Female ; Humans ; Hyperthyroidism ; drug therapy ; etiology ; Infant, Newborn ; Male

Objective To explore the effect of comprehensively-designed experiment teaching methodology in the teaching of geriatric nursing. Methods Sixty-three nursing students in the grade of 2010 were assigned into the experiment group, where the comprehensively-designed experiment teaching methodology were adopted. And the fifty-eight nursing students in the grade of 2009 were assigned as the control group, where the traditional experiment teaching methods were adopted. The two groups were compared in terms of theory test scores and evaluations to the two teaching methods. Result The theory examination score and students'evaluation in the experiment were higher than those of the control group (P<0.05). Conclusion Comprehensively-designed experiment teaching method used in the teaching of geriatric nursing is beneficial for the students to improve their interest in learning, cultivate their comprehensive quality, shorten the gap between the experimental teaching and clinical practice and improve the teaching effect of geriatric nursing.

Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.

Objective To study the feasibility and curative effect of transumbilical single-incision (TSIL) vs multiple-incision (MIL) laparoscopic splenectomy.Methods Ten cases (2 cases of idiopathic thrombocytopenia purpura,1 case of hereditary spherocytosis,3 cases of splenic hemangioma and 4 cases of cirrhotic splenomegaly) underwent TSIL from Jan 2010 to Ju12011,and 12 cases (3 cases of ITP,2 cases of hereditary spherocytosis,3 cases of splenic hemangioma and 4 cases of splenomegaly) underwent MIL.Clinical data were compared with each other.Results No severe complications occurred in either group.The mean operation time of single-incision group and multiple-incision group was ( 182 ± 23 ) min and ( 169 ± 19) min,and blood loss was( 160 ± 13 ) ml and ( 155 ± 16) ml ( P ＞ 0.05 ).The post-operative pain score in TSIL and in MIL group was respectively [ ( 1.60 ± 0.20) vs (3.60 ± 0.90) on day 1,P ＜ 0.05 ; (0.50 ±0.10) vs (2.00 ±0.45) on day 2,P ＜0.05].There was no significant difference between the two groups in the recovery of the gastrointestinal function,the length of hospital stay and the cost of hospitalization, all P ＞ 0.05.The umbilical incision in TSIL cases is more cosmetic.Conclusions Transumbilical single-incision laparoscopic splenectomy is feasible and safe in experienced hands.

Objective To investigate the mutations of CLCNKB gene in a family with classic Bartter syndrome. Methods Genetic DNA was extracted from peripheral blood leucocytes of family members.The coding exons and intron exon junctions of CLCNKB gene were amplyfied by PCR and sequenced directly.Fifty unrelated healthy subjects were selected to exclude the possibility of polymorphism. Results A heterozygous(missense)mutation(482T>G,L161R)was detected in the exon 4 of patients.The hetemzygous mutation(L161R)was found in the mother,while no mutation was found in the father of this family.L161R had not been reported and was a novel mutation when referring to literatures and human genomic database home and abroad.Conclusion A new CLCNKB gene mutation(L161R)is identified for the first time.

Objective To analyse the flow characteristics in the true lumen and false lumen,and the relationship between the flow characteristics and the collapse degree of the true lumen using MRI.Methods Eleven patients with acute Stanford type B aortic dissection were examined by true FISP、3D CE MRA、PC cine MRI on a Siemens Sonata 1.5 T.Not only the quantitative data on the hemodynamics such as peak velocity,average velocity,average flow volume,forward volume,retrograde volume and net volume,and the area of the true lumen and false lumen can be acquired,but also the blood flow model,ie the velocity-mapping.Then we analysed the relationship between the flow characteristics and the collapse degree of the true lumen.Results The average area of the false lumen in the proximal descending aorta(about 2 cm distal to the entry)was(8.10±2.93)cm2,and(2.59±0.93)cm2 of the true lumen in the same slice (P＜0.05).The average velocity in the false lumen,(2.81±0.73)cm/s,was significantly lower than in the true lumen[(15.52±2.84)cm/s,P＜0.01],wheras the average flow(36.32±5.37)ml/s,was not significantly difierent(P＞0.05)from the average flow in the false lumen(37.62±24.58)ml/s.The velocity-mapping curve looked like same in the true and false lumen in this level.And in the abdominal aorta(about the level of the hepatic hilar),the average flow(10.46±5.57)cm/s was significantly lower(P＜0.05)than in true lumen[(4.04±2.96)cm/s].At this level,the direction of blood flow in the true lumen was retrograde(upward)in the mid and late systolic phase in six patients,and normal in the diastolic phase and early systolic phase,that was to say,bidirectional blood flow can be caught in the true lumen of the abdominal aorta.The collapse degree of the true lumen was closely correlated with the the average velocity and the flow volume in the false Iumen,and the coefficient correlation and P value were 0.931 and 0.000,0.926 and 0.000 respectively.Conclusions PC cine MRI can quantitatively measure the peak velocity,average velocity,average flow volume,forward volume,retrograde volume and net volume,and combined with 3D CE MRA can evaluate the collapse degree of the true lumen.It is important for clinical application in the diagnosis,therapeutic management and the therapeutic opportunity choice of the acute Stanford type B aortic dissection.

