Objective To study the effects of sucking sputum with face upwards and neck raised in order to supply a new method for sputmn sucking.Methods One hundred and twenty-three patients were randomly divided into the experimental group(n=61)and the control group(n-62).The experimental group adopted modified mode:cleaned up the sputum within the mouth and nasal cavities with the traditional manner firstly,then the patients lay down,the nurses raised the patients'neck softly with one hand,removing the pillows,while putting the hypothenar of the other one on his forehead,kept the airway open to suck sputum.The control group adopted common mode,but using the modified method when the common mode failed.Results There was significant difference in phlegm sucking effect between the two groups(P＜0.01).Besides,the first-time success rate d tube insertion,incidence of trachcotomy,mucosal injury and hemorrhage and satisfaction degree of patients'family were statistically different between the two groups(P＜0.01).Conclusion Sucking sputum with face upwards and neck raised waS superior to the traditional one.

Objective To investigate protective of umbilical cord-mesenchymal stem cells ( UC-MSC ) on idiopathic pulmonary fibrosis ( IPF ) experimental mode was induced by bleomycin in mice .Methods IPF experimental mode induced by bleomycin with intratracheal injection , and then the fourth generation UC-MSC was injected in caudal vein.The lung tissues were obtained to evaluate the influence of UC-MSC on IPF by the observation of histological evaluation(HE) and Masson staining, the detection content of hydroxyprine(HYP), superoxyde dismutase(SOD) and malonaldehyde ( MDA) .Results The HE and Masson staining showed that bleomycin +UC-MSC group could alleviate inflammatory cell infiltration and pulmonary interstitial collagen deposition.bleomycin+UC-MSC group could decline the content of HYP(P<0.01), MDA(P<0.05) and improve the content of SOD(P<0.01)compared with bleomycin group.Conclusion UC-MSC exhibits an protective effect on IPF experimental mode induced by bleomycin in mice.

Objective To explore the role of astrocytes transient receptor potential channel 6(TRPC6) in rat brain injury (TBI).Methods Thirty-nine male Sprague-Dawley(SD) rats were divided into the sham operation group,injury group and deferoxamine(DFX) group(n=13).According to the previous model construction scheme established by our research group Feeney method,the rat brain impact injury model was established.The Morris water maze test was performed and the defected brain volume was measured.The immunofluorescence was adopted to detect the co-expression of TRPC6 and GFAP.Then Western blot was performed.Results The defected brain volume after TBI in the DFX group was significantly decreased compared with the injury group [(115.35 ± 13.70)mm3 vs.(209.99 ± 16.70)mm3]] (P＜0.05).The Morris water maze test found that the platform search strategy and search time in the DFX group were(3.13 ± 0.35) and(36.15 ± 26.63)s,which were significantly improve d compared with (2.13±0.64) and(110±47.34)s in the injury group(P＜0.05).The immunofluorescence found that GFAP in the DFX group was highly expressed,moreover the co-expression with TRPC6 was increased.Western blot found that TRPC6 in the DFX group was significantly down-regulated(P＜0.01).Conclusion In rat TBI early stage,strocytes are activated after DFX treatment and TRPC6 is highly expressed,playing a neuroprotective role.

Objective To discuss the practice of nursing management model of stroke unit based upon the international standards implemented in the neurological unit.Methods The experiences of the stroke unit management were summarized and applied to instruct the clinical practice.Results After the implementation,the average hospitalization days,the proportion of drugs,medical cost,and mortality rate decreased.The satisfactory degree of patients with the stroke unit increased.Conclusions The nursing management model of stroke unit not only improved the quality of nursing service to stroke patients,but also decreases the mortality and disability rate,shortened the length of hospital stay,and enhanced the satisfaction degree of patients and their family members.

