中华全科医学

Report of social needs for health management profession personnel in Shanghai

DONG En-hong, BU Jia, ZHAO Fang, WEI Jun-jing, WANG Li-ping, BAO Yong

2016, 14(10): 1607-1610,1679. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.001

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Objective To analyze the current situation of social needs for health managementprofessional talents in medical institutions at various levels in Shanghai. Methods The Probability Proportional to Size(PPS) sampling method was used to sample randomly 100 institutions from medical institutions in Shanghai to survey the social needs for health managementprofessional talents. Results ①The general condition:in the distribution of education level,"undergraduate" accounted for the highest proportion(68.33%);in number of in-position,"1-2" accounted for the highest proportion(53.8%);the top three proportions of position were:"clinical medicine"(64.4%),"nursing"(33.8%) and "health management"(22.2%).②The requirements for the education level were successively "bachelor degree"(53.3%),"according to different demands"(38.9%) and "junior college"(15.6%);The requirement for certificate were "College English Four Certificate"(84.4%),"professional qualification certificate"(68.9%) and "computer grade Certificate"(31.1%).The top 3 important elements were "professional skills"(100.0%),"easy-going personality"(84.4%) and "academic performance"(46.7%).③ The requirement for training of professional talents:The top three future positions were "health management division"(84.4%),"medical secretary"(68.9%) and "medical insurance management"(15.6%).The top three vocational capacity were "Health assessment,intervention,counseling,education and marketing"(92.2%),"Information-based construction and application"(84.4%) and "basic medical insurance management"(68.9%);the demand number for health management profession talents by each institution was "5-6"(61.5%),which has the highest proportion in the next three years. Conclusion Training of professional talents should bring forth new ideas in the training scale,professional positioning and core skills so as to improve quality of health management profession personnel in Shanghai.

LI Dan, PAN Jia-hua

2016, 14(10): 1611-1612.

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Influence of thoracic sympathetic modulation on the heart rate variability in patients with primary palmar hyperhidrosis

FEI Yong, DENG Jia-jia, XIE Ke-yue, ZHANG Li, NI Hua-dong, GUO Jian-guo, XU Shi-jie, YAO Ming, HUANG Bing

2016, 14(10): 1613-1615,1785. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.002

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Objective To observe the evolution of heart rate variability(HRV) in patients with primary palmar hyperhidrosis after thoracic sympathetic modulation and evaluate the effects of the thoracic sympathetic modulation on the autonomic nerve system. Methods From January,2015 to November,2015,28 patients with primary palmar hyperhidrosis who were preparation for thoracic sympathetic modulation(Group P) and 22 outpatient healthy volunteers(Group C) in our hospital were enrolled into the study.The puncture of thoracic sympathetic nerve was guided by CT through the gap of T_3-4,until the needle tip arrive at the top of the fourth ribs head.2 ml of 1% lidocaine(mixed with Iohexol injection) was injected.The fingertip perfusion index(PI) was elevated more than 5 folds,the temperature of hands increased more than 3℃(about 20 min later).Then,2.5 ml of absolute alcohol was injected adjacently to thoracic sympathetic nerves.LF,HF,TP and LF/HF were recorded at the time points of before the operation(T0),10 min(T1),24 h(T2) after the operation at Group P.LF,HF,TP,the normalized values of LF(LFnu),the normalized values of HF(HFnu)and LF/HF were recorded at the time points of before the operation(T0) at Group C. Results In Group P,Oximetry-derived perfusion index and the temperature of hands raised(7.79±0.85) times and (5.03±0.85)℃ in average,respectively.All of the patients with palmar hyperhidrosis were cured within 3 months,there were no severe complications.As compared with those at T0 in Group P,TP,HF,HFnu at T1,T2 in Group P and T0 in Group C was significantly increased,and LF,LFnu,LF/HF was significantly decreased(P<0.05);There was no significantly differences between Group P at T1,T2 and Group C at T0(P>0.05). Conclusion CT-guided thoracic sympathetic modulation can be used for treating primary palmar hyperhidrosis safely and effectively,which may reduce the tension of the postoperative sympathetic nervous system,increase the tension of the vagus nerve system and improve the balance of the autonomic nervous system.

Clinical differences between sequential injection and single injection of botulinum toxin type A for curing masseteric hypertrophy

PAN Sheng-sheng, NI Bin-ting, LI Li-qun

2016, 14(10): 1616-1618,1685. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.003

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Objective To study the clinical effects of different injection methods of Botulinum toxin type A for curing masseteric hypertrophy. Methods A total number of 36 patients with idiopathic masseter hypertrophy in our hospital between December 2012 to December 2014 were enrolled into this study.15 patients received single injection and 21 patients received sequential injection group.By using the repeated measurement design,the masseter thickness of all subjects were detected and compared at the time of 1,3,6,9,12,18 months after the injection. Results The masseter thicknesses of the two groups were different after the injections,and the differences was statistical significant(F=38.91,P<0.001).For the single injection group,the masseter thicknesses was(14.80±0.18)mm before the injection,and decreased to (11.21±0.18)mm,(10.54±0.19)mm,(9.62±0.18)mm,(10.21±0.22)mm,(12.63±0.18)mm and(13.79±0.35)mm at the time of 1,3,6,9,12,18 months after the injection,respectively,the difference was statistical significant(F=955.59,1 503.4,2 239.03,1 183.99,384.87 and 70.39,respectively,P<0.001).For the sequential injection group,the masseter thicknesses was (14.93±0.18)mm before the treatment,and decreased to (11.41±0.16)mm,(10.62±0.18)mm,(10.00±0.18)mm,(9.50±0.25)mm,(9.33±0.25)mm and (10.44±0.24)mm at the time of 1,3,6,9,12,18 months after the injection,respectively,the difference was(F=2 184.58,3 724.88,1 610.48,3 105.48,3 665.60 and 1 948.86,respectively,P<0.001). Conclusion The sequential injection of Botulinum toxin A for 18 months has better clinical effects than the single injection of Botulinum toxin A in the treatment of masseteric hypertrophy.

Study of the clinical relevance between HDAC3 expression and gastric cancer

XU Li, HUANG Xiao-xu, XIA Ya-bin, HAN Zhen, HU Kai-feng

2016, 14(10): 1619-1622,1695. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.004

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Objective To study the correlation between the expression of HDAC3 and the occurrence,development and prognosis of gastric cancer. Methods The gastric cancer tissue microarray containing 111 samples with following-up information was utilized.The expression of HDAC3 protein was detected by immunohistochemistry and the correlation between the experimental data and clinical parameters as well as prognosis of gastric cancer was analyzed by SPSS software. Results HDAC3,specifically expressed in the nucleus,was significantly higher in gastric cancer tissues than para-carcinoma tissues(P=0.001).Clinical index correlation analysis showed that HDAC3 expression was positively correlated with T staging,M staging,N staging and clinical staging of gastric cancer patients significantly(r>0.2,P<0.05).Subsequent survival analysis also confirmed that the prognosis of patients with high HDAC3 expression were significantly worse(6.3% vs. 22.0%,P=0.029),in addition,age,tumor size,histological grade,T stage,N staging and clinical staging index were also significantly negative correlated with patients' survival time(P<0.05).Then,we included these seven prognostic factors in the Cox multivariate regression analysis.The results showed that only the T staging(P=0.043) but not HDAC3 and all other indicators was independent prognostic factor(P>0.05). Conclusion We speculate that the gastric cancer cells over-expressing of HDAC3 may have stronger invasion and migration ability,and could be easily transferred to the surrounding and distant tissues and organs,thus reducing the patient's lifetime.It is also possible that HDAC3 might be not in the leading role in this cancer promoting process which may be regulated by other gene and signaling network.Next,we plan to establish HDAC3 over expression gastric cancer cell lines,giving anticancer drugs and HDAC3 inhibitor treatment,in order to further study the specific molecular signaling network of HDAC3 in gastric cancer.

Effect of Yiqi Yangyin Decoction on suppressing tumor growth in mice bearing Lewis lung cancer via the Notch signal pathway and CD4^+CD25^+ regulatory T cells

YANG Guo-liang, HU Dan-dan

2016, 14(10): 1623-1625,1788. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.005

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Objective To investigate the dose-effect relationship for Yiqi Yangyin Decoction on suppressing tumor growth via Notch signal pathway and CD4⁺CD25⁺ regulatory T cells in mice bearing Lewis lung cancer. Methods Sixty inbred C57BL/6 mouse bearing Lewis lung cancer were randomly divided into four groups:model group(Group A),chemotherapy group(Group B),equivalent dose group(Group C),high dose group(Group D).The mice in Group A were only developed an animal model.The mice in Group B were induced by intraperitoneal injection of CTX according 15 mg/kg every week.The mice in Group C were treated with Yiqi Yangyin decoction of 0.435 ml/kg by intragastric gavage,and the mice in Group D were treated with Yiqi Yangyin decoction of 1.36 ml/kg by intragastric gavage.The change of tumor volume was recorded.Then all the rats were sacrificed and all tumor tissues were weighted.The Notch signal expression in tumor tissues was tested. Results ①Relative tumor volume(RTV) and relative suppressing-tumor rate:RTV of every group(except model group) was reduced.RTV of Group D was reduced mostly among the four groups.RTV of Group B was reduced more than that of Group C(P<0.05);the relative suppressing-tumor rate of Group D was highest in all four groups(P<0.05).The rate of Group B was higher than that of Group C(P<0.05).②The expression of Notch signal pathway and CD4⁺CD25⁺ Treg cell:the expression of Notch1 mRNA and CD4⁺CD25⁺ Treg in group C was higher than that in group B(P<0.05),but the expression in group D was lower than those in the group B and C(P<0.05);there was no significant difference in the expression of Notch3 mRNA between group B and group C(P>0.05),but the expression of Notch3 mRNA in group D was lower than those in the group B and C(P<0.05);the expression of Jagged1 mRNA and Hesl mRNA in group B,C and D were lower than that in group A(P<0.05);there was no significant difference in the expression of Jagged1 mRNA and Hesl mRNA between group B and group C(P>0.05),but the expression of Jagged1 mRNA and Hesl mRNA in group D was lower than those in the group B and C(P<0.05). Conclusion Yiqi Yangyin decoction can suppress the Lewis lung cancer cell,and the effect has dose-response relationship.The mechanism maybe associated to the expression regulation of Notch1 signal pathway and CD4⁺CD25⁺ Treg.

