中华全科医学

The influence factors of career satisfaction of general practitioner in city's community health service institution

SUN Tao, CAO Qiu-ru, ZHANG Shu-e, ZHAO Yan, FAN Chao, LI Li, GAO Lei, LIU Xin-yan, ZHANG Zhong, FAN Li-hua

2017, 15(2): 183-185. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.001

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Abstract:
Objective In China,the health system reform aims to build a health system which can serve to deal with health challenge of today and future.To build a stabilized group of general practitioner (GP) is a necessary premise of reform.However,there is a lack of effective academic dialogue on GP's career satisfaction and influencing factors.This study aims to investigate the career satisfaction of GP and analyze its influencing factors,thus to provide some theoretic references for reform practice. Methods Several available survey tools were used in the study.By means of the stratified and convenient sampling method we collected 215 GPs from the community health service institution in city to conduct the questionnaire survey,and the multiple liner regression analysis method was performed to examine the influencing factors. Results The rate of professional achievement satisfaction was 53.74%,career progress was 45.12%,career income was 20.19%,self-realization was 28.80%,and skill development was 43.13%.The influencing factors of career satisfaction of GP include job embedment (β=0.381,P<0.01),transformational leadership (β=0.234,P<0.01),job satisfaction (β=0.197,P<0.01) and career income (β=0.147,P<0.01). Conclusion The overall career satisfaction is at a low level.The driving forces of GP are,in sequence,enterprising,autonomous and business occupational drive.GP cares more about the occupational development and realization degree of self target.To be sure,they also care about their own professional earnings.

2017, 15(2): 186-187.

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Value of susceptibility weighted imaging in the diagnosis of neonatal intracranial hemorrhage and the hemorrhagic difference between preterm and term neonates

ZHAO Xiao-jun, LIU Kun, ZHOU Zhong-jie, HUANG Xiao-yan, ZHOU Yong-jin, YE Xin-jian, ZHANG Xian, YAN Zhi-han

2017, 15(2): 188-191,209. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.002

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Objective To investigate the value of susceptibility weighted imaging (SWI) in the diagnosis of infants with intracranial hemorrhage (ICH) and the hemorrhagic difference between preterm and term neonates. Methods One hundred and fifteen cases of suspected brain injury underwent conventional MRI,DWI and SWI to determine whether they had ICH and record the numbers of each hemorrhagic lesion.The detecting rate,distribution and number of ICH were compared among these methods,and the distribution and number of ICH were compared between preterm and term neonates. Results SWI had a higher detection rate than conventional MRI and DWI (the detection rate was 32.2%,26.1% and 12.2%,respectively P<0.05) and conventional MRI also had a higher detection rate than DWI (P<0.05).Of the 37 cases of ICH,conventional MRI,DWI and SWI detected 66,33,125 hemorrhagic lesions respectively.More hemorrhagic lesions were found on SWI than conventional MRI and DWI (all P value<0.05),and more lesions were showed on conventional MRI than DWI (t=4.932,P<0.05).Hemorrhagic lesions mainly located at germinal matrix-ventricle,cerebrum and cerebellar hemispheres.SWI showed more hemorrhagic lesions than conventional MRI and DWI in these areas (all P value<0.05).SWI and conventional MRI detected more subarachnoid and subdural hemorrhage than DWI (P<0.05),but no difference was found between SWI and conventional MRI.Preterm infants had more hemorrhagic lesions than term infants (P<0.05),especially in the germinal matrix-ventricle (P<0.05).The numbers of hemorrhagic lesions were found no significant difference in other brain areas (P>0.05). Conclusion SWI is a better tool to detect neonatal ICH than conventional MRI and DWI.But differences can be found among these Methods when detecting ICH in different brain areas.The newborns with suspected ICH should undergo SWI,conventional MRI and DWI to make a comprehensive judgment whether they have ICH and the numbers of hemorrhagic lesions.Our Results provide important clues for clinical diagnosis,treatment and prognostic assessment of neonatal ICH.

