Objective We discussed the nursing management measures to improve the qualified rate of sputum culture specimen of patients with pulmonary infection. Methods We monitored the qualified rate of sputum culture specimen, positive rate, pathogen distribution and drug resistance for patients with pulmonary infection in our hospital. Data collected from January 2007 to February 2008 were set as the test group. Data collected from January 2005 to December 2006 were set as the control group. The monitoring effect was compared in the two groups. Results The qualified rate of sputum culture specimen and the distribution of bacteria and fungus in the test group were different from those of the control group (P<0.01). Conclusions To strengthen the quality control of sputum culture specimen, comprehensively improve the cognition of nurses to the significance of qualified rate of sputum culture specimen and the techique of collecting sputum culture specimen could ensure the qualified rate of sputum culture specimen.

OBJECTIVE To study the disposition,hospital divisions and risk factors that induce nosocomial infections,and approach utility measure for prevention.METHODS To investigate and analyze the nosocomial infections in the patients who hospitalized from 2004 to 2006,through the way combined with retrospective investigation and the cases report by doctors.RESULTS In our hospital,the nosocomial lower respiratory tract infection was the highest(33.7%).The second was the upper respiratory tract infection(23.0%),and the gastrointestinal tract infection(18.7%).The incidence of nosocomial infection in medical and paediatrics department was higher than other departments,the main infection site in internal medicine department was lower respiratory tract(49.1%),but in pediatrics it was skin soft tissue infection(41.6%).There was significance difference of risk factors in nosocomial infection.CONCLUSIONS To grasp the causes of nosocomial infection,emphasize the monitoring for the high risk factors in departments,strengthen the prevention for nosocomal infection among the staff,standardize the various kinds of nursing operation and reasonably apply antibiotics,all are the effective measures for the prevention of nosocomial infection.

Objective To investigate the effect of recombinant human endostatin combined with chemotherapy on the expression of vascular endothelial growth factor (VEGF) in patients with advanced cancer.Methods250 patients with advanced malignant tumors were randomly selected from February 2012 to February 2016 the Third Hospital of Jiaxing, with unit control method experiment principle divided into two groups: experimental group (125 cases) and control group (125 cases).The experimental group treated by recombinant human endostatin combined chemotherapy, control group received routine chemotherapy for a week during the period of 21 days, after two cycles of treatment, clinical efficacy and adverse reactions of the two groups of patients were compared, and the expression of VEGF in tumor blood vessels weredetected.ResultsAfter two cycles of treatment, objective response rate, disease control rate in the experimental group patients was significantly higher than that in control group (P<0.05);after treatment, the expression level of VEGF in serum of the experimental group and the control groupwere decreased significantly, but the experimental group was lower than that of control group was more obvious (P<0.05).ConclusionRecombinant human endostatin combined with chemotherapy in the treatment of advanced malignant tumors can enhance the effect of chemotherapy, regulate the level of VEGF.

Educational reform of pathophysiology oriented to clinical application is to pass the physician qualifica -tion examination .One of essential approach is to implement pathophysiology teaching with the translational medical philosophy and promote the harmonious development of physician -patient relationship with the utilization of the de-velopment and changes of disease in the teaching process .In that way, the pathophysiology in basic and clinical medicine is worthy of the name of “bridge”, and ultimately achieves the goal of “the transformation and develop-ment of the cultivation of clinical application talents”.

