中华全科医学

Innovation of training mechanism of rural order tuition-free medical students under the background of new reform in China's healthcare system

SHEN Zheng-fu, QI Yu-long, MENG Bei, YANG Xiu-mu

2016, 14(1): 1-3,15. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.001

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This paper will summarize the main problems of rural medical talents in China,including serious shortage of the total number,low comprehensive quality and poor service quality. The main reason for the reluctance to grass-roots employment of medical students include: 1There are differences between urban and rural areas,the basic-level of economic level and income is relatively backward and low; 2most of the basic level hospitals are relatively remote,amateur cultural life is relatively monotonous; primary care units cannot meet the needs of incumbency training and learning,the level of knowledge cannot be updated and improved; 3 basic medical facilities are simple,outpatient medical cases is relatively less and single,their talents may not be able to fully achieve and development space is narrow. These are the main reasons of medical students are not willing to work at the basic-level. Due to the perspective of higher medical colleges and universities long service to the large hospital of the big city,medical education pattern is difficult to meet the needs of rural medical and health talents and inharmoniousness between the real needs of rural residents and the existing economic and social conditions in rural areas,it also neglects the idea of services of the basic-level medical and health so that it cannot meet the needs of rural basic-level medical and health work and the students cannot do their best to service the medical work,even the distribution of urban and rural health human resources is more and more unreasonable. These are the main problems in the cultivation of medical talents in China. Based on in-depth analysis the status of talents for the basic medical and health、the main reasons of medical students are not willing to go to work in rural areas and the existing problems in medical talents training mode in China,this paper starts from the construction of organization,improve the medical students training program,take scientific measures to promote the cultivation mechanism innovation in order to develop targeted and practical oriented students,construct practice bases and strengthen teacher training to meet the needs of students. All these intent to carry out the mechanism innovation for training rural oriented tuition-free medical students.

CHEN Lan-ju

2016, 14(1): 4-5.

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Correlation between osteoporosis and bone erosionin in patients with early rheumatoid arthritis

QI Shan, XU Sheng-qian, XIAO Hui, WU Ying, LIU Wen, XU Jian-hua

2016, 14(1): 6-8. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.002

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Objective To investigate the characteristics of osteoporosis(OP) and bone erosion in patients with early rheumatoidarthritis(RA). Methods A total of 427 patients with RA(including 139 early RA with disease duration less than 1 year and 288 non-early RA ).BMD of proximal femur and lumbar vertebrae were measured by dual energy X-ray absorptiometry(DEXA).The assessment of bone erosion by examination of hands X-ray in all early RA patients,meanwhile,clinical index and the treatment with glucocorticoid(GC) were recorded.Data of 158 normal people were collected as control group. Results The prevalence of OP in early RA and non-early RA were 23.5%,35.4%,while in control group was 13.9%(χ²=24.84,P＜0.001).BMD sat different positions were decreased in all three groups(P＜0.05).In the early RA,patients with OP had elder age as compared with the group without OP(P＜0.05).There were no significant difference regarding the use of GC,RF,ESR,CRP and DAS28 scores between OP group and non-OP gorup(P＞0.05).The BMD of total femoral area and lumbar spine were negatively correlated with the X-ray stage(P＜0.05).The BMD of L₂ and L_2~4 were also negatively correlated with anti-CCP(P＜0.05).The percentage of bone erosion was 13.7%,which was lower than that of OP(χ²=4.18，P=0.041) in the early RA.The average disease duration of early RA patients with OP was shorter than that in early RA patients with bone erosion(0.59±0.35 yr vs. 0.82±0.29 yr,t=2.46,P=0.018). Conclusion The patients with early RA show obvious OP which occurs earlier than bone erosion,and the incidence of OP is higher than bone erosion.We should pay more attentions to the occurrence of OP in early RA.

Antihypertensive effects of short-term continuous positive airway pressure therapy on obstructive sleep apnea hypopnea syndrome patients of different genders combined with hypertension

SHENG Hong-yu, YAO Xiao-guang, MULALI Bieke, SHAO Liang, WANG Ying-chun, HONG Jing, OUYANG Wei-jin, CHENG Qiu-yan, SUN Le, TONG Ling, ABULIKEMU Suo-fei-ya, LI Nan-fang

2016, 14(1): 9-11. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.003

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Objective To compare the difference in antihypertensive effects of short-term continuous positive airway pressure (CPAP) between man and women obstructive sleep apnea hypopnea syndrome(OSAHS) with hypertension. Methods Total 100 OSAHS inpatients confirmed by polysomnography combined with hypertension in our department were enrolled between November 2012 and May 2013,and were divided into two groups based on gender.All patients received nocturnal CPAP therapy for 7 days(＞6 h/night) on the basis of prior antihypertensive medications treatment,daily blood pressure was measured.The blood pressure value and proportion of patients reaching their blood pressure targets were compared within each group,and the blood pressure lowered by the treatment was compared between the two groups. Results ①post-treatment morning mean blood pressure was significantly lowered at day 7 than pre-treatment value in male patients[(103.4±10.4) mm Hg vs. (113.4±11.7) mm Hg,P＜0.05,1 mm Hg=0.133 kPa],whereas similar results were not observed in female patients;lowering scope of mean atrial blood pressure was significantly higher at day 7 in males patients than that in female patients[(10.1±12.5) mm Hg vs. (1.7±6.7) mm Hg,P＜0.05)].②The proportion of patients reaching their post-therapy morning systolic blood pressure and of diastolic blood pressure targets of at day 7 were higher than the pre-treatment in male patients(79.0% vs. 43.2%,P＜0.05 and 79.0% vs. 28.4%,P＜0.05);only the proportion of reaching morning diastolic blood pressure targets of post-treatment is significantly higher than the pre-treatment in female patients(89.5% vs. 57.8%,P＜0.05). Conclusion The effects of short-term CPAP therapy in male CPAP patients with hypertension are superior to those in female patients,and thus gender-specific treatment should be considered in clinical settings.

Investigation of bacteria toxins and bacteria invasion proteases and capsular antigen associated genes distribution of Staphylococcus aureus isolated from burn ward

XU Xiao-min, FAN You-fen, HU Su-pei, LIANG Shan-yan, CUI Sheng-yong, WANG Chun-ping

2016, 14(1): 12-15. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.004

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Objective To investigate bacteria toxins and bacteria invasion proteases and capsular antigen associated genes distribution of Staphylococcus aureus isolated from burn ward. Methods Staphylococcus aureus were isolated from our unit from July to December 2013,and ten bacteria toxins associated gens(hla,hlb,hld,hlg,hlg-2,pvl,lukE,lukM,psm-mec,psm-α),nine bacteria invasion associated proteases (ssp,splB,edinA,edinB,edinC,sak,hysA,lip,nuc) and two capsular antigen associated gens(cap5,cap8) were amplified through PCR technique. Results Among 20 strains of Staphylococcus aureus,the positive rate of hla was 85.0%,hlg-2 was 80.0%,psm-α was 70.0%,lukE was 55.0%,pvl was 15.0%,hlb was 10.0%,hld,hlg,lukM and psm-mec were all 0%;of lip and nuc was 90.0%,splB was 60.0%,hysA was 20.0%,ssp,edinA,edinB,edinC and sak was 0%;of cap5 and cap8 was 30.0% and 70.0%,respectively. Conclusion In this research,the high positive rate of bacteria toxins associated gens and bacteria invasion associated proteases expression rate in 20 strains of Staphylococcus aureus may associate with delay wound healing.

Synthesis and studies on antidepressant activity of 2',4',6'-trihydroxychalcone derivatives

JIN Hong-guo, ZHOU Min, HE Song-bin, TANG Wei-guo

2016, 14(1): 16-19. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.005

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Objective To synthesize 2’,4’,6’-trihydroxychalcone derivatives and study their antidepressant activity and mechanism. Methods The 2’,4’,6’-trihydroxyacetophenone was used as the starting material;by hydroxyl protection,alodl condensation reaction and hydrolysis reactions,we get the target compounds 3a-3k,its structure was confirmed by IR,1HNMR and MS.The antidepressant activities of the target compounds were evaluated by using the forced swim test(FST) and tail suspension test(TST) in rats.The 5-HTP induced head-twitch and yohimbine-induced lethality tests were used to observe the impact of the synthesized compound 3h on the head-twitch and yohimbine-induced lethality in mice. Results The results showed that all six compounds significantly reduced the immobility times during the FST at a dose of 10 mg/kg,indicative of antidepressant activity.The compound 3h showed the most antidepressant activity.In addition,compound 3h showed antidepressant activity at three doses of 10 mg/kg,20 mg/kg and 40 mg/kg,significantly reduced immobility times in FST and TST in mice.It was found to be the most antidepressant activity at 20 mg/kg.The compound 3h increased the head-twitch and had not raised the mortality of mice. Conclusion Six compounds showed significantly the antidepressant activity.The mechanism may be related to the system of 5-HT in central nervous system.

Influence of duration of untreated psychosis on cognitive functions and prognosis of drug-naive patients with first-episode schizophrenia

SUN Ji-jun, SUN Yu-yong, ZHU Chun-yan, MA Wan, PAN Sheng-ming, SHI Jian-fei

2016, 14(1): 20-22,67. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.006

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Objective To explore the influence of duration of untreated psychosis(DUP) on the cognitive functions and prognosis of drug-naive patients with first episode schizophrenia. Methods A total of sixty-eight drug-naive patients with first episode schizophrenia were randomly(by DUP) divided into short DUP group(n=33) and long DUP group(n=35).The WCST and P300 were used to evaluate the cognitive function at baseline,3rd month and 12th month after the treatment,and the results were contrasted with 35 health controls.ANOVA was used to analyze the data. Results ①Before the treatment,there were significantly differences in the cognitive function(P=0.000-0.006) between the DUP group and the control group;there was significantly difference in cognitive function(P=0.000-0.046) between short DUP group and long DUP group,except completing the number of classification and latency of P300(P=0.393,0.484).②After the treatment,there were still significantly differences in cognitive function between the long DUP group and control group(P=0.000-0.026),though the cognitive function of patients in the long DUP group was improved at some extent;However,there were significantly differences only in completing the number of classification and amplitude of P300 in short DUP group(P=0.042,0.000);③After the treatment,the cognitive function of the patients in short DUP was recovered obviously as compared with the patient in the long DUP,the differences by ANOVA was significant(F=4.258-6.764,P=0.017-0.045) except in completing the number of classification. Conclusion DUP had adverse effect on the cognitive functions of schizophrenia patients.To reduce the prevalence of long DUP should improve the recovery of the cognitive function of patients.

