Objective:To explore application value of rehabilitation nursing in patients With cerebral stroke.Methods:A total of 97 patients With cerebral stroke Were randomly divided into rehabilitation nursing group (n=50,received early rehabilitation nursing)and routine nursing group (n=47,only received routine nursing)according to number table method.Scores of clinic neurologic impairment score scale (CSS)and activity of daily living scale (ADL)Were compared betWeen tWo groups at admission and after discharge.Results:There Were no significant difference in CSS and ADL scores betWeen tWo groups at admission (P<0.05 both);compared With routine nursing group after dis-charge,there Was significant decrease in CSS score [(14.27±7.45)scores vs.(7.87±6.25)scores]and significant increase in ADL score [(50.52±19.59)scores vs.(74.52±20.61)scores]in rehabilitation nursing group,P <0.05 or <0.01;compared With routine nursing group,there Were significant decrease in incidence rates of various complications (89.36% vs.18.0%)in rehabilitation nursing group during admission,P <0.01. Conclusion:Early directed rehabilitation nursing contributes to recovering nervous function,improving prognosis and quality of life in patients With cerebral stroke.

ObjectiveTo explore the application of evidence-based nursing in ulcer pressure prevention of patients in cardiovascular surgery department and effect evaluation. MethodsEvidence-based nursing was applied to 342 patients in our department from January 2008 to October 2010,and the nursing effect was evaluated. ResultsNon of the 342 patients suffered ulcer pressure,the course of disease was shortened and the treatment effect was increased. ConclusionsApplication of evidence- based nursing in cardiovascular surgery patients can significantly reduce the occurrence of pressure ulcers,greatly improve the patients' quality of life,and also can increase the observation,analysis and problem solving ability of nursing staff.

Objective To explore the safety and feasibility of laparoscopy in diagnosis and treatment of neonates and infants diseases.Methods Laparoscopic operations were performed in 297 neonates and infants aging from 2 hours to 6 months,from January 2001 to May 2007.The diseases of 297 cases included 80 cases of congenital hypertrophic pyloric stenosis,67 cases of obstructive jaundice,35 cases of indirect inguinal hernia,31 cases of biliary atresia,21 cases of middle or high anal atresia,21 cases of biliary hyperviscosity,7 cases of congenital diaphragmatic hernia,7 cases of jejunal atresia,6 cases of choledochal cyst,5 cases of Hirschsprung's disease,5 cases of duodenal web,3 cases of uronephrosis,2 cases of esophageal hernia,2 cases of esophageal atresia,2 cases of intestinal malrotation,1 case of intestinal obstruction,1 case of intussuception,,and 1 case of congenital muscular troticollis.Results The laparoscopic operations were completed in 294 cases,of which 67 received diagnostic cholangiography,80 received pyloromyctomy,35 received hernia sac high ligation,21 received biliary irrigation,5 received operations for membranous stenosis of duodenum,2 received Ladd operations for malrotation of intestine,1 received reduction of intussusception,1 received enterolysis,and 1 received incision of lower end of sternocleidomastoid muscle;and some complicated procedures including 31 cases of hepatic portal duct-jejunostomy,21 anoplasty,7 repair of diaphragmatic hernia,7 enterectomy and entero-anastomosis of intestinal atresia,6 hepatic duct-jejunostomy,5 radical surgery for Hirschsprung's disease(megadolicho-colon),3 pyeloplasty,2 operations for esophageal atresia,and 2 fundoplication for hiatus hernia.No massive hemorrhage,intra-or post-operative blood infusion,accidental damage or peri-operative death was reported.Three cases of biliary atresia were converted to open surgery due to oozing of blood in hepatic portal.All case were followed for 2 months-6 years,and no long-term or short-term complication was found.Conclusions Laparoscopic technique is safe and reliable in the diagnosis and treatment of diseases in neonates and infants,which is characterized by minimal invasion,quick recovery and satisfactory cosmetic effects.

OBJECTIVE To investigate the incidence of bacteria colonization on lumbar epidural catheter tips in postoperative analgesia patients. METHODS The catheter tips were cultured in 100 patients with ASA grade Ⅰ-Ⅱ undergoing lower extremity osteoarticular operation.Lumbar epidural catheters were placed in the operating room with aseptic technique.Diluted local anesthetic and fentanyl infusions were used for postoperative analgesia.The epidural catheter was removed with aseptic technique and the tips sent for microbiological culture after 3 days. RESULTS From 100 patients,bacteriological examination revealed bacteria colonization in 9(9.0%),mainly Staphylococcus epidermidis(6;66.7%),followed by Enterococcus(1;11.1%),Gram-negative bacilli(1;11.1%),and yeasts(1;11.1%).No patient developd infectious complications. CONCLUSIONS Our results show that the risk of bacteria colonization associated with lumber postoperative analgesia in three days is low.No patient develops local or central nervous infection.Epidural postoperative analgesia can be routinely used without worry of infection in epidural space.But we recommend prophylactic measures should be applied in the high-risk groups.

