The rapidly aging society gives rise to sizable demands for chronic disease nursing care. With IT development as backup, the hospital has developed a platform for regional collaborative nursing informationization within a medical alliance and a health management platform for home care of the elderlies. This practice can build an extended nursing care model, featuring the three main service lines of " hospital-family, hospital-medical alliance and hospital-community hospital-family". The model provides diversified, personalized, disease specific, informationization and multi-disciplinary coverage for nursing care, providing the primary level with high quality nursing resources.Medical alliances and corresponding communities share information, for a full-range, full region and full timeframe coverage of nursing health supervision and scientific guidance, thus effectively minimizing the rate of revisit to upper-level hospitals by patients and implementing the hierarchical medical system.

Objective:To evaluate the clinical application value of gastrointestinal contrast-enhanced ultrasound combined gas injection method in verifying the location of nasointestinal tube in critically ill patients.Methods:Data of 60 critically ill patients who had the indications of indwelling nasointestinal tube were collected from September 1,2015 to September 1,2016 in the Intensive Care Unit of Zhejiang Provincial People(s) Hospital.The position of nasointestinal tube in patients who underwent bedside blind insertion would be confirmed routinely through gas injection auscultation method.After tube was inserted,its route was scanned by ultrasound with gas perfusion assistance.Afterwards,rapid gas perfusion was used until suspicious tube end position was determined.Furthermore,oral ultrasound contrast agent was injected into the tube if instantaneous strong echo of gas was observed in localized lumen,and contrast agent filling meant the placement being successful.Two methods of position confirmation of nasointestinal tube in critically ill patients included gastrointestinal contrast enhanced ultrasound combined gas injection and gas injection auscultation only,and the effect of the two methods was compared and confirmed by chest and abdominal X ray examinations to verify the location of nasointestinal tube below pylorus.Results:A total of 60 patients were included in this study,58 patients(96.7％)in gastrointestinal contrast enhanced ultrasound combined gas injection group were successfully positioned.Among them,the placements of tube in 56 cases were below pylorus,while 2 cases were above pylorus.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of location of gastrointestinal contrast enhanced ultrasound combined gas injection method were 96.6％,100％,100％,50％,96.7％ and of gas injection auscultation method were 74.1％,50％,97.7％,6.3％ and 73.3％.The differences of the sensitivity,specificity,negative predictive value and accuracy between the two methods were statistically significant (P ＜ 0.05).Conclusion:Gastrointestinal contrastenhanced ultrasound combined gas injection method is a safe,simple and convenient method with high sen-sitivity,specificity,negative predictive value and accuracy in confirming the location of the nasointestinal tube.

Objective To study the change rules with age in morphologic properties of common carotid artery,and to discuss its aging process after kidney transplantation.Methods Thirty-one patients with end stage renal disease (ESRD) supported by hemodialysis,31 kidney transplant recipients (KTR) and 84 control subjects were offered an ultrasound of carotid artery.The carotid intima media thickness (CIMT) and common carotid artery diameter (CCAD) of right carotid arteries were measured by ultrasonic frequency tracking.The tends for slope of CIMT and CCAD with age were analyzed by linear regression analysis.Results Compared with KTR group and control group,ESRD group had significantly thicker CIMT and wider CCAD,but there was no significant difference between KTR group and control group.The linear regression showed the development of CIMT were positively associated with age (P＜0.05).Compared with KTR group and ESRD group respectively,the slope of CIMT with age (unstandardized coefficients b) in control group was greater (Z=1.417,P =0.006;Z =2.223,P＜0.001).There was no significant difference between KTR group and ESRD group (Z =1.038,P =0.723).The development of CCAD were also positively associated with age (P＜0.05).Compared with control group,the slope of CCAD with age in ESRD group was less (Z =1.677,P =0.002).Conclusions After successful kidney transplantation,some morphologic properties of carotid artery are improved and resume the normal aging process.

Objective To analyze the relation between carotid intima-media thickness (IMT) and the shear rate (SR),and to explore the effect of SR on IMT in the patients with end-stage renal disease (ESRD)and the kidney transplant recipients (KTR).Methods From March 2014 to December 2015,31 KTR and 31 patients with ESRD supported by hemodialysis and 84 control subjects underwent an carotid ultrasound in Shanghai General Hospital affiliated to Shanghai Jiaotong University.Bilateral carotid IMT and SR were measured.The differences of IMT and SR in three groups were compared by single factor analysis of variance.SNK-q test was used to compare the two groups.The correlation between SR and bilateral IMT was analyzed by linear regression analysis in healthy control group,ESRD group and KTR group.Results On the right,in ESRD,KTR and control group,the IMTs were (561.9± 147.7) μm,(480.5±90.3) μtm and (529.7±131.80) μtm respectively.Compared with KTR and control group,the IMT on right was thickest in ESRD,but there was no significant difference between KTR and control group in right IMT.On the left,the IMTs were (517.5± 164.7) μm,(506.7± 126.3) μm and (467.0± 106.4) μm in control group,ESRD and KTR,respectively.Among groups,there was no significant difference.On the right,the SRs were (134.01 ±56.4) s-1,(133.4±43.7) s-1 and (175.8±68.3) s-1 in ESRD,KTR and control group,respectively.In ESRD and KTR groups,the SR of the right carotid artery was less than that of the control group,and had significant difference (q=3.133,P=0.002;q=3.470,P ＜ 0.001).There was no significant difference in right SR between ESRD and KTR.On the left,the SRs were (146.3±55.9) s-1,(138.5±43.8) s-1 and (154.7±60.8) s-1 in ESRD,KTR and control group,respectively,and had no significant difference.There was linear negative correlation between SR and IMT in healthy control group,ESRD group and KTR group,respectively (right:r=-0.384,-0.082,-0.454;left:r=-0.572,0.223,-0.276,all P ＜ 0.05).Conclusions The IMT was thickened in ESRD group,but got thinning after successful kidney transplantation.The SR played a vital role in this alteration of IMT.

