Objective To investigate the present status of the emergency nursing training to form the curricula system for emergency nursing training of nurses (including course projects,class hour,teaching form,training aim).Methods Based on the actual investigation,literature research,using Delphi method,the training course system of emergency nursing was established.Results Cronbach's α coefficient was 0.943 and the expert authority coefficient was 0.868.Emergency training should be included in the nursing training program,and the four modules courses were built.With reference to emergency management requirements of home and abroad and the training model of foreign troops as well as combining the reality of our country to set up the training objectives,to improve class hour,enrich teaching form,and adjust the training content to set up the emergency training evaluation model.Conclusions The results of this study supply basic guarantee for nurses to increase coping ability of emergency affairs as well as training basis and reference with clear structure and content,reasonable design and reliable results.

Objective To observate the effects and reliability of azithromycin and ambroxol hydrochloride and glucose Injection in treatment of children with acute lower respiratory tract infection contraindicating to penicillin and cephalosporins. Methods 56 cases of children with acute lower respiratory tract infection for whom penicillin and cephalosporins were treated with azithromycin and ambroxol hydrochloride and glucose injection(group A) and other 100 cases without penicillin and cephalosporins contraindication were randomly divided into group B(treatment with cephalosporin) and group C (treatment with azithromycin). The clinical efficacy and adverse reactions of 3 groups after treatment in children were compared. Results In group A and group B, fever, cough, wheezing and other clinical symptoms, positive signs of the disappearance time of the lung were significantly shorter than those in the group C. The clinical efficacy of the two groups had significant difference as compared with group C (P0.05). Conclusion It is a good treatment with azithromycin and ambroxol hydrochloride and glucose injection to cure children cases with acute lower respiratory tract infection contraindicating to penicillin and cephalosporins, and it' s curative effect is equivalency with cephalosporin. It is worth to use this treatment in clinical practice.

Objective To investigate the damage mechanism of fluetuant high glucose on the INS-1 cells (pancreatic β-cell lines).Methods The cells were divided into five groups:the control groups (A group:5.5 mmol/L of glucose),the continuing high glucose group (B group:16.7 mmoL/L of glucose),the fluctuant glucose group ( C group:16.7 mmol/L of glucose for cultivation for 2 h,then the concentration changed to 5.5 mmol/L for cultivation for 3 h,which was repeated 3 times per day;the ceils were kept in the medium containing 5.5 mmol/L of glucose during night time for 9 h),the continuing high glucose plus NAC ( 1.0 mmo/L) group ( D group),the fluctuant glucose plus NAC group ( E group).The intracellular reactive oxygen species (ROS) was observed by the flow cytometry.The activity of glucose-6-phosphate dehydrogenase (G6PD) was estimated by the tetrazolium linked cytochemical method.Results 72 h after intervention,the levels of ROSwere 37.77±2.31,86.97±7.97,124.27±10.04,60.92±2.61 and 51.47±3.36,respectively,in A～E group;the activities of G6PD were 1.25±0.03,1.09±0.02,1.03±0.01,1.12±0.02 and 1.21±0.01,respectively;the levels of NADPH were (0.123±0.003) mmol/mg prot,(0.112±0.004) mmoL/mg prot,(0.099±0.002 ) mmol/mg prot,( 0.116±0.005 ) mmol/mg prot and ( 0.120±0.002) mmol/mg prot,respectively.The level of ROS in the cells of the fluctuant glucose group were significantly higher than that in the continuing high glucose group ( P ＜ 0.01 ).The G6PD activity and NADPH was significantly lower in fluctuant high glucose group than those in the continuing high glucose group (P ＜0.01 ).NAC co-cultivation decreased the extent of cell's change.Conclusions Exposure of INS-1 to high glucose lead to increased oxidative stress, possible mechanism included decreased G6PD activity and subsequent imbalance between oxidation and reduction.

