To evaluate the effect of extravascular lung water index (EVLWI) and procalcitonin (PCT) on the severity of burn sepsis caused by Gram-negative bacilli.

From March 2015 to March 2019, 20 patients with burn sepsis of Gram-negative bacilli (Gram-negative bacilli burn sepsis group) and 18 patients with burn sepsis of non Gram-negative bacilli (non Gram-negative bacilli burn sepsis group) who were hospitalized in the Department of Burns, Tongren Hospital of Wuhan University & Wuhan Third Hospital were selected in this study. The patients in both groups were monitored with pulse indicating continuous cardiac output (PiCCO), and the changes of values of EVLWI when diagnosed sepsis and septic shock were recorded. The values were averaged for 3 times, and the mean values were taken. When the patients were diagnosed with sepsis or septic shock, venous bloods of patients were collected immediately, 3 mL of non-anticoagulant blood was collected, and serum was retained after centrifugation and detected for PCT, and the PCT values of patients were recorded in both groups. The differences of EVLWI and PCT between the two groups were compared, and data were processed with t test, Bonferroni correction. The receiver operating characteristic (ROC) curves of EVLWI and serum PCT in predicting burn sepsis and septic shock patients with Gram-negative bacilli were drawn, and 95% confidence interval, Youden index, best critical value, sensitivity and specificity for the diagnosis of burn sepsis or septic shock patients caused by Gram-negative bacilli were calculated.

When the patients were diagnosed for sepsis, the values of EVLWI and PCT of patients in Gram-negative bacilli burn sepsis group were (10.6 ± 1.6) mL/kg and (6.64 ± 1.63) ng/mL respectively, which were higher than those in non Gram-negative bacilli burn sepsis group [(7.9±1.7) mL/kg and (4.60±1.31) ng/mL respectively], and the differences between the two groups were statistically significant (t=5.043, 4.206; with P values below 0.05). When the patients were diagnosed for sepsis shock, the values of EVLWI and PCT of patients in Gram-negative bacilli burn sepsis group were (15.0±1.3) mL/kg and (12.87±2.65) ng/mL respectively, which were higher than those in non Gram-negative bacilli burn sepsis group [(10.7±1.5) mL/kg and (6.29±1.79) ng/mL], and the differences between the two groups were statistically significant (t=9.608, 8.867; with P values below 0.05). By drawing ROC curve, the values of EVLWI and PCT which were used to determine the best critical values of burn sepsis patients caused by Gram-negative bacilli and burn sepsis patients caused by non Gram-negative bacilli were 10.5 mL/kg and 5.9 ng/mL respectively, with Youden index of 50% and 59%, sensitivity of 50% and 70%, and specificity of 100% and 89% respectively. The best critical values of EVLWI and PCT in the diagnosis of burn septic shock of gram negative bacilli and burn septic shock of non gram negative bacilli were 13.5 mL/kg and 9.2 ng/mL respectively, with Youden index of 90% and 95%, sensitivity of 90% and 95%, and specificity of 100% and 100% respectively.

EVLWI and PCT can be used as effective indexes to evaluate the severity of burn sepsis caused by Gram-negative bacilli, and can further improve the accuracy of risk prediction of burn sepsis caused by Gram-negative bacilli.

To investigate the accuracy of high-frequency ultrasound for measuring the thickness of each layer of rat skin from a donor site.

Establishing 40 models of the donor site which came from ten SD rats. The thickness of each layer of skin from rat donor sites and the thickness of split skin were measured using high-frequency ultrasound and histology, respectively, and then the 95% limits of agreement (95%LOA) for measurement data was calculated by the Bland-Altman approach.

The Bland-Altman plot showed that the 95% LOA of the differences in the epidermis thickness, dermal thickness, full-thickness skin thickness and split skin thickness was (-15.80 μm to 14.30 μm, P=0.54), (-9.99 μm to 8.59 μm, P=0.36), (-32.33 μm to 32.03 μm, P=0.95 ), and (-33.62 μm to 32.87 μm, P= 0.89), respectively. In this study, the Bland-Altman plot shows that the difference in dermal thickness and the thickness of the split skin calculated by the two methods were all within the 95% LOA. Only one spot representing the difference in dermal thickness was outside the 95% LOA, and one spot representing the difference in full-thickness skin thickness was outside the 95% LOA. Compared with the maximum allowable clinical error range (±10% of the mean thickness of histological measurements), the 95% LOA of the dermal thickness, full-thickness skin thickness and split skin thickness were all within the clinically acceptable range, and the results showed that 95% of the points of the epidermal thickness were within the 95%LOA and within the clinically acceptable range.

