Objective To find out the nurse's cognitive level of the postoperative pain management and its relevant elements,and influence of intervention measures on their postoperative pain management,so that can provide a theoretic basis for a more effective postoperative pain management.Methods The grounded theory research method taken from qualitative research Was mainly used,and triangulation was applied in collecting the information,such as observational method,interviewing method among nurses and collecting questionnaire among nurses and patients.In addition,the information was analyzed by using the constant tomparative method,generalized the relative elements influencing the postoperative pain managemen,summarized the intervention measure.In the end.analyzed comparatively the change of the nurses'knowledge and behavior of the postoperative pain management before and after intervention.Results Surgical nurses'knowledge and behavior of the postoperative pain management was improved in various degrees.The difference of the data has statistical significance.Satisfaction degree of patients improved and the theoretical model included conceptual structure,contributory factors and results.Conclusions The advance of the surgical nurse's self-awareness can improve the level of the postoperative pain management.

AIM: To find a more efficient and accurate method for medical image enhancement to resolve the problem of low local contrast, which often appears in magnetic resonance (MR) images.METHODS: Based on the investigation into the previous methods, a new algorithm was presented. The main features were as follows: Non-dual was used in the morphological operations and addition instead of multiplication was used in the contrast stretching operations. To avoid some gray-level bias, the method of normalized gray-level under condition was proposed.RESULTS: The new algorithm was tested by real MR images and simulated experiments. Compared with the previous method, the new method is more accurate, faster and less sensitive to noise.CONCLUSION: Non-dual morphological operations can achieve local contrast enhancement in a more accurate way, and the gray level bias can be eliminated by normalization.

BACKGROUND: Studies have confirmed that nerve growth factor can promote wound tissue to release al kinds of endogenous growth factors and growth factor receptors, which play a positive regulatory role. The nerve growth factor can promote cel proliferation and accelerate wound healing, thus making the wound healing developed from the passive waiting healing to active control healing. OBJECTIVE: To investigate the effects of local application of nerve growth factor on the expressions of transforming growth factor β1 and basic fibroblast growth factor in rat burn wounds. METHODS: Twenty-four adult Sprague Dawley rats were used in the study, and Ⅱ degree deep burn wound was made on the back of rats. Then, these rats were randomly divided into four groups. After burn wound debridement, the wounds were covered with gauzes containing 1, 2.5 and 5 μg/mL nerve growth factor solution and normal saline respectively. At 3, 5, 9 and 14 days after treatment, the wound healing time and percentage of residual wound were observed. Then, wound tissues were cut for histological examination, in order to detect the expressions of transforming growth factor β1 and basic fibroblast growth factor in wounds, as wel as the cel ular DNA cycle. RESULTS AND CONCLUSION: The wound healing time in the treatment groups was shorter than that in the control group, especial y in 5 ug/mL nerve growth factor treatment group (P < 0.01), and the percentage of residual wound in the treatment groups was less than that in the control group. The histological examination showed the number of nucleated cells in the superficial dermis of the treatment groups was significant increased when compared with that in the control group; the expressions of transforming growth factor β1 and basic fibroblast growth factor in the treatment groups at different time points were stronger than those in the control group, and the expressions at 5 and 9 days were stronger than those at 3 and 14 days; percentage of cells in S phase of the treatment groups was significantly increased, especial y in 5 mg/L nerve growth factor group (P < 0.01). The results indicate that local application of nerve growth factor can accelerate wound healing by increasing the expressions of transforming growth factor β1 and basic fibroblast growth factor, stimulating mitosis and promoting proliferation.

Objective To explore clinical features and therapeutic experience of burns of diabetes patients,for enhancing the curative rate of this diease.Methods The clinical data including the general condition and antishock,blood glucose controlling,surgery,symptomatic and supportive treatments of burns in 46 diabetes patients were analyzed.Results During three to seven days,the fasting plasma glucose of all patients dropped to below 10 mmol/L,and it dropped to below 8 mmol/L in 28 surgical patients.All patients were cured except one died in a bad way occurring multiple organ dysfunction syndrome,and the curative rate reached to 97.8％.Complications occurred in 26 cases and the incidence was 56.5％.Conclusion The burns in diabetes patients are very complicated.It is being effective to combine systemic with local treatments for the condition.

