Objective To identify the needs of home nursing of adult inpatients, and analyze the re-lated factors of the needs in order to give direction and information for the home care nursing. Methods A self-designed questionnaire was used to investigate the needs of home nursing of 172 adult inpatients. Results Of the 172 patients, 56(32.6%) patients considered the home care was necessary, and 66(38.4%) patients in an indifferent attitude,50(29.0%) patients thought it unnecessary. The need was positively related with the comprehension of home care. The need for home care of patients from different departments, age groups and subjective judgement of self-health had significant difference. Conclusions Home care are necessary for some kind of adult inpatients. We should perfect adult home care system and improve nursing level of community.

Five hundred elderly patients with ischemic stroke admitted from January 2008 to December 2010 were enrolled in the study,including 352 recurrent cases and 148 primary cases.There was a positive correlation of stroke recurrence with age,blood pressure,blood glucose and lipid levels,smoking and alcohol consumption of patients(P ＜0.05 ); while the stroke recurrence was negatively correlated with physical exercise(P ＜ 0.05).Stepwise multiple regression analysis indicated that the blood pressure,blood glucose and lipid levels were risk factors for the recurrence of ischemic stroke in elderly patients.

One hundred and twenty stroke patients were randomly divided into rehabilitation group (n =60) and control group (n =60).Patients were assessed with National Institute of Health Stroke Scale (NIHSS) ,Fugl-Meyer Assessment (FMA),Bathel Index (BI) and World Health Organization Quality of Life Assessment Instrument Brief Version(WHOQOL-BREF) before and 6 weeks after treatment by the same doctor.The scores of NIHSS,FMA,BI and WHOQOL-BREF were improved significantly in rehabilitation group after treatment; while those of control group were no improved.The scores after treatment of rehabilitation group were significantly higher than those of control group ( P ＜ 0.05 ).

A total of 120 patients with initial stroke at a community health service center in Shanghai from January 2009 to March 2011 were divided randomly into intervention group (n =60) and control group (n =60).Individual comprehensive rehabilitation was carried out based on the evaluations in the intervention group.Routine therapy was given to the patients in the control group.General data evaluations were conducted at pre-intervention and 1 year post-intervention respectively.The levels of blood pressure,blood glucose and blood lipid(LDL-C) were all lower in the intervention group than those in the control group (P ＜ 0.05).The rates of proper behavior were all higher in the intervention group than those in the control group (P ＜ 0.05).And the rates of recurrence and mortality were lower in the intervention group than those in the control group (P ＜ 0.05).

