ObjectiveTo discuss the influence of nursing intervention on psychological state of transfusion patients in outpatient and emergency department. MethodsSCL-90 questionnaires were used to investigate 600 transfusion patients in outpatient and emergency department to understand their psychological state. Psychological nursing was given to them before, during and after transfusion, SCL- 90 questionnaire was used again for investigation at the last day of transfusion,χ2 test was used to evaluate the results. ResultsAfter psychological care, the somatization, interpersonal relationships, anxiety, depres-sion, hostility and terrorism and other items significantly alleviated compared with those before interven-fion. ConclusionsTo grasp the patients' psychological state and give psychological care to them can ef-fectively reduce the adverse psychological reaction of patients, improve the quality of care and safety and promote the treatment and rehabilitation of diseases.

Objective To investigate the pathway of lymphatic drainage of proteins from cerebral parenchyma in subarachnoid hemorrhage rat models. Methods Healthy adult male Wistar rats were divided into Saline group, Evans blue-labeled albumin (EBA) group, and SAH + EBA group. SAH models were produced by double injection of autologous arterial blood into cisterna magna. Using a modified microinjection method, EBA was injected into left candate-putamen of the EBA group and EBA + SAH group rats. In Saline control group, saline was injected. After injection, at 12 hours, 1 day, 2 days, 3 days and 5 days, the animals were sacrificed and the fluorescence signals of EBA were imagined and analyzed along the possible lymphatic drainage pathway, e.g. the brain tissue, the wall of common carotid artery, and cervical lymphatic nodes. Results One day after injection, in EBA group, the fluorescence of EBA initially appeared on the left of the brain, the wall of common carotid artery, left lateral cerebral ventricle, and the perivascular spaces of cerebral vessels. The fluorescence signals gradually expanded to the opposite side.Large amount of fluorescence granules accumulated in the outer layer of common carotid artery. Fluorescence was also found in cervical lymphatic nodes. Two days after injection in this group, the density of fluorescencein the brain became weaker while the density of fluorescence in rhinencephalon became stronger. The fluorescence of EBA was found in lymphatic nodes adjacent to abdominal aorta. In SAH + EBA group,reduced amount and velocity of the drainage of EBA from left caudate-putamen to rhinencephalon, cervical lymphatic nodes, and lymphatic nodes adjacent to abdominal aorta were observed. From 12 hours to 5 days after injection, fluorescence intensity of EBA in deep cervical lymphatic nodes in SAH + EBA group(8.9 ±2. 0, 11.9 ± 2. 5, 17.4 ± 3.7, 26.7 ± 4. 5 and 59.0 ± 8. 1 ) were lower than those in EBA group ( 14. 5 ±3.2, 27.5 ±7.4, 60.3 ±12.3, 138.0±12.0 and 108. 1 ±13.4, F=13. 17, 24.04, 66.81, 302.77 and 59.36, P ＜ 0. 01 ). From 2 to 5 days, fluorescence intensity of EBA in lymphatic nodes adjacent to abdominal aorta was also lower in SAH + EBA group( 11.0 ± 1.5, 12. 5 ±2. 8, 23.6 ±3. 2) than those in EBA group(26. 3 ±5.9, 47.5 ±9.6, 41.0 ±9.3; F =38. 17, 72.52, 19.01, P ＜0.01). Conclusion SAH can result in reduced drainage of macromolecular substances, e.g. protein, from the brain via lymphatic pathway.

Objective To analyze statistically complications associated with usage of extracorporeal membrane oxygenation after cardiac surgery in 82 cases.This report reviews our experience in extracorporeal membrane oxygenation support treatment in adult patients with cardiac failure after cardiac surgery.Methods To collect statistical data of 82 adult patients with extracorporeal membrane oxygenation support in one ward of Anzhen Hospital from January 2008 to January 2012,including renal failure,infection,haemorrhage,limb ischemia,microembolus,hemolysis,hypohepatia,lymphatic leakage,etc.Results The complication rate was 53.7％ (44 cases).Renal failure morbidity and mortality rates were the highest (36.6％,56.7％).Infection was the second highest(34.1％,40.0％).To analyse the relationship between application timing of continuous renal replacement therapy and mortality of extracorporeal membrane oxygenation by using regression analysis method,P =0.012.Both are related,and mortality increase with time.Conclusion Renal failure and infection are the main complications of adult receiving extracorporeal membrane oxygenation with cardiac surgery,and had significant effect on the prognosis.Application timing of continuous renal replacement therapy and mortality of extracorporeal membrane oxygenation are related.Prevent early and treat timely should be benefit to the patients wih high-risk factors.

