Objective To explore the effect of special management intervention on improving the rational use of antibacterials before operation in Department of orthopedics.Methods A total of 129 patients who did not carry out the special management of nursing integration were enrolled in this study, and 130 cases of special care for medical integration were administered to 2 patients.The rational use of Antibacterials in the two groups was observed.Results The qualified rate of antibacterial drugs before intervention was 106 (82.2%).The qualified rate of using antibiotics was 125 (96.2%) before intervention, and the difference was statistically significant (P< 0.05) before intervention.Conclusion The special management of medical integration is significant to improve the rational use of antibiotics in Department of orthopedics, and is worthy of clinical and nursing work.

Objective To evaluate the life quality of surgically treated patients with liver cancer. Methods After operations, the life quality was regularly measured in 36 patients with liver cancer for 2 years by Gastrointestinal Life Quality Index (GLQI). Results The mean preoperative GLQI score was 106?13. It was significantly decreased from the 2nd to 10th week after the operations (P

Objective To investigate the effects of ulinastatin on renal ischemia/reperfusion (I/R) in rats and assess the possible mechanism. Methods Seventy-five male SD rats weighing 210-250 g were randomly divided into three groups with 25 animals in each group : (Ⅰ) control group received sham operation; (Ⅱ)renal I/R group and (Ⅲ) ulinastatin + I/R group. The animals were anesthetized with intraperitoneal ketamine 50 mg?kg-1 . Bilateral kidneys were exposed through midline incision and bilateral renal pedicles were occluded with atraumatic mini-clamp. The kidneys turned pale. In control group the kidneys were exposed but their pedicles were not clamped, while in ulinastatin group (Ⅲ) ulinastatin 12 500 u was given i. v. 30 min before ischemia and at the beginning of reperfusion. Blood samples and kidneys were obtained at 0, 2, 6, 12, 24 h of reperfusion for determination of blood urea nitrogen (BUN) and serum creatinine (Cr) concentrations and the expression of heat shock protein 70 (HSP 70) and bcl-2 in kidney and for microscopic examination. Paller scoring system was used to evaluate the severity of histological changes ( the higher the score, the worse is the change) .Results BUN and serum Cr levels were significantly lower at 12 and 24 h of reperfusion in group Ⅲ than in group Ⅱ (P 0.05) . Conclusion Ulinastatin can reduce the risk of renal dysfunction and injury associated with renal I/ R. The protective effect of ulinastatin may be associated with the up-regulation of bcl-2 expression.

Objective To analyze the clinical features and risk factors of migraine patients with white matter le-sions (WMLs). Methods One hundred ten clinically diagnosed migraine patients who underwent magnetic resonance im-aging (MRI) scans from October, 2010 to August, 2013 were enrolled in Shandong Provincial Hospital. One hundred ten migraine patients were divided into two groups:WMLs group and non-WMLs group based on the presence or absence of WMLs in MRI scans. The clinical features of the patients and location and number of WMLs were investigated. Noncondi-tional multivariate stepwise logistic regression after univariate analysis was used to analyze the data. Odds ratio (0R) and 95 confidence interval after adjustment for possible confounding variables were calculated. Results①There were 36 patients with WMLs among the 110 migraine patients. The incidence of WMLs in migraine patients was 32.7%. The WMLs in migraine patients were predominantly present in the frontal and parietal lobes (59.1%). ② Compared with non-WMLs group, there were significant increases in disease duration (5.3±3.7 vs. 7.6±4.9, P﹤0.01), frequency of head-ache attack (3.5 ± 2.3 vs. 4.6 ± 2.2, P﹤0.05), aura (18.9%vs. 36.1%, P﹤0.05) and family history of migraine (12.2%vs. 44.4%, P﹤0.01) in WMLs group.③The independent risk factors of WMLs in migraine patients were family history of mi-graine (OR=5.995), aura (OR=3.067) and long disease duration (OR=1.165). Conclusions Family history of migraine, au-ra and disease duration are the predictive risk factors of WMLs in migraineurs.

