Objective To investigate the effect of clinical pathway in health education for preventing post partum urinary retention. Methods 883 women who performed vaginal delivery in our department before implementation of clinical pathway from July to December, 2007 were set as the control group, 1172 women who performed vaginal delivery after implementation of clinical pathway were selected as the experimental group from January to June, 2008. Then the first micturition condition was compared between the two groups. Results The rate of autonomic micturition was 95.9% in the experimental group, and 91.6% in the control group, The rate of autonomic micturition was higher than that of the control group. Conclusions Application of clinical pathway to prevent post partmn urinary retention can improve obstetrical nursing quality.

ObjectiveTo explore the proper service mode during perinatal period in obstetric de-partment through application of clinical nursing pathway theory. Methods2597 outpatient and inpatient pregnant women were randomly chosen. The experimental group (1332 cases): the clinical nursing pathway in different stages of perinatal period was designed, nurses completed their tasks according to the standard process. The control group (1265 cases): accepted the routine healthcare education and ordinary delivery method. The delivery outcome and the delivery time of the two groups were observed and recorded, satisfac-tion degree with the nursing service and nurses' mental condition before and after the application of clinical nursing pathway were also investigated. ResultsThe rate of cesarean operation of the experimental group was lower than that of the control group. The difference of total delivery time in the two groups was signifi-cant. The satisfaction degree to the nursing service improved obviously in the experimental group. The dif-ference of nurses' self- confidence, self- determination, working satisfaction, sense of competence before and after the application of clinical nursing pathway was significant. ConclusionsApplication of clinical nursing pathway in pregnant and lying-in women during perinatal period can improve the confidence of natural delivery, shorten the delivery time, reduce the cesarean operation rate, improve satisfaction degree to nurses' work, mental condition, and their general diathesis.

Objective To analysis the clinical features of valproate (VPA)-induced encephalopathy in elderly people in order to improve our cognition toward it.Methods From March 2003 to March 2011,a total of 10 cases with VPA-induced encephalopathy were retrospectively reviewed and summarized.The data collected included clinical manifestations,biochemistry,EEG and therapeutic effects.Results In the 10 cases,8 were males and 2 females.The age ranged from 65-88 years old (mean age 75.4±10.3 years).7 subjects were on treatment with VPA alone,and the other 3 in combination with other anti-epileptic drugs.The serum VPA level in this study ranged from 62.1-122.7 μg/ml with mean of (92.3 ± 30.1) mg/L (normal range 50-100 mg/L).All subjects presented with confusion and cognitive impairment.The serum ammonia level in this study ranged from 56.7-225.1 μmol/L with mean of (101.4±55.2) μmol/L (normal range 11-32 μmol/L).All cases were with normal liver function.Electroencephalography was characterized by signs of severe encephalopathy with continuous generalized slowing,a predominance of θ and δ activity,occasional bursts of epileptiform discharges and triphasic waves.All cases were improved 3-21 days after VPA withdrawal.Conclusions VPA-induced encephalopathy that manifested in confusion and cognitive impairment is not uncommon in elderly patients and it has a good prognosis and the early withdrawal of VPA lads to improvement in almost all cases.

Semont maneuver was performed in 97 patients with benign paroxysmal positional vertigo involving the posterior semicircular canal.Among 97 patients the Semont maneuver was successful in 69 cases and failed in 28 cases.There were three nystagmus patterns during the third position of the Semont maneuver:orthotropic nystagmus (n=45), no nystagmus (n=42) and reversed nystagmus (n=10);and the effective rates in three groups were 93%, 64% and 0%, respectively (P<0.05).The duration of latency period and nystagmus status in Dix-Hallpike test has no effect on repositioning efficacy ( P>0.05) .

To analyze the pathogenesis, clinical symptoms, misdiagnosis and operation of endometriosis in unusual sites,32 cases of unusual site endometriosis were analyzed. 468% was correctly diagnosed before operation,and 625% was found to have a history of operation.Good prognosis can be achieved by combined treated on the basis of discussing its pathogenesis clarifying its increasing incidence rate,and attaching importance to its malignant tendency.

Objective To observe any therapeutic effect of transcutaneous electric nerve stimulation (TENS) on patients with shoulder-hand syndrome after stroke (SHSAS) and to examine the influence of TENS on sympathetic skin response (SSR).Methods Sixty-eight patients with SHSAS were randomly divided into a treatment group (35 cases) treated with routine rehabilitation training and TENS therapy and a control group (33 cases)treated with routine rehabilitation training only.The therapy for both groups lasted 3 weeks.The severity of pain and edema of the affected upper limb was assessed with a visual analogue scale (VAS) while sympathetic skin response was recorded from the affected upper limb before and after treatment.Results VAS scores improved significantly in the treatment group,and significantly more than in the control group.There was no significant difference in the SSR latencies,amplitudes or abnormality rates between the two groups before treatment.The latencies and abnormality rates of both groups improved significantly after treatment,but the improvement in the treatment group was more obvious.The SSR amplitudes did not change significantly after treatment in either group.There was a positive correlation between the SSR latencies and abnormality rates and the VAS scores,but no significant correlation between SSR amplitude and the VAS scores.Conclusions TENS therapy combined with routine rehabilitation training showed not only good clinical results,but also significant changes in SSR among patients with SHSAS.This indicates that SSR could be used to evaluate therapeutic effects in SHSAS patients.

