Objective To explore the effect of Plan. Do-Check-Act on homogenization of nursing processes in ICU. Methods A total of 36 nurses were selected to implement Plan. Do-Check-Act in ICU according to evidence-based medicine. Their nursing was inspected by a senior nurse. The differences of the following items before and after Plan. Do-Check-Act were compared: nursing quality comprehensive quality control index and specialized quality control index. Results After the implementation of Plan. Do-Check-Act, comprehensive quality control index of clinical nursing quality score by (89.28 ± 2.36) points up to (97.45±1.38) points, and there was significant difference(t=-7.310, P<0.01). The specialized quality control indicators including the incidence of ventilator associated pneumonia, the incidence of catheter-related bloodstream infection, the incidence of catheter-associated urinary tract infections, the incidence of accidental extubation, the incidence of pressure sores, the incidence of glycemic out of control, the incidence of sedation out of control and retention time were 26.2%(53/202), 17.8%(36/202), 18.8%(38/202), 11.9%(24/202), 2.5%(5/202), 18.3%(37/202), 15.3%(31/202), (168.0 ± 3.3) h before the implementation and 7.1%(14/196), 3.1%(6/196), 4.1%(8/196), 0.5%(1/196), 0, 3.6%(7/196), 3.1%(6/196), (96.0±4.2) h after the implementation. There were significant differences (χ2=4.913-25.907, t=66.195, all P<0.01). Conclusions The Plan. Do-Check-Act is an effective way to improve nursing quality of ICU to make it homogeneous, reduce adverse nursing and iatrogenic complications.

20?, ranging from 21? to 75?(average, 35?), and 59 cases 20?. Results Successful decompression in which the distance from the middle point of connecting line between bilateral transverse processes to the posterior wall of vertebral body was more than 8 mm, was achieved in 59 cases (85.5%); satisfied correction of kyphosis was noticed in 10 cases. Post-operatively the mean angle of kyphosis deformity was 10.8? ranging from 0? to 40?. During the mean follow-up period of 12.5 months, neurological functional recovery was noticed in 63.8% of total cases. For complete spinal cord injury, 17.6% of cases recovered partially(sensory function), whereas neurological function recovery was noted in 78.8% of cases with incomplete spinal cord injury, the statistical difference was significant between the incomplete and complete spinal cord injury cases. Conclusion The old thoracolumbar fracture with incomplete spinal cord injury could be treated with transpedicular anterior decompression and osteotomy, neurological functional recovery is expected.

Objective To study the effect of Dahuang-Mudan decoctionby retention enemafor the thepatients with acute pelvic inflammation disease (APID) and toxic heat flourishing type. Methods Ninety patients with APID (toxic heat flourishing type) were randomly divided into treatment group and control group (45 case per group). The patients in both groups were given cefamandolenafate injection and tinidazole injection;and the Dahuang-Mudan decoction by retention enema was added to the treatment group.The C-reactive protein (CRP), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and clinical symptoms scores in both groups before treatment and after 2 weeks of treatment were observed. Results After treatment, CRP (3.16 ± 1.25 mg/L vs. 8.68 ± 1.45 mg/L, t=19.126), TNF-α(4.02 ± 1.06 ng/L vs. 9.64 ± 2.08 ng/L, t=15.966), IL-6 (60.34 ± 14.35 ng/L vs. 88.24 ± 12.16 ng/L, t=9.839), temperature recovery time (3.22 ± 1.13 d vs. 4.73 ± 1.36 d, t=5.638), abdominal pain disappeared time (5.26 ± 1.43 d vs. 7.45 ± 1.32 d, t=7.418), leukocyte recovery time (7.34 ± 2.06 d vs. 9.58 ± 2.26 d, t=4.834), hospital stay time (10.24 ± 3.42 d vs. 13.43 ± 4.38 d, t=3.791) in the treatment group were significantly lower than those in the control group (P<0.01). The clinical effect rate (77.27% vs. 48.84%, χ2=7.562) in the treatment group were significantly higher than that in the control group (P<0.01). Conclusions The treatment of APID (toxic heat flourishing type) with Dahuang-Mudan decoction by retention enema can reduce the inflammatory response of pelvic, promote the absorption of exudate and adhesion in pelvic.

