Objective To summarize the experience in nursing 2 patients with anti-glomerular basement membrane disease.Method The nursing measures such as close observation of disease condition,careful nursing of medication,nursing during the treatment of double filtrated plasmapheresis and mental care to the patients and their family members.Results After treatment,the concentration of anti-GBM antibody was declined and the level of serum creatinine was also decreased.The renal function got rccovered to a certain extent.Conclusion Such nursing points as close observation of renal and pulmonary pathgenesis,timely and accurate administration of medicine according to doctor's orders and active observation and prevention of complication from double filtrated plasmapheresis are key.

Objective To characterize the medial femoral circumflex artery based on three-dimensional computed tomographic angiography (3DCTA) so as to provide anatomical aids for diagnosis and treatment of hip injuries.Methods To do this research the 3DCTA data of 103 patients (206 hips) were collected who underwent 3DCTA from March 2012 to June 2014 for examination of the pelvis and lower extremities.They were 55 men (mean age,54.7 ± 15.9 years) and 48 women (50.0 ± 16.1 years).① The origin and course of the medial femoral circumflex artery was observed.② The length of the artery trunk was measured.The distances between the origin(A) of the artery to the main anatomical marks [the peak of greater trochanter (B),the inward peak of lesser trochanter (C),and the crosspoint (D) of the femoral artery and the pubic edge or the acetabulum inlet edge] were measured.Comparisons of the measurements were conducted between genders.③ The distance between point A and point E,the starting point of the femoral profound artery,was measured.Comparisons of the measurements were conducted between genders.Results 2.9％ (3/103) of the subjects had their bilateral medial femoral circumflex arteries originate from the femoral artery,94.2％ (97/103) had their bilateral medial femoral circumflex arteries originate from the femoral profound artery,and 2.9％ (3/103) had one medial femoral circumflex artery originate from the femoral artery and the other from the femoral profound artery.1.9％ (4/206),76.7％ (158/206) and 21.3％ (44/206) of the subjects had the artery of screw type,of circuitous type and of straight type,respectively.The artery trunk goes posteriorly and medially after it is issued,divides into branches along the course,continues to go around the back of the femoral neck,and finally goes to the outward and upper direction.There were no statistical differences between males and females regarding length of the artery trunk,or distances between points AB,AC,AD or AE (P ＞ 0.05).Conclusion Since 3DCTA can clearly demonstrate the origin,course and anatomical morphology of the medial femoral circumflex artery,it can be used to provide anatomical aids for clinical evaluation and treatment of hip injury.

The training of clinical skill is closely linked with medical personnel education.However,traditional paper-type training materials were unable to meet the training needs.As a new type of training materials,trial-and-error video-type clinical skill training materials (abbreviated as TEVT clinical skill training materials) have gradually attracted attention with its characteristics of lively and interesting,potentially informative,high acceptance among students,the advantages' of stimulating students' initiative exploration and consideration,fostering students' critical spirit and humanities.On the basis of analyzing the advantages' of TEVT training materials,we discussed the developing specialties of TEVT clinical skill training materials from four aspects as the material orientation and the application object,material sources,constructing the developing team and editing the teaching materials.Furthermore,we reflected the application prospect of TEVT clinical skill training materials in the future,in order to explore an available implementation path for the development of TEVT clinical skill training materials.

Objective To observe the expression of protein kinase C(PKC)isoforms in pulmonary artery of chronic inflammatory pulmonary hypertension(PHT)rats.Methods Chronic inflammatory PHT model rats were established induced by monocrotaline(MCT).Western blotting analysis was used to detect the expression of four PKC isoforms(PKC?,PKC?Ⅱ,PKC? and PKC?)in pulmonary arteries of rats during the development of PHT.Results The values of mean pulmonary artery pressure and right ventricular hypertrophy index increased significantly after the injection of MCT,which suggested successful formation of PHT.Western blotting analysis showed that PKC?,PKC?Ⅱ and PKC? isoforms were presented in pulmonary arteries of normal and PHT rats,while PKC? isoform was not detected.The expressions of PKC? in both cytosolic and membranous fractions increased within 14 days,and decreased a little during the development of PHT.But the increase of PKC? in cytosolic fraction was much more obvious than that in membranous fraction.The highest expression of both PKC?Ⅱ and PKC? in cytosolic fractions appeared at the eighth day,while the expression of both isoforms in membranous fraction went up continuously.Conclusions PKC?,PKC?Ⅱ and PKC? isoforms were involved in the development of chronic inflammatory PHT.The changes of their expression might be the results of PKC isoforms translocation which is related to the proliferation regulation of pulmonary artery smooth muscle cells.

0.05).Phlebitis occurred in 3 cases(4.2%) in PICC group,pneumothorax happened in 2 cases in CVC group.Calhelerization failure in CVC group was 7 cases who then received PICC successfully.No deep vein thrombosis occurred in either group. Conclusions:PICC has no possible severe complications of central venous access such as pneumothorax.The new method provides a safe,reliable and effective venous access for mid and long term usage in old patients.

