中华全科医学

Effectiveness of target-based responsibility and pay-for-performance systems for family doctor service team

CAO Yong-qi, HUAN Hong-mei, BAO Yong

2016, 14(5): 697-699,742. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.001

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Objective To analyze the effect of target-based responsibility and pay-for-performance salary systems for family doctor service team on the service delivery in Meilong community health service center of Minhang. Methods The performance evaluation system and distribution platform of the family doctor service team were established in Meilong community health service center.The service quantity,service quality,service cost/efficiency and residents satisfaction was evaluated the implementation of target-based responsibility and pay-for-performance systems.The efficacy of this system was discussed. Results When compared with the conditions before the reformation,the number of outpatient visits per year had grown by 11.43%,the total services had grown by 155.43%,the total amount of chronic disease management standardization increased by 50.08%,the total standardized work of maternal and child health increased by 17.03%,and the standardized work of the campus doctors increased by 81.52%.The implementation of pay-for-performance system has leaded to a reduction in the use of antibacterial agents among communities to 8.08%,while an increase in the effective control rate for hypertension populations to 92.43%,and an increase in the effective control rate for diabetic population to 84.32%. Conclusion After the implementation of target-based responsibility and pay-for-performance systems,the service quantity of CHSC is significantly increased,service quality is better guaranteed.The worker’s enthusiasm and passion to work and the service efficiency can be obviously improved,the optimization of talent structure is obvious,and the resident satisfaction s also improved,and thus enhances a sense of confidence and sense of identity to the community health service.The target-based responsibility and pay-for-performance systems can improve the efficiency of the family doctor system service team,and ensure the sustainable development of Community Health Service Center.

WANG Ying, DOU Peng-fei

2016, 14(5): 700-701.

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The value of TFE3 and cathepsin K in diagnosis of Xp11.2 translocation renal cell carcinoma

HUANG Dao-guang, CHEN Xian-cheng, GAN Wei-dong, LI Xiao-gong, ZHANG Gu-tian, GUO Hong-qian

2016, 14(5): 702-704,776. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.002

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Objective To observe the expression of transcription factor E3(TFE3) and cathepsin K(Cath-K) in Xp11.2 translocation renal cell carcinoma. Methods Sixty-five cases renal cell carcinoma paraffin block specimens were collected from January 2006 to March 2013 at the Affiliated Drum Tower Hospital of Nanjing University Medical School that less than 45 years or pathology suspected Xp11.2 translocation renal cell carcinoma,TFE3 and Cath-K immunohistochemistry and fluorescence in situ hybridization (FISH) were detected.FISH positive was used to be diagnosis criteria of Xp11.2 translocation renal cell carcinoma,and to analyze TFE3 and Cath-K sensitivity,specificity,positive predictive value and negative predictive value in the diagnosis of Xp11.2 translocation renal cell carcinoma. Results TFE3 and Cath-K diagnosis Xp11.2 translocation renal cell carcinoma sensitivity were 95.5% and 72.7%,the specificity were 93.0% and 100%,the positive predictive value were 87.5% and 100%,negative predictive value were 97.6% and 87.8%.United TFE3 and Cath-K diagnosis Xp11.2 translocation renal cell carcinoma sensitivity was 94.1%,specificity was 100%,positive predictive value was 100%,negative predictive value was 98.0%. Conclusions Age,hematuria and tissue morphology remains were one of the indicators in diagnosis of Xp11.2 translocation renal cell carcinoma.TFE3 with a high sensitivity and negative predictive value,Cath-K with a high specificity and positive predictive value in diagnosis of Xp11.2 translocation renal cell carcinoma.Combined TFE3 and Cath-K can improve the accuracy diagnosis of Xp11.2 translocation renal cell carcinoma.

Effect of icotinib hydrochloride on PI3K/AKT and HIF-1α signaling pathway in lung cancer A549 cells

PAN Qin-shi, HU Li-juan, LIN Xiao-mei, CHEN Jian, WANG Yu-min

2016, 14(5): 705-708. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.003

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Objective To investigate the effect of Icotinib hydrochloride on PI3K/AKT and HIF-1α signaling pathway in lung adenocarcinoma A549 cell. Methods The lung adenocarcinoma A549 cells were cultured and treated with different concentration of Icotinib hydrochloride.The cell counting was used to assess the cell growth,MTT to evaluate the cell proliferation,microscope to observe the changes of cellular morphology,TUNEL to test the apoptosis rate,and immunohistochemistry to determine the expression of PI3K/AKT and HIF-1α protein. Results The growth of tumor cells inhibited significantly with irregular configuration when the concentration of Icotinib hydrochloride increased.And at 50 mg/L,a large number of GNM cells turned into necrosis.Icotinib hydrochloride inhibited the proliferation in a dose- and time-dependent manner.The treatment groups were different from the control group with significant difference(P＜0.01);The apoptosis rate in 12.5 mg/L group,25 mg/L group,50 mg/L group,DPP(25 mg/L) group were significant higher than that in the control group,the differences were statistically significant(P＜0.05);the expression of PI3K/AKT and HIF-1α protein of A549 in 5 mg/L group,50 mg/L group,DPP(25 mg/L) group were significantly lower than that in the control group,the differences were statistically significant(P＜0.05). Conclusion Icotinib hydrochloride has inhibitory effect on the proliferation of human lung adenocarcinoma A549 cell,the mechanism of action of Icotinib hydrochloride may involve inducing apoptosis and inhibiting of PI3K/AKT and HIF-1α signaling pathway.

A retrospective analysis of syphilis epidemiological data in a hospital in Xinjiang from 2012—2014

WANG Xiao-dong, Abuduhalike·Hailili, DONG Xiao-yang, ZHOU Shan, HADILIYA·Hasamu, PALIDA·Abulizi

2016, 14(5): 709-711. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.004

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Objective To investigate the epidemic characteristics of syphilis in Xinjiang,and to provide a scientific basis for the melecular epidemiological studies of syphiliswith high occurrence rate and its prevention and treatment. Methods The classification of statistical date were retrospectively analyzed for syphilis in our hospital between 2012 and 2014. Results ①Clinical stage:The main recessive syphilis(1 642 cases for 96.7% in 3 years),early cases of syphilis:29 cases for 1.7%,secondary syphilis 13 cases for 0.77%,third syphilis:3 cases for 0.18%,and congenital syphilis 11 cases for 0.6%.②Geographical distribution:Urumqi were high endemic areas(682 cases accounted for 40%),Kashi in southern Xinjiang region(total of 118 cases accounted for 6.9%).③Sex distribution:Number of cases for male and female are basically the same(a total of 918 cases of male 54%,female 46% of 780 cases).④Distribution of ethnic: mainly Han patients and followed by Uighurs and Husker (Han 813 cases accounted for 47.9%,Uygur 620 cases for 36.5%,Kazak 99 cases for 5.8%).⑤Education: The largest number of cases with high school,508 cases were in high school(29%),443 cases of college and above(26.1%),junior 374 cases(22.0%),primary 302 cases(17.7%).High school and college educated population incidence largest number,followed by college and higher education groups;⑥Marital status: the main infected population are married people(88.2%).⑦Contact history: by way of infection Non-marital heterosexual contact.⑧Route of infection:The main route of transmission was spread between heterosexual,spread among heterosexual as the main route of transmission(1 351 cases accounting for 79.5%),mother to child transmission (10 cases accounted for 0.59%). Conclusion A high prevalence trends of syphilis will be sustained in Xinjiang area.The understanding of epidemiological characteristics of the high incidence of syphilis in Xinjiang will help the prevention and treatment of syphilis.

Clinical characteristics of pulmonary embolism in patients with connective tissue disease: an analysis of 13 cases

SHAO Li-jiang, ZONG Jian-ping, CHEN Xian-han, ZHOU Li, MA Guo-feng, YING Ke-jing

2016, 14(5): 712-714,822. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.005

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Objective To analyze the clinical characteristics of connective tissue disease(CTD) in patients with pulmonary embolism,and provide the basis for the early diagnosis and treatment. Methods We retrospectively reviewed the clinical data of 13 hospitalized patients with connective tissue disease and pulmonary embolism from January,2013 to December,2014.The clinical manifestations,imaging features,treatments and prognosis of these patients were described. Results Among the 13 patients,the rheumatoid arthritis(4 cases),systemic lupus erythematosus(3 cases),Sjogren’s syndrome(3 cases),primary antiphospholipid syndrome(1 case),autoimmune hemolytic anemia with antiphospholipid syndrome(1 case) and Polymyalgia Rheumatica(1 case) were combined.The main manifestations included dyspnea(9 cases),chest pain(6 cases),hemoptysis(4 cases) and fever(4 cases).Five cases were with extremity swelling,and 2 of them had unilateral lower limb swelling.CT pulmonary angiography performed in 11 cases showed that the complications included pulmonary artery trunk filling defect(1 case),lobar pulmonary artery filling defect(2 cases),segmental pulmonary artery filling defect(8 cases).Five cases underwent radionuclide pulmonary ventilation/perfusion(V/Q) examination,and the results showed that all of them were with pulmonary segment perfusion ventilation mismatch.Twelve cases were with other radiological changes,including effusion(5 cases),fibrosis(4 cases),bronchiectasis(4 cases),interstitial lung disease(2 cases) and pleural effusions/pleural thickening(6 cases).The transthoracic echocardiography inn 13 cases showed that 6 cases were with mild to severe pulmonary hypertension.Twelve cases underwent lower extremity venous ultrasound examination,and the results showed that 5 cases were with deep venous thrombosis,1 case with superficial venous thrombosis.All patients received anticoagulant therapy and the 30 days all-cause mortality was 0. Conclusion The symptoms such as dyspnea and chest imaging changes in the patients with connective tissue disease indicate the pulmonary embolism.

The features of surface electromyography of knee joint control ability disorders in spastic hemiplegia patients

FAN Liu-bo, LIU Su-zhi, HAN Wen-sheng, LIU Bao-hua, LU Zhan, WANG Ling-ling

2016, 14(5): 715-717,874. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.006

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Objective To analyze the features of surface electromyography(sEMG) signal of the thigh muscle in convalescent stroke patients during knee voluntary extension and flexion. Methods Thirty-five stroke patients with who suffers spastic hemiplegia in Taizhou Hospital of Zhejiang Province from July,2013 to December,2014 and age-and sex-matched normal controls were involved in this study.The signals of sEMG of root mean square value(RMS) and co-contraction ratio(CR) from the patients and controls were compared. Results The knee extension in patients with bilateral quadriceps,biceps femoris RMS value were significantly decreased compared with normal control group(P<0.01),and health,ipsilateral RMS values significantly different(P<0.01);when knee,ipsilateral quadriceps and biceps femoris of RMS values are less than the normal control group,there was a significant difference(P<0.01),and health,ipsilateral RMS values significantly different(P<0.01);patients with contralateral medial femoral biceps muscle and the RMS value of the shares is less than the normal control group,but there was no significant difference(P>0.05);When knees,ipsilateral and contralateral CR greater than the normal control group,there was a significant difference(P<0.05);contralateral CR was less than normal control group showed no significant difference(P>0.05);knee extension,ipsilateral and contralateral CR were greater than the normal control group,there was a significant difference(P<0.05). Conclusion There are initiative antagonistic muscle coordination abnormal in the hemiplegic patients after stroke spastic muscle flexion ipsilateral healthy muscle.The SEMG technology in real-time quantitative evaluation of stroke patients after knee spastic muscle control disorders and active antagonistic muscle coordination,and provide a strong basis prognosis for the development and evaluation of rehabilitation programs.