Association of estrogen receptor 1 gene polymorphism with idiopathic scoliosis in adolescents:a Meta-analysis

LI Chao-ding, XU Jie, WANG Xi-an, SHI Chao

2016, 14(10): 1626-1628,1761. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.006

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Objective To assess the potential associations of estrogen receptor 1 gene (ESR1) rs9340799(Xbal locus) and rs223469(PvuⅡ locus) polymorphism with adolescent idiopathic scoliosis(AIS). Methods Studies on AIS published up to July 23,2015 were initially searched from PubMed,Wangfang Med Online,China Biological Medicine Database(CBM),China National Knowledge Infrastructure(CNKI) and VIP Database,and then eligible case-control data on associations of ESR1 with AIS were retrieved by the inclusion criteria.Meta-analysis was performed using Stata software(version 12.0),and odds ratio(OR) value for the data was pooled for evaluation of the publication bias. Results By the pre-determined inclusion and exclusion criteria,a total of 4 articles were finally included in this meta-analysis.Associations of ESR1 rs9340799 predisposition with AIS appeared in 4 articles,and rs2234693 in 3.The studies indicated that the OR value for correlation of ESR1 rs9340799 gene polymorphism with AIS was 1.08(0.83-1.21),1.06(0.91-1.24) and 1.08(0.63-1.83) for allele model(G vs. A),dominant model (GG+AG vs. AA),and recessive model(GG vs. AG+AA),respectively.The difference was not significant.By association of ESR1 rs2234693 gene polymorphism with AIS,the OR value was 1.08(0.92-1.26),1.07(0.85-1.35) and 1.14(0.85-1.54),respectively for allele model(C vs. T),dominant model(CC+TC vs. TT) and recessive model(CC vs. TC+TT),with no statistical significance. Conclusion Our meta-analysis suggests that current studies can not supply enough evidences to prove the associations of ESR1 rs9340799 and rs2234693 gene polymorphisms with AIS.

Application of leflunomide and methylprednisolone combined with entecavir in the treatment of hepatitis B virus associated glomerulonephritis

CHEN Zheng, LIU Lei, ZHANG Yan, CHEN Wei-dong, GUO Ya-ling

2016, 14(10): 1629-1631. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.007

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Objective To explore the efficacy and safety of leflunomide and methylprednisolone combined with entecavir for the treatment of HBV-associated glomerulonephritis(HBV-GN). Methods Thrity-seven patients hospitalized with HBV-GN from January,2014 to December,2015 were selected;all of them were confirmed with HBV-GN based on renal biopsy;Twenty-one patients were assigned to the treatment group to receive treatment with leflunomide and methylprednisolone combined with entecavir,and 16 patients were assigned to the control group to receive entecavir antiviral treatment alone.Patients in the two groups were compared for reduction in urine protein,ALT and HBV-DNA load at 3 and 6 months of treatment. Results After 3 months of treatment,the urine protein level in the treatment group was (1.76±1.20) g/24 h,which was significantly better than (2.70±1.50) g/24 h in the control group(P<0.05);at 6 months of treatment,the urine protein level in the treatment group was(1.61±0.90) g/24 h,which was significantly better than(2.34±1.20) g/24 h in the control group(P<0.05);there was no significant difference between the two groups in ALT(17.0±6.3) U/L in treatment group compare with (19.7±4.0) U/L in control group(P>0.05);by 3 months of antiviral treatment,HBV-DNA load had normalized in patients in both groups upon monitoring;there was no significant difference between the two groups in ALT(19.0±4.7) U/L in treatment group against (18.3±4.4) U/L in control group(P>0.05);and HBV-DNA load had normalized in both groups. Conclusion As the therapeutic approach for HBV-GN remains controversial in clinical practice,the patient would typically develop into ESRD within several years due to uncontrolled urine protein,which could markedly decline the patient's quality of life or even be life-threatening,and has been a heavy burden on the national medical insurance system.Considering that the efficacy and safety of leflunomide and methylprednisolone combined with entecavir for the treatment of HBV-GN remain unclear,this study is expected to provide more evidences for the management of HBV-GN.

Clinical efficacy of Esomeprazole on nonsteroidal anti-inflammatory drugs caused peptic ulcer bleeding

ZHENG Sheng, YANG Juan, TANG Ying-mei, YANG Jin-hui

2016, 14(10): 1632-1634,1635. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.008

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Objective To analyze clinical haemostatic effect and incidences of adverse reactions of Esomeprazole treatment for patients who suffered from peptic ulcer bleeding because of taking nonsteroidal anti-inflammatory drugs. Methods From January,2012 to June,2015,496 cases of peptic ulcer with upper gastrointestinal haemorrhage who visited our digestive department receiving treatment were randomly divided into two groups:Esomeprazole group(280 patients) and control group of Omeprazole(216 patients) were treated with different treatment regimen.The efficacy,adverse reactions of test group and control group were compared. Results The clinical total effective rate of test group and control group were 97.85% and 88.88%,respectively.Test group was significantly higher than control group (chi-square test,P<0.05).The average disappearance time of clinical symptoms in test group and control group were (3.2±1.5)d and (4.8±1.3)d,respectively.Test group was significantly shorter than control group by analysis of variance(P<0.05).There was no significant difference in adverse reaction rate between test group and control group (chi-square test,P>0.05). Conclusion Esomeprazole combined with hemocoagulase treatment gastrointestinal bleeding caused by nonsteroidal anti-inflammatory drugs is significantly better than omeprazole combined with hemocoagulase.Test group,which has hemostatic effect exactly,can effectively shorten the time of the patients stay in EICU and is the ideal disposal measures.

Treatment of lower extremity ischemity ischemic arterial diseases: an analysis of 228 cases

YIN Xiao-liang, GAO Yong, CHEN Shi-yuan, NIE Zhong-lin, TANG Wen-bo

2016, 14(10): 1635-1637,1650. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.009

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Objective To evaluate the clinical incidence and therapeutic measures of lower extremity arterial ischemic disease. Methods The clinical data of 228 patients with lower extremity arterial ischemic disease were retrospectively analyzed,which included drug treatment,embolectomy,catheter directed thrombolysis(CDT),percutaneous transluminal angioplasty(PTA),artery bypass grafting,amputation and the combination of a variety of treatments who were admitted to our hospital from January,2014 to July,2015. Results There were 87 cases of acute arterial ischemia,48 cases of acute artery embolism,39 cases of acute arterial thrombosis,79 cases were effective(90.8%),8 cases were invalid(9.2%),amputation in 7(8.0%),die in 1(1.2%);in 141 cases of chronic ischemia,atherosclerosis occlusion(ASO) in 105 cases,thromboangiitis obliterans(TAO) in 36 cases,effective in 127 cases(90.1%),invalid in 14 cases(9.9%),amputation in 12(8.5%),die in 2(1.4%). Conclusion The increasing incidence of ischemic disease of lower extremity,if treatment is not timely,disability,lethal rate is higher,in order to reduce the morbidity and mortality rate,it should be according to the priorities of the disease,lesion location and the characteristic of combining the patients' conditions considering the choice of drugs,percutaneous transluminal angioplasty,open surgery or a combination of a variety of treatments.

Effect of prostaglandin E2 on the immune function of CD4^+CD25^+ regulatory T cells

TANG Lu-ming, WANG Lin-xia, PAN Xiao-dong, SUN Lai-fang

2016, 14(10): 1638-1640,1768. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.010

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Objective To explore the influence of prostaglandin E2 on the immune function of CD4⁺CD25⁺ regulatory T cells. Methods CD4⁺CD25⁺ Tregs isolated from the spleens of male BALB/C mice were seeded on 96-well cell culture plates coated with anti-CD3 and soluble anti-CD28,and cells were stimulated with prostaglandin E2.According to the different concentrations of PGE2 stimulation,the cells were divided into four groups:control,A(7 μmol/L),B(14 μmol/L),and C(28 μmol/L) groups.The proliferation of cells,IL-10,IL-2 and expression of Foxp3 in Tregs were determined at various intervals. Results After being stimulated with PGE2 for 12 h,the proliferation of cells in A,B,and C groups had no significant difference(P>0.05),and IL-2,Foxp3 expression in B,C groups were respectively down-regulated and up-regulated markedly(P<0.05),and IL-10 levels in C group was markedly up-regulated(P<0.05) compared with control group.For 24 h,the proliferation of cells in B,C groups were significantly increased(P<0.05),IL-2 levels in A,B,and C groups were significantly down-regulated(P<0.05),but Foxp3 expression was increased(P<0.05),IL-10 levels in C group was markedly up-regulated(P<0.05).For 72 h,the proliferation of cells,IL-10 and Foxp3 expression in A,B,and C groups was markedly up-regulated(P<0.05),but IL-2 levels in three groups were significantly down-regulated(P<0.05). Conclusion These data indicate that PGE2 stimulation can directly strengthen immunosuppression function of Treg in vitro,which may further exert some regulating effect on the immune function of effector T cells.

Effect of PARP-1 silencing on the cisplatin-resistance and related biological behavior of epithelial ovarian cancer cells

CHENG Li, XING Hui, ZHOU Min

2016, 14(10): 1641-1643,1702. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.011

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Objective To investigate the effect of PARP-1 silencing on the cisplatin-resistance and related biological behavior of epithelial ovarian cancer cells. Methods The A2780 human epithelial ovarian cancer cells was selected for the study and small RNA interference technology was used for silencing the expression of PARP-1.The Western blot test,RT-PCR experiments and MTT experiments were used to observe PARP-1 protein,mRNA expression and cell trends survival. Results In the PARP1-siRNA transfection group,PARP-1mRNA expression was significantly lower than that of A2780 group and NC-siRNA transfected group(P<0.05);PARP-1 protein expression in PARP1-siRNA transfection group was significantly lower than that of A2780 IOD group and NC-siRNA transfected group(P<0.05);Compared with 0 μmol/L,the IOD of PARP-1 protein expression in 5 μmol/L and 10 μmol/L group were significantly lower(P<0.05);With cisplatin concentration increasing,cell viability in PARP1-siRNA transfection group decreased fastest. Conclusion PARP1-siRNA transfection can significantly reduce PARP-1 expression of human ovarian cancer cell line A2780,meanwhile the sensitivity of cells to cisplatin drugs and cell viability decrease significantly.

