Objective:To investigate the efficacy of lanthanum carbonate versus calcium acetate in the treatment of hyperphosphatemia in patients receiving maintenance hemodialysis. Methods:A total of 202 patients with chronic renal failure who received maintenance hemodialysis in Department of Nephrology, Yiwu Central Hospital from March 2016 to January 2017 were included in this study. These patients were on dialysis for ≥ 6 months with blood phosphorus level > 1.78 mmol/L before dialysis. They were randomly divided into the lanthanum carbonate ( n = 100) and calcium acetate ( n =102) groups. Two patients in the lanthanum carbonate group withdrew from the study due to intolerance of vomiting. All patients were treated for 9 months. During the study period, low calcium dialysate was rationally used, and strict dietary phosphate restriction was applied. The changes in serum phosphorus, calcium and parathyroid hormone contents before and after treatment were compared between the two groups, and they were compared between before and after treatment in each group. Results:During the treatment, the average dose of phosphate binder was 1 500 mg/d in the lanthanum carbonate group and 3 335 mg/d in the calcium acetate group. There were no significant differences in general demographic data and biochemical indexes between the two groups (both P > 0.05). No significant differences in dietary phosphorus content and dialysate calcium concentration were observed between the two groups (both P > 0.05). In the calcium acetate group, blood phosphorus content decreased from (2.12 ± 0.35) mmol/L before treatment to (1.55 ± 0.24) mmol/L after treatment ( t = 13.43, P < 0.01). In the lanthanum carbonate group, blood phosphorus content decreased from (2.14 ± 0.3) mmol/L before treatment to (1.45 ± 0.17) mmol/L after treatment ( t = 20.01, P < 0.01). In the lanthanum carbonate group, the difference in blood phosphorus content between before and after treatment was (0.69 ± 0.29) mmol/L, which was significantly higher than that in the calcium acetate group [(0.57 ± 0.37) mmol/L, t = 2.553, P < 0.01]. Hypercalcemia did not occur in both groups, and there were no significant differences in carotid intima thickening and presence of calcified plaque between the two groups (both P > 0.05). Conclusion:Under the premise of effectively implementing rational low calcium dialysate use and strict dietary phosphate restriction, both calcium acetate and lanthanum carbonate can effectively reduce the blood phosphorus level in patients undergoing maintenance hemodialysis. Lanthanum carbonate has better effect in reducing serum phosphorus level than calcium acetate, but it is likely to produce gastrointestinal reactions. Neither treatment method bears the risk of hypercalcemia.

BACKGROUND:Restoring the stability of the spine has become the consensus of spinal surgery. The canaloplasty technology has been continuously improved, but how can we get the good clinical effect of the canaloplasty, and the price affordable, many domestic scholars have to try al kinds of the improved operation methods. OBJECTIVE:To evaluate the clinical application value of cannulated screws fixation in canaloplasty. METHODS:From February 2011 to February 2013, total y 24 patients with spinal disease treated by canaloplasty using cannulated screw were retrospectively analyzed, of which 12 cases of cervical stenosis, 2 cases of intraspinal tumor in thoracic and 10 cases of intraspinal tumor in lumbar. Al patients were fol owed up after treatment. Postoperative CT and MRI were done in al patients. Clinical symptoms and radiographic changes were observed after treatment. The Japanese Orthopaedic Association score and the spinal canal cross-sectional area measurement were conducted in the patients with cervical stenosis between the preoperation and postoperation. Visual analog scale score was evaluated in patients who have the tumor in the thoracolumbar spine between the preoperation and postoperation. RESULTS AND CONCLUSION:Al patients had no complications such as nerve or blood vessel damage. Al patients were fol owed up 12 to 24 months. Imaging evaluation showed that internal fixator was stable without the hol ow screw loss or displacement. The bone grafting in groove reached bone fusion. There was no occurrence of lamina col apse or“re-close of door”. The Japanese Orthopaedic Association score and spinal canal cross-sectional area of patients with cervical stenosis during the fol ow-up after 12 months of treatment were significantly superior to those in preoperation (P<0.01). After 12 months of treatment, Japanese Orthopaedic Association scores showed that the excel ent rate of classification assessment was 92%. During the fol ow-up after 12 months of treatment, the visual analog scale of patients with thoracolumbar tumor improved from (8.2±1.6) points before treatment to (2.3±1.3) points at the first year after discharge (P=0.004 2). These results suggest that the application of cannulated screws in the canaloplasty can not only enhance the stability of the rear pil ar, and can improve the healing rate of osteotomy, and has the characteristics of inexpensive, easy to operate, and repair effect is good.

