Objective To generate data on the current medical rehabilitation resources in Hubei province so as to improve the management of rehabilitation quality.Methods Medical institutions on the second level and above were investigated using a questionnaire which covered installations,personnel,equipment and field of operations.Results A total of 176 questionnaires were recovered.Among them,166 (94.3％) of the hospitals had established a department of rehabilitation medicine,and 122 (69.3％) had set up an independent rehabilitation ward,accounting for a total of 3,359 beds.Altogether,there were 1,260 rehabilitation physicians (36.7％ of the assigned personnel),904 therapists (26.3％) and 1,272 nurses (37％).Senior physicians,therapists and nurses were 26％,3.1％ and 28.3％ of the respective totals.Conclusion Rehabilitation medicine in Hubei Province remains relatively poorly developed.It is weak in terms of building the discipline,management and devices,especially in a serious lack of professionals and rehabilitation therapists.

BACKGROUND:The most effective method for the treatment of acetabular fracture is open reduction and internal fixation, however, this treatment for some special types of acetabular fracture cannot get satisfactory prognosis, and is prone to complications, such as traumatic coxarthrosis and avascular necrosis of femoral head. OBJECTIVE:To evaluate the curative effect of open reduction and internal fixation and total hip arthroplasty in the treatment of special acetabular fracture. METHODS:Twelve cases of acetabular fracture were included, including seven cases of traffic accident wound, three cases of crush injury, and two cases of fal ing injury. The type of bone fracture:two cases of posterior wal fracture, two cases of posterior column and posterior wal fracture, one case of T shaped fracture, five cases of transverse and posterior wal fracture, and two cases of acetabular roof sexual fracture. Complications:one case was femoral head centric dislocation, five cases were latter dislocation, and three cases were caput femoris fractures. Before injury, three cases had coxarthrosis, and two cases were avascular necrosis of femoral head. Al the cases were treated with open reduction internal fixation and total hip arthroplasty, of which nine cases were treated with biological prosthesis, and three cases were treated with bone cement prosthesis. The time from hospitalization to surgery was 3-15 days, and average was 6 days. The patients were fol owed-up once every 2 months in 1 year after replacement, and the Harris score was used to evaluate the hip function recovery. RESULTS AND CONCLUSION:No surgical site and deep wound infection, joint dislocation, lower limb deep vein thrombosis, and death were found in these 12 cases. Among them, 11 cases were fol owed-up for a longtime;the fol ow-up was lasted for 6-82 months. The acetabular fracture was healed at 6-16 months after reduction without prosthesis loosening and sinking. The hip function was evaluated during final fol ow-up according to the Harris score:excellent in eight cases, good in two cases, poor in one case, and the excellent and good rate was 91%. Open reduction internal fixation and one-stage total hip arthroplasty can avoid long-term bed, get out of bed as soon as possible, and reduce complications, thus reconstruct the hip joint painlessly and good functional y.

Objective To investigate the level of occupational well-being among the community nurses and analyze factors influencing their occupational well-being,in order to improve community nurses' well-being.Methods In January 2013,a total of 156 nurses from five community health service centers in Shanghai were selected as subjects by convenience sampling,who were surveyed with general information questionnaire and occupational well-being questionnaire.Results The overall score of occupational well-being among 156 community nurses was (161.20 ± 22.22),and the scores of all dimensions were above the medium level,among which the dimension of "interpersonal relationship" reached the highest score of (4.88 ± 0.68),but "welfare treatment" score was (3.80 ± 0.82) and the lowest.The scores concerning the two dimensions of "work value" and "self-acceptance" showed statistically significant differences among nurses who had different monthly income and years of working (F =2.845,3.360,3.056,3.164,respectively; P ＜ 0.05).Conclusions The occupational well-being of nursing staffs from community still should be improved,especially in the dimension of "welfare treatment".The managers should actively care about the nurses who have lower seniority and lower income,in order to increase their recognition of work value and self-acceptance.

OBJECTIVETo investigate clinicopathologic features of solitary plasmacytoma of bone (SPB) and the role of immuno-phenotype and immunoglobulin gene rearrangement detection in the diagnosis and differential diagnosis of SPB.

