Objective To discuss the methods and effects of replantation to treat complex thumb severance. Methods 56 cases of complex thumb severance combined with soft tissue defects were treated with simple vessel transplantation, veno flap transplantation, dorsal index digital island flap transplantation, digital artery transfer, transfer of radial index digital artery pedicled island flap, or veno arteriolization. The soft defects were repaired by the transfer of extensor index finger tendon and superficial ring finger flexor tendon. Results 50 cases survived and 6 cases failed, with the survival rate being 89%. 42 cases were followed up for 5 to 25 months. The function of the treated thumbs was assessed as excellent in 10, good in 25 and bad in 7. The excellent and good rate was 83%. Conclusion Complex thumb severance can be treated by unconventional replantation so as to achieve good effects.

Epidemiological studies have suggested that the increase of uric acid level has a direct correlation with the risk of ischemic stroke. However,the significance of this correlation remains controversy. Most findings have suggested that hyperuricemia is a risk factor for stroke and poor outcome after stroke.Very few studies have suggested that hyperuricemia has protective effect on acute ischemic stroke.Although the effect of hyperuricemia on pathophysiological mechanisms of stroke remains uncertain, the interventional strategy by lowering the levels of blood uric acid for preventing ischemic stroke is worth to be considered. This article mainly reviews the recent clinical trials data and related mechanisms.

Objective To evaluate the efficacy of isolated ultrafiltration (IUF) for patients with cardiac insufficiency after acut emyocardial infarction (AMI).Methods The acut emyocardial infarction patients admitted from August 2010 to August 2014 were recruited for study.After primary percutaneous coronary intervention (PCI),102 patients presented cardiac insufficiency taking the form of hypotension and acute left heart failure.All heart failure patients dealt with routine medications at first,and were then randomly (random number) divided into two groups,group A was routine medication group and group B was isolated ultrafiltration after routine medication group.Data recorded at different intervals in the same group were analyzed by ANOVA.Data recorded from two groups at the same intervals were analyzed by t test.Data of mortality in the two groups were analyzed by x2 test.P value less than 0.05 was considered statistically significant.Results Of them,51 patients were treated with routine medication resulting in gradual improvement of cardiac function,but the improvement was slower compared with the isolated ultrafiltration group.Other 51 patients were treated with isolated ultrafiltration,and isolated ultrafiltration was discontinued in 2 patients owing to progressive thrombocytopenia and in another one patient owing to systolic blood pressure below 90 mmHg,with clinical manifestations of organ hypoperfusion,poor peripheral circulation,cool clammy skin and oliguria.In the rest of 48 patients in the isolated ultrafiltration group,vital signs were stable,and heart failure symptoms and serum electrolytes improved significantly (P ＜0.05).After one week of using isolated ultrafiltration,left ventricular ejection fraction (LVEF) also improved (P ＜ 0.05).The differences in mortality within one month,the mean ICU stay,the mean hospitalized stay,and the rate of recurrent heart failure were significant between the two groups (P ＜ 0.05)Conclusions The isolated ultrafiltration is a relatively safe and effective strategy for patients with cardiac insufficiency and hypotension after acut emyocardial infarction.

Objective To investigate the attitude of clinical nurses to the practice of holistic nursing and provide basis for establishing harmonious relationships between patients and nurses.Methods primary nurses were randomly selected and underwent investigations on quality check of nursing work quarterly by serf-designed inventory.Results 24 nurses considered it necessary to carry out holistic nursing but 70 of them were reluctant to undertake it.They thought it boring because of the high requirement of holistic nursing and much literal document in practice.Conclusion Nursing services calls out seeking truth and dealing with concrete matters at present.The holistic nursing is not equipped with professional title since serious shortage of nursing staff.The emaphasis should be focused on the health education according to different situations in hospitals.Besides we should practice holistic nursing step by step instead of by the modality.

Objective To evaluate the effect of implantation of chitosan membrane with triamcinolone(TA) into perichoroidal space combined with intraocular vancomycin injection on the protection of retina in rabbit endophthalmitis.Methods The drug membrane was made of gelatin-chitosan.The right eyes of 30 normal pigment rabbits were inoculated intravitreally with 0.1 ml mixture of 105 CFU standard strain Staphylococcus aureus(ATCC 25923).Twenty-four hours later,rabbits were equally randomized to intravitreal vancomycin group(Group A),intravitreal vancomycin and TA eye dropping(Group B),and intravitreal vancomycin combined with TA membrane implantation(Group C).Clinical observation of ocular fundus was done every day with indirect ophthalmofundoscope.B ultrasound examination was carried out in 24 h after inoculation and on the 14th day after therapy.Electroretinogram(ERG) was done before therapy and the 14th day after therapy.Histopathologic grading and electron microscopy were carried out at the 14th day.Results After implanting the drug membrane into perichoroidal space,the inflammation in group C was markedly less than the other 2 groups,and its inflammation score was significantly lowest(P

