BACKGROUND:Chitosan and gelatin have good biocompatibility and biodegradable properties.More and more attentions have been given to the application of the composite membrane of chitosan/hydroxyapatite(HA)and gelatin/HA as the tissue scaffolds.OBJECTIVE:To prepare a biocompatible composite membrane of chitosan/HA/gelatin having nanometer multilayer HA,and to investigate whether such a membrane might be a candidate of the tissue scaffolds for the bond repair and regeneration,DESIGN:Controlled observation.SETTING:College of Chemistry and Environmental Engineering,Jianghan UniversityMATERIALS:The experiments were performed at the Laboratory of Fine Chemistry,College of Chemistry and Environmental Engineering,Jianghan University from February to August 2007.Chitosan (Yuhnan Ocean Biochemistry Co.,Ltd,Zhengjiang,China,Mw 13.44×104,93% degree of deacetylation),and gelation(provided by Shanghai Chemical Reagent Co.,Shanghai,China)were used in the present study.METHODS:The mixture chitosan/CaCl2 solution was casted on a glass plate to give the membrane of chitosan/CaCl2.Then,the membrane was soaked in KH2PO4 solution,0.1 mol/L NaOH solution,and 3 wt% gelatin aqueous solution,respectively.The resulted membrane was washed and dried to obtain the chtiosan/HA/gelatin composite membrane.The morphological observation of the composite membrane and HA crystal were carded on a scanning electron microscope.The mechanical properties of the composite membrane were measured using the universal testing machine.The tensile strength(σb)and the elongation at break (ε)were calculated.The thermal stability of composite membrane was determined using a WCT-2C thermobalance.MAIN OUTCOME MEASURES:The morphologies,the mechanical properties,and the thermal stability of the composite membrane and HA crystal were observed.RESULTS:The multilayer HA crystal with 400 nm thickness in the composite membrane was observed.The tensile strength(σb)and the elongation at break(ε)of the composite membrane were 3.83-10.25 MPa and 3.97%-10.14%,respectively.The decomposition temperature of HA-treated membrane was 310℃,which was higher than that of chitosan/gelatin membrane(305℃).CONCLUSION:The composite chitosan/HA/gelatin membrane was prepared by using chitosan/CaCl2,KH2PO4 and gelatin solutions.Such a biocompatible composite membrane with multilayer HA might be a promising tissue scaffold.

Objective To research the acute adverse effects of air pollution on the risk of stroke in the air pollution exposed people.Methods Daily counts of strokes occurrence (2004-2007) were obtained from the population-based stroke registry in one district of Shanghai.Air pollution data was obtained from the Shanghai Environmental Monitoring Center.A semi-parametric generalized additive model was used to study the acute effects of air pollution on stroke occurrence after controlling for long-term and seasonal trends,weather variables,and day of the week.Results The relative risks of stroke occurrence for per 10 ?g/m3 increase of PM10,SO2 and NO2 were 1.02 (95%CI:1.01-1.03),1.05 (95%CI:1.04-1.06) and 1.09 (95%CI:1.08-1.10),respectively.Conclusion The study has provided a new evidence for the association between air pollution and risk of stroke occurrence.

Objective The aim of this study was to reveal the clinical features of colorectal polyps by investigating its endoscopic features using a magnifying videoscope. Methods One hundred and five colorectal polyps presented in colonoscopy were included in this study. A magnifying videoscope with a zoom ranging from ? 1 to ? 100 magnification combined with indigocarmine dye was employed to observe the pit pattern of colorectal polyps. Pit pattern was analyzed according to Kudo' s modified classification as follows; (1) type Ⅰ ; round pit; (2) type Ⅱ; asteroid; (3) type Ⅳs; tubular or round pit, which is smaller than the normal pit (type Ⅰ ) ; (4) type ⅢL: tubular or round pit, which is larger than the normal pit (type Ⅰ ) ; (5 ) type Ⅳ : dendritic or gyrus - like pit; ( 6 ) type Ⅴ : irregular or amorphous pit; and ( 7 ) mixed type. Types Ⅰ and Ⅱ represented the pit pattern of nonneoplastic polyps and types Ⅲ L , Ⅲs, Ⅳ , Ⅴ , and mixed type represented the adenomatous polyps represented neoplastic polyps. Results In all samples of polyps, 17 were of the pedunculated type, 40 subpedunculated type and 48 sessile type. Among the 17 pe-dunculated type, 12 were type Ⅰ ,Ⅱ pit pattern. In those subpedunculated types, type Ⅰ , Ⅱ pit pattern were found in 15. 0% (6/40) , type ⅢL , Ⅲs , Ⅳ, and Ⅴ were detected in 85. 0% (34/40) . Type Ⅰ ,Ⅱ pit pattern were found in 41. 7% (20/48), type Ⅰ,ⅢL, ⅢS, Ⅳ, and V were in 58.3% (28/48) in sessile type. Of all polyps 88 (83. 8% ) were situated between the splenic flexure and rectum , but'no correlation was found between pit pattern and location of polyps. The incidences of neoplastic changes in the lesions with pit pattern Ⅰ,Ⅱ ,ⅢL, Ⅲs,Ⅳ, Ⅴ , and mixed type were 0% , 11. 8% , 77. 3% , 75. 0% , 100. 0% , 100. 0% , and 70. 0% , respectively. The diagnostic sensitivity of neoplastic and nonneoplastic polyps were 96. 7% and 80. 0% , and specificity were 86. 6% and 94. 7% . The overall diagnostic accuracy in differentiating neoplastic from nonneoplastic polyps was 89. 5% . Conclusions The pit pattern analysis of colorectal polyps by magnifying colonoscopy combined with indigocarmine staining is a useful and objective tool fur differentiating nonneoplastic lesions from adenomas or invasive carcinoma of the large bowel. There-fore it may be possible to determine, at the lime of colonoscopy, which lesions require treatment or not, and which one should be removed by endoacopy, or by surgery.

