Objective To explore the effect of failure mode and effect analysis (FMEA) on reducing the unplanned extubation rates for patients with severe craniocerebral injury. Methods FMEA model was used to analyze the main reasons of unplanned extubation patients with severe craniocerebral injury, 7 failure modes with higher RPN scores was selected. The nursing intervention for the fixation of the catheter were improved. The control group with 181 cases of patients without FMEA application were given routine care. FMEA group owning 196 cases were given the optimization process. The incidence rate of unplanned extubation of two groups was compared. Results After improvement of the nursing process of patients with severe craniocerebral injury for fixing the catheter, the RPN of 7 failure modes was lowered. Compared with the control group, the total rate of unplanned extubation in FMEA group decreased to 1.1% (9/832), less than 5.1% (40/779) of the control group. The statistical difference was significant (χ2=22.410, P < 0.01) . The rate of UEX in gastric tube, urinary catheter and central venous catheter were 3.1%(6/196), 1.0%(2/196), 0, lower than 8.8%(16/181), 4.9%(9/181), 3.9%(7/181) in the control group. The statistical difference was significant(χ2=5.718, 5.224, 7.724, P < 0.05). No statistical difference in tracheal cannula and drainage tube of head between the two groups was found(P>0.05). Conclusions The FMEA model can be effective in reducing the rate of unplanned extubation .

Objective To detect the change of hemorrheology and prethromboticstate markers levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the pathogenic mechanisms of cardio-cerebrovascular thromboembolic diseases in OSAHS patients. Methods Polysomnography was performed in 86 patients with OSAHS and in 20 control subjects matched for age and body mass index. The patients with OSAHS were divided into mild group , moderate group , and severe group according to the apnea hypopnea index (AHI). Hemorrheology and prethromboticstate markers levels were measured in all the subjects for correlation analysis. Results The whole blood viscosity, erythrocyte aggregation index, and erythrocyte electrophoresis time in mild OSAHS group , moderate OSAHS group and severe OSAHS group were significantly higher than those in the control group. The whole blood viscosity, erythrocyte aggregation index, and erythrocyte electrophoresis time were also significantly different between the three OSAHS groups , increasing with the severity of OSAHS. Plasma viscosity was not significant difference between OSAHS groups and the control group. Plasma D-D , AT-Ⅲ and vWF levels were also not significant difference between OSAHS groups and the control group. Conclusions The change of hemorrheology in OSAHS patients may contribute to the vulnerability of patients to cardio-cerebrovascular thromboembolic diseases.

Objective To analyze the genotype and plasmid transfer of Enterobacteriaceae carring blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Methods From April 2012 to October 2014 ,a total of 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ( including Imipenem‐resistant , meropenem‐resistant or Ertapenem‐resistant) were isolated from 5 hospitals in Wenzhou and Hangzhou . Identification and antimicrobial susceptibility test were performed using Vitek 2 Compact automatic microbiology analyzer . Phenotypes of carbapenemase were screened using modified Hodge test and ethylenediamine tetraacetic acid‐disk synergy test .Extended spectrum βlactamase test was determined by the double disk combination test which was recommended by Clinical and Laboratory Standards Institute .AmpC activity was tested by a three‐dimensional Cefoxitin method .Drug resistant genes including blaNDM‐1 and linkage of ISAba125‐NDM were detected by polymerase chain reaction (PCR) .The purified PCR products were cloned and sequenced .Plasmid conjugation experiment and elimination method were carried out to test partial bacterial strain and K . pneumoniae carrying blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Results Of the 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ,28 were strains of K .pneumoniae ,1 strain of K . oxytoca,2strainsof Escherichiacoli,1strainof K.planticolaand1strainof E.cloacae.Thirteenstrains were isolated from Hospital of Sir Run Run Shaw of Zhejiang University ,thirteen from Wenzhou Hospital of Traditional Chinese Medicine ,one from Wenzhou People′s Hospital ,three from the First Affiliated Hospital of Wenzhou Medical University and three from Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine .Thirty‐one strains were confirmed as carbapenemase‐producing with 24 of blaKPC‐2 ,3 of blaNDM‐1 ,1 of blaNDM‐5 and 3 of blaIMP‐4 .Among them ,one strain carried blaNDM‐1 with blaIMP‐4 and one strain carried blaNDM‐1with blaKPC‐2 ,respectively .The plasmid transfer and conjugation experiment was performed between strains carrying blaNDM‐1 and Escherichia coli EC600 or K . pneumoniae ATCC13833 and genes of blaNDM‐1 and ISAba125‐NDM were obtained .Conclusions blaKPC‐2 gene is the popular carbapenemase genotype .blaNDM‐1 or blaNDM‐5 may be correlated with linkage gene of ISAba125‐N DM .Coexistence of blaNDM‐1 carrying blaIMP‐4 or blaKPC‐2 is detected in the same strain , respectively . Enough importance should be attached to the strains ,because most of them are multiple drug resistance with related genes located in the plasmid which is easily spread between strains .

