Objective:To investigate the perceptions of ICU patients on nurse caring behaviors and related factors,then raise nursing straties. Methods:101 ICU patient samples were selected from two tertiary general hospital(sGrdae A)in Fuzhou.The mod- ified caring behavior assessmen(tCBA)scale was used to interview the subjects. Results:The most important caring behaviors were to help patients satisfy their basical requiments. There were statistically significant differences in the perceptions of importance of nurse caring behaviors among the patients’demographic data such as marriage and length stayed in ICU.Conclusion:ICU patients need nurse caring behaviors. Nurses should provide patients with individual caring behaviors to satisfy their requi-ments. So nursing quality and patient satisfaction would be improved.

Objective To compare the effectiveness of lactulose oral solution combined with PEG-4000 electrolyte lavage solution with PEG-4000 electrolyte lavage solution only in colonoscopy preparation.Methods A total of 121 patients preparing for colonoscopy were randomly divided into two groups:61 patients in lactulose oral solution combined with PEG-4000 electrolyte lavage solution group (the experimental group =group A),and 60 patients in PEG-4000 electrolyte lavage solution group(the control group =group B).During the colonoscopy,the endoscopist blindly scored the cleanness of the bowel,and recorded any adverse event to assess the safety.Results According to the Boston bowel preparation scale,the experimental group scored 7.07 ±0.79,and the control group scored 6.18 ± 1.03,which showed significant significance(P =0.000).There was no significant difference in the time of accessing rectum between the two groups[(8.80 ± 1.74) min VS(9.22 ± 1.94) min,P =0.220].Polyp detection rate in group A was higher than that in group B,with no significant difference (22.95％ VS 15.00％,P ＞ 0.05).The small polyp (≤0.5 cm)detection rate in group A was higher than that in group B with significant significance(P =0.038).No adverse event was recorded in either group.Conclusion The bowel preparation with lactulose oral solution combined with PEG-4000 electrolyte lavage solution is more effective than that with PEG-4000 electrolyte lavage solution alone.It will enhance the detection rate of small polyps with no evident adverse reactions.

Objective To investigate the effect of Helicobacter pylori (Hp) plantation in Barrett's esophagus (BE) columnar epithelium on esophageal adenocarcinoma (EA) in the elderly.Methods 109 patients with reflux esophagitis (RE),51 patients with Barrett's esophagus and 16 patients with esophagus adenocarcinoma were diagnosed by endoscopy and pathological biopsy.The 4-quadrant biopsies in esophagus lesions were respectively taken from each patients.1 were tested by silver staining and urease test for rapid detection of Hp,and the other were stained by HE staining for pathological analysis,AB /PSA staining and immunohistochemistry for gene expressions of cyclooxygenase-2 (COX-2) and B cell lymphoma / leukemia-2 (Bcl-2).Results Hp colonization in RE group,BE group and EA group were 0％,44.4％ and 42.1％ respectively.The expression levels of COX-2 in abnormal squamous epithelium in RE group,BE group and EA group were 46.7％,100％ and 100％ respectively.The expression of COX-2 was higher in BE and EA groups than in RE group (x2=126.21,both P＜0.05).Moreover,a gradually increase in COX-2 expression was observed in abnormal esophageal squamous epithelium from RE to BE to EA.COX-2 expression was significantly increased in mucosa in BE and EA patients with Hp plantation and in lower esophageal carcinoma in EA patients with Hp plantation and without Hp plantation.Bcl-2 expression in esophageal squamous epithelium was 40.2％,85％ and 100％ in RE,BE and EA groups respectively.The expression of Bcl-2 was higher in BE and EA groups than in RE group (x2 =125.25,P＜0.05).Bcl-2 expression was increased in mucosa BE patients with Hp plantation.Conclusions Hp plantation in BE esophageal columnar epithelium can increase the expression of COX-2,and induce its downstream Bcl-2 expression,inhibit cell apoptosis,and might lead to EA.

