Objective To investigate the coping style and influencing factors of the recipients after relative kidney transplantation. Methods Medical coping modes questionnaire (MCMQ) and observa-tion interview were performed in the sampling survey, 56 case of recipients after relative kidney transplanta-tion according to the adopted standard were analyzed. Results The confronting score of all the cases were close to that of normal model, but the avoiding score and yielding score significantly increased. The prospective health conditions of the relative donors, function and survival time of the graft kidney, rejection reaction and other complication after transplantation were the main factors affecting the coping style of the recipients. Conclusions Based on the accurate evaluation of the coping style, nursing intervention should be aimed at the recipients following relative riving donor kidney transplantation, in order to help the recipients create a correct coping style and improve the survival rate of patient/kidney.

Objective To investigate the effect of dexmedetomidine pretreatment on the expression of caspase-12 in lung tissues undergoing one-lung ventilation (OLV) in rats.Methods Thirty male Sprague-Dawley rats, aged 6-8 weeks, weighing 180-220 g, were randomly allocated into 3 groups (n=10 each) using a random number table: two-lung ventilation (TLV) group, OLV group and dexmedetomidine group (Dex group).Bilateral lungs were ventilated for 2 h in group TLV.In OLV and Dex groups, unilateral lung was ventilated for 1.5 h followed by 0.5 h TLV.In group Dex, dexmedetomidine was infused intravenously at a rate of 3.0 μ g · kg-1 · h-1 over 60 min starting from 60 min prior to OLV.The equal volume of normal saline was given instead of dexmedetomidine in OLV and TLV groups.Peak airway pressure (Ppeak) and mean airway pressure (Paw) were recorded at 45 min of OLV and 15 min of TLV in OLV and Dex groups, and at 15 min of TLV in group TLV.The rats were then sacrificed, and left lungs were removed for microscopic examination of the pathologic changes (using HE staining) and the ultrastructure of lung tissues (with transmission electron microscope) and for determination of wet to dry lung weight ratio (W/D ratio), cell apoptosis in lung tissues (by TUNEL), caspase-12 mRNA expression (using real-time reverse transcriptase-polymerase chain reaction), and caspase-12 expression (by Western blot).Results Ppeak and Paw were significantly lower at 15 min of TLV than at 45 min of OLV in OLV and Dex groups (P＜0.05).Compared to group TLV, W/D ratio and AI were significantly increased, and the expression of caspase-12 protein and mRNA was up-regulated in OLV and Dex groups (P＜0.01).Compared to group OLV, W/D ratio and AI were significantly decreased, and the expression of caspase-12 protein and mRNA was down-regulated in group Dex (P ＜ 0.01).The pathologic changes of lung tissues were significantly alleviated in group Dex as compared with group OLV.Conclusion The mechanism by which dexmedetomidine pretreatment alleviates acute lung injury caused by OLV is associated with down-regulated expression of caspase-12 and inhibited cell apoptosis in rats.

Objective To evaluate the surgical indications and treatment of spontaneous cerebellar hemor-rhage.Methods The clinical data and surgical methods of 46 patients with spontaneous cerebellar hemorrhage were retrospectively analyzed.Results Follow up 6 months,4 cases were dead.Outcomes were assessed by the ADL:17 cases wereⅠ,10 cases were Ⅱ,9 cases were Ⅲ,4 cases were Ⅳ,2 cases were Ⅴ.Conclusion The surgical way should be selected according to degree of patients,conditions severity and CT imaging of hemorrhage in the patients with spontaneous cerebellar hemorrhage.The curative of timely proper surgery on the patients with spontaneous cerebellar hemorrhages is good.

In this paper,we analyzed the current status of objective structured clinical exam-ination (OSCE) in the assessment of the domestic medical students, the results achieved and the problems encountered. Meanwhile,we proposed that we can optimize the station,unify SP selection and training and improve the evaluation content and subject in order to enhance the operating effect of OSCE.

Objective To explore the clinical and echocardiographic characteristics of primary malignant pericardial mesothelioma (PPM).Methods Cases of PPM with description of echocardiographic presentations from China mainland were searched from database during 1981 to 2015.Data about the clinical and echocardiographic features of the patients were collected.Results A total of 122 patients were included for analysis.It involved mainly middle-aged [(39.9 ± 14.7)years] and male patients (79,64.8％).The most common echocardiographic demonstration was pericardial effusion (74.6％) with were mostly bloody (97.7％),followed by pericardial masses (36.9％) and pericardial thickening (18.0％).The echocardiographic diagnostic accordance rate was about 26.2％.Conclusions The most common presentation of PPM on echocardiogram is massive pericardial effusion.Echocardiography is of great value in screening and assessment of PPM.The definitive diagnosis is made by histopathological examination.

Objective To evaluate the blood-saving effect of prophylactic tranexamic acid (TXA) use in the patients undergoing cervical spine surgery.Methods A total of 100 patients of both sexes,aged 55-75 yr,with body mass index of 19.0-25.0 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective cervical laminectomy and instrumentation,were divided into TXA group and normal saline group (group NS) using a random number table,with 50 patients in each group.TXA 15 mg/kg was intravenously injected at 30 min before skin incision in group TXA,and the equal volume of normal saline was given instead in group NS.Hemoglobin was measured before operation and on postoperative days 1,3 and 5.The intraoperative,postoperative,total blood loss,hidden blood loss and requirement for blood (allogeneic and autologous blood) transfusion were recorded.The development of complications such as epidural hematoma,deep vein thrombosis and pulmonary embolism was also recorded.Results Compared with group NS,the postoperative blood loss,total blood loss and blood transfusion rate were significantly decreased,the postoperative hemoglobin was increased (P＜0.05),and no significant change was found in the intraoperative blood loos or hidden blood loss in group TXA (P＞0.05).No patients developed complications such as epidural hematoma,deep vein thrombosis or pulmonary embolism in the two groups.Conclusion Prophylactic TXA use produces blood-saving effect to some extent in the patients undergoing cervical spine surgery.

