ObjectiveTo investigate the influencing factors of preoperative fearful anxiety,and explore the effect of nursing intervention for the improvement of preoperative fearful anxiety. Methods500 cases of surgical patients in our hospital from January 2009 to January 2010 were chosen as the research objects.They were randomly divided into the control group and the observation group with 250 patients in each group.The control group was given routine preoperative nursing care.The observation group was given preoperative nursing intervention.The general information,surgery program,knowledge of surgical program,the patients' family situation and economic situation were taken for statistics.Their SAS score 30 minutes before the surgery was determined,and the influencing factors of preoperative fearful anxiety were analyzed. ResultsThe study showed that the influencing factors of fearful anxiety included:character,education background,family economic status,knowledge of the situation of surgery and other factors.The anxiety score 30 min before surgery was compared,the observation group was significantly lower than that of the control group.The difference between the two groups was significant. ConclusionsThe preoperative fearful anxiety was directly related to patients' own situation and level of medical services.Fully understanding of the situation before surgery and targeted preoperative nursing interventions can effectively reduce preoperative anxiety,and is conducive to the successful implementation of operation and postoperative rehabilitation.

Objective:The study was to investigate the effects of epidermal growth factor receptor (EGFR) antibody (cetuximab,C225) combined with cyclooxygenase 2(COX-2)inhibitor (nimesulide) on the proliferation and apoptosis of colon cancer HT-29 cells, and explore the potential molecular mechanism. Methods:C225 and nimesulide alone or in combination were incubated with HT-29 cells. MTT assay was used to measure the cell proliferation. AO/EB staining and flow cytometry were used to measure the cell apoptosis. RT-PCR was used to detect the COX-2 and non steroidal anti-inflammatory drug-activated gene (NAG-1) mRNA expression levels. The expression of Akt and phosphor-Akt protein was examined by Western blotting. Results:The inhibitory effect of nimesulide combined with C225 was significantly stronger than that of nimesulide alone [(72.8±2.3)% vs (51.8±1.8)% , P<0.05]at 48 h. Typical changes of apoptosis in HT-29 cells were observed in nimesulide combined with C225 treatment group. The apoptosis rate of combined group was significantly higher than that of single nimesulide group [(57.67±0.86)% vs(33.27±1.47)%]and single C225 group [(6.27±0.55)%,P<0.05]. C225 down-regulated the expression of COX-2 mRNA. The expression of NAG-1 mRNA was up-regulated in all treatment groups and the expression of phosphor-Akt was significantly down-regulated in combined treatment group than single nimesulide or C225 group. Conclusion:Nimesulide combined with C225 has obvious synergistic effects in inducing apoptosis. The potential mechanisms may be that EGFR signaling pathway is involved in the regulation of cycloxygenase-2 expression in HT-29 cells and finally influence the proliferation and apoptosis of HT-29 cells through the up-regulation of NAG-1 and down-regulation of phosphor-Akt expression.

Objective To evaluate the value of cardiovascular digital imaging and echocardiography in diagnosis of transposition of the great arteries.Methods Thirty cases of transposition of the great arteries were examined with cardiovascular digital imaging technique,two-dimensional echocardiography and color Doppler.11 cases of them underwent surgery.A comparison was made between the data obtained and surgical findings.Results The rate of coincidence of digital imaging and echocardiography with operation in diagnosing transposition of the great arteries was 92.3%(36/39)and 84.6%(33/39) respectively.Both echocardiography and cardiovascular digital imaging techique could clearly show the abnormalities of the heart and great vessels.Echocardiography was sensitive to valvular pathological changes,though cardiovascular digital imaging was superior to echocardiography in demonstrating abnormalities of great arteries and systemic-pulmonary collateral circulations.Conclusion Combination of echocardiography with cardiovascular digital imaging technique can greatly improve the rate of diagnostic accuracy for transposition of the great arteries.

