ObjectiveTo analyze the impact of social resources on self-management in patients undergoing coronary stent implantation, and provide evidence for nurses to predict patients' self-management behavior and take intervening measures. MethodsA convenience sample of 359 patients undergoing coronary stent implantation between July and December 2013 was selected according to the criteria. Three instruments were used to collect data including general data scale, chronic illness resources survey (CIRS) and coronary artery disease self-management scale (CSMS). ResultsThe score of CIRS among 359 patients was 2.77±0.60, and the scores of six subscales in descending order were support of neighborhood/community, media and policy, and family and friends, and personal coping, and support of physician/health care team, and organizations. The total score of CSMS was 55.58±10.59, and the scores of three subscales in descending order were:daily management, emotion management, and medical management. The total self-management score and factor scores of CIRS were significantly correlated with the total and factor scores of CSMS (r=0.183-0.663, P<0.05), while the correlation of support of physician/health care team and family and friends with daily life management was negative (r=-0.215, -0.294; P<0.05). ConclusionIn this study, patients' total social resources are at a low level; the standard of self-management is at a moderate level, while medical management has the lowest score; good social resources can promote self-management, but supports from medical staff, family and friends are bad for patients' daily life management.
【摘要】 目的 探討降低冠狀動脈支架植入術后拔管所致血管迷走神經反射（vasovagal reflexs，VVR）的護理干預措施及效果。 方法 將2011年1-3月冠狀動脈支架植入患者120例隨機分為兩組，對照組58例，試驗組62例，對照組按常規方法拔管，試驗組除常規方法外根據患者不同情況予針對性護理干預。 結果 120例患者中共發生VVR 10例，其中對照組發生8例，試驗組發生2例。兩組比較差異有統計學意義（Plt;0.05）。 結論 冠狀動脈支架植入手術患者實施針對性的護理干預可有效降低血管迷走神經反射的發生，提高手術成功率。【Abstract】 Objective To investigate the nursing intervention measures and effects on reducing the vasovagal reflexs (VVRs) after the coronary stent extubation. Methods The clinical data of 120 patients who underwent coronary stenting between January and March 2011 were retrospectively analyzed. Patients were randomly divided into control group (n=58) treated with conventional coronary stent extubation and experiment group (n=62) treated with conventional coronary stent extubation and professional nursing intervention care. Results In 120 patients, VVRs occurred in 10 including 8 in the control group and 2 in the experiment group. The difference between the two groups was significant (Plt;0.05). Conclusion The coronary stent implantation with specific nursing interventions can effectively reduce the vascular vagal reflex, and leads to a higher success rate of the surgery.
Objective To compare canine decel luarized venous valve stent combining endothel ial progenitor cells (EPC) with native venous valve in terms of venous valve closure mechanism in normal physiological conditions. Methods Thirty-six male hybrid dogs weighing 15-18 kg were used. The left femoral vein with valve from 12 dogs was harvested to prepare decelluarized valved venous stent combined with EPC. The rest 24 dogs were randomly divided into the experimental group and the control group (n=12 per group). In the experimental group, EPC obtained from the bone marrowthrough in vitro ampl ification were cultured, the cells at passage 3 (5 × 106 cells/mL) were seeded on the stent, and the general and HE staining observations were performed before and after the seeding of the cells. In the experimental group, allogenic decelluarized valved venous stent combined with EPC was transplanted to the left femoral vein region, while in the control group, the autogenous vein venous valve was implanted in situ. Color Doppler Ultrasound exam was performed 4 weeks after transplantation to compare the direction and velocity of blood flow in the distal and proximal end of the valve, and the changes of vein diameter in the valve sinus before and after the closure of venous valve when the dogs changed from supine position to reverse trendelenburg position. Results General and HE staining observations before and after cell seeding: the decelluarized valved venous stent maintained its fiber and collagen structure, and the EPC were planted on the decelluarized stent successfully through bioreactor. During the period from the reverse trendelenburg position to the starting point for the closure of the valve, the reverse flow of blood occurred in the experimental group with the velocity of (1.4 ± 0.3) cm/s; while in the control group, there was no reverse flow of blood, but the peak flow rate was decreased from (21.3 ± 2.1) cm/s to (18.2 ± 3.3) cm/s. In the control group, the active period of valve, the starting point for the closure of the valve, and the time between the beginning of closure and the complete closure was (918 ± 46), (712 ± 48), and (154 ± 29) ms, respectively; while in the experimental group, it was (989 ± 53), (785 ± 43), and (223 ± 29) ms, respectively. There was significant difference between two groups (P lt; 0.05).After the complete closure of valve, no reverse flow of blood occurred in two groups. The vein diameter in the valve sinus of the experimental and the control group after the valve closure was increased by 116.8% ± 2.0% and 118.5% ± 2.2%, respectively, when compared with the value before valve closure (P gt; 0.05). Conclusion Canine decelluarized venous valve stent combined with EPC is remarkably different from natural venous valve in terms of the valve closure mechanism in physiological condition. The former rel ies on the reverse flow of blood and the latter is related to the decreased velocity of blood flow and the increased pressure of vein in the venous sinus segment.
Objective?To review the recent progress of the researches in construction of tissue engineered osteochondral composites, and to discuss the challenges in construction of tissue engineered osteochondral composites.?Methods?The recent literature on the construction of tissue engineered osteochondral composites was extensively reviewed and analyzed.?Results?The studies on the construction of tissue engineered osteochondral composites are relatively more in vivo, the current focus is that different tissues derived mesenchymal stem cells are widely used to be seed cells; single-phase scaffold has been limited, studies on biphase scaffold and triphase scaffold are new trends; the design and performance of bioreactor need to be further optimized in the future.?Conclusion?The construction of tissue engineered osteochondral composites will be a promising method for the treatment of cartilage defects.
