To enhance the quality education of nursing students and cultivate high quality nursing staff,who can meet the social requirements,a new mode of integrating humanistic quality education into clinical nursing education is proposed.Approaches to improve humanistic quality of nursing students are initiated from four aspects: determination of teaching goals,establishment of teaching tenet "human as basis",optimization of learning environment and vividness of teaching methods.The main purpose of this paper is to promote research and practice for further innovation in Chinese nursing clinical teaching.

Objective To analyze the prevention and management of in-hospital complications to the surgical treatment of hip fractures in elder patients (≥80 years). Methods An retrospective data of 198 hip fracture patients with surgical treatment between Jan. 1996 and Mar. 2004 was reviewed. Their age ranged from 80 to 98 years with an average of 85.2 years. 93 cases were femoral neck fracture (Garden type Ⅰ 2 cases, type Ⅱ 10 cases, type Ⅲ 52 cases and type Ⅳ 29 cases) while 105 were intertrochanteric fracture ( Evan type Ⅰ 3 cases, typeⅡ 37 cases, type Ⅲ 39 cases and type Ⅳ 26 cases). Local anaesthesia, general anaesthesia and epidural anaesthesia were used in 2, 38 and 158 cases respectively. Femoral neck fractures were treated with bipolar femoral head replacement in 77 patients, total hip replacement in 13 patients, and compressive cannulated screw fixation in 3 patients respectively. Intertrochanteric fractures were treated with close reduction and dynamic hip screw (DHS) internal fixation. Results The average operation duration and blood loss were 53 min and 110 ml respectively in the bipolar femoral head replacement group, 94 min and 165 ml in the total hip replacement group, 35 min and 30 ml in the screw fixation group and 40 min and 60 ml in the DHS group. 17 cases under cemented hip replacement suffered obviously transient arterial blood pressure drop. 36 cases (18.2%) had postoperative complications, among which the mental system and circulation system were more inclined to be involved. The average in-hospital time was 18.6 days and 2 cases died in hospital. The average time from admission to operation (waiting time ) was 6 days. Among 46 cases longer than 7 days, 9 cases (19.6%) had postoperative complications. Among 152 cases no longer than 7 days, 27 cases (17.8%) had postoperative complications. It showed no statistical significant difference between the two groups in complication incidence. Conclusion To gain good results in elderly patients of hip fracture by operation, less invasive and quick anaesthetic technique and operative procedures are encouraged. Meticulous preoperative preparation, active preventing and treating the intraoperative and postoperative complications should be emphasized on.

Objective To observe the clinical efficacy of acupuncture and moxibustion combined with cognitive training in treating cognitive impairment after traumatic brain injury (TBI). MethodsSixty patients were recruited into the study and randomly divided into the control group and the treatment group according to the MINIMIZE software. Patients in the control group were treated with cognitive training and regular treatment. Besides the traditional treatment, patients in the treatment group were additionally treated with acupuncture and moxibution. The treatment lasted four weeks. Mini-Mental State Examination (MMSE) and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were applied to evaluate the patients’ cognitive function before and after the treatment.Results In the end, there were 27 patients in the control group and 28 patients in the treatment group, because 5 patients withdrew from the study. After treatment, scores of MMSE, LOTCA and their sub-items in the control group and the treatment group increased significantly (P<0.05), and the scores in the treatment group were higher than the control group (P<0.05).Conclusion Combination of acupuncture, moxibution, and cognitive training could help patients after TBI to increase the scores of MMSE and LOTCA, and improve the cognitive impairment caused by TBI. Its therapeutic effect is superior than the pure cognitive training.

Objective To investigate the measures to improve the newborn hearing screening quality.Methods835 cases of neonates using distortion product otoacoustic emissions for hearing screening,after first,second and third hearing screening,the final 5 cases failed,diagnosed by ABR screening hearing handicap in 3 cases.Experience constantly was summed up during screening process to improve screening quality.Results835 newborns were screened.The rate of failing to hearing screening was 0.60％,the rate of hearing impairment diagnosed by ABR was 0.36％,and the positive proportion of hearing screening was 0.24％.ConclusionOur experience during screening progress is to take some measures to improve the newborn hearing screening quality,with reducing false positives and avoiding false negatives,by choosing screening time,cleaning external ear and electric-otoscopy examination,environmental noise control,updating test procedures according to the physiology and development of the newborns,testing calibration instruments of otoacoustic emissions hearing screening,selecting suitable earplug,probe with correct plsce,and combining acoustic impedance examination,with a long term follow-up of listening in high risk neonates with passing screening.

