2016 Vol. 14, No. 3

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A comparative study on job satisfaction of community health workers in Shanghai
NI Yang, WANG Su-ping, SUN Xiao-fan, BAO Yong
2016, 14(3): 341-343. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.001
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Objective To investigate the requirements and job satisfaction of community health workers,and compare the differences among the personnel in different positions. Methods This project was sponsored by the Shanghai committee of development.Experts were employed to survey the requirements and job satisfaction of doctors,nurses,public health workers and administrative staffs from 14 community health service centers(CHCs).A total of 400 questionnaires were distributed to 3 CHCs in urban areas and 280 valid questionnaires were returned,995 questionnaires were distributed to 7 CHCs in rural-urban fringe area and 665 valid questionnaires were returned,and 605 questionnaires were distributed to 4 CHCs in suburbs and 395 valid questionnaires were returned. Results The 1 340 valid survey responses showed that male to female ratio was about 3∶1 among the community workers;the education was mostly undergraduate students or junior college student,accounted for 48.0% and 48.0%,respectively;the medical and nursing staffs accounted for the most of the personnel in the post(38.3% and 34.4%,respectively);51.6 % of them were with primary technical job title.The overall satisfaction degree of community health services staff was higher with a score of 3.13.The difference existed among the staffs from different jobs,and managerial personnel had higher job satisfaction as compared with other works,in which the public health groupswere at the end. Conclusion The job factors should be fully accounted into when the policies are formulated.The continuing education policy should benefit most works in CHCs.The CHCs should promote cultural progress and create learning organizations,and improve the overall effect of CHCs with the help of the learning atmosphere.
CHEN Lan-ju
2016, 14(3): 344-345.
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Comparison of Mini-TLIF using quadrant minimally invasive system and open-TLIF in treatment of lumbar disc herniation
ZHANG Wei, GAO Dong, GAO Hao-ran, GAO Quan-you, HAN Kang, WANG Yan-dong, LI Yao-zhang, ZHOU Yong, XING Yong-jun
2016, 14(3): 346-348,464. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.002
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Objective To compare the clinical effect and safety of the Mini-TLIF using quadrant minimally invasive system or Open-TLIF in patients with lumbar disc herniation,and to find the most appropriate operative treatment of TLIF. Methods We retrospectively reviewed 186 patients with lumbar disc herniation who were treated in ousr hospital from 2011 to 2014.A total of 102 patients underwent Mini-TLIF and 84 underwent Open-TLIF.The clinical outcomes were evaluated by the operation time,length of incision,amount of bleeding and volume of drainage afteroperation.ODI,VAS,modified Macnab criteria and fusion rate between two groups were also compared. Results There were significantly advantage in Mini-TLIF group in length of incision,amount of bleeding and volume of drainage after operation(P<0.05),but no difference in operation time.The VAS score in Mini-TLIF group was significantly better after the operation but no difference in 6 months after the operation.There was no significantly difference between the two groups in ODI,lumbar function and the fusion though the fusion rate in Open-TLIF group was higher than Mini-TLIF. Conclusion Mini-TLIF has obvious advantages in some aspects like less operation trauma,blood less and satisfied short-term effect in the treatment of lumbar disc herniation,which could be a new choice and be further carried out in the clinical work.
Recombinant human thrombopoietin in the treatment of secondary immune thrombocytopenia
LIU Wen-bin, WU Di-jiong, YE Bao-dong, GAO Yan-ting, YU Qing-hong, SHEN Yi-ping, ZHOU Yu-hong
2016, 14(3): 349-351. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.003
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Objective To evaluate the efficacy and safety of recombinant human thrombopoietin(rhTPO)in the treatment of secondary immune thrombocytopenia(ITP). Methods The clinical data of 21 patients with secondary ITP in our hospital from January 2009 to October 2014 were reviewed retrospectively.All patients were treated with subcutaneous rhTPO 300 U/(kg·d).For the patients who achieved complete response or effective response in 4 four weeks,the intermittent maintenance therapy with rhTPO were conducted for 1-3 times a week last 3 months. Results Among the 21 secondary ITP patients,the complete response rates(CR),effective response rates(R)and overall response(OS)after 4 weeks of rhTPO treatment were 47.6%,19.0% and 66.7%,respectively.Compared with the value before the treatment,the highest average of the platelet count after the treatment was significantly higher(P＜0.01);14 patients received rhTPO intermittent maintenance therapy,whose the count of platelet after the 3 months treatment was significantly higher than that before the treatment(P＜0.05).But the percentage of Th,Tc and Tregs of secondary ITP patients had no remarkably changed as compared with those before the treatment(P＞0.05).The adverse reactions were found in 3 patients(14.3%),included pains in joints and muscles,fatigue and dizziness,and were relieved after the symptomatic treatment. Conclusion The rhTPO has significant clinical effect and good tolerance for secondary ITP patients,although it cannot improve the numbers of Treg cells.The intermittent maintenance therapy can get a longer benefit for the patients who achieved complete response or effective response after rhTOP continuous treatment.
Analysis of related factors with postherpetic neuralgia
WU Xiao-min, YU Yong-jian, CAI Fang, WANG Hong-fa
2016, 14(3): 352-354. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.004
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Objective To study the risk factors of postherpetic neuralgia,and provide the basis for the clinical treatment. Methods Total 79 cases patients with herpes zoster in our hospital were recricted and divided into postherpetic neuralgia group(29 cases) and non-postherpetic neuralgia group(50 cases).A questionnaire survey was conducted among all patients.The shingles type,treatment time,the invloved area ofskin,prodromalpain and the correlation with postherpetic neuralgia were recorded and anlyzed. Results The treatment time for herpes zoster and the incidence of postherpetic neuralgia was significantly correlated(P<0.05),the incidence of post-herpetic neuralgia less than five days of treatment was 13.3 percent,the incidence of post-herpetic neuralgia more than five days of treatment was 42.2 percent,the incidence of postherpetic neuralgia less than 5 days of treatment was significantly higher than the incidence of postherpetic neuralgia more than 5 days of treatment;the involved area of skin of herpes zoster and the incidence of postherpetic neuralgia was significantly correlated(P<0.05).The incidence of post-herpetic neuralgia with a small area of the affected shingles was 25.0 percent,the incidence of post-herpetic neuralgia with a large area of the affected shingles was 51.4 percent,the incidence of postherpetic neuralgia with a large area of the affected shingles was significantly higher than the incidence of postherpetic neuralgia with a small area of the affected shingles;The prodromalpain of herpes zoster and the incidence of postherpetic neuralgia was significantly correlated(P<0.05),the incidence of post-herpetic neuralgia with prodromalpain was 47.9 percent,the incidence of post-herpetic neuralgia without prodromalpain was 19.4 percent,the incidence of postherpetic neuralgia with prodromalpain was significantly higher than the incidence of postherpetic neuralgia without prodromalpain. Conclusion The incidence of postherpetic neuralgia has no correlation with herpes zoster type,but significantly correlation with treatment time,the involved area of skin and prodromalpain.The active and effective early treatment can reduce the incidence of post-herpetic neuralgia.
Differences of cognitive functions in the patients with different-subtype chronic insomnia disorder and correlations between cognition and objective sleep
ZHANG Ping, CHEN Gui-hai, WANG Fang, XIA Lan, WEI Qi-guo
2016, 14(3): 355-358. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.005
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Objective To explore the differences of cognitive functions in the patients with chronic insomnia disorder(CID) in the different subtypes and the correlations between cognition and objective sleep parameters. Methods Ninety-five patients with CID were diagnosed in sleep and memory disorders outpatient clinic from August 2012 to February 2014.Then patients were divided into the group of patients with difficulty initiating sleep(14 patients),patients with early morning awakening(EMA,24 patients),patients with difficulty maintaining sleep(24 patients) and patients with mixed symptoms (MS,33 patients) in accordance with complaints.The sleep profile was measured using one-night polysomnogram.On the next morning,the sleep quality,cognitive function and depressive state were evaluated using Pittsburgh Sleep Quality Index(PSQI),Montreal Cognitive Assessment Scale(MoCA) and Hamilton Depression Scale(HAMD),respectively. Results The subscale scores of MoCA in the attention(H=10.94,Ps<0.05) and delayed recall(H=22.79,Ps<0.001)were significantly different among the 4 subtypes of patients,i.e.,the EMA and MS groups had lower scores compared to the other two groups (Ps<0.05).Moreover,the scores in the subscales of visual-spatial and executive function and language positively correlated with the N3 duration(r=0.245,0.219;Ps<0.05) and N3 in sleep period time (r=0.234,0.222;Ps<0.05);the scores in attention subscale positively correlated with the N2 duration and N2 in sleep period time(r=0.209,0.364,Ps<0.05);and the scores in delayed recall subscale positively correlated with the N2 duration and N2 in sleep period time(r=0.218,0.290;Ps<0.05),and N3 duration and N3 in sleep period time (r=0.335,0.343;Ps<0.05). Conclusion The cognitive functions had discrepancies among the patients with different subtypes of CID,and visual-spatial and executive function,attention subscale and delayed recall subscale might be associated with objective parameters of NREM sleep in the CID sufferers.
Evaluating the diagnostic value of some related index for children with severe measles combined pneumonia by ROC curve
AN Shu-hua, LIU Xiao-juan, LI Jin-ying, LI Quan-heng, LIU Lan-ping, GAO Wen-jie, TIAN Li-yuan, WANG Ya-kun, LI Qing-tao, YANG Fan
2016, 14(3): 359-361,411. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.006
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Objective To explore the clinical features of children with measles combined pneumonia,and evaluate the severity-related indicators by the ROC curve. Methods The clinical data of 62 children with measles combined pneumonia in our hospital were reviewed.The patients were divided into severe group(n=15)and the control group(n=47)according to the condition.The fasting venous blood within 24 h after the admission was prepared for the test of WBC,NE%,PLT,CRP,IgM,IgA,IgG were tested with immunoturbidimetric assay,LDH with enzymatic method,and albumin with bromocresol green method.The clinical characteristics and laboratory indexes of both groups were compared with single factor analysis,and the ROC curve for the indicators which had statistical difference. Results The history of measles vaccination,WBC,NE%,PLT,IgM,IgA,IgG between the two groups had no statistical differences.The course prior to the admission in the severe pneumonia group was 10.0(5.0,15.0)d which was longer than that in the control group[6.0(3.0,10.0)d];the duration of fever of children was 11.0(8.0,16.0)d which was longer than that in the control group[7.0(3.0,9.0)d](P＜0.05);the CRP was 17.0(4.0,50.0)mg/L which was higher than that in the control group[6.0(1.0,13.0)mg/L],LDH was 433.0(373.0,601.0)U/L which was higher than that in the control group[352.0(277.0,427.0)U/L],P＜0.05.The AUC(area under the ROC curve) of the course prior to admission,duration of fever,CRP,LDH were 0.689,0.784,0.723 and 0.731,respectively;the critical value was 9,7.5 d,25.5 mg/L and 366.0 U/L,respectively;the sensitivity was 60.0%,93.3%,73.3% and 86.7%,respectively;and the specific degrees was 74.5%,57.4%,68.1% and 59.6%,respectively;95%CI was 0.547-0.830,0.657-0.911,0.566-0.881,0.587-0.876,respectively. Conclusions The course prior to admission,duration of fever,CRP,LDH are the related indicators.The patients whose course prior to admission,long duration of fever and high levels of CRP and LDH are easily to present severe measles combined with pneumonia.The lower diagnostic value of the course prior to admission was lower for measles combined with severe pneumonia,and the duration of fever,levels of CRP and LDH has medium diagnostic value.
