Objective To seek for the best clinical nursing pathway for early limbs activity of patients with high-risk hemiplegia in the department of cerebral surgery and to reduce limbs paralysis and improve their life quality.Methods Patients(112 cases)with high-risk bemiplegia in the department of cerebral surgery from January to December in 2007 were set as the experimental group.They took part in limbs early activity on the first day on admission with application of clinical nursing pathway.Patients(89 cases)of the same kind who took part in limbs activity from January to December in 2006 were set as the control group.The two groups were compared with Brunnstrom scale beth on admission and discharge.Results The Brunnstrom grade of upper limbs,hands and lower limbs of the experimental group was evidently higher than that of the control group(P＜0.05).Especially the isolated movement and coordination ability of the hands significantly increased(P＜0.01). Conclusions Early limbs activity with clinical nursing pathway for patients with high-risk hemiplegia in the department of cerebral surgery could reach the aim of recovery of limbs functional activity.

BACKGROUND: As an important part of systemalimbica, hippocampus involves in emotion, perceiving and learning memory and can be affected by anesthesia.OBJECTIVE: With target controlled infusion of propofol, the depth of anesthesia was well controlled. And under anesthesia in various depths, cfos gene expressions in different regions of hippocampus in rabbits were detected to find the target site for central nervous inhibition by propofol.DESIGN :It was a randomized controlled study.SETTING:Department of Anesthesiology ,Shenzhen Second People's Hospital; Department of Anesthesiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: The experiment was conducted in the Neurobiological Laboratory of Tongji Medical College, Huazhong University of Science and Technology from May 2000 to June 2001. Thirty Japanese white rabbits were selected and randomly divided into control group, light anesthesia group and deep anesthesia group, with 10 rabbits in each group.METHODS:Intravenous cannulas were placed in external jugular vein (EJV) and femoral artery in all animals. According to the propofol plasma concentration, the infusion of propofol and the depths of anesthesia were well controlled. In light anesthesia group, the plasma concentration of propofol was (9.28±0.12)mg/L. In deep anesthesia group, the plasma concentration of propofol was (11.63±0.29)mg/L. Thirty minutes after being anesthetized, the animals in the two experimental groups were decapitated and the animals in control group were killed by air embolism through ear vein. Coronal sections were sliced continuously, in thickness of 7μm and 1 slice in 100 μm tissue was selected. In situ hybridization was performed to detect the c-f os mRNA in Area CA1, CA3 and dentate gyrus of the hippocampus. In each rabbit, 5 sections were selected randomly.Under a light microscope, photos were taken in 15-20 fields. And then average absorbency and average grayscale were calculated. The grayscale scores were classified as 256 scales. A lower grayscale score indicated a higher positive rate.MAIN OUTCOME MEASURES: ①Under various depths of anesthesia,in situ hybridization results of Area CA1, CA2 and dentate gyrus of the anesthesia, average grayscale scores of Area CA1, CA2 and dentate gyrus of the hippocampus in rabbits were assessed.② Under various depths of anesthesia, average grayscale scores of Area CA1, CA2 and dentate gyrus of the hippocampus in rabbits were calculated.RESULTS:Thirty rabbits entered the statistical analysis procedure.①Under various depths of anesthesia, in situ hybridization results of Area CA1 of the hippocampus in rabbits: In control group, brown, sparse or dense, light-stained or deep-stained c-fos positive cells could be observed. In light anesthesia group, dense, moderately stained c-fospositive neurons could be observed. In deep anesthesia group, cells were denser with deeper stained cytoplasma. ② Under various depths of anesthesia, in situ hybridization results of dentate gyrus of the hippocampus in rabbits: In light anesthesia group, positive cells were strongly stained in deep brown with transparent and vacuolar nuclei. In deep anesthesia group, a large number of c-fos positive cells in great dense could be observed. ③Under various depths of anesthesia, grayscale scores of different regions of the hippocampus in rabbits: Compared with control group, grayscale scores of Area CA1 and dentate gyrus of the hippocampus were significantly decreased in both light and deep anesthesia groups [(168±5), (80±7), (59±5)% ,P ＜ 0.05; (163±8),(103±15), (67±6)%,P ＜ 0.05,P ＜ 0.01]. This was more significant in deep anesthesia group than in light anesthesia group (P ＜ 0.01 ). For Area CA3, the grayscale scores in each group were similar.CONCLUSION: ①With the increasing depth of propofol anesthesia, c-fos gene expression is increased in hippocampus in rabbits. ② After anesthesia, the average grayscale score of Area CA1 and dentate gyrus of the hippocampus are significantly decreased, and this is more significant after deep anesthesia. However, there is no significant change in Area CA3. This indicates that the central inhibitory receptor sites of propofol are various in different brain regions, which supposes that the Area CA3 is not the central receptor sites of propofol.

