Objective:To establish nursing quality indicator system for freestanding hemodialysis facilities and identify the weight values of indicators.Methods:With the structure-process-outcome quality model as the framework, the literature analysis method, field survey and semi-structure interview were used to form the indicators item pool. Through Delphi method, experts were consulted for two rounds. The indicator weight was calculated by AHP.Results:The indicator system of this study included 3 primary indicators, 15 secondary indicators and 46 tertiary indicators. Among the primary indicators, the process quality indicator had the largest weight (0.493), followed by the outcome quality indicator (0.310), and the structure quality indicator had the smallest weight (0.196).The process quality were the main evaluation contents. According to the indicator weight, the main manpower allocation (0.131) in secondary indicators had the highest weight, and the proportion of nurses with different hemodialysis work experiences (0.108) in the tertiary indicators had the highest weight.Conclusion:The indicator system of this study is scientific and integrated, which can be used as a nursing quality evaluation tool to verify its practicability in clinical nursing practice.

Objective To investigate the relationship between the carotid intima-media thickness(IMT),the characterization of atherosclerotic plaque as well as the degree of carotid stenosis and ischemic stroke.Methods Tbe patients with first-ever acute ischemic stroke (ischemic stroke group)detected by color Doppler ultrasonogaphy and the outpatients and hospitalized patients without ischemic stroke in the same period(control groupl were collected retrospectively.The demogaphic data,vascular risk factors,and characterization of atherosclerotic plaque were compared between the two groups.Ischemic stroke group was divided into stroke subtype groups according to the TOAST classification.Their characteristics of carotid atherosclerosis were corapared.Restdt,A total of 200 patients with first-ever acute ischemic stroke and 200 patients without ischemic stroke were included in the study.The carotid IMT in the ischemic stroke group WaS sigaificantlv thicker than that in the control group(left side:1.04±0.22 mm vs.0.69±0.13 mm,t=7.34,P<0.01;right side:1.05 ±0.21 mm vs.0.71±0.16 mm,t=7.43,P<0.01).The proportions of the patients with moderate and severe stenosis were significantly higher(moderate stenosis:38% vs.14%,x1=7.64,P<0.01:SCVele stenosis:27% vs,6%,x2=7.93,P<0.01),and the proportion of patients with mild stenosis was no significant difference.The detection rate of carotid plaque in the ischemic stroke group was significantly higher than that in the control group(87.0% vs.31.5%,X2=7.01,P<0.01).The numbers of unstable plaque(tipid soft plaque,flat plaque,and mixed plaque)in the ischemic stroke group were 301(65.3%),and significantly mole than 65(31.7%)in the control group(x2=6.30,P<0.01).There was no significant difference in the distribution of carotid plaque between the two groups.The plaques were most common at the carotid artery bifurcation.Compared with those in other stroke subtypes.such as cardioembolism,small-vessel occlusion.stroke of other determined etiology,and stroke of undetermined etiology,the cm'otid IMT(left side:F=22.34,P<0.01;right side:F=21.41,P<0.01),and the proportion of Upid soft plaque(x2=7.93,P<0.01),carotid severe stenosis(x2=6.83,P<0.01),carotid occlusion(x2=14.00,P<0.01)in stroke patients with large-artery atherosclerosis were significantly incleased.Condusiom Carotid IMT,the numlbers of unstable Plaque as well as the degree of carotid stenosis were associated with the occurrence of isehemic stroke.

BACKGROUND:Cataract is not the necessary symptom for myotonic dystrophy(DM).But it may be the early and even only clinical symptom of DM.Molecular diagnosis can provide the important evidence for the diagnosis of DM.OBJECTIVE:To explore the characteristics of cataract in 26 patients with myotonic dystrophy of 3 pedigrees from Shanghai Songjiang area.DESIGN:Analysis on the Genealogy of Pedigree.SETTING:Department of Neurology,Shanghai Changhai Hospital.PARTICIPANTS:Twenty-six patients of 3 pedigrees,aged 7 to 71 years old,which were preliminarily diagnosed as DM patients or were suspicious DM patients,admitted to Department of Neurology,Shanghai Changhai Hospital between May 2001 and August 2003,were recruited in this study.Among the involved patients,13 corresponded to the clinical diagnosis standard from Practical Neurology,and the other 13 patients have adverse symptoms and (or) body signs of partial or mild DM,suspecting with DM patients.METHODS:①Peripheral blood of 1 mL was taken and genome DNA was extracted.By using a thermocycler,a polymerase chain reaction (PCR) was carried out to examine the CTG repeats according to criteria of molecular diagnosis (CTG repeats from 80-3350).②In addition,slit-lamp examination for specific lens opacity was carried out and the association between DM and cataract was analyzed.MAIN OUTCOME MEASURES:①CTG trinucleotide repeat numbers.②Association between DM and cataract.RESULTS:Of the 26 patients,25 participated in the final analysis except 1 who suffered from sterility clinically.①25 patients were consistent with the molecular diagnostic criteria of DM (CTG repeats from 80-3 350).The remaining 1 with CTG repeats of 13 was clinically sterility and therefore belonged to the normal individual.The (CTG)n triplet repeats of 17 patients with cataract were 2380±80,while 8 patients with cataract were 2298±105(P＞0.05).②Cataract was characterized as iridescent lens opacity or blue posterior cortical lens opacity in 17 patients.Among the 17 patients,cataract in 8 patients was the only early clinical sign whose(CTG) n triplet repeats were higher than the normal ones.CONCLUSION:In the pedigrees with DM patients,characteristic cataract,as a main and even only early clinical sign,will provide important clinical evidence for the early diagnosis of DM.