Low serum interleukin-1 receptor antagonist level leads to poor outcomes in hepatitis B-related liver failure patients

LAI Jing-lan, LIU Yu-ming, LIN Chun, PAN Chen, SUN Fang, HUANG Zu-xiong, LIN Yong, ZHOU Rui, LIN Yuan-bao

2016, 14(5): 718-720,745. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.007

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Objective To investigate the correlation of serum interleukin-1 receptor antagonist(IL-1RA) levels to outcomes of hepatitis B-related liver failure. Methods For the 31 hepatitis B-related acute-on-chronic liver failure patients,28 acute hepatitis B patients,30 chronic hepatitis B patients and 15 health controls,the serum IL-1ra and other six cytokines were measured by using Q-Plex.We further analyzed the concentrations of cytokines between death and survival HB-ACLF patients. Results The serum IL-1ra concentration was highest in patients with HB-ACLF[(338.9±268.8)pg/ml] when compared to those in AHB[(182.7±123.1)pg/ml,P=0.012],CHB[(77.07±40.5)pg/ml,P<0.001] and HCs [(37.9±15.6)pg/ml,P<0.001].However,the ratio of IL-1ra to IL-1β in patients with HB-ACLF(2.96±1.54) was lower than that in AHB patients(4.54±2.29),P=0.048.Serum IL-1ra in AHB patients was also higher than those in CHB(P<0.001) and HCs(P<0.001).Both IL-1ra(P=0.02) and IL-1ra/IL-1β(P=0.007) were lower in No-survivors than Survivors in HB-ACLF patients. Conclusion IL-1ra plays an important role in the development of HB-ACLF and is associated with outcome of HB-ACLF.

Clinical outcome of patients with Graves disease after receiving ¹³¹I therapy and analysis of related risk factors

XU Zhi-yong, ZHOU Jia-qiang, LOU Cen

2016, 14(5): 721-723. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.008

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Objective To explore the prognosis of patients with Graves disease after iodine ¹³¹I treatment and related risk factors. Methods The clinical history of 1 007 cases of Graves disease admitted in our hospital during 2005-2010 were recorded in detail.All patients were followed up by telephone in 2011,and status of thyroid function was determined in reference with previous diagnosis. Results Total 766 patients completed the last follow-up.After ¹³¹I therapy,102 of the cases (13.4%) had their thyroid function returned to normal,536(69.9%) showed hypothyroidism,and 128(16.7%) remained hyperthyroidism.The statistical analysis showed that the incidence of hypothyroidism was 78.2%,the efficiency of clinical treatment was 90.1% for patients with thyroid weighing less than 30 g;the incidence of hypothyroidism was 74.8%,the efficiency of clinical treatment was 88.1% for thyroid weighting 30-60 g;and the incidence of hypothyroidism was 58.1%,the efficiency of clinical treatment was 72.3% for thyroid weighing more than 60 g(all P＜0.001).The incidence of hypothyroidism was 89.1%,the efficiency of clinical treatment was 97.8% if course of disease was less than 3 months;the incidence of hypothyroidism was 75.4%,the efficiency of clinical treatment was 90.8% if 3-12 months;the incidence of hypothyroidism was 63%,and the efficiency of clinical treatment was 77% if over 12 month(all P＜0.001).Multivariate logistic regression analysis showed that the course of disease less than 1 year,thyroid weighed less than 60 g and secondary isotope therapy was more likely to lead to hypothyroidism.Higher dose of isotope therapy was needed to achieve desired effect if thyroid weighed more than 60 g and course of disease more than 1 year. Conclusion A better efficacy can be achieved if course of disease is less than 1 year and thyroid weighs less than 60 g,but hypothyroidism is also more likely.Higher dose of ¹³¹I is needed if course of disease is more than one year,and the thyroid weighs more than 60 g.

A comparison study of general anesthesia and spinal anesthesia in the management of total hip arthroplasty

CHENG Hao, GUO En-qi

2016, 14(5): 724-726. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.009

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Objective Both general anesthesia and spinal anesthesia were regularly used in the management of total hip arthroplasty.However,which type of anesthesia was better remained unclear.The present study was to compare the influences of general anesthesia and spinal anesthesia on patients underwent total hip arthroplasty. Method From January,2008 to October,2015,584 patients were retrospectively studied.The patients were assigned into general anesthesia group(n=302) and spinal anesthesia(n=282) according to anesthesia methods.The primary outcome measures included rate of any adverse event,deep vein thrombosis,cerebrovascular accident,pulmonary embolism,surgical site infection,urinary tract infection and mortality in the first 28 days.The second outcome measures were rate of tachycardia and hypotension during the operation,preoperative preparation time,operation time and postoperative room stay time. Result There was no difference between the two groups in gender,age,body mass index and the modified Charlson comorbidity score on admission.When compared with spinal anesthesia group,the patients in general anesthesia group got a significantly longer operation time(99.67±11.60 vs. 92.64±7.57 min,P<0.001),a significantly longer postoperative room stay time(16.26±2.44 vs. 12.98±1.97 min,P<0.001),a significantly higher rate of any adverse event(8.28% vs. 3.90%,P=0.028),a significantly higher rate of hypotension during the operation(29.47% vs. 19.86%,P=0.007),a significantly higher rate of deep vein thrombosis(2.65% vs. 0.35%,P=0.024) and a higher rate of blood transfusion(18.54% vs. 12.06%,P=0.03). Conclusion Spinal anesthesia contributed to lower rate of any adverse event and deep vein thrombosis in the first 28 days.Moreover,lower rate of intraoperative blood transfusion and hypotension,less operation time and postoperative room stay time were observed in spinal anesthesia group as well.

Effect of Minimally invasive trans-muscular pedicle screw fixation in treatment of thoracolumbar fractures

SHEN Peng, DUAN Jia-zhong

2016, 14(5): 727-729. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.010

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Objective To investigate theefficacy ofminimally invasive trans-muscular pedicle screw fixation in the treatment thoracolumbar fractures. Methods The clinical data of 50 cases of thoracolumbar fractures undergoing minimally invasive trans-muscular pedicle screw fixation and 50 cases undergoing traditional surgery surgery in the same period I our hospital between March,2012 and March,2015 were reviewed.Theclinical data,perioperativesituation,imaging and Disability Index score before after the surgery were compared between the two groups. Results The age,gender and thoracolumbar injury site were not significant differences between the two groups(P>0.05),the bleeding amount and drainage of minimally invasive surgery group was significantly lower than that of traditional surgery group(P<0.05),the operation time and hospital stay of minimally invasive surgery group were significantly lower than that of traditional incision group(P<0.05).The anterior height ofthe involved cone was higher than before in both groups(P<0.05).Thevertebral kyphosis angle and Cobb angle after the operation in both groups were lower than before(P<0.05).The dysfunction index scores within six months after the surgery in both groups were significantly lower than before(P<0.05). Conclusion Both minimally invasive surgery and traditional surgery for thoracolumbar fractures have good therapeutic effect,they can improve the functional disorders of patients.The minimally invasive surgical treatment have less damage,lessbleeding,shorter hospital stay and recovery quick than traditional incision treatment.

Impact of combined therapy of Chinese and Western medicine on immune function after surgery for breast cancer

HU Kui, ZHAO Kai, TAN Qun-ya, NIE Ji-feng, XU Wen-bin

2016, 14(5): 730-732. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.011

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Objective To study the impact of combined therapy of Chinese and Western medicine onpostoperation immune function and inflammatory factors of breast cancer patients with neoadjuvant chemotherapy. Methods Ninety breast cancer patients in our department undergwent the neoadjuvant chemotherapy before the operations and were randomly divided into two groups after the surgery:control group(n=45)and study group(n=45).The patient in the study group received combined therapy of Chinese and Western medicine on the base of routine treatment.The levels of CD4⁺,CD8⁺,NK cells,IgA,IgG and IgM were detected with automatic biochemical analyzer,and IL-6,IL-10,TNF-α with ELISA before the operation(T₁),and 24 h(T₂),1 w(T₃),4 w(T₄),9 w(T₅)after the sugery.The data was analyzed using SPSS 16.0 software. Results Compared with T₁,the levels of CD8⁺at T_2-3,IgG and IgM at T_3-5 in both groups were increased.The levels of CD4⁺ and NK cell at T_2-3,and CD4⁺/CD8⁺ at T_2-5 in the control group were declined.The levels of CD4⁺ and NK cell at T₂,and CD4⁺/CD8⁺ at T_2-3 in the study groups were declined.IL-6,TNF-α level were increased and IL-10 were declined at T_3-5 in the contral groups and at T_2-3 in the study groups(P<0.05).Compared with the control group,the levels of CD4⁺,CD4⁺/CD8⁺,NK cells,IgG,IgM were increased at T_3-5,but CD8⁺ was declined;IL-6 and TNF-α level were declined at T_4-5,but IL-10 were increased(P<0.05). Conclusion The combined therapy of Chinese and Western medicine can improve the postoperative immune function and decreased systemic inflammation in breast cancer patients receiving neoadjuvant chemotherapy.

Efficacy of simple periodontal treatment and combined periodontal and orthodontic treatment on periodontal disease

LAN Xu-hua, FAN Tong-hai, LEI Gui-hua, JU Xiao-yun, WANG Ying

2016, 14(5): 733-735. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.012

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Objective Tocompared the efficacy of simple periodontal treatment and periodontal orthodontic in the treatment of periodontal disease. Methods Total 38 cases of periodontal disease patients in our hospital were selected as research subjects,38 patients were first treated with simple periodontal treatment,after the periodontal status entering the stationary phase,thecombined periodontal and orthodontic treatment was performed.The measurement probing depth,crownlength,root length and alveolar bone density were compared before and after simple periodontal treatment and before and after the periodontal orthodontic treatment. Results The probing depthafter simple periodontal treatment was significantly lower than before the treatment(P<0.05),the periodontal probing depth after the periodontal orthodontic treatment was significantly lower than before treatment (P<0.05).The crown length aftersimple periodontal treatment was significantly higher than before(P<0.05),the crown length after periodontal orthodontic treatment was significantly higher than before(P<0.05).The root length of after simple periodontal treatment was no difference than before(P>0.05),the root length after periodontal orthodontic treatment was no difference than before(P>0.05).The alveolarcrestal bone mineral density aftersimple periodontal treatment was significantly higher than before(P<0.05),the crestal bone mineral density after periodontal orthodontic treatment was significantly higher than before(P<0.05).The apical bone mineral density aftersimple periodontal treatment was significantly higher than before(P<0.05),the apical bone mineral density after periodontal orthodontic treatment was significantly higher than before(P<0.05). Conclusion The simple periodontal treatment and periodontal orthodontic treatment for periodontal disease can all improve periodontal condition,increase crown length without increase root length.The simple periodontal treatment can increase the alveolar bone density,but the periodontal orthodontic treatment will reduce alveolar bone density.

