中华全科医学

Current status of family doctor service system undertaking in Beijing suburban areas: focus group interviews with general practitioners

ZHANG Dan-dan, WANG Tong, JIN Guang-hui, SHAO Shuang, DU Juan

2016, 14(9): 1425-1428. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.001

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Objective As family doctor service has been carried out for approximately five years in Beijing,while the study of family doctor service mainly focus on current situation,pattern and incentive mechanism in Beijing urban area,little research is available in suburb area.Therefore,in order to provide reasonable countermeasures and suggestions to promote the development of family doctor service in Beijing suburb areas,related interviews were conducted for some general practitioners,which is helpful for us to know the current situation of the family doctor service. Methods Sixteen general practitioners(GPs),from ten suburb community health service institutions of Beijing,were interviewed in the form of focus group interviews from November,2014 to January,2015,and interview data were coded,classified,streamline,so as to sum up the interview subjects. Results From the interview,the family doctor service condition has been revealed:Family doctor service content can't meet the need of the patient,which causes the patient's low recognition to the family doctor service.Related policies for family doctors service system were still needed to be strengthened.Low incomes lead to the short of the community health workers,the family doctor service increases daily work.In suburb areas,the mainly way of signing contract in the family doctor service is home signing,and the mainly way of serving is providing regular patrol medical service.In suburb areas,rural doctors play an important role in family doctor service team,the staff who provide prevention and healthcare can't play an efficient role.The family doctor service fails to reach the expected effect;however,the relationship between doctors and patients has been improved. Conclusion In order to develop the Beijing suburb family doctor service,the rural doctor should play their efficient role;we should strengthen the proper publicity and guidance on family doctor service system;optimize the content of family doctor service system,meet the demand of the key crowd;and improve the matching policies of family doctor service system continuously to promote the development of suburban family doctor service.

ZHANG Shi-fa, QIN Dao-jian, MAO Shuang-gen

2016, 14(9): 1429-1430.

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Analysis of TP53 gene mutation and its intratumoral heterogeneity in esophageal squamous cell carcinoma

JIANG Ye, CHANG Chen, MA Sai, PAN Bei-qing, ZHANG Yu, XU Xin, CAI Yan, WANG Ming-rong, HAO Jia-jie, LI Min

2016, 14(9): 1431-1434. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.002

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Objective To explore the correlation between TP53 gene mutation heterogeneity state of esophageal squamous cell carcinoma(ESCC) tumor and clinicopathologic features. Methods The primary tumor of Esophageal Squamous Cell Carcinoma(ESCC) and its operational end cutting issues were prepared.PCR and direct sequencing were performed to detect TP53 gene exon No. 2-11 mutation status and assesse the correlation of TP53 gene mutation and clinicopathological parameter of 4 different locations of tumor lesions and its intratumoral heterogeneity. Results Among 30 cases of Esophageal Squamous Cell Carcinoma(ESCC) tumors,18 cases were with TP53 mutations with a proportion of 60%(18/30),which including 16 cases of point mutations,3 cases of nonsense mutations,13 cases of missense mutations,and 2 cases of deletion mutation that lead to frame shift.Most mutations were focused on the TP53 gene No. 5-8 exons,while No. 5 was with the highest mutation rate of 23.3%(7/18).The 282th exons codon mutation(R282W) was found in 2 cases,175 exons codon mutations(R175H) in 3 cases.By comparing the ratio of mutant allele peak height and normal allele peak height(relative intensity,RI),we found that there was obvious differences in 4 tumor location RI in 12 of 16 cases,the remaining 4 cases were also with different location RI. Conclusion The high frequency of TP53 gene mutation in esophageal squamous cell carcinoma(ESCC) and each tumor is with different degree of intratumoral heterogeneity.

Value of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of mediastinal or lung malignant lesions and prediction of target therapy in lung cancer

LI Wei, ZHANG Ting, GAO Hua, LIU Chao, CHEN Yu-qing, HUANG Li-nian, QI Xue-yuan, WU Jing, WANG Xiao-jing

2016, 14(9): 1435-1438. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.003

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Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) in mediastinal or lung malignant lesions and the prognosticate value of target therapy in lung cancer. Methods Retrospective clinical trial of 91 consecutive patients with enhanced lymph node or mass in the mediastinum,with or without pulmonary lesions non-diagnosis by routine electronic bronchoscope were included in this study between May,2012 and December,2015.The samples were obtained from the lesions using EBUS-TBNA.EGFR mutation in 24 EBUS-TBNA samples was detected.The numbers of final diagnosis,the features of ultrasonic and complication were recorded. Results Two hundred and twenty-seven lymph nodes and twenty-three masses were sampled by EBUS-TBNA in 91 malignant patients.The subcarinal nodes and right lower paratracheal lymph node accounted for 44.2%(304/692)and 31.5%(218/692);86 patients were confirmed by EUBS-TBNA.The overall sensitivity,specificity and accuracy of EBUS-TBNA were 94.5%,100.0% and 94.5%,respectively.The diagnosed cases included 48 cases lung adenocarcinoma(55.8%),23 cases of small lung cancer(26.7%),6 cases of squamous cell carcinoma(7.0%),5 NSCLC(5.8%),and 5 cases of non-small lung cancer unable to type;the metastases from extrapulmonary included 1 case of cervical cancer,1 case of colon cancer,1 case of esophageal cancer and 1 case of renal carcinoma.The round lymph nodes (L/S<1.5),heterogeneous,clear boundary,absence of the lymph door structure and irregular blood supply were the common phenomenon of malignant lesions for ultrasound image.EGFR mutation rate of EBUS-TBNA specimens was 70.8%,the mutation rate of tissue specimens was 63.6%(7/11),and the mutation rate of liquid cytology was 76.9%(10/13).The positive rate between two specimens showed no significant difference(χ²=0.509 1,P=0.47);Minor complications were found in 17 cases. Conclusion EBUS-TBNA was not only a minimally invasive,safety and effective diagnosis technique for mediastinal or lung malignant lesions but also an ideal tool for prediction of target therapy in lung cancer.

Affection of 8 weeks aerobic exercise on sleep quality and emotional impact in patients with acute myocardial infarction

YU Zhi-hong, ZHU Li-yue, YAN Ting, ZHOU Jian-mei

2016, 14(9): 1439-1441. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.004

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Objective To observe the affection of 8 weeks aerobic exercise on sleep quality and emotional impact in patients with acute myocardial infarction(AMI). Methods Total 60 cases of AMI undergoing PCI were enrolled and randomly divided into exercise group and control group with 30 cases in each group.The control group received the routine drug therapy,while the exercise group received additional cardiopulmonary exercise testing on the basis of the routine drug treatment,and individualized exercise prescription for 8 weeks aerobic exercise with 20%-59% of their heart rate reserve.PSQI,SAS and SDS were used to assess the sleep quality and emotional evaluation before and after the treatment. Results The total PSQI scores in the exercise group decreased by 3.16(P<0.01),which was obviously lower than that in the control group(P<0.05);the score for items such as subjective sleep quality,sleep latency,sleep sustainability,habitual sleep efficiency,sleep disorders,use of sleep medicine and daytime dysfunction were all decreased significantly(P<0.01).The score for SAS and SDS in the exercise group decreased by 9.07 and 12.06,respectively(P<0.01),that was lower than that in the control group(P<0.01). Conclusion The 8 weeks low-to moderate-intensity cardio exercise can be safe and improve the sleep quality and anxiety in AMI patients undergoing stenting operation.

The relationship between the expression of ezrin protein,IL-18 and the survival of osteosarcoma pulmonary metastasis

NI Zhe, SHANG Xi-fu, SUN Yong-jin

2016, 14(9): 1442-1444. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.005

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Objective To investigate the relationship between the expression of ezrin protein,IL-18 and the survival of osteosarcoma pulmonary metastasis. Methods Forty-four patients with osteosarcoma specimens were selected and the expressions of ezrin protein and IL-18 in the tissue of osteosarcoma were detected by immunohistochemical.All patients were followed up for 3 years.The survival and progress of the disease were recorded. Results Ezrin positive expression rate(76.47%) in Preoperative patients with pulmonary metastasis were higher than preoperative patients without pulmonary metastasis(29.63%),and the differences was statistically significant(P<0.05).Preoperative patients with pulmonary metastasis and ezrin expression positive in the process of follow-up of 6 cases with pulmonary metastases,lung transfer probability is 75.00%,higher than that of preoperative patients without pulmonary metastasis and the expression of ezrinnegative,and the differences was statistically significant(P<0.05).IL-18 positive expression rate(64.71%) in Preoperative patients with pulmonary metastasis were higher than preoperative patients without pulmonary metastasis(37.04%),and the differences was statistically significant(P<0.05).In patients with pulmonary metastasis preoperatively,IL-18 masculine and feminine emerged during the follow-up of patients with pulmonary metastasis rate were 40.00% and 47.06%,respectively,and the differences had no statistically significant(P>0.05).Ezrin positive expression of 3 year survival rate was significantly lower in patients with negative expression of patients,and the differences was statistically significant(P<0.05).IL-18 positive expression of 3 year survival rate was significantly higher in patients with negative expression of patients,and the differences was statistically significant(P<0.05). Conclusion Ezrin protein expression and IL-18 positive related to the progress and pulmonary metastasis of osteosarcoma.

Value of miR-224 for detection of HCC at early stage

LIN Ling, LU Bao-chun

2016, 14(9): 1445-1448. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.006

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Objective To discuss the clinical value of miR-224 in the diagnosis of HCC at early stage. Methods Two cohorts of 335 subjects,including early-stage HCC,liver cirrhosis(LC),chronic hepatitis B(CHB) and healthy controls(HC),were enrolled,and the area under the curve(AUC) were calculated for miR-224 alone or in combination with AFP to evaluate the sensitivity and specificity in diagnosing HCC at early stage. Results The serum miR-224 in early-stage of HCC patients increased significantly as compared with LC,CHB and HC patients,however,it decreased significantly after surgical treatment;the serum miR-224 was positively correlated with that in the tumor tissue.ROC analysis demonstrated that the AUC for serum miR-224 was 0.880(95%CI:0.838-0.923;sensitivity was 86.5%,specificity was 76.7%) in discriminating early-stage HCC from all controls(LC,CHB and healthy controls),higher than that for AFP(AUC=0.700,95%CI:0.633-0.767;sensitivity was 71.9%,specificity was 63.7%),P<0.01.Moreover,serum miR-224 still had a better performance than AFP in discriminating HCC from the disease controls including LC and CHB,or from either of the both.When two markers(miR-224 and AFP) were used together,the diagnostic accuracy increased significantly as compared with either marker alone. Conclusion The serum miR-224 is a potential biomarker for detecting early-stage HCC,with better performance than AFP,and correlates positively with that in the tumor tissues,thus probably reflecting the development and progression of HCC.

