This paper explores the effect of FCM in undergraduate teaching of neurosurgery,so as to improve the examination results of undergraduates and their satisfaction with teaching,exercise their critical thinking ability and enhance the teaching effect.

To study the effect of（BOPPPS）combined with（MDT）in clinical teaching of neurology.The practice shows that the use of BOPPPS combined with MDT teaching mode in clinical teaching of neurology can effectively improve the assessment results of interns,improve their competence,stimulate learning interest and enthusiasm,improve teaching satisfaction,and further enhance the teaching effect.This has high clinical promotion value.

探讨进展性案例结合思维导图教学法在神经外科实习护士培训中的应用效果.实践表明,进展性案例结合思维导图教学法可有效提升神经外科实习护士的理论和实践成绩,提高临床护理岗位胜任力、批判性思维能力及护理教学满意度,值得进一步推广应用.

目的 探讨全身化疗联合调强放射治疗对复发性晚期三阴性乳腺癌(TNBC)的疗效.方法 采用回顾性研究方法,选择122例在我院诊治的复发性晚期TNBC患者作为研究对象,根据治疗方法的不同分为观察组(62例)与对照组(60例).对照组给予全身化疗治疗,观察组在对照组的基础上联合调强放射治疗.比较两组患者的疗效、毒副反应、免疫功能以及预后.结果 观察组患者治疗总有效率显著高于对照组(67.7％vs.33.3％,P<0.05).两组患者治疗期间骨髓抑制、消化道反应、脱发等毒副反应发生率比较,差异均无统计学意义(P>0.05).观察组患者治疗后CD3+、CD4+水平显著高于治疗前,并显著高于对照组(P<0.05),而对照组治疗前后CD3+、CD4+水平比较,差异无统计学意义(P>0.05).观察组患者总生存期及无进展生存期均显著长于对照组(P<0.05).结论 全身化疗联合调强放射治疗可提高复发性晚期TNBC患者的疗效,改善其免疫功能,延长其总生存期及无进展生存期,且不增加毒副反应.

目的 探讨干扰组织蛋白酶F(CTSF)的表达对胃癌HGC-27荷瘤裸鼠肿瘤体内增殖能力的影响.方法 30只Balb/c裸鼠采用皮下注射胃癌HGC-27细胞建立成瘤模型,然后随机分为对照组、顺铂组与联合组,每组10只.顺铂组给予顺铂注射治疗;联合组在与顺铂组治疗的基础上采用慢病毒感染载体CTSF-短发夹RNA(CTSF-shRNA)注射给予干扰CTSF表达治疗;对照组给予相同剂量相同注射方法的生理盐水治疗,三组均治疗观察4周.记录三组裸鼠的肿瘤体积、血管内皮生长因子(VEGF)与细胞凋亡变化情况.结果 荷瘤裸鼠治疗第2、4周的肿瘤体积、CTSF与VEGF mRNA及蛋白相对表达水平均依对照组、顺铂组、联合组之序递降,组间两两比较均有统计学差异(P＜0.01,P＜0.05).治疗第2、4周的肿瘤组织细胞凋亡指数依对照组、顺铂组、联合组之序递升,组间两两比较均有统计学差异(P＜0.01,P＜0.05).结论 干扰CTSF的表达联合顺铂治疗较单纯顺铂治疗对抑制胃癌HGC-27荷瘤裸鼠肿瘤体内增殖能力、促进肿瘤组织细胞凋亡、抑制VEGF表达的作用更明显,从而具有很好的抑瘤效果.

目的:探讨PTEN基因通过Akt-mTOR对乳腺癌细胞增殖与凋亡的影响.方法:人乳腺癌MDA-MB-231细胞随机分为两组:pcDNA3.0组与pcDNA3.0-PTEN组,分别转染pcDNA3.0质粒、pcDNA3.0-PTEN质粒2μg,转染48 h收集细胞.采用CCK-8法检测细胞存活率,双染法检测细胞凋亡,Western-blot检测细胞蛋白表达.结果:pcDNA3.0-PTEN组的细胞存活率低于pcDNA3.0组,对比差异有统计学意义(P＜0.05).与pcDNA3.0组对比,pcDNA3.0-PTEN组的细胞凋亡率显著上升,对比差异有统计学意义(P＜0.05).pcDNA3.0-PTEN组的PTEN蛋白表达量高于pcDNA3.0组,Akt、mTOR蛋白表达量低于pcDNA3.0组,对比差异有统计学意义(P＜0.05).结论:PTEN基因过表达可通过抑制Akt-mTOR信号通路,提高乳腺癌细胞凋亡指数,降低细胞增殖活性,从而发挥抑癌作用.

