Objective To explore a method for rapid bedside temporary pacing by the right internal jugular vein approach.Method The right internal jugular veni puncture was taken by Jernigan technique and self made J tipped introducer was introduced to get to the high right atrium by the vein approach,then the J curvature of the introducer at the distal end is turned and directed at the tricusped valve outside the body,the lead attached to external pacemaker was inserted and advanced through the introducer until continuous ventricular captures appeared on the fluoroscopy.Results 30 patients in total were paced rapidly and successfully at bedside without Roentgenography.Continuous right ventricular pacing was got within 1～3 (median 2) minutes from vein puncture and within 6～30(median 13) seconds after the placement of the introducer had been completed,respectively.Conclusions The rapid bedside temporary pacing can be performed safely and rapidly through the J tipped introducer by the right internal jugular vein approach without Roentgenography.

Objective To improve the effects of health education(HE)and satisfaction degree on HE of inpatients by executing hierarchical full-responsibility nursing. Methods Fourteen wards were randomly chosen form the hospital and divided into the control group and the experimental group, each group having 7 wards. The control group carried out routine holistic nursing model, and the experimental group carried out a new hierarchical full-responsibility nursing system. Reforming nursing scheduling and diminishing the nursing unit to assure that the patients acquired the continous and stable nursing service when they were in hospital. The effect and the degree of satisfaction of HE were compared between two groups after 6 months. Results The effects of HE in the experimental group were significantly better than those in the control group, and the degree of satisfaction on HE in the experimental group was much higher than in the control group. Conclusions The hierarchical full-responsibility nursing system can give patients systematic and normalized HE. It can significantly improve the effects and the degree of satisfaction on HE.

Objective To study the role of cutaneous nerve and protease activated receptor 2 (PAR2)in the development of pruritus in atopic dermatitis(AD).Methods Dermal sheets were prepared from chronically pruritic skin lesions of 7 patients with AD,as well as from the normal skin of 7 healthy human controls.Double labeled immunofluorescence was performed using mouse anti-protein gene product 9.5(PGP9.5)monoclonal antibody and rabbit anti-substance P(SP)polyclonal antibody to observe the morphological changes in cutaneous nerve fibers,and Image-Pro Plus 6 software was used to semiquantitively assess the length,diameter of nerve fibers,integral optimal density of PAR2 and SP in dermal sheets.Results Immunofluoresence double staining showed that PAR2 co-expressed with PGP9.5 or SP in cutaneous nerve fibers.Compared with the normal control skin,both the total length and average diameter of PGP 9.5-expressing nerve fibers were increased(11051.8±1900.9 μm vs 7264.0±2659.9 μm,4.23±0.15 μm vs 3.95±0.15 μm,both P＜0.01)in pruritic lesions,while only the average diameter of SP-expressing nerve fibers was up-regulated(3.99±0.20 μm vs 3.80±0.07 μm,P＜0.05),and the total length of them remained unchanged(4304.7±1455.0 μm vs 3380.0±1735.4 μm,P＞0.05).Also,increased integral optimal density was observed for SP and PAR in pruritic lesions in comparison with the normal control skin (27.71±16.52 vs 12.63±4.31.35.99±8.63 vs 22.69±9.56.both P＜0.05).Conclusion Our results indicate a hyper-plasia of cutaneous nerve fibers in chronic itchv skin lesions of AD and an increase in the expression of PAR2 and SP in the cutaneous nerve fibers,suggesting that the signal enhancement in PAR2 pathway may be related to the mechanism of pruritus in patients with AD.

The lecture, role play, combination of team learning and self-directed learning, group presentation,these multiple pedagogies were adopted in the teaching of selective medical English course.The questionnaire result showed this multiple teaching strategy can foster the students' interest in medical English, enhance their awareness of active learning and increase the ir learning efficacy, which is an effective teaching model, and can be applied and promoted in the medical English teaching.

