Objective To investigate the effect of applying scenario simulation practice in the professional ICU nursing students' emergency and intensive care intensified skill training before internship.Methods Totally 120 professional ICU nursing students from grade 2010 and 2011 were enrolled.Control group included 60 students from grade 2010 and experimental group included 60 students from grade 2011.Studnets in control group accepted standardized routine training while those in experimental group accepted scenario simulation practice.All students participated in skill examination after training.Two questionnaires were designed to survey nursing students and clinical teachers respectively at one month after internship.One questionnaire was to evaluate students' attitude to the training and the other one was to survey clinical teachers' evaluation of students' abilities.T test was used to statistically analyze skill examination performance and questionnaire scores between two groups.Results Skill examination performance of experimental group was better than that of control group (P＜0.01).Effects of intensified training were better in experimental group than in control group (P＜0.05,P＜0.01) including the aspects of combining theory and practice,shortening internship role transition time,enhancing selfconfidence of clinical practice and relieving tension anxiety before practice,etc.Clinical teachers thought that the experimental group's analysis ability,strain capacity,operation ability,communication ability,team cooperation ability and actively acquiring knowledge ability were stronger than those of control group (P ＜ 0.01).Conclusions Scenario simulation practice is helpful to improve operation ability and comprehensive ability.Nursing students can adapt to the clinical work better.Findings may be beneficial to the improve-ment of teachers' professional level.

Objective To investigate and analyze the behavior and therapeutic status of rheumatoid arthritis (RA) patients. Methods Out patients diagnosed with rheumatoid arthritis in our hospital from May to August 2007 were enrolled. The data including sex, age of onset, site of first hospitalization and medication status were collected and analyzed. Results In this 181 RA patients, the mean age of onset was (53±11) year-old, mean history duration was (10±8) years, the ratio of male to female was 1:4.2. The orthopedics department was the most common site of first hospital visit (32.0%, 58/181) and rheumatology department was the most common site to clarify the diagnosis (62.4% ,113/181). The diagnosis delay caused by patients themselves was (5.9±17.2) months and the delay caused by doctors was (9.0±22.0) months. More than half of the patients were not treated appropriately before they came to our hospital. Methotrexate was the most commonly used DMARDs (67.3%), followed by leflunomide (46.4%), sulfasalazine (37.5%) and hydroxyehloroquine (19.6%). Conclusion In this cohort, the proportion of patients who come to rheumatology department immediately after disease onset is low. There is delay between symptoms and final diagnosis. More than half of the patients are not treated appropriately.

Objectives Understanding the characteristic changes of Keshan disease (KD) in different epidemic period to provide reference basis for prevention and teatment. Methods On the basis of medical record as fundamental element, the relative conditions of Keshan disease's prevailing and spreading period were compared. Results In high incidence years, familial aggregation [accounted for 12%(6/50)] and seasonal aggregation were found, and KD cases occurred mainly from May to September, which was 78% (39/50)of the total cases in the whole year. Circulatory dysfunction(gallop rhythm, pulmonary role, jugular venous engorgement, cyanosis of lips) was more severe in high incidence years than that in low incidence years(X2=8.53,P<0.01). The average age of incidence was (4.07±1.46) years old in high incidence years and (6.11±2.71) years old in low incidence years. The type constitution in high incidence years was significantly different from that in low incidence years (X2=40.68, P<0.01), and chronic type of KD accounted for 22.85%(707/3094),46.09%(53/115), respectively, in high and low incidence years. Conclusions Making a further research of seizure of disease, and improving diagnosis and cure management level are also the important content for prevention and cure research work of Keshan disease at right time.

