2016 Vol. 14, No. 11

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A preliminary study on the activities of daily living of the Dai elderly in rural Ruili,Yunnan province
ZHANG Kai-ning, GAO Chu-qun, MO Guo-fang, LIU Dan, JIANG Xu-chang, LI Jun-jie, TANG Jia, WANG Li, JIA Xian-jie
2016, 14(11): 1789-1791,1885. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.001
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Objective To investigate disability of the Dai elderly in traditional rural communities in Ruili,Dehong Prefecture in Yunnan province,in order to well evaluate the needs of the increasing elderly for long-term care services in remote and border area in China,and provide reference for the long term strategic planning for elderly among EMGs in China. Methods The multi-stage random cluster sampling method was used to sample 187 Dai elderly from 12 traditional villages in Ruili.Barthel index was used to evaluate the activities of daily living(ADL)of of the Dai elderly aged over 60 years. Results Based on the ADL measures on 187 elderly in Dai villages,the disability rates of Dai elderly were estimated statistically in terms of point estimation and 95% confidence interval(CI) estimation.The severe disability rate and its 95%CI were 6.95%(6.02%,7.88%),and moderate disability rate and its 95%CI were 4.28%(3.69%,4.87%),while mild disability rate 77.01%(74.47%,79.54%).Meanwhile,the rate of non-disability and its 95% CI were 11.76%(10.28%,13.25%).The disability rate,defined as severe and moderate disability,of Dai elderly and its 95%CI were 11.23%(9.80%,12.66%).Age was found closely associated with disability:the older,the lower the ADL,meaning more serious disability(P<0.001).High-significantly higher disability was found for the young elderly women than men(P<0.01),but no significant difference was identified between women and men among those groups aged 65 years old and above(P>0.05). Conclusion s This paper reports,as the first time in China,the disability rates of elderly in Dai villages.The disability rates gradually have been increasing by age for the Dai elderly in traditional rural communities in Ruili.Among the rural elderly Dai villagers younger than 65 years old,women show a higher disability rate.No significant difference has been identified between men and women among the age groups older than 65 years old.The disability rates of the Dai elderly in traditional rural communities are relatively lower than the national average ones stated by other studies in China.
ZHANG Ya-jie, DAI Chuan-lin, PAN Jia-hua
2016, 14(11): 1792-1793.
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Significance of the dynamic proportion and function of regulatory B cells in the rheumatoid arthritis patients' peripheral blood
YU Wen-wen, ZHAO Dong-bao
2016, 14(11): 1794-1797,1862. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.002
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Objective To investigate the role of CD19+CD24hiCD38hi regulatory B (Breg) cells in the progression of rheumatoid arthritis (RA), the proportion and function of Breg cells were detected in the peripheral blood of RA patients. Methods Flow cytometry staining were used to detect the percentage of peripheral blood CD19+CD24hiCD38hi B cells and CD4 T cells from the healthy controls and RA patients;and the effects of CD19+CD24hiCD38hi B cells on the proliferative capacity of Nave CD4 T cells were detected by the live cell fluorescence dye CFSE labeling assay.The effects of CD19+CD24hiCD38hi B cells on the ability to secret IFN-γ of CD4 T cells and the ability to secret IL-10 of CD19+CD24hiCD38hi B cells were also be detected. Results The proportion of the CD19+CD24hiCD38hi B cells in the peripheral blood in RA patients was significantly decreased compared with the healthy group controls.However,the proportion of CD4 T cells in the RA patients was higher than those in healthy controls,and the differences were more significant with the progression of RA(P<0.05).Functional studies demonstrate that the ability to secret IL-10 of CD19+CD24hiCD38hi B cells was lower in the RA patients(P<0.01).Moreover,the ability to inhibit the proliferation and secretion capacity of Nave CD4 T cells was greatly decreased compared with healthy controls(P<0.01). Conclusion The ability to secrete IL-10 of CD19+CD24hiCD38hi B cells in the peripheral blood is reduced in the RA patients,leading to the impairment of the function of the immune suppression,and the increased proportion of CD4 T cells in the peripheral blood with the rised levels of IFN-γ,and accelerate the progression of RA patients.
Clinical analysis of 23 cases of ectopic pheochromocytoma
CHANG Xiao, SHEN Dan, NIAN Xin-wen, HOU Jian-guo, SUN Ying-hao
2016, 14(11): 1798-1801. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.003
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Objective To summarize the clinical data of 23 ectopic pheochromocytomas collected in Changhai hospital,and to improve the diagnosis and management of this disease. Methods The clinical data of 23 cases of pathologically proven ectopic pheochromocytomas in our hospital were retrospectively reviewed and systematic followed up. Results Total 23 cases of pathologically proven ectopic pheochromocytomas in our hospital between May,1991 and March,2016,10 female patients and 13 male patients with a median age of 50.4 years,were enrolled into this study.The manifestations of ectopic pheochromocytomas were usually typical.Headache was shown in 7 cases(30.43%),palpitations was shown in 5 cases(21.7%),abdominal pain was shown in 5 cases(21.7%),painless hematuria was shown in 2(8.7%),and sweating was shown in 1 cases(4.3%),and other 10 cases of patients without any symptoms(occult occurrence).All of tumors were located in retroperitoneum.The anatomic locations of the ectopic pheochromocytomas were adjacent to the abdominal aorta and the inferior vena cava in 14 cases(60.9%),adjacent to the renal hilum in 4 cases(17.3%),and adjacent to the head of pancreas in 3 cases(13.0%).Other 2 cases were located in urinary bladder.CgA immunohistochemisty was a significant criterion in pathological diagnosis in our cases.All of the 23 of patients conducted surgical excision.Twenty(87.0%) of them were open surgeries,one cases conducted laparoscopic surgeries,and 2 cases conducted transurethral resection of bladder tumor.Most of the benign patients remained free from recurrence with good prognosis,while 2 malignant cases presented with poor prognosis. Conclusion Ectopic pheochromocytoma is a kind of rare tumors,usually located in retroperitoneum,and adjacent to the abdominal aorta and the inferior vena cava.Most cases have good prognosis,and surgical excision is the mainly treatment.
Determination of neobavaisoflavone in Psoralea corylifolia L. by HPLC
ZHOU Huan, GENG Xiang-yan, LIU Qing, MA Tao, FANG Dan-jun
2016, 14(11): 1802-1805,1869. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.004
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Objective To establish a high performance liquid chromatography (HPLC) method for the content determination of neobavaisoflavone in Psoralea corylifolia L. Select the suitable extraction solvent,suitable mobile phase, appropriate determination wavelength and determine the optimal ultrasonic extraction time extraction of Psoralea corylifolia L. of neobavaisoflavone. Methods HPLC was applied and the determination was performed on WondaSil® C18(150.0 mm×4.6 mm,5 μm).0.05% trifluoroacetic acid aqueous solution as the mobile phase A,and the acetonitrile as mobile phase B,gradient elution HPLC method was applied,solution at a flow rate of 1.0 ml/min and detection wavelength at 254 nm.The column temperature was 30℃,and injection volume was 20 μl.100% 30 min methanol ultrasonic extraction of neobavaisoflavone.The precision of the control sample was repeated 6 times with the same concentration of the control sample.Parallel system repeatability 6 prepared neobavaisoflavone sample solution into the sample solution.The stability of the same neobavaisoflavone sample solution was detemined at different time sampling 5 times the sample solution.Parallel preparation of 6 samples of the sample solution to add the same amount of control samples calculated sample recovery rate. Results Through methodological study, the linear regression equation of neobavaisoflavone is:A=79 375C-9 063.7,R2=0.999,the linear range of Neobavaisoflavone was 0.75-12.00 μg/ml,neobavaisoflavone concentration and peak area showed a good linear relationship.Sample average recovery rate was 97.51%,RSD=1.21%(n=6).Precision,repeatability,stability and recovery were all good.There were differences in neobavaisoflavone different sources of Psoralea corylifolia L. Conclusion By optimizing the chromatographic condition,this paper establishes the method for the determination of Psoralea corylifolia L. in neobavaisoflavone content, examines the special attributes,standard curve,limit of detection and quantitative limit,precision,repetition,stability,and recovery rate.The results showed that the HPLC method for the content determination of neobavaisoflavone in Psoralea corylifolia Lis user-friendly,accurate and reliable, with good repeatability and stability,which can be used for quality control of Psoralea corylifolia L.
Analyzing and preventing loose causes of early postoperative intervertebral fusion of lumbar disc herniation
SHI Chao, XU Jie, LI Chao-ding, YANG Liu-zhong, FENG Hu
2016, 14(11): 1806-1809. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.005
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Objective To investigate the causes and prevention methods of lumbar disc herniation after lumbar interbody fusion (within three months). Methods A retrospective analysis of 268 patients with lumbar disc herniation in the period from January,2007 to January,2014 was carried out in 10 patients with early stage interbody fusion and posterior decompression and interbody fusion. Ten cases of patients with early fusion cage loose clinical data were analyzed. The observation intervertebral fusion device loosening were age, activity time, interbody fusion device initial position, endplate disposition, additional disc space before graft, application of the cross connecting rod, infection and treatment of index were analyzed. Results Cases of intervertebral fusion device loose, patients aged 26 to 58 years, mean age 43.2 years;one month within the proportion of patients with 6 cases (60%);interbody fusion device initial position after partial with 4 cases (40%),plate processing bad with 7 cases (70%);no additional disc space before the patient's bone with 2 cases (20%);without the use of a transverse connecting rod accounted with 7 cases (70%);postoperative infection in 2 cases (20%). Conclusion These results indicate that younger patients,early activity and interbody fusion in poor initial location and endplate preparation adverse caused by intervertebral fusion device attached to the poor,no additional disc space before bad bone,without using a transverse connecting rod and infection may be caused by lumbar disc herniation surgery appears early intervertebral fusion device loosening.
Clinical efficacy of autologous platelet-rich plasma combined with intra-articular hyaluronic acid injection forknee osteoarthritis
KE Chen-rong, ZHANG Rui, XUE Ji-xin
2016, 14(11): 1810-1812,1905. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.006
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Objective To explore the effect of autologous platelet-rich plasma(PRP) combined with intra-articular hyaluronic acid(HA)injection in the treatment of knee osteoarthritis. Methods One hundred and fifty cases of knee osteoarthritis met criteria in our hospital was collected in March,2009 to March,2015.They were randomly divided into three groups:the group A,the group B and the group C.The general information of the three groups were comparable.The group A was given knee intra-articular injection of HA 6 ml,the group B was given knee intra-articular injection of PRP 6 ml,and the group C was given knee intra-articular injection of PRP 4 ml and HA 2 ml at 10 min afterwards,once a week for five weeks.The Western Ontario and McMaster American Universities Osteoarthritis Index score(WOMAC score),the International Knee Documentation Committee knee evaluation form(IKDC) score,Lequesne index,adverse reactions of three groups were recorded and analyzed before and after the treatment. Results The WOMAC score and Lequesne index of group C were lower than those in the other two groups,while the IKDC score were higher than the other two groups.The WOMAC,IKDC score,Lequesne index score of group B were superior than group A(P<0.05).Three patients of three groups were not found severe drug related adverse reactions during treatment. Conclusion PRP combined with HA can significantly control the pain and improve the joint function with high safety and efficacy.And it deserved clinical promotion.
