Objective To review the preliminary experience of primary laparoscopic pull-through for Hirschsprung's Disease in children.Methods Since May 2000,25 patients with Hischsprung's disease underwent Laparoscopic Pull-Through. The oldest age was 6 years old and the youngest was 20 days. All patients underwent anesthesia and tracheal intuition, carbon dioxide was insufflated into abdominal cavity via a Veers needle, reaching a insulation pressure of 1.33～1.86 kPa (10～14 mmHg). One umbilical camera port one-instrument port at left abdomen and one instrument port at right abdomen were made.Results The mean operative time was 165-min. Oral feeding was started 3 days postoperatively. The average hospitalization was 9 days (7～10 days).No complication was encountered.Conclusions Primary laparoscopic Pull-Through for Hirschsprung's Disease in children is safe and feasible.

Objective To describe uncertainty in illness of patients with hepatocellular carcinoma intending to undergo transcatheter artery chemoembolization (TACE) and to identify the related factors. Methods A descriptive and correlative design was used. By convenience sampling, 95 patients with hepatocellular carcinoma were recruited from Sun Yat-Sen University Cancer Center in this study. Mishel Uncertainty in Illness Scale was used to assess uncertainty in illness and information needs of patients with hepatocellular carcinoma intending to undergo TACE and the demographic questionnaire and Information Needs Assessment Scale were used to measure demographic data, disease and treatment characteristics and information needs of patients. Results The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle (77.61±9.15) points. The mean score of indeterminacy subscale was (50.16 ± 6.16) points. Uncertainty in illness of patients with hepatocellular carcinoma intending to undergo TACE was affected by the degree of education background, domicile, family economic status, way to pay for the medical expenses, course of diseases, how many times he (she) used to undergo assisted treatments and the level of information needs. Conclusions The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle and it is important to assess patients′uncertainty in illness at clinical work and to take effective interventions to content patients′information needs to decrease the level of uncertainty.

Objective To present our experience with laparoscopic pyloromyotomy and laparoscopically assisted endorectal pull through for Hirschsprung's disease (HD) in newborns and infants.Methods Twenty newborns or infants with hypertrophic pyloric stenosis and HD,age ranged from 16～120 days and weight from 2.7～8 kg.Under epidural anesthesia and tracheal intubation,carbon dioxide was insufflated into abdominal cavity via a Veress needle,reaching an insufflative pressure of 12～14 mm Hg.One umbilical and two or three subcostal canulas for instrumentation were demanded.The pyloromyotomy was performed in patients with hypertrophic pyrolic stenosis and in patients with HD the affected colon and rectum were mobilized by dissecting the supplying vessels and cutting the peritoneal reflection,and pull-through procedure was carried out.Results The operation time was 25～150 minutes with rare complications.Oral feeding was resumed on the following day postoperation.The patients recovered and discharged from hospital 3～7 days after operation.Conclusions Laparoscopic pyloromyotomy and laparoscopic endorectal pull-through for HD in newborns and infants are safe and feasible.The advantages of this procedure include minimal trauma to abdomen,rapid restoration of stomach and bowel function and quick rehabilitation.

Objective To explore the application of scene simulation teaching combined with research design in the teaching of Community Nursing and evaluate its effects.Methods The scene simulation teaching combined with research design was used in the teaching of Community Health Promotion and Health Education in 68 nursing undergraduate students.The student groups were required to do the scenario case preparation and presentation,and conduct the research design according to specific situations of community health education.The mastery of related knowledge of students before and after the class was compared.Results All the student groups completed the course requirements.After class,the students better grasped the community health education,research design and other related knowledge compared with before class.Sixty-one students (89.71％) regarded the scene simulation teaching combined with research design was suitable for the teaching of Community Health Promotion and Health Education,and over 80％ students regarded this teaching was benefit for the development of their ability of self-learning,teamwork and flexible application of knowledge.Conclusions The scene simulation teaching combined with research design can not only help students master related knowledge,but also focuses on students' ability training,which is suitable for comprehensive application of knowledge.

Objective The purpose of this study was to describe the influence of therapy compliance on prognosis of children with thalassaemia major (TM). Methods Children with TM was recruited by convenient sampling. The therapy compliance was measured by compliance index (CI) and serum ferritin (SF), The correlation between therapy compliance and incidence of complications were studied. Results Low therapy compliance existed in children with TM, 22.12% (CI) and 55.77% (SF). But no statistical difference existed in therapy compliance between boys and girls (P>0.05). Complication incidence in children with low therapy compliance was 85.19% (CI) and 100.00% (SF). The incidence of cardiac complication was 60.49% (CI) and 84.78% (SF), hepatic complication was 46.91% (CI) and 76.09% (SF), infectious complication was 8.64% (CI) and 10.86% (SF), growth retardation complication was 55.56% (CI) and 67.39% (SF), anemia complication was 43.21% (CI) and 21.74% (SF). The incidence rate of complications was lower in children with better therapy compliance than those with worse therapy compliance (P<0.01). Conclusions Children with TM had low therapy compliance and high incidence rate of complications. Low therapy increased the incidence rate of complications.