Background The pathogenic mechanism of thyroid associated ophthalmopathy (TAO) is still unclear,which is considered to be an autoimmune disease.It is confirmed that interleukin-17A (IL-17A) plays an important role in the occurrence and development of many autoimmune diseases.It is unclear that whether IL-17A participates in the pathogenesis of TAO.Objective This study was to explore whether IL-17A secreted by coculture system of peripheral blood mononuclear cells (PBMCs) and orbital fibroblasts (OFs) participates in the pathogenesis of TAO and its possible mechanism.Methods Periphery blood and orbital connective tissue were obtained from 12 patients with TAO and 8 patients who received prosthesis implantation for eyeball atrophy in Xiangya Hospital during April to December 2014.PBMCs were isolated by density gradient centrifugation,and OFs were cultured by explant culture method.The purity of T leukomonocyte in PBMCs was tested by flow cytometry,and OFs were identified by Giemsa staining and immunochemistry.OFs and PMBCs were incubated into 96-well plate in a 1:20 proportion to establish co-culture system.Different concentrations of phytagglutinin (PHA) (0,1.0,2.5,5.0,10.0 μg/ml) was added for 72 hours,and IL-6,IL-17A levels in the co-culture system supernatant and IL-17A receptor (IL-17RA) of the total cell membranes in the co-culture system were assayed by ELISA.The differences of IL-6,IL-17A,IL-17RA levels in co-culture system were compared between the TAO group and control group.Results The mean purity of T leukomonocyte in PBMCs was (81.10±0.21)％ in the TAO group and (80.05 ±0.38)％ in the control group respectively,with no significant difference between them(t =0.923,P＞0.05).Cultured OFs showed the positive response for Vimentin expression and Giemsa staining.After stimulated by 1.0 μg/ml PHA,the proliferation of both PBMCs and OFs were increased in the co-culture system.Apoptosis exist in PBMCs and the number of OFs decreased when PHA was higher than 1.0 μg/ml.The growth of PBMCs and OFs was faster in the TAO group than that in the control group in the same concentration of PHA.The contents of IL-6,IL-17A and IL-17RA in co-culture system were significantly different among various concentrations of PHA subgroups (IL-6:Fgroup =12.561,P=0.000;F ion =23.356,P =0.001.IL-17A:Fgroup =12.037,P =0.000;Fconcentration =19.206,P=0.000.IL-17RA:Fgroup =16.216,P=0.000;Fconcentraction =4.627,P=0.018).The production of IL-6,IL-17A and IL-17RA reached peak in both TAO group and the control group after 1.0 μg/ml PHA stimulated.However,the concentrations of IL-6,IL-17A and IL-17RA reduced with the increase of PHA concentration.The concentrations of IL-6,IL-17A and IL-17RA in co-culture system were significantly higher in the TAO group than those in the control group under the stimulation of the same concentration of PHA (all at P＜0.05).Conclusions The co-culture system of PBMCs and OFs stimulated with PHA can be the imitation of TAO pathogenesis in vitro,and PHA can amplify its immune reaction to imitate TAO pathogenic processes intuitively.The IL-6,IL-17A and IL-17RA secreted by PBMCs and induced by PHA are increased in TAO patients,implying that IL-17A participates in the pathogenesis of TAO through magnifying cellular immune response and inflammatory reaction.

Object To investigate the saponin from the seeds of Trigonella foenum graecum Linn (STFG) Methods The total saponin from STFG was extracted and purified by using the absorptive resin, the single saponin was isolated by using the column chromatography as well as dry column chromatography of silica gel H The chemical structure was elucidated by 13 CNMR , FAB MS, DEPT spectroscopic evidence and the results of fraction hydrolysis of acquiring their secondary glucosides Results A new saponin A from the total saponin has been obtained, the fraction hydrolysis carried out and the secondary glucoside Ⅰ and Ⅱ identified by determining the structure of saponin A The chemical structure of saponin A is: diosgenin 3 O ? L rhamnopyranosyl(1→4) ? D glucopyranosyl(1→4) ? D glucopyranoside The secondary glucoside Ⅰ is: diosgenin 3 O ? D glucopyranoside; Ⅱ is: diosgenin 3 O ? D glucopyranosyl(1→4) ? D glucopyranoside Conclusion Glucoside A is a new saponin with three molecules of sugar

Object To do detail investigation of the saponins from the Chinese materia medica Huluba (the seeds of Trigonella foenum graecum L ) Methods The pure saponins from the total saponins were isolated by employing the column chromatography and dry column chromatography of silica gel H Their chemical structures were elucidated by 13 C NMR , FAB MS, DEPT spectroscopic evidence and the results of the fraction hydrolysis of acquiring their secondary glucosides were obtained Results Two new saponins B and C were isolated and both were the glucosides consisted by four molecules of sugar with diosgenin The chemical structure of B is: diosgenin 3 O ? L rhamnopyranosyl (1→3) ? L rhamnopyranosyl (1→4) ? D glucopyranosyl (1→4) ? D glucopyranoside And saponin C is: diosgenin 3 O ? D glucopyranosyl (1→4) ? L rhamnopyranosyl (1→4) ? D glucopyranosyl (1→4) ? D glucopyranoside Conclusion Saponins B and C are two new ones with four molecules of sugar respectively

