Objective To evaluate the safety and efficacy of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer.Methods The clinical data were retrospectively analyzed in 108 patients undergoing radical LAG for advanced gastric cancer from March 2008 to November 2011.Results 98 out of 108 patients were followed-up,the follow-up rate was 90.7％,with medium follow-up period of 30 months (range 6-70 months).26 patients died and 3 patients developed recurrence during the follow-up period.The overall recurrence rate was 26.9％ (29/108),in which the recurrence rate was 0 for Ⅰ B cases,18.8％ (6/32) for ⅡA,30％ (6/20) for ⅡB,30.8％ (8/26) for ⅢA,and37.5％ (9/24) for ⅢB,respectively.The overall 1,2,3-year survival rates were 95.4％,88.9％,73.8％,and 1,2,3-year progression free survival rates were 93.5％,83.3％,73.8％,respectively.Conclusions Compared with open gastrectomy LAG is a safe and feasible surgical procedure with satisfactory 3-year survival in patients of advanced gastric carcinoma.

Objective To study the effect of new barrel theory in improving evaluation of hospitalized patients. Methods Eight hundred hospitalized patients from September 2012 to August 2013 were randomized equally into the control group and the observation group.The last one or two items affecting patient satisfaction from the control group were used as objectives to be improved.Causal effect analysis was done pertinent to the items and the worksheet was bettered and improved and then enforced.The two groups were compared after intervention with new barrel theory in terms of satisfaction of patients during admission and discharge. Result The satisfaction of patients in the observation group during admission and discharge was significantly better than that in the control group(P<0.05).Conclusion The new barrel theory used to detect the flaws in nursing service and improve the workflow can improve assessment from the patients so that the management quality can be enhanced.

Objective To construct evaluation standards for pediatric nursing responsibility. Methods With the method of expert enquiry for Delphi, coefficient of variation of each index through expert grading and Kendall W′s coordination coefficient were used to test the coordination degree in opinions among experts. After the coefficient of larger variation and lower weight were removed , the elements of nursing duty were ranked based on the weight by using hierarchy analysis method. Results The established practical pediatric nurses responsibility evaluation standard consisted of 3 modules, with 11 dimensions and 33 items. The Cr expert authority coefficient was between 0.77~0.90, with an average of 0.88. The variation coefficient of each index was low, ranging between 0.013 0.135 (<0.25). The Kendall W′s coordination coefficients of the primary, secondary and tertiary indicators were 0.482, 0.552 and 0.438, respectively, with significant differences in the coordination coefficient (P<0.001). Conclusion The experts are active and authoritative in participating in the standard establishment and they highly agreed on the standard , which indicates that the established the standard is reliable in a higher degree.

Objective To analyze the change of surgical route and range of hysterectomy in the past 10 years.Methods From January 2000 to December 2010,the clinical data of patients with hysterectomy were analyzed retrospectively,including clinical features,surgical path and scope of operation.Results There were 1980 patients.The predominant reason for hysterectomy was leiomyomas (52.88％,1047/1980),adenomyosis (17.78％,352/1980),cervical intraepithelial neoplasia (12.17％,241/1980).The age of the patients with hysterectomy for abdominal,transvaginal and laparoscopic was (46.54 ± 7.35),(58.73 ± 10.49),(44.10 ±5.12) years.In 2000-2005,the proportion of abdominal,transvaginal and laparoscopic proportion were 81.78％ (615/752),8.64％ (65/752) and 9.57％ (72/752).In 2006-2010 were 64.50％ (792/1228),6.51％ (80/1228) and 28.99％ (356/1228).In 2006-2010,the proportion of abdominal significantly decreased and laparoscopic significantly rised compared with those in 2000-2005,there were statistically significant differences (P ＜ 0.01).In 2000-2005,unilateral and bilateral annex removal ratios were 15.43％ (116/752),12.23％ (92/752),in 2006-2010 were 8.63％ (106/1228),7.49％(92/1228).Unilateral and bilateral annex removal ratios in 2006-2010 were significantly lower than those in 2000-2005,there were statistically significant differences (P ＜ 0.01 or ＜ 0.05).Conclusions Over the past 10 years,hysterectomy route and range changed with the percentage of laparoscopic increasing,and concomitant unilateral or bilateral annex removal decreased.

