Objective To explore the Clinicopathological characteristics of patients with primary adenosquamous and squamous carcinoma of stomach. Methods The clinical data of 12 cases of primary squamous and adenosquamous carcinoma of the stomach were reviewed retrospectively, and the immunohistochemical staining of CK17 and CKI8 protein were performed in primary gastric adenosquamous carcinoma. Results Primary adenosquamous and squamous carcinoma of the stomach accounted for 0.28% of all the 4352 patients with gastric cancer during the same period. Of the 12 patients, 10 were adenosquamous carcinoma and other two were squamous carcinoma. There were 10 males and 2 females in this group, with their mean age being 65 years. The main clinical presentation included epigastric pain and discomfort, followed by hematemesis and melena. The definite diagnosis rate was 33% (4/12) by gastroscopy and biopsy before operation. The tumors were less than 5 cm in diameter in 3 patients, and more than 5 cm in 9 patients. The surgical procedure was radical resection in 8 patients and palliative resection in 4 patients. There were 1 case of stage Ⅰ, 5 cases of stage Ⅲ, 6 cases of stage Ⅳ. 10 patients died of tumor recurrence and metastasis within 2 years after operation, one died of other unrelated disease, and one was alive for more than 5 months. The component of both adenosquamous and squamous carcinoma were more than 30% in 4 patients with adenosquamous carcinoma who underwent palliative resection and died within 6 months after operation. Conclusions Primary adenosquamous and squamous carcinoma of the stomach were rare, and had specific clinicopathological characteristics. Having both biological behaviours of adenocarcinoma and squamous carcinoma may lead to poor prognosis in adenosquamous carcinoma of stomach.

Nowadays,in instruction of clinical practice,inaprepriate practice resulting from inappropriate instructional concept is one reason responsible for medical entanglement.In order to make instruction of clinical practice to be more standard,in the meantime coodinate the relation between everu aspect,and let it play the important role in cultivating medical talents, it must adopt the most fundamental intructional conecpt, In other words,the instructional concept of human-basis,quality,law-abiding,creation and wholiness.

Objective To evaluate the relationships between the unstable coronary lesions and the levels of serum C-reactive protein(CRP) and urico-acid (UA).Methods 205 patients with primary diagnoses as coronary heart disease were examined by selective coronary angiography,and in the mean time ,the serum CRP and UA levels were measured.These patients were grouped the control,the unstable coronary lesion group and stable coronary lesion group according to the extent of coronary artery atherosclerosis stenosis.All data were undergone statistical analysis.Results The serum CRP level in unstable coronary lesion group was higher than that in stable coronary lesion group(P0 05).Conclusions The serum CRP level is significantly positive relation with the unstable coronary lesions.The serum UA level is not association with the unstable coronary lesions.

Objective To investigate the relationship between vitiligo and thyroid diseases .Methods Chemiluminescence was used to detect serum levels of free triiodothyronine (FT3) ,free thyroxine(FT4) ,thyrotropic stimulating hormone(TSH) ,anti‐thy‐roglobulin antibody(TG‐Ab) and anti‐thyroperoxidase antibody(TPO‐Ab) in 289 vitiligo patients and 128 healthy subjects .All re‐sults were statistically analyzed .Results The abnormal rates of FT3 ,TG‐Ab and TPO‐Ab in vitiligo patients were higher than healthy subjects (P<0 .05) ,which might be correlated with the age and gender of vilitigo patients .Conclusion Levels of thyroid function and autoantibody might be abnormal in vilitigo patients ,which could be more obvious in male and adolescent patients .It could be advantageous to screen thyroid function and antibody levels in patients with vitiligo .

In this study, a novel tetrapeptide hydrophilic interaction chromatography (HILIC) material was synthesized, and corresponding enrichment method for glycopeptides was developed.The tetrapeptide modified silica gel materials (denoted as Poly-DAPD) were synthesized by atom-transfer radical-polymerization (ATRP) and characterized by N2 adsorption desorption and thermometer, thermal gravimetric analyzer (TGA) and X-ray photoelectron spectrometer (XPS).The characterization results indicated that tetrapeptide had been successfully synthesized on silica gel.Poly-DAPD materials showed high enrichment selectivity toward fetuin glycopeptides under solid-phase extraction (SPE) mode.Comparing with commercialized ZIC-HILIC in glycopeptides enrichment of fetuin digest which mixed with 5 mole ratio of albumin bovine (BSA), the as-prepared materials showed higher selectivity in both aspects of the identified number of glycopeptides and anti-interference property.The SPE results demonstrated that the tetrapeptide-based HILIC materials could be a potential tool in large-scale glycosylation analysis.

