Humans ; Phosphorus Compounds ; toxicity ; Poisoning ; therapy

Based on a survey of community health service organization in several cities, community health service model based on the family clinic was compared with state-owned community health service model, and status quo, advantages and problems of family community health service organization were analyzed. Furthermore, policies for the management of community health service organization based on the family clinic were put forward.
China ; Community Health Services/*methods ; Community Health Services/*organization & administration ; Data Collection ; Delivery of Health Care/organization & administration ; Hospitals, Community/*organization & administration

BACKGROUND:Traumatic soft tissue defects of the limbs are usual y accompanied with the exposure of tendon, joint capsule, bone or internal fixator, which can be reconstructed by skin flap. Previous research has shown that it is an important method to repair traumatic tissue defects with flaps. However, rarely research reports perioperative management about flap bed so far. OBJECTIVE:To explore the perioperative strategy for repairing traumatic soft tissue defects with revascularized flaps. METHODS:Total y 94 cases undergoing secondary skin flap repair were enrol ed. Intraoperative debridement using tourniquet was performed, and the wound was washed with mass of physiological saline. Whether the tissues, including bone, tendon, joint capsule and internal fixator, were reserved or not depended on their viability, and then the flaps were harvested to repair defects, and drainage was placed properly at last. RESULTS AND CONCLUSION:The flaps survived in al cases. Exudation occurred in 5 cases with the exposure of bone, and 28 cases with the exposure of tendon or joint capsule healed normal y. No complications were associated with the reservation of the internal fixators, but delayed-union occurred in three cases and nonunion in one case. These findings indicate that the perioperative treatment of the application of skin flap is worthy of attention. Careful debridement, advisable choice of the flap, efficient drainage and using antibiotic normatively are al keys. Treatment of the bone, tendon, joint capsule and internal fixator which are exposed should not only weigh the advantage and disadvantage, but also relax the indication of reserving them.

Objective To explore the clinical significance of application of trans-abdominal Heller combined with Dor fundoplication for esophageal achalasia in the elderly.Methods Clinical data of 9 patients with esophageal achalasia undergoing trans-abdominal Heller combined with Dor fundoplication from Oct.2009 to Dec.2013 were collected.The postoperative effects and complications were analyzed.Results The operations were successful in the 9 patients with no conversion to open operation and no complications.The maximum esophageal diameter was reduced to (1.94 ± 0.76) cm from (3.69 ±-1.34) cm (P＜ 0.05).Rest lower esophageal sphincter pressure declined by 12.18 mmHg in average (1 mmHg=0.133 kPa,P＜0.05).Dysphagia score fell to 2.49 points from 7.88 points (P＜0.05).There were no retrosternal pain and dysphagia,stenosis and food retention in the lower esophagus and cardia place,and obvious expansion in esophageal.There were statistically significant differences in the above indexes.Conclusions The trans-abdominal Heller combined with Dor fundoplication can significantly improve the symptoms of esophageal achalasia in elderly patients,and effectively prevent postoperative gastroesophageal reflux,and has the characteristics being minimally invasive and fast,and fewer complications.

