In order to evaluate the value of magnetic resonance cholangiography (MRC) and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia (EHBA) and infantile hepatitis syndrome (IHS), 52 patients with infantile cholestatic jaundice were examined by MRC and duodenal fluid examination. Original interpretations were compared with clinical outcome. Calculated sensitivity of duodenal fluid examination in diagnosis of EHBA was 100%, and specificity was 91.1%. Sensitivity of MRC in the diagnosis of EHBA was 94.4% and specificity 88.24%. The sensitivity of MRC and examination of duodenal fluid combined in diagnosis of EHBA was 94.4% and specificity 97.06%. We are led to conclude that MRC and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA and the combined use of the two techniques yield better results.

Objective To investigate the sources and transmission routes of clustered cases of healthcare-associated infection(HAI) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) in the intensive care unit (ICU) of a hospital,and provide evidence for the prevention and control of HAI.Methods Clustered cases of MDR-AB HAI in ICU were investigated,specimens of patients and environment were collected and cultured,the isolated strains were performed antimicrobial susceptibility testing.Results Five strains of pathogenic bacteria were isolated from sputum of patients with HAI,5 infected patients were at adjacent beds from the same ICU;the onset time was on January 2-7,2016.A total of 21 strains of pathogenic bacteria were isolated from environmental specimens during the same period,these strains were from quilt,bedside cabinet,treatment trolley,faucet,bedrail,breathing tube,and hands of health care worker(HCWs).Antimicrobial susceptibility testing results showed that strains from patients and environment were all MDR AB,and had the similar antimicrobial resistance pattern.Conclusion The occurrence of clustered HAI cases is due to contamination of HCWs' hands and hospital environment by MDR-AB.

Objective To investigate the first decompression time of TR Band hemostasis after transradial percutaneous coronary intervention (TRI), provide evidence to support and guidance for clinical nursing practice. Methods By searching Cochrane Library, OVID, PubMed, Chinese biomedical literature service system(CBM),China National Knowledge Infrastructure(CNKI), VIP database(VIP), Wanfang database, the randomized controlled trials (RCTs),controlled clinical trials (CCT) and historical cohort study(HCT) of TR Band hemostasis after coronary artery intervention were collected and analyzed. Two reviewers used bias risk assessment tool according to Cochrane recommendation Handbook 5.0 to evaluate, Meta-analysis was carried out using RevMan 5.1.5 software. Results A total of 1 881 patients in 2 RCTs and 3 CCTs were included.Compared with the first decompression time 30 min, patients in 1 h group with limb swelling and pain incidence were statistically significant difference [ (OR=2.22, 95%CI 1.25-3.93, P<0.01) vs. (OR=1.63,95%CI 1.02-2.59, P < 0.05)], bleeding at the puncture sites or the operative limbnumbness or ecchymosis there was no significant difference [(OR=0.77,95%CI 0.35-1.71, P>0.05) vs.(OR=2.14, 95%CI 0.75-6.12, P>0.05)vs.(OR=11.73, 95%CI 0.64-215.74, P>0.05)];1h compared with 2 h patients with limbs, pain, hemorrhage rate had significant difference [(OR=0.09, 95%CI-0.13--0.05, P<0.01) vs. (OR=2.07, 95%CI 1.24-3.46, P<0.01)]; a comparison between 90 min and 2h, the limb pain and swelling incidence were statistically significant difference [(OR=2.77, 95%CI 1.82-4.23, P<0.01)vs.(OR=2.73,95%CI 1.41-5.28, P<0.01)], the puncture site bleeding, hematoma, ecchymosis rate and the operative limb numbness extent differences were no statistical significance [(OR=0.97,95%CI 0.61-1.54, P>0.05) vs. (OR=0.95, 95%CI 0.52-1.75, P>0.05)vs. (OR=0.96,95%CI 0.54-1.73, P>0.05)]. Conclusions 30 min decompression after TRI can reduce operative limb swelling and pain incidence rate. There is no obvious influence between puncture site bleeding and operative limb numbness.

