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Objective:To investigate the effect of different spray-coagulation time of argon plasma coagulation (APC) injury on the Glisson system primary branche(G1) in the hepatic portal of pigs.Methods:Fifty clean healthy domestic pigs (27 females and 23 males, aged 7 to 14 months) were selected, with the body weighted (100.0±9.5) kg. They were randomly divided into five groups (A, B, C, D, and E), with 10 pigs in each group. G1 models were made and sprayed by APC for 1, 2, 3, 4, and 5 seconds. The damage, maximum damage area, maximum damage depth, and damage of the three branches of the Glisson system (the first branches of the portal vein, intrahepatic bile duct, and hepatic artery) were compared among the groups. The pigs were divided into two groups based on whether the three branches were damaged or not: the three-branch damage group ( n=23) and the control group ( n=27). The maximum damage area and maximum damage depth were compared between the two groups. Results:After the APC spraying, circular or elliptical damage appeared on the surface of the G1, with changes such as yellow-brown color, brown color, charred appearance, and defects. Under the microscope, G1 capsule was found to be deficient, the fibrous tissue beneath the capsule was ruptured, and the structures of small blood vessels and small bile ducts were incomplete. " Burn marks" and damage to the three branches of the Glisson system in G1 were also observed, and the damage was more severe at the center of the spray-coagulation. As the spray-coagulation time increased, the maximum damage area of the G1 model also increased, and the two were positively correlated ( r=0.90, P<0.001). The maximum damage depth was also positively correlated with spray-coagulation time ( r=0.97, P<0.001). The numbers of pigs with damage to the three branches of the Glisson system in Groups A-E were 0, 2, 5, 6, and 10, respectively, and the number of pigs with damage increased with the spray-coagulation time. In the three-branch damage group, the spray-coagulation time, maximum damage area, and maximum damage depth were all higher than those in the control group (without three-branch damage), and the differences were statistically significant (all P<0.05). Conclusion:The degree of damage to G1 caused by APC is positively correlated with the spray-coagulation time, and damage to the three branches of the Glisson system in G1 is related to the maximum damage area, maximum damage depth, and APC spray-coagulation time.
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Objective:To investigate the clinical features, diagnosis, treatment and prognosis of children with osteomyelitis caused by Streptococcus pneumonia. Methods:The demographic characteristics, diagnosis, clinical manifestations, imaging features, treatment and short-term prognosis of Streptococcus pneumonia osteomyelitis cases in 18 children′s hospitals from January 2012 to December 2017 were retrospectively collected and analyzed. Results:A total of 9 cases were enrolled, with a median age of 1 year and 3 months.Four children had underlying diseases.The main manifestations were local swelling, pain, limited mobility (9 cases) and fever (8 cases). Sites of infection included humerus (4 cases), femur (3 cases) and tibiofibula (2 cases), and 8 cases were complicated with septic arthritis; The laboratory tests showed increased white blood cells (8 cases, median 22.02×10 9/L), C-reactive protein (7 cases, median 55.44 mg/L) and erythrocyte sedimentation rate (6 cases, median 70 mm/1 h) of those patients.Five patients received monotherapy in the initial treatment regimen with cephalosporins. Then the therapeutic schedules were adjusted according to the culture and antibiotic sensitivity. All patients were treated with puncture, incision drainage or fenestrating decompression.Eight patients were cured and discharged finally. Conclusions:Streptococcus pneumonia osteomyelitis is more common in younger children and may have no risk factors.The common infection site is long bone metaphysis, and those patients are easily complicated with septic arthritis.Antibiotic combined with surgical treatment are crucial to a good outcome.
