The distribution of collagen Ⅳ (CⅣ) and its correlation with renal histological lesions were investigated in 107 cases with IgA nephropathy. Strong positive staining of CⅣ and Fn was found in glumerruli with crescents, segmental and global sclerosis, as well as in the tubular basement membrane and interstitium. The extent of CⅣ deposit was correlated well with tubular atrophy, interstitium fibrosis, infiltration of cells and renal pathologic changes. The results show that the increment of CⅣ and Fn in glomeruli is associated with the development of crescents, glomerular sclerosis. The inflammation of interstitium may stimulate renal tubular cells to produce extravagent amounts of CⅣ, which might further result in tubular atrophy and fibrosis.

Objective To retrieve and analyze the available evidence on prevention of needlestick injuries among healthcare workers and summarize the best available evidence.Methods We searched the BMJ best practice,Uptodata,Cochrane Library(2014),Joanna Briggs Institute Library,Registered Nurses' Association of Ontario,Scottish Intercollegiate Guidelines Network,National Guideline Clearinghouse,and complementally searched the PubMed,EM-base,CNKI and Centers for Disease Control to collect literatures including guideline,evidence summary,best practice information sheet,recommended practice and systematic review.Results Nine references were selected including a clinical decision support system,3 evidence summaries,2 recommended practices and 3 systematic review.Finally,7 items of best evidence were summarized,including:wearing double gloves,never recapping needles,using blunt-tip suture,using a neutral zone for passing sharp device,adopting the safety features of sharps,using sharp disposal containers,and continuous education for needlestick injuries.Conclusion Healthcare workers should regulate their behaviors of using sharp instruments during clinical practice and guarantee personal safety by consulting high level evidence.

Objective To investigate nursing interns’knowledge and attitude towards needle stick injury before clinical practice.Methods In 20-23 June,2015,nursing interns who were about to start clinical practice in a hospi-tal were investigated,nursing interns’knowledge and attitude towards needle stick injury were surveyed through questionnaire.Results A total of 350 questionnaires were distributed,324 (92.57%)responded questionnaires were available.40(12.35%)questionnaires were responded by male interns,and 284(87.65%)were by female in-terns;34(10.49%)interns had bachelor degree;the mean age of interns were (20.83 + 1 .24)years old.The correct answer rates about questions related to injury occurring during needle recapping and wearing gloves were low (about 60%).About 70% of the interns gave the correct answers to questions about hepatitis B infection due to needle stick injury following hepatitis B vaccination,as well as medication after injury.Score for individual question about attitude towards needle stick injury was ≤3,the major related problems were susceptibility of blood borne diseases and recapping needles.Conclusion Needle stick injury-related knowledge and attitude among nursing interns is inadequate,including recapping needles,timely report,susceptible to infectious diseases,and so on.It is necessary for schools and teaching hospitals to strengthen the education about occupational protection among nursing interns, so as to improve the attitude and ability of professional protection.

Objective To explore the clinical efficacy of enteral nutrition combined with traditional Chinese medicine (TCM) acupuncture and moxibustion for treatment of craniocerebral trauma complicated by gastric paralysis.Methods A prospective study was conducted.One hundred and sixty-seven patients with craniocerebral trauma complicated by gastric paralysis admitted to the Department of Neurological Critical Care Medicine in Affiliated Hospital of the Logistics University Chinese People's Armed Police Force from January 2013 to October 2015 were divided into single group (83 cases) and combined group (84 cases) according to the random number table method.The basic treatment program was the same in the two groups.On the basis of gastrointestinal decompression,a nasojejunal tube was indwelled in the digestive canal of the patients in single group,and the nutrient food could be given by dripping slowly and continuously through the tube into the body,while in the combined group,they were additionally treated by acupuncture and moxibustion at auricular point,zusanli and neiguan acupoints,1 time a day,each time 30 minutes.Both groups were treated consecutively for 30 days,and then the clinical efficacies were evaluated.Before and after treatment in both groups,the changes of total serum protein (TP),pre-albumin (PA),hemoglobin (Hb) were observed;the incidences of reflux,vomiting,abdominal distension,diarrhea,pulmonary infection and intestine derived infection were also evaluated.Results After treatment the levels of TP,PA,Hb were significantly higher in combined group than those in the single group [TP (g/L):36.97 ± 2.17 vs.33.14± 2.13,PA (mg/L):215.19 ± 7.91 vs.203.15 ± 6.12,Hb (g/L):126.73 ± 11.17 vs.117.61 ± 11.24,all P ＜ 0.01].The numbers of patients with reflux,vomiting,abdominal distension,diarrhea were significantly lower in combined group than those in the single group,respectively (the number of patients had reflux being 15 cases vs.31 cases,vomiting 13 cases vs.28 cases,abdominal distension 17 cases vs.29 cases,diarrhea 17 cases vs.31 cases) and pulmonary infection (17 cases vs.29 cases),intestine derived infection (4 cases vs.12 cases),all the above comparisons showing statistically (all P ＜0.05).Conclusions Enteral nutrition combined with acupuncture and moxibustion treatment can effectively enhance the patients' nutritional status,reduce gastrointestinal dysfunction and the incidence of complications,thus the prognosis of patients with craniocerebral trauma complicated by gastric paralysis is obviously improved.

