ObjectiveTo explore the nursing students'puzzles about career planning,and provide a basis for the training.MethodsA qualitative research was conducted on 14 university nursing interns by in-depth interview and observing.The whole interview was noted.The data was analyzed according to Colaizzi's phenomenological procedure.ResultsThe experience could be classified into four aspects,including hazy understanding of career planning,lack of understanding of themselves,limited ca reer identity and lack of social cognition.ConclusionNursing educators should enhance the training against the nursing students'puzzles and make sure they can make a good career planning.

Objective To evaluate the clinical efficacy and toxicity of rituximab combined with CHOP (R-CHOP) in the treatment of relapsed or refractory diffuse large B cell lymphoma (DLBCL).Methods 30 patients were enrolled.All patients,pathologically confirmed to be CD20 positive DLBCL (all in stages Ⅲ-Ⅳ ), were relapsed or refractory after received 2-6 cycles of chemotherapy. Then all of them received R-CHOP schedule for 4 to 6 cycles, each cycle was 21 days. Clinical data before and after R-CHOP were collected.A retrospective analysis of the R-CHOP therapy,either compared to the literature or self-control was performed to evaluate the efficacy and toxicity. Results All the 30 patients were evaluable, induding 15 cases were complete remission (CR), 10 cases were partial remission (PR), 3 cases were stable disease (SD),and 2 cases were progressed disease (PD).The CR rate was 50.0 ％ (15/30),the total response rate (RR) was 83.3 ％ (25/30).All patients were well tolerated to the therapy.Only 3 cases were Ⅱ degree neutropenia,1 case was Ⅰ degree thrombocytopenia, and 2 cases suffered nausea and other mild gastrointestinal discomfort. Conclusions R-CHOP regimen could also achieve good response for relapsed or refractory DLBCL significantly.The common adverse effects of rituximab were mild.All the patients were well tolerated.

A method was developed for determining residual narasin in chicken tissues by HPLC with post-column derivatization. The samples were extracted with iso-octane. Further cleanup was performed on LC-si cartridge after centrifugation. Then the eluent was dried by nitrogen and residues were dissolved in methanol, water mixture (90∶ 10 v/v). The samples were analyzed on an Inertsil ODS-3 C18 column with a mixture of methanol-acetic acid-water as the mobile phase and vanillin as the derivatization reagent. The detection wavelength was 520 nm. The samples were quantified with the external standard calibration curve method. The limit of detection and the limit of quantification for narasin in chicken tissues were 6.0 μg/kg and 20 μg/kg, respectively. The average recoveries of narasin in chicken tissues were 76.4 %-93.1 %, the intra-assay relative standard deviations were 2.6 %-8.9% and the inter-assay relative standard deviations were 4.7%-9.7% at spiked levels of 20-1800 μg/kg. There was a good linear correlation (the calibration coefficient is above 0.9993) between the peak areas and concentration of narasin in the range of 70-10000 μg/L.

Objective To observe the preventive and therapeutic effects of L-carnitine on the metabolic disorder and cardiac remodeling in alcoholic cardiomyopathy. Methods Experimental animals were divided into three groups: alcohol-fed group(A), an alcohol/L-carnitine fed group(B) and a control group(C). Free fatty acid(FFA) and earnitine were detected in the blood serum at different time. mRNA and protein expressions of peroxisome proliferator-activated receptors (PPARα and PPARγ), retinoic acid receptor retinoid X receptor alpha (RXRα), earnitine palmitoyl transferase isoform and medium-chain acyl-CoA dehydrogenase (MCAD) were observed with RT-PCR and Western blotting methods. Results (1) When group A and B were compared with group C, FFA was increased and carnitine was decreased;mRNA and protein expressions of PPARα, RXRα, CPT-Ⅰ and MCAD were decreased with the development of alcoholic cardiomyopathy (ACM), being more significantly in group A than group B (P < 0.05). (2) mRNA and protein expressions of PPARγ had no statistical significance between these three groups at the end of 2 and 4 months(P>0.05), but after 6 months, they were increased in group B and decreased in group A (A vs. C,P<0.01;B vs. C,P<0.05). Conclusion Metabolic disorder and cardiac remodeling occur in the development process of ACM; they are partly prevented by L-carnitine through downregulating mRNA and protein expressions of PPARct, RXRα, CPT-Ⅰ, MCAD and PPARγ.

