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This paper introduced the current situation of the talent training system of French nursing college, including enrollment conditions, length of schooling, training objectives, teaching methods, curriculum framework, etc., in order to explore the way of localization of nursing talents training reform, and hope to further strengthen the cooperation and training of colleges and universities, to explore the diversified enrollment mode of students,to deepen the training mode guided by working competence, and to enhance unique and internationalization of Nursing courses.
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Objective The aim of this study is to investigate whether functional intracranial collateral circulation can predict the security of carotid endarterectomy (CEA) by transcranial doppler (TCD) combined with transcranial color code duplex (TCCD) preoperatively.Methods A total of 437 patients with carotid stenosis undergone CEA surgeries from January 2013 to November 2015 were included in this study.According to the functional intracranial collateral artery via TCD and TCCD,patients were divided into four groups:(A) anterior communicative artery (ACoA) (B) posterior communicative artery (PCoA) (C) both ACoA and PCoA and (D) external-internal carotid artery (E-ICA) or no communicative artery.Velocities and the pulsatility index (PI) of the ipsilateral middle cerebral artery (MVMCA) were compared among the four groups during clamping and de-clamping period.Results After clamping,there were significant difference of decreasing scale of MVMCA and PIMCA among the four groups (F=43.737,P＜0.001;F=9.298,P ＜ 0.001),especially for the group D (t=9.330607,0.488951,t=5.534661,2.797039,t=10.0751,0.488951;all P ＜ 0.005).After de-clamping,compared with the baseline,there were also significant difference of increasing scale of MVMCA and PIM CA among the four groups (F=6.260,2.840,all P ＜ 0.05);compared with clamping,there were also significant difference of increasing scale of MVMCA among the four groups (H=62.210,P ＜ 0.001),the increasing scale of MVMCA for group D was significant higher than the other three groups (t=4.104773,2.190371,3.06337,all P ＜ 0.005).However,there was no differences of increasing scale of PIMCA among the four groups (P ＞ 0.05).The occurrence of cerebral hyperperfusion syndrome (CHS) were in significant differences (x2=13.255,P=0.004) among the four groups.Higher occurrence rate of CHS was found in group D compared with groups A and C (H=8.734,6.764,all P ＜ 0.01).Insufficient intracranial collateral circulation was an independent risk factor for CHS (OR=5.917,95％CI:1.325-26.415,P=0.02).Conclusion The evaluation of intracranial collateral circulation with TCD combined with TCCD can help to predict potential risk of CHS preoperatively,and improve the safety of CEA.
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Objective To evaluate the correlation between the types of vertebral artery occlusion and their compensatory hemodynamic changes and posterior circulation ischemia using color Doppler flow imaging combined with transcranial color-coded sonography.Methods From June 2015 to June 2016,A total of 108 patients with vertebral artery occlusion confirmed by vascular sonography,digital subtraction angiography (DSA) or CT angiography (CTA) were enrolled retrospectively.According to the magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) findings,they were divided into posterior circulation infarction (n=78 in infarction group) and non-posterior circulation infarction (n=30 in TIA group).Color Doppler flow imaging and transcranial color Doppler ultrasonography were used to examine the contralateral vertebral artery extracranial diameter, peak systolic velocity(PSV) and end diastolic velocity(EDV) of bilateral extracranial and intracranial vertebral arteries.The differences of the vertebral artery occlusion types,establishment of collateral circulation and hemodynamic changes of the contralateral vertebral artery were compared between the two groups.Results The patients with single vertebral artery occlusion in the infarction group and TIA group were 69 (88.5%) and 26 (86.7%) respectively;those with bilateral vertebral artery occlusion were 9 (11.5%) and 4 (13.3%) respectively.There was no significant difference in the number of vertebral artery occlusion between the two groups (χ2=0.000,P=1.000).The proportion of patients with vertebral artery occlusion in intracranial segment in the infarction group was higher than that in the TIA group (70.5% [55/78] vs.36.7% (11/30);χ2=10.444,P=0.001).The proportion of patients with the establishment of collateral circulation in the infarction group was lower than that in the TIA group (14.1% [11/78] vs.43.3% (13/30);χ2=10.711,P=0.001).The peak systolic velocity (PSV) and the end diastolic velocity (EDV) of contralateral extracranial vertebral artery in patients with single vertebral artery occlusion in the TIA group were higher than those in the infarction group (65±21 cm/s vs.57±15 cm/s,25±8 cm/s vs.20±7 cm/s,t=2.043 and 2.606 respectively,all P<0.05).Conclusion The establishment of collateral circulation and hemodynamic compensation of the contralateral vertebral artery after vertebral artery occlusion were closely associated with the occurrence of posterior circulation ischemia.
