Objective To understand the status quo of continuing medical education in different levels of hospitals in primary health technical personnel,and provide suggestions for the development of continuing medical education.Methods Questionnaire survey,Statistical analysis and Interview.Results Health technical personne of medical institutions at all levels in primary health technical personnel were generally more emphasis on continuing medical education,but the management system,input and the need are different in the different levels of hospital.Continuing medical education in the basic level hospitals is much lower than the high level hospitals.Conclusions We should strengthen the transformation of continuing education mode,put forward the practical development strategy,improve the level of medical education,and narrow the gap between different levels of hospitals,so as to achieve the purpose of common progress.

Objective To study the expressions and prognostic significance of high mobility group protein A1 (HMGA1) and high mobility group protein A.2 (HMGA2) in pancreatic carcinoma.Methods The expressions of HMGA1 and HMGA2 were examined by immunohistochemical SP method in 60 cases of pancreatic carcinoma and 30 cases of normal pancreatic tissues.The relationship between the expression and prognosis was also analyzed.Results The expressions of HMGA1 and HMGA2 in pancreatic carcinoma were significantly higher than those in normal tissues,and the positive expression rates were 70.0％ vs.6.7％ (x2 =32.105,P =0.000) and 73.3％ vs.3.3％ (x2 =39.200,P =0.000).The expression of HMGA1 in pancreatic carcinoma was correlated with histological grade (x2 =6.774,P =0.034),TNM stage (x2 =4.776,P =0.029) and lymphatic metastasis (x2 =12.614,P =0.000).The expression of HMGA2 in pancreatic carcinoma was correlated with histological grade (x2 =8.200,P =0.017) and TNM stage (x2 =7.253,P =0.007).The expression of HMGA1 was positively associated with HMGA2 expression (r =0.393,P =0.001).Kaplan-Meier analysis showed that the median survival time of HMGA1 and HMGA2 positive patients were shorter than those patients with HMGA1 negative and HMGA2 negative (14.0 months vs.24.0 months,x2 =14.568,P =0.000;15.0 months vs.21.0 months,x2 =7.270,P =0.007).Conclusion HMGA1 and HMGA2 are highly expressed in pancreatic carcinoma,and play synergistic roles in the generation and progress of pancreatic carcinoma.There is certain value of combined detection of HMGA1 and HMGA2 to predict the prognosis of pancreatic carcinoma.

Objective To explore the construction and application effects of extended care form for children with epilepsy based on Omaha System.Methods Based on Omaha System,the form was established by referring medical records,literature review and three rounds of focus group discussion.From February to June,2016,48 children with epilepsy were selected as the observation group and received routine care as well as management using the form based on Omaha System;from August to December,2015,48 children with epilepsy were selected as the control group and received routine care and follow-up.The effects of intervention and scores of Family Management Measure were compared between two groups.Results Nursing issues in all domains for the observation group 3 months after intervention were lower than those during hospitalization except financial situation (P＜0.05);there was statistically significant difference in scores of knowledge-behavior-status of main nursing issues before and after intervention except cognition and mental health items (P＜0.05).Duration of hospitalization,expenditure,readmission rate,EEG results and scores of FAMM in the observation group were better than those in the control group (P＜0.05).Conclusion The construction and application of the form based on Omaha System can provide references for longterm management for children.

Objective To analyze the prognostic factors for patients with hepatic encephalopathy (HE) in acute-on-chronic liver failure(ACLF).Methods A retrospective analysis was performed on 159 ACLF patients with HE.The hepatic encephalopathy was determined to baseline,the patients were divided into survivors(n =13) and nonsurvivors(n =146),The 32 factors affecting the prognosis were analyzed by Cox proportional hazard model with SPSS.Results One-month,three-month,and six-month survival rates were 20.13％,10.06％ and 8.18％,respectively.Cox regression analysis of prognostic factors showed that it could the stage of hepatic encephalopathy and HRS significantly improve the survival rate of the patients with HE in acute-on-chronic liver failure.The stage of hepatic encephalopathy and HRS could significantly decrease the survival rate of the patients(x2 =18.344,11.368,all P ＜ 0.05),elevated the levels of hepatic encephalopathy (relative risk (RR) =1.591) and HRS (RR =1.809) indicate worse prognosis with hepatic encephalopathy in acute-on-chronic failure.Conclusion The stage of hepatic encephalopathy and HRS were independent risk factor sof prognosis in acute-on-chronic liver failure.

Opioids can activate the pro-nociceptive channel by which the sensitivity to pain has been increased, which is called opioids induced hyperalgesia (OIH). The mechanism of OIH has not been identified, but it is possibly involved in the increased activity of central glutamatergic system, changed function of opioid receptors, roles of peripheral receptors, effects of endogenous neuropeptides, decreased function of inhibitory neurotransmission system, and changed elements in signal transduction pathway, etc.

Objective To determine the levels of insulin-like growth factor binding protein-2 (IGFBP-2) in glioma tumor tissue and their clinical significance. Methods The levels of IGFBP-2 in glioma samples from 45 patients were detected with immunohistochemistry. Their correlation with tumor grade, p53 and Ki67 expression levels and the outcome of patients were tested. Results IGFBP-2 increased in glioma tissue in a grade-dependent manner, and significantly correlated with p53 and Ki67 expression. High IGFBP-2 level is significantly associated with earlier tumor recurrence and shorter overall survival. Conclusion Tumor IGFBP-2 levels can supply more prognostic information to the tumor grading system.

