Objective To compare the efficacy and safety of thrombolysis and anticoagulant therapy for post-traumatic acute submassive pulmonary embolism (PE) in middle-aged and elderly patients.Methods Totally 45 patients with post-traumatic acute submassive pulmonary embolism in our hospital were selected.Patients were divided into thrombolysis group (n =22) and anticoagulation group (n=23) according to their conditions.Symptoms and signs,blood gas analysis,D-dimer,echocardiography,CT pulmonary angiography (CTPA) were performed before and after thrombolysis or anticoagulant therapy.Results There were no significant differences in clinical curative rate between thrombolysis group and anticoagulation group [95.5％ (21/22) vs.91.3％ (21/23),x2 =0.32,P＞0.05],and no case was found dead in both two groups.There was a significant difference in hemorrhage rate between thrombolysis group and anticoagulation group [27.3％ vs.4.3％,x2 =4.53,P ＜ 0.05].At 24 hours after thrombolysis or anticoagulant therapy,the improvement rate of dyspnea,PaO2 level was significantly higher and the pulmonary arterial pressure was significantly lower in thrombolysis group than in anticoagulation group [45.5％ (10/22) vs.17.4％ (4/23),(80.4±8.1) mm Hg vs.(73.6±9.3) mm Hg,(51.2±6.2) mm Hgvs.(60.3±5.7) mm Hg,respectively,all P＜0.05],and there were no statistical significances at other time points between the two groups.Conclusions The clinical curative rate and fatality rate are similar in thrombolysis group versus anticoagulation group.Hemorrhage rate is higher in thrombolysis group than in anticoagulation group.Thrombolysis can relieve dyspnea rapidly,reduce pulmonary artery pressure and make the embolized blood vessels recanalized.Patients with low bleeding risk in a critical condition are suggested to take thrombolysis therapy,while patients with high bleeding risk in a light condition are suggested to take anticoagulant therapy.

Objective To evaluate whether three chronic kidney disease epidemiology collaboration (CKD-EPI) equations (CKD-EPI2009Scr,CKD-EPI2012SCysC and CKD-EPI2012Scr-SCysC) are applicable in the prediction of glomerular filtration rate (GFR) in Chinese patients with diabetic nephropathy (DN).Methods One hundred and eight patients with DN who were hospitalized in the First Affiliated Hospital of Guangzhou Medical University with GFR being measured by dynamic renal imaging with 99mTc-DTPA from June 2012 to April 2014 were enrolled in this study.GFR measured by dynamic renal imaging with 99mTe-DTPA was used as the reference value (rGFR).GFR was estimated by the CKD-EPI2009Scr equation,the CKD-EPI2012SCySC equation,and the CKD-EPI2012Scr-SCysC equation (labeled as eGFR1,eGFR2,eGFR3).The correlation,30％ accuracy,staging consistency,deviation and diagnostic accuracy were compared among the three CKD-EPI equations.Results The rGFR in 108 DN patients was (61.78±26.51) ml· min-1· (1.73 m2)-1.The correlation between three eGFRs and rGFR was significant (all P ＜ 0.01),the correlation coefficients were 0.738,0.708,0.782.The 30％ accuracy were 74.07％,52.78％,67.59％,The 30％ accuracy of eGFR1 and eGFR3 were higher than eGFR2 (all P ＜ 0.05),but there was no significant difference between eGFR3 and eGFR1 (x2=0.874,P=0.436).The staging consistency was not ideal,Kappa values were 0.391,0.180 and 0.422.For the deviations between three eGFRs and rGFR,there was no significant difference between eGFR3 and rGFR (P ＞ 0.05),eGFR1 underestimated rGFR,eGFR2 overestimated rGFR (all P ＜ 0.01).The results of the Bland-Altman chart showed that consistencies between three eGFRs and rGFR were poor,the degree of deviation of eGFR3 was the smallest.The area under the ROC curve (AUC) of three eGFRs was 0.878,0.883 and 0.915.The AUC,sensitivity,specificity,overall compliance rate and Youden index of eGFR3 were the highest.Conclusions The eGFRs predicted by the three CKD-EPI equations showed good relevance,accuracy and diagnostic accuracy with the rGFR,but poor in consistencies.Comparatively,CKD-EPI2012Scr-SCysC may be better than others,but its consistency limits exceeds the acceptable limits.Therefore,the applicability of using the three CKD-EPI equations to predict the GFR in Chinese DN patients requires a larger sample and multiple verifications as well as further improvement.

