Bile leak is a commonly complication after biliary tract surgery.In the past,operation was considered priorly to deal with bile leak besides putting a drainage tube in advance.Minimally invasive surgery has gradually become a primary management of bile leak,with the development of minimally invasive surgery such as abdominoscope in the 20th century.

Objective To explore the self efficacy of newly-contracted nurses in a tumor hospital in Guangzhou and to find out the related factors. Methods By convenience, cluster sampling method, 333 newly-contracted nurses from a tumor hospital in Guangzhou were recruited in the study. The general self-efficacy scale (GSES) and a self-designed demographic questionnaire were used to look into their self-efficacy and explore the related factors. Results The average score of self efficacy was (2.67 ± 0.41). The level of self-efficacy was related to education and the type of hospital for internship. Nurse with bachalor degree and graduated from comprehensive hospital had higher self-efficacy. Conclusions The self efficacy of the newly contracted nurses is intermediate. The education level and the type of hospital for internship both influence the level of self efficacy. The special hospitals should strengthen the teaching and training of students and lay stress on developing their capacity to prepare them for the job.

To explore the effects and mechanisms of combining astragaloside IV (the effective component of Astragalus membranaceus) with notoginsenoside R1, ginsenoside Rb1 and ginsenoside Rg1 (the effective components of Panax notoginseng) against oxidative injury in PC12 cells induced by cobalt chloride (CoCl₂).

Objective To establish a HPLC method for determination of geniposide content in Qingkailing Capsule. Methods HPLC with Gracesmart C18 was used and detection wavelength was 238 nm with acetonitrile-water (15∶85) as mobile phase. The flow rate was 1.0 mL/min. Results The standard curve was linear over the range of 0.060 4～0.302 0 ?g (r=0.999 8). The average recovery was 98.73%, and RSD was 1.61%. Conclusion This method is reliable, accurate and suitable for the determination of geniposide in Qingkailing Capsule.

Objective To construct a scientific,valid evaluation system for excellent clinical nurses.Methods Based on the framework of competency theory,systematic literature reviewing,nursing experts discussion and the Delphi method were used to determine the primary indexes for the evaluation system.The evaluation system was determined from three perspectives,doctors',nurses' and patients'.Analytic Hierarchy Process (AHP) was then used to determine the weight of each index.Results The weight of doctors',nurses' and patients' perspective was 0.2,0.4,0.4 respectively.Doctors' and nurses' perspective(hereinafter referred to as staff's perspective) had the same evaluating indexes,which both consisted of 5first-dimensions,22 second-dimensions.The patients' perspective contained 3 first-dimensions,14 seconddimensions.In two-round Delphi technique,the rates of questionnaire retrieve were 91.2％ (31/34),100.0％(31/31),respectively;the colleagues' coordination coefficients were 0.784,0.858,respectively,and the patients' coordination coefficients were 0.05,0.216,respectively.Conclusions A evaluation system of high reliability and validity for excellent clinical nurseshas been successfully constructed.It may be utilized as a tool to for nursing administrator selection,training,assessment of excellent clinical nurses.

Objective To investigate the expression of engulfment and cell motility protein 1 (ELMO1) in hepatocellular carcinoma(HCC) and its effects on cell migration.Methods The expression of ELMO1 in HCC cell lines and HCC tissues was assessed by Western blot.We used transient transfection with an ELMO1 expressing vector to over-express ELMO1 protein in SK-HEP-1 cells.Over-expression of ELMO1 was confirmed by Western blot.siRNAs specific to ELMO1 (ELMO1 siRNA) were used to knockdown ELMO1 expression.Rho Family Small GTPase Activation Assay, Western blots, transwell assay were used to determine the migration potential of cells.Student's test was employed for statistical analysis.Results The expression of ELMO1 protein was obviously up-regulated in HCC tissues and cell lines (P<0.05).Over-expression of ELMO1 promoted cell migration in SK-HEP-1 cells, while knock-down of ELMO1 showed the opposite effect.Conclusion ELMO1 up-regulation significantly correlates with cell migration in hepatocellular carcinoma.

