Electrocardiography ; Humans ; Myocardial Ischemia ; physiopathology

[Objective]To investigate the effect of treating degenerative spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery.[Method]From January 2005 to December 2005,17 cases who underwent transforaminal lumbar interbody fusion with a pedicle screw system by microendoscopic surgery were analyzed retrospectively.The index diagnosis was degenerative lumbar spondylolisthesis with herniated nucleus pulposus in 11 cases,and with spinal canal stenosis in 5 cases.There were 10 male and 7 female,average age was 47.6(ranged,35～68)years.According to Meyerding grading system,roentgengram showed that there were 10 cases of grade Ⅰ?,7 cases of grade Ⅱ?,11 cases of L_4 and 6 L_5.[Result]Seventeen cases were reviewed after surgery.The postoperative follow-up ranged from 12 months to 24 months(averaged 16.2 months).Operative time averaged 160 minutes.Estimated blood loss averaged 120 ml.Mean length of hospital stay was 8 days.There were no nerve injury occurred during operation.No cases converted to open operation.In complications,one case suffered from intervertebral infection.Outcomes were quantified using Oswestry Disability Index.The average Oswestry score decreased from 48.3% preoperatively to 16.5% at 3 month and 14.0% at 6 month postoperatively.The rate of excellent and good was 97.5%.At last follow-up,all patients had solid fusions by radiographic criteria.[Conclusion]Transforaminal lumbar interbody fusion for lumbar vertebral degenerative spondylolisthesis by microendoscopic surgery has the advantages of shorter skin incision,less tissue damage,less blood loss and quicker postoperative recovery.

10mm,solitary sessile,growth during follow-up,associated with gallstone,obvious symptomatic or novel imaging techniques indicating NPG occurs.

Objective To evaluate the clinical effect of itraconazole oral solutions on pulmonary candidiasis albicans in ICU patients.Methods A total of 71 patients with candida ablicans in their sputum clutures were randomized into two groups.The itraconazole group(n= 36)received itraconazole 200 mg,p.o.(including nasal feeding),q12h for 14 days.The fluconazole group(n=35)received fluconazole 400 mg for the first dose,then 200 mg,i.v.drip,qd for 14 days.Results There were 31 patients in the itraconazole group and 29 paitents in the fluconazole group who completed their treatment.In the itraconazole and fluconazole group,the clearance of candida ablicans was 64.52%(20/31)vs.65.55%(19/29),cleaning time(10.12?2.57)vs(8.87?1.95)days,effective rate 58.06%(18/31)vs 62.07%(18/29),recovery rate is 19.35%(6/31)vs 17.24%(5/29),occurrence of hepatic dysfunction is 25.81%(8/31)vs 24.14%(7/29),and withdrawal for inefficacy was 3.23%(1/31)vs 6.90%(2/29),respectively.These parameters did not have statistical significance.Conclusion Itraconazole oral solutions can be used effectively and safely in the treatment of pulmonary candidiasis albicans in ICU.Patients with renal dysfunction do not need to adjust the dosage.

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

The Risk-sharing agreements have achieved remarkable success in improving patients'access to drugs, lowering the uncertainty of the drugs cost-effectiveness, financial risk control and other aspects of medical in-surance fund , so they have attracted widespread attention by the concerned governments and insurers .This paper sys-tematically reviewed the patient access schemes in UK from several aspects , including the origin of the program , clas-sification , application processes and the implementation effects as well .The results of the research indicated that Chi-na has basically met the conditions for implementation of the risk-sharing agreements .In order to gradually promote the risk-sharing agreements implementation , this paper suggests that China should clarify the main root of risk-sharing agreements implementation , establish risk-sharing agreements standardization process and strengthen the application of health technology assessment in health resources allocation to improve the Chinese medicines bargaining system more scientifically and efficiently .

Exercise training plays a critical role in the prevention and control of type 2 diabetes mellitus (T2DM). New guidelines on exercise training for T2DM patients was jointly published by American College of Sports Medicine and American Diabetes Association at the end of 2010. In the Guidelines on Prevention and Treatment of Type 2 Diabetes Mellitus in China issued by Chinese Diabetes Society, the role of exercise training is also clearly defined. The implementation of guidelines requires individualized exercise training prescription and program. In this article, we review the procedure of individualized aerobic exercise training prescription, resistant exercise, safety issues, and other relevant topics.
Diabetes Mellitus, Type 2 ; therapy ; Exercise Therapy ; methods ; Humans

α-Galactosidase A (α-Gal A ) activities in plasma and peripheral blood granulocytes of 100healthy subjects and one patient with Fabry disease was determined by means of fluorogenic substrate.The results showed that the enzymatic activities of peripheral blood granulocytes and plasma in 100 subjects were (51.97 ± 15.24)and(148.08±26.30) nmol · h-1 · ml-1 respectively.The α-Gal A activities in plasma and granulocytes were positively correlated( r=0.533,P＜0.01 ).The enzymatic activities in peripheral blood granulocytes and plasma of the patients with Fabry disease were 1.05 and 10.06 nmol · h-1 · ml-1 respectively,both much lower than those of 100healthy subjects.These results suggest that α-Gal A activity in plasma and peripheral blood granulocytes can be used for diagnosis and screening of Fabry disease.

