Objective Through application of clinical pathway in hospitalization patients undergoing uterectomy, we aimed to study the efficacy of clinical pathway in uterectomy patients. Methods 120 patients randomly sampled into the experimental group and the control group with 60 in each. The experimental group received diagnosis, treatment, nursing and rehabilitation according to the clinical pathway table, patients in the control group received routine nursing interventions. The average hospitalization days, medical costs, patient satisfaction degree, disease cognition, first exercise time after operation and medical disputes were compared between the two groups. Results The average hospitalization days and hospitalization costs of the experimental group were obviously lower than those in the control group, patients' satisfaction degree, knowledge of health and first functional exercise time in the experimental group were better than those of the control group, while the medical disputes in the experimental group were obviously de -creased in the experimental group. Conclusions Application of clinical pathway in nursing care for uterectomy patients can effectively decrease hospitalization days, medical costs and disputes. It is also helpful for patients to cooperate with doctors in diagnosis, treatment, nursing, thus increase the satisfaction degree of patients, ensure the reasonable use of medical resources and promote the sustainable improvement of nursing quality.

OBJECTIVE To investigate the drug-resistance of AmpC enzyme derepressing Enterobacter cloacae isolated from patients of respiratory department.METHODS Totally 364 strains of E.cloacae(162 strains from respiration department) collected from Jan 2001 to Dec 2006 were investigated to know their ward distribution,infection site and susceptibility test results.Three-dimensional tests were adopted to test AmpC lactamase.RESULTS Among the total 162 strains from respiration department,AmpC producers were 76 strains,accounting for 46.91%. Among the 202 strains from the other departments,however,AmpC producers were 36 strains,accounting for 17.82%.And drug-resistance of E.cloacae from respiration department was distinctly higher than that from the other departments.CONCLUSIONS E.cloacae from respiratory department has the higher isolating rate and drug-resistance rate.We should take effective measurement to contain nosocomial infections with E.cloacae.

OBJECTIVE To investigate the resistance phenotype and clinical feature of super extended spectrum ?-lactamases(SSBLs) producing Escherichia coli in order to provide reference for the clinical application of drugs.METHODS Totally 945 strains of ESBLs producing E.coli collected from Jan 2003 to Jun 2007 were identified by API microbiological assay system.Susceptbility tests were performed by K-B methods.Improved three-dimensional tests were adopted to test ESBLs and AmpC lactamase.Test data were analyzed statistically by WHONET 5.3 software.RESULTS From them eighteren strains of SSBLs producers were detected.Between the positive for ESBLs strains and the negative strains,there were some significant differences in the antimicrobial resistance(P

OBJECTIVE To investigate nosocomial infection and antibiotic resistance of Pseudomonas aeruginosa among geriatrics patients and to instruct clinical monitoring and control infection.METHODS P.aeruginosa isolates from geriatrics patients were identified and the resistance to antibiotics was determined by K-B method.RESULTS The risk factors of nosocomial infection were underlying diseases,low immunological function,long time hospitalization,invasive treatment,and prolonged antibiotic therapy.The resistant rates to trimethoprim/sulfamethoxazole and cefotaxime in PA were 74.8% and 60.2%,respectively.The resistance rate to imipenem was 3.9%.CONCLUSIONS It is suggested to carry out proper measurement to control the spread of multiresistant strains in order to improve the treatment of PAE infection in geriatrics patients.

This study was aimed to optimize the extraction process of hyperoside from leaves ofAcanthopanax senticosusby compounding-enzyme method and orthogonal experiment. The hyperoside compound was regarded as standard and determined by HPLC. Based on the experiments of 4 factors including the enzyme amount, temperature, extraction time and PH values, the extraction process of hyperoside was determined by the orthogonal experiments and variance analysis. The results of single-factor experiments showed that different enzymes showed different effects on the enhance yield of hyperoside. The effects of different factors showed that the order of PH, neutral protease, temperature, time, pectinase, xylanase and cellulose was from strong to weak. Through orthogonal analysis, the optimum conditions were 2% pectinase, 2% xylanase, 0.5% neutral protease, and 0.5% cellulose, under the temperature of 30°C, extraction time of 10 min, and pH = 4.5. Under these conditions, the extraction rate was 1.84%. The yield was increased 107% compared with traditional process. It was concluded that the use of compounding enzyme can increase the yield of hyperoside, which possessed a lot of economic benefits.

