To investigate the application effect of nursing intervention for elderly patients with diabetic foot.

One thousand one hundred and fifty one cases of elderly diabetic foot patients were proceed with comprehensive nursing intervention, including blood glucose control, blood pressure control, appropriate exercise, prevention of hypoglycemia, foot care, diet nursing, health education guidance, the foot wound care, foot negative pressure wound therapy nursing, autologous stem cell transplantation, lower limb interventional treatment hospital nursing, tissue engineering skin care, health guidance, and telephone follow-up measures.

The blood pressure and blood sugar of 1151 cases of elderly diabetic foot patients were controlled well, and the wound was healed. Hypoglycemia reactions were not observed. One thousand one hundred and forty seven cases were restored, and four cases were improved by outpatient treatment.

Comprehensive nursing intervention treatment can improve the cure rate of elderly diabetic foot patients, and decrease the rate of amputation. The elderly diabetic foot patients' quality of life was improved by comprehensive nursing intervention treatment measures.

Pressure ulcer is one of the common chronic refractory wounds and has received extensive attentions because of its high incidence and prevalence, long treatment interval and high cost. There are two editions of international guideline on pressure ulcer that have been published at present. National Pressure Ulcer Advisory Panel (NPUAP) released its new staging system on pressure ulcer in 2016, so in this paper, the authors make a brief interpretation about it.

The pathophysiology of non-traumatic osteonecrosis of the femoral head is more complex than that of traumatic osteonecrosis, and corticosteroid-induced osteonecrosis presents a huge challenge because of the multiple effects of corticosteroids on multi-system pathways. These pathways include the effects of corticosteroids on osteoblast differentiation, osteoblast and osteoclast apoptosis, lipid metabolism, coagulation pathways, and calcium metabolism. These pathways are frequently interrelated with each other, which makes the pathogenesis even more difficult to understand. Host factors and underlying disease have been shown to play a significant role in the risk of developing osteonecrosis. Identification of genetic variants that convey additional risk will also help to personalize the way we care, both in the prevention and treatment of osteonecrosis.

With the continuous improvement of people′s living standard in our country and the more perfect diabetes screening method and specification, the incidence of diabetes in our country were significantly increased. Diabetic foot is a serious complication of diabetes with the high incidence rate, high disability rate and high fatality rate in the course of chronic diseases. Therefore, it is very important to prevent diabetic foot, reduce the incidence of diabetic foot and do early diagnosis and treatment. Medical workers should pay attention to blood sugar in patients with diabetes to conduct a comprehensive management: control 2 h postprandial blood glucose, prevent hypoglycemia, improve the standard rate of glycosylated hemoglobin, develop good living habits, do a good job of foot health, ensure full health, select the appropriate footwear, prevent foot injury, receive timely treatment of foot diseases. Treatment for diabetic foot is a system engineering, and hospitals should choose the way of multidisciplinary collaboration (such as endocrinology, orthopedic and vascular surgery) according to own actual situation, or create a wound repair platform (set of endocrinology, orthopedic, intervention, vascular surgery, etc) to form a professional team, and make the treatment of diabetic foot standardized, efficient, reduce the rate of amputation, improve the cure rate.

To investigate the clinical effect of lengthened biological femur shank artificial hip joint replacement in the treatment of intertrochanteric fracture in elderly patients.

Forty-one elderly patients with intertrochanteric fracture treated with lengthened biological femur shank artificial hip joint replacement through posterolateral approach of hip joint were analyzed retrospectively, who were come from the department of orthopedics, the Inner Mongolia autonomous region Chifeng hospital and the second affiliated hospital of Inner Mongolia medical university from February 2010 to August 2015. The hip function was evaluated according to the Harris scoring system after the surgery.

The operation time of the 41 cases in this group was 41-95 min, the average time was 62 min. The intraoperative blood loss was about 180-450 mL, with an average of 300 mL. The postoperative ambulation time of the 41 cases in this group was 3-5 d, the average time was 4 d, the postoperative bed stay time was short. The hospital stay was 12-18 d, with an average of 15 d. There were no complications such as deep vein thrombosis, pulmonary embolism, fat embolism, dislocation of joint, death and so on. Postoperative review, the X-ray showed that the fracture reduction was satisfactory, and the lower extremities were of equal length, the prosthesis position and intertrochanteric fracture were all well restored. After 1-5 years of follow-up, there were no infection, prosthesis loosening, subsidence and rupture, hip varus and valgus deformity, etc. The hip function was evaluated according to the Harris scoring system after the surgery, and the excellent and good rate was 88.7%.

