Objective To investigate the level and influencing factors of self-efficacy among nurses with needlestick injuries and explore effective strategies to improve self-efficacy.Methods 713 clinical nurses with needlestick injuries had been enrolled by convenience and stratified sampling method to comphte the investigation using the self-designed demographic questionnaire and General Self-Efficacy Scale.Results The average score of the self-efficacy was (2.70 ±0.52) points.69.1％ of the needlestick injury nurses had the sclf-efficacy score at the middle level; only 19.1％ of them had a higher level score on self-efficacy.Gender,title,section,initiative report,work environment,and occupational safety training were identified as the influencing factors of the self-efficiency.Conclusions Even though more than half of the nurses with needlestick injuries had a middle level self-efficacy,they need further improvement.Other influencing factors should be explored in future in order to develop the corresponding management intervention which can strengthen the self-efficacy of nurses with needlestick injuries.

Objective To assess the detection of urinary neutrophil gelatinase associated lipocalin (NGAL) and blood prohibitin (PHB) levels in early diagnosis of children with acute kidney injury (AKI).Methods One hundred and twenty children with severe allergic purpura,sepsis,kidney disease or heart disease admitted from June 2011 to June 2013 in our hospital were enrolled,including 60 cases with AKI and 60 cases without AKI;and 60 healthy children were selected as the control group.The urinary NGAL and blood PHB levels were measured with ELISA method.Results At d1 after diagnosis,the urinary NGAL level in severe AKI group [(146.76 ±61.22) μg/L] was higher than that in non-AKI group [(21.79 ± 17.31) μg/L] and control group [(17.42 ± 13.11) μg/L] (t =15.430 and 22.216,P ＜ 0.01).At d2 after diagnosis,the urinary NGAL level in severe AKI group [(82.31 ± 44.76) μg/L] was higher than that in non-severe AKI group [(21.56 ± 28.56) μg/L] (t =8.863,P ＜0.01).At d1 of diagnosis,the blood PHB level in severe AKI group was higher than that in non-severe AKI group [(14.03 ±6.43) vs.(8.01 ± 6.13),t =11.271,P =0.004];blood PHB in severe AKI group was higher than that in non-AKI group [(10.63 ± 4.21) vs.(8.00 ± 4.76),t =7.051,P =0.017].The levels of urinary NGAL and serum PHB gradually decreased over time in children with severe AKI.The area under the ROC curve (AUC) of urinary NGAL and blood PHB for diagnostic of AKI were 0.833 and 0.952 (P ＜ 0.01),respectively.The diagnostic rate of the combination of the two parameters was 100％.Conclusions The diagnostic value of PHB alone or NGAL in AKI still may be improved.The detection of PHB combined with NGAL can make up each other and improve the diagnosis of AKI,which contribute to the early diagnostic of AKI for clinical workers and provide effective intervention measures,and then reduce the mortality.

Objective To explore application of pulse indicator continuous cardiac output(PICCO)in the treatment of septic shock during continuous renal replacement therapy (CRRT).Methods 34 patients with septic shock who underwent CRRT were randomly divided into the control group and the experimental group.Heart rate(HR),mean arterial pressure(MAP)and central venous pressure (CVP) were monitored in the control group.The experimental group were monitored by PICCO technology in addition to conventional monitoring,the hemodynamics parameters were collected such as end-diastolic volume index (GEDI),extravascular lung water index(EVLWI),and systemic vascular resistance index(SVRI),etc.Dehydration volume and supplementary volume were controlled by means of two group's hemodynamics parameters.The change of Acute Physiology And Chronic Health Evaluation-Ⅱ (APACHE Ⅱ),lactate (Lac),saturation of central venous oxygen(SevO2) and oxygenation index (PaO2/FiO2) were observed.Results After treatment of 72h,the decrease of APACHE Ⅱ and lactate in the experimental group was higher than those in the control group,the increase of ScvO2 in the experimental group was higher than those in the control group,the increase of PaO2/FiO2 in the experimental group was evidently higher than those in the control group.Conclusions During PICCO monitoring technique to guide CRRT therapy in patients with septic shock,the volume status of patients can be accurately controlled,organizational cycle can be improved,oxygenation of lung can be obviously improved,which contributes to treatment of septic shock.

