Objective To investigate the effect of strengthening self -management on the treatment compliance and outcome in hepatitis B patients with decompensated cirrhosis treated with entecavir.Methods A total of 120 hepatitis B patients with decompensated cirrhosis, who received antiviral therapy with entecavir in our hospital from January 2010 to January 2012,were randomly divided into control group (n=60)and intervention group (n =60).Both groups received routine nursing care;in addition,regular telephone follow -up was performed for the intervention group to provide guidance for the self -management during the comprehensive prevention and treatment of decompensated cirrhosis.The two groups were compared in terms of withdrawal rate,rehospitalization rate,hepatitis B virus (HBV)DNA negative conver-sion rate,incidence of primary liver cancer,and mortality one year later.Continuous data were analyzed by t test,and categorical data by chi -square test or Fisher′s exact test.Results The withdrawal rate and rehospitalization rate in the intervention group were 0 and 18.3%, respectively,versus 8.3% and 35% in the control group (P <0.05 for both).The HBV DNA negative conversion rate,incidence of prima-ry liver cancer,and mortality in the intervention group were 90%,3.3%,and 5.3%,versus 88.3%,5%,and 6.7% in the control group (P >0.05 for all).Conclusion Strengthening self -management,as well as regular health education,can improve treatment compliance and promote recovery in hepatitis B patients with decompensated cirrhosis treated with entecavir.

Objective To explore the mechanism 、diagnosis of pancreatic encephalopathy(PE);To evaluate the therapy of PE.Methods To analyze the treatment and diagnosis of 23 PE patients.Results 12 PE patients were cured.11patients were dead,the mortality is 47.8%,5patients in operation group died,the mortality is 62.5%.6 patients in non-operation group were dead,the mortality is 40%,among them,5patients died for multiple organ system falure.one died for septic shock.Conclusions PE is relating to serum amylase inflammatory mediators and infection etc.The diagnosis of PE is based on AP and neurological and mental abnormality.The relative auxiliary diagnosis standard is uncertain.the conventional therapy of PE 、the remedy of MOSF and disorder in water and electroltes were basic therapy.the nerve preserving is necessary for PE's therapy.

Objective To investigate the feasibility and efficacy of vaginal sacrospinous ligament fixation (VSSLF) procedure which reserving uterus in the treatment of uterine prolapse. Methods 8 cases with uterine pro-lapse underwent VSSLF procedures which reserving uterus from July 2006 to December 2008. Those with incontinence d urine simultaneously underwent ventrofixation of the middle piece of the urethra and folding of the ligamentum pos-terius of the uretha and those with anterior or posterior vaginal wall prolapse underwent eolporrhaphia anterior-posteri-or. Results All patients successfully accomplished by VSSLF,without intraoperative or postoperative hemorrhage or organ injury. All patients' prolapse symptoms were relieved efficently according to the pelvic organs prolapse quantifi-cation(POP-Q). Patients were followed-up for 18 months after operation. 8 patients all recovered well without any complication related to the procedure after operation. Conclusion VSSLF is a simple,safe,effective and micro-inva-sire way for patients with uterine prolapse who want to reserve uterus.

Objective To evaluate the application effect of evidence-based nursing in reducing ventilator-associated pneumonia (VAP) of patients with severe head injury. Methods 100 patients with severe head injury using mechanical ventilation were randomly divided into the control group and the observation group with 50 patients in each group.The observation group explored evidence from nursing of ventilator tube,oropharyngeal and sound sects care,airway care,balloon sleeves care to prevent biofilm on the endotracheal tube(ETT-BF) to fall off,enteral nutrition care,decubitus care,ward environment and the hand disinfection of medical staff and was given evidence- based nursing.The control group took routine care.The incidence of VAP,off-line time and mortality rate of the two groups were compared during the same time period. Results The incidence of VAP,off-line time,mortality rate showed significant difference between the two groups.The observation group showed better effect. Conclusions Implementation of evidence-based nursing can significantly reduce the off-line time of patients with severe traumatic brain injury using mechanical ventilation.It can decrease the incidence of VAP and mortality rate,improve the prognosis and reduce medical cost.