Objective To explore the more than 80-year-old age patients laparoscopic cholecystectomy clinical curative effects and complications.Methods More than 260 cases of 80-year-old require cholecystectomy older patients,patients with detailed records related history,select one of the 200 patients with laparoscopic cholecystectomy to treatment,the rest of the 60 patients to do open cholecystectomy treatment,to observe the clinical curative effect of the two groups ; For patients with laparoscopic group in postoperative patients according to whether there was the occurrence of complications were divided into two groups,using multiple factors regression analysis the factors caused by complications.Results Laparoscopic surgery group blood loss,operative time,length of hospital stay,drainage time,lead flow,the surgical incision length were (62.7 ± 60.3) ml,(62.7 ± 21.4) ml,(5.6 ± 1.3) d,(3.6 ± 0.7) d,(174.4 ± 121.4)ml,(4.9 ± 1.2)cm,open group were (210.4 ± 120.4)ml,(115.7 ±30.4)ml,(8.8 ±3.4)d,(6.2 ± 2.5) d,(318.2 ± 132.5) ml,(12.2 ± 1.4) cm,two groups of various observation indexes were statistically significant differences (t =3.16,4.16,2.18,3.16,2,56,5.18,P ＜ 0.05).Laparoscopic cholecystectomy patients in 200 cases of 6 patients with complications (3.0％),single factor analysis results showed that:age,diabetes history,operation time and blood loss,drainage laparoecopic cholecystectomy complications had a correlation (P ＜ 0.05) ;Multiple factors analysis results showed that:with the age increasing,diabetes history was laparoscopic cholecystectomy complications independent risk factor (P ＜ 0.05).Conclusion For age more than 80 years patients,laparoscopic cholecystectomy down than open surgery has good curative effect,its complications are the main factors for increased age and always have diabetes history.

Objective To evaluate the efficiency of combined screening for chromosomal abnormalities in the first trimester and the ultrasound characteristics of these fetuses.Methods Retrospective study for 5000 singleton pregnancies by combined screening of trisomies 21,18,13 and Turner syndrome.Risk algorithms were developed for calculation of patient-specific risks for each of the three trisomies based on maternal age,fetal nuchal translucency,free β human chorionic gonadotropin and serum pregnancy associated plasma protein A at 11 to 13 +6 weeks of pregnant.The value of nuchal translucency (NT) and β-hCG and pregnancy-associated plasma protein A (PAPP-A) level were inputted computer,and calculate the risk value (≥ 1 ∶ 270) by automatic analysis software.Two hundred and four cases with high risk were performed transabdominal chorionic villus biopsy to detect the fetal chromosomal karyotypes.Meanwhile,other ultrasonic characteristics of fetal were elevated.Results (1) Five thousand cases of pregnant women were detected,including 4983 normal cases,62 cases were induced labor for a variety of reasons in the second trimester,including 40 cases with normal karyotype but with congenital heart disease,17 cases of chromosome abnormalities (9 cases trisomy 21,2 cases trisomy 18,1 cases trisomy 13,4 cases 45X),2 cases spina bifida,2 cases digestive tract obstruction,1 cases giant bladder.One case with low risk of fetal chromosomal abnormalities in combined screening,but high risk of age (maternal age were over 40 years old),it was 21 trisomy syndrome after the prenatal diagnosis.(2) Five cases of nasal bone loss in 9 cases of trisomy 21 (5/9),5 cases with three tricuspid regurgitation (5/9),4 cases of venous ductus a wave flow reverse (4/9),3 cases of fetal nasal bone loss accompanied by tricuspid regurgitation and venous ductus a wave flow reverse (3/9).One case of nasal bone loss in 2 cases of trisomy 18,2 cases were tricuspid regurgitation and venous ductus a wave flow reverse.Two cases in 4 cases of 45X had venous ductus a wave flow reverse.There were 8 cases (0.16％) nasal bone absence in 4983 cases of normal karyotype fetus,48 cases (0.96％) of tricuspid regurgitation and 44 cases (0.88％) of venous ductus a wave flow reverse.Thirty-two cases in 40 cases (80％) of fetal congenital heart disease were tricuspid regurgitation,30 cases of venous ductus a wave flow reverse (75％).Eight cases of nasal bone absence normal karyotype fetus were found the nasal bone at 20 weeks gestation.Conclusion Combination screening of nuchal translucency with serum markers in the first trimester were high detection rate and low false positive rate; a wave reversion and fetal nasal bone absence accompanied by tricuspid regurgitation can improve the detection rate of abnormal karyotype; abnormalities ultrasound marker may be associated with fetal congenital heart disease at 11-13 +6 weeks of pregnancy.