Objective To investigate the effects of dexmedetomdine on hemodynamics and myocardial injury in patients with pulmonary hypertension undergoing mitral valve replacement.Methods Forty ASA Ⅱ or Ⅲ patients with pulmonary hypertension,aged 18-64 yr,undergoing mitral valve replacement,were randomized into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv midazolam 0.05 mg/kg,sufentanil 1 μg/kg,etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg and maintained with combined intravenous-inhalational anesthesia.Narcotrend index values were maintained at 40-50.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min after intubation followed by infusion at 0.5 μg· kg-1· h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Venous blood samples were taken immediately before dexmedetomidine administration,at 10 min after termination of cardiopulmonary bypass (CPB),at the end of operation,and at 6 and 24 h after operation for determination of plasma levels of creatine kinase MB (CK-MB) and cardiac troponin Ⅰ (cTnI) by ELISA.Before and after administration of dexmedetomidine,at skin incision,at sternum splitting,before and after CPB,and at the end of operation,HR,MAP,mean pulmonary arterial pressure (MPAP),cardiac output (CO),systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were detected by using Swan-Ganz catheter and Vigilance Ⅱ monitor.The requirement for vasoactive drugs and condition of spontaneous heart beats were recorded.Results In group D,each hemodynamic parameter was maintained stable at skin incision and sternum splitting,and MPAP was decreased after CPB and maintained at a lower level.The plasma levels of CK-MB and cTnI,consumption of phenylephrine and dopamine,and requirement for epinephrine were significantly lower in group D than in group C (P ＜ 0.05).There was no significant difference in the consumption of milrinone and rate of spontaneous heart beat between the two groups (P ＞ 0.05).Conclusion During mitral valve replacement for patients with pulmonary hypertension,dexmedetomidine infused at 0.05 μg·kg-1· h-1 after a loading dose of 1 μg/kg is helpful in maintaining systemic circulation and pulmonary circulation stable and provides myocardial protection to some extent.

Objective To compare the levels of indoxyl sulfate (IS) and p-cresyl sulfate (PCS), representative substances of serum protein-bound toxins,between patients undergoing peritoneal dialysis (PD) and healthy volunteers, and to explore the factors influencing the levels of serum IS and PCS. Methods Limosis vein blood (3 mL) were collected from 72 PD patients in Peritoneal Dialysis Center and 24 healthy voluteers in Physical Examination in Changzheng Hospital of Second Military Medical University from Feb. 2015 to Jul. 2015. The concentrations of serum total IS,total PCS,free IS and free PCS were detected by high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-ES--MS/MS) method. The relationship between IS, PCS and age, gender, small molecule toxins,adequacy of PD, residual renal function,nutritional status and C-reaction protein (CRP) in PD patients were analyzed by simple correlation andmultivariable linear regression analysis. Results The concentrations of serum total IS and total PCS in PD patients were significantly lower than those in healthy volunteers (P<0. 001). Compared with PD patients without residual renal function (RRF), the concentration of serum total IS was significantly lower in PD patients with RRF (P = 0. 001). Serum total IS was positively correlated with free IS (r=0. 719,P<0. 01) and dialysis duration (r=0. 306,P<0. 01),while tt was negatively correlated with residual renal Kt/V (r=-0. 372, P<0. 01),residual renal creatinine clearance rate (Ccr) (r=-0. 515,P<0. 01),and residual renal estimated glomerular filtration rate (eGFR) (r=-0. 495,P<0 01). Serum free IS was negatively correlated with residual renal Ccr (r=-0. 430, P〈0. 01) and residual renal eGFR (r= -0. 431,P〈0. 01). Serum total IS and free IS were not related to age,hemoglobin or CRP.conclusion serum level is negatively correlated with RRF. But not with age, hemoglobin or CRP, suggesting that proection of RRF is conducive to the removal of serum IS in parients undergoing PD.