Objective To explore the protective effect of a small balloon on bifurcation lesions by applying a single stent treatment of coronary bifurcation lesions strategy. Methods Fifty patients with coronary bifurcation lesions were randomly divided into A group and B group( 25 cases for each group ). Patients in A group were treated with the pre-entry protection branch guide wire to complete the main branch balloon pre-dilation,stenting,while in B group were treated with the set aside the branches of a small balloon. The information of main branch balloon pre-dilation,stenting were recorded. The blood flow slowed down,the incidence of side branch occlusion or stent placement,and the incidence of postoperative 24 h troponin I( cTnI) levels were measured. Results Nine cases(36%)in A group occurred lower branch blood flow,which due to 4 cases(16% )with significantly narrow branch stenting,2 cases(8%)with complete occlusion. There were only 2 cases(8%)with decrease branching blood flow in B group,and the difference was significant(P=0. 041, 0. 022). The cases with higher cTnI after 24 h in A group were 11( 39%),significantly higher in group B (3(12 %);P =0. 027 ). Conclusion Compared with the traditional protection guidewire,the approach of setting aside a small balloon to protect important branch can effectively prevent important branch occlusion, branch involvement due to lower incidence of myocardial infarction.

Objective To investigate the clinical skill and experience of laparoscopic herniorrhaphy in the treatment of abdominal hernia. Methods Clinical data of 30 cases of abdominal hernia undergoing laparoscopic her-niorrhaphy in Shengjing Hospital from May 2004 to December 2008 were analyzed retrospectively. There were 23 in-guinal hernia,4 incision hernia and 3 hiatal hernia. TEP in 20 cases,TAPP in 3 cases,lPOM in 4 cases and Nissen hiatal hernia repair in 3 cases were performed. Results The mean operating duration was 72 min for TEP, 127 for TAPP,150 min for IPOM,and ]60 min for hiatal hernia repair and the mean time for hospitalization was 4.6,5.8, 7.5, and 5.3 days. No conversion to open surgery happened among these cases. No recurrence was found. Conclu-sions Laparoscopic herniorrhaphy appears to be an effective and convenient technique for the treatment of abdomi-nal hernia and has many advantages of minimally invasive surgery.

Objective To explore the application of single-person operated mammotome minimally inva-sive surgery in treatment of benign breast lesions. Methods Clinical information of 403 patients were collected and retrospectively analyzed. 262 patients receiving ultrasound guided single-person operated mammotome mini-mally invasive surgery for benign breast masses were selected as the treatment group,141 patients undergoing open surgery for treatment of benign breast masses were selected as the control group.Operative time, introopera-tive blood loss,length of stay,postoperative healing time, as well as the occurrence of complications were com-pared between the two groups. Result Compared with the control group, the operative time was shorter, the in traoperative blood loss was less, the scar size and the postoperative healing time were shorter for the treatment group. The difference had statistical significance (P<0.05).The rate of postoperative pain, local ecchymosis, local infection and breast deformity for the treatment group was significantly lower than those of the control group (P<0.05). The difference had statistical significance (P<0.05). The recurrence rate between the two groups had no sta-tistical significance (P>0.05). Conclusions Single-person operated Mammotome minimally invasive surgery has the advantages of good operative time,good cosmetic effects, small surgical trauma, less blood loss, fast postoper-ative healing and few complications, which is worthy of clinical application.

