Objective To compare activated and normal Schwann cells in GAP43 gene expression. Methods 10 male SD rats, weighed from 100 g to 120 g. The right median nerve of SD rats was transected at the axillary level and was buried in muscle for predegeneration. 1 week later, the distal segment of the transected right median nerve with 1 cm long was harvested. The untreated left median nerve was harvested as control with same length. The epineurium of nerve was stripped, then the nerve tract was cut to small pieces. Schwann cells were obtained by way of double kinases digestion with 0.25% trypsin and 0.03% collegenase. The right median nerve was activated with additional liquid during digestion so as to obtain the activated Schwann cells. The normal Schwann cells were harvested from left median nerve. rt-PCR was used for GAP43 gene enlargement. mRNA was distilled from activated Schwann cells and untreated Schwann cells respectively. Then the mRNA was reversely transcripted to cDNA with SuperScriptTM, and cDNA worked as template for PCR enlargement. The product of PCR was separated with 1% agarose gel electrophoresis for 40 -50 min and stained with SYBR Green Ⅰnucleic acid gel. Fluorescence intensity of GAP43 PCR products was measured and then compared between the experiment group and control group. Results The Fluorescence intensity of GAP43 PCR product of activated Schwann cells was higher than that of normal Schwann cell. There was significant difference (P=0.003, Paired t test). It indicated that GAP43 mRNA of activated Schwann cells was much more than that of the normal Schwann cells. Conclusion GAP43 gene expression is up regulated in activated Schwann cells in contrast to normal Schwann cells. Activated Schwann cells secreting more GAP43, which may be one of the important mechanisms in promoting nerve regeneration.

Objective To investigate the effects of WeChat follow-up of relatives on knowledge cognition, change of behavior, visual acuity and blood glucose for diabetic retinopathy (DR) patients.Methods Totally 107 typeⅡdiabetic patients from January 2014 to December 2015 in the Department of Endocrinology were enrolled in the study, with the inclusion criteria of 60 years of age and older and diagnosed with diabetic retinopathy. Subjects were divided into the WeChat group (53 cases) and the control group (54 cases) based on the order of enrollment. The control group was given routine care and health education, while the WeChat group was given additional follow-up of relatives through WeChat with distribution of health education messages for the management of DM and DR once each week for 12 months. Questionnaires were used to collect information on patient's knowledge of DR prevention & treatment and behavior change, FBG, PBG, and HbA1c, and visual acuity were also collected to assess the effectiveness of the intervention. Chi-square test was used to compare the patients' cognitive rate, behavioral change and stage of retinopathy. The t-test was used to compare fasting blood glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin and visual acuity. Results Cognitive Knowledge change on DR were analyzed for the following questions:the time of the first fundus examination after diagnosis of diabetes and occurrence of systemic complications; what are key measures for prevention of early blindness in patients with DR;fundus checkup requirements while blood glucose control is ideal;types of major eye complications for diabetic patients; when laser treatment should be done for DR patients; how long apart should patients check the fundus;what is the normal range of blood glucose;and the types of server damages of DR;etc. The cognitive rates of WeChat group after follow-up were as follows 88.7%, 67.9%, 56.6%, 96.2%, 79.2%, 67.9%, 69.8%, 94.3%, 75.5%. WeChat group compared with the Control group after follow-up (χ2 values were 16.77, 30.76, 16.30, 7.75, 9.68, 36.03, 9.25, 10.57and 9.41, respectively, all P<0.01), the difference was statistically significant. The results of WeChat group before and after the follow-up were (χ2 values were 19.41, 38.22, 17.90, 8.23, 9.34, 38.22, 21.81, 12.08 and 25.52, respectively, all P<0.01), the difference was statistically significant. The cognitive rate for DR risk factors for the WeChat group was 24.5% before follow-up and 43.4%after follow-up;the after follow-up difference between WeChat group and the Control group was statistically significant (χ2=5.33, P<0.05). WeChat group before and after follow-up comparison (χ2=4.21, P<0.05) was also statistically significant. For values of fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin, results of WeChat group before follow-up were as follows (13.18± 4.46) mmol/L, (16.17 ± 3.97) mmol/L, (10.18 ± 2.76)%;results of WeChat group after follow-up were (8.45 ± 2.26) mmol/L, (11.34 ± 2.34) mmol/L,(7.83 ± 1.40)% respectively. The after follow-up comparison between WeChat group and the Control group showed statistically significant differences (t values were-7.06,-7.30, and-6.37, respectively, all P<0.01). Within the WeChat group, before and after follow-up comparison were all significantly different (t values were 6.83, 7.59 and 5.54, respectively, all P<0.01). The vision of WeChat group before follow-up was 0.68 ± 0.18, after follow-up was 0.71 ± 0.20. There were no significant differences in the two groups after follow-up, before and after follow-up WeChat group, the Control group before and after follow-up about visual acuity comparison (t values were 1.02,-1.10, and 0.57, respectively, all P>0.05). The two groups of patients were compared in balanced diet, regular eating time, meal volume, wearing loose clothing and exercise shoes and socks before each exercise, exercising for more than 30 min, weekly checkup of blood glucose, blood sugar test before and after the exercise and other measurements of behavior changes were significantly different (χ2 values were 11.54, 11.77, 13.68, 5.89, 10.23 and 8.72, respectively, all P<0.01 or 0.05). There were no significant differences in self-withdrawal of medication and Retinopathy stageⅠand stageⅡpatients and between these two patient groups (χ2 values were 1.20, 0.01 and 0.01, respectively, all P>0.05). Conclusions The practice of WeChat follow-up of relatives can improve cognition ability for DR patients aged 60 years and older, it can promote the healthy behavior and the BG monitoring effectively.

