ObjectiveTo explore the causes and countermeasures for extravasation of intravenous fluids in children. Methods726 cases of intravenous infusion in pediatric surgery department from May to December 2011 in our hospital were observed. ResultsThere were 30 cases with extravasation of intravenous infusion in the 726 cases,the leakage rate was 4.13％.The specific causes of fluid extravasation included:younger age of children,not cooperating with the infusion in 18 cases,accounting for 60.00％,followed by non standardized fixation methods in 5 cases,accounting for 16.67％,and accompanying family members refused to be disturbed accounted for 13.33％,Nursing visits to owe in a timely manner accounted for 6.67％.The rate of younger age of children and lack of cooperation leading to fluid extravasation were significantly higher than other causes,the difference was statistically significant. ConclusionsChildren age,fixation method,cooperation of family members,inspections and other factors can be controlled.Along with the continuous improvement of medical standards and a variety of active and effective implementation of the measures,these factors can be controlled effectively.Strengthening the training of nurses and vocational skills to enhance their own sense of responsibility,to give standardized infusion operation and fixation,and give predictable observation and treatment,can effectively prevent the occurrence of extravasation of intravenous fluids.

Objective To investigate the serum levels of vascular endothelial growth factor(VEGF)in patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and make a primary relative study on the relationship between VEGF and pH.Methods Thirty-nine patients with mild to moderate OSAHS,36 patients with severe OSAHS and 18 healthy snorers who had been admitted to the First Hospital Affiliated to Wenzhou Medical College from Feb.2003 to Sep.2004 were enrolled in this study.The serum levels of VEGF were detected in all patients at 7:00 AM the next day after the detection of polysomnography(PSG).Additionally 31 patients with OSAHS were detected by doppler echocardiography to get the values of pulmonary artery pression.Results There was nocturnal hypoxia in patients with OSAHS compared with healthy snorers,and the degree of nocturnal hypoxia was depended with the grade of OSAHS(both achieved statistical difference)by the detection of PSG.The levels of VEGF was significantly higher in patients with severe OSAHS than in healthy snorers(P

Rotundine (1 micromol L(-1)) was incubated with a panel of rCYP enzymes (1A2, 2C9, 2C19, 2D6 and 3A4) in vitro. The remained parent drug in incubates was quantitatively analyzed by an Agilent LC-MS. CYP2C19, 3A4 and 2D6 were identified to be the isoenzymes involved in the metabolism of rotundine. The individual contributions of CYP2C19, 3A4 and 2D6 to the rotundine metabolism were assessed using the method of total normalized rate to be 31.46%, 60.37% and 8.17%, respectively. The metabolites of rotundine in incubates were screened with ESI-MS at selected ion mode, and were further identified using MS2 spectra and precise molecular mass obtained from an Agilent LC/Q-TOF-MSMS, as well as MS(n) spectra of LC-iTrap-MS(n). The predominant metabolic pathway of rotundine in rCYP incubates was O-demethylation. A total 5 metabolites were identified including 4 isomerides of mono demethylated rotundine and one di-demethylated metabolite. The results also showed that CYP2C19, 2D6 and 3A4 mediated O-demethylation of methoxyl groups at different positions of rotundine. Furthermore, the ESI-MS cleavage patterns of rotundine and its metabolites were explored by using LC/Q-TOF-MSMS and LC/iTrap-MS(n) techniques.

Objective To analyze the related factors of nursing risk in department of nephrology and to explore strategies of risk management.Methods Risk management was implemented to 39 nurses in department of nephrology of our hospital.The KAP scores,the incidence of nursing risk events,nursing complaints and patients' satisfaction degree before and after the implementation of nursing risk management were compared.Results After the implementation of nursing risk management,nurses' KAP score was significantly higher; the incidence of nursing risk events and complaints significantly reduced; patients' satisfaction degree to nursing were significantly higher compared with those before the implementation.Conclusions The implementation of nursing risk management can effectively improve the quality of nursing and reduce the incidence of nursing risk events.

Objective To establish normal reference ranges for serum cystatin C (Cys C)in relatively healthy middle-aged and elderly(＞50 years)Chinese individuals.Methods A total of 1087 candidates were consecutively selected and serum Cys-C levels were measured by transmission turbidimetry.Frequency analysis and histogram were used to establish the 95％ confidence reference range according to methods provided by CLSI (C28-A2).Results Based on the definition and verification procedures for clinical laboratory reference ranges(CLSI C28-A2,second edition),Cys-C levels of 1087 participants fell within the range of 0.30-1.55 mg/L;Male participants had higher serum Cys-C levels than female participants(Z=-10.19,P＜0.01).The serum Cys-C level increased with age,regardless of gender(R =0.600,P＜ 0.01).Differences in Cys-C levels between age groups were statistically significant (x2=411.17,P＜ 0.01).The reference ranges of normal serum Cys-C levels for different age groups (50-,55-,60-,65-,70-,75-,) were 0.42-0.98mg/L,0.45-1.04mg/L,0.47-1.34mg/L,0.46-1.38mg/L,0.61-1.33mg/L,0.61-1.28 mg/L,respectively,for males,and 0.39-0.94mg/L,0.42-1.01mg/L,0.40-0.91mg/L,0.46-1.03mg/L,0.57-1.04mg/L,0.55-1.27mg/L,respectively,for females.Conclusions This study established preliminary normal serum Cys-C reference ranges for healthy middle-aged and elderly(＞ 50 years)individuals in this region,which can serve as parameters for disease diagnosis and treatment evaluation.

