Objective To evaluate the impact of different ages, different gender, with or without exercise and different fracture sites on the nutritional status using mini nutritional assessment (MNA-SF) in hospitalized elderly fracture patients. Methods A total of 1 353 hospitalized elderly patients with fracture were included. The MNA-SF investigations were completed within 3 days after admission. The diet, body weight, physical activity, psychological trauma or stress, psychological problems, body mass index (BMI), calf circumference (CC), history of aerobic exercise and the fracture sites were recorded three days after admission. The nutritional status were evaluated including normal nutrition, risk of malnutrition and malnutritional status. The relationships of nutritional status were analyzed between different ages, different gender, with or without exercise, different fracture sites. Results There were significant differences in the incidence of normal nutrition, risk of malnutrition malnutrition and non-normal nutritional status between different ages, different gender, with or without exercise, femoral intertrochanteric fracture and upper limb fracture. There were also significant differences in the incidence of normal nutrition, risk of malnutrition and malnutrition between femoral neck fracture and upper limb fracture. Conclusion There is a higher incidence of non-normal nutritional status in patients older than 80 years, female, with no regular exercise and with femoral intertrochanteric fracture.

Objective To detect the osteopontin (OPN) autocrine function of the osteoclasts in neurofibromatosis type 1 heterozygote (Nfl+/-) and wild type (Nfl+/+) mice.Test the osteoclasts function of neurofibromatosis type 1 heterozygote (Nfl+/-) and wild type (Nil+/+) mice with exogenous neutralizing OPN antibody,analysis the role of autocrine OPN in the hyperfunction of osteoclast in neurofibromatosis type 1.Methods Culture the low density bone marrow cells from Nfl heterozygote (Nfl+/-) and wild type (Nfl+/+) mice (4-6 weeks old) with macrophage colony-stimulating factor (M-CSF) and receptor activator of NF-κB ligand(RANKL),Measure.the OPN concentration in osteoclast culture superenant with ELISA.Culture the low density bone marrow cells from Nf1+/-and Nf1+/+ mice with or without exogenous neutralizing antibody for OPN.The function of osteoclasts and osteoclast progenitors in formation,migration,adhesion,and bone absorption were tested.Results A significantly higher concentration of OPN was detected in the Nf1+/-osteoclast culture media as compared to that of wild type.In control,Osteoclast functions,including migration,adhesion,and bone resorption of Nf1 +/-were higher than that of wild type.Addition OPN neutralizing antibody to the Nf1+/-OCL significantly reduced OCL formation.Neutralizing OPN antibody diminished both wild type and Nf1+/-OCL adhensiontion,Anti-OPN minimized OCL migration in both wild type and Nf1 +/-OCL cultures as measured by the transwell assays.Neutralizing OPN antibody diminished both wild type and Nf1+/-OCL pit formation,P＞0.05 for comparing Nfl+/-vs.wild type OCLs with anti-OPN antibody.Conclusion The hyperfunction of osteoclast in Nf1 heterozygote is related with autocrine osteopontin,inhibition of OPN may be an effective treatment for bone destruction of neurofibromatosis type 1.

Objective To investigate the relationships between the clinical and subclinical REM sleep behavior disorder(sRBD)and the cognitive function in patients with PD. Methods We enrolled 53 patients with PD from the Second Affiliated Hospital of Nanchang University. The age ,gender and education level of each patient were recorded. Patients with dementia were excluded. The correlative scales were assessed by the form of face to face,including Montreal cognitive function score(MoCA),Unified Parkinson Disease Rating Scale(UPDRS), Parkinson Disease Sleep Scale (PDSS) and so on. The sleep quality was assessed by polysomnography(PSG), meanwhile PD patients were divided into the RBD group(PD-RBD),the subclinical RBD group(PD-sRBD)and the normal REM group(PD-REM)based on the polysomnography. The cognitive function was compared among the three groups. Results (1)MoCA score of PD patients in the RBD group was lower than that in the normal REM group(P = 0.032.(2)No significant difference was observed in the cognitive function between the sRBD group and the normal REM group.(3)Length of morbidity of PD patients with RBD was longer than that of PD patients with sRBD(P=0.021). Conclusions The presence of RBD may be an important relative factor for the develop-ment of cognitive dysfunction in PD patients. We haven′t detected that the subclinical RBD was associated with the cognitive dysfunction in patients with PD. It is not clear whether the subclinical RBD in PD patients develops to RBD in all patients,which needs further investigation.

Objective To explore the application effects of Donabedian's structure-process-outcome three-dimension quality assessment model on perioperative blood glucose management among elderly patients with hip fracture. Methods From September 2016 to April 2017, a total of 129 elderly patients with hip fracture of the Third Hospital of Hebei Medical University were numbered according to admission order. From September to December 2016, a total of 62 cases were in control group receiving routine blood glucose management. From January to April 2017, 67 cases were in observation group treated with blood glucose management based on Donabedian's three-dimension quality assessment model. And then, we compared the blood glucose on admission and before discharge, waiting time before surgery, healing time of wound and cases of hypoglycemia. At the same time, we investigated the demands of training content of medical staff (n=133). Results There was no statistical difference in the first blood glucose 24 hours after admission and 2 hours after meal of patients between two groups (P＞0.05). After intervention, the waiting time before surgery, healing time of wound and incidence rate of hypoglycemia in observation group [(3.34±0.88) d, (4.43±1.38) d and (3/67, 4.5%)]were less than those in control group [(4.63±1.41) d, (6.47±2.24) d and (10/62, 16.1%)];the fasting blood glucose and blood glucose 2 hours after meal in observation group [(5.96±1.21), (7.60±0.96) mmol/L] were lower than those in control group [(10.80±1.14), (9.94±1.98) mmol/L]one day before discharge all with significant differences (P＜ 0.05). There was also significant difference in blood glucose 2 hours after meal in observation group before and after intervention (P＜0.05). The demands of training content of medical staff (n=133) included diet management, correct usage of insulin, oral hypoglycemic agents instruction, blood glucose monitoring management;the influencing factors on implementing blood glucose management involved busy work, inconsistent dinner time, insufficient knowledge, and so forth. Conclusions Blood glucose management process based on Donabedian's three-dimension quality assessment model can effectively control perioperative blood glucose among elderly patients with hip fracture, shorten waiting time before surgery as well as healing time of wound and reduce cases of hypoglycemia which makes for overall rehabilitation of patients.

