Objective To evaluate the effect of fast track surgery nursing in perioperative nursing of patients undergoing laparoscopic resection of colorectal cancer. Methods 60 cases undergoing laparoscopic resection of colorectal cancer were divided into the control group and the obserevation group with 30 patients in each group.The control group was given routine nursing,the observation group accepted fast track surgery nursing.The operation situation,clinical effect and the rate of postoperative complications were compared between two groups. Results There was no significant difference of anesthesia duration,operation time and intraoperative blood loss in two groups.Time of getting out of bed,exhaust time and hospital stay in the observation group were much shorter than those in the control group.The rate of postoperative complications were 26.7％ and 46.7％ in the observation group and the control group respectively,the difference was significant. Conclusions Application of fast track surgery nursing in perioperative nursing of patients undergoing laparoscopic resection of colorectal cancer can promote the quick recovery of patients and reduce the hospital stay and postoperative complications.

Objective Through observing the change of serum cTnT level and other biochemical markers such as T3 and TNF-αin acute ischemic stroke patients , to investigate the correlation between the indictors change and short-term prognosis and stroke severity .Methods This study observed 68 patients (male 35 cases ,mean age 68 ±11.4 years; female 33 cases, mean age 69 ±10.3 years).All cases were collected fasting blood sample to test cTnT ,T3 and TNF-α.Death and other unexpected events were recorded in the form of telephone follow-up within one month in survival patients during and discharge from hospital.Results According to cTnT detection level ,all cases were divided into two groups , normal group (54 cases,79.4%) and positive group(14 cases,20.6%).There was statistical significance between posi-tive cTnT and NIHSS score neurological deficits ( p <0.01).cTnT was negratively correlated with T3( r =-0.324 , P <0.05 ) ,but positively with TNF-α( r =0.67 , P =0.017 ) .All patients were followed up for one month.14.7%patients died including 11.7%during hospital and 3% after discharge.After age, NIHSS adjustment cTnT remains an independent risk factor for death ( RR=2.34 ,95%CI=1.22-5.02 , P<0.01 ) .Conclusion After acute ischemic stroke , cTnT is correlated with dropping T 3 level and in-creasing TNF-αlevel, suggesting that both stress and inflammatory response may be involved in heart dam-age.Abnormal elevation of cTnT influenced short-term prognosis of acute ischemic stroke , which can be used as short-term indicators of poor prognosis in the clinical observations .

Objective To investigate effects of ischemic postconditioning on the nitric oxide ( NO) and nitric oxide synthase ( NOS) in diabetic rat brain tissues .Methods Thirty Wistar rats were diabetic models induced by intraperitoneal injuction of stepto-zotocin (STZ), and randomly divided into three groups: Control group (normal, diabetic), cerebral ischemia group, and ischemic postconditioning ( I-POST) group.The rats of cerebral ischemia group and ischemic postconditioning group were made model of cere -bral ischemia by ligation carotid artery .Hematoxylin-eosin ( HE) was used to observe their pathological changes in control and diabetic groups.Enzyme-linked immunosorbent assay ( ELISA) method was used to detect the expression and changes of NO and NOS in the sera in each group .Western Blot method was used to investigate the expression and changes of NOS in the retinal tissues in each group .Results For I-POST group , brain tissue defects were decreased , neuronal cells were increased , serum inducible NOS ( iNOS) content was significantly lower than endothelial NOS (eNOS) and neuronal NOS (nNOS) ( P <0.05), brain tissue iNOS expression was significantly weaker than ischemia group ( P <0.05 ) and was not different from normal group ( P >0.05 ) .Conclusions Is-chemic postconditioning can protect the brain tissue of diabetic rats by inhibiting NOS activity especially iNOS .

OBJECTIVE To intensify the management of the nursing in operating room and to prevent and control nosocomial infection. METHODS During the course of the management of nosocomial infection in operating room,the causation of nosocomial infection was found through analyzing the possible tache of nosocomial infection and a series of relevant measures were taken to improve the control of nosocomial infection in operating room. RESULTS The management system of nosocomial infection in operating room was intensified and nosocomial infection in operating room was controlled effectively. CONCLUSIONS The establishment of the effective system and measures of nosocomial infection in operating room have an important effect on the improvement of the management of the nursing operating room and the control of nosocomial infection.

