Objective To investigate the nurses' mastery of the patients' condition and effect of incident prevention after the application of risk assessment management in elderly patients in psychiatric wards.Methods 56 inpatients spanning from January to December 2010 were enrolled as the observation group and 55inpatients spanning from January to December 2009 were enrolled as the control group.The control group received routine care,while the observation group received risk assessment management based on routine care,which mainly include:doctors' assessment of the patient' s condition changes,therapies,medication and side effects,as well as nurses' weekly assessment of risks of falls,food choking and pressure sores and taking pertinent nursing measures.Nurses' mastery of the patients' condition and effect of incident prevention before and after the application of risk assessment management was compared.Results Average score of nurses'mastery of patients' condition was (77.36 ± 1.26) points in the control group and ( 85.60 ± 3.07) points.The difference was statistically significant ( t =11.690,P ＜ 0.01 ).The control group had 45 cases of incidents and the observation group had 19 cases.There was significant difference between the two groups (x2 =13.87,P ＜ 0.05).Conclusions The risk assessment management is beneficial to the nurses' mastery of the patients'condition and incident prevention,thus boost the nursing quality.

OBJECTIVETo investigate the clinical results of external fixation and AO titanium elastic intramedullary nailing for treatment of tibia-fibula comminuted closed fractures.

METHODSFrom June 2010 to June 2012,58 patients with tibia-fibula comminuted closed fractures were treated with external fixation and AO titanium elastic intramedullary nailing, including 31 males and 27 females with an average age of 38.5 years old ranging from 21 to 57 years old. According to the system of AO Classification, the fractures were classified as type B1 in 9 cases,type B2 in 7 cases, type B3 in 10 cases, type Cl in 14 cases, type C2 in 12 cases,and type C3 in 6 cases. According to the system of Winquist-Hanson,the fractures' comminuted were classified as grade 1 in 23 cases, grade 2 in 17 cases, grade 3 in 12 cases, and grade 4 in 6 cases. According to the system of Johner-Wruhs, clinical results were compared between different type and grade groups by the time of last followed-up.

RESULTSAll 58 patients were followed up with an average time of 6.8 months (ranged from 18 to 36 weeks). All fractures had clinical healing with an average time of 28 weeks (ranged from 24 to 32 weeks). The total rate of good to excellent results was 91.4%. The rate of good to excellent in the group of grade 1 was higher than that of other grades. The complication rates and fracture healing time would increase respectively with higher Winquist-Hanson's grade. The complication rates in the group of type C3 was higher than that of other types, but the rate of good to excellent was lower than that of other types. The complication rates in the group of type B1 was lower than that of other types,but the rate of good to excellent was higher than that of other types.

CONCLUSIONMinimal invasiveusing AO titanium elastic intramedullary nailing combined with external fixation for treatment of tibia-fibula fractures especially for the multiple-segment,long spiral mild-to-moderate comminuted with hidden fracture can get satisfactory reduction and reliable fixation,it conformes to the principle of BO completely, protects the fracture end blood supply,reduces the external fixation time, has less skin soft tissue complications, postoperative function recovered satisfactorily.

Adult ; Bone Nails ; Bone Plates ; External Fixators ; Female ; Fibula ; injuries ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Fractures, Closed ; surgery ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Tibia ; injuries ; surgery ; Young Adult

Objective To detect the expression and activity of AMP-activated protein kinase α subunit (AMPKα) and peroxisome proliferator-activated receptor-α (PPARα) in liver of high-fat fed rats treated with metformin, and to investigate the mechanisms underlying metformin decreasing the total cholesterol (TC) and triglyceride (TG) contents of the liver. Methods Total 30 male Wistar rats were randomly divided into control group (group C), high-fat diet fed group (group HF) and high-fat diet feeding plus metformin treatment group (group Met,metformin was administered orally at the last month of high-fat diet feeding). After feeding for 5 months, TC and TG in liver and sera were determined, respectively. The mRNA and protein levels and activity of AMPKα and PPARα in the liver were determined by real-time PCR and Western blotting. The activity of PPARα transcriptor binding to DNA was detected by ELISA. Results Five months of high-fat diet feeding induced a significant decrease in AMPKα and phosphorylated-AMPKα protein expression as well as AMPKα2 and PPARα mRNA levels in the liver of rats (all P＜0.05), while it did not alter PPARα protein expresssion and the PPARα activity binding to DNA as well as AMPKα1 mRNA levels. The TC and TG contents in the liver (P＜0.05) and serum (P＜0.05) were sharply increased in group HF than those in group C. Treatment with metformin for 1 month led to a marked increase of AMPKα2 mRNA level, AMPKα and phosphorylated-AMPKα protein expression as well as the PPARα activity in group Met compared with group HF(all P＜0.05), while the PPARα protein expression and the PPARα mRNA level did not show significant change. Consistent with these findings, the TC and TG contents in rat liver as well as sera were strikingly decreased (all P＜0.05). Conclusion The activations of AMPKα and PPARα induced by metformin may contribute to the decrease of TC and TG content in liver and sera of the high-fat fed rats.

