Objective To investigate the effect of ulinastatin on postoperative cardiac troponin I ( cTnI) in patients underwent carotid endarterectomy ( CEA) under general anesthesia. Methods Forty patients with severe symptomatic carotid artery stenosis underwent unilateral CEA under general anesthesia from January 2011 to March 2012 were divided into either a ulinastatin group or a control group according to a random number table ( n=20 in each group) . Patients in the ulinastatin group received 500 000 U of ulinastatin via veins before induction of anesthesia. The patients in the control group were given the same amount of isotonic saline. The serum concentrations of cardiac troponin I ( cTnI ) were detected before surgery and at day 1,2,and 3 after procedure. Myocardial injury was defined as the cTnI peak concentration>0. 04μg/L . Results The levels of serum cTnI before procedure and at day 1,2,and 3 after procedure in the ulinastatin group were median (M) 0. 00 (0. 00-0. 03) μg/L,0. 07 (0. 00-1. 45) μg/L,0. 01 (0. 00-1. 21)μg/L,and 0. 05 (0. 00-0. 89)μg/L,respectively;those in the control group were 0. 00 (0. 00-0. 01)μg/L,0. 00 (0. 00-1. 42)μg/L,0. 00 (0. 00-1. 39)μg/L,and 0. 00 (0. 00-1. 24)μg/L, respectively. At day 1 after procedure,6 patients ( 30%) in the control group and 11 ( 55%) in the ulinastatin group occurred myocardial injury. There was no significant difference between the two groups (P<0. 05). In all the patients with the increased cTnI levels,the peak cTnI occurred at the first day after procedure,however,they did not reach the level ( >1. 5μg/L) of indicating patients occurring myocardial infarction. Conclusion Ulinastatin may not decrease the postoperative serum cTnI levels in CEA patients under general anesthesia. For whether to the CEA patients have myocardial protective effect,more samples are needed to be confirmed.

Objective To determine the influencing factors on prognosis of neonatal necrotizing enterocolitis (NEC) in premature infants with a gestational age of 28-32 weeks.Methods Forty-six cases of NEC (Bell stage Ⅱ or Ⅲ) with a gestational age of 28-32 weeks admitted to Bayi Children's Hospital from January,2009 to January,2013 were analyzed retrospectively.Twenty-nine cases were assigned to the cured group and 17 cases were assigned to the poor prognosis group according to prognosis.General conditions,laboratory results,treatment and complications in the two groups were analyzed.The Chi-square test,Fisher's exact test and univariate analysis of variance were used for statistical analysis.Results There were no statistically significant differences regarding gender,average birth weight and mean age of onset between the two groups [average birth weight (1 410.52±281.59) g vs (1 266.47±280.32) g and mean age of onset:(20.79± 10.61) d vs (16.71 ±9.41) d for the cured group versus the poor prognosis group,respectively].There were no difference in changes in white blood cells and platelets between the two groups.There were six cases of positive blood culture in the poor prognosis group and none in the cured group.There were no differences in procedures such as blood transfusion and ibuprofen administration [41.4％ (12/29) vs 11/17 and 6.9％ (2/29) vs 5/17,both P＞0.05,in the cured group versus the poor prognosis group,respectively].There were significant differences in the use of Bifidobacterium between the two groups [69.0％ (20/29) vs 5/17,x2=6.758,P=0.009].Fourteen cases in the cured group and 10 cases in the poor prognosis group underwent surgery,and all 10 cases in the poor prognosis group died.Seven cases underwent repeated surgery,one infant in the cured group and six infants in the poor prognosis group and a significant difference was observed (Fisher's exact,P=0.007).A statistically significant difference in granulocyte colony-stimulating factor (G-CSF) treatment was observed between the two groups,where 15 cases in the cured group and three cases in the poor prognosis group were treated with G-CSF (x2=5.225,P＜0.05).Statistically significant differences in septicemia,patent ductus arteriosus,gastrointestinal perforation,multiple organ failure (MOF),disseminated intravascular coagulopathy (DIC) and septic shock were observed between the two groups [septicemia:44.8％ (13/29) vs 15/17,x2=8.478; patent ductus arteriosus:17.2％ (5/29) vs 9/17,x2=6.451; gastrointestinal perforation:3.4％ (1/29) vs 6/17; MOF:0.0％ (0/29) vs 5/17; DIC:0.0％ (0/29) vs 3/17; septic shock:3.4％ (1/29) vs 6/17,all P＜0.05 in the cured group versus the poor prognosis group,respectively).Conclusions Oral intestinal microbial preparations before the onset of NEC and G-CSF therapy after the onset of NEC may be protective factors in improving the prognosis of NEC,while patent ductus arteriosus,septicemia,gastrointestinal perforation,MOF,DIC and septic shock are risk factors.Emphasis should be placed on the administration of intestinal microbial agents,prevention of infection and treatment of complications.