Blistering cupping is special as eliminating wind and dampness as well as removing phlegm and blood stasis, and it achieves effects through suction. In this paper we reviewed relevant literature combined with clinical experience so as to summarize its operation attention through exploring the origin, mechanism and application. We divide the progress into the blistering period, the phlegm-stasis-eliminating period, and the escharosis period according to the changes of bubble and the things pulled out. Blistering cupping creates ways to eliminate concrete unhealthy influences through smoothing meridians and collaterals, such as phlegm and retained fluid, dampness and blood stasis. Thus chronic diseases are relieved. Also,we propose the rules of "blistering acupoints being related to disease location as well as the nature of acupoints and diseases". The therapy has been used to treat diseases of respiratory system, osteoarticular, skin and subcutaneous tissue, mental and behavioral disorders, and tumor, among which the effects of intractable diseases of respiratory and osteoarticular systems are definite. It deserves to be further explored and promoted.

Objective To explore and set up the nurse post ability of the leveling exam plan in a third-grade class-A hospital.Methods The entry of more than one year of nurses will participate in the examination of N1-N4 is divided into four levels.According to different levels to set up the post ability of the leveling exam plan,through the review and interview,evaluate its effects and satisfaction in a third-grade class-A hospital.Results After the post ability of the leveling exam plan,nurses of different levels get more satisfied with the score on the assessment form,specialized knowledge,the core system,emergency plan,communication skills,ability of operation and emergency disposal,which significantly higher than the traditional methods,there were statistical differences between two groups.(t value was as follows:1.46,2.13,1.98,2.57,2.69,1.87,P ＜ 0.05),but the difference of foundation knowledge was not obvious (P ＞ 0.05).The new program get higher scores of nurses in critical thinking,clinical care,ethical,legal practice and professional ability,results were significant differences (t value was as follows:2.18,2.01,1.46,2.78,P＜ 0.05),but the scores in scientific research ability,leadership,interpersonal relationship,education and consulting capacity was not significantly different (P ＞ 0.05).Conclusion It is concluded that nurses of different levels on the leveling exam plan get a higher satisfaction.Through the new program,to assess the level of nurses,effectively improve the capacity on critical thinking,clinical nursing,ethical standards,law practice and professional development.

Objective To observe the effect of small doses of dexmedetomidine on postoperative analgesia and comfort after colorectal cancer radical operation in elderly patients .Methods 60 cases of elderly patients for elective colorectal cancer resection ,ASAⅠ~Ⅱgrade anesthesia were selected .According to randomly digital table , they were divided into the dexmedetomidine given group ( group D) and control group ( group C),30 cases in each group.The patients of group D was given to 0.5μg/kg dexmedetomidine for induction of anesthesia infusion , 15minutes bolus injection was completed ,intraoperative maintain 0.2μg· kg-1 · h-1 dexmedetomidine fixed to the front end of surgery 10 min.And group C was given to infusion of 0.9%sodium chloride injection in the same capacity . The operation time, amount of fentanyl using , comfort and VAS scores were recorded within 24h, maintain VAS score≤3 points.When VAS score>3 points,the pressing PCA was given ,and the number of times of pressing the PCIA was recorded.The adverse reactions occurred within 24h such as nausea and vomiting were also recorded . Results In the two groups,the results of postoperative analgesia were good ,but the VAS score of group D at each time of PCA point were less than those of group C (tend of surgery =5.99,tafter operation 2h =4.76,tafter operation 4h =4.08,all P<0.01).The Bruggrmann comfort score of group D were greater than those of group C (tend of surgery =9.86,tafter operation 2h =4.91,tafter operation 4h =6.84,all P<0.01).The incidence of adverse reactions of group D was 13.30%,which was less than 26.67%of group C(χ2 =4.32,P<0.05).Conclusion Small doses of dexmedetomidine given to improve the analgesic effect in elderly patients with colorectal cancer cure can improve comfort and reduce the incidence of adverse reactions ,and has a role in reducing postoperative nausea and vomiting .

