Objective To summarize the perioperational nursing strategies for patients undergoing mandibular defect repair by forearm flap composite fibula flap.Methods From January 2009 to December 2012,9 patients with mandibular defect and soft tissue defects after resection of malignant tumors received fibula flap and forearm flap.Before operation,the patient received psychological education and the preparation of donor flap and receptor area together with oral preparation was performed.After operation,the vital signs and blood circulation in the flap were observed.Results The fibula and forearm flaps in 8 patients survived.The fibula flap in one patient survived while the forearm flap developed with vascular crisis.The success rate for the transplanted flap was 89.9%. Conclusion The perioperative nursing strategies are key to increase survival rate of flaps and the success rate of operation.

Objective:To explore therapeutic effect of noninvasive bilevel positive airway pressure ventilation (Bi- PAP)on aged patients with acute left heart failure (ALHF)and evaluation value of NT-proBNP for therapeutic effect in these patients.Methods:A total of 80 aged ALHF patients treated in our hospital were selected.According to random number table,they were equally divided into routine treatment group and BiPAP group (received BiPAP therapy based on routine treatment group ).NT-proBNP level,heart rate (HR),systolic blood pressure (SBP),di- astolic blood pressure (DBP),respiratory rate (RR)and arterial blood gas were compared between two groups be- fore and after treatment.Linear correlation analysis was used to evaluate the correlation among plasma NT-proBNP level and above indexes.Results:There were no significant difference in all indexes between two groups before treatment (P>0.05 all).Compared with before treatment,on 4h after treatment,there were significant reductions in levels of HR,SBP,DBP,RR and NT-proBNP,and significant rise in partial pressure of oxygen in artery (PaO2 ) in both groups (P<0.05 or<0.01),and compared with routine treatment group,there was significant rise in PaO2 [(75.13±19.93)mmHg vs.(85.88±18.47)mmHg],and significant reduction in NT-proBNP level [(3786.71± 1270.38)pg/ml vs.(2658.65±1222.08)pg/ml]in BiPAP group (P<0.05 both).Linear correlation analysis indi- cated that NT-proBNP level was significant positively correlated with HR (r=0.383),SBP (r=0.360),RR (r=0.345)and PaCO2 (r=0.413),and significant inversely correlated with PaO2 (r=-0.471),P<0.05 or<0.01. Conclusion:BiPAP ventilation therapy can improve clinical therapeutic effect in aged ALHF patients,and NT-proB- NP is help to evaluating its therapeutic effects.

Objective To detect the serum expression level of Pokemon and explore its clinical value combines with AFP,AFP-L3 or DCP in hepatocellular carcinoma (HCC).Methods In this study,the serum levels of Pokemon,AFP,AFP-L3 and DCP in 30 patients with HCC,34 patients with benign liver diseases and 30 healthy controls were examined by enzyme-linked immunosorbent assay.Then,the clinical significance of Pokemon expression level was analyzed.In the end,the diagnostic evaluation of four serum biomarker alone detection was used to analyze the sensitivity,specificity,the area under the curve and Youden index in the diagnosis of HCC.Results The serum expression level of Pokemon in patients with HCC was (22.63 ± 6.82) ng/ml,which was significantly higher than that in the group with benign liver diseases and healthy controls [(3.54±1.26)ng/ml,t =8.594,P＜0.001;(1.95 ±0.57)ng/ml,t =10.021,P＜0.001].The expression level of Pokemon in HCC patients was correlated to tumor size (t =2.678,P =0.021) and TNM stag (t =2.578,P =0.034).The serum expression levels of AFP,AFP-L3 and DCP in patients with HCC were (774.56 ± 96.52) ng/ml,(26.37 ± 2.54) ng/ml and (93.49 ± 30.45) mAU/ml,which were significantly higher than those in the group with benign liver diseases [(22.21 ± 3.57) ng/ml,(7.05 ± 2.71) ng/ml,(34.68 ± 10.13) mAU/ml] and healthy controls [(14.65 ± 4.45) ng/ml,(3.84 ± 1.09) ng/ml,(25.87 ± 9.01)mAU/ml,F=58.46,P=0.000;F=12.47,P=0.000;F=23.41,P=0.000].The sensitivity and specificity of Pokemon,AFP,AFP-L3,DCP in the diagnosis of HCC were 84.6％ and 87.5％,52.5％ and 78.9％,95.0％ and 80.0％,77.1％ and 87.5％,respectively.Conclusion The enhanced Pokemon serum level,with its sensitivity and specificity higher than AFP,points out Pokemon may be a potentially useful biomarker to diagnose HCC.

