Objective To investigate the treatment of chronic heart failure in two communities in Pudong and find the deficiency of standardized treatment in community hospital.Methods A retrospective study of all the inpatient,family bed and outpatient with heart failure who visit Hudong and Lujiazui community health Service center was conducted from March 2012 to March 2015 retrospectively.General situation(gender,age,smoking history,drinking history,daily salt intake,concomitant disease),etiology and if have the acute heart failure onset in half a year and what are the incentives,drug treatment and treatment of concomitant hypertension and diabetes mellitus were analyzed by face to face follow up.Results The study included 300 patients,average age was (58 ± 10) years.Daily salt intake of 55.0％ (165/300)patients was more than 9 g.Coronary heart disease (45.7 ％,137/300),hypertension (30.7％,92/300)and cardiomyopathy (9.0％,27/300)were the chief heart failure etiology.59.3％ (178/300) patients had acute heart failure in half a year.Acute blood pressure(20.8％,37/178),transfusion too fast or too much and infection(14.6％,26/178) were the chief incentives leading to acute heart failure.83.3％ (250/300)patients used ACEI/ARB,but only 32.0％ (80/250) of them applied the target dose.53.7％ (161/300)patients used beta blockers and 98.1％ (158/161) of them could not reach the target dose.Tartaric acid metoprolol (51.6％,83/161),peso parlour (18.6％,30/161) and carvedilol (14.9％,24/161) were commonly used drug in clinic.76.6％ (230/300)patients had hypertension and blood pressure was controlled in 82.2％ (189/230) of them successfully.44.0％ (132/300) patients had diabetes mellitus and glycosylated hemoglobin (HbA1c) was controlled from 7 ％ to 8 ％ in 23.5 ％ (31/132) of them.Conclusion In the community treatment of heart failure,the drugs recommended by guidelines were low usage and achieved the target dose rarely.Treatment of concomitant diseases was not good.The knowledge of new progress was not enough.

Objective To survey the knowledge of chronic stable coronary artery disease management among general practitioners (GPs) in Shanghai Pudong New Area.Methods The survey was conducted among 363 GPs with at least 2-year work experiences from community health service centers in Shanghai Pudong New Area from July to September in 2014.A self-designed questionnaire based on the guidelines/consensus of chronic stable coronary artery disease management were used in the survey.The questionnaire consisted of 4 parts:diagnosis,drug therapy,revascularization and treatment of special types.Results Among 363 participants 362 questionnaires were completed.History taking,physical examination and electrocardiogram were applied for diagnosis in all participants,49.2％ (178/362) also used coronary computed tomography angiography,26.5％ (96/362)used exercise testing for assistant examination.More than 95.0％ of participants recognized that smoking,obesity,hyperlipidemia,hypertension,diabetes were risk factors.75.7％ (274/362) of participants used aspirin,91.4％ (331/362) knew the dose of aspirin as 75-150 mg;for aspirin intolerance 14.6％ (53/362)would use clopidogrel alternatively.50.6％ (183/ 362) of participants sometimes used statins;and 39.2％ (142/362) did not use stain because of not knowing the contraindication.Facing increases of alanine aminotransferase or aspartate aminotransferase levels 95.3％ (345/362) of participants would immediately discontinue stain;80.4％ (291/362) discontinued statins as creatine kinase increased.32.0％ (116/362) of participants gave enough drug-free period avoiding nitrates resistance.79.6％ (288/362) seldom used β-blockers and 42.5％ (154/362) failed to use β-blockers because not knowing the contraindication.78.7％ (285/362) knew percutaneous coronary intervention but did not know its indications;83.1％ (301/362)knew coronary artery bypass but did not know its indications.27.6％ (100/362) knew calcium antagonists were first-line drugs for variant angina and 93.6％ (339/362) never heard of microvascular angina.Conclusion The survey shows that GPs from community health service centers in Shanghai Pudong are not well familiar with examination of coronary heart disease and lack of sufficient knowledge of drugs recommended by the guideline,not well understand the indications for revascularization and the diagnosis and treatment of special types of coronary heart disease.

