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Objective:To acquire more scientific, accurate and efficient unplanned extubation (UEX) quality management data by using information technology to directly take the quality index data of unplanned extubation from the nursing medical record system.Methods:From June 2019 to August 2019, a knowledge base of pipeline management including the name of pipeline, pipeline evaluation, pipeline care measures, and reasons for unplanned extubation of pipeline was established in Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine. Through the analysis of each node of pipeline management, pipeline management system was established. And the non-planned pipeline management data set was directly collected to the nursing quality management system for statistics and analysis, which was verified.Results:In clinical application from September 2019 to september 2020, the direct collection of unplanned extubation quality index data saved 496 hours of nursing labor costs per month, and the accuracy of direct data collection increased from 95.8% (161/168) in trial operation to 100.0% (494/494). The underreporting rate of adverse events decreased to 0. Satisfaction with the application of the quality index management system for unplanned extubation was (4.35 ± 0.73) points.Conclusions:The direct collection of quality index data for unplanned extubation improves the accuracy of the data. Nurses no longer need to report unplanned extubation incidents. The clinical nursing information system and the nursing management system are interconnected to improve the management efficiency of unplanned extubation. It is worthy of application and promotion in clinic.
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Objective@#Analyze the changes of indicator of antimicrobial usage and detection rate of multidrug-resistant gram-negative bacteria (MDR-GNB), in order to evaluate the impact of antimicrobial stewardship program (ASP).@*Methods@#The antimicrobial stewardship program was implemented since December 2011 at the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University. Intensified effort was made from 2014 to 2017. We divided the program into four stages, one before ASP (2010-2011) and three after ASP (2012-2013 as the first, 2014-2015 as the second and 2016-2017 as the third post-ASP stages). The usage rates in outpatient,emergency department and inpatient, along with the antibiotic use density (AUD, defined as daily doses/per 100 patient-days), the AUD of the third-generation cephalosporins and carbapenems in inpatient were reviewed retrospectively. The detection rates of extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli, ESBLs-producing Klebsiella pneumonia, carbapenem-resistant E. coli, carbapenem-resistant Klebsiella pneumonia, carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa were also analyzed at the same time. The correlation analysis between the detection rate of MDR-GNB and the indicator of antimicrobial usage was made.@*Result@#Among four stages, the usage rates were 55.2% (560 578/1 015 540) , 38.1% (493 554/1 296 336) , 26.8% (378 602/1 411 595) and 23.1% (347 817/1 502 817) in outpatient, 75.6% (429 582/568 230) , 61.4% (382 558/623 138) , 43.6% (265 102/608 071) and 35.1% (218 484/622 397) in emergency department, and 76.0% (30 568/40 221) , 53.7% (30 437/56 636) , 49.9% (37 395/74 895) and 50.3% (35 493/70 544) in inpatient, respectively. All indicators decreased significantly (χ2=297 811.798, 3 155 704.783, 5 592.037, P<0.01). The AUD in inpatient was 38.4,31.8,21.7 and 19.41,and the AUD of the third-generation cephalosporins were 13.83, 11.21, 6.20 and 6.84, respectively, which decreased significantly after ASP (r=-0.878, -0.781, P<0.05). The AUD of carbapenems were 1.94,1.77,1.87 and 1.93, respectively (r=0.123, P>0.05). A total of 11 289 strains of bacteria were collected, including 5 589 strains of E. coli, 2 823 strains of K.pneumoniae, 1 637 strains of A. baumandii, and 1 240 strains of P. aeruginosa.The detection rates of ESBLs-producing E.coli and ESBLs -producing K. pneumoniae in four stages were 75.4% (1 034/1 371) , 66.6% (893/1 341) , 57.8% (834/1 443) , 46.7% (670/1 434) and 78.7% (547/695) , 67.5% (455/674) , 49.3% (421/854) , 32.5% (195/600) , respectively,both decreased significantly (χ2=266.204; 328.805, P<0.01). The detection rates of Carbapenem-resistant A. baumannii were 28.2% (115/408) , 26.7% (126/472) , 24.3% (125/515) and 12.0% (29/242) respectively,and showed significant decreasing trend after ASP (χ2=18.112, P<0.01). The detection rates of carbapenem-resistant P. aeruginosa were 11.3% (40/355) , 18.5% (58/313) , 13.4% (46/343) and 7.0% (16/229) , respectively,with the most obvious decrease in the third stage after ASP. The detection rates of carbapenem-resistant E. coli and carbapenem-resistant K. pneumonia were continuously lower (<5%). There were positive correlations between the detection rates of ESBLs-producing E. coli and K. pneumoniae and all usage indicators (r1=0.930, 0.974, 0.746, 0.958, 0.842; r2=0.910, 0.960, 0.765, 0.963, 0.898, P<0.05).@*Conclusion@#The antimicrobial stewardship program can effectively reduce both the usage of antimicrobial and the production of MDR-GNB, which has great value to promote rational clinical use of antimicrobials and reduce bacterial resistance.