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Objective To investigate the evaluation value of anterior communicating artery patency for patients with severe carotid artery stenosis treated by carotid endarterectomy (CEA )with transcranial color Doppler ultrasonography. Methods From June 2014 to June 2015,89 consecutive inpatients with unilateral symptomatic severe carotid stenosis treated with CEA at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They were divided into either a patent group (n=45)or a non-patent group (n=44)according to whether the anterior communicating artery was patent or not (DSA findings). Whether the anterior communicating artery was patent or not diagnosed by the transcranial color Doppler ultrasonography was compared with the consistency of the digital subtraction angiography (DSA)results. The differences of intraoperatively implemented temporary shunt rate and the differences of hemodynamic parameters including peak velocity (PSV),end-diastolic velocity (EDV),and pulsatility index (PI)of the preoperative and postoperative bilateral middle cerebral artery and anterior cerebral artery (ACA)of both groups were analyzed. Results Compared with the results of DSA, the sensitivity and specificity of transcranial color Doppler ultrasonography for preoperative evaluation of the patency of anterior communicating artery were 91. 1%(41/45)and 97. 7%(43/44)respectively,the total accordance rate was 94. 4%(84/89)(Kappa=0. 888,P0.05). There were no significant differences in PSV,EDV and PI of the contralateral ACA in the non-patent group between after procedure and before procedure (all P>0. 05). Conclusions Transcranial color Doppler ultrasonography can accurately and objectively evaluate whether the anterior communicating artery is patent or not in patients with unilateral severe carotid stenosis. It has an important clinical significance for selective shunt in CEA and improving the success rate of CEA.
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Objective Our aim was to study the influence of integration courses combining the death education and resilience cultivation on nursing students.Methods 290 nursing students were randomly divided into the control group and the intervention group with 145 students in each group.The students in the intervention group was provided with the integration courses for 20 class hours based on the curricula of the control group.The influence on the resilience,death anxiety,feeling of sense of life,coping style of students was observed.Results Measurement results showed that the students of two groups had no differences in the four aspects before education,but after education the two groups students showed significant difference,including the average score of resilience and death anxiety,total score of feeling of sense of life as well as the dimensions score of life goals and life value t value was 5.703,3.294,3.649,4.130 and 2.129,P ＜ 0.05.In addition,the mean effectiveness of positive coping styles,problem solving and seeking social support of the two groups showed significant difference too,and all the difference had statistical sense,t value was 1.992,1.977 and 3.344,P ＜ 0.05.Conclusions The integration course can reduce death anxiety as well as improve the resilience of nursing students.
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Objective To investigate the correlation between the stroke-related risk factors and carotid stenosis lesions of ≥40 year′s old Han and minority populations in a community in Beijing as well as the clinical value of carotid ultrasound screening. Methods An investigation of risk factors for stroke and the results of carotid artery ultrasound screening in 510 cases (≥40 years old) Han population and 243 minority population in a community in Minzu University of China in Beijing in April 2014 were analyzed. Results (1)The prevalence of hypertension of the Han population was significantly higher than that of the minority population (53. 5% [n=273] vs. 44. 4% [n=108]; χ2 =5. 43,P=0. 02). (2) The detected rate of carotid intima-media thickness ( IMT ) of the Han population was higher than that of the minority population (77. 5% [n=395] vs. 69. 1% [n=168]; χ2 =6. 03,P=0. 01). There was no significantly difference in the detected rates of carotid plaques and carotid artery stenosis between the two groups (χ2 =0. 56,1. 13 respectively,all P>0. 05). (3) Hypertension and smoking were the independent risk factors for carotid-intima thickening in Han population ( hypertension:OR,1. 851;95% CI 1. 213-2. 825; smoking:OR,2. 311;95% CI 1. 065-5. 016;all P<0. 05). Hyperlipidemia was an independent risk factor for carotid artery intima-media thickening in the minority population (OR,2. 586;95% CI 0. 952-8. 694,P<0. 01). Conclusion To investigate the risk factors for stroke in minority population in China are of particular importance for the prevention of carotid atherosclerotic disease. Carotid ultrasound examination is an important diagnostic technique for early detection of carotid atherosclerotic disease.
