In this study, the factors caused deterioration and death in 40 pationts who had talked after head injury were analysed. It showed that the intracranial hematoma was the most common cause of deterioration and death (67. 5%), and therefore early diagnosis and surgical treatment of hematoma are very important for these patients. For the patients with intracranial hematoma, selection of indication of the conservation treatment must be more careful and strict. If the ICP monitor or a series of CT-sean could not be used in time, surgical treatment should be choiced more actively in these patients. Some patients whose hematomas were not found by CT-scan or even postoperative conditions had been improved could get deterioration again, thus more attention must be paid to the occurrences of delayed intracranial hematomas. The postoperative complications were another kind of factors responsibe to death, such as pulmonary infection, intracranial infection, gastrointestinal bleeding and so on(22. 5%). The corresponding preventive measures should be taken more effectively according to circomstances.

Objective To summarize perioperative nursing of babyport embedded.Methods The preoperative nursing included adequate preoperative evaluation,paying more attention to psychological nursing care for children and their families,introducing babyport characteristics and daily care,eliminating ideological concerns of children and their families; assisting relevant preoperative preparation.After surgery,children were under close observation of vital signs,the surface skin condition of the infusion port implanted,pain management,catering management,psychological care,standardization of nursing,treatment of common problems,enhanced education for discharge.Tracking files were established for each children with babyport implanted,regular follow-up tracing was given.Results Among 59 cases,58 cases were without complications,babyport of one case was removed due to infection.After followed-up for 3～18 months after discharge,58 cases of babyport embedded patients were without complications,patients and families expressed satisfaction.Conclusions Standardized perioperative nursing of babyport embedded surgery and standardized service of tracking and return service can ensure patients' safety and improve the patients'quality of life,increase service quality and patients' satisfaction.

To observe the influence of Mycobacterium tuberculosis 19-kDa lipoprotein (Mtb P19) on function and phenotype of macrophage,the Mtb P19 was prepared from cultured Mtb H37Ra and the phorbol myristate acetate-differentiated THP-1 cells were incubated with P19 at the concentration of 10 μg/mL with 5% CO_2 at 37℃ for up to 48 hours.Supernatants were collected for TNF-α and IL-6 detection by ELISA,then the phenotype fluorescent antibodies were stained to analyze HLA-DR expression changes between control group and experimental group.Flow cytometry and microscopy was used to assay the phagocytosis in macrophages stimulated by Mtb P19.IL-6 and TNF-α in collected supernatants were detected.Results indicated that both were found significant increases and their phagocytosis were enhanced.Comparing to the control group,the mean fluorescence intensity showed a significant increase 24hs after stimulation.It presents that Mtb P19 could be able to induce macrophages activation,and it would be significantly important for protection during infection period.

To observe the effect of Mycobacterium tuberculosis 19 kDa lipoprotein (Mtb P19) upon the expression and distribution of Toll-like receptor-2 (TLR-2) on the surface of macrophages, Mtb P19 was prepared from the cultured M.tuberculosis H37 Ra strain , and phorbol myristatye acetate (PMA)-differentiated THP-1 cells were co-cultivated with Mtb P19 at concentration of 10 g/mL and at 37 ℃ temperature and a condition containing 5% CO_2.for 6 hours.. The distribution of TLP-2 on the surface of macrophages was investigated by immuno-cellular chemical method (ICC) while the effect of Mtb P19 upon the expression of TLR on the surface of macrophages was assayed by fluorescent antibody staining. In addition,the changes of TLR-2 expression before and after the effect of Mtb P19 were investigated by flow cytometry analysis and change of TLR-2 arrangement after stimulation with Mth P19 was determined by co-focal microscopy. It was found that the TLR-2 molecules were evenly distributed on the surface of macrophages as demonstrated by ICC. The mean fluorescent intensity increased significantly after stimulation with Mtb P19 for 6 hours in comparison with that of the control group, and the patchy surface with fluorescent staining positive zones could be detected on the surface of macrophages. Nevertheless , the distribution of TLR-2 molecule in the control group appeared to be randomly dynamic. It is evident that the Mth P19 not only can induce the surface expression of TLR-2 molecules, but also cause a functional aggregation of this receptor.

