Evidence Summary of risk assessment of pressure injury among surgical patients / 中国实用护理杂志

Objective@#To summarize the best evidence of risk assessment of pressure injury among surgical patients.@*Methods@#We searched JBI Library、Cochrane Library、NGC、SIGN、PubMed、CNKI, CBM, etc., to collect documents including guidelines, evidence summaries, best practice information sheets, systematic reviews and expert consensus. Three researchers independently reviewed studies and extracted data from the publications meeting inclusion criteria.@*Results@#8 publications were recruited, including 5 clinical guidelines and 3 evidence summaries. Finally,12 items of best evidence were summarized, as follows. Health care professionals should involve in assessing of patients who are at risk of developing pressure ulcers, including pain related to pressure ulcers, complaints and skin inspections. Use a valid/reliable risk assessment tool in conjunction with the identifcation of additional risk factors (e.g., perfusion and oxygenation, increased body temperature, and advanced age), along with clinical judgment. Consider additional risk factors specific to individuals undergoing surgery including: duration of time immobilized before surgery, length of surgery, increased hypotensive episodes during surgery, low core temperature during surgery; and reduced mobility on day one postoperatively. Assess for intrinsic/extrinsic risk factors. Undertake a reassessment if there is any significant change in the individual′s condition. Include a comprehensive skin assessment as part of every risk assessment to evaluate any alterations to intact skin. Undertake a comprehensive skin assessment that includes skin temperature, color, edema, change in tissue consistency in relation to surrounding tissue, skin moisture, and skin integrity. Inspect the skin under and around medical devices at least twice daily for the signs of pressure related injury on the surrounding tissue. Assess and document physical characteristics including: location, category/stage, size, tissue types, color, periwound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Staff education should be a core component of any quality improvement project aimed to improve the accuracy of pressure injury classification and quality of documentation. Health professionals should receive education regarding the prevention, assessment and management of pressure injury. The use of multi-component strategies or a computerized clinical decision support can be considered in quality improvement initiatives for improving pressure injury classification and documentation.@*Conclusions@#Medical institutions should strengthen training of nursing staff, especially pressure ulcer assessment and standardization of nursing records. It is also needed to raise awareness of relevant risks. Nursing staff should perform risk assessment dynamically and professionally, in order to timely identify the occurrence of pressure injuries to and ensure patients′ safety. Since best evidence would be updated along with research project, researchers should selectively apply evidence based on clinical settings and hospital conditions.

Single lung transplantation assisted by extracorporeal membrane oxygenation technique duringperioperative period:a report of 6 cases / 中华器官移植杂志

Objective To summarize the application experiences and curative efficacies of single lung transplantation assisted by extracorporeal circulation with coated lung ,centrifugal pump and coated pipe .Methods Retrospective analysis was conducted for clinical data of 6 adult patients with respiratory insufficiency undergoing single lung transplantation .The changes of hemodynamics and oxygenation before and after adjuvant treatment were observed ,the effects of adjuvant evaluated and the experiences of application summarized .Results The hemodynamic parameters post-assistance significantly improved as compared with that pre-assistance and pulmonary arterial pressure dropped from (56 ± 15 ) to (45 ± 13 ) mmHg with statistically significant differences . Arterial blood gas parameters significantly improved .PO2 spiked from (47 ± 12) to (68 ± 9) mmHg and PCO2 declined from (65 ± 14) to (55 ± 12)mmHg .And there were statistically significant differences .All patients were discharged successfully .Conclusions The simple extracorporeal membrane oxygenation system of coated lung , centrifugal pump and coated pipe during routine extracorporeal circulation may guarantee the operative safety of single lung transplantation and provide a new therapeutic option .

Evidence Summary of risk assessment of pressure injury among surgical patients / 中国实用护理杂志

Objective To summarize the best evidence of risk assessment of pressure injury among surgical patients. Methods We searched JBI Library、Cochrane Library、NGC、SIGN、PubMed、CNKI, CBM, etc., to collect documents including guidelines, evidence summaries, best practice information sheets, systematic reviews and expert consensus. Three researchers independently reviewed studies and extracted data from the publications meeting inclusion criteria. Results 8 publications were recruited, including 5 clinical guidelines and 3 evidence summaries. Finally,12 items of best evidence were summarized, as follows. Health care professionals should involve in assessing of patients who are at risk of developing pressure ulcers, including pain related to pressure ulcers, complaints and skin inspections. Use a valid/reliable risk assessment tool in conjunction with the identifcation of additional risk factors (e.g., perfusion and oxygenation, increased body temperature, and advanced age), along with clinical judgment. Consider additional risk factors specific to individuals undergoing surgery including:duration of time immobilized before surgery, length of surgery, increased hypotensive episodes during surgery, low core temperature during surgery; and reduced mobility on day one postoperatively. Assess for intrinsic/extrinsic risk factors. Undertake a reassessment if there is any significant change in the individual′s condition. Include a comprehensive skin assessment as part of every risk assessment to evaluate any alterations to intact skin. Undertake a comprehensive skin assessment that includes skin temperature, color, edema, change in tissue consistency in relation to surrounding tissue, skin moisture, and skin integrity. Inspect the skin under and around medical devices at least twice daily for the signs of pressure related injury on the surrounding tissue. Assess and document physical characteristics including:location, category/stage, size, tissue types, color, periwound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Staff education should be a core component of any quality improvement project aimed to improve the accuracy of pressure injury classification and quality of documentation. Health professionals should receive education regarding the prevention, assessment and management of pressure injury. The use of multi_component strategies or a computerized clinical decision support can be considered in quality improvement initiatives for improving pressure injury classification and documentation. Conclusions Medical institutions should strengthen training of nursing staff, especially pressure ulcer assessment and standardization of nursing records. It is also needed to raise awareness of relevant risks. Nursing staff should perform risk assessment dynamically and professionally, in order to timely identify the occurrence of pressure injuries to and ensure patients′safety. Since best evidence would be updated along with research project, researchers should selectively apply evidence based on clinical settings and hospital conditions.

