Objective To investigate the nursing points of the mechanical ventilated patients after percutaneous endoscopic gatrostomy (PEG). Methods The nursing approaches of 28 mechanical ventilated patients after percutaneous endoscopic gatrostomy in our department was analyzed retrospectively. Results The nutritional status of the 28 patients was improved to different degree after enteral nutrition (EN) support by PEG. Thereby, the nutritional requirement of the mechanical ventilated patients was ensured effectively. Among these patients, 4 patients could take food by mouth after taking off ventilator and extubation and stoma tube was pulled out, 15 patients were discharged carrying with stoma tube and convalescent care was continued, 3 patients died of primary diseases. Conclusions The PEG is a simple,safe and cost-effective approach of nutritional support for EN of mechanical ventilated patients. The key point of insuring EN of severe patients is intensive nursing and to prevent and reduce the complication of PEG.

Objective To observe the influence of exercises on the mRNA expression of peroxisome proliferator-activated receptor (PPAR-α) and its target genes of acyl-CoA oxidase (ACO),Enoyl-CoA-hydratase and 3-hydroxyacyl-CoA-dehydrogenase (EHHADH) in the skeletal muscles in insulin-resistance mice to develop a way to improve the lipid metabolism.Methods Twenty male ApoE knockout mice were randomly divided into two groups,the high-fat diet group (group HFD) and the exercise training group (group Ex).The HFD group were fed with highfat diet,while the Ex group were fed in the same way,with additionally swimming training.And ten healthy male C57BL/6j mice were chosen as the control group(group ND).After 12 weeks of intervention,the serum lipid,blood glucose and insulin levels were determined,and homeostasis model assessment insulin resistance index (Homa-IRI) was calculated.The bilateral gastrocnemiuses were cut to be observed under a transmission electron microscope,and the mRNA expression of PPAR-α,ACO and EHHADH in skeletal muscle were measured using reverse transcription polymerase chain reaction(RT-PCR).Results The transmission electron microscope showed that the sarcolemma edema,mitochondrial swelling,as well as focal myocytolysis and edema within myofibrils were observed in the HFD group.The total cholesterol,low-density lipoprotein cholesterol,free fatty acid,fasting glucose,insulin and HomaIRI of the HFD group were significantly higher than the control group (P ＜ 0.05),while the mRNA expression of PPAR-α,ACO and EHHADH was significantly deceased than the latter(P ＜ 0.05).After swimming,the abovementioned pathological changes disappeared.The serum lipid of the Ex group were significantly lower (P ＜ 0.05),while HDL was significantly higher (P ＜ 0.05).And fasting insulin,glucose and HOMA-IR of the Ex group were significantly lower (P ＜ 0.05),while the mRNA expression of the above in the Ex group were significantly increased (P ＜0.05).Conclusion Swimming training could improve insulin resistance and metabolic disorder of lipid of ApoE knockout mice.The possible mechanisms may be through up-regulating the expression of PPAR-α,which in turn stimulates the expression of ACO and EHHADH mRNA to strengthen fatty acid β-oxidation.

Objective: To observe the autonomic nerve functional changing and the impact of comprehensive exercise in patients with cardiovascular neurosis (CN). Methods: Our research included in 2 groups: CN group, n=48 and Control group, n=30 normal subjects. Resting heart rate (RHR) and heart rate at the first recovery minute (HRR1) were measured by cardiopulmonary exercise testing (CPET) for comparison between 2 groups. In CN group, 30 patients were chosen and randomly assigned into 2 subgroups: Medication subgroup, patients received β-receptor blocker, n=14 and Comprehensive exercise subgroup, patients received the same medication plus aerobic and Thera-band resistance training, n=16; both subgroups were intervened for 3 months. Symptom checklist 90 (SCL-90) was used to evaluate relevant parameters before and after intervention, the changes of RHR and HRR1 were also compared between 2 subgroups. Results: ① Compared with Control group, CN group had the higher RHR and lower HRR1, all P<0.01. ② Compared with pre-intervention, both subgroups had improved RHR, HRR1 and SCL-90 scores at post-intervention, all P<0.05; compared with Medication subgroup, Comprehensive exercise subgroup showed improved SCL-90 scores and HRR1, all P<0.05. Conclusion: Comprehensive exercise including aerobic and Thera-band resistance training could effectively improve the clinical symptoms in CN patients, which might be related to changing the autonomic nerve function in relevant patients.

Objective We tried to explore the puerperal women's nature demand for management of health quotient,so as to provide theoretical basis for the health quotient management mode of puerperal women.Methods The phenomenological methodology was used in the research.Data of fifteen puerperal women were collected by semi-structured interview and analyzed by Colaizzi method.Results Four themes were summarized:health consciousness,health needs,in-hospital education status,social support needs.Conclusions The health quotient management of puerperal women is feasible.Therefore,the health quotient management model of maternal dominance and medical staff,family,peer support will be one of the maternal and infant health care research.

