Objective To investigate and compare the argumentativeness and attitudes towards thinking and learning between clinical nurses in general adult wards and wards for patients requiring particularity healthcare for the identification and development of core communication skills.Mettods “Argumentativeness Scale” and “Attitudes toward Thinking and Learning Survey” in Chinese were used to measure a convenience sample of 504 clinical nurses in seven hospitals.Results The scores in items reflecting rationality,positivism,empathy and acceptance in 247 nurses in wards for particularity heahhcare were significantly different from those nurses working in internal medical wards for adults with internal medical problems.Conclusions To develop harmonious interpersonal relationships in nurses,we should strengthen competencies in emotional regulation and rational thinking in nurses in wards for adults with in-ternal medical problems.

Objective To provide the basis for early detection and treatment of precancerous lesions of gastric carcinoma, and reference for early discovery, diagnoses and treatment of gastric cancer, by examining the differences of expression of Helicobaeter pylori (Hp), both in the gastric mueosa and in blood serum, between precancerous lesions of gastric carcinoma patients and gastric cancer patients. Methods Used immunechromatographic method and protein chip system to determine the expression of Hp in blood serum and used immunohistochemistry to detect the expression of Hp in gastric mucosa. The patients had been diagnosed by pathological methods, 170 patients with precancerous lesions of gastric carcinoma, 111 patients with gastric carcinoma and 31 patients with superficial gastritis. Results The expression of Hp was detected on every stage of precancerous lesions and gastric carcinoma. Compared with the detection rates of Hp, precancerous lesions of gastric carcinoma was higher than gastric carcinoma and superficial gastritis, superficial gastritis was the lowest. The differences of the three were significant (P<0.01). The detection rate of Hp in the gastric mueosa (86.2%, 66.7%, 38.7%, respectively)was obviously higher than in blood serum (80.6%, 52.3%, 32.3%, respectively). Conclusions Hp participates in the process of the precancerous lesions and gastric carcinoma. The expression of Hp both in the gastric mueosa and in the blood serum could be one of the indexes, which might report the process and curative effect of precancerous lesions. With such advantages as simple and applicability, the detection of Hp in the blood serum could be used widely. The endoscopy and the detection of Hp in the gastric mucosa are suggested for patients with Hp positive in the blood serum.

OBJECTIVE To understand the distribution of common pathogens and their drug resistance trend and to provide the basis of the correct selection of antibiotics for clinic.METHODS Retrospective analysis was taken for blood culture specimens during 2 years in our hospital.And statistical analysis was done.All of 4028 cases of blood culture specimens were detected on automatic BacT/Alert3D rapid blood culture system,strains isolated were taken to VITEK-2 automatic microbiological analysis/sensitivity system for identification and drug susceptibility testing.Drug susceptibility results were analyzed using WHONET 5.3 software.RESULTS Totally 435 pathogen were isolated from 4028 cases of blood culture sample and the positive rate was 10.8%.195 Gram-negative bacteria strains accounted for 44.8%,mainly Escherichia coli,Klebsiella pneumoniae,Burkholderia cepacia,Acinetobacter baumannii,and Pseudomonas aeruginosa.Gram-positive bacteria accounted for 49.9%;mainly Staphylococcus epidermidis,S.haemolyticus and S.aureus dominated.Fungi were 23 strains(5.3%),mainly Candida albicans.Among them,extended-spectrum ?-lactamases(ESBLs) produced by E.coli and K.pneumoniae strains were 43.9% and 48.8%,respectively.Meticillin-resistant S.aureus and coagulase-negative staphylococci were 35.3% and 72.9%,respectively.But vancomycin-resistant S.aureus was not found.CONCLUSIONS The bacteria identification detected in blood culture class is quite complicated,and the drug resistance is high.Laboratories should increase the detection rate of bacterial culture and provide drug monitoring results for the clinics on time based on CLSI norms.Clinicians should use the antibiotics reasonably based on the drug susceptibility results in order to reduce nosocomial infections and the emergency of multiple drug-resistant strains.

