中华全科医学

Survey on utilization of health service among old floating population in Shanghai

NIE Huan-huan, BAO Yong

2016, 14(12): 1971-1973,1979. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.001

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Objective To investigate the utilization of health service among old floating population in Shanghai and explore the influencing factors,provide a scientific basis for improving their level of utilization of health services. Methods The data of 2015 National Dynamic Floating Population Monitoring Survey was used to analyze the utilization of health service among old floating population in Shanghai.Chi-square test was used to the statistical analysis. Results Total 752 old floating people were enrolled.The insurance rate among the old floating population was 85.7%,most of them took part in the insurance in their hometown.The rate to go to a doctor when sick was 56.8%(427 persons),the rate of 174 high blood pressure/diabetes patients who had received community follow-up was 29.9%(52 persons).The rate of hospitalization was 4.0%(30 persons),40 old person had been diagnosed need be hospitalized,but only 30 persons who did it,the main reason for who should be hospitalized but not was family/self-feel no need,the rate was 60.0%(6 persons).The utilization of health service rate was highest in those who floating for pension and lowest in those for work,also higher in those who had took part in community health examination than those without community health examination.Whether had basic medical insurance had no effect on health services utilization,but those who participated in residents medical insurance was significantly higher than those had other types of health insurance. Conclusion The utilization of health service among old floating population in Shanghai is quite low,they are the blind area of basic public health services such as chronic disease community management,basic social insurance does not play its due role in safeguarding.We should work out better policies and measures suitable for the special population in the area of medical especially basic public health services,as well as improve their health literacy to improve their health services utilization rate.

DAI Chuan-lin, PAN Jia-hua

2016, 14(12): 1974-1975.

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Relation between serum bilirubin level and in-hospital mortality of patients with acute ST-segment-elevation myocardial infarction

XIAO Yun-yun, XU Biao, WANG Chun

2016, 14(12): 1976-1979. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.002

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Objective To explore the relation between serum total bilirubin(STB) and serum direct bilirubin(SDB) levels and in-hospital mortality of patients with acute ST-segment-elevation myocardial infarction(STEMI) who undergo primary percutaneous coronary intervention(PCI). Methods A total of 427 acute STEMI patients in Nanjing Drum Tower hospital were enrolled in the study and their clinical data were collected and analyzed.SPSS 20.0 software was used to compare the differences between two groups,the receiver operating characteristic curve analysis and a Cox proportional hazards regression model was used to determine the relationships between the bilirubin and the in-hospital mortality. Results Elevated STB level(STB ≥ 19.85 μmol/L)and SDB level(SDB ≥ 4.65 μmol/L) were associated with a high risk of death(HR=2.38,95%CI:1.05-5.40;HR=3.91,95%CI:1.66-9.17,respectively).After adjusting for other confounders(gender,history of smoking,drinking,diabetes,stroke,locations of MI),evaluated STB level and SDB were still independently associated with a higher risk of death(HR=2.71,95%CI:1.19-6.16;HR=4.49,95%CI:1.90-10.59,respectively). Conclusion Higher STB and SDB levels after PCI may increase the in-hospital mortality of STEMI patients.

Different Moxibustion on changes of immunoglobulin level in immunosuppressive rabbits

LI Lei-yong, WU Ai-hua, TIAN Yue-feng, WANG Jun

2016, 14(12): 1980-1982. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.003

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Objective To observe influence of herbal cake-separated moxibustion and moxibustion on the immunoglobulin levels in immunosuppressive rabbits,and discuss the related mechanism. Methods A total of 40 rabbits were randomly divided into 4 groups:blank group,model group,herbal cake-separated moxibustion group and moxibustion group with 10 rabbits in each group.An immunosuppressive animal model induced by cyclophosphamide(Cy)in rabbit(intraperitoneal injection 60 mg/kg for 7 consecutive days).Two days after the completion of the model,the treatment groups received herbal cake-separated moxibustion and moxibustion(total 10 times,qod.),respectively.The abdominal vein blood was collected after the treatment was finished,and the levels of IgG,IgM,C3 and C4 were tested. Results Compared with the blank group,the levels of IgG,IgM and C3 of model group were significantly lower(P<0.01).After the treatment,The level of IgG changed obviously,and the difference was significant as compared with blank group and model group(P<0.01).The changes of IgM and C3 level were also significant(P<0.01)as compared with model group.For moxibustion group,the levels of IgG,IgM and C3 changed significantly as compared with model group(P<0.01),the level of C3 was lower than blank group(P<0.01). Conclusion Different moxibustion have obvious influence on improving immunosuppressive state by cyclophosphamide in rabbits.The effect of Herbal cake-separated moxibustion is better than moxibustion,which indicates a synergistic effect between herbs and moxibustion.

Change in the number of autophagosomes in podocyte and its clinical significance in Immunoglobulin A nephropathy

LIANG Shi-kai, JIN Juan, GONG Jian-guang, LIN Bo, LI Yi-wen, HE Qiang

2016, 14(12): 1983-1986. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.004

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Objective To observe the number of autophagosomes in podocyte of IgAN,and explore the relationship between autophagy and the progression of renal disease. Methods Clinical data of 35 patients who were diagnosed as IgAN admitted to the Zhejiang Provincial people's Hospital from January,2013 to December,2014 were retrospectively analyzed.The changes of kidney tissue pathology were detected after HE,PAS and Masson staining by light microscope.The autophagosomes of podocyte were detected by transmission electron microscopy. Results Compared with the control group,the number of autophagosomes in podocyte of IgAN group were lower,and there was a statistically significance(P<0.001).However,with the increase of pathological stage,the decrease in the number of autophagosomes was less obvious.The number of autophagosomes in Lee Ⅳ stage were statistically higher than the LeeⅡ than the Lee Ⅱ IgAN group(P=0.001).Furthemore,there was a statistically bigger number of autophagosomes in female patient than male patients(P=0.035). Conclusion Podocyte autophagy participates in the progression of IgAN.

The study of IGF-1R siRNA enhancing sensibility of lung cancer cell to Trail induced apoptosis

LIU Li-ming, HU Jun-feng, ZHANG Yong, XIA Xue-mei, GONG Bei-lei, CAO Da-long

2016, 14(12): 1987-1989,1993. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.005

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Objective To investigate the changes of the proliferation and apoptosis of lung adenocarcinoma cell A549 to IGF-1R specific RNA interference and its sensitivity to Trail. Methods The IGF-1R specific siRNA transcription template was chemically synthesized and connected to the siRNA expression vector.The restructured expression vector was transfected into E.coli.Amplified vector was extracted.Enzyme digestion and DNA sequencing were used to prove that the expression vector was successfully constructed.Stable expression of IGF-1R-siRNA A549 cell lines were screened by G418.FQ RT-PCR,Western blot and immunohistochemistry were used to detect inhibitory effect.Before and after the Trail treatment,MTT and flow cytometry were used to test proliferation and apoptosis of A549 cells. Results DNA sequencing results proved the successful construction of IGF-1R-siRNA expression vector.The selected monoclonal cells with stable expression of IGF-1R-siRNA decreased IGF-1R mRNA and protein expression by 79.01%(0.17±0.06 vs. 0.81±0.15,P<0.01) and 76.05%(1.36±0.26 vs. 5.68±0.45,P<0.01)than that of control A549 cells.Immunohistochemistry also showed a lower expression of IGF-1R. After treatment of Trail on A549 with IGF-1R-siRNA, the cell proliferation rate decreased(P<0.05); the apoptosis rate was obviously increased(P<0.01). Conclusion The constructed IGF-1R-siRNA expression vector can decrease the expression of IGF-1R gene in A549 cells.IGF-1R-siRNA can effectively inhibit the proliferation and enhance the Trail induced apoptosis in lung cancer cell A549.

Pharmacokinetic-pharmacodynamicsmodeling antihypertensive effect of metoprolol and irbesartan

WU Cai-xia, PENG Xiao-wan, FAN Wei-dong, JIE Jin-hong

2016, 14(12): 1990-1993. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.006

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Objective In hypertension treatment guidelines,Beta-1 receptor antagonist combined with angiotensin Ⅱ receptor antagonist are not be recommended for priority.But it is common for the combination of both medicines in clinical practice.In order to provide evidence for the rational use of clinical drug,metoprolol were selected as selective beta 1 receptor blocker,Irbesartan was chosen as the representative of the angiotensin receptor Ⅱ.In patients with high blood pressure,a pharmacokinetic pharmacodynamics-combination model was established,to discuss the antihypertensive effect characteristics of the two drugs. Methods A total number of 24 patients with hypertension were divided into two groups,one group was given metoprolol,another group were given Irbesartan.The blood drug concentration and blood pressure were measured.To calculate the pharmacokinetic parameters,the blood drug concentration and blood pressure were measured at different time.The pharmacodynamics parameters were also determined using combined pharmacokinetic-pharmacodynamics(PK-PD) model presented by Sheiner et al.The data of reduced blood pressure were determined and compared with the predicted data. Results The pharmacokinetic profiles of metoprolol and irbesartan were fitted to one and two compartment model respectively.There was an anticlockwise hysteresis loop between antihypertensive effect and plasma concentrations of the agents.The relationship between antihypertensive effect and concentration of effect compartment of the agents was investigated using Sigmoid-Emax model.The data of Ce(50) and Keo for metoprolol and irbesartan were (130.2±68.4)μg/L,(0.051±0.025)/min and (380±140)μg/L,(0.54±0.08)/h,respectively.The determined data of the antihypertensive effect was close to those predicted. Conclusion To Study the antihypertensive effect of metoprolol and irbesartan with PK-PD model may be more rational for the clinical medication.

Expression and Significance of Galectin-3 and MMP-9 protein in cervical carcinoma

ZHANG Miao-miao, WANG Cai-zhi

2016, 14(12): 1994-1997,2007. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.007

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Objective To study the expression and significance of Galectin-3 protein and MMP-9 protein in cervical carcinoma. Methods Immunohistochemical sp staining method was used to detect the expression of Galectin-3 protein and MMP-9 protein in 15 cases of normal cervical epithelium,15 cases of cervical intraepithelial neoplasia,and 48 cases of cervical carcinoma.The results were analyzed combining with clinicopathological data. Results The expression of Galectin-3 protein was apparently higher in cervical carcinoma than in normal cervical epithelium and cervical intraepithelial neoplasia,the expression of MMP-9 protein was also apparently higher in cervical carcinoma than in normal cervical epithelium and cervical intraepithelial neoplasia,the difference was statistically significant(P<0.01).In cervical carcinoma tissues,the positive expression rate of Galectin-3 protein elevated along with pathologic stage,and the rate in patients with lymphatic metastasis is higher than that in patients without lymph node metastasis,the same tendency was observed for MMP-9 protein,the difference was statistically significant(P<0.05).The positive correlation was also found between Galectin-3 and MMP-9 protein expression in cervical carcinoma(P<0.01). Conclusion The abnormal expression of Galectin-3 and MMP-9 is involved in the cervical carcinoma cells proliferation,malignant transformation,invasion and metastasis.They may play an important role during the occurrence and development of human cervical carcinoma,and the mechanisms need to be further studied.