OBJECTIVETo study the distribution and expressions of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in the III-IV stage of pressure ulcer wound, and to explore their correlation with ulceration.

METHODSForty-one patients hospitalized in the two Affiliated Hospital of Wenzhou Medical College from June 2010 to March 2012 were recruited, including twenty-one patients with 23 pressure ulcer of stage III-IV, 14 acute injury patients, and 6 donors of normal skin. Samples harvested from the 41 patients through surgery were divided into four groups, including pressure ulcer centre group (n = 23), pressure ulcer margin group (n = 23), acute wound group (n = 14), and normal skin group (n = 6). The histological changes in wounds were observed after HE staining. The distribution of collagen fiber in wound was observed with Masson staining. Expressions of VEGF and bFGF in wounds were detected with immunohistochemical staining. Data were processed with independent samples t test and paired samples t test.

RESULTS(1) In the two pressure ulcer groups, large number of inflammatory cells were found in aggregation; the expression of collagen fiber was decreased or disappeared; the positive expressions of VEGF and bFGF were mainly located in fibroblasts and endothelial cells. The expression levels of VEGF and bFGF were respectively 100 ± 39, 132 ± 46 in pressure ulcer centre group, and 228 ± 48, 299 ± 80 in pressure ulcer margin group. The differences between the two pressure ulcer groups were statistically significant (with t values respectively 13.497 and 13.020, P values below 0.01). (2) In acute wound group, a large number of fibroblasts but a small amount of collagen fibers were observed; the positive expressions of VEGF and bFGF were mainly located in fibroblasts, with respective expression levels of 292 ± 59 and 443 ± 194, which were significantly higher than those of the two pressure ulcer groups (with t values from 2.370 to 11.570, P < 0.05 or P < 0.01). (3) In normal skin group, structure of tissue was appropriate, and abundant collagen fibers were observed; the expression levels of VEGF and bFGF were respectively 45 ± 18 and 54 ± 22, which were significantly lower than those of the other three groups (with t values from 3.983 to 14.087, P values all below 0.01).

CONCLUSIONSIn contrast with those of the acute wounds, the expression levels of VEGF and bFGF are significantly decreased in the pressure ulcer wound at stage III-IV. It may be closely correlated with the decrease or cessation of the synthesis of collagen fiber.

Adult ; Aged ; Aged, 80 and over ; Female ; Fibroblast Growth Factor 2 ; metabolism ; Humans ; Male ; Middle Aged ; Pressure Ulcer ; metabolism ; Vascular Endothelial Growth Factor A ; metabolism ; Wound Healing

Objective This study is to investigate the use of vancomycin in geriatric patients and promote the safe and rational usage of vancomy-cin.Methods By retrospective analysis, data were extracted from medical records of 180 geriatric patients who intravenously used vancomy-cin in 2014 in terms of etiology check, diseases, therapeutic drug moni-toring, medication duration, therapeutic efficacy, etc. Results The treatment of vancomycin in 58.88%geriatric patients was based on expe-rience and 75.55% geriatric patients use vancomycin to treat infection instead of pretending infection and the effective rate was 38.89%.The biggest reason to use vancomycin was pulmonary infection ( 54.37%) , 87.78% of the patients completed etiology check and drug sensitive test, and staphylococcal infection accounts for 16.29%of the positive results, 29.44% of the patients completed therapeutic drug monitoring. Conclusion Most of the usage is rational.The time of treatment is still to be discussed.The treatment is mainly based on the experience.Thera-peutic drug monitoring ( TDM ) is under specification.Clinical pharma-cists should try to make the monitor time in clinic and the application of vancomycin in the geriatric patients more reasonable .

Objective To explore the necessity that clincal pharmacists carry out pharmaceutical care in intensive care unit.Methods Based on knowledge of pharmacy and therapeutic drug monitoring,clinical pharmacists did medication adjustment of vancomycin for a patient who had severe pneumonia.Results and conclusion According to the therapeutic drug monitoring and renal function monitoring,we did medication adjustment timely,avoiding the patient from suffering severe renal damage.It is necessary for clinical pharmacists to carry out pharmaceutical care in the treatment of critical patients in ICU and do research on individual therapy of vancomycin to formulate more reasonable therapy.

