain response was measured,saliva samples were collected and salivary cortisol levels were assayed using Enzyme Immunoassay Kit before and after pain stimulus.Result A total of 82 infants were included in our study,42 in the intervention group,and 40 in the control group.There were no statistically significant differences between two groups in pain response at discharge and 8 months of CA.At time of discharge and at 8 months of CA,infants in intervention group had higher salivary cortisol levels than in control group at time of discharge and 8 months of CA after pain stimulus [6.8 (5.6,11.7) ng/ml vs.5.4 (2.6,10.8) ng/ml,5.0 (3.3,5.6) ng/ml vs.4.8 (3.0,5.5) ng/ml] after log transformation,two groups were statistically significant (P ＜ 0.05).However,before the pain stimulus,no differences were found between two groups.Multiple stepwise regressions analysis showed that salivary cortisol level post pain stimulus was negatively related to the total number of pain stimulus,and positively related to sucrose analgesia at discharge and 8 months of CA.Conclusion Sucrose analgesia may mitigate the negative effect of repeated pain stimulus on cortisol regulation in preterm infants,however,may have no influence on pain response of them.