Children without company of parents in pediatric intensive care unit,often irritable crying,injured,or scratching themselves,pulling in all kinds of wire and/or catheter on the body,and even adverse events,such as dropping of bed.To ensure the safety of the children,we invent a multifunctional strait-jacket,and it is applied in clinic in order to solve the above problems.The structure of this strait-jacket is open,easy to install wire and all kinds of operation;shoulder,cuff with button loops fix bed guardrail by a rope,to prevent the roll shift;cuff with double fold gloves can avoid scratch the skin,remove the line,having the effect of palm warm;waist adding two constraints,not improving constraints on the waist but abdomen to keep warm.By clinical application,this strait-jacket improves the comfort of the constraint,can prevent the occurrence of complications due to improper constraints,such as skin abrasions,physical damage,blood circulation obstacle,alleviate the pain for the children.

Objective To explore the predicting value of plasma asymmetric dimethylarginine (ADMA) in cardiac structure and function of patients with chronic kidney diseases (CKD).Methods A total of 100 CKD patients were enrolled in this cross-sectional study.According to staging of the K-DOQI guideline,CKD patients were divided into five groups.Twenty healthy people were enrolled as control.Plasma level of ADMA was determined by reversed-phase high performance liquid chromatography.Cardiac structure and function were detected by color echocardiography.Results Plasma levels (μmol/L) of ADMA in CKD stage 3 to 5 patients (1.3318±0.4684,1.5712±0.4210,2.1093±0.7714) were significantly higher than those in CKD stage 1,2 patients (0.4387±0.2575,0.4809±0.2846) and healthy control (0.4611±0.1615) (all P＜ 0.01).Meanwhile,ADMA level of CKD stage 5 was significantly higher as compared to CKD stage 3-4.The left ventricular mass index (LVMI) was significantly higher in stage 4-5 patients than that in stage 1-3 and healthy control.Plasma ADMA was positively correlated with LVMI (r=0.476,P=0.028) and negatively correlated with left ventricular ejection fraction (EF) (r=-0.327,P=0.041).Multivariate stepwise Logistic regression analysis revealed plasma ADMA level was an independent predictors for EF (OR=0.984,P＜0.01).Conclusions Plasma level of ADMA begins to increase in CKD patients of stage 3 and rises proportionally to the decline of renal function.Plasma ADMA level is useful in predicting the cardiovascular complications of CKD patients.

For the purposes of meeting the needs of COPD patients for health education, decreasing times and costs of re-hospitalization, and increasing patient satisfaction and nurses' working enthusiasm. In 2011, our hospital established a specialist nursing clinic for chronic obstructive pulmonary disease (COPD), and two nursesentitled-deputy directorswith rich clinical experiences for more than fifteen years and strong communication skills were se-lected to take charge of the clinic, and they were responsible for nursing assessment, making individualized pul-monary rehabilitation plan, health guidance, long-term follow up, etc., for discharged stable COPD patients and COPD patients with no need for hospitalization. Patient satisfaction was improved from 83% to 96% after implemen-tation.

To investigate the best intennittence and reasonable dosage of CDC pulse therapy on different activity degree of lupus nephritis (LN). Methods 96 severe LN cases were divided into three groups. Croup A; CTX pusle treatment (IV-CTX), once 2 weeks, 8- 12 mg'kg'Vd for two days; Group B: IV-CTX once a month, 0.5 - 1.0/m2; Group C: IV-CTX once 3 months, 0.5 - 1.0/m2. Prednisone was given to three groups simultaneously. Results The time taking effect was shorter significantly in Group A than that in Group B and C. Remission rate was higher significantly in Group A than that in Group B and C ( P 0. 05). Intermittence of 15 cases (23.8%) from Group Ek C was changed to once 2 weeks and then the disease activity had been controlled since these patients became worse during the treatment. Intennittence of 3 patients (9% ) from Group A was delayed a week because of the decreasing of WBC counting. There was no significantly difference between three groups in side effect and its incidence. Conclusion A reasonable IV-CTX should be choosen according to the disease activity. IV-CTX 8 - 12 mg'kg'Vd for two days, once 2 weeks should be used for acute and severe LN. When disease becomes mild, IV-CTX can be changed to 0.5 - 1.0/m2, once a month. After LN activity is controlled basically, 0.5- 1.0/m2, once a month is recommended.

