For the purposes of meeting the needs of COPD patients for health education, decreasing times and costs of re-hospitalization, and increasing patient satisfaction and nurses' working enthusiasm. In 2011, our hospital established a specialist nursing clinic for chronic obstructive pulmonary disease (COPD), and two nursesentitled-deputy directorswith rich clinical experiences for more than fifteen years and strong communication skills were se-lected to take charge of the clinic, and they were responsible for nursing assessment, making individualized pul-monary rehabilitation plan, health guidance, long-term follow up, etc., for discharged stable COPD patients and COPD patients with no need for hospitalization. Patient satisfaction was improved from 83% to 96% after implemen-tation.

Objective To evaluate the efficacy of pneumocystoscopy for congenital malformation of the vesicoureteral junction. Methods A total of 18 children (male 11 and female 7, aged from 3 months to 7 years with a mean of 3.6 years) with congenital malformation of the vesicoureteral junction (22 ureters) were enrolled in this study. Among the patients, 9 had vesicoureteral reflux (4 of them had bilateral reflux), 2 had bladder diverticulum complicated with urethral stenosis, and 7 had urethral stenosis and ipsilateral hydronephrosis. After the bladder was insufflated with CO2 through a Foley catheter (16 mm Hg), three trocars were inserted into the bladder, and the bladder was fixed on the abdominal wall using silk thread. By pneumocystoscopy, the Cohen procedure was done through the trocars. A Foley catheter was indwelled at the end of the procedure. Results The procedure was completed in all but one patient, who was converted to open surgery because the contraction of the urethra. The mean operation time was 130 min (110 to 145 min) for unilateral cases (13), and 242 min (225 to 250 min) for bilateral cases. The patients were discharged form hospital 9 to 12 days after the operation, and were followed up fro 6 months to 5 years with a mean of 3.8 years. During this period, MUC showed no ureteral reflux. One of the cases developed mild infection of the urethra, and was cured by circumcision. Conclusion Pneumocystoscopy is effective for congenital malformation of the vesicoureteral junction.

Objective To explore the relationship between dietary factors and female breast cancer. Methods A 1∶1 matched case-control study was conducted in 175 cases with histopathological diagnosis and 175 matched controls(Apr.2004 to Jul.2005), a questionnaire about general information and dietary intakes over 10 years was used in the present investigation. Results The univariate conditional analysis showed that high intake times of fruits, vegetables and soybean food were the protective factors and the relationship between intake frequencies of fruits, vegetables and soybean food intake and breast cancer showed a dose-response manner. The multivariate analysis showed that psychological hurt was the risk factors, high vegetables and soybean food intake and more delivery times were the protective factors. Conclusion High intake times of vegetables and soybean food are the protective factors for female breast cancer.

Objective To screen out the tetrahydrobiopterin def iciency in patients with hyperphenylalaninemia by urinary pterin analysis. Methods Analysis of urinary neopterin (N) and biopterin (B) was done in 96 patients with hyperphenylalaninemia by high performance liquid chromatography. Combined BH4 loading test was performed for patients with abnormal urinary pterin profiles. Results Eleven patients were diagnosed as ha ving BH4 deficiency caused by 6 pyruvoyl tetrahydrobiopterin synthase deficiency. They had a much high N/B ratio(N/B:197?250) and a very low B percentage (1.0?0.8)%. Blood phenylalanine levels were decreased from (720 1 200) ?mol/L to (120 240) ?mol/L after taking BH4 tablets in 4 of 11 patients. Conclusion The incidence of BH4 deficiency among hyperphenylalaninemia is about 12%. Analysis of urinary pterin is feasible and effective in screening of BH4 deficiency.

