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Objective:To explore the application effect of situation comedy teaching combined with peer teaching in clinical practice teaching of undergraduate nursing students.Methods:A total of 96 undergraduate nursing students who practiced in a first-class hospital at grade 3 in 2019 were randomly divided into the observation group and the control group, with 48 nursing students in each group. The control group adopted clinical teaching mode, including group theory teaching and group operation demonstration. On the basis of this, the observation group additionally adopted the clinical teaching mode of situation comedy teaching combined with peer teaching. The differences between the two groups in the assessment of nursing knowledge and skills assessment, independent learning ability and teaching satisfaction were observed. SPSS 20.0 software was used for t-test. Results:After the implementation of clinical teaching, the scores of nursing comprehensive ability of nursing students in the observation group (87.71 ± 5.11) were higher than those in the control group (78.47±6.24) ( P < 0.05). The independent learning ability of nursing students in the observation group (98.80±10.61) was significantly higher than that in the control group (74.47±9.83), and the difference was statistically significant ( P < 0.05). The score of teaching satisfaction in the observation group (2.83±7.07) was significantly higher than that in the control group (50.17±6.75), and the difference was statistically significant ( P < 0.05). Conclusion:The application of situation domedy teaching combined with peer teaching in the clinical teaching of undergraduate nursing students can improve their independent learning ability and clinical practice ability. Meanwhile, the process of teachers and students participating in situational experience and peer analysis and discussion can increase the teacher-student interaction, and improve the satisfaction of nursing students with clinical teaching.
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As China is about to enter an era of deep aging， the coexistence of multiple diseases is gradually increasing. Coronary heart disease （CHD） and cognitive dysfunction also show increasing incidence year by year. The two diseases affect and cause each other， becoming the major chronic diseases harmful to the health of the elderly. It is of great clinical significance to explore the methods integrating traditional Chinese and western medicine for the prevention and treatment of the two diseases. The relationship between CHD and cognitive dysfunction in traditional Chinese medicine （TCM） was first recorded in Huangdi’s Internal Classic （Huang Di Nei Jing）. As the understanding of CHD and cognitive dysfunction is deepening， the influences of stasis and toxin on both diseases have attracted increasing attention. According to the theories of TCM， CHD and cognitive dysfunction have common points in the etiology and pathogenesis. Therefore， the theory of treating different diseases with same method provides a theoretical basis for the clinical treatment of different diseases with the same pathogenesis. Moreover， this theory conforms to the principle of integrated and individualized prevention and treatment of multi-disease coexistence in modern medicine. This paper systematically proposed that the coexistence of stasis and toxin is a major pathogenesis of CHD and cognitive dysfunction. We then explored the possible mechanisms of the blood-activating and toxin-removing method in the treatment of CHD and cognitive dysfunction based on the theory of treating different diseases with same method. The mechanisms include the regulation of ceramide metabolism， activation of silent mating-type information regulation 2 homolog 1 （SIRT1）， inhibition of pyroptosis， regulation of mitogen-activated protein kinase/nuclear factor-κB （MAPK/NF-κB） signaling pathway， inhibition of mitochondrial division， and regulation of DNA methylation. We hope this paper will provide an idea for the future research on the prevention and treatment of CHD and cognitive dysfunction with TCM.
