Objective To summarize our experiences in the long-term continuous maintenance of the peripherally inserted central catheter (PICC) in a patient with intestinal fistula.Method The systematic holistic nursing care has been provided according to the nursing practices to a patient with intestinal fistula since 2006,during which eitht PICCs were used successively.Results The eight PICCs were placed for 3-14 months.The 1 st,3rd,5th,and 7th cathers were retained for 12,13,11,and 14 months.The second catheter was retained for 6 months,and then removed due to increased body temperature (38.7℃).The 4th cather was retained for 3 months,then catheter-related bloodstream infection was suspected due to high body temperature (39℃) ; culture for fungi at the tip showed positive results.The 6th catheter was retained for 7 months,inserting from jugular vein to the superior vena cava; however,it was removed due to puncture point local purulent changes at the puncture site.The 8th catheter was applied for 8 months,but was rmoved due to tube occlusion,which responded poorly to urokinase.Conclusion The application of PICC in patients with fistula can relieve the pain and improve the quality of life.

Colonic neoplasms is the third most commonly diagnosed cancer in men and second most commonlv diagnosed cancer in women worldwide.The morbidity of Colonic neoplasms is increasing year by year.Despite the fact that surgery is still the main treatment for patients with colon cancer,surgery alone hasn't improved the treatment effectiveness.The current management of colon cancer has come to multidisciplinary team (MDT) modality.MDT modality could offer the optimal treatment option and the internal communication.Under the pattern of MDT which integrates the surgery,chemotherapy,radiotherapy,interventional therapy,targeted therapy and immune therapy,there has been a big progress in the diagnosis and treatment of colon cancer.Patients with metastatic colon cancer should undergo a discussion by a multidisciplinary team before the initial treatment.

Objective To understand the actual psychological conditions of pregnant patients with gynecologic malignancies during chemotherapy so as to instruct the nurses to provide individualized psychological care to the patients and their relatives. Method The in-depth interviews were conducted to 7 patients by implementing the phenomenological approach of qualitative study. The acquired data were analyzed. Result The patients experienced four psychological conditions: pessimism about prognosis, anxiety to know more about the chemotherapy and guilty to their family and hope for treatment effect. Conclusion Nurses should pay attention to the psychological conditions of pregnant patients with gynecologic malignancies and help them successfully live through the treatment.

This study was aimed to evaluate the efficacy and safety of Y ixin Tongmai Decoction in prevention and treatment of diabetes mellitus complicated with coronary heart disease ( CHD ) after coronary stenting restenosis . Sixty cases were randomly divided into the conventional western medicine treatment plus Y ixin Tongmai Decoction group ( treatment group ) and conventional treatment of western medicine group ( control group ) . Observation was given on the in-stent restenosis before treatment and one-year after treatment . And the traditional Chinese medicine ( TCM ) Syndrome Scale , changes of single symptom in TCM syndrome , effect of Y ixin Tongmai Decoction on blood glucose and other adverse reactions were also observed before and one-year after treatment . The results showed that in the curative effect evaluation , the restenosis rate of treatment group was 6 . 90%, and the restenosis rate of control group was 17 . 24%. There was significant difference be-tween two groups ( P < 0 . 05 ) . According to the standard of TCM syndrome curative effect , the total effective-ness in the treatment group was 86 . 21%, and that of the control group was 31 . 03%. And there was signifi-cant difference between two groups ( P < 0 . 05 ) . In the safety evaluation , there were no obvious abnormalities during safety detection in the clinical study of two groups. There was no influence on blood sugar levels. And no drug related adverse reactions occurred . It was concluded that Y ixin Tongmai Decoction can reduce coro-nary stent restenosis rate in diabetes complicated with CHD (chest pain) with the syndrome of qi deficiency and blood stasis , phlegm-turbid stasis . It can significantly improve the TCM syndrome and single symptom of patients with good safety .