Objective To study the relationship of Dll-1/Notch signal transduction pathway with the pathological characteristics of colorectal cancer and the effect on proliferation and apoptosis of colorectal cancer cells. Methods We assessed Notchl and Dll-1 protein levels in 63 cases of colorectal cancer and adjacent normal tissue by Western blotting.SW480 cells were treated with DAPT (γ-secretase inhibitor) at different treating times.MTT assay and flow cytometry were used to measure the proliferation and apoptosis of SW480 cells,seperately.The expression of the intracellular domain of Notch (NICD),Hes-1 and Bcl-2 were measured by Western blotting.Statistical methods were used including independent samples t test,paired sample t test and single factor analysis of variance. Results Notch1 and Dll-1 protein level increased in colorectal cancer tissues compared with adjacent normal mucosa,the mean values were 1.75-fold and 2.21-fold,respectively(t =2.554,P =0.012 and t =3.565,P =0.005).Also we found that the overexpression of Notch1 and Dl1-1 was related to the differentiation( t =2.463,P =0.017 and t =2.390,P=0.019),staging(t =2.675,P =0.007 and t =2.310,P =0.021) and lymph nodes metastasis(t =2.229,P =0.021 and t =2.210,P =0.023) of colorectal cancer.Treating SW480 cell with Notch pathway inhibitor (γ-secretase inhibitor,DAPT) resulted in growth inhibition,apoptosis induction and there was downregulation of NICD and Bcl-2 expression along with the treating time. Conclusions Overexpression of Notch1 and Dll-1 is related to the pathological characteristics of colorectal cancer.Blockade of Notch1 signal pathway may inhibit cell proliferation and induce cell apoptosis of colorectal cancer,as well as inhibit the expression of Bcl-2.

Objective To evaluate the digital tomosynthesis in the diagnosis of occult bone fracture. Methods Both DR and DTS were performed in 135 cases with traumatic-induced pain. All the cases were suspected of bone fractures but with no abnormal findings in DR images. Two radiologists reviewed all the images and diagnosed in consensus. All cases were followed up and the imaging diagnoses were reviewed. Results Bone fractures or joint dislocations of 61 cases were shown in DTS images but not in DR images, including atlanto-axial fracture and subluxation in 7 cases, articular fracture of limbs in 20 cases, bone fractures of wrist, hand and foot in 11 cases, fractures of cervical, thoracic and lumbar vertebra in 7 cases, fracture of sacrococcyx in 8 cases, fracture of nasal bone in 4 cases, fractures of Sternum ,rib ,orbit and mandible in 1 case. Thirty-four cases with bone fractures were determined by using DTS in suspected cases and 17 cases were denied. Both DR and DTS images showed normal findings in 23 cases. Imaging diagnoses of all cases were consistent with the results of follow up. Conclusion DTS can depict bone fractures especially in the deep and complex bony structures, which may improve the diagnostic accuracy of bone fracture.

BACKGROUND:LARS artificial ligament was designed by Laboureau from France using polyethylene terephthalates with the anatomic structure of human ligament and mechanical principle of weight.This ligament is not only accorded with physiological structure of normal anterior cruciate ligament,but also significantly elevates anti-torque,can resist repetitive twist,bend and excessive traction.OBJECTIVE:To summarize characteristics of clinical application of LARS artificial ligament in transplant reconstruction following acute anterior cruciate ligament of knee joint injury.METHODS:A total of 23 patients with acute anterior cruciate ligament injury,comprising 17 males and 6 females,aged 21-54 years,were selected.Time-from injury to surgery was 3 days to 3 weeks.Polyethylene terephthalatas LARS artificial ligament made in France was used to reconstruct damaged ligament.The transplant was evaluated before and after implantation according to Lysholm knee joint criteria.RESULTS AND CONCLUSION:Following 11.2 months (10-14 months) of follow-up,unstable symptoms of affected knees of all 23 cases disappeared.Anterior and posterior drawer tests were negative,with good joint function.Average extension and flexion degree was 0°-120°.In accordance with Lysholm knee joint score,significant difference was found from (40.34±4.00) points preoperatively to (90.21±4.00) points postoperatively (P<0.01).They could do common athletic activities at about 2 months following surgery.In some cases,magnetic resonance examination demonstrated that residue ligament gradually grew into artificial ligament,which gradually became thicker.Above-mentioned results have verified that under an arthroscope,reconstruction of anterior cruciate ligament using polyethylene terephthalates LARS artificial ligament showed simple operation and small wound,which may lead to immediate stability,early rehabilitation exercises.Simultaneously,interlacing of residue ligament and artificial ligament keeps the nerve conduction pathway of propdoceptive sense,which prevents joint function limitation greatly.Moreover,short-term outcomes are satisfactory.

