Objective To analyze the cause of constipation of elderly patients with thighbone fracture in order to reduce the incidence of constipation.Methods We gave psychological nursing,activity instruction to 42 elderly patients with thighbone fracture and helped them to form a habit to defecate at fixed time.Results Twelve patients defecated one time every one to two days,Ten patients began to defecate on the second day.26 patients defcated at fixed time.Four patients(9.5%)showed constipation and the symptoms alleviated after use of glycerine enema.Conclusions Selective nursing could settle the problem of constipation for elderly patients with thighbone fracture.It could reduce the pain of patients and promote their rehabilitation.

Objective To observe the clinical effect and safety of platdet GP Ⅱb/Ⅲa receptor antagonist firofiban on acute coronary syndrome(ACS)patients with nO reflow after intevention procedure.Methods 48 ACS patients with no reflow were randomly divided into tirofiban group(n=26)and control group(n=22),the tirofiban group received intravenous tirofiban for 48-36homs,control group received nitroglycerin and urokinase.The rate of the TIMI grade offorward flow and the primary end pints(death,persistent myocardial isehemic and new onset myocardial infarction)and adverse reactions of drags were observed Resalts Tirofiban improved target vessel TIMI flow significantly than control groug(73.8%vs 18.2%,P＜0.01),the rate of the main end point events significantly decreased(15.4%vs 63.6%,P＜0.05),the bleeding complications was similar between two groups,no severe bleeding events occurred.Condusion Tirofiban is effecfive and safe in treating ACS patients with no reflow.

Objective To analyze the immediate and following up result of 122 patients with acute myocardlal infarction(AMI)which underwent emergency percutaneous coronary interventlon(PCI).Methods 122 cases of AMI patients underwent the emergency PCI by transfemoral artery approach during June 1998 to December 2005.119 casea performed primary PCI,3 performed rescue PCI.Results The successful rate of vessel visualization and operation were 95.1%.93.4%.respectively.5 eases were with the help of intra-aortic balloon pumping.Subacute instent thrombosis occurred in 2 patients.In-hopital mortality was 4.1% (5/122).The left ventricular ejection fraction in echocardiography one after week was(0.55±0.16).Average hospital day is(9.5±5.8)(1～36).6-month mortality was 5.7%(7/122).Conclusion Primary PCI expanded the indication for the treatment of STEMI patients wlth establishment of patent infarct related artery and normal blood flow,increased tlle survival of high-risk patients,and shortened the hospitalization.Rescue PCI was an effective measure for the patients failing to intravenous thrombolysis.

Objective To compare the efficacy and safety of singular double antithrombotie therapy (DT) using warfarin plus clopidogrel and the combined antithrombotie therapy of 3-month triple antithrombotie therapy (TT) using warfarin, aspirinand clopidogrel and 9-month double antithrombotie therapy (DT) for the patients with atrial fibrillation undergoing PCI. Methods Ninety patients with atrial fibrillation undergoing PCI were randomly divided into two groups evenly: one group was treated with dual antithrombotic therapy group (DT) and the other group with the combined therapy, e. g. 3-month triple antithrombotie therapy (TT) and 9-month double antithrombotie therapy (DT + TT for short). All patients were followed-up by 12 months. The two groups were compared in terms of incidences of death , myocardial infarction , stroke , target-vessel revascularisation , stent thrombosis and bleeding adverse events. Results The incidences of myocardial infarction, stroke, target-vessel revascularisation , stent thrombosis and bleeding adverse events in the TT + DT group were all significantly lower than the DT group (P < 0.05). The follow-up on the safety indicated that the rate of bleeding in the TT +DT group was insignificantly higher than the DT group (P > 0.05). Conclusion There is no significant difference in safety between the two groups. However, the therapy of TT + DT is more effective.

Objective:To explore therapeutic effects of sodium nitroprusside (SNP) combined verapamil on no-reflow during percutaneous coronary intervention (PCI).Methods: A total of 106 patients, who suffered from no-reflow during PCI in our department from Jan 2011 to Dec 2013, were selected.According to random number table method, patients were divided into SNP group (n=55, received SNP based on routine treatment) and combined treatment group (n=51, received verapamil based on SNP group).Cardiac troponin I (cTnI) level before and 16h~18h after PCI, cardiac function indexes after 12-month follow-up, incidence of major adverse cardiovascular events (MACE) were measured and compared between two groups.Results: Compared with before PCI, there were significant rise in cTnI level in both groups on 16~18h after PCI, P=0.001 both;compared with SNP group, there were significant reductions in cTnI level [(1.31±0.44)μg/L vs.(0.11±0.02)μg/L] and percentage of cTnI>0.10μg/L (94.5% vs.54.9%) in combined treatment group, P=0.001 both.Compared with SNP group after 12 months, there was significant rise in left ventricular ejection fraction [(62.29±3.06)% vs.(65.65±3.94)%], and significant reductions in left ventricular end-diastolic dimension[(50.24±3.73)mm vs.(47.60±4.72)mm] and left ventricular end-systolic dimension [(33.29±2.11)mm vs.(31.00±4.33)mm] in combined treatment group, P<0.05 all.There were no significant adverse reactions during hospitalization and follow-up in both groups.Conclusion: When no-reflow occurs during PCI, intracoronary injection of SNP combined verapamil can improve cardiac function, and its safety is good, which is worth extending.