Expression and its significance of SphK-1 in liver tissue of mice with liver injury

FENG Ying-qiao, YANG Yuan-sheng, CUI Shu-lan, CHEN Ken, WANG Hui, ZHOU Wen, LÜ Xiao-long

2016, 14(1): 23-25,54. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.007

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Objective To establish the liver injury model in mice induced by 5% dextran sodium sulfate(DSS),detect the expression of sphingosine kinase-1(SphK-1) in liver of mice,and evaluate the relationship between the level of SphK-1 and hepatic injury. Methods Forty SPF Balb/C male mice were randomly divided into 4 groups:blank control group,DSS model group(subdivided into 6,8,12 weeks three sub-group),10 mice in each group.The hepatic injury mice model was induced by intragastric administration of 5% DSS[0.6ml/(d·mouse)].The improved Reitman method was used to detect the serum level of ALT.The hepatic pathological changes were tested by hematoxylin eosin(HE) stain.The expression of SphK-1 in the liver of mouse was detected by quantitative PCR. Results In comparing with control group,the serum levels of ALT was raised in each sub-group(P＜0.05).The hepatic pathological injury was obviously in each sub-group,the most visible change by naked eye was observed in 6 weeks sub-group,the necrosis and lymphocytes infiltration were observed under light microscope.The expression of SphK-1 in liver was reduced in all three sub-groups,the most predominance reduction was observed in 12 weeks,the differences had statistical significance when compared with the control group(P＜0.05).There was a substantially inversely proportional between the expression of SphK-1 and the content ALT in serum. Conclusion Hepatic injury mice model can be induced by 5% DSS.The SphK-1 expression level of liver was decreased along with the level of liver damage in sub-group.We presume that SphK-1 may be closely related with liver damage.

Effects of early high-dose ulinastatin combined mucosolvan on respiratory function and levels of inflammatory cytokines in patients with severe burns

YE Sheng-jie, CHEN Ru-jun, PANG Shu-guang, ZHANG Wen-zhen, FANG Sheng-jiao, ZHANG Jin-cheng, LIN Cai

2016, 14(1): 26-28. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.008

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Objective To explore the effects of early high-dose ulinastatin combined Mucosolvan on respiratory function and levels of inflammatory cytokines in patients with severe burns. Methods One hundred severe burn patients were randomly divided into observation group and control group.All the patients were given conventional regimen burns,at the same period,the observation group was treated with early high-dose ulinastatin 400 000 U combined Mucosolvan 450 mg,the control group was given regular doses of early Ulinastatin 100 000 U combined Mucosolvan 30 mg.The respiratory function parameters and inflammatory cytokines were observed. Results ①After the treatment,one-way repeated-measures ANOVA showed that the respiratory rate,PaO₂,PaO₂/FiO₂ at each time point was statistically significant(P＜0.05);the respiratory rate of the observation group decreased significantly when compared with the control group 7 d and 12 d after the treatment,while PaO₂ and PaO₂/FiO₂ increased significantly as compared with the control group 3 d,7 d and 12 d after the treatment,the difference was statistically significant(P＜0.05);②After the treatment,one-way repeated-measures ANOVA showed that serum TNF-α,IL-1,IL-6 and IL-8 levels at each time point statistically significant(P＜0.05),serum TNF-α,IL-1,IL-6 and IL-8 levels increased at d2 and d7,but decreased at d12 after the treatment;the increased serum TNF-α,IL-1,IL-6,IL-8 levels were not obviously as compared with the control group,while the levels at d12 declined significantly when compared with the control group,the difference was statistically significant(P＜0.05). Conclusion Early high-dose ulinastatin combined Mucosolvan for the patients with severe burns can protect their respiratory function,reduce the levels of inflammatory cytokines with a significant clinical effect.

Utility of DCP and AFP in diagnosis of primary liver cancer

ZHENG Hai-lun, ZHAO Rui, LI Da-peng, WANG Qiang-wu, WANG Jian-chao, WANG Qi-zhi

2016, 14(1): 29-31. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.009

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Objective To explore the clinical diagnosis significance of single or combined testing the levels of serum des-gamma-carboxy prothrombin(DCP) and alpha-fetoprotein(AFP) in primary liver cancer(PLC). Methods The serum levels of DCP and AFP in 70 patients with PLC,in 50 patients with cirrhosis of liver,and in 50 patients with viral hepatitis type B and in 50 healthy cases were detected by the enzyme-link immunosorbent assay(ELISA).The difference was compared with each other.The Spearman correlation analysis was performed to explore the relation between DCP and AFP.The sensitivity and specificity of the DCP and AFP for the diagnosis of PLC were analyzed by ROC Curve.The clinical diagnosis value of DCP and AFP in PLC was evaluated. Results The serum DCP and AFP level in the PLC group was significantly higher than that in the cirrhosis of liver group,in the viral hepatitis type B group and in the healthy cases group,the differences was statically significant(P＜0.01).The Area Under Curve of the ROC Curve of the DCP single detection for PLC was greater than that AFP(P＜0.01).The area under Curve of the ROC Curve of the DCP and AFP were 0.977(95%CI:0.954-1.000) and 0.853(95%CI:0.785-0.921),respectively.There were not significantly correlation between AFP and DCP level by Spearman correlation analysis.The sensitivity(90.0%) and specificity(97.3%) of DCP single detection were significantly higher than AFP for the diagnosis of PLC.The sensitivity(95.7%) increased in the clinical diagnosis of the PLC by using AFP and DCP combined detection. Conclusion DCP is a very effective serum tumor maker in the clinical diagnosis of the PLC.DCP and AFP combined detection can increase the sensitivity in the PLC clinical diagnosis and refrain from the missed diagnosis of the PLC.

The effect of Xiaoaiping combined Thermochemistry on the gefitinib-resistant lung adenocarcinoma cell line A549:a experimental study

DING Ji-yuan, HUANG Jing, KOU Jun-yan, ZHANG Zhen, ZHENG Wan-zhen, LI Jun

2016, 14(1): 32-34. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.010

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Objective To observe the effects and mechanisms of Xiaoaiping combined with thermotherapy on gefitinib-resistance lung adenocarcinoma cell line A549,to provide theory evidence in thermochemotherapy for clinic. Methods The cultivated gefitinib-resistance lung adenocarcinoma cell line A549 was treated with ①5% CO₂,37 ℃ training;②to join xiaoaiping;③5% CO₂,42 ℃ culture;④5% CO₂,42 ℃ joint xiaoaiping.MTT assay was applied to analyze the inhibiting effects on the proliferation of A549 cells;RT-PCR,ELISA was performed to detected the content of VEGF,bFGF. Results The inhibition rate is 12% for Xiaoaiping,the inhibition rate is 12% for temperature 42 ℃,the inhibition rate is 45% for Xiaoaiping combined thermochemistry group,significant differences were observed(P＜0.05),so Xiaoaiping combined thermochemistry group have higher inhibiting effects on the proliferation compared Xiaoaiping,Thermochemistry group;the expression of VEGF is 78.95% for Xiaoaiping,the inhibition rate is 37.02% for temperature 42 ℃,the inhibition rate is 24.82% for Xiaoaiping combined thermochemistry group,significant differences were observed(P＜0.05);The protein expression of VEGF was 60.87%,4.78%,and 0.35%,respectively,significant differences were observed(P＜0.05),while the bFGF has no significant difference.There was an decreased expression of VEGF,bFGF and stronger inhibition of VEGF protein expression in Xiaoaiping combined thermochemistry group compared with Xiaoaiping,Thermochemistry group. Conclusion Xiaoaiping combined thermochemistry could reverse NSCLC resistance by reducing VEGF protein expression mediated tumor angiogenesis,thus inhibit tumor cell proliferation.

Expression and association of 12-LO with apoptosis in mice with experimental autoimmune myocarditis

HE Yue-e, WU Rong-zhou, CHOU Hui-xian, XIANG Ru-lian

2016, 14(1): 35-37,97. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.011

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Objective To examine the myocardial expressions of 12-lipoxygenase(12-LO),NO levels in the peripheral blood in mice with experimental autoimmune myocarditis,and analyze the relationship between their expressions and apoptosis. Methods A total of five-week-old male BALB/C mice were randomly divided into two groups: control group(C group 24) and autoimmune myocarditis group(AM group 24).AM group were immunized with porcine heart myosin(100 μg) in an equal content of CFA in a total volume of 0.2 ml and C group were injected with PBS in an equal content of CFA in a total volume of 0.2 ml at the 1th day and 7th day.Eight mice of each group were sacrificed in 14th,21th and 30th day.Expression of 12-LO and iNOS mRNA was determined by RT-PCR.Serum NO levels was measured by Nitrate reductase. The histological and ultrastructure changes were observed under light microscope and electron microscope. Results The expression of 12-LO mRNA,iNOS mRNA,NO and apoptotic index(AI) were up-regulated at the 14th day(0.68±0.28;82.99±2.64；57.51±2.17;13.20±2.54) and reached peak at the 21th day (1.53±0.27;92.74±3.99;76.44±3.01;24.97±1.54),then decreased at the 30th day(1.05±0.10;87.40±3.32;64.77±3.92;14.95±2.15).Compared with C group,These indicators were significantly higher in AM group(P＜0.05).And 12-LO mRNA expression in the AM group was significantly correlated with NO and apoptotic index(r=0.882;0.877;P＜0.05). Conclusion The expression of NO and 12-LO are found in mice with autoimmune myocarditis,and they are positively associated.12-LO involved in the pathogenesis of AM,may be affected by oxidative stress via NO.

