Mesalamine (5-aminosalicylic acid, 5-ASA) is used for ulcerative colitis, mild Crohn′s disease. The orally taken mesalamine is excreted primarily as N-acetyl-5-aminosalicylic acid (N-acetyl-5-ASA) via urine, renal damage and hematuria are rare. However, red-brown urine discoloration has been noted by some patients, which is associated with the reaction between N-acetyl-5-ASA and remaining hypochlorite in the disinfectant-containing water. This article reports a case of mesalamine-associated red-brown urine discoloration and reviews related literatures.

Neuroendocrine tumours (NETs) are clinical heterogeneous. To date, no studies have focused on the genetic characteristics of NETs at different anatomical sites. We aim to explore the genetic similarities or differences between NETs at different sites. The patients were from a clinical study STEM (from a single institute, NCT03204032, NCT03204019). This cohort included 47 patients, including 14 Pancreatic NETs (pNETs), 11 Rectal NETs, 14 Thoracic NETs, and 8 Others. Whole exome sequencing (WES) was performed. The WES data of pancreatic cancer (PCa), rectal cancer (RC) and lung cancer (LC) from TCGA were used to compare the genetic characteristics with NETs. Somatic mutational analysis showed that there were no differences in tumor mutation burden, intra-tumoral heterogeneity or mutation spectrum between different NETs. We found several specific driver mutations for pNETs (MEN1 et.al), Rectal NETs (APC et.al) and Thoracic NETs (CACNA1A). Compared with cancers, few significantly mutated genes were shared by pNET and PCa; mutations in APC mostly occurred in both Rectal NET and RC; and some common mutations were observed in Thoracic NET and LC. Copy number analysis showed that copy number loss frequently occurred in all NETs. Deletions of chromosomal regions 14q11.2, 19p13.2, 19q13.31 and 1p36.21 were observed in all NETs. Moreover, we found several specific alterations of chromosomal regions for different NETs. Compared with NETs, counterpart cancers harbored copy number gain as well as copy number loss. Some altered chromosomal regions were shared by Thoracic NET and LC, while none were shared by NET and cancer at pancreas or rectum. Furthermore, we investigated the main altered pathways previously reported in pNETs or small intestine NETs. All NETs had frequent alterations in WNT pathway, PI3K/mTOR pathway, DNA repair pathway, chromatin remodeling pathway and cell cycle pathway. However, several differences in pathway alterations were observed between different NETs, indicating that pathway alterations may be achieved through different genetic routes. NETs at different sites had different genetic characteristics, which have the potential to distinguish the primary site of NETs.

BACKGROUND:Diabetic mellitus erectile dysfunction (DMED) refers to erectile dysfunction (ED) secondary to diabetes. As people's lifestyle changes and the population ages, the incidence of DMED continues to increase. Many clinical trials have proven that PDE5-inhibitors-vardenafil has a significant effect in the treatment of Diabetic mellitus erectile dysfunction. In this systematic review, we aim to evaluate the effectiveness and safety of PDE5-inhibitors-vardenafil for Diabetic mellitus erectile dysfunction.METHODS:We will search PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to February 2019.We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of Diabetic mellitus erectile dysfunction.ETHICS AND DISSEMINATION:This systematic review will evaluate the efficacy and safety of PDE5-inhibitors-vardenafil for treating Diabetic mellitus erectile dysfunction. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.TRIAL REGISTRATION NUMBER:PROSPERO CRD42018095185.

Objective To explore the effect of appreciation intervention on anxiety and complications in patients with renal biopsy. Methods A total of 197 cases of renal biopsy patients were divided into the control group (n=96) and the observation group (n=101). The observation group was given comprehensive nursing intervention with appreciation, the control group was only given comprehensive nursing care, the two groups were evaluated with Zung Self-rating Anxiety Scale (SAS) upon admission and 1 week after puncture. Results After intervention, the SAS score of the observation group was 30.87 ± 4.52, and the SAS score of the control group was 32.32 ± 3.72, and the difference between the two groups was statistically significant (t=2.45,P<0.05). Totally 97 patients in the observation group and 78 cases in the control group received bed urination exercises, and the difference between the two groups was statistically significant (χ2=9.412,P<0.01). The complications of two groups were collected, the complications in the observation group were 27 cases, and the complications in the control group were 50 cases, the difference between the two groups was statistically significant (χ2=13.285,P<0.01). Among the postoperative complications, 8 of the patients in the observation group had urinary retention, and 19 of the control group had urinary retention (t=2.446,P=0.015). In the observation group, 3 cases had abdominal distention, and 10 cases in the control group suffered from abdominal distension (t=2.117, P=0.035). In the observation group, 1 case had low back pain, and 6 cases in the control group suffered from lumbago (t=2.004, P=0.047); the difference was statistically significant. Conclusions Appreciate intervention for patients with renal puncture biopsy has a positive impact on the bed urination exercise in puncture before surgery. It can alleviate the anxiety of patients received renal biopsy, reduce urinary retention, abdominal distension and pain complications, and improve bedridden experience.