Objective To study the clinical characteristics and potential influencing factors of rehabilitation of cognition in post-stroke patients with aphasia.methods Forty-one patients with aphasia after ischemic stroke,admitted to Nanfang hospital and Nanfang Yanling Hospital from June 2015 to November 2016 were included.Their primary clinical information and NIHSS scores were registered.In acute phase,Aphasia Battery of Chinese and Boston Diagnostic Aphasia Examination was used to evaluate language ability and classify the aphasia type.Non-language-based Cognitive assessment (NLCA) was used to assess patients' nonlinguistic cognition.Besides,the assessment of post-stroke depression and dependence degree of daily living activities were performed.3 months later,patients were evaluated again.A total of 30 aphasia patients completed the final follow-up.Result s(1) Compared with the baseline in patients with aphasia after stoke,all domains of language ability were significantly improved after 3 months(P<0.05).(2)Every nonlinguistic cognitive score was significantly increased within 3 months(total NLCA score(65.83±13.02 vs 48.00±25.11),memory(17.23±2.49 vs 13.30±5.42),visual spatial ability(10.67±2.43 vs 8.07±3.75),logical reasoning ability(6.53±1.48 vs 4.97±2.43),attention(25.57±5.79 vs 17.43±12.33),executive function(5.77±3.47 vs 4.20±4.23),all P<0.01).(3)The NLCA total score (62.40±14.23 vs 72.70±6.34)and scores in visual spatial (9.95±2.67 vs 12.10±0.74)and abstract reasoning(6.05±1.54 vs 7.50±0.71) of persisting aphasia patients were significantly lower than that of aphasia recovered group(all P<0.05).(4) Multivariate regression showed that initial NLCA score had a negative predictive effect on cognitive function improvement of aphasia patients 3 months after stroke(β=-0.603,P<0.01).Conclusion The rehabilitation of cognitive function in patients with aphasia after stroke is similar to that of language function.Patients with persisting aphasia may have worse performance on nonlinguistic cognition and ability of daily living,even with more serious depressive emotion.Evaluation of nonlinguistic cognition in post-stroke aphasia patients in acute phase is necessary and the score seems to be an important predicting factor of 3-month cognition.

Objective To investigate the inhibitive effect of siRNA(small interfering RNA,siRNA) on the phosphodiesterase type 5(PDE5) in smooth muscle cells of human corpus cavernosum,and provide experimental groundwork for the gene therapy of erectile dysfunction (ED). Methods Small interfering RNAs targeting PDE5 gene were systhesized by using web design software provided by Ambion,there siRNAs and control siRNA were systhesized by Ambion. SiRNAs were transfected into smooth muscle cells of human corpus cavernosum by using siPORTTM Lipid reagent;down-regulation of PDE5 mRNA was detected by RT-PCR;the inhibitive effect of PDE5 was detected by Western Blotting. Results The results of RT-PCR indicated siRNA1、siRNA2 and siRNA3 made down-regulations of PDE5 mRNA expression in the transfected groups 58.2%、14.9% and 11.8%;the PDE5 expression decreased 70.5%、19.8% and 17.3%;however the expression did not have different in control siRNA and frank group. Conclusions The synthesized siRNAs in vitro were able to down-regulate the expression of PDE5.There were different capabilities of the specific siRNAs down-regulation.It was suggested that the siRNA technique provide not only an extremely powerful tool for the functional analysis of genome but also a new method for ED gene therapy.

Objective: To understand the awareness of palliative care and its influencing factors in community residents in Hangzhou,so as to provide basis for the development of palliative care service. Methods: By convenient sampling method,the residents in the urban-rural junction of Xihu District were recruited. A self-designed questionnaire was used to investigate their awareness of palliative care. The logistic regression model was employed to analyze the influencing factors. Results : A total of 519 questionnaires were recovered,with a response rate of 97.92%. There were 227 males and 292 females,accounting for 43.74% and 56.26%,respectively. There were 43,218 and 258 residents with more,basic and little understanding about palliative care, accounting for 8.29%,42.00% and 49.71%. The residents learned about palliative care mainly through television and radio,with 245 cases accounting for 47.21%;and they thought that the main reason for low awareness of palliative care was a lack of related knowledge,with 396 cases accounting for 76.30%. The results of multivariate logistic regression analysis showed that 50-59 years old（OR = 0.467,95% CI：0.285-0.767）,primary school education and below（OR = 2.248,95%CI：1.239-4.079）and experience of caring for dying patients（OR = 1.551,95% CI：1.094-2.199）were the influencing factors for the awareness of palliative care. Conclusion The residents in Hangzhou had relatively low awareness of palliative care,which were associated with age,education level and experience of caring for dying patients.

