Objective To explore the method of comfort nursing in patients with nasogastric feeding and observe the influence on enhancement of patients satisfaction degree. Methods Case control study Was used in 162 conscious patients with nasogastric feeding.80 patients from January 2005 to January 2006 were selected as control group and given routine nursing.82 patients from February 2006 to May 2007 were named as the test group and received confort nursing.The satisfaction degree of patients, injury of nasal mucosa, shedding rate of the gastric tube and aspiration rate were investigated with self-designed discomfort questionnaires. Results The satisfaction degree in the test group Was 63.41％,which was higher than that of the control(40.00％,P＜0.01).The rate of nasal mucosa injury, shedding of the gastric tube and aspiration rate were lower in the test group(1.22％,2.44％,1.22％)than those in the control group(8.75％,10.00％,7.50％,P＜0.05).Conclusion The application of comfort nursing in patients with nasogastric feeding contributed to the enhancement of satisfaction degree of patients and nursing quality.

Objective To evaluate the value of X-ray stereoscopic localized biopsy in diagnosis of breast minute calcification.Methods X-ray stereoscopic localized puncture and biopsy in 50 cases with breast minute calcification were analyzed retrospectively.Results In 50 cases,there were 18 cases of breast cancer,in which 3 were carcinoma in situ,10 were in clinical stage Ⅰ,5 were in clinical stage Ⅱ.The other 32 cases were benign lesion,in which there were 6 fibroadenoma ,5 microcyst,1 intraductal papilloma,18 cystic hyperplasia,2 duct ectasia.Conclusion Calcification is an important manifestation in diagnosis of breast cancer,especially the early stage of breast cancer.X-ray localized biopsy is the first and useful method in detecting the position and quality of the caicification.

Objective To evaluate the value of X-ray stereotaxic puncture in the diagnosis of early breast cancer.Methods The X-ray manifestations of 53 cases of early breast cancer verified by pathology were analysed.Results In 53 cases,there were 23 cases of lumps,17 were simple calcification,8 nodes with calcification,12 asymmetry improved density with disorder structue,15 stellatesign,18 augmentation blood,3 conduit breakag.Conclusion Mammography with X-ray stereotaxic localized puncture is the first useful method in diagnosing the early stage of breast cancer.

Objective To investigate the influence of salmeterol with fluticasone on airway inflammation of patients with acute exacerbation chronic obstructive pulmonary disease (COPD).Methods 40 COPD patients in the stage of acute exacerbation were randomly divided into salmeterol with fluticasone group( A group) and controll group (B group).Bronchial alveolar lavage( BAL) was performed as usual.The concentrations of IL-8 and TNF-α in bronchial alveolar lavage fluid(BALF) were measured by ELISA.The results were compared with that of 18 healthy volunteers.Results The levels of IL-8 and TNF-a in BALF of patients in A group(10.60 ± 1.42) μg/L, (14.80 ± 2.05) μg/Land B group( 10.77 ± 1.98) μg/L, (14.70 ± 2.03) μg/L were significantly higher than that of C group (3.40 ±0.65)μg/L, (4.67 ± 1.01) μg/L( all P <0.01) ;Before treatment,the levels of IL-8 and INF-α in BALF of A group( 10.60 ± 1.42)μg/L,(14.80 ±2.05) μg/L and B group( 10.77 ± 1.98) μg/L,(14.70 ±2.03) μg/L had no significant differences (all P > 0.05) ,and the concentrations of IL-8 and TNF-a in BALF in group A (4.39 ± 0.92)μg/L,(5.84 ±1.26) μg/L were significantly lower than that in group B(9.69 ± 1.43) μg/L, (12.88 ± 2.51) μg/L after two weeks treatment ( all P < 0.01).Conclusion Salmeterol with fluticasone could inhibit airway inflammation of COPD patients in the stage of acute exacerbation.