Objective To investigate the relationship between nutritional risk status and implementation of nutrition therapy in mechanical ventilated (MV) chronic obstructive pulmonary disease (COPD) patients, so as to provide evidence for individualized nutrition therapy. Methods A prospective multicenter observational study was conducted. MV COPD patients admitted to Department of Intensive Care Units (ICU) of 10 County Hospitals in Zhejiang Province from January 2015 to January 2016 were enrolled, and according to nutrition risk screening 2002 (NRS2002) score, they were divided into nutritional high risk group (NRS2002 3-5) and nutritional extremely high risk group (NRS2002 6-7). Nutrition therapy situation and hospital mortality were compared between the two groups; multivariate Cox regression analysis was used to analyze the risk factors affecting the prognosis of patients with COPD under mechanical ventilation. Kaplan-Meier curve was used to analyze the prognosis at 30 days; receiver operating characteristic (ROC) curve was used to test the robustness of multivariable regression analysis. Results ① One hundred and six COPD patients with MV were analyzed; among them, 90 patients were in the nutritional high risk group, and 16 were in the nutritional extremely high risk group. There were no significant differences in age, gender and body mass index (BMI) between the two groups (all P > 0.05); the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, NRS2002 score in patients of nutrition risk extremely high group were obviously higher than that in patients with nutrition high risk group (APACHEⅡ: 24.9±6.1 vs. 20.3±5.8, NRS2002 score: 6.3±0.5 vs. 4.2±0.8, both P < 0.05). ② Patients in both groups received early enteral nutrition (EN) therapy, the proportion of patients in nutritional extremely high risk group received early EN was lower than that of patients in the nutritional high risk group [12.5% (2/16) vs. 17.7% (16/90)], along with the prolongation of hospital stay, the proportions of patients beginning to receive the EN were gradually increased in the nutrition extremely high risk group and high risk group, after 2 days the EN increased significantly, and reached the highest value on day 6 after entering ICU [100.0% (16/16), 98.9% (89/90), respectively]; within 3 days after admission into ICU, the proportion of EN in nutrition extremely high risk group was obviously lower than that in nutrition high risk group, and from day 4, there was no statistical significant difference in proportion of EN between the two groups (all P > 0.05). The time to start parenteral nutrition (PN) treatment was relatively early admission to the ICU on day 1 and the proportion of this therapy was high in the two groups [56.2% (9/16), 27.7% (25/90), respectively], the PN proportion did not decrease with the length of hospitalization and the increase of EN. The proportion of patients in the nutrition extremely high risk group who started PN treatment was higher, which reached 56.2% admission to the ICU on day 1.③ With extension of hospital stay, the calories of EN were gradually increased in the nutritional high risk group, the highest calories in nutritional high risk groups was 4 318 (3 912, 4 812) kJ/d at day 7; while the highest calories in nutritional extremely high risk groups was 3 602 (2 167, 4 615) kJ/d at day 6 and a slight decreased at day 7; the difference of calories within the first week between the two groups had no significance (all P > 0.05). The calorific value of PN therapy remained at a constant level during hospitalization within 7 days, and after admission into ICU for 4-5 days, the target range of calories was achieved. ④ Kaplan-Meier survival curve analysis showed that the mortality at 30 days in the extremely high risk group was significantly higher than that in the high risk group [62.5% (10/16) vs. 11.1% (10/90), χ2 = 15.4, P < 0.01]. ⑤ Multiple cox-regression analysis showed that NRS2002 scoring was the independent risk factor affecting the mortality of patients in hospital [odds ratio (OR) = 2.08, 95% confidence interval (95%CI) = 1.39-3.12, P = 0.005]. ⑥ ROC curve analysis: according to ROC curve analysis of the effectiveness of multi-factor regression model, area under ROC curve (AUC) was 0.79, sensitivity was 70.00%, specificity was 74.42%, positive likelihood ratio was 2.74, negative likelihood ratio was 0.40, 95% confidence interval (95%CI) was 0.702-0.864, P = 0.001, and it showed that the regression model had a good prediction effect. Conclusions MV COPD patients have significant nutritional risk and all receive early EN therapy. The proportion of beginning to use PN treatment in patients with nutritional extremely high risk is relatively high. Initial nutritional status is the independent risk factor of poor prognosis in MV patients with COPD.

OBJECTIVE: To examine the level of occupational exposure to whole body vibration( WBV) in a hydroelectric power station,and evaluate its effects on workers' health. METHODS: A hydroelectric power station in Hangzhou City was chosen as study subject by using judgment sampling method. The level of WBV exposure to workers and high vibration level areas were measured,and the vibration frequency was analyzed. The comfort and allowing duration of occupational exposure in WBV exposed workers was evaluated. RESULTS: The median root-mean-square of accelerometer acceleration of WBV exposure in generator floor,turbines-floor,middle-floor,hydraulic floor of the hydroelectric power station were 0. 894,0. 995,1. 095 and 0. 904 m/s~2,respectively. The central frequency of WBV in this station was 1. 25 Hz. Among the 105 monitoring spots,8. 6% of WBV exposed workers of the spots did not perceive or feel uncomfortable,but 91. 4%of them felt uncomfortable or very uncomfortable. Only 12. 4% of the WBV exposed workers tolerated more than 8 hours of WBV occupational exposure. CONCLUSION: There is an occupational hazard of WBV in this hydroelectric power station.The low frequency vibration with central frequency below 1. 25 Hz is the key control point of the WBV of this hydroelectric power station.