A high level of agreement was discovered between high-frequency ultrasound and histology for measuring skin thickness of donor sites. High-frequency ultrasound can provide non-invasive , qucik, accurate and objective measurement for skin thickness, which have promising application in assessing the depth of donor site.

To explore the application and effect evaluation of standardized nursing process in burn operation room.

One hundred patients who had operations in burn operation room in Ruijin hospital, Shanghai Jiaotong University School of Medicine, from April 2016 to December 2016 were chosen as the experimental group, 100 patients underwent surgery in burn operation room in Ruijin hospital in the same term as control group. The control group was carried out nursing operation and cooperation according to routine procedure. The experimental group was carried out nursing work according to the standardized nursing process, and the nursing work was divided into three parts, namely preoperative nursing, intraoperative nursing and postoperative nursing. The differences in the incidence of nursing defects before and after the implementation of standardized nursing procedures in the two groups, and the results of the satisfaction rate survey among physicians and patients were compared. SPSS 22.0 statistical software was used to analyze the data.

The satisfaction rate of doctors in the experimental group was (98.600±2.114)%, which was higher than that of the control group (96.605±3.339)%, and the difference between the two groups was statistically significant (t=4.900, P<0.05). The satisfaction rate of patients in the experimental group was (94.520±1.096)%, higher than that in the control group (92.550±3.591)%, and the difference between the two groups was statistically significant (t=5.247, P<0.05). The rate of sterilization, equipment operation, specialty coordination and nursing safety in nursing defects in the experimental group was 1%, 2%, 3%, 1%, the data was lower than 10%, 9%, 9%, 7% in the control group, the difference between the two groups was statistically significant(with P values below 0.05).

The implementation of standardized nursing process can reduce nursing defects of nurses in operation room and improve the nursing quality of operation room, so as to effectively save the operation time, improve efficiency and satisfaction rate of doctors and patients.

To analyze and explore the safety and efficacy of pedicle screw fixation and short segment internal fixation in the treatment of lumbar brucellosis spondylitis.

A retrospective analysis from March 2009 to May 2015 according to the diagnostic criteria of posterior debridement, intertransverse fusion, disease and treatment of vertebral pedicle screw short segment internal fixation of 20 cases of lumbar brucellar spondylitis patients, male 12 cases, female 8 cases, age 20-66 years old, average 41.3 years old. Segmental lesions (L2-S1 were less than 3 segments). X-ray, CT and MRI examinations were performed before operation to determine the inflammatory infiltration and bone destruction in the diseased segment, vertebral pedicle and vertebral body. Postoperative imaging observation of bone graft fusion and vertebral stability, and before and after the surgery the pain visual analogue scale, Cobb angle, Frankel classification of neurological function and laboratory detection of erythrocyte sedimentation rate, C reactive protein (CRP) evaluation indexes were compared and statistically analyzed.

All the 20 patients were followed up for 24-48 months, with an average of 32 months. The follow-up period showed no recurrence, no incision infection and sinus formation, internal fixation, no loss, breakage and loosening. All patients with symptoms of poisoning and infection of brucellosis spondylitis symptom disappeared, preoperative Frankel grade: C grade 6 cases, D grade 5 cases, 9 cases of grade E, the last follow-up Frankel grade: D grade 2 cases, 18 cases of grade E. Visual analogue scale from preoperative (8.85±1.62) points to one week after operation (3.39±0.95) points at the final follow-up (0.81±0.11) points (F=72.05, P<0.05). Convex Cobb angle before and after operation for an average of 15.31 degrees plus or minus 2.42 degrees, one week after operation for 4.28 degrees plus or minus 2.12 degrees at the end of the follow-up, 4.21 degrees - 1.31 degrees (F=214.85, P<0.05). Erythrocyte sedimentation rate from preoperative (40.25±1.51) mm/h recovered to one week after operation (16.46±5.72) mm/h, at the end of follow-up (8.47±0.62) mm/h (F=184.49, P<0.05). C reactive protein by preoperative (71.11±7.22) mg/L recovered to one week after operation (22.44±4.82) mg/L, at the end of follow-up (5.12±0.73) mg/L (F=265.71, P<0.05). The bone graft fusion time was 6-11 months, with an average of 7.4 months.