Secondary glaucoma is a kind of complications after vitrectomy, its etiologies are various and complex. Ineffective therapies might cause irreversible damage on optic nerves and visual field defect, even the loss in visual function. Nowadays, this project has been paid great attention by various researches both in China and abroad. Both the pathogens and therapies of secondary glaucoma after vitrectomy are analyzed as follows.

Patients in intensive care unit were more critically ill, and often accompanied by dottiness and restless. In order to avoid the adverse events and self-injury, body constraints were often used on the patients. Therefore, this paper would discuss the ethics of body constraints and give the suggestions. According to the literature review and the analysis of the clinical nursing experience of relevant ethical principles, data was collected. The principle of informed consent, respect, and harmless was hard to decide on the issue of body constraints for patients in ICU. Nurses might pay attention to the application of ethical principles, and strengthen the humanistic care. On the issue of body constraints for ICU patients, nurses might pay special attention to the application of possible ethics principles in nursing process and reduce the application of the body constraints, and promote the physical and mental comfort of patients. It reflected the progress of the humanistic solicitude in the current clinical nursing and important value.

Objective:To investigate the pathogenic bacteria distribution and risk factors of pulmonary infection after tracheotomy in patients with stroke coma,and to put forward preventive measures.Methods:96 patients with stroke coma from January 2016 to February 2017 in our hospital were retrospectively analyzed.The incidence of pulmonary infection and distribution of pathogenic bacteria of patients with stroke coma were analyzed.At the same time,the risk factors of pulmonary infection were analyzed by single factor and multiple factors logistic regression analysis,and corresponding preventive measures were put forward.Results:The incidence of pulmonary infection after tracheotomy in 96 patients with stroke coma was 48.96％ (47/96).A total of 104 pathogens were isolated and cultured,including gram negative bacteria 69 strains (66.35％),gram positive bacteria 20 strains (19.23％) and fungus 15 strains (14.42％).Single factor regression analysis results showed that pulmonary infection after tracheotomy in patients with stroke coma was closely related with age,basic diseases,time of tracheotomy,and bed time,use of broad-spectrum antibiotics,smoking history,artificial airway,times of sputum suction and inhalation(P＜0.05),and it was not related to the patient's gender,weight,stroke type (P＞0.05).Multivariate logistic regression analysis showed that age 45 years old,complicated with basic disease,time oftracheotomy 5 d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway were risk factors of pulmonary infection after tmcheotomy in patients with stroke coma (P＜0.05).ROC analysis results showed that the critical point (threshold C) oftmcheotomy time was 4.3 days,and the sensitivity and specificity were 0.851 and 0.918 respectively.Conclusion:The main pathogenic bacteria of pulmonary infection after tracheotomy in patients with stroke coma is gram-negative bacteria,age 45 years old,complicated with basic disease,time of tmcheotomy 5d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway can lead to pulmonary infection after tracheotomy in patients with stroke coma,and the risk of pulmonary infection in patients with stroke coma will increase considerably after the time of tracheotomy for more than 4.3 days.Targeted measures should be taken to reduce the risk of pulmonary infection according to pathogenic features and risk factors.

Objective To investigate the effects of the silence of teratocarcinoma-derived growth factor-1 ( TDGF-1 ) gene on invasion of human pancreatic cancer cell. Methods Three small interfering RNA (siRNA) targeting for TDGF-1 genes (S1, S2, S3 ) were designed and established, then the gene with the best silencing effects was screened. Human pancreatic cancer cell line PANC1 were transfected by siRNA with different concentrations (3. 125, 6.25, 12.5 nmoL/L), the cells without transfection, and simply treated with liposomes were controls. The expressions of mRNA and protein of TDGF-1 were determined by real time PCR and Western blot assay, respectively. The anchorage-independent growth was examined by clon formation in soft agar, and invasion ability was evaluated by boyden chamber model. PANC1 cells with transfection for 48h were injected into the nude mice to evaluate the invasion ability in vivo. Results The expressions of TDGF-1 mRNA and protein of cells transfected by siRNA were decreased in a dose-and time-dependent manner, which were significantly lower than those in liposomes group. Number of colony formation and transmembrane cell were 19.8 ± 2.2 and 49.8 + 2.6 in the control group, and 5.6 + 1.2 and 8. 1 + 1.1 in the 12.5 nmol/L transfection group. The volumes of tumor 4 weeks after transplation in the control group, liposomes group and the 12.5 nmol/L transfection group were (2.228 ± 0.016 ) cm3, ( 2.186 ± 0.028 )cm3 and ( 0.728 ± 0.023 )cm3. Conclusions TDGF-1 gene silence could inhibit invasion ability of human pancreatic cancer cell PANC1.