AIM: To investigate the effect of urokinase plasminogen activator (uPA) on metastasis inhibition of gastric cancer SGC7901cells induced by parthenolide. METHODS: The changes of SGC7901 cells reproductive activity were analyzed by MTT. Light microscope was used to observe the cell morphological changes. The effects of parthenolide on migration and invasion capacity of SGC7901 cells were determined by using matrigel and transwell system. The expression of uPA was detected by Western blot and RT-PCR assays. RESULTS: Parthenolide inhibited the proliferation of SGC7901 cells in a time-and concentration -dependent manner ranging from 100 to 200 ?mol/L. Light microscopy showed the suppressing effect on growth of SGC7901 cells. After exposed to parthenolide, the migration and invasion capacity of SGC7901 cells were significantly decreased, the number of cells gradually decreased through the basement membrance. The Western blot assay showed that the expression of uPA protein declined gradually after exposed to parthenolide for various period of time. CONCLUSION: Parthenolide can inhibit the growth and metastasis activity of SGC7901 cells, and uPA played an important role in the latter process.

OBJECTIVE To investigate the knowledge about hand hygiene among the outpatients and then take some valid methods to enhance their understanding about hand hygiene.METHODS By randomly asking patients from two departments in a level A of the tertiary hospital,one was a digestion and the other was a non-digestion department question designed by ourselves.The data were generally described by percentage and ?2 test with SPSS 6.0.RESULTS All the patients had not enough and correct hand hygiene knowledge from both two groups.The patients from digestion department paid more attention on their hand hygiene than from non-digestion one.The most patients from both two groups thought they needed to know more about hand hygiene and hospital should equipped with some fast hands cleaning instruments.CONCLUSIONS It is a very important duty for nurses to explain and publicize more about general hygiene and show patients how to clean their hands in order to decrease hospital infection.

Objective To investigate the effects of Bushen Yangxue decoction combined with hormone replacement effects on sex hormone level and symptom score in patients with premature ovarian failure .Methods 112 patients with premature ovarian failure from March 2014 to November 2015 in Zhejiang Tongde Hospital were divided into two groups with 56 cases in each group.The control group was treated with hormone replacement therapy , the combined group was treated with Bushen Yangxue decoction on the basis of the control group.The curative effect was compared between the two groups, the sex hormone, traditional Chinese medicine symptoms score, QOL score and endometrial thickness were compared between the two groups before treatment, at the end of treatment and 3 months after discontinuation.Results At the end of the treatment, there was no significant difference in total effective rate between the combined group (91.07%) and the control group (85.71%).At the end of the treatment, the scores of TCM symptoms and QOL scores were significantly lower in the two groups, and the endometrial thickness was significantly higher (P<0.05), compared with the control group at the end of treatment,the combined group TCM symptom score was lower(P<0.05), QOL score and endometrial thickness had no significant difference, after stopping drug for three months, there was no significant difference in the levels of TCM score, QOL score, endometrial thickness between the two groups.In the control group TCM score, QOL score were significantly higher, and significantly higher than the levels of the same period of the combined group, endometrial thickness was significantly lower, and the level of the same period was significantly lower than that of the combined group(P<0.05), at the end of treatment, the two groups of FSH, LH significantly decreased, E2 significantly increased(P <0.05), there was no significant difference between the two groups, after stopping drug for three months, there was no significant difference in the levels of E2, LH, FSH.The control group, LH and FSH levels were lower and E2 levels were higher in the control group at three months after discontinuation compared with those at the end of treatment (P<0.05).Compared with the control group, LH and FSH levels were lower and E2 levels were higher in the combined group after 3 months of drug withdrawal (P<0.05).Conclusion Bushen Yangxue decoction combined with hormone substitution method can significantly increase in patients with premature ovarian failure of sex hormone level, improve the recovery of patients with ovarian function.

