Objective To investigate how surgical patients are assessed regarding pressure ulcer risks and the usage of evaluation tools in different stages during perioperative period.Methods Totally 210 nurses from operating rooms and surgical wards in 7 tertiary hospitals of Jiangsu Province were investigated with self-designed questionnaire.Results Operating room nurses of 7 hospitals used different kinds of scales for pressure ulcer risk assessment,the same scale document was used during the different stages of operation,the frequency and time for pressure ulcer risk assessment varied from one to three times,preoperative visit to handover in surgical ward were different;the Braden scale was used by surgical nurses to evaluate pressure ulcer risk after operation,while most surgical nurses believed that the existing scale lacked specificity and intraoperative risk factors that should be considered when assessing postoperative patients.Conclusion The frequency and time of pressure ulcer risk assessment of patients during perioperative period are not standardized,the content of scale is limited and lacks specificity,the assessment of pressure ulcer risk during perioperative period is discontinuous and non-dynamic.There are no specific risk assessment scales targeting preoperative,intraoperative and postoperative pressure ulcer risk assessment.

Objective To study the type variation of microglial activation in spinal dorsal horn of rats after sciatic nerve injury.Methods Healthy adult male Sprague-Dawley rats were randomly divided into the control and experimental groups, 24 rats in each group.The experimental group underwent ligation of sciatic nerve trunk to generate nerve injury in the rats.The pain behavior in the rats was measured at the 1th, 7th and 14th postoperative days, and the changes of microglial activation in the rat lumbar spinal cord dorsal horn was detected by immunofluorescence staining.qRT-PCR assay was used to validate the activation trends of M1 and M2 types of microglia cells.Results No significant changes were found in the microglial cells in the spinal cord dorsal horn of rats in the sham-operation group during 14 days after operation.In the sciatic nerve ligation group at 1 day after operation, no significant change was observed in the number of microglial cells, but the expression of marker of M1 microglia was significantly increased.At 7 and 14 days after operation, the number of microglial cells and the expression of M1 microglia marker in the spinal cord dorsal horn were increased significantly.Conclusions Microglia activation in the spinal dorsal horn starts at the first day after sciatic nerve injury, and lasts at least for two weeks after the operation.M1 microglia activation dominates during this period.

BACKGROUND: The previous experiments have conformed the traditional Chinese medicine (TCM) Jiannaaan, with the effects of tonifying kidney, promoting blood circulation and resolving phlegm, can inhibit the increased content of glucocorticoid (GC) in 2-24 hours after cerebral ischemic reperfusion (CIR), and reduce toxic effects of promoting nervous cell apoptosis induced by high GC. However, it is unclear whether this effect exists in GC receptor (GR).OBJECTIVE: To observe the intervention of TCM Jiannaoan on GR,further study protective mechanism of Jiannaoan power to hippocampal neurons after CIR, and perform positive control with compound almitrine.DESIGN: A randomized and controlled trial taken animals as subjects.SETTING: Center Laboratory of Beijing University of Chinese Medicine.MATERIALS: The experiment was conducted at the Center Laboratory of Beijing University of Traditional Chinese Medicine between July 2002 and March 2003. Eighty male SD rats were randomized into 5 groups with 16 in each: Sham group, model group, treatment group, positive control group and antagonist group. And each group was divided into 4 subgroups: 2, 6,12 and 24 hours after CIR, with 4 rats at every time point.METHODS:①Administration: Except model group, rats in other 4 groups were administrated by intragastric infusion since 7 days before model establishment, once per day, with dose of 7 μL/g per day distilled water in sham group, 7.39 mg/kg per day compound almitrine in positive control group, 6.7 g/kg per day Jiannaoan crude drug (consisted of desertliving cistanche herb, tatarinowii sweetflag rhizome and rhubarb, etc) in treatment group and 10 g/kg per day GR antagonist mifepristone in antagonist group.② After 7-day administration, the CIR models were prepared on the experimental rats with middle cerebral artery occlusion (MCAO) filament method, while the rats in sham group were sutured after common carotid artery detachment at anesthesia, without filament.MAIN OUTCOME MEASURES: All the rats were executed to take out brains at different time points of reperfusion, and the change of GR protein expression was observed with immunohistochemical method then the amount of positive cells were calculated in 3×200 sight of CA2 region.RESULTS: Totally 80 rats were entered into the result analysis. Compared with uninjured side, the protein expression of GR in model group,treatment group, positive control group and antagonist group were significantly lower than that of sham group (P ＜ 0.05), in which GR expression of injured side was equal to that of uninjured side without significant difference. No obvious change was found in the protein expression of GR among treatment group, positive group and antagonist group at different time points of reperfusion, and no significant difference was found between above groups and model group (P ＞ 0.05).CONCLUSION: Jiannaoan power is selective for adjusting GR and content of GC: Jiannaoan can not adjust expression of GR, identical as compound almitrine; But Jiannaoan can protect the neurons through decreasing the content of GC in plasm and brain tissues after CIR.