Therapeutic analysis of neuroendoscopic transcortical fenestration of septum pellucidum in treatment of intraventricular hemorrhage
TONG Min-feng, LIU Ji-hong, ZHANG Wei, YUAN Jian-lie
2016, 14(3): 362-364. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.007
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Objective To compare the clinical efficacy of neuroendoscopic transcortical fenestration of septum pellucidum and conventional ventricular drainage in treatment of intraventricular hemorrhage. Methods Total 112 patients with spontaneous intraventricular hemorrhage in our hospital from Jun.2012 to Jun.2014 were randomly divided into observation group(57 cases) and control group(55 cases).The observation group received neuroendoscopic transcortical fenestration of septum pellucidum,while control group received external ventricle drainage.The time of operation,removal of hematoma,indwelling time,postoperative complications (secondary hemorrhage,intracranial infection,hydrocephalus),disease duration,mortality,Glasgow prognostic score GOS) 3 months later,and other clinical curative effect index were observed.The statistical analysis was carried out by SPSS 13.0 software,The quantitative data was described with mean and standard deviation( s),Student t-test for the quantitative variables and Chi-square test for the categorical variables,and Wilcoxon signed-rank test for rank data were performed.The prognosis of the two groups was compared by statistical analysis. Results 3 days after the operation,CT showed that the hematoma clearance rate was greater than 50% in the 50 cases (87.72%) of the treatment group and 18 cases(32.73%) in the control group .Statistical analysis:Z=6.2002，P＜0.01,there were significant differences.At the same time,the postoperative complications,the time of catheterization,the course of disease,the mortality,and the prognosis of the Glasgow(GOS) 3 month after the operation were better than that in the control group(χ2=4.193，χ2=11.009，χ2=9.843，t=14.096，t=14.629，Z=3.239，P＜0.05).The operation time between the two groups had no statistically significance(P＞0.05). Conclusion The removal of ventricular hemorrhage with neuroendoscopic transcortical fenestration of septum pellucidum has higher hematoma clearance rate,can obviously reduce the morbidity and mortality in patients with spontaneous intraventricular hemorrhage,reduce complications,shorten the course of the disease,and reduce the economic burden of patients.
Effectiveness of concurrent chemoradiation with Cisplatin or Nedaplatin for locally advanced cervical cancer
LUO Li-min, ZHAO Zhan, JIA Yong-shi, WU Shu-qiang
2016, 14(3): 365-367. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.008
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Objective To explore the effect and safty of concurrent chemoradiationwith Cisplatin(CDDP)or Nedaplatin(NDP)in treatment of locally advanced Cervical cancer(CC). Methods Total 72 patients with advanced CC undergoing concurrent chemoradiation in our hospital from May 2013 to July 2014 were selected.36 cases in the observation group were given NDP treatment for 3 months(40 mg/m2 weekly,until the external lighting end),while 36 cases in the control group were given CDDP treatment for 3 months(40 mg/m2 weekly,until the external lighting end),one times a week,total 5 weeks.The effect was evaluated according to the Evaluation Criteria in Solid Tumors(UICC),and 1-year survivl rate,transfer rate,recurrence rate and adverse reactions were followed up. Results The remission rate was 94.4%(34/36)in the observation group,while was 72.2%(26/36)in the control group,the remission rate in the observation group was obviously higher than that of the control group(χ2=6.400,P<0.05);1-year survival rate,transfer rate and recurrence rate in the observation group were 91.7%(33/36),5.6%(2/36)and 8.3%(3/36),while in the control group was 86.1%(31/36),25.0%(9/36)and 33.3%(12/36),1-year transfer rate and recurrence rate in the observation group was obviously better than that in the control group(χ2=5.258/6.821,P<0.05);the incidence of low white blood cell count(Ⅲ-Ⅳ),low platelets,nausea,vomiting and diarrhea in the control group was significantly higher than those in the observation group(P<0.05). Conclusion The concurrent chemoradiationwith Cisplatin(CDDP)or Nedaplatin(NDP)in treatment of locally advanced Cervical cancer(CC)has a good short-term effect,with lower incidence of adverse reactions,worthy of further promotion in clinical practice.
Associations of ulcerative colitis with Bsm Ⅰ,Apa Ⅰ and Taq Ⅰ polymorphisms in vitamin D receptor gene
ZHENG Bo, MIN Xiao-yan, WANG Jian-zhang, PEI Ji-hua, XU Chang-long, JIANG Yi
2016, 14(3): 368-370. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.009
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Objective To investigate the associations between VDR gene(Bsm-Ⅰ,Apa-Ⅰ and Taq-Ⅰ) polymorphisms and ulcerative colitis(UC) in a Chinese Population. Methods Total 198 cases of UC and 312 normal subjects were recruited.VDR Bsm Ⅰ,Apa Ⅰ and Taq Ⅰ polymorphisms was genotyped with direct sequencing.Haplotype analysis was conducted using Haploview 4.2. Results The allelic and genotypic frequencies of VDR(Bsm I,Apa I,Taq I) did not statistically differ between UC patients and the controls (all P＞0.05).The haplotype analysis showed that the Bsm I,Apa I and Taq I polymorphic loci were in a strong linkage disequilibrium.In addition,the frequency of AAC haplotype in UC patients was significantly lower than in the controls[3.53%(14/396) vs 7.21%(45/624),P=0.014,OR=0.472,95%CI:0.255-0.871]. Conclusion Individuals with AAC haplotype formed by VDR(Bsm Ⅰ,Apa Ⅰ,Taq Ⅰ)might have a lower risk of UC.
Effect of minimally invasive procedure for removal of intracranial hematoma on small hypertensive intracerebral hemorrhage in putamen
SUN Jun-qi, BI Cai-qin, WANG Qing-song
2016, 14(3): 371-373. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.010
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Objective To explore the effect of minimally invasive procedure for removal of intracranial hematoma in the treatment of small hypertensive intracerebral hemorrhage in putamen. Methods A total of 80 patients with small hypertensive intracerebral hemorrhage in putamen were randomly assigned to observation group(n=40) and control group(n=40).The control group received the conservative treatment,while the observation group received minimally invasive procedure for removal of intracranial hematoma in addition to the conservative treatment.The remaining hematoma volume and edema volume around the hematoma and efficiency and neurologic impairment score on the first day,the first week,second week and third week,the significant efficiency on third week,and the difference of activity of daily living on third month were compared between the two groups. Results There was significant difference in remaining hematoma volume and edema volume around the hematoma between the two groups on the first day,the first week,second week and third week after treatment(P＜0.01) ;There was difference in neurologic impairment score between the two groups on the first day,the first week,second week and third week after treatment(P＜0.01);There was significant difference of efficiency between the two groups on the third week after the treatment(P＜0.05);There was significant difference of the cure rate of activity of daily living between the two groups on the third week after the treatment(P＜0.05). Conclusion The minimally invasive procedure for removal of intracranial hematoma can quickly remove the intracranial hematoma,relieve brain edema,improve neurologic impairment,and improve the patient’s quality of life.The curative effect is superior to the internal medicine conservative treatment,and is a relatively safe and effective treatment for small hypertensive intracerebral hemorrhage in putamen.
Chronic hypopituitarism after traumatic brain injury and replacement therapy
WANG Jun-you, TENG Ling-fang, SHAO Bo, LIN Da, LIN Zheng, LIN Li-gang, LIN Gao-jun, YIN Kang, JIN Ling-jiang
2016, 14(3): 374-376,422. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.011
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Objective To investigate themorbidity of chronic pituitary hormone deficiency and the efficacy of replacement therapy in patients with traumatic brain injury. Methods Total 120 patients with chronic sequelae of cerebral trauma were enrolled and assessed at 6 and 12 months after injury for hormonal function.Major hormonal deficiencies,including GH,ACTH,TSH,LH/FSH and ADH deficiencies,were identified.The clinical data and CT imaging data were analyzed.The general and acute injury characteristics were compared in patients with and without hypopituitarism by the use of multivariate logistic analysis.In addition,GH replacement for hypopituitarism patients was conducted,and the efficacy was assessment. Results Out of 120 patients tested at 12 months after injury,the incidence of GH,ACTH,TSH,LH/FSH and ADH deficiency was 19.2%,3.3%,0%,12.5% and 1.7%,respectively.As compared to 6 months after injury,there was no different for GH deficiency,however,other hormonal deficiencies were a certain degree of recovered.Compared with the non-hypopituitarism patients,hypopituitarism patients had higher BMI,hypoxia rate,diffuse brain swelling,evacuated intracranial hemorrhage rate and computed tomography score(P＜0.05).The multivariate logistic model revealed that BMI,hypoxia rate,diffuse brain swelling,and computed tomography score were independent risk factors for hypopituitarism patients.In addition,compared with the pre-treatment value,hypopituitarism patients had better LCFS,DRS and FIM scores after GH replacement therapy. Conclusions The incidences of GH and LH/FSH deficiency were high for patients after traumatic brain injury;BMI,hypoxia rate,diffuse brain swelling,and computed tomography score were independent risk factors for hypopituitarism patients.GH replacement for hypopituitarism patients was useful for their recovery.
