Objective To formulate standardized procedure of incontinence-associated dermatitis (IAD) in ICU and evaluate the outcomes.Methods The standardized procedure of IAD,including training program,risk assessment workflow,grading intervention process and physician-nurse communication style,was formulated based on the best evidences combined with the experience of clinical team and patients needs.Then,IAD standardized procedure was applied to the quality improvement project of ICU,and the incidence and severity degrees of IAD were evaluated.Results The total incidence of IAD was on the decline before,during and after improvement,22.43％(96/428),16.06％(71/442),13.90％(51/367),the difference was statistically significant (x2=11.06,P＜ 0.01).The incidence of severe IAD was 2.57％ (11/428),0.45％ (2/442),0.27％(1/367) before,during and after improvement,the difference was statistically significant (x2=11.67,P＜0.01).The incidence of fungal infection was 5.14％ (22/428),2.04％ (9/442),1.63％ (6/367) before,during and after improvement,the difference was statistically significant (x2=10.53,P ＜ 0.01).Conclusions Application of evidence-based practice with specification of IAD,can improve nursing quality and promote patient safety.

BACKGROUND:Vacuum-sealing drainage in wound skin grafting can close wound, reduce the leakage, promote granulation hyperplasia and improve skin new speed.
OBJECTIVE:To compare the clinical effects of two kinds of wound surface dressings used in wound skin grafting.
METHODS: Eighty patients who needed skin grafting for trauma were retrospectively studied and chosen from September 2010 to March 2012. They were divided into two groups: biomaterial group (dressings mainly made of luffa fibers) and synthetics group (seaweed polyvinyl alcohol foam). The vacuum-sealing drainage device and wound dressing were removed after 1 week treatment. The skin grafting coverage and wound healing time were recorded.
RESULTS AND CONCLUSION:Al patients of two groups got effective skin grafting coverage rate, and no patient appeared with infection and nonunion. The skin grafting coverage and wound healing time of the biomaterial group significantly differed from the synthetics group (P< 0.05). These findings indicate that compared to the synthetic material group, the biomaterial group can be better for effective drainage, good circulation, bacteria inhibition and fast repair.

BACKGROUND:Nano-hydroxyapatite/polyamide 66 has been used in the treatment of early avascular necrosis and obtained the good curative effect that can significantly reduce the pain and delay the col apse of the femoral head. OBJECTIVE:To evaluate the efficacy of core decompression with bone graft and nano-hydroxyapatite/polyamide 66 scaffold implantation versus core decompression with bone graft and tantalum rod implantation in treating early-stage avascular necrosis of the femoral head. METHODS:Total y 60 patients with early femoral head necrosis were randomly divided into two groups:observation group and control group. The observation group was treated by core decompression with bone graft and nano-hydroxyapatite/polyamide 66 scaffold implantation, and the control group treated by core decompression with bone graft and tantalum rod implantation. Then, we compared the time of operation, postoperative drainage volume, hospital stay, hospitalization expense, the number of postoperative pain between two groups. Al the subjects were fol owed for 12 months. The efficacy of two different surgical methods was evaluated by Harris scores, imaging curative effect and comprehensive curative effect. RESULTS AND CONCLUSION:Postoperative drainage volume, hospital stay, and hospital expenses were lower in the observation group than the control group (P<0.05). There were no significant differences in the operation time and the number of postoperative pain between the two groups (P>0.05). In the Harris hip scoring, only walking auxiliary score in the observation group was significantly better than that in the control group (P<0.05). There were no significant differences in the X-ray change and comprehensive efficacy evaluation between the two groups (P>0.05). For patients with early osteonecrosis of the femoral head, core decompression with bone graft and tantalum rod or hydroxyapatitescaffold implantation have similar clinical efficacy.

Objective To study the characteristic surface myoelectric signals generated by children with hemiplegic cerebral palsy (HCP) during maximum isometric voluntary contraction (MIVC) of the wrist flexors and extensors.Methods Sixty-eight children with HCP 2 to 14 years of age were assessed with surface electromyography (sEMG).The electrodes were applied on the skin over the wrist flexors and extensors.The integrated EMG signals (iEMGs),root mean square amplitudes (RMSs) and co-contraction ratios during MIVC were recorded and analyzed.Results In a MIVC,the RMS,iEMG and co-contraction ratio were all significantly different between the involved and uninvolved hands,though the iEMGs of the wrists of the two hands were strongly correlated.The RMSs of the wrists of the involved and uninvolved hands were also strongly positively correlated when grasping maximally using the involved hand.Conclusions The involved hand of children with HCP has excessive co-activation of the wrist flexors,poor muscle recruitment and little isolated selective control of movement.It may be very important to facilitate wrist extensor contraction,inhibit wrist flexor co-activation and induce involved hand use to improve the hand function of children with HCP.

The rotator cuff injury may be associated with subacromial impingement , ischemic degeneration , abnormal biome-chanical factors, However, depending on the size and type of repair , acute or chronic injury , can need different repair methods .Under the influence of various factors , traditional repair methods have the lower success rate for rotator cuff injury .With deeply understanding the mechanism of injury and the development of tissue engineering and materials science , the treatment of rotator cuff injury may get the better results with the use of new materials .

This article reviewed the literatures about degeneration at the segments adjacent to the fusional and instrumental segments. The hypertrophic degenerative arthritis of the facet joints, intervertebral instability and spinal stenosis were the common pathologic changes. The changes usually occurred at the upper segment of spinal fusion. The average time period for the development of adjacent segment degeneration might be shortened after spinal fusion with instrumentation. The main reason was stress and hypermobility increased at the adjacent segment and postoperative malalignment of the spine after spinal fusion.