Objective To analyze the coincidence of the patients with capillary electrophoresis hemoglobin A 2 increase with defi-nitely diagnosed beta thalassaemia and to investigate its application value in the diagnosis of beta thalassaemia.Methods Two hundreds and sixty outpatients and inpatients with hemoglobin A 2 increase in our hospital from May 2014 to May 2015 were per-formed the genetic testing.Results Among 260 patients with hemoglobin A2 increase ,beta thalassemia gene mutations were detec-ted in 257 cases ,the coincidence rate reached 98.85% ,and the common 17 beta thalassemia gene mutations were not detected in the other 3 cases ,follow-up further detection of rare beta thalassaemia gene and beta globin gene sequencing was performed ,1 case of SEA-HPFH βdeletion type was found ,1 case was Taiwaneseβdeletion type and 1 case was Codon 89-93(-AGT GAG CTG CAC TG) heterozygous mutation ,it was verified that 3 cases of hemoglobin A2 increase without detecting 17 kinds of common beta thalassemia gene mutations were still beta chain mutation occurrence or big fragment deletion.At the same time ,among 257 speci-mens of beta thalassemia gene mutations ,42 cases were compound alpha thalassaemia ,accounting for 16.34% of beta thalassaemia. Conclusion Capillary electrophoresis hemoglobin A2 increase can provide a fast and accurate basis for beta thalassemia diagnosis , but which can not rule out the possibility of compoound alpha thalassaemia ,when the patient's hemoglobin A2 is increased ,alpha and beta thalassaemia genetic diagnosis should be simultaneously carried out.

Objective To understand the influene of inhabited environment on psychological and be-havioral symptom of dementia (BPSD) in patients with Alzbeimer's disease. Methods Nenrepsychiatric in-ventory was used to measure the occurrence of BPSD of 100 home and 100 resthome patients with Alzheimer's disease.Tbe data were analyzed with software SPSS version 13.0. Results The scores of hallucinations, anxi-ety,aberrant motor behavior and sleep disturbance in resthome patients were significant higher than those of home patients.There was significantly difference in the extent of occurrence in aberrant motor behavior, apathy/ indifference, hallucinations, sleep disturbance, anxiety,depression/dysphoria and appetite/eating disorders be-tween home and resthome patients,among which the extent of occurrence in resthome patients was higher except for body weight decreasing and appetite/eating disoniers. Conclusions The occurrence of BPSD is different according to different inhabited environment, symptoms of resthome patients are worse, so families should be ap-pealed as far as possibile to allow AD patients living at home.

OBJECTIVE:To screen and analyze the ?-lactamases-resistant genes in imipenem-resistant pseudomonas aeruginosa (IMPRPa). METHODS: ?-lactamases-resistant genes including IMP,VIM and OprD2 in 60 clinically isolated IMPRPa strains were detected by polymerase chain reaction (PCR),and sequence analysis was performed on the PCR amplified products of some of IMP and VIM genes. RESULTS: Of the 60 IMPRPa strains,?-lactamases-resistant positive genes were as follows: IMP gene was positive in 7 strains,VIM gene was positive in 18 strains,and both IMP and VIM genes were positive in 3 strains. Sequencing of the PCR products of IMP and VIM genes were IMP-1 and VIM-2 types,and OprD2 gene deletion was noted in 29 strains. CONCLUSION: OprD2 protein channel deletion and metal-producing ?-lactamases are the chief mechanisms for the resistance of IMPRPa to imipenem.

Objective To investigate the family burden from behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer disease (AD) living at home and in nursing home.Methods Neuropsychiatric Inventory/Neuropsychiatric Inventory-Nursing Home (NPI) and Family Burden Interview Scale (FBIS) were used to measure the occurrence of BPSD in 200 AD patients. The data were analyzed.Results In-home patients' total score and family daily activities, family entertainment, family relationships, family members' mental health and the body healthy dimension scores of FBIS were significantly higher （ P<0.05）, and the dimension scores of economic burden were significantly lower ( P<0.01) than those of patients in nursing home. Patients' total score of NPI was positively correlated with the economic burden, family entertainment, family relationships, family members' mental health and the body healthy dimension scores of FBIS （ P<0.01）. Every dimension score of NPI and total score of FBIS positively related ( P<0.05). Dimension score of family daily activities of FBIS was not related to all of the dimension scores and total score of NPI ( P>0.05).Conclusion The family burden from BPSD should not be ignored, especially the patients living at home, which suggests that AD patients should be sent to nursing home to spend their rest life.

Objective To understand the prevalence and the nursing status of incontinence and incontinence-associated dermatitis (IAD),analyze the risk factors of the occurrence of IAD,and to provide effective measures for the prevention and management of IAD.Methods Using the questionnaire survey, 1 318 hospitalized patients in 2 grade three hospitals of Suzhou were investigated,and then the results were analyzed.Results The prevalence of incontinence was 10.70％(141/1 318),among the prevalence of urinary incontinence was 4.63％(61/1 318),fecal incontinence was 4.32％(57/1 318);with 24.11％(34/141) of incontinent patients having IAD;disposable pad and briefs were the most common containment devices,only 36.17％ (51/141) of the incontinent inpatients using skin protectant after perineal skin clean.Single factor analysis revealed that IAD was related with wards, types of incontinence, character of stools, frequency of feces, antibiotics, modes of nutrition support, Braden scores, level of albumin and prealbumin.Unconditional Logistic regression indicated that risk factors of IAD included the level of serum albumin (OR=0.769, P＜ 0.05), Braden scores(OR=0.335, P＜ 0.05) and frequency of feces(OR=11.076, P ＜ 0.05).Conclusions Incontinence and IAD are common in hospitalized patients,low serum albumin, low Braden scores and high frequency of feces are the risk factors of IAD.The clinical nurses have not paied enough attention on the prevention of IAD, lacked relevant knowledge and skin care regimen.