ObjectiveTo investigate current status of community health management for hypertensive patients.Methods A total of 59 communities from 5 provinces of China were selected by cluster sampling methods,and 55 communities responded.The detailed health management for hypertensive patients was collected through structured interviews. Results (1) Self-management support in health education:the rates of diet control,physical exercise and medication guide were 100.0％ (55/55),96.4％(53/55) and 98.2％ (54/55),respectively,and the rates of home blood pressure monitoring,patientdoctor cooperation,and social mental guidance were 83.6％ (46/55),85.5％ (47/55) and 85.5％ (47/55),respectively.(2) Delivery system redesign:the rates of doctor training,branch cooperation,routine follow-up study and health promotion were 100.0％ ( 55/55 ),67.3％ ( 37/55 ),72.7％ (40/55) and 74.5 ％ (41/55),respectively.(3) Decision support:the rates of embedding evidence-based guidelines on daily clinical practice,expert consultation and health maintenance were 72.7％ (40/55),67.3％ (37/55)and 92.7％ (51/55),respectively.(4) Clinical information systems:the usage rates of long-term followup or monitoring system were 80.0％( 44/55 ) and 89.1％ ( 49/55 ),respectively. ( 5 ) Community resources and policies:the rates of health promotion,environment supporting and community action were 96.4％ (53/55),72.7％ (40/55) and 85.5％ (47/55),respectively.(6) Health system support:the rates of using effective evaluation indexes,senior leader supporting,continuous policy making and increased reimbursement of medical insurance in health-care organizations were 81.8％ (45/55),85.5％ (47/55),74.5％ (41/55) and 61.8％ (34/55),respectively.The rates of providing incentives,increasing staff in community,encouraging general practitioner to participate in policy making and increasing the salary of general practitioner were 58.2％ (32/55), 50.9％ ( 28/55 ), 54.5％ ( 30/55 )and34.5％ ( 19/55 ),respectively.ConclusionThe community hypertension management in some areas of China considers the principles of chronic disease models,and may play an important role in the prevention and control of high blood pressure in communities.

Objective To investigate the observation and nursing for patients with atria] fibrillation (AF)after left atrial linear ablation surrounding ipeilateral pulmonary veins (PVs). Methods Thirty patients with persistent AF underwent left atrial linear ablation surrounding ipsilateral PVs guided by CARTO electroanatomic mapping system and double Lasso catheters technique. The end point of ablation was defined as absence of all PV spikes after isolation and bidirectional conduction block between left atrial and PVs. Results After a median of (245±65)days of follow-up, twenty-one patients were free of AF. Eight patients subjected recurrent atrial tachyarrhymias, including 5 typical AFL, 2 atrial taehycardia and 1 paroxysmal AF. Two patients with persistent AF remaining PV spikes in left superior PV failed to be translated to sinus rhythm. Nine patients underwent repeated ablation and 8 of them were free of atrial taehyarrhythmia after (192±92) days follow-up. Total success rate after two procedures was 92.8%. Conclusions Nurses should perform effective care according to the symptom of patients before, during and after ablation procedure and relieve the patients from pain.

Objective To investigate an effective method of autologous arteriovenous fistula formation for the elderly uremic patients with diabetic nephropathy.Methods The nest in the elbow above the median cubital vein at the curved incision 1-2 cm,inline high Fistula,namely arm cephalic vein and brachial artery bifurcation of the upper portion of the distal radioulnar side anastomosis in 20 cases over 75 years elderly uremic patients with diabetic nephropathy.And compared the effect of 16 cases of patients with similar conventional fistula.Results Twenty cases over 75 years elderly uremic patients with diabetic nephropathy were successful in all high dynamic fistula intravenous,blood flow was (1 007±131) ml/m,the immediate opening rate of 16 patients similar to conventional instant fistula was 12.5％,and a year after the opening rate was 6.25％ Conclusion High fistula are more easy to shape conventional,easy mature,full blood flow characteristics comparing with commom fistula,so elderly uremic patients with diabetic nephropathy fistula making difficult situation has been effectively improved.

Adaptor Proteins, Signal Transducing ; chemistry ; metabolism ; Animals ; Apoptosis ; Cell Differentiation ; Cell Line, Tumor ; Cell Proliferation ; Humans ; Neoplasms ; pathology ; Phosphorylation ; Protein Isoforms ; RNA-Binding Proteins ; chemistry ; metabolism ; Transcription Factors ; antagonists & inhibitors

OBJECTIVETo observe the difference of the clinical effects of different needle retention times for acute lumbar sprain treated with float needle.

METHODSOne hundred and twenty patients with acute lumbar sprain were randomly divided into a 6 h group, a 12 h group, a 24 h group and a western medication group, 30 cases in each one. In the three float needle groups, plastic hose was detained near the pressure pain point on the lumbar after subcutaneous scattering with float needle. The needle retention time was 6 h, 12 h and 24 h respectively. In the western medication group, 75 mg voltaren tablet was adopted orally every day and the treatment was given for four days. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) about low back pain were observed before and after treatment. Also, the comprehensive effect was assessed after treatment.

RESULTSAfter treatment, the VAS scores and the ODI scores were improved obviously than those before treatment in all groups (all P< 0. 05). In the three float needle groups, the VAS scores and the ODI scores were superior to those in the western medication group (all P<0. 05). The differences in VAS scores and ODI scores among the three float needle groups were not statistically significant after treatment (all P>0. 05). The effective rate in the 6 h, 12 h and 24 h group was 93. 3% (28/30), 90. 0% (27/30) and 93. 3% (28/30) respectively, which were better than 73. 3% (22/30) in the western medication group (all P<0. 05).