Experimental observation of SOD and NO in serum or tissue in rat model with pressure ulcer

XU Yun-xia, LI Ping, CHU Ming-zi, ZHONG Zheng-rong

2016, 14(12): 1998-2001. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.008

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Objective Our previous results showed that the pathological damage of the skin and tissue exposure to pressure could be caused by 3 h-compression in rats.Further observation was needed for the level of superoxide dismutase(SOD) and nitric oxide(NO) in serum or tissues in SD rats with pressure ulcer so as to screen the optimal frequency of repositioning and risk assessment markers for pressure ulcer. Methods Total 48 SD rats were divided into six groups(8 in each group):the control(untreated),and pressure for one hour(1 h),two hours(2 h),three hours(3 h),four hours(4 h) or six hours(6 h) followed by the same time interval.After 24h,blood and local tissues samples from compression area were prepared for SOD and NO determination by enzyme-linked immunosorbent assay(ELISA).And statistical significance analysis of variance for SOD and NO were tested by Student's t test. Results Compared with the control,lower activity of SOD and higher level of NO were found in 3 h,4 h and 6 h groups.And the differences were statistically significant(P<0.05) and time dependence.However,there were not statistical significances between the control and the 1 h or 2 h group(P>0.05). Conclusion A pressure duration for 3h is a threshold for the levels of SOD and NO above which pressure damage may occur.Therefore,SOD and NO may be regarded as the early-stage and noninvasive markers in risk assessment at pressure ulcer.

Application of low curved incision in radical operation for thyroid carcinoma

LIU Tie-cheng, ZHOU Rui, QIAN Jun, HAN Fu-sheng, CHEN Ya

2016, 14(12): 2001-2003. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.009

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Objective To evaluate the postoperative life quality and satisfaction with the appearance of low curved incision for the functional neck dissection in patients with differentiated thyroid carcinoma(DTC). Methods The clinical data of 56 patients with DTC in our hospital between February,2013 and February,2016 were analyzed retrospectively.The operation of hemithyroidectomy with isthmus resection,or subtotal/total thyroidectomy,followed by central lymph node(level Ⅵ) and ipsilateral neck(level Ⅱ-Ⅴ) dissection,was performed in all patients.The low curved incision operation was chosen for 30 patients in the low-incision group,while conventional L-shaped incision operation was selected for 26 patients in the conventional-incision group.The postoperative life quality and appearance of low curved incision were followed up,and the efficacy was evaluated and compared between the two groups through tables and pictures. Results The low curved incision for thyroid cancer did not interfere the neck dissection,and no procedure-related complications occurred.There was lower incidence in chief complaint of stiff in the shoulder,tight,pain and numbness and relative higher life quality in the low-incision group when compared with the conventional-incision group(P<0.05).The patients in the low-incision group showed a higher satisfaction with the appearance of low curved incision,such as the color,width,thickness and suppleness of scar,the difference was statistical significant between the two groups(P<0.05). Conclusion The low curved incision is the ideal choice for thyroid cancer radical surgery,with a well hidden scar,satisfactory appearance and normal neck function.

The clinical significance of serum cystatin C level change in Parkinson's disease

YE Ming, CHEN Yu-hua, LIU Xiao-lin, XU Li, XU Wen-fang, XIE Jing, SHI Peng, QU Hong-dang

2016, 14(12): 2004-2007. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.010

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Objective To investigate the correlation and clinical significance between serum cystatin C (Cys-C) level and Parkinson's disease(PD). Methods Seventy patients of PD were selected as the observation group(PD g-roup),30 healthy people were selected as the control group,PD group was divided into three subgroups according to the score of H&Y staging:early stage group(25 cases),medium stage group(24 cases)and advanced stage group(21 cases).A immunology turbidimetric was employed to measure the serum Cys-C levels.Compare the PD group and control group differences in the levels of serum Cys-C,and compare PD group each subgroup differences in the levels of serum Cys-C.At the same time,the correlation between serum Cys-C levels and gender,age,H&Y staging and U-PDRS motor score were analyzed. Results The serum level of Cys-C was significantly higher in PD group than the control group,the difference is statistically significant (t=3.61,P<0.01);the serum level of Cys-C was significantly higher in the advanced stage group than in the medium stage group and early stage group,the differences are statisticallysignificant(P<0.05,P<0.01);the serum level of Cys-C was significantly higher in the medium stage group than in the early stage group and control group,the differences are statistically significant(P<0.01,P<0.01);the serum level of Cys-C was higher in the early stage group than in the control group,but the difference was not statistically significant(t=1.31,P=0.12>0.05).Pearson correlation analysis revealed the serum Cys-C level of the PD group had a positive correction with H-Y stage(r=0.67,P<0.01),UPDRS Ⅱ score(r=0.64,P<0.01),UPDRS Ⅲ score(r=0.59,P<0.01). Conclusion The serum level of Cys-C was significantly higher in PD than the control group;The serum Cys-C levels associated with the progression of PD,can reflect the severity of the disease and play a role in the development of PD.

Role of procalcitonin in evaluation of the severity of acute pancreatitis and the early prediction

CHENG Feng, WANG Zhen-jie, QIU Zhao-lei, DU Zhao-hui, ZHANG Feng

2016, 14(12): 2008-2010. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.011

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Objective To analyze the correlation of procalcitonin(PCT) level and severity of acute pancreatitis(AP),and discuss its role in the early prediction of AP. Methods Total 100 cases of AP were enrolled and divided into mild acute pancreatitis group(MAP group) and severe acute pancreatitis group(SAP group),10 healthy subjects were recruited as controls at the same period.The levels of PCT at d1,d3,d5 and d7 after the admission were tested.The acute physiology and chronic health evaluation(APACHE Ⅱ) was performed in all patients within 24 hours.The duration of hospital stay was recorded.The results were analyzed statistically to evaluate the relationship between PCT level and severity of AP. Results The levels of PCT at d1,d3,d5 and d7 in SAP group were significant different from those in MAP and control group(P<0.05),but the difference was not significant between MAP group and control group(P>0.05).There were significant difference in APACHE Ⅱ score,but not in length of stay,between MAP and SAP group.Binary Logistic regression analysis showed that PCT(PCT1,PCT3 and PCT7) level was the risk factor for AP.The odds ratio(OR) for PCT1 were 10.558.The calculated the upper and lower limits were 52.847 and 2.109 at 95%CI for Exp(B). Conclusion The elevated or sustained PCT high level in SAP patients prompts that PCT level play an important role in the early(24 hours) prediction of SAP.

The influence of total laparoscopic surgery on T cell subsets and its cytokines in patients with early differentiated thyroid cancer

ZHOU Xiao-dong, HUANG Xiao-e, LU Ke-bin, ZHANG Hai, TAN Zhuo

2016, 14(12): 2011-2013,2048. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.012

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Objective To investigate the effects of total laparoscopic surgery on T cell subsets and its cytokines in patients with early stage differentiated thyroid carcinoma. Methods From January,2013 to January,2015,we prospectively collected 50 cases with early differentiated thyroid cancer admitted to our hospital as the study group,and during the same period,50 healthy adults admitted to our hospital for health examination were randomly selected as the control group.The study group was given total endoscopic resection of thyroid carcinoma.The main outcome measures were the peripheral blood T cell subsets and their cytokines in the two groups. Results When compared with the control group,the proportion of CD4⁺T cells in the study group was significantly decreased[(20.48±6.43)% vs. (27.53±7.38)%,P=0.000];the proportion of CD4⁺/CD8⁺T cells was significantly decreased[(20.73±5.39)% vs. (28.94±7.39)ng/ml,P=0.000];the level of IL-6 was significantly decreased[(20.73±5.39)ng/ml vs. (28.94±7.39)ng/ml,P=0.000];IL-10 level increased significantly[(45.39±15.62)ng/ml vs. (23.94±5.39)ng/ml,P=0.000];the TNF-α was significantly lower[(8.48±2.14)ng/ml vs. (13.58±3.49)ng/ml,P=0.000].The levels of CD8⁺ T cells between the two groups had no statistical significance[(32.48±7.49)% vs. (34.58±8.12)%,P=0.463].Postoperative CD4⁺T cells in the study group were significantly increased[(24.82±3.32)% vs. (20.48±6.43)%,P=0.012];IL-6 was significantly increased[(20.48±6.43)ng/L vs. (20.73±5.39)ng/L,P=0.000];IL-10 was significantly decreased[(38.59±9.83)ng/L vs. (45.39±15.62)ng/L,P=0.002];the TNF-α was significantly higher[(11.75±3.29)ng/L vs. (8.48±2.14)ng/L,P=0.000]. Conclusion Patients with early differentiated thyroid cancer can be immunosuppressed,and total laparoscopic surgery is helpful to improve the immune function of early differentiated thyroid cancer patients.

Clinical use of diffusion tensor imaging combined with neuronavigation for brain tumor surgeries

LIU Hou-yin, XU De-cai, HAN Yi

2016, 14(12): 2014-2016. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.013

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Objective To investigate the guiding significance of Diffusion Tensor Imaging (DTI)combined with neuronavigation for brain tumor surgeries. Methods Fifteen cases of glioma and 6 cases of meningioma underwent conventional MRI scan,contrast-enhanced MRI and DTI before the operations.Three-dimensional trajectories were reconstructed from diffusion tensor imaging(DTI) data by using white matter fiber tract mapping.The surgical planning,approach and resection range were determined according to the reconstructed images.The brain tumor tumorectomy was performed under a microscope combined with neuronavigation. Results Among 15 cases of glioma,6 cases showed simple displacement,9 cases showed both displacement and disruption;among 6 cases of meningioma,4 cases showed simple displacement,2 cases showed displacement and a small amount of disruption.The total resection(13 cases) and subtotal resection(2 cases) were performed for 15 cases of glioma,and few nerve fiber damage by surgical injury occurred.The total resection was performed in all 6 cases of meningioma,and there was no nerve fiber damage.12 patients with preoperative symptoms of neurologic function loss displayed obvious improvement in 6 months.2 cases suffered from new-onset partial motor aphemia that recovered in 6 months,2 cases suffered from new-set hemiplegia,1 case recovered in 6 months,1 case didn't improved. Conclusion DTI combined with neuronavigation can guide the brain tumor surgery at maximum extent on the basis of protecting of nerve function.

