Objective To explore the status quo of knowledge,belief,and practice of anticoagulationrelated self-management in rehabilitation period for patients with haeat valves replacement.Methods Van Manen's hermeneutic phenomenology was used as qualitative research method.Twenty patients who had undergone heart valves replacement operation were selected and interviewed.The results of interview were analyzed with category analysis.Results After repeated self-examination,comparison,and summery,four themes were refined,including patients lack anticoagulation-related knowledge and skills in rehabilitation period,the levels of patients' attitudes and beliefs varied greatly,patients' compliance of self-management behavior and taking medicine was low,there were limited channels to get anticoagulation-related information in rehabilitation period.Conclusions More attention should be paid to patients for anticoagulation management after valve replacement operation,especially to those of low literacy,older age,and rural area.Nurses should implement the specific health education about anticoagulation management to patients during discharge guide and following-up period to minimize complications,promote the survival rate,and improve their quality of life.

Objective:To construct a prokaryotic expression plasmid containing HCVF gene,and purify the recombinant fusion protein in E.coli system. Methods: F gene of Hepatitis C virus was amplified by PCR method from plasmid H/FL(containing full length cDNA sequence of HCV 1a subtype),cloned into pET32a(+)vector,and then transformed into E.coli JM109. After identified by restriction diges- tion and DNA sequencing,recombinant plasmid was transformed into E.coli BL21 and induced with IPTG. The fusion protein trxA- F was further confirmed by Western blot analysis and purified by affinity chromatography method. Results: Restriction digestion and PCR screening showed that HCV F gene was cloned into pET32a(+)successfully. After BL21 was transformed with recombinant vector pET32a (+)- HCVF and induced with 0.5mmol/L IPTG,a 35.4kDprotein band was found bySDS- PAGE. And this recombinant protein showed a highly specific and strong reaction with anti- His monoclonal antibody by Western blot analysis. Conclusion: The prokaryotic expression plasmid pET32a(+)- HCVF was successfully constructed,which will be helpful for further research.

The results of the arterial blood study in 30 patients of cor pulmonale in acute exacerbation were reported.The study included gas analysis, and dominations of serum lactate,pyruvate, potassium,sodium and chlorine.All the items were determined simultaneously.The data demonstrated that when the arterial oxygen tension of the patients with cor pulmonale in acute exacerbation dropped below 60mmHg, the blood lactate concentration was most likely to show a rise, which was related not only to hypoxemia but also to alkalosis.Observations of the changes in concentration of blood lactate and pyruvate in some patients led us to believe that these changes were associated with the seriousness of the disease. Regular measurement of blood lactate and pyruvate concentrations might be helpful to judge the condition of the patient. Persistent rise in blood lactate concentraion suggested poor prognosis.

Objective To investigate postpartum blood lose of cesarean section (CS) within 24 hrs in Nanjing area Methods Stratified samples were collected from hospitals of different levels and located at different districts The amount of postpartum blood loss was precisely measured by methods of weight, volume and area Results There were 1 125 CS in a total of 4 171 deliveries The main indications for CS were cephalo pelvic disproportion, fetal distress, breech presentation, and there was 10 4% of CS without definite causes The average amount of blood loss was 520 ml in CS, which was far more than that in vaginal delivery ( n = 3 046) If postpartum hemorrhage (PPH) is defined as blood lose of 500ml or more, the incidence of PPH was 53 7%; if it is defined as 700 ml, the incidence was 19 8% Conclusions Cesarean section is an important cause of PPH, and CS without proper indication should be avoided It seems reasonable to defined the criteria of PPH in CS as 700 ml or more

