Objective To investigate graduating nursing students′expected pressure, stress levels, nursing identification degree and their influence factors, provide a reference for hospitals and schools to enact measures to reduce pressure and improve nursing identification degree. Methods It was a cross-sectional survey. Three hundred and sixty- one graduating nursing students were selected and investigated by graduating nursing students′expected work pressure and expected resources before starting a career. Results Graduating nursing students′expected stress score was (2.13±0.53) points, nursing identification degree score was (2.57±0.57) points and they were both at median level and effected by several personal internal and external factors. Nursing students expected getting help from hospitals, schools and interpersonal aspects before starting a career. Conclusions Excepted stress and nursing identification degree are influenced by kinds of factors. Hospitals and schools should know about their expected requirements and enact measures to reduce pressure and improve nursing identification degree in time to keep nursing talent.

Objective To evaluate the ability of multi-slice spiral CT angiography(MSCTA)in showing the celiac trunk and its degree branches,and the value of MSCTA in preoperative evaluation of laparoscopic-assisted gastrectomy for advanced gastric carcinoma.Methods A total of 25 consecutive patients scheduled for laparoscopic-assisted gastrectomy with D2 lymph node dissection were evaluated by MSCT,CT angiography(CTA)were reconstructed separately using a volume rendering algorithm(VR).The space anatomy characteristics of celiac artery and its degree branches were evaluated according to the CTA results,and with anatomy information,laparoscopic-assisted gastrectomy with D2 lymph node dissection was processed with references to anatomy.Results In all the 25 cases,the left gastric artery and gastroduodenal artery were accurately identified on MSCTA.In 12 of them,the right gastric artery was accurately identified.The origin of the spleen artery is relatively constant.Laparoscopic-assisted gastrectomy with D2 lymph node dissection was successfully completed without conversion to open surgery in all the cases.The reconstructed celiac trunk and branches are identical with anatomy.Conclusions Three-dimensional CTA using MSCT clearly reveals the anatomy of celiac artery and their space structure.It plays an important role in guiding lymph node dissection during laparoscopic-assisted gastrectomy for advanced gastric carcinoma.

Objective To evaluate the usefulness of ultrasonography in detecting parathyroid lesions in the patients with hyperparathyroidism. Methods The results of ultrasonography were compared with operative and histologic findings, and other imaging techniques such as 99m-Tc-sestamibi scintigraphy and CT in 210 patients with proved hyperparathyroidism.Results The overall sensitivity and specificity of ultrasonography in detecting parathyroid lesions were 68.62%, 93.79%. Lesions at lower pole of thyroid were more likely to be detected than ectopic ones. Ultrasonography was helpful in diagnosis of parathyroid adenoma, hyperplasia or carcinoma when combined with clinical manifestations. Conclusions Ultrasonography is a useful means in preoperative localizing of hyperparathyroidism.

Objective To investigate the clinical efficacy of the optimization of treatment with lamivudine or de novo combination therapy with lamivudine and adefovir dipivoxil.Methods A total of 98 cases of chronic hepatitis B patients were randomly divided into optimization of treatment group and de novo combination therapy group,optimization of treatment group treated with lamivudine optimization therapy,de novo combination therapy group treated with lamivudine and adefovir dipivoxil,virological,serological,biochemical and other indices were detected every 12 weeks,analyzed treatment effect after 48 weeks.Results Two groups were comparable baseline before treatment(P ＞0.05).HBV DNA negative rate,e antigen-negative rate,and resistance rates at week 48 were 86％,37％,and 0 in the de novo combination therapy group,and 59％,12％ and 18％ in the optimized treatment group (P ＜0.05).The e antigen seroconversion and ALT normalization rates were 23％ and 91％ in the de novo combination group,and 6％ and 86％ in the optimized treatment group (P ＞0.05).There was similar incidence of adverse reactions.Conclusions Compared to the de novo combination therapy group,the lamivudine-optimized treatment group can achieve higher HBV-DNA negative rate,e antigen-negative rate,lower resistance rates,and good safety.

Objective To investigate the effect of dexmedetomidine on postoperative renal function of patients with rheumatic heart disease following valvular heart surgery. Methods Fifty patients following valvular heart surgery were randomized into experimental group and control group,with 25 cases in each group. The patients in experimental group receiveddexmedetomidine 0.5 μg/kg infusion 15min before induction, and then 0.5 μg/(kg·h) infused to the end of surgery, while those in control group received the same amount of saline in the same way. Blood from central venous was collected before surgery, at the end of surgery, 24 h and 48 h after surgery in order to detect Src, BUN and Cys C and the length of ICU duration was also recorded. Results Src and Cys C of the patients in both groups obviously elevated 24h after surgery when compared with pre-operation , while BUN elevated at both 24 h and 48 h after surgery(P < 0.05). Compared with those in control group, Src, BUN and Cys C were lower in experimental group ( P < 0 . 05 ) , and the length of ICU duration was shorter (P < 0.05). Conclusion Dexmedetomidine could improve the postoperative renal function after valvular heart surgery and lead to a better prognosis.