Effects of zoledronate on RANK expression and differentiation of mononuclear cells to osteoclasts

WU Xiao-wei, LI Shao-han, CAO Wen-juan

2016, 14(10): 1644-1646,1782. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.012

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Objective To investigate the effect of zoledronate on osteoclastogenesis and theexpression of Capthsin K,Receptor activator of nuclear factor kappa-B(RANK) which related with Osteoclast differentiation,and explore the mechanism of action of zoledronate on osteoclastogenesis. Methods The receptor activator of nuclear factor kappa-B ligand(RANKL) was used to induce differentiation of RAW264.7 cells into osteoclasts in vitro.The cells were divided into two groups at the beginning of the induction:Group one(G1) were induced by 50 ng/ml RANKL as the control group;Group two(G2) were treated with 1×10^-6 mol/L zoledronate simultaneously with the osteoclast induction.The cells were acquired after four days induction.The cells were stained with tartrate resistant acid phosphatase(TRAP) and the osteoclastswere counted.Activity of alkaline phosphatase was detected.The expression of Cathepsin K and RANK were detected by Real-time PCR and western blot,respectively. Results The osteoclastogenesis was decreased by the addition of zoledronate.The number of TRAP+ cells in G2 was decreased(62.0±10.2)% as compared to G1(P<0.05).TRAP activity in G2 was declined as (31.0±4.1)% as compared to G1(P<0.05);the expression of Cathepsin K and RANK in G2 were significant declined by (78.0±4.2)% and (49.0±1.9)% when compared to G1(P<0.05). Conclusion Zoledronate can decrease osteoclastogenesis by inhibiting the expression of RANK in osteoclast precursors.

Prognostic difference in colorectal cancer patients with or without lymphovascular invasion

HUANG Qing, ZHU Hai-bo, ZHOU En-cheng, DONG Mi-lian, YANG Lei-lei, FANG Cheng-feng, CHEN Jian-hui, MAI Yi-feng

2016, 14(10): 1647-1650. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.013

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Objective To investigate the prognostic difference of colorectal cancer patients with or without lymphovascular invasion after the surgical treatment. Methods The clinicopathological data of colorectal cancer patients in our hospital between 2005 and 2010 were retrospectively analyzed.The relationship between lymphovascular invasion and clinical parameters were analyzed with ANOVA.Univariate and Cox multivariate analysis were also conducted to identify the prognostic factor of colorectal cancer patients.Kaplan-Meie was performed to investigate the correlation between lymphovascular invasion-positive and the prognosis of patients. Results ANOVA showed that lymphovascular invasion closely related to tumor differentiation(P=0.01),lymphatic metastasis(P<0.001),TNM(P<0.001) and survival rate(P<0.001).Cox regression analysis showed that lymphovascular invasion(P=0.001),lymphatic metastasis(P=0.025),TNM stage(P<0.001) were the independent prognostic factor for colorectal cancer patients.Kaplan-Meie analysis of lymphovascular invasion demonstrated that the patients with lymphovascular invasion-positive had a significantly shorter survival time than those with lymphovascular invasion-negative patients(P<0.001). Conclusion Lymphovascular invasion had a compact relationship with lymphatic metastasis,and the positive-lymphovascular invasion might be a potential independent prognostic factor for patients with colorectal cancer.The more efficient therapy and method for colorectal cancer patients with positive lymphovacular invasion should be adopt to improve living standard and prolong survival time.

Retroperitoneal laparoscopic versus open nephrectomy for localized renal cell carcinoma

GE Xue-kai, ZHOU Wen-sheng

2016, 14(10): 1651-1653. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.014

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Objective To compare the clinical efficacy and safety of laparoscopic and open nephrectomy on the treatment of localized renal cancer. Methods From February,2013 to February,2014,79 cases of localized renal cell carcinoma were collected in the department of urology,first affiliated hospital of bengbu medical college.Clinical stage were Ⅰ and Ⅱ.After the laparoscopic group of 42 cases,28 cases of male,female 14 cases.Tumors located in the left side of the 14 cases,28 cases on right side.Open surgery group of 37 cases,25 cases of male,female 12 cases.Open surgery group of 37 cases,25 cases of male,female 12 cases.Tumors located in the left side of the 13 cases,24 cases on right side.Compare two groups patients,general information,operation time,Postoperative bed time,intraoperative blood loss,postoperative blood laboratory index changes,length of hospital stay,etc.Laboratory parameters was obtained by detecting peripheral venous blood.Data using SPSS 19.0 analysis software.The measurement data were expressed by mean plus or minus standard deviation(x±s),t test with two independent samples was used for analysis.P<0.05 difference was statistically significant. Results There was no difference between the 2 groups in the basic situation,the maximum diameter of the tumor,the tumor location and urea nitrogen(P>0.05) in third days after surgery.The postoperative follow-up period was 12-24 months.There were no tumor recurrence,incision implantation and distant metastasis in the 2 groups. Conclusion In the treatment of localized renal cell carcinoma,retroperitoneal laparoscopic radical nephrectomy compared with open radical nephrectomy has advantages such as less trauma,faster recovery,less bleeding,less operation time and reduce postoperative complications.

The effect of different thickness of skin flaps on the postoperative efficacy and complications of radical breast cancer

ZHANG Nian-qing, ZHANG Song, WEI Jun, WANG Gang

2016, 14(10): 1654-1656. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.015

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Objective During recent years,the use of a number of free flap method in the breast cancer surgery,the flap thickness also have different discussion.We tried to make surgery done thoroughly,often worried thick flap may cause residual tumor,affecting local recurrence and distant metastasis after surgery.While ignoring the complications of breast cancer.This article further investigate the effect of different thickness of the flaps on the postoperative efficacy and complications of radical breast cancer. Methods The breast cancer patients were randomly divided into thin flap surgery group,medium thickness skin flap surgery group for comparison research.In addition to the two groups of patients during surgery using the different methods of the flap thickness,the rest is the same. Results In the 87 cases of free thin flap group,5 cases of locoregional recurrence,the recurrence rate of 5.7%,5-year survival of 62 cases,5-year survival rate was 71.3%,17 flap necrosis,severe necrosis of the six cases;localized area effusion 39 cases,22 cases occurred area effusion duration of the delay.In the 99 cases of thick free flap group,six cases of locoregional recurrence,the recurrence rate of 6.1%,5-year survival of 75 cases,5-year survival rate was 75.8%,4 flap necrosis,severe necrosis 1 case;localized area effusion 21 cases,six cases occurred area effusion duration of the delay.The distant metastasis and local recurrence rates in the two groups had no statistical difference,and the partial necrosis rate of skin flap and the duration of the incidence of local effusion,regional effusion were statistically significant differences(P<0.05). Conclusion The different thickness of skin flaps had no obvious effectradical breast cancer in postoperative distant metastasis and local recurrence rate,medium thickness skin flap can effectively lower the local skin flap necrosis rate and incidence of local effusion,shorten the duration of the regional fluid.

Values of embracing fixator for damage-control surgery in the management of traumatic flail chest

CHEN Yong-jie, ZHANG De-feng, YI Hong, LIU Chuan, XIA Li-qiong, ZHU Jian-ting, YAO Xu-hui, LI Zi-long

2016, 14(10): 1657-1659. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.016

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Objective To investigate the values of embracing fixator for damage-control surgery in the management of traumatic flail chest. Methods Sixty patients with traumatic flail chest were enrolled in this prospectively study.According to the principle of completely random digital table,all patients were randomly signed into experiment group(n=30) or control group(n=30).Damage control surgery with embracing fixator was adopted in experiment group,while fixed rib fixation was adopted in the control group.The primary outcomes were clinical interventions,major complications and clinical outcomes. Results When compared with the control group,patients in the experiment group got a significantly shorter analgesic drug use time[(2.41±1.43) d vs. (4.21±2.61) d,P=0.012];a significantly shorter antibiotic use duration[(3.24±2.93) d vs. (6.32±2.43) d,P=0.008)];a significantly shorter mechanical ventilation duration[(2.82±0.79) d vs. (5.21±1.33) d,P=0.028];a significantly lower rate of pulmonary atelectasis(3.33% vs. 23.33%,P=0.023);and a significantly shorter hospital duration[(18.32±7.43) d vs. (26.43±11.93) d,P=0.002].There was no difference between the two groups in mechanical ventilation,closed drainage of thoracic cavity,closed drainage of thoracic cavity duration,lung infection and acute respiratory distress syndrome(P>0.05).None patients died during the study period. Conclusion The embracing fixator for damage control surgery in the management of traumatic flail chest improves the clinical outcomes and hospital duration.

The clinical application of the scenery picture memory test combined with clock drawing test and clock reading test to screen the cognitive impairment patients in the elderly

CAO Yan-jing, LIN Ping, JIN Mu-dan, ZHENG Feng-ming, LI Peng, LIANG Li-zhen

2016, 14(10): 1660-1662. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.017

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Abstract:
Objective To investigate the sensitivity and specificity of Scenery Picture Memory Test and combined with the the Clock Drawing Test(CDT) and clock reading(CRT) to screen the mild cognitive impairment and AD patients in the elderly. Methods All of the subjects were recruited from the outpatient department of the Third Hospital of Hangzhou and the memory disorder clinic.All the subjects were given MMSE,SPMT,CDT and CRT.According to the test Results The 182 subjects were divided into normal group,mild cognitive impairment group,early AD group and progressed AD group.In the 4 groups,with 45(24.73%)of the dementia diagnosed with MCI,38(13.74%)were early AD,25(13.74%) were diagnosed with moderate to severe AD,74(29.38%) were normal health.Results:The sensitivity and specificity of SPMT in patients with MCI were 76.25% & 79.83%,compared with CDT(41.06%,77.65%)and CRT(36.03%,57.80%),it is significantly higher than the latter.However,there was no significant difference in the sensitivity and specificity among SPMT(82.33%,86.44%),CDT(72.0%,79.83%)and CRT(49.23%,85.62%) in diagnosis of early AD(P>0.05).The similar results were observed in the progressed AD group,the sensitivity and specificity of SPMT was 77.85% and 84.29%,CDT was 77.14%,77.85%,and CRT was 54.30%,59.90%,respectively. Conclusion SPMT can be used as an effective approach to screen the mild and early cognitive impairment in the elderly.

