Objective To study the impact of head nurses'support on the creation of encouraging management atmosphere.Methods We randomly selected 120 clinical nurses from the Sir Run Run Shaw hospital.Then we adopted head nurses'support questionnaires,nurses'stressor questionnaires and career satisfaction questionnaires and drew argumentation of our hypothesis by introducing double-factor theory.Results The management atmosphere was only inferior to the workload among all of the stressor resources.The supportive behaviors of head nurses were positively related to the career satisfaction of nurses and the encouraging management atmosphere.Conclusion Head nurses'could relieve nurses'working pressure and unsatisfactory attitude toward work by using supportive management style.In this way they could increase encouraging factors in the management and facilitated the creation of encouraging management atmosphere and improvement of effective management.

Objective We aimed to study the characteristics and risk factors for blood transfusion in very low birth weight infants (VLBWI). Methods Clinical data of 180 VLBWI, hospitalized from January, 2012 to June, 2016, were studied retrospectively. The infants were divided into two groups according to whether blood transfusion is administered or not. Two groups were compared with general information, diseases in hospital and treatment taken. Results Of the 180 VLBWI, 118 cases (65.6%) were diagnosed with anemia when hospitalized. 57 cases (31.7%) needed blood transfusion with a mean gestational age of 30.3±1.9 weeks and a mean birth weight of 1233.3±123.7 g, The first time to blood transfusion ranged from 2 to 5 weeks after birth, transfusion volume 20ml/Kg once. Fourty-eight (48) cases (84.2%) only took blood transfusion once. Birth weight, gestational age, basal hemoglobin, hematocrit, volume of blood taking before transfusion, duration of hospitalization, duration of continuous positive airway pressure, duration of paraenteral nutrition, duration of vasoactive drugs used, need for intubation、delivery mode, neonatal respiratory distress syndrome, apnea, neonatal hypothyroidism and patent ductus arteriosus showed significant difference between the two groups. Logistic regression analysis revealed that gestational age, birth weight, basal hemoglobin, long duration of hospital stay and blood loss from laboratory testing were risk factors for blood transfusion in VLBWI (P<0.05). Conclusions The rate of blood transfusion in VLBWI was relatively high. Complex complications, critical condition, blood loss from laboratory testing and basal hemoglobin were main risk factors for blood transfusion.

Objective To summarize the clinical features of chronic ruptured patellar tendon, and introduce the augmentation technique of repair of chronic ruptured patellar tendon with high strength polyester sutures and postoperative rehabilitation.Methods Six cases of chronic patellar tendon rupture were treated and reinforced with high strength polyester sutures from 2002 to 2007.Patellar tendon ruptures was primary end Ho -end repaired, and reinforced with 4 polyester sutures that were passed through in-traosseous tunnels within the patella and tibial tubercle.The surgery reestablished knee extensor continuity and restored the length of patellar tendon.Augmentation techniques were reliable, and allowed patients to walk and bend the knee, regain adequate quadriceps strength early.Postoperative rehabilitation: on the 1st day after surgery, walking upright and passive flexion of 90° was allowed, and brace protection was unnecessary; 3 weeks later, straight leg raise; 6 weeks later, brisk walking; 12 weeks later, squatting and climbing stairs; 6 months later, sports was allowed, including the jump and kick.Results All patients were followed up from 1 to 5 years.No patient sustained a re-rupture.All patients satisfied with their result.The Lysholm score were 100.Kach knee had restored full range of motion 6 months later, and regained adequate quadriceps strength.Conclusion Augmentation techniques with high strength polyester sutures is reliable and demonstrate good intermediate to long-term results.It can avoid re-operation for removal of the cerclage wire, allow patients to walk and bend the knee, regain adequate quadriceps strength early.

OBJECTIVETo evaluate the effect of concentrated growth factor extract (CGFe) on the proliferation and differentiation of MC3T3-E1 osteoblasts attached to sandblasted and acid etched titanium surfaces.