Objective To compare effects, advantages and disadvantages of simple internal fixation to that of l imited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group (n=39) and the external fixator group (n=27). The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The external fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups (P gt; 0.05). Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the princi ple of internalfixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases inthe internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture heal ing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture heal ing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups (P gt; 0.05). Conclusion The therapeutic effects of simple internal fixation and l imited internal fixation with external supporting frame fixation were similar in the treatment of complex fractures of tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.
Objective To evaluate the value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy (ESWL). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2010), MEDLINE (OVID 1950 to April 2010), EMbase (1979 to April 2010), CBM (1978 to April 2010), CNKI (1979 to April 2010), and VIP (1989 to April 2010), and manually searched journals as well. All the randomized controlled trials (RCTs) of treating ureteral stone with ESWL after stent placement were included. We evaluated the risk of the bias of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Three RCTs with C-level evidence involving 319 ureteral stone patients were identified. The results of meta-analyses showed that: a) Effect of treatment: The ureteral stent placement before ESWL did not take better effects in aspects of the complete clearance rate (WMD= 1.10, 95%CI 0.87 to 1.38), the quantity of lithotripsy (WMD= 0.43, 95%CI –?1.05 to 0.19), the frequency of shock wave (WMD= 0.00, 95%CI –?0.25 to 0.25), and the power of shock wave (WMD= 0.20, 95%CI –?0.05 to 0.46); and b) Postoperative complications: The ureteral stent placement were prone to cause dysuria (RR= 2.30, 95%CI 1.62 to 3.26), microscopic hematuria (RR= 2.66, 95%CI 1.97 to 3.58), gross hematuria (RR= 6.50, 95%CI 1.50 to 28.15), pyuria (RR= 1.78, 95%CI 1.44 to 2.21), positive urine culture (RR= 2.13, 95%CI 1.71 to 2.64), and suprapubic pain (RR= 3.10, 95%CI 1.59 to 6.04). Conclusions Ureteral stent placement before ESWL is inadvisable. Multi-factors which lead to bias affected the authenticity of our review, such as low-quality and small amount of RCTs. Further large-scale trials are required.
Objective To study repair of osteochondral defects by using composite of autologous BMSCs and chitosan/HAP (CS/HAP) bilayered scaffold in rabbits and its feasibil ity as osteochondral tissue engineering scaffolds. Methods CS/HAP bilayered scaffolds were produced with CS and HAP using a lyophil ization and sintering method. The pore size of the scaffold was observed by scanning electron microscopy (SEM). Anhydrous ethanol substitution method determined its porosity. BMSCs were isolated from bone marrow and cultured by general bone marrow methods. Both CD44 and CD45 on the BMSCs surface were detected with immunocytochemistry to identify BMSCs. Cell-scaffold complex was made with BMSCs as seed cells and CS/HAP bilayered scaffold as carrier by fibrin glue planting technique. The distribution ofBMSCs in CS/HAP scaffold was tested by SEM. The osteochondral defect (4 mm in diameter and 3 mm in height) model was made in the right knee joint of 36 Japanese white rabbits, which were randomly divided into 3 groups. Defects were repaired with CS/HAP and BMSCs composite ( group A, n=12) and with CS/HAP implants (group B, n=12); defects were not treated as a control (group C, n=12). Histological evaluation and gross observation were carried out at 6 weeks (n=6 in each group) and 12 weeks (n=6 in each group) postoperatively. Semi-quantitative histomorphological analysis was done to evaluate the repair cartilage tissue according to the modified Wakitani grading scale. Results CS/HAP bilayered scaffold possessed a porosity of 76.00% ± 5.01% and pore size of 200-400 μm (mean 300 μm ) in CS layer, and 72.00% ± 4.23% and 200-500 μm (mean 350 μm) in HAP layer, respectively. BMSCs formed colonies within 10-14 days. Immunocytochemistry results showed BMSCs had positive CD44 expression and negative CD45 expression. At 6 and 12 weeks after operation, gross and histological observation showed that the cartilage defects were fully filled with regenerated tissue, but bone defects were partially repaired in group A; the cartilage and bone defects were partially filled with regenerated tissue in group B and group C. The modified Wakitani grading scale were 5.17 ± 1.17 and 3.20 ± 0.75 in group A, 9.00 ± 0.63 and 6.00 ± 0.89 in group B, and 10.00 ± 0.89 and 9.60 ± 0.82 in group C at 6 weeks and 12 weeks postoperatively, respectively; showing significant differences between group A and groups B, C (P lt; 0.05). Conclusion The novel CS/HAP bilayered scaffold possesses porous structure and will possibly become a newbiomaterial of osteochondral tissue engineering.
目的:評價外固定支架治療橈骨遠端骨折的療效。方法:2004年3月至2008年8月以外固定支架或輔以克氏針、可吸收螺釘內固定治療橈骨遠端骨折３7例。結果:31例獲得4～28 個月(平均14 個月)的隨訪,所有骨折均臨床愈合,平均愈合時間8周。腕關節功能按Sarmiento標準進行評定,優17例,良9例,可4例,差1例,優良率839%。結論:外固定支架治療橈骨遠端骨折療效可靠,值得推廣。