Objective To explore clinical nursing pathway(CNP) teaching method for nursing practice students.Methods Nursing practice students ( n =120 ) were randomly divided into two groups:experimental group and control group.CNP teaching method was applied in experimental group while traditional teaching method was used in control group.The test results of theory,operational skill,comprehensive quality,patient's satisfaction degree and nursing mistake between the two groups were compared.Results The results of theory,operational skill,comprehensive quality,patient's satisfaction degree in experimental group were obviously better than those in control group(P ＜0.05),the result of nursing mistake in experimental group was greatly decreased compared with that in control group(P ＜ 0.05).Conclusion CNP teaching method is superior to traditional teaching method and it greatly improve the teaching quality.

Objective To study the feasibility and morphological characteristics of wide caliber of local biliary tract constructed by increasing pressure of local bile duct in a short period of time.Methods Twelve mongrel dogs were randomized into 2 groups.In group A,only inlaid bile duct dilator(IBDD)was placed for biliary drainage in common bile duct.In group B,IBDD was placed in tommort bile duct for biliary drainage and dilated it through affusing 0.1 ml,0.1 5 ml,0.2 ml and 0.25 ml water on postoperative day 1,8,15 and 22,respectively.The expandable ballbladders were kept on being dilated with increasing pressure for a month.Total bilirubin(TB),alanine aminotransferase (ALT),aspartate aminotransferase;aspartate transaminase(AST)of serum,bile duct diameter (BDD),histologic changes of biliary duct wall and hepatic tissue,and postoperative biliary tract contrast were determined before and after operation in both groups.Results There was no significant difference in TB,ALT,AST and histologic changes of hepatic tissue in bilary predilation and postdilation of each group and between group A and group B.There was great difference in BDD in bilary predilation and postdilation of each group and between group A and group B.In group B,the biliary wall was thickened and the lumina of bile duct widened,favorable tenacity of broaden biliary tract was shown.The specific staining of the broadened biliary wall showed that collagen and elastic fibers compacted fine and close and there was no breakage.Conclusion Dilated local bile duct constructed by increasing internal pressure of local bile duct has thick wall,wide caliber and its collagen and elastic fibers compact fine and close.This provides condition to supply early-stage cholangio-jejunostomotic reconstruction of bile duct iniury and create wide stoma for cholangio-jejunostomy in dogs.

Objective: This research is conducted to analyze the background, the main practices and the results of the synergistic service of health institutions in Changzhou city, as well as to provide references for promoting the construction of integrated medical and health service system.Methods: This paper uses qualitative interviews and questionnaires to collect information and analyzes the data based on synergetic management theory.Results:Changzhou city has tentatively achieved the synergy of its health institutions by introducing relevant policies, setting up healthcare unions at the municipal level, integrating internal resources among healthcare unions, establishing health information platform and feedback mechanism, etc.Conclusion: The regional synergistic service of health institutions can be effectively promoted by introducing policies at the municipal level, promoting the mutual sharing and communication on information, and integrating internal resources among healthcare unions.But, as there still exist problems such as the distribution of benefits is not perfect, the degree of synergy is not close, etc., thus, the government is suggested to expand the implementation scope of the close-type medical service synergy and further improve the distribution policy of benefits.

Objective:To explore the factors affecting the postoperative prognosis of early cervical squamous cell carcinoma and inves-tigate the different radiotherapy techniques. Methods:A total of 100 postoperative patients of early cervical squamous cell carcinoma treated in Affiliated Tumor Hospital of Xinjiang Medical University and Affiliated Tumor Hospital of Sun Yat-sen University from March to September 2013 were enrolled in our study. The prognostic factors for these patients were analyzed. After being subjected to differ-ent postoperative radiotherapy techniques, the efficacy and complications of the techniques were assessed for patients, including 50 cases of conventional radiotherapy (CRT) and 50 cases of image-guided radiotherapy (IGRT). Results:The 3-year overall survival rate was 89%, and the 3-year disease-free survival rate was 78%. The 3-year overall survival rates of the CRT and IGRT groups were 78.57%and 89.06%, respectively. The difference between these rates was statistically significant (P=0.034). The 3-year survival rates of the CRT and IGRT groups were 66.67%and 87.36%, respectively. The difference was statistically significant (P=0.042). The incidence of ear-ly and late complications in the CRT group was higher than that in IGRT group, and the difference of P<0.05 was statistically significant. Multivariate analysis showed that postoperative radiotherapy, parametrial invasion, lymph node metastasis, lymphovascular space in-vasion, perineural invasion, and deep stromal invasion were the independent risk factors for the prognosis of patients with early stage cervical squamous cell carcinoma. Conclusion:Early prognosis of cervical squamous cell carcinoma results from the interaction of mul-tiple factors. The 3-year survival rate of the IGRT group was significantly better than that of the CRT group in the early stage of cervical squamous cell carcinoma. IGRT alleviates acute and chronic toxicities and helps improve the quality of life of patients.