Sixty four patients undergoing endoscopic sinus surgery were randomly divided into two groups.In nimesulide group (n=32) patients were given nimesulide capsule 100 mg after surgery and 32 patients in control group were given 100 mg vitamin C as placebo.The visual analogue scale (VAS) was used to evaluate the degree of pain during withdrawing nasal packing.The VAS value of the nimesulide group was 2.8±1.1 3 h after surgery and 2.7±1.2 during with drawing nasal packing,that of control group was 6.7±0.6 and 8.3±0.6,respectively (both P<0.01).The results revealed that nimesulide had a siguificant analgesic effect in endoscopic sinus surgery.

Fifty four patients with chronic sinusitis (without nasal polyps) were randomly divided into two groups. Thirty patients in experimental group were treated with dirithromycin and 24 patients in control group were treated with clarithromycin. The doses was both 250 mg q. d. and the duration of treatment was 3to 6 months. The VAS scores of subjective symptoms (nasal obstruction, purulent nasal discharge,headache, smell worse ) and Lund-Mackay scores of objective signs (sinus CT ) in both groups were improved significantly compared with the baseline(P ＜0.05), and there were no statistical significances between two groups ( P ＞ 0. 05 ). The curative effect was positively correlated with the duration of treatment.The total effective rates were 73% and 67% and adverse reaction rates 7% and 21% in two groups,respectively (P ＞ 0. 05 ); but the adverse reactions in control group were more serious than those in experimental group. During the six-month follow-up, no recurrence and aggravation were observed. The results suggest that low-dose dirithromycin may be more suitable for long-term treatment of chronic sinusitis.

Objective To evaluate the reliability and validity of the Chinese version of the Newest Vital Sign(NVS). Methods The NVS was translated and back-translated. Cultural adaption of scale was performed by Delphi expert consultation and pilot study. The reliability and validity of the Chinese version of the NVS was tested in 451 Chinese residents. Results Chinese version of the NVS consisted of 6 items with Pearson correlation between item and total score of scale ranging from 0.50 to 0.71. Two factors were abstracted by exploratory factor analysis and explained 61.51% of total variance. Confirmatory factor analysis showed that the fitness of the model was acceptable:comparative fit index was 0.96, Tuker-Lewis index was 0.92, standardized root mean square residual was 0.04, root mean square error of approximation was 0.077. Cronbach α coefficient was 0.71, retest reliability was 0.92. Conclusions Chinese version of the NVS has good reliability and validity, which can be used to test the health literacy of residents in China.

Objective: To explore the effects of multiple free homologous superficial peroneal artery perforator flaps of crus for repair of multiple hand wounds. Methods: From November 2017 to December 2018, eight cases with eighteen hand wounds were hospitalized in our unit. Among them, wounds were distributed in the forefinger and middle finger in four cases, wounds were distributed in the middle finger and ring finger in two cases, wounds were distributed in the forefinger, middle finger, and ring finger in one case, and wounds were distributed in the middle finger, ring finger, and little finger in one case. The area of skin defect ranged from 1.5 cm×0.8 cm to 4.0 cm×3.0 cm. There were 4 males and 4 females, aged 34-62 years. Wounds of six cases were repaired by two free superficial peroneal artery perforator flaps from homolateral crus, and those of two cases were repaired by three free superficial peroneal artery perforator flaps from homolateral crus. Superficial peroneal artery and its accompanying vein of flap were anastomosed by end to end with digital artery and palmar or dorsal subcutaneous vein of recipient site during the operation. The area of flap ranged from 2.5 cm×1.2 cm to 5.0 cm×4.0 cm. No nerve was harvested during the operation, and donor site was sutured directly. The survival of the flaps and the healing of donor sites were recorded. During follow-up, the recovery of donor and recipient sites was observed. Results: All flaps survived well, donor site healed well. No vascular crisis occurred. Follow-up for 4 to 12 months showed that the appearance of flap was satisfactory with good color, texture, elasticity, and function. Protective sensation of recipient site was recovered. Five months after operation, flap of finger pulp in one case was swollen slightly with two-points discrimination of 10 mm, which received the thinning surgery. Obvious scar formation was not observed in donor site of crus. The appearance of the donor site was good without functional damage. Conclusions The application of multiple free homologous superficial peroneal artery perforator flaps of crus to repair the multiple hand wounds has advantages of easy acquisition, easy operation, little effect on donor sites, and satisfactory clinical effects.