ObjectiveTo observe β cell function in newly diagnosed diabetic patients with ketosis before and in remission period and evaluate its classification and predictive value.MethodsA total of 206 patients newly diagnosed as diabetic ketosis who had been treated with intensive insulin therapy in our hospital and entered in the honeymoon after the withdraw of insulin therapy were followed for 36 months from onset of diabetes.They were divided into two groups of type 1 and type2 diabetes ( group A and B),according to the dependence or independence on insulin treatment. The β cell function of the two groups before and in remission period was compared by oral glucose tolerance test (OGTF).β cell function was measured with the AUC of insulin and C-peptide and homeostatic model assessment β-cell function (HOMA-β),while homeostatic model assessment insulin resistant (HOMA-IR) for insulin resistant.The duration of the honeymoon and the change of insulin and C-peptide curve before and in honeymoon were also observed.ResultsThe AUC of insulin and C-peptide,the HOMA-β and the HOMA-IR before and after the intensive insulin treatment were lower in group A than that in group B [ before the insulin treatment:(10.18 ±2.36)mIU · h · L-1 vs (20.28 ±6.89)mIU · h · L-1,(1.56 ±0.53) μg · h · L-1 vs (3.75 ±0.67) μg · h · L-1,3.68 ± 1.08 vs 18.20 ±6.59,1.22 ±0.49 vs 3.06 ± 1.54,respectively;after the insulin treatment:(29.86 ± 8.65 ) mIU · h · L-1 vs (93.35 ± 19.42 ) mIU · h · L-1,( 3.99 ± 0.79 )μg · h · L-1 vs ( 12.54 ±3.83) μg · h · L-1,8.50 ±2.46 vs 56.17 ± 19.42,0.63 ±0.56 vs 1.42 ±0.78,respectively ].The duration of the honeymoon in group A was significantly shorter than in group B [ (7.9 ±5.2) months vs (20.9 ± 9.9 ) months ].In oral glucose insulin and C-peptide release test,the peak of insulin and C-peptide releasing curve in group A was brought forward by a half to 1 hour after intensive treatment while delayed in group B by 1 or 2 hours.The releasing peak of insulin and C-peptide in group A was less than two folds of the basic value,while four to ten fold of the basic value in group B.The positive ratio of glutamic acid decarboxylase antibody,insulin autoantibody and insular cellular antibody in group A and group B were 21.2％ vs 4.8％,18.1％ vs 3.3％,9.2％ vs 10.6％,respectively.ConclusionsOf all the patients newly diagnosed as diabetes ketosis who had entered into the honeymoon after intensive insulin therapy,91％ were type 2 diabetes.Inferior β cell function before insulin therapy,weaker remission after insulin therapy and shorter duration of remission period suggest the classification of type 1 diabetes.

Objective To investigate the relationship between the severity of diabetic retinopathy and serum bilirubin level. Methods From August 1 2008 to December 31 2009, hospitalized patients of 1062 cases with type 2 diabetes were divided into three groups according to fundus examination: no diabetic retinopathy (NDR) group (457 cases), non-proliferative diabetic retinopathy (NPDR) group (484 cases)and proliferative diabetic retinopathy (PDR) group ( 121 cases). The difference in serum bilirubin level was compared. Results Total bilirubin in PDR, NPDR and NDR group were (9.96 ± 3.84), ( 11.41 ± 3.82),( 13.38 ± 3.98) μ mol/L respectively. There was significant difference among three groups (P ＜ 0.01 ). Logistic multivariate regression analysis showed that a drop in serum total bilirubin level was an independent risk factor of diabetic retinopathy. Conclusions Bilirubin level and the severity of diabetic retinopathy have some relationship. The antioxidant bilirubin and anti-inflammatory effect should be paid attention to.

OBJECTIVE:To establish the quality standard of Belamcandin standard substance.METHODS:Different indices of standard Belamcandin were examined with quantitative and quantitative analyses according to the corresponding measures stipulated in the Appendix of pharmacopoeia of people's republic of China(part Ⅱ)published in 2005.RESULTS:The specific rotatory power of 3 batches of standard Belamcandin was —28?～—30?([?]25 D,c0.11,Pyridine);the E1% 1 cmwas 790～830;the melting point was 252～254 ℃ and the ash content was less than 0.5%.The content of Belamcandin in the products was above 99.5% as revealed by HPLC.CONCLUSION:All of the indices were shown to meet the standards for standard substances and the established standard can be used for the quality control of standard Belamcandin.

[Summary] Thyroid-associated ophthalmopathy ocular damage involved in lacrimal, tear film, cornea, and conjunctiva which can lead to ocular discomfort and decreased visual.The mechanism of thyroid-associated ophthalmopathy ocular surface damage and treatment is reviewed.