ObjectiveTo evaluate the effect of the comprehensive surgical management of primary venous reflux disease in lower extremity. MethodsComprehensive surgical management was performed on 108 patients( 126 limbs) with primary venous reflux disease between February, 1996 and Sept, 2000. All limbs were performed with superficial venous operation. External valvuloplasty of femoral vein valve was given to 83 cases(97 limbs) simultaneously, and to 22 cases (26 limbs) with concomitant subfascial endoscopic perforator surgery(SEPS). 3 cases (3 limbs) were operated with concomitant SEPS only. ResultsVenous claudication,swelling, and aching disappeared in 80.2% of limbs( 101/126) and apparent improvement in 19.8 % of limbs(25/126). All varicose veins were gone. Ulcer healing pre sented in 80 % of the limbs(8/10) with ulcers and ulcer decreasing in 20% of the limbs(2/10) in 3～6 months after superficial and deep venous operations. Ulcer healing presented in 23 cases(26 limbs) with ulcers and ulcer decreasing in remaining 2 limbs in 14 to 32 days after additional SEPS besides superficial and or deep venous operations. Deep venous valve sufficiency was demonstrated in 89.7% (113/126) of the limbs by Color Duplex. ConclusionIn the patients with severe primary venous reflux disease,comprehensive surgical management with concomitant superficial, deep and perforating veins might greatly improve the clinical effect.

Objective　In order to explore the prevalence of hypophosphatemia in postoperative patients of general surgery,as well as the time and dosage of phosphate replacement and its effects.Methods　To serum phosphate levels of 45 patients with phosphate replacement begun on the second postoperative day and 45 without replacement were monitored at the preoperative day,and the first,third,fifth and seventh postoperative day.Results　The incidence of hypophosphatemia was 91.1%(41/45) in cases without phosphate replacement.While it was 57.8%(26/45) in those with replacement.The serum phosphate concentrations in cases with phosphate replacement were higher than those without replacement on the third(P<0.001),fifth(P<0.05) and seventh(P<0.01) postoperative day.The Apache Ⅱ scores in cases with phosphate replacement decreased on the third postoperative days compared with those on the first day(P<0.001).Conclusion　The postoperative replacement of phosplates can avert the occurrence of hypophosphatemia and improve the Apache Ⅱ score.

Objective To investigate the practice effect of WeChat software on extended care for patients with anterior resection syndrome. Methods From August 2014 to August 2015, 50 patients with anterior resection syndrome were chosen as control group. From September 2015 to August 2016, 50 patients with anterior resection syndrome were chosen as experimental group. Patients in experimental group could use WeChat software independently. Control group got extended care by telephone, while experimental group was carried out through WeChat platform. They were followed up for 6 months. WeChat software offered patients professional guidance on evaluation and exercise methods of defecation function by video and text with some figures. The questions from patients were answered through WeChat software during followed up. Results The defecation function after 1 month of surgery for patients with excellent, good, average, poor was 15, 20, 12, 3 cases respectively in the experimental group, and 9, 15, 19, 7 cases respectively in the control group. The defecation function after 3 month of surgery for patients with excellent, good, average, poor was 19, 21, 8, 2 cases respectively in the experimental group, and 12, 18, 17, 3 cases respectively in the control group. The difference of the defecation function after 1,3 months of surgery were statistically significant (χ2=8.395, 8.251, P<0.05). But the difference of the defecation function after 6 months of surgery had no statistical significance (χ2=7.505, P>0.05). The compliance of medication, diet and rehabilitation exercise, regular review after 6 months of surgery for patients was (2.14 ± 0.72), (7.21 ± 1.63), (11.20 ± 0.63), (5.04 ± 0.78) points respectively in the experimental group, and (1.37 ± 0.58), (5.72 ± 1.32),(9.75 ± 1.56),(4.72 ± 0.43)points respectively in the control group, and the differences were statistically significant (t=2.68-5.75, P< 0.01).Conclusion WeChat software can improve defecation function and treatment compliance, thus greatly improve the quality of life of patients with mid-low rectal cancer.

Objective To explore osculating value method combined with rank sum ratio method in evaluation of nursing quality in the hospital nursing management application, to provide a scientific basis for decision making. Methods By reference, from the working efficiency, the quality of nursing, 3 dimensions of nursing skill training, the choice of 11 commonly used in the evaluation of nursing quality indicators, the raw data of each index was normalized, the school of nursing quality with 2004-2013 years of osculating value method analysis was assessed, the development of nursing quality combined with rank and file classified score method. Results The nursing quality of the overall upward trend, according to the grading each year osculating value and ranking in 2011, nursing quality best, osculating value was 0.000, the worst quality of nursing in 2004, osculating value was 3.248;the annual nursing quality grading was reasonable, 2011, 2012 and 2013 were in good quality grade, 2004, 2005 and 2006 were of poor quality grades, the rest of the year at a medium level, with statistically significant difference of the file, P<0.05. Conclusion Osculating value method combined with rank sum ratio method in comprehensive evaluation of nursing quality in the hospital has the objectivity and practicability.

