2017 Vol. 15, No. 10

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General practice residency training program in USA
JIANG Chun-yan, ZHENG Jia-lin, TONG Ceng-han, ZHU Shan-zhu
2017, 15(10): 1639-1641. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.001
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Objective To learn more about general practice(GP)residency training program in USA and to provide helpful references to general practice training in China. Methods We went to University of Nebraska Medical Center(UNMC) and attended a training of GP faculty.During this time we got the facts of American GP residency training program and how American general practitioners worked. Results American GP residency training program had a relatively-mature development and had got well training effects.The following characters of the program were impressive.Firstly,the design of the program was strict and practical so as to ensure graduates provide safe,high-quality,comprehensive and continuous patient care in all settings.The program was designed with a broad range of block requirements and was focused on training the ability of solving common health problems and grasping common clinical techniques in community.Meanwhile,continuity clinic was designed in the training to allow graduates to provide comprehensive and continuous care.Secondly,American general practitioners provided medical service in clinic,hospital and nursing houses.The services ranged from prevention,health care,treatment,rehabilitation,and health education,etc.They also provide continuous management for patients with chronic diseases or in need of rehabilitation.In this way the general practitioners were able to provide comprehensive and continuous health care for patients and their families.Thirdly,communication and humanistic care were essential skills for general practitioners.American general practitioners paid more attention to communication and humanistic care for patients in both training program and their clinical practice.All of the above were valuable references to GP residency training in China. Conclusion Standardized and normalized residency training program is the footstone of GP training and the key guarantee of high quality primary care in USA.
YANG Ting, YANG Xiao-hui
2017, 15(10): 1642-1643.
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Prognostic value of myeloid differentiation primary response 88 and Toll-like receptor 4 in breast cancer patients in Xinjiang
MA Fang-jing, YANG Lei, WANG Hai-yan, GUO Li-ying, CUI Wen-li
2017, 15(10): 1644-1648. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.002
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Objective Breast cancer remains a major cause of death in women worldwide,and tumor metastasis is the leading cause of death in breast cancer patients after conventional treatment.This study evaluated the prognosis of breast cancer patients based on contributors to the innate immune response:myeloid differentiation primary response 88(MyD88) and Toll-like receptor 4(TLR4). Methods We analyzed data of 200 breast invasive ductal carcinoma(IDC) patients who were treated at the department of breast surgery,the First Affiliated Hospital of Xinjiang Medical University from 2005 to 2007.Overall survival(OS) and disease free survival(DFS) were compared. Results In total,153 patients(76.50%) were disease-free without relapse or metastasis,whereas 47(23.50%) patients developed recurrence or metastasis.A significant positive correlation was observed between MyD88 and TLR4 expression(P<0.001).Patients with high expression were more likely to experience death and recurrence/metastasis events(P<0.05).Patients with low MyD88 or TLR4 expression levels had better DFS and OS than patients with high expression levels(log-rank test,P<0.001).Patients with low MyD88 and TLR4 expression levels had better DFS and OS than patients with high expression levels of either (log-rank test,P<0.001).In a multivariate analysis,high MyD88 expression was an independent predictive factor for decreased DFS(adjusted HR,3.322;95% CI:1.663-6.631;P=0.001) and OS (adjusted HR,4.500;95% CI:1.544-13.098;P=0.005). Conclusion TLR4-MyD88 signaling pathway activation or MyD88 activation alone may be a risk factor for poor prognosis in breast cancer.Therefore,TLR4-MyD88 signaling pathway activation in tumor biology provides a novel potential target for breast cancer therapy.
The analysis of perioperative period blood loss and the timing of blood transfusion in the aged patients with femoral intertrochanteric fracture
ZHAO Xiao-lin, LIANG Zhi-lin, TONG Xun-zhe, WANG Bo, DU Xiao, YANG Bo, GAO Mao-long
2017, 15(10): 1649-1651,1690. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.003
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Objective To evaluate the changes of HCT,HGB and hidden blood loss in the patients with femoral intertrochanteric fracture before and after the treatment. Methods We conducted a retrospective analysis of the cases data of the aged patients with femoral intertrochanteric fracture from January,2013 to December,2015,built a database with EpiData and calculated the hidden blood loss with Gross equation.The changes of HCT and HGB were analyzed with t test. Results According to inclusion criteria,33 cases entered the database,with 91.52 ml average blood loss during operation.The average HCT mean of 33 cases was 33.34±4.79 before surgery,followed by the lowest (26.53±4.49) on the third day after surgery and then it tended to increase.On the third day after surgery,The hidden loss blood in 33 cases was the highest(790.25 ml,92.10%).There were statistical differences between HCT before operation and those on the first day,third day,fifth day,seventh day after operation in transfusion group(P<0.05).There were statistical differences between HCT before operation and those on the first day,third day,fifth day,seventh day after operation in no-transfusion group(P<0.05).There were no statistical differences between HCT before operation,on the third day,fifth day,seventh day after operation in transfusion group and those in no-transfusion group.There was statistical difference between HCT on the first day after operation in transfusion group and that in the non-transfusion group(P<0.05).There were statistical differences between HGB before operation and those on the first day,on the third day in transfusion group(P<0.05).There was no statistical difference between HGB before operation and those on the fifth,on the seventh day after operation.The differences were statistically significant(P<0.05) between HGB before operation and those on the first day,third day,fifth day,seventh day after operation in no-transfusion group(P<0.05).There were statistical differences between HGB in the transfusion group before operation and on the first day after operation and those in no-transfusion group(P<0.05).The differences were not significant between HGB in transfusion group on the third,fifth,seventh day after operation and those in the no-transfusion group. Conclusion The record of hidden blood loss of elderly patients with femoral intertrochanteric fracture should be closely monitored in the clinical work together with HGB,HCT value changes,especially on the third and fifth day after operation.We should estimate the hidden blood loss and perioperative blood loss and then give them corresponding treatments.
Protection of edaravone no the rat microglia after ischemia reperfusion
HUANG Ding-ding, WENG Hao, LIU Rong, XU Zhi-yong, LIU Hai-jian, ZHAO Wei-wei
2017, 15(10): 1652-1654. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.004
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Objective To evaluate the Janus kinase2/signal transducers and activators of transcription 3(JAK2/STAT3) signaling pathway on edaravone inhibiting inflammatory reaction after ischemia-reperfusion injury in rats. Methods Cultured Sprague-Dawley rats microglia in vitro,using the random number table method,microglia were divided into 3 groups(n=20 each):normal culture group(group C);Glutamate group(group Glu);edaravone group(group Eda);Microglia in group Glu and group Eda exposed to medium containing 1 mmol/L Glu for 30 min.Microglia cell were treated with 100 μmol/L edaravone after glutamate neurotoxicity in group Eda.The CCK8 assay was used to detect the changes in cell viability.Real time quantitative PCR technique was used to the level of JAK2 STAT3 mRNA,ELASA was used to detect the changes of inflammatory mediators;Apoptosis of microglia was assayed by flow cytometry. Results Compared with group C,cell survival rates in group Glu decreased,and the expression of JAK2 and STAT3 mRNA were up-regulated,and the contents of TNF-α,IL-2 were increased,and the cell apoptosis rate increased,respectively(P<0.05);Compared with group Glu,the cell survival rates increased in group Eda,and expression of JAK2 and STAT3 mRNAdecreased in group Eda,and contents of TNF-α and IL-2 were decreased,and cell apoptosis rate decreased in group Eda,respectively(P<0.05). Conclusion Edaravone post-processing inhibits inflammatory cytokine expression of the rat microglia after ischemia and reperfusion injury related toJAK2/STAT3 signaling pathway.
A study of metastin on inhibiting the capacity of metastasis and invasion in highly metastatic nasopharyngeal carcinoma SUNE-1-5-8F cells
JING Qi-jun, JIANG Hao, XIANG Ping, LIU Hao
2017, 15(10): 1655-1658,1721. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.005
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Objective To investigate and discuss the effect of metastin on inhibiting the capacity of metastasis and invasion in highly metastatic nasopharyngeal carcinoma SUNE-1-5-8F cells. Methods ①The SUNE-1-5-8F cells' were treated with different concentration of metastin(102 nM,103 nM,104 nM).Contrast the cells before and after treatment.Finally,the capacity of metastasis and invasion were tested by transwell assay.②Forty female mouse were randomly dividend into metastin group and control group.Both were injected with 2×106/ml.SUNE-1-5-8F cells under the right armpits.Mouse in metastin group were injected with 1.17 mg/kg metastin at day 2.The tumor inhibition rate,metastasis inhibition rate and life extension rate were detected by BALB/c-nu nude mouse model assay.The expression of kisspeptin protein was analyzed by immunohistochemistry. Results ①Metastin inhibited the SUNE-1-5-8F cells' capacity of metastasis and invasion in cell assay(P<0.05),whose capacity had a positive correlation with the concentration of metastin.②Metastin didn't inhibit the proliferation of tumor in nude mouse assay(P>0.05),but it reduced the pulmonary metastasis(P<0.05).And metastin influenced the life extension rate of nude mouse(P<0.05).The result of immunohistochemistry showed that the expression of kisspeptin protein of the metastin group was significantly different from the control group (P<0.05). Conclusions ①Metastin inhibits the SUNE-1-5-8F cells' capacity of metastasis and invasion in cell assay,whose capacity has a positive correlation with the concentration of metastin.②Metastin reduces the pulmonary metastasis and prolonged life,but it doesn't inhibit the proliferation of tumor in nude mouse assay.
The change of potassium channels and CaN/NFAT signal pathway in Xinjiang kazak hypertension patients
WANG Ling-peng, CHEN Yan-yu, ZHANG Yuan-ming, LIANG Ping, LUO Jian
2017, 15(10): 1659-1661,1717. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.006
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Objective To study peripheral blood lymphocyte CaN change/NFAT signal pathways in the kazak in Xinjiang hypertension patients,and to reveal the potassium channels to participate in the specific mechanism in the hypertension. Methods Between February,2014 and November,2014 in Xinjiang medical university first affiliated hospital heart center first option of kazak in Xinjiang simple hypertensive patients without antihypertensive treatment,venous blood was collected,the hsCRP ELISA technology testing,hsCRP level of 3 mg/L or selected patients with high blood pressure,a total of 50 cases,hsCRP level<3 mg/L of 50 cases of hypertension patients,50 cases of kazak people health.The peripheral blood lymphocytes were collected and separated.The Real-time PCR and Western blot were used to detect the Kv1.3,TNF-α gene and protein expression level,CaN,NFAT activity. Results In high hsCRP hypertension group and low hsCRP Kv1.3 hypertension group,TNF-α mRNA and protein expression level and CaN/NFAT activity is higher than normal control group(P<0.05),the difference was statistically significant.High hsCRP Kv1.3 hypertension group,TNF-α mRNA and protein expression level and CaN/NFAT activity expression level was higher than low hsCRP hypertension group,the difference was statistically significant(P<0.05). Conclusion CaN pure/NFAT signal pathway activity increased in Xinjiang kazak patients with high blood pressure,potassium channels may be involved in the occurrence of hypertension development by CaN/NFAT signal pathways.