Experimental study on effects of bortezomib and lenalidomide on NK/T-cell lymphoma cell lines
DU Chao, WENG Wei, SUN Zhi-xin, HAO Si-guo, TAO Rong
2016, 14(3): 377-380. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.012
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Objective To investigate the effects of bortezomib and lenalidomide on the induction of cell apoptosis in natural killer/T-cell lymphoma(NK/TCL) cell lines. Methods Trypan blue exclusion test was used to account living cells.Flow cytometry was applied to detect cell apoptosis and contents of cellular DNA for analysis of cell cycle distribution.The apoptotic cells were quantified by dual labeling of recombinant annexin V and propidium iodide. Results The cytotoxic effects of bortezomib on SNK-1,SNK-6 and SNT-8 were observed.Bortezomib at clinical therapeutic concentrations significantly reduced the cells survival by inducing cell apoptosis in NK/TCL cell lines.The percentages of survival cells were (47.2±3.5)%,(33.5±3.9)%,(52.1±4.3)% for SNK-1,SNK-6,and SNT-8,respectively,after bortezomib(30 nmol/L) treatment for 24 hours(P＜0.01 as compared with control).The IC 50 of bortezomib for SNK-1,SNK-6,and SNT-8 were 19.5,12.7,and 20.7 nmol/L,respectively.By flow cytometry analysis,we found that 24 hours exposure to bortezomib significant induced apoptosis with (47.0±4.2)% for SNK1(30 nmol/L),43.0±3.8% for SNK6(10 nmol/L),and (53.0±4.1)% for SNK-8 (30 nmol/L).Lenalidomide showed no significant effect on cell survival,cell proliferation and distribution of cell cycle.Lenalidomide in combination with bortezomib showed no synergistic effect on inducing cell apoptosis. Conclusion Bortezomib is a powerful agent in inducing NK/TCL cells apoptosis.It is a potential therapeutic agent in NK/TCL treatment.Lenalidomide showed no significant effect on NK/TCL cells in culture;moreover,it showed no synergistic effect with bortezomib on inducing cell apoptosis.Whether lenalidomide has effect on NK/TCL in vivo should be further studied.
Risk factors of rebleeding and its clinical significance in 1 417 cases of acute non-variceal upper gastrointestinal bleeding
PENG Qiong-hui, WANG Xiao-lei
2016, 14(3): 381-383. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.013
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Objective To investigate the risk factors of rebleeding in patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB),and the predicting value of Blatchford and Rockall scoring system. Methods Qualified data of 1 417 patients with ANVUGIB admitted to Tongji Hospital between 2008 and 2012 were collected and scored with Blatchford and Rockall scoring system.According to the outcomes,they were divided into two groups,which including improved group and rebleeding group.Univariate analysis and multivariate logistic regression models were used to evaluate the data of patients’ general state,bleeding performance,co-morbidity,complication,endoscopic situation,usage of drugs and predictive value of risk score. Results Univariate analysis showed that there were the statistically significant between age,heart rate,shock index(SI),blood urea nitrogen(BUN) concentration,ratio of co-morbiditiy of heart disease,hepatic disease,tumor spread,shock anemia(P＜0.05),and both of Rockall and Blatchford system have the value on predicting rebleeding(P＜0.05).Multivariate logistic regression showed high SI,co-morbiditiy of hepatic failure or hepatic disease and high Rockall score are the independent risk factors for rebleeding(P＜0.05). Conclusion The patients with high SI,co-morbiditiy of hepatic failure or hepatic disease and high Rockall score are more likely to suffer rebleeding.
Effect of the superfine grinding“Xiaobi Zhitong San”hot compress and plus acupoint for treatment of degenerative lumbar canal stenosis in elderly patients with lumbar spinal canal stenosis
GE Cai-hua, LIU Zhi-an, CENG Xian-hui, YANG Bo-yuan, YANG Yang
2016, 14(3): 384-386. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.014
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Objective To investigate the effect of superfine grinding “Xiaobi Zhitong San” hot compress and plus acupoint for treatment of degenerative lumbar canal stenosis in elderly patients with lumbar spinal canal stenosis and impact on the patient’s clinical symptoms,to provide reference for the clinical treatment of senile lumbar spinal stenosis. Methods From August 2013 to December 2014,60 elderly patients with lumbar spinal canal stenosis in our hospital were selected as the research object and were randomly divided into treatment group and control group with 30 cases in each group.The control group was given diclofenac treatment,the treatment group was given superfine grinding “Xiaobi Zhitong San” hot compress and plus acupoint treatment.After treatment for 4 courses,the clinical efficacy and the degree of pain were compared between the two groups. Results The total effective rate in treatment group was 86.67%,significantly higher than that (63.33%) in the control group(P＜0.05);After treatment,the two groups of patients with pain were significantly improved(P＜0.05),the degree of pain to improve the situation in the treatment group was better than control group(1.91±0.74 vs. 2.52±1.03)(P＜0.05);After treatment,the clinical symptoms in the two groups were improved significantly(P＜0.05),the treatment group of improvement of clinical symptoms was better than control group,the difference was statistically significant(P＜0.05). Conclusion The superfine grinding “Xiaobi Zhitong San” acupoint sticking therapy significantly compress with senile lumbar spinal canal stenosis and efficacy,can significantly reduce the clinical symptoms and pain levels of patients,it is worthy of attention.
CT guided anococcygeal nerves destruction technique and its application in treating malignancy associated perineal pain
ZHANG Li, HUANG Bing, YAO Ming, GUO Jian-guo, XIE Ke-yue
2016, 14(3): 387-388,444. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.015
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Objective To report a new clinical therapeutic technique,anococcygeal nerves destruction under CT guidance,in treating malignancy associated perineal pain after fecal and urinary diversion surgery,and evaluate the analgesic efficacy of this technique. Methods Three cases of late stage of malignancy associated perineal pain with artificial anourethral fistula have been involved in this study.The pain scored higher than 5 for all the three patients even they took more than 200 mg OxyContin per day.CT guided anococcygeal nerves destruction was performed when no contraindication to cavitas subarachnoidealis penetration was found.Coronal CT scan was performed to L4-S1 vertebrae,5 mm thick.The best penetrating spot for needle puncture was determined.After Local anesthesia,a #7 lumbar puncture needle was used to enter the cavitas subarachnoidealis through the intervertebral space between L5 and S1.When good cerebrospinal fluid circulation was confirmed,1.2 ml 5% phenol glycerin (1 ml 6% phenol glycerin plus 0.2 ml 30% iohexol) was slowly injected at the rate of 1 ml/min.The distribution of the physic liquor has been confirmed from another CT scanning,and 3D reconstruction.The patients kept their position for another 30 min after the puncture needle was removed,and was then sent to the wards.During the transportation and the first 6 h after,the patients need to keep sitting posture.The patients were monitored for vital signs during the treatment and for the first 12 h.Then they were tested for analgesic area using needle punching,and receiving follow up calls after discharge. Results The 3D reconstruction after surgery showed in all 3 cases,that the injected physic liquor was located in the terminal cistern,and the upper bound of the physic liquor located below the L5 vertebrae.After surgery,all patients lost their sensation at perineal area,and felt no pain even punched to bleed.Perineal pain was all gone.All the patients had the same,not affected muscle strength and sensation of their two lower limbs as that before the surgery.2 cases were followed up until death (survival durations were 9 months and 15 months);another case is still going on(4 months after surgery),all with no recurrent perineal pain. Conclusion Anococcygeal nerves destruction under CT guidance is a novel,safe,efficacious strategy in treating malignancy associated perineal pain,especially for those patients with terminal cancer and received fecal and urinary diversion surgery.
Association of ICAM-1 K469E polymorphism with cerebral infarction in Han nationality in China
JIANG Hui-hua, ZHU Min, ZHOU Yuan-lin, JIN Xiao-ping, KE Shao-fa, WANG En, ZHENG Hai-bin, HONG Wei-jun
2016, 14(3): 389-390,481. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.016
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Objective To study the association of ICAM-1 K469E polymorphism with cerebral infarction in Han nationality in China. Methods All 213 cases of cerebral infarction(CI group)and 224 people in physical examination(control group)in our hospital from July 2009 to October 2013 were enrolled into this study.All the subjects were compatible in nationality,age abd gender.The polymerase chain reaction and restriction fragment length polymorphism(PCR-RFLP)was performed to determine the ICAM-1 K469E polymorphism. Results The areas of cerebral infarction was related to ICAM-1 polymorphism:the index in the extensive cerebral infarction group was significantly higher than that in the small cerebellar infarcts group and lacunar cerebral infarction group,the difference was statistical significance(P<0.05);there was no statistical significance between the small cerebellar infarcts group and lacunar cerebral infarction group(P>0.05).For ICAM-1 genotypes,KK in CI group was was significantly more than that in the control group,the differences was statistically significant P<0.05);EE was slightly lower as compared with the control group;there was no statistically significant in the EK genotype between the two groups(P>0.05);for the alleles,K/E in the CI group was much higher when compared with the control group,the difference was statistically significant(P<0.05). Conclusion The morbidity and areas of cerebral infarction in Han nationality was obviously correlated to ICAM-1K 469E polymorphism,E allele may be the importsant gene for the cerebral infarction in Han nationality in China.
Meta-analysis of risk factors for pancreatic fistula after pancreatoduodenectomy in China
FAN Heng-wei, LIU Hui-chun, LI Zong-kuang, CUI Pei-yuan, ZHOU Lei, JIN Hao, TAN Yi, WU Hua, XU Lu-bai
2016, 14(3): 391-393,477. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.017
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Objective To explore the risk factors of pancreatic fistula after pancreatoduodenectomy(PD) in China,and provide a theoretical basis for reducing the incidence of postoperative pancreatic fistula. Methods Meta-analysis was used in 33 papers on risk factors of the pancreatic fistula after pancreaticoduodenectomy published in China from June 2002 to June 2012. Results There were no positive correlation between the incidence of pancreatic fistula after PD and the age and gender of patients,preoperative levels of albumin and hemoglobin,operation time,and the combination with diabetes,hypertension and coronary heart disease(P＞0.05).The patient with high level of preoperative jaundice (higher than 171 μmol/L) were with higher incidence of pancreatic fistula after PD when compared with the patients with a preoperative jaundice level of less than 171 μmol/L(P＜0.05),furthermore,the preoperative biliary drainage therapy might not decrease the incidence of pancreatic fistula after PD(P＞0.05).The patients with pancreatic duct diameter greater than 3mm had lower incidence of pancreatic fistula than those with duct diameter less than 3 mm(P＜0.05).The pancreatic duct drainage with stent decreased the incidence of pancreatic fistula after PD(P＜0.05).The patients with the amount of bleeding during the operation more than 1 000 ml had a higher incidence of pancreatic fistula after PD(P＜0.05).The postoperative somatostatin administration might decrease the incidence of pancreatic fistula after PD(P＜0.05).The patients with a history of abdominal surgery had a higher rate of pancreatic leak than the control group after PD(P＜0.05). Conclusion The pancreatic fistula after PD does not positively correlated with gender and age of patients,preoperative levels of albumin and hemoglobin,operation time,and the combination with diabetes,hypertension and coronary heart disease.The preoperative severe jaundice,small pancreatic duct diameter,without the support of the pancreatic duct drainage,the amount of bleeding,unused somatostatin and operation on abdominal region are the risk factors of the pathogenesis of pancreatic fistula.
