Objective To introduce the super minimally invasive transintercostal device closure of ventricular septal defect (VSD) and summarize it's therapeutic effect.Methods Nine patiens with VSD from August 2014 to December 2014 in our hospital were enrolled,which performed super minimally invasive transintercostal device closure of VSD.All patients were followed up prudently post-operation.Echocardiography was scheduled according to the protocol.Results All cases were successfully occluded.There was no death case in the peri-operation period and severe complications after operation.Conclusions The super minimally invasive transintercostal device closure of VSD is safe and reliable.

Objective To evaluate the clinical application of 3 D ultrasound in the diagnosis of bladder diseases. Methods In 21 patients with bladder disease,3 D images were studied with a Voluson 530D diagnostic system.At first,the two dimensional images of lesions were collected,then defined 3 D volumes of interest were stored,reconstructed and analyzed. Results 3 D ultrasound provided a clear stereoscopic view and depicted the appearance of the 21 bladder diseases,displayed the internal structures,and showed invasive depth within and outside the bladder wall and also metastasis of the adjacent organs. Conclusions 3 D ultrasound can clearly demonstrate the morphologic characteristics and internal structures of the bladder disease and provide much more reliable information for the diagnosis of diseases.

Objective To investigate the dermoscopic features of palmoplantar melanocytic lesions.Methods The dermoscopic images of palmoplantar melanocytic lesions that underwent examination in the Department of Dermatology in Peking University First Hospital from September 2009 to October 2011,were retrospectively analyzed.Results Totally,155 benign acral melanocytic lesions in 121 patients and 23 acral melanomas in 22 patients were analysed in this study.Among the benign acral melanocytic lesions,the parallel furrow pattern and its variations (34.2％) were the most common,followed by the fibrillar pattern (22.6％).Two benign lesions (1.3％) showed a parallel ridge pattern.Of 23 melanoma lesions,12 (52.2％) exhibited parallel ridge pattern,and 14 (60.9％) showed irregular diffuse pigmentation that was present in all of the invasive melanoma lesions.The fibrillar pattern,as a common benign acral dermoscopic pattern,was also present in 39.1％ of melanoma specimens.Conclusions Dermoscopy is valuable to some extent in the differential diagnosis of benign melanocytic nevi and malignant melanoma in palmoplantar region,and may facilitate the secreening for early melanoma.

Objective To estimate the application value of dermoscopy in the differential diagnosis of basal cell carcinoma (BCC).Methods Patients who underwent dermoscopic examination and had been definitely diagnosed by pathological examination in the Peking University First Hospital were enrolled in this study.In a blind study,dermoscopic images of 86 BCC lesions from 81 patients (case group) and 68 non-BCC hyperpigmented lesions with similar degree of hyperpigmentation and location from 61 patients (control group) were evaluated for features suggestive of BCC and melanocytic lesions.The diagnostic capability of dermoscopy in patients with BCC was evaluated by diagnostic test.Pathology served as the gold standard method for diagnosis.The frequency of features suggestive of melanocytic lesions was calculated in BCC lesions,and dermatoscopic findings were compared between heavily and lightly pigmented BCC lesions.Results The sensitivity,specificity,positive predictive value,negative predictive value of the classic dermoscopic pattern for the diagnosis of BCC were 98.84％,89.71％,92.39％,98.39％ respectively,with a Youden index of 0.88.The coincidence rate was 94.81％ between pathologic and microscopic diagnosis.Pigment network,multiple brown to black globules/dots,pigmentation around hair follicle openings were observed more frequently in melanocytic lesions compared with BCC lesions (all P ＜0.05).Blue-whitish veil-like structures were observed in 61.63％ of the BCC lesions.The presence of blue-black blotch and blue-whitish veil-like structures was significantly more frequent in heavily pigmented BCC lesions than in lightly pigmented BCC lesions (both P ＜0.01).Conclusions The classic dermoscopic pattern of BCC shows a favorable diagnostic capacity in Chinese population.Large-scale studies are needed to estimate the value of some features proposed in this study,such as peripheral pigment in palisade arrangement,peripheral hyperpigmentation and hypo-or hyperpigrnentation around hair follicle openings,in the differential diagnosis of pigmented diseases.

