Adolescent ; Adult ; Catheterization, Central Venous ; instrumentation ; Device Removal ; Humans ; Male ; Vena Cava, Inferior ; Vena Cava, Superior

Objective:To seek the short term standardization study nurses training education content and the ap-proach to learning, provide theoretical basis for improving the study effect of nurse training.Methods:Choosing 3 ~6 months in 2014 in our hospital study questionnaire survey was conducted among 114 nurses, questionnaire by general in-formation, content of training needs, demand method of three parts and using SPSS19.0 to analyze the collected data. Results:The 82.7%of study nurses think pre-service training is very necessary.Pre-service training demand of the top three comprises:occupational protection (82.7%), health care, with communication skills (80.0%) and infection prevention and control (78.2%).Refresher training needs during the top three in turn:specialized rescue of critically ill patients and cooperation (88.2%), clinical application and nursing adverse event processing (79.1%), effective communication nurses and patients (79.1%).Demand content score between the different degree and the title of ad-vanced nurse was statistically difference (P<0.05).The training methods, in the first three order practice (89.10%), seminar (74.5%), case analysis and discussion (67.30%).Conclusion:According to the study demand of nurse stand-ardized training content and ways of learning, considering the influence factors such as education, job title, targeted training plan, improve the effect of short-term training.

The aim of this study was to study the synthesis of two folate conjugates and their application in the preparation of folate targeted liposome, and to investigate their targeting effect in hepatocellular carcinoma HepG2 cell line in vitro. In this study, Folate-PEG-Cholesteryl hemisuccinate(Folate-PEG2000-CHEMS and Folate-PEG4000-CHEMS)were synthesized by linking folate and cholesterol succinate with two kinds of PEG materials. Structures of Folate-PEG2000-CHEMS and Folate-PEG4000-CHEMS were characterized by 1H NMR and ultra-high resolution mass spectrometry. Calcein was selected as the model drug, and calcein liposomes FA-PEG2000-L and FA-PEG4000-L were prepared by film dispersion method using Folate-PEG2000-CHEMS and Folate-PEG4000-CHEMS, respectively. The particle size and Zeta potential of FA-PEG2000-L and FA-PEG4000-L were measured by laser particle size analyzer. The drug delivery effect of FA-PEG2000-L and FA-PEG4000-L was evaluated by cellular uptake experiment in HepG2 cell line in vitro. Flow cytometry and laser confocal scanning microscope were used to determine fluorescence in HepG2 cells in vitro. The results showed that the average particle size of calcein liposome was (205.8 ± 10.2) nm, and the Zeta potential of calcein liposome was -(1.19 ± 0.31) mV.There was no significant difference in particle size and Zeta potential between FA-PEG2000-L and FA-PEG4000-L. The fluorescence intensity of FA-PEG4000-L liposome group was about 3.6 and 3.1 times higher than that of non-targeted liposome group and FA-PEG2000-L liposome group, with statistically significant difference (P < 0.01). The drug delivery efficiency of FA-PEG4000-L group in HepG2 cells was higher than that in FA-PEG2000-L and non-targeted groups, and the results indicated that Folate-PEG4000-CHEMS can promote the uptake of liposome by HepG2 cells in vitro. All in all, Folate-PEG4000-CHEMS could be applied in the preparation of folate targeted liposome, which could promote the uptake of liposome by HepG2 cells.

Objective To survey and control an extensively drug-resistant Acinetobacter baumannii (A.bauman-nii)(XDRAB)lower respiratory tract infection (LRTI)outbreak in intensive care unit (ICU)of a hospital. Methods From October 27,2013 to December 27,2013,5 cases of XDRAB LRTI occurred in ICU,epidemiological investigation was conducted,sources and transmission routes of infection were searched,intervention measures were performed.Results XDRAB were isolated from patients’sputum and environmental object surface,drug-resistant spectrums of isolated XDRAB were almost the same,suggesting the outbreak was due to the contamination of envi-ronment by the same pathogen.54 specimens were taken before disinfection,26 were positive,XDRAB were isola-ted from door handles,sheets and telephones.Investigation concluded that the outbreak of XDRAB infection was due to contamination of indoor environment and equipment,incomplete disinfection,and inadequate hand hygiene compliance of health care workers.After the implementation of a series of control measures,XDRAB was not found,and there was no new XDRAB infection cases.Conclusion Environment contamination is the main cause of this XDRAB healthcare-associated infection(HAI)outbreak,strict implementation of isolation,prevention and con-trol measures of MDROs can effectively control HAI outbreak caused by A.baumannii.