Objective To observe the influence of parturients hemodynamics and curative effect of preventing hypotension syndrome by using hypotension syndrome prevention bracket in cesarean section with spinal anesthesia.Methods One hundred parturients of cesarean section,ASA grade Ⅰ-Ⅱ,were divided into two groups according to whether the use of hypotension syndrome prevention bracket with 50 cases each:observation group and control group.Control group in anesthesia after the success of the surgery made bed left tilt 15°,and observation group in anesthesia after the success immediate used hypotension syndrome prevention bracket.In the two groups,the change of systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),mean arterial pressure (MAP),the incidences of hypotension syndrome and nausea and vomiting during and after operation,and anesthesia to uterine incision time and anesthesia time were observed.Results There was no significant difference in anesthesia to uterine incision time,anesthesia time,intraoperative infusion quantity,amount of bleeding between the two groups (P ＞ 0.05).The incidences of hypotension syndrome and nausea and vomiting in observation group were 8.00％ (4/50) and 4.00％ (2/50),in control group were 42.00％ (21/50) and 24.00％ (12/50),there were significant differences between the two groups (P ＜ 0.05).The observation group at 5 min after anesthesia SBP,DBP,MAP were (106.12 ± 12.91),(57.26 ± 11.43),(73.57 ± 11.03) mm Hg (1 mm Hg =0.133 kPa),and the control group were (95.44 ± 19.53),(50.15 ± 15.53),(66.36 ± 15.64) mm Hg,there were significant differences between the two groups (P ＜ 0.05).The observation group at 10 min after anesthesia SBP,DBP,MAP were (104.35 ± 11.86),(55.92 ± 10.81),(72.54 ± 10.37) mm Hg,the control group were (102.31 ± 15.48),(55.12 ± 11.89),(70.72 ± 11.33) mm Hg,there were significant differences between the two groups (P＜ 0.05).The observation group at 3 min after the delivery of fetus and the end of operation DBP,MAP were (54.13 ± 9.14) and (62.63 ± 8.61) mm Hg,(68.13 ± 10.40) and (80.88 ± 9.05) mm Hg,the control group were (49.24 ± 11.55) and (58.04 ± 11.67) mm Hg,(70.57 ± 8.58) and (75.35 ± 10.41) mm Hg,there were significant differences between the two groups (P ＜ 0.05).Conclusion Cesarean section parturients using hypotension syndrome prevention bracket can reduce the occurrence of hypotension syndrome,which can help to maintain the stability of parturients hemodynamics,it is worth of clinical promotion.

Objective To investigate the incidence rate and risk factors of obstetric emergency hysterectomy.Methods The clinical data of childbirth puerpera in Shangqiu four municipal hospitals were retrospectively analyzed,80 patients underwent routine obstetric emergency hysterectomy were selected as hysterectomy group,56 postpartum hemorrhage patients without uterus excision were randomly selected as control group.The related risk factors of obstetric emergency were analyzed.Results (1) The total delivery number was 65 259 cases,cesarean rate was 47.46％ (30 972/65 259),postpartum hemorrhage rate was 4.61％ (1 429/30 972),and uterus removal rate of cesarean section was 0.18％ (56/30 972),vaginal delivery postpartum hemorrhage rate was 3.28％ (1 124/34 287),in the courtyard the vaginal delivery emergency uterus removal rate was 0.03％ (12/34 287).The postpartum hemorrhage rate and obstetrics emergency uterus removal rate were higher than vaginal delivery,the differences were statistically significant (x2 =77.22,33.24,all P ＜ 0.05).(2) The results of the single factor analysis showed that,placenta previa and implant,placental abruption,merge multiple or huge uterine fibroids,uterine rupture,blood coagnlation dysfunction,armount of bleeding ＞ 2 000ml,vanda operation with oxytocin rate between the two groups,there were significant differences(P ＜ 0.01).(3) The results of unconditional multi-factor Logistic regression analysis showed that,placental abruption,uterine rupture,merge multiple or huge uterine fibroids,blood coagulation dysfunction,amount of bleeding ＞ 2 000ml were independent risk factors which lead to obstetric emergency hysterectomy.Vanda operation with oxytocin and hysterectomy had negative correlation.Conclusions Obstetric emergency hysterectomy was related with a variety of factors.Strengthen the perinatal health care,and actively prevent emergency hysterectomy can reduce the dangerous factors of uterus removal rate and has important significance.

Diabetic ketoacidosis is one of the most common causes of death in the pediatric diabetes,and it is also one of the most common endocrine emergencies in children.With the further studies of this disease,more attentions are paid to the central nervous damage about DKA.The mechanisms about DKA-related cognitive dysfunction from the macro to the micro are constantly updated.This article gives a review on the pathogenesis of the cognitive dysfunction due to DKA.