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Cognitive impairment secondary to cardiovascular disease is a common complication in the elderly population， which seriously threatens the health of patients and affects the long-term quality of life. Cardiovascular diseases can lead to vascular endothelial injury， cerebral hypoperfusion， and brain lesions， and then cause cognitive impairment. Cardiovascular risk factors also increase the risk of secondary cognitive impairment in patients. It is particularly important to seek for early diagnosis and traditional Chinese medicine （TCM） and western medicine prevention and treatment. Based on the "holistic concept"， TCM puts forward the theory of "the connection of heart and brain". The heart and brain are connected and both are in charge of mental activities. Heart injury affects the brain， resulting in abnormal consciousness， which is considered to be the pathogenesis of cognitive impairment secondary to cardiovascular disease in TCM. Later generations of doctors propose the theory of "simultaneous treatment of the heart and the brain" on the basis of "treating different diseases with the same treatment" and "the connection of heart and brain". The theory contains two meanings. One is that different diseases can be treated by the same method because of the same etiology and pathogenesis. The other is the coexistence of different diseases and the treatment should be targeted to the same risk factors. This paper systematically discussed the TCM pathogenesis of cognitive impairment secondary to cardiovascular disease and the prevention and treatment strategy of "simultaneous treatment of the heart and the brain". In this paper， the deficiency of qi and blood was the foundation， and the interaction of blood stasis and poison and the obstruction of the pulse and the loss of the body were the key factors. Activating blood， detoxifying arteries， and connecting the orifices were the main treatment method for the disease. This paper is expected to enrich the connotation of "simultaneous treatment of the heart and the brain"， and provide new ideas for the prevention and treatment of cognitive impairment secondary to the cardiovascular disease with TCM.
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The high morbidity and fatality rates of cardiovascular and cerebrovascular diseases seriously harm human health，greatly affect the quality of life and increase the burden of disease. Thus， more and more attention has been paid to the relationship between heart and brain. "Simultaneous treatment of heart and brain" is the continuous deepening and development of the theory of "simultaneous treatment of different diseases" in traditional Chinese medicine （TCM）， and exploring the relationship between heart and brain as well as the current situation of Chinese medicine treatment has important clinical significance for the establishment of integrated traditional Chinese and western medicine diagnosis and treatment programs of cardiovascular and cerebrovascular diseases. Through a systematic theoretical tracing of the "simultaneous treatment of heart and brain"，the authors held that cardiovascular and cerebrovascular diseases had the same origin，and that heart and brain took blood as the material basis and governed mind jointly. They also expounded the modern biological relationship of the simultaneous treatment of heart and brain. In other words，the pathogenic factors of cardiovascular and cerebrovascular diseases were the same， with complicated comorbidities， and the disorders of neurohumoral reflex and endocrine system and immune system regulation could affect each other's function. Additionally，the present situation of clinical application of Chinese medicine for simultaneous treatment of heart and brain and its intervention effect on cardiovascular and cerebrovascular diseases were discussed. It was found that these Chinese medicines could protect cardiovascular and cerebrovascular diseases through multi-target，multi-pathway and multi-link regulation. Combined with the existing problems in the current research，the authors thought and looked forward to the practical strategies of treating cardiovascular and cerebrovascular diseases with Chinese medicine by paying attention to key groups，focusing on dominant diseases，giving full play to the value of Chinese medicine，and scientifically explaining the connotation of simultaneous treatment of heart and brain， in order to provide ideas and reference for the follow-up transformation application research and better guidance of clinical practice.
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Objective To investigate the outcome of fetus with abnormal increase of pulmonary artery systolic pressure at second and third trimester by color Doppler ultrasound . Methods Ninety-five fetuses with a little or mild tricuspid regurgitation ( control group) and 60 fetuses with moderate and severe tricuspid regurgitation (observation group) were included . The degree ,velocity ,and differential pressure of tricuspid regurgitation were measured and the variations of baseline information and the measured value of pulmonary systolic pressure between the two groups were compared . As for the follow -up on observation group ,the pressure of fetus with high pulmonary systolic pressure ( > 20 mmHg) was repeatedly measured every 4 weeks until it return to normal . Results There were significant differences in terms of gestational weeks ,velocity and pressure of tricuspid regurgitation ,as well as pulmonary systolic pressure between the two groups ( P < 0 .001) . Pulmonary systolic pressure was positively correlated with gestational weeks , velocity and pressure of tricuspid regurgitation ( r = 0 .442 ,0 .998 ,0 .999 ;all P < 0 .001 ) ,but had no correlations with the age of pregnant women ( r = - 0 .001 , P = 0 .674) . The follow-up revealed that ,in observation group , 47 cases ( 78 .3％ , systolic pressure < 50 mmHg ) presented with the decreased pulmonary systolic pressure ,the disappeared or the slight appeared regurgitation before birth ,meanwhile , 13 ( 21 .7％ ,systolic pressure ≥ 50 mmHg) exhibited severe tricuspid regurgitation and persistent pulmonary elevation ,with the highest of more than 70 mmHg accompanying the varying degrees of right heart failure . Only one of 13 fetuses died due to persistent pulmonary hypertension and hypoxia ( oxygen saturation <45％ ) . The fetal pulmonary artery systolic pressure of the remaining 12 cases recovered from 5 to 105 days after birth ,with normal heart function . Conclusions The majority of fetal pulmonary arterial hypertension complicated with obvious tricuspid regurgitation is reversible functional alteration , which can restore normality in most cases before or after birth .
