Objective To probe into the proper ratio of doctors and nurses and appropriate nursing programs in community health service. Methods A number of methods were used, including task analysis, use of old handsexperience, sociological survey, and literature review. Results Medical consultation took 1 105 minutes, taking blood pressure took 141.5 minutes, transfusion took 493.5 minutes, intramuscular injection took 44.5 minutes, and drawing blood took 77.5 minutes. According to the above results, the ratio of doctors and nurses was respectively 3.18∶1, 0.94∶1, and 2.02∶1. Also, by analyzing in a comparative way the nursing programs already developed both at home and abroad and taking into consideration the reality, suggestions were put forward as to the kind of nursing program communities ought to start. Conclusion The findings are of referential value to administrative departments of health and medical institutions.

Objective To analyze the cause of neonatal unplanned extubation( UEX)of gastric tube as well as explore the strategies. Methods Seven hundred and sixteen neonates with gastric tube were registered. Their intubation time,intubation aim,extubation time,extubation reasons of unplanned extubation of gastric tube were recorded and analyzed. Results The incidence of UEX of gastric tube was 13. 3%(95 cases) and 1. 54 per 100 tube days in the neonates. The incidences of UEX in channel orally and body unrestraint were 33. 6%(46/137)and 24. 3%(42/173),higher than that of nasopharyngeal tube(18. 5%(49/579))and body restraint(9. 8%( 53/543 )),and the difference was significant( P = 0. 046,0. 004 ). Incidence of UEX in adhesive tape fixing group was 18. 1%( 23/127 ),higher than in bandage group( 11. 4%( 41/359 )) and transparent dressing group(9. 4%(31/330)),and the difference was significant(P=0. 034). Incidence of UEX caused by doctors or nurses was 24. 2%(23/95). There were more UEX from 12 to 14 O'clock and 22 to 1 O'clock. The channel of gastric tube( Oral cavity and nasopharynx,P = 0. 031,RR = 1. 563,95% CI 1. 205-2. 341),fixing method of tube( tape,bandage and transparent dressing,P=0. 004,RR=1. 492,95%CI 1. 320-3. 541)and body restraint(had/hadn't,P=0. 021,RR=1. 298,95%CI 1. 087-3. 271)were the influence factors of UEX. Conclusion The approaches including selecting nasal cavity as the tube channel,effective fixing of the tube,proper body restraint,perfect wandering round and standard nursing practicing are effective strategies to prevent UEX of gastric tube.

Objective:To evaluate of effects of Qingxianyin in the treatment of oral lichen planus(OLP),and to explore its regula-tion of T lymphocytes cellular immune mechanism.Methods:25 cases of OLP were treated by Qingxianyin for 8 weeks and 25 heathy subjects were served as the blank controls.Before and after treatment,peripheral blood CD4 +,CD8 + lymphocyte counts and percentages and CD4 +/CD8 + ratio were measured by flow cytometry.The clinical effects of Qingxinayin were evaluated.Results:After 8 weeks of treatment,significant effect,improvement and ineffecacy were observed in 1 8,5 and 2 cases respectively.The total effective ratio was 92.0%.The CD4 + lymphocyte counts and percentage increased(P <0.05),CD8 + counts and percentage de-creased(P <0.05),CD4 +/CD8 + ratio increased(P <0.05).After treatment the indexes changed towards those of the healthy con-trols.Conclusion:Qingxianyin is effective in the treatment of OLP by promoting mucosal healing,microcirculation and improving im-mune function.

Objective To explore the curative mechanism of Jieyuan (JY) Capsule on rats renal failure induced by 5/ 6 nephrectomy. Methods Chronic renal failure (CRF) rat models induced by 5/6 nephrectomy were administered with JY Capsule. The serum levels of blood urea nitrogen (BUN) and serum creatinine (Scr),hematological and biochemical indexes,and renal histological features were observed. Results JY Capsule reduced levels of BUN and Scr,ameliorated the electrolyte,increased the number of red blood cell and hemoglobin content,and alleviated pathological changes of the kidney tissue. Conclusion JY Capsule can relieve the rat CRF symptoms and postpone the progress of CRF.