Objective To design and express a novel peptide based on ricin toxin antibody in E. coli, and to evaluate its biological activity. Methods Based on the crystal structure of ricin toxin A chain (RTA) and the RTA-rRNA interact in the complex model, the steric conformation of RTA was theoretical modeled and its functional domain was preliminarily determined. The humanized single-domain RTA antibody was designed rationally by computer-guidod molecular design method. Its coding sequence was ob- tained by overlapping extension PCR, and cloned into the pET-32a vector. The fusion protein was then ex-pressed in E. coli BL21 (DE3), identified by Western blot, and purified with Ni-NTA agarose. The binding and neutralizing activity of this novel peptide for riein was evaluated by competitive ELlSA assay and MTT assay. Results A recombinant human single-domain antibody expressing a polypeptide against RTA in the CDR3 loop was designed. The fusion protein was successfully expressed in E. coll. The purified protein can bind to ricin, and neutralize its activity in SP2/0 viability assay. Conclusion The success of the novel pep-tide based on riein toxin antibody provides a novel method to develop new generation of ricin antagonists.

Objective:To assess the guidance of 3D reconstruction in the surgical and orthodontic management of maxillary palatal impacted canines with cone-beam computed tomography (CBCT).Methods:22 adolescent patients with 26 impacted maxillary conines were examined by CBCT.CBCT 3D reconstruction was used to observe the impaction of the canines.Measurements were taken to evaluate spatial relationship between the canine and adjacent structures and resorption of neighboring incisor roots.Results:CBCT was effective to localize the impacted canines.All of the maxillary palatal impacted canines inclinated mesially,angles of impacted ca-nines to occlusal plane were 61.1°±18.1°,there were 8,5,3 and 10 impacted canines found in classⅠ,Ⅱ,Ⅲ and Ⅳ mesial mal-position respectively.3 adjacent lateral incisors and 2 central incisors were extracted because of severely root resorption.Normal occlu-sion was achieved for 26 impacted canines by the traction of the canines into dental arch and reaching the occlusal plane.Conclusion:CBCT can spatially show the palatal impaction of maxillary canines and the relationship to adjacent tooth,can guide the treatment plan and traction direction,therefore increase therapeutic effect.

Objective To investigate the value of spectral CT with iodine parameters in distinguishing moderately-differentiated adnocarcinoma from poorly-differentiated adenocarcinoma.Methods 61 patients with gastric adenocarcinoma underwent preoperative CT scanning that included arterial phase(AP) and venous phase(VP) with gemstone spectral imaging(GSI) mode.All measurements were performed on the GSI viewer.The iodine concentration (IC) and the water concentration (WC) of the primary lesion were measured.Then the normalized iodine concentration (NIC) and contrast enhancement ratio (CER) were calculated.The CT values were measured at 70 keV Mono image.All the values of CER, NIC, IC and WC in the primary lesion were recorded and assessed by independent-samples t test.Receiver operating characteristic (ROC) was used to determine the threshold of IC and NIC for differentiating poorly-differentiated adenocarcinoma and moderately-differentiated adnocarcinoma.Results The IC values between moderate differentiation group and poor differentiation group were 8.73±4.05 vs 11.07±4.80(100 μg/cm3) in AP and 16.89±4.89 vs 21.18±5.96(100 μg/cm3) in VP.The values of NIC between moderately differentiated group and poorly differentiated group were 0.10±0.06 vs 0.13±0.06 in AP and 0.38±0.10 vs 0.49±0.12 in VP respectively.Significant difference of NIC (tVP=3.38, PVP<0.01) and IC (tVP=2.87, PVP=0.01) were only found between poor differentiation group and moderate differentiation group in venous phase.The value of WC and CER (both P>0.05) in double phases revealed no significant difference between the two groups.Conclusion Iodine quantitative parameters of spectral CT can be potentially used to preoperatively evaluate the differentiation degree of gastric adenocarcinoma.Thus, the iodine parameters can reflect the differentiation degree of gastric adenocarcinoma.