Objective To evaluate the effects of dexmedetomidine on action potential in isolated rabbit sinoatrial node cells.Methods Twenty-four healthy New Zealand rabbits of both sexes,weighing 1.5-2.5 kg,were sacrificed.Their hearts were removed and sinoatrial nodes were dissected and placed in Tyrode solution.Sixty isolated sinoatrial nodes were randomly divided into 6 groups (n =10 each):control group (group C),0.5 ng/ml dexmedetomedine group (group D1),5.0 ng/ml dexmedetomedine group (group D2),dexmedetomidine 5.0 ng/ml + yohimbine 1 μmol/L (alpha 2-adrenoreceptor antagonist) group (group D2 + Y),dexmedetomidine 5.0 ng/ml + 2 mmol/L CsCl (blocker of pacemaker current) group (group D2 + C),and dexmedetomidine 50.0 ng/ml group (group D3).After perfusion with the Tyrode' s solution for 60 min,C group was perfused with Tyrode' s solution for another 40 min,D1-3 groups were perfused with Tyrode's solution cont(a)ining dexmedetomedine 0.5,5.0 and 50.0 ng/ml,respectively,for40 min,and D2 + Y and D2 + C groups were perfused with Tyrode' s solution containing 1 μmol/L yohimbine and 2 mmol/L CsCl,respectively,for 20 min,and then 5.0 ng/ml dexmedetomedine was added and sinoatrial nodes were perfused for 20 min.Maximal rate of depolarization (Vmax),amplitude of action potential (APA),action potential duration at 50％ and 90％ repolarization (APDso and APD90),velocity of diastolic (phase 4) depolarization (VDD),and rate of pacemaker firing (RPF) were recorded at 60 min of perfusion with Tyrode' s solution (T1),20 min of perfusion with yohimbine or CsCl (T2) and termination of perfusion with dexmedetomedine (T3).Results Compared with group C,APA,VDD and RPF were gradually decreased at T2,3 in groups D1-3 (P ＜ 0.05),and there was no significant difference in Vmax,APD50 and APD9o among C and D1-3 groups (P ＞ 0.05).VDD and RPF at T2 in group D2 + C and APA,VDD and RPF at T3 in groups D2 + Y and D2 + C were significantly lower than those at T1 (P ＜ 0.05).APA,VDD and RPF in group D2 + Y and APA in group D2 + C were significantly lower at T3 than at T2 (P ＜ 0.05).Conclusion Dexmedetomidine can decrease the sinoatrial node autorhythmicity in a concentration-dependent manner in rabbits,and the mechanism may be related to the inhibition of pacemaker current,but not alpha 2-adrenoreceptor.

Objective To evaluate the effects of real-time continuous glucose monitoring (RT-CGM) system on oxidative stress and mortality in critically ill patients and to explore the correlation between glucose index,oxidative stress and mortality.Methods Selected 123 cases of critically ill patients were enrolled in this prospective randomized controlled study.They were randomly divided into the RT-CGM group(n =61) and blood glucose meter group (GM group,n =62).The following parameters were compared between the two groups:mean amplitude of glucose excursions (MAGE),hypoglycemia incidence,low blood glucose index (LBGI),high blood glucose index (HBGI),28-day mortality and plasma level of 8-iso-PGF2α (8-iso) at 48 hours (R2),72 hours (R3) and 96 hours(R4) after admission to ICU.The correlation between glucose index and plasma level of 8-iso-PGF2α were analyzed.The correlation between glucose index,plasma 8-iso level and 28-day death were analyzed.Results The parameters of MAGE,hypoglycemia incidence,LBGI and HBG1 in the RT-CGM group and the GM group were (3.73 ±1.09) mmol/Land (4.19±1.11)mmol/L(P=0.02),3.28％ and 14.52％(P=0.03),0.0011 and 0.0119 (P ＜ 0.01) and 0.2258 and 0.3697 (P ＜ 0.01),respectively.The plasma levels of 8-iso at R2,R3,R4 in the RT-CGM group and the GM group were (111.44 ± 16.99) ng/L and (114.03 ± 14.64) ng/L(P=0.37),(94.53 ±14.92)ng/L and (110.31 ±13.42) ng/L(P＜0.01) and (57.84±12.22) ng/L and (84.41 ± 14.16)ng/L(P ＜0.01),respectively.The r values between MAGE,LBGI,HBGI and the plasma level of 8-iso were 0.69,0.71 and 0.67,respectively (all P values ＜ 0.01).Multivariate stepwise regression analysis showed MAGE,LBGI,HBGI entered final models (corrected R2 =0.61,P ＜ 0.01) with β values of 0.64,0.65 and 0.6 respectively(all P values ＜0.01).The 28-day mortality in the RT-CGM group and the GM group was 9.84％ and 30.65％ (P ＜0.01).The OR values of MAGE,hypoglycemia incidence,LBGI,HBGI and the plasma level of 8-iso for 28-day death were 2.14 (0.98-4.35),3.43 (1.12-5.82),2.67 (1.01-5.14),1.32 (0.24-2.96) and 1.89 (0.67-3.44),respectively.Conclusion RT-CGM can optimize the care in critically ill patients by improving hypoglycemia,hyperglycemia,glucose variability and oxidative stress and bring more detailed concern in the process,and to reduce the mortality.