Nurses play a key role in disaster prevention, delivery and management of care in disaster situations. Training high education level and enhancing disaster core competencies of disaster nurses are essential part in response to mass casualty incidents and reserving the nursing talent. Masters′degree of disaster nurses began in 2013 in China. At that time, disaster nursing task force was composed of faculty members from both the Hong Kong Polytechnic University and School of Nursing in Sichuan University, and then, students of disaster nursing were enrolled by School of Nursing in Shandong University and Chuanbei College. Masters′ degree training programme of disaster relief nurses was not perfect in China. This paper reviewed the studies on masters′degree training programme of disaster relief nurses.

Objective To explore the life experiences of donors undergoing pediatric living related liver transplantation and elucidate it 's the influencing factors of quality-of-life .Methods A qualitative study was performed with a phenomenological-hermeneutic approach .Twelve living related liver transplantation donors were face-to-face interviewed by a semi-structured interview and 7-step Colaizzi method was applied for data analysis .Results Four domains and 9 sub-domains were summarized as follows :body disturbance (pain ,discomfort & physical changes) ,sense of uncertainty (recipient-dependent sensitive ,self-doubt & confusion under family pressure ) ,role conflict (patient-carer & family-social) and contentment & gratitude (willing to sacrifice ,living in the present &benefiting from social funds ) .Conclusions The levels of quality-of-life vary greatly in different donors .Body disturbance ,sense of uncertainty ,role conflict ,contentment and gratitude are the major influencing factors of quality-of-life for donors undergoing pediatric living related transplantation .

Background:Celiac disease is an autoimmune enteropathy which can present with patchy mucosal lesions.Therefore,the diagnosis of the disease requires histological evaluation of multiple site biopsies.Aims:To analyze the pathological characteristics of multiple site small intestinal biopsies in adult patients with celiac disease and provide reference for early identification and diagnosis of celiac disease.Methods:The pathological data of 22 adult patients who were newly diagnosed as having celiac disease at the People's Hospital of Xinjiang Uygur Autonomous Region from August 2019 to April 2022 were collected retrospectively.All patients were positive for serum anti-tissue transglutaminase antibody IgA,and biopsies of duodenal bulb,descending part of the duodenum and terminal ileum were obtained under endoscopy.Histological examination was performed by experienced pathologists according to the modified Marsh grading system.Results:The most common pathological grade of duodenal bulb(50.0%)and descending part of the duodenum(45.5%)was Marsh Ⅲc,while those of terminal ileum was Marsh Ⅲa(63.6%).All of the bulb biopsies,95.5%of the descending part and 72.7%of the terminal ileum biopsies showed characteristic histological changes of celiac disease.Mucosal pathology was patchy in 7 patients,of which one patient was duodenal bulb and terminal ileum involved,and 6 were duodenum involved only.Fifteen patients had diffuse small intestinal mucosal pathology involving duodenal bulb,descending part and terminal ileum,of which 4 patients showed concordant histology(the same Marsh grade in duodenal bulb,descending part and terminal ileum)and 11 patients showed discordant histology.In 18 patients(81.8%),duodenum was the only affected site or duodenum showed more serious mucosal lesions compared with terminal ileum.Conclusions:Adult celiac disease may affect the whole small intestine,and the mucosal involvement may be patchy,which highlights the importance of taking small intestinal biopsies from multiple sites repeatedly in the diagnostic work-up of celiac disease.

