This paper summarized nursing experience of one patient with diffuse esophageal spasm(DES) undergoing peroral endoscopic myotomy (POEM).Key points of nursing included:preoperative training of use of medical bedpan;respiratory functional exercises;postoperative management of body position,nursing of gastrointestinal decompression,management of refined diet and prevention and nursing of complications.The patient recovered well and no complication occurred.The patient was discharged on the eighth day after surgery.

OBJECTIVE:To evaluate the relative bioavailability of two products(CLMC 1 ,CLMC 2 )of Clarithromycin in man.METHODS:A single oral500mg dose of CLMC 1 or CLMC 2 was given to20healthy male volunteers in an open randomized crossover study.The plasma concentrations of CLMC 1 and CLMC 2 were measured by microbial assay.The pharmacokinetic parameters were calculated with3p97pharmacokinetic program and the bioequivalence was evaluated.RESULTS:The con?centration-time curves of CLMC 1 and CLMC 2 fitted to a two-compartent open model.C max were(2.23?0.83)?g/ml and(2.14?0.70)?g/ml;T max were(1.95?0.39)h,(1.78?0.41)h;AUC (0～T) were(9.50?2.52)(?g?h)/ml,(9.35?2.54)(?g?h)/ml respectively.The relative bioavailability of CLMC 1 was(101.60?9.35)%.CONCLUSION:The results of two and one-side t tests suggest that the CLMC 1 is bioequivalent with the CLMC 2 .

Objective To compare the infection free and overall survival between first and subsequent tunneled cuffed hemodialysis catheters in geriatric patients.Methods The study involved57 geriatric patients [32 male,25 female; mean age (72.4 ± 6.7) years]undergoing maintenance hemodialysis in our blood purfication unit over a period of 72 months.Among a total of 131 catheters and 2686 catheter months including 57 first catheters and 74 consecutive catheters,48 wire guided exchange (WGE) and 26 removal and replacement (RAR),55/131 (42.0％) catheters were exchanged because of catheter-related bacteremia (CRB),37131 (28.2％) exchanged because of malfunction or cuff extrusion,39 /131 (29.9％)catheters were removed electively or was still functional at the end of the study period.Results One-year survival rates for first and consecutive catheters were 35.8％ and 28.4％,respectively.There was no difference in the overall survival between first catheters group and subsequent catheters group [(29.8±7.9)months vs.(28.7±6.0)months,t=0.711,P=0.443].However,infection free survival of first catheters group was significantly prolonged in comparison with that of subsequent catheters group [(13.1 ± 3.5) months vs.(11.6±2.7) months,t =2.415,P=0.018].The overall and infection-free survival in WGE group were not different with those of RAR group [(28.2 ± 7.2 ) months vs.( 28.5 ± 5.8 ) months,(11.1±3.1)months vs.(12.2±2.1)months,t=-0.163,0.103,P＞0.05].The infection free survival of first catheters group and WGE group was prolonged in comparison with that of in situ group[(13.1±3.5)months and (11.1±3.1)months vs.(8.2±2.1)months,t =7.602,5.601,P＜0.05].Conclusions WGE is safe and effective in the elderly patients if the tunnel and the exit site are not infected and has the potential benefit of preserving the vascular access site.

ObjectiveTo investigate the correlation between single nucleotide polymorphism (SNP)of complement factor H (CFH) gene and exudative age-related macular degeneration (AMD) susceptibility.MethodsThis is a retrospective case control study. 136 exudative AMD patients (AMD group) and 140age and sex-matched normal subjects (control group) were enrolled in this study. The peripheral blood was collected,polymorphism genotypes and frequency of CFH Y402H(rs1061170),CFH-257C ＞ T (rs3753394) and CFH IVS15 (rs1329428)were measured by polymerase chain reaction (PCR) and allelespecific restriction endonuclease digestion. The SHEsis software was performed on haplotype construction to analyze the frequency.ResultsThere are TT, TC, CC genotypes and T, C allele in CFH Y402H (rs1061170); CC, CT, TT genotypes and C, T allele in CFH-257C＞T (rs3753394); AA, AG, GG genotypes and A, G allele in CFH IVS15 (rs1329428). The differences of genotypes and allele frequency between 2 groups were statistically significant (P＜0. 05). The TC genotype in CFH Y402H, TT genotype in CFH-257C＞T (rs3753394) and GG genotype in CFH IVS15 (rs1329428) were associated with exudative AMD susceptibility (OR=4. 11,2. 55,3.11;P＜0.05). The T, C and G allele were the risk alleles (OR=3.14,1.72,1.79;P＜0. 05). The differences of frequency between TCG, CTG and CTA haplotype were statistically significant(X2 =10.53,6.60, 32.82;P＜0.05). ConclusionThere is correlation between SNPs of CFH gene and exudative AMD susceptibility.

