Objective To evaluate the effect of wound experts′ intervention on the primary caregivers′ behavior of caring patients with pressure ulcers. Methods According to the principle of convenience sampling, 200 cases of patients with out-hospital pressure ulcers were collected in the hospital emergency department between December 2013 and December 2015. Each 100 cases were randomly divided into the intervention group and the control group according to odd even packet. Primary family caregivers in the intervention group were implemented the additional behavioral intervention by professional wound experts on the basis of the conventional education, while the control group only with conventional education. Primary caregivers′behavior score in the intervention group were compared in 1 month and 2 months. And the differences of recovery rate and incidence of pressure ulcers were compared between intervention group and control group. Results The recovery rate of pressure ulcers in intervention group was 59% (59/100) ,which was significantly higher than 32% (32/100) of the control group (χ2=14.690, P=0.000), and the incidence of pressure ulcers rate was 24% (24/100) in intervention group which was significantly lower than 39%(39/100) in the control group (χ2=5.214,P=0.022). Primary caregivers′behavior scores in the intervention group were (48.27±6.12) points after 1 month and (46.18± 4.44) points after 2 months, while those in the control group were (44.15 ± 4.33) points and (43.33 ± 5.67) points, respectively, and the difference of behavior scores in different time-points were statistically significant (F=18.93, P < 0.01). Moreover, the difference of behavior scores was also statistically significant between intervention group and control group (F=5.512, P < 0.05). Conclusions Wound experts′ intervention on home primary caregivers can effectively help improve caregivers′ behavior, promote the healing of pressure ulcers, and reduce the occurrence of complications.

A variety of extra-cellular signals could activate the target molecules and induce the associated biological effects depended on different signal pathways. Apoptosis, or programmed cell death, is a conservation process essential for normal development and homeostasis of biologist. It's known that a number of factors and pathways can lead to apoptosis. Specific phosphorlipids and proteins of biomembrane could activate the signal cascades of apoptosis. The interaction of caspases, bcl-2 family and mitochondria play an essential role in regulation of apoptosis.

Bacteremia ; diagnosis ; Humans ; Infant, Newborn ; Male ; Pseudomonas Infections ; diagnosis

Objective To investigate the emergency treatment and correlation factors of aqueous misdirection during glaucoma and cataract surgery in glaucoma patients.Design Retrospective case series.Participants 126 cases(132 eyes)of angle-closure glaucoma patients with aqueous misdirection during surgery,100 cases(100 eyes)of angle-closure glaucoma patients without aqueous misdirection during surgery and 100 cases(100 eyes)of senile cataract patients.Methods We performed pars plana vitreous water-bag aspiration or anterior vitrectomy on glaucoma patients with aqueous misdirection during surgery.All the factors in observation group and control groups were compared and analyzed by logistic regression.Main Outcome Measures Preoperative highest intraocular pressure(HIOP),intraocular pressure after maximum dose(IOP),anterior chamber depth(ACD),lens thickness(LENS),axial length (AXL),mean keratometry(K),intraocular lens diopter within-0.5D corrected by SRK-T formula(IOLD).Results Among all the 132 angle-closure glaucoma eyes whose posterior chamber pressures were increased during surgery,we performed pars plana vitreous water-bag aspiration in 123 eyes(93.18%),and anterior vitrectomy in 9 eyes(6.8%).Postoperative complications included shallow anterior chamber in 20 eyes(7 eyes with malignant glaucoma,9 eyes with choroidal detachment,4 eyes with delayed local suprachorodal hemorrhage),and vitreous local hemorrhage in 1 eye.Means of all the observation indexes on three groups showed significant difference(all P