Effect of laparoscopic radical prostatectomy reserving partial proximal prostate urethra on 36 cases of prostate cancer

XU Gang, YU Li-hang, PAN Shou-hua, YAN Jia-jun

2016, 14(10): 1663-1665. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.018

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Abstract:
Objective To observe the effect of retention laparoscopic radical prostatectomy with reserving partial proximal prostate urethra on the early urinary incontinence,and to explore its clinical value. Methods Seventy-two cases of prostate cancer in our hospital from June,2013 to March,2015 were enrolled in this study.There were consistent with surgery evidence.According with the paired grouping method,they were divided into two groups with 36 cases in each group;the control group took the non-retained part of the proximal prostatic urethra prostatectomy while the observation group accepted retention laparoscopic radical prostatectomy with reserving partial proximal prostate urethra.Separation of the tip of the prostate and the urethra at the junction,the surgeon at the tip of the prostate by using small gauze to separate the glass ball from the 0.5-1.0 cm long urethra.Both groups were treated with anti-infectious treatment.72 patients were followed up for 12 months to compare early urinary incontinence between two groups. Results The operation time,intraoperative bleeding,hospitalization time and the catheter indwelling time in the observation groups were (145.2±42.7)min,(415.2±91.2)ml,(11.2±2.2)d and (15.3±2.6)d,which had no significant statistical differences as compared with (139.8±35.8)min,(398.5±98.6)ml,(10.9±1.9)d and (14.5±2.5)d,P>0.05.At 1 months,3 months and 6 months after the operation in the observation group,the complete continence was seen in 19 cases(52.8%),31 cases(86.1%),32 cases(88.9%),which were significantly higher than those in the control group[8 cases(22.2%),16 cases(44.4%),25 patients(69.4%)],P<0.05.The ICIQ-SF score in the observation group after 1 month,3 months and 6 months were significantly lower than that of the control group,P<0.05. Conclusion The laparoscopic radical prostatectomy reserving partial proximal prostate urethra can improve the early urinary control of patients,which has important clinical value.

Prevention and risk factors of traumatic cerebral infarction in patients with craniocerebral injury

NI Xiao-wei, KONG Lai-fa, HUANG Ming-wei

2016, 14(10): 1666-1668. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.019

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Abstract:
Objective To determine the prevention and risk factors of traumatic cerebral infarction in patients with brain injury,so as to improve its prevention and treatment. Methods Total 277 cases of brain injury patients admitted to our hospital from January,2011 to January,2014 in our hospital were collected.All patients underwent craniotomy,according to whether there was a traumatic cerebral infarction,patients were divided into observation group of 26 cases,251 cases in the control group.Application of single factor analysis of two groups of patients with age,sex,BMI,whether the merger of hypertension,coronary heart disease and admission hyperglycemia,combined injury,cerebral infarction history,mode of operation,type of brain injury,types of cerebral infarction,GCS score,whether complicated with cerebral hernia and whether complicated with malignant brain edema.The risk factors of traumatic cerebral infarction in patients with craniocerebral injury were analyzed by multifactor non-conditional Logistic regression analysis. Results A total of 26 patients complicated with cerebral infarction.The occurrence rate was 9.4%.Preoperative hyperglycemia,subdural hematoma,decompressive craniectomy,GCS less than eight score,combined with cerebral hernia and malignant brain swelling was related with the brain injury after operation occurred(P<0.05). Conclusion Peoperative hyperglycemia,GCS less than eight score,combined with cerebral hernia and associated with malignant brain swelling increase the independent risk factors of traumatic cerebral infarction after craniocerebral injury operation.Intervention should be strengthened in the prevention and treatment of traumatic cerebral infarction after traumatic brain injury.

Curative effect of noninvasive ventilator on acute heart failure

XU Xiao-fei

2016, 14(10): 1669-1670. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.020

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Abstract:
Objective To observe the role of noninvasive positive pressure ventilation(NIPPV) with bilevel positive airway pressure(BiPAP)ventilator in the treatment of acute left heart failure. Methods A total number of 112 cases acute left heart failure in our hospital between June,2012 and October,2015 were enrolled and randomly divided into 2 groups.The 58 patients in the treatment group(group BiPAP) received NIPPV with BiPAP on the basis of routine drug for heart failure treatment,while the 54 patients in the control group were only administrated with routine drug for heart failure treatment.The symptoms,signs and hemodynamics of patients were recorded and compared before and after the treatment. Results The significant efficiency was 55.6% in the control group and 72.4% in the treatment group;the total effective rate was 75.9% in the control group and 96.6% in the treatment group;the difference in the significant efficiency and total effective rate was significant between the two groups(P<0.05).There were no significant difference in heart rate,breathing,systolic blood pressure,blood oxygen saturation and blood carbon dioxide partial pressure before the treatment between the two groups(P>0.05);after the treatment,the above indexes in the treatment were significantly better than that of control group(P<0.05). Conclusion BiPAP noninvasive ventilation can avoid complications caused by endotracheal intubation or tracheostomy,improve patient comfort,retainthedefense function of airway and the function of speech and swallowing without interference on breathing,and significantly improve left heart function.It is a kind of safe and effective rescue measures,which is worth popularization in clinic.

The value of “We Chat group” in acute myocardial infarction patients about using seamless referral and the emergency treatment

ZHU Liang-feng, TANG Guan-min, ZHAI Chang-lin

2016, 14(10): 1671-1673,1676. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.021

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Abstract:
Objective To explore the value of a new way of communication"WeChat group" in patients with acute myocardial infarction in the surgical referral. Methods According to whether the related medical information timely upload to WeChat group,we divided acute myocardial infarction patients with emergent PCI as WeChat group and control group from the grass-roots hospitals from January to December 2014,which WeChat group 46 cases,control group 40 cases.And we observed standard rescue process completion rate and the occurrence rate of major cardiovascular complications in two groups. Results There was no significant difference in ECG completion rate and preoperative medications in two groups.But it was significantly higher in WeChat group in preoperative procedures completion rate,emergency operation delivery rate and occlusive vascular patency rate than those of the control group,and the difference were statistically significant(χ²=5.27,5.47,6.61,P<0.05);The major cardiovascular complications incidence in WeChat group occurred was significantly lower than that of the control group,and the difference was statistically significant (χ²=4.45,P<0.05).The sudden cardiac death occurred in WeChat group and control group were 2 cases and 7 cases,respectively,and there was significant difference between two groups (χ²=3.94,P<0.05). Conclusion As a new way of communication,WeChat has the characteristics of fast,convenient and efficient,can significantly improve the efficiency of communication,and can significantly improve the completion rate of referral of patients with acute myocardial infarction standardization process,improve the success rate,and it is worthy of popularization and application.

Correlational research of hypertension with coronary heart disease and chronic inflammation leukocytes

LUO Chun-yan, LAI Chun-lin, XING Jin-ping, YAN Pu-juan, RUAN Lu-fang

2016, 14(10): 1674-1676. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.022

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Abstract:
Objective To detect the serum levels of hypersensitive C-reactive protein(hs-CRP),lipoprotein associated phospholipase A₂(LP-PLA₂)and tryptase(TPS) in patients with hy-pertension.To analyze the correlation of them and hypertension with coronary heart disease,and to explore clinical significance of the three leukocytes in the hypertension with coronary heart disease. Methods A total of 155 patients were participated in the study,all the patients were divided into three groups,pure hypertension group of 75 cases,hypertension with coronary heart disease group of 80 cases,and 48 normal controls enrolled in the study.Using ELISA detect the level of LP-PLA₂,TPS.The differences of the two leukocytes levels between three groups were analyzed.The risk factors of hypertension with coronary heart disease were analyzed with logistic regression analysis,and ROC curve we-re used to evaluate the diagnostic value of hs-CRP,LP-PLA₂ and TPS for coronary heart disease. Results The concentrations of hs-CRP,LP-PLA₂ and TPS in the hypertension with coronary heart disease group were higher than that in the pure hypertension group and the normal controls(P<0.05).Logistic regression analysis demonstrated that hs-CRP,LP-PLA₂,and TPS are the risk factors of hypertension with coronary heart disease(P<0.05).The area under the ROC curve were 0.775,0.656,0.793. Conclusion The serum levels of hs-CRP,LP-PLA₂ and TPS have a certain correlation with hypertension with coronary heart dis-ease.hs-CRP,LP-PLA₂,and TPS are the risk factors of hypertension with coronary heart disease.They could be important forecast factors in the clinical evaluation of hypertension with coronary heart disease.

Correlation of abnormal calcium-phosphorus homeostasis and heart malfunction patients with chronic kidney disease

WU Ling, BAI Yun-huan, CHEN Ting, ZHANG Li, WANG Yun-ruo, ZHU Hong, LI Fen, CHEN Mao-jie

2016, 14(10): 1677-1679. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.023

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Abstract:
Objective To analyze the relationship between the calcium-phosphorus metabolic profiles and cardiac malfunction characteristics in the chronic kidney disease(CKD) patients,discuss the role of calcium phosphorus metabolism in the heart damage,and provide reference for the privation of cardiovascular events in CKD patients. Methods A total number of 98 inpatients at stages of CKD3,CKD4 and CKD5 were recruited.Fasting venous blood was taken and calcium-phosphorus metabolic indices,including serum calcium,serum phosphate(Pi),intact parathyroid hormone(iPTH),β-collagen-specific sequences,total N-terminal propeptide of type Ⅰ procollagen(TPINP),and N-terminal-midfragment of ostecalcin(N-MID) were measured via electrochemiluminescence.Cardiac damage parameters,including left ventricular end diastolic diameter,interventricular septal thickness,left ventricular posterior wall thickness,ejection fraction(EF),and blood flow velocity at mitral diastolic late phase(A) and at mitral diastolic early phase(E) were obtained from echocardiography. Results There was an escalating trend in deteriorating calcium-phosphorus metabolic indices for patients from stage CKD3 to stage CKD5(P<0.05).Among 98 patients,35.7%(n=36) had myocardial hypertrophy,71.4%(n=70) had the diastolic dysfunction,and 27.5%(n=27) had systolic dysfunction.Correlations between abnormal calcium-phosphorus metabolic indices,such as β-CTX,N-MID,TP1NP,Pi,and iPTH,with myocardial hypertrophy,cardiac systolic indicator EF and the A/E value,diastolic dysfunction index,were evidenced. Conclusion In the context of kidney dysfunction,the abnormalities of calcium-phosphorus homeostasis may contribute to cardiac malfunction in CKD patients.

