Objective To investigate the clinical application of Morse Fall Scale by primary nurses.Methods Morse Fall Scale was used to assess the falling risk in 21,378 patients by the primary nurses.The application of the Morse Fall Scale, choices of right time for assessment and the occurrence of falls in patients with risks of falling were evaluated by a self-designed questionnaire.Results Among 21,378 patients, 222 patients were at risk of falling.In terms of the items like the history of falls,more than one diagnosis,intravenous injection,the accuracy of assessment was above 91.6%.In terms of the items like aided walking,gait,cognitive state,the assessment accuracy is below 86.0%.The accuracy of assessment timing selection in the situations like admission,the score by Morse fall scale over 24at admission and the accuracy in choosing right time for assessment was was above 90.2% after transferring to other deparments and falling.The accuracy in choosing the right time for fall assessment was below 67.9% under such conditions as apostasies,and oral administration of drugs probably leading to fall. Conclusions It is acceptable that the primary nurses use the Morse fall scale to assess patients with risky falls and for the right choice of assessment.Attention should be paid to strengthen the nurses training to improve the accuracy of the scale,to make sure to choose right time for the assessment so as to prevent the falls of patients to the greatest extent.

Objective To observe the clinical efficacy of alprostadil combined with valsartan in treatment of chronic glomerulonephritis proteinuria.Methods 78 patients with chronic glomerulonephritis proteinuria were randomly divided into two groups,and each group had 39 cases.The control group was given conventional treatment,while the observation group was given alprostadil combined with valsartan on the basis of the control group.The clinical outcomes were compared between the two groups.Results The total effective rate of the observation group was 92.31％,which was significantly higher than 74.36％ of the control group (x2 =9.825,P ＜ 0.05).After treatment,the 24h Upro,BUN and SCr of the observation group were (1.00 ± 0.39) g/24h,(7.11 ± 0.15) mmol/L and (80.86 ± 0.65) μmol/L,which were significantly lower than those of the control group [(1.30 ± 0.48) g/24h、(9.18 ± 2.21) mmol/L and (98.71 ± 4.34) μmol/L],the differences were statistically significant (t =9.32,7.83,7.12,all P ＜ 0.05).Conclusion Alprostadil combined with valsartan in the treatment of chronic glomerulonephritis proteinuria has significant effect,and it can significantly alleviate clinical symptoms,improve renal function,which should be widely applied in clinical.

Objective To analyze the timing and frequency of spontaneous gasping during cardiopulmonary resuscitation in a rat model,and evaluate its value bearing some relation to duration of cardiac arrest (CA ) in predicting the severity of post-resuscitation myocardial dysfunction.Methods Twenty-seven healthy Sprague-Dawley rats were randomly (random number)divided into 3 groups according to different durations of CA:CA 4 min (n=9),CA 6 min (n=9)and CA 8 min (n=9).CA of rats was electrically induced and untreated for 4,6 or 8 min respectively in the corresponding groups,and then cardiopulmonary resuscitation (CPR)was initiated and continued for 8 min in all animals.The emergence timing and frequency of spontaneous gasping during cardiopulmonary resuscitation and resuscitation outcomes were documented.Myocardial function such as cardiac output,ejection fraction and Tei index was measured by echocardiography prior to CA and at 1 h,2 h and 4 h post-resuscitation.Results The earliest appearance of gasping with highest frequency was observed in the CA 4 min group during CPR.Gasping appeared later with decreased frequency observed following longer duration of CA.There were statistically significant differences in the timing and frequency of gasping among the 3 groups.In the CA 4 min group with frequent gasping,all animals were successfully resuscitated with 8-min CPR with the least number of defibrillation,which was significantly better than that in the CA 8 min group.During the evaluation of post-resuscitation myocardial function,cardiac output,ejection fraction and myocardial work index (Tei index) were better in the CA 4 min group with frequent gasping,worse in the CA 6 min group and worst in the CA 8 min group, showing statistically significant differences in cardiac function among the 3 groups. Conclusions The spontaneous gasping appeared sooner with higher frequency during cardiopulmonary resuscitation indicated shorter duration of CA,and predicted better success of resuscitation and post-resuscitation myocardial function.

Objective To discuss operative treatment of old fractures of pelvis. Methods Since February 2000, 14 cases with old fracture of pelvis have been treated in our hospital with operative scar or callus settlement, traction and reduction, and internal fixation. Results All patients were followed up from 6 months to 3 years and 6 months. According to such indexes as pelvic shape, length difference between lower limbs, gait, and radiogram, the scores were excellent in 8 cases, fine in 4 and poor in 2, with the excellent and good rate being 85.7%. Conclusion With reasonable design and appropriate method, operative treatment is fit for old fractures of pelvis because it can avoid severe disability and improve the quality of life of the patients.

