Objective To take the initiative in Huaibei region of Pseudomonas aeruginosa OprM efflux phenotype and the presence of genetic analysis to explore the multi-drug resistant Pseudomonas aeruginosa and the active efflux mechanism.Methods assignment pump inhibitor carbonyl cyano-right-chlorophenyl hydrazone(CCCP)on Pseudomonas aeruginosa ciprofloxacin(CIP) reversal of the sensitivity tests to screen active efflux of Pseudomonas aeruginosa phenotype-positive bacteria;using PCR amplified active efflux phenotype-positive bacteria OprM genes.Results CCCP under the action of 36 Pseudomonas aeruginosa,24 strains of the CIP to improve the sensitivity of four times more active efflux phenotype positive rate was 66.7%(24/36);in OprM gene PCR extension by experiment,there are 16(44.4%,16/36)was amplified 848bp fragment of OprM.Conclusion active efflux phenotype in clinical Pseudomonas aeruginosa in widespread;OprM of Pseudomonas aeruginosa genes in active efflux of the most common bacteria.

Objective To investigate the pain level and its influential factors in patients after operation of hepatobiliary surgery. Methods 120 patients were evaluated with the demographic data, State Trait Anxiety Inventory Form (STAI) , Visual Analogue Scale (VAS) , Perceived Social Support Scale (PSSS) and Eysenck Personality Questionnaire (EPQ). Results The highest pain level was within 2h in patients after the operation,then decreased gradually,but its still in the moderate level until 72h after the operation;the pain scores of the PCIA group were lower than the control group ( 2h, 12h after the operation) (P ＜ 0.05, (P ＜ 0. 01 ). The preoperative state anxiety (S-AI) scores were higher than the norm (P＜0. 01 ). The psychoticism Personality characteristics influents the postoperative pain ( 12h,24h after the operation); there were positively correlations between P and VAS (12h, 1week after the operation). The analgesia methods influent the postoperative pain(2h,48h after the operation). The S-AI influents the postoperative pain (2h-48h after the operation) ,there were positively correlations between S-AI and VAS (2 ～ 72h after the operation). The social support influents the postoperative pain (48h after the operation); there were negatively correlations between PSSS score and VAS (48h ,72h and 1 week after the operation). The age and occupation of the patients influent the postoperative pain. Conclusion There was serious pain in patients after operation of hepatobiliary. The preoperative S-AI ,the psychoticism personality characteristics, analgesic modalities, social support, age, occupation of patients are influential factors of pain in patients after abdominal operation.

[Objective]To evaluate the effects of transpedicular internal fixation system for occipitocervical fusion.[Method]From Jan.2004 to Jan.2007,occipitocervical fusion was performed in 21 patients(12 male,9 female,mean age 45.3 years) with transpedicular internal fixation system(Sofamor Danek Company).There were 14 with upper cervical tumor,3 with cervical congenital malformation and 4 with dens axis fracture combined with atlantoaxial dislocation.The clinical outcomes were investigated by clinical observations,radiologic studies and statistical analysis.[Result]All the patients were followed up for 6 to 40 months with an average of 21 months.The result of X-ray showed that bony fusion was successful in 16 patients at 3 months and 5 patients at 6 months of follow-ups.There was no deterioration of spinal cord injury.The JOA scores of neurofunction increased from 5-17 points(mean 12.6 points) to 8-17 points(mean 15.8 points),with the improvement of 72%.All patients were partly limited in rotation movement.Seventeen patients had a rotatain of 100?,three was 80?,and one was 50?.[Conclusion]Transpedicular internal fixation system has multiaxial screw of three-column fixation and plastic rods,which offers strong fixation and good fusion.It can also benefit the maintenance of cervical curve.It is an effective and reliable method for reconstruction of upper cervical stability.