Objective To summarize the successful experience of radiodiagnosis specialist nursing model in our hospital.Methods Retrospectively analyze the course of establishment and development of radiodiagnosis specialist nursing model in our hospital.Many aspects including setting of the nursing unit,post,quota and salary,development of post responsibilities,systems,standards and procedures,establishment of quality control and performance evaluation system,standardization of the conventional specialist technology,study and application of the new specialist technology were expounded.Results Radiodiagnosis specialist nursing model had been established and improved after five years' exploration.Quality index of care,service and safety showed a steady upward trend.Specialist new technologies had prominent features.Teaching and research achieved initial success.Conclusions Establishment of radiodiagnosis specialist nursing model makes radiology nursing connotation more comprehensive.More importantly,it is of significance in guiding the development of radiodiagnosis specialist nursing.

AIM: To observe the effects of valproic acid(VPA) and HA14-1 on Bcl-2 overexpressed leukemia cells in vitro and in vivo.METHODS:(1) Cells were divided into control group,HA14-1 group,VPA group and HA14-1+VPA group.The apoptotic rate,the mean fluorescent index(MFI) of Bcl-2,the levels of caspase 3,8 and 9 were detected with FCM.(2) 24 h after transplantation with BALL-1,the NOD/SCID mice were divided into 4 groups as(1),then the survival time was compared.The expression of CD19 in the peripheral blood cells,bone marrows,livers,spleens and lungs of each group was detected.RESULTS:(1) The apoptotic rate in HA14-1+VPA group was(76.5?6.9)%,this was significantly elevated compared to the data in other groups(P

Objective To investigate the status of knowledge and performance on Chinese Heart Failure Diagnosis and Treatment Guideline (2014 version) in general practitioners of Shanghai Pudong communities.Methods The survey was conducted from April to June in 2014 with a self-designed questionnaire.Total 390 general practitioners (GPs) in Pudong New Area were selected by cluster sampling method.The contents of questionnaire included:diagnosis and differential diagnosis,drug therapy,non drug therapy of chronic heart failure.Result Total 385 questionnaires were retrieved with a response rate of 98.7％ (385/390).The results showed that in aspect of diagnosis and differential diagnosis,373 (96.9％) Gps made the diagnosis based on history and physical examination,171 (44.4％)Gps never used BNP or NTPro-BNP tests,280 (72.7％)GPs did not know how to identify systolic or diastolic heart failure,86 (22.3％)Gps made the differential diagnosis according to the EF value.In aspects of drug therapy,the rate of beta blockers use was 10％-30％ in 284 (73.8％) Gps,149 (38.7％) Gps did not use beta blockers because of not knowing the contraindications,289 (75.1％) Gps used a maximum dose of betaloc for 25-50 mg,no one used 101-200 mg,242 (62.9％)Gps did not know the target dose of betaloc,the rate of ACEI/ARB use was 10％-30％ in 330 (85.7％) Gps,258 (67.0％) Gps would increase the dose but not knowing the target dose.The main reason for not using the target dose of Betaloc and ACEI/ARB was not knowing the dose.In aspect of non-drug therapy:240 (62.3％)Gps never heard of cardiac resynchronization therapy (CRT) and 271 (70.4％)Gps never heard of implantable cardioverter defibrillator (ICD).The senior rank GPs grasped the guideline much better than Gps with primary and intermediate professional ranks.Conclusion General practitioners in community health centers should further study the guideline of heart failure,particularly need to strengthen the knowledge and ability of drug therapy.