METHODSTrials were divided into experimental and control groups. The experimental group used a-MEM that contained CGFe (10% FBS), whereas the control group only used a-MEM (10% FBS). MTT assay was employed to detect the number of osteoblasts on the first, third, and fifth days. Alkaline phosphatase (ALP) activity and scanning electron microscope (SEM) were used to detect the osteoblast differentiations on the third and fifth days and to observe the osteoblast extensions on titanium surfaces for 12 h, respectively. Meanwhile, the levels of the osteogenetic biomarkers Runt-related transcription factor-2 (Runx2) and Osterix (Osx) on the third and seventh days were quantified via real-time polymerase chain reaction (PCR).

RESULTSMTT assay indicated that on the first, third, and fifth days, the absorbance in the experimental group significantly increased than that in the control group (P < 0.05). ALP activity: on the third and fifth days, the absorbance of the experimental group was significantly higher than that of the control group (P < 0.05). SEM: at 12 h, the extension of the experimental group cells was larger than that of the control group. Real-time PCR: given the standardization in the group, the gene expression level of the control group on the third day was 1, and the Runx2 and Osx gene expressions in the experimental group were larger than those of the con- trol group.

CONCLUSIONCGFe can efficiently stimulate the proliferation, differentiation and extension of MC3T3-E1 cells.

Objective To investigate neurological recovery effect and mechanisms of blood activating and phlegm removing decoction in the treatment of patients with hypertensive cerebral hemorrhage.Methods 68 patients with hypertensive cerebral hemorrhage in our hospital were divided into two groups.34 patients of the control group were given conventional western medicine,and 34 patients of the observation group were taken conventional western medicine combined with blood activating and phlegm removing decoction.The clinical outcomes, hematoma volume change and neurological recovery were compared,and analyzed its mechanism of action.Results The effective rate of the observation group(94.12%) was significantly higher than 73.53%of the control group (χ2 =5.31,P<0.05). After 7d,14d,21d treatment,NIHSS scores of the observation group [(12.87 ±1.43) points,(8.55 ±1.11) points and (5.67 ±0.76) points] were significantly lower than those of the control group [(20.43 ±2.57) points, (17.66 ±2.08)points,(14.54 ±1.44)points],and the differences were statistically significant (t=14.99,22.53, 31.76,all P<0.05).After treatment,hematoma volume of the observation group[(6.44 ±0.54)mL]was significant-ly lower than before treatment[(16.30 ±1.90)mL]and after treatment in the control group [(12.11 ±1.44)mL] (t=29.11,21.50,all P<0.05).After treatment,ALD score of the observation group [(66.34 ±5.22)points] was significantly lower than before treatment[(27.53 ±2.20)points]and after treatment in the control group[(47.55 ± 3.33)points],and the differences were statistically significant(t=39.95,17.70,all P<0.05).Conclusion The effect of blood activating and phlegm removing decoction in the treatment of patients with hypertensive cerebral hemor-rhage is significant,can significantly improve neurologic impairment and daily living skills,has no obvious conflict of interest and high application value,worthy of promotion and application.

Objective To explore the role of IEGs in the central neurotoxicity of mice induced by anatoxin-a ANTX-A. Methods 80 Kunming mice were divided into groups and treated with ANTX-A at 200, 50 and 12.5 ?g/kg respectively i.p. for one month, 0.9% sodium chloride solution was used as the control. The expression of c-fos and NGFI-A genes and CREB protein in mouse brain were determined by using RT-PCR and immunocytochemical methods. Results The expression of c-fos gene significantly increased in the females of 50, 200 ?g/kg groups and in the males of 200 ?g/kg group compared with the control group. The expression of C-FOS and CREB-1 protein was significantly higher in 200 ?g/kg group than that in the control group. In all ANTX-A treated groups, the expression of NGFI-A gene did not show a significant difference compared with the control. Conclusion c-fos and CREB-1 genes may play a role in the central neurotoxicity induced by anatoxin-a.