Expression of Thr157 phosphorylated p27kip1 protein in human breast carcinoma and its clinical significance
GUO Zhi-qin, LU: Qing-shan, WU Wan-xin, WANG Zhen, YUAN Lin-na, LU Li-hui, WEN Xiao-wei, YAO Ming
2017, 15(10): 1662-1665. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.007
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Objective To study the expression of Thr157 phosphorylated p27kip1(P-p27Thr157) in human breast carcinoma and its clinical significance. Methods The expression of P-p27Thr157 protein was detected respectively by immunohistochemical EnVision method and Western blot in 111 specimens of breast carcinoma tissues and 8 paired specimens of breast carcinoma and adjacent normal tissues.The relationships between the expression levels of P-p27Thr157 protein and its clinicopathological characteristics in primary breast carcinoma were retrospectively analyzed. Results The positive expression rates of P-p27Thr157 protein was 87.4% (97/111),including high expression in 64 cases(57.7%,64/111),low expression in 47 cases(42.3%,47/111) and 9.9%(11/111) in cancerous and paired adjacent normal tissues respectively(P<0.05).Strong P-p27Thr157 expression was seen in cancerous tissues but not in paired adjacent normal tissues.P-p27Thr157 expression was correlated with tumor size,lymph node metastasis and TNM stage(all P<0.01).The prognosis of patients with high expression of P-p27Thr157 was significantly poorer than of those with low expression.Moreover,high expression of P-p27Thr157 appeared to be correlated with a shorter overall survival(OS) of breast cancer patients.P-p27Thr157 expression was positively correlated with proliferation index Ki-67(r=0.528,P<0.05),and negatively correlated with p27(r=-0.458,P<0.05). Conclusion The abnormal expression of P-p27Thr157 protein may be involved in the development and pathogenesis of breast carcinoma,and it might be used as a novel diagnostic marker and therapeutic target in breast carcinoma.
A comparative study of the effect of phacoemulsification and small-incision cataract surgery corneal endothelial cells
LI Ning, WANG Jian-feng, BU Jing-li, LI Juan
2017, 15(10): 1666-1668,1703. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.008
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Objective To observe and compare the influence of phacoemulsification and small-incision cataract surgery(SICS) on the endothelial cell count(ECC),the morphology(coefficient of variation and Hexagonality) of corneal endothelial cells(CECs) and the central corneal thickness(CCT),and evaluate the their safety on the CECs. Methods The clinical data of 200 cases of cataract in our hospital between January,2015 and December,2015 were analyzed.The patients were randomly divided into phacoemulsification group(100 cases) and SICS(100 cases),and all the patients were followed up for 6 weeks.The changes of CCT,endothelial cell density(ECD),coefficient of variation(CV) and Hexagonality were compared between the two groups after the operation. Results There was no significant difference in the observed indexes between the two groups before the operation and 6 weeks after the operation.The difference in CCT was statistically significant at 1 weeks after the operation between the two groups(P<0.05).There were no statistically significant differences in ECD loss between the two groups at 1 weeks and 6 weeks after the surgery(P>0.05).There were no statistically significant differences in CV and Hexagonality between the two groups before the operation,and 1 and 6 weeks after the surgery(P>0.05). Conclusion Both phacoemulsification and SICS can cause corneal endothelial cell loss to different degree,but there were no statistically significant differences between the two groups in the function and morphology of corneal endothelial cell.Preoperative examination,fine and skilled operation,careful observation after the operation are the keys to reduce the loss of CECs in cataract patients.
Analysis of prognostic factors in esophageal cancer patients with satisfactory short-term outcome after neoadjuvant chemoradiotherapy followed by minimally invasive surgery
KONG Min, CHEN Bao-fu, WANG Chun-guo, MA De-hua, YE Min-hua, ZHOU Chao, WANG Jiao-chen, YE Zhong-rui, ZHU Cheng-chu
2017, 15(10): 1669-1671,1734. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.009
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Objective To investigate the prognostic factor in esophageal cancer patients with satisfactory short-term outcome after neoadjuvant chemoradiotherapy followed by minimally invasive surgery(MIS). Methods From June,2011 to June,2014,21 case of locally advanced esophageal carcinoma undergoing neoadjuvant chemoradiotherapy followed by MIS and meeting the inclusion criteria were selected.According to EUS,CT and other examinations,all patients were divided into clinical stage ⅡA-ⅢB before the treatment.The first phase of treatment was concurrent chemoradiotherapy(CRT),NP has been adopted as a preoperative chemotherapy program(vinorelbine 25 mg/m2,d1,8,22,29 and cisplatin 25 mg/m2,d1-4,22-25).During the same period,conventional fractionated radiotherapy with a dose of 40 Gy/20F was performed.Seven weeks after CRT,all patients received the treatment of subtotal resection of esophageal with a combined use of thoracoscopy and laparoscopy through right chest,abdomen and left cervical.Twenty-one cases of patients were of satisfactory recent efficacy:pathological remission in the primary tumor,smooth implementation of surgery,without postoperative major complications.Age,gender,tumor location,tumor size,clinical stage before the treatment,neoadjuvant chemoradiotherapy completion,the time interval between neoadjuvant chemoradiotherapy and MIS,operation duration,perioperative bleeding,the cleaned lymph node region and the number,positive lymph node pathology,hospital stay and other related factors have been multivariate analyzed. Results For 21 patients of satisfactory recent efficacy,the follow-up was 16 to 60(44.6±12.6) months,the 3-year and 5-year survival rates were 85.21%,73.85%,respectively.The multivariate analysis showed the age,metastatic lymph nodes were the independent prognostic factors. Conclusion The regimen of neoadjuvant chemoradiotherapy followed by MIS in the treatment of locally advanced esophageal carcinoma is efficacy,especially for patients with satisfactory short-term outcome.But the heterogeneity of tumor,individual differences,age,lymph node metastasis and other factors may affect the prognosis.
Expression of HIF-1α,Treg and Th17 in the peripheral blood of patients with nonalcoholic fatty liver disease
TANG Tao, CAI Xu-hua, LI Wei-ping, LIU Jiang
2017, 15(10): 1672-1674,1820. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.010
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Objective To study the expression of HIF-1αin the peripheral blood and the ratio of Treg and Th17 cells in T cells in patients with nonalcoholic fatty liver disease(NAFLD),and to explore the relationship between those and pathology of NAFLD. Methods A total of 39 patients who were diagnosed as nonalcoholic fatty liver disease in our hospital from October,2015 to April,2016 and 20 healthy volunteers were collected in this study.Flow cytometry were used to measure and analyze the portion of CD4+/CD25+/Foxp3+ Treg cells and CD4+/IL17+ Th17 cells in total CD4+T lymphocytes.Enzyme linked immunosorbent assay(ELISA) were employed to test the expression level of HIF-1α.Expression of HIF-1α and the portion of Treg cells and Th17 cells were compared between two groups.They were also compared between NAFLD patients in the fat group (BMI ≥ 28 kg/m2) and those in the non-fat group(BMI<28 kg/m2).Student's t test and chi-square test were employed in the statistics. Results NAFLD patients had a much higher expression level of HIF-1α (t=11.284,P<0.001).The portion of Treg and Th17 cells in total CD4+T lymphocytes were significantly higher in NAFLD group than in control group (t=11.313,P<0.001 and t=8.737,P<0.001) and the ratio of Th17/Treg was also higher (t=4.055,P<0.001).Non-fat NAFLD patients expressed obviously higher level of HIF-1α than fat NAFLD patients(t=2.035,P<0.05).The portion of Treg and Th17 also increased in non-fat NAFLD patients (t=2.066,P<0.05 and t=2.089,P<0.05) but no significant difference of the ratio of Th17/Treg was observed (t=0.048,P>0.05). Conclusion Patients with NAFLD has higher expression level of HIF-1α and imbalance of Th17/Treg.HIF-1α and balance of Th17/Treg could be involved in the onset and development of NAFLD,and may have relationship with insulin resistance to some extent.
Expression and role of CLOCK gene in thyroid carcinoma and thyroid adenoma
LIU Dong-liang, HUA Ming, ZHOU Feng, HAN Chang, NIU Wan-cheng, LI De-ben, ZHANG Zhao-hui
2017, 15(10): 1675-1677,1785. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.011
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Objective Thyroid adenocarcinoma is one of the most common malignancies in the endocrine system,while thyroid adenoma is the most common thyroid benign tumor.Some research has showed the difference in the gene expression between benign and malignant thyroid tumor.The aim of this study was to investigate the expression and clinical significance of biological rhythm gene CLOCK in thyroid carcinoma and adenoma. Methods Total 74 cases of thyroid carcinoma and 55 cases of thyroid adenoma were collected from March,2012 to March,2015 in our hospital.The expression of CLOCK was detected by immunohistochemical method.We analyzed its relationship with clinicopathological features. Results The positive rates of CLOCK in thyroid carcinoma and thyroid adenoma were 68.9%(51/74) and 32.7%(18/55),respectively,the difference was significant(P<0.001).The expression of CLOCK in thyroid carcinoma was 4.2±3.8,and in thyroid adenoma was 2.1±2.0,there was significant difference(P<0.001).The positive expression rate of CLOCK in cancer tissues with lymph node metastasis was significantly higher than that without lymph node metastasis(P=0.012).The positive expression rate of CLOCK was significantly correlated with the tumor size(P=0.028),and the CLOCK positive expression rate increased with TNM stage(P=0.023). Conclusion Up-regulation of CLOCK is not only involved in the formation of thyroid carcinoma,but also plays an important role in the process of tumor invasion and metastasis.
The role of TNF-α and Pro-BNP in sepsis induced myocardial dysfunction
LIU Bing-wei, HU Wei, HU Wei-hang, ZHU Ying, WANG Jian-rong, CENG Xiao-kang
2017, 15(10): 1678-1680,1811. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.012
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Objective Once sepsis appears cardiac dysfunction,mortality is high,so early diagnosis has significant clinical significance,this study explored the role of tumor necrosis factor-α(TNF-α) and pro-B-type brain natriuretic peptide(Pro-BNP) in sepsis induced myocardial dysfunction. Methods Fifty patients with Sepsis induced myocardial dysfunction were involved.After 24 h admission according to cardiac ultrasound examination for left ventricular ejection fraction(LVEF),the patients were divided into LVEF ≤ 40% group and LVEF>40% group.According to the prognosis was divided into survival group and death group.TNF-α,B-type pro-brain natriuretic peptide(Pro-BNP) and TNI were measured in the selected patients.APACHE Ⅱ score was recorded.Left ventricular end-diastolic diameter(LVSD) was measured by echocardiography.The levels of TNF-α,Pro-BNP and APACHE Ⅱ scores and the correlation between TNF-α,Pro-BNP and LVEF were analyzed.The ROC curve was used to evaluate the specificity and sensitivity of TNF-α and Pro-BNP in the diagnosis of cardiac dysfunction. Results The levels of TNF-α,Pro-BNP and APACHEⅡ in LVEF>40% group were lower than those in LVEF ≤ 40% group.The difference was statistically significant.TNF-α,TNI in survival group was lower than that in death group.Pro-BNP,LVSD in the two groups was P<0.01;LVEF (40.03±1.50) was significantly higher than that in the death group(38.76±2.86),but no statistically significant difference.There was correlation between TNF-α,Pro-BNP and APACHEⅡ score(r=0.88,P<0.05;r=0.70,P<0.05).TNF-α and Pro-BNP were negatively correlated with LVEF(r=-0.76,P<0.05;r=-0.79,P<0.05).The area under the ROC curve of TNF-α was 0.772 and the area under the ROC curve of Pro-BNP was 0.771. Conclusion TNF-α and Pro-BNP were significantly increased in patients with Sepsis induced myocardial dysfunction.The increase of TNF-α and Pro-BNP correlated with poor prognosis.
