Objective To study the efficiency of tele-consultation on Internet with transmitting realtime 12-lead ECG carried out by the Chest Pain Center evaluated by the length of time required for the emergency percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI).Methods A total of 435 STEMI patients treated by emergency PCI were divided into the group A (n =98,admitted in 2010),group B (n =114,admitted in 2011) and group C (n =223,admitted in 2012).Data were collected before (2010) and after establishment of the Chest Pain Center (2011 to 2012) including the length of time elapsed from onset of symptoms to the first medical contact (FMC),the length of time required from FMC to the intra-aortic balloon inflated (FMC-2B) and the length of time required from entering the gate of hospital to the intra-aortic balloon inflated (D-2B).Measure data were described with non-normal median and interquartile intervals.Comparisons were made among groups with rank sum test.Results The median time of D2B of three groups were 107,78 and 59 mins in groups A,B and C,respectively.The differences in D2B among three groups were significant (P =0.000).The time of the D2B was shortened significantly because of the patients transferred to the hospital with a variety of ways (P =0.008).However,the length of D2B time was not significantly changed (P =0.846) when patients came to the hospital all on themselves.The median times from symptom onset to FMC in the group A,group B and group C were 112,62 and 78 mins.and the differences among three groups were not statistically significant (P =0.368).The median times of FMC2B in three groups were 287.0,313.5 and 421.8 mins,respectively,and there were no significant differences (P =0.135).Conclusions The establishment of the Chest Pain Center and Internet of things can effectively shorten the duration of D2B in STEMI patients.However,the reduction of time length from the symptom onset to reperfusion must rely on the coordination between communities and health care system.

Objective This study is based on the physicians'appraisal system upon HIS system to annually assess the associate chief physicians in clinical departments in the mode of attending in charge. Methods 74 doctors above the title of associate chief physician from 14 departments in such mode were selected as objects of study and evaluated upon relative requirement of the performance appraisal index system by means of brainstorming,expert consulting and so on to confirm the content,standard and scoring method of appraisal.Work efficiency index and work amount can be acquired out of HIS system, while details and problems during the assessment can be dealt together with clinical practice.Finally all index and results were collected through HIS system and total scores of relative doctor can be automatically calculated.SPSS 13.0 statistics software also can be used to descriptively analyze the frequency and percentage data.Results The total appraisal scores and scores in every grade of the 74 doctors,who are attending in charge with title above associate chief physician as well as bearing the same responsibility in both medicine and surgery department,were collected,analyzed and respectively ranked respectively.Conclusion The results of appraisal basically indicate general level of the doctors,as well as provide strong evidence for enhancing human resource management of the hospital, which will continuously improve the basis for assessment to performance of associate chief physician under mode of attending in charge,as well as collect experiences for deeply optimizing program of assessment system.

Objective:To explore the effect of red blood cell distribution width (RDW) on long-term follow-up study in patients with acute pulmonary thromboembolism (APE).
Methods:A total of 214 consecutive patients with the first episode of APE admitted in our hospital from 2009-01 to 2012-12 were enrolled. The patients were divided into 2 groups:RDW≤15%group, n=202 and RDW>15%group, n=12. Baseline RDW was measured at admission, the follow-up study was conducted at 3, 6, 12 months thereafter, and then at once per year. The major primary end point was chronic thromboembolic pulmonary hypertension (CTEPH). The independent predictor for CTEPH occurrence was studied by uni-and multivariate logistic regression analysis and the predictive capability of RDWwas evaluated by ROC curve.
Results: All patients ifnished the follow-up study at the mean of (31±17) months. The overall occurrence rate of CTEPH was 7.5% (16/214), which was higher in RDW>15% group than that in RDW≤15% group (33.3% vs 5.9%, P=0.002). Multivariate logistic regression analysis indicated that with adjusted clinical data and other predictors, RDW>15%was still the strong predictor for CTEPH occurrence (OR=7.916, 95%CI 1.474-42.500, P=0.016). Adding RDW to the evaluating model, the predictive capability could be signiifcantly improved by ROC curve (AUC increased from 0.856 to 0.901, P<0.01).
Conclusion: Elevated RDW is the independent predictor for CTEPH occurrence in APE patients, which is helpful to estimate the prognosis and treatment strategy in APE patients.