Objective To analyze the chemical constituents of kumquat essential oil(KEO)and the acute toxicity of KEO in mice. Methods The chemical constituents of KEO were analyzed by GC-MS. After preliminary test, KM mice were randomly divided into control and KEO groups with 20 mice in each group(10 male and 10 female). The doses of KEO were designed with ratio 0.758 between the 100% and 0% mortality amount as 10, 7.60, 5.70, 4.40, 3.30 and 2.50 ml/kg. The acute toxicity was evaluated by examination of the mice for 14 days after single administration of KEO. Results The principal constituents in KEO were α-pinene(0.46%), β-phellandrene(0.11%), β-myrcene(2.34%), D-limonene(95.62%), geranyl acetate(0.10%), β-copaene(0.67%), and γ-elemene (0.13%), which accounted for 99.43% of the total chemical content of KEO. The half-lethal dose(LD50)of KEO in mice by the acute toxicity test was 6.24 ml/kg with the 95% confidence limit of(5.39-7.33)ml/kg in female mice and 5.73 ml/kg with the 95% confidence limit of(4.91-6.79)ml/kg in male mice. The possible toxic target organs were liver, spleen and gastrointestinal tract. Conclusion KEO with the content of D-limonene was obtained from kumquat for the first time, and the toxicity of the KEO was low according to the toxicity classification standard of World Health Organization.

Objective To summarize the experience in endovascular repair of De Bakey type Ⅲ aortic dissection in recent years and summarize the prevention and management of the related perioperative complications.Methods From January 2009 to January 2011,49 cases of endovascular repair for De Bakey type Ⅲ aortic dissection were performed under general anesthesia in our department.There were 45 male and 4 female.The follow-up was performed in the outpatient department or by telephone.Results There was no inhospital death and no paraplegia events.Severe complication included:coma,2 cases ( 4.1％ ) ; endoleak,2 cases (4.1％ ) ; upper limb ischemia,2 cases (4.1％ ).Recurrent proximal aortic dissection,1 case.Fever was occurred in most of those cases.Conclusion Endovascular repair of aortic dissection improves the outcome of aortic dissection patients.But more attention should be pay to prevent the severe complications,It will help to improve the prognosis and life quality by reducing the risk of retrograde dissection,acute brain ischemia and endoleak.

This study aimed to explore Semaphrin4D (Sema4D) expression and clinical significance in non-small cell lung cancer (NSCLC), and to define the roles and mechanisms of Sema4D in regulating the malignant behaviors of A549 cells by small interfering RNA (siRNA). Firstly, immunohistochemistry revealed that Sema4D was more frequently expressed in NSCLC than in lung benign lesion (P<0.05) and its overexprssion was associated with low differentiation (P<0.05), poor pTNM staging (P<0.05) and occurrence of lymph node (LN) metastasis (P<0.05). Endogenous Sema4D expression was suppressed by Sema4D siRNA in A549 cells overexpressing Sema4D. Protein levels of Sema4D, total Akt and p-Akt were examined by Western blotting. Cell proliferation, migration and invasion abilities were measured by MTT assay and Transwell assay respectively. Results showed that Sema4D siRNA significantly suppressed phosphorylation of AKT in A549 cells, but it did not alter total AKT expression. In addition, efficient down-regulation of SemaD significantly inhibit cell proliferation (P<0.05), migration (P<0.05) and invasion (P<0.05) in A549 cells. These findings suggest that Sema4D might serve as a reliable tool for early prediction of NSCLC poor prognosis. Sema4D could play an important role in promoting tumor proliferation, migration and metastasis in the NSCLC, by influencing the Akt protein phosphorylation. Inhibition of Sema4D may be a useful approach for the treatment of NSCLC.

AIM:To explore the corneal biomechanical properties of the elderly with different axial length(AL)and corneal curvature by Corneal Visualization Scheimpflug Technology(Corvis ST).

