Objective To explore different management on malposition of PICC line.Methods 36 PICC line malposition clients,who went through pulling the catheter back,adjusting the position of the insertion limb were not successful,but by using the combination of the following 5 methods can successfully manage the malposition of PICC line:pulling the catheter 1cm back from the commencement point,withdrawing some length of catheter,Changing position,palpating clients' back,practising deep breathing,then X ray to confirm the catheter tip location,record the times and the successful rate.Results Among 36 clients,31 were managed successfully by the first time,3 Clients twice and 2 clients were not successful and had to remove inserted successfully at the basilica vein at the opposite arm.Overall,the successful rate is 94％.Conclusions The combination of the following 5 methods can successfully manage the malposition of PICC line:pulling the catheter 1 cm back from the commencement point,withdrawing some length of catheter,Changing position,palpating clients' back,practising deep breathing.

BACKGROUND: The dynamic characteristics of electroencephalogram (EEG) include a decrease in the chaotic dimension, the correlation dimen sion, the Lyapunov exponent, the chaotic complexity, the freedom of EEG and an enhanced synchronization and periodicity of the EEG from several minutes to tens of minutes before epileptic seizures. All these characteristics prefigure the forthcoming seizures. Some studies have proven that the non linear dynamical system can be used as a feasible approach to explore the potential variables for describing the chaos portrait of EEG. OBJECTIVE: To analyze the electric characteristics of EEG signal in the epileptic seizures in rat model by investigating the nonlinear dynamical variables, such as the approximate entropy (ApEn) and correlation dimen sion. DESIGN: Observational and experimental study based on animals. SETTING: Department of Medical Engineering, Department of Gastroen terology, Second Artilleryman General Hospital of Chinese PLA; Department of Physics, Faulty of Biomedical Engineering, Fourth Military Medical Uni versity of Chinese PLA. MATERIALS: From September 2001 to January 2002, this study was conducted at the Complexity Laboratory of the Biomedical Department of the Fourth Military Medical University of Chinese PLA. Six male SD rats,weighing 150- 200 g, were selected.INTERVENTIONS: After intraperitoneal injection of chloral hydrate (0. 5 mL), the male SD rats were deeply anesthetized. When their EEG signal became stable, bemegride injection was diluted at 1:1 with saline and was given on a volume of 0.5 mL to the rats intraperitoneally. After a while,the epileptic seizures started marked by a spasm with a deep roar. The entire epileptic seizures were recorded. According to the shape of EEG waves and the corresponding symptoms of the rats during their seizures, data of the four phases, referring to normal condition, preictal phase, ictal phase and postictal phases of epileptic seizures, were selected for nonlinear analysis. The variations of the ApEn and the correlation dimension were calculated.MAIN OUTCOME MEASURES: In the four phases of the seizures, before seizures, preictal phase, ictal phase and postictal phases, the changes in the ApEn and correlation dimension were observed.RESULTS: All the 6 rats entered the statistical procedure. During epilepsy, the ApEn and correlation dimension of the EEG signal in ictal phases (0. 447 ±0. 126, 2. 166 ±0. 377) decreased significantly while those in preictal phases(0. 807 ±0. 182, 4. 773 ±0. 319) and postictal phases (1. 241 ±0. 125, 6. 042 ±0. 373) (t = -3. 984to 17. 902, P ＜0. 01). The ApEn and the correlation dimension of the EEG signal in preictal and ictal phases had significant difference with those observed under normal conditions (1.313 ± 0. 090, 6. 405 ± 0. 694) (t = -5. 228 to 12. 740, P ＜ 0. 01 ).CONCLUSION: The changes in ApEn and correlation dimension showed by nonlinear dynamical approach in this study reflect the characteristics of EEG signals in preictal time, ictal time and postictal timeof the epileptic seizures and the differences among them. Additionally, they also reveal the laws in the changes of the complex ictal EEG signal.

Thermotherapy has become another important tumor treatment after surgery, radiotherapy, chemotherapy, and targeted treatment. Magnetic hyperthermia (MH) is a new type of hyperthermia, which has attracted widespread attention due to its advantages of non-invasiveness / minimal invasiveness, high efficiency and good tissue penetration. It provides a new option for the molecular level treatment of malignant tumors with high efficacy and low toxicity, which has become a new research direction of tumor treatment. Magnetic materials and suitable magnetic fields are needed to realize MH. Iron oxide nanoparticles (IONs) are widely studied as MH agents because of their high biocompatibility and heating ability. In this article, the research progress on magnetic iron oxide nanomaterials and MH combined with antitumor therapy based on magnetic nanoparticles were analyzed, and the potential application of MH in cancer treatment was reviewed.