ObjectiveTo analyze the causes of discomfort occurring in the interventional treatment of diabetic foot, to discuss the individualized nursing measures for improving the patient's comfort and cooperation,and for increasing the successful rate of the interventional procedure.MethodsThe control group included 9 patients who received conventional nursing care.The study group had 13 patients who accepted individualized nursing care and nursing intervention, which was designed according to every patient's individual conditions. ResultsIn the control group, one patient could not endure the surgery to the end because of the long operating time. Another two patients had to take examinations repeatedly because the imaging quality was very poor,which was caused by the body movement due to uncomfortable mechanical stimulation.Urinary retention occurred in one patient.The mean operative time of the control group was 2.8 hour per surgery.The average dosage of contrast medium used was 150 -300 ml per procedure.All the subjects in the study group completed the surgery successfully,the mean operative time was 2.2 hour per surgery and the average dosage of contrast medium used was 100 -200 ml per procedure.Conclusion During the perioperative period of interventional treatment for diabetic foot, the effective individualized nursing care and nursing intervention,the measures to improve patient's comfort and the cooperation,etc. can certainly increase the successful rate,saving the operating time and reducing the contrast dosage.

AIM　To investigate the poteintation of vincristine-induecd apoptosis by tetrandrine, neferine and dauricine isolated from Chinese medicinal plants in the human mammary MCF-7 multidrug resistant cells. METHODS　The apoptotic cells were detected by fluorescent staining of a combination of Hoechst 33342 and propidium iodide (PI), flow cytometry and agarose electrophoresis. RESULTS　The apoptotic cells induced by vincristine alone accounted for about 10% of all the cancer cells, while the percentage of apoptotic cells induced by a combination of vincristine with tetrandrine, neferine, or dauricine was found to be significantly higher than that by vincristine alone, and their reversal effects were positively correlated with the drug concentration and the exposure time. In addition, tetrandrine was shown to be the most potent in the reversal efficacy among the three compounds to be tested for apoptosis in vitro. CONCLUSION　Tetrandrine, neferine and dauricine showed obvious potenitiation of vincristine-induced apoptosis in the human mammary MCF-7 multidrug-resistant cells.

Objective To survey the knowledge level of atrial fibrillation (AF) among general practitioners (GPs) in Shanghai Pudong New Area.Methods From July to September 2016,a stratified cluster sampling method was used to collect questionnaires from GPs who met the inclusion criteria in 12 community health service centers in Shanghai Pudong New Area.A self-made questionnaire was applied according to Current knowledge and management recommendations of atrial fibrillation-2015,which included 5 domains:antithrombotic therapy,rhythm control,ventricular rate control and evaluation of the guideline.Results A total of 377 questionnaires were distributed,and 371 were recovered.Among 371 participants there were 151 males and 220 females aged (41.3±8.3) years,including 156 (42.0％) with junior professional titles,158 (42.6％) with intermediate titles,and 57 (15.4％) with senior titles.More than 90％ of participants recognized that age,hypertension,myocardial infarction,and heart valve disease were risk factors of AF.For patient evaluation,54.2％ (201/371) of participants would use electrocardiogram,47.9％ (1 78/371) would use thyroid function,21.0％ (78/371) would use echocardiography,3.2％ (12/371) would use respiratory sleep monitoring,and 95.4％ (354/371) did not heard of cardiovascular implantable electronic devices.82.2％ (305/ 371) of participants thought rheumatic mitral stenosis,46.4％ (172/371) thought CHA2DS2-VASc score over and 2 and 12.7％ (47/371) thought hypertrophic cardiomyopathy as indications for anticoagulant;and 38.5％ (143/371) of participants rarely used CHA2DS2-VASc.The rhythm conversion would applied for the onset of atrial fibrillation in 42.9％ participants (159/371),for symptoms after the control of ventricular rate in 39.9％ (148/371) participants and for symptomatic patients in 12.7％ participants (47/371).59.8％ (222/371) of participants did not know the anticoagulation therapy for AF cardioversion,44.5％ (165/371) participants had not heard radiofrequency ablation for AF.38.5％ (143/371) of participants knew the Chinese guidelines for AF,of which 45.5％ (65/143) of the GPs used the guidelines;80.4％ (115/143) of the GPs thought the guide was very instructive.GPs with senior professional titles had better mastery of clinical evaluation,antithrombotic therapy,catheter ablation,and awareness of guideline than junior and middle-level general practitioners.Conclusion The survey shows that there is relative lack of knowledge on the risk factors,clinical assessment methods,anticoagulation indications and cardioversion anticoagulation therapy of AF,as well as lack of awareness and application of the AF guideline for GPs in Shanghai Pudong New Area.