Objective evaluate the role of vagus nerve?muscarinic cholinergic receptor ( M recep?tor) pathway in mitigation of myocardial ischemia?reperfusion (I∕R) injury by intrathecal morphine postcon?ditioning in rats. Methods Seventy adult male Sprague?Dawley rats in which intrathecal catheters were suc?cessfully placed without complications, weighing 250-350 g, were randomly assigned into 7 groups ( n=10 each) using a random number table:sham operation group (Sham group), I∕R group, intrathecal morphine postconditioning group ( MP group) , vagal transection ( VT) group, VT+ intrathecal morphine postcondi?tioning group (VT+MP group), atropine (ATP, M receptor antagonist) + morphine postconditioning group ( ATP+MP group) , and ATP group. Myocardial I∕R was produced by occlusion of the anterior descending branch of left coronary artery for 30 min followed by 2 h of reperfusion. Morphine ( 3μg∕kg, 10μl) was in?trathecally infused over 5 min starting from onset of reperfusion in MP group. Normal saline 10 μl was in?trathecally infused over 5 min starting from onset of reperfusion in NS group. The bilateral vagus nerves were transected at 10 min before reperfusion in VT+MP group. Atropine ( 0?1 mg∕kg, 0?5 ml) was intravenously infused over 5 min starting from 10 min before reperfusion in ATP+MP group. The occurrence of cardiac ar? rhythmia ( premature ventricular contractions ( PVCs) and ventricular tachycardia ( VT)∕ventricular fibrilla?tion ( VF) ) within the first 30 min of reperfusion was recorded. The rats were sacrificed at 120 min of reper?fusion, and myocardial specimens were obtained for determination of myocardial infarct size ( IS) as a per?centage of area at risk (AAR). IS∕AAR ratio was calculated. Results Compared with Sham group, the number of PVCs and VT∕VF and IS∕AAR ratio were significantly increased in the other groups. Compared with I∕R group, the number of PVCs and VT∕VF and IS∕AAR ratio were significantly decreased in MP group. Compared with MP group, the number of PVCs and VT∕VF and IS∕AAR ratio were significantly in?creased in VT+MP and ATP+MP groups. Conclusion Vagus nerve?M receptor pathway is involved in miti?gation of myocardial I∕R injury by intrathecal morphine postconditioning in rats.

Objective To explore the impact of medication self-management module on treatment compli-ance and social function of patients with schizophrenia. Methods 66 inpatients with schizophrenia in their non-acute stage were randomly divided into training group(n=33) and control group(n=33). Both groups received the anti-psychotics therapy. Medication self-management module was only given to the training group for 8 weeks.All subjects were follow up for 6 months and were evaluated with self-made drug treatment compliance rating scale,self-made work ability rating scale, social disability screening schedule(SDSS). Results Treatment compliance,the total scores of SDSS of training group were significantly higher than that of control group after 8 weeks and 6 months: treatment compliance (χ~2=9.188,29.630, P < 0.01); the total scores of SDSS ((2.63±2.74) vs (5.27 ±3.05), (1.69±2.35) vs (4.91±3.06), P=0.000); work ability of training group was significantly higher than that of control group after 6 months (χ~2=19.443, P=0.000). Treatment compliance (χ~2=8.053, P=0. 018), the total scores of SDSS((2.63±2.74) vs (6.81±3.06), P=0.000) of training group after 8 week and 6 months were significantly higher than that of pretraining. Treatment compliance and work ability of both groups on 6 months follow up were significantly lower than that of 8 weeks (P < 0.01). Correlation analysis can-firmed that there was positive relation between the total scores of SDSS and treatment compliance, work ability on 6 months later. Conclusion Medication self-management module could significantly improve treatment compliance,social function and work ability of patients with schizophrenia.

Objective To evaluate the feasibility of endovascular repair for retrograde type A aortic dissection.Method 35 patients of retrograde type A aortic dissection admitted to Peking University People's Hospital from December 2001 to March 2014 were treated with endovascular repair.There were 33 males and 2 females with mean age of 46 ± 9 years.29 were on acute stage,2 on subacute stage and 4 on chronic stage.The entry tear was in the descending thoracic aorta in 32 cases,between the left subclavian artery and the left common carotid artery in one,and between the left common carotid artery and the innominate artery in two.Results Entry closure was achieved in all patients with a covered stent.2 patients died in 30 days postoperatively (5.7％).1 patient with two chimney developed acute renal artery embolized which was infused by false lumin (2.9％).One patient developed transient paraparesis after graft deployment(2.9％).During the follow-up period,the aortic remodeling is perfect,no entry tear was noted in the ascending thoracic aorta.All the endografts for preserving supra-aortic branches were patent.Conclusions The endovascular repair for retrograde type A aortic dissection is feasible and effective.

