Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP),and endotoxin in bloodstream infection with different microorganisms,so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients.Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2 ± 16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively.According to the results of blood culture,the microorganisms could be categorized into gram-negative bacteria,gram-positive bacteria and fungus groups,and the levels of serum CRP,PCT,and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission.Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18％),43 gram-positive strains (28.29％),and 16 fungal strains (10.53％).In the gram-negative strains,Klebsiella pneumoniae (n =29),Acinetobacter baumannii (n =24),Escherichia coli (n =23),Burkholderia cepacia (n =9) and Pseudomonas aeruginosa (n =4) were the most common isolates.In the Gram-positive strains,13 strains of Staphylococcus aureus were isolated.(2) In the gram-negative bacterial bloodstream infections group,there were 60 (64.52％) patients with endotoxin positive,and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections.The median levels of PCT were significantly different among the three groups [gram-negative strains group:7.760 (3.365,28.585) ng/mL,gram-positive strains group:0.705 (0.265,3.225) ng/mL,fungal infection group:1.245 (0.543,1.998) ng/mL].In the fungal bloodstream infection group,the mean level of CRP was higher than that in other two groups [gram-negative strains group:(126.01 ± 66.53) mg/L,gram-positive strains group:(77.58 ±54.21) mg/L,fungal infection group:(140.14 ±71.21) mg/L].(3) The receiver operating characteristic (ROC) curve of inflammatory cytokines was made for the diagnostic value in bloodstream infections.ROC curve used to distinguish between gram-positive bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP =0.791.When PCT cut-off value was 0.92 ng/mL,and CRP cut-off value was 68.00 mg/L,the sensitivity was 50％ and the specificity was 95.5％.ROC curve used to distinguish between the gram-negative bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.16 ng/mL and CRP cutoff value was 94.10 mg/L,and endotoxin was positive,the sensitivity was 82.8％ and the specificity was 100％.ROC curve used to distinguish between gram-negative bacterial bloodstream infections group and gram-positive bacterial group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.68 ng/ mL,CRP cut-off value was 106.5 mg/L,endotoxin was positive,the sensitivity was 74.2％ and the specificity was 97.7％.Conclusions Gram-negative bacteria were the most common microorganisms in bloodstream infections in ICU patients.Compared with single inflammatory cytokine,the serum concentrations of PCT,CRP and endotoxin used together could provide more sensitivity and specificity for the early diagnosis of bloodstream infection with different microorganisms.

Objective To investigate how surgical patients are assessed regarding pressure ulcer risks and the usage of evaluation tools in different stages during perioperative period.Methods Totally 210 nurses from operating rooms and surgical wards in 7 tertiary hospitals of Jiangsu Province were investigated with self-designed questionnaire.Results Operating room nurses of 7 hospitals used different kinds of scales for pressure ulcer risk assessment,the same scale document was used during the different stages of operation,the frequency and time for pressure ulcer risk assessment varied from one to three times,preoperative visit to handover in surgical ward were different;the Braden scale was used by surgical nurses to evaluate pressure ulcer risk after operation,while most surgical nurses believed that the existing scale lacked specificity and intraoperative risk factors that should be considered when assessing postoperative patients.Conclusion The frequency and time of pressure ulcer risk assessment of patients during perioperative period are not standardized,the content of scale is limited and lacks specificity,the assessment of pressure ulcer risk during perioperative period is discontinuous and non-dynamic.There are no specific risk assessment scales targeting preoperative,intraoperative and postoperative pressure ulcer risk assessment.