Prognosis comparison of drug treatment and PCI treatment on non-ST-segment-elevation myocardial infarction
ZHANG Li, ZHAI Chang-lin
2016, 14(11): 1813-1815,1847. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.007
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Objective To explore the prognosis of drug therapy and PCI treatment of non-ST segment elevation myocardial infarction. Methods Total 623 cases of non-ST-segment-elevation myocardial infarction receiving drug treatment(drug treatment group) and 412 cases of drug therapy with PCI(drug therapy+PCI treatment group) in Taizhou First People's Hospital were enrolled into this study.The incidence of endpoint events and median survival time in both groups were observed,and TIMI score and age differentiation of endpoint events were compared. Results The incidence of the primary endpoint events and secondary endpoint events of the drug treatment group were higher than that of the drug therapy+PCI treatment group(P<0.05).The median survival time of the primary endpoint events and secondary endpoint events of drug treatment group were lower than that of drug therapy +PCI treatment group(P<0.05).The difference of the incidence of primary endpoint events and secondary endpoint events in the drug treatment group and drug therapy+PCI treatment group with TIMI score 0-2 was not statistically significant(P>0.05),the incidence of primary endpoint events and secondary endpoint events in the drug treatment group with TIMI score 3-5 and 6-7 were higher than that of the drug therapy+PCI treatment group(P<0.05).The difference of incidence of the primary endpoint events and secondary endpoint events in the drug treatment group and drug therapy+PCI treatment group with <65-year-old patient was not statistically significant(P>0.05),the incidence of primary endpoint events and secondary endpoint events in the drug treatment group with 65-75 years and >75 years were higher than that of the drug therapy+PCI group(P<0.05). Conclusion PCI therapy can reduce the incidence of adverse outcome events of non-ST-segment-elevation myocardial infarction,prolonged median survival time,improve the prognosis of patients with TIMI grade intermediate-risk or high-risk and older more than 65 years.
Clinical efficacy of different drug therapy combined with risperidone and cognitive-behavioral in the treatment of residual schizophrenia
HUANG Lei, QIAN Jian-jun, TIAN Guo-qiang, JIANG Hai-chao, FENG Hong
2016, 14(11): 1816-1819. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.008
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Objective To analyze the clinical efficacy of cognitive behavior research and analysis combined with risperidone in the treatment of residual schizophrenia. Methods One hundred and eighty cases of residual schizophrenia in psychiatric hospital from January,2013 to January,2016 were selected.The treating physician will use a double-blind method.All patients were randomly divided into two groups:Observation group underwent Hydrochloride tablets Schering joint risperidone and cognitive behavioral therapy;the control group underwent clozapine plus risperidone and cognitive behavioral therapy.Two groups of patients were assessed clinically efficacy.The two groups were observed and recorded Hamilton Depression Rating Scale, Anxiety Scale score,individual self-esteem scale score, individual and social function and insight Assessment Scale score. Results After treatment and 1 month to assess the efficacy of clinical observation group clinical efficacy rate (93.33%) was higher (84.44%),the difference was statistically significant (P<0.05).After treatment,the scores, the observation group after treatment Hamilton Depression Scale,Hamilton Anxiety Scale,insight assessment scores were significantly lower than those in the control group,while the observation group after treatment of personal self-esteem scale,individuals and Social Functioning scale scores were significantly higher than those after treatment,the differences were statistically significant (P<0.05). Conclusion Schering joint Hydrochloride tablets risperidone and cognitive behavioral therapy is effective in improving negative symptoms of patients with residual schizophrenia,cognitive social function, improve quality of life for clinicians widely used.
Effect of transjugular intrahepatic portosystemic shunt surgery on metabolism of patients with cirrhosis and portal hypertension
JIN Rui-fang, CHEN Ren-pin, LIN Xiu-qing, CHEN Zhou-feng, YANG Dan-hong
2016, 14(11): 1820-1822. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.009
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Objective To study the change of body mass index,glucose metabolism,and liver and kidney function in patients with cirrhosis and portal hypertension after transjugular intrahepatic portosystemic shunt(TIPS),and evaluate the effect of TIPS surgery. Methods A total of 56 patients with cirrhosis and portal hypertension undergoing TIPS surgical treatment in our hospital between November,2014 and October,2015 were enrolled into this study.The body mass index,glucose metabolism and liver and kidney function change before and after the surgery were compared. Results The weight at postoperative 1 month and 6 months were higher than preoperative and postoperative 7 days(P<0.05);the dry weight at postoperative 7 days,1 month and 6 months were higher than that before surgery(P<0.05).The fasting insulin levels at postoperative 7 days,1 month and 6 months were significantly lower than preoperative(P<0.05).The alanine aminotransferase and aspartate aminotransferase at postoperative 7 days were higher than before the surgery(P<0.05),the alanine aminotransferase and aspartate aminotransferase levels at postoperative 1 month and 6 months were lower than that before surgery(P<0.05),the alanine aminotransferase and aspartate aminotransferase levels at postoperative 1 month and 6 months were less than postoperative 7 days(P<0.05),the albumin level at postoperative 7 days was no significant difference with preoperative,the albumin level at postoperative 1 month and 6 months were higher than that before the surgery(P<0.05).The urea level at postoperative 7days,1 month and 6 months were lower than preoperative(P<0.05). Conclusion TIPS in patients with cirrhosis and portal hypertension can increase the weight and dry weight,and improve liver function,insulin resistance and urea metabolism.
Clinical analysis of acute kidney injury with the brain diseases in ICU
LIU Cheng, ZOU Qi, ZHAO Fei
2016, 14(11): 1823-1825. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.010
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Objective To explore the risk factors for acute kidney injury in ICU during the course of treatment of brain diseases and its prognostic factors. Methods The medical records of hospitalized patients in ICU from June,2011 to July,2015 were collected,all AKI with the brain diseases were selected,a total of 59 cases.According to the conditions of the brain disease patients with AKI,we collected the general data (including age, gender,Glasgow Coma Scale, with or without chronic diseases.), the special data (including indexes of renal function, whether there is shock,surgery,whether there is the use of nephrotoxic drugs, the total amount of mannitol), as well as the prognosis,ICU stay and costs.Through the AKIN diagnostic criteria is graded, the relationship between the prognosis of the patients and the prognosis of the patients at 28 days and discharged are observed, the relationship between AKI and prognosis of patients are analyzed by single factor variance analysis,and the risk factors for disease stage and prognosis are analyzed by Logistic regression analysis. Results AKI Ⅰ,Ⅱ and Ⅲ were accounted for 39.0%,30.5% and 30.5%,respectively,the proportion of cured or improved is 45.8%,and the proportion of non-healing patients accounted for 54.2%.GCS score of 5(4,7) of all patients,1 000(400,1 440) of the total use of mannitol,22 patients with renal toxicity drugs,ICU length of stay is 14(13,23)d,a total cost of 5.7(4.5,8.6) million.Risk factors for AKI staging:GCS score,whether there is the use of nephrotoxic drugs and whether having chronic diseases,factors affecting the outcome such as Age,GCS score,whether there is the use of nephrotoxic drugs,sex and AKI classification,and the higher the AKI staging,the higher hospitalization time and costs. Conclusion There is a high mortality rate in patients of acute kidney injury with the brain diseases in ICU.The clinicians require attaching great importance to its various risk factors, to make early prevention and early diagnosis of brain disease with AKI,which can improve the prognosis and reduce the economic burden of patients.
Therapeutic effects and adverse reactions of bortezomib-containing combination chemotherapy on for multiple myeloma
ZHANG Li, LUO Wen-da, SHEN Jian, FENG Zhang-wei
2016, 14(11): 1826-1828. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.011
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Objective To explore the clinical efficacy and adverse reactions of Bortezomib-containing combination chemotherapy on multiple myeloma. Methods Total 35 cases of multiple myeloma treated with Bortezomib in Taizhou Hospital from January,2009 to June,2014 were enrolled and divided into newly diagnosed group and relapsed group that including ≥ 4 cycles group and <4 cycle group.The curative efficacy,2-year overall survival and progression-free survival at 2 years,and chemotherapy adverse reactions of the each groups were observed. Results The efficacy of newly diagnosed group was superior than that of the relapsed group(Z=-0.842,P=0.004).The efficacy of ≥ 4 cycles group was superior than that of <4 cycle groups(Z=-2.224,P=0.026).2-year overall survival was closely related to ISS staging and efficacy(P<0.05),there was no significant correlation with pre-treatment status and extramedullary lesion(P>0.05).The progression-free survival at 2 years was closely related to extramedullary disease(P<0.05) and was no significant correlation with the pre-treatment state,ISS staging and efficacy(P>0.05).In 35 cases of multiple myeloma,14 cases were with gastrointestinal symptoms,13 cases with peripheral neuropathy,21 cases with thrombocytopenia,and 13 cases with leukopenia. Conclusion The therapeutic effect of bortezomib-containing combination chemotherapy for multiple myeloma is more precise,especially for the newly diagnosed patients.The treatment of more than four cycles is usually with a better efficacy,and adverse reactions can also be tolerated.
Effects of dexmedetomidine-induction on transsphenoidal pituitary tumor surgery perioperative
DING Lei-ming, ZHENG Zhen-hui, WANG Zhen
2016, 14(11): 1829-1831. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.012
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Objective To study the effects of dexmedetomidine-induction on transsphenoidal pituitary tumor surgery perioperative. Methods Fifty patients from the Fifth Affiliated Hospital of Wenzhou Medical Anesthesiology transsphenoidal pituitary tumor surgery were selected as research subjects,the 50 patients were divided into dexmedetomidine group and control group according to the random number method,the dexmedetomidine group patients were pumped dexmedetomidine intravenously at 15 minutes before induction,the control group patients were pumped saline intravenously at 15 minutes before induction.The systolic,diastolic blood pressure and heart rate of two groups were observed at all time points,the remifentanil and prop propofol dosage,operation time and extubation time of two groups as well as were observed. Results The systolic blood pressure of dexmedetomidine group at 5 min after intubation,5 min after extubation and 10 min after extubation were lower than that of control group corresponding time points (P<0.05).The diastolic blood pressure of dexmedetomidine group at 5 min after intubation,5 min after extubation and 10 min after extubation were lower than that of control group corresponding time points(P<0.05).The heart rate of dexmedetomidine group at before intubation,5 min after intubation and 5 min after extubation were lower than that of control group corresponding time points(P<0.05).The difference of remifentanil and prop propofol dosage in dexmedetomidine group and control group were not statistically significant(P>0.05).The difference of operation time and extubation time in dexmedetomidine group and control group were not statistically significant(P>0.05). Conclusion Dexmedetomidine induced is beneficial to favor transsphenoidal pituitary tumor surgery perioperative systolic blood pressure,diastolic blood pressure and heart rate stable and does not affect the amount of anesthetic, surgical time and extubation time.
Blood glucose and blood lipid metabolism in first-episode schizophrenia patients and effect of Olanzapine
ZHU Wen-biao, ZHU Yi-xuan, CHEN Ce, LIN Yong
2016, 14(11): 1832-1834,1835. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.013
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Objective To explore the blood glucose and lipid metabolism of episode schizophrenia patients and the influence of Olanzapine on blood glucose and lipid metabolism. Methods From July,2014 to December,2015,112 patients with schizophrenia were selected as schizophrenia group,while 112 cases of healthy subjects were recruited as control group.Schizophrenia patients were given Olanzapine with a dose of 10-20 mg/d for three months.The blood glucose and lipids metabolism of both groups were observed.The effect of Olanzapine on blood glucose levels,lipid levels,abdominal circumference and BMI in patients with schizophrenia was assessed. Results Total cholesterol and High-density lipoprotein of the schizophrenia group was lower than that of the control group(P<0.05),the difference of fasting glucose,total cholesterol,triglycerides and low-density lipoprotein between the two group were not statistically significant(P>0.05).The difference of fasting blood glucose level of before olanzapine treatment,olanzapine treatment 1 month,2 months,3 months in episode schizophrenia patients was not statistically significant(P>0.05).The total cholesterol,triglycerides and LDL levels at olanzapine treatment 1 month,2 months,3 months were significantly higher than that of before treatment(P<0.05).The abdominal circumference and BMI at olanzapine treatment 3 months in patients with schizophrenia were significantly higher than that before treatment(P<0.05). Conclusion During the episode of schizophrenia,the patients has abnormal lipid metabolism.Olanzapine therapy can improve lipid metabolism and cause the changes of abdominal circumference and BMI of patients,but has little effect on glucose metabolism.
