In a survey on chronic disease management in Xujiahui Community,we found that the general practice team was facing the following problems：①Heavy burden of follow-up work by a relatively smaller number of physicians;②Misunderstanding of health and insufficient recognition of the importance of chronic disease management among community residents;and③Delayed database construction and inefficient performance.In this study,we described the strategies to improve chronic disease management in communities.

Nephrotic syndrome,a common glomerular disease in pediatric department,is characterized by its long course of disease and facility to repeat or relapse,thus severely influences the physical and mental health of pediatric patients.Besides physical pains,most family members and patients show different degrees of mental stress towards this specific disease.Based on investigating clinical cases,we explored the features of mental stress among children with nephritic syndrome and their family members,and came up with corresponding psychological interference by effective communication skills between doctors and children with nephritic syndrome,offering humane concern,and proper instruction in clinical treatment in order to increase the compliance of children patients and their family members to medical treatment.Therefore,children patients and their family members manifest favorable attitude and cooperate with medical staff in the treating process,thus a satisfactory treating outcome will be achieved.

Aim To observe the effect of DL-buthionine s ulfoximine(DL-BSO) on the radiosensitivity of rat C 6 glioma cells under the a erobic and the hypoxic condition. Methods The source of radiati on was 60Co ?-rays. The rats C 6 glioma cells were treated by radia tion alone or DL-BSO+radiation under the aerobic and the hypoxic condition. Col ony forming assay was used to measure effects of DL-BSO on the radiosensitivity . Results Radiosensitive effect of DL-BSO was time-depedent u nder the aerobic condition. After treatment with 0.1 mmol?L -1 DL-BSO fo r 2, 6, 12 hours, the radiosensitive effect was not observed, whereas an enhance ment of radiosensitivity was seen at 24 and 48 hours. An enhancement of radiosen sitivity was seen at 2～48 hours after treatment with 0.1 mmol?L -1 DL-B SO under the hypoxic condition. The radiosensitive effects related to DL-BSO co ncentration under the aerobic and the hypoxic condition. Conclusion Both under the aerobic and the hypoxic conditions DL-BSO can increase the radio sensitivity of rat C 6 glioma cells. DL-BSO increased the rat C 6 gliom a cells radiosensitivity especially under the hypoxic condition, and radiosensit ive effect of DL-BSO is time and concentration-dependent.

Objective To investigate the effectiveness and safety of psychological intervention combined with Metformin Hydrochloride Enteric-Coated Capsules in the treatment of type 2 diabetes mellitus. Methods A total of 80 patients with type 2 diabetes mellitus were selected from May 2015 to October 2016 in our hospital. The subjects were randomly divided into control group and experimental group, with 40 patients in each group. The control group was given repaglinide treatment, given metformin treatment of Metformin Hydrochloride Enteric-Coated Capsules on the basis of the experimental group, psychological intervention on the mental status of patients and patients, strengthen communication and exchanges, increase confidence in the treatment and the treatment compliance of patients. Results After the corresponding treatment, the patients in the experimental group and the control group had no serious adverse reactions, and the safety was better. The probability of hypoglycemia in the experimental group (15%) was significantly higher than that in the control group (5%), with statistical difference (P<0.05). Before treatment, the fasting blood glucose levels of the experimental group and the control group were (9.21±2.31) and (9.38±2.28) nmol / L, and there was no significant difference between the two groups, and there was no statistical significance The fasting blood glucose level (7.31±1.02), nmol / L in the experimental group was significantly lower than that in the control group (7.90±0.82) nmol / L. The effect of diabetes treatment in the experimental group was significantly better than that in the control group, with statistical difference (P<0.05). Conclusion Psychological intervention combined with Metformin Hydrochloride Enteric-Coated Capsules in the treatment of type 2 diabetes mellitus has high efficacy and low incidence of adverse reactions. It has clinical significance.

Objective To evaluate the rat model of dry eye induced by topical administration of benzalkonium chloride and compare the morphological characteristics of corneal and conjunctival tissues of the normal and model rats . Methods Topical administration of benzalkonium chloride (0.3%) twice per day for seven days to induce the rat model of dry eye.Pathology with HE and periodic acid-Schiff staining and transmission electron microscopy were performed to evaluate the corneal and conjunctival changes .Results The corneal and conjunctival epithelial cells were sloughed off , the number of goblet cells was decreased in the dry eye model .Microvilli were obviously lost in the surface epithelial cells of the dry eye rat cornea and conjunctiva compared with the normal rats , as indicated by the amount and size of microvilli . Conclusions The changes in the corneal and conjunctival epithelia of BAC-induced rat dry eye are similar to the changes in human dry eye .This rat model may play an essential role for dry eye studies in the future .