BACKGROUND:Percutaneous vertebroplasty has been extensively applied in treatment of osteoporotic vertebral compression fractures, and now it is also used in spinal metastatic tumor. OBJECTIVE:To evaluate the effectiveness of percutaneous vertebroplasty for metastatic tumor of thoracic lumbar vertebrae by bone cement perfusion at different times and temperature gradient. METHODS:A total of 24 cases (38 vertebrae) of metastatic tumor receiving percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient were reviewed retrospectively. Al patients were classified into group A (11 vertebrae in 9 cases) featured with apparent vertebral compression (≥ 1/4) and group B (27 vertebrae in 15 cases) of no obvious compression (<1/4). The percutaneous vertebroplasty was conducted with C-arm fluoroscopy positioning. Bone cement was injected by perfusion at different times and temperature gradient method. Visual Analogue Scales and Owestry Disability Index were recorded to assess pain al eviation and functional restoration before and after bone cement injection at different times and temperature gradient. The height of treated vertebrae was also analyzed. Fol ow-up was performed for 12 to 56 months. RESULTS AND CONCLUSION:Al 24 patients successful y underwent percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient. Bone cement (4±1) mL was averagely injected into each thoracic vertebra. Bone cement (5±1) mL was injected into each lumbar vertebra. Postoperative recheck radiographs revealed good bone cement distribution, no nerve root injury or spinal compression occurred. Vertebral height was significantly higher posttreatment compared with pretreatment in both groups (P<0.05). Visual Analogue Scales and Owestry Disability Index scores were significantly lower at 1 day, 1 month after treatment and during final fol ow-up compared with preoperation in al patients (P<0.05). No significant difference in Visual Analogue Scales and Owestry Disability Index scores was detected between two groups at the same time point. Results suggested that percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient for metastatic tumor of thoracic lumbar vertebrae could reduce the occurrence of bone cement leakage, and could ease the pain quickly for apparent and non-apparent compressed tumor metastatic vertebrae. It is an effective method to treat metastatic tumor of vertebrae.

Objective:To study the effect of learning plan guidance based on clinical nursing pathway applied in the teaching of surgical nursing.Methods: The nursing specialty students from two classes of grade 2010 were divided into experiment group and control group for the research randomly. Learning plan guidance based on clinical nursing pathway was performed in experiment group, while traditional teaching method was performed in control group. Students were evaluated by teacher during the course; Theoretical examination was carried out after the course. The students in the experiment group were required to fill in questionnaire.Results: Attitude of students in the experiment group is positive. Experimental group was excelled control group obviously in theoretical examination, and the difference was statistically significant (P<0.01).Students in the experiment group made a positive evaluation for teaching effect.Conclusion: Learning plan guidance based on clinical nursing pathway is suit for the reform in teaching of surgical nursing. It can improve the student nurses' comprehensive abilities.

0.05). The effect of group A was better than that of group B in relieving symptoms and improving routine blood and urine examination indexes, MG and urinary creatinine levels, blood lipid content and renal function (P

This paper introduces chief physician LIU Huilin's empirical characteristics in treating cluster headache based on holism and pattern-identification-based treatment,with spirit-regulating filiform needling,filiform fire needle pricking,and collateral-pricking for bloodletting sequential therapy,which inherits the academic thoughts of"acupuncture-moxibustion for treating spirit"from Professor ZHOU De'an and"three-unblocking acupuncture therapy"from HE Puren,thus providing a reference for treating cluster headache with acupuncture-moxibustion therapy.

Objective To evaluate the reliability and validity of three-district and four-level triage standards in adult emergency department.Methods A randomized sampling cross-sectional study was conducted. A total of 1106 emergency adult patients admitted to the Second Xiangya Hospital of Central South University in Hunan Province from December 2015 to April 2016 were enrolled. The triage was independently performed by 12 nurses according to the emergency triage criteria. Based on the shift style, 2 nurses were assigned to each shift as the triage guider and assistant respectively, who did the triage for every patient independently. The clinical data were recorded as follows: the demographic data, emergency information (triage time, emergency way, complaints, vital signs, and conscious state), triage information (triage level, admitted department), waiting time, treatment time, destination and outcomes. The reliability of three-district and four-level triage standards was analyzed by Spearman correlation, and the receiver operating characteristic curve (ROC) was plotted to evaluate its validity.Results ① A total of 254 patients were enrolled for reliability evaluation in the first 2 weeks of the study. The overall internal consistency rate ofthe triage instructors and the triage assistants was 72%, the total Kappa value was 0.686 [95% confidence interval (95%CI) = 0.608-0.757,P < 0.001]. ② Validity analysis showed that in the 1125 emergency patients collected during the study, a total of 1106 patients were finally enrolled in the analysis excluding the patients who refused to accept the treatment, whose data was incomplete and who was diagnosed as prehospital death. With the increase of three-district and four-level triage level, a significant increase was showed in the waiting time of patients, the treatment time, and the retention rate; on the contrary, the salvage rate, the hospitalization rate, hospitalization time, emergency mortality, in-hospital mortality and total mortality rate were decreased [the waiting time of patients from triage level 1 to 4 (minutes) was 1.00 (1.00, 1.75), 1.00 (1.00, 5.00), 8.00 (2.00, 23.00), 10.00 (4.50, 28.00), the treatment received time (minutes) was 1.00 (1.00, 10.00), 6.00 (1.00, 23.00), 48.00 (25.00, 105.00), 87.00 (41.00, 140.00), the retention rate was 4.76%, 10.94%, 55.91%, 42.86%, the salvage rate was 95.24%, 87.94%, 20.81%, 0%, the hospitalization rate was 57.14%, 70.98%, 53.62%, 20.41%, the hospitalization time (days) was 19.50 (9.75, 28.00), 11.00 (8.00, 17.00), 12.00 (8.25, 17.00), 10.50 (8.75, 15.25), the emergency mortality was 19.05%, 6.92%, 1.41%, 0%, the in-hospital mortality was 16.67%, 15.09%, 6.25%, 0%, and the total mortality rate was 28.57%, 17.63%, 4.76%, 0%, allP < 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) of three-district and four-level triage standards for identifying patients needed an immediate intervention (triage level 1 to 2) was 0.854 (95%CI = 0.831-0.878), and the sensitivity and specificity were 78.62% and 89.89%, respectively, the misdiagnosis rate was 10.11%, and the missed diagnosis rate was 21.38%.Conclusion The three-district and four-level triage standards were proved to be a reliable and valid instrument, which can distinguish the severity of the disease and help nurses to triage patients correctly.