Effect of local infiltration of ropivacaine in general anesthesia on postoperative restlessness after pediatric tonsillectomy

DAI Ren-feng, WANG Wei-juan, LIU Ying

2016, 14(5): 736-738. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.013

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Objective To investigate the effect of local infiltration with ropivacaine on postoperative restlessness after pediatric tonsillectomy. Methods One hundred cases of elective pediatric tonsillectomy patients aged for 5 to 10 years were enrolled.They were randomly divided into ropivacaine group(R group) and control group(C group),50 cases for each.R group were infiltrated with 5 ml 0.25% ropivacaine around peritonsillar at the beginning of the operation;while C group were infiltrated with normal saline.The intraoperative MAP,HP,and SpO₂ were monitored.The severity of postoperative restlessness were evaluated by PAED assessment model and the dose of analgesic drugs used,the number of the cases with adverse reactions such as nausea ,vomiting,itching,and respiratory depression were recorded by visiting the patients at the time point of 15 min,30 min,1 h,4 h after operations. Results No significant differences(P>0.05) were observed between the two groups in age,weight,gender and operation time.However,the PAED scores of respective time point differed significantly(P<0.05) between the two groups[(10-15 scores)R group 9 cases,C group 17 cases,P<0.01；(15-20 scores)R group 1 cases,C group 5 cases,P<0.01]. Conclusion The incidences of restlessness and complications during the recovery period of sevoflurane anesthesia could be efficiently reduced by local infiltration with ropivacaine during which no adverse reactions were noticed and it might be worth of clinical promotion.

Effect of stereotactic hematoma aspiration on the NSE expression after experimental intracerebral hemorrhage in rat

LI Zhao-xing, WANG Ya-nan, WANG Xiao-ying, SUN Sheng-jie, JIANG Tao, ZHANG Jun-hao, LUO Kai, ZHU De-hui

2016, 14(5): 739-742. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.014

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Objective To establish the stereotactic hematoma aspiration and observe the effect and meaning of stereotactic hematoma aspiration on the experimental rat model of intracerebral hemorrhage (ICH) induced by Ⅳ collagenase. Methods The 135 healthy male adult Wistar rats were randomly divided into sham operation group,ICH group and hemorrhage aspiration group.The models of ICH were established by injecting Ⅳ collagenase into caudate nucleus of the rats,which were injected with 3 000 U of urokinase in 5 μl to dissolve blood clots on 10 h after ICH and treatment by hematoma aspiration on 2 h after the urokinase was injected.The neurological impairment in rats was evaluated by means of Bederson.The expression of NSE in cortex was detected by the immunohistochemistry and Western Blot. Results The expression of NSE in the peripheral region of hematoma in hematoma aspiration group and ICH group was significantly higher than that in sham operation group at each time point(P<0.05).The expression of NSE in the peripheral region of hematoma in hematoma aspiration group was slightly higher than that of ICH ground one day after ICH(P>0.05),but there was no significant difference.Compared with ICH group,the expression of NSE in the peripheral region of hematoma in hemorrhage aspiration group was significantly decreased on 3rd and 5th day after ICH(P<0.01). Conclusion The rat model of ICH induced by Ⅳ collagenase was stable and reliable and ideal model which can be used to implement stereotactic hematoma aspiration.The neurobehavioral function is damaged and the expression of NSE in perihematomal tissue after ICH is increased obviously.The early hematoma aspiration can remove hematoma better,weaken the expression of NSE,reduce the number of neuronal degeneration cells and improve neurobehavioral function significantly after ICH.

The effect of Shenfu injection on T-lymphocyte subsets and natural killer cells and prognosis in severe trauma patients

LEI Li-mei, LAN Xiang, KAO Yan, ZHENG Hao

2016, 14(5): 743-745. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.015

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Objective To investigate the effect of Shenfu injection on T-lymphocyte subsets and natural killer(NK) cells in severe trauma patients and the influence of ICU treatment time,multiple organ dysfunction syndrome(MODS) incidence rate and mortality. Methods Sixty severe trauma patients were divided into the control group (n=30) and shenfu group(n=30).Other 30 cases were chosen as health control group at the same phase.All patients were received conventional treatments,however,the shenfu group patients were additionally received the shenfu injection treatment in the early stage.The T-lymphocyte subsets(CD3⁺，CD4⁺，CD8⁺) and NK cells were detected on 3rd and 7th day by flow cytometry.The ICU treatment time,MODS incidence rate and mortality were surveyed. Results Compared to health control group,the T-lymphocyte subsets and NK cell counts were significantly low in treatment groups before received treatment.On 3rd treatment day,the CD3⁺,CD4⁺,CD8⁺T-lymphocytes ,NK cells and CD4⁺/CD8⁺rate in shenfu group were significantly raised(P<0.05).On 7th treatment day,the CD3⁺,CD4⁺,CD8⁺ T-lymphocytes,NK cells and CD4⁺/CD8⁺rate in shenfu and control group were significantly higher than health control group(P<0.05).The ICU treatment time,MODS incidence rate and mortality in shenfu group were significantly lower than control group(P<0.05). Conclusion Base on conventional therapy,the early use of shenfu injection can significantly improve immune dysfunction of the T-lymphocyte subset and NK cell in severe trauma patients,so that the ICU treatment time,MODS incidence rate and mortality were reduced.

The correlation of mean platelet volume and LVEF,hs-CRP and cTnI inelderly patients with acute myocardial infarction

WU Zheng, LI Wen-zheng, LI Shi-ying, CHENG Shu-juan

2016, 14(5): 746-748,816. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.016

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Objective To discuss the correlation of mean platelet volume(MPV) and left ventricular ejection fraction(LVEF),serum high-sensitivity C-reactive protein(hs-CRP) and Cardiac troponin I(cTnI) levels in elderly patients with acute myocardial infarction (AMI). Methods One hundredcases of elderly patients with AMI were selected as the research object and as the observation group.The levels of MPV,LVEF,hs-CRP, and cTnI were detected within 24 h after admission hospital.There were quartile grouped according to the levels of MPV,Q1 group (MPV≤11.22 fl),Q2 group(MPV is 11.23-13.52 fl),Q3 group(13.53-14.26 fl),Q4 group(MPV≥14.26 fl),and 25 cases in each group;50 cases healthy volunteers were selected as control group that according to the patients in the observation group,age and sex matched at the same period.Compared to the observation group and the control group differences of each index,and analyzed the correlation between the patients in the observation group MPV and LVEF and hs-CRP,cTnI level. Results ①The MPV,LVEF and serum hs-CRP,cTnI levels in the observation group were significantly higher than those in the control group the differences were statistical significance (t₁=19.142，t₂=31.411，t₃=102.362，t₄=61.234，P＜0.05);②There was statistical significance in the LVEF and serum hs-CRP,cTnI levels between the different MPV groups (P<0.05),and Q1 group,Q2 group,Q3 group,Q4 serum hs-CRP,cTnI levels sequentially increased,LVEF decreased;③The linear correlation analysis showed a negative correlation of patients MPV and LVEF in the observation group (r_LVEF=-0.362，P＜0.05),and the linear correlation analysis showed a positive correlation of serum hs-CRP,cTnI level(r_hs-CRP=0.448，r_cTnI=0.512，P＜0.05). Conclusion MPV levels were significantly higher in elderly patients with AMI,and LVEF,hs-CRP and cTnI will have a significant correlation,and presumably it will be used as the objective index to evaluate the condition of patients with AMI.

Clinical observation of ventilation effect of I-gel supraglottic airway used in general anesthesia in elderly edentulous patients

CUI Wen-tao, CHEN Zheng-wei

2016, 14(5): 749-751,759. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.017

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Abstract:
Objective To observe the ventilation effect of I-gel Laryngeal Mask Airway(LM) in the general anesthesia in elderly edentulous patients by comparing with dentate patients,so as to provide reliable data for clinical. Methods In this study,60 elderly male patients with inguinal hernia repair under general anesthesia in our hospital from May,2014 to May,2015 were selected and divided into no tooth group(group NT) and the normal group(group T) with 30 cases in each group.The type of laryngeal mask was chosen according to the body weight.The laryngeal mask was placed after induction of anesthesia to perform mechanical ventilation.Mean arterial pressure(MAP) and heart rate(HR) were recorded before intubation(T0),during intubation(T1),at 3 min after intubation(T2) and before extubation(T3),during extubation(T4),at 3 min after extubation(T5);The time for LM intubation,attempt times of intubations,the class of position by flexible fiberoptic bronchoscopy,airway leak pressure,the related complications and blood gas analysis were recorded.The ventilation condition was also compared in the two groups before and after the operation. Results The insertion time of laryngeal mask airway in NT group was (8±5) s and the number of times was more than T group[(7±7) s],the difference was not statistically significant(P>0.05);There was no difference in the success rate of laryngeal mask insertion,laryngeal mask airway,airway seal pressure and air leakage between the two groups(P>0.05);The hemodynamics of the two groups were stable and the other complications were not different between the two groups(P>0.05). Conclusion I-gel supraglottic airway can enable a mirrored impression of the pharyngeal and laryngeal structures and can effectively reduce the pressure on the laryngeal tissue and provide a more secure environment for the elderly patients,it can also effectively prevent the hemodynamic fluctuations during general anesthesia due to ventilation in elderly edentulous patients,and reduce the incidence of adverse events during the operation,which shows an important role in the clinical practice.

Therapeutic efficacy of cyclophosphamide on thymoma in patients with myasthenia gravis

HE Li-feng, LIU Kai-ming, WANG Zhen

2016, 14(5): 752-753,789. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.018

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Objective To investigate therapeutic efficacy of cyclophosphamide on thymoma in patients with myasthenia gravis. Methods From January,2010 to December,2015,93 cases of myasthenia gravis with thymoma in Huzhou Central Hospital and Second Affiliated Hospital were selected and divided into low malignant thymoma group(44 cases) and high malignant thymoma group(49 cases) according to the degree of thymoma malignancy.The patients in both groups received cyclophosphamide intravenous treatment.The general condition,the quantitative myasthenia gravis score,therapeutic efficacy and adverse reactions were compared between the two groups. Results The quantitative myasthenia gravis score between the two groups had no differences before and after the treatment(P>0.05).After the treatment,the quantitative myasthenia gravis score in both group L and group H were decreased(P<0.05).The curative effective rate in group L was 88.6% and in group H was 85.7%,the difference was not significant(P>0.05).There was no difference in the white blood cell count dropping,aminotransferases increasing,fatigue,nausea and vomiting between the two groups(P>0.05). Conclusion Cyclophosphamide is safe and effective in the treatment of thymoma in patients with myasthenia gravis with,the therapeutic efficacy is similar for low and high malignant thymoma.

