Objective To investigate the status and correlation between fatigue and health locus of control in patients with chronic obstructive pulmonary disease ( COPD ) . Method The multidimensional fatigue symptom inventory-short form and health locus of control questionnaire were used to investigate the fatigue and health locus of control among 150 COPD patients. Results The score on fatigue was 78.82 ± 1.50, in the middle-high level. The two factors scored the higher were physical fatigue and activity. The total score on health locus of control was 61.76 ± 5.02, at a middle-low level. The dimensions of health locus of control, ranked in a descending way in scores, included external control by destiny and authorities and internal control. The scores on external control by destiny and authorities were positively related that of total score on fatigue (P<0.05 for both) and the score of internal control was negatively correlated (P<0.05). Conclusion The fatigue of COPD patients was at high level and the health locus of control was at middle level. In the clinical practice, nurses should pay attention to the enhancement of patients′health locus of control to help them take up health behaviors for the purpose of lowering their fatigue.

Hepatitis C virus (HCV) is a blood-borne virus transmitted through contact with blood and blood products,and it is a major cause of liver cirrhosis and hepatocellular carcinoma.Many epidemiological studies have confirmed the association between HCV infection and renal disease.Membranoproliferative glomerulonephritis associated with mixed cryoglobulinemia is the most common type of HCV-related renal disease manifesting as nephropathy or nephritic syndrome,proteinuria,hematuria,and reduced glomerular filtration rate.The treatment of HCV-related renal disease includes antiviral therapy,B cell clearance,and non-specific immunosuppressive therapy.At the same time,the launch of rnew antiviral drugs has brought hope to the patients who cannot tolerate conventional regimens.This article reviews the research advances in epidemiology,clinical manifestations,pathogenesis,and treatment of HCV-related renal injury.

Objective To understand the feedback of seven-year students of clinical medicine about the application of PBL teaching method and investigate its related factors.Methods Four classes of seven-year students of clinical medicine of Nanjing Medical University which had received PBL teaching method were randomly selected in grade 2009 and 2010 (243 students)and 233 valid questionnaires were analyzed statistically.The questionnaire has four main parts and they are about basic situation,factors that may affect the PBL Teaching,students' subjective attitude,their effect evaluation and suggestion for improvements.SPSS 11.0 was used to analyze the first part of the resuhs withx2 analysis(P＜0.05).Results 233valid questionnaires were recovered and 79.0％(184/233) of students held a favorable position toward PBL application in their course.It is irrelevant to no other related factors but the accessibility of information(P=0.000).More than half of the students think it is suitable for PBL on the clinical medical students(57.5％,134/233),PBL teaching is more free and easy(51.9％,121/233)and can improve their awareness of participation(72.5％,169/233).However more students (193) are in favor of more traditional teaching combined with PBL,with the former dominated.Conclusion PBL teaching method in seven-year clinical medical program has been proved to be quite effective.Though with certain drawbacks,it is a good supplement to the traditional teaching methods in many aspects,and it is definitely of great significance in improving the quality of teaching.

Objective To evaluate the value of imaging examination and diagnosis of airway foreign body in children. Methods 218 of airway foreign bodies confirmed by bronchoscopy were retrospectively analyzed in terms of clinical and imaging data. Results 218 patients included 140 males and 78 females. Their ages ranged 6 months to 12 years(mean,19.2 months). All patients had conventional radiographs on frontal chest films,neck lateral films and fluoroscopy. 34 cases underwent 64-slice spiral chest CT examination. According to the location of the foreign bodies,29 cases were in throat and subglottic,55 cases in trachea and 134 cases in bronchus(79 cas-es in the right,55 cases in the left). According to the character of the foreign bodies,5 cases were metal,29 cas-es in bone,93 cases in peanuts,59 cases in seeds,22 cases in fruits and vegetables and 10 cases in others respec-tively. Thirty-fourcases showed a direct sign of the foreign body and 177 cases showed the indirect signs. 34 cases on CT examination directly were showed foreign body in the tracheal bronchi. The diagnostic accuracy of CT exami-nation was 100%. Conclusions X-ray photograph and fluoroscopy were the first choice for aspiratory foreign bod-ies in children. CT examination is an important supplementary method when conventional X-ray examination is neg-ative.