Objective To observe the effect of kindred-like nursing on coma after severe craniocerebral trauma. Methods 48 cases of sereve craniocerebral trauma were divided into two groups: the control group (n=24) who accepted routine nursing, and the observation group (n=24) who accepted the kindred-like nursing in addition. Results More patients revived in the observation group than in the control group (P<0.05) 14 and 28 d after admission. Conclusion Kindred-like nursing can facilitate the reviving from coma after severe craniocerebral trauma.

OBJECTIVE: To investigate the protective effect of celastrol on allergic rhinitis rats and its possible mechanism. METHOD: Allergic rhinitis (AR) model of rats was established by OVA. The behavioural characteris tics were observed at the 1st, 4th and 7th dayafter stimulation treatment. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione (GSH) and glutathione peroxidase (GSH-PX) in the nasal mucosa breathing zone were measured. The expression of the nuclear factor erythroid 2 related factor 2 (NRF2) nuclear protein and the catalytic submit of glutamylcysteine ligase (GCLC) cytoplasmic protein in the nasal mucosa breath ing zone were determined. RESULT: We observed obvious behaviour changes related with allergic rhinitis in AR rats, together with decrease of SOD, GSH and GSH-PX and increase of MDA in the nasal mucosa breathing zone. Moreover, NRF2 nuclear protein expression and GCLC cytoplasmic expression were suppressed in the nasal mucosa. The changes above were alleviated in celastrol pretreatment group. The potential mechanism may be related to the upregulation of NRF2 nuclear protein expression and GCLC cytoplasmic expression after celastrol pretreatment. CONCLUSION Celastrol can significantly relieve the allergic symptoms in AR rats. The mechanism of this protective effects may relate to the upregulation of NRF2 nuclear protein expression and GCLC cytoplasmic expression in the nasal mucosa breathing zone.
Animals ; Disease Models, Animal ; Glutamate-Cysteine Ligase ; metabolism ; Male ; NF-E2-Related Factor 2 ; metabolism ; Nasal Mucosa ; metabolism ; Rats ; Rats, Sprague-Dawley ; Rhinitis, Allergic ; drug therapy ; Triterpenes ; therapeutic use

Objective To investigate the main predisposing factors of hematoma enlargement in spontaneous intracerebral hemorrhage,reduce the early mortality,and improve clinical outcomes.Methods By a retrospective study of 268 patients,all patients underwent their first computed tomography (CT)scan within 24 hours of arrival and a second CT scan within 72 hours of admission.These predisposing factors were analyzed by means of univariate and multivariate logistic regression analyses.Results The patients occurred early hematoma enlargement were accounted for 27.99％ (75/268).Univariate analyses indicated that hematoma shape,midline shift,breaking into the ventricle,thrombin clotting time (TT),white blood cells,neutrophil percentage,serum creatinine,fasting plasma glucose (FPG),and Glasgow coma scale (GCS) were significantly different between the patients with or without hematoma enlargement (P ＜0.05).Furthermore,multivariate logistic regression analyses revealed that the following four factors were independently associated with hematoma enlargement:the midline shift [OR (95％ CI) =3.356 (1.251-8.999),P =0.000],the GCS score [OR (95 ％ CI) =0.745 (0.671-0.827),P =0.023],the FPG [OR (95％ CI) =3.022 (1.232-7.408),P =0.016],and the breaking into the ventricles [OR (95％ CI) =2.851(1.158-7.019),P =0.005].Conclusions The midline shift of brain CT scan,the GCS score,the FPG,and the breaking into the ventricles maybe the independent predisposing factors of hematoma enlargement.Therefore,timely review of CT scan and dynamic monitoring of peripheral blood biochemical indicators should be very important for further therapy.

Objective To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) with flexible bone cement injector through unilateral puncture. Method Unilateral puncture line PVP treatment for thoracolumbar vertebral compression fracture was conducted in 78 patients, which was divided into observation group and control group according to the use of different equipment. The flexible bone cement injector was used in 36 cases of observation group, which injected the bone cement into three places at the vertebral body. The ordinary straight bone cement injector was applied in the 42 cases of the control group. The operation time, the time of radiation exposure, and the amount of bone cement injection were recorded, and the leakage of bone cement was observed. The visual analogue scale (VAS), relative vertebral height and Cobb angle were recorded at 1 week, 1 and 2 years follow-up. The time of operation, the time of radiation exposure, the amount of bone cement injection, the incidence of bone cement leakage, VAS, relative height of vertebral body and Cobb angle were compared between the two groups using independent samples t test orχ2 test. Result All patients in the two groups were successfully treated by surgery. There were no significant differences between the observation group and the control group in the operation time and the time of radiation exposure and the incidence of bone cement leakage (P>0.05). The injection amounts of bone cement in the observation group and the control group were (5.6 ± 0.7) and (3.2 ± 0.6) ml, with statistically significant difference (P<0.05). There were no significant differences in VAS score, relative vertebral height and Cobb angle between the two groups at 1 week after operation (P>0.05). At 1 year and 2 years after operation, the differences of the above indexes between the two groups were significantly different (P<0.05), with the observation group being superior to the control group. Conclusions Application of flexible bone cement injector for PVP operation is safe and feasible. Compared with the traditional straight bone cement injector, the use of flexible bone cement injector will not increase the operation time, radiation exposure time and the incidence of bone cement leakage but will improve the long-term effect.