Objective To investigate the key points of nursing during the course of breast tumor excision by endoscope. Method Summarized the nursing points of 24 patients who have accepted the breast tumor excision by endoscope. Results The key points of successful operation were sufficient preparation before the operation, the special skills of nurses, exactly and quickly transfer instruments and expert cooperation. Conclusion Paving attention on psychological nursing, the correct and skillful nursing care can reduce the operation time, and then make sure the successful operation.

Chronic constipation(CC)is one of the most common gastrointestinal disorders. Treatment of CC includes drug and non-drug treatment. Biofeedback(BF)is a psychological behavior therapy and has become the first-line therapy of CC. However,the efficacy of BF reported varied substantially. This article reviewed the evaluation of efficacy of BF on CC.

Objective To investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of pulmonary cryptococcosis.Methods 15 patients who were diagnosed as pulmonary cryptococcosis were retrospectively studied,all of them were examined by sputum smear,X ray,CT and EBUS-TBNA.Results 15 patients who received EBUS-TBNA were diagnosed pulmonary cryptococcosis by pathological methods and germiculture,during the process no complication was detected.Conclusion EBUS-TBNA is a safe and effective means in the diagnosis of pulmonary cryptococcosis for pulmonary cryptococcosis patients hard to be diagnosed clinically.

Objective To investigate the clinical value of low molecular weight heparin (LMWH) as prophylaxis against venous thromboembolism after rectal cancer surgery.Methods The clinical data of 120 patients who received rectal cancer surgery at the Tianjin People's Hospital from October 2008 to October 2010 were retrospectively analyzed.All patients were divided into the test group (50 patients) and the control group (70 patients).Patients in the test group received subcutaneous injection of 0.4 ml of LMWH (4100 U) at 8-12 hours after operation,and then once a day thereafter until mobilization.LMWH was not given to patients in the control group.Patients in the 2 groups who experienced venous thromboembolism (VTE) and postoperative bleeding were recorded and compared.The clinical data of patients with VTE were proceeded with risk factors analysis.All data were analyzed using the t test,chi-square test or by calculating Fisher exact probability.All factors influencing VTE formation were analyzed using Logistic regression analysis.Results The incidences of VTE in the test group and the control group were 2.0％ (1/50) and 14.3％ (10/70),respectively,with a significant difference between the 2 groups (x2=3.915,P ＜ 0.05).The incidences of postoperative blood loss in the test group and the control group were 6.0％ (3/50) and 2.9％ (2/70),respectively,with no significant difference between the 2 groups (x2=0.149,P ＞ 0.05).Varicose veins of lower limbs,previous cardiopulmonary diseases,obesity and age ＞ 65 years were the independent risk factors of VTE (OR =2.3,2.5,1.4,2.1,P ＜0.05).The number of patients with VTE increased as the increase of the risk factors.Conclusion Early injection of LMWH after rectal cancer surgery is safe and effective in preventing VTE.

Objective To analyze the clinical characteristics of drug-induced liver injury (DILI) from Chinese literatures published in Chinese Periodical Full-text Database (CNKI) from 2007 to 2011.Methods Using drug-induced liver injury as key words,the literatures in CNKI were searched,and the data of age,gender,medication,clinical manifestation and prognosis were analyzed.Results In search of CNKI,281 literatures were collected; finally 111 relevant papers were obtained.Total 10 693 cases of DILI were included with a male/female ratio of 1.14:1 and a mean age of 45.6 y ranging from 7 months to 93 y.Among 1093 cases with the age grouped,the highest incidence of DILI was in age 41-60 y(38.52％)and 20.68％ patients were over 60 y.Among 6592 cases with clinical manifestation recorded,43.51％ patients were asymptomatic and abnormal liver function was detected in health check-up; and others presented nonspecific gastrointestinal symptoms,including fatigue,nausea,vomiting and jaundice.In 9340 cases with medication recorded,the 6 most common drugs inducing DILI were antituberculotics (32.74％),Chinese herbs(22.12％),antibiotics(9.18％),antineoplastics(6.34％),NSAIDs (4.80％)and antithyroid drugs (4.37％).The most common type of toxicity was hepatocellular injury (63.66％,4438/6971).In general the prognosis was good with a fatality rate of 1.67％.Conclusions Antituberculotics and Chinese herbs are the main causes of DILI.Some DILI patients have occult onset and others have nonspecific gastrointestinal symptoms.Most patients have good prognosis if they are treated timely.