The expression and significance of Th17,Treg and Th17/Treg in peripheral blood of patient with acute cerebral infarction
REN Qing-qing, QIAN Wei-dong
2017, 15(10): 1681-1683,1710. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.013
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Objective To explore the expression and significance of Th17,Treg and ratio of Th17 and Treg(Th17/Treg) in peripheral blood in patient with acute cerebral infarction. Methods Acute cerebral infarction(ACI) group (72 cases) and healthy control(HC) group(48 cases) were investigated.The levels of Th17 and Treg in peripheral blood were detected by Flow cytometry.According to National Institute of Health stroke scale(NIHSS) scores,ACI group was divided into light group,medium group and severe group.According to the Pullicino formula,divided into small infarction volume group,medium infarction volume group and big volume infarcts.In addition,Th17,Treg and Th17/Treg correlations with NIHSS and infarction volume were analyzed,respectively. Results The level of Th17[(7.26±1.92)%] and Th17/Treg(2.38±1.80) increased significantly(P<0.05) and the level of Treg[(4.29±1.82)%] decreased significantly(P<0.05),compared with HC group[(7.26±1.92)%,2.38±1.80,(8.03±1.10)%)].The differences in level of Th17,Th17/Treg and Treg in different infarction volume groups and different NIHSS scores groups were significantly,respectively(P<0.05).The correlation between Th17/Treg and NIHSS,infarction volume were significantly positive(r=0.865,r=0.672,P<0.05). Conclusion Th17 and Treg and Th17/Treg are closely related to the severity of acute cerebral infarction.To a certain extent,detecting the change of Th17/Treg can assessment progression of the disease.
Comparative study of clinical effects of different anesthesia methods in acute abdomen complicated with septic shock
WANG Jun, ZHENG Jun-gang, RUAN Yi-meng, LU Zi-hui, HUANG Zhang-shun, ZHOU Hai-dong
2017, 15(10): 1684-1686,1772. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.014
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Objective Comparative study of clinical effects of general anesthesia and general anesthesia with epidural anesthesia in acute abdomen complicated with septic shock. Methods The acute abdomen with septic shock in 175 patients,of which 85 patients were on the basis of general anesthesia with epidural anesthesia were retrospectively analyzed.The difference of MAP,HR,SpO2 before and after anesthesia and the incidence of adverse reactions such as nausea and vomiting,restlessness,respiratory depression and pain in the two groups were compared. Results There was no significant difference in hemodynamic parameters between the two groups before clinical anesthesia.During the period of induction of anesthesia,intubation and extubation,the central arterial pressure and heart rate of the patients in the observation group were significantly lower than those in the control group.The incidences of nausea and vomiting,restlessness,respiratory depression and pain were significantly lower in the observation group than in the control group,which was statistically significant.Epidural anesthesia on the basis of general anesthesia was the protection factor of occurrence of clinical pain in patients with acute abdomen complicated with septic shock after surgery(OR=0.200, 95%CI:0.098-0.408, P<0.01). Conclusion During the course of clinical surgery of patients with acute abdomen complicated with septic shock,the increase in epidural anesthesia on the basis of general anesthesia could effectively improve the oxygen saturation,heart rate and mean arterial pressure of patients during anesthesia.And it could significantly reduce the possibilities of postoperative nausea and vomiting,fretful,respiratory depression and pain and other adverse reactions incidence simultaneously.It played an important role in maintaining the health of patients,reducing the pain and improving the cure rate.
Efficacy evaluation of thrombolysis combined with anticoagulant therapy in the treatment of patients with Lower extremity deep vein thrombosis combined with moderate pulmonary embolism
GUO Zhi-yu
2017, 15(10): 1687-1690. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.015
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Objective To explore the recent efficacy of Urokinase combined with anticoagulant therapy in the treatment of patients with Lower extremity deep vein thrombosis combined with moderate pulmonary embolism. Methods A total of 108 cases of Lower extremity DVT with moderate pulmonary embolism in our hospital from October 2012 to October 2015 were enrolled and randomly divided into control group(n=54) and observation group(n=54).The control group received low molecular weight heparin and warfarin,while the observation group received additional urokinase thrombolysis treatment.The remission of cough,chest pain and breathing difficulties,leg circumference discrepancy and curative efficacy were observed.The international normalized ratio(INR),fibrinogen(FIB),D-dimer,platelet(PLT),arterial oxygen partial pressure(PO2) and coagulation index PT,APTT and TT before and after the treatment were compared statistically. Results After the treatment,the leg circumference discrepancy in both groups was reduced(P<0.05),and the difference was statistical significant between the two groups(P<0.05).In the observation group,the total effective rate(92.59%) of lower limb DVT was significantly higher than 75.93% in control group(P<0.05).The total effective rate of pulmonary embolism in the observation group was higher than that in the control group,and the difference was significant(P<0.05).D-dimer decreased in both groups,especially in the observation group,the difference was statistical significant between the two groups(P<0.05).There was no significant difference in INR,FIB,PLT and PO2(P>0.05).PT,APTT and TT time decreased obviously in both groups after the treatment(P<0.05),and more obvious in the observation group,the difference between the two groups was significant(P<0.05). Conclusion The recent therapeutic effect of Urokinase combined with anticoagulant in the treatment of lower extremity deep vein thrombosis combined with moderate pulmonary embolism is notable,be worthy of further promotion in clinical practice.
Clinical analysis of 73 patients with Stevens Johnson syndrome or toxic epidermal necrolysis
YE Yu-jian, ZHU Yi-ping, XU Ai-e
2017, 15(10): 1691-1693,1794. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.016
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Objective To analyze the pathogenic factors,clinical characteristics,treatment and outcome of Stevens Johnson syndrome(SJS) and toxic epidermal necrolysis(TEN),so as to provide data for its clinical prevention. Methods The clinical data of 73 patients with SJS or TEN was analyzed,and 34 patients were treated with prednisolone sodium succinate combined immunoglobulin(Group A),and 39 patients were treated with prednisolone sodium succinate combined hematodialysis(Group B).The general data,pathogenic factors,clinical features,laboratory results,treatment and outcomes were all summarized. Results The etiology of 58 patients has been determined,in which 57 patients were induced by drugs(98.3%);the drugs were given priority to allopurinol and carbamazepine,accounted for 34.5% and 24.1%,respectively.The common clinical features were fervescence,electrolyte disturbances,elevated leukocyte,liver enzymes and urea nitrogen,with an occurrence rates over 30%;the incidence of hyperglycemia was 20.5%.The total pathogenic bacteria positive rate was 91.8%,in which the skin pathogenic bacteria positive rate was the highest(83.6%).The bacteria were mainly staphylococcus aureus(61.6%).There was no significant difference in fever subsidence time,hospital stay and death rate between the two groups(P>0.05).The treatment expense of Group A was lower than that of Group B,the difference had statistical significance(P>0.05). Conclusion In the past two years,the mainly drugs that induced SJS and TEN were purine and carbamazepine.On the basis of symptomatic treatment,both glucocorticoid combined immune globulin and glucocorticoid combined hemodialysis can get good curative effect.
A comparison of residual dizziness between primary benign paroxysmal positional vertigo and secondary benign paroxysmal positional vertigo
HU Jin, FU Wei-da, YOU Ke, LU Xia
2017, 15(10): 1694-1696. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.017
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Objective To compare the difference in incidence rates,duration and the score of dizziness handicap inventory(DHI) of residual dizziness between parents with primary benign paroxysmal positional vertigo(BPPV) and the patients with secondary BPPV,and provide reference for the clinical treatment of secondary BPPV. Methods According to the etiology,196 cases of BPPV undergoing particle repositioning maneuvers in our hospital between May,2012 and December,2015 were enrolled and divided into secondary BPPV group(n=73)and primary BPPV group(n=123).The gender,age,the course before repositioning treatment,incidence rates and duration of residual dizziness,and the score of DHI were analyzed. Results There were no significance between the two groups in the gender,age,the course before repositioning treatment(P>0.05).The incidence rates of residual dizziness in secondary BPPV group was higher than that in primary BPPV group(65.75% vs. 49.45%,P<0.05).The duration of residual dizziness in secondary BPPV group was longer than that in primary BPPV group[(11.54±4.15)d vs. (9.21±4.54)d,P<0.05].The secondary BPPV group had a higher score of DHI(18.44±6.67 vs. 14.79±6.00,P<0.05). Conclusion The secondary BPPV patients had higher incidence rates,longer duration and high DHI score of residual dizziness.In our clinical work,we should attach more importance to the secondary BPPV patients.The early intervention of residual dizziness will improve the quality of life of BPPV patients.
Effect of trimetazidine combined with remote ischemic preconditioning on myocardial damage and prognosis in elderly ischemic heart disease patients after percutaneous coronary intervention
WANG Pin-xiao, ZHANG Yun-xia, SUN Teng-fei, QIAO Jian-hong
2017, 15(10): 1697-1699. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.018
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Objective To investigate the effect of trimetazidine combined with remote ischemic preconditioning(RIPC) on myocardial damage and prognosis in elderly ischemic heart disease patients undergoing percutaneous coronary intervention(PCI). Methods A total of 96 elderly ischemic heart disease patients treated with PCI were randomly divided into observation group(48 cases) and control group(48 cases) from January,2016 to September,2016.All the patients of 3 groups received antiplatelet routine drug treatment,etc.The control group received additional trimetazidine therapy,while the observation group received additional trimetazidine and RIPC.The changes of cTnI and CK-MB before and after the treatment and the incidence of adverse cardiovascular events at follow-up of 6 months were observed in both groups. Results The levels of cTnI and CK-MB increased significantly in both groups at 24 h after treatment(P<0.05),the levels of cTnI and CK-MB of the observation group was significantly lower than that at 24 h after the treatment(P<0.05);6 months follow-up showed that there were 2 cases of recurrent angina in the observation group,with an incidence of 4.17%;there were no myocardial infarction and death cases;while there were 10 cases of recurrent angina in the control group with an incidence of 20.83%,there were 5 case of myocardial infarction with an incidence of 10.42%,there was no death case. The incidence of recurrent angina and myocardial infarction of the observation group was significantly lower than that in the control group(P<0.05). Conclusion Trimetazidine combined with remote ischemic preconditioning in elderly ischemic heart disease patients after PCI can obviously reduce the levels of cTnI and CK-MB,reduce the myocardial damage and incidence of adverse cardiovascular events.
Clinical effect of the different dosage of colchicine on 98 cases of gouty arthritis
LU Shi-kai
2017, 15(10): 1700-1703. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.019
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Objective To investigate the clinical effect of the different dosage of colchicine on gouty arthritis. Methods Ninety-eight patients admitted to our hospital from March,2015 to June,2016 were randomly divided into group A(n=33),group B(n=33) and control group(n=32).The control group was treated by meloxicam,the group A was treated with a small dose of colchicine based on the control group,and the group B was treated with the conventional dose of colchicine based on the control group.It compared the clinical efficacy,the time of pain relief,the frequency of episodes and recurrence,the level of serum uric acid,erythrocyte sedimentation rate and C reactive protein,and adverse reaction. Results The clinical effective rate was 96.97% in group A,90.91% in group B,which were significantly higher than that of 78.13% in the control group(χ2=10.664,P=0.005).And there was significant difference between the group A and the control group (Z=-3.631,P<0.001).There were statistically significant differences in the time of pain relief,the frequency of episodes and recurrence among three groups(F=9.281,P<0.001;F=4.372,P=0.016;F=6.714,P=0.002).Group A and group B were significantly lower than the control group(P<0.05).After treatment,the level of erythrocyte sedimentation rate and C reactive protein were significantly decreased among three groups (P<0.05),and they were significantly lower in group A and group B than the control group (P<0.05).There was no significant difference in the level of serum uric acid among three groups (P>0.05).The adverse reaction rate of group A was 21.21%,and 12.50% of control group,which were significantly lower than that of 54.55% in the group B(χ2=15.461,P<0.001).And there were significant difference between the group A and B,the group B and the control group (χ2=7.791,P=0.005;χ2=12.827,P<0.001). Conclusion It has a significant clinical efficacy of a small dose of colchicine in the treatment of gouty arthritis.It can effectively shorten the time of pain relief and the frequency of recurrence,reduce the level of erythrocyte sedimentation rate,and high safety,which is worthy of popularization and application.