Xiangxi (the western part of Hunan province) Liu's infantile tuina,as one main school of current infantile tuina in China,highlights the compatibility of the specific points of Wujing in children,the idea of treatment by syndrome differentiation,and produces unique efficacy in the treatment of common diseases in children.Exogenous fever in children can be treated with this method with excellent efficacy.Based on the clinical experience and effective cases treated by this tuina school,the authors elaborated the clinical thought and experience from the perspective view of tuina,for the promotion of Xiangxi Liu's infantile tuina in clinic.

Objective The use of extracorporeal membrane oxygenation (ECMO) as a treatment for the failure of cardiopulmonary function after cardiac surgery is increasing and has been reported to be 3% to 5% in the cases with congenital heart disease. We reviewed our experience with ECMO in children who received heart surgery for congenital heart disease and complicated with severe heart failure postoperatively. Methods Eight patients received ECMO, seven was due to the failure to wean from bypass and one had fulminant myocarditis. Import membrane oxygenator,veno-arterial mode ECMO and right atriumascending aortic cannulation were used in 7 cases and peripheral cannulation via femoral veno-artery route was used in 1 case.Supportive intervention persisted from 65 to 498 hours, with flow rate maintained at 80 to 120 ml per minute per kilogram body weight. Results Five patients died, with a mortality of 62.5%, and 3 cases discharged, with a survival rate of 38%. Bleeding occurred in 5 cases, thrombosis occurred in 2 cases, hemolysis was identified in 1 case and DIC was observed in 1 case.One case had liver failure and 2 cases had malnutrition. Oxygenator plasma leakage occurred in 2 cases. Mean arterial blood pressure increased significantly after the establishment of ECMO as compared with that before the procedure [( 60.2 ± 7.8 )mmHg vs. (48. 1 ± 5.2 ) mmHg, P≤0.05]. The arterial concentration of lactate decreased significantly, from (5. 1 ± 0. 8 )mmol per liter before ECMO to ( 3.6 ±0. 5 )mmol per liter after ECMO, P ＜0.05. Conclusion For patients who survived the congenital heart surgery and no residual anatomic deformity, ECMO can be used as early as possible as a treatment for severe heart failure which resulted from coexistent of left and right ventricular and pulmonary insufficiency. An overall mortality may be decreased by ECMO technique as it plays a substitution role for gas exchange in the lung. As a result, the concentration of oxygen and the airway pressure used during ventilation, and the resultant lung injury can be reduced. Appropriate strategies involve transfusion of fresh platelet and packed red blood cells, replacement of frozen plasma and blood products, as well as rational use of vasoactive drugs and heparin, and maintaining a stable internal environment. Following strategies are also recommended: using continuous arterio-venous hemofiltration and durable heparin-coated membrne oxygenator, reducing hemorrhagic complications, monitoring pressure on both side of the film, identifying plasma leakage carefully and reducing the mechanical complications.

Objective To study the association of the expression of bone morphogenetic protein (BMP) antagonist gremlin and vascular calcification in radial arteries of patients with stage 5 of chronic kidney disease (CKD).Methods Radial arteries of 40 patients with stage 5 of CKD were collected as specimens of the study group,which were trimmed off during arterial venous fistula operations.Splenic trabecular arteries were collected as specimens of the control group,which were removed from 38 patients with simple traumatic splenic rupture.All the arteries were examined histologically for calcification with yon Kossa stain.Expressions of gremlin and BMP-2,-7were detected by immunohistochemistry and their serum concentrations were detected by ELISA.Images of histological sections were semi-quantitatively analyzed by Image-Pro Plus 6.0.SPSS 19.0software was used to perform statistical analysis.Results Significantly positive von Kossa stain was found in radial arteries from 12 of 40 patients (30％) in study group,which located in the layer of medial smooth muscle cells.However,there was no obvious positive stain in control group.Additionally,in study group,significant expressions of gremlin and BMP-2 were detected in those radial arteries of positive yon Kossa stain,which also located in the layer of medial smooth muscle cells.Positive correlations were found among gremlin expression level,BMP-2 expression level and yon Kossa stain intensity.However,the BMP-7 expression intensity in arteries of study group was much weaker as compared to control group.Conclusions Both gremlin and BMP-2 may be involved in the process that the smooth muscle cells of radial arteries in patients with stage 5 of CKD phenotypically transform into osteoblast-like cells.However,BMP-7 possibly prevents this process.

