Objective To investigate the factors for the difficulty of removing intrauterine devices(IUD)and preventive measures among women in perimenopausal and menopausal period.Methods The IUDs were taken out among 192 women from family planning clinics and the influential factors for the outcome of removing IUD such as age,menopausal years were summarized through the statistical analysis.Results Among 192 cases of IUD removal, 163 cases went smoothly,the percentage was 84.90%,but the process of 29 cases was difficult,the percentage was 15.10%.The age,menopausal years,IUD positioned period,regular physical examination,cervical atrophy degree and intrauterine adhesion were the statistical factors to IUD removal(χ2 =6.740,7.429,11.235,8.443,11.998,9.016, all P <0.05 ).The residence,abortion history and times of pregnancy had no significant influence (P >0.05 ). Conclusion The important way to prevent and solve the difficulty of IUD removal is supervising women to take regular physical examination,learn more knowledge about IUD,remove IUD during half a year after menopause in order to increase the success rate and safety.

OBJECTIVE To observe the sterilization effect of nanophotocatalytic air disinfector(NPD) on the indoor air of emergency room.METHODS Under the static and active circumstances,the on the-spot sterilization was adopted and observed.RESULTS In the static circumstances,after the machine had properly functioned over 60 minutes,the elimination rate of natural bacteria in debridement room and dressing change area reached 100.00% and 90.44%,respectively;in the active,after the machine had properly functioned over 60 minutes,the elimination rate of natural bacteria in debridement room and dressing change area reached 95.99% and 86.68%,respectively.The bacteria amount in the air decreased as the sterilization time was extended.CONCLUSIONS The NPD has good sterilization effect on indoor air.It can be adopted for the air sterilization in the emergency room under active circumstances.

Objective To observe the efficacy of zhibituo combined with atorvastatin on type 2 diabetic patients with hyperlipidemia and its impact on blood lipids,fibrinogen (Fib) and D-dimer.Methods One hundred and seventy type 2 diabetic patients with hyperlipidemia visited our hospital from January 2010 to December 2012 were randomly divided into observation group and control group(with 85 cases in each group).Control group were given atorvastatin (1 0 mg,1 times / day),and the observation group were treated with zhibituo(1.05 g,3 times/day) on the basis of atorvastatin treatment,both treatment were 8 weeks.The levels of fasting plasma glucose (FPG),glycosylated hemoglobin (HbAlc),lipids,Fib and D-dimer were observed before and after treatment,and the efficacy of the two groups were compared.Results The efficacy in observation group was significantly higher than that in the control group (92.94％ (79/85) vs.81.18％ (69/85),x2 =4.229,P ＜ 0.05).There was significant difference on the levels of total cholesterol (TC) ((7.46 ±1.83) mmol/L vs.(4.28 ± 1.94) mmol/L,triglycerides (TG) (3.57 ± 1.32) mmoL/L vs.(1.47 ± 0.86)mmol/L,low-density lipoprotein cholesterol (LDL-C) (4.68 ± 1.04) mmol/L vs.(2.19 ± 0.72) mmol/L,high density lipoprotein cholesterol (HDL-C) (0.85 ± 0.21) mmol/L,vs.1.47 ± 0.43) mmol/L,fasting plasma glucose (FPG) ((8.65 ± 2.19) mmol/L vs.(6.38 ± 0.83) mmol/L).glvcosvlated hemoglobin (HbAlc) ((7.49 ± 1.67)％ vs.(6.28 ± 1.48)％),fibre(FiB) ((7.42 ± 1.38) mg/L vs.(3.76 ± 1.18)mg/L),and D-dimer ((1.18 ±0.17) g/L vs.(0.51 ±0.18) g/L) in observation group before and after treatment(t =10.993,12.289,18.849,11.945,8.936,4.999,18.584,24.949 respectively,all P ＜ 0.05).And there was also significant difference on the levels ofTC ((7.51 ± 1.27) mmol/L vs.(5.10 ±2.18) mmol/L),TG((3.48 ± 1.29) mmol/L vs.(1.88 ±0.37) mmol/L),LDL-C((4.57 ± 1.18) mmol/L vs.(2.81 ±0.83) mmol/L),HDL-C ((0.83 ± 0.22) mmol/L vs.(1.16 ± 0.28) mmol/L),FPG((8.72 ± 1.92) mmol/L vs.(7.42 ± 1.82) mmol/L),HbAlc((7.53 ± 1.32)％ vs.(6.79 ± 1.23)％),Fib((7.38 ± 1.63) mg/L vs.(4.41 ± 1.02) mg/L) and D-dimer ((1.20 ±0.15) g/L vs.(0.65 ±0.12) g/L) in control group before and after treatment (t =8.807,10.992,11.248,8.544,4.530,3.781,14.240,26.397,respectively,all P ＜0.05).The elevated levels of the observation group were more obvious compared with control group ((t =2.591,4.038,5.202,5.570,4.793,2.443,3.842,5.967 respectively,all P ＜0.01).Conclusion The efficacy of zhibituo combined with atorvastatin is obvious in type 2 diabetic patients with hyperlipidemia,it is helpful to regulate the disorders of fibrinolysis and coagulation.

