ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=−3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
Objective To investigate the efficacy and the safety of external therapy of ultrasound (ETUS) enhancing thrombolysis on the experimental retinal vein occlusion. Methods The effect of ETUS enhanced thrombolysis and the impact of ultrasound energy and exposure were investigated respectively after both eyes of 51 rabbits with retinal branch vein occlusion created by photodynamic initiated thrombosis were divided into 4 groups. The first 2 groups are the ETUS groups, including one group (15 rabbits) underwent intravenous injection with urokinase (UK) (1700-2200 UK dissolved into 20 ml normal saline), and other group (12 rabbits) underwent intravenous injection with normal saline. In these 2 groups, each rabbit received ETUS treatment (1.0 W/cm2, 20 min) in one eye and the fellow eye did not which was as the control. The latter 2 groups are the energy and duration of ultrasound groups, and 12 rabbits in each group underwent ETUS with the energy of 0.7 and 1.0 W/cm2 respectively. Each of the 2 groups was divided into 3 subgroups (8 rabbits in each) according to the radiated durations (8, 14, and 20 minutes). All of the eyes except the control ones underwent ETUS with 1 MHz ultrasound and 100 Hz pulsed ultrasound once a day for 3 days. Fundus fluorescein angiography (FFA) was used to detect the vascular condition 4 days after ETUS, and at the 15th day, retinal light microscopy and electron microscopy were performed. Results The vascular recanalization rate in ETUS+UK treatment group was 66.7%, which is obviously higher than which in single UK group (20.0%, P=0.025), normal saline group (8.3%, P=0.005), and ETUS+ normal saline group (8.3%, P=0.005). The vascular recanalization rates in groups with different energy of ultrasound increased obviously as the radiated durations increased (P=0.006, 0.001), while no apparent effect of energy of ultrasound on the vascular recanalization rate was found in the groups with different radiated duration (Pgt;0.05). The eyes which had undergone ETUS treatment had retinal tissue damage and ultrastructure changes of the retinal ganglion cells (RGC), and deteriorated as the radiated duration increased. Conclusion ETUS may enhance the thrombolysis induced by urokinase in experimental retinal vein occlusion. Simultaneously, ETUS can lead to the damage of retinal tissue and changes of the ultrastructure of RGC. (Chin J Ocul Fundus Dis, 2007, 23: 166-169)
In the management of diabetic nephropathy patients with hemodialysis, diabetes link nurse (DLN) can realize the continuity of nursing management, simplify the communication between multiple disciplines, and play multiple roles such as relieving patients’ psychology, participating in scientific research and clinical management. In this paper, by introducing the origin and development status of DLN in foreign countries, and summarizing the function and clinical contribution of DLN in the management of diabetic nephropathy hemodialysis patients. This article combines the current development status of DLN in China, to arouse the attention of clinical nursing colleagues, and provide some reference for the management of diabetic nephropathy patients with hemodialysis and the training of DLN in China.
Objective To investigate the expression and significance of Fork head /winged helix protein 3 (Foxp3) , retinoic acid-related orphan receptorγt (RORγt) , and interleukin-17 (IL-17) in Guinea pigs with emphysema. Methods Smoking and active immunization with elastin were separately used in guinea pigs to establish emphysema model. Then the destruction of lung tissue was assayed by measurement of the average radius of alveolar. The expressions of Foxp3 , RORγt, and IL-17 in lung tissue of the guinea pigs were detected by immunohistochemical technique. The results were compared with the normal control group by the analysis of variance or kruskal-Wallis test. Spearman rank correlation was used to analyze the correlation between the ratio of Foxp3/RORγt and IL-17, also the correlation between Foxp3/RORγt and the average radius of alveolar. Results In the smoking group and the active immunization group, the average radius of alveolar were significantly longer than the control group (Plt;0.05) . And the expression of Foxp3/RORγt was significantly unbalanced, with the number of Foxp3-positive cells decreased and RORγt-positive cells increased (Plt;0.05) . Meanwhile the level of IL-17 was significantly increased compared with the control group ( Plt;0.05) . The difference between the smoking group and the active immunization group was not significant (Pgt;0.05) . The ratio of Foxp3/RORγt was negatively correlated with the level of IL-17 and the average radius of alveolar. Conclusions Active immunization with elastin can induce emphysema in guinea pigs. The Foxp3/RORγt expression was unbalanced in lung tissue of guinea pigs with emphysema.This imbalance may be an important mechanism attributed to the disordered expression of CD4+ Treg cells and Th17 cells, which may be involved in autoimmune regulation and development of chronic obstructive pulmonary disease.
