Objective To search the status quo of students'thanatopsis in order to push focused education on terminal care to the nursing major students.Metheds To distribute home-made questionnaire to 268 nursing students.Results students who cannot talk about death normally account for 21.3 percent;who never considered death or unnecessary to consider death account for 12.9 percent of the total;who considered a lot account for 10 percent;who cannot handle terminally ill account for 74.3 percent;and who prefer self-suicide when suffered defeat account for 4.9 percent.Conclusion Nursing students have insufficient ideas of death,and they need to think deeply about the meaning of death and to nurture a positive outlook on death in order to get a correct terminal care education.

OBJECTIVE:To provide reference for rational use of antidepressant drugs in the clinic. METHODS:By DDD anal-ysis recommended by WHO,the utilization of antidepressant drugs in 34 hospital from Nanjing area during 2011-2014 were ana-lyzed statistically in respects of main type,consumption sum,DDDs and DDC,etc. RESULTS:The consumption sum and DDDs of antidepressants were increased year by year in 34 hospital from Nanjing area during 2011-2014,with the average annual growth rate of 18.21% and 19.25% respectively. The top 2 drugs by DDDs were paroxetine and setraline;DDC of tomoxetine,trazodone and dutoxetine took up the first 3 place;consumption sum of paroxetine,setraline,venlafaxine and escitalopram took up the first 4 places;consumption sum of paroxetine,mirtazapine and citalopram synchronized with their DDDs,and serial number ratio was close to or equal to 1.00. CONCLUSIONS:The use of antidepressant drugs in 34 hospitals from Nanjing area is rational in struc-ture and level;selective 5-hydroxytryptamine(5-HT)reuptake inhibitors(SSRI)and selective 5-HT noradrenaline reuptake inhibi-tor(SNRI)take up the predominant place;new type of antidepressant drugs are used widely and of great use potentiality in the fu-ture.

0.05).CONCLUSION:Results of study shows there is no significant difference between the therapy of 131I combined with ATD and 131I alone.

Objective To discuss the diagnostic value of monochromatic energy image spectral CT in active small bowel bleeding and to screen the optimal energy level that indicates active bleeding of the gastrointestinal tract.Methods The bleeding model was established using the small intestines of pigs in vitro.Seven blood flow rates were simulated:0.500,0.400,0.300,0.200,0.100,0.050,0.025 ml/min,respectively.For each rate,a GE Discovery HD750 CT scanner was used in GSI scan mode and 64 slice CT was performed,with a delay of 15 s and 40 s simulated the arterial phase and portal venous phase,respectively.Each out of the blood flow rate in the 2 modes was respectively scanned 5 times.The GSI reconstruction platform was employed to obtain 7 monochromatic energy images(40,50,60,70,80,90,100 keV).A set of polychromatic energy images was obtained from an ordinary scan.The detection rates of the contrast agent exudation regions using the two scanning methods were compared.The contrast to noise ratios(CNR) for the contrast agent exudation regions were measured.Randomized block analysis of Variance was performed to compare the differences in CNR between energy levels.The x2 test was used to compare the detection rates obtained from the 2 scanning methods.Results The detection rates for energy spectral CT and 64 slice CT in the arterial phase were 31/35 and 23/35,respectively; there was significant difference(x2=5.185,P=0.023).The total detection rates of portal venous phase were 35/35 and 32/35,respectively,there was no significant difference(x2=l.393,P=0.238).On the ordinary scan mode,the detection rates of arterial and portal venous phase difference was statistically significant(x2 =6.873,P =0.009);but on the GSI scan mode,there was no significant difference(x2=2.386,P=0.122). The CNR values at 8 group energy levels for arterial phase and portal venous phase were statistically different(respectively P＜ 0.05),the CNR value of the contrast agent exudation regions at 50 keV and 60 keV monochromatic energy images on the GSI scan mode higher than that of polychromatic energy images,the difference was statistically significant(respectively P＜0.05),the CNR in portal venous phase images were higher than that of arterial at all energy groups,differences were statistically significant(t=-3.996 to-2.380,respectively P＜ 0.05).Conclusions Monochromatic energy image spectral CT demonstrates superiority over polychromatic energy images in detecting active bleeding of the gastrointestinal tract.The optimal monochromatic energy value for detection was between 50 keV and 60 keV,and the detection was easier in the portal venous phase than in the arterial phase.

