Hotspots and difficulties of biliary surgery in older patients / 中华医学杂志(英文版)

With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.

Construction of the evaluation index system on TCM service capability of county-level hospitals of traditional Chinese medicine / 中华医院管理杂志

Objective:To build the evaluation index system of traditiond Chinese medicine(TCM) service capacity in county-level TCM hospitals, for references to improve the TCM service capability in China.Methods:Based on the " structure-process-result" evaluation model, a preliminary screening index system for the evaluation of TCM service capacity in county-level TCM hospitals was established by analyzing relevant literature and policies; Two rounds of Delphi expert consultation were made to screen the evaluation indexes; The combination weighting method based on both expert scoring method and entropy weight method was used to determine the index weight.Results:The evaluation index system of TCM service capacity of county-level TCM hospitals was finally incorporated into 3 first-level indicators, 9 second-level indicators and 33 third-level indicators. The top five third-level indicators in terms of comprehensive weight were the person time of TCM preventive care in the year(12.02%), the person time of manual reduction diagnosis and treatment(9.03%), the person time of acupuncture and moxibustion(6.55%), the proportion of income from inpatient TCM services in medical income(5.87%) and the person time of massage(5.34%).Conclusions:From the perspective of the whole process of TCM service, the evaluation index system of TCM service capacity of county-level TCM hospitals reflectd the health service capacity of county-level TCM hospitals, highlighted the characteristics of TCM.

One case of diagnosis and treatment of pancreatic neuroendocrine neoplasms with suspected autoimmune pancreatitis / 中华内分泌外科杂志

Because of low incidence, atypical clinical symptom, pancreatic neuroendocrine tumor (pNENs) and autoimmune pancreatitis (AIP) alway have suspected diagnosis and misdiagnosis. This paper aims to improve the diagnosis and treatment of two diseases by a case of pancreatic neuroendocrine tumor with suspected autoimmune pancreatitis.

Application of linkage teaching in pediatric nursing skills course based on integration of theory and practice / 中国实用护理杂志

Objective:To explore the application of linkage teaching model between hospitals and colleges based on integration of theory and practice in the course of pediatric nursing skills.Methods:Two undergraduate classes of pediatric nursing in a college in 2017 were selected as the experimental group and the control group by random sampling. The experimental group adopted the combined teaching method of colleges and hospitals based on the integration of truth and practice, while the control group adopted the traditional teaching method. The results of skill operation assessment were compared between the two groups, and the results were evaluated by the self-designed teaching effect evaluation questionnaire.Results:The results of the combined nursing skills teaching in colleges and universities were higher in the experimental group (91.24±3.01) than that in the control group (87.33±2.96), the difference was statistically significant ( t value was 5.027, P<0.05). The evaluation score of teaching effect of the experimental group was 62.61 ± 2.94, which was significantly higher than that of the control group (49.67 ± 7.79) ( t value was 7.965, P<0.05). Conclusions:The combined teaching mode of colleges and hospitals based on the integration of theory and practice is beneficial to improve students′ comprehensive quality and learning effect, further shorten the gap between college theory and clinical practice, and is an effective form of pediatric nursing education.

One case report on VHL disease with multiple cysts of the pancreas as the main symptom / 中华内分泌外科杂志

Von Hippel-Lindau (VHL) disease is a benign or malignant tumor syndrome which involves multiple systems and organs.Recently,a patient was diagnosed and hospitalized with an initial clinical symptom of pancreatic multiple cystic space-occupying.Multidisciplinary examination and consultation confirmed that there were hemangioblastomas in cerebella,spinal cord and retina,but with no clinical symptoms;therefore,it was diagnosed as VHL disease.According to previous case reports,only a few single cases revealed lesions in so many parts of the central nervous system with typical imaging manifestations.We present an overview and aim to improve the diagnosis of VHL disease with the initial clinical symptom of pancreatic lesions.

Application progress of counter-example teaching approach in nursing education / 中国实用护理杂志

Traditional teaching approach is a method which lack of overall quality cultivation among students. However, the teaching approach which is combined with counter examples can stimulate their study interests, enhance critical thinking ability and promote theory-practice combination. Counter-example teaching approach has been applied in nursing education in these years and It plays an active role in improving nursing educational quality. This paper aims to provide reference to formulate a scheme of cultivating all-round developed nurses through summarizing the advantages and disadvantages, and application process of counter-example teaching approach used in nursing education.