Objective To evaluate the complication rate of secondary surgery in patients with benign thyroid disease. Methods From June 1992 to June 2003, 65 patients underwent reoperation. Operative procedures. pathology and complications were reviewed. Results The first surgery was unilateral in 27 cases (41.5%), bilateral in 38 (58.5%). Reoperation identified carcinoma in 8 cases with complications developed in 8 cases and left over permanent in 1 case (1.5%). Conclusion The complication rate of second operation is higher than that of first thyroid surgery, but still acceptable.

Optically pure α-substituted propanoic acids and their derivatives represent as an important kind of organic building blocks and key intermediates,which has been widely used in the synthesis of chiral drugs.Some of them have been used directly as nonsteroidal anti-inflammatory drugs (NSAIDs),such as ibuprofen,naproxen,ketoprofen and so on.Dihydroartemisinic acid (DHAA),the same structure as the α-substituted propanic acids,is a key intermediate for the synthesis of artemisinin,the most effective and current used anti-malarial drug.Therefore,the asymmetric synthesis of α-substituted propanoic acids is always a hot topic for chemical scientists.Asymmetric catalytic hydrogenation attracts more and more attentions because of its atom economy and efficiency.This dissertation will disclose the asymmetric synthesis of α-substituted propanoic acids using transition metal-complex as a chiral catalyst.

Objective To establish a swine model of 10 min prolonged cardiac arrest (CA) induced by electrically triggered ventricular fibrillation,and then evaluate the quality of the model and the value in the establishment of post-cardiac arrest syndrome.Methods Fourteen domestic healthy swine weighing 38 ±3 kg were selected for study.Ventricular fibrillation was induced for 10 min,and then cardiopulmonary resuscitation (CPR) was initiated and continued for 5 min.The resuscitated animals were observed for 72 h after resuscitation.The resuscitation outcomes and survival rate were recorded.The functions of heart,lung and brain,and systemic inflammatory response and tissue perfusion were regularly evaluated for 72 h post-resuscitation.Results Eleven of the fourteen swine obtained restoration of spontaneous circulation (ROSC),and the rate of successful resuscitation and 72 h survival were both 78.6％.Significantly worse post-resuscitation myocardial function was found in all animals compared to the value prior to CA and the myocardial function was evaluated by decreased stroke volume and global ejection fraction,and increased levels of serum cardiac troponin-Ⅰ and n-terminal pro brain natriuretic peptide.Postresuscitation extra-vascular lung water index and pulmonary vascular permeability index were significantly increased accompanied with significantly decreased oxygenation index compared with the values before CA,indicating the occurrence of acute lung injury.In addition,post-resuscitation systemic inflammatory response and tissue low perfusion evidenced by significantly higher levels of serum tumor necrosis factor-α and interleukin-6 and arterial blood lactate were observed.Consequently,severe neurological deficit with significantly higher levels of serum neuron-specific enolase and S-100B was observed following 72 h postresuscitation.Conclusions This swine model of prolonged cardiac arrest induced by electrically triggered ventricular fibrillation was a well established model with high success rate of resuscitation,significant vital organ injury and relatively long duration of survival;it is an excellent model for the study of post-cardiac arrest syndrome.

BACKGROUND:Calcium sulfate has good biocompatibility and biodegradability, which is a safe and effective bone graft substitute.
OBJECTIVE:To investigate the osteogenesis ability of calcium sulfate combined with bone marrow mesenchymal stem cells.
METHODS:After L4/5 posterior lumbar discectomy, 36 rabbits were randomized into three groups:rabbits in autologous bone group were implanted with autologous iliac bone via the intervertebral space;animals in al ogenic bone group were implanted with decalcified bovine bone;rabbits in tissue-engineered bone group were implanted with calcium sulfate combined with bone marrow mesenchymal stem cells. Bone formation and molding were observed by gross observation, anteroposterior and lateral X-ray, histology and biomechanics at 4, 8 and 16 weeks. Cal us specimens were employed for histological observation of interbody fusion. Biomechanical analysis of spinal fusion site was conducted at 16 weeks.
RESULTS AND CONCLUSION:Sixteen weeks later, interbody fusion was complete in the autologous bone group, the trabecular bone bridged continuously and a large amount of woven bone was merged into pieces;in the al ogenic bone group, incomplete bony fusion was found between the intervertebral space, most of cartilage tissues differentiated into bone, but fibrous tissue was also ful of the central part;in the tissue-engineered bone group, interbody fusion was complete, and a large amount of woven bone was fused into pieces, while the artificial bone was absorbed and ossified with smal residual. Failure strength and stiffness in the autologous bone and tissue-engineered bone groups were superior to those in the al ogenic bone group. These findings indicate that the calcium sulfate/bone marrow mesenchymal stem cells tissue-engineered bone has excellent osteogenic and osteoinductive capacity that can exert a good function of promoting spinal interbody fusion.

