Objective: To explore and analyze the correlation between nurses' willingness to stay in the operating room and job stressor, job burnout and work-family conflict. Methods: A total of 128 nurses from Mianyang Central Hospital, Third People′s Hospital of Mianyang, Mianyang People′s Hospital were selected as the research objects. The questionnaire of nurses' retention intention, the scale of nurses' job stressor, the scale of nurses' occupational fatigue and the scale of work stress conflict were used to investigate and analyze the correlation between nurses' retention intention and work stressor, occupational fatigue and family conflict. Results: The average retention intention of the nurses surveyed in this study was (3.16±0.71), and the retention intention of the nurses was in the middle level. Operating room nurses' total score of work stress was (95.27±15.28). Among them, the scores of time allocation and workload, nursing specialty and work were the highest (2.86 ± 0.73) and (2.75 ± 0.64), respectively. The highest score of personal achievement was (33.26 ± 8.39). The total score of work family conflict of nurses in operating room was (58.32 ± 11.29), and the total score was (3.09 ± 0.58). The average score of work family conflict based on time was the highest, which was (3.91 ± 0.64), which was the main source of work family conflict of nurses. Pearson correlation analysis showed that nurses' intention to stay was negatively correlated with work pressure, job burnout and work family conflict (r value was-0.374,-0.400,-0.327, P < 0.05). Conclusions Nurses' willingness to stay in the operating room is at a medium level. Nursing managers can reduce the pressure of occupational fatigue by reducing work stress and improve the willingness of nursing staff to stay.

Irreducible dislocation of the elbow is an uncommon event. We present the case of a posterolateral elbow dislocation after a fall injury in a 67-year-old woman. A closed reduction performed in the emergency department was unsuccessful since the limited passive range of motion resulted in difficulty to perform longitudinal traction and flexion. Computed tomography images showed that the posterolateral aspect of the capitellum was impacted by the tip of the coronoid process, thus appearing similar to the Hill-Sachs lesion in the humeral head. Subsequent open reduction of the elbow revealed the dislocation to be irreducible since the tip of the coronoid process had wedged into a triangular Hill-Sachs-like lesion in the capitellum. The joint was reduced by providing distal traction on the forearm, and main fragments were disengaged using digital pressure. At the 3-month follow-up, the patient reported no dislocations, and had an acceptable range of motion. Thus, we propose that to avoid iatrogenic injury to the joint or other nearby structures, irreducible dislocations should not be subjected to repeated manipulation.
Aged ; Dislocations ; Elbow ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Forearm ; Humans ; Humeral Head ; Joints ; Range of Motion, Articular ; Traction

Objective To compare the clinical efficacy between absolute fixation and bridging fixation in plate osteosynthesis for simple distal tibia fracture.Methods A retrospective case control study was conducted to analyze 41 patients with simple distal tibia fracture admitted to the Chongqing People's Hospital from January 2013 to November 2016.There were 24 males and 17 females,aged 24-70 years [(46.3 ± 13.1)years].According to AO/OTA classification,fractures weres was AO/OTA type 42A1 in 29 cases,type 42A2 in nine cases,type 42A3 in two cases,and type 43A1 in one case.All patients were treated with plate and screw fixation.According to the method of plate fixation,the patients were divided into the locking compression plate (LCP) absolute fixation group (14 patients),the LCP bridge fixation group (12 patients) and the LCP + dynamic double thread locking screw (DDTL) bridge fixation group (15 patients).The patients were followed up by taking anteroposterior and lateral radiographs of tibia and fibula during outpatient visits 1,2,3,6 months and 1 year after operation.The operation time,time to radiological fracture union,time to full weight bearing,callus index and complications were analyzed.Results All the patients were followed up for 12-18 months [(14.5 ± 2.0)months].In the LCP absolute fixation,LCP and LCP + DDTL groups,the operation time was (74.3 ± 15.6) minutes,(78.6 ± 20.1) minutes and (82.5 ± 24.6) minutes,respectively;the time to radiological fracture union was (4.3 ± 1.5) months,(4.5 ± 1.3) months and (4.6 ± 1.4) months,respectively;the time to full weight bearing were (3.4 ± 0.7) months,(3.5 ± 0.6) months and (3.6 ±1.1) months,respectively (all P ＞ 0.05).There was no significant difference in complication incidence among the three groups (P ＞ 0.05).However,the callus index in the LCP + DDTL group (1.19 ±0.13) was significantly higher than that of the LCP absolute fixation group (1.08 ±0.06) and that of the LCP group (1.09 ± 0.09) (P ＜ 0.05).Conclusion For simple distal tibia fracture,both absolute and bridging fixation can attain good fracture union,and LCP combined with DDTL can better promote the formation of callus and facilitate the union.