Objective To explore a reasonable treatment for intertrochanteric hip fractures in the aged patients by comparing the fixation effects of cannulated compression screws and intramedullary fixation nails. Methods From January 1998 to December 2004, in our department 123 old patients with intertrochanteric hip fracture were fixed with cannulated compression screws or intramedullary nails. They were followed up and their complete clinic data kept. According to the Evans classification, of the 51 patients who received treatment with cannulated compression screws for their anterograde intertrochanteric hip fracture, 14 were type Ⅰ , 24 type Ⅱ , 10 type Ⅲ and three type Ⅳ , while of the 72 patients who received treatment with intramedullary nailing, 10 were type Ⅰ , 12 type Ⅱ , 28 type Ⅲ , 14 type Ⅵ , and eight retrograde intertrochanteric hip fractures. A retrospective comparison was made between the old patients treated with the two different fixation devices in terms of operative time, blood loss, transfusion, average hospitalization time, intraoperative and postoperative complications, functional recovery one year postoperatively and treatment expenses. Results The differences between the two groups in operative time, blood loss, transfusion, treatment expenses were of statistical significance (P0.05). Conclusions Cannulated compression screws should be chosen for old patients with anterograde intertrochanteric hip fractures of Evans types Ⅰ & Ⅱ or of Evans types Ⅲ & Ⅳ who are at a high risk, in a poor health or severely osteoporotic state. For patients with unstable Evans types Ⅲ & Ⅳ or with retrograde intertrochanteric hip fractures, intramedullary nails are suitable.

Objective To explore the feasibility of the double venipuncture instead of central venous catheter as a temporary vascular access in hemodialysis.Methods The upper arm below the 1/3 was tied a tourniquet,and fistula needle directly punctured the vein in the middle of the elbow.After the success of the puncture,elastic bandage was replaced by a tourniquet,and the ball movement was done by imitating the blood donation member for blood donation at hand gripping a ball or elements as the artery blood lead.Another elbow vein or lower limb saphenous vein was punctured.Thirty patients using double venipuncture dialysis or central venous catheter dialysis 2 weeks or more were randomly selected into each group,and biochemical and renal function was measured before dialysis.Results All of 1 282 patients who were newly into the blood dialysis,mature arteriovenous fistula was in 8 patients (0.6％,8/1 282),deep venipuncture to insert the central venous catheter was in 542 patients(42.3％,542/1 282),using the double venipuncture was in 732 patients (57.1％,732/1 282).The flow of blood was 180-200 ml/min,the avalible time was 1-2 months.The serum creatinine,blood urea nitrogen,calcium,phosphorus and carbon dioxide combining power had no significant difference between two groups (P ＞ 0.05).Conclusions The majority of patients with double venipuncture blood flow can satisfy the need of dialysis.Because the operation is simple,no recycling and may reduce the deep venipuncture,it is an ideal temporary vascular access.

Aim The effect of polysaccharide of spirulina on mouse myelosuppression induced by cyclophosphamide was studied. Methods Mice in the model, treatment groups Ⅰ and Ⅱ were given cyclophosphamide(ip 100 mg · kg- 1) for there days. At the same time mice in the treatment groups Ⅰ and Ⅱ were given ig spirulin 30 mg · kg-1 and 60 mg · kg-1 for ten days, while mice in the control group and model group were given ip 20 mg · kg-1 of NS. Peripheral blood and marrow cytometry, micromcelsus and chromosome aberration were analyed. Results In the dosages of 30 and 60 mg · kg-1 polysaccharide of spirulina, the polysaccharide of spirulina had perfect action on the perihemateikon and the function of bone hematoplast induced by cyclophosphamide(P ＜0.01) and antagonistic action on increase of bone cell micronuclsus(P＜0.05); The ratio of chromosome aberration in the treated group was lower compared with that in the model group. The inhibitory ratio was 51.2% and 62.5% in the treated groups Ⅰ and Ⅱ .Conclusion Polysaccharide of spirulina can perfect the hematoplast function of mice injured by cyclophosphamide.

Chorismic acid is a mid-metabolite that plays a central role in the metablism process distributing in the bacterium, epiphyte and plants. It is a common precursor substance of the all aromatic amino acids that can turn into phenylalanine and tyrosine catalyzed by bi-functional enzyme chorismate mutase (CM)-prephenate dehydratase (PDT) and chorismate mutase-prephenate dehydrogenase (PDH) respectively. CMp-PDT with its regulate domain Rp were called P-protein and CMt-PDH with its regulate domain Rt were called T-protein. P-protein and T-protein from E. coli. have a similar structure, both of which contained three domains: CMp, PDT, Rp in P-protein and CMt, PDH, Rt in T-protein. P-protein and T-protein are regulated by their effectors phenylalanine and tyrosine respectively through binding to their Rp and Rt domains. Rp and Rt domains were switched between P-protein and T-protein by cloning of chimeric proteins. The results showed that regulatory effects were switched along the switch of R domains and the switch of the regulatory domains lead to the switch of effectors. It means that the combination of the regulatory domain and the effector is specific and the regulating of the regulatory domain to the enzyme activity is non-specific. This property of R domains may make them possible molecular elements in the study of molecular machines.

