Objective To establish a two-way evaluation system and to explore the application effect of two-way evaluation method in clinical nursing teaching.Methods We carried out two-way evaluation and individual evaluation test to 40 nursing students practicing in the Department of Inter nal Medicine of our hospital in 2012 and 20 teachers responsible for teaching.By using the envelope method,nursing students and teachers were randomly divided into two groups,with 20 nursing students and 10 teachers in the experimental group and the control group respectively.Students' assessment form and the teachers teaching level evaluation table were made,and teachers of both group gave scores every two weeks to the nursing students by nursing students' evaluation sheet,and the score of feedback were given to the nursing students in experimental group.At the same time,the nursing students in experimental group gave scores every two weeks to the teachers of the same group by the teachers' teaching evaluation sheet,and feedback the results.SPSS 13.0 was used to make statistical analysis and the scores of nursing students and teachers of both groups and the last scores were compared with paired sample T test of mean.The results of the experimental group and the control group in the same period were compared with two independent samples T test of mean.Results Comparing the nursing students'scores of both groups with the scores they themselves got last time,the scores of the fourth,sixth,and the eighth week were statistically significant(P＜0.05)and comparing the experimental group teachers' score with and the scores they themselves got last time,the scores of the fourth,sixth,and the eighth week were also statistically significant(P＜0.05); from the fourth week on,nursing students' scores in experimental group compared with those in control group in the same period,show the differences statistically significant(P＜0.05).Conclusion Two-way evaluation system is beneficial to improving the enthusiasm and initiative of the teachers and students.Two-way evaluation and bidirectional interaction are helpful to timely detection of problems and improvement and can effectively improve the quality of clinical nursing teaching in internal neurological medicine.

Objective\ To further clarify the biological effects of TGF?1 on blastocyst implantation. Methods We used female adult Kunming mice to mate with male for observing the distribution of TGF?1 and its receptor at different stages of implantation with immunohistochemical method. Results\ Compared with nonpregnancy,TGF?1 and its receptor immunostaining markedly increased in epithelial and glandual cells on day 4 of pregnancy.The moderate extracellular staining of TGF?1 was present around the fibroblasts.On day 5\|6 of pregnancy,strong immunostaining in intensity of TGF?1 and its receptor was noted in primary decidual zone.With blastocyst invasion,TGF?1 and its receptor immunostaining diffused in decidual cells. Conclusion\ TGF?1 might play an important role via its receptor during blastocyst implantation.\;

Objective: To investigate the characteristics of hearing loss in occupational noise-exposed workers in automotive manufacturing industry. Methods: According to Technical Specifications for Occupational Health Surveillance (GBZ188-2014) , 530 noise-exposed workers were examined for health and pure tone audiometry during January to June, 2017, and the data were collected for analysis. Poisson regression analysis was used to analysis the relationship between work age and hearing loss. Results: After correction of age and gender, pure-tone threshold of 500, 1 000, 2 000, 3 000, 4 000, 6 000 of the noise-exposed workers in the <3 year-exposure group were 20.15±3.60, 18.80±3.43, 18.54±3.38, 19.10±4.03, 20.32±6.79, 23.48±8.92 dB (A) ; the values in the 3-10 year-exposure group were 20.96±5.38, 19.25±4.76, 19.22±5.29, 20.17±7.50, 21.36±8.88, 25.39±11.60 dB (A) ; the values in the >10 year-exposure group were 20.18±3.67, 18.34±3.60, 18.36±4.25, 18.49±4.41, 20.32±9.24, 22.50±9.57 dB (A) . Poisson regression analysis showed that the relative risk (RR) of hearing loss of the noise-exposed workers compared with the noise-free workers was 4.38 (P<0.05) . Conclusion The noise-exposed workers in automotive manufacturing industry revealed hearing loss, which was associated with their actual working age of noise exposure.

Objective To study the effects of thymus transplantation(TT)combined with CD4--DLI on T cell reconstitution after allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods BALB/c mice were randomly divided into three groups:hematopoietic stem cell transplantation (HSCT group),hematopoietic stem cell transplantation combined with thymus transplantation(TT group)and hematopoietic stem cell transplanta-tion combined with thymus transplantation plus CD4+ T cell-depleted lymphocyte infusion(CD4--DLI group). On day-1,the mice were treated with the lethal dose of radiotherapy. On day 0,C57BL/6 mice were used as donor for hematopoietic stem cell transplantation. The mice were sacrificed on 5 days,2 weeks,4 weeks and 3 months after transplantation,respectively. The peripheral blood and spleen cells of mice were collected for determinations of T cell surface antigen,T cell receptor,naive T cells and intracellular cytokines. HE staining was used to assess the development of donor thymus. Results TT and CD4--DLI did not impair each other′s effects on T cell reconstitu-tion. TT combined with CD4--DLI increased the number of T cell reconstruction. CD4--DLI promoted the effect of TT on enlargement naive CD4+and CD8+T cell pool. Combination of TT and CD4--DLI enhanced the cytokine pro-duction of T cells. Conclusion TT combined with CD4--DLI had no side effects on TCR repertoire and thymus. Conclusion TT combined with CD4--DLI can enhance the reconstitution of T cell number and function via thymus dependent and thymus independent mechanism.

