Objective To establish the procedural pain nursing care protocols to improve the management of perioperative pain in elderly patients after total knee replacement,as well as to relief postoperative pain,and promote the rehabilitation.Methods 82 patients were randomly divided into the control group (45 cases) and the intervention group (37 cases).The control group was controlled by usual care,and the intervention group was offered with the standardized pain nursing care.The scores for postoperative pain,the satisfaction for analgesia,the complications associated with analgesia and the injection rate of Dolantin at 24,48,72h postoperatively were compared between two groups.Results The score for postoperative pain at rest in the intervention group was significantly lower than that in the control group at 24 h postoperatively,but there was no statistical difference at 48 h and 72 h postoperatively.Pain scores during passive activity at 24,48h,and 72h postoperatively were significantly lower in the intervention group when compared with that of the control group.The rates of side effects at 24,48,72h postoperatively in the intervention group were significantly lower than those in the control group.The injection rate of Dolantin in the control group were significantly higher than that in the intervention group.The score for both analgesia and life satisfactory in the intervention group was significantly higher than that in the intervention group at 24,48,72h postoperatively.Conclusions Procedural pain nursing care can reduce the pestoperative pain,complications and the injection rate of Dolantin in patients after total knee replacement.It can also improve elderly patients' satisfaction of analgesia and promote early recovery of their joint function.

[Objective]To study the correlated factors of hidden blood loss after simultaneous bilateral total knee arthroplasty.[Method]From Feb.2005 to Feb.2007,a retrospective analysis of 44 patients underwent knee arthroplasty was conducted to calculate the mean blood loss and occult blood loss according to Gross formula.The true total blood loss was calculated depending on height weight and pre-and post-operation HCT.[Result]The mean total blood loss were 2 065 ml in these cases with occult blood loss of 1 198 ml.In patients with autologous blood transfusion,the mean total blood loss were 2 180 ml with occult loss of 937 ml(42%).In patients without autologous blood transfusion,the mean total blood loss were 1 195 ml with occult blood loss of 799 ml(41%).[Conclusion]The hidden blood loss result in large volume of the total blood loss in the postoperative period which can not be fully compensated by autologous blood transfusion and it 's very important to additional blood supply during simultaneous bilateral total knee arthroplasty.

The paper expounds the connotation of HIS troubles, the methods for determining HIS troubles and the necessity of establishing a contingency plan for clearing such troubles. It also puts forward some specific measures for managing the contingency plan: ①defining the accountability and division of work in clearing various kinds of troubles; ②doing a good job of coordination in clearing troubles; ③carrying out strict training for the relevant personnel; and ④conducting checks and supervision all the time. Establishment of the plan makes it clear to HIS managers that enough attention ought to be paid to the prevention of troubles.

Objective To observe the validity and feasibility of PBL teaching method in occupational health and occupational medicine theory teaching.Methods Sixty-one five-year undergraduates majored in preventive medicine were selected and self-control was applied.Two teaching contents which had similar teaching requirements were selected,one applied PBL teaching method and the other applied traditional teaching method.Students' results and passing rate in examination were analyzed and compared.SPSS 16.0 software was used for statistical analysis and data were manifested as ((x-) ± s).T test was used to do comparison between average results and chi-square test was used to do comparison between rates.SAS 9.0 software was employed and Fisher's exact probability analysis was performed on percent of pass.P＜0.05 stands for statistically significant differences.Results Test scores of the students taught by PBL teaching method were significantly higher than those of students taught by traditional teaching method (P＜0.05).Both female and male students' test scores were improved (P＜0.05) and increase of female students' test scores were more obvious than male students'.Passing rate of female students taught by PBL teaching method was significantly higher than female students taught by traditional teaching method (P＜0.05).Conclusion PBL teaching method applied in occupational health and occupational medicine theory teaching can significandy improve the quality of teaching.

AIM To establish an animal experimental model for study on prevention of cisplatin toxicity and explore the possible mechanisms of the toxicity induced by cisplatin administration. METHODS Cisplatin was administered i.p consecutively for five days to male mice weighted from 28 to 30 g. The toxic effects induced by different doses of cisplatin on hearing, liver and kidney were determined. RESULTS Dose dependent decrease of body weight, abnormality of kidney and liver coefficients, levels of BUN and activities of ALT in serum were induced by cisplatin administration. Furthermore, Levels of GSH, activities of GSH Px and SOD increased significantly in kidney. Reversely, levels of GSH, activities of GSH Px and SOD in liver decreased and levels of LPO increased significantly in animals given cisplatin compared with those in control animals. CONCLUSION Obvious damage on hearing, liver and kidney of mice could be induced after consecutively 5 days administration of cisplatin with doses range from 3 0 to 4 0 mg?kg -1 (body weight). Oxidative damage is one of the mechanisms of these toxic effects on liver and kidney induced by cisplatin. But for different organs or at different stages of cisplatin administration, the main mechanism may be different.

Objective To compare the safety and effectiveness of power peripherally inserted central catheters (Power PICC) and double cavity central venous catheter (CVC) application in intensive care unit (ICU). Methods 458 cases were reviewed during January to September in 2014 and divided into two groups: Power PICC group (245 cases) and CVC group (213 cases) , and average retention time, successful rate of inserting catheter and the incidence of complications were compared. Results The average retention time of Power PICC group was (21.6±5.8) days which was longer than (13.1±3.4) days of CVC group (t=2.234, P <0.05). No statistics difference of successful rate between two groups (P>0.05). No significant difference for the total incidence of complications between two groups as 14.69% (36/245) and 19.72%(42/213)(P>0.05). No significant difference for the total incidence of complications in the operation time between two groups as 5.31% (13/245) and 4.23% (9/213)(P>0.05). But rate of catheter malposition for Power PICC group [ 2.86% (7/245) ] was higher than CVC group 0 (X2=4.428, P <0.05). Rate of the total incidence of complications in the retention time Power PICC group [ 9.39%(23/245) ] was lower than CVC group [ 15.96%(33/213)(P<0.05). And rate of catheter related blood stream infection of CVC group [3.29%(7/213)] was much more higher than Power PICC group (0)(X2=6.139,P<0.05). Conclusions Power PICC and CVC are both applicable for ICU, and Power PICC has more advantage regarding safety and effectiveness than CVC and can be one replacement for CVC.