METHODSA total of 21 cases of SPB were selected during a period from 1990 to 2008. A retrospective clinicopathologic study and immunohistochemistry (EnVision or EliVision methods) of 17 antigens were performed. In addition, universal IgH (FR3A/LJH/VLJH) primers and BIOMED-2 PCR multiplex tubes were used for IgK and IgL rearrangement analysis.

RESULTSThe age of patients ranged from 36 to 72 years with a media of 50 years. Axial skeleton was the most common site of involvement, accounting for 66.7% of the cases (14 of 21), followed by the extremities of 33.3% (7 cases). Low serum level of M-components was found in 5 cases, including two of IgG type (21.4 g/L) and three of IgA type. Clinical manifestations were closely related to the anatomic sites involved, such as pain due to bone destruction, symptoms and signs caused by compression of spinal cord or nerve root, and pathological fracture. All cases presented as a solitary osteolytic lesion. According to the histological grading criteria, grade I tumor was seen in 12 of 21 cases (57.1%). The remaining were grade II (5 cases, 23.8%) and grade III (4 cases, 19.0%). Immunohistochemically, the neoplastic cells expressed two or more plasma cell antigens, including CD138, CD38 and PC, but no CD19 and CD20. CD79a expression detected in 23.8%(5/21) of the cases. Expression of CD56, CD27 and CD44v6 were 57.1% (12/21), 15.0% (3/20) and 23.8% (5/21), respectively. Follow-up data were available in 12 of the 21 patients (57.1%). Five patients were alive and 7 died. Three patients developed multiple myeloma (MM) and died of the tumor.

CONCLUSIONSSPB is a rare tumor with bone pain as the most common presenting symptom due to bone destruction. The diagnosis of EMP can only be established after exclusion of an extramedullay invasion by MM. Immunophenotype and IgH gene rearrangement analysis play important roles in the diagnosis of SPB.

ADP-ribosyl Cyclase 1 ; metabolism ; Adult ; Aged ; Bone Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Gene Rearrangement, B-Lymphocyte, Heavy Chain ; Humans ; Immunophenotyping ; Lymphoma, Large B-Cell, Diffuse ; metabolism ; pathology ; Lymphoma, Large-Cell, Anaplastic ; metabolism ; pathology ; Male ; Melanoma ; metabolism ; pathology ; Middle Aged ; Multiple Myeloma ; pathology ; Plasmacytoma ; genetics ; metabolism ; pathology ; surgery ; Retrospective Studies ; Survival Rate ; Syndecan-1 ; metabolism

BACKGROUNDEvidence suggests that systemic inflammation may play an important role in the progression and morbidity of chronic obstructive pulmonary disease. It remains controversial whether inhaled corticosteroid in combination with a long-acting beta(2)-adrenoceptor agonist can attenuate systemic inflammation. We evaluated the effect of salmeterol/fluticasone propionate on circulating C-reactive protein level in stable chronic obstructive pulmonary disease patients.

METHODSAn open-label clinical trial was conducted to recruit 122 outpatients with stable moderate-to-severe chronic obstructive pulmonary disease from department of respiratory medicine in two teaching hospitals between June 2007 and March 2008. Patients were randomized into two groups (1:1) to receive either the combination of 50 microg salmeterol and 500 microg fluticasone twice daily (n = 61), or the combination of 206 microg albuterol and 36 microg ipratropium q.i.d (n = 61) over 6 months. Circulating C-reactive protein concentrations were measured before randomization and during the follow-up. The efficacy of treatment was also assessed by spirometry, as well as health status and dyspnea score at baseline and after 6-month treatment.

RESULTSBaseline characteristics of two groups were similar. Compared with ipratropium/albuterol, the combination of salmeterol/fluticasone significantly reduced circulating level of C-reactive protein (-1.73 vs. 0.08 mg/L, respectively, P < 0.05) after 6-month treatment. Forced expiratory volume in one second (FEV(1)) and health status also improved significantly in salmeterol/fluticasone group compared with ipratropium/albuterol. Salmeterol/fluticasone treatment subjects who had a decrease of circulating C-reactive protein level had a significant improvement in FEV(1) and St George's Respiratory Questionnaire total scores compared with those who did not (185 vs. 83 ml and -5.71 vs. -1.79 units, respectively, both P < 0.01).