Effects of edaravone combined tolosemide on oxidative stress,inflammatory factors,microcirculation and hemorheology in patients with acute cerebral hemorrhage
WEN Xiu-mei
2017, 15(10): 1704-1706. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.020
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Objective To investigate the effects of edaravone combined torasemide on oxidative stress,inflammatory factors,microcirculation and hemorheology in patients with acute cerebral hemorrhage. Methods One hundred and thirty-two patients with acute cerebral hemorrhage were randomly divided into two groups,each group 66 cases.The control group was given routine treatment,and the observation group was added edaravone and Torasemide based on control group.After treatment,the oxidative stress(SOD,GSH-Px,CAT),inflammatory factors(CRP,TNF-α,IL-2),microcirculation(Fib,PLT,PAG) and hemorheology(Blood viscosity at high Shear Rates,Blood viscosity at middle Shear Rates,Blood viscosity at low Shear Rates,Hematocrit,Erythrocyte aggregation index) of two groups were compared. Results After treatment,the SOD,GSH-Px and CAT levels of two groups were significantly increased(P<0.05),and each indicator of observation group were significantly higher than those of control group(P<0.05).After treatment,CRP and TNF-α levels of two groups were significantly reduced(P<0.05),and each indicator of observation group were significantly lower than those of control group(P<0.05);IL-2 levels of two groups were significantly increased(P<0.05),and IL-2 of observation group was significantly higher than that of control group(P<0.05).The Fib,PLT and PAG levels of two groups were significantly decreased(P<0.05),and each indicators of observation group were significantly lower than those of control group(P<0.05).After treatment,Blood viscosity at high Shear Rates,Blood viscosity at middle Shear Rates,Blood viscosity at low Shear Rates,Hematocrit,Erythrocyte aggregation index levels of two groups were significantly decreased(P<0.05),and each indicators of observation group were significantly lower than those of control group(P<0.05). Conclusion Edaravone combined torasemide could effectively improve the oxidative stress,inflammatory reaction and hemorheology of patients with acute cerebral hemorrhage and promote the circulation rate of blood microcirculation.
Effect of remifentanil combined anesthesia on IL-8 and oxidative stress in patients with colon cancer after laparoscopic surgery
WANG Qian-rong, XU Heng-yi, HE Huan-zhong, GAO Bin
2017, 15(10): 1707-1710. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.021
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Objective To investigate the effect of remifentanil combined anesthesia on IL-8 and oxidative stress of patients with colon cancer after laparoscopic surgery. Methods One hundred and sixty-two patients with laparoscopic cholecystectomy were randomly divided into two groups by random number table method.Patients in control group(81 cases) were given fentanyl combined anesthesia,and patients in research group(81 cases) were given remifentanil combined anesthesia.The postoperative recovery index,serum cytokines,oxidative stress,T lymphocyte subsets and adverse events of two groups were compared. Results The Postoperative spontaneous breathing recovery time,wake up time,catheter removal time,directional force recovery time of research group were significantly lower than those of control group(P<0.05).After operation,the IL-8,IL-6,IL-6,CRP and TNF-α levels of two groups were significantly increased(P<0.05),the IL-8,IL-6,CRP and TNF-α levels of research group were significantly lower than those of control group(P<0.05),the IL-10 level was significantly higher than that of control group(P<0.05).After operation,the SOD,GSH and CAT levels of two groups were significantly reduced(P<0.05),the SOD,GSH and CAT levels of research group were significantly higher than those of control group (P<0.05).After operation,the MDA levels of two groups were significantly increased(P<0.05),the MDA level of research group was significantly lower than those of control group(P<0.05).After operation,the CD3+,CD4+,CD4+/CD8+ levels of two groups were significantly reduced(P<0.05),the CD3+,CD4+,CD4+/CD8+ levels of research group were significantly higher than those of control group(P<0.05).The nausea and vomiting,chills,restlessness,cough,tachycardia rate of research group were significantly lower than those of control group(P<0.05). Conclusion Remifentanil combined anesthesia could significantly improve the cytokines and reduce oxidative stress of patients with colorectal cancer after laparoscopic surgery,shorten wake up time and catheter removal time,with well analgesic effect and high safety.
Analysis of homocysteine and blood lipid levels in patients with chronic obstructive pulmonary disease
HU Ping, WANG Juan, ZHANG Yun-jian
2017, 15(10): 1711-1713,1751. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.022
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Objective To study the changes and relationship of homocysteine(Hcy) and blood lipid levels in patients with different stages of chronic obstructive pulmonary disease(COPD) and explore the role of homocysteine in COPD patients. Methods From January,2015 to June,2016,77 cases of inpatients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),61 cases of outpatients for stable COPD,and 353 healthy volunteers were enrolled in this study.The serum Hcy,hs-CRP,blood lipid,serum creatinine(sCr),and uric acid(UA) were detected and analyzed.The correlations with the study parameters were investigated. Results There was no statistical difference in three groups with age and gender.The Hcy and hs-CRP levels were significantly higher in AECOPD and stable COPD group compared to healthy controls(Hcy:P<0.001 and P=0.034;hs-CRP:P<0.001 and P=0.028).Additionally,Hcy and hs-CRP levels in AECOPD group were higher than that of stable COPD group(P=0.040 and P=0.009).The levels of TG and TC in AECOPD group were lower compared to stable COPD group and the healthy controls(TG:P=0.017 and P=0.001;TC:P=0.002 and P<0.001).LDL-C levels in AECOPD were significantly lower compared to stable COPD group and healthy controls(both P<0.001).Furthermore,the LDL-C level in stable COPD group was significantly lower compared to healthy controls(P=0.041),but there was no statistical difference of TG,TC level(P=0.844 and P=0.093).sCr level in AECOPD group was higher than that of healthy controls(P=0.004).There was no relationship between Hcy and blood lipid,sCr,UA,hs-CRP levels both in AECOPD and stable COPD group. Conclusion The Hcy levels in patients with AECOPD increased.Some comorbidities such as cardiovascular diseases and metabolic syndrome,maybe the result of increased serum Hcy levels in COPD patients.
Alendronate sodium combined with insulin for osteoporosis in patients with type 2 diabetes mellitus
YE Cong-cong, JIANG Hui, PAN Li-qin
2017, 15(10): 1714-1717. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.023
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Objective To investigate the efficacy and mechanism of alendronate sodium combined with insulin in the treatment of osteoporosis(OP) in the patients with type 2 diabetes mellitus(DM). Methods Total 94 cases of OP among patients with T2DM in our hospital between March,2015 and March,2016 were enrolled and randomly divided into observation group(47 cases) and control group(47 cases).On the basis of routine treatment,the control group was administrated with metformin and insulin,while the observation group with alendronate sodium and insulin.The levels of serum glycosylated hemoglobin(HbA1c),fasting blood-glucose(FBG),serum calcium(Ca),tartrate-resistant acid phosphatase 5b(TRAP-5b),bone gla protein(BGP),and bone-specific alkaline phosphatase(BAP) were tested.The bone mineral density(BMD) of the femoral neck,Wards triangle and greater trochanter were measured by DPX-LBMD dual energy x-ray measuring instrument. Results The total effective rate was 89.36% in the observation group and significantly higher than that(72.34%) in the control group(P<0.05).The levels of BAP,TRAP-5b and BGP after the treatment in the observation group were improved more significantly as compared with the control group(all P<0.05).The BMD of the femoral neck,wards triangle and the greater trochanter in the observation group were significantly higher than those in the control group(all P<0.05). Conclusion Alendronate sodium combined with insulin in the treatment of osteoporosis among the patients with type 2 diabetes mellitus can effectively improve the level of bone mineral density,with remarkable effect,high safety,and is worthy of promotion.
Changes of levels of serum ceruloplasmin in patients with Alzheimer's disease
LIN Yong, SHEN Jian-gen, LI Guo-rong, ZHANG Xiao-ling, PU Zheng-ping, JIN Wei-dong, WANG Lian-e, HUANG Man-li
2017, 15(10): 1718-1721. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.024
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Objective To explore changes and of levels of serum ceruloplasmin (CER) in patients with Alzheimer's disease(AD) and their indications. Methods A total of 1,086 AD patients were screened in this trial.Finally 125 patients with AD were selected and randomly divided into mild (28 cases),moderate(42 cases) and severe (55 cases) groups according to Clinical Dementia Rating Scale(CDR).Meanwhile,40 healthy elderly people were also selected as the control group.The levels of their serum CER were tested at fasting state.The differences of serum CER levels among all groups were done to explore the dynamic regulation of serum CER levels in AD patients and to analyze the correlation between the severity of dementia and serum CER levels. Results Levels of CER of patients in moderate and sever groups were significantly lower than those in control group(0.17±0.48 vs. 0.24±0.54;0.15±0.41 vs. 0.24±0.54).There's a positive correlation between the level of CER and scores of Mini-mental State Examination (MMSE) according to the multiple linear regression analysis (r=0.473,P=0.014).There were interactions between severity of dementia and level of serum CER that patients with moderate dementia had the highest score in The Brief Psychiatric Rating Scale (BPRS) when the level of serum CER reached approximately to 0.17 g/L. Conclusion The abnormality of serum CER levels in AD patients may correlate to AD progression.There's a positive correlation between the level of serum CER and the severity of cognitive impairment that the lower the level of CER,the more severe the cognitive impairment was.There were interactions among severity of dementia,the level of serum CER and patients' behavioral and psychiatric symptoms.
Clinical efficacy of erythropoietin in the treatment of patients with cancer-related anemia
TANG Xiao-wan, LEI Jin-hua, LI Jian-hua, ZHANG Zhan, HUANG Hui, TU Chuan-fa, WANG You-qun
2017, 15(10): 1722-1724. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.025
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Objective To investigate the clinical efficacy and mechanism of erythropoietin in the treatment of patients with cancer-related anemia. Methods In our hospital,from February,2012 to February,2016,80 cases of tumor associated chronic anemia patients enrolled in this study.All met the diagnostic criteria and no obvious contraindications were randomly divided into two groups according to random number table,each group of 40 cases.The control group received intravenous drip of sucrose iron in the treatment of regular treatment,while the observation group received subcutaneous injection of erythropoietin therapy on the basis of routine treatment.The blood index changes,KPS score curative effect,hematology index curative effect and adverse reaction were compared between the two groups. Results After treatment,the improvement of blood flow in the observation group was significantly better than the control group(P<0.05).The total effective rate of two groups of patients after treatment KPS scale score was significantly better than the control group(P<0.05).After treatment,the effective rate of the observation group was 95%,the effective rate of the control group was 47.5%,the observation group was significantly higher than that of the control group(P<0.05).The total adverse reactions in the observation group were 12.50%,significantly lower than the control group of 37.50%,and the difference was statistically significant (P<0.05).The total adverse reactions in the observation group were 12.50%, significantly lower than the control group of 37.50%, and the difference was statistically significant (P<0.05). Conclusion In the treatment of anemia associated with tumor curative effect,erythropoietin has less adverse reactions,worthy of clinical application.