Objective To study the protective role of continuous veno-venous hemofiltration (CVVH) in cardiac insufficiency refractory to diuretic therapy after acute myocardial infarction.Methods A total of 104 acute myocardial infarction patients admitted from march 2012 to march 2016 were recruited.According to their wishes,the patients were divided into two groups,continuous veno-venous hemofiltration combined with routine therapy as experimental group (n =52) and conventional treatment as control group (n =52).Mortality rate within one month,the mean length of ICU stay,the mean length of hospital stay,ventilator usage and urine output volume were documented.Then the difference in BW between pre-and post-treatment was determined for evaluation of fluid retention,and blood plasma C-reactive protein (ΔCRP),interleukin 6 (ΔIL-6),interleukin 8 (ΔIL-8),tumor necrosis factor-α (ΔTNF-α) and left ventricular ejection fraction (ΔLVEF) were measured and calculated.A multiple linear regression model to predict ΔLVEF was established.Data recorded at different intervals in the same group were analyzed by ANOVA.Data of the monitoring biomarkers,the mean length of ICU stay,the mean length of hospital stay of two groups were recorded at the same given intervals were analyzed by t test.Data of mortality rate within one month,drugs and ventilator usage in two groups were analyzed by x2 test.P value less than 0.05 was considered statistically significant.Results There were significant differences in mortality rate within one month,the mean length of ICU stay,the mean length of hospital stay,and the duration of ventilator usage between the two groups (P ＜ 0.05).Total volume of fluid output (urine and ultrafiltration volume) was higher in experiment group than that in control group in 48 hours after the treatment (P ＜ 0.01).The levels of CRP,IL-6,IL-8 and TNF-α decreased significantly (P ＜ 0.05) in experiment group after treatment but not in control group (P ＞ 0.05) as compared with those before the treatment.BW was decreased and LVEF was increased in both groups after treatment (P ＜ 0.05) compared with those before the treatment.Levels of CRP,IL-6,IL-8 and TNF-α were lower in experiment group than those in control group after treatment (P ＜ 0.05).BW was meagerly lower and LVEF was meagerly higher in experiment group than those in control group without statistical significance (P ＞ 0.05).However,the degrees of ΔLVEF andΔBW were greater in experiment group than those in control group (P ＜ 0.01).In experiment group,significantly positive correlations were found among ΔBW,ΔCRP,ΔIL-6,ΔIL-8,ΔTNF-α and ΔLVEF (P ＜0.05).Multiple linear regression analyses showed that ΔBW and ΔTNF-α were the independent factors forΔLVEF and ΔBW was the main independent factor for ΔLVEF in control group.ΔLVEF was positively correlated with ΔBW (P＜0.01) but had no correlation with ΔCRP,ΔIL-6,ΔIL-8 and ΔTNF-α (P ＞0.05).Multiple 1inear regression analyses showed that only ΔBW was the independent factor for ΔLVEF.Conclusion CVVH plays protective role in acute myocardial infarction patients with consequent cardiac insufficiency refractory to diuretic therapy by clearance of inflammatory cytokines and removal of retained fluid,and the removal of retained fluid is the most import mechanism to protect heart function.

Objective Observed the mobilization effects、 the safety and feasibility of autologous circulating blood stem cell by G-CSF in acute myocardial infarction (AMI). Methods 45 patients with AMI were randomly allocated to receive either inclusive type Granulocyte Colony-Stimulating Factor (G-CSF), to mobilize the stem cell. The patients received the dose of G-CSF 300?g-600?g/day, by hypodermic injection, and the duration of applying G-CSF was 5 days. In the process of the mobilization of the circulating blood stem cell, prior to applying G-CSF and on the 3rd、4th、5th、6th、7th after applying G-CSF, the white blood cell (WBC) and CD34+ cell count in the circulating blood should be observed; and the following side effects also should be paid attention to, such as: bone pain, tetter, fever, gastrointestinal effects( nausea 、vomit、 coprostatis ),deteriorated of angina or heart failure and some rare effects(spontaneous spleen rupture, severe purulent infection, hypercoagulable state, autologous immune diseases). Results Prior to applying G-CSF and the 3rd、4th、5th、6th、7th after applying G-CSF, the counts of WBC were (8.42?2.59)?10 9/L、(31.28?8.34)?10 9/L、(35.24?9.38)?10 9/L、(37.03?13.07)?10 9/L、(35.34?14.68)?10 9/L、(20.35?9.22)?10 9/L;the counts of CD34+ cell were (14.89?11.46)?10 6、(67.78?50.88)?10 6、(124.79?136.13)?10 6、(208.92?206.97)?10 6、(206.10?184.57)?10 6、(66.63?56.56)?10 6;The peak of curve that WBC and CD34 + cell count changed with applying days was on the 5th .The count of CD34 + cell in the circulating blood was positive referent with the count of WBC in the circulating blood(r=0.835);was not reference with age、 sex、body weight、and the onset time of AMI. There were total 17 complications during the mobilization of circulating blood stem cell. The incidence of complications during mobilization is 37.8%(17/45), including bong pain being 15.6%(7/45)、fever being 6.7 %(3/45)、pale being 4.4 %(2/45)、tetter being 4.4 %(2/45)、deterioration of heart failure being 4.4 %(2/45),spleen thrombosis being 2.2 %(1/45).No death happened. Conclusion : In patients with AMI, the mobilized peak of WBC and CD34 + cell counts changed with applying days was at the 5th, and the count of CD34 + cell in the circulating blood was positive referent with the count of WBC in the circulating blood(r=0.940),was negative referent with body weight of patients(r=-0.398). And mobilization of autologous circulating blood stem cell was feasible and safe.