BACKGROUND: Cerebrovascular disease often causes dysfunction of the brain nerve, and nerve cel apoptosis is the important factor of cerebral nerve dysfunction. The excessive expression of c-fos can block the transduction of intracelular signal so that producing some apoptosis-promoting factors, which involve in nerve cel apoptosis process after ischemia injury of brain. Bcl-2 is an inhibited factor. It might to be the key to treat ischemic cerebrovascular disease by inhibiting or reducing the apoptosis of nerve cels after ischemia injury. OBJECTIVE: To investigate the therapeutic effect and mechanism of the Total Flavone of Hawthorn Leaf on chronic cerebral ischemia rats. METHODS: A total of 72 healthy male Sprague-Dawley rats were randomly divided into sham surgery group, model group, Total Flavone of Hawthorn Leaf group and ginkgo leaf group. Permanent bilateral carotid artery ligation was used to prepare chronic cerebral ischemia model in the model group, Total Flavone of Hawthorn Leaf group and ginkgo leaf group. Total Flavone of Hawthorn Leaf group and ginkgo leaf group respectively received 140 mg/kg Total Flavone of Hawthorn Leaf and 12.3 mg/kg ginkgo leaf intragastricaly for 36 days from 36 days after model induction. Model group and sham surgery group received 3.5 mL/kg physiological saline intragastricaly. RESULTS AND CONCLUSION: Compared with the model group, the expression of c-fos protein significantly deceased in the Total Flavone of Hawthorn Leaf group (P < 0.01), Bcl-2 expression levels significantly increased (P < 0.01), and Ca2+ content decreased (P < 0.05). Moreover, no significant difference in above indexes was detected between Total Flavone of Hawthorn Leaf group and ginkgo leaf group (P> 0.05). These data indicated that the protective effect of Total Flavone of Hawthorn Leaf on chronic cerebral ischemia was associated with its inhibition of neuronal apoptosis. Its mechanism of anti-apoptosis might be associated with up-regulating expression of Bcl-2, down-regulating expression of c-fos and decreasing Ca2+ content in brain.

BACKGROUND:Based on the integration of virtual reality technology with acupoints, acupuncture can be expressed three-dimensional y.
OBJECTIVE:To explore the structure of points through reconstructing digitalized three-dimensional visualization of Neiguan (PC6) structure based on VOXEL-MAN and Micro-XCT.
METHODS:Muscles and other tissues adjacent with Neiguan (PC6) were segmented and merged based on the VOXEL-MAN system combined with the anatomical knowledge of acupoints;nerves and blood vessels were performed with three-dimensional reconstruction;the needle-inserting animation of Neiguan (PC6) was obtained by running script file. Three-dimensional visualization and virtual needle-inserting researches of Neiguan (PC6) were performed. Nature of the acupoints was detected by the Micro-XCT-200 machine additional y.
RESULTS AND CONCLUSION:The visualization of the anatomical structure of local Neiguan (PC6) was completed, and the localization and expression of Neiguan (PC6) in the digitized virtual human were realized. The Neiguan (PC6) structure was researched with Micro-XCT-200, and showed there was no new tissue. Local three-dimensional reconstruction of the acupoint structure could help to display the anatomical structure of acupoints and simulate the acupuncture process. It could also help to observe the relationship between the needle body and the surrounding tissues during needle-inserting, which supplying a good basis not only for exploring the security of needle-inserting, but also for improving the clinical effect of acupuncture. The research on the structure of acupoint Neiguan (PC6) by Micro-XCT-200 provides further experimental evidence for the hypothesis of three-dimensional acupoint.