Efficacy of TCM Qingre Sanjie therapy combined with pantoprazole sodium and mosapride citrate on chronic pharyngitis with gastroesophageal reflux
ZHANG Wei-min, TANG Shi-xiong, WANG Yao-wen, BAO Wei-liang
2017, 15(10): 1725-1727. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.026
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Objective To investigate the efficacy of TCM Qingre Sanjie therapy combined with pantoprazole sodium and mosapride citrate in the treatment of chronic pharyngitis with gastroesophageal reflux. Methods Two hundred and fifty-two cases of chronic pharyngitis and gastroesophageal reflux in the hospital from December,2015 to December,2016 were randomly divided into two groups,with 126 cases in each group.The control group received mosapride citrate tablets and pantoprazole sodium capsules,while the observation group was administrated with TCM Qingre Sanjie therapy based on control group.After the treatment,the symptoms(acid reflux,heartburn,abdominal pain,belching,throat foreign body sensation) scores,gastrointestinal hormones[serum gastrin(GAS),plasma motilin(MTL)],airway inflammation[nitric oxide(NO),endothelin-1(EP-1)],clinical efficacy of the two groups were compared. Results After the treatment,the symptoms of two groups were significantly decreased(P<0.05),and symptoms levels of observation group were significantly lower than those of the control group(P<0.05).After the treatment,GAS and MTL levels of both groups were significantly increased(P<0.05),and GAS and MTL levels of the observation group were significantly higher than those of the control group(P<0.05).After the treatment,the NO and EP-1 levels of both groups were significantly decreased(P<0.05),and NO and EP-1 levels of the observation group were significantly lower than those of the control group(P<0.05).The total effective rate of the observation group was 89.68%,which was significantly higher than that of the control group(75.40%),P<0.05.There was no significant difference on adverse reactions between the two groups(P>0.05). Conclusion TCM Qingre Sanjie therapy combined with pantoprazole sodium and mosapride citrate could effectively improve gastrointestinal hormones and airway inflammation,and alleviate the clinical symptoms of chronic pharyngitis with gastroesophageal reflux patients,with satisfactory treatment results.
Predictive value of Creasy's high risk factors score in prediction of threatened premature labor
LIU Wei, LANG Xiao, ZHANG Li-jun
2017, 15(10): 1728-1730. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.027
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Objective To discuss the predictive value of Creasy's high risk factors score in prediction of threatened premature labor,in order to improve precursor to the diagnosis of premature birth,decrease the rate of premature birth and improve the quality of birth. Methods We selected 532 pregnant women of 28-36+6 gestational weeks as the research objects from January 2016 to June 2016 in our hospital.All cases were analyzed with Creasy risk factor score.We used χ2 test to compare Creasy risk factor's high risk scores between different gestational weeks,and the incidences of threatened premature labor were compared between with and without threatened premature labor in different gestational weeks by t test,to calculate the sensitivity,specificity,accuracy and positive predictive value of each score. Results Creasy's premature labor scores the highest between 9 to 12 points,accounting for 34.40% (183/542).A total of 127 cases suffered from threatened premature labor,with an incidence rate of 23.87%(127/532).When Creasy's high risk factors scores 12,the sum of sensitivity 88.97%(113/127) and specificity 83.95%(340/405) reaches the maximum.At the same time,the accuracy 85.15%(453/532) and positive predictive value 63.48%(113/178) are the highest.Therefore,we set ≥ 12 points as the critical value to predict threatened premature labor.The rate of pregnancy in patients with<12 Creasy's high risk factors score was 85.71%(12/14),higher than 76.11%(86/113) in those with ≥ 12 scores.The scores in threatened premature labor women were significantly higher than those without in different gestational weeks of 28-29+6(15.24±3.22 vs. 7.25±1.84,t=26.633,P<0.001),30-31+6(16.11±3.51 vs. 8.41±1.88,t=23.680,P<0.001),32-33+6(17.21±3.38 vs. 8.68±1.96,t=27.050,P<0.001) and 34-36+6(13.58±3.06 vs. 6.35±1.62,t=25.529,P<0.001). Conclusion Creasy risk factor score ≥ 12 may predict the occurrence of threatened premature labor effectively.Higher Creasy's high risk factors score leads to higher incidence of threatened premature labor and lower successful rate of pregnancy.
Effect of Lamaze breathing method on negative emotion and delivery outcome of maternal
ZHANG Yi-mei, LEI Xia, ZHANG Le-yan, JIANG Zhong-xian, XIAO Hong-xin
2017, 15(10): 1731-1734. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.028
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Objective To investigate the effect of lamaze breathing method with unprotected delivery technology on maternal negative emotions and birth outcomes,thus to provide effective reference to the improvement of the quality of delivery for obstetrics and high quality nursing service. Methods A total of 460 cases of low-risk primiparas who set up a cord of medical care and delivered in our hospital were randomly divided into control group and observation group with 230 cases in each group.While the control group received routine prenatal care and pregnancy education,using the technology of traditional protection of perineum childbirth,observation group voluntarily accepted lamaze breathing since the 28th weeks and insisted on learning practice every day until the parturient with unprotected perineum delivery technology.Self rating Anxiety Scale(SAS) and self rating Depression Scale(SDS) were used to compare between the two groups of primiparas' negative emotional status and observation of the two groups were made to compare the perineal laceration,the second stage of labor time,postpartum hemorrhage and neonatal weight asphyxia. Results The primiparas in observation group got (33.20±9.53) SAS score and (31.15±6.44) SDS score within 12 h before delivery which were lower than those in the control group,(64.38±5.50) SAS score and (61.89±5.09) SDS score respectively,with statistical significance(t=42.96,56.79,P<0.001).In the observation group,the perineal integrity rate was 12.17%,second degree perineal laceration incidence was 25.65%(59/23).In the control group perineal integrity rate was 2.61%,second degree perineal laceration incidence was 39.13%(90/230).The perineal integrity rate and second degree perineal complete laceration in the observation group was significantly lower than those in the control group(χ2=14.01,9.54,P<0.05).Postpartum hemorrhage amount in the observation group was (225.12±46.12)ml lower than that(248.20±50.28)ml in the control group,and the difference was statistically significant(t=5.13,P<0.05);The observation group had 4 cases of neonatal asphyxia(1.74%),less than that 19(8.26%) in the control group,and the difference was statistically significant(χ2=10.30,P<0.05). Conclusion The lamaze breathing method in the low-risk parturient with unprotected perineum delivery of primipara technique can improve negative emotions,reduce perineal injury,reduce postpartum hemorrhage and neonatal asphyxia,and promote natural childbirth.
Clinical efficacy of China-made septal occluder in 104 children with congenital heart disease
JU Liang, QIAN Wei, LI Hong, LI Qi, SHA Hong, HUA Qi, HU Jing, XU Ling
2017, 15(10): 1735-1737,1801. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.029
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Objective To evaluate the clinical efficacy of China-made septal occluder in the transcatheter closure of congenital heart disease(CHD) in children. Methods A total of 104 children with congenital heart disease in our hospital from January,2014 to July,2016 were selected for transcatheter closure,including 49 cases of male,55 female,aged from 10 month 5 days to 15 years,mean (3.8±2.9) years,weight from 8.5 to 68 mean (16.25±9.3) kg.All patients were occluded with the China-made septal occluder including 54 patients with ostium secundum atrial septal defect(ASD),21 patents with patent ductus arteriosus(PDA),26 with perimembranous ventricular septal defects(PVSD),1 with muscular ventricular septal defect(MVSD),1 with PVSD combined ASD and 1 ASD combined with PDA.The patients with ASD and VSD were treated with oral aspirin 3-5 mg/(kg·d) for a period of 6 months after the operation(most 100 mg/d).Transthoracic echocardiography(TTE),Chest radiograph and electrocardiograph(ECG) were performed immediately and after the procedure to evaluate the efficiency.Twenty-four hour dynamic ECG was performed after transcatheter closure of VSD.First month,third months,sixth months,and twelfth months and per annum after the operation,the patients were followed up by TTE and ECG. Results The total of 106 septal occluders had been implanted,while 4 patients implanted with 2 occluders.The incidence of serious complication was 1%,and the other complications were 17 cases.All the patients had no pericardial tamponade,no occluder shift,no hemolysis,no thrombosis or embolism formation. Conclusion The method to transcatheter closure with China-made septal occluder is safe and effective.The incidence of serious complication is very low.But in the course of treatment should be strictly grasp the indications and contraindications of interventional treatment,postoperative long-term follow-up TTE and ECG.
A study on the influencing factors of the professional choice of nursing students in Anhui
CAO Jian, ZHANG Xiu-jun
2017, 15(10): 1738-1740. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.030
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Objective To investigate and analyze the influencing factors of nursing students' career choice in Anhui,and to provide reference for promoting the reform of community nursing education in vocational college and guiding the community employment of nursing students. Methods Applying self-designed questionnaires of community career choice to survey 1 212 nursing students in vocational college. Results Among positive factors of career choice,88.78% nursing students believed that community work could better take care of the family.And 79.04% nursing students were aware of the community health care was connected to the patient's health.They were willing to contribute to the community.The work attributes of community hospitals was accepted by 78.38% nursing students.Among the negative factors of career choice,only 9.08% nursing students thought that personal value could be realized in community health service organizations.And 14.93% nursing students thought that benefits were the main factors affecting the choice of community.And 25.33% nursing students believed that community work could improve their personality.Among them,there were significant differences in freedom,personality,job attribute and promotion in the career choice of students with varied degrees(P<0.05).But there were no significant difference in value realization,welfare,family care,making acquaintance,healthy and social relations(P>0.05). Conclusion Reasonable income distribution and more effective guidance for correct values were important aspects in attracting talents.The primary care institutions with their own characteristics will help attract more excellent college graduates in community nursing.
Association study of DNA methyltransferase gene polymorphisms and depressive disorder in perimenopausal woman
KANG Jun-jun, CHOU Jian-yin, TAO Jing, ZHANG Lan, MAO Hong-jing, TANG Guang-zheng, YIN Yan, YU Zheng-he
2017, 15(10): 1741-1743,1755. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.031
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Objective To investigate the relationship between DNMT3B gene polymorphisms and qualitative characters/quantitative characters of depressive disorder in perimenopausal woman. Methods Four hundred and three patients were randomly selected from 4 684 perimenopausal women attending three gynecological clinics and one psychological clinic,spans from November,2009 to January,2013,then data were collected.The Beck's depression inventory(BDI) and SCID-I/P were used to screen the depressive symptoms and diagnose the depressive disorder,finally 65 patients and 122 matching controls were picked out.Peripheral blood samples were collected from all of the 398 patients.Two tag single nucleotide polymorphisms(SNPs,rs6141813 and rs2424908) in DNMT3B gene were genotyped by snapshot genotyping assay.The BDI was used to quantify the phenotypes of depressive symptoms.SNPStats software was used to analysis the relationship between DNMT3B gene polymorphisms and depressive disorder or depressive symptoms. Results There were no statistical differences in genotype or allele distribution of two tag snaps in DNMT3B gene between two groups(P>0.05);The haplotype of TC jointed by rs6141813 and rs2424908 polymorphism of DNMT3B gene was positive correlated to quantitative trait of depressive symptoms (Add value=2.45;95% CI=0.14-4.75;P=0.04) with the strong linkage disequilibrium existent(D'=0.98,r2=0.62). Conclusion The results suggest that polymorphisms in DNMT3B gene maybe is associated with quantitative character of depressive symptoms,and it maybe has tiny role in gene level for determine one to be patient or not finally.