Influence of catgut embedding combined timely Yuxie prescription on immune function and exercise tolerance in patients with COPD in stable phase

WANG Shi-qiang, LOU Li-ming, CHEN Su-zhen, HUANG Li-sou, LIU Wen-bing, HU Dan-dan, XU Yi-kai

2016, 14(12): 2017-2019,2030. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.014

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Objective To investigate the influence of catgut embedding combined timely Yuxie prescription on immune function and exercise tolerance in patients with COPD in stable phase. Methods One hundred and sixty cases patients with COPD in stable phase from May,2015 to May,2016 in our hospital were randomly divided into 2 groups by random number method,each group 80 cases.Patients in control group were given conventional Western medicine,and patients in observation group were added catgut embedding combined timely Yuxie prescription.The immunoglobulin(IgA,IgG,IgM),T cell subsets(CD3⁺,CD4⁺,CD8⁺),exercise tolerance (6 min walking distance,blood lactate concentration,PO₂) and symptom scores of two groups were observed. Results After treatment,IgA,IgG,IgM levels of two groups were significantly increased(P<0.05),and IgA,IgG,IgM levels of observation group were significantly higher than control group(P<0.05).After treatment,CD3⁺,CD4⁺ levels of two groups were significantly increased(P<0.05),CD8⁺ levels of two groups were significantly decreased (P<0.05),and the changes of observation group were higher than control group(P<0.05).After treatment,6 min walking distance of observation group was significantly higher than control group(P<0.05).After treatment,the PO₂ and blood lactate concentration changes of observation group were significantly better than control group(P<0.05).After treatment,symptom scores of two groups were significantly decreased(P<0.05),and symptom score of observation group was significantly lower than control group(P<0.05). Conclusion Based on conventional Western medicine,catgut embedding combined timely Yuxie prescription can significantly improve immune function exercise tolerance and clinical symptoms of patients with COPD in stable phase.

Effects of Taxus polysaccharide on serum IL-2 and IFN-γ of immunosuppression mice

LI Lu-lu, ZHU Hui-min, CAI Yuan-zhen, CHEN Qi, CHEN Hua-qun, ZHANG Ya-li

2016, 14(12): 2020-2022. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.015

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Objective To explore the mechanism of the Taxus polysaccharide regulating immune function of immunosuppression mice. Methods Forty-eight male mice were randomly dividend into control group,model group,taxus polysaccharise group(low,medium and high does group) and positive control group.Mice in the control group were injected with 0.9% NaCl solution,other were injected with 0.2 mg/kg hydrocortisone every day for 14 days to establish the immunocompromised model.The control group and model group were with 200 mg/kg normal saline,three Taxus polysaccharide groups were treated with Taxus polysaccharide(100,200 and 400 mg/kg by body weight),one positive control group was treated with polysaccharide of hericium erinaceus.The cellular IL-2 and IFN-γ of mice was tested by Enzyme-linked immunoassay detection,The number of serum CD4⁺ and CD8⁺ were detected by flow cytometry. Results ①The serum of IL-2,IFN-γ in model group was significant lower as compared with control group(P<0.01),Compared with model group,the levels of IL-2 in the treatment groups were increased(P<0.01).Compared with model group,the serum of IFN-γ of the high,middle dose group had increased,with obvious significance in addition to the low dose group;②The number of CD4⁺T cells and CD8⁺T cells in model group were obviously reduced as compared with control group(P<0.05);The number of CD4⁺T cells and CD8⁺T cells in high-dose and middle-dose groups had obviously increased as compared with model group(P<0.01). Conclusion The mechanism of Taxus polysaccharide regulating the immune function in immunodepressed mice may associate with improvement immune function through regulating humoral immunity.

Investigation on resistance mechanisms of tuberculosis though the function changes of Th17 cell and CD4^+ CD25^+ Foxp3^+ regulatory T cells

SONG Qun, WANG Xin-xia, TONG Zhao-wei

2016, 14(12): 2023-2026. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.016

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Objective To analyze the changes of Th17 cells,CD4⁺CD25⁺Foxp3⁺regulatory T(Treg)cells,and cells cytokines in peripheral blood of tuberculosis patients with drug-resistant,and investigate the resistance mechanism though immunological point. Methods Thirty-there cases of drug-resistant tuberculosis patients(resistance group),49 cases of ordinary TB(general group),and 51 healthy volunteers(control group)were selected and comparative studied.The Th17 cells and CD4⁺CD25⁺Foxp3⁺ Treg cells ratio were detected.The expression of specific transcription factors RORγt and mRNA in Foxp3 were detected by RT-PCR.The serum IL-17A,IL-17F,TGF-β1 and IL-10 levels were detected by ELISA. Results The Th17 cells ratio and RORγt mRNA expression of normal group were lower than the control group,and resistance group were lower than the normal group;The CD4⁺CD25⁺Foxp3⁺ Treg cells ratio and Foxp3 mRNA expression were higher than the control group,and resistance group were higher than normal group;The Th17/CD4⁺CD25⁺Foxp3⁺ Treg cells and RORγt/Foxp3 of normal group were lower than the control group,and resistance group were lower than normal group(P<0.05).IL-17A and IL-17F levels of normal group were lower than control group,and resistance group were lower than normal group.The TGF-β1 and IL-10 levels were higher than control group,and resistance group were higher than normal group(P<0.05). Conclusion The balance offset of Th17/CD4⁺CD25⁺Foxp3⁺ Treg cell to CD4⁺CD25⁺Foxp3⁺ Treg cell and immune system suppression might be one of important mechanism of chronic and produce resistant in tuberculosis.

Structural changes of renal tissue caused by repeated ESWL

LIU Jian-min, LI Zhen, WANG Sheng, WANG Feng-chao, CHENG Ze-nong, LI Qing-wen

2016, 14(12): 2027-2030. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.017

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Objective To access the progressive,permanent,and irreversible damage of kidney of rabbit for repeat ESWLs,seek digital times-effect relationship of ESWL,learn the processes of eternal and irreversible damages of renal function caused by multiple and repeat ESWLs,and guide ESWL for the patient with recurrent or complicated kidney stone to reduce renal damage and prevent severe renal function damage. Methods Animal and design of the studies are same as study I.We killed the rabbits,removed the kidney,and performed historical examinations our earlier after ESWL,observed changes of histological structure and fibrosis of glomeruli and tubules;digitized the numbers of glomeruli under microscope by H.E.and Masson stain;detected expression of TGF-β₁,collagen Ⅳ by immunohistochemical stain under microscope. Results ①Accumulated damage of kidney occurred after repeat ESWL with structural changes of nephron,and fibrolification of glomeruli and tubules occurred gradually with the increasing of ESWL times.②There are significant difference on average numbers of glomerular under 100 times microscope fields between ESWL group and control group.After 6-times of ESWL,numbers of glomeruli decreased significantly,and degree of renal fibrosis gradually enhanced with increased ESWL times.③There were significant differences in comparison of degree of TGF-β₁ and Collagen Ⅳ expression increased,and the degree markedly enhanced after 4 times of ESWL,and as the times of ESWL increasing,the degree increased gradually. Conclusion Multiple,repeat ESWLs can cause accumulated damage of kidney with fibrosis;After 4-times ESWLs,expressions of TGF-β₁ and Collagen Ⅳ increased,these predicted severe fibrilification would occur,which can cause permanent,irreversible kidney damage.ESWL should be performed with strict indications for renal stone patients and control ESWL within 4 times to prevent the irreversible accumulated damage of kidney and protect renal function maximum.

Risk factors of urosepsis after ureteroscopy with holmium laser lithotripsy

WU Hong-liang

2016, 14(12): 2031-2033. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.018

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Objective To study the risk factors of urosepsis after ureteroscopy with holmium laser lithotripsy. Methods The clinical characteristics(age,gender,rate of positive urine culture before the operation,diabetes mellitus,polyp,diameter of stone,and operation time) of 399 ureteral calculus patients undergoing ureteroscopic holmium laser lithotripsy in our hospital between June,2011 and June,2015 were retrospectively analyzed.Among them,23(5.76%) suffered urosepsis.There were 14 female patients(11 cases were in perimenopausal stage) and 9 male patients.The mean age was 50.8±16.5 years(range 39-78 years).The mean operative time was 62.8±23.5 min(range 47-197 min).The urine culture of 16 patients were positive,including gram-negative bacteria Escherichia coli in 11 cases,Klebsiella pneumonia in 2 cases,gram-negative bacteria staphylococcus aureus in 2 cases and staphylococcus epidermidis in 1 case.All patients need not blood transfusion.The chi-square test and a logistic regression model were used to identify key risk factors. Results In univariate analysis,the significant associations were observed between advanced age(≥ 70 years),female gender,diabetes,positive urine culture,operative duration>60 min and sepsis after ureteroscopic holmium laser lithotripsy(all P<0.05).But polyp and stone diameter were insignificant for urosepsis(both P>0.05).While in multivariate analysis,female gender,diabetes,positive urine culture,operative duration>60 min were identified as independent risk factors for urosepsis after ureteroscopy with holmium laser lithotripsy(all P<0.05). Conclusion Female gender,diabetes,positive urine culture,operative duration>60 min are the key risk factors of urosepsis after ureteroscopy with holmium laser lithotripsy.

Incidence of pulmonary infection and correlation with deep venous thrombosis in elderly stroke patients

MA Li-zhong, DONG Ling-wan, ZHU Jing, LIU Ying-ying, ZHOU Yuan-lin, LU Min-ye

2016, 14(12): 2034-2036. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.019

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Objective To study the incidence of pulmonary infection and correlation with deep venous thrombosis in elderly stroke patients,and provide basis for prevention of complication in elderly stroke patients. Methods By adopting the method of retrospective study,clinical data of elderly stroke patients were collected,and the patients were followed for months.Incidence and correlation of pulmonary infection and deep venous thrombosis were analyzed and compared among groups,and correlation of pulmonary infection and deep venous thrombosis was analyzed.Stoke patients were grouped by complication morbidity,and prognosis situation of groups were compared. Results In 6-month follow-up period,of 145 elderly stroke patients,36(24.8%) complicated with pulmonary infection,and 27(18.6%) complicated with deep venous thrombosis,and 13(9.0%) complicated with pulmonary infection and deep venous thrombosis.Incidence of complication of study group was higher than control group,and difference was statistically significant(P<0.05).There was no significant difference of complication incidence between genders,and complication incidence of Ischemic stroke was higher than hemorrhagic stroke.There was correlation between pulmonary infection and deep venous thrombosis(P<0.05,r=0.258).There was significant difference of Poor prognosis rate of different complication groups(P<0.05). Conclusion Incidence of pulmonary infection and deep venous thrombosis was high,and there was positive correlation synergy to deteriorate prognosis between pulmonary infection and deep venous thrombosis.Intervening measures should be taken to reduce risk of complication,and improve prognosis of elderly stroke patients.