Objective To evaluate the correlation between preoperation hepatic function and mortality after heart transplantation using the Receiver Operating Characteristic(ROC) cures and Kaplan-Meier survival analysis.Meanwhile determining the Optimal Operating Point(OOP) and doubtable value interval of the significant indicator for studing it with short to medium term survival analysis.Methods To collect statistical data of 91 cases with heart transplantation in the heart transplantation centre of Anzhen Hospital from January 2009 to June 2014,including the last preoperation hepatic function index.Containing alanine aminotransferase (ALT),aspartate aminotransferase (AST),total protein (TP),albumin (ALB),ratio of albumin and globulin(A/G),serum total bilirubin(STB),connect bilirubin(CB),ratio of connect bilirubin and serum total bilirubin CB/STB,etc.Plotting the ROC curves for all variables in perioperation using SPSS 17.0 statistical software,firstly.Next,to determine the significant indicator according to the area under the ROC curve (AUC) (AUC ＞ 0.7),and to find OOP/Youden index and doubtable value interval of the significant index.And then,total cases were divided into three groups according to doubtable value points.Finally,using Kaplan-Meier survival analysis to reveal the variation tendency of three survival cures for different groups.Results The ratio of albumin and globulin is the sole variable associated with mortality in perioperation,and AUC =0.825(SE =0.056,P =0.000,95％ CI =0.715～0.936).Paients whose A/G≤1.13 had significantly lower survival rates than the other two groups in short to medium postoperative term,P ＜0.001.But after 32 months,the variation tendency of three groups tended to stability.Conclusion The preoperative ratio of albumin and globulin of patient and postoperative mortality were related,but the correlation decreased with the increase of time.The short to medium term survival rates declined significantly for patients whose A/G≤ 1.13.So preoperative A/G could forecast the prognosis of paitents as reference indicator.

Objective To analyze the association of elevated carotid intima-media thickness(CIMT)with low-grade albuminuria in a community-based population. Methods A total of 10 375 participants aged 40 years or older were recruited using cluster sampling from Jiading district, Shanghai. Standardized questionnaires were adopted to collect information on health status and lifestyles. Anthropometric measurements including weight, height, and blood pressure, and biochemical tests for blood and urine were performed. CIMT was detected by B-mode ultrasound examinations. 9 523 subjects were included for final analysis. All these subjects were divided into 4 groups according to sex-specific urinary albumin to creatinine ratio ( UACR ) quartiles. CIMT≥upper decile of the population was defined as elevated CIMT and low-grade albuminuria was defined as UACR≥sex-specific upper quartile. The relationship between UACR and CIMT was investigated by multiple logistic regression analysis. Results The prevalence of elevated CIMT in this population aged 40 years or older with albuminuria in normal range was 21. 44%. Comparing to participants without elevated CIMT, those with elevated CIMT showed higher level of UACR (4. 79 vs 4. 51 mg/g, P<0. 01). The metabolic status was deteriorated with the increment of UACR level. The prevalences of elevated CIMT were 18. 99%, 19. 24%, 20. 20%, and 27. 33% from the lowest to highest UACR quartile, respectively(Ptrend<0. 01). After adjusting for some conventional cardiovascular risk factors, multiple logistic regression revealed that compared with the participants in the lowest quartile of UACR, those in the highest quartile had a 1. 25-fold risk of elevated CIMT. Conclusions This study shows that low-grade albuminuria is positively associated with elevated CIMT, independent of conventional cardiovascular risk factors in middle-aged and elderly adults.

Objective To investigate the maternal and fetal outcomes of pregnant women with subclinical hypothyroidism, and clinical observation of thyroxine replacement. Methods From March 2014 to March 2015, the clinical records of 216 women with subclinical hypothyroidism(including 166 cases with thyroxine replacement), and hypothyroidism(n=69)during pregnancy who delivered at our hospital were reviewed. The maternal complications and neonatal outcomes were compared with 406 healthy women who delivered during the same period. Results The age, number of fetus, and morbidity rate of gestational hypertension were without significant differences in those groups. The morbidity of gestational diabetes in subclinical hypothyroidism group and hypothyroidism group were significantly higher than those in control group(13.4%, 17.4% vs 0.2%, P<0.05). The rate of thyroid peroxidase antibody and thyroglobulin antibody positive in subclinical hypothyroidism group and hypothyroidism group were significantly higher than those in control group(26.9%, 23.2% vs 9.9%; 15.7%, 23.2% vs 8.1%, all P<0.05). No matter treated or not treated in subclinical hypothyroidism group, the preterm birth, Apgar score, low birth weight, birth defects, and infant congenital hypothyroidism were without significant differences as compared to the control group(P>0.05). Further compared those between treated and untreated subclinical hypothyroidism, the results were also without significant difference(P>0.05). Conclusions Subclinical hypothyroidism had no significant influence on pregnancy outcomes and perinatal events. Thyroxine replacement in subclinical hypothyroidism pregnant women also had no significant influence on pregnancy outcomes and perinatal events.