Objective To explore the clinical effects of sitagliptin alone or its combination with metformin on the patients with type 2 diabetes registered on their first clinic/hospital visits.Methods Eightytwo patients with type 2 diabetes who diagnosed with oral glucose tolerance test (OGTT),insulin test and glucagons stimulating C-peptide test from May 2011 to February 2012 in our hospital were randomly divided into two groups:the patients in control group took sitagliptin alone (control group,n =41) and the patients in experimental group took sitagliptin combined with metformin (experimental group,n =41).Eighty-two patients,after the mission,were given diabetic diet and moderate exercise therapy.Taking sitagliptin 100 mg,1 times/d;combined with metformin groups given sitagliptin 100 mg/d,metformin 250 mg,3 times/d.Six months later,the major indexes comparing between before and after treatment of weight,body Mass Index (BMI),glycosylated hemoglobin(HbA1c),OGTT,fasting plasma glucose (FPG),2 h plasma glucose (2 hPG),fasting insulin (FINS),2 h postprandial insulin (2 hINS),fasting C-peptide and 2 h postprandial C-peptide levels were measured to research the changes during the treatments.Results After treatments,all the indexes were decreased significantly,and the BMI,HbA1c,FPG,2 hPG,FINS,2 hINS,fasting C-peptide and 2 h postprandial C-peptide in the group with sitagliptin united with metformin were significantly lower than the group with sitagliptin((27.4 ± 1.2) kg/m2 vs.(27.9 ±1.5) kg/m2,t =-2.812;(8.1 ±1.2)％ vs.(8.8 ± 1.3)％,t =-2.953;(8.17 ±1.22) mmol/L vs.(9.22 ± 1.28) mmol/L,t =-4.940;(10.16 ± 1.68) mmol/L vs.(11.01 ± 1.62) mmol/L,t =-3.362; (9.22 ± 1.93) mU/L vs.(9.85 ± 1.59) mU/L,t =-2.212;(74.62±13.73) mU/L vs.(83.75 ± 13.12) mU/L,t =-5.235;(1.43 ±0.34) μg/L vs.(1.77 ±0.27)μg/L,t =-3.194; (6.80 ± 1.40) μg/L vs.(7.61 ± 1.64) μg/L,t =-4.480 ; P ＜ 0.05).Conclusion Sitagliptin is useful to treat type Ⅱ diabetes,plays important roles in improving patients' quality of life and insulin resistance,control of blood glucose,reduce the family and the burden of social health,and the effect will be more better when united with metformin.

Objective To retrospectively analyze the serum enzymes in childhood amputees as a result of earthquake,and to discuss their clinical significance.Methods From 150 children amputees who were victims of Sichuan Wenchuan earthquake in 2008 and Sichuan Lushan earthquake in 2013,45 cases with complete records of serum enzymes examinations were reviewed retrospectively.They were divided into three groups:amputation group (n=6),fasciotomy decompression group (n =5),general trauma without injury to extremity group (n =34).Serum enzyme examination data were compared for statistical analysis to find the difference among groups.Ten children who were not victims of earthquake were selected from department of orthopaedics to serve as controls,and 20 adult amputees as a result of earthquake served as another control group.Results There were significant differences in injury severity scale (ISS) and the contents of all serum enzymes,including aspartate transaminase (AST),alanine aminotransferase (ALT),creatine kinase (CK),lactate dehydrogenase (LDH),and hydroxybutyrate dehydrogenase (HBDH),between the amputation group and other patients (FISS=15.474,P＜0.001 ; FAST=10.770,P＜0.001 ; FALT=12.799,P＜0.001 ; FcK=12.848,P＜0.001; FUDH=13.126,P＜0.001; FHBDH=13.186,P＜0.001),and the difference in amputation group was even more significant.AST,LDH,HBDH in childhood amputees group were significantly higher than those in adult amputation group.The contents of ALT and CK were slightly increased.Serum enzyme contents were found to be significantly helpful for prediction of disease condition and prognosis.It was also found that CK was extremely helpful in assessing the degree of illness in patients with severe trauma,especially in patients complicated by severe soft tissue injury.In all the groups,of patients,it was found that CK rose from (129 ± 62) U/L in non-earthquake induced trauma group to (44 208 ± 39 788) U/L in earthquake amputation group,and it was thus increased more than 300 times.Its highest value even reached 117 513 U/L,which was more than 840 times of the normal.If a timely amputation or muscle compartment decompression was performed,CK might decline rapidly down to the normal value.Conclusions The comprehensive and continuous assessment of serum enzymes is mandatory during the treatment of children with acute trauma.It is of important clinical significance to correctly judge the condition and to determine optional treatment measures.