Analysis of current situation and influencing factors of the empathy ability of nursing students
LI Qing-wen
2017, 15(10): 1744-1747. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.032
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Objective To investigate the empathy ability of college students majoring in nursing,and analyze its correlation with personality characteristics and the factors related to it,with the aim of providing reference for training nursing students' empathy ability. Methods Select,with cluster sampling method,740 Shenyang Medical College undergraduates and higher vocational nursing students as the research object.And perform the investigation on nursing students' empathy ability with the general information questionnaire,the Interpersonal Reactivity index-c and big five personality scale,to research on the students' empathy ability and the factors related. Results This group of nursing students got (53.46±8.39) points empathy score,with (2.43±0.38) average items points.T test and single factor variance analysis show that the difference is statistically significant in empathy score of students,grades,father's education level of nursing students(P<0.05),but no significant differences in empathy scores of different gender,level,student cadres,singleton,political affiliation,family economy,family composition,mother of different cultural levels of nursing students(P>0.05).Empathy and personality traits and each angle of nursing students are 136.18±10.06,average item score is 3.10±0.23;the majority of empathy dimensions are correlated with personality dimensions (P<0.05);hierarchical regression analysis shows that personality characteristics can explain 12% of the variation independent of empathy. Conclusion The empathy ability of nursing students is in the middle level,and the personality characteristics are important factors affecting empathy.In school education,teachers should actively enlarge their strength of personality traits to exert a subtle influence on the students,preparing for their future career.
Analysis of Ureaplasma urealyticum infections and drug resistance in the infertile patients
LIU Si-yu, ZHU Yan, ZHANG Xiao-mei, WU Rong-zhen
2017, 15(10): 1748-1751. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.033
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Objective To investigate the distribution of Ureaplasma urealyticum and drug resistance in the infertile women so as to provide references for early diagnosis and treatments. Methods A total 200 cases infertile women who treated in the hospital from January to December 2015 were assigned as the observation group,meanwhile,200 healthy pregnant women were chosen as the control group.Ureaplasma urealyticum infections of two groups of women were detected by real time fluorescence PCR(FQ-PCR)and nine kinds of antibiotics sensitivity test.The clinical data of 8 571 women who examination in the hospital from January,2010 to December,2015 were retrospectively analyzed,then the total distribution of Ureaplasma urealyticum infections were investigated. Results Infertile group of 200 cases Ureaplasma urealyticum infected higher than healthy group obviously(62.50% vs. 41.50%).The differences were significant(P<0.05).Drug susceptibility test show Ureaplasma urealyticum high sensitivity to doxycycline,minocycline and clarithromycin were 97.60%,96.80%,and 93.60%,respectively;sensitivity to azithromycin and josamycin were 81.60% and 74.40%,respectively.The drug resistance rates high of oxygen danofloxacin and roxithromycin were 20.00% and 10.40%.In 8 571 clinical samples,4 091 proved to be positive in Ureaplasma urealyticum testing and the general infection rate was 47.73%.Ureaplasma urealyticum positive rate showed increasing trend from 2010 to 2015.The results showed that relatively high infection rates were among 20-29,30-39,40-49 than others.The differences were significant(P<0.05). Conclusion In recent years Ureaplasma urealyticum infection has increased significantly in our hospital,infected women were mainly concentrated in the fertile age groups,these asymptomatic infections might affect pregnant women and involved in adverse pregnancy outcomes,so Ureaplasma urealyticum should check as soon as possible among infertility women,and using antibiotics based on susceptibility testing rationally.
Clinical value of echocardiogram and myocardial enzymes detection in patients with acute pulmonary embolism
SUN Quan, GAO Feng, HUANG Guo-qing, YU Da, CHEN Ting-ting
2017, 15(10): 1752-1755. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.034
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Objective To investigate the clinical value of echocardiogram and myocardial enzymes detection in patients with acute pulmonary embolism(APE). Methods A total of 60 acute pulmonary embolism patients were selected as research group(n=60) and 60 physical examination individuals as control group(n=60).The echocardiogram(EDV,ESV,EF,PER and PFR) and levels of myocardial enzymes(CK,CK-MB,LDH and AST) were tested.The pulmonary embolism-associated deterioration and death were compared between the patients with right ventricular dysfunction and the subjects with normal right heart function. Results Compared with the control group,EDV and ESV of the research group were significantly higher(P<0.05),EF,PER and PFR were significantly lower than those in control group,but SV has no significant difference between the two groups(P>0.05);The levels of CK,CK-MB,LDH and AST of the research group were significantly higher than those in the control group(P<0.05);In the 60 patients with acute pulmonary embolism,29 patients were with ventricular dysfunction,the incidence of pulmonary embolism-associated deterioration and mortality in these patients were significantly higher than the individuals with normal right heart function(P>0.05). Conclusion Echocardiography can help to evaluate right ventricular function in patients with acute pulmonary embolism,while myocardial enzymes detection will contribute to assess myocardial injury.Echocardiography and myocardial enzyme detection may be helpful to the diagnosis and prognosis evaluation of patients.
Diagnostic value of transesophageal atrial pacing in patients with paroxysmal supraventricular tachycardia
XU Wei, HU Si-gan, HUANG Yu-li, WU Ting-yu, WANG Ben-fang
2017, 15(10): 1756-1758. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.035
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Objective To investigate the role of transesophageal atrial pacing in diagnosis and specific typing of paroxysmal supraventricular tachycardia(PSVT),thus provide assistance for further radiofrequency ablation. Methods Total 61 cases of PSVT induced by transesophageal atrial pacing were studied by determining R-P'E and P'E-R interval of esophageal lead,R-P' interval of Vl lead,and direction of P',all of which were compared with the results of radiofrequency ablation. Results ①In line with the results of radiofrequency ablation,the types of PSVT among the 61 patients were as follows:25 cases of AVNRT(slow-fast type),1 case of AVNRT(fast-slow type),24 cases of O-AVRT(left-sided accessory pathway),7 cases of O-AVRT(right-sided accessory pathway),1 case of O-AVRT(double pathways),and 3 cases of atrial tachycardia.②Among the 61 cases,those whose R-P'E<70 ms were all AVNRT(slow-fast type),those whose R-P'E>80 ms were mostly O-AVRT,those whose R-P'EP'E-R were mostly atrial tachycardia.③Those cases whose V1 lead R-P'>R-P'E were all left-sided accessory pathway,and those whose V1 lead R-P'Conclusion Transesophageal atrial pacing has high clinical value in typing of PSVT,developing treatment programs and providing assistance for further radiofrequency ablation.
Current situation and thinking of general practitioners' multi-sited practice under the new medical reform in China
ZHAO Rui, LIU Feng, ZHU Kun
2017, 15(10): 1759-1762. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.036
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Objective In order to promote the rational flow of general practitioners(GP) and advance the implementation of multi-sited practice,this paper aims to put forward some suggestions and countermeasures for improving the GP multi-sited practice. Methods Based on the SWOT(strengths;weaknesses;opportunities;threats) analysis method and comparison of domestic and foreign general practitioner practice systems,this paper analyzes the advantages,disadvantages,opportunities and threats of GP multi-sited practice under the new medical reform in China,and then formulates corresponding countermeasures. Results Most of the foreign GP can be free to practice and multi-sited practice.In most developed countries and regions,the employment of GP is mainly based on self employment.GP in China are mostly employees of public institutions.The main advantages of the implementation of GP multi-sited practice are that it can better promote the rational flow of general practitioners,to fully mobilize the enthusiasm of general practitioners and help improve the development and management ability of primary hospital.The disadvantages of the implementation of GP multi-sited practice includes the lack of manpower which makes it hard to sustain and no medical risk guarantee and perfect supporting system.On the basis of overcoming the disadvantages,grasping the opportunity and avoiding the threat by analysis,the article puts forward some countermeasures for the development of GP multi-sited practice. Conclusion By means of SWOT scientific analysis,GP multi-sited practice advantages and disadvantages coexist.Establish a legal and institutional environment for GP multi-sited practice,strengthen hospital internal management,reform the personnel distribution system in medical institutions,and eliminate all kinds of medical resources allocation imbalance within the system,so as to effectively mobilize the GP's advantages of multi-sited practice,seize the opportunity and achieve remarkable results in GP multi-sited practice under the new medical reform.
Advances in new approaches for the immunotherapy of acute myeloid leukemia
LIN Jing-yi, ZHANG Yu-jing, GAO Jin-cheng, HONG Luo-jia
2017, 15(10): 1763-1767. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.037
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Acute myeloid leukemia(AML) is a kind of disease of hematopoietic cells in bone marrow immature aggregation,continuous amplification and suppression of hematopoiesis.Its core treatment in recent 30 years remained unchanged,but the survival rate and the prognosis of the disease is still not ideal.However,current research on the immune mechanism of the immune therapy has been perfected,so the immune therapy may be an effective solution in the treatment of AML,provides a new weapon for the prognosis and the survival rate of the disease.The protocols for immunotherapy include allogeneic hematopoietic stem cell transplantation,targeted therapies(gene engineered T cells,monoclonal antibodies,etc.),killing tumor cells through different mechanisms.Allogeneic hematopoietic stem cell transplantation,as the most effective treatment for AML can effectively prevent the recurrence of AML by immune mediated graft versus leukemia effect and eradicate leukemic cells.Advances in transplantation and haploidentical transplantation have enabled everyone to have a stem cell transplant.Targeted therapy,such as genetically engineered T cells(T cells,chimeric antigen receptor) monoclonal antibody,novel bispecific monoclonal antibody can specifically kill specific antigen expression of leukemia cells without harming normal cells will become a new strategy for AML immunotherapy.Other therapies,such as natural killer cells and NK cells,are safe and effective in reducing the risk of AML recurrence.In addition,increasing NK cell activity may be the best treatment for leukemia in the future.Although some programs are still in the study stage,immunotherapy will be an important treatment for AML in the future.This paper will review the current research progress of AML immunotherapy and related molecular mechanism.
The research progress of hydrogen in the protection of nerve injury
ZHANG Zhe, YE Bin, MA Hui
2017, 15(10): 1768-1772. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.038
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Hydrogen was considered as an inert gas and had been used in diving medicine only,and had not been valued in other medical disciplines.Since 2007,the Japanese scholars have found that hydrogen can effectively remove free radicals and prevent the cerebral ischemia reperfusion injury,which begins to change the people's cognition.Since then,scientists have actively carried out various experiments to study the effect of hydrogen.At present,the effect of hydrogen is confirmed to be antioxidant,anti-inflammatory,anti apoptosis and so on.Dozens of disease models and human diseases with hydrogen therapy are effective,but the mechanism of treatment is not clear.Nerve injury is a kind of disease which is difficult to be cured and has a slow onset.The injury mechanism of nerve injury includes oxidative damage and inflammatory reaction.There is no effective solution to treat it.The researchers are giving more and more attention to the research on the biological effects of hydrogen and investigate the protective effect on nerve injury.There are a variety of nerve injury model proved to be effective by hydrogen or hydrogen water treatment.At present,hydrogen or hydrogen water treatment has been applied to a variety of nerve injury model,including traumatic brain injury,brain ischemia and hypoxia injury,bleeding and spinal cord blow injury,clamp injury,ischemia-reperfusion injury,peripheral nerve defect injury,optic nerve injury and autoimmune encephalomyelitis.In this paper,the research progress of hydrogen in the protection of nerve injury is reviewed.
