Objective To study the deep vein thrombosis (DVT ) in lower extremities of patients with or without cardiovascular disease after fracture .Methods Five hundred and eighty-four frac-ture patients were divided into cardiovascular disease (CVD) group (n=235) and non-cardiovas-cular disease (NCVD) group (n=349) .Patients in CVD group were further divided into subgroup A (with essential hypertension) ,subgroup B (with CHD) ,and subgroup C(accompanying essen-tial hypertension and CHD) .Incidence of DVT in CVD group ,NCVD group ,subgroups A-C at different ages after fracture was compared .Results The incidence of DVT was significantly high-er in CVD group than in NCVD group (P<0 .01) ,in two groups on days 0-7 after fracture than on days 8-14 or >14 after fracture ,and in patients with their age ≥60 years than in those with their age <60 years .Conclusion DVT is easier to occur in CVD patients with their age ≥ 60 years than in those with their age <60 years after fracture .DVT usually occurs within 1 week af-ter fracture .Importance attached to high risk population and measures taken as soon as possible against it can reduce DVT after fracture .

The hierarchical medical system is to match and balance the medical service demand and supply. This article probed into main problems encountered in introducing such a system, discussed the mechanism of action for the system which was based on diseases, and proposed the driver model for a disease-based hierarchical medical system.

ObjectiveTo investigate the value of high-frequency ultrasound in assessment of the therapeutic efifcacy of traditional Chinese medicine in patients with breast dysplasia using.MethodsFrom March to September in 2014, 50 patients with breast dysplasia in the Third Affiliated Hospital of Beijing University of Chinese Medicine were enrolled in the study. In addition, they were treated with Xiaozheng pills. Before and after treatment, these patients were examined using ultrasound. The thickness of the breast gland layer in each patient was measured. When the dilated ducts lactiferous, cysts, hypoechoic areas, or nodules of the breast were detected, the diameter or volume was measured or calculated. A grading system of the breast dysplasia was used to evaluate the disease degree, and the quadrants of the breast dysplasia were counted. The thickness of the breast gland layer, the volume of cysts and nodules, the diameter of hypoechoic areas and the dilated ducts lactiferous, the number of the breast dysplasia were compared with the pairedt-test. The grading of the breast dysplasia was compared with rank sum test.ResultsThere were significant decreases in the thickness of the grand layer, the diameters of the ducts lactiferous and the hypoechoic area after treatments [(15.92±4.73) mm vs(13.02±4.20) mm,t=2.240,P<0.01; (2.26±0.58) mm vs (1.71±0.47) mm,t=5.202,P<0.01; (21.14±5.57) mm vs(17.80±4.63) mm,t=5.529,P<0.01]. However, there were no significant differences in the volume of cysts and nodules. The grading of the breast dysplasia showed statistical difference (z=-5.667,P<0.01), and the number of the breast dysplasia quadrants was reduced markedly (5.38±1.85 vs3.28±1.97,t=7.566,P<0.01).ConclusionsUltrasound can be an effective method in assessment of patients with breast dysplasia treated with the traditional Chinese medicine. The assessment can be based on some signs, including the thickness of the grand layer, the diameters of the ducts lactiferous, and the diameters of the hypoechoic area. The grading system and breast quadrants counting in these patients may be added as supplementary criteria to make a complete therapeutic evaluation.

Objective To understand the influence of the disease-based hierarchical medical system on inpatients flow covered by the new rural cooperative medical system ( NRCMS) , and that on the funding diversion and medical costs so incurred. Methods One county was selected from the eastern, central and western regions of China respectively, where the disease-based hierarchical medical system has been in place. Policy documents of the three counties were reviewed to analyze such changes as NRCMS inpatients flow, inpatients subsidy diversion, NRCMS fund surplus rate of the current year and medical costs per hospitalization before and after the system was in place. Results A comparison with 2014 found a 1. 26%drop of the out-of-county inpatients of county W of the western region, a 2. 00% increase of township hospitals inpatients of county D in the middle region, and the same ratio of out-of-county and in-county inpatients in county F of the eastern region in 2015. Compared with 2014, the fund surplus rate of county W increased 10. 46%, and the inpatient subsidy ratio of county D decreased 2. 51% for those in out-of-county medical institutions in 2015. Thanks for the quota payment of specific diseases under global budget in county W, the inpatient medical costs per hospitalization dropped at both county and township medical institutions. Conclusions The disease-based hierarchical medical system could optimize the NRCMS inpatients distribution among various medical institutions, conducive for establishment and operation of such a system.