AIM: To observe the influence of serum contained Tongmai herbal medicine on calcium overload of the anoxic myocardial cells. METHODS: Serum contained Tongmai herbal medicine was prepared with the serum pharmacological method and the model of anoxic myocardial cells was established. The intracellular free calcium concentration and the expression of the L-type calcium channel were determined with Fura-2/AM and RT-PCR, respectively. RESULTS: The serum contained Tongmai herbal medicine and levo-anlodipine decreased the intracellular free calcium concentration in the anoxic myocardial cells. The serum contained Tongmai herbal medicine also suppressed the expression of L-type calcium channel in the anoxic myocardial cells, but levo-anlodipine had no effect on the expression of L-type calcium channel. CONCLUSION: Tongmai herbal medicine can attenuate calcium overload in anoxic myocardial cells.

Objective:To explore the prognosis and risk factors for conversion from off-pump coronary artery bypass grafting (OPCABG) to coronary bypass grafting (CABG) during surgery.
Methods: We retrospectively analyzed 2613 patients with elective OPCAB in our hospital from 2001 to 2012, there were 62 (2.37%) patients converted to CABG during the operation as Conversion group, the rest 2551 patients were set as Non-conversion group. The peril-operative baseline clinical data and prognosis condition were compared between 2 groups. The risk factors causing the in-operative conversion were studied with binary logistic regression analysis.
Results: The total conversion rate was 2.37%, including 42 patients of hemodynamic instability, 6 with dififculty of target vessel exposure, 9 with malignant arrhythmia, 3 with graft occlusion and 2 patients with other reasons. Compared with Non-conversion group, the Conversion group had increased post-operative drainage and ventilation time, higher rates of second thoracotomy for stop bleeding and higher peril-operative mortality. Binary logistic regression analysis indicated that chronic obstructive pulmonary disease, previous history of CABG, NYHA class≥3, LVEF≤40%and left main disease were the independent risk factors for in-operative conversion.
Conclusion: Conversion from OPCAB to CABG during the operation would be result in signiifcantly higher morbidity and mortality in relevant patients.

OBJECTIVETo describe the long-term survival of off-pump coronary artery bypass grafting (CABG) and to analysis the risk factors of operative mortality and long-term survival.

METHODSFrom January 2001 to December 2012, 2 831 patients undergoing off-pump CABG in Peking University People's Hospital, 2 099 cases (74.1%) of them were male, the average age was (63±9) years. The perioperative data was retrospectively collected. Binary Logistic regression was used to find the risk factors which affect the operative mortality. Follow-up evaluation was completed regularly. Kaplan-Meier survival curve, Log-rank test and Cox regression model were used to find out factors which affect the long-term result.

RESULTSTotally 2 831 patients underwent isolating off-pump CABG, in whom 45 patients died perioperative, 2 786 patients discharged successfully. Binary Logistic regression showed that sex (female) (χ2=4.4, OR=2.307, P=0.035), peripheral vascular disease (χ2=17.4, OR=6.616, P=0.000), New York Heart Association (NYHA) class grade≥3 (χ2=10.5, OR=3.491, P=0.001), ejection fraction≤40% (χ2=16.9, OR=5.230, P=0.000), emergency surgery (χ2=11.9, OR=5.127, P=0.001) are risk factors of operative mortality. The follow-up time was (74±44) months. Totally 107 patients were lost from follow-up, 109 patients died in follow-up. The survival rate at 1, 3, 5 , 8 and 10 years was 97.2%, 95.5%, 94.3%, 93.6%, 92.1%, respectively. Univariate analysis showed that age (>65 years), hypertension, renal insufficiency, peripheral vascular disease, history of myocardial infarction, NYHA class grade≥3 and emergency surgery were risk factors of the long-term survival (χ2=8.150 to 88.241, P<0.05). Cox regression analysis showed that age (>65 years) (χ2=12.1, RR=2.295, P=0.000), renal insufficiency (χ2=12.3, RR=3.160, P=0.000), peripheral vascular disease (χ2=42.5, RR=5.626, P=0.000), NYHA class grade≥3 (χ2=9.1, RR=1.994, P=0.002) and emergency surgery (χ2=5.5, RR=2.247, P=0.019) were independent risk factors that affect the long-term survival.

CONCLUSIONSSex (female), peripheral vascular disease, NYHA class grade≥3, ejection fraction≤40%, emergency surgery are risk factors of operative mortality. Age (>65 years), renal insufficiency, peripheral vascular disease, NYHA class grade≥3 and emergency surgery are independent risk factors that affect the long-term survival. Off-pump CABG has favorable perioperative and long-term outcome, and it definitely is a very safe and effective technique for coronary artery revascularization.

Aged ; Cardiovascular Diseases ; Coronary Artery Bypass, Off-Pump ; mortality ; Coronary Artery Disease ; surgery ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction ; Peripheral Vascular Diseases ; Retrospective Studies ; Risk Factors ; Treatment Outcome