Objective: To investigate the clinical characteristics and diagnosis and treatment strategies of patients with severe traumatic aortic injury (TAI). Methods: A total of 25 patients with TAI, who hospitalized in our hospital between August 2005 to March 2021 and underwent thoracic aortic endovascular repair (TEVAR), were included in this retrospective study. According to the time from admission to TEVAR, the patients were divided into emergency TEVAR group (14 cases, TEVAR within 24 h of admission) and elective TEVAR group (11 cases, patients underwent surgery or fracture reduction and fixation first for serious injuries and then underwent TEVAR more than 24 h after admission). The general clinical data of patients, injury severity score (ISS), time from admission to intervention, total hospital stay, the proportion of closed chest drainage and the proportion of abdominal organ repair were obtained and compared. Clinical follow-up and 1-year postoperative aortic computed tomography angiography (CTA) were performed on the patients. Death, the occurrence of aortic adverse events and injury recovery were followed up and recorded. Results: The mean age of these 25 TAI patients was (41.4±14.4) years, 20 patients were males (80.0%). 21 patients (84.0%) had persistent chest and back pain, 17 (68.0%) had pleural effusion and 5 (20.0%) had mediastinal hematoma. The injury severity score (ISS) was significantly higher in the elective TEVAR group than in the emergency TEVAR group (24.9±14.4 vs. 35.5±9.3, P=0.044). The time from admission to intervention ((1.0±0.0) d vs. (3.4±0.9) d, P<0.001], the time from admission to TEVAR ((1.0±0.0) d vs. (11.5±13.8) d, P=0.030) and total hospital stay ((6.1±2.3) d vs. (26.8±7.7) d, P<0.001) were significantly longer in elective TEVAR group than in emergency TEVAR group. The proportion of thoracic closed drainage was significantly lower in the elective TEVAR group than in the emergency TEVAR group (9 (64.3%) vs. 2 (18.2%), P=0.042). The proportion of abdominal organ repair was significantly higher than in the emergency TEVAR group (0 vs. 4 (36.4%), P=0.026). All of 25 patients were discharged alive and followed up for (84.0±30.5) months. All patients survived and completed 1-year postoperation CTA. There were no aortic adverse events occurred, and no complications after surgery, and the fractures and organ injuries healed well. Conclusions: The clinical characteristics of severe TAI are acute multi-injuries combined with persistent chest and/or back pain, pleural effusion, and mediastinal hematoma. Timely diagnosis and treatment are important factors for the outcome. The treatment strategy for multi-injuries should give priority to dealing with life-threatening injuries. TEVAR is the primary treatment strategy for severe TAI and is related to satisfactory outcomes.
Adult ; Aorta, Thoracic/surgery* ; Aortic Diseases ; Blood Vessel Prosthesis Implantation/adverse effects* ; Endovascular Procedures/methods* ; Female ; Hematoma/surgery* ; Humans ; Male ; Middle Aged ; Pleural Effusion/surgery* ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Background: The dose and time point for switching from clopidogrel to ticagrelor remain controversial, especially for Chinese acute coronary syndrome (ACS) patients with complicated coronary artery disease (CAD). Hence, the purpose of this study was to further explore the optimal dose and time point for the switching strategy to balance the increase in platelet inhibition and the decrease in adverse events in Chinese ACS patients with complicated CAD managed by percutaneous coronary intervention (PCI). Methods: From July 2017 to December 2017, the prospective, randomized, open-label study (the SwitcHIng from clopidogrel to ticagrelor study) assigned the eligible Chinese ACS patients with complicated CAD managed by PCI (n = 102) for 90 mg of ticagrelor at 12 h (T-90 mg-12 h), 90 mg of ticagrelor at 24 h (T-90 mg-24h) or 180 mg ticagrelor at 24 h (T-180 mg-24 h) after the last dose of clopidogrel. The primary endpoint was the comparison of maximal platelet aggregation (MPA) values at 2 h after switching strategies among the three groups. In addition, the MPA values at baseline, 8 h and before discharge and the rates of high ontreatment platelet reactivity were evaluated, the incidences of bleeding episodes and dyspnea during hospitalization and at 30-day follow-up in our study were also recorded. The MPA was measured by light transmittance aggregometry in our study. A repeatedmeasures analysis of variance (ANOVA) model and one-way ANOVA were used to compare data for the primary endpoint. Results: The MPA values were significantly decreased in the T-180 mg-24 h group compared with the T-90 mg-12 h group (P = 0.017) and decreased numerically compared with the T-90 mg-24 h group (P = 0.072) at 2 h. In particular, the MPA values were markedly reduced in the T-90 mg-24 h group compared with the T-90 mg-12 h group at 8 h after switching treatment (P = 0.002). There was no significant difference among the three groups in all bleedings and dyspnea events. Conclusions: The optimal treatment strategy recommended in this study for Chinese ACS patients with complicated CAD managed by PCI is 180 or 90 mg of ticagrelor at 24 h after the last dose of clopidogrel. In addition, a negative interaction was detected in this study between the overlap for clopidogrel and ticagrelor at 12 h after the last dose of clopidogrel. Trial Registration ClinicalTrials.gov, NCT03577652; http://clinicaltrials.gov/ct2/show/NCT03577652.

Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). However, whether the PFME guided by a therapist (G-PFME) can contribute to the recovery of urinary continence for patients after RP is still controversial. We performed this meta-analysis to investigate the effectiveness of G-PFME on UI after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone. Literature search was conducted on Cochrane Library, Embase, Web of Science, and PubMed, to obtain all relevant randomized controlled trials published before March 1, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the continence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME. Twenty-two articles with 2647 patients were included. The continence rates of G-PFME were all superior to control at different follow-up time points, with the odds ratio (OR) (95% confidence interval [CI]) of 2.79 (1.53-5.07), 2.80 (1.87-4.19), 2.93 (1.19-7.22), 4.11 (2.24-7.55), and 2.41 (1.33-4.36) at 1 month, 3 months, 4 months, 6 months, and 12 months after surgery, respectively. However, there was no difference between additional preoperative G-PFME and postoperative G-PFME, with the OR (95% CI) of 1.70 (0.56-5.11) and 1.35 (0.41-4.40) at 1 month and 3 months after RP, respectively. G-PFME could improve the recovery of urinary continence at both early and long-term stages. Starting the PFME preoperatively might not produce extra benefits for patients at early stage, compared with postoperative PFME.
Humans ; Male ; Muscle, Skeletal/physiopathology* ; Pelvic Floor/physiopathology* ; Physical Therapy Modalities ; Prostatectomy/adverse effects* ; Prostatic Neoplasms/surgery* ; Treatment Outcome ; Urinary Incontinence/therapy*

OBJECTIVETo investigate the effect of premature rupture of the membrane (PROM) on neonatal complications in premature infants.

METHODSThe registration information of 7684 preterm infants with gestational age <37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without (control).

RESULTSThe preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group (P<0.05). The 95% confidence interval of the OR value was <1 for mortality, and was >1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus (GDM), gestational period hypertension and 5-min Apgar score <7, the incidences of NEC, ROP and BPD were significantly different between the two groups (P<0.05) with 95% confidence interval of OR value >1, but the mortality rate and incidence of ICH were not significantly different between the two groups (P>0.05).

CONCLUSIONPROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.

Apgar Score ; Birth Weight ; Female ; Fetal Membranes, Premature Rupture ; pathology ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Newborn, Diseases ; etiology ; Infant, Premature ; Pregnancy ; Risk Factors

Objective To study the knowledge,attitude and practice on the evidence-based nursing (EBN) and its influencing factors.Methods A total of 180 nursing students with the high education were recruited and investigated with a self-designed questionnaire,which included fundamentals of knowledge (8 items),evidence-based attitude and belief( 14 items),evidence-based practice ( 8 items),and adopted 3 rating scale,every natural endowments 1-3 points.The Cronbach's α of the questionnaire was 0.910,and its Cronbach's α of items respectively was 0.850,0.897,0.893.Results The mean score of knowledge,attitude and belief,and behavior was ( 10.85 ± 2.83 ),( 34.34 ± 4.94 ),( 10.84 ± 3.24 ),respectively.The study mode,evidence-based nursing training,evidence - based nursing practice were the main influencing factors of the overall level(P ＜0.05).Conclusions The clinical nursing students show a positive attitude toward EBN,but they lack of basic EBN knowledge and practice.So the evidence-based nursing training should be strengthened and the sooner the better.