OBJECTIVE:To provide reference for further standardizing and perfecting the management of drug unpacking in outpatient pharmacy.METHODS:A total of 6 primary and secondary health institutions (4 community health service centers and 2 secondary hospitals) were selected from 2 districts in Shanghai to conduct a questionnaire survey on the use of their drugs and drug unpacking in outpatient pharmacy.The survey data was analyzed statistically.RESULTS:Totally 6 institution questionnaires and 6 pharmaceutical staff questionnaires were sent out,all were received with recovery of 100％.In 2015,the average number of essential medicines in community health service centers and secondary hospitals were 496.50,542.00,respectively,and the average number of varieties sold were 530.75,1 052.00.In outpatient pharmacy of surveyed community health service center,the number of unpacked drugs was 10-21 which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 5.56-16.70 ten thousand yuan.In outpatient pharmacy of 2 two secondary hospitals,the number of unpacked drugs were 17 and 23,respectively,most of which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 13.19 to 158.06 ten thousand yuan.The proportion of unpacked drugs was less than 5％ of the total number of varieties sold,and the proportion of consumption sum of unpacked drugs was less than 1％ of total consumption sum.Estazolam tablets and Alprazolam tablets took up the top 5 in the list of consumption sum of unpacking drugs in 2 types of intervi ewed instiutions.All the surveyed institutions were not equipped with drug dispensing machine in the outpatient pharmacy,still depended on manually unpacking.There were four institutions to regularly arrange the unpacking,unpacking frequency was usually 1 to 3 times a week,supplemented by the need to arrange unpacking,and another two to implement a daily unpacking.There were 5 institutions to develop a drug unpacking mechanism in the institutions,but the relevant system was not perfect.CONCLUSIONS:The enthusiasm of pharmaceutical saff in primary and secondary health institutions in Shanghai to carry out or engage in unpacking work need to be improved,the instructions for unpacked drugs are not available on request,and the way to unpack drugs still needs to explore.

Objective To investigate the effect of nano-silver antibacterial dressing on infection control in the patients with diabetic foot. Methods 60 patients with diabetic foot who were treated in our hospital from January 2017 to January 2018 were selected as the study subjects. They were randomly divided into intervention group and control group, with 30 cases in each group. Both groups strictly controlled blood glucose levels. After debridement, the intervention group was given nano-silver antibacterial dressing. The control group was given vaseline dressing. The degree of wound pain, the severity of wound ulcer, and the area of ulcer were evaluated at the time of enrollment and 4 weeks after treatment. The ulcer healing time and the number of dressing changes were counted in both groups. Results After intervention, the Wagner grading of the two groups was significantly improved compared with that before treatment, and the difference was statistically significant (P<0.05); after treatment, the Wagner grading in the intervention group was significantly better than that in the control group, and the difference was statistically significant (P<0.05). After intervention, the ulcer area of the two groups was significantly lower than that before the intervention (P<0.05); the ulcer area in the intervention group was smaller than that in the control group after intervention (P<0.05). The VAS in the two groups after intervention was significantly lower than that before the intervention (P<0.05); the VAS in the intervention group was significantly lower than that in the control group after intervention (P<0.05). The ulcer healing time in the intervention group was significantly shorter than that in the control group, and the difference was statistically significant (P<0.05); the number of dressing changes was significantly lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion The application of nano-silver antibacterial dressing can promote the healing of ulcers, reduce the ulcer area, improve the Wagner grading and reduce the number of dressing changes.

Objective To investigate the clinical characteristics of patients infected with human adenovirus type 7 and to provide guidance for early diagnosis and timely control of the outbreak.Methods A total of 301 patients infected with the human adenoviruses who were quarantined in hospital from December 2012 to February 2013 were observed.Epidemiological questionnaires were used to collect data of clinical features of the disease including symptoms,signs,images and laboratory tests.To confirm infection,real time polymerase chain reaction was performed using patients' swabs to detect viral nucleotide.Results Most cases happened in December to the next February.Totally 277 cases of the 301 patients were male,and only 24 cases were female.Mean age was (19.1±1.9) years old,range 15 to 29 years old.Identifiable epidemiologic links were seen between patients.The most common symptoms were fever (100.0％),cough (70.4％),expectoration (48.2％),and sore throat (47.8％).In addition,some patients presented with headache,dizziness,chills,fatigue.The most common signs were pharyngeal congestion (62.5％),enlargement of tonsils (56.5％) and lymphatic follicular hyperplasia (26.6％).Some patients' tonsil was covered with white secretions.Lung images were abnormal in 75 cases,which were presented with mild pneumonia with or without surrounding exudative lesions and pleural effusion in lung images.Laboratory tests showed that the number of white blood cells in the peripheral blood in most of the patients (99.0 ％) was elevated or normal.The proportions of neutrophils (54.2％) and monocytes (80.7％) and the level of C-reactive protein (42.2％) increased,while the proportion of lymphocytes reduced (67.1％).The average course of disease was (6.6±2.9) d.With the treatment of intravenous ribavirin and reduning,all patients were cured.Conclusions Human adenovirus type 7 is quite contagious and may cause epidemic outbreak,especially in winter.The majority exhibits mild symptoms of upper respiratory tract infection with short duration,including fever,cough,expectoration and sore throat.Through timely and active treatment,all patients have a good prognosis.