Influence of different doses of rosuvastatin on inflammatory factors,endothelial function and visfatin levels in patients with unstable angina pectoris
WANG Liang-guo, GAO Zhan, XIA Xue, ZHU Qian-li, HU Long, CHEN Fang-hui
2016, 14(11): 1835-1837,1866. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.014
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Objective To compare the influence of different doses of Rosuvastatin on inflammatory factors,endothelial function and Visfatin levels in patients with unstable angina pectoris and its safety. Methods A total of 120 cases of unstable angina pectoris in our hospital between February,2011 and May,2015 were enrolled and randomly divided into observation group and control group with 60 cases in each group.All patients received the routine therapy.The patients in the control group received orally 10 mg Rosuvastatin,1 time a day,while the patients in the observation group received orally 20 mg Rosuvastatin,1 time a day,the course in both groups was 12 months.After the treatment,the levels of HIF-1α,visfatin,TNF-α,vWF,ET-1,NO and hs-CRP were tested.The endothelial function in both groups was determined.The incidence of cardiovascular adverse events during the treatment and adverse drug reactions were recorded. Results After the treatment,the serum alpha HIF-1,Visfatin,TNF alpha,hs-CRP,vWF and ET-1 levels in both groups decreased,more obviously in the observation group as compared with the control group.The serum NO level was increased in both groups,especially in the observation group,the difference between the two groups was significant(P<0.05).After the treatment,the baseline artery diameter,lumen diameter during inflation and flow mediated dilation(FMD)were increased,especially in the observation group,the difference between the two groups was significant(P<0.05).The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group,and the difference was statistical significant(P<0.05).The incidence of abnormal liver function in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05). Conclusion The high-dose Rosuvastatin for unstable angina pectoris have a better comprehensive clinical efficacy as compared with the routine dose,it can obviously improve the long-term efficacy,however,the incidence of adverse reactions is dose-related,and therefore the pros and cons should be weighed during the clinical use.
Efficacy analysis of external fixator and volar locking-plate fixation in treatment of type C fracture of distal radius
LUO Yu-xiao, LU Jian-min, FANG Xin
2016, 14(11): 1838-1840,1872. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.015
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Objective The type C fracture of distal radius were the common types of fractures,its treatment methods mainly include external fixation and volar locking-plate internal fixation.The choice of operation type is still controversial.This paper will compare the clinical efficacy of the two surgery types,and provide a reference for the clinical application. Methods A total of 84 cases of type C fracture of distal radius were collected from January,2011 to January,2014 in our hospital.According to the surgery method,42 cases were assigned into external fixation group,another 42 cases into internal fixation group.The operative time,blood loss,hospitalization time,fracture healing time,ulnar deviation,palmar tilt,radial height,and Cooney wrist score at 6 months and 12 months after the operation between the two groups were compared. Results Compared with internal fixation,the external fixation group was with less operation time (30.2±8.9)min,amount of bleeding during operation (21.7±7.3)ml,hospitalization time (4.3±1.2)d and fracture healing time (11.9±4.4)weeks(P<0.05),while the external fixation group had great ulnar deviation (20.5±3.1)degree and radial height (13.7±1.8)mm,but the palmar tilt was significantly smaller (10.2±2.9) as compared with the internal fixation group(P<0.05);6 months after the operation,Cooney wrist score for the range of motion and grip strength score was significantly higher(P<0.05);the postoperative Cooney wrist score 12 months after the operation for the function,scope of activities,flexion/extension activity and grip strength were significantly higher(P<0.05);One years after the operation,the excellent and good rate of external fixation group was 90.5%,and of the internal fixation group was 81.0%,the differences between the two groups was significant(P<0.05). Conclusion Volar locking-plate internal fixation and external fixator for type C distal fractures of distal radius can achieve good effect.The external fixator is with advantages of quick recover after operation,small trauma,good wrist joint activities and higher excellent rate.
Clinical analysis of 34 patients with traumatic hemorrhagic shock undergoing limited fluid resuscitation
HAN Jia-yu, ZHANG Si-quan, ZHOU Ke-xing, YAN Cheng-min, LU Guan-zhen
2016, 14(11): 1841-1843. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.016
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Objective To investigate the clinical effect of limited fluid resuscitation in the treatment of traumatic hemorrhagic shock patients. Methods Total 68 traumatic patients with hemorrhagic shock were divided into 2 groups by random number method.The patients in the control group were given positive fluid resuscitation,while the patients in the observation group were given limited fluid resuscitation.The heart rate,mean arterial pressure,oxygen saturation,the used fluid resuscitation amount and hemoglobin concentration,serum lactate level,prothrombin time(PT),activated partial thromboplastin time(APTT) cure rate,mortality,morbidity of two groups were accounted. Results After the treatment,mean arterial pressure and oxygen saturation levels of both groups were significantly increased(P<0.05),mean arterial pressure of the observation group were significantly lower than that in the control group(P<0.05),and oxygen saturation levels of the observation group were significantly higher than that in the control group(P<0.05).After the treatment,heart rate of both groups was significantly reduced(P<0.05),heart rate of the observation group was significantly lower than that in control group(P<0.05).The fluid resuscitation amount hemoglobin concentration of the observation group were significantly lower than that in the control group(P<0.05).After the treatment,the levels of serum lactate levels were significantly lower(P<0.05),and serum lactate levels of the observation group was significantly lower than that in the control group(P<0.05);The prothrombin time(PT),activated partial thromboplastin time(APTT)levels of the two groups were significantly increased(P<0.05),PT and APTT of the observation group were significantly lower than that in the control group(P<0.05).The cure rate of the observation group was 67.5%,significantly higher than that in the control group 26.5%(P<0.05).The mortality rate and complication rate of the observation group were 8.82% and 23.5%,significantly lower than 26.5% and 47.1% in the control group(P<0.05). Conclusion Limited fluid resuscitation can stabilize the tissue perfusion pressure and peripheral circulation,mobilize clotting mechanism,improve patient survival,reduce mortality.
Effects of Buyang Huanwu Decoction combined with edaravone on the regulation of neuronal mitochondrial apoptosis pathway in mice with brain ischemia and reperfusion injury
ZHONG Fang-fang, WU Cheng-long, SUN Xin-fang, WANG Zhao-wei
2016, 14(11): 1844-1847. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.017
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Objective To investigate the effects and mechanism of Buyang Huanwu Decoction combined with edaravone on protecting the brain of mice with cerebral ischemia-reperfusion injury. Methods The middle cerebral artery occlusion/reperfusion model was established by the improved intraluminal filament technique in mice.The 90 mice were randomly divided into five groups(each group 18):sham operation group;model group;BYHWD group(10 ml/kg,ig);ED group(3 mg/kg,iv);BYHWD+ED group (BYHWD 10 ml/kg,ig+ED 3 mg/kg,iv).Seven days after the administration of drugs,the differences of neurologic impairment score on 1,3 and 7 d were observed.On 7 d,the cerebral infarction volume was determined using TTC staining.Apoptotic cells were quantified with TUNEL method.The positive cells of bcl-2,bax and caspase-3 were detected by immunohistochemistry method.The data between groups was compared with one-way analysis of variance;the comparison between 2 groups was with t test.P value<0.05 was accepted as statistically significant. Results On 1,3 and 7 d,the neurological deficit score had decreased over time.On the same time,the model group had the highest score,the combination group had the lowest score(P<0.01).On 7 d,the infarction volume percentage of combination group reduced than the single group(P<0.01);drug groups could reduce apoptosis cells(P<0.05);increase the number of bcl-2 expressed cells,reduce the number of bax and caspase-3 expressed positive cells,the change trend of combination group was more obvious than others(P<0.05). Conclusion The combination of Buyang Huanwu decoction and edaravone has a better protective effect on cerebral ischemia-reperfusion injury through the modulation of related factor of mitochondrial apoptosis pathway.
Risk of early respiratory failure in traumatic cervical spinal cord injury patients and influencing factors
ZHU Ye, CHEN Jian, HE Deng-wei, WU Zhong-wei, ZHU Ke-jun
2016, 14(11): 1848-1850. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.018
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Objective To study the risk of early respiratory failure complication in patients with traumatic cervical spinal cord injury(TCSCI) and related influencing factors,and provide basis for evaluation and promotion of prognosis of patients. Methods The study was a reviewing trial.Total 212 TCSCI patients in our hospital from June,2011 to June,2015 were enrolled into this study.The clinical data were collected,and patients were grouped based on respiratory failure.Forty-one TCSCI patients with early respiratory failure were selected as study group,and 171 patients without respiratory failure as control group,and prognosis situation of patients were compared between groups.The influencing factors on early respiratory failure were analyzed by single factor analysis and Logistic aggression analysis. Results There was difference between the patients with or without fracture dislocation(χ2=7.964,P=0.005),skeletal level(χ2=15.826,P<0.001),injuring reasons(χ2=4.305,P=0.014),ASIA classification(χ2=51.947,P<0.001).Logistic aggression revealed that whether accompanied by fracture dislocation(OR=6.120,95%CI:1.574-9.644),skeletal level(OR=2.215,95%CI:1.369-3.454),ASIA classification(OR=1.925,95%CI:1.122-2.774)were impact factors of early respiratory failure complication of TCSCI. Conclusion The fracture dislocation,skeletal level above C4,high ASIA classification could be risk factors of early respiratory failure complication,specific precautionary measures should be reinforced to decrease risk of respiratory failure and improve prognosis.
The clinical study of external insertion of intramedullary nail in semi knee extensor for the treatment of tibial shaft fractures
HOU Li-qiang, WANG Hao-min, CAO Zhi-qiang, YU Jing, LENG Yan-kui
2016, 14(11): 1851-1853,1879. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.019
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Objective To investigate the clinical effect of external insertion of intramedullary nail in semi knee extensor for the treatment of tibial shaft fractures. Methods Forty-six cases of tibial shaft fracture patients were selected as studying object from the Second Department of Orthopedics of Jinhua Guangfu Hospital in Zhejiang from June,2012 to October,2014.All the patients were randomly divided into observation group(n=23) and control group(n=23) according to the random number table.The observation group were treated with external insertion of intramedullary nail in semi knee extensor,and the control group underwent conventional incision in patellar tendon or lateral patellar tendon approach.With 6 to 12 months' follow-up,range of motion of the knee and ankle joint,healing time and complications of two groups were compared. Results The excellent rate of observation group(91.30%) were higher than control group 56.52%(P<0.05),while the total complication rate(4.35%) was lower than the control group(39.13%),which is statistically significant(P<0.05).The postoperative knee flexion(142.36±7.82)°,extension angle of dorsiflexion(9.85±0.82)°,plantar flexion degree(22.85±5.42)° and plantar flexion (48.32±3.45)° of observation group was higher than those of the control group(132.14±4.58)°,(1.25±0.22)°,(15.62±6.33)°,(32.59±4.78)°,P<0.05.The load time (2.45±0.62) months,the callus appears time (2.52±0.48) months,the healing time (8.42±2.22) months,and the removal of fixed time (10.22±3.56) months of observation group were shorter than those of the control group (3.78±0.56) months,(3.89±0.72) months,(10.48±2.69) months,(12.89±3.79) months(P<0.05),and postoperative pain score(4.02±1.12) points was lower than the control group (7.26±2.12) points(P<0.05). Conclusion External insertion of intramedullary nail in semi knee extensor for the treatment of tibial shaft fractures can effectively improve the clinical treatment of patients and reduce postoperative complications,beneficial for the patients to improve their joints function in addition to promoting their rehabilitation..