Objective To analyze the status of the treatment for atrial fibrillation (AF) in a community health service center in Shanghai Pudong New Area. Methods Clinical data of all patients with AF attended in Hudong Community Health Service Center of Shanghai Pudong from August 2016 to August 2017 were retrospectively reviewed. The gender,age,smoking history,drinking history,concomitant diseases, antithrombotic therapy, rhythm control, ventricular rate control drugs, health education, needs for setting up AF clinics in the community were analyzed. Result The study included 220 patients,with average age of (59.7±10.4) years; 34.1％(75/220)patients had hypertension and the blood pressure was controlled in 41.3％(31/75); 20.5％(45/220)patients had diabetes mellitus and glycosylated hemoglobin(HbA1c)was controlled well in 26.7％(12/45). Three cases of mitral stenosis were treated with warfarin anticoagulation. Among 217 patients without valvular atrial fibrillation,157 had thromboembolic risk score≥2,20.4％ (32/157) of whom used warfarin anticoagulation,10.8％ (17/157) used new oral anticoagulant (NOAG) and 58.1％ (91/157) had never used warfarin or NOAG anticoagulation. The reasons were as follows:doctors did not prescribe (41.9％, 39/91),patients did not accept (35.2％,32/91), and so on. There were 21.8％ (48/220) of patients undergoing drug cardioversion,and 5.9％ (13/220) undergoing electrical cardioversion. For control of ventricular rate, 55.9％ (123/220) patients used beta blockers,13.6％ (30/220) used non?dihydropyridine calcium antagonists, and 23.6％ (52 / 220) used digitalise. Less than 55％ of patients were given health education of physical exercise,weight management and medicine use. For AF clinic in community hospital,56.8％ (125/220) of patients needed,and 17.3％ (38/220) very need; 50.0％ (110/220) patients trusted and 12.3％ (27/220) very trusted in anticoagulation management in community hospitals. Conclusion The anticoagulant rate is relatively low, treatment of concomitant diseases is less satisfactory and the health education might be incomplete in the community surveyed in this study.

OBJECTIVETo explore the indications and effect of surgical resection for hepatic metastases from colorectal adenocarcinoma and to discuss the implications of clinicopathologic features on the prognosis.

METHODSA retrospective study of 61 patients undergoing hepatectomy for metastatic tumors from colorectal adenocarcinoma from January 1991 to December 2000 in our hospital was performed retrospectively.

RESULTSThe 1-, 3- and 5-year survival rates after hepatic resection were 72.13%, 58.10% and 26.01% respectively. Complications occurred in 8 cases. Tumor pesudomembrance was found in 20 cases. Dukes stage, pathologic type,the number of hepatic metastases and tumor pesudomembrance were all significant factors for prognosis after surgery (P< 0.05). The 3-year survival rate of the patients with postoperative comprehensive treatment was higher than that with non-postoperative treatment (P< 0.05). The size of hepatic metastases and the resecting time didn't affect the prognosis (P > 0.05).

CONCLUSIONThe hepatic metastases from colorectal cancer should be treated by a surgical approach. The earlier stage of clinical pathology,higher differentiation extent, metastases less than 3, the formation of pesudomembrance of the metastatic tumor and the postoperative comprehensive treatment predict a better survival.

Adult ; Aged ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Humans ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate