BACKGROUND: Buqi tongluo prescription, which is characterized by invigorating qi and promoting blood circulation, dredging collaterals and dispersing stagnation, promoting tissue regeneration, and promoting blood circulation to remove obstruction in the collateral, can promote blood circulation at local injured part and ameliorate nutrien of nerve so as to accelerate axonal regeneration of peripheral nerve and functional recovery of nerve conduction.OBJECTIVE: To observe the effect of buqi tongluo prescription of various agents on recovery of nerve function after peripheral nerve injury and compare the results with the combination of vitamin B1 and B6.DESIGN: Randomized controlled animal study.SETTING: Department of Orthopaedics of the First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine.MATERIALS: A total of 48 Wistar rats of confined clean grade were selected in this study. After modeling on right sciatic nerve, rats were randomly divided into buqi tongluo capsule group, buqi tongluo parenteral solution group, vitamin group and blank group with 12 in each group.METHODS: All rats were cut their right sciatic nerve laterally, and then anastomosis in situ was used immediately to establish models of peripheral nerve injury. Administration began on the third day after operation once a day. ① Rats in buqi tongluo capsule group were perfused with powder of buqi tongluo capsule (including huangqi, renshen, danggui, chuanxiong and danshen which was diluted with saline) of 0.9 g/(kg·d) raw drugs (ig). ② Rats in buqi tongluo parenteral solution group were injected with 0.9 g/(kg·d) buqi tongluo parenteral solution (ip). ③ Rats in vitamin group were perfused with 15 mg/(kg·d) suspension (1.5 g/L) of vitamin B1 and B6.④ Rats in blank group were perfused with 0.01 mL/g saline.MAIN OUTCOME MEASURES: Four rats from each group were selected for 4, 8 and 12 week time points after administration to record bilateral nerve conduction velocity. Recovery rate was regarded as the ration between nerve conduction velocity at the injured side and nerve conduction velocity at the normal side.RESULTS: A total of 48 rats were involved in the final analysis. ① At each time point, nerve conduction velocity in two buqi tongluo prescription groups were faster than that in vitamin group and blank group (P ＜ 0.05, 0.01), and that in vitamin group was faster than that in blank group (P ＜ 0.05). ②At each time point, recovery rate of nerve conduction velocity in two buqi tongluo prescription groups was higher than that in vitamin group and blank group (P ＜ 0.05, 0.01), and that in vitamin group was higher than that in blank group (P ＜ 0.05).CONCLUSION: Both buqi tongluo capsule and buqi tongluo parenteral solution can promote recovery of nerve function after peripheral nerve injury, and the effect is superior to that of vitamin B1 and B6.

Objective To evaluate the methods for the prevention of internal jugular vein malposition of peripherally inserted central catheter (PICC) in patient with limited neck motion.Methods 210 patients who underwent PICC placement using ultrasound-guided modified Seldinger technique were divided into observation group (n =106) and control group (n =104) with a random number table.Ultrasound probe compression on the internal jugular vein was used in the observation group,while finger compression was used in the control group.The 2 groups were compared in terms of incidence of internal jugular vein malposition,accuracy of PICC tip position in X-ray,and incidence of complications.Results Incidence of PICC malposition was significantly lower in the observation group than the control group [3 (2.8％) vs.36 (34.6％),P =0.000].The accuracy of PICC tip position in both groups was 100％.No complication was observed in the observation group,while the rate of complication in the control group was 4.8％,with a statistically significant difference (P =0.022).Conclusion The ultrasound probe compression method can significantly lower the incidence of internal jugular vein malposition of PICC and is safer than the finger compression method.

ObjectiveTo study the effects of botulinum toxin type A (BTX-A) injection combined with functional training on the tiptoe deformation and gross motor function in children with spastic cerebral palsy (SCP). Methods60 SCP children with tiptoe deformation whose family consented to inject BTX-A were as treatment group and treated with BTX-A combined with function training, while other 46 SCP children as control group were only treated with functional training. They were assessed with Composite Spasticity Scale (CSS), the angle of ankle passive dorsiflexion motion and D and E domains of Gross Motor Function Measure (GMFM) before and 1 week, and 3 months after treatment. ResultsThe effect of BTX-A began from 24 to 72 h after injection, reached the peak from 1 to 2 weeks, maintained beyond 3 months with few side effects. There were significant differences between 2 groups in the outcome of CSS,the angle and the standing and walking value (GMFM) 1 week and 3 months after treatment (P<0.01). ConclusionBTX-A combined with functional training is more effective on reducing spasticity of the lower extremity, correcting the tiptoe deformation, increasing the range of ankle motion, improving gross motor function.

Objective To summarize the experience of diagnosis and treatment strategy of pancreatic injury.Methods The data of 36 cases of pancreatic injurics admitted to Fujian Medical University Provincial Clinical College from 1990 to 2011 were analyzed retrospectively.Results 14 cases(39％)were diagnosed preoperatively,and the other cases were diagnosed during the laparotomy.2 cases underwent non-surgical treatment.34 cases underwent surgical treatment,among whom 23 cases underwent pancreatic debridement and drainage,6 cases underwent distal pancreatectomy(4 cases undergoing distal pancreatectomy plus splenectomy included),4 cases underwent distal Roux-Y pancreajejunostomy plus proximal pancreas closure,and 1 case underwent pancreatoduodenectomy.31 cases (86％) were cured,and 5 cases died (14％).Conclusions Most of the pancreatic injury is diagnosed through laparotomy.Surgical opcration is the main approach to treat pancreatic injury.Nonsurgical treatment is primarily limited to grade Ⅰ and Ⅱ pancreatic injury without obvious peritonitis,major pancreatic duct injury,and associated injuries.Surgical procedure should be selected based on the grading scale of pancreatic injury,associated injuries and overall conditions of the patient.