Risk factor analysis central venous catheter infection in neurosurgical patients

YANG Yu-ling, LI Ping, ZHANG Qiao-ping, LIN Shao-qin, MU Dong-mei

2016, 14(12): 2037-2039,2146. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.020

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Objective To investigate the risk factors of central venous catheter infection in neurosurgical patients. Methods Total 322 cases of neurosurgery patients with central venous catheter in our hospital from January,2013 to January,2015 were retrospectively analyzed. Based on infection or not, patients were divided into infection group and non-infection group. The gender,age,catheter location(femoral vein,subclavian vein,internal jugular vein),retention time(3-6 d,7-14 d,15-31 d),catheter material (flexible,hard),junction disinfection (iodine compound,0.5% povidone iodine,2% chlorhexidine gluconate),catheter lumens number (single chamber,dual chamber),infusion type(intravenous nutrition,general liquid),parenteral nutrition input(yes or no),catheter connector(heparin cap,no pin connector),underlying diseases(hypertensive intracerebral hemorrhage,traumatic brain injury,acute cerebral embolism,brain tumors),glucose abnormalities(yes or no),liver function(normal or abnormal)of two groups were collected.The univariate and multivariate Logistic regression analysis were carried out to analysis the collected data to investigate the risk factors analysis of neurosurgical patients on infection of central venous catheter. Results In all 322 cases of patients,31 cases (9.6%) patients occurred central venous catheter infection.Univariate and multivariate Logistic regression analysis results showed that age,catheter location,indwelling time,catheter material,lumen catheter number,infusion types,input parenteral nutrition,underlying disease,glucose abnormalities,liver function abnormalities were the risk factors infection of central venous catheter in neurosurgical patients. Conclusion Neurosurgical patients easily occur central venous catheter infection.So clearing the risk factors of central venous catheter infection would be helpful for the targeted nursing and reducing the infection rates.

Curative effect of nerve growth factor on severe craniocerebral injury and its influence on the levels of MMP-2 and NSE

MOU Yi-ting, TONG Ling-yun, WANG Yong, MA Wei-zhong, ZHANG Hua-xian, JIN Peng-cheng

2016, 14(12): 2040-2041,2066. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.021

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Objective To investigate the curative effect of nerve growth factor on severe craniocerebral injury and its influence on the levels of matrix metalloproteinase-2(MMP-2) and neuron-specific enolase(NSE),to provide reference for the treatment of patients with severe craniocerebral injury. Methods The clinical data of 91 cases of severe craniocerebral injury in our hospital between June,2014 and December,2015 was reviewed.The control group(44 cases) received conventional symptomatic treatment,while the observation group(47 cases) received additional nerve growth factor treatment on the basis of conventional treatment.The levels of serum NSE and MMP-2,GCS score and the incidence of adverse incidence before and after the treatment were compared between the two groups. Results The serum level of MMP-2 and NSE at 14 d after the treatment in observation group was significantly lower than that before the treatment,the level of MMP-2 at d 14 after the treatment in the observation group was obviously higher than that in the control group,while the level of NSE at 14 d after the treatment in the observation group was lower than that in the control group,the difference was all statistically significant(P<0.05);GCS score of 14 days after treatment in Two groups was significantly higher than before treatment,GCS score at 14 d after the treatment in the observation group was significantly greater than that in the control group,the difference was statistically significant(P<0.05);After two weeks of treatment,the incidence of adverse reaction in the observation group was 14.89% (nausea and vomiting in 3 cases,dizziness in 2 cases,and lower extremity pain in 2 cases) and in the control group was 9.09% (nausea and vomiting in 2 cases,dizziness in 1 cases,and arrhythmia in 1 cases),there were no statistically significant difference(χ²=0.720,P=0.396). Conclusion The nerve growth factor can obviously reduce the serum level of MMP-2 and NSE,and contribute to the recovery of neural function with a good security.

Expression and its significance of transforming growth factor β1 and matrix metalloproteinases 2 in lens epithelial cells of diabetic cataract rats

WEN Ji-quan, HONG Ming-sheng, ZHANG Yang

2016, 14(12): 2042-2044,2094. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.022

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Objective To investigate the expression and its significance of transforming growth factor β1(TGF-β1) and matrix metalloproteinases 2(MMP-2) in lens epithelial cells(LECs)of diabetic cataract rats. Methods The 28 SD rats were randomly divided into cataract group and control group,and the rat model of diabetic cataract was established.The rats LECs change in two groups were detected.The expression of TGF-β1 and MMP- 2 in LECs of the two groups were detected. Results HE staining:the LECs of cataract group rats morphological was abnormal,derangement was disordered,nuclear size was uneven,and cytoplasm was loose;the LECs of control group rats was normal.The mean optical density of TGF-β1 protein and MMP-2 protein in LECs at 2 weekend and 4 weekend in cataract group rats(0.0447±0.002,0.075±0.006;0.028±0.003,0.055±0.006) were higher than that of the control group(0.006±0.001,0.0063±0.002;P=0.000,0.000),the mean optical density of TGF-β1 protein and MMP-2 protein in LECs at 4 weekend were higher than that of 2 weekend in cataract group rats(P<0.05).TGF-β1 protein and MMP-2 protein in LECs of cataract group rats was positively correlated(r=0.915,P=0.004). Conclusion Development of diabetic cataract may be correlated to the exaltation of TGF-β1 protein and MMP-2 protein levels of LECs,and the TGF-β1 protein and MMP-2 protein in LECs of diabetic cataract were positively correlated.

Clinical application of limbs ischemic precondition in non-cardiac ischemic stroke patients for secondary prevention

ZHU Ying-biao, GUAN Chang-rong, TANG Ya-nan, GAO Li-xia, ZHANG Sheng-wu, LU: Jin, LI Jie, CHEN Wei-kang, LI Pu-gang, LU Li-ping

2016, 14(12): 2045-2048. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.023

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Objective To investigate the clinical efficacy of limb ischemic preconditioning(LIPreC) in non-cardiac ischemic stroke patients for secondary prevention. Methods A total of 360 patients with non-cardiac ischemic stroke confirmed by clinic and imaging from June,2011 to May,2014 were recruited and randomized divided by 1:1 into LIPreC group and control group(CON group).Accordance with the medication of China ischemic stroke and TIA secondary prevention guidelines 2010,both groups were treated to control the risk factors before or after recruitment.LIPreC group was given limb ischemic precondition training after the recruitment for one year.The ischemic lesions in head were analyzed by 3.0 T MR.NIHSS and MMSE were used to evaluate the clinical symptoms,recovery degree and cognitive function.The neurological improvement and re-infarction rate of patients were observed. Results ①The recurrence rate of cerebral infarction in LIPreC group(4.4%,8 cases) was lower than that in CON group(10.6%,19 cases),P=0.044.②The incidence of increasing intracranial lacunar infarct in LIPerC group(13.3%,24 cases) was lower than that in CON group(23.9%,43 cases),P=0.014.③MRI examination showed that the recurrent infarct volume in LIPreC group[(3.6±1.7) ml] was smaller than that in CON group[(5.4±1.3) ml],P=0.004.④The increased lacunar lesions count per capita in LIPreC group(1.6±0.2) was less than CON group(1.7±0.1),P=0.015.⑤The improvement rate of neurological deficit symptoms in LIPreC group(90.6%,163 cases) was higher than that in CON group(82.8%,149 cases),P=0.043.⑥The improvement rate of cognition in LIPreC group(88.6%,31 cases) was significantly higher than that in CON group(64.9%,24 cases),P=0.026. Conclusion LIPreC can reduce the recurrence rate of acute ischemic stroke,infarct volume of recurrence,number of new lacunar infarct and severity of secondary stroke,and so physical and cognitive dysfunction of non-cardiac ischemic stroke patients.LIPreC has a wide application prospect in the area of non-cardiac ischemic stroke secondary prevention.

Effection of nephritis rehabilitation piece with standard hormone therapy in elderly qi and Yin deficiency syndrome prognostic

FANG He-jing, LI Shuang-qing, YING Jun, WANG Zheng-tong, HUANG Jian, WU Min-hua

2016, 14(12): 2049-2050,2090. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.024

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Objective To observe effection of nephritis rehabilitation piece with standard hormone therapy in elderly qi and Yin deficiency syndrome curative effect and prognosis of nephrotic syndrome. Methods Total 120 patients with nephrotic syndrome from October,2013 to September,2014 in our hospital were divided into observation group group(60 cases) and control group(60 cases).All patients received oral prednisone with initial measurement of 1 mg/(kg·d).Patients of observation group received extra nephritis rehabilitation treatment,three times a day,a 8.After 12 months,atients of 2 groups were compared before and after treatment by 24 h urine protein,serum albumin,total cholesterol,triglycerides,quantitative level,platelets number and plasma changes of pituitary adenylate cyclase activating polypeptide,an clinical curative effect bwtween two groups after treatment was compared. Results After treatment,observation group patients(95.0%) were significantly higher than that of control group(78.3%),and observation group patients with blood platelet count (161.64±20.63)×10⁹/L improving effect was significantly better than the control group (171.24±21.86)×10⁹/L,the 24 h urine protein quantitative observation group patients (1.75±0.52)g to improve the effect significantly,due to the control group (3.03±1.72)g group in patients with serum albumin,total cholesterol,triglycerides,and serum pituitary adenylate cyclase activating polypeptide improvement effect was significantly better than control group,difference had statistical significance(P<0.05).And adverse reactions(33.3%) of observation group was significantly lower than the control group(56.9%),statistically significant difference(P<0.05). Conclusion Use of nephritis rehabilitation with standard combination treatment with hormone elderly qi and Yin deficiency syndrome nephrotic syndrome,can effectively alleviate the patient's clinical symptoms,improve the relevant indicators,improve the clinical curative effect,at the same time reduce the incidence of adverse reactions,and the prognosis is good.