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Objective To study the effect of inflammatory markers on the level of reactive oxygen species (ROS) and mitochondrial DNA (mtDNA) copy numbers in granulosa cells of patients without polycystic ovary syndrome (PCOS). Methods Fifty patients without PCOS treated with in vitro fertilization and embryo transfer (IVF-ET) were selected in this study. The granulosa cells were extracted and cultured in vitro. Cells were randomly divided into treatment group and control group. The 5 nmol/L interleukin (IL)-1, IL-6 and tumor necrosis factor (TNF)-αwere given to treatment group, and same amount of inflammatory diluted solution was added to control group. The levels of ROS and copy numbers of mtDNA were compared between two groups. Results The ROS levels and mtDNA copy number of granulosa cells were significantly higher in IL-1, IL-6 and TNF-αtreatment groups than those of control group (P<0.05). Conclusion Inflammatory markers of IL-1, IL-6 and TNF-αincrease the level of ROS and damage mtDNA in granulosa cells.
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Objective To build the index about the training effect of oncology specialist nurse and test the reliability and validity.Methods By consulting literature and the methods of Delphi,which was consulted by the 9 experts and the two rounds of 35 experts,the original index was estabhshed.The correlation coefficient and validity of the index was evaluated.Results A total of the index was consist of 106 first-l,second-land third-llevel items.Questionnaire recovery rate was 100％ (35/35).The level of authority was 0.816.Expert opinion concentration in various purposes mean variation coefficient was less than 0.244 2.The coordination level of expertise was 0.302.The overall reliability Cronbach α was 0.963.Adopting the method of double variable Spearman calculated the correlation coefficient was above 0.428.Cronbach a of second-and third-level indexes were 0.512-0.895.The second-land third-level indexes correlation coefficient were 0.428-0.931.Conclusions The index about the training effect of oncology specialist nurse has the high authority and representative.The reliability and validity of the index are better,which can be used to evaluate the efficacy of the evaluation about the training of oncology specialist nurse.
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Objective To investigate the clinical values of next-generation sequencing (NGS) technology in diagnosis of miscarried chorionic villi genetic disorders. Methods Patients who underwent miscarriage (n=87) were enrolled in this study. Among all patients, 32 cases were of recurrent miscarrage and 55 cases were of sporadic miscarriage. In all collected patients, 35 women were 35 years or older while other 52 women were less than 35 years old. Positive detection rate and the abnormal detection rate were compared between these two methods. Chromosomes abnormal rates were also compared among different types of miscarrage and different ages. All aborted villi tissue were analyzed by NGS of whole genome and G-band?ing karyotype. Results The successful detection rate of chorionic villi by NGS (100.00%) was higher than that of G-band?ing karyotype (74.71%), and the detection rate of abnormal chorionic villi by NGS (58.62%) was also higher than that of G-banding karyotype (50.77%). Three cases of chromosome structure anomaly were found in those 51 chromosome anomalies (5.88%). Other 48 cases of chromosome anomalies were aneuploidy anomalies (94.12%) include 39 cases of trisomy, 2 cases of double trisomy and 1 case of triple trisomy and 6 cases of monomer. On the other hand, 32 cases of chromosome aneuploi?dy anomalies were found in 33 chromosome anomalies by G-banding karyotype, which include 24 cases of trisomy, 2 cases of double trisomy, 1 case of triple trisomy, 5 cases of monomer and 1 case of chromosome structure anomaly. Most NGS re?sults (n=64) were in agreement with G-banding karyotype but with 1 case of discrepancy. Chromosomal abnormality rate de?tected by NGS in sporadic miscarrage group and recurrent spontaneous miscarrage group were 60.00%and 56.25%respective?ly. There was no significant difference (P>0.05). Chromosomal abnormality rate picked by NGS in women aged≥35 years old (71.43%) was higher than that in women<35 years old (50.00%) with statistically significant difference (P<0.05). Conclu?sion NGS technology showed highly accuracy in detecting chromosomal abnomality from villi tissue. Therefore, it could help to detect genetic disorders of miscarrage. It is useful to determine the reasons of miscarrage and guide the next pregnancy.
