Objective To establish the evidence-based nursing educational programme for preventing ventilator-associated pneumonia (VAP) and evaluate the effects in critical care nurses. Methods The evidence-based nursing practice guidelines for preventing VAP from 2008 American Association of Critical Care Nurses was used as training materials,which guided the curriculum design. Seventeen critical care nurses were trained. The difference of the nurses' knowledge and practice was evaluated before and after training by an evaluation scale of nursing quality criteria for preventing VAP. Results After the training,nurses' knowledge and practice of preventing VAP were improved(Z=-3.624,P=0.000). Except the factor score of handwashing,there were significant differences on the factor scores of body position care,endotracheal tube care,enteral nutrition,maintaining the tube cuff pressure,oral care and ventilator equipment management (P<0.01). Conclusion The educational programme of evidence-based nursing for preventing VAP can improve the nurses' knowledge and practice of preventing VAP. Furthermore,it can promote the application of evidence-based nursing for preventing VAP,and thereby to improve the quality of nursing,and provide guidance for the training of critical care nurses and continuing education.

The latest progress of modern radiotherapy techniques in the management of breast cancer after breast-conserving surgery was introduced first.Then the clinical effect and the adverse effect of these advanced techniques were analyzed.Finally,in order to provide an up-to-date evidence based data on the role of modern radiotherapy techniques in the management of breast cancer,the importance of how to choose appropriate patients for these advanced techniques was discussed.

Objective To study the effect of perioperative psychological nursing on living-related liver transplantation. Methods The following measures were adopted according to the donors' concrete condition: using nursing procedure in holistic nursing, to assess and determine the main problems in perioperative period, nurses mastered psychological nursing knowledge and skills in individualized psychological nursing, giving pertinent and individualized health education to patients in accordance with their psychological problems during the perioperative period. Results The donors could face the operation with good psychological state after being given fully-integrated and whole-system psychological nursing. Conclusions Psychological nursing is important for living-related liver transplantation during the perioperative period.

Objective To investigate pulmonary circulation effects of protamine different infusion ways on the acyanotic congeni -tal heart disease(CHD) patients with pulmonary arterial hypertension(PAH) after extracorporeal circulation surgery .Methods Se-lect 80 cases of the CHD patients prepared for extracorporeal circulation surgery ,according to the different routes of administration and with or without PAH ,80 patients are divided into 4 groups (n= 20) :A1(non-PAH ,aortic root administration) ,A2(non-PAH , central venous administration) ,B1(PAH ,aortic root administration ) ,B2 (PAH ,central venous administration) .pulmonary artery pressure(PAP) ,pulmonary venous pressure (PVP) ,central venous pressure (CVP) ,peak airway pressure (Ppeak) ,plateau airway pressure(Pmean ) at the time point of preoperative(T0) ,before infusion of protamine (T1) ,1 minute after infusion of protamine (T2) ,3 min (T3) ,5 min (T4) ,10 min (T5) ,15 min (T6) and 25 min (T7) were recorded .The level of venous blood thromboxane B2(TXB2) was detected .Results After infusion protamine ,the PAP ,PVP ,CVP ,Ppeak and Pmean of group A2 and group B2 are higher compared to group A1(P< 0 .05) and group B1(P< 0 .01) respectively ;Compared with preoperation (T0) ,the TXB2 in 4 groups increased obviously after infusion protamine (T2 to T7) (P< 0 .05) ;Compared with group A1 and group B1 ,the TXB2 of group A2 and group B2 increased more significantly (P< 0 .01) .Conclusion Patients with congenital heart disease after intracardi-al surgery with extracorporeal circulation use trace pump infusion protamine through the aortic root ,which have little effect on pul-monary circulation ,can significantly reduced TXB2 release compared with central vein administration ,it can avoid a high concentra-tion of protamine directly into the pulmonary circulation that can strongly stimulate the pulmonary vascular and tracheal smooth muscle .Especially in the CHD patients with PAH .