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Objective To investigate color Doppler flow imaging (CDFI)and transcranial color-coded sonography (TCCS)for detection and evaluation of severe stenosis of intracranial vertebral artery (IVA) before and after stenting,as well as the hemodynamic changes of restenosis and their clinical value. Methods A total of 102 patients with severe stenosis of IVA confirmed by CDFI plus TCCS and DSA from November 2011 to November 2013 were analyzed retrospectively. Extra- and intracranial segments peak systolic velocity (PSV),end-diastolic velocity (EDV),IVA pulsatility index (PI),extracranial resistance index (RI),tube diameter,spectrum morphology,and hemodynamic parameters before stenting and 1 week, 3,6 and 12 months after stenting were compared. According to the results of TCCS,they were further divided into either a restnosis group (n=16 )or a non-restnosis group (n=86 ). Results (1 )The results of TCCS detection showed:PSV,EDV,and PI of the stenotic segments were improved significantly at 1 week after stenting,they were 109 ± 40 cm/s vs. 258 ± 63 cm/s,47 ± 18 cm/s vs. 132 ± 45 cm/s,0. 91 ± 0. 15 vs. 0.75 ± 0. 18,respectively. There were significant differences (all P0. 05). (2)The results of CDFI showed:PSV and EDV of the ipsilateral extracranial segment were improved significantly after procedure compare with those before procedure, they were 64 ± 15 cm/s vs. 51 ± 15 cm/s and 24 ± 6 cm/s vs. 19 ± 7 cm/s (all P<0. 05). The RI value and vertebral artery diameter of the extracranial segment were improved gradually,and they reached the peak at 12 months after procedure (0. 61 ± 0. 07 vs. 0. 63 ± 0. 12,P=0. 038;3. 6 ± 0. 4 mm vs. 3. 4 ± 0.5 mm,P=0. 009). Conclusion CDFI in combination with TCCS can objectively evaluate the extra-and intracranial hemodynamic changes before and after IVA stenting,and provide reference information for the effectiveness of stenting and the imaging evaluation of restenosis.
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Objective To investigate the criteria of hemodynamic parameters for diagnosis of intracranial segment vertebral artery stenosis with transcranial color-coded sonography (TCCS ). Methods A total of 622 outpatients or inpatients with suspected posterior circulation ischemia were enrolled retrospectively,from which 216 patients were selected with TCCS,color Doppler flow imaging (CDFI)screen,and digital subtraction angiography (DSA)examination,including 33 patients (15. 3%) had normal intracranial vertebral arteries,the stenosis rates<50% were 45 cases (20. 8%),50%-69%were 44 cases (20. 4%),and 70%-99% were 94 cases (43. 5%). The mean velocity (MV)of intracranial segment,the ratios SPRP (PSV1/PSV2 ),SPRE (EDV1/EDV2 )of the systolic and end diastolic flow velocity between the intracranial segment and the intervertebral space segment were calculated respectively by detecting the intracranial segment of vertebral artery,the intervertebral space segment peak systolic velocity (PSV1 ,PSV2 )and end diastolic velocity (EDV2 ,EDV1 ). The DSA findings were used as the criteria,the area under the receiver operating characteristic (ROC ) curve was calculated and the optimal cut-off points were obtained. Results The optimal cut-off points of TCCS diagnosis of intracranial vertebral artery stenosis were as follows:the parameter standards of stenosis rate <50% were 110 cm/s≤PSV1≤145 cm/s and 65 cm/s≤MV≤85 cm/s,the parameter standards of stenosis rate 50%-69%were 145 cm/s≤PSV1≤190 cm/s and 85 cm/s≤MV≤115 cm/s,and the parameter standards of stenosis rate 70%-99% were PSV1≥190 cm/s and MV≥115 cm/s. Conclusion TCCS may effectively evaluate the hemodynamic changes of intracranial vertebral artery stenosis and provide reference for the ultrasound evaluation criteria of intracranial vertebral artery stenosis.