Effect of low molecular weight heparin on preventing inferior vena DVT in diabetic patients after laparoscopic surgery

YAN Mei-juan, LOU Xiao-kan, WU Jia

2016, 14(9): 1449-1452. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.007

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Objective To explore the effect of low molecular weight heparin(LMWH) on preventing inferior vena deep venous thrombosis(DVT) in diabetic patients after laparoscopic surgery. Methods Total 100 patients with type 2 diabetes which were prepared for laparoscopic surgery were divided into 2 groups randomly.The non-LMWH group was given conventional surgery,while the LMWH group was injected abdominal subcutaneous LMWH.The fasting blood of patients was extracted both before and after surgery,and the platelet functions(PLT,MPV,PCT,CD62p,vWF),coagulation-fibrinolytic function(PT,APTT,Fib,AT-Ⅲ,t-PA,PAI-1) and hemorheology(whole blood viscosity,plasma viscosity,HCT,RBCAI) were detected.At the same time,50 patients without diabetes which were prepared for laparoscopic surgery were selected as the control group for comparative study. Results The DVT incidence of non-LMWH group was higher than that of the LMWH group and the control group(P<0.05),while there was no significant difference between LMWH group and the control group(P>0.05).Before surgery,there was no significant difference in PLT,MPV,PCT,CD62p,vWF,whole blood viscosity,plasma viscosity,HCT,RBCAI,Fib,AT-Ⅲ,PAI-1 or t-PA level between the LMWH group and non-LMWH group(P>0.05);and AT-Ⅲ and t-PA were both lower than those of the control group,the others were all higher than those of the control group(P<0.05).After surgery,the AT-Ⅲ and t-PA level of all the groups decreased,and the non-LMWH group was lower than the LMWH group,the LMWH group was lower than the control group;the others of all the groups increased,and the non-LMWH group was higher than the LMWH group,the LMWH group was higher than the control group,all the difference between groups had statistical significance(P<0.05). Conclusion The platelet function,coagulation-fibrinolytic function and hemorheology of patients with diabetes was different from normal individuals,which lead to high incidence of postoperative DVT after laparoscopic surgery,and LMWH can make a protective effect,which has higher application value.

The effect of neureglin on the morphology and structure of brain tissues after cerebral ischemia reperfusion injury in rats

GU Ning, JI Ya-qing, ZHANG Rui, HAO Cui, LI Hong-yun, GUO Yun-liang

2016, 14(9): 1453-1456. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.008

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Objective To study the effect of neuregulin 1β(NRG1β) on the morphology and structure of brain tissues after cerebral ischemia and reperfusion injury in rats. Methods A focal cerebral ischemic model was established by inserting a monofilament thread to achieve middle cerebral artery occlusion(MCAO),and the rats were randomly divided into 5 groups:the sham operation group,the model group,the treatment group,the inhibitor group,the inhibitor plus treatment group.The intervention treatment was performed by internal carotid artery injection of 5 μl (2 μg/kg) NRG1β.The regional cerebral blood flow(rCBF) was measured by Laser Doppler flowmeter(LDF).The cerebral infarct volumes were determined by triphenyl tetrazolium chloride(TTC) staining.The morphology of cortical brain tissues was observed by hematoxylin-eosin staining.The expression of pERK5 was evaluated by immunohistochemical assay.The ultrastructure of blood-brain barrier was detected by transmission electron microscope. Results After cerebral ischemia,the rCBF of rats significantly dropped to no more than 30% of the baseline,while after the reperfusion,the rCBF returned to more than 80% of the baseline.In model group,the damage of cortex infarctions,nerve cells and neurons structure was aggravating,and the expression of pERK5 protein compensatorily enhanced after cerebral ischemia reperfusion injury.Compared with the model group,the expression of pERK5 protein further enhanced(P<0.05),the damage of nerve cells alleviated,cerebral infarction volume shrank(P<0.01) in the treatment group.In the inhibitor group,cortex nerve cell seriously damaged,the expression of pERK5 protein significantly decreased,the cerebral infarction volume significantly increased,and the cortex nerve cell was seriously damaged.Compared with the inhibitor group,the expression of pERK5 protein in the inhibitor plus treatment group obviously increased(P<0.01),the nerve cell seriously damaged,the volume of cerebral infarction significantly reduced(P<0.001). Conclusion NRG1β may play a neuroprotective role through activating the ERK5 signaling pathway to improve the morphology and ultrastructure of brain tissue infarction area.

Correlation analysis of aplastic anemia and T cell subsets and regulatory T cells

WANG Wen-song, QIAN Mei-hua, WANG Man-ling, YANG Tian-xin, LAN Jian-ping

2016, 14(9): 1457-1459. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.009

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Objective To analyzed T cell subsets and regulatory T cells of aplastic anemia patients,and discuss the relationship between aplastic anemia and T cell subsets and regulatory T cells. Methods Thirty cases of aplastic anemia(aplastic anemia group) were assigned into severe aplastic anemia group and non-severe aplastic anemia group,while 30 normal subjects were recruited as control group.The peripheral blood CD4⁺CD25⁺ regulatory T cells and T cell subsets expression was compared among the three groups. Results The expressions of peripheral blood CD4⁺CD25^high and CD4⁺CD25⁺CD127^low in aplastic anemia group were lower than those in the control group(P<0.05),but CD4⁺CD25⁺CD127^high was higher than that in the control group(P<0.05).The peripheral blood CD3⁺CD4⁺ and CD4/CD8 in aplastic anemia group were lower than those in the control group(P<0.05),but CD3⁺CD8⁺ was higher than that in the control group(P<0.05).The expression of peripheral blood CD4⁺CD25^high and CD4⁺CD25⁺CD127^low in the severe aplastic anemia group were lower than non-severe aplastic anemia group(P<0.05),but CD4⁺CD25⁺CD127^high was higher than non-severe aplastic anemia group(P<0.05).The peripheral blood CD3⁺CD4⁺ and CD4/CD8 of severe aplastic anemia group were lower than non-severe aplastic anemia group(P<0.05),while the peripheral blood CD3⁺CD8⁺ of severe aplastic anemia group were higher than non-severe aplastic anemia group(P<0.05). Conclusion T cell subsets and regulatory T cells of aplastic anemia patients are abnormal.The pathogenesis and severity of aplastic anemia may be correlation with T cell subsets and regulatory T cells.

Effect of intensity modulated radiation therapy(IMRT) on the serum levels of TGF-1,IL-8 and T-lymphocyte subsets in patients with nasopharyngeal carcinoma

SONG Xian-lu, YU Yi, LIAO Zhi-wei, HUANG Wen-jin, ZHOU Tong-chong

2016, 14(9): 1460-1462. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.010

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Objective To investigate the effects of intensity modulated radiation therapy(IMRT) on the serum levels of TGF-1,IL-8,and T-lymphocyte subsets in patients with nasopharyngeal carcinoma. Methods One hundred and fifteen patients with nasopharyngeal carcinoma were divided into the control group(n=57) and the observation group (n=58) according to the radiation therapy,and the patients were treated with conventional two-dimensional radiotherapy and IMRT.Comparison of two groups of patients with 5 year survival rate and recurrence,adverse reactions,the serum levels of TGF-β1,IL-8,and T lymphocyte subsets were compared before and after treatment. Results ①patients in the observation group showed no regional recurrence survival rate and disease-free survival rate were significantly higher than those in control group(P<0.05),the observation group of patients with local recurrence rate was significantly lower than the control group(P<0.05),observation group of patients with distant metastasis free survival rate was slightly higher than that of control group(P>0.05);②adverse reactions in the control group in the process of radiotherapy in patients with the total incidence rate was 40.35%(23/57),the observation group was 34.48%(20/58),there was no significant difference in the adverse reactions between the two groups(P>0.05);③the serum TGF-beta 1,and IL-8 levels in the two groups of patients after treatment were significantly lower than those before treatment(P<0.05-0.01),and in the observation group,the index level decreased significantly than the control group(P<0.05);④the CD3,CD4 and CD4/CD8 levels in the two groups of patients after treatment were significantly higher than before treatment (P<0.05),CD8 levels after and before treatment were both significantly decreased(P<0.05). Conclusion The effect of IMRT on nasopharyngeal carcinoma is significant,which may be achieved by improving the level of serum TGF-β1,IL-8,and T lymphocyte subsets in patients with nasopharyngeal carcinoma.

Clinical analysis of 80 cases of senile knee osteoarthritis treated with arthroscopic debridement combined with sodium hyaluronate injection

XU Xin, DONG Yun, XU Hua, CHENG Jian-ming

2016, 14(9): 1463-1465. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.011

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Objective To study the clinical effect of arthroscopic debridement combined with sodium hyaluronate injection for senile knee osteoarthritis(KOA). Methods A total of 80 senile patients with KOA from February,2013 to February,2014 were randomly divided into the control group(n=36)and the experiment group(n=44),the patients in the control group received single arthroscopic debridement treatment,and the patients in the experiment group received arthroscopic debridement combined with sodium hyaluronate injection.The differences of clinical efficacy rate,the recurrence rate,IL-1 level in synovial fluid and serum nitric oxide level,the score by Lysholm Knee Scoring Scale before treatment,3 months and 12 months after the treatment were compared between the two groups. Results The clinical efficacy rate in the experiment group was significantly higher,the recurrence rate was significantly lower when compared with the control group(P<0.05).The difference in the level of IL-1 in synovial fluid and serum nitric oxide before the treatment were no significant(P>0.05),but decreased after the treatment,especially in the experiment group(P<0.05).There was no significant in the difference of Lysholm score before the treatment(P>0.05),but at 3 months and 12 months after the treatment the Lysholm score in both groups increased,especially in the experiment group(P<0.05). Conclusion Arthroscopic debridement combined with sodium hyaluronate injection can improve the effect of senile knee osteoarthritis,which may be associated with the change IL-1 and NO levels.

Effect of atorvastatin on postischemic angiogenesis in diabetic rats with middle cerebral artery occlusion

HU Yi-kui, YE Heng-tai, SHEN Wei, WANG Lan, LI Cheng-yan, WANG Xun

2016, 14(9): 1466-1469. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.012

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Objective To study the effect of atorvastatin on postischemic angiogenesis in diabetic rats with middle cerebral artery occlusion(MCAO). Methods Thirty six male SD rats were randomly divided into normal control group(NC),hyperglycaemia model group(DM) and atorvastatin-treated groups(DM+AT) with 12 rats in each group. The streptozotocin-induced rat model of diabetes mellitus was developed in DM and DM+AT groups.Then the rats in all three groups underwent ligation and excision to induce unilateral carotid artery ischemia(MCAO model).The rats in DM+AT group were given atorvastatin 10 mg/kg.d by gastric infusion for 2 weeks,while in DM group given normal saline for 2 weeks.During the period,the rats freely drank the water and taken food,without hypoglycemic medications.All rats were sacrificed on 15th day and the expression of VEGF,Ⅷ factor and microvessel density(MVD) were detected by immunohistochemical staining. Results The cerebral infarction scores for the NC,DM and DM+AT groups were (15.7±2.8)%,(23.2±2.1)% and (19.3±2.5)%,respectively;MVD for the NC,DM and DM+AT group was 8.1±0.52,6.4±0.38 and 2.4±0.18,respectively;the serum VEGF levels for the NC,DM and DM+AT groups were 2.1±3.3,18.7±2.3 and 13.8±2.7,respectively;the serum Ⅷ factor levels for the NC,DM and DM+AT groups were 10.2±2.8,8.3±1.7 and 6.3±1.3,respectively.The difference were all significant(P<0.05). Conclusion High blood sugar can inhibit the postischemic angiogenesis,and atorvastatin,through adjusts the expression of VEGF and Ⅷ factor,may improve the conditions.