ObjectiveTo investigate the effect of immunoglobulin G (IgG) extravasated from blood circulation on the expression of toll-like receptor 4 (TLR4) induced by peripheral lipopolysaccharide (LPS) in rat brain. Methods The rats were divided into four groups in random, 5 rats in each. Group one received LPS 100μg/kg by intraperitoneal administration, normal saline was given by intravenous injection 6 hours later; group two was injected with adrenalin (AD) 15μg/kg intravenously; group three was treated with LPS intraperitoneally, AD was injected 6 hours later; group four was injected normal saline intravenously as control. For all groups, the animals were sacrificed 30 min after the last injection, and the brains were taken for investigation of the TLR4 expressions by immunofluorescence staining and RT-PCR. Result Immunofluorescence staining showed that IgG immunoreactive product was patch-like, distributed in the brain parenchyma in all the animals that received AD. In the LPS+normal saline group, IgG was found merely around the blood vessels. Meanwhile, in LPS+AD animals, TLR4 immunoreactive product coexisted with microglia marker Iba-1 within the IgG extravasated area. The double-labeled cells dispersed in the brain parenchyma and near to the cerebral vessels. In the LPS+saline group, TLR4 positive cells were endothelial-like. RT-PCR results indicated that the expression level of TLR4 in the LPS+AD group were significantly higher than that in the LPS+saline group or AD group or the saline control (P<0.01). Conclusion Extravasated circulating IgG may enhance the TLR4 expression in the rat brain induced by peripheral LPS.

Objective To observe and evaluate the application of case-based learning in occupational health teaching of clinical medicine students.Methods Seven-year undergraduates majored in clinical medicine were selected as study subjects,divided into two groups,and received case-based learning(55 persons,story case for theory course,field case for experiment course)and traditional teaching(56 persons,theoretical instruction for theory course,instructional video for experiment course),respectively.T test and x2 test were used to analyze and compare students' after-school evaluation results and the questionnaire survey results of both groups respectively.Results The total score of the after-school evaluation[(11.84 ± 2.86) vs.(9.80 ± 3.39),t=-3.419],basic cognitive ability score[(4.80 ± 1.08) vs.(4.05 ± 1.43),t=-3.097] and analyzing ability score[(7.04 ±2.21) vs.(5.75 ± 2.59),t=-2.813] of students in the case-based learning group were significantly higher than those of the students in the traditional teaching group(P＜0.05).Questionnaire survey showed that the number and proportion of case teaching group of students held a positive attitude towards the teaching methods used in improving students' ability to analyze problems(x2=4.757),increasing study interest (x2=4.371),promoting knowledge mastery (x2=4.276) is higher than traditional teaching group (P＜0.05).Conclusion Case-based learning can inspire students' learning initiative,improve their creative ability to use knowledge,analyze and solve practical problems,so as to promote the course scores.

Objective To study protective immunity effects of co-immunization with P30 DNA vaccine and protein vaccine. Methods Forty-eight 5-6 weeks old BALB/c female mice were divided into four groups (A,B,C,D), 12 mice of each group. In group A (control group) each mouse was immunized with 100 ?g pcDNA3.1 plasmid DNA by intramuscular (i.m.) for three times at week 0,2 and 4; in group B (P30 protein group) each mouse was immunized (i.m.) with 50 ?g rP30+50 ?g CFA for three times at week 0, 2 and 4; in group C (pcDNA3.1-P30 group) each mouse was immunized with 100 ?g pcDNA3.1-P30 plasmid DNA (i.m.) for three times at week 0, 2 and 4; in group D (P30 DNA+rP30 co-immunization group) each mouse was immunized with 100 ?g pcDNA3.1-P30 plasmid DNA (i.m.) for two times at week 0, 2 and immunized by subcutaneous with 50 ?g rP30+50 ?g CFA at week 4. Each mouse was infected with 100 tachyzoites of Toxoplasma gondii RH strain four weeks later after last immunization. The anti-P30 antibodies were detected with ELISA before the challenge. Results The P30 DNA vaccine was successfully constructed. High titers of anti-P30 antibodies were induced in each mouse immunized with DNA vaccine. The protective trial proved that there was no significant difference between control group and experimental group though the survival time of mouse from experimental group had been prolonged. Conclusion The P30 DNA vaccine could induced high titers of anti- P30 antibodies in immunized mice, and it may be a potential DNA vaccine candidate.

Objective: To establish the method of determination of the content of Berberine hydrochloride and Palmatine hydrochloride in Wuji Pills. Methods: Ultrasonic extraction, HPLC was used to determine Berberine hydrochloride and Palmatine hydrochloride in Wuji Pills on C 18 Column, using 0.033mol/L KH 2PO 4 CH 3CN(90∶40) as mobile phase, with detection at 265nm. Results: The linearity of this method was well. The average recoveries were 99.07% for Berberine hydrochloride and 98.59% for Palmatine hydrochloride. RSD were 1.3% and 1.7%, respectively. Conclusion: This method shows good separating degree and can be used for quality control of Wuji Pills.