Application of harmonic scalpel in surgery for parotid gland tumor in the elderly patients

ZHOU Yuan, JIANG Hong-gang, CHEN Zhi-heng, LU Bo-hao

2016, 14(1): 38-40. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.012

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Objective To investigate the clinical value of harmonic scalpel in surgery for parotid gland tumor in the elderly patientsand its safety. Methods A retrospective analysis was made on clinical date of 62 cases of parotid neoplasms aged 60 or over in our hospital from Jan. 2010 to Jan. 2014,among them 32 cases undergoing surgery with harmonic scalpel(harmonic scalpel group) and 30 patients undergoing with traditional electrosurgicalscalpel(traditional electrosurgicalscalpel group).The total operation time,time for cutting off superficial lobe,intraoperative blood loss,24 hours volumeof postoperative drainage,total volume of postoperative drainage,length of hospital stay,drainage time,the cost of hospitalization,postoperative VAS and incidence of complication of both groups were observed and compared. Results The total operation time(min),time for cutting off superficial lobe(min),intraoperative blood loss(ml),24 hours volume ofpostoperative drainage(ml),total volume of postoperative drainage(ml),length of hospitalstay(d),drainage time(d),and postoperative VAS within 2 days of the 2 groups were 58.8±10.1 vs. 79.3±13.1(t=-6.897,P＜0.001),42.7±9.9 vs. 61.3±15.7(t=-5.559,P＜0.001),14.1±5.0 vs. 23.7±5.6(t=-7.166,P＜0.001),19.5±4.8 vs. 36.7±9.2(t=-9.083,P＜0.001),43.1±6.9 vs. 90.7±10.8(t=-20.756,P＜0.001),5.4±0.5 vs. 7.4±0.7(t=-13.431,P＜0.001),3.5±0.5 vs. 5.6±0.7(t=-13.776,P＜0.001) and 2.4±0.8 vs.3.1±0.9(t=-3.251,P=0.002),respectively,and the difference was statistical significant(P＜0.01).The cost of hospitalization(yuan),localcomplicationand other system complication of the 2 groups were 7 615.6±278.4 vs. 7 700.0±271.6(t=-1.207,P=0.232),1 vs. 3(χ²=0.341,P=0.559) and 10 vs. 14(χ²=1.551,P=0.213),respectively,and the difference was not statistical significant(P＞0.05). Conclusion The harmonic scalpel in surgery for parotid gland tumor in the elderly patients is safe and effective.The advantagesincludeshorter time of surgery,less intraoperative blood loss,less postoperative drain output and quicker recover.It is worth to be further promoted in clinical.

Clinical study of allogeneic peripheral blood hematopoietic stem cell transplantation in treatment of 45 cases of acute leukemia

WANG Xiao-gang

2016, 14(1): 41-43. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.013

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Objective To study the clinical curative effect and complications of allogeneic peripheral blood hematopoietic stem cell transplantation(HSCT) in the treatment of acute leukemia. Methods From February 2008 to February 2014,allogeneic peripheral blood hematopoietic stem cell transplantation was used in our department to treat 45 cases of patients with acute leukemia,including 24 cases of acute myeloid leukemia,19 cases of acute lymphoblastic leukemia,1 case of accelerated phase chronic myelogenous leukemia and 1 case of blastic phase chronic myelogenous leukemia.Bu and Cy were used as conditioning regimen for HSCT,Ara-c+Bu/Cy was used for HLA-haploidentical/mismatch donors,and additional Me-CCNU for patients with suspected central nerve involved.The graft versus host disease(GVHD) was prevented by using Ciclosporin A+short-course methotrexate(MTX)+mycophenolate mofetil(MMF),and additional antithymocyte globulin(ATG) for HLA-haploidentical patients.After the treatment,patients were followed up to February 2014 and the outcome was evaluated. Results All the 45 patients were implanted completely,with hematopoietic reconstruction,and the median survival time was 19 months(2-63 months).There were 10 cases of death,4 cases died for recurrence,4 cases died for GVHD,secondary tumor(non-hodgkin’s lymphoma) in 1 case,2 intracranial hemorrhage in 1 case death,and the rest were followed up to now,and 3 year disease-free survival in 6 cases. Conclusion As the development of HLA match technology,transplantation related complications prevention and supporting treatment,allogeneic hematopoietic stem cell transplantation will become a safe and effective treatment method for hematologic malignancies.

The value research of attached gingiva reconstruction for oral implant rehabilitation

LI Hai-xia

2016, 14(1): 44-46. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.014

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Objective To demonstrate the value of attached gingiva reconstruction in oral implants by clinical trials research,and provide reference for clinical use. Methods From March 2010 to May 2014,attached gingival reconstruction was admitted in the treatment of 120 patients in our hospital dentistry,according to the principle of randomized 120 patients were divided into observation group and control group 60 patients.Patients in the observation group attached gingiva reconstruction treatment,that in the middle of one side of the tongue dental alveolar region of a patient to be cut;the control group were treated with traditional treatment,in the middle parts of the incision surgery,attached gingiva reconstruction 4 weeks of treatment and three months,six months later,to the width of the patient keratosis mucosa,gingival margin appearance,rebuild and improve the situation of other indicators of attachment points.The SPSS 22.0 statistical software was used for statistical analysis. Results ①The two groups of patients were compared,we found that the repair status in observation group were significantly better than the control group,the difference was significant,P＜0.05;②Reconstruction Coordination rate was observed in patients with gingival margin appearance was significantly higher attachment point,rebuild defective rate was significantly lower than the control group,the difference was significant,P＜0.05. Conclusion Attached gingiva reconstruction applied to the oral implant rehabilitation can significantly improve the efficacy of restoration,improve the situation,increase the rate of reconstruction coordination,reduce the incidence of defects.Stability conducive to the patient’s mouth after the repair the affected area of the gums;from an aesthetic viewpoint,attached gingiva reconstruction also has great significance,and the surgical method has the advantage of simple and has very important clinical value.

Autologous blood transfusion in the perioperative period of artificial total hip replacement

JIANG Qi-fang, QIU Sai-wen, WANG Li-qin

2016, 14(1): 47-49,62. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.015

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Objective To Analyze the effect of autologous blood transfusion replacement on the blood clotting,immune function of patients with total hip arthroplasty. Methods From August 2013 to March 2015 90 cases of total hip arthroplasty patients in our hospital were chosen,according to the number table all the patients were randomly divided into two groups(autologous blood transfusion therapy) and control group(row allogeneic blood transfusion NOTE treatment).Both groups were recorded amount of autologous blood transfusion,allogeneic blood transfusion,postoperative drainage,venous blood monitoring all patients,blood and coagulation Checker 2 h,24 h after transfusion,preoperative and postoperative 1 d,3 d of T lymphocyte subsets CD3⁺,CD4⁺,CD8⁺,natural killer cells(NK cells),calculated CD4⁺/CD8⁺ value,and LgM,LgG,TNF-α values. Results Hb,Hct,PTL,APTT,ACT indicators in the two groups of patients before transfusion were lower than 24 h operation,two indicators have 2 h after blood transfusion after transfusion 24 h relatively improved,but were lower than the preoperative,and the difference statistically significant(P＜0.05);the two groups after transfusion 2 h PT higher than before surgery,24 h were decreased after transfusion;transfusion after two FIB level lower than the preoperative value,less than 24 h after transfusion after transfusion 2 h,but lower than that before surgery,the difference was statistically significant(P＜0.05).After the transfusion 24 h of CD3⁺,CD4⁺,CD4⁺/CD8⁺,NK cell index compared with surgery significantly reduced allogeneic blood transfusion group,but CD8⁺ slightly increased after transfusion 72 h allogeneic transfusion group CD3⁺,CD4⁺,CD4⁺/CD8⁺,the number of NK cells continue to reduce,CD8⁺ value slightly increased,the difference was statistically significant(P＜0.05).Preoperative LgM,LgG,TNF-α levels were not significant differences(P＞0.05);two groups after 24 h,72 h of LgM,LgG were lower than the preoperative,and the difference statistically significant(P＜0.05);observation group after 24 h,72 h of LgM,LgG,TNF-α levels were higher values(P＜0.05). Conclusion Autologous blood transfusion has little effect on immune function,and the blood shortage problem solve and prevent undesirable complication of allogeneic blood transfusion caused the occurrence.

Association study of SNP in DDC and DRD1 gene with childhood autism in Chinese Han population

YU Hong, LIU Jun, YANG Ai-ping, YANG Guo-hui, YANG Wen-juan, ZHANG Zeng-yu

2016, 14(1): 50-51,139. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.016

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Objective To explore the association between single nucleotide polymorphisms(SNPs in Dopa decarboxylase(DDC) and dopamine receptor-1(DRD1) genes and childhood autism in Chinese Han population. Methods TaqMan Probes Real-Time PCR was used to determine genotype and allele frequency of SNPs of DDC gene (rs6592961)and DRD1 (rs251937)gene in 97 Chinese autism children and 100 healthy children.The Children Autism Rating Scale(CARS) was used to evaluate clinical phenotype feature.The allele and genotype between case group and control group were analyzed by Chi-square test. Results ①There was no statistically significant correlation to allele or genotype between control group and case group(P＞0.05).②There was no statistically significant correlation between allele or genotype of SNPs of DDC gene(rs6592961)and DRD1 gene(rs251937)and the degree of autism(P＞0.05). Conclusion The SNP of DDC gene(rs6592961)and DRD1 gene (rs251937)may not be related to childhood autism in Chinese Han population.

Effects of intermittent strong stimulation and chronic persistent mild stimulation on the behavior of rats and levels of NO and ET-1

TANG Li-qun, YU Xiao-qin, PAN Zhi-min

2016, 14(1): 52-54. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.017

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Abstract:
Objective To observe the influence of intermittent strong stimulation and chronic persistent mild stimulation on the levels of nitric oxide(NO) and endothelin 1(ET-1) in senile rats. Methods A total of 24 senile Wistar rats were randomly divided into the control group,continuous strong stimulation intervention group,chronic persistent mild stimulation intervention group.After the feeding on adaptability,the continuous strong stimulation intervention group received strong stimulation while the chronic persistent mild stimulation intervention group received the mild stimulation,the stimulation in both groups including water swimming,thermal stimulation,fasting,ban water,tail clip,day and night upside down,high-speed horizontal shaking,and flashing light illuminate were performed for 56 days.The change of body weight and preference for sugar were observed;while the levels of vascular active substances such as NO and ET1 were tested. Results After the stimulation,the weight increase and preference for sugar in both stimulation intervention groups decreased not obviously as compared with the control group(P＞0.05).The levels of NO and ET-1 increased obviously in the chronic persistent mild stimulation intervention group when compared with the control group(P＜0.05). Conclusion Every kinds of stimulations will cause the depression in the senile rats,and affect the levels of NO and ET-1,which plays an important role in the pathogenesis and prognosis of cardiovascular disease.