Objective To study the consistency among non-invasive and invasive brachial artery pressure,radial artery pressure and invasive central arterial pressure,and to explore the correlation between the severe degree of coronary artery disease and invasive central aortic pressure.Methods A total of 331 patients who underwent coronary angiography in our hospital were selected.The invasive central aortic pressure,invasive and non-invasive brachial arterial pressure,radial artery pressure in all patients were measured.The severe degrees of atherosclerosis were recorded.The differences among invasive brachial arterial pressure and invasive radial artery pressure,non-invasive brachial artery pressure and non-radial artery pressure and invasive central aortic pressure were compared.Results The systolic pressure values measured in invasive and non-invasive brachial artery and radial artery were higher than that measured by central aortic pressure,while the diastolic pressure values measured in the four peripheral artery were lower than that measured in central aorta.The pressure values measured by non-invasive brachial artery pressure were more close to that measured by invasive central aortic pressure (P＞0.05).The systolic pressure was increased and the diastolic pressure was reduced in central aortic pressure with the coronary vessel lession numbers increased.The values of systolic pressure in patients with single-vessel,double-vessel and triple-vessel lesions were (118.2± 19.5) mm Hg,(124.9 ± 19.7) mm Hg and (137.7 ± 20.6) mm Hg,respectively and the values of diastolic pressure were (86.8±8.4) mm Hg,(85.3± 10.3) mm Hg and (83.1± 9.4) mm Hg,respectively.There were significant differences in systolic and diastolic pressure values among patients with single-vessel lesions,double vessel lesions and triple-vessel lesions(F=3.93,4.31,both P＜ 0.05).Conclusions The blood pressure values measured by noninvasive brachial artery pressure are more close to that measured by invasive central aortic pressure.There is a significant correlation between the severe degree of coronary heart disease and invasive central aortic pressure.Non invasive brachial artery pressure can be used in the early detection of cardiovascular dysfunction.

Objective To observe and compare the efficacy and safety of implantation of tissue expanders adjacent to or under keloid tissues for large keloids on anterior chest. Methods Between Mar 2006 and June 2009, a total of 17 patients with large keloid lesions on anterior chest received treatment with 21 tissue expanders,among which 12 were placed under the normal skin adjacent to keloids, and 9 were inserted under the keloid lesions. The scar size varied from 4.5 cm × 3.0 cm to 15.7 cm × 5.5 cm. The capacity was 70 to 400 ml for expanders adjacent to the keloid tissue, 80 to 500 mi for those beneath the keloid tissues. After tissue expansion for 6 to 8 weeks, the expander was removed and keloid lesions were resected followed by the repair of defect with expanded flaps. Further more, the patients received intraoperative local intradermal injection of betamethasone and postoperative superficial electron beam irradiation with divided doses of 7 Gy in 3 consecutive days within 1 week after the surgery. Follow-up varied from 12 to 50 months. Results Twenty expanders, except 1expander pocket which was removed ahead of time due to infection, were implanted successfully during the whole course of treatment. The main complication was expander exposure in 4 patients, including 1 expander adjacent to the keloids and 3 under keloid lesions, which showed no significant influence on secondary operation. Fifteen patients reported relief of symptoms and achieved satisfactory outcomes, while 2 patients, including 1 treated with expanders adjacent to the keloids and 1 with expanders under the keloid tissue, showed great suture tension and experienced delayed stitch removal followed by the recurrence of keloids after the operation.Conclusions The implantation of tissue expanders under the adjacent normal skin or keloid lesions is an ideal treatment option for large keloids on anterior chest. Regional suture tension is a direct contributor to the recurrence of keloid formation after surgical excision.

Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture. Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008. The patients who had an operation within two days (the early surgery group) were compared with the outcome for those who had an operation more than two days (the later surgery group). Outcomes measured were mortality, post-operative complications, operative details, the comorbidity and the activities of daily living of patients. Results One hundred and sixteen patients were included in the study. There were 45 cases in the early surgery group, including 13 males and 32 females. The patients ranged from sixty-five to eightyeight years old, with an average age of 78.76 years. While there were 71 patients in the late surgery group,including 24 males and 47 females. The patients ranged from sixty-six to one hundred and three years old,with an average age of 80.00 years. The demographic data of patients show no significant difference in two groups. There was no difference in intraoperative conditions such as anesthesia, amount of bleeding, type of fixation between two groups. Patients in early surgery group experienced shorter length of hospital stay, and fewer pulmonary complications. The mortality of early surgery group do not show a significant increase at discharge, 6 month, 12 month postoperatively compared to that of the later surgery group. However patients in the early surgery group show a significant increase of ADL scores at discharge, 6 month postoperatively,but not at 12 month. Conclusion The timing of surgery has an impact on clinical outcome in elderly hip fracture. Early surgery was associated with improved function in the first 6 month postoperatively, but not 12months, but it was not associated with mortality.

Objective To explore the influence of Roy adaptation mode and resistance training on cardiac function and life quality of patients with chronic heart failure. Methods One hundred patients with chronic heart failure in our hospital cardiovascular department were enrolled in the study. All patients received conventional treatment of chronic heart failure. They were equally divided into the control group and the observation group using random digit grouping method. The control group received conventional nursing mode and observation group received Roy adaptation mode joint resistance training. The cardiac function and life quality of two groups were compared after two months. Result After three months′intervention, each index of cardiac function was significantly better than that of the control group ( P < 0 . 01 ) , 6 minutes waking distance of the observation group was significantly longer than that of the control group ( P < 0 . 01 ) , and the life quality score was significantly higher than that of the control group (P<0.01). Conclusion The Roy adaption mode and resistance training can improve heart function and the overall quality of life of the patients with chronic heart failure.

Objective To retrospectively analyze the therapeutic effect of wide surgical excision combined with low-dose adjuvant interferon-alpha 2b on cutaneous malignant melanoma.Methods A total of 32 patients with cutaneous malignant melanoma received wide surgical excision after preoperative examination and staging.The excisions were performed with a margin measuring 1-2 cm from the visible lesions or biopsy scars.Surgical modalities included direct suture after excision(4 patients),dactylolysis or toe amputation(6 patients),free skin grafting(15 patients),random skin flap transfer(3 patients)and pedicle skin flap transfer(4 patients).Lymph nodes were selectively dissected in 9 patients with regional transfer of lymph nodes,and inguinal lymph nodes were cleared away in 2 patients.One week after the operation,patients received adjuvant therapy with subcutaneous injection of interferon-alpha 2b(3 million IU,thrice per week)for one to three years.Results Preoperative tumor staging revealed 21 cases of cutaneous malignant melanoma at stage Ⅱ,and 11 cases at stage Ⅲ.The excisions healed by the first stage in all the patients.Up to June 2011,2 patients had been lost to follow up,5 patients with stage Ⅲ melanoma had died.Survival was observed in all of the 4 patients receiving 1-year follow up,12 of 13 patients receiving 1-3 year follow up,5 of 7 patients receiving 3-5 year follow up,and 4 of 6 receiving 5-year follow up.Of the 25 surviving patients,regional lymph node metastasis was observed in 8 patients,which developed within 2 years after the operation in 2 patients.The adjuvant therapy with interferon-alpha 2b lasted 3 years in 8 patients,and more than 1 year in 11 patients.Side effects were mild.Conclusion Wide surgical excision plus low-dose interferon-alpha 2b is effective for the treatment of stage Ⅱ and Ⅲ cutaneous malignant melanoma with lower local recurrence and higher survival rate.

Objective To observe the variation of the blood pressure in patients with persistent vegetative state (PVS) during whirl-pool-bubble bath. Methods 5 PVS patients accepted whirlpool-bubble both therapy, 38℃for 20 minutes. Their blood pressure was recorded 0, 10 and 20 minutes after immersing for 4 weeks. Results The systolic pressure decreased 20 minutes after immersing compared with that just immersing, but all above 60 mmHg. The systolic and diastolic pressure maintained in a satisfactory range during whirlpool-bubble bath. Conclusion Hypotension has not been found in the patients with PVS during whirlpool-bubble bath.