Early diagnosis and surgical treatment of acute traumatic diaphragmatic rupture
LIANG Shu-zeng, CHENG Hui, ZHANG Xue-mei
2016, 14(3): 394-396,403. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.018
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Objective To summarize the clinical experiences of early diagnosis and treatment of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 21 cases(18 males and 3 females) with traumatic diaphragmatic rupture in our hospital from April 2001 to November 2013 were retrospectively reviewed.These were composed of 13 cases with closed injury and 8 cases with opend injury.They were injured with sharp instrument injury(12 cases),injury caused by traffic accident(5 cases),iatrogenic injury(2 cases) and injury by fall(2 cases).Left-sided TDR was found in 17 patients,right in 4.Among all patients,complicating with diaphragmatic hemias(12 cases),traumatic shock(10 cases),hemopneumothorax(20 cases),pericardium rupture(5 cases),ventricle rupture(2 cases),injury of superior vena cava(1 case),laceration of lung(8 cases),gastric rupture(4 cases),hepatic rupture(4 cases),rupture of spleen(2 cases),rupture colonale(2 cases),serious craniocerebral injury(3 cases),spinal fracture(4 cases) and paraplegia(2 cases) were surgical treated.Computerized topography was performed preoperatively in 16 cases.All patients received operation,and selected laparotomy in 6 cases,thoracototomy incision in 7 cases,thoracolapara incision in 2 cases,video-assisted thoracoscopic surgery in 3 cases.The causes,diagnosis,emergency treatment and operation method are analyzed. Results TDR usually combined with chest visceral injury,and was complexity in clinical manifestation.Thirteen patients were definitely diagnosed before the surgery(positive rate 61.90%),and 8 patients including video-assisted thoracoscopic surgery in 3 cases were diagnosed definitely during the surgery.Eighteen patients were cured and 3 patients were died. Conclusion Raise awareness and emergency chest CT examination were major means of early diagnosis.The early diagnosis and actively surgical treatment in time of complicated injuries is the key to cure the traumatic diaphragmatic rupture.Video-assisted thoracoscopic surgery is the highest potential approach to manage TDR.
A controlled research of automatically hemorrhoids ligation and Milligan-Morgan hemorrhoidectomy in treatment of patients with Ⅲ or Ⅳ degree mixed hemorrhoids
TANG Mao-shan
2016, 14(3): 397-398,467. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.019
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Objective To investigate the clinical effect of automatic hemorrhoids ligation(RPH,modified rubber band ligation) and Milligan-Morgan Hemorrhoidectomy(M-M) in treatment of patients with Ⅲ or Ⅳ degree mixed hemorrhoids. Methods Total 164 cases of Ⅲ or Ⅳ degree Mixed hemorrhoids in our hospital from January 2013 to December 2014 were randomly divided into observation group and control group,with 82 cases in each group.The patients in the control group were given Milligan-Morgan Hemorrhoidectomy(M-M),while the patients in the observation group were given automatically hemorrhoids ligation(RPH).The wound healing time,clinical efficacy and complications(anal margin edema,bleeding,skin tag forming,dysuria,and pain) of both groups were observed. Results The wound healing time of the observation group was (21.5±4.9) d,which was significantly shorter than that in the control group[(25.1±6.2)d],P＜0.05.The total effective rate of the observation group was 95.1%,which was significantly higher than that in the control group 84.1%(P＜0.05).The anal margin edema,bleeding,skin tag forming,dysuria,and pain status of the observation group were 2.2±0.7,3.6±0.9,2.1±0.6,3.1±0.8,8 cases,respectively,which were significantly better than control group(2.9±0.8,4.1±1.1,2.7±0.8,3.9±0.9,and 20 cases,respectively),P＜0.05. Conclusion Compared with traditional Milligan-Morgan Hemorrhoidectomy,automatic hemorrhoid ligation can effectively treat Ⅲ or Ⅳ degree mixed hemorrhoids,with advantage of short wound healing time,high efficacy and low complication.
Application evaluation of Paliperidone combined with sodium valproate on mental disorders aggressive behavior due to brain injury
LIANG Xiao-song
2016, 14(3): 399-400,434. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.020
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Objective To observe and explore the effectiveness of Paliperidone combined with sodium valproate on mental disorders aggressive behavior due to brain injury,and to improve the treatment of mental disorders due to brain injury attacks. Methods Total 96 patients with mental disorders aggressive behavior in this hospital since April 2011 to February 2015 were selected and divided into two groups according to the randomization method,with 48 patients in each group.The control group received paliperidone(initial 6 mg/day,plus to 9-12 mg/days after 1 week)treatment,while the observation group received sodium valproate(0.5 g/d,according to the condition of the need to increase to 0.8 g/d,once a day orally)on the basis of the control group.The Clinical Global Impressions scale(CGI)was used to evaluate the efficacy,and the incidence of adverse reactions were recorded,the data was analyzed by SPSS. Results The difference of CGI score before the treatment between the two groups was not statistically significant(P>0.05);2 weeks,4 weeks and 8 weeks after the treatment,the CGI score of the observation group were (3.1±0.8)point,(2.7±0.7)point and (2.0±0.5)point,the control group (3.9±0.7)point,(3.5±0.8)point and (2.8±0.6)point,CGI score in the observation group was significantly lower than that in the control group(P<0.05);the incidence of adverse reactions in the observation group was 12.5%(6/48),while was 10.4%(5/48)in the control group,the difference was not statistically significant(P＞0.05). Conclusion Paliperidone combined with sodium valproate therapy can significantly improve psychiatric symptoms in patients with mental disorders aggressive behavior due to brain injury,the therapy does not increase the inciedence of adverse reaction,and is safe and effective.
Clinical effect of hematodialysis combined with hemoperfusion in the treatment of severe acute pancreatitis
ZHAI Lei
2016, 14(3): 401-403. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.021
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Objective To explore the clinical therapeutic effect of hematodialysis combined with hemoperfusion in the treatment of severe acute pancreatitis,and provide a reasonable basis for clinical treatment. Methods Thirty cases of severe acute pancreatitis patients in our hospital from May 2013 to October 2014 were selected,they were received hematodialysis combined with hemoperfusion,and observed the changes of vital signs and chemistry during the treatment: heart rate,body temperature,average arterial pressure,APACHE Ⅱ score,oxygen synthetic index and respiratory rate. Results The 27 patients were improved and discharged,3 patients died,the duration of hospital stay and mortality were (14.1±5.5) days and 10%.Using hematodialysis combined with hemoperfusion in the treatment process and process variations of the clinical indices were better before treatment,compared with those before treatment,P<0.05,with statistical significance.The changes of biochemical indexes were better than that before treatment after treatment compared with those before treatment,P<0.05,with statistical significance. Conclusion The hematodialysis combined with hemoperfusion in treatment of severe acute pancreatitis patients can reduce the mortality of patients with severe acute pancreatitis (SAP),which has good clinical therapeutic effect and less complications.It has great significance to clinical improvement and prognosis.
Factors affecting the postoperative bladder over activity syndrome in patients with benign prostatic hyperplasia after TURP
JIANG Yue
2016, 14(3): 404-406. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.022
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Objective Transurethral resection of the prostate(TURP)is the best way to deal with the symptoms of lower urinary tract obstruction caused by benign prostatic hyperplasia(BPH).However,there is no significant effect on the overactive bladder(OAB)symptoms among certain number of patients after the surgery. Methods The clinical data of 286 cases of patients with BPH were collected in our hospital from June 2011 to June 2014.All the patients underwent TURP.Single-factor ANOVA was performed among the prostate volume,residual urine volume,average flow rate of urinary,maximum flow rate of urinary,detrusor and stability,IPSS score,QOL score,urinary tract infection and urinary retention.Multiple-factor non-conditional logistic regression analysiswas performed evaluate the influence factors of postoperative overactive bladder syndrome after TURP. Results TURPwere successfully performed in all patients.After the operations,OAB symptoms were not alleviated in 42 cases(observation group),alleviated in 244 cases(control group).As compared with the control group,The patients in the observation group were with greater prostate volume,more residual urine,less maximum flow rate of urinary,poor detrusor stability,and higher IPSS score,the difference was statistically significant(P<0.05).Multiple-factor non-conditional logistic regression analysis showed that preoperative less maximum urinary flow rate,poor detrusor stability and higher IPSS score could increase the risk of OAB symptoms after TURP(P<0.05). Conclusion OAB symptoms after TURP were correlated with maximum urinary flow rate(Qmax),detrusor instability and IPSS score.These risk factors should be actively controlled to improve the quality of life and prognosis of patients.
The influence of breast-conserving surgery combined with sentinel node biopsy on the postoperative recovery status and complications of the older patients with breast cancer
FU Jia-qing, YAN Jin-liang, TIAN Jing-zhong, WANG Xiao-dong
2016, 14(3): 407-408,490. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.023
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Objective To explore the effect of breast conserving combined sentinel lymph node biopsy operation on the status of recovery and complication of old patients with breast cancer after operation. Methods The 102 cases of old patients with breast cancer treated in our hospital from February 2012 to February 2015 were retrospective studied.The 42 patients who accepted emulsion combined with sentinel lymph node biopsy operation treatment were selected as study group;while another 60 patients who accepted the traditional operation therapy as control group.On the recovery of operation condition,the results of patients in the 2 groups after operation and complications were analyzed. Results In the operation condition of 2 groups of patients in the study group patients,the total amount of bleeding,operation time,removal of drainage tube time,total drainage volume were (65.2±20.8) ml,(58.4±13.6)min,(5.3±1.1)d,(102.6±20.4)ml;while patients in the control group,the total amount of bleeding operation time,removed the drainage tube time,total drainage volume were (102.3±19.6)ml,(163.2±52.1)min,(29.7±9.8)d,(269.2±10.1)ml.In the aspects of complications,the patients in study group received subcutaneous tissue necrosis,edema of the upper limb,subcutaneous effusion were 1 cases (2.4%),0 cases(0.0%),1 cases(2.4%);the control group of patients with subcutaneous tissue necrosis,edema of the upper limb,subcutaneous effusion were 7 cases(11.7%),16 cases(26.7%),4 cases(6.7%).The postoperative recovery of patients with good psychological state,the study group was 39 cases(92.9%);the study group patients psychological condition of 31 cases (53.3%).Compared to the patients in the 2 groups had significant difference(P<0.05). Conclusion For elderly patients with breast cancer treated with breast conservation,the method combined the sentinel lymph node biopsy operation can have better effect.
