Objective:To summarize the nursing experience of a patient with hyperthyroidism-induced liver injury combined with type 1 diabetes complicated by Wernicke encephalopathy.Methods:Patients with hyperthyroidism-induced liver injury, type 1 diabetes and Wernicke encephalopathy co-existing consciousness disorders, contradiction between medication and dietary care, separation anxiety, and specificity of drugs shared by the above three diseases were given appropriate care and discharged health education and continued care.Results:After active treatment and nursing, the patient′s consciousness became clear, nausea and vomiting improved, and liver function and thyroid function indexes gradually returned to normal. The patient was treated with oral 131I and discharged without any adverse effects. Conclusions:The patient′s condition is complex and the clinical care is different from that of ordinary patient. The nurses detect the change of the condition early, adopt a personalized nursing plan for the contradiction between medication and diet of the patient, pay attention to psychological care, reduce the occurrence of complications, and ensure the smooth discharge of the patient.

Objective To investigate the clinical manifestation and diagnosis of Hashimoto thyroiditis (HT). Methods 45 HT patients diagnosed by fine needle aspiration cytology (FNAC) were enrolled in this study. Their medical history, clinical parameters, data of laboratory examination, colour doppler ultrasonic image and FNAC were analyzed. Results This disease was more common in women than in men, and most of cases occurred during 35～50 years old. Almost all cases had the symptoms of thyromegaly and laryngopharynx malaise. The patients had normal thyroid function, hypothyroidism or hyperthyroidism. The levels of both antithyroid globulin antibody and antithyroid microsome antibody increased in 39 cases. The ultrasonic imaging features of thyroid were such as following: diffusive nonhomogenous hypoecho pattern in 19 cases, numerous hypoecho micronodes in 15 cases, hyperecho micronodes in 3 cases, and hyperecho bandlike echo pattern with swelling of neck lymph nodes in 8 cases. Conclusion Diagnosis of HD should put emphasis on a complete medical history, physical examination and necessary laboratory tests. Antithyroid auto-antibody assay and thyroid ultrasonic examination were very important for diagnosis of HD, and FNAC may be indispensable in suspected cases.

Objective To study infection of the lung tissue by bronchoalveolar lavage for BALF and explore whether GM can help improve the he diagnosis efficiency in patients without granulocyte deficiency with IPA, and find the threshold of GM values. Methods Between January 2011 and December 2011, 173 cases of patients were considered possible invasive pulmonary aspergillosis in parallel BALF GM detection in the center of the respiratory endoscopic examination.. According to the diagnostic criteria at home and abroad, all the cases were divided into four groups, including group of IPA, group of tuberculosis, group of bacterial pneumonia and group of non-infection. Using ELISA method for determination of serum and BALF GM. The diagnostic value was made by statistical methods in BALF GM detection without patients of granulocyte deficiency with IPA. Results There were 11 cases in the group of IPA, 23 cases in the group of tuberculosis, 90 cases in the group of bacterial pneumonia and 49 cases in the group of non-infection. In patients without granulocyte deficiency with IPA,BALF GM value was higher comparing with the patients without IPA. There were significant difference between the two groups; Comparing the GM value in the serum, the detection of BALF GM was higher in IPA. ROC curve analysis found that when the BALF GM test value was 0.95 or higher, there was highest possible with IPA. Conclusion BALF GM testing is beneficial to patients of invasive pulmonary aspergillosis without granulocyte deficiency in early identification with IPA. This study found that BALF GM best value is 0.95 or higher.

Objective To explore the effect of specific labeling method in improving the mixed placing of medical waste in neonatal intensive care unit(NICU).Methods Medical waste classification of 34 trash cans in the NICU of a hospital between July and December 2014 were investigated,July-September was pre-implementation phase of spe-cific labeling,October-December was post-implementation phase,mixed placing of medical waste between pre-and post-implementation phase was compared.Results A total of 504 cases of medical waste classification in NICU were investigated,252 cases respectively in pre-and post-implementation phase,74 cases of mixed placing were found. Mixed placing rates before implementing specific labeling was higher than after implementing (25.40%[64/252]vs 3.97%[10/252],χ2 =46.187,P <0.001 );before implementing specific labeling,57 cases of infectious waste and non-infectious waste were mixed placing,after implementing specific labeling,only 8 cases of infectious waste and non-infectious waste were mixed placing.Mixed placing were mainly performed by trainees for in-service training and interns,accounting for 39.06% before implementing and 50.00% after implementing.Conclusion The specific labeling for standardizing and managing of medical waste can improve the classification of medical waste in NICU, significantly improve the compliance of all kinds of health care workers to the standard handling of medical waste.