The morphological and molecular identifications of Cyclospora-like oocysts of dogs were underwent in the present study, in which the morphological characteristics of the Cyclospora-like oocysts firstly found in the stool samples of dogs, such as shape, size, acid-fast staining,sporulation and auto-fluorescene, were observed. According to the published sequence of the rDNA gene of Cyclospora in GenBank, 3 primers were designed and were used to amplify part of the 18S rDNA gene of dog-associated Cyclospora-like organism by nested PCR.The amplicons were purified and cloned into vector pMD19T. Then, the positive clones screened were sequenced and subjected to sequence homology and phylogenetic analysis. It was found that the morphological charactertistics of the Cyclospora-like oocysts in dogs were similar to that of the human Cyclospoa oocysts and the size of-the amplified fragment of 18S rDNA was proved to be 715 bp, that was identical to that of the target fragment. Based on the results of sequence homology and phylogenetic analysis, the dog-associated Cyclospora-like organism was identified as the Cyclospora species.

Objective To evaluate the safety and effectiveness of partial cystectomy combined with chemotherapy in treating localized muscle invasive bladder cancer.Methods The patients admitted to localized muscle invasive bladder cancer from October 2011 to December 2015 were screened according to the strict inclusion criteria,and the final 53 patients were enrolled in the study,37 males and 16 females,aged 36 to 85 (63.72 ± 13.31)years.Tumor diameter 1.5-4.0 (2.52 ±0.56)cm,the number of≤ 3 and the edge of the tumor from the ureteral opening ＞ 2 cm.All pathological types are urothelial carcinoma.All patients were examined by MRI clinical stage T2a-T2b period.A total of 53 patients with muscle invasive bladder cancer who refuse or older,merge the heavier medical disease,difficult to tolerate radical cystectomy.Using partial cystectomy,intraoperative electrosurgical excision to deep muscle,parallel to the tumor bed frozen to confirm negative margins,postoperatively systemic chemotherapy of gemcitabine combined cisplatin and bladder perfusion chemotherapy of hydroxycamptothecin.Results Patients were successfully opcrated,and no margin positive or incision planting cases.The operating time is 55-110 min and average (79.11 ± 17.25)min.There was no serious complication in operation and postoperative,pathological diagnosis was invasive epithelial cell carcinoma of the urinary tract,pathology classification:low level 41 cases,and high level 12 cases.Follow up of 12 to 62 months,an average of (27.11 ± 12.22)months,21 cases of recurrence,12 patients had superficial recurrence in the bladder who was treated successfully by transurethral resection of bladder tumor,5 cases of multiple myometrial invasion who was treated by radical cystectomy (3 cases died of bladder cancer after the surgery in 8,12,and 18 months later),4 cases of myometrial invasion with recurrence of pelvic lymph node metastasis or even distant metastasis to give up treatment (all died within six months of bladder cancer).The first tumor recurrence time 3-18 months,11 months and the median time.Conclusions Our data indicate that partial cystectomy combined with chemotherapy is a safe and effective in treating localized muscle invasive bladder cancer,with less trauma,shorter operative time and higher safety,so as to provide an alternative treatment for patients with advanced age,high risk or who can not be implemented transurethral resection of bladder tumor or who refused to undergo radical cystectomy.

