OBJECTIVETo observe thee efficacy of different ways of percutaneous coronary intervention (PCI) for treating elderly coronary heart disease (CHD) patients.

METHODSTotally 470 elderly CHD patients were classified to three age brackets (equal to or more than 85 years old, 60 to 74 years old, 75 to 84 years old). They were assigned to the transradial intervention (TRI) group (236 cases) and the transfemoral intervention (TFI) group (234 cases) according to different intervention pathways. Correlated indices and postoperative clinical efficacy were compared between the two groups.

RESULTSA higher successful rate of surgery was obviously got in patients 85 years old or older than 85 than in those 60 to 74 years old and 75 to 84 years old (P <0. 05). The incidence of major cardiovascular events (MACE) was reduced at post-operative 12 and 24 months in patients 85 years old or older than 85 (P <0. 05). The case number for changing intervention pathway were increased in the TRI group with statistical difference (P <0. 05). Compared with the TFI group, the case number for changing intervention pathway was increased; the time for arteriopuncture, the time for catheterization, and the time for X-ray exposure were prolonged; the time for postoperative bedding were obviously shortened; the incidence of vascular complications at the puncture site were lowered. The incidence of postoperative 12-month MACE was lowered, all with statistical difference (all P <0. 05). The incidence of MACE within postoperative 24-month MACE decreased in patients 60 to 74 years old and 75 to 84 years old (P <0. 05). The incidence of MACE within postoperative 24 months increased in patients 85 years old or older than 85 of the TRI group with statistical difference (P <0. 05).

CONCLUSIONTRI can be preferably chosen for PC in treating elderly CHD patients.

Aged ; Aged, 80 and over ; Coronary Artery Disease ; surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction ; Percutaneous Coronary Intervention ; methods ; Radial Artery ; Treatment Outcome

Gestational hyperlipidemic pancreatitis is an uncommon complication of pregnancy that incurs a high risk of morbidity and mortality of both maternal and fetal patients.We described the response of continous renal replacement therapy in a woman with extreme gestational hyperlipidemia and severe pancreatitis.Five consecutive plasma exchanges didn't lead to a remarkable reduction(10.4% and 4.8%,for the first and fourth times,respectively) at triglyceride levels as the literatures have reported,which reveals that plasma exchange and continous veno-venous heamofiltration may be importment,instead of crucial methods in dealing with gestational hyperlipidemic pancreatitis.Abstract:SUMM ARY Gestational hyperlipidem ic pancreatitis is an uncommon complication of pregnancy that in-curs a high risk ofmorbid ity and mortality of both maternal and fetal patients.W e described the response of continous renal replacement therapy in a woman with extreme gestational hyperlipidem ia and severe pancreatitis.Five consecutive plasma exchanges d idn’t lead to a remarkable reduction(10.4% and 4.8%,for the first and fourth times,respectively) at triglyceride levels as the literatures have reported,which reveals that plasma exchange and continous veno-venous heamofiltration may be importment,in-stead of crucialmethods in dealing with gestational hyperlipidem ic pancreatitis.

BACKGROUND:Wnt signal pathway is involved in the regulation of bone marrow mesenchymal stem cells differentiating into osteoblasts, promotes osteoblasts proliferation and differentiation, inhibits programmed death of osteoblasts, and indirectly affects the function of osteoclasts.
OBJECTIVE:To summarize the relationship between Wnt/β-catenin signal pathway and bone disease.
METHODS:A computer-based online search was performed to find papers published between January 2000 and January 2014 in CNKI database and Elsevier database. The key words were“Wnt/β-catenin, osteoblasts, bone marrow mesenchymal stem cells, osteoarthritis, chondrocytes”in Chinese. Documents concerning the effects of Wnt/β-catenin signal pathway on osteoblasts and bone disease were included.
RESULTS AND CONCLUSION:Wnt signaling pathway is consisted of Wnt/β-catenin signal pathway (Wnt typical signal pathway), Wnt/Ca2+signal pathway and Wnt/planar cellpolarity signal pathway. Wnt signaling pathway is one of the most important regulatory systems that plays a key role in modulating the differentiation, proliferation and programmed celldeath of osteoblasts, osteoclasts and chondrocytes. The role of Wnt signal pathway in patients with rheumatoid arthritis is mediated by osteoblasts. The inhibitory factor of Wnt signal pathway in osteoblasts is upregulated, which reduces the ratio of osteoprotegerin/receptor activating factor ligand, promotes the osteoclasts differentiation and immaturation. The researches addressing the components and effect of Wnt signal pathway are important for the special treatment of bone diseases and the prevention of osteoporosis or other bone diseases.