Objective To evaluate the effects of fasudil on neointima hyperplasia in rat carotid artery balloon-injury model,and explore the potential molecular mechanisms of this effect.Methods Totally 30 male Sprague-Dawley (SD) rats were randomly divided into sham operation group,balloon injury group,2.5 ml/kg fasudil intervention group,5 ml/kg fasudil intervention group,10 ml/kg fasudil intervention group.The intima-to media(I/M) area ratio of neointima was calculated at 14th day after operation; the protein expression of proliferating cell nuclear antigen(PCNA) was measured by immunohistochemical and the integrated optical density (IA) was calculated.As the marker of oxidative stress,the levels of 8-hydroxy-2'-dcoxyguanosine (8OHdG) and malondialdehyde (MDA) were measured by enzyme-linked immunosorbent assay (ELISA).The expressions of phosphorylated and non phosphorylated Ras,mitogen activated protein kinase kinase (MEK1/2) and extracellular signal regulated kinase (ERK1/2) were measured by Western blot.Results The I/M ratios were (0.22 ± 0.01) in sham operation group,(2.71 ± 0.23) in balloon injury group,( 1.72 ±0.24)in 2.5 ml/kg fasudil intervention group,(1.23±0.11)in 5 ml/kg fasudil intervention group,(0.85±0.12)in 10 ml/kg fasudil intervention group.As compared with sham operation group,I/M area ratio was increased in balloon injury group,and three fasudil intervention group inhibited neointima hyperplasia in a dose-dependent manner (all P＜0.01).The IA indexes were(15.11 ±1.42),(53.42±2.30),(45.25±1.62),(22.55±0.88) and(19.61±0.79) in the above five groups,respectively,showing the fasudil inhibited PCNA expression (all P＜0.01).Fasudil also inhibited the levels of 8-OHdG and MDA in a dose-dependent manner [8OHdG:(54.34±4.50)μg/kg,(106.81 ± 6.67)μg/kg,(94.21 ± 3.34) μg/kg,(65.58 ± 5.13) μg/kg,(51.32 ± 2.34) μg/kg; MDA:(19.94 ± 0.65 ) μmol/kg,( 58.83 ± 2.81 ) μmol/kg,(48.94 ± 1.35 ) μmol/kg,(40.62 ± 3.24 )μmol/kg,( 36.85 ± 0.91)μmol/kg (all P＜0.01)].Compared with balloon injury group,the relative expressions of Ras in three fasudil intervention group were 0.49±0.12,0.39±0.13,0.20±0.23 vs.0.62±0.10(P＜0.05 or,P＜0.01); MEK1/2 0.35±0.14,0.29±0.09,0.11±0.12 vs.0.56±0.1(P＜0.05 or,P＜0.01); ERK1/2 0.48±0.15,0.32±0.08,0.12±0.09 vs.0.64±0.13(P＜0.05 or,P＜0.01).The activations of ERK1/2,MEK1/2 and Ras were strongly suppressed in fasudil treated samples on day 14 after balloon injury.Conclusions Blockade of oxidative stress and Ras MEK1/2 ERK1/2 pathway is involved in the fasudil attenuating of balloon injury-induced neointima hyperplasia

Objective To compare the effect of vaginal and laparoscopic myomectomy.Methods According to the digital table,98 patients with uterine fibroids were randomly divided into the two groups,the control group(n =4 9 eases) and the observation group (n =4 9 cases).The patients in the control group were operated through laparoscopic myomectomy,while the patients in the observation group were operated through vaginal myomectomy.The operative time,blood loss,postoperative gastric function recovery time,exhaust time,complications,recurrence and quality of life,etc.were observed.Results The operative time,blood volume were (115.4 ± 29.4) min,(191.4 ± 30.2) mL in the control group and (70.1 ± 18.2) min,(156.1 ±21.6)mL in the observation group.The operative time,blood volume in the control group were more than those in the observation group,there were significant differences between the two groups (t =3.169 4,2.162 8,P ＜ 0.05).Gastric function recovery and exhaust time were (2.8 ± 0.7) h,(23.1 ±4.1)h in the control group and (1.3 ±0.5)h,(15.1 ±3.5)h in the observation group.Gastric function recovery and exhaust time in the control group were higher than those in the observation group (t =2.091 4,3.771 8,all P ＜ 0.05).The number of cases of complications and recurrence were 1,2 in the control group and 2,1 in the observation group.There was no significant difference between the two groups about the number of cases of complications and recurrence (x2 =2.02,0.00,all P ＞ 0.05).Quality of life after operation was (7.26 ± 2.01) in the control group,and (8.42 ± 2.17) in the observation group.The quality of life in the observation group improved more significantly than the control group (t =0.361 8,3.901 6,all P ＜ 0.05).Conclusion Vaginal myomectomy had less trauma,quicker recovery,and help to improve the quality of life.