ObjectiveTo investigate the associations of plasma homocysteine (Hcy) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels with dementia.MethodsThe patients with dementia admitted to hospital were enrolled retrospectively.They were divided into a vascular dementia (VaD) group, a mixed dementia (MD) group, and an Alzheimer's disease (AD) group according to the Hachinski Ischemic Score, and the dementia severity was further divided into a mild group, a moderate group and a severe group according to the Mini-Mental State Examination.The non-demented patients hospitalized during the same period were selected as controls.The demographics, vascular risk factors, and plasma Hcy and Lp-PLA2 levels in each group were compared.Logistic regression analysis was used to determine the independent associations of the plasma Hcy and Lp-PLA2 levels with the risk of dementia and severity.ResultsA total of 125 patients with dementia were enrolled, including 52 (41.6%) in the VaD group, 21 (16.8%) in the MD group, and 53 (41.6%) in the AD group.There were 49 patients (39.2%) in the mild group, 51 (40.8%) in the moderate group, and 25 (20%) in the severe group.A total of 40 non-demented patients were enrolled as control group.The plasma Hcy and Lp-PLA2 levels in VaD, MD and AD groups were significantly higher than those in the control group (all P<0.001).Multivariable logistic regression analysis showed that the advanced age (odds ratio[OR] 1.12, 95% confidence interval [CI] 1.03-1.21;P=0.010), high plasma Hcy level (OR 1.44, 95% CI 1.21-1.71;P<0.001), high Lp-PLA2 level (OR 1.01, 95% CI 1.00-1.02;P=0.006), and previous stroke (OR 4.29, 95% CI 1.50-12.36;P=0.007) were the independent risk factors for dementia;high Hcy level (OR 1.48, 95% CI 1.21-1.82;P<0.001, high Lp-PLA2 level (OR 1.01, 95% CI 1.00-1.03;P=0.002), and previous stroke (OR 152.78, 95% CI 20.41-999.97;P<0.001) were the independent risk factors for VaD;advanced age (OR 1.10, 95% CI 1.02-1.17;P=0.008) and high Hcy level (OR 1.41, 95% CI 1.25-1.58;P<0.001) were the independent risk factor for severe dementia.ConclusionsThe increased plasma Hcy and Lp-PLA2 levels are associated with dementia.Reducing the plasma Hcy and Lp-PLA2 levels may be beneficial to the treatment and prevention of dementia.

Objective:To efficiently amplify NK cells and determine their cytotoxic activity against a variety of tumor cell lines in vitro,thereby providing evidence for potential clinical application.Methods: PBMCs were isolated from adult peripheral blood and co-cultured with K562 cells that were genetically modified to express 4-1BBL,IL-15 and IL-21 on the surface for 15 days to effectively amplify NK cells.The total cell number and Purity of CD3-CD56+ cells were measured.Granzyme B and perforin expression of the amplified NK cells were detected by flow cytometry and real-time PCR.The anti-tumor effect on different cancer cells was evaluated.Results: This method obtained a more than 1.1×1010 CD3-CD56+ NK cells with 95% purity over a 15 day amplification procedure.The expanded NK cells could efficiently release granzyme B and Perforin.The cytotoxicity against different tumor cells was followed the order from strong to weak:gastric,pancreatic,cervical,ovarian and renal cancer cells,with the highest activity against gastric cancer cell line A549 (90% at E∶T=10∶1) (P<0.05).A time-dependent killing effect of activated NK cells on cervical,liver and pancreatic cancer cells was observed.Conclusion: This amplification procedure can consistently generate large amounts of pure NK cells with effective cytotoxic function against a variety of tumor cells.

By Analyzing the significance and objective,practicing the organizing and management of the clinical application teaching in department of gynecology,the author explored the new teaching methods in current social condition.

Purpose To explore the correlation between fetal cardiac function and interventricular septal thickness in fetuses of gestational diabetes mellitus (GDM) mothers. Materials and Methods Thirty-nine GDM mothers were involved in the study and divided into group MH (fetuses of GDM mothers with interventricular septal hypertrophy) and group NMH (fetuses of GDM mothers with normal interventricular septal thickness). Ultrasonic cardiogram was performed for both groups to assess such variables as interventricular septum thickness at end diastole (IVSd), left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), right ventricular fraction shortening (RVFS), the ratio of E and A of mitral flow (E/AMV), the ratio of E and A of tricuspid flow (E/ATV), peak velocity of aortic valve (VPAO), peak velocity of pulmonary valve (VPPA) and myocardial performance index (MPI). The results were further compared with those of control group. Results The VPAO, VPPA, LVEF and LVFS in group NMH were significantly higher than those in control group (P<0.05). The VPAO, VPPA, LVEF, LVFS and RVFS in group MH were significantly higher than those in control group whilst the E/AMV and E/ATV significantly lower than those in control group (P<0.05). The LVEF, LVFS and RVFS in group MH were significantly higher than those in group NMH whilst the E/AMV and E/ATV significantly lower (P<0.05). MPI in group MH was significantly higher than that in group NMH (P<0.05), whilst both were significantly higher than that in control group (P<0.05). The LVEF, LVFS, RVFS, VPAO and VPPA were positively correlated with IVSd (r=0.48, 0.51, 0.45, 0.30, 0.30;P<0.05). Conclusion Cardiac function in fetuses of GDM mothers may be associated with interventricular septal thickness.

