This paper summarizes the systematic management of artificial airway for 36 postoperative patients with laryngeal cancers. A full-time nurse is responsible for the systematic artificial airway management to implement respiratory care,endotracheal tube care,infection prevention and control,nutritional support and health education. As a result,the incidence of fever,frequent cough,and bloody sputum was 2.12%. Pharyngeal fistula and pulmonary infection occurred in one patient,respectively. All the patients recovered well after intensive care. It is suggested that systematic artificial airway management can effectively reduce complications,improve the quality of nursing and increase patient satisfaction.

Objective To explore the pit patterns of mucosal atrophy, intestinal metaplasia, dysplasia of gastric mucosa and early gastric cancer by magnifying chromoendoscopy. Methods The pit patterns of gastric mucosa of 594 patients with gastrosia were observed with electronic magnifying endoscopy (Olympus GIF Q-240Z) assisted with methylene blue staining. Biopsies were taken from suspicious sites as observed after magnification for histopathologic examination. Results The diagnostic sensitivity, specificity and accuracy of magnifying chromoendoscopy for mucosal atrophy were 74.6%, 90.4% and 84.1%, respectively. In the central part of mild atrophic areas gastric pits were found to be decreased in quantity or even disappeared, while in severe atrophic area, scar-like changes were seen due to the disappearance of pits, with elongation and tortuosity of surrounding. Mucosa with intestinal metaplasia was lightly stained by methylene blue, and pit patterns appeared as villi, scars or coarse lines. Mucosa of dysplasia or early gastric cancer was heavily stained by methylene blue, and gastric pits were amorphous and irregular in size. Conclusion Gastric mucosal atrophy, intestinal metaplasia, dysplasia and early gastric cancer have their peculiar pit patterns, and magnifying chomoendoscopy may be useful in the diagnosis of these lesions.

Objective The aim of this study was to reveal the clinical features of colorectal polyps by investigating its endoscopic features using a magnifying videoscope. Methods One hundred and five colorectal polyps presented in colonoscopy were included in this study. A magnifying videoscope with a zoom ranging from ? 1 to ? 100 magnification combined with indigocarmine dye was employed to observe the pit pattern of colorectal polyps. Pit pattern was analyzed according to Kudo' s modified classification as follows; (1) type Ⅰ ; round pit; (2) type Ⅱ; asteroid; (3) type Ⅳs; tubular or round pit, which is smaller than the normal pit (type Ⅰ ) ; (4) type ⅢL: tubular or round pit, which is larger than the normal pit (type Ⅰ ) ; (5 ) type Ⅳ : dendritic or gyrus - like pit; ( 6 ) type Ⅴ : irregular or amorphous pit; and ( 7 ) mixed type. Types Ⅰ and Ⅱ represented the pit pattern of nonneoplastic polyps and types Ⅲ L , Ⅲs, Ⅳ , Ⅴ , and mixed type represented the adenomatous polyps represented neoplastic polyps. Results In all samples of polyps, 17 were of the pedunculated type, 40 subpedunculated type and 48 sessile type. Among the 17 pe-dunculated type, 12 were type Ⅰ ,Ⅱ pit pattern. In those subpedunculated types, type Ⅰ , Ⅱ pit pattern were found in 15. 0% (6/40) , type ⅢL , Ⅲs , Ⅳ, and Ⅴ were detected in 85. 0% (34/40) . Type Ⅰ ,Ⅱ pit pattern were found in 41. 7% (20/48), type Ⅰ,ⅢL, ⅢS, Ⅳ, and V were in 58.3% (28/48) in sessile type. Of all polyps 88 (83. 8% ) were situated between the splenic flexure and rectum , but'no correlation was found between pit pattern and location of polyps. The incidences of neoplastic changes in the lesions with pit pattern Ⅰ,Ⅱ ,ⅢL, Ⅲs,Ⅳ, Ⅴ , and mixed type were 0% , 11. 8% , 77. 3% , 75. 0% , 100. 0% , 100. 0% , and 70. 0% , respectively. The diagnostic sensitivity of neoplastic and nonneoplastic polyps were 96. 7% and 80. 0% , and specificity were 86. 6% and 94. 7% . The overall diagnostic accuracy in differentiating neoplastic from nonneoplastic polyps was 89. 5% . Conclusions The pit pattern analysis of colorectal polyps by magnifying colonoscopy combined with indigocarmine staining is a useful and objective tool fur differentiating nonneoplastic lesions from adenomas or invasive carcinoma of the large bowel. There-fore it may be possible to determine, at the lime of colonoscopy, which lesions require treatment or not, and which one should be removed by endoacopy, or by surgery.

Objective The effectiveness on the enrichment of nuclear red blood cells(NRBC) in umbilical cord blood by polyvinylidene difluoride membrane was investigated with intervention on membrane ionic channels.Methods NRBC was isolated by the isolation solution with a density of 1.067 g/ml.The rates of the cell enrichment using verapamil and furosemide intervention by discontinuous density centrifugation were examined by flow cytometry.The NRBC that past through PVDF membrane with pore size of 5 ?m were checked and quantified by nested-PCR.Results The optimal centrifugation density was 1.067 g/ml.The mean purity of NRBC after centrifugation was 2.54%,yet the purity after intervention increased to 9.36%(3.7-fold increment).The NRBC passing through PVDF membrane was from 0.83% to 6.15%,with enrichment of 7.4 times.When NRBC was 120 cells/ml,the density of the nested PCR products increased by nearly 4 times after intervention(4.48 vs 17.78).Conclusions Verapamil and furosemide could affect the morphology of cells and promote the rate of NRBC enrichment.

Objective:To discuss the effect of individualized physical exercise prescription on patients’ nutrition status, physical ability and self-care ability in patients with intestinal fistula and severe malnutrition. Methods:Twenty-four patients were divided randomly into two groups, the experiment group exercised according to physical exercise prescription, control group exercised in a routine way. The patients’ weight, physical ability and self-care ability were measured on the day before exercise and the 28th day after exercise. Results:Patients in the exercise group had significant more exercise than those in the routine group, and the physical ability and self-care ability were significant better that those in the routine group. Conclusion:Individualized physical exercise prescription can accelerate the recovery of physical ability and self-care ability, it can be used safely and effectively in patients with intestinal fistula and severe malnutrition.

OBJECTIVE To explore the interventions for ventilator-associated pneumonia(VAP) caused by Acinetobacter baumannii by making investigation to the ICU patients on ventilators.METHODS Bacteria culture of bronchial discharge of patients on ventilators was conducted and followed by causation analysis of VAP caused by A.baumannii.RESULTS The prevalence of VAP caused by A.baumannii was 8.7%.The main reasons for VAP caused by A.baumannii were inappropriate use of antibiotics,long duration of mechanical assisted ventilation,contaminated ventilator and its accessories,unable to perform proper aseptic technique,and severity of the underlying illness.CONCLUSIONS For patients on ventilator,effective nursing interventions and sterilization and isolation techniques can reduce the infection and promote the treatment effects.

Objective To evaluate the diagnostic value of Endoscopic ultrasonography(EUS) and endoscopic therapies in gastrointestinal submucosal tumors under the guidance of EUS.Methods Patients underwent endoscopy for dyspepsia at our unit. Two hundred and thirty eight patients were found to have a presumed submucosal tumor(SMT) and all subjected to Endoscopic ultrasonography(EUS). Endoscopic therapy including endoscopic mucosal resecation(EMR), endoscopic mucosa strip removal(EMSR), snare cauterization,sclerotherapy or surgery operation had been taken according to the different deriving layers of submucosal tumors. The ultimate diagnosis was confirmed by histology.Results Seventy three stromal tumors derived from muscularis mucosa,7 carcinoid in mucosa propiria; 6 cysts, 13 lipomas, 17 etopic pancreases in stomach and 5 varices in gastric fundus derived from submucosa; 95 benign stromal tumors and 21 malignent stromal tumors derived from muscularis propria,1 carcinoid invaded muscularis propria. 61 benign stromal tumors derived from muscularis mucosa , 8 benign stromal tumors derive from muscularis propria, 8 lipomas, 4 cysts, 8 etopic pancreases and 7 carcinoids were resected by endoscopy; 33 benign stromal tumors from muscularis propria, 18 malignent stromal tumors, 2 lipoma and 2 etopic pancrease,1 carcinoid were resected surgically. Submucosal tumors 97.97% diagnosed by EUS were identified by pathology.Conclusion Different layers of gastrointestinal tract with submucosal tumors can be distinguished clearly by EUS, leading to definite diagnosis of submucosal tumors. EUS is important in selecting treatment procedures of submucosal gastrointestinal tumors and should routinely be performed on all presumptive submucosal tumors prior to attempt at removal.