Objective? To investigate the current situation of intravenous therapy in 38 ClassⅡ and above hospitals in Hu'nan Province and analyze the existing problems. Methods? A questionnaire survey was conducted in 38 hospitals in Hu'nan Province in November 2018 using the Nursing Situation of Intravenous Therapy in Hospitals at All Levels designed by the Professional Committee of Intravenous Therapy and Chinese Nursing Association. To understand the status quo of intravenous therapy, quality management of intravenous therapy, and the status of specialist nurses in intravenous therapy. Results? In 38 hospitals, totally 36 hospitals provided continuous intravenous therapy services through intravenous therapy/peripherally inserted central catheter (PICC) clinics and a designated hospital department; 21 hospitals had established intravenous therapy/PICC clinics; the outpatient service was flexible in form, but the qualification certification of outpatient nurses needed further regulation. The proportion of hospitals carrying out medium and long-term catheter infusion and hospitals carrying out PICC transfusion with Modified Sedinger Technique (MST) puncture guided by ultrasound was 100.00% and 72.22%, respectively. In vascular visualization technology, hospitals using infrared, ultrasound and X-ray technology were 2.63%, 63.16% and 34.21% respectively. There were some gaps in the skin disinfectant and disinfection scope, concentration of flushing and sealing fluid and maintenance frequency between the hospitals and the national standards in peripheral and central venipuncture and catheter maintenance. In terms of quality management of intravenous therapy, 34 hospitals had established intravenous therapy teams, whose quality evaluation criteria are different. In terms of specialist nurses team construction, there were 505 specialist nurses in venous therapy/PICC in 38 hospitals. The structure of specialist nurses had been continuously optimized in terms of education, title and length of service. However, hospitals needed to pay more attention to the development of specialist nurses. Conclusions? The contents of continuous nursing of intravenous therapy need to be further expanded, the management of PICC clinic needs to be strengthened, the standardized use of infusion devices and connectors needs to be improved, the knowledge and practice gap between puncture nursing and catheter maintenance of intravenous therapy exists, and the quality control standards of hospitals need to be standardized and regulated, more attention should be paid to the development of specialist nurses.

Objective:To establish the content of training courses for infusion therapy specialist nurses, and evaluate the implementation effect of the course, so as to provide a theoretical reference for the training of infusion therapy specialist nurses.Methods:Based on the preliminary investigation research on the needs of nurses for the training of intravenous therapy knowledge, the Delphi method was used to determine the training content of 6 modules and 62 projects. From March to May and from September to November 2019, two training sessions were carried out at the vascular access technology training base in Hunan Province. A total of 97 nurses from 84 hospitals participated in and completed the theoretical and practical courses, and the number of students in the two training sessions were 46 and 51 respectively. The learning effect of the students was understood with the pass rate of the staged assessment, the pass rate of the graduation assessment and the self-evaluation questionnaire.Results:The 97 students' self-evaluation of the mastery of learning content was 3.30 to 5.00. In the staged assessment, the theoretical score was (87.50±4.48) , the peripherally inserted central catheter (PICC) maintenance operation score was (86.25±5.62) , the infusion port maintenance score was (89.50±6.25) , and the PICC catheterization operation score was (84.42±4.13) . The qualification rate of theoretical and operational assessment was both 100.0%. In the graduation assessment, 97 students all completed the graduation assessment requirements, a total of 4 941 indwelling needles were successfully placed, 509 PICCs were successfully placed, and 97 small lectures were completed. The graduation assessment pass rate was 100.0%.Conclusions:This course has a high degree of expert positivity, expert authority and coordination of expert opinions, and the curriculum setting is scientific. The training course promotes the students' mastery of the specialized knowledge theory and practical skills of intravenous therapy, and can provide a theoretical basis for the training of intravenous therapy specialist nurses in my country.

