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.

Objective To analyze the efficacy of umbilical one trocar laparoscopic appendectomy (UOTLA) in treatment of complicated appendicitis in children. Methods Clinical data of 78 cases of children patients with complicated appendicitis from January 2012 to October 2015 was summarized, including 44 cases as UOTLA group received umbilical one trocar laparoscopic appendectomy, 34 cases as OA group received open appendectomy. Then statistically analyzed all the patients' operation time, postoperative hospital stay, postoperative abdominal abscess, incision infection, early inflammatory intestinal obstruction and pain level. Results The laboratory test results of C reaction protein (CRP) had no significant difference between the two groups, while peripheral white blood cell count decreased more significantly in UOTLA group than that in OA group; the operation time of UOTLA group was shorter than that in OA group with no statistical difference [(66.59 ± 33.24) vs (72.86 ± 30.36) min, P > 0.05], but postoperative hospital stay was shorter [(8.21 ± 1.67) vs (9.21 ± 2.01) d, P < 0.05]. Abdominal abscess after operation: 3 cases in UOTLA group, while 1 case in OA group (P > 0.05); incision infection: 6 cases in UOTLA group, 9 cases in OA group (P > 0.05); early inflammatory intestinal obstruction: 1 cases in UOTLA group, 5 cases in OA group (P > 0.05); the pain level, postoperative recovery time was significantly shorter in UOTLA group compared with OA group (P < 0.05). The average expenses comparison of the two groups has no statistical difference [(10639.37 ± 2970.92) vs (10765.04 ± 2902.64) yuan, P > 0.05]. Conclusion UOTLA is safe and effective for complicated appendicitis in children due to minimally invasive, less pain and faster recovery without significant increase in the cost and postoperative complications. It can be applied in children with purulent, perforated appendicitis and gangrene, perforated appendicitis and other complicated appendicitis.

Objective 7 cases of thoracic spinal cord injury without radiographic abnormality (SCIWORA) were analyzed to elevate the level of diagnosis and treatment.Methods The type of spinal cord injury were classified into complete injury in 2 and incomplete injury in 5 according to Frankel. 5 cases had MRI examination. Conservative therapy was adopted in 5, and operation was programmed in 2.Results 4 cases recovered completely , 2 cases recovered partly , and 1 case had no recovery.Conclusion MRI provides reliable foundation for diagnosis and treatment to thoracic SCIWORA. The result is satisfactory in those incomplete injury.

The clinical data of 42 patients with pelvic organ prolapse, who underwent laparoscopic sacral colpopexy using prolene meshes were retrospectively reviewed. During the operation prolene meshes were placed in the rectovaginal septum and vesicovaginal septum ,and the uterus was preserved in all cases.The mean operation time was (92 ± 12)min and the mean blood loss during the operation was (98 ± 11 )ml.Postoperatively, both prolapse and symptoms were significantly improved ( P ＜0. 01 ) according to the pelvic organ prolapse quantification (POP-Q) system. The operation is an effective and minimally invasive new technique which offers a chance for patients with pelvic organ prolaps who desire to preserve uterus.

Objectives : The objective of this study is to develop a Japanese version of the Constitution in Chinese Medicine Questionnaire (CCMQ) in Chinese, which is comprised of 60 items with 9 sub-scales, and evaluate its reliability and validity. Methods : We conducted a survey of 130 participants in the Toyama area of Japan from Dec. 2005, to Feb. 2006. A test-retest method was used. Feasibility was evaluated by the response times to the questionnaire, and the response rates of the CCMQ items. Internal consistency within the sub-scales was assessed by Cronbach's α coefficient. Reproducibility was confirmed between the first and second occasions using weighted kappa and Spearman correlation. Lastly, criterion validity was evaluated by correlation between CCMQ and SF-36 sub-scales. Results : Response time was 8 minutes on average and its rate was nearly 100%. Internal consistency was achieved for each of the 9 sub-scales with a 0.65 to 0.79 α coefficient. Reproducibility ranged from 0.41 to 0.81 for the items, and from 0.79 to 0.88 for the sub-scales. Regarding the criterion validity, the “Gentleness type” sub-scale was positively correlated with SF-36 (0.46, P<0.001), while other 8 pathological constitutional types of the CCMQ were negatively correlated with SF-36 (-0.35 to -0.50, P<0.001) as expected. Conclusions : We developed a Japanese version of the CCMQ and found acceptable levels of reliability and validity using a survey of 130 subjects in Japan. This suggests that the CCMQ could be a useful tool in comparing the constitution profiles between Chinese and Japanese.
Japanese language ; Chinese People ; Questionnaires ; SF Brand of Topical Fluoride ; Medicine