ObjectiveTo investigate the influence of the number of T-junctions between central venous catheter and pressure transducer on measurement of central venous pressure (CVP) in patients.Methods A prospective controlled study was conducted. The patients with CVP monitoring in Department of Critical Care Medicine of the Fifth Center Hospital in Tianjin from February to October in 2014 were enrolled. The patients were divided into three groups according to the number of T-junction between central venous catheter and pressure transducer: without T-junction control group and 1, 2, 3 T-junctions groups. In each patient, corresponding CVP values with different number of T-junctions placed between the central venous catheter and pressure sensors were determined within a certain period, and a square-wave graphic was obtained and preserved on the monitor. The own frequency (fn) and the attenuation coefficient (D) of the system of pressure measurement were calculated after measurement of the shock wave following a square-wave to obtain the distance between two vibrations and the amplitude of the shock wave. The difference in CVP, fn and D were compared among the groups.Results A total of 20 cases were enrolled, and 150 groups of data were collected.① With the increase in the number of T-junction, CVP showed a tendency of gradual reduction. The CVP of the groups of control and 1, 2, 3 T-junctions was (7.00±1.60), (7.00±3.00), (5.00±2.00), and (4.00±1.00) mmHg (1 mmHg = 0.133 kPa), respectively. The CVP of 3 T-junctions group was significantly lower than that of the control group (F = 9.333,P = 0.015).② With an increase in the number of T-junction, fn showed a tendency of gradual increase. The fn of groups control and 1, 2, 3 T-junctions was (12.30±0.79), (16.00±0.91),(18.10±1.75), (20.90±2.69) Hz, respectively. The fn of 1, 2, 3 T-junctions group was significantly higher than that of the control group (F1 = 45.962,F2 = 45.414,F3 = 46.830, allP = 0.000); the fn of groups 2 and 3 T-junctions was significantly higher than that of 1 T-junction group (F1 = 5.827,P1 = 0.042;F2 = 15.038,P2 = 0.004), but there was no significant difference between the groups of 2 T-junctions and 3 T-junctions (F = 3.800,P = 0.087).③ With an increase of the number of T-junction, D also showed a tendency of gradual increase. The D of 1, 2, 3 T-junction group was 1.62±0.27, 1.60±0.22, 1.82±0.25, and 2.15±0.58, respectively. There were no differences among four groups.ConclusionAfter the application of T-junctions between central venous catheter and pressure transducer, CVP values will be underestimated, the reason of which is considered to be the increase in length and thinner lumen of the T-junctions.

Objective To investigate the effect of daily quality checklist on intensive care unit (ICU) the incidence of severe patients with hospital associated infection (HAI). Methods A historical control study was conducted. In Tianjin Fifth Center Hospital from June 2016 to May 2017, 286 severe patients with mechanical ventilation (MV) and using ICU daily quality checklist were assigned as the experimental group, and from June 2015 to May 2016, 291 severe patients who did not use the daily quality checklist were selected as the control group. In the control group, the routine treatment, nursing care and ward rounds were the daily ordinary work; in the experimental group, the severe disease ICU quality checklist system was strictly carried out, and every day the doctor and nurse on duty applied the checklist to assess and verify the medical quality given to the patient, including sedation, analgesia, MV, glycemic control, nutrition, etc 16 items. The incidences of ventilation associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), 28-day mortality, time of MV and the length of ICU stay were compared between the two groups. Results Compared with the control group, the incidences of VAP, CRBSI and CAUTI of experimental group were obviously decreased (VAP: 1.78‰ vs. 5.09‰, CRBSI: 1.46‰vs. 5.21‰; CAUTI: 1.39‰ vs. 4.41‰, all P ＜ 0.05), the time of MV and the length of ICU stay in experimental group were significantly shorter than those in the control group [the time of MV (days): 7.81±2.74 vs. 10.62±3.67, the length of ICU stay (days): 8.40±1.94 vs. 11.35±2.47, both P ＜ 0.05]; there was a decreasing tendency of 28-day mortality in experimental group compared with that in control group [5.24% (15/286) vs. 6.19% (18/291)], but no statistical significant difference was seen (P ＞ 0.05). Conclusion Implementation of daily quality checklist can effectively decrease the incidence of HAI in ICU patients, reduce the time of MV and the length of ICU stay.