Objective To investigate blocking ascending branch of uterine arteries in operation of hysteromyomas rejecting by laparoscope.Methods 60 petients(except cervix myoma,intraligamentary myoma,submucosa myoma),randomly devided to reseach group(30 cases)and control group(30 cases).Blocking ascending branch of uterine arteries before rejecting hysteromyomas by laparoscope in reseach group,directly rejecting hysteromyomas by laparoscope in control group.The volumes of blood loss in operation,the duration of operation,postoperative recovery(Time of passing flatus,wound healing,length of stay)were compared between two groups.During the follow-up months,observing hysteromyoma recidivism and improvement of menstruation.Results All patient were rejected hysteromyomas by laparoscope.The volumes of blood loss in research group were less than that in control group(P0.05),All wounds were well healed in both groups,the rate of hypermenorrhea improvement was 100%(26/26)in research group,but That in control group was 80%(16/20),There was significant difference between two group.Conclusions Blocking ascending branch of uterine arteries may obviously decrease the volumes of blood loss in operation of hysteromyomas rejecting by laparoscope,It presents rapider convalescence,higher rate of symptom improvement and less complication operation.

Objective:To observe the effect of sodium fluoride (NaF) on the expression of phosphatidylinositol-3-kinase/protein kinase B (PI3K/Akt) signal and apoptosis in human osteosarcoma Saos-2 cells.Methods:Saos-2 cells were divided into 0 (control), 5, 10, 20 and 40 mg/L fluoride groups ( n= 3) according to the dose of NaF. The cells were collected after 24 and 48 h of culture in vitro. Western blotting was used to detect the expressions of PI3K/Akt signal and Forkhead transcription factor (FoxO) 1, and the apoptosis level of Saos-2 cells was detected by flow cytometry. Results:There were no significants differences in the expressions of PI3K and Akt in Saos-2 cells at 24 and 48 h ( P > 0.05). At 24 h, the expressions of phosphorylated PI3K (p-PI3K) in 5, 10, 20 and 40 mg/L fluoride groups (0.40 ± 0.06, 0.45 ± 0.02, 0.37 ± 0.06, 0.32 ± 0.06) were higher than that in the control group (0.28 ± 0.04, P < 0.05); at 48 h, the expressions of p-PI3K in 5 and 10 mg/L fluoride groups (0.46 ± 0.06, 0.58 ± 0.03) were higher than that in the control group (0.29 ± 0.04, P < 0.05), and that in the 40 mg/L fluoride group (0.21 ± 0.03) was lower than that in the control group ( P < 0.05). At 24 h, the expressions of phosphorylated Akt (p-Akt) in 5, 10 and 20 mg/L fluoride groups (0.27 ± 0.01, 0.30 ± 0.03, 0.27 ± 0.03) were higher than that in the control group (0.20 ± 0.02, P < 0.05); at 48 h, the expressions of p-Akt in 5 and 10 mg/L fluoride groups (0.42 ± 0.04, 0.60 ± 0.02) were higher than that in the control group (0.27 ± 0.01, P < 0.05), and that in the 40 mg/L fluoride group (0.18 ± 0.02) was lower than that in the control group ( P < 0.05). The expressions of FoxO1 in 10, 20 and 40 mg/L fluoride groups at 24 h (0.38 ± 0.07, 0.41 ± 0.06, 0.47 ± 0.08) were higher than that in the control group (0.34 ± 0.04, P < 0.05). At 48 h, the expressions of FoxO1 in 5, 10, 20 and 40 mg/L fluoride groups (0.36 ± 0.08, 0.37 ± 0.10, 0.54 ± 0.04, 0.73 ± 0.04) were higher than that in the control group (0.28 ± 0.04, P < 0.05). At 24 and 48 h, the apoptosis rates of control group and 5, 10, 20 and 40 mg/L fluoride groups were (2.867 ± 0.583)%, (3.647 ± 0.035)%, (3.773 ± 0.095)%, (5.440 ± 0.325)%, (7.203 ± 0.476)%; (3.707 ± 0.286)%, (4.023 ± 0.241)%, (4.970 ± 0.368)%, (12.473 ± 0.949)%, (19.387 ± 1.892)%, respectively. The apoptosis level of 40 mg/L fluoride group was higher than that of control group at 24 h ( P < 0.05), and that of 20 and 40 mg/L fluoride groups were higher than that of control group at 48 h ( P < 0.05). Conclusion:Fluoride can directly activate the PI3K/Akt signaling pathway in osteoblasts, and then has anti-apoptotic effect.