Objective To explore the postoperative nursing experience of respiratory tract in patients with heart disease and pulmonary hypertension.Method Thirty-two patients with adult heart disease combined with pulmonary hypertension were managed with perioperative pertinent care as well as postoperative rational use of ventilator and effective supply of oxygen,strengthened monitoring of pulmonary hypertension and respiratory care.Result The postoperative putrnonary infection pulmonary artery pressure were well controlled in all the patients even though two of them died of pulmonary hypertension crisis and pulmonary infection.Conclusion For patients with adult heart disease combined with pulmonary hypertension,nursing measures including strengthened care to the respiratory tract to ensure the effective supply of oxygen can reduce postoperative mortality and the incidence of complications.

Preeminent Doctors Education and Training Plan has put forward an urgent request to reform the five-year clinical undergraduate medical talent training mode and strengthen the professional spirit cultivation for medical students. As a pilot project, our college continuously explored the professional spirit cultivation mode for medical students in preeminent physician class and has almost established the three-dimensional mode of whole process, joint participation, multi approach and stressing practice.

Objective To formulate genuine case mix plans using medical record information available in China. Methods An account was given of the research background of case mix studies, the current status of the studies and applications at home and abroad, the case mix model for measuring medical "output", data sources and statistical methods of classification. Results Case mix plans for army inpatients, civilian inpatients and outpatients were respectively formulated, and software for calculating the case mix index of a hospital which can run on Windows 95/98 computer systems was developed. Conclusion The theoretical, methodological and data conditions necessary for the formulation of case mix plans based on the first pages of medical records in China are now ripe and the case mix plans formulated on the basis of data from large samples can now be used for the control of medical costs, the assessment of a hospital's medical "output" and the estimation of the financial compensations for hospitals.

OBJECTIVE:A pharmacoeconomical analysis was performed to evaluate three therapeutic schemes for preventing post-appendectomy infections in children METHODS:The study included 119 children undergoing appendectomy According to the pathological results of appendix,they were divided into group Ⅰ and group Ⅱ,and treated with three different schemes respectively The schemes consisted of A:cefazolin+benzylpenicillin+metronidazole,B:cefotaxime+benzylpenicillin+metronidazole and C:cefazolin+benzylpenicillin+metronidazole+claforan These three schemes were assessed with pharmacoeconomic evaluation RESULTS:As for group Ⅰ,scheme A and B were better than scheme C As for group Ⅱ,scheme A was the best CONCLUSION:Application of pharmacoeconomics will optimize therapeutic scheme and guide rational use of drugs

Objective To study the effects of costimulatory blockade with anti-inducible costim- ulator antibody(ICOS mAb)in combination with CTLA4Ig on prevention of islet allograft rejection. Methods Experimental animals were randomly divided into 4 groups(10 rats in each group).CT- LA4Ig + ICOS mAb group(group A):intraperitoneal injection of CTLA4Ig on day 0,2,4 and ICOS mAb on day 1,3,5 after islet transplantation;ICOSmAb group(group B):intraperitoneal injection of ICOS mAb on day 1,3,5 after islet transplantation;CTLA4Ig group(group C):intraperitoneal injection of CTLA4Ig on day 0,2,4 after islet transplantation;control group(group D):simple islet transplantation.The islet allograft survival and pathological changes in the transplanted islets after transplantation were observed.By using RT-PCR,the expression of IL-2 and IL-10 mRNA in the transplanted islets was detected.The expression of CD4~+ and CD8~+ T cell was detected by flow cy- tometry.Results In group A,the survival time was obviously prolonged as compared with other three groups and the transplanted islets were near normal under a light microscope.As compared with other three groups,the expression of IL-2 mRNA was significantly decreased in group A(P0.05).The expression of CD4~+ and CD8~+ T cell was not obviously up-regulated on the day 21 after transplantation.Conclusion The blockade of costimulatory signals with ICOS mAb in combination with CTLA4Ig has a favorable effects to restrain the rejection of islet transplantation.

Objective To analyze the clinical characteristics of systemic lupus erythematosus (SLE) patients with septic arthritis.Methods Twelve SLE patients with septic arthritis admitted to Peking Union Medical College Hospital from January 1990 to December 2012 were retrospectively analyzed.Results The median duration from onset of SLE to septic arthritis was 8.5 months (ranged from 1 to 120 months).All patients had received higher doses of steroid therapy (equal to prednisolone 1 mg ·kg-1 ·d-1) and immunosuppressant,and 5 of them had received methylprednisolone pulse therapy.The infectious manifestations included joint pain (all cases),swelling (5 cases),reduced joint function (8 cases) and fever (10 cases).All patients were oligo-arthritis.The hip and knee joints were most commonly involved.Three patients were infected by Salmonella,4 patients were infected by S.aureus,and 3 patients were infected by tuber culosis.Conclusion When SLE patients with long term steroid and immunosuppressant therapy developedacute joint pain and swelling,septic arthritis should be considered.Synovial fluid Gram stain,culture,blood culture and arthroscopy should be performed promptly.Appropriate antibiotics should be administered,and early treatment can improve the outcomes.

