Objective To establish criteria for determination of sputum retention in elderly patients with non-ar-tificial airway. Methods Interview and Delphi methods were used to preliminarily determine clinical indication of sputum retentionand its classification through two-round expert consultation among 25 experts. Final criteria for de-termination of sputum retention were determined through experts group discussion. Results During the two rounds of consultation,all the questionnaires were collected,the experts' authority coefficients were 0.936 and 0.926 respec-tively,and the coordination coefficient of expert opinion was statistically significant.Criteria for determination of spu-tum retention included ineffective cough plus auscultation phlegm sound,with or without complaining of sputum,de-creased blood oxygen saturation,difficulty breathing and cyanosis. Conclusion Based on expert consultation and ar-gument,the criteria for determination of sputum retention can facilitate clinical nurses to detect sputum retention.

Objective: To investigate the case-mix method by clinical pathway. Methods: K-MEANS cluster analysis was applied to case-mix classification and artificial neural network was used for case-mix prediction. Results: Five hundred and twenty three inpatient records constructed a case-mix classification scheme of 4 groups.Statistical significant difference of costs existed in 4 groups.The training error of artificial neural network was low(0.0 029) and the predicting result was accurate(98.91%). Conclusion: Case-mix result was more reasonable using records under clinical pathway.The existing models of case-mix depend on dividing individual variables, but artificial neural network does not.

Objective To observe the acupoint massage on gestational diabetes about mellitus and pregnancy outcome.Methods Using simple random sampling method,96 cases of gestational diabetes mellitus were randomly divided into the observation group and control group.The control group were given the conventional treatment, the observation group were given acupoint massage,pregnancy outcomes and blood glucose in the two groups before and after intervention were compared.Results The two groups after treatment of fasting blood glucose,2h postprandial blood glucose and glycated hemoglobin levels were significantly lower than that those of before treatment, but the observation group[(6.92 ±0.66)mmol/L,(8.12 ±0.70)mmol/L,(6.88 ±0.39)%]improved significantly better than those of the control group[(7.93 ±1.03)mmol/L,(9.54 ±1.33)mmol/L,(7.95 ±0.63)%],the difference was statistically significant(t =3.27,2.39,2.73,all P<0.05).The observation group after treatment,the 2H C peptide levels in fasting serum C peptide and postprandial[(0.50 ±0.07)nmol/L,(0.54 ±0.06)nmol/L]signifi-cantly increased than those of the control group after treatment[(0.38 ±0.04)nmol/L,(0.49 ±0.04)nmol/L],with statistical significant differences(t=2.41,2.15,P<0.05).The patients in the control group after treatment,statistical average daily insulin dosage was (55.84 ±8.73) u,the observation group was (32.24 ±5.03) u,the observation group was significantly lower than that of the control group,the difference was statistically significant(t=13.84,P<0.05).The observation group cesarean section,polyhydramnios,postpartum hemorrhage,fetal distress,pregnancy induced hypertension incidence rate(12.50%,4.17%,2.08%,4.17%,0%) were lower than those of the control group(29.17%,16.67%,12.50%,22.92%,12.50%),the difference was statistically significant(χ2 =4.042, 3.877,3.852,7.206,6.400,all P<0.05).Conclusion The acupoint massage therapy can effectively enhance the gestational diabetes treatment effect,improve the pregnancy outcome in patients with gestational diabetes mellitus.

Objective To explore the clinical effects of integrative nursing for rectal cancer patients with colostomy.Methods A total of 80 cases of rectal cancer patients after colostomy were selected from our hospital from December 4,2009 to May 15,2013.They were assigned to the control group and the observation group according to the admission sequence with 40 patients in each group.The control group had been treated with conventional care,the observation group had been treated with integrative care intervened by ostomy technician.Postoperative anxiety,quality of life and complication rates were analyzed between the two groups.Results Anxiety score from the Self-Rating Anxiety Scale was lower in the treatment group respectively on the day of the operation,one month after operation and one year after operation (58.22 ± 8.23 vs.64.46 ± 9.82,50.55 ± 7.53 vs.59.76 ± 9.83,42.26 ± 2.88 vs.58.46 ± 9.82),P ＜ 0.05.the incidences of complications were significantly rarer than the control group such as the postoperative infection [7.50％ (3/40) vs.25.00％ (10/40)],colostomy hemorrhage [5.00％ (2/40) vs.25.00％ (10/40)],colostomy necrosis [2.50％ (1/40) vs.30.00％ (12/40)],other complications [5.00％ (2/40) vs.15.00％ (6/40)],P ＜0.01 or ＜0.05.Moreover,the defecation function,psychological function,social function and material life (92.55 ± 20.56 vs.84.03 ± 24.60,83.05 ± 23.66 vs.61.86 ± 18.20,79.95 ± 36.02 vs.71.09 ± 27.56,59.08 ± 28.56 vs.50.55 ± 25.96) were improved obviously in the observation group,while the incidences of nausea and vomiting and pain (10.15 ± 3.67 vs.18.99± 7.29,12.05 ± 7.90 vs.22.10 ± 9.56) were lower than the control group,based on QLQ-C30 core questionnaire for the European Quality of Life Evaluation,P ＜ 0.05.Conclusions Integrative nursing may effectively improve rectal cancer patients' quality of life after colostomy,reduce the postoperative complications and relieve anxiety,which may be useful in the clinical application.