10.3969/j.issn.1000-8179.2013.12.003

Objective To investigate the clinical value of combined detection of glycoprotein 125 (CA125) and human epididymis protein 4 (HE4).Methods 46 patients with ovarian malignant tumor (malignant tumor group) and 48 patients with benign ovarian tumors (benign tumor group) treated in our hospital from June 2013 to August 2015 were selected.The serum levels of CA125 and HE4 were detected in all the patients and its diagnostic value was evaluated by ROC curve.The levels of CA125 and HE4 in patients with different pathological types were compared.Results The best diagnostic value of CA125 was 47.9 U/L,The serum level of CA125 ≥47.9 U/L predicted the specificity of ovarian malignant tumor was 87.34% and that the sensitivity was 76.69%.The best diagnostic value of HE4 was 55.68 pmol/L.The serum level of HE4 ≥ 55.68 pmol/L predicted the specificity of ovarian malignant tumor was 90.34% and that the sensitivity was 83.01%.There was significant difference in CA125 and HE4 between the patients with benign and malignant ovarian tumors (P<0.05).No significant difference in the diagnosis of malignant ovarian tumor and the specificity by using combined detection of HE4 and CA125 (P>0.05)However,the sensitivity was significantly higher than that of single detection,the difference was statistically significant (P<0.05).The levels of CA125 and HE4 in patients with epithelial ovarian tumors were higher than those with non epithelial ovarian tumors,and the difference was statistically significant (P<0.05).The levels of CA125 and HE4 in patients with mucinous ovarian cancer were significantly lower than those in patients with serous ovarian cancer (P<0.05).Conclusion The combined detection of serum CA125 and HE4 can significantly improve the value of differential diagnosis of ovarian tumors,and CA125 and HE4 may play an important role in the pathological classification of malignant ovarian tumors.

Objective:To correlate serum levels of neuron specific enolase (NSE) and inflammatory factors with recovery of neurological function in patients with severe traumatic brain injury.Methods:Ninety-six patients with severe traumatic brain injury who received treatment from January 2018 to January 2020 in Taizhou Hospital were included in this study. These patients were divided into a mild-to-moderate group ( n = 51) and a severe group ( n = 45). Additional 60 healthy controls who concurrently received health examination were included in the healthy control group. Serum NSE level was detected by enzyme-linked immunosorbent assay, serum C-reactive protein (CRP) level by immunoturbidimetry, serum procalcitonin (PCT) level by chemiluminescent assay, and serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels by enzyme-linked immunosorbent assay. All patients were followed up for 3 months. Recovery of neurological function was evaluated by modified Rankin Scale. Results:Serum NSE level was (50.42 ± 13.25) μg/L and (36.79 ± 10.28) μg/L in the severe and mild-to-moderate groups, respectively, which was significantly higher than that in the healthy control group [(6.13 ± 1.78) μg/L, t = 25.641, 22.688, both P < 0.05). Serum NSE level in the severe group was significantly higher than that in the mild-to- moderate group ( t = 5.576, P < 0.05). Serum CRP, PCT, IL-6 and TNF-α levels were (78.95 ± 15.46) mg/L, (3.46 ± 0.75) μg/L, (432.15 ± 78.29) μg/L and (36.57 ± 8.98) μg/L] respectively in the severe group, (34.65 ± 7.48) mg/L, (1.68 ± 0.51) μg/L, (285.41 ± 36.75) μg/L and (17.54 ± 5.26) μg/L] respectively in the mild-to-moderate group and (3.25 ± 0.86) mg/L, (0.08 ± 0.02) μg/L, (73.52 ± 13.89) μg/L and (1.64 ± 0.50) μg/L, respectively in the healthy control group. Serum CRP, PCT, IL-6 and TNF-α levels in the severe and mild-to-moderate groups were significantly higher than those in the healthy control group ( t = 37.890, 34.922, 34.870, 30.099, 32.284, 24.315, 40.980, 23.312, all P < 0.05). Serum levels of these indicators in the severe group were significantly higher than those in the mild-to-moderate group ( t = 17.493, 13.414, 11.500, 12.451, all P < 0.05). In the severe group, neurological function recovered well in 34 patients and poorly in 17 patients. Serum NSE level in patients with poor neurological function recovery was significantly higher than that in patients with good recovery [(68.93 ± 14.25) μg/L vs. (34.61 ± 12.36) μg/L, t = 8.457, P < 0.05). Serum CRP [(113.24 ± 27.39) mg/L], PCT [(4.57 ± 0.87) μg/L], IL-6 [(598.90 ± 43.52) μg/L] and TNF-α [(58.78 ± 12.13) μg/L] levels in patients with poor recovery were significantly higher than those in patients with good recovery [(32.19 ± 6.90) mg/L, (2.23 ± 0.65) μg/L, (261.39 ± 26.56) μg/L and (14.53 ± 4.26) μg/L, t = 11.956, 9.788, 29.280 and 14.537, all P < 0.05). Serum NSE, CRP, PCT, IL-6 and TNF-α were positively correlated with poor prognosis ( r = 0.849, 0.743, 0.795, 0.683, 0.701, all P < 0.05). Conclusion:In patients with severe traumatic brain injury, serum NSE, CRP, PCT, IL-6 and TNF-α levels increase, which are positively correlated with poor prognosis.