Curative effect of Zhiling capsule combined Valsartan on chronic nephropathy and its influence on renal function

XU Xiao-yan, JIN Ling-wei, HUANG Wen, ZHOU Zhi-hong

2016, 14(12): 2051-2054. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.025

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Objective To evaluate the clinical efficacy of Zhiling Capsule combined with Valsartan in the treatment of chronic nephropathy and its influence on renal function. Methods Total 76 cases of chronic kidney disease were divided into observation group and control group by random number table method with 38 cases in each group.The control group received Valsartan,while the observation group received additional Zhiling Capsule.The curative effect was compared between the two groups.Before and after the treatment,T lymphocytes(CD3,CD4,CD4/CD8),soluble cell adhesion factor-1(sICAM-1),renal function index(Scr,BUN,UAER,and GFR) of both groups were tested. Results The therapeutic efficacy in the observation group was significantly better than that in the control group,the difference was statistically significant(z=2.262,P<0.05).After the treatment,the level of CD3 in the observation group was significantly increased,inversely,the levels of CD4,CD4/CD8 and sICAM-1 were significantly decreased,the difference was statistically significant(P<0.05);but the level of sICAM-1 decreased significantly(P<0.05).After the treatment,the level of CD3 in the observation group was significantly higher than that of the control group,inversely,the levels of CD4,CD4/CD8 and sICAM-1 was significantly lower than those in the control group,the difference was statistically significant (t=6.642,6.734,5.462,2.319,P<0.05).After the treatment,the levels of Scr,BUN and UAER were all significantly decreased in both groups,and the level of GFR was significantly increased(P<0.05);The levels of Scr,BUN and UAER in the observation group were significantly lower than those in the control group,and the level of GFR was significantly higher than that of the control group(t=4.390,2.386,3.824,2.719,P<0.05). Conclusion Zhiling Capsule combined with Valsartan can significantly improve the immune function and renal function in patients with chronic kidney disease.

Effect of hydromorphone on peri-operative cytokines in laparoscopic surgery patients

AO Qing-hua, XIA Dong-yun, SHU Jing-hua, FENG Juan, QIU Guo-mei, ZHOU Hui-fang

2016, 14(12): 2054-2056,2152. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.026

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Objective To explore the effect of hydromorphone on perioperative stress factors and inflammatory cytokines in laparoscopic surgery patients. Methods Selected 100 cases of anesthesia laparoscopic surgery patients from January,2015 to December,2015 in Shaoxing City maternal and child health hospital as research subjects,and were divided into hydromorphone group and fentanyl group.ELISA assay detected serum cortisol,norepinephrine,epinephrine,C-reactive protein,tumor necrosis factor-α(TNF-α),interleukin-10(IL-10) and interleukin-6(IL-6) levels. Results Compared with burglary 5 min,the mean arterial pressure and heart rate when patients were intubated in two groups increased(P<0.05),the mean arterial pressure and heart rate at 10min after extubation of fentanyl group decreased(P<0.05).Compared with fentanyl group,the mean arterial pressure and heart rate of hydromorphone group at 10 min after extubation increased(P<0.05).Compared with burglary 5 min,the norepinephrine,epinephrine levels at intubation in two groups increased(P<0.05),cortisol levels decreased (P<0.05),the norepinephrine levels at 10 min after extubation of fentanyl group increased(P<0.05);compared with fentanyl group,the norepinephrine and epinephrine levels of hydromorphone group at intubation decreased(P<0.05),cortisol levels increased(P<0.05).Compared with burglary 5 min,the TNF-α and IL-6 levels in two groups at surgical 30 min,the end of surgery,postoperative 1 h increased(P<0.05),the IL-10 levels of two groups after the end of surgery and postoperative 1h increased(P<0.05);compared with fentanyl group,the TNF-α and IL-6 levels of hydromorphone group at surgical 30 min,the end of surgery,postoperative 1h decreased(P<0.05),and the IL-10 levels increased at the end of surgery,postoperative 1 h(P<0.05). Conclusion Hydromorphone used in anesthesia for laparoscopic surgery is beneficial to hemodynamically stable and can reduce perioperative stress response and inflammation response.

Effect of probiotic supplements on the immune function infants with meconium aspiration syndrome

WEI Xian, YANG Shu-jie, GAN Bin, YI Hai-ying

2016, 14(12): 2057-2059. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.027

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Objective To explore the role of probiotic supplements in improving the immune function in infants with meconium aspiration syndrome(MAS). Methods Total 49 newborns with MAS in our neonatology department between January,2013 and January,2015 were randomly divided into treatment group(Ⅰ group) and observation group(Ⅱ group),while 34 healthy term infants during the same period were recruited as contrast group (Ⅲ group).During the follow up,the levels of blood IgG,IgM,IgA and tumor necrosis factor-α(TNF-α) were tested at 1,3,6 and 12 months of age.The patients with wheeze for 4 times or over were counted,and the results were analyzed. Results In 1 month age, the IgM content of blood in different groups had significant differences (P<0.05),as follows Ⅰgroup (0.057±0.049)g/L, Ⅱgroup(0.059±0.013)g/L,Ⅲgroup(0.030±0.037)g/L.In 6 month age, the IgG content of blood in three groups were as follows(6.233±1.213)g/L,(5.230±1.158)g/L,(7.238±1.612)g/L, the IgA content of blood in three groups were as follows (0.423±0.258)g/L,(0.332±0.191)g/L,(0.512±0.398)g/L;the TNF-α content of blood in three groups were as follows(2.006±1.129)ng/ml,(2.520±1.188)ng/ml,(1.191±0.319)ng/ml,all of them had significant differences(P<0.05)。In 12 month age,the IgG content of blood in three groups were as follows(8.332±1.782)g/L,(7.150±1.238)g/L,(8.672±1.912)g/L;the IgM content of blood in three groups were as follows(1.487±0.533)g/L,(1.058±0.390)g/L,(1.548±0.853)g/L;the IgA content of blood in three groups were as follows(0.423±0.258)g/L,(0.332±0.191)g/L,(0.512±0.398)g/L;the TNF-α content of blood in three groups were as follows(1.289±0.293)ng/ml,(2.127±1.276)ng/ml,(1.223±0.363)ng/ml,all of them had significant differences(P<0.05).The number of breathing which equal or greater than 4 times in three groups had no significant difference(P>0.05),as follows Ⅰgroup 0 case(0/29),group 3 cases(3/20),Ⅲ group 1 case(1/34),but the incidence rate of breathing Ⅲ group was obviously higher than that of groupⅠand Ⅱ. Conclusion Meconium aspiration syndrome infants who suppled probiotics had some improvement on immune function,and had the potential to reduce the risk of develiping asthma.>

Analysis of postoperative pregnancy of patients with endometriosis related infertility

XIE Ling-hong, WANG Hui-hua

2016, 14(12): 2060-2062. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.028

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Objective To study the postoperative pregnancy of infertility patients with endometriosis,and to analyze the risk factors for postoperative pregnancy rate after laparoscopic surgery for endometriosis. Methods Total 200 cases of endometriosis related infertility undergoing laparoscopic surgery in our hospital between March,2010 and March,2014 were enrolled into this study.The postoperative pregnancy rate of infertility patients with endometriosis was observed,and the influence of endometriosis stage,lesion location,lesion diameter and age on the postoperative pregnancy rate was assessed. Results Six months after the surgery,the total pregnancy cases was 21 cases and total pregnancy rate was 10.5%(21/200);6-12 months after the surgery,the total pregnancy cases was 25 cases and total pregnancy rate was 12.5%(25/200);more than 12 months after the surgery,the total pregnancy cases was 11 cases and total pregnancy rate was 5.5%(11/200).The differences in the pregnancy rate for difference endometriosis stage,lesion site,diameter and ages were statistically significant(χ²=14.017,19.488 and 11.946,P<0.05).The postoperative pregnancy rate decreased with the higher endometriosis stage,more lesion site,larger lesion diameter and higher age of patients. Conclusion The pregnancy rate during one year after the operation in infertility patients with endometriosis is relatively high.The endometriosis stage,lesion location,lesion diameter and age will affect the postoperative pregnancy rate.

The combined treatment effect of Levetiracetam to family intervention treatment in children with epilepsy

WANG Kai-xuan, ZHANG Jing, SHENG Fang, ZHANG Li-san

2016, 14(12): 2063-2066. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.029

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Objective To evaluate the efficacy and safety of levetiracetam in combination with family intervention in the treatment of epilepsy in children. Methods Eighty cases with epilepsy enrolled in our hospital from January,2013 to March,2016 were randomly divided into the control group and observation group The age,course of disease and type of seizure had no statistical differences between the two groups.Two groups were treated with levetiracetam which was orally administered at the dose of 10 mg/kg taken twice daily,in the morning and evening.According to clinical efficacy and tolerability the dose was gradually increased to 30 mg/(kg·d).Therapist should try to use the lowest effective dose to control seizures.The observation group on this basis was given family-style intervention,and the two groups were treated for 3 months.The clinical efficacy,cognitive function and quality of life scores of the two groups were compared and the incidence of adverse reactions were observed and recorded. Results After the treatment,the total effective rate of the observation group was 87.50%,higher than the control group 70.00%,with a statistical significance(P<0.05).The quality of life scores in the observation group were significantly better than those in the control group(P<0.05).After the treatment,the IQ,VIQ,PIQ,FIQ scores of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Levetiracetam combined with family intervention can significantly improve the clinical efficacy of children epilepsy,improve the quality of life of children,improve cognitive scores in children,and fewer adverse reactions,thus safer and worthy of clinical application.

Effect of epidural anesthesia for cesarean section on hemodynamics of patients with severe pre-eclampsia

SHI Xiu-ya, HU Hua-min, FENG Ying

2016, 14(12): 2067-2069. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.030

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Objective To investigate the effect of epidural anesthesia for cesarean section on hemodynamics of patients with severe pre-eclampsia. Methods Selected 90 cases of severe preeclampsia as the experimental group,90 cases of healthy pregnant women as the control group from April,2013 to March,2014 in Ninghai County MCH.The pregnant women in two groups were cesarean section underwent epidural anesthesia.The changes of blood pressure and heart rate before and after anesthesia,birth weight and Apgar score and the situation hypotension were observed in two groups pregnant women. Results The infusion volume(1 067±315)ml,the amount of lidocaine(4.5±2.7)ml and ephedrine(6.5±2.9)mg in anesthesia of experimental group pregnant women were lower than that of the control group(1 358.0±322.0)ml,(7.3±3.1)ml,(14.1±6.7)mg (P<0.05).The birth weight in the experimental group(975±675)g was lower than that of the control group(3 214±602)g(P<0.05),the newborns 1 min Apgar score ≤ 7 proportion in the experimental group(28.9%) was higher than that of the control group(12.2%,P<0.05),the newborns 5 min Apgar score ≤ 7 proportion in the experimental group was higher than that of the control group,but the difference was not statistically significant(P>0.05).Systolic blood pressure and diastolic blood pressure:the blood pressure before anesthesia,the minimum blood pressure after anesthesia,blood pressure before anesthesia-minimum blood pressure after anesthesia of experimental group pregnant women were significantly higher that of the control group(P<0.05).The heart rate before anesthesia,the minimum heart rate after anesthesia,heart rate before anesthesia-minimum heart rate after anesthesia of experimental group pregnant women[(98.2±15.7,82.9±16.3,16.7±11.6)times/min] were significantly higher than those of the control group[(82.6±11.5,76.1±13.8,6.5±10.4)times/min,P<0.05].The incidence of hypotension in the experimental group(68.9%) was significantly higher than that of the control group(35.6%,P<0.05). Conclusion The rate of hypotension in severe preeclampsia patients with cesarean delivery under epidural anesthesia is high,should pay attention to the prevention of hypotension in cesarean delivery.

