Objective To establish the capability level classification system and capability level staffing standard of ICUs in tertiary hospitals, in an effort to raise the efficiency of nursing resources while ensuring quality of care of patients. Methods Such methods as experts meetings and Delphi Method were called into play to establish the nurses capability level system in ICUs with the convenient sampling method, we made clinical observation and research in 5 ICUs of 3 tertiary hospitals in Shanghai. Results Nurses in ICUs were classified into four levels, so were their responsibilities and job description. This way the system of nursing staff capability levels takes shape, and the staffing standards for nurses in ICUs of tertiary hospitals come into being. Conclusion Such tiered staffing standards in tertiary hospitals enable clinical nursing managers to deploy and efficiently use nursing staff of all levels.

Objective To study the methods and effects of endoscope-assisted partial thyroidectomy through subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle.Methods The study included 15 patients with unilateral thyroid benign nodules.A transversal subclavicular incision 2~3 cm in length was made.Endoscope-assisted partial thyroidectomy was performed through the subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle.Results The operation was accomplished successfully in all the 15 patients.The operation time was 40~80 min(mean,50 min) and the intraoperative blood loss was 10~50 ml(mean,20 ml).No surgical complications occurred.The patients were discharged from hospital on 3~4 postoperative days.Follow-up observations in the 15 patients for 1~12 months(mean,7 months) revealed no recurrence.Conclusions Endoscope-assisted partial thyroidectomy through subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle has the advantages of minimal invasion,little blood loss, low complication rate,quick recovery,and good cosmetic results.

ObjectiveTo study the clinical significance of splenectomy in cirrhotic patients undergoing hepatic resection for PLC.Methods26 PLC patients with portal hypertension and hypersplenism were randomly divided into two groups: incidental splenectomy group ( n =11), and hepatectomy only group ( n =15). Postoperative blood picture and liver function was compared.ResultsThe WBC and PLT count significantly elevated after splenctomy, (8 9?1 6)?10 9 /L, (310?32)?10 9 /L; vs. (3 7?1 4)?10 9 /L and (104?41)?10 9 /L respectively (all P

Objective To study T lymphocyte subsets immunological condition of spleen in primary hepatocellular carcinoma (PHC) with liver cirrhosis. Methods T lymphocyte subsets such as CD4,CD8,CD4/CD8 in peripheral and spleen venous blood in 31 cases of PHC with liver cirrhosis were detected by FCM.and 13 patients with liver cirrhosis were observed as the control group. Results In 6 patients with stage Ⅰ liver cancer, CD8 of peripheral venous blood significantly decreased (P

ObjectiveTo study the changes of immune function after hepatectomy for hepatocellular carcinoma(HCC) in patients with liver cirrhosis.MethodsPatients with liver cirrhosis were used as control group,CD4?CD8?CD4/CD8? and protein expression level of IFN ??IL2?IL10 in peripheral blood from 18 advanced HCC cases with liver cirrhosis before and after heaptectomy were detected by flow cytometry(FCM) and ELISA.Results Postoperative CD4(33?3)%?CD4/CD8(1 1?0 1)?IL2(71?11)?pg/ml?IFN ?(90?15)?pg/ml level elevated compared to that of pre operation 〔CD4(29?4)%?CD4/CD8(0 9?0 3)?IL2(57?15)?pg/ml?IFN ?(78?13)?pg/ml〕(all P

OBJECTIVE:To explore the effect of dexmedetomidine with different doses combined with ropivacaine on the bra-chial plexus block. METHODS:Totally 90 patients with upper extremity surgery of brachial plexus block were randomly divided in-to test group,control group 1 and control group 2. Test group was treated with 0.375%ropivacaine 40 ml+dexmedetomidine 100μg, brachial plexus injection;control group 1 was treated with 0.375% ropivacaine 40 ml+dexmedetomidine 50 μg,brachial plexus in-jection;and control group 2 was treated with 0.375% ropivacaine 40 ml,brachial plexus injection. Onset time of sensory and motor nerve block,block duration,postoperative pain time for the first time and pain score,analgesia duration,quality of analgesia and muscle relaxant,before anesthesia induction(T0),plasma cortisol concentrations in nerve block 10 min (T1),the start of surgery (T2)and incidence of adverse reactions were observed. RESULTS:The onset time of sensory and motor nerve block and postopera-tive pain score for the first time in test group werecontrol group 1>control group 2,plasma cortisol concentrations at T1 and T2 were higher than T0,and T2>T1>T0,test group0.05). CONCLUSIONS:Ropivacaine combined with 100 μg dexmedetomidine can effectively im-prove brachial plexus block and shorten the onset time of sensory and motor nerve block,with good safety.

