Objective To investigate the value of measurement of cardiac output in children by bio-reactance versus echocardiography.Methods Pediatric patients admitted in pediatric department of Peking University First Hospital from September to December 2012 who needed hemodynamic monitoring were enrolled prospectively.Cardiac index(CI)and stroke volume(SV)were measured by echocardiography and non-invasive cardiac output measurement(NICOM)and compared by Spearman correlation and Bland-Alt-man analysis.Results Thirty patients were included.The median age was 7.25 years.CI[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated significantly[3.42(2.28,4.92)L /(min?m2 ) vs.3.51 (2.94,4.85 )L/(min?m2 ),R =0.385,P =0.035 ].Bland-Altman analysis revealed a bias of-0.22 L/(min?m2 )(P =0.051 ),limits of agreement of -1.40 to 0.95 L/(min?m2 ).SV[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated more significantly [36.3 (12.6,87.8 )ml vs.39.4(14.7,86.9)ml,R =0.768,P ﹤0.001 ].Bland-Altman analysis revealed a bias of -3.1 ml(P =0.176),limits of agreement of -27.4 to 21.2 ml.Conclusion There is no significant difference between NICOM and echocardiography for the measurement of CI and SV in pediatric patients.Further validation studies need to be conducted before routine clinical use.

Objective To explore the appropriate frequency of ventilator tube replacement by researching the influence of different ventilator circuit change frequency on ventilator-associated pneumonia (VAP).Methods A prospective randomized sampling study was conducted.The patients undergoing invasive mechanical ventilation over or equal to 3 days admitted to emergency intensive care unit (EICU) of the First Affiliated Hospital of Kunming Medical University from December 2012 to December 2015 were enrolled.The patients were divided into 3,7 and 10 days group according to the frequency of ventilator tube replacement.Bacteriology of ventilator tube and the incidence of VAP were compared among the groups.Results Ninety-eight patients were enrolled,mainly with the artificial airway of endotracheal intubation or tracheotomy,with 56 male and 42 female,aging 8 to 86 years with mean of (51.97 ± 17.56) years.There were no statistical differences in gender,age,Glasgow coma scale (GCS) score,cough function and application of glucocorticoid,enteral nutrition,atomization and sedative therapy among three groups,indicating that the risk factors among three groups were consistent.The bacteria detection rates of extension tube,breathe out tube,breathe in tube,and hydrops collection cup were 36.7％,36.7％,33.3％,and 33.3％ respectively in 3 days group,and they were 73.0％,67.6％,62.2％,and 62.2％ in 7 days group respectively,and were all 90.3％ in 10 days group.It was showed that the bacteria detection rate in different pipe parts was almost the same with the same change frequency,and the rate was higher with the longer usage of ventilator tube (x2 values were 20.599,19.879,21.975,21.975,all P =0.000).The longer of the tube used time,the higher incidence of VAP.The incidence of VAP in 3,7,10 days groups were 26.7％,59.5％ and 77.4％,respectively,but there was statistically significant difference among all groups (x2 =30.486,P ＜ 0.001).Based on the value of 3 days group,the incidence of VAP in the 7 days group was 15.950 folds of 3 days group,and the incidence of VAP in the 10 days group was 18.333 folds of the 3 days group (both P ＜ 0.001).Conclusion This study suggests that the longer of pipeline using time,the more serious degree of bacterial contamination of pipeline,the higher incidence of VAP.

Objective To evaluate the safety and comfort of postoperative patients with hepatocellular carcinoma after interventional therapy in the early stage and late stage, so as to determine the time to get out of bed after operation. Methods We searched PubMed, EMbase, Cochrane Library (2016 second), Web of Science, CBM, Wanfang Data and CNKI database, collect test/ambulation time of hepatocellular carcinoma after interventional therapy were searched from inception to September 10, 2016. Meta analysis was performed by 2 reviewers independently by screening literature, extracting data and evaluating the risk of bias in the study. RevMan 5.0 software was used to analyze the data. Results A total of 9 studies were included in the study, and 1164 patients were included. The Meta analysis results showed that:compared with 24 hours in bed after operation, 12 hours early ambulation method to reduce postoperative pain, postoperative [odds radio (OR)=0.07, 95% confidence interval (CI) 0.03-0.15, P <0.05] and dysuria (OR =0.18, 95% CI 0.10-0.33, P < 0.05), abdominal distension (OR =0.14, 95% CI 0.07-0.29, P<0.05), insomnia (OR=0.15, 95% CI 0.05-0.43, P<0.05). But in the local punctura, such as congestion (OR=0.99, 95%CI 0.45-2.18, P=0.98), hematoma (OR=0.90, 95% CI 0.38-2.13, P=0.80), the difference was not statistically significant. Conclusions The available evidence indicates that the early postoperative 12 hours after interventional therapy can effectively reduce the incidence of postoperative complications. To be included in the quantity and quality of the research, the conclusion still need to carry out more high-quality research to be verified.