The study and analysis of the effectiveness of "health education mobile classroom" in the outpatient department of children's hospital / 中国实用护理杂志

Objective To evaluate the effect of "health education mobile classroom " in the outpatient department of children's hospital, and to analyze the needs of the outpatient and family members on health education. Methods Through the retrospective analysis of the information of the outpatient and emergency patients in the children's specialist hospital to determine the content, the venue and the time period of the "health education mobile classroom". Selection and training the health educator to implement the health education. At the same time, push the training content through the mobile APP to the patient's family, to expand the education audience. To compare and analyze the patient satisfaction of the hospital and the satisfaction with the dimensions of the project. In the evaluation of the effect of health education and the influencing factors, the relationship between income, occupation and children is positively related, and age is negatively related to it. Results After the implement of this project, the satisfaction of the patient had increased for 3.65%(P=0.001). Overall assessment of the audience was very satisfied with (3.94 ± 0.25) points. In each dimension analysis, the satisfaction of the "training method"was the highest, at (3.94 ± 0.26) points. Satisfied with the attitude of the trainers and comprehensive ability were more than 3.80 points. Conclusions The "health education mobile classroom" can improve patient satisfaction in the outpatient department and emergency of children's specialist hospital. Audience has a certain degree of acceptance and satisfaction with this health education mode.

Preparation and characteristics of 10-hydroxycamptothecin loaded folate-receptor targeted phase-change contrast agent / 中国介入影像与治疗学

Objective To prepare a 10-hydroxycamptothecin (10-HCPT) loaded folate-receptor targeted phase-change contrast agent (FR-HCPT-PNPCA),and to study the general characteristics including drug loading,phase changing and targeting capability in vitro.Methods Using a method of two-step emulsification,the phase-change nanoparticles loading anticancer drug (10-HCPT) with lipids shell and liquid pefluorocarbon core were prepared.The entrapment efficiency and the drug-loading amounts were studied by high performance liquid chromatography,and the phase transition of the nanoparticles after heating was observed.The targeting ability was evaluated on liver cancer cell line 7721 in vitro.Results The FR-HCPT-PNPCA,with a drug encapsulation rate of about 70.42 ％ and drug loading amounts of about 20.05 ％,was prepared successfully.When being heated to 70℃,obvious phase changing and microbubbles generating could be observed under microscope.In addition,a large amount of FR-HCPT-PNPCA particles could adhere specifically around the 7721 cells.Conclusion The prepared FR-HCPT-PNPCA,which has a stable characteristic and high performance of drug loading and tumor targeting,is expected to become a promising multifunctional molecular ultrasound probe for diagnosis and treatment of tumor.

Preventive Effect and Underlying Mechanism of Tetramethylpyrazine on Hypobaric and Hypoxic Pulmonary Hypertension in Rats / 中国药师

Objective:To investigate the preventive effect of tetramethylpyrazine (TMP) on hypoxic pulmonary hypertension in rats and the underlying mechanism.Methods:Thirty-six male Sprague-Dawley rats were randomly divided into three groups:the normal control group,hypobaric and hypoxic group and TMP group (100 mg·kg-1·d-1).After the animal models of hypobaric and hypoxic pulmonary hypertension were established,mean pulmonary artery pressure (mPAP),mean carotid artery pressure (mCAP),ratio of right ventricular/(lift ventricular + interventricular septum) (RVHI) and morphological changes of pulmonary vessels were observed and the rates of wall thickness/external diameter (WT%) and wall area/total vascular area (WA%) were calculated.The contents of nitric oxide (NO),endothelin-1 (ET-1),hypoxic-inducible factor-1 (HIF-1) and vascular endothelial growth factor (VEGF) were detected in serum after the 21-day treatment with TMP.Results:The values of mPAP,RVHI,WT% and WA% of hypobaric and hypoxic group were significant higher than those of the normal control group (P0.05).The values of NO in serum of hypobaric and hypoxic group was lower than those of the normal control group (P<0.05) and those of TMP group were obviously higher than those of hypobaric and hypoxic group (P<0.05).The values of ET-1,HIF-1α and VEGF in serum of hypobaric and hypoxic group were higher than those of the normal control group (P<0.05) and those of TMP group were obviously lower than those of hypobaric and hypoxic group (P<0.05).Conclusion:TMP can effectively prevent pulmonary hypertension induced by hypobaric and hypoxic and structural remodeling of pulmonary arterioles.The mechanism may be related to the content up-regulation of NO and activity down-regulation of ET-1,HIF-1α and VEGF in serum of rats.