BACKGROUND:It is wel-known that mechanical stimulation could promote fracture healing. However, what kind of mechanical stimulation induced by treadmil exercise can increase the bone conductibility of bone material and promote the healing of bone defect is stil unclear.
OBJECTIVE:To evaluate the influence of indirect mechanical stimulation produced by treadmil exercise on bone defect healing and osteogenesis of bone materials.
METHODS:Sprague-Dawley rats at 12 weeks old were used in this study to establish a bone defect of 3 mm in diameter and height at the left distal femur. Afterwards, calcium sulphate scaffolds were implanted into the defects. The rats were divided into treadmil exercise group and control group. Treadmil exercise was began at 1 week postoperatively, 10 m/min, 45 minutes per day, 5 days per week, for 3 weeks. Control group did not receive any exercise. Micro-computed tomography was used to determine bone formation in the bone defects at 1, 2, 3, and 4 weeks after surgery. The sections of left distal femur were subject to hematoxylin-eosin staining, the new bone formation and degradation of bone materials in the bone defects were observed.
RESULTS AND CONCLUSION:Micro-CT analysis showed that, a smal amount of new bone formed in both treadmil exercise group and control group at 1 week after surgery. In treadmil exercise group, new bone formation was significantly higher than the control group at 2, 3, 4 weeks (P<0.05). At 4 weeks, histological results also confirmed the difference of new bone formation in bone defect between treadmil exercise group and control group. In addition, bone mineral density of treadmil exercise group was higher than that of control group at 2, 3, 4 weeks, but no significant difference was found (P>0.05). The results suggest that moderate treadmil exercise could promote bone defect healing and enhance osteoconductivity of bone substitute.

BACKGROUND: Posterior lumbar interbody fusion(PLIF) has been an effective method for treating the instability of the lumbar spine.OBJECTIVE: To explore the changes in mobilization range after treatment of lumbar segmental instability with titanium-coated fusion cages (Prospace).DESIGN: A before-and-after controlled observational trial based on the patients.SETTING: Orthopedic department of a university-affiliated hospital.PARTICIPANTS: Totally 16 patients with lumbar instability(4 males and 12 females aged 37 to 68 years with the average age of 51.6 years) were treated by posterior lumbar interbody fusion(PLIF) using titanium-coated cage from December 2002 to. December 2003. There were 4 cases of disc herniation, 6 lumbar spinal stenosis, 3 degenerative spondylolisthesis and 3 isthmic spondylolisthesis, among which 5 cases were spondylolisthesis Ⅰ and one spondylolisthesis Ⅱ.METHODS: All the cases received PLIF. In each case, double cages were inserted with the postlateral bone graft and pedicle screw systems were supplemented. The radiology and clinical effects before and after operation were compared.MAIN OUTCOME MEASURES: ① The average height of disc space and foramina and mobilization range of the vertebral bodies before and after operation; ② The Oswestry Disability Index score.RESULTS: All the cases were followed up for 6 to 16 months with an average of 12 months. The total fusion rate was 100%, and the postoperative height of disc space and foramina recovered satisfactorily. The Qswestry Disability Index score was 44. 2 ± 3.9 before operation and 25.5 ± 3.6 after operation with a significant difference. The rate of excellent and good curative effects was 93.8%.CONCLUSION: The titanium-coated cage used in PLIF to treat lumbar instability can achieve good immediate stability after operation.