Objective To study the effect of dexmedetomidine hydrochloride injection ( Dex) on awakening quality in Pediatric Patients with congenital heart disease undergoing fast_track anesthesia and whole Video_assisted thoracoscoPic surgery. Methods One hundred and twenty Pediatric Patients ( ASA I orIIleVel) with congenital heart diseases were randomly chosen for this study. They receiVed femoral artery and Vein cannulation to establish cardioPulmonary byPass and three small holes were obtained in the right chest for the PurPose of undergoing the whole Video_assisted thoracoscoPic surgery on rePairmen of atrial sePtal defect or simPle Ventricular sePtal defect. They were randomly diVided into two grouPs: Dex_assisted fast_track anesthesia grouP (D grouP,n=60) and general fast_track anesthesia grouP (C grouP,n=60). Each one in grouP D was injected with loading dose of Dex (1 μg·kg-1),then was intraoPeratiVely infused with maintenance dose of 0. 5 μg·kg-1·h-1. Children in grouP C were giVen the same dose of saline in the same way. Hemodynamic changes in the two grouPs at each time Point:before anesthesia ( t0 ) ,at the time of extubation ( t1 ) ,5 min Post_extubation ( t2 ) ,10 min Post_extubation ( t3 ) ,15 min Post_extubation ( t4 ) , 30 min Post_extubation (t5) and at the time of transferring out of CICU (t6),resPectiVely,were obserVed. Restlessness extent, incidence,time of eye oPening after calling, fully awaking time, extubation time, the time of transferring out of CICU and VAS scores,were also recorded. Results From t0 to t2-t5 ,SBP in D grouP was decreased from (114. 2±10. 5) mmHg to (107. 2±10. 3) -(105. 3±11. 3) mmHg,DBP decreased from (61. 3±9. 2) mmHg to (58. 8±7. 8) -(57. 3±6. 3) mmHg,and HR gradually decreased from (95. 2±15. 7) time·min-1 to (85. 7±13. 7)-(83. 3±12. 6) time·min-1,with significant differences (P<0. 05). ComPared with C grouP,SBP and DBP at t2-t5 were decreased significantly (P<0. 01),and HR at t1-t5 decreased significantly (P<0. 01). OVerall incidence of agitation was significantly higher in grouP C than in grouP D (48. 3%vs. 16. 7%,P<0. 01). Incidence of moderate and seVere agitation were significantly higher in grouP C than in grouP D (18. 3%vs. 6. 7%,and 20%vs. 1. 7%,resPectiVely,P<0. 01). In grouP D,time of eye oPening after calling,fully awaking time,extubation time,and the time of transferring out of CICU were Prolonged,without significant difference as comPared with grouP C (P>0. 05). VAS at 30 min after extubation was significantly higher in grouP C than in grouP D(4. 7±0. 7 vs. 2. 4±0. 6,P<0. 05). Conclusion Injection of Dex with loading dose (1 μg·kg-1) and intraoPeratiVe infusion of maintenance dose of 0. 5 μg·kg-1·h-1 in children with congenital heart disease undergoing fast_track anesthesia and whole Video_assisted thoracoscoPic surgery could be conduciVe to maintain hemodynamic stability, reduce restlessness occurrence, enhance security during awakening Process, and alleViate Post_oPeratiVe Pain.

Objective To analyze the rule of lymph node metastasis in thoracic esophageal carcinoma,and to study the proper radiation target. Methods From September 1986 to December 1997,549 patients with esophageal carcinoma who had undergone radical reseetion were divided into surgery alone group (S,275 patients) or surgery plus radiotherapy group( S + R,274 patients). Radiotherapy was begun 3 to 4 weeks after operation. The radiation target included beth supra-clavicular areas and the entire mediastinum. The total dose was 50 Gy in 25 fractions over 5 weeks for the supra-clavicular areas and 60 Gy in 30 fractions over 6 weeks for the entire mediastinum. Results The 5-year overall survival of patients with lymph node metastasis in one anatomic site and two anatomic sites was 31.5% and 13.9% (P=0.013), respectively. For patients with > 2 positive nodes metastasis receiving surgery alone, the corresponding 5-year survival was 24.8% and 4.9% (P=0.046) ,respectively. The median number of dissected lymph nodes of the upper-,middle-and lower-segment esophageal carcinoma was 13,17 and 20, respectively. The rate of metastatic lymph node in the para-esophagus region was the highest(61.5%-64.9%) ,which was not different among the different primary sites(P=0.922). The anastomotic stoma recurrence rate of the upper-segment esophageal carcinoma was higher than that of the middle- or lower-segment carcinomas(16.7% ,3.1% ,and 7.7%, χ2=9.02,P<0.05). Conclusions For the thoracic esophageal carcinoma,the number of anatomic sites of lymph node metastasis is an important factor affecting the survival. The lower rate of lymph node metastasis of the upper segment esophageal carcinoma may be corrected with the less lymph node dissected. The rate of lymph node metastasis in para-esophageal region is not related with the lesion segment. The anastemotie stoma is an important radiotherapy target for upper segment esophageal carcinoma.