Objective To investigate the effect of hyperbaric oxygen therapy on awareness,sports,activities of daily living in the rehabilitation of patients with early traumatic brain injury,and to observe the curative effect. Methods 80 patients with severe traumatic brain injury whose disease course within 1 months were randomly divided into observation group and control group,40 cases in each group.The control group received conventional drug therapy in neurosurgery and rehabilitation training.The observation group received hyperbaric oxygen therapy on the basis of the control group.Before treatment and one month after treatment,consciousness (GCS score),motor function (FMA score),activities of daily living (MBI score),and the clinical efficacy were compared between two groups.Results The scores of FMA,MBI and GCS in the control group were (7.81 ±2.27),(26.05 ±22.58),(15.25 ±12.14), which in the observation group were (7.78 ±2.32),(27.01 ±23.60),(14.37 ±12.54),and the differences were not significant (P >0.05).After 1 month of treatment,the scores of the control group were (9.44 ±2.76),(43.10 ± 31.54),(42.75 ±16.58),which of the observation group were (10.67 ±2.48),(56.98 ±29.68),(52.76 ± 17.23).The scores in the two groups were improved,the observation group increased more and the clinical efficacy was more obvious,there were significant differences between the two groups (P =0.039,0.046,0.009).Conclusion Hyperbaric oxygen plays an active role in early rehabilitation of patients with traumatic brain injury,it can improve consciousness,motor function and activities of daily living,and can improve the prognosis.

Objective To discuss the nursing points for patients with malignant obstructive jaundice who are receiving biliary stenting combined with linear 125I seeds strand implantation. Methods A total of 41 patients with malignant obstructive jaundice were enrolled in this study. Biliary stenting combined with linear 125I seeds strand implantation was performed in all the 41 patients. Sufficient preoperative preparation and psychological intervention were carefully implemented. During the operation, active cooperation with the surgical procedures and close observation of patient’s vital signs as well as adverse reactions such as nausea and vomiting were strictly carried out. After the treatment the management of PTCD drainage tube, the protection of radiation and the early detection of complications were further emphasized. Results The technical success rate of biliary stenting together with linear 125I seeds strand implantation was 100%. The serum total bilirubin levels, determined at one week, one and 3 months after the treatment, were significantly decreased when compared with the preoperative data. Clinically, the jaundice basically subsided. Bile-cardiac reflex occurred in one case and displacement of PTCD drainage tube in 2 cases. Twelve patients developed chills and fever after operation. Acute renal insufficiency occurred in one patient, which was relieved after effective management. The median survival time was 10.9 months. Conclusion Careful and comprehensive preoperative preparation can ensure a successful operation. Intraoperative close observation of patient’s condition and skilled cooperation with the operator, and high quality postoperative nursing measures and close observation for early signs of complications are essential nursing points to ensure that the patients can safely get over the rehabilitation period.

Objective To explore the methods for estimating premorbid intelligence of patients with cerebral infarction.Methods Ten regression equations were employed to estimate intelligence quotients (IQs) of 74 patients and 74 demographically matched,healthy adults.Those valid estimated IQs were transformed into standard scores and adopted to evaluate the difference with don' t hold' subtests.Results In the healthy group,there were trivial difference between the estimated IQs and obtained IQs with mean discrepancy less than one and the correlation coefficients between them ranged from 0.755 to 0.956.However in the patients group,the estimated IQs were significantly higher than obtained IQs with mean discrepancy of 3.20-10.67.Mean estimated IQs of the patient group were lower than those of healthy group to varing degrees with mean discrepancy of 0.83-8.28,in which the mean IQs estimated just with demographic variables showed small between group effect size of 0.26,and so did IQs estimated with combination of demographic variables and performance on the Information or Figural Matrix (effect size:0.24 and 0.38 respectively).The latter two kinds of estimated IQs were adopted and transformed into standard scores to estimate premorbid intelligence.The two kinds of estimated normal scores of intelligence were higher than normal scores of the Digit Symbol (0.70 and 0.63 respectively) and the Block Design(0.67 and 0.61 respectively)in the patients group.As regarding the healthy group,the counterparts of discrepancies between estimates of intelligence and obtained scores were 0.21,0.21,0.12 and 0.12 respectively,which were significantly smaller than those in the patients group.Conclusion IQ estimated with combination of demographic variables and performance on the Information or Figural Matrix are suggested to estimate premorbid intelligence of patients with cerebral infarction.