Clinic analysis of 134 cases of acute stroke with multiple organ dysfunction syndrome

ZHOU Xiao-jie, CHEN Jie, TAN Li-fei, WANG Xiao-rong, WANG Dan

2016, 14(1): 55-56，59. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.018

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Abstract:
Objective To compare the APACHEⅢ,MODS,SOFA,LODS scores of patients with acute stroke and multiple organ dysfunction syndrome of different prognosis,and analyze the clinical characteristics and mortality risk factors,provide reference for reducing the mortality rate. Methods A total of 134 patients with acute stroke patients and multiple organ dysfunction syndrome from December 2011 to September 2013 in our department were retrospectively analyzed.Based on the prognosis,the patients were divided into death group and survive group.All patients were evaluated by acute physiology and chronic health evaluation Ⅲ(APACHE Ⅲ),multiple organ dysfunction score(MODS),sequential organ failure assessment (SOFA) score,Logistic Organ Dysfunction Rating(LODS score).And logistic regression analysis was used to analyzed the factors of APACHE Ⅲ score,MODS score,SOFA score,LODS scores,blood glucose levels,C-reactive protein levels,underlying diseases integral multivariate,so to analyzed the prognostic risk factors. Results The age,APACHE Ⅲ,MODS,SOFA,LODS in the survive group were significantly lower than that of death group(P＜0.05).The logistic regression analysis results showed that blood glucose ＞7.8 mmol/L,C-reactive protein,underlying diseases score,APACHE Ⅲ,MODS,LODS,SOFA were the independent risk factor for prognosis. Conclusion APACHE Ⅲ,MODS,SOFA,LODS score are helpful for the prognosis of acute stroke patients with multiple organ dysfunction syndrome,and high blood glucose,C-reactive protein,underlying diseases score were the independent risk factor for prognosis.

The influence of different concentrations of dexmedetomidine on stress reaction in elderly patients undergoing pulmonary lobectomy

PANG Xi-you

2016, 14(1): 57-59. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.019

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Abstract:
Objective To observe the effect of different concentrations of dexmedetomidine on of stress reaction in elderly patients undergoing pulmonary lobectomy. Methods Sixty cases of elderly patients needed pulmonary lobectomy were selected as the research objects,according to the matching grouping method they were divided into three groups with each group of 20 cases.Before inducting give different concentrations of dexmedetomidine infusion.The group A,B,and C were adopted 0.4 μg/kg,0.6 μg/kg,and 0.8 μg/kg,respectively,while pump injection for 10 min.All patients were given penehyclidine,propofol,fentanyl,cisatracurium for induction.Adopted double cavity intubation give propofol,remifentanil,cisatracurium for maintain depth of anesthesia,and maintain the BIS around 40-60,to compare hemodynamic indexes among three groups of patients at different time,and determine cortisol concentrations to assess stress reaction. Results After intubation,after placing lateral decubitus position,intraoperative 1 h and pull tube immediately,the heart rate and mean arterial pressure in group A were higher than those in group B,group C and group B was higher than those in group C,group B’ blood pressure and heart rate were more stable,all P＜0.05.The concentrations of cortisol in A group were higher than those in B and group,C group,and P＜0.05.After intubation,lateral position,skin incision,intraoperative 1 h,operation at the end and pull tube immediate cortisol concentrations were higher than that in group C,P＜0.05. Conclusion Hemodynamics after infusion of 0.6 μg/kg dexmedetomidine in patients undergoing lobectomy is more stable,and it can effective intraoperative stress response,so it has important clinical value.

Clinical analysis of surround-mammary areola incision in the surgery of mammary fibroadenoma

CHEN Jie

2016, 14(1): 60-62. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.020

264 4

Abstract:
Objective To compared the operation method of surround-mammary areola incision with traditional radial incision operation and analyze the clinical effects of mammary fibroadenoma to provide the clinical value of surround-mammary areola incision. Methods From January 2013 to January 2015,100 patients who were diagnosed with mammary fibroadenoma by breast ultrasound,breast molybdenum target,and breast fine needle aspiration cytology,were divided into two groups,the experiment group(50 cases) and the control group(50 cases),by digital random method .The experiment group take the method of surround-mammary areola incision operation,however,the control group adopt the way of the traditional radial incision operation,and the clinical curative effect and beautiful effect,complications,and postoperative recurrence were compared.We adopted the SPSS 18.0 and statistically analyzed all data by χ² test,P＜0.05 statistically significant. Results The experimental group’s overall efficiency is 94.00%,significantly higher than that of control group(66.00%) at the aspect of clinical efficacy and its difference was statistically significant(χ²=12.500，P＜0.001);the experiment group’s satisfaction was 96.00% higher than that of the control group in beautiful effect and its difference was statistically significant(χ²=10.714，P=0.001);however,in respect of complications,the group’s overall concurrent rate is only 6.00%(2 cases of hematoncus,1 case of areola paresthesia)far lower than the control group(22.00%,6 cases of of hematoncus,3 cases of areola paresthesia,2 cases of nipple discharge) and its difference was statistically significant(χ²=5.316，P=0.021);in terms of relapse,the experimental group recurrence rate was only 4.00%,significantly lower than 18.00% in the control group,and the above mentioned difference was statistically significant (χ²=5.005，P=0.025). Conclusion Compared with traditional radial incision operation,the method of surround-mammary areola incision operation can effectively treat mammary fibroadenoma,and its clinical and beautiful effect is good,the complications and recurrence rate is low,so it is worth popularizing in the clinic practice.

Logistic regression analysis on urinary tract infections after endourological surgery

TANG Gui-liang, ZHOU Yi, LUO Zhen-gang, YAN Jia-jun

2016, 14(1): 63-64,165. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.021

236 1

Abstract:
Objective To investigate the urinary tract infection(UTI),pathogenic distribution and associated risk factors after endourological surgery. Methods A total of 450 patients undergoing endourological surgery in Shaoxing City People’s Hospital from February 2014 to May 2015 were retrospectively analyzed for risk factors causing UTI.Factors of age,sexuality,body mass index(BMI),ASA score,complications,operative time and hospital stay were displayed according to the types of surgery. Results Four hundred and fifty patients including 387 males and 63 females，with the average age of 69±12.Cases underwent 233 cases of transurethral resection of the prostate,transurethral resection of bladder tumor and transurethral lithotripsy were 233,139,and 50,respectively.The body mas index,ASA scores and complication umber were(23.3±3.3)kg/m²，1.69±0.63 and 0.99±0.97.The average time was (54±37)min for operation and (5.0±1.6)d for hospital stay.Antibiotics were used prophylactively in 61.8% patients.UTI were observed in 30 patients with infection rate of 6.67%.There were 25 strains of gram negative bacilli，accounting for 71.4%，while gram negative bacilli 8 strains，accounting for 22.9%，fungi 2 strains,accounting for 5.7%.The main species of the pathogens were Escherichia coli(45.7%),Klebsielle pnenmoniae(14.3%) and Enterococcus faecalis(11.4%).Regression analysis showed operative time(OR=1.58，P＜0.05),prophylactic antibiotics(OR=1.52，P＜0.05),age(OR=1.91，P＜0.05) and complications(OR=4.26，P＜0.05) were significant risk factors for UTI in endourological surgery. Conclusion Operative time,prophylactic antibiotics,age,complications play important roles in the development of UTI.We should pay attention to time control and use antibiotics prophylactively especially in old patients with multi-complications to prevent infection in endourological surgery.

Application of anesthesia with sevoflurane,propofol and fentanyl in tonsillectomy of children

YE Song

2016, 14(1): 65-67. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.022

158 0

Abstract:
Objective To analyze the application of sevoflurane,propofol and fentanyl in tonsillectomy of children. Methods Forty ASA children undergoing elective tonsillectomy were selected,and randomly divided into two groups:the control group received ketamine,propofol and fentanyl(n=20),the observation group received sevoflurane,propofol and fentanyl(n=20).The anesthesia induction completion time,induced compliance score,intraoperative mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SPO₂),respiratory frequency(RR) were compared.The time of extubation and wake-up,incidence of agitation and incidence of nausea and vomiting were noted after operation. Results Patients exhibited lower MAP,HR,RR during induction of anesthesia in the observation group than in the control group(P＜0.05).The induced compliance score in the observation group was better than in the control group(P＜0.05).The incidence of agitation and incidence of nausea and vomiting were lower in the observation group than in the control group(P＜0.05).The spontaneous breathing recovery time,consciousness recovery time,and extubation time of the observation group was lower than the control group(P＜0.05). Conclusion In tonsillectomy of children,sevoflurane,propofol and fentanyl has high safety,less side effect,and to some extent,shortens the children wake up time.

Change of serum lipoprotein(a) in wounded-bone patients and its clinical significance

ZHANG Rong, LIU Yong-fang, CHEN Da-qing, YU Ke-he

2016, 14(1): 68-69，72. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.023

255 0

Abstract:
Objective To study the change of serum lipoprotein(a)[Lp(a)]of wounded-bone patient and its clinical significance. Methods Total 2 500 cases of wounded-bone patients in our hospital were assigned into observation group;200 physical examinees were selected as control group.The levels of serum Lp(a) and lipid index,myocardial index of the two groups were detected,and the dynamic change between wounded patients and the healthy subjects was compared.The relationship between Lp(a) and lipid index,myocardial index were analyzed. Results Serum Lp(a)levels of 10.0% healthy subjects(20 cases) were more than 300 mg/L.Among the wounded-bone patients,when they were wounded after 24 h,72 h,1 week and 1 month,there were 32.4%,34.0%,35.2%,17.0% patients Lp(a)levels more than 300 mg/L.Serum Lp(a)levels of wounded-bone patients were higher than those of healthy subjects when the patients were wounded after 24 h,72 h and 1 week(P＜0.05).When the patients were wounded after 1 month,serum Lp(a) levels of patients were same with the healthy subjects(P＞0.05).There was no significant difference between the two groups in lipid index,myocardial index.Regression analysis showed that there was no correlation between Lp(a) and lipid index,myocardial index in wounded-bone patients. Conclusion Serum Lp(a) levels of wounded patients are remarkably higher than those in healthy subjects;the Lp(a) level increases is independent of cardiovascular disease;the increase of Lp(a)levels in wounded-bone patients could be associated with wounded stress.