Objective To study the long-term efficacy of bladder pressure expansion and perfusion therapy by bladder hydraulic expansion with alkalify lidocaine,heparin,dexamethasone for the treatment of ketamine correlation cystitis Methods From January 2008 to September 2011,the data from 19 male and 3 female patients,who were diagnosed as ketamine-associated cystitis was retrospectively analyzed.The mean age was (26 ± 5)years old.All patients accepted bladder pressure expansion under the spinal and epidural anesthesia.After expansion,the silicon three-channel catheters were left in those patients.2％ lidocaine (20 ml) and 5％ bicarbonate (10 ml) was perfused into the bladder.Meanwhile,the heparin (2.5 U) and dexamethasone (10 mg) were added into the solution,as well.After perfusion,the catheter was clamped until the patient could not tolerate.The perfusion was performed three times every day for 5 days.The volume of urine was recorded each time.The OABSS score,urine volume,maximum urine flow rate,day and night urination frequency were followed within 5 years.And the data was compared with those preoperative and postoperative 1 week,1 month,3 months,6 months.Results 22 patients accepted the procedure successfully.No complications,such as fever or bladder rupture,occurred.At the end of 5 years,the bladder volume daily urinating frequency,night urinating frequency,maximal flow rate,OABSS score were (238.3 ± 37.3) ml,9.2 ± 2.3,2.1-± 1.3,(18.2 ± 8.3) ml/s,4.4-± 2.4,respectively.Compared to the one week and one month after the operation,those results have significant difference (P ＜ 0.01).Compared to the 3 months after the procedure,the bladder volume has significant difference [(238.3-± 37.3) ml vs.(158.3-± 18.3) ml,P ＜ 0.01].No significant differences were noticed in those items 6 months after the procedure (P ＞ 0.05).Conclusion The long-term efficacy of bladder pressure expansion with alkaline lidocaine,heparin and dexamethasone the anesthesia in the treatment of ketamine associated cystitis is good.The outcome is stable,and no obvious complications.

Objective To investigate the curative effect of low-temperature plasma-assisted uvulopalatopharyngoplasty(UP-PP)in the patients with positional and non-positional obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Twenty-six patients with OSAHS diagnosed by polysomnography monitoring receiving the low-temperature plasma-assisted UPPP in our hospital from January 2014 to December 2015 were selected and divided into the positional OSAHS group(PPs) and non-positional OSAHS group(NPPs) according to the apnea-hypopnea index (AHI) under different sleep positional status.The AHI change before and after operation and operation effective rate were compared between the two groups.Results Theoverall AHI,supine position AHI and lateral position AHI in the PPs group all were lower than those in the NPPs group(P＜0.05),moreover the blood oxygen related indexes were higher than those in the NPPs group(P＜0.05).The overall surgical effective rate in the OSAHS patients was 73.08％ (19/26),in which the surgical effective rate was 100％ (7/7) in the PPs group and 63.16％ (12/19) in the NPPs group,the difference between the two groups had no statistical significance(P=0.13).The postoperative total AHI,supine position AHI and lateral position AHI in the two groups were decreased compared with before operation(P＜0.05);the decrease range of lateral position AHI in the NPPs group was significantly higher than that in the supine position AHI[0.96(0.86,1.00)vs.0.53(0.34,0.77),P＜0.01].78.95 ％ (15/19) postoperation patients in the NPPs group converted to PPs.Conclusion Low-temperature plasma-assisted UPPP has some effects on OSAHS patients,in which the benefit of NPPs are more apparent.