Objective To explore the applicable nursing intervention mode of family treatment and nursing for children with hemophilia which was appropriate for local hemophilia treatment center (HTC).Methods The nursing intervention group,which consisting of nurses,hemophilia patients aged 2 ～ 18 and their parents,discussed and summarized the problems in family treatment and nursing for children with hemophilia,through literature review and expert consultation,developed comprehensive nursing intervention measures,which including individualized coagulation factors injection training,hemophilia classes,children hemophilia families sodality and follow-up visiting of the family treatment and nursing behaviors.The effect of nursing intervention was judged through measuring and comparing the family treatment and nursing behaviors.Results After intervention,among 22 items of family treatment and nursing behaviors,19 items were significantly improved than that of no intervention ( x2=59.88,36.47,96.30,13.57,34.67,55.06,55.06,21.85,22.69,45.69,39.33,68.25,11.99,35.39,35.39,17.24,81.51,85.75,13.57,respectively; P＜0.01 ).Before intervention,the incidence of "correctly record every bleeding and treatment" among the patients was 2 cases(3.85％ ),while after intervention,that was 48 cases ( 92.31％ ),and the incidence of "monthly report the bleeding and therapy nursing information to nurses" was raised from 5 cases (20％) to 52 cases ( 100％ ) after intervention,and the difference was statistically significant (x2=81.51,85.75,respectively;P＜0.01).Conclusions Comprehensive nursing intervention measures can improve the families' treatment and nursing behaviors of children with hemophilia and achieve the effective management of patients' information at the sam time,which is applicable for local hemophilia treatment center.

OBJECTIVETo investigate the role of Caspase-8 and Bcl-2 in the formation of loose bodies in Kashin-Beck disease (KBD).

METHODSSpecimens of cartilage loose bodies were collected from 50 adult patients with KBD, and the samples of articular cartilage were collected from 10 healthy adults to serve as control. Avidin-biotin alkaline phosphatase immunohistochemistry was employed to examine Bcl-2 and Caspase-8 positivities in the chondrocytes in the loose bodies.

RESULTSIn KBD loose bodies, the percentage of chondrocytes positive for Bcl-2 and Caspase-8 [(18.40∓8.78)% and (67.54∓12.29)%, respectively] were significantly higher than those of the control group [(12.25∓1.58)% and (24.70∓4.35)%, respectively]. Caspase-8 was found to promote chondrocyte apoptosis in the loose bodies, and this effect overrode the apoptosis-suppressing effect of Bcl-2. Bcl-2 and Caspase-8 positivities were found mainly in the deep hypertrophic chondrocytes in the cartilage or in cells adjacent to the bone tissues.

CONCLUSIONKBD loose bodies contain an increased percentage of apoptotic chondrocytes positive for Bcl-2 and Caspase-8. The apoptosis-inducing effect of Caspase-8 was a dominant feature in the cartilage pathology of KBD compared to the apoptosis-suppressing effect of Bcl-2.

Adult ; Apoptosis ; Cartilage ; pathology ; Case-Control Studies ; Caspase 8 ; metabolism ; Female ; Humans ; Joint Loose Bodies ; metabolism ; Kashin-Beck Disease ; metabolism ; pathology ; Male ; Middle Aged ; Proto-Oncogene Proteins c-bcl-2 ; metabolism

Objective To understand the expectation of good death in ordinary patients with a view to provide a research basis for the hospice.Methods 190 outpatients were surveyed with good death scale.Results On the core items,the patients gave the highest score to “good relationship with family(4.18 ±0.69)”,followed by “physical and cognitive control(4.15 ±0.72)”,“preparation for death(4.13 ±0.70)”placed the third,“dying in a favorite place(3.98 ±0.85)”,“physical and psychological comfort(3.84 ± 1.00)” placed the fourth and fifth in sequence,however “life completion(3.77 ± 0.91)” scored the lowest.Conclusions A good hospice care needs to help patients access to family support,meet the person who want to meet,maintain independence and self-care,and respect for their value.

Objective to learn the non-cancer patients' attitude towards terminal cancer treatment and death,and influential factor.Provide scientific basis for the choice of terminal cancer treatment and death education.Methods 307 non-cancer patients in common clicnic were investigated by a self-designed questionnaire.Results 73.6% of'the patients didn' t mind talking about death,the score they gave to such items as "hospice care',"making a will of treatment" and "euthanasia" was more than 3.8.The Logistic Regression analysis suggested that city residents tend to approve of " hospice care"," making a will of treatment" and "euthanasia";the elder people tend to approve of "euthanasia","more love for life after thinking of death-related issues" and "talking about death with family members openly".The discrepancies were statistically significant.Conclusions The bioethieal concepts such as "hospice care"," euthanasia" are being gradually accepted by the public.To achieve the transition from a "cure" to "care",we still should make an effort to build a more open atmosphere for death,reduce the differences between urban and rural areas and carry out death education earlier.

en the cancer patients and the other groups.