Objective To explore the clinical effect between atorvastatin combined with amlodipine and amlodipine monotherapy for the treatment of hypertension .Methods 116 patients with primary hypertension were randomly selected.According to treatment methods, they were divided into the control group and the observation group,60 cases in the control group was given amlodipine therapy.56 patients in the intervention group,with atorvasta-tin treatment on the basis of the control group.Systolic and diastolic blood pressure before and after the treatment, carotid artery intima-media thickness (IMT) were observed,and carotid plaque area,serum total cholesterol (TC), low density lipoprotein cholesterol ( LDL-C) and urinary albumin ( mAlb) were detected.Results After treatment, systolic blood pressure of the observation group and the control group were (138.51 ±12.90) mmHg and (147.62 ± 13.45)mmHg,lower than those before treatment(t=12.67,10.35,all P<0.05),and the patients of the observation group lower than the control group (t=7.82,P<0.05).The diastolic blood pressure of the observation group and the control group after treatment were (90.17 ±4.30)mmHg and (93.63 ±6.26)mmHg, lower than that of the before treatment(t=9.86,11.03,all P<0.05),the observation group was lower than that in the control group (t=5.14, P<0.05).IMT of the observation group and the control group were (0.73 ±0.34)mm and (0.85 ±0.39)mm,lower than those before treatment(t=6.60,6.29,all P<0.05),and that in the observation group was lower than that in the control group (t=5.74,P<0.05).The plaque area of the observation group and the control group patients were (12.02 ±1.45)mm2 and (13.52 ±1.86)mm2,lower than those before treatment(t=8.13,8.59,all P<0.05),and the patients in the observation group was lower than the control group (t=6.22,P<0.05).mAlb,TC and LDL-C of the observation group and the control group after treatment were lower than those before treatment(t=7.65,8.01, 6.08,6.44,5.94,6.02,all P<0.05),and the patients in the observation group was lower than the control group,the difference had statistical significance (t=5.86,5.37,5.63,all P<0.05).The adverse reactions of two groups had no significant difference (χ2 =1.08,P>0.05).Conclusion There is a good clinical effect of atorvastatin combined with amlodipine for the treatment of hypertension and there is no obvious adverse reactions,which is worthy of clinical application.

Objective To investigate the clinical effects of reconstruction by using the free iliac flap with nerve anastomosis to repair the composite tissue defects of heel.Methods From March 2009 to August 2012,five cases with the composite tissue defects of heel,including 2 cases with the bottom defects and 3 cases with the tibial defects of heel,were repaired by the free iliac flap,and the feeling of the heel were reconstructed by nerve anastomosis of the flap.The ventral wound were sutured simply.Results All iliac flaps survived and the wound healed in one stage.Patients were followed up from 6 months to 12 months.Appearance and function recovered and the feeling recovered from S2-S3.The foots walked freely.The skin of iliac abdomen were scarred and lead to hyperpigmentation.Conclusion Using the free iliac flap with nerve anastomosis could repair the bone and soft tissue defects of heel and reconstruct the sensation of warmth and sense of pain of the heel.With the characteristics of hidden wound and little damage,the clinical effects was satisfied.

BACKGROUND:Neural stem cells(NSCs)are characterized by widely resources,convenient harvesting,easy culture and prone to import and express exogenous genes,which can be served as carriers of gene therapy for neural system disease.OBJECTIVE:To review the application of NSCs in spinal cord injury.METHODS:Databases of PubMed(http://www.ncbi.nlm.nih.gov/PubMed)and Wanfang(http://www.wanfangdata.com.cn)were searched by the correspondence author using key words of "neural stem cells,spinal cord injury,cellular transplantation" both in English and Chinese to retrieve papers concerning isolation,identification,differentiation of NSCs as well as its application in repairing spinal cord injury.A total of 82 documents were initial obtained by computer,after repetitive studies were excluded,23 papers were included in the final analysis.RESULTS AND CONCLUSION:The NSCs transplantation has been widely used in animal experiments.Currently,the applications of NSCs in repairing spinal cord injury are concentrated on the following aspects:Firstly,cellular replacement therapy,namely,direct transplanting NSCs or activating in vivo NSCs to differentiate into neurons and glial cells,and then integrating transplanted cells with the existed neural cellular structure to cure the disease.Secondly,NSCs were utilized as gene carriers,which carrying target gene to body and reach the aims of cellular replacement and gene therapy.Thirdly,autologous NSCs were induced differentiation for self neural repair via studying growth factors and cytokines.