Objective To observe the effect of Ulinastatin (UTI) on intestinal barrier function of elderly patients with sepsis in order to explore an optimized program of early treatment for such patients instituting a guidelines for clinical practice.Methods All selected patients randomly (ramdom number) divided into conventional treatment group (n =34) and UTI treatment group (n =34).Peripheral venous blood samples of elderly patients with sepsis were routinely taken at days 0,2,3,7 (D0,D2,D3,D7) after admission for detecting the changes of ptasma values of Intestinal fatty acid binding protein (IFABP),Diamine oxidase (DAO),and D-lactate (D-Lac).While patients' APACHE Ⅱscores,length of ICU stay and 28 d mortality also were recorded at the same time.Results At admission,there were no significant differences in patients' APACHE Ⅱscores,plasma values of IFABP,DAO and D-Lac between two groups (P ＞ 0.05).During the course of treatment,the patients' APACHE Ⅱscores,plasma values of IFABP,DAO and D-Lac were declining in both groups,while those declinations in UTI group showed significantly more prominent.Compared with conventional therapy group,IFABP level was significandy lower in UTI group (P ＜ 0.05),and the plasma values of DAO and D-Lac were significantly lower at D2 and D3 in UTI group (P ＜ 0.05),but not at D7 (P ＞ 0.05).The plasma levels of IFABP,DAO and D-Lac were positively associated with APACHE Ⅱscores,but not with length of ICU-stay (P ＞0.05).After treatment,28d mortality did not differ significantly between the two groups (P ＞0.05).Conclusions UTI has a protective effect on intestinal barrier function in elderly patients with sepsis.UTI can improve the prognosis of elderly patients with sepsis and reduce ICU stay,while has no significant effect on reducing 28 d mortality.

Objective To analyze the clinical manifestations and the features of brain MRI and cerebrospinal fluid (CSF) findings in adult Chinese patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods We reviewed the clinical manifestations,brain MRI and CSF examinations of 29 patients who were diagnosed as anti-NMDAR encephalitis.Results The major clinical features of anti-NMDAR encephalitis patients included psychiatric symptoms (86％,25/29),seizures (83％,24/29),decreased consciousness (55％,16/29),involuntary movements (55％,16/29),central hypoventilation (34％,10/29),and hypersalivation (17％,5/29).Some patients also experienced autonomic instability,hemiplegia and aphasia.Underlying ovarian teratoma was identified in 14％ of affected patients(4/29).Brain MRI was found abnormal in up to 62％ patients (18/29),located in the temporal lobes,hippocampus,thalamus,brain stem,cingulate gyrus,frontal and parietal cortex,corpus callosum,internal capsule,basal ganglia and periventricular area.CSF findings were abnormal in 83％ of patients with anti-NMDAR encephalitis.Oligoclonal banding in CSF was positive in 95％ patients (19/20).The recurrence rate during 3 years was 31％ (9/29).Conclusions Anti-NMDAR encephalitis is a treatable disease,yet with high recurrence rate.Its predominant clinical features are psychiatric symptoms and seizures,while involuntary movements,central hypoventilation and hypersalivation are its characteristic manifestations.Lesions in MRI are widespread,not only restricted to limbic lobe.

Objective To realize real-time medical insurance settlement system of Xi'an based on Outpatient One Card Solution to reduce the errors due to artificial accounting.Methods The system was developed with C# language and Oracle 10g, based on interface function dynamic library calling rule and HIS data structure requirements provided by Xi'an municipal medical insurance center.Results The system realized real-time settlement of the patient with medical insurance card.Conclusion The system simplifies medical insurance outpatient treatment flow and implements data communication.