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Objective To investigate the influence of pregnancy and delivery on maternal graft and newborns after renal transplantatior.Method Two cases of successful pregnancy and delivery after renal transplantation were retrospectively analyzed and the literatures were reviewed.Result The first recipient received the immunosuppressive treatment,which was based on the mycophenolate after renal transplantation.Three years after transplantation,the recipient had the requirement of pregnancy,but there was no pregnancy without contraception for over one year.On the next month after the myocphenolate-based immunosuppressive regimen changed to the purine-based,B ultrasound revealed follicular growth,ovulation and pregnancy.Caesarean section was performed at 37 gestational weeks and a body was delivered.The weight of the boy was 2 750 g,and the Apgar scores of the newborn were 10.The second recipient received triple immunosuppressive therapy (cyclosporin A + azathioprine + methylprednisolone),and got natural pregnancy 4 years after renal transplantation.The recipient was hospitalized due to the increased blood pressure and reduced fetal heart rate at 33 W+2 gestational weeks,and discharged after treatment.Caesarean section was performed at 38 W+1 gestational weeks,the weight of the boy was 3 000 g,and the Apgar scores of the newborn was 10.After follow-up for 8 years old,there was on abnormity of the function of the transplanted kidney and the growth of the newborns.Conclusion Successful pregnancy and delivery are possible in renal transplant recipients with normal renal function.Regulating the immunosuppressive regimen appropriately,and treating the complications of pregnancy effectively can obtained the satisfactory outcome of pregnancy.
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Objective:To investigate the effective method to avoid the ovarian hyperstimulation syndrome(OHSS)in infertile patients underwent in vitro fertilization-embryo transfer(IVF-ET)and whole embryo freezing and thawing 2-3 cycles after egg retrieval.Methods:The controlled ovarian hyperstimulation(COH),the number of retrieved oocytes,the number of embryo freezing,and clinical pregnancy rate were compared between 239 patients with the ET cycle(group A)and 164 patients with whole embryo freezing and thawing(group B).Results:The levels of initial dosage of gonadotropins(Gn)and total dosage of Gn were higher in group A compared with those of group B(P ＜ 0.01).The level of estradiol(E2)on day of human chorinonic gonadotrophin(hCG),the number of retrieved oocytes and the number of embryo freezing were lower in group A compared with those of group B(P＜ 0.01).There were no differences in patient age,COH,rate of OHSS and clinical pregnancy rate between group A and group B.Conclusion:Freezing the whole embryos and thawing ET 2-3 cycles after egg retrieval didn't influence the treatment results in infertile patients.