Objective The tissue culture of the stem apex of Knoxia valerianoides was done to research the optimum culture medium for test-tube seedlings for large-scale planting.Methods The stem apex of wild K.valerianoides was used as the explants and cultivated in different culture media separately to induce fascicled-bud,root,and plantlet regeneration.Results The cultural medium MS+BA 2.0 mg/L+NAA 0.1 mg/L was suitable for the sub-multiplication of fascicled bud and the medium 1/2MS+NAA 1.0 mg/L for root inducement and the plantlet regeneration.The transplantation survival rate of the plantlet regeneration was 70%.Conclusion The tissue culture of K.valerianoides could be used to produce test-tube seedlings for large-scale planting.

Objective To investigate the possible causes of the different diagnostic sensitivity of voluntary single fiber electromyography (SFEMG) and repetitive nerve stimulation(RNS) in patients with myasthenia gravis (MG). Methods The voluntary SFEMG and RNS at low rates were recorded successively from the same extensor digitorum communis (EDC) muscle on the same day in 67 patients with MG. Results The diagnostic sensitivity of SFEMG and RNS was 92.5% and 50.7%, respectively, with the former statistically significantly higher than the later. The percentage of decrement of RNS was positively correlated with 3 SFEMG parameters, i.e. the mean jitter, percentage of abnormal pairs of potential and percentage of impulse blocking. Among the 34 cases with significant decrement on RNS, 2 had no impulse blocking and the maximum decrement reached 62%, while 33 cases with normal RNS had up to 58% of impulse blocking. Conclusion The voluntary SFEMG was more sensitive than RNS in diagnosing MG even in the same muscle. The blocking phenomenon observed in voluntary SFEMG was not completely corresponding to the decrement in RNS.The possible explanations were partly because that RNS recorded the total muscle fibers response in surface of the muscle and SFEMG examined the increasing or blocking at individual motor end-plates, and partly because that the voluntary SFEMG and RNS might explored endplates belonging to different motor units.

OBJECTIVE:To explore the cultivation method for community pharmaceutical care talents in higher vocational colleg-es. METHODS:According to the talent training aims to meet the demand of community pharmaceutical service positions in higher vo-cational colleges,the teaching reform was carried out for talent cultivation mode,course structure system,training base construction and teaching methods. RESULTS:In terms of talent cultivation mode,the work-integrated learning mode was built;in terms of course structure system,“Medicine,Pharmacy,Humanities and Expansion”course module was constructed to further optimize it;in terms of training base construction,the capital investment was increased to improve the school training base,meanwhile,cooperation between schools and enterprises was carried out to strengthen the construction of out-of-school training bases;in terms of teaching methods, PBL,case teaching model and situational teaching method were implemented. CONCLUSIONS:The quality of pharmaceutical talents has been significantly improved by implementing reform of the talent cultivation mode,the course structure system and teaching meth-ods,together with constructing training bases.

Objective: To investigate the physical and intellectual development and mutation characteristics of the phenylalanine hydroxylase (PAH) gene among 53 newborns with phenylketonuria (PKU), so as to provide insights into the management and genetic counseling of PKU Methods: The medical records of 54 children with definitive diagnosis of PKU and standardized therapy until 2 years at the Center for Neonatal Disease Screening of Shanxi Children' s Hospital from 2018 to 2021 were collected. Newborns' body weight and height developments were evaluated using the World Health Organization growth chart (2006 version), and the intellectual development was assessed using the national criteria of Development Behavior Assessment Scale among Children at Ages of 0 to 6 Years (WS/T 580-2017). The gene mutations were detected among neonates and their children, and the physical, intellectual developments and genetic characteristics of neonates with PKU were descriptively analyzed. Results: The 53 PKU cases included 29 male children and 24 female children, 36 cases with classic PKU and 17 cases with mild PKU, and 30 cases from rural areas and 23 cases from urban areas. The study subjects had a median age of 30 (10) d at initial therapy, and a mean blood phenylalanine concentration of (1 507±685) μmol/L at definitive diagnosis. There were 52 cases with normal height developments (98.11%), and all cases had normal weight and intellectual developments. The mean developmental functional quotient (DFQ) was significantly greater among urban children with PKU than among rural children [(94.92±8.57) vs. (87.65±6.57); t=-3.498, P=0.001], and the mean DFQ was significantly higher among children with mild PKU than among those with classic PKU [(95.55±8.76) vs. (88.57±7.11); t=-3.095, P=0.003]. There were 37 mutations detected in the PAH gene, which were mainly distributed in exons 3, 6, 7, 11, 12 and intron 4. Three high-frequency mutation sites were detected, including c.728G>A, c.611A>G and c.1197A>T, including three novel mutations (c.674C>G, c.1316-2A>C and c.1069T>C). Conclusions Following standardized treatment, the children with PKU have comparable physical and intellectual developments as compared to normal children. c.728G>A, c.611A>G and c.1197A>T were predominant mutations in the PAH gene among these 53 children with PKU, and three novel mutations were identified, including c.674C>G, c.1316-2A>C and c.1069T>C.