Accumulated renal damage due to repeat extracorporeal shock wave lithotripsy in rabbits

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

2016, 14(9): 1470-1472. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.013

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Objective To establish the accumulated kidney damage animal model induced by multiple and Repeat extracorporeal shock wave lithotripsy(ESWL),explore the digital times-effect relations between ESWL and accumulated kidney damage,and guide the clinical treatment of renal calculi hope to reduce renal damage and prevent severe renal function damage. Methods A total of 72 male adult rabbits were randomly divided into 6 groups according to the times of ESWL.The renal pelvis or calyx(on the basis of real-life condition of recurrent kidney stones) was randomly selected to perform ESWL with HK.ESWL-V lithotripter.The levels of Cr,GGT and NAG in urine were tested before and after ESWL.The renal arterial resistive index(RI) was measured with color Doppler flow imaging(CDFI) before and after ESWL. Results ①The levels of urine Cr,r-GT and NAG increased in all trial groups,and increased gradually with ESWL times.There was significant difference in urine Cr,r-GT and NAG between the trial groups and control group.②ESWL increased the resistance of renal blood flow,which was significant difference between each experimental group(P<0.001).The average renal vascular resistance index(RI) increased with ESWL times. Conclusion The characteristics of recurrent stone positions changes can be accurately and veritably simulated by using rabbits ESWL random site model.The multiple and repeat ESWLs can cause penetrating damage on kidney with fiberization accumulatively.The times of ESWL to ipsilateral kidney should be strictly controlled according to the clinical indications.The parameters of ESWL should be changed based on the feature of stones to prevent the accumulated damage of kidney due to ESWL and protect renal function as possible.

Effects of different anesthesia on S100β protein and postoperative cognitive dysfunction in elder patients undergoing colorectal cancer resection

BIAN Bu-rong, GAO Jing, LIU Bo, HAN Li-feng, GAO Yan-dong, GUO Yu-feng

2016, 14(9): 1473-1476. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.014

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Objective To observe the effects of different anesthesia on the level of S100β protein and postoperative cognitive dysfunction(POCD) in elder patients undergoing colorectal cancer resection. Methods Total 50 patients undergoing colorectal cancer resection,age ≥ 65,ASAⅠ-Ⅱ,were randomly divided into observed group(n=25) and control group(n=25) according to anesthesia methods.The observed group received general anesthesia combined with epidural anesthesia,while the control group received general anesthesia only;the two groups were taken the same general anesthesia medication but different drug concentration and dose in the anesthesia maintenance.The levels of serum S100β protein in the two groups at different time point(T0:before anesthesia,T1:2 h after surgery,T2:24 h surgery,T3:48 h after surgery,T4:72 h after surgery) were tested;The MMSE score,incidence of POCD,anesthesia time,recovery time,time to extubation,the number of awaken restlessness,the dose of Ephedrine and additional Sufentanil during the surgery,and the incidence of intraoperative awareness at each time point were recorded. Results The incidence of POCD were higher in the two groups at T1,the difference between the two groups was not statistically significant(P>0.05).But the incidence of POCD was significant lower in the observation group at T2,T3,and T4(P<0.05).The S100βprotein level at T1 and T2 were significantly higher than that at T0 in the observed group(P<0.05),while the S100β protein level at T1-T4 was higher than that at T0 in the control group(P<0.05).The time to recovery of consciousness and time to extubation in the observed group was significantly shorter than those in the control group(P<0.05),the incidence of awaken restlessness in the observed group was significantly lower than that in the control group(P<0.05),and the amount of Ephedrine and additional Sufentanil dose of observed group was significantly less than that in the control group(P<0.05). Conclusion The general anesthesia combined with epidural anesthesia for elder patients with colorectal cancer resection can reduce anesthesia drug dose and the incidence of early POCD,improve the quality of anesthesia.The changes of S100β protein levels have certain significance in predicting the occurrence of early POCD.

Role of AFP-L3 and GP73 in diagnosis of primary hepatic carcinoma

ZHAO Rui, WANG Qi-zhi, ZHENG Hai-lun

2016, 14(9): 1477-1479. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.015

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Objective To explore the clinical significance of serum tumor maker lens culinaris agglutinin-reactive α-fetoprotein(AFP-L3) and Golgi protein-73(GP73) single or combined detection in the diagnosis of primary hepatic carcinoma(PHC). Methods The serum levels of AFP-L3 and GP73 in 80 patients with PHC,in 50 patients with cirrhosis of liver and in 50 healthy cases was detected by the enzyme-link immunosorbent assay (ELISA),and were compared among difference groups,and the clinical diagnosis value of AFP-L3 and GP73 in PHC was evaluated. Results The levels of serum AFP-L3 in patients with PHC,cirrhosis and healthy group:(65.234±21.315)ng/ml,(18.614±20.655)ng/ml and (13.209±14.560)ng/ml,respectively.The serum AFP-L3 in patients with PHC were higher than that in the cirrhosis of liver group and in the healthy cases group(P<0.001).Taking AFP-L3 level ≥ 36.076 ng/ml as diagnostic criteria,the sensitivity of AFP-L3 level in PHC diagnosis was 75.00% and the specificity was 94.00%.The levels of serum GP73 in the patients with PHC,patients with cirrhosis of liver and healthy group were (0.431±0.180)IU/ml,(0.228±0.047)IU/ml and (0.213±0.034)IU/ml,respectively.The serum GP73 in patients with PHC were higher than that in the cirrhosis of liver group and in the healthy cases group(P<0.001).Taking GP73 level ≥ 0.298 IU/ml as diagnostic criteria,the sensitivity of GP73 level in PHC diagnosis was 80.00%,the specificity of GP73 level in PHC diagnosis of GP73 level in PHC diagnosis was 96.00%.The combination of AFP-L3 and GP73 was sensitivity of 92.50% and specificity of 90.00%. Conclusion AFP-L3 and GP73 were very effective serum tumor maker in the clinical diagnosis of the PHC.AFP-L3 and GP73 have a higher specificity.AFP-L3 and GP73 combined detection could increase the sensitivity in the PHC clinical diagnosis.AFP-L3 and GP73 combined detection of PHC is useful.

Role of expansion screw in treatment of skeletal Class Ⅲ malocclusion with maxillary protraction in mixed dentition

TIAN Rui-xue, XIE Xiao-fei, GAO Yi-lin, HUANG Yong-song

2016, 14(9): 1480-1482. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.016

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Objective To investigate the effect of anterior protraction with expansion screw in the treatment of skeletal Class Ⅲ malocclusion in mixed dentition. Methods Thirty-two children with skeletal Class Ⅲ malocclusion were randomly divided into two groups.Sixteen patients of group A received simple protraction,while the other sixteen patients of group B received the rapid maxillary expansion for two weeks followed by maxillary protraction.The treatment time was six to nine months.After the treatment,the cephalometric measurement in lateral X-ray film was done to compare the difference using t-test by SPSS. Results ①In group A,the anterior teeth of both jaws met along their incisal edges in 3 cases,and crossbite was relieved,anterior overbite and override recovered in 13 cases;While in group B,crossbite was relieved,anterior overbite and override recovered in all 16 cases.②After the treatment,SNA,Ptm-A,ANB,Wits,U1-SN,ANS-Me,FH-MP increased significantly in both groups(P<0.05).Wits,ANS-Me,FH-MP in group A increased more significantly when compared with group B(P<0.05).The increase of U1-SN and the decrease of SN-PP and L1-MP in group B changed more significantly as compared with group A. Conclusion The maxillary protraction,with or without rapid expansion,can obtain significant effect in the treatment of skeletal Class Ⅲ malocclusion.The combined treatment can reduce the labial axial inclination of anterior teeth,and mandibular counterclockwise rotation.

Clinical observation on the treatment of spontaneous intracranial hypotension with blind epidural autologous blood patch

ZHOU Qun, TANG Min, XI Chun-hua, ZHU You-ling, LI Lei

2016, 14(9): 1483-1484. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.017

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Objective To discuss therapeutic mechanism and application value of blind epidural autologous blood patch in the treatment of spontaneous intracranial hypotension(SIH). Methods All patients met the diagnostic criteria of 2nd edition of international classification of headache disorders(2004).The blind epidural autologous venous blood patch was performed in 6 patients with SIH (2 males and 4 females,aged 44-70 years).The puncture and external epidural catheter was performed at intervertebral disc space between L₁ and L₂.The Fresh autologous venous blood was transferred into epidural space through the catheter.All the patients were followed up to observe the therapeutic efficacy. Results All patients responded well to the treatment and achieved a complete resolution of symptoms.Among the 6 patients,4 cases recovered by the first procedure,1 case recovered after the second transfusion,the other one received additional epidural autologous venous blood patch treatment between L₂ and L₃ one time,and L₁ and L₂ two times.The 3-9 months follow up showed that there was no recurrence after the operation. Conclusion The blind epidural blood patch is an effective,safe and easy way to treat spontaneous intracranial hypotension,not need the leakage point location by imaging.

Clinical values of atorvastatin combined with estrogen in the management of menopausal women with osteoporosis

SONG Yong-jin, YING Jin-he

2016, 14(9): 1485-1487. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.018

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Objective To investigate the clinical values of atorvastatin combined with estrogen in the management of menopausal women with osteoporosis. Methods From January,2013 to November,2015,80 menopausal women with osteoporosis were enrolled in this prospective study.All patients were randomly signed into the experiment group or control group.The experiment group received the management of atorvastatin combined with estrogen while the control group received estrogen only.The primary outcomes included the level of estrogen,calcitonin,calcium,phosphorus,serum alkaline phosphatase,serum osteocalcin,and bone mineral density of femoral neck. Results There was no difference between the two groups in pre-treatment or post-treatment estrogen(P>0.05).No difference was observed in calcitonin before treatment[(191.18±49.12) vs. (210.23±58.16)pg/ml,P=0.118].However,when compared with the control group,patients in the experiment group got a significant higher level of calcitonin after the treatment[(262.10±72.50) pg/ml vs. (231.78±62.57) pg/ml,P=0.049)].There were no difference between the two groups in the level of calcium,phosphorus,serum alkaline phosphatase(P>0.05),and a significant difference was observed in serum osteocalcin when compared with the control group[(11.53±2.69)μg/L vs. (9.05±2.27)μg/L,P<0.001].There was no difference between the two groups in bone mineral density before treatment[(0.49±0.03)g/cm² vs. (0.48±0.04)g/cm²,P=0.174)] while a significant higher level of bone mineral density was observed in bone mineral density after the treatment[(0.54±0.03)g/cm² vs. (0.48±0.03)g/cm²,P=0.000]. Conclusion Atorvastatin combined with estrogen can increase the level of bone mineral density in menopausal women with osteoporosis.

