The authors expound the idea and service priorities of terminal care, making it clear that pain control and emotional support of relatives after the death of the patient are the major content of terminal care at present. They suggest that nursing in terminal care be implemented according to the situation of our country. Firstly, institutions for terminal care need to be established. Secondly, education of patients, their relatives and medical workers themselves regarding death ought to be strengthened. Thirdly, training in knowledge and skills of consolation should be conducted among nurses. And fourthly, nurses should be encouraged to cultivate noble moral sentiments, enhance training in clinical skills, receive education in psychology, and master nursing skills in psychology so as to do a good job of terminal care.

The animal models of calcium oxalate stones induced by hyperoxaluria, hypercalciuria and lack of vitamin were summaried, and effects of different inhibitors and Chinese traditional medicines on the formation of calculi in animals were discussed.

Objective To evaluate the effects and security of single or combined sufentanil application on sedation and analgesia for mechanically ventilated patients in intensive care unit(ICU).Method A total of 160 ICU patients with mechanical ventilation were randomly allocated into four groups:sufentanil group,sufentanil plus midazolam group,sufentanil plus dexmedetomidine group and fentanyl group.Facial pain scale(FPS),Ramsay score and vital signs were employed to assess the effects of different therapies on organ functions and adverse reactions.Result After the treatment,FPS in all groups were significantly decreased and maintained around 3 points.Ramsay scores were significantly increased(P <0.001)and the score in group given sufentanil combined with midazolam or dexmedetomidine at the time points of30 min,1 h,6 h were even higher.Compared with the preoperative data,indicators of lung function(PaCO2and blood lactic acid),liver function(AST)and renal function(Cr)were decreased in all groups(P <0.05).Respiratory rate in the fentanyl group was significantly higher than the others.Total consumption ofsufentanil in group with combined sufentanil application was significantly lower.No significant differencesin adverse reactions were noticed among the groups(P >0.05).Conclusion For mechanically ventilatedpatients,sufentanil has efficient sedative and analgesic effects with less physiological interference and severe adverse reactions.Combined application is beneficial in decreasing total sufentanil consumption andinhibition to respiratory system,which is worthy of being spread.

Objective To analyze the clinical typing, pathological classisfication, and prognosis of primary IgA nephropathy (IgAN).Methods Clinical typing, pathological classisfication and relationship between clinical manifestations and pathological features of 220 cases with IgAN were analyzed in 10 years.Results IgA nephropathy occupied 42.9％ (220/512) of all the patients received renal biopsy at the corresponding time.Asymptomatic abnormal urinalysis was the most common clinical manifestation(39.0％ (86/ 220)), followed by hypertension (17.7％ (39/220)) and recurrent macroscopic hematuria (15.4％ (34/220)).Grade Ⅲ pathological change(29.5％ (65/220)) was the most co mmon,followed by grade Ⅱ (27.3％ (60/ 220)) and grade Ⅳ (18.2％), Grade Ⅰ/Ⅴ were relatively less ((11.4％ (25/220), 13.6％ (30/220)).No correlation could be found between types of deposited immune complex and pathological lesion extent(x2=4.87, P＞0.05).The clinical manifestations were significantly correlated with the severity of glomerular lesions (x2 =13.14,P＜0.05).During the follow-up for 106 patients (mean duration of 23 months), 90 patients(84.9％) had normal renal function and 75 patients(70.8％) had decreased excretion of protein in urine (＜1 g/24 h).Conclusion The clinical typing of primary IgA is correlated with pathological changes.The prognosis of IgA is markedly correlation with the pathological lesion degree.Renal functions will be improved if the different treatments were given according to the different renal pathological features.