CONCLUSIONSalmeterol/fluticasone treatment reduced circulating C-reactive protein concentration in clinically stable moderate-to-severe chronic obstructive pulmonary disease patients after 6-month treatment.

Albuterol ; analogs & derivatives ; therapeutic use ; Androstadienes ; therapeutic use ; C-Reactive Protein ; metabolism ; Female ; Fluticasone ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; drug therapy ; metabolism ; Salmeterol Xinafoate ; Treatment Outcome

We wished to understand the genetic recombination and phylogenetic characteristics of human en- terovirus A71 (EV-A71) and to explore its potential virulence-related sites. Full-length genomes of three EV-A71 strains isolated from patients in Chenzhou City (China) were sequenced and analyzed. Possible re- combination events and crossover sites were analyzed with Recombination Detection Program v4. 1. 6 by comparison with the complete genome sequences of 231 strains of EV-A71. Similarly, plot and bootscanning analyses were undertaken with SimPlot v3. 5. 1. Phylogenetic trees based on the sequences of VP1 regions were constructed with MEGA v5. 2 using the Kimura two-parameter model and neighbor-joining method. Results suggested that recombination events were detected among the three EV-A71 isolates from Chenzhou City. The common main parent sequence was from JF799986 isolated from samples in Guang- zhou City (China) in 2009, and the minor parent sequence was TW/70516/08. Intertypic recombination e- vents were found in the C4b strain (strain SHZH98 isolated in 1998) and C4a strain (Fuyang strain isola- ted in 2008) with the prototype strains of CVA4 and CVA14 in the 3D region. The chi-square test was used to screen-out potential virulence-related sites with nucleotide substitutions of different types of hand, foot, and mouth disease (HFMD) cases using SPSS v19.0. Results suggested that there were no significant nucleotide substitutions between death cases and severe-HFMD cases. Eighteen significant nucleotide substitutions were found between death/severe-HFMD cases and mild-HFMD cases, and all these 18 substitutions were distributed only in P2 and P3 regions. Intertypic recombination among the predominant circulating EV-A71 strains in the Chinese mainland and other EV-A strains probably dates before 1998, and intratypic recombination might have occurred frequently in the HFMD outbreak from 2008 to 2012. Substitutions in the non-capsid region may be correlated with the changes in virulence of EV-A71. These data suggest that researchers should pay more attention to the relationships between substitutions in the noncapsid region and the virulence of the virus.
Enterovirus A, Human ; genetics ; pathogenicity ; Mutation ; Phylogeny ; Recombination, Genetic ; Virulence

Objective:To explore the application of magnetic resonance(MR)quantitative analysis technique of fat in analyzing the relationships between liver fat fraction(LFF)and pancreatic fat fraction(PFF)and the severity of nonalcoholic fatty liver disease(NAFLD),and between them and liver function.Methods:A total of 185 patients who received MR whole-liver mDIXON sequence scan were selected,and their LFF and PFF were measured.They were divided into NAFLD group(160 cases)and control group(25 cases)according to the fat fraction(FF)of liver.The body mass index(BMI),alanine aminotransferase(ALT),triglycerides(TG),fasting blood glucose(FBG),low-density lipoprotein(LDL-c),high-density lipoprotein(HDL-c),LFF and PFF between two groups were compared.Spearman analysis method was adopted to analyze the correlation between LFF and various indicators,and between PFF and various indicators.Logistic regression analysis was used to analyze the influencing factors of NAFLD severity.Results:In 160 patients of NAFLD group,72 cases were mild degree(LFF WAS 5.1%-14.0%),and 76 cases were moderate degree(LFF was 14.1%-28.0%),and 12 cases were severe degree(LFF>28.0%).There were significant differences in LFF,PFF and BMI between NAFLD group and control group(tLFF=17.259,tPFF=9.058,tBMI=7.430,P<0.05),and the differences of ALT,TG,FBG,LDL-c and HDL-c between two groups also were significant(t=6.591,t=3.957,t=3.267,t=2.112,t=-3.727,P<0.05),respectively.There were significant differences in LFF,PFF,BMI,ALT,TG,FBG,LDL-c and HDL-c among mild group,moderate group and severe group of patients(F=21.944,F=16.391,F=5.872,F=30.240,F=3.984,F=3.863,F=3.398,F=1.214,P<0.05),respectively.BMI,ALT,TG and FBG appeared positive correlation with LFF and PFF of NAFLD patients(r=0.31,r=0.52,r=0.33,r=0.35,r=0.30,r=0.36,r=0.27,r=0.29,P<0.05),and HDL-c appeared negative correlation with them(r=-0.16,r=-0.3,P<0.05),respectively.Multivariate Logistic regression analysis showed that HDL-c was an independent protective factor of the severity of NAFLD(OR=0.004,P<0.05),and LFF,PFF,BMI,ALT,TG,LDL were independent risk factors of the severity of NAFLD(OR=2.252,OR=1.988,OR=1.404,OR=1.196,OR=1.025,OR=5.150,P<0.05),respectively.Conclusion:LFF and PFF are closely related to the severity of NAFLD and the indicators of liver function,and the increases of LFF and PFF are independent risk factors of the aggravation of NAFLD.The MR quantitative analyses of LFF and PFF values have a certain guiding significance in clinical monitoring for NAFLD severity and liver function.