Life quality situation and influencing factors of lung cancer patients before and after chemotherapy

PAN Jian-fang, XU Shui-tu, ZHENG Yan, ZHU Yue-yan

2016, 14(5): 754-756,792. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.019

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Abstract:
Objective To investigate thelife quality situation and influencing factors of lung cancer patients before and after chemotherapy. Methods Total 86 lung cancer patients in our hospital between January 2012 and December 2014 were enrolled into thisstudy.Four cycles chemotherapy was carried out in all patients.EORTC QLQ-30 questionnaire was used to survey the quality of life,health average score and their relationship with the influencing factors. Results The physical score,moodscores,communityrating,dyspneascore,quality of life scores after four cycles chemotherapy were significantly lower than that before chemotherapy(P<0.05),the nausea and vomiting score,ratinginsomnia,loss of appetite score,constipation and diarrhea scores after four cycles chemotherapy were significantly higher than that before chemotherapy(P<0.05),the healthy average score of advanced lung cancer patients were no significant correlation with the age,gender,histological type,education level and the underlying disease(P>0.05).The anorexia score of female lung cancer patients was higher than males patients(P<0.05),the appetite score,constipation score,nausea score of patients aged over 60 were significantly higher than that of patients aged less than 60(P<0.05),the insomnia scores of patients with low educational level was significantly higher than that of patients with high education level (P<0.05),the fatigue scores of patients with underlying disease was higher than patients without underlying disease(P<0.05). Conclusion The physical score,mood scores,social score,dyspnea score,quality of life scores after chemotherapy in advanced lung cancer patients will decrease,and the nausea,vomiting score,insomnia score,loss of appetite score,constipation,diarrhea rates may increase.The quality of life in patients with advanced lung cancer is related with gender,age,and education level and basis diseases.

Clinical value of Carotid artery s stenting in prevention of ischemic stroke

ZHANG Yong-qiang, YING Xiao-wei, LI Ling-xiao, WANG Li-song, WANG Xi-jia

2016, 14(5): 757-759. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.020

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Abstract:
Objective To explore the clinical value of carotid artery stenting(CAS)in the prevention of ischemic stroke(ICS). Methods A total of 96 patients with CAS in this hospital from February 2010 to December 2013 were selected and were randomly divided into two groups with 48 cases in each group,the control group was treated with drug alone,while the observation group accepted CASS.The level of triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL),and CAS severity in both groups were detected before and after the treatment,the adverse events were also recorded. Results The difference of lipid levels between the two groups before the treatment was not statistically significant(P>0.05);after the treatment,TG,TC and LDL in the observation group was (1.42±0.36) mmol/L,(3.15±0.32) mmol/L and (2.01±0.24) mmol/L,respectively,and in the control group was (1.76±0.43) mmol/L,(3.96±0.92) mmol/L and (2.52±0.34) mmol/L,respectively,the difference was statistically significant(P<0.05);the rate of CAS severe in the observation group was 2.1%(1/48),while in the control group was 18.8%(9/48),the difference was statistically significant (P<0.05);the incidence of carotid transient ischemic attack(TIA),ICS,new discovery infarction and death in the observation group were significantly lower than those in the control group(P<0.05). Conclusion CASS can control the degree of stenosis in patients with CAS,and prevent the occurrence of ICS,thus is safe and effective treatment methods.

Conditional survival after hepatic resection for hepatocellular carcinoma

FU Hong, CHEN Zhi-liang, FANG Jian-feng, YU Nan-song

2016, 14(5): 760-762. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.021

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Abstract:
Objective To estimate the conditional survival for patientsafter hepatic resection for hepatocellular carcinoma(HCC). Methods Clinical data from 556 patients who underwent HCC resection were reviewed and the actuarial survival estimated.The 3-year conditional survival was calculated as CS=S(x+3)/S(x) and represents the probability of surviving an additional 3 years,given that the patient has already survived x years. Results The 1-,3-,and 5-year survival rates were 69.0%,57.7%,and 25.3%,respectively.Single factor analysis found that the following pathological parameters were closely related tosurvival rate:staging of liver cancer,tumor differentiation,microvascular invasion,intraoperatie red blood cell input and smaller values of the liver fibrosis.Themultivariate analysisfound that the independent risk factors of long-term survival were fibrosis(RR=1.789；95%CI：1.046-3.059；P=0.034),packed red blood cells transfusion(RR=2.093；95%CI：1.252-4.746；P=0.021)and differentiation(RR=0.279；95%CI：0.0752-0.936；P=0.029).The 3-year CS rate of the entire study cohort assessed at 1,2,3,4 and 5 years from thetreatment was 38.9%,51.7%,64.4%,76.7% and 78.4% respectively.The CS of subgroups stratified by fibrosis,packed red blood cells transfusion and differentiation didn’t differ significantly from the third year after resection onward,as more advanced patients had probably escaped early recurrence. Conclusion Conditional survival showed that the impact of different variables influencing survival is not linear over time after hepatic resection.Information derived from conditional survival can be used to better manage patients with HCCs.

Clinical analysis of recombinant tissue plasminogen activator combined with thrombolytic therapy in treatment of acute cerebral infarction(ACI)

LUO Xiao-chun, GONG Wen-jian, LI Min-hui

2016, 14(5): 763-765. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.022

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Objective To discuss the curative effects of recombinant tissue plasminogen activator combined with thrombolytic therapy in treatment of acute cerebral infarction(ACI). Methods From January,2013 to October,2015,clinical data of 75 ACI patients in our hospital were retrospectively analyzed from morbidity to give medicine<4.5 h,of which 24 patients were given medicine<3 h(Group A),30 cases were given medicine 3-4.5 h(Group B),and 21 cases were given medicine<4.5 h.And respectively in 24 h before and after treatment,7 days after treatment the NIHSS score,clinical efficacy intracranial hemorrhage and death of the three groups were evaluated. Results After treatment for 24 h and 7 d,the NIHSS scores in group A and group B were significantly lower than before treatment(t≥3.38,all P<0.05),and significantly lower than that in the control group after treatment(t≥3.42,P<0.05);After treatment for 24 h and 7 d,the NIHSS score comparison difference in group A and group B had no statistical significance(t=0.81,0.99,P<0.05).In group A and group B,7 d efficient rate was significant higher than that in the control group after treatment(χ²=11.667,11.286，P<0.05),but in group A and group B the efficient rate had no statistically significant difference(χ²=0.098,P>0.05).The mortality in group A and group B was significantly lower than that in the control group,but the death rate of group A and group B had no statistically significant difference(χ²=0.026，P>0.05).In group B intracranial hemorrhage rate was significantly higher than that in group A,which had statistically significant difference(χ²=3.881,P<0.05). Conclusions It has significant clinical efficacy by using rt-PA thrombolysis 3-4.5h and <3h after morbidity,however,the extension of time window can lead to an increased risk of intracranial hemorrhage,which doesn’t increase the risk of death;And in patients with acute cerebral infarction within 4.5h of stroke onset should be also actively given rt-PA intravenous thrombolysis treatment.

Clinical observation on intravenous thrombolysis for acute ischemic stroke under the guidance of multi-mode MRI

SUN Yong-xing, WU Xiao-lian, ZHANG Ning-yuan, LIU Yu-xiang

2016, 14(5): 766-768. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.023

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Objective To learn the guidance effect of multi-mode MRI in intravenous thrombolysis of acute ischemic stroke;and to ensure the effectiveness and safety of intravenous thrombolytic therapy. Methods Total 102 patients with acute ischemic stroke in our hospital from August,2013 to August,2015 were selected.According to the results of multi-mode MRI test,the two groups were treated with intravenous thrombolytic therapy.The patients didn’t receive the intravenous thrombolytic therapy were chosen as the control group;while the patients receiving intravenous thrombolysis(alteplase) were assigned into the treatment group.The NIHSS score of two groups before and 6,24h and 7d after the treatment were compared,and the effect was evaluated at 7 d after treatment,and the adverse reactions were observed. Results According to the non-matching of PWI/DWI,55 cases in the treatment group were treated with intravenous thrombolysis,47 cases in the control group were not treated with intravenous thrombolysis.There were no significant differences in age,gender,smoking history,stroke history,and complication of the two groups(P>0.05).The NIHSS score before and 6,24 h and 7d after the treatment in the treatment group were 8.52±4.77,6.14±4.07 and 3.90±2.23,respectively,which were significantly less than those of the control group(t=1.775,2.875,2.024,P<0.05).The total efficiency of the treatment group was 83.64%(46/55),significantly higher than the control group(χ²=6.264,P<0.05).During the treatment,the incidence of adverse reactions in the control group was 10.64%(5/47),and in the treatment group was 12.73%,the differences between the two groups was not statistical significant(χ²=0.107,P>0.05). Conclusion Multi-mode MRI has a guiding role in intravenous thrombolysis for acute ischemic stroke,which can improve the therapeutic effect of intravenous thrombolysis,and had good clinical application value.

Relationship and mechanisms for the recurrence of cerebral infarction with Helicobacter pylori infection

YANG Hong-xia, ZHU Zhong-yong, LIU Song-qing

2016, 14(5): 769-770,834. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.024

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Objective To explore the relationship between the HP infection and the recurrence of cerebral infarction and the possible mechanisms. Methods HP was tested among 624 primary cerebral infarction patients in our hospital from January 2009 to March 2012,298 cases with positive result were assigned into HP positive group,and 326 cases with negative result into HP negative group.ALL patients were followed for 3 years.The recurrence rate of cerebral infarction was compared between the two groups.The serum levels of CRP were detected by radio-immunity methods and the levels of homocysteine(HCY) were detected by immunoturbidimetry methods.After the standard “quadruple chemotherapy” for HP,the recurrence rate of cerebral infarction,and levels of CRP and HCY were compared between 126 cases turned back negative and other patients. Results The recurrence of cerebral infarction was higher in HP positive group(29.4%) than HP negative group(19.6%) (χ²=7.833,P=0.005).After the eradication of HP,the recurrence of cerebral infarction was decreased as compared with non-eradication of HP(20.8% vs. 35.5%),χ²=7.264,P=0.007.The levels of CRP and HCY were increased in HP positive group[(8.12±2.86) mg/L,(16.86±6.83) μmol/L)] when compared with HP negative group[(6.82±2.18) mg/L,(14.76±6.21) μmol/L](P＜0.01),and were decreased after the eradication of HP[(7.23±2.16) mg/L,(15.22±5.68) μmol/L] as compared with non-eradication of HP[(8.64±3.26) mg/L,(17.32±7.38) μmol/L](P＜0.01). Conclusion The HP infection is related to the recurrence of cerebral infarction by increasing the levels of CRP and HCY.