Objective To apply Plato analysis method to clinical cases which were reported from clinical nursing, finding out the key link of the risks which were related to the cases:the key age, the key period, the key spectrum of disease and the key projects, etc. To carry out the feedforward control of the quality of care, and ensure the quality and safety of nursing. Methods A database were set up including clinical special cases, high-risk cases, security hidden danger cases and emergency cases. Thetwo eightprinciple of Plato analysis method was used to find out the main factors, the principal contradiction, the key hazard and the key problems of the cases, etc. The aim was to provide guidelines of risk analysis, risk prevention and risk aversion for nurses, and improve their consciousness of security hidden danger, and reduce security hidden danger cases. Results The results of 207 cases collected from 2014 to 2015 showed that the main risks involved the age groups were 41-80 years old and 21-30 years old. The major risks involved the spectrum of disease were the nervous system, cardiovascular disease, surgical anesthesia related problems, kidney disease, cancer and respiratory system. The major risks involved the time were the midnight, morning and afternoon. The major risks involved the locations were sickroom, emergency room, auxiliary inspection departments and outpatient. The major risks involved items were disease mutation, psychological problems, medication safety and instrument safety, among the disease mutation, timely discovered, rescued 13 patients with heart and breathing pause, stop 13 patients who attempted suicide. Since the Plato analysis method was applied to identify the security risks of the clinical cases, the number of falling, all kinds of pipe shed, skin problems and suicides were decreased from 6, 6, 7, 5 in 2014 to 2, 2, 2, 1 in 2015, declining trend year by year. Conclusions Applying the Plato analysis method to identify the security risks of the clinical cases which can find out the main problems of cases and improve nursing quality and management efficiency.

Objective To study the expression of SGK1 in T lymphocytes from pediatric asthma,and the effect of SGK1 on the differentiation of T cells,also to explore the function of SGK1 regulating the differen-tiation of T subset in pediatric asthma. Methods Twenty-eight children with asthma were recruited in Xi′an children′s hospital and divided into moderate group and severe group according to diagnostic guideline of asth-ma. The serum levels of IL-4,IL-13 and IL-17A were analyzed by ELISA. The CD4 +T cells from PBMC and na?ve T cells were selected using magnetic beads. Na?ve T cells were differentiated in vitro under cytokines. SGK1 expression were analyzed with Real-time PCR. The ability of Th2 and Th17 on secreting IL-4 and IL-17A were detected after SGK1 was inhibited by siRNA. In vivo,shRNA-SGK1 Na?ve T cells were transferred into the mice asthma models by intravenous injection. The airway inflammation were observed in shRNA-SGK1 Na?ve T models. Results Compared with healthy children,the serum levels of IL-4、IL-13 and IL-17A increased signifi-cantly in the children with asthma. Importantly,the levels of these three cytokines were much higher with the de-velopment of asthma. SGK1 were up-regulated remarkably in CD4 +T cells from the children with asthma and were positively correlated with IL-13 and IL-17A. Besides,SGK1 expression increased in the differentiated Th2 and Th17 in vitro,but had no change in the differentiated Th1. The levels of IL-4 and IL-17A associated with Th2 and Th17 decreased after SGK1 was inhibited by siRNA. Similarly,In vivo,the serum levels of IL-13 and IL-17A and airway inflammation were reduced in shRNA-SGK1 Na?ve T models. Conclusion The over-expres-sion of SGK1 in pediatric asthma enhances the asthma progress by promoting the differentiation of T subsets.

Objective This study aims to evaluate the effect of joint training on professional core competencies of Intensive Care Unit (ICU) nurses.Methods Nurses enrolled in Joint Training Program (the experimental group) between 2007 to 2009 were interviewed with questionnaire and compared with those received general training (the control group).Data were collected before and after 10 months of training.Scores of ICU nurse core competencies from the two groups were analyzed and compared.Restults Comparing with the control group,scores of the experimental group showed statistical differences on total score,theory dimension,technical dimension and 54 items.Conclusions Joint training could improve the professional core competencies of ICU nurses,especially the competences of management and application of nursing to critically ill patients and ICU special skills.