Objective To detect the differential expression profile of microRNAs between patients with or without gall?bladder stone. Methods Samples from 30 patients with gallbladder stones (GS) and 30 without gallbladder stones (GP) were collected, in which microRNAs expression profiles were examined using high-throughput sequencing instrument Illumi?na HiSeq 2500. MicroRNA sequences were obtained and compared to Genebank and Rfam database for classification. Differ?entially expressed microRNAs were screened, and their target genes were predicted. Significant enrichment analysis of GO and KEGG were performed. Real-time quantitative PCR was performed on selected miRNAs in order to validate their expres?sion. Results Clean tags were obtained from both GS group (n=2 215 832) and GP group (n=1 424 770). A total of 17 mi?croRNAs were differentially expressed between GS and GP groups with statistical significance, among which 9 were up-regu?lated and 8 were down-regulated in GS group compared to those in GP group. GO (Gene ocology) analysis showed that target genes were enriched in ion binding and transport, apolipoprotein binding, calcium channel activity, protein kinase activity, steroid hormone biosynthesis and metabolism. KEGG(Kyoto Encyclopedia of Genes and Genomes)analysis is shown for the target genes enriched in cancer related pathways, including WNT, HIPPO pathways. qRT-PCR validation of some differen?tially expressed miRNAs confirmed the result of high-throughput data analysis. Conclusion The differential expression levels of microRNAs may play an important role in occurrence and development of gallbladder stones.

This paper is aimed to assess the effects of red blood cell (RBC) transfusion on clinical outcomes in cardiac surgery. Trials were identified by computer searches of the Pubmed, MEDLINE, Cochrane Library (Issue 10, 2012), from January 1980 to October 2012. References in identified trials and review articles were checked and experts contacted to identify any additional trials. The homogeneous randomized controlled trials (RCTs) were analyzed with RevMan 5.1 software. Five trials involving a total of 1,203 patients were identified. The results of meta-analyses showed that restrictive transfusion strategies reduced the risk of receiving a RBC transfusion (MD = - 1.46, 95% CI -1.18(-) -1.1) and the volume of RBCs transfusion (RR = 0.69, 95% CI 0.53-0.89). No significant difference was noted between the two strategies in terms of mortality, adverse events and hospital or intensive care length of stay. Based on the results mentioned above, one can draw a conclusion that restrictive transfusion strategies reduced the risk of receiving RBC transfusion and the volume of RBCs transfused. Restrictive transfusion strategies did not appear to impact on the rate of adverse events and hospital or intensive care length of stay, compared to liberal transfusion strategies.
Cardiac Surgical Procedures ; adverse effects ; Erythrocyte Transfusion ; Humans ; Randomized Controlled Trials as Topic ; Treatment Outcome

Objective To evaluate the effect of different tube voltage and noise index (NI)on image quality and radiation dose during peripheral artery CTA with automatic tube current modulation(ATCM)technique.Methods Seventy-two patients were ran-domly divided into three groups with different scanning tube voltage and noise index as follows:group A with 100 kV and NI of 1 5, group B with 80 kV and NI of 1 5,group C with 100 kV and NI of 20.Image quality,segmental vascular enhancement,signal-to-noise ratio (SNR),contrast-to-noise (CNR)and effective dose (ED)were independently evaluated in 3 groups.The methods of sta-tistics analysis were ANOVA,and P <0.05 represented the significant difference.Results There was no significant difference of image quality of the peripheral artery among 3 groups.The CT value,SNR,CNR in group B (80 kV)was the highest,and there were statistical differences between A,B groups and B,C groups of arteries (P <0.05),and there was no satistiacal difference between A group and C group.Compared with group A and group B,the CTDlvol,DLP and ED of group C was reduced 50.45%,51.20%,51.21% and 35.03%,34.91%,34.92%,respectively,and the difference was statistical significance (P < 0.05 ),and there was no significant difference between group A and group B (P >0.05).Conclusion Using ATCM low-kV with high NI scanning can reduce radiation dose without interference on image quality for peripheral artery CTA.

