Objective To describe the structure and the level of the stress of nursing students in clinic practice,and supply reference for reform of clinical teaching method.Methods Totally 100 undergraduate nursing students in clinic practice,who would graduate from nursing school and begin to work in 2013,were interviewed and investigated.Results The main stress sources were divided into five aspects:recognition,clinical nursing ability,career development,field response and exhaustion of body and mind.Conclusions The structure and level of the stress of nursing students changed a lot.Some new appropriate reform should be introduced into clinic education,in order to help nursing students to complete psychological change and role adaptation.

Objective To study 3D construction and printing of bone tissue engineering scaffolds by bone defect modeling on Mimics software based on CT data. Methods CT data of jaw bone defect from patients were acquired and the images were segmented using threshold segmentation combined with region growing . The three dimensional model was reconstructed by Boolean operation. The individual 3D digital model was reconstructed with internal structure by combining with computer; preparing poly-lactic acid scaffold in virtue of 3D technology. Results Using the Mimics software, we successfully constructed a 3D digital reconstruction model of bone defect based on CT data. The constructed scaffold model with certain internal form and structure was matched with the bone defect of patients, and the constructed model was exported onto STL standard format, which may be in common use. Conclusion The 3D digital model of bone defect scaffolds may effectively be reconstructed based on the CT data using Mimics software and computer aided design.

Objective To observe the effects of porous polylactic acid/polyglycolic acid copolymer(PLGA) filling into extraction socket on the regeneration of alveolar bone in rats.Methods Sixty male Wistar rats were divided into experimental group and control group(n=30).PLGA scaffold was immediately implanted in the mandibular incisor root sockets after removal of incisor teeth.Soft X-ray photography,structural observation,light microscopy were used to evaluate the effects of composite on bone healing in a rat tooth extraction socket.Results The relative lengths of residual alveolar ridge in the experimental group 4,8 weeks after operation were shorter than that in the control group,and there were significant differences between the experimental group and the control group(P

Objective To explore the feasibility of laparoscopic common bile duct exploration without T-tube drainage.Methods A to-tal of 37 patients who were addmitted into our hospital from May 2014 to August 2015 with common bile duct stones were analyzed.Among these patients,22 cases were given T-tube drainage while the other 15 cases were not.The operation time,hospitalization expenses,anal ex-haust time,postoperative hospitalization time,bile leakage rate and the satisfaction of patients after surgery in the two groups were observed. Results In the non-T-tube group,the anal exhaust time was (1.41 ±0.82)d and the hospitalization time was(4.82 ±1.61)d,which were lower than(3.81 ±1.09 )d and (11.17 ±1.19 )d respectively in the T-tube group,and the differences were statistically significant (P <0.05).The number of bile leakage (0%)in the non-T-tube group was also significantly lower than 31.82% in the T-tube group (P <0.05).The satisfaction rate of patients in the non-T-tube group(100%)was significantly higher than that in T-tube group (50%),and the difference was statistically significant(P <0.05).Conclusion The laparoscopic common bile duct exploration without T-tube drainage is feasible and it can be popularized in clinic.

Objective To explore the effects of different processing parameters of mobile digital radiography (DR) on image quality of bedside chest radiography.Methods Post processing parameter on 150 cases bedside DR chest image like multi frequency laplasse transform (MLT),image processing (IP) were modified,and the optimization scheme of post-processing parameters were analyzed and summarized.The paired sample t test was used to compare the difference of the imaging quality score and optical density between the default parameter group and the post processing parameter optimization group through measure the optical density of lung related area.Results Brightness,contrast and the low density in dynamic range were the main factors affecting the quality of bedside chest radiography.After modifying and optimizing the post-processing parameters,the density value of the second intercostal area was 1.68±0.04,the density value of the hilum was 0.77±0.46,the density value of pulmonary peripheral (near chest wall 1 cm and overlap with a single rib) was 0.62± 0.06,the density value of cardiac shadow was 0.44 ± 0.04,the density value of subphrenic was 0.37 ± 0.04,the lung markings was clearly showed in the lateral field of lung and was visible in the spine and heart shadow area which meet the diagnostic requirement.The density value of those parts before modify were lower than the modify value which was more closer to the reference density value,and the difference had statistically significant.The image quality score of the postprocessing parameter optimization group was 3.53 ± 0.14,which was higher than 3.02 ± 0.23 of the default parameter group,and the difference had statistically significant.Conclusion The appropriate post-processing parameters is the key to guarantee the reasonable density of lung areas image quality and the optimization post-processing parameter can improve the image quality of bedside chest radiography by the mobile DR.

