Objective To evaluate the comprehensive experiment in fundamental nursing by using the indicator system and analyze the teaching effect.Methods 450 nursing graduates of grade 2011 were divided into 56 groups and comprehensive experiments were graded by using the indicator system in each group.Results The four indexes in level one scored (18.08±1.50),(19.99±2.31),(28.18±3.35),(18.16±1.73) points and accounted for 90％ 、80％ 、81％、91％ respectively.The total points' scorings and proportions were (84.41±5.84) points and 84％ respectively.Some deficiencies were found to be improved during evaluation.Conclusions Nursing comprehensive experiment evaluation indicator system can assess comprehensive experiments well,and the related competencies of nursing graduates need to be improved.

Objective To investigate the effects of echocardiography-guided pacemaker parameters optimization in order to enhance the efficacy of cardiac resynchronization therapy(CRT).Methods Seventeen patients with chronic heart failure received biventricular resynchronous pacing therapy.A-V delay and V-V delay was optimized under the guiding of spectral Doppler echocardiography and tissue Doppler imaging.Results The indices of heart function in all patients were significantly improved after the treatment.The NYHA class of the patients was improved from class Ⅲ～Ⅳ to class Ⅱ～Ⅲ.Since PAV/SAV was optimized to 130-180/100-150 ms,left ventricular filling time(LVFT) was increased from (354±147)ms to (420±112)ms,mitral reflux (MR) was decreased from (8.41±4.55)cm2 to (5.36±4.71)cm2.After VV delay was optimized to 4-40ms,standard deviation of time to regional peak systolic velocity (Ts-SD-12) was decreased from (48.4±17.9)ms to (30.2±18.6)ms,left ventricular outflow tract velocity time integral(VTI LVOT) was increased from (20.6±9.0)cm/s to (26.1±3.1)cm/s.Conclusions Echocardiography-guided optimization of the pacemaker parameters is necessary in order to enhance the efficacy of CRT.

Objective To evaluate the effect of curcumin on diabetic neuropathic pain (DNP) in rats. Methods Forty-eight male SD rats weighing 200-230 g were randomly divided into 6 groups ( n = 8 each) : group Ⅰ normal control (group C); group Ⅱ DNP (group D) ; group Ⅲ DNP+ DMSO (solvent of curcumin) (group DD) and group Ⅳ , Ⅴ , Ⅵ DNP + curcumin 50, 100 or 200 mg/kg ( group DC50, 100, 200 ). Diabetes was induced with intraperitoneal (IP) streptozocin 75 mg/kg in group Ⅱ -Ⅵ. Curcumin 50, 100 and 200 mg/kg were given IP once a day for 14 consecutive days starting from 14 d after streptozocin in group Ⅳ , Ⅴ and Ⅵ respectively. Venous blood samples were taken before and 72 h after IP streptosocin for determination of blood glucose level. Successful induction of diabetes was defined as blood glucose > 14.6 mmol/L. Mechanical paw withdrawal threshold to yon Frey stimuli (MWT) and paw withdrawal latency to thermal nociceptive stimulus (TWL) were measured 2 d before and 14 d after IP streptesocin and on the 1, 3, 7, 14 d of curcumin administration. Animals with pain threshold measured at 14 d after IP streptozocin decreasing by less than 15% of the baseline were excluded from the study. The animals were sacrificed after the last pain threshold measurement and the lumbar segment of the spinal cord and p65 was significantly higher in group D than in group C ( P < 0.05). Curcumin administration significantly reduced thermal and mechanical hyperalgesia induced by diabetes and down-regulated the expression of p-JNK and horn and DRG.

Objective To evaluate the impact of autoantibodies to angiotensin Ⅱ type 1 receptor AT1-AA on clinic outcomes of delayed graft function (DGF) grafts.Method We reviewed the records of all 139 consecutive adult recipients who received single kidney transplantation and clinical management between Jan.2010 and Dec.2012 in our centre.The serum levels of AT1-AA were measured by a streptavidin-enzyme-linked immunosorbent assay.All patients with DGF were enrolled in this study and divided into two groups:(1) AT+ DGF group (serum AT1-AA positive,11 cases) ;(2) AT-DGF group (serum AT1-AA negative,23 cases).All clinical and laboratory data were recorded in our transplant database system at each visit.Result 139 recipients were enrolled.The overall presence of DGF was 24.5％ (34/139).The incidence of DGF in patients with high binding AT1-AA was significantly higher than that in those with low binding of AT1-AA (11/24 vs.23/115,45.8％ vs.20.0％,P＜0.05).In addition,longer duration of renal replacement therapy (59 ± 32 vs.47 ± 26 months,P＜0.05),higher resistance index (0.80 ± 0.10 vs.0.72 ± 0.10,P＜0.05) of allografts and more severe acute tubular injury (2.7 ± 0.5 vs.1.8 ± 1.1,P＜0.05)/acute tubular necrosis (0.9 ± 0.5 vs.0.5 ± 0.3,P＜0.05) were observed in AT + DGF group than in AT-DGF group.One-year graft survival and death censored graft survival were similar between two groups (90.9％ vs.95.7％,P＞0.05).Conclusion Presence of high binding anti-AT1 receptor had detrimental impacts on initiation and development of DGF.