Objective To study an improved automated method for isolation and purification of large amounts of human pancreatic islets from large mammals,and try to create conditions for preparation and isolation of large amounts of human islets.Methods An improved automated system was used to isolate and purify panreatic islets of sogs.Under the general anaesthesia(GA) condition,the pancreas of the dogs was via in situ vascular perfused using cold HC-A solution and then removed en bloc with duodenum and spleen.Then they were placed in cold UW aolutian.Intraductal collagenase-Ⅴ and pefabloc(4 ℃) was delivered with controlled perfusion.lslets were dissociated in system of Ricordi Chamber and purified islets separated with Ficoll density gradient centrifugation under controlled temperature.Digestion time,islets remaining trapped in exocrine tissue,final islet purity,insulin and C-pep secretory activity,and islet recovery were observed.The purified islets were observed under light microscope and electronic microscope after 24 h culture.Results The digestion time rate was(25.0?6.0) min,islets remaining trapped in exocrine tissue was(9.4?2.4)%,final islet purify rate was(89.7?3.5)%,islet recovery after digestion was(17.2?3.6)?104 IEQ/pancreas.Islet recovery after purification was(8.3?2.0)?104IEQ/pancreas.Insulin and C-pep secretory activity of the purified islets and their ultrastructure after 24 h culture were ideal.Conclusions Our improved automated method and facilities for isolation of canine pancreatic islets are reliable,The morphology and function of the procured islets are excellent and they can foreseeably be used for large-scale preparation of huma islets for clinical use.

Objective To investigate the protective effect of losartan on acute ischemia-reperfusion(I/R)(injury) of pancreas in rats.Methods Seventy-two Wister rats were randomly divided into 3 groups:(1)(Control group);(2)Ischemia-reperfusion group:the anterior mesenteric artery and the celiac artery were(occluded) for 15 min,30min and 60min followed by 6 hours reperfusion;(3)Losartan group:losartan(40mg/kg)were administered by gavage at 12h and 1h before arterial occlusion.The pathologic changes of pancreatic tissue were observed under light microscopy;TUNEL was used to detect apoptosic of pancreatic cells;Bcl-2 expression in the pancreatic cells of rats was analyzed by immunohistochemistry technique.(Results) Losartan treatment reversed the histological abnormalities including infiltration of inflammatory cells and atrophy of acinar cells.Compared with losartan group,pancreatic tissue of I/R group exhibited increased MDA[((20.1?1.2))nmol/g and((34.9?2.6)) vs(17.9?2.1)nmol/g and(25.2?3.3)nmol/g,P

Objective To study the therapeutic efficacy and toxicity of Bevacizumab combined with Chemotherapy in patients with advanced and metastatic cancer.Methods Fifty-nine patients of advanced metastatic cancer (Forty-two patients of refractory metastatic colorectal cancer and 17 advanced adenocarcinoma) were treated with normalized chemotherapy combined with Bevacizumab.Patients with refractory metastatic colorectal cancer were treated with Bevacizumab combined with FOLFIRI or FOLFOX4,and patients with advanced adenocarcinoma of NSCLC were treated with Bevacizumab in combination with docetaxel and cisplatin for 4-6 cycles,Bevacizumab was used until progressive disease (PD).During treatment,adverse effect were assessed with Common Toxicity Criteria V3.0 developed by National Cancer Institute.Results Among the 42 patients of metastatic colorectal cancer,27 were treated with First-line 1 with complete remission (CR),13 partial response(PR),4 stable disease(SD) and 9 PD,the effective rate (ER) was 51.9％ ( 5/15 ),disease control rate(DCR) was 66.7％ (18/27);Fifteen patients were treated with second-line PR,of which 5 PRD,4 SD,6 PD.ER was 33.3％ (5/15),and DCR was 60.0％ (9/15).The effective rate were slightly higher in the First-line treatment group than that in the second-line treatment group,however,the difference was not statistically significant (x2=1.335,P=0.248 ).Among the 17 patients of NSCLC,of which 1 CR,7 PR,5 SD,4 PD.RR was 47.1％ (8/17),and DCR was 76.5％ (13/17).The major toxicities were one grade 3 hemoptysis observed in one patient,grade 3 thrombosis was observed in one patient.Other common adverse effects,were epistaxis,hemoptysis,hypertension and proteinuria,which were not severe and could be well tolerated.Conclusion Bevacizumab Combined with Chemotherapy was effective in short term for the patients with advanced and metastatic cancerMost patients could tolerate the side effects.Further studies should be done to prove the long-term effects.