Objective To investigate the status quo of nurses' comfort about physical touch and to analyze the influencing factors.Methods Totally 398 nurses were selected during March to May 2017 from three tertiary hospitals in Tianjin with convenience sampling.General information questionnaire,Maslach Burnout Inventory General Survey (MBI-GS),and Nurses' Comfort with Touch Scale (NCTS) were used to collect data and analyze influencing factors.Results The score of nurses' comfort with touch was (44.18±6.27).The average score of nurses' comfort was (5.84±1.43) in task-oriented contact dimension,higher than scores of the other three dimensions.Multiple linear regression analysis indicated that age and emotional exhaustion were main influencing factors.Conclusion The nurses' comfort with touch was at a moderate level.Nurses aged between 25 and 46 years,with emotional exhaustion scored less than 27,had higher comfort with touch.

Objective　To diagnose the pre-symptomatic cases of Chinese Wilson's disease(WD) and detect the potential carriers by using fluorescence PCR technique. Methods　Screening the high frequency spot Arg778Leu of WD gene mutation in 66 Chinese WD patients, 55 healthy family members and 30 controls, and selecting 3 random samples (2 from WD patients, 1 from controls) for DNA sequencing to testify the accuracy of fluorescence PCR. Results　Among 66 Chinese WD cases, 5 were found homozygous for mutation of Arg778Leu and 21 were compound heterozygous; the gene mutation rate was totally 39.4%.Out of 55 healthy family members, 12 were found heterozygous, and it was confirmed that 11 of these 12 individuals were WD gene carriers but not pre-symptomatic patients. The results of direct DNA sequencing consisted with those results detected by fluorescence PCR. Conclusion　The Arg778Leu mutation in exon 8 is the high frequency spot of Chinese Wilson's disease gene. Fluorescence PCR analysis is a rapid, accurate gene diagnostic method and demonstrates a high detecting rate.

Objective:To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure.Methods:A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. According to the random number table method, the patients were divided into the experimental group and control group, with 50 patients in each group. After successful endotracheal intubation, all patients were placed in a supine position with the head of the bed raised by 30°. The experimental group used the minimum air leakage method, and used the cuff pressure manometer to obtain the cuff pressure. In the control group, cuff pressure was maintained at 25-30 cmH 2O (1 cmH 2O = 0.098 kPa). Parameters such as cuff pressure and ventilator leakage volume at the beginning and 4 hours, 8 hours after the inflation were compared between the two groups, as well as the incidence of ventilation-associated pneumonia (VAP) and airway complications after extubation. Results:Among the 100 cases, 53 were males and 47 were females. The age ranged from 23 to 87 years old, with an average of (68.53±8.46) years old. The intubation time ranged from 1 to 16 days.① At 4 hours and 8 hours after inflation, the cuff pressures of the two groups were lower than that of the first time of inflation, and the air leakage of the ventilator increased gradually with the extension of time. Compared with the control group, cuff pressures at each time point in the experimental group were significantly higher than those in the control group [mmHg (1 mmHg = 0.133 kPa): 33.72±9.14 vs. 25.68±5.26 at 0 hour, 30.54±7.81 vs. 24.35±4.93 at 4 hours, 26.57±5.64 vs. 22.42±4.14 at 8 hours, all P < 0.05], and ventilator leakage volumes were smaller than those in the control group (mL: 25.57±8.51 vs. 34.65±9.47 at 0 hour, 40.54±8.51 vs. 60.34±7.85 at 4 hours, both P < 0.05). ② The incidence of VAP in the experimental group was significantly lower than that in the control group (4% vs. 10%, P < 0.05). There was no statistically significant difference in the incidence of other airway complications between the experimental group and control group (airway mucosal edema: 14% vs. 12%, ulcer: 8% vs. 6%, tracheal esophageal fistula: 0% vs. 0%, hoarseness: 4% vs. 6%, cough: 30% vs. 34%, sore throat: 28% vs. 32%, tracheal softening: 0% vs. 0%, cuff rupture: 10% vs. 8%, all P > 0.05). Conclusions:The optimal cuff pressure is very important for preventing VAP and reducing airway complications. The minimum air leakage method makes the clinical obtained endotracheal intubation cuff pressure more accurately, with less air leakage, safe and effective, and it is worthy of clinical promotion.