ObjectiveTo investigate the clinicopathologic characteristics of different nation nonHodgkin lymphoma (NHL)in Urumqi of Xinjiang Uygur Autonomous Region.MethodsFour hundred and sixty-six cases of NHL were collected.Their sections including HE and immunohistochemical staining were examined again for diagnosis and classification.ResultsAmong 466 cases NHL,B cell neoplasm was 369cases (79.2 ％) and T cell lymphoma was 97 cases (20.8 ％).193 cases (41.4 ％) occured in the lymph node and 273 cases (58.6 ％) extranodal lymphoma.The most common subtypes were diffuse large B-cell lymphoma,small lymphocytic lymphoma/chronic lymphocytic leukaemia,extranodal marginal zone lymphoma of mucosaassociated lymphoid tissue,NK/T cell lymphoma,peripheral T-cell lymphoma,follicular lymphoma.Tlymphoblastic lymphoma (T-LBL) and anaplastic large cell lymphoma (ALCL) in the Uygur were higher than the Han [7.5 ％ (9/120) vs 1.3 ％ (4/308),x2 =11.276,P=0.001; 4.2 ％ (5/120) vs 2.3 ％ (7/308),x2 =1.137,P =0.286],and T/NK cell lymphoma in the Han was higher than the Uygur [7.1 (22/308) vs 3.3 ％ (4/120),x2 =2.196,P =0.138].There was no statistically significance between the Uygur and Han in different subtypes of B-NHL (P ＞0.05).ConclusionIn Urumqi aera,the incidence is higher in extranodal lymphoma than that in nodal.B-NHL is more in Urumqi area than that in other area in our country.There is no difference obviously for mobility B-NHL in the Uygur and Han,but T-LBL and ALCL in the Uygur are higher than those in the Han,and T/NK cell lymphoma in the Han is higher than that in the Uygur.It is suggested to confirm further whether the different associated with different nation and region.

Objective To compare the effects of different methods of getting out of bed for the first time in patients receiving lumbar disc herniation operations.Methods Totally 60 patients receiving lumbar disc herniation operations were divided into the experimental group and the control group with 30 patients in each group.The patients in the experimental group got out of bed with prone position.The patients in the control group got out of bed with lateral position.The pain scores and degrees of comfort were recorded.Results The experimental group scored 5.4±1.3 in pain degree,and the control group scored 6.1±1.8,t=0.37,P ＞ 0.05,the difference was not significantly different.The experimental group scored 85.7±10.9 in comfort degree,and the control group scored 70.6±11.5,t=4.21,P ＜ 0.05,the difference was significantly different.Conclusions The method of getting out of bed with prone position can reduce negative emotions of patients receiving lumbar disc herniation operations and improve degrees of comfort.

Objective To assess the effect of QRS duration (QRSd) and cardiac function during right ventricular apex(RVA) pacing,right ventricular outflow tract (RVOT) pacing and right ventricular bifocal (RV-Bi) pacing. Methods Eight patients underwent RVA pacing,RVOT pacing and RV-Bi pacing during pacemaker implantation operation.The ejection fraction (EF),stroke index (SV),cardiac output(CO),QRS QRSd,QRS axis (QRSa) were measured after each pacing at the same pacing frequency. Results Compared with RVA pacing,the EF,SV and CO increased during RVOT pacing and RV-Bi pacing.The cardiac function of RV-Bi pacing was significantly increased (P

OBJECTIVE Identify the effect of Brandt-Daroff exercises for positional vertigo with atypical positioning nystagmus.METHODS 11 cases of positional vertigo during 2006～2007 with atypical positioning nystagmus when carrying Dix-Hallpike and roll test,the nystagmus had the follwing characters:poly-positions,atypical direction,long lasting(more than 3 mins),no fatigue.After ruling out centrul neural system disorders,the patients were instructed to do Brandt-Daroff exercises 2-3 times/day,and 6-10 times every time.RESULTS After doing the exercises for 3-4 days,the vertigo of all the 11 cases were all relieved.After 1-2 weeks,10 cases were cured,syptom of the other 1 was relieved significantly,and the nystagmus was alleviated.CONCLUSION Cases with atypical positioning nystagmus may present a different kind of BPPV related with the otolith and vestibular nerve disease.Brandt-Daroff exercises was a good method for the atypical positioning nystagmus cases.

