Objective To explore the imaging characteristics of testicular germ cell tumors and to improve the MRI diagnostic level. Methods MRI and clinical data of 25 cases confirmed testicular germ cell tumor by pathological examination were retrospectively analyzed. All the 25 cases were performed plain scan of MRI,and 16 patients underwent MRI enhanced scan.The size,morphology,signal intensity, adjacent structures,enhancement figure and tumor supplying artery were assessed and the histopathological findings were servered as the standard of reference.Results In the all 25 testicular germ cell tumors,10 cases were seminoma,8 cases showed homogeneous low signal intensity,2 cases of seminoma were low signal intensity on T2 WI,furthermore 5 cases performed poor nodular enhance-ment,2 cases performed homogeneous enhancement,4 cases performed fibrous septa enhancement.4 cases were yolk sac tumor ap-peared equal-low signal on T1 WI,slightly high signal intensity on T2 WI and progressive enhancement.Mature teratoma,pidermoid cyst and mixed germ cell tumor were 3 cases respectively,the MRI demonstrated mixed low signal intensity on T1 WI and mixed high signal on T2 WI.2 cases were embryonal carcinoma demonstrated middle-low signal intensity on T1 WI,and mixed low signal intensity on T2 WI.The two cases revealed bleeding signal intensity and septa enhancement.Conclusion MRI can be used to diagnose germ cell tumors with high accuracy,and provides essential information for pathological type,stage and differential diagnosis.

Objective To prospectively determine the feasibility of high-resolution in vivo MR imaging in the evaluation of esophageal carcinoma invasion at 3.0 T.Methods One hundred and eighteen patients with esophageal carcinoma,proven by the gastroscopic biopsy,were prospectively studied using 3.0 T MR.The esophageal specimens were sectioned transversely to keep consistent in the orientation with the MR images,the histopathological stage was made and the thickness of the tumor on the largest diameter of the slice were measured.The MR images were reviewed in the transverse plane.According to the seventh American joint committee on cancer,the MR stage was made and the tumor's thickness was measured.The MR images and the histopathological slices were matched.The staging diagnostic efficacy of the MR imaging was evaluated with the histopathological results as the standard reference,Kappa test was used to compare the stage of MR imaging with that at the histopathological analysis.Bland-Altman scatterplots were used to compare the thickness of tumor measured on the MR images with that at the histopathological measurement.Results Ninety seven cases(82.2％,97/118) of MR stage were accurately made,including 7 T1a,15 T1b,18 T2,25 T3 and 32 T4a cases,furthermore,14 cases were over staged and 7 cased were underestimated.The MR stage was highly consistent with the histopathological stage (Kappa=0.772).The sensitivity for the staging of high-resolution MR imaging at 3.0 T was 58.3％(7/12) to 100.0％(32/32),the specificity was 95.3％ (82/86) to 98.1％ (104/106),and the accuracy was 91.5％ (108/118) to 96.6％ (114/118),respectively.Bland-Altman scatterplots demonstrated that the discrepancy of the mean thickness between the value obtained by three radiologists respectively and the histopathological analysis were 2.0,2.6 and 2.1 mm,which demonstrated a good consistency.Conclusion High-resolution MR images obtained at 3.0 T can be used to evaluate the depth of carcinoma invasion and provide excellent diagnostic accuracy for preoperative staging.

Objective To explore the effects of project-achieving quality control circle (QCC) in day surgery nursing optimization model so as to provide a theoretical support for hospital day surgery nursing management and process improvement. Methods A total of 119 patients with day surgery in April 2018 and 170 in November 2018 at Ningbo First Hospital of Zhejiang Province were selected as subjects. This study developed activities based on the QCC activity theme of "Construction of Day Surgery Nursing Management Model by Various Measures", plan-do-check-action (PDCA) cycle and 10 steps of project-achieving QCC. Before and after optimizing process, the field follow-up for patients was carried out by telephone follow-up and questionnaire investigation, and tangible results (satisfaction of pre-hospital service, completion rate of follow-up, score of patients' continuous nursing needs, satisfaction with day surgery) as well as intangible results (skill application, teamwork, communication and coordination, computer application, activity confidence and activity participation) were evaluated. Results Patient's satisfaction of pre-hospital service raised from 52.1% to 82.4% before and after optimizing process; the rate of follow-up increased from 35.3% to 97.0%; patient's satisfaction with day surgery raised from 40.3% to 82.9%; the score of continuous nursing needs decreased from (20.90±12.91) to (17.59±11.78); the differences were all statistically significant (P＜ 0.05). The intangible results also improved, such as skill application of members in QCC. Conclusions The project-achieving QCC based day surgery nursing optimization model improves the completion rate of follow-up in nurses and patient satisfaction, and lowers patients' needs for continuous nursing and increases nursing team cohesion.