Objective To investigate the effect of sevoflurane on adriamycin-induced damage to primary neonatal rat cardiomyocytes.Methods Primary neonatal rat cardiomyocytes were isolated from Sprague-Dawley rats (within 24 h after birth) and cultured in DMEM liquid culture medium.The cells were seeded in 96-well plates (200μl/hole) or 6-well plates (2 ml/hole) with a density of 5 × 104/ml and randomly divided into 4 groups (n =24 each):control group (group C),adriamycin group (group A),sevoflurane group (group S) and adriamycin + sevoflurane group (group AS).In groups A and AS,adriamycin 1 μmol/L was added to the cultured medium,the equal volume of PBS was added instead in groups C and S,and the cells were then incubated for 24 h.The cells were exposed to 2.4％ sevoflurane for 2 h starting from 24 h of incubation in groups A and AS.The cell viability,concentrations of cTnI and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the culture medium,and expression of Bax and Bcl-2 were detected 2 h after the end of exposure to sevoflurane.The Bax/Bcl-2 ratio was calculated.Results Compared with group C,the cell viability and expression of Bcl-2 were significantly decreased,while the concentrations of cTnI and NT-proBNP in the culture medium,expression of Bax and Bax/Bcl-2 ratio were significantly increased in group A,and the cell viability was decreased in group AS (P ＜ 0.05).The expression of Bcl-2 was significantly higher and the concentrations of cTnI and NT-proBNP in the culture medium,expression of Bax and Bax/Bcl-2 ratio were significantly lower in group AS than in group A (P ＜ 0.05).Conclusion Sevoflurane can reduce adriamycin-induced damage to primary neonatal rat cardiomyocytes and inhibition of cell apoptosis is involved in the mechanism.

Objective To study the pathogenesis and the effect of early drugs therapy of symptoms after concussion.Methods One-hundred and thirteen patients with symptoms after suffered concussion enrolled in the study and divided randomly into three groups.The patients of different groups were treated respectively with drugs,i.e.erigeron breviscapus,nimodipine,energy mixture.Symptom Check-List 90 ( SCL-90 ) and electroencephalogram(EEG) and cerebral blood flow of trancranial Doppler(TCD) were examined in the early and late stage of post-concussion.Normal population were recruited as control.All examination results and the effect of treatment were compared between treatment group and control group.Results In the scores of SCL-90,the factor scores of somatization symptom,compulsion,depressive disorder,anxiety disorders,and hostile symptom in 113 post-concussion patients in early stage were all higher than those in the normal( t =10.78,2.08,9.53,11.09 and 2.52,P ＜0.01or P ＜0.05),and as well as that of somatization symptom,depressive disorder,anxiety disorders,terror and mental disorder symptom in 12 post-concussion patients in late stage compared to normal( t =3.21,6.85,3.07,3.14 and 4.73,Ps ＜ 0.01 ).The test of EEG was abnormal in 57.4 ％ of patients in early stage and in 33.3％ in the late stage.Of all TCD results,67.0 ％ was abnormal in the early stage and 25.0％ in the late stage,The disappearance rate of post-concussion symptoms in the 14th day was significantly higher in the erigeron breviscapus group ( 45.0％ ) than in the nimodipine group ( 23.7％ ) ( x2 =3.91,P ＜0.05 ) and in the energy mixture group ( 20.0％ ) ( x2 =5.25,P ＜ 0.05 ).The disappearance rate of postconcussion symptoms in the 30th day in the energy mixture group(40.0％ ) was significantly lower than those in nimodipine group( 68.4％ )( x2 =5.94,P ＜ 0.05 ) and in erigeron breviscapus group( 75.0％ )( x2 =9.43,P ＜ 0.01 ).The occurrence rate of post-concussion sequelae was higher in the energy mixture group ( 22.9％ )than in the nimodipine group ( 5.2％ ) ( x2 =4.77,P ＜ 0.05 ) and in the erigeron breviscapus group (5.0％ )( x2 =5.15,P ＜ 0.05 ) three month after injuries.Conclusion The occurrence of symptoms originated from the organic damage of brain tissue.However,its changes were influenced by psychologic factors after concussion.Early vasodilative drugs therapy could improve the recovery of patients with post-concussion symptoms in time and decrease the occurrence of post-concussion sequelae.

Objective To investigate the relationships among clinical features, endoscopic characteristics and pathologic epithelial types of Barrett esophagus. Methods Magnification chromoendoscopy ( MCE) was performed in 2506 patients with gastroesophageal reflux disease ( GERD) and 106 patients with Barrett esophagus in our hospital during Feb,2003 -Feb,2004 were analyzed. The clinical features, endoscopic characteristics, pathologic epithelial types and their relationships were analyzed. Results The symptoms of gastro esophageal reflux disease ( GERD) were the main presentation of Barrett esophagus but 27 (25. 5% ) cases without such presentation. Four types of mueosal patterns, dot pattern, ridge or villous pattern and irregular/distorted pattern. were noted within the columnar mucosa using high magnification endos-copy: There were three epithelial types within the columnar lined esophagus: intestinal metaplasia (IM ) , cardiac and fundie types. Three epithelial types were noted in the methylene blue staining areas; ridged/vil-lous pattern and irregular/distorted pattern, all of them were in epithelial types of intestinal metaplasia. Conclusion Magnification chromoendoscopy helps to identify areas with IM, and having important significance in diagnosis and clinical follow up of Barrett esophagus.