Objective To summarize our experiences in the long-term continuous maintenance of the peripherally inserted central catheter (PICC) in a patient with intestinal fistula.Method The systematic holistic nursing care has been provided according to the nursing practices to a patient with intestinal fistula since 2006,during which eitht PICCs were used successively.Results The eight PICCs were placed for 3-14 months.The 1 st,3rd,5th,and 7th cathers were retained for 12,13,11,and 14 months.The second catheter was retained for 6 months,and then removed due to increased body temperature (38.7℃).The 4th cather was retained for 3 months,then catheter-related bloodstream infection was suspected due to high body temperature (39℃) ; culture for fungi at the tip showed positive results.The 6th catheter was retained for 7 months,inserting from jugular vein to the superior vena cava; however,it was removed due to puncture point local purulent changes at the puncture site.The 8th catheter was applied for 8 months,but was rmoved due to tube occlusion,which responded poorly to urokinase.Conclusion The application of PICC in patients with fistula can relieve the pain and improve the quality of life.

Objective To set up a HPLC method for the determination of the contents of notoginsenoside R1,ginsenoside Rg1 and Rb1 in Kangliu pills.Methods It was performed on Kromasil C18(4.6 mm?150 mm,5 ?m),and the mobile phase was acetonitrile-0.05% phosphoric acid with gradient elution system.The flow rate was 1.0 mL/min,the detective wavelength was 203 nm,injection volume was 10 ?L and the column temperature was 30 ℃.Results The liner range of notoginsenoside R1 was 82.8～621 ?g(r=0.999 9) and the average recovery was 100.057%(RSD=0.399 6%).The liner range of ginsenoside Rg1 was 109.8～ 823.5 ?g(r =0.999 6) and the average recovery was 99.248%(RSD=1.004 6%).The liner range of ginsenoside Rb1 was 112.6～844.5 ?g(r=0.999 9) and the average recovery was 99.812%(RSD=1.474 4%).Conclusion The method is simple,accurate and reproducible,and suitable for the content determination of notoginsenoside R1,ginsenoside Rg1 and Rb1 in Kangliu pills.

Objective To explore the relationship between artenosclerotic changes in the carotid arteries and the development of coronary beart disease (CHD), and also to study the changes in endothelial function in patients with CHD, with the aid of ultrasonographic examination. Methods One hundred and twenty inpatients were divided into CHD group ( n =90) and control group ( n =30) according to the results of coronary arteriogram. In intima media thickness (IMT) and arteriosclerotic plaques were determined in carotid arteries with B mode ultrasonography. Dilatation of the brachial arteries during reactive hyperemia and after sublingual administration of glyceryl trinitrate (GTN) were determined at the same time. Results The intimia media thickness of CHD group was significantly higher than that of the control group, and had no significant but there was no significant difference among groups of 1,2,or 3 diseased vessel groups. Atherosclerotic plaques were mostly found in the carotid bifurcation and common carotid artery segments. The discovery rate was higher in patients with 2 or 3 diseased coronary arteries. The contents of TC and LDL C, and incidence rate of hypertension and diabetes mellitus were higher in CHD group. The flow mediated dilatation and GTN induced dilatation of brachial arteries in patients with CHD were significantly reduced compared with those in control group( P

Adolescent ; Arteriovenous Fistula ; therapy ; Catheter Ablation ; methods ; Coronary Artery Disease ; therapy ; Female ; Heart Defects, Congenital ; therapy ; Humans ; Male ; Middle Aged

Coronary Restenosis ; therapy ; Drug-Eluting Stents ; adverse effects ; Humans ; Treatment Outcome

Objective To investigate the efficacy of the combination ofJiangtang decoction and insulin in the treatment of type 1 diabetes mellitus in children.Methods A total of 43 children with type 1 diabetes mellitus were enrolled and randomly allocated to either a insulin group (control group) and a insulin plusJiangtang decoction group (treatment group) using the table of random digits, with 23 patients in the control group and 20 in the treatment group. The patients in the control group were treated with insulin, and those in the treatment group were administrated withJiangtangdecoction on the basis of the treatment in the control group for 2 months. Body mass index (BMI), fasting plasma glucose (FPG), postprandial blood glucose (PBG) and hemoglobin A1c (HbA1c) were measured.Results The levels of FPG, PBG and HbA1c were significantly decreased in the treatment group (twere 3.376, 54.493, and 2.798, respectively; allP<0.01), and the PBG level was significantly decreased in the control group (t=29.714,P=0.000). The levels of FPG, PBG and HbA1c in the treatment group were significantly lower than those in the control group (twere 2.715, 2.191 and 5.627, respectively;P<0.05 orP<0.01). There was no difference in BMI between the treatment group and the control group (t=0.159,P=0.874). The proportion of patients with HbA1c <7.5% in the treatment group (60.0%, 12/20) was higher than that in the control group (26.1%, 6/23;χ2=5.055,P=0.025).Conclusion Combination ofJiangtang decoction and insulin can decrease the level of FPG, PBG and HbAlc, and its therapeutic effect is superior to insulin alone for type 1 diabetes in children.