OBJECTIVE:To establish the method for the content determination of rapamycin (RAPA) in human monocyte THP-1 derived foam cells,and to study the effects of RAPA targeting preparation(RAPA-NP-Apt)targeting at foam cells. METH-ODS:Foam cells model were established through THP-1 cells were induced by oxidized low density lipoprotein. Foam cells were incubated with 200 ng/mL RAPA or 200,400,800 ng/mL RAPA-NP-Apt for 60 min. The content of RAPA was determined by HPLC. The determination was performed on Diamonsil C18 column with mobile phase consisted of acetonitrile-water(90:10,V/V) at flow rate of 1.0 mL/min. The column temperature was set at 40 ℃,and the detection wavelength was 278 nm. The sample size was 20 μL. RESULTS:The concentration of RAPA ranged 50-6400 ng/mL (r=0.99996) with average recovery of 98.72%(RSD=0.62%,n=3). RSDs of inter-day and intra-day were not more than 6.15%(n=6),RSD of stability was lower than 2%(n=6),and RSD of repeatability was 1.64%(n=6). After foam cells were incubated with RAPA or low-concentration,medi-um-concentration and high-concentration of RAPA-NP-Apt,the contents of RAPA were 12,43,98,140 ng/106 cells. CONCLU-SIONS:The method is simple,stable and reproducible. It can be used for content determination of RAPA in foam cells. RA-PA-NP-Apt can improve the effects of RAPA targeting at foam cells.

ObjectiveTo investigate the association between CD4+/CD8+ ratio in peripheral blood and patient prognosis after hepatectomy for liver cancer. MethodsThe clinical data of 150 patients who received partial hepatectomy for liver cancer in the 180 Hospital of PLA from October 2008 to November 2011 were analyzed retrospectively. CD4+/CD8+ ratio in peripheral venous blood was measured before surgery, and the patients were divided into low-CD4+/CD8+ group (CD4+/CD8+ ratio ≤1, 52 patients) and high-CD4+/CD8+ group (CD4+/CD8+ ratio ＞1, 98 patients). Clinical indices were compared between the two groups, and outpatient follow-up and telephone follow-up were applied to record survival rate and tumor recurrence. The chi-square test was applied for comparison between the two groups, and Kaplan-Meier method (log-rank test) was applied for survival analysis. Univariate and multivariate logistic regression analyses were performed for clinical factors to determine the related risk factors for recurrence after hepatectomy for liver cancer. ResultsThe low-CD4+/CD8+ group had significantly lower 1-, 3-, and 5-year survival rates than the high-CD4+/CD8+ group (χ2=36.473, 41983, and 55.214, respectively; all P＜0.001), and the 5-year survival rate differed significantly between the two groups (χ2=81.471; P＜005); the low-CD4+/CD8+ group had significantly higher 1-, 3-, and 5-year tumor recurrence rates than the high-CD4+/CD8+ group (χ2=44.041, 68.234, and 55.157, respectively; all P＜0.05). Univariate analysis showed that CD4+/CD8+ ratio, tumor diameter, existence of satellite lesions, hepatitis B virus infection, depth of tumor invasion, microvascular invasion, lymph node metastasis, and degree of tumor differentiation were high risk factors for recurrence after resection of liver cancer. Multivariate analysis showed that CD4+/CD8+ ratio, tumor diameter, degree of tumor differentiation, lymph node metastasis, and microvascular invasion were independent risk factors for recurrence after resection of liver cancer. ConclusionThe patients with a CD4+/CD8+ ratio of ≤1 before resection of liver cancer have poor prognosis and high recurrence rates, and CD4+/CD8+ ratio has a certain predictive value for prognosis after resection of liver cancer.

Objective To investigate the incidence and related risk factors of post-traumatic stress disorders (PTSD) after acci-dents in the Pearl River Delta .Methods Inpatients after accidents from April 2009 to February 2010 in seven hospitals of the Pearl River Delta cities ,such as Guangzhou ,Shenzhen and Zhuhai ,were surveyed with PTSD Checklist-Civilian Version (PCL-C) and self-made questionnaire .Results In a total of 554 post traumatic patients ,a prevalence of 28 .5% of PTSD symptoms were found in this region with 7 .8% (marks≥50) of severe degree and 20 .8% (marks :38-49) of mild to moderate degree .In the severe PTSD symptoms group ,the top three items were getting nervous and upset once faced similar situation ,difficulty sleeping or easy to be a-wake ,and the trauma experience caused recurring disturbing memory ,ideas or image .Multivariate analysis showed that female ,una-ble self-care ,incapable of working ,lack help from friends ,multiple injury ,and injury time longer were all associated with the PTSD symptom incidence .Conclusion The prevalence of PTSD symptoms is relatively high in injured patients after accidents in the Pearl River Delta .Early identification and intervention of PTSD symptoms in post-traumatic patients are important for the prevention of PTSD .