目的:探讨全程健康教育路径对提高三阴性乳腺癌患者治疗依从性及护理满意度的意义.方法:106例三阴性乳腺癌患者分为对照组和研究组,每组53例.所有患者均行乳腺癌根治术或保乳术,对照组予以常规健康教育,研究组予以全程健康教育.结果:研究组治疗依从率显著高于对照组(P<0.05);两组护理后生活质量评分较护理前显著增高,研究组护理后生活质量评分显著高于对照组(P<0.05);研究组护理满意度显著高于对照组(P<0.05).结论:全程健康教育路径应用于三阴性乳腺癌患者的围手术期护理,可显著提高患者的治疗依从性和护理满意度,从而改善患者的生活质量.

目的:观察绝经前乳腺癌改良根治术后患者化疗期间行综合性护理干预的效果.方法:将本院94例乳腺癌患者作为研究对象,分为对照组于化疗后行常规护理干预及观察组于化疗期间行综合性护理干预,两组各47例.通过生存质量评价量表(QLQ-C30)评估患者护理后生活质量的情况.结果:观察组功能质量评分中的情绪功能、躯体功能、角色功能及社会功能的评分较对照组均显著升高（均P＜O.05）,而两组认知功能的评分并无明显差异(P＞0.05).观察组症状表现评分中的失眠、疼痛、恶心呕吐、疲倦、便秘、食欲下降的评分较对照组均显著降低（均P ＜0.05）,而两组腹泻及呼吸困难评分的比较,均无明显差异(均P＞0.05).结论:绝经前乳腺癌改良根治术后患者化疗期间行综合性护理干预能够明显减轻化疗反应,有效改善临床症状,有助于提高患者的生活质量.

Objective To investigate the effects of selective psychological intervention on cancerous fatigue and life quality of patients with breast cancer after operation.Methods A total of 110 patients with breast cancer who reveived surgical treatment in our hospital from September 2014 to December 2016 were randomly divided into observation group (n =55) and control group (n =55) accorded to random envelope lot method.The patients in control group were treated by conventional nursing care,however,the patients in observation group,on the basis of control group,were treated by selective psychological intervention,with a treatment course of 3 months for both groups.Results The incidence rotes of postoperative incision infection,subcutaneous effusion,upper limb edema,skin flap necrosis and other complications in observation group were significantly lower than those in control group (P ＜ 0.05).The levels of CD3+ and CD4+ on 3 months after operation in both groups were significantly higher than those on 1d after operation (P ＜0.05),moreover,which in observation group were significantly higher than those in control group (P ＜ 0.05).In addition the scores of behavior/severity,emotion,sensation,cognition/emotion in observation group were significantly lower than those in control group (P ＜ 0.05),moreover,the scores of somatization,compulsion,interpersonal relationship,depression and anxiety in observation group were also significantly lower than those in control group (P ＜ 0.05).Conclusion The application of selective psychological intervention in patients with breast cancer after operation can alleviate cancerous fatigue status,which can decrease incidence of complications,improve patient's immunity function so as to improve life quality and prognosis of patients,therefor,which provides a basis for further improving the psychological intervention of breast cancer.

Objective:To investigate the application values of whole course optimization nursing in reducing diges-tive tract reaction of patients with MAC30 positive breast cancer with chemotherapy.Methods:From September 2012 to January 2016,78 cases of MAC30 positive breast cancer in our hospital for diagnosis and treatment were selected as the research objects.All the cases were divided into observation group and control group with 39 cases in each group according to the random draw envelope principle.The control group was given routine treatment and nursing,and the observation group was given the whole course optimization nursing based on the control group for 3 months.Results:The compliance rate in the observation group and the control group during chemotherapy were 100.0% and 87.2%, respectively,and the compliance of the observation group was higher than that of the control group(P<0.05).The incidence of nausea,vomiting,constipation and diarrhea in the observation group during chemotherapy were 23.1%, 20.5% and 5.1%,respectively,and 89.7%,61.5% and 33.3% in control group,so these of the observation group were significantly lower than that of the control group(P <0.05).The scores of quality of life in the observation group and the control group after chemotherapy were(57.55士10.25)scores and(70.14士9.89)scores,which were significantly lower than those before treatment of(87.49士11.48)scores and(87.10士10.41)scores(P<0.05).The quality of life score in the observation group after chemotherapy was significantly lower than the control group(P<0.05).Conclusion:The application of whole course optimization nursing in MAC30 positive breast cancer patients can reduce the occurrence of digestive tract reaction and improve the compliance of medication during chemo-therapy,so as to improve the quality of life of patients.