Prof. Cui Yun's clinical experience in diagnosis and treatment of epididymitis
TAO Fang-ze, CUI Yun, ZHOU Xiao-min, ZHENG Jun-zhuang, ZHANG Fan, SUN Yan, YIN Yi-hong, REN Guo-qing, FANG Yue-kun, XU Wen-li
2017, 15(10): 1773-1775,1790. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.039
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Objective To introduce professor Cui Yun's clinical experience in the treatment of epididymitis. Methods The clinical cases of epididymitis treated by Professor Cui Yun were collected.Prof.Cui Yun's clinical experience in diagnosis and treatment of epididymitis were comprehensively summarized on the basis of fully understanding the etiology and pathogenesis and combining the related discussion of ancient famous physicians.Some cases were discussed as evidence. Results Prof.Cui Yun agree that Epididymitis occurs with congenital deficiencies,exogenous evil,improper diet,and internal injuries caused by emotions.Dysfunction of the spleen in transportation and insufficiency of testicles was the precondition.Downward flow of dampness heat and internal toxin damaging epididymis are the key pathological points.Liver depression and turbidity toxin are the main pathogenic factors.Chronic illness impairs yin and leads to stasis.Prof.Cui puts forward that the treatment should take improving transportation by strengthening spleen as the foundation,soothing the liver and regulating qi as supplementation,clearing heat、removing dampness and transforming turbidity and detoxification as a necessary intervention over the disease process,and nourishing yin and dispersing blood stasis as treatment focus.For clinical prescription,harmonization method is considered most effective. Conclusion The thought of Prof.Cui Yun about mechanism and treatment of epididymitis is profound,and the clinical efficacy is obvious.It's worth of clinical use and further research.
The application of PBL teaching mode in clinical practice teaching in department of neurology
LIU Xiao-lin, CHEN Yu-hua, XIE Jing, XU Wen-fang, MA Bo, YE Ming, LI Qian-qian
2017, 15(10): 1776-1778. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.040
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Objective To explore the application of problem-based learning(PBL) in the teaching of Neurology in clinical practice. Methods A total of 60 clinical interns were randomly divided into experimental group and control group from February 2015 to November 2015 in the neurology department in our hospital.There were 30 students in the experimental group,including to 18 boys and 12 girls,age ranging from 21 to 24 with the mean age of (22.2±1.51) years.There were 30 students in the control group,16 boys and 14 girls,age ranging from 21 to 25 years with the mean age of (22.9±1.65) years.There was no significant difference between the two groups in age,gender and neurological theory scores(P>0.05),and they were comparable.The experimental group was taught with PBL,while the control group was taught with traditional teaching method.The effects of the two groups were observed. Results The control group students' theoretical knowledge and practical skills assessment scores were 81.2±4.6 and 71.1±4.4 respectively.The experimental group students' theoretical knowledge and practical skills assessment scores were 89.6±3.5 and 81.6±4.9 respectively.The experimental group students' scores were higher than those in the control group(P<0.05).In the questionnaires,there was little difference in evaluation of the basic knowledge of students about "self-learning ability "and "mastering basic knowledge" of the two groups of students,but the evaluation of the experimental group was significantly higher than that of the control group on improving the students' to learn interest,expanding their knowledge of medicine and solving practical clinical problems. Conclusion The effect of PBL in the clinical practice teaching is more prominent in neurology department,and it can improve the theoretical achievement and practical operation ability of Neurology interns.
Application of knowledge competition in otolaryngology head and neck surgery teaching
WANG Wei, ZHAN Xiao-dong, JIANG Li-na, YANG Xiao-di, QIANG Hua-long, CHENG Zhong-qiang
2017, 15(10): 1779-1781. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.041
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Objective To explore the teaching effect of knowledge contest in clinical teaching of otorhinolaryngology head and neck surgery. Methods Two classes of clinical medicine were randomly selected and grouped:class 1(29 students) with regular teaching and class 2(29 students) with the knowledge contest on the basis of regular teaching.At the end of the semester,we compared the scores of both classes of otorhinolaryngology head and neck surgery,to study how students have mastered the subject and their satisfaction of teaching and so on. Results Our study shows that most students are in favor of knowledge contest,that knowledge contest helps to improve learning interest and their initiatives,that it helps students to master knowledge and inspire curiosity and improve the spirit of exploration,and that knowledge contest can also improve oral expression and exam preparation.The results show that the class with knowledge contest did significantly better than the class without knowledge contest (P<0.05). Conclusion Our study shows that most students are in favor of knowledge contest,that knowledge contest helps to improve learning interest and their initiatives,that it helps students to master knowledge and inspire curiosity and improve the spirit of exploration,and that knowledge contest can also improve oral expression and exam preparation.The results show that the class with knowledge contest did significantly better than the class without knowledge contest.
BEN Kan-bian-ji-bu
2017, 15(10): 1781-1781.
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Effect of neuromuscular electrical stimulation combined with swallowing rehabilitation training on post-stroke dysphagia and its effect on movement of the hyo-laryngeal complex
LIU You-shan
2017, 15(10): 1782-1785. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.042
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Objective To evaluate the effect of neuromuscular electrical stimulation combined with swallowing rehabilitation on post-stroke dysphagia and its effect on movement of the hyo-laryngeal complex. Methods Total 56 patients with post-stroke dysphagia from January,2016 to January,2017 were randomly divided into observation group and control group(n=28).The general data,results of the drinking water test,grapevine grade,VFSS swallowing dysfunction score,and hyoid and laryngeal complex of the two groups were observed and compared. Results After the treatment,the results of the drinking water test in the two groups were significantly higher than those before the treatment(P<0.05),and the water level of the observation group was significantly higher than that of the control group(P<0.05).The effective rate of the observation group was significantly higher than that of the control group(P<0.05).The results of the two groups were significantly higher than those before treatment(P<0.05),and the results of the observation group were significantly higher than those of the control group(P<0.05).The effective rate of the observation group was significantly higher than that of the control group(P<0.05).The scores of VFSS swallowing dysfunction were significantly improved in both groups after the treatment(P<0.05),and the score of VFSS swallowing dysfunction in the observation group was significantly higher than that in the control group(P<0.05).When the diet was swallowed,the distance between the hyoid bone and the uplift of the hyoid were significantly increased in the observation group(P<0.05).There was no significant difference in the movement of thyroid cartilage before and after the treatment in the observation groups(P>0.05).There was no significant difference in the movement of hyoid bone and thyroid cartilage before and after the treatment in the control group(P>0.05). Conclusion NMES combined with swallowing function can improve the clinical symptoms of dysphagia after stroke and the muscle strength of the mylohyoid and geniohyoid muscle,and effectively restore the swallowing function.
A meta-analysis of 7. 5% hypertonic saline contrast mannitol in reducing the intracranial hypertension
HAN Xue-xin, REN Jia-bin, LI Ze-fu, YU Xiu-rong, XU Hong-mei
2017, 15(10): 1786-1790. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.043
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Objective Meta-analysis was used to compare the effect of 7.5% hypertonic saline and mannitol in reducing intracranial pressure,in order to provide reference for clinical application. Methods Cochrane Library,PubMed,Medline,Academic Search Premier,the China Biological Medicine Database,CNKI,VIP and Wanfang Database were retrieved.The related literature about randomized controlled trials of comparing intracranial hypertension by 7.5% hypertonic saline and the mannitol from the establishment of databases to January 2016 were collected.Literature screening,data extraction and assessment of methodological quality were retrieved in accordance with the method of a systematic review of evidenced-based medicine.RevMan 5.3 software was used to conduct meta-analysis for each indicator. Results Totally 10 articles were enrolled,including 447 patients,with 226 in the 7.5% HS group and the other 221 in the mannitol group.The value of ICP after the intervention of HS group was lower than the mannitol group(P=0.020),and the maintenance time was longer than the mannitol group as well(P=0.004).There was no significant difference in the CVP,plasma osmotic pressure and the serum sodium after the intervention.The MAP level of HS group was lower than the mannitol group. Conclusion In reducing intracranial pressure 7.5% HS and mannitol are effective and have longer duration,but the effect of maintaining the MAP is not as good as that of mannitol.
An analysis of common statistical errors in medical papers
TIAN Yun-peng, CHEN Li
2017, 15(10): 1791-1794. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.044
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Objective The common statistical mistakes seen in medical researches,including common misuse of t test and χ2 test,are enumerated in this paper.The common misuse of t test includes t test instead of paired t test,t test instead of one-way ANOVA,and t test instead of a repeated measures analysis of variance.χ2 test is incorrectly used instead of Fisher exact probability method,rank test,or paired χ2 test.The case analysis on the common statistical problems in medical papers shows that the main reasons for misuse of statistical methods are the application premise error of a special statistical method,incorrectly choice of statistical methods divorced from the actual situation and the purpose of statistical analysis,not fully understanding whether the research data to meet the conditions of parameter testing,and incorrectly determine the measurement data corresponding to the experimental design type.To ensure the accuracy of statistical applications in a scientific journal,the editorial department should invite statistical review experts to control the quality of the manuscript; the editors should strengthen their own statistical professional quality,improve the level of statistical professional knowledge,deeply think and grasp the statistical analysis of the manuscripts in the process of editing manuscripts,timely look over the statistical data and consult the relevant statistical expert where you have a question.Finally,the authors should have more exchanges with the statistical experts in the research design,from the source to avoid the design of the loopholes and deviations.It is suggested to improve the application ability of statistics from the authors,editors and peer review experts to ensure the scientificalness,reliability and validity of scientific research,and reduce the induction of the error messages to readers.
Efficacy of TCM nursing countermeasures on chronic renal failure with pulmonary infection
FENG Qin-li, YAO Ming, ZHANG Xiao-ping, PENG Xin-xian, XU Long-sheng
2017, 15(10): 1795-1797. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.045
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Objective To observe the effect of Traditional Chinese Medicine nursing countermeasures on the chronic renal failure with pulmonary infection. Methods All 62 cases of chronic renal failure with pulmonary infection in hospital from August,2012 to April,2014 were assigned into intervention group,while all 51 cases of chronic renal failure with pulmonary infection from July,2010 to July,2012 were selected as control group.The control group was given the general nursing;while the intervention group was given Traditional Chinese Medicine nursing additionally,including emotional nursing,diet nursing,Chinese medicine enema nursing.The clinical therapeutic effect,pulmonary infection recurrence,and the GFR 1 month after admission were compared between the two groups.The experimental data were analyzed by SPSS 13.0 software,measurement data with x±s using t test,count data using Chi-square test. Results The total effective rate of control group and intervention group were 56.87% and 88.71%,respectively,the difference was statistically significant(χ2=14.87,P<0.001);The recurrence rate of the two groups was 24.14% and 7.27%,respectively,the recurrence rate of intervention group rate decreased obviously,the difference was statistically significant(χ2=4.75,P=0.029);and the change of GFR 1 month after admission was 4.08±0.44 and 6.57±0.89,respectively,the difference was statistically significant(t=19.34,P<0.01). Conclusion Traditional Chinese Medicine nursing can effectively supply adjuvant treatment for chronic renal failure with pulmonary infection,the recurrence rate of the infections is low,the clinical efficacy can be improved obviously.TCM nursing measures can effectively assist patients to improve their own immunity and have broad clinical significance.