Objective To investigate the location of receptor interacting protein 3( RIP3) in Necroptosis and its function in this signal passage, and explore the relationship between receptor interacting protein 1 ( RIP1 ) and RIP3 in nuclear translocation. Methods Primary cerebrocortical neurons were cultured for 12 days,then pre-treated with zVAD-fmk(20μ,mol/L) for half an hour to block apoptosis. ①Extracting nuclear and cytoplasmic protein after neurons were exposed to TNF for different time ,then protein levels of RIP3 were analyzed by western blot and immunofluorescence for qualitative observation;②In the following research,the neurons were treated with Nec-1 and shRlPl ,then the protein level of RIP1 and RIP3 with western blot were analyzed, cell viability were determined by measuring LDH levels. Results ①In signaling pathways of necroptosis, the protein level of RIP3 in cytoplasmic decreased gradually with prolonged TNF exposure, to the corresponding it rolled up in nucleus and a-chieved the peak in 12 hours of TNF treatment ( Cytoplasmic 0. 45 ± 0. 03 ,0. 41 ± 0. 02,0. 73 ± 0. 03 ,0. 90 ± 0.01,1.15 ±0.04,1.30 ±0.02,0.99 ±0.03,0.63 ±0. 03;Nucleus 0. 07 ±0.02,0. 26 ±0.02,0. 57 ±0. 02,0. 68 ± 0.02,0. 80 ± 0.01,0.92 ± 0.02,1.28 ± 0.03,0. 87 ± 0.02) (P < 0.01). ②Blocking the relationship between RIP1 and RIP3 with necrostatin-1 and shRIPl , nuclear translocation of RIP3 decreased and caused a great increase in cell viability( 1.00 ±0.05,0.39 ±0.03,0.50 ±0. 03) (P<0. 01). Conclusion RIP3 mainly locates in cy-tolymph of normal cells,it translocates into nucelus as necroptosis takes place. RIP1 function with RIP3 in nuclear translocation. Block nuclear translocation of RIP3 is a potential way to protect cells.

It has been suggested that progression of bladder transitional cell cancer (BTCC) may be regulated at the molecular level by a typical pattern of expression of genes involved in apoptosis. Recently Livin, belonging to the inhibitors of apoptosis (IAP) family, has been found to be expressed in most solid tumors, where its expression is suggested to have clinical significance. In order to explore the significance of Livin expression in the development of BTCC, immunohistochemistry and RT-QPCR were used to detect the expression of Livin mRNA in tumor tissues and adjacent normal tissues of 30 cases of BTCC. The results showed that the positive rate of Livin expression in adjacent normal tissues and tumor tissues was 0 and 60% (18/30) respectively. The-DeltaDeltaCT value of Livin in BTCC tissues was 8.0454 (7.4264-8.6644) times of that in adjacent normal tissues. The expression of Livin mRNA had no correlation with tumor pathological grades and clinical stages. It was suggested that there was weak expression of Livin mRNA in adjacent normal tissues, but strong in tumor tissues.