Objective To evaluate the value of the mRECIST criteria in assessing the efficacy of transcatheter arterial chemoembolization(TACE) combined with sorafenib in the treatment of hepatocellular carcinoma (HCC).Methods A total of 35 patients who were treated with a combination of TACE and sorafenib for unresectable hepatocellular carcinoma fulfilled the mRECIST and RECIST criteria in our hospital from June 2011 to November 2012.Enhanced CT and/or enhanced MRI were used before (baseline) and after (3 month reexamination) combination treatment in our hospital.The mRECIST and RECIST criteria were used to evaluate the efficacy,and these efficacy assessments were compared.Results In the RECIST criteria,complete remission (CR) was 0％,partial remission (PR) was 2.9％,stable disease (SD) was 85.7％％,and progressive disease (PD) was 11.4％％.In the mRECIST criteria,CR was 8.6％,PR was 51.4％,SD was 34.3％,and PD was 5.7％.For the RECIST criteria,the objective response rate (CR+-PR) was 2.9％,the disease control rate (CR+PR+SD) was 88.6％,and the disease progression rate was 11.4％.For the mRECIST criteria,the objective criteria was 60％,the disease control rate was 94.3％,and the disease progression rate was 5.7 ％.The difference between the efficacy assessment results of mRECIST and RECIST was statisti cally significant(P＜0.001).Conclusion The mRECIST criteria can evaluate the efficacy of target le sions based on viable tumors,which is more adaptive to TACE and targeted drugs with new mecha nisms.

Objective To monitor the distribution of pathogenic bacteria causing wound infection in trauma patients and their susceptibility to antibiotics in an effort to offer evidence for the rational clinical use of antibiotics.Methods Pathogens were identified by expressive type,but a very few was determined by the molecular methods.Micro-dilution or Kirby-Bauer method for minimum inhibitory concentration (MIC) was adopted for drug susceptibility test.Results A total of 121 species of pathogens numbering 1,257 bacterial strains were isolated from 1,066 patients.Strain number of the top 10 species accounted for 70.09％.Gram-positive cocci accounted for 48.93％ and Gram-negative bacilli for 49.72％.Among Staphylococcus aureus and epidermidis,methicillin-resistant bacterial strains accounted for 34.76％ and 71.08％ respectively,but none were resistant to vancomycin or linezolid.Enterococcus faecalis contained 6.06％ vancomycin-resistant enterococcal (VRE) and remained ＞ 90％ sensitive to teicoplanin,ampicilin and vancomycin.Enterococcus faecium contained 10.53％ VRE and remained ＞90％ sensitive to teicoplanin and ＞ 80％ sensitive to vancomycin.Baumanii contained 12.77％ multidrug resistant strains and remained ＞ 70％ sensitive to imipenem and meropenem.Baumanii/calcoaceticus complex contained 29.72％ multi-drug resistant strains and remained ＞ 50％ sensitive to imipenem and meropenem.Pseudomonas aeruginosa contained 3.73％ multi-drug resistant strains and remained ＞90％ sensitive to amikacin,meropenem,imipenem and piperacillin/tazobactam.No E.coli,klebsiella pneumoniae and enterobacter cloacae resistant to imipenem or meropenem were found.E.coli contained 69.51％ extended-spectrum β-lactamases (ESBLs)-producing strains and remained ＞ 90％ sensitive to piperacillin/tazobactam and ＞ 80％ sensitive to amikacin.Klebsiella pneumoniae contained 53.13％ ESBLs-producing strains and remained ＞ 80％ sensitive to amikacin.Conclusions Common bacteria are the leading cause of posttraumatic infection.Enterococcus faecalis and enterococcus faecium demonstrate higher susceptibility to teicoplanin; two kinds of acinetobacter demonstrate higher susceptibility to imipenem.

