Objective To formulate a rational adjuvant therapeutic evidence-based nursing plan for a patient with grade II red and swelling type phlebitis. Methods According to the condition of the patient and using the PICO principle, we put forward clinical problems. Then we comprehensively searched the National Guideline Clearinghouse (NGC), ACP Journal Club, The Cochrane Library, DARE, PubMed, MEDLINE, CNKI and Google Scholar from 2000 to 2012. Relevant clinical guidelines, evidence summaries, systematic reviews/ meta-analyses, randomized controlled trials (RCTs), and high quality reviews on adjuvant therapy of grade II red and swelling type phlebitis were collected and their authenticity, importance and applicability were evaluated. Results One systematic review, four meta-analyses, five RCTs, and one review were totally included. According to current evidence as well as the patient’s clinical conditions and preference, a comprehensive and effective adjuvant therapeutic and nursing programme was given to the patient. For grade II red and swelling type phlebitis with blisters and severe pain, paretic infusion should be immediately stopped on the lesion-side limb, and venous indwelling needle should be extracted. Then, mucopolysaccharide polysulfate cream should be applied on the skin impaired by vein inflammation, and the local area should be gently massaged for 3 min, twice daily (once in the morning and evening, respectively). After four-day treatment and nursing care, the patient with phlebitis had already recovered. Conclusion Evidence-based medicine approaches could help us develop comprehensive therapeutic plans for patients which promote recovery of patients with phlebitis, alleviate pain, improve health, and increasepatients’ quality of life.
Objective To assess the systematic reviews of magnesium sulfate used to treat severe asthma. Methods An electronic search was performed in The Cochrane Library (Issue 2, 2008), ACP Journal Club (1991 to June 2008), MEDLINE (1990 to June 2008), Chinese Journal Full-text Database (1979 to June 2008), Chinese Scientific and Technological Periodical Databases (VIP) (1980 to June 2008), and Chinese Bio-medicine Database (CBM) (1980 to June 2008) to collect systematic reviews of magnesium sulfate treatment for severe asthma. The retrieved systematic reviews were reassessed, and then we adopted the evidence for clinical practice. Results Nine systematic reviews were included, and all of them included 14.1 ± 2.9 items of QUOROM (the quality of reporting of Meta-analyses) on average. In general, the included systematic reviews had comparatively high quality. Evidence illustrated that intravenous infusion of magnesium sulfate could improve pulmonary function and reduce hospital admission without any serious side effects. However, no evidence could verify that patients with asthma can benefit from aerosolized and oral magnesium sulfate. In a specific case with severe asthma, we used magnesium sulfate via intravenous infusion which helped the control of symptoms with no adverse reactions. Conclusion Magnesium sulfate via intravenous infusion can improve pulmonary function and reduce hospital admission rates. Due to its effectiveness, safety, and low cost, it deserves widespread application in patients with severe asthma.
【Abstract】 Objective To investigate the effectiveness of the medical calcium sulfate—OsteoSet bone graft substitute in the treatment of defect after excision of jaw cyst. Methods Between December 2009 and May 2010, 15 cases of jaw cystic lesion were treated，including 9 males and 6 females with an average age of 36.6 years (range, 15-75 years). Orthopantomography (OPT) method was used to measure the cyst size before operation, and the size ranged from 1.5 cm × 1.5 cm to 8.0 cm × 3.0 cm. The range of bone defect was from 1.5 cm × 1.5 cm × 1.5 cm to 8.0 cm × 3.0 cm × 3.0 cm after cyst excision intraoperatively. The patients underwent cyst curettage and OsteoSet bone graft substitutes implantation (2-15 mL). Radiological method was used to evaluate the repair effect of OsteoSet pellets. Results The pathology biopsy was periapical cyst in 7 cases, odontogenic keratocyst in 5 cases, and dentigerous cyst in 3 cases. Fifteen patients were followed up 6-12 months. Thirteen patients achieved wound healing by first intention; 2 cases had longer drainage time (5 and 7 days, respectively), the incision healed after the pressure bandage. Swelling occurred in 1 case after 1 month with no symptom of infection. No postoperative infection and rejection was found. The X-ray examination showed that the materials filled the bone defect well after 1 day of operation. OsteoSet bone graft substitutes were absorbed by one-half after 1 month of operation and totally after 3 months by OPT. The low density area was smaller in the original cysts cavity, and high density in the cysts increased significantly with fuzzy boundaries of cysts. At 6 months after operation， there was no obvious difference in image density between the original cavity and normal bone, and the capsule cavity boundary disappeared, and defect area was full of new bone. Conclusion The medical calcium sulfate—OsteoSet bone graft substitute is an ideal filling material for bone defect.
