OBJECTIVE To discuss the management method of hospital medical waste in nursing activity,prevent from the pollutant proliferation,and avoid the second exposure.METHODS Reinforced the management of the medical waste,established the management network of medical waste,and made the training of all staffs,we drew up a series of effective measures according to the law and regulation.RESULTS Various plan and measure were done, nursing personnel were fully aware of the importance of the environmental protection.(medical) waste(management) was much better than before.The infection which related to the medical waste was not occurred.(CONCLUSIONS) Doing well management of the medical waste is depending on some conditions,which are as(follows:)(1)the leaders pay more attention to;(2)strengthen the training of all staffs;and(3)the management system is sound.

Objective To develop an evidence-based community extended care model for patients with asthma.Methods Mixed research methods were applied to integrate best evidences:80 literatures were included in systemic review; 394 medical records were analyzed; 112 nurses admitted a test and a questionnaire to assess their competence on asthma care; clinical observation to both hospital and community centers were conducted; 6 multidisciplinary experts were consulted; and 100 patients admitted a questionnaire on patient needs and 17 of them were further interviewed.Results The nursing care model with the feature of hospital and community health service center collaborating to provide extended care for patients with asthma was established.Conclusions The development of a nursing care model for practice should be based on the current best evidence generating from the best research evidence,professional judgment on clinical practice requirement and patients' needs.

Objective To observe the clinical manifestation and pathological immunohistochemical features of intraspinal extramedullary peripheral primitive neuroeetodermal tumour (PNET). Methods From Apr. 1996 to Aug. 2007, totally 5 patients with intraspinal extramedullary peripheral PNET were treated, including 3 male and 2 female, aging from 11 to 48 years. The primary site was cervical vertebral in 2 (C5-C7 and C5-T1 ) and thoracic vertebral in 4( T4-T6, T6-T8 ,T4-T5 and C5-T1 ). The clinical manifestation was paresis of limbs in 5 and incontinence in 4. All the patients were pathologically diagnosed Results All of the three patients who had CD99 staining expressed CD99 ( + ). All the 5 patients received surgery followed by radiotherapy and 4 received postoperative chemotherapy. The most common treatment failure was local recurrence. The overall survival time of the 5 patients was 4.8year,2.5year,2. 1ycar, 1.6year and 0.8 year respectively. Conclusions Intraspinal extramedullary peripheral PNET is highly malignant tumor.Patients have very poor survival and local control New treatment protocol should be studied to improve the local disease control and increase remission rate. To distinguish central PNET from peripheral PNET has crucial significance since different entities have different treatment protocol and prognosis.

Objective To explore the action mechanism and clinical significance of CD4+CD25+ regulatory T (Treg) cells in the development of atopic dermatitis (AD). Methods Peripheral blood mononuclear cells (PBMC) were obtained from 46 patients with AD and 20 normal human controls. Flow cytometry was performed to detect the number of CD4+CD25+ Treg cells, real-time fluorescence PCR assay to measure the Foxp3 mRNA level in PBMC, ELISA to determine the serum levels of IL-2, IL-4, IL-10 and IFN-γ. Results A statistical decrease was observed in the percentages of peripheral CD4+CD25+ Treg cells among CD3+ T cells and CD4+ T cells in AD patients compared with normal controls (t' = 3.775, 4.533, both P＜ 0.01 ), and in the percentage of peripheral CD4+CD25+ Treg cells among CD3+ T cells in patients with acute AD compared with those with chronic AD (t = 2.217, P ＜ 0.05), but no significant difference was noted between patients with acute AD and those with subacute AD or between those with subacute AD and those with chronic AD in the percentage of peripheral CD4+CD25+ Treg cells among CD3+ T cells (t = 1.558, 0.49, both P ＞ 0.05). The mRNA level of Foxp3 in PBMC from AD patients was statistically decreased compred with that from normal controls (z =-2.368, P ＜ 0.05 ). The count of CD4+CD25+ Treg cells was positively correlated with serum levels of IL-2 and IL-10 (r = 0.512, 0.494, both P ＜ 0.05), but had no significant correlation with serum levels of IL-4 and IFN-γ (r = -0.110, -0.237, both P ＞ 0.05). Conclusions In AD patients, there is a decrease in the count of CD4+CD25+ Treg cells and in the level of Foxp3 mRNA, which may suppress the proliferation of and secretion of Foxp3 mRNA by Th2 cells, lead to Th2 predominance, participate in the development of AD.

Objective To evaluate the effectiveness of clinical pathways for pediatric asthma.Methods The literatures on the application of clinical pathways for pediatric asthma were collected in the databases such as PubMed,Cochrane Library,Ovid,ScienceDirect,EBSCOhost,CNKI,Wanfang and CBM while a manual search was added.The search was performed from 1980 to 2014.Two reviewers independently screened references,extracted data and assessed the risk of bias.Data was pooled and analyzed by using Revman 5.2 version.Results Eleven studies involving 2 207 participants from nearly 1 048 relevant studies met the inclusion criteria.1 174 participants were in the clinical pathway group while the other 1 033 participants were in the control group.Meta-analysis result showed that patients with asthma in a clinical pathway had a shorter length of stay,less medical cost,reduced rate of emergency room visits,and improved health education.However,clinical pathway did not appear to reduce readmission.Conclusions Clinical pathway can significandy reduce the length of hospital stay,cost,rate of emergency room visits and improve health education.