Objective To investigate the incidence and risk factors of optic atrophy in cerebral palsy(CP).MethodsThe clinical dates of 872 children with CP were analyzed retrospectively.ResultsThe incidence of optic atrophy was 17.1% in CP.There was no significant difference among sexes,age and clinical types.Asphyxiation (OR=1.787,95%CI:1.225～2.608) and premature delivery (OR=2.074;95%CI:1.332～3.230) were significantly related to optic atrophy.ConclusionIn children with CP,the incidence of optic atrophy is high.Asphyxiation and premature delivery are risk factors of optic atrophy.Examination of ocular fundus should be considered as one of the routine examinations.

Parenteral nutrition - associated liver disease (PNALD)or cholestasis (PNAC)is the main compli-cation of prolonged parenteral nutrition in premature infants. It is characterized by cholestatic jaundice,which is defined as direct serum bilirubin of ≥34. 2 μmol/ L with or without liver enzymes abnormalities,rule out other causes. The risk factors contributing to the incidence of PNALD are premature,low birth weight,the duration of parenteral nutrition (PN),components of PN,sepsis,intestinal disease,genetic susceptibility. Although the damage is frequently mild,and resolves after discontinuation of parenteral nutrition,in some cases it progresses into cirrhotic changes. Ursodeoxycholic acid and lipid emulsions based on fish oil with a high content of long - chain polyunsaturated fatty acids ω - 3 has been proposed to be efficacy. But effective preventive and therapeutic strategies for PNALD have not been established yet. In-novative therapeutic strategies needs to be investigated.

Objective Because of the major trauma from thoracotomy , postoperative pain may arouse patients'psychological and physiological stress response and hence affected the treatment outcome and functional recovery seriously .We retrospectively studied the correlation between the staging of pain and nursing interference to investigate the effect of nursing interference on the pain intensity after thoracic surgery . Methods Five hundred and eighty cases of patients surviving thoracotomy between December 2013 and March 2014 in Nanjing Jingling Hospital were reviewed .Correlations between comfortable nursing measures such as effective analgesia , postural care , catheter care , environmental interventions , psychological intervention and the standard assessment of pain were analysed according to postoperative pain stage . Results With comprehensive nursing interference , the highest pain score occurred in the first 24 hour (2.89 ±0.39).The score was reduced gradually to 2.25 ±0.90 in stage Ⅱ, 1.58 ±0.57 in stage Ⅲ and 1.06 ±0.24 in stage Ⅳrespectively . Conclusion Comprehensive nursing interference according to pain staging may relieve pain effectively after thoracotomy .

Objective To evaluate the effectiveness of standardized three-stage rehabilitation program on spasticity and motor function in the upper extremities after cerebral hemorrhage.Methods A total of 364 patients were included and randomly assigned to a control group (n =181) and a rehabilitation group (n =183).The standardized three-stage rehabilitation program,which included early-stage bedside rehabilitation,specialized treatment in rehabilitation ward during recovery and rehabilitation follow-up at regular intervals was applied in the rehabilitation group,but only rehabilitation guidance and follow-up after discharge were provided for the control group.The modified Ashworth scale (MAS) and Fugl-Meyer assessment (FMA) were performed at the time of recruitment,1 month (M1),3 months(M3) and 6 months(M6) later.Results There was no statistical difference between the groups at recruitment.The occurrence rate of spasticity was 22.7％ in the control and 23.5％ in the rehabilitation group.At M6 the occurrence rate of spasticity was about 59.7％ and 43.2％ in control group and rehabilitation group respectively,and the number of patients grade 1 + and grade 2 on the MAS was 50/181 in the control group,significantly more than in the rehabilitation group (25/183).At all time points,MAS grade 0 accounted for a large proportion of both groups.At M6,both MAS distributions and scores of the two groups were different statistically (P ＜ 0.01).FMA scores in both groups increased significantly (P ＜ 0.01) with time,with the score being (17.13 ± 16.46),(24.87±18.36),(30.68±19.41) at M1,M3 and M6 in the control group and (24.71 ±19.80),(39.83 ± 19.50),(48.87 ± 18.25) in the rehabilitation group,but the average scores of the latter were consistently significantly higher than the former (P ＜ 0.01).Conclusions Standardized three-stage rehabilitation can alleviate spasticity and improve motor function of the upper extremities in cerebral hemorrhage patients.