Correlation between PSA level and Gleason score in prostate cancer

YU Li-hang, XU Gang

2016, 14(5): 771-773. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.025

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Objective To analyze the correlation between serum PSA level,free prostate specific antigen/total rostate specific antigen(f-PSA/t-PSA) and Gleason score in prostate cancer,and to investigate the value of PSA in the diagnosis and identification of prostate cancer. Methods The clinical data of 109 cases of prostate cancer patients who were treated in urology of Shaoxing City People’s Hospital from June 2014 to September 2015 were retrospectively analyzed,and all patients were diagnosed as prostate cancer with the help of prostate biopsy guided by ultra-B.Patients were divided into different groups according to the clinical data,with/without family genetic history,and on the basis of Cancer TNM classification.The serum PSA level of patients in different family history and clinical stage was analyzed,and the correlation between serum PSA level,f-PSA/t-PSA and Gleason score in prostate cancer was evaluated. Results The mean serum PSA level of patients with a family history of prostate cancer was(323.59±267.15)ng/ml,higher than that of no family history,(198.11±100.22)ng/ml,P<0.05,and the difference was statistically significant.The serum PSA level in patients with different clinical stages were quite different,lowest in Ⅰ period,(6.28±4.08)ng/ml,highest in Ⅳ period(459.08±123.01)ng/ml.The serum PSA level of prostate cancer was positively correlated with prostate tissue biopsy Gleason score(r=0.367,P＜0.001).Mean serum free/total prostate-specific antigen in patients with poorly differentiated carcinoma was 0.145±0.017,differentiation of carcinoma was 0.225±0.021,well differentiated carcinoma was 0.345±0.104,and prostate cancer pathological Gleason score was negative correlated to serum f-PSA/t-PSA(r=-0.378,P=0.008). Conclusion The serum prostaglandin specific antigen was correlated with Gleason score,and serum PSA level was important for the clinical diagnosis and treatment of prostate cancer,and it should be included in the screening program for prostate cancer.

Effect of surgical release combined with unilateral hinged external fixation on posttraumatic elbow stiffness

ZHOU Ping, PANG Fei, SUN Xin

2016, 14(5): 774-776. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.026

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Objective To evaluate the clinical effect of surgical release combined with unilateral hinged external fixation in treatment of posttraumatic elbow stiffness,and provide the basis for the clinical treatment. Methods A total of 82 consecutive cases suitable for the experiment were randomly divided into control group(n=40) and experiment group(n=42);the patients in the control group received releasing combined with common plaster fixation,while the patients in the experiment group received releasing combined with unilateral hinged external fixation;the clinical effects were compared between the two groups. Results The mean follow-up time was (11.2±2.1)months.the Mayo score,the excellent rate of joint and activity in the two groups were all better than before and the patients in the experiment group were all with more improvements as compared with the control group(P<0.05). Conclusion The surgical release combined with unilateral hinged external fixation in the treatment of posttraumatic elbow stiffness could be better than common plaster fixation.

Effectiveness of random pattern flap surgery after tissue expansion in treatment of face and neck burn scar

CAI Hai-jun, TAN Jing-lei

2016, 14(5): 777-779. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.027

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Objective To observe and explore the clinical value of expanded random-pattern flaps in the treatment of face and neck burn scar,and provide the basis for selection of treatment plan. Methods All 80 patients with face and neck burns scar between April 2008 and February 2015 in our hospital were selected and randomly divided into observation group and control group with 40 cases in each group according to random number method.All patients who met the inclusion and exclusion criteria were selected,and the general information of two groups were comparable.The observation group received the expanded random-pattern flap surgery,while the control group received a simple adjacent skin flaps surgery.One month after the operation,the improvement of itching and pain at repaired site as well as postoperative complications were compared. Results All flaps survived well,healed well;the efficiency for improving the itching and pain symptoms in the observation group was 90.0%(36/40) and 92.5%(37/40),while in the control group was 77.5%(31/40) and 75.0%(30/40),the difference was statistically significant (χ²=4.296/4.500,P＜0.05);the complications occurred in 5 cases in the observation group with a rate of 12.5%,the difference was not statistically significant (χ²=0.774,P＞0.05). Conclusion The adjacent skin near the scars near the site is suitable for the expanded random-pattern flaps in the treatment of face and neck burn scar.The treatment can achieve the desired effect,and does not affect the safety of flap.It is worth spreading in clinical practice.

Effectiveness of Shugan Jieyu capsule combined antipsychotics on negative symptoms of Senile Schizophrenia

CHEN Ke

2016, 14(5): 780-781,795. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.028

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Objective To explore the effectiveness of Shugan Jieyu capsule(SGJY) combined antipsychotics Sertraline(Ser)on the negative symptoms of Senile Schizophrenia(SSP). Methods Total 96 patients with SSP negative symptoms in this hospital between August,2012 and April,2015 were selected and randomized divided into two groups,48 cases in the observation group and the control group.The control group was treated with Ser,while the observation group with SGJY on the basis of control group.Before and after the treatment,the negative symptoms,positive symptoms,general psychiatric symptoms score and total score in two groups were evaluated,and the comprehensive effects of the two groups were evaluated,as well as the adverse reactions of the two groups were statistically analyzed. Results The difference of negative symptom score,positive symptoms score,general mental pathological symptom score and total score before the treatment was not statistically significant between the two groups(P>0.05);after the treatment,the negative symptom score,positive symptoms score,general psychiatric pathology symptom score and total score in the observation group was (9.4±3.2) points,(16.8±4.2) points,(10.9±3.8)points and (37.2±7.2) points,respectively,while in the control group was (12.6±4.1) points,(20.5±3.8) points,(14.3±3.6) points and (46.8±7.9) points,respectively,the score in the observation group were significantly lower than that in the control group(P<0.05);the efficiency in observation group was 95.8%(46/48),while in the control group was 81.2%(39/48),the observation group was significantly higher as compared with the control group(P<0.05);the adverse reactions rate in observation group was 8.3%(4/48),while in the control group was 12.5%(6/48),the difference was not statistically significant(P>0.05). Conclusion SGJY combined with Ser treatment can significantly improve symptoms in SSP patients with negative symptoms,the effect is significant.

Clinical analysis of adjacent finger skin flap and reverse island flap for repairing fingertip defect

LI Jian-rui, LIN Xiao-yong, LIAO Hai, WU Jian-wei

2016, 14(5): 782-783,813. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.029

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Objective To investigate the clinical value of same finger reverse island flap for repairing fingertip defects. Methods Sixty cases of fingertip defect in our hospital from January,2013 to October,2015 were selected.All cases conform to operation indication and have no obvious surgical contraindication.The patients were randomly divided into two groups.Thirty-two fingers of 30 cases in the adjacent finger skin flap group were taken the adjacent finger flap surgery treatment,in the dorsal of adjacent finger middle segment designed the flap according to fingertip defects area.Thirty-six fingers of 30 cases in the same finger reverse island flap group were taken the same finger dorsal island flap repair surgery treatment,in the dorsal of finger middle segment designed flap according to the defects area,the lateral margin less than side central line.The triangle flaps at distal margin were designed.The general condition and curative effect of the two groups were compared. Results The operation time of same finger reverse island flap group was (41.5±12.3)min,adjacent finger skin flap group was (42.6±13.6)min.There was no significant difference between the two groups,P>0.05.The length of stay in the same finger reverse island flap group was (7.3±0.8)d,significantly shorter than that in the adjacent finger skin flap group(10.8±1.2)d,the difference was statistically significant,P<0.05.There were 12 cases(40.0%) superior,17 cases(56.7%) good,1 case(3.3%) fine and no inferior case in same finger reverse island flap group.There were 11 cases(36.7%) superior,12 cases(40.0%) good,7 case(23.3%) fine and no inferior case in adjacent finger skin flap group.The excellent rate of same finger reverse island flap group was 96.7%,it was significantly better than adjacent finger skin flap group’s 76.7%,χ²=5.192,P<0.05,the difference was statistically significant. Conclusion The method of reverse island flap of the same finger to repair fingertip defect has better curative effect and important clinical value,which is worth to be popularized.

Clinical effects of personalized orthopedic bone plates in the treatment of tibia complex fractures

LU Zhong-hui, ZHENG Yuan-yuan, TONG Song-lin

2016, 14(5): 784-785,868. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.030

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Objective To study the clinical effect of personalized orthopedic bone plates in the treatment of complex fractures of tibia and provide reference for the clinical treatment. Methods A total of 64 cases ofmulti-part complex fractures of tibiabetween March 2010 and March 2014 in our hospital were randomly divided into two groups.The study group(30 patients) received the internal fixation with the custom personalized plates made by computer digital technology,while the control group(34 patients) received the traditional fixation.After the treatment,the clinical effect was observed and compared between the two groups. Results The assessment for the average amount of bleeding,operation time,hospitalization time and healing times in the study group was significantly better than the control group,and the difference between the two groups were statistically significant(t=7.731,8.257,8.965,7.665,all P＜0.05).The total efficiency in the study group was 91.1% and in the control group was 100%,the difference between the two groups was statistically significant (u=8.765,P＜0.05),which revealed that the custom personalized plates made by computer digital technology could achieve better therapeutic efficacy. Conclusion The custom personalized plates are appropriate for the multi-part complex fractures of tibia with a better effect and less complications.The patients can recover in a short period.It is worthy to be popularized in clinical.

The protective effect of phosphate sodium on hypoxic-ischemic encephalopathy oxidative stress and myocardial injury in newborns

ZHANG Ying, CHEN Guo-qing, ZHANG Qin

2016, 14(5): 786-789. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.031

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Objective To discuss clinical efficacy of creatine phosphate sodium in treating neonatal hypoxic ischemic encephalopathy(HIE) with myocardial damage and probable mechanism. Method Ninety-two HIE patients with myocardial damage in our hospital were randomly divided into control group (46 cases) and treated group(46 cases) with reference to digital table method.All patients were treated with supportive treatment including low flow oxygen therapy and so on.Patients of control group were given single sialic acid four hexose ganglion glucoside ester sodium intravenous drip(20 mg/time,qd).Patients of treatment group were given creatine phosphate sodium based on treatment of control group(0.5-1.0 g/time,qd).Courses for two groups were 2 weeks.Serum creatine kinase(CK),cardiac troponinI(cTnI) and creatine kinase-MB(CK-MB) in two groups were compared.Expression of serum nicotinamide adenine dinucleotide phosphate oxidase 2(NOX2)in two groups were detected by immunoblotting.Serum levels of reactive oxygen species(ROS),nitric oxide(NO),nuclear factor-κB(NF-κB),tumor necrosis factor-α(TNF-α) and interleukin(IL)-6 were detected in two groups. Results Serum levels of CK,cTnI and CK-MB after treatment were obviously lower in treatment group than those of control group(P＜0.01).LVEF and E/A after treatment in treatment group were evidently higher than those of control one(P＜0.01).After treatment,serum NOX2,ROS,NO,NF-κB,TNF-α and IL-6 in treatment group were obviously lower thanthose of control one with statistically significant difference(P＜0.01). Conclusion Creatine phosphate sodium could reduce the myocardial injury markers effectively,improve heart function in treating HIE.One of the probable mechanisms may be related to restraining NOX2/ROS oxidative stress pathways and mitigating downstream inflammatory lesions.