Objective To investigate the prevalence, molecular mechanism and genetic characteristics of azithromycin-resistant Neisseria gonorrhoeae (N.gonorrhoeae) strains isolated in Shenzhen.Methods N.gonorrhoeae strains were collected in Shenzhen from 2011 to 2015.Agar dilution method and E-test were used to detect the minimum inhibitory concentrations (MIC) of these strains to azithromycin.All azithromycin-resistant (AZM-R) strains (MIC≥2 μg/ml) and some azithromycin-sensitive strains (MIC≤0.25 μg/ml) which were randomly selected as the control group were screened for mutations in 23S rRNA, mtrR and erm genes and genotyped by using N.gonorrhoeae multi-antigen sequence typing (NG-MAST).Results A total of 788 N.gonorrhoeae strains were collected, 148 (18.8%) of which were AZM-R strains (MIC≥1 μg/ml).Eighteen out of 21 high-level AZM-R (AZM-HLR) strains had A2143G mutations in the four copies of the 23S rRNA gene.Twelve out of 29 middle-level AZM-R (AZ-MLR) strains had missense mutations, among which C2611T mutations in the four copies of the 23S rRNA were detected in 10 strains.Incidence of G45D/Y105H mutation in AZM-HLR strains was higher than that in AZM-MLR (χ2=12.702, P=0.000) or AZ-S (χ2=4.462, P=0.035) strains according to the analysis of the promoter and coding region of mtrR gene.PCR analysis revealed that only one strain carried ermB gene (MIC=2 μg/ml).The 788 N.gonorrhoeae strains were typed into 81 sequence types (STs) by NG-MAST, most of which were represented by one strain only.STs of ST3356 and ST1866 that were identified in the AZ-R strains in the current study had been noted in a previous report of emerging AZM-R N.gonorrhoeae strains in Nanjing, Chongqing and Guangzhou.Neighbor-joining (NJ) phylogenetic tree showed that the resistant strains did not form a separate cluster.Conclusion Currently, it is not suitable to use azithromycin as a monotherapy for gonorrhea in Shenzhen.Mutations of A2059G and C2611T in 23S rRNA of N.gonorrhoeae were respectively responsible for high-level and middle-level resistance to azithromycin.Repeated emergence of ST1866 and ST3356 will help us monitor and analyze the epidemiological characteristics of N.gonorrhoeae strains resistant to azithromycin in Shenzhen.

Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB)is a commonly seen gastrointestinal emergency.Rockall and Blatchford scoring system are commonly used for risk stratification in ANVUGIB.Aims:To investigate the predictive values of Rockall and Blatchford scoring system for assessing the risk of blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Methods:Five hundred and ninety hospitalized patients with ANVUGIB were scored by Rockall and Blatchford scoring system,respectively.Predictive values of these two scoring systems for assessing the risk of blood transfusion,surgical intervention and mortality were assessed by area under the receiver operating characteristic (ROC)curve (AUC).Results:Rockall and Blatchford scores in patients with blood transfusion,surgical intervention and died were significantly higher than those in patients without blood transfusion,surgical intervention and survived (P <0.01 ).The AUC of Rockall scoring system for predicting blood transfusion,surgical intervention and mortality were 0.785 (95% CI:0.743-0.828,P=0.000),0.765 (95% CI:0.693-0.837,P=0.000),0.835 (95% CI:0.703-0.966,P=0.005),respectively.The AUC of Blatchford scoring system for predicting blood transfusion,surgical intervention and mortality were 0.812 (95%CI:0.775-0.848,P=0.000),0.870 (95%CI:0.811-0.930,P=0.000),0.784 (95% CI:0.614-0.954,P=0.017),respectively.Conclusions:Rockall and Blatchford scoring system have high predictive value for blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Rockall scoring system is better for predicting mortality,while Blatchford scoring system is better for predicting blood transfusion and surgical intervention.