Objective To assess differences in brain activation between active and passive movement of the right hand using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI). Methods Nine healthy adult right handed volunteers were studied. fMRI was performed with active and passive finger-to-finger movement. Results Right hand active and passive movement produced significant activation in the contralateral sensorimotor cortex ( SMC ), the contralateral premotor cortex ( PMC ), bilaterally in the supplementary motor area (SMA) and in the ipsilateral cerebellum. The activated brain areas were centered on the contralateral SMC and PMC and located more forward during active movement than during passive movement. The contralateral SMC was the most strongly and the most frequently activated brain area. The contralateral posterior parietal cortex (PPC) was less relevant to the hand movements. Unlike active movement, passivemovement activated more areas in the posterior central gyrus than in the anterior central gyrus. Conclusions Both active and passive movement significantly activate the brain areas which are responsible for hand movement, but there are some differences in the locations of the cortex areas activated and in the incidence activation except in the contralateral SMC.

Objective: The metaanalysis aims to estimate the prevalence of suicide plan among college students in mainland China, and to provide more clues and reference for control and prevention of suicide. Methods: The relevant studies were systematically searched via electronic databases (PubMed，Embase，CNKI，Wan Fang Data，VIP). We only selected original articles that either reported on Chinese retrieval words of "college students" "undergraduate" "university" "college" "colleges and universities" "suicide plans" "detection rate" "prevalence" "report rate", and the English retrieval words of "undergraduate" "college" "university" "suicide" "suicidality" "suicide plans" "suicidal plans suicide intending" "prevalence" "report rate" "detection rate" "China" "Chinese". And Stata 12.0 software was used to make a metaanalysis of the data. Results: A total of 18 eligible studies, with 47 071 college students, were finally included. The maximum and minimum reported prevalence of suicidal plan among college students in China mainland was 4.4%(95%CI: 3.4%-5.4%).Subgroup analyses showed that the pooled estimate of suicidal plan of boys(5.4%) was higher than girls’(4.2%); The prevalence among college students from earth, middle and west areas were 5.1%，2.7%，4.5%, respectively; The prevalence among college students in 2010 and after (4.4%)was higher than that before 2010(4.3%), The prevalence among college students of life time suicide plan (4.9%)was higher than that during the past 12 months(4.0%), but there was no statistical significance in the subgroup(P>0.05) . Sensitivity analysis suggested that the results of metaanalysis were relatively stable, while funnel plot analysis suggested that publication bias might exist. Conclusion Prevalence of suicidal plans among college students in mainland China is respectively low, and there was no statistical significance in gender, region, the period of time and simple size.

Objective:To investigate any change in the effective connectivity between the bilateral anterior central gyruses after transcranial magnetic stimulation (TMS).Methods:Twenty-one healthy subjects were examined using resting state functional magnetic resonance imaging (rs-fMRI) before and after receiving continuous theta burst stimulation (cTBS). The brain atlas of the Institute of Automation of the Chinese Academy of Sciences was used for fine partitioning of the bilateral anterior central gyruses. Granger causality analysis was used to compare any changes in the effective connectivity between them.Results:After the cTBS inhibited the right M1 area, significant changes in effective connectivity among the sub-regions of the bilateral M1 area were observed. The effective connectivity of the right upper limb to the left upper limb and the left head to face were weakened, while that of the left upper limb to the right head, as well as of the face to the right upper limb was enhanced.Conclusion:For people whose right M1 area has been inhibited by cTBS, the effective connectivity changes in both upper limb functional areas of the M1 region reflect inter-hemispheric inhibition. Opposite changes were found in the trunk and upper limbs.