Objective To analyze the clinical features and its influencing factors of depression pa?tients with and without psychotic symptoms. Methods According to the presence of psychotic symptoms, 374 patients with major depression were divided into psychotic major depression ( PMD group,79 case) and nonpsychotic major depression ( NMD group,268 case) . All patients completed social demographic question?naire ( including gender,age,marital status,educational level,family history,positive family history of psychi?atric disorder,disease onset age,frequency of attack,times of hospitalization,etc.) and Hamilton's depression scale (HAMD?24). Results Positive family history(PMD group 47/79,NMD group 104/268, P<0.01), psychiatric disorder positive family history(PMD group 19/79,NMD group 26/268, P<0.01) and times of hospitalization(PMD group(2.52±1.29),NMD group(1.39±1.31), P<0.01) in the PMD group were signifi?cantly higher than the NMD group.HAMD total scores(PMD total score(47.85±8.69),NMD total score (43.44±8.51), P<0.01),the factor score of anxiety/somatization(PMD group(11.40±3.28),NMD group (9.19±3.54), P<0.01) and cognitive impairment(PMD group(12.24±3.77),NMD group(9.45±3.68), P<0.01) in the PMD group were significantly higher than the NMD group.Disease onset age(PMD group(30.09 ±5.17),NMD group(35.95±9.06), P<0.01),the course of the disease(PMD group(1.58±0.76),NMD group(3.02±2.87), P<0.01),the factor score of day and night change(PMD group(0.76±0.46),NMD group(1.01±0.51), P<0.01) in PMD group were significantly lower than the NMD. Logistic regression anal?ysis showed the major depression with positive family history of mental disorders( β=3.278) ,attack in early age( β=-2.524),seriously cognitive dysfunction in patients( β=3.836) may indicate the psychotic symp? toms( P<0.05).Conclusion PMD patients more positive family history,psychiatric disorder positive family history,likely to be hospitalization,severe symptoms and attack in early age compared with NMD. With posi?tive family history of mental disorders,attack in early age,seriously cognitive dysfunction in patients with ma?jor depression may indicate the psychotic symptoms.

Objective To investigate the alternation of left ventricular systolic function in patients underwent transcatheter aortic valve implantation operation(TAVI) by three-dimensional speckle tracking technology (3D-STI).Methods Totally 20 patients with severe aortic stenosis were enrolled.All the subjects underwent successful TAVI operation.The real-time 3D full volume datasets on apical four-chamber view were acquired on before,7 days and 1 month after TAVI.Left ventricular global longitudinal strain(GLS),regional peak systolic longitudinal strain(LS),regional peak systolic circumferential strain(CS) and regional peak systolic radial strain(RS),were analysed using off-line TomTec software,the differences among the three groups were compared.Results Compared with the preoperation,aortic valve blood flow velocity (AV),mean aortic valve pressure gradient(mPAG) of 7 days after operation decreased significantly.Threedimensional left ventricular ejecation fraction(3D-LVEF) among the patients whose 3D-LVEF under 50％had a remarkable increase and whose 3D-LVEF exceed 50％ before operation had no significant change,while 1 month after operation the 3D-LVEF had a significant improvement compared with the preoperational data regardless of 3D-LVEF under 50％ or not.The GLS and LS of all segments of 7 days after TAVI were higher than pre-operation(all P ＜0.05),and it had a further improvement 1 month after TAVI.Conclusions LV systolic function had improvement early after TAVI.3D-STI is a new,convenient way to detect the global and regional left ventricular systolic function of TAVI patients.

Objective To evaluate the clinical outcome of a method of renconstruction of Type Ⅱb defect of thumb both and reserving the length of the donor toe.Methods From March 2012 to Febrary 2014,there were 11 cases of thumb defect treated in our hospital.According to Gu Yudong's classification,all were type Ⅱ b.Three were open defect and others were closed defect.All were treated with combined transfer of big toe wrap-around flap and autogenous iliac graft for thumb reconstruction while a superficial circumflex iliac artery perforator flap was used to resurface the donor defect.The donor site of the belly was sutured directly.Results All of the reconstructed thumb survived.Among 11 flaps,arterial crisis occurrred in 1 case,venous crisis occurred in 2 cases,and all survived after operative treatment.The patients were followed-up from 3 mooths to 15 months,all the thumbs had a good appearance.The thumb opposition function was good and sensation recovery to S3 + and two-point discrimination from 6-8 mm.The donor big-toe was preserved.All the flaps had satisfactory color and texture,but looked a little plump.All the patients had no effect on walking and running.Four flaps had more beautiful appearance after flap plastic.There was only one linear scar on the belly donor without any discomfort.Conclusion It is an effective method of combined transfer of big toe wrap-around flap and autogenous iliac graft while a superficial circumflex iliac artery perforator flap was used to resurface the donor defect used to reconstrucution of Type Ⅱ b defect of thumb is very good.