A 55-year-old male patient presented with tense bullae on the extremities and trunk.Histological examination revealed subepidermal vesicles and superficial dermal infiltration of eosinophils and lymphocytes.The patient was primarily diagnosed with bullous pemphigoid.However,serum autoantibodies of the patient bound to the dermal side of salt-split skin,and no serum antibodies against BP180,BP230 or type Ⅶ collagen were detected by enzyme-linked immunosorbent assay.Hence,the diagnoses of bullous pemphigoid and epidermolysis bullosa acquisita were excluded.As Western blot and immunoprecipitation analysis showed,there existed antibodies capable of binding to a dermal antigen with a relative molecular mass of 200 000 in the serum of the patient.Based on the above findings,the patient was diagnosed as anti-laminin γ1 (p200) pemphigoid.

Objective To investigate the effects of abdominal breathing training on sleep disorders in elderly patients with chronic heart failure. Methods Total of 100 patients with chronic heart failure complain of sleeping disorders and Pittsburgh Sleep Quality Index (PSQI)>7 points were assigned into two groups by random digits table method, 50 cases in each group. The observation group and the control group were nursed in the same way except that abdominal breathing was adapted to the observation group. Sleep status, heart rate, blood pressure, SpO2 and brain natriuretic peptide (BNP) were evaluated before training, one week and eight weeks after training respectively. Statistics was used to analyze the differences between two groups. Results After training one week, the sleep status of the observation group was ameliorated, but without significant difference compared to the control group (P>0.05). And after training eight weeks, the PSQI, BNP and heart rate were (9.21 ± 6.38) points, (193.78 ± 152.16) μg/L, (63.5 ± 10.8) times/min in the observation group, and (12.92 ± 0.33) points, (417.55 ± 262.47) μg/L, (70.7 ± 8.5) times/min in the control group, and there was significant differences between 2 groups (t=3.627, 2.041, 2.767, all P < 0.05), while the blood pressure, SpO2 did not change obviously(P>0.05). Conclusions Abdominal breathing training could ameliorate sleep status in elderly patients with chronic heart failure.

Background and purpose:Huachansu has been widely used to treat cancer in China.But maximum tolerated dose(MTD) of huachansu is still not well defined.The purpose of this study was to conduct a Phase Ⅰ study to determine the MTD of huachansu in the treatment of patients with hepatocellular carcinoma,non-small cell lung or pancreatic cancer.Toxic profile and efficacy of huachansu were also assessed qualitatively.Methods:Huachansu was intravenously administered to patients with stage Ⅲ/Ⅳ hepatocellular carcinoma,non-small cell lung cancer,or pancreatic cancer.Each cycle consisted of daily huachansu for 14 days with an interval of 7 days between two cycles.2 or more cycles were delivered to the patients if no severe adverse event occurred.The planned dose escalation schedule for huachansu was as follows,10,20,40,60,90 and 120 ml/(m2?d).Results:Fifteen patients(3 at each level) have been recruited to the study(11 with hepatocellular carcinoma,2 with pancreatic cancer,and 2 with lung cancer).There were no dose limiting toxicities found after dose level 5.Among all these patients,the efficacy in 14 patients could be valued,in which,6 were SD(42.9%),8 were PD(57.1%).At dose level 1,there was one patient with hepatocellular carcinoma achieving a 20% reduction in tumor mass that lasted 11 months,6 of 15(42.9%) patients with stable disease and 8 of 15(57.1%) with progress disease after the treatment.Conclusions:To date,dose limiting toxicity has not been seen with doses up to eight times higher than that typically used before.Of interest, several patients had prolonged stable disease or minor tumor shrinkage.