Objective To report the short-term result of unicompartmental knee arthroplasty (UKA) for osteoarthritis and spontaneous osteonecrosis of the knee, and discuss the indications and surgical pitfalls for the procedure as well. Methods From April 1999 to July 2000, unicompartmental knee arthroplasty were performed in 20 cases (24 knees). Osteoarthritis in 18 cases (20 knees) and spontaneous osteonecrosis in 2 cases (2 knees); 10 males (12 knees) and 10 females (12 knees). The range of motion (ROM), femorotibial angle (FTA) and JOA score were adopted as main parameters to evaluate the outcome of the operation. The mean age of the patients at the time of operation was 73.3?7.1 years,and 75.0?6.8 years at the final follow-up. The mean follow-up period was 25.7?15.0 months. The prostheses used in the group were unicompartment sleigh shaped artificial joint of Link Endomodel Sled Knee, Waldemar Link or YCMK. Results Before operation, the mean ROM was from 5.4??6.1?(extension) to 120.0??15.0?(flexion), the flexion deformity was significantly corrected after operation. The average extension was 2.1??2.5? at the time of follow-up, significantly improved comparing with 5.4??6.1? of pre-operation (P

Objective:To analyze 3 123 cases of medical device adverse events(MDAE)and provide some suggestions for the MDAE monitoring.Method:By the retrospective case study,3 123 MDAE reports were analyzed in Hunan Province in 2007.Result:The reports mainly came from medical institutions and other drug-use units.Intrauterine devices (IUD),medical suture thread and orthopedic implants caused a higher proportion of adverse events.The quantities of MDAE reports were imbalanced in different regions.Conclusion:The MDAE monitoring should be promoted by propaganda and training in order to ensure the safe use of medical devices in public.

Objective To investigate the diagnostic value of serum tumors M2 pyruvate kinase (TuM2-PK),carcino-embryonic antigen (CEA),CA199,CA724,CA125 and CA242 in colon cancer.Methods Serum levels of TuM2-PK,CEA,CA199,CA724,CA125 and CA242 in 231 patients with colon cancer,105 patients with colon benign lesion diseases and 166 normal controls were measured by the ELISA and electrochemiluminescence assays.The operation working characteristic curve (ROC) and the logistic regression-ROC were used to evaluate the diagnostic value of tumor markers for colon cancer individually and in combination.The models of logistic regression analysis and partial least-squares discriminant analysis (PLS-DA) were established to diagnose patients with colon cancer based on the optimal panel of serum tumor markers.Resalts Concentrations of serum TuM2-PK,CEA,CA199,CA125 and CA724 in the colon cancer group are higher than those in the colon benign diseases group and the normal controls (P＜0.05).The area under the operation working characteristic curve (AUC) of CA199 is the highest 0.79 [95％ confidence interval (95％CI),0.75-0.83] at the cutoff value of 69.5 U/L with 64.1％ of sensitivity and 89.7％ of specificity.The AUC of combined serum tumor markers based on logistic regression analysis is higher than those in individuals,of which serum (CEA+ CA199+TuM2-PK) is the optimal [AUC=0.89,95％ confidence interval(95％CI),0.86-0.92].The diagnostic accuracy of logistic analysis and PLS-DA model for colon cancer is 82.7％ and 77.5％,and for colon cancer is 93.7％ and 95.6％,respectively.Conclusion The combination of serum tumor markers CEA,CA199 and TuM2-PK is more suitable as a diagnostic model for the screening of colon cancer.

Objective To assess therapeutic effects and safety of high intensity focused ultrasound ( HIFU ) and radiotherapy for the treatment of rectal carcinoma. Methods In combination with low dose of radiotherapy, we treated 121 cases of rectal carcinoma with FEP BY01 type HIFU therapy from Jul.1998 to Dec.2000 and 43 cases were followed up for more than one year. ResultsComplete response (CR) was achieved in 27 cases(22%), partial response (PR) in 80 cases (66%),and no change(NC)was found in 14 cases (12%) with a total response rate of 88 4%.There were no complications. One year survival rate was 81%(35/43) and 2 year survival rate was 77%(23/30). ConclusionHIFU in combination with radiotherapy is a new method to treat rectal carcinoma with significant therapeutic effect and high safety.

Objective To retrospectively evaluate effects of early dynamization of interlocking intramedullary nail on union of tibial shaft fractures.Methods From January 2002 to Septemher 2004,75 patients with tibial shaft fractures were treated in our department with internal fixation using static interlocking iutramedullary nails.Early dy- namization(6 to 10 weeks postoperative)was adopted in 32 patients (the dynamic group) according to the fracture con- ditions,while the other 43 patients were treated without early dynamization (the non-dynamic group).The healing time of fractures and the rate of delayed union in both groups were documented.Results All the cases were followed up for a mean duration of 6.5 months (range,4 to 13 months).The mean healing time was 115.6 days (range,105 to 126 days) in the dynamic group and 124.5 days (range,119 to 133 days) in the non-dynamic group.The difference was statistically significant between the two groups (P＜0.05).There were two cases (6.2%) of delayed union in the dynamic group and four (9.4%) in the non-dynamic group.The difference was not significant (P＞0.05). Conclusion Early dynamization of interlocking intramedullary nail can promote union of tibial shaft fractures.