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

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 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.

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 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.

In this study ,we detected the positive rate of anti‐HBs and anti‐HBc antibody among the subject population in Fujian Medical University Union Hospital ,and to evaluate different detection methods of anti‐HBc antibody .The positive rate of anti‐HBs and anti‐HBc antibody were detected by chemiluminescent microparticle immunoassay (CMIA) and one‐step com‐petitive enzyme‐linked immunosorbent assay (ELISA) from the year 2012 to 2013 .The subject population was divided into three groups :group 1 with the age of less than 2 years old ,group 2 with the age of 2‐20 years old ,and group 3 with the age of more than 20 years old .The positive rates of anti‐HBV antibody in the different groups were analyzed .Furthermore ,anti‐HBc antibody of 92 samples selected from the immunized population was detected by CMIA and three kinds of ELISA reagents . Meanwhile ,the detection of anti‐HBc antibody by the same ELISA reagent but different operating modes were performed in these samples .The highest positive rate of anti‐HBs antibody was detected in group 1 ,and there was no significance difference of positive rate between two detection methods of anti‐HBs antibody among three groups .The positive rate of anti‐HBc anti‐body using CMIA was significantly lower than those with ELISA among group 1 and 2 .Among the 92 samples ,the positive rate of anti‐HBc antibody was 2 .2% using CMIA .With three kinds of method of ELISA reagent ,the positive rate of anti‐HBc antibody were 79 .3% ,82 .6% and 94 .6% ,respectively ,and there was no statistical significance among the results of three ELISA reagents .Anti‐HBc was not detected from 19 samples using ELISA methods with different operating modes .It's con‐cluded that the anti‐HBs antibody declined with the increase of age ,and it is necessary to discriminate the specific population to strengthen immune system .The obviously higher positive rate of anti‐HBc antibody was found by ELISA in immunized popula‐tion than that by CM IA . Concerning on the false positive of ELISA , specimen sampling with one specific test item or the CMIA method was recommended to detect the anti‐HBc antibody .

Objective To explore the application effect of Sandwich teaching method in clinical teaching in the department of neurosurgery.Methods Totally 144 clinical medicine students were divided into 2 groups:Sandwich teaching group (n=72) and traditional teaching group (n=72).The analysis of test and the questionnaire of the students were conducted after the course.Comparison between the two groups was made using independent sample t test and measurement data were expressed as as ± s.P＜0.05 signifies statistically significant differences.Rank sum test was used to compare the distribution of the test scores.Results The test score was statistically higher in Sandwich teaching group than control group [(76.38 ± 10.84) vs.(69.67 ± 10.50)].And the main distribution of the test scores was 70～90 in Sandwich teaching group while 60～80 in control group.Questionnaire showed that the scores of Sandwich teaching group were statistically higher than those ofthe control group in five aspects such as enhancing self-learning ability,improving the ability to analyze and solve problems,and so on.Conclusions Sandwich teaching method achieves good teaching effect and it is worth recommending in clinical teachifig.

Objective To observe the effects of estradiol-17? (E 2-17?) on the induction of experimental autoimmune thyroiditis (EAT). Methods Ten-week old female Wistar rats were ovariectomized (OVX). EAT of Wistar rats was induced by immunization with thyroglobulin (Tg) from SD rats in the presence of complete Freund′s adjuvant. Thyroiditis was pathologically evaluated by HE staining. E 2-17? and PRL levels were measured by RIA, anti-Tg antibody (TgAb) was detected by ELISA, and interferon (IFN)-?, interleukin (IL)-10 mRNA in thyroid were assayed by RT-PCR. Results The serum level of E 2-17? (17.60?1.02)pmol/L and PRL (2.45?0.15)?g/L were much lower in OVX rats than intact rats 〔(58.56?6.99)pmol/L and (3.22?0.17)?g/L, respectively〕 (both P