Objective:To deeply study and explore the cognitive and barrier factors of clinical nurses' nutrition management in patients with pressure injury (PI), and provide evidence for developing quantifiable standardized management model and strengthening individualized nutrition management.Methods:A semi-structured in-depth interview was conducted with 11 nurses. The NVivo10.0 software and Colaizzi's 7-step analysis of phenomenological data were used to analyze interview data.Results:The study summarized four themes that hindered nutrition management: subjective judgment bias; education training lags behind and radiates one-sided; lack of policy and configuration; conflict between workload, roles and perceptions.Conclusions:There are many obstacles to the implementation of nutrition management in patients with PI. An objective, feasible and standardized nutrition management plan should be established, support should be provided by policy, configuration and information system, and relevant knowledge training and multi-team cooperation should be strengthened to improve patient life.

Objective To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolism or carotid intima-media thickness (CIMT) in Type 2 diabetic(T2DM). Methods According to the liver B-ultrasonography, a total of 321 T2DM patients were divided into two groups, with or without NAFLD. Metabolic indexes such as BMI, BP, blood glucose, blood lipid, uric acid ( UA ), insulin, C-peptipe,insulin resistance index(HOMA-IR) between the two groups were compared, and the relationships between alanine aminotransferase (ALT) and the above indexes were analyzed. Furthermore,the CIMT of the two groups were compared, and the relationships between NAFLD, ALT and CIMT were investigated by correlation and regression analysis. Results Compared with the group without NAFLD, the patients with NAFLD had higher level of BMI, triglyceride ( TG ), UA, fasting blood glucose ( FBG ), fasting insulin ( FIns ), fasting C peptide (FCP) ,HOMA-IR,and lower level of high density lipoprotein ( HDL-C ) significantly; BMI ( OR = 1.25, P ＜0. 001 ), TG ( OR = 1.74, P = 0. 008 ) and HOMA-IR ( OR = 2. 33, P = 0.010) were independent risk factors of NAFLD while H DL-C was independent protective factor; ALT was positively correlated with BMI (r = 0. 255, P ＜0. 001 ) ,TG(r =0. 156,P ＜0. 018) ,UA(r =0. 239,P ＜0. 001 ) ,FIns(r =0. 213,P =0. 001) ,FCP(r =0. 199,P ＜0. 003), HOMA-IR ( r = 0. 247, P ＜ 0. 001 ) and negatively correlated with HDL-C ( r = - 0. 199, P =0. 002) ,and BMI (β =0. 456,P =0. 048) ,UA (β =0. 021 ,P =0. 025) and HOMA-IR(β =3.634 ,P =0. 004)were independent associated facrors. The difference of CIMT between the two groups didn't reach statistical significance, while mutiple regression analysis revealed that ALT was independently associated with CIMT(β =0. 002,P = 0. 013). Conclusion T2DM patients with NAFLD show more serious disorder of metabolism and insulin resistance. ALT is an independent risk factor of CIMT in T2DM patients.

Objective To compare the effects and complications of lumboperitoneal shunt ( LP ) and ventriculoperitoneal shunt ( VP ) in the treatment of post?traumatic hydrocephalus. Methods Eighty patients with post?traumatic hydrocephalus treated in the neurosurgery department of Zhangjiagang Hospital of Traditional Chinese Medicine from March 2014 to March 2010 were retrospectively analyzed. The patients were randomly divided into two groups,40 patients treated with LP were assigned into the LP group and 40 patients undergone VP treatment were seen as the VP group. All patients were followed up for 1 year to investigate and compare the symptom improvement rate,neurological deficit score and the incidence of complication of the two groups. Results The total effective rate of hydrocephalus disappearance in the LP group was 41. 50% ( 37/40) and 87. 50%( 35/40) in the VP group. The difference between the two groups was not statistically significant (χ2=0. 556,P=0. 456);the neurological deficit scores before treatment in the LP group and VP group were (28. 35±8. 64) points and (29. 13±7. 98) points,there was no significant difference between the two groups (t=0. 419,P=0. 676) . The difference in the scores of neurological deficit after treatment in the LP and VP group was not statistically significant ( (19. 32±5. 34) points vs. (21. 62±4. 86) points,t=1. 480,P=0. 143),the average scores of neurological deficits in the two groups were significantly better than those before treatment ( t=5. 623, 5. 084,P<0. 001 ) . There was no significant difference in the average score of improvement of urinary incontinence between the two groups before and after treatment ( t=0. 376,1. 265,P>0. 05) ,the average score of urinary incontinence improvement after treatment in both groups were better than those before treatment ( t=4. 891,5. 370,P<0. 001) . In the LP group,the incidence of bleeding,infection,shunt related complications and shunt abnormality were all 2. 50% ( 1/40 ) , the overall complication rate was 10. 00%, the incidence of bleeding,infection,shunt related complications and shunt abnormality in the VP group were 7. 50% (3/40), 10% ( 4/40 ) , 5% ( 2/40 ) 10%, ( 4/40 ) , the overall complication rate was 32. 50%, there was significant difference between the two groups (χ2=6. 050,P=0. 014) . Conclusion LP and VP have significant curative effect on the treatment of post?traumatic hydrocephalus,but the overall incidence of LP complication after 1 year is significantly lower than that of VP,and is worth popularizing widely in clinical practice

