Objective To building a kind of system emergency management of nursing. Meth-ods Analyized the hazardous, made out related plans and trained staff according to the Joint commission international accreditation standards for hospital, and then elvaluated the effects of it. Results All kinds of risks in the hospital about emergency management were decreased, the ability of nursing department to defect the emergencies enhanced obviously. Conclusions JCI could help hospital practise the scientific, standarized, ordered and detailed nursing emergency management, which can guarantee a kind of safety en-vironment for patients, their family and staff of hopital.

Objective To investigate the efficacy of dexmedetomidine on anesthesia analgesia and postopera-tive cognitive dysfunction (POCD)in elderly patients with lumbar surgery.Methods Ninety elderly patients with lumbar surgery were randomly divided into dexmedetomidine group (A group with 46 cases)and control group (B group with 44 cases)by the random number table method.A group received load dosage (1μg/kg)dexmedetomidine before anesthesia induction,and this process must last for more than 10 minutes,then the dexmedetomidine was main-tained at a speed of 0.5μg/(kg·h)during the operation.B group were given the same dosage normal saline in the same way instead.The amount of intraoperative sedation drugs was observed and analyzed in the two groups.MMSE was measured at one day before surgery and seven days after surgery.And,the incidence rate of POCD was compared between the two groups.Results The dosage of intraoperative sedation drugs of fentanyl[(0.57 ±0.11 )mg vs (0.78 ±0.13)mg;t =8.286,P =0.000],propofol[(522.5 ±137.2)mg vs (734.2 ±175.8)mg;t =6.384,P =0.000]and remifentanil[(0.92 ±0.26)mg vs (1.38 ±0.73)mg;t =3.947,P =0.000]in A group were significantly lower than those of group B.After treatment for 7 days,the MMSE score in A group[(27.57 ±1.58)points]was higher than that of B group[(25.02 ±2.14)points](t =6.451,P =0.000).The incidence rate of POCD in A group (6.52%)was significantly lower than that of B group (22.73%),and the difference was statistically significant (χ2 =4.779,P =0.028).Conclusion In elderly patients with lumbar surgery,the dexmedetomidine can cut down the dosage of intraoperative sedation drugs,and it also could reduce the incidence of POCD.

Objective:To study the change of plasma cyclic nucleotide in patients of rheumatic heart disease with pulmonary hypertension and to evaluate the relationship between plasma cyclic nucleotides and hemodynamics. Methods:Plasma cGMP and cAMP were examined by radioimmunoassay, hemodynamic data were obtained with Swan Ganz catheter and the HP compact configurable monitors. Results:Plasma cyclic nucleotide increased in patients of rheumatic heart disease with pulmonary hypertension and had an obvious correlation with the level of PAPM, PVR, PAWP and CI. Conclusion:Increased cAMP and cGMP is one of the pathophysiological characters of pulmonary hypertension, cAMP and cGMP, as the second messenger, may play an important regulating role in the development of pulmonary hypertension.

Objective To analyze the clinical characteristics of coronary artery disease (CAD) in patients with nonalcoholic fatty liver disease ( NAFLD). Methods Totally 234 subjects underwent coronary angiography, including 148 men and 86 women with complete data on metabolic syndrome ( MS) and abdominal ultrasonography; the mean age was 66. 6 years. The severity of CAD was assessed by coronary stenosis index (CSI). Metabolic syndrome was diagnosed according to the Guideline on Prevention and Treatment of Blood lipid Abnormality in Chinese Adults. Results Ultrasonography revealed that 62 patients had NAFLD (26. 5%). In patients with NAFLD, the prevalence of central obesity was higher than those without NAFLD (75. 8% vs 50. 0% , P< 0.01). With regards to age, CAD patients with NAFLD were more common in patients under 60 years (27.4% vs 13.7% , P=0.005). CSI score was similar in CAD subgroup and CAD & NAFLD subgroup (P>0.05), however the age of patients in CAD & NAFLD subgroup was significantly lower compared to CAD subgroup ( P = 0.006). According to the results of logistic regression, central obesity was the independent risk factor of NAFLD (β= 1.701, P<0.001). Logistic regression demonstrated that age was independently associated with CAD (β = 0.032, P=0.027). Further more, multiple stepwise regression analysis showed that age was the single parameter that best predicted CSI score (β= 0. 125, P = 0. 022). Conclusions It is important to screen coronary artery disease in middle aged patients with central obesity or NAFLD.

OBJECTIVETo evaluate the clinical characteristics of radiation encephalopathy in nasopharyngeal carcinoma (NPC) patients of mainland China.