Influence of different implant simulation software on the accuracy of surgical template

ZHANG Jian-xing, YOU Jia, TIAN Ming-fei

2017, 15(2): 192-194,345. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.003

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Objective To evaluate the influence of different dental implant simulation software on the accuracy of surgical template. Methods Sixteen healthy people were chosen for the analysis.All the patients were scanned with cone beam computerized tomography (CBCT) and the data were imported into the different dental implant simulation software,53 implants were planned and the stereolithographic (SLA) surgical templates were made with the technology of SLA.The surgical templates designed by Simplant were group A,designed by 6D implant were group B.A CBCT scan of the surgical template fitted on plaster model was performed,and the images were matched with the virtual implant plan images,the actual implant position was acquired from the position of surgical template.The deviation between the actual and planned implant position was analyzed. Results Group A:the deviation at the hex was (0.582±0.216) mm,horizontal deviation was (0.226±0.132) mm,vertical deviation was (0.522±0.213) mm;apex deviation was (0.643±0.256) mm,horizontal deviation was (0.332±0.222) mm,vertical deviation was (0.524±0.214) mm;contact radio was (88.7±4.6)%.Group B:the deviation at the hex was (0.456±0.222) mm,horizontal deviation was (0.193±0.123) mm,vertical deviation was (0.388±0.238) mm;apex deviation was (0.515±0.233) mm,horizontal deviation was (0.277±0.19) mm,vertical deviation was (0.39±0.236) mm;contact radio was (91.1±4.0)%. Conclusion The influence of different implant simulation software on the accuracy has statistical significance.

Etiology research of pointed condyloma with pseudocondyloma features

SHAO Xiao-hong, OU Rong-ying, DENG Hai-song, XU Yun-sheng

2017, 15(2): 195-197. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.004

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Objective To study the clinical etiology of pointed condyloma with pseudocondyloma features. Methods Patients with pointed condyloma (15 cases),pseudocondyloma (15 cases),and pointed condyloma with pseudocondyloma features (25 cases) in our hospital from January,2013 to December,2015 were retrospectively analyzed.The clinical features,pathology,and HPV type of 3 groups were compared and analyzed,to study the clinical etiology of pointed condyloma with pseudocondyloma features. Results Warty lesions of typical pointed condyloma showed rough,easily rupture small reddish pimples;Warty lesions of pseudocondyloma lesions mostly showed 1-2 mm cluster size pimples on inside of the labia minora at both sides;Warty lesions of pointed condyloma with pseudocondyloma features was the same with pseudocondyloma lesions.Acetic acid white experiment of pointed condyloma showed positive,acetic acid white experiment of pseudocondyloma showed negative,and acetic acid white experiment of pointed condyloma with pseudocondyloma features showed weakly positive.All pointed condyloma showed HPV-positive[4 kinds low-risk HPV (6,11,43,55),10 kinds high-risk HPV (16,18,33,39,51,52,53,58,59,66)],one HPV subtypes 4 cases,two HPV subtypes 6 cases,three HPV subtypes 3 cases,four HPV subtypes 2 cases;pseudocondyloma HPV tests were all negative;pointed condyloma with pseudocondyloma features showed HPV-positive[3 kinds low-risk HPV (6,11,81),7 kinds high-risk type HPV (16,18,33,35,51,53,58)],one HPV subtypes 8 cases,two HPV subtypes 12 cases,3 HPV subtypes 3 cases,four HPV subtypes 2 cases. Conclusion Patients with pseudocondyloma features might contain high-risk HPV infection of the genital warts.

Effects of Sevoflurane and Propofol combined with Remifentanil on hemodynamics in elderly patients with esophageal cancer after radical operation

CHEN Yuan-liang, XU Li-li, LAN Zhi-jian, ZHANG Lei

2017, 15(2): 198-201. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.005

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Objective To investigate the effects of Sevoflurane and Propofol combined with Remifentanil on hemodynamics in elderly patients with esophageal cancer after radical operation. Methods A total of 72 cases of esophageal cancer patients in our hospital were divided into two groups with 36 cases in each group.All patients were induced by Remifentanil (3 ng/ml),Propofol (3 μg/ml) and cis-ammonium bromide for anesthesia induction.The patients in the observation group were given seven Sevoflurane combined with target controlled infusion of Remifentanil for anesthesia maintenance,while the patients in control group were given target controlled infusion of Propofol combined with Remifentanil for anesthesia maintenance.Before anesthesia (T1),skin incision (T2) and the end of operation (T3),extubation (T4),the hemodynamics index of two groups of patients were compared,including systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP),heart rate (HR),the depth of anesthesia (BIS value).The pain of patients after extubation was assessed by visual analogue scale (VAS).The awaking time and time to extubation of patients in two groups were recorded.The incidence of adverse reactions of both groups was recorded,including nausea and vomiting,restlessness and shivering and respiratory depression. Results At T2 and T3,SBP,DBP,MAP,HR,BIS values of patients in both groups were significantly lower than in the level of T1,the difference was statistically significant (P<0.05).At each time point,SBP,DBP,MAP,HR,BIS value between the two groups were compared,the difference was not statistically significant (P>0.05).The VAS score,awaking time and time to extubation of the observation group were significantly lower than those of the control group,the difference was statistically significant (P<0.05).Adverse reaction rates (11.11% vs.13.89%) were compared between the two groups,and the difference was not statistically significant (P>0.05). Conclusion Sevoflurane and Propofol combined with Remifentanil anesthesia in elderly patients with esophageal cancer is similar.The recovery time is shorter in procedure with Sevoflurane combined with Remifentanil.