Objective To evaluate the efficacy of endoscopic variceal ligation(EVL)in esophageal variceal bleeding (EVB)in elderly patients with hepatic cirrhosis,and the safety of endoscopic operation under anesthesia.Methods From July 2007 to July 2013,170 patients diagnosed as liver cirrhosis complicated with EVB were retrospectively analyzed.Among them,139 patients who received EVL were divided into elderly anesthesia group (n=52,age≥60 years),elderly non-anesthesia group (n=45 ,age≥60 years)and non-elderly anesthesia group (n=42,age<60 years);the other 31 cases (age≥60 years) received propranolol therapy.The degree of satisfaction of visual fields and esophageal peristalsis under the gastroscope,the effect,adverse effects and complications of EVL,the recurrence of EVB and mortality of each group were analyzed.Two-way analysis of variance and crosstabs chi square test were performed for statistical analysis.Results The satisfaction rate of visual fields and esophageal peristalsis under the gastroscope were 82.5 % (104/126)and 89.7% (113/126)in elderly anesthesia group;82.6% (71/86) and 89.5 % (77/86)in non-elderly anesthesia group;40.3% (29/72)and 44.4% (32/72)in elderly non-anesthesia group.The satisfaction rate of visual fields and esophageal peristalsis under the gastroscope in anesthesia group were better than those in non-anesthesia group (χ2 =47.46,64.28;both P <0.01 ). The efficacy rates of EVL in elderly anesthesia group,elderly non-anesthesia group and non-elderly anesthesia group were 84.6%(44/52 ),68.9%(31/45 )and 81 .0%(34/42 ),respectively.The variceal recurrence rates were 19.2% (10/52 ),20.0% (9/45 )and 19.0% (8/42 ),respectively.There was no significant difference among them (all P > 0.05). Rebleeding rate of medication treatment group was 58.1%(18/31),which was obviously higher than that of elderly anesthesia group (19.2%,10/52 ), elderly non-anesthesia group (31 .1 %,14/45 )and non-elderly anesthesia group (23.8%,10/42 ),and the difference was statistically significant (χ2 =15 .10,P <0.01 ).No case of hepatic encephalopathy was found in elderly anesthesia group or non-elderly anesthesia group after EVL.The incidence of pneumonia in elderly non-anesthesia group was 4.2%(3/72),which was higher than that of elderly anesthesia group and non-elderly anesthesia group,and the difference was statistically significant (χ2 =8.93,P =0.01). The mortality within a month after EVL in elderly anesthesia group,elderly non-anesthesia group and non-elderly anesthesia group was 0,8.9% (4/45 )and 0,and the difference was statistically significant (χ2 =9.27,P =0.01).Conclusion The efficacy of EVL under anesthesia in EVB in elderly patients with liver cirrhosis was good,with no induction or aggravation of hepatic encephalopathy or irreversible complications were found.

The needles were inserted in the center of inferior margin and on the left and right sides of patella. Then moxibustion with warming needle and electroacupuncture were used respectively to treat 25 cases of patellar ligament strain. The effective rates were 96.0% and 69.6% respectively.

Objective To explore the effects of different ways of nutritional support on organ functional recovery and prognosis in the elderly with multiple organ dysfunction syndromes (MODS).Methods 85 patients with MODS were randomized into enteral nutrition(EN) group (n=43 cases)and total parenteral nutrition(TPN) as control group (n=42 cases).EN group received nutritional support by nasogastric feeding tube or percutaneous endoscopic gastrotomy (PEG)/ percutaneous endoscopic jejunostomy (PEJ),and TPN group got nutrition by central vein for at least 2 months of therapeutic course.Body mass index (BMI),hemoglobin (HB),functions of liver and kidney,electrolytes,blood glucose and lipid,serum albumin(ALB),transferring(TRF),prealbumin (PA),immunoglobulin(IgA,IgG,IgM),leukomonocyte (CD3+,CD4+,CD4+/CD8+) were compared between two groups before and after treatment.Results The levels of Hb,BMI,ALB,TRF and PA after treatment for 1 and 2 months significantly improved (t1EN =2.672,2.440,2.209,3.331,5.025,t1TpN=2.720,2.337,2.179,3.418,2.221 and tEN2nd maonh=2.279,3.021,2.337,3.005,5.779,tTPN2nd month=2.118,2.956,3.018,3.310,2.119,all P＜0.05) in two groups as compared with before treatment,and there was remarkable difference in the level of PA between EN group and TPN group(t=2.336,P＜0.05).Hyperlipemia at 1 and 2 months after treatment occurred in TPN group (t1TPN =3.609,t2TPN =3.114,P＜0.05).The levels of IgG (t1st month=2.664,t2nd month =2.983,P＜0.05) and IgA (t1st month =2.437,t2nd month =3.005,P＜0.05) were higher after treatment for 1 and 2 months than before treatment.The levels of CD3+,CD4+ and CD4+/CD8+ cells improved (t2nd month =2.399,3.478,2.579,3.995,P ＜ 0.05 ) and IgM (t2nd month =3.886,P＜0.05) increased after treatment for 2 months in EN group.In EN group,aspiration pneumonia appeared in 34 cases and the occurrence rate decreaed (x2 =51.12,P ＜ 0.05 ) after PEG/PEJ operation (only 5 cases).Reflux esophagitis reduced and alleviated 2 months after PEG/PEJ operation (x2=13.53,P＜ 0.05).ConclusionsTimely sufficient EN support may improve nutritional and immunological status in elderly patients with MODS.PEG/PEJ can reduce the occurrence of aspiration pneumonia and reflux esophagitis caused by the nasogastric feeding tube.