Objective To evaluate the effect of group psychological intervention and relaxation training on nurses' job burnout.Methods A total of 236 female registered nurses [mean age (27±4) years,and mean employment (17±3) years] were randomly assigned to the intervention group (n=120) and the control group (n=116).The intervention group had 60-minute group psychological intervention,10-minute psychological relaxing exercises and 20-minute progressing muscle relaxing exercises per week for 8 weeks.The control group did not receive any instrument.The participants were assessed at the 1st and 8th week by using the Job Burnout Scale.Results There was no statistical significance in three dimensions of the Job Burnout Scale between the two groups at baseline (P＞0.05).However,after the intervention,the intervention group had lower scores of EE (13.62±7.86 vs.19.83±4.89) and DP (5.25±3.27 vs.6.55±3.43) and higher scores of PA (38.28±6.34 vs.32.13±7.06) than the control group (all P＜0.01),and had lower scores of EE (18.92±8.36 vs.13.62±7.86) and DP (6.44±3.56 vs.5.25±3.27) and higher scores of PA (28.39±7.78 vs.38.28 ± 6.34) than baseline (all P＜0.01).The control group showed no significant difference in those parameters before and after the intervention (P＞0.05).In the intervention group,1-9 years employment subgroup had lower scores of EE (13.21±7.32 vs.16.91±5.63) and DP (5.61±4.33 vs.7.80±4.59) and higher scores of PA (36.34±7.28 vs.31.39±6.88) than the control group; 10-19 years employment subgroup had lower scores of EE (11.68±5.95 vs.15.14±6.43) and DP (5.11±3.65 vs.7.82±5.21) and higher scores of PA (31.24±8.90 vs.27.33±5.96) than the control group (all P＜0.01); 20-29 years employment subgroup had lower scores of EE (12.37±5.23 vs.15.36±4.98) than the control group (P＜0.01).Conclusions Group psychological intervention and relaxation training could effectively relieve nurses' job burnout.