Objective To explore the surgical technique and clinical effects of free anterolateral thigh flaps with fascia lata for repair of dorsal tendon and soft tissue defect of ophisthenar.Methods From February,2014 to July,2016,dorsal tendon and soft tissue defect of ophisthenar in 13 cases was repaired by free anterolateral thigh flaps with fascia lata.The area of soft tissue defect was 5.0 cm×6.0 cm-9.0 cm×12.0 cm.Extensor tendon defect and bone exposure occurred in all cases.The area of flap was 6.0 cm×7.0 cm-10.0 cm×13.0 cm,while the area of anterolateral thigh flap was 3.0 cm×4.0 cm-6.0 cm×8.0 cm.The regular post-operatively followed-up was performed.Results All flaps survived.The donor sites healed well without skin graft.The followed-up time was 6-36 months with the average of 13 months.The appearance of the flap was good.The color and texture of flaps was similar to the dorsal skin of ophisthenar.Three female patients who were not satisfied with the flap appearance received the revision and the results were satisfactory.The activity of finger flexion and extension was satisfactory.All patients walked well without difficulty.According to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,the function recovery result was excellent in 8 cases,good in 4 cases,and poor in 1 case.Conclusion It is a good method to use the free anterolateral thigh flaps with fascia lata to repair of dorsal tendon and soft tissue defect of ophisthenar.

Osteoarthritis(OA)is the most common degenerative disease in clinical practice.Joint pain is the main manifestation of OA,and in severe cases,it can lead to joint deformity.The main pathological changes include destruction of articular cartilage,synovitis,thickening of subchondral bone,bone redundancy,degeneration of articular ligaments,and enlargement of articular periosteum.Clinicopathological changes and pain degrees in OA patients vary from person to person,and treatment options vary from person to person.Clinically,non-steroidal anti-inflammatory drugs are used to treat the pain of OA patients now,but the effect is not ideal,and long-term use of these drugs will bring obvious toxic and side effects.Traditional Chinese medicine obtains good results in relieving the pain of OA patients.Therefore,this paper reviews the research on traditional Chinese medicine treatment and pain mechanisms of OA,with a view to providing ideas and references for clinical relief of pain in OA patients.

Objective To investigate the relationship between health literacy and cognitive function in elderly inpatients.Methods A cross-sectional survey was conducted among 216 elderly people who were admitted to a class Ⅲ grade A hospital by convenience sampling. Social demographic characteristics scale, questionnaire on Chinese citizens' health literacy and minimum mental state examination were used in this survey.Results The health literacy score of elderly inpatients was (64.33±12.79) and the cognitive function score was(26.52±2.27). The scores of health literacy and cognitive function had moderate correlation in hospitalized elderly patients (r=0.52,P<0.05). The single factor analysis showed that the health literacy of the elderly inpatients was statistical different in the education level,the average monthly family income,occupation, chronic disease and cognitive function (P<0.05). The results of multiple linear regression analysis showed that educational level,cognitive function,occupational and chronic diseases were independent factors of health literacy among the elderly inpatients.Conclusions The cognitive function of elderly inpatients varies greatly, and the higher level of cognitive function is a protective factor for the health literacy of elderly inpatients. It is an important approach to improve health literacy among elderly patients in hospital by lowering the burden of cognitive function to communicate health information.

In order to meet the urgent needs of social high-level nursing talents in the times and reality, scholars at home and abroad pay more and more attention to the development of professional spirit of nursing students. By using systematic analysis, this paper summarized five kinds of widely used professional spirit teaching methods, such as role model teaching, reflective learning teaching, PBL teaching, behavior-oriented teaching and hidden curriculum teaching so as to break the traditional teaching mode and explore scientific and effective teaching methods.