Objective To discuss the clinical efficacy of Mepilex surgical dressing in prevention of pressure sore. Methods 46 patients with high risk factors and Norton grading lower than 10 point were divided into the experimental group and the control group with 23 patients in each group. The control group was given reduction of local pressure, protection of the skin, nutritional support and other conventional measures to prevent pressure sore. Besides conventional nursing measures, the experimental group was given Mepilex to cover the bone eminence place, replaced every 7～10 days. The occurrence and development of the pressure sore was observed on the second, fourth, sixth and eighth week after admission. Results The occurrence rate of the experimental group on the sixth week was 4.55%, and the control group was 26.09%,the difference had statistical significance. The cure rate of the two groups showed no difference on the eighth week. Conclusions Application of Mepilex to treat patients with high risk of pressure sore has good effect.

Objective To calculate the biological reference of plasma amino acid on L-8900 amino acid analyzer and to provide reference for clinical diagnosis with domestic reagents replacing original reagent .Methods By testing the original standards and the same batch of plasma (50 cases) ,we compared original reagents with domestic reagents for their performance (including resolution , repeatability ,accuracy ) .We tested the plasma free amino acids of 400 cases of healthy people using the domestic reagents to estab-lish biological reference interval of plasma amino acid ,and do correlation analysis between the amino acids level and liver function . Results (1)Domestic reagents showed high accuracy in the results of 5 consecutive detection of amino acids were high peak separa-tion and high peak retention time and high peak area .(2)Statistics derived biological reference interval of 19 amino acids and 10 kinds of amino acids had significant differences .(3)Correlation analysis showed that ALT and liver function were negatively corre-lated with threonine(P<0 .05) .GLU and valine ,isoleucine ,leucine were positively correlated(P<0 .05) .CHO and negatively cor-related with isoleucine(P<0 .05) .Conclusion Domestic agents can replace the original reagents ,on the basis ,the biological refer-ence intervals of plasma amino acids have great importance to clinical diagnosis and prognosis .

Objective To investigate the Effects of thyroxine on the level of serum homocysteine and urinary albumin excretion rate in elderly patients with early diabetic nephropathy and subclinical hypothyroidism.Methods Seventy-five patients with early diabetic nephropathy and subclinical hypothyroidism were randomly divided into levothyroxine treatment group and conventional treatment group.Urinary albumin excretion rate (UAER),serum levels of homocysteine,creatinine,and lipids were measured at both pre-and post-treatment of 48 weeks.Results After treatment,serum total cholesterol,low density lipoprotein-cholesterol,triglyceride,thyrotropin,homocysteine,UAER,and serum creatinine in the levothyroxine treatment group were significantly lower than those in the conventional treatment group [(-0.52 ± 0.12 vs 0.31 ± 0.40) mmol/L,(-0.33 ± 0.22 vs 0.24 ± 0.36) mmol/L,(-0.16±0.18 vs0.19±0.29)mmol/L,(-4.4 ± 1.2 vs 1.2 ±0.8)mIU/L,(-1.4 ±2.0 vs0.9± 1.0)mmol/L,(-13 ± 13 vs 10 ± 7) pg/ml,(-2 ± 2 vs 3 ± 2) μmoL/L,respectively,all P＜0.01].Conclusions Treatment with levothyroxine could significantly improve serum lipid profiles and reduce homocysteine,UAER,and creatinine,and exert a protective effect on the kidney in the elderly patients with early diabetic nephropathy and subclinical hypothyroidism.

