In the implementation of community health service,the working efficiency of the community nurses becomes increasingly important to the overall service standards of the service centers as the local residents have begun to take it into consideration when evaluating the service quality.By illustrating the roles of nurses in all the six major functions played by the community health service,this paper intends to arouse the attention from the concerning authorities to the training of the nurses so that the nurses can be developed in an all-round way and provide better services for the community.

Objective To explore the pathogenesis of invasive pituitary adenomas,and to improve the effect of clinical treatment.Methods 15 pairs of invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were selected from 114 specimens collected and the Id1 gene expression and Id1 protein expression in invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were tested by quantitative RT-PCR,Western blot and immunohistochemical methods;Then small interfering RNA (siRNA) was used to interfer Id1 gene expression in NQ-04 cells.Results The Id1 gene expression in invasive pituitary adenoma tissues was significantly higher than that in noninvasive pituitary adenoma tissues(n =15,t =2.725,P =0.013) ;The migration of pituitary adenoma cells interfered was significantly reduced.Conclusion The invasive pituitary adenoma tissues has high level of Id1 gene expression,which may be correlated with its invasion.And Id1 is expected to become a biological marker of diagnosis and determination in the prognosis of pituitary adenoma.

OBJECTIVE:To establish a RP-HPLC method for simultaneous determination of caffine,acetaminophen and isopropylphenazone in human plasma after oral dose of saridon.METHODS:Hypersil Hypurity TM Advance was used as chromatographic column and the mobile phase was a mixture of0.01mol/L phosphoric acid-methanol-tetrahydrofuran(86∶12∶2).The detection wavelength was273nm.RESULTS:The calibration curves were linear in the ranges of0.39～100.0?g/ml for caffine,1.96～500.0?g/ml for acetaminophen,and1.17～300.0?g/ml for isopropylphenazone,respectively.The accuracy of all was higher than95.0%.The inter-day and intra-day RSD was less than10.0%.CONCLUSION:The present method is sensitive,accurate,convenient,and highly specific,which can meet the requirement in plasma determination of three components in Saridon tablet.

Objective To determine the effect of resurfacing completely degloved thumbs by free perforator flaps in a spiral fashion.Methods A retrospective case series study was made on 22 patients with completely degloving injury of the thumb treated by different free perforator flaps in a spiral fashion from June 2009 to December 2014,including 19 male and 3 female patients at the age of 18-46 years (mean,27.8 years).A total of 13 patients were reconstructed using the medial arm perforator flaps ranging in size from 8.0 cm × 3.0 cm-14.5 cm × 3.5 cm,and 9 patients were reconstructed using the peroneal artery perforator flaps ranging in size from 6.0 cm × 3.5 cm-21.0 cm × 10.0 cm.Follow-up was made to evaluate the sensation,appearance and function of the thumbs and the recovery of flap donor sites.Results All flaps survived completely,with no occurrence of postoperative vascular crisis and infection.Only one medial arm flap and one soleus perforator flap distal flap showed blood flow disorder in the distal sections and were healed uneventfully after conservative therapy.Function and cosmetic recovery of the reconstructed thumbs were good.Follow-up ranged from 9 to 22 months (mean,14.5 months).Twopoint discrimination test of the flaps was recovered to 6-13 mm.No linear scar contracture was left.Flap donor site wound healed primarily.All patients were satisfied with the overall results.Conclusion The free perforator flap in a spiral fashion can avoid linear scar contracture,maximally decrease donor site morbidity and achieve satisfactory functional recovery and good aesthetic restoration,indicating a good candidate for reconstruction of thumb degloving injury.