Objective:To discuss the effect of individualized physical exercise prescription on patients’ nutrition status, physical ability and self-care ability in patients with intestinal fistula and severe malnutrition. Methods:Twenty-four patients were divided randomly into two groups, the experiment group exercised according to physical exercise prescription, control group exercised in a routine way. The patients’ weight, physical ability and self-care ability were measured on the day before exercise and the 28th day after exercise. Results:Patients in the exercise group had significant more exercise than those in the routine group, and the physical ability and self-care ability were significant better that those in the routine group. Conclusion:Individualized physical exercise prescription can accelerate the recovery of physical ability and self-care ability, it can be used safely and effectively in patients with intestinal fistula and severe malnutrition.

Objective:To investigate the knowledge of hand-cleaning in student nurses,cultivate their awareness of washing hands,improve their submitting of washing hands and standardize their washing procedure,so as to reduce the hospital-acquired infection via hands.Methods: A self-designed questionnaire on hand-cleaning-related knowledge was used to survey 100 student nurses in their clinical practice in our hospital.Results:In the 100 questionnaires,some student nurses have poor-mastering of the signs of hand-cleaning,and have indefinite concepts of the time,position and frequency of hand-cleaning.The most frequently forgotten part of hands cleaning is finger(42%),the second is wrist(29%).Lots of student nurses(92%) mistakingly thought that washing hands with warm water was much better.Conclusion:The student nurses had relatively poor knowledge on hand-cleaning,much more attention should be paid on the education of this aspect by nursing department,in order to improve self-protection and control of hospital-acquired infection effectively.

Objective To evaluate the diagnostic value of Endoscopic ultrasonography(EUS) and endoscopic therapies in gastrointestinal submucosal tumors under the guidance of EUS.Methods Patients underwent endoscopy for dyspepsia at our unit. Two hundred and thirty eight patients were found to have a presumed submucosal tumor(SMT) and all subjected to Endoscopic ultrasonography(EUS). Endoscopic therapy including endoscopic mucosal resecation(EMR), endoscopic mucosa strip removal(EMSR), snare cauterization,sclerotherapy or surgery operation had been taken according to the different deriving layers of submucosal tumors. The ultimate diagnosis was confirmed by histology.Results Seventy three stromal tumors derived from muscularis mucosa,7 carcinoid in mucosa propiria; 6 cysts, 13 lipomas, 17 etopic pancreases in stomach and 5 varices in gastric fundus derived from submucosa; 95 benign stromal tumors and 21 malignent stromal tumors derived from muscularis propria,1 carcinoid invaded muscularis propria. 61 benign stromal tumors derived from muscularis mucosa , 8 benign stromal tumors derive from muscularis propria, 8 lipomas, 4 cysts, 8 etopic pancreases and 7 carcinoids were resected by endoscopy; 33 benign stromal tumors from muscularis propria, 18 malignent stromal tumors, 2 lipoma and 2 etopic pancrease,1 carcinoid were resected surgically. Submucosal tumors 97.97% diagnosed by EUS were identified by pathology.Conclusion Different layers of gastrointestinal tract with submucosal tumors can be distinguished clearly by EUS, leading to definite diagnosis of submucosal tumors. EUS is important in selecting treatment procedures of submucosal gastrointestinal tumors and should routinely be performed on all presumptive submucosal tumors prior to attempt at removal.