Influence of Xuezhikang on expression of suppressor of cytokine signaling 3 mRNA in obese rat liver

ZHENG Jian

2016, 14(1): 70-72. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.024

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Abstract:
Objective To analyze the impact of Xuezhikang on suppressor of cytokine signaling 3 (SOCS-3) mRNA expression levels in obese rats liver,and explore theregulatory mechanism of Xuezhikang on glucose and lipid metabolism. Methods The obese rats model were established and divided into model group,low dose Xuezhikang group (Xuezhikang 0.23 g/kg ),middle dose Xuezhikang group (Xuezhikang 0.69 g/kg) and high dose Xuezhikang group (Xuezhikang 1.15 g/kg),with 10 rats in each group,all the rats in the four groups were administrated with high-fat foods;10 rats to which no Xuezhikang was applied were selected as null group and were administrated with conventional food.The rats in null group and model group received the same volume of water as Xuezhikang.The levels of serum insulin,leptin,glucose,C-peptide and liver SOCS-3 mRNA were detected. Results The levels of serum insulin,leptin,glucose and C-peptide in the model group were significantly higher as compared with the null group(P＜0.05),but they were decreased by Xuezhikang treatment(positively with the dose of Xuezhikang),P＜0.05;The liver SOCS-3 expression was significantly increased as compared with the null group(P＜0.05),rat liver SOCS-3 mRNA expression was depressed by Xuezhikang treatment (positively with the dose of Xuezhikang),P＜0.05;The level of liver SOCS-3 mRNA was negative correlated with serum leptin(r=-0.612) and serum insulin(r=-0.726),P＜0.05. Conclusion Xuezhikang can effectively decrease the levels of serum glucose,leptin,insulin and C-peptide and improve lipid disorders through regulating the expression of SOCS-3 mRNA.

Risk factors for cognitive dysfunction in patients suffering from transient ischemic and carotid artery stenosis

ZHANG Wei-ping

2016, 14(1): 73-75. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.025

123 1

Abstract:
Objective To investigate the risk factors for the cognitive dysfunction in patients suffering from transient ischemic attack (TIA) combined with internal carotid artery (ICA) stenosis. Methods The clinical data of 129 cases transient ischemic attack (TIA) in our hospital from January 2013 to December 2014 were reviewed.The patients ICA stenosis were assigned into observation group,other into the control group. Results The difference in the symptoms of high blood pressure was statistically significant(χ²=4.498,P=0.034).There were statistically significant difference in the frequency of TIA among the patients with mild, moderate and severe ICA(P<0.05);MMSE(t=6.718,P<0.001),MoCA (t=5.529,P<0.001) and CCSE (t=4.270,P<0.001) for the patients in the observation group was significantly lower than those in the control group;MMSE,MoCA and CCSE for the patients with moderate and severe ICA were lower than that for the patients with mile ICA,the difference has statistically significant(P< 0.05);The serum CRP level in patients with cognitive impairment was significantly higher than that of the patients with cognitive impairment(t=5.065,P<0.001);Multivariate Logistic regression showed that carotid artery stenosis, hypertension and high serum CRP level were the independent risk factors for cognitive dysfunction in patients suffering from TIA. Conclusion ICA, high blood pressure and elevated serum levels of CRP are the independent risk factors for cognitive dysfunction in patients suffering from TIA.

A controlled clinical trial of efficacy of HHD and HDF + HD

XU Wan-dong, HUANG Li-dan, ZHU Huan-yang, WU Wen-you, DAN Yi-sheng

2016, 14(1): 76-78，162. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.026

286 2

Abstract:
Objective To compare the clinical efficacy of high flux hemodialysis(HHD) and hemodiafiltration(HDF)+hemodialysis(HD) in the treatment of chronic renal failure with uremia. Methods A total of 62 cases of chronic renal failure with uremiatreated with hemodialysis from August 2013 to December 2014 in our hospital were enrolled into the observation group,and 74 patients treated with hemodialysis in cooperative hospital in the same period were enrolledinto control group.The patients in the observation group were given high flux hemodialysis(3 times each week);and the patients in the control group were given hemodiafiltration(once each week) and hemodialysis(twice each week).Before and after the hemodialysis,the small-molecular substances(blood urea,creatinine,uric acid,potassium,phosphorus),middle-molecular substances(parathyroid hormone),and large-molecular substances(blood β₂-microglobulin,cysteine protease inhibitors C) levels of two groups were observed.And after the hemodialysis,the urea dialysis adequacy indicators(urea clearance index,standard protein catabolic rate,time-averaged urea concentration) of both groups were compared.The clinical efficacies of HHD and HDF+HD were compared between the two groups. Results After the dialysis,the levels of all observed toxinsin both groups were significantly reduced(P＜0.05);and levels of serum phosphorus,parathyroid hormone,cystatin C in the observation group were significantly lower than those in the control group(P＜0.05).The differences inurea clearance index,standard protein catabolic rate,time-averaged urea concentration were not significant between the two groups(P＞0.05). Conclusion As compared with HDF+HD,HHD has better efficacy on removing the middle- and large-molecular toxins.

The analysis of relative factors of poor controll of blood pressure of maintenance hemodialysis patients

CHEN Hao

2016, 14(1): 79-80，107. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.027

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Abstract:
Objective To analyze the relative factors for poor blood pressure control in patients with maintenance hemodialysis (MHD), investigate the main causing such result and provide evidence for the future clinical settings. Methods Total 160 MHD patients between Mar.2010 and Feb.2015 in our department were enrolled and divided into study group (n=121) with poor blood pressure control and controlled group (n=39) with good blood pressure control. The clinical data of them were reviewed.The univariate analysis and multiple Logistic Regression analysis were performed for HD duration, body composition changes before and after HD, dry weight assessment, amount of EPO,glomerular filtration rate of the remnant kidney and irregular hemodialysis. Results The univariate analysis showed that there was statistical significance in the PTH level, amount of EPO,dry weight assessment, body composition changes before and after HD,glomerular filtration rate of the remnant kidney and irregular hemodialysis between the two groups (P<0.05).The multiple Logistic Regression analysis revealed that there was statistical significance in dry weight assessment and irregular hemodialysis(P<0.05). Conclusion The main dangerous factors for poor blood pressure control in patients with maintenance hemodialysis(MHD) are dry weight not up to standard and irregular hemodialysis.The valid assessment of dry weight,regular HD and effective management of blood press in the treatment will be helpful for MHD.

Application of negative expiratory pressure technique in diagnosis and treatment of bronchiolitis in infants

ZHAN Lu, SHAO Zheng-yang, LIAN Jun-lan, HE Fei, YAN Wei-chao

2016, 14(1): 81-83. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.028

169 0

Abstract:
Objective To investigate the clinical significance of negative expiratory press(NEP) test in the diagnosis and treatment of bronchiolitis in infants. Methods A total of 100 infants with bronchiolitis(observation group) and 50 normal infants undergoing the medical examination(control group) in our hospital from June 2013 to October 2014 were selected and documented.NEP technique was performed by using Use McGrady spirometer,and the expiratory flow limited(EFL) was calculated with NEP tidal flow-volume curves and the same flow-volume curve during quiet.Then the tidal value and EFL value were compared with the national norm of normal children. Results One hundred cases of bronchiolitis according to their condition were divided into three groups,including mild group(40 cases),moderate group(30 cases),and severe group (30 cases).EFL in the mild group was (22.75±10.06)%,in the moderate group was(30.46±10.27)%,and in the severe group was (77.39±10.72)%,while in the control group was (12.73±10.01)%,the difference in EFL was statistical significant (P＜0.01);EFL value rose with the severity of the disease.VT/kg in the mild group was (10.52±2.00)ml/kg,in the moderate group was (8.88±2.52)ml/kg,in the severe group was(10.13±2.71) ml/kg,while in the control group was (9.54±2.11) ml/kg,the difference among the groups was not statistical significant,P＞0.05.RR in the mild group was (30.46±10.27) times/min,in the moderate group was (33.00±9.06) times/min,in the severe group was(37.00±9.06) times/min,and in the control group was (31.46±8.27) times/min,there was no statistical significance among the groups,P＞0.05. Conclusion NEP technique can be used to detect the EFL value in infants with bronchiolitis.EFL is closely related with the condition of disease,and raise with the severity.It's possible to evaluate the disease at early stage through the EFL value,which can be used to support early diagnosis and treatment for infant bronchiolitis.

Analysis of epidemiological characteristics of unintentional injuries among 1 282 children in ICU

JIN Wei-ying, WENG Cui-ye, PAN Zhi-huan, XIE Zuo-kai, ZHANG Bo, LIN Li, PAN Guo-quan, LI Chang-chong, ZHANG Wei-xi

2016, 14(1): 84-86,89. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.029

310 0

Abstract:
Objective To survey the epidemiological characteristics of unintentional injuries among hospitalized children in ICU. Methods The retrospective study included 1 282 children of 0 to 14 years treated for unintentional injuries from ICU of Yuying Children’s Hospital between 2005 and 2014. Results Total 1 282 cases of children with unintentional injuries accounted for 27.86% of the hospitalized cases in ICU for the same period.Boys had a higher incidence of injury than that of girls with a ratio of 1.85∶1.The injury cases were mainly in 1-3 age group(39.63％).The unintentional injuries mainly occurred from 14:00 to 19:00 that 16:00 was the peak time.The number and rate of unintentional injury were the highest in summer(from July to September).The places in turn were in public places(53.74%),at home(45.55%) and at school(0.7%).The unintentional injuries of different age groups occurred in different places.Parent’s occupation in turn were workers(mainly engaged in manual labor),private owners,professional technicians and administrators.The top five causes of unintentional injury were traffic accident(37.13％),falls from height(28.94%),poisoning(9.20%),drowning(7.64%),and falling injuries(7.02%).The unintentional injury rates varied considerably with the age.The healed rate of this group was 35.80%,improved(50.08%),not improved(11.08%),and death(3.04%).Significant differences existed in the number of inpatients,types of occurrence,healed and death,hospitalization expenses between the Comparison of two groups before and after 5 years. Conclusion The unintentional injuries of hospitalized children in ICU are related with gender,time and season,occupation of parents and so on.The unintentional injury in different age groups shows the specificity in places and types of injuries.

Analysis on TORCH infection in pregnant women and newborn in Nanning area

LI Dong-ming, ZHANG Shuo, TAO Chun-feng, HUANG Hai-feng, LI Ying-feng, SHE Shang-yang

2016, 14(1): 87-89. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.030

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Abstract:
Objective To investigate the status of TORCH infection in pregnant women and newborn and its relationship with abnormal pregnancy and neonatal common diseases in Nanning area. Methods TORCH antibody was detected by using enzyme linked immunosorbent assay method in the serum form 39 281 pregnant women,4 833 cord blood and 18 757 newborn from January 2008 to December 2013.The clinical diagnostic information was collected and analyzed.The positive of TORCH in abnormal pregnancy group,normal pregnancy group and infants with different diseases were compared. Results The positive rate of TORCH-IgM was 2.86%,0.89% and 1.60% in 39 281 pregnant women,4 833 cord blood and 18 757 newborns,respectively.And the rate of CMV-IgM was higher than other pathogen in those three groups(0.88%,0.34% and 1.31%,respectively).The positive rate of TORCH-IgM in normal group and abnormal group were 1.44% and 0.45%,respectively(P＜0.05),and was 18.70%,2.74%,1.93% and 1.64% in newborn with hepatitis syndrome,pathological jaundice,septicemia and pneumonia,respectively. Conclusion CMV was the main pathogen of infection in pregnant women and newborn,and were associated with hepatitis syndrome and pathological jaundice.It is necessary to take the screening for TORCH in this area.