Objective To investigate the effect of intrathecal morphine preconditioning on the expression of nerve growth factor (NGF) in the dorsal root ganglia (DRG) in a rat model of myocardial ischemia-reperfusion (I/R).Methods Thirty healthy adult male Sprague-Dawley rats in which intrathecal catheters were successfully placed without complications,weighing 250-350 g,were randomly divided into 5 groups (n =6 each) using a random number table:sham operation group (S group),I/R group,intrathecal morphine preconditioning group (ITMP group),μ receptor antagonist CTOP + intrathecal morphine preconditioning group (CTOP + ITMP group),and CTOP control group (CTOP group).Myocardial ischemia was induced by 30 min of occlusion of the anterior descending branch of the left coronary artery followed by 120 min of reperfusion in all the groups except S group.Intrathecal morphine preconditioning was produced by 3 cycles of 5 min intrathecal injection of morphine 3 μg/kg (10 μl) at 5 min intervals within 30 min before ischemia in ITMP group.In CTOP+ITMP and CTOP groups,1 μg/μ1 CTOP 10 μl was injected intrathecally at 10 min before morphine preconditioning and 40 min before ischemia,respectively.At 120 min of reperfusion,the rats were sacrificed,and myocardial specimens were obtained for determination of myocardial infarct size,and DRGs were removed for determination of the expression of NGF by using immunohistochemistry and Western blot.Results Compared with S group,the myocardial infarct size was significantly increased,and the expression of NGF in DRGs was significantly up-regulated in I/R group (P＜0.05).Compared with I/R group,the myocardial infarct size was significantly decreased,and the expression of NGF in DRGs was significantly down-regulated in ITMP group (P＜ 0.05),and no significant change was found in the parameters mentioned above in CTOP group (P＞0.05).Compared with ITMP group,the myocardial infarct size was significantly increased,and the expression of NGF in DRGs was significantly up-regulated in CTOP+ITMP and CTOP groups (P＜0.05).Conclusion The mechanism by which intrathecal morphine preconditioning reduces myocardial I/R injury is related to activation of spinal μ receptors,inhibition of NGF expression in DRGs,and reduction of responses to noxious stimulation in the rats.

Aim To investigate the role of NO/cGMP in the cardioprotective effects of intrathecal morphine preconditioning against myocardial ischemia-reperfu-sion injury in rats. Method 54 Male Sprague-Dawley Rats were used to establish the model of intrathecal catheter placement. The rats were randomly assigned to
9 groups. SHAM (sham group), CON (control, sa-line) , ITMP ( intrathecal morphine preconditioning, 3μg·kg-1 ) , L-NAME+ITMP ( NO synthetase inhibi-tor,L-NAME ) , ODQ + ITMP ( guanylate cyclase in-hibitor, ODQ ) , KT5823 + ITMP ( PKG inhibitor, KT5823),L-NAME,ODQ,KT5823,6ratsineach
group. ITMP were produced by three cycles of 5 min intrathecal injection of morphine and 5 min intermis-sion before myocardial ischemia, CON were achieved by intrathecal injection of saline in the same way, L-NAME+ITMP, ODQ +ITMP, KT5823 +ITMP were prepared by intrathecally administering L-NAME ( 30 nmol), ODQ(11 nmol) and KT5823(20 pmol) 10 minutes prior to ITMP respectively, L-NAME, ODQ, KT5823 worked as the control of inhibitors themselves respectively without ITMP. Subsequently, all rats were subjected to 30 min of left coronary artery occlusion followed by 2 h of reperfusion except the SHAM group. Myocardial infarct size, as a percentage of the AAR,
was determined by 2 , 3 , 5-triphenyltetrazolium stai-ning. Results Compared with CON, the volumes of IS and IS/AAR were reduced in ITMP ( P <0.01 );the protective effects of ITMP were abolished by pre-treatment with L-NAME, ODQ and KT5823 ( P <0.01 );Conclusions NO/cGMP might be involved in the cardioprotective effect of intrathecal morphine pre-conditioning against myocardial ischemia and reperfu-sion injury in rats.

OBJECTIVE To explore occurrence, distribution,and resistance profile of ?-lactamases in clinical isolates of Enterobacter cloacae for rational use of antibiotics in clinic. METHODS Susceptibility test to 13 antibiotics was also performed through disk diffusion test.ESBLs were conformed according to NCCLS.DIDST test was adopted to detect AmpC ?-lactamases in E.cloacae isolates. RESULTS Among 78 isolates collected,13(14.9%) produced AmpC ?-lactamases,24(27.6%) produced ESBLs,10(11.5%) produced both ?-lactamases.These produced(?-lactamases) strains resisted to almost all ?-lactams,except for imipenem.The ?-lactamases producers possessed seriously multi-and cross-drug resistance. CONCLUSIONS ESBLs and AmpC ?-lactams are the main mechanism of E.cloacae resistance to antibiotic.