Objective To explore the influence of introducing standardized patient (SP) into problem-based learning (PBL) to the autonomous learning abilities for undergraduate nursing students based on clinical thinking training. Methods To select 2 classes randomly from full-time professional nursing undergraduate classes enrolled in 2012 from Tianjin university of traditional Chinese medicine, was divided into the experimental group and the control group by random number table method. The control group uses PBL teaching mode, and the experimental group adopts introducing SP into PBL teaching mode. Course lasts for 4 weeks, a total of 18 hours. To evaluate two groups nursing students′the percentage of asking questions by themselves and examination results in the end of the course, and evaluate nursing students′autonomous learning ability before and after the course and after three months of clinical practice respectively. Results The percentage of asking questions by themselves and examination results of the experimental group were 87.80%(36/41) and (84.24±5.12) points, (87.85±5.44) points, the control group were 68.89%(31/45) and (81.51±6.63) points, (84.40±7.96) points, the difference was statistically significant (χ2=4.46, t=2.13, 2.37, P<0.05);There was no statistical significance between two groups in the score of autonomous learning ability before the course (P>0.05), while after course and after three months of clinical practice of the experimental group were (93.71±9.56) points, (103.27±11.92) points, the control group were (85.47 ± 9.28) points , (91.36 ± 10.56) points, the difference was statistically significant (t=3.56, 4.89, P<0.01). Conclusions The teaching mode of introducing SP into PBL can train and improve the autonomous learning ability of undergraduate nursing students,and can provide reference for nursing teaching mode reform.

Objective To determine the impact of emotional intelligence, resilience and psychological empowerment of clinical nurses on self-directed learning competence. Methods Totally 270 clinical nurses from six tertiary first-class hospitals in Tianjin City were investigated with Nursing Staff Self-directed Learning Competence Scale, Emotional Intelligence Scale, the Conner-Davidson Resilience Scale and Psychological Empowerment Questionnaire, and then, the datum was analyzed by professional statistical software. Results The total score of self-directed learning competence was (124.96 ± 21.73) points, the total mean score was (3.68 ± 0.64) points, while the mean score of different dimension from high to low was self-motivational belief (3.78±0.67) points, self-monitoring and regulation (3.65 ± 0.69) points, task analysis (3.61 ± 0.76) points, self-evaluation (3.47 ± 0.72) points. The total mean score of emotional intelligence was (3.87±0.53) points, the total mean score of resilience was (2.74±0.54) points, the total mean score of psychological empowerment was (3.74±0.57) points. The total score and score of all dimensions of emotional intelligence, resilience as well as psychological empowerment were positively correlated to self-directed learning competence(r=0.269-0.650, P<0.01). There was a statistically significant difference of total mean score of nurses′ self-directed learning competence from different department in this investigation, F=8.407, P <0.01, while there was no statistically significant difference of total mean score of nurses′self-directed learning competence by different gender, different marital status, different cultural level, different professional and technical titles and different establishment, F or t values was-1.626,-0. 0387, 0.882, 0.926 and 1.125 respectively, P > 0.05. Self-reliance, self-determination, emotional use, self-efficacy, perseverance were indicated as predictive factors of self-directed learning competence among clinical nurses, which explained 58.5 percent of the variance. Conclusions The self-directed learning competence of clinical nurses was at moderate level. The self-directed learning competence can be influenced by emotional intelligence, resilience and psychological empowerment. So we can enhance their self-directed learning competence by improving emotional intelligence,resilience and psychological empowerment.

Three cases of terminal stage heart disease received orthotopic heart transplantation at the Department of Cardiothoracic Surgery, the First Hospital of Nanchang University between August 2001 and December 2003. These three cases were all female and died of brain death. Body weight difference between donor and recipient was less than 20%. All three cases underwent superior and inferior vena cave osculation and received immunosuppressive therapy of cyclosporine A, prednisone, and mycophenolate postoperatively. They were successfully discarded. Heart function recovered to grade Ⅰ-Ⅱ(NYHA). No infection or serious rejection was found during the surgery. These results indicate that good donor heart preservation, consummate perioperative processing, and proper immunosuppressiva therapy are the key measures of successful heart transplantation.

Objective:To evaluate the effects of Preventing Jaundice and Antibacterial Biological Medical Gel in prevention of hyperbilirubinemia and umbilical infection in newborn.Methods:A total of 600 healthy neonates in a tertiary hospital were selected. Participants were randomly divided into the control group ( n=300) and the observation group ( n=300). The control group was given routine nursing guidance while the observation group was treated with Preventing Jaundice and Antibacterial Biological Medical Gel. The differences in the number of times of the fetus feces in 3 days after birth, the first fetal feces, yellow discharge time of the fetus feces, the incidence of hyperbilirubinemia, the incidence of neonatal phototherapy and the incidence of umbilical infection between the two groups were compared. Results:The number of times of the fetus feces in 3 days after birth and the first fetal feces and yellow discharge time of the fetus feces of the observation group were (8.12±1.36) times, (7.39±3.71) hours, (26.05±3.98) hours, respectively. The control group were (5.31±1.02) times, (13.04±5.26) hours, (28.65±3.54) hours, respectively. The difference between the two groups was significant ( Z value was -6.133, -6.483, t value was -19.011, P<0.05). The incidence of hyperbilirubinemia, being in neonatal intensive care unit, the incidence of blue light irradiation and the incidence of umbilical infection of the observation group was 0.67%(2/300), 0, 1.00%(3/300) and 0, respectively. The control group was 3.33%(10/300), 2.00%(6/300), 5.00%(15/300) and 3.33%(10/300), respectively. the difference between the two groups was significant ( χ2 value was 4.209-8.247, P<0.01). Conclusions:Preventing Jaundice and Antibacterial Biological Medical Gel could help control the incidence of hyperbilirubinemia and reduce the umbilical infection. It is worth clinical spreading.