Objective To observe the clinical efficacy of plasma exchange(PE),PE combined with plasma bilirubin absorp-tion(PE+PBA),and PE combined with double plasma molecule absorption system(PE+DPMAS),to investigate the best treat-ment options for the patients of hepatitis B-associated subacute severe.Methods Totally 140 patients who had hepatitis B-associat-ed were randomly divided into a PE group,a PE+PBA group,and a PE+DPMAS group.The dinical symptoms and blood rontine, electrolytc and the main biochemical indexes were recorded both before and after treatment and compared among the three groups. Results The total effective rate was higher in the PE +DPMAS group than in the PE group and PE+PBA group,which were 70.8%,60.9%,67.4% respectively,but there was no significant difference(P >0.05).compared with before treatment,serum total bilirubin (TBIL),alanine aminotransferase (ALT),aspartic acid amino shift enzyme (AST),valley aminoacyl transfer peptidase (GGT),alkaline phosphatase (ALP),globulin (GLB)and other biochemical indexes decreased significantly after treatment in 3 groups (P <0.001).PA was increased in the PE group and decreased in the PE+PBA and PE+DPMAS group after treatment,the differences were significant(P <0.05).After treatment,PT was shortened in the PE group,the differences were significant(P <0.05),but there were no significant difference between the PE+PBA and PE+DPMAS groups(P >0.05).Serum K+ and Cl- was obviously declined after treatment in the PE group,there was significant difference(P <0.001).Serum Na+ was obviously declined after treatment between the PE + PBA and PE + DPMAS groups (P < 0.001 ),but the difference was no significant in the PE groups.Serum Ca2+ was significantly decreased in the three groups of patients after treatment(P <0.001).WBC,Hb and PLT were significantly statistical difference after treatment(P <0.05).Conclusion The three groups also can improve liver function and the treatment rate for the patients of subacute hepatitis B-associated severe hepatitis.PE+PBA and PE+DPMAS groups can effective-ly reduce two thirds of the overall usage of the plasma.PE+DPMAS groups that the quantity of Cl- ,Ca2+ ,Hb decline much least in the three groups show larger value in the clinical application.

Objective To study the effect of computerized pressure hemostat on lower limb deep vein thrombosis in high-risk elderly patients.Methods From September to December 2013,36 orthopedic hospitalized patients who received operations were divided into the hemostat group and the non-hemostat group with 18 patients in each group.D-dimer changes and lower limb deep vein thrombosis were observed in both groups.Results D-dimer was significantly increased in both groups compared with that before operation,but the extent of elevation in the non-hemostat group was lower than that in the hemostat group.D-dimer and cases of lower limb deep vein thrombosis in the hemostat group was higher than those in the non-hemostat group after operation,which showed significant difference.Conclusions The use of computerized pressure hemostat will increase the risk of lower limb deep vein thrombosis in elderly patients,so the technical operation procedures should be strictly enforced accompany with safely use of computerized pressure hemostat.

Objective To analyze the relationship between the morphological characteristics and rotator cuff tear (RCT) by MR.Methods The data of clinic and shoulder MRI of 37 patients with RCT (patients group) were analyzed retrospectively,and 19 healthy volunteers were collected in control group.The acromial shapes were classified into type Ⅰ (flat),type Ⅱ (curved),type Ⅲ (hooked) and type Ⅳ (convex).Additional measurements about pathogenesis of RCT including acromio-humeral distance (AHD),acromial index (AI),lateral acromial angle (LAA) and acromial thickness were performed for further assessment.Results Type Ⅱ was the most commonly encountered acromial shape in patients group (16/37,43.24 ％) and control group (11/19,57.89 ％).There was no statistically significant difference in the incidence of each acromial shape between two groups (P＞0.05).However,the AHD,AI,LAA and acromial thickness showed statistically significant difference between the patients group and control group (all P＜0.05).The type Ⅲ acromion was signifi candy different from the other types in patients group (P＜0.05).Conclusion MRI can clearly display RCT.The AHD and LAA are smaller,the AI and acromial thickness are bigger in RCT patients.Type Ⅲ acromion may increase risks for RCT.