Objective The purpose was to describe the outcomes and characteristics of the obstetric patients with concurrent eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP) syndrome. Methods We retrospectively collected the materials between December 1999 and December 2008 in Obstetric Critical Care Center of Guangzhou. There were 76 patients in rolled then they were divided into two groups according to with or without HELLP syndrome. All the patients were injected Magnesium Sulfate to control seizure and to prevent the recurring of seizure. We analyzed the characteristics (such as age, gestational weeks, blood pressure after seizure), complications, biochemistry markers, the rate for intensive care unit (ICU) admittion, the need for mechanical ventilation, the Glasgow coma score (GCS) when admitted into ICU, computed tomography scan (CT) or magnetic resonance imaging (MRI),death rate of maternal and others, then compared between the two groups. Results ( 1 ) General data:There were 17 patients admitted with both eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of eclampsia with HELLP syndrome was 22% (17/76).In eclampsia with HELLP syndrome group, the systolic blood pressure was higher and the rate of preterm also was higher [ (182 ± 20) mm Hg (1 mm Hg=0. 133 kPa)vs. (159± 21 ) mm Hg, P ＜ 0. 05 ]. But in regard to the age, gestational weeks, the rate of regular prenatal care and diastolic blood pressure, there were no differences between the two groups. (2) Biochemistry markers: the aspartate transaminase (AST), lanine transaminase (ALT), blood urea nitrogen and creatinine were significantly increased in eclampsia with HELLP syndrome group than eclampsia without HELLP syndrome group [ (879 ± 337) U/L vs. (90 ± 27)U/L, (344 ±83) U/Lvs. (43 ±11)U/L, (2245 ±294) U/L vs. (485 ±61)U/L, (14 ±9) mmol/L vs.(7 ± 3) mmol/L, ( 140 ± 92) μmol/L vs. (83 ± 28 ) μmol/L, P ＜ 0. 01, P ＜ 0. 05 ], and the platelet was lower in eclampsia with HELLP syndrome group [ (38 ± 13) × 109/L vs ( 172 ±46) × 109/L, P ＜0. 01 ].(3) Clinical outcomes: The maternal death rate was 35% (6/17) in eclampsia with HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (3%, 2/59)(P ＜ 0. 05 ). There were more patients admitted to ICU and more patients who need mechanical ventilation in eclampsia with HELLP syndrome (13/17 vs. 34%, 9/17 vs. 24/, P ＜0. 05), also more patients with GCS ≤8 in eclampsia with HELLP syndrome when admitted to ICU ( 8/17 vs. 7/59, P ＜ 0. 05 ), compared to the eclampsia without HELLP syndrome group. There were more patients complicated with cerebral venous thrombosis and cerebral hemorrhage in eclampsia with HELLP syndrome group than other group (8/17 vs.7%, P ＜ 0. 05 ). Five of six patients died of cerebral hemorrhage in eclampsia with HELLP syndrome group,while other two missing cases in eclampsia without HELLP syndrome group all died of cerebral hemorrhage.The all missing cases were performed CT or MRI and seven (7/8) of them showed cerebral hemorrhage.Conclusion The incidence of concurrent eclampsia and HELLP syndrome was not rare, it happened seriously and with more mortalities, such as cerebral hemorrhage, and also the maternal mortality rate was significantly higher. It should be warning that the obstetrician should take great attention for these women,and consider life support treatment for them.