Objective The aim of this study was to describe nursing student-patient relationship in Yunnan province,and study its influencing factors and practice effectiveness.Methods The multi-phase stratified cluster random sampling method was adopted to investigate 483 internship nursing students in two first class hospitals in Yunnan province.Results Among 483 nursing students,379 (78.5％) students belonged to facilitative relationship,101 (20.9％) students belonged to authoritative relationship,and 3 (0.6％) students belonged to mechanistic relationship.Sociodemographic data and factors related to three type of relationship showed no statistical significance among three types of nursing students.But student's personal and professional growth,student's increased confidence and self-esteem demonstrated statistical significance among three types of nursing students.In student's personal and professional growth,students of authoritative relationship got the lowest score (3.96±0.78) compared with students of mechanistic relationship and facilitative relationship [(4.17±0.29),(4.17±0.54)],F=4.82,P ＜ 0.01.In student's increased confidence and self-esteem,no significant difference was seen.Conclusions Nursing students' perceptions of student-patient relationship are mostly facilitative.And students' personal and professional growth and confidence and self-esteem increased obviously through internship for students with facilitative student-patient relationship.

Objective To assess the quality of life(QOL)of advanced schistosomiasis patients,and understand its influenc-ing factors. Methods A questionnaire survey was carried out by using WHOQOL-BREF,and the information of demography, family,illness,health status,and health service was collected. Results Among the 217 advanced patients,the average age was (75.33±6.94)years,the ratio of male to female was 2∶5,89.86%of them were farmers,75.58%were illiterate or semi-illiterate, and 88.94%belonged to the splenomegaly type. Totally 61.29%of the cases had the scores over average for the overall QOL,but the scores for the health and well-being were lower. There were a significant difference among the average scores of different do-mains of QOL(χ2 =23.46,P<0.01). Both the year of being diagnosed and clinical classification was not associated with the scores of QOL. Regularly taking physical activities was significantly associated with each of all the 4 domains. The factors such as onset of acute disease in 2 weeks,taking therapeutic pills daily,marital status,age,etc. impacted the specific domains of QOL. The overall QOL and the 4 domains of the patients were at medium level;meanwhile,the score of physiological domain was lower than the scores of the other 3 domains. Conclusions The QOL(s)of advanced schistosomiasis patients in Qingpu District are rel-atively good. It is important to provide effective community health services and encourage the patients to take part in tempered sports or physical activities in order to keep their normal activities of daily living.

Objective To construct Z-score models for normal fetal heart size measurements derived from fetal echocardiography.Methods Fetal echocardiography were performed in 910 normal singleton fetuses from 14th to 40th gestational weeks.Fetal transverse heart diameter (HD),heart length (HL),heart circumference (HC) and heart area (HA) were derived from a standard four-chamber view during end diastole.Using fetal somatic sizes as independent variables and heart sizes as dependent variables,the regression analyses of the mean (M) and the standard deviation (SD) for each parameter were calculated separately.A group of fetal heart diseases were assessed using these models.Results Strong correlations were found between fetal heart sizes and somatic sizes.Linear-cubic regression equations were each fitted to the models of the means of the heart sizes,whereas linear-quadratic equations were fitted to the models of the SDs.HD (r =0.984-0.986) was a dependent variable that provided the highest correlation coefficient with all of the fetal sizes,followed by HL (r =0.981-0.984),HC (r =0.981-0.982) and HA (r =0.978-0.979).All fetuses with Ebstein' s anomaly and most with homozygous α thalassemia-1 demonstrated Z scores reflective of increased heart sizes.Conclusions The fetal heart sizes Z-scores models had been constructed.The calculation of Z-scores for heart sizes as a function of fetal somatic size is feasible and simple.They might be useful for quantitative assessment of some cardiac diseases and used as new predictive indicators for homozygous α-thalassemia-1 particularly.