Objective To investigate the effect of hydroxyethyl starch (HES) 130/0.4 on intraabdominal hypertension (IAH) and inflammatory cytokines in early stage of severe acute pancreatitis (SAP).Methods Clinical data of 55 case of SAP with IAH from Nov 2007 to Oct 2013 in Pancreas Surgery Department of Wuhan Union Hospital were analyzed retrospectively.All patients received conventional treatment without operation.According to the method of fluid resuscitation,patients were divided into treatment group (n =24) and control group (n =31).In treatment group,patients received ringer solution plus 6％ HES 130/0.4 for fluid resuscitation,and patients in control group received only ringer solution for fluid resuscitation.The IAP level,APACHE Ⅱ score and serum inflammatory cytokine from day 1 to 8 were measured.Results The baseline data between the two groups were comparable.The IAP level was significantly lower in treatment group than that in control group from day 5 to day 8 [(10.2 ±2.9),(8.8 ±2.9),(7.9 ± 2.5),(6.9±2.6)mmHg vs (11.9±2.7),(10.5±2.7),(9.5±2.4),(8.6±2.5)mmHg,1 mmHg=0.133 kPa,respectively],and the difference between the two groups was statistically significant (P ＜0.05).There was no significant difference in APACHE Ⅱ score between the two groups,but the decline of APACHE Ⅱ score from baseline (△APACHE Ⅱ score) was more significant in treatment group (P ＜0.05).The serum IL-1 and IL-8 level in treatment group at day 8 was lower than that in control group [(15.1 ± 13.7) μg/L vs (23.6 ± 13.5) μg/L,(11.2 ± 12.8) μg/L vs (23.8 ± 27.9) μg/L,respectively],and the difference between the two groups was statistically significant (P ＜ 0.05).And the serum TNF-α level in treatment group at day 4 and day 8 was lower than that in control group [(31.9 ± 12.1) μg/L vs (43.4 ± 22.4) μg/L,(24.2 ± 12.8) μg/L vs (35.1 ± 15.3) μg/L],and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Early fluid resuscitation with HES 130/0.4 and ringer solution relieves IAH,reduces APACHE Ⅱ score and down-regulates IL-1,IL-8 and TNF-α level.

Surgical robots, as a new means for surgeons, have been gradually applied in orthopedics. Initially, the development of orthopedic robots was stagnant for a long time because of limited techniques available, clumsy equipment, high costs, and low market demands. The recent decade has witnessed rapid growth of artificial intelligence in all walks of life, increasing investment in research and development, reducing manufacture costs and expanding demands for precise and individualized medical treatment so that a wide variety of novel and ingenious robotic systems have been proposed, prototyped, and commercialized in most of the major procedures in orthopedic surgery, including knee and hip replacements, cruciate ligaments surgery, spine surgery, corrective osteotomy, bone tumor surgery, and trauma surgery. This review depicts the history of development and future prospects in application of surgical robots in the field of orthopedics.

OBJECTIVETo investigate the expression profiles of myocardin gene during the differentiation of bone marrow-derived mesenchymal stem cell to smooth muscle cells in the conditional medium combined with a high concentration of fetal bovine serum (FBS).

METHODSMarrow-derived mesenchymal stem cells were isolated and purified from mouse femoral bone and shinbones using differential adherent methods. Cells at the third passage were induced by 20% FBS in conditioned medium, conditioned medium alone, 20% FBS or 10% FBS alone respectively. Mouse aortic smooth muscle cells were cultured as the positive control. Levels of mRNA and protein expression of myocardin and several smooth muscle cells marker genes were determined by immunofluorescence, RT-PCR and Western blot before and 3, 7, 10, 14 d after the induction. The presence of smooth muscle myofilaments was detected by using transmission electron microscope.

RESULTSNaive bone marrow-derived mesenchymal stem cells displayed multiple morphological forms including fusiform, polygon, oval, and micro-spherical, as compared to the single macro-spindle form after the induction. Typical appearance of peak valley was displayed on the 21st day after induction. At the same time, the expression of smooth muscle marker genes was reinforced along with an up-regulation of myocardin expression. Immunofluorescence study showed that the cells expressing myocardin and smooth muscle marker genes such as alpha-SMA and SM-MHC increased. Fluorescence domain of myocardin translocated from cytoplasm to nucleus and the amounts of double positive cells for myocardin with alpha-SMA or SM-MHC also increased. RT-PCR confirmed that the mRNA expression of myocardin increased gradually and remained stabilized after achieving its peak on the 7th day after induction. The expression of smooth muscle marker genes, alpha-SMA and SM22alpha, remained stable on the 10th day of induction. It was also confirmed by Western blot that the protein expression of both myocardin and alpha-SMA were markedly increased during the induction. Finally, transmission electron microscopy revealed the presence of myofilament on the 21st day after induction.

