In order to promote the optional subjects' function in perfecting knowledge construction and developing the character of the students,through analyses of the results of 670 classmates’selection of optional subjects,we know in detail what kind of optional subjects students like and need.Therefore based on how to organize teaching and manage optional subjects we bring up the suggestions for enhancing the optional subjects ' development and management:setting students as the center and increasing optional subjects,establishing the leading teacher's system,reforming teaching method,enriching teaching means,and strengthening the management of the examination of optional subjects.

Objective To investigate the release and intracellular localization of high mobility group box chromosomal protein 1(HMGBl)in the peripheral blood monocytes of rheumatoid arthritis(RA) patients and the inhibitive effect of thaiidomide.Methods 19 RA patients and 20 healthy controls were included in the study.Monocytes were separated from peripheral blood with Ficoll density gradient centrifugation.Monocytes were treated with 100 ng/ml tumor necrosis factor α(TNFa)or 100 ng/ml TNFα plus 40 μg/ml thalidomide and grown in an incubator at 37℃ with 5%CO,for 24 hours.The cuIture supernatants of the monocytes were collected.HMGB1 level in the culture medium was detected with Western blot.In addition,the intraceUular localization of HMGB1 in the fflonocytes was investigated with immunocytochemical analysis. Results Without stimulation. the release of HMGBl protein was significantly increased in the culture supernatants of peripheral blood monocytes from RA patients as compared with that from healthy controls(P<0.05).TNFα(100 ng/ml)did not further increase the release of HMGBl in the monocytes from the patients with RA.Thalidomide(40 μg/ml)could inhibit the release of HMGB1 in the monocytes from RA patients stimulated with TNFα(P<0.05).In the monocytes from RA patients,HMGBl was mainly localized in the nucleus.Treatment with TNFOL(100 ng/ml)for 24 hour resulted in a cytoplasmic translocation of HMGB1,which was inhibited significantly by thalidomide. Conclusion TNFα induces the release and cytoplasmic translocation of HMGBI in the peTipheral blood monocytes of RA patients and thalidomide inhibits the release and translocation of HMGB1.

Objective To investigate perioperative nursing of respiratory system in severe scoliosis patients.Methods 26 severe scoliosis patients with respiratory function training before operation were retrospected.All of them tested pulmonary function before and after training,postoperative respiratory system nursing were also taken to maintain airway unobstructed,including respiratory rate and oxygen saturation monitoring,effective pain management and respiratory complications controlling.Results The average forced vital capacity(FVC)was 45.9%and 52.1%before and after breathing exercises,the mean forced expiratory volume in one second(FEV1)was 43.8%and 48.8%before and after breathing exercises,with lung function improvement in 69.2%patients. There were two hemopneumothorax and three mild or moderate pleural effusion occurred within 10 days after surgery,but all recovered after effective treatment and nursing.Conclusions Perioperative systematic and effective training in respiratory function and airway management can improve lung function and surgical safety,reduce the incidence of postoperative pulmonary complications,and promote early rehabilitation .

Objective:To study the clinical features, experiences of diagnosis and treatment, and treatment process of ovarian nonspecific steroid cell tumor. Methods:The clinical materials of one case of ovarian nonspecific steroid cell tumor were retrospectively analyzed,and the related literaturels were reviewed. Results:The patient displayed amenorrhea and masculine characteristics.Preoperative ultrasonography demonstrated the solid tumor of 53 mm ×39 mm on the right ovary,consideration for the right side of ovarian malignant tumor,and laparotomy was performed.The pathologic results showed that the tumor cells were arranged in nests,and the cytoplasm was bright or eosinophilic, and the nucleus were round or oval with nucleolus.The immunohistochemical staining results revealed that calretinin,vimentin and inhibin were positive in the tumor cells.The patient was diagnosed with ovarian nonspecific steroid cell tumor.The postoperative follow-up of 3 months was performed,and there was no recurrence.Conclusion:The diagnosis of ovarian nonspecific steroid cell tumor should be combined with the clinical manifestation and pathologic results,and operion is the main treatment method.

