Objective To study the pathogenesis of avascular necrosis of femoral head(ANFH) in young adults.Methods The data of DSA of femoral head(113 femoral heads) with ANFH proved by clinic or radiology and treated by interventional radiology and 45 normal peoples(46 femoral head) were comparatively analysed.Results The variation of artery of femoral head in interventional treating group was appeared in 28 cases(35.9%),51 arteries involved,including 17 internal iliac arteries variation(33.3%),29 medial femoral circumflex arteries variation(56.9%),4 lateral femoral circumflex arteries variation(7.8%),1 lateral and medial femoral circumflex arteries common bole variation(2.0%).The variation of artery of femoral head in control group was appeared in 5 cases,5 arteries involved.There was significant difference between the two groups(P

Objective: To evaluate the efficacy and safety of albumin-bound paclitaxel-based chemotherapy for patients with advanced breast cancer. Methods: A total of 33 patients with advanced breast cancer were enrolled into this study from July 2009 to April 2012. All patients received albuminbound paclitaxel-based chemotherapy. The adverse reactions were evaluated every cycle, and the shortterm response was evaluated every two cycles. The patients were followed-up, and the survival was analyzed. Results: Of twenty-eight patients who could be evaluated for short-term response, one patient achieved complete response, six patients achieved partial response, and fourteen patients had stable disease. The objective response rate was 25.0% (7/28), and the disease control rate was 75.0% (21/28). Twenty-seven of the 33 patients were analyzed for the survival. The median progression-free survival was 4.5 months [95% confidence interval (CI ): 3.0-6.0], and the median overall survival was 15.0 months (95% CI : 7.9-22.1). The main toxicity was myelosuppression (grades 3 and 4 neutropenia and anemia were seen in 69.7% (23/33) and 21.2% (7/33) of patients, respectively). Hypersensitivity reactions occurred in 21.2% (7/33) of patients. The most frequent hypersensitivity reactions were drug fever and (or) skin rash, and no serious hypersensitivity reaction occurred. Conclusion: Albumin-bound paclitaxel is effective and tolerable in patients with advanced breast cancer, and there is no need for premedication. Copyright © 2013 by TUMOR.

Objective To learn the overall results of the final test paper in nursing undergraduates of Peking Union Medical College, and to provide the theoretical support for teaching quality assessment of nursing undergraduates.Methods The difficulty coefficient, the discrimination index, the reliability (Cronbach α coefficient) and the degree of coverage were analyzed based on education measurement and education statistical methods.Results The mean total score was 67.8±12.5, ranged from 38 to 95.The difficulty coefficient, the discrimination index and the Cronbach α coefficient were 0.68, 0.30 and 0.71 respectively.The rates of loss score were 33.8% for choice questions, 37.2% for completion questions, 22.5%for true or false questions and 24.8% for calculation questions respectively.Among the total 30 examination questions, the proportions of the most difficult ones, the difficult ones, the moderate ones, the easy ones and the easiest ones were 30.0%,13.3%,20.0%,20.0% and 16.7% respectively.28 examination questions (93.3%) had the best or better discrimination.Conclusions The test paper held the moderate difficulty and the good discrimination, reliability and the degree of coverage.The results of the examination accurately reflect the knowledge and ability of the students.In addition, more attention should be paidto improve the knowledge of nursing undergraduates on the importance of the medical statistics in medical scientific research.

Objective To observe the incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy (HCM).Methods 612 HCM patients were analyzed prospectively from July 1990 to November 2007.The age,sex,height,weight,medical history,main symptoms and incidence of atrial fibrillation were recorded.Results The patients'mean age was (47.8±14.9).414 patients(67.6%) were male.377 patients (61.6%)had left ventrieular outflow truer obstruction.94 patients(15.4%)and atrial fibrillation.43 patients(6.O%)had sustained and 51 patients (9.4%) had paroxysmal.The patients with atrial fibrillation were older in age and were predominantly female.Their medical history were longer,left atrial diameter(LAD)longer and plasma B-type natriuretie peptide(BNP)higher.logistic regression analysis indicated that the medical history(P=0.012),LAD(P=0.0001) and BNP (P=0.017)were the independent predictors of atrial fibrillation in HCM.Atrial fibrillation was accompanied by a decrease in functional status and an increase in risk of stroke.Conclusions The incidence of atrial fibrillation in HCM was high.The medical history.LAD and BNP were the independent predictors of its occurrence.

Objective Fabry' s disease is a rare X-linked recessive disease. Its cardiac manifestations are not well recognized. Methods The data of 3 patients from different Chinese kindreds with Fabry's disease and cardiac manifestations who seeked medical advice in our department in 2007 were analyzed. The age, sex, family history, main symptoms, ECG and echocardiographic findings were recorded for all the patients. The diagnostic criteria of Fabry's disease was based on α-galactosidase (α-GAL) quantity in white blood cells. Results All of the patients were female. Their age was from 41 to 57. Two of them had the typical symptoms of Fabry's disease in their young age. All of them had family history of the disease and cardiac symptoms. ECG showed ST-T change and echocardiography showed hypertrophy of left ventricule of different degrees. Their α-galactosidase level in white blood cells was lower than normal. The α-galactosidase level in patient 1 was the lowest. Her cardiac symptoms were most serious in the three patients and she had involvement of other organs. Conclusion Patients with Fabry's disease may have cardiac manifestations. Family history, typical symptoms in young age and the characteristics of multi-systemic disorder are helpful clues to the diagnosis.

