Objective To summarize the clinical experience of repairing facial scar with tubed pattern skin flap from the cervical cutaneous branch of transverse cervical artery.Methods Firstly,a skin flap in the cervical cutaneous branch of transverse cervical artery was designed at chest according to the size of facial scar.The chest skin would be expanded if it was not large enough.Secondly,a skin flap was cut,and the proximal end was rolled and sutured as a tube,whereas the remote end was formed an interface.Thirdly,the scar was removed from the facial scar area and the wound was covered with the tubed pattern skin flap interface.After a blood circulation was established between the face skin and the flap,the flap was trained so that it had plentiful blood supply.Lastly,the tubed pattern skin flap was cut off and open,the remaining facial scar was removed,and the wound was covered and sewed up with the sectioned tubed pattern skin flap.Results The facial scar 35 patients were repaired with tubed pattern skin flap from the cervical cutaneous branch of transverse cervical artery.The survival rate of flap was 100％.Twenty patients received thinning and shaping on flaps in 0.5 to 1 year after surgery.All patients were satisfied with this repair within 1 ～ 5 year follow-up.Conclusions The tubed pattern skin flap in the cervical cutaneous branch of transverse cervical artery is of highly similar to the facial skin.In addition,the supply of the skin is enough.Therefore,it is an ideal flap to repair large facial skin defects.

Objective To understand the serum levels of advanced glycation end products (AGEs),soluble receptor for advanced glycation end products (sRAGE) in newly diagnosed patients with type 2 diabetes.Methods 60 patients of newly diagnosed type 2 diabetes were chosen from 2010 September to 2011 December in Department of Endocrinology Changshou Chinese medicine hospital in Jiangsu Province,and 30 healthy people were screened as control group.Various clinical and biochemical parameters were detected,using enzyme-linked immunosorbent assay for the detection of serum AGEs and sRAGE levels.Results The levels of serum AGEs in newly diagnosed type 2 diabetic patients and control group were (1379.2 ± 431.8) and (1154.5 ±326.4) pg/ml,and there were significant differences between two groups (P＜0.05).The levels of serum sRAGE in newly diagnosed type 2 diabetic patients and control group were (14.6± 9.3)and (19.5 ± 8.9)ng/ml,and there were also significant differences between two groups (P＜0.05).The level of serum AGEs in newly diagnosed type 2 diabetic patients was positive correlation with glycosylated hemoglobin (HbA1c),and the level of serum sRAGE was associated with low density lipoprotein cholesterol (LDL-C) negative correlation.Conclusion The level of serum AGEs increase in newly diagnosed type 2 diabetic patients,and the level of serum sRAGE decrease in newly diagnosed type 2 diabetic patients.

Objective To investigate the features and risk factors associated with lymph node metastasis in colorectal neuroendocrine neoplasm.Methods Clinical and pathological data of 63 patients with colorectal neuroendocrine neoplasm treated in Yinzhou People's Hospital between June 1997 to December 2012,were analyzed retrospectively.Comparisons of categorical data and univariate analysis of risk factors of lymph node metastasis were conducted by x2 test,multivariate analysis was conducted by Logistic regression analysis.Results Of the 63 patients the rate of regional lymph node metastasis was 30％ (19/63) with 58％ limited to para-intestinal lymph nodes in 11 cases,26％ limited to mesenteric lymph nodes in 5 cases,and 16％ limited to mesenteric root central lymph nodes in 3 cases.No metastasis exceeding central lymph nodes was observed.According to univariate analysis,tumor size,depth of invasion,ulceration in mucous membrane,invasion of lymphatic vessel and pathological grading suggested by WHO were related to regional lymph node metastasis (P ＜ 0.01).Multivariate regression analysis revealed that tumor size,invasion of lymphatic vessel and pathological grading were independent risk factors for lymph node metastasis in colorectal neuroendocrine neoplasm (P ＜ 0.05).Conclusions Colorectal neuroendocrine neoplasm with larger tumor size,invasion of lymphatic vessel or higher grade (G2,G3) has high risk of regional lymph node metastasis.

