Objective To construct an evidence-based prevention and management programme for peristomal moisture-associated skin damage in patients with enterostomy,and to evaluate its clinical effectiveness in improving the knowledge level of nurses and patients about peristomal moisture-associated skin damage in patients with enterostomy and reducing the incidence and severity of peristomal moisture-associated skin damage.Methods Through literature screening,evaluation,and summary,the best evidence for the prevention and management programme of peristomal moisture-associated skin damage in patients with enterostomy was summarized.From October 2021 to March 2022,based on the Ottawa research application model,review indicators were developed based on the best evidence for clinical review,identifying obstacles and promoting factors in evidence application,and developing action strategies to improve the evidence-based practice content for the prevention and management of peristomal moisture-associated skin damage in patients with enterostomy.From April to June 2022,evidence-based practice was conducted in the oncology surgery ward of a tertiary hospital in Anhui Province.The implementation rate of various review indicators by nurses,the knowledge level of peristomal moisture-associated skin damage of nurses and patients,and the incidence and severity of peristomal moisture-associated skin damage were compared before and after evidence-based practice.Results 46 cases were included before the evidence-based practice and 49 cases were included after the evidence-based practice.After evidence-based practice,the implementation rate of each review index was improved;the overall implementation rate increased from(0-66.67％)to(83.33％-100％);the score of the patient's knowledge questionnaire on peristomal moisture-associated skin damage was increased from(69.67±8.31)to(80.18±8.07).The score of the nurse's knowledge questionnaire on peristomal moisture-associated skin damage was increased from(79.83±5.97)to(88.28±5.43).At 4 weeks and 12 weeks of discharge,the incidence of peristomal moisture-associated skin damage was decreased,with a statistically significant difference(P＜0.05);the severity of peristomal moisture-associated skin damage was also significantly reduced,with a statistically significant difference(P＜0.05).Conclusion Conducting evidence-based practice for the prevention and management of peristomal moisture-associated skin damage can effectively improve the implementation rate of nurse review indicators,improve the knowledge level of nurses and patients with peristomal moisture-associated skin damage,and reduce the incidence and severity of peristomal moisture-associated skin damage in patients with enterostomy.

Objective: To investigate oral health related life quality and associated factors of senior primary school students in Bengbu City, so as to provide scientific basis for targeted oral health education for children. Methods: A stratified cluster random sampling method was adopted to select 1 760 senior students (grade 5 to 6) from 12 primary schools in 4 districts of Bengbu City from September to November 2022. A cross sectional survey was conducted on the oral health of students through questionnaires related to oral health. The effect of oral problems on quality of life was assessed by the Child Daily Life Oral Influence Scale (Child-OIDP). Chi square test, non parametric test and binary Logistic regression model were used to analyze the influencing factors of oral health related quality of life in senior primary school students. Results: The prevalence of oral problems affecting the quality of daily life was 70.00%, and the severe impact rate was 15.06%. Oral feeding was the most affected (57.95%). The Child-OIDP score was (7.49±8.57). Binary Logistic regression analysis showed that mother s education level, self rated teeth and oral conditions, bruised tooth, toothache in the past year, and gingival bleeding in the past 2 weeks were significantly associated with the incidence of Child-OIDP ( OR=1.86-5.00, P <0.05). Conclusion It is common that oral problems affect the quality of daily life of senior primary school students in Bengbu. Families and schools should strengthen oral health knowledge education and behavior guidance, so as to reduce the impact of oral problems on daily life among senior primary school students.