Analysis of the clinical effect of small dose dopamine combined with dobutamine in children with severe pneumonia

JIANG Hai-zhen

2016, 14(1): 90-92. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.031

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Abstract:
Objective To explore the clinical effect of small dose dopamine combined with dobutamine in children with severe pneumonia serological indicators,improve clinical symptoms and clinical efficacy and safety,for the clinical treatment to provide guidance. Methods One hundred and twenty-one children with severe pneumonia were selected from February 2012 to June 2015 in my courtyard department of pediatrics ward.The children were randomly divided to observation group and control group.Patients in the control group(59 cases) were treated with conventional anti infection,oxygen inhalation,keep respiratory tract unobstructed and symptomatic treatment,the research group (62 cases),on the basis of conventional therapy,were treated with small dose dopamine combined with dobutamine,observation and analysis in serologic changes in two groups before and after treatment in children with serum levels of inflammatory factors and immune factor level,records of children with clinical symptoms to improve the situation,assess clinical effect and complication of the situation. Results There were no difference in the pro-inflammatory cytokine levels and the levels of immune factors between the two groups of children before the treatment(P＞0.05).However,the levels of the inflammatory cytokines and immune factors were significant changes after treatment(P＜0.01).In the effect of treatment,the two groups are different(Z=-2.169,P=0.03＜0.05) in the recovery time,breathing improvement,heart rate improvement time,three concave syndrome improvement,there are significant differences on pulmonary rate (P＜0.01).Dyspnea frequency and cough frequency of the control group during the treatment were (2.15±0.94)d and (6.94±1.76) times/d,the same indexes of the patients in the observation group during the treatment were (1.19±0.53)d and (4.31±1.25) times/d,there were significant differences between them(P＜0.01);in the control group,3 cases of nausea and vomiting,2 cases in observation group were nausea and vomiting.No difference(P＞0.05),after adjusting the infusion speed to alleviate the symptoms completely disappeared after the transfusion. Conclusion Small dose dopamine combined with dobutamine treatment of severe pneumonia in children has significant effect,could improve clinical symptoms at short time,with high safety,worthy of promotion.

CHEN Jing-jing, PENG Ming-xue, QIN Ming-hua, JIANG Guo-ying, PENG Ying-chun

2016, 14(1): 93-94,104. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.032

223 1

Abstract:

Clinical effect analysis of strengthening psychological support on patients with severe respiratory medicine

WU Li-qin, ZHANG Xiao-ying, SUN Xiao-lei, LI Feng-fei, GUAN Hui-fang, XU Zhang-qing

2016, 14(1): 95-97. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.033

101 0

Abstract:
Objective To investigate the clinical effect of strengthening psychological support for patients with acute respiratory disease. Methods Total 112 cases of patients with severe respiratory disease in our hospital between August 2013 and March 2014 were selected as study subject.All patients were randomly divided into observation group and control group,each group 56 cases.The patients in the control group were given basic nursing,while the patients in the observation group were given strengthening psychological support nursing based on basic nursing.Before and after the nursing,PaO₂,PaCO₂,respiratory rate and heart rate indicators of both groups were observed. Results After the treatment,PaO₂ levels of both groups were significantly increased,the difference was statistically significant(P＜0.05),and PaO₂ level of the observation group[(93.1±11.2)mm Hg] was significantly higher than that of the control group[(82.4±9.8) mm Hg],the difference was statistically significant(P＜0.05);After the treatment,PaCO₂,respiratory rate and heart rate of both group were significantly reduced,the differences were statistically significant(P＜0.05),and PaCO₂,respiratory rate and heart rate of the observation group[(57.3±7.6) mm Hg,(20.1±3.5)beats/min,(87.5±8.2)beats/min] were significantly lower than that of the control group[(66.4±7.4)mm Hg,(23.7±3.7)beat/min,(95.1±9.4)beat/min],the differences were statistically significant (P＜0.05). Conclusion For patients with severe respiratory diseases,on the base of close attention on disease progression and implemention of basic nursing,the strengthening psychological support nursing can effectively enhance the confidence to overcome the disease and promote better recovery.

Function of rational emotive behavior therapy inpsychological intervention for women with advanced breast cancer

LIU Jin, LIU Xiao-hong

2016, 14(1): 98-100. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.034

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Objective The female patients with advanced mammary cancer commonly suffer from serious psychological problem.The aim of this study is to explore the function of rational emotive behavior therapy in psychological intervention in order to improve their psychological stress response capacity and quality of life. Methods A total of 126 female patients with advanced mammary cancer in our department were divided into experiment group and control group,the normal nursing was given to all patients,and mental nursing of rational emotive behavior was additional given to the patients of experiment group.Symptom checklist 90,Eysenck Personality Questionnaire and World Health Organization Quality of Life-100 were adopted to evaluate the mental condition,personality and living quality. Results The rational emotive behavior therapy had improved the mental state of patients such as somatization,force,interpersonal sensitivity,depression,anxiety and terror etc.,the number of positive factor in SCL-90 reduced 3.2±1.4 in the experimental group and 2.0±0.9 in the control group,the improvement of total average was 1.7±0.6 in the experimental group and 0.7±0.4 in the control group.The rational emotive behavior therapy had also improved the introverted,emotional instability and psychoticism,as well as the quality of life such as psychological,independence,social relation and mental support.The total score of WHOQOL-100 was 43.1±7.2 in the experimental group and 27.2±8.3 in the control group. Conclusion The reasonable emotion therapy could obviously improve the mental state and quality of life in patients with advanced breast cancer,and is worthy of popularization and application in psychological therapy.

Analysis on the establishment of health records and health education status of floating population in Shanghai

NIE Huan-huan, SHEN Wan-wan, BAO Yong

2016, 14(1): 101-104. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.035

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Objective To investigate the status and determinants of floating population on establishing health records and health education,analyze the main influencing factors,and provide suggestions and strategies for improving public service utilization among floating population,thereby promote the equalization of basic public health services and improve population health. Methods Using the data from Shanghai Municipal Commission of Health and Family Planning during the 2014 National Dynamic Floating Population Monitoring Survey.The statistical analysis was performed. Results The proportion of the establishment of health records of the floating population was on 18.9% ;the proportion of accepted reproduction and contraception, nutrition and health knowledge were 66.7% and 65,4 %,respectively;while the TB prevention,mental disorder prevention and other infectious diseases prevention were only 29.6%,19.2% and 31.1%,respectively.The main way for them to get health education was by billboards and TV/broadcasting,accounted for 80.2% and 70.3%,respectively.Among all the influencing factors of establishing health records and health education,the most important factor was the present living area,urban or rural area. Conclusion The establishment of health records of floating population is much lower than the local residents,their awareness and attention of health records need to be improved.Type of health education of floating population is not balanced,and the method is simple.The provision of basic public health services for floating population should be developed proportionately among the different regions.The appropriate services mechanism should be formulated to promote their use of basic public health services.

Analysis of mortality,morbidity and screening detection rates of cervical carcinoma in Yinzhou district,Ningbo city

WENG Hong-fei, YING Yan-yan, WANG Yong, JI Wei, WANG Hong-fei, LI Xiao-yong, CUI Jun, LI Hui, LIN Hong-bo, XU Guo-zhang

2016, 14(1): 105-107. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.036

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Abstract:
Objective To analyze the mortality,morbidity and screening detection rates of the cervical carcinoma in Yinzhou district,Ningbo City and to provide the evidence for prevention and control of the cervical carcinoma. Methods The Yinzhou residents death registration data from 2004 to 2013,the incidence data from 2010 to 2013 and theThinprep cytology test(TCT) data in 2014 of the cervical carcinoma were collected and analyzed with statistics indexes including proportion,adjusted-rate,trend χ²,etc.The adjusted rates were calculated according to the Segi’s world standard in 1985. Results There were 112 death cases and the crude mortality of the cervical carcinoma from 2004 to 2013 was 2.90 per 105 in Yinzhou district,Ningbo city.The adjusted mortality of world population was 2.06 per 10⁵.The mortality increased with year(trend χ²=4.02,P=0.045) and age(trend χ²=135.60,P＜0.001).The crude morbidity of the cervical carcinoma from 2010 to 2013 was 14.11 per 10⁵ in the same area,accounting for 215 incidence cases.The standardized incidence ratio in the general population was 9.34 per 10⁵.There was no significant difference of morbidity among the years from 2010 to 2013(trend χ²=0.38,P=0.539).The age-specific morbidity curve was the shape of inverted U type.2 295 married women received the ThinPrep Pap test in 2014.Fifty-eight of them were abnormal and the rate was 2.53%.The most abnormal type was ASC-US(40 cases) and the proportion was 68.97%. Conclusion Yinzhou had the higher mortality and lower morbidity of the cervical carcinoma when compared to China.The early prevention and control of the cervical carcinoma and TCT screening should be reinforced for the whole married women.

Application of 3.0T MR vascular imaging in studying characteristics and related factors of blood supply around breast cancer

XU Hai-yan, ZHAO Hong, ZOU Li-wei, ZHENG Sui-sheng, QIAN Bo

2016, 14(1): 108-110，130. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.037

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Abstract:
Objective To study the characteristics of blood supply around the breast cancer and correlation with tumor size,shape,apparent diffusion coefficient(ADC) values and pathological grading. Methods Ninty-four cases of breast cancer confirmed by histopathology and examined by 3.0T MR dynamic enhanced scan were enrolled into this study.Siemens 3.0T magnetic resonance instrument was used for the morphological data as well as the maximum diameter of lesions,ADC values,and pathological classification data were obtained from the clinical material.ADW4.4 workstation was adopted to subtract the scan image from the most striking enhanced image in dynamic enhanced image,and maximum intensity projection(MIP) was used to acquire the bilateral breast 3D subtraction angiography images.Besides,the number,diameter,and length of surrounding blood vessels and the contralateral breast vessels were recorded,and the correlation between characteristics of blood supply of the affected mammary gland and its tumor shape,size,ADC values and pathological classification were analyzed. Results Among the 94 cases,the blood supply around the lesions in 79 cases increased more than the contralateral side.The main performances of breast artery anomalies and tumor blood vessels in this study lied in that the tumor blood vessels were more concentrated on the edge of the tumor area;the diameter of blood vessel enlarged,the number of terminal small arteries increased and their go-line was irregular and twisted.The number of abnormal arterial around the breast lesions and tumor blood vessels shown in enhanced MR and MIP reconstruction were correlated with the size and the ADC values of the lesions.The maximum diameter and the ADC values of the tumor were positively correlated with the number of peripheral vascular lesions(r₁=0.567,r₂=0.230,P＜0.05).The tumor shape and the pathological grading of infiltrating ductal carcinoma were not significantly correlated with the number of surrounding blood vessels. Conclusion Breast cancer is a tumor with rich blood supply.The number of abnormal arterial around the breast lesions and tumor blood vessels are correlated with the size and ADC values of the lesions while not significantly correlated with the shape of the lesions and the pathological grading of infiltrating ductal carcinoma.