Objective To study the association between serum prolactin(PRL)level,prolactin receptor(PRLR)expression on peripheral blood mononuclear cells and the disease activity in the patients with systemic lupus erythematosus(SLE).Methods Serum PRL level was measured by time-resolved fluoroimmunoassay(TrFIA)in113patients of SLE and in28gender-and-age matched control subjects,SLEDAI index was estimated.It was also investigated by logistic multiple regression analysis that the association between clinical manifestations,immunologic parameters,anti-dsDNA antibody titers and hyperprolactinemia in113patients of SLE.The specific binding(SB)rate of peripheral blood lymphocyte PRLR was measured by radioactive binding ligand assay(RLBA)and the mRNA expression of PRLR by reverse transcription polymerase chain reaction(RT-PCR)in24active SLE patients,22inactive SLE patients and15gender-and-age matched control subjects.Results The serum PRL levels of63active patients were much higher than those of50inactive patients and28control subjects.The serum PRL levels ranged9~51.2?g/L in79.3%of active patients.It was also found that PRL level was in positive linear correlation with the titer of anti-dsDNA antibody.The concentration of interleukin2receptors in hyperprolactinemia group was higher than that in normal group.It was shown that proteinuria,low levels of complement3and high titers of anti-dsDNA antibody were associated with hyperprolactinemia by logistic multiple regression analysis.The SB rate of PRL receptor was5.03?2.51%(x?s),the total binding rate(TB)was15.4?6.98%in24active patients with SLE.The SB rate of active patients was much higher than that of22inactive patients(SB4.18?2.26%,TB rate14.03?6.54%)and that of15gender-and-age matched control subjects(SB1.62?1.05%,TB8.19?1.47%).The mRNA expression of PRLR in active patients(x?s,0.85?0.45)was much higher than in inactive patients(0.58?0.43)and that in control subjects(0.20?0.13).Conclusion The slightly increased serum level of PRL,high expression of PRLR and the increased specific binding rate are associated with the disease activity of SLE.

Objective To investigate the empathy of obstetric nurses and the related factors.Methods Chinese Version of the Jefferson Scale of Empathy was used to investigate the empathy of 80 obstetric nurses in our hospital and the related factors.Results The score on empathy of obstetric nurses was 65~137,averaged 108.87±10.62 and ranked at the medium level.The empathy was mainly influenced by whether the nurses had studied the empathy-related courses and the satisfaction with their occupation and working environment.Conclusion The empathy of obstetric nurses is at the medium level.Their empathy is mainly influenced by whether the nurses have studied the empathy-related courses and the satisfaction of their occupation and working environment.In addition to promote the training,the nursing manager should improve the satisfaction of the occupation and working environment.

ObjectiveTo explore the clinical feature of severe hand, foot and mouth disease (HFMD) in pediatric patients, and to observe the hemodynamic changes in those with acute pulmonary edema.Methods A prospective observation study was conducted. Thirty-five severe HFMD pediatric patients with acute pulmonary edema admitted to the intensive care unit (ICU) and Department of Pediatric of First People's Hospital of Foshan from May 2008 to September 2014 were enrolled. The clinical features were thoroughly investigated. Hemodynamic data were monitored by pulse-indicated continuous cardiac output (PiCCO) in 5 cases, and the changes in PiCCO parameters were observed at ICU admission (0 hour), and 24, 48, 96 hours after treatment.Results Thirty-five patients who met the diagnostic standard of severe HFMD were enrolled, including 22 male and 13 female, aged from 7 months to 4 years. Six patients were younger than 1 year, 13 1-2 years, 12 2-3 years, and 4 patients 3-4 years old. The most common time of occurrence of pulmonary edema was 3-4 days after the onset of the disease. Fever and central nervous system symptoms were found in all the patients, and examination of the cerebral spinal fluid (CSF) revealed non-bacterial inflammatory changes. PiCCO results showed a tendency of lowering of heart rate (HR), systemic vascular resistance index (SVRI), and extravascular lung water index (EVLWI) after the treatment, and the values obtained at 96 hours were significantly lower than those at 0 hour [HR (bpm): 119.0±14.7 vs. 200.8±19.7, SVRI (kPa·s·L-1·m-2):148.9±14.6 vs. 209.6±58.7, EVLWI (mL/kg): 10.5±1.9 vs. 34.8±10.8,P< 0.05 orP< 0.01], global end-diastolic volume index (GEDVI) was also gradually decreased without significant differences among all the time points, together with a tendency of increase in stroke volume index (SI) and cardiac index (CI). The values of the parameters at 96 hours were significantly higher than those at 0 hour [SI (mL/m2): 38.5±6.5 vs. 17.4±2.8, CI (mL·s-1·m-2): 75.0±8.0 vs. 55.5±8.5, bothP< 0.01]. Left atrium was found to be enlarged, and left ventricular systolic function decreased in two patients by cardiac ultrasonic. Four out of 35 patients died, and functional disability of extremities was found in 1 patient. Other patients were cured and discharged without any sequelae.Conclusions Severe HFMD complicated by acute pulmonary edema is a perilous condition in children, accompanied commonly by pathologic changes in central nervous system and systolic dysfunction of left ventricle. According to the results with PiCCO monitoring, HFMD patients suffering from acute pulmonary edema may be of cardiac origin in addition to neurogenic origin.