Brucellosis lumbar spondylitis under the premise of good indications for surgery, as long as the preoperative imaging information and surgery to determine the correct status of vertebral infection, select the removal of posterior lesion, bone graft, vertebral nail set, short section Segment of the fixed surgical plan for the relief of pain, infection control, relieve nerve compression, stabilize the spine, reduce trauma and promote functional recovery is safe and reliable, and has good clinical results.

探究负压创面治疗技术(NPWT)在Ⅲ～Ⅳ度褥疮治疗中的临床效果。

回顾性分析笔者单位2010～2016年收治112例Ⅲ～Ⅳ度褥疮患者，2010年1月至2014年12月常规方法(清创＋普通换药＋皮瓣手术治疗)治疗65例Ⅲ～Ⅳ度褥疮(传统治疗组)，2015年1月至2016年12月采用负压伤口治疗技术(清创＋NPWT ＋皮瓣手术＋NPWT治疗)治疗47例Ⅲ～Ⅳ度褥疮(NPWT治疗组)，对比研究两组治疗方法对创面创腔缩小直径、换药次数、住院时间、创面感染情况、术后皮瓣成活情况的影响，并进行愈后回访。

与传统治疗组比较，NPWT治疗组治疗褥疮创面可明显缩小创面创腔直径、减少创面换药次数、缩短住院时间，差异均有统计学意义(t＝3.76、－28.88、－20.17，P值均小于0.05)；NPWT治疗组较传统治疗组降低创面感染情况、减少皮瓣淤血及坏死的发生，两组计较差异均有统计学意义(χ²＝8.10、6.24，P值均小于0.05)。

NPWT具有封闭开放创面、去除坏死组织、减少细菌生长、促进肉芽生长，促进术后皮瓣成活等优点，因此通过清创联合NPWT治疗，再应用皮瓣手术修复和术后NPWT治疗是修复Ⅲ～Ⅳ度褥疮创面的一种较为理想方法。

The formation mechanism of chronic refractory wounds is complex, which is a difficult problem to be solved. Effective classification and systematic evaluation of chronic refractory wounds are of great significance to guide clinical practice. Combining with domestic and foreign of chronic refractory wounds’clinical and basic research, the review is given to the etiology, classification and clinical system assessment of chronic refractory wounds. The review aims to build the evaluation system for clinical diagnosis and treatment of chronic refractory wounds, lays a solid foundation in order to further carry out the diagnosis and treatment of chronic refractory wounds, which has the good practical value.

To evaluate existing drugs for the treatment and prevention of scars and keloids through network meta-analysis methods.

By searching the PubMed, Blackwell, Cochrane Central, Web of Science, Ovid, and Scopus database and the domestic Chinese Biomedical Literature Database, Wanfang database and the Chinese Journal Full-text Database database, literatures were retrieved relevant to the scar medication and prevention research, the data provided by the relevant documents into the Excel spreadsheet, and then import the spreadsheet into the R (2.15.1 version) software (http: //www.r-project.org/), the use of Meta software package and Q test for analysis.

A total of 35 studies were included in the research which contained 28 literatures in English and 7 literatures in Chinese by database searches. Pooled analysis indicated that the drug′s effect on keloids treatment of the overall response rate was (80.0±3.0)%. The overall recurrence rate was (28.0±3.0)%. The effect size of the keloid treatment roughly in the order: steroids, bleomycin, 5-fluorouracil, mitomycin C, verapamil and collagenase. The OR for collagenase was less than 1, suggesting that it was ineffective and potentially harmful, and 95% CI of OR for 5-fluorouracil covered 1, thus its therapeutic effect had yet to be further confirmed. The recurrence ORs for adjuvant treatment of the drugs for keloids were: bleomycin, 5-fluorouracil, verapamil, hormone, imiquimod colchicine and tamoxifen. The drugs which confidence interval exceeds 50% were imiquimod, tamoxifen and verapamil. The comparison between the drugs for the treatment of keloid was not significant. As for the keloid adjuvant therapy, steroids and imiquimod were superior to other drugs in term of the recurrence rate whereas tamoxifen had the highest recurrence rate.

Options of drugs for keloid treatment: steroids, bleomycin, mitomycin C, and verapamil, while for the prevention of recurrence was steroids, the role of other drugs had yet to be confirmed.

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.