Objective:To develop the evaluation index system for clinical teaching quality supervision of nursing undergraduates.Methods:Based on the theory of Donabedian's structure-process-outcome quality model, literature review, semi-structured interviews, Delphi method and Analytic Hierarchy Process were adopted to determine the teaching quality supervision index system for clinical nursing interns.Results:After two rounds of expert consultation, questionnaire response rates were 92.86%(26/28), 100.00%(26/26); expert authority coefficients were 0.871, 0.887 and the two rounds of expert consultation authority coefficient was 0.879; coefficients of variation ranged from 0.00 to 0.15 and 0.04 to 0.12; coordination coefficients ranged from 0.256 to 0.667 and 0.402 to 0.804 ( χ2 values were 60.276-427.571, P<0.01). The final index system consisted of 3 first-level indicators, 9 second-level indicators, and 36 third-level indicators. The analytic hierarchy process was used to determine the weights of all indexes, and the consistency test (CR<0.1) was performed. Conclusions:The construction of the index system for clinical teaching quality supervision of nursing undergraduates is scientific with reasonable weight. It can provide reference for the improvement and reform of clinical nursing teaching work.

AIM: Utilizing mRNA fluorescent differential display RT-PCR in our previous study,we found that the mRNA expression level of an intermediate protein(IF)-desmuslin was dramatically down-regulated in the abnormal veins of patients with primary vein incompetence.In this study,we testified the alteration of desmuslin expressing style at gene transcription and translation levels.METHODS: Specific PCR primers were designed according to the sequence of desmuslin mRNA.The cDNA fragments of desmuslin obtained from differential display were labeled by DIG as specific probes.Then semi-quantitative RT-PCR and Northern blotting techniques were applied to investigate the expression level of desmuslin mRNA in normal and abnormal veins.Simultaneously,the specific single-cloned antibody bestowed by Yuji Mizuno was used to evaluate the amount of DMN protein in the two groups by Western blotting and immunohistochemical techniques.RESULTS: In the abnormal veins isolated from the patients with primary vein incompetence,the expression of desmuslin mRNA was significantly down-regulated,compared with that in control group(semi-quantitative RT-PCR: 0.19?0.05 vs 0.83?0.08,P

Objective To assess the role of superficial vein and calf perforating vein in chronic venous insufficiency of lower limbs. Methods Consecutive seventy-five cases (78 limbs) of slight PDVI ( I? -Ⅱ?) were evaluated. Venous hemodynamics were detected by color duplex, color Doppler velocity profile technology and APG preoperatively, in the first month, the third month and the first year postoperatively. Data were statistically analyzed. Results Symptoms and signs disappeared in 88. 5% (69/78) limbs. The ulcer-healing rate was 92. 8% ( 13/14). The postoperative VFI at each check-point significantly decreased than that before operation (P0.01). Conclusions Superficial venous reflux can be effectively broken up by the operations. Venous stasis on calf effectively decreased by subfascial endoscopic perforator surgery (SEPS). But neither of the two procedures greatly improve the hemodynamic status of deep vein.

Objective To investigate the surgical treatment of infected femoral pseudoaneurysm caused by injection of heroin. Method Retrospective analysis was made on the clinical data of 14 cases of infected ruptured femoral pseudoaneurysm caused by injection of heroin. Results All 14 cases underwent operation. The ruptured sizes of arteries were 0.5 cm-2.0 cm . All cases were treated by resection of the aneurysm and replacement of iliac-femoral artery with artificial graft. Blood supply and function were good in all limbs after operations. Aneurysm cavities and incision wounds were treated with debridement, drainage and anti-infective treatment. All wounds were healed. 2 weeks and 3 months after operation, the grafts were patency demonstrated by Color Doppler examination. None of them was complicated with anastomosis leakage or thrombosis. Conclusion Thorough debridement of aneurysms and reconstruction of the artery are the effective approach in treating the infected ruptured femoral pseudoaneurysm caused by injecting heroin. Sufficient drainage, anti-infective and anti-coagulation therapy should be considered after the operation.

Objective To study the diagnostic value of air plethysmography (APG) in deep venous valvular incompetence of lower limbs and the relationship between deep venous reflux and calf muscular pump function. Methods Sixty-five varicose cases (89 limbs) were detected by APG in alterations of venous filling index (VFI), ejection fraction(EF), residual volume fraction(RVF) and outflow fraction(OF). Of 89 limbs, 18 limbs were in GradeⅠ of deep venous reflux, 24 in Grade Ⅱ, 18 in Grade Ⅲ and 12 in Grade Ⅳ. Integrated vectors analysis (Hotelling T 2test) was done with these index. Venography was performed in all patients. Results There were statistical differences in VFI between each two Grades of deep venous reflux except for between Grade Ⅰ and Ⅱ. There were also statistical differences in EF,RVF and OF between Grade Ⅳ and the other Grades. Hotelling T 2test showed significant testing efficiency of APG. ConclusionsDeep venous valvular insufficiency of lower limbs can be assessed by APG. VFI is a reliable quantitative index for evaluating the degree of deep venous reflux. There may be an exponent relation between deep venous reflux and calf muscular pump function.

ObjectiveTo analyze the effect of external valvuloplasty of the superficial femoral vein for primary deep venous valvular incompetence in the lower limbs (PDVI). Methods Consecutive seventy four cases(96 limbs) of PDVI were enrolled for prospective study, and color Doppler velocity profile technology and APG were performed preoperatively, the first month, the third month and the first year postoperatively. Results Postoperative venous reflux volume, VFI and score of venous dysfunction significantly decreased ( P