Objective To analyze and summarize the efficacy and the experience in the application of type Ⅰ and type Ⅱ bundled pancreaticojejunostomy in pancreaticoduodenectomy. Methods Between Jan.2005 and Dec. 2009, a total of 38 patients who underwent bundled pancreaticojejunostomy was enrolled, and their clinical data were retrospectively analyzed. 20 patients received type Ⅰ bundled pancreaticojejunostomy and 18 patients received type Ⅱ bundled pancreaticojejunostomy. The operative time, postoperative hospital stay, mortality and complications were compared. Results The operative time of type Ⅰ bundled pancreaticojejunostomy was (91 ± 20) min, and it was (63 ± 21) min in type Ⅱ procedure, and the difference was statistically significant (P ＜ 0. 05). The mortality and complications, postoperative hospital stay were 10.0%(2/20), 45.0% (9/20) and (20 ±2)d in type Ⅰ procedure, while they were 5.6% (1/18),38.9% (7/18) and(23 ±2)d in type Ⅱ procedure, and the difference was not statistically significant.Conclusions There was no significant difference in the effects between type Ⅰ and type Ⅱ bundled pancreaticojejunostomy. Carefully selective application of type Ⅰ and type Ⅱ bundled pancreaticojejunostomy helps complete these procedures.

Objective:To explore the influence of ulinastatin combined with thymosinα1 on the immune function of patients with a-cute brain injury. Methods:Sixty-eight cases of patients with acute brain injury were divided into the control group and the observation group randomly with thirty-four ones in each. The control group was given the routine treatment, and the observation group was given ulinastatin combined with thymosinα1 additionally. After the 1-day, 3-day, 7-day and 14-day treatment, transforming growth factor-β1 (TGF-β1), interleukin-6(IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and the other serum inflammatory cyto-kine levels, and CD4 +, CD8 +, CD4 + /CD8 +, HLA-DR and cellular immune index levels were detected in the two groups. The prog-nosis effects were evaluated by the prognostic classification of brain injury, and the adverse reactions were analyzed in the two groups as well. Results:After the 1-day treatment, there were no significant differences in the serum inflammatory cytokines and immune param-eters between the groups (P>0. 05). After the 3-day, 7-day and 14-day treatment, serum TGF-β1, IL-6, IL-10 and TNF- α levels were higher than those on the first day after the treatment, and TGF-β1 showed an increasing trend with time extension, while IL-6, IL-10, TNF-α and CD4 + and CD4 + /CD8 +rose first and then decreased. After the 3-day, 7-day and 14-day treatment, serum IL-10 and CD4 +levels in the observation group were significantly higher than those in the control group, and IL-6 and TNF-αlevels were signifi-cantly lower than those in the control group (P<0. 05). After the 3-day and 14-day treatment, CD4 + and CD8 + levels in the observa-tion were significantly higher than those in the control group, and after the 7-day and 14-day treatment, HLA-DR levels were signifi-cantly higher than those in the control group (P<0. 05). The prognosis effect of the observation group was better than that of the con-trol group with statistically significant difference (P<0. 05). Conclusion:Ulinastatin combined with thymosin α1 is used to treat the patients with acute brain injury with better cellular immune function improvement and prognosis effect, which is worthy of clinical popu-larization and application.

To design teaching course of problem-based learning (PBL) combined with case-based learning (CBL) for standardized training of clinicians based on clinical decision thinking mode (CDTM) of diagnosis and treatment process for primary liver cancer. The CDTM of treatment choice for primary liver cancer is multi-scheme selection model. The general decision rule includes decision condition, action plan and decision tree. For the theoretical study of clinical decision rules, it is suitable to design PBL teaching, but it is suitable to design CBL teaching course for clinical decision-making practice. The teaching course of PBL combined with CBL is conducive to improving the ability of clinicians' clinical decision thinking step by step.