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Objective To explore the psychological availability of the full-time candidates for master degree of nursing during the clinical work. Methods A phenomenological approach was adopted in this study. About 11 full-time candidates for master's degree of nursing took part in the semi-structured and in-depth interviews and the acquired data were analysed. Results About 4 themes promoting psychological availability were identified: strong research knowledge and skills, career development confidence, perception of attention from leaders and more satisfactory salary. The four themes hindering psychological availability were:clinical work tasks, lower level of expertise, lack of social support and lower perception of self benefit. Conclusions The full-time candidates for master's degree hold active perception and much expectation about their clinical work but meanwhile they feel passive and disappointed. Nursing administrators should develop distinguishing and definite clinical personnel training and continuing education programs for them, offer them an access to learning chances and emotional support in order to improve the psychological availability and stabilize the nursing team.
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There are three types of glial cells in(for short): sheath glia, socket glia and glutamate receptor glia. They are mainly located in four sensory organs including the amphid, the cephalic organ, the outer labial sensilla and the inner labial sensilla.glial cells play key roles in dendrite extension, neurite guidance and extension, and are essential for synaptogenesis and maintain the normal morphology and the function of sensory nerve endings as well. A recent study shown that some nematode neurons are derived from the glial cells. Moreover, nematodes glial cells can directly modulate the function of sensory neurons. Some glial cells can also respond to certain external stimuli, such as mechanical stimulation, and adjust the accompanying neuronal activities.The article summarizes the progress on effects of nematodes glial cells on the nervous system development and function.
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Objective To investigate the experience of family caregivers in nursing perioperative patients undergoing permanent cardiac pacemaker. Methods Twenty-five family caregivers taking care of the patients undergoing permanent cardiac pacemaker participated in the non-structural study. Data were analyzed by phenomenological procedure. Result The factors by category analysis includes fear, anxiety and uneasiness due to preoperative lack of relevant knowledge and postoperative lack of caring experience, lowered health level of the caregivers, strong demand for health education and lack of confidence in home care. Conclusions The family caregivers′ experience varies with different phases in perioperative period. Nurses should provide personalized services to enhance the continuity of home care so as to enhance the care quality.
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Objective To investigate the features of malignancy in end-stage aristolochic acid nephropathy (AAN) patients undergoing renal replacement therapy in the First Affiliated Hospital of Wenhou Medical University.Methods One hundred and two patients diagnosed as end-stage AAN during 2004 to 2013 were enrolled in the study,and separately udergoing hemodialysis,peritoneal dialysis and renal transplantation,to study the features of the malignancy and its risk factors.Results (1) There were totally 42 AAN patients suffering from malignancy,and 39 of them had urinary cancer.Eight cases of urinary cancer had metastasis,and 11 cases of bladder cancer had repeated recurrences.Patients suffering from malignancy had an increased mortality compared to patients without malignancy (13/42 vs 7/60,P =0.022).(2) Thirteen malignacy cases were diagnosed before the end-stage of AAN,the rest cases appeared in 1-13 years[(4.62±3.31) years] after renal replacement.(3) A further logistic regression analysis of the 29 maligancy patients after renal replacement showed that,the dose of aristolochic acid (counted by Mutong) was the only risk factor of malignancy (P =0.091),compared with the dose of Mutong less than 60 g,the patients with an accumulated dose of Mutong more than 200 g had a 4.26 folds (95％CI 1.02,17.83)higher risk of malignancy.There was no statistic difference of the malignancy risk among different renal replacement therapies,which however might influence the pathogenic sites of the urinary cancer.The simple bladder cancer was the most common malignancy among the hemodialysis patients (72.72％),and the upper urinary tract cancer among the peritoneal dialysis patients (66.67％),while the complex of both were dominant among the renal transplantation patients(40.00％).Conclusions Among the end-stage of AAN patients undergoing renal replacement therapy in Wenzhou area,the incidence of urinary cancer is high,with a character of complex,multiple and repeated recurrences.The occurence of malignancy seems to be separated from the renal function,but turns out obviously dose-dependent.There was no statistical difference of cancer risk among hemodialysis,peritoneal dialysis,and renal transplantation,which may induce different pathogenic sites of the urinary cancer.