METHODS: A cross-sectional study. A total of 220 patients(426 eyes)undergoing phacoemulsification were collected in this study. One of them whose the AL was 22-24 mm and the corneal curvature was 42-44 D were divided into male and female groups(44 eyes and 49 eyes, respectively). One of them whose the corneal curvature was 42-44 D were divided into 22-24 mm, 24-26 mm, and more than 26 mm groups according to AL(99 eyes, 22 eyes and 12 eyes, respectively). One of them whose the AL was 22-24 mm were divided into 42-44 D, and more than 44 D according to corneal curvature(88 eyes, 102 eyes, respectively). Corvis ST was used to measure the biomechanical parameters of the cornea. The differences in the parameters between different groups were analyzed using the independent-samples t-test or one-way analysis of variance and correlation analyses were performed using Pearson correlation analysis.

RESULTS: When comparing the corneal biomechanical parameters, no statistically significant differences were found between male and female groups(P>0.05). The first applanation length and second applanation length among different corneal curvatures were statistically significant(P<0.05). There was statistically significant only for the difference of the second applanation length and central cornea thickness between two groups of 22-24 mm and 24-26 mm(P<0.05). There was statistically significant for the difference of the second applanation length, deformation amplitude, central cornea thickness, the first applanation time, intraocular pressure and corrected intraocular pressure between the two groups of 22-24 mm and more than 26 mm(P<0.05). But there was no statistically significant differences of the parameters between groups of 24-26 mm and more than 26 mm(P>0.05). The patient's AL was positively correlated with deformation amplitude, intraocular pressure and corrected intraocular pressure(r=0.263, P=0.002; r=0.463, P=0.000; r=0.449, P=0.000), and there is negative correlation between the patient's AL and central cornea thickness, the second applanation length(r=-0.240, P=0.006; r=-0.344, P=0.000).

CONCLUSION: The corneal curvature and ocular AL may be the factor affecting the corneal biomechanical properties. The longer AL, the thinner corneal thickness, the more easily the corneal is deformed, and with the increase of the AL, intraocular pressure also increases. When discussing whether the preparation of the cataract incision is affected by the patient's own factors, the different corneal curvatures and AL shall be considered.

BACKGROUND: Skin defect is commonly repaired by autologous skin graft, but in which, it is required healthy skin provider and it probably results in scarring deformity to various extents. The successful construction and clinical application of tissue-engineered skin (TE skin) mark the major breakthrough in treatment of skin defect.OBJECTIVE: To analyze the relationship between operation method and healing rate, through repair of skin defect with TE skin, to provide experimental evidence on clinical application of TE skin.DESIGN: Randomized controlled observation was designed.SETTING: Department of Oral and Maxillofacial Surgery, Teaching-Research Room of Histology and Pathology and Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University of Chinese PLAMATERIALS: The experiment was performed in Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University, in which 6 healthy York pigs were employed, of clean grade,aged varied from 2.5 to 3 months. 3 groups were randomized, named TE whole-layer group, TE dermal and auto-epidermal group and auto-graft group, 2 pigs in each group. 8 wounds were prepared in each pig, round in shape and 50 mm in diameter, 16 wounds in each group, totally 48wounds.METHODS: ①Preparation of TE whole layer and TE true skin. ② In TE whole-layer group: The whole layer of skin was cut off from fat layeralong the drawn line. When bleeding stopped thoroughly and the wound was covered with wet physiological saline gauze, TE whole-layer skin was collected and windowing was done on the skin for drainage. Physiological saline was used to rinsed away the culture solution on the surface of TE skin, and then, the cuticular layer was upward-covered the wound, avoiding gas vacuole between cuticular layer and wound. Single-layer oleic gauze, physiological saline gauze, aseptic dry gauze and elastic sponge cushion were covered successively, about 3-5 mm in thickness each layer. After routine dressing, elastic bandage was wrapped with compression terminally. ③ TE dermal and auto-epidermal group: The whole- layer skin was cut off with same method. Thin split-thickness skin (TIS) 0.1-0.2 mm was collected with drum dermanuring machine and soaked in physiological saline. The same method was used to collect the managed TE true skin and cover it on the wound, covering immediately on autoTTS. The rest management was same as TE whole-layer group. ④ Autograft group: The whole-layer skin was cut off and the fat tissue was removed, afterwards, it was re-grafted on the auto-wound, covered with various layers of dressing and bandaged with compression. ⑤ The survival case was determined if it was discovered no infection, necrosis and scaling of grafted skin, less than 3 mm in diameter when the wound was opened for changing fresh dressing each time, otherwise, the failed case was recorded. The survival rate in each group was analyzed statistically in 4 weeks after operation.MAIN OUTCOME MEASURES: Survival situation of grafted skin in 4weeks after operation in each group.RESULTS: In 4 weeks after operation, the survival rate of grafted skin was 75% in TE whole-layer group was 87% in TE dermal and auto-epidermal group and was 94% in auto-graft group. The results were similar basically in comparison among 3 groups (x2=-2.34, P ＞ 0.05).CONCLUSION: The effect of TE skin graft on repair of skin defect is near to that of auto-epidermal graft, testifying that the repair of skin defect with TE skin is feasible.