Objective To investigate the related risk factors in patients with atrial fibrillation in order to prevent and delay the occurrence of atrial fibrillation.Methods Five hundred and fifty-eight inpatients with atrial fibrillation were retrospectively analyzed from June 2005 to June 2008.They were divided into several groups according to the age and the characteristics of the elder patients with atrial fibrillation were analyzed.Results In the 558 cases with atrial fibrillation, there were 298 males (53.4%) and 260 females (46.6%) aged from 21 to 97 years.The average age was (72.8 ±10.1) years.There were 57 cases aged 21-59 years(10.2 %)and 501 cases aged 60-97 years(89.8 %).The total number of inpatients in our hospital was 11 869, and there were 4049 cases aged<60 years, 2527 cases aged 60-69 years, 3971 cases aged 70-79 years, 1244 cases aged 80-89 years and 78 cases aged>90 years.The proportions of the inpatients with atrial fibrillation in the above five age groups of inpatients were 1.4%(57 cases), 4.2%(107 cases), 6.6% (262 cases), 9.5%(118 cases)and 17.9% (14 cases), respectively.In 558 cases with atrial fibrillation, there were 230 cases (41.2%) with paroxysmal atrial fibrillation, 44 cases (7.9%) with persistent atrial fibrillation and 284 cases (50.9%) with permanent atrial fibrillation.The most common underlying disease was hypertension in the 558 cases, followed by coronary heart disease, heart failure, diabetes, rheumatic heart disease and so on.Conclusions The prevalence of atrial fibrillation is increased with aging.Hypertension, coronary heart disease, rheumatic heart disease, heart failure, hyperthyroidism,diabetes, chronic pulmonary disease and renal failure are all the risk factors for atrial fibrillation.

Objective To explore the value of coronary flow reserve(CFR) evaluating myocardial ischemia measured by adenosine triphosphate (ATP) stress transthoracic Doppler echocardiography (TTDE),and the feasibility of CFR to predict coronary stenosis.Methods Fifty-four patients suffering chest pain with known or suspected coronary artery disease were performed ATP stress TTDE to measure resting and maximum expansion coronary blood flow velocity and calculate CFR.all patients were performed by coronary angiography (CAG) and single-photon emission computed tomography (SPECT) myocardial perfusion imaging.Results ① To evaluate myocardial ischemia,there was not statistical significant difference between non-invasive CFR and SPECT myocardial perfusion imaging(P ＞0.05).CFR≤2.0 was the best cutoff value for evaluating myocardial ischemia which yielded a sensitivity of 93.3 ％ and specificity of 89.7％.②Coronary artery stenosis was negatively correlated with CFR (P ＜0.001).ROC curve analysis demonstrated that CFR≤ 1.60 yielded a sensitivity of 92.3％ and specificity of 73.3％ to predict coronary stenosis significantly.Conclusions CFR measured by ATP stress TTDE can evaluate myocardial ischemia of coronary artery disease and predict LAD significant stenosis before CAG.Using CFR and CAG has important clinical value for choosing treatment of stable coronary artery disease.

Objective To investigate the effects of OB built-in tampon indwelled in anus combined with acupoint massage in ICU patients with incontinence-associated dermatitis (IAD). Methods 100 patients with incontinence hospitalized in ICU were randomly assigned to control group (n=50) versus combined therapy group (n=50). The patients in the control group accepted routine nursing while the patients in the combined therapy group were treated with OB built-in tampon indwelled in anus combined with acupoint massage besides the routine nursing care. The two groups were compared in terms of incidence rate of IAD, IAD occurrence time, severity of IAD and incontinence-related nursing workload. Results The incidence rate of IAD and the severity of IAD in the combined therapy group were lower than those of the control group.The IAD in the combined therapy group occurred later than in the control group. Thetime for incontinence-related nursing and the frequency of perineum washing in the combined therapy group were shorter and lower than in the control group. Conclusions The application of OB built-in tampon indwelled in anus combined with acupoint massage in ICU patients with incontinence can not only reduce the incidence rate and severity of IAD but also lower the workload of nursing.The therapy is worthy of clinical application.