Objective:To deeply understand the reason and inner experience of day surgery patients canceling surgery through qualitative research, so as to strengthen the management of day surgery patients.Methods:This research adopted phenomenological research method. From June to December 2019, purpose sampling was used to select 12 patients who had canceled the day surgery at Ningbo First Hospital in Zhejiang Province for a semi-structured interview. The Colaizzi 7-step analysis method was used for data analysis.Results:Through repeated refining, analysis and extraction of interview data, the reasons and inner experience of day surgery patients who canceled surgery were finally summarized into 5 themes. Those themes included fear of day surgery, distrust of day doctors, affected by basic diseases and physiological factors, lack of confidence in community medical care, insufficient preparation before surgery.Conclusions:The reasons for day surgery patients to cancel surgery include fear of surgery, distrust of doctors, basic diseases and physiological factors, lack of confidence in community medical care, and insufficient preparation before surgery. It is recommended that day surgery medical and nursing staff strengthen day ward management, improve their professional level and ability to communicate with patients, and at the same time promote the construction of hospital-community integration to ensure the medical safety of patients after discharge from the hospital, and further reduce the cancellation rate of day surgery.

Objective:To investigate the protective effect and mechanisms of umbilical cord tissue transplantation on radiation-induced learning and memory impairment in rats.Methods:Sixty SD rats were randomly divided into three groups with 20 in each group: control group, model group (whole brain X-ray irradiation, dose 20 Gy) and treatment group (whole brain X-ray irradiation, dose 20 Gy + umbilical cord tissue transplantation). The changes of body mass were observed, and the learning and memory of rats were observed by water maze test on the 14th and 28th day after irradiation, the neuron state of hippocampus was observed by HE staining, and the expressions of NF-κB pathway related proteins and IL-6 in hippocampus were detected by Western blot.Descriptive analysis and hypothesis testing were processed by SPSS 17.0.Results:(1) On the 28th day, the escaping latency in the water maze experiment of the treatment group was significantly higher than that of the control group and lower than that of the model group (control group: (11.77±3.02) s, model group: (23.75±3.27)s, treatment group: (18.49±2.32)s; t=3.940, -2.943, both P<0.05); the number of crossing platform in the treatment group was significantly lower than that in the control group and higher than that in the model group (control group: (7.20±0.84), model group (3.60±1.14 ), treatment group (5.00±1.00); t=-3.773, 2.064, both P<0.05). (2)HE staining showed that the neurons in the control group were arranged orderly and the cytoplasm was transparent.The neurons in the model group were arranged disorderly and the contraction of the cell body was triangular or irregular.The number of neurons in the treatment group was less than that in the model group. (3) On the 14th day, the relative expression of TLR4 in the treatment group was significantly higher than that in the control group and lower than that in the model group (control group: (0.69±0.03), model group: (1.06±0.11), treatment group: (0.90±0.04); t=7.275, -2.368, both P<0.05). The relative expression of NF-κB p65 in the treatment group was significantly higher than that in the control group and lower than that in the model group (control group: (1.67±0.12), model group: (2.08 ±0.06), treatment group: (1.93±0.08); t=3.236, -2.684, both P<0.05). The relative expression of IL-6 in the treatment group was significantly higher than that in the control group and lower than that in the model group (control group: (0.77±0.08), model group: (1.12±0.07), treatment group: (0.95±0.06); t=3.274, -3.495, both P<0.05). The relative expression of Bcl-2 / Bax in the treatment group was significantly lower than that in the control group and higher than that in the model group (control group: (1.40±0.52), model group: (0.48±0.06), treatment group: (0.72±0.0 3); t=-2.263, 6.350, both P<0.05). The expression trend of IL-6 and Bcl-2 / Bax protein on the 28th day was the same as that on the 14th day. Conclusion:Cord tissue transplantation can improve the learning and memory impairment caused by radiotherapy, which may be related with the inhibition of inflammation caused by radiotherapy.