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Objective To evaluate the short-term and long-term effects in patients of carotid artery subtotal or complete occlusion after carotid endarterectomy ( CEA) using vascular ultrasound. Methods A total of 107 consecutive patients were diagnosed as carotid artery occlusive disease with DSA and treated with CEA at Beijing Xuanwu Hospital,Capital Medical University from January 2005 to January 2014 were enrolled retrospectively. Sixty-three of them had subtotal occlusion ( the carotid artery stenosis rate 95% to 99%) and 44 had complete occlusion. The occurrence of perioperative complications of all patients was documented. The follow-up study used outpatient follow-up and telephone tracking. The patients of surgical recanalization were followed up with ultrasound at 1 week, 3, 6, 12, and 24 months after procedure. The clinical prognosis, restenosis, vascular structure and hemodynamic changes of the patients after CEA were documented. Results (1) Of the 107 patients,86 (80. 4%) achieved recanalization after procedure and 21 (19. 6%) did not. The incidence of stroke and death was 4. 7% (5 cases) within 30 days after procedure,among them the incidence of subtotal occlusion group was 4. 8% ( n=3 cases) and the complete occlusion group was 4. 5% (2 cases). (2) Within one week after procedure,the peak systolic velocity ( PSV) ,end diastolic velocity ( EDV) ,and pulsatility index ( PI) of the ipsilateral middle cerebral artery in the recanalization patients increased significantly (120 ± 39 cm/s vs 60 ± 17 cm/s,50 ± 18 cm/s vs 33±11cm/s,and0.96±0.20vs0.67±0.14,respectively).Thereweresignificantdifferences(allP6 to 12 months was 94. 2%(n=65),>12 to 24 months was 94. 2%(n=65),and more than 2 years was 91. 3%(n=63). Conclusion Vascular ultrasound can conduct short-term and long-term follow-up for carotid artery occlusive disease after CEA. The degree of blood flow improvement should be identified and restenosis should be found in time after procedure.
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Objective To investigate the combination of color Doppler flow imaging (CDFI) and transcranial Doppler (TCD) in the assessment of the hemodynamic changes of vertebral artery occlusion disease and their clinical value. Methods A total of 101 patients with vertebral artery occlusion detected by the combination of CDFI and TCD and confirmed by DSA were enrolled from January 2005 to January 2009. Taking the result of digital subtraction angiography (DSA) as a golden standard, The differences between the different types of the side of vertebral artery occlusion and contralateral vertebral artery on the extra- and intracranial segments were compared and analyzed in peak systolic velocity (PSV), end diastolic velocity (EDV), resistive indices (RI), pulsatility index (PI), spectrum morphology, and hemodynamics. Results No blood flow signals were detected by CDFI and TCD in patients of complete occlusion of the vertebral artery; the weak blood flow signals were detected by CDFI in patients of the occlusion in the intracranial segment of the vertebral artery. 3he blood flow signals after the establishment of collateral circulation in patients of the segmental occlusion were detected in the extraeranial segment or intraeranial segment of the vertebral artery. The PSV on the occluded sides of the extraeranial segments were decreased more significantly than that on the unoccluded sides (27.39 ± 12.44 cm/s vs. 62.61 ± 13.22 cm/s, P = 0.000); RI was significantly higher than the unoccluded sides (0. 99 ± 0. 21 vs. 0. 62 ± 0.07, P = 0. 000). When a vertebral artery had the segmental occlusion and the collateral circulation was established, the PSV, EDV, and PI of the intracranial segment of the vertebral artery on the occluded sides were decreased more significantly than those on the unoccluded sides, PSV were 37. 81 ± 12.28 cm/s and 73.17±30. 99 cm/s, respectively (P =0. 000), EDV were 17.58 ± 7.10 cm/s and 29.31 ± 12.94 cm/s, respectively (P = 0. 000), PI were 0.84 ± 0.22 and 1.01 ±0. 18, respectively (P=0. 000). The compard DSA showed that the sites of vertebral artery occlusion were different, There was significant difference in the Doppler flow velocity spectrum between the CDFI and TCD. Conclusions PSV, EDV, RI, and PI are the hemodynamic parameters of accurately assessing vertebral artery occlusion, and the combination of CDFI and TCD has significant value for the hemodynamie changes of different types of vertebral artery occlusion and the clinical comprehensive assessment.
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Guided by the study theory of constructivism,we utilize informational environment and resource to design the teaching of “nursing of mental disorders who abuse psychoactive substances”,change teaching methods divorced from reality,advocate situation teaching,recommend student' s initiative and cooperative study and improve the students' practical and innovative ability.