Dermatitis, Occupational ; diagnosis ; Diagnostic Errors ; Female ; Humans ; Trichloroethylene ; adverse effects ; Young Adult

ObjectiveTo analyze literature on acupuncture-related adverse events published in periodicals in Science Citation Index (SCI) and Medllars Online(Medline).MethodsWe searched the Web of Science database and the Medline database to identify articles about the safety of acupuncture therapy.Case reports,case series,surveys and other observational studies were included if they reported factual data,but review articles,translations and clinical trials were excluded.ResultsFindings:The inclusion criteria were met by 232 articles that in total reported on 389 cases of adverse events after acupuncture.Conclusion Acupuncture therapy is relatively safe,most acupuncture-related adverse events can be avoided by standardized clinical practice.Establishment of acupuncture medical safety standard system is extremely urgent.

Objective To explore the clinical value of diffusion weighted imaging (DWI) in the diagnosis of breast disease ,and compared with ultrasound and mammography .Methods The clinical data of 28 patients who were pathologically confirmed with breast cancer were retrospectively reviewed .The diagnostic accuracy of DWI ,mammogra-phy and ultrasound , the surface diffusion coefficients ( ADC value ) were statistically analyzed .Results ( 1 ) DWI scan:the diagnostic accuracy of malignant tumor was 90.9%(20/22),the ADC value of malignant tumor was (0.955 ±0.199) ×10 -3mm2/s;the diagnostic accuracy of benign lesions was 83.3%(5/6),the average ADC value of benign lesions was (1.660 ±0.339) ×10 -3 mm2/s,there were statistically significant differences ( t=2.371,P<0.05).(2)Mammography:the diagnostic accuracy of malignant tumor was 81.8%(18/22),the diagnostic accuracy of benign lesions was 33.3%(2/6).(3) Ultrasound:the diagnostic accuracy of malignant tumor was 86.4%(19/22),the diagnostic accuracy of benign lesions was 50.0%(3/6).The diagnostic accuracy of malignant tumor had no significant difference among three techniques (χ2 =0.752,P>0.05),but for the diagnostic accuracy of benign lesions,DWI was better than ultrasound and mammography ,the difference was statistically significant (χ2 =6.146, P<0.05).Conclusion For the diagnosis of malignant breast tumors and benign lesions ,DWI is better than ultra-sound and mammography ,which has high clinical application value .

Objective To investigate the fatigue experience of the community-dwelling frail elderly to establish the conceptual model.Methods Grounded theory was adopted.With MAXQDA v10.4.15.1for 3 levels coding,the conceptual model of fatigue experience of community-dwelling frail elderly people was structured through constant comparison and in-depth analysis.Results Multi-response,selfmanagement,safe and belonging,hitting rock bottom,accepting and transferring formed the conceptual model.Conclusions Based on the conceptual model,nurses should pay more attention to concern about the fatigue experience of community-dwelling frail elderly people,and probe different assessment methods to enrich comprehensive geriatric assessment (CGA),then improve the community health service level and the quality of elderly people's life.

Objective To study the effects of enteral immunonutrition on immune function in patients with multiple trauma. Method A total of 32 patients with multiple trauma admitted to general ICU in ChangZheng hospital, Shanghai from March 2007 to May 2008 were randomly (random number) divided into two groups,enteral immunonutrition group (EIN group, n = 16)and the general formula enteral nutrition group (EN group, n = 16).Two groups of patients on the third day after injury began to accept the EIN and the general formula EN which respectively support at least 14 days. The patients peripheral blood lymphocyte count (TLC), immunoglobulin (IgG,IgM, IgA) ,and T-lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) were detected on the day of the group formation, the seventh and the fortteenth day of the nutritional support. Results TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in EIN Group on the 7th and 14th day than that on the first day ( P ＜0.05), and extended with the EIN and sustained increase. All immunization indicators of EN group on the 7th day were no significant changes compared with the day of the group formation, and on the 14 th day TLC, IgG, IgM,IgA, CD4 and CD4/CD8 ratio were significantly higher than that on the day of the group formation ( P ＜ 0.05),but were significantly lower than that in the EIN group on the 14th day ( P ＜ 0.05). Conclusions Compared with the general formula EN, EIN is more helpful to restore and increase the humoral and cellular immune function in early post-multitraumatic phase.

