Objective To explore the effect of Tracer Methodology on the physical restraint management of the elderly patients. Methods The idea of Tracer Methodology was based on a case study of physical restraint, and then complementary tracking and system tracking. The key problem, which was founded in using Tracer Methodology on the physical restraint management of the elderly patients, could be continuously improved from the regulations, procedures, training, implementation, inspection, feedback, rectification, the implementation and the effectiveness. The normative rate of physical restraint was compared before and after the implementation of this method. Results After using the Tracer Methodology, the rate of physical constraint in the elderly patients was 82% (41/50), which was significantly increased (χ2=5.877,P=0.015) compared with before implementation of this method, which was 60% (30/50). Conclusions Tracer Methodology could improve the normative rate of physical restraint in elderly patients. Meanwhile, it was beneficial for nurses to participate in quality management, and strengthen the team cooperation.

Objective To study the features of clinic ,pathology and prognosis in children with steroid-resistant nephritic syn-drome(SRNS) .Methods Children with SRNS hospitalized in Division of Nephrology and Immunology in our hospital from January 2003 to December 2012 were analyzed retrospectively in clinic ,pathology and prognosis .Results 162 patients were investigated , which accounted for 10 .8% of children with Primary nephritic syndrome(PNS) ,and the mean age of onset was 6 .9 ± 3 .8 years old . Renal biopsy was performed in 132 patients ,60 of them showed mesangial proliferative glomerulonephritis(MsPGN) ,30 showed fo-cal segmental glomerulosclerosis(FSGS) ,19 showed minimal change disease(MCD) ,8 showed membranoproliferative glomerulone-phritis(MPGN) ,5 showed membranous nephropathy(MN) ,1 showed proliferative sclerosis glomerulonephritis(PSGN) .Patients with non-minimal change disease(non-MCD)had a significant prevalence of hematuria .The distribution of pathologic type among age groups and clinical classification was significantly different ,respectively(P<0 .05) .(2)132 patients were followed up ,58 of them were in complete remission ,26 were in partial remission ,15 were not in remission ,8 were dead ,and the mean time for com-plete remission was 15 months(3-84 .Prognosis correlated with pathologic type(P<0 .01) .Conclusion (1)There is a preponder-ance of non-MCD in children with SRNS ,and MsPGN and FSGS is the major pathologic type .Hematuria is a predictor of glucocor-ticoid resistance .(2)Children with SRNS have a long time proteinuria and poor prognosis .FSGS has a poor prognosis ,when com-pared with MsPGN .

Objective To analyze the application of non-protective midwifery in China so as to provide a theoretic basis for the develop-ment of this technique. Methods The full-text literatures of non-protective midwifery published in China during January 2004 and January 2014 were searched and obtained in China National Knowledge Infrastructure ( CNKI) ,Wanfang Database and VIP Database via computer. All searched literatures were analyzed with the literature study method. Results Totally 21 literatures were obtained by search. They were centrally from the coastal areas and mainly the controlled studies,and focused on the comparison of non-protective midwifery vs. protective midwifery in perineal laceration,second birth course and intrapartum bleeding volume. Conclusion The literatures show that non-protective midwifery is significantly beneficial for patients,though it develops later and concentrates at partial areas. Such midwifery technique shall be popularized all around the country.

Objective To understand the clinical significance of serum immunoglobulins and C3 at the initial episode on the treat-ment and prognosis of childhood primary nephrotic syndrome(PNS) .Methods 426 children patients with first episode of PNS ad-mitted to the nephrology department of our hospital from January 1 ,2003 to December 30 ,2012 were retrospectively analyzed .The clinical data were collected for conducting the analysis on the immuneglobulins and C 3 levels in different age groups ,clinical classifi-cation ,hormone response ,recurrence ,prognosis and correlation among various pathological types .Results (1)Compared with the healthy children ,the peripheral blood IgG level in childhood PNS was significantly decreased ,while the IgM and IgE level were sig-nificantly increased .(2)The IgE level in steroid-sensitive nephrotic syndrome(SSNS) was higher than that in steroid-resistant ne-phrotic syndrome(SRNS);which in frequent recurrence nephrotic syndrome was higher than that in non-recurrence nephrotic syn-drome .(3) The C3 level in the PNS children patients aged over 1 years and nephritis nephrotic syndrome(NNS) was lower than that in simple nephrotic syndrome(SNS) .Conclusion PNS is correlated with the immune dysfunction .Serum IgE level increase clinically manifests by the steroid sensitivity and frequent relapse ;the lower the C3 level ,the poorer the prognosis .

Objective To investigate the preventive effect of thin foam dressings(Allevyn Thin)combined with ice compress on facial plastic postoperative swelling and to summarize the nursing key points.Methods Sixty patients after facial plastic surgeries in our department were randomly divided into the observation group and the control group with 30 cases in each group.In the control group,ice packs wrapped with sterile gauze were placed on the patients’ wound dressings postoperatively and fixed properly for 30 to 40 minutes with an interval of 30 minutes,6 to 10 times a day for 72 hours postoperatively.In the observation group,thin foam dressing was stick to the wounds,followed by ice compress as in the control group.The facial swelling degrees of both groups were compared on day 3 and day 7 postoperatively.Result The swelling degree in the observation group was significantly smaller than that of the control group(P<0.01).Conclusion Thin foam dressings combined with ice compress can effectively improve the postoperative early swelling of patients receiving facial plastic surgery and therefore it is worthy of clinical popularization and application.