The lengthened biological femur shank artificial hip joint replacement in the treatment of intertrochanteric fracture in elderly patients with short postoperative bed stay time, less complications, rapid recovery of hip function, which can effectively improve the quality of life of postoperative patients.

创面感染的防治一直是临床工作的重点，本文从创面感染的诊断方法、预防以及处理措施着手，结合介绍新的创面处理设备和新型敷料，如水刀及超声刀用于创面清创、新型敷料创面换药、新型抗菌药物用于创面多重耐药菌的治疗等，以及归纳总结了创面感染临床护理的策略和重点，以期为临床医护人员预防创面感染提供有效的措施，进而控制感染创面的发生，促进创面愈合，减少患者痛苦。

探讨异种(猪)脱细胞真皮基质(ADM)敷料在不同深度烧伤创面的适应证、禁忌证和治疗效果。

严格按照入选标准，选取2010年12月至2017年8月解放军第三二二医院烧伤整形科收治的317例烧伤患者。将异种(猪)ADM敷料贴附于清创后创面，外层包扎固定，适时换药。观察创面感染情况、再上皮化速度、愈合时间、愈合后皮肤弹性与色泽、瘢痕生长情况。

应用异种(猪)ADM敷料后换药次数减少，肉芽组织新鲜，创面愈合加快。愈合后皮肤未见增生性瘢痕。

对于非关节部位的Ⅱ度烧伤创面、面积较小(如直径小于1 cm)的Ⅲ度慢性肉芽创面，异种(猪)ADM敷料可显著促进创面愈合，提高创面愈合质量，值得推广。但禁用于有明确手术指征、感染未控制或进行性加深的创面(如电烧伤、化学或毒物烧伤)等。

To discuss the mechanism of xenogenic(porcine) acellular dermal matrix (ADM) alleviating the inflammatory reaction in the process of treating deep partial thickness skin burn injury.

Seventy deep partial thickness skin burn injury patients were chosen and randomly divided into two groups. The patients in experimental group were treated with ADM while other patients were treated with povidone iodine ointment in control group. To regard the day of hospital admission as the 1st day after injury, The levels of tumor necrosis factor-alpha(TNF-α), interleukin-1beta, interleukin-6 and interleukin-10 were detected on the 1st, 3rd, 7th and 10th day post burn at all the patients and the change of patients′ vital signs as well as peripheral blood leukocyte count were monitored. SPSS 13.0 statistical software was used to process the data. Multiple comparision between groups was made using the Student-Newman-Keuls methods.

The serum TNF-α level of patients in the experimental group was(1.55±0.62) ng/mL, which was lower than that of patients in the control group on the 3rd day post burn, the difference was statistically significant (P<0.05). In addition, the vital signs and peripheral blood leukocyte count of patients in experimental group returned to normal more quickly than that of patients in the control group. However, There were no significant differences in serum levels of interleukin-1beta, interleukin-6 and interleukin-10 between the two groups at different times post burn(P values were less than 0.05).

Through lowering the level of serum TNF-α of patients, ADM is able to alleviate the postburn systemic inflammatory response syndrome and reduce the occurrence of severe complications.

创面已成为当今医学领域研究的热点问题，有创面问题存在就可能造成感染的发生，反过来阻碍创面的愈合，所以预防和控制创面感染也是热点内容之一。本文从创面感染治疗的历史、判断标准、常见细菌、细菌生物膜、治疗及预防等几个方面阐明创面感染的防治理念。创面感染重在预防，一旦感染发生，治疗需要各方面通力合作，从创面形成的源头治疗开始，运用传统和现代各种先进技术及产品，有针对性地消除或减弱致病因素、去除致病菌及细菌生物膜、及时修复创面是治疗创面感染的关键。

创面带来的主要问题有4个：感染、出血、疼痛、瘢痕。其中感染对机体危害最大。本文重点针对创面感染问题，特别是由创面感染导致的并发症以及如何加强创面感染的预防与处理及抗生素的选用方式，结合本单位及作者的一些初浅看法供同道们参考。

With the change of disease spectrum, the chronic refractory wound is gradually becoming the focus of clinical attention. It has become a difficult medical problem because of the high incidence, complex etiology and difficult treatment. Wound repair is the key of treatment of the chronic refractory wound. Meantime, the transplantation of the skin flap plays an important role in wound repair. In this paper the authors review the history of skin flap for wound repair, and discuss the indications and the application of skin flaps in the different parts and the different causes of chronic wounds. The authors also summarize the new concepts and new technologies to improve the survival rate of flap transplantation.