Objective To observe the clinical efficacy of long-snake moxibustion in treating asthma due to deficiency of lung and spleen. Method Seventy patients were randomized into a treatment group and a control group. The treatment group was intervened by using long-snake moxibustion, while the control group was by regular acupuncture treatment. The therapeutic efficacy was evaluated after 1-month treatment. Result In the treatment group, 22 subjects showed marked efficacy, 27 showed effective, 6 failed, and the total effective rate was 89.1%; in the control group, 18 subjects showed marked efficacy, 25 showed effective, 12 failed, and the total effective rate was 78.2%. The therapeutic efficacy of the treatment group was significantly higher than that of the acupuncture group(P＜0.05). Conclusion Long-snake moxibustion can produce a higher therapeutic efficacy than regular acupuncture in treating asthma due to deficiency of lung and spleen.

Adult ; Anastomosis, Surgical ; Esophagus ; surgery ; Humans ; Male ; Stents ; Stomach ; surgery ; Tracheoesophageal Fistula ; surgery

Objective To develop an easy,rapid and reproducible cefotaxime-agar medium(CTX- AM)for phenotypic detection of extended-spectrum ?-lactamases(ESBLs)and AmpC ?-lactamases (AmpCs)in Enterobacteriaceae.Methods The surface of a cefotaxime(CTX,0.5 ?g/ml)-Mueller- Hinton agar and ceftizoxime(CAZ,1 ?g/ml)-Mueller-Hinton agar plate was inoculated with a lawn of E. coli ATCC 25922 according to the standard disk diffusion method,respectively.Immediately prior to use.blank and clavulanic acid(10 ?g),cloxacillin(300 ?g),clavulanic acid/cloxacillin(10/300 ?g) disk were rehydrated with 10 ?l of saline and several colonies of each test organism were applied to disks. Then the results of CTX-AM method to interpret based on a zone of growth around the periphery of disks.A total 58 of ESBL and AmpC producing and non-producing isolates of Enterobacteriaceae,as identified by the double-disk enhancement test(DDET)and the three-dimensional extract method(TDEM).were used to evaluate the CTX-AM method.Positive control(E.cloacae 029M,K.pneumoniae ATCC 700603)and negative control(E.coli ATCC 25922)strains were included.Results The results of CTX-AM method were similar to the DDET and TDEM method for detecting ESBLs and AmpC production in Enterobacteriaceae,respectively.But inhibitor-resistant ?-lactamase(IR-BLs)and other ?-lactamases were not detected by DDET method.Conclusions The new method described here allows for testing of ESBL and AmpCs on a single plate.It is easy to perform and interpret,and also cost-effective,clinical laboratories may use this technique routinely to detect the oresence of ESBL and AmoCs.

0.05 for all).Conclusions The allelic frequencies of LPL gene at Pvu Ⅱ locus in Hei Yi Zhuang were different from those in Han,but the genotypie frequencies in Hei Yi Zhuang were not different from those in Han.There was no significant correlation between the polymorphism of LPL gene at Pvu Ⅱ site and the serum lipid levels in two ethnic groups.

OBJECTIVETo understand the status of standard medication of antiretroviral therapy and identify its correlationship with preventing mother-to-child transmission of HIV (PMTCT).

METHODSQualitative and quantitative methods for measuring of standard medication towards antiretroviral therapy of PMTCT were used in a cross-sectional study of 167 pregnant women who had accessed to PMTCT services and 57 physicians providing service from January 2005 to June 2007 in 5 HIV epidemic counties in Yunnan province.