The diagnostic value of ⁹⁹Tc^m-MIBI double phase scintigraphy in patients with hyperparathyroidism

CHI Xiao-hua, WANG Quan-shi, LI Gui-ping, LIU Feng, QI Yong-shuai, DU Li

2017, 15(2): 202-205. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.006

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Objective To analyze the diagnostic value of⁹⁹Tc^m-sestamibi (MIBI) double phase scintigraphy in patients with hyperparathyroidism. Methods The clinical data of 73 patients with hyperparathyroidism confirmed by surgery pathology were retrospective analyzed.⁹⁹Tc^m-MIBI double phase scintigraphy was performed and whole body scan,computerized tomography (CT) or single photon emission computerized tomography/computerized tomography (SPECT/CT) were carried out when necessary.Serum calcium (Ca) and phosphorus (P) were measured for all patients before and after operation.Serum parathyroid hormone level was determined before operation and in most of patients in one week post-operation. Results Twenty-nine cases of patients were primary parathyroid hyperthyroidism who undertook⁹⁹Tc^m-MIBI double phase scintigraphy,28 lesions were detected.Thirty-one lesions were found in pathology,28 were hyperplasia parathyroid adenoma and 3 were parathyroid hyperplasia.The sensitivity of⁹⁹Tc^m-MIBI imaging for primary hyperparathyroidism lesions diagnosis was 90.3%(28/31).In 44 cases with secondary parathyroid function hyperthyroidism,there were 154 lesions with parathyroid hyperplasia confirmed by pathology,and 118 lesions were detected by⁹⁹Tc^m-MIBI imaging.The sensitivity for parathyroid hyperplasia diagnosis was 76.6%(118/154).In parathyroid adenoma with positive imaging,most of the tumors were clearly visualized with intensely radioactive concentration in tumor,and most patients characterized by hypercalcemia and hypophosphatemia.While in patients with parathyroid hyperplasia the radioactive concentration in hyperplastic tissue was mild and far lower than that in parathyroid adenoma.Although,there was not obvious increasing of serum calcium,significantly elevated serum phosphorus was observed in patients with parathyroid hyperplasia.However,in both of patients with parathyroid adenoma and parathyroid hyperplasia,the level of serum parathyroid hormone was decreased after operation in one week. Conclusion ⁹⁹Tc^m-MIBI had higher diagnosis sensitivity in parathyroid adenoma than parathyroid hyperplasia,and it's helpful in the discovery of ectopic parathyroid tissue and its preoperative localization.

Free forearm flap for oral and maxillofacial defects after tumor resection:an analysis of 47 cases

SHAO Xia, YE Peng-cheng, FANG Yi-ming, WANG Jing-xiao, WU Li-jun

2017, 15(2): 206-209. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.007

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Objective To investigate the effect of free forearm flap in the treatment of oral and maxillofacial defects after tumor resection. Methods The clinical data of 47 cases of oral and maxillofacial tumor patients in our hospital from January,2013 to December,2015 were retrospective analyzed.All patients were given tumor resection,and the defects were repaired by forearm flap.After the surgery,the flap survival rate,swallowing function,pronounce function complications were observed,also the changes of serum sialic acid (SA) and interleukin (IL)-2 levels before and after treatment were observed. Results All patients were treated with surgery at the first time and the repair treatment included excision,flap design,cut flap,anastomotic repair.The patients were followed up for 6 to 18 months;the flap survival rate reached 95.7%(45/47).After 1 month,the SA level of patients was (0.72±0.24) mg/L,which was significantly lower than before surgery (0.96±0.27) mg/L (P<0.05),and IL-2 level of patients was (13.94±4.12)μg/L,which was significantly higher than before surgery (5.69±1.38)μg/L (P<0.05).After 3 month,swallowing function:2 grade 9 cases (19.1%),3 grade 38 cases (80.9%).After 6 months,34 cases (72.3%) patients can clearly pronounce.The complications included:scar 14 cases (29.8%),pigmentation 39 cases (83.0%),itching 24 patients (51.1%),and skin abnormal feel 43 cases (91.5%). Conclusion The forearm free flap can treat oral and maxillofacial defects after tumor resection with satisfactory efficacy.The flap survival rate is high and swallowing function and pronunciation function is recovered well.