Sal-like 4 (SALL4) plays an important role in promoting the cellular proliferation and maintaining the pluripotency of embryonic stem cells and tumor cells.In fully differentiated cells,the expression of SALL4 is silenced or down-regulated.However,the expression of SALL4 is found to be restored or up-regulated in a variety of non-germ cell tumors.Besides,the expression of SALL4 is often associated with disease progression,treatment effect and prognosis.Therefore,examining the expression level of SALL4 will be of great importance in the diagnosis of disease and monitoring the disease progression for non-germ cell tumors.

Objective To report clinical and laboratory features of a rare case who was primary myelofibrosis (PMF) with positive JAK2 V617F terminating in T-acute lymphoblastic leukemia (T-ALL).Methods A rare case of PMF terminating in ALL was found, the quantity and quality of JAK2 gene mutation were defined by PCR methods, collected the clinical dates. Results The JAK2 V617F gene mutations were all positive pre and post-blast, the mutant rates respectively were 71.21% and 83.56 %. The interval from PMF to leukemia was 22 months, and from leukemia to death was 27 days. Conclusion PMF with positive JAK2 V617F terminating in ALL is a rare case, clinical prognosis is poor and survival time is short.

Liquid Chromatography-Mass Spectrometry ( LC-MS) is becoming more and more widely used in clinical laboratory ,and LC-MS related quality management requires more rigid than it was .According to CLSI C62-A,this article provides a reference for the validation procedure of LC-MS assay, including limit of detection and lower limit of the measuring interval , linearity and dilution, imprecision, assay interferences and trueness.

Objective To observe the effects of metformin on expression of Adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK),nuclear factor-κB (NF-κB) and transforming growth factor β1 (TGF-β1) in cultured rat glomerular mesangial cells (MCs),and explore its renoprotective mechanisms.Methods MCs were cultured in the medium with normal glucose (group NG,5.6 mmol/L),high glucose (group HG,25mmol/L) and different concentrations of metformin (group M1,M2,M3).After 48 h exposure,the supernatants and MCs were collected.The expression of NF-κB and TGF-β1 mRNA was analyzed by real time-PCR.Total-AMPK,phospho-Thr-172 AMPK (p-AMPK),NF -κB p65 and TGF-β1 were visualized by Western blot.Results The real time-PCR and Western blot result showed MCs could express AMPK,NF-κB and TGF-β1 mRNA and protein.After stimulated by HG,the levels of intracellular NF-κB and TGF-β1 expressions were significantly increased compared with group NG (P ＜ 0.05); The levels of NF-κB and TGF-β1 were significantly decreased in group M1,M2 and group M3 compared with group HG in a dose-dependent manner.After stimulated by HG,the level of intracellular p-AMPK were down-regulated compared with group NG(all P ＜ 0.05); The expression of p-AMPK increased with the rising of metformin concentration,presenting the opposite trend (P ＜ 0.05),while the level of total-AMPK protein was unchanged with exposure to HG or different concentrations of mefformin(P ＞ 0.05).Conclusion Metformin can suppress the expression of NF-κB and TGF-β1 of glomerular MCs induced by HG via AMPK activation,which may partly contribute to its reno-protection.