Objective To compare the real time diagnosis and treatment values of magnifying endoscopy and electronic colonoscopy Methods A total of 105 colorectal polyps for colonoscopic examination were included in this study A magnifying videoscope with zoom ranges from ?1 to ?100 magnification and a common electronic endoscopy combined with indigocarmine dye were employed to observe the pit patterns of colorectal polyps Pit patterns were analyzed according to Kudo's modified classification as follows: ①type Ⅰ: round pit; ②type Ⅱ: asteroid pit; ③type Ⅲs: tubular or round pit, which is smaller than a normal pit (type Ⅰ); ④type ⅢL: tubular or round pit, which is larger than a normal pit (type Ⅰ); ⑤type Ⅳ: dendritic or gyrus like pit; ⑥type Ⅴ: irregular or amorphous pit; and ⑦ mixed type Results Magnifying colonoscopy revealed that phenotypes of non neoplastic and neoplastic lesions were 78 57% and 21 43% in inflammatory and hyperplastic polyps, 3 33% and 96 67% in neoplastic polyps, and 100% non neoplastic phenotype in juvenile polyps, respectively Pit pattern analysis according to Kudo's modified classification showed that the diagnostic sensitivity of neoplastic and non neoplastic lesions was 96 67% and 80%, and specificity was 86 57% and 94 73%, respectively The overall diagnostic accuracy in differentiating neoplastic from non neoplastic lesions was 89 52% Pit pattern by common electronic colonoscopy showed that the diagnostic sensitivity of neoplastic and non neoplastic lesions was 88 3% and 73 3%, and specificity was 81 5% and 82 5%, respectively The overall diagnostic accuracy in differentiating neoplastic from non neoplastic lesions was 82% Conclusion The pit pattern analysis of colorectal lesions by magnifying colonoscopy or electronic endoscopy combined with indigocarmine dye is a useful method for the identification of non neoplastic polyps, adenomas and invasive carcinomas in the large bowel Therefore, it may be possible to determine, at the time of colonoscopy, which lesions should be removed endoscopically and surgically

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 endoscopic and ultrasonic endoscopic features of colorectal carcinoid and the indications of endoscopic treatment. Methods The clinical data of 22 patients with colorectal carcinoid who had been admitted to our hospital from 2002 to 2007 were collected. The endoscopic and ultrasonic endoscopic features and the relationship between the features and invasion depth of colorectal carcinoid were analyzed. Results Under the endoscope, early carcinoid presented submucosa tumor with 1.5cm in diameter, and yellow or white smooth surface; advanced carcinoid presented submucosa tumor with 0.8-3.0cm in diameter, and yellow or white little nodus or ulcerative surface. The ultrasonic endoscopic feature of the colorectal carcinoid was orbicular-ovate low level echo tumor with punctiform slightly high-level echo and an unsharpness edge. Sixteen mucosal layer-cancers and submucosal layer-cancers were removed by endoscopic mucosal resection, and 10 of them were additional treated by argon plasma coagulation. After a follow-up period of 4-36 months, no recurrence was observed. Conclusions Endoscopy and endoscopic ultrasonography are effective methods to diagnose colorectal carcinoid and its invasion depth. Endoscopic treatment is a simple, safe and effective means to treat the early colorectal carcinoid tumors.