Objective To study MRI volumetric measurement of hippocampal formation using statistic parametric mapping(SPM) software and to discuss the value of the method applied to Alzheimer's disease (AD).Methods The SPM software was used to divide the three-dimensional MRI brain image into gray matter, white matter and CSF separately.The bilateral hippocampal formations in both AD group and normal control group were delineated and the volumes were measured.The SPM method was compared with conventional method based on region of interest (ROI), which was the gold standard of volume measurement The time used in measuring the volume by these two methods were respectively recorded and compared by two independent samples' t test.Moreover, 7 physicians measured the left hippocampal formation of one same control with both of the two methods.The frequency distribution and dispersion of data acquired with the two methods were evaluated using standard deviation coefficient Results (1)The volume of the bilateral hippocampal formations with SPM method was (1.88±0.07) cm~3 and (1.93±0.08) cm~3 respectively in the AD group, while was (2.99 ±0.07) cm~3 and (3.02 ±0.06) cm~3 in the control group .The volume of bilateral hippocampal formations measured by ROI method was (1.87 ±0.06) cm~3 and (1.91 ±0.09) cm~3 in the AD group, while was (2.97 ±0.08)cm~3 and (3.00 ±0.05) cm~3 in the control group.There was no significant difference between SPM method and conventional ROI method in the AD group and the control group(t=1.500, 1.617, 1.095, 1.889,P> 0.05) .However, the time used for delineation and volume measurement was significantly different.The time used in SPM measurement was (38.1 ±2.0) min, while that in ROI measurement was (55.4 ±2.4) min (t=-25.918, P<0.01).(2)The average volumes of the left hippocampal formation with the two methods measured by the 7 physicians were (2.86±0.20) and (2.76±0.52) cm~3 respectively.The frequency distribution of hippocampal formation volume measured by SPM method and ROI method was different.The CV_(SPM) was 7% and the CV_(ROI) was 19%.Conclusions The borders of hippocampus formation in brain gray matter could be conveniently delineated by SPM software.The accuracy and repetition of measurement was improved by SPM method.The shorter time used in measurement made it possible for MRI volumetric measurement of hippocampal formation to be applied in assessment of relevant neuropsychiatric diseases.

Objective:To study the effect of Xihuang Capsule combined with GP regimen on the serum levels of tumor necrosis factor-oα (TNF-α),vascular endothelial growth factor (VEGF),matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) of patients with advanced breast cancer.Methods:88 patients with advanced breast cancer admitted in our hospital from March 2014 to February 2015 were selected and divided into the observation group and the control group according to the order of admission.The control group was treated by the GP program,the observation group was given Xihuang capsule combined with GP regimen.The serum levels of TNF-α,VEGF,MMP-2 and MMP-9 in the two groups were compared before and after treatment.The clinical efficacy and incidence of side effects were analyzed.Results:The total effective rate of observation group was significantly higher than that of the control group [84.09％ (37/44) vs 50.00％ (22/44)] (P＜0.05).There was no significant difference in the serum levels of TNF-α,VEGF,MMP-2 and MMP-9 between the two groups before treatment (P＞0.05).After treatment,the serum TNF-α,VEGF,MMP-2 and MMP-9 levels were significantly lower than those before treatment (P＜0.05).The serum levels of TNF-α,VEGF,MMP-2 and MMP-9 of observation group were significantly lower than those of the control group (P＜0.05).There was no significant difference in the incidence rate of nausea and vomiting between the two groups (P＞0.05).The incidence ofalopecia,diarrhea,abnormal liver function,decreased appetite,anemia and leukopenia in the observation group were significantly lower than those of the control group (P＜0.05).Conclusion:Xihuang Capsule combined with GP regimen could more effectively reduce the levels of serum TNF-α,VEGF,MMP-2 and MMP-9 of patients with advanced breast cancer than GP regime alone with higher safety.