Objective:To investigate the effects of continuous early comprehensive nursing intervention on the psy-chological and quality of life of elderly patients with meningioma associated protein(MAC30)positive breast cancer. Methods:From September 2011 to December 2016,160 cases MAC30 positive breast cancer in the elderly patients after operation in our hospital were selected as the research object. All the patients were divided into observation group and control group with 80 cases in each group randomly. The control group was given routine nursing,the observation group was given actively continuous early comprehensive nursing intervention,two groups' nursing observation times were 3 months. Results:There were no statistical significance compared in the activity of shoulder joint before nursing in the two groups(P > 0. 05),and were significantly higher after nursing(P < 0. 05),and the observation group was significantly higher than the control group(P < 0. 05). The psychological status scores after nursing in the observation group and the control group were (14. 39 ± 2. 22)points and (19. 30 ± 3. 19)points that were significantly lower than those before treatment of (31. 28 ± 4. 29)points and (32. 00 ± 3. 89)points(P < 0. 05),and the observation group was lower than those of control group after nursing(P < 0. 05). The scores of overall health,pain,body image and future outlook in the observation group after nursing were significantly lower than those of the control group(P <0. 05). Conclusion:The application of continuous early comprehensive nursing intervention in patients with MAC30 positive breast cancer after operation can improve the shoulder mobility and improve the psychological status of pa-tients with breast cancer,so as to improve the quality of life.

Objective To investigate the curative effect and safety of single-hole transaxillary endoscopic thyroidectomy in the treatment of thyroid tumor.Methods Totally 130 patients with thyroid tumor were randomly divided into observation group and control group,with 65 patients in each group.Observation group underwent single-hole transaxillary endoscopic thyroidectomy and control group underwent conventional open thyroidectomy.The operation lasting time,intraoperative blood loss,hospitalization stay,postoperative 24-and 48-h visual analogue score,and postoperative 1-month complication rate were compared between two groups.Results The intraoperative blood loss ((23.09±10.20) mL) was significantly less,postoperative hospitalization stay ((4.33± 1.24) d) was significantly shorter,and postoperative 24-and 48-h visual analogue scores (3.82 ± 1.02,2.79 ± 0.82) were significantly lower in observation group than those in control group ((38.13±12.94) mL,(6.22±0.98) d,5.42±1.44,3.88±1.07) (P＜ 0.05),and there was no significant difference in the operation lasting time between observation group ((170.35±20.51) min) and control group ((165.33±19.40) min) (P＞ 0.05).The complications in 1 month after operation included subcutaneous emphysema in 1 patient,hypocalcemia in 1 and hypoparathyroidism in 1 in observation group,while subcutaneous emphysema in 3 patients,recurrent laryngeal nerve injury in 1,hypocalcemia in 4,and hypoparathyroidism in 4 in control group.The postoperative 1-month complication rate was significantly lower in observation group (4.6 ％) than that in control group (18.5 ％) (P＜0.05).Conclusion The single-hole transaxillary endoscopic thyroidectomy has a good feasibility,and it can promote the rehabilitation,relieve pain,and reduce the complication rate in the treatment of thyroid tumor.