Objective To investigate serum galectin-3 levels in patients with chronic heart failure and evaluate its clinical significance for heart failure.Methods A total of 108 chronic heart failure patients were selected.The selected patients were divided into three groups according to the classification of New York Heart Association (NYHA,from degree Ⅱ to Ⅳ).In addition,30 healthy persons were chosen as control group.All the patients received cardiac ultrasound examination.Plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP),serum levels of galectin-3 and interleukin-6 (IL-6) were measured and analyzed.Results Galectin-3 levels were significantly higher in chronic heart failure patients compared with control group(P ＜ 0.05).In chronic heart failure group,the increase of serum concentration of galectin-3 was correlated with the degree of NYHA function classification.Correlation analysis showed that blood level of galectin 3 was strongly positive correlation with concentration of NT-proBNP and IL-6.There was no correlation between galectin-3 with the cause of heart failure,left ventricular diameter(LVD),and left ventricular ejection fraction (LVEF).Conclusions The levels of galectin-3 was significantly increased in chronic heart failure,and was correlated with degree of heart failure.Galectin-3 might be a new biomarker of heart failure and could provide additive value to NT-proBNP levels in the diagnosis of heart failure.

Objective To explore the association between inflammatory cytokines and islet β-cell function in chronic persistent asthma patients. Methods 112 adults with persistent asthma and 60 healthy volunteers were enrolled in this study. According to the severity of disease, all subjects were divided into persistent-mild group and persistent-moderate group. Plasma tumor necrosis factor-α(TNF-α), interleukin6(IL-6) and C-reactive protein (CRP) were determined. Oral glucose tolerance and insulin releasing test were performed. The ratio of the area under the curve of insulin to area under the curve of glucose ( AUC1/AUCG ), homeostasis model assessment for insulin resistance ( HOMA-IR), insulin sensitivity index( ISI),homeostasis model assessment for β-cell function (HBCI) and early insulin secretion index(△I30/△G30)were calculated. The values of forced expiratory volume in l second ( FEV1 ), forced vital capacity(FVC)and FEV1/FVC were recorded. Results In patient groups, the values for plasma TNF-α, IL-6, CRP,AUC1, AUC1/AUCG, HOMA-IR, HBCI significantly increased compared with those in control group, while ISI declined ( t =2. 02～13.62, P ＜0. 05). Multiple step regression analysis showed that HOMA-IR was positively correlated with CRP, LDL-C, BMI, AUC1, TNF-α( P ＜0. 01 orP ＜0. 05), but negatively correlated with FEV1 ( P ＜ 0. 05 ). Conclusion The results indicated that inflammatory cytokines ( TNF-α,IL-6,CRP) might result in insulin resistance in asthma patients who had hyperinsulinism at the same time.

Objective To investigate the effects of chronic high glucose on α-cells glucagon releasing in relation to insulin resistance induced by high glucose. Methods TC1-6 cells, an α-cell line, were incubated separately in DMEM containing high (25.0 mmol/L), medium (11.1 mmol/L) and low (5.5 mmol/L) concentrations of glucose for 1 to 5 days. The secretion and gene expression of glueagon were measured. When TC1-6 cells had been cultured for 5 days, three different concentrations of insulin were added for 6 h and then glucagon secretion was detected. Western blot was used for 1 and 3 days to confirm the effect of high glucose on phosphorylation of Akt in TC1-6 cells. Results (1) Exposure of TC1-6 cells to 11.1 and 25.0 mmol/L glucose resulted in a slight increase of glucagon secretion compared with those incubated with 5.5 mmol/L. However, after 5 days in media containing 25.0 mmol/L glucose, glucagan secretion was significantly increased as compared to cells treated with low glucose [(136.80±10.94 vs 78.62±4.72 ) ng/106 cells, P<0.05]; moreover, in TC1-6 cell cultured with high glucose glucagon mRNA expression was increased significantly. (2) 10-7 mol/L insulin reduced significantly glucagon secretion of TC1-6 ceils exposed to low glucose [(21.59±1.30 vs 55.12±3.86) ng/106 cells], but just scarcely inhibited glucagon secretion of cells incubated with high glucose [(106.58±8.53 vs 117.18±10.55) ng/106 cells]. When insulin concentration was increased to 10-5 mol/L, glucagon secretion of TC1-6 cells in high glucose was also reduced [(46.55±3.72 vs 118.61±10.68 )ng/106 cells]. (3) After treated with 10-5 mol/L insulin for 2h, the levels of Akt phosphorylation in both groups of TC1-6 cells were increased by 180% and 70%, while the level in high glucose group was significantly lower than that in low glucose group. In the presence of phosphoinositide 3 kinase inhibitor, the levels of Akt phosphorylation were both lowered, but the inhibition in low glucose group was more significant than in high glucose group. Conclusion High glucose induces hypersecretion of glucagon, which may be due to the a-cell insulin resistance.