Objective　To explore the effects of hypoxia on the syntheses and secretion of adrenomedullin (AM), calcitonin gene related peptide (CGRP) and c-type natriuretic peptide (CNP) and the relationship between these peptides. Methods　Rat models were established with hypoxia for 10, 20 and 30 d respectively and rats under normal altitude were served as control. Pulmonary artery pressure and the maximum increasing speed of right ventricle (RVdp/dtmax) were measured in every group. The dynamic changes of AM, CGRP and CNP concentrations in plasma were studied with radioimmunoassay. Results　During hypoxia, pulmonary artery pressure and RVdp/dtmax were enhanced. Plasma AM and CNP concentrations were increased while CGRP was decreased significantly. The plasma level of AM had positive correlation with that of CNP, but negatively correlated with that of CGRP. Conclusion　Results indicate that hypoxia may cause pulmonary artery pressure change and right ventricle has compensatory reaction to hypoxic pulmonary hypertension. Dynamic changes of plasma AM, CGRP and CNP concentrations can be regarded as indexes for condition of illness.

Objective:This study aimed to investigate the associations between single-nucleotide polymorphism (SNP) of IGF-1 and IGFBP-3 gene and risk of non-smoking female lung cancer in Chinese population. Methods:Genotyping was performed using the TaqMan method in 287 histologically confirmed non-smoking female lung cancer cases and 281 healthy controls. Results:The geno-type distributions of IGF-1 polymorphisms were significantly different between cases and controls (P<0.001). Analysis of multivariate logistic regression showed that the carriers of the CC genotype exhibited a significantly decreased risk of lung cancer in non-smoking female (adjusted OR=0.28, 95%CI:0.15-0.54). IGF-1 rs1520220 GG genotype may reduce the risk of advanced lung cancer incidence in nonsmoking female (adjusted OR=0.30, 95%CI:0.09-0.96). Log-rank test and Cox regression analyses revealed that variant geno-types of IGF-1 rs2946834 CT/TT had a significantly decreased lung cancer mortality risk compared with the homozygote CC in≥60 age group or patients with a lung tumor>3 cm. Conclusion:The IGF-1 polymorphism was associated with the risk of lung cancer and prognosis among non-smoking female. More rigorous laboratory studies of large sample population and functional studies are warrant-ed to confirm our findings.

Objective To explore the influence of self care interaction mode on the health behavior of the patients with thoracolumbar fracture.Methods 127 cases of thoracolumbar fracture were randomly divided into the observation group (62 cases)and the control group (65 cases)according to random digital table method.The patients of the observation group were given self nursing interactive nursing.The patients of the control group were given rou-tine nursing.The comparative study of the following indicators of the two groups of patients:(1)activities of daily liv-ing (ADL);(2)bedridden patient self -care skills of and self -care knowledge assessment;(3)satisfaction,compli-cations,the average length of days and discharged patient telephone visit the initiative.Results The discharge self nursing ability raise,health behavior change,self -care knowledge and self -care skills of the observation group were significantly better than the control group,there were statistically significant differences(P <0.05);after discharge from the hospital,bed incidence of complications (6.5%)of the observation group was significantly lower than the control group (18.1%),the difference was statistically significant (χ2 =4.16,P <0.05)and satisfaction degree (91.7 ±6.5)was higher than the control group (87.3 ±7.5),with statistically significant difference (t =3.59,P <0.05),and the average hospitalization day (16.11 ±7.61 )d was lower than that of the control group (19.95 ± 11.55)d,there was statistically significant difference (t =2.20,P <0.05).Conclusion Self care interactive mode is conducive to mining the self -care ability of patients,improve the self -care ability of patients,and has good social benefits.

Objective:To investigate the expression of protein arginine methyltransferase 5 (PRMT5)in the gastric cancer tissue,and to explore the relationship between the PRMT5 expression and the occurrence and the clinicopathologic characteristics of gastric cancer, and to find a new treatment target for gastric cancer.Methods:Forty-three cases of gastric cancer tissue and 15 cases of adjacent normal gastric tissue were used as gastric cancer group and control group,respectively.The immunohistochemical staining was used to detect the expression of PRMT5 in the specimens.Results:Compared with control group (13.3%),the expression rate of PRMT5 in gastric cancer group (72.1%)was significantly increased (P < 0.05).In control group,there was some weak positive expression of PRMT5,the expressions were weak or moderate,the tan particles mainly located in the cytoplasm,less in the nuclei.In high differentiation gastric cancer specimens,the tan particles mainly located in the cytoplasm and more in nuclei, characterized by medium or strong expressions. In poorly differentiated and undifferentiated gastric cancer specimens,the tan particles mainly located in the cytoplasm and nucleus,and strongly expressed in nucleus.The higher expression of PRMT5 was associated with the size of tumor diameter,degree of differentition,depth of invasion,degree of lymph node metastasis,and TNM stage (P <0.05 or P <0.01),but had no correlation with the gender and age of patients (P >0.05).Conclusion:High expression of PRMT5 may play an important role in the occurrence and development of gastric cancer.