Objective To investigate the effect of simvastatin on heme oxygenase (HO) -1expression and ventricular remodeling in rats with non-ischemic heart failure. Methods Seventy eight male Wistar rats were randomized into three groups: normal control group (n = 18), model group and simvastatin group (n= 60). Male Wistar rats in model and simvastatin group were given adrimycin(ADR) in an accumulated dose of 15 mg/kg for two weeks (2.5 mg /kg, peritoneal injection, three times per week), and 8 rats were dead. The survival rats (n= 52) were then randomly divided into two groups: model group (n=26) and simvastatin group (n=26), and 6 rats were dead in model group, while 7 dead in simvastatin group at the end of the study. Then rats in simvastatin treatment group(n=19)were given simvastatin 20 mg·kg-1·d-1 by gavage for four weeks,and rats in model group (n=20) and in control group (n=18) were treated with 5% glucose by gavage.At the forth week, another 9 rats were selected into the study and given ADR with an accumulated dose of 15 mg/kg for two weeks. The hemodynamics, mRNA expression of HO-1 in myocardium, left ventricular function as well as hydroxyproline were measured at the end of the sixth week. Results At the sixth week, compared with control group, systolic (+) and diastolic (-) function of the left ventricule (±LVdp/dtmax) of rats in model group and simvastatin group were reduced significantly, and the reduction amplitudes of + LVdp/dtmax and -LVdp/dtmax were 28.2%, 11.9% and 33.0%,27.9%,4, respectively (F = 4.899,3. 890, all P<0.01). The + LVdp/dtmax of rats in simvastatin group was higher than that in model group (F= 2.461, P<0.05). The content of myocardium hydroxyproline was elevated from the end of the second week [(485.0±52.9)g/kg vs. (364.0±41.6)g/kg,F=0.441 ,P<0.01]. At the end of the sixth week, the content of myocardium hydroxyproline of model group elevated continuously [(572.9±75.4) g/kg vs. (485.0±52.9)g/kg, F=0.654,P<0.05], but not for simvastatin group [(475.9±86.5) g/kg vs. (485.0±52.9)g/kg, P>0.05]. The mRNA expression of HO-1 in myocardium 'in model group was higher than that in control group [(0.6217±0.1229) vs. (0.2475±0.1053), F = 0.128, P < 0.01]. The mRNA expression of myocardium HO-1 was increased further by simvastatin treatment [(0.7860±0.1133) vs. (0.6217±0.1229),F=3.622,P<0.05]. Conclusions Compared with control group, the myocardial HO-1expression of heart failure rats is increased. Simvastatin treatment enhances the myocardium HO-1 expression further and alleviates myocardial injury and the degree of heart failure.

Objective To investigate obstructive sleep apnea syndrome (OSAS) in patients with aortic dissection (AD). Methods Questionnaire analysis was applied to patients with or without AD according to Berlin questionnaire. Questionnaires were collected and common characters and related symptoms were compared between the two groups. Further comparison on related symptoms was made between the AD group and hypertensive patients in the control group. Results Totally 70 questionnaires were collected with 33 for the AD group (29 males and 4 females) and 37 for the control (29 males and 8 females). The average age (P ＜0.05) was 50.9 years for the AD group (range 32 to 70) and 53.4 years for the control (range 25 to 83). Snoring occurred in 29 AD patients (87. 88% ) and in 22 control patients (59. 46% ) (P ＜ 0. 05 ). Snoring everyday occurred in 19 AD patients (57. 58% ) and in 12 controls (32.43%) (P ＜0.05). Loud snoring was reported from 23 AD patients (69.70%) and 10 controls (27.03%) (P ＜0. 05). Apnea occurred in 15 AD patients (45. 45% ) and 8 controls (21.62%) ( P ＜0. 05). Apnea nearly everyday occurred in 9 AD patients ( 27.27% ) and 5 controls ( 13. 51% ) ( P ＜0. 05). Fatigue after sleep occurred in 23 AD patients (69. 70% ) and 15 controls (40. 54% ) (P ＜0. 05).Fatigue nearly everyday after sleep occurred in 10 AD patients (30. 30% ) and 6 controls ( 16. 22% ) ( P ＜0. 05). Hypertension was found in 28 AD patients ( 84. 85% ) and 20 controls ( 54. 05% ) ( P ＜ 0. 05 ).The average age of hypertensive control were 62 ± 16, greater than that of AD group (P ＜0. 05). In the 20 hypertensive control patients, loud snoring in 7 (35%), lessen than that of AD group (P ＜0.05).Compared with hypertensive controls, AD patients had greater body length ( P ＜ 0. 05 ) and lesser waist-tohip ration (P ＜ 0. 05 ). Conclusions Compared with normal control, OSAS is more common in AD patients.

Objectives To implement the guideline-based clinical practice program for identification and manage-ment of dysphagia in stroke patients,and to create a good evidence-based practice culture,and to improve the quality of clinical care. Methods In this study,we use the Iowa model of evidence-based practice as a guide, reference guide issued by RNAO to implement the corresponding implementation strategy tool,and gradually apply the program to the pilot ward. Results The implementation of the program had a positive impact on the patient level (quality of life,satisfaction and hospitalization),the nurse level(satisfaction and knowledge),and the level of eachau-ditcriteria. Conclusion It is possible to improve the clinical nursing quality by adapting the high quality guide-lines for the identification and management of dysphagia in foreign countries and this study can provide reference for the research of future guideline implementation.

We reviewed the metabolic studies on flavonoids of Radix Scutellariae, and found that intestinal flora has played a very important role in the metabolism on Radix Scutellariae. This provided the theoretical basis for studying the bioavailability and metabolic characteristics of Radix Scutellariae.

This paper introduced the measures to construct the hierarchical medical system in Yichang city. The authors identified problems found and proposed the city to take the following countermeasures. Such steps included service capacity building at primary level, motivating primary medical workers, attracting patients to primary care, and improving policies of hierarchical medical system.