Comparison of therapeutic effects of intensity modulated radiation therapy and conventional radiotherapy for esophageal cancer in the elderly over 80 years old

WEI Jie, WANG Jun, LU: Xing-wang

2016, 14(9): 1488-1491. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.019

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Objective To investigate the efficacy and side effects of intensity modulated radiation therapy(IMRT) and conventional radiotherapy(CRT) in the treatment of esophageal carcinoma in older patients aged over 80 years. Methods The clinical data of 41 cases of senile esophageal carcinoma (aged over 80 years) undergoing radiotherapy in our hospital between November,2009 and October,2012 were reviewed retrospectively.18 cases received IMRT and 23 cases received CRT with a total radiation dose of 48-69 Gy and 24-34 fractions.The short-term,long-term efficacy,symptom relief rate,toxic and side effects were statistically analyzed,and Kaplan-Meier method was used to analyze the survival rate,Log-rank test was used to evaluate the difference between the groups. Results The short-term response rates in the IMRT group and the CRT group were 88.9% and 60.9% respectively,the difference was statistical significant(χ²=4.308,P=0.044);The Median Survival Times were 12 months and 9 months for each;The 1- and 3- survival rates were 44.4%(8/18),21.7%(5/23)and 16.7%(3/18),4.3%(1/23)and had statistical significance(χ²=5.919,P=0.015).The symptom relief rates of the IMRT group and the CRT group were 83.3%(15/18) and 82.6%(19/23),respectively,and there was no statistical significance(χ²=0.004,P=0.951).The adverse effect mainly included radioactive esophagitis,pneumonia,myelo suppression and anorexia (grade 1-2).There was no radio therapeutic toxic and side effects over Level 3 in both groups. Conclusion Radiotherapy is a safe and efficient way for the aged esophageal carcinoma patients over eighties.IMRT can improve the therapeutic efficacy.

Clinical analysis of bile leakage during laparoscopic cholecystectomy

DENG Rui, CHU Liang, LI Pei-sheng

2016, 14(9): 1492-1494. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.020

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Objective Bile leakage is the common complication of Laparoscopic cholecystectomy.The purpose of this study was to investigate the causes,treatment and prevention of bile leakage during LC. Methods The clinical data of 774 patients with LC in our hospital between January,2006 and July,2015 was retrospectively analyzed.The clinical parameters,types of management and procedure-related complications were documented. Results Three cases of bile leakage were observed in 774 cases undergoing LC.3 patients presented postoperative fever,chills,jaundice,and abdominal pain and so on.The abdominal cavity puncture under ultrasound diagnosed as bile leakage,the incidence rate was 0.39%.Of 3 cases of bile leakage,one case of capillary bile leakage in gallbladder bed was treated with abdominal drainage guided ultrasound,one case of cystic duct titanium clip slip off and other one was aberrant duct were treated with laparoscopic stump ligation,all three were cured and discharged.The follow up showed there were no long-term complications. Conclusion Bile leakage is a common and serious complication after LC.The operator should carefully evaluate the assessment of the patients and the surgical difficulty,fully understand the risk of surgery,and actively prevent and avoid the occurrence of postoperative complications.Bile leakage is mainly due to bile duct injury and bile duct ligation of the cystic duct off.Accurate identification of the cystic duct during the operation,the timely abdominal drainage and surgical treatment are critical for prevention of the bile leakage caused by LC.

Clinical values of early enteral nutrition combined with Shenmai injection in patients with open surgery of digestive tract

JIN Xi-biao, WANG You-qing, YE Zi, YANG Yong-zhi, MAO Kui

2016, 14(9): 1495-1497. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.021

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Objective To investigate the influences of early enteral nutrition combined with ShenMai injection on intestinal functions and immunologic functions in patients with open surgery of digestive tract. Methods From January,2011 to June,2015,120 patients undergoing the open surgery of digestive tract in our hospital were enrolled in this prospective study.The patients were randomly assigned into observational group and control group.Early enteral nutrition combined with ShenMai injection was given to the observational group while parenteral nutrition was given to the control group.The primary outcomes included immunoglobulin A,immunoglobulin G,immunoglobulin M and albumin.The secondly primary outcomes included digestive tract fistula,nausea,vomiting,diarrhea,fever,abdominal pain and anal exhaust time. Results There was no differences between two groups in gender,age,BMI,primary site of disease,preoperative and 1-day postoperative immunoglobulin A,immunoglobulin G,immunoglobulin M and albumin(P>0.05).However,when compared with the control group,the patients in observational group got a significantly increase in 8-days postoperative immunoglobulin A,immunoglobulin G,immunoglobulin M and albumin(P<0.001);a significantly lower rate of diarrhea(11.67% vs. 25.00%,P=0.037);a significantly shorter of anal exhaust time[(1.42±0.50)d vs. (2.03±0.80) d,P<0.001].There was no difference in digestive tract fistula,nausea,vomiting,fever and abdominal pain(P<0.05). Conclusion Early enteral nutrition combined with ShenMai injection can improve the intestinal functions and immunologic functions in patients with open surgery of digestive tract.

Relationship between alcohol-induced oxidative stress and cognitive impairment

LIU Lin-jing, YE Min-jie, GUO Han-feng, YANG Chuang, LIU Jia-hong, ZHANG Jin-liang, PAN Jian-she, WANG Xiao-qiong

2016, 14(9): 1498-1500. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.022

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Objective To investigate the relationship between alcohol-induced oxidative stress and cognitive impairment. Methods Fifty alcohol dependent male patients met DSM-IV Criteria and 40 healthy subjects were enrolled into this study.The repeatable battery for the assessment of neuropsychological status(RBANS) were used to assess the cognitive function,and the levels of the main mark of plasma free radical metabolism such as the activity of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px) and malondialdehyde(MDA) were tested. Results There was no significant difference in the age and educational level between the two groups.In the observation group,the levels of SOD and GSH-Px decreased,while the level of MDA increased,and the score for total RBANS and every item decreased(P<0.05).The total RBANS score did not show obvious association to the level of SOD.However,the total RBANS score(2.22±0.03,P<0.05),immediate memory factor(2.23±0.03,P<0.05) and attention factor(2.07±0.04,P<0.05) showed relations to the levels of GSH-Px,and total RBANS score(2.13±0.04,P<0.05),immediate memory factor(2.18±0.04,P<0.05),breadth of vision actor(2.12±0.04,P<0.05),attention factor(2.46±0.02,P<0.05) and delayed memory factor(2.43±0.02,P<0.01) showed correlation to the level of MDA. Conclusion The alcohol dependent patients are with oxidative stress and cognitive impairment.The abnormal cognitive function mat be related to the oxidative stress.

Role of comorbidity score in predicting the risk of chemotherapy toxicity in patients with acute myeloid leukemia

GUO Wen-jian, HUANG He, HE Mu-qing, YAO Rong-xin, DONG Ai-shu

2016, 14(9): 1501-1503. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.023

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Objective To evaluate the comorbidity factors by Charlson Comorbidity Index and hematopoietic cell transplantation comorbidity index,assess their relationships with chemotherapy toxicity,and discuss the suitability of the two index. Methods Total 66 cases of first acute myeloid leukemia aged 40 or above in our hospital between 2010 and 2014 were enrolled into this study.Charlson Comorbidity Index and hematopoietic cell transplantation comorbidity index were used to evaluate the comorbidity factors.Chi-square test or Fisher's exact test and Spearman's rank correlation analysis were performed to analyze the correlations.Logistic regression model was employed to predict the relative risk. Results The incidence of severe infection in patients with high comorbidity score(CCI ≥ 4,29 cases or HCT-CI ≥ 3,22 cases) was higher than that in patients with lower comorbidity score(CCI<4,10cases or HCT-CI<3,17 cases),the difference was statistical significant(P<0.05).But the high comorbidity score was not obviously correlated with the occurrence of other severe conditions.Multivariate analysis showed that high CCI score was still associated with an increased risk of severe infection in the CCI group(OR=4.385,95%CI:1.134-16.924;P<0.05),however,in the HCT-CI group,high HCT-CI score(≥ 3) was not obviously related to the severe infection after chemotherapy,but age(≥ 60 years) was associated with an increased risk of severe infection(OR=4.597,95%CI:1.002-21.146;P<0.05). Conclusion The patients with AML with high CCI or HCT-CI are easily to catch a severe infection after chemotherapy;Charlson Comorbidity Index is more suited for the prediction of comorbidity factors in patients with AML.

Effects of anti-TB treatment in patients with Pulmonary tuberculosis and diabetes and influencing factors

HU Hai-juan, ZOU Sheng-qiang

2016, 14(9): 1504-1505. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.024

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Objective To compare the curative effect of anti-TB treatment in patients with pulmonary tuberculosis and diabetes(PTB-DM group) and pulmonary tuberculosis without diabetes(PTB group) with survival analysis.And discuss the impact factors on PTB-DM prognosis. Methods A prospective cohort study on the follow-up data of 116 pulmonary tuberculosis complicated with diabetes patients and 120 pulmonary tuberculosis without diabetes patients in our hospital were performed.Kaplan-Meier method was used to evaluate the inefficiency.The log-rank test and Cox proportional hazard regression model were used for univariate and multivariate analysis of the prognosis of patients with PTB-DM. Results The survival curve showed that the cumulative inefficiency rate was higher in PTB-DM group than that in PTB group(Log-rank test,P=0.001).Univariate factor analysis indicated that the age,cavities in the lung,retreatment TB,drug resistance and drug-induced hepatotoxicity were statistically significant(Log-rank test,P<0.05).In Cox proportional hazard regression model,multivariate factor analysis showed that the age,retreatment TB,drug resistance were statistically significant(P<0.05). Conclusion Diabetes can weaken the curative effect of TB treatment.For TB patients,especially the patients with other high risk factors affecting tuberculosis prognosis,regularly monitoring and effectively controlling their blood glucose can increase TB improvement rate and improve the prognosis of patients.

Efficacy of Xipayi collutory combined with Shuanghuanglian granules in treatment of recurrent oral ulcer

LI Fang, HUANG Yang-sheng, YE Min, ZHOU Li-jing, FU Hai-biao

2016, 14(9): 1506-1508. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.025

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Objective To investigate the clinical efficacy of Xipayi collutory combined with Shuanghuanglian granules in the treatment of recurrent oral ulcer. Methods Total 166 cases of recurrent oral ulcer in our hospital between January,2014 and December,2015 were enrolled and randomly divided into 2 groups with 83 cases in each group.The patients in the control group were given Xipayi collutory,while the patients in the observation group were given additional Shuanghuanglian granules on the basis of Xipayi collutory.The patients in the two groups were treated for 5 days.Before and after the treatment,serum tumor necrosis factor-α(TNF-α),interleukin-2(IL-2) and interleukin-6(IL-6) levels of both groups were detected.The ulcer status and pain degree of the two groups were accounted.SPSS statistical software was used to analyze the difference in the therapeutic efficacy between the two groups. Results After the treatment,TNF-α and IL-6 levels of both groups were significantly reduced(P<0.05),and TNF-α and IL-6 levels of the observation group was significantly lower than that of the control group(P<0.05).After the treatment,IL-2 levels of the two groups were significantly elevated(P<0.05),and IL-2 level of the observation group was significantly higher than that of the control group(P<0.05).The ulcer diameter and pain degree of the observation group was significantly lower than those in the control group(P<0.05).The total efficacy rate of the observation group was 89.5%,which was significantly higher than the control group(75.6%),P<0.05. Conclusion Xipayi collutory combined with Shuanghuanglian granules can effectively reduce the inflammatory reaction,ulcer status and pain degree in patients with recurrent oral ulcer,with a satisfactory efficacy,which is worthy of promotion.