Objective To explore the effect of nutritional risk and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) on the prognosis of critically ill patients. Methods From January 2014 to November 2015, 138 critically ill patients were screened using Nutritional Risk Screening 2002 (NRS-2002) in intensive care unit (ICU) of our hospital. APACHEⅡand nutritional status of the patients were measured at the same time. Patients were divided into the survival group and death group according to the prognosis,the NRS-2002, nutritional status and APACHEⅡscores were compared between the two groups.The effect of NRS-2002 and APACHEⅡon the prognosis of critically ill patients was analyzed. Results Of 138 critically ill patients, 131 cases were found nutritional risk and 82 patients survived (62.60%) ,7 cases were found without nutritional risk and 5 patients survived,There were no significant differences in survival rate of both groups(P=0.714). The APACHEⅡscores in the nutritional risk group were (22.14 ± 6.86) points, which were obviously higher than those of non-nutritional risk group(5.80 ± 1.90)points. There were significant differences(t′=17.47,P<0.01). The RBC, HGB and ALB of patients in the death group were(3.18±0.31)×1012/L,(104.00±12.83)g/L and(28.54±3.83)g/L,respectively, which were significantly lower than those of the survival group, that were(3.52±0.53)×1012/L,(118.00±16.32)g/L and(31.44±4.81)g/L ,respectively. There were significant differences(t/t′=3.67-4.75,P<0.01). The CRP of patients in the death group were(88.59 ± 19.24)mg/L,which were obviously higher than those of the survival group(44.36±17.88)mg/L. There were significant differences(t=13.67,P<0.01), while there were no significant differences for TLC in two groups(P>0.05).Logistic regression analysis showed APACHEⅡ, nutritional risks, RBC,HGB,ALB and CRP were all the risk factors for the prognosis of critically ill patients(P<0.01), while APACHEⅡ, RBC, nutritional risks and ALB were the leading influencing factors. Conclusions There exists higher nutritional risks among the critically ill patients. APACHEⅡ, RBC, nutritional risks and ALB should be given more attention when they are admitted in the ICU. Patients′nutritional status should be comprehensively evaluated and the prognosis of the patients should be predicted.

Objective To test the effects of TNF-α inhibitor Etanercept on myocardial ischemia/ reperfusion (MI/R) injury in posttraumatic mice,and explore related mechanisms.Methods Traumatic mouse model was established with Noble-Collip drum.Five days after trauma,Notch1 was knocked down by intramyocardial injection of Notch1 small interfering RNAs (siRNA) or scrambled siRNA (20 μg).Seven days after trauma,mice were subjected to MI/R (30 minutes ischemia followed by reperfusion).Sham operation was similarly performed without coronary artery ligation.Ten minutes before reperfusion,mice received Etanercept (8 mg/kg,i.p.).ELISA was used to detect plasma levels of TNF-α and troponin I (cTnI) and myocardial nitrotyrosine content.Twenty-four hours after reperfusion,left ventricular ejection fraction (LVEF) was measured by echocardiography.Infarct size was determined by Evans blue/2,3,5-triphenyl tetrazolium chloride (TTC) double staining.Cardiac caspase-3 activity was detected using a caspase-3 kit.Myocardial TNF-α and Notchl intracellular domains (Notch1 ICD) expressions were determined by Western blot.Chemiluminescence was used to assess myocardial superoxide anion content.Results (1) Compared to vehicle group,Etanercept treatment significantly reduced cTnl content,infarct size and caspase-3 activity (all P ＜0.01),while obviously increased LVEF (P ＜0.01).(2) Etanercept treatment also significantly reduced plasma and myocardial TNF-α contents (P ＜ 0.01),whereas markedly increased myocardial Notch1 ICD content (P ＜0.05).(3) Compared to scrambled siRNA group,Notch1 deficiency significantly increased cTnI content,infarct size and caspase-3 activity (P ＜ 0.05),whereas obviously reduced LVEF (P ＜ 0.05).(4) Etanercept significantly reduced myocardial superoxide anion and nitrotyrosine content (P ＜ 0.01),which was reversed by downregulation of Notch1 (P ＜ 0.05).Conclusions TNF-α inhibitor Etanercept can alleviate MI/R injury after trauma by reducing myocardial oxidative/nitrative stress via activating Notch1 signaling pathway.