Objective To evaluate the effect of cardiopulmonary ultrasound in guiding volume ther-apy in the patients with sepsis-induced myocardial injury. Methods Thirty-eight patients of both sexes with septic myocardial injury, aged 28-64 yr, weighing 60-90 kg, received anti-infection, respiratory and circulatory comprehensive treatment. The patients were divided into group Ⅰ ( n=19) and group Ⅱ(n=19) by using a random number table method. Central venous pressure (CVP) was used to guide vol-ume therapy, and fluid replacement was carried out using the CVP 2-5 principle in groupⅠ. Cardiopulmo-nary ultrasound was used to guide volume therapy in group Ⅱ. Blood samples were taken before volume therapy and on 1, 3 and 5 days after volume therapy to determine the concentrations of N-terminal pro-B-type natriuretic peptide, cardiac troponin I and creatine kinase isoenzyme MB in serum. The CVP, positive fluid balance, lactic acid, central venous oxygen saturation and urine volume were recorded at 6, 24, 48 and 72 h after volume therapy. Left ventricular ejection fraction was recorded at 1, 3 and 5 days after vol-ume therapy. The length of intensive care unit stay and 28-day fatality were recorded. Results Compared with groupⅠ, the CVP and fluid positive balance were significantly decreased at each time point after vol-ume therapy, the concentration of serum N-terminal pro-B-type natriuretic peptide was decreased at 5 days after volume therapy ( P<0. 05) , and no significant difference was found in concentrations of cardiac tropo-nin I and creatine kinase isoenzyme MB in serum, lactic acid, central venous oxygen saturation and urine volume, left ventricular ejection fraction, length of intensive care unit stay or 28-day fatality rate at each time point in groupⅡ( P>0. 05) . Conclusion Cardiopulmonary ultrasound can reduce the volume of liq-uid infused, avoid fluid overload and avoid accentuating myocardial injury when used to guide volume thera-py in the patients with sepsis-induced myocardial injury.

Objective To compare the accuracy of inferior vena cava (IVC) ultrasound,central venous pressure (CVP) and pulse indicator continuous cardiac output (PiCCO) in predicting fluid responsiveness in septic shock patients with myocardial depression.Methods Fifty patients with septic shock complicated with myocardial depression,aged ＞ 18 yr,were enrolled in the study.The method for fluid replacement test was as follows:0.9％ sodium chloride injectionor lactated Ringer's solution 500 ml was intravenously infused over 20 min,and positive fluid responsiveness was defined as an increase in PiCCO-monitored CO＞ 10％ after fluid replacement.Patients were divided into positive fluid responsiveness group and negative fluid responsiveness group according to the fluid replacement test.PiCCO was used to monitor stroke volume (SV),stroke volume variation (SVV) and pulse pressure variability (PPV) before fluid replacement,CVP was measured,and the diameter of IVC (d-IVC) and variability of IVC (v-IVC) were measured by bedside ultrasound.The receiver operating characteristic curve was drawn to evaluate the accuracy of each index in predicting fluid responsiveness.Results Compared with negative fluid responsiveness group,d-IVC was significantly decreased and v-IVC,SVV and PPV were increased before fluid replacement in positive fluid responsiveness group (P＜0.01).Three point five mmHg,14.5 mm,16.5％,17.0％ and 11.5％ were selected as the cutoff value for CVP,d-IVC,v-IVC,SVV and PPV,respectively.The sensitivity of CVP,d-IVC,v-IVC,SVV and PPV in predicting fluid responsiveness was 100％,92％,80％,44％ and 68％,respectively,and the specificity was 28％,80％,72％,100％ and 72％,respectively,and the area under the receiver operating characteristic curve (95％ confidence interval) was 0.609 (0.450-0.768),0.862 (0.750-0.974),0.777 (0.642-0.911),0.734 (0.596-0.873) and 0.733 (0.594-0.872),respectively.Conclusion PiCCO and IVC ultrasound provide higher accuracy in predicting fluid responsiveness in septic shock patients with myocardial depression,and IVC ultrasound is more superior because of non-invasive examination.