Efficacy of routine laparoscopic and gasless laparoscopic management of ectopic pregnancy

ZHOU Qin, WANG Ying-nan, XU Ying-zi

2016, 14(10): 1680-1682. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.024

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Abstract:
Objective To discuss the effect of gasless laparoscopic and gasless laparoscopy treatment of ectopic pregnancy. Methods The gasless laparoscopy was performed in 75 cases of ectopic pregnancy in our hospital,while the routine laparoscopic management was carried out in another 75 cases of ectopic pregnancy as control.The preoperative pelvic bleeding,peroperative bleeding,operative time,time to exhaust,postoperative pain,postoperative hospital stay,hospital costs and postoperative complications and blood gas analysis of preoperative and postoperative in two groups were compared. Results The operative time was (32.49±21.06)min,time to exhaust was (11.79±3.78)h,hospitalization costs was(6 897.34±205.31)Yuan,and the incidence of nausea and vomiting and incidence of shoulder and back pain(36.0% and 6.7%,respectively) in the observation group,which were lower than the control group[(49.35±24.56)min,(16.52±4.34)h,(7 891.24±179.86)Yuan,66.7% and 26.7%](P<0.05).At 10 minutes after the beginning of surgery and the end of surgery,the pH value,PO₂ and SaO₂ in both groups were lower than those before the surgery(P<0.05),however,the PaCO₂ were higher than before the surgery(P<0.05).At 10 minutes after the beginning of surgery and the end of surgery,the pH value,PO₂ and SaO₂ in the observation group were lower than those in the control group(P<0.05),but the PaCO₂ were higher(P<0.05). Conclusion Gasless laparoscopic treatment for ectopic pregnancy can shorten the operation time and postoperative discharge time,reduce hospital costs,decrease the incidence of postoperative complications,with little effect on blood gas analysis,it is worth popularizing in clinic.

A study on three different methods for neonatal sedation

SHE Ya-e, GU Yue-ping, TENG Yi-qun, HE Meng-zao

2016, 14(10): 1683-1685. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.025

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Abstract:
Objective To explore the best method for chloral hydrate sedation for cases like cranial computer tomography (CT) and brainstem auditory evoked potential. Methods The 398 newborns who needed chloral hydrate sedation were randomly divided into three groups according to three different dosing methods,namely mouth feeding for 98 infants,rectal administration for 150 cases,and tube feeding for the rest 150 neonates.There were no significant differences between weights at birth,ages in days or kinds of diseases for the infants in the three groups.To observe the smoothness of operations for the three groups,then monitor the sedative effects and occurance of adverse reactions within 24 hours for those infants who successfully took medicine in. Results The difference between the degree of ease of the three methods was statistically significant(P<0.05).When comparing the smoothness of operations for the groups one by one,there was significant difference between tube feeding group and rectal administration group(P<0.012 5),and there was significant difference between tube feeding group and mouth feeding group(P<0.012 5).However,there was no significant difference between the degree of ease between rectal administration group and mouth feeding group(P>0.012 5).The sedative effects of the three groups showed no significant difference (P>0.05).Within 24 hours,the only significant difference in adverse reactions had been the possibility of getting diarrhea (P<0.05).Comparing the possibility of getting diarrhea for groups one by one,there was significant difference between rectal administration group and tube feeding group (P<0.012 5).The difference was also significant between rectal administration group and mouth feeding group (P<0.012 5).There was no significant difference in the possibility of getting diarrhea between tube feeding group and mouth feeding group(P>0.012 5). Conclusion As for neonatal sedation,tube feeding is better than mouth feeding and rectal administration,since it smooths the operation with lower pain level for patient and less adverse reactions.It reduces the workload for nurses as well.

Clinical study of cytomegalovirus-induced infectious mononucleosis-like syndrome in children

HONG Shu-jun, PAN Jing, NI Wen-quan, CHEN Ye, PAN Jia-hua, CHEN Ming-wu

2016, 14(10): 1686-1688,1725. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.026

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Abstract:
Objective To investigate the clinical features of cytomegalovirus-induced infectious mononucleosis-like syndrome in children. Methods We retrospective1y reviewed the information of 81 children diagnosed with cytomegalovirus-induced infectious mononucleosis-like syndrome in our hospital between January,2010 and December,2014,including their laboratory examine results and clinical data.The data were compared with 30 EB virus induced infectious mononucleosis children. Results A total number of 81 children with mononucleosis-like syndrome caused by CMV(CMV group),aged from 1 to 11 years with an average age of 5.4 years old,the male and female ratio was 1:0.84,were enrolled into this study.The main clinical manifestations of the patients included fever,lymph node enlargement,angina,splenomegaly,palpebral edema,wheezing and so on.When compared with 30 EBV induced infectious mononucleosis children(EBV group),the thermal process of CMV group was (9.15±4.65)days,the difference between two groups was not statistically significant(t=0.979,P>0.05).The length of patient stay in CMV group was (15.88±4.31) days,the difference between two groups was statistically significant(t=2.492,P<0.001).WBC of CMV group was (16.85±6.33)×10⁹/L,the neutral granulocyte count of CMV group was (4.19±2.84)×10⁹/L,and the lymphocyte count was (12.50±6.03)×10⁹/L,the difference between two groups were not statistically significant(t=1.16,t=1.08,t=1.44,P>0.05).The platelet count of CMV group was (260.46±80.69)×10⁹/L,the difference between two groups was statistically significant(t=7.02,P<0.001),as well as the degree of abnormal lymphocytes increased(t=3.814,P<0.001).The increase of abnormal lymphocyte had relationship with the length of stay(F=82.79,P<0.05). Conclusion Fever is the most common clinical manifestations of cytomegalovirus-induced infectious mononucleosis-like syndrome.The liver function damage of infectious mononucleosis-like syndrome caused by cytomegalovirus is better than EBV induced infectious mononucleosis,and the degree of abnormal lymphocytes increased is lower and recovered faster.

Effect of community education on reducing fall-related injuries in older people

GONG Qin-feng, DU Bin, XU Xiang

2016, 14(10): 1689-1692. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.027

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Abstract:
Objective To investigate the rate of the fall among all the older people making a call to the emergency medical services,and fall-related injuries,explore the relations between the common diseases in the elderly and the fall,and evaluate the role of community education in reducing fall-related injuries in older people. Methods A prospective case-control study method was adopt.The older people making a call to the emergency medical services on account of the fall in Qingyunpu District of Nanchang city between January,2013 and December,2014 were enrolled and were divided into control group(between January 1,2013 and December 31,2013) and experimental group(between January 1,2014 and December 31,2014) according to the time period.50 among 72 communities in Qingyunpu district were randomly sampled to carry out the community educations of risk factors of falls and the first aid knowledge about the fall in 2014.The older patients making a call to the emergency medical services on account of the fall were followed up to investigate the examinations,diagnosis,admission and surgical treatments in the hospitals. Results When compared with 2013,the amount of elderly people increased by 0.64%,the rate of elderly people making a call to the emergency medical services increased by 8.45%,however,the rate of older people making a call to the emergency medical services on account of the fall decreased by 14.75% in 2014.The call time was different between the two groups(χ²=10.444,P=0.034);the time from the fall to making a call to the emergency medical services shorted obviously.The amount of older people with trauma was significant different(χ²=6.162,P=0.046),the patients with craniocerebral injury or bone fracture decreased clearly,but sprains and muscle strains increased,the difference in the types of diseases was not significant(χ²=11.15,P=0.266).The community education did not change the types of illness in elderly people;but some senile diseases were obviously correlated to the fall. Conclusion The community education can reduce the rate of injury caused by the falls,the early professional rescue and treatment can reduce the incidence of secondary injuries and complications.The fall commonly occurs to the older people with cardiovascular and cerebrovascular illness,bone and joint diseases,neurological diseases,diabetes,lung infection diseases,especially hypertension,and thus the community education should pay more attentions to them.The contents of education should include high risk factors of falls,common first aid measures for the injury such as fracture,brain injury and spinal cord injury caused by the fall.

SWOT analysis of the community health service institution in the development of diabetes peer education

LIU Dou, YIN Fang, XIA Ai-shu, ZHOU Wei-wei, LU: Lin

2016, 14(10): 1693-1695. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.028

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Abstract:
As the situation of diabetes in China is becoming serious in recent years,control in diabetes health education and management work has become the main means.Exploring the effective way of healthy education and promoting the development of community diabetes management are to realize our country grass-roots health services equalization.With health education that is as a community's healthy service institutions being an important means for management of diabetes,the single mode of traditional education which is more insufficient influences and restricts the development of community diabetes management.In China,with the lack of medical resources,peer education as a new way can fully integrate resources which the community health service institutions own.The promotion of community has significance for patients to control diseases and the prevention of complications to provide support.In recent days,staffs from health care can't cognize the significance of peer education,peer education intervention mode is simple,and there has not yet been community norms implementation model and effectiveness of the evaluation criteria,but external environment and internal conditions still exist many deficiencies that hinder the peer education in community diabetes further development.In this paper,the SWOT analysis to carry out peer education on diabetes can make full use of internal strengths and avoid the external risks from the four dimensions of the strengths,weaknesses,opportunities and threats analysis.This paper puts forward the countermeasure for diabetes of peer education in community;also provide reference for the management of community chronic disease.

Effect of psychological nursing on the anxiety and satisfaction of patients with pain free abortion

GU Hui-fang, GU Xiao-ling, JIANG Lan-fang

2016, 14(10): 1696-1698,1706. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.029

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Abstract:
Objective To explore the effect of psychological nursing on the anxiety and satisfaction of patients with pain free abortion,and to accumulate experience for this kind of special group. Methods Total 86 patients with pain free abortion in our hospital from February 2013 to March,2015 were divided into study group and control group with 43 cases in each group.The control group carried out the traditional nursing measures,while the research group underwent the strengthening psychological nursing on the basis of the traditional measures.All the patients received the SAS scale evaluation 2 hours before the operation,and the degree of pain and nursing satisfaction were evaluated. Results Before the operation,there were 14 cases of mild anxiety,23 cases of moderate anxiety and 6 cases of severe anxiety in the study group;there were 7 cases of mild anxiety,21 cases of moderate anxiety and 15 cases of severe anxiety in the study group;the mean anxiety degree in the study was light than that in the control group(P<0.05).In the study,21 cases were with grade 1 pain,8 cases with grade 2 and 14 cases with grade 3,while in the control group,13 cases with grade 1,9 cases with grade 2 and 21 cases with grade 3.The degree of pain in the study group were less than those of the control group,the difference was statistically significant(P<0.05).The difference in the satisfaction with the preoperative,intraoperative and postoperative care,service attitude,postoperative care and health education was significant between the two groups(P<0.05). Conclusion The strengthening psychological nursing intervention in patients with pain free abortion can effectively reduce the anxiety,improve the body satisfaction and achieve more satisfactory clinical results.

Confirmatory factor analysis of the Level of Expressed Emotion scale in Chinese version

ZHANG Hong, LIN Li-qiong, CHEN Yuan-sheng, JIANG Qin, LIN Li-hua

2016, 14(10): 1699-1702. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.030

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Abstract:
Objective Level of Expressed Emotion(LEE) scale is a self-assessment questionnaire for patients to assess the emotional expression of family members.The reliability and validity of this scale has been discussed and used in many areas of clinical in Abroad.Currently the LEE scale is introduced and combined with the cultural background for the revision and application only by Singapore and Hong Kong.Therefore,this study intends to explore the possibility of using the Chinese version of the LEE scale to predict the emotional expression of family members in psychiatric patients with chronic diseases,in order to predict and evaluate the emotional expression of family members in the clinical use of LEE in China,and to provide evidence for reducing family factors on the recurrence of disease. Methods Total 130 patients with mental disorders who meet the criteria of this study were assessed with the Chinese version of LEE scale,Family Assessment Device(FAD) scale and the Brief Psychiatric Rating Scale.Through factor analysis,reliability test and correlation analysis to compare the effectiveness of the Chinese version of LEE scale in clinical practice. Results The result of factor analysis of LEE had good construct validity of three subscales:LES(26 Items),INTR(10 Items) and IRR(7 Items).The 3 subscales have a high internal consistency(LES:α=0.91;INTR:α=0.6;C:α=0.59).Among subscales showed a significant positive correlation.At the same time,there are still have some differences in the type of the component and the number of items with the results of other studies.Therefore,the effectiveness of the clinical use of this scale should be further evaluated. Conclusion The 3 subscales of LEE have a higher reliability and validity for predicting the emotion expression of the family members in psychiatric disorders.But the content of the items still need to be further investigated.

Effectiveness study of family contract service in the management of patients with mental disorders

DONG Lan, GAO Qiang, WEI Xue-ping, WANG Lei, SONG Yu-ping

2016, 14(10): 1703-1706. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.031

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Abstract:
Objective To investigate the family contract service in the management of patients with severe mental disorders and provide reasonable basis for community mental health service. Methods The cluster random sampling was used to identify 100 individuals from one township hospital and one community health service center in Anqiu county of Weifang.The methods of questionnaire survey,retrospective analysis and rating scale were used to study the scores of Positive and Negative Syndrome Scale(PANSS),Morningside Rehabilitation States Scale(MRSS),risk assessment and family mental health knowledge awareness in the respect of if the family contract was signed with patients. Results The scores of PANSS were significant declined in 2year after signed contract,1 year after signed contract and signed before. MRSS total scores,symptom,behavioral expression scores and dependent factor scores were also declined in 2 year after signed contract,1 year after signed contract and signed before. It has significant difference in the risk classification among 1 year after signed contract,2 years after signed contract and signed before (H=240.33,P<0.005). Significant difference also appeared in the family mental health knowledge awareness among 1 year after signed contract,2 years after signed contract and signed before (H=201.021,P<0.01). Conclusion The family contract service is benefit to the stability of the patients and social rehabilitation,it can reduce patient risk behavior and improve the family mental health knowledge awareness.It is suitable for our country's community mental health service and deserve to continuous improvement and comprehensive application.

Analysis of vital capacity weight index of 1806 elementary school students from Haidian District of Beijing

CHEN Xu-xin, SHU Liu-yi, HAN Zhi-hai, TIAN Guang

2016, 14(10): 1707-1709,1718. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.032

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Abstract:
Objective To analyze vital capacity weight index of 1 806 elementary school students from Haidian District,Beijing in 2014,and to provide references for improving children and adolescents' health level. Methods The cluster random sampling method was used to sample 1 806 elementary school students from Haidian District to measure their height,weight and vital capacity.The vital capacity weight index was calculated by using the formula[Vital Capacity/weight(ml/kg)].The t-test was used to compare the differences of vital capacity and vital capacity weight index between the boy group and the girl group in different age groups.Chi square test was used to compare the differences in underdeveloped rate and excellence rate.BMI value was calculated according to formula[weight/height²(kg/m²)],and the students was divided into light weight,normal weight,overweight and obesity based on corresponding standards.The difference in vital capacity weight index was compared among the groups with different BMI value. Results A total number of 1 806 elementary school students were enrolled into this study,which included 923 boys and 883 girls.The absolute vital capacity of both in boys and girls in generally increased with the age.Among the same age group,the vital capacity of boys was larger than that of girls and the difference was statistical significant(except for the age group of 10 years old),P<0.05.The difference in vital capacity weight index between boys and girls was significant in 6,7 and 9 years old groups(P<0.05),but not in 8,10 and 11 years old groups(P>0.05).The underdeveloped rate of girls was higher than that of boys(8.4% vs.5.1%),P<0.05;but the excellence rate was not significant(11.5% vs. 13.4%),P>0.05.The vital capacity weight index was negatively correlated with the BMI,and the vital capacity index declined prominently with the increase of BMI. Conclusion The physical function in lightweight and normal weight groups is superior to that in overweight and obesity groups,which indicate that overweight and obesity affect physical healthy development to some extent;the vital capacity weight index will decline with the increase of weight.

Risk factors of deep venous thrombosis of lower extremity in elderly patients after stroke

LU Min-ye

2016, 14(10): 1710-1712. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.033

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Objective To explore the risk factors of the deep venous thrombosis of lower extremity in elderly patients after stroke,and to provide reference for the preventive interventions. Methods From January,2014 to July,2015,the clinical data of 448 elderly bedridden patients after stroke were analyzed retrospectively.The risk factors were analyzed by single factor analysis and multi factor Logistic regression analysis. Results There were 25 cases of deep venous thrombosis of lower extremity among 448 patients after stroke with a rate of 5.58%;Single factor analysis showed that dehydrating agent,phlebitis,hypertension,diabetes,hyperlipidemia,infection,tumor,and the elevated levels of hs-CRP,D-dimer,CD62p,CD63 PAI-1 and platelet aggregation were the risk factors of deep vein thrombosis(P<0.05);Logistic regression analysis showed that dehydrating agent,phlebitis,hypertension,infection,tumor,and the elevated levels of hs-CRP,D-dimer,CD62p CD63,PAI-1 and platelet aggregation were the independent risk factors for the deep venous thrombosis in the elderly patients after stroke(P<0.05). Conclusion Dehydrating agent,phlebitis,hypertension,infection,tumor,and the elevated levels of hs-CRP,D-dimer,CD62p CD63,PAI-1 and platelet aggregation are the independent risk factors for the deep venous thrombosis of lower limb in the elderly patients after stroke,and the intervention measures should be taken to reduce the incidence of deep venous thrombosis.

Survey on trust and satisfaction to primary care and its factors among rural residents in Anhui province

WANG Hai-luan, ZHANG Jin-xia, CAI Xiao-shan, YANG Shao-tian, HU Chuan-qi, HU Chuan-lai

2016, 14(10): 1713-1715,1722. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.034

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Objective To investigate the trust of rural residents in Anhui Province for the primary care and the influencing factors,and provide basis for the construction of classification of medical service system and allocation of basic medical and health resources. Methods A questionnaire survey on the trust and satisfaction to primary care and its factors was conducted among farmers who lived around our representative rural-oriented medical student investigators from wide areas of Anhui province in 2015.A total of 739 valid responses were collected and analyzed. Results Fifty-four point thirteen percent of rural residents argued that the treatment was inconvenient,74.70% agreed that there was at least one "convenient" item in the treatment process.The "not convenient" items mainly included"waiting times and waiting order(38.29%)","the doctor's image,attitude and level(35.86%)" and "reasonable and appropriate fees for(33.42%)" and so on.Multivariate logistic regression analysis showed that this level of trust not only with physiological factors survey age,sex,etc.,but also to marital status,education level,family size,housing area and the living environment,indirectly suggesting that social,economic and behavioral factors significantly affect the level of trust on the status of rural primary health care services. Conclusion The availability to primary health care institutions for rural farmers should be improved.The trust and satisfaction of rural residents to primary care services should be improved not only directly by the delivery of health services,but also indirectly by the new rural social and economic development and health lifestyles and harmonious society construction and others.

The application value of serum ferritin in the Type 2 diabetes

WU Xiu-ji, YAO Min, HE Qi-jun, YU Ling-ling

2016, 14(10): 1716-1718. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.035

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Objective To explore the application value of serum ferritin in the Type 2 diabetes mellitus (T2DM) patients. Methods Choose from February,2013 to October,2015 in Haikou City People's Hospital of Endocrinology,diagnosis and treatment of patients with T2DM(T2DM group) 120 cases,according to glycated hemoglobin (HbA1c) levels are divided into:the efficacy of good group(A) and efficacy of 53 cases poor(group B) 67 cases,while selecting normal controls(NC) group,60 cases.Serum iron(SI),serum ferritin(SF),transferring(TRF),glycosylated hemoglobin(HbA1c),fasting plasma glucose(FPG) and fasting insulin(FINS) were determined and Calculated Insulin resistance index(HOMA-IR) and pancreatic β-cell function(HOMA β-cell) and compared the changes in T2DM group and NC group,group A and group B of the indicators and analysis of its relevance. Results Compared with the NC group,T2DM group FPG,HbA1c,FINS,HOMA-IR and SF were increased(P<0.05);Compared with group A,SF SF and HOMA-IR of group B all increased(P<0.05),HOMA β-cell decreased(P<0.05);T2DM patients with SF and HbA1c were positively correlated(r=0.584,P<0.05),positively correlated with HOMA-IR(r=0.451,P<0.05),and HOMA β-cell negative correlation(r=-0.468,P<0.05). Conclusion T2DM patients with iron metabolism disorders,iron overload may increase insulin resistance and β cell damage;SF may be an important factor affecting its efficacy,high SF is difficult to control blood glucose.

