Objective To investigate the prevalence of multidrug and multiple diseases in coronary heart disease in the hospitalized elderly patient.Methods Six hundred and twenty-two hospitalized coronary heart disease patients during 2008-2012 year were assigned to adult coronary heart disease group and they were divided into adults(18-64 years old) and elderly(≥65 years old) groups.Number of drugs was counted and number of diseases was counted based on diagnosis.Multidrug was defined as the kinds of concurrent drug use was over 5.Results The average kinds of drugs used in adult coronary heart disease group was (5.2 ± 3.4).The average kinds of drugs used in elderly coronary heart disease group was (11.2 ± 7.2).The average kinds of drugs in elderly coronary heart disease was higher than that of adult coronary heart disease (t =2.508,P ＜ 0.01).The average types of diseases in elderly coronary heart disease was higher than that of adult groups ((5.1 ±3.1) vs.(8.2 ±4.8),t =2.400,P ＜0.01).Conclusion Multidrug and multiple diseases are prevalent in the hospitalized coronary heart disease patient,and they are more prominent in elderly coronary heart disease patients.It is needed to further optimize the treatment.

Objective To evaluate the relationship between varicocele (VC) and the prostativenouplexuby coloDoppleflow imaging(CDFI) and to explore the etiology of varicocele .MethodThe innediameterand the hemorrheologiparameterof spermativein and prostativenouplexuwere observed in 135 patientwith lefvaricocele(lefVgroup) ,51 patientwith bilat-eral V(bilateral Vgroup) and the control group(100 cases) by CDFI .The diameteof the prostativenouplexus(PVD) ,peak velocity of reflux flow (RFV) in the Valsalvtesand the peak velocity of antegrade flow (AFV) aresin 3 groupwere statistical-ly analyzed .ResultPVD and RFV in the bilateral Vgroup were greatethan those in the lefVgroup and the control group (P＜0 .01) .PVD and RFV in the lefVgroup had no statistical differencecompared with the control group (P＞0 .05) .AFV had no statistical difference among 3 group(P>0 .05) .PVD ,RFV and AFV in 30 caseof Vhad no statistical differencebe-tween before and afteoperation (P>0 .05) .Conclusion Bilateral Vmay be accompanied with potential systematic vascular abnormalities.

BACKGROUND: Coronary artery disease (CAD) risk in type Ⅱ diabetics is one of the hot topics in clinical research.OBJECTIVE: By using electron-beam tomography(EBT) technology, heart scans were performed to investigate coronary artery lesion in type Ⅱ diabetics and their CAD risks were evaluated as well.DESIGN: Comparative study based on type Ⅱ diabetics complicated with coronary artery lesion.SETTING: Gerontology department in a hospital affiliated to a military medical university of Chinese PLA.PARTICIPANTS: From January 2002 to June 2004, 93 inpatients between the ages of 36 and 78 in the Gerontology Department of Xijing Hospital, an affiliation to the Fourth Military Medical University of Chinese PLA, were selected(male 80, female 13) . Totally 25 of all the patients proved normal by physical examinations were set as normal control(male 22, female 3) group; other inpatients were divided into the abnormal blood glucose group and the coronary heart disease (CHD) group respectively according to their examination results. Of the 57 patients in the abnormal blood glucose group,49 were male and 8 were female. This group was divided into two subgroups:the impaired glucose tolerance group(IGT) containing 29 patients and the diabetes group containing 28 patients. In this group, 44 patients have had heart symptom of different extent. Of the 11 patients in the CHD group, 9 were male and 2 were female. Inclusion criteria: patients with type Ⅱ diabetes were defined by American Diabetes Association in 1979; patients with CHD were defined in the report of the Joint International Society and Federation of Cardiology/World Health Organization Task Force on the standardization of clinical nomenclature and criteria for diagnosis of ischemic heart disease in 1979, and they were all confirmed by coronary angiography. Exclusion criteeases.METHODS: Both plain EBT heart scanning and contrast-enhanced heart scanning were performed on the 93 patients to evaluate the occurrence of coronary artery calcification(CAC), the number of stenosed coronary arterie,and the number of soft plaques. Additionally, other examination results including blood glucose, blood HbA1c and blood lipid were also collected for comparison between the conditions of coronary artery and assessment of the CHD risk among groups.MAIN OUTCOME MEASUREMENTS: In all the groups, the occurrence of CAC, the number of stenosed coronary arteries and the number of plaques were compared, and the CHD risk was analyzed.RESULTS: The occurrence of coronary artery calcification was significantly increased in all the study groups as compared with the control group(x2 = 18.88, P < 0. 01 ). Increasing trend was also observed in the study groups when calculating the number of branches with coronary stenosis and plaques ( F = 10. 758, P < 0. 01; F = 9. 991, P < 0.01 ). CHD risk in diabetes was estimated to be 7. 514 (95% confidence interval, 1. 885 -63. 778).CONCLUSION: Coronary artery lesion can be easily observed in type Ⅱ diabetics,and high CHD risk is predicted in this population. Early diagnosis of CAD and early rehabilitation intervention in grade 2 are extremely important in improving the quality of life and reducing the disability ratio of type Ⅱ diabetics.Huang C, Gao JY, Wong XM, Li R, Yang AL, Zheng MW, Xue FB. Risk analysis of coronary artery disease in type Ⅱ diabetics.