Age impact in mouse model of secondary hepatic alveolar echinococcus was investigated in this research . Twenty-nine 8-week-old ,twenty-five 18-week-old and twenty-five 28-week-old female mice were anesthetized with 20% ure-thane by intraperitoneal injection and then transhepatically injected by Echinococcus multilocularis (E .m) tissue suspension through skin incision and abdominal muscle to liver in all three groups to establish mouse model of secondary hepatic alveolar e-chinococcus .Results showed that the survival rates for the three groups of mice were 62 .1% ,84% and 68% ,respectively (P>0 .05) .The E .m infection rates in liver were 72 .2% ,71 .4% and 76 .5% ,respectively (P>0 .05) .The diameter of E .m cysts in liver were 0 .915 ± 0 .103 cm ,1 .247 ± 0 .112 cm and 1 .215 ± 0 .197 cm ,respectively (P>0 .05) .The mass of E .m cysts in liver were 0 .332 ± 0 .035 g ,0 .532 ± 0 .155 g and 0 .382 ± 0 .085 g ,respectively (P> 0 .05) .HE stain showed no difference in pathology .Results indicated that the establishment of secondary hepatic alveolar echinococcus model by using transhepatic injection through skin incision and abdominal muscle of 18-week-old mice was capable of simplifying operation and improving the survival rate of the mice .

Objective To investigate the effects of limb ischemic post-conditioning (LIpostC) alone or its combination with therapeutic hypothermia (TH) on systemic inflammatory response and lung injury after cardiac arrest (CA) and resuscitation. Methods Twenty-one healthy male pigs weighing (37±2) kg were randomly divided into 3 groups (n = 7 each): control group, LIpostC group, and LIpostC+TH group. The animal model was established by 10 minutes of untreated CA and then 5 minutes of cardiopulmonary resuscitation (CPR).Coincident with the start of CPR, LIpostC was induced by four cycles of 5 minutes of limb ischemia followed by 5 minutes of reperfusion in the LIpostC and LIpostC+TH groups. After successful resuscitation, TH was implemented by surface cooling to reach a temperature of 32-34℃ until 4 hours post-resuscitation, followed by a re-warming rate of 1 ℃/h for 4 hours in the LIpostC+TH group. Normal temperature was maintained in the control and LIpostC groups. The resuscitation outcomes in each group were recorded during CPR. At 15 minutes prior to CA (baseline) and during 4 hours post-resuscitation, the level of arterial lactate was measured and PaO2/FiO2 was calculated, and extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were measured meanwhile by a PiCCO monitor. At 15 minutes prior to CA (baseline) and during 24 hours post-resuscitation, the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured by enzyme linked immunosorbent assay (ELISA). Results Six animals in each group were successfully resuscitated. Coronary perfusion pressure (CPP), duration of resuscitation, number of shocks and epinephrine dosage during CPR were not statistically significant among the three groups. The baseline of arterial lactate, PaO2/FiO2, EVLWI, PVPI and cytokines prior to CA were also not statistically significant among the three groups. The levels of serum TNF-α and IL-6 after resuscitation were gradually increased in all the three groups; however, the values of TNF-αand IL-6 were significantly lower in the LIpostC and LIpostC+TH groups than that in the control group, and they were further decreased in the LIpostC+TH group when compared to the LIpostC group [TNF-α (ng/L): 305±22 vs. 343±26 at 4 hours, 350±29 vs. 389±18 at 24 hours; IL-6 (ng/L): 239±14 vs. 263±19 at 24 hours, all P < 0.05]. The levels of lactate reached the peak at 2 hours post-resuscitation and then gradually decreased in all the three groups; it finally returned to the baseline in the LIpostC and LIpostC+TH groups, which was markedly lower than that in the control group (mmol/L: 1.4±0.7, 1.2±0.3 vs. 3.1±1.7, both P < 0.05). During 4 hours post-resuscitation, PaO2/FiO2 was significantly higher and EVLWI and PVPI were markedly lower in the LIpostC and LIpostC+TH groups than that in the control group; additionally, PaO2/FiO2 and EVLWI were further improved in the LIpostC+TH group than the LIpostC group [4-hour PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 391±26 vs. 361±20; 4-hour EVLWI (mL/kg): 10.1±1.5 vs. 12.1±1.2, both P < 0.05]. Conclusion LIpostC can be used to alleviate systemic inflammatory response and lung injury after porcine CA and CPR, and its combination with TH further enhanced its protective effects.