Background Drug resistance is the main cause of failure after chemotherapy of retinoblastoma (RB),and how to improve the sensitivity of RB cells to chemotherapic drug become an urgent issue.All trans retinoic acid (ATRA) can inhibit the growth of tumor cells.However,whether ATRA increases the sensitivity of RB cells to chemotherapic drug is unclear.Objective This study aimed to investigate the inhibitory effect of ATRA with vincristine on the proliferation of SO-RB50 cells.Methods SO-RB50 cells were cultured routinely.Different concentrations of ATRA or vincristine were added into the medium for 48 hours for the determination of IC50 by cell counting kit-8 (CCK-8) method.Cultured cells were divided into normal control group,ATRA group,vincristine group and combined drug group.The cells were treated by ATRA or vincristine with the dose of IC50,and the proliferation of the cells was detected every day at the 24-hour interval for 6 consecutive days.The percentage of the cells in different cell cycles was analyzed 72 hours after treatment using flow cytometry.Cell apoptosis rate was detected and calculated 48 hours after treatment by annexin V/propidium iodide (PI) method.Results The IC50 of ATRA was approximately 12.84 μ mol/L,and that of vincristine was 0.11 μg/ml.The growth curve of SO-RB50 cells was gradually raised as the lapse of time,but the curves were relatively low in the ATRA group,vincristine group and combined drug group,with the lowest curve in the combined drug group.The proliferation values of the cells (A450)were 1.078±0.022,0.611 ±0.038,0.596 ±0.031 and 0.483 ±0.030 in 48 hours after treatment,and those in 72 hours were 1.380± 0.021,0.799 ± 0.016,0.668 ± 0.041 and 0.532 ± 0.033 in normal control group,ATRA group,vincristine group and combined drug group,showing significant differences among the groups and various time points (Fgroup =1115.207,P =0.000;Ftime =257.781,P =0.000).The A450 values of the ATRA group,vincristine group and combined drug group were significantly lower than those of normal control group (all at P＜0.05).The percentage of the cells in different cell cycles was changed after 72 hours' treatment and the differences were statistically significant (FG0/G1 =130.565,Fs =57.435;FG2/M =114.290,P＜0.05).Compared with the normal control group,the percentage of G0/G1 phase cells was increased and S phase cells was decreased significantly in ATRA group,the percentage of G0/G1 phase cells was decreased and G2/M phase cells was increased significantly in vincristine group(P＜0.05).The apoptotic rate of the cells was (7.17±0.18) ％,(27.34±1.36) ％,(27.49±2.45) ％ and (34.50±1.84) ％ in normal control group,ATRA group,vincristine group and combined drug group,with a significant difference among the groups (F=147.555,P＜0.05),and the apoptotic rate in the combined drug group was remarkedly lower than that of normal control group,ATRA group and vincristine group (all at P=0.000).Conclusions ATRA can improve the sensitivity of SO-RB50 cells to chemotherapeutic drug.The combined application of ATRA and vincristine enhance the inhibitory effect on the cells probably by regulating cell cycle and inducing apoptosis.

Pi-dan is a signifi cant conception,which comes from Inner Canon of Huangdi.From the vivid description of Pi-dan in Inner Canon of Huangdi,we consider that the formation and process of Pi-dan is equivalent to metabolic syndrome.They are have the same etiological factor:obesity,the same pathogenesis:abdominal fullness and interior heat,and they can result in diabetes,hypertension,hyperlipidemia,fat liver,gout and a series of severity vascular complication.The theory of Pi-dan exactly points out that obesity the original cause of metabolic syndrome,and suggests that early prevention and treatment for obesity is an important method to prevention metabolic syndrome and its complications.The main pathogenesis of Pi-dan is abdominal fullness and interior heat,and the main therapeutic methods are Xiaogaojiangzhuo,Kaiyuqingre,and Huoxuetongluo.