METHODSBased on the principle of systematic review, the search for literature in computerized Chinese Biology & Medicine database, 1979 to June 2001 (CBM) was performed, with the papers appraised according to conformation criteria, the methodological quality of the studies analyzed, and clinical data of patients processed using the statistical model.

RESULTS553 cases accumulated from 18 identified articles submitted by 16 hospitals in China were analyzed. The mean incidence of encephalopathy diagnosed by CT or MRI was 1.9% (0.4% - 2.6%). The disease focus was located in the temporal lobe (80%) and in the brain stem (17%). The mean dose received in the first course of radiotherapy to the nasopharynx or skull base was 72.9 Gy, and the latent period of this disease was 3.6 years.

CONCLUSIONThe probability of encephalopathy after radiation for nasopharyngeal carcinoma in mainland China is reported in this review. Multi-center case-control or Cohort studies are required in the future.

Adult ; China ; Humans ; Middle Aged ; Nasopharyngeal Neoplasms ; complications ; radiotherapy ; Postoperative Complications ; radiotherapy ; Radiation ; Radiotherapy

Objective To analyze the association of blood uric acid level with the severity of coronary artery stenotic changes, metabolic syndrome (MS), and its components. Methods A total of 343 individuals ( male 223,female 120) who underwent coronary angiography and had complete data on MS and serum uric acid were collected. The severity of coronary artery disease (CAD) was assessed by the coronary stenesis index (CSI). MS was diagnosed according to the Guideline on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults. Results (1)The mean uric acid level was significantly lower in women than in men [ ( 306.3±76.9 vs 358.9±85.2 ) μmol/L, P＜0.01 ]. The prevalence of MS and its components showed no difference between men and women. (2) The uric acid level in women with 3 components was higher than those with1( P＜0. 01 ) or 2 ( P＜0.05 ) components of metabolic disorders, but not in men. (3) Quartiles of concentration of uric acid were computed. Compared with those in the lowest quartile of uric acid, women in the highest quartile had higher CSI score [ 7.0 (2.5-12.0) vs 2. 0( 0.0-6.0), P= 0. 025 ]. Moreover, the uric acid level was higher in women with multivessel lesions than nonCAD patients [ (327.0±81.9 vs 284.9±78.6) μmol/L, P = 0.033 ]. However, no correlation was found between uric acid level and the severity of coronary artery lesion in men. (4) Logistic regression showed that age (β=0.042, P=0. 007) and dyslipidemia(β=0.836, P=0. 037 ) were the independent risk factors of CAD in men, and hypertension(β=1. 127, P=0.039) and dyslipidemia(β=0.901, P=0.009)in women. Conclusions In women with higher uric acid level, the clustering of metabolic abnormalities was increased, and the coronary artery lesion was more severe. High uric acid level might be a marker of CAD for women.

Objective To investigate the relationship between the dynamic changes of interleukin-1β (IL-1β) levels and severity and complications of patients with multiple trauma at the early stage.Methods Among 97 patients with multiple trauma in Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital between August 2015 and May 2016,12 patients were excluded as follows,(1) with burns or chemical injuries;(2) pregnancy or menopausal women;(3) had bacterial infection a week ago;(4) with chronic diseases.The other 85 patients with multiple traumas were classified into three categories according to the injury severity score (ISS).That is,the slight group (22 cases,9≤ ISS ＜ 15),moderate group (35 cases,15 ≤ ISS ＜ 25) and severe group (28 cases,ISS ≥ 25).Their venous blood samples were collected at 6,12,24,48 and 72 hours after trauma respectively,and the serum IL-1 β levels were measured using a specific immunoluminometric assays.The basal conditions including age,the hospitalization days and so on among these three groups were compared via ANOVA.The mean IL-1 β levels at above time intervals among three groups were compared.Finally,the relationship between the peak concentration of IL-1β and injury severity and complications was analyzed by multiple Logistic regression.Results (1) As the increasing severity of trauma,the patients with longer days of hospitalization and higher rate of multiple organ dysfunction syndrome (MODS) (P ＜ 0.05).(2) The levels of IL-1 β in the moderate and severe groups were remarkably higher than those in the slight group (P ＜ 0.02).(3) The IL-1β levels in each group peaked at 6 hours after trauma and began to decline.(4) Multivariate logistic analysis showed that peak concentration of IL-1 β was still an independent predictor for injury severity (moderate group:odds ratio,1.21;95％ confidence interval:1.05-1.39,P =0.007;severe group:odds ratio,1.20;95％ confidence interval:1.03-1.40,P =0.019) and sepsis (odds ratio,1.28;95％ confidence interval:1.10-1.50,P =0.001),but had no significant association with MODS and trauma mortality even after controlling other risk factors.Conclusions The serum IL-1β at 6 hours after injury could be used as an early effective indicator to evaluate the injury severity and infectionrelated complications in patients with multiple trauma.