Objective To observe the effect of Juli Sanjie Pill(JSP) on estrogen receptor(ER)? and ER? expression in the myometrium and hysteromyoma tissue,and to explore the correlation of ER? and ER? expression levels with the incidence of hysteromyoma. Methods Forty hysteromyoma patients were divided into two groups: 20 patients with operative indications after oral use of JSP and asking for operation,were enrolled in the treatment group,and other 20 patiens without mediation of medicine but asking for operation were in the control group.The ER? and ER? expression levels in hysteromyoma tissue and the surrounding normal myometrium of the two groups were detected by radioimmunoassay.Results There presented the expression of ER? and ER? in the hysteromyoma tissue and the surrounding normal myometrium of the two groups,and the levels in the hysteromyoma tissue were higher than that in the myometrium(P0.05).Conclusion The incidence of hysteromyoma is correlated with the local expression of ER? and ER? in the uterus.The therapeutic mechanism of JSP for hysteromyoma is probably related with the decrease of ER? and ER? expression levels in hysteromyoma tissue and with the decrease of ER? level in the surrounding normal myometrium.

Objective To discuss the influence of different doses budesonide aerosol inhalation on serum cytokines levels in children with severe asthma.Methods 96 children with severe asthma aged 4 to 14 years old in our hospital were chosen,and they were randomly divided into the observation group and the control group,48 cases in each group.All patients were given conventional treatment, and the control group was given 1mg/time budesonide treatment on the basis of conventional treatment (3 times a day),while the observation group was given 2mg/time budesonide treatment (3 times a day).Before and 1 week after treatment,the clinical symptoms of two groups were observed and compared,as well as the changes of IL-4,IFN-gamma,IL-10 and TNF-α.Results In the obser-vation group,wheezes,coughing,wheezy sound and rales disappearance time were (2.10 ±0.77)d,(5.45 ±1.20)d, (3.46 ±1.03)d,(5.55 ±1.35),which were significantly shorter than (2.98 ±1.02)d,(7.48 ±1.19)d,(5.43 ± 1.06)d,(7.56 ±1.67)d in the control group (t=4.77,8.32,9.23 and 8.32,all P<0.01).4 weeks after treat-ment,the total effective rate of the observation group was 89.6%,which was significantly higher than 72.9% of the control group (χ2 =4.376,P<0.05).After treatment,the IL-4,IL-10,TNF-alpha,IFN-gamma levels in the observation group were (4.06 ±1.77)pg/mL,(12.77 ±2.05)pg/mL,(4.15 ±1.11)ng/mL,(26.23 ±2.78)pg/mL, which had significant changes compared with (9.02 ±2.23)pg/mL,(10.21 ±1.30)ng/mL,(6.66 ±1.62)pg/mL, (17.33 ±2.31)pg/mL before treatment(t=12.07,24.56,16.20,17.25,all P<0.01).After treatment,the IL-4, IL-10,TNF-alpha,IFN-gamma levels in the control group were (9.11 ±2.05)pg/mL,(6.80 ±1.23)ng/mL, (9.88 ±2.20)pg/mL,(21.22 ±2.80)pg/mL,which had significant changes compared with (9.11 ±2.05)pg/mL, (10.38 ±1.37) ng/mL,(6.71 ±1.77) pg/mL,(17.30 ±2.05) pg/mL before treatment( t=5.36,13.47,7.77, 7.83,all P<0.01).But IL-4,TNF-alpha levels in the treatment group were significantly lower than those in the control group (t=7.32,11.08,all P<0.01),while IL-10 and IFN-gamma levels were significantly higher than those in the control group (t=6.65,8.80,all P<0.01).The incidence of adverse reactions of the two groups had no statistically significant difference (χ2 =0.771,P>0.771).Conclusion High doses of budesonide aerosol inhalation in the treatment of children with severe asthma has obvious clinical curative effects,which could significantly improve the patients'clinical symptoms,and also has low incidence of adverse reactions,which is worthy of clinical promotion.