Objective To evaluate the value of bedside lung ultrasound for diagnosis of acute re-spiratory distress syndrome ( ARDS) and for assessment of the severity. Methods Fifty patients of both se-xes suspected of having ARDS ( oxygenation index＜300 mmHg) and required lung CT tests and Pulse Indi-cator Continuous Cardiac Output because of their condition, aged 18-80 yr, were selected. At 24 h after entering ICU, chest CT, lung ultrasound and arterial blood gas analysis were performed to record Extravas-cular Lung Water Index ( EVLWI) and the number of B lines, and lung injury ultrasound score and oxygen-ation index were calculated. The patients diagnosed with ARDS by chest CT and lung ultrasound were divid-ed into 3 groups: mild group ( 200 mmHg＜oxygenation index≤300 mmHg) , moderate group ( 100 mmHg＜oxygenation index≤200 mmHg) and severe group ( oxygenation index≤100 mmHg) . Kappa consistency a-nalysis was used to assess the consistency between lung ultrasound and chest CT in diagnosis of ARDS. The receiver operating characteristic curves of th number of B lines, EVLWI and lung injury ultrasound score in assessing the severity of ARDS were drawn, and the area under the curve and 95％ confidence interval ( CI) , critical value, sensitivity and specificity were calculated. Results Forty-six patients were diag-nosed as having ARDS by both chest CT and lung ultrasound. There was good consistency ( Kappa value 0. 648, P＜0. 01) between chest CT and lung ultrasound in diagnosis of ARDS. There was good consistency ( Kappa value 0. 788, P＜0. 01) between lung ultrasound and chest CT in diagnosis of pulmonary consolida-tion. Lung ultrasound and chest CT were in good agreement ( Kappa value 0. 825, P＜0. 01) with each oth-er in diagnosis of pulmonary consolidation in the posterior region. Compared with mild group, the lung inju-ry ultrasound score was significantly increased, and the number of B lines was increased in moderate group, and the lung injury ultrasound score and EVLWI were significantly increased, and the number of B lines was increased in severe group ( P＜0. 05) . Compared with moderate group, the lung injury ultrasound score and EVLWI were significantly increased, and the number of B lines was increased in severe group ( P＜0. 05) . The area under the curve ( 95％ CI ) of the number of B lines in diagnosing severe ARDS was 0. 915 ( 0. 905-0. 935 ) , and the critical value, sensitivity and specificity were 15. 5, 78. 9％ and 85. 2％, respectively. The area under the curve ( 95％ CI) of lung injury ultrasound score in diagnosing severe ARDS was 0. 856 (0. 833-0. 878), and the critical value, sensitivity and specificity were 25. 5, 73. 7％ and 82. 5％, respectively. The area under the curve (95％ CI) of EVLWI in diagnosing severe ARDS was 0. 907 ( 0. 888-0. 933) , and the critical value, sensitivity and specificity were 15. 5, 73. 7％and 92. 6％, respectively. Conclusion Lung ultrasound can be used for diagnosis of ARDS and for evalu-ation of the severity of ARDS.

