Etiquette education is an essential part of modern nursing quality education.In order to improve the general quality of the nursing students by etiquette education,the nursing teachers can infiltrate the essence of etiquette education into education reform,by theory teaching,demonstration, portrayal training,scenario training,and so on.

Objective To summarize the MRI findings of spinal paraganglioma,in order to improve the diagnostic accuracy of imaging. Methods The MRI findings of 6 patients with spinal paraganglioma were retrospectively reviewed.All cases were proved by pathology.Results All 6 cases of spinal paraganglioma were located in lumbar spinal canal.There were serpentine vessels shade observed above the tumor in 5 cases.Two cases with smaller size of lesions exhibited as homogeneous signal intensity with homogenous enhancement. The other 4 cases with larger size of tumors exhibited as heterogeneous signal intensity because of intratumoral cystic change,hem-orrhage and hemosiderin deposit at the margin of the tumor.Conclusion Serpentine vessels above the tumor can be seen in spinal paragangliomas.Intratumoral cystic change and hemorrhage,hemosiderin deposit at the margin of the tumor are the MRI character-istics of spinal paraganglioma.

Objective To discuss the clinical effect of weight loss training and oral intake of mefformin on obese women with polycystic ovary syndrome.Methods 60 cases of obese women with polycystic ovary syndrome in Nan'an District Maternal and Child Health Hospital were studied.They were divided into 2 groups,30 cases in each group.The control group received simple weight loss training and the observation group received weight loss training combined with the oral administration of metformin.The clinical data of the 60 cases were retrospectively analyzed and the clinical efficacy and safety of different treatment methods were evaluated.Results After treatment,two groups of patients have been effectively improved.16 cases(53.3％)in the control group and 29 cases(96.7％)in the observation group resumed normal menstruation,and the differences had statistical significance.Fasting blood sugar(FBS),BMI,testosterone and luteinizing hormone levels of the two groups had significant improvement after treatment,in addition,the improvement of these indicator were more obvious in the observation group than those in the control group,and the difference had statistical significance.The difference of FBS,BMI,testosterone and luteinizing hormone levels had statistical significance between before and after treatment(P =0.003 7,0.001 2,0.002 0 and 0.002 4,respectively).Conclusion The combination therapy of weight loss training and oral intake of metformin is effective in treating obese women with polycystic ovary syndrome.It is the main method in treating obese women with polycystic ovary syndrome.

BACKGROUND: Some studies have demonstrated that the degradation of extracellular matrix (ECM), which matrix metalloproteinases (MMPs) participates in, plays a key step in the corneal neovascularization (CNV). Tissue factor pathway inhibitor 2 (TFPI-2), a new type serine proteinase inhibitor found recently, can effectively inhibit the activity of MMPs. Whether TFPI-2 gene transfection can influence CNV is unclear.OBJECTIVE: To investigate the effect of TFPI-2 gene transfection on CNV.DESIGN: Randomized controlled experiment.SETTING: Laboratory for Department of Surgery, Wuhan Union Hospital; Central Laboratory, the Affiliated Third Hospital of Sun Yat-sen University.MATERIALS: This study was carried out in the laboratory for Department of Surgery of Wuhan Union Hospital and State Central Laboratory of the Third Hospital Affiliated to Sun Yat-sen University between June 2004 and March 2006. Sixty healthy purebred adult New Zealand rabbits of either gender, weighing 2.5 to 3.0 kg, were involved. Preoperatively, no obvious anterior segment ocular lesion was found by slit-lamp examination. pBos-Cite-neo/TFPl-2 was kindly gifted by Dr. Zhong Ren (Department of Hematology, Union Hospital). Peroxydase blocking agent, nonimmune goat serum,mouse anti-human MMP-1, 2 and 3 monoclonal antibodies, biotin labeled goat-anti-mouse IgG second antibody (Santa cruz Company) were used in this study.METHODS: Experimental intervention: Experimental rabbit models of CNV were created in each group by silver nitrate cautery. Then, the rabbit models were randomized into 3 groups and 20 rabbits for each group. Different reagents were subconjunctivally injected via many points in each group: saline in the group Ⅰ, empty vector in the group Ⅱ, plasmid encoding TFPI-2 in the group Ⅲ. Experimental evaluation: CNV growth was observed under the slit-lamp biomicroscope.The expression of TFPI-2 in each rabbit model was detected by reverse transcription-polymerase chain reaction (RT-PCR) method 2 weeks after modeling; the expression of MMPs in corneal tissue was detected by immunohistochemical method at 3,5,7,9 and 14 days after modeling.TFPI-2 gene expression was significantly higher in the group Ⅲ than in the group Ⅱ and group Ⅰ (P ＜ 0.01); The MMP-1, 2, 3 expressions in the corneal tissue were significantly lower in the group Ⅲ than in the group Ⅱ and group Ⅰ,respectively, especially MMP-1, 3.

Hypopharyngeal cancer is not common and its prognosis is among the worst in head and neck cancer.Radiation therapy is an important choice of treatment,including radiotherapy alone,radiotherapy combined with surgery and radiotherapy combined with chemotherapy.The improvement of radiation therapy improves the prognosis of hypopharyngeal cancer patients,and radiotherapy combined with surgery is the standard treatment for hypopharyngeal cancer.Nowadays,in order to enhance the preserving rates of the organ and faction,radiotherapy combined with chemotherapy is becoming a research hotspot.