The study of protective effects of dipeptidyl peptidase Ⅳ inhibitor on early diabetic nephropathy patients

LIN Yong-qiang, ZHAO Run-ying, JIANG Yi, CAI Xiao-qiao

2016, 14(9): 1509-1511. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.026

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Objective To observe the protective effects of dipeptidyl peptidase Ⅳ inhibitor on early diabetic nephropathy patients and to explore the mechanism of renal protection. Methods Total 120 patients suffered with Diabetic nephropathy Ⅲ were randomly divided into test group 1,test group 2,and control group,40 cases in each group.All patients were treated with losartan potassium tablets 50 mg qd+Metformin Sustained Release Tablets 0.5 g bid for 4 weeks.On this basis,the test group 1 plus sitagliptin phosphate tablets 50 mg qd;test group 2 plus sitagliptin phosphate tablets 100 mg qd; the control group were treated with gliclazide MR 30 mg bid. Results Twenty-four weeks after treatment,BMI,FPG,2HPG,HbA1c were significantly decreased compared with before treatment of the three groups(P<0.05).Compared to the control group,the mAlb,urine protein/creatinine ratio,serum cystatin C of test group 1 and test group 2 were all significantly lower than those of the control group at the same time(P<0.05).The test group 2 decreased more significantly than the test group 1(P<0.05).After treatment,hs-CRP,IL-6,TNF-α,NF-κB p65 phosphorylation levels of the three groups were significantly decreased,and these factors of test group 2 were significantly lower than that of the test group 1(P<0.05).Correlation analysis showed that mALB and BMI,FPG,2hPG,HbA1c had no significant correlation(P>0.05),and hs-CRP,IL-6,TNF-α,NF-κB p65 phosphorylation levels were significantly positively correlated(P<0.01). Conclusion The protective effect of phosphate on renal function is independent of the hypoglycemic effect.It is possible to reduce the release of inflammatory cytokines by inhibiting the inflammatory state of the body,which can further improve the inflammatory damage of the kidney and protect the kidney,and the effect is dose dependent.

The effect of neonatal resuscitation training on the incidence of neonatal asphyxia and mortality

GU Hai-hong, YU Li-jun, ZHANG Hao, HUANG Lie-ping, XU Qiao, LIN Zhen-lang

2016, 14(9): 1512-1515. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.027

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Objective To investigate the effect of neonatal resuscitation training program on the incidence of asphyxia,suffocation recovery success rate and mortality. Methods The clinical data of suffocation 1 502 patients in our hospital obstetric were collected from 2000 to 2005 and from 2011 to 2013.The data from 2000 to 2002 were defined as the control group,from 2003 to 2005 as first observation group,2011 to 2013 to second observation group,comparative analysis of three groups of neonatal asphyxia and very severe asphyxia,resuscitation success rate,mortality and asphyxia asphyxia after very severe hypoxic-ischemic encephalopathy incidence changes. Results Three groups of neonatal asphyxia incidence rates were 5.60%,4.53% and 3.68%,the difference was significant(P<0.01).Three neonatal resuscitation success rates were 79.3%,90.0% and 90.2%,second observation group and first observation group compared with the control group,the difference was statistically significant(P<0.01).Three groups of neonatal asphyxia mortality rate 2.69 ‰,1.51 ‰ and 1.14 ‰,observed two groups and the control group a significant difference(P<0.01).Three groups of newborns with very severe asphyxia was 2.69 ‰,1.72 ‰ and 1.27 ‰,three pairwise comparisons were significant difference(P<0.05).Three groups of newborns with very severe resuscitation success rates were 46.2%,75.0% and 82.1%,three pairwise comparisons were significant difference(P<0.05) three groups of neonatal HIE occurrence rates were 33.3%,25.0% and 21.7%,second observation group and first observation group compared with the control group,the difference was statistically significant(P<0.05). Conclusion The relevant departments of the hospital medical staff in neonatal resuscitation training program,our hospital can reduce the incidence of neonatal asphyxia,improve the success rate of recovery,reduce perinatal and neonatal mortality to improve the quality of neonatal survival.

Effect of nutrition intervention on gestational diabetes mellitus and its effect on the prognosis of neonate

YANG Yang, ZOU Lei, REN Ting, CHEN Jie, WANG Xun-hong

2016, 14(9): 1516-1518. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.028

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Objective To evaluate the effect of perinatal nursing care and nutrition intervention on diabetes during pregnancy and its influence on the outcome of the newborn,and provide reference for clinical treatment. Methods Total 96 cases of diabetes during pregnancy in our hospital from June,2013 to June,2015 were selected and randomly divided into control group and experience group according to the different nursing methods.The control group was given routine nursing care,while the experience group received perinatal nursing care and nutrition intervention.The fasting plasma glucose(FPG),2 h postprandial plasma glucose,glycosylated hemoglobin(HbA1c),triglyceride(TG),cholesterol(TC),low density lipoprotein(LDL-C) and high density lipoprotein(HDL-C) of the two groups were tested.The incidence of gestational hypertension,the rate of cesarean section and neonatal complications were recorded to assess the maternal infant prognosis. Results FPG and PPG on the first week after the intervention in the experience group were superior to the control group(P<0.05);TG and TC on discharge in the experience group were much lower than those in the control group(P<0.05);when compare with the control group,the occurrence of hypertension of pregnancy,rate of cesarean section and the occurrence of neonatal complications in the experience group decreased greatly(P<0.05). Conclusion Strengthening perinatal nursing care and nutrition intervention are benefit for controlling blood sugar and blood lipid and improving the outcome of mother and infants.

Research for incidence and related factors of macrosomia in Suzhou city

WANG Mao, JI Yan-li

2016, 14(9): 1519-1521. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.029

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Objective To investigate the incidence of macrosomia in Suzhou,analyze the related factors of macrosomia,and provided basis for reducing the incidence of macrosomia. Methods The statistic data of macrosomia incidence has been acquired from regional health information platform.The case-control method was used to analyze the related factors of macrosomia.A total of 299 macrosomia cases were included in the observation group,while 300 cases of normal birth weight infants were included in the control group in the same period.By consulting medical history,the details about mothers during pregnancy and the newborns were investigated.SPSS 19.0 statistics software was sued to analysis the data. Results There was 86 178 cases newborn in 2014 in Suzhou,including 5 320 cases of macrosomiawith an incidence of 6.17%.The maternal situation between the two groups,including gravidity and parity,maternal age,pre-pregnancy body mass index(BMI),weight gain during pregnancy,gestational diabetes mellitus(GDM),mode of delivery and gestational age,has statistical differences.The unconditional multiple Logisitic regression analysis showed that weight gain during pregnancy was the main risk factors,followed by pre-pregnancy body mass index(BMI) and gestational diabetes mellitus(GDM);the male newborns,mode of delivery and gravidity was also related with the incidence of macrosomia. Conclusion ①The incidence of macrosomia in 2014 was lower than the average national level(7.3%),and lower than the 10.6% in developed economic regions of Anhui province.②The result shows that the dangerous factors of macrosomia including pre-pregnancy body mass index(BMI),weight gain during pregnancy,gestational diabetes mellitus(GDM),gravidity and parity,gestational age,and male newborns.③The pre-pregnancy education should strengthen to control pre-pregnancy body mass index;the guidance during pregnancy should be strengthen to control pregnancy weight;the appropriate exercise and balanced diet,and reducing the incidence of gestational diabetes mellitus should be regarded as the main intervention factors for the privation of macrosomia.

The community management research in chronic heart failure by united teamwork model on specialist medicine and general family medicine

PAN Gui-jun, WANG Hui-hua, TANG Hui-yun, LU Ping, CHEN Ye, WANG Xin, SONG Wei, XU Shi-rong

2016, 14(9): 1522-1524. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.030

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Objective Watch specialist-general joint team mode of community patients with chronic heart failure management effect,grope for establishing an effective pattern of the community management of chronic heart failure. Methods We researched 90 patients having chronic heart failure.With methods of random grouping,the patients were divided into management group and control group.The management group was managed by united teamwork,meanwhile the control group was managed by the GPs who didn't take part in this research.We collected the data on follow-up,health guidance,scales and laboratory indexes.After a year,we analyzed two group data on EF value,NT-proBNP,MLHFQ score,standard drug-taking rates on CHF,mortality and hospitalization rate. Results Compared with the baseline,there was no statistical significance on these two groups about age,cardiac function classification,drug-taking rates and other observation indexes(P>0.05).After managing,there was statistical significance among 6MWT(t=2.660,P=0.009),NT-proBNP(z=-3.380,P=0.033),MLHFQ score(z=-2.375,P=0.018) and physical(z=-3.460,P=0.037) and emotion score(z=-7.750,P<0.001).There was statistical significance among the drug-taking rates on ACEI/ARB(χ²=12.823,P<0.001)and β-blocker(χ²=11.390,P<0.001).There was statistical significance on hospitalization rate between management group and control group(χ²=4.220,P=0.040). Conclusion Compared with the general practice team model,the united teamwork model on specialist medicine and general family medicine can improve the management effect and life quality,and it is worth popularizing.

Present situation and consideration of equalization of essential public health services in Shanghai community health services institutions

PAN Yi-hui, YAO You-hua, XIONG Jian-jing, HUANG Jin, LIU Deng, ZHU Xiao-jian

2016, 14(9): 1525-1527. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.031

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The promotion of equalization of essential public health services is an important content of our deepening reform of medical and health system.It has an important significance for protecting health equity and improving health level of residents.Three aspects are described for the present situation of equalization of basic public services work in Shanghai community health services facilities as the equalization of basic public health financial investment,the equalization of basic public health resource allocation and the equalization of basic public health supply.The results show that the equalization of Shanghai essential public health services supply is higher and develops in accordance with the national requirement.The basic and the major projects are increased the same time.The indexes of the service amount and service rate are regularly checked.The equalization of basic public health resource allocation is relatively perfect.The community health service centers or sites are complete and the layout is reasonable.They can satisfy the basic public health service demand of residents.The equalization of basic public health financial investment is inadequate.Low financial investment districts depend on the cheap unit labour costs and more work time of the medical staff.Strengthen the execution of policy document and the reasonable allocation of public health talent team is suggested for the relative scarce human resources problem.The clear financial and administrative power and the improvement of the basic public health service evaluation mechanism are suggested for the problem that fiscal investment affects the equalization of basic public health services.This can improve the level of refinement and the entire of the public health service and management.