Efficacy of microvascular decompression on patients with primary hemifacial spasm
HU Sheng-li, WANG Chao-jia, ZHANG Yu-qiang, LIU Kai-jun, LI An-rong, WANG Hui
2016, 14(11): 1854-1856,1941. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.020
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Objective To investigate the efficacy of microvascular decompression(MVD) on patients with primary hemifacial spasm(HFS)and sum up experiences to enhance the curative effects and decrease complications. Methods The data of 57 patients with HFS during June,2010 to June,2015 who had underwent MVD were retrospectively analyzed for the efficacy and complications. Results Fifty-six patients had specific one or more offending vessels,accounting for 98.2 percent,which were respectively anterior inferior cerebellar artery,posterior inferior cerebellar artery as well as vertebral artery.There was no specific offending vessel in one case.Significant vascular pressure trace was seen in facial nerve root of 12 patients in operation.Hemifacial spasm immediately disappeared in 8 patients and hemifacial spasm was obviously relieved in 4 patients after operation.Among 57 patients,symptoms of HFS disappeared immediately after operation in 51 patients and significantly relieved in 6 patients,the symptoms of whom gradually disappeared in 6 months later.Slight facial paralysis appeared in 6 patients after operation and gradually disappeared in 5 patients 6 months later.There was 1 patient with mild facial paralysis followed up for 2 years.Hearing impairment appeared in 5 cases after operation and there was no obvious improvement in 6 months to 2 years.Permanent hearing loss appeared in 1 patient after operation.Tinnitus appeared in 2 patients after operation and disappeared 3 months later.Dizziness and ataxia appeared in 2 patients after operation and disappeared in 1 month.There was neither report of cerebrospinal fluid leakage and intracranial infection,no report of disability and death.No recurrence was noted during the follow-up period of 1 to 4 years(mean 2.5 years). Conclusion MVD is a safe and effective treatment for HFS.Effect of MVD for elderly patients with HFS was satisfying,thus age was not a contraindication of MVD.MVD,with high cure rate and low complication rate,should be the first choice for the treatment of HFS.Solid theoretical foundation and skilled micromanipulation technique are essential to improve the curative effect and reduce complications.
Efficacy of sufentanil on agitation and hemodynamic status during recovery period from etomidate-based anesthesia induction
ZHOU Yu-mei, GUO Wen-jun
2016, 14(11): 1857-1859. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.021
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Objective To observe the effect and safety of Sufentanil for prevention from agitation and stress reaction during recovery period from etomidate-based anesthesia in elderly patients undergoing radical gastrectomy. Methods Ninety ASA Ⅰ-Ⅱ patients undergoing radical gastrectomy under general anesthesia,aged 60 to 75 years,were enrolled in this study.The patients were randomly divided into three groups:Group S(maintained with Sufentanil),Group F(maintained with Fentanyl) and Group R(maintained with Remifentanil).The hemodynamic changes during the anesthesia in all groups were recorded.The MAP,HR and SpO2 were recorded at T1(extubation),T2(20 minutes after extubation) and T3(30 minutes after extubation).The stay in the recovery room,postoperative complications,Riker Sedation-Agitation score and VAS score in the recovery period,and FLACC score for facial expressions,body movements,activities,crying,can be soothing 30 minutes after the extubation were documented. Results During Induction of Anesthesia and surgery,the hemodynamics parameters in all three groups were stable.During recovery time,the heart rate and blood pressure in group S were more stable as compared with group F and group R;The incidence of agitation,Riker Sedation-Agitation score and FLACC score in the group S was obviously lower than those in group F and R,the difference was significant(P<0.05).The difference in the time to recovery and time to extubation among the three groups was not significant(P>0.05). Conclusion The maintain anesthesia with Sufentanil in patients undergoing radical gastrectomy can maintain a stable hemodynamics,not prolong the time to extubation and recovery,and effectively prevent the agitation caused by etomidate-based anesthesia during recovery period and decrease the stress reactions.
Influence of Huoba Huagen tablets combined with valsartan on renal function and lipid metabolism in patients with diabetic nephropathy
WANG Xiu-qin, PAN Zhao-bao, GAO Rui-hao, HAN Shou-hua, WANG Shu-yi
2016, 14(11): 1860-1862. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.022
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Objective To investigate the influence of Huoba Huagen tablets combined with valsartan on renal function and lipid metabolism of patients with diabetic nephropathy(DN),and to provide support for its clinical application. Methods A total number of 184 cases of diabetic nephropathy in our hospital from January,2015 to December,2015 were enrolled and randomly divided into control group and observation group by random number method with 92 cases in each group.The patients in the control group were given valsartan,while the patients in the observation group were administrated with Huoba Huagen tablets and valsartan.Before and after the treatment,the renal function indicators[24 h urinary protein(QUP),24 h urinary albumin excretion rate(UAER),serum creatinine(Scr)]and lipid metabolism[cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C)] levels of both groups were tested,and the therapeutic efficacy was documented.SPSS 18.0 was used to compare the difference in renal function indicators and lipid metabolism between the two groups. Results After the treatment,the levels of UAER,QUP and Scr in both groups were significantly reduced(P<0.05),especially in the observation group,the difference was significant as compared with the control group(P<0.05);after the treatment,the levels of TC,TG and LDL-C of both groups were significantly reduced(P<0.05),and more obviously in the observation group as compared with the control group(P<0.05).The total efficacy of the observation group was 87.0%,which was significantly higher than 0.7% of the control group(P<0.05). Conclusion Huoba Huagen tablets combined with valsartan can effectively improve renal function and lipid metabolism of patients with diabetic nephropathy with a satisfactory efficacy.
Survival analysis of IMRT in recurrent endometrial carcinoma
ZHANG Li-ping
2016, 14(11): 1863-1866. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.023
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Objective To analyze the result of intensity modulated radiation therapy(IMRT)in recurrent endometrial carcinoma and its influence factors. Methods Fourty cases of patients with endometrial cancer in our hospital from September,2012 to October,2013 were treated with IMRT for regionally pelvic or paraortic nodal recurrences.Compare FIGO stage,number of recurrent sites,size of largest recurrent node,lymph node dissection,histology and grade characteristics according to the types of chemotherapy.Survival rate was calculated by Kaplan-Meier method. Results Fourteen (35%) initially received chemotherapy and 22(55%) received concurrent chemotherapy.FIGO stage:Ⅰ/Ⅱ of 21 cases,Ⅲ/Ⅳ of 19 cases. Number of recurrent sites:15 cases of single site,25 cases of multiple sites.Tumor diameter:23 cases <3 cm diameter,17 cases ≥ 3 cm. Lymphatic stromal invasion:13 cases of pelvic nodal recurrences,8 cases of paraortic recurrences only,19 cases of simultaneous pelvic and paraortic recurrences.Pathological:31 cases of adenocarcinoma,clear-cell carcinoma in 3 cases,3 cases of adenosquamous carcinoma,3 cases of serous adenocarcinoma.Histological grade:7 cases of poorly differentiated,22 cases of intermediate differentiated,11 cases of well-differentiated. No different clinical characteristics observed between patients treated with and without chemotherapy(P>0.05).The 2 year survival rate was 72.5%.Patients undergoing initial chemotherapy prior to IMRT had shorter survival rate(P=0.043).Patients receiving concurrent chemotherapy had significantly longer survival rate(P=0.045). Conclusion Concurrent chemotherapy with IMRT can improve survival time in patients with recurrent endometrial cancer. Initially chemotherapy is not beneficial to survival rate.
Risk factors and strategies of drug-induced liver injury in untreated pulmonary tuberculosis patients
MAO Jia-bin, SUN Pei-ying, XU Jin-tian
2016, 14(11): 1867-1869. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.024
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Objective To account the incidence of drug-induced liver injury(DILI) in untreated pulmonary tuberculosis patients,and investigate the risk factors of drug-induced liver injury. Methods All 620 cases of pulmonary tuberculosis patients in our hospital from January,2013 to December,2015 were retrospectively analyzed.The patients were divided into injury group(117 cases) and non-injury group(503 cases)based on drug-induced liver injury.The risk factors questionnaire included the following items:factors of gender,disease duration,age,drinking history,smoking history,HbsAg positive,diabetes,blood pressure level,Body mass index,using of protection liver drug.Univariate factor and Logistic regression analysis were carried out to analyze the related risk factors. Results The liver damage rate was 18.9%.Univariate analysis showed that the age,drinking history,smoking history,HbsAg positive,diabetes,blood pressure level,Body mass index,non-using of protection liver drug were the risk factors of DILI of pulmonary tuberculosis.And multivariate Logistic regression analysis showed that the age,drinking history,smoking history,HbsAg positive,diabetes,blood pressure level,Body mass index,non-using of protection liver drug were the risk factors of DILI of pulmonary tuberculosis. Conclusion Treatment naive patients with pulmonary tuberculosis easily occur DILI after the application of anti-TB drugs,and age,drinking history,smoking history,HbsAg positive,diabetes,blood pressure level,Body mass index,non-using of protection liver drug were the risk factors of drug-induced liver injury.These risk factors should be paid more attention.
Expression of vascular endothelial growth factor-A and its role in micro vessel formation and lymphatic formation in colorectal cancer
JIANG Hua-feng, YING Xiao-jiang, CHEN Hong-liang, WANG Xiao-yan
2016, 14(11): 1870-1872. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.025
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Objective To analyze the relationship between vascular endothelial growth factor-A(VEGF-A) expressions and the density of Lymphatic vessel and micro vessel(LVD and MVD). Methods A total number of 79 patients with colorectal cancer in our hospital from 2011 to 2015,including 52 cases of rectal carcinoma and 27 cases of colon carcinoma,were collected.The connection between the clinical pathological features and the value of LVD,the relationship between the expressions of VEGF-A and the levels of MVD and LVD,the relationship between LVD and MVD were analyzed. Results The value of LVD in normal tissues was obviously lower than that in colon cancer tissues.LVD had close correlation with lymphatic vessel tumor thrombus(P<0.05),had no correlation with lymph node metastasis,TNM stage,differentiation degree and depth of invasion of colorectal cancer(P>0.05).The expression of VEGF-A in tumor tissues had close correlation with MVD(CD34 count),P<0.05,but had no correlation with LVD(podoplanin count),P>0.05.The value of LVD was obviously lower than MVD in colon cancer(P<0.01).But LVD count had no correlation with MVD count(P>0.05). Conclusion The lymphatic formation plays an important role in the whole development process of colorectal cancer.Micro vessel formation and lymphatic formation may be two processes that are independent of each other.The VEGF-A has induction effect on micro vessel formation in colorectal cancer,but it has no correlation with lymphatic formation.LVD value is obviously lower than MVD value in colorectal cancer,but their relationship is not obvious.