Clinical features of ankylosing spondylitis patients with hip joint lesions

ZHANG Feng-xiao, ZHAO Yang, NING Xiao-ran, LI Fang, ZHENG Gui-min, YAN Yong-long, YU Zhi-bo

2017, 15(2): 210-212. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.008

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Objective The ankylosing spondylitis (AS) with the hip joint involvement will lead to a poor prognosis.The early intervention in time can improve the prognosis of patients.The purpose of this paper is to explore the clinical and radiographic features of AS with hip joint lesions,and the influence of different intervention on prognosis of patients,and improve the understanding of the AS with hip joint lesions. Methods Total 220 cases of AS with hip joint lesions (group A) and 182 cases of AP without hip joint lesions (group B) were studied to compare the clinical signs and symptoms,laboratory indexes,imaging findings and treatment effect. Results The patients in group A had an earlier onset age[(21.97±21.97) years vs.(26.60±9.97) years,P<0.001)],longer time for clinical definite[(5.75±4.27) years vs.(3.84±3.60) years,P<0.001)],more juvenile-onset cases (44.5% vs.20.88%,P<0.001),more cases with hip joint starting symptoms (41.36% vs.28.02%,P<0.05) when compared with group B;The level of C-reactive protein[(30.36±25.52) mg/L vs.(22.58 ±18.83) mg/L,P<0.01],and sacroiliac joint CT grading (level Ⅲ:91 vs.56 cases,P<0.01;level Ⅳ:42 vs.24 cases,P<0.01) in group A were higher than those in group B.The patients in the two groups treated with tumor necrosis factor (TNF)-alpha blockers combined hip joint injection of sodium hyaluronate had a better prognosis by 1 year follow-up. Conclusion AS patients with the hip joint involvement often presented more initial hip joint symptoms,earlier onset age,longer time for diagnosis.Strong inflammatory reaction may be the main risk factor of AS hip involvement.The early application of TNF alpha blockers combined with hip injection of sodium hyaluronate can obviously relieve symptoms and improve the function of hip joint,and could be protection factor of AS with hip joint lesions.

Effect of dexmedetomidine on hemodynamics and recovery from general anesthesia in patient undergoing abdominal surgery

WU Qi-cheng, LIU Hong-qin, FANG Jun

2017, 15(2): 213-216. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.009

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Objective To explore the effect of dexmedetomidine on hemodynamics and recovery from general anesthesia in patient undergoing abdominal surgery. Methods Total 148 patients undergoing gastrointestinal operation in Zhejiang Cancer Hospital from January,2013 to December,2015 were selected and divided into dexmedetomidine group and control group.Dexmedetomidine group were given dexmedetomidine with an infusion pump before the induction of anesthesia,while the control group were given midazolam before the induction of anesthesia.The hemodynamic changes during the induction of anesthesia,operation and extubation in the two groups were observed,and the Ramsay sedation score and RASS score were observed after extubation. Results In dexmedetomidine group,the systolic blood pressure,diastolic blood pressure,mean arterial pressure and heart rate at intubation,5 min after intubation and 10 min after intubation were all lower than those before the anesthesia procedures beginning (P<0.05);the result was reversed in the control group (P<0.05),and the difference between the two groups was significant (P<0.05).In the dexmedetomidine group,systolic blood pressure,diastolic blood pressure and mean arterial pressure and heart rate at each time of surgery and extubation did not change significantly (P>0.05);But in the control group,these observed items at gastrointestinal exploration and section were elevated significantly as compared with the values at the incision (P<0.05),and all were higher than those of the dexmedetomidine group (P<0.05).The systolic blood pressure,diastolic blood pressure and mean arterial pressure and heart rate at 1 min,5 min and 10 min after the extubation were all higher than before the extubation (P<0.05),which were higher than those of the dexmedetomidine group (P<0.05).The Ramsay sedation scores of dexmedetomidine group at 10 min and 20 min after the extubation were significantly higher than those of the control group (P<0.05),the RASS scores of dexmedetomidine group at 10 min and 20 min after the extubation were significantly lower than those of the control group (P<0.05). Conclusion Dexmedetomidine can stabilize perioperative hemodynamics of patient abdominal surgery,and help the restore of patients from general anesthesia.

