Objective To explore the negative emotion and self-management of elderly patients with COPD during their community-based rehabilitation.Methods Phenomenological research method of qualitative research was used,12 elderly patients with COPD during their community-based rehabilitation period received in-depth interviews.Results There were three themes sublimated from the patients negative emotions:aloneness and inferiority feeling,self-abasement and guilty feeling,sense of helplessness.Self-management of negative emotions also had three themes:gratitude mood,complying with the disease and distracting attention.Conclusions It is necessary to pay close attention to the negative emotions of elderly patients with COPD during their community-based rehabilitation; the community healthcare services should bear the responsibility of COPD patients' rehabilitation; we should explore practical intervention plan work on gratitude mood of elderly patients with COPD ; mobilize all social resources to do a good job on social support in elderly patients with COPD.

Objective To investigate the clinical and genetic characteristics of a progressive symmetric erythrokeratoderma (PSEK).Methods The clinical and genetic characteristics of a PSEK were compared and analyzed with clinical collection and review of 17 PSEK families reported in China since 1980.Results PSEK was consistent with autosomal dominant inheritance.PSEK had the feature with incomplete penetrance and variable expression.The clinical features included hyperkeratotic plaques with distinct border and strikingly symmetric distribution pattern on the extremities.Part of patients was extended to other areas of the body.The onset of the disease commonly started in infancy or childhood.The general health condition was not affected.PSEK might be associated with other clinical symptoms.The diseased potential increased in the family of consanguineous marriage.Conclusions PSEK has genetic heterogeneity.Its causative genes have not been determined.Further studies are needed.

Objective To introduce the clinical application of a extensive revense peroneal artery flap in repairing big soft tissue defect in foot, especially in repairing a big defect in distal foot and the exposure of one or more metatarsophalangeal joint. Methods The skin flaps were used in 11 cases to repair the big soft tissue defect in foot, including the distal part of foot. The flap upper boundary may surpass the capitulum fibulae; The lower boundary may reach the back line between external malleolus and internal malleolus; Lat-eral boundary could overrun anterior margin of fibula about 2 cm; Inboard boundary could get to medial mar-gin of gastrocnemius muscle. In attention: the two branch vessels from peroneal vessel in the site of 11-13 cm and of 5-7 cm above the outer anker would be included in the flap. Results Ten of 11 skin flaps survived satisfactory. A small, marginal portion of one flap in one case presented necrosis. Conclusion The reverse peroneal artery flap is easy to elevate and safety, which is an ideal flap for a huge soft tissue defect in foot, especial in the distal part of foot.

Objective To explore the role of type Ⅶ collagen (COL7A1) gene in the pathogenesis of pretibial dominant dystrophic epidermolysis bullosa (DDEB-Pt).Methods Peripheral blood samples were obtained from a sporadic Chinese patient of Han nationality with DDEB-Pt,his parents and 100 healthy human controls.A modified salting-out method was used to extract genomic DNA from the blood samples,and PCR was performed to amplify 118 exons of the COL7A1 gene followed by DNA sequencing.Results A G→A mutation was identified at position 6109 (G6109A) in exon 78 of the COL7A1 gene in this patient,which caused a change from GCT to ACT at codon 2037 in the triple helix region,and resulted in the substitution of glycine (Gly) by arginine (Arg) (p.Gly2037Arg).Conclusion A novel glycine substitution mutation was identified in the COL7A1 gene in the patient with DDEB-Pt,which may be a pathogenic mutation.

Objective To evaluate the efficacy of applying problem based learning (PBL) combined with traditional teaching in clinical internship in department of gastroenterology.Methods Totally 60 full-time medical undergraduates of clinical medicine in clinical internship in department of gastroenterology of the Second Hospital of Baoding were randomly divided into PBL group (n=30) and traditional group (n=30).Practical effect of the different modes was evaluated by questionnaire and examination resuits.Data were analyzed by SPSS 15.0.Enumeration data were compared between groups using x2 test and measurement data were manifested (x-) ± s with P ＜ 0.05 signifying significant difference.Results PBL group was superior to traditional group in comprehensive analysis capabilities,motivation to learn and learning outcomes with statistically significant differences between the two groups (P values were 0.001,0.007 and 0.005).Concerning stimulating students' interest and satisfaction of the teaching mode,the difference between the two groups was not statistically significant (P ＞ 0.05).PBL group was superior to traditional group in the pre-class preparation,full and accurate expression of views in classroom and clinical logic,with statistically significant differences between the two groups (P values were 0.002,0.000 and 0.002).There was no difference in communicative abilities with patients between the two groups (P=0.118).PBL group had higher scores than traditional group in the quiz,case analysis and overall performance,with statistically significant differences between the two groups (P values were 0.005,0.045 and 0.013).Concerning score of glossary and multiple-choice questions,differences between two group were not statistically significant (P＞0.05).Conclusions PBL combined with traditional teaching method is suitable for internship teaching in the department of gastroenterology for full-time undergraduates of clinical medicine.PBL can improve students' clinical comprehensive analysis capabilities and helps to develop the ability to take the initiative to solve practical problems.

Objective To explore the current situation of knowledge,beliefs and behavior of elderly patients with COPD during their community-based rehabilitation.Methods Phenomenological research method of qualitative research was used,14 elderly patients with COPD during their community-based rehabilitation period received in-depth interviews.Results There were three themes and corresponding subthemes sublimated from the patients:self-management knowledge and skills,self-management beliefs and attitudes and self-management behavior.Conclusions It is necessary to pay close attention to spreading disease related health information,especially for patients with low health literacy.During the process of COPD self-management projects,we should focus on negative beliefs and negative attitudes on their selfmanagement behavior choice,which is as important as strengthening the patients' self-efficacy.