ObjectiveTo investigate the value of CEUS in differential diagnosis of benign and malignant thyroid solid lesions.MethodsTotally 45 patients with thyroid solid lesions underwent CEUS examination.The enhancement mode and blood perfusion characteristics of malignant and benign lesions were analyzed,and the results were compared with pathology.ResultsCEUS diagnosed 31 benign lesions and 14 malignant masses.The diagnostic accordance rate of CEUS was 93.75％ (30/32) and 92.31％ (12/13) for benign and malignant lesions respectively.In 31 benign lesions,27 (27/31,87.10 ％) showed entire homogeneous enhancement,4 (4/31,12.90％) presented inhomogeneous enhancement.In 14 malignant masses,1 (1/14,7.14 ％) showed homogeneous hypoechoic enhancement,12 (12/14,85.71％) presented inhomogeneous hyperechoic enhancement and 1 (1/14,7.14％) presented non-enhancement.ConclusionCombined with two-dimensional grey scale ultrasound and CDFI,CEUS enables dynamic observation of the microvascular perfusion of thyroid lesions,therefore helps to differentiate benign and malignant thyroid lesions.

Objective To explore the clinical significance of the precision evaluation of computed tomography angiography and color Doppler image formation technology to the condition of the vascular system in the donor site.Methods From January,2014 to December,2014,CTA and color Doppler were used to examine conditions of the first dorsal metatarsal artery's courser and the size of original caliber in 25 patients with thumb or finger defected.Also the distance between skin and the first dorsal metatarsal artery.The accurate positions and adjacent relations of vessels in donor site were precisely marked and then the vessel original caliber was measured.Results All the first dorsal metatarsal arteries of 25 cases can be appeared clearly in CTA and color Doppler.Blood vessels line and filling results were completely consistent in intraoperative findings.The difference of the vessel original average caliber was statistically significant (P ＜ 0.05) (1.20 ± 0.25 mm,1.41 ± 0.15 mm and 1.3 ±0.2 mm in Doppler,CTA and operation,respectively) while the distance was not significant (P ＞ 0.05)(9.20 ±3.06 mm,10.32 ± 2.76 mm and 0.2 ± 2.6 mm in Doppler,CTA and operation,respectively) All the 25 transplanted toes were survived.Conclusion CTA combined color Doppler image formation technology in thumb or finger reconstruction can objectively reflect the real situation of the vessels in donor sites,and the structural characteristics and classification of anatomy for individualized,and has important clinical value in preoperative foot blood supply assessment.

Objective To investigate the effect of angiotensin Ⅱ(AngⅡ) and losartan on ? cells,and its related molecular mechanisms.Methods Normally cultured RIN-m cells were divided into three groups:control group(cultured with RPMI 1640 medium),AngⅡ group(treated with 100 nmol/L AngⅡ),losartan group(treated with 1 ?mol/L losartan 15min before addition of 100nmol/L AngⅡ).After incubation for another 48h,the apoptosis rate of RIN-m cells was quantified by flow cytometry(FCM) with Annexin-V FITC/PI dual staining.The expressions of Bcl-2 and Bax mRNA and protein were determined by RT-PCR and Western blotting,and the activities of Caspase 3 and Caspase 9 were detected by spectrophotometry.Results The apoptosis rate of RIN-m cells was significantly higher in AngⅡgroup than in both control and losartan group(P0.05).In comparison to the control group,the expressions of Bcl-2 mRNA and protein significantly declined,while of Bax mRNA and protein increased obviously in AngⅡ group(P0.05),but the expressions of Bcl-2 mRNA and protein were significantly higher(P0.05).Conclusion AngⅡ may induce the apoptosis of ? cells through mitochondrial pathway,and pre-intervention with losartan,which partly reverses the effect of AngⅡ,may play a protective effect on ? cells.