Objective To investigate the association between the peroxisome proliferator-activated receptor-or (PPARα) polymorphism rs1800206 (c.484C ＞ G,L162V) and the risk of metabolic syndrome (MES)Methods There were 1184 subjects aged 40-60 years recruited from our hospital between March 2010 and March 2011.The PPARα polymorphism 484C ＞ G was genotyped using TAQMAN assay by real-time PCR. The relationship between PPARα polymorphism and MES risk were investigated.Results The genotype frequencies were 91.4％,8.4％ and 0.2％ for the PPARα CC,CG and GG,respectively.This SNP was in Hardy-Weinberg equilibrium(P =0.845).Compared with the most common CC genotype,the variant genotypes(CG + GG) had higher fasting glucose((5.82 ± 1.59) mmol/L vs (5.49 ± 1.17) mmol/L,t =2.630,P =0.009) and LDL-C levels((3.53 ± 1.03) mmol/L vs (3.36 ± 0.65) mmol/L,t =2.376,P =0.018) and lower HDL-C levels ((1.56 ± 0.35) mmol/L vs (1.65 ± 0.43) mmol/L,t =2.430,P =0.015).Furthermore,the 484G variant genotypes(CG + GG)was associated with the risk of MES after adjusting for age,gender,education,BMI and lifestyle (smoking and alcohol status) (adjusted OR =1.89 ;95％ CI =1.09-3.23,P =0.012).Condusion PPARα polymorphism rs1800206 is a significant independent predictor of the MES in Southern Chinese.

Objective To explore the clinical characteristics, surgical methods and outcome of recurrent retinal detachment in silicone oil-filled eyes after vitreoretinal surgery. Design Retrospective, observational case series. Participants 55 patients (55 eyes) diagnosed as recurrent retinal detachment with silicone oil-filled eyes. Methods To analyze the clinical manifestations of recurrent retinal detachments and adopt different methods to make retina reattach including vitreoretinal surgery with or without silicone oil removal and scleral buckle revision alone. Patients were followed up for 3 months. Main Outcome Measures Clinical manifestations, retinal re-attachment and visual acuity. Results The characteristics of recurrent retinal detachment in silicone oil-filled eyes were inferior location mainly, less than 2 quadrants, with proliferation and hole. Fifty of the 55 patients underwent repeat surgical repair. Surgical methods included re-vitreoretinal surgery in 39 eyes with silicone oil removal, re-vitreoretinal surgery in 9 eyes without silicone oil removal and scleral buckle revision alone in 2 eyes. After a follow-up of 3 months, retina re-attached in 41 eyes, partially attached in 7 eyes, and detached in 2 eyes. Conclusions Repair of recurrent retinal detachment in silicone oil filled eye is challenging. Favorable anatomic outcome may be achieved in selected patients with proper surgical measures according to the characteristics of recurrent retinal detachment.

Purpose:To investigate the effect of CD40 ligandization on breast cancer cell line and endothelial vein cell line.Methods:The expression of CD40 and its ligand on breast cancer cell line(M231),EVC cell line,fresh clinic breast cancer cell were determined by indirect immunofluorescence assay with flow cytometry(FCM) analysis.Then M231 cells cultured with CD40 agonsitic monoclone antibody,adriamycin alone or in combinations for 72 hours and proliferation of M231cells was determined by MTT assay.FCM was employed to study the cells' death or apopotosis with Annexin V PI assay.Results:M231 and ECV cell line and fresh clinic breast cancer cell are highly expressed CD40 but no CD40L.CD40 ligandization can not only inhibit the proliferation of M231 cell line but also inhibit ECV cell line by promoting the death or apoptosis of these cells.Combined CD40 agonsitic monoclone antibody with adriamycin may obviously inhibit proliferation of M231 and ECV cell line.Conclusions:CD40 ligandization may have double therapeutic effect to breast cancer: inhibit the proliferation of breast cancer cell and inhibit tumor angiogenesis by inhibiting vascular endothelial cell.