Objective To explore the role of hemoglobin (Hb) level in mortality and morbidity of chronic kidney disease (CKD)patients,aiming to give some evidence for therapy of anemia.Methods Randomized,clinical trials (RCTs) were identified by searching Medline,Embase and the Cochrane library.All the analyses were performed using the Revman software available free from the Cochrane collaboration.Results Twenty-three trials involving 10 204 patients were identified.Overall,the high Hb target was associated with increased risk of all-cause mortality (RR=1.10,95％ CI 1.00 to 1.21),hypertension (RR=1.40,95％ CI 1.12 to 1.75),stroke and hospitalization (RR=1.07,95％ CI 1.00 to 1.14) compared with low Hb target (P＜0.05).No significant difference was found in the risks of non-fatal mycardial infarction (RR=1.13,95％ CI 0.79 to 1.62) and renal replacement therapy (RR =1.00,95％ CI 0.85 to 1.18).Conclusions Targeting low Hb target is beneficial to CKD patients based on reduced risk of hypertension,hospitalization,stroke and all-cause mortality.However,no significant difference is found in non-fatal mycardial infarction and renal replacement therapy.

Apoptosis is a cell suicide process with a major role in development and homeostasis in bodies. Dysregulation of apoptosis, involved with inhibitors of apoptosis (IAPs), contributes a variety of disease states including cancer. The recent progress of members of IAPs family and the anticancer strategy against IAPs is reviewed in this paper.

Objective To investigate the effect of sevoflurane preconditioning on the expression of Toll-like receptor 4(TLR4) during myocardial ischemia reperfusion(IR) in rats.Methods Thirty male SD rats weighing 250-300 g were randomly divided into 3 groups (n=10 each):sham operation group (S group) , IR group and sevoflurane preconditioning group(SP group).Myocardial ischemia was produced by temporary ligation of anterior descending branch of left coronary artery for 30 min followed by 2 h reperfusion. In SP group, the animals inhaled 2.5% sevoflurane for 30 min followed by 15 min washout before ischemia. The rats were sacrificed at 2 h of reperfusion, hearts removed and myocardial tissues obtained for microscopic examination.The expression of TLR4, NF-κB and TNF-α was detected using Western blot. Results The expression of TLR4, NF-κB and TNF-α was significantly up-regulated in IR and SP groups compared with group S (P＜0.05).The expression of TLR4, NF-κB and TNF-α was significantly down-regulated in group SP compared with group IR (P＜0.05).The myocardial injury was attenuated in group SP.Conclusion Sevoflurane preconditioning can attenuate myocardial IR injury by inhibiting the up-regulation of TLR4 expression and reducing the inflammatory response.

Objective: To compare the clinical efficacy of open surgery, peritoneal laparoscopic excision and retroperitoneal laparoscopic excision for adrenal pheochromocytoma. Methods. We retrospectively ana-lyzed the clinical data of 54 patients with adrenal pheochro-mocytoma (27 males and 27 females). Patients' age ranged from 19 to 71. The diameter of tumors ranged from 1.5 to 7.0 cm. Fifty patients had symptoms of hypertension and their course of disease ranged from 2 months to 15 years. None of the patients had inva-sion and metastasis in surrounding organs. According to modus operandi, the patients were divided into 3 groups. The 20 patients in group A underwent open surgery, the 16 patients in group B underwent peritoneal laparoscopic excision, and the 18 patients in group C underwent retroperitoneal laparoscopic excision. The surgical duration, volume of blood loss, severe blood pressure fluctuation, recovery time of intestinal function,postoperative hospital stay, and decrease of blood pressure were compared among the three groups. The re-sults were statistically analyzed. Results: All surgeries were successful, with no complications. All specimens were proved pheochromocytoma. The mean surgical duration was 120.60±18.18 min in group A, 105.13±17.46 min in group B, and 102.22±16.01 min in group C. The volume of blood loss was 146.50±36.20 mL in group A, 116.56±37.32mL in group B, and 120.28±33.80mL in group C. Twelve cases in group A, 5 cases in group B and 5 cases in group C had blood pressure fluctuation. The recovery time of intestinal function was 2.40±0.79 d in group A, 1.75±0.45 d in group B, and 1.58±0.49 d in group C. The postoperative hospital stay was 11.15±1.87 d in group A, 5.94±0.85 d in group B, and 5.94±0.80 d in group C. There was statistical signifi-cance between group A VS group B and group C (P<0.05). There was no statistical significance between group B and group C. There were 18, 15 and 17 cases in group A, B and C who had postoperative decrease of blood pressure, with no statistical difference among the three groups (P>0.05). All cases were followed up for 9 months to 6 years, with no recurrence. Conclusion: Peritoneal laparoscopic excision and retroperitoneal laparoscopic excision can be considered as the preferred choice for adrenal pheochromocytoma, with mini-mal invasion, fast recovery, and satisfactory safety.

Objective:To investigate the current situation of surrogate in China,analyze the reasons,and then provide effective suggestions and countermeasures.Methods:A questionnaire survey was conducted among medical staff and patients in an institution with assisted reproductive technology (ART),combining literature review and sociological research methods such as data maps,to explore and analyze the surrogacy.Results:The number of institutions with ART increased rapidly and its regulation became difficult.More surrogate network was observed in first-tier cities as well as the eastern and southeastern coastal provinces.That respondents agreeing with surrogacy was quite serious in some provinces.The reasons of surrogate were patients' needs,social concepts,weak government supervision,and so on.Conclusions:It should improve the laws of ART,explore long-term supervision mechanism,strengthen the management of internet,shield the information about surrogate,enhance medical ethics education for ART staff,and guide the infertility patients to establish the correct ethical concepts.