By questionnaire we conducted a cluster sampling survey on 150 general practice meutors in Zhejiang province who completed training program during November 2011 to May 2013.By using Kirkpatrick's four level evaluation methods,we evaluated the training program based on the response level,learning level and behavior level.A total of 141 valid questionnaires were collected.The results showed that 92.2％ of participants (130/141) were satisfied with the training contents,94.3％ (133/141) were satisfied with the teachers,87.9％ (124/141) were satisfied with the training environment,83.7％ (118/141) thought the training contents useful,and 89.4％ (126/141) were satisfied with the training organization.Only 31.2％ (44/141) of participants mastered the knowledge and skills of general practice before training,and the figure increased to 87.2％ (123/141) after training.The results also showed that 67.3％ (95/141) of participants were able to use the knowledge acquired in the training,and 81.6％ (115/141) of them were able to apply the concept of general practice in their teaching practice.These results indicate that general practice mentors are satisfied with the training in the aspects of response,learning and behavior,aud the training program would play a positive role in promoting their performance in teaching practice.

Objective To study the relationship between essential hypertension(EH)with serum homocysteine(HCY),uroten-sinⅡ(UⅡ),angiotensin converting enzyme(ACE)and N-terminal pro-brain natriuretic peptide(NT-proBNP).Methods By collec-ting the clinical cases,UⅡwas determined by ELISA and HCY,ACE and NT-proBNP were simultaneously detected by ELISA.The detection results were analyzed and compared between the patients with essential hypertension(EH group)and the healthy con-trols.Results The levels of serum HCY,UⅡ,ACE and NT-proBNP in the EH group were significantly increased compared with the healthy control group;the area under curve (AUC)of serum HCY,UⅡ,ACE and NT-proBNP in the ROC curve in the EH group were 0.93,0.765,0.792 and 0.972 respectively,which showed clinical diagnostic significance.Conclusion The levels of HCY,UⅡ,ACE and NT-proBNP are highly expressed in EH and have significant differences compared with the healthy popula-tion,which has the diagnostic value to EH.

Objective: To investigate the development of osteoporosis (OS) and its influencing factors among physical examination populations aged over 35 years in urban areas of Hangzhou City, so as to provide insights into OP prevention. Methods: Subjects aged over 35 years that underwent physical examinations in Wenhui Street Community Health Service Center of Gongshu District, Hanghzhou City during the period between April and July, 2022 were enrolled. Subjects' demographic characteristics and physical examination data were collected, and the bone mineral density and serum vitamin D levels were measured. The factors affecting the development of OP were identified using a logistic regression model. Results: A total of 1 561 subjects were recruited, including 616 males (39.46%) with a median (interquartile range) age of 62 (18) years, and 945 females (60.54%) with a median (interquartile range) age of 62 (19) years. The prevalence of OP was 43.69% among the study subjects. Multivariable logistic regression analysis identified women (OR=1.367, 95%CI: 1.105-2.979) and increased age (OR=1.057, 95%CI: 1.044-1.069) as risk factors for OP and elevated serum 25-hydroxy-vitamin D levels as a protective factor for OP (OR=0.969, 95%CI: 0.954-0.985). Conclusions The prevalence of OP was 43.69% among physical examination populations aged over 35 years in urban areas of Hangzhou City, and gender, age and serum 25-hydroxy-vitamin D were factors affecting the development of OP.

Objective To explore the effect of shifting the little finger abductor muscle and cutting open the metatarsophalangeal joint dorsal articular capsule to improve the appearance and function of reconstructed thumb.Methods From August 2007 to May 2012,twelve cases of Ⅳ°or Ⅴ°defect of thumb were repaired by free transplantation of the second toes with metatarsophalangeal joint.During operation,using the abductor muscle of little finger to reconstruct palmar opposition function,cutting open the joint capsule of metatarsophalangeal joint,adjusting the tension of the joint by the little finger abductor muscle and toe short extensor muscles,which were used to improve the appearance and function of reconstructed thumb.Results Twelve reconstructed thumbs all survived.Followed up from 6 to 24 months,the appearance and function were improved obviously.According to the evaluation trial standards,nine cases were optimal and 3 cases were good.Conclusion The shift of the little finger abductor muscle could reconstruct palmar opposition function,combined with metatarsophalangeal joint dorsal articular capsule incision and adjusting joint tension,could improve the appearance and function of reconstructed thumb.The effect of operation was satisfied.