Objective To study the effect of continous subcutaneous insulin infusion (CSII) and mutiple subcutaneous insulin infusion (MSII) on type 2 diabetes mellitus during perioperation. Methods One hundred and eighty surgical patients complicated with Type 2 diabetes were randomly divided into two groups,98 cases in the CSII group (treated with CSII of novolin R) and 82 cases in the MSII group (treated with MSII of novolin R and no-volin N). Blood glucose level,the time to reach normal blood glucose level, the average dosage of insulin, the inci-dence of hypoglycemic,infection rate of incisions and inpatient days were measured in two groups before and after treatment. Results The level of fasting blood glucose after treatment in the CSII group (4.8 mmol/L (SD: 1.6)) was significantly lower than that of the MSII group (6.4 mmol/L(SD :2.1)) (t = 7.74,P < 0.05), and 2-h glucose in the CSII group (7.6 mmol/L(SD :2.3)) was significantly lower than that of the MSII group (9.3 mmol/L(SD: 2.4)) (t = 7.72, P < 0.05). The time to reach normal blood glucose level in the CSII group (4.1 days (SD: 2.9)) was shorter than that of MSII group (6.9 days (SD :2.0)) (t=2.81, P < 0.05). The average dosage of insulin in the CSII group (40.7 U(SD: 10.3)) was lower than that of the MSII group (63.2 U (SD: 17.0)) (t=3.57, P <0.05). The incidence of hypoglycemic in the CSII group (3.05%) was lower than that of the MSII group (9.20%) (χ~2 = 4.92,P < 0.05). The infection rate of incisions in the CSII group (0.0%) was lower than that of the MSII group (10.9%) (χ~2 =4.18, P < 0.05). The inpatient days in the CSII group (15.3 days (SD :7.2)) was shorter than that of the MSII group (22.5 days (SD :9.7)) (t = 3.12, P < 0.05). Conclusions Compared to multiple sub-cutaneous insulin infusion, continuous subcutaneous insulin infusion is more effective in controlling blood glucose, hypoglycemic and incision infection, thus is recommend to perioperative patients complicated with type 2 diabetes mellitus.

Objective To evaluate the efficacy of transarterial interventional therapy (TAIT) in treating patients with metastatic liver cancer, and to investigate the factors influencing the prognosis of patients. Methods From January 1997 to June 2000, 470 patients with metastatic liver cancer had undergone TAIT 1231 times in the Cancer Hospital of the Chinese Academy of Medical Sciences. The clinical data of the patients were retrospectively analyzed. The short-term and long-term efficacy and the side effect of TAIT were assessed. The potential factors influencing the prognosis of the patients were determined by Cox regression analysis. Results Complete remission was observed in 94 patients, and partial remission in 143. The total effective rate was 50.4% (237/470). The median survival time was 13.5 months. The O. 5-, 1-, 2-, 3-, 5-year survival rates were 86.4%, 66. 8%, 35.6%, 16.9%, 7.3%, respectively. No severe complication occurred. The factors influencing the prognosis of the patients were: the resection of the primary tumor, blood supply of the tumor, multiple metastases of liver cancer, thrombus in the portal vein, adjuvant chemotherapy after TAIT, tumor originated from breast cancer, tumors invading multiple lobes, concurrent metastasis in other sites (X2= 17. 322, 12. 593, 8.721, 8.573, 8.492, 7. 838, 5. 623, 5. 463, P < 0.05). Conclusions TAIT is an effective palliative therapy for metastatic liver cancer which cannot be resected. The factors mentioned above influence the prognosis of patients after TAIT.