Objective To introduce Torg's modified Bristow procedure for recurrent anterior dislocation of the shoulder joint,and to evaluate it's clinical result.Methods 25 shoulders with recurrent anterior dislocation were treated with Torg's modified Bristow procedure from January 2002 to December 2006.Based on history,physical examination and X-ray examination,all the diagnosis were confirmed.The follow-up period ranged from 1 to 5 years,with an average of 3.1 years.Results All the cases had Hillsachs lesions and Bankart lesions.After 2 years,only one shoulder had redislocated and 96% of patients were satisfied with the operative repair.The Rowe standard rating scale:excellent 72%;good 24%;fair 4%;poor 0%.Conclusion Torg's modified Bristow procedure provided a good functional result in patients with recurrent shoulder dislocations.

Objective To study the difference of transverse incision and longitudinal incision for B-T-B graft harvesting in reconstruction of anterior cruciate ligament.Methods Sixty four cases of reconstruction of anterior cruciate ligament from January 2004 to December 2004 were observed.Transverse incisions were used in 32 cases,and longitudinal incision were chosen in the other 32.The operation time,the length of incision,the thickness of scar,the injury of saphenous nerve and the joint function of knee were compared.Results All patients were followed up more than 1 year.The average duration of surgical procedure with longitudinal incision was 11 minutes shorter than that with transverse incision.The scar of transverse incision is smaller and thinner than that of longitudinal incision.The injury of saphenous nerve and knee joint function of knee revealed no notable difference in the 2 groups.Conclusions Transverse incision for B-T-B graft harvesting in reconstruction of anterior cruciate ligament is a better choice.

Objective To investigate the vicissitude of infection pathogens and their change in resistance to antibiotics in our hospital in the past 10 years, and to offer scientific information for clinical anti-infection treatment. Methods The data of pathogens identified and susceptibility test with VITEK system as well as K-B methods from 1995 to 2002 were analyzed. Results Gram negative bacteria was the predominance bacteria in recent 5 years, accounting for 60.7%-70.2% of all pathogens, with Pseudomonas aeruginosa ranked first, followed by Escherichia coli, Klebsiella pneumoniae, Serratia sp, Enterobacter sp and Acinetobacter sp. The ratio of Acinetobacter sp seemed to be increased in 1998, and it kept a high level in recent years. The isolation rate of Staphylococcus aureus from clinical specimens was the highest among pathogens since 1999, and 42.9%-74.5% of them were Methicillin-resistance S. aureus (MRSA). MRSA was found to be highly resistant to many antibiotics, and there was a tendency of increasing resistance to all kinds of antibiotics in Ps. aeruginosa and Acinetobacter species. Conclusion The significant changes in infectious pathogens in our hospital were an increase in S. aureus and decrease in E.coli in constituent ratios, as well as an elevation of drug resistance level of predominate bacteria. The results suggest that corresponding adjustment should be made in the strategy of infection treatment.

Objective To study the mechanism of resistance to antibiotics and disinfectants of Pseudomonas aeruginosa isolated from clinical specimens in a hospital, and to provide a reference for the use of aminoglycoside antibiotics for the treatment of P. aeruginosa infection as well as disinfection and sterilization. Methods 35 strains of multi-resistant P. aeruginosa were screened from clinical specimens by susceptibility test of agar dilution. Five kinds of aminoglycoside modifying enzyme gene and qzcE?1 gene were detected by polymerase chain reaction (PCR) method. Results The positive rates of aminoglycoside modifying enzyme genes, including aac(3)-Ⅱ, aac(6′)-Ⅰ, aac(6′)-Ⅱ, ant(3″)-Ⅰ and ant(2″)-Ⅰ, were 48.6%, 40%, 54.3%, 45.7% and 60%, respectively, and nearly all strains were positive for 2 or more than 2 kinds of above aminoglycoside modifying enzyme gene. The positive rate of qzcE?1 gene was 94.3%. Conclusions There was a close relationship between aminoglycoside modifying enzyme producing P. aeruginosa and its multi-resistance to antibiotics, The results suugested that aminoglycosides should be used cautiously, and it should be based on the result of susceptibility test in the treatment of P. aeruginosa infection, and it was inadvisable to use quaternary ammonium and biguanides disinfectant in disinfection and sterilization.