Objective To investigate the influence factors of quantitative changes of dendritic cells (DC) in neonate born to HBsAg positive mother.Methods Sixty HBsAg positive mothers and their newborns were enrolled from the Third People's Hospital of Taiyuan from July 2011 to March 2012.The serum hepatitis B virus (HBV) markers and HBV DNA in mothers and newborns before vaccination were determined by chemiluminescence immunoassay (CLIA) and fluorescence quantitative polymerase chain reaction (PCR).The circulating frequencies of DC subsets were determined in the newborns by flow cytometry (FCM).The comparison of data was done by Mann-Whitney test and t test.The correlation analysis was done by Spearman rank correlation analysis and chi square test.Results Among 60 newborns,5 were HBsAg positive and HBV DNA negative.Among 60 HBsAg positive mothers,21 were HBeAg positive and 29 were HBV DNA positive.There was no significant quantitative difference of neonatal myeloid dendritic cells (mDC) and plasmacytoid dendritic cells (pDC) between intrauterine infection group and intrauterine non-infection group (Z=-0.535,P=0.59 and Z=-0.027,P=0.98,respectively).However,mother's HBeAg positive status was closely related with neonatal HBeAg positive status (Pearson contingency coefficient was 0.928,P＜0.01).The frequencies of mDC in newborns born to HBeAg positive mothers were significantly lower than those born to HBeAg negative mothers (0.60±0.57 vs 0.87±0.58; Z=-2.085,P＜0.05).However,there was no significant quantitative differences of mDC and pDC between newborns born to HBV DNA positive mothers and born to negative mothers (Z=-1.272,P=0.20 and Z=-0.806,P=0.42,respectively).The frequencies of pDC were significantly lower in newborns born to mothers with HBV DNA＞ 1 × 107 copy/mL compared to newborns born to HBV DNA negative mothers (0.30±0.18 vs 0.64±0.55; t=-2.996,P=0.005).Conclusions HBeAg positive status of mothers may reduce neonatal frequencies of mDC.Neonatal frequencies of pDC may be reduced when the mothers' HBV DNA loads are more than 1 × 107 copy/mL.

Objective To investigate the influence factors of non-responsiveness and lowresponsiveness to hepatitis B vaccine of infants born to hepatitis 1 surface antigen (HBsAg) positive mothers.Methods A total of 219 HBsAg positive mothers and their full-term neonates were selected from July 2011 to December 2012 in the Third People's Hospital of Taiyuan.Serologic hepatitis B virus (HBV) markers and HBV DNA load of mothers and their neonates were determined.Neonates were followed up for 12 months to observe the effect of HBV intrauterine infection,hepatitis B e antigen (HBeAg) status,sex,delivery mode,feeding option and suffering from infectious disease during followup period on the immune response to hepatitis B vaccine.Chi-square test was used in univariate analyses and unconditional Logistical regression was used in multivariate analyses.Results There were 16 cases of non-responsiveness and 33 cases of low-responsiveness in all 219 neonates.The rate of non-responsiveness and low-responsiveness was 22.37 ％.In univariate analyses,neonatal HBeAg positivity (x2 =4.895,P=0.027),natural birth (x2 =5.210,P=0.022),suffering from infectious diseases during follow-up period (x2 =4.329,P=0.037) were significantly associated with non-responsiveness and low-responsiveness.There was no relationship between mother HBeAg positivity and the level of response to hepatitis B vaccine.In multivariate analyses,natural birth (OR=2.022,95 ％CI:1.045-3.914) and suffering from infectious diseases (OR=2.324,95 ％ CI:1.058-5.103) were associated with non-responsiveness and low-responsiveness.Conclusion Infants born to HBsAg positive mothers with natural birth or suffering from infectious diseases during follow-up period are more likely to be non-responsiveness and lowresponsiveness to hepatitis B vaccine.

Objective To evaluate the effect of combination therapy with milrinone and esmolol on hemodynamics and cardiac function in patients with septic myocardial depression. Methods From October 2010 to October 2013,after the hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output (PICCO),74 sepsispatients withCI < 2.2 L/min · m2 after fluid resuscitation were enrolled in the study and were divided into group A with intravenous injection of dobutamine hydrochloride ,and group B with intravenous injection of milrinone and esmolol,with 37 cases in each group. The patients'PICCO indicators, echocardiography and cardiac biomarker(CK,CK-MB,MYO,cTnI and ProBNP)in two groups were compared before and after 3-day treatment. Results (1)CI and GEF were significantly increased in group B after 3-day treatment when compared with those in group A.(2)Compared with those in group A,early diastolic mitral flow velocity/end diastolic mitral velocity (E/A) and right ventricular diastolic diameter(RVD) in group B had statistical significance.(3) CK-MB,cTnI and ProBNP decreased significantly in group B when compared with those in group A. Conclusion Combination therapy with milrinone and esmolol can increase cardiac ejection function,slow down the heart rate,reduce the heart blood and vascular preload,lessen the injury of myocardial and improve heart function.