Effect of early intervention and compliance on growth and development of preterm infants at 1 year of age

ZHANG Jian, LIU Guang-hui, LU Wei-wei, LU Lin-yang, ZHAO Feng-xia, WANG Le

2016, 14(12): 2070-2072. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.031

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Objective To explore the effect of early intervention and the compliance of patients on physical growth and neurodevelopment of preterm infants at 1 year of age,provide a basis for intervention on development of preterm infants. Methods Total 151 cases of preterm in department of neonatology of Anhui provincial Children's Hospital from Dec.2010 to Dec.2013 were enrolled and divided into good compliance group(63 cases)and poor compliance group(88 cases)by following up for one year.The body weight and body length,psychomotor development index(PDI)and mental development index(MDI)in the two groups were compared. Results The body weight and length of poor compliance group were lower than those of good compliance group[(76.5±3.1)cm vs. (77.7±2.4)cm,(9.82±1.20)kg vs. (10.51±1.25)kg],and the differences were statistical significance(t=-2.456、t=-3.439,P<0.05).The index of PDI and MDI of poor compliance group were lower than those of good compliance group[76.6±13.7 vs. 84.0±13.0,82.3±13.6 vs 88.0±15.7],and the differences were statistical significance(t=-3.347、t=-2.398,P<0.05).The incidence of PDI<70 in of poor compliance group was higher than that of good compliance group(26.1% vs. 12.7%,χ²=4.064,P<0.05) at corrected gestational age for 12 months.But there was no significant difference for cerebral palsy. Conclusion Early intervention can promote the development of preterm infants,good compliance with follow up and intervention can improve the catch-up growth and Psychomotor development,reduce the risk of developmental disorders.

Analysis of curative effects on KangF u XiaoY an suppository combined with azithromycin in the treatment of pelvic inflammation disease complicated by mycoplasma infection

DAI Ying-ying

2016, 14(12): 2073-2075. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.032

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Objective To compare the curative effect of KangFu XiaoYan suppository combined with azithromycin and azithromycin alone in the pelvic inflammation disease complicated by mycoplasma infection. Methods From January,2014 to December,2015,112 cases were selected in our hospital as the research object. According to admission order, 112 patients were divided into the control group(n=56)and the treatment group(n=56). The control group were given intravenous infusion of azithromycin,0.5 g/times,1 times/d, 2 days after the use of azithromycin oral preparation,0.25 g/times,1 times/d. Treatment group on the basis of the control group to give KangFu XiaoYan suppository embolism anus,1 per night. In two groups, 1 courses of treatment is 7 days, a total of 6 courses. After the treatment,the clinical efficacy, safety and changes of T lymphocyte subsets in peripheral blood were compared between the two groups.The data were processed by SPSS 17.0 statistical software. Results The clinical efficiency of the treatment group was significantly better than that of the control group (P<0.05).The incidence rate of adverse effect in the treatment group was lower than that in control group(8.93% vs. 12.50%),but the difference was not statistically significant (P>0.05).The two groups of patients after treatment, blood, urine, stool, liver function no obvious abnormal,high safety.Treatment of peripheral blood T cells subsets CD4⁺ percentages (45.51±5.15%) was significantly higher than those in control group (43.89%±4.06%),CD8⁺T cell ratio for(35.92%±3.05%) was significantly lower than that in control group (37.06%±3.25%),the ratio of CD4⁺/CD8⁺ was significantly higher than that of control group,the difference was statistically significant(P<0.05). Conclusion KangFu XiaoYan suppository combined with azithromycin in the treatment of pelvic inflammation disease complicated by mycoplasma infection has good curative effects,with safety,few side effects,the proportion of T cell subsets in peripheral blood was significantly improved.

Curative effect of comprehensive rehabilitation program in children with hemiplegic cerebral palsy

GAO Wei, CHEN Xiang

2016, 14(12): 2076-2079. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.033

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Objective To discuss the therapeutic efficacy of comprehensive rehabilitation treatment on the motor ability and intelligence in children with hemiplegic cerebral palsy. Methods Total 69 children with hemiplegic cerebral palsy in Yuying Children's Hospital of Wenzhou Medical University between January,2012 and January,2014 were enrolled and divided into control group(34 cases) and experimental group(35 cases).The control group received the traditional rehabilitation treatment,while the experimental group received the comprehensive rehabilitation treatment.The changes in the motor ability and intelligence before and after the treatment were compared between the two groups. Results The motor skills development quotient(DQ) score of the control group was 54.78±27.37,which was obviously lower than (67.24±26.34) the experimental group,P<0.05.After the treatment,the object,language and human respond skill DQ score of the control group were 54.38±9.23,55.08±9.37 and 53.87±26.12,respectively,which were obviously lower than 67.24±26.34,67.24±26.34 and 66.19±25.54 of the experimental group.The motor ability and intelligence in the experimental group were improved obviously as compared with the control group,the difference was significant,P<0.05.The rehabilitation effects of the motor ability in children with mild or lighter mental retardation is superior to that in children with moderate,severe and very severe intelligence defects; the rehabilitation effects of intelligence in children with mild or lighter motor skills is superior to that with moderate,severe and very severe motor skill defects.The outcome of children with the initial treatment time less than 6 months was better than those with the initial treatment time more than 6 months. Conclusion s The comprehensive rehabilitation treatment can effectively improve the motor ability and intelligence of the children with hemiplegic cerebral palsy.The early rehabilitation treatment could achieve a better outcome,so the parents of patients should take the children to accept comprehensive rehabilitation treatment as early as possible.

A qualitative study of cognition of community nursing administrators on standardized pressure ulcer management at home

LI Yan, HUANG Yong-xia

2016, 14(12): 2080-2082,2141. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.034

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Objective To understand the cognitive status quo of the pressure ulcer management at home in the community of Shanghai city,understand the necessity,feasibility,obstacles and difficulties of the policy,manpower and personnel qualification when we carry out pressure ulcer management at home,to clear away the obstacles and difficulties when the full implementation of pressure ulcer management will be carried out in the future in Pudong New Area,and provide references for the first try when comprehensive promotion community pressure ulcer management at home in the future. Methods The phenomenology of the qualitative research was adopted,10 community nursing administrators in Pudong New District were conducted semi-structured interviews through purposive sampling method.All the interviewee was asked three core issues:do you think whether it is necessary to carry out standardized pressure ulcers management in community home bed patients and the reason;what is the current status for pressure ulcers management in your unit;what obstacles and favorable factors you encounter when you do it.The data was analyzed using Colaizzi content analysis. Results The interview result presents three main themes.Community nursing managers generally recognized the necessity of standardized management of pressure ulcer at home in community,and the enthusiasm for the pressure ulcer management at home was not high.There were barriers and difficulties in implementation of home pressure ulcer management. Conclusion Shanghai community nursing management directors have fully understood the necessity of pressure ulcer management at home at present,to further strengthen publicity and education for pressure ulcers home care services is necessary.The imperfect practice of pressure ulcers management at home also exists.We also need to increase the corresponding training and education,and then to establish a suitable wound training mode for community management of pressure ulcers,health policy support and economic incentives for the community nurses health issued by the competent department.

Correlation study between parenting styles,family environment and depressive personality disorder in adolescents

SHI Jie, WANG Jian-nu:, SHI Yin-yan, ZHU Chun-yan

2016, 14(12): 2083-2086. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.035

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Objective To explore the characteristics of depressive personality disorder,parenting patterns and family environment of adolescents,and to provide evidence for family intervention,psychological treatment of depressive adolescents. Methods By case-control study,100 adolescents with depression(study group) and 100 healthy adolescents(control group)were assessed with Eysenck Personality Questionnaire(EPQ),Family Environment Scale(FES-CV)and Parental Rearing Style Questionnaire(EMBU),and the results were analyzed. Results ①There were statistical significance in personality,parenting style and family environment between depressive adolescents and healthy adolescents.②The scores of internal and external dimensions in the study group were significantly lower,and neurotic dimension scores were significantly higher in the study group(P<0.01);Compared with that of the control group,the scores of contradictoriness were higher,the scores of factors of intimacy,emotion expression,independence,achievement,entertainment and knowledgeability of the depressive family were obviously lower; the scores of parental warmth and understanding were lower in the depressive family(P<0.01)and the scores of punishment,rejection,over intervention and protection of mother and over protection of father and over intervention were higher(P<0.01)than that of the control group;③The emotional warmth and comprehension in parenting pattern were positively correlated with internal and external dimensions of EPQ,and negatively correlated with psychoticism and neuroticism;rejection and punishment were negatively correlated with internal and external,rejection and punishment were positively correlated with psychoticism and neuroticism;while both parents' refusal to deny and the severe punishment were negatively correlated with EPQ. Both parents' refusal to deny and punishment were positively correlated with EPQ's neuroticism and neurotic factors;the intimacy and entertainment of family environment were related to the four dimensions of EPQ. Conclusion s ①Adolescents with depression had much more problems in depressive personality disorder,parenting patterns,family environment compared with healthy adolescents;②Unhealthy family environment,unreasonable parenting style will lead to personality problems and the emergence of depression.To improve the family environment of depressive adolescents and the parenting style will promote the growth of personality together with disease rehabilitation.

