This paper summarized nursing experience of one patient with diffuse esophageal spasm(DES) undergoing peroral endoscopic myotomy (POEM).Key points of nursing included:preoperative training of use of medical bedpan;respiratory functional exercises;postoperative management of body position,nursing of gastrointestinal decompression,management of refined diet and prevention and nursing of complications.The patient recovered well and no complication occurred.The patient was discharged on the eighth day after surgery.

Objective To investigate the expression of insulin-like growth factor Ⅱ mRNA binding protein 3 (IMP3) in non-muscle invasive bladder cancer and its relationship with the tumor recurrence and progression.Methods IMP3 protein expression was detected by immunohistochemistry in 130 cases of nonmuscle invasive bladder cancer specimens who underwent transurethral resection the first time at Beijing Chao-Yang hospital,from October 2010 to October 2013.Besides,we analyzed 20 cases of muscle-invasive samples and 20 benign tissues adjacent to cancer as control.The 130 patients were followed up by telephone and other methods.According to the UICC-TNM standard.Survival analysis was calculated by using the Kaplan-Meier method,and the difference in survival curves was analyzed by using the log-rank test.For multiple analyses,The Cox proportional hazards regression model was used.Results The positive expression rate of IMP3 in 130 patients with non-muscle invasive bladder cancer was 59.2％ (77/130),of which 30.0％ (39/130) was weak expression,29.2％ (38/130) was strong.However there was 80.0％ (16/20) in muscle-invasive specimens,of which 20.0％ (4/20) was weak,60.0％ (12/20) was strong (P =0.011).IMP3 was not detected in all benign tissues adjacent to cancer (P ＜0.001).All the 130 patients were followed-up for 5 to 69 mnonths,45 cases experienced disease recurrence,20 patients had progressed and 12 cases died.IMP3 expression was significantly related to higher tumor stage (P ＜ 0.001),high tumor grade (P =0.014),and tumor recurrence (P =0.003).Kaplan-Meier plots and log-rank tests showed that patients with IMP3-positive tumors had a lower disease-free survival (P =0.002) and progression-free survival rate (P =0.010) than those with IMP3-negative tumors.In the multivariable Cox analysis,we found that IMP3 protein was an independent predictor of disease-free survival (P =0.010) in non-muscle invasive urothelial carcinoma of bladder.Conclusions IMP3 was not expressed in benign tissue adjacent to cancer,whereas highly expressed in bladder cancer,and high IMP3 expression is an independent prognostic factor in NMIBC that can identify the patients with a high potential to relapse.

ObjectiveTo investigate the characteristics of left ventricular structural damage in patients with primary aldosteronism(PA).MethodsA total of 438 inpatients with hypertension from January 2007 to June 2010 were screened for PA,and diagnosis was made in 213 PA patients and 225 patients with essential hypertension (EH).The left ventricular structure of all subjects was evaluated according to the results of echocardiographic measurements.Results The duration of hypertension and plasma aldosterone level in patients with PA were significantly higher (P＜ 0.01 ),while the serum potassium and plasma renin activity were significantly lower (P＜0.01 ) than those in patients with EH.The interventricular septum thickness,left ventricular end-diastolic dimension,left ventricular mass index (LVMI),left ventricular end-diastolic volume,and stroke volume in patients with PA were significantly higher than those in EH patients( P＜0.01 ) after the duration of hypertension was corrected.In patients with PA,the prevalence of left ventricular hypertrophy (LVH) was higher than that in EH patients ( 53.1％ vs 33.8 ％,x2 =16.57,P ＜ 0.01 ). Normal left ventricular geometry ( NG ),concentric remodeling ( CCR ),concentric hypertrophy( CCH),and eccentric hypertrophy (ECH) were found respectively in 24.9％,22.1％,22.1％,and 30.9％ of patients with PA.Multiple stepwise regression analysis showed that the seated plasma aldosterone level (β=0.43,P ＜ 0.01 ) and systolic blood pressure (β =0.45,P ＜ 0.01 ) were the main factors that influenced LVMI.The course was the main parameter that influenced relative wall thickness(β=0.011,P＜0.05 ).Conclusion The prevalence of LVH is higher in patients with PA than that in EH patients.The eccentric hypertrophy is the most common left ventricular geometrical pattern in patients with PA.

e extra-adrenal pheochromocytoma.

One hundred and fifty-six patients with primary aldosteronism(PA)and 189 patients with essential hypertension (EH) were included in this study.The value of estimate glomerular filtration rate (eGFR) was calculated by MDRD equation.The plasma levels of aldosterone,triglycerides,creatinine and fasting glucose were measured.The plasma creatine,24 hour urine albumin excretion in PA patients were higher and eGFR and plasma aldosterone were lower than those in EH patients ( all P ＜ 0.01 ).Multiple regression analysis revealed that the plasma concentrations of aldosterone ( P =0.003 ) and creatinine ( P =0.001 ) were independent predictors of eGFR.

Objective To discuss the coverage of finger soft tissue defect with dorsal proximal digit fasciocutaneous flap on the middle and distal digit.Methods From May,2013 to December,2014,8 cases with soft tissue defects at 8 fingers were treated with dorsal proximal digit fasciocutaneous flap.The flap sizes ranged from 2.5 cm × 2.0 cm to 3.5 cm × 3.0 cm.The donor site were closed straightly.Results Eight flaps of 8 fingers survived.All the wounds at the donor sites healed well.Eight fingers in 8 cases were followed up for 6-12 months.The color,texture and contour of the flaps were satisfied.The two-point discrimination distances were 8-10 mm.Conclusion The skin defect in the middle and distal digit can be satisfied covered with dorsal proximal digit fasciocutaneous flap.This flap is a simple,reliable and safe management for digit defect and can be performed in the primary hospital.To ensure the surviving of the flap,ensure the surviving of the flap,the awareness of the anatomy of the flap should be known well.The limits of its reconstruction of sensation and coverage size exit in its application.