Clinical phenotypic analysis of overweight and obese adolesents in Wenzhou

TIAN Jiang-xuan, LIU Pei-ning, ZHENG Chao, GU Su-ping, PAN You-jin, WU Xiao-ying, RUAN Lu-ya, WANG Jing

2016, 14(5): 790-792. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.032

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Objective To analyze the clinical manifestations of overweight and obese children in Wenzhou. Methods Cross section and case-control study were conducted in this study.Total 312 students in primary and high schools who received physical examination in our hospital between Jan.,2012 and Dec.,2014 were recrited and were divided into obesity group(109 cases),overweight group(89 caes)and normal weight group(114 cases).The anthropometric data(gender,age,height,weight),BMI,B-scan liver images,fasting blood glucose,fasting insulin,liver function,renal function,blood lipids profile,HOMA-IR and HOMA-B were recorded and analyzed. Results As compared with normal weight group,the levels of glutamic-pyruvictransaminase(GPT),glutamic-oxalacetictransaminease(GOT)and glutamyltranspeptidase(GGT)were significantly increased in overweight and obese group(P all <0.05).The levels of total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterin(LDL-C)were higher but high density lipoprotein cholesterin(HDL-C)were lower in overweight and obese group when compared with those in normal weight group(P all <0.05).According to the ultrasoundresults ,the prevalence of non-alcoholic fatty liver(NAFLD)were 45% in obese group,which was higher than those in overweight(8%)and normal weight group(0%),P<0.01,respectively.HOMA-IR was significantly higher in overweight and obese group when compared with those in normal weight group(P<0.01,respectively). Conclusion The overweight and obesity children have the characteristics of insulin resistance,include theincreased levels of transaminase,dyslipidemia,and increased prevalence of nonalcoholic fatty liver disease(NAFLD).

Management methods of high-risk HPV infection in middle-aged and older women

ZHANG Wen-jin, LU Cai-ling, YAN Chen-yun, ZHAO Xiu-min, TAN Ling, HUANG Jia-ou

2016, 14(5): 793-795. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.033

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Objective To explore the influence of management methods for HR-HPV infection on the outcome in middle-aged and older women(age between 45 and 70). Methods Total 66 cases of female patients with positive HR-HPV in our hospital from January 2012 to April 2014 were selected and grouped.There were 23 cases received HR-HPV combined with TCT(followed up group),21 cases received HR-HPV combined with EC(EC group),and 22 cases received HR-HPV combined with TCT and policresulen vaginal suppository(treating group).Theoutcomes were followed up and compared after 6,12 and 24 months.And the value of TCT and EC was compared. Results There was no significant difference in the outcomes among the three groups(P>0.05).For the diagnosis of cervical lesions ≥CIN Ⅰ,the sensitivity of TCT examination was 75%(3/4),the specificity was 95.12%(39/41),the positivive predicted valur was 60%(3/5)and the negative predicted value was 97.5%(39/40),the sensitivity of EC examination was 50%(1/2),the specificity was 94.73%(18/19),the positive predicted value was 50%(1/2)and the negative predicted value was 94.73%(18/19).There was no significant difference among these indexes between those two methods(P>0.05).The result of TCT examination was relatively consistent with the histopathological result(kappa=0.6303),as well as EC examination(kappa=0.447 5). Conclusion HR-HPV combined with TCT can be used in the folloow up for of HR-HPV infection in middle-aged and old women,and EC should be the most inexpensive and effective management method if necessary.

The expression of astrocyte elevated gene-1(AEG-1) in cervical cancer and it's correlation with angiogenesis

YU Jian-qin, ZHOU Qing, WANG Han-chu, ZHENG Fei-yun, CHEN Zhi-wen

2016, 14(5): 796-798,853. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.034

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Objective To observe the expression of astrocyte increased gene 1(AEG-1) in cervical cancer and it’s correlation with microvessel density,vascular endothelial growth factor(NF-κB) and nuclear factor κB(p65 VEGF). Methods Forty-five cases of invasive cervical carcinoma and 12 cases of chronic cervicitis were collected from the First Affiliated Hospital of WenZhou Medical University.The expression levels of AEG-1,p65 VEGF and NF-κB protein were detected by immunohistochemical MaxVision method,and the microvessel density(MVD) was detected by tumor microvessel endothelial markers(CD34) and Weidner count method.The expression of AEG-1,p65 NF-κB and VEGF in cervical cancer tissues was observed under optical microscope and the staining was observed.Correlation of AEG-1 expression with p65 NF-κB and VEGF expression in cervical cancer tissues was analyzed by Pearson. Results The expression of AEG-1 in cervical cancer and chronic cervicitis were (0.186±0.043) and (0.051±0.002),and the difference was statistically significant(P<0.01).AEG-1 expression level was positively correlated with lymph node metastasis of cervical cancer(P<0.01),while it was not positively correlated with the indexes of age,differentiation,tumor size,pathological type,and adjacent to the peri-uterus organizations(P>0.05).AEG-1 expression and p65 NF-κB(r=0.501,P＜0.001),VEGF(r=0.718,P＜0.001) and MVD(r=0.815，P＜0.001) were positively correlated with Pearson. Conclusions AEG-1 is highly expressed in cervical cancer tissues,and it can promote angiogenesis of cervical cancer.The mechanism may be related to AEG-1 activation of NF-κB signaling pathway and the regulation of VEGF levels.

Assessment of curative effect of different treatment regimens for uterine myoma

LIU Xiao-wan, Gulijianati·maowuliti, SUN Hai-yan, HUANG Shu-hua, MAYINUER·Nikezi, WANG Lin, LU Ping

2016, 14(5): 799-801. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.035

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Objective To assess the curative effect of different treatment regimens and provide personalized therapy for leiomyoma of uterus. Methods The clinical data of 170 cases of intramural uterine myoma confirmed by ultrasound examination in our hospital between 2008 and 2013 were reviewed.The preoperative ultrasound or MRI was used to assess the conditions of patients and select the regimen.30 patients received uterine artery embolization(UAE),90 patients received transabdominal or laparoscopic hysteromyomectomy,and 50 patients received high intensity focused ultrasound.The curative effects were evaluated by ultrasound and MRI at the end of the treatment. Results The effectiveness of UAE,laparoscopic hysteromyomectomy and high intensity focused ultrasound were 46.7%,94.4% and 86.0%,respectively,the difference between UAE group and laparoscopic hysteromyomectomy group or high intensity focused ultrasound group was statistical significant(P<0.05),but not significant between laparoscopic hysteromyomectomy group or high intensity focused ultrasound group(P>0.05). Conclusion The curative of hysteromyomectomy and high intensity focused ultrasound is superior to UAE in the treatment of leiomyoma of uterus,but the high intensity focused ultrasound had certain limitations.

Application of visiting doctor services in community health service in north mountainous area of Beijing

GUO Jun-ying, CHEN Jing-jing, YAN Zhi-jun, QU Chang-xin, PENG Ying-chun

2016, 14(5): 802-804. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.036

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Objective To investigate the effect,as well as the deficiencies of the visiting doctor services in community health service centers and propose suggestions for improvements. Methods The visiting services teams were composed of general practitioners,community nurses,health workers and pharmacists who had received the necessary training.The teams,with hemopiezometer,electrocardiograph,fast blood glucose meter and some common drugs,carried out the diagnosis and treatment of common diseases,diabetes and other chronic disease management,elderly residents health management,health education and so on,in the incorporated villages within the jurisdiction.The statistical data from the visiting doctor services and the data obtained from outpatient and emergency between 2012 and 2014 was analyzed and compared. Results The times of visiting services and the number of participants increased year by year.Among the patients who were visited,the rate of elderly people aged above 60 was higher when compared with the patients from outpatient and emergency.In the past three years,the proportion of participating in health management and chronic disease management kept rising.The resident satisfaction with health service was improved obviously. Conclusion The visiting doctor services mode can decrease the human labor cost of community health organizations,promote the health management and chronic disease management.This medical pattern,with the characteristic of long-term stability and sustainability,is especially suited for the mountainous area where the old people left behind when compared with the expert inspection mode.The visiting doctor services combined with the health management works that taken by community health agency can provide the flexible services according to the needs of visited subjects and residents.The program also meets some problems such as less medical service items,insufficiency of drug supply,increasing transportation cost,et al.

OUYANG Tao, YI Shao-ya, CENG Xiu-zhen

2016, 14(5): 805-806. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.037

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Efficacy of Sertraline hydrochloride tabletscombined with triple therapyonpeptic ulcer and depression in patients with Helicobacter pylori infection

CHEN Chun-feng, GAO Jing-fang, ZHU Xiang-zhen, QIN Dan-ping, LIU Cai-xia

2016, 14(5): 807-809. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.038

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Objective To study efficacy of Sertraline hydrochloride tablets in the treatment of peptic ulcer and depression in patients with Helicobacter pylori infection. Methods Total 166 cases of Hp-positive peptic ulcer patients with depression were randomly divided into treatment group(86 cases) and control group(80 cases).The two groups were given the same triple therapy to treat Hp positive peptic ulcer,thetreatment group was given sertraline to treat thedepression,and the control group was given amitriptyline to treatdepression.The degree of pain,results of the electronic gastroscopy,Hp clearance rate,HAMD score and adverse drug reactions were observed. Results Total 166 Hp strains(75.9%) were highly resistant to metronidazole,but lowresistant to amoxicillin,levofloxacin,furazolidone andclarithromycin.After8 weeks oftreatment,abdominal pain was improved significantly in both groups,andthe treatment group was better than the control group,the difference was statistically significant(P<0.05).HAMD score for the two groups was (12.4±3.6) and (19.0±3.9),respectively,significantly decreased after thetreatment,and the HAMD score in the treatment group was lower than that in the control group,the difference was statistically significant (P<0.05).The efficiency of the treatment group was 55.8%,the total efficiency was 89.5%,the markedly effective rate and total effective rate in the treatment group was significantly higher(χ²=10.597,6.019,all P<0.05) as compared with the control group.Hp clearance rate in treatment group was 93.0%(80/86) and in the control group was 78.8%(63/80),the difference was statistically significant(P<0.05).The incidence of adverse reactions was no statistically significant(χ²=1.457,P>0.05). Conclusion Sertraline hydrochloride tablets combined with triple therapy can effectivelytreat the depression in Hp positive peptic ulcerpatients,with fewer adverse reactions and a high clinical value.

