OBJECTIVE To introduce process management to procedure and standardization of infection management in common ward.METHODS Establishing and applying hospital infection control process,to use it in internal medicine and surgery wards(eight wards).Retrospective investigation was conducted to analyze the data.RESULTS Before and after using infection control process,there were significant differences between incidence of hospital infection in inpatients(P

ObjectiveTo improve nursing quality by paying attention to management of nurses' psychology and behavior and changing individual and collective behavior.MethodsGuided by dynamic field theory,giving nursing staff continuous periodic training and counseling,establishing a staff interview system,giving systematic support and enhancement to develop a high-performance team.A case-control study was carried out in eight wards to evaluate implementation effect by comparison study.ResultsBefore and after introducing dynamic field theory,there were significant differences in job satisfaction of nurse staff (P<0.01),in patients' satisfaction(P<0.05),in evaluation of nursing staff management efficiency(P<0.05).ConclusionsApplication of dynamic field theory in nursing management can improve job satisfaction of nurse staff,patients' satisfaction and nurses' post suitability,and obtain continuous nursing quality improvement.

Objective To evaluate the potential protective effects of erythropoietin (EPO) in combination with granulocyte-colony stimulating factor (G-CSF) on hypoxia cardiomyocytes. Methods After left ventricular cardiomyocytes were isolated from neonate rat, the cells were inoculated in a cultural atmosphere of 95%N2 and 5%CO2 for 24 h to establish hypoxia cardiomyocytes model. The protective effects of EPO and G-CSF at different concentrations were evaluated for the optimal concentration. Then the protective effects of EPO in combination with G-CSF were investigated under the optimized concentrations. The survival, apoptotic and necrotic rates of cardiomyocytes were assessed by flow cytometry. Results The mortality and ratio of apoptotic cells to total necrotic cell were higher in hypoxia cardiomyocytes than normal cells significantly (26.73% vs 5.63%,70.05% vs 37.83%, P0.05), and the combination group was much better than EPO and G-CSF alone groups (P

Objective:To observe the clinicopathological features of gastrointestinal stromal tumor (GIST) cases with concurrent carcinoma. Methods:Patient data of 24 GIST cases with concurrent carcinoma were collected from the 157 GIST cases reported be-tween 2002 and 2012. The clinicopathological features of the GIST cases with concomitant carcinoma were studied. The expression of CD117, CD34, and SMA by the tumors was assayed using the immunohistochemical EliVision method. In particular, the expression of the proliferation marker Ki-67 was studied. Results:GIST cases with concurrent carcinoma accounted for 15.3%of the total GIST cas-es studied. The GIST patients with concurrent carcinoma included 14 males and 10 females. The male-female ratio of these patients was 1.4∶1. The age of the patients ranged from 41 years to 66 years, with a median age of 55 years. Lesions at the inferior segment of the esophagus were found in 7 of the 24 selected GIST cases;lesions at the gastric wall and in the intestines were observed in 15 and 2 cas-es, respectively. The diameter of the GIST cases with concurrent carcinoma ranged between 0.6 and 3.8 cm, with an average of 1.50 ± 0.85 cm. Slight dysplasia was observed in 4 of the 24 cases; no heteromorphism was present in the remaining 20 cases. The mitotic counts of GIST cases with concurrent carcinoma ranged from 0/50 HPF to 5/50 HPF, with an average of (0.79±1.83)/50 HPF. The pro-liferative index of Ki-67 in the GIST cases with concurrent carcinoma ranged between 0 and 7.72, with an average of 2.16 ± 3.26. The concurrent carcinoma cases included 5 cases with esophageal carcinoma, 2 with cardiac carcinoma, 15 with gastric cancer, and 2 with intestinal cancer. In contrast to the GIST cases with concurrent carcinoma, the GIST cases without carcinoma complications included 74 males and 59 females. The male-female ratio was 1.25∶1. The age of the patients without concurrent carcinoma ranged from 43 years to 71 years, with a median age of 54 years. Among the 133 GIST cases without cancer complications, gastric, intestinal, and esophageal lesions were found in 114, 13, and 6 cases, respectively. The diameter of GISTs without cancerous complications ranged from 2.4 cm to 15.5 cm, with an average of 6.11 ± 7.09 cm. Different degrees of dysplasia were seen in 82 of the 133 cases. The mitotic counts in the GIST cases without cancer complications ranged from 0/50 HPF to 53/50 HPF, with an average of (3.81±23.67)/50 HPF. The prolifera-tive index of Ki-67 for these cases ranged from 0 to 39.21 and averaged at 6.22 ± 16.96. The male-female ratio of the GIST cases with cancer complications was higher compared with the GIST cases without. The average diameter of GISTs with complications was small-er compared with that of GISTs without complications. The mitotic counts and the proliferative index of Ki-67 were significantly lower in the GIST cases with cancer complications than in those without (t=1.981, P<0.05 vs. t=1.993 5, P<0.05). Conclusion:Concurrent car-cinomas were found in 15.3% of the total GIST cases. No special clinical symptoms were observed in most GIST cases with cancer complications, as revealed when the carcinomas were examined. The proliferative index of Ki-67 in the GIST cases with concurrent car-cinoma is significantly lower compared with that of the GIST cases without complications.