To investigate the animals infection situation of novel bunyavirus in Xinyang City ,Henan Province ,China , animal serum samples such as cattle ,dog ,swine ,mice were collected in Shangcheng County and Guangshan County in Xinyang City .All the serum samples were detected by novel bunyavirus ELISA and real time RT-PCR method .A total of 292 animal serum samples were collected including 5 kinds of animals .The result of all the animal serum samples were negative by using real time RT-PCR ,and the positive rate was 45 .19% (141/312) by ELISA method .Of the 5 animal serum samples including mice ,cattle ,goats ,swine and dogs ,the positive rate were detected to be 1 .06% ,100 .00% ,76 .27% ,3 .57% ,and 75 .00%respectively .There was significant difference in results among 5 kind of animal serum antibodies .Animals such as cattle and dog may be the host of novel bunyavirus which were detected novel bunyavirus antibodies in cattle and dog in Xinyang City , Henan Province ,China .

Objective To explore the clinical characteristics and related factors of Helicobacter pylori (Hp) infection in gastric stump lesion.Methods Eighty-nine patients with subtotal gastrectomy gastrointestinal symptoms underwent gastroscope,the clinical data were retrospectively analyzed.The relationship between gastric Hp infection and different operation reasons,different operation,different degree of inflammation,postoperative time,the existence of bile reflux was assessed.Results There were 29 cases of gastric Hp infection,the positive rate of Hp was 32.6％ (29/89).There were no significant difference between different preoperative disease such as duodenal ulcer (bleeding/perforation),gastric ulcer (bleeding/perforation),gastric cancer,leiomyosarcoma and HP infection (P ＞0.05).There was no significant different positive rate of Hp infection between Billroth Ⅰ and Billroth Ⅱ after operation (P ＞0.05).The rate of Hp infection increased with the degree of inflammation (moderate to severe) in gastric stump and anastomotic inflammation.There were significant difference [gastritis severity of inflammation:27.3％ (12/44) vs.57.1％ (16/28),anastomotic inflammation:25 ％ (10/40) vs.50％ (18/36),P ＜ 0.05] ;there was significant difference between two groups of more than 10 years [43.9％ (18/41)] and less than 10 years [22.9％ (11/48)] of Hp infection rate (x2 =4.433,P =0.035) ; the positive rate of Hp infection in group of no bile reflux under gastroscopy were higher than the group of bile reflux,there was significant difference [22.2％ (10/45) vs.43.2％ (19/44),x2 =4.449,P =0.035).Multivariate Logistic regression analysis showed that,the degree of inflammation (severe) and bile reflux was associated with gastric Hp infection,inflammation (severe) was the dominant risk factor [OR =1.24,95％ CI:1.22-1.56,P =0.01],with bile reflux were protective factors [OR =0.76,95％CI:0.58-0.99,P =0.04].Conclusions Hp infection can promote and aggravate the gastric remnant mucosa inflammation,Hp infection and bile reflux can lead to gastric mucosa pathological changes,there can be independence pathogenic factors,also can cause at the same time,regulate the eradication of residual gastric Hp infection is very important,also deal with the residual stomach regular line of gastroscope and Hp,histologic examination.

Objective To investigate the value of prospectively electrocardiogram (ECG)-triggered high-pitch coronary computed tomography angiography at 70 kV and 30 mL contrast medium with Stellar detector dual-source CT.Methods 60 patients with the BMI<24.9 kg/m2 were randomized into two groups:Group A (30 cases)with the tube voltage of 70 kV and 30 mL contrast medi-um.Group B (30 cases)with the tube voltage of 100 kV and 50 mL contrast medium.All the patients were performed with a Stellar detector dual-source CT using a prospectively ECG triggered high-pitch spiral technique.The images of Group A were reconstructed with SAFIRE technique,while Group B were with FBP technique.The objective image quality includes CT attenuation,SNR, CNR.And radiation dose was also calculated.The subjective was evaluated by 4-scale point.Independent sample t test was used.Re-sults There was no difference for subjective image quality between the groups,A:(3.38±0.942),B:(3.50±0.682),(t=-0.562, P >0.05).The CT attenuation of the 70 kV group were higher than that of the 100 kV group for all the segments(P <0.01).The SNR and the CNR have no statistically significant difference between the groups (P >0.05).Compared with the 100 kV group,the radiation dose of the 70 kV group was reduced by 76.5% (A:0.19±0.023 mSv,B:0.81±0.101 mSv,P <0.01).Conclusion Using 70 kV with 30 mL contrast medium in Stellar detector dual-source CT coronary angiography for the patients with a normal BMI could obtain qualified diagnostic image with low radiation dose and contrast medium.

Objective To evaluate feasibility and time efficiency of dual-source flash post-processing software (Bone Reading)for reconstruction of bronchial artery.Methods The imaging data of 70 patients with suspected bronchial artery dilatation who underwent bronchial artery-CTA were evaluated by 2 independent radiologists.First,the related contents of bronchial artery such as origination,number, type,route and lumen diameter were evaluated by multiple planar reconstruction (MPR),maximum intensity projection (MIP)and volume rendering technique (VRT).The results and process time were recorded.After a month,the post-processing software(Bone Reading)was used to evaluate the same contents.Results There was very good correlation between both readers for both reading methods without significant differences.There was significant difference of process time between with regular method and with Bone Reading (P<0.05)for both readers.Process time could be decreased by approximately 35%.Conclusion The application of CT software (Bone Reading)is feasible in the CTA of bronchial artery.This method may gain a significant time saving in comparison to regular method.