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Objective@#To observe the changes of LC3, lc3-Ⅱ/lc3-Ⅰ ratio, Nrf2 and Bcl2 in myocarditis induced by coxsackievirus group B type 3 (CV-B3) infection and myocardial damage in SD rats caused by particulate matter of four different pollution sources, and to further explore the mechanism of autophagy and apoptosis of myocardial cells and myocardial damage.@*Methods@#Adult SD rats were randomly divided into CV-B3 infection group (20 rats), automobile exhaust group (20 rats), coal smoke group (20 rats), burning straw group (20 rats), atmosphere group (20 rats) and control group (20 rats). The expressions of LC3, Bcl2 and Nrf2 in rats were detected by Western blot at 12 hours, 48 hours, 5 days and 10 days.@*Results@#In the first three groups of rats expression of LC3, Bcl2 and Nrf2 was upregulated, this was seen early in CV-B3 group, the peak was high, and recovery was fast; while in automobile exhaust group the above changes appeared later, the amplitude was low; in the coal smoke group rats the above changes appeared even later, but the amplitude of change was higher than that in automobile exhaust group, but lower than that of CV-B3 group. In automobile exhaust and coal smoke groups Bcl2 and Nrf2 expression was still slightly increased at day 10. After 48 hours, the above measurements in rats in the atmosphere group were temporarily up-regulated, and returned to normal on day 5. The above measurements of rats in the straw smoke and the control group did not show significant change.@*Conclusions@#In the SD rats with acute viral myocarditis induced by CV-B3 and myocardial damage induced by automobile exhaust, coal smoke and atmospheric particulate matter, the whole process of metabolism, renewal, repair and anti-damage activity of myocardial cells can be accomplished through autophagy activation, apoptosis inhibition and antioxidant mechanism.
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Objective To investigate the relationship between the level of circulating CD133+/KDR+ endothelial progenitor cells (EPCs) and outcome in patients with acute ischemic stroke.Methods Inpatients with first-ever ischemic stroke within 24 hfrom the onset and age-and sex-matched healthy subjects were enrolled in the study.The demographic and clinical data of the patients were collected.The level of CD133+/KDR+ EPCs was detected by flow cytometry.All patients were followed up at 90 d.The modified Rankin Scale was used to evaluate the clinical outcome,0-2 was defined as good outcome and >2 was defined as poor outcome.Results A total of 126 consecutive patients with first-ever ischemic stroke within 24 hfrom the onset and 60 age-and sex-matched healthy subjects were enrolled.In patients with ischemic stroke,33 (26.19%) were large artery atherosclerosis (LAA),74 (58.73%) were small artery occlusion (SAO),19 (15.08%) were cardioembolism (CE);82 (65.08%) had good outcomes and 44 (34.92%) had poor outcomes.The number of circulating EPCs at baseline in patients of the LAA subtype (0.071%±0.018%),CE subtype (0.068%±0.16%) and SAO subtype (0.118%±0.12%) was significantly lower than that in the control group (0.246%±0.052%;all P<0.05),and the CE subtype (P=0.028) and LAA subtype (P=0.037) were significantly lower than the SAO subtype;the CE subtype was lower than the LAA subtype,but the difference was not statistically significant (P=0.762).The proportions of patients with LAA subtype (40.91% vs.18.29%;χ2=7.577,P=0.006) and CE subtype (29.55% vs.7.32%;χ2=11.049,P=0.001) and atrial fibrillation (29.55% vs.10.98%;χ2=6.582,P=0.009),and age (69.64±9.62 years vs.61.12±7.31 years;t=5.570,P<0.001),and baseline NIHSS score (14.16±4.22 vs.6.96±2.04;t=12.919,P<0.001),baseline systolic blood pressure (176.06±13.42 mmHg vs.164.12±11.69 mmHg,1 mmHg=0.133 kPa;t=5.187,P<0.001),low-density lipoprotein cholesterol (2.92±0.52 mmol/L vs.2.49±0.36 mmol/L;t=5.447,P<0.001),fasting blood glucose (8.76±2.88 mmol/L vs.6.82±2.24 mmol/L;t=4.185,P<0.001),C-reactive protein (7.62±1.82 mg/L vs.4.57±1.58 mg/L;t=9.790,P<0.001),and D-dimer (1.14±0.08 mg/L vs.0.97±0.22 mg/L;t=4.946,P<0.001) levels in the poor outcome group were significantly higher than those in the good outcome group,while the proportion of the SAO subtype patients (29.55% vs.74.39%;χ2=23.759,P<0.001),high-density lipoprotein cholesterol (0.94±0.68 mmol/L vs.1.16±0.14 mmol/L;t=2.829,P=0.005),and baseline EPCs (0.069%±0.018% vs.0.098%±0.021%;t=7.755,P<0.001) were significantly lower than those in the good outcome group.Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio 1.242,95% confidence interval 1.126-1.372;P<0.001),CE subtype (odds ratio 3.460,95% confidence interval 1.312-5.146;P=0.016),and the lower baseline EPCs (odds ratio 1.632,95% confidence interval 1.006-3.024;P<0.001) were the independent risk factors for poor outcome in patients.Conclusion s The level of circulating EPCs was decreased significantly in patients with acute ischemic stroke,and the lower level of baseline EPCs was an independent predictor of poor outcome in patients with ischemic stroke at 90 d.
