Objective To evaluate the diagnostic value of bedside lung ultrasound on severe pneumonia in elderly patients.Methods Bedside lung ultrasound lung ultrasound and chest CT were performed in 104 elderly patients admitted to the emergency department for suspected severe pneumonia,from November 2010 to January 2013.According to the characteristics of the chest CT image,patients were divided into consolidation group (big leaf or lung segment distribution density shadow) and the unconsolidation group (for the performance of the cable sample,ground glass sample,or small patch sample changes).Differences in ultrasonic characteristics were compared between the two groups.Results Ultrasonic image characteristics were pulmonary consolidation,subpleural lesion,pleural changes and parapneumonic effusions in patients with severe pneumonia.Among 65 patients with chest CT image of pulmonary consolidation in consolidation group,60 patients were found pulmonary consolidation by lung ultrasound,and all 39 patients in unconsolidation group were not found pulmonary consolidation by lung ultrasound,and there was a significant difference in detect rate by lung ultrasound between the two groups (x2 =87.546,P＜ 0.001).The number of subpleural lesion and pleural changes were (1.16 ± 1.07) and (3.14 ± 2.20) respectively in consolidation group and (3.85 ± 1.93) and (11.73 ± 3.69) respectively in unconsolidation group,which had significant differences between the two groups (t=7.439,12.133,both P＜0.001).There was no significant difference in the incidence of parapneumonic effusions between the two groups (45/65 vs.29/39,x2 =0.086,P=0.496).Conclusions Ultrasound image characteristics of severe pneumonia in elderly patients included pulmonary consolidation,pleural lesions,pleural changes and parapneumonic effusions.Ultrasonic characteristics will be pleural lesions,pleural changes in severe pneumonia patients without chest CT image of pulmonary consolidation.

Objective To evaluate the effectiveness of training management applying character color theory in patients with peritoneal dialysis on the compliance and dialysis effect. Methods Of 95 patients undergoing catherization for peritoneal dialysis from January 2013 to May 2014 in the peritoneal dialysis center,72 patients accepted character color psychological questionnaire designed by Le Jia for character color analysis.72 patients were divided into matched control group and experimental group according to their choice with red, yellow, blue, green character color, 36 cases in each group. The control group adopted the traditional training way of accepting 7 days′training course teached by the professional nursers,one follow- up management each month. According to the difference of character color,the experimental group were given different education training courses, interactive learning, and follow- up time. After 6 months′follow- up, the two groups adopted peritoneal dialysis self management behavior questionnaire designed by Liu Pengfeng and self- efficacy scale designed by education research center for chronic disease in Amercian Stanford University. The score of self management ability and self- efficacy and the change of load capacity, blood pressure, dialysis adequacy and biochemical indicators of the two groups were analyzed. Results In the control group and experimental group,the score of self management ability and self- efficacy and the level of dialysis adequacy were statistically significant, respectively, (5.64±1.57) points vs. (6.75±1.32) points;(5.22±1.48) points vs. (6.69±1.43) points; 1.64±1.64 vs 1.85±0.13.Z and P values were respectively -2.969, -3.828, -6.361, and 0.003, 0.000, 0.000.Edema happened in the control group was 24 cases, and 11 cases in the experimental group. P and χ2 values were 0.013 and 10.017.Systolic blood pressure and di-astolic blood pressure were respectively (147.78±15.69) mmHg (1 mmHg=0.133 kPa) vs.(135.39±9.01) mmHg,(95.86±7.50) mmHg vs. (83.94±7.46) mmHg in the two groups. Z and P values were respectively -3.843, -5.666, and 0.000, 0.000.There was significant difference between the experimental group and control group. Conclusion The education and training applying character color feature in patients with peri-toneal dialysis can mobilize the initiative of self management, improve the patients' self- care competency and self-efficacy, enhance patients′compliance, that can improve the effect of peritoneal dialysis.