ObjectiveTo discuss the hematological adverse reactions of oral omeprazole administration with convention dosage and treatment course in aged patients.MethodsFour hundred and nine cases of reflux esophagitis by endoscopic diagnosis from Beijing Hospital during January 2000 to December 2010 were divided into three groups according to their ages: group A ( 168 cases) aged from 60 to 69 years,group B ( 152 cases) aged from 70 to 79 years and group C (89 cases) aged equal to or above 80 years.Each group of patients was randomly divided into three subgroups,A 1 ( 56 cases),B 1 ( 51 cases) and C 1 ( 30 cases ) were administered with oral omeprazole,20 mg,bid; A2 ( 56 cases ),B2 ( 51 cases ) and C2 ( 30 cases ) were administered with oral famotidine,20 mg,bid; A3 ( 56 cases),B3 ( 50 cases),C3 ( 29 cases ) and all above subgroups were administered with oral sucralfate,10 ml,tid.The treatment course lasted for one month.The clinical efficacy,WBC count,RBC count,the Hemoglobin level,platelet count,as well as the prothrombin time,thrombin time,activated partial thromboplastin time,fibrinogen,Plasma fibronectin and serum D-Dimer were tested and compared after 10-days and 30-days treatment.ResultsAfter the treatment,all the patients had alleviated symptoms,to varied extend,especially in subgroups treated with oral omeprazole and sucralfate.After 30 days' treatment,blood WBC counting in B1 subgroup declined to lower than normal values in two cases; PLT counting drops in 1 case; blood WBC dropped in 6 cases and PLT dropped in4 cases of the C1 subgroup;blood WBC counting dropped in 1 case and PLT dropped in 2 cases of the C2 subgroup.Hemoglutination did not show significant change in all groups (P ＞ 0.05 ).Conclusion The hematological adverse reactions of oral omeprasole in aged patients,under convention dosage and treatment course,occured with age increase,especially for blood WBC and platelet counting.

Objective To investigate the clinical manifestations,pathological features hy endoscopy and possible risk factors of ischemic colitis (IC).Methods A retrospective analysis was made upon 89 hospitalized patients diagnosed as IC.Logistic regression analysis was performed to determine morbidity risk factors.Results The majority of patients with IC in our study group had histories of hypertension,heart disease,hyperlipidemia,diabetes,etc.The common features included abdominal pain (80.9％,72/89),hematochezia (76.4％,68/89),etc.Colonic mucosal lesions presented regional distribution under colonoscope (80％,72/89),with manifestations of petechial hemorrhages,edema,segmental erosion,pleomorphism ulcerations,visible lesion edge and sharply defined segment of involvement,even be characterized by lumens stricture (13.5％,12/89).Histopathological examination revealed mucosa edema,necrosis,hemorrhage and formation of ulceration,inflammatory cell infiltration,and submucous hemorrhage,etc.Laboratory examination showed that white blood cells,neutrophils,serum fibrin,D-Dimer,serum TC,TG and serum apolipoprotein B were higher than normal.Colonic mueosal roughness,thumbmark symptoms,etc,and even bowel limited spasm,stricture or curtailment were visible in 47 patients underwent barium enema.Colonic wall thickening was visible in 29 patients underwent mesentericography,however,strictured or closed blood vessels were not found logistic regression analysis showed that hypertension,diabetes,higher TG,atrial fibrillation were strongly associated with onset of IC (all P values ＜ 0.05).Conclusions Since IC symptoms are not typical,it requires early colonoscopy to clarify diagnosis.Hypertension,diabetes,hyperlipidemia,and atrial fibrillation are risk factors for IC.