A Survey on academic adaptation condition of Rural Oriented Medical Students

LIU Shi-fang, YU Chang-yin, CHEN Ai-ai, TAN Xiao-long, YE Dong-heng, HE You-fu

2016, 14(12): 2087-2090. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.036

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Objective To investigate the academic adaptation condition and characteristics of rural oriented medical students in order to provide reference for improving their academic adaptation ability. Methods The College Student Academic Adaptation Scale which including learning motivation,learning attitude,learning ability,teaching model and learning environment were filled out by 602 rural oriented medical students.Then the data were collected and analyzed. Results The average score of academic adaptation of rural oriented medical students was 3.25±0.46,which was higher than the average critical value.The score of average,learning attitude,teaching model and learning environment dimensions of females were higher than those of males(P<0.05).The score of learning environment of students from city and only-child family were higher than that of students from countryside and non-only-child family(P<0.05).The score of learning attitude of non-only-child family was higher than that of only-child family(P<0.05).The score of average,learning motivation,learning attitude,learning ability and teaching model were higher in success in class than those in failed in class(P<0.05).The score of average,learning motivation,learning ability and learning altitude in grade 1,2,3 were higher than those in grade 4(P<0.05).The average score of academic adaptation t in grade 3 was the highest,while in grade4 was lowest. Conclusion The academic adaptation of rural oriented medical students is better than average critical value.But academic adaptation in different grade,gender,family environment and passing examination was differences.The appropriate learning plans should be made for different students for improving their academic adaptation ability efficiently.

Relationship between N-nitrosodimethylamine and risk of urogenital cancers: a Meta-analysis based on cohort studies

JIAO Su-fang, WANG Yan, LU: Hui-xin, BAO He-ling, TAN Ji-bin

2016, 14(12): 2091-2094. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.037

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Objective To analyze the relationship between N-nitrosodimethylamine(NDMA) and the risk of urogenital cancers by means of Meta-analysis based on cohort studies. Methods The cohort studies on the carcinogenic NDMA and occurrence/dead risk of malignancy of genitourinary system among population that published in journals from 1980 to 2014 were identified from the following databases:the Chinese Journal Full-text Database(CNKI),Chinese BioMedical Literature Database(CBM),Wanfang Database,PubMed and EBSCO.The fix and random effects model was employed and statistical analysis is conducted using RevMan 5.1 software. Results A total of 13 studies were found,of which 7 articles including urogenital cancers were included in the Meta analysis.There was significant correlation between NDMA and all kinds of cancer(RR=1.17,95%CI 1.02-1.34).The NDMA did not have positive effect with urogenital cancers(RR=0.99,95%CI 0.95-1.03).There was not significant positive correlation between NDMA and prostate cancer(RR=0.97,95%CI 0.92-1.03) and ovarian cancer(RR=0.87,95%CI 0.69-1.08),but NDMA could increase the risk of breast cancer without significance(RR=1.03,95%CI 0.94-1.12).However,the NDMA had positive effect with bladder cancer(RR=1.26,95%CI 1.01-1.57). Conclusion The population cohort studies have showed that the NDMA would not significantly increase the risk of urogenital cancers,but had different effect with different types.It is essential to accumulate evidence derived from population cohort studies to prove the correlation.

Various methods of joint inspection for clinical research of idiopathic thrombocytopenic purpura in children

HUANG Bao-shan, YAO Hong, QUAN Shan-shan, XU Jia-li

2016, 14(12): 2095-2097. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.038

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Objective To study the clinical significance of the changes of reticulocyte(RET)and lymphocyte subsets count in children with idiopathic thrombocytopenic purpura(ITP). Methods Total 110 cases of ITP in our hospital between February,2014 and October,2015 were enrolled and divided into cured group,valid group and invalid group according to the curative effect,and 25 children were selected as control group.FACS Canto II flow cytometry and Sysmex-XT4000i automatic blood cell analyzer were used to test the expression of lymphocyte subgroup and percentage of reticulocyte with fluorescence intensity. Results ①After the treatment,the levels of CD3⁺ T lymphocytes and (CD3⁺CD4⁺) T helper(Th) lymphocytes decreased significantly,inversely,(CD3⁺CD8⁺) T suppressor(Ts) lymphocyte and (CD3⁺,CD19⁺) B lymphocyte increased obviously.There were significant difference in the expression of CD3⁺,Th,Ts and B lymphocytes between patients and control(P<0.05),but the expression of NK cells (CD3^-CD56⁺/CD16⁺) were not improved in each group,and the difference among the all groups was not significant(P>0.05);②In the patients,LFR% decreased obviously,but RET%,HFR%,MFR% and IRF were significantly elevated,and the difference was significant when compared with the control group(P<0.01). Conclusion The reticulocyte related parameters and the level of T lymphocyte subsets of children with ITP play an important role in the diagnosis and prognosis judgment.

ZHAO Yu-rong, DONG Wen-bing, LIN Li

2016, 14(12): 2098-2100. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.039

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LI Di, ZHANG Ru-zhi

2016, 14(12): 2101-2104. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.040

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LIN Xiao-yan, CUI Rong-rong, CAI Feng-feng

2016, 14(12): 2104-2106,2122. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.041

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Study of human resources optimization for public hospital under the new round of medical and health system reform

DING Xia-xia, SHEN Yong-xiang, DONG Li-ming

2016, 14(12): 2107-2109,2135. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.042

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Objective Nowadays,with a new round of medical and health system reform continued to deepen,the traditional hospital management system will change.The aim of this study is to investigate the current situation about human resources of B hospital and analyze the problems and the internal-outer environment of human resources,in order to provide a scientific basis for the allocation and use of human resources of public hospital. Methods Data collection approaches for qualitative research were involved.The depth interview,participatory observation and literature were formulated during the data collection of hospital human resources.SWOT method was used to analyze the internal-outer environment of human resources. Results There were some problems in the development of the hospital,such as the lagging ideas of human resources management,unreasonable job setting,inadequate salary incentive and the outflow of talent. Conclusion The relevant departments of the hospital should pay more attentions to the ideas of human resources strategy,job setting and competitive mechanism.At the same time,the administrator also should adopt the salary incentive policy and make the importance of training for employees,also establish of appropriate hospital performance evaluation system,promote hospital management level.On the one hand,this study can enrich the theory of human resources management and provide a reference for optimizing the human resources of B hospital and other medical institutions at various levels;on the other hand,the result of this paper will avoid the shortage of human resource in hospital B,and further more settled a foundation for the long-term development.

Recognize the essence of medicine and relationship between doctors and patients thus address the root causes of medical disputes

LI Tan-cun

2016, 14(12): 2110-2112. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.043

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In recent years,the doctor-patient relationship became more and more tensely,and medical disputes escalated.The manifestation of medical dispute transformed from the original pure "dispute each other,each stick to his own opinion" to public security event that participated by professional "medical dispute profiteer" for the purpose of unfair profit,or even illegal events.The criminal law amendment(9) came into effect on November 1,2015,the behavior of medical dispute profiteer shifted from administration punishment to criminal punishment.Although criminal punish "medical dispute profiteer "behavior safeguarded the legitimate interests of the medical institutions and medical personnel,it didn't solve medical disputes from the source.It can be proved by many domestic injury medical incidents.The way to solve the doctors-patient problems in criminal punishment belongs to the end-of-pipe treatment;it cannot solve the contradiction from the source.Often at this time the normal medical order has been destroyed,the safety of medical personnel has been damaged;property safety of medical institutions has been damaged.Therefore,how to solve medical disputes from the source and explore the "source" of preventing and disposing the medical dispute has become the focus of the community.In this paper,the author put forward that recognizing the essence of medicine,understanding the limitations of medical;recognizing the essence of doctor-patient conflict,understanding the nature of the doctor-patient contradiction is actually "the contradiction of growing public health needs between the relatively backward medical technology",rather than the contradiction between the groups of "doctors" and "patients";facing the inevitability and long-term of the contradiction,seeking the feasible measures of easing the contradiction by both doctors and patients;perfecting the complaint channels of medical dispute,introducing the third-party mediation mechanism actively;improving the medical insurance system,expanding insurance coverage and the proportion of medical insurance;introducing medical disputes or medical accident insurance mechanism was fundamental to ease the doctor-patient relationship and solve the contradiction between doctors and patients.

Development of the effect evaluation index system of standardized training for resident based on Kirkpatrick model

LUO Yun, CHEN Yi, HU Xing-lan, NIE Meng-jun

2016, 14(12): 2113-2115. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.044

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Objective In order to make the work of standardized training for resident be standard and homogenous,this research develop a effect evaluation index system of standardized training for resident based on Kirkpatrick model,so that we can facilitate a comprehensive control on this work as well as provide basis for improving it. Methods The research team was set up,a draft of the index system was constructed,and the questionnaire was formed,then a total of 10 experts from Beijing,sichuan,jiangxi were selected according to the requirement.The expert consultation was finished by Delphi method,the results were analyzed with SPSS 18.0,and the index weight of the index system was established by AHP and Stratified analyse method. Results The questionnaire recovery rates of the two rounds were 100%.It indicated that the enthusiasm of the experts were very high.The Index system contained a total of 4 first-level indicators,11 second-level indicators and 45 tertiary indicators.In the coordination coefficient test of the rounds(P<0.01).The difference had statistics significance.Kendall'W value of the two rounds were all greater than 0.2 and the second round was greater than the first round,indicated that the opinion of the experts reached the unity after the two rounds. Conclusion The enthusiasm and Kendall'W of the experts in this study are very high,the indexes are objective and comprehensive,so this index system can be a evaluation tool of effect of standardized training for resident,and it can provide reference data for other training in the hospital,at the same time it makes the foundation to promote national specialist standardization training.

The investigation about undergraduate nursing students' sense of identity and learning effects based on the health assessment teaching reform

QIN Xue, DONG Yin-feng, CHANG Yao, XING Qing-qing, ZHANG Hua

2016, 14(12): 2116-2118. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.045

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Objective To understand the recognition and evaluation of the health assessment teaching reform of the 2014 nursing undergraduate students in our college,and provide an important reference for the teaching reform of the course of health assessment and the formulation of formative assessment system. Methods Through a series of teaching reforms in health assessment for the 2014 nursing undergraduate students,the measures involved asking questions about the knowledge they have learned,arranging random quizzes in class,making small video of practice after class,organizing periodical theoretical and practical exams,and the overall evaluation at the end of the term,etc. Results Survey shows that only 5% of the students have the habit of preview before class,and they are used to listening to the teacher in class.Only 21% of them review after class.Most of the students prefer to cram before exams.Therefore,the enthusiasm of students' autonomous learning needs to be improved.85% think that adding questions before class and random small tests in class can improve students' initiatives.73% of them agree to participate the practical examination step by step.In addition,they also think that it's necessary for students divided into groups to take practical exams.It's important to train their abilities of teamwork and team spirits.Moreover,as far as to the final grade of this course,the failure rate is about 0.6%,more than 56.7% students get over 80.The majorities believe that the teaching time of this course should be increased,especially for the operation course.Furthermore,74% students think the stage assessment is better than final assessment. Conclusion With the questions before class,the small tests and phased assessment,it is beneficial to improve the students' initiatives and learning effect.

