This article selects chronic disease management research of academic literatures published in the national library in PubMed database from January 2000 to December 2013.Literature Bicomb co-occurrence analysis system was used for data extraction,analysis on the current international research achievements of chronic disease management,development situation and existing problems,reveal the research trend of chronic disease management and the status quo,which provided reference for the similar domestic research.

Objective To evaluate the clinical effect of cluster nursing measures and conventional nursing measures to prevent the ventilator associated pneumonia.Methods The domestic related literatures were searched using computer,and the results underwent comprehensive analysis according to RevMan 5.2 in the Cochrane collaboration.The quantitative comparison of two different nursing measures in reducing the incidence of ventilator associated pneumonia was conducted.Results A total of 23 articles which contained 6 146 patients met the inclusion standard.Due to heterogeneity between the included studies,the random effects model analysis was adopted to merge the RR combined (Total)=0.46,95％ CI(0.38,0.56),showed that cluster of nursing measures to significantly reduce the incidence of ventilator associated pneumonia.Conclusions The effect of cluster nursing measures for ventilator associated pneumonia prevention is superior to the conventional nursing measures,which should vigorously be advocated in clinic.

Application of virtual experiment in the pathophysiology experimental teaching brings more vividness and interest,increases students'activities to complete experiments just like being in a real laboratory.it also relieves the contradiction between teaching requirements and experimental conditions effectiveIy,and take a new learning style to students and promote the changes of teachers'teaching model and teaching idea.

The shoulder joint is the largest joint of range of motion in the human body,but the stability is relatively low.Ath-letes and soldiers who engage in the high strength training are prone to shoulder joint instability, while Bankart lesion is the common factor which leads to shoulder joint instability.With the invention of the new medical devices and updating therapeutic method, the treatment of Bankart lesions is improved continuously.In this paper, we will review the key points of diagnosis and therapeutic method.

BACKGROUND:Different local anesthetic solutions for tumescent liposuction are necessary and have a certain effect on the biological characteristics of human adipose stem cels.
OBJECTIVE:To explore the effect of different tumescent local anesthesia on the proliferation and differentiation of human adipose stem cels culturedin vitro.
METHODS: Passage 3 human adipose stem cels were intervened by different tumescent local anesthesia (bupivacaine, ropivacaine, lidocaine). Cels cultured in low-glucose DMEM served as controls. Proliferation ability, lactate dehydrogenase activity in the supernatant and percentage of cels under adipogenic differentiation were detected.
RESULTS AND CONCLUSION:After intervention for 1, 2, 3, 4, 5 days, the supernatant lactate dehydrogenase activity in the bupivacaine, ropivacaine, lidocaine groups was significantly higher than that in the control group (P < 0.05), and moreover, the lactate dehydrogenase activity in the bupivacaine group was significantly higher than that in the ropivacaine group and lidocaine group (P < 0.05). The absorbance value of human adipose stem cels was lower in the bupivacaine, ropivacaine, lidocaine groups than the control group (P < 0.05) as wel as lower in the bupivacaine group than the ropivacaine and lidocaine groups (P < 0.05). There was no significant difference in the percentage of cels under adipogenic differentiation between groups (P > 0.05). Overal, these findings indicate that different tumescent local anesthesia (bupivacaine, ropivacaine, lidocaine) can al inhibit the proliferation of human adipose stem cels, but have no certain effects on the adipogenic differentiation.

Objective To evaluate the clinical effect of different oral care solution.Methods Literature data were collected by computer retrieval covering China National Knowledge Infrastructure (CNKI),China Biology Medicine (CBI) and Wanfang database,and Note Express and Addis software were used to evaluate the randomized controlled trials of literature.Results 19 separate randomized controlled trials were included in the research hterature;Network Meta analysis results showed that in the prevention of ventilator-associated pneumonia,the electrolyzed oxidizing water,compound chlothexidine,hydrogen peroxide,sodium bicarbonate,distilled water and 0.9％ saline had statistically significant difference (OR=0.25,95％CI=0.02-0.72),and the effect of sodium bicarbonate was better than the other oral care solutions;in the prevention of oral odor,the oral care solution had no significant difference (OR=0.86,95％CI=0.34-1.74),and sodium bicarbonate of the total ranked the best preventive effect;in the prevention of oral infection,the oral care solution had no significant difference (OR=0.62,95％CI=0.09-1.60).Conclusions Based on the meta analysis results,with 0.9％ saline for common interventions,sodium bicarbonate oral nursing liquid is superior to other oral nursing liquid in the prevention of ventilator-associated pneumonia,oral smell and infection.