Objective To investigate the effects of volatile oil from artemisia dracunculus on myocardial injury caused by viral myocarditis in mice and explore its possible mechanism.Methods Totally 160 adult male BALB/c mice were randomly divided into normal control group (10) and viral myocarditis group (150).Viral myocarditis mice models were reproduced by intraperitoneal inoculation with a solution of coxsackievirus B3 (CVB3),a viral strain with affinity to myocardium,and then randomly divided into model,astragalus group,and low-,medium-,and high-dose volatile oil from artemisia dracunculus groups.After 1 hour of viral infection,normal control group and model group mice were given normal saline by intragastric administration,astragalus group mice were injected with astragalus 0.1 mL in each mouse by intraperitoneal injection,and the mice in other three groups were given low,medium and high dose (2％,5％,10％) 0.3 mL volatile oil from artemisia dracunculus in each mouse by intragastric administration,respectively,once a day for one week consecutively.The mortality,heart/body weight ratio,the activity of natural killer cells (NK cell),virus titer in myocardial homogenate,serum cardiac troponin Ⅰ (cTnI) level and myocardial pathological changes were observed.Results ① Mortality:the mortality of model group was higher than that of the normal control group,astragalus group,low and medium dose volatile oil from artemisia dracunculus groups (60.0％ vs.0％,23.3％,20.0％,28.7％),and the difference in the mortality being of no statistical significance between model group and that of high-dose volatile oil from artemisia dracunculus group (60.0％ vs.47.6％,P ＞ 0.05);the mortality of astragalus group was obviously lower than that of high-dose volatile oil from artemisia dracunculus group (P ＜ 0.01),and the differences in comparisons between the mortalities of astragalus intervention group,and medium-and low-dose volatile oil groups were not statistically significant (all P ＞ 0.05),and the comparison of mortality between low-and medium-dose volatile oil groups were also not statistically significant (P ＞ 0.05).② Immunization parameters:on the 8th day after modeling,the activity of NK cells in the model group was significantly lower than that in the normal control group [(15.91 ± 3.87)％ vs.(38.50 ± 2.32)％],the activities of NK cells in astragalus group,medium-and low-dose volatile oil from artemisia dracunculus groups were significantly higher than that in model group [(19.38 ± 3.27)％,(18.54 ± 3.09)％,(18.36 ± 2.64)％ vs.(15.91 ± 3.87)％,all P ＜ 0.05].None of virus was detected in the myocardial homogenate in the normal control group,and the virus titers in astragalus group,low and medium dose volatile oil from artemisia dracunculus groups were significantly lower than the titer of the model group (10-9/mL:1.96 ± 0.44,1.95 ± 0.46,1.95 ± 0.48 vs.2.41 ± 0.51,all P ＜0.01).③ Myocardial injury parameters:the level of cTnI in the normal control group was less than 0.1 μg/L,obviously lower than that in the model group [(15.84 ± 3.89) μg/L],as well as the ratio of heart/body weight in model group was also significantly higher than that in normal control group (× 10-4:8.3 ± 1.3 vs.4.6 ± 0.1),and the cTnI and the ratio of heart/body weight of astragalus intervention group,low and medium dose volatile oil from artemisia dracunculus groups were markedly lower than those of model group [cTnI (mg/L):10.03 ± 2.35,10.81 ± 2.56,11.10 ± 1.89 vs.15.84 ± 3.89,ratio of heart/body weight (× 10-4):7.2 ± 0.8,7.3 ± 1.0,7.3 ± 0.6 vs.8.3 ± 1.3].In the normal control group,there were no inflammatory cell infiltration and necrosis in myocardial tissue,the scores of myocardial pathological changes were 0.In the model group,the scores of inflammatory cell infiltration (3.25 ± 0.45) and of necrosis (2.91 ± 0.51) were markedly higher than those in the normal control group.And the above scores in astragalus group,low and medium dose volatile oil from artemisia dracunculus groups were significantly lower than those of the model group (infiltration score:2.92 ± 0.39,2.95 ± 0.35,2.95 ± 0.37 vs.3.25 ± 0.45,necrosis score:2.46 ± 0.50,2.50 ± 0.51,2.54 ± 0.50 vs.2.91 ± 0.51,all P ＜0.05).Conclusions Volatile oil from artemisia dracunculus can protect cardiomyocytes by removing the virus and regulating the immune function in the body.But the protective effects of volatile oil from artemisia dracunculus is related to the dosage,and the effects of low and medium dose are better.

Objective:To understand the management status of breast cancer-related lymphedema, and to provide a basis for the formulation of prevention and treatment plans for breast cancer-related lymphedema.Methods:Using accidental sampling, a questionnaire designed by the research team was used to survey nurses in 58 hospitals in Jiangsu Province.Results:This study surveyed a total of 58 hospitals, of which 53 were general hospitals and 5 specialized hospitals. Only 11 hospitals (18.97%) had treatment rooms dedicated to conservative treatment of lymphedema, 9 hospitals (15.52%) had opened lymphedema clinics, and 15 hospitals (25.86%) had professional international lymphedema therapists. All the 58 hospitals had different degrees of prevention and management of breast cancer-related lymphedema.Conclusions:The comprehensive management of lymphedema has not yet been achieved, and the management standards of lymphedema also need to be further improved. It is important to establish a unified and standardized management plan and practice standards.