Curative effect of sertraline hydrochloride tablets on depression in patients with ulcerative colitis

YIN Li-min, ZHANG Zhong-chen, LIU Jin-lin

2016, 14(5): 810-813. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.039

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Objective To investigatethe curative effect of sertraline hydrochloride tablets in the treatment of depression in patients with ulcerative colitis and provide an effective drug intervention for depression. Methods Total 74 patients with ulcerative colitis complicated with depression were randomly divided intoobservation group(42 cases) and control group(32 cases).In addition to support treatment and psychological intervention,the observe group received also sertraline combined and mesalazine,while the control group received only mesalazine.Ulcer colitis activity index(UCAI),depression self-rating scale(SDS) and Hamilton Depression Rating Scale(HAMD) of both groups was evaluated. Results After thetreatment,UCAI,SDS and HAMD scale scores in both groups were decreased as compared with the values before treatment,the differences were statistically significant(t=8.074,8.679,13.269,6.906,3.321,7.604,P<0.05);There was no significant difference in UCAI between the two groups after the treatment(t=0.972,P>0.05).After the treatment,SDS and HAMD scale scores of the observation group were lower than those in the control group(t=3.958,2.945,P<0.05).After the treatment,the total effective rate for ulcerative colitis in the observation group was 71.43%(30/42),and in the control group was 65.63%(21/32),the difference was not statistically significant(χ²=0.286,P>0.05).After the treatment,the total effective rate of depression of the observation group was 78.57%(33/42),and the total effective rate of the control group was 53.13%(17/32),χ²=5.367,P<0.05.During the treatment,the adverse drug reaction rate of the observation group was 19.05%(8/42) and in the control group was 21.88%(7/32),there was no statistically significant difference(χ²=0.090,P>0.05). Conclusion Among the patients receiving mesalazine for ulcer colitis,the administration of sertraline can play good role in the treatment of depression,without increase in the incidence of adverse drug reactions.

The research of life review intervention on psychological status of patients with end-stage cancer application

LIN Hai-yu, HUANG Le-ting, SHI Yang-ru, SHA Wen-na, WANG Wu-ping, ZHOU Xin-hua, LIN Ying, WANG Yi-su

2016, 14(5): 814-816. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.040

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Objective To study the life review intervention,and to improve the psychological status of patients with end-stage cancer effect. Methods Sixty cases of end-stage cancer patients were selected in hospital according to time sequence number,even as the observation group,odd for the control group.Observation group life review method is used to implement the psychological intervention and control group according to the traditional nursing care model,USES the cancer patients quality of life questionnaire,Hamilton depression scale,Hamilton anxiety scale,rosenberg self-esteem scale measurement method for evaluation of two groups of patients before and after the intervention of psychological status. Results The intervention of the observation group and control group patients before the assessment of quality of life scores of each dimension,and the patient’s score difference of depression,anxiety,inferiority complex has no statistical significance(P>0.05).After the intervention,the observation group of physical function,role function,emotional function,cognitive ability,social function,the overall quality of life score were higher than the control group,the t test analysis showed that the differences were statistically significant(P<0.05);After the intervention group of HAMD,HAMA,SES score were significantly lower than the control group,and the difference was statistically significant(P<0.05).After intervention,the ratio of depression,anxiety and inferiority in observation group were 10%,16.7% and 10%，lower than those of in control group(P＜0.05). Conclusion Life review can improve the quality of life of cancer patients with end-stage,improve cancer patients negative psychological mood,anxiety,depression,inferiority complex,has clinical value.

Relationship amongwork-family balance,coping styles andsubjective well-being in ICU nurses

SHAO Ju-qin, ZHOU Yu-yi, ZHANG Hai-yan

2016, 14(5): 817-819. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.041

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Objective To discuss the relationship among the work-family balance,coping styles andsubjective well-being in ICU nurses,provide the basis for the health interventions of nurses. Methods Cluster sampling was used in the study,and 234 clinical nurses was included.Subjective well-being scale,work family balance scale and simple coping style questionnaire were used to survey the study objects. Results Correlation analysis showed that the family intrusionwas negatively correlated with items of satisfaction of life and interests,energy,sad or happy state,behavior and emotion control,relaxation and tension(r＜0,P＜0.05),with the correlation coefficient ranging from -0.261 to -0.127;the family intrusion was negatively correlated with items of subjective well-being(r＜0,P＜0.05),with the correlation coefficient ranging from -0.342 to -0.127.The negative copingwas negatively correlated with items of satisfaction of life and interests,worrying abouthealth,energy,sad or happy state,behavior and emotion control(r＜0,P＜0.05),with the correlation coefficient ranging from -0.357 to -0.157.The family facilitationwas positively correlated with items of satisfaction of life and interests,worrying abouthealth,worrying abouthealth,energy,behavior and emotion control,relaxation and tension(r＞0,P＜0.05),with the correlation coefficient ranging from 0.192 to 0.236.The work facilitationwas positively correlated with items of Subjective well-being(r＞0,P＜0.05),with the correlation coefficient ranging from 0.161 to 0.376.Positive copingwas positively correlated with items of satisfaction of life and interests,worrying abouthealth,worrying abouthealth,energy,behavior and emotion control,relaxation and tension(r＞0,P＜0.05),with the correlation coefficient ranging from 0.185 to 0.324.The multiple regression showed that the influence factors of subjective well-being scores were: title,economic level,children,work family balance and coping styles. Conclusion Clinical nurses and managers should adjust the work-family balance and improve the level of coping styles to improve the ICU nurses subjective well-being.

Analysis of physical examination results of residents in Jishanstreet of Shaoxing city in 2014

JIN Ting

2016, 14(5): 820-822. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.042

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Objective To explore the basic cause and regularity of chronic non communicable diseases(chronic disease)by analyzingthe health examination results,andputs forward countermeasuresforprotection of the health of residents. Methods The health examination results of the residents aged 18 year and over who wanted to join a health insurance program for urban and rural residentsin 2014 were analyzed.The test items included routine blood and urinetest,renal function and liver function,blood lipid,fasting blood glucose,ultrasonic examination of liver and spleen,ECG,bloodpressure,height,weight and waist circumference; and gynecologic examination,uterine appendagesexamination,B-mode ultrasonography examination of pelvis and routine vaginal discharge test in childbearing age women(20-64 years old) of their own accord. Results Total 5 440 in 5 748 individuals in physical examination were with chronic diseases,thetotal prevalence rate was 94.64%(male 93.10% and female 95.87%).The difference in the overall prevalence and the incidence of high blood fat,overweight,hypertension,abnormalityin electrocardiogram,fattyliver,gallbladderdisease,abnormal liver function and high blood sugar were significant between the male and female group(P<0.05).The difference in the overall prevalence and the incidence of high blood fat,overweight,hypertension,abnormality in electrocardiogram,fattyliver,gallbladderdisease,abnormal liver and renal function and high blood sugaramong different age groups were significant(P<0.05).The difference in the incidence of gynecological diseases and disorders among different age groups were significant(P<0.05). Conclusion Chronic diseases were the main influence factors to the health of residents.Theregular physical examination can understand the physical condition of the residents,some comprehensive measures will promote the health of urban and rural residents.

Predictive role of prenasal thickness by prenatal ultrasound test for Down syndrome

BAI Li-li, YE Feng, DONG Xue-qin, XU Xue-qin, MAO Yi-jian, CHEN Xiao-li

2016, 14(5): 823-825,862. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.043

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Objective To detect the prenasal thickness(PT) of fetuses with prenatal ultrasound test,investigate the predictive role of prenasal thickness for fetuses with Down syndrome,and determine the multiples of the median(MoM) value of PT in ultrasonic examination,and assess the clinical value of PT in screening for Down syndrome fetuses. Mesthods PT was measured in normal and DS fetal at 16-25 weeks of gestation in our hospital from June,2012 to June,2014.The Student’s t-test or Wilcoxon rank sum test was used to compare the mean difference between the two groups.Spearman’s Rank-order Correlation was implemented to determine the correlation of two variables.The MoM(PT) value of two groups was calculated by using a quadratic model for the Trisomy risk assessment.The sensitivity,specificity,positive and negative predictive value,positive and negative likelihood ratio were observed. Results The average PT in the normal group was (3.51±0.91)mm,and in the DS group was (5.16±0.79)mm,the difference was statistically significant(t=12.23,P<0.05) PT increased with the gestational age.MoM(PT)values in DS and unaffected pregnancies were 1.371 and 1.010 MoM,respectively.Using PT alone for screening of DS,the false positive rate was 5% and the sensitivity was predicted to be 58%,the positive predictive value was 0.46,the negative predictive value was 0.97,the positive likelihood ratio was 11.63,the negative likelihood ratio was 0.44;When combining of PT with high risk age,the false positive rate was 5% and the sensitivity was increased to 75%,the positive predictive value was 0.52,the negative predictive value was 0.98,the positive likelihood ratio was 14.94,the negative likelihood ratio was 0.26. Conclusion PT is considered as the effective sonographic marker to screen Down syndrome in the second trimester.PT of fetuses with Down syndrome is thicker than that of the unaffected pregnancies.The combination of PT and pregnant women age will obviously increase the detection rate of Down syndrome fetus.When the risk cut-off levels are > or =1 in 250 for Down syndrome,the invasive examination should be performed.

A primary research of sound velocity tissue quantification in nonalcoholic fatty liver disease

HUANG Guo-qing, YUAN Hua-qin, WU Jun, GAO Feng, XU Hong-en

2016, 14(5): 826-827,857. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.044

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Objective To evaluate the feasibility and clinical application of sound velocity matching tissue quantization(SVQ) quantitative evaluation of non-alcoholic fatty liver disease(NAFLD) feasibility and clinical value. Methods Nonalcoholic fatty liver cirrhosis in 22 patients were confirmed by liver biopsy or clinical data,30 healthy subjects were selected as the control group,two groups of patients with no significant difference between general information and two groups of patients were collected clinically relevant information on the two groups of patients to detect the speed of sound to match tissue to quantify the value of the acquisition to match the speed of sound(ZSI),calculate the speed of sound organization(SV) and tissue sensitivity curve(ROC),an average of five times the acquisition,calculate averages,calculate the area under the curve(AUC) and Youden index based on the information collected and determine the threshold(cutoff),determine the sensitivity of the critical value,specificity,positive likelihood ratio(LR⁺),negative likelihood ratio(LR^-). Results The general information on age,height,weight and other data were no statistically significant differences in the two groups(P>0.05).Observation group were BMI,and SV are present ZSI significantly compared with the control group,the difference was statistically significant(P<0.01).Diagnosis of NAFLD using SVQ related cirrhosis,area under the curve of 0.921.In SV=1 587 m/s as a cutoff value,and calculate the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,the value was 92.3%,80%,4.615,0.1. Conclusion Matching tissue to quantify the speed of sound technical evaluation of non-alcoholic fatty liver disease has a high diagnostic value,and has certain specificity and good clinical value,worthy of promotion.