BACKGROUND: Tissue engineering plays an important role in treating rotator cuff injury. Promoting the healing of injured rotator cuff and preventing adhesion by regulating growth factor expression are main functions. OBJECTIVE:To compare the effects of corticosteroids and hyaluronic acid on the expressions of epidermal growth factor (EGF),platelet-derived growth factor (PDGF),transforming growth factor ? (TGF-?) and basic fibroblast growth factor (bFGF) in injured rotator cuff. DESIGN,TIME AND SETTING: The randomized controlled animal experiment was performed at the Animal Experimental Center,School of Medicine,Shanghai Jiao Tong University from July to September 2007. MATERIALS: Totally thirty-six Sprague-Dawley (SD) rats were randomly assigned into four groups: normal group (n=6),rotator cuff injury group (n=6),hyaluronic acid group (n=12) and corticosteroids group (n=12). METHODS: Full-thickness defects across 50% of the total width (5 mm) of the bilateral infraspinatus tendon were excised. Models of rotator cuff injury were created at the synovium. 0.05 mL hyaluronic acid was injected into the subacromial bursa mucosa in the hyaluronic acid group,whereas 0.05 mL corticosteroids in the corticosteroids group. MAIN OUTCOME MEASURES: At three and six weeks after injury,the infraspinatus were harvested to detect EGF,PDGF,TGF-? and BFGF by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: By using corticosteroids treatment,the expression of EGF remained greater at the six weeks than twofold at the three weeks; the expression of EGF after hyaluronic acid treatment greatly decreased at six weeks (P

Objective To evaluate the overall failure rate of one or two-stage exchange arthroplasty for infections in total knee arthroplasty (TKA) and the predictors affecting the outcome of exchange.Methods Thirty-nine cases received one or two-stage exchange arthroplasty for periprosthetic joint infections after primary TKA in Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Southeast Hospital affiliated to Xiamen University from January 2012 to November 2014 were reviewed.Periprosthetic tissue and articular fluid of all patients were analyzed by bacterial culture.All patients were followed up for more than one year.C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),procalcitonin (PCT) and blood routine were tested every four weeks,and the evaluation on pain,total periprosthetic function,range of motion and deformation of arthroplasty were conducted.Differences between groups were analyzed using chi-square test or Student's t test when appropriate.A stepwise selection approach in logistic regression analysis was used to screen key predictors for outcome of one or two-stage exchange for infections in TKA.Results There were 39 patients who had undergone one or two-stage exchange for infections in TKA,including 20 males (51.3％) and 19 females (48.7％) with an average age of (62.4±11.7) years.Among the 39 patients,18 gram-positive strains were isolated from specimens,and 6 gram negative strains,2 Mycobacterium tuberculosis and 1 candida albicans.Ten of 39 reimplantations developed reinfection.Between the success and failure groups,there were significant differences in the time from primary TKA to revision (P =0.023),operative time (P =0.029),multidrug resistant organisms (P =0.045),the preoperative and post-operative ESR (P=0.002 and P＜0.001,respectively) and post-operative CRP (P=0.018).Multivariable logistic regression analysis demonstrated that time from primary TKA to revision (OR =0.96,95％CI:0.92-1.00,P=0.025),preoperative ESR (OR=0.97,95％CI:0.95-1.00,P=0.045) and post-operative ESR (OR =0.94,95％ CI:0.91-0.98,P =0.002) were independent indicators associated with the outcome of one or two-stage revision.Conclusions The failure rate after revision for infected TKA is relatively high.The time from primary TKA to revision,preoperative and post-operative ESR could predict the outcome of one or two-stage revision effectively.

Using whole-cell patch clamp technique this study investigated the effects of adenosine (Ado) on action potential, L-type calcium current (I(Ca.L)), delayed afterdepolarizations (DADs), and transient inward current (I(ti)) induced by isoproterenol (Iso) in guinea pig isolated single ventricular myocytes. The results showed: (1) Ado alone had no significant direct effects on action potential and I(Ca.L) in guinea pig ventricular myocytes at 20-100 micromol/L. However, Ado significantly attenuated the prolongation of action potential duration (APD) and the increase of the peak amplitude of I(Ca.L) induced by Iso. Iso (10 nmol/L) markedly increased APD(50) and APD(90) from 340+/-21 ms to 486+/-28 ms and from 361+/-17 ms to 501+/-29 ms, respectively (P<0.01), and increased the amplitude of I(Ca.L) from 6.53+/-1.4 pA/pF to 18.28+/-2.4 pA/pF (P<0.01). The peak potential of current-potential relationship shifted to the left. Ado (50 micromol/L) abbreviated APD(50), APD(90) to 403+/-19 ms and 419+/-26 ms (P<0.01), and decreased the peak amplitude of I(Ca.L) to 10.2+/-1.5 pA/pF (P<0.01 vs Iso), but did not change resting membrane potential (RMP), action potential amplitude (APA), and overshoot (OS). (2) Iso (30 nmol/L) reproducibly elicited DADs with 100% incidence of DADs under this condition. Ado (50 micromol/L) completely inhibited Iso from inducing DADs. Iso (30 nmol/L) elicited I(ti) with 2-second depolarizing voltage-clamp pulses rising to +20 mV from a holding potential of -40 mV, the incidence of I(ti) being 100%, and the I(ti) was suppressed in the presence of Ado (50 micromol/L) with the incidence of I(ti) decreased to 14.3% (P<0.05). These data indicate that Ado antagonizes the stimulatory effect of Iso, and that the antiarrhythmic mechanism of Ado preventing Iso-induced DADs is due to the inhibition of intracellular Ca(2+) overload through attenuating the prolongation of APD, the enhance of I(Ca.L) and I(ti).
Action Potentials ; drug effects ; Adenosine ; pharmacology ; Animals ; Anti-Arrhythmia Agents ; pharmacology ; Arrhythmias, Cardiac ; physiopathology ; Calcium Channels, L-Type ; drug effects ; Female ; Guinea Pigs ; Heart Ventricles ; cytology ; Isoproterenol ; antagonists & inhibitors ; Male ; Myocytes, Cardiac ; physiology ; Patch-Clamp Techniques