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Objective To explore the continuous improvement to reduce the suctioning pediatrics lumen instruments return-cleaning rate of the first time washing, improve work efficiency and reduce the cost by applying root cause analysis. Methods Using causal analysis of fishbone diagram to analysis and verify the main reason of leading to high lumen instruments return-cleaning rate. According to the three terminal factors of continuous quality improvement, quality control group was set up, lumen instruments cleaning quality control standards was made, water flow mode of lumen instruments cleaning was changed, selected the appropriate cleaning tools and real picture show, synchronize quality control measures of publishing the quality and safety board. Compared before and after return-cleaning rate of three different detection methods and the different parts of the same suction lumen instruments. Results Before carrying out eye-measurement, cotton swab to wipe, ATP bioluminescence back washing rate was 0.89% (2/225), 7.11%(16/225), 27.11%(61/225), respectively after implementation of 0, 0.44%(1/226), 3.98%(9/226), visual observation before and after the return rate of washing was no statistically significant difference (χ2=2.018, P>0.05);Cotton swab to wipe, ATP bioluminescence back washing rate difference was statistically significant (χ2=13.820, 45.999, P0.05). Conclusions ATP bioluminescence assay has fine effects to detect the return-washing rate of the inner wall of the lumen instruments. The Root Cause Analysis method significantly reduced the return-washing rate of the inside surface of the suction lumen instruments, improve the efficiency, save the medical cost and reduce the hospital infection.
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Objective To investigate the relationship between the serum copeptin levels and the outcomes in patients with acute ischemic stroke.Methods Patients with first-ever ischemic stroke within 24 h were enrolled in the study.Enzyme-linked immunosorbent assay was used to detect the serum copeptin levels.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of baseline stroke.The modified Rankin Scale (mRS) scores were used to evaluate the outcomes at day 90,and 0-2 was defined as good outcome.The age-and sex-matched healthy subjects were used as controls.Results A total of 86 consecutive patients with first-ever ischemic stroke within 24 h were enrolled and 50 age-and.sex-matched healthy subjects were used as controls.The serum copeptin levels of the patients with acute ischemic stroke at 24 h,day 7 and 14 were 7.81 ± 0.66 pmol/L,4.78 ± 1.76 pmol/L,and 2.82 ± 1.42 pmol/L,respectively.They were all significantly higher than those of the control group (1.67 ± 0.56 pmol/L;all P＜0.05).In 86 patients,74 (86.05％) had good outcome and 12 (13.95％) had poor outcome.The age (67.64 ± 9.62 years vs.61.12± 7.31 years;t=-3.420,P=0.020),NIHSS score (14.16±4.22 vs.6.96± 2.04;t=-8.263,P＜ 0.001),baseline systolic blood pressure (166.06± 13.42 mmHgvs.154.12± 11.69 mmHg;t=5.216,P=0.037;1 mmHg=0.133 kPa),fasting blood glucose (8.79 ±2.98 mmol/L vs.6.92 ±2.24 mmol/L;t =2.076,P =0.041),C-reactive protein (7.02 ± 1.72 mg/L vs.4.07 ± 1.58 mg/L;t =-1.724,P =0.019),copeptin level at 24 h (9.67 ±2.28 pmol/L vs.6.88 ±2.82 pmol/L;t =13.962,P ＜ 0.001),copeptin level at day 7 (8.22 ± 2.14 pmol/L vs.2.97 ± 2.04 pmol/L;t =20.564,P ＜ 0.001),copeptin level at day 14 (4.77 ± 1.86 pmol/L vs.2.02 ± 0.76 pmol/L;t =8.428,P =0.032),as well as the proportions of atrial fibrillation (33.33％ vs.8.11％;x2 =4.986,P=0.036),large artery atherosclerotic stroke (41.67％ vs.21.62％;x2 =6.729,P =0.038),cardioembolism (33.33％ vs.8.11％;x2 =4.986,P=0.036) in the poor outcome group were significantly higher than those in the good outcome group.The proportion of patients with small arterial occlusive stroke was significantly lower than that of the good outcome group (16.67％ vs.70.27％;x2 =16.972,P =0.041).Multivariate logistic regression analysis showed that the serum copeptin level at 24 h (odds ratio 2.424,95％ confidence interval 1.92 0-3.562;P ＜ 0.001) and day 7 (odds ratio 2.326,95％ confidence interval 1.768-3.482;P ＜ 0.001),and baseline NIHSS score (odds ratio 2.146,95％ confidence interval 1.616-3.268;P ＜ 0.001) were the independent risk factors for the poor outcomes.Conclusions The increased baseline serum copeptin level is an independent risk factor for poor outcomes at day 90 in patients with acute ischemic stroke.