LU Yue-zhong, MAO Xin-feng, SHEN Xiao-yong, LI Xiong-feng

2016, 14(5): 828-830,849. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.045

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SUO Yan-feng, ZHU Yan-bo, LU Jia

2016, 14(5): 831-834. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.046

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ZHANG Pan, LOU Pei-an

2016, 14(5): 835-837. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.047

126 1

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MENG Bei, YANG Xiu-mu

2016, 14(5): 838-840,871. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.048

138 2

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Effects of acupuncture treatment on collateral circulation and Rehabilitation of limb function in patients with acute cerebral infarction caused by middle cerebral artery occlusion

LUO Kai-tao, ZHU Jia-hao, XU Ying-mei, FAN Di-hui, NI Chun-chu

2016, 14(5): 841-843. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.049

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Objective To observe the effects of acupuncture treatment on collateral circulation and rehabilitation of limb function in patients with acute cerebral infarction(ACI) caused by middle cerebral artery(MCA) occlusion. Methods Eighty patients who met the inclusion criteria were randomly divided into control group (n=40) and treatment group(n=40).The treatment group received regular treatment with acupuncture treatment,while the control group received only regular treatment.The patients in the treatment group was acupunctured with Quchi,Sousanli,Neiguan,Hegu,Liangqiu,Xuehai,Zusanli,Yanglinquan,Yinlingquan,Xuanzhong,Qiuxu,Sanyinjiao,Taichong,Baihui and Sishencong for two courses,once a day,six days were for a course,then broke one day.The transcranial Doppler(TCD),Simplify Fugl-meyer motor function assessment and Modified Barthel Index were used to compare the collateral circulation situation and rehabilitation of limb function between the two groups. Results ①After the treatment,the collateral compensative capacity(peak systolic velocity,PSV) of the ipsilateral anterior cerebral artery(iACA) and contralateral MCA(cMCA) in both groups were improved(P<0.01),and the treatment group was significantly as compared with the control group(P<0.01);but there was no significant difference in iVPCA/cVMCA between the two groups after the treatment(P>0.05);②Scores of SFM assessment increased significantly in both groups,while the treatment group was more significant(P<0.05);③Both groups had significant improvement with MBI,and the treatment group improved more than the control group(P<0.01). Conclusion Acupuncture can improve the collateral compensative capacity,promote rehabilitation of limb function,and improve activities of daily living in patients with acute brain infarction caused by middle cerebral artery occlusion,this method is worth of promotion in clinical practice,but the effects of acupuncture for different cerebral infarction should be further studied.

Application of CBL with based PBL in teaching of clinical oncology

WU Qiong, SU Fang

2016, 14(5): 844-846. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.050

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In recent years,with the rapid development of the basic subjects,the traditional teaching methods cannot adapt to the new development in teaching of clinical oncology.In order to improve the teaching quality and adapt the new development situation and the transformation of medical model,new teaching method is needed to be used in clinical oncology teaching.PBL teaching method is a new teaching method which based on clinical cases and with problems as the guide;the teaching mode is submit questions first and then teach the content.This method guide the students to tackle problems through their independent inquiry and cooperation,it emphasizes the students’ subjective initiative,develop the ability to solve problems and the ability of autonomous learning.PBL teaching method is helpful to strengthen the training of students’ comprehensive quality.PBL teaching method also put forward higher requirements for teachers,promote teachers to strengthen the business level,expand the knowledge field,make the teachers’ knowledge structure to be more perfect and knowledge update more quickly,lead to an further improvement in teaching level.But the implement time of PBL teaching method in our country is not long,and is subject to the limits of our country’s education system,it is still a kind of new teaching method,in the exploratory stage and not formed mature system model,many teachers are insufficient understanding of PBL teaching mode.This article expound the application of the PBL teaching method in clinical oncology from these aspects:the application of PBL teaching method in medical education,the advantages compares to traditional teaching method,the concrete teaching scheme,the existing problems and solutions.By using new teaching methods in clinical oncology,it will achieve the objective of replacing traditional teaching mode by quality education mode,and cultivate excellent doctors to meet the needs of clinical oncology.

Effect of mutual-aid training mode on nursing skills and quality of Chinese medicine nurses

LI Hua, ZHANG Xu-ping, JIANG Ping, ZHOU Xiao-fang

2016, 14(5): 847-849. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.051

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Objective To explore the effect of mutual-aid training mode on nursing skills and quality of Chinese medicine nurses. Methods Thirty Chinese medicine nurses working at Department of Traditional Chinese Medicine in our hospital were randomly divided into two equal groups,control group and experimental group.Control group received conventional training mode and experimental group received mutual-aid training mode.Nursing assessment score,nursing quality score and satisfaction degree in the two groups was compared and analyzed. Results The nursing assessment score (72.1±7.8) points and nursing quality score (92.1±7.3) points in the experimental group after training were obviously higher than that in the control group (62.3±7.4) points and (84.3±8.2) points,the difference was statistically significant(P<0.05).The satisfaction degree in the experimental group (93.33%) was significantly higher than that in the control group(53.33%),P<0.05. Conclusion Mutual-aid training mode applied in Chinese medicine nurses shows significant training effect in the nursing knowledge and skill training,improves nursing operation skills and nursing quality to varying degrees,increases satisfaction degree,has a high nursing safety,harmonizes the nurse-patient relationship,enhances nurse’s knowledge and technology,promotes the cooperation between physicians and nurses,and is of great significance,which indicate wide clinical application.

Analysis of the effect oftransitionalcare for the discharged elderlypatients in Wuhan

ZHANG Qian, MA Hong-mei, ZHANG Shuang, XU Xu, LIAO Chun-xia

2016, 14(5): 850-853. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.052

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Objective To explore the effect of transition care for discharged elderly patientson their quality of life,satisfaction and readmission rates. Methods Total 92 old patientsin two tertiary hospitals inWuhan were chosen and divided into two groups according to the random number table before the discharge.There were 46 people in control group and 46 people in experimental group.Both groups received the same general nursing,while the experimental group received additionalindividual transition care according to the situation of the rehabilitation through telephone follow-up on 1st,2nd,4th and 6th after the discharge.All participants were investigated by the questionnaire of quality of life scale(QOL-BREF) and the nurse satisfaction on the discharge day and the second and sixth mouth after the discharge.All the data were analyzed by using t test and χ² test. Results There were no significant difference in the scores of the elderly’s quality of life(t=-1.199,P=0.234),the satisfaction of the nursing(t=0.803,P=0.424) and the rate of readmission(0,0) on the discharge day and so did the second mouth(t=-1.695,P=0.100;t=-0.143,P=0.887;t=3.079，P=0.079),between the two groups,but the scores on the sixth mouth after the discharge in the experimental group were significantly higher than those in the control group(t=-6.893,P=0.000;t=-3.499,P=0.001;t=7.397,P=0.007),P<0.05. Conclusion Transitionalcare can effectively improve the quality of life in elderly after discharge,decrease the readmission rates,reduce the use of medical resources,andincrease patients satisfaction with the nursing care.

Prevention effect of evidence-based nursing on venous thrombosis after gynecological laparoscopic surgery

SHEN Li-fang, HU Fei-hong, CHEN Ying

2016, 14(5): 854-857. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.053

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Objective To investigate the preventive effect of evidence-based nursing on postoperative venous thrombosis in patients undergoing gynecological laparoscopic surgery. Methods Total 300 cases of gynecologic laparoscopic surgery patients from August,2014 to March,2015 were divided into two groups by random, parallel and double blind methods.The control group was treated with routine nursing; the observation group was treated with evidence-based nursing, and the main measures were preoperative Autar assessment, cognitive intervention, mechanical prevention and etc.The two groups were compared of prevention knowledge of postoperative venous thrombosis, lower extremity discomfort, the occurrence of venous thrombosis and nursing satisfaction. Results the knowledge scores of venous thrombosis after operation in the observation group was 89.51±12.78 significantly higher than 75.14±18.54 in the control group, and the incidence of lower limb swelling, lower limb pain, and shallow vein in the observation group was 10.7% lower than 30.0% in the control group, the difference was statistically significant(t=10.23,χ²=12.51,P<0.05).The lower extremity deep venous flow velocity in the observation group was (25.53±3.47) cm/s faster than (20.14±2.51) cm/s in the control group,the diameter of vein thrombus was 2.0% less than 6.7% in the control group,the incidence of venous thrombosis was (0.23±0.09) cm lower than (0.42±0.12)cm in the control group, the difference was statistically significant(t=4.05,χ²=3.94,t=2.17,P<0.05).Nursing satisfaction in the observation group was 96.0% higher than 90.0% in the control group,the difference was statistically significant(t=15.30,18.49,20.41,12.45，χ²=5.14，P<0.05). Conclusion Evidence based nursing can effectively reduce the incidence of venous thrombosis after gynecological laparoscopic surgery, and avoid postoperative nursing risk.

Effect of standardized nursing care on protection of skin from radiation lesions in breast cancer patients

SHEN Yong-ju, WENG Jian-xia, GE Yun-rong, HU Shan-shan, WANG Ying-ying

2016, 14(5): 858-859. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.054

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Abstract:
Objective To investigate the effect of standardized nursing care on protection of skin from radiation lesions in breast cancer patients. Method Total 165 breast cancer patients with postoperative radiation-induced skin reactions were enrolled and divided into observation group(83 cases) and the control group(82 cases).There was no significant difference in the age and other baseline information between the two groups.The control group received the routine postoperative nursing for breast cancer,while the observation group received the standardized nursing care based on the routine nursing,which included skin care,diet guidance,health education and psychological counseling.The overall efficacy,nursing efficiency and QLQ-C30 scores were observed and compared between the two groups. Results There no significant difference in the ratio of radiation-induced skin between the two groups.After the nursing intervention,the improvement of skin reactions in the observation group was significant better than the control group(64.63% vs. 79.51%),P<0.05).Two overall health score of QLQ-C30 scale in patients with nursing in nursing after than before obviously increased.At the same time as compared with the control group,the observation group nursing after the score improved more obviously(P<0.05).The overall health score in both groups were improved after the nursing intervention,especially in the observation group(P<0.05). Conclusion The standardized nursing care can effectively improve the quality of life of patients with breast cancer undergoing the radiotherapy.

MO Hong, HU Jing, CAO Hong-xia

2016, 14(5): 860-862. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.055

160 1

Abstract:

CHANG Yan, ZHANG Hai-li, MA Yan, ZHAO Feng-juan, SHI Yu-xin

2016, 14(5): 863-865. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.056

130 1

Abstract:

LIAO Nan-sheng, LIN Feng

2016, 14(5): 866-868. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.057

132 0

Abstract:

CHEN Bo-jun

2016, 14(5): 869-871. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.058

106 0

Abstract:

YE Gao-feng

2016, 14(5): 872-874. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.059

106 0

Abstract:

JI Zheng, LIN Su, ZHOU Chang-zuan, XU Fu-kang, SUN Yong, GUO Yan, PAN Sun-lei, HE Yi-ping, XING Yang-bo, PENG Fang, GUO Hang-yuan

2016, 14(5): 875-878. doi: 10.16766/j.cnki.issn.1674-4152.2016.05.060

123 0

Abstract:

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2016 Vol. 14, No. 5

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