Effect of mindfulness-based music therapy on cognitive function and emotion of breast cancer patients during chemotherapy
DING Yue, SUN Zhen-er, WU Wei
2017, 15(10): 1798-1801. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.046
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Objective To explore the effect of mindfulness-based music therapy(MBMT) on the cognitive function and emotion in breast cancer patients during chemotherapy and provide support for psychology health practice. Methods The purposive sampling method was used to choose 72 breast cancer patients who had chemotherapy after surgery.They were randomly divided into MBMT group and control group.Both groups received routine nursing care,while the intervention group also received MBMT two times once a week for six weeks.The MMSE scale and POMS scale were used after the intervention to investigate the effect of MBMT on cognitive function and emotion. Results There were no significant difference between the two groups at baseline in all scales(P>0.05).There were two patients run off in MBMT group and one patients run off in the control group.Only 34 patients in the MBMT group and 35 in the control group completed the scales.The t-test showed the directional ability,memory,attention,memory and MMSE total score were improved after the six weeks intervention(P<0.05),the cognitive function and each dimension score in the MBMT group were higher than those in the control group;TMD total scores,anger,tiredness,energy,self-esteem in MBMT group were obviously lower than those in control group,there were significant difference(P<0.05);but not in tension(P=0.247),depression(P=0.066) and confusion(P=0.095) between two group.The score for negative emotion in the MBMT group was lower than that in the control group with a statistical significant(P<0.05). Conclusion MBMT showed a trend toward improving psychological outcomes by enhancing cognitive function and negative emotion in breast cancer patients.
Analysis of the influence of comprehensive nursing intervention on internal fixation of proximal femoral nail in treatment of hip fracture function in elderly patients with intertrochanteric fracture
GE Jun, YANG Ke-xia, GUAN Jian-zhong
2017, 15(10): 1802-1804. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.047
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Objective To probe into the influence of comprehensive nursing intervention on internal fixation of proximal femoral nail in the treatment of hip fracture function in elderly patients with intertrochanteric fracture,and to provide reliable basis for clinical rehabilitation guidance. Methods We selected 98 cases of elderly patients with femoral intertrochanteric fracture treated with proximal femoral intramedullary nail fixation who was treated from May,2015 to May,2016 and agreed to participate in this research.And we randomly divided them into two groups,with 49 cases in the control group given routine nursing intervention including preoperative examination,medication guidance,reasonable diet,etc.and 49 cases in the observation group receiving comprehensive nursing intervention including preoperative preparation,psychological nursing,postoperative observation,complications prevention,pain nursing,functional exercise,etc.We used Harris scoring criteria to assess postoperative function recovery of hips,compared two groups of postoperative complications,and designed questionnaire at the same time to assess the satisfaction on the nursing.Postoperative function recovery of hip between groups was compared via the t test,and postoperative complications between groups by chi-square test,nursing satisfaction between groups by rank sum test,with P<0.05 for statistical significance. Results After treatment,the Harris score in the observation group was (86.81±10.62) score,which was higher than that in the control group (72.32±7.43) score,and the difference was statistically significant(t=7.826,P<0.05).The complication rate after operation in the observation group was 4.08%,which was lower than 18.37% in the control group,with statistical significance(χ2=5.018,P<0.05).The nursing satisfaction in the observation group was 97.96%,97.96%,which was higher than 75.51% in the control group,and the difference was statistically significant(Hc=3.501,P<0.05). Conclusion The proximal femoral intramedullary nail fixation in elderly patients with femoral intertrochanteric fractures combined with comprehensive nursing intervention can promote the recovery of hip joint function,reduce the incidence of postoperative complications and improve the quality of nursing.Therefore,it has good application effect.
Adverse reactions and management in Endostar combined with concurrent chemoradiotherapy for inoperable stage Ⅲ non-small cell lung cancer
SHEN Jia-qin, SHAO Qiu-yue, YE Ying-jun, WANG Jin, MA Hong-lian, XU Yu-jin, HU Xiao, CHEN Ming, XIE Shu-ping
2017, 15(10): 1805-1807. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.048
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Objective To observe the adverse reactions of recombinant human endostatin(Endostar) combined with chemoradiotherapy in the treatment of unresectable stage Ⅲ non-small cell lung cancer,and to provide theoretical basis for the new treatment. Methods The clinical data of 23 patients with inoperable locally advanced non-small cell lung cancer in our hospital from November,2013 to January,2015 were reviewed.The patients received Endostar[7.5 mg/(m2·d)] by 5 days continuous infusion at weeks 1,3,5,and 7,while two cycles of etoposide(50 mg/m2) at d1 to d5 and cisplatin (50 mg/m2) at d1 and d8 were administered at weeks 2 and 6 with concurrent three-dimensional conformal or intensity modulated conformal radiotherapy to a dose of 60-66 Gy.Toxicity was evaluated according to CTCAE 3.0. Nursing care and intervention were given when necessary during radiotherapy and chemotherapy. Results The treatment and clinical evaluation were conducted in all 23 patients,the main adverse reactions included low white blood cell count in 14 cases(grade 3 and 4,60.9%),anemia in 4 cases(grade 3 and 4,17.4%),low blood platelet count in 8 cases(grade 3 and 4,34.8%),radiation pneumonia in 1 case(grade 1,4.3%),radiation esophagitis in 1 case(grade 3,4.3%),hypotension in 6 cases(26.1%),and arrhythmia in 1 case(4.3%).There were no renal disorder,bleeding or coagulation disorders,and treatment-related death. Conclusion Endostatin infusion administration can improve the compliance of patients.The short term outcome and tolerability of Endostar combined with concurrent chemoradiotherapy for unresectable stage Ⅲ non-small cell lung cancer are good,it can reduce the toxicity,increase compliance and improve quality of life of patients.
Standardized PICC maintenance situation at the intermission of chemotherapy and its influence factors
PAN Lian-jun, LIU Ai-xia, ZHANG Su-li
2017, 15(10): 1808-1811. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.049
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Objective To study the standardized peripherally inserted central catheter(PICC)maintenance rate at the intermission of chemotherapy and its influence factors,and to provide evidence for preventive intervention to increase of normative PICC maintenance rate. Methods A total of 120 cancer chemotherapy patients once discharged with PICC in treatment intermission from April,2014 to August,2015 in four municipal hospitals in Jinhua were chosen as research objects.Maintenance records of all patients were established.Patients completed maintenance record at the intermission of chemotherapy,and were surveyed PICC maintenance situation and complication via questionnaires.Normative PICC maintenance rate and ill-formed maintenance were analyzed,and influence factors on PICC maintenance of study group were analyzed by single factor and multi-factor methods. Results Standardized PICC maintenance rate was low,and normative maintenance rate of study group was 52.50%(63/120).Ill-formed maintenance included incomplete PICC case(7.50%),deficiency of self-observation and specialized examination(15.83%),incorrect method of sealing and fixing(10.00%),irregularity of maintenance and disinfection(25.83%),serious complication and improper drawing(18.33%).Single analysis revealed statistical differences in age,complication with T2DM,remaining time of PICC,temperature,D-Dimer between groups(P<0.05),and multi-analysis revealed that age(OR=3.467,95% CI:1.755-6.453),complication with T2DM(OR=5.225,95% CI:2.612-10.774),temperature(OR=2.596,95% CI:1.387-5.895)and D-Dimer(OR=7.515,95% CI:2.369-19.454)were independent influence factors. Conclusion Standardized PICC maintenance rate at the intermission of chemotherapy was low,and advanced age,fever and raise of D-Dime are supposed to be the risk factors of non-standard PICC maintenance,and preventive intervention should be taken to increase normative maintenance rate.
Risk factors and nursing strategies of acute respiratory failure after pneumonectomy
WANG Chun-fen, LI Ji, XIE Chan-chan, CHEN Ya-li, ZHANG Chao
2017, 15(10): 1812-1814. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.050
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Objective To investigate the risk factors and nursing strategies of acute respiratory failure after pneumonectomy. Methods Eighty-eight patients with pneumonectomy from April,2015 to February,2016 were selected and divided into respiratory failure group and no respiratory failure group according to with or without acute respiratory failure after operation.The data of two groups were collected,including general information (gender,age,smoking index,cardiovascular history),preoperative pulmonary function[FVC,1 second expiratory volume(FEV1),max(MVV),forced expiratory volume(FEV1/FVC)],surgical methods(part lung resection,pneumonectomy),fluid volume(intraoperative fluid volume,postoperative day fluid volume),and were analyzed by univariate analysis and logistic regression analysis. Results The incidence of acute respiratory failure after pneumonectomy was 31.8%.Univariate analysis and logistic regression analysis results showed that age,smoking index,cardiovascular history,FVC<1.8 L,FEV1<1.5 L,FEV1/FVC<70%,operation mode,intraoperative fluid volume,postoperative fluid volume were postoperative risk factors for acute respiratory failure. Conclusion Postoperative acute respiratory failure easily occurred in patients with pneumonectomy,with age,smoking index,cardiovascular history,FVC<1.8 L,FEV1<1.5 L,FEV1/FVC<70%,operation mode,intraoperative fluid volume,postoperative fluid volume as postoperative risk factors for acute respiratory failure.The risk factors of ARF should be paid attention to in clinical work,and prevention and treatment should be carried out.
The postoperative recovery of gastrointestinal function effects observation of nurse-patient cooperation QCC for the gastric cancer patients
HAN Bo
2017, 15(10): 1815-1817. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.051
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Objective Surgery is dominant in the treatment of early gastric cancer,but a lot of postoperative patients had different degrees of gastrointestinal dysfunction;QCC activity refers to the same workplace spontaneous composition of a small group by relaxing the on-site management,which can make oneself volunteered to participate in the management of activities and can improve the quality of nursing.This study aims to investigate the postoperative recovery of gastrointestinal function effects observation of nurse-patient cooperation QCC for the gastric cancer patients. Methods We selected 140 gastric cancer patients with elective surgery from August,2011 to February,2015 treated in our hospital and equally divided into treatment group and control group based on a completely random method.The control group received conventional intervention,while the treatment group was given nurse-patient cooperation QCC intervention on the basis of the control group interventions,with two weeks' nursing observation. Results The total effective rates after nursing care in the treatment group and the control group were 92.9% and 78.6% respectively,while the total effective rate in the treatment group was significantly higher(P<0.05).The postoperative anal exhaust time and defecation in the treatment group were (87.24±13.98)h and (80.01±15.90)h that were significantly lower than the control group of (103.98±18.13)h and (92.76±11.99)h (P<0.05).The serum motilin contents after care in the treatment group and the control group were (173.87±12.76)pg/ml and (137.39±13.11)pg/ml which were significantly higher than those before nursing care (95.33±10.39)pg/ml and (95.10±11.32)pg/ml(P<0.05),while the differences between the two groups were statistically significant(P<0.05). Conclusion The nurse-patient cooperation QCC for the gastric cancer patients can promote the secretion of motilin,which is conducive to the recovery of gastrointestinal function,thereby enhances the overall efficacy of rehabilitation and should be widely applied.
LU Dan, WANG Ya-qun, YU Hang-ping, DONG Li-qiang
2017, 15(10): 1818-1820. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.052
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