Effect of anxiety and depression on prognosis of elderly patients with heart failure

WANG Zheng, WANG Zhang-yuan, CAO Tao, SUN Zhang-yi, QIN Jian

2016, 14(9): 1528-1529. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.032

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Objective To study the incidence and related factors of anxiety and depression in elderly patients with heart failure,explore the effect of anxiety and depression on the prognosis of patients,and provide the basis for the treatment of elderly patients with heart failure. Methods Total 225 elderly patients with heart failure were collected in Xuanwu hospital of Capital Medical University from June,2014 to June,2015.Zung self-rating Anxiety Scale(SAS) and self-rating Depression Scale(SDS) were used to analyze the incidence of anxiety and depression;According to the prognosis,49 cases were divided into death group,176 cases were divided into survival group,t test was used to compare the difference of SDS and SAS score between the death group and the survival group;According to SAS and SDS,112 patients with anxiety,113 patients with no anxiety,168 patients with depression,57 patients with no depression,the application of chi square test were used to compare the difference of SAS and SDS between the anxiety and depression groups and no anxiety and depression groups respectively;The influence of age,gender,income,heart function,culture degree and living alone and other factors on the anxiety and depression were analyzed by using multivariate logistic regression analysis of correlation. Results The incidence of anxiety was 63.6%(112/225)in elderly patients with heart failure,and the incidence of depression was 74.6%(168/225).The SAS and SDS score in the death group were 61.30±6.79 and 65.32±5.85 respectively,the SAS and SDS scores in the survival group were 54.06±7.67 and 55.68±7.62 respectively,the SAS and SDS scores in the death group were higher than those in the survival group,the difference between the two groups was statistically significant(P=0.001,0.001).The mortality rate in anxiety group was 41.07%(46/112),the mortality rate in no anxiety group was 2.6%(3/113),the mortality in the anxiety group was significantly higher than that in no anxiety group(χ²=26.83,P=0.001).The mortality rate in depression group was 27.9%(47/168),the mortality rate in no depression group was 3.5%(2/57),the mortality rate in depression group was significantly higher than that in no depression group(χ²=14.95,P=0.001).Multivariate logistic regression analysis showed that the heart function,alone and the degree of culture were significantly related with the anxiety(P<0.01),the heart function and culture degree were significantly related with depression(P<0.05). Conclusion The incidence of depression and anxiety in elderly patients with heart failure were higher,these could affect the prognosis of patients,the related factors for active intervention should be done to deal with the anxiety and depression.

Research on rotation event-related evoked potentials P500 in patients with first onset of depression during mental rotation tasks

ZHANG Li-na, DING Ying, CHEN Yan-bo, SUN Guo-qing, ZHANG Lei, TAN Zhong-lin

2016, 14(9): 1530-1532. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.033

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Objective To investigate the EEG characteristics and related physiological mechanisms in patients first onset of depression during mental rotation tasks,and provide reference for the treatment of depression. Methods The patients with depression in our hospital from January,2013 to June,2014 were assigned into the observation group,while the subjects for physical examination were selected as control group.The clinical data was reviewed.E-prime software was used to determine the error rate and response time.The changes of brain potentials were detected by Brain AMP MR32 portable event-related potential recording system.The differences between the subjects with different rotation angle error rate and response time and P500 latency at P3,PZ and P4 and amplitude were compared,and the correlation analysis on P500 latency and amplitude with HAMD score were conducted. Results The error rate for both erect image and mirror image under different rotation angle in the observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).In the observation group,the error rate for both erect image and mirror image increased with the rotation angle degrees,and the reaction time at different rotation angle degrees was longer than that in the control group,the difference was statistically significant(P<0.05);P500 latency at P3,PZ and P4 in the observation group was significantly longer than that in the control group,but the amplitude was lower than that in the control group,the differences were statistically significant (P<0.05);In the observation group,HAMD scores was positive correlated with the latency at P3 and the amplitude at P3 and PZ(P<0.05). Conclusion After mental rotation,the cognitive function in patients with depression can appear a certain degree of damage,the incubation period of P500 should prolong and the amplitude decline.HAMD scores show positive correlation with P3 and PZ incubation period and P3 amplitude.

Analysis on hospitalization behavior and related influencing factors among upper gastrointestinal cancers patients in rural areas

WANG Ning, WANG Bao-hua

2016, 14(9): 1533-1536. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.034

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Objective To analyze the hospitalization behavior and related influencing factors among upper digestive tract cancer patients in rural areas,and provide reference for the promotion of early hospitalization. Methods The total of 1 235 stomach and esophagus cancer cases were randomly selected from cancer registration system of 12 counties in Henan,Shandong,Jiangsu and Anhui Provinces.All of the patients were the new and survival cases in 2013.The face-to-face interview was conducted to collect the information on demographic characteristics,whether knowing his/her illness condition,whether seeking the medical service,and the condition of diagnosis,hospitalization and treatment.The statistical analysis was conducted by using SAS 9.3. Results Among the 1 182 patients with complete basic information,there were 859 stomach cancer cases(72.7%) and 323 esophagus cancer cases (27.3%).The proportion of farmer was 90.3%.There were 906 cases had been hospitalized,accounting for 76.6%.The proportion of patients who did not know the illness condition was 39.4%.There were 47.1% patients having metastasized cancer,48.2% patients being the late stage of cancer,and 32.3% patients having not adapt any radiotherapy,chemoradiotherapy and surgery.The univariate analysis showed that the educational level,occupation,marital status,whether knowing the illness condition,whether having metastasized cancer and tumor staging were statistically related with hospitalization.The multiple logistic regression analysis showed that patients with education levels of middle school[OR=2.2,95%CI(1.4,3.7)] and high school or above[OR=6.5,95%CI(1.5,27.8)] were more likely to be hospitalized compared to those with education level of elementary school or below.Compared with unmarried,divorced and widowed patients,married patients was 2.1[95%CI(1.5,2.9)] times being hospitalized.Compared with patients who did not know the illness condition,patients who knew the condition were 1.5 times[95%CI(1.1,2.1)] being hospitalized.Compared with patients in early stage of cancer,patients in late stage were 0.3 times[95%CI(0.2,0.5)] being hospitalized. Conclusion The educational level,marital status,whether knowing his/her own illness,and stage of the illness were the main factors affecting patients' hospitalization.

Analysis of diagnostic efficacy of fine-needle aspiration for ultrasonic parameters of thyroid nodules

PENG Chan-juan, YANG Chen, SHI Kai-yuan, FENG Na, PAN Yu-yun

2016, 14(9): 1537-1539. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.035

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Objective To investigate diagnostic effectiveness of ultrasound-guided fine-needle aspiration(US-FNA) for the sonographic features of thyroid nodules like size and calcification. Methods A retrospective analysis of the clinical patients of 614 thyroid nodules from 2012 to 2014.According to the maximal diameter of thyroid nodules,the nodules were divided into group A(≤ 5 mm),B(5-10 mm),and C(>10 mm),and according to the calcification,the nodules were divided into group N(no calcification),group Mi(Microcalcification) and group Ma(Macrocalcification).By the Bethesda System,>grade IV was the malignant cytologic criteria for diagnosis of thyroid nodules.At the same receiver operating characteristic curve was to evaluate the diagnosis of size and calcification between groups. Results ①In group A,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of US-FNA were 92.1%,96.6%,94.0%,97.2%,and 90.3%.In group B,they were 91.1%,95.3%,93.0%,96.3%,and 89.1%.In group C,they were 93.6%,96.2%,95.1%,94.8% and 95.2%,respectively.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the three groups showed no significant difference(P>0.05).In group N,they were 93.6%,96.4%,93.6%,96.3% and 90.9%.In group Mi,they were 89.5%,88.9%,93.0%,95.1% and 89.7%,and in group Ma,they were 96%,97.1%,96.8%,96.6% and 97.1%,respectively.The three groups also show no significant difference(P>0.05).②AUC of group A,B,and C were 0.94,0.93,and 0.95,while group N,Mi,and Ma were 0.94,0.93,and 0.97. Conclusion US-FNA is not limited to the size,calcification of thyroid nodules,but have high diagnostic value.

Preliminary study of lung iodine map by dual-energy CT after inhalation of Iodine gas in rabbits

CHEN Song-kuan, YANG Guang-zhao, MAO Guo-qun, JIA Yu-zhu, ZHOU Yu-qi

2016, 14(9): 1540-1543. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.036

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Objective To study the feasibility of pulmonary ventilation imaging by dual-source CT(DSCT) after inhalation of Iodine gas in rabbits. Methods A total of 18 experimental rabbits were divided into group 1(1/3),group 2(1/2),and group 3(2/3) according to the proportion of inhaled Iohexol(300 mgI/ml) and normal saline,with 6 in each group.The intraperitoneal anesthesia was performed with 15% chloral hydrate (1 kg/ml) in a fasting state.The marginal ear vein was then opened.Sumianxin Ⅱ(1 kg/0.5 ml) was used for additional venous anesthesia in order to reach an ideal state.The iodine gas with different concentration was aerosol inhaled by the rabbits under anesthesia for DSCT scanning.After the post-processing of the DSCT images,the iodine imaging was obtained for the subjective and objective evaluation. Results The subjective rating of imaging qualities was consistently preferable(Kappa=0.786).The total scores in the three groups were 3.25±0.5,4.40±0.44,and 4.20±0.40,respectively.Group 2 had the highest total and subjective scores.The comparison of objective rating between group 1 and group 2 was statistically significant(P<0.05),while between group 2 and group 3 was not statistically significant (P>0.05).Group 2 (one iohexol plus two saline) was the best concentration for DSCT imaging;150 s,210 s and 270 s after the aerosol inhalation were the best phases for observation.The distribution of iodine in the lung was generally uniform for this group,with all pictures rating above 3. Conclusion It is feasible to study the rabbit pulmonary ventilation by aerosol inhaling iodine gas DSCT.