Objective To evaluate the diagnostic value of the level of plasma D-dimer,high-density lipoprotein (HDL),carcino embryonic antigen (CEA) and carbohydrate antigen 724 (CA724) in gastric cancer.Methods The plasma and clinicopathological data of 103 gastric cancer patients and 111 normal controls were collected.The levels of D-dimer,HDL,CEA and CA724 were detected.SPSS 13.0 statistical software was applied to analysis the sensitivity and specificity of each examination method and to find out the appropriate combination.Results The levels of D-dimer,CEA and CA724 in patients with gastric carcinoma were 0.87 (2.69) μg/ml,2.66 (4.38) ng/ml,5.10 (7.79) U/ml,respectively,they were distinctly higher than those in normal controls [0.22 (0.21) μg/ml,1.28 (1.60) ng/ml,1.81 (1.60) U/ml,all P =0.000].HDL level was significantly lower in patients than that in normal controls [0.86 (0.35) mmol/L vs 1.29 (0.44) mmol/L,P=0.000].The area ofROC curve of D-dimer,HDL,CEA,CA724 were 0.799,0.859,0.739,0.743,respectively.The cut-off of D-dimer was 0.46 μ.g/ml,the sensitivity was 68.0 ％,the specificity was 86.5 ％.The cut-off of HDL was 0.995 mmol/L,the sensitivity was 73.8 ％,the specificity was 84.7 ％.The cut-off of CEA was 3.585 ng/ml,the sensitivity was 44.7 ％,the specificity was 92.0 ％.The cut-off of CA724 was 3.765 U/ml,the sensitivity was 57.3 ％,the specificity was 89.2 ％.The sensitivity of D-dimer+HDL+CA724 was 83.5 ％,the specificity was 89.2 ％.The sensitivity and specificity of D-dimer+HDL+CEA+CA724 were 84.5 ％ and 89.2 ％,respectively.Conclusions The D-dimer+HDL+CEA+CA724 may provide the evidence for diagnosis of gastric cancer.Combined detection has higher sensitivity and specificity.

Objective To identify the histopathological characteristics of multiple organ dysfunction syndrome (MODS) with V. vulnificus in mice. Methods Sixteen healthy KM mice (6～8 week old ) divided randomly into two groups, study group ( n =12) and control group ( n =4) The animal model of MODS was established by received either an intraperitioneal, intramuscular subcuneous inoculum of 4.34?10 6 cfu/0.2 ml of V.vulnificus or intraperitioneal injection of a sterile physiological salt solution (control group). Pathological changes of the man organs were individually obsenved in under election microscope (EM). Results Mortality rates exced 100%, 12/12) in study group after inoculums of mice within 4～8 h, while in 0% (0/0) in the control . The detection rate of V. vulnificus were in 100%(12/12) from blood, hearts, lungs, livers, intramuscularly, subcutaneous in the study group, while in 0% (0/4) after sterile saline intraperitioneal injection. The man histopathological changes were :degeneration and necrosis of the parenchyma cells in the different organs;interstitial swelling, mitochondriondrial injure of multiple organs.These changes were especially obvious in the lungs and myocardeum. Conclusions Above pathological changes suggested that results of MODS caused by V. vulnificus septicemia,the multiple organs failure as an important feature of the fatality of V. vulnificus infections,and my be helpful for researchers investigating of V.vulnificus.