CONCLUSIONSBone marrow-derived mesenchymal stem cells can be effectively induced into smooth muscle-like cells by conditioned medium combined with 20% FBS. Myocardin plays an important role in the differentiation process of bone marrow-derived mesenchymal stem cells to the peripheral smooth muscle cells.

Animals ; Bone Marrow Cells ; cytology ; physiology ; Cattle ; Cell Differentiation ; physiology ; Male ; Mesenchymal Stromal Cells ; cytology ; metabolism ; Mice ; Muscle, Smooth, Vascular ; cytology ; Myocytes, Smooth Muscle ; physiology ; Nuclear Proteins ; genetics ; metabolism ; physiology ; Reverse Transcriptase Polymerase Chain Reaction ; Trans-Activators ; genetics ; metabolism ; physiology ; Up-Regulation

OBJECTIVETo isolate and purify components from polysaccharides of purple sweet potato (PPSP) and to test their anti-tumor activity.

METHODSDEAE-Cellulose and CM-Cellulose exchange chromatography were applied to separate components of PPSP. The anti-tumor activities of each component were measured by MTT assay on Hela and HepG(2) cells and their monosaccharide composition were analyzed by TLC chromatography, followed by infrared spectroscopy studies.

RESULTSThrough weak anion exchange chromatography and gradient elution by sodium chloride solution, four components were separated and named as PPSP, PPSPII, PPSPIII and PPSPIV, respectively. MTT tests showed that PPSP II and PPSPIII inhibited Hela and HepG2 tumor cells in a certain extent. The structural analysis revealed that PPSPI was mainly composed of glucose and galactose, PPSP II was composed of glucose and had a typical absorption peak of β-D-glucose chitosan pyranose, PPSP III was a glycoprotein showing a protein absorption peak.

CONCLUSIONFour components were separated from PPSP successfully, among which PPSP II and PPSP III shows anti-tumor activities on Hela and HepG(2) cells in vitro.

Antineoplastic Agents, Phytogenic ; pharmacology ; HeLa Cells ; Hep G2 Cells ; Humans ; Ipomoea batatas ; chemistry ; Polysaccharides ; pharmacology

OBJECTIVETo study the effect of exogenous pulmonary surfactant (PS) on the acute lung injury to ischemia-reperfusion injury.

METHODSThe model of ischemia-reperfusion was established. Thirty male Sprague-Dawley rats were randomly divided into control (n = 10), I/R (n = 10), and PS (n = 10) groups.

CONTROL GROUPthe isolated rat lungs were reperfused for 4 hours. I/R group: the isolated rat lungs were reperfused for 2 hours after 2 hours ischemia. PS group: exogenous pulmonary surfactant (10 mg/100 g BW) were given to the ischemic lungs through bronchus 2 hours before reperfusion. Wet to dry lung weight ratio (W/D) and pulmonary artery pressure (PAP) were checked. Immunohistochemical technique was used to determine the immune reactivity of lung tissues to endothelia nitric oxide synthase (eNOS) and surfactant protein A (SP-A). The pulmonary changes were also observed by light and electronic microscopes.

RESULTSW/D and PAP in I/R group were significantly higher than in PS group (P < 0.01). The expression of eNOS and SP-A in I/R group were significantly lower than those in PS group (P < 0.05).

CONCLUSIONSPS can significantly protect lung injury induced by ischemia-reperfusion in the isolated rat lungs. This protective effect is associated with the mechanism that the exogenous PS may reduce SP-A loss in the ischemia-reperfusion and activate the up-regulation of eNOS.

Animals ; In Vitro Techniques ; Lung ; blood supply ; pathology ; Male ; Nitric Oxide Synthase ; metabolism ; Nitric Oxide Synthase Type III ; Pulmonary Surfactant-Associated Protein A ; metabolism ; Pulmonary Surfactants ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; metabolism ; pathology