Clinical efficacy of combined therapy with Esomeprazole,domperidone and hydrotalcid in patients with bile reflux gastritis
LIN Yong, YE Dan, SHI Zheng-chao
2016, 14(3): 409-411. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.024
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Objective To evaluate the clinical efficacy of the combined therapy withesomeprazole,domperidone and hydrotalcid in patients with bile reflux gastritis(BRG)by observing the clinical symptoms and electronic gastroscopy. Methods Total 90 cases of BRG were randomly divided into control group and observation group according to a completely random number table,45 cases in each group.The control group received domperidone and aluminum magnesium treatment,while the observation group received the combined therapy with esomeprazole,domperidone and hydrotalcid.The clinical symptoms,bile reflux and the condition of the gastric mucosa by the gastroscopy were compared between the two groups. Results There was no statistically significant difference in age,gender,disease duration,clinical symptoms and bile regurgitation,etc.between the two groups(P>0.05).After the treatment,the symptom score of both groups were improved significantly as compared with those before the treatment,and the score of the observation group decreased more significantly than the control group(P<0.05).After the treatment,the gastric acid content and gastric acid secretion of the observation group was (85.13±61.64) mg/ml and (1.31±0.27) mmol/h,respectively,which were significantly lower than (136.28±92.36) mg/ml and (2.81±0.54) mmol/h of the control group(P<0.05).After the treatment,gastric mucosal congestion,edema,erosion,lake bile stained mucus cases were significantly improved in both groups,and the degree of improvement in observation group was more obvious as compared with the control group(P<0.05).Gastric congestion,edema,erosion score of observation group was (0.82±0.29),(0.56±0.16) and (0.62±0.15) points,respectively,and of the control group was(1.38±0.32),(1.53±0.18) and (1.36±0.19) points,respectively,the differences were statistically significant(P<0.05). Conclusion The combined therapy with esomeprazole,domperidone and aluminum magnesium carbonate in patients with bile reflux gastritis has a synergistic effect,which will better improve the clinical symptoms and protect the gastric mucosa.
Influence and significance of hepatic transcatheter arterial chemoembolization combime with endostar on levels of serum VEGF,HIF-1A,OPN and MMP-9 in patients with hepatocellular carcinoma
FANG Lei, ZHAO Zhan, WU Qian-neng, ZHU Yuan-dong, XIE Xin-cheng
2016, 14(3): 412-414. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.025
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Objective To observe and explore the influence and significance of Hepatic Transcatheter Arterial Chemoembolization(TACE) combine with Endostar on serum VEGF,hypoxia inducible factor(HIF)-1,osteopontin(OPN),matrix metalloproteinase 9(MMP-9) in patients with Hepatocellular carcinoma(HCC). Methods Total 80 cases of HCC between July 2011 and November 2014 in our hospital were selected and divided into two groups according to the random number method.The control group received TACE treatment,while the observation group receiged the combined therpaudy with endostar and TACE.HIF-1A,OPN,VEGF and MMP-9 levels were measured before the treatment and 4 weeks after the treatment,the efficacy in both groups were evaluated after the treatment,and adverse reactions were recorded and compared. Results The difference of VEGF,HIF-1A,OPN and MMP-9 levels before the treatment was not statistically significant(P>0.05),after the treatment,VEGF,HIF-1A,OPN and MMP-9 levels in the observation group were(431.2±132.2)pg/ml,(58.4±0.7)ng/L,(76.4±18.2)μg/L and(194.3±82.2)ng/ml,respectively,while was(562.8±184.4)pg/ml,(62.4±1.1)ng/L,(88.3±19.2)μg/L and(238.4±94.4)ng/ml,respectively,in the control group,VEGF,HIF-1A,OPN and MMP-9 levels in the observation group were significantly lower than those in the control group(P<0.05);The efficacy in observation group was 95.0%(38/40),while was 77.5%(31/40)in the control group,the observation group was significantly higher(P<0.05);the difference of adverse reactions incidence was not statistically significant(P>0.05). Conclusion Endostar combined with TACE in the treatment of HCC can reduce VEGF,HIF-1A,OPN and MMP-9 levels,and limit tumor progression effect.
Relationship between CD4+ CD28null T cell and diabetic microangiopathy
GAO Zu-hua, TANG Ke-ke, QIU Xia-sang, YAN Qin-ming, HONG Ping-ping
2016, 14(3): 415-416,448. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.026
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Objective To investigate the relationship between CD4+CD28null T cell and diabetic microangiopathy. Methods One hundred and forty-one patients with type 2 diabetes were selected in the endocrinology department.According to the presence of microvascular disease,these patients were divided into four groups:the type 2 diabetes patients without documented microangiopathy(T2DM) group;the diabetic retinopathy(DR) group;the diabetic nephropathy(DN) group;the group with diabetic retinopathy and nephropathy(DR+DN) group.The healthy control group was consisted of 26 subjects.The expression of CD4+CD28null T cells of these groups were compared and analyzed to find out the related factors which affects diabetic microangiopathy. Results Compared with normal control group,the expression of CD4+CD28null T cell of all diabetic groups are significantly increased(χ2=19.98,P＜0.01).Compared with T2DM group,the expression of CD4+CD28null T cell of groups DR,DN and DR+DN are significantly increased(Z=-2.19,-2.87,-2.67,P＜0.05),and CRP of these groups are also significantly increased(Z=-3.11,-2.36,-2.86,P＜0.05).But the differences of the expression of CD4+CD28null T cell and CRP between groups DR,DN and DR+DN have no statistical significance.The logistic regression analysis shows that the duration,the expression of CD4+CD28null T cell,CRP and waistline are the independent risk factors for diabetic microangiopathy. Conclusion The expression of CD4+CD28null T cell of type 2 diabetes patients is higher than that of the healthy subjects.Further,these diabetes patients with microangiopathy have a higher expression.CD4+CD28null T cell may affect the progress of diabetic microangiopathy independently.
Correlation factors of obstructive sleep apnea hypopnea syndrome with chronic obstructive pulmonary disease
LUO Xia-jie, YE Hong-bo, LU Yan-ping, YANG Jiang-ming
2016, 14(3): 417-419. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.027
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Objective To explore the related factors of obstructive sleep apnea-hypopnea syndrome(OSAHS)complicated by chronic obstructive pulmonary disease(COPD),so as to provide reference for the improvement of clinical prognosis and disease control. Methods All 266 cases of OSAHS patients in our hospital between February,2011 and March,2014 were enrolled,and were divided into OSAHS group(n=186)and overlap syndrome group(n=80)according to complication of COPD.The gender,age,BMI values,medical grading of OSAHS,smoking,primary hypertension,coronary heart disease,diabetes,renal dysfunction and cerebral vascular disease in both groups were recorded and analyzed.The lung function parameters(FEV1/FVC,FEV1)and arterial blood gas analysis(PaCO2,PaO2)were compared. Results Univariate analysis showed that the difference in age,BMI,lung function,arterial blood gas analysis,medical grading of OSAHS,smoking,hypertension,coronary heart disease and chronic renal insufficiency were statistically significant(P<0.05);Logistic regression analysis showed that BMI,FEV1/FVC,smoking and PaO2 were the risk factors(P<0.05),which were the independent risk factor for COPD in OSAHS patients.Multivariate regression analysis showed that BMI(OR=3.180),FEV1/FVC(OR=3.168),smoking(OR=2.803) and PaO2(OR=1.870)were included into the Logistic regression model(P<0.05). Conclusion The obesity,lung function injury,smoking and hypoxia are the independent risk factors of obstructive sleep apnea hypopnea syndrome in patients with chronic obstructive pulmonary disease,which need more attentions to be paid by clinicians.
Efficacy of traditional Chinese medicine combined western medicine on urinary tract infection in female senile patients
CHEN Bo, WAN Jing-yuan
2016, 14(3): 420-422. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.028
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Objective To explore the efficacy ofcombining traditional Chinese and western medicine in the treatment of urinary tract infection diseasein female patients,modify the dosage regime and improve the curative efficacy. Methods Total 100 cases of urinary tract infection disease in female senile patients in our hospital were randomly divided into observation group and control group with 50 cases in each group.The control group was received antibiotic treatment according to their drug susceptibility test results,and the observation group was given Traditional Chinese medicine based on the control group.The efficacy,symptoms improved time,CRP and length of stay in the two groups of patients were compared after two weeks treatment. Results The total effective rate in the observation group was 98.0%,significantly higher than that in the control group(80.0%),the difference was statistically significant(Z=3.375,P＜0.01);the relief time of Urinary frequency and urinary pain in observation group were significantly shorter than those of the control group,the difference was statistically significant t=7.203,9.433,P＜0.01);The level of serum CRP reduced obviously when compared with the control group,the difference was statistically significant(t=12.141，P＜0.01);In the observation group after the treatment,the length of stay was (11.7±2.5)days ,significantly less than that in the control group(16.2±2.8) days,the difference was statistically significant(P＜0.05). Conclusion Combining traditional Chinese and western medicine for urinary tract infection diseasein female senile patients had significant effect and less length of stay,and can significantly reduce the serum levels of inflammatory mediators,which is worthy of clinical promotion and research.
Retrospective analysis on antenatal screening results of 44 410 cases in the second trimester in Yuhang District of Hangzhou
HU Cai-xia, TAN Jian-qin, WANG Fang, CHEN Yi-ming
2016, 14(3): 423-425. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.029
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Objective To study the second trimester prenatal screening operation in Yuhang district of Hangzhou,and to evaluate the significance of using trimester serum mark of screening for finding chromosomal abnormalities and neural tube defects. Methods A total of 44 410 cases were collected during 2006 to 2011 from five hospitals in Yuhang,informed consent and voluntary to participate.Time- resolved fluorescence method(DELFIA) was used to measure concentration of α-fetoprotein(AFP) and Free β human chorionic gonadotropin (free-β-hCG) of cases’ serum.Risk 2T computer software was used to evaluate the risk of Down syndrome(DS),Edward syndrome(ES) and neural tube defects(NTD).Karyotype analysis was done after amniocentesis or umbilical cord blood puncture to high risk of DS,ES cases.3D color Doppler ultrasound was used to detect the low risk of NTD cases. Results The rate of prenatal screening and the absolute number of prenatal diagnosis increased year by year,while the proportion of amniocentesis and umbilical cord blood puncture and the diagnosis rate decreased.1 945 cases of 44 410 cases had high risk,and the total positive rate was 4.38%.Total 10 cases of DS,6 cases of 18-trisomy,13 cases of NTD and 39 cases of other abnormalities of fetus were diagnosed from high risky pregnant women;4 cases of DS and 9 cases of NTD were diagnosed from low risky pregnant women. Conclusion Free prenatal screening is an effective means to improve the prenatal screening rate; the application of trimester Down’s syndrome screening combined with prenatal diagnoses is an effective way to reduce birth defects.