Objective: To compile and evaluate the Chinese version of perioperative nursing quality assessment scale, detect and verify the reliability and validity of evaluation scale, and establish a scientiifc evaluation system. Methods: We applied Tuija Leinonene and Helena Leino-kilpi scales as the theoretical framework, and established perioperative nursing quality assessment scale by translation, language study, and expert consultation. hTe questionnaire survey population was 276 patients who had surgery and 200 nurses working in the operating rooms at the 3 Affliated Hospitals of Central South University. hTe scale was tested validity and reliability. Results: Perioperative nurse quality evaluation scale consisted of 32 items and 7 dimensions, including body care, receive information, support, respect, medical staff characteristics, environment and nursing process. The test-retest reliability of scale was 0.977 for patients and 0.997 for nurses. hTe split half reliability of scale was 0.761 for patients and 0.887 for nurses. hTe Cronbach's α of total scale for the patients was 0.918, and the Cronbach's α of factors was 0.658-0.838. hTe Cronbach's α of total scale for the nurses was 0.932, and the Cronbach's α of factors was 0.650-0.836. hTe correlation coeffcient of scale for the patients was 0.363-0.603; the factors and the total correlation coeffcient was 0.535-0.788. hTe correlation coeffcient of scale for the nurses was 0.410-0.700; the factors and the total correlation coeffcient was 0.743-0.902. Conclusion: The Chinese version of the perioperative nursing quality assessment scale is a measurement instrument with a high level of validity and reliability for Chinese society and can be used to determine the quality of perioperative nursing care in our country.

Objective To observe the expression and distribution of angiopoietin-like protein 3(ANGPTL3) in kidney of adriamycin(ADR)-induced nephrotic rats, and to explore the possible association of ANGPTL3 with the development of proteinuria and hyperlipidemia. Methods Adriamycininduced nephrotic rat models were established by a single injection of adriamycin via the tail vein. Immunohistochemical staining (IHS)and dot-ELISA were used to examine the expression and distribution of ANGPTL3 in kidney and the level of ANGPTL3 in serum of ADR rats at day 7,14, 21 and 28 after adriamycin injection. Results (1) In ADR rats, urinary protein and the level of triglyceride and cholesterol in serum increased significantly at day 14 (P

Objective To study the expression of angiopoietin-like protein 3(ANGPTL3) mRNA successively in kidney of adriamycin (ADR)-induced nephrotic rats during the development of proteinuria, and to disclose the possible assosiation of ANGPTL3 with proteinuria. Methods Adriamycininduced nephrotic rat models were established by a single injection of adriamycin via the tail vein. Glomeruli and cortex tubuli of rats were dissected by laser microdissection. Real time quantitative RT-PCR was used to study the expression of ANGPTL3mRNA in kidney of ADR rate at 7, 14, 21 and 28 days successively following adriamycin injection. Results (1) In ADR rats, urinary protein and the level of triglyceride and cholesterol in serum increased significantly at day 14 (P

ObjectiveTo explore the current status of physical exercise of older adults and its effect on depression.Methods270 subjects from three living strata(public,community and hospital) were randomly investigated by the Geriatric Depression Scale-short form(GDS-s) and the self-designing Geriatric Exercise Scale.ResultsOlder adults had a higher risk of suffering from depression.There were significant differences between attitudes and prevalence rates among the subjects in three environments.Exercises had significant influence on older adults' depression,with the more negative attitude,less frequency,shorter exercising time,less companions,worse feeling after doing exercises,the more serious of one's depression.The demographic variables had also significant influence on both exercise and depression of older adults.ConclusionDoing exercise is one of the important measures to prevent,reduce and overcome depression of older adults.