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ObjectiveTo investigate the effects and mechanisms of IL-32γ-shRNA-mediated gene silencing on the proliferation and apoptosis of fibroblast-like synoviocytes in patients with rheumatoid arthritis (RA).MethodsA eukaryotic expression plasmid of shRNA targeting IL-32γ was transfected into fibroblastlike synoviocytes by liposome in patients with rheumatoid arthritis.RT-PCR was used to determine the expression level of IL-32γ.Western blotting was used to detect the levels of cyclin D1 and p-Akt.The proliferation of RA-FLS was examined by MTT.Cell cycles were analyzed by flow-cytometry.The apoptosis of cells were measured by TUNNEL.Comparisons between groups were tested by t test.Results ① The expression of IL-32γwas significantly inhibited by shRNA-IL-32γ-expressing plamid PGCsi 3.0 targeting sequence 1,2 and 3,and the inhibition rate had reached 75.6％,66.2％ and 64.1％,respectively.② The absorbance value of proliferation of RA-FLS in EASY-shRNA-IL-32γ group was significantly lower than that in the shRNA-control group and normal group at day 3 [(0.23±0.03) vs (0.35±0.03) and (0.36±0.04),P＜0.05] and 5 [(0.27±0.03) vs (0.52±0.05) and (0.53±0.04),P＜0.01 ] after transfection.③ The rate of RA-FLS at phase G1 in the EASY-shRNA-IL-32γ group was significantly higher than that in the shRNA-control group and normal group respectively [(88±6)％ vs (69±5)％ and (68±4)％,P＜0.05],while those at phase S+G2 in the EASY-shRNA-IL-32γgroup was significantly lower than that in the shRNA-control group and normal group [ ( 13.6±3.0)％ vs (30.2±4.1)％ and(32.1±4.3)％,P＜0.01].④The rate of RA-FLS apoptosis in the EASY-shRNA-IL-32γ group was significantly higher than that in the shRNA-control group and normal group[(20.50±3.21 )％ vs (9.20±0.32)％ and (8.60±0.22)％,P＜0.01].⑤ The expression of cyclin D1(0.36±0.04) and p-Akt(0.31±0.03) in the EASY-shRNA-IL-32γ group was significantly lower than that in the shRNA-control group [ (0.59±0.08) and (0.53±0.06)] and normal group [(0.61±0.07) and (0.52±0.06),P＜0.01].ConclusionEASYshRNA-IL-32γ can inhibit RA-FLS proliferation by down-regulating the expression of cyclin D1 and induce RA-FLS apoptosis by down-regulating the expression of p-Akt.
