Objective To explore the influence of fluid management and prognosis guided by goal direction on patients undergoing gastrointestinal surgery.Methods Eighty ASA grade Ⅰ-Ⅲ,consecutive consenting patients undergoing gastrointestinal surgery were divided into observation group (40 patients)and control group (40 patients) by random digits table method.The intraoperative fluid management in control group was based on central venous pressure(CVP),and kept CVP at 8-10 mmHg(1 mmHg =0.133 kPa).The intraoperative fluid management in observation group was based on stroke volume variation (SVV),and kept SVV at 10 ％-12％.The operation time,intraoperative and postoperative 3 d fluid management,time of defecation and exhaust,time of full or semi-liquid diet,length of stay in hospital,rate of complications after operation for 48 h between two groups were compared.Results The volume of total fluid,colloid solution and crystalloid solution received during operation in observation group were significantly lower than those in control group[(2 686.0 ± 977.5) ml vs.(4 837.5 ± 1 566.0) ml,(792.4 ± 197.6) ml vs.(1 284.6 ± 356.7)ml,(1 894.9 ± 460.4) ml vs.(3 569.9 ± 1 318.7) ml] (P ＜ 0.05).The time of semi-liquid diet,length of stay in hospital in observation group were significantly lower than those in control group [(171.1 ± 45.3) h vs.(235.8 ±89.5) h,(11.4 ±1.8) d vs.(14.7 ±4.9) d] (P＜0.05).The time of full liquid diet,time of defecation and exhaust between two groups had no significant difference(P ＞ 0.05).The rate of complications between two groups had no significant difference(P ＞ 0.05).Conclusion Compared with monitoring CVP,the fluid management based on SVV can decrease the fluid volume during operation and shorten the length of stay in hospital.

This paper analyzed the current scientific research situation of medical postgraduates in Xi'an Jiaotong university,stated briefly the existing main problems and relevant influence factors including poor scientific research ability due to low quality enrollment,unreasonable construction of experimental platform,patchy quality of tutor teams et al.To solve the problems above,several policies were proposed,mainly including strengthening basic experimental skills of medical undergraduates,reforming the postgraduate curriculum system,optimizing the building of experimental platform and reinforcing the development of tutor teams.

BACKGROUND:Cannulated screw tension band combined with wire fixation is most commonly used for treatment of patel a fractures.
OBJECTIVE:To evaluate the clinical outcomes of combination of cannulated screw tension band and wire fixation in the treatment of patel a fractures.
METHODS:A literature search method was employed to retrieve relevant articles addressing cannulated screw tension band and wire fixation of patel a fractures. In-depth analysis of literatures meeting the study criteria was carried out. Patients with patel a fractures who received cannulated screw tension band and wire fixation were fol owed up to evaluate the postoperative fracture healing, complications and functional recovery of the knee joint at the injury side. Then, the clinical efficacy of cannulated screw tension band combined with wire fixation was analyzed.
RESULTS AND CONCLUSION:After treatment with cannulated screw tension band and wire fixation, patients with patel a fractures exhibited good fracture healing and low probability of complications, including screw or wire loosening, broken, and shedding. Functional recovery of the affected knee was up to 90%. Clinical case analysis showed that cannulated screw tension band combined with wire fixation achieved good outcomes in the treatment of patel a fracture, with over 90%functional recovery of the affected knee, which is consistent with the reported results. It indicates that the cannulated screw tension band combined with wire fixation is one of the ideal and reliable methods in use for internal fixation of patel a fractures.

Objective To understand the psychological needs of old people in nursing homes,so that more humanistic services will be supplied to old people,and hopefully to facilitate the management of the nursing home facilities.Methods Field research method was used in this paper in four nursing homes in Chongqing City.Data were collected by observation and interview.Results Data were coded and translated into three themes:wishing to be listened,especially the new resident; eager to be more respected and the feeling of being at home; the most important thing was happiness.Conclusions To concern the psychological needs of old people in nursing homes and supply corresponding service have a significant meaning for improving the survival state and their life quality,as well as increase service level.

Technology and technique of coronary artery stent have been developed to a certain degree, restenosis rate of metal stent reduces to 15%, but coronary artery stent is still difficult for long-term effect of interventional therapy on coronary atherosclerotic heart disease. Drug-eluting stent is newly discovered during recent years, while it is prospect for preventing restenosis postoperatively. Although clinical efficacy of drug-eluting stent is encouraged, indication is still simple. In addition, some events related to drug-eluting stent remain poorly unknown. This study was designed to compare security between drug-eluting stent and metal bared stent, analyze major factors correlated with security of drug-eluting stent, and investigate the development of drug-eluting stent.