Objective Bioactive borate glass (BG) has good biocompatibil ity and biodegradation. To investigate the feasibilty of bioactive borate glass as a carrier of the antibiotic controlled-releasing by implanting vancomycin-loaded BG (VBG)into the focus of tibia chronic osteomyel itis after debridement. Methods VBG and vancomycin-loaded calcium sulfate (VCS) were prepared with a vancomycin content of 80 mg/g. Sixty-five New Zealand white rabbits, weighing 2.12-3.91 kg (mean, 2.65 kg), were used. The tibia chronic osteomyel itis rabbit models were establ ished by injecting methicill in-resistant Staphylococcus aureus (MRSA, 0.1 mL, 1 × 109 cfu/mL) into the right tibia of 65 rabbits. After 3 weeks of injection, 54 rabbits of successful models were randomly divided into groups A (n=11), B (n=11), C (n=16), and D (n=16). Simple debridement was performed in group A; BG, VCS, and VBG were implanted into the infection sites of groups B, C, and D respectively after thorough debridement. A sample of the debrided tissues was harvested for bacterial examination. The vancomycin serum levels were determined in groups C and D at 1, 2, 4, 10, 24, and 48 hours after operation. The boron serum levels were determined in groups B and D at 10, 24, 48, 72, and 120 hours after operation. After 8 weeks, the effectiveness was assessed radiographically, bacteriologically, and histopathol ogically. Results Ten rabbits died after operation. No vancomycin was detected in group C; the vancomycin level increased gradually, reached the highest level at 4 hours after operation, and then decreased rapidly in group D. No boron was detected in group B; the boron reached the highest serum level at 10 hours after operation, and then decreased gradually in group D. At 8 weeks, calcium sulfate degraded in group C; BG degraded partially in group D; and no obvious degradation was observedin group B. The repair effect was better in group D than in group C. There was no significant difference in radiograph scoring between groups A, B, C and D (P gt; 0.05) before operation, but there was significant difference between group D and groups A, B, C (P lt; 0.05) at 8 weeks after operation. The bacterial culture showed that all the MRSA results were positive in 4 groups. At 8 weeks, the negative rates of MRSA examination were 36.36%, 18.18%, 73.33%, and 81.25% respectively in groups A, B, C, and D, showing significant differences between group D and groups A, B (P lt; 0.05). The histopathological observation showed that a large number of new bones formed and no foreign body reaction occurred in group D. The histopathologic scores of groups A, B, C, and D were 6.45 ± 3.62, 7.55 ± 3.36, 4.27 ± 2.91, and 3.81 ± 3.04 respectively, showing significant differences between group D and groups A, B, and between group C and group B (P lt; 0.05). Conclusion VBG can improve the repair of bone defect in the treatment of chronic osteomyel itis.
Objective To investigate the effect of chondroitinase ABC (ChABC) on the expression of growth associated protein 43 (GAP-43) and gl ial fibrillary acidic protein (GFAP) after spinal cord injury (SCI) in rats. Methods A total of 150 adult female SD rats, weighing 250-300 g, were randomly divided into ChABC treatment group (group A), sal ine treatment group (group B), and sham operation group (group C) with 50 rats in each group. In groups A and B, the rats were made the SCI models and were treated by subarachnoid injection of ChABC and sal ine; in group C, the rats were not treated as a control. At 1, 3, 7, 14, and 21 days after operation, the Basso, Beattie, and Bresnahan (BBB) score system was used toevaluate the motion function, and immunofluorescent histochemical staining was used to observe the expressions of GAP-43 and GFAP. Results At different time points, the BBB scores of groups A and B were significantly lower than those of group C (P lt; 0.05); there was no significant difference in BBB score between groups A and B after 1, 3, and 7 days of operation (P gt; 0.05), but the BBB score of group A was significantly higher than that of group B after 14 and 21 days of operation (P lt; 0.01). At different time points, the GAP-43 and GFAP positive neurons of groups A and B were significantly higher than those of group C (P lt; 0.05). After 14 and 21 days of operation, the GAP-43 positive neurons of group A were more than those of group B (P lt; 0.01). After 7, 14, and 21 days of operation, the GFAP positive neurons of group A were significantly less than those of group B (P lt; 0.01). Conclusion ChABC can degrade gl ial scar, improve the microenvironment of the injured region and enhance the expression of GAP-43, which promotes axonal growth and extension.
