Objective To observe the effect of valsartan combined with salvia miltiorrhiza ligustrazine in treating early diabetic nephropathy(DN),looking for an effective method for the treatment of early DN.Methods 51 DN patients were divided into two groups,28 cases in the treatment group were treated with valsartan and salvia miltiorrhiza ligustrazine therapy,23 cases in the control group only received valsartan treatment.Fasting blood glucose before and after treatment (FPG),2h postprandial blood glucose (2hPG),glycosylated hemoglobin (HbA1 c),BUN,Scr,urine albumin excretion rate(UAER) index were detected.Results Before and after treatment,FPG,2hPG,HbA1c,UAER in the two groups had statistically significant differences (t =5.361,6.458,3.026,7.894,5.648,7.604,6.590,8.652,all P ＜ 0.05).After treatment,2hPG,HbA1c,UAER between the two groups had statistically significant differences (t =3.125,3.520,3.881,all P ＜ 0.05).No statistical difference was observed before and after treatment in two groups of BUN,Scr (P ＞ 0.05).Conclusion Valsartan combined with salvia tetramethylpyrazine in treatment of early DN was more effective than single valsartan treatment,and no significant adverse reactions was found in combined treatment.Therefore,the combined treatment can be used as a new method for clinical treatment of early DN.

Nurse workstation, a typical client program of "No.1 Military" project, is trailed and speculated with Oracle tools such as TOAD, and then the general startup flow mode for "No.1 Military" project can be determined, which is instructive for its maintenance and programming.

ObjectiveTo evaluate the application value of the emergency laparoscopic surgery in incarcerated inguinal hernia of children. MethodsManual reduction of incarcerated hernia was laparoscopic- assisted after anesthesia, high-ligation of hernia sac was done by one hole method of laparoscopic treatment.ResultsAll of 22 cases of pediatric incarcerated hernia were done, no complications occurred. Eighteen patients were followed up for 3 - 15 months, 9.3 months on average, without serious complications. ConclusionsThe emergency laparoscopic surgery in children of incarcerated inguinal hernia is safe and feasible,with smaller trauma, quicker recovery and smaller health risk.

Objective To evaluate the effects of hypogastric artery ligation to treat massive hemorrhage in pelvic fractures with abdominal organ injuries. Methods The pelvic fractures of 16 patients were classified as Tile B type in 10 cases and C type in 6. Among them there were 6 open fractures and 20 sites of abdominal visceral injuries. The capacity of retroperitoneal hematoma, which was ruptured in 6 cases, ranged from 800 ～2 500ml with 1 400ml on average. The bleeding volume in the survivals was 1 500～5 800ml with 2 600ml on average. Ligation of bilateral hypogastric artery was carried out in all patients with intra abdominal injuries within 6h. Of them, skeletal traction was used in 7 cases while pelvic external fixation in 5 cases. Results One death occured dut to consumptive coagulopathy with hematorrhea. Of the 15 survivals, bleeding was controlled in 8 cases, decreased in 5 and uncontrolled in 2. The effective rate was 81.3%(13/16) and the survival rate 93.8%(15/16). Conclusion When emergency celiotomy is performed for abdominal injuries, a rational application of hypogastric artery ligation can play a positive role in control of pelvic hematorrhea.

Objective To investigate the different effects of different resection position of fibula on shape of tibiofibular syndesmosis,and explore the best position of cut fibula,providing reference for clinical surgeon to use fibula reasonably.Methods Ten adult male cadaverie specimens 172-176 cm long were used for 20 shank-ankle specimens.10 cm long fibula was cut proximally at the lower point 1/6,lower point 1/4,lower point 1/3,middle point 1/2 respectively,which was compared with the nornlal one to analyze the changes of shape of tibiofibular syndesmosis.Results Normally,the distance oftibiofibular syndesmosiswas(0.30±0.10)mm.Underthe condition of cut at the lower point 1/6,the distance of tibiofibular syndesmosis was enlarged[(0.54±0.20)mm](P＜0.05).In contrast,under the condition of cut 10 cm long fibula proximally at the middle point 1/2.the distance of tibioffbu1ar syndesmosis hadlittle effect[(0.31±0.20)mm](P＞0.05).Conclusion The best resection position of fibula is in the proximity of the fibula at the point 1/2.