Objective: To analyze the epidemiological characteristics of notifiable infectious diseases reported in Zhejiang Province in 2020 for prevention and control. Methods: Data of notifiable infectious diseases reported in Zhejiang Province in 2020 were extracted from China Information System for Disease Control and Prevention. The incidence and death of notifiable infectious diseases were analyzed and compared with the averages from 2015 to 2019; then the characteristics of some key diseases such as coronavirus disease 2019 ( COVID-19 ), influenza and other infectious diarrhea were summarized. Results: Totally 487 271 cases of 30 kinds of infectious diseases were reported. The incidence and mortality rate was 832.94/100 000 and 0.615 4/100 000, which were 7.05% and 14.60% lower than the average value of 2015-2019.The weekly morbidity of Class A and Class B infectious diseases fluctuated between 1.24/100 000 and 3.68/100 000, and hit the bottom in the sixth to eighth week. The morbidity of Class C infectious diseases was 154.19/100 000 in the first week, then dropped to 4.83/100 000 in the second to sixth week and maintained at a low level. High morbidity of infectious diseases were reported in Hangzhou ( 1 412.62/100 000 ), Jinhua ( 960.35/100 000 ) and Ningbo ( 921.25/100 000 ). The morbidity of class C infectious diseases in Hangzhou was 1 248.80/100 000, which was far higher than that of other ten prefecture-level cities. The diseases with high reported morbidity were influenza (438.45/100 000), other infectious diarrhea (140.29/100 000 ), hand-foot-and-mouth disease ( 99.64/100 000 ), pulmonary tuberculosis ( 41.92/100 000 ), syphilis (41.37/100 000) and viral hepatitis ( 30.48/100 000 ). More deaths were reported in AIDS and pulmonary tuberculosis, and the mortality were 0.482 1/100 000 and 0.116 2/100 000. A total of 1 306 confirmed cases, 302 asymptomatic infections and 1 death of COVID-19 were reported. Conclusion In 2020, the incidence rate of notifiable infectious diseases in Zhejiang decreased compared with the average value of 2015-2019. Pulmonary tuberculosis, syphilis and hepatitis B still have high morbidity, and the COVID-19 epidemic spread widely. The morbidity of some respiratory infectious diseases and imported infectious diseases have dropped significantly compared with previous years.

Objective:To study the antidepressant effect of Baihe Zhimu decoction (BZD)and its influence in the key factors (CaM,CaMKⅡ,CREB)of CaM signaling pathway in hippocampus of the rats with depression,and to explore the antidepressant effect of BZD. Methods:Fifty rats were divided into control group,model group, fluoxetine group,low and high doses of BDZ groups (n = 10).Expect for control group,all the rats in other groups were made depression models by means of chronic unpredictable mild stress along with isolated raising,for 21 d.Then the rats were fed with NS, fluoxetine (1.8 mg · kg-1 ), and BZD (1.5 and 3.0 g · kg-1 ), respectively;for 28 d.The learning and memory ability,autonomous activities and the fixed time in 5 min of the rats were tested by Morris water amaze,Open-field Test and Forced Swimming Test respectively. The damage and repair status of hippocampal neurons were observed by Nissl staining method;the expression levels of CaM,CaMKⅡ protein,CREB mRNA in hippocampus of the rats were detected by Western blotting and RT-PCR method. Results:Compared with model group,the total time of rats in the platform quadrant of Morris water maze in BZD groups and fluoxetine group,the total distance and the number of crossing platform were increased (P <0.05 or P <0.01),and the time of first crossing platform were shortened (P <0.01);the total scores in open field test were increased (P <0.01),the fixed time with 5 min in the forced swimming test was shortened (P <0.05 or P <0.01).Compared with fluoxetine group,the fixed time within 5 min of the rats in swimming test was shortened (P <0.05).The result of Nissl staining showed that the hippocampal neuron injury in BZD groups and fluoxetine group was improved compared with model group.The molecular test results showed that the CaM and CaMKⅡprotein expression levels in hippocampus of the rats in BZD groups and fluoxetine group were increased compared with model group (P < 0.05 or P < 0.01).Compared with model group,the CREB mRNA expression levels in fluoxetime group and BZD groups were increased (P < 0.05 or P < 0.01).Conclusion:BZD has antidepressant effect and can improve the hippocampal neuron injury of the rats with depression and its mechanism is related to increasing the expression levels of CaM,CaMKⅡ and CREB in hippocampus CAM signaling pathway of the rats.