Objective To investigate the effect of chondroitinase ABC (ChABC) on the expression of growth associated protein 43 (GAP-43) and gl ial fibrillary acidic protein (GFAP) after spinal cord injury (SCI) in rats. Methods A total of 150 adult female SD rats, weighing 250-300 g, were randomly divided into ChABC treatment group (group A), sal ine treatment group (group B), and sham operation group (group C) with 50 rats in each group. In groups A and B, the rats were made the SCI models and were treated by subarachnoid injection of ChABC and sal ine; in group C, the rats were not treated as a control. At 1, 3, 7, 14, and 21 days after operation, the Basso, Beattie, and Bresnahan (BBB) score system was used toevaluate the motion function, and immunofluorescent histochemical staining was used to observe the expressions of GAP-43 and GFAP. Results At different time points, the BBB scores of groups A and B were significantly lower than those of group C (P lt; 0.05); there was no significant difference in BBB score between groups A and B after 1, 3, and 7 days of operation (P gt; 0.05), but the BBB score of group A was significantly higher than that of group B after 14 and 21 days of operation (P lt; 0.01). At different time points, the GAP-43 and GFAP positive neurons of groups A and B were significantly higher than those of group C (P lt; 0.05). After 14 and 21 days of operation, the GAP-43 positive neurons of group A were more than those of group B (P lt; 0.01). After 7, 14, and 21 days of operation, the GFAP positive neurons of group A were significantly less than those of group B (P lt; 0.01). Conclusion ChABC can degrade gl ial scar, improve the microenvironment of the injured region and enhance the expression of GAP-43, which promotes axonal growth and extension.
Objective To investigate the synergetic effect and possibil ity of repairing spinal cord injury (SCI) by transplantation of olfactory ensheathing cells (OECs) and chondroitinase ABC (ChABC) in adult rats. Methods Three adult male SD rats were used to isolated olfactory bulb and primarily cultured OECs. In the 8th or 9th day, OECs were transplanted, the concentration of cells was modulated to 1 × 105/μL. Fifty-four SD rats were made the models of T8 spinal cord crush injury and divided into 4 groups. In group A (control, n=36), injured site was not treated; in groups B, C and D (n=6), OECs, ChABC and OECs+ChABC were injected into injured site, respectively. At 1, 2, 3, 7 and 14 days after injury, the BBB score system was used to evaluate the motion function. At 0, 1, 2, 3, 7, 14 days in group A and at 14 days in groups B, C, D after injury, the maximal transverse diameter and gross area of necrosis were evaluated on HE stained sections. The immunofluorescence double label ing staining for gl ial-fibrillary acidic protein (GFAP)/CS56, GFAP/growth associated protein 43(GAP-43) and GFAP/neurofilament 160(NF160) was carried out to evaluate the regeneration of nerve fiber. Results At 14 days after injury, there were significant difference in the BBB scores between group A and groups B, C, D (P lt; 0.05), and between groups B, C and group D (P lt; 0.05), HE staining showed that the formation of cavity was observed in each group at 14 days after injury. There were significant difference in the maximal transverse diameter and gross area of necrosis between groups B, C, D and group A (P lt; 0.01), and between groups B, C and group D (P lt; 0.01). The immunofluorescence staining indicated that expression of GFAP were more intense in group A than in other groups, and the cavity of the lesion site was apparent, but it was moderate in groups B and C. The expression of GAP-43 was more intense in group D than in groups B and C. The expression of NF160 was more intense in group D. Conclusion Transplantation strategy of OECs combined with ChABC was effective in the repair of SCI in some extent.