Objective To evaluate the effects of community-based rehabilitation therapy on activitv of daily living performance of the Chinese stroke patients. Methods In a single blinded,randomized,controlled multicenter trial,737 consecutive stroke patients were stratified by two groups of cerebral infarction and hemorrhage. All the patients were randomly divided into a rehabilitation group and a control group.The patients in the rehabilitation group received atandardized community-based rehabilitation therapy,while those in the control group did not.All the patients were followed up for 5 months for evaluation of their performance with activity of daily living by using Modified Barthel Index before intervention,after follow-up 2 and 5 months,respectively. Results Patients in the rehabilitation group performed better in ADL as reflected by the Modified Barthel Index score than those in the control group after 5 months of intervention(P＜0.05).Although both the rehabilitation group and control group improved over time,the rehabilitation group showed a greater improvement with the Modified Barthel Index scores when compared with the control group(P＜0.01).After 5 months follow-up,the total gain of Modified Barthel Index scores was 26.28 and 32.89 for those with cerebral infarction and hemorrhage,respectively,in the rehabilitation group. In comparison,the gain of Modified Barthel Index scores was 7.65 and 2 1.70 for those with cerebral infarction and those with hemorrhage,respectively in the control group.This implies a difference in improvement of 1 8.63 in cerebral infarction group and 1 1.19 in hemorrhage group,in favor of the rehabilitation group. Conclusion Standardized community-based rehabilitation therapy may help stroke patients to improve their performance in activity of daily living significantly.

Objective To analys hyperinsulinemia in Bartter syndrome. Methods Twenty-three cases of Bartter syndrome [age (27 ±9) years;fasting serum potassium(2. 8 ±0. 5)mmol/L], 20 patients of aldosterone-producing adenoma [APA, age (45 ± 11 ) years, fasting serum potassium ( 3.0 ± 0. 4 ) mmol/L], 20 patients of idiopathic hyperaldosteronism [IHA, age (51 ± 11 ) years, fasting serum potassium (3.4 ±0. 2)mmol/L] were diagnosed in Peking Union Medical College Hospital from September 2003 to May 2008. All patients underwent 3-hours oral glucose tolerance test(3hOGTT), postural stimulation test and calculated HOMA-insulin resistance ( HOMA-IR ) and HOMA-insulin sensitivity ( HOMA-IS ) by Homeostasis model.Results The insulin area under curve-(229.0±162.4)mIU·L-1·h] was singnificantly higher than APA group [(227.7±158.6)mIU·-1·h].But HOMA-IR in Bartter group were similar to APA group( 1.96 ± 1.14 vs 1.41 ± 0. 91 ), and HOMA-IR in APA group was lower than IHA group ( 1.96 ± 1.14 vs 2.40 ± 1.60, P ＜ 0. 05 ). There was no deference in HOMA-IS among three groups,but APA group had lower level. In all three groups, the peak of insulin secretion was delayed. Conclusion Bartter syndrome patients commonly present with hyperinsulinemia.