Objective To test the predicative roles of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1( KIM-1 ) for acute kidney injury (AKI) in critically ill patients. Methods Children from pediatric intensive care unit, were randomly divided into four groups:critically ill patients with AKI (group 1 ), critically ill patients with non-AKI (group 2) , chronic kidney disease group (group 3), healthy control group (group 4). 1.5 ml venous blood and urine specimens were collected and kept under-70°C. Serum creatinine , urine NGAL and urine KIM-1 were analyzed. Results Compared with group 2, group 3 and group 4, the urine NGAL and urine KIM-1 increases obviously in group 1 (P<0.05). There is no signiifcance of urine NGAL and urine KIM-1 between group2, group3 and group 4 (P>0.05). The concentration of urine NGAL increased more than 10 times of base-line level 2 days before the diagnosis of AKI under the Acute Kidney Injury Network standard with area under curve (AUC) 0.955 (P<0.05) , and the concentration of urine KIM-1 increased more than 5 times of base-line level 1 day before AKI with AUC 0.878 (P<0.05). The AUC was 0.984 (P<0.01) when they were combined. There is negative correlation between the increased times of urinary KIM-1, urinary NGAL and vally value of creatin clearance rate. Conclusions The concentrations of urine NGAL and urine KIM-1 are useful early biomarkers for predicting AKI, especially when they were combined.

Objective To investigate the distribution and antimicrobial resistance of gram-negative bacilli isolated from wound specimens of orthopedic patients,and provide reference for the rational use of antimicrobial agents. Methods 682 isolates of gram-negative bacilli were collected from orthopedic department in a comprehensive hospi-tal between January 2011 and December 2013, antimicrobial susceptibility testing results were analyzed. Results The main gram-negative bacilli isolated from wound specimens of orthopedic patients were Pseudomonas aeruginosa (P .aeruginosa)(16.72%),Escherichia coli (E.coli)(15.40%),and Enterobacter cloacae (E.cloa-cae)(12.76%).The detection rates of extended-spectrum beta-lactamase-producing E.coli and Klebsialla pneu-moniae (K .pneumoniae)were 54.29%(57/105)and 31 .43% (22/70)respectively,and mainly distributed in the trauma orthopedic department,accounting for 49.12% and 45.45% respectively.The susceptibility rates of E.coli, K .pneumoniae ,and E.cloacae to meropenem and imipenem were all 100.00%.The susceptibility rates of E.coli and K .pneumoniae to amikacin,piperacillin-tazobactam and amoxicillin/clavulanic acid were all >80%.Suscepti-bility rate of E.cloacae to most antimicrobial agents were 71 .26% -100.00% except for piperacillin(64.37%). Susceptibility rates of P .aeruginosa to most antimicrobial agents were >85% except for cefepime (78.95%)and aztreonam (65.79%).Conclusion Gram-negative bacilli are the most common pathogens in wound infection of or-thopedics patients.In order to use antimicrobial agents rationally and improve clinical treatment effect,it is impor-tant to realize the distribution of pathogens and antimicrobial resistance.

This paper introduces the concept of sustainable nursing education, and summarizes the international organizations related to sustainable nursing. This article reviews what the nursing education need to do to better prepare nursing students for the future, which contributes to Chinese nursing education.