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Objective To investigate the effect of estrogen on regression of vascular calcification in rats induced by vitamin D3 plus nicotine.Methods Ninety-six female SD rats were divided randomly into control group (n=24) and calcification group (n=72).Vascular calcification of 72 rats was induced by vitamin D3 and nicotine (VDN).On the day 1,the VDN group rats were injected with vitamin D3(300 000 U/kg,i.m),and were intragastric administrated with nicotine (25 mg/kg),after 9 hours,another dosage of nicotine was given again.After 4 weeks,the VDN group rats were subdivided randomly into 4 groups:VDN group(n=16),Sham operation group (n=16),ovariotomy group (n=16),estrogen group(after ovariotomy,17β-estrogen was subcutaneously injected,50 μg· kg-1· d-1,n=16).Results After 4 weeks,the VDN group showed obvious vascular calcification,and calcium content of the vessel wall was significantly higher than that of control group (P＜0.01).Extensive calcification was witnessed on the aortic tunica media of the VDN group.After 12 and 8 weeks,the calcium content of the vessel wall in each subdivided groups was significantly lower than that at 4 weeks point(P＜0.01),and the lowest calcinm content was in estrogen group,meanwhile the reduction of previously accumulated arterial calcium precipitate in each group was different.Conclusions It is a reversible process that vascular calcification induced by vitamin D plus nicotine in rats.Estrogen can promote the regression of vascular calcification.
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The present study examined the functional profile of dendritic cells (DCs) in patients with rheumatoid arthritis (RA) and the effects of simvastatin on the function of DCs. A total of 40 patients who was recently diagnosed as having RA were equally assigned to two groups: the routine treatment group (group R) and the routine treatment plus simvastatin group (group R+S). Twenty healthy individuals served as control. The peripheral blood mononuclear cells (PBMCs) were isolated before and 4 weeks after the treatment and then cultured with interleukin-4 (IL-4) and granulocyte-macrophage colony stimulatory factor (GM-CSF) to prepare mature DCs. The expression of co-stimulating factor CD86 on the surface of DCs was assessed by flow cytometry. And the stimulating capacity of DCs was measured by mixed lymphocyte reaction (MLR). The contents of cytokines in culture supernatants of DCs in MLR were detected by ELISA. Blood lipids and high-sensitivity C-reactive protein (hs-CRP) were detected. The relationship between the expression of CD86 and the blood CRP level was also investigated. The results showed that, as compared with the control group, the CD86 expression and the level of cytokines secreted by DCs were significantly increased in RA patients and greater stimulating capacity of DCs in MLR was demonstrated in RA patients. T lymphocytes in MLR secreted higher levels of proinflammatory cytokines (IL-2, IL-17, TNF-α and INF-γ) and lower level of anti-inflammation cytokine (IL-10). The function of DCs was markedly weakened and the level of hs-CRP and low-density lipoprotein was substantially lowered in group R+S in comparison to group R. The CD86 expression was positively correlated with hs-CRP. It was concluded that DCs in RA are highly activated and DC-initiated immune reaction may play an important role in the pathogenesis of RA. Simvastatin administration can significantly inhibit the DCs function and reduce the level of hs-CRP, indicating the suppression on inflammatory reaction may be one of the mechanisms by which simvastatin exerts its effect in treating RA.
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Adult , Female , Humans , Male , Middle Aged , Anti-Inflammatory Agents , Pharmacology , Therapeutic Uses , Arthritis, Rheumatoid , Drug Therapy , Allergy and Immunology , C-Reactive Protein , Metabolism , Cytokines , Metabolism , Dendritic Cells , Allergy and Immunology , Simvastatin , Pharmacology , Therapeutic UsesABSTRACT
The present study examined the functional profile of dendritic cells (DCs) in patients with rheumatoid arthritis (RA) and the effects of simvastatin on the function of DCs. A total of 40 patients who was recently diagnosed as having RA were equally assigned to two groups: the routine treatment group (group R) and the routine treatment plus simvastatin group (group R+S). Twenty healthy individuals served as control. The peripheral blood mononuclear cells (PBMCs) were isolated before and 4 weeks after the treatment and then cultured with interleukin-4 (IL-4) and granulocyte-macrophage colony stimulatory factor (GM-CSF) to prepare mature DCs. The expression of co-stimulating factor CD86 on the surface of DCs was assessed by flow cytometry. And the stimulating capacity of DCs was measured by mixed lymphocyte reaction (MLR). The contents of cytokines in culture supernatants of DCs in MLR were detected by ELISA. Blood lipids and high-sensitivity C-reactive protein (hs-CRP) were detected. The relationship between the expression of CD86 and the blood CRP level was also investigated. The results showed that, as compared with the control group, the CD86 expression and the level of cytokines secreted by DCs were significantly increased in RA patients and greater stimulating capacity of DCs in MLR was demonstrated in RA patients. T lymphocytes in MLR secreted higher levels of proinflammatory cytokines (IL-2, IL-17, TNF-α and INF-γ) and lower level of anti-inflammation cytokine (IL-10). The function of DCs was markedly weakened and the level of hs-CRP and low-density lipoprotein was substantially lowered in group R+S in comparison to group R. The CD86 expression was positively correlated with hs-CRP. It was concluded that DCs in RA are highly activated and DC-initiated immune reaction may play an important role in the pathogenesis of RA. Simvastatin administration can significantly inhibit the DCs function and reduce the level of hs-CRP, indicating the suppression on inflammatory reaction may be one of the mechanisms by which simvastatin exerts its effect in treating RA.