Objective:To investigate the effect of pulmonary vascular dysfunction in the prognosis of patients with acute lung injury (ALI).Methods:Patients with ALI who underwent pulmonary artery catheterization in the department of critical care medicine of Wuhan NO.1 Hospital from June 2017 to June 2019 were enrolled. The general information, clinical and hemodynamic indexes [central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), pulmonary artery systolic pressure (sPAP), pulmonary artery diastolic pressure (dPAP), mean pulmonary artery pressure (mPAP), cardiac index (CI)], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, arterial blood gas parameters [pH, partial pressure of oxygen (PO 2), partial pressure of carbon dioxide (PCO 2), oxygenation index (PaO 2/FiO 2)], whether there was shock or not; ventilator parameters [platform pressure (Plat), positive end-expiratory pressure (PEEP)], etc. were recorded. Pulmonary artery oxygen saturation, pulmonary vascular function indexes [transpulmonary potential gradient (TPG) and pulmonary vascular resistance index (PVRi)] were calculated. The relationship between TPG, PVRi and mechanical ventilation time, the length of intensive care unit (ICU) stay, cardiovascular days and 60-day mortality were analyzed in patients with different prognosis of 60-day and whether the TPG increased (≥12 mmHg was defined as elevated TPG, 1 mmHg = 0.133 kPa). Results:A total of 65 patients were included in the study, including 30 males and 35 females; aged (48.9±15.2) years old. Forty-eight cases survived in 60-days, 17 died, and the 60-day mortality was 26.2%. At the baseline, there were no significant differences in cardiopulmonary function measurements, such as CVP, sPAP, dPAP, PAWP, CI, etc. between the two groups of patients with different prognosis. The APACHEⅡ score, shock ratio, TPG and PVRi of the death group were significant higher than those of the survival group [APACHEⅡ: 34±9 vs. 28±11, shock: 52.9% vs. 25.0%, TPG (mmHg): 16.2±1.9 vs. 14.6±2.1, PVRi (kPa·s·L -1): 31.8±4.2 vs. 29.7±3.5, all P < 0.05]. The 60-day mortality of 47 patients with TPG ≥ 12 mmHg was significantly higher than that of 18 patients with TPG < 12 mmHg (34.0% vs. 5.6%), and the mechanical ventilation time and the length of ICU stay were also significantly longer (days: 17±9 vs. 11±8, 16±5 vs. 12±5), and the cardiovascular days also increased significantly (days: 23±7 vs. 18±6), and the differences were statistically significant (all P < 0.05). Pearson correlation analysis showed that PVRi was significantly correlated with mechanical ventilation time, the length of ICU stay and cardiovascular days ( r1 = 0.317, P1 = 0.030; r2 = 0.277, P2 = 0.005; r3 = 0.285, P3 = 0.002). In the individual multivariate Logistic regression model, the highest PVRi was an independent risk factor for the 60-day mortality [odds ratio ( OR) = 30.5, 95% confidence interval was 20.4-43.1, P = 0.023]. Conclusion:Pulmonary vascular dysfunction is common in ALI patients and is independently associated with adverse outcomes.

Objective To study the clinical efficacy of Bikini incision minimally invasive total hip arthroplasty on elder patients with femoral head necrosis and its effect on bleeding.Methods Seventy-six elder patients with femoral head necrosis in Sanmenxia Central Hospital from January 2015 to December 2016 were randomly divided into the study group(38 cases)and the control group(38 cases).The patients in the study group were treated with Bikini incision minimally invasive total hip arthroplasty by anterior approach,while the control group underwent total hip arthroplasty by anterolateral approach.Harris score and WOMAC score were used to evaluate the clinical function of hip joint.The operation time,length of incision,intraoperative blood loss, blood transfusion,hospitalization time,hemoglobin level at 72 h after surgery,the first ambulation time,the lower limb length discrepancy,postoperative complication were recorded and compared between two groups.Results The Harris scores at 1,2,4 months after operation in the two groups were significantly improved(P<0.05), while WOMAC scores of patients at 1,2,4 months after operation were significantly lower than those before treatment(P<0.05).However,there were no significant differences at different time between the groups(P>0.05).The hospitalization time and the first ambulation time in the study group were significantly shorter than those in the control group((6.1±2.8)d vs.(7.9±3.2)d,P=0.011;(5.3±1.5)d vs.(6.4±1.7)d,P=0.004).After 4 months of treatment,the lower limb length discrepancy in the study group was less than that of the control group((6.5 ± 2.3)mm vs.(10.4 ± 3.5)mm,P<0.01).In addition,there were no significant differences between two groups in the operation time,length of incision,complication occurrence,intraoperative blood loss and blood transfusion(P>0.05).Conclusion Treating femoral head necrosis with Bikini incision minimally invasive total hip arthroplasty can achieve favorable effectiveness,with no increase in intraoperative blood loss and rapid recovery of postoperative joint function,but further follow-up is needed.