ObjectiveTo explore the effects of recombinant human growth hormone(rhGH)on myocardial inflammatory cytokine expression and heart function in rats with acute myocardial infarction (AMI). MethodsRats with AMI induced by left anterior descending coronary branch ligation were randomized to rhGH and control groups compared with sham-operated group. The effects of 4 weeks of therapy with GH starting 24 hours after myocardial infarction on myocardial cytokines expression and heart function were studied. Myocardial inflammation was examined by analyzing the myocardial cytokine production including the pro-inflammatory cytokines: interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α and the anti-inflammatory cytokine: IL-10. Echocardiography was used to evaluate heart function. ResultsThe levels of TNF-α, IL-1β, IL-6 and IL-10 in the infarcted and non-infarcted region of control group were markedly elevated compared to sham-operated group (all P＜0.05). After 4 weeks therapy, rhGH reduced the expression of TNF -α, IL-1β, IL-6 and increased IL-10 expression in the infarcted and non-infarcted region of rhGH group compared to control group (all P＜0. 05 ). Echocardiography showed that rhGH markedly improved left heart function (P＜0. 05 ). ConclusionsEarly rhGH treatment can improve heart function and myocardial inflammatory cytokine expression after AMI. One of immunopharmacologic mechanisms underlying the beneficial effects of rhGH on heart function improvement may involve the attenuation of pro-inflammatory cytokines and the increase of anti-inflammatory cytokine levels in cardiac myocytes.

Exosomes are vesicles with a double globular membrane of lipids that can be secreted by a variety of cells, including stem cells. Exosomes have unique biological characteristics and irreplaceable powerful functions which play an important role in intercellular communication. The various cytokines, signal proteins, lipids and regulatory nucleic acids contained in stem cell exosomes can play a protective role against the injury of kidney, liver, heart, blood vessels and nerves. Stem cell exosomes delay the process of intervertebral disc degeneration by inhibiting the apoptosis of nucleus pulposus cells and increasing the synthesis of extracellular matrix, etc. The mechanism of its role is mainly through miRNA and related signaling pathways. Exosomes contain complex components. Although the mechanism of action of exosomes in intervertebral discs has been preliminarily explored, the components contained in exosomes are complex and the specific situation has not been fully understood, which still needs further study. In this review, the characteristics and functions of stem cell exosomes, extraction, identification and storage methods, the impacttovarious other tissues, as well as the effects on intervertebral discs and their mechanisms were elaborated in order to provide a basis for the study of intervertebral disc degenerative diseases.

Objective:To evaluate the volume changes of cervical longus and cervical extensor after anterior cervical discectomy and fusion (ACDF), and the correlation with the clinical efficacy of patients.Methods:All of 57 patients with cervical spondylotic myelopathy who underwent single-segment ACDF surgery from January 2013 to December 2018 were analyzed. The follow-up time was 23.0±4.8 months (range 16-34 months). All included subjects underwent MR examination within 1 week before operation and 3rd, 12th months after operation and at the last follow-up. The axial section cross section area (AxCSA) of the cervical longus and the ratio of length to short diameter line (RLS) at the level of each disc of C 2-C 7 were measured on the axial T2WI. Calculate the volume of the cervical longus based on the layer thickness. At the same time, measure the cervical extensor cross-sectional area (CESA) of the same level including the multifidus, cervical semispinous muscle, semispinous head, splinter head, and cervical splinter muscles, and compare CESA with the corresponding vertebral cross-sectional area (VBA). The ratio is analyzed as the volume of the neck extensor muscle, namely CESA/VBA. At the 3rd and 12th months after operation and at the last follow-up, the axial pain was assessed by visual analogue scale (VAS) for assessing pain, and the modified Japanese Orthopedic Association score (mJOA) and the neck dysfunction index (NDI) were used to assess the functional status of the cervical spine. Analyze the morphological changes of thecervical longus and extensor cervical muscles before and after the operation and during the follow-up period, and analyze the correlation with VAS, mJOA, and NDI. Results:Compared with the preoperative period, the average AxCSA of the surgical segment decreased at the 3rd and 12th months after the operation and at the last follow-up. The difference was statistically significant ( F=24.113, P<0.05), which was changed from 140.84±19.51 mm 2 respectively reduce to 117.74±17.15 mm 2 ( t=6.714, P<0.05), 116.37±18.67 mm 2 ( t=6.841, P<0.05) and 116.27±18.65 mm 2 ( t=6.873, P<0.05). Compared with preoperatively, they were reduced by 16.40%, 17.37% and 17.45%, respectively, while the average RLS of surgical segments increased slightly, and the difference was statistically significant ( F=22.612, P<0.05), which increased from preoperative 1.97±0.67 to 2.73±0.60 (38.58% increased, t=6.380, P<0.05), 2.82±0.64 (43.15% increased, t=6.926, P<0.05) and 2.74±0.62 (39.09% increased, t=6.368, P<0.05). The volume of thecervical longus of the patients decreased after the operation, and the difference was statistically significant ( F=64.511, P<0.05), which decreased from 8853.48±458.65 mm 3 before the operation to 7834.53±461.59 mm 3 (11.51% decreased, t=11.822, P<0.05), 7926.42±456.24 mm 3 (10.47% decreased, t=10.819, P<0.05), 7892.38±450.78 mm 3 (10.86% decreased, t=11.283, P<0.05). There were no statistically significant differences in the non-surgical segment AxCSA, RLS and the volume of thecervical longus at the 3rd and 12th months after surgery and the last follow-up ( P>0.05). There was no statistically significant difference of CESA and CESA/VBA compared to preoperative in the surgical segment and non-surgical segment ( P>0.05). Pearson correlation analysis showed that the volume of cervical longus and VAS at the 3rd month ( r=-0.308, P<0.05), the 12th month ( r=-0.210, P<0.05) and the last follow-up ( r=-0.404, P<0.05) were negatively correlated; Among the volume of cervical longus and NDI in the 3rd month ( r=-0.511, P<0.05), 12th month ( r=-0.518, P<0.05) and the last follow-up ( r=-0.352, P<0.05), there was a negative correlation; However, there was no statistically significant correlation between the cervical longus muscle volume and mJOA at each follow-up time point ( P>0.05); There was no significant correlation between CESA/VBA and VAS, NDI, and mJOA at the 3rd, 12th and last follow-up ( P>0.05). Conclusion:The volume and morphology of cervical longus after ACDF was significantly reduced compared with that before the operation, but the volume and morphology of the cervical extensor muscle did not change significantly. ACDF surgery mainly affects the cervical longus corresponding to the surgical segment, and the volume is negatively correlated with the VAS and NDI during follow-up.