Objective To retrospectively review the clinical characteristics and antimicrobial resistance profile of nosocomial bloodstream infections caused by Klebsiella pneumoniae in surgical patients for better use of antimicrobial agents.Methods The clinical data of the surgical patients who were diagnosed with K.pneumoniae-associated bloodstream infections in Tung Wah Hospital from January 2013 to June 2015 were reviewed and analyzed retrospectively.The diagnosis of bloodstream infections was based on national diagnostic criteria.The pathogens were routinely isolated and identified.Antimicrobial susceptibility testing was carried out by using Kirby-Bauer method.The data were analyzed by WHONET 5.6 software.Results A total of 78 surgical patients were identified with nosocomial bloodstream infections due to K.pneumoniae during this period,including primary bloodstream infections (12.8％,10/78) and secondary bloodstream infections (87.2％,68/78).These infections were mainly associated with surgical and invasive procedures.Nearly 40％ of the K.pneumoniae isolates were resistant to ceftriaxone,cefuroxime and piperacillin.ESBLs were produced in 43.6％ (34/78) of the K.pneumoniae isolates.The ESBLs-producing strains showed significantly higher resistance rates to various antibiotics than non-ESBLs-producing strains.Piperacillin-tazobactam,amikacin,imipenem,and meropenem still have good antibacterial activity against these K.pneumoniae isolates.However,imipenem-resistant strains are emerging.Conclusions Most of the bloodstream infections caused by K.pneumoniae were secondary to infections in other body sites in surgical patients.Hospital infection control measures should be strengthened.Meanwhile,the clinicians should take full advantages of microbiological laboratory to profile the pathogens and their susceptibility patterns,which is crucial for rational use of antibiotics.

Objective:To investigate the effects of Zhitaiqing Granule on aortic endothelial cells in rabbit with experimental atherosclerosis. Methods:10 New Zealand rabbits were selected as blank control randomly and fed with normal forage,while the rest rabbits were fed with high-fat forage in formula A. After six weeks,hyperlipidemia models were formed and they were randomly divided into model group,Zhitaiqing treatment group,simvastatin control group and hawthorn tablet control group. From the 7th week,rabbits in treatment and control groups were fed with corresponding drugs while the blank and model groups with the same quantity of normal saline by lavage. After 11 weeks lavage,total cholesterol (CHO),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C),apolipoprotein AI (apo AI),apolipoprotein B (apo B).were detected. With the help of optical microscope,the pathological changes of the aortic arch,thoracic aorta and abdominal aortic intima were observed. Results:In Zhitaiqing group,CHO,LDL-C,and ApoB reduced dramatically (P

Objective To evaluate the treatment effects of the olecranon comminuted fracture by the angle stability prin-ciple combined with support under the articular surface. Methods From November 2008 to June 2012, 13 patients (7 male and 6 female, aged from 20 to 77 years) suffered from olecranon comminuted fracture were treated with Synthes anatomy locking com-pression plate and screws combined with Kirschner wires supporting under the articular surface through the posterior median ap-proach. Fractures occurred in the left elbow in 9 and in the right elbow in 4. According to the Mayo classification, 11 cases were classified as Mayo type IIB and 2 as IIIB. According to the Schatzker-Schmeling classification, 2 fractures were type A2, 9 type C, and 2 type D. One patient with type C fracture also had type I coronoid fracture according to Regan and Morrey classification. The Mayo elbow performance index (MEPI) and the shortened disabilities of the arm shoulder and hand (Quick-DASH) were employed to evaluate the functions. All patients took the satisfaction survey and X-ray during the follow-up. Results All patients were fol-lowed-up for 8 to 41 months. The mean ROM of the elbow joint was 112° (range, 65°-140° ), and the mean rotation angle of the forearm was 170° (range, 150°-180°). The mean score for the MEPI was 96 (range, 85-100), excellent 12, good 1. The mean score for the Quick-DASH was 6.2 (range, 0-16.7). In the satisfaction survey, 8 patients were very satisfied, 4 satisfied, 1 common level. All patients took the X-ray during the follow-up and all of them had achieved fracture union completely with the mean time period as 12.7 weeks (range, 11-24 weeks). No cubitus varus, valgus, and instability were found in all patients. No complication, such as infection, ulnar nerve injuries and etc. was found. Five patients complained about mild discomfort caused by internal fixation at 3 months after surgery. Three of them were diagnosed as joint stiffness because of ROM within 100° . One case in 3 elbow stiffness patients developed osteoarthritis after eight months, but no pain during joint activity. Internal fixation was removed in one case;an-other young patient took the operation for removal of internal fixation and release of medial ligament;the third patient refused oper-ation. Conclusion Angle stability principle (Synthes anatomy locking compression plate and screws) combined with supporting under the articular surface (Kirschner wires) can achieve stable fixation in treating olecranon comminuted fracture. It may realize the early exercise of the elbow joint with excellent clinical results. Therefore, it may be an optional choice in clinical practice.

