Objective To explore the application of PBL (Problem - Based learning) mode in fami-ly peritoneal dialysis training to improve the teaching effects of peritoneal dialysis training. Methods The PBL mode was applied in every peritoneal dialysis training lesson, the teaching effects were evalued af-ter a lesson immediately. Results The PBL mode would be helpful to inspire patients' and their family members' interest to learn the knowledge of peritoneal dialysis training.It was also helpful in knowledge un-derstanding, knowledge mastering and establishment of treatment confidence. Conclusions The PBL mode was an important way to improve the teaching effects of peritoneal dialysis training and realize the teaching objective. It is worth applying in practice of peritoneal dialysis training.

OBJECTIVE To investigate the clinical character and risk factor of nosocomial lower respiratory tract(infection)(NLRTI) due to Burkholderia cepacia in intensive care units(ICU) and discuss how to control infection.METHODS The clinical data of 37 cases were reviewed and analyzed,and 43 cases with non-B.cepacia NLRTI served as control group.RESULTS The difference in ICU stay time,mechanical ventilation,bronchoscopy,H_2-receptor blocker/antacid,use of antibiotics≥2 kinds and vein catheter between patients with and without B.cepacia(NLRTI) was statistically significant.CONCLUSIONS ICU stay time,mechanical ventilation,bronchoscopy,(H_2-receptor) blocker/antacid,use of antibiotics≥2 kinds and vein catheter are risk factors of B.cepacia NLRTI.Susceptibility of antibiotics to B.cepacia showed multidrug resistance to which should be paid attention in ICU,respiratory tract invasive operation limitation,medical facility sterilization and rational use of antibiotics are very important.

Objective To discuss the application of nano-hydroapatic crystals and polyamide composite(n-HA/PA66) for artificial vertebrae in treating thoracic or lumbar vertebrae tumor.Methods A total of 14 cases suffering from thoracic or lumbar vertebrae tumor underwent deuto-total vertebrae resection via anterior approach,then canalis vertebralis was deboosted,artificial vertebrae was implanted and fixed with screw-stick system.Fourteen patients,9 male and 5 female were admitted by our hospital from Dec 2003 to Sep 2005,aged 32 to 68 years old(average 50).The tumor located at T_(11) in 2 cases,T_(12) in 2,L_1 in 5,L_2 in 5.Pathological diagnosis showed 3 cases were of aneurysmal bone cyst,5 of hemangioma,2 of giant cell tumor,3 of metastatic thoracic lumbar vertebra tumor. Results The follow-up lasted 3-18 months,mean 10 months.The rate of bone graft fusion reached 85.7%,with no loosened internal fixation or breakage of screw or stick.No screw breakage or spinal instability occurred during the follow-up.All cases were alive till follow-up finished.Conclusion If the thoracic vertebral tumor compresses spinal cord seriously,the patients should be recommended for surgical treatment.Total vertebrectomy followed by reconstruction could relieve the compression caused by tumor and restore the stabilization of spine effectively.Artificial vertebrae is the ideal substitute material for bone transplantation,for it has good biocompatibility,high security,high rate of bone graft fusion and firm fixation.

Objective To explore the diagnostic value of magnetic resonance Fiesta sequence combined with MRCP for Mirizzi syndrome. Methods Retrospective analysis was carried out for 18 patients who received MR examination before surgery in our hospital from June 2010 to April 2014 and were diagnosed as Mirizzi syndrome by surgical pathology. Various signs of Mirizzi in Fiesta and MRCP were analyzed and compared with surgical results. Diagnostic accuracy was compared between the combined use of Fiesta and MRCP and the use of Fiesta or MRCP alone. Results Among 18 patients with Mirizzi, 15 were type Ⅰ and 3 were type II. Calculi in gallbladder neck or cystic duct could be seen in all the 18 patients, common bile duct under pressure could be seen in 16 patients and unclear Calot triangle structure could be seen in 11 patients. Accuracy of Fiesta combined with MRCP for the diagnosis of Mirizzi syndrome was sig-nificantly higher than that of Fiesta or MRCP alone, and the differences were statistically significant (P<0.05). It was highly consistent with the surgical results. Conclusion Fiesta combined with MRCP has relatively high value for pre-operative diagnosis of Mirizzi syndrome.

Objective:To summarize the nursing experience of a puerperal woman with cryptococcal meningitis complicated with intracranial venous sinus thrombosis.Methods:Before the surgery, the patient′s consciousness, pupil, headache and other symptoms of cranial hypertension closely were observed. And the prodromal stage of cerebral hernia was timely detected and the emergency rescue measures if needed was implemented. The cause of intracranial venous sinus thrombosis was analyzed and the risk intervention was carried out. At the same time, the blood potassium concentration was closely monitored, the hypokalemia was effectively controlled, and the anticoagulant observation and nursing was performed. Cooperated with doctors for intracranial venous sinus angiography+ balloon dilatation. The postoperative complications were prevented and patients′ health and psychology was remodeled.Results:The patient recovered well physically and psychologically after the operation.Conclusions:Effective clinical observation, symptom management, risk intervention and prevention of complications can promote patient recovery.