根据消毒供应中心的工作内容，设计出具有供应室特点的书面交班报告，简单、实用，反映出消毒供应中心三区工作量化及特殊情况处理，便于质控管理。
ObjectiveTo introduce the research progress of conservative treatment, internal fixation, hip arthroplasty, and multidisciplinary team (MDT) modes in the treatment of femoral neck fracture in the elderly.MethodsBy consulting domestic and foreign literature in recent years, the characteristics and application of various treatment methods and new treatment modes for femoral neck fracture in the elderly were summarized and analyzed.ResultsThe elderly non-displaced femoral neck fracture should be treated surgically, and conservative treatment has a high risk of secondary displacement. The displaced fracture should be operated as soon as possible. There is no difference in long-term functional outcome between hemiarthroplasty and total hip arthroplasty. Hemiarthroplasty has less intraoperative blood loss, shorter operation time, and is suitable for the elderly patients with poor basic condition. Total hip arthroplasty is suitable for the elderly patients with better basic condition and higher demand of life quality. MDT can effectively reduce preoperative waiting time and length of stay, reduce the incidence of medical complications, improve the nutritional status of patients, and reduce the mortality of patients.ConclusionSignificant results have been achieved in the treatment of femoral neck fractures in the elderly by methods such as internal fixation, hip arthroplasty, and MDT.
ObjectivesTo systematically review the efficacy of dyclonine and lidocaine for preparation before gastroscopy.MethodsPubMed, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of dyclonine vs. lidocaine for preparation before gastroscopy from inception to December 31st, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 11 RCTs were included. The results of meta-analysis showed that: dyclonine could improve anesthetic effect (RR=1.38, 95%CI 1.31 to 1.47, P<0.000 01), and was more capable to remove bubble (RR=1.40, 95%CI 1.28 to 1.52,P<0.000 01), and had superior textures (RR=1.43, 95%CI 1.18 to 1.74,P=0.000 3).ConclusionsOral dyclonine can improve the visual definition of gastric mucosa and anesthetic effect, and has superior textures. Thus, dyclonine can be regarded as a recommended option prior to gastroscopy. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo discuss and analyze the sense of dignity and its influencing factors of maintenance hemodialysis (MHD) patients.MethodsPatients with MHD in hemodialysis center of West China Hospital of Sichuan University were selected from November 2019 to January 2020. Patients were selected by convenience sampling. The patients were investigated with Patient Dignity Inventory (PDI), Connor-Davidson Resilience Scale (CD-RISC) and Hospital Anxiety and Depression Scale.ResultsA total of 150 patients were included. The average scores of CD-RISC, anxiety, depression and PDI were 61.20±14.54, 4.97±1.38, 5.90±2.42 and 41.32±16.24, respectively. Among them, 121 cases (80.67%) had mild dignity impairment, 22 cases (14.67%) had moderate dignity impairment, 6 cases (4.00%) had severe dignity impairment, and 1 case (0.67%) had very serious dignity impairment. The results of multiple linear stepwise regression showed that depression, economic burden, social support, and vascular access were all positive predictors of esteem scores (P<0.001).ConclusionsClinical nurses can aim at the main factors affecting the sense of dignity of MHD patients. And individualized nursing plan and intervention measures can be formulated to improve the sense of dignity of patients and improve the quality of life of maintenance hemodialysis patients.
Objective To assess the efficacy and safety Losartan for essential hypertension associated withhyperuricemia. Methods Included randomized controlled trials of Losartan versus Valsartan. Electronic searchconducted in CENTRAL, the Cochrane Library (until 2008, Issue 4), PubMed, EMBASE, Chinese Biomedicine database,Chinese Scientific Journals Full-text Database, and China Journal Full-text Database (until 2008, Issue 10). Two reviewers extracted data independently. RevMan 5.0 software developed by the Cochrane Collaboration was used for Metaanalysis.Results Only 7 trials with 1 136 eligible patients were included in the systematic review. Meta-analysis showedno significant difference in reductions of systolic blood pressure, diastolic blood pressure, and adverse events betweenLosartan and Valsartan groups. However, a significant difference of serum uric acid reduction was observed betweenLosartan and Valsartan group. Losartan play a significant role of decreased serum uric acid levels. Conclusions Based on this systematic review, Losartan is effective and well tolerated in reducing BP and serum uric acid levels. Further large randomized, double blind, placebo controlled trials are needed in long-term safety and efficacy and different subgroups of Losartan.
ObjectiveTo analyze the risk factors for postoperative mortality of the elderly patients with femoral neck fracture undergoing hemiarthroplasty.MethodsPatients who underwent hemiarthroplasty for femoral neck fractures between January 2011 and December 2015 were enrolled as object. One hundred and nine patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin level and nutritional status. Univariate analysis and Cox proportional hazard regression model were used to screen the risk factors for postoperative mortality.ResultsThe 1-year and 2-year mortalities were 6.4% (7/109) and 17.4% (19/109), respectively. Univariate analysis showed that the age, preoperative hemoglobin level and nutritional status were the influencing factors of postoperative mortality in the elderly patients with femoral neck fractures treated with hemiarthroplasty (P<0.05). Multivariate analysis showed that the age≥80 years and malnutrition were the independent risk factors for postoperative mortality (P<0.05).ConclusionTo improve the clinical outcomes, perioperative risk should be comprehensively evaluated by multidisciplinary and perioperative management should be strengthened in the elderly patients with femoral neck fracture, especially those with advanced age and malnutrition, for the high postoperative mortality.