Autoimmune Diseases ; Child ; Humans

Objective To investigate the cognition of falling from doctors,nurses and patients in eight Chongqing local hospitals,and develop targeted health education to prevent the occurrence of falling events.Methods Based on data analysis of 368 falling cases from eight Chongqing local hospitals,a selfdesigned questionnaire was developed and used to investigate doctors,nurses and patients from these eight hospitals.1 393 questionnaires were returned,with a recovery rate of 97.69％.The method of t test,analysis of variance and Chi Square （x2) test were used for analysis.Results Nurses had highest recognition for falling features,doctor followed,patients with the lowest,the differences had statistical significance; Nurses' cognitive degree from Third-Grade A-Level hospital was above that of nurses from Second-Grade A-Level hospital,the differences had statistical significance; Doctors' cognition of hospitalization days when falling and susceptible population of falling was lower than that of nurses.Nurses thought falling tended to occur from nightfall to midnight.Conclusions Survey found that,the cognitions of falling from doctors,nurses and patients were different from actual results.Cognition were also different among three sides of them,according to the survey results,health education for different objects should be provided,raise everyone's awareness,thus using targeted falling prevention measures to reduce the incidence of falling.

OBJECTIVE To investigate the antibacterial resistance of clinical isolates from inpatients of non-ICU departments in China in 2006-2007.METHODS Clinical isolates were collected by member hospitals of Mohnarin according to unified protocol.Bacterial susceptibility testing was carried out using Kirby-Bauer(KB),MIC or E-test methods according to CLSI 2006.The data were analyzed by WHONET 5.4 software.RESULTS A total of 77253 clinical isolates from inpatients of non-ICU departments in Mohnarin member hospitals were collected from Jun 2006 to May 2007,of which Gram-negative bacteria accounted for 53549(69.3%),and Gram-positive cocci for 23704(30.7%).Meticillin-resistant Staphylococcus aureus(MRSA) and coagulase-negative Staphylococcus(MRCNS) strains accounted for 57.6% and 83.3%,respectively.There was no glycopeptide-resistant Staphylococcus to be found,but small part of coagulase-negative Staphylococcus was teicoplanin intermediate or resistant.50.9% Of Enterococcus faecalis and 69.9% of E.faecium strains were resistant to high concentration gentamicin.1.1% And 2.7% of E.faecalis and E.faecium isolates were resistant to vancomycin,0.8% and 2.7% resistant to teicoplanin.There were 9.9% isolates of Streptococcus pneumoniae were penicillin-nonsusceptible.About 34.5% Escherichia coli and 23.5% Klebsiella pneumoniae isolates were ESBLs-producing strains.Isolates of Enterobacteriaceae were still highly sensitive to imipenem and meropenem,the average resistant rate was less than 2%.There were about 70% E.coli isolates resistant to quinolones,and 20-60% of non-fermentative Gram-negative bacilli were resistant to antibacterials.CONCLUSIONS Bacterial resistance is severe in inpatients in our country,and the resistant rates are increasing.More effective measures should be taken

The physicians and nurses in the intensive care unit often discuss about withdrawing or withholding life-support therapy of critical ill patients with them or their family members.In this article,we expatiate on the importance,approach,agendas and medical ethical issues of the communication about end-of-life care between clinicians and families.

?AIM: To explore the application of 25G vitreous cavity perfusion in phacoemulsification for cataract after vitrectomy.?METHODS:Forty-eight patients (50 eyes) with cataract after pars planavitrectomy in our hospital from September 2013 to September 2014 were selected to receive phacoemulsification and implantation of artificial lens with 25G vitreous cavity perfusion. Best corrected visual acuity ( BCVA ) , intraocular pressure ( IOP ) , postoperative discomfort, healing of scleral puncture and postoperative complications were observed.?RESULTS: All patients underwent surgery successfully. Compared to before operation, there was less patients with BCVA ≤0. 1, more patients with BCVA 0. 3-0. 5,>0. 5,>0. 3 (P<0. 05). The visual acuity of 1 eye decreased because of vitreous hemorrhage caused by original fundus lesion recurrence. The mean IOP before operation and at 1, 7d, 6mo after operation were 14. 67±0. 62mmHg, 14.75±0.56mmHg, 14.86±0.58mmHg, 14.88±0.59mmHg, respectively. There were no statistically significant differences of IOP between that before operation and those at 1, 7d, 6mo after operation (P>0. 05). No obvious eye discomfort and severe complications after operation were observed.? CONCLUSION: The effect of 25G vitreous cavity perfusion in phacoemulsification for cataract after vitrectomy is good and it can maintain IOP, keep anterior chamber stable and decrease the complications risk.