OBJECTIVE:To investigate the pharmacokinetic characteristics of puerarin and puerarin lobate extract in rats and compare the difference of pharmacokinetic behavior of them. METHODS:24 SD rats were randomly divided into high-dose and low-dose groups of puerarin (300,100 mg/kg) and puerarin lobate extract (equal to 300,100 mg/kg of puerarin). 0.2 ml blood sample were collected from posterior venous plexus of bulbus oculi before intragastric administration and 0.083,0.17,0.33,0.5, 0.67,1,1.5,2,3,4,6,8,10 h after administration,respectively. The pharmacokinetic parameters were calculated by using DAS 3.0 software. RESULTS:Compared with puerarin high-dose group,AUC0-t and cmax of puerarin low-dose group increased sig-nificantly,while CL decreased significantly;MRT0-t of puerarin low-dose group and puerarin lobate extract high-dose and low-dose groups decreased significantly (P<0.01). There was no statistical significance in pharmacokinetic parameters between puerarin lo-bate extract low-dose group and puerarin lobate extract high-dose group (P>0.05). CONCLULSIONS:There is difference in the pharmacokinetic behavior between puerarin and puerarin lobate extract in rats. Some components of puerarin lobate extrats maybe speed up the elimination of puerarin in rats,so as to shorten the average retention time of it.

OBJECTIVETo assess the diagnostic value of cardiac magnetic resonance (CMR) in patients with acute viral myocarditis.

METHODSThirty patients with suspected acute viral myocarditis admitted in first people's hospital of Shunde from June 2011 to June 2013 were included in this prospective study. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of acute viral myocarditis were evaluated by clinical diagnosis. Diagnostic value among different scan methods and Lake Louise criteria were compared.

RESULTSAcute viral myocarditis was diagnosed in 63.33% (19/30) patients.Values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy within the overall cohort were 57.89%, 72.73%, 78.57%, 50.00%, 63.33%, respectively by edema imaging (ER).Values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy within the overall cohort were 78.95%, 63.64%, 78.95%, 63.64%, 73.33%, respectively using global relative enhancement (gRE).Values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy within the overall cohort were 78.95%, 54.55%, 75.00%, 60.00%, 70.00%, respectively using late gadolinium enhancement (LGE) criteria.Values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy within the overall cohort were 84.21%, 81.82%, 88.89%, 75.00%, 83.33% using Lake Louise criteria. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy using Lake Louise criteria were significantly higher than using ER, gRE, LGE alone(all P < 0.05).Specificity was higher using ER than using gRE and LGE (both P < 0.05). The sensitivity, NPV, and diagnostic accuracy were significantly higher using gRE than using ER (all P < 0.05) and was similar as using LGE (all P > 0.05).

CONCLUSIONCardiac magnetic resonance is an excellent imaging modality for the diagnosis of acute viral myocarditis.

Acute Disease ; Contrast Media ; Gadolinium ; Heart ; Humans ; Magnetic Resonance Spectroscopy ; Myocarditis ; diagnosis ; virology ; Predictive Value of Tests ; Prospective Studies ; Sensitivity and Specificity

Objective:To evaluate the long-term impact of three different outdoor activity intervention strategies on the prevalence of myopia among school-aged children in China.Methods:Cross-sectional data from the Refractive Error Study in Children (RESC) on the baseline prevalence of myopia and 10-year longitudinal data from the Guangzhou Twin Eye Study (GTES) on the baseline incidence of myopia were utilized.The effect size of outdoor activity intervention was derived from longitudinal data of the Guangzhou Outdoor Activity Longitudinal Study (GOALS). Three intervention strategies were proposed: intervention for children in grades 1 to 6 (Strategy A), intervention for children in grades 1 to 3 (Strategy B), and intervention for children from the last year of kindergarten to grade 3 (Strategy C). Outdoor activity interventions across all strategies included an extra 40 minutes of daily outdoor activity time.Simulated analyses assumed that the prevalence of myopia would decrease with declining incidence and increasing school grade, and the degree of myopia among highly myopic children would decrease with delayed myopia onset.This study was approved by the Ethics Committee of Zhongshan Ophthalmic Center (No.2006-5).Results:With prolonged intervention time, the overall prevalence of myopia in children showed a significant declining trend.After 5 years of implementation, Strategy A resulted in a decrease in myopia prevalence from 34.67% to 25.71%, which decreased to 24.89% after 10 years, with an average annual reduction of 0.98%.Strategies B and C had similar long-term effects, with myopia prevalence after 10 years being 26.00% and 26.20% respectively, with an average annual reductions of 0.87% and 0.85%.Strategy A yielded the greatest reduction in myopia severity, with a decrease of -5.94 D after 5 years and -5.88 D after 10 years in the initial 15-year-old highly myopic individuals.Strategy B followed with -6.08 D and -6.02 D after 5 and 10 years, respectively.Conclusions:Implementing intensified outdoor activity intervention among children in grades 1 to 6 may be the recommended strategy to reduce the overall prevalence of myopia in regions with high rates of myopia among school-aged children.

