ObjectiveTo discuss the effect of evidence-based nursing on prevention of pulmonary complications in postoperative elderly lung cancer patients.MethodsTwenty elderly lung cancer patients from January to June 2010 were randomly divided into the observation group and the control group with 10 patients in each group.The control group was given regular care methods.The observation group received evidence-based clinical nursing methods.The preventive effect of pulmonary complications was observed in both groups.ResultsOne case was found to have pulmonary complications in the observation group,while four cases in the control group.The total cure rate of the observation group was higher than that of the control group.ConclusionsEvidence-based nursing methods can satisfy the medical demand of patients and their family members to the utmost degree,reduce the incidence of pulmonary complications and contribute to the early recovery of patients.It is worthy of clinical application.

ObjectiveTo investigate the risk factors of upper gastrointestinal hemorrhage in elder patients with lung cancer after operation,providing the basis for clinical prophylaxis and treatment of complications.Methods360 elder patients with lung cancer in department of thoracic surgery of our hospital were enrolled from Jun 2005 to Dec 2010,the complications after operation were reviewed retrospectively.ResultsAfter investigation,we found that only 10 patients(2.8％ ) had upper gastrointestinal hemorrhage.6 cases of them were fluid and electrolyte imbalance,8 cases of them were hyoxemia,3 cases of them was hypotension after operation.8 cases of them were older than 70 years old.There was significant difference between older and smaller than 70 years old.ConclusionThe incidence of postoperative upper gastrointestinal bleeding in elderly patients with lung cancer was 2.8％,which was a relatively uncommon condition in clinic.Its major risk factors were age,fluid and electrolyte imbalance,hypotension and hyoxemia caused by operation.

Teaching in classroom is an essential pattern of clinical theoretic education. Evaluation, which is one of the most available methods to monitor and manage the teaching quality is simultaneously an effective way to build up a teaching group and train the teacher. The evaluating system should include students' opinions, companion's advice and experts' instruction. It is very important for making the evaluating more scientific, more significant and more accurate.

ObjectiveTo evaluate the safety,therapeutic effect and complications of the operation of multi-section osteotomy and intramedullary fixation for children with osteogenesis impeffecta.Methods One hundred and twenty-three children with osteogenesis imperfecta,including 85 males and 39 females,were selected from August 2005 to August 2008.According to the modified Sillence classification,45 cases was in type Ⅲ,74 in type Ⅳ,and 5 in type Ⅴ.Patients' age was ranging from 2 years and 1 month to 15 years and 7 months (mean,8 years and 3 months).The location of osteotomy was established according to the pre-operative measurement of X-ray image,and all the procedures of osteotomy were completed under direct vision.Then we chose the intramedullary pin with suitable size and insert the pin into femur from greater trochanter,and tibia from pelma.After the surgery,external fixation (spica cast for the femur,long leg plaster cast for the tibia) was made for further stabilization.Plaster supporters were removed 6 weeks later and all children began to stand and walk under the protection of orthoses.In addition,all patients received the treatment of pamidronate disodium periodically.ResultsAll 123 children were followed up for an average of 38months (range,13-64 months).Parents of all children were satisfied with the result of surgical operation,and the children's self-care and motion ability improved obviously.Fourteen children were performed the second operation due to the translocation of Rush pin,and 25 children changed the internal fixation because of the shorter Rush pin 2 years postoperatively.Bone delayed union was not found in all patients.Conclusion Multi-section osteotomy and intramedullary fixation for children with osteogenesis imperfecta could correct skeletal deformity,improve motion ability and avoid second fracture efficiently.However,such complications as translocation of intramedullary pin and changing the internal fixation with the growth of child need to pay more attention.