ObjectiveTo explore the methods of nursing coordination in recanalization operations for vertebral artery occlusion and provide feasible reference for clinical practice. MethodsXuanwu Hospital of Capital Medical University had carried out recanalization of vertebral artery occlusion earlier than most hospitals world-widely. This study summarized 44 cases of recanalization of vertebral artery occlusion from October 2014 to February 2019 according to the anatomical characteristics of the deep position of vertebral arteries and abundant blood vessels in surrounding tissues. The key points of nursing cooperation during recanalization of symptomatic vertebral artery occlusion included: communication with doctors before operation, familiarity with the operation plan and nursing plan preparation for the whole process; preparation of special intraoperative instruments and deep surgical instruments according to the results of digital subtraction angiography (DSA); anticoagulation and thrombus nursing during operation; appropriate arrangement of the instruments in the operating room and avoidance of repeated moving as well as the smooth cooperation between members of the surgical team are the key factors to ensure the safety of the recanalization operation for vertebral artery occlusion. ResultsAll the 44 cases of vertebral artery recanalization were successful, including 26 cases of vertebral artery endarterectomy combined with stent implantation, 18 cases of simple angiography, 1 case of simple balloon dilation, and 2 cases of vertebral artery transposition combined with stent implantation. ConclusionsThe flexible, efficient and comprehensive cooperation of surgical nurses is the key step of the successful operation of recanalization of vertebral artery occlusion.

OBJECTIVETo observe effectiveness and safety of electroacupuncture at Neimadian for analgesia in the extremities after orthopedic operation.

METHODSTwo hundred cases enrolled were divided into two groups. The test group of 100 cases were treated with electroacupuncture at Neimadian and oral administration of placebo, and the control group of 100 cases with oral administration of tramadoli hydrochloride.

RESULTSThe mean score for pain signs at all the time points before and after analgesic treatment in the test group had more decreases as compared with the control group (P < 0.001); and in the good rate after treatment, the test group was higher than the control group (P < 0.001, P < 0.05), and for safety, the test group was higher than the control group (P < 0.001).

CONCLUSIONThe analgesic effect and safety of electroacupuncture at Neimadian are superior to the routine analgesic after operation of the extremities.

Acupuncture Analgesia ; Analgesics ; Electroacupuncture ; Humans ; Pain Management

OBJECTIVETo introduce the clinical application of the upper lip scar tissue flap in correcting secondary nasal deformities of unilateral cleft lip.

METHODSTwo types of the upper lip scar tissue flap were developed in correcting nasal deformities with Millard's technique.

RESULTSThe procedure was performed on 51 patients. All the scar tissue flaps survived completely. The deformities were better corrected than before.

CONCLUSIONThe scar tissue flap has adequate blood supply. This procedure is routinely combined with other commonly used techniques to correct secondary deformities of cleft lip. It is particularly applicable for repairing the nasal deformity when usable tissue is not enough.

Child ; Cicatrix ; surgery ; Cleft Lip ; surgery ; Humans ; Nose Deformities, Acquired ; etiology ; surgery ; Rhinoplasty ; methods ; Surgical Flaps ; blood supply ; surgery