Objective To investigate whether correlation exists between quantitative perfusion parameters obtained from dynamic contrast?enhanced magnetic resonance imaging (DCE?MRI) and different prognostic factors or immunohistochemical subtypes of breast cancers. Methods A retrospective analysis of DCE?MRI was performed in 87 breast cancer patients with 91 pathology confirmed breast lesions. All the patients underwent the immunohistochemistry after the operation, 80 breast cancer patients with 84 breast lesions were divided into different subtypes based on the immunohistochemical profiles. All the patients underwent plain MRI and DCE?MRI. The volume transfer constant (Ktrans), rate constant (kep) and volume of EES per unit volume of tissue (Ve) value were calculated. Results of the immunohistochemistry and observation results of the the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor?2 (HER?2) were recorded. Subtypes were also categorized. The degree of the expression of Ki?67 was observed simultaneously. Among the 87 breast cancer patients (with 91 breast lesions), 68 were ER?positive,18 were ER?negative, 60 were PR?positive, 26 were PR?negative;30 were HER?2 positive and 58 were HER?2 negative. Eighty breast cancer patients (with 84 breast lesions) were divided into different subtypes:19 were Luminal A, 49 were Luminal B, 7 were HER?2 positive subtype and 9 were triple negative breast cancer (TNBC). The quantitative perfusion parameters with diffierent expression of the receptors were analyzed through Mann?Whitney U test, the correlation between the degree of the expression of Ki?67 and quantitative perfusion parameters was obtained with Spearman test. Furthermore, the distributions of the perfusion parameters between groups according to immunohistochemical subtype were compared using the Kruskal?Wallis test. Results Ktrans and kep value were higher in tumors with ER?negative and PR?negative than with ER?positive and PR?positive and difference was statistically different ( P<0.05). There was no statistically significance in the quantitative perfusion parameters between HER?2 positive and HER?2 negative (P>0.05). The degree of the expression of Ki?67 was 5%to 90%the mean value was 33%, the median and interquartile range of Ktrans, kep and Ve value was 1.33/min (0.88/min), 2.63/min (2.34/min) and 0.51 (0.22) respectively. There was no significant correlations between the degree of the expression of Ki?67 and Ktrans and kep value (r value was 0.24 and 0.22 respectively, P value was 0.03 and 0.04 respectively), and the degree of the expression of Ki?67 was not associated with Ve (r=0.00, P=0.97). Ktrans value was lower in Luminal A and Luminal B than that in HER?2 positive subtype and TNBC, kep value was lower in Luminal A and Luminal B than that in TNBC, and Ve value in Luminal A, Luminal B and HER?2 positive subtype were higher than that in TNBC, kep value was lower in Luminal B than that in HER?2 positive subtype, statistically significance was seen among them (P<0.05).Triple?negative breast cancer showed the highest kep value (3.99/min) and the lowest Ve value (0.41) than the other subtypes. Conclusion The different subtypes of breast cancer may be predicted to some extent with quantitative perfusion parameters, and there is no correlation between quantitative perfusion parameters and the prognostic factors.

Objective To prepare dual-targeted microbubbles carrying both anti-CD34 monoclonal antibody and anti-ICAM-1 monoclonal antibody,to identify its basic characteristics,and to investigate its targeting performance in vitro.Methods ICAM-1-targeted microbubbles (MgIcAM-1),CD34-targeted microbubbles(MBcD34) and dual-targeted (with both monoclonal antibodies) microbubbles (MBD) were prepared by biotin-avidin bridging chemistry method.The targeted microbubbles were observed under light microscrope and characterized by a Mastersizer 3000,DFY software,laser confocal microscopy,and flow cytometry.The targeting specificity and attachment capability of dual-targeted microbubbles to endothelial progenitor cells (EPCs) and damaged human umbilical vein endothelial cells (HUVECs) were assessed in vitro.Results The morphous,diameter,surface potential,concentration,and the antibody-binding rates of microbubbles were not statistically significant in MBIcAM-1,MBCD34,and MBD (P ＞0.05).Echo intensity in MBD significantly increased compared with MBICAM1,MBCD34,and MBiotin (P ＜ 0.01).The targeting experiment in vitro showed that the attachment rate of MBD to EPCs and damaged HUVECs significantly increased compared with MBiotin (P ＜0.01),while no remarkable difference in attachment rate was found between MBD and MBcD34 in EPCs,and between MBD and MBIcAM-1 in damaged HUVECs (P ＞0.05).Conclusions Dual-targeted microbubbles carrying both anti-CD34 monoclonal antibody and anti-ICAM-1 monoclonal antibody are prepared successfully.The study in vitro has proved that the dual-targeted microbubbles can specifically bind to both EPCs and damaged HUVECs.