Objective To study the MRI features of pituitary lesions in children with short stature caused by growth hormone de-ficiency.Methods The MRI findings of clinical and pathological confirmed pituitary lesions in 40 children were retrospectively re-viewed.All cases had 3.0T MRI examination.Results The pituitary lesions included hypoplasia of antehypophysis (25 cases),pitu-itary stalk interruption syndrome (3 cases),pituitary atrophy after craniopharyngioma excision (2 cases)and pituitary hyperplasia (10 cases).MRI of antehypophysis hypoplasia showed that the height of antehypophysis was less than normal.Pituitary stalk inter-ruption syndrome showed not only hypoplasia of antehypophysis,but also absence or marked thinning of pituitary stalk and ectopic bright signal of posterior pituitary lobe on T1 WI.Atrophy of the pituitary was seen after resection of craniopharyngioma,and the stalk was unclear.All of the pituitary hyperplasia were caused by hypothyroidism.MRI of pituitary hyperplasia displayed antehy-pophysis enlargement and upward apophysis symmetrically.There were no pituitary stalk interruption,translocation and abnormal signal.The pituitary hyperplasia had obvious homogeneous enhancement.Pituitary gland reduced in size after replacement therapy. Conclusion MRI can show the features of pituitary lesions in children with short stature caused by growth hormone deficiency clear-ly.Correct diagnosis can be made and the therapeutic effect can be monitored combining with clinical manifestation.

Objective To evaluate the value of magnetic source imaging(MSI) in localizing the epileptic foci of patients with histologically proved grey matter heterotopia(GMH) and seizure. Methods MSI examinations were performed on 8 patients with GMH and seizure. The location of the epileptic foci defined by MSI was compared with the results of the ECoG. After imaging examinations, all patients received operation with 13-48 months follow up to observe the effectiveness of the operation. Results Among the 8 patients, 1 had hippocampal sclerosis,2 had focal cortical dysplasiaof type Ⅰ B and 1 had focal cortical dysplasia of type Ⅱ B. MRI showed normal findings in 2 cases, subcortical heterotopia in 4 cases, and nodulor heterotopia in 2 cases with one having schizencephaly. The epileptic foci defined by MSI were at right temporal lobe in 2 cases, left frontal lobe in 2 cases, biparietal lobe in1 case, left parietal lobe in 1 case, left temporal lobe in 1 case, and left frontal-parietal lobe in 1 case. The epileptic foci defined by MSI were completely overlaid with area of GMH in 4 cases, closely behind the area of GMH in case, and partly overlaid with area of GMH in 1 cases with size larger than that of the latter. One patient showed two epileptic foci with one located within the area of GMH and the other one 2 centimeters anterior to the area of GMH.One case's epileptic focus located 2 centimeters posteolateral to the area of GMH . The locations of the epileptic foci defined by MSI showed no difference with those defined by ECoG in all patients. According to Engel classification of treatment effect of epilepsy, 6 patients achieved Engle class Ⅰ ( seizure free after operation ), and 2 patients Engel class Ⅳ ( no changes in the frequcenty of occurrence of seizures before and after operation ). Conclusion MSI can noninvasively and precisely localize the epileptic foci before operation in patients with GMH and seizure.

Objective To study the Hainan Utstein templates used for cardiac arrest and resuscitation registries to evaluate the epidemiological characteristics and outcomes of the patients with CPR by multi-center study. Methodsccording to the Utstein templates for cardiac arrest and CPR set by International Liaison Committee on resuscitation in 2004, a Hainan Utstein CPR registry chart was designed and a prospective descriptive study was carried out to evaluate the epidemiological characteristics, impact factors and outcomes of the patients with resuscitation attempt in emergency departments of thirteen hospitals in Hainan Island between January 2007 and December 2010.Results Of 1125 patients with cardiac arrest, male accounted for 73. 8％ and female was 26. 2％. The mean ( ± S. D) age of the cardiac arrest patients was 53.9 ± 13. 1 years old.Coronary heart diseases and hypertension were the most common preexisting chronic diseases in the studied patients. The ROSC rate and discharge rates after survival in 1125 patients with CPR were 23. 8％ and 7.4％ respectively. The ROSC rate and discharge rates after survival were 36. 3％ and 11.6％ in the in-hospital cardiac arrest (IHCA) group, respectively whereas 11.5％ and 3. 3％ in out-hospital cardiac arrest (OHCA) group. Of 188 patients with ventricular fibrillation/Pulseless ventricular tachycardia, the ROSC rate and discharge rate after survival were 58.0％and 21.8％,respectively. Of them, 448 (39. 8％ ) of the cardiac arrest patients had underlying cardiac causes, and the ROSC rate and discharge rate after survival were 36. 3％ and 11.5％ respectively in IHCA group whereas 11.6％ and 3. 3％ in OHCA group. The ROSC rate and discharge rate after survival were 69. 8％ and 7. 4％respectively in the tertiary hospitals whereas 30. 2％ and 7. 3％ in the secondary hospitals. Conclusions Patients experienced cardiac arrest were predominantly male. Coronary heart disease and hypertension were the two most common preexisting chronic diseases. The ROSC rate and discharge rate of patients with IHCA were higher than those with OHCA. ROSC rate and discharge rate after survival were higher in the ventriculat fibrillation/Pulseless ventricular tachycardia group than the other cardiac rhythms first witnessed groups. The time delayed of starting CPR after onset of cardiac arrest had a critical impact on survival and discharge rate in both IHCA and OHCA groups.