Objective To investigate the effects of early Xuebijing injection on procalcitonin (PCT) with septic shock patients.Methods Sixty-five patients with septic shock were randomly divided into the control group and Xuebijing injection group.The patients in Xuebijing injection group were received Xuebijing injection therapy(50 ml Xuebijing + 100 ml 0.9％ NaCl injection,2 times/d,for 7 d) besides basic treatment,while in the control group were received basic treatment including antibiotic susceptibility + early fluid resuscitation + correct acidosis.At the entering the ICU day and 1,3,5 d after treatment,patients were collected 5 ml venous blood serum C reactive protein(CRP) and PCT,and before treatment and at the 5th,7th day after treatment conducted APACHE Ⅱ evaluation to observation of curative effect of two groups.Results Before treatment,there were no significant difference in terms of heart rate,blood pressure,PCT,CRP,APACHE Ⅱ scores between the two groups (P ＞ 0.05).There was no significant difference in terms of PCT and CRP between the two groups at the 1 d after treatment(P ＞0.05).While at the 3th day after treatment,PCT and CRP of Xuebijing group were lower than of control group and the differences were significant ((7.37 ± 2.58) μg/L vs.(12.25 ± 3.32) μg/L,(64.32 ± 11.12) mg/L vs.(72.37 ± 12.42) mg/L;P ＜0.05).The APACHEⅡ score in control group at before and 5th,7th day after treatment were (20.48 ± 4.41),(16.52 ± 3.45),(12.78 ± 2.91) respectively,in Xuebijing injection group were (20.74 ± 4.73),(12.48 ± 2.76),(9.24 ± 6.67) respectively.And all indices were significant different time points between groups (P ＜ 0.05).At 7th day after treatment,15 cases were improved,10 cases progressed and 8 cases died in the control group and the effect rate was 75.8％ (25/33).Meanwhile,22 cases were improved,5 cases progressed and 5 cases died in the Xuebijing group and effect rate was 84.8％ (27/32).There was significant difference between two group(x2 =7.27,P =0.03).Conclusion Early Xuebijing injection application can inhibit the PCT r~tion of septic shock patients and improve the prognosis.

OBJECTIVE To evaluate bacterial drug resistance detection value in lower respiratory tract infection treatment.METHODS The data of distribution and antimicrobial resistance of clinical strains in sputum samples in patients with lower respiratory tract infection within some periods were collected and analyzed by WHONET software.Meanwhile,the delivery rates and detection positive rates of clinical species and antibiotics application status in clinic were retrospectively analyzed.RESULTS The delivery rates and detection positive rates of clinical species in patients with lower respiratory tract infection within some periods were 67.8% and 55.9%,respectively.The proportion of Gram-negative bacilli and Gram-positive cocci was 82.39% and 14.18%,respectively.Different drug resistance was displayed in different pathogenic bacteria.Resistant rate of Enterobacteriaceae bacteria and non-ferment bacteria against ciprofloxacin and piperacillin/tazobactam was 47.8%,34.8%and 31.5%,44.7%,respectively and resistant rate of S.aureus against levofloxacin was 63.9%.CONCLUSIONS Although the pathogenic bacteria in patients with lower respiratory tract infection show higher drug resistance to general antibiotics,most of patients with lower respiratory tract infection are treated according to clinical experience of doctors,not based on the results of bacterial culture and antimicrobial susceptibility test.Therefore,the results of bacterial culture and antimicrobial susceptibility test do not play a proper role to direct anti-infective therapy in clinic.

Objective To investigate the relationship among health literacy and treatment compliance and prognosis in patients with diabetes combined tuberculosis.Methods One hundred and eighty-one cases patients with diabetes combined tuberculosis were selected as the objectives and evaluated literacy level,compliance scale by the health literacy scale and compliance questionnaires.The control of tuberculosis,blood glucose control,treatment compliance and prognosis were analyzed in the patients with different health literacy level.Results Of 181 patients,there were 89 cases patients'(basic health literacy group) the total scores of health literacy and compliance were＞80 points,the efficacy of pulmonary tuberculosis control and blood sugar control were respectively 84.2％ (75/89) and 93.2％ (83/89);92 cases patients' the total scores of health literacy and compliance were ≤ 80 points,the efficacy of pulmonary tuberculosis control and blood sugar control were respectively 59.7％ (55/92) and 67.4％ (62/92),the differences were significant (x2 =12.78,18.11;P ＜0.05).Pearson correlation analysis showed that the total scores of health literacy were positive correlated with the scores of treatment compliance (r =0.688,P ＜ 0.001).Logistic regression analysis showed that three dimension of health literacy (health knowledge and concept,healthy lifestyle and behavior,health skills) that can combined predict the variance of rehabilitation compliance(P＜0.01).Conclusion The health literacy level of diabetes combined tuberculosis patients can effectively predict the rehabilitation compliance.Measures should be taken to improve the patient's level of health literacy,so as improve the compliance of rehabilitation and prognosis.

