[Objective]To observe the effect of opposing needling accompanying continual static stretch(CSS) on high-spasticity poststroke.[Methods]80 patients with high spasticity poststroke were randomly divided into four groups.A group:treated with opposing needling accompanying CSS;B group:treated with opposing needling;C group:treated with CSS;D group:acupoints selected from anti-spasm muscle.The therapeutic effect of the four methods was evaluated on proving spasm degree and motor function.[Results]Four methods had effect on high muscle tension in patients poststroke.The marks of Ashworth scale and Fugl-Meyer scale of the four groups had remarkable difference(P

Objective To identify the expression of DLK1 protein in different types of renal cell carcinomas and its correlations with pathological characteristics and metastasis. Methods Immunohistochemistry analysis was performed to evaluate the expression of DLK1 protein in 94 cases of primary clear cell renal cell carcinoma, 76 cases of papillary renal cell carcinoma, 45 cases of chromophobe renal cell carcinoma, 71 cases of distal metastatic and 24 cases of lymph node metastatic clear cell renal cell carcinoma, as well as 18 cases of normal renal tissue. The correlations of DLK1 protein expression with pathological characteristics were analyzed. Results DLK1 protein was expressed in proximal and distal renal tubular epithelial cells in all the normal renal cases. In contrast, DLK1 protein expression was lower in different types of renal cell carcinoma. The low or negative expression of DLK1 protein in clear cell renal cell carcinoma, papillary renal cell carcinoma and chromophobe renal cell carcinoma was 33.0% (31/94), 27.6% (21/76) and 33.3% (15/45), respectively. Compared to normal renal tissue, DLK1 protein expression was significantly down-regulated in renal cell carcinomas (P＞0.05), whereas there was no significant difference on DLK1 protein expressions among the different types (P＞0.05) of renal cell carcinomas. DLK1 protein expression was not correlated with sex (60 male and 34 female cases), age (≥55, 50 cases and 55, 44 cases), grade (41 cases in grade I, 9 cases in grade II, 21 cases in grade III and 23 cases in grade Ⅳ respectively) and lymph node metastasis (76 cases with and 18 cases without lymph node metastasis) in clear cell renal cell carcinoma (P＞0.05). There was also no significant difference among primary, lymph node and distal metastatic lesions of clear cell carcinoma (P＞0.05). Conclusions DLK1 protein expression is commonly down-regulated in different types of renal cell carcinomas. Down-regulation of DLK1 protein expression is not associated with pathological characteristics and metastasis in clear cell renal cell carcinoma.

Objective To shorten the turn around time of positive blood culture results by optimizing the blood culture positive specimen processing flow.Methods In January 26,2015,the microbiology department started the blood culture positive specimen processing flow optimization project,and applied the Lean Six Sigma method in the microbiological process management.The TAT data of 124 positive blood cultures containing Enterobacteriaceae were collected before and after the start of the project in about two months.We analyzed the turnaround time median,mean and standard deviation and reference Z value,process performance index,millions of error opportunities.We decompose the turnaround time into six time periods to find the key points of the process improvement and the influencing factors,and then put forward the reform measures to optimize the blood culture inspection process.MiniTab17.0 statistical software was used to process capability analysis and double sample t test.Results After the implementation of the project,the average turnaround time of the blood culture was shortened from 77.10 h to 64.03 h,improved by 13.06 h(16.94％).Process performance greatly improved in Ppk value increased from 0.49 to 0.88,the benchmark Z value increased from 1.48 to 2.63.After the improvement,except the positive alarm time of blood culture,the mean of the other decomposition time was significantly shorter than before.Conclusions The application of Six Sigma in process management can greatly improve the work efficiency and process performance.This project can save a lot of manpower,material and financial resources,reduce the waiting,shorten turnaround time,that achieve the desired results.