The primary focus of our paper is on the potential for in-house journal ranking lists to create friction between international collaborating researchers due to differences in how particular journals are rated on different lists. Using a questionnaire distributed to Chinese accounting researchers, we identify a number of potential friction points between Chinese and UK researchers. We find that almost all of our Chinese respondents use their own school's in-house ranking list as the primary or exclusive reference point for assessing journal quality, and 73% of respondents acknowledge that this has caused problems when working with scholars from other universities because of differences in how their institutions rank journals.

为了方便住院患者临时用药，临床科室一般都备有固定数量的基数片剂。按照药片管理规定，药疗护士需要每日清点，按用量补充，以保证临床用药。我院大多数临床科室多用容积为60 ml的广口玻璃磨砂瓶存放基数片剂。相对于药片来讲，瓶子大，药片小，护士每日清点药片数量费时费力，取药时容易遗撒，并且零散片剂上无法标记效期，导致护士在用药时无法保证药品“先入先出”的药品管理原则，只能整年度更换，造成浪费。这成为临床护士药品管理和用药安全方面的难题。通过观察和临床实践，发现利用生活中常见的透明吸管可以解决这个难题。

妊娠可由于高凝状态、缺氧及容量负荷增大等因素导致肺动脉高压.肺动脉高压是指由多种心、肺或肺血管本身疾病引起,以肺血管阻力进行性升高为主要特征,可致右心负荷增大、右心功能不全、肺血流减少,而引起的一系列临床表现[1],肺动脉高压最常见的首发症状是活动后气短、晕厥或眩晕、胸痛、咳血等.由于肺动脉压升高可出现右心衰竭,可见颈静脉怒张,肝肿大,腿部和踝部水肿.肺动脉压≥80 mmHg(1 mmHg=0.133 kPa)为重度肺动脉高压,最终导致患者因右心衰竭死亡.有研究报道,妊娠合并继发性肺动脉高压的孕妇病死率为56％,其中仅25.6％妊娠能足月分娩,围生期病死率高达28.3％[2].本科室2012年10月收治1例妊娠并发重度肺动脉高压伴阴道流血产后9周的患者,经过积极治疗和精心护理,获得明显临床效果,现报道如下。

肺出血-肾炎综合征(Goodpasture's syndrome,GPS)是以肺弥漫性出血、肺泡内纤维素沉着和肾小球肾炎为特征的一组综合病症[1].由于GPS患者的肺泡壁毛细血管基膜和肾小球基底膜存在交叉反应,故可以引起继发性肾损伤[2].该病罕见,预后不佳,可发生于任何年龄,尤以青年男性多见,平均年龄为21.0～26.8岁,男女比例3.6～9.0:1,临床特征为咳血、水肿、贫血、尿检异常及进行性肾功能减退,咳血发生率为82％～98％,94％的患者以咳血为首发症状[3].2012年9～11月我院收治了1例GPS患者,经过精心治疗与护理,病情好转出院,本文将护理体会进行总结,现报道如下.

>在临床护理工作中,基数药品管理要求规定:药物必须要根据有效期的先后顺序进行摆放,针剂药品我院要求用原包装盒盛放药物。基数药通常只设5～10支作为基数,但包装盒大小不一,药品将如何整齐有序的摆放,给临床护士提出了一个难题。工作难点:(1)护士按顺序摆好安瓿后,安瓿容易歪倒,从而打乱了固有的有效期顺序;(2)在歪倒的安瓿中,护士取药时不一定每次都拿到效期最近的药品;

药品有效期的管理是保证临床用药安全有效的重要环节,也是临床护理质量管理的工作重点.栓剂药品在病房常备基数药品中是不可或缺的,在工作中我们发现,领用病房基数栓剂药品时,药房通常根据医嘱单支发放,导致药品散放在药盒中,在清点药品时需要全部取出,逐支清点,放回药盒后再次成为散放状态;护士在使用时也需重复清点、寻找最近有效期的药品.我们在临床实践中自制栓剂药品粘贴板应用于基数药品管理,改变了栓剂药品散放在药盒中的状态,便于清点、取用和检查,现将方法介绍如下.