Objective To investigate the scope of application of precise hepatectomy and its value.Methods The clinical data of 112 consecutive patients with liver neoplasm who received hepatectomy at Renji Hospital from November 2006 to March 2009 were retrospectively analyzed.Precise hepatectomy technique was applied to 88 patients(precise group),whereas pringle maneuver was applied to the rest 24 patients(prince group).Patients in precise group had undergone lobectomy,segmentectomy or local resection,while patients in pringle group received segmenteetomy or local resection.The perioperative conditions of patients in the 2 groups were compared via Fisher exact probability and l test.Results No perioperative mortality,hepatic failure,reoperation due to massive hemorrhage or bile leakage was observed.The blood transfusion rate,blood loss,postoperative total bilirubin(Tbil),prothrombin time(PT)were 7%(2/29),220 ml,20 μmol/L,13 seconds in patients who received segmentectomy and local resection in precise group,and were 4%(1/24),210 ml,19μmol/L and 13 seconds in patients who received segmentectomy and local resection in pringle group,with no significant difference(t=0.248,0.263,0.246,P>0.05).The operation time,postoperative white blood cell (WBC)count.alanine aminotransferase(ALT)value and fever incidence were 60 minutes,7.5×10~9/L,66 U/L,10%(3/29)in patients who received segmentectomy and local resection in precise group,and were 15 minutes,14.0×10~9/L,335 U/L and 42%(10/24)in patients who received segmentectomy and local resection in pringle group,with significant difference(t=4.962,4.961,4.959,P<0.05).In precise group,the blood transfusion rate,postoperative WBC count,ALT value.PT and fever incidence were 9%(4/45),8.3×10~9/L,153 U/L,17 seconds and 13%(6/45)in patients who received Iobectomy,and were 12%(5/43),8.2×10~9/L,133 U/L,14 seconds and 14%(6/43)in patients who received segmentectomy or lncal resection,with no significant difference (t=1.652,1.225,1.236,P>0.05);the blood loss,operation time and postoperative Tbil level were 350 ml,250 minutes and 32μmol/L in patients who received lobectomy.and were 240 ml,150 minutes and 21 μmol/L in patients who received segmentectomy or local resection(t=4.915,4.967,4.829,P＜0.05).Conclusions Precise hepatectomy can decrease damage to patients,but it should be applied in selected patients according to the tumor location and the excision range.Precise hepatectomy is recommended to be applied in lobeetomy.

Objective To study the application of standardized patients practice and agent physician system in digestion medical clinical practice. Methods One hundred and fifty five-year-clinical medical students who began digestion medical clinical practice from 2008 to 2009 were selected and randomly divided into teaching reform group and control group, each group containing 75 people. According to teaching reform group students' willingness and through the selection, 69 were identified as agent physician. Standardized patients and agent physician simulation clinical training were applied in the teaching reform group while conventional teaching methods were used in the control group. Sta-tistical analysis of the experimental data was conducted using SPSS 11.0 statistical package. Measure-ment data use independent-samples t test and rank sum test was used for heterogeneity of variance. Results Teaching reform group students' inquiry contents and skills scores for each project were higher than those of control group and the score difference was statistically significant (P<0.05) in chronological order, the transition language, interrogation schedule, repeated questions, summary records, citing verification, instrumentation courtesy, friendly behavior, praise and encouragement, eliciting the patient's views, concerns about the effects of disease, care and support and assistance aspects. After the end of the third internship, two groups were compared in operation results, reform history collection, physical examination skills group score and the excellent and good rate being higher (P=0.002, 0.001). After three times' practice, teaching group students' scoring pass rate in medical ethics demeanor, interrogation techniques and physical examination skills, case analysis is higher than that of the control group students, and the difference was statistically significant(P<0.05). Conclusion Application of standardized patients and implementing agency resident simulation clinical training in the guide teaching of digestion department of internal medicine has achieved good effect.