Objective:To explore the effect of healthcare failure mode and effect analysis (HFMEA) management mode on perioperative nursing quality of cancer patients at arm infusion port.Methods:Using the convenient sampling, 68 cancer patients with arm infusion port in Hunan Cancer Hospital from January to October 2020 were selected as the control group, and 84 cancer patients with arm infusion port from November 2020 to August 2021 were selected as the intervention group. The control group followed the hospital's original perioperative safety management of chest wall port and peripherally inserted central catheter (PICC) insertion, while the intervention group adopted the HFMEA management mode for the perioperative safety management of arm infusion port. The risk priority number (RPN) , the occurrence of high-risk failure modes and complications of the two groups were compared.Results:The RPN values of failure modes such as inadequate preoperative evaluation, loss of intraoperative accessories, low puncture position, too short catheter clipping, loose connection between catheter and injection base, catheter positioning after incision suture, and insufficient postoperative health education in the intervention group were lower than those in the control group, with statistical differences ( P<0.05) . The incidence of inadequate preoperative evaluation, inadequate postoperative health education and postoperative complications in the intervention group were statistically lower than those in the control group ( P<0.05) . Conclusions:The HFMEA management mode can reduce the risk of perioperative links of cancer patients at arm infusion port and decrease the incidence of postoperative complications, which is worthy of clinical promotion.

Objective To evaluate the effects of"PICC fixed standard operation flow chart"in PICC fixed quality management. Methods Patients with PICC were admitted to the control group from January to June in 2014, given the routine PICC fixed method. PICC patients in the observation group who were enrolled from July to December 2014 were given new PICC fixed method that obey the"PICC fixed standard operation flow chart", which was established from relevant norms and guidelines and related literature. The incidence rate of medical adhesive related skin injury and unplanned extubation of PICC were compared with those of the two groups. Results The incidence rate of medical adhesive related skin injury was decreased from 35.20％(70034/198962) to 18.03％(37862/209955) (Z=-3.363, P<0.01) and PICC unplanned extubation decreased from 1.31‰(20/15384) to 0.37‰(7/18919) , the difference was statistically significant (χ2=6.940, P<0.05). Conclusions The PICC fixed standard operating flow chart can be used as a guide to implement the PICC fixation. Based on this, the quantitative management index is applied to the PICC fixed quality management, which can standardize the fixation of the PICC , reduce the related complications caused by the fixation of the catheter, prevent the occurrence of unplanned extubation of PICC , provide effective protection to ensure safe PICC long-term use and improve the patient's comfort.

Objective:To investigate the normal reference values of spinal bone mineral density measured by quantitative computed tomography (QCT) and the differences of bone mineral density (BMD) in different regions of in Chinese adult males.Methods:Men who underwent low-dose CT lung scan for cancer screening in regions of Northeast, North, East, South, Central and Southwest of China from January 2018 to December 2019 were selected. And the lumbar vertebrae BMD values in the male subjects were measured by the QCT system (Mindways Software, Inc.). The mean BMD values and their decline rates were calculated at an age interval of 10 years, and the prevalence of osteoporosis was calculated according to the American College of Radiology spine QCT osteoporosis diagnostic criteria.Results:A total of 50 682 males with a mean age of (50.22±12.79) years (ranged 20 to 98 years) were included in this study. The peak BMD of (173.11±28.56) mg/cm 3 in the healthy Chinese adult male population appeared in the age group of 20 to 29 years and then declined with age. Before the age of 70 years, the BMD was relatively higher in males in South China, and it was lower in Central China and Southwest China, and it was intermediate in Northeast, North and East of China, with statistically significant differences. There was no significant differences in BMD in the males in the two age groups of 70 to 79 years and 80 and older among the regions in China. The overall decline rate of spinal BMD in Chinese males under QCT was about 46.92% over the lifetime, and it declined obviouslyin the 40-49 age group. The overall prevalence of osteoporosis in Chinese male population aged 50 years and above was approximately 11.42%, with the highest prevalence in Southwest China and Central China (14.72% and 13.87%, respectively) and the lowest in North China and South China (8.53% and 7.71%, respectively). Conclusions:A reference of lumbar spine BMD values for healthy males in China based on QCT is established. BMD values were highest in South China and Lowest in Central China.