BACKGROUND: New-type tissue engineering materials and post-proliferation Schwann cells are implanted into biosynthesis tube for repairing peripheral nerve defect, which are two great developments in the field of artificial biomaterial tube.OBJECTIVE: Taking chitosan-collagen as scaffold, activated Schwann cells as seed cells, we are in attempt to observe the affinity between them as well as growth rule of activated Schwann cells on Chitosan-collagen, so as to provide basis for pre-construction of artificial nerve.DESIGN: Open experiment.SETTING: Department of Hand Surgery, Huashan Hospital Affiliated to Fudan University.MATERIALS: This experiment was conducted at the Key Laboratory of Hand Function Reconstruction, Ministry of Public Health from July 2003 to December 2003. Four male SD rats, of clean degree, were used in this experiment. Chitosan-collagen film was made in Qisheng Biomaterial Technique Institute, Shanghai, Schwann cells activator solution was made in our laboratory (self-made).METHODS: After rats were anaesthenia, the sciatic nerve was cut off to perform predegeneration for 7 days. Another anaesthenia later, the rats were euthanized. Both sides of sorciatic nerves were cut off quickly and put in the D-HANK's solution containing penicillin and streptomycin.Epineurium was eliminated and chipped into 1 mm pieces, then put in the centrifuge tube containing 5 g/L trypsinase and 0.6 g/L collagenase. 0.5 mL activator solution every 2 mL liquid was added and the activated Schwann cells were harvested with the way of two-step enzymolysis. 2×107 L-1 activated Schwann cells in 200 μL were inoculated to Chitosan-collagen film and Petri dish . Two weeks later, cellular growth was observed under phase contrast microscope and scanning electron microscope. Cellular purity was identified with S-100 staining.MAIN OUTCOME MEASURES: ① Drawing cell growth curve and confirming in vitro doubling time. ②Observation of activated Schwanri cells under an inverted phase contrast microscope. ③ Observation of activated Schwann cells inoculated on Chitosan-collagen film under scanning electron microscope.RESULTS: ① Confirmation of in vitro doubling time: Concentration of activated Schwann cells inoculated on both Chitosan-collagen and Petri dish was 2×107 L-1, the final concentration was up to 3.0×108 L-1 and 2.0×108 L-1 respectively 2 weeks later. Doubling time of activated Schwann cells cultured on Chitosan-collagen film was 4 days calculated according to DT=(t-t0) lg2/(lgn-lgn0). ②Observation of activated Schwanncells under an inverted microscope: 24 hours later, the activated Schwann cells inoculated to Petri dish mostly changed from spherical to long shuttle-shape,mutation appeared and most were two-pole shape, fewer were three-pole shape; Morphologically, there was no significant difference between activated Schwann cells inoculated on Chitosan-collagen film and on Petri dish. Activated Schwann cells inoculated to Chitosan-collagen film were like "words cayed on the sand" under phase contrast microscope and the purity was over 95%. ③ Observation of activated Schwann cells inoculated to Chitosan-collagen under scanning electron microscope: Most of activated Schwann cells grew in the introcession of Chitosan-collagen or closely to surface of Chitosan-collagen, presenting regular head-to-end connection and adhesion to Chitosan-collagen film. The cell body was fusiform,with diameter of 4-6 μm, 60-80 μm in length. Cells were shuttle-shape with some small branches. Morphology of Chitosan-collagen film was still complete at week 1.CONCLUSION: There exists great affinity between Chitosan-collagen film and high-purity activated Schwann cell; so tissue-engineering scaffold made of the two components probably promote peripheral nerve regeneration.

Objective To compare the result differences of different dynamic nerves transferring to different segments of the radial nerve. Methods From 1997 to 2000, different ways of intercostal nerves or contralataral C 7 transfering to different segments of the radial nerves were carried out in 36 cases with total avulsed brachial plexus injuries that were followed up for average 42.39 months. Four-fold table was selected to statistically calculate the effective rate of muscle strength recovery. Results The total effective rate was 56% (20/36). The effective rate of the functional rehabilitation of elbow extension was 5/8 in the group with neurotization to radial nerve trunk and 4/4 in the group with neurotization to branches innervating the triceps brachii muscle of radial nerve. The highest effective rate up to 75% (9/12) of the functional rehabilitation of wrist and digit extension belonged to the group with contralateral C 7 transferring to the radial nerve segment in the humeral spiral groove where branches innervating the triceps brachii muscle had already diverged. Conclusions The way of neurotization to radial nerve trunk and to branches innervating the triceps brachii muscle of the radial nerve can win good functional rehabilitation of elbow extension. Contralataral C 7 transfering to the radial nerve segment in the humeral spiral groove ranks the best way for function recovery of the wrist extension. Age below 30 years and operation interval less than 12 months are helpful for functional rehabilitation of the radial nerve.

Objective To investigate the high-risk factors leading to a poor prognosis of small renal cell carcinoma, and provide theoretical basis for the individualized treatment regimen. Methods This retrospective study analyzed the clini?cal and histological data of 18 patients with small renal cell carcinoma treated in the Department of Urology of the Second Hospital of Tianjin Medical University from January 2004 to July 2015. All the patients underwent ultrasound, plain and en?hanced CT examinations, also, received the surgeries. The tumor diameters, pathological types, pathological stages, Fuhrman grading of tumors and the prognosis of patients were analyzed. Results Preoperative CT examination revealed that 18 pa?tients with the average tumor diameter of (3.1 ± 0.6) cm (ranged 2.0 to 4.0 cm). Five patients were diagnosed as T1aN0M0, 4 patients with T1aN0M1 (3 cases with lung metastasis, 1 case with brain metastasis), 3 patients with T1aN1M0 (CT examina?tion showed a lymph node metastasis), 6 patients with T3aN0M0 (renal vein invasion or renal vein tumor thrombus). Patholog?ical examination after surgery showed that 12 patients were Fuhrman gradeⅡ, 5 were gradeⅢand 1 was gradeⅣ;15 cases were clear cell carcinomas, 1 case was papillary carcinoma, 1 was hybrid cellular tumor (malignant rhabdoid tumor with sar?comatoid differentiation) and the last case was sarcomatoid carcinoma renal cell carcinoma (Fuhrman grade V). 4 patients (T3a, Fuhrman grade Ⅱ) underwent retroperitoneal laparoscopic partial nephrectomy and the remaining underwent laparo?scopic radical nephrectomy. The median follow-up time was 22.5 months (ranged 6 to 48 months). Four cases died (2 cases with tumor diameters of 3.8 cm and 4.0 cm at preliminary diagnosis,2 cases with sarcomatoid renal carcinoma and 1 with brain metastasis), 1 case was lost. Other patients were found no tumor recurrence and metastasis. Conclusion The small re?nal cell tumor with diameter≥3.0 cm, FuhrmanⅢ/Ⅳgrade,sarcomatoid cancer or metastasis should be considered as high-risk factors of small renal cell carcinoma. The high-risk small renal cell carcinoma is heterogeneous in its biological behav?ior, which is expressed as aggressive growth and early invasion of renal tissue and even metastasis. The individualized treat? ment should be made based on preoperative imaging findings and postoperative pathology.