Objective To evaluate the clinical application of multimodality treatment of brain arteriovenous malformation (BAVM) with Onyx embolization and microsurgery.Methods There were 48 patients with BAVM treated by combination of Onyx embolization and microsurgery.The clinical features,therapeutic process,complications and discharge status (by MRI,DSA and Glasgow outcome scale,GOS) were recorded in detail.The prognosis was estimated by modified Rankin scale (mRS) with 6-42 months' follow-up.Results The total resection rate was 97.9％.The therapy-related complications happened in 8 patients (16.7％).Among them,4 cases had dysfunction of central nervous system (8.3％),2 cases with intra-cerebral hemorrhage (4.2％),and 2 suffered from severe cerebral edema (4.2％).Good recovery was seen in 38 cases (79.2％) evaluated by GOS when discharged from hospital.The follow-up result mRS ＜ 3 was 97.9％.Conclusion Multimodality treatment of BAVM with Onyx embolization and microsurgery should be a good therapeutic strategy.

Background and purpose:Bladder cancer is the most common urological tumor, and its pathogen-esis is still not fully understood. The study was aimed to observe the expressions of key genes in many tumor-associated signaling pathways in normal bladder tissue and bladder carcinoma, and to provide further evidence for the subsequent study of bladder cancer recurrence and metastasis.Methods:Twenty-seven cases of bladder cancer specimens were col-lected, and normal bladder tissues and bladder cancer tissues were distinguished by frozen section. Then, the expressions of 84 genes of cancer-related signaling pathways in bladder cancer tissues and normal bladder tissues were screened by Cancer Pathway Finder PCR Array produced by QIAGEN company.Results:Compared with the normal bladder tissues, the bladder carcinoma tissues had 8 up-regulated genes and 19 down-regulated genes. In this study, the impact of epithe-lial-mesenchymal transition (EMT) signaling pathway was selected as a research direction in which theGSC,KRT14,DSP were up-regulated,SNAI2,SNAI3 were down-regulated. ThereforeGSC,KRT14,DSP,SNAI2 andSNAI3 were chosen as target genes, and verified by qRT-PCR in many examples. The result showed that the expressions ofGSC gene in bladder cancer tissues were up-regulated, but with no statistical significance;KRT14,DSP expressions in bladder cancer were higher than those in normal bladder tissues (P<0.05);SNAI2,SNAI3 expressions in bladder cancer were lower than those in normal bladder tissues (P<0.05), andSNAI3 showed the most obvious expression differences.Conclusion:KRT14,DSP andSNAI3 may play an important role in bladder cancer’s occurrence, development and metastasis.

Objective To investigate the effect of notch signaling pathway on drug resistance and invasiveness of bladder cancer .Methods We observed the changes of growth and morphology of bladder cancer T 24 , 5637 and J82 cells which treated for 48 hours using γ-secretase inhibitor by inverted microscope .The mRNA and protein lev-els of the EMT molecular markers , including E-cadherin , N-cadherin , vimentin and Alpha-smooth muscle actin were examined by RT-PCR and Western blot in bladder cancer cells;Detected the changes of drug resistance and invasion respectively by MTT and Transwell in bladder cancer cells .Results After completely blocking the Notch signaling pathway , the inverted microscope showed that bladder cancer cells became smaller and more disperse ;RT-PCR and Western blot showed the mRNA and protein levels of E-cadherin were up-regulated ( P<0.05 ) , contrast , N-cadherin , vimentin and Alpha-smooth muscle actin were down-regulated ( P<0.05 ); The prolifera-tion of bladder cancer cells were significantly inhibited by MTT test;The number of through microporous membrane cells significantly decreased ( P<0.05 ) shown by Transwell test .Conclusions The Notch signaling pathway is completely blocked that nhibites proliferation and EMT of bladder cancer cells , reduces drug resistance and inva-sion in bladder cancer cells .It suggests that drug resistance and invasiveness of bladder cancer can be changed through EMT which is regulated through notch signaling pathway .