Objective To explore the reasons for rebleeding and its coping strategies.Methods To study the 19 hypertensive intracerebral hemorrhage patients'medical records who suffered postoperative rebleeding in our department from June 2011 to May 2015.Results Rebleeding time:within 6 hours:11 cases,6 ~24 hours:5 cases, 2 ~3 weeks:3 cases.Among 19 cases,hematoma puncture drainage in 2 cases,small bone window craniotomy surgery in 9 cases,craniotomy with big bone flap decompression in 8 cases,6 cases with severely disabled and 7 cases died. Conclusion Intraoperative bleeding operation is not standardized,early postoperative blood pressure control failure in patients,preoperative instability function are the main causes of postoperative bleeding.Choosing a better operating time,the specification intraoperative hemostasis and controlling blood pressure to stable after surgery can reduce the membership of hypertensive intracerebral hemorrhage incidence of postoperative bleeding.

AIM:To observe the Toll-like receptor 9 (TLR9) activation in microglia BV-2 cells after oxygen-glucose deprivation and reoxygenation ( OGDR) , and its effects on neuronal apoptosis.METHODS:The BV-2 cell super-natants were collected after the corresponding treatment and added to mouse primary cortical neurons after OGDR for 4 h, followed by normal culture for 24 h.The cells were divided into normal BV-2 group, NC-siRNA group, TLR9-siRNA group, OGDR group, OGDR+NC-siRNA group, OGDR+TLR9-siRNA group and control group (without adding BV-2 cell supernatant) .The changes of the neuronal morphology were observed under an inverted phase-contrast microscope, and the neuronal apoptosis was detected by TUNEL.The protein expression of cleaved caspase-3 was detected by Western blot-ting.RESULTS:After OGDR, the axon turned thin, twisted and broken, and neuronal swelling, decrease in refraction and vacuolar degeneration were observed.The green-stained apoptotic bodies in the neurons in all groups were positive. Compared with control group, the caspase-3 protein levels in other groups were increased.Compared with the normal BV-2 group, the caspase-3 protein in OGDR group and TLR9-siRNA group was increased.Compared with OGDR+TLR9-siRNA group, the caspase-3 protein in TLR9-siRNA group and OGDR group was decreased.CONCLUSION: After OGDR, TLR9 activation in BV-2 cells induces neuronal apoptosis with the increase in caspase-3 protein level.Inhibition of TLR9 expression reduces neuronal damage.

OBJECTIVE:To investigate the influential factors of adverse drug reaction(ADR)in elderly patients during medi-cation,and to provide reference for reducing the incidence of ADR in geriatrics department. METHODS:The clinical data of elder-ly patients admitted to our hospital from Jan. 2011 to Dec. 2015 were collected and analyzed by single factor and unconditional Loigstic multiple regression analysis. The risk influential factors of ADR were investigated. RESULTS:A total of 1 680 patients re-ceived drug therapy,and the incidence of ADR was 7.92%(133/1 680). Organs/systems involved in ADR were mainly allergic re-action(49 cases,36.84%)and digestive system(48 cases,36.09%). The results of single factor analysis showed that the age of patients,drug dosage,route of administration,treatment course,the type numbers of drug combination and others were the inde-pendent influential factors of ADR. By unconditional Loigstic multiple regression analysis,it was found that the risk of ADR in-creased with the drug dosage,treatment course,intraverous administration and various drugs use,etc. CONCLUSIONS:It is nec-essary to pay attention to ADR monitoring,particularly risk factors monitoring of ADR in the elderly patients,strengthen medica-tion guidance to improve medication compliance,take the necessary preventive measures to reduce the incidence of ADR.

Objective To study the diagnosis and treatment of omental torsion.Methods 73 patients with omental torsion from Jan 1995 to Dec 2009 in literatures together with the one we reported were reviewed and analyzed The range of ages was from 3 to 65 years,and the median age was 25.3 years.Among them,35 cases were less than 18 years old(47%,and 27 with obesity) and others more than 18 years old(53%,1 with obesity).The accurate diagnosis before operation exsited in 9 patients.49 patients(66%) were diagnosed as primary omental torsion,and childhood obesity was the most related factor.Conversely,25(34%) were diagnosed as secondary omental torsion,while the most common reason was adhersion.In contrast with other clinical symotoms and signs,abdominal pain and tenderness were occurred in almost every people.Bultro sonography(positive rate:24%,6/25) was hardly useful in diagnosis but CT (positive rate:96%,23/24) and MRI(positive rate:100%,2/2) were beniticial.Operation was applied in all patients,while laparoscopy was uesed in 23 patients.As a rule,the appendix was removed together in 61 persons.The cobort of patients was recoverd fully without serious complications such as hemorrhage and intestinal infarction.Conclusion Omental torsion was a relatively rare disease,and the diagnosis should be easy with the help of CT and MRI,and the laparoscopy was the better choice for surgeons.