Objective To investigate the effect of the administrative intervention on smoking cessation of medical personnel and demonstrate the feasibility and the validity of this approach.Methods Two comparable hospitals were selected,one hospital with 136 smoking medical staff members was used as the intervention group;the other hospital which had 127 smoking medical staff members was used as the control group.We applied administrative intervention and health education to the intervention group and health education only to the control group.The intervention time was 10 months,we used the questionnaire survey before and after intervening to evaluate the smoking rate,the intention to quit smoking,the willingmess to accept the help of quitting and the proportion of those who quitted smoking.Results The smoking rate of intervention group (37.4％) was lower than that of control group (77.2％),the difference was statistically significant (x2=40.99,P＜0.01).The proportion of control group smokers in planning(51.1％) is statistically significant as compared with intervention group (46.18％) (x2=46.18,P＜0.01).The proportion of people who were willing to accept the help from families and friends and smoking cessation counseling in intervention group was significanly higher than that in the control group.(x2=10.04,x2=7.73,x2=7.58;P＜ 0.01).But the proportion of accepting the medicine for quitting smoking was not significantly different (x2=0.16,P＞0.05).The proportion of smokers who wanted to quit smoking on their own willingness in control group was significantly higher than that in intervention group (x2=36.27,P＜0.01).After10 months,61 people (46.6％) in the intervention group succeeded in quitting smoking and 13 (10.6％) people in control group succeeded (x2=28.21,P＜0.01).Conclusion Administrative intervention has feasibility and validity when hospitals take activities for smoking cessation.

Objective:To optimize the extraction process for the total alkaloids of Longzuan Tongbi Fang by central composite design and response surface method.Methods:The independent variables were the ethanol contention,solvent consumption and extraction time,and the dependent variable was the weighted overall desirability of the content of total alkaloids and kukoline.The extraction process for the total alkaloids of Longzuan Tongbi Fang was optimized by central composite design and response surface method.Results:The optimum extraction conditions were as follows:9-fold amount of solvent was used,refluxed for 130 min,extracted twice,and the ethanol concentration was 75%.Conclusion:The central composite design and response surface method used for the extraction optimization for the total alkaloids of Longzuan Tongbi Fang is very simple and highly predictive.

Objective To investigate the incidence of contrast induced nephropathy (CIN) among different patient groups after contrast agent injection.Methods A total of 1243 patients were included in this study (male =694,female =549).The SCr level one week before and 72 hours after the CT examination and the incidence of CIN were recorded and comparison was made among groups according to sex,age,body mass index (BMI),the history of high blood pressure (HBP),diabetes mellitus (DM),chronic kidney disease (CKD),chronic heart failure (CHF),tumor,nephrotoxicity drug (NTD) usage.The frequency,type,dose and injection velocity of the contrast media(CM)were also recorded.Multivariate predictors of CIN were identified by Logistic regression using step-wise selection with entry and exit criteria of P ＜0.10,results were tabulated as odds ratios (OR) with 95％ confidence intervals (CI).Results Among 1243 consecutive patients,the incidence of CIN was 5.5％ (68/1243).Patients with a history of HBP,DM,CHF,CKD or tumor presented with higher incidence of CIN than that of controls (5.9％,51/868 vs.4.5％,17/375).CIN developed in 9 of 203 patients (4.4％,9/203) with CKD and in 59 of 1040 patients (5.7％,59/1040)without CKD.There was no significant difference between the two groups(x2 =0.51,P =0.30).In CKD (-) group,the incidence of CIN was higher in females,patients with DM and patients using LOCM than those of males,DM (-) and using low osmolality contrast medium (IOCM) (P ＜ 0.05),but there was no statistical significance in CKD (+) group.Logistic regression analysis showed that women,age ≥ 75 years,DM,LOCM,NTD,tumor,the time of using CM more than once per month were the most significant predictors of CIN (OR ＞ 1).Conclusion Women,age ≥ 75 years,LOCM,NTD,tumor,and the frequency of using CM more than once per month were more likely to develop CIN.