Objective To learn the behaviorist changes of county and township hospitals in their care of the diseases categorized in the hierarchical system before and after the system was in place. Methods Descriptive statistics and correlation analysis were used to analyze the changes of the diseases categorized in the hierarchical system which were cared at both county and township levels. Results The inpatients coverage of such diseases in county W in the western region at county and township hospitals was 44. 97%and 59. 28% respectively. These data were higher than that in county F in the eastern region, which were 18. 32% and 15. 58% respectively. As discovered in the Spearmen rank correlation analysis, the inpatients growth of diseases under the hierarchical system of counties F and W in 2015 was positively correlated to the difference between the pricing for the disease in question and the average hospitalization fee for the same disease in 2014 (r=0. 462, P<0. 001;r=0. 304, P=0. 018 ). In county W where the quota payment of specific diseases was in place, the increase of the average cost per hospitalization in 2015 was positively correlated to the above mentioned difference in 2014 and 2015(r=0. 447, P<0. 001). Conclusions The coverage of such diseases should be expanded. Changes in the pricing for such diseases will influence inpatients flow, while quota payment per disease can curb the increase of costs per hospitalization.

[ABSTRACT]OBJECTIVETo evaluate the clinical value of ultrasound guided fine-needle aspiration (US-FNA) in the diagnosis of thyroid nodules with different size.METHODSThe clinical data of 122 thyroid nodules of 109 cases referred to FNAC for diagnosis were retrospectively reviewed. The final operating histological results of 122 nodules were considered gold standard. RESULTSNon-diagnostic FNAC results occurred in 17 nodules (13.9%). FNAC achieved a sensitivity of 78.6%, a specificity of 93.9%, a positive predictive value of 93.6%, a negative predictive value of 78.3%, and a total accuracy of 85.7%. There was no significant difference between the diameter of the nodule≤1 cm group and>1 cm group, except negative predictive value. The non-diagnostic results rate was no significant difference between groups of different nodule size, benign or malignant nodules, and different operators. CONCLUSIONFNAC is a sensitive, specific and accurate method for differential diagnosis of thyroid nodules.

Objective To evaluate the value of evoked potentials (EP) in diagnoses of minimal hepatic encephalopathy (MHE) for liver cirrhotic patients without overt hepatic encephalopathy (OHE). Methods A blind and self control study was conducted in 114 liver cirrhotic patients without OHE. All patients were tested for MHE by the number connection test-A(NCT-A), digit symbol test (DST), visual evoked potentials (VEP), brain-stem auditoru evoked potentials (BAEP), short latency somatosensory evoked potentials (SSEP), P300 auditory event-related potentials (P300ERP). MHE was identified when the NCT-A or/and DST was abnormal. The positive rate was compared among VEP, BAEP, SSEP and P300ERP for their reliability and validity in diagnosis of MHE. Results Of 114 patients, 60 patients were found with MHE (52. 6%), which was positively correlated with Child-Pugh classifications (r=0. 278, P = 0. 003). The positive rate was found 17.5% in VEP, 29.8% in BAEP, 38. 6% in SSEP and 57. 0% in P300ERP. There was no significant difference in diagnosis of MHE between P300ERP and NCT-A+DST (X2 =0. 432,P = 0. 511). The sensitivity of VEP, BAEP, SSEP or P300ERP for diagnosis of MHE was 13. 3%, 41. 7%, 46. 7% or 73. 3%, respectively, whereas the specificity was 77. 8%, 83. 3%, 70. 4% or 61. 1 %, respectively. The receiver operating characteristic curve revealed that the best sensitivity and specificity for the diagnosis of MHE was P300EERP (area under the curve was 0. 672, 95%CI 0. 572 * 0. 773). The agreement of NCT-A+DST with VEP, BAEP, SSEP or P300ERP was 43. 9%, 61. 4%, 57. 9% or 67. 5%. Conclusions P300ERP is a sensitive and specific method for the diagnosis of MHE. which can serve as a supplement but not instead of NCT-A+DST.