Abstract: Objective ， To explore the effects of lead exposure on copper level copper transporter protein expression and Methods oxidative stress in mouse cerebral cortex. The specific pathogen free adult male C57BL/6 mice were randomly ， - - - divided into control group low lead exposure group and high lead exposure group with 10 mice in each group. The mice in low - ， and high lead exposure groups were respectively given 250 and 500 mg/L lead acetate in drinking water every day and the mice - ， in the control group were given double distilled water for 12 weeks. Twenty four hours after exposure Morris water maze and ， elevated cross maze were used to test the neurobehavioral function of mice. The cerebral cortex of mice was isolated and the levels of lead and copper were detected by inductively coupled plasma mass spectrometry. The activities of glutathione （ - ）， （ ） （ ） peroxidase GSH Px catalase CAT and malondialdehyde MDA were detected by histochemical method. The relative （ ） ， ， expression levels of copper transporter such as synthesis of cytochrome C oxidase SCO 1 SCO 2 and cytochrome C oxidase （ ） Results - - assembly protein 11 COX11 were detected by western blot. The escape latencies of mice in the low and high lead （ P ）， ， - exposure groups were prolonged all <0.05 while the number of crossing the platform the percentage of open arm entry - （ P ） times and the percentage of open arm retention time decreased all <0.05 compared with the control group. Mice in both the - - （ P ）， - low and high lead exposure groups increased levels of lead and copper in the cerebral cortex all <0.05 decreased GSH Px （ P ）， （ P ） and CAT activity all <0.05 and increased SCO1 relative expression all <0.05 compared with the control group. Mice in - （P ）， - the high lead exposure group showed prolonged escape latency <0.05 reduced GSH Px and CAT activities in the cerebral （ P ）， （ P ） - cortex all <0.05 increased MDA level and relative expression of SCO1 and SCO2 all <0.05 compared to mice in the low Conclusion - lead exposure group. Lead exposure increased the expression of copper and copper transport related proteins in mouse cerebral cortex and induced oxidative stress leading to central nervous system damage resulting in neurobehavioral abnormalities in mice.

Objective To observe the effect of application of Lamaze childbirth method in childbirth. Methods The observation group(110 cases)was trained by Lamaze childbirth method in late pregnancy period. The control group (110 cases) was not trained by Lamase childbirth method in antepartum period, and were given regular observation and nursing. Mastering of natural childbirth knowledge, pain intensity, childbirth time, mode of delivery and amount of bleeding post- childbirth 2h were observed in the two groups. Results The observation group mastered more natural birth knowledge than the control group, childbirth pain was obviously reduced, natural birth rate was higher than the control group, the first and second labor time was shorter than the control group, the amount of bleeding was obviously less than the control group 2 hours post childbirth. Conclusions Pregnant women need Lamaze childbirth method training before childbirth and instruction of maternity nurses. These may relieve pain, shorten childbirth time and reduce amount of bleeding post childbirth by application of Lamaze childbirth method.

Objective:To research and compare the therapeutic effect of oxycodone hydrochloride controlled—release tablets and morphine sulfate controlled—release tablets on the visceral cancer pain.Methods:Total of 72 patients with visceral cancer pain were randomly assigned into two groups:OO group was treaded by oxycodone hydrochloride controlled—release tablets,MO Group was given morphine sulfate controlled—release tablets.According to the principle of NCCN(2008),the two groups were titrated by morphine,and then diverted to controlled-release agent.The visual analogue scale(VAS)was kept smaller than 4.The side effects of two groups'and the rescue analgesic doses were recorded after the application of the controlled-release agent for 15 days,and the cost-effectiveness was analysed.Results:The rescue analgesic doses of the OO group were smaller than that of the MO group (P0.05).Conclusion:The two drugs have notable analgesic effect in the visceral cancer pain.Considered gastrointestinal tract side effects and the rescue analgesic dose,Oxycodone hydrochloride controlled—release tablets surpass the Morphine sulfate controlled-release tablets.Oxycodone hydrochloride controlled-release tablets may be a potential regimen for visceral cancer pain.

Formative evaluation is a medical education evaluation form used to correct its own track in the course of activities so as to get better effect. In the medical education, it can significantly improve the medical students' ability such as active learning ability, relearning ability, ability to master and apply know l edge, ability of scientific thinking and debating, ability of innovation and analysis, ability of association and communication, and so on.

