Objective To investigate the risk factors for early neurological deterioration (END) in patients with acute middle cerebral artery infarction.Methods From January 2009 to December 2012,81 patients with acute middle cerebral artery infarction completed cerebral angiography admitted to the Department of Neurology,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.END was defined as that the National Institutes of Health Stroke Scale (NIHSS) score increased ≥2 or the motor score increased ≥ 1 with in 72 h after admission compared with the baseline score on admission.All the patients were divided into either an END group (26 cases) or a non-END group (55 cases) according to whether the occurrence of END.Univariate factor analysis was used to analyze the differences of the clinical data between the two groups.The grade standard of collateral circulation was assessment with the collateral circulation assessment system of the American Society of Interventional and Therapeutic Neuroradiology/Sociey of Interventional Radiology.Multivariable Logistic regression analysis was used to analyze the risk factors for END after acute middle cerebral artery infarction.Results Compared with the patients in the non-END group,the proportions of age 60 years (65.4％ [17/26] vs.36.4％ [20/55];x2 =5.992,P =0.014),high-sensitivity C-reactive protein level ≥4.0 mg/L (76.9％ [20/26] vs.45.5％ [25/55];x2 =7.080,P =0.008) and diabetes (38.5％ [10/26] vs.16.4％ [9/55],x2 =4.802,P =0.028) in the END group were increased significantly,while the collateral circulation grade was decreased significantly (Z =-3.253,P ＜ 0.01).Multivariable Logistic regression analysis showed that the age ≥60 years (OR,3.412,95 ％ CI 1.075-10.824;P =0.037),high-sensitivity C-reactive protein level ≥ 4.0 mg/L (OR,3.812,95％ CI 1.141-12.740;P =0.030),and collateral circulation grade (OR,2.165,95％ CI 1.241-5.514;P =0.009) were the independent risk factor for END in acute middle cerebral artery infarction.Conclusion The decreased collateral circulation level,age ≥ 60 years and high-sensitivity C-reactive protein≥4.0 mg/L were the independent risk factors for occurring END in acute middle cerebral artery infarction.

Objective To explore the development situation of hospital nursing assistants in certain regions of China in order to provide reference and evidence for improving the professional standardization management of nursing assistants .Methods Used questionnaire survey to investigate and analyze 538 nursing assistants'social demographic characteristics , education training , welfare, working conditions and degree of satisfaction.Results In the surveyed sample, 87.9% respondents were female nursing assistants; and 53.0%aged 40 to 49;78.3% came from rural area;73.6% only received middle school education or had lower education background.The nursing assistants who participated in pre-service training accounted for 96.5%, who participated in professional qualification training accounted for 31.4%, and only 15.1% had certification.The average monthly income of nursing assistants was 1902.5 RMB, but only 9.8%respondents had insurance and housing fund.41.4% nursing assistants had average daily working time longer than 8 hours.The highest proportion work done by nursing assistants was sorting and replacing the bed unit and personal items (92.3%), while the lowest percentage work was measuring axillary temperature for patients (26.3%).50.3% nursing assistants once had the idea of changing career, and 50.8% respondents'relatives and friends had a general thought or disagreed to their profession.In the sample, the satisfaction degree of the income and welfare was the lowest (43.1%).Conclusions Nursing assistants were almostly middle-aged women,who were normally without higher education and enough training .They did intensive work while received very low income;the service range provided by them was limited , too; and the stability of the team and occupation identity were poor.