Objective Medication for pituitary adenomas is mainly targeted on the prolactin-secreting and growth-hormone types and shows poor therapeutic effects on other adenomas .Therefore, new drugs urgently need to be developed for this purpose .This study was to investigate the effects of glivec and everolimus on mouse pituitary AtT-20 cells and their molecular mechanisms in vitro. Methods Mouse pituitary AtT-20 cells were incubated with glivec or everolimus or combination of both and their inhibitory effect on the proliferation of the cells was measured by CCK-8 assay.The mRNA levels of AKT and ERK were determined by q-PCR and the ex-pressions of the phosphorylated AKT (p-AKT) and ERK (p-ERK) were detected by Western blot. Results Used alone, both glivec and everolimus inhibited the proliferation of the AtT-20 cells in a time-and dose-dependent manner , but their combination produced a mutually antagonistic effect, with combination index values of 1.13 ±0.06, 1.12 ±0.03, and 1.07 ±0.03 respectively.The two a-gents , either used alone or in combination , induced no significantly inhibitory effects on the mRNA and protein expressions of AKT and ERK ( P >0.05 ).Both glivec and everolimus up-regulated the expressions of p-AKT and p-ERK, and their combination manifested an even stronger effect (P>0.05). Conclusion Both glivec and everolimus inhibit the proliferation of AtT-20 cells when administered alone, but their combination produces an antagonistic effect .Their action mechanism might be that when targeting some signaling path-ways to inhibit cell proliferation , glivec, as well as everolimus , in-duces a feedback activation of AKT and ERK .

Objective To provide evidence for clinical practice by analyzing the factors associated with bloodstream infection in ICU patients through retrospective case-control study. Methods Using self-made data collection form, 133 cases of blood sample record from HIS system during May 2013 to December 2015 at Peking Union Medical College Hospital ICU ward were collected. In this study, 54 patients with positive blood culture results were allocated to the case group while 79 patients with negative results were in the control group. Baseline characteristics, which included sex, age and chronic diseases, were almost the same between both groups. Binary Logistic regression analysis was used to identify factors related to blood infection. Results During May 2013 to December 2015, there were 54 blood infectious cases, among which 19 cases with positive gram bacteria accounted for 35.2%(19/54), 57.4%(31/54) of gram-negative bacilli and 7.4%(4/54) of fungal infection. Logistic regression analysis revealed that blood filtration treatment (OR=7.691), pulmonary infection (OR=7.682), ICU (OR=1.115), Acute Physiology and Chronic Health Evaluation (APACHEⅡ) scores(OR=1.096), procalcitonin (OR=1.065) were risk factors of bloodstream infection for ICU patients, while albumin (OR=0.763) was a protective factor. Conclusions Blood filtration treatment, pulmonary infection, hospital length of stay, APACHEⅡand procalcitonin are factors associated with bloodstream infection in ICU patients. Clinical procedures in ICU should mainly focus on improvement of prevention awareness, strict aseptic technology, professional quality of nursing staff. Besides, guarantee of patients′nutrition, effective treatment of primary diseases, and shortened hospital length of stay are also important to reduce the infection and improve quality of life of these patients.

Dermatitis, Occupational ; diagnosis ; Diagnostic Errors ; Female ; Humans ; Trichloroethylene ; adverse effects ; Young Adult

Background and purpose:The time from ifrst onset of symptoms or signs to a deifnitive diagnosis is deifned as diagnostic interval (DI). The relation of DI to other clinicopathological parameters andthe impact of DI on prognosis of patients with triple-negative breast cancer (TNBC) remain unclear.This article plans to make an intensive study of these questions.Methods:The clinical records of a series of 83 consecutively presenting unselected patients referred to the Shanghai Sixth People’s Hospital with diagnosed TNBC between September 2009 and September 2015 were retrospectively reviewed. Clinical and pathological factors included were investigated by univariate analysis using the Kaplan-Meier method, the factors associated with prognosis were further evaluated by multivariable analysis with Cox progression model.t-test and Kruskal-Wallis test were used to study the correlation between DI and other characters.Results:DI: stage T3>T1 (P=0.01), stageⅢ>Ⅱ (P=0.03) andⅠ (P=0.01). Compared with patients of DI≥3 months, the <3 months group had earlier age (P=0.028) and TNM stage (P=0.035). T stage, N stage, neoadjuvant chemotherapy, TNM stage and DI are inlfuencing factors of overall survival (OS). Age, T stage, N stage, TNM stage, menstrual status and neoadjuvant chemotherapy are inlfuencing factors of progression-free survival (PFS). TNM staging is an independent inlfuencing factor for OS and PFS.Conclusion:Patients with later disease stage were more likely to have a longer DI; The shorter DI, the earlier age and stage of disease; DI is the inlfuence factor of OS; TNM stage is an independent inlfuencing factor for OS and PFS.

0.05). Conclusion Ryanodine receptor of asthmatic guinea-pig showed hypersensitivity. Under specified condition, the characteristics of ryanodine receptor still retains in subcultured ASMCs of asthmatic guinea-pig.