Objective To discuss the clinical and pathological features of herniation secondary to cerebral infarction. Method Clinical and pathologic characteristics of 50 cases died of herniation due to cerebral infarction were analysised. Results The clinical manifestations,such as consciousness disturbance,pupillary change,hemiplegia or tetraplegia were detected in all 50 cases,the average time from onset to herniation was (3.36?1.12)d,the time herniation to death was 20 h～7 d,average about (1.5?0.98)d. The large size cerebral infarctions caused by internal carotid artery,middle cerebral artery and/or vertebral artery occlusion were pathologically confirmed.hemorrhagic cerebral infarctions caused by cerebral embolism were found in 25 cases and the ischenmic infarctions caused by cerebral thrombosis in 25 caese.Site of infarction were cerebral hemisphere (31 cases), brain stem (15 cases), supratentorial and infratentorial brain (4 cases).Of the 50 cases,36 cases had hippocampal gyrus herniation,36 cases with cerebellur throat-almond herniation,18 cases with central herniation,17 cases with cingulated gyrus herniation,and 27 cases with sphenoidal crest herniation. Usually there were several herniation existing in the same patient. Among 50 cases,11cases had two kinds of herniation,10 cases with three kinds of herniation,9 cases with four kind of herniation, and 5 cases with five kinds of herniation.Conclusions Herniation secondary to cerebral infarction were mainly presented in the large size cerebral infarction caused by internal carotid artery or middle cerebral artery occlusion.the time of herniation was in early stage of disease.Most of patients were hippocampal gyrus herniation and cerebellur throat-almond herniation.Usually there were several herniation existing in the same patient.

Objective To discuss the clinical characteristics and pathological changes of basilar artery aneurysm.Methods The clinical materials and brain topography results were analyzed retrospectively in 4 patients with basilar artery aneurysm.Results The onsets of disease in all cases were acute and common manifestations were coma,positive meningeal irritation sign and ocular dyskinesis.3 cases showed hypertention,2 cases presented with hemiparalysis,all cases died of herniation.3 cases of basilar artery trunk fusiform aneurysm and 1 case of basilar artery furcation saccular aneurysm were detected in autopsy.There were aneurysm rupture,subarachnoid hemorrhage and swell,necrosis,softening,gliosis of brain tissue confirmed pathologically in all cases.Conclusion Hypertension is probably the most important cause of aneurysm rupture.Signs and symptoms of subarachnoid are the most common manifestation when basilar artery aneurysm ruptures with poor prognosis.Herniation is the main cause of death.

Objective To investigate the pharmacological actions related with therapeutic effect and indications of crude and processed semen cassiae,and to compare the differences between them.Methods Serum contents of ALT and AST were determined in acute liver injury mice induced by CCl4,the intestinal propulsion of Evans blue was measured in normal mice and in constipation mice,and stool properties,defecation latency and defecate amounts in constipation mice were also investigated.Results Both crude and processed semen cassiae showed obvious liver-protective effects,and decreased the contents of ALT and AST in serum,but processed semen cassiae was better than crude in protecting liver.Both of them increased the intestinal propulsion in normal and constipation mice,improved the stool properties,shortened the defecate latency and increased the defecate amounts in constipation mice.Conclusion Both crude and processed semen cassiae have the effects of protecting liver,lubricating bowel and promoting defecation.The processed is superior to the crude in liver protection and enzyme decrease,and they have similar effect in lubricating bowel and promoting defecation.

Objective To analyze the effect and the problems of the comprehensive application of quality management tools in order to improve nursing quality and ensure patient safety.Methods To summarize the implementation of Plan,Do,Check,Action(PDCA),quality control circle(QCC),root cause analysis(RCA),healthcare failure mode and effect analysis(HFMEA) in the nursing quality improvement.Aiming at problems arising in application process,the measures such as systematic training of quality management knowledge,case demonstration,standardized evaluation throughout the whole process,holding competition activities,inviting experts to give immediate guidance were applied.Results Among 1 798 PDCA and QCC programs,the result of 1 795 programs reached the target value,3 substandard programs reached the expected outcome finally after cause analysis,procedure break down and adjust of improvement contents.No nursing error or adverse events occurred.The indicators of nursing quality improved and patient satisfaction was 98.58％,which got the third position among all national hospitals.Conclusions The comprehensive application of four quality management tools was helpful in enhancing the effect of nursing quality improvement.