BACKGROUND:Several studies have demonstrated that mesenchymal stem cel s exhibit strong immunomodulation on al ergic asthma. However, there are no reports to compare therapeutic effects under different administration ways.
OBJECTIVE:To examine the immunomodulatory effects of MSCs via different administration routes on asthmatic mice.
METHODS:Seventy-two Balb/c mice experienced three independent tests, and 24 mice were selected for each test. Twenty-four mice were randomly divided into four groups (n=6):control group, model group, intravenous treatment group and intratracheal treatment group. The mouse model of asthma was induced via intraperitoneal injection of ovalbumin at 1, 7, 14 days and 30-minute aerosol inhalation of ovalbumin at 22-26 days. In the latter two groups, mesenchymal stem cel s were injected intravenously (200μL, 5×109/L) or intratracheal y (50μL, 2×109/L) into the mice at 1 day before aerosol inhalation.
RESULTS AND CONCLUSION:Compared with the control group, the airway inflammatory response was significantly increased in the model group. Intravenous administration of mesenchymal stem cel s significantly al eviated the symptoms of al ergic airway inflammation, including the airway hyperreactivity, the inflammatory cel counting in the bronchoalveolar lavage fluid, inflammatory cel infiltration in the lung tissue. Meanwhile, the levels of Th2 type cytokines in the bronchoalveolar lavage fluid and IgE in serum also decreased after intravenous administration of mesenchymal stem cel s. However, the intratracheal application of mesenchymal stem cel s did not exhibit the similar effects. Intravenous, not intratracheal, application of mesenchymal stem cel s can exert immunomodulatory effects through the blood circulation.

Objective To evaluate the clinical characteristics of patients with adrenocorticotropin-independent macronodular adrenal hyperplasia (AIMAH).Methods A total of 10 AIMAH cases were enrolled in this retrospective study.The clinical and laboratory findings of all patients were collected and analyzed.Results All patients manifested some clinical features and biochemical evidence of Cushing's syndrome.The plasma adrenocorticotropic hormone (ACTH) level was undetectable in all the patients and their serum cortisol secretion rhythm was abnormal.Low and high-dose dexamethasone suppression tests failed to suppress the cortisol secretion.The bilateral macronodular adrenal enlargement was shown by CT/magnetic resonance imaging.The supine-upright posture test was positive in four patients.Three patients were performed bilateral adrenalectomy,five were unilateral adrenalectomy and the remaining two patients were taken propranolol.All the patients had followed up for 10 to 89 months.Contralateral adrenalectomy was performed in two patients with recurrent symptoms after unilateral adrenalectomy and two patients given propranolol were underwent bilateral adrenalectomy when their symptoms had not been improved or recurred.Conclusion AIMAH is a relatively rare subtype of Cushing's syndrome with unique clinical and laboratory findings.Propranolol is a good choice if the supine-upright posture test is positive.Unilateral adrenalectomy appears to be an effective and safe alternative treatment for AIMAH.Bilateral adrenalectomy could be performed if the symptoms have not been improved or recurred after unilateral adrenalectomy.

Objective To elucidate the genome organization of small deletion mutants of hepatitis B virus(HBV).Methods Amplified the HBV genomes by polymerase chain reaction from the serum of the patients with chronic hepatitis B and cloned the small HBV DNA less than 1 kb,then sequenced and analyzed the gene organization of these small deletion mutants of HBV.Results Totally one hundred and twenty-four small deletion mutants of HBV genomes categorized to sixty-four types were obtained and classified into three groups according to the criteria of the characteristics of gene organization,for example,spliced variants,regular deletion mutants and the deletion mutants with an internal poly (dA).All of these isolated mutants shared some common features as the deletion in coding regions and regulatory elements,66% of the mutants retained the cis elements crucial for the viral replication and encapsidation,while 48% retained the X region.Conclusions Small deletion mutants of HBV are commonly detected in the serum from chronic hepatitis B patients,the characteristic structure of such mutants implies that they might be closely co-related with the pathogenicity of HBV.The exact mechanisms need further study yet.