Objective To evaluate the clinical value of cerebrospinal fluid ADA,IL-23 joint detection in the diagnosis of tuberculous meningitis related diseases.Methods 253 cases with tuberculous meningitis related diseases were selected as the research subjects.According to the diagnosis,they were divided into tuberculous meningitis group (meningitis group,138 cases ),tuberculous meningitis complicated with hydrocephalus group (hydrocephalus group,35 cases)and control group(80 cases).All patients after admission received lumbar puncture, the part of cerebrospinal fluid specimens were inspected,the cerebrospinal fluid ADA,IL -23 joint test was conducted.Meningitis group and hydrocephalus group were given anti -TB drugs (INH,RFP and PZA +sm ) combined with chemotherapy.3 months after treatment,the meningitis group and hydrocephalus group received lumbar puncture cerebrospinal fluid ADA,IL -23 joint test again.The levels of ADA,IL -23 in cerebrospinal fluid were compared.Results Before treatment,cerebrospinal fluid ADA,IL-23 levels in the meningitis group were (12.64 ± 5.54)u/L and (48.38 ±10.78)pg/mL,those in the hydrocephalus group were (15.81 ±6.92)u/L and (77.21 ± 13.42 mm)pg/mL,which in the control group were (3.21 ±2.20)u/L and (9.05 ±3.89)pg/mL,ADA,IL-23 levels in meningitis group and hydrocephalus group before treatment were significantly higher than the control group (F=117.24,724.97,P<0.001).Spearma analysis showed that each group of cerebrospinal fluid ADA and IL-23 had no correlation.After treatment,the cerebrospinal fluid ADA,IL-23 levels in the meningitis group were (3.79 ± 3.13)u/L and (13.46 ±6.62)pg/mL,which in the hydrocephalus group were (6.42 ±4.35)u/L and (25.42 ± 8.54)pg/mL,the meningitis group before and after treatment had statistically significant differences in cerebrospinal fluid ADA,IL-23 (t=16.34,32.43,all P<0.001);hydrocephalus group before and after treatment had statistically significant differences in cerebrospinal fluid ADA,IL-23 (t=6.80,19.26,all P<0.001 ).Conclusion Cerebro-spinal fluid ADA,IL-23 joint detection in the early diagnosis of tuberculous meningitis related diseases and clinical observation has high clinical value.

Objective To investigate the clinical efficacy of nifedipine sustained-release formulation(SR)and nifedipine controlled-release(GITS)in the treatment of essential hypertension.Methods 160 patients with essential hypertension were randomly divided into two groups.The SR group was treated with SR 20 mg twice a day;GITS group was treated with GITS 30 mg once a day.All patients were given ambulatory blood pressure monitoring(ABPM)and observed the 24-hour average blood pressure,heart rate,changes in the trough/peak(T/P)values,and adverse reactions before and after treatment in two groups.Results The T/P value of systolic blood pressure(SBP)and diastolic(DBP)in the GITS group was 68.5％,74.6％,respectively,which were higher than those of SR group(57.2％,61.1％)(x2=6.32,7.05,all P＜0.05);GITS group was significantly lower than the SR group in heart rate(t=4.17,P＜0.05);Adverse reactions between two groups had no significant difference(x2=0.16,P＞0.05).Conclusion SR and GITS can effectively lower blood pressure,but GITS is more efficient,stable,safe,small impact on the heart rate.

Objective To observe the therapeutic effects and comphcations of treatment by using transcatheter arterial chemombolization(TACE) combined with functional splenic embolization(FSE) on patients with primary hepatocelluar carcinoma (HCC) combinded with hypersplenism.Methods Eighty HCC patients with hypersplenism were randomly divided into two groups by computer program.Observation group was treated with TACE and FSE,while control group was treated by only TACE.The iodine oil deposition,blood routine parameters and related complications were observed.Results (1) After one-month' s treatment,abdominal CT scan showed that 38 cases(79.17％) of patients in the observation group and 27 cases (84.38％) of patients in control group had iodine oil deposition in over 50％ of the tumor area.(2) The white blood cell counting in observation group were (7.65 ± 2.3) × 109/L,(5.89 ± 1.9) × 109/L,(5.02 ± 1.7) × 109/L in the follow-up examination 1 week,1month and 3 month after splenic embolization,respectively,which were significantly increased from the preoperative level of (2.21 ± 1.1) × 109/L(P ＜ 0.05).Platelets counting were (93 ± 29)× 109/L,(127 ± 32) × 109/L and (119 ± 26) × 109/L in observation group at 1 week,1 month and 3 month after splenic embolization,respectively,which were significantly higher than the preoperative level of (39 ± 20)× 109/L (P ＜ 0.05).In the control group,there were no statistically significant difference between the preoperative and postoperative levels (P ＞ 0.05).(3) Both of the the two groups showed no serious complications.Conclusion TACE combined with FSE is a safe and an effective method to treat hypersplenism combined in HCC patients.