Objective To investigate infection status and antimicrobial resistance mechanism of methicillin-resistant Staphylococcusaureus(MRSA),and provide reference for the rational antimicrobial use in clinic. Methods Staphylococcusaureus (SA)isolated from various specimens in Xuzhou area in 2012-2015 were collected,MR-SA strains were preliminarily screened by cefoxitin disk diffusion method,and confirmed by amplification of mecA gene,antimicrobial resistance of MRSA was determined by Kirby-Bauer method,minimal inhibitory concentration (MIC)was measured by E-test method,genotypes of staphylococcal chromosomal cassette mec(SCCmec)were de-termined by multiplex PCR. Results A total of 116 strains of MRSA were identified among 210 SA strains in 2012-2015,114 of which were positive for mecA gene,the total detection rate of MRSA was 55.24% . Susceptibility rates of MRSA to vancomycin,quinupristin/dalfopristin,and linezolid were all 100% ,resistance rates of MRSA to chloramphenicol and furantoin were both low,which were 15.52% and 1.72% respectively,resistance rates of MR-SA to 10 kinds of antimicrobial agents were all>80% ;resistance rates of MRSA to penicillins,aminoglycosides, macrolides,quinolones,sulfanilamide,rifampicin,tetracycline,and clindamycin were all higher than methicillin-sensitive Staphylococcusaureus(MSSA). MICs of vancomycin to MRSA in 2012-2015 were all 1.0μg/mL,MIC90 were all 1.5μg/mL,one MRSA isolate was with a vancomycin MIC of 2.0μg/mL in 2015. MRSA typing results of 116 MRSA isolates showed that SCCmec II,SCCmec III,and SCCmec IV accounted for 9.48% (n= 11),73.28% (n= 85),and 1.72% (Iva,n= 2;IVb,n= 2)respectively,13.79% (n= 16)of MRSA isolates were nontypeable, SCCmec I and SCCmec V type strains were not found. Conclusion MRSA is seriously multidrug-resistant,the drift has not been discovered in MIC value of vancomycin against MRSA,the major SCCmec genotype of MRSA is SCCmec III,infection control measures should be taken to control MRSA infection.

Objective To investigate the effect of gastric capsule combined with psychological intervention on immune function and quality of life in patients with advanced gastric cancer.Methods A total of 130 patients with advanced gastric cancer were enrolled in this studyfrom July 2014 to August 2016 in our hospital,andrandomly divided into two groups.Twogroups were treated with chemotherapy,andobservation group was treated anotherwithWeinaian capsule.The immune indexes, quality of life and side effects of the 2 groups before and after chemotherapy were compared and analyzed.Results After chemotherapy,CD4+、CD8+、CD4+/CD8+、CD3+ and NKlevel of observation group were better than that of control group(all P<0.05).After chemotherapy,SF-36 score of physical function, health status, vitality, emotional and mental health scores of observation group werebetter than that of control group(all P<0.05).During chemotherapy,proportion of gastrointestinal reaction and liver and kidney injury of observation group were 35.38% and 21.54%,lower than that of control group 63.08% and 40.00%(all P<0.05).Conclusion Weinaian capsule can improve immunologic function of advanced gastric cancer patients undergoing chemotherapy and reduce adverse reactions,so as to improve the quality of life of patients.

Objective To evaluate the feasibility,technique and preliminary clinical results of the intraoperative three-dimensional (3-D) computer navigation system assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.Methods From October 2010 to April 2013,14 patients (18 hips) with osteonecrosis of the femoral head were treated by free vascularized fibular graft transfer,assisted by intraoperative3-D computer navigation system.Of 18 hips,8 were classified as stage Ⅱ ;6 as stage Ⅲ,4 as stage Ⅳ according to Steinberg system.The entire procedures were visualized and guided by the 3-D navigation system,including location of optimal entry point,exploration of the field,excision of the necrotic bone tissues,and the fibular grafting transfer with vessel anastomosis.The follow-up records included the results of X-ray,the Harris score of the hip,and the complications.Results Operations of all 14 patients (18 hips) were smooth and successful with patent vessel and umcompromised grafts evidenced by ECT scan at day 7 postoperatively.Postoperative X-ray confirmed the complete eradication of necrotic focuses with surrounding calcified bone and the accurate positioning of fibular grafts.The mean follow-up period was 23.6 months (8-29 months).Harris scores significantly improved from 57.5 ± 14.5 before operations to 87.5 ±2.5 after,with 6 hips' scores classified as Excellent,and 11 as Good.X-ray obtained more than 1 year after operation suggested improvement was achieved in 15 hips.Conclusion Intraoperative 3-D computer navigation system has multiple merits in assisting free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head,including clear anatomic structure,better accuracy,less damage,and reliable functional recovery,which imply it is a highly applicable approach.