Objective To evaluate the effect of Botulinum Toxin A (BTX-A) on spastic diplegia by surface electromyography (sEMG). Methods 50 children with cerebral palsy following spastic diplegia were recruited and injected with BTX-A in triceps surae. They were assessed with the clinical test and the sEMG before and after the treatment. Results After the treatment, the integrated electromyography(iEMG) of triceps surae and foot dorsiflexion angle all decreased. Conclusion sEMG is an objective tool to assess the change of spasticity in children with diplegia after BTX-A injection.

Objective To evaluate the clinical effect of posterior decompression, internal fixation and interlaminar fusion for the treatment of severe osteoporotic vertebral fracture and collapse complicated with spinal canal encroachment. Methods A retrospective study was carried out in 27 cases of severe osteoporotic vertebral fractures complicated with spinal canal encroachment. The patients were treated with posterior decompression, internal fixation and interlaminar fusion during the period from January 1, 2009 to December 31, 2014. All patients were given vertebral pedicle screw fixation after pedicle augmentation with bone cement. The pain scores of visual analogue scale(VAS), Oswestry Disability Index(ODI), Cobb angle , thoracolumbar Cobb angle and the recovery of neurological function(estimated by Frankel grading system) of the patients were compared beforeoperation, one week after operation and at the end of follow-up. The incidences of internal fixation failure, adjacent vertebral fracture and bone cement leakage also were recorded. Results The patients were followed up for an average of 27 months. The spinal canal occupation rate caused by fracture fragment of posterior vertebral wall was 27.41%~63.85%, with an average of(43.24 ± 10.61)%. Postoperative VAS pain scores, ODI, Cobb angle and thoracolumbar Cobb angle were statistically different from those before operation (P < 0.05). The correction rate for Cobb angle and thoracolumbar Cobb angle was (63.31 ± 23.47)%, (61.91 ± 17.54)%respectively. At the end of the follow-up, the correction loss rate for Cobb angle and the thoracolumbar Cobb angle was (15.38 ± 39.92)%, (21.79 ± 32.20)% respectively, the difference being insignificant compared with those one week after operation(P>0.05). In respect of Frankel grading of neurological function at the end of the follow-up, 6 cases were in grade D and 19 cases were in grade E, but the differences were insignificant compared with those before operation (P > 0.05). None of the patients had surgical site infection, screw looseness or breakage, or rod breakage during the follow-up period. There were 8 patients with asymptomatic bone cement leakage after operation. Vertebral compression fractures recurred in 5 patients, of which 2 had adjacent vertebral fractures and 3 had non -adjacent segment. Conclusion The therapy of posterior decompression, internal fixation and interlaminar fusion is effective for the treatment of severe osteoporotic vertebral fracture and collapse complicated with spinal canal encroachment by obviously relieving pain, improving the physiological function of the spine and stabilizing the spine.

Objective To observe the effects of electromyographic biofeedback electric stimulation therapy on lower extremities motordysfunction in children with spastic hemiplegic cerebral palsy (CP). Methods According to the consent of the custodians to the new therapy,60 children with spastic hemiplegic CP were divided into treatment group and control group with 30 cases in each group. All children weretreated with motor training, physical therapy and wore the ankle-foot orthosis (AFO). The treatment group was received electromyographicbiofeedback electric stimulation therapy on their lower extremity additionally. Composite Spasticity Scale (CSS) of the hemiplegic lower extremities,the ankle angle of passive dorsiflexion motion, D and E domains of Gross Motor Function Measure (GMFM-88) were performedto comparatively evaluate the effects before and 12 weeks after treatment. Results The outcomes were improved compared with the ones ofpre-treatment (P<0.05), and improved more in the treatment group (P<0.05). Conclusion The electromyographic biofeedback stimulationtherapy in combination with rehabilitation functional training in the treatment for children with spastic hemiplegic CP is more effective onspasticity of the lower extremity, increasing the range of ankle motion, improving gross motor function of lower extremities.

OBJECTIVE: To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C ₂ segment. METHODS: The literature about the surgery for cervical OPLL involving C ₂ segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. RESULTS: For cervical OPLL involving the C ₂ segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. CONCLUSION OPLL involving the C ₂ segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C ₂ segment.
Humans ; Longitudinal Ligaments/surgery* ; Ossification of Posterior Longitudinal Ligament/surgery* ; Treatment Outcome ; Osteogenesis ; Decompression, Surgical/methods* ; Cervical Vertebrae/surgery* ; Laminoplasty/methods* ; Kyphosis/surgery* ; Retrospective Studies