Objective:To evaluate the efficacy of esketamine combined with fascia iliaca compartment-subarachnoid block in optimizing anesthesia in elderly patients undergoing hip fracture surgery.Methods:Sixty-two American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ elderly patients of either sex, aged 60-85 yr, with body mass index of 18.5-30.0 kg/m 2, were divided into 2 groups ( n=31 each) using a random number table method: fascia iliaca compartment-subarachnoid block group (FS group) and esketamine combined with fascia iliaca compartment-subarachnoid block group (ES group). In FS group, patients underwent ultrasound-guided fascia iliaca compartment block at 30 min before the operation of subarachnoid anesthesia on the surgical side. In ES group, esketamine 0.25 mg/kg was intravenously administered at 5 min before skin incision based on the fascia iliaca compartment-subarachnoid block. Patient-controlled intravenous analgesia was used for postoperative analgesia, and tramadol 1 mg/kg was intravenously given for rescue analgesia when numerical rating scale score > 4. The pressing times of patient-controlled analgesic pump, the number of rescue analgesia and consumption of tramadol were recorded within 48 h after operation. The occurrence of postoperative adverse reactions (respiratory depression, nausea and vomiting, dizziness, drowsiness, pruritus, illusion, nightmares) was recorded. Results:Compared with FS group, the consumption of postoperative tramadol was significantly decreased, and the pressing times of patient-controlled analgesic pump and the number of rescue analgesia were reduced in ES group ( P<0.05). There were no significant differences in the incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:Combination of esketamine with fascia iliaca compartment-subarachnoid block for hip fracture surgery can raise postoperative analgesia and optimize clinical management strategies in elderly patients.

Objective:To evaluate the effect of ultrasound-guided single fascia iliaca compartmentblock (FICB) combined with esketamine on postoperative delirium (POD) in elderly patients undergoing hip fracture surgery.Methods:Sixty-two patients of either sex, aged 60-85 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing hip fracture surgery under subarachnoid anesthesia, were divided into 2 groups ( n=31 each) using a random number table method: single FICB group (group FICB) and single FICB combined with esketamine group (group FICB+ E). Ultrasound-guided FICB was performed on the operated side at 30 min before subarachnoid anesthesia. In FICB+ E group, esketamine was intravenously injected as a bolus of 0.3 mg/kg at 5 min before skin incision followed by an infusion of 0.25 mg·kg -1·h -1 until 30 min before the end of procedure. Patient-controlled intravenous analgesia was used for postoperative analgesia, and tramadol 1 mg/kg was given for rescue analgesia. The pressing times of patient-controlled analgesia, the number of rescue analgesia, and consumption of tramadol were recorded within 48 h after operation. The Ramsay sedation score was used to assess the degree of sedation at skin incision, 30 min after the start of surgery, 30 min before the end of surgery, at the end of surgery, and at discharge from the post-anesthesia care unit. Postoperative delirium (POD) occurred within 7 days after surgery was assessed using the Confusion Assessment Method. The serum concentrations of tumor necrosis factor-alpha, interleukin-6, S100β and glial fibrillary acidic protein (GFAP) were detected by enzyme-linked immunosorbent assay on admission to the operating room and at 3 and 7 days after surgery. The occurrence of adverse drug reactions (respiratory depression, nausea and vomiting, dizziness, somnolence, urinary retention) was recorded. Results:Compared with group FICB, the incidence of POD was significantly decreased within 3 days after surgery, the consumption of tramadol, pressing times of patient-controlled analgesia and the number of rescue analgesia were reduced, Ramsay sedation score was increased at each time point, and the serum concentrations of tumor necrosis factor-alpha, interleukin-6, S100β and glial fibrillary acidic protein were decreased after surgery ( P<0.05), and no significant change was found in the total incidence of POD at 7 days after surgery in group FICB+ B ( P>0.05). Conclusions:Ultrasound-guided single FICB combined with esketamine can provide adequate analgesia and sedation in the perioperative period for elderly patients with hip fractures, reducing the risk of early postoperative (within 3 days) POD.