Objective Glycodelin-A is one of glycoproteins secreted from endometrial epithelial cells , and it plays an im-portant role in embryo implantation , inhibition of reject reaction and pregnancy maintenance .Glycodelin-A will become an important potential marker in evaluating the endometrial receptivity and predicting the pregnancy outcome .The aim of this study was to investigate the correlation of glycodelin-A detected on the day of HCG and endometrial receptivity and the effects of glycodelin -A on the pregnancy outcome in the intrauterine insemination (IUI) period. Methods One hundred and seven woman patients with bilateral unobstruct-ed tubes and without endometrial lesions , endometrial polyps or intrauterine adhesions from Oct 2012 to Feb 2014 in our hospital were recruited in this study .Serum glycodelin-A in women receiving IUI on the day of HCG was measured by ELISA .Serum estradiol (E2), progesterone (P), and corpus luteum (LH) levels were measured by immunochemiluminometric assays .The condition of the endometrium was examined by transvaginalultrasonography . Results The serum glycodelin-A level on the day of HCG was higher in pregnant group [(1.47 ±0.38)ng/mL] than that in nonpregnant group ([0.62 ±0.13]ng/mL).The serum glycodelin-A level on the day of HCG was higher in endometrial thickness ≥7 mm group ([1.53 ±0.49]ng/mL) than endometrial thickness <7 mm group ([0.51 ±0.17]ng/mL). Conclusion The serum glycodelin-A level on the day of HCG may reflect endometrial receptivity to a cer-tain extent , which might have prognosis value for pregnancy following IUI .

Objective To investigate the clinical value of KL-6 mucin in differential diagnosis of benign and malignant obstructive jaundice.Methods A total of 41 patients with malignant tumors and 15 with benign lesions were recruited in the study.KL-6 mucin levels of bile and serum were measured using enzyme-linked immunosorbent assay (ELISA).The serum alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were also measured using radioimmunoassay (RIA).All data were analyzed by Mann-Whitney U test and Receiver Operating Characteristics (ROC)curves.Results CEA,CA19-9,and KL-6 mucin in serum and KL-6 mucin in bile in patients with malignant tumors were significantly higher than those in patients with benign lesions (P ＜ 0.001).There were no significant differences in serum AFP between the two groups.An receiver operating characteristic (ROC)curves analysis revealed that the detection of KL-6 mucin in bile was reasonably accurate in differentiating malignant obstructive jaundice from benign (area under curve [AUC] 0.954).While the AUC of the ROC curves for serum AFP,CEA,CA19-9,KL-6 mucin and KL-6 in bile and 0.954 were 0.657,0.753,0.894,0.846 and 0.954 respectively.Using the ideal threshold as the cut-off point,the sensitivity and specificity of KL-6 mucin for differential diagnosis of benign and malignant obstructive jaundice was 90.24％and 93.33％.Conclusion As a tumor marker,KL-6 mucin in bile is valuable in differential diagnosis of benign and malignant obstructive jaundice.

OBJECTIVETo study diffuse alveolar hemorrhage (DAH) in patients with hematologic malignancies after chemotherapy and discuss the possible etiology and appropriate therapy.

METHODSSymptoms, physical examinations, laboratory examination, chest radiographs or computed tomographic (CT) scans, treatments and outcomes of two patients with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL) each after chemotherapy were presented.

RESULTSBoth of the patients developed cough, progressive dyspnea, a drop of hemoglobin level, hypoxemia and widespread pulmonary infiltrate on chest radiographs or CT scans after chemotherapy. Moreover, case 1 (ALL) had high fever and bloody fluid drained from the intubation of mechanical ventilation, case 2 (NHL) developed continual hemoptysis. They were diagnosed as DAH and improved significantly after intermediate- or high-dose corticosteroid therapy.