To explore the effects of dexamethasone combined with ligustrazine on the content of tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta 1 (TGF-β1) in bronchoalveolar lavage fluid (BALF) from pulmonary fibrosis induced by bleomycin (BLM) in rats and the degree of pulmonary fibrosis.

Sixty male SD rats were randomly divided into 5 groups: normal control group (N group, n=12), pulmonary fibrosis model group (M group, n=12), dexamethasone intervention group (D group, n=12), ligustrazine intervention group (L group, n=12) and dexamethasone combined with ligustrazine intervention group (DL group, n=12). The rats in M, D, L and DL group were treated with BLM 5 mL/kg (dissolved in 0.9% sodium chloride solution 0.3 mL) by intratracheal instillation to induce pulmonary fibrosis, and the rats in N group with 0.9% sodium chloride solution 0.3 mL instead. Then the rats were given intraperitoneal injection of 0.9% sodium chloride solution 2 mL for N and M group, dexamethasone 3 mg/kg (dissolved in 0.9% sodium chloride solution 2 mL) for D group, ligustrazine 50 mg/kg (dissolved in 0.9% sodium chloride solution 2 mL) for L group, dexamethasone 3 mg/kg combined with ligustrazine 50 mg/kg (dissolved in 0.9% sodium chloride solution 2 mL) for DL group everyday.All of rats were killed at the 28th day.The content of TNF-α and TGF-β1 in BALF were measured by enzyme-linked immunosorbent assay (ELISA), and the histopathology of pulmonary fibrosis was observed by light microscope.

The content of TNF-α and TGF-β1 in BALF of D group, L group and DL group were lower than that of M group, and the difference was statistically significant (all P<0.05). The content of TNF-α and TGF-β1 of DL group were (25.182±4.823) pg/mL, (14.047±2.234) pg/mL respectively, and lower than that of D group and L group, the difference was statistically significant (all P<0.05). The results of histopathology showed the structure of alveoli of N group was normal, whereas no normal alveolar structure and massive infiltrated fibroblast could be observed in M group. Compared with M group, the severity of pulmonary fibrosis of D group and L group reduced, and thickening alveoli septum and compressed and distorted alveoli could be observed. Compared with D group and L group, the severity of fibrosis of DL group reduced further, and alveoli structure could be observed in some districts. The semiquantitative score of pulmonary fibrosis of M group, D group, L group and DL group were 6 (5.00, 6.75), 5 (4.00, 5.75), 5(4.25, 5.75) and 4 (4.00, 5.00) respectively. The score of D group, L group and DL group were less than that of M group, and the difference was statistically significant (all P<0.05). The score of DL group was less than that of D group and L group , and the difference was statistically significant (all P<0.05).

Dexamethasone combined with ligustrazine can reduce the content of TNF-α and TGF-β1 in BALF and decrease the severity of pulmonary fibrosis in rats than one single drug, which contribute to combination therapy for pulmonary fibrosis.

To investigate the dynamic expression of Notch1 signaling and the secretion of interleukin-6 (IL-6) and tumor necrosis factor alpha(TNF-α) from macrophage RAW264.7 cells induced by severe burn rat serum.

Twenty-four male Sprague-Dawley rats were divided into sham burn group and burn at 24 h and 7 d groups randomly, each group had eight rats. The rats of burn groups were made the third degree burns about 30% total body surface area. The serum of burn rats were collected at 24 h and 7 d after burn. The sham burn group was employed 37℃ water-bath and the serum was treated as a control. The mixed culture medium contained 20% burned serum, RAW264.7 cells were cultivated with each group of burned serum for immediate moment, 4, 8, 12, 24, 48 h. In addition, 100 ng/mL lipopolysaccharide+ 20% sham burn serum were applied to culture medium, which were employed to cultivate RAW 264.7. The Notch1 signaling of macrophages were detected after cultivation and the secretion of IL-6 and TNF-α in culture supernatants of each group was measured by enzyme linked immunosorbent assay.

(1) The expression of Notch1 protein had no obvious change at immediate moment, 4, 8, 12, 24, 48 h after stimulation of sham burn serum.(2) In burn at 24 h group, the expression of Notch 1 protein was significantly increased and as time progresses the signaling peaked. (3) In burn at 7 d group, the expression of Notch 1 protein had no obvious change, which was flat as the sham burn serum group.(4) In the mixed culture medium of lipopolysaccharide+ sham burn serum group, the level of Notch1 signaling was significantly increased after stimulation. (5) The contents of IL-6 and TNF-α in burn at 24 h group and in lipopolysaccharide+ sham burn serum group were significantly higher than those of the sham burn serum group and the burn at 7 d group.