Objective To observe the lung protective effect of Tongfu Xiefei method (TFXF) in rats with sepsis, and to discuss its possible mechanism.Methods Forty-two Sprague-Dawley (SD) rats were randomly divided into blank control group (n = 6), model group (n = 18) and TFXF group (n = 18). Sepsis model was reproduced by cecal ligation and puncture (CLP) in rats of model group and TFXF group. After the reproduction of sepsis model, rats in TFXF group received Tongfu Xiefei granules 0.01 mL/g by gavge, while those in model group were given equal dose of normal saline by the same way. The rats in blank control group received no treatment. At 3, 6, 12 hours after CLP, abdominal aorta blood was collected for blood gas analysis and inferior vena cava blood was collected for determination of the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Bronchoalveolar lavage fluid (BALF) was collected for measurement of concentrations of total protein (TP), total phospholipid (TPL), and desaturated phosphatidyl choline (DSPC). The ratio of wet/dry lung weight ratio (W/D) was measured, and malondialdehyde (MDA) and myeloperoxidase (MPO) in lung tissues were determined. The pathologic changes in their lungs were observed with light microscopy.Results Compared with those in blank control group, the levels of pH value, arterial oxygen partial pressure (PaO2), HCO3-, base excess (BE) were lowered, and partial pressure of carbon dioxide of arterial blood (PaCO2) was increased in model group. The serum concentrations of TNF-α and IL-6 were gradually increased after the reproduction of sepsis model. Compared with those in blank control group, the levels of TP, TPL, and DSPC/TPL in model group were decreased, while the levels of W/D, MDA and MPO were increased. Compared with those in model group, pH value was elevated in TFXF group at 3 hours (7.27±0.04 vs. 7.18±0.07,P < 0.05). PaO2 (mmHg, 1 mmHg = 0.133 kPa) was improved at 3, 6, 12 hours (3 hours: 128.00±16.05 vs. 106.78±10.73, 6 hours: 98.46±15.97 vs. 72.80±16.33, 12 hours: 90.70±9.31 vs. 74.28±12.19, allP < 0.05). The serum concentrations of TNF-α (ng/L) in TFXF group were significantly lower than those in model group at 12 hours (508.20±94.08 vs. 756.60±138.77,P < 0.05), and the serum concentrations of IL-6 (ng/L) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 687.80±35.00 vs. 849.40±148.28, 12 hours: 728.80±214.41 vs. 917.00±245.96, bothP < 0.05). Compared with those of model group, the levels of TP (g/L) in BALF in TFXF group were significantly decreased at 12 hours (1.01±0.23 vs. 1.60±0.47,P < 0.05), and the levels of TPL (mg/L) in TFXF group were significantly increased at 12 hours (86.40±11.33 vs. 62.40±16.33,P < 0.05). The levels of DSPC/TPL in TFXF group were significantly higher than those in model group at 6 hours and 12 hours (6 hours: 0.58±0.13 vs. 0.38±0.10, 12 hours: 0.45±0.13 vs. 0.24±0.07, bothP < 0.05). The levels of W/D in TFXF group were significantly higher than those in model group at 3 hours (3.84±0.25 vs. 2.99±0.50,P < 0.01), but lower than those in model group at 12 hours (3.21±0.53 vs. 4.89±1.14,P < 0.05). The levels of MDA (nmol/mg) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 4.04±2.58 vs. 8.89±2.61, 12 hours: 11.31±3.60 vs. 20.60±8.10, bothP < 0.05), while the levels of MPO (U/g) in TFXF group were lower than those in model group at 12 hours (4.79±0.66 vs. 7.22±1.76,P < 0.05). Compared with model group, the lungs in TFXF group showed less morphological changes under light microscopy, such as pulmonary edema, congestion, effusion and fibrosis.Conclusions The method of Tongfu Xiefei may improve hypoxemia and metabolic acidosis, alleviate lung edema and ameliorate pulmonary pathological changes in rat sepsis model. Tongfu Xiefei method shows a protective effect in sepsis by the way of reducing peroxidative damage, inhibiting the release of proinflammatory factors and abating degradation of lung surfactant.