OBJECTIVE:To provide reference for promoting the further implementation of national essential medicine system and rational use of drugs in community health service center. METHODS:Outpatients’information in Changqiao Street Communi-ty Health Service Center from Sept. 2,2009 to Nov. 25,2014 was collected to statistically analyze the drug variety,the number of prescriptions,the consumption sum and the DDDs before and after the implementation of essential medicine system and after the supplement of non essential medicines. RESULTS:Essential medicines occupied the main position of drug utilization in each stage, with substantial growth in respects of consumption sum and number of prescriptions;the sum of Chinese patent drugs and essential cardiovascular drugs occupied more than 50% of the total consumption sum and number of prescriptions,with higher growth rate;essential medicines occupied the top 10 in respects of consumption sum and DDDs,among which most were the drug varieties in“Shanghai supplement essential drugs in community health service center”(2010 Edition),with some overlap the varieties in“Na-tional Essential Medicine System”(2012 Edition);cardio-cerebrovascular drugs occupied the dominant position;the growth rates of cefotiam and atorvastatin took up the top 2 ranking in the list of consumption sum,while the growth rates of calcium carbonate D3 and irbesartan and hydrochlorothiazide took up the top 2 ranking in the list of DDDs. CONCLUSIONS:Essential medicine cata-log covers the common drugs in the community health service center,in which the rational use of Chinese patent drugs and antibac-terial deserves needs to be noticed. The clinical rational use of the essential medicines should be strengthened,the essential medi-cine catalog should be adjusted and non essential medicines should be supplied when necessary in order to truly meet the needs of patients and optimize the allocation of medical resources.

Objective To observe the therapeutic effects of exercise combined with tiotropium bromide and salmeterol/fluticasone inhaling on stable chronic obstructive pulmonary diseases (COPD).Methods Sixty COPD patients with pulmonary function Ⅲ-Ⅳ grade were randomly allocated into experiment group and control group (30 cases in each group).The patients in experiment group were treated with inhaled tiotropium bromide and salmeterol/fluticasone combined with excise,while the patients in control group were treated only with inhaled tiotropium bromide and salmeterol/ fluticasone.Respiratory training with shrinkage lip respiration and steps training was given to the patients in experiment group for 8 weeks.Main outcome measures included forced expiratory volume in one second (FEV1),FEV1,in the anticipation value (FEV1%),FEV1/forced vital capacity (FVC),Medical Research Council (MRC) score,activities of daily living (ADL) score and 6-minute walking distance (6MWD).Results MRC score in control group and experiment group was both lower than that of pre-treatment (P < 0.01).ADL score,6MWD and pulmonary functional parameters in both groups were improved than those of pre-treatment (P< 0.01).FEV1,FEV1%,FEV1/FVC,MRC score,ADL score and 6MWD were (1.41 ±0.25) L,(53.76 ±11.17)%,(62.12 ±10.78)%,(1.56 ± 1.16) scores,(5.51 ±0.18) scores and (342.7 ± 19.7) m after treatment in experimentgroup,and (1.28 ± 0.23) L,(46.27 ±8.85)%,(55.76 ±8.57)%,(2.29 ±1.13)scores,(4.47 ±0.13)scores and (280.6 ± 17.8)m after treatment in control group.There were significant differences between two groups (P<0.05).Conclusion Tiotropium bromide,salmeterol/ fluticasone inhaling can improve life quality and pulmonary functional parameters in patients with stable COPD,while exercise combined with that can significantly enhance the therapeutic effects.