Objective To investigate the safety and feasibility of fast track surgery (FTS)in patients with vaginal hysterectomy for non -prolapsed uterus.Methods 1 1 0 cases of vaginal hysterectomy for non -prolapsed ute-rus with benign uterine disease were randomly divided into two groups:fast track group (n =55)and conventional group (n =55).The operative time,intraoperative blood loss,postoperative nausea and vomiting,anal exhaust time, postoperative hospital stay,medical cost and perioperative complications were compared between the two groups. Results In FTS group,the incidence rate of postoperative nausea and vomiting,the postoperative anal exhaust time, hospital stay,cost of hospitalization were 1 6.4%,(1 3.73 ±2.41 )h and (4.38 ±1 .08 )d,(7 541 .00 ± 253.1 7)yuan,respectively,which in the control group were 36.4%,(1 8.56 ±1 .54 )h,(4.89 ±1 .26 )d, (8 1 55.1 5 ±495.89)yuan,the differences were statistically significant between the two groups (χ2 =5.67,t =-1 2.53,-2.28,-8.1 7,all P <0.05).There was no significant difference in the operative complications between the two groups (P >0.05).Conclusion FTS has good security.It can short the hospitalization time,reduce medical costs and improve the quality of life in patients who underwent vaginal hysterectomy for non -prolapsed uterus with benign uterine disease.

Forty-six patients with intractable urticaria were treated by acupuncture plus garlic-partitioned moxibustion. The results were compared with those of simple acupuncture in a control group of 30patients. The total effective rate were 91.3%, in the observation group and 73.3%, in the control group. It is showed that acupuncture plus garlic-partitioned moxibustion has a better effect on intractable urticaria than simple acupuncture.

ObjectiveTo explore the changes of the levels of cytokines in patients with first-episode depression and the effect on the levels of cytokines after the treatment with duloxetine.MethodsThe serum levels of interleukin 1 ( IL-1 ),interleukin 6 ( IL-6 ),tumor necrosis factor-alpha ( TNF-αt ),interleukin4 ( IL-4 ),interleukin10(IL-10) were measured in 38 patients with depression before and after duloxetine treatment by enzyme linked immunosorbent assay(ELISA).HAMD score were assessed at pre- treatment and post-treatment to assess curative effect.The control group was 30 healthy individuals.All data were statisticaly analyzed by SPSS.ResultsBefore treatment,the HAMD score and the levels of serum IL-6,TNF-α,IL-1 in first-episode depressant patients were remarkablely higher than those in the control group( IL-6:( 10.66 ± 3.12 ) pg/ml vs (2.72 ± 0.91 ) pg/ml ;TNF-α:(77.49 ±3.12) pg/ml vs (37.48 ±5.87) pg/ml; IL-1:(39.09 ± 3.77 ) pg/ml vs ( 10.31 ± 1.05 ) pg/ml ),the levels of serum IL-4 and IL-10 in first-episode depressant patients were remarkablely lower than those in the control group(P＜0.05,P＜0.01 ).The HAMD score and the levels of serum IL-6,TNF-α,IL-1 in post-treatment were remarkablely lower than pre-treatment (P ＜ 0.05 ),but which were still higher than the control group(P＜ 0.05 ).The levels of serum IL-4 and IL-10 in post-treatment were remarkablely increased than pre-treatment(P＜0.05).The levels of serum IL-6,TNF-α,IL-1 were positively correlated with the HAMD score( r =0.667,0.486,0.727,P ＜0.01 ),but the levels of serum IL-4 and IL-10 were negatively correlated with the HAMD scorae ( r=-0.433,-0.269,P＜0.05,P＜ 0.01 ).ConclusionsThe first-episode depressant patients show immune disorder induced by cytokines.Anti-depressant activity of duloxetine may participate in the regulation of cytokines and Th1/Th2 unbalance.