Objective:To observe any dependence of anticipatory postural adjustment (APA) on the difficulty of fine upper limb tasks and to document any effect of reticulospinal tract (RST) facilitation on APAs during such tasks.Methods:The study′s bivariate mixed design involved 4 different tasks and 3 different priming states. Thirteen healthy, male, right-handed subjects were recruited. They were asked to complete the 4 tasks of reaching, grasping a cup, pinching a card using the thumb or using the little finger, respectively for 10 times 1 in response to two different starting cues delivered through an earphone. Half of the trials with each task were initiated with 114dB white noise to startle and activate the reticulospinal tract (RST), while the others were activated with 80dB beeps as a control. Electromyographic signals were recorded from the bilateral sternocleidomastoid (SCM), lower trapezius (LT), latissimus dorsi (LD), lumbar erector spinae and right anterior deltoid muscles and also from the right flexor and extensor carpi radialis muscles (ECR/FCR). In the subsequent processing the electromyographic time domain and frequency domain indicators were converted into a pre-motor reaction time, a time to muscle peak contraction, an activation latency, and APA or compensatory postural adjustment (CPA) amplitude of the tested muscles. These were compared among the different tasks and stimuli. In addition, the 114dB test tasks were classified as two different priming status as SCM + and SCM - according to whether the sternocleidomastoid muscle (SCM) was activated in advance. Results:After RST activation the pre-motor reaction time and the time to peak contraction of all of the muscles were significantly shortened in all of the tasks. The deltoid muscle reaction times in the SCM + , SCM - and control states were (106.89±43.78)ms, (136.78±48.74)ms and (168.60±73.17)ms, respectively, and those differences are significant. The APA amplitudes of the contralateral LT and ipsilateral LD were significantly greater than normal, but the timing of muscle activation onset and the APA/CPA amplitudes of the ECR/FCR were not affected. The latency in the anticipatory muscle activation of the ECR in the little finger grip task was significantly shorter than that in reaching. Conclusions:The extensor carpi radialis show task-specific early activation in fine tasks of the upper limbs with different difficulties. RST activation can lead to early starting of expected actions, accelerate muscle contraction and increase APA amplitude of some trunk muscles, but it has no significant effect on APA/CPA amplitudes in the forearm muscles.