Adrenal Cortex Hormones ; blood ; Adult ; Exercise ; physiology ; Gonadal Hormones ; blood ; Humans ; Luteinizing Hormone ; blood ; Male ; Pituitary-Adrenal System ; Serum ; metabolism ; Students ; Testosterone ; blood

Objective To investigate the methods for establishment of evaluation index system of clinical nursing pathway management.Methods Delphi method was used to screen evaluation indexes of clinical nursing pathway management and three rounds of expert consultation was carried out to establish the clinical nursing pathway management evaluation system. Analytic hierarchy process and comprehensive evaluation method was used to determine the levels of the index weight,and finally the establishment of weight factors at all levels.Results Aiming at the process of clinical nursing pathway management and following the principle of continuous improvement,an evaluation index system of clinical nursing pathway management was established.Conclusions The evaluation index system of clinical nursing pathway management provides a feasible and effective evaluation tool for the application and improvement of clinical nursing pathway and guides the promotion of application and development of clinical nursing pathway.

Objective To investigate clinical nursing pathway management combined with nurse hierarchical system so as to promote the smooth implementation of clinical pathways.Methods The process of clinical nursing pathway was distributed into the work of nurses at different levels by using the present available resources; their process quality was quantitatively evaluated, which was closely related to their achievements, with the aim of making the nursing activity procedurized and standardized.Results Patients' satisfaction before and after implementing the clinical care pathway management combined with nurse hierarchical system was significantly different (P<0.01); the average hospital stay for a single disease was decreased after its implementation (P<0.05).Conclusions Implementing clinical nursing pathway management combined with nurse hierarchical system could effectively control the health care costs, improve quality of care and achieve the best possible care and management objectives.

Representative pioneer tree root systems in the subtropical area of South China were examined with regard to their structure, underground stratification and biomass distribution. Excavation of skeleton roots and observation of fine roots of seven species including the Euphorbiaceae, Theaceae, Melastomataceae, Lauraceae and Fagaceae families was carried out. The results showed that: (1) Pioneer tree roots in the first stage of natural succession were of two types, one characterized by taproot system with bulky plagiotropic branches; the other characterized by flat root system with several tabular roots. The late mesophilous tree roots were characterized by one obvious taproot and tactic braches roots up and down. Shrub species roots were characterized by heart fibrous root type featured both by horizontally and transversally growing branches. Root shapes varied in different dominant species at different stages of succession. (2) Roots of the different species varied in the external features-color, periderm and structure of freshly cut slash. (3) In a set of successional stages the biomass of tree roots increased linearly with the age of growth. During monsoon, the total root biomass amounted to 115.70 t/ha in the evergreen broad-leaved forest; 50.61 t/ha in needle and broad-leaved mixed forest dominated by coniferous forest; and 64.20 t/ha in broad-and needle-leaved mixed forest dominated by broad-leaved heliophytes, and are comparable to the underground biomass observed in similar tropical forests. This is the first report about roots characteristics of forest in the lower sub-tropical area of Dinghushan, Guangdong, China.
Biomass ; China ; Magnoliopsida ; growth & development ; Plant Roots ; growth & development ; Time Factors ; Trees ; growth & development ; Tropical Climate

OBJECTIVETo investigate the antibacterial effects of zirconium phosphate gauze loaded with silver on rat burn wounds seeded with commonly seen bacteria.

METHODSWistar rats were employed in the study and were scalded and infected. The minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC) of zirconium phosphate loaded with silver were determined by double dilution in tubes. The effect on wound healing and the subeschar bacterial count of the rat burn wounds were observed after the wounds had been covered by gauze loaded with zirconium phosphate and silver, and also with the gauze which has been rinsed for 20 times.

RESULTSThe MIC of silver loaded zirconium phosphate on Staphylococcus aureus, Pseudomonas aeruginosa and E. coli were 8, 8 and 16 mg/L, respectively, while the MBC were 16, 8 and 32 mg/L, respectively. The subeschar bacterial count in the burn wounds with the gauze with silver loaded zirconium phosphate was ten times lower than that in those which were treated with gauze with SD-Ag and 100 times lower than that with ordinary gauze. But there was no difference in the bacterial count between the wounds which were treated with fresh gauze with silver loaded zirconium phosphate and that with the gauze which has been rinsed for 20 times (P > 0.05). Furthermore, wound healing seemed to be better with the gauze with silver loaded zirconium phosphate when compared with those by the other two kinds of gauze.