Changes and significance of serum intestinal fatty acid binding protein in children with traumatic brain injury complicated with gastrointestinal dysfunction / 中国小儿急救医学

Objective To study the changes and significance of serum intestinal fatty acid binding protein (IFABP) in children with traumatic brain injury(TBI) complicaled with acute gastrointestinal injury (AGI). Methods A total of 95 children suffering from TBI hospitalized in the PICU of the First Affiliated Hospital of Zhengzhou University from January 2017 to March 2018 were enrolled in the study. According to the modified Glasgow coma score combined with clinical classification criteria for acute closed head injury, the cases were devided into mild(43 cases),moderate (23 cases),and severe(29 cases). Children were gra-ded according to AGI (AGI Ⅰ42 cases,AGI Ⅱ 30 cases,AGI Ⅲ 13 cases,and AGI Ⅳ 10 cases). Thirty healthy children who underwent physical examination at outpatient service were enrolled as the control group. Blood samples were collected at the time of admission and on the 3rd day after admission. Serum IFABP was detected by ELISA,and the differences of serum IFABP concentrations were compared among groups. The correlations between IFABP with TBI classification and AGI grade were analyzed. The receiver operating characteristic (ROC) curve was drawn,and the predictive values of IFABP for the diagnosis of children with TBI complicated with AGI were evaluated. Results On the day of admission,the serum levels of IFABP in mild,moderate and severe brain injury group were significantly higher than that in control group (all P <0. 01). And serum IFABP concentration gradually increased with the increase of brain injury (all P < 0. 01).Serum IFABP levels in children with AGI grade Ⅰto Ⅳ were significantly higher than those in control group (all P < 0. 01). The levels of serum IFABP also increased with the increase of AGI level (all P < 0. 01). The concentration of serum IFABP was positively correlated with the grade of TBI and AGI (rs = 0. 82,P < 0. 01;rs = 0. 70,P < 0. 01). In each group,the levels of serum IFABP on the 3rd day after admission were lower than those on admission (all P < 0. 01). The ROC curve analysis showed that serum IFABP was of high diag-nostic value in children with TBI complicated with AGI,and the area under the ROC curve was 0. 88. When the cutoff value of IFABP was 431. 36 ng/ L,the sensitivity and specificity were 71. 61％ and 90. 00％ ,re-spectively. Conclusion Serum IFABP can be used as a sensitive indicator for the early diagnosis and disease assessment in children with TBI complicated with gastrointestinal dysfunction.

Pathological Features of Myocardial Contraction Band Necrosis in Sudden Cardiac Death / 法医学杂志

OBJECTIVE@#To investigate the pathological features and significance of myocardial contraction band necrosis in sudden cardiac death.@*METHODS@#Using HE and PTAH staining, the distribution sites and pathological features of myocardial contraction band necrosis were observed. The data were analyzed according to the extent of necrosis.@*RESULTS@#The locations, pathological features and the extent of necrosis were similar in different sudden death cases. The locations were related with sites of myocardial damage. The papillary muscles of left ventricular were most occurred, followed by the anterior wall of left ventricular. In the sudden death cases caused by stress cardiomyopathy, the extent of myocardial contraction band necrosis was lighter than the others. Most cases were predominantly level 1, the others were level 2.@*CONCLUSION@#Used as the diagnosis basis of acute myocardial ischemia, the myocardial contraction band necrosis has important significance to determination of death.