BACKGROUND: It is a new tendency to treat central nervous system injury or tumor therapy using the combination of seed cells and gene therapy.OBJECTIVE: To observe the dose-relationship between transfection and expression of rabbit bone marrow mesenchymal stem cell (BMSCs) with adenovirus vector carrying green fluorescent protein (Ad-GFP), and to study its effects on cell biological properties, in addition, to explore the feasibility of using Ad-GFP vector to construct gene modified BMSCs.DESIGN, TIME AND SETTING: A randomized grouping, contrast observation. The experiment was performed at the Southern Medical University between August 2008 and March 2009.MATERIALS: New Zealand white rabbits, irrespective of genders, weighing 2.0-3.0 kg, were selected.METHODS: BMSCs were separated and cultured in vitro, and then the cell immunophenotypes were detected by flow cytometry.The adenovirus was obtained by packaging 293 cells and was used to transfect BMSCs with various liters (1 ×-10~3-1×10~(10) PFU/mL).Cytometry was used to analyze the transfection efficiency.MAIN OUTCOME MEASURES: Cell morphological changes were detected under an invert microscope. The cell proliferation was detected by CCK8 kits. BMSCs transfected with Ad-GFP were induced differentiating into neuron-like cells by adding of β-mercaptoethanol.RESULTS: The surface markers of 3-6-generation BMSCs were negative to CD34 and CD45, but positive for CD29 and CD44.When the virus titers were 1 ×10~7 PFU/mL, the transfection rate was 55%, which were 85% when the virus titers were 1 ×10~9 and1×10~(10) PFU/mL. However, cell pathology phenomenon occurred when the virus titer was 1 ×10~(10) PFU/mL. The fluorescence was strongest expressed at day 7, and it still can be seen at day 28. The BMSCs trasfected with Ad-GFP could differentiate into neuron-like cells under induction of p-mercaptoethanol, with positive neuron-specific enolase.CONCLUSION: Ad-GFP with suitable titers can infect BMSCs effectively with little influence on the biology property or differentiation function. BMSCs can serve as seeds cell in gene therapy field when utilizing ad-GFP vector system.

Objective To construct the competency model of emergency and critical care clinical nurses and provide a reference for allocation and selection of the emergency and critical care clinical nurses. Methods Twenty emergency and critical care clinical nurses were interviewed by using behavioral event interview method. The optimal competency elements were screened by comparing the difference in their competency in different performance levels, so the competency model was constructed. Results Two distinctive competencies and nine threshold competencies were comprised in the competency model. The category agreement of the competency model was 0.790 and the coding reliability coefficient was 0.882. Conclusions The competency model of emergency and critical care clinical nurses is of high reliability. The model provides a scientific basis for allocation and selection of appropriate emergency and critical care clinical nurses and develops human resources from newly graduated nurses.

Objective: To explore the effect of salvianolate combined with the conventional therapy on acute ischemic stroke and observe the influence on serum inflammatory cytokines of interleukin-6(IL-6).Methods: According to the random number table, 70 patients were randomly divided into the observation group (n =35) and the control group (n =35), and both were given the conventional therapy for acute ischemic stroke.The observation group was given intravenous injection of 200mg salvianolate in 250ml normal saline once a day additionally.The treatment course was 2 weeks.Another 30 persons with physical examination were in the healthy control group.The neurologic damage deficiency score (NIHSS score) was evaluated after the 3-, 7-,10-and 14-day treatment in the groups, the serum IL-6 in 24 h after onset, and after the 3-, 7-,10-and 14-day treatment was detected and compared with that in the healthy control group.Results: After the 7-day treatment, NIHSS score in the observation group decreased significantly when compared with that on admission (P＜0.05), and remained the decreasing trend.After the 10-day treatment, NIHSS score in the control group decreased significantly when compared with that on admission (P＜0.05).After the 7-day treatment, NIHSS score in the observation group was lower than that in the control group (P＜0.05).Compared with that in the healthy control group, the serum level of IL-6 in the observation group and the control group was higher in 24 h of admission (P＜0.05).The serum level of IL-6 in the observation group decreased after the 7-day treatment, and was similar to that in the healthy control group after the 14-day treatment (P＞0.05).The serum level of IL-6 in the control group decreased after the 10-day treatment, while was higher than that in the healthy control group during the whole study period (P＜0.05).The serum level of IL-6 in the observation group was lower than that in the control group after the 7-day treatment (P＜0.05), and the peak value in the observation group was notably lower than that in the control group (P＜0.05).Conclusion: Salvianolate combined with the conventional therapy can effectively decrease the NIHSS score and the content of IL-6 in the patients with acute ischemic stroke, which shows better effect than the conventional therapy alone.