CONCLUSIONThe silver loaded zirconium phosphate was found to be bacteriocidal against bacteria commonly seen in the burn wounds.

Animals ; Anti-Bacterial Agents ; administration & dosage ; pharmacology ; Bandages ; Burns ; microbiology ; therapy ; Colony Count, Microbial ; Female ; Male ; Rats ; Rats, Wistar ; Silver ; administration & dosage ; pharmacology ; Wound Healing ; drug effects ; Wound Infection ; microbiology ; therapy ; Zirconium ; administration & dosage ; pharmacology

OBJECTIVETo explore the role of indirect antigen presentation pathway on the immunogenecity of epidermal cells.

METHODSHuman epidermal cells (HEC), allogeneic human peripheral blood lymphocytes (PBL) and mononuclear cells (PBM, including monocytes) were isolated and cultured in vitro. HECs were transfected by human-originated CTLA4Ig-adenovirus vector. The CTLA4Ig expression was observed. Allogeneic PBLs or PBMs were added to the transfected and non-transfected HECs with simple cultured PBLs and PBMs as the control. The proliferation of PBL and PBM was determined by (3)H-TdR incooperation.

RESULTSHECs could be successfully transfected by CTLA4Ig-adenovirus vector and expressed corresponding proteins. The non-transfected HECs could stimulate slight proliferation of allogeneic PBLs (P < 0.05) and stimulate remarkable proliferation of PBMs (including monocytes) (P < 0.05). The proliferation reaction of PBLs and PBMs decreased significantly (P < 0.05) after being stimulated by HEC which was modulated by CTLA4Ig genes.

CONCLUSIONIndirect antigen presentation pathway might play important roles in the HEC immunogenicity which could be evidently inhibited by CTLA4Ig.

Adenoviridae ; genetics ; Antigen Presentation ; immunology ; physiology ; Antigens, CD ; Antigens, Differentiation ; genetics ; immunology ; CTLA-4 Antigen ; Cell Division ; immunology ; Cells, Cultured ; Coculture Techniques ; Epidermis ; cytology ; immunology ; metabolism ; Genetic Vectors ; genetics ; Humans ; Leukocytes, Mononuclear ; cytology ; immunology ; Lymphocytes ; cytology ; immunology ; Signal Transduction ; Transfection

OBJECTIVETo investigate the prognostic factors related to triple-negative breast cancer (TNBC) by analyzing clinicopathologic characteristics, treatment and prognosis.

METHODSThree hundred and five TNBC patients treated between January 2004 and December 2011 were enrolled and retrospectively reviewed with Kaplan-Meier and Cox proportional hazards models. All patients were females and the age onset were 24-82 years old (the median were 50 years old).

RESULTSThe follow-up period was 1 to 114 months, with median 38 months. The 5-year disease free survival (DFS) rate was 68% and overall survival (OS) rate 75%. The peak risk of recurrence occurs within the first 2-3 years after initial treatment of the disease, but distant relapse after this time is much less common. Survival analysis showed that surgery type (χ(2) = 4.030, P = 0.045), tumor grade (χ(2) = 8.000, P = 0.046), lymph-vascular invasion (χ(2) = 10.386, P = 0.001) and lymph node stage (χ(2) = 119.36, P = 0.000), TNM stage (χ(2) = 65.961, P = 0.000) and treatment plan (χ(2) = 28.371, 21.874, 32.163, all P = 0.000) were statistically related to DFS; while age (χ(2) = 10.226, P = 0.006), lymph-vascular invasion (χ(2) = 18.881, P = 0.000), lymph node stage (χ(2) = 98.958, P = 0.000), TNM stage (χ(2) = 65.342, P = 0.000) and type of treatment (χ(2) = 17.862, 18.708, 31.921, all P = 0.000) were related to OS. The lymph nodes stage was prognostic factor related to both DFS and OS.