Objective To evaluate the role of p38 mitogen-activated protein kinase (p38MAPK) in the spinal cord in the development of persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR) and the relationship with Toll-like receptor 4 (TLR4).Methods One hundred and twenty male SpragueDawley rats,weighing 200-250 g,aged 2 months,in which intrathecal catheters were successfully implanted,were randomly divided into 5 groups (n =24 each) using a random number table:sham operation group (group S),SMIR group,SMIR + dimethyl sulfoxide (DMSO) group (group DMSO),SMIR + p38MAPK inhibitor SB203580 group (group SB203580) and SMIR + TLR4 small interference RNA (siRNA) group (group TLR4siRNA).The rats were anesthetized with intraperitoneal chloral hydrate 400 mg/kg.The skin and superficial muscle of the medial thigh were incised and a small pair of retractors inserted.This tissue was retracted for 1 h causing potential stretch of the saphenous nerve.2％ DMSO 10 μl and SB203580 5 μg were injected intrathecally at 30 min before operation and 1-12 days after operation in DMSO and SB203580 groups,respectively.TLR4siRNA 2 μg was administered intrathecally at 1 day before operation and 1-12 days after operation once a day in group TLR4siRNA.Mechanical paw withdrawal threshold to von Frey filament stimulation (MWT) was measured at 1 day before operation and 1,3,7,12 and 22 days after operation.Four rats in each group were sacrificed after measurement of MWT at each time point,and the L4-6 segments of the spinal cord were obtained for detection of the expression of phosphorylated p38MAPK (p-p38MAPK) by Western blot analysis.Results Compared with group S,MWT was significantly decreased after operation,and the expression of p-p38MAPK was up-regulated after operation in SMIR and DMSO groups.Compared with group SMIR,MWT was significantly increased after operation,and the expression of p-p38MAPK was down-regulated after operation in SB203580 and TLR4siRNA groups,and no significant changes in MWT and p-p38MAPK expression were found at each time point in group DMSO.Conclusion TLR4-triggered activation of p38MAPK in spinal cord is involved in the development of SMIR-evoked persistent postoperative pain in rats.

ObjectiveTo investigate the role of NF-κB signaling pathway in the spinal cord in persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR) in rats.MethodsNinety male SD rats weighing 200-250 g in which intrathecal (IT) catheter was successfully implanted without complication were randomly divided into 3 groups ( n =30 each):group sham operation ( group S ) ; groups SMIR and group pyrrolidine dithiocarbarnate (a NF-κB inhibitor) (group PDTC).Persistent postoperative pain was evoked by SMIR according to the method described by Flatters in groups SMIR and PDTC.PDTC 10 ng in 10 μl was injected IT over 30 s once a day for 7 consecutive days after operation in group PDTC.Mechanical paw withdrawal threshold to von Frey filament stimulation (MWT) was measured at 1 d before (T0,baseline) and 1,3,7,12 and 22 d after surgery (T1-5).Five animals in each group were sacrificed at each time point after MWT measurement and their lumbar segments of the spinal cord were removed for determination of TNF-α content (by ELISA).ResultsSMIR significantly decreased MWT after operation at T1-5 and increased TNF-α content in the spinal cord at T3-5.PDTC significantly attenuated SMIR-induced hyperalgesia and increase in TNF-α content in the spinal cord.Conclusion NF-κB signaling pathway in the spinal cord plays an important role in the development of SMIR-induced persistent postoperafive pain in rats.

Objective To investigate the correlations of Mycoplasma penetrans(MPe)infection with the differentiation.invasiveness and metastasis of stomach and colorectal calFcinomas.Methods Sixty five patients with stomach carcinoma,57 patients with colorectal carcinoma and 80 healthy individuals as controls were enrolled in this study.MPe was isolated and then confirmed by PCR.χ2 test was performed to analyze the correlations of MPe infection with the differentiation,invasiveness and metastasis of carcinoma.Results The rate of MPe isolated from stomach carcinoma group(41/65,63.1%)was significantly higher than that from stomach ulcer group(χ2=38.2,P＜0.01).The rate of MPe isolated from eolorectal carcinoma group (1/20,5%)was also significantly higher than that from colorectal polyps group(χ2=21.2,P＜0.01).The proportion of poor differentiation and the invasiveness in MPe positive stomach carcinoma group were significantly higher than those in MPe negative group(χ2:33.4 and 25.0.P＜0.01).The proportion of poorly differentiation and lymphatic metastasis(N3)in MPe positive colorectal carcinoma group were significantly higher than those in MPe negative group(χ2=34.4,P＜0.01).Conclusion Differentiation,invasiveness and metastasis are highly correlated with MPe infection in stomach and colorectal carcinomas.

