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.

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.

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.

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

BACKGROUND:The posterior lumbar interbody fusion is one of the effective methods for the treatment of lumbar and sacral spine diseases. Most surgeons fix the cage by compressing the disc space in order to keep stability and prevent dislodgement. However, some surgeons think that the non-compression technique does favor for increasing of the disc and foraminal height and thus improving the clinical outcomes, and does not increase the risk of fusion shift.
OBJECTIVE:To compare the effects in fixing the cage by the compression and non-compression techniques on posterior lumbar interbody fusion.
METHODS:Data of 64 patients with single-segment lumbar degeneration undergoing posterior lumbar interbody fusion between August 2009 and June 2014 were retrospectively analyzed. Fusion device was fixed according to compression of intervertebral space. These patients were divided into compression group (n=30) and non-compression group (n=34).
RESULTS AND CONCLUSION:(1) Curative effects:Lumbar and leg pain visual analogue score,
Oswestry disability index, SF-36 score and the height of intervertebral space, intervertebral foramen height and lumbar lordosis were significantly improved postoperatively in each group compared with preoperatively (P<0.05). The intervertebral space, intervertebral foramen height and lumbar lordosis were significantly better in the non-compression group than in the compression group (P<0.05). (2) Lumbar fusion rate:No significant difference in lumbar fusion rate was detected 6 and 12 months after surgery and during final fol ow-up (P>0.05). (3) Correlation analysis:The increase of the intervertebral space and the height of the intervertebral foramen were not significantly correlated with the improvement of the clinical curative effect (P>0.05). (4) Test results demonstrated that outcomes of the compression technique to fix the cage are equivalent to the non-compression in posterior lumbar interbody fusion. Non-compression is advantageous to increase the intervertebral space and the height of the intervertebral foramen. Both of them are conducive to the recovery of lumbar lordosis, but are not correlated with the increase in clinical curative effect.

Objective To further identify the isolated Mycoplasma genitalium (Mg) from the high risk population of STD in China. Mothods The morphology of Mg standard strains and clinical isolates were observed under electron microscopy (EM) and atomic force microscopy (AFM). Mg sample preparation for AFM was fixed on mica and AFM images of scanning observation were captured by contacting and tapping modes and operated under normal atmospheric pressure and temperature. Results and Conclusion Mg had a diversity of shapes, including flask, pear, spindle or round shape with projecting neck portion and slightly broadened terminal structure under EM. The morphologic features under AFM were similar to those observed by EM. The typical Mg showed shapes of flask and pear with noticeable narrow ring or mark in the neck portion. The size of Mg measured under EM and AFM was similar as well. Mycoplasma

Objective To study the feasibility and reliability of median nerve somatosensory evoked potential monitoring in neurosurgery around the brain stem. Methods in selected 43 patients SEP N20, waveforms were recorded after stimulation of left and right median nerves respectively. Anesthesia was maintained with intravenous anesthetics throughout the operation. As soon as N20 waveform changed significantly, the surgeon was informed and the operative procedure was modified whenever possible. Results SEP waveforms were almost stable during maintaining with total intravenous anesthesia (TIVA). Within 43 cases, SEP waveform of & patients significantly changed. In these cases, SEP of 5 patients returned to normal gradually and no further neurologic dysfunction happened postoperatively. The other 3 cases did not recover, and postoperative neurologic complications happened. There was no false-negative or false-positive result. The correlation between intraoperative SEP changes and postoperative neurologic alterations was significant statistically. Conclusions SEP recording is a reliable technique for intraoperative monitoring during neurosurgery around the brain stem. TIVA is helpful for SEP monitoring.

OBJECTIVETo compare the efficacy between acupuncture at stellate ganglion combined with intravenous administration of alprostadil and simple intravenous administration of alprostadil on lower limb atherosclerosis of early diabetes mellitus.

METHODSSixty patients of lower limb atherosclerosis of early diabetes mellitus were randomly divided into an observation group and a control group, 30 cases in each one. Patients in the two groups were treated with basic treatment to control blood glucose and lipid. In addition, patients in the control group were treated with intravenous administration of alprostadil (10 µg) and sodium chloride solution (100 mL); based on this, patients in the observation group were treated with acupuncture at stellate ganglion. The treatment was given once a day; the consecutive treatment of two weeks constituted one session, and totally 4 sessions were given. The total syndrome score, glycosylated hemoglobin (HbA1c), blood flow of posterior tibial artery and dorsal artery of foot were observed before and after treatment; the clinical efficacy was compared between the two groups.

RESULTSCompared before treatment, the total syndrome score, HbA1c, blood flow of posterior tibial artery and dorsal artery of foot were significantly improved after treatment (all P < 0.05), which were more obvious in the observation group (all P < 0.05). After treatment, the total effective rate was 93.3% (28/30) in the observation group, which was significantly superior to 86.7% (26/30) in the control group (P < 0.05). CONCLUSION Acupuncture at stellate ganglion combined with intravenous administration of alprostadil achieve better effect than simple intravenous administration of alprostadil for lower limb atherosclerosis of early diabetes mellitus, which improve the clinical symptoms, regulate blood sugar and increase the blood flow of lower limb.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Atherosclerosis ; etiology ; physiopathology ; therapy ; Diabetes Mellitus, Type 2 ; complications ; Female ; Humans ; Lower Extremity ; blood supply ; innervation ; physiopathology ; Male ; Middle Aged ; Stellate Ganglion ; physiopathology ; Treatment Outcome

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.

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.