Objective To study the status of the usage and the awareness of drip chamber in the application in administration of medicine .Methods The self-designed questionnaire about drip chamber used for administration of medicine was used to survey 310 nurses.Results There were different kinds of appellations for the drip chamber , among with the “Murphy's Dropper” was used the most , and it was not in line with the national and the international standards .298 nurses ( 96.13%) in the survey accepted and used the drip chamber for administration of medicine .246 nurses (82.55%) replaced the intravenous injection by the drip chamber for administration of medicine .Only 12 nurses were opposed to the drip chamber for administration of medicine.All the respondents failed to give the exact answer of drug concentration changes and the amount of electrolyte solution used for rinsing drip set .Conclusions The application of drip chamber should be standardized by national and international standards .Nurses fail to fully recognize the way of using drip chamber for medicine, so it cannot be replaced completely by the intravenous injection .

Objective To investigate feasibility and effectiveness of combined level-one quality control and management mode. Methods Contents of combined level-one quality control and management mode were introduced, including determining departments combination, establishment and work procedure of the combined quality control group, frequency of combined quality control, and approaches of continuous quality improvement. Quality control data of the Nursing Department from January 2013 to December 2014 were taken to statistically analyze compliance rate of 6 nursing quality standards, satisfaction of hospitalized patients, and incidence of nursing defects, before and after implement of combined quality control&management mode. Results Compared with before, after implementation of combined level-one quality control and management mode, compliance rates of nursing documentation, basic nursing, treatment safety, head nurse management, and ward management, as well as satisfaction of hospitalized patients, and incidence of nursing defects were statistically significant (χ2 =4. 182, 8. 177, 6. 157, 5. 148, 5. 135, 7. 875, 7. 754; P <0. 05). Compliance rates of health education quality before and after the implementation were not statisticallysignificant (χ2 = 4. 182, P > 0. 05 ). Conclusions Implementation of combined level-one quality control and management mode can improve compliance rate of nursing quality standards and satisfaction of hospitalized patients, and decrease incidence of nursing defects, which is a new feasible and effective management mode in clinical work.

Liver fibrosis is a significant health burden,marked by the consistent deposition of collagen.Unfortunately,the currently available treatment approaches for this condition are far from optimal.Lysyl oxidase-like protein 2(LOXL2)secreted by hepatic stellate cells(HSCs)is a crucial player in the cross-linking of matrix collagen and is a significant target for treating liver fibrosis.Mesenchymal stem cell-derived small extracellular vesicles(MSC-sEVs)have been proposed as a potential treatment option for chronic liver disorders.Previous studies have found that MSC-sEV can be used for microRNA delivery into target cells or tissues.It is currently unclear whether microRNA-4465(miR-4465)can target LOXL2 and inhibit HSC activation.Additionally,it is uncertain whether MSC-sEV can be utilized as a gene therapy vector to carry miR-4465 and effectively inhibit the progression of liver fibrosis.This study explored the effect of miR-4465-modified MSC-sEV(MSC-sEVmiR-4465)on LOXL2 expression and liver fibrosis development.The results showed that miR-4465 can bind specifically to the promoter of the LOXL2 gene in HSC.Moreover,MSC-sEVmiR-4465 inhibited HSC activation and collagen expression by downregulating LOXL2 expression in vitro.MSC-sEVmiR-4465 injection could reduce HSC activation and collagen deposition in the CCl4-induced mouse model.MSC-sEVmiR-4465 mediating via LOXL2 also hindered the migration and invasion of HepG2 cells.In conclusion,we found that MSC-sEV can deliver miR-4465 into HSC to alleviate liver fibrosis via altering LOXL2,which might provide a promising therapeutic strategy for liver diseases.

Objective:Analysis the protective effect of the partial femoral to femoral cardiopulmonary bypass(CPB) on thoracoabdominal aortic aneurysm repair(TAAAR).Methods:From September 2016 to August 2020, 50 cases of TAAAR under partial CPB were performed at our hospital. Thirty males and 20 females with an average age of(40.5±12.4) years old(ranging 21 to 69 years old) were involved. Partial CPB without selective organ perfusion were applied at the early stage. Since November 2019, the adjunct of perfuse the celiac and superior mesenteric artery with warm blood and irrigate the renal artery with 4℃ HTK solution was used in TAAAR, and 25 patients were operated under this adjunct.Results:The average CPB time was(116.9±35.4) min, the lowest central body temperature during the partial CPB was(34.7±0.7)℃. Total early postoperative mortality was 6%(3/50, 3 deaths in partial CPB alone group). Paraplegia occurred in 4 cases(8%), new happened postoperative hemodialysis was in 6 cases(16%). Among the hemodialysis event, 2 cases(8%, 2/25) were in the group with selective organ perfusion, and 4 cases(16%, 4/25) in the group without using the adjunct.Conclusion:Mild hypothermic partial cardiopulmonary bypass combined with selective organ perfusion have protective effects on spinal cord and abdominal organ in patients underwent TAAAR.