Objective To investigate the level and influence factors of sleep quality in caregivers to neurological intensive care unit (NICU) survivors. Methods The Pittsburgh Sleep Quality Index (PQSI) and the sleep quality influence factor scale were administered on 167 family caregivers to NICU survivors. Results The score of PQSI was 8.81 ± 3.25,and 55.68%(98/167) of caregivers reported poor sleep quality. Logistic regression analysis showed that medical insurance(OR=2.025, P<0.01), hospital stay (OR==2.235, P<0.01), whether caregivers in service (OR=0.583, P<0.05), resisdence(OR=2.341, P<0.01), and tracheal tubes/ventricular drainage (OR=5.857, P<0.01) were influencing factors of sleep quality. Conclusions It proved that our intervention should focus on family caregivers to NICU survivors social and psychological characteristics may help to enhance their sleep quality and quality of life.

The requirements for library-provided knowledge service in training of doctorial students were studied according to the analysis of problems in trainingof doctorial students .Theinformation support platform for innova-tive training of doctorial students was constructed by incorporating knowledge service intothe training of doctorial students from the aspects of topic selection, project establishment, scientific research,project completion and choosing excellent doctorial students in order to improve their information awareness and innovative ability.

Objective To evaluate the clinical effects of sinus tarsi approach and eight-shape approach in the treatment of calcaneal fractures.Methods Analyzed the outcomes of 23 patients(21 males and 2 females)with calcaneal fractures(25 feet)treated with plate via sinus tarsi approach and eight-shape approach.The mean age of patients was 38 years old(ranged from 24 to 55 years).According to Sanders classification:16 feet in type Ⅱ,9 feet in type Ⅲ.Results The average operation time was 85 min(ranged from 70 min to 100 min),and no wound compli-cations occurred.X-ray review showed that bony healing,and healing time was 3-6 months.The average duration of follow-up was 13 months(ranged from 12 to 18 months).The result was excellent in sixthteen cases,good in six cases and fair in one case according to Maryland score.The satisfactory rate was 95 .6%.Conclusion Open reduction and internal fixation via the sinus tarsi approach and eight -shape approach provides not only reliable fixation,but also less complications.

Objective To explore the best turn lateral position angle of the patients with stroke in acute phase. Methods 100 patients with stroke in acute phase weredivided into five groups according to 15 ° ,30 ° 45 ° , 60 ° , 90 ° turn lateral position angle separately and then observed the skin temperature of good location of pressure ulcers of the patients before and after turning over 2 h. The changes of blood pressure, heart rate and the finger tip pulse oxygen saturation were recorded within the turn over 2 hours. Results The skin temperature, blood pressure, heart rate, blood oxygen saturation among the groups had no statistical significance (P>0.05) in the difference turn angle of lateral position.The skin temperature, blood pressure, heart rate, blood oxygen saturation between the groups had no statistical significance (P>0.05) in the same turn angle of lateral position.Conclusions Five different turn lateral position angle have no obvious difference on the vital signs and the skin temperature in patients with stroke in acute phase. It is suggested to adopt the turn lateral position angle of less than 90° from the perspective of biomechanics and patients′comfort.

Objective To explore influence of Naoxintong capsule combined with edaravone on clinical efficacy and vascular endothelial function of patients with type-2 diabetes complicated with cerebral infarction.Methods 80 cases of patients with type-2 diabetes complicated with cerebral infarction treated in Shengsi People's Hospital in Zhejiang from January 2014 to January 2016 were selected as the objects, and were divided into control group and study group randomly, forty-one cases in each group.The control group were given edaravone treatment, and the study group were added Naoxintong capsule on the basis of the control group, treatment for two weeks in the two groups.Clinical therapeutic effect of the two groups and changes of TCM syndrome score before and after treatment were compared, and scores of nerve function defect and daily life ability were evaluated, and changes of blood glucose and glycosylated hemoglobin levels were detected, and endothelin ( ET-1 ) , nitric oxide ( NO ) , thromboxane B2 ( TXB2 ) and 6-keto prostaglandin F1(6-keto-PGF1) were tested before and after treatment in the two groups.Adverse reactions were observed in the two groups in treatment. Results The total effective rate of the study group was significantly higher than that of the control group(P<0.05), and TCM syndrome scores of the two groups were significantly decreased after treatment in the two groups(P<0.05), which of the study group was significantly lower than that of the control group(P<0.05).After treatment, NIHSS score of the two groups significantly decreased(P<0.05), and ADL score significantly increased(P<0.05), and changes of the study group were significantly higher than those of the control group(P <0.05).Fasting blood glucose and glycosylated hemoglobin levels significantly decreased in the two groups(P<0.05), which of the study group were significantly lower than those of the control group ( P <0.05 ).Levels of ET-1 and TXB2 significantly decreased ( P <0.05 ) , levels of NO and 6-keto-PGF1 significantly increased ( P <0.05 ) , and changes in the study group were significantly higher than those in the control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups.Conclusion The effect is obvious of Naoxintong capsule combined with edaravone in treratment of patients with type-2 diabetes complicated with cerebral infarction, and can improve vascular endothelial function of patients.It can be widely used in clinical.