Effect of modified sutureligation method for infants with umbilical cord edema
DENG Hui-ling, DENG Hui-zhuan, ZHAO Feng-qiao, DENG Li-juan
2016, 14(3): 426-427,461. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.030
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Objective To investigate the feasibility and advantages of modified suture method for cutting edematous umbilical cord. Methods Total 200 cases of live births according to their sequence in the delivery were divided into observation group and control group with 100 cases in each group.The improved suture ligation method was used in the observation group.The clinical data of two cases were analyzed retrospectively.The difficult of operation,operating time,umbilicus hemorrhage,infection,and time for umbilical cord stump to fall off were compared between the two groups. Results The operating time was(15.0±0.3)s in the observation group and (11.0±0.4)s in the control group,there was no significant different about the technical difficulty and operating time between two groups;the time for umbilical cord stump to fall off in the observation group was 3-6 d in 25 cases,7-10 d in 64 cases,＞10 d in 11 cases,and in the control group was 3-6 d in 15 cases,7-10 d in 43 cases,＞10 d in 42 cases,the time of the observation group was significantly less than the control group,the difference was statistically significant (Chi-square value 24.754,P＜0.05).The rate of complications in the control group was 46%,including 9 cases of umbilical bleeding,5 cases of knot-off,8 cases of omphalitis,5 cases who needed to cut the umbilical again,19 cases of granulomas and poor wound;while in the observation group was 11%,including 5 cases of omphalitis,1 case who needed to cut the umbilical again,5 cases of granulomas and poor wound,without umbilical bleeding and knot-off.The incidence of complications in the observation group was significantly less than that in the control group,and the difference was statistically significant (chi-square value of 34.149,P＜0.05). Conclusion Umbilical cord edema;Newborn;Improvement;Suture ligation for bleeding control;Prevention of bleeding
Application of two critical illness scores in assessment of hand-foot-mouth disease combined with encephalitis
ZHOU Yong-hai, CHEN Yi-li, XIA Fang-qin, LIU Pei-ning
2016, 14(3): 428-430. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.031
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Objective To investigate the advantages ofpediatric critical illness score(PCIS) and the pediatric risk of mortalityⅢ(PRISM Ⅲ) in the judgment of the severe extent and prognosis in children with hand-foot-mouth disease and encephalitis. Methods PCIS and PRISM Ⅲ were sued to assess the severity of children with hand-foot-mouth disease and encephalitis.The patients were divided into three groups(very critical,critical,noncritical group) according to the scores.The mortality was calculated and compared among the three groups.The specificity and sensitivity of PCIS and PRISM Ⅲ in the judgment of the death risk in children hand-foot-mouth disease combined with encephalitis were compared through measuring the area under the ROC curve(AUC). Results ①PCIS score:To compare the mortality of the groups of non-critical,critical and very critical subgroups,the difference was statistically significant(8/466,10/12,5/5,χ2=93.099,P＜0.001).②PRISM Ⅲ score: To compare the mortality of the corresponding groups,the difference was statistically significant(4/458,4/7,15/18,χ2=114.579,P＜0.001).③The comparison between PCIS and PRISMⅢ score: the differences were not statistically significant in mortality between the two groups of non-critical,critical and critical subgroups,respectively(1.72% vs. 0.87%,χ2=1.282,P=0.258,88.24% vs. 76.00%,χ2=0.349,P=0.555).④Multiple logistic regression analysis revealed heart rate,blood pressure(systolic blood pressure) and renalfunction of PCIS sore and the state of consciousness and bloodglucose of PRISM Ⅲ score had more effective prediction of the death risk(P＜0.05,respectively).⑤The area under the ROC curve(AUC) for PCIS and PRISMⅢ were 0.929 and 0.985,respectively. Conclusion PCIS and PRISM Ⅲ score,with high specificity and sensitivity,can be used in the judgment of the severe extent and prognosis of children with hand-foot-mouth disease and encephalitis.
The effectiveness evaluation of statins and therapeutic lifestyle changes for the patients with dyslipidemia
TANG Hui-yun, JIANG Ying-ying, JIN Li-yin, CHEN Ye, PAN Gui-jun
2016, 14(3): 431-434. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.032
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Objective To study the effectiveness evaluation of statins treatment and therapeutic lifestyle changes for the patients with dyslipidemia. Methods Two hundred and thirty-one patients with dyslipidemia in the community conform to statin therapy,were randomly divided into two groups,112 cases in the intervention group,give TLC combined with statin treatment,119 cases in the control group,only to give the knowledge related to statin therapy and general dyslipidemia education.Before and after the treatment, the TC,TG,LDL-C,HDL-C,G level of the two groups were test and health knowledge questionnaire scores in the intervention group. Results After 3 months of intervention,the TC,TG,LDL-C,G levels of intervention group were lower than before(P＜0.05),but the patients in the control group only TC,LDL-C levels lower than before(P＜0.05),TG,G had no obvious change(P＞0.05),HDL-C of the two groups had no obvious change(P＞0.05)； comparison with TC,TG,LDL-C and G between two groups,the treatment group were lower than the control group(P＜0.05)；health knowledge questionnaire scores were higher than before after intervention(P＜0.001). Conclusion The effect of community comprehensive prevention and treatment on patients with dyslipidemia is more effective,the TLC is the basic measures of treatment of patients with dyslipidemia.
Investigation on behaviors and lifestyles about residents in rural communities in the city of Zhongshan and Guangzhou
LI Liang-chang, HUANG Xiang, YANG Hua-jie, ZHANG Dong-ying, LAI Xiu-juan, ZHOU Zhi-heng, WANG Jia-ji
2016, 14(3): 435-437. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.033
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Objective To understand the behaviors and lifestyles on the rural residents between Guangzhou city and Zhongshan city,and provide evidence for health education and intervention. Methods The 19 466 and 2 639 rural residents from Guangzhou and Zhongshan were taken out randomly and investigated in self-designed questionnaires,respectively.The data entry was used EpiData 3.1 software,and used SPSS 16.0 software to analyze the lifestyle behaviors among rural residents in the two cities. Results The smoking rates of the rural residents in Guangzhou and Zhongshan cities were 17.7%(3 445 people) and 25.3%(668 people),drinking rates were 10.9%(2 122 people) and 13.3%(351 people),respectively,and the sleep quality of Guangzhou residents(15 184 people,78%)was better than that of Zhongshan (1 496 people,56.7%).Comparison of smoking status,drinking condition,sleep quality among the 2 cities residents was statistically significant(P＜0.01).The time of sitting still of two cities among residents was too long,and smoking and drinking rates between the two cities of residents aged beyond 45 years were above than other age groups,diet of two city residents have irrational behaviors,and the form of physical exercise and health knowledge were concentrated and a single. Conclusion The rural residents had some unhealthy behaviors,especially those beyond the 45 years-old,which should implement health education and health interventions to the point.
The patients' awareness rate analysis on the basic public health services for basic medical and health institutions in three cities of Guangxi
TAN Xiong-yan, JIANG Qin, WU Cai-yuan, WEI Xue, ZUO Yan-li
2016, 14(3): 438-440. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.034
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Objective To realize the patients’ cognition and attitude to basic public health service projects,to analyze the factors that put impact on the cognitive situation,to learn its direction in the future,and to provide the reference and advice for promoting basic public health services work. Methods We used a typical sampling method to extract three cities in Guangxi,and used simple random sampling method to select 36 basic medical and health institutions.We descriptively analyzed its basic situation,and used χ2 test and binary Logistic regression to analyze for single factor and multiple factors,respectively. Results The questionnaire recovery rate was 97.92%.The highest accepted level of services was establishing health files,and 50.98% respondents had accepted the service.51.35% patients knew the policy.The main approach to popularize the policy was by paramedics and TV/radio,and the rates were 24.20% and 23.26%,respectively.Through single factor analysis,the difference with cities,degree,careers and types of medical insurance,awareness differences were of statistical significance(P＜0.05).Through multiple-factor analysis,the patients,coming from different cities and with different degree,awareness differences were statistically significant(P＜0.05). Conclusion The project popularity was not balanced and the awareness rate was not high,so basic medical and health institutions should popularize basic public health services and pragmatic work,develop characteristic service work and use various sources to strengthen the publicity.
Role of dynamic contrast-enhanced MRI in distinguishing pseudoprogression from true progression of glioma
QIAN Hai-feng, SUN Sheng-jie, WU Xiao, LI Feng-qi, LI Zhang-yu, HU Chun-hong
2016, 14(3): 441-444. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.035
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Objective To evaluate the value of 3-T dynamic contrast-enhanced MRI(DCE-MRI)in distinguishing pseudoprogression(PP)from true progression(TP)of glioma. Methods DCE-MRI examination were performed in 32 cases of glioma to distinguish pseudoprogression fromtrue progression.The values of volume transfer constant(Ktrans),volume fraction of extravascular extracellular space(ve),reflux constant(kep)and fractional plasma volume(vp)were calculated in the newly developed abnormal enhancement by pharmacokinetic model.Mann-Whitney U test was used to calculate the statistical significance between TP group and PP group.Receiver operating characteristic(ROC)curve was performed for evaluation of the sensitivity,specificity and AUC. Results TP group(n=18)showed higher Ktrans(0.34 min-1 vs. 0.17 min-1)and higher ve(0.53 vs. 0.39) when compared with the PP group(n=14),the differences were statistically significant(Z=3.02,P＜0.01;Z=2.03,P＜0.05).However,the differences in kep and ve were not statistically significant(P＞0.05).ROC curve showed the AUC value to diagnose TP and PP of Ktrans was the highest(0.815),and the sensitivity and specificity were 72.2% and 85.7%. Conclusion The permeability parameters on DCE-MRI is useful in distinguishing pseudoprogression from glioma true progression,and to be a guidance for clinical treatment.