Objective To analyze the clinical characteristics of gastric polyps in different histopathological types. Methods Based on histopathological difference, gastric polyps were categorized into fundic gland polyps, hyperplastic polyps, inflammatory polyps, adenomatous polyps, etc; Different types of polyps in the aspects of distribution, Helicobacter pylori (H. pylori) infection, the relationship between the proton pump inhibitors (PPI) and the occurrence of gastric polyps to provide guidance on treatment Results 365 cases of gastric polyps were diagnosed in 10 197 patients who underwent gastroscopy. The prevalence was 3. 6%. The histopathological type of the polyps were fundic gland polyps (61. 1%), hyperplastic polyps (23. 3%) , inflammatory polyps (12. 3%) , adenomatous polyps (2. 2%). 289 cases showed single polyps, which was the majoriry across all types of gastric polyps. Majority of the gastric polyps were located in gastric body and fundus, followed by gastric antrum and cardia Most of the fundic gland polyps were located in gastric body and fundus; Majority of the hyperplastic polyps and adenomatous polyps were located in gastric antrum; The main locations of inflammatory polyps were cardia and gastric body and fundus. A higher percent (51. 6%) of fundic gland polyps patients used PPI. The difference was statistically significant compared with the hyperplastic polyps(8. 2%)and inflammatory polyps group(8.9%) (x2 = 48. 31,27. 63 ,P <0. 01). The H. pylori infection rate of hyperplastic polyps and inflammatory polyps were 72.4% and 74.4% ,respectively, both of which were higher than that of fundic gland polyps(20. 2%)(x2 =46. 50,35. 04, P < 0. 01) . One year after the H. pylori eradication, the recurrence cases of hyperplastic polyps and inflammatory polyps were 1/41 and 0/19,respectively. Conclusions The main histopathological type of gastric polyps is fundic gland polyps followed by hyperplastic polyps. The main location of the gastric polyps is gastric body and fundus, followed by gastric antrum and cardia. The distribution of different types of gastric polyps has some characteristics. Long-time usage of PPI may increase the risk of fundic gland polyps. The occurrence of hyperplastic polyps and inflammatory polyps may be related to H. pylori infection. The H. pylori eradication helps preventing the recurrence of hyperplastic and inflammatory gastric polyps.

Objective To summarize the clinical and pathological data of gastric polyps under gastroscope,and to investigate the clinical characteristics of gastric polyps in elderly patients.Methods The 692 cases of gastric polyps diagnosed by gastroscopy and pathology were retrospectively analyzed.The elder group was defined as aged 60 years and over.The young group was defined as aged less than 60 years.The data were analyzed by SPSS software.Results The detected ratios of gastric polyps were 3.9% in the elder group and 2.9% in the young group (χ2 =15.792,P<0.01).The rates of gastric polyps found in fundus,gastric body and gastric antrum were 32.0%,41.3% and 19.8% respectively in the elder group.And the corresponding rates in the young group were 37.5%,45.8% and 11.1% respectively (χ2 = 2.277,1.404,10.289,P = 0.131,0.236,0.001).The pathological types of the gastric polyps were in the order of fundic gland (60.0%),hyperplastic (26.2%),inflammatory (11.3%),adenomatous (1.7%) and others (0.8%).The diagnostic rates of hyperplastic polyps in the elder group and the young group were 31.7% and 21.9% respectively;the corresponding rates of adenomatous polyps were 3.0% and 0.8% respectively (χ2 = 8.525,4.834,P=0.004,0.028).Conclusions The detected ratio of gastric polyps is higher in the elder group than in the young group.In both groups,the polyps in the fundus and the body are more prevalent,followed by those in the antrum.The diagnostic rate of polyps in the antrum is significantly higher in the elder group than in the young group.Although the main pathological type of the gastric polyps is fundic gland in both groups,the diagnostic rates of hyperplastic polyps and adenomatous polyps are both higher in the elder group,the risk of cancer is higher as well.Therefore,in the elderly,the gastric polyps are recommended to be cut off as soon as possible and followed up closely.