Objective: To investigate the associations between early life exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM 2.5 ) and the risk of autism spectrum disorder (ASD) among school aged children. Methods: A total of 165 children with ASD and 165 age and gender matched typical development (TD) children were recruited. Children s basic information were obtained via questionnaires, and the severity of ASD symptoms was assessed with Social Responsiveness Scale (SRS). Early life PM 2.5 exposure (preconception, entire pregnancy, and the first two years after birth) were extracted from the Tracking Air Pollution in China (TAP) datasets. Conditional Logistic regression and generalized linear model were used to evaluate the associations of early life exposure to PM 2.5 with the risk and the ASD severity symptoms, respectively. Results: The PM 2.5 exposure of ASD group during preconception[(55.08±9.34)μg/m 3], entire pregnancy[(50.44±8.71)μg/m 3], the first year after birth [(45.04± 8.25 )μg/m 3] and the second year after birth [(40.19±7.12)μg/m 3] were significant higher than those in TD children [(47.66± 7.63 , 44.19±7.16, 38.95±6.07, 35.76±5.65)μg/m 3]( t =7.94, 7.13, 7.70, 6.32, P <0.05). After adjusting for potential confounding, each increase of 1 μg/m 3 in PM 2.5 was associated with higher risk of ASD during preconception ( OR=1.21, 95%CI =1.13-1.29), entire pregnancy( OR=1.18, 95%CI =1.11-1.26), the first year after birth ( OR=1.30, 95%CI =1.18-1.43) and the second year after birth ( OR=1.29, 95%CI =1.17-1.42). No similar results were observed regarding the analyses of SRS total and sub scale scores( P >0.05). Conclusion Early life exposure to PM 2.5 is relate to the risk of ASD, these findings indicated that more attention should be paid to ambient PM pollution in the early life prevention and control of ASD.

As the operation volume in hospitals is increasing year by year, surgical instruments are widely used, which pose a great challenge to the daily management of surgical instruments. The authors investigated the existing problems which occurred in the management of surgical instruments, and came out with instruments coding navigation index and specialized placement scheme for the operating room as solutions. The specific measures included dividing sterile items into specialized categories, setting cabinets respectively for specialized and general subjects, building equipment coding and identification, establishing surgical instruments navigation index and carrying out training program, to serve as reference for efficient and fine management of surgical instruments.

Objective To explore the monitoring of cerebrospinal fluid (CSF) dynamics in a model of brain herniation induced by acute intracranial hypertension in Guangxi Bama-Mini pigs by phasecontrast cine magnetic resonance imaging (PC cine MRI).Methods Femoral artery blood were extracted from 10 pigs,and injected into the frontal and temporal parietal lobe to make a model of brain herniation induced by acute intracranial hypertension.The mean arterial blood pressure (MAP),intracranial pressure (ICP),and cerebral perfusion pressure (CPP) were monitored.Routine T1WI,T2WI,coronal,sagittal and cerebrospinal fluid flow sequence (fast PC cine slice) which positioned on the cervical 3 (C3) vertebral body as the center and perpendicular to the spinal scans were performed on all experimental animals before and after blood injection with 3.0T Magnetic Resonance Imaging.The ICP,MAP,CPP,the absolute values of CSF peak flow velocity and the absolute value of carotid peak flow velocity before and after blood injection were compared.Results The ICP,MAP,CPP,and the absolute value of CSF peak flow velocity before injection of autologous arterial blood were statistically significant as compared with those after blood injection [(6.80±2.044) mmHg vs (52.20±1.619) mmHg,(76.80±7.068) mmHg vs (142.80±12.399) mmHg,(70.00±6.074) mmHg vs (90.50±12.250) mmHg,and the absolute value of CSF peak flow velocity was (243.20±77.671) mm/s vs (201.40±55.482) mm/s,respectively,P＜0.01].The absolute value of the peak velocity of the carotid artery before blood injection was not statistically significant compared with that after blood injection [(876.80±239.908) mm/s vs (799.40±241.829) mm/s,P＞0.05].Conclusion After the formation of brain herniation induced by acute intracranial hypertension,the CSF flow in the C3 level spinal canal showed a low dynamic change,and the CSF flow velocity waveform was disordered and malformed.The non-invasive measurement of CSF dynamics by PC cine MRI can provide an important basis for the change of CSF dynamics in the model of brain herniation induced by acute intracranial hypertension,and provide a theoretical basis for further research on damage control neurosurgery in the future.

Toll-like receptors (TLRs) is a type of pattern recognition receptors (PRRs), which are singular, non-catalytic and highly homologous. TLRs not only play significant roles in natural immunity, but also act as a bridge between innate immunity and adaptive immunity. Recent studies have revealed that TLRs play critical roles in the development of non-resolving inflammation-related cancer,including the formation of tumor microenvironment, invasion and metastasis, immune escape, etc. Further investigation into the mechanisms responsible for the function of TLRs will be of great value in tumor prevention, early diagnosis and therapy.
Humans ; Inflammation ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Neoplasms ; Toll-Like Receptors ; Tumor Microenvironment