Objective To investigate the anti-IFN-α effects of the novel protein TSR'r' encodedby the 458 nt-1308 nt spliced variant of hepatitis B virus genome,and to determine its functional domaias.Methods the TSR'r' gene(originated from open reading frame of HBV DNA polymerase,T represents terminal protein region,S represents the Spacer region,R'represents the truncated reverse transcriptase region,and r'represents the truncated RNaseH region)of the 458 nt-1308 nt spliced variant of HBV genome and its deletants were amplified by PCR and were cloned into the pcDNA3.1/HisC vector.The recombinant vector was transfected into Huh7 hepatocytes individually by FuGENE6 transfection reagent,and the expression of the fusion protein was detected by Western blot.Huh7 hepatocytes were co-transfected with p6 16CAT and the recombinant vector harboring either TSR'r'or the related deletant,and treated with IFN-α 2a 48 h post transfection.After 24 h stimulating.the cells were lysed and the intracellular CAT value was calculated.All data were processed with One-way analysis of variance(ANOVA).Resuits Recombinant vectors harboring either the TSR'r'gene or related deletant were constructed successfully,and the fusion proteins were expressed well in Huh7 cells.When Huh7 hepatocytes were co-transfected with p6-16CAT and TSR'r' recombinant.the intracellular CAT values reduced gradually as paralleled with the increasing amount of TSR'r'recombinant.Furthermore,as compared with the empty vector,intracellular CAT values also decreased significantly when the Huh7 cells co-transfected with recombinant harboring TP plus Spacer regions,while any of the other deletants(harboring either TP or Spacer region or neither)showed no significant difference.Conclusion The novel protein encoded by the 458 nt-1308 nt spliced variant of hepatitis B virns genome suppressed the response of Huh7 hepatocytes to IFN-α.and the N-terminal TP plus Spacer region was the functional domain of the protein for anti-IFN-α effects.

Objective To evaluate the clinical value of hs-CRP,Tbil and BUA in the diagnosis of coronary atherosclerosis on 320 slice dynamic volume computed tomography(320-DVCT).Methods 160 patients with stable angina pectoris were included.All patients underwent 320-DVCT coronary artery imaging and laboratory testing including plasma hs-CRP,Tbil and BUA.The plaques of coronary artery were classified as soft plaque,fibrous plaque and calcified plaque on CT values.The three indicators were used to confirm the ability of diagnosis on number of lesions,plaque character and the degree of stenosis.100 healthy persons served as the control group.Results With the concentration of hs-CRP,BUA increased and Tbil concentration decreased,the number and the stenosis degree of coronary lesions became increased,and easier to form a soft plaque.Conclusion The hs CRP,Tbil and BUA can offer the accurate diagnosis of lesions number,plaque character and stenosis degree of the coronary artery,which is showed on 320-DVCT.The hs-CRP,Tbil and BUA are conducive to the risk assessment of coronary atherosclerosis.

Objective To investigate the problems during using, standard and quality management of the POCT glucose meters in hospital, to analyze the solutions, and to provide reference data for improving the test level of POCT in hospital.Methods The amount, brand and application of portable glucose meters in the hospital were obtained by 3 rounds of surveillance from May to July in 2013.All of those glucose meters were taken part in external quality assessment of Clinical Laboratory Center of National Health and Family Planning Commission.The test results of those glucose meters were compared with that of automatic biochemical analyzer, the comparison results were then analyzed.Results The POCT glucose meters possessed 5 brands in our hospital, and the amount and type of glucose meters in some clinical departments were often changed.When 4 brands which were detected as quality control samples by ministry of health, the accuracy of detection results of 3 concentration of brand Ⅲ were substandard, the CV% of two levels were 11.9%and 10.1%respectively, the remaining 3 brands were in line with the requirements.The qualified percentages of 3 times of comparison were 85.0%, 92.0%and 97.4%.Conclusions The hospital should select the brand of portable glucose meters reasonably, correct use of glucose meters, and it is very necessary to build indoor and interstitial quality evaluation system, at the same time, suggesting the hospital to establish the POCT quality management team, to carry out the instrument comparison periodically, so to guarantee the accurate, reliable results of POCT in hospital.