Objective On basis of physical dose optimization, LQ model was used to investigate the difference between the curves of biological effective dose and physical isodose. The influence of applying the biological dose concept on three dimensional conformal radiotherapy of prostate carcinoma was discussed. Methods Four treatment plannings were designed for physical dose optimization: three fields, four-box fields, five fields and six fields. Target dose uniformity and protection of the critical tissue -rectum were used as the principal standard for designing the treatment planning. Biological effective dose (BED) was calculated by LQ model. The difference between the BED curve drawn in the central layer and the physical isodose curve was studied. The difference between the adjusted physical dose (APD) and the physical dose was also studied. Results Five field planning was the best in target dose uniformity and protection of the critical tissue -rectum. The physical dose was uniform in the target, but the biological effective doses revealed great discrepancy in the biological model. Adjusted physical dose distribution also displayed larger discrepancy than the physical dose unadjusted. Conclusions Intensified Modulated Radiotherapy (IMRT) technique with inversion planning using biological dose concept may be much more advantageous to reach a high tumor control probability and low normal tissue complication probability.

Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients (4 men and 1 woman) aged 20 to 35 years (mean 25) underwent laparoscopic extravascular stent of the left renal vein (LRV) for treatment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min (65-70min). No complications occurred during surgery. The postoperative follow-up was 9 to 39 months (mean 28). Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravgscular stent of the renal vein could be a feasible approach for re-establishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.

Objective To explore the significance and important measure of integrative treatment of multiple trauma patients with severe craniocerebral injury in emergency center. Methods One hundred and forty-eight multiple trauma patients with severe craniocerebral injury in emergency center from November 2002 to February 2006 were analysed retrospectively. Result In total 148 cases, 72 were cured and 26 dead, 7 were in status of plant man, 17 experienced severe deformity, and 26 did mild deformity. Conclusion Multiple trauma patients with severe craniocerebral injury usually experience a serious situation and rapid development. Therefore emergency doctors are required for organizing salvage of such patients, at the same time treatment and diagnosis are implemented. Firstly the most important key to successful salvage is appropriate disposal of fatal injury and early elimination of shock. Proper surgical choice, especially at the first time, inspection and protection of visceral functions, and attention to nutritional support are other vital methods to gain more successful salvage. ICU is also emphasized for its essentiality.

Objective To analyze the relationship of penA, ponA, porB and mtrR gene mutations with the reduced sensitivity to ceftriaxone in N.gonorrhoeae isolates from Shenzhen city.Methods A total of 296 clinical isolates of N.gonorrhoeae were collected in Shenzhen city from 2009 to 2011.The agar dilution method was used to estimate the sensitivity of these N.gonorrhoeae to ceftriaxone.Totally, 53 strains with reduced sensitivity to ceftriaxone (minimum inhibitory concentration (MIC): 0.06-0.50 μg/ml) were identified, and 53 strains with high sensitivity to ceftriaxone were randomly selected from the remaining strains and served as the control group.PCR was performed to amplify the penA, ponA,porB and mtrR genes from the 106 isolates followed DNA sequencing.Results The mosaic structure of the penicillinbinding protein 2 (PBP2) gene (penA gene) was found in only one isolate with a ceftriaxone MIC of 0.125 0 μg/ml.Amino acid sequence analysis of the remaining 105 isolates yielded 16 different amino acid patterns.The MICs of ceftriaxone were relatively high (0.062 5 μg/ml) in N.gonorrhoeae strains harboring the amino acid patterns ⅩⅢ, ⅩⅧ or ⅩⅩⅩⅧ,but relatively low (0.008 0 μg/ml) in those harboring the amino acid pattern Ⅱ.No significant differences were observed in the frequency of mtrR, porB or ponA gene mutations between N.gonorrhoeae isolates with reduced sensitivity to ceftriaxone and those with high sensitivity (all P ＞ 0.05).Conclusions The mosaic structure of PBP2 may be not the primary reason for reduced sensitivity of Neisseria gonorrhoeae to ceftriaxone in Shenzhen, while different amino acid patterns produced by various mutations in amino acid residues at positions 500-580 in the non-mosaic PBP2, together with mtrR, porB and ponA mutations, may play more important roles in the reduced sensitivity.