Objective To translate the Symptom Intrusiveness Rating Scale and test its reliability and validity. Methods The scale was modified based on translation, back-translation and cross-culture adaptation. Ninety-five patients were recruited from wound&stoma clinic of one upper first-class hospital. the questionnaire were tested by internal reliability and test-retest for reliability and exploratory factor analysis and confirmatory factor analysis for validity. Results The coefficient of Cronbach α was 0.823 and the retest reliability was 0.893. The content validity index was 0.871. Three factors, which were F1:functional status, F2: social relations, F1: mental health, were extracted by exploratory factor analysis and they could explain 78.53% of total variance. Confirmatory factor analysis indicated a good model and fit indices c 2/df=1.061, GFI=0.903, RMSEA=0.065, NFI=0.932, IFI=0.996. The Chinese version of SyIRS was moderately related with SF-36v2 physical subscales (r=-0.42, P<0.01), and mental subscales (r=-0.45, P<0.01). Conclusions The Chinese version of Symptom Intrusiveness Rating Scale is a reliable and valid instrument, which is applicable to assess the patient’s quality of life associated with chronic wound related pain.

Objective To investigate the caring experiences of family caregivers of patients with enterostomy in different stages based on"Timing It Righ"framework. Method Phenomenological research method was used to conduct an unstructured interview with 40 caregivers of patients in different stages (perioperative period, discharge preparation period, adjustment period and adaptation period).The acquired data were analyzed by Colaizzi phenomenological research method. Result According to the"Timing It right"framework, five themes about nursing experience of caregivers of patients with enterostoma at different stages were extracted: 1) uncertainty of disease and post-traumatic stress disorder at the perioperative period; 2) Re-challenges after subjective initiative adjustment during the discharge preparation period; 3) practice and re-cognition during the adjustment period; 4) post-traumatic growth during the adaptation period.Conclusions The caregiver's experience of an enterostomal patient presents a dynamic process. There are different experiences and needs for inner-heart care in different stages.Family caregivers were with strong information and emotion need at the perioperative period;they were with strong helpless feeling during the dischsrge preparation;they were with information and stoma instrument need in adjustment period;they were with care ability need during adaption period. Nursing staff should provide relevant mental support and professional guidance up to the different stages so as to improve mental health of caregivers of stoma patients and enhance their knowledge and skills on care-giving.

This study determined the effect of hepatitis B virus (HBV) replication in peripheral blood mononuclear cell (PBMC) from HBsAg-positive mothers on HBV intrauterine transmission.A total of 150 HBsAg-positive mothers and their neonates were recruited in this study.Within 24 h after birth,HBV serological markers,serum HBV DNA,PBMC HBV relaxed circular DNA (rcDNA),and covalently closed circular DNA (cccDNA) were measured in the HBsAg-positive mothers and their neonates before passive-active immune prophylaxis.The relationship between HBV replication in PBMC and HBV intrauterine transmission was examined through Chisquare test and logistic regression.The rate of HBV intrauterine transmission was 8.00％ (12/150) in the 150 neonates born to HBsAg-positive mothers.The positivities of PBMC HBV rcDNA and cccDNA in the HBsAg-positive mothers were 36.67％ (55/150) and 10％ (15/150),respectively.Maternal PBMC HBV cccDNA was a risk factor of HBV intrauterine transmission (OR =6.003,95％ CI:1.249-28.855).Maternal serum HBeAg was a risk factor of PBMC HBV rcDNA (OR =3.896,95％ CI:1.929-7.876) and PBMC HBV cccDNA (OR =3.74,95％ CI:1.186-11.793) in the HBsAg-positive mothers.Administration of hepatitis B immune globulin was a protective factor of PBMC HBV cccDNA (OR =0.312,95％ CI:0.102-0.954) during pregnancy.The positivity of PBMC HBV rcDNA was related to that of cccDNA in the HBsAg-positive mothers (x2=5.087,P =0.024).This study suggests that PBMC is a reservoir of HBV and an extrahepatic site for virus replication and plays a critical role in HBV intrauterine transmission.