Objective To investigate the value of cluster cate forpatients with ventilator-associated pneumo-nia (VAP) in the intensive care unit. Method Three hundred fifty-four consecutive patients with mechanical ven-tilation support in the Emergency Intensive Care Unit of Nanjing First Hospital from January 2006 to September 2007 were included in this study. The cluster care included elevating patient's head and chest to at least 30 de-grecs to the horizontal level, intensiving frequency of oral-pharyngeal nursing with thorough suction, washing hands, changing ventialtor tube at shorter regular interval, closely observing temperature, sputmn, WBC count, pu-turn, white blood cell count, chest X-ray examination and respiratory tract bacterial culture etc. Another 398 me-chanical ventilated patients with conventional care in the Hospital from January 2004 to November 2005 were taken as control. The t -test and X2 -test were used for analysis. Results The morbidity of VAP was significantly de-creased after cluster care(16.6 % vs. 24.6% P<0.01), the length of intensive care unit stay (LOS) was shorter in patients with cluster care than those in patients of control [(10.75±5.86) d vs. (14.26±9.40) d, P <0.05]. Conclusions Pneumonia associated with mechanical ventilation can be effectively reduced by the cluster care.

Objective To study the changes and the significance of the frangible lymphocyte in patients with fulminant viral hepatitis and investigate the relationship between the degree of frangible lymphocyte and the severe of fulminant viral hepatitis. Methods 32 cases confirmed with fulminant viral hepatitis, 66 cases with chronic hepatitis have been studied. 15 cases children from 3 to 5 years old and 46 cases adults have been used with control groups. 100?l lymphocytes (1?106/ml) and 100?l tumor cells(1?105/ml) mixed with 100?l self-serum at 37℃ for 5min to 30min. The fragmental lymphocyte can defined as a frangible lymphocyte. The lymphocyte attached with tumor cell is undestroyed anything can be regarded as negative frangible lymphocyte. Less than 30 percent of lymphocyte attached with tumor cells is destroyed will be conformed as low-grade frangible lymphocyte, between 30 percent to 60 percent regard as mid-grade, and more than 60 percent as severe-grade mode. Results The equiform frangible lymphocyte is detected in fulminant viral hepatitis and other groups like that in SARS in 2003 years. There is none of children have frangible lymphocyte. Only 3 person’s lymphocytes show severe-grade frangible and 9 people display mid-grade in 46 adult individuals. Contrarily There is high of 46.9 percent of cases with fulminant viral hepatitis show severe-grade frangible lymphocytes, only 4 cases is negative and 3 cases is recovered in one months of them. The frangible lymphocytes in fulminant viral hepatitis are significantly lower than those in chronic hepatitis patients not only in mid-grade frangible but in severe type. There is no significant recovery of frangible lymphocyte from acute to recover in fulminant viral hepatitis, but the degree of the lymphocytes are closely relate to the state of an illness. Conclusion The percent of frangible lymphocytes in children is lowest among adult people, chronic hepatitis and fulminant viral hepatitis. The proportion of frangible lymphocytes in fulminant viral hepatitis is highest, and significantly higher than that in chronic hepatitis. The phenomenon of frangible lymphocytes may be an important characteristic of an innate immunology reaction of the body.

This article was aimed to observe the preventive effect of diabetes with atherosclerosis (AS) treated with Bie-Jia-Jian Pill (BJJP) on level of blood lipids, endothelin (ET), nitric oxide (NO), and matrix metalloproteinase-9 (MMP-9). Male SD rats were randomly divided into 5 groups, which were the blank group, model group, low-dose BJJP group, high-dose BJJP group and Xue-zhi-kang (XZK) group, to observe changes on the level of blood lipids, ET-1, NO and MMP-9 within 5 groups after 8-week administration. The results showed that compared with the blank group, the level of the content of NO in the model group was significantly decreased (P< 0.05), the level of ET-1 was significantly increased (P < 0.05). Compared with the model group, the high-dose and low-dose BJJP group as well as XZK group can significantly decrease the level of ET-1 (P< 0.05, or P< 0.01), increase content of NO (P< 0.05, or P< 0.01), and decrease the expression of MMP-9 (P< 0.05). It was concluded that the BJJP can regulate blood lipids, protect endothelial cell of blood vessels, stabilize plaques for the anti-AS effect.

Objective To evaluate the effectiveness of health management on quality of life of hypertensive patients living in underdeveloped rural regions. Methods Minqin County of Gansu Province was taken as research field, and health education covered all the population. Individual follow-up was adopted by quasi-experiment,and SF-8 scale was used to evaluate the change of scores of quality of life at baseline and the end of the study. Results The score of various dimension of quality life of interventive group showed a significant decrease at the end of follow-up ( P < 0. 05) , and the net score of general health status was 10. 92,the net score of impact to social role exerted by physical function was 9. 59,and the net score of social function was 4.61. Moreover, there was statistical difference between the intervention group and the control group for their quality of life(P <0. 05) , which showed in detail that each dimension of quality of life of the intervention group had higher score than that of the control group, after adjusting baseline difference by analysis of covariance. Conclusions All these results suggest that the active screening, following up and health education, conducted by the primary health care staff of township hospitals, under the idea of health management, can improve the quality of life of hypertension patients effectively in the rural area of underdeveloped region.

Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed.Conclusion Closed reduction and cannulated screws internal fixation of Ideberg Ⅲ type glenoid fractures recently obtained satisfactory results.

Objective To study the effects of diazepam and sodium valproate infusion with CRRT in treatment of patients with tetramethylene disulfotetramine poisoning. Methods Diazepam and sodium valproate were continuously infused to patients by infusion pump. Meanwhile, CRRT was used to eliminate tetramethylene disulfotetramine. Results Convulsion was effectively controlled within one hour in 7 patients. After treatment with CRRT for 1 to 4 times, all patients recovered. Conclusion CRRT with diazepam and sodium valproate infusion were effective in patients with tetramethylene disulfotetramine poisoning.

BACKGROUND:Pelvic and acetabular fractures in elderly are frequently observed in the clinic, and the incidence gradual y increased. Moreover, it is difficult to conduct reduction and fixation due to their physical status and osteoporosis to different degrees. Locking plate is ideal fixation material in surgical treatment of acetabular fractures in elderly due to the special functions and good molding of screw and locking plate.
OBJECTIVE:To analyze the advantages and disadvantages of locking reconstruction plate used in the acetabular fracture for the aged patients and to improve the clinical effect of acetabular fractures in elderly.
METHODS:From January 2010 to February 2013, 21 aged patients with acetabular fracture were treated by open reduction and internal fixation with locking reconstruction plates made of titanium and 00Cr 18 Ni 14 Mo 3 stainless steel in the Department of Orthopedics Affiliated Hospital of Jining Medical University.
RESULTS AND CONCLUSION:Of 21 patients, 20 cases were fol owed up for 12-18 months (mean 14 months), but one dropped out. Al the fractures were healed within 4-6 months and no failure cases. According to Matta evaluation criteria, the satisfactory rate was 90%. According to the D’Aubigne scoring system, the excellent and good rate was 95%. These data indicated that locking reconstruction titanium plate is reliable, has low failure rate and satisfactory clinical effects for acetabular fracture in aged patients, and is ideal fixation material in treatment of acetabular fractures in elderly.

According to the three-parameter expression of blood , the dual-frequency complex impedance information is selected as the known quantity. In this paper , the particular solution process of three-parameter is introduced. A calculational method to obtain basic quantity and pulsatile quantity of three-parameter of blood electrical impedance is established.

Objective To explore the teaching effects of physiology lectures and students' attitude to lectures,their suggestions for contents,forms and other aspects of lectures.Methods Random sampling questionnaire survey was conducted among 500 students of 2008 grade and 2009 grade in Xiangya medical school of central south university.The percentage of the option in the questionnaire was calculated and the findings were directly described.Results All students thought that physiology lectures were necessary.Teachers should arrange lectures which students were interested in,pay attention to inspire thinking and enhance teacher-student interaction.67.6％ of students thought that the knowledge learned from lectures can be used in expanding scientific thinking.Conclusions The lectures are popular among most students,playing an important role in cultivating students' ability of strict scientific thinking.

ObjectiveTo evaluate hybrid operation for arteriosclerosis obliterans (ASO) of the lower extremity.MethodsClinical data of 35 ischemic limbs in 32 ASO cases receiving hybrid operation from May,2007 to August,2009 were retrospectively analysed.The indications,clinical result,complications,perioperative mortality,vascular patency rate and limb salvage rate was evaluated.ResultsThirty-five ischemic limbs in 32 cases underwent hybrid operation. Procedures were successful in 94％ cases (33/35). The average postoperative ABI significantly increased from 0.49 ±0. 18 to 1.06 ± 0. 17 ( one day after surgery) or 0. 96 ± 0. 16 ( six months after therapy). One patient suffered limb amputation due to surgical failure, one case was complicated with cerebral infarction and the operation was terminated. No patient died in perioperative period. Twenty-six cases (28 ischemia limbs) were followed-up from 2 month to 28 months, the follow-up rate was 87％ (26/30). Vascular patency rate in 6 months after operation was 93％ (26/28), and limb salvage rate was 96％ (27/28). Two cases suffered from below-knee reocclusion 5 -6 months after therapy, and one of these two cases needed a limb amputation.ConclusionHybrid operation is the therapy of choice for multifocal lesions in arteriosclerosis obliterans of the lower extremities with a low risk and higher patency in short term.