Objective To identify the role of IL-17A during respiratory syncytial virus (RSV) in-fection in a mouse model. Methods Female wild-type C57BL/6 mice and IL-17A knockout ( IL-17A-/-) mice at the age of 6 to 8 weeks were both randomly divided into two groups:control and RSV groups. Mice in the control groups were given the supernatant of Hep-2 cell culture, while those in the RSV groups were treated with RSV A2 through intranasal administration. Leukocytes in bronchoalveolar lavage fluid ( BALF) samples were counted. Left lung tissues were stained with hematoxylin and eosin ( HE ) to evaluate his-topathological scores. Airway hyperresponsiveness ( AHR) was measured by whole-body plethysmography. The concentrations of IFN-γ were determined with ELISA. RSV titers were measured by plaque assay. To assess the effects of IL-17A on IFN-γproduction and its role in RSV infection, IL-17A-/- mice were treated with exogenous recombinant murine IFN-γ or IL-17A, while wild-type mice were given IFN-γ neutralizing antibody intervention. Results The counts of inflammatory cells and neutrophils in BALF, lung tissue his-topathological scores, AHR, IFN-γlevels and virus titers of the wild-type group were higher than those of the IL-17A-/-group after RSV infection. IFN-γlevels, inflammatory cell counts in BALF, AHR and lung tissue histopathological scores were significantly increased in RSV-infected IL-17A-/- mice after the intervention of recombinant murine IL-17A or IFN-γ. RSV titers were much higher in the recombinant murine IL-17A-trea-ted group, but not affected by the recombinant murine IFN-γ intervention. Inflammatory cell counts in BALF, AHR and lung tissue histopathological scores were significantly decreased in RSV-infected wild-type mice following IFN-γ neutralizing antibody treatment, but no significant changes were found in RSV titers. Conclusions IL-17A might be involved in the pathogenesis of pulmonary diseases during RSV infection through promoting IFN-γ production and inhibiting viral clearance in mice.

Objective To observe the effects of excessive fluoride on osteocalcin and glucose metabolism in mice.Methods Thirty-two male C57 mice (body mass:18-24 g) were selected as study subjects which were randomized into four groups (8 mice in each group) according to their body mass by random number table method:0 mg/L group (control group),50 mg/L fluorine group,100 mg/L fluorine group and 150 mg/L fluorine group.Sodium fluoride in distilled water was freely taken by these animals to replicate fluorosis animal model.After 12 weeks,total osteocalcin,uncarboxylated osteocalcin,insulin and glucagon were measured by enzyme-linked immunosorbent assay,fasting blood glucose and glycated hemoglobin were measured by chemiluminescence.Results After 12 weeks of intervention with sodium fluoride,serum total osteocalcin,uncarboxylated osteocalcin,fasting blood glucose,glycated hemoglobin,insulin,and glucagon were significantly different between different groups (F =17.23,22.29,4.43,45.57,4.45,55.21,P ＜ 0.05).Total osteocalcin,uncarboxylated osteocalcin,fasting blood glucose,glycated hemoglobin,and insulin in the 100,150 mg/L fluorine groups were higher than those of control group [(30.02 ± 5.35),(35.22 ± 4.98) vs (20.23 ± 3.22) μg/L;(8.72 ± 1.34),(11.01 ± 1.02) vs (5.80 ± 1.60) μg/L;(7.53 ± 2.29),(8.53 ± 2.81) vs (4.99 ± 1.60) mmol/L;(6.74 ± 0.68),(7.12 ± 0.25) vs (4.95 ± 0.28) mmol/L;(2.65 ± 0.25),(2.74 ± 0.47) vs (2.13 ± 0.28) mU/L,P＜ 0.05].The serum glucagon levels in the 50,100,150 mg/L fluorine groups were lower than that in the control group [(20.90 ± 3.00),(23.68 ± 2.58),(21.63 ± 2.42) vs (38.61 ± 3.73) ng/L,P ＜ 0.05].Conclusion Excessive fluoride can lead to elevated osteocalcin level and abnormal glucose metabolism in mice.

