Objective To explore and classify the subjective opinions of nurses on whistle- blowing, and identify the subjective characteristics of each type. Methods This study applied Q -methodology, protocols which could determinate subjective opinions of nurses on histle-blowing were set up and underwent interview investigation, data of the interviews went through Q-factor analysis. Results Most nurses had a positive attitude toward whistle - blowing because it could prevent any nursing activity not based on expertise and professional ethics from causing disadvantages for patients. At the same time, however, they requested the creation of a legal framework in which whistle-blowing was done in a way to increase trust among colleagues. Meanwhile, some nurses showed resistance to whistle - blowing. Conclusions Whether whistle - blowing can reach its aims depends on nurses' attitude toward it. Most Korean nurses support whistle-blowing. Nursing activity not based on expertise and professional ethics and causing disadvantages for patients can be avoided if a legal framework is established for whistle-blowing.

Objective To compare the effect of methotrexate combined with laparoscopic surgery on pregnancy outcome of patients with tubal pregnancy treated with conservative treatment.Methods 96 patients who were diagnosed of tubal pregnancy,fertility requirements and no clinical data given birth were analyzed retrospectively.Depending on the method of treatment was divided into 46 cases of methotrexate and laparoscopic group of 50 patients.Postoperative intrauterine pregnancy,ectopic pregnancy and secondary infertility situation again were compared.Results Laparoscopic group in intrauterine pregnancy rate was 70.0％,which was significantly higher than that in the methotrexate group(47.8％),and the difference was statistically significant(x2 =13.229,P ＜ 0.05) ;laparoscopic ectopic pregnancy rate was 14.0％ against 17.4％ with methotrexate group,the difference was not statistically significant(x2 =2.037,P ＞ 0.05) ; methotrexate group was 34.8％ of secondary infertility was significantly higher than thatin the laparoscopic group (16.0％),the difference was statistically significant (x2 =12.784,P ＜ 0.05).Conclusion Laparoscopic surgery after conservative treatment of tubal repregnancy outcome is better than methotrexate.

OBJECTIVE:To discuss the use of allopurinol for the reduction of serum uric acid level in patients with chronic kidney disease complicating hyperuricacidemia so as to delay the progression of chronic renal disease.METHODS:A total of 47 patients with chronic kidney disease complicating hyperuricacidemia were randomly divided into treatment group and control group:the treatment group was given allopurinol 100～200mg?d-1 in addition to the antihypertensive therapy as adopted in the control group or the common therapy for 12 months.RESULTS:As compared with the control group,serum creatinine level was lower and the rate of renal function deterioration was significantly decreased in the treatment group(P

Objective: Our purpose was to study the concentration of soluble tumor necrosis factor receptor-Ⅰ(sTNFR-Ⅰ) in the serum of patients with acute tuberculosis. Methods: The levels of soluble TNFR-Ⅰ in serum were measured in 11 patients with acute tuberculosis. Concentration of sTNFR-Ⅰ were measured by using enzyme-linked immunological binding assay. Results: In patients with acute tuberculosis, especially severe tuberculosis, serum levels of sTNFR-Ⅰ increased significantly (P<0.01), compared with those of control. After antituberculosis therapy, serum levels of sTNFR-Ⅰin patients with acute tuberculosis decreased by various degrees. Conclusion: Measurements of sTNFR-Ⅰ in serum of patients with acute tuberculosis could be an important index in the judgement of the outcome of the disease.