Objective To investigate the applied value of abnormalities of fetus with oligohydramnios in mid-pregnancy by anmioinfusion. Methods Fifty women with oligohydramnios diagnosed by ultrasonograph were analysed retrospectively. During the procedure 60-300 ml saline solution at 37 ℃ were infused into the amniotic cavity,made prenatal diagnosis at the same time necessarily. And examined the women to know whether the fetal anomaly existed or not after the amnioinfusion by the ultrasound. Results There were 15 cases with fetal anomaly, 8 cases with genitotirinary anomaly(2 cases associated with multiple organs anomaly), 1 case with single umbilical artery, 4 cases with chromosomal abnormality (2 cases associated with fetal growth restriction), 2 cases with pulmonary hypolasia. There was no significant difference in dilivery outcome between others and 35 cases with normal pregnant women (P >0.05). Conclusion Transabdominal amnioinfusion has double function on beth diagnosis and therapy for the oligohydramnios in the mid-pregnancy.

Objective To investigate the readiness for hospital discharge of patients who had undergone spinal operation at West China Hospital, Sichuan University, to guide the medical care and health education. Methods A total of 164 patients after spinal operation who have readying to discharge were selected and investigated by General Information Questionnaire, Activity of Daily Life Scale and Readiness for Hospital Discharge Scale. Apply the Excel for data inputting, SPSS19.0 for statistical analysis and choose rate, x±s and so on for statistical description according to the types of data. Results Of all the 164 patients, 47 cases (28.7%) weren′t well prepared, 117 cases (71.3%) were well prepared;the score of
Readiness for Hospital Discharge Scale was (142.38±34.23 points and the average score of all the articles was (7.12±1.72) points. Conclusions The readiness for hospital discharge score of patients who had undergone a spinal operation at West China Hospital, Sichuan University is low and their readiness for hospital discharge is inadequate. Medical staff can improve the patients′readiness for hospital discharge by strengthening health guidance in order to promote the recovery of patients.

Objective To evaluate the effect of transitional care on the quality of life in patients with maintenance hemodialysis (MHD).Methods 101 MHD patients with symptoms of kidney ＜ 80 points were assigned into the interventional group (47 of 51 cases completed the study) and the control group (45 of 50 cases completed the study) by random number table method.The patients in the interventional group received transitional care for 6 months,while control group received routine care.The effects on function index,satisfaction index and clinical index were evaluated at the 3rd month and 6th month after intervention.Results 6 months after intervention,the scores of physical composite,mental composite,burden of kidney disease,symptoms/problems list,effects of kidney disease in the interventional group were 51.78±5.91,55.32±5.36,29.79±17.64,79.39±6.73,68.02±11.38,while the scores of the control group were 38.22±9.46,42.03±8.32,19.58±17.25,69.49±10.10,52.09±16.78,and the difference between the two groups was statistically significant (t=5.308-9.063,Z=-3.07,P ＜ 0.01).The scores of self-management behavior,health locus of control in the interventional group were 71.30-±5.42,25.74±2.42,while the scores of the control group were 65.0±8.74,22.47±3.97 (t=4.132,4.759,P ＜ 0.01).The nursing satisfaction in the interventional group scored 91.06±7.29,which was significantly higher than the control group scored 86.22±10.72 (Z=-2.45,P＜ 0.05).The level of serum phosphorus (PO4),Ca × PO4 products,parathormone (PTH) in the interventional group were (1.76±0.35) mmol/L,(51.02±10.04) mg2/dl2,464.56 ng/L,which were significanlty lower than (2.01±0.54) mmol/L,(57.41±17.38) mg2/dl2,625.78 ng/L in the control group (t=-2.691,-2.167,-2.000 in tum,P ＜ 0.01 or 0.05).Conclusions Transitional care achieves good effectiveness on the quality of life in patients with MHD.