Objective To investigate the changes of cellular immunity and humoral immunity in children with acute or critical illness. Methods Seventy-three critically ill children admitted to PICU of Chil-dren′s Hospital Affiliated to Fudan University during the period from April,2015 to September,2015 were the objects of study. Blood samples were collected within 48 hours after admition. The lymphocyte subpopulation was measured by flow cytometry,and the level of humoral immunity was measured by rate immune scatter turbidimetry,and the neutrophil function was measured by flow cytometry-DHR analysis. Twenty-three cases from 73 cases were detected the second time after admitted to hospital for seven days. Ten health children be-fore elective surgery were selected as control. Results (1) Compared with the control,the percentages of CD3 +T cells and CD8 +T cells were significantly decreased in critically ill children within 48 hours of admis-tion[(57. 43 ± 13. 46)%,(21. 26 ± 7. 87)% vs. (66. 24 ± 5. 27)%,(26. 82 ± 7. 63)%,P<0. 05]; At the same time,CD4 +T cells and NK cells had no significant change[(33. 42 ± 11. 29)%,(8. 83 ± 7. 77)% vs. (34. 89 ± 4. 94)% (11. 34 ± 5. 60)%,both P<0. 05]; While B cells were significantly increased[(31. 69 ±13. 83)% vs. (21. 08 ±7. 24)%,P<0. 05]. Neutrophil activation rate[(14. 32 ±14. 81)%] was signifi-cantly higher than the normal reference value ( 0 -10%) and the activation rate was more than 90% after stimulated by PMA. The plasma level of complement C3[(0. 88 ± 0. 31) g/L] was lower than that of the control group[(1. 19 ± 0. 18)g/L,P<0. 05]. (2) Compared with the first time,the percentages of CD3 +cells and CD4 + cells were increased after treated for one week in 23 patients[(61. 20 ± 13. 56)%,(36. 79 ± 9. 95)% vs. (56. 80 ± 13. 99)%,(32. 86 ± 10. 87)%,both P<0. 05]. No significant difference in neutrophil activation and activation rate after PMA stimulation was found compared with admition. IgA,IgM and comple-ment C3 were significantly increased[(0. 98 ± 0. 75) g/L,(1. 00 ± 0. 39) g/L,(1. 15 ± 0. 34) g/L vs. (0. 80 ± 0. 69) g/L,(0. 86 ± 0. 48) g/L,(0. 93 ± 0. 23) g/L,all P<0. 05]. Conclusion Immune disorders occur in critically ill children in the early stage of illness,the most obvious change is cellular immune response,and im-mune function starts to recover after one week.

Objective:to construct and apply the bilingual teaching materials.Methods:teachers in Nantong university compiled Pathology,Direction of pathological experiment and test which were written in both Chinese and English as the in-class bilingual teaching materials according to the characteristics of Chinese students,meanwhile compiled Pathological formative exercises,Pathological listening and reading,Basic problems of modern clinical pathological research for students' practice and elective course materials or reading materials after class.Results:A series of 4 bilingual teaching materials were all published by science publishing house except Pathological listening and reading was used as in class teaching materials.These teaching materials played an important role in the bilingual pathological teaching in Nantong university.Conclusion:The construction and innovation of bilingual teaching materials are basic guarantees for bilingual teaching.

Objective:To cultivate the students' learning ability and innovation spirit to better grasp the pathological knowledge,the Pathology Department of Nantong University carried out all-round research and practice of education reform in many links and many stages.Methods:To establish and perfect the teaching syllabus scientifically,combine class teaching with the second classroom activity as well as innovate examination mode and evaluation system.Results:The syllabus design not only fulfills the need of talent training,fits the actual level of the students,but also embodies the principle of the combining of imparting knowledge,fostering ability and raising quality.In addition,it also reflects the characteristics of pathology itself.Opening the second classroom activities of pathology is beneficial complementary to the course content.Various examination forms are used to have a comprehensive assessment of the students,creating an equal and fair competitive environment and competition,learning,exceeding atmosphere.Conclusion:The reform and innovation of pathological teaching of Nantong University can mobilize the students to learn with many sense organs all-directionally,match the cognition rules,promote the students' comprehension,apprehension and application about pathological knowledge/skills and embody the students' dominant position in teaching,which is warmly accepted by students.