Objective To compare the etiological constitution of recurrent miscarriage (RM) between patients with consecutive two and three or more miscarriages through combining the routine examination results and embryonic karyotype. Methods Patients with a history of two or more consecutive clinical miscarriages(≤12 weeks of gestation)consulting in the RM clinic of the First Affiliated Hospital of Sun Yat-sen University from March 2011 to January 2016 were collected. Six hundred and ninety-six with detailed history recorded, routine clinical examinations of RM and at least once embryonic karyotype were ultimately enrolled in this study. Their etiological constitution of RM were analyzed in groups of consecutive two and three or more miscarriage. The etiologies of RM in analysis consisted of women age, body mass index (BMI), chromosome abnormalities of couples, uterine abnormalities, endocrinology abnormalities and antiphospholipid syndrome(APS). Results (1)Among 696 patients, the abnormal embryonic karyotypes was 60.6%(422/696)and routine RM etiologies was 32.2%(224/696), leaving the ratio of unexplained RM was only 29.0%(202/696).(2)A total of 717 embryo karyotype were found in 696 patients, included 21 cases with twice embryo karyotype results the percentage of normal embryo was 39.7%(285/717), while abnormal ones was 60.3%(432/717). Among the types of abnormal karyotype, the most common ones (>10%)were trisomy 16(19.2%, 83/432), monosome X(11.3%, 49/432)and trisomy 22(10.9%, 47/432). (3)Among the 696 RM patients, the number of two and three or more miscarriages were respectively 446(64.1%,446/696)and 250(35.9%,250/696). Comparing groups of three or more miscarriages with two miscarriages, there were significant differencein older age as well as uterine adhesion(P<0.05). But no difference was found in body mass index(BMI), the rates of chromosome abnormalities of couples, uterine abnormalities except uterine adhesion, endocrinology abnormalities and APS (all P>0.05) between two groups. Conclusions The abnormal embryonic karyotype is the most common cause of first-trimester RM. The etiological constitution of two and three or more recurrent miscarriages is accordant, suggesting that routine clinical examination and the embryonic karyotype should be started following two consecutive clinical early miscarriages.

Objective: To explore the influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage (VSD) for inpatients in burn unit. Methods: From October to December 2016, 60 patients, aged (43.6±2.8) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the routine nursing group, and among the patients, 37 cases were male and 23 cases were female. From May to July 2017, 58 patients, aged (44.2±3.2) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the cluster nursing group, and among the patients, 36 cases were male and 22 cases were female. The patients′ medical records were retrospectively analyzed. After VSD treatment, patients in routine nursing group received routine nursing, and patients in cluster nursing group received cluster nursing. A cluster intervention group was formed and headed by a chief surgeon. The cluster nursing plan was formulated and implemented strictly from the following six aspects of material preparation, negative pressure value control and negative pressure mode setting, drainage tube nursing, semi-permeable membrane reinforcement, standardizing changing process and timing of drainage capsule, and health education. During VSD treatment, the incidence of inadequate drainage, reasons of inadequate drainage and the occurrences, occurrences of inadequate drainage of wounds in different types and sites, and satisfaction of patients in two groups were observed and calculated. The patient satisfaction items included procedure of drainage capsule replacement, the method of tube fixation, the content and form of health education. Data were processed with independent sample t test and chi-square test. Results: (1) During VSD treatment, the incidence of inadequate drainage of patients in routine nursing group was 43.33% (130/300), which was significantly higher than 17.24% (50/290) in cluster nursing group (χ²=43.350, P<0.01). (2) During VSD treatment, the incidences of inadequate drainage caused by blockage of drainage tube due to scabbing of drainage, low negative pressure, air leakage of semi-permeable membrane, improper changing process of drainage capsule, shedding, compression, reversal of drainage tube of patients in cluster nursing group were 7.93% (23/290), 4.48% (13/290), 1.72% (5/290), 1.03% (3/290), and 2.07% (6/290), respectively, significantly lower than 16.67% (50/300), 11.67% (35/300), 4.33% (13/300), 4.00% (12/300), and 6.67% (20/300) in routine nursing group (χ²=10.379, 22.951, 4.832, 7.840, 7.399, P<0.05 or P<0.01). (3) During VSD treatment, the incidences of inadequate drainage of burn wounds, trauma wounds, pressure ulcer, venous ulcer in lower limbs, and diabetic foot of patients in cluster nursing group were significantly lower than those in routine nursing group (χ²=17.835, 6.809, 9.478, 4.939, 8.631, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different types of patients in the same group were close (χ²=0.434, 0.057, P>0.05). (4) During VSD treatment, the incidences of inadequate drainage of wounds in limbs, trunk, buttocks, and sacrococcyx of patients in cluster nursing group were significantly lower than those in routine nursing group (χ²=31.892, 9.588, 4.939, 4.549, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different wound sites of patients in the same group were close (χ²=0.071, 0.069, P>0.05). (5) The satisfaction scores in changing process of drainage capsule, method of tube fixation, content and form of health education of patients in cluster nursing group after VSD treatment were significantly higher than those in routine nursing group (t=5.166, 4.471, 7.958, 8.975, P<0.01). Conclusions Cluster nursing intervention on patients receiving VSD treatment could reduce the incidences of inadequate drainage of wounds in different types and sites caused by various reasons. It also can improve patient satisfaction.