Objective To study the association of carotid atherosclerosis with high-sensitivity creative protein(hs-CRP),lipoprotein-a(Lp-a) and superoxide dismutase(SOD) in patients with chronic renal failure (CRF).Methods Seventy-one CRF patients were divided into Group A of 45 patients under maintenance hemodialysis and Group B of 26 patients without hemodialysis,and 20 healthy donor was Group C in this study.And 71 CRF patients were divided into carotid atherosclerosis group (43 cases) and non carotid atherpsclerosis group(28 cases) according to whether the carotid atherosclerosis plaque was detected out.Fortythree CRF patients presented carotid atherosclerosis including 17 patients with soft plaque,10 patients with hard plaque and the other 16 with mixed plaque.Color ultra-sound was used to measure the carotid intimal medial thickness(IMT) and define the type of plaque.Levels of hs-CRP,Lp (a) and SOD were detected and analyzed in this study.Results (1) Levels of hs-CRP,Lp-a,SOD and IMT were significantly different in group A ((7.39±2.25) ag/L,(428.43±102.25) mmol/L,(71.35±21.52) KU/L and (1.23±0.31) mm,respectively),group B((7.41±1.67) mg/L,(432.12±96.43) mmol/L,(68.14±15.25) KU/L and (1.18±0.26) mm,respectively),and group C ((2.11 ± 0.86) mg/L,(193.32 ± 62.31) mmol/L,(94.23 ± 21.13)KU/L and (0.61 ±0.22) mm,respectively),the differences were significant (F =2.998,2.783,2.032,2.802;P＜0.05).Plaque incidence was increased in group A(68.9％) and group B(69.2％) compared with group C (12.5％) with statistical significance (x2=17.863,17.989;P＜0.001).(2) Furthermore,for CRF patients,hsCRP and Lp-a were positively related to IMT in group A (r =O.436,0.279;P＜0.05) and group B (r =0.652,0322;P ＜ 0.05),SOD presenting negative relationship with IMT (r =-0.283,P ＜ 0.01 for group A,and r =-0.164,P＜0.05 for group B).(3) Level of hs-CRP and Lp-a in carotid atherosclerosis group were higher than those in non carotid atherosclerosis group((7.58±2.47) mg/L vs.(3.41±1.26) mg/L,(437.31±115.38) mmol/L vs.(256.24± 101.22) mmol/L),the differences were significant (t =2.917,2.583;P ＜0.05).Level of SOD in carotid atherosclerosis group was lower than that in non carotid atherosclerosis group ((68.43±13.36) KU/L vs.(76.22±17.12) KU/L),the difference was signifiant(t=2.156,P＜0.05).(4)Level of hs-CRP and SOD in patients with soft plaque and mixed plaque were statistically different from those in patients with hard plaque(F=4.210,2.056;P＜0.05).Conclusion The micro-inflammatory status,oxidative stress and disturbance of Lp-a metabolism are extensively existed in CRF patients and closely connect to each other.Therefore,they might correlate with the formation of plaques in carotidartery.

Pneumonia is one of the most common medical complications after stroke.Stroke-associated pneumonia (SAP) can not only increase the length of hospital stay and medical cost of patients,but also an important risk factor for mortality and morbidity in patients with stroke.All these indicate that the importance of prediction and prevention of SAP.This article reviews the advances in research on the prediction and prevention of SAP.