Pathogen detection of herpetic stomatitis and herpangina

XIA Chan, YU Jian, JIN Long-teng, WEN Zheng-wang, CHEN Yi-ping

2016, 14(10): 1719-1722. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.036

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Objective To study and compare the pathogen characteristics of patients with herpes stomatitis and herpangina. Methods From March 1,2015 to August 31,2015,60 cases diagnosed clinically as herpetic stomatitis and 50 cases as herpangina were included in this study.Colloidal gold assay was used for the detection of two kinds enterovirus of CoxA16 and EV71,ELISA was used for the detection of herpes virus Ⅰ and Ⅱ,RT-PCR method was used for the detection of enterovirus 5'-UTR gene fragment,EV71 VP1 and CoxA16 VP1 sequence,PCR was used for the detection of herpes virus Ⅰ and Ⅱ glycoprotein gene sequences.The pathogen differences of the two diseases were compared. Results For patients with Herpes stomatitis,PCR results showed the positive herpes virus in 38 cases,positive intestinal virus in 18 cases,not clear pathogen in 4 cases;IgM results showed positive herpes virus in 35 cases,positive intestinal virus in 11 cases.For Herpangina,PCR results showed positive herpes simplex virus in 2 cases,positive intestinal virus in 38 cases;IgM results showed positive herpes virus in 2 cases,positive intestinal virus in 35 cases.In the cases diagnosed clinically as herpetic stomatitis and herpangina cases,some pathogenic results were intersectional. Conclusion There may be some confusion between the clinical diagnosis of herpes stomatitis and herpangina,the pathogen can be rapidly determined by ELISA and colloidal gold method,and the PCR detection method can be further carried in some cases that is difficult to identify.

Detection of infectious pathogens in the first trimester of pregnancy and its clinical significance

WAN Yan-zhen, ZHANG Fu-hua, DAI Yu-long

2016, 14(10): 1723-1725. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.037

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Objective To investigate the condition of hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV),treponema pallidum(TP) and TORCH infection in pregnant women in the first trimester of pregnancy from Qingdao district,so as to guide the clinical health education propaganda for couples of child-bearing age. Methods The serum samples of pregnant women in the first trimester of pregnancy in obstetric outpatient department of Qingdao Women & Children's Hospital from Jan. 2013 to Dec. 2014 were collected.The serum markers for HBV(HBsAg,HBsAb,HBeAg,HBeAb,HBcAb),HCV(HCV-cAg,HCV-Ab),HIV[HIV(1/2)-Ab] and TP(TP-Ab) were detected by enzyme-linked immunosorbent assay(ELISA),and TORCH-IgM were detected by electrochemiluminescence immunoassay. Results The infection rate of the infectious pathogens in pregnant women in the first trimester of pregnancy were high,including 3.961% of positive rate for HBsAg,0.055% for HCV-Ab,0.000% for HIV-Ab,0.585% for TP-Ab and 9.194% of total positive rate for TORCH-IgM.Furthermore,positive rates for TP and TORCH in pregnant women with advanced age were drastically higher than those with appropriate age and significant differences were found in the positive rates for HBsAg,CMV-IgM and HSV(1/2)-IgM among the different seasons. Conclusion The infection rate in pregnant women in the first trimester of pregnancy is high.The health education propaganda for couples of child-bearing age should be strengthened,and the screening of HBV,HCV,HIV,TP and TORCH infection both before and during pregnancy should be further popularized for better prenatal and postnatal care.

ZHANG Cai-fu

2016, 14(10): 1726-1728. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.038

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GAO Guo-zhen, GUO Miao-lan, WANG Shao-ling, WEN Li-tao, CENG Li-ting, SHAO Xia

2016, 14(10): 1729-1732. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.039

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FANG Xi, CHEN Lin-jie, XIE Zhang-hao, FAN Xiao-yun

2016, 14(10): 1732-1735. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.040

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LIN Mu, HE Jia

2016, 14(10): 1735-1738. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.041

65 0

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LIANG Bing, LI Miao, HU Bing-qing

2016, 14(10): 1739-1741. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.042

86 0

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WU Qu-mei, ZHAO Jiu-fa

2016, 14(10): 1742-1744. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.043

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The clinical research of acupuncture combined with rehabilitation training on stroke patients with hemiplegia

XU Lei, HUA Qi-hai, YAN Xing-zhou, JIANG Yong, WANG Min

2016, 14(10): 1745-1747. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.044

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Objective To investigate the function of acupuncture combined with rehabilitation training on stoke patients with hemiplegia,and provide the best therapy method for stroke patients with hemiplegia. Methods Fifty-three stoke patients with hemplegia were randomly divided in to the treatment group and the control group.All the patients were derived from the department of rehabilitation medicine,neurology,emergency medical inpatients.After statistics analysis,there was no statistically significant diference in patients(P<0.05),and its comparable.The treatment group had 25 cases and the control group had 28 cases.The treatment group was adopted the medicine of acupuncture combined with rehabilitation,the control group was adopted simple rehabilitation.Both groups were treated once a day,ten days are one course,both groups were treated 4 courses.They were assessed simplified Fugl-Meyer and Barthel before and after training.We used statistics software SPSS 19.0 for the research of statistical data.The measurement data were expressed by mean plus or minus standard deviation(x±s),T test and Chi-square test were used for analysis. Results After treatment of 4 courses,FMA scores and ADL scores of treatment group was obviously superior to control group,the difference was statistically significant(P<0.05).The treatment group and control group of FMA scores and ADL scores within the group compared with before treatment the difference was statistically significant(P<0.05). Conclusion Acupuncture and rehabilitation training are effective,and improve the patients' motor function and daily life activities ability.Acupuncture combined with rehabilitation training are more effective than simple rehabilitation training,and help the patients return to society.

Comprehensive evaluation of medical quality by using Rank sum ratio method and comprehensive index method

DING Zhuang-zhuang, XIE Qiu-juan

2016, 14(10): 1748-1750,1757. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.045

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Objective To comprehensively assess and analyze the medical quality index,to grasp the overall trend of medical quality level,and provide the basis for the improvement of medical quality and service ability. Methods On the basis of literature analysis,the number of emergency visits and discharges,surgical cases,bed utilization rate,bed turns,average hospital stay,diagnosis coincidence rate between admission and discharge,cure and improvement rate,rescue achievement ratio,average hospitalization cost,proportion of drug cost,etc.medical indicators were made to evaluation system.The comprehensive index method were used to evaluate the medical quality of the last 8 years,and Rank sum ratio(RSR) method was used to grade the development of medical quality. Results The medical quality comprehensive index rose gradually in 2008-2015,and the comprehensive index in 2015 and 2014 was 1.96 times and 1.96 times that of 2008,respectively.According to the sort of RSR values and step results,medical quality was low in 2008-2010 and better in 2014-2015,the medical quality in the rest of years were in the medium level. Conclusion s The medical quality are improved in 2008-2015.On the basis of ensuring the medical quality and medical safety,a variety of forms are carried out to reduce the workload,improve medical efficiency and technical content,so as to optimize quality and enhance the overall strength of hospital.RSR method and comprehensive index method,considering the importance of medical evaluation index,can scientifically and objectively reflect the hospital medical quality,increase the efficiency of the analysis and make the evaluation more scientific and reasonable.

Application of multi-round multi-module grading method in laparoscopic visual reality skill training

BAI Cheng-rui, WANG Bing-qiang, GUO Ai, LI Ya-dong, GAO Yin-guang, WU Hong-wei, SONG Jian-ning, ZHAO Ning

2016, 14(10): 1751-1754. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.046

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Objective To explore the effect of multi-round multi-module grading training method in laparoscopic visual reality surgical skill training in participants with different clinical experiences. Methods The training was divided into different round and module.There were basic module (the first module),middle level module(the second module) and advanced module(the third module) in each round.The training started from the first module of the first round training.After a certain hours(6 hours) of training,the assessments should be taken,the doctors who pass the exam came into a higher level module training in the same round,the doctors who failed to enter the next module still learning in the corresponding module of the second round until they pass the exam and then came into the next module in the same round.So,if it is still no successful promotion in the second round,then the doctors continued to practice in the corresponding module of the next round.The training completed after passing three modules for certain round and receiving the final review by the surgical experts. Results Total 55 doctors participated in 3 rounds training.The training started from the first module of the first round.Every doctor accepted the assessment after a 6 hours training.28 trainees passed the examination and then entered into the second module of the first round training.After another 6 hours training,16 trainees passed the examination and entered into the third module of the first round training.16 trainees passed the three modules of the first round training.The qualified students will joint in the final expert review at last.After the same training way at the second and the third round of training,all the 55 doctors passed the training.After the multi-round multi-module grading skill training in laparoscopic visual reality operation exercises,the sense of space position and operation handle feel,skillful using of instruments and the ability of both hand-eye and hand-hand had improved significantly of the doctors with different clinical experiences.More than 70% of the passing students can transit to clinical practice gradually. Conclusion In the laparoscopic visual reality skill training,application of the method of multi-round multi-module grading training,the laparoscopic operation skills of the students with different clinical experience improved obviously,and laid a solid foundation for the students for the approaching clinical practice.