BACKGROUND: Bone marrow stromal stem cells (BMSCs) are characterized by rapid amplification and wide differentiation.Thus, to establish in vitro BMSC induction models contributes to the study of tissue engineering.OBJECTIVE: To investigate the possibility of inducing the differentiation of rat BMSCs into cardiomyocytes by 5-azacitidine in vitro.OESING, TIME AND SETTING: The cytological in vitro study was performed at the Central Laboratory of First Affiliated Hospital of Liaoning Medical University from June 2005 to June 2008.MATERIALS: A total of 20 Sprague Dawley rats were supplied by the Experimental Animal Center, Liaoning Medical University.5-azacitidine (Sigma, USA) was used.MHEHODS: Following anesthesia, the rats were used to isolate the femur and tibia. BMSCs were isolated and cultured by the whole bone marrow method + adherent method. When 90% BMSCs were confluence, BMSCs were passaged. BMSCs at the third passage were incubated in a 24-well plate at 2×10~4/well, with 5,10, 15, 20 μmol/L 5-azacitidine. Simultaneously, a blank control group (without inductor) was set. Following 24 hours of induction, BMSCs were incubated in normal medium for 3 weeks.MAIN OUTCOME MEASURES: The following parameters were measured: cell appearance and growth curve, morphological changes following induction, and expression of connexin-43 and a-striated muscle actin.RESULTS: Cultured BMSCs were spindle-shape, with some cell confluence. P3 cells following incubation entered static phase at 1 and 2 days, and entered logarithmic phase at 3 days, reached a peak at 9 days, and then entered platform stage. Cell number became decreased at 12 days. Following induction of 5 μmol/L 5-azacitidine, no significant difference was found in BMSCs.Following induction of 10 μmol/L 5-azacitidine, BMSCs became long and big, extended towards a direction, with the property of myotube formation cells. Following induction of 15 umol/L 5-azacitidine, a few cells survived surrounding the 24-well plate.Following induction of 20 μmol/L 5-azacitidine, cells died. Following induction of 10 μmol/L 5-azacitidine for 3 weeks, expression of connexin-43 and a-striated muscle actin was determined in BMSCs. However, a negative expression was detected in the blank control group.CONCLUSION: BMSCs cannot differentiate into cardiomyocytes by itself. Following in vitro induction, BMSCs can differentiate into cardiomyocytes. Low-dose 5-azacitidine concentration cannot induce the differentiation, but high-dose 5-azacitidine concentration will induce death in a large number of cells. Thus, 10 μmol/L is an optimal concentration.

Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture. Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008. The patients who had an operation within two days (the early surgery group) were compared with the outcome for those who had an operation more than two days (the later surgery group). Outcomes measured were mortality, post-operative complications, operative details, the comorbidity and the activities of daily living of patients. Results One hundred and sixteen patients were included in the study. There were 45 cases in the early surgery group, including 13 males and 32 females. The patients ranged from sixty-five to eightyeight years old, with an average age of 78.76 years. While there were 71 patients in the late surgery group,including 24 males and 47 females. The patients ranged from sixty-six to one hundred and three years old,with an average age of 80.00 years. The demographic data of patients show no significant difference in two groups. There was no difference in intraoperative conditions such as anesthesia, amount of bleeding, type of fixation between two groups. Patients in early surgery group experienced shorter length of hospital stay, and fewer pulmonary complications. The mortality of early surgery group do not show a significant increase at discharge, 6 month, 12 month postoperatively compared to that of the later surgery group. However patients in the early surgery group show a significant increase of ADL scores at discharge, 6 month postoperatively,but not at 12 month. Conclusion The timing of surgery has an impact on clinical outcome in elderly hip fracture. Early surgery was associated with improved function in the first 6 month postoperatively, but not 12months, but it was not associated with mortality.

Objective To observe the effects of fosamax on the fracture healing and the bone mineral density(BMD)in postmenopausal women with radius distal osteoporotic fracture(RDOF).Methods All the 62 patients with RDOF were randomly divided into 2 groups after the fracture was fixed manually.Thirty-two patients in treated group took fosamax 1 tablet(70 mg)per week for 12 weeks and caltrate D 600 mg per day,while the other 30 patients in control group took caltrate D 600 mg per day only.The BMD and the fracture healing time were detected after 12 weeks' treatment.Results The fracture healing time was(9.31±2.50)weeks in treated group and was(13.0±2.8)weeks in control group(t=5.54,P＜0.01).BMD was significantly increased after treatment in treated group[(0.615±0.075)g/cm2 vs.(0.665±0.085)g/cm2,t=2.50,P＜0.05],while there was no obvious change of BMD in control group[(0.620±0.085)g/cm2 vs.(0.617±0.075)g/cm2,P＞0.05].BMD was higher in treated group than in control group after treatment(t=2.46,P＜0.05). Conclusions Fosamax can promote formation of bony callus,increase BMD and shorten external fixation time of radius distal osteoporotic fracture in postmenopausal women.