Objective To explore the function of intensive care unit (ICU) in earthquake disaster. Mothod ICU in tent set by doctors from Second Military Medical University and Sichuan Jiangyou People's Hospital in 5·12 Wenchuan earthquake disaster. The value of ICU in tent was estimated by retrospective analysis of the experi-ence of emergency treatment for the critical injuries. Results Inside ICU in tent,there were many critical patients successfully rescued, including a soldier with septic shock, a casualty with traumatic shock during aftershock, a middle school student with crush injury and cornpartment syndrone, a peasant trapped under mined buildings for 168 hours with capillary leak syndrome, and a traffic victim and an aged patient with cardiac arrest. Patients after replatation of severed limb and patients after thoracic operation were monitored. Teaching rounds in the wards and logistics health drilling were made as well. Conclusions ICU in tent as a place where the critical casualties and patients after major operations could be rescued,cared for and monitored successfully,as well as the venue of teach-ing activity and logistics health drilling.

Objective to analyze the relation between glycosylated hemoglobin (HbA1c) of pregnant women with gestational diabetes mellitus (GDM) and neonatal blood glucose.Methods HbA1c values of 743 pregnant women with GDM are detected,and according to HbA1c level,they were divided into 3 groups,such as G1 (HbA1c＜5.5％),G2 (5.5％≤HbA1c≤6.5％) and G3 (HbA1c＞6.5％).Newborn babies' blood glucose values of the women in each group are monitored respectively in the 1st hour and at the 4th and 8th hour.Neonatal hypoglycemia and incidence of threshold blood glucose in the three groups are compared by SPSS 17.0 software.Results (1) The incidence of neonatal hypoglycemia in G1 and G2 are both higher than thatin G3 in the 1st hour (P＜0.05).The incidence of neonatal hypoglycemia in G3 is higher than that in G1 and G2 at the 4th and 8th hour (P＜0.05).(2) With time extending,the incidence of neonatal hypoglycemia declines in G1 and G2 (P＜0.05),but there is no obvious decline in G3 (P＞0.05).(3)The incidence of threshold blood glucose in G3 and G2 are higher than that in G1 in the 1st hour,and at the 4th,8th hour(P＜0.05),and there is no obvious statistical difference between G2 and G3 (P＞0.05).(4)With time extending,the incidence of threshold blood glucose declines in G1 (P＜0.05),but it doesn't decline in G3 evidently(P＞0.05).And there was no obvious decline in G2 in the 4 hours after babies were born(P＞0.05).(5)A mother's HbA1c level has a negative correlation with her baby's blood glucose in 1 hour after birth(r=-0.401,P＜0.05).Conclusion The higher HbA1c level of pregnant women with GDM increases,the higher risks of their neonatal hypoglycemia and threshold blood glucose are.

Objective:To observe the effects of rosiglitazone on transforming growth factor-?1(TGF-?1)/SMADs signal pathway in dia- betic rat myoeardium(DM)and cardiac remodeling. Methods:Thirty male SD rats were randomly divided into normal control,DM and rosiglitazone groups,each having 10 rats.Diabetic rats were induced by a single intrapefitoneal injection of streptozotoein(60mg/kg).A cannula connected to a trans- ducer was inserted into the heart to measure the cardiac function.The body weight,heart weight and heart weight/body weight (HW/BW)were measured.The ultrastruetural changes were evaluated by electron microscope and collagen content was assessed by Van Gieson staining.The mRNA expression level of SMAD3 and SMAD7 were determined by RT-PCR.The protein level of TGF-?1,SMAD3 and SMAD7 were detected by immunohistochemistry. Results:Compared with the normal controls,diabetic rats experienced marked myocardium damage.Cardiac function,espe- cially diastolic function was impaired,HW/BW(P