Objective To optimize several key factors in preparing protein microarray,and establish microarrays to detect autoantibodies.Methods Four factors,including incubation time of the microarray after spotting,the blocking reagent,the length of blocking time,the length of time conjugating with the second-an- tibody,were selected to carry out orthogonal optimization,then we determined the optimal spotting concentra- tion of antigen and the best dilution of serum with the optimized conditions obtained from the above.On the basis of the optimized conditions,we prepared microarray to detect six autoantibodies simultaneously,which were compared with IIF and ELISA.Results The best conditions we determined from the experiment were: incubating the spot microarray for 120 min,PBST containing 1% BSA and 2.5% saccharose as the blocking reagent and blocking for 30 min,reacting with the second-antibody for 30 min,the appropriate spotting con- centrations of six antigens differed from 100?g/ml to 300?g/ml and the best serum dilution was 1:2.Com- pared with IIF for ANA detection,the sensitivity of the microarray was 88.6%,the specificity was 83.3%,and compared with ELISA in detecting the other five autoantibodies,the sensitivity of the microarray was between 80.0% and 88.2%,and the specificity was between 90.2% and 98.6%.Conclusion The optimization condi- tions we obtained are suitable for preparing protein microarray,and the detection sensitivity and specificity of autoantibodies by microarray are consistent with the conventional methods in general.The microarray for de- tecting autoantibodies is applicable in the clinical diagnosis of autoimmune disease.

Objective To investigate the variation of the thioredoxin system (Trx),and the role of it in transient out-ward potassium current (Ito) channels in left ventricular myocytes of diabetes mellitus (DM) in rats. Methods Forty-five SD rats were divided into DM group and control group. DM group were treated with streptozotocin (STZ) to induce DM model. The values of left ventricular end diastolic diameter (LVEDD), end-systolic diameter (LVESD), fractional shortening (LVFS), ejection fraction (LVEF) and heart rate (HR), QRS duration and corrected QT (QTc) interval were detected by echocardiogra-phy (UCG) and electrocardiogram (ECG) in two groups. The left ventricular myocardial tissue samples were taken to detect the Trx,glutaredoxin (GRX),thioredoxin reductase (TrxR) and glutathione reductase (GR) by using UV spectrophotometer. The level of free thiol (P-SH) of total cardiac protein was detected by 5, 5′-dithio-bis-2-nitrobenzoic acid method. Ito of the cardiomyocytes was recorded by whole-cell patch-clamp method. After being incubated in vitro with insulin(Ins), treated with TrxR inhibitor-auranofin(AF) and 13-cis-retinoic acid(RA), the changes of Ito of the cardiomyocytes were observed. Results Compared with control group, the values of heart rate (HR), left ventricular minor axis decurtaion rate (LVFS), left ventricular ejection fraction (LVEF) and TrxR were lower in DM group. The values of LVEDD, LVESD, QRS and QTc inter-vals, Trx, Grx and P-SH were higher in DM group than those of control group. Ito density was significantly higher in DM+Ins group than that of DM group, Ins+RA group and Ins+AF group when the stimulation voltage ≥ 0 mV (P ＜ 0.05). Conclusion The impaired Trx system in diabetic rat myocardium was the electrophysiological basis of the reduced ventric-ular function and arrhythmia. And Ins was able to reverse the decreased Ito of cardiomyocytes in DM rats.

OBJECTIVETo investigate the value of mediastinoscopy in diagnosis of the thoracic diseases and the determination of the operative indication.

METHODSFrom 1979 to 2000, 165 patients were given mediastinoscopy by local infiltration anesthesia (rare cases with additional vein bacic anesthesia). The exploration and biopsy were given to the neoplasms and lymph nodes around the trachea through the pretracheal interstice.

RESULTSThe diagnosis of 125 patients by mediastinoscopy accorded with the pathological diagnosis and that of 21 patients was not accorded with the pathology. The rate of definitive diagnosis was 85.6% (125/146). The other 19 cases were not included into the ground because 11 cases were not given definitive diagnosis and 8 cases with lung cancer were not be performed operation although the results of mediastinoscopy were negative. Twenty patients with lung cancer which had metastasis in the mediastium and 7 patients with malignant lymphadenoma avoided exploratory thoracotomy.

CONCLUSIONThe mediastinoscopy is a effective examinative method to the disease involving the lymph nodes in the mediastinum and the thoracic disease closing on the mediastinum. The mediastinoscopy in appropriate especially to the simple enlargement of lymph node in the mediastinum that is not given definitive diagnosis. The cases with lung cancer accompanied enlargement of lymph node in the mediastinum and that with tumors in the mediastinum may choose the mediastinoscopy.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; Lymph Nodes ; pathology ; Male ; Mediastinal Neoplasms ; diagnosis ; Mediastinoscopy ; Middle Aged ; Thoracic Diseases ; diagnosis