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objective To explore the effect of diabetes management program with the goal of behavior changes on behavior change and metabolic index of patients with type 2 diabetes mellitus.Methods By setting up the diabetes management team,establishing personalized management file,carrying out education program,setting the goal of behavior changes and evaluating goal's trace,One-year management was carried out for 56 cases of type 2 diabetic patients.Patients' behavior changes were evaluated after six months management and one year later the metabolic indexes were contrasted.Results After 6 months management,the rate of goal achievement was 96%,the rate of one year behavior stabilization was 92%,the body mass index (BMI),fasting and postprandial blood glucose,glycosylated hemoglobin (HbAlc) one year later were decreased dramatically.Conclusions There is important significance of diabetes management program with the goal of behavior changes for behavior changes and metabolic indexes control in type 2 diabetic patients.
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Objective To explore the influence of humanistic care on psychological stress in diag-nostic process for patients with lung cancer. Methods 40 suspicious lung cancer patients were divided into the experimental group and the control group according to admission sequence. The control group ac-cepted routine care, the experimental group received humanistic care based upon routine care. Zung's self-rating anxiety scale(SAS) and self- rating depression scale(SDS) were applied in two groups at admission day and 2 days post- diagnosis, the results underwent comparison with norm using t test. Results On ad-mission day 2 groups showed no significant difference in SAS and SDS, 2 days post- diagnosis the SAS and SDS score were evidently lower than those of the control group. Conclusions Lung cancer patients were in anxiety and depression condition during diagnostic process, and humanistic care could effectively relieve their psychological stress.
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Objective To investigate the current status and changing patterns of hemodialysis in Wenzhou areas of China from 1999 to 2006. Methods Data of blood purification centres of 18 hospitals in Wenzhou areas from 1999 to 2006 were collected. The incidence, prevalence, mortality, the etiology and the relevant factors such as age, gender, dialysis ages, outcomes and causes of death in end stage renal disease(ESRD) patients on hemodialysis(HD) were analyzed retrospectively. Results The incident number and the number of patients increased annually while the mortality remained steady. The male patients outnumbered the female every year, but the male/female ratio was decreasing. The percentage of both young and oldly patients was increasing. The first cause was chronic glomerulonephritis, although the constituent ratio of glomerulonephritis decreased year by year. The constituent ratio of diabetic nephropathy and hypertensive nephropathy increased. The constituent ratio of dialysis age 1-2 years group decreased, ≤1 year, 2-3 years, 3-4 years groups were relatively steady, and 4-5 years, 5-10 years, 10 years groups increased. The number of patients receiving renal transplantation and transferring to peritoneal dialysis increased annually. The leading cause of death was cardiovascular incidence (19.9%), followed by cerebrovascular disorder (10.8%), systemic failure (10.8%), hemorrhagic diseases(4.7%) and infectious diseases(4.3%). The constituent ratio of cardiovascular incidence and cerebrovascular disorder were relatively steady. The constituent ratio of hemorrhagic diseases and systemic failure showed great fluctuation. The constituent ratio of infectious diseases and malnutrition was decreasing. Conclusions In Wenzhou area from 1999 to 2006, the patients number has been increasing annually. The onset age of HD is 30-70 years old, and proves a younger tendency and older tendency. The leading cause is chronic glomeralonephritis. The constituent ratio of diabetic nephropathy and hypertensive nephropathy rises year by year. The long-term survival rate of HD patients is improved. The leading cause of death is cardiovascular accident.