Sixty patients with early diabetic nephropathy (DN) and normal blood pressure were randomly divided into telmisartan treatment and control groups.And the blood biochemical parameters,urinary albumin excretion rate (UAER),the serum levels of homocysteine (HCY) and transforming growth factor-β1 (TGF-β1) were measured at both pre- and post-treatment of 24 weeks.After treatment,the levels ofUAER,HCY [(61 ±26) vs.(98±38) mg/L,(11.70 ±2.86) vs.(14.4±2.8) μmol/L (P＜ 0.01 ) ]and homeostasis model of insulin resistance index,TGF-β1 [ ( 3.17 ± 0.66) vs.( 3.60 ± 0.87 ),(66 ± 14) vs.(77 ± 17 )U/L respectively (P ＜ 0.05 )]in the telmisartan group were significantly lower than those in the control group.It indicated that telmisartan could improve the insulin sensitivity,significantly decrease the serum levels of HCY and TGF-β1,reduce UAER and exert kidney protection effects in the patients with early DN.

Objective To investigate the effects of direct hemoperfusion with polymixin B-immobilized fiber (DHP-PMX) in patients with sepsis. Methods We searched Pubmed, Embase, Web of Science databases and identified relevant randomized controlled trials (RCT) from January 1995 to May 2010. Meta-analysis of DHP-PMX on mortality and levels of endotoxin in patients with sepsis were conducted using the methods recommended by the Cochrane Collaboration. Results Eleven RCTs were included.Eight of them included the mortality of patients (sample size: 211 DHP-PMX and 178 conventional medical therapy). In total, the mortalities of patients with sepsis in DHP-PMX group and conventional group were 37.4% (79/211) and 68.5% (122/178) respectively. Compared with the conventional medical therapy,DHP-PMX appeared to significantly reduce mortality ( OR =0.24,95% CI 0.16-0.38 ,P ＜0.000 01 ). The results were similar when two RCTs enrolling patients with methicillin resistant staphylococcus aureus (MRSA) infections were excluded( OR =0. 27,95% CI 0. 17-0. 45, P ＜0. 000 01 ). When the analysis was limited to the nine studies that reported 28- to 30-day mortality, results were unchanged( OR =0. 29,95% CI 0.17-0.48 ,P ＜0.000 01 ). Six RCTs had the available data of endotoxin. The level of endotoxin decreased 31 ng/L(95% CI 22.46-39.55 ) after DHP-PMX therapy, and the decreasing was statistically significant (P＜0. 000 01 ) ,while the level of endotoxin in patients of conventional group did not change (P =0.94).Conclusions This study suggests a favorable effects of DHP-PMX on mortality and endotoxin decreasing in patients with sepsis. However, lack of enough cases and blinding need to be considered. Further investigation with large sample of high quality RCTs is needed.

Objective To evaluate the effects of noninvasive positive pressure ventilation (NPPV)used after extubation on mortality and rate of reintubation in patients with acute respiratory failure (ARF).Method Pubmed, Embase, Web of Science databases were searched to collect data from randomized controlled trials (RCT) of the relevant subject from January 1995 to May 2010. Meta analysis of data about NPPV on mortality and rate of reintubation in patients after extubation carried out by using the methods recommended by the Cochrane Collaboration. Results Six RCTs included sample size of 381 NPPV and 379routine medical care. In total, the mortalities of patients in NPPV group and routine medical care group were 18.6% (62/334) vs. 21.6% (72/333), respectively, and the rates of reintubation of the two groups were 30.2% (115/381) vs. 33.5% (127/379), respectively. Compared with routine medical care, NPPV did not significantly reduce the mortality ( OR: 0.83, 95% CI =0.57 ～ 1.21 ,P =0.34) and rate of reintuation( OR: 0.83, 95% CI = 0.59 ～ 1.16, ( P = 0.27). When the analysis was focused to the four studies of them in which patients received NPPV as soon as extubation, the results were quite different. From these four studies, the mortalities of patients in NPPV group and routine medical care group were 12. 2% (22/181) vs.23.9% (44/184),(P=0.004), and the rate of reintubation of the two groups were 14.0% (32/228) vs.20.4% (47/230), (P =0.07). Compared with routine medical care, early application of NPPV to patients after extubation reduced the mortality. Conclusions This study suggests the favorable effects of early application of NPPV to patients after extubation on the mortality of acute respiratory failure.