Objective To investigate the diagnostic value of telomerase activity and mutatioms of P53 gene in bronchoalveolar lavage fluids (BALF) in lung cancer. Methods Collect BALF from 86 patients with lung cancer and 82 patients with benign bronchial-pulmonar diseases. Telomeric Repeat Amplificaton Protocol (TRAP) and Polymerase Chain Reaction Single Strand Conformational Polymorphism(PCR-SSCP) were used in this study. Meanwhile, conduct fibrobronchoscope brush biopsy and protractor biopsy. Results ①The positive rate of telomerase in experimental group is 82.56% and that of mutatioms of P53 gene is 32.56%, which are both higher than 4.48% and 0% (P0.05) between the mutatioms of P53 and the expression of telomerase activity with respect to pathological classification of lung carcinomas. ③ In central-type lung cancer group, the combining positive rate of telomerase and mutatioms of P53 is 94.34%, the positive rate of routine fibrobronchoscope practice is 86.79%,there were no statistical differences between them. In peripheral lung cancer group, the combining positive rate of telomerase and mutatioms of P53 is 75.76%, which is higher than the positive rate of routine fibrobronchoscope practice that is 45.45%(P

Objective To study the effect of extended Whipple′s resection for carcinoma of head of pancreas.Methods Seventy-five patients who underwent surgery for carcinoma of head of pancreas were divided into control group(traditional Whipple′s operation,n=38) and study group(extended Whipple′s operation,n=37).The survival,complication,mortality and recurrence rates were compared between the 2 groups.Results In control group and study group,the complication rate was 60.53%and 29.73%;the mortality rate was 5.26% and 2.70%;the recurrence rate was 78.95% and 35.14%;and 3-year survival rate was 15.79% and 35.14%,respectively.Conclusions Extended Whipple′s resection for carcinoma of head of pancreas can decrease postoperative recurrence rate and increase 3-year survival rate.

Objective To investigate the status and rehabilitation needs of stroke patients. Methods 127 patients with stroke in communitywere investigated with questionnaire designed ourselves. Results 127 questionnaires responded. The most patients needed the educationof rehabilitation, the training of limbs function and psychological rehabilitation. Conclusion The needs of stroke patients in the communitywere obtained.

OBJECTIVETo investigate the correlation between enhanced computed tomography (CT) findings and pathological results of rare parotid gland tumors, and improve diagnosis accuracy.

METHODSThe enhanced CT manifestations of 22 cases with pathologically documented rare parotid gland tumors, which included 6 cases of basal cell tumor, 5 cases of myoepithelioma, 4 cases of vascular invasion, 3 cases of lymphatic cyst, 3 cases of lipoma, and 1 case of chondrosarcoma, were retrospectively analyzed. The location, size, shape, density, and relationship with surrounding structure were evaluated on CT images.

RESULTSThe enhanced CT showed that basal cell tumors occurred in the superficial lobe of the parotid gland, with clear boundary, within the cystic lesion. The lesions were moderate to obviously enhanced, which may be accompanied by enlarged lymph nodes. Myoepithelial tumors were located in the superficial lobe of the parotid gland, with a small cystic prone and microcalcification within a few cases. The lesions were moderate to obviously enhanced. Hemangiomas of soft tissue mass prominent in the parotid gland surface were mild to significantly enhanced. Larger lesions may occupy the entire parotid gland, with uneven density and visible vein stone. The CT density values of the lymphatic cyst were usually higher. Chondrosarcoma mainly manifested cystic mass at the calcification edge. Lipoma with fat density mass exhibited clear boundary without enhancement. Fiber separation could be observed in the lesion.