Objective To investigate the experience of microinvasive surgical occlusion of ventricular septal defect (VSD).Methods A total of 142 children with VSD was given microinvasive surgical occlusion from March 2009 to December 2013 at our hospital.There were 90 males and 52 females,the age ranged from 8 months to 11 years,and body weight from 7 kg to 35 kg,and ventricular septal defects were divided into membranous type,film cycle headquarter type,pulmonary valve type,and muscle type.The diameter of VSD was 2 ～ 10 mm.Under general anesthesia,an incision was made in the lower part of sternum or intercostals space,and a special occluder was inserted to close the ostium via right ventricle puncture under the guidance of transesophageal echocardiography.Results A total of 139 cases had successful occluded with a 97.8％ of successful rate,using blocking umbrella 4 ～ 12#,including 25 eccentric umbrella.Two cases were operated under extracorporeal circulation because of aggravated aortic valve insufficiency.One case without handled muscular ventricular septal defect combined atrial septal defect for guide wire pass muscular defect failed.Full set did not have death and third degree A-V block.Conclusions Microinvasive surgical occlusion is easy to handle,operation-time short,and relative broad for the closure of ventricular septal defect.It has a fast recovery and good effectiveness with a beautiful outlook and safety.

Dysphagia is one of the most common and life-threatening complications in patients with stroke, and nutritional support plays an important role in rehabilitation. This article reviewed the progression of study on assessment for dysphagia and nutrition, and the timing, method and complication of enteral nutrition.

Objective To explore the best time period of pulse oximetry in congenital heart disease (CHD) screening. Methods Totally 5433 newborns delivered or treated in Ningbo Women and Children’s hospital were enrolled in the study. Cardiac color ultrasound was used to arrive diagnosis and every screening time period (0?~?24 h、24 h?~?48 h、48 h?~?72 h) was analysed. Results Among the three time periods: the sensibility was in the range of 54.72%?~?67.92%, specificity was 99.11%?~?99.61%, false negative rate was 32.08%?~?43.40%, false positive rate was 0.39%?~?0.89%, Youden index was 0.54?~?0.68, coincidence rate was 98.67?~?99.30, and kappa was 0.44?~?0.65. Conclusion The best screening time is the period between 48h and 72 h after birth.

Objective To observe the changing levels of serum sFas before and after intravenous i mmunoglobulin (IVIG) treatment of incomplete Kawasaki disease (IKD),to explore the roles of sFas in the pathogenesis of IKD and IVIG treatment mechanism.Methods Thirty eight cases of IKD children were selected as experimental group and 20 examples of the same age of children as the control group.The IKD children were treated by IVIG in combination with aspirin (ASP) ; and blood test was performed before treatment,3 days after treatment,and 14 days after treatment,respectively.Dual-resistant sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum sFas,plasma Fibrinogen (PT-D),d-dimer (D-D),and c-reactive protein (CRP).Results The levels of serum sFas,PT-D,D-D,and CRP were significantly higher than the control group for IKD children before treatment[(0.55 ± 0.14)ng/L vs (0.24 ±0.04) ng/L,(552.3 ± 147.2) mg/dl vs (277.3 ±82.5)mg/dl,(649.0 ±201.6) μg/L vs (315.4 ±91.8)μg/L,and(72.2 ±28.7)mg/L vs (7.2 ±2.9)mg/L; t' =12.41,9.11,8.64,13.82;All P ＜ 0.05] ;3 days after treatment,compared with those before treatment and control group,the sFas level of IKD children at the third day after treatment was significantly decreased compared to that before treatment and control groups,respectively [(0.43 ± 0.09) ng/L vs (0.55 ± 0.14) ng/L,(0.24 ± 0.04) ng/L,F =47.624,All P ＜0.05] ;For the level of sFas at the 14th day after treatment,no statistical significance was found between IKD children and the control group[(0.24 ±0.05) ng/L vs (0.24 ±0.04) ng/L,t =0.596,P ＞ 0.05].Conclusions The abnormally increased serum sFas level before IVIG treatment suggests that dysfunction of apoptosis be involved in the pathogenesis of the IKD.Intravenous immunoglobulin treatment may be involved in the apoptosis process.

Objective To explore the association of expression of apoptosis-associated gene BAK and cFLIP with the biological behaviors in endometriosis. Methods The expression of BAK and cFLIP protein gene in eutopic and ectopic tissue samples from 40 cases with pathologically confirmed ovarian endometriosis and 40 cases with pathologically confirmed normal endometrium was detected by immunohistochemical method. Results ①The expression of BAK and cFLIP protein gene was found in three groups of different endometrial tissue. ②The expression of BAK protein gene was increased gradually in ectopic endometrial , eutopic endometrium and normal tissue and there was significantly difference between every two groups ,while cFLIP was contrary expressed (P <0.05); ③In normal endometrium, The expression of BAK protein gene in secretory phase was higher than that in proliferative phase (P < 0.05), while cFLIP was contrary expressed, in eutopic endometrium and ectopic endometrial tissue , The expression of BAK and cFLIP protein gene in secretive phase showed no statistically significant difierence with that in proliferative phase (P > 0.05). ④The expression of BAK protein gene in severe group (Ⅲ-Ⅳ period) is lower than mild group both in eutopic or ectopic endometrial tissues,while cFLIP was contrary expressed (P < 0.05). ⑤The expression of BAK and cFLIP was negatively correlated with each other in ectopic endometrium (r=-0.389,P< 0.05). Conclusion BAK and cFLIP was negatively expressed in EMS, which may take a part in the endometrial apoptosis and disorderly proliferation. BAK and cFLIP may play an important role in the the diagnosis and treatment of endometriosis.