In the implementation of community health service,the working efficiency of the community nurses becomes increasingly important to the overall service standards of the service centers as the local residents have begun to take it into consideration when evaluating the service quality.By illustrating the roles of nurses in all the six major functions played by the community health service,this paper intends to arouse the attention from the concerning authorities to the training of the nurses so that the nurses can be developed in an all-round way and provide better services for the community.

Objective To determine the effect of resurfacing completely degloved thumbs by free perforator flaps in a spiral fashion.Methods A retrospective case series study was made on 22 patients with completely degloving injury of the thumb treated by different free perforator flaps in a spiral fashion from June 2009 to December 2014,including 19 male and 3 female patients at the age of 18-46 years (mean,27.8 years).A total of 13 patients were reconstructed using the medial arm perforator flaps ranging in size from 8.0 cm × 3.0 cm-14.5 cm × 3.5 cm,and 9 patients were reconstructed using the peroneal artery perforator flaps ranging in size from 6.0 cm × 3.5 cm-21.0 cm × 10.0 cm.Follow-up was made to evaluate the sensation,appearance and function of the thumbs and the recovery of flap donor sites.Results All flaps survived completely,with no occurrence of postoperative vascular crisis and infection.Only one medial arm flap and one soleus perforator flap distal flap showed blood flow disorder in the distal sections and were healed uneventfully after conservative therapy.Function and cosmetic recovery of the reconstructed thumbs were good.Follow-up ranged from 9 to 22 months (mean,14.5 months).Twopoint discrimination test of the flaps was recovered to 6-13 mm.No linear scar contracture was left.Flap donor site wound healed primarily.All patients were satisfied with the overall results.Conclusion The free perforator flap in a spiral fashion can avoid linear scar contracture,maximally decrease donor site morbidity and achieve satisfactory functional recovery and good aesthetic restoration,indicating a good candidate for reconstruction of thumb degloving injury.

OBJECTIVE:To establish a RP-HPLC method for simultaneous determination of caffine,acetaminophen and isopropylphenazone in human plasma after oral dose of saridon.METHODS:Hypersil Hypurity TM Advance was used as chromatographic column and the mobile phase was a mixture of0.01mol/L phosphoric acid-methanol-tetrahydrofuran(86∶12∶2).The detection wavelength was273nm.RESULTS:The calibration curves were linear in the ranges of0.39～100.0?g/ml for caffine,1.96～500.0?g/ml for acetaminophen,and1.17～300.0?g/ml for isopropylphenazone,respectively.The accuracy of all was higher than95.0%.The inter-day and intra-day RSD was less than10.0%.CONCLUSION:The present method is sensitive,accurate,convenient,and highly specific,which can meet the requirement in plasma determination of three components in Saridon tablet.

Objective To explore the pathogenesis of invasive pituitary adenomas,and to improve the effect of clinical treatment.Methods 15 pairs of invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were selected from 114 specimens collected and the Id1 gene expression and Id1 protein expression in invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were tested by quantitative RT-PCR,Western blot and immunohistochemical methods;Then small interfering RNA (siRNA) was used to interfer Id1 gene expression in NQ-04 cells.Results The Id1 gene expression in invasive pituitary adenoma tissues was significantly higher than that in noninvasive pituitary adenoma tissues(n =15,t =2.725,P =0.013) ;The migration of pituitary adenoma cells interfered was significantly reduced.Conclusion The invasive pituitary adenoma tissues has high level of Id1 gene expression,which may be correlated with its invasion.And Id1 is expected to become a biological marker of diagnosis and determination in the prognosis of pituitary adenoma.

Objective To provide evidence for clinical practice by analyzing the factors associated with bloodstream infection in ICU patients through retrospective case-control study. Methods Using self-made data collection form, 133 cases of blood sample record from HIS system during May 2013 to December 2015 at Peking Union Medical College Hospital ICU ward were collected. In this study, 54 patients with positive blood culture results were allocated to the case group while 79 patients with negative results were in the control group. Baseline characteristics, which included sex, age and chronic diseases, were almost the same between both groups. Binary Logistic regression analysis was used to identify factors related to blood infection. Results During May 2013 to December 2015, there were 54 blood infectious cases, among which 19 cases with positive gram bacteria accounted for 35.2%(19/54), 57.4%(31/54) of gram-negative bacilli and 7.4%(4/54) of fungal infection. Logistic regression analysis revealed that blood filtration treatment (OR=7.691), pulmonary infection (OR=7.682), ICU (OR=1.115), Acute Physiology and Chronic Health Evaluation (APACHEⅡ) scores(OR=1.096), procalcitonin (OR=1.065) were risk factors of bloodstream infection for ICU patients, while albumin (OR=0.763) was a protective factor. Conclusions Blood filtration treatment, pulmonary infection, hospital length of stay, APACHEⅡand procalcitonin are factors associated with bloodstream infection in ICU patients. Clinical procedures in ICU should mainly focus on improvement of prevention awareness, strict aseptic technology, professional quality of nursing staff. Besides, guarantee of patients′nutrition, effective treatment of primary diseases, and shortened hospital length of stay are also important to reduce the infection and improve quality of life of these patients.