Objective To investigate nurses' organizational career management and job satisfaction in the third-grade class-A hospital,and analyze the relationship between them.Methods A total of 576nurses were recruited by two-stage stratified random sampling method from four third-grade class-A hospitals.They were investigated with Nurses' Organizational Career Management Questionnaire and Job Satisfaction Scale.Results The mean score of nurses' organizational career management and job satisfaction was(2.94±0.52)and(3.32±0.46).There were significant differences on the scores of job satisfaction in nurses with different ages,nursing age,shift,posts,professional tifles,departments,monthly income and type of hospitals.Nurses' organizational career management was positively correlated to job satisfaction.After controlling for the demographic variables,the overall state of organizational career management could explain 34.2 percent for the variances of job satisfaction respectively.Conclusions It is suggested to pay close attention to nurses' organizational career management and take effective career management measures to improve nurses' job satisfaction so as to stabilize the nursing team and retain the excellent nurses.

OBJECTIVE To observe the effect of vacuum-assisted closure in clinical persistent infection patients.METHODS Thirty two sufferers infected in soft tissue,bones and joints were treated by general methods but without durable concrescence.It lasted averagely 138 days.In our department it treated by vacuum-assisted closure in 23 days.Thereby a comparison of self-control came into being.RESULTS Thirty two cases were cured after following at least one year except for one case with recrudescence.CONCLUSIONS Vaccum-assisted closure is the most effective surgery therapy measurement and is a kind of unidirectional drainage.If we can use it felicitously then we can treat infection in orthopedics′ effectively.

ObjectiveTo explore the pathogenesis, clinical manifestations, diagnosis, and treatment of autoanti-body-associated congenital heart block.MethodsThe clinical data of one child with autoantibody-associated congenital heart block was retrospectively analyzed.ResultsIn 24 week gestation, fetal bradycardia had been found by routine fetal echocar-diography. After birth, the anti-SSA/Ro antibodies and anti-SSB/La antibodies were positive in both infant and her mother. The diagnosis of autoantibody-associated congenital heart block was conifrmed. Intravenous immunoglobulin at 1 g/kg was adminis-trated. At 6 months follow-up, the electrocardiogram suggested type I second degree atrioventricular block.ConclusionIn the fetus or neonates found to have bradycardia and excluded the cardiac structural abnormalities, the autoimmune antibody should been tested and early intervention should been promoted.

Objective To determine the inhibitive effect of interferon-a on hepatic metastasis of colon cancer. Methods Metastatic model of human colon cancer was established by orthotopic implantation of histologically intact human tumor tissue into the colon wall of nude mice.The mice were randomly divided into 4 groups:(1)Control group(receiving saline solution only);(2)5-FU treatment group;(3) IFN-?-2b treatment group;and(4)5-FU combined with IFN-?-2b treatment group(combined group). 5-FU and IFN-?-2b were given via peritoneum injection 1 time/2 days for eight weeks.The mice were killed at nine weeks.The tumors were weighed,the microvessel density(MVD) was detected,and the liver was examined histologically in order to discover the micrometastasis. Results In control group, 5-FU group,IFN-2b group and combined group,the tumor weight was(1.53?0.78)g,(0.87?0.59)g,(0.81?0.43)g and ( 0.23?0.09)g, respectively;the tumor inhibition rate was 0,43.1%,47.1% and 84.9%, respectively;the hepatic metastasis rate was 85.7%,78.6%,21.4% and 0 respectively.MVD in IFN-? group and combined group was significant lower than that in control group and 5-FU group. Conclusions IFN-? can inhibit the growth and hepatic metastasis of orthotopic implanted human colon cancer by inhibiting the tumor angiogenesis.It may be more effective when INF-? combined with cyotoxic agents.

Objective Objective To study the effect of adenovirus mediating Smad 7 gene regulated by radiation via Egr-1 on the primary tumor and lung metastasis in C57BL mice implanted with Lewis lung cancer.Methods The radio-inducible elements from the Egr-1 gene promoter were inserted upstream to a cDNA encoding Smad7 and integrated into a replication-defective adenovirus to generate recombinant adenovirus(AD.Egr-Smad 7).270 mice implanted with Lewis lung cancer in the hind legs were used and the experiment was started when the transplanted tumor diameter reached 0.8 to 1.0cm.Then three investigations were undertaken,each demanding 90 mice implanted with Lewis lung cancer respectively.To each group,90 mice models were randomized into 3 groups: the normal control group;the NS control group;and the implanted AD.Egr-Smad 7 group.Every 6 mice in each group were irradiated by different single dose to study the following: 1.The maximal and minimal diameters of the tumor were recorded to observe the tumor growth tendency,the tumor growth delay and the mice survival time,2.The incidence of lung metastasis two weeks after the radiation was recorded.3.The incidence of lung metastasis when the tumor volume was four times as large as that at the beginning of radiation was recorded.Results The adenovirus mediating Smad 7 gene expression regulated by irradiation via Egr-1 in C57BL mice implanted with Lewis lung cancer was able to inhibit the progression of the primary tumor and prolong the survival of the mice significantly as compared with the control group(P0.05).Conclusions The gene expression of AD.Egr-Smad 7 regulated by radiation is not risky in promoting the local progression and distant metastasis of Lewis lung cancer in mice.On the other hand,the gene expression of AD.Egr-Smad 7 regulated by radiation could inhibit the progression of the primary tumor and prolong the survival time of the mice significantly.It is safe,to some extent,of using AD.Egr-Smad 7 to block the signal transduction of TGF-?locally as a novel strategy for gene therapy aiming at the prevention of radiation-induced lung

