Objective To explore the influence of continuing nursing care on sexual quality of patients after laparoscopic subtotal hysterectomy.Methods Seventy-eight patients with selective laparoscopic subtotal hysterectomy enrolled from March 2014 to April 2015 were numbered according to their enrollment date,and divided into control group and intervention group randomly.Both groups were conducted laparoscopic subtotal hysterectomy under general anesthesia.After the surgery,the control group was treated with standard nursing care and the intervention group received continuing nursing care beyond the standard nursing care.Participants' sexual quality of 3 months and 6 months after surgery were evaluated using the female sexual function index (FSFI) Results The scores of FSFI of intervention group were significantly higher than those of the control group.Conclusion The continuing nursing care of patients after laparoscopic subtotal hysterectomy can effectively improve patient's short-term sexual quality,which is worth of being applied in gynecology nursing care in the future.

Objective To study the clinical characteristics, diagnosis, treatment and its effectiveness of vulvar intraepithelial neoplasm Ⅲ(VIN Ⅲ).Methods Clinical data, including age of the patients, mode of surgical operation, pathological features, results of post-operation follow-up, of 12 cases of VIN Ⅲ admitted to the Peking Union Medical College Hospital(PUMCH)during January 1984 to December2006 were retrospectively analyzed.Results Mean age of the 12 cases was 40.3(ranging from 23 to 56)years.All the patients had symptoms of vulvar itching, three with VUlVar ulcer and one with vulvar pain.There was single neoplasm focus in two cases and multiple focuses in 10 cases, five cases with neoplasm in other sites and five with human papilloma virus(HPV)infection.All the 12 patients received surgical operation, three with simple vulvectomy(one with some residue at perianal incisal edge)and other nine with lumpectomy(four with some residue at incisal edge).Eight cases were followed-up for 9.0 months in average(ranging 1～22 months)after surgical operation, including three with some residue at incisal edge.Relapse was found in two cases three and 11 months after operation, respectively, who received re-operation, including one with residue at incisal edge and one without residue.Conclusions It is necessary to attach more importance to biopsy for the cases of suspected VIN Ⅲ, as well as colposcopic diagnosis for those with vaginal or vulvar neoplasm and testing for HPV infection.Surgical operation, including simple vulvectomy and lumpectomy with or without adjunctive measures, are main treatment for patients of VIN Ⅲ and follow-up is also important for all those with VIN Ⅲ.

ObjectiveTo explore the appropriate teaching methods for medical international students.MethodsTotally 84 students in grade 2005 and 63 students in grade 2006 took part in clinical skills training in 2010 and 2011.The traditional method was employed in grade 2005 and interactive teaching and imagery training was applied in grade 2006 combined with the traditional methods.ResultsThe scores of clinical skill tests ( posterior thorax puncture test,abdomen puncture test,bone puncture,catheterization test) were significantly higher in grade 2006 than in grade 2005 with statistical differences,P ＜ 0.01.The clinical skill test scores were not statistically different between grade 2005 and 2006 before training,P ＞ 0.05,but the scores were statistically different between grade 2005and 2006 after training,P ＜ 0.05.Conclusion Using polynary teaching methods synthetically is helpful to improve the clinical skill training effect for medical international students.

Objective To study influence of hospital-community-family integrated nursing model for patients with coronary heart disease based on Omaha system under the " Nightingale + " era.Methods A total of 90 coronary heart disease patients were selected as research objects,and were divided into observation group and control group according to digital table method,with 45 cases per group.The control group implemented traditional nursing,while observation group implemented hospital-community-family integrated nursing model based on Omaha system under the " Nightingale +" era.Results The observation group had higher compliance,quality of life after discharge than the control group (P ＜ 0.05).The incidence rates of primary and secondary cardiovascular adverse events were lower than that in the control group (P ＜ 0.05).Conclusion Hospital-community-family integrated nursing model for patients with coronary heart disease based on Omaha system is feasible,and can enhance compliance after discharge coronary heart disease patients,improve the quality of life,reduce the incidence rate of cardiovascular adverse events.

Objective To study influence of hospital-community-family integrated nursing model for patients with coronary heart disease based on Omaha system under the " Nightingale + " era.Methods A total of 90 coronary heart disease patients were selected as research objects,and were divided into observation group and control group according to digital table method,with 45 cases per group.The control group implemented traditional nursing,while observation group implemented hospital-community-family integrated nursing model based on Omaha system under the " Nightingale +" era.Results The observation group had higher compliance,quality of life after discharge than the control group (P ＜ 0.05).The incidence rates of primary and secondary cardiovascular adverse events were lower than that in the control group (P ＜ 0.05).Conclusion Hospital-community-family integrated nursing model for patients with coronary heart disease based on Omaha system is feasible,and can enhance compliance after discharge coronary heart disease patients,improve the quality of life,reduce the incidence rate of cardiovascular adverse events.

Sphingosine 1-phosphate(S1P)is a pleiotropic sphingolipid metabolite that has been shown to regulate important physiological function by activation of its G-protein-coupled receptors S1PRs. S1P has been identified as an important signaling molecule in maintaining epithelial and endothelial barrier function. S1P signaling pathway is involved in epithelial and endothelial barrier function by regulation of adherens junction and tight junction assembly, cytoskeletal reorganization, and focal adhesion formation. Thus, S1P signaling pathway may become a novel therapeutic target for cell barrier dysfunction during some illnesses such as acute lung injury, inflammatory bowel disease and sepsis. In this review, the research progress of S1P signaling pathway in regulating epithelial and endothelial barrier function and the application of S1P in barrier dysfunction-related diseases were summarized, so as to provide references for future research.

Objective: To assess the efficiency and safety of low-dose decitabine in patients with lower-risk myelodysplastic syndrome (MDS) to couple with the clinical significance of MDS-related gene mutations. Methods: This study was done in 4 institutions in Zhejiang Province. A total of 62 newly diagnosed patients with lower-risk MDS were assigned to two groups of decitabine (12 mg·m^-2·d^-1 for 5 consecutive days) and best supportive care (BSC) . Their bone marrow samples were subject to examinations of MDS-related 15 gene mutations. The primary endpoints were the proportion of patients who achieved overall response (ORR) after at least two cycles and progression-free survival (PFS) , and their relevances to the gene mutations. Results: Of 62 enrolled patients, and 51 cases were included in the final analysis. 16 of 24 patients (66.7%) in decitabine group achieved ORR versus 8 of 27 (29.6%) in BSC group (χ²=6.996, P=0.008) ; PFS prolongation of decitabine versus BSC was statistically significant (not reached vs 13.7 months, P=0.037) . Among 51 patients, at least one gene mutation was identified in 20 patients (39.2%) , including 4 single SF3B1 mutation. PFS in cases with gene mutations (not including single SF3B1 mutation) was significantly shorter than of no gene mutation (9.2 months vs 18.5 months, P=0.008) , but not for ORR (37.5% vs 58.1%, P=0.181) . Among 16 patients with mutated genes, ORR in decitabine and BSC groups were 75% (6/8) and 0 (0/8) , respectively. The most adverse events in decitabine group were grade 3 to 4 neutropenia (45.8%) and grade 3 to 4 infections (33.3%) . Conclusion This preliminary study showed that low-dose decitabine produced promising results with an acceptable safety in lower-risk MDS patients, especially for those with mutated genes. Further study targeting poor prognostic lower-risk MDS patients should be warranted.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.