Objective To investigate the value of PCT in the diagnosis of severe infection in children.Methods The clinical data of patients with infectious diseases treated in our hospital from December 2013 to February 2016 were retrospectively analyzed.According to the degree of infection,the patients were divided into local infection group and severe infection group,At the same time,the clinical data of 50 children with non infectious diseases were selected as control group.The differences of serum PCT and cytokine levels were observed between the three groups,at the same time,according to the prognosis of patients with severe infection group were divided into improvement group and deterioration group,The differences of serum PCT and inflammatory cytokines levels in the patients with severe infection in the improvement group and the worsening group,Analysis of the correlation between PCT levels and serum inflammatory cytokines levels in children with severe.Results There were significant differences in the levels of PCT,IL-18,IL-6 and hs-CRP between the three groups,which were from high to low: severe infection group,local infection group and control group; Deterioration of PCT,IL-18,IL-6,hs-CRP and levels were higher than the improvement group(t=-10.099,-8.949,-10.827,-2.088,P<0.05); The level of PCT were positively correlated with IL-18,IL-6 and hs-CRP levels in children with severe infection(r=0.385,0.412,0.408,P=0.012,0.008,0.017).Conclusion PCT has a good diagnostic value in children with severe infection,and it is closely related with the level of inflammatory cytokines in children with severe infection.

Enthusiasm is an intrinsic motive that drives the ethical and moral aspects of nursing practice.Love is the source of enthusiasm.An enthusiastic nurse loves life,work and patients.Loving patients is essential to inflame passion for patient care.A desire for and pursuits of benevolence is the key to enthusiasm.Only the element of benevolence integrated into enthusiasm can nurses arouse a sense of compassion,responsibility and honour,which is then advanced to the realm of humanitarian-Heal the Wounded,Rescue the Dying.The essence of enthusiasm is sincerity,that is,providing patients wholehearted care rather than hypocritical act.Caring for patients is based on goodwill and altruism.Enthusiasm is also the driving force for nurses' creativity.It inspires a positive life,pushes to pursue self-actualization and propels continuous creation.

Objective To analyze the genetic diversity of Psammosilene tunicoides,an endangered and endemic medicinal plant,in southwest China.Methods The genetic diversity of seven representational populations of P.tunicoides including 137 individuals had been investigated by amplified fragment length polymorphisms(AFLP)maker technique.Results The genetic diversity had been revealed as follow:the Nei's genetic diversity index(He),Shannon's information index(I),percentage of polymorphic loci(PPB)were 0.243 4?0.179 1,0.373 5?0.248 5,and 82.30%,respectively at the species level;and 0.091 8?0.161 0,0.140 2?0.236 2,and 30.48%,respectively at population level.The genetic differentiation index(Gst)was 0.624 6 and genetic differentiation coefficient by Shannon's diversity(Ist)was 0.624 6.The result of dendrogram of seven populations indicated that Lijiang and Gejiu of Yunnan populations shared the maximum genetic identity,though they distributed in a relatively great geographical distance;Kunming population of Yunnan had the greater genetic distance from other populations.Nine characteristic fingerprint bands that can distinguish the different populations had been acquired.Conclusion The genetic diversity of P.tunicoides is relatively higher at the species levels,while lower within population levels,and a significant degree of genetic differentiation occurrs among the populations.There is little relativity between the relationship of populations and geographical distance.The combination of characteristic fingerprint bands between intraspecies and populations provide important basis data for germplasm resources diagnostics and plant breeding by AFLP maker technique.