Objective To explore tolerance-related factors of enteral nutrition(EN) by nasogastric (NG) tube in ICU patients, and to provide several nursing strategies for improving the patients' tolerance. Methods 83 patients using EN with NG tube in ICU were collected.Tolerance-related factors of EN were analyzed by multivariate Logistic regression analysis. Results Among the 83 patients, 36 patients (43.3%) could tolerate very well, 47 patients (56.6%) couldn't tolerate.After treatment 27 patients' tolerance was fair, the other was poor.Multivariate Logistic regression analysis showed that age, APACHE-Ⅱ score, the time of beginning EN, albumin level, drug administration by NG tube or not were the major factors affecting tolerance of NG tube feeding. Conclusions Patients' feeding with NG tube was well-tolerated in ICU.Besides the factors from patients as the severity of disease status and level of serum albumin,the time of beginning EN, drug administration by NG tube were significantly correlated with tolerance.

Objective To explore the effects of application calcitonin gene related peptide(CGRP) in cisterna magna on cerebral vasospasm after experimental subarachnoid hemorrhage (subarachnoid hemorrhage,SAH) in rat models.Methods 64 male Wistar rats were randomly divided into 4 groups.Group A was normal control group.After the subarachnoid hemorrhage models were established,group B,C,D were given normal saline,CGRP and adenovirus CGRP through cisterna magna respectively.White blood cells in cerebrospinal fluid were detected by automatic blood analyzer,CGRP activity was detected by enzyme linked immunosorbent assay,circulating endothelial cells were observed through laser scanning confocal microscope and parietal cortex regional cerebral blood flow were observed by laser doppler flowmeter.Basilar artery vasospasm and arterial blood gas analysis were detected by digital subtraction angiography and blood gas analyzer respectively.Results Before and after administration,there were no statistical differences in white blood cells and artery blood gas among the 4 groups (both P＞ 0.05).After administration 48 h,compared with group A,concentrations of CGRP in cerebrospinal fluid group B (0.006±0.002) did not increase (P＞0.05),but increased 200 times in Group C ((1.160±0.170) nmol/L,P＜0.05)and nearly 400 times in group D ((2.071±0.412) nmol/L,P＜0.05).Peripheral blood circulating endothelial cells count:after administration 48 h,group C((5.56±0.61) ind/0.9 μL) was less than in group B((9.94± 0.73) ind/0.9 μL).Group D((5.16±0.61) ind/0.9 μL) was less than group C(P＜0.01).Regional cerebral blood flow:after administration,compared with group B,cerebral blood flow of group C and group D increased,and the differences were both statistically significant (P＜0.01).Basilar artery diameter was detected after administration 12 h,group D ((1.000±0.025) mm) was 13％ bigger than group B ((0.670±0.028)mm,P＜0.05),3％ bigger than group C ((0.900±0.023) mm) (P＞0.05).Conclusion Cerebral vasospasm after SAH can be effectively improved by administration CGRP in cisterna magna.Adenovirus CGRP effect is better than CGRP.

To investigate the relationships between constitutional types of traditional Chinese medicine (TCM) and hypertension so as to provide epidemiological evidence for the theory of correlation between constitution and disease.