Objective To evaluate the tissue response induced by three kinds of bone transplantation materials implanted in rat so as to provide proper evidence for their cl inical appl ication. Methods Thirty-six healthy mature Sprague- Dawly mice, weighing from 229 g to 358 g, were randomly assigned to groups A and B (n=18). Three kinds of materials wereimplanted into muscles of rats. Calcium sulfate (CS) granular preparations and allogeneic demineral ized bone matrix (DBM) were transplanted into the left (group A1) and right (group A2) thigh muscle pouches of group A. Respectively, whereas xenogenic DBM were transplanted into the left (group B1) thigh muscle pouches of group B and the right (group B2) sites were taken as control without implant. The samples (n=6) were collected to make the observation of gross and histology and to analyze histological score after 2, 4, and 6 weeks. Results The gross observation: implanted materials were gradually absorbed at late stage in group A1. No obvious degradation and absorption, but fibrosis of tissues were observed in group A2 and B1. The inflammatory reactions were more severe in groups A2 and B1. In group B2, only the changes of scar were seen at operative site. The histological observation: no obvious inflammatory reactions were seen in group A1, CS were gradually absorbed and completely absorbed at 6 weeks, while fibrosis of tissues increased at late stage. Inflammatory reactions in group A2 and group B1 were alleviated gradually, no obvious absorption and degradation were observed. The different two DBM could induce granulation tissues and bone formation at different sites and secondary fibrosis with no obvious immune response was observed. In group B2, there was an increase in collagen fiber density and angiogenesis at late stage. The scores of inflammatory infiltration were significantly higher in groups A2, B1 than in groups A1, B2 (P lt; 0.05), and the scores of fibrosis was larger in groups A1, A2 and B1 than in group B2 (P lt; 0.05). Conclusion CS has rapid dissolution and good biocompatibil ity. It is a good replaceable packing materials of bone defects in some upper l imb’s or acute bone fracture. Both of two DBM have biocompatibil ity and osteoinductive potential, which dissolution are very slow. Due to these capacity, they can be served as an ideal materials in treatment of lower l imb’s bone defect and nonunion.
Objective To investigate the clinical effect of medical grade calcium sulfate(Osteoset) as a bone graft substitute. Methods From December 2004 to May 2005, 9 cases of bone defect(limb group)were repaired with Osteoset pellets; bone defect was caused by benign tumor inlimbs, including 3 cases of fibroma xanthomas in humerus(1 case) and acetabulum (2 cases), 2 cases of bone cysts in humerus(1) and radius(1), 1 case of nonossifying fibroma, 1 case of ossifying fibroma and 2 cases of osteofibrous dysplasia in femurs. Five cases of lumbar posterolateral fusion (spine group) were treated with Osteoset pellets as autograft volume expander, including 2 cases of lumbar spinal stenosis, 2 cases of lumbar spondylolisthesis and 1 case of lumbar spondylolysis. Radiological method was used to evaluate the repair effect of Osteoset pellets. Results The mean follow-up time was 6.2 months (3to 9 months). Osteoset pellets began to be absorbed after 1 to 3 months of operation, and were totally absorbed and replaced by osseous tissue after 4 to 6months. No local recurrence was detected in limb group and the function of limbs was normal. At 6 months after operation, all patients in spine group got bony fusion. Conclusion Medical grade calcium sulfate (Osteoset) isan ideal bone graft substitute with excellent bone repair effect.
Objective To evaluate collagen（Col）hyaluronan (HA) chondroitin sulfate (CS) tri-copolymer as a new biomimetic biodegradable polymer scaffold for application of the articular cartilage tissue engineering. Methods The Col-HACS tricopolymer was prepared by freezing and lyophilization and was cross-linked by 1-ethyl-3(3-dimethy inaminoproyl) carbodiimide (EDC). The morpholog icalcharacteristics of the matrices were evaluated by the SME and HE stainings. The rabbit chondrocytes were isolated and seeded in the tricopolymer scaffold. Morphology, proliferation and differentiation of glycosaminoglycan (GAG), and phenotypic expression of the rabbit articular chondrocytes cultured within the tricopolymer scaffold were indicated by the histological examination, SEM, biochemica l analysis, and reverse transcriptase PCR for collagen typeⅡ（ColⅡ）. Results The chondrocytes proliferated and differentiated well, and th ey preserved the phenotypic expression of ColⅡ in the Col-HA-CS scaffold. After the 21day cell culture within the Col-HA-CS scaffolds, the cartilage-specific morphologyand the structural characteristics such as lacunae appeared，and DNA and GAG conten ts increased with the time. In addition, DNA and GAG contents were significantly higher in the Col-HA-CS matrix than in the collagen matrix alone (Plt;0.05 ). Conclusion These results show that the Col-HA-CS tri-copolymer matrices can provide an appropriate environment for the generation of cartilage-like tissues and have a potential application in the cartilage tissue engineering scaffold field.