Objective To explore the effect of using cluster nursing measures on expectoration in mechanical ventilation patients after craniocerebral operation. Methods Convenient sampling and controlled trials at not the same period were used. Sixty-seven mechanical ventilation patients after craniocerebral operation were selected as the research objects in Department of Neurosurgery Intensive Care Unit (ICU) of the First Hospital Affiliated to Wenzhou Medical College. Thirty-two patients treated from June 2015 to June 2016 were assigned in the control group, and they were given routine respiratory nursing care; 35 patients admitted and treated from July 2006 to July 2017 were included in the intervention group, and they were given evidence-based cluster nursing intervention measures on the basis of routine care. The differences in expectoration effect, arterial blood gas analysis index, incidence of pulmonary infection and prognosis of patients in two groups were compared. Results Compared with control group, the amount of expectoration in the intervention group was significantly increased (mL/d: 49.69±9.45 vs. 33.72±10.63, P < 0.05), while the daily number of sputum suction (times: 21.57±2.31 vs. 28.76±22.66), the time needed for each sputum suction(s: 6.81±1.74 vs. 9.28±2.52), respiratory frequency (bpm: 26.26±1.83 vs. 28.58±1.36), incidence of pulmonary infection [0 vs. 12.5% (4/32)], time of mechanical ventilation (days: 6.37±2.51 vs. 8.92±3.32), time of ICU stay (days: 7.49±3.87 vs. 10.33±2.12), time of hospital stay (days: 10.31±1.99 vs. 14.56±3.57), fatality rate [8.6% (3/35) vs. 21.9% (7/32)] in the intervention group were significantly decreased (all P < 0.05); after treatment the arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation degree (SpO2) were significantly increased than those before treatment, and the arterial partial pressure of carbon dioxide (PaCO2) was significantly decreased than that before treatment, and the degrees of improvement in the intervention group on 5 days were significantly better than those in the control group [PaO2(mmHg, 1 mmHg = 0.133 kPa): 60.89±3.44 vs. 57.34±2.49, PaCO2(mmHg): 41.06±4.32 vs. 45.22±4.78, SpO2: 0.986±0.030 vs. 0.963±0.023, all P < 0.05]. Conclusion The cluster nursing measures can effectively improve the expectoration effect for mechanical ventilation patients after craniocerebral surgery, reduce the mortality and incidence of pulmonary infection, shorten the stay in ICU and improve the prognosis, suggesting that the measures be worthy to be applied widely in clinics.

OBJECTIVES: This study evaluated the prognostic power of serum uric acid (UA) in predicting adverse events in elderly acute coronary syndrome (ACS) patients with diabetes mellitus (DM). METHODS: The analysis involved 718 ACS patients ‍>80 years old whose general clinical data and baseline blood biochemical indicators were collected prospectively from January 2006 to December 2012. These patients were classified into two groups based on DM status, and then followed up after discharge. The Kaplan-Meier method was used for major adverse cardiac event (MACE) rates and all-cause mortality. Multivariate Cox regression was performed to analyze the relationship between UA level and long-term clinical prognosis. Receiver operating characteristic (ROC) curves were analyzed to predict the cutoff value of UA in elderly ACS patients with DM. There were 242 and 476 patients in the DM and non-DM (NDM) groups, respectively, and the follow-up time after discharge was 40‒120 months (median, 63 months; interquartile range, 51‒74 months). RESULTS: The all-cause mortality, cardiac mortality, and MACE rates in both DM and NDM patients were higher than those in the control group ( CONCLUSIONS Serum UA level is a strong independent predictor of long-term all-cause death and MACE in elderly ACS patients with DM.