CONCLUSIONCT can reflect the pathological features of rare parotid gland tumors by demonstrating their corresponding imaging features. Enhanced CT is the most effective means of imaging to identify the nature of rare tumor of the parotid gland lesions.

Objective To discuss the surgical treatment of spinal injury, and provide insights on key points and related issues for operations. Methods Two hundred and five cases of spinal fracture were treated through posterior surgical treatment. Under C-arm X-ray monitoring, surgeries had been operated on pedicle screws insertion, vertebral canal decompression, over-extending reduction position, and placed the connecting rod, knocked in the bone graft and finally transplanted the paraspinal bone. Results After operations , the height and morphology of vertebral bodies and spinal physiological curvature were basically recovered analyzed by X ray examination. The follow-up results (in the average of 14 to 36 months) indicated that there were 4 cases of delayed infection, 7 cases of loosen screw, 6 cases of broken screw (14 screws)and 1 case of broken stick, with no secondary nerve injury or other syndromes. Conclusion The vertebral pedicle screw internal fixation manipulated easily, which could sufficiently enlarge vertebral canal in order to decompression. In addition, during the operation, together with over-extending reduction position is beneficial to regain the height of fractured vertebral bodies.

Objective Toinvestigatetheapplicativevalueof3D-DSAandheadMRIorCTfusion technology for guiding the individualized treatment of intracranial arteriovenous malformation (AVM ). Methods Twenty-onepatientswithAVMdiagnosedwithDSAattheDepartmentofNeurosurgery,Nanjing General Hospital of Nanjing Military Command from January 2015 to May 2015 were analyzed retrospectively. All patients performed DSA,MRI,and CT scan respectively before procedure,and they also performed 3 D-DSA and MRI or CT fusion. Of the 21 patients,15 performed MRI and 3D-DSA fusion,6 performed CT and 3D-DSA fusion. According to the image fusion results of the patients,the individualized treatment regimens were further developed,including microsurgical resection,endovascular embolization,and stereotactic radiotherapy (alone or combined treatment). The patients were followed up and observed for 2 to 6 months after procedure.Results Fromthe3D-DSAwithheadMRIorCTfusionimagesofthepatientsbeforetheprocedure not only could observe the vascular architecture of AVM,the relationship between the niduses and the surrounding nerve structures,but also could precisely locate the positions of AVM with small aneurysms or tiny AVMs. According to the results of image fusion,17 patients with AVM were treated with microsurgical resection,2 were treated with interventional embolization and stereotactic radiotherapy,and 2 were treated with stereotactic radiotherapy only. Of the 17 patients with AVM underwent microsurgical resection, none experienced intracranial rebleeding during the follow-up period. The last Glasgow outcome scale (GOS)score was 5 in 13 cases,and 4 in 4 cases. One patient with AVM underwent combined stereotactic radiotherapy had intracranial rebleeding during the follow-up period,and their last GOS score was 4. The other remaining 3 patients did not have new neurological deficits or rebleeding during the follow-up period,and theirGOSscorewas5.Conclusions 3D-DSA,headMRI,andCTfusiontechnologyarenovel, the operative method is simple,and the fusion image is accurate. They can effectively develop the individualized treatment regimens for patients with AVM.

Objective To investigate the effectiveness and safety of endovascular embolization for the treatment of middle cerebral artery aneurysms. Methods From March 2007 to May 2015,the clinical data of 170 patients with 173 middle cerebral artery aneurysms treated with endovascular embolization at the Department of Neurosurgery,Nanjing Jinling Hospital were analyzed retrospectively,including 120 (69.4%)ruptured aneurysms and 53 (30. 6%)unruptured aneurysms. The incidence of complications and prognosis were compared between the 2 groups. Results (1)A total of 170 patients who could perform endovascular embolization after preoperative evaluation successfully completed the interventional procedure. None of the patients died. (2)18 patients (10. 6%)had intraoperative and postoperative complications,including 4 (7. 5%,4/53)in the unruptured aneurysm group and 14 (11. 7%,14/120)in the ruptured aneurysm group. There was no significant difference in the incidence of complications between the two groups. (3)101 patients were followed up for 3-48 months. No new nervous system symptoms and reruptured aneurysm were observed. One patient had recurrence in the unruptured aneurysm group and 4 had recurrence in the ruptured aneurysm group. Conclusion Endovascular treatment of middle cerebral artery aneurysms is a safe,effective,and feasible technique.