Objective To investigate the effect of cosmetic surgery on the facial soft tissue injuries.Methods The clinical data of 52 patients with facial soft tissue injuries from June 2013 to June 2014 were analyzed retrospectively.And plastic surgical techniques were applied to the early treatment of facial soft tissue injuries in patients,according to the size of defect and the degree of deformity of the patients,different plastic surgery treatment was chosen,such as skin flap or skin graft to repair wound surfaces.In this process,one must follow sterile noninvasive principle strictly with emphasis on the technique of plastic surgery such as entire debridement,wound healing application of skin flap and so on.Results Total 49 cases of facial soft tissue injuries were healed by first intention without significant complications,while 4 cases of them had mild scars.Absorbable suture exposition appeared in 3 patients after primary healing.Those sutures were romoved after disinfected and no sequelaes were happened.All patients were recovered with good appearances and functions to the most exent.Conclusions The treatment of facial soft tissue injuries,by applying plastic and aesthetic surgery,could reduce scar and postoperative deformity,and secondary corrective procedures can be avoided in most patients.

Objective Disorder of intestinal barrier function is associated with the non-alcohol fatty liver disease ( NAFLD) . The present paper aimed to explore the intestinal barrier function in the rat model of NAFLD . Methods Sixteen SD rats were ran-domly divided into an NAFLD and a normal control group of equal number .The NAFLD models were constructed by high-fat feeding . HE staining was used for pathologic examination of the liver , the levels of TNF-α, IL-1, and endotoxin (ET ) were measured by ELISA and the limulus reagent method , and the expressions of intestinal ZO-1 and Occluding were determined by real time PCR . Resu lts Compared with the normal controls , the NAFLD rats showed typical hepatic lipid deposition , with significantly increased levels of serum TNF-αand IL-1 and plasma ET and decreased expressions of intestinal ZO-1 and Occluding (P<0.05). Conclusion Intestinal barrier function is decreased in NAFLD rats .

?AIM: To study the changes of choroidal thickness and hemodynamic parameters in patients with diabetic retinopathy and their influencing factors.?METHODS: From January 2013 to January 2015, 100 patients (100 eyes) with type 2 diabetes were divided into 3 groups:34 patients without diabetic retinopathy ( NDR) , 36 patients with non proliferative diabetic retinopathy ( NPDR) group, and 30 patients with proliferative diabetic retinopathy (PDR). According to the results of OCT, the patients with diabetic retinopathy were divided into 2 groups: diabetic macular edema ( DME ) group ( 28 cases) , and 38 cases without diabetic macular edema. During the same period in our hospital 35 subjects for physical examination were selected as the control group. The hemodynamic parameters of the posterior ciliary artery in different groups of patients at different distance from the center of the macular were compared, analyzing influencing factors.?RESULTS:With the aggravation of diabetic retinopathy, the choroidal thickness in different distance from the center of the macular decreased. The choroidal thickness of NPDR and PDR group were thinner than that of the control group (P<0. 05). The choroidal thickness of NDR group was not different from the control group (P>0. 05). There was no significant difference in the choroidal thickness between the DME patients and non DME patients (P>0. 05). Pearson correlation analysis showed that there was no significant correlation between choroidal thickness of patients with diabetic retinopathy and diabetic duration, fasting blood glucose, HbA1c, eye axis length, systolic blood pressure and diastolic blood pressure (P>0. 05), but there was a correlation with BCVA (logMAR) (P<0. 01). EDV and PSV in NDR group and NPDR group were significantly lower than those in control group, RI was higher than that in control group. PSV and EDV in PDR group were significantly lower than those in other three groups, RI was higher than the other three groups, and the difference was statistically significant ( P<0. 05).?CONCLUSION:With the severity of retinopathy in type 2 diabetic patients, the choroidal thickness decreased, and the thickness of the choroid is beneficial in the comprehensive analysis of 2 diabetic retinopathy.

Objective: To investigate the characteristics of mortality of injury among residents in Gusu District, Suzhou City, Jiangsu Province from 2013 to 2023, so as to provide the evidence for developing targeted measures of injury prevention and control. Methods: Gender, age and underlying cause of deaths due to injury in Gusu District were collected through Death Reporting Information System of Chinese Disease Prevention and Control Information System and Jiangsu Death Reporting Information System from January 1, 2013 to December 31, 2023. The crude mortality, Chinese-standardized mortality and world-standardized mortality of injury were analyzed, and the trend in mortality was analyzed using annual percent change (APC). Results: Totally 4 217 deaths due to injury were reported in Gusu District from 2013 to 2023. The crude, Chinese-standardized and world-standardized mortality rates were 51.58/105, 23.24/105 and 21.98/105, respectively, all showing a tendency towards a rise (APC=6.802%, 2.688% and 2.823%, all P<0.05). The crude mortality rate of injury was higher in women than in men (54.61/105 vs. 48.41/105, P<0.05). The five most common causes of injury included fall (32.99/105), traffic accidents (6.03/105), suicide (4.23/105), drowning (3.00/105) and asphyxia (2.16/105), accounting for 93.86% of the total number of deaths. The crude mortality rates of fall, suicide and asphyxia appeared a tendency towards a rise (APC=9.724%, 6.333% and 5.638%, all P<0.05). The crude mortality rates of injury among men, women and overall residents appeared a tendency towards a rise with age (all P<0.05). Fall was the primary cause of injury death among residents aged 65 years and above, and suicide was the primary cause of injury death among residents aged 15 to 44 years. Conclusions The crude mortality of injury appeared a tendency towards a rise in Gusu District from 2013 to 2023. The main causes of death were fall, traffic accidents, suicide, drowning and asphyxia, with the crude mortality of fall, suicide and asphyxia showing an upward trend.