Objective To discuss the clinical application of feeding-artery embolization in treating massive hemoptysis.Methods The feeding-artery angiography was performed in 72 patients with massive hemoptysis.Based on the angiographic findings polyvinyl alcohol(PVA)or spring coil were selected as the embolization materials.The therapeutic results were retrospectively analyzed. Results Hemoptysis was completely controned almost immediately after the embolization procedure in 46 cases,while it was obviously alleviated in 13 cases.In 11 cases the hemoptysis disappeared completely after 2-4 times of embolization treatment,and in 2 cases surgery had to be employed.Conclusion Embolization of feeding-artery with PVA particles or spring coils is an effective and safe treatment for massive hemoptysis.The key point for decreasing reoccurrence is to occlude all feeding.arteries as far as possible.

The construction of a network resource data base for clinical skill teaching aiming at sharing excellent teaching resources was completed by integrating all kinds of teaching resource including characters,eourseware,pictures,cartoons,videos and examination questions,etc.In view of the generally weak situation of the current domestic education resource data base construction,the contents,guiding ideology,principle,object,orientation,function and the management mechanism of the network resource data base construction were devised for clinical skills teaching.Suggestions for specific ideas and construction problems were proposed to promote the construction and optimization of the network resource database for clinical skills teaching.

Objective To study the clinical characteristics and iduronate-2-sulfatase (IDS)gene mutation of one child patient with mucopolysaccharidosis type Ⅱ (MPS Ⅱ).Methods All the 9 exons of IDS gene were amplified by polymerase chain reaction (PCR)technlogy.The PCR products were screened by direct gene Sanger sequencing.Results A missense muta-tion (c.445T>C)on exon 4 was found after the analysis of the gene sequencing results of PCR products in this patient’s IDS gene.Thi smutation leaded to the 149th codon TCT encoded serine into a CCT encoding proline (p.Ser149Pro).Mean-while,the IDS gene in the parents were widetpye,so this was a de novo mutation.Conclusion The de novo mutation of IDS gene is the cause of our patient with?mucopolysaccharidosis,one novel mutation (p.Ser149Pro)was identified.

Objective To explore the clinical features of neonatal septicemia caused by Lester. Methods The clinical features of septicemia caused by Lester bacteria in 9 neonates confirmed by blood culture during from January 2011 to June 2016 were retrospectively analyzed. Results All of the 9 cases were premature and cesarean delivery. The main clinical manifestations were cyanosis (7 cases), fever (5 cases), anhelation (4 cases), hypomyotonia (4 cases), and respiratory distress (3 cases). Blood cultures in 9 cases were detected Lester bacteria with 3 cases found in sputum and 1 case in both sputum and cerebrospinal fluid. Drug sensitivity test showed that Lester bacteria were sensitive to ampicillin, penicillin, and sulfamethoxazole. All of the 9 cases adjusted anti-infective medications after the diagnosis of Lester septicemia by blood culture, and all of them were cured or improved, and discharged. Conclusion Neonatal Lester infection is a serious infectious disease. Fever in pregnant women should alert clinicians to Lester infection. Early detection of pathogens and targeted treatment can help improve prognosis.

Objective · To design and build a high-throughput sequencing approach based on targeted panel sequencing (TPS) using for the primary immunodeficiency disease (PID) diagnosis. Methods · By reviewing the literature and querying the relevant databases to determine the known diseasecausing genes of PID, capture probes using for the TPS were designed and customized for all exons and flanking sequences of these genes. A child suspected with PID was diagnosed by the customized TPS. Results · The PID sequencing panel contains a total of 100 known pathogenic genes. The sequencing data of the patient has 16414298 reads. The average coverage depth is 157 X, 98.35% of the target region sequencing depth is greater than 20 X, and 99.97% of the target region sequencing depth is greater than 1 X. Finally, a heterozygous nonsense mutation was found in the exon 2 of the CXCR4 gene (c.1000C>T, p.Arg334*) in the child. The results of Sanger sequencing confirmed the variation in the child and showed that his parents were wildtype at the corresponding sites, indicating the mutation is de novo. Conclusion · This study established a high-throughput sequencing diagnostic approach for PID, with which a case of WHIM syndrome was successfully diagnosed.