Objective To study the roles of TLR2 and TLR4 in the progress of invasive pulmonary aspergillosis(IPA) in experimental mice.Methods The mice were divided into three groups including the group of normal mice,the group of normal mice infected with A.fumigatus and the group of IPA mice.The mice were sacrificed at four time points(8 h,24 h,48 h and 72 h) after infection.The lung tissues from each group were collected for pathological analysis and RT-PcR for detecting the expression level of,TLR2,TLR4 and β-tublin.The ratio of density value of band of each PCR product on electrophoresis to the density value of β-tublin was used to evaluate the expression level of each gene like TLR2.TLR4 and TNF-α.Re-suits The pathological analysis showed the normal structure and no inflananatory reaction in the lungs in the group of normal mice.The infiltration of inflammatory cells,weak injuries and no germination of spore into hypha in the lungs of normal mice infected with A.fumigatus,and serious injuries like destruction of alveolar structure,bleeding,infiltration of inflammatory cells and germination of spore into hypha in the lungs of IPA mice.The expression level of TLR4 at 8 h,24 h,48 h and TNF-α at 24 h and 48 h were lower in IPA mice than that in healthy mice with infection(P<0.05).Conclusion There was low expression of TLR4 and TNF-α in IPA mice lung tissues.Typical pathological injuries in the lungs and germination of spore into hy-pha in IPA mice were observed by the microscope.

Objective To observe characters of sputum of patients with tracheotomy by heat and moisture exchanger(HEM)undergoing hyperbaric oxygen therapy(HBOT)in multi-person chamber.Methods In randomly block design,239 patients were selected and received HBOT using HEM combined with L-shape tube(group HEM,n=128)and by L-shape tube(group L,n=111)respectively.The characters and volume of sputum,times of sucking sputum and cases of sealing/extubation of tubes were assessed over first and tenth sessions of HBOT.Results The times of sucking and volume of sputum over first session of HBOT in the group HEM were more than those in group L.The sputum was changing from ropiness over first session to tenuity over tenth sesion(P＜0.01).Cases with sealing/extubation of tubes in group HEM were more than those of group L(P＜0.01).Conclusions It is helpful to humidify and discharge deposited sputum of patients over routine hyperbaric oxygen by HEM.And the case8 of sealing/extubation of tubes are also reduced.

Objective To investigate the change of plasma marinobufagenin (MBG) level and the expression of its receptor Na+-K+-ATPase (NKA) in renal biopsy specimens of chronic glomerulonephritis (CGN) patients. Methods Twenty-eight CGN patients and 14 healthy people were enrolled in the study. The plasma MBG concentration was measured by competitive inhibition ELISA system. Immunofluorescence and immunohistochemistry staining were applied to detect the expression of NKA in renal biopsy specimens of 28 CGN patients and analyzed by semi quantitively. Results Compared with healthy controls, CGN patients had significant lower plasma MBG concentration [(0.579±0.214) nmol/L vs (0.715±0.154) nmol/L, P＜0.05], without further significant difference between CGN patients with hypertension and with normal blood pressure [(0.595±0.231) nmol/L vs (0.557±0.197) nmol/L, P＞0.05]. Meanwhile, proximal tubular staining of NKA was decreased compared with normal controls. The NKA positive staining area of the CGN group was lower than that of normal controls [2.1% (0.5%-6.2%) vs 5.6% (3.5%-10.8%), P＜0.01] and correlated with 24-hour urinary sodium excretion (r=0.551, P＜0.01).Conclusion Decreased plasma MBG level and its receptor expression on proximal tubules may play a role in the regulation of sodium in CGN.

Objective To investigate the diagnosis and treatment of aggressive fibromatosis after thyroidectomy.Methods One patient who were admitted into our hospital on January 16,2014 were discovered to have left cervical mass at the regular follow-up 8 months after opertaion.The ultrasonic examination showed that there were low echo area of 58 mm ×30 mm in the 3 ~5 muscular layer at the left neck. And it was diagnosed as aggressive fibromatosis through the puncture disease inspection.Whereafter,the patient were readmitted into hospital and recieved radical resection of the tumor on left side of the neck.The clinical,pathological and radiological data of the patient were collect-ed and analyzed so ao to discuss the diagnosis and treatment experience combined with related literatures.Results Postoperative pathologic examination confirmed that it was aggressive fibromatosis.The patient was actively cooperated with perioperative treatment,and the postoperative recovery was good with no local recurrence during the follow-up up to now.Conclusion Early diagnosis and surgical treatment are needed for patients with aggressive fibromatosis after thyroidectomy.

Human enterovirus 71 (HEV71) is a major causative agent of hand,foot and mouth disease.Children infection with HEV71 can lead to series of neurological complications including aseptic meningitis,cerebral ataxia and even fatal outcomes.During recent decades,epidemic of hand,foot and mouth disease have occurred in many countries and regions in the world,which has become a major public health problem for children's health.There are no specific antiviral drugs for HEV71 infection,so it is necessary to develop safe and effective vaccine.In recent years,the research on HEV71 vaccine has made a breakthrough,and this article reviews the research progress of the vaccine.