Evaluation of the effect of teacher training for students combining postgraduate education of specialized master degree of the general practitioners with resident standardization training

CHEN Yi, CAI Wen-wei, WANG Cao-feng, LU Ping, LIU Xiao-yan, XUN Xue-qin, SHENG Jing

2016, 14(12): 2119-2122. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.046

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Objective To investigate the situations of teachers' qualifications for students combining postgraduate education of specialized master degree of the general practitioners with resident standardization training,and evaluate the effect of teacher training on demand in the general practitioners community practicing training base. Methods From October 2014 to September 2015, a self-made questionnaire was investigated in teachers (n=32) that in the general medicine department of the Ninth People's Hospital Affiliated to Shanghai Jiaotong University Medical College and teachers (n=32) belongs to a community teaching base to get the overall situation in these two group of teachers. The clinical skills training and teaching training were carried out in these teachers respectively. The training effects were evaluated by the teachers themselves and the combining postgraduate students of the resident standardization training base. Results ①The teachers of clinical teaching base were all special doctors, and the proportion of the general medical teacher training certificate was significantly lower than that of the community teaching base (50.00% vs. 87.50%, P<0.01); while the educational ground and professional titles of the teachers in community base was significantly lower than those in clinical base.②Teachers in clinical base mostly wanted to strengthen the general theory of learning; while the community base teachers needed more skills training and teaching methods of training.③After skills and teaching training, the teachers in community base were great improved in clinical skills and teaching abilities (57.75±7.99 vs. 50.50±9.19, P<0.05 and 88.40±3.47 vs. 83.20±3.93, P<0.05, respectively),as well as the teaching methods and general medical ideas (28.10±1.28 vs. 26.10±1.91, P<0.05 and 11.70±1.33 vs. 10.20±1.39,P<0.05, respectively). There was no significant difference in teaching attitude and teaching content before and after the training. Conclusion There was difference in the demand for the training between the teachers from the clinical bases and from the community teaching bases,thus the training should be provided on the demand.The training aims at the teachers from the community teaching bases can obviously their clinical skills and teaching ability.

Perioperative nursing total knee arthroplasty patients

WU Xiang-ping, CHEN Xiao-dong

2016, 14(12): 2123-2125. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.047

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Objective To study the perioperative nursing plan of total knee arthroplasty,so as to improve effectively the postoperative recovery and life quality of patients,and shorten the length of hospital stay. Methods Total 80 patients undergoing total knee arthroplasty in our department of between April,2015 and April,2016 were divided into experimental group and control group according to random number table with 40 cases in each group.The control group was given the routine nursing care,while the experimental group was given a comprehensive perioperative nursing.The postoperative pain and the hospital for special surgery(HSS) score at 2 weeks,1 month,3 months and 6 months after the operation were recorded in both groups;the time for patients to achieve more than 90 degree knee flexion and postoperative hospital stay were compared between the two groups. Results The pain visual analog scale(VAS) score at postoperative 6 h,12 h and 24 h in the experimental group was lower than that in the control group,the difference was statistically significant(P<0.05);The time for patients to achieve more than 90 degree knee flexion and postoperative hospital stay in the experimental group were all less than those in the control group,the difference was statistically significant(P<0.05).HSS score at 2 weeks,1 month,3 months and 6 months after the operation in both groups were improved,however,the difference between the two groups was statistically significant(P<0.05). Conclusion The high-quality care for the total knee arthroplasty patients can effectively reduce postoperative pain,shorten the length of hospital stay,and improve the postoperative recovery and quality of life of patients,which has important significance on the development orthopedic surgery nursing.

Effect of meticulous nursing management on patients with malignant obstructive jaundice after percutaneous biliary stent implantation

ZHU Cui-cui, SUN Qiang, LIU Hui-chun

2016, 14(12): 2126-2128. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.048

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Objective To analyze the effect of meticulous nursing management on patients with malignant obstructive jaundice after percutaneous biliary stent implantation,to provide the basis for clinical nursing of malignant obstructive jaundice. Methods Total 70 cases of malignant obstructive jaundice undergoing percutaneous biliary stent implantation in our hospital between May,2016 and May,2014 were enrolled and divided into study group and control group by random digits table with 35 cases in each group.The control group received the routine nursing,while the research group received the meticulous nursing intervention.Anxiety self-rating scale(SAS) and self-rating Depression Scale(SDS) score,postoperative complications and nursing satisfaction of both groups were observed before and after the nursing management. Results There was no statistical difference in SAS and SDS score before the nursing intervention between the two groups.The SAS and SDS scores after nursing intervention of the two groups were significantly lower than those of the control group.The scores of SAS and SDS in the study group were lower than those in the control group(P<0.05).The incidence rate of postoperative complications in the study group was 2.86%(1/35),which was significantly lower than that of the control group 20% (7/35),P<0.05.The nursing satisfaction rate of the study group was 100.00%(35/35),which was significantly higher than that of the control group 82.86%(29/35),P<0.05. Conclusion The meticulous nursing care can reduce the incidence of complications,anxiety,depressive state of patients with malignant obstructive jaundice,have remarkable effect on the patients undergoing percutaneous biliary metal stent implantation,and is suitable for clinical application.

Nursing of PTCD with biliary stenting for malignant biliary obstruction: analysis of 34 cases

PAN Ke-yan, ZHANG Yan-fang, XU Wen-qing, ZHOU Lei

2016, 14(12): 2129-2132. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.049

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Objective To evaluate the care efficacy of percutaneous transhepatic biliary drainage(PTCD) combined with biliary stenting in patients with malignant obstructive jaundice,and to summarize the nursing experience in complications. Methods The nursing materials for 34 patients with malignant obstructive jaundice treated by PTCD combined with biliary stenting in our department between April,2008 and March,2014 were analyzed retrospectively. Results The surgery in all cases was successfully.The jaundice relieved exactly in 5 days in 6 cases;relieved exactly in 14 days in 18 cases;improved obviously in 14 days in 7 cases,among them,yellow skin and sclera,and skin pruritus faded away in 3 to 7 days,color of urination and defecation recovered in 2 to 5 days;elevated amylase level in blood and urine in 5 cases,recovered after somatostatin treatment of 4 to 7 days;localized biliary peritonitis in 4 cases,the symptoms disappeared after the replacement of PTCD catheter;accidental catheter detachment in 2 cases,coped timely;1 patient was discharged with a tube pinch.There was no perforation,peritonitis and other complications. Conclusions PTCD combined with biliary stenting for malignant obstructive jaundice was effective,with less invasive.The reasonable and effective perioperative nursing care can provide a good guarantee for the success of the procedure and patient prognosis.The systematic and personalized care programs as well as effective measures can provide important protection for stent implantation in patient recovery.

Role of quality control circles in reducing the incidence of incontinent dermatitis in patients with gastrointestinal surgery

CHEN Yue-hong, HUO Rui, XU Xin-xing, ZHANG Hai-li

2016, 14(12): 2132-2135. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.050

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Objective To investigate the value of the quality of control circle technique in reducing the incidence of incontinent dermatitis,to release the pain of patients,shorten the hospital delay,and improve patients satisfaction. Methods The quality circle group for preventing incontinence dermatitis was established in our hospital between January,2014 and October,2014.The theme "reduce the incidence of incontinence dermatitis in patients with gastrointestinal surgery" was determined.The self-made check sheet was used to investigate 120 patients during 3 months,and the brainstorming method was performed to assess the influencing factors of incontinence dermatitis.The fishbone diagram,Plato and histogram were used to evaluate the effect of patients,families and medical staff on the incidence of incontinence dermatitis.Meanwhile,QC group learned skin assessment related theory,improved nursing tool,trained the nursing process,summarized the essential factors,made true cause check sheet,determined the strategy,and developed standardized processes for promoting in whole hospital. Results The high risk of pressure sores,delayed replacement of diaper,local skin moist,inaccurate and delayed nursing assessment that met in nursing process was solved. Conclusion The quality management circle activity is helpful in improving the personal quality,responsibility,enthusiasm and self-confidence,group cohesiveness,problem solving skills,doctor-patient communication,and make continual improvement of nursing quality.

Nursing cooperation during minimally invasive aortic valve replacement with right chest small incision

ZHANG Ying

2016, 14(12): 2136-2139. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.051

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Objective To discuss the experience of nursing cooperation during minimally invasive aortic valve replacement with right chest small incision,so as to provide reference for clinical. Methods Thirty-six cases of aortic valve disease in Beijing An Zhen Hospital between July,2012 and November,2015,included 23 male and 13 female,aged(45±11)years old,were enrolled into this study.There were 24 cases of aortic regurgitation and 12 cases of aortic stenosis.Preoperative cardiac function NYHA classification:grade Ⅱ 33 cases and grade Ⅲ 3 cases.All patients underwent minimally invasive aortic valve replacement with right chest small incision,with double lumen endotracheal intubation under general anesthesia and cardiopulmonary Bypass.The operating room nurses well performed the preoperative education,prepared preoperative articles and equipment sufficiently,cooperated actively with doctors during the operation,and improved the nursing process.The vital signs of patients during the surgery,the operation time,cardiopulmonary bypass time,aortic occlusion time,hospitalization time,prognosis and postoperative complications were observed and recorded. Results The surgery was successful and the intraoperative vital signs were stable.All of the patients were cured and discharged from the hospital,and no postoperative complications were found.The operation time was (232±33) min,cardiopulmonary bypass time (120±25) min,and aortic clamping time (91±29)min,hospitalization time (11±5) d. Conclusion It is minimally invasive,rapid recovery and with recent good results of the minimally invasive aortic valve replacement with right chest small incision.To do the preoperative education well,prepare preoperative articles and equipment sufficiently,cooperate with the operation actively and improve the operation room nursing process,is the key to the success of the surgery.

CHEN Ye, QI Pei-jun, BAI Jin, ZHANG Shi-kun, MA Fen-fen, HE Mao-sheng, LOU Ke-xin, LI Zhi-hong

2016, 14(12): 2139-2141. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.052

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WEI Lin-ping

2016, 14(12): 2142-2143. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.053

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MO Yong-xiang, CHEN Yu-tang, GAO Zhi-qin

2016, 14(12): 2144-2146. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.054

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LI Jing, HUANG Xiao-jing, ZHOU Kai, ZHANG Chao, LIN Chui-cong

2016, 14(12): 2147-2149. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.055

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LI Xing-chen, AN Zhen-mei

2016, 14(12): 2149-2152. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.056

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About Journal

2016 Vol. 14, No. 12

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