To find out the risk factors of hospital infection in childhood primary nephrotic syndrome(nephrosis) and prophylactico therapeutic measures, 190 cases of child patients hospitalized for nephrosis during the period lasting from 1991 to 1999 were collected. Then a retrospective analysis of the distribution of the various risk factors was made using the single factor analysis and the logistic multi factor regression model. The hospital infection rate was found to be 34.2%, with respiratory infection accounting for 69.7%. The single factor analysis indicated that the risk factors included quantity of urinary protein per kilogram of weight within 24 hours(urinary protein), length of stay, length of hormone usage, entities of antibiotics used and length of such usage. The multi factor analysis indicated that the risk factors included urinary protein, entities of antibiotics used and length of such usage. The authors present the view that strengthening the control of respiratory diseases, setting up clean wards, and ensuring the rational use of antibiotics are some of the key measures for reducing the rate of hospital infection. The quantity of urinary protein is a sensitive index of hospital infection in nephrosis. Once diagnosis of nephrosis has been confirmed, it is necessary to use ACH in full dose and for a complete course of treatment so as to reduce the loss of protein from the urine as soon as possible.

Objective To study the relevant factors and prevention of X-ray missed diagnosis in rib fracture.Methods 28 cases of rib fracture in the X-ray missed diagnosis were retrospectively reviewed. The relevant factors and preventive question of X-ray missed diagnosis were explored.Results Careless reading of film(n=3),wrong position of taking film(n=7),film of low quality(n=4),image of rib fracture concealed by other image (n=11) and improper time of taking film(n=3) were found as the cause of missed diagnosis.Conclusions The X-ray examination of chest is the most practical method in diagnosing rib fracture. The choice of position in taking film,quality assurance of film,the right time in taking film and carefulness in reading film may affect the diagnosis of rib fracture.

OBJECTIVE To investigate extended-spectrum ?-lactamases(ESBLs) producing bacteria and daily(defined) doses (DDDs) of the third generation cephalosporins.METHODS The cosumpsion of the third generation cephalosporins in five(hospitals) from 2000 to 2002 and the incidence of ESBLs producing bacteria were(analyzed).RESULTS In these years,the total DDDs were 1.3064 million therapeutic days,0.3335 million in 2000;0.4312 million in 2001;(0.5417) million in 2002.The average ESBLs producing ratio was 33.67%,ie,29.64%,32.58% and(38.45%) in 2000,2001 and 2002.CONCLUSIONS The incidence of ESBLs producing bacteria and DDDs of the third generation cephalosporins are raised gradually. More faster raised DDDs would result in higher incidence of ESBLs producing bacteria.

Objective:TO investigate the effects of the different factors on the quality control of PCI. Methods: Elucidating the correlation of PCI with the different personnel. Results: Success or failure of PCI is related to quality of subsystems in which the most importance is to manage and control concerning personnel including operating staff,nurses and patients. Conclusion:The organic coordination and total quality management of all parts are the safeguard of successful PCI.

Objective To assess the impact of preoperative ureteral stenting on outcome of flexible ureteroscopic lithotripsy . Methods The clinic data of flexible ureteroscope lithotripsy were analyzed retrospectively .All 52 eligible patients were divided into three group :goup A(no preoperative ureteral stenting );group B (preoperative ureteral stenting for 3-10 days);group C(preopera‐tive ureteral stenting for two weeks or more ) .The application of ureteral access sheath ,operation time ,stone free rates ,hospital stays ,complications were compared among the three groups .Results There were no significant differences in aging ,gender ,stone size , distribution ,average hospitalization days ,postoperative complications among the three groups (P>0 .05) .There were significantly differ‐ences between group A and group B ,group C(P<0 .05) ,and there were no difference between group B and group C (P>0 .05) on the suc‐cess rate of indwelling ureteral access sheath ,average operation time ,stone free rate .Conclusion Preoperative ureteral stenting could en‐hance the success rate of indwelling ureteral access sheath ,shorten the operation time ,improve the stone free rate .There was similar out‐come of flexible ureteroscopic lithotripsy between preoperative ureteral stenting for 3-10 days and two weeks or more .