Spiral CT scanning of upper airway in OSAHS with low-dose

ZHANG Zhi-jing, ZHENG Wen-long, WU Ai-qin, LIN Xu-bo, ZHAO Xiao-jun, XU Chong-yong

2016, 14(9): 1544-1546. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.037

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Objective To explore the clinical value of the upper airway low-dose spiral CT applied in the obstructive sleep apnea and hypopnea syndrome(obstructive sleep apnea hypopnea syndrome,OSAHS). Methods One hundred and twenty patients OSAHS were divided equally into the experimental group and the control group.All patients were underwent the upper airway low-dose spiral CT scanning during the four different states of breathing,calm,the end of deep inspiration and deep expiration,inspiration closed mouth and nose.The tube current of the experimental group used low-dose was 50 mA,the control group used the regular dose was 360 mA.The values of the volumetric CT dose index(CTDI_vol),dose length product(DLP) and the effective dose (effective dosed,E) for each case were respectively recorded.The CT value of ROI in each case was measured on the same tongue position,and the Standard Deviation(SD) of CT value and the Standard Deviation (SD) of CT value was also recorded.The double-blind method was used to subjectively evaluate the image quality,and overall image quality was assessed using a 3 grading scale(excellent,good,poor),then,statistical analysis was done with related data. Results There was no significant difference in length of scanning between the experimental group and the control group,compared to control group,significant differencens in DLP and E value were observed(t=108.252,P<0.001) and CTDI_vol,DLP,E value in experimental group decreased by 87.5%.Signal-Noise Ratio decreased significantly in experimental group(SNR value 6.31±1.75 vs. 10.17±3.13 respectively,t=3.19,P=0.006).Compared to control group,noise increased significantly in experimental group(SD value 25.74±2.61 vs. 1.70±0.17 respectively,t=29.022,P<0.001).Subjective evaluation of image quality with control group was mainly excellent,and mainly good with experimental group,only three cases were of poor-grade,but it did not influence the measurements and diagnostics. Conclusion Scanning of upper airway in OSAHS with 50 mA low-dose can reduce radiation dose significantly,dose not affect the measurement and diagnosis of airway,and has practical value clinically.

A comparison of clinical curative effect between ultrasound-guided percutaneous transhepatic cholangiography needle suction and catheter drainage for liver abscess

CHEN Wen-xian, HU Xin-e, HAN Yun-sheng, XIONG Wei-lu:, XU Hua-jun, MO Qing-qing

2016, 14(9): 1547-1549. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.038

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Objective To compare the clinical efficacy of ultrasound-guided percutaneous transhepatic cholangiography(PTC) needle suction and catheter drainage for liver abscess. Methods A total of 40 cases of bacterial liver abscess in our hospital were randomly divided into group A and B with 20 cases in each group.The patients in the group A were treated with simple suction technique by using PTC needle under the guide of ultrasound;while the patients in the group B were treated with Ultrasound-guided catheter drainage.The one-time recovery rate,time for body temperature recovery,pain remission and abscess cavity disappeared,and duration of hospital stays;the follow-up was carried out to observe the incidence of recurrence and complications. Results All 20 cases in group B were one-time cured with an effective rate of 100%;however,in the group A,only 13 cases in the first attempt were cured with a rate of 65%;4 cases recovered by the second attempt in 2 to 5 days after the first attempt,the other 3 cases remained larger vomica after the second puncture underwent catheter drainage.The difference of clinical effectiveness between the two groups was significant(P<0.05);The time for body temperature recovery,pain remission,abscess cavity disappeared and hospital stay in group A was(3.0±0.6)d,(2.5±0.6)d,(12.5±3.5)d and(15.6±4.0)d,respectively,which were longer than those of group B[(2.0±0.5) d,(1.2±0.5) d,(7.2±2.0) d and(10.3±3.0) d,respectively],the difference was significant(P<0.05);The incidence of complications of group A was 40%,which was higher than that of the group B(5.0%),the difference was significant(χ²=5.161,P<0.05). Conclusion The ultrasound-guided catheter drainage for liver abscess can effectively improve the curative efficacy,relieve the pains of patients,shorten the treatment time,which is worth of clinical promotion.

WANG Ming-hong, YU De-hua, ZHANG Bin, LU Yuan, ZHANG Han-zhi, FAN Hui-qin, CAI Feng-feng

2016, 14(9): 1550-1552. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.039

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CHEN Ke, CHEN Bo, XIONG Mao-ming

2016, 14(9): 1553-1556. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.040

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LIU Wen-hui, QIAN Yin-feng

2016, 14(9): 1557-1559. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.041

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ZHENG Guan-qun, ZHAO Fu-you, WU Qiong, YANG Yan

2016, 14(9): 1560-1562. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.042

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HOU Chang-feng, MAO Shuang-gen

2016, 14(9): 1563-1565. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.043

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Pathogenic bacteria monitoring and disinfection effects for the surface of wall mounted medical oxygen system

ZHANG Wei-jian

2016, 14(9): 1566-1567. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.044

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Objective To investigate the disinfection effects for the wall mounted medical oxygen system in hospital and compare the disinfection costs,so as to provide disinfection data for the control of nosocomial infection. Methods A total of 120 wall mounted medical oxygen system in four wards of our hospital were randomized into 4 groups:control group,observation group 1,observation group 2 and observation group 3.For disinfection,normal saline was used in the control group,75% alcohol was used in the observation group 1 500 mg/L chlorine-containing disinfectant solution was used in the observation group 2,and chlorhexidine gluconate (3M^TM Avagard^TM) fast disinfectant solution was used in the observation group 3.The positive rate of pathogenic bacteria before and after disinfection,and the type of pathogenic bacteria after disinfection and the price of disinfectant were compared among different groups.The disinfection costs of all the groups were calculated and compared. Results Before the disinfection,there was no significant difference in the positive rate of pathogenic bacteria among 4 groups (P>0.05).After the disinfection,the positive rate of pathogenic bacteria was significantly decreased in 3 observation groups (P<0.01),but there was no significant difference in that of control group(P>0.05).After the disinfection,the observation group 3,observation group 2,observation group 1 and control group demonstrated positive rates of pathogenic bacteria from low to high,and there was significant difference among 4 groups(P<0.01).In the control group,cocci and bacilli bacteria survived after the disinfection,but the number of cocci and bacilli bacteria was significantly decreased in all the three observation groups(P<0.05),and there was significant difference among 3 groups(P<0.05).As for the disinfections costs,75% alcohol of the same volume had the lowest price,followed by chlorine-containing disinfectant solution,while the Avagard disinfectant solution had the highest price but the best disinfection effects,and there was significant difference among these 3 groups(P<0.01). Conclusion s Three types of disinfectant solution can all achieve the purpose of disinfection,but they all have advantages and disadvantages.Chlorhexidine gluconate fast disinfectant solution and chlorine-containing disinfectant solution have better effects.Hospitals should choose appropriate disinfection methods based on their economic conditions,so as to achieve the purposes of disinfection and sterilization as well as reducing the nosocomial infection rate.

Application of problem-based learning in clinical teaching in department of cardiology

HU Si-gan, CHEN Hui, CHEN Yao, LI Miao-nan, XU Qiong, HUANG Yu-li, KANG Pin-fang

2016, 14(9): 1568-1570. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.045

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Objective To evaluate the effect of Problem-based Learning(PBL) in the clinical teaching in Department of Cardiology. Methods Total 60 clinical undergraduate students were divided into experimental group and control group.PBL was applied to the experimental group,while the control group received the traditional approach.The evaluation scale and exam scores were taken as the evaluation index. Results The subjective score of the experimental group was significantly higher than that of the control group 41.64±7.46 vs. 37.85±6.82,P<0.05).There was no significant difference between the two groups in objective and total score(42.94±5.69 vs. 45.51±4.82,P>0.05).The brainstorming(23.23±5.78 vs. 18.43±4.24,P<0.01),search data and problem solving ability(13.65±5.78 vs. 10.43±6.56,P<0.05),interaction and communication skills(18.87±4.98 vs. 15.82±3.44,P<0.05),and self-learning ability(23.25±3.43 vs. 20.98±4.65,P<0.05)in the experimental group were all better than those of the control group.There was no difference in the sharing of knowledge(12.87±3.78 vs. 13.56±3.56,P>0.05)between the two groups. Conclusion PBL is student centered and problem based learning method.PBL may efficiently increase the interest of students in learning,cultivate their innovation ability,enhance search data problem solving ability and vivify the classroom atmosphere.

New type of medical undergraduate tutorial system in intensive medicine teaching effect assessment

FANG Zhi-cheng, CHEN Li, ZHENG Xiang

2016, 14(9): 1571-1573. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.046

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Objective To evaluate of new medical undergraduate tutorial system in the intensive medical professional teaching effect,tutor system reform measures,popularization and application. Methods This research adopts randomized controlled method,three consecutive terms,a total of 320 students,respectively,with the improved new tutorial system and tutorial system in traditional teaching,each group of 160,a questionnaire survey was conducted on two groups of students around the teaching effect,to understand student feelings,opinions,ask for the tutorial system improvement suggestions;Statistics students graduate with the national examination of medical practitioners theory,operation skills examination results,understand a student theory,clinical practice ability raise;At various levels and of the scientific research project number,the number of published research papers,examination for graduate student passengers,etc.To understand the student scientific research ability raises and evaluates the tutor system teaching effect. Results Questionnaire survey showed that 96.78% students think new tutor system implementation necessity and help to raise their learning,interested in new tutorial system is higher.Compared with the traditional tutorial system teaching,mentoring new medical undergraduate students to the theory of medical practitioners examination results(71.26±3.57 vs. 85.38±7.13,P<0.05),the national medical skills test scores(69.26±5.01 vs. 81.26±5.01,P<0.05),the difference between the two groups is obvious,the student theory,independent operation ability,the paper number,the number of published articles,the online number of postgraduate,were significantly higher than the traditional tutorial system of students,comparing the two groups have significant differences,students' scientific research consciousness and ability to ascend. Conclusion The improved new tutorial system correctly,measures strength,which can effectively improve the level of students' clinical theory,exercise practice ability,the ability to work independently,and can cultivate students' scientific thinking ability,students' learning interest is high,the clinical teaching effect is good,can be applied in the teaching.

The methods and effects evaluation of individualized health education for community practice on general medical students

WANG Dao-qiong

2016, 14(9): 1574-1577. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.047

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Objective To teach general medical students to learn methods and means of individualized health education during the stage of their community practice, observe changes of knowledge and skills before and after practicing,evaluate the effect,and,explore the training mode of community practice,improve the teaching ability and comprehensive quality of the teachers. Methods A total of 120 general medical students,who came from the Fifth Clinical College of Chongqing Medical University,participated five-stage training mode during August,2013 to June,2015.The questionnaire survey and examinations were conducted before and after training. Results After the five-stage training,the test score in importance of individual health education,theoretical knowledge,and operational skills of the students changed significantly(P<0.05).Before the practice,the theory test score was 70.83%,after was 93.33%.The average score of the pre-operation examination was 63.22±2.89,after was 88.74±3.79.Only 54.2% of the students considered that the health education was important in the community,but after was 90.7%. Conclusion The five-stage training helps general medical students to master the individualized health education knowledge and skills,enhances teaching ability and comprehensive quality of community general practice teachers,and provides a effective training model.

Role of quality control circle in improvement of nursing service quality in psychiatry department

ZHANG Lin-han, DAI Lin-lin, FENG Li-ming, LI Hui, LIU Bing, YAN Jia-xing, QU Xue-hua

2016, 14(9): 1578-1581. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.048

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Objective To study the role of quality control circle( QCC) in enhancing the high quality nursing service in psychiatry department. Methods We implemented the quality control circle activity at the department of psychiatry. The cause of defects existing in the process of implementation of the quality of nursing service was analyzed. After selecting the theme activities,the targeted strategy and reform program were establish and implemented to promote the high quality nursing service. Results QCC activity increased the overall pass rate of nursing service from 82. 45% to 96. 57%,the difference was statistically significant( χ²= 17. 47,P < 0. 001). The pass rate for the aspects of nursing papers writing,health propaganda and education,mastering patient's condition,basic nursing and specialized nursing care were significantly improved( P < 0. 001). The overall satisfaction of inpatients with psychiatric nursing service rose from 80. 32% to95. 10% after the intervention( χ²= 20. 25,P < 0. 001). As compared with the control group,the service attitude and initiatives of nurse staffs,ward environment,provided convenient service,health propaganda and education were significantly improved( P < 0. 05). Conclusion The quality control circle activity can significantly reduce the defects and problems during the implementation process of quality nursing service,and improve the nursing quality and patients satisfaction. The quality control circle activities can be promoted in the department of psychiatry.