The purpose of this study was to investigate the different effects of ACh on the action potential and force contraction in guinea pig atrial and ventricular myocardium by using standard microelectrodes and force transducer. The results showed that the duration of the action potential (APD) of atrial myocardium was shortened from 208.57+/-36.05 to 101.78+/-14.41 ms (n=6, P<0.01), and the APD of the ventricular myocardium was shortened from 286.73+/-36.11 to 265.16+/-30.06 ms (n=6, P<0.01).The amplitude of the action potential (APA) of the atrial myocardium was decreased from 88.00+/-9.35 to 62.62+/-20.50 mV (n=6, P<0.01), while the APA of the ventricular myocardium did not change significantly.The force contraction of atrial myocardium was inhibited completely (n=6, P<0.01), while the force contraction of ventricular myocardium was inhibited by 37.57+/-2.58% (n=6, P<0.01). The ACh effects correlated with its concentration. The K(D) of the APD shortening effects in the atrial and ventricular myocardium were 0.275 and 0.575 micromol/L. The K(D) of the negative inotropic in the atrial and ventricular myocardium were 0.135 and 0.676 micromol/L, respectively. The corresponding data points were compared using t test between the atrial and ventricular myocardium, and the differences were significant when the ACh concentration was above 10 nmol/L. Furthermore, atropine (10 micromol/L) and CsCl (20 mmol/L) blocked the effects of 10 micromol/L ACh on the APD of ventricular myocardium, while CdCl2 (0.1 mmol/L) had no influence on these effects. In conclusion, ACh could shorten the action potential duration and inhibit the force contraction of atrial and ventricular myocardium in a concentration-dependent manner. There are differences in the effects of ACh on the atrial and ventricular myocardium. The atrial myocardium is more sensitive to ACh than the ventricular myocardium. It is probable that the muscarinic receptor and the potassium channel, but not the calcium channel, are involved in the ACh-induced shortening of the ventricular APD.
Acetylcholine ; pharmacology ; Action Potentials ; drug effects ; Animals ; Calcium Channels ; metabolism ; Guinea Pigs ; Heart Atria ; drug effects ; Heart Ventricles ; drug effects ; Microelectrodes ; Potassium Channels ; metabolism ; Receptors, Muscarinic ; metabolism

Objective To study the effectiveness and safety of methods of transurethral bipolar plasmakinetie prostatectomy for benign prostatic hyperplasia with large volume.Methods The transurethral bipolar plasmakinetic prostatectomy with Nesbit (Nesbit group,45 cases)and prying-up technique (pryhag-up group,60 cases)were performed in 105 patients of the prostatic volume of more than 60 g.The results could be obtained by comparing operative time,intraoperative and postoperative blood loss and the time of postoperative sustained washing of the bladder between the two groups.Results In Nesbit group,the efficiency of average cutting gland was (0.79±0.17)g/min,the average intraoperative blood loss was (3.87± 1.09)ml/g,the decrease in postoperative Hb within 24 hours was (6.84±3.96)g/L,the average time of postoperative continuous washing of the bladder was 72 hours,8 patients were given by blood transfusion.In prying-up group,the corresponding data were(1.16±0.20) g/min,(1.60±0.64)ml/g,(3.87±2.33 )g/L,36 hours respectively,none of patients was given by blood transfusion.There were statistically significant in two groups(P＜0.05).Conclusions The adoption of prying-up is more favorable compared with Nesbit method in the aspects such as less blood loss,shorter operating time,less lotion,more thorough resection of the gland,higher security.It is conducive to delivering lecture,and it enables the standard operational procedure available.