Present status analysis and strategies of general practitioners' professional training in Eastern Guangdong

LIN Kai, QIU Wei-li, ZHENG Xiao-hua

2016, 14(10): 1755-1757. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.047

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Objective To investigate the status and demands of general practitioners(GPs) in Eastern Guangdong,and provide scientific evidences for the training system and methods of general practice. Methods A questionnaire survey was carried out among 110 trainees(cluster sampling) attended the 4th Job Training Course in Eastern Guangdong Province to investigate the cognition,practice environment and training demands of trainees. Results GPs in the group were normally short of education background and professional title,72.73% of them were with diploma courses and below,90.90% of them were with junior professional title,in which 55.45% were assistant doctors.95.45% of trainees had never received any education or training of general practice,and 37.27% of trainees agreed that the training necessary for the practice.The discontents of the practice status were resulted from working condition,working environment,promotion and career development opportunities and training supports,accounted for 60.0%,42.7%,28.18% and 20.9%,respectively.The defects of professionalism included health record management,medical examination and laboratory,maternal and children health care,psychotherapy,nutriology,rehabilitation medicine and medical ethics,for 82.73%,83.64%,80.00%,84.55%,85.45%,84.55% and 82.73%,respectively. Conclusion The obvious problems in GPs include short of education background and professional title,hard practice environment,lack of cognition on training,short of knowledge and skill.It reminds that the government should enhance the policies on General Practice to found a sustainable GPs training system in China,as well as optimize the practice environment of GPs reasonably to provide them career development opportunities with sense of accomplishment.The more incentive policies should be designed to retain and attract talent.

Effect of health care integration combined with evaluation of self-efficacy on the anxiety,depression and quality of life in retreated pulmonary tuberculosis patients

ZHU Li-ya, SU Fei-fei, LI Li-min, CHI Qiong

2016, 14(10): 1758-1761. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.048

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Objective To investigate the effect of health integration approach combined with patient self-efficacy training on anxiety,depression and quality of life of patients with drug-resistant tuberculosis. Methods The 120 retreated pulmonary tuberculosis patients in our hospital from January,2010 to January,2014 were randomly divided into control group and observation group with 60 cases in each group.All patients were treated with a standardized drug-resistant tuberculosis treatment programs,the course was 12 months.The medical care integrated manner was performed in both groups.The observation group received additional self-efficacy training.Anxiety score(SAS) and depression scale score(SDS) Scale were used to evaluate the depression and anxiety of patients before and after the treatment;Quality of Life Assessment Scale(WHOQOL-BREF) was used to measure the QOL of patients before and after the treatment.One year follow up was carried to observe the incidence of hemoptysis again and recurrence rate. Results After the treatment,SAS and SDS scores in both groups were decreased when compared with the values before treatment,and more obviously in the observation group,the difference was statistically significant(P<0.05).After the treatment,the scores for each item increased obviously in both groups,especially in the observation group,the difference was statistically significant(P<0.05).The rate and volume of hemoptysis again and the recurrence rate in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05). Conclusion The health care integration combined with evaluation of self-efficacy can more effectively improve the psychological conditions,quality of life and treatment compliance in patients with drug-resistant tuberculosis when compared with the health care integration alone,which is worthy of clinical application.

Effect of postoperative intensive nursing intervention on preventing lower extremity venous thrombosis and constipation in elderly patients with lower limb fracture

WU Miao-miao, SHI Mi, HU Fei-hong, ZHENG Ling-ling, DAN Xia-xia, FAN Yan-yan, WU Jiao-zhen

2016, 14(10): 1762-1765. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.049

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Objective To explore the effect of postoperative intensive nursing intervention on preventing lower extremity venous thrombosis and constipation in elderly patients with lower limb fracture. Methods A total number of 80 elderly patients with lower limbs fracture in the Second Affiliated Hospital of Wenzhou Medical University from July to December 2015 were selected as the observation group,and were given intensive nursing intervention;While 80 elderly patients with lower limbs fracture in the same hospital from January to June 2015 were selected as the control group,and were given routine nursing.The venous thrombosis,constipation and life quality were compared between the two groups. Results The abdominal distension,stool shape,spontaneous defecation,defecation score in the observation group were1.62±0.34,1.60±0.43,1.27±0.45 and 1.21±0.36,which were lower than 2.02±0.33,1.92±0.31,1.92±0.32 and 1.76±0.38 in the control group;the defecation time was(15.29±3.47) min,which was shorter than(23.21±4.19)min in the control group;And the incidence of constipation was 10.0% in the observation group,which was lower than 25.0% in the control group,the difference was statistically significant(P<0.05).The lower extremity deep venous flow velocity in the observation group was (25.53±3.47) cm/s,which was faster than (20.14±2.51) cm/s in the control group,the incidence of venous thrombosis was 2.0% in the observation group,which was lower than 11.3% in the control group;the diameter of vein thrombus was (0.23±0.19) cm,which was less than (0.42±0.12) cm in the control group,the difference was statistically significant(P<0.05).For life quality,the energy,body pain,emotional function,physiological function in the observation group after the operation was 72.41±15.75,71.85±10.62,76.13±12.51 and 80.13±12.53,which was higher than 64.52±11.31,63.21±10.35,64.05±12.10 and 69.52±12.69 in the control group,the difference was statistically significant(P<0.05). Conclusion The postoperative intensive nursing intervention can reduce lower extremity venous thrombosis and constipation in elderly patients with lower limb fracture,and improve their life quality.

Transparent hydrocolloid dressing for fixation of subclavian central venous catheters in Department of Neurosurgery

YANG Yu-ling, MU Dong-mei, LI Ping, ZHU Hua-mei, LI Chan-qi

2016, 14(10): 1766-1768. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.050

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Objective To explore the effect,costs and workload of using transparent hydrocolloid dressing for fixation of subclavian central venous(SVC) catheters. Methods Total 160patients undergoing SVC were included and were randomly divided into control group and test group.3M HP Tegaderm^TM dressing in the control group and transparent hydrocolloid dressing in the test group were used for the fixation of catheters.The catheter-related complications,total medical cost and workload of dressing were observed.The Student t-test was used to compare continuous variables,χ² test was used to compare categorical variables. Results There were significant difference between the teat group and control group in the incidence of infections[6.8%(5/74) vs. 17.7%(14/79),χ²=4.224,P=0.040],skin allergies[1.4%(1/74) vs. 8.9%(7/79),χ²=4.248,P=0.037],accidental extubation[2.7%(2/74) vs. 11.4%(9/79),χ²=4.231] and unplanned extubation[5.4%(4/74) vs. 15.2%(12/79),χ²=3.906,P=0.048].When compared with the control group,the test group had a longer average dressing time interval[(5.9±1.1)d vs. (4.8±1.0) d,t=2.217,P=0.025],a lower dressing workload[(41.4±7.0)min vs.(50.6±9.8)min,t=2.078,P=0.039];The single dressing time[(13.8±2.3)min vs.(13.5±2.5)min,t=0.223,P=0.894] and the total cost of dressing[(140.4±40.2)Yuan vs.(143.6±37.6)Yuan,t=0.257,P=0.851] were no significant difference between the two groups. Conclusion Transparent hydrocolloid dressings can better maintain SCV and reduce nursing workload without additional cost,which is worth promoting applications in neurosurgical nursing.

Investigation on clinical nurses' perception of adverse events and analysis of influencing factors

MAO Qiu-yun, QI Fen, ZHAO Bo-lian, ZHANG Wei

2016, 14(10): 1769-1771. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.051

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Objective To investigate the current situation and influential factors of clinical nurses' perception of adverse events,and discuss the corresponding measures for improving the risk awareness of nurses. Methods The on-site survey was conducted among 917 clinical nurses from ten hospitals in Taian city between April,2015 and August,2015 using a self-designed demographic questionnaire and Clinical Nurses Adverse Events Risk Perception Structure Scales to investigate the influential factors of clinical nurses' perception of adverse events.The data were analyzed with SPSS 19.0 and AMOS 17.0. Results A scale of three factors and 20 items was identified by using item analysis and exploratory factor analysis.Exploratory and confirmatory factor analysis revealed that there were three dimensions of adverse events risk perception:patient care risk,system process risk and nurse operation risk.The score of clinical nurses adverse events risk perception was 16.48±3.79.The score of each dimension in descending order were:nurse operation risk,system process risk and patient care risk.Work experience,departments and hospital level were the significant influencing factors of clinical nurses' risk perception of adverse events. Conclusion The level of clinical nurses' perception of adverse events need to be improved.The nurse managers should pay more attentions to improve nurse risk awareness and reporting adverse event in order to promote the management of the safety of patients and reduce occurrence of adverse event.

Application of evidence-based nursing in patients with central venous catheter-related infections after open heart surgery

ZHONG Hai-ning, LI Jun-feng, ZHANG Ai-li

2016, 14(10): 1772-1774. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.052

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Objective To observe the effect of systematic nursing intervention on central venous catheter-related infections after open heart surgery,in order to provide nursing experience in reducing infection rate. Methods From January,2014 to June,2015,206 patients underwent central venous catheters placement after open heart surgery in our department were randomly divided into experimental group and control group(n=103).The patients in the control group received the conventional nursing while the patients in the experimental group received the evidence-based nursing.First of all,the problems in nursing associated with central venous catheter-related infections were retrieved from literatures,including advanced age,prolonged catheter placement,improper aseptic technique,quality of catheter nursing,method of catheter placement etc.The nursing plan was taken up according to problems above and individual differences,and implemented in perioperative period.The incidence of adverse effects of central venous catheter placement,including infection of puncture site,central venous catheter related bloodstream infections and duration,local bleeding,catheter extrusion,catheter obstruction,etc.were observed. Results The rate of puncture site infection in the experimental group and control group was 5.82% and 18.44%,respectively,which was significantly different(P<0.01).The incidence of central venous catheter related bloodstream infection in the two groups was 3.89% and 11.65%,respectively,which was significantly different (P<0.05).The incidence of catheter obstruction,extrusion and local bleeding in two groups were 3.89% vs. 13.59%,5.82% vs. 16.50%,2.91% vs. 9.70%,respectively,which were all significantly different (P<0.05). Conclusion The evidence-based nursing in central venous catheter nursing after open heart surgery can significantly reduce the incidence of central venous catheter-related infections and adverse effects.

HU Xian-bao, ZHENG Xiang, JIN Xi-biao

2016, 14(10): 1775-1777. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.053

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GE Si-tang, WANG Jin, LUO Jie, ZHANG Zong-bing, LI Shi-qing

2016, 14(10): 1778-1780. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.054

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JIN Xiao-qian, CHENG Xiao-mei, LIN Miao, LI Lin, LU Zhang

2016, 14(10): 1780-1782. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.055

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BIAN Jun

2016, 14(10): 1783-1785. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.056

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DONG Jin-hua, XUE Li-li

2016, 14(10): 1786-1788. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.057

86 0

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2016 Vol. 14, No. 10

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