ObjectiveTo study the anatomical abnormalities of basal ganglia and research their influence on depression status in patients with post stroke depression (PSD)by diffusion tensor imaging (DTI) of MRI.MethodsPatients with basal ganglia infarction were recruited,and divided into groups of PSD and non depression control group by Hamilton Depression Rating Scale (HAMD) assessment. All the patients were evaluated with National Institute of Health Stroke Scale ( NIHSS). And the patients were checked by DTI sequence.Fractional anisotropy (FA),average diffusion coefficient (ADC) values and the number of nerve fiber were measured in bilateral caudatum,pallidum,putamen and thalamus.ResultsThe score of NIHSS (6.29 ± 3.45 ) was significantly higher in PSD group than that in non-depression group (3.95 ± 1.90 ;t =2.219,P =0.036). No significant difference was found between the two groups for the DTI data of the basal ganglia nuclei ( t =0.056-1.618,all P ＞ 0.05 ). Compared with contralateral construction (0.40 ± 0.02 ),the FA value decreased in the left putamen ( 0.37 ± 0.03 ) in the PSD group ( t =2.243,P =0.045 ).By Spearman correlations analysis,the HAMD score was positively correlated with NIHSS score ( r =0.464,P =0.017 ),and negatively correlated with the FA values of left pallidum (r=-0.563,P=0.005),right pallidum (r=-0.416,P=0.035) and left putamen (r =-0.428,P =0.029).Conclusions The occurrence of PSD was associated with neurological functional deficit following basal ganglia infarction.The depression level was correlated with the increasing of NIHSS score,the reductions in bilateral pallidum and left putamen FA values.This research contributes to evaluation of the PSD status in patients with basal ganglia infarction.

Objective: To explore the psychological experience of patients with aortic dissection facing rescue of follow patients in CCU, so as to provide evidences for proposing appropriate nursing countermeasures and responding measures. Methods: A qualitative study was used on 16 patients with aortic dissection within 24 hours when the rescue of follow patients was in CCU through semi-structured in-depth interviews and the interview data were collected and analyzed by Colaizzi content analysis. Results: The enlargement of somatic discomfort symptoms. The various emotional. The different coping strategies. The inner needs. Conclusions When rescuing patients with other aortic dissection in CCU, medical staffs should pay more attention to the distress of physical discomfort symptoms such as pain, promote their benign mood during rescue and encourage patients to adopt positive coping styles. At the same time, constructing a reasonable social and family support ways to help patients recover physically and mentally, ensure the quality of nursing services and patient safety, and improve their hospitalization comfort.

Objective To estimate the value of clinical parameters (such as patients' age,longitudinal melanonychia width and location) for the differential diagnosis of malignant and benign longitudinal melanonychia as well as for the evaluation of the necessity for invasive management.Methods A retrospective study was performed on 28 cases of subungual malignant melanoma collected from 2000 to 2010 as well as on 62 cases of benign longitudinal melanonychia from 2005 to 2010.Clinical analysis was carried out to compare the differences in clinical parameters such as.patients' age,longitudinal melanonychia width and lesional location,between the malignant melanoma and benign longitudinal melanonychia cases.Logistic regression analysis and ROC method were used to determine valuable clinical parameters for the differential diagnosis of malignant and benign longitudinal melanonychia.Results Significant differences were observed in the median age at diagnosis (23.0 years vs.52.5 years,Z =5.44,P ＜ 0.01 ),age at onset (21.0 years vs.48.0 years,Z =4.70,P ＜ 0.01 ),and longitudinal melanonychia width (3.0 mm vs.15.0 mm,Z =5.69,P ＜ 0.01 ) between the patients with malignant melanoma and benign longitudinal melanonychia.The involvement of thumb and hallux was observed in 77.8％ of the subungual melanoma cases,and 48.3％ of the benign cases (x2 =6.57,P ＜ 0.05).ROC method and Logistic regression analysis indicated that the age at onset and diagnosis as well as width of longitudinal melanonychia were of diagnostic value for the differential diagnosis of malignant and benign longitudinal melanonychia.Conclusions Not all longitudinal melanonychia cases need an invasive management at the time of awareness.The age at onset and diagnosis,width of melanonychia and site of the onset appear to be valuable in the differential diagnosis of malignant and benign longitudinal melanonychia,and there is a possibility to guide clinical diagnosis and treatment by establishing a mathematical model with these parameters.