The Notch1 signaling and the secretion of IL-6 and TNF-α of macrophage could be stimulated by burn serum and this kind of high level signaling could be imitated by lipopolysaccharide.

Traumatic lacerations and surgical incisions always result in inevitable scars. There are a large number of patients with scars following surgery or trauma. Management of scars is a complicate and systematic project. Before a surgery, incision design and standard suture protocol should be paid attention, then silicone products, corticosteroids and tension-free methods could be used to prevent scars, many therapeutic regimens such as topical scar therapies, intralesional scar therapies, physical therapies, surgeries, and autologous fat grafting are effective to relieve scar related symptoms and signs. This article provides an overview of currently approaches to prevent and manage scars.

With expert questionnaire and investigation, this study aimed to build the orthopedic specialized nurses core competence evaluation index system, which was suitable.

At the early stage of this study, literature retrieval method and expert interview were used to build the draft of core competence evaluation index for orthopedic specialized nurse. Then the experts engaged in orthopedic clinical nursing, orthopedic nursing education, nursing management and nursing research, were selected from class a tertiary hospital in Beijing, Tianjin, Shanghai, Shanxi, Sichuan and etc provinces. With two-round of Delphi survey, the authors integrated the experts′ advice, and the core competence evaluation index system and items of each level were determinate ultimately.

By applying the above methods, the authors established the core competence evaluation index system of orthopedics specialized nurse. The evaluation index system includes 6 primary indexes: professional attitude, professional practice ability, critical thinking ability, nursing management ability, communication ability and the professional development ability. The second indicator had 21 items, and the third indicator had 65 items. After two rounds of Delphi method, the expert positive coefficient were 0.90 and 0.94, the authority coefficient were 0.87 and 0.86, the coordination coefficient was 0.247-0.263.Through the data, expert opinion of index entried to converge, they approved the items more.

Through a series of scientific research methods, the core competence evaluation index system of orthopedic specialized nurse was established. This system may provide comprehensive and quantifiable assessment for orthopedic specialized nurses’ evaluation, and has a guiding significance for training orthopedic specialized nurses in the future.

Hypertrophic scar is one of the widespread pathological scars, which results from tissues over-restoration and extracellular matrix disorderly deposition after deep burn injury. It often causes itching, pain, possible appearance damage and functional limitation, seriously affecting the quality of patients′ life. The current prevention and treatment of hypertrophic scars include non-surgical methods and surgical treatment. Non-surgical techniques include noninvasive therapy, injection therapy, radition therapy, microneedle treatment, photoelectric acoustic therapy and fat transplantation. Non-surgical treatment is the main application technology in the early formation of hypertrophic scar, the combined application of several non-surgical treatment may be an effective way for treating hypertrophic scar, and surgical treatment is the ultimate safeguard of hypertrophic scar. The development directions of prevention and treatment in hypertrophic scar include the development of hypertrophic scar animal models and objective assessment methods, the development of burn wound depth and objective assessment of the seriousness of scar, the development of technical tissue engineering skin and stem cell therapy, as well as multi-center, random, controlled clinical trials. In short, A concept should be established that prevention-based, prevention combined with treatment in the wound healing stage for large area burn trauma patients, rather than treating hypertrophic scar after its formation.

观察复春散1号联合重组牛碱性成纤维细胞生长因子外用凝胶治疗难愈性创面的效果。

选取2011年1月至2015年6月青岛市中心医院烧伤整形科57例存在坏死组织的难愈性创面患者，按照随机数字表法分为治疗组30例、对照组27例。两组创面均按照常规换药清创，清除能够提起、粘连不紧密的坏死组织，以0.5%碘伏消毒，0.9%氯化钠溶液清洗。治疗组(30例)将复春散1号与重组牛碱性成纤维细胞生长因子外用凝胶混合外用，对照组(27例)内用0.9%氯化钠溶液纱布湿敷，两组外层均用干燥无菌纱布包扎。两组均每日换药1次，共30 d。观察两组患者创面坏死组织完全脱落、露出肉芽组织所需时间，治疗15、30 d后的创面愈合率，创周炎症反应、创面分泌物情况以及不良反应发生情况。指标比较采用t检验和χ²检验。