ObjectiveTo explore the clinical application of preoperative biliary drainage in the treatment of patients with malignant obstructive jaundice (MOJ) with acute cholangitis (AC). MethodsA retrospective study was performed on the clinical data of 74 patients with MOJ and AC who were treated with preoperative biliary drainage in our hospital from January 2010 to December 2014. In those patients, 29 patients treated with percutaneous transhepatic biliary drainage (PTCD) were assigned to PTCD group, and 35 patients treated with endoscopic retrograde biliary drainage (ERBD) were assigned to ERBD group. The levels of total bilirubin (TBil), direct bilirubin (DBil), and alanine aminotransferase (ALT) before and after treatment, total hospitalization cost, average duration of hospitalization, and postoperative complications were compared between the two groups. The advantages and disadvantages were compared between the two preoperative biliary drainage approaches. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. ResultsIn both groups, the levels of TBil, DBil, and ALT were significantly reduced after treatment (all P＜0.05). The ERBD group had significantly larger decreases in the levels of the three biochemical indices than the PTCD group (all P＜0.05). The ERBD group had significantly shorter average duration of hospitalization and significantly lower total hospitalization cost than the PTCD group (t=3.172, P＜0.05; t=2.562, P＜0.05). The incidence of acute pancreatitis in the ERBD group was significantly higher than that in the PTCD group (14.28% vs 3.45%, P＜0.05); however, the incidence rates of biliary tract bleeding, biliary tract infection, and resection or puncture site infection were significantly lower in the ERBD group than in the PTCD group (all P＜0.05). ConclusionPreoperative biliary drainage can substantially control AC symptoms and improve liver function. Compared with PTCD, ERBD achieves shorter duration of hospitalization, lower total hospitalization cost, and lower incidence rates of complications after treatment, which can be taken as the first choice for the treatment of MOJ with AC.

BACKGROUND:There is still controversy whether human bone marrow mesenchymal stem cells can maintain their biological characteristics,energy metabolism patterns,and multidirectional differentiation potential after long-term expression in vitro.Further comprehensive and systematic research is needed. OBJECTIVE:To evaluate the effects of long-term expansion in vitro on the biological characteristics of mesenchymal stem cells. METHODS:Human bone marrow mesenchymal stem cells cultured to passage 5,10,and 15 in vitro.MTT assay was used to detect cell proliferation ability.Flow cytometry was used to detect cell cycle.The multi-differentiation potential of mesenchymal stem cells was detected by inducing to adipogenic,osteogenic and chondrogenic differentiation.Cell migration and invasion abilities were detected by scratch test and Transwell assay.The mitochondrial oxidative phosphorylation and glycolysis function were analyzed using energy metabolism analyzer.The cell senescence was detected by senescence-associated β-galactosidase staining.The expression levels of p21,p16,and p53 proteins were detected by western blot assay. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells at passages 5,10,and 15 grew adherently;the volume of passage 15 mesenchymal stem cells increased and its proliferation ability decreased;the percentage of S-phase cells decreased(P<0.05).With the increase of culture passages,the migration and invasion abilities decreased gradually(P<0.05).There was no significant difference in the differentiation potential,demonstrated by adipogenic,osteogenic and chondrogenesis induction.The ability of oxidative phosphorylation of mitochondria and glycolysis decreased gradually(P<0.05).The number of senescence-associated β-galactosidase-positive cells increased with the increase of passages(P<0.05),and the expression of senescence protein p21,p16,and p53 increased gradually(P<0.05).The results indicated that the biological characterization of mesenchymal stem cells changed after long-term in vitro expansion.Mesenchymal stem cells cultured over 10 passages may have a reduced activity due to increasing senescence.Therefore,bone marrow mesenchymal stem cells cultured less than 10 passages are suitable for clinical research/therapy.