Objective:To investigate the effects of docetaxel for postoperative chemotherapy of advanced gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 311 patients with advanced gastric cancer who were admitted to Lanzhou University Second Hospital from January 2013 to December 2018 were collected. There were 224 males and 87 females, aged from 26 to 82 years, with a median age of 58 years. Of 311 patients, 204 cases undergoing chemotherapy with the FOLFOX regimen (oxaliplatin, calcium folinate, 5-fluorouracil) were allocated into the FOLFOX group, and 107 cases undergoing chemotherapy with the FLOT regimen (docetaxel, oxaliplatin, calcium folinate, 5-fluorouracil) were allocated into the FLOT group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups of patients after matching; (2) follow-up; (3) analysis of survival factors; (4) subgroup analysis; (5) adverse reactions. Follow-up was performed using a combination of outpatient examination, hospitalization review and telephone interview to detect situations of patients chemotherapy, postoperative survival, tumor recurrence and metastasis up to February 2019. The propensity score matching was realized using the nearest neighbor method with 1: 1 ratio and caliper setting as 0.02. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability method. Rank data was analyzed using non parametric Rank sum test. The survival curve and rate were respectively drawn and calculated using the Kaplan-Meier method. The survival analysis was done using the Log-rank test. Univariate analysis and multivariate analysis were conducted using the COX regression model. Subgroup analysis was done using interaction test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups of patients after matching: 198 of 311 patients had successful matching, including 99 in each group. Cases with tumor differentiated as poorly differentiation or well differentiation, cases with CA19-9 <27 U/mL or ≥27 U/mL, cases with CA125 <35 U/mL or ≥35 U/mL before propensity score matching were 109, 95, 156, 48, 186, 18 in the FOLFOX group, and 42, 65, 93, 14, 104, 3 in the FLOT group, respectively, showing significant differences in the above indicators between the two groups ( χ2=5.649, 4.798, 4.039, P<0.05). After propensity score matching, the above indicators were 44, 55, 85, 14, 96, 3 in the FOLFOX group, and 42, 57, 85, 14, 96, 3 in the FLOT group, respectively, showing no significant difference in the above indicators between the two groups ( χ2=0.082, 0.000, 0.000, P>0.05). (2) Follow-up: 198 patients of the two groups after matching were followed up for 2 to 69 months, with a median follow-up time of 38 months. During the follow-up, 92 cases survived without tumor, 2 cases underwent tumor recurrence or metastasis, and 104 cases died including 103 with tumor related death and 1 case with non-tumor related death. The courses of chemotherapy were 5.6±0.7 and 5.4±0.8 for the FOLFOX group and FLOT group, respectively, showing no significant difference between the two groups ( t=1.651, P>0.05). The 1, 3, and 5-year cumulative survival rates of patients were 72.2%, 31.5%, 27.7% and 83.2%, 42.8%, 38.2% for the FOLFOX group and FLOT group, respectively. The median overall survival time were 21 months and 34 months for the FOLFOX group and FLOT group, respectively, showing significant difference between the two groups ( χ2=4.473, P<0.05). (3) Analysis of survival factors: results of univariate analysis showed that cases undergoing chemotherapy with the FLOT regimen, cases with tumor as diffuse type of Lauren classification, cases with tumor as mixed type of Lauren classification, cases with tumor differentiated as well differentiation, cases with tumor diameter≥5 cm, cases with CA19-9≥27 U/mL, cases with carcinoembryonic antigen (CEA)≥3.4 μg/L, cases with tumor as T4 stage of T staging, cases with tumor as N2 stage of N staging, cases with tumor as N3 stage of N staging, cases undergoing distal gastrectomy and cases undergoing total gastrectomy were related factors influencing postoperative survival of patients ( hazard ratio=0.659, 1.617, 1.798, 0.672, 1.726, 1.655, 1.942, 2.036, 2.536, 4.085, 1.810, 2.310, 95% confidence interval: 0.444-0.978, 1.024-2.556, 1.105-2.926, 0.457-0.990, 1.159-2.569, 1.006-2.723, 1.295-2.912, 1.190-3.484, 1.409-4.564, 2.491-6.697, 1.020-3.211, 1.261-4.233, P<0.05). Results of multivariate analysis showed that cases undergoing chemotherapy with the FLOT regimen, cases with CEA≥3.4 μg/L, cases with tumor as N2 stage of N staging and cases with tumor as N3 stage of N staging were independent risk factors influencing postoperative survival of patients ( hazard ratio=0.622, 1.732, 2.217, 4.039, 95% confidence interval: 0.418-0.926, 1.124-2.670, 1.200-4.097, 2.448-6.662, P<0.05). (4) Subgroup analysis: results of subgroup analysis showed that of the different subgroups using gender, age, tumor Lauren classification, tumor differentiation degree, tumor location, tumor diameter, tumor markers, tumor T staging, tumor N staging and surgical procedures as subgrouping index, the efficacy difference between the FLOT group and the FOLFOX group was the same (interaction P>0.05). (5) Adverse reactions: the incidence of grade Ⅲ-Ⅳ adverse reactions of leukopenia, anemia, thrombocytopenia, nausea, vomiting and liver and kidney dysfunction were 11.1%(11/99), 2.0%(2/99), 3.0%(3/99), 12.1%(12/99), 4.0%(4/99), 1.0%(1/99) and 34.3%(34/99), 1.0%(1/99), 9.1%(9/99), 24.2%(24/99), 4.0%(4/99), 0 in the FOLFOX group and the FLOT group, respectively. There were significant differences of the incidence of leukopenia and nausea between the two groups ( χ2=15.213, 4.889, P<0.05). There was no significant difference of the incidence of thrombocytopenia between the two groups ( χ2=3.194, P>0.05) and there was no significant difference of the incidence of anemia, vomiting and liver and kidney dysfunction between the two groups ( P>0.05). There was no patient in the two group withdrawal from chemotherapy as no tolerance to toxic reactions. All patients were treated with glucocorticoids, proton pump inhibitors and serotonin receptor antagonists during chemotherapy. Patients undergoing leukopenia were treated with granulocyte stimulating factor. Conclusions:Compared with FOLFOX regimen, FLOT regimen which adds docetaxel significantly prolongs the postoperative median overall survival time of patients with advanced gastric cancer. However, FLOT regimen increases the incidence of grade Ⅲ-Ⅳ adverse reactions of leukopenia and nausea.