CONCLUSIONSDAH is a rare fatal acute noninfectious pulmonary complication in patients with hematologic malignancies after chemotherapy. Early accurate diagnosis, identifying the underlying cause and appropriate treatment are critical for the management of DAH.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Female ; Hemorrhage ; drug therapy ; etiology ; Humans ; Lymphoma, Non-Hodgkin ; drug therapy ; Male ; Methylprednisolone ; therapeutic use ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Pulmonary Alveoli

OBJECTIVETo analyze the prognostic factors in elderly patients with acute myeloid leukemia (AML).

METHODSThe clinical data of 211 AML patients with age 55 years or over and treated in Shanghai Jiaotong University Medical School affiliated Ruijin Hospital from 2007 to 2011 were collected and analyzed. Multivariate and univariate analysis of clinical data were performed using a Cox regression model and log-rank test, including age, subtype, performance status, white blood cell count, serum LDH and albumin level, and treatment strategy.

RESULTSAcute promyelocytic leukemia (APL) patients had longer survival than other subtypes. To rule out the impact of APL on the prognostic analysis, we conducted multivariate and univariate analysis excluding APL patients. The significant parameters of the univariate analysis were age (P = 0.003), achieving remission (P < 0.01), performance status (P < 0.01), organ dysfunction (P < 0.01), increased WBC counts (P = 0.022), increased LDH level (P = 0.006) and low albumin level (P < 0.01). Multivariate analysis showed that only failure of achieving remission (P < 0.01), poor performance status (ECOG 3-4) (P < 0.01) and increased WBC counts (P < 0.01) were independent prognostic factors. The patients aged 70 years or over had poor overall survival, and no significant difference of OS was observed among patients with age between 55 and 69 years. For patients aged 55 - 69 years received either DA/IA or CAG treatments had longer survival than those with palliative treatments. For those aged 70 years or over, only patients with CAG treatment had significantly longer survival than palliative treatment. For the patients with age less than 70 years and achieving complete remission after induction, intermediate-dose cytarabine consolidation might not improve survival.

CONCLUSIONElderly AML patients should be treated individually. The intermediate-dose cytarabine consolidation might not improve survival of elderly AML patients.

Aged ; Aged, 80 and over ; Female ; Humans ; Leukemia, Myeloid, Acute ; diagnosis ; drug therapy ; Male ; Middle Aged ; Survival Rate

According to the principle of evidence-based medicine (EBM), Chinese medical literatures based descriptive statistical analysis of common Chinese medical syndrome types were performed. By data extraction, standardization, and frequency calculation of disease names and syndrome types from 286 literatures in line with the inclusion criteria, the frequencies of diseases and syndromes were obtained to analyze common syndrome types in clinical practice, to analyze the distribution features of disease related syndromes and syndrome related diseases, to analyze the distribution of basic Chinese medical syndrome types in clinical common diseases as a whole, thus providing reference for clinical and basic researches.
Evidence-Based Medicine ; Humans ; Medicine, Chinese Traditional

OBJECTIVETo investigate the molecular basis for a novel human leukocyte antigen (HLA) allele B*5827.

METHODSDNA from the proband was analyzed by polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO) typing. The amplified product was sequenced bidirectionally.

RESULTSAbnormal HLA-B locus was observed and its nucleotide sequence was different from the known HLA-B allele sequences, with highest homology to HLA-B*5820 allele. It differs from HLA-B*5820 by 8 nucleotide substitutions in exon 3, i.e., nt 290 (G > C), nt 346 (T > A), nt 390 (A > C), nt 404 (G > C), nt 413 (C > G), nt 471 (A > G), nt 486 (A > G) and nt 487 (C > A), resulting in an amino acid change from ser > arg at nt 97, phe >tyr at nt 115, ser > arg at nt 130, thr > ala at nt 157 and thr > glu at nt 162. Nucleotide differences of nt 404 (G > C) and nt 413( C > G) did not change amino acid.

CONCLUSIONThe sequences of the novel allele have been submitted to GenBank (access No.GU071234). A novel HLA class I allele B*5827 has been officially assigned by the WHO HLA Nomenclature Committee in Jan. 2010.

Alleles ; Base Sequence ; Cloning, Molecular ; Genotype ; HLA-B Antigens ; chemistry ; genetics ; Humans ; Molecular Sequence Data ; Polymerase Chain Reaction ; Sequence Analysis, DNA