Objective Medication for pituitary adenomas is mainly targeted on the prolactin-secreting and growth-hormone types and shows poor therapeutic effects on other adenomas .Therefore, new drugs urgently need to be developed for this purpose .This study was to investigate the effects of glivec and everolimus on mouse pituitary AtT-20 cells and their molecular mechanisms in vitro. Methods Mouse pituitary AtT-20 cells were incubated with glivec or everolimus or combination of both and their inhibitory effect on the proliferation of the cells was measured by CCK-8 assay.The mRNA levels of AKT and ERK were determined by q-PCR and the ex-pressions of the phosphorylated AKT (p-AKT) and ERK (p-ERK) were detected by Western blot. Results Used alone, both glivec and everolimus inhibited the proliferation of the AtT-20 cells in a time-and dose-dependent manner , but their combination produced a mutually antagonistic effect, with combination index values of 1.13 ±0.06, 1.12 ±0.03, and 1.07 ±0.03 respectively.The two a-gents , either used alone or in combination , induced no significantly inhibitory effects on the mRNA and protein expressions of AKT and ERK ( P >0.05 ).Both glivec and everolimus up-regulated the expressions of p-AKT and p-ERK, and their combination manifested an even stronger effect (P>0.05). Conclusion Both glivec and everolimus inhibit the proliferation of AtT-20 cells when administered alone, but their combination produces an antagonistic effect .Their action mechanism might be that when targeting some signaling path-ways to inhibit cell proliferation , glivec, as well as everolimus , in-duces a feedback activation of AKT and ERK .

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

OBJECTIVE:To establish the HPLC fingerprint chromatogram of Danzhen headache capsules. METHODS:HPLC method was adopted. The column was Dikma Diamonsil C18 with the mobile phase of methanol-acetonitrile-water(gradient elution) at the flow rate of 1.0 ml/min;the temperature was 40 ℃,the detection wavelength was 340 nm,the sample size was 20 μl and the detection time was 65 min. RESULTS:RSDs of precision,stability and reproducibility tests were no more than 0.23%;13 com-mon peaks were identified in 10 batches of Danzhen headache capsules and the similarity of all samples were higher than 0.90. CONCLUSIONS:The method is simple,accurate and reproducible,and can be used for the process stability evaluation and quali-ty control of Danzhen headache capsules.

Background and purpose:The pedicled pectoralis major myocutaneous lfap has been a common choice of tissue lfaps for head and neck reconstruction. Nowadays, with rapid advancement in microsurgery, free lfaps gradually replace the pedicled lfaps. However, not all patients are good candidates for reconstruction surgery using free tissue lfaps. Adjacent pedicled lfaps are safer and more reliable. This paper explores potential application of pedicled pectoralis major myocutaneous flap in reconstruction of complex surgical defects following resection of advanced head and neck malignancies through modification of their preparation and repair method.Methods:Flap design scheme and method of preparation were modiifed to improve the pectoralis major muscle lfap. Fifty-one patients with surgical defects from resection of head and neck malignancies received reconstruction surgery using modiifed pectoralis major muscle lfaps.Results:Modiifed pectoralis major muscle lfaps survived completely in 51 patients. The area of defect regained its shape and appearance after reconstruction surgery. The area of defect obtained excellent functional recovery. Postoperative functional injuries to the donor sites were minimized.Conclusion:Modiifcation in designing and preparing method of the pectoralis major muscle flap improved repair range and distance in reconstruction of complex surgical defect following resection of head and neck malignancies. It also reduced necrosis rate of skin lfaps. Postoperative donor and recipient sites regained their appearance and functions successfully. The pectoralis major muscle lfap is one of the important tissue lfaps used in reconstruction of surgical defect following resection of a head and neck malignancy.

Objective To explore the feasibility of the reconstruction of three dimensional dynamic finite element model of the knee joint based on two-dimensional CT and MRI image data. To analyze the impact of mobile-bearing versus fixed-bearing platform prostheses of the knee joint on patellofemoral stress by the finite element method. Methods A three-dimensional digital model of the knee joint including bone,cartilage,meniscus, ligaments and tendons was reconstructed through the Mimics software. The best clinical bone cutting angle and implant placement position measurement were simulated according to the standard of total knee replacement by computers in a three-dimensionalknee model. A three-dimensional dynamic finite element model of mobile-bearing and fixed-bearing total knee arthroplasties was reconstructed finally. The data was analyzed by the SPSS 19.0 software. The test standard level α was 0.05. Results There was no significant difference in the peak value of patellofemoral stresses between fixed-bearing and mobile-bearing platform posterior cruciate-substituting prostheses at 0° ,30° ,60° ,90° ,or 120° of knee flexion(P>0.05). Conclusion There is no significant difference in the peak value of patellofemoral stresses between fixed-bearing and mobile-bearing platform prostheses.