Objective To understand the effect of astragalus on insulin resistance and plasma amylin levels in newly diagnosed type 2 diabetic patients.Methods 88 patients of newly diagnosed type 2 diabetes were randomly divided into three groups:Group A (lifestyle intervention group) contained 30 patients,Group B (metformin treatment group) also contained 30 Patients,and Group C (astragalus and metformin treatment group) contained 28 Patients.Patients in group A were intervened with the control of diet,blood pressure and lipids level; patients in group B were additionally treated with metformin on the basis of group A; patients in group C were additionally treated with metformin and astragalus on the basis of group A.The course for both treatments were 8 weeks.Various clinical and biochemical parameters were detected before and after the treatment in all three groups and enzyme-linked immunosorbent assay was adopted for the detection of plasma amylin.Results Fasting blood glucose levels were significantly decreased after treataent in the three groups (t=-2.696、-4.029、-3.995,P＜0.05) ; insulin resistance index reduced in group B and group C (t=-2.599、-3.813,P＜0.05),the difference between group C and group B was statistically significant (t=-2.334,P＜0.05) ;treatments of group B and group C could improve the beta cell function index (t=2.303、2.384,P＜0.05),and they also could increase the plasma amylin level (t=2.341、3.045,P＜0.05).Conclusion Astragalus and metformin can improve insulin resistance index and increase plasma amylin levels in newly diagnosed type 2 diabetic patients.

Objective To observe the effects of telmisartan on cogtive function and the expression of Ghrelin receptors,growth hormone secretagogues receptor(GHSR) in diabetic rats. Methods Forty rats were randomly divided into 3 groups: control group,diabetic model group,and telmisartan treatment group. Streptozotocin-induced diabetic rat model(65 mg/kg,ip) was established. In the telmisartan treatment group,the rats were treated with telmisartan (13.3 mg?kg-1?d-1) for 12 weeks. Learning and memory abilities of the rats were tested by the Morris water maze. The mRNA and protein levels of GHSR in frontal cortex were detected by RT-PCR and immunohistochemistry. Results Compared with the diabetic model group,the telmisartan treatment group showed a significant decrease in the mean time of escape latencies(P

This paper expounds the concept and connotation of the nurse professionalism, introduces the re-search status of foreign nurses professionalism assessment tools,discusses the influence factors of nurse professional-ism,including:personal factors, organizational factors and occupational factors.It also puts forward following sugges-tions:constructing the nurse professionalism of theoretical system and evaluation methods, advocating the spirit of nurses professionalism cultivation,creating a health care professional environment,providing the reference the devel-opment of our country's theory and improve the nurse professionalism.

Objective To study the changes of serum markers of hepatic fibrosis in patients with fatty liver,and to provide clinical diagnosis and treatment for patients with fatty liver.Methods Three hundred and sixty-one patients with fatty liver were divided into light,medium and heavy three degrees according to the intrahepatic echo and structure.Serum markers of hepatic fibrosis-hyaluronic acid (HA),laminin (LN),procollagen Ⅲ (PC Ⅲ) and type Ⅳ collagen (C-Ⅳ) were examined by enzyme linked immunosorbent assay (ELISA),and the ordinal logistic regression model was used to analyze,regarding the grade of fatty liver as dependent variable.Results The levels of serum fibrosis markers HA,LN,PC Ⅲ and C-Ⅳ in patients with mild,moderate and severe fatty liver were (94.53 ± 16.21),(101.38 ± 20.42),(127.34 ± 26.54) μg/L,(107.25±22.63),(117.38±24.84),(136.62±32.27) μg/L,(110.27±23.15),(121.55±27.36),(138.62± 30.62) μg/L,(72.61 ± 15.46),(82.06 ± 18.28),(92.96 ± 21.35) μg/L respectively,there was significant difference in serum fibrosis markers among mild,moderate and severe fatty liver patients (F =675.719,398.771,303.960,840.570;P＜0.05),while the markers of patients with severe fatty liver were higher than normal.The ordinal logistic regression model showed that the serum fibrosis indexes of HA,LN,PC Ⅲ and C-Ⅳ had significant effects on the grading of fatty liver(P＜0.05),whose odds ratio were 1.322,1.229,1.899,3.935,that was the higher the HA,LN,PC Ⅲ,C-Ⅳ,the more severe fatty liver.Conclusion There were liver fibrosis trend in patients with severe fatty liver.Detection of serum markers of hepatic fibrosis can be used as an important basis for monitoring and diagnosis of fatty liver disease.