Objective To investigate the diagnosis and treatment methods of traumatic renal infarction.Methods A retrospective analysis was performed on 6 cases of traumatic renal infarction treated between September 2008 and February 2013.There were 5 males and 1 female,at age of 5-65 years (average,36.2 years).Causes of injury included vehicle collisions in 4 cases and high falls in 2.Out of 6 cases,segmental renal infarction was identified in 2 and total infarction in 4.According to American Association for the surgery of trauma renal trauma grading system,2 cases were classified to grade Ⅳ and 4 to grade Ⅴ.Results Three cases were managed conservatively,which showed segmental infarction in 1 case and total infarction in 2.Three cases underwent surgical exploration,followed by partial nephrectomy in 1 case,left kidney removal plus partial pancreectomy in 1 and right kidney removal in 1.There were no major complications intraoperatively or postoperatively and no cases received blood transfusion.Period of follow-up was 3-34 months.In conservative management,there were no renal atrophies in segmental renal infarction cases and some degree of atrophies in total renal infarction cases,but none presented with arterial hypertension.Conclusions Enhanced CT is the preferred diagnostic tool for evaluation of traumatic renal infarction.Conservative therapy is the optimal option for most cases,but nephrectomy is reserved for cases of infection or renal hypertension.

Objective To investigate the relationship of BPH in patients with newly diagnosed type 2 diabetes mellitus with age,weight,blood glucose levels.Methods Totally 141 cases with type 2 diabetes and BPH in elderly patients were discussed.Glucose level,the international prostate symptom score (IPSS),prostate volume (PV) and maximum urinary flow rate (Qmax) were determined.Results The levels of IPSS(10.9±2.5 vs.16.4±3.0,P＜0.01; 10.9±2.5 vs.19.4±3.3,P＜0.05) and PV(43.3±7.7 vs.47.9±10.5,43.3±7.7 vs.48.1±8.6,both P＜0.05) were increased in age group of 70-79 years and age group ≥ 80,Qmax in age≥ 80 years was decreased (12.0±2.6 vs.8.5±1.4,P＜0.05) compared with age group of 60-69 years.In contrast to BMI ≤ 24 kg/m2 group,IPSS score,PV and HOMA-IR were increased in BMI ≥ 28 kg/m2 (9.8±3.4 vs.18.8±4.1,P＜0.01; 41.1±10.8 vs.49.1±11.4,1.87±1.1 vs.3.89±2.0,P＜ 0.05).IPSS and PV were higher (12.6±5.7 vs.16.9±4.2,42.9±9.7 vs.48.3±10.6,P＜0.05),Qmax was lower (11.7±1.9 vs.9.0±1.6,P＜0.05) in patients with HbA1c ≥7％ versus HbA1c＜7％.Conclusions Age,obesity,high blood glucose and insulin resistance can promote the progress of BPH in the elderly newly diagnosed type 2 diabetic patients.Therefore,control of weight,and lowering the glycosylated hemoglobin may inhibit the progress of BPH.

Objective Less research has been done in the influence of two-child pohcy on mode of delivery.The article aimed to investigate the rates of cesarean section before and after two-child policy along with indications and complications in order to provide scientific basis and solution for improving the vaginal delivery rate.Methods Retrospective analysis was conducted on medical record data of 7044 puerperas in Nanjing General Hospital of Nanjing Military Region before (3,526 women from January 1,2012 to December 31,2013)and after (3,518 women from January 1,2015 to December 31,2016) two-child policy.Before the two child policy there were 3122 primiparas and 404 multiparas,after two-child policy there were 2546 primiparas and 972 muhiparas.Comparison was done between two groups in the aspect of vaginal delivery rate,cesarean section rate and the distribution of primiparas in choosing the mode of delivery.Results The vaginal birth rate of women before and after the policy was 59.22％ and 63.22％ respectively,among which the rate of vaginal delivery of primiparas increased dramatically from 60.57％ before the policy to 66.10％ after the policy(P＜0.05).After two-child policy,the primiparas cesarean section indication with social factors,macrosomia decreased,which was 12.67％ vs 5.68％、16.65％ vs 11.82％,respectively.However,the rate of cesarean section with in-vitro fertilization increased,which was 5.52％ and 10.10％ respectively (P ＜ 0.05).Conclusion After two-child policy,the puerperant,especially for the primiparas were more likely to choose vaginal spontaneous delivery.At the same time,the proportion of the primiparas caesarean section also changed.The mode of delivery should depend on corresponding indications properly.