Objective To study the association of serum L-kynurenine changes with nutritional status and vascular stiffness in maintenance hemodialysis (MHD) patients. Methods Twenty gender- and age-matched healthy volunteers (healthy group) and 40 MHD patients,including 20 cases with α-keto aicd(α-keto acid group)and 20 cases without α-keto aicd(non-α-keto acid group)were enrolled in the study.Serum L-kynurenine was measured by high performance liquid chromatography.C-reactive protein (CRP)and interleukin 6 (IL-6)were detected.Subjective global assessment(SGA)and malnutrition inflammation score(MIS)were applied to evaluate the nutritional status.Pulse wave velocity(PWV)was used to evaluate arterial stiffness for both groups of MHD patients. Results Serum L-kynurenine was significantly higher in MHD patients than that in healthy subjects[(3.20±1.12)μmol/L vs (1.74±0.27)μmol/L,P<0.01],while such difference was not found between α-keto aicd group and non-α-keto-aicd group [(3.20±0.88)μmol/L vs (3.29±1.34)μmol/L,P>0.05].IL-6 was significantly higher in MHD patients as compared to healthy subjects[(6.45±3.78)ng/L vs(1.38±1.59)ng/L,P<0.01],while such difference was found between α-keto aicd group and non-α-keto aicd group[(3.37±0.82)ng/L vs (9.62±2.48)ng/L,P<0.051.There was no difference of CRP concentration between two MHD groups.As compared to non-α-keto acid group,higher SGA score(26.00±1.75 vs 22.67±2.61,P=0.001),lower MIS score(5.82±2.27 vs 10.00±2.62,P=0.002),lower left side PWV[(21.11±8.21)m/s vs(24.57±5.45)m/s,P=0.244]and lower right side PWV[(19.27±3.22)m/s vs (24.19±5.41)m/s,P=0.015]were observed in α-keto aicd group.Pearson analysis showed positive correlation between serum L-kynurenine and IL-6(r=0.352,P=0.011)and negative correlation between L-kynurenine and pre-dialysis Scr(r=-0.412,P=0.019). Conclusions Inflammation is common in MHD patients.Tryptophan degeneration product L-kynurenine may indicate inflammation status.α-keto acid improves nutritional status,anemia and arterial stiffness maybe through the alleviation of inflammation in MHD patients.

Objective The purpose of the present study was to investigate the effect of peroxisome proliferator-activated receptors δ（PPAR δ）activation with dietary GW610742X on the expression of tenascin-C in the infarcted and remodeling myocardium.Methods Sixty male Wistar rats were divided into four groups,including control group,sham group,myocardial infarction（MI） group,and MI＋GW610742X（GW）group.The left coronary artery was ligated to establish the MI model.PPAR δ activator GW610742X（100mg/kg/d）was administrated into the rats of GW group.At 3 months after procedure,the expression and distribution of tenascin-C in left ventricular free wall from each group were examined by Western blotting and immunofluorescence,respectively.Results After 3 months following procedure,there were obvious necrosis and fibrosis in left ventricular free wall from MI group.The expression of tenascin-C in MI and GW group was significantly higher than those in control and sham group（P 〈 0.01）.Moreover,tenascin-C expression in GW group was remarkably decreased compared to MI group（P 〈 0.05）.Additionally,tenascin-C expression in sham group was similar to that in control group（P 〉 0.05）.Conclusion The tenascin-C is upregulated in infarcted myocardium during the remodeling process,which can be significantly attenuated by PPAR δ activation.