The effect of sonographic elastography on diagnosing the axillary lymph nodes in patients with breast cancer

YANG Mei-qin, LIU Gui-lin, FANG Ming, HONG Yuan-you

2016, 14(1): 111-113，152. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.038

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Objective To explore the effect of sonographic elastography on diagnosing the axillary lymph nodes in patients with breast cancer. Methods One hundred and thirty four patients of breast cancer with 160 axillary lymph nodes were analyzed respectively in this study.The properties of axillary lymph nodes were evaluated by conventional ultrasound and sonographic elastography,respectively.The accuracy of two different evaluation methods for reactive and metastatic lymph nodes were evaluated according to pathological diagnosis results.The sensitiveness and specificity was analyzed by the McNemar method. Results In the conventional ultrasound method,the ratio of diagnosis for L/S＜2,the thickness of lymph node cortex≥0.3 cm,the extent for blood flow abundance,blood type for reactive lymph nodes are 29.2%,41.5%,26.2%,and 16.9%,respectively;and for lymph node metastasis are 69.5%,68.4%,73.7%,and 86.3%,respectively.In the sonographic elastography method,the ratio of diagnosis for 1 grade,2 grades,3 grades,and 4 grades of reactive lymph nodes are 80.0%,58.5%,84.6%,and 38.5%;and for lymph node metastasis are 31.6%,60.0%,50.5%,and 64.2%,respectively.Compared with the conventional ultrasound method,the sonographic elastography can increase the susceptibility from 63.2% to 73.8%(P=0.014),and also can increase the specificity significantly from 64.4% to 72.9%,the difference had statistically significance(P=0.043).The area under the curve in the elastography score(0.829) was greater than the conventional ultrasound(0.763).The difference was statistically significant(P＜0.05). Conclusion The sonographic elastography method can improve the accuracy and specificity in the judging of the properties of axillary lymph nodes of patients with breast cancer,and can offer the reliable basis for clinical axillary lymph node dissection.

Analysis of the clinical significance and the risk factors of prenatal ultrasound screening for fetal congenital heart disease

YAN Jing-bin, YAN Xiu-mei, YANG Jian-xiang, CHEN Xian-qiu, LIANG Bi-rong, LUO Jian-feng, DAI Miao-lei, BAI Xiao-hui

2016, 14(1): 114-115,160. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.039

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Objective To investigate the prenatal ultrasound screening for fetal congenital heart disease (CHD) value,analysis of risk factors influencing the occurrence of CHD. Methods One thousand seven hundred and ninety-two cases of pregnant women for prenatal ultrasound screening for fetal congenital heart disease were retrospectively analyzed in our hospital from January 2011 to August 2014，compared with prenatal ultrasound screening results and autopsy after delivery system,ultrasound examination results; a total of 50 cases of ultrasound diagnosis of pregnant women with CHD,150 cases of pregnant women with CHD,“Questionnaire” risk factors of congenital heart disease combined with the existing literature screening for risk factors of CHD,by single factor and multiple factor Logistic regression analysis of risk factors of CHD. Results Prenatal ultrasound diagnosis of CHD in 72 cases of pregnant women,postpartum echocardiography examination confirmed 9 cases,2 cases were misdiagnosed as atrial septal defect,61 cases confirmed by autopsy; single factor Logistic regression analysis,advanced maternal age,maternal cold,CHD family history,history of adverse pregnancy,gestational diabetes,chromosome abnormalities,abnormal amniotic fluid volume,pregnant women smoking or passive smoking,viruses or chemicals and early pregnancy,history of adverse life events such as the 10 factor is CHD disease risk factors;multivariate Logistic regression analysis,found that maternal cold,CHD family history,pregnancy history,chromosome abnormalities,abnormal amniotic fluid volume and maternal smoking or passive smoking 6 major factors are risk factors for the CHD. Conclusion Prenatal ultrasound screening for fetal congenital heart disease is a noninvasive diagnostic method,efficient,for the risk factors of pregnant women,the timely implementation of prenatal ultrasound screening for early intervention and reduce the birth rate of CHD,has an important significance in eugenics.

Role of color doppler ultrasound in diagnosis of lower limb vascular angiopathy in elderly patients with type 2 diabetes mellitus

SUN Jian-hao, LAI Yong-fei, ZHU Ji-ming

2016, 14(1): 116-118. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.040

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Abstract:
Objective To discuss the clinical significance and diagnosis value of color Doppler ultrasound for lower limbs angiopathy in elderly patients with T2DM. Methods Total 450 elderly patients with T2DM were enrolled into observation group and 200 healthy volunteers into the control group in our hospital between June 2010 and May 2013.The color Doppler ultrasound was performed to estimate the angiopathy of lower Limbs. The data was analyzed and compared between the two groups by using SPSS 13.0. Results The rate of atherosclerotic plaque formation in the observation group was 95.6% (430/450), significantly higher than 26.5%(53/200) in the control group (χ²=345.85,P<0.01); The detection rate of lower limb vascular lesion was 12.8%(22/172) in the patients with T2DM with a duration less than 10 years,61.7%(116/188) in the patients with a duration of 10-20 years(χ²=90.90,P＜0.01), and 100.0%(90/90) in the patients with a duration over 20 years (χ²=46.52,P＜0.01);The difference was statistical significant.The inner diameter of the lower limb vascular in T2DM patients become stenosis, when compared with the control group,the inner diameters of the lower limb arteries (common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, posterior tibial artery, dorsal pedal artery) in T2DM patients with a duration of 15 years or more were thinner (t=94.64，173.46，103.49，176.33，122.84，103.65，P＜0.01), respectively;the stenosis of dorsal pedal artery in the observation group was significantly serious than that in the control group(χ²=349.93，88.71，13.85，41.12，16.94，P<0.01, respectively). Conclusion The color Doppler ultrasound for the diagnosis of lower limb vascular angiopathy in elderly patients with T2DM is receptive, with the advantages of high accuracy and safety, easy to operate, high repeatability and noninvasive evaluation. It can provide certain clinical guiding for the treatment of the disease.

ZHU Huan-gao, LIAO Lin, ZHANG Rui, DONG Jian-jun

2016, 14(1): 119-121. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.041

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ZHANG Huan-huan, WEI Zhao-lian

2016, 14(1): 122-124. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.042

210 2

Abstract:

ZHANG Jiang-bo, SHU Han-sheng

2016, 14(1): 125-127. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.043

342 4

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Efficacy analysis of traditional Chinese medicine decoction in treatment of recurrent oral ulcer

CHU Qun-feng

2016, 14(1): 128-130. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.044

148 1

Abstract:
Objective To investigate the clinical efficacy and safety of Chinese medicinal herb soup assisted with routine western medicine in the treatment of recurrent oral ulceration(ROU). Methods Total 154 cases of recurrent oral ulcer in our department from January 2011 to December 2013 were randomly divided into observation group and control group,each group 77 case.The patients in the control group were given conventional western medicine,while the patients in the observation group were added Chinese medicinal herb soup.After one month treatment,the efficacy,healing ulcer time,pain time,pain level and adverse reaction of both groups were observed.All data were analyzed by SPSS 18.0 statistical software. Results The recently and long-term total effective rate of observation group were 97.4% and 85.7%,which were significantly higher than that of control group (85.7% and 67.5%),the differences were statistically significant(P＜0.05).The healing ulcer time,pain time,pain level of the observation group were (4.45±1.8)d,(3.1±1.3)d,(12.3±4.8) score,which were significantly higher than that of control group[(7.09±2.3)d,(5.4±1.7)d,(25.1±6.9) score],the differences were statistically significant(P＜0.05).There was no significant differences of two groups on adverse reaction rates(P＞0.05). Conclusion Based on conventional western medicine,Chinese medicinal herb soup in treatment of recurrent oral ulcer can significantly shorten disease course,relieve pain,and enhance clinical efficacy.

Clinical observation of using integrative medicine to treat osteoporosis of urban white collar

HUANG Wei-chun, ZHANG Yong-jin, WEI Li-hong

2016, 14(1): 131-132，143. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.045

279 0

Abstract:
Objective To discuss the curative effects and clinical safety of using integrative medicine to treat osteoporosis of urban white collar. Methods From January 2014 to January 2015,112 cases of patients with osteoporosis in our hospital were chosen and divided into the observation group and the control group using random number methods (56 cases in each group).The control group were treated with conventional western medicine(Allen sodium phosphate tablets),while the observation group had Bushen Jiangu soup on basis of the control group treatment.Both groups of patients had 3 months of treatment. Results Three months after treatment the total effective rate in the observation group was 96.4%,significantly higher than that in the control group 76.8%(χ²=9.314,P＜0.05).Three months after treatment traditional Chinese medicine symptoms of the two groups had significant reductions in the total integral (all P＜0.05),but the observation group decreased more obviously(P＜0.05).Treatment for 3 months,the lumbar spine bone mineral density of the two groups significant increased in the L_2～4(all P＜0.05),but the observation group increased more obviously(P＜0.05).Treatment for 3 months bone turnover biochemical markers in the two groups had significant reduction(both P＜0.05),but the observation group decreased more obviously(P＜0.05).During treatment liver and kidney functions in both groups were within the normal range,and adverse reactions in the two groups were mainly gastrointestinal reaction,which could be tolerated and all patients had no drug withdrawal. Conclusion Using allen sodium phosphate tablets combined with Jianpi zhuanggu soup to treat osteoporosis has better clinical curative effects and higher clinical safety,worthy of clinical promotion.