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Objective To investigate the clinical manifestations,laboratory findings and renal patho logic changes,as well as their relationships in patients with lupus nephritis (LN).Methods According to the latest classification criteria of lupus nephritis,the clinical manifestations,laboratory findings and renal patho logic changes and their relationships of 281 cases of biopsy proven LN were retrospectively analyzed.Results Totally 281 cases of LN patients were enrolled in total.The ratio of male to female was 1∶9.7.Proteinuria ac companied with hematuria (35.2%) and nephrotie syndrome (33.8%) were the main clinical manifestations. The most common renal pathological change was type Ⅳ LN (35.9%) and type Ⅲ,Ⅳ and Ⅴ accounting for 89.0% totally.The main pathologic changes of nephrotic syndrome were type Ⅳ and Ⅴ,while those who ac companied with renal dysfunction were mainly type Ⅵ and Ⅳ.Most simple hematuria cases showed mild renal injury.However,type Ⅳ and Ⅴ accounted for 40.4% in the 47 cases of LN whose 24 hours urine protein＜ 1.0 g and with normal renal function.Most severe proteinuria was found in Type Ⅴ and higher serum creatinine and anti-dsDNA antibody level were found in type Ⅵ and Ⅳ.The lowest lever of serum complement 3 (C3) was found in type Ⅳ.The amount of 24 hours urine protein showed negative correlation with semm C3 but positive correlation with serum creatinine.Serum C3 demonstrated negative relationship with serum creatinine and anti-dsDNA antibody,while serum creatinine was positively related to anti-dsDNA antibody level. Conclusion The major renal pathological lesions of LN are type Ⅲ,Ⅳ and Ⅴ.There are associations be tween clinical and pathological changes,but axe not always consistent.Proteinuria,low serum C3 and high an ti-dsDNA antibody level may provide clue to severe and active LN.Renal biopsy is important in the diagnosis and progression evaluation of LN.
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Objective To seek an approach to differentiate between tumors from parotid space and from parapharyngeal space on axial CT or MR imaging. Methods Forty-five patients with tumors originated at the parotid or parapharyngeal space were reviewed retrospectively. The diagnosis was confirmed pathologically in all of the cases. The correlation among neoplasms and the posterior belly of digastric muscle and its shifting situation were evaluated on axial CT or MRI scans by two senior radiologists. All of the estimations were compared with the results of operation. Results Twenty-seven tumors from parotid space were located in the superficial side to the posterior belly of digastric muscle and pushed it medially. On the contrary, 18 neoplasms from parapharyngeal space were situated at the profound side to the posterior belly and shifted it laterally. Conclusion Tumors superficial to the posterior belly of digastric muscle and pushing it medially indicate that they come from parotid space. While neoplasms profound to the posterior belly of digastric muscle and shifting it laterally mean that they come from parapharyngeal space.
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To investigate the outcome of renal transplantation in the elderly patients,the sur-vival rate,postoperative complications,rejection incidences and causes of death after renal trans-plantation in the elderly patients were compared to those of the contemporary younger patientsduring a follow-up of 5 years.No significant difference was found in the patients/graft survivaljection incidence was only 16%6 months after renal transplantation.Infection was the most com-mon complication and the main cause of death.The findings suggest that the elderly patients aresuitable for the renal transplantation as younger ones.
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Objective To diagnose Chinese autosomal dominant polycystic kidney disease (ADPKD) rapidly by detecting microsatellite SM7. Methods Microsatellite SM7 was amplified by modified PCR in two temperatures. Gene linkage analysis was performed. Rusults DNA analysis predicted 9 asymptomatic members as PKD1 gene carriers. Conclusion The presymptomatic gene diagnosis could be done rapidly by detecting microsatellite SM7 with modified PCR amplification in two temperatures.