Objective To investigate COL1A1 gene mutation by PCR-high resolution melting (PCR-HRM) and an-alyze the correlation between genotype and clinical phenotype in a child (proband) with osteogenesis imperfecta (OI). Methods The family history of OI pedigree along with the clinical data was collected. Blood samples from the proband and his family members, as well as 50 normal controls, were collected. The mutation of COL1A1 gene was screened using PCR-HRM and validated by the gene sequence. Results The detection of PCR-HRM showed the abnormal result of COL1A1 17 exon in proband with a lower melting temperature (Tm) value than that of normal controls by 0.4℃. There were signifi-cant differences in the standardization melting curve and the different melting curve between the proband and the normal controls. The sequencing result was c.1138G>A, which meant that cDNA of 1138 base G mutation into A. The mutations transformed the amino acid glycine into a serine at amino acid 380(P. Gly 380 Ser), which resulted in missense mutations. The proband’s father and grandmother had the same mutation of COL1A1 gene. The mutation was not found in the proband’s mother and normal controls. There was no report for such mutation in Chinese population. Pedigree analysis showed the fami-ly genetic characteristics of autosomal dominant inheritance. The proband was clinically diagnosed as OI type Ⅳwith more severe clinical phenotype. Conclusion PCR-HRM analysis is a new effective method for genetic screening of OI. COL1A1 mutation of c.1138G>A is a newly discovered mutation in Chinese population. Gly replaced inαhelical domain may lead to a more severe clinical phenotype.

Objective To evaluate the clinical effect of therapy of the trisacryl gelatin microspheres combinee the gelatin sponge particle on embolize the bronchial artery in acute massive hemoptic patients. Methods One huneree cases with massive hemoptysis were selectee as our subjects ane eivieee into control ane research group(n = 50 for each group). Patients in control group were given only gelatin sponge particle,ane in research group were given the trisacryl gelatin microspheres combinee the gelatin sponge particle to embolize the bronchial artery. All cases were followee up for more than 12 months. Ane the effect of therapy was recoreee. Results In research group,42 cases(84. 0% ,42 / 50)were got the bleeeing stop immeeiately after embolization,7 cases in 72 h(14. 0% ,7 / 50),ane the effective rate of hemostasis was 98. 0%(49 / 50). In the control group,41 case(82. 0% ,41 / 50)were got the stop bleeeing immeeiately,8 cases in 72 h(16. 0% , 8 / 50),ane the effective rate of hemostasis was 98. 0%(49 / 50). There was no statistic eifference between two groups(P > 0. 05). After more than one year follow-up,3 cases(6. 12% )were reoccurree in the therapy group ane 15 cases(30. 61% )was in the control group. The eifference was significant between two groups after surgery for one year( χ2 = 9. 801,P < 0. 01 ). There was no serious complication in patients of two groups. Conclusion The operation of BAE is effective therapy for the massive hemoptoe,ane it is provee to be a safe,effective ane lower rate of recurrence approach of the trisacryl gelatin microspheres combinee the gelatin sponge particle for eouble embolzation the bronchial artery.

Objective:To investigate the relationship between Toll-like receptor and the immune regulation about inflammation by Sertoli cell in vitro.Methods:Here we examined the expression and potential functions of TLR family in rat Sertoli cells.Using our well-characterized urealyticum(UU) induced model we tested the expression changes of TLR2 and TLR6 at 12~(th),24~(th),36~(th) hours after UU infection in vitro.Results:We demonstrated that TLR2-8 are highly expressed;TLR9 and TLR10 are expressed at relatively low level;the expression of TLR1 and TLR5 are not detected in normal rat Sertoli cells.Comparing with control group,Sertoli cells express more TLR2 and TLR6 after infected by UU.Conclusion:There is some relationship between the activation of TLRs and the immune regulation about inflammation by Sertoli cell.