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Objective To improve the cleaning quality of reusable medical instruments continuously through root cause analysis,reduce healthcare-associated infection(HAI)and the wear and tear of instruments.Methods The major factors influencing the cleaning quality of instruments were analyzed and clarified by fishbone diagram,contin-uous quality improvement was carried out based on 5 terminal factors,the rate of rusting,stain,repeated cleaning, damage,and clinical department satisfaction before and after the implementation of continuous improvement were compared.Results The qualified rate of instrument clean increased from 94.24% before implementing measures to 97.60% after implementing measures,the rate of rusting,stain,repeated cleaning,damage decreased from 3.39%, 2.37%,5.76%,and 2.08% to 1 .55%,0.85%,2.40%,and 0.48% respectively,there were significant difference among different groups(all P <0.001 );the score of satisfaction rate to central sterile supply department elevated from(93.87±3.87)before implementing measures to (98.08 ±0.59)after implementing measures(t =6.80,P <0.001).Conclusion Root cause analysis is important in improving cleaning quality of reusable instruments continu-ously,as well as reducing HAI and the wear and tear of instrument,it can save medical cost.
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Objective To explore the substantial results of using comprehensive practical teaching mode and holistic nursing thinking method in the course of teaching fundamentals of nursing science,and then improve the vocational quality and ability of nursing students.Methods Randomly determined two classes as objectives: experiment class and control class.control class was adopt traditional practical teaching mode,experiment class was adopt comprehensive practical teaching mode in small community.Results Ability of standard operation,communication and knowledge were significant higher in experiment class than those of in control class.Conclusions Comprehensive practical teaching mode in small community has actual significance for strengthen the comprehendsive ability of nursing students.
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BACKGROUND: Selenium is one of necessary microelement of human body. It acts as the active center of selenium-contained enzyme with antioxidant function, which can clean up internal free radical, effectively catalyze harmful perhydride deoxidizing into innocuous hydroxyl compound,reinforce immunity of human body, prevent and cure cardio-cerebrovascular diseases and cancer.OBJECTIVE: To provide evidence for preventing and treating cardiocerebrovascular diseases via comparison of blood selenium content between patients and healthy persons.DESIGN: Case-control analysis.SETTING: Dalian Railway Medical School, Dalian Railway Hospital, Department of Applied Chemistry, Dalian Railway College.PARTICIPANTS: Totally 319 blood samples (169 males, 150 females)were collected from patients with cardio-cerebrovascular diseases from Dalian Railway Hospital from March 2000 to May 2001. Among them,there were 164 with hypertension, 97 with coronary atherosclerotic heart disease (CAHD), 41 with cardiac dysrhythmia and 17 with cerebral vascular accident. 300 healthy patients (159 males and 141 females) were in the healthy group.METHODS: The blood selenium content of patients with cardio-cerebrovascular diseases was detected with neopolarography.MAIN OUTCOME MEASURES: ①Total level of blood selenium of testees of the two groups. ②Comparison of level of blood selenium between males and females. ③Comparison of level of blood selenium of patients with different diseases.RESULTS: A total of 619 testees were involved in the result analysis. ①The total level of blood selenium of the patient group was lower than that of the healthy group [(114.0±52.5), (146.5±51.0) μg/L,P ＜ 0.001],which was only 76% of that of the healthy persons. ②Content of blood selenium of males and females was normal distribution. There was insignificant difference between males and females (P ＞ 0.10), but the level of blood selenium in females was slightly higher than that of males. ③The levels of blood selenium of patients with hypertension, CAHD, cardiac dysrhythmia were 82.7%, 68.6% and 66.0% of that of healthy persons, respectively, but the difference between males and females was insignificant(P ＞ 0.10). The level of blood selenium of patients with cerebrovascular accident (CVA) was the lowest, (84.4±28.9)μg/L, which was 57.6% of healthy persons.CONCLUSION: The content of blood selenium of patients with cardiocerebrovascular diseases is lower than that of healthy persons. Organic selenium and inorganic selenium should be supplemented moderately.