CONCLUSIONSTNBC was characterized by poor prognosis and rapid progression. The lymph nodes metastatic status was the most important prognostic factor of TNBC.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Triple Negative Breast Neoplasms ; diagnosis ; pathology

ObjectiveTo evaluate the effects of intranasal dexmedetomidine premedication on Sedation anxiety score, circulation index, drug dosage (atropine, sufentanil), and adverse reactions in patients undergoing strabismus surgery with local anesthesia. MethodsNinety patients undergoing strabismus surgery were enrolled and randomly divided into the dexmedetomidine group (n=45) and control group (n=45). 30min before the local anesthesia, dexmedetomidine was given intranasally with a dose of 2 μg/kg in the dexmedetomidine group, while the control group treated equal volume saline. The MAP and HR values before pre-dose (T0), 10 min (T1), 20 min (T2), and 30 min (T3) were recorded. The Ramsay score was calculated 30 minutes after administration. SAS scores were made 1 day before surgery and 1 day after surgery. Meanwhile, we measured the dosage of atropine, sufentanil, and the incidence of adverse reactions during surgery. ResultsThe HR and MAP of patients in the dexmedetomidine group were significantly lower than those in the control group at T2 and T3 (P<0.05). The SAS score of the dexmedetomidine group was significantly lower than that of the control group 1 day after the operation. There was no significant difference between the dexmedetomidine group and the control group in the dosage of atropine, the incidence of oculocardiac reflex (OCR), and respiratory depression. The dose of sufentanil in the dexmedetomidine group was lower than that of the control group. The incidence of nausea and vomiting in the control group was significantly higher than that of the dexmedetomidine group.Conclusion Dexmedetomidine (2 μg/kg) preoperative nasal drip has a good sedative effect without obvious adverse reactions and could be safely assisted in clinical anesthesia for patients undergoing local anesthesia correction surgery.

Objective:To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus(SLE)in a real-world setting,and to analyze the related factors of low disease activity and clinical remission.Methods:One thousand patients with SLE were enrolled from 11 teaching hospitals.Demographic,clinical and laboratory data,as well as treatment regimes were collec-ted by self-completed questionnaire.The rates of low disease activity and remission were calculated based on the lupus low disease activity state(LLDAS)and definitions of remission in SLE(DORIS).Charac-teristics of patients with LLDAS and DORIS were analyzed.Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission.Results:20.7％of patients met the criteria of LLDAS,while 10.4％of patients achieved remission defined by DORIS.Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration,compared with non-remission group.Moreover,the rates of anemia,creatinine eleva-tion,increased erythrocyte sedimentation rate(ESR)and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group.Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission.The results of Logistic regression analysis showed that increased ESR,positive anti-dsDNA antibodies,low level of complement(C3 and C4),proteinuria,low household in-come were negatively related with LLDAS and DORIS remission.However,hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission.Conclusion:LLDAS and DORIS remission of SLE patients remain to be improved.Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.

Purpose::Cerebral edema (CE) is the main secondary injury following traumatic brain injury (TBI) caused by road traffic accidents (RTAs). It is challenging to be predicted timely. In this study, we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries.Methods::This case-control study included 218 patients with TBI caused by RTAs. The cohort was divided into CE and non-CE groups, according to CT results within 7 days. Demographic data, imaging data, and clinical data were collected and analyzed. Quantitative variables that follow normal distribution were presented as mean ± standard deviation, those that do not follow normal distribution were presented as median (Q 1, Q 3). Categorical variables were expressed as percentages. The Chi-square test and logistic regression analysis were used to identify risk factors for CE. Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries. The efficacy of the model was evaluated using the receiver operator characteristic curve. Results::According to the study, almost half (47.3%) of the patients were found to have CE. The risk factors associated with CE were bilateral frontal lobe contusion, unilateral frontal lobe contusion, cerebral contusion, subarachnoid hemorrhage, and abbreviated injury scale (AIS). The odds ratio values for these factors were 7.27 (95% confidence interval ( CI): 2.08 -25.42, p = 0.002), 2.85 (95% CI: 1.11 -7.31, p = 0.030), 2.62 (95% CI: 1.12 -6.13, p = 0.027), 2.44 (95% CI: 1.25 -4.76, p = 0.009), and 1.5 (95% CI: 1.10 -2.04, p = 0.009), respectively. We also observed that patients with mild/moderate TBI (AIS ≤ 3) had a 50% probability of developing CE 19.7 h after injury (χ 2= 13.82, adjusted R2 = 0.51), while patients with severe TBI (AIS > 3) developed CE after 12.5 h (χ 2= 18.48, adjusted R2 = 0.54). Finally, we conducted a receiver operator characteristic curve analysis of CE time, which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI, respectively. Conclusion::Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury. Specifically, those with more severe injuries experienced an earlier onset of CE. These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.