Objective:To investigate the efficacy of induced membrane technique combined with anterolateral thigh flap transfer in treating composite foot defect.Methods:A retrospective case series study was performed for 7 patients with composite foot defect treated at 920th Hospital of Joint Logistic Support Force of PLA from February 2014 to December 2018. There were 5 males and 2 females, with the age of 20-73 years [(38.9±16.3)years]. The composite defect located at the forefoot in 5 patients, midfoot in 1, and hindfoot in 1. There were 9 metatarsal bone defects, 1 medial cuneiform bone defect, and 1 calcaneus bone defect. The size of soft tissue defect varied from 6 cm×5 cm to 70 cm×35 cm. At stage I, the anterolateral thigh flap transfer and vancomycin loaded cement implantation were performed. The flap survival and complications were recorded. At stage II, the cement was removed and autogenous bone was grafted into the induced membrane. The duration of two-stage operation, bone union time, and complications were recorded. The postoperative function was assessed using Maryland foot score system before operation and at the last follow-up and postoperative compications were documented.Results:All patients were followed up for 22-54 months [(33.8±9.7)months]. At stage I, flaps survived in all patients, and bulking of the flap was seen in 3 patients. One patient with calcaneus bone defect had repeated infection after operation, and received debridement. At stage II, 6 patients received bone grafting surgery. The duration of two-stage operation was 2-4 months [(2.8±0.9)months]. The bone union time was 3 and 7 months [(4.7±1.2)months]. At the last follow-up, the Maryland foot function score was 63-92 points [(82.1±8.7)points], significantly different from 0 point before operation ( P<0.01). The results were excellent in 1 patient, good in 5, and fair in 1. Except for one nonunion of metatarsal bone, all the other 8 sites were with bone union uneventfully. Conclusion:The induced membrane technique combined with anterolateral thigh flap transfer is an effective protocol for composite foot defect, which can well repair soft tissue and bone defect, and restore walking.

Objective:To introduce the concept and procedures of precise flap surgery in construction of knee defects and to report the preliminary clinical outcomes.Methods:The data of 16 patients with knee defects at 17 sides were retrospectively analyzed who had been treated under the guidance of the concept of precise flap surgery at Department of Orthopedic Surgery, The 920th Hospital of Joint Logistic Support Force of PLA from August 2014 to March 2022. There were 12 males and 4 females, aged 44(34, 54) years. The wounds were at the left side in 8 cases, at the right side in 7 ones and at bilateral sides in one, and their sizes ranged from 5 cm×3 cm to 15 cm×11 cm. The time from injury to surgery was 8.5(6.0, 13.0) days. Optimal repair protocols were chosen after the donor and recipient sites were evaluated according to the methods of precise flap surgery: a retrograde anterolateral thigh flap in 7 sides, a descending genicular artery perforator flap in 3 ones, a saphenous artery flap in 2 ones, and a superior genicular lateral artery perforator flap, a popliteal artery perforator flap, a medial sural perforator propeller flap, a peroneal artery perforator propeller flap, and a randomized flap in one, respectively. The flap sizes ranged from 10 cm×6 cm to 15 cm×15 cm. The outcomes and complications of skin flap repair, and functional recovery of the affected limb were recorded.Results:All the flaps at 17 sides survived after surgery; 3 cases developed distal edge necrosis which responded to dressing change. The follow-ups for the 16 patients were 14.5(10.0, 28.0) months. All the flaps presented with good color, texture and contour. Flap bulking, local osteomyelitis, and scar ulcer was found in one case respectively. According to the revascularization assessments in the digital replantation criteria by Hand Surgery Society, Chinese Medical Association, all the flaps at 17 sides were excellent. Accoding to the knee functional evaluation of Hospital for Special Surgery (HSS) at the last follow-up, the 17 affected limbs scored 86(80,91) points, yielding 9 excellent, 7 good and 1 fair sides.Conclusion:Although the defects and donor sites around the knee vary greatly, precise flap surgery may lead to effective control of the variations, choice of an optimal reconstruction protocol, and precise wound repair.

Objective:To investigate the preliminary clinical effect of posterior interosseous artery propeller flap in the repair of dorsal of wrist and hand wounds.Methods:From March, 2015 to December, 2019, 9 cases of dorsal of wrist and hand wounds were repaired with posterior interosseous artery propeller flap, including 6 cases of dorsal hand defect and 3 cases of dorsal wrist defect. Defect area: 6 cm × 4 cm-3 cm × 3 cm; There were 3 cases of metacarpal fracture, 1 case of phalangeal fracture and 1 case of tendon rupture. According to the size and shape of the wound, the posterior interosseous artery propeller flap was designed to transfer and repair the soft tissue defect wound. The size of the flap: 20 cm × 5 cm-12 cm × 3 cm, the size of posterior interosseous artery propeller flap was recorded and the surgical characteristics were summarized; The survival of the flap, donor and recipient complications were observed and followed-up.Results:All flaps were cut smoothly and the donor areas were sutured directly. The flap survived completely in 8 cases and partial necrosis in 1 case; One case complicated with wound infection. The follow-up ranged from 6 to 31 months, with an average of 14 months. The texture and shape of the flap were good; The last DASH score was 3-18, with an average of 9.3; There were 2 cases of mild scar hyperplasia in the donor area and 1 case of mild scar hyperplasia at the edge of the flap.Conclusion:Posterior interosseous artery propeller flap may be an effective method to repair small and medium-sized wounds of dorsal of wrist and hand.