目的 探讨上调磷酸酶及张力蛋白同源物(phosphate and tension homology deleted on chromsometen,PTEN)基因表达对三阴性乳腺癌细胞增殖及侵袭的影响及其作用机制.方法 对数期人三阴性乳腺癌ZR-75-细胞株随机分为PTEN组、突变型PTEN(mutated PTEN,M-PTEN)组和对照组,PTEN组、M-PTEN组分别转染人野生型PTEN真核表达质粒(pBP-PTEN)、突变型PTEN质粒(pBP-M-PTEN),对照组未作处理.转染后24、48、72 h,MTT法检测3组ZR-75-1细胞生长抑制率,转染后72 h,Transwell法检测3组侵袭细胞比率,流式细胞仪检测细胞周期,Western blot法检测磷酸化局部黏着斑激酶(phosphorylated focal adhesion kinase,P-FAK)、磷酸化蛋白激酶B(phosphorylated protein kinase B,P-Akt)表达水平.结果 PTEN组PTEN蛋白相对表达量(8.49±2.92)高于M-PTEN组(0.77±0.24)(P＜0.05),对照组无PTEN蛋白表达;转染后24、48、72 h,PTEN组细胞生长抑制率[(27.33±21.49)％、(37.20±11.48)％、(48.11±8.14)％]均高于M-PTEN组[(5.98±1.44)％、(6.98±2.84)％、(10.83±3.11)％]和对照组[(1.09±0.33)％、(2.10±0.83)％、(4.20±2.71)％](P＜0.05),M-PTEN组与对照组比较差异无统计学意义(P＞0.05);转染后72 h,PTEN组侵袭细胞数目[(24.29±5.82)％]低于M-PTEN组[(56.30±11.84)％]和对照组[(89.29±10.49)％](P＜0.05),M-PTEN组与对照组比较差异无统计学意义(P＞ 0.05);PTEN组G1期细胞比率[(54.89±2.67)％]低于M-PTEN组[(57.02±1.33)％]和对照组[(63.98±1.09)％],S期细胞比率[(36.56±2.10)％]高于M-PTEN组[(35.98±2.67)％]和对照组[(30.78±0.99)％](P＜0.05),G2/G1期细胞比率[(1.85±0.33)％]与M-PTEN组[(1.90±1.10)％]和对照组[(1.91±1.00) ％]比较差异均无统计学意义(P＞0.05),M-PTEN组G1、S、G2/G1细胞比率与对照组比较差异均无统计学意义(P＞0.05);PTEN组P-FAK蛋白相对表达水平(0.75±0.12)低于M-PTEN组(2.19±0.82)与对照组(3.23±0.62) (P＜0.05),P-Akt蛋白相对表达(2.11±0.42)与M-PTEN组(1.83±0.74)和对照组(1.94±0.53)比较差异均无统计学意义(P＞0.05);M-PTEN组P-FAK、P-Akt蛋白相对表达与对照组比较差异无统计学意义(P＞0.05).结论 PTEN抑癌基因可通过抑制乳腺癌细胞FAK磷酸化,抑制肿瘤细胞复制,进而抑制乳腺癌细胞增殖及侵袭.

目的 探讨空气波压力治疗对于乳腺癌患者术后抑郁和生活质量的影响.方法 将早期乳腺癌术后患者96例按照住院的次序分为观察组48例与对照组48例,对照组给予术后常规护理,观察组在对照组护理的基础上给予空气波压力治疗护理,2次/d,10次为1个疗程,共2个疗程.术后3个月比较两组患者上肢水肿发生情况、抑郁自评量表(SDS)评分、生活质量评分及护理满意度.结果 术后3个月观察组患者上肢水肿发生率为5/48(10.4％),对照组上肢水肿发生发生率为13/48(27.1％),两组比较差异有统计学意义(P＜0.05).观察组与对照组护理后的SDS评分均低于护理前,且观察组护理后SDS和生活质量评分低于对照组(P＜0.05).观察组的护理满意度为高于对照组(P＜0.05).结论 空气波压力治疗在乳腺癌患者术后的应用能减少上肢水肿的发生,缓解患者术后抑郁情绪,从而改善生活质量与护患关系.

Objective:To investigate the role of nursing safety management in general perioperative. Methods:Analyzed general surgery perioperative safety risk, summarized nursing experience in safety management, security management strategy proposed treatments. Results:Nursing safety management of general surgery patients is able to improve perioperative nursing quality care to avoid the risk, reduce defects care to protect the patient's successful rehabilitation. Conclusion:In general surgery perioperative nursing safety management can effectively guarantee the quality of care, reduce nursing errors.

目的通过多中心研究评价颈前小切口甲状腺手术的有效性和安全性.方法对2006年10月~2012年10月辽宁省抚顺市抚顺市中心医院共336例甲状腺肿物患者进行颈前小切口甲状腺手术,评价手术时间、手术出血量、术后并发症发生率等指标.结果手术时间(71.2±30.3)min;手术出血量(26.7±23.1) mL;术后3例患者出现暂时性喉返神经麻痹,12例出现血清肿,出血1例,16例术后呛咳,4例出现手足抽搐,无1例中转开放手术.结论颈前小切口甲状腺手术的并发症发生率与传统手术类似,可达到传统手术的治疗效果,是一项安全可行的微创手术.

目的探讨围手术期护理在微创手术治疗乳腺肿块中应用及必要性。方法对58例实施腔镜乳腺肿块切除手术的患者从入院至出院采用围手术期舒适护理。结果手术全部成功,术后无并发症发生,患者对护理工作及手术效果满意率达100%。结论做好患者的身心护理及良好护理配合是保证良好手术效果必不可少的条件。