Objective To explore the mechanism of Xiaoying decoction on experimental autoimmune thyroiditis (EAT) rats in view of regulatory T cells and Th17 cells.Methods SD rats were divided into five groups,normal control group,model control group,tripterygium glycoside group,Xiaoying decoction low and high dose groups.Except for normal control group,the other groups were established the model of EAT.Rats in the Xiaoying decoction low,and high dose groups were given Xiaoying decoction of 17.24 and 68.95 g·kg-1;rats in the tripterygium glycoside group were given tripterygium glycoside 6.25 mg·kg-1.The serum free triiodothyronine(FT3),free thyrocyte(FT4) and thyroglobulin antibody were detected by RIA method.Thyrocyte morphology was observed under optical microscope.The expression levels of Foxp3 mRNA and IL-17 mRNA were detected by real-time PCR.The changes of Treg cells and Th17 cells were analyzed by flow cytometry.Results Compared with the normal control group,FT3,FT4 and TgAb were increased in the model control group (P ＜0.01,P ＜0.01,P ＜0.05).Compared with the model control group,FT3,FT4 and TgAb were decreased in tripterygium glycoside group and Xiaoying decoction high dose group (P ＜ 0.05).The infiltration score in the normal control group,model control group,tripterygium glycoside group,Xiaoying decoction low and high dose groups were 0,4,4,3.5,2.Compared with model control group,the infiltration was improved (P ＜0.01).Foxp3 mRNA expression was decreased while IL-17 mRNA increased in the model control group as compared with the normal control group(P ＜ 0.01).In contrast,the expression of Foxp3 mRNA was increased and IL-17 mRNA expression was decreased in Xiaoying decoction low and high dose groups,tripterygium glycoside group as compared with the model control group (P ＜0.05).Compared with the normal control group,rats in the model control group had fewer Treg cells and more Th17 cells (P ＜0.01).Compared with the model control group,the percentage of Treg cells was elevated and Th17 cells was reduced in tripterygium glycoside group and Xiaoying decoction high dose groups (P ＜ 0.01).Conclusion The therapeutic mechanism of Xiaoying decoction on EAT rats may be related to changing the percentage of regulatory T cells and Th17 cells with up-regulating the expression of Foxp3 mRNA and down-regulating the expression of IL17mRNA.

Objective:To explore the impact of clinical pharmacists involved in the treatment team on the reasonable drug use rate in medical orders. Methods:Totally 782 medical records including hypertension and 1-3 kinds of hypertension associated diseases in our hospital from January 2011 to December 2011 were used as the pre-intervention group, and 1 061 ones with the same conditions from September 2012 to August 2013 were used as the post-intervention group. The patients of the two groups were divided into 8 dis-ease subgroups, clinical pharmacists performed timely intervention on the medical orders in the post-intervention group, and the rational drug use rate between the two groups was compared. Results:In hypertension, hypertension associated coronary heart disease, hyper-tension with heart failure and hypertension with diabetes subgroups,the difference in the rational drug use proportion before and after the intervention was statistically significant(P<0. 01), in hypertension with coronary heart disease and heart failure, hypertension associ-ated coronary heart disease and diabetes, hypertension with heart failure and diabetes subgroup, the difference in the rational drug use proportion before and after the intervention was statistically significant(P<0. 05), while in hypertension with coronary heart disease, heart failure and diabetes subgroups, the difference was not statistically significant(P>0. 05). After the medical records in the 8 sub-groups were aggregated, the difference in the rational drug use proportion before and after the intervention was statistically significant( P<0. 01). Conclusion:Clinical pharmacists should involve in the clinical treatment to intervene irrational drug use,which can signifi-cantly improve the medical record rationality, avoid the health risks as much as possible and ensure the medication safety and treatment effectiveness for patients.