Objective To investigate the correlation between the degree of liver fibrosis and Aspartate aminotransferase-to-Platelet Ratio Index ( APRI ) in children with biliary atresia ( BA ) , and evaluate the clinical significance of liver fibrosis in biliary atresia.Methods A total of 97 patients with diagnosed BA were recruited between January 2010 and June 2013.AST, PLT and APRI were determined one week before laparotomy.The severity of hepatic tibrosis was.Judged by Metavir system the correlation among AST, PLT, APRI and severity of liver fibrosis were evaluated, and their diagnostic value for degree of liver fibrosis was analyzed by ROC.Results Sera AST levels and PLT counts of BA patients were found to be positively(r=0.367, P<0.01) and negatively(r=-0.403, P<0.01) correlated with Metavir scores of liver fibrosis, respectively.There existed positive correlation between APRI and the severity of hepatic fibrosis (r=0.541, P<0.01).The area under ROC curve of APRI to diagnose none or mild fibrosis and moderately severe fibrosis was 0.78, with sensitivity of 77.9%and specificity of 62.1%at the optimal cut-off value of 0.75; the area under ROC curve of APRI to diagnose moderately severe fibrosis with liver cirrhosis arrived 0.85, with sensitivity of 75.0% and specificity of 89.4% at the optimal cut-off value of 1.77.The accuracy of none or mild fibrosis, moderate fibrosis and cirrhosis diagnosed by APRI were 73.2%, 64.9%, 87.6%, respectively.Conclusion APRI can be used as a non-invasive parameter to assess the severity of hepatic fibrosis with BA.

Objective:To validate the role of color Doppler ultrasound in an animal model to detect early heterotopic ossification (HO) after brain-traumatic/burn/tenotomy.Methods:Forty-four rats were randomly divided into two groups. Rats in experimental group ( n=22) were operated to build brain-traumatic/burn/tenotomy model and others in control group ( n=22) underwent only skin incision injury. Color Doppler ultrasound, X-ray film examination at 2, 3, 4, 6, 8 and 10 weeks post-injury were performed to follow up the progression of HO in both groups respectively. Histology was used to confirm bone formation. Results:In the experimental group, disorder structure with a hypoechoiccore in treated Achilles tendon was visualized using color Doppler ultrasound in the 2nd week. Additional tiny hyperechoic foci were observed in the 3rd week, which increased in the fourth week and fused into a mineralized island in the sixth week. No obvious abnormality was found in control group at the aforementioned time point. X-ray could detect heterotopic bone tissue in the sixth week in the experimental group but not in the control group. X-ray and HE stainning had confirmed bone formation in the tenth week in the experimental group.Conclusions:Color Doppler ultrasound can detect early HO and continuously follow up the progression of HO.

Objective To explore the effect of WeChat group in nursing teaching in neurology department.Methods 159 cases of nursing undergraduate interns in Neurology Department were randomly divided into 2 groups.The control group used the traditional teaching method while the experimental group adopted WeChat group aided teaching management on the basis of traditional teaching methods,with effect evaluation after 5 weeks practice.SPSS 19.0 was used for chi-square test and t test.Results In both two groups of nursing students,scores of theory opera-tion were obviously improved (P＜0.05),and the experimental group theory results,operation ability and satisfaction were higher than the control group (P＜0.05),and the frequency of occurrence of adverse events was significantly lower than the control group (P＜0.05).Conclusion WeChat group is conducive to improv-ing the quality of nursing teaching as well as students' overall quality,which is worthy of further promotion.