Purpose: This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients. Materials and Methods: Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010. Results: With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group. Conclusion Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.

Objective:To investigate the curative efficacy of radical prostatectomy (RP) for T 4 stage prostate cancer invading bladder neck. Methods:The clinical data of 22 patients with T 4 stage prostate cancer invading bladder neck treated with RP from April 2013 to March 2021 were analyzed retrospectively. The mean age of the patients was (64.09±6.33) years, and the preoperative blood PSA was 57.70(39.40, 68.56) ng/ml. Preoperative MRI or PSMA-PET examination revealed bladder neck invasion, including 16 cases (72.73%) of urinary retention. Clinical stage of T 4N 0M 0 accounted for 40.91% (9/22), T 4N 1M 0 accounted for 45.45% (10/22), and T 4N 1M 1 accounted for 13.64% (3/22). Preoperative patients were not treated with neoadjuvant endocrine or chemotherapy. Laparoscopic or robotic assisted laparoscopic radical prostatectomy and pelvic lymph node dissection were performed. Results:The 22 operations were successfully completed without conversion. The operation time was(184.27±34.82) min, the amount of intraoperative bleeding was (210.91±83.03) ml, the retention time of drainage tube was (4.73 ± 1.03) days, the recovery of gastrointestinal function took 3 (2, 3) days, and the postoperative hospital stay was (6.68 ± 1.39) days. Postoperative pathology showed that the Gleason score of 7 points accounted for 4.54% (1/22), 8 points accounted for 13.64% (3/22), and 9 points accounted for 81.82% (18/22). The positive rate of margin was 81.82% (18/22). Pathological stage of T 4N 0M 0 accounted for 22.73% (5/22), T 4N 1M 0 accounted for 63.64% (14/22), and T 4N 1M 1 accounted for 13.64% (3/22), of which extracapsular or seminal vesicle invasion accounted for 90.91% (20/22). The incidence of postoperative complications above grade 3 was 9.09% (2/22), and the rate of urinary control recovery after 3 months of surgery was 90.91% (20/22). 16 patients with preoperative urinary retention were able to urinate normally after operation. All patients were treated with adjuvant androgen deprivation therapy (ADT) with or without antiandrogens, and 13 cases (59.09%) were treated with adjuvant radiotherapy. The postoperative PSA value before adjuvant treatment was 2.53 (0.51, 5.44) ng/ml. The median survival time was not reached. Two patients died of prostate cancer at 71 and 84 months and one patient died of heart disease at 28 months. Conclusions:RP surgery could effectively relieve the condition of urinary retention with low incidence of operative complications. Although the positive rate of surgical margin is high, RP could be used as one of the treatment options for T 4 stage prostate cancer invading bladder neck, while the long-term effect is still needed to be further analyzed.

Objective:To explore the clinical application of robot-assisted laparoscopic single-position nephroureterectomy and bladder sleeve resection for upper urinary tract urothelial carcinoma (UTUC).Methods:The clinicopathological data of 15 UTUC patients admitted to Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from October 2018 to May 2020 were retrospectively analyzed. There were 8 males and 7 females, with a median age of 58.6 (ranging 52.6-69.6) years, including 8 cases of renal pelvic cancer, 2 cases of upper ureteral cancer, 5 cases of middle and lower ureteral cancer.The tumor located on the left side in 5 cases and right side in 10 cases. All 15 patients underwent robot-assisted one-step transperitoneal nephroureterectomy and bladder sleeve resection by the same surgeon. The patients were placed in a 70° healthy side lying position with a 10° head lower and foot high position. After routinely dissecting the kidneys and controlling the renal hilum, we continued to dissect the ureter down to the orifice of the bladder. The lymph node dissection was performed when dissecting the kidney and ureter. Then the ureter was resected like a sleeve and the bladder was sutured. Observation indicators, such as operation time, blood loss, postoperative drainage tube and urinary catheter placement days, were recorded.Results:All 15 patients were successfully completed the operation in the same position and the same robot berth without conversion. The median operation time was 103 (ranging 82-185) min, and the intraoperative median blood loss was 60 (ranging 30-120) ml. The postoperative median drainage catheter placement time was 3 (ranging 2-5) d, the postoperative median hospital stay was 5 (ranging 4-7) d, and the postoperative urinary catheters were placed for 14 days. Postoperative pathological examinations of 15 patients showed UTUC without positive margins. The median follow-up time was 15 (ranging 10-30) months. All 15 patients survived. One patient was found a recurrence in the bladder after cystoscopy. There was no tumor progression after bladder tumor resection and bladder perfusion chemotherapy, and no tumor recurrence or metastasis was seen in the remaining 14 cases.Conclusions:Robot-assisted single-position transperitoneal nephroureterectomy for UTUC does not need to change patient position and robot berth, which effectively shortens the operation time, and achieves good tumor control effect. The short-term follow-up results were satisfactory.