The legal problems and countermeasures of hospital at home

CUI Qi-qi, ZHENG Ya-ting, YAO Wei-guang

2016, 14(1): 133-135. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.046

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Abstract:
Faced with the challenges of high medical costs,unreasonable distribution of much needed medical resources,the aging society and the low national health quality,Hierarchical Diagnosis System and Community Health Service will be still the main direction and focus of health care reform in China.As a new form of Community Health Service,Hospital at Home,which chooses suitable patients to be treated at home,not only relieve the difficulty to be in large general hospital,but also takes economical and convenient health service to the residents,and improves the surroundings of medication.It is well assessed by people.However,due to the short duration and the lack of service institutions or experience,the problems of Hospital at Home have been emerged onto surface,which also limit the effect and further development of itself.In order to push to formulate an advance Hospital at Home Management Practice accommodating to the situation of China,and perfect the institutions of Hierarchical Diagnosis System and Community Health Service,this article analyses four legal problems in Hospital at Home,including the conflict between stuff and law,the legal risk,the legal authority of protocol and the funding guarantees.Meanwhile,the appropriate measures are suggested,such as multi-site physician practice,the risk control of legal responsibility,the protection of medical stuff’s legal rights and expanding the level of medical insurance.In the end,we draw a conclusion that the sustainable development of Hospital at Home needs to be supported by laws and regulations.

Simply analysis of medical liability insurance and medical accident insurance

LI Jia-xin, YANG Jing

2016, 14(1): 136-139. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.047

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For many years,China summarize constantly the experiences through researching,practicing and improving the cases of medical disputes at home and abroad,and has got a new mechanism to solve medical disputes with Chinese characteristics.Today,the third-party mediation mechanism for solving medical disputes has been spread nationally from theory to practice,and lots of doctor-patient dispute mediation committees,which are the platform for solving medical disputes,were found across the country.These committees can greatly relieve the contradiction of doctor and patient.At the same time,the medical liability insurance,which aims to cooperate and improve the operation of the third party mediation mechanism,has also been spread tentatively for many years in a nationwide.Lots of experience and improved insurance clauses were obtained from failure.Medical liability insurance is not only an auxiliary,but also play an important supporting role for the doctor-patient dispute mediation committee’s work.Lacking of the medical liability insurance,the third party mediation mechanism exists in name only.A stable triangle has been formed form insurance company,medical institution and medical disputes mediation committee,and this triangle can ensure that the third-party mediation mechanism run successfully.With the spreading of medical liability insurance in national scope,the advantages and disadvantages of medical liability insurance have been gradually revealed.In order to compensate the weakness of medical liability insurance,accidental medical insurance comes up as a supplement.A few of local governments have practiced the accidental medical insurance,and accidental medical insurance has become more important as supplement.Accidental medical insurance and medical liability insurance support the third party mediation mechanism,and make the third party mechanism full of vitality,and can solve doctor-patient conflicts effectively.

Investigation of the learning curves of simulation-based lumbar puncture training for medical undergraduates

ZHANG Yi, YU Yong-sheng, WANG Jie-ling, TANG Yu-yan, TAO Ran, TANG Zheng-hao, JIANG Hong, XI Min, ZANG Guo-qing

2016, 14(1): 140-143. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.048

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Abstract:
Objective To explore the learning curves of simulation-based lumbar puncture training and evaluate its long-term outcome,which can provide a basis for arrangements and effect assessments of simulated training for medical undergraduates. Methods Twenty-five medical undergraduates who had not received any relevant lumbar puncture training and had no clinical experience of lumbar puncture were enrolled in this study.Each participant performed seven supervised trials on the simulator in two weeks.Participants’ performances were assessed by operation mistake(OM),operation time(OT) and operation confidence(OC).Learning curves for each variable were generated.Long-term outcome of the simulation-based lumbar puncture training was measured six months later after the initial training on the simulator. Results Obvious improvements were noted in OM,OT,and OC among the first four trials(P＜0.05).The learning curves of OM and OT descended in the first five trials.However,the learning curve of OC ascended in the first five trials.Plateaus of OM,OT,and OC in the learning curves occurred in the fifth trial.There was no significant difference between the result of the retest performed six months later and that of the seventh trial(P＞0.05). Conclusion This study demonstrates that simulation-based lumbar puncture training can significantly improve the individual’s skill.The learning curves of OM and OT descend with the numbers of operation,while the learning curve of OC ascends with the numbers of operation,but they all reach plateaus in the fifth operation.Good effect can be achieved by five trials.

Exploration of new method for standardized training ofgeneral practitioners

WANG Xiang, JIANG Xiao-lan, YANG Fan, LI Jian

2016, 14(1): 144-146. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.049

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Abstract:
General practice,as a new medical subject and the inevitable trend of modern medical change,has attracted more and more attention from the government and medical field.The general practice education is an important cornerstone to promote the development of general medical.It is one of the most important tasks of China’s present deepening healthy system reform to establish high-quality talent team with comprehensive medical knowledge and substantial clinical experience.At present，Training of general practitioners was introduced to our country in the late 1980 of the 20th century and gradually leaded into the medical education historical track and formed a certain scale at the same time.However,there is no uniform training standards in China now because the general teaching has new content and covers a wide range of knowledge.In each area，Attention to general education is not of the same degree,the training form,level of teachers,teaching methods,and assessment standards are all not the same,so the result of training ofgeneral practitioners is obvious difference.Through bringing in overseas general medical elites and establishing an independent general practice system,setting up general practice training institutions and improving the training management system,building a team consisting of key teachers and formulating a syllabus,making a strict assessment system，Our hospital contributes to the explore of new pattern of standardizing training of general practitioners.In this way,we open the new field of general teaching education,hoping to inprove the general practice training quality.Training more qualified general practitioners to make sure the support for the reform of basic health care systems in our country and meet the arrival era of medical grade.What we’re looking forward to is to adapt to continuous development of social and meet the people’s increasing demand for health services.

The influence of nursing intervention on venous thromboembolism after orthopedics major operation

BIAN Na, WANG Ru-na, SUN Yan-min, LIU Dan, ZHOU Yong, HAN Kang

2016, 14(1): 147-149. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.050

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Objective To observe and summarize the effects of nursing intervention on venous thromboembolism(VTE) after orthopaedics major operation. Methods From January 2010 to January 2013,176 patients which were cured in hospital were randomly divided into two groups(using randomized digital table):the group of nursing intervention (the experimental group) and the group of routine nursing care (control group) which were given the different nurses.The general condition,limb length and deep vein thrombosis were compared and analyzed among groups. Results All patients were followed up at least 6 months after the operation.Nursing intervention group of deep vein thrombosis rate(8/95) is significantly lower than the control group(25/81).Circle length in nursing intervention group were significantly better than that in control group. Conclusion The nursing intervention can play a significant role in the preventing of venous thromboembolism which should be further promoted and used in clinical work.

The effect of community nursing intervention on quality of life of alzheimer patients and caregivers

XIAO Wen-yu, ZHENG Shu-hua, HE Xiao-zhen

2016, 14(1): 150-152. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.051

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Abstract:
Objective To investigate the nursing status for Alzheimer patients and living conditions of caregivers; to explore the effect of community nursing intervention on quality of life of patients and caregivers. Methods Sixty cases in community with Alzheimer disease were randomly divided into observation group and control group.The control group received the general health guidance and health education,and in addition to the implementation of general health guidance and health education,the observation group received new community nursing intervention,including dietary adjustments,activities of daily living,psychological nursing,regular home visits.Mental state and ability of daily life of Alzheimer patients and life quality evaluation of caregivers were tested before and after 2 years intervention. Results The scores from MMSE in observation group were significantly higher than the control group and before intervention(t=2.59,P＜0.05;t=2.36,P＜0.05),but the scores from ADL in intervention group were significantly lower than the control group and before intervention(t=2.97,P＜0.01;t=2.13,P＜0.05); the scores from MMSE and ADL in the control group had no change (P＞0.05) after 2 years intervention.The scores from WHOQOL-BREF for caregivers in observation group were significantly higher than the control group and before intervention(t=3.86,P＜0.01;t=5.90,P＜0.01),The scores from WHOQOL-BREF for caregivers in the control group had no change(P＞0.05) after 2 years intervention. Conclusion Taking reasonable and practicable community nursing intervention could improve the quality of life for Alzheimer patients and slow the course of Alzheimer disease which also reduce the mental stress of caregiver and the burden of families.

The investigation of artificial abortion of adolescents and nursing countermeasures in our city

ZHANG Xiao-ding, MA Xiao-li, XUAN Bai-yun

2016, 14(1): 153-155. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.052

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Objective To investigate and understand the status of abortion in our city youth,looking mainly due to the impact of abortion,and explore the nursing countermeasures after artificial abortion. Methods The data of 2 100 cases of artificial abortion from three different levels of hospitals which can be artificial abortion in our city,they were unmarried pregnant teenagers from 13 to 24 years old,anonymous questionnaire survey was used to collect data among them and grouping nursed. Results Two thousand and nineteen questionnaire was available,the effective rate accounted for 96.14 percent,the effective average age of subjects (18.25±2.36) years old,first sex aged＜16 years old accounted for 28.38 percent. Unmarried cohabitants accounted for 37.54 percent,and more sexual partners accounted for 30.96 percent.63.55 percent of the young people choose contraception low age of first sex,non-reading adolescent,unmarried cohabitation and multiple sexual partners were independent risk factors(OR values were 0.53,0.33,3.05,1.83).In nursing group,the members had better mental state,the lower abdominal pain after surgery,inflammatory diseases and again induced abortion were significantly reduced,compared with non-nursing group,the difference was statistically significant(P＜0.05). Conclusion The low age of first sex,non-reading adolescent,unmarried cohabitation and multiple sexual partners are independent risk factors of artificial abortion of adolescents,enhance the nursing can effectively reduce the corresponding postoperative complications and the chance of abortion again.

PAN Xiao-cheng, CHEN Xiao-ling, WANG Hua-ping, WU Yi-dong, ZHAO Shi-yong, XU Jing-xia

2016, 14(1): 156-157. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.053

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WU Jian-jun, LI Bao-hua, ZHANG Yan-bin, JIANG Wei-hua

2016, 14(1): 158-160. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.054

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SHEN Dong

2016, 14(1): 161-162. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.055

90 1

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YE Hui-ying, LI Ming, HAN Shan-shan, YE Ya-li

2016, 14(1): 163-165. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.056

121 0

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About Journal

2016 Vol. 14, No. 1

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