RESULTSA total of 167 mothers were recruited, of which 65.87% (110/167) demonstrated for standard medication. The percentage of rational selection of antivirus-therapy regimen was 88.02% (147/167). HIV positive mothers with rational using medicine during labor covered 81.37% (131/161). 87.42% (146/167) of women demonstrated good compliance. The main correlations with the standard medication level of HIV positive pregnant women and their infants were as follows: diagnose time (OR = 2.617; 95% CI: 1.184 - 5.783), place of delivery (OR = 0.064; 95% CI: 0.007 - 0.607), minorities (OR = 0.344; 95% CI: 0.162 - 0.730), understanding of HIV women for antiretroviral therapy (OR = 6.843; 95% CI: 1.449 - 32.312), and doctors' cognition about the regimen for antiretroviral therapy was not enough; 5 key knowledge points (purpose of PMTCT, the consequence of not requiring standard medication, the effect of knowing regimens, the relationship of CD4 levels and selected regimens, the side effect of the relevant medicine) score rate was 47.72% (136/285).

CONCLUSIONThe proportions of standard medication in PMTCT antiretroviral therapy were not high. Standard medication might be associated with multiple factors from doctors, patients and society. It is necessary to make some steps to improve standard medication of antiretroviral therapy in PMTCT.

Anti-HIV Agents ; therapeutic use ; China ; Cross-Sectional Studies ; Female ; HIV Infections ; drug therapy ; prevention & control ; transmission ; Humans ; Infectious Disease Transmission, Vertical ; prevention & control ; Pregnancy ; Pregnancy Complications, Infectious ; drug therapy

Objective: To evaluate cardiopulmonary exercise testing (CPET) on sildenaifl effect for treating the patients with pulmonary arterial hypertension (PAH). Methods: A total of 25 PAH patients received sildenaifl treatment in our hospital from 2012-01 to 2014-01 were enrolled as PAH group, in addition, there were a Control group including 24 healthy subjects. The CPET, echocardiography, NYHA function class, 6-mimute walking distance (6MWD) and plasma levels of NT-proBNP at the baseline, (6-12) months and (13-18) months after sildenaifl treatment were assessed and compared between 2 groups. Results: Compared with Control group, PAH group showed decreased aerobic capacity (peakVO?2, Peak O2pulse) and ventilation efifciency (PETCO2@AT, VE?/VC?O2@AT), allP<0.05. At (8±2) months after sildenaifl treatment, aerobic capacity and ventilation efifciency was improved, meanwhile, NYHA function class, 6MWD and plasma levels of NT-proBNP were improved, allP<0.05. At (16±2) months after sildenaifl treatment, 6MWD was similar,P=0.26, while peak VO?2 and peak O2 pulse were decreased than they were at (8±2) months after sildenaifl treatment,P=0.04 and 0.06; the ventilation efifciency was elevated (as presented by increased VE?/VC?O2@AT and decreased PETCO2@AT,P=0.04 and P=0.04); plasma level of NT-proBNP was increased,P=0.05. Conclusion: CPET can effectively evaluate sildenaifl effect for treating PAH patients and therefore and guide the drugs therapy.

BACKGROUND: In recent years, the rapid development of medical and tissue engineering has provided more choices for making nerve conduit preparation. OBJECTIVE: To review the application of nerve conduits in the repair of peripheral nerve injury. METHODS: The first author retrieved the CNKI and PubMed databases to search relevant articles published from 2010 to 2016. The key words were "nerve conduit, peripheral nerve" in Chinese and English, respectively.RESULTS AND CONCLUSION: The nerve conduit materials are mainly classified into biotype and non-biotype. Biotype materials mainly include muscle, amniotic membrane, vein and small intestinal submucosal layer. The non-biotype materials include chitosan, collagen, silk fibroin, polylactic acid, polycaprolactone, polyaniline and silicone tubes. Some materials currently have been approved to enter the clinical stage. There are more or less problems in the clinical application of nerve conduits in the repair of peripheral nerve injury. For example, the length of a defect that can be repaired is limited; the mechanical properties and mechanical properties are not exactly matched with nerve regeneration; the degradation rate is inconsistent with the rate of nerve regeneration; and poor biocompatibility exists.