ObjectiveTo explore the effects of Botulinum toxin type A （BTX-A） on upper extremities function of children with spastic cerebral palsy. Methods27 children with spastic cerebral palsy who were treated with comprehensive rehabilitation training and BTX-A were arranged as treatment group, and other 30 children who were treated with comprehensive rehabilitation training only as control group. They were assessed with upper extremities functional test (UEFT) before and after treatment. ResultsAfter 3 months of treatment, the scores of UEFT improved more in the treatment group than in the control group (P<0.01). ConclusionBTX-A can improve upper extremities function of the children with spastic cerebral palsy.

Objective To investigate the effects of mesenchymal stem cells(MSCs)on the pathological structure and cytokine expression of lung tissue in septic model of diabetic rats. Methods Diabetic rats were ran-domly divided into control,sham-operation,sepsis and MSC-treated groups. The diabetic model was induced by high-sucrose and high-fat diet combined with streptozotocin and cecal ligation and puncture. The pathological changes of lung tissue were observed at 6,12,18 and 24 hours after operation respectively,and the expression of SP-D,TNF-α,IFN-γ and IL-10 in lungs were measured.Results The levels of SP-D,TNF-α and IFN-γ in lung tissue increased gradually with the elongation of time after CLP. The expression of IL-10 in lung tissue increased and then decreased. The trend of MSC intervention increased the content of SP-D,TNF-α and IL-10 in the lung tissue of non-diabetic septic rat model and reduced the content of IFN-γ.MSC intervention reduced the SP-D and TNF-α content.The intervention of MSC had no effect on the content of IFN-γ in the lung tissue of diabetic septic rats.However,it increased and then decreased the content of IL-10.Conclusions The model of sepsis in diabetic rats can be established by feeding combined high-sugar and high-fat diet and streptozotocin combined with cecal ligation and puncture. Mesenchymal stem cells affect sepsis inflammation and organ damage. But its specific role depends on the immune status and the timing of mesenchymal stem cell selection.

Objective The aim of present study was to detect methylation rate of CpG unit of brain derived neurotrophic factor (BDNF) promoter and to study the epigenetic mechanism of autism spectrum disorders (ASD).Methods Total of 12 ASD patients and 12 healthy controls were recruited.The methylation rate of CpG unit in BDNF promoter Ⅰ and Ⅳ were detected using Sequenom MassArray method.The methylation model,correlationship,evolutionary relationship of CpG units in BDNF promoter Ⅰ and Ⅳ were detected and compared between ASD patients and healthy controls.Results The methylation rate was identified in 17 and 8 CpG units in BDNF promoter][and BDNF promoter Ⅳ.A close correlation distance was detected in BDNF promoter Ⅰ CpG units 4,7,10,35,and BDNF promoter Ⅳ CpG units 11.12,14.BDNF promoter][CpG units 4,7,10,35,and BDNF promoter Ⅳ CpG units 11.12,14 could be clustered.ASD patients had a significant lower methylation rate in BDNF promoter Ⅰ CpG unit 5.6 and Ⅳ CpG units 3 and 15 compare with healthy controls (P＜0.05).Conclusions The DNA methylation rate in BDNF pronoter Ⅰ CpG unit 5.6 and Ⅳ CpG units 3 and 15 may be used as potential biomarkers of ASD.

Objective: To investigate the clinical characteristics and outcomes of Maisonneuve fractures. Methods: Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days). Results: Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21). Conclusion The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.

Objective To explore the construction of modular intervention for patients dependent on mechanical ventilation in ICU,and to conduct the clinical empirical study.Methods A total of 100 mechanical ventilation-dependent patients in ICU were enrolled and divided into two groups according to the admission order,with 50 patients in each group.Control group received routine intervention,while observation group was treated with modular intervention in addition to the treatment given to control group.The weaning success rate,weaning time,complications,rehabilitation index,blood gas analysis index,psychological state,and nutritional status were compared between two groups.Results Compared with control group,observation group had higher weaning success rate,shorter weaning time,ICU stay and general ward admission,and lower incidence of complications(P<0.05).After intervention,observation group had lower PaCO2,and higher PaO2 and PaO2/FiO2 than control group(P<0.05);the scores of SAS,SDS and APACHEⅡwere lower in observation group than in control group(P<0.05);and the serum levels of ALB,PA,TRF and TP in observation group were higher than those in control group(P<0.05).Conclusion Modular intervention for mechanical ventilation-dependent patients in ICU can increase weaning success rate,improve blood gas analysis index and nutritional status,alleviate negative emotions,reduce complications and speed recovery.

Objective:To explore the mental workload status of nurses in the Intensive Care Unit (ICU) and analyze its influencing factors.Methods:The convenience sampling was used to select 240 ICU nurses from 4 ClassⅢ Grade A hospitals in Beijing from February to April 2020 as the research object. The survey was conducted using the General Information Questionnaire, the Chinese version of National Aeronautics and Space Administration Task Load Index (NASA-TLX) , and the Chinese version of the Caring Assessment Tool-administration (CAT-admin) . Multiple linear regression analysis was used to analyze the influencing factors.Results:Among 240 ICU nurses, the total scores of the Chinese version of NASA-TLX and the Chinese version of CAT-admin were (82.26±14.82) and (131.16±21.96) , respectively. Multiple linear regression analysis showed that nurses' perceived care of managers, children's condition and working years were the influencing factors of ICU nurses' mental workload and the difference was statistically significant ( P<0.01) , which could explain 40.9% of the total variation. Conclusions:The mental workload of ICU nurses is at the upper-middle level. Nursing managers should take targeted measures according to the influencing factors to reduce the mental workload of ICU nurses.