Objective To summarize the clinical experiences and efficacy of laparoscopic total extraperitoneal repair(TEP) for inguinal hernia.Methods From April 2004 to August 2006,294 TEP operations was performed on 269 patients with inguinal hernia by using laparoscopy under epidural or general anesthesia.Among the patients,175 had indirect hernia,40 direct hernias,25 bilateral hernias,and 29 recurrent hernias.Results The operation was completed without converting to open surgeries in all the cases.The mean operation time was(63.1?37.5) min,blood loss(12.3 ?8.2) ml,and hospital stay(3.7 ?1.4) d.Of the patients,24 had peritoneal tearing(8.2%,24/269),4 had groin hematoma(2.4%,4/269),and 2 had foreign body sensation(0.7%,2/269).The patients were followed up for 6-12 months(median,9 months),the recurrence rate was 1.0%(3/294). Conclusion Laparoscopic TEP is safe and effective for patients with inguinal hernia.

Objective We aimed to study the status of nurse-physician collaboration in tertiary general hospitals and analyze the influencing factors,and provide references for improving the status and the service of medical-nursing quality.Methods Totally 280 nurses and 186 doctors working in medicine,surgery,emergency room,operating room and ICU in tertiary general hospitals were recruited in the study.The participants were investigated with the questionnaire of Nurse-Physician Collaboration Scale,Jefferson Scale of Attitudes towards Physician-Nurse Collaboration and the Tool for Organizational Culture.Results The status of nurse-physician collaboration was in a good condition,doctors scored (82.98±12.97),which was significantly higher than those of nurses (76.71±14.25),and there was sighificant difference.For doctors,the influencing factors included organizational culture,cooperative attitudes,gender,the type of contract; for nurses,the influencing factors included organizational culture,the department and marital status.Conclusions It is suggested to improve the condition of nurse-physician collaboration from the hospital managers and medical staff's point of view in tertiary general hospitals and construct the harmonious relationship between health care to provide high quality service for patients.

Objective To provide basis for clinical teaching methods and course system,this article analyzed practice nursing students self-directed learning readiness status and its influencing factors.Methods The report surveyed a total of 240 nursing students in Zhengzhou University,the Peking Union Medical College by using the general information questionnaire,the Chinese version of Nursing SelfDirected Learning Readiness Scale and The Questionnaire of Clinical Teaching.The total score of the practice nursing students' self-directed learning readiness was obtained on the basis of quantitative analysis,and in this paper,the development and research status had been summarized through document analysis.Results The total score of the practice nursing students' self-directed learning readiness was (116.59±21.79) scores.The influencing factors of practice nursing students' self-directed learning readiness included:whether the students like nursing major,whether perception learning difficulties,whether having the experience of group learning,and the satisfaction to clinical teachers,curriculum system optimization.Conclusions Currently practice nursing students self-learning readiness is relatively low and have many influencing factors.A targeted training should be taken during the clinical teaching and the course system should be optimized to improve the practice nursing students' self-directed learning readiness.

Objective:To explore the real return-to-work experiences and expectations of young and middle-aged stroke patients in community, in order to provide reference for the formulation of the support plan for returning to work from the perspective of patients, and further promote their return to work.Methods:Using the phenomenological method of qualitative research, 11 young and middle-aged stroke patients in Zhengzhou community from April to May, 2019 were interviewed in a semi-structured way, then the interview data were analyzed and the theme was extracted.Results:The community young and middle-aged stroke patients return-to-work experiences and expectations included the following five themes: uncertain return-to-work belief, limited work-related ability, complex inner feelings in the process of returning to work, insufficient external support and expectation of returning to work after stroke (The desire to return-to-work, expectation to get support and help related to returning to work).Conclusions:In order to promote young and middle-aged stroke patients in community to return to work, the three-way interaction mode of community-society-workplace should be considered from the aspects of patients' personal and external support to help patients recover actively, establish beliefs, reduce negative emotions, and further promote patients to return to work.

Objective To explore the clinical effects of injection rhinoplasty with non-absorpted material and prevention of the complications.Methods A total of 578 patinets with rhinoplasty in Interpretation Medical Cosmetic Center of Wuhan City and Southwest Hospital from March 2010 to January 2016 were selected,who included 239 cases injected by absorbed material,213 cases injected by non-absorbed material and 126 cases implanted by silicone prosthesis.Then the clinical effects,curative keeping time and complications of three groups in 0,1,3,6 and 12 months after injected or implanted were observed.Results 578 patients of nasal shape and outline were significantly improved immediately after surgery and injection,but the adverse reaction and complication of silicone prosthesis increased more than those of other two groups,the differences were significant(P<0.01).While,the nose shape and outline and cosmetic effects of patients by silicone prosthesis or absorbed material postoperated became worse from 6 months to 1 year(P<0.05),and the non-absorbed groups had kept much better in the nose shape and outline and the satisfactory effects than the other two groups,the differences were significant(P<0.01).Conclusion Injection of rhinoplasty is safe and effective,meanwile the injection rhinoplasty with non-absorbed material is more suitable for Asian with less adverse reaction.