Traditional Chinese medicine enema and probiotics in the treatment of ulcerative colitis / 中国基层医药

Objective To explore the clinical curative effect of traditional Chinese medicine enema,amino salicylic acid preparation and probiotics in the treatment of ulcerative colitis.Methods 168 patients were selected as the research objects which were confirmed by endoscopic examination and the diagnosis of ulcerative colitis patients,randomly divided into the control group of 84 cases and observation group of 84 cases.The control group was given with sulfasalazine(SASP) treatment,a dose of 1g,4 times/d,period of treatment was 28d.In the observation group,oral SASP treatment combined with microecological preparation often meian and traditional Chinese medicine enema,Chang An capsule,2 capsules (500mg)/time,3 times/d,postprandial oral; Herbal Enema with angelica,white lentils,flavescent sophora root,cicada,windproof suffering after filtering,every night before bed retention enema.The clinical efficacy was compared between the two groups.Results After the treatment,the Sutherland index of the observation group was (1.82 ± 1.65),which was significantly lower than (5.51 ± 1.59) of the control group (t =10.436,P ＜ 0.05).In observation group,the clinical total effective rate,the total efficiency of endoscopic and histological total effective rate was 88.1％,81％,76.2％,the control group were 66.7％,57.1％,50％,the two groups had significant difference(x2 =4.353,4.512,5.113,P＜0.05).Conclusion The traditional Chinese medicine enema,amino salicylic acid preparation and probiotics in the treatment of ulcerative colitis has good curative effect,can relieve the clinical symptoms of patients,improve the degree of intestinal diseases.

Wif-1 methylation and β-catenin expression in colorectal serrated lesions / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate methylation status of Wif-1 and β-catenin expression in colorectal serrated lesions.</p><p><b>METHODS</b>Various colorectal lesions were collected including 52 cases of hyperplastic polyps, 41 cases of sessile serrated adenoma, 23 cases of traditional serrated adenoma, 24 cases of colorectal cancer and 24 cases of normal mucosa. All specimens were subject to immunohistochemical staining of β-catenin.SYBR Green PCR analysis of Wif-1 promoter methylation was performed in 29 cases of hyperplastic polyps, 29 cases of sessile serrated adenoma, 19 cases of traditional serrated adenoma, 14 cases of colorectal cancer and 16 cases of normal mucosa.</p><p><b>RESULTS</b>Abnormal expression rates of β-catenin in normal mucosa, hyperplastic polyps, sessile serrated adenoma, traditional serrated adenoma and colorectal cancer were 12.5% (3/24), 59.6% (31/52), 63.4% (26/41), 73.9% (17/23) and 100.0% (24/24), respectively. The corresponding methylation rates of Wif-1 promoter were 2/16, 10/29 (34.5%), 16/29 (55.2%), 15/19 and 13/14 (P < 0.05), respectively. Abnormal β-catenin expression was positively correlated with Wif-1 promoter methylation in traditional serrated adenomas (r = 0.536, P < 0.05).</p><p><b>CONCLUSIONS</b>Abnormal β-catenin expression and methylation rate of Wif-1 promoter are significantly higher in colorectal serrated lesions. Methylation of Wif-1 promoter may be related to the abnormal expression of β-catenin through activation of Wnt/β-catenin signaling pathway, which may contribute to the development of colorectal serrated lesions.</p>

Forensic analysis of 24 dismembered homicide cases in Shanghai / 法医学杂志

OBJECTIVE@#To explore the characteristics of the dismembered homicide cases in Shanghai and to provide the valuable guidance for forensic pathological practices.@*METHODS@#Twenty-four cases of dismembered homicides were selected from 2005 to 2012 in Institute of Forensic Science, Shanghai Public Security Bureau. The general information of the victims and suspects, cause of death, criminal motive, postmortem body parts, tools and information of discarding body parts were retrospectively analyzed.@*RESULTS@#Among the 24 dismembered homicide cases, victims were female in 16 cases, and suspects were male in 23 cases and were acquaintances in 22 cases. The main causes of death were mechanical asphyxia and traumatic brain injury. Most of the criminal motives were emotional disputes. The number of postmortem body parts was commonly from 20 to 30. The tools were mainly sharp instruments, including kitchen knives used in 20 cases. The postmortem body parts were discarded to different transregional areas, mainly using vehicles.@*CONCLUSION@#The dismembered homicide cases in Shanghai show the following characteristics: the number of postmortem body parts is in large quantity; the methods of dismembered corpse are complex and different; the job characteristics of suspects are difficult to determine; the distance from homicide scene is far and the vehicles are commonly used.

Analysis of 27 death cases of the abandoned babies in Shanghai / 法医学杂志

OBJECTIVE@#To analyze and summarize the characteristics of the death cases of the abandoned babies in Shanghai, and to explore the main points and features in forensic investigation.@*METHODS@#Twenty-seven death cases of the abandoned babies were selected from 2007 to 2011 in the Institute of Forensic Science of Shanghai Public Security Bureau. The cases were retrospectively analyzed in the respects of scene of abandonment, cause of death and manner of death, etc.@*RESULTS@#Among the death cases of the abandoned babies in Shanghai, most of the infants were alive with young unmarried mothers. The main cause of death was mechanical asphyxia, and homicide occurred more commonly.@*CONCLUSION@#It is significantly difficult to determine the cause and manner of death in such cases, needing to be a comprehensive analysis on the case background, the investigation of scene and the examination of injury, etc.