BACKGROUND:Kinesin II family member 3A (KIF3A), as an important member of the kinesin-2 family, not only holds some general characters of kinesin including the regulation of intracel ular transport and mediation of microtubule movement, but also possesses its own specific features.
OBJECTIVE:To review the research progress of the function of KIF3A recently.
METHODS:A computer-based online research for relative literatures published from January 1996 to July 2016 was performed in PubMed and CJFD databases using the English retrieval words of“KIF3A;kinesin;molecular motor”and Chinese keywords of“kinesin;microtubule;function;molecular motor;spinal cord injury”, respectively. A total of 92 articles were retrieved, and 62 eligible articles were included according to the inclusion criteria.
RESULTS AND CONCLUSION:KIF3A is involved in new bone formation regulation, in the control of nephron number, cell survival and gene expression, in sperm formation and in the inhibition of prostate cancer and glioblastoma process:In the meanwhile, whether KIF3A is involved in spinal nerve injuries is discussed. All provide valuable new information and new ideas for further in-depth study on the KIF3A.

Objective To investigate the therapeutic effect of the ultra-early stent-assisted coil embolization of the ruptured intracranial aneurysms. Methods The clinical data of 13 patients with ruptured intracranial aneurysm treated by ultra-early stent-assisted coil embolization were analyzed retrospectively. The preoperative Hunt-Hess gradeⅠ-Ⅱ was in 7 cases,gradeⅢ was in 4 cases,and grade Ⅳ was in 2 cases. The patients were treated with stent-assisted coil embolization under the general anesthesia with endotracheal intubation within 24 h of aneurysm rupture. The postoperative embolization was assessed according to the Raymond grading standard. The postoperative complications and the assessment of the follow-up results from 1 to 6 months after procedure according to the modified Rankin scale (mRS ) scores were observed. Results All 11 patients recovered well,1 case had postoperative hemiplegia,1 case had postoperative bleeding,and none of them died. During the follow-up period,no patients had rebleeding, 1 had recurrence,and DSA revealed that the patient was embolized completely at 2 months after reembolization. Conclusion The method of ultra-early stent-assisted coil embolization of ruptured intracranial aneurysms is feasible. It may improve the cure rate of the ruptured aneurysms and improve the prognosis of patients.

Objective To investigate the modified methods and effects of the flaps with nutrient vessels of superficial vein-cutaneous nerve of lower limb which used for repair of the lower extremity soft-tissues defects.Methods Between December 2003 and September 2009, 18 patients were treated with this modified skin flap, in which 11 cases male; 7 cases were female, age from 5 to 73 years.Average age was 45.9 years.Repair parts: 4 cases of dorsal foot, 3 cases of foot, heel in 2 cases, the ankle weeks in 2 cases, calves under 1 / 3 of 7 cases, of which 8 cases of bone exposure wounds, tendons exposed in 3 cases.Surgical repair of soft tissue defect size of about 6 cm×4 cm-22 cm × 10 cm, which retained the donor sural nerve function retrograde sural nerve flap in 4 cases, with a thin layer of muscle retrograde sural nerve flap in 4 cases.Results All the flaps were survived completely without any complications.The appearance and functional results were satisfactory with following up for 3 to 36 months.18 cases of flap were survived completely, primary healing, without any complications such as vein congestion or engorgement.The 4 cases which remains the cutaneous nerve in site had an average recovery time about 13 days of the donor site.The innervated region of the cutaneous nerve had no acroesthesia or dysesthesia.Conclusion This modified operation methods of flap, enhanced the blood support of the flap, impmved the survive rates and also preserved the sensory function of the patients' donor site.This modified flap with nutrient vessels of superficial vein-cutaneous nerve is a convenient and safe method in repairing lower extremity soft-tissues defects.