OBJECTIVE： To analyze the application of antibiotics in 18 community health service centers in Shanghai Chongming district， and to further strengthen rational use of antibiotics. METHODS： By retrospective analysis， statistical analysis was made on the monitoring data of antibiotic use and 21 600 prescriptions reported by 18 community health service centers in Chongming district of Shanghai from Jan. 2016 to Dec. 2018 in respect of antibiotics use， top 5 antibiotics in the list of DDDs， prescription analysis， etc. RESULTS： From 2016 to 2018， the average annual total income of medical treatment， drugs and antibiotics of 18 community health service centers in Chongming district of Shanghai were 490 499 000 yuan， 427 231 500 yuan and 41 602 900 yuan respectively. Annual average incomes of outpatient and inpatient antibiotics were 35 435 700 and 6 262 100 yuan. Annual consumption amount of antibiotics were 2 129 627.71 and 70 829.51 DDD. The proportion of antibiotics was 9.76％. Annual antibiotics use density （AUD） was 29.41 DDD. Compound annual growth rate （CAGR） was negative for antibiotics ratio （－3.27％）， outpatient antibiotics consumption amount （－18.40％）， antibiotics consumption amount for outpatient per time      （－17.83％）， inpatient antibiotics consumption amourt （－1.25％） and AUD （－0.98％）. The dosage form of top 5 antibiotics in the list of DDDs within 3 years were oral preparation， among which cefuroxime， cefaclor， levofloxacin and cefpropene were all ranked in the top five in three years. In 21 600 prescriptions， average number of drug per prescriptions was 1.99， the average amount of prescription was 120 yuan， and the number of antibiotics types used accounted for 8.24％ of total drug types； 15.43％ of the prescriptions used antibiotics， the average amount of the prescriptions containing antibiotics was 114.46 yuan， and the total amount of antibiotics accounted for 8.24％ of the total amount of the prescriptions. CONCLUSIONS： The rational use of antibiotics in Chongming community health service center has been continuously improved， and can provide reference for drug management of primary hospitals.