Objective To discuss the appropriate timing of providing enteral nutrition through nasojejunal tube for patients with severe craniocerebral injury.Methods 126 cases of patients were divided into 3 groups randomly,providing enteral nutrition through naso-jejunal tube for the first group,the second group and the third group within 12～24 hours,48 hours later and 72 hours later after injury respectively.The nutrition situation of 3 groups was recorded 6 hours later,48 hours later,on the 5th day and the 10th day,including indicators such as total serum protein,blood albumin,serum creatinine,etc and complication cases of diarrhea,hemorrhage of digestive tract,palirrhea,aspiration,inhalation pneumonia and so on within 2 weeks after injury.Results In terms of indicators of albumin,creatinine 48 hours after injury and total protein,albumin and creatinine on the 5th day and 10th day,the first group were better than the second and third group,there were statistic differences between the three groups.Complication comparison within 2 weeks after injury:the difference of palirrhea cases among the three groups was significant,the third group had a higher ratio than the first and second group.And there was no statistic difference in the other indicators like diarrhea,hemorrhage of digestive tract,aspiration and inhalation pneumonia.Conclusions It is high time that patients with simple severe craniocerebral injury are provided with enteral nutrition through naso-jejunal tube within 12 to 24 hours,which can improve patients nutrition situation without the increase of the complications.

Objective To explore imaging features of Zinner syndrome.Methods Eight male patients with clinically diagnosed Zinner syndrome performed abdominal and pelvic CT and /or MRI scan.The radiological data was studied retrospectively.Results Eight cases showed seminal vesicle cyst with ipsilateral renal agenesis on CT and/or MR imaging ( left side, n =5; right side, n =3).The maximal diameter of seminal vesicle cysts varied from 4.2 to 7.0 cm, and appeared as oval cystic lesion with irregular contour or tube-like dilatation , which appeared low density on CT image and hypo-or hyperintensity on T 1 WI and hyperintensity on T 2 WI.Bladder compression was found in 6 cases.Fuild-fuild level in the cysts was seen in 2 cases.Remnants of ureter structure were seen in only 1 case.There was no other accompanying abnormality of urinary system.Conclusions Zinner syndrome presents with characteristic imaging features , and the key issue is differential diagnosis of seminal vesicle cysts.

Objective: To set a quantified diagnostic standard for large intestinal cancer of spleen qi deficiency syndrome. Methods: The spleen qi deficiency syndrome was identified by experts on the basis of clinical epidemiological investigation of 311 patients suffering from large intestinal cancer. Corresponding points were assigned to the correlative factors (traditional Chinese medicine symptoms) on the basis of symptom differences between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome. The best threshold was determined by receiver operating characteristic curve (ROC) according to syndrome differentiation from expert team, and the quantified diagnostic standard was established. The syndrome identification from the expert team which was regarded as golden standard was tested retrospectively. Results: All the traditional Chinese medicine symptoms possibly related to spleen qi deficiency syndrome were analyzed based on the opinions of experts, and 28 symptoms were confirmed as candidate correlative factors. The occurrence of 11 symptoms between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome showed statistical differences by means of crosstabs analysis (P<0.05). The 11 symptoms were filtered by logistic regression analysis, and tiredness, fatigue, loose stool, and poor appetite were finally determined as the symptoms relative to large intestinal cancer. These four symptoms were analyzed with conditional probability conversion and endowed with 16, 11, 4 and 8 points respectively. The diagnostic standard of spleen qi deficiency syndrome of large intestinal cancer was over 13 points. The sensitivity, specificity and accuracy of retrospective examination were all above 80%, and its positive likelihood ratio was 9.89. Conclusion: The quantified diagnostic standard for spleen qi deficiency syndrome of large intestinal cancer is in accordance with clinical characteristics of large intestine cancer and the characteristics of TCM syndrome diagnosis.

OBJECTIVE: To study the effect of Chinese herbal medicine 1023 Recipe in blocking cancer transformation of experimental oral precancerous lesion and its mechanism. METHODS: We treated the experimental oral precancerous lesion in hamster's cheek pouch using 1023 Recipe (consisting of Radix Astragali, Gynostemma Pentaphyllum, Rhizoma Chuanxiong and selenium-rich green tea) for 6 weeks, and observed its effect in blocking cancer transformation, detected 2 kinds of agglutinin receptors (receptors of wheat germ agglutinin and Ricinus communis agglutinin) in the mucosa of the hamster's cheek pouch. RESULTS: The rate of cancer transformation in 1023 Recipe treated group was lower than that in the control group without treatment (P<0.05). Agglutinin receptors in the two groups were different significantly. CONCLUSION: 1023 Recipe is effective in treating hyperplasia, and can prevent its cancer transformation. The mechanism may be that 1023 Recipe can induce precancerous lesions to differentiate into normal tissues.