Objective To explore the effect of self efficacy combined with mobile health information service applied in pulmonary rehabilitation in residence in elderly patients with chronic obstructive pulmonary disease. Methods Sixty-eight elderly patients in stable situation were divided into the control group and the intervention group with 34 cases in each group accoridng to the random digit table. In the control group, the nursing intervention included health education and telephone follow-up. The intervention group adopted self efficacy theory combined with mobile health information service. The items such as persistence in pulmonary rehabilitation, Exercise Self-Regulatory Efficacy Scale (Ex-SRES) and health condition were assessed. Results After intervention for 12 weeks, the scores of persistence in pulmonary rehabilitation in residence in the intervention group scored 5.35 ±1.42, which was higher than that in the control group (2.03±1.40), the difference was significant (t=160.43, P<0.01). Ex-SRES of the intervention group scored 62.06±13.10,91.21±11.12, which were higher than those of the control group, 50.38±18.03,42.56±18.23, the difference was significant (t=9.32,176.88, P<0.01) . The interaction between treatment effects and time effect was significant in COPD Assessment of Tool (CAT) and Ex-SRES respectively(F=489.95,P=0.00;F=134.80, P=0.00). Comparing value of CAT in baseline (24.97±4.74,24.62±5.39) and at the end of the twelfth week(24.94±4.74,24.65±5.35), the difference was not significant in two groups respectively(P>0.05). The improvement of CAT was significant at the end of the twenty-forth week (21.90±4.67) in the intervention group (t=-12.09, P<0.01). Conclusions Self efficacy theory and the application of mobile health information services can help patients persist in long-term rehabilitation exercise training.

Objective To apply short message service (SMS) for pulmonary rehabilitation in residence. Methods A total of 102 old pa-tients with chronic obstructive pulmonary disease (COPD) in stable situation were equally divided into three groups randomly. They all ac-cepted a two-week lesson of exercise project, and then took in the project for 22 weeks. Meanwhile, group A phoned to their experts once a week, group B was phoned by their experts once a week, and group C accepted SMS once a day and sent back to the experts. They were in-vestigated with Exercise Self Regulatory Efficacy Scale (Ex-SERS), modified British Medical Research Council Scale (mMRC) and COPD Assessment Test (CAT) before and after intervention. Results The score of Ex-SERS was the most in group C (F=179.53, P<0.001), with the interaction of time (F=387.09, P<0.001). While the scores of mMRC (F=8.754, P<0.001) and CAT (F=11.32, P<0.001) were the least in group C. Conclusion Application of SMS in the integrated management for pulmonary rehabilitation in residence may improve the self regu-latory efficacy of exercise, release the dyspnea and the influence on living in patients with COPD.

BACKGROUND:Fracture healing in diabetic patients is usual y unsatisfactory because of hormones and metabolic disorder, and an eventual multiple organ dysfunction resulting from high blood glucose. OBJECTIVE:To dynamical y observe the changes of cytokines during the fracture healing process in diabetic rats before and after insulin treatment. METHODS:A total of 120 Sprague-Dawley rats were included in this study. Of them, 90 rats intravenously injected with 5%tetraoxypyrimidine to induce rat models of diabetes were randomized into insulin treatment and diabetes groups, respectively. The remaining 30 rats were intravenously injected with equal volume of saline and selected as control group. The next day, blood glucose was determined. Healing at 1, 4, and 8 weeks after fracture were observed by the X-ray film. Biomechanical strength of the injured right tibia was measured at 4, 6, and 8 weeks after modeling. Cytokines in the osteotylus were determined by immunohistochemical staining and in situ hybridization technique. RESULTS AND CONCLUSION:The X-ray films showed that the speed of fracture healing in the diabetes group was slower than insulin treatment and control groups. Biomechanical strength of the osteotylus in the diabetes group was significantly decreased compared with the insulin treatment and control groups. However, there were no significant differences in above-mentioned parameters between the control and insulin treatment groups. Bone morphogenetic protein 2, basic fibroblast growth factor, transforming growth factor-beta, and vascular endothelial growth factor were widely expressed in the osteotylus and their expressions in diabetes group were significantly lower and slower than those in the control and insulin treatment groups. There was no statistical difference between control and insulin treatment groups. These results indicate that osteotylus formation speed, biomechanical strength, and growth factor expressions at the fracture site in diabetes rats were decreased compared with normal rats. Insulin treatment can enhance cytokine levels at the fracture site, thereby promoting the osteoblast proliferation and fracture healing.