The effect of HIFU combined with nanoscale ultrasound molecular probes with simple virus thymidine kinase gene on angiogenesis in the nude mouse tumor / 重庆医学

Objective To observe the change of the protein and gene expression of hypoxia inducing factor-1α(HIF-1a) and vascular endothelial growth factor (VEGF) in the nude mouse tumor,which has been treated by HIFU combined with nanoscale ultrasound molecular probes with HSV1-TK gene microvascular density.Methods Sixty nude mice were implanted with HepG2 Cells to establish subcutaneous transplanted tumor.Divided this mice into six groups at random after treated by HIFU:MB+ HSV-TK+ GPC3 (group A),MB + HSV-TK (group B),HSV-TK +GPC3 (group C),HSV-TK (group D),MB + GPC3 (group E),PBS (group F).They were injected into the tail vein every after 3 days.Mice in group A,B,D and E were exposed to ultrasound by 2 W/cm2,1 MHz,5 mintues and 0.2 mL ganciclovi(GCV) was intraperitoneally injected at the first 48 hours after injection.After the treatment,immunohistoche were used to detect the microvascular density(MVD),Western blot and immunohistoche was employed to test the protein change of the VEGF and HIF-1α,Q-PCR was used to test the mRNA gene transcription of VEGF and HIF-1α in the tumor tissues.Results After 14 days,the protein expression of HIF-1α and VEGF in group A was significantly lower than that in group B,C,D,E and F (P＜0.05),the MVD level in the tumor is also like this,and the difference is statistically significant.Conclusion Anoscale ultrasound molecular probes with HSV1-TK can reduce the the level of VEGF,MVD and HIF-1α in the tumor which has been treated by HIFU,so it can inhibit tumor growth and improve the therapeutic efficacy after HIFU treatment.

Hepatitis B virus inhibits expression of liver cell immune checkpoint PD-1 ligand gene / 重庆医学

Objective To analyze the impact of hepatitis B virus (HBV) replication and its coded X gene (HBx) expression on cell gene expression profile,especially the immune related gene expression level changes.Methods Overexpressed HBx gene was transiently transfected through lenti-virus and pcDNA3,the RNA-Seq and RT-qPCR methods were used to detect the expression levels of immune related genes,which were verified in HBV replication cell line.Results This study found that the HBV replication and HBx expression suppressed the expression of immune checkpoint PD-1 ligand gene (PD-L1/CD274) in a dose-dependent manner,while the expression of H-box mutant in HBx gene lost this inhibition effect.Conclusion HBV/HBx possesses the ability for inhibiting PD-L1/CD274 ligand gene expression,may relieve the checkpoint of antigen-specific T cell activation in viral infection acute stage,activates cytotoxic T cells,which may cause that T cell attack and clear highly replicated cells,helps virus to enter the lower replication status,and reaches the balance status between virus-host and lays a basis of HBV chronic infection.

Hepatitis B virus inhibits expression of liver cell immune checkpoint PD-1 ligand gene / 重庆医学

Objective To analyze the impact of hepatitis B virus (HBV) replication and its coded X gene (HBx) expression on cell gene expression profile,especially the immune related gene expression level changes.Methods Overexpressed HBx gene was transiently transfected through lenti-virus and pcDNA3,the RNA-Seq and RT-qPCR methods were used to detect the expression levels of immune related genes,which were verified in HBV replication cell line.Results This study found that the HBV replication and HBx expression suppressed the expression of immune checkpoint PD-1 ligand gene (PD-L1/CD274) in a dose-dependent manner,while the expression of H-box mutant in HBx gene lost this inhibition effect.Conclusion HBV/HBx possesses the ability for inhibiting PD-L1/CD274 ligand gene expression,may relieve the checkpoint of antigen-specific T cell activation in viral infection acute stage,activates cytotoxic T cells,which may cause that T cell attack and clear highly replicated cells,helps virus to enter the lower replication status,and reaches the balance status between virus-host and lays a basis of HBV chronic infection.

Study on the transfection of dextran derivative nanoparticles to the mda-mb-435 human breast cancer cells / 中国药理学通报

Aim To prepare the dextran derivative nanoparticles with higher transfecting efficiency to mda-mb-435 human breast cancer cells.Methods The dextran 40 and the sodium periodate were reacted with different mole ratio to form the intermediate:oxidized dextrans having different aldehyde content.With different reactants matching,the spermine were grafted onto the oxidized dextrans mentioned above to form the dextran-spermine imine conjugates which were reduced by the excess reducing agent NaBH4 to produce the end products 9 species of dextran derivative nanoparticles(extran-spermine amine conjugates).The dextran derivative nanipartical of the highest gene transfecting efficiency was selected from the 9 species of dextran derivative nanoparticles by the experiment of gene transfection,using the pEGFP-C1 plasmid as the reporter,the mda-mb-435 human breast cancer cells as the transfected cells.Results The dextran derivative nanoparticles with the highest transfecting efficiency was the one that had the highest content of spermine grafted onto the oxidized dextran40 obtained by the reaction between sodium periodate and dextran40 with the mole ratio of 0.8.Conclusion The dextran derivative nanoparticles of the highest transfecting efficiency to the mda-mb-435 human breast cancer had been prepared.