Objective To investigate the characteristics of clinical manifestations and genetics of late-onset cobalamin (cbl) C deficiency,also named as combined methylmalonic acidemia and homocystinemia, cblC type. Methods We reviewed 26 late-onset cblC deficiency patients diagnosed in Qilu Hospital, Shandong University from 2012 to 2017 and analysed the clinical, biochemistry, neuroimaging, follow-up and MMACHC gene data. Results Among the 26 patients, male:female ratio is 11:15, with the age of diagnosis from 4 to 39 years and sibling comorbidity in 4 families. The clinical manifestaions of nervous system included spastic paraplegia,mental and behavior disorder,intelectual decline,epilepsy,ataxia,dystonia and peripheral neuropathy. There were four cases with proteinuria at onset. At first visit, the levels of serum total homocystinuria of all patients were elevated, from 61.4 to 193.4μmol/Lwith methylmalonic acidemia. The neuroimaging data of the 26 cases showed 11 with cerebral atrophy, 10 with thoracic spinal cord atrophy, five with brain parenchymal lesions, three with longitudinal myelopathy which were reversible in follow-up, one with syringomyelia, one with multiple cerebral artery stenosis. In all the cases, cobalamins were supplied parenterally and folate, betaine, L-carnitine, vitamin B6 were supplied orally during acute metabolic crisis, and the symptoms of acute encephalopathy disappeared but symptoms of spastic paraplegia had little improvement. In chronic stage, frequency of intramuscular injection of hydroxocobalamine could be decreased while the index can still be improved. All the 26 cases had definite mutations in MMACHC gene, the most common mutations of which were found to be c.482G>A(15/52) and c. 609G>A(13/52). Conclusions Homocystine is the important biomarker for cblC deficiency. Once diagnosed, parenteral hydroxocobalamin and oral betaine should be supplied for a lifetime with good prognosis. The most common mutations of MMACHC gene in our cases are c. 482G>A and c. 609G>A missense mutations.

OBJECTIVETo investigate the influence of najanalgesin on glutamate-glial transporter 1(GLT-1) in spinal cord of rats after L5 spinal nerve ligation and transection (SNL), and explore the spinal analgesic mechanism of najanalgesin.

METHODOne hundred male SD rats were randomly divided into 6 groups: sham(A), SNL(B), SNL + najanalgesin(C), SNL + saline (D), SNL + najanalgesin + liposome (E), SNL + najanalgesin + liposome + GLT-1 As-ODNs(F) and treated with intrathecal injections of 10 p.L saline (A and D), 40 ng X kg(-1) najanalgesin (C, E and F), qd, respectively. Besides intrathecal administration of najanalgesin the rats were intrathecally injected with 10 microL of GLT-1 antisense oligodeoxynucleotides (As-ODNs) (F) and 10 micdroL of liposome(E) once daily on day 3. The L4-L6 segments of the spinal cord were isolated in 1, 4 and 7 d(A,B,C and D), 7 d(E and F) after surgery. The mRNA and protein of GLT-1 were determined.

RESULTThe SNL model has successfully been set up. Compared to sham group, the expression of GLT-1 mRNA and protein level in group B and D both increased firstly and decreased later, the expression of GLT-1 in group C was significantly increased and kept stable, which were also higher when compared to group D in day 7th. Compared to SNL + najanalgesin group, after intrathecal injection of GLT-1 As-ODNs the GLT-1, expression of GLT-1 in F group significantly decreased. While intrathecal administration of liposome had no significant effect on the spinal GLT-1 expression.

CONCLUSIONNajanalgesin could increase the mRNA and protein expression of GLT-1 in spinal cord, which may be one of its spinal mechanisms of analgesia.

Animals ; Elapid Venoms ; pharmacology ; Elapidae ; Excitatory Amino Acid Transporter 2 ; genetics ; metabolism ; Gene Expression Regulation ; drug effects ; Male ; Neuralgia ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; drug effects ; metabolism

Objective:To investigate the clinicopathological features and imaging differential diagnosis of intravascular large B-cell lymphoma (IVLBCL) in the central nervous system (CNS).Methods:A case of CNS IVLBCL with multiple intracerebral microbleeds (CMBs) diagnosed in the Department of Neurology, Qilu Hospital of Shandong University in 2017 was reported. The clinical and imaging data, histological and immunohistochemical markers were retrospectively analyzed, and the relevant literature was reviewed.Results:The patient was a 31-year-old woman presented with headache and seizures. Cranial magnetic resonance imaging (MRI) showed multifocal lesions involving mainly the cortical and subcortical white matter (bilateral cerebral hemisphere and right cerebellar hemisphere), hyperintense signal on T 2-weighted and fluid-attenuated inversion recovery images, with hypointense signal on T 1-weigthed and diffusion-weighted images and contrast enhancement in some lesions. The susceptibility weighted imaging revealed multifocal cortical or subcortical hypointense lesions, involving mainly the subcortical white matter. Brain magnetic resonance angiography was normal. Brain magnetic resonance venography showed left side transverse sinus was hypoplastic. Cranial magnetic resonance spectroscopy showed decreased N-acetylaspartylglutamate peak, elevated choline peak and inverted lipid double peak. Her symptoms and the lesions once improved after starting steroid treatment. However, CNS recurrence occurred after 1 week of steroid withdrawal. She underwent the biopsy of the right frontotemporal lobe. The pathological examination showed multiple microscopic hemorrhages and edema scattered in the brain tissue. A large number of heterologous mononuclear cells were aggregated in small blood vessels in the parenchyma and meninges. Immunohistochemical analysis revealed that the tumor was negative for Epstein-Barr virus encoded small RNAs, CD 3, CD 10, cytokeratin and CD 138, and positive for CD 20, CD 79α, B-cell lymphoma (BCL)-2, BCL-6, myelocytomatosis oncogene (C-myc) and multiple myeloma oncogene-1 (MUM-1). The Ki67 proliferation index was about 70%. The diagnosis of IVLBCL was confirmed. Conclusions:IVLBCL in CNS is a rare and swiftly progressive disease with poor prognosis. Its clinical symptoms and imaging are nonspecific. Early diagnosis and treatment is critical. Biopsy is the gold standard for diagnosis. Random skin biopsy may be helpful for the early diagnosis. Furthermore, regarding the cause of multiple CMBs, the possibility of IVLBCL should be considered in the differential diagnosis, in addition to the common causes, such as primary angiitis of the CNS and cerebral amyloid angiopathy.

