Kidney is the most important organ to maintain the balance of hyperkalemia.Due to reduced glomerular filtration rate or renal tubule potassium excretion dysfunction, all kinds of acute and chronic kidney diseases can result in increased hyperkalemia.Therefore, hyperkalemia becomes a common electrolyte disorder in children with kidney disease.Hence, the diagnosis and differential diagnosis of renal hyperkalemia are particularly important for clinicians.

AIM: To evaluate the clinical feature of 9 patients harboring mitochondrial DNA ( mtDNA ) G11778A mutation with Leber hereditary optic neuropathy ( LHON) .
●METHODS: Nine LHON patients were enrolled and followed- up between 2012 to 2015 in Shenzhen Eye Hospital, clinical data were collected and analyzed.
●RESULTS: Six cases had maternal inheritance history ( 67%) . Three were sporadic cases. The patients aged from 9 to 43 years old, with average age of (22. 00±9. 42) years. Simultaneous onset with both eyes was in 5 cases (56%). Successively onset was in other 4 cases (44%). The ratio between male and female was 2:1. In the last follow-up, the visual acuity was finger counted in 2 eyes (11%), 0. 01-0. 1 in 12 eyes (67%), 0. 12-0. 4 in 2 eyes (11%),≥0. 4 in 2 eyes (11%). All patients had pale disc and clear boundary. ln the Humphrey visual field examination, 10 eyes had typically cecocentral or paracentral scotoma, 8 eyes had diffuse visual field defect.
●CONCLUSION: ln the 9 LHON patients with mtDNA G11778A mutation, simultaneous onset cases were more than successively onset cases within 1y cases. In most cases, LHON patients kept stable visual acuity. Rare cases had a raise in visual acuity within 1y. Majority patients had typically cecocentral or paracentral visual field scotoma. In the last stage of LHON, visual field present diffused defect. The secondary affected eye was similar performed defect as the former one.

[ ABSTRACT] AIM:To study the effect of thrombopoietin ( TPO) on chemical hypoxia-induced apoptosis of the Rattus norvegicus adrenal pheochromocytoma (PC12) cells.METHODS:The cultured PC12 cells were randomly divided into normal control group, cobalt chloride ( CoCl2 ) group, CoCl2 +TPO group and TPO group.The cell viability was mea-sured by MTT assay.The effect of TPO on CoCl2-induced cell apoptosis was analyzed by flow cytometry with Annexin V/PI double staining.The intracellular reactive oxygen species ( ROS) were detected by fluorescence microscopy, and the chan-ges of the mitochondrial membrane potential ( MMT) were determined by flow cytometry and fluorescence microscopy.RE-SULTS:Chemical oxygen agent CoCl2 significantly inhibited the growth of PC12 cells (P<0.01).The apoptotic rate in CoCl2 group was obviously higher than that in control group ( P<0.05) , while the apoptotic rate in CoCl2 +TPO group was obviously lower than that in CoCl2 group (P<0.05).TPO decreased the production of ROS, and inhibited the decrease in MMP induced by CoCl2(P<0.01).CONCLUSION: TPO has a protective effect against CoCl2-induced apoptosis of PC12 cells by decreasing the production of ROS and inhibiting the decrease in MMP.

Objective To investigate the effect of Doula delivery ball apparatus combined with correct occipitoposterior.Methods Four hundred primiparas whose dilatation of cervix of 3 cm and position of foetus was occipitopostenor position, were randomly divided into observation group and control group according their wishes, and each group of 200 cases.Doula delivery ball was used for the observation group,while the free body position, the traditional delivery mode was the control group.The vaginal delivery rate, degree of pain, postpartum 2 h bleeding volume and neonatal asphyxia rate were compared between the two groups.Results The degree of pain Ⅲ degree was 4.0％ (8/200) ,lower than the control group(50.0％ (100/200), x2 =11.55,P＜0.01).The vaginal delivery rate in observation group was 84.5％ (169/200), higher than that in control group (60.5％ (121/200);x2 =28.905,P=0.001).Postpartum 2H bleeding was (156.3±53.2) ml, lower than the control group((268.1±54.6) ml, t =20.70, P＜0.01).The Postpartum bleeding rate was 0.5％ (1/200), lower than that in control group (4.0％ (8/200) ,P =0.018).Conclusion Doula delivery ball is applied to the first active stage of labor can effectively relieve pain, promote the safety of natural childbirth.

The present paper consults the concept of clinical competence, cultivation actuality, examination and assessment system of master of nursing specialist (MNS) at home and aboard based on literature analysis.Currently there is neither unified concept of master nursing specialist clinical competence, nor a unique clinical ability training mode of MNS.This paper mainly expounds the differences of the nursing professional master degree graduate students clinical ability evaluation system at home and abroad in the assessment methods, assessment tools, assessment agencies and assessment index, pointing out that our country should make a unified concept of the clinical competence.We should develop a flexible, diverse clinical competency assessment method, establish specialized evaluation agencies which are independent of the government, and implement 3 level quality monitoring system-graduate school of the university, clinical college graduate school and nursing department of, to ensure the training quality.