Objective:To investigate the application of Folly urethral catheter in transvastatal resection of adhesion (TCRA) and its preventive effect on prevention of re-adhesion.Methods:A total of 78 patients with intrauterine adhesions admitted to the Department of gynecology and obstetrics of the Maternal and Child Health Care Hospital Affiliated to Anhui Medical University from March 2018 to March 2019 were selected as the study objects.The prospective study was conducted and divided into two groups according to the computer random number method.In the control group, 39 cases were treated by TCRA combined with intrauterine placement of contraceptive ring, while in the observation group, 39 cases were treated by hysteroscopic adhesion separation operation combined with Folly catheter placement.The curative effect, intrauterine adhesions, menstrual improvement score, recurrence and pregnancy were compared before and 6 months after operation.Results:The total effective rate of the observation group was 94.87% (37/39), and that of the control group was 79.49% (31/39), The difference between the two groups was statistically significant (χ 2=4.129, P<0.05). The score of intrauterine adhesions was (22.14±2.57) in the control group and (1.76±0.87) in the observation group, and (23.05±3.08), (1.81±0.60) in the observation group, there was no significant difference between the two groups( t=1.417, 0.295; all P>0.05). At 3 months after operation, the scores of intrauterine adhesions and menstrual states in the control group were (17.63±2.88) and (1.07±0.38), respectively, and those in the observation group were (14.27±3.52) and (0.53±0.21), the difference between the two groups was statistically significant( t=4.614, 7.767, all P<0.001). There were significant differences in the scores of intrauterine adhesions and menstrual state before and after operation in the observation group ( t=7.297, 4.539, all P<0.001). There were significant differences in the scores of intrauterine adhesions and menstrual states before and after operation in the observation group ( t=11.723, 12.575, all P<0.001). The recurrence rate was 23.08% (9/39) in the observation group and 46.15% (18/39) in the control group at 6 months after operation.The difference was statistically significant ( P=0.032). The pregnancy rate of the observation group was observed.12.82% (5/39), 7.69% (3/39) in the control group, the difference was not statistically significant( P=0.455). Conclusion:Hysteroscopic adhesion separation combined with Folly catheter placement for the treatment of intrauterine adhesions can significantly improve the short-term efficacy, prevent re-adhesion, and better regulate the menstrual cycle.

Objective To observe the influence of ratio of endoscope-sheath diameter on renal pelvic pressure during PCNL.Methods The model of 24 isolated adult porcine kidneys were used to imitate percutaneous nephrolithotomy from September 2016 to June 2017.Each tract was established (F12,F14 and F16).Three kinds of endoscopes (F8 all-seeing needle percutaneous nephroscope,F6/7.5 and F8/ 9.8 rigid ureteroscope),input a 200μm laser,were adopted.There were 8 combinations,and 3 kidneys were used for each one.Renal pelvic pressure was measured 3 times repeatedly in every combination with steady irrigation (50,100,150,200,250,300,350,400,450,500 cmH2O).Results The linear equations,ratios of endoscope-sheath diameter and highest renal pelvic pressures for each combination were:F8-F12,Pr =0.026 P0-1.533,0.67,12.2 ± 0.54;F6/7.5-F 12,Pr =0.112 P0-5.001,0.92,51.2 ± 0.93;F8-F 14,Pr =0.010P0 + 1.067,0.58,6.2 ± 0.48;F6/7.5-F14,Pr =0.020P0 + 1.000,0.79,10.8 ± 0.46;F8/9.8-F14,Pr =0.144P0 +20.933,0.87,84.7 ± 1.17;F8-F16,Pr =0.005P0 + 1.067,0.50,2.8 ±0.34;F6/7.5-F16,Pr =0.009P0 + 0.533,0.68,5.1 ± 0.32;F8/9.8-F16,Pr =0.020P0 + 2.200,0.75,12.6 ± 0.56.The combinations of F6/7.5-F12 and F8/9.8-F14 might lead to a high renal pelvic pressure without proper irrigation (＜401.7 cmH2O for F6/7.5-F12;＜ 132.4 cmH2O for F8/9.8-F14).Conclusion In order to keep a safe pressure,a proper ratio of endoscope-sheath diameter (＜ 0.80) and appropriate irrigation must be considered.