Objective To investigate the effect of applying specialist nursing assessment indicator system on improving nurse′s health assessment ability in orthopedic department. Methods A specialist nursing assessment indicator system was developed by applying evaluation indicators of nursing care quality. That assessment indicator system consisted of 9 sub-indicators. They were assessments on local blood circulation, sensation and motion, muscle strength, pain, risk of developing pressure ulcer, risk of falling down and assessment on anal sphincter function, etc. In addition, standard assessment process was developed and applied to train 54 nurses in orthopedic department, in order to standardize and improve their ability on specialist nursing assessment. Furthermore, the assessment process was transferred into specific nursing interventions to improve nurse′s health assessment ability, too. The accurate rate on those 9 indicated assessments were evaluated and analyzed regularly, pre and post the indicator system application. In the present study, each of the 54 nurses was required to assess five patients basing on the items in the assessment indicator system. The total assessment times were 270. Results After applying the indicator system, the accurate rates of assessments on local blood circulation, sensation and motion, muscle strength, pain, risk of developing pressure ulcer, anal sphincter function and assessment on developing deep venous thrombosis were 98.89% (267/270), 99.63% (269/270), 99.26% (268/270), 97.41% (263/270), 98.15% (265/270), 91.85% (248/270), 98.15% (265/270), which were higher than 95.19%(257/270), 92.96%(251/270), 96.30%(260/270), 90.37%(244/270), 92.22%(249/270), 85.56%(231/270), 92.22%(249/270) of the time when the system was not used, and the difference was significant (χ2=5.34-16.82, P < 0.05). However, the accurate rates on assessing risk of falling down and assessing ADL were not significant different, comparing to the results before applying the indicator system (χ2=0.34, 0.41, P>0.05). Conclusions Applying the specialist nursing assessment indicator system was able to standardize nursing assessment behavior and improve nurse′s assessment ability. In addition, it was beneficial to improve the quality of specialist nursing care in orthopedic department.

Objective To explore the methods for quality management and continuous improvement of nursing care quality in the orthopedic demonstration ward by taking the hospital accreditation as an opportunity. Methods From July 2012 to June 2013, the continuous care quality improvement in the ward was carried out to find out the problems with PDCA (plan, do, check, action) cycle method, including enhancing the function of orthopedic nursing quality management groups, conducting all-staff training and improving the knowing rate by referring to the standards of hospital assessment standards. Results After the performance of whole-process quality management, the percentage of indexes assessed at level A, B and C was increased from 42.2%to 50.0%, 17.2%to 14.7%and 40.2%to 35.3%, respectively. The score of nurses' responsibility accreditation was increased from 92 to 95. The rates of patient and nursing staff satisfaction were increased from 91.8%to 98.9%and 92.57%to 97.7%, respectively. Conclusion In accordance with the standards for hospital accreditation, the continuous improvement of nursing quality in the orthopedic demonstration wards can improve the specialist care of orthopedic care, improve patients' and nurses' satisfaction, thus making the daily work more scientific and standardized.

A glassy carbon electrode (GCE) modified with gold nanoparticles loading on the reduced graphene oxide (rGO)-multi-walled carbon nanotubes (MWCNTs) composite film was fabricated by a two-step procedure.Firstly, rGO-MWCNTs composite were prepared by in-situ chemical reduction method with hydrazine as a reducing agent.Then, AuNPs were deposited on the surface of rGO-MWCNTs using simple cyclic voltammetry.This modified electrode was characterized using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS) and electrochemical methods.Furthermore, the electrochemical behavior of bisphenol A (BPA) was also investigated using this modified electrode.The results showed that the modified electrode had high electrochemical activity for the oxidation of BPA.In 0.10 mol/L phosphate buffer solution (PBS, pH 7.0), the linear range for the determination of BPA with differential pulse voltammetry (DPV) was in the range of 5.0 × 10-9 -1.0 × 10-7 mol/L and 1.0 × 10-7-2.0 × 10-5 mol/L.The detection limit was 1.0 × 10-9 mol/L (S/N=3).The as-prepared modified electrode was successfully used to determine BPA in river water and the shopping receipt samples with recovery ranges of 97%-110% and 98%-104%, respectively.