OBJECTIVE To investigate the application of blood test in the prognosis of nasal NK/T-cell lymphoma.METHODS The clinicopathologic and follow-up data of 62 patients with nasal NK/T-cell lymphoma proven by pathological examination were collected.The blood lactic dehydrogenase(LDH),globulin(GLB),albumin(ALB),hemoglobin(Hb),and white blood cell(WBC) were examined in these patients.The correlation between these factors and prognosis were analyzed with univariate analysis and multivariate analysis.RESULTS Of the 62 patients,47 were males and 15 were females.Their median age was 42 years.Ninety two percent of the patients were in Ann Arbor I/Ⅱ stage,and 76 % had international prognostic index(IPI) of 0 or 1.Before treatment,92 % of the patients had ECOG performance status(PS) score of 0-1,26 % had anemia,53 % presented B symptoms.The median overall survival time was 27 months(95 % CI:10-45months).In univariate analysis,gender,age,PS score,LDH,IPI,B symptoms,Hb and WBC were statistically significantly correlated to the prognosis.In multivariate analysis,Hb1 were statistically significant unfavorable prognostic factors.CONCLUSION Hb together with B symptoms and PS score may be independent prognostic factors for nasal NK/T cell lymphoma.

Objective To discuss the value of preoperative digital design of struetund bone graft for acetabular wall defects. Methods The . dieom data from spiral CT scans were imported into Mimics 10.0 to build the 3D solid model of the pelvis of an old female patient with left acetabular wall defects. The 3D solid model of the defect area was built by Mirror and 3D mask editing. A simulated bone graft was conducted on the 3D model by segmentation and trimming according to the data measured on the reconstructed model. Results The reconstructed 3D model of the patient's pelvis could be presented in different colors, transparenees, or combinations of interested tissues. The acetabular wall defects could be visualized very clearly at different angles. The geometric data of the bone graft could be measured to ensure the bone graft would fit the defects accurately. Conclusion Preoperative digital design based on 3D com-puterized reconstruction of acetabular wall defects may provide a valuable aid to clinical treatment, because it is a simple, rapid, and accurate method of increasing the fitness of bone graft and the defects,

Objective To investigate the characteristics of cognitive changes in type 2 diabetes mellitus pa-tients complicated with stroke. Methods One hundred and one stroke patients were recruited and allocated to thetype 2 diabetes mellitus group (34 patients) and sixty-seven patients in the control group (67 patients) according tobeing with or without type 2 diabetes mellitus. All the patients were evaluated, after 3 weeks, 6 months and 12months of onset of stroke, with regard to their cognitive functions by using the Mini-mental State Examination(MMSE) and Montreal Cognitive Assessment (MOCA). Results Average scores obtained in MMSE and MOCAtests were significantly lower at 3 weeks and 6 months after onset in the type 2 diabetes mellitus group when comparingwith control group. In the type 2 diabetes mellitus group, no significant difference was observed between 3 weeks and6 months after onset of stroke with regard to scores of MMSE and MOCA ( P > 0.05 ), however, the score at 6 monthswas significantly lower than that at 12 months after onset (P <0.05). On the other hand, scores of MMSE (P >0.05 ) and MOCA (P > 0.05 ) in the control group were not any statistically different among various time points ofobservation. Conclusion Type 2 diabetes mellitus will aggravate cognitive dysfunctions of stroke patients, whichstarted to recover in 6 months of onset of the stroke.

Objective To compare the values of the mangled extremity syndrome index (MESI), the mangled extremity severity score (MESS) and the limb salvage index (LSI) in deciding amputation or salvage in the management of the mangled extremity syndrome (MES). Methods Clinical data of 353 MES patients including 95 with amputation and 258 with salvage admitted in recent eight years were retrospectively evaluated by using MESI, MESS and LSI, the value of which in deciding amputation or salvage was assessed with receiver operating characteristic ( ROC ). Results There was statistical difference in aspect of mean scores of three grading systems between patients with amputation or salvage (P＜0. 01). For MESI, MESS and LSI, the sensitivities was 89.47%, 85.26% and 83.15% respectively, the specificities was 100%, 96.89% and 96.12% respectively, the coincidence was 97.16%,93.76% and 92.63% respectively, the areas under ROC curves was 0. 924, 0905 and 0. 861 respectively and the cut-off points were equal or over 20, 7 and 6 respectively. Conclusions Three scoring systems are all highly capable of predicting early amputation or not in MES management. The MESI is recommended as a quantitative criterion for determining amputation or salvage.

Objective To explore the clinical curative effect of early enteral nutritional support for acute se-vere organophosphorus pesticide poisoning.Methods 56 cases with acute severe organophosphorus pesticide poison-ing were selected and divided into group A and group B in accordance with the random number table.Both groups were given conventional emergency treatment.Enteral nutrition support with nutrition pump was applied for 30 cases of group A in 48 -72hours,while group B in 72h -5d.The time of consciousness recovery,CHE increase to normal 60%,the incidence rate of intermediate syndrome,gastrointestinal complications of abdominal pain,abdominal disten-sion,vomiting,reflux,diarrhea,VAP,MODS of the two groups of patients were compared.Results The time of con-sciousness recovery (3.6 ±0.8)d in group A was lower than that of group B(4.1 ±0.6)d (t=2.612,P<0.01), the CHE increase to normal 60%(5.5 ±1.3)d in group A was lower than that of group B(6.3 ±1.1)d(t=2.464, P<0.05),the incidence rate of intermediate syndrome(3.3%)in group A was lower than that of group B(38.5%) (χ2 =4.691,P<0.05),the VAP of 13.3% in group A was lower than that of group B(46.2%)(χ2 =7.352,P<0.01),the MODS of 13.3% in group A was lower than 38.5% of group B(χ2 =4.691,P<0.05),the duration in ICU of (8.0 ±1.2)d in group A was lower than (12.0 ±2.4)d of group B(t=7.705,P<0.01).There was no sig-nificant difference of gastrointestinal complications between the two groups (P >0.05 ).There was no significant difference of gastrointestinal complications between the two groups (P>0.05).Conclusion Early enteral nutritional support is effective and safe for acute severe organophosphorus pesticide poisoning and worthy of promotion.