Objective To evaluate the clinical efficacy of the application of auricular composite tissue flap in treatment of nasal alar de-fect. Methods 43 cases of nasal defects patients were admitted to our hospital from January 2008 to March 2013, 23 cases of them were treated with auricular composite tissue flap transplantation, and the other 20 cases were given nasolabial sulcus flap transfer operation. All patients were followed-up for 6 to 12 months, and the rate of secondary surgery, proliferation of scar, and flap survival of the two groups were compared. Results Treatment of auricular composite tissue flap transplantation has more advantages in terms of the rate of secondary surgery, proliferation of scar, and flap survival, and the difference is of statistical significance (P<0. 05). And there is no obvious differ-ence in satisfaction degree of cosmetic outcomes. Conclusion Auricular composite tissue flap surgery has the advantages of simple opera-tion, good appearance and good efficacy.

Objective To explore a new surgical method for the treatment of refractory fistula after breast augmentation and to improve patients healing efficiently.Methods This paper had collected two groups,a total of 178 cases of injected breast augmentation,who had shown the polyacrylamide hydrogel(PAAG)mixture shift,and caused abdominal fistula.Among them,89 cases further adopt new design in the treatment of fistula by using breast muscle membrane tissue flap and improve the effect of fistula treatment after the removal of fistula.And the other 89 cases were token the pure clean the cavity away caused by the abnormal material shift into the chest and abdominal wall.Results It was observed that PAAG widely distributed in the chest and abdominal wall and formatted the fistula connected mammary gland,axillary,chest abdominal wall.The area of lesions lacuna shrink by 80％ for the group used tissue flap after 2 weeks,but those not with tissue flap shrink by 45％(P＜0.01).At 4th week,all the patients of flap group achieved tissue healed,while the completely heal ratio of control group was only 73％.Compared two groups of healing rate,the group with tissue flap was obviously better than ones only with surgical method.Conclusion It suggests that main reasons for the liquidity bag and huge cavity are PAAG mixture shift into thoracic and abdominal wall and formed chronic fistula and connected the chest and abdominal wall.Local muscle membrane tissue flap can obviously promote the chest and abdominal wall fistula healing.

AIM: To investigate the role of nuclear factor kappa B (NF-?B) inhibitor in the responsiveness of isolated pulmonary artery rings to protein kinase C (PKC) in rats with hypoxia-induced pulmonary hypertension. METHODS: The pulmonary artery rings removed endothelium were prepared from model rats with hypoxia-induced pulmonary hypertension and control rats. The effects of PKC activator PMA (0.5 ?mol/L) time-response cures and NF-?B inhibitor PDTC (0- 1 000 ?mol/L) concentration-response cures on pulmonary artery rings were observed. The responsiveness of each ring was tested by applying a maximally effective concentration of phenylephrine (10 ?mol/L). Data were calculated as relative ratio by the maximally responseness ( P_0 ) setting at 100%,and the relative responseness tensions to PMA and PDTC were derived by dividing by the counts in P_0. t_ 1/2 and T show the time achieving half-maximal response and lasting maxima response to 0.5 ?mol/L PMA,respectively. RESULTS: mPAP and RV/(LV+S) in hypoxia group were greater than those in control group ( P

Objective To explore effect of daily clearance and improvement mode application in man-agement of clinical nursing responsible group. Methods 200 patients from hand and foot surgery department of our hospital between January to June, 2007 were included into the control group, and 200 patients who were in hospital between July to December, 2007 were included into the experimental group. Then quality of care and satisfaction of patients were compared respectively between the two groups to study application effect of daffy clearance and improvement mode. Results After six months application of daily clearance and improvement mode, significant difference was seen in the two groups. Condusions Application of daffy clearance and improvement mode in management of clinical nursing responsible group is an effective method in nursing supervision.

Objective To discuss the prognoais after hyperglycemia and electrolyte imbalance caused by stress in moderate or severe hypoxic ischemic encephalopathy newborns. Methods Blood sugar and electrolyte of 73 HIE patients, who hospitalized in our hospitial, including 73 moderate or severe patients and 63 mild patients. Results There was significant difference with increase of serum glucose,decrease of serum sodium and calcium between mod- erate or severe and mild HIE. The rate of hyperglycemia, hyponatremia and hypocalcemia was higher in moderate or severe HIE with 2 or more organ dyafunction than I alone. Conclusion The moderate or severe HIE newborns early time presents the hyperglycemia and the low blood sodium, the low serum calcium often prompts organism existence serious stress response, and prompts electrolyte disorder.