Objective To investigate the discrepancy of aldosterone synthesis process and potential regulation abnormality between aldosterone-producing adenoma(APA) and normal adrenal(NA) with microarray. Methods cRNA probes labelled with biotin were prepared from mRNA of APAs(APA group,n=10) or NAs(control group,n=7).The probes were hybridized with oligonucleotide microarray of target gene expression profile.Expression levels were read from the fluorescent intensity scanned.The difference of gene expression profile was analyzed by computer software.Differentially expressed genes were verified by real-time RT-PCR. Results Compared with control group,97 genes were up-regulated and 168 genes were down-regulated in APA group.In the genes related to steroid hormone synthesis,only CYP11B2 was significantly up-regulated.In the physiologic regulators of aldosterone synthesis,CYB5A,CYP17A1,DUSP1 and HMGCR were down-regulated,while RENBP and NR1H2 were up-regulated.As a key enzyme in the biosynthesis of cortisol,the expression of CYP17A1 gene was inhibited. Conclusion Among the aldosterone synthesis related enzyme and corresponding regulatory genes in APA,CYP11B2 may be a key synthetase,and the suppressed physiologic regulators of aldosterone synthesis may indicate the existence of neoplastic modulation.

Objective To analyze the characteristics of preoperative CTO lesions by coronary CT angiography (CCTA) and to compare the lesion characteristics and clinical data of patients with subsequent vs failed PCI.Methods A total of 113 patients were randomly selected and 116 vessels were analyzed by CCTA before PCI.The patients were further investigated as PCI success group vs PCI failure group according to their PCI result.Multivariate logistic regression analysis was used to determine the factors that affected the success of CTO intervention.The ROC curve was used to determine and evaluate the CT-CTO score and J-CTO score for diagnostic efficacy.Results The success rate of PCI was 55.2％.64 lesions were successfully opened,with the success rate of 72.4％.The prevalence of smoking in patients in the PCI failure group was significantly higher than that in PCI success group (65.4％ vs.42.2％,P ＜ 0.05).There were no significant differences between the two groups in age,gender,history of hypertension,diabetes mellitus,and myocardial infarction(P ＞ 0.05).Statistical differences were observed between the PCI success group and the PCI failure group in the presence of occlusion segment head-end bifurcation,occlusion severe incision,severe calcification (calcification ≥ 180°),occlusion segment length ≥ 20 mm,occlusion of calcification lesions,occlusion segment distal shape of the unambiguous of fiber cap shape of the distal occlusion segment under CCTA(P ＜ 0.05).In the PCI failure group,approximately 17.3％ of the patients had previous attempt to open the CTO lesions,which were higher than the PCI success group (9.4％).However,The difference was not statistically significant (P ＞ 0.05).Multivariate logistic regression analysis showed that the unambiguous distal fibrous cap of the occlusion segment and the occlusion of the proximal branch and the occlusion length ≥20 mm were the main factors affecting the failure of CTO intervention.In terms of prediction,the predictive value 30 CT-CTO score yielded a higher area under the ROC curve than that of the J-CTO score (0.8776 vs 0.7387,P ≤ 0.05).Conclusion CT angiography can predict the success rate of intervention for CTO lesions.Compared with J-CTO score,CT-CTO score has a higher predictive value.Unambiguous fiber cap shape,occlusion segment head end bifurcation,occlusion segment length ≥20 mm were the independent risk factors that affecting the success of CTO operation.

Aged ; Humans ; Male ; Urinary Diversion ; adverse effects ; Urinary Fistula ; diagnosis ; etiology

BACKGROUNDCerebral microbleeds (CMBs) occur frequently in patients suspected of cerebrovascular disease and they are the principle radiographic findings in patients with sub-clinical neurological impairment. The objective of this study was to assess the prevalence, distribution, severity and associated clinical features of CMBs in a prospective hospital patient based cohort undergoing brain MRI for suspected cerebrovascular disease, excluding cases with known intracranial hemorrhage or prior large-area stroke.

METHODSThe study population consisted of 447 patients who were evaluated with T2*-gradient echo sequences to detect the CMBs lesion number, location, and their association with white matter hyperintensities and clinical parameters, including blood pressure.

RESULTSCMB lesions were presented in 95 of the 447 patients (21.3%). The distribution of CMBs was 43.95% cortical, 19.77% thalamic, 14.41% in the brainstem, 11.58% cerebellar, 6.21% periventricular white matter, 5.64% involving the basal ganglia regions, and 0.28% involving the hippocampus. There was a statistically significant association between the presence of CMBs and advancing age (adjusted OR 2.082, P < 0.01), the severity of hypertension (adjusted OR 2.208, P < 0.01). Also there was a statistically significant (P < 0.01) correlation between the presence of CMBs and the severity of hypertension and white matter lesions.

CONCLUSIONSCMBs occur frequently in patients with no prior large-area stroke who were referred for brain MRI for suspected cerebrovascular disease. The severity of CMBs correlates with the severity of hypertension and the presence of cerebral white matter changes detected by MRI.

Aged ; Cerebral Hemorrhage ; epidemiology ; etiology ; pathology ; Female ; Humans ; Hypertension ; physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Risk Factors ; Stroke ; complications ; epidemiology