Objective To investigate the dose and time kinetics of induction of apoptosis induced by doxorubicin in J urkat leukemiacells, and to explore its pertinent molecular mechanisms. Methods Human Jurkat leukemia T - cells were treated with doxorubicin at theconcentration of 0.1 mg/L, 0.2 mg/L, 0.5 mg/L and 1.0 mg/L for 6,12,24 and 36 hours, respectively, of which one sample was pre-treated with zVAD- fmk (benzyloxycarbonyl - Val -Ala - Asp - fluoromethylketone) prior to addition of doxorubicin 0.2 mg/L. Apop-tosis was detected with both annexin V - FITC and propidium iodide ( PI ) staining and annexin V FITC and PI double positive cellswere analyzed by flow cytometry. Western blot was used to evaluate the level of Fas ligand (FasL) and FADD (Fas - associated death do-main) expression. Results The differences of apoptotic cells induced by all dose of doxorubicin were not significant (P＞0.05 ) at 6hour;at 12 hour, only the highest dose, 1 mg/L, significantly induced cell apoptosis;while the lowest dose,0.1 mg/L, did not significantlycaused cell apoptosis for all time points. After exposure to the doses of 0.2 and 0.5 mg/L for 24 or 36 hours,a significant increase in per-centage of apoptotic cells was observed (P ＜ 0.001 ). Apoptosis induced by doxorubicin was completely inhibited when the cells were incu-bated with doxorubicin in the presence of zVAD - fmk (P ＜ 0. 001 ). The level of FasL and FADD expression correspondingly increasedwith exposure time to doxorubicin. Conclusions Doxorubicin induces apoptosis in a dose - and time - dependent manner; upregulatedFasL may initiate the activation of the Fas signaling pathway and caspases are the ultimate executioner in the induction of leukemia cellapoptosis by doxorubicin.

0.05) at 6 hour;at 12 hour,only the highest dose,1 mg/L,significantly induced cell apoptosis;while the lowest dose,0.1 mg/L,did not significantly caused cell apoptosis for all time points.After exposure to the doses of 0.2 and 0.5 mg/L for 24 or 36 hours,a significant increase in percentage of apoptotic cells was observed(P

OBJECTIVETo explore the value of spinal canal and dural sac dimensions for the treatment of lumbar disc herniation in MRI.

METHODSThe clinical data of 144 patients with single-level lumbar disc herniation underwent nonsurgical or surgical treatment from January 2010 to December 2012 were retrospectively analyzed. There were 91 patients in the nonsurgical group, including 55 males and 36 females, ranging in age from 20 to 68 years old with an average of (43.37±12.48) years; and there were 53 patients in the surgical group, including 28 males and 25 females, ranging in age from 20 to 64 years old with an average of (42.98±12.95) years. JOA scores (29 scores) were used to evaluate clinical manifestation (including subjective symptoms, objective findings, limitation of daily activities and bladder function) and outcomes. The parameters related to spinal canal and dural sac dimensions (including spinal canal midsagittal diameter and available diameter, lateral recess width, spinal canal and dural sac cross-sectional area) in the initial axial T2-weighted MRI were measured, and odds ratio of available diameter to midsagittal diameter, odds ratio of lateral recess width to midsagittal diameter and area ratio of dural sac to spinal canal were calculated. Then, the differences of all parameters between two groups, and the correlations with initial JOA scores were analyzed.

RESULTS(1) All patients were followed up from 1 to 3 years with an average of 2.1 years. JOA scores before treatment were 16.27±2.96 in nonsurgical group and 12.64±3.30 in surgical group, there was statistically significant difference (t=6.319, P<0.01). At final follow-up time, there was no statistically significant difference in JOA scores (25.41±2.22 vs 25.76±2.29), improvement rate [(72.95±12.54)% vs (76.80±9.45)%], and the excellent and good rate (84.91% vs 78.02%) between two groups (P>0.05). But, the relapse rate of nonsurgical group was higher than surgical group (14.29% vs 5.67%). (2) Spinal canal midsagittal diameter and available diameter, lateral recess width, spinal canal and dural sac area, the ratio of available diameter to midsagittal diameter, and the ratio of lateral recess width to midsagittal diameter in surgical group were smaller than that of nonsurgical group, but the area ratio of dural sac to spinal canal was larger, and there were statistically significant differences between two groups (P<0.01). (3) The initial JOA scores showed significantly positive correlation with spinal canal midsagittal diameter and available diameter, lateral recess width, and canal and dural sac area (P<0.01); also presented positive correlation with the ratio of available diameter to midsagittal diameter and the ratio of lateral recess width to midsagittal diameter (P<0.05); but there was a significantly negative correlation between initial JOA scores and the area ratio of dural sac to spinal canal.

CONCLUSIONBoth nonsurgical and surgical treatment of lumbar disc herniation can obtain good effect, but the recurrence rate of non-surgical treatment is higher. Preoperative MRI measurement parameters of spinal canal and dural sac dimensions has certain value for the treatment selection of lumbar disc herniation, but further refinement and validation is still required.

Adult ; Aged ; Dura Mater ; pathology ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; therapy ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Spinal Canal ; pathology

Animals ; Cell Proliferation ; DNA ; genetics ; immunology ; Female ; Hepatitis B Core Antigens ; genetics ; Hepatitis B virus ; genetics ; Interferon-gamma ; blood ; genetics ; Killer Cells, Natural ; immunology ; Lymphocyte Activation ; Mice ; Mice, Inbred BALB C ; Plasmids ; genetics ; immunology ; Random Allocation ; Recombination, Genetic ; Spleen ; cytology ; immunology ; metabolism ; T-Lymphocytes ; immunology