Effect of tertiary rehabilitation care on patients with post-stroke unilateral spatial neglect

MA Lan, CHEN Fang, LIU Hong-ying, LI Xiao-mei, FENG Ling

2016, 14(9): 1582-1584. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.049

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Objective To observe the effect of standardized rehabilitation nursing in tertiary rehabilitation system on patients with post-stroke unilateral spatial neglect(USN). Methods According to diagnostic criteria for USN,we chose 122 patients who were in our rehabilitation center between January,2013 and November,2015 and assigned them into a control group and intervention group based on serial number.The control group was given level-1 and level-2 rehabilitation nursing,while the intervention group was given the standardized tertiary rehabilitation system.A comparative assessment on the severity of USN and the Activities of Daily Living(ADL)of the patients were evaluated before and after the treatment(for three months and six months). Results The Barthel index of these two groups of patients had increased significantly after three months and six months of treatment(F=525.11,P<0.01;F=989.26,P<0.01);furthermore,the severity of USN(P<0.01) and Catherine-Bergego Scale(CBS) score(P<0.01) had also been significantly improved;and the Barthel index of the intervention group was more obviously improved than that of the control group after three months and six months of treatment(t=2.597,P<0.01;t=11.322,P<0.01),so was the decline of CBS(t=2.37,P<0.05;t=3.949,P<0.01);and the proportion of patients with severe USN in the intervention group was obviously declined than that of the control group after six months of treatment(χ²=4.32,P<0.05). Conclusion The standardized tertiary rehabilitation care can effectively improve the symptoms of USN and the patients' activities of daily living,effectively improve the severity of USN.

Analysis the self-effect influencing factors of breastfeeding and discuss the effect of quality control circle activities

WANG Yang, ZOU Lei, REN Ting, CHEN Jie, WANG Xun-hong

2016, 14(9): 1585-1588. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.050

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Objective To analyze the influencing factors of maternal breast feeding self-efficacy,and to investigate the intervention effect of QCC on breastfeeding self-efficacy,provide the basis for obstetrics quality control circle. Methods The 189 hospital outpatient reviewed maternal from April 2011 to December 2011 were selected as the research object.Designed the questionnaire on the basis of consulting the relevant literature and consulting experts,including the basic situation,social support and knowledge of breast feeding.Used Chinese version of the breastfeeding self efficacy scale to measure breast feeding self-efficacy,used the Likert 5 score method to evaluate breast feeding self-efficacy.The effect of quality control circle intervention used experimental study.First,the first obstetrical and second obstetrical puerperants in the early admission to the Chinese version of breastfeeding self efficacy scale were used.Then,the first obstetrical puerperants were set in observation group and treated with quality control circle on the basis of conventional care.The second obstetrical puerperants were set in control group and treated only conventional care.Two groups of puerperants in the Chinese version of breastfeeding self efficacy measurement at discharged. Results The total score of 189 maternal breastfeeding self-efficacy scores ranged from 62 to 150,the average score was 103.3±13.6.Single factor T test analysis found that age,mode of delivery,parity,family monthly mean income of maternal exist significant difference(P<0.05).Multiple linear regression analysis showed that age,mode of delivery,parity is affecting breastfeeding self-efficacy independent factors.There was significant difference in breast feeding self-efficacy(P<0.05) in the observation group at admission and discharge.There was no significant difference in the efficacy of breast feeding(P>0.05) in the control group at admission and discharge. Conclusion Age,mode of delivery,and parities could affect the breastfeeding self-efficacy,qualitycontrol circle could improve maternal breastfeeding self-efficacy.

Effects of quality control circle concept on medical waste disposal in operating room

ZHU Jun-hong, ZHANG Xia, LIU Zu-ming, LUO Xiang-hong

2016, 14(9): 1589-1591. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.051

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Objective To investigate the applying ways and effects of quality control circle(QCC) for medical waste disposal in the operating room to provide a reference for clinical rational choice for medical waste disposal method. Methods The prospective study was performed from July,2014 to July,2015 in our hospital among 8 nurses from general surgery operating room who were included in "medical waste green circle"(two charge nurses,three nurses,and three composition nurses).The operating room medical waste disposal before and after the implementation of QCC countermeasures were compared,and the problem-solving skills,team cohesion,communication and coordination ability of QCC members were surveyed. Results The defects and problems existing in the medical waste disposal from August,2014 to January,2015 were 60 times,including 22 times of garbage and medical waste mix,accounting for 36.7%;8 times of sharps mishandled,accounting for 13.3%;4 times of medical waste bag sealing lax,accounting for 6.7%;16 times of long time storage of medical waste in the operating room,accounting for 26.7%;10 times of medical waste bags leak,accounting for 16.7%.After the implementation of QCC,only 10 times of defects and problems occurred in the medical waste disposal from January 2015 to July,the difference were significantly when compared with that before the QCC implementation(P<0.05).After the implementation of QCC,the problem-solving skills,team cohesion and communication skills scores were significantly improved(P<0.05). Conclusion The applying of QCC for medical waste disposal in the operating room can improve the overall quality and ability of circle members,reduce the incidence of medical waste defects,thereby improve the quality of hospital management.

Evaluation of quality of life and nursing care for patients with hepatic cirrhosis and carcinoma

LIU Xiao-jing, LIU Rong-mei, MENG Wen, LIU Meng-jia, LI Xue-mei, YANG Yu-lan, ZHANG Yong-yong, SHANG Yu-jun

2016, 14(9): 1592-1594. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.052

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Objective To evaluate the quality of life(QOL) of patients with hepatic cirrhosis and carcinoma,determine the key points of nursing care,and provide a reference for the nursing and health education. Methods Quality of Life Scale and the Functional Assessment of Cancer Therapy Scale were used to survey the QOL among 110 patients(60 cases of hepatic cirrhosis and 50 cases of carcinoma) between April and June in 2014.Epidata 3.02 and SPSS were used to entry and analyze questionnaire data.The non-structured interviews were used to understand the life condition of patients and the received support from family and social. Results Forty percent of patients were with moderate or severe pain and discomfort,43.3% of the patients was with moderate to severe anxiety or depression.Most of the patients were with psychological problems.Lots of patients with liver disease were lack of basic knowledge,and cannot be self-management.The patients in New Rural Co-operative Medical System received less social support as compared with workers and urban residents.18 of 25 patients with New Rural Co-operative Medical System were not supported by friends,whole only 3 of 72 cases urban workers and urban residents were not supported by friends,the difference was statistically significant(P<0.05).However,in family and other supports,there was no significant difference between patients with the New Rural Co-operative Medical System and urban workers and urban residents. Conclusion The nursing care for specific lesions and psychological nursing care for the patients with hepatic cirrhosis and carcinoma should be paid more attentions.The medical facilities should promote the targeted healthy knowledge education for patients,and concern the liver disease group,and encourage them to obtain social support actively.

Influence of telephone interviews and home visits on medication compliance of cancer pain patients at home

LIN Hai-yu, CHEN Shu-fen, SHA Wen-na, ZHOU Xin-hua, WANG Wu-ping, SHI Yang-ru, LI Xia

2016, 14(9): 1595-1597. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.053

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Abstract:
Objective To evaluate the influence of nurse led telephone interviews and on-site visit on the medication compliance of advanced cancer pain patients at home,and provide reference for improving the quality of life of patients. Methods Between October,2013 and June,2015,86 cases of advanced cancer pain patients discharged from our Department,with clear mind and ability to communicate and finish the pain scores,were followed up by telephone interviews and home visits.The cancer pain care team was established and the follow-up process was drafted,the members were trained according to the follow-up process.Then periodic follow-up records for cancer pain patients were created,and the cancer pain education manual prepared by the team,pill box with alarm and cancer pain diaries book were provided for every patients.24 h hotline was set up,and telephone interviews were performed every three days and home visits were performed every week to observe the management of medicines,analgesic effect,adverse reactions and pain dietary;the guidance,propaganda and education were given based on the inner feelings of patients.The Wechat public account was established to communicate with patients and perform lectures on pain,improve the medication compliance of cancer pain patients.The pain scores and medication compliance were analyzed by using SPSS 17.0 statistical software. Results The trace and intervention by telephone interviews and home visits to cancer pain patients at home relieved the pain(mild,moderate and severe) of patients and improved the medication compliance(full,partial and noncompliance),the difference was significant(P<0.05). Conclusion The nurse led telephone interviews and on-site visit can improve the medication compliance of cancer pain patients at home and their quality of life.

Effects of early stage functional exercise on rehabilition of patients affected limb with breast cancer modified radical surgery

LIU Hui

2016, 14(9): 1598-1600. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.054

193 0

Abstract:
Objective To explore the effects of early stage functional exercise on rehabilitation of patients affected limb with breast cancer who have accepted modified radical surgery. Methods 40 cases of patients with modified radical mastectomy were admitted to the People's Hospital of Fuyang City from December,2012 to June,2015,and they were divided randomly into two groups according to functional training methods.The control group with 20 cases were given the guidance of regular functional training and psychological intervention.While the observation group with 20 cases were implemented additional early stage functional exercise as well as the guidance of regular functional training and psychological intervention.Patient compliance and the limb shoulder range of motion ROM) were statistically analyzed to evaluate the effects of early stage functional exercise on the patients with breast cancer at the time of one month after the surgeon. Results The control group with 20 cases gain the patient compliance of 85%,and the observation group get the patient compliance of 85%,the difference between these groups have no statistical significance(P>0.05);while there is statistically significant difference between the two groups in the limb shoulder range of motion(P<0.05),19 cases of the observation group reach the standard of the shoulder range of motion (95%),while there are just 14 cases of the control group reaching the standard.It indicates the patients in the observation group gain better recovery than the patients in control group with breast cancer recovery through early stage functional exercise with psychological intervention. Conclusion Early functional exercise on patients with breast cancer who have accepted modified radical mastectomy can significantly promote the functional recovery of patients affected limb.

JIA Zhi-yang, LI Hong-xia, HE Chun-jiao, ZHOU Zhi-gang

2016, 14(9): 1601-1603. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.055

71 0

Abstract:

XU Guang-wu, LU Yu-zhang, GONG Neng-yin, WU Hao-han, WANG Wen-qiang, QIAN Shi-qing, XIE Ming

2016, 14(9): 1604-1606. doi: 10.16766/j.cnki.issn.1674-4152.2016.09.056

112 0

Abstract:

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2016 Vol. 14, No. 9

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