Objective To investigate the outcome of postoperative hypopituitarism and hormone replacement in patients with pituitary adenoma,and to analyze the potential factors related to postoperative hypopituitarism.Methods A total of 215 postoperative patients with pituitary adenoma were analyzed.Pituitary functions( including gonadal,thyroid,and adrenal axes ) were asessed by strict criteria.Data of surgery history and hormone replacement situation were collected for statistical analysis.Results The prevalence of hypopituitarism was 54.0％,including 36.7％ hypogonadism,32.6％ hypothyroidism,and 28.4％ hypoadrenalism.Replacements of gonadal steroid,glucocorticoid,and thyroxine were carried out in 25.6％,84.3％,and 80.6％ of the cases,respectively.Univariate analysis showed that male sex and large tumor were related to hypopituitarism. Conclusion After pituitary adenomectomy,approximately half of the patients present anterior pituitary dysfunction,while quite a number of them have not been treated appropriately.

Objective:To explore the current situation of knowledge, attitude and practice in the prevention and treatment of lymphedema after tumor treatment among nurses in cancer hospitals, and analyze its influencing factors.Methods:This study is a cross-sectional study. From October to November 2021, convenience sampling was used to survey 478 nurses from Hunan Cancer Hospital using the self-made Lymphedema Prevention and Treatment Knowledge, Attitude and Practice Questionnaire, which included 41 items from three dimensions of knowledge, attitudes and practice. The influencing factors of nurses' knowledge, attitude and behaviors related to lymphedema were studied using univariate analysis and multiple linear regression analysis.Results:The knowledge, attitude and practice scores and the total score of nurses in the cancer hospital regarding the prevention and treatment of lymphedema after tumor treatment were (17.05±9.81) , (49.96±6.03) , (30.51±11.03) , and (97.53±21.52) , respectively. The score rate of knowledge dimension was the lowest at 42.63%, while the score rate of attitude dimension was the highest at 90.84%. Multiple linear regression showed that working with lymphedema patients, participation in lymphedema training, training forms (on-the-job continuing education, school studies, self-study) , and the nurses' department being the breast or gynecological oncology department were the influencing factors for the nurses' knowledge, attitude, and practice in the prevention and treatment of lymphedema ( F=15.801, P<0.01) . Conclusions:Nurses in the cancer hospital generally have a moderate level of knowledge, attitude and practice in the prevention and treatment of lymphedema after tumor treatment. They have poor knowledge mastery and need to improve their behavioral, but their attitude is relatively positive. Nursing managers in cancer hospitals should strengthen training on lymphedema related knowledge among nurses from departments other than breast and gynecological oncology, strengthen nurses' knowledge and behavior in the prevention and treatment of lymphedema, and cultivate lymphedema therapists and specialized nurses. At the national level, policies should be introduced to establish a complete lymphedema rehabilitation training system, and improve nurses' ability to prevent and treat lymphedema in clinical practice.

OBJECTIVETo assess the clinical value of single-port video-assisted thoracoscopic surgery (VATS) for treatment of pulmonary diseases.

METHODSFrom October, 2009 to December, 2013, 105 patients with pulmonary diseases were scheduled for single-pore VATS for pulmonary lobectomy (19 patients), wedge resection of the lung (34 patients), and bullae resection and pleurodesis for spontaneous pneumothorax or pulmonary bleb (52 patients).

RESULTSOf the 105 patients, 101 patients underwent single-port VATS; the procedure was converted to open thoracotomy in 1 patient and to conventional three-port VATS in 2 patients. The operative time was 50.6∓36.8 min (20-200 min) with intraoperative blood loss of 70∓56.9 ml (10-300 ml), thoracic drainage time of 4.2∓3.2 days (2-14 days), and postoperative hospital stay of 5.4∓3.8 days (3-16 days). Postoperative complications of the procedures included prolonged air leakage (6 cases) and atelectasis (2 cases). All the other patients recovered smoothly without serious complications.

CONCLUSIONSingle-port VATS is a safe and efficient procedure that allows rapid postoperative recovery and is a method of choice for selected patients with pulmonary diseases.

Humans ; Length of Stay ; Lung ; surgery ; Lung Diseases ; surgery ; Pneumothorax ; Postoperative Complications ; Postoperative Period ; Thoracic Surgery, Video-Assisted ; Thoracotomy