Objective To explore the relationship between the prothrombotic state and blood coagulation-fibrinolysis system changes with deep venous thrombosis(DVT)in aged patients after total joint arthroplasty,and to propose preventive measures.Methods 400 patients who underwent total hip or knee replacement from January 2003 to June 2011 were classified into suspected DVT(n=200 cases)and non-suspected DVT(n=200 cases)according to Well's clinical scoring system.The patients were divided into 4 subgroups based on the measures to prevent DVT:low molecular weigh heparin group,intermittent pneumatic bag compression group,combined above measures group,control group who refused any preventive measures.Plasma thrombin-antithrombin complex(TAT),plasmin-α2 antiplasmin complex(PAP)were determined preoperatively.Venous Doppler ultrasound was performed before surgery,4 d and 10 d after surgery to detect the presence of DVT.Results Totally 71 cases(17.8％)were diagnosed as DVT and 5 cases(1.3％)as pulmonary thromboembolism(PTE).The incidence of DVT in suspected DVT group(28.5％,57 cases)was lower than in non-suspected DVT group(7.0 ％,14 cases)(x2 =31.66,P＜ 0.01).Among patients with suspected DVT,the DVT prevalence in combined measures group(2.0 ％,1 cases)was decreased than in low molecular weigh heparin group(14.0％,7 cases),intermittent pneumatic bag compression (34.0％,17 cases)and control groups(64.0％,32 cases)(x2=4.89,17.34,18.01,all P＜0.05).In the patients with non-suspected DVT,the DVT prevalence in combined measures group(0.0％)was lower than in control group(24.0 ％,12 cases)(x2 =13.64,P＜0.01).The average preoperative level of TAT[(9.63±3.06)μg/L]in patients with DVT was higher than without DVT[(2.59±0.87)μg/L](t=35.70,P＜0.01),while PAP level in patients with DVT[(38.52± 21.13)μg/L]was reduced than without DVT[69.75±30.26)μg/L](t=8.27,P＜0.01).Conclusions The levels of TAT and PAP before total hip or knee replacement are predictive for lower extremity DVT.The clinical effectiveness of Well's scoring on DVT prevention is dependent on the different TAT and PAP state.

Objective To investigate the screening significance of transcranial Doppler (TCD) for patients with patent foramen ovale ( PFO) induced cerebral embolism and to improve the treatment aiming at the causes.Methods Thirty-six patients of less than 60 years old with unknown-cause cerebral embolism and transient ischemic attack were enrolled.Besides conventional examination,the 24 h Holter,transthoracic echocariiography,carotid artery Doppler ultrasonography (CAU),routine TCD,TCD foaming test,transesophageal echocardiography (TEE),CT angiography (CTA) of head and neck,ultrasonography of vein in bilateral lower limbs were examined in all patients.Results All the patients showed no atrial fibrillation.No structural heart disease and intracardiac occupying lesion were shown in transthoracic echocardiography.No carotid stenosis was shown in carotid artery Doppler ultrasonography.Routine TCD showed no intracranial artery stenosis.No thrombus was found in ultrasonography of deep veins in bilateral lower limbs.CTA of head and neck showed everything was normal.Fourteen patients were observed with right-to-left shunt in heart by TCD foaming test,including 10 cases with microbubble signals(MBS) in 10 s,and 4 cases with MBS after Valsalva maneuver.Among 14 patients,12 patients were proved PFO by TEE.Conclusions PFO is one of the causes of cardiogenic cerebral embolism.TCD is accurate and reliable for the screening of PFO.

0.02 kgf was considered as signifieant.All patients were studied within the first week of presentation with stroke, and underwent every day follow-up within the first month.Results Nine htmdred and fourteen patients were recruited into the study during 1-year period. WECSFP without lesion in brain stem was present in 4.4% of patients within the first week of stroke presentation.The patients with WECSFP had less JFS than the patients without WECSFP(P

Objective: To develop a health management system for outpatient follow-up of kidney transplant patients. Methods: Access 2010 database sotfware was used to establish the health management system for kidney transplantation patients in Windows XP operating system. Database management and post-operation follow-up of the kidney transplantation patients were realized through 6 function modules including data input, data query, data printing, questionnaire survey, data export, and follow-up management. Results: The system worked stably and reliably, and the data input was easy and fast. The query, the counting and printing were convenient. Conclusion: Health management system for patients after kidney transplantation not only reduces the work pressure of the follow-up staff, but also improves the effciency of outpatient follow-up.