The morbidity of diabetes has been increasing rapidly in recent years. Delayed wound healing has become a common complication in diabetes, which seriously affects the orthobiosis of patients. Exploring and finding the molecular mechanisms of diabetic wound healing and the effective therapies to promote wound healing have important clinical significances. Stem cells transplant has become a research hotspot in accelerating diabetic wound healing. This article reviewed the present approaches concerning stem cells transplant in diabetic wound healing both at domestic and abroad, and looked forward the clinical therapy of stem cells on diabetic wound healing.
Diabetes Mellitus ; therapy ; Humans ; Stem Cell Transplantation ; Stem Cells ; Wound Healing

Objective To observe the effect of combined continuous femoral nerve blockade (CFNB)with epidural morphine postoperative analgesia on total knee arthroplasty (TKA)in elderly patients.Methods Eighty elderly patients scheduled to undergo TKA were randomly divided into two groups:groups FN and FNM.Groups FNM and FN were received 0.1% morphine 2 ml and normal saline 2 ml through epidural space respectively at the end of surgery.After surgery,all patients were implanted catheter around femoral nerve guided by ultrasound,and were infused 0.2% ropivacaine 25 ml.Continuous infusion of 0.2% ropivacaine for femoral never block was administrated at a rate of 5 ml/h for 48 hours to all patients.VAS scores and bending degree during rest,active and passive exer-cise were recorded at time point of postoperative 24,48,72,96 h.Ambulation status on the fifth day after operation were observed.Satisfaction of hospitalization were graded before hospital discharge. Results Compared with group FN,VAS scores during rest,active and passive excercise were signifi-cantly decrease at 24 h in group FNM (P <0.05 or P <0.01).The bending degree of knee joints in group FNM were significantly greater compared with group FN at 24 h after surgery (P <0.01).Am-bulation status on the fifth day after surgery were significantly better in group FNM compared with group FN (P <0.05).The level of patient satisfaction was much higher in group FNM (P <0.05). Conclusion After TKA,CFNB combined with single epidural morphine injection can provide better analgesia and bending degree with a high level of satisfaction.

ObjectiveTo observe the efficacy and safety of inhaled tiotropium capsule on adult bronchial asthma.MethodsThirty-four adult asthma patients were randomized into two groups.We evaluated the addition of tiotropium bromide to an inhaled glucocorticoid in the treatment group( n =17 ),as compared with the addition of the LABA Formoterol in the control group ( n =17 ).Serial measurements of lung function,symptom control and quality of life were performed.ResultsAfter 8 weeks of treatment,peak expiratory flow (PEF) in the addition of tiotropium bromide group[ ( 359 ± 12 ) L/min vs.( 275 ± 5 ) L/min,P ＜ 0.05 ] and the addition of the LABA Formoterol group [ ( 346 ± 11 ) L/min vs.( 275 ± 9 ) L/min,P ＜ 0.05 ] were significantly higher than those before treatment.The forced expiratory volumes in one second ( FEV1 )were also significantly elevated in both groups [ Tiotropium bromide group:( 2.80 ± 0.28 ) L vs.( 2.30 ± 0.28 ) L,P ＜ 0.05 ; LABA Formoterol group:( 2.69 ± 0.34 ) L vs.( 2.25 ± 0.34 ),P ＜ 0.05 ] compared with pre-treatment.Average dose of emergent drug ( ventolin ) usage were decreased in both groups after treatment [ Tiotropium bromide group:(0.96 ± 0.34 ) puff/d vs.(4.11 ± 1.03 ) puff/d,t =3.05,P ＜ 0.05 ; LABA Formoterol group:( 0.88 ± 0.44 )puff/day vs.( 4.43 ± 0.87 ) puff/day,t =3.23,P ＜ 0.05 ].Meanwhile,significantly improved quality of life scores and alleviation of asthma symptom were found in both groups as compared with baseline ( P ＜ 0.05).However,no significant differences in the above variables after treatment were found between two groups( P ＞0.05 ).ConclusionWhen added to an inhaled glucocorticoid,tiotropium improved symptoms and lung function in patients with inadequately controlled asthma.Its effects appeared to be equivalent to the addition of Formoterol.