Natural orifice translumenal endoscopic surgery(NOTES)is a surgical technique which is performed with an endoscope passed through a natural orifice,and then through an internal incision in the viscera(stomach,vagina or rectum)to perform intraabdominal operations.Since the first successful transgastric appendectomy performed by Dr.Rao and Reddy in 2004,NOTES is developing rapidly.The advantages of NOTES include no injury and scar in the body surface;lower anesthesia requirements;faster recovery and shorter hospital stays;avoidance of transabdominal wound infections.NOTES can also be applied to patients who are not suitable for open surgery and lapascopic surgery.NOTES has the potential to revolutionize the field of minimally invasive surgery by eliminating abdominal incisions,however,the safety and efficacy of NOTES still needs to be investigated in lhe future.

Fibronectin in normal human breast tissue and in breast tumors were stu-died by immuno-gold silver staining method.In normal mammary tissue,fibronectin was present in basement membrane and stroma but absent in epi-thelial cells.Changed distribution pattern was observed in benign tumorsand malignant tumors,there was an appearance of fibronectin in epithelialcells of acini and ductules and decreased in stroma.The differences wasthat fibronectin decreased in basement membrane in benign tumors and dis-appeared in that of malignant tumors which reflect to some extent the inva-sive nature of tumors.

ObjectiveTo investigate the application and effect of problem-based learning ( Problem-based learning,PBL ) pedagogy in theoretical teaching of pediatric nursing.MethodsThe two nursing classes in the same grade were selected respectively as a control group of 62 people and research group of 62 people.Traditional pedagogy was taken in control group to give lessons for theory pediatric nursing,while PBL pedagogy was taken in research group to give lessons ftr theory pediatric nursing.At the end of the semester,students' scores in theory exam,practice exam and case care were analyzed by using t tests.ResultsThe results of the two groups of students were compared,with t value 4.96 of the theoretical results,t value 5.312 of the experimental results,t value 8.06 of the case study,and P ＜0.05 in three items,suggesting statistically significant difference.ConclusionsPBL pedagogy can raise nursing students' learning interest in the theory of pediatric nursing,and improve teaching effect on theory of pediatric nursing.

Microwave ablation(MA)has been one of the most quickly developed minimally invasive techniques for trearing hepatocellular carcinoma(HCC)in the last decade.Under accurate imaging guidance,MA shares the common advantages of thermal ablation such as flexible treatment approaches,good tolerability and the ability to consistently create reproducible and predictable necrotic areas.It also exhibits several particular advantages compared with other thermal ablation methods,including higher thermal efficiency,higher capability of coagulating blood vessels,faster ablation time,and an improved convention profile.Over the years,MA equipments,especially the antenna,have been refined for safety and to increase the coagulation zone.With the development of internally-cooled antenna and using the frequency of 915 MHz nficrowave,the technique is becoming safer and the coagulation zone increased significantly.Initially,MA was limited to the treatment of small HCC,but with the improvement of antenna and treatment strategV,large HCC(＞5 cm)can also be ablated effectively.For the"curative"treatment of HCC.the following eriteria need to be met:single HCC with the lesion of 6 am or smaller;three or fewer HCC lesions with a maximum diameter of 4 cm,and absence of portal vein thrombosis or extrahepatic metastases.A five-year cumulative survival rate has exceeded 50%,which is comparable with resection.Moreover,the local immune function is enhanced after MA.A change in immunocyte infiltration takes place in number,configuration and location after patients with HCC are treated with MA.Further research for MA may be focused on the improvement of the maneuverability of the equipment,increase of the accuracy of antenna puncture and consummate the clinical therapeutic standardization.

Objective To discuss the influence of follow-up intervention on disease control of pa-tients with diabetes mellitus. Methods 160 patients who received education about diabetes mellitus were divided into the intervention group and the control group randomly according to the date of dis-charge with 80 patients in each group.The intervention group was given regular follow-up visit (including telephone fol-low-up) which lasted 12 months.The control group received no regular foUow-up.The health behavior,self-management ability and alleviation state of cognition level,fast glucose, glycosylated hemoglobin were com-pared after intervention between the two groups by t test andχ2 test. Results The health behavior,self-management ability and alleviation state of cognition level in the intervention group were better than those of the control group.The blood glucose 6 and 12 months after discharge was higher than that at the time of dis-charge and that of the intervention group at the same time point.The glyeosylated hemoglobin of the interven-tion group was reduced 6 and 12 months after discharge compared with that at the time of dis-charge. Conclusions Out-of-hospital follow-up is an effective method to extend hospital health educa-tion to patients' home. It can instruct and supervise the patients to assume the responsibility of subsequent targets control,so it plays a positive role in the blood glucose control,improvement of life quality and promo-tion of psychological and physical health.It is worthy of wide popularization.

OBJECTIVE:To control the drug quality risk in drug withdrawal links of hospital pharmacy,and provide reference for the application of quality risk management(QRM)in hospital pharmacy. METHODS:Drug QRM was developed in drug with-drawal links through risk identification,risk assessment,risk control,risk assessment and other steps. Using the incidence of risk factors and reusable rate of withdrawal drug as indexes,related data of before(Jul.-Dec. 2015)and after(Jan.-Jun. 2016)devel-oping QRM in our hospital were compared to evaluate the effect of drug QRM. RESULTS:Determining whether specific storage drugs kept the required storage conditions,whether the numbers of withdrawal drugs counted to minimal packaging and other 5 fac-tors were high-risk factors(the risk score of each factor>4 points);control measures were taken separately for high risk factors, then high-risk factors were reduced to acceptable levels(risk score<4 points). After developing QRM,the incidence of risk factors were reduced than before(reduce 1.35%-6.19%),reusable rate of withdrawal drug was increased(98.64% vs. 86.32%)(all P<0.05). CONCLUSIONS:Developing QRM in drug withdrawal links of hospital pharmacy can reduce the drug quality risk.

Objective:To investigate the changes of humoral and cellular immunity markers in various liver disease by ABO blood group,the reliable evidences were provided.Methods:The cases of 500 health men (NC) as contrals,various acute and chronic liver disease with the positive index of hepatitis B which include acute hepatitis (ASC) 140 cases,chronic hepatitis (CH) 192 cases,post-hepatitis cirrhosis (LC) 160 cases,primary hepatocellular carcinoma (PHC) 70 cases were examined by immune-spresding assay,APAAP immune-bridge assay and so on in the study,the changes of serumal IgG,IgM,IgA,IgD,Ige,complement C_3(C_3),total complment (CH50),circulatory,immune complex (CIC),E-rosetter formation rate (E-RFC) and T-lymphocyte subsets in the group of NC,ASC,CH,LC and PHC were investigated respectively. Results:Compared to contrals,the humoral immune markers of all groups of liver disease changed markedly,Ige increased changed apparently and IgG increased.Secondly from ASC,CH,LC, to PHC,mean while,C_3 and CIC increased obviously and E-RFC decreased obviously in the group of PHC.Compared to the group of other blood type incresed markedly (P