Objective:To explore the potential serum biomarkers of patients with lupus nephritis(LN)by using two-dimensional electrophoresis combined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF/TOF MS),so as to lay the foundation for illuminating pathogenesis.Methods:A total of 40 LN patients were divided into two groups,the active LN group and the inactive LN group,with 20 in each.In addition,20 IgA nephritis patients and 20 healthy volunteers were enrolled as IgAN group and healthy control group.Two-dimensional gel electrophoresis was used to separate and analyze the serum proteins,and MALDI-TOF/TOF MS was applied to the identification of the differentially expressed pro-teins.Results:A total of fifty differentially expressed proteins were identified.Compared with that in healthy control group,23 differentially expressed proteins were discovered in active LN group and inactive LN group,among which,8 proteins were up-regulated and 1 5 proteins were down-regulated.And 1 8 differentially expressed proteins,compared with IgA nephritis group, were found in active LN group and inactive LN group,including 13 up-regulated proteins and 5 down-regulated proteins.Fur-thermore,the number of up-regulated and down-regulated proteins in active LN group,compared with those in inactive LN group,were 4 and 5,respectively.Among the 50 identified differentially expressed proteins,the expression of serum amyloid protein A(SAA )in active LN group was higher than that in the other groups while the expression of complement component C4A in active LN group was lower than that in the other groups.And the expression of chain B (solution structure of double super helix model)in the inactive LN group was higher than that in the other groups.Compared with that in healthy control group,the expression of vitamin D-binding protein isoform 1 precursor,chain A(crystal structure of uncomplexed vitamin D-binding protein)and chain B (a covalent dimer of transthyretin that affects the amyloid pathway)was up-regulated in both ac-tive LN group and inactive LN group,while the expression of the vitronectin precursor,ficolin-2 isoform a precursor and chain A (crystal structure of the catalytic domain of human complement C1 s protease)was down-regulated.Compared with that in IgA nephritis group,the expression of lipoprotein CIII and vitronectin precursor was up-regulated in both active LN group and inactive LN group.Conclusions:Combination of two-dimensional gel electrophoresis and MALDI-TOF/TOF MS is effective for screening and identification of differentially expressed proteins in serum from LN patients.These differentially expressed pro-teins could be used as biomarkers for noninvasive diagnosis and evaluation of LN.Further study on these proteins would be conducive to understanding the pathogenesis of LN.

Objective? To explore the application effects of bundle care strategy to enhanced recovery after surgery (ERAS) based on evidence-based nursing practice for patients with gastric cancer during perioperative period. Methods? From July 2017 to June 2018, a total of 100 patients undergoing radical gastrectomy in Ningbo First Hospital were selected and divided into control group and observation group according to admission time, with 50 cases in each group. The control group received routine enhanced recovery nursing based on guidelines. Bundles of care was determined and implemented in the observation group based on the embodiment of ERAS after literature review combined with expert consultation. The first anal exhaust time, defecation time, ambulation time, hospitalization days, ADL score on the third day after operation, pain score at 24 and 48 hours after operation, and complications of infection were compared between the two groups. Results? The first anal exhaust time, defecation time and ambulation time of the observation group were 66 (53,78) h, 88 (76,100) h and 29 (24,36) h, which were all lower than those of the control group [72 (60,90) h, 96 (82,120) h and 36 (24,48) h], and the differences were statistically significant (P＜0.05). The ADL score on the third day after operation was (65.88±14.37), which was higher than that of the control group (59.18±14.31), and the difference was statistically significant (P＜0.05). The hospitalization duration of the observation group was 11 (10,12) days, which was shorter than that of the control group 12 (11,13) days, and the difference was statistically significant (P＜0.05). There was no statistical significance in the difference in the pain score at 24 and 48 hours after operation and the complications of infection between the two groups (P＞0.05). Conclusions? Bundle care strategy of enhanced recovery after surgery for patients with gastric cancer can promote postoperative gastrointestinal function recovery, improve postoperative self-care ability and shorten postoperative hospital stay.

Objective:To explore the application effect of evidence-based clinical practice of enhanced recovery after surgery multiple discrepancies theory (ERAS-MDT) in perioperative nursing of patients with hepatectomy.Methods:From January to December 2018, 62 patients with hepatectomy who received perioperative care of ERAS-MDT in the Department of Hepatobiliary and Pancreatic Surgery of Ningbo First Hospital of Zhejiang Province were selected as the control group. We reviewed the implementation effect, searched the clinical practice guidelines, systematic reviews and evidence summary related to ERAS-MDT, carried out field investigation and expert consultation, summarized the obstacle factors, formulated countermeasures, and built a standardized operation mode of ERAS-MDT. From January to December 2019, a total of 66 patients with hepatectomy who received standardized ERAS-MDT perioperative nursing were selected as the observation group. The first exhaust time, defecation time, first ambulation time, first oral feeding time, hospitalization time, nutritional status and pain score were compared between the two groups.Results:The first exhaust time, defecation time, first ambulation time, first oral feeding time, hospitalization time of the observation group were earlier than those of the control group, and the differences were statistically significant ( P<0.05) . The albumin level of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05) . The pain scores of the observation group on the operation day was lower than those of the control group, and the difference between the two groups was statistically significant ( P<0.05) . Conclusions:A standardized management model of ERSA-MDT based on evidence-based clinical practice exhibits positive effect on the perioperative recovery of hepatectomy patients, which can further improve the clinical outcome of patients.