Objective To systemically analyze the effect of continuous aspiration of subglottic suction (CASS) on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients.Methods PubMed,Cochrane Library,Ovid,EBSCOhost,ScienceDirect,Google scholar,CNKI,CBM and Wanfang Database were searched for the RCTs about the effect of CASS on the outcomes of mechanical ventilated patients from July 1994 to July 2014,and the relevant journals were also hand-searched.Data were extracted independently by two reviewers.Meta analysis was conducted using RevMan 5.1 software.Results Data extracted from 7 RCTs with a total of 1 566 patients were analyzed.The risks of developing clinically diagnosed VAP were significantly lower among the patients receiving CASS [RR =0.54,95％ CI(0.43,0.65),P＜0.01],episodes of VAP occurred later in patients receiving CASS [MD=3.52,95％CI(1.98,5.06),P＜0.01],the duration of mechanical ventilation [MD=-2.03,95％CI(-2.23,-1.73),P＜0.01]and length of ICU stay were reduced [MD=-2.99,95％CI(-3.75,-2.23),P＜0.01],while no significant differences were detected between the two groups regarding the mortality rate [RR=0.98,95％CI (0.80,1.20),P＞0.05].Conclusion This study proved that the CASS did have effect in reducing the incidence of VAP,but it is limited by lack of enough RCTs with high quality.Large sample of high quality RCTs is necessary to examine the wider applicability of CASS.

Objective To describe the burden of caregivers of children with asthma,and to provide reference for the development of family care support program.Methods Qualitative research was used to carry out semi-structured interviews with 13 caregivers of children with asthma in the pediatric outpatient of the First Affiliated Hospital of Guangzhou Medical University.The data collected were analyzed with Colaizzi 7-step analysis method.Results The carcgiver burden was classified into 4 themes,including time and energy exhaustion,heavy economic burden,insufficient knowledge of care and negative emotions.Conclusions The burden of caregivers of children with asthma has a relatively great impact on the daily work and life,even the physical and mental health.Care workers should be concerned about the status of caregiver burden and provide targeted interventions,which could help caregiver adapt to their roles,maintain and promote the health of children patients and their families.

Objective To observe the protective effect of progesterone(PROG) on rat retinal ganglion cells(RGCs) in chronic ocular hypertention models.Methods The chronic ocular hypertention rat model was made by cauterizating three episcleral veins.Rats were divided into control group,high level PROG group,middle level PROG group,low level PROG group according to different concentrations of PROG injected intraperitoneally.The left eye was model eye and the right eye was control eye.Three months later,the animals were executed and the eyeballs were enucleated.The RGCs were detected by HE staining and Thy-1.1 immunohistological staining.The apoptosis of RGCs was detected by TdT-dUDP terminal nick end-labeling(TUNEL) technique.Results The number of RGCs of model eyes in high level PROG injection group was more than those in control group,low level and middle level groups(P

Objective To evaluate the outcome of Stage Ⅱ nasopharyngeal carcinoma(NPC) trea-ted by conventional fractionation radiotherapy. Methods From January 1990 to May 1999,216 patients with untreated stage Ⅱ NPC were irradiated by 6 MV photons and 9-12 MeV electrons with linear accelera-tor. Of 26 patients with residual lesions after 70 Gy irradiation, 18 received intracavitary brachytherapy and 8 received stereotactic irradiation boost. Results The 10-year overall survival (OS) of patients with T2 N0 M0, T1N1M0 and T2N1M0 disease were 90%, 80% and 75.2% (χ2 = 3.26, P =0. 200), respectively. The corresponding disease-free survival(DFS) and distant metastasis-free survival(DMFS) were 79% ,60% and 62.6% (χ2 = 5.87, P = 0.053) ;90% ,74% and 68.0% (χ2 = 7.09, P = 0. 030), respectively. In uni-variate analysis, T stage had no impact on OS, DFS or DMFS (χ2 = 0.44, P = 0. 500 ; χ2 = 0.44, P = 0.500 ; χ2 = 0.25, P = 0. 610), while N stage significantly influenced DFS and DM FS (χ2 = 5.86, P = 0. 015 ; χ2 = 5.31 ,P = 0. 021). Multivariate analysis showed that N stage was an independent prognostic factor for DFS and DMFS(χ2=5.03,P=0.025;χ2=6.47,P=0.01). Conclusions Stage Ⅱ NPCwithposifivelymph node treated by radiotherapy alone is inadequate. In order to improve DFS and DMS, combined chemo-radio-therapy should be considered.

Objective To investigate the clinical features,treatment outcome and prognosis of pa tients with nasopharyngeal adenoid cystic carcinoma(ACC).Methods From March 1963 to August 2002, 33 patients with ACC were retrospectively reviewed.Among them,13 received multimedality therapy(S + R in 9 and R +S in 4) and the remaining 20 received radiotherapy alone.The interval between the first visit and clinical diagnosis was 12 months(1.0-36.4 months).The misdiagnosis rate was 55% (18/33),with the most common error of otitis media.The clinical symptoms of ACC were similar to those of squamous carcino ma in nasopharynx,though the cervical lymph node metastasis was rare(12%) and cranial nerve invasion was common (58%). ResultsAfter a median follow-up of 60.8 months (5.0-245.2 months),the 5-and 10-year overall survival rates,free-disease survival rates,local regional control rates and metastasis-free sur vival rates were 66% and 29% ,41% and 27% ,61% and 40% ,62% and 62% ,respectively.Among the 20 patients(61%) with recurrence,15 had local regional failure(13 in situ and 2 in cervical lymph node) ,and 9 had distant metastasis(5 in the lung,2 in the lung and bone,1 in the liver and I in the bone).Univariate analysis showed that clinical stage was a prognostic factor(Ⅰ + II vs Ⅲ + Ⅳ,P = 0.009),while treatment modality(radiotherapy alone vs multimodality therapy) was not. ConclusionsNasopharyngeal ACC is a locally aggressive disease with a long course.Either radiotherapy alone or muhimodality therapy(S + R/R + S) is effective in the treatment.