Objective To study and to optimize culture conditions of islet-like cells induced in vitro from fetus bone marrow(BM) mesenchymal stem cells(MSCs).Methods BM was obtained from miscarried human fetus.The MSCs between three to eight passages were used to differentiate into islet-like clusters-through three stages of culture supplemented with 2mercaptoethanol,epidermal growth factor(EGF),basic fibroblast growth factor(bFGF),B_(27) and nicotinamide.Results The 2nd stage cells expressed nestin and/or panceatic and duod-enal homeobox 1(PDX-1),and the 3rd stage cells formed islet-like clusters expressing insulin and glucagon together with positive dithizone staining.Specific insulin secretion could be detected(81.3?23.6?u /ml) from differentiated MSCs which have the capacity to respond to different glucose concentrations.Conclusion Fetal bone marrow MSCs can be differentiated into pancreatic islet-like clusters,and 20mmol/L nicotinamide could be the optimal concentration in culture.

Objective To assess the prevalence and risk of coronary artery disease (CAD) in Chinese adults with type 2 diabetes mellitus (T2DM) using electron beam computed tomography (EBCT) and EBCT angiography (EBCTA). Methods: Ninety-four cases were enrolled in this study including diabetes (n=28), impaired glucose tolerance (IGT, n=30), coronary heart disease (CHD, n=11), and control (n=25). Cardiac EBCT plain scanning and EBCTA were performed on all of these subjects to evaluate coronary artery calcification (CAC) scores, and number of segments of stenosed coronary arteries. Both CAC and/or coronary artery stenosis were defined as patients with coronary artery lesions (CAL). Results CAC scores were not different with the control, diabetes, IGT, or CHD (P＞0.05)groups. Compared to control (0.520±1.295), more stenosed coronary arteries segments (P＜0.05) were detected in diabetes (2.964±1.915), IGT (2.200±2.024), and CHD (2.273±1.679). Number of stenosed artery segments were correlated with age (r=0.215, P=0.019),postprandial glucose (r=0.224, P=0.015), total cholesterol (r=0.323, P=0.000), and duration of diabetes (r=0.208, P=0.004). The incidences of CAL in diabetes (96.43%), IGT (93.33%), and CHD (90.91%) was substantially higher than that in normal control (56.00%, P＜0.01).The odds ratio of CAL associated with having diabetes was estimated to be 7.514 (95% CI: 1.885-63.778). Conclusions Coronary artery lesions are prevalent in Chinese adults with type 2 diabetes, implying a high CAD risk. EBCTA holds potential in depicting the details of CAL and can be used to track the progression of CAD in diabetes patients.

Methods: Preoperatively, all 160 patients with OVCFs underwent pressure-pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and imaging assessments. Pain intensity and pain-related disability were evaluated before and after PVP. Results: Preoperatively, patients with OVCFs had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy participants (p<0.05). Unlike patients with acute fractures, patients with subacute/chronic OVCFs showed higher TS with or without lower CPM in the pain-free area compared with healthy participants (p<0.05). Postoperatively, RBP occurred in 17 of 160 patients (10.6%). All preoperative covariates with significant differences between the RBP and non-RBP groups were subjected to multivariate logistic regression, showing that intravertebral vacuum cleft, posterior fascia edema, numeric rating pain scale scores for low back pain at rest, and TS were independently associated with RBP (p<0.05). Conclusions Augmented central pain processing may occur in patients with OVCFs, even in the subacute stage, and this preexisting CS may be associated with RBP. Preoperative assessment of TS in pain-free areas may provide additional information for identifying patients who may be at risk of RBP development, which may be beneficial for preventing this complication.

Objective:To explore the role of one-to-one tutorial system combined with reflective teaching method in the teaching of clinical nurses in intensive care unit (ICU).Methods:A total of 21 nurses who practiced in ICU from March 2019 to October 2019 were set as the control group, and 21 nurses who practiced in ICU from December 2019 to July 2020 were set as a research group. The control group adopted traditional teaching, and the research group adopted the tutorial system combined with reflective teaching. The theoretical and technical performance assessment results, professional self-efficacy before and after teaching, and clinical comprehensive ability before and after teaching were compared between the two groups. SPSS 26.0 was used for t test χ2 test, and rank-sum test was used for rank distribution. Results:After teaching, there were significant differences between the two groups in the grades distribution of theoretical and technical operation examination results ( P<0.05). The excellent and good rate of theoretical and technical operation examination in the study group were higher than those in the control group ( P<0.05). Before teaching, there was no significant difference in the scores of job responsibility and education requirements in professional self-efficacy scale and clinical comprehensive ability (observation ability, communication ability, health education ability, humanistic care ability, emergency response ability, professional knowledge, accurate execution of doctor's advice and coordination ability with doctors) between the two groups ( P > 0.05). After teaching, the scores of professional self-efficacy scale and clinical comprehensive ability of nursing students in the two groups were significantly increased ( P<0.05). The scores of professional self-efficacy scale and comprehensive ability of nursing students in the study group after teaching were higher than those in the control group ( P<0.05). Conclusion:The application of one-to-one tutorial system combined with reflective teaching method can significantly improve the professional self-efficacy of nursing students, improve the teaching effect, and improve the clinical comprehensive quality of nursing students.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.