Influence of wearing overnight orthokeratology on corneal morphology in teenagers

CHEN Jing-cheng, CHEN Zi-lin, YANG Xiao-hong

2017, 15(2): 217-219,317. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.010

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Objective To study the early changes of corneal morphology in high school adolescents wearing overnight orthokeratology. Methods A total of 60 adolescent myopia patients (117 eyes) meeting the standards of wearing overnight orthokeratology in our hospital from September,2014 to September,2015 were enrolled and divided into group A (58 eyes,myopia ≤-3.00 D) and group B (59 eyes,-3.00 DResults The uncorrected visual was improved significantly one day after wearing overnight orthokeratology in both groups,and became more stable one week later.The corneal curvature recovered as compared with that before wearing the glasses,and the thickness of cornea got thinner with different degrees,and became more stable 1,3 and 6 months later.The curative effect of group B was more obvious as compared with group A with a statistically significant difference (P<0.05).Through with varying degrees of dry eye symptoms,the changes of corneal morphology including optic axial length,anterior chamber depth and intraocular pressure were not significant as compared with those before wearing the glasses in both groups (P>0.05). Conclusion To wear overnight orthokeratology can in a short time improve the uncorrected visual acuity and prevent the development of myopia,especially for the moderate myopia,it is a safe,fast and effective treatment for adolescent myopia,and worth popularizing in clinical use.

Lymphotoxin-beta receptor activation in bladder cancer cells affecting NF-κB signaling and proliferation

ZHOU Lian-lian, LIN Xiang-yang, SHEN Mo

2017, 15(2): 220-223,333. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.011

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Objective To study the effect of lymphotoxin-beta receptor (LTβR) activation on NF-κB signaling and proliferation of bladder cancer cells. Methods The bladder cancer cells 5637 were cultured in our study,the activation of LTβR was induced by lymphotoxin α1β2(LTα1β2),a functional ligand.The qRT-PCR was applied to detect the mRNA expression of NF-κB family main members (RelA,RelB),cytokines including LTα,LTβ,LIGHT,TNFα,IL-6,IL-1β,and the proliferation-related genes including CyclinD1 and Survivin.The level of phospho-p65(p-p65) was determined by western blot.Cell viability was tested by CCK-8. Results After activation of LTβR,RelA mRNA was up-regulated about 2.5 times (P=0.003),TNFα,IL-1β,CyclinD1 and Survivin mRNA expressions were up-regulated significantly (all P<0.05).Along with the down-regulated expression of LTβR,the mRNA expression of the above-mentioned gene were also decreased (P all<0.05).WB determined that there was an up-regulated trend of p-p65 after activation of LTβR (all P>0.05).There were no significant differences in the proliferation of bladder cancer cells compared to the control (P both>0.05). Conclusion Activation of LTβR can promote the expression of NF-κB family member RelA and the activation of the classical NF-κB signaling.It might be a participant in the emergence of inflammatory microenvironment through up-regulating the expression of TNFα and IL-1β mRNA;Though CyclinD1 and Survivin have been up-regulated,but LTβR has no effect on the proliferation level of bladder cancer cell.

Expression of ocular surface MUC5AC and MUC19 mucin in castrated female rabbit model of dry eye syndrome treated with acupuncture

ZHANG Yi, DU Er-gang, JIANG Shu-le, XU Yi-le

2017, 15(2): 224-226,364. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.012