Objective To assess the antimicrobial resistance and resistance-related mutations in rpoB and katG genes in Mycobacteria tuberculosis isolates from patients with cutaneous tuberculosis. Methods Seven strains of Mycobacteria were isolated from lesions or secretions of patients with cutaneous tuberculosis and identified as M. tuberculosis. Proportion method was used to test the susceptibility of M. tuberculosis isolates to rifampicin, isoniazid, streptomycin and ethambutol. PCR and sequencing were performed to analyze the mutations in rpoB and katG genes. Results Of the 7 isolates of M. tuberculosis, 1 was resistant to rifampicin,isoniazid and ethambutol simultaneously, and the other 6 were sensitive to rifampicin, isoniazid, streptomycin and ethambutol. All the 7 isolates were positive for the amplification of rpoB and katG genes by PCR. DNA sequencing revealed two mutations at codon 531 (TCG to TTG) and codon 315 (AGC to ACC) in the multi-drug resistant strain, which were absent in the other 6 strains. Conclusion Multi-drug resistance has emerged in M. tuberculosis isolates from patients with cutaneous tuberculosis, which is likely to be related to improper treatment.

OBJECTIVE:To establish a method for the content determination of chlorogenic acid,protocatechuic acid and total phenolics in Chaenomeles sinensis,compare the content of total phenolics and 2 phenolic acids from different areas. METHODS:Wavelength switching HPLC method was conducted to determine the chlorogenic acid and protocatechuic acid. The column was Shim-pack CLC-ODS(M)with the mobile phase of acetonitrile-0.1% phoephoric acid(15∶85,V/V),the detection wavelength was 259 nm(for protocatechuic acid)and 325 nm(for chlorogenic acid)and the switching time was 14 min. With the index of proto-catechuic acid,Folin-Ciocalteau colorimetric method was conducted to determine the total phenolics. RESULTS:The 2 methods of quantitative analysis showed that the precision,repeatability,recoveries and standard curves were all validated by methodology. The mass fraction of total phenolics was 0.87%-3.77% with the average of 2.16%;the chlorogenic acid was 0.053%-0.387% with the average of 0.192% and the protocatechuic acid was 0.024%-0.541% with the average of 0.087%. The order of total phenolics content in C. sinensis from different areas was Yunnan>Anhui Xuancheng>Sichuan>Hubei and the order of total amount of chlo-rogenic acid and protocatechuic acid from different areas was the same as the total phenolics. There were differences among the con-tents of C. sinensis from different areas,however,the positive correlation was found between the content of total phenolics and the total amount of chlorogenic acid and protocatechuic acid with the pearson correlation coefficient of 0.719(P<0.01).CONCLU-SIONS:The established method is simple,accurate and reproducible and can be used for the content determination of chlorogenic acid,protocatechuic acid and total phenolics in chaenomelis fructus.

Objective To observe the clinical efficacy of comprehensive acupuncture therapy in treating tinnitus in elderly neurosensory deafness. Method Eighty elderly neurosensory deafness patients were randomized into a treatment group and a control group, 40 cases in each group. The control group was intervened by oral administration of Mecobalamin tablets, and the treatment group was intervened by acupuncture plus acupoint injection plus auricular point sticking. The changes of tinnitus intensity after the treatment in the two groups were observed, the clinical efficacies were compared between the two groups, and the correlation between disease duration and therapeutic efficacy was also observed. Result The tinnitus degree was significantly changed after the treatment in both groups (P<0.01). The total effective rate was 83.3% in the treatment group, versus 57.1% in the control group. There was a significant difference in comparing the clinical efficacy between the two groups (P<0.05). In both groups, the clinical efficacy of the patients with a disease duration ≤3 years was significantly different from that of the patients with a disease duration > 3 years in the same groups (P <0.05). Conclusion Comprehensive acupuncture therapy is an effective method in improving tinnitus in elderly neurosensory deafness.

Objective To study the characteristics of the serum free light chain ( sFLC ) and cytokines levels and the effects of cyclophosphamide (CTX) on patients with primary Sj(0)gren's syndrome (pSS) complicated with amyloidosis.Methods Nine patients of pSS with amyloidosis who were admitted to Department of Rheumatology of the hospital from Jan 2005 to Mar 2011 were selected.The serum levels of sFLC and cytokines TNF-α,TGF-β1,IL-4 were measured before and 3,6,12 months after the treatment respectively.Meanwhile,Twelve patients with pSS without complications were selected as controls.Repeated measures analysis of variance was used for data analysis.Results The sFLC in serum of pSS patients with amyloidosis was λ type,the κ type was not found.The level of serum sFLC after 12 months treatment [(22±42) mg/L]was significantly lower than before treatment [(180±15) mg/L].The levels of TNF-α,TGF-β1,IL-4 after 12months treatment [(24.0±1A),(58±5),(38.8±3.2) ng/L,respectively] were significantly lower than before treatment [(31.1±L0),(65±5),(61.2±3.8) ng/L,respectively].Conclusion The levels of serum sFLC and eytokines are abnormally increased in patients of pSS with amyloidosis.After treatment,the levels of cytokines are decreased initially which indicates that these cytokines may play a key role in the pathogenesis of pSS.CTX therapy may lead to better efficacy and more favorable prognosis.

A series of surveillance and management actions was taken to minimize out-of-plan re-operations. These actions include: 1) Building and completing the surveillance and management mechanism against unplanned re-operations; 2) Building a real-time surveillance and reporting mechanism; 3) Enhancing quality control and continuous improvement at the operating departments; 4) Enhancing the supervision on regulations implementation by quality control departments of the hospital; 5) Enhancing quality control for medical records; 6) Building a feedback mechanism for surveillance results; 7) Building a penalty and reward mechanism. Efforts for one year and a half on such surveillance and management proved successful, as the incidence of out-of-plan re-operations fell from 1.7% before these actions to 1.0% afterwards.