Objective To study the findings of measles associated with pneumonia and to improve the diagnostic level of this disease.Methods The chest X-ray of 280 cases with pneumonia among 310 children with measles from January 2005 to August 2006 were collected and analyzed retrospectively.Results The most common findings of chest X-ray examinations included blurred and increased lung markings(in all cases),pulmonary air-sacs luminance increase and emphysema-like change in 206 cases(73.6%),spotted shadows and patches in the bilateral middle and lower field in 91 cases(32.5%),enlarged and blurred pulmonary hila in 115 cases(41.1%),interstitial appearance in 98 cases(35%),serious pneumonia and ARDS in 4 cases(1.4%).Conclusion It is valuable in the diagnosis and differential diagnosis of measles accompanying pneumonia in children to analyze the chest X-ray combining with clinical situation.

Objective To observe the impact of Angong Niuhuang Wan(安宫牛黄丸) on orexin-A,neuropeptide Y(NPY) and Leptin in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Total 50 mild and moderate cases of OSAHS which were definitely diagnosed by the results of polysomnogram′s monitoring were selected and randomly divided into treatment group and control group(each n=25).The treatment group took one pill of Angong Niuhuang Wan everyday before sleep for 30 days,while the control group received no treatment.Then the levels of orexin-A,NPY and Leptin were tested by radio-immune assay and enzyme linked immunosorbent assay(ELISA) to compare the changes of 3 indexes before and after the treatment and compare the result differences between the two groups.Results Compared with the control group,after treatment,apnea hypopnea index(AHI) and arousal index of treatment group were obviously decreased((16.33?3.57) times/h vs.(22.23?9.98) times/h,(103.58?32.90) times/s vs.(127.89?42.78) times/s),the average pulse oximetric saturation(MSpO2) and the lowest pulse oximetric saturation(LSpO2) were significantly increased(0.950?0.032 vs.0.934?0.048,0.830?0.041 vs.0.826?0.127,P0.05).The correlative analyses indicated that the levels of orexinA,Leptin and NPY in the patients of OSAHS had positive correlations with AHI(r1=0.445,r2=0.480,r3=0.454) and awareness index(r1=0.613,r2=0.510,r3=0.479,P

Objective To observe the parameters and effect of endocardial pacing by steel wire electrode cardiac puncture on heart with normal beat in living animal, and evaluate its safety.Methods After anaesthesia and thoracotomy in 6 living dogs with normal heart beat, the pericardia were excised. Steel wire electrodes with annular or hook tips were used respectively at right ventricular 4 corresponding spots to perform cardiac puncture endocardiac pacing (each dog experienced 8 times of puncture); the time from puncture to effective pacing, pacing parameter and puncture complication (time and quantity of bleeding) of each electrode at each spot were recorded. Finally, the two types of electrode completed 24 times of manipulation respectively; the data collected of the two types were compared. Results The cardiac pacing successful rates in the two groups were 100%; the time taken from the beginning of heart puncture to effective pacing in annular tip group was less than that in hook tip group, but the time difference between the two groups showed no statistical significance (s: 18.4±2.3 vs. 19.6±4.1,P > 0.05). The parameters of pacing in the annular tip group, such as operation time (s: 18.4±2.3 vs. 19.6±4.1), the threshold value of pacing (V: 2.1±0.2 vs. 2.2±0.8), the amplitude of R wave sensed (mV: 11.3±3.2 vs. 12.6±4.1) and the impedance of electrode (Ω: 674.2±89.7 vs. 668.5±101.3) were not significantly different compared with those in the hook tip group (allP > 0.05). Either after puncture or after the electrodes were taken out, the time of bleeding [after puncture (minutes): 4.4±2.3 vs. 4.5±3.1, after the electrodes taken out (minutes): 4.1±2.2 vs. 4.8±2.5] and the volume of bleeding [after puncture (mL): 2.8±2.4 vs. 3.2±3.5, after the electrodes taken out (mL): 3.3±1.7 vs. 3.5±2.6] were not significantly different between the two groups (allP > 0.05).Conclusions In living dogs with normal heart beat, the manipulation and function of endocardiac pacing by cardiac puncture with either steel wire annular or hook tip electrode are well and effective, and the performance is simple and safe without any serious myocardial injury and complication. Thus, it is helpful to quickly establish efficient endocardiac pacing in emergency cases.