治疗组坏死组织完全脱落、露出肉芽组织所需时间平均为(11.4±2.5) d，对照组为(17.8±3.7) d，两组比较差异有统计学意义(t＝7.584，P＝0.000)。治疗15 d后，治疗组和对照组的创面愈合率分别为(33.8±8.4)%和(18.4±6.8)%；治疗30 d后，治疗组与对照组的创面愈合率分别为(67.5±15.1)%、(39.9±20.8)%，两组比较差异均有统计学意义(t＝7.545、5.762，P＝0.000、0.000)。治疗期间治疗组和对照组创周炎症反应发生率分别为0和18.5%，两组比较差异有统计学意义(χ²＝3.995，P<0.05)；治疗组创面湿润或微湿，无明显分泌物，对照组创面均有多少不等的分泌物。两组均无不良反应发生。

复春散1号联合重组牛碱性成纤维细胞生长因子外用凝胶有利于难愈性创面坏死组织的脱落、杀菌消炎、改善血液循环、促进组织生长，显著缩短了创面愈合的时间，值得临床推广应用。

To investigate the effet of ulinastatin on pulmonary tissue inflammatory mediators, vistal vasopermeability and tissue water content after moderate burn-blast combined injury in rats.

Eighty male Sprague-Dawley rats were randomly divided into the control group and ulinastatin group. A model with moderate burn-blast combined injury, was produced in both groups. Immediately after injury rats were intravenously given either 1 mL sodium chloride solution in control group or 1 mL sodium chloride solution containing ulinastatin in ulinastatin group (40 000 U/kg). The content of tumor necrosis factor-α, interleukin (IL) - 6 and interleukin (IL) - 8 were detected by enzyme linked immuno sorbent assay (ELISA) at 6 hours and 24 hours after injury. The vasopermeability was detected by the method of evans blue and the rates of tissue water content in lung were detected by the dry /wet weight. Measurement data between groups was analyzed by t test.

Compared with control group after 6 h, the inflammatory mediators of TNF-α、IL- 6 and IL- 8 in ulinastatin group were (2103±168)pg/mL, (2315±185)pg/mL and(1827±134)pg/mL, significantly lower than those(2912±184)pg/mL, (2793±223)pg/mL and (2178±145)pg/mL in control group, the difference was statistically significant(t=6.114, 8.123, 7.347, P<0.05). Compared with 24 hours, the inflammatory mediators of TNF-α、IL - 6 and IL - 8 in ulinastatin group were (1235±86)pg/mL, (1093±98)pg/mL and(973±77)pg/mL, even more significantly lower than those(1853±166)pg/mL, (2152±172)pg/mL and(1807±126)pg/mL in control group, the difference was statistically significant(t=5.176, 7.043, 5.732, P<0.05). Compared with control group after 6 hours and 24 hours, the visceral content of evans blue in ulinastatin group were (63.9±3.3), (59.8±3.2)μg/g, significantly lower than those(78.2±3.7), (76.3±3.5) μg/g in control group, the difference was statistically significant(t=7.023, 7.382, P<0.05). Compared with control group after 6 hours and 24 hours, the rate of tissue water content in lung in ulinastatin group were (76.3±1.45)%、(73.8±1.35)%, obviously lower than those (79.8±1.52)%、(78.3±1.47)% in enzyme linked immuno sorbent assay, the difference was statistically significant(t=2.041, 2.758, P<0.05).

The results indicate that ulinastatin significantly alleviate systemic inflammation, inhibit visceral vasopermeability and tissue edema, and it can be used to be early period therapy of burn shock and improve the survival rate.

探讨负压封闭引流(VSD)技术结合大张皮移植治疗深度烧伤创面的疗效。

收集南昌大学第一附属医院烧伤外科2012年7月至2013年6月28例深度烧伤创面，将行大张皮移植封闭创面后应用VSD技术治疗的患者设为观察组；2011年7月至2012年6月32例深度烧伤创面行大张皮移植后采用打包加压治疗的患者设为对照组。记录比较两组患者二次手术率、创面细菌培养阳性率、术后平均换药次数、平均抗生素费用及平均住院时间。

观察组患者二次手术率(28.57%)、创面细菌培养阳性率(25.00%)均分别低于对照组患者，两组比较差异有统计学意义(χ²＝4.66、9.90，均P<0.05)；观察组患者术后平均换药次数(5.0±1.5)次、平均抗生素费用(2676.8±386.5)元及平均住院时间(23.3±8.1)d均明显低于对照组(10.0±3.2)次、(3524.9±503.1)元、(32.5±9.8)d，两组比较差异有统计学意义(t＝2.784、2.154、2.445，均P<0.05)。

VSD技术结合大张皮移植术相比于传统的大张皮移植术后打包加压包扎能降低创面细菌培养阳性率，减少抗生素平均费用，提高皮片成活率，减少植皮次数，缩短病程，减轻患者痛苦，便于操作和护理，在经济条件允许的患者中值得临床推广。