Objective To study the relationship between the low level lead exposure of pregnant woman and the gestational age of fetus. Methods The peripheral blood and the umbilical blood samples were collected from 1 000 healthy puerperants and their newborns. The puerperants were divided into three groups according to the blood lead levels: very low-level group(0.483 ?mol/L). Results The rate of premature labor was 9.40% in the very low-level group, 14.07% in the low-level group and 23.81% in the high-level group respectively. The blood lead level of puerperants had a positive correlation with the umbilical blood lead of newborns. The umbilical blood lead of premature was higher than that of mature. As the blood lead level of the pregnants increased, the gestational age shortened and the probability of low age premature increased. Conclusion As for the toxicity of lead to the fetus, there is no a threshold. Low level lead exposure of the pregnant woman is one of the causes of premature labor.

Objective To evaluate endoscopic ultrasonography (EUS) in assessing endoscopic re-sectability of early esophagogastric cancer. Methods Data of 65 consecutive cases suspected as having early esophagogastric cancer with EUS and confirmed by pathology after endoscopic mucosal resection or endoscop-ic submucosal dissection within 2 weeks were retrospectively analyzed. The invasion depth of the lesion de-tected by EUS was compared with that from pathology. Results The accuracy of EUS in diagnosis of depth of early cancer invasion was 93.8% (61/65), and the overall accuracy in assessment of endoscopic resectabili-ty was 89. 2%. Conclusion Endoscopic resectability of early esophagogastric cancer can be accurately eval-uated with EUS.

Objective To investigate the inhibitory mechanism of rabeprazole on acid secretion of parietal cells in rats. Methods Seventy two Spraque-Dawley rats were divided into control group(normal saline), low dose of rabeprazole group (rabeprazole 10 mg/kg) and high dose of rabeprazole group (rabeprazole 20 mg/kg) with 24 each. Four rats in each group were treated at 1 h, 2 h, 4 h, 6 h, 12 h and 24 h, respectively, pH value and activity of H+-K+-ATPase were tested by NaOH titrimetric method and chromatometry, respectively. The changes of ultrastructure of parietal cells were observed by electron microscope. Results Compared with control group(1.97±0.30), pH value in low (3.37± 0.97)and high (5.96±0.26)dose groups were significantly increased(P<0.01), and the activity of H+-K+-ATPase was inhibited obviously at 1 h after administration(3.28±0. 41 vs 1.47±0.27 and 0.92±0.07, P<0.05). Those differences could be found even at 12 h(P<0.01). The ultrastructural changes of parietal cells were consistent with the increase of pH value and decreased activity of H+-K+-ATPase. The significant difference was found in acid depression and excellent time between low and high dose of rabeprazole groups. Conclnsions The uhrastructural changes of parietal cells and the activity of H+-K+-ATPase can accurately reflect the acid secretion in rats. Rabeprazole has powerful and rapid effects in inhibiting acid secretion which correlates with the dosage.

Objective To investigate the pathological features of gastro-esophageal high-grade intraepithelial neoplasia (HGIEN) confirmed by biopsy and to compare the differences of its diagnosis after endoscopic resection. Methods Data of 147 patients with gastro-esophageal HGIEN confirmed by biopsy, who underwent EMR or ESD in recent 4 years were analyzed for the pathological findings of pre- and post- procedures. Results Among 147 cases of HGIEN diagnosed by endoscopic biopsy, 106 lesions were in esophagus and 41 in stomach. After endoscopic resection, intraepithelial neoplasia was confirmed in 97 (66%), and cancer was diagnosed in 50 (34%), of which submucosal layer was involved in 11. There were 34 cases of adenocarcinoma and 16 squamous cell carcinomas, in which 22 cases (44%) were poorly or moderately differentiated. Conclusion More than one third cases of biopsy diagnosed HGIEN are confirmed to be carcinoma after endoscopic resection, which needs active therapeutic measures.