50%).The resistance of Enterococcus avium and E.faecalis to ciprofloxacin was over 30%.CONCLUSIONS To Gram-negaive bacteria may use ?-lactamase inhibitors with antimicrobials and amikacin.To nonfermenters may use ciprofloxacin.To Gram-positive bacteria may use teicoplanin,nitrofurantoin,ampicillin/sulbactam and others.

Objective Substance P and its receptor are thought to play an important role in the mechanisms of pain The purpose of this study was to investigate the effects of intrathecal (IT) morphine on substance P expression in the dorsal horn of spinal cord in a rat model of incisional pain Methods Sixteen male SD rats weighing 250 300g were randomly divided into four groups of 4 animal each: in group Ⅰ (sham operation) 30 min after IT normal saline(NS) 20 ?l 1 4% isoflurane was inhaled for 5 min but no incision was made; in group Ⅱ (control group) 30 min before incision NS 20 ?l was given IT; in group Ⅲ (postoperative analgesia group) morphine 5 ?g (10 ?l) was given IT 30 min after incision; group Ⅳ ( preemptive analgesia group) morphine 5 ?g (10 ?l) was given IT 30 min before incision The animals were anesthetized with intraperitoneal pentobarbital sodium 40 mg?kg -1 PE 10 catheter was inserted intrathecally to the lumbar region according to method of Yaksh 5 days later incision of 1 cm long was made in the plantar region of left hindpaw parallel to the muscle under isoflurane anesthesia according to the method of Brennan Pain behavior was assessed by a cumulative pain score Immuno histochemistry technique was used to measure the expression of substance P Results IT morphine given either before or after incision decreased the cumulative pain scores Incision made in the plantar region of left hindpaw increased substance P expression in the ipsilateral dorsal horn of spinal cord (0 62?0 07 vs 0 40?0 09) In group Ⅳ increase in substance P expression in the dorsal horn of spinal cord was inhibited Conclusions The analgesia provided by preemptive IT morphine is possibly mediated via the decrease in substance P in the dorsal horn of spinal cord

Objective It has been shown that protein kinase C (PKC), especially PKCy is involved in the nociceptive processing at the spinal level. This study was designed to investigate the effects of intrathecal (IT) morphine on PKCy immuno-reactivity in the spinal dorsal horn in a rat model of incisional pain. Methods Twenty-four male SD rats weighing 250-300 g were anesthetized with intraperitoneal pentobarbital 40 mg?kg-1. PE-10 catheter was inserted intrathecally to the lumbar region according to Yaksh. Five days later an incision of 1cm long was made in the plantar region of left hindpaw, parallel to the muscle under isoflurane anesthesia according to Brennan. The animals were randomly divided into 4 groups with 6 animals in each group : group Ⅰ sham-operation group received IT artificial cerebro-spinal fluid (ACSF) 20 ?l and 30 min later inhaled 1.4% isoflurane for S min but no incision was made; group Ⅱ received ACSF 20 ?l IT 30 min before incision was made; group Ⅲ post-incisional morphine group received morphine 5 ?g IT 30 min after incision and group Ⅳ pre-incisional morphine group received morphine 5 ?g IT 30 min before incision. The animals were sacrificed under general anesthesia 2 h after incision. The L4-5 segment of spinal cord was removed for determination of the expression of PKC? in the spinal dorsal horn by immuno-histochemical method.Results In group Ⅱ the PKC?-IR gray density in the spinal dorsal horn of the operated side was significantly higher than that of contralateral side and that in group Ⅰ( P

Objective To determine the content of trigonelline in Radix Mirabilis.Methods A RP -HPLC method was established.The chromatographic c olumn was Inertsil NH 2 Columns(250?4.6mm,5?m.).The mobile phase was acetonitrile -water(80∶20).The flow rate was 0.8mL?min -1 and the detection wavelength was at 265nm,and the column temperature was 30℃.Results The calibration curve was linear in t he range of 0.1872～0.9360?g .The aver-age recovery for trigonelline was 99.6%and RSD was 1.76%(n=6).Conclusion The method is simple and effec-tive and can be used to determine the c ontent of trigonelline in Radix Mirabilis.