Objective To observe the effect of transcranial low frequency electrical stimulation on the contents of monoamines in ischemic area of rats with middle cerebral artery occlusion(MCAO).MethodsPermanent MCAO model of Wistar rat was established with silk thread enveloped with polyammoniacum.The ischemic areas received various intensity of transcranial low frequency electrical stimulation for 1 hour in rats underwent 1 hour of ischemia.Then the affected tissue was processed with fluorospectrophotometry to determine the contents of dopamine(DA),noradrenalin(NE) and 5-hydroxytryptamine(5-HT).ResultsCompared with the sham-operation group,the contents of DA,NE and 5-HT in ischemic area of MCAO model rats decreased obviously(all P<0.01),while all three monoamines investigated in the sham-operation group with transcranial low frequency electrical stimulation had no significant change.In the MCAO groups stimulating with lower(10 V) and middle(30 V) intensity transcranial low frequency electrical field,the contents of DA,NE and 5-HT in ischemic area had no significant increase.But in the MCAO group stimulating with high(50 V) intensity transcranial low frequency electrical field,the contents of DA,NE and 5-HT in ischemic area increased significantly(P<0.05).ConclusionSome degree of intensity transcranial low frequency electrical field stimulation can increase the contents of DA,NE and 5-HT in ischemic area of rats subjected to MCAO.

Objective Pedode foxatoon at the level of fracture vetebral technology is widely used in rebuilding spnal fracture recently.The purpose of minimally invasive surgery for thoracolumbar fractures is to reduce the injury , fix segments, and rebuild the stability of the spine .This study aimed to investigate the short-term clinical effect of pedicle fixation at the fractured vertebra via the pa-ravertebral intermuscular approach for the treatment of thoracolumbar fractures . Methods We treated 24 cases of thoracolumbar fracture by pedicle fixation at the fractured vertebra via the paravertebral intermuscular approach , rebuilt spinal stability , and corrected kyphotic deformity .We evaluated the improvement of pain symptoms and life quality using The Visual Analogue Scale ( VAS) and The MOS 36-Item Short-Form Health Survey (SF-36), and assessed the corrected status of vertebral height loss and kyphotic deformity by radiographic measurement .All the patients were followed up for over 12 months. Results The VAS score of the patients was signifi-cantly higher while the SF-36 score remarkably lower before surgery than the scores in 12 months which were ([7.65 ±0.13] -[1.54 ±0.07], P<0.05) and ([90.21 ±2.02]-[117.21 ±1.02], P<0.05).Imaging evaluation showed desirable correction of the reduced height of the injured vertebrae and kyphotic deformity . Conclusion Pedicle fixation at the fractured vertebra via the pa-ravertebral intermuscular approach , with its advantages of minimal invasiveness and fewer segments of fixation , can effectively correct vertebral height reduction and kyphotic deformity .

BACKGROUND:Chitosan and its derivatives have become one of the most active research topics in the field of tissue-engineered scaffold material substitute for cartilage owing to their porous structure, ease of chemical modification, and high affinity to in vivo macromolecules. OBJECTIVE:To summarize chitosan and its derivatives in terms of design, modification and its application in tissue engineering. METHODS:A computer-based search of CNKI and PubMed databases was performed for papers on application of chitosan and its derivatives in cartilage tissue engineering published from January 1990 to January 2015 with the key words“chitosan;chitosan derivatives;scaffold;tissue engineering;cartilage”in Chinese and English. RESULTS AND CONCLUSION:Chitosan is a natural polymer from renewable resources, modification of chitosan has been found to be necessary for its advanced tissue engineering applications. The modification of chitosan can be divided into two categories including chemical modification and physical blending, which improve its biological properties such as biocompatibility and biodegradability. Recent studies have suggested that chondrocytes maintained round morphology and preserved synthesis of cel-specific extracel ular matrix molecules on chitosan substrates in vitro and chitosan scaffolds seeded with chondrocytes showed partial repair of cartilage defects in vitro. Chitosan and its derivatives are promising candidates as a supporting material for tissue engineering applications.

Objective To assess the radiographic and clinical outcomes of opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach in the treatment of unstable thoracolumbar fractures. MethodsFrom January 2008 through March 2010,a consecutive series of 13 thoracolumbar fractures were managed with opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach.They were 8 males and 5 females,aged from 20 to 58 years(median age,37.2 years).The fractures happened at T11 in 2 cases,at T12 in 3 cases,at L1 in 6 cases and at L2 in 2 cases.The autologous ilium was used for all the anterior strut grafts.The time from injury to surgery ranged from 21 days to 2 years (average,8 months).The mean heights of anterior and posterior borders of the vertebral body,the cobb angles and treatment-related complications were compared between preoperation and postoperation and the patients' satisfaction was assessed with the visual analogue scale(VAS).Statistical analyses were performed with the paried-sample t test. Results The patients were followed for 12 to 36 months (average,17 months).The latest follow-up radiographs were available for all patients.The mean heights of anterior and posterior borders of the vertebral body restored respectively from preoperative 21.02 ± 3.02 cm and 31.34 ± 5.18 cm to postoperative 31.88 ±3.46 cm and 33.75 ± 3.66 cm.The mean cobb angle was corrected from preoperative 28.46° ± 5.81° to postoperative 4.62° ± 3.48°.The mean VAS score decreased from preoperative 7.63 ± 0.72 to 1.39 ± 1.02 at the final follow-up.There were significant differences between preoperation and postoperation in the radiographic and clinical outcomes ( P ＜ 0.05).No mortality or major complications occurred involving large blood vessels or abdominal viscera or internal organs. Conclusion The opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach is safe and effective for old unstable thoracolumbar fractures.