AIM: To analyze the characteristics of internal fixation implantation therapy for comminuted patella fracture. METHODS: A computer-based search of Pubmed database and Chinese Journal Full-text Database was undertaken, and the quotations of each literature were checked after the primary screening. Inclusion criteria: the papers about the application of internal fixation materials in comminuted patella fracture, those published in authority journals within recent five years were preferred. Exclusion criteria: repeated study or Meta analysis. RESULTS: Internal fixation approach differs as the fracture type. Tension band fixation is generally accepted to treat transverse patella fracture. Kirschner wire plus tension band fixation are inferior to transverse fixation, but in comminuted fracture it can induce more complications; despite of wide application, nickel titanium patella fixator is unsuitable for comminuted fractures due to its hypersensibility and carcinogenicity; silk or steel wire loop fixation fits various comminuted fractures, but metal cerclage is predisposed to induce infection and breakage because of insufficient fixation force. CONCLUSION: There is no common way for comminuted patella fracture therapy. Further researches on material and method which can cure all kinds of comminuted patella fracture are still needed.

Objective To explore the quality control method of leucodepleted red cell concentrate (LDRC) preparation ,to choice an optimal processing , in order to raise the quality of LDRC,so as to ensure the efficiency and safty for the preparation application.Methods 62 bag red cells concentrates suspensin(each 150ml,preparation from 200ml whole blood) were investigated.By linear regression multianalyzed the effects of some factors on efficiency for removal of leukocytes from red cell concentrates.Free hemoglobin value(n=8) was detected before and after leukodepleted filtration.1% samples were tested and bacterial cultured,and observed the clinical adverse effects after LDRC tranfusion.Results ⑴The plasma and platelet in red cell contentrate before filtration,the time of filtration had influence significantly on the result of leukocyte depletion.⑵The percentage of leukodepleted red cell in which residual leukocyte less than 5?10 6/unit and 1?10 6/unit were 100% and 46.9%. The percentage of leukodepleted red cell in which the leukocyte removal efficiency more than 2log(99%)and 3log(99.9%) were 100% and 56.1% .After controlling the time of filtration,the percentage of leukodepleted red cell in which residual leukocyte less than 1?10 6/unit was up from 46.9% to 90.91% and the percentage of leukodepleted red cell in which the leukocyte removal efficiency more than 3log(99.9%)/bag was up from 56.1% to 78.1%.⑶Red blood cell recovery rate was (90.48?4.73)%. There was no significant change of free hemoglublin before and after filtration.⑷No bacteria were detected by germiculture.⑸Evident side effects was no seen after transfusion.Conclusions During the course of removal of leukocytes from red cell concentrates by filtration, the sustained quality control is necessary for improving the quality of leukodepleted red cell.So enforcing aseptic manipulation rigorously and controlling the components of blood,the time of blood storage and filtration appropriately are quite important.

Objective To explore the clinical values of holter among different types of pacemaker postoperations .Methods Selected 120 patients undergoing pacemaker implantation from November 2013 to October 2014 ,who also received holter examina-tion after operation .The sensing and pacing dysfunction and pacemaker associated arrhythmia were analyzed according to their hol-ter results .Results In the DDD group ,the detection rate of the ventricular premature contraction ,the atrial premature contraction , the paroxysmal atrial tachycardia ,the paroxysmal atrial fibrillation and the paroxysmal supraventricular tachycardia were 38 .9% , 44 .4% ,8 .3% ,2 .8% and 2 .8% ,respectively .In the DDD group ,the detection rate of the sensing and pacing dysfunction and pace-maker associated arrhythmia was 69 .4% ,which was significantly higher ( P < 0 .05) than that in the VVI group (42 .5% ) ,the VVIR group(30 .0% ) ,the DDDR group(31 .3% ) and the AAI group(25 .0% ) ,respectively .In the VVI group ,the positive rate of the ventricular premature contraction ,the atrial premature contraction ,the paroxysmal atrial tachycardia ,the paroxysmal atrial fi-brillation and the paroxysmal supraventricular tachycardia were 37 .5% ,42 .5% ,10 .0% ,17 .5% and 2 .5% ,respectively .In the VVIR group ,the appearance rate of the ventricular premature contraction ,the atrial premature contraction and the paroxysmal atrial tachycardia were 25 .0% ,25 .0% and 5 .0% ,respectively .In the DDDR group ,the detectable rate of the ventricular premature con-traction ,the atrial premature contraction ,the paroxysmal atrial tachycardia and the paroxysmal atrial fibrillation were 31 .3% , 25 .0% ,12 .5% and 12 .5% ,respectively .Finally ,in the AAI group ,the detection rate of the ventricular premature contraction and the atrial premature contraction were 25 .0% each .Conclusion The clinical application of holter can evaluate the working states of different types of pacemakers ,and can monitor the sensing ,the pacing dysfunction and the pacemaker associated arrhythmia .