Objective To explore the influence of hematopoietic growth factors on the TBI patients in the conditioning regimen for stem cell transplantation,and to evaluate the effect of cytokines on treatment of acute radiation disease.Methods The usage of hematopoietic growth factors,implantations and the side-effects of the patients and donors of TBI in the conditioning regimen for stem cell transplantation were retrospectively analysed from 1990 to 2012,and the effect and side-effects of cytokines on the hematopoietic function recovery and stem cell mobilization were observed.Results All patients recovered from their hematopoietic function except one died due to the side-effecs.The median time of white blood cell recover was 10 d in auto-SCT and 12 d in allo-SCT in the G-CSF group.The median day of platelet recovery was 11.67 ± 1.53 in rhIL-11 arm and 13.70 ±6.27 in no rhIL-11 arm in the auto-SCT group.The incidence rates of dental ulcer and diarrhea in the TBI patients were 48％ and 44％,respectively.The occurrence of side-effect was rare in the period of cytokines treatment,but was over 50％ during stem cell mobilization.Conclusions Cytokines play very important roles in the hematopoietic function recovery and stem cell mobilization in the TBI patients.

This study aimed at evaluating the quality of the precise powder decoction pieces (PPDP) of L.japonicae Flos (LJF) compared with the traditional commercial slices with chemical fingerprint methods and DNA molecular identification technology.Different specifications of PPDP were prepared,their dry extract contents were in contrast with that of commercial slices.The three batches of commercial slices were collected,and the content uniformity,fingerprint and similarity evaluation before and after the mixing and pulverization were studied by HPLC-DAD and DNA sequence alignment.As a result,the paste rate of PPDP was slightly higher than that of the traditional commercial slices.The dissolution of chlorogenic acid of PPDP was higher than that of the traditional commercial slices.RSD of inter-assay dissolutions of chlorogenic acid of commercial slices was 11.93％,which was reduced to 8.29％ after mixing and preparing into PPDP.The fingerprint showed that the slimilarity of the fringerprint of the mixed and powdered LJF was elevated with 7 common peaks.All the common peaks were increased at different levels.In conclusion,compared with traditional commercial slices of LJF,PPDP apparently improved the dissolution rate and the quality uniformity,indicating that the boiled powder of CRP obviously presented vantages in clinic.

OBJECTIVETo test the different contrctile responses of extracellular nucleotides, such as ATP, UTP and nucleotide uridine adenosine tetraphosphate (Up4A) in gastric longitudinal muscle (LM) and circular muscle (CM). Examined the effect of P2X and P2Y receptor antagonists (in this study, we used IP5I and suramin) and cyclooxygenase inhibitor (indomethacin) on Up4A induced contractile responses in LM and CM.

METHODSThe rats were sacrificed and the stomachs were opened to gain LM and CM. Using organ bath system to assess contrctile responses of smooth muscle.

RESULTSUp4A could induce contractile responses in both CM and LM, which were similar with ATP and UTP. IP5 did not attenuate Up4A could induce contractions in both LM and CM, but suramin and indomethacin significantly inhibited Up4A contraction in CM, but not in LM.

CONCLUSIONOur results suggest that extracellular nucleosides and their inhibitors induce different responses between LM and CM.

Adenosine Triphosphate ; pharmacology ; Animals ; Dinucleoside Phosphates ; pharmacology ; Indomethacin ; Muscle Contraction ; Muscle, Smooth ; physiology ; Nucleotides ; pharmacology ; Rats ; Suramin ; Uridine Triphosphate ; pharmacology

Objective To establish guinea pig model of type Ⅰ anaphylaxis, isolate the anaphy-lactic antibody(IgE and IgG) preliminarily from sera of sensitized guinea pigs, and investigate its functional characteristics. Methods Animal model was established by sensitizing guinea pigs with OVA and Al(OH)_3, level of antibody was determined by ELISA, IgE and IgG in sera were preliminarily isolated through saturated ammonium sulphate precipitate and affinity chromatograph of Protein A. A continuous passive cutaneous ana-phylaxis test (PCA) was performed by sensitizing guinea pigs individually with IgE and IgG and then challenging at different time , and the variation of blue spots in skin were observed after challenge . Results Concentration of IgE in model group and control group were 719.3750 ng/ml and 2.5250 ng/ml, the optical density of IgG in model group and control group were 0.9921 and 0.0174, the level of two antibodies in model group were significantly higher than that of control group (P<0.05). In 9 d continuous PCA test, the blue spot induced by IgE in skin lasted for 9 days and appeared the largest when challenged at day 5. The diameter of blue spot induced by IgG was the largest when challenged at day 2 and then decreased fast. Con-clusion Anaphylactic antibodies were successfully preliminarily isolated from sera of sensitizing guinea pig, both IgE and IgG play roles in type Ⅰ anaphylaxis of guinea pig, the hypersensitive reaction induced by IgG is fast and short than that induced by IgE, and IgG may become an important surrogate marker in immunotoxic-ity evaluation(type Ⅰ anaphylaxis)of vaccine.