Objective To explore the interaction model of social capital, mental health,occupational burnout, turnover intention and the related influence factors on nurses. Methods By random cluster sampling, investigated 723 nurses with Nurses' Turnover Intention Inventory, the Maslach Burnout Inventory, Social Capital Questionnaire and Chinese Health Questionnaire, then explored the interaction model by path analysis. Results Nurses' position can influence their social capital(the path coefficient was 0. 124), social capital and occupational turnout can influence nurses' mental health(the path coefficient were -0. 231,0. 151), the mental health and occupational turnout both can influence nurses' turnover intention directly(the path coefficient were 0. 088,0. 151 ), the model is acceptable(CMIN/DF 1. 645, GFI 0. 984, AGFI 0. 966, IFI 0. 941, CFI 0. 937, RMSEA 0. 037).Conclusion Social capital can provide a new perspective for nurses' management, developing the social capital resources can relieve nurses' mental problems effectively; relieving the turnout and mental problem can decrease nurses' turnover intention finally.

The nature and functions of astrocytes (AS)， the pathological changes and roles of AS after spinal cord injury， the experimental methods of inhibiting AS proliferation and glial scar formation， and so on, were reviewed. AS beneficially affects repairing injured spinal cord at different periods of differentiation. However， adult AS secreting the factors formed the chemical glial barrier which severely affects nerve regeneration and hinders axon extension. Because of the static， activated and proliferative AS tending to coexist after spinal cord injury， and complex factors of barrier formation， the current approach taken by a single method is difficult to effectively control the AS proliferation and glial scar formation.

ASIA Impairment Classification is the standard for spinal cord injury. With or without anal sphincter contraction will tell the degree of injury. Now, many articles have introduced the anal sphincter manometry and electromyogram. We should study whether there is any relationship between the manometry, electromyogram and ASIA.

After spinal cord injury, there was bowel dysfunction.This became the major obstacle for the spinal cord injury patients to improve their living skills. For these patients, the bowel pathophysiological condition changed a lot including the bowel movement, fecal incontinence, bowel dysfunction, rectal dysfunction. This article reviewed the bowel dysfunction and the bowel care after spinal cord injury.

BACKGROUND:Reducing blood loss could help to prevent the complications of total knee arthroplasty, relieve the swelling and discomfort postoperatively and accelerate the rehabilitation. OBJECTIVE:To explore the methods for reducing blood loss during total knee arthroplasty. METHODS:Totally 63 patients undergoing primary unilateral total knee arthroplasty were divided into two groups. Group 1 included 27 patients who received the conventional surgical techniques using tourniquet during the whole procedure with wound drainage, as control group. Group 2 included 36 patients who received the modified procedure only using tourniquet during prosthesis implantation without wound drainage, as experimental group. In the experimental group, we stitched the capsule closely. The preoperative and postoperative hemoglobin, decrease of hemoglobin, knee pain score, range of motion blood transfusion rate and wound healing were compared between the two groups. RESULTS AND CONCLUSION:(1) There was no significant difference in preoperative hemoglobin between the two groups. At 1, 4 and 7 days postoperatively, the hemoglobins were significantly lower in the control group than in the experimental group, and the decreases of hemoglobins were significantly lower in the control group than in the experimental group. (2) Knee pain score was not significantly different between the two groups. (3) The range of motion of the knee was significantly larger in the experimental group than in the control group at 7 days. (4) Blood transfusion rate was 18.5%in the control group, and wound healing was poor in one patient. There was no transfused case and wound problem in the experimental group. All wounds were healed normally. (5) There was no infection or hematoma in two groups. (6) With the modified procedure, we could reduce blood loss during total knee arthroplasty without blood transfusion after surgery, which was helpful to postoperative rehabilitation.