Objective To explore an effective mode for the prevention and control of hypertension in agricultural and pastoral areas in Xinjiang by comparing the effect of mode A with that of B in blood pressure-lowering treatment. Methods 1445 patients with hypertension in agricultural and pastoral areas were included in this study. They voluntarily received mode A or B blood pressure-lowering treatment. The changes in heart rate , blood pressure, lipid, and glucose, and the incidences of cardiovascular and cerebrovascular events and adverse events were noted;and the effect of modes A and B was compared. Results 87.07%of the patients chose mode A group, while 12.93%chose mode B. The rate of pressure control was 70.71%in mode A group and 68.75%in mode B group , with no significant statistical difference (P>0.05). In 12th month of treatment, the decreased level of systolic pressure was (19.09 ± 20.33)mmHg in the group with mode A and (14.14 ± 17.85) mmHg in the group with mode B, showing a significant statistical difference between the two groups (P=0.047); and the declined level of diastolic pressure was (11.17 ± 13.23)mmHg and (8.17 ± 11.17) mmHg, respectively, with no significant statistical difference. Conclusion Mode A blood pressure-lowering treatment can effectively control blood pressure in hypertensive patients living in agricultural and pastoral areas in Xinjiang.

Objective To explore the relationship between genetic polymorphisms of sixtransmembrane protein of prostate 2 (STAMP2) and metabolic index,TNFα in Xinjiang Uygur population.Methods STAMP2 gene functional regions were sequenced in Uygur Xinjiang population diagnosed as metabolic syndrome.Patients were divided into the following three groups by their TNFα concentration:the high level group(TNFα≥7.95 μg/L,n =313),the moderate level group(TNFα ＞5.34-＜7.95 μg/L,n =268)and the low level group(≤5.34 μg/L,n =313).The selected representative variations were genotyped by TaqMan-PCR in 894 Uygur individuals.The association of the genetic variations of STAMP2 gene with metabolic index and TNFα was analyzed.Results Three representative variations were genotyped,including rs8122,rs1981529 and rs34741656.The genotype distribution and allele frequencies of rs8122and rs1981529 were statistically different among the three groups (P ＜ 0.05),while no difference was observed with rs34741656(P ＞0.05).By ANOVA analysis,statistical difference was showed between the rs1981529 polymorphism AA and AG in the concentration of TNFα(P ＜ 0.05).None of the polymorphisms was significantly associated with TC,HDL-C,LDL-C and TG (P ＞ 0.05).Conclusion Two STAMP2 gene polymorphisms,rs8122 and rs1981529 are associated with the concentration of TNFα in Xinjiang Uygur population.

Objective To investigate the outcome between endoscopically assisted and routine anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome.Methods From Februray 2008 to June 2010, forty-four patients with cubital tunnel syndrome were treated with routine anterior subcutaneous transposition (routine group,28 cases) and endoscopically assisted anterior subcutaneous transposition (endoscope group,16 cases).The operate time,drug administration,scar and postoperative hospital stay were compared.The patients were followed 1-12 month postoperatively,postoperative time back to work and function of ulner nerve were recorded.Results The results of endoscope group were as follows: operative time was (67.20 ± 19.69)min; postoperative scar length was (1.5％ ± 0.58) cm; rate of administration of anodyne was 6.3％; postoperative hospital stay was (2.4％ ± 1.42) days; postoperative time back to work,(14.6 ± 4.69)days; the results of open surgery group were as follows:operative time (62.8％ ± 11.06) min; postoperative scar length was (8.7％ ± 1.42) cm; rate of administration of anodyne was 42.8％; postoperative hospital stay was (5.7％ ± 2.53) days; postoperative time back to work was (29.40 ± 8.75) days; all differences of the results were significant between two groups (P ＜ 0.05).According to function of ulner nerve scoring system,one year postoperatively, excellent or good results were 82.14％ in routine group and 81.25％ in endoscope group,no significant difference between two groups (P ＞ 0.05). Conclusion Compared with routine anterior transposition of the ulnar nerve,endoscopically assisted anterior transposition has the following advantages: smaller incision and less tissue damage,less postoperative pain and sooner returning to work.And similar outcome was achieved from the two group.

The clinical data of 330 patients with primary aldosteronism (PA) from January 2006 to March 2010 were retrospectively analyzed. The prevalence of 1, 2, and 3 stage hypertension in these subjects was 3.64％,20. 91％, and 75.45 ％, respectively. Of all PA patients, 89.09％ were young adults and 81.82％ were overweight or obese. There was a marked preponderance of male patients in the overweight or obese group ( P＜0. 01 ). The incidence of hypokalemia was 32. 12％. The concentration of serum potassium was not associated with the disease course. Logistic regression showed that the concentration of plasma aldosterone was an independent risk factor of hypokalemia in PA patients( P＜0. 01 ). 79. 09％ PA patients presented the plasma aldosterone level over 12 ng/dl and the renin activity level of less than 1 ng · ml-1 · h-1. The aldosterone-to-rennin activity ratio was ＞20 in 94.24％ of the patients with PA.