Objective: To explore the therapeutic efficacy and mechanism of transcutaneous electrical acupoint stimulation (TEAS) for menopausal insomnia. Methods: A total of 80 patients with menopausal insomnia were randomly divided into a control group and an observation group, with 40 cases in each group. The patients in the control group received conventional Western medication treatment, and the patients in the observation group received TEAS on the basis of conventional Western medication treatment. The treatment for both groups lasted for 4 weeks. Before and after treatment, Pittsburgh sleep quality index (PSQI) and modified Kupperman scale were evaluated, and the serum levels of estradiol (E2) and follicular stimulating hormone (FSH) were measured. The therapeutic efficacy was evaluated after treatment. Results: After treatment, the total effective rate of the observation group was significantly higher than that of the control group (P<0.05); in the control group, the improvement of PSQI score was significant (P<0.05), while the change of modified Kupperman score was insignificant (P>0.05); the PSQI and Kupperman scores in the observation group were significantly improved after treatment (both P<0.05), and there were significant differences between the observation group and the control group in PSQI and Kupperman scores (both P<0.05). After treatment, the serum E2 and FSH levels in the control group were not statistically different from those before treatment (both P>0.05); the serum E2 level was significantly increased (P<0.05), and the FSH level was decreased (P<0.05) in the observation group after treatment, and the between- group differences in serum levels of E2 and FSH were significant (both P<0.05).Conclusion: TEAS plus conventional Western medication in treating menopausal insomnia is effective, and can significantly improve the symptoms of insomnia and menopause, which may be related to the regulation of serum E2 and FSH levels.

30%-50% patients with non-small cell lung cancer (NSCLC)will occur cerebral metastasis in the course of their illnesses.NSCLC with brain metastases is one of the difficulties in cancer treatment. Treatment measures include surgery,radiotherapy,chemotherapy,biological targeted therapy and so on.The new prognostic scoring system is recommended to predict the prognosis of patients.Individualized treatment methods should be chosen according to prognostic score.

Objective To enrich pancreatic cancer stem cells through culturing mammospheres, and to detect the expressions of epidermal growth factor receptor(EGFR) and a disintegrin and metalloprotease 9 (ADAM9) and investigate their significance. Methods PANC1 cells were cultured in serum-free conditioned medium to continuously generate mammospheres, and parts of mammospheres were cultured on a collagen substratum to induce differentiation. Mammospheres cells and differentiated cells were collected, flow cytometry was used to detect the proportion of side population (SP) cells, and the expressions of EGFR, ADAM9 mRNA and protein were detected by real-time PCR and Western blotting. Results PANC1 cells mammospheres were successfully generated and could be passed continuously. After differentiation, mammospheres cells could regain the ability of adherent growth. The proportion SP cells in mammospheres cells and differentiated cells were ( 5.40 ± 0.38 ) % and (2.80 ± 0.42 ) %, and the difference was statistically significant ( P ＜ 0. 05 ).Compared with differentiated cells, the expression of EGFR and ADAM9 mRNA of mammospheres cells upregulated 2.5 and 3.0 folds ( P ＜ 0. 05 ). The expressions of EGFR and ADAM9 protein of mammospheres cells were 0.90 ± 0. 09 and 0.64 ± 0.07, which were significantly higher than those in differentiated cells (0.62 ±0.11 and 0.48 ±0.09, P ＜0.05). Conclusions Mammosphere cells contained higher proportion of pancreatic cancer stem cells. ADAM 9 may play an important role in the occurrence and development of pancreatic cancer through the EGFR signaling pathway.

Objective To discuss and evaluate the value of multi slice spiral CT angiography in the diagno -sis of penetrating atherosclerotic ulcer materials .Methods 17 patients of PAU were collected and examined with MSCT,the location,radiological diagnosis and complications of PAU on axial ,CTA and 2D/3D images were analyzed. Results Ulcer-like aortic projections were observed of 17 patients,and connected with aortic cavity ,where narrow neck sign was showed .The indirect signs included localized or extensive IMH ,calcification of aortic wall and dilata-tion of aorta .Conclusion Multi slice spiral CT angiography is an effective method for the diagnosis of PAU by provi -ding valuable information for the diagnosis and treatment .

Objective To investigate the clinical value of multi-slice spiral CTA ( MSCTA ) and image-post processing techniques in diagnosis of acute aortic syndrome ( AAS) .Methods 71 patients with AAS were scanned by TOSHIBA Aquilion 64-slice spiral CT,the images on axial and 2D/3D were analyzed.Results 71 cases included 48 cases of aortic dissection ( AD) ,10 cases of intramural hematoma ( IMH) and 13 cases of penetrating atheroscle-rotic ulcer ( PAU) .MSCT depicted the imaging features of AAS:AD showed intimal flap and true and false lumens;IMH showed crescent or circular thickening of aortic wall .PAU showed a niche filling with contrast medium and pro-truding the aortic lumen ,where narrow neck signwas shown .The location ,radiological diagnosis and complications of AAS were observed in 71 patients.Intervention treatment or surgical treatment was conducted in 27 cases after defi-nite diagnosis .Conclusion MSCT is a fast and noninvasive examination technique , and it can provide important information for the diagnosis and treatment of AAS .