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OBJECTIVE To investigate the antibiotic use during perioperative period in surgery after administration according to Antibiotic Drug Use Guideline.METHODS The antibiotics usage status among 462 outpatient cases in Mar 2005 and 483 cases in Mar 2006 during perioperative period in surgery were surveyed.RESULTS The preventive use rate of antibiotic medication in surgery in 2005 and 2006 were respectively 99.48% and 88.12%(P
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OBJECTIVE To investigate the risk factors of professional exposure among medical staff and explore the preventive strategies.METHODS The influence of factors including profession,exposure process,exposed materials,treatment process,and follow-up among 110 medical staff with professional exposure was analyzed.RESULTS The general incidence of professional exposure was 52.73%,35.45% and 6.36% for clinical doctors,nures,and workers,respectively.Among all exposure cases,we found the incidence was 62.73% for pricking wound,20% for various liquid contamination,4.55% for glass injury,2.73% for scalpel cutting,and 4.55% for other instrument related damage.The reasons leading to exposure were treatment and nursing care,surgery assistance,and instrument and materials manipulation,which accounted for 40%,31.82%,and 18.18% of total incidence,respectively.All of the exposure cases had been properly treated.None of the investigated cases had been found illed with blood derived transmitted disease caused by professional exposure.CONCLUSIONS It is critical to intensify the training of medical staff for the knowledge of professional exposure and to improve their personal protective awareness,so that the incidence of professional exposure could be reduced.
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OBJECTIVE To offer scientific basis for reasonable usage and management of antibiotics through surveying the situation and problems of antibiotics usage in surgery during perioperative period.METHODS The antibiotics usage status among 462 cases of patients during perioperative period was retrospectively analyzed.RESULTS Antibiotics were used in 460 patients.The rate of prophylactic usage was 83.26%,the rate of therapeutic one was 16.74%;the duration of postoperative prophylaxis was:80.68% of the patients were treated with antibiotics for 4 days or more,the longest one was 28 days;43.26% of the patients received single antibiotic treatment,and 44.13%,11.96%,or 0.65% of patients received 2,3 or 4 kinds of antibiotics combined therapy respectively.CONCLUSIONS Improper application of antibiotics during perioperative period needs higher level administration.
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Objective To observe the effect of drug pairs of extracts from Rhizoma Chuanxiong(RC)and Radix Paeoniae Rubra(RPR)in different proportions on promoting blood circulation and removing blood stasis in rats and to find the optimal proportion between the two extracts.Methods The Wistar rat models of blood stasis were established by injection of adrenalin.The changes of the platelet aggregation and adhesiveness and erythrocyte aggregation were observed.Results Blood vessel contraction increased,the platelet aggregation and erythrocyte aggregation increased,erythrocyte deformation occurred and the blood viscosity increased in the model rats.The drug pairs could reduce blood viscosity,ameliorate erythrocyte ability of deformation,reduce erythrocyte aggregation and inhibit platelet aggregation.The effects were obvious especially in the groups of RC and RPR in the proportions of 0.45 g to 0.45 g,0.21 g to 0.45 g.Conclusion The drug couples from RC and RPR in different proportions could improve the blood rheology,the effect being obvious in the groups of RC and RPR in the proportions of 0.45 g to 0.45 g,0.21 g to 0.45 g.
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Objective To further study the clinical efficacy and safety of salvianolate injection for the treatment of angina pectoris in coronary heart disease (CHD)with heart-blood stagnation syndrome. Methods A randomized imitative-blind mutli-center clinical trials with positive control and 3 parallel tests was carried out in 480 cases. The patients were divided into three groups: the control group received salviane injection 20 mL (n=120), the treatment group 1 (n=240) and treatment group 2 (n=120) received salvianolate injection in a dosage of 200 mg and 400mg respectively . After 14-daytreatment , the clinical efficacy and safety of salvianolate were observed. Results The total angina pectoris efficacy rates were 88.085 %in treatment group 1, 89.744 %in treatment group 2 and 67.257 %in control group (P
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Rabbit model of arteriosckrosis of iliac artery was used in this experiment. Results showed: after 4 weeks of PTA operation, the calibre of the artery in large dose concentrated pill (LCP) group was obviously larger than that of the western drug group and Lovastatin group (P