Objective? To observe the correlation factors of venous injury caused by peripheral intravenous indwelling catheter, so as to guide the rational use of clinical intravenous indwelling catheter, so as to avoid venous injury and promote vascular recovery. Methods? This study was carried out in five Class Ⅲ Grade A hospitals. In each hospital, we randomly selected one of the departments: Digestive Internal Medicine, Nephrology, Hepatobiliary Surgery, Extraglandular Surgery and Respiratory Medicine as the research departments. The inpatients admitted from March to June 2018 were selected and included in the study as a whole with the consent of the patients. In this study, 81 qualified patients were successfully injected with the peripheral intravenous indwelling catheter infusion and observed. According to the prescription of the doctors and hospital department policies, peripheral intravenous indwelling catheter was used for infusion. Specialists were arranged to record the patients' infused solution, evaluate the puncture site of the indwelling catheter before puncture and the results of venous blood vessel evaluation before puncture. Observe and record the reasons for the removal of indwelling catheter, the patency during the removal, the indwelling time, the marking of indwelling vein, evaluate and record the condition of the puncture site of indwelling catheter and the grade of phlebitis. The elasticity and filling degree of venous vessels were evaluated and recorded on the 14th day after catheter removal. Results?(1)The severity of local phlebitis was positively correlated with the severity of vascular injury when removing intravenous indwelling catheter; the incidence of moderate and severe vascular injury was 9.09% when local symptoms were grade Ⅰ phlebitis; the incidence of moderate and severe vascular injury was 95.83% when local symptoms were grade Ⅱ and Ⅲ phlebitis when removing intravenous indwelling catheter; and there was statistical difference in the incidence of moderate and severe vascular injury between the two groups (P＜0.01). (2)No moderate or severe vascular injury occurred after asymptomatic removal of intravenous indwelling catheter, and the vascular recovery rate was 100.00%. The incidence of moderate or severe vascular injury was 42.37% and the vascular recovery rate was 57.63% in patients with symptomatic removal of intravenous indwelling catheter. There was a statistically significant difference in the incidence of venous injury and recovery between the two groups (P＜ 0.01). (3)There was no significant difference between the indwelling time of intravenous indwelling catheter and the incidence of phlebitis and the rate of vascular injury and recovery during the time period of this clinical study (P＞0.05). Conclusions? Phlebitis after peripheral intravenous indwelling catheter infusion is the main cause of vascular injury and hinders venous recovery. Preventive measures should be taken in clinical puncture and use of venous indwelling needles; the removal of indwelling catheters should not be based only on indwelling time; the symptoms of puncture sites and patients' reactions should be evaluated in accordance with the regulations to avoid phlebitis above grade Ⅱ; in order to avoid vascular injury caused by infusion of peripheral intravenous indwelling catheters, asymptomatic removal of intravenous indwelling catheter is recommended.

Objective To describe the features of clinical,imaging and cerebral spinal fluid (CSF) of listerial rhombencephalitis to improve the understanding of this disease in clinical practice.Methods All the clinical data of three cases of listerial rhombencephalitis from April to August 2017 in Qilu Hospital were collected and analyzed retrospectively.Results All the three cases were healthy adult women before,with a rapidly progressive course,beginning with fever (38.2-40 ℃),headache accompanied by nausea and vomiting,followed by cranial paralysis,dysphagia and paralysis of the limbs on the 2nd to 5th day of onset,and developed to acute respiratory failure and unconsciousness on the 5th to 8th day of onset.All the three patients were diagnosed with CSF culture positive for Listera monocytogenes on the 3rd to 5th day after admission.The initial CSF lactic acid increased significantly,representing 12.3,12.0 and 10.0 mmol/L respectively;CSF white blood cells were 416× 106/L,760× 106/L and 793× 106/L,respectively,and the protein levels were 0.76 g/L,0.57 g/L and 1.47 g/L,respectively.Brain images showed brain stem was involved in all the three patients,therein cases 1 and 3 with cerebellar hemisphere involved,case 2 with upper cervical spinal cord involved,and case 1 with supratentorial hydrocephalus involved.After treatment with sensitive antibiotics,case 1 recovered,case 2 died,and case 3 lived with dysphagia.Conclusions Listerial rhombencephalitis should be suspected when a patient started with fever and headache,rapidly progressed to cranial nerve paralysis,brainstem symptoms,and acute respiratory failure,especially when the brain imaging suggested brainstem involved with increased white blood cells and apparently elevated lactic acid level of CSF.The earlier the sensitive antibiotics initiated,the better the patients' prognosis.