CONCLUSIONThe effect of float needle for acute lumbar sprain is better than voltaren, and there is no apparent difference in retention times.

Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Low Back Pain ; physiopathology ; therapy ; Lumbar Vertebrae ; injuries ; physiopathology ; Male ; Middle Aged ; Needles ; Sprains and Strains ; physiopathology ; therapy ; Young Adult

Application of Multiple-Media and Internet Technology in Teaching of Medicine Ethics can over come the shortcomings of traditional teaching of Medicine Ethics.it has many advantages;Firstly,it is more informational and easier to operate;Secondly,it can improve the efficiency to reach the teaching aims;Thirdly,the teacher and students Can communicate each other,and make the students be the center of teaching.

ve In order to improve the reliability of somatosensory evoked potentials (SSEP) monitoring during anesthesia, we compared the effects of three commonly used volatile anesthetics on SSEP to choose suitable volatile anesthetic and determine the appropriate end-expiratory concentrations which have least effects on SSEP monitoring. Methods Sixty ASA I - II patients undergoing elective intracranial surgery were randomly divided into three groups: group A received enflurane; group B isoflurane and group C desflurane. The demographic data including age, body weight, height and sex were not significantly different between the three groups. In addition to SSEP, ECG, BP, SpO2, PET CO2 and end-tidal concentration of inhalation anesthetic were monitored. The SSEP electrodes were placed on N13 on the neck and N20 on the scalp. Before experiment the patient was asked to lie quietly for 10 min, then the patient started breathing 100% O2 and fresh-gas-flow (FGF) was set at 5 L/min. Median nerve on one side was stimulated and SSEP waves from cortex and cervical spinal cord were recorded as baseline tracing before anesthesia. The concentration of inhalation anesthetic was gradually increased from 0 to 0.3, 0.5, 0.75, 1.0 and 1.5 MAC. Each concentration was maintained for 15 min and SSEP waves were recorded. During experiment if the patient developed respiratory depression, oral airway was inserted and assisted ventilation was performed to maintain PETCO2 at 35-45minHg. If the patient developed hypotension, fluid was infused at an increased rate and vasopressor was given if necessary to maintain normal BP (baseline ? 20 % ) . Results The three volatile anesthetics did not change N13 latency and amplitude. Increasing concentrations of enflurane, isoflurane and desflurane were associated with graded reduction in N20 amplitude and increase in N20 latency and N13-N20 interpeak latency. Conclusions The results suggest (1) cortical SSEPs are moresensitive to the volatile anesthetics than subcortical SSEPs, (2) end-tidal concentration of enflurane less than 0.75 MAC is compatible with effective SSEP monitoring, whereas the end-tidal concentration of isoflurane or desflurane compatible with effective SSEP monitoring was less than 1.0 MAC. Enflurane has greater effect on SSEP than isoflurane and desflurane.

Objective To compare the differences of chemotaxis at the tissue specific level and topographic specificity level during peripheral nerve regeneration after the severance injury of the sciatic nerve in rats of different ages. Methods 40 specific pathogen free Sprague Dawley 18 day old rats (called as young group) were chosen to correspond as nearly as possible to humans of about 1 year of age. 40 adult rats (called as adult group) were chosen to correspond as adult humans. The tissue and topographic specificity models were set up respectively after the severance of the sciatic nerve at the right side. Electromyography and morphological evaluations were conducted for determination of the nerve regeneration on 3 and 6 weeks postoperatively. Results On 3 and 6 weeks after operation, the recovery rate of nerve conduction velocity, the exact rate of nerve regeneration, the ratio of nerve conduction velocity between tibial and peroneal nerve, the ratio of amplitude of CMAP between tibial and peroneal nerve, the ratio of the number of myelinated axon between the tibial and peroneal nerve at the distal part in the young group were lower than those in the adult group respectively. There were statistically significant differences between the 2 groups. The recovery rate of amplitude in compound muscle action potential (CMAP) was lower in the young group than in the adult group, but the difference was not significant enough. Conclusion Since the tissue and topographic specificities in the young rats are both inferior to those in the adult rats, co contraction between agonists and antagonists may result from cross innervation during the peripheral nerve regeneration.

Objective: To observe the clinical effect of acupotomy plus cupping for knee osteoarthritis (KOA). ＜br> Methods: Sixty cases with KOA were randomly divided into a treatment group and a control group, 30 cases in each group. The patients in the treatment group were given acupotomy and cupping, while the patients in the control group were given injection of Sodium Hyaluronate. The index of severity for osteoarthritis (ISOA), the change of the effusion of knee joint and clinical effects were observed after treatment. ＜br> Results: The total effective rate was respectively 96.7% in the treatment group and 66.7% in the control group. The difference in the clinical effects between the two groups was statistically significant (P＜0.05). After treatment, ISOA scores and scores of knee effusion in the two groups were remarkably reduced than those before treatment (P＜0.05). The changes of the scores of the two indexes were statistically significant (both P＜0.05). ＜br> Conclusion: Acupotomy plus cupping is better than injection of Sodium Hyaluronate in treatment of KOA.

Efficient use of the hospital information system can protect and promote the orderly operation of medical practice.The HIS usage effect by the medical staff is mainly affected by individual mastery of information technology,IS technical level and the organizational environment.A survey and analysis of these three factors were made at three tertiary hospitals in Anhui,and the results indicate personal command of information technology,technology and organizational impact to bear significant positive impacts on medical staff' use effect.Based on the results,the paper proposed countermeasures and suggestions on strengthening the HIS construction and enhancing medical staffs HIS use effect.