Efficacy and safety of double-channel endoscope in the diagnosis and treatment of postoperative low-level bile duct obstruction after Billroth Ⅱ subtotal gastrectomy
YIN Xiao-bo
2016, 14(11): 1873-1875. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.026
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Objective To study the efficacy and safety of double-channel endoscope in the diagnosis and treatment of low-level bile duct obstruction after Billroth Ⅱ subtotal gastrectomy. Methods A total of 67 cases of low-level bile duct obstruction after Billroth Ⅱ subtotal gastrectomy in our hospital between January,2013 and May,2015 were enrolled and randomly divided into observation group(33 cases)and control group(34 cases).The dual channel direct vision endoscopy was performed in the observation group,while traditional endoscopic treatment was performed in the control group.The curative effect,the level of serum total bilirubin(TBIL),alanine aminotransferase(ALT) and aspartate aminotransferase(AST),incidence of complication,and mortality during postoperative 6 months and 12 months were compared between the two groups. Results The total effective rate in the observation group was 87.88%(29/33),which was significantly higher than that of control group 64.71%(22/34,Z=-2.097,P<0.05);the serum total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)levels were significantly lower than control group(t=4.235,4.482,4.401,P<0.05).The incidence of bleeding and intestinal perforation rate was 3.03% and 0.00% during the treatment in the observation group,which were significantly lower than those(20.59% and 14.71%)in the control group(χ2=4.910,5.244,P<0.05).The mortality rates in the observation group during 6 months and 12 month after the operation were 12.12% and 21.21%,respectively,which were significantly lower than 35.29% and 50% in the control group,the differences was statistically significant(χ2=4.947,6.057,P<0.05). Conclusion The effect of double-channel endoscope is distinct in the diagnosis and treatment of ow-level bile duct obstruction after Billroth Ⅱ subtotal gastrectomy.It can effectively ireduce the incidence of complications,prolong servial of patient,and worthy of clinical application.
The application of protective stoma in the terminal ileum with self-closing intubation in colorectal surgery
TONG Feng, YING You-hua, JIANG Wen-liang, PAN Hai-hua, ZHAO Wei, LI Hong-chen
2016, 14(11): 1876-1879. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.027
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Objective To investigate the feasibility and safety of the spontaneously closed protective stoma at the terminal ileum to prevent anastomotic leakage in colorectal surgery. Methods A retrospective analysis of 106 cases of colorectal surgery with protective stoma patients from May,2011 to December,2015 in Lanxi People's Hospital.They were divided into two groups:83 cases with spontaneously closed protective stoma at the terminal ileum and 23 cases with conventional loop ileostomy or loop transverse colostomy.Two groups were compared for the following indicators:postoperative complications,nutrition and infection-related indicators(TP,Alb,PA,CRP,PCT and so on),intestinal repatency time,hospitalization costs and so on. Results Two protective stoma methods all have a protective effect on colorectal anastomoses.There was no statistically significant difference in anastomotic leakage rate,the incidence of postoperative infection in 7 days in addition to nutrition indicators in 14 days.The average intestinal repatency time of the spontaneously closed protective stoma group is 19 d,while the conventional group is 125 d.The recovery of enterokinesia and defacation of the spontaneously closed protective stoma group was significantly earlier than that of the conventional group;meanwhile,parastomal hernia,intestinal obstruction and other complications of the experimental groupwere significantly less than the conventional group.Hospitalization time and costs of the experimental group were significantly lower than the conventional group. Conclusion For the patients with advanced age,malnutrition,diabetes and other complications,receiving neoadjuvant chemotherapy before operation,anus-retained operation for low rectal cancer,and the patients was unsatisfied with intraoperative anastomoses,left colorectal cancer complicated by acute obstruction,acute injury of left colon or rectum and other patients dissatisfied with intestinal tract preparation are suitable for protective stoma.Compared with conventional loop ileostomy or loop transverse colostomy,spontaneously closed protective stoma has the same effect of preventing anastomotic leakage,and can shorten hospitalization time,avoid 2nd stage operation,ease patients' pain and reduce hospitalization costs.
Therapeutic efficacy of 131I combined with Prednisone on Graves' disease
ZHONG Ji-jun, FENG Ping, LIU Wei-ping, GAO Qian-gang, HU Wei
2016, 14(11): 1880-1882. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.028
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Objective To evaluate the clinical efficacy of 131I combined with Prednisone in the treatment Graves' disease. Methods 128 cases of Graves'disease were randomly divided into two groups,the control group was treated only with 131I,while the combined group with 131I and Prednisone tablets(30 mg,qd) prescribed for the first month,and 15 mg,qd for the second month,and 5 mg,qd for the third month.Total course was 3 months.Thyroid function and TRAb and Graves ophthalmopathy were assessed 3 months and 6 months after 131I treatment. Results 3 months after 131I therapy,the simple Graves ophthalmopathy deterioration rate in the control group was 16.7%,and in the combined group was 10%(χ2=0.349,P>0.05);Infiltrative ophthalmopathy deterioration rate in the control group was 23.1%,and in the combined group was 10%(χ2=0.219,P>0.05);the total deterioration rate in both group(20% vs. 10%,χ2=1.055,P>0.05)was not significant.TRAb levels in the control group and combined group were (112.23±45.88) IU/L vs. (90.11±46.32) IU/L for 3 months of treatment,t=2.679,P<0.01;(90.55±33.55)IU/L vs.(70.77±50.88)IU/L for six month of treatment,t=2.513,P<0.02;and (44.27±40.56)IU/L vs.(30.66±37.98)IU/L for 9 months of treatment,t=0.548,P>0.05,respectively.The control rate of hyperthyroidism in the control group and combined group were 70% vs.75% for 3 months of treatment,χ2=0.353,P>0.05,and 81% vs. 86% for six months of treatment,χ2=0.153,P>0.05,respectively. Conclusion 131I combined with Prednisone can effectively decrease the levels of TRAb after 3 and 6 months of treatment,but cannot improve the curative effect of hyperthyroidism;the combined therapy can also decline infiltrative ophthalmopathy deterioration rate,and improve the clinical symptoms of thyroid associated ophthalmopathy.The combined use of Prednisone must be based on the score for eye conditions.
Orthodontic combined with repair on treatment of maxillary anterior dentition defects with malocclusion:60 cases analysis
WENG Ning
2016, 14(11): 1883-1885. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.029
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Objective To investigate the clinical effect of orthodontic combined with repair on maxillary anterior dentition defects with malocclusion. Methods Total 120 patients with maxillary anterior dentition defects with malocclusion in our hospital from January,2013 to December,2015 were randomly divided into two groups by random number method,each group 60 cases.Patients in control group were given repair treatment,and patients in observation group were added orthodontic treatment.After treatment,the dental conditions (occlusion,teeth aligned,front teeth overbite coverage),efficacy,satisfaction,treatment cost,debris index and attachment loss index after 1 year of two groups were accounted. Results The occlusion,teeth aligned,front teeth overbite coverage of observation group were 80.0%,86.7%,93.3%,which were significantly higher than control group 61.7%,68.3%,75.0%,the differences were statistically significant(P<0.05).The efficacy rate of observation group(93.3%) was significantly higher than control group(70.0%),the difference was statistically significant(P<0.05).The treatment satisfaction and treatment cost of observation group were 80.0% and (8 067.6±394.5)yuan,which were significantly higher than control group 43.3% and(2 211.7±251.6)yuan,the differences were statistically significant(P<0.05).After 1 year,the debris index and attachment loss index of observation group were 0.13±0.08 and 5.16±1.42,which were significantly lower than control group 0.66±0.17 and 6.49±1.63,the differences were statistically significant(P<0.05). Conclusion Orthodontic combined with repair can effectively treat patients with maxillary anterior dentition defects with malocclusion,improve the teeth deformity,debris index and attachment loss index with higher satisfaction.But the cost is higher.
Effect of channel points massage combined with Yijinjing exercising on chronic fatigue syndrome with sleep disorder
QIAN Li-feng, YAO Qing, ZHU Gao-feng
2016, 14(11): 1886-1888,1951. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.030
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Objective The sleep disorder is one of a relative severe symptoms associated with the patients with chronic fatigue syndrome,by using the green,noninvasive,no dependence therapy of Channel Points Massage combined with Yijinjing exercising,we investigated the clinical effect of channel points massage combined with Yijinjing exercising on Chronic fatigue syndrome with sleep disorder. Methods Total 60 cases patients of chronic fatigue syndrome with sleep disorder in our clinic or hospital were recruited and randomly divided into treatment group(30 cases)and control groups(30 cases).The control group received cognitive behavioral therapy,twice a week,40-60 minutes each time,eight weeks were for a course;while the treatment group received channel points massage combined with Yijinjing exercising,three times a week for channel points massage,treatment for every day in the afternoon about 45 minutes,one time a day for Yijinjing exercising,one hour each time,eight weeks were for a course.Both groups were assessed with multidimensional fatigue inventory(MFI-20)and pittsburgh sleep quality index(PSQI)before and after 8 weeks of treatment. Results Before the treatment,there was no significant different in the observed items between the two groups(P>0.05).After 8 weeks of treatment,the treatment group was significant in the scores of general fatigue,physical fatigue,reduced activity,reduced motivation and mental fatigue in multidimensional fatigue inventory(MFI-20)than the control group(P<0.05);the treatment group was significant in pittsburgh sleep quality index(PSQI)than that in the control group(P<0.05). Conclusion Channel points massage combined with Yijinjing exercising can effectively improve the states of fatigue and sleep quality of chronic fatigue syndrome with sleep disorder,the treatment is cheap,simple and effective,it is worthy for the clinical application and popularization of appropriate technology in primary medical institutions.
The diagnostic value of neutrophil CD64 index in bacterial infections of acute exacerbations of chronic obstructive pulmonary disease
NI Xiao-hui, ZHU Ping, LIU Yun-jie, DING Yu-jie
2016, 14(11): 1889-1891. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.031
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Objective To investigate the diagnostic value of neutrophil CD64 index in bacterial infections of acute exacerbations of chronic obstructive pulmonary disease(AECOPD). Methods The investigation enrolled 50 patients with chronic obstructive pulmonary disease(COPD),among whom 10 with stable COPD,16 with nonbacterial infections AECOPD and 24 with bacterial infections AECOPD.For all COPD patients,the white blood cell count(WBC),erythrocyte sedimentation rate(ESR),c-reactive protein(CRP),procalcitonin(PCT) and neutrophil CD64 index were measured and compared between the three groups.The receiver operating characteristic(ROC) curves were estimated.The areas under ROC curves(AUC) were compared by z-test,and the optimal cut-off values for diagnosis were determined. Results The WBC,ESR,CRP,PCT and neutrophil CD64 index in three groups were significantly different.The ROC curves of the WBC,ESR,CRP,PCT and neutrophil CD64 index for diagnosing bacteria infections of AECOPD were estimated,and their AUC were 0.779,0.750,0.772,0.885,0.929,respectively.The AUC of neutrophil CD64 index was significantly larger than these of WBC,ESR or CRP(P<0.05),while larger than that of PCT,but there was no statistical difference between the both(P>0.05).With the cutoff value of 2.35,the sensitivity and specificity of neutrophil CD64 index for diagnosis were 87.5% and 84.6%. Conclusion The Neutrophil CD64 index as a inflammatory biomarker,was available for diagnosis of bacterial infections of AECOPD.