Objective To investigate the relationship between spinal neuronal microRNA 212 (miR-212) and phosphorylation of cAMP response element-binding protein (CREB) in a mouse model of bone cancer pain (BCP).Methods Thirty-two male SPF C3H/HeJ mice, aged 4-6 weeks, weighing 20-25 g, were randomly divided into 4 groups (n=8 each) using a random number table: sham operation group (group S), BCP group, BCP + intrathecal negative control locked nucleic acid (LNA) group (group BC) , and BCP + intrathecal miR-212 antisense LNA group (group BL).After the mice were anesthetized with intraperitoneal pentobarbital sodium, 20 μl of α minimal essential medium containing NCTC 2472 cells 2×105 was injected directly into the medullary cavity of the distal femur.In BC and BL groups, negative control LNA and miR-212 antisense LNA 12 pmol/5 μl were intrathecally injected, respectively, once a day for 7 consecutive days, starting from day 14 after inoculation.In S and BCP groups, the equal volume of DNAse/RNAse-free water was given instead.The number of spontaneous flinches (NSF) and mechanical paw withdrawal threshold (MWT) were measured on 1 day before inoculation and 4, 7, 10, 14 and 21 days after inoculation.The mice of each group were sacrificed after measurement of pain threshold on 21 days after inoculation, and the lumbar enlargement segments of the spinal cord were harvested to detect the expression of phosphorylated CREB (p-CREB) and CREB using Western blot.Results Compared with group S, the MWT was significantly decreased, and the NSF was increased on 7-21 days after inoculation, and the expression of p-CREB was up-regulated in BCP, BC and BL groups.Compared with group BCP, the MWT was significantly increased, and the NSF was decreased on 21 days after inoculation, and the expression of p-CREB was down-regulated in group BL, and no significant change was found in the parameters mentioned above in BC group.There was no significant difference in the expression of CREB between the four groups.Conclusion Spinal neuronal miR-212 is involved in the maintenance of BCP probably by promoting phosphorylation of CREB in mice.

Objective To construct an evaluation index system of ward management,which can evaluate the efficiency of ward management fairly, and make the ward management more scientific and standardized.Methods Delphi method was used in semi-structured interview of 31 experts and 74 experts were subject to questionnaire consultation, so as to establish the index system.Results The index system of ward management so built consisted of three level-1 indexes of safety and quality, teamwork and patient satisfaction, six level-2 indexes of daily monitoring, service environment, adverse events, doctor-nurse cooperation, evaluation of administrators and patient satisfaction, and 25 level-3 indexes.Practice of this system in the past two years reduced adverse events and elevated quality of care.Conclusions This system as used clinically proves its operability and objectivity.

Objective To evaluate the effectiveness of suberselective uterine arterial embolization for uterine fibroids.Methods Uterine arterial embolization with golyvimylalcohol(PVA) particles or Iodized oil and Gelfoam or Pingyangmycin lipiodol and Gelfoam was performed in 182 patients with uterine fibroids.Results Bilateral and unilateral superselective uterine arterial embolization were performed in 173 cases and 9 cases respectively. 6～28 months (mean 11 months) after the procedure, complete disappearance of tumor(16 cases), an average shinkage of 67% in tumor volume(152 cases) and a mean 42% reduction of uterine volume were obtained in 168 followed-up cases. The clinical symptoms were relieved significantly.The main side effets were hypogastic pain(135/182).Conclusion Superselection uterine arterial embolization is an effective and microinvasive method in treating uterine fibroids.

OBJECTIVETo explore the clinical application value of Provider-Initiated HIV Testing and Counseling (PITC) by analyzing the positive rate of HIV tests for people in need of PITC and that of routine HIV tests.

METHODSWe retrospectively analyzed the demographic and epidemiologic data about the patients seeking PITC services or undergoing routine HIV tests in Nanjing Drum Tower Hospital between January and December 2013.

RESULTSThe positive rate of initial HIV screening was 1.98% in the PITC group and 0.24% in the routine test group, while that of confirmed HIV was 0. 40% in the former and 0.07% in the latter, both with statistically significant differences between the two groups (P < 0.01). The positive rate of HIV was markedly higher in males than in females, particularly in the PITC group.

CONCLUSIONPITC has a high clinical value in HIV detection for targeted subjects and therefore deserves general application in dermatology.

Counseling ; Dermatology ; Female ; HIV Seropositivity ; diagnosis ; epidemiology ; Humans ; Male ; Mass Screening ; methods ; Retrospective Studies ; Sex Factors