Objective To explore the effect of different doses remifentanil on hyperalgesia and the analgesic effect of gynecological laparoscopic operation.Methods Ninety gynecologic laparoscopic operation patients were divided into A group,B group and C group by random digits table method with 30 cases each.The anesthesia induction in A group and B group was intravenous injection remifentanil 1.5 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg,and in C group was intravenous injection fentanyl 3 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg.The maintenance of anesthesia in A group was infusion of remifentanil 0.3 μ g/ (kg· min),in B group was infusion of remifentanil 0.2 μ g/ (kg· min),and in C group was infusion of fentanyl 2 μ g/kg.The operation time,anesthesia time,time to extubation,intraoperative doses of propofol and remifentanil (A group and B group) were recorded.The visual analogue score (VAS) before operation and 15,30,60,120,240 min after extubation were recorded.The analgesia time,number of analgesia and adverse reaction after extubation were observed.Results There were no statistical differences in operation time and anesthesia time among 3 groups (P ＞ 0.05).The extubation time in A group and B group was significantly shorter than that in C group:(5.9 ± 2.7) and (6.1 ± 2.3) min vs.(9.6 ± 3.3) min,the dose of propofol in A group was significantly lower than that in B group and C group:(461.3 ± 69.7) mg vs.(543.4 ± 101.9) and (552.5 ± 93.8) ng,the dose of remifentanil in A group was significantly higher than that in B group:(1.12 ± 0.33) mg vs.(0.71 ± 0.1 l) mg,there were statistical differences (P＜ 0.05).The VAS 15,30,60,120,240 min after extubation in 3 groups were significantly higher than those before operation,A group:(7.3 ± 1.2),(7.4 ± 1.3),(6.5 ± 0.8),(4.5 ± 0.6),(4.1 ± 0.3) scores vs.(1.2 ± 0.3) scores,B group:(6.4 ± 1.5),(6.6 ± 1.1),(5.3 ± 0.4),(4.6 ± 0.3),(4.0 ± 0.4) scores vs.(1.5 ± 0.4) scores,C group:(3.4 ± 0.5),(4.2 ± 0.8),(4.1 ± 0.6),(3.8 ± 0.7),(3.8 ± 0.6) scores vs.(1.4 ± 0.2) scores,there were statistical differences (P ＜ 0.05).The VAS 15,30,60 min after extubation in A group were significantly higher than those in B group,and the VAS 15,30,60,120 min after extubation in A group and B group were significantly higher than those in C group,there were statistical differences (P ＜ 0.05).There was no statistical difference in VAS 240 min after extubation among 3 groups (P ＞ 0.05).The number of analgesia in A group,B group and C group were 28,29 and 3 cases,and the analgesia time were (16.1 ± 4.6),(17.9 ± 5.8) and (68.5 ± 10.l) min,there were statistical differences (P＜ 0.05),there were no statistical differences between A group and B group (P＞ 0.05),and there were statistical difference between A group,B group and C group (P ＜ 0.05).There was no statistical difference in adverse reaction among 3 groups (P ＞ 0.05),and there was no respiratory depression in 3 groups.Conclusion The degree of hyperalgesia is related to the dose of remifentanil during gynecologic laparoscopic operation.

Objective To compare the X-ray features between Hirschsprung alied disease (HAD)and Hirschsprung disease ( HD), and analyze the differentiations. Methods From December 2004 to December 2009, nineteen cases of HAD, aged from 30 days to 10 years (median, 14 months), received barium enema examinations in our institution. Other 19 cases with HD, also received barium enema examinations, were chosen randomly. They were aged from 42 days to 8 years ( median, 8 months). The imaging features of HAD and HD were analyzed retrospectively. The incidence rate of colon stenosis,"truncation sign" and spasm notch and R/C ratio (the longest diameter of rectum/colon) were calculated and compared between these two groups. In all these cases, diagnosis was confirmed by postoperative histopathology. The position of barium retained was also evaluated. These parameters of both groups were compared by x2 and Fisher test. Results There was statistical significance in the incidence rate of colon stenosis between HAD (9/19) and HD (18/19) (x2 = 10.364, P ＜0.01). However, there was no statistical significance in "truncation sign" and spasm notch between HAD (4/19 and 3/19, respectively)and HD ( 1/19 and 1/19, respectively) (P ＞0. 05 for both). R/C ratio was 0. 42 ±0. 15 in HAD group and 0.29±0. 12 in HD group, and there was statistical significance between them (t =2.892,P＜0.01). In HAD group, barium retained in distal sigmoid colon in 1 case (1/19), in distal descending colon in 7 cases (7/19), in distal transverse colon in 1 case (1/19), in total colon in 6 cases (6/19); However, in HD group, barium retained in distal rectum in 3 cases (3/19), in distal sigmoid colon in 13 cases ( 13/19), in distal descending colon in 3 cases (3/19). Conclusions There were some differences in the imaging features between HAD and HD though they presented similar clinic experience. HAD cases presented a lower incidence rate of colon stenosis and a higher R/C ratio than HD cases. In HAD cases, the most common site of barium retained is distal descending colon, while in HD cases, it is distal sigmoid colon.