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Objective To investigate the effect of acupuncture on the expression of MUC5AC and MUC19 in castrated female rabbits model of dry eye symptom after menopause. Methods A total of 45 healthy adult female rabbits were randomly divided into control group,model group and acupuncture group (15 rabbits each group).The ovariectomy surgery was performed in the model group and acupuncture group to produce dry eye models.The acupuncture treatment was performed in the acupuncture group within 2 weeks after the surgery.The Schirmer test,tear film break-up time (BUT),fluorescein staining,rose bengal staining and immunohistochemical staining were performed to test MUC5AC and MUC19 expression before the surgery and 2(w2),3(w3) and 6(w6) weeks after the surgery. Results At w2 and w3 after the castration surgery,Shirmer value,BUT value,fluorescein staining scores and rose bangle staining scores of both model group and acupuncture group were significantly different from those of the control group (P<0.05).At w3,there was a significance difference in Shirmer value and fluorescein staining scores between model group and acupuncture group (P<0.05).At w6,Shirmer value,BUT value,fluorescein staining scores and rose bangle staining scores of model group were significantly different from those in the control group and puncture group (P<0.05).On w3,the expression of MUC5AC and MUC19 in the acupuncture group increased obviously as compared with model group (P<0.05),and the levels of MUC5AC and MUC19 in the two groups were different from those of the control group (P<0.05).Six weeks later,the levels of mucins in the acupuncture group were higher than those of the model group (P<0.05). Conclusion The acupuncture treatment can promote the expression of MUC5AC and MUC19 mucin on ocular surface in rabbits with dry eye symptom after menopause,suggesting its role in the treatment of dry eye symptom.

Relationship between renal pathological classifications and clinical parameters

ZHANG Mei, XU Sheng-qian, CAI Jing, CHEN Shan-yu, XU Jian-hua

2017, 15(2): 227-229,242. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.013

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Objective To investigate the relationship between renal pathological classifications,activity index (AI),chronicity index (CI) in Lupus nephritis and clinical parameters,as well laboratory index. Methods Ninety-six LN patients with kidney biopsy were collected from February,2011 to March,2014.The retrospective analyses were conducted for the correlations between pathological manifestations and clinical,laboratory index. Results ①According to ISN/RDS in 2003,out of 96 LN patients,none of case was categorized as LN-Ⅰ,9 cases (9.38%) were belonged to LN-Ⅱ,9 cases (9.38%) were classified as LN-Ⅲ,67 cases (69.79%) were LN-Ⅳ,11 cases (11.46%) were LN-Ⅴ.②SLEDAI,AI,CI in LN patients were obviously different among different pathological types,LSD test Results showed that AI in LN-Ⅳ were higher than that in LN-Ⅱ,LN-Ⅲ and LN-Ⅴ(P<0.0 001).CI in LN-Ⅳ were higher than that in LN-Ⅱ(P<0.05).SLEDAI in LN-Ⅳ were elevated than LN-Ⅱ and LN-Ⅲ(P<0.05).③Along with the increasing of SLEDAI in LN patients,AI gradually raised (F=15.469,P<0.001).There were no statistic difference regarding CI among patients with different SLEDAI (F=0.442,P=0.724).④Urine protein level in LN-Ⅳ was remarkable higher than that in LN-Ⅱ and LN-Ⅴ(F=1.348,P=0.002;F=0.894,P=0.022).Serum uric acid level in LN-Ⅳ was higher than that in LN-Ⅱ and LN-Ⅴ(F=98.396,P=0.011;F=72.063,P=0.040).⑤Results showed that AI was positively correlated with SLEDAI,urine protein,24 hour urinary protein,ACL,ANA and anti-C1q antibody levels (P<0.05-0.001),while negatively associated with serum C3,C4 and HB levels (P<0.05).There was a positive correlations between CI and urine protein,a negative correlations between CI and amount of urine uric acid in 24 hours (P<0.05). Conclusion The pathological type in patients with LN and AI,CI are closely related with clinical and laboratory indexes.We should emphasis the value of SLEDAI and serum C3 on indicating AI in pathological manifestation.

Anti-autophagy role of estradiol after spinal cord injury in rats

ZHU Min-yu, TENG Hong-lin, WANG Jing, LIN Chao-wei, HUANG Ke-lun, CHEN Bi, WANG Yu, LI Chi, ZHOU Yang

2017, 15(2): 230-233,337. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.014