Although the percentage of preterm infants developing intraventricular haemorrhage (IVH) has been greatly re-duced in the past three decades, increased survival of extremely preterms has meant that severe IVH with subsequent posthae-morrhagic hydrocephalus is still one of the serious unsolved problems for managements of preterms. Therapeutic interventions for posthaemorrhagic hydrocephalus include serial lumbar punctures, repeated aspiration through a ventricular access device, ventriculoperitoneal shunting, drainage, irrigation and fibrinolytic therapy, diuretic therapy treatment to reduce cerebrospinal fluid production, intraventricular fibrinolytic therapy, etc. This review summarizes the current concepts on the pathophysiology, inter-vention indications, and the effectiveness and safety of different interventions of subsequent posthaemorrhagic hydrocephalus.

Fetal hydrocephalus is a kind of congenital malformation,which is characterized by the enlargement of the ventricular system and the obstruction of cerebrospinal fluid.It is not accompanied by a primary brain atrophy,with or without the increase of head circumference.Early diagnosis and early treatment is very important.Without the timely inter-vention,most of the patients will die during the perinatal and infant period,and even the survivors often suffer from cere-bral palsy and mental retardation.However,the long -term prognosis and clinical course of patients with hydrocephalus is not yet fully understood.There is controversy on the factors which influence the long -term outcome,such as the timing of diagnosis of hydrocephalus,the severity of ventricular dilatation,the basic disease and accompanying anomalies.So,should establish comprehensive protocols to avoid and decrease fetal hydrocephalus,as well as pay attention to the clinicopatho-logical research,prenatal diagnosis,perinatal management and early treatment of fetal hydrocephalus.

Objective To screen the influencing factors related to prolonged mechanical ventilation (PMV). Methods Series of parameters of 154 elderly patients with pneumonia or COPD exacerbation were collected before using ventilator, after weaning of ventilator or at the 21st day of ventilating, respectively. Results By single factor analysis, PMV related to not only age, lying on bed, white blood cell, neutrophil, P (A-a)O 2, BUN, Cr, upper digestive tract bleeding, heart rate(HR), and blood pressure(BP) before using ventilator, but also related to heart function and consciousness after ventilator weaning or ventilating for 21 days. By multiple factor analysis, age, P (A-a) O 2 , heart function when ventilating for 21 days were related to PMV. Age≥82.0, P (A-a)O 2 ≥95.0 mm Hg, heart function≥grade 3 were high risk factors of PMV. Furthermore, it was found that the accuracy rate for meeting with those three parameters among 8 elderly patients with PMV was 87.5%. Conclusions Age, P (A-a)O 2 and heart function when ventilating for 21 days might be the independent factors of PMV.

Objective To discuss the reasonable utilization of β-lactam antibiotics in patients with renal failure on hemedialysis. Methods The clinical characteristics of patients with renal failure on hemodylysis,who de-veloped the adverse effect of nervous system and psychiatric symptom while being treated with β-lactam antibiotics,were retrospectively analyzed. Results The adverse effect of nervous system and psychiatric symptom showed dur-ing and after hemodialysis,including: mental confusion,hyperexcitabiliy,incoherent speech,lethargy and amyestasia in two cases. Physical examination did not show signs of cerebral focal injury in all cases. Computed tomography of brain in 7 patients did not show acute lesions. The symptoms completely disappeared after withdrawal of β-lactam antibiotics but bemodialysis or hemodiafiltration continued. Conclusion β-lactam antibiotics used in conventional dose could cause temporary adverse effect of nervous system in patients with renal failure on bemodialysis,which is related to prolongation of drug half life.

SALL4 gene is closely related to body malformations related diseases, embryonic stem cell development, and hematopoietic malignancies. SALL4 can activate hematopoietic stem cell through Wnt signaling pathways, and promote continued proliferation of leukemia stem cells, leading to leukemia. In-depth study of SALL4 gene and its protein function will help clarify the pathogenesis of leukemia, providing a new target for the treatment of leukemia.