Objective:To establish the normal reference value of lumbar bone mineral density (BMD) under quantitative CT (QCT) in Chinese healthy adult females and to explore the regional differences.Methods:Total of 35 431 healthy women who met the inclusion criteria of Chinese health quantitative CT big data program were selected in this study. The BMD of the central plane of L 1 and L 2 vertebrae was measured by Mindways′s QCT system, and the mean value was taken. One-way analysis of variance was used to compare the BMD differences of lumbar vertebrae in women of different ages and regions. The subjects were grouped by an age interval of 10 years, and the level of BMD in different regions of the same age group were compaired. Results:The peak BMD of Chinese healthy adult women appeared in the age group of 20-29 years (Northeast China(183.01±24.58) mg/cm 3, North China (188.93±24.80) mg/cm 3, East China (187.54±27.71) mg/cm 3, South China (186.22±33.72) mg/cm 3, Central China (176.33±24.91) mg/cm 3, Southwest China(182.25±28.00) mg/cm 3), and then it decreased with age. The level of BMD in different regions decreased with the age. Before the age of 70 years, BMD in Central and Southwest China was always at a low level((176.23±24.91) to (90.38±28.12) mg/cm 3, 182.25±28.00 to (88.55±25.68) mg/cm 3), lower than those in Northeast China ((183.01±24.58) to (99.69±27.85) mg/cm 3), North China ((188.93±24.80) to (95.89±26.12) mg/cm 3), East China ((187.54±27.71) to (95.65±27.86) mg/cm 3). After 70 years of age, BMD tended to be the same in different regions ( P>0.05). The BMD values in Central China and Southwest China were similar in the age group of 40-60 years ( P>0.05). The BMD values in the health adult femles in the age group of 60 years in different regions of Chinawere all lower than those of bone mass abnormality (all P<0.05). The detection rate of osteoporosis in females over 50 years was the highest in Southwest China (25.65%) and it was the lowest in North China (17.30%). Conclusions:This study establishes reference values of BMD under QCT in healthy Chinese women, which can be used as a reference basis for identifying women with low BMD who are at risk of osteoporosis. The BMD value is the lowest in Southwest China and the highest in South China.

Objective:To use quantitative computed tomography (QCT) technology to measure the bone mineral density of the spine of the Chinese healthy population, and to explore its correlation with hemoglobin and serum albumin.Methods:The data in this study came from the China Health Quantitative CT Big Data Project (China Biobank). The spine bone density was measured by using QCT Pro Image Analysis System and all cooperating centers used the European spine phantom (NO.145) for quality control. Total of 50 053 healthy persons who met the criteria for entry were selected as the research subjects. The subjects were divided into 7 groups according to age. The general data, spine bone density, serum albumin, hemoglobin of the subjects were collected. The single-factor analysis of variance, Pearson correlation analysis and multi-classification logistic regression model were applied to analyze the correlation between bone density and hemoglobin and serum albumin.Results:The bone mineral density of healthy people decreased with age ( P<0.05), and there were significant differences in hemoglobin, serum albumin and body mass index (BMI) among different age groups (all P<0.05). Linear correlation analysis showed that there were positive correlation between bone mineral density and hemoglobin in healthy males in different age groups ( r=0.086, 0.101, 0.076, 0.090, 0.072, 0.123, 0.100, all P<0.01). There were negative correlation between bone mineral density and hemoglobin in certain age groups in women (40-49 years group: r=-0.027; 70-79 yearsgroup: r=-0.077; both P<0.05). And corelation were found between bone mineral density and serum levels of albumin in certain age groups of healthy subjects (among men, 30-39 years group: r=-0.048; 40-49 years group, r=-0.027; 70-79 years group, r=-0.051; among women, 30-39 years group: r=-0.044; 40-49 years group, r=-0.042; 50-59 years group, r=-0.086; 70-79 years group, r=-0.070; all P<0.05). After adjusting for age and BMI, the multi-category logistic regression analysis showed that the hemoglobin level was protective factor of normal bone density ( OR=1.022, 95% CI:1.017-1.027) and decreased bone density ( OR=1.012, 95% CI:1.007-1.016) in healthy males, and the serum albumin was risk factor for normal bone density ( OR=0.926, 95% CI:0.905-0.948) and decreased bone density ( OR=1.006, 95% CI:0.951-1.011) in healthy women. Conclusion:There is a correlation between bone mineral density and hemoglobin and serum albumin in Chinese healthy population. Hemoglobin is a protective factor for bone mineral density in men, and serum albumin is a risk factor for bone mineral densityin women.