Objective To explore the situation and risk factors of peripherally inserted central catheter (PICC)-related infections among neonate so as to provide a nursing reference for preventing catheter-related infections. Methods From September 2015 to June 2017, a prospective study was carried out to 811 neonates with PICC from 7 hospitals in Shenzhen City to observe the incidence of catheter-related infections. Simple correlation and multiple factors unconditional Logistic regression was used to analyze the correlative factors of catheter-related infections. Results Among 811 neonates, there were 770 (94.9%) without and 41 (5.1%, 1.95/1 000 catheter days) with catheter-related infections along with 20 cases with exit-site infection and 21 cases with catheter related bloodstream infections (CRBSI). Top three pathogens of CRBSI included Staphylococcus epidermidis, fungus and klebsiella pneumonia. Simple correlation showed that there were statistical differences in gestational age, birth weight of the neonate, disinfection methods of infusion connector, sterile protective barrier during maintenance of catheter between infection group and non-infection group (χ2=4.026,4.964, 4.369,7.463;P＜ 0.05). Multiple factors unconditional Logistic regression revealed that the risk factor contained birth weight＜ 1 200 g (OR=2.099, 95%CI: 1.103-3.996, P＜ 0.05), and the protective factors consisted of sterile protective barrier during maintenance of catheter (OR=0.393, 95%CI: 0.206-0.749,P＜0.01). Conclusions Birth weight ＜1 200 g, sterile protection during maintenance of catheter are the influencing factors of neonatal PICC catheter-related infections. Sterile protective barrier during maintenance of PICC for neonate should include wearing sterile mask, round hat, using aseptic packets and wearing sterile gloving to maintain the catheter. Aseptic technique should be paid more attention to during indwelling catheter and maintaining catheter for premature with birth weight ＜1 200 g.

Objective:To explore the values of ultrasound, pathology combined with inflammatory indicators in predicting high nodal burden (HNB) in patients with early breast cancer and to construct a nomogram to provide reference for individualized diagnosis and treatment.Methods:The ultrasonographic, pathological features and preoperative inflammatory indicators of 378 female patients diagnosed with early breast cancer confirmed by pathology in the South Hospital of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from January 2014 to July 2022 were retrospectively analyzed. They were randomly divided into training set ( n=302) and test set ( n=76) in a ratio of 8∶2, and the baseline data of the two groups were compared. The optimal cutoff values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were obtained by ROC curve. In the training set, with axillary high lymph node load (≥3 metastatic lymph nodes) as the dependent variable, independent influencing factors of HNB were identified by univariate and multivariate Logistic regression analyses, and the nomogram was established. The test set data were used to verify the model. The discrimination, calibration and clinical applicability of the model were assessed by the area under the ROC curve (AUC), C-index, the calibration curve, Brier score and the decision curve analysis, respectively. Results:There were no significant differences in all variables between the training set and the test set (all P>0.05). ROC curve analysis results showed that AUCs of NLR, PLR and LMR were 0.578, 0.547 and 0.516, respectively, and the optimal cut-off values were 2.184, 150 and 3.042, respectively. Univariate Logistic regression analysis showed that age, pathological type, histological grade, Ki-67, lymphovascular invasion, NLR, PLR, ultrasonic characteristics (maximum diameter of primary tumor, shape, long/short diameter of lymph node, cortical thickness, cortical and medullary boundary, lymph node hilum, lymph node blood flow pattern) were correlated with HNB of early breast cancer (all P<0.05). Multivariate Logistic regression analysis showed that ultrasonic characteristics (maximum diameter of primary tumor >2 cm, effacement of lymph node hilum, non-lymphatic portal blood flow), lymphovascular invasion, Ki-67>14% and NLR>2.184 were independent risk factors for HNB in early breast cancer ( OR=7.258, 8.784, 6.120, 8.031, 3.394 and 3.767, respectively; all P<0.05) and were used to construct the nomogram model. The AUC of the training set was 0.914 (95% CI=0.878-0.949), C-index was 0.914; The AUC of the test set was 0.871 (95% CI=0.769-0.973), C-index was 0.871, indicating good discrimination. Calibration curve and Brier score were 0.090, indicating high calibration degree of the model. The clinical decision curve indicated good clinical benefit. Conclusions:The nomogram based on ultrasonic characteristics (maximum diameter of primary tumor, lymph node hilum, lymph node blood flow pattern), lymphovascular invasion, Ki-67 and NLR can effectively predict the risk of HNB in patients with early breast cancer, and provide a reference for precision diagnosis and treatment to avoid excessive or insufficient treatment.

Objective:To understand the characteristics and differences of diarrhea-related symptoms caused by different pathogens, and the clinical features of various pathogens causing diarrhea.Methods:Etiology surveillance program was conducted among 20 provinces of China from 2010 to 2016. The acute diarrhea outpatients were collected from clinics or hospitals. A questionnaire was used to survey demographics and clinical features. VFeces samples were taken for laboratory detection of 22 common diarrhea pathogens, to detect and analyze the clinical symptom pattern characteristics of the patient’s.Results:A total of 38 950 outpatients were enrolled from 20 provinces of China. The positive rates of Rotavirus and Norovirus were the highest among the five diarrhea-causing viruses (Rotavirus: 18.29%, Norovirus: 13.06%). In the isolation and culture of 17 diarrhea-causing bacterial, Escherichia coli showed the highest positive rates (6.25%). The clinical features of bacterial diarrhea and viral diarrhea were mainly reflected in the results of fecal traits and routine examination, but pathogenic Vibrio infection was similar to viral diarrhea. Conclusion:Infectious diarrhea presents different characteristics due to various symptoms which can provide a basis for clinical diagnosis.