Correlation between CT perfuson parameters and expression of vascular endothelial growth factor in Laryngeal cancer
XIANG Jun-yi, LI Yuan, ZHAO Kai-yue, YANG Wen-jun, CHEN Ren-biao, QI Le
2016, 14(3): 445-448. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.036
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Objective To observe the correlation between the CT perfusion parameters and the expression of vascular endothelial growth factor(VEGF)in lesions of laryngeal cancer. Methods Twenty-three lesions of laryngeal cancer were scanned by spiral CT,and the perfusion parameters were calculated with perfusion functional software.The parameters included blood flow(BF),blood volume(BV),mean transit time(MTT)and permeability surface(PS).Histopathological slides were prepared for the VEGF immunohistochemical staining.Correlation between the CT perfusion parameters and VEGF was studed. Results ①Between benign and malignant lesions of laryngeal cancer with CT perfusion parameters(BF,BV,MTT and PS)was difference.BF of malignant tumor was higher than that of benign lesions(P＜0.05).②In laryngeal cancer,BF and BV was positively correlated with VEGF(r=0.502,0.327,P＜0.05),MTT and VEGF showed a negative correlation (r=-0.511,P＜0.05),there was not correlative between PS and VEGF(r=0.275,P＞0.05). Conclusion CT perfusion parameters of laryngeal cancer is correlated with the level of VEGF,which may reflect the expresion of VEGF.The CT perfusion should be helpful to diagnosis and treatment laryngeal cancer.
Analysis of components of carotid atherosclerotic plaques with gemstone spectral CT
CHEN Zhen-jing, SHEN Wei-qiang, ZHU Hua-yong, ZHENG Hao, FAN Shu-feng
2016, 14(3): 449-451,458. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.037
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Objective To analyze the components of carotid atherosclerotic plaques with gemstone spectral CT. Methods Forty-three cases with ischemic symptoms who showed carotid atherosclerotic plaques by ultrasound and MRI underwent CTA of carotid artery by gemstone spectral imaging(GSI).Process the hybrid images to the single images,then do the semi-quantitative analysis of energy spectrum material of the plaques to get the slope of curve and effective atomic number of the different tissues with the aid of 3D-reconstruction and GSI viewer.The statistical methods are general statistical description(such as mean and standard deviation). Results Ninety-eight lesions,including 37 lipid plaques (37.76%),48 fibrous plaques (48.98%),and 13 plaque hemorrhage (13.26%).The rules of spectrum curve of each component of the plaque:lipid deposition show an arched upward curve,CT values increase gradually with higher energy.Fibrous matrix and intraplaque hemorrhage reveal the attenuation curve,CT values decrease gradually with higher energy.And the attenuation amplitude of fibrous matrix is higher than that of intraplaque hemorrhage in low energy area.In lower energy area,the dispersion degree of three components is more obvious.The slopes of curve and effective atomic numbers of lipid deposit,fiber content,intraplaque hemorrhage were -3.54±0.78,2.36±0.56,0.45±0.09 and 3.24±0.80,8.56±0.63,7.26±0.59,respectively.There were statistical differences between any two kinds of plaques (all P＜0.05). Conclusion Spectral CT angiography can give more quantifiable data(lipid composition,fiber content,plaque hemorrhage ingredients) of carotid atherosclerotic plaques to help us judging the extent of the atherosclerosis of the vessel.
Spatio-tem-poral image correlation fot the prenatal auxiliary diagnosis of congenital malformations
YANG Jing, LIU Xia, XV Chuan-yi, ZHANG Yan-fei, SHI Hai-hua, YAO Xiu-rong, YANG Wei-ping
2016, 14(3): 452-454. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.038
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Objective To explore the application and accuracy of spatio-tem-poral image correlation(STIC)in prenatal diagnosis for cardiac malformations. Methods Fetal echocardiography was performed to screen fetal cardiac abnormalities,and STIC was followed for the suspicious fetus.The terminational or deathfetus underwent histopathological examination,while the live birth received neonatal ultrasound diagnosis.The diagnostic accuracy on cardiac malformations was compared between STIC and two-dimensional ultrasound. Results Total 12 782 cases were screened,217 cases were involved,and final valid cases were 203,in which 112 cases were diagnosed by autopsy pathology,91 cases by neonatal ultrasound or CT,MRI.The diagnostic accuracy of ultrasonic cardiogram on fetal cardiac malformations was 94.09%,missed diagnosis rate was 4.43%,and misdiagnosis was 1.48%;the diagnostic accuracy of STIC was 98.52%,missed diagnosis rate was 0.99%,and misdiagnosis rate was 0.49%.The diagnostic accuracy STIC was higher than that of ultrasonic cardiogram(χ2=5.61,P＜0.05),but the missed diagnosis rate was lower(χ2=4.58,P＜0.05),yet there was no statistical difference on misdiagnosis rate between two measures(χ2=0.25,P＞0.05). Conclusion Real-time 4D STIC has better clinical application value on auxiliary diagnosis in fetus with cardiac malformations,and it is not only beneficial to remedy the defects of two-dimensional ultrasound,but also can improve the accuracy on the auxiliary diagnosis of fetal cardiac malformations,so provides more reliable and scientific basis for prenatal screening.
Prospective ECG gating for triple rule-out CT angiography in assessment ofacute chest pain
XU Jian, CHEN Jun-fa, XIAO Hua-wei, MAO De-wang, DI Xing-bo
2016, 14(3): 455-458. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.039
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Objective To evaluate triple rule-out CT angiography with prospective ECG-gated 320-detector CT in patients with acute chest pain. Methods Total 170 patients with heart rate ≤70 bpm undergoing triple rule-out CT angiography were divided into group P(prospective ECG gating)and group R(retrospective ECG gating).The images of the coronary arteries,pulmonary artery and thoracic aorta were reconstructed in all patients.All images were processed for image analyses and compared between the two groups. Results No significant difference was showed in the ratio of acceptable segments between two groups.There was no significant difference in CT values ofpulmonary artery [(383.00±53.64)HU vs.(366.48±60.96)HU],coronary artery [(426.31±79.75)HU vs. (407.49±91.00)HU],thoracic arteries [(416.53±63.44)HU vs. (413.58±58.62)HU],noise [(20.46±5.84) vs. (18.55±4.67)],SNR [(22.06±6.47) vs. (23.13±5.76)],CNR [(15.12±5.43) vs.(15.92±4.77)],respectively.However,the significance was found in ED(t=-9.41,P＜0.01). Conclusion Low dose and diagnostic image quality can be achieved with prospective ECG-gated triple rule-out CT angiography.
Application of dynamic 4D CT in patients with acute cerebral infarction undergoing thrombolysis with rt-PA
SHAO Yong-liang, ZHOU Sheng-hua, WENG Qing-ji, LU Li-ping, XIONG Min-rong
2016, 14(3): 459-461. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.040
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Objective To investigate the clinical value of dynamic 4D spiral CT for cerebral blood flow perfusion and vascular imaging in patients with acute cerebral infarction before and after thrombolysis with rt-PA. Methods The imaging data of dynamic 4D CT of 62 patients with acute cerebral infarction undergoing thrombolysis with rt-PA were retrospectively analyzed,and the regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),peak time(TPP)and mean transit time(MTT)in the focal region of patients with acute cerebral infarction before and after the thrombolysis with rt-PA was compared. Results All 62 patients included 55 cases of local arterial branches decreased for and 7 cases without obvious abnormalities by cerebral angiography;after the thrombolysis with rt-PA,there were 60 cases of the local vascular branches increase,and 2 cases without obvious abnormalities by cerebral angiography.The levels of rCBF,rCBV,TPP and MTT before the thrombolysis were 20.73±5.44,1.21±0.30,19.37±3.70 and 6.52±0.77,respectively,and after thrombolysis were 37.66±8.10,1.96±0.41,18.98±4.25 and 6.55±0.81,respectively.Between the two groups,there were statistical significant difference in the levels of rCBF and rCBV(P<0.05),but not in the levels of TTP and MTT(P>0.05). Conclusion The perfect cerebral blood flow perfusion and vascular imaging in patients with acute cerebral infarction before and after thrombolysis with rt-PA can be shown by dynamic 4D CT and the scan will provide accurate bases for the evaluation of treatment.
LÜ Xin-xiao, PAN Li-wei, ZHANG Sheng-le, YANG Chong-ze
2016, 14(3): 462-464. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.041
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YU Su-yun, WANG Lei, JU Mei-jun
2016, 14(3): 465-467. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.042
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LIU Yu, PENG Ying-peng, CHU Xi, HUANG Xiang-qin, CHEN Zhao, JIANG Hong
2016, 14(3): 468-470. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.043
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ZHANG Yuan, LIANG Bing
2016, 14(3): 471-473. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.044
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LU Zhong-xing, GU Yue-qin
2016, 14(3): 474-477. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.045
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LI Juan
2016, 14(3): 478-481. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.046
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Curative effect of sports training in elderly patients with atherosclerosis obliterans of the lower limbs undergoing non-intervention operation
ZHU Li-yue, LIU Xin-wen, YU Zhi-hong, SHOU Xiao-ling, YAN Ting, ZHAO Xiao-xia
2016, 14(3): 482-484. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.047
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Objective To assess the curative effect of aerobic exercise in the elderly patients with arteriosclerosis obliterans(ASO) of the lower extremity undergoing non-interventional therapy. Methods A total of 65 patients with ASO of the lower extremity undergoing non-interventional therapy were enrolled and randomly assigned to study group and control group.The 6-min walk test(6MWT),cardiopulmonary exercise testing(CPET) assessment and ankle brachial index(ABI) detection were performed in both groups.The control group received the routine treatment,while the study group received additional aerobic exercise for three months.6MWT,CPET and ABI were rechecked after the treatment. Results In the study group,the walking distance increased by 75.75 m,claudication distance increased by 71.4 m,VO2peak increased 169.2 ml/min[2.46 ml/(kg·min)],AT value increased 2.19 ml/kg·min,the metabolic equivalent increased 0.5 METs,and ABI values increased by 0.08,the difference were significantly as compared with the values before exercise intervention(P＜0.05).After the treatment,the difference in the above indexes between the two groups were significantly different(P＜0.05). Conclusion The aerobic exercise under the guidance of the individualized exercise prescription can effectively improve symptoms,walking distance,exercise endurance and ABI values in the elderly patients with h ASO of the lower extremity undergoing non-interventional therapy.