Objective Ouabain is a cardiotonic steroid that can induce the apoptosis of many tumorous cells .This study was to investigate the anti-tumor mechanisms of ouabain by observing its effects on the apoptosis of T lymphoblastic leukemia Jurkat cells and the expressions of hTERT and c-myc mRNA and protein . Methods Jurkat cells were treated with ouabain at the concentrations of 50 and 100 nmol/L for 24 and 48 hours, and those treated with 1 ×PBS served as the control .Then the apoptosis rate of the cells was detected by flow cytometry after Annexin V/PI staining, the expressions of hTERT and c-myc mRNA determined by RT-PCR, and those of hTERT and c-myc protein by Western blot . Results The apoptosis rates of the Jurkat cells in the 50 and 100 nmol/L oua-bain groups were (5.67 ±3.71)%and (9.63 ±4.83)%respectively at 24 hours, and (19.67 ±4.55)%and (37.60 ±11.89)%at 48 hours, significantly higher than (4.23 ±1.01)%in the PBS control group at 48 hours (P<0.05).Compared with the control, the expressions of hTERT and c-myc mRNA were decreased by 200%and those of hTERT and c-myc protein by 224%and 400%, re-spectively, at 48 hours (P<0.05).There was a positive correlation between the reduction of the mRNA levels and that of the protein levels of hTERT and c-myc (P<0.05). Conclusion Ouabain can down-regulate the mRNA and protein expressions of hTERT and c-myc, which may be one of the mechanisms of its induction of the apoptosis of Jurkat T lymphocyte leukemia cells .

[Objective]To study the effects of titanium cable system used as a treatment alternative for comminuted patella fractures.[Method]Fifty-seven cases of comminuted patella fractures were treated from November 2004 to August 2007.The patients were divided into three groups:the group of titanium cables,AO modified tension band and nickel titanium-patella catcher respectively,according to the choice of internal fixation.The operation time,the amount of blood loss,the first knee exercise time after operation,length of hospitalisation,medical expenses,time off for employees,complication and long-term knee function were studied.All the data were analyzed and compared by statistical ways.[Result]The 57 patients were followed up for 11 to 48months(means,22.4 m).Patients who were fixed with titanium cables could start most early extending and flexing the knee(5.6 d after operation),but most expense in medical usages(9500 RMB).The good or excellence rate was 95.1% in patients treated with titanium cables cerclage,which was better than that of the other two groups.[Conclusion]Titanium cables cerclage can cure comminuted patella fractures.The method had advantage of better long-term curative effect and less complication,and so on.It's worthy to be recommended for the therapy of comminuted patella fracture.

Objective To establish a method for the determination of 14 kinds of lanthanide (La) series elements in human feces at the same time by ICP-MS.Methods In January 2009,human feces were collected for three consecutive days from 30 subjects in Tianjin area,the fecal samples for the three-day period were weighed and homogenized;then dried;grinded and ashed,the samples were digested by HNO3 before determination.The solution was directly analyzed by ICP-MS to determine the concentrations of the 14 kinds of La series elements in human faces with rhenium (Re) internal standard calibration.Results The linear ranges were 0-10 ?g/L with a correlation coefficient for each element of more than 0.999.The detection limits of 139La,140Ce,141Pr,143Nd,147Sm,151Eu,158Gd,159Tb,163Dy,165Ho,166Er,169Tm,174Yb and 175Lu in human feces were 0.48,0.49,0.47,1.6,1.9,0.46,0.79,0.18,0.65,0.39,0.38,0.17,0.09 and 0.09 ng/L respectively.The recoveries of this method were 93.42%-108.21%,and RSDs were 2.91%-9.20%.The analytical values of the certified reference material of human hair GBW 09101a by this method showed closed agreement with the reference values.Conclusion This method has relatively higher sensitivity and less interference,and is applicable to the rapid determination of 14 kinds of La series elements in human faces at the same time.