Objective To develop a detection method based on the technology of gene chips which can quickly distinguish genes of Enterococcus faecalis, E.faecium and vancomycin resistance.Methods Based on the specific gene ( ddl) sequences of two types of Enterococcus from GenBank, oligonucleotide probes which could detect and distinguish special genes and drug resistance genes ( vanA,vanB) of Enterococcus were designed and compounded.Then,the probes were dotted to modified slide.The target DNA fragments of vancomycin-resistant Enterococcus ( VRE) were labeled with biotin by multiple PCR amplification, and then hybridized with oligonucleotide probes on slide.The results were analyzed by portable imager.The multiple PCR system, hybridization reaction and condition of the chemiluminescence method were optimized before the specificity, sensitivity and reproducibility of the chip were evaluated.Results One universal primer, four specific primers, one universal probe and four specific probes were selected.This gene chip was demonstrated of high specificity and repeatability.The detection sensitivity was 103 CFU/ml.The gene chip detection results of 10 clinical samples were basically consistent with the drug sensitivity test ( 8/10 ) .Conclusion A gene chip technique for the detection of VRE is established successfully.It is possible to distinguish the type of VRE and detect the genetic phenotypes of drug resistance by gene chip technique.

Objective To study the targeting survivin small interfering RNA ( siRNA ) to inhibit proliferation and apoptosis survivin gene expression in rheumatoid arthritis synovial fibroblasts ( RASFs) .Methods RA patients were isolated and cultured in vitro synovial fibroblasts ( RASFs) , designed and synthesized siRNA targeting survivin and negative control, by liposome transfection RASFs cell; real-time quantitative polymerase chain reaction (PCR) and Western blot RASFs detect mRNA expression and protein levels of survivin.Tetrazolium blue (MTT) assay of cell proliferation;TUNEL assay apoptosis.Results The experimental group compared with the negative control siRNA group and control group, 48h after transfection of synovial fibroblasts survivin mRNA and protein expression levels were significantly decreased ( P<0.05 ) .The experimental group compared with the negative control siRNA group and control group, synovial fibroblast proliferation after transfection significantly decreased ( P<0.05 ) . After the experimental group transfected 24h, 48h, 72h growth inhibition rates were (11.5 ±2.6)%, (26.2 ±3.4)%, (47.6 ±4.1)%, at 72 hours after transfection most significant.The rate of apoptosis in experimental group (23.87 ±1.6)%, significantly higher than the negative control group (9.72 ± 1.15)% and the control group (8.70 ±1.09)% (all P<0.05).Conclusion siRNA targeting survivin expression levels through reducing survivin, inhibit synovial fibroblast proliferation and promotes apoptosis.