Study on improving the clinical skills of internships in department of gastroenterology
DENG Min, WANG Qi-zhi, LIU Xiao-yang, GU Lin, XUE Yong-ju, ZHU Yu
2016, 14(3): 485-486,508. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.048
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Medical education is a practical education,which is the subject of life.To cultivate qualified medical students,a solid theoretical knowledge is the foundation,but the level of clinical skills is an important link.Practice is the key period for medical students to learn the theoretical knowledge,cultivate the clinical thinking ability and improve the level of clinical skills.Through analyzing the current situation,we found that the clinical skills training can improve the relationship between doctors and patients and improve the quality of medical service.Secondly,in the department of internal medicine clinical work,the common clinical operation in the actual work of the hospital is not very satisfactory,the quality of clinical skills training of undergraduate interns is declining,and the ability of clinical thinking and solving problems are insufficient.Therefore,it is necessary to discuss how to further improve the clinical skills of interns in the department of internal medicine.For the specialty characteristics of digestion Department,a series of measures including two aspects of deep clinical,participate in diagnosis and treatment workclinical practice,establish the clinical skills teaching team,strengthen the key training,strengthen the theory teaching,uniform standard clinical skills operation standard,make full use of clinical skills training room and pay attention to the cultivation of critical thinking in teaching to improve the teaching methods and the teaching platform to improve the clinical skills of interns.Through the above training,the students have a deeper understanding of the importance of basic clinical skills,master the clinical skills in the department of internal medicine,and lay a solid foundation for a qualified doctor in the future.
Role of primary nursing in nutritional risk screening in patients with astrointestinal cancer
JIA Xiu-mei, XU Fang, DING Fang, GU Ye-chun
2016, 14(3): 487-490. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.049
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Objective To investigate therole of primary nursing in nutritional risk screening in patients with astrointestinal cancer. Methods Total 400 newly admitted gastrointestinal cancer patients in our hospital between May 8,2010 and March 31,2013 were selected and randomly divided into control group and observation group with 200 cases in each group.The control group received routine care,while the observation group received the primary nursing on the base of the routine nursing.The nutritional risk screening was performed in both groups.The outcome of patients after the surgery and nursing satisfaction were compared between the two groups. Results The nutritional support was performed in both groups after the nutritional risk screening.The nutrition status indicators such as albumin and prealbumin content,incidence of post-operative complication and hospital stays were not significant between the two group(P＞0.05).However,the quality of nursing service was improved and patients satisfaction was more than 98% in the observation group when compared with the control group (P<0.05).The nursing negligence in the observation group(2%)was significantly lower than that in the control group(7%). Conclusion To perform the primary nursing with nutritional risk screening work in gastrointestinal cancer patients can improve nursing service and patient satisfaction,and worth further clinical practice.
Application of hospital-community-family holisticnursing in the rehabilitation of stroke patients
YUAN Xiu-yin, REN Jun-cui, LIU Chang, ZHANG Xiu-jun, LI Juan
2016, 14(3): 491-493,514. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.050
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Objective To explore the application of hospital-community-family holistic nursing in the rehabilitation of stroke patients,further make full use of hospitals,community and family resources,fully extend and improve the scope and content of continuation rehabilitation care for stroke patients,and look for a more simple,fast,efficient,practical,affordable new path for the rehabilitation of stroke patients. Methods Total 191 stroke in-patients resided in the community streets belong to our hospital were recruited from November 2013 to July 2014 and assigned into experimental group(98 cases)and control group(93 cases).The control group received the routine rehabilitation nursing,while the experimental group received the hospital-community-family holistic nursing provided by community nurses and ward nurses.The ability of daily life(Barthel Index),mental condition(Hamilton Rating Scale for Depression,HRSD),and patient satisfaction for nursing service were survived at discharge and 6 months late. Results The ability of daily life,mental condition and patient satisfaction were improved in both groups(P<0.05),and more obvious in the experimental group undergoing hospital-community-family holistic nursing. Conclusion Hospital-community-home holistic nursing can effectively improve the ability of daily life and mental condition of stroke patients,promote the physical and psychological recovery.
Clinical effect of nursing intervention after minimally invasive evacuation of intracranial hematoma
XU Ying
2016, 14(3): 494-495,511. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.051
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Objective To analyze the efficacy of perioperative,intraoperative and postoperative nursing intervention in patients with hypertensive cerebral hemorrhage after minimally invasive evacuation of intracranial hematoma,and observe the neurological deficit score and postoperative complications. Methods Total 96 patients with hypertensive cerebral hemorrhage received minimally invasive evacuation of intracranial hematoma in our hospital between August 2014 and August 2015.They were randomly divided into two groups.48 cases in the control group were given conventional nursing intervention,and 48 cases in the observation group were given perioperative,intraoperative and postoperative targeted nursing intervention.The clinical effect after the treatment,and the neurological function scores before and after the treatment,as well as the incidence of postoperative complications were compared between the two groups and analyzed using SPSS 20.0 software. Results The overall response rate of clinical nursing in the observation group (95.83%) was obviously higher than that (72.92%) in the control group,the difference was statistically significant(χ2=9.5605,P<0.05).The neurological deficit scores in the observation group (12.03±4.73) points was obviously lower than that in the control group (18.65±5.04) points,the difference was statistically significant(t=6.6356,P<0.05).The incidence of postoperative complications such as rehemorrhage,hypostatic pneumonia,constipation and deep venous thrombosis in the observation group (10.42%) was obviously lower than that in the control group(70.83%),the difference was statistically significant(χ2=33.87,P<0.05). Conclusion The perioperative nursing intervention can effectively improve neurological function and clinical outcomes,reduce complications,promote the recovery,and improve the quality of life in patients undergoing intracranial hematoma evacuation.
Clinical value of predictive nursing in the treatment of patients with hepatitis and hepatic coma
LUO Feng-lian
2016, 14(3): 496-497,500. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.052
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Objective To analyze the clinical effect of predictive nursing in the treatment of patients with hepatitis and hepatic coma,improve the methods of predictive nursing to promote nursing degree to provide evidence in future work. Methods The 64 cases of hepatitis and hepatic coma patients from Apr. 2011 to Apr. 2015 were divided into study group and controlled group by random number method.There were no difference between ages,disease,gender(P>0.05).The controlled group was treated with common nursing,the study group was treated with predictive nursing based on common nursing,including establishing predictive nursing awareness,controlling nitrogen source and preventing complication to ensure patients in good condition.The coma duration,death,incidence of complications of these two groups were compared. Results The coma duration of study group was (3.02±1.13)d,and there were 3 deaths and 2 incidence of complication.The coma duration of controlled group was (7.56±1.84)d,and there were 7 deaths and 12 incidence of complication.The coma duration,death,incidence of complications of study group were all better than controlled group (P<0.05). Conclusion Treating patients with hepatitis and hepatic coma with predictive nursing can improve clinical effect,short coma duration,decrease rate of death and incidence of complication with better effect to extend in clinic.
Evidence-based nursing for patients with painless gastroscopy
ZHANG Zhou-juan
2016, 14(3): 498-500. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.053
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Objective To observe the effect of evidence-based nursing in ptients with painless gastroscopy,and compare the nursing satisfaction of patients receiving evidence-based nursing or routine nursing. Methods Total 100 patients undergoing painless gastroscopy in our hospital from July 2014 to June 2015 were selected and divided into research group and control group with 50 cases in each group.The general information of two groups had no statistical significance difference,it has comparability.The research group received the evidence-based nursing while the control group receieved the routine nursing.All the patients took Self-Rating Anxiety Scale(SAS)before and after the nursing to evaluate their anxiety condition,took Newcastle Satisfaction of Nursing Service(NSNS)research after the examination to evaluate their satisfaction of nursing service.SPSS 19.0 statistical software was used to analyze data.The measurement data was expressed by x±s,and adopted t-test.The categorical data adopted Chi-square test.P<0.05 expressed that difference has statistical significance. Results Before the nursing,the SAS of research group was(47.57±10.22).After the nursing,the SAS of the research group was(40.13±6.07).The anxiety condition of research group had an obvious improvement(t=4.43,P<0.05).Before the nursing,the SAS of control group was(47.74±11.36).After the nursing,the SAS of control group was(46.58±7.53).The anxiety condition of control group had an unconspicuous improvement(t=0.60,P>0.05).The NSNS of research group was(73.85±1.57).The NSNS of research group was(67.33±2.74).The nursing satisfaction of research group was obviously higher than control group(t=14.60,P<0.05). Conclusion The inspection time for painless gastroscopy is short and success rate is high.Evidence-based nursing can scientifically combine clinical knowledge and experience.Evidence-based nursing for painless gastroscopy can relieve the pain of patients.Evidence-based nursing can obviously relieve the anxiety degree of patients with painless gastroscopy.It’s contributed to improve nursing satisfaction and the trust of doctor-patient,and reduce medical dispute.
Evaluation of the expected effect of early nursing intervention model for newborns with cesarean section
CHENG Chao-xia
2016, 14(3): 501-503. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.054
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Objective To analyze the effect of early nursing intervention on the cesarean newborns. Methods The 160 cases of cesarean newborns in our hospital from February 2014 to June 2015 were selected as the research object,and 160 cases were randomly divided into observation group and control group.Control group was adopted the clinical routine nursing model;Observation group was adopted to the early nursing intervention model based on the routine nursing,and to compare the difference between the two groups. Results By the intervention of different clinical nursing mode,the observation group,80 cases of neonatal breastfeeding rate was 83.75%,and the control group,80 cases of neonatal breastfeeding rate is 82.50%,compared two groups,P>0.05,no statistical significance.But neonatal clinical health index comparison of two groups,observation group,80 cases of neonatal after early nursing intervention,the physical weight loss rate of 17.50%,rashes,blain incidence of 2.50%,compared with the control group in neonatal physiological weight loss rate of 40.00%,8.75% incidence of rash,blain,significant difference between groups,P<0.05,with statistical significance;and observation group of neonatal urine normal time,jaundice fade indicators such as time,also were significantly better than control group in newborns,contrast differences between groups,P<0.05,with statistical significance. Conclusion For cesarean section newborn actively give early nursing intervention mode,compared with the traditional nursing intervention mode,it can effectively promote the newborns breastfeeding rates,promote the healthy development of the neonatal body at the same time,strengthen the neonatal prognosis of quality of life,is worth further clinical application promotion.
LIU Yi-min, RUAN Chun-lan
2016, 14(3): 504-505. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.055
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TONG Duo, HU Jia-qing, HU Bin, ZHONG Ze
2016, 14(3): 506-508. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.056
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ZHOU Xue-liang, CHEN Yun-ping, LI Xiao-lin, CHEN Qin, JIN Jian-qiang
2016, 14(3): 509-511. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.057
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XU Hong-wei, YANG Cheng-lin, LU Yong-wei, CHA Xue-feng, WANG Yin-hai
2016, 14(3): 512-514. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.058
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