在临床护理工作中,我们常需为患者将药物研碎服用或者鼻饲,但是在操作中发现药物在研钵中研碎时费时费力,如研药者需要小心避免研药时药物颗粒溅出,以免影响服药剂量;研药后需用毛刷反复清扫研钵使药物粉末全部进入药杯;每次研药后需清洗晾干研钵、碾药棍及毛刷,若研药的患者多,每次研药间隙不便清洗等.

>本研究旨在探讨中国HIV感染者奈韦拉平(NVP)血浆药物浓度与疗效和肝毒性发生的关系。一、对象与方法1.对象:这是一项前瞻性、多中心、随机研究,227例入组的初治患者分别来自全国13个分中心,在2002—2008年期间均接受包含NVP的一线抗病毒治疗方案。研究经过各参与单位医学伦理委员会审查,所有患者均签署知情同意书。入组标准:年龄18～65岁;用ELISA检测HIV-1抗体阳性并通过Western blot法确认;自愿签署知情同意书;未接受

住院患者经常需要留取大量尿液或引流液的标本送检.例如,以往我科医生进行腹腔穿刺抽取腹水标本时,需要用500ml玻璃瓶2～3个收集腹水送检,每次都要开启未开封的玻璃瓶注射液,将瓶内液体丢弃之后用空瓶留取标本.

临床上行血液透析、连续性肾脏替代治疗或其他血液净化治疗时,需要通过颈内静脉置管术建立透析通路.术后护士对穿刺部位进行包扎固定的同时,需要妥善固定导管,以防止导管滑出、折叠或扭曲.

卟啉病又称紫质病,系由血红素生物合成途径中特异酶缺乏所致的一种卟啉代谢紊乱代谢病.卟啉或其前体如δ-氨基-r-酮戊酸(ALA)和胆色素原(PBG)生成,浓度异常升高,并在组织中蓄积,由尿和粪中排出,分遗传性和获得性两大类.急性间歇性血卟啉病(AIP),为一种常染色体显性遗传病,由于胆色素原(PBG)脱氨酶缺乏所致.起病常在20-40岁,男女之比为2:3.临床上以间歇腹痛、植物神经功能失调和神经精神症状为主要表现.我科于2010年10月收治1例以月经周期孕酮增高诱发的急性间歇卟啉病患者,起病隐匿,周期性发作,经积极治疗和护理,病情好转出院,现报道如下。

临床禁食患者常需要静脉输入高营养液体,在配置液体过程中,经常需要向袋装液体内加入瓶装氨基酸等药物,加入药液量可多达200 ml,用注射器抽取,存在很多安全隐患和不便利,如增加瓶口被污染的几率,瓶口的橡胶塞在多次穿刺后极易出现破溃,导致药液外漏,操作步骤繁琐,降低了工作效率.我病房在配制静脉高营养药液时使用输液连接管,避免了上述的问题,取得了良好的效果,现介绍如下.

体温是生命体征的指标之一,其测量的准确性直接关系到疾病的诊断、治疗和护理.目前,临床护士标记体温频率常不能按照正确频率测量,主管护士需要反复翻看体温本;一般住院患者的体温测试按内科护理常规进行,但是,临床上体温测量往往不能在患者体温正常3d后及时、正确更改测量频率.为此,笔者将体温标记频率的经验进行归纳,现报道如下.

>患儿男,8岁,因发作性肌束颤动7年,注意力下降2年就诊于我院。患儿为第1胎足月顺产儿,1岁前身体、智力发育同正常婴幼儿。自1岁始,间断发生无明显诱因的午后哭闹,随即四肢肌束颤动、意识丧失,多次到急诊就诊,检查头颅核磁、CT、脑电图等均未见明显异常,监测血糖明显降低,给予葡萄糖静脉注射后症状缓解。随患儿年龄的增长,该症状频繁出现,曾在外院诊为"低血糖",给予分餐治疗后病情平稳。2005年始,患儿上学后多次于午后无诱因出现发作性反应迟缓,活动能力下降,手脚

<正>附红细胞体病(简称"附红体病")是由附红细胞体附着在血液里红细胞表面或游离于血浆中而引起的一种人畜共患传染病。临床上以发热、贫血、淋巴结肿大或黄疸等症状为主要特征[1]。该病发病率高,死亡率低,目前确诊可依靠直接涂片镜检,传播方式包括接触传播、垂直传播、昆虫媒介传播等,在临床上以血源性传播为主。