Objective To investigate the effects of leptin on Th17 cells and the possible mechanism. Methods The leptin-deficient ( ob/ob) mice and their homologous wild-type mice were used in the study.The percentages of Th17 cells in peripheral blood samples, spleen tissues and lymph nodes were measured by flow cytometry ( FCM) analysis.The splenic CD4+T cells, separated from the ob/ob mice and the wild-type mice by using magnetic beads,were respectively cultured with leptin at various concentrations and with anti-leptin neu-tralization antibody to evaluate the effects of leptin on Th17 cells.The quantitative real-time PCR was performed to analyze Th17 cell-related cytokines at transcriptional levels.The levels of IL-6 and IL-17A in the supernatants of CD4+T cell culture were measured with Luminex technology.Results Compared with the wild-type mice, the ob/ob mice showed lower percentages of Th17 cells in both peripheral blood samples and spleen tissues (0.49%±0.03%vs 1.29%±0.1%, 1.56%±0.22%vs 2.47%±0.11%).There was a decrease in the percentages of Th17 cells upon the in vitro treatment of CD4+T cells from wild-type mice with anti-leptin antibody.The per-centages of Th17 cells were increased in a dose-dependent manner upon the in vitro treatment of CD4+T cells from ob/ob mice with leptin.Moreover, the levels of IL-17A and IL-6 and the transcriptional levels of RORγt, IL-17A and IL-6 in leptin deficiency group were lower than those of wild-type group, but were increased upon the treatment with leptin.No significant difference with the transcriptional levels of TGF-βand IL-23 was ob-served between the two groups with and without intervention.Conclusion Leptin deficiency seriously hampered the generation of Th17 cells in mice and resulted in a decreased expression of RORγt, IL-17A and IL-6 at mRNA level.The treatment of CD4 T cells with leptin might promote the generation of Th17 cells through up-regulating the transcription of RORγt and IL-6.

Objective To study the influence of hemodiafiltration on high-sensitivity C-reactive protein (hs-CRP),serum parathyroid hormone (iPTH) and cardiac function in uremic patients undergoing maintenance hemodialysis (MHD).Methods Forty patients with uremia were divided into hemodiafiltration (HDF) group (n =20) and hemodialysis(HD) group(n =20) by random numbers.Serum hs-CRP and iPTH were measured before treatment and at 6 months after treatment.Their left ventricular diastolic diameter (LVEDD),left ventricular end-systolic dimension (LVESD),interventricular septal thickness (IVST) and left ventricular ejection fraction(LVEF) were measured by echocardiogram.Ten healthy volunteers were recruited as the normal controls.Results After treatment,serum hs-CRP and iPTH decreased significantly in the HDF group (hs-CRP:(3.32±1.t4) mg/L vs.(7.84 ±2.21) mg/L,t =2.072,P =0.046;iPTH:(155.36 ±81.33) ng/L vs.(190.25 ±82.31) ng/L,t =2.121,P =0.023).No significant difference of serum hs-CRP and iPTH was observed in the HD group before and after treatment (hs-CRP:(7.91 ±2.11) mg/L vs.(7.68 ± 1.86) mg/L,t =1.731,P =0.111 ; iPTH:(177.43 ± 85.43) ng/L vs.(184.35 ± 87.21) ng/L,t =1.331,P =0.210).Color Doppler indices of cardiac structure of the HDF group significantly improved after treatment compared with before treatment (LVEDd:(55.3 ±3.7) mm vs.(58.8 ±4.3) mm,t =2.345,P =0.015 ;LVESd:(33.5 ±2.6) mm vs.(36.4±4.3) mm,t=2.178,P=0.046;IVST:(10.2±1.7) mmvs.(13.1 ±1.8) mm,t=2.630,P=0.012;LVEF:(55.3 ±2.6)％ vs.(42.5 ±3.3)％,t =2.860,P =0.010;LVMI:(132.5 ±9.1)g/m2 vs.(137.4 ± 8.7) g/m2,t =2.871,P =0.009).After treatment,cardiac structure of the HDF group was significantly better than that of the HD group (LVEDd:(55.3 ± 3.7) mm vs.(59.1 ± 4.2) mm,LVESd:(33.5 ±2.6) mm vs.(36.1 ±3.4) mm,IVST:(10.2±1.7) vs.(12.4 ±1.3) mm,LVEF:(55.3 ±2.6)％vs.(43.4±2.7)％,LVMI:(132.5 ±9.1) g/m2 vs.(139.4 ±8.9) g/m2;P ＜0.05).During the six month treatment,the incidence rate of cardiovascular events of the HDF group was significantly less than the HD group (36.39％(524/1440) vs.(72.08(1038/1440),x2 =21.583,P＜0.01).Conclusion HDF may efficiently remove iPTH,improve cardiac function of uremic patients,and help them recover from micro-inflammatory state.