Objective To investigate the effects of preconditioning with emulsified isoflurane(eISO)on inflammatory response to myocardial ischemia-reperfusion(I/R)injury in rats.Methods Forty SD rats of both sexes weighing 250-280 g were randomly allocated into 4 groups(n =10 each):groupⅠ sham operation(S);group Ⅱ myocardial I/R + normal saline(NS); group Ⅲ I/R + eISO and group Ⅳ I/R + 30％ intralipid(Ⅱ.)(vehicle for eISO).Myocardial ischemia was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 180 min reperfusion.NS,30％ intralipid and elSO 2 ml/kg were infused iv over 30 min at 30 min before myocardial ischemia in groups Ⅱ,Ⅲ and Ⅳ respectively.The animals were killed at the end of 180 min repeffusion.Their hearts were removed for determination of infarct size and myocardial NF-κB p65 and ICAM-1 expression(by immuno-histochemistry)and plasma concentration of TNF-t(by radioimmunoassay).Results Myocardial I/R induced myocardial infarct and significantly increased plasina TNF-a concentration and myocardial ICAM-1 and NF-κB p65 expression in gro up Ⅱ,Ⅲ and Ⅳ as compared with'sham operation group (Ⅰ).Plasma TNF-a concentration and myocardial ICAM-1 and NF-kB p65 expression were significantly lower in group Ⅲ(eISO)than in group Ⅱ and Ⅳ.Conclusion Down-regulation of myocardial NF-kB and ICAM-1 expression and inhihition of inflammatoy response are involved in the mechanism by which preconditioning with iv elso protects against myocardial I/R injury.

Objective To characterize clinical features,antimicrobial susceptibility and the outcome of nosocomial Acinetobacter baumannii meningitis.Methods All patients with nosocomial meningitis due to Acinetobacter baumannii in 2nd Affiliated Hospital Medical School of Zhejiang University between January 2010 and October 2011 were retrospectively reviewed.Results During the study period,40 patients of this nosocomial infection were identified,who came from neurosurgery ward (19 cases,47.5％),neurosurgieal intensive care unit (18 cases,45.0％),emergency intensive care unit (2 cases,5.0％) or intensive care unit (1 case,2.5％).All the patients had a history of recent neurosurgical procedures. Fever and disturbance of consciousness were the major manifestations,and cerebrospinal fluid examination showed elevated white blood ceil count and protein,and reduced glucose.All isolated pathogens were resistant to the first line antibiotics.The fatality rate was high. Conclusions The most common risk factor for nosocomial Acinetobacter baumannii meningitis is neurosurgery. Resistance to the first line antibiotics is common among all pathogens isolated.The prognosis of the meningitis is poor.

Objective: The effect of whole body irradiation (WBI) on B7-1 and B7-2 express ion in peritoneal macrophages in mice was observed.Methods:Immunohistochemistry (ABC method) was used. Results: The upregulation of B7-2 expression induced by WBI X-rays appeared ea r lier than that of B7-1.The study on the dose-effect relationship showed that t he ex pression of both B7-1 and B7-2 reached its peak at 0.075 Gy after WBI X-rays. Th e doses inducing a second peak of B7-1 and B7-2 upregulation were higher in th e case of WBI in comparison with in vitro irradiation. Conclusion: The results suggested that the upregulation of expression of B7 mole cules after irradiation might be an important factor involved in the enhancing e ffect of low dose radiation on immunity.

Clinical studies show that the factors that impact the quality of life (QOL) in patients with lung cancer are comprehensive.Physiological factors include breathing difficulties,cancer-related fatigue.Depression,anxiety and other psychological factors also play a major role.Social and family support is also crucial to improve the QOL in patients with lung cancer.

Macrophage migration-inhibitory factor (MIF) is a cytokine which can promote tumorigenesis.MIF can promote tumorigenesis by directly inducing oncogene transformation,stimulating cell division,as well as indirectly inhibiting tumor apoptosis,promoting its invasiveness and angiogenesis.MIF-targeted biological therapy may become a new therapeutic strategy for malignant tumor.

[Summary] With the rapid development of economy ,obesity and type 2 diabetes (T2DM ) have become a serious social problem in China. Metabolic surgery was started to carry out in late 20th century in our country . Currently ,there were many deficiencies in the selection of operation indication ,surgical pattern and procedure ,prevention and treatment of complications ,perioperative management and postoperative follow‐up. Therefore ,to standardize nationwide surgical treatment of obesity and diabetes ,to reduce the incidence of postoperative complications ,Chinese Society for Metabolic & Bariatric Surgery (CSMBS) ,surgeon branch of Chinese Medical Doctor Association called domestic famous experts together to jointly draft a practical manual :Guide to Surgical Treatment of Obesity and Type 2 Diabetes in China (2014). With the spread of this guide ,the number of metabolic surgery increased significantly ,the procedure and management of surgery were further standardized.