The influence of Perindopril combined with amlodipine or hydrochlorothiazide on senile hypertension patients blood pressure variability
XU Liang, CHEN Hong-wu, CHEN Yan-chun, ZHAO Xiang-hai, JI Yan-ni, ZHANG Ming, YANG Song
2016, 14(11): 1892-1894. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.032
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Objective To observe the influence of different antihypertensive drugs combination on senile hypertension patients blood pressure variability. Methods From January 2015,to January,2016,128 cases of patients with senile primary hypertension in our hospital were chosen and randomly divided into A and B two groups(64 cases in each group).Group A were given 5 mg/d amlodipine and 4 mg/d perindopril,while group B were given 4 mg/d perindopril and 25 mg/d hydrochlorothiazide.Before taking the medicine and 8 weeks later noninvasive portable ambulatory blood pressure monitors were used to test 24 h ambulatory blood pressure (systolic blood pressure and dynamic diastolic blood pressure),and measure value coefficient of variation CV as an indicator of BPV. Results Eight weeks after taking medicine, indexes including 24 h mean systolic blood pressure(24hSBP),day mean systolic blood pressure(dSBP), night mean systolic blood pressure(nSBP),24 h mean systolic blood pressure coefficient of variation (24hSCV),day mean systolic blood pressure coefficient of variation (dSCV) and night mean systolic blood pressure coefficient of variation (nSCV) were significantly lower than that in group B(P<0.05).Eight weeks after taking medicine,24h mean diastolic blood pressure (24hDBP) day mean diastolic blood pressure (dDBP),night mean diastolic blood pressuren (DBP) in the two groups had no statistically significant difference(P>0.05).In the A group, 24 h mean diastolic blood pressure coefficient of variation (24hDCV),day mean diastolic blood pressure coefficient of variation (dDCV) and night mean diastolic blood pressure coefficient of variation(nDCV) were significantly lower than in the B group (all P<0.05).In group A,nitric oxide were significantly higher than that in group B,and while endothelin level was significantly lower than that in group B(P<0.05). Conclusion Amlodipine combined with perindopril and perindopril combined with hydrochlorothiazidel could all effectively reduce the elderly patients with essential hypertension blood pressure variability,but amlodipine combined with perindopril has more obvious effects.
Outcome analysis of ASCUS by cervical thin-prep cytology test in postmenopausal women
YU Jian-fei, CHEN Fang-zhi, SHI Yu-huan, ZHONG Hui-zhen
2016, 14(11): 1895-1897. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.033
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Objective To explore the outcome of cervical atypical squamous cells of undetermined significance(ASCUS) in postmenopausal women. Methods Between January,2013 and December,2014,712 cases of ASCUS by thin-prep cytology test(TCT)in Ruian City Hospital were enrolled and divided into postmenopausal group and premenopausal group.TCT results,positive rate of ASCUS and high-grade TCT,outcome of ASCUS,and the correlation of ASCUS outcome and HPV infection were observed in both groups. Results The positive rate of ASCUS in the postmenopausal group was lower than that of premenopausal group,but the difference was not statistically significant (P>0.05);the positive rate of cervical squamous intraepithelial lesion in the postmenopausal group was lower than that of the premenopausal group(P<0.05),the positive rate of cervical cancer in postmenopausal group was higher than that of premenopausal group(P<0.05);and the different of ASCUS outcome between the postmenopausal group and premenopausal group women was statistically significant(P<0.05),the proportion of high-grade lesions and cervical squamous cell carcinoma in the postmenopausal group were higher than that of the premenopausal group,the proportion of benign in postmenopausal group was lower than that of premenopausal group;In the postmenopausal group,22 cases of ASCUS developed a high-level disease associated with HPV infection,in which 21 cases were high-risk HPV infection;9 cases developed a cervical squamous cell carcinoma,and all of them were with high-risk HPV infection.In the premenopausal group,15 cases of ASCUS developed a high-level disease combined with HPV infection,all 15 cases were with high-risk HPV infection;9 cases developed a cervical squamous cell carcinoma combined with HPV infection,all 9 cases were with high-risk HPV infection. Conclusion The positive rate of ASCUS in postmenopausal women is lower,but ASCUS developing high-level lesions and cervical cancer is higher as compared with the premenopausal women,and the ASCUS outcome are closely related to high-risk HPV infection.
Effect of free posture in the second stage of labor on promoting spontaneous delivery
FU Ai-ping, ZHOU Lin, YUAN Ling, WANG Zhi-hua, YUAN Li, LEI Xia, CHEN Zi-mei, LIU Jie
2016, 14(11): 1898-1900,1909. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.034
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Objective To explore the effect of free posture to exert and deliver in the second stage of labor. Methods A total of 320 low risk primiparas were randomly divided into observation group and control group with 160 primiparas in each group.The observation group took free posture in the second stage of labor,while control group took supine lithotomy position.The effect was measured by comparing the time of the second stage,delivery mode,neonatal asphyxia,postpartum hemorrhage,perineal lacerations,lateral episiotomy and pain index. Results The spontaneous delivery rate of the observation group was 85%(136/160),significantly higher than 70.6%(113/160) of the control group,(χ2=3.22,P<0.05).In the observation group,the integrity rate of perineum was 15.0%(24/160),significantly higher than 4.3%(7/160) in the control group(χ2=10.56,P<0.05).The lateral episiotomy rate in the observation group 3.1%(5/160)was significantly lower than 20.0%(33/160) in the control group(χ2=17.14,P<0.05).There was no severe pain in the observation group,while in control group there were 38(24%)severe pain cases(χ2=38.03,P<0.05).The time of the second stage in the observation group (38.9±18.6) min was significantly shorter than (58.6±23.7) min in the control group(t=6.54,P<0.05).The percentage of postpartum hemorrhage was not significantly different(χ2=0.11,P>0.05) between the two groups.The percentage of neonatal asphyxia was not significantly different(χ2=0.389,P>0.05) between two groups. Conclusion The free posture in the second stage of labor could increase rate of vaginal delivery,reduce rate of perineal lacerations and lateral episiotomy,relieve maternal pain and reduce time of the second stage.Besides,free posture in the second stage of labor did not increase neonatal asphyxia and postpartum hemorrhage.Therefore,it is worth recommending in clinical applications.
Effectiveness of aminophylline combining with naloxone for neonatal severe disease and respiratory depression
LIU Jiang-hai
2016, 14(11): 1901-1902,1931. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.035
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Objective To observe and explore the effectiveness of aminophylline (Ami) combining with naloxone(Nal) for neonatal severe disease and respiratory depression. Methods Total 84 Neonatal severe disease and respiratory depression accepted drug treatment in this hospital during June,2013 to June,2015 were selected,and were divided into two groups accorded to the random number method,42 cases in each group, the control group was treated with Oral Ami, while the observation group was treated with Nal on the basis of the control group.Respiratory rate (RR),end-tidal CO2 pressure (PetCO2) and pulse oximetry (SPO2) before and after treatment as well as incidence of adverse reactions were recorded and compared,and comprehensive efficacy were evaluated. Results The difference of RR,PetCO2 and SPO2 before treatment was not statistically significant(P>0.05);after treatment,RR,PetCO2 and SPO2 in the observation group were (15.2±1.8) times/min,(42.7±5.2) mm Hg (1 mm Hg=0.133 kPa) and (99.3±1.3)%,while was (12.4±1.3) times/min,(48.5±5.8) mm Hg and (99.6±0.9)% in the control group,RR in observation group were significantly higher than the control group,while PetCO2 were significantly lower than the control group(P<0.05);total effective rate was 88.0%(37/42) in observation group,while was 69.0%(29/42) in the control group, the difference was statistically significant(P<0.05);the difference of adverse reactions incidence between the two groups was not statistically significant(P>0.05). Conclusion Ami and Nal can improve respiratory depression in neonatal intensive disease and respiratory depression, the effect is significant, and no significant side effects,thus it is a safe and effective solution for the Neonatal severe disease and respiratory depression.
Satisfaction degree and influence factors of community health service in a district in Beijing
DING Fang-ran, MAN Xiao-wei, ZHAO Xuan, ZHAO Li-ying, JIANG Yan, CHENG Wei
2016, 14(11): 1903-1905. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.036
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Objective To select the residents in one district of Beijing as the survey object and investigate their cognition, usage and satisfaction degree of community health service,as well as analyze the influence factors. Methods Five hundred residents around community health service center and neighborhood were intercepted randomly.The questionnaire response rate was 100.00%,data efficient rate was 95.80%. Four hundred and seventy-nine valid questionnaires were analyze with statistical software SAS (version 9.3). The situations of cognition, usage and satisfaction degree were analyzed with descriptive method.Analyze the influence factors with multiple linear regressions. Results There were 479 residents in the survey,the average age was 57.74 years old.The survey found that vaccination(4.39±1.64) got the highest score of cognition degree.Basic medical services(3.18±2.41) got the highest score of usage degree. Family doctor service (4.76±0.43) got the highest score of satisfaction degree. Visits number,account type,education degree,initial clinical appeal were the influence factors of cognition degree.Age,sex,visits number,account type,insurance type,with chronic illnesses or not,initial clinical appeal were the influence factors of usage degree.Age,sex,insurance type,initial clinical appeal were the influence factors of satisfaction degree. Conclusion Accessibility of community health service is fine.Scores of cognition degree in various index are different.Scores of usage degree in various index are low overall.Scores of satisfaction degree in various index are good and the influence factors are different.
Psychological defense mechanism,social support and family functioning for first-episode schizophrenia patients in period of recovery
ZHU Chun-yan, SUN Ji-jun, JIANG Zhang-wang, ZHANG Zhi-wen, TANG Jian-ping
2016, 14(11): 1906-1909. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.037
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Objective To explore the characteristics of the psychological defense mechanisms,social support,and family functioning for first-episode schizophrenia patients in rehabilitation period and provide a theoretical basis for the development of effective and comprehensive rehabilitation plan. Methods Total 138 schizophrenia patients after atypical antipsychotic treatment in rehabilitation period(schizophrenia group),and 150 healthy people(control group) were assessed with defense style questionnaire(DSQ),social support rating scales(SSRS) and family assessment device(FAD),and analyze the difference in all the questionnaires between the two groups. Results ①The total score of the immature mechanism in the schizophrenia group was significantly higher[(4.36±1.03) vs. (3.35±0.95),t=2.278,P=0.035],the scores of projection,passive aggressive,complaining,autistic fantasy,schizoid,withdrawal and somatization were all significantly higher(t=2.157-3.503,P=0.003-0.042);The total score of the middle defense mechanism was significantly higher[(4.91±0.86) vs. (4.10±0.75),t=2.242,P=0.038],the scores of reaction formation,removal,avoidance,pseudo-altruism,isolation,denial,association tendency,expectations were significantly higher(t=2.125-4.465,P=0.001-0.048);The total score of the mature mechanism was significantly lower[(4.89±1.30) vs. (6.04±1.29),t=2.142,P=0.046],the scores of suppression and humor were significantly lower,when compared with the control group(t=-8.946,-6.535,each P<0.001).②Compared with control group,the total score of SSRS in the schizophrenia group was significantly lower[35.19±5.27 vs. 42.34±8.38,t=-5.238,P=0.001],the scores of the objective,subjective support score,and the utilization of support were significantly lower(t=-7.034-2.864,P=0.000-0.004).③The total sore of FAD was significantly higher[2.23±0.09 vs. 1.89±0.10,t=7.642,P<0.001],the sores of function,problem solving,commutation,role,affective reaction and behavior control score of the FAD were all significantly higher(t=5.261-8.033,each P<0.001). Conclusion The first-episode schizophrenia patients in rehabilitation period show an immature tendency of psychological defense mechanism,with poorer social support and defected family functioning.