Objective To assess the potential diagnostic value of the potential of flexible image col-or enhancement system(FICE)with magnifying endoscopy for superficial esophageal lesions by observing the intrapapillary capillary loops(IPCL)in esophageal mucosa. Methods IPCL in patients with esophageal diseases were studied with Fujinon EG-590ZW FICE endoscopy. The relationship between changes of IPCL in 31 cases of superficial esophageal lesions and pathological findings was studied. Results The vascular patterns of IPCL were analyzed and classified as follows: Type Ⅰ,often seen in normal esophagus,were e- venly distributed with regular forms. TypeⅡ,protracted,often occured in esophagitis. Type Ⅲ showed two or three of such four changes as,dilatation,wave-like inflection,irregular caliber and deformity,which was mainly seen in dysplasia. While Type Ⅳshowed all the four changes mentioned above and frequently ap- peared in esophageal cancer. Of the 17 cases of esophagitis,fifteen cases were TypeⅡIPCL and the others Type Ⅲ. Of the 10 cases of dysplasia,eight were Type Ⅲ IPCL and two high-grade dysplasia showed Type Ⅳ IPCL. One sml early esophageal cancer showed Type Ⅲ IPCL and all three advanced esophageal cancer showed TypeⅣ IPCL. Conclusion The esophageal microvessels can be clearly seen by FICE with magnif- ying endoscopy,and the differentiation of superficial esophageal lesions can be fairly performed with the ob- servation of IPCL,it gives an important practical siginificance in diagnosing tumorous lesions.

Objective: To investigate the absorption of EVA and PVC infusion sets to insulin.Methods: Two infusion sets of EVA and PVC were used to contain insulin which was mixed with TNA and preserved at 4℃ and 25℃ for o,8,24 and 48 h,respectively.The content of insulin was observeed for changes.Results: The content of insulin mixed with TNA in EVA bags was obviously higher than in PVC bags preserved at 25℃ for 48h(P

Objective To compare the real time diagnosis and treatment values of magnifying endoscopy and electronic colonoscopy Methods A total of 105 colorectal polyps for colonoscopic examination were included in this study A magnifying videoscope with zoom ranges from ?1 to ?100 magnification and a common electronic endoscopy combined with indigocarmine dye were employed to observe the pit patterns of colorectal polyps Pit patterns were analyzed according to Kudo's modified classification as follows: ①type Ⅰ: round pit; ②type Ⅱ: asteroid pit; ③type Ⅲs: tubular or round pit, which is smaller than a normal pit (type Ⅰ); ④type ⅢL: tubular or round pit, which is larger than a normal pit (type Ⅰ); ⑤type Ⅳ: dendritic or gyrus like pit; ⑥type Ⅴ: irregular or amorphous pit; and ⑦ mixed type Results Magnifying colonoscopy revealed that phenotypes of non neoplastic and neoplastic lesions were 78 57% and 21 43% in inflammatory and hyperplastic polyps, 3 33% and 96 67% in neoplastic polyps, and 100% non neoplastic phenotype in juvenile polyps, respectively Pit pattern analysis according to Kudo's modified classification showed that the diagnostic sensitivity of neoplastic and non neoplastic lesions was 96 67% and 80%, and specificity was 86 57% and 94 73%, respectively The overall diagnostic accuracy in differentiating neoplastic from non neoplastic lesions was 89 52% Pit pattern by common electronic colonoscopy showed that the diagnostic sensitivity of neoplastic and non neoplastic lesions was 88 3% and 73 3%, and specificity was 81 5% and 82 5%, respectively The overall diagnostic accuracy in differentiating neoplastic from non neoplastic lesions was 82% Conclusion The pit pattern analysis of colorectal lesions by magnifying colonoscopy or electronic endoscopy combined with indigocarmine dye is a useful method for the identification of non neoplastic polyps, adenomas and invasive carcinomas in the large bowel Therefore, it may be possible to determine, at the time of colonoscopy, which lesions should be removed endoscopically and surgically

Objective There is no quantization scheme for the early ambulation in patients with gastrointestinal tumor after operation of enhanced recovery .The aim of this study was to explore a suitable objective method of postoperative ambulation for gastro -intestinal tumor patients . Methods Sixty six gastrointestinal tumor postoperative patients were randomly assigned to two groups :ex-perimental group ( 33 cases ) and control group ( 33 cases ) .Enhanced recovery was adopted in the both groups afterthe operation . Wireless smart bracelets ( fitbit flex) were used in the experimental group , and the ambulation of patients was monitored by the hand of synchronous real time computer digital panel .At the same time, the patients was supervised for positive ambulation . Traditional quantitative methods of electronic pedometer were used in the control group.The postoperative ambulation , effect and compliance were compared between the two groups . Results Postoperative ambula-tion steps in the experimental group were increased compared with the control group on the days 1, 2, and 3postoperative, and the data were (208.70 ±45.76) vs (144.36 ±47.68), (560.73 ±148.67) vs (407.00 ±85.92), and (894.70 ±91.68) vs (674.00 ±73.06) steps (P<0.05).The first time of early ambulation, flatus, ca-tharsis, and compliance of ambulation showed significant difference in the two groups (P<0.05). Conclusion Wireless intelligent monitoring bracelet is objective and effective for monitoring and quantifying postoperative ambulation .It is superior to the traditional quantitative methods , and can improve the effect and compliance of the ambulation .Moreover , it can promote postoperative recovery in patient with enhanced recovery surgery .