Objective To explore the characteristics and value for predicting prognosis of cytokines in septic children with or without neutropenia.Methods Totally 138 septic children were divided into the neutropenia and non-neutropenia groups according to absolute neutropenic count.Septic children were divided into the shock and non-shock groups according to circulation function and organ perfusion.The levels of C-reactive protein,procalcitonin,cytokines,PRISM-Ⅲ and clinical outcomes were analyzed between the relative groups.Results (1) Totally 138 septic children were recruited,64 with neutropenia and 74 without neutropenia.The level of PRISM-Ⅲ of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.048).Mortality showed no significant difference between the two groups,but hospital stay in the neutropenia group was longer than that in the non-neutropenia group.The levels of C-reactive protein,IL-6,and IL-10 ihe neutropenia group were significantly higher than those of the non-neutropenia group (P=0.001;P=0.001;P=0.032).The level of TNF-α in the neutropenia group was significantly lower than that of the non-neutropenia group (P=0.032).(2)Among the 64 septic children with neutropenia,23 were combined with shock.The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.001).The mortality of the shock group (43.5％,10/23) was significantly higher than the non-shock group (2.4％,1/41) (P=0.001).C-reactive protein,procalcitonin,IL-6,IL-10 and TNF-α in the shock group elevated obviously than those in the non-shock group (P=0.001;P=0.001;P=0.001;P=0.005;P=0.019).The area under receiver operating characteristic curve was 0.8 for IL-6 (cut-offvalue 315.38 pg/mL),0.8 for IL-10 (cutoff value 45.18 pg/mL),and 0.85 for TNF-α (cut-off value 1.95 pg/mL).(3) Among the 74 septic children without neutropenia,19 were combined with shock The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.022).There was no significant difference of mortality between the two groups (P=0.3).IL-10 level in the shock group elevated obviously than that in the non-shock group (P=0.015).(4) Among the 42 children with sepsis shock,23 were combined with neutropenia.The PRISM-Ⅲ level of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.005).There was no significant difference of mortality between the two groups (P=0.29).The levels of C-reactive protein,procalcitonin,IL-6 and IL-10 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.001;P=0.001;P=0.001;P=0.035).There was no difference of TNF-α level between the two groups.(5) Among the 96 children without sepsis shock,41 were combined with neutropenia.No difference of PRISM-Ⅲ level was observed between the neutropenia and nonneutropenia groups.The mortality of the neutropenia group was significantly lower than that in the non-neutropenia group (2.4％ vs 20％,P=0.02).The levels of C-reactive protein and IL-6 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.005;P=0.033).The TNF-α level was significantly lower than that in the non-neutropenia group (P=0.007).Conclusions Compared to children without neutropenia,septic children combined with neutropenia have longer hospital stay,and septic shock children combined with neutropenia have higher mortality,and levels of IL-6,IL-10 and TNF-α were also significantly increased.The levels of IL-6,IL-10 and TNF-α can help to predict prognosis of children with sepsis.

Alpinia oxyphylla is mainly produced in Hainan,and also one of the four famous traditional Chinese medicines in South China with increasing importance in traditional Chinese medicine industry. Field surveys and literatures show that A. oxyphylla has widely used as a medicinal and edible plant,it is an important raw material for many Chinese patent medicines,health products and food,with a long history of artificial cultivation and application. The future development is prospected on health market. But A. oxyphylla industry has faced a lot of problems,including unreasonable planting layout,lack of good varieties,imperfect seed breeding system,low level of standardization,inconsistent quality of medicinal materials,low level of industry,and so on. The suggestions for sustainable development are listed below.First,it is essential to strengthen the research on the basis and application technology of A. oxyphylla,speed up the selection and breeding of improved varieties,and popularize standardized cultivation techniques. Secondly,it is important to strengthen the research on quality standards,improve the quality evaluation system of medicinal materials. Thirdly,it is necessary to take full advantage of the functional components to develop functional products with Hainan characteristics,find out the unique product characteristics of A. oxyphylla,build a famous brand and improve the product competitiveness in the market. It is also important to strengthen policy support and industrial supervision,promote the healthy and rapid development of A. oxyphylla industry.
Alpinia ; chemistry ; China ; Drugs, Chinese Herbal ; pharmacology ; Medicine, Chinese Traditional ; trends ; Plant Breeding ; Plants, Medicinal ; chemistry ; Seeds