Improvement on anxiety and depression of targeted nursing intervention in patients with thyroid surgery
SUN Li, LI Yi-min
2016, 14(11): 1910-1911,1958. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.038
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Objective To observe and explore the improvement on anxiety and depression of targeted nursing intervention in patients with thyroid surgery. Methods Targeted nursing intervention model were carried out on 54 patients with thyroid surgery from April,2015 to March,2016,as the intervention group;54 cases accepted only normal nursing were selected as the control group.Self-rating depression scale(SDS),self-rating anxiety scale(SAS) and pittsburgh sleep quality index scale(PSQI) were used for assessment of depression,anxiety and sleep quality in both groups,and activities of daily living scores (BI rate) and the quality of life scale(SQLS) score were evaluated in both groups,SPSS software were used to analyze the results. Results The difference of SDS score,SAS score,PSQI score,BI rate and SQLS score before nursing between the two groups was not statistically significant(P>0.05);after nursing,SDS,SAS and PSQI in the intervention group were (31.2±9.5) points,(33.5±10.8) points and (37.9±6.2) points,and was (47.9±11.6) points,(53.1±5.8) points and (48.3±9.4) points in the control group,the difference was statistically significant(P<0.05);after the nursing,BI score and SQLS score in intervention group was significantly higher,the difference was statistically significant(P<0.05). Conclusion The implementation of targeted nursing intervention model has a significant effect on improving the mental status and sleep quality of patients with thyroid surgery,and it is helpful to improve the quality of life.
Psychological distress and related factors in patients with breast cancer
WANG Yang, FAN Shan-hong, CAO Lei, MA Yan
2016, 14(11): 1912-1914. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.039
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Objective To investigate the prevalence of psychological distress during chemotherapy among inpatients with breast cancer,and analyze its related factors for providing evidence of clinical psychological intervention strategies. Methods Selected 100 subjects of female breast cancer who had been treated with chemotherapy admitted to Lintong maternal and child health hospital from May,2013 to November,2014.The questionnaires included the general information and psychological distress thermometer(DT),data were input to EpiData 3.0 database after investigation,and using SPSS 18.0 for statistical analysis,P<0.05 indicates statistically significant differences. Results The frequency of psychological distress(DT ≥ 4)was 71.0%.Univariate analysis showed that:psychological distress degree is related to age,the degree of education,the way of payment for treatment cost,Family per capita income per month,whether menopause before chemotherapy and chemotherapy cycle(P<0.05).Logistic regression analysis showed that:older of patients(OR=0.731,95%CI:0.409-0.842)and use health insurance to payment for treatment cost(OR=0.349,95%CI:0.144-0.846)were protective factors of psychological distress in breast cancer patients after chemotherapy(P<0.05).and the degree of education(OR=1.463,95%CI:1.033-2.071)is the risk factor of psychological distress in breast cancer patients after chemotherapy(P<0.05). Conclusion The Most patients of breast cancer had serious psychological distress, the main risk factors were higher education,age and higher ratio at one's own expense in treatment. This article maybe provide the right way to relieve the patients' psychological distress.
A retrospective investigation of the rational use of human albumin in treatment of hypoproteinemia in our hospital
CHEN Meng, ZHOU Yue-hong, SHEN Lu-fei
2016, 14(11): 1915-1917. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.040
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Objective To investigate the use of human albumin in treatment of hypoproteinemia in our hospital,and to provide reference for rational use of drug in the clinic. Methods Using a pharmacy administration software of Haitai,Meikang and HIS,all cases of the human albumin and recipes from January to June in 2015 were reviewed,the irrational drug utilization recipes were summarized by EpiData software and evaluated in accordance with hospital Prescription Evaluation Management Norms(Trial) and Prescription Management Norms. Results Total 342 cases hypoproteinemia were enrolled,and 178 inpatients were prescripted of human albumin,the average hospital stay was 20.5±5.3 days,the average treatment course and consumption of human albumin were 7.6±1.5 days and (63.4±9.6)g,respectively.The respiratory and digestive diseases were the two primary causes of hypoproteinemia.The most of the patients were with a lower level of serum albumin (between 20 g/L and 30 g/L,accounting for 85.4%) before the use of serum albumin.There were 22 cases of irrational prescriptions of human albumin,accounted for 12.4%of the all prescriptions,in which 6 cases were the nonstandard prescriptions that accounted for 27.3%,and 14 cases of unsuitable prescriptions that accounted for 68.2%,and 1 case of abnormal prescriptions that accounted for 4.5%. The amount of 20% human albumin took the majority of irrational albumin prescriptions,while the amount of 5% human albumin took the highest rate of irrational albumin prescriptions. Conclusion Human albumin was used widely in the treatment of hypoproteinemia in our hospital,in which some cases are irrational.We should develop the drug using standard of human albumin and strictly grasp the indications of drug use to promote the safety and rational use of human albumin.
Value of DWI on the evaluation of liver fibrosis and inflammation in patients with chronic viral hepatitis
HUANG Yan-hua, HU Xiang-hua, ZHOU Ning, CHEN Fang-hong
2016, 14(11): 1918-1920. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.041
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Objective To investigate the value of diffusion-weighted imaging(DWI) on the evaluation of liver fibrosis and inflammation in patients with chronic viral hepatitis. Methods Selected 93 cases of chronic viral hepatitis and 25 cases of healthy people from January,2014 to December,2015 in Lishui Central Hospital as research subjects.All subjects were given magnetic resonance DWI inspection,measured the ADC value at b=100,500 and 1 000 s/mm2. Results When b=100 s/mm2,there was no statistical significance of the ADC values at different stages (P>0.05);when b=500 and 1 000 s/mm2,there was statistical significance of the ADC values at different stages(P<0.05),the higher the stage of fibrosis,the lower the ADC value.When b=100,500,1 000 s/mm2 respectively,the ADC was negatively correlated with liver fibrosis stage (P<0.05).When b=100,500,1 000 s/mm2,the ROC curves of the DWI diagnosis of liver fibrosis ≥ 3(severe fibrosis) were 0.66±0.04,0.89±0.06,0.82±0.05,the sensitivity were 76.1%,87.7%,75.6%,and the specificity were 58.4%,82.0%,83.6%.When b=100 s/mm2,there was no statistical difference of the ADC values at different grades of inflammation(P>0.05);when b=500 and 1 000 s/mm2,the difference of the ADC values at different grades of inflammation was statistically significant(P<0.05),the higher the grade of inflammation,the lower the ADC value. Conclusion The ADC value of DWI MRI is in negative correlation with liver fibrosis and inflammation of chronic viral hepatitis.DWI examination has assessment value on chronic viral hepatitis liver fibrosis and inflammation.
CT,MRI and ultrasonography features of hepatic angiomyolipomas:an retrospective analysis of 15 cases
LIU Hong-ming, LAI Can, XIE Xiao-hong
2016, 14(11): 1921-1923,1964. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.042
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Objective To summarize CT,MRI and ultrasonography manifestations of hepatic angiomyolipomas(HAML),and investigate the application and value of CT,MRI and ultrasonography on HAML. Methods Total 15 cases of HAML confirmed by surgery or pierced pathology testing in our hospital from April,2011 to March,2016 were retrospective analyzed,the CT,MRI or ultrasonography features of HAML were typing discussed,the imaging features of different types of HAML were summarized. Results Fifteen patients underwent CT examination,5 patients underwent MRI examination,4 patients underwent US examination,and 1 patient underwent CT,MRI and US examination.Fibroids(2 cases):tiny little adipose tissue was seen in CT,MRI;inhomogeneous hypoechoic was seen in US.Lipoma type(5 cases):diffuse fat density was seen in CT,and twisted vascular shadow was senn after enhancement;high signal was seen in T1WI,T2WI of MRI,slight enhancement in the arterial phase was seen after enhancement;Hyperechoic was seen in US.Hemangioma type(3 cases):tumor density was seen in CT,internal partially calcified,significantly continuing enhanced after enhancement;low signal was seen in T1WI of MRI,and high signal was seen in T2WI.Mixed(5 cases):Intermixed signal of tissue density and fat density was seen in CT,no enhancement in fat after enhancement;inhomogeneous high signal was seen in T1WI,T2WI of MRI;solid uneven hyperechoic was seen in US. Conclusion CT,MR and ultrasound imaging features of different subtypes of HAML patients were different.The patients could be diagnosed based on the fat ingredient in tumor.
Evaluation of 2D speckle tracking imaging on left ventricular function of patients with type 2 diabetes and hypertension
WANG Xi-dan, BU Zhi-bin
2016, 14(11): 1924-1926,1935. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.043
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Objective To analyze the value of 2D speckle tracking imaging on the evaluation of left ventricular function in patients with type 2 diabetes and hypertension. Methods We selected 87 patients with type 2 diabetes and hypertension as the observation group and 87 cases of healths as the control group from December,2013 to December,2015 in Jinhua Central Hospital.The left ventricular parameters in the two groups were detected by echocardiographic measurements,the left ventricular apex strain of each section were detected by 2D speckle tracking imaging technique. Results The difference of the left ventricular ejection fraction,diastolic left ventricular wall thickness,diastolic septum thickness and left ventricular diameter in the observation group and control group were not statistically significant(P>0.05).The diastolic mitral E peak/A peak of the observation group(0.98±0.17) was lower than that of the control group(1.27±0.26),t=9.243,P<0.05.The systolic apical left ventricular,left ventricular long axis,four-chamber and two-chamber strain peak in the observation group(-21.8±2.8,-22.2±2.9,-21.7±2.6,-22.2±2.9)were lower than that of the control group(-22.9±3.2,-23.4±3.3,-23.5±2.4,-23.4±2.8),t=2.525,2.415,3.619,2.335,P<0.05.The early diastolic left ventricular long axis,four-chamber and two-chamber strain peak in observation group(1.19±0.13,1.20±0.14,1.16±0.23) were lower than that of the control group(1.31±0.28,1.35±0.29,1.28±0.21),t=2.925,3.274,2.823,P<0.05.The late diastolic left ventricular long axis,four-chamber and two-chamber strain peak in the observation group(1.18±0.27,1.28±0.29,1.25±0.24) were higher than that of the control group(1.07±0.22,1.17±0.23,1.15±0.18),t=3.024,2.945,2.657,P<0.05. Conclusion 2D speckle tracking imaging technology can early reveal the left ventricular dysfunction in patients with type 2 diabetes and hypertension.
Clinical diagnostic value of pineal calcification in patients with first episode schizophrenia
CHENG Zu-sheng, XIA Rui-ming, XIA Guo-yuan, CAO Shi-lin, ZHU Shao-feng, QI Hong-yang, WANG Ai-zhi
2016, 14(11): 1927-1931. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.044
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Objective To investigate the clinical diagnostic value of pineal calcification(PC) in patients with first episode schizophrenia(FES). Methods The brain CT image of 220 cases who were diagnosed FES clinically were retrospective analyzed to observe whether the pineal has calcification and to measure its size.Meanwhile,compared with the healthy matched groups(n=200).Patients were divided into two subgroups according to the clinical classification:paranoia and non-paranoia group.After statistical treatment:①Analysis of the differences of PC between the patients and the controls.②The differences of PC between paranoia and non-paranoia group of FES.③The differences of PC between the gender of male and female in patients and groups.④The correlation between the size of the PC and the age of the patients. Results ①There were 139 cases (male 71,female 68) with PC in the FES patients,the incidence of PC was 63.18%(139/220).However,there were only 90 cases(male 41,female 49) of PC in the control groups,the incidence was 45%(90/200).The incidence of PC in FES patients was significantly higher than that in control group (χ2=13.97,P=0.001).②There was no significant difference in the incidence of PC between paranoia and non-paranoia group of FES(χ2=0.28,P=0.60).③There was no significant difference in the incidence of PC between the gender of male and female(χ2=0.88,P=0.35;χ2=0.25,P=0.62)④The size of PC in FES patients increased with the age before the age of 18,and was positively correlated(r=0.96,P<0.001).The pineal gland was calcificated earlier in FES patients compared with the controls. Conclusion The incidence of PC in FES patients was higher than that in the control groups,PC has a certain reference value for the early clinical diagnosis of FES.