Objective To assess systematically the effect of problem-based learning (PBL) versus traditional methods in nursing students.Methods Relative literature was searched by computer at home and abroad.according to the inclusion and the exclusion criteria,which were analyzed by RevMan5.2 software,and literature selection and repetition were used according to the Note Express software.Results A total of 9 studies of randomized controlled or not randomized controlled trial were brought into the study by random effects model.A total of 1 187 were collected into the study,574 in the experimental group and 613 in the control group.According to subgroup analysis showed by measurement scale,problem-based learning (PBL) can significantly improve the critical thinking ability of nursing students.The results had high stability and reliability.Conclusions PBL teaching method can significantly improve the critical thinking ability of nursing students,and provide a better learning method for clinical teachers and students,which is worthy of further promotion.

Objective To investigate preanalytical and intraindividual biological variations of 19 biochemistry analytes. Methods For the study of preanalytical variations, 10 consecutive blood specimens were taken from each of 21 individuals and the specimens were taken from different arms and with various evacuated blood tubes and venous occlusion durations and processed with different storages before and after centrifugal separation of serum. Another 3 aliquots of blood, each at an interval of 1 week, were taken from the individuals for the study of intraindividual biological variations. All the serum samples were analyzed in duplicate for 19 biochemistry analytes. Analysis of variance was performed on the results for the estimation of preanalytical and biological variations. Results Various preanalytical treatments or factors caused some systematic variations but random specimen errors were the main contributors of preanalytical variations. Chloride, sodium and calcium showed preanalytical variations of less than 1% and other analytes ranging from 1%-7%. Different analytes showed varied intraindividual biological variations. The least biological variations ( <2% ) were observed on chloride, sodium and calcium and the largest ( >20% ) on bilirubin,triglycerides, alanine aminotransferase and creafine kinase. Conclusions Preanalytical variations under laboratory settings in China and intraindividual biological variations in Chinese for 19 biochemistry analytes have been estimated. These data will be useful in the estimation of measurement uncertainty and the interpretation of clinical laboratory results.

Objective To investigate the expression of inflanmatory cytokines such as interlukin-1β (IL-1 β),interlukin-6 (IL-6),tumor necrosis factor-α (TNF-α) and intercelluar adhesion molecule-1 (ICAM-1),and explore their relationships with neuronal function score after fluid percussion brain injury in rats.Methods The experimental models were established in 48 adult rats.The water content of edematous brain and the expression of IL-Iβ,IL-6,TNF-α and ICAM-1 were measured with dry-wet measure,immunohistochemistry at 6 h,12 h,24 h,3 d,7 d after operation respectively.Results Compared with animals of shame operation (SO) group,neuronal function score decreased in TBI group from 6h (3.78±0.84),reached to the lowest level at 24h (2.65±0.32),and gradually increased at 3d (4.75±0.71).IL-6,IL-1β,TNF-α and ICAM-limmunoreactive expression increased from 6h,reached its maxmum at 24h,lasted to 3th day,and began to decrease at 7d.The linear regression analysis indicated that expression of IL-1β,IL-6,TNF-α and ICAM-1 had negative correlations with change of neuronal function score(r=-0.912,r=-0.892,r=-0.794,r=-0.887 respectively,P＜0.05).Conclusion IL-6,IL-1β,TNF-α and ICAM-1 expression is upregulated following fluid percussion injury in rats,and shows negative correlations with neuronal function score.The possible mechanisms is that inflammatory cytokines are involved in nerve function impairment by inducing secondary brain injury.

Objective To analyze of internal strength in patients with chronic disease,make clear the concept development,property,prerequisites,outcome and evaluation index of internal force.Methods To retrieve the relevant research literature in the knowledge service platform of Pubmed,PsycINFO and Chinese CNKI,Wanfang data,using the Rodgers analysis method to analyze the evolution of the concept of internal force.Results The molding process of internal strength of patients with chronic diseases included 4 defining characteristics:self concept,support,development and transcendence.Conclusions Rodgers evolution concept analysis method can help medical workers make clear concept essence of internal strength,deepening their cognition and understanding,so as to provide the basis for the implementation of the related research and clinical interventions.