XUE Chao, WANG Min
2016, 14(11): 1932-1935. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.045
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XIA Yi
2016, 14(11): 1936-1938. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.046
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Application of clinical examiner competition model in teacher training and general practitioners 'core ability training
WANG Chun-mei, CHEN Ying-min, QIN Jian-ye, ZHAI Yi, HUANG Xu-yuan, ZHU Kun
2016, 14(11): 1939-1941. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.047
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Objective To explore the impact of examiner competition mode in clinical training and developing the core competence of general practitioner. Methods During the past two years,the model combined with examiner competition and annual appraisal for standardized training of personnel were adopt in the clinical teacher training and on-site student training in our hospital.According to Shanghai Resident Standardization Training Clinical Criteria of Assessment,considering core ability of physicians,the examiner competition was designed(including competition procedure rules);in reference to mini-CEX test,the competition score table and examiner's evaluation form for students were designed.Both internal and external teaching supervision experts were invited as judge for this contest.Examiners were selected based on the internal preliminary contest.The cases for the assessment were selected by the examiners from the real case of illness.The students taking part in the general practitioner education and training were chosen as standardizationpatients.General practitioners who had already received the training over 1 year participated in this competition,and the result was recorded as the skill assessment score for the current year.After the competition,experts group gave a summary of merit and demerit.Examiners shared their participating testimonials.Teaching supervision expert discussed along with examiners to improve the assessment case.Hospital leader who takes charge in the education gave a summary report and raised the improvement measure and education requests.In this process,the competition mode,content,and experience were applied to the clinical teaching and examination. Results The qualified rate of training students in all kinds of test and practice test inside and outside hospital were significantly.In 2015,the qualified rate of trained students in the first attending medical licensing examination was 100%. Conclusion Examiners competition mode can improve the effect of general practitioner training and learning.It is worth for reference and promotion in general practitioners training.
Reform of medical teaching mode and cultivation of medical students' ability
LU Yong-kun, DONG Yan-hua, JIN Yu-hua
2016, 14(11): 1942-1944. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.048
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With the rapid development of science and technology and the change of medical service,the medical education is facing new challenges.In order to adapt to the trend of the globalization of medical education and the social needs,medical colleges and universities need to reform the concept of education,and train high-quality talents with comprehensive ability.The reforms in our school were carried out in the following aspects and had achieved good results:changing teaching ideas and the teaching method of "three centers" in the past,establishing the ideas of giving them what they need and not what they deserve.Teachers changed their roles from a instructors or transfer of information to a manager and mentor of learning,adapted student-centered teaching activities and improved the ability to think independently and the ability of autonomous learning.At the same time,we respected the students' personality,and admitted the diversity of students' interests and personality.We also integrated teaching content,reformed teaching settings,emphasized the integration of basic and clinical curriculum,and carried out practice Teaching.We adopt case-based learning and problem-based learning,improved the students' clinical thinking ability and practical ability,improved classroom teaching skills and the art of teaching,improved students' learning interest,strengthened clinical practice and the teaching of medical simulation,and improved the practical ability.Taking the national professional qualification examination as a reference,objective structured clinical examination method was adopted to assess students' medical knowledge and clinical practice ability as well as clinical thinking ability,lay the first stone for successfully pass the national qualification examination and obtain qualifications.Combined with formative assessment,we stimulated students' interest in learning,and provided lasting motivation for students' autonomous learning;strengthened humanistic quality education and professional moral education and cultivate medical talents excellent in character and learning.
Efficacy of extended care on patients with intravesical chemotherapy
ZHU Zheng, ZHANG Shi-geng, ZHU Hong-wei, DONG Hui-ping, CHEN Jie
2016, 14(11): 1945-1948. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.049
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Objective To compare the effectiveness of routine care and extended care on intravesical chemotherapy,and discuss the advantage of extended care for patients with intravesical chemotherapy. Methods The patients with bladder cancer undergoing postoperative intravesical chemotherapy in the Second Affiliated Hospital of Zhejiang Chinese Medical University between January,2009 and June,2012 were enrolled into this study.A total of 104 patients in the control group received the routine care,while 110 patients in the extended care group received routine care combined with extended care.The SF-36 scores,satisfaction and compliance situation before and after nursing intervention were compared between the two groups. Results Before the intervention,there was no significant difference in the bodily pain,role physical functioning,physical health,general health,social functioning,mental health,mental,emotional role functioning and healthy conversion rates between the extended care group and control group(P>0.05).After the intervention,the bodily pain,role physical functioning,physical health,general health,social functioning,mental health,mental,emotional role functioning and healthy conversion rates in the extended care group were all higher than those in the control group(P<0.05).In the extended care group,the bodily pain,role physical functioning,physical health,general health,social functioning,mental health,mental,emotional role functioning and healthy conversion rates increased obviously after the intervention(P<0.05).The satisfaction scores of the extended care group was higher than that of the control group(P<0.05).The compliance of the extended care group was better than that of the control group(P<0.05). Conclusion The extended care can improve the quality of life,satisfaction and compliance of patient undergoing intravesical chemotherapy.
Influence of emotional intelligence on job involvement in ICU nurses
LI Qian-qian, CHEN Jie, CAO Fu-xiao, DAI Wei-jie, DONG Mei-hua, YAO Xiao-qin, SHAO Xiao-lu, WANG Ben-ji
2016, 14(11): 1948-1951. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.050
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Objective To investigate the degree and influencing factors of the emotional intelligence and job involvement among the nurses in the ICU,and to analyze the influence of emotional intelligence on job in ICU nurses. Methods A total of 1 536 nurses in ICU were selected to get the scores of the questionnaire by general situation questionnaire,Emotional Intelligence Scale and job involvement questionnaire.A database of survey questionnaire was established with SPSS 16.0 software was used for date management,statistical description,chi-square,hierarchical regression analys,conclusion and induction. Results ①The scores of Emotional Intelligence Scale of ICU nurses was 58.28±10.08 which was in the medium level;②The scores of job involvement questionnaire was 40.72±6.02 which was in the middle and upper level,and there were significant differences in the scores of different ages,different titles and positions.③The total score of emotional intelligence of ICU nurses and the scores of 4 dimensions were significantly related to job involvement(P<0.05).④The age,professional title,emotional intelligence and 4 dimensions were significantly correlated with the work involvement(P<0.05). Conclusion Emotional intelligence of ICU nurses were significantly related to job involvement.The higher level of emotional intelligence,the higher level of ICU nurse' job involvement.Nursing managers should take active and effective measures to improve the level of emotional intelligence in ICU nurses,which to improve their work involvement and to improve the quality of ICU nursing work.
Effects of diabetes self-management education on improving self-care abilities
SUN Yue-ming, CHEN Lu-lu
2016, 14(11): 1952-1954. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.051
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Objective To explore the effects of diabetes self-management education(DSME) among diabetes patients on improving their self-care ability. Methods Total 160 patients were recruited in our hospital from May,2014 to January,2015.The diabetes self-management education of the nature,cause,harm and prevention of diabetes was performed among the patients and their families through lecture,communication,consultation and related image data,to develop their self-management skills and strengthen their awareness of self-management.Summary of diabetes self-care activities(SDSCA) scale was used to compare the changes in self-care abilities before and after the self-management education by medical workers. Results The score ofeating behavior,exercise behavior,blood sugar monitoring,foot care and smoking behavior after the self-management education were higher than those before the education,the difference was statistically significant(t=16.235,30.142,24.363,39.125,11.217,P<0.001),but the score of drug taking behavior was not obviously changed before and after the self-management education,the difference was not statistically significant(t=1.128,P=0.124). Conclusion The diabetes self-management education can improve the symptoms of diabetes,prevent the occurrence of complications,and improve the clinical treatment effects.It also can effectively improve the self-care ability of patients and the accompanying ability of their family carers,and improve the quality of life.
Comparison on efficacy of external application of potato slices and Magnesium Sulfate wet packing in treating Mannitol extravasation:a systemic review
DU Hong-yan, MA Yao, WEI Xiao-yan, MA Jing-jing, ZHU Ming-fang, ZHENG Yin-yan, HUANG Jing-jing, LI Dong-sheng
2016, 14(11): 1955-1958. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.052
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Objective To analyze the results researching the function of external application of potato slices and magnesium sulfate wet packing in treating mannitol extravasation,explore the curative effect of external application of potato slices,and provide the evidence-based nursing practice for the treatment of mannitol extravasation. Methods A online search was conducted by using the resources of CNKI,WanFang Database,CBM,VIP Database,Cochrane Library,Pubmed and Web of Science.The randomized controlled trials on the efficacy in treating Mannitol extravasation between external application of potato slices and 50% Magnesium Sulfate wet packing were screened via the exclusion and inclusion creteria.Then two researchers evaluated the papers quality respectively and extracted data.A Meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 studies involving 818 patients with Mannitol venous effusion were included.Meta-analysis showed that the recovery rate and significant efficiency in potato group were apparently higher than Magnesium Sulfate group[RR=1.39,95%CI(1.14-1.69),P<0.001].The inefficiency in the potato group was obviously lower than the Magnesium Sulfate group[RR=0.35,95%CI(0.19-0.65),P<0.001].The funnel plot showed no publication bias. Conclusion The potato slice has a better effect in treating 20% Mannitol extravasation as compare with 50% Magnesium Sulfate,without adverse reactions,non-toxic,and low cost,so it can be widely used in clinical.
Surgery cooperation for treatment of femoral intertrochanteric fracture in the old by type Ⅲ gamma pin
WANG Lin-na, PAN Cheng-yan, LI Shi-ping
2016, 14(11): 1959-1961. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.053
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Objective To investigate the surgery cooperation for minimally invasive treatment of femoral intertrochanteric fracture in the old by using type Ⅲ Gamma pin. Methods Retrospective analysis of clinical data was carried out in 24 patients with elderly femoral intertrochanteric fracture after treating by type Ⅲ Gamma pin between June,2014 and June,2015 in our hospital. All patients' clinical data in surgery cooperation were summarized including preoperative nursing, intra-operative cooperation and post-operative cooperation. Results All 24 patients have got stable vital signs during the operation.The duration of operation was 40-70 minutes,mean time (56.5±7.8) minutes.The intra-operative bleeding was 40-100 ml,(72.6±18.4) ml in average.No complications,such as acute cerebral infraction, pulmonary embolism,and vascular nerve injuries, were found during the operation.Post-operative follow-up was 5-12 months,(8.2±1.6) months in average.The healed time of fracture was 3-4 months,(3.4±0.5) months in average.Harris score was 75-92 points at the last follow-up,(83.4±4.7) points in average.The good rate was 83.3%.No incision infection,internal fixation failure complications were reported. Conclusion As an intramedullary fixation device,type Ⅲ Gamma pin meets the minimally invasive surgery concept. It is easy and simple to handle,with technology standardization,routinization,less operation time,little bleeding,as well as realized the biomechanical stability.Circulating nurses shall be skilled in orthopedic traction table and know how to use the C-arm.Instrument nurses shall know how to use the type Ⅲ gamma pin-related instruments as well as the operation procedure.Closely cooperated operation is necessary for a successful surgery.
XIA Can-can, YANG Yang, JIANG Zhi-wei, WANG Gang, PENG Nan-hai
2016, 14(11): 1962-1964. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.054
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MA Xing-juan, ZHOU Xiao-ying, CHU Ya-su, WANG Jian, LI Nan, SHI Li-na, WEI Xiao-ping
2016, 14(11): 1965-1966,1970. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.055
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LU An-shi
2016, 14(11): 1967-1968. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.056
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WU Long, ZHANG Jun
2016, 14(11): 1969-1970. doi: 10.16766/j.cnki.issn.1674-4152.2016.11.057
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