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Objective To investigate the role of autophagy in estradiol intervention for severe acute spinal cord injury (SCI). Methods A total of 72 adult female Sprague-Dawley rats,weighed 200-220 g,were randomly divided into 3 groups (n=24).Severe SCI models were established with an artery clip (15 g closing force) in model group and intervention group.The intervention group received an intramuscular injection of estradiol benzoate every other day one week before injury and last into sacrifice.The Basso,Beattie,Bresnahan (BBB) open field locomotor rating scale were performed on 7,14,21 and 28 days after SCI to evaluate the functional recovery of locomotion.Real-time PCR and Western blot analysis were used to detect the expression of autophagy marker and Immunohistochemical staining for LC3 was performed using spinal cord sections obtained on days 3 after SCI. Results High dose of estradiol significantly improved locomotor recovery in vivo;the BBB scores in the intervention group were higher than that in the model group on 14,21,and 28 days after spinal cord injury.The expression of LC3 and Beclin-1 in model groups were higher than sham group at 3 days after SCI;E2 treatment inhibited the expression at both mRNA and protein level.Conversely,the expression levels of autophagy substrates protein P62 in the model group was significantly reduced when compared with the sham group.However,the expression was increased when treated with estradiol.Immunohistochemical result indicated that the enhanced immunoreactivity for LC3 in motor neurons after SCI was repressed when treated with high dose of estradiol. Conclusion The neuroprotective effects of E2 in SCI is related to the restraint of excessive autophagy.

Effects of dexmedetomidine on the effect-site concentration of remifentanil for successful laryngeal mask insertion in women

JIN Hao-jie, CHEN Lan-feng, GAO Bao-bin, LIU Hua-cheng

2017, 15(2): 234-236,301. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.015

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Objective To investigate the effects of dexmedetomidine on effect-site concentration of remifentanil for successful laryngeal mask (LMA) insertion in women and to provide clinical basis in the application of dexmedetomidine to general anesthesia retaining spontaneous respirations. Methods Forty-eight patients scheduled for hysteroscopic examinations were randomly allocated to experiment group (group D) and control group (group P).At the beginning of anesthesia induction,experimental drugs (dexmedetomidine 0.5 μg/kg in group D;normal saline in group P) were intravenously administrated at a constant velocity for 10 min by an infusion pump in each group.Propofol was effect-site target controlled infused following saline and dexmedetomidine administration completion.Three minutes after propofol infusion,remifentanil was effect-site target controlled infused and the initial concentration was set at 2.0 μg/ml in both groups.The status of LMA insertion was recorded,and according to the recorded status,the target remifentanil concentration of the following patient was determined by Dixon's up-and-down method (ratio is 1:0.85),and then EC₅₀ of remifentanil was determined.The respiratory and circulatory parameters at each stage (T0:before applying dexmedetomidine or saline;T1:3 min after applying dexmedetomidine or saline;T2:after TCI of remifentanil and before LMA insertion;T3:1 min after LMA insertion;T4:5 min after LMA insertion) were recorded and compared. Results Effect-site EC₅₀ values of remifentanil for successful LMA insertion were 2.74 μg/ml (95%CI:2.30-3.36 μg/ml) for group D and 1.13 μg/ml (95%CI:0.91-1.38 μg/ml) for group P (P<0.05).After TCI of remifentanil,SBP in group P was significantly lower than that in group D (T2,P=0;T4,P=0.002);HR in group D was significantly lower than that in group P at T1,T3,T4 after dexmedetomidine was administered (T1,T3,T4,P=0).The incidence of apnea in group D was significantly lower than that in group P whether before (36.36% vs.76.92%,P=0.003) or after (16.67% vs.66.67%,P=0.018) LMA insertion. Conclusion Dexmedetomidine can significantly reduce the EC₅₀ values of remifentanil for successful LMA insertion,and beneficial to preserve spontaneous respiration in general anesthesia with LMA airway,worthy of clinical application.

Effect of Entecavir on liver cirrhosis and hepatogenic diabetes in patients with hepatitis B and related biochemical indicators

CHEN Ying-gang, LÜ Chun-miao, CHEN Hai-jun, WANG Jian-ming, YUAN Qing, WU Ping, SHENG Qi-yue

2017, 15(2): 237-239. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.016

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Objective To investigate the effect of Entecavir in the treatment of liver cirrhosis and hepatogenic diabetes in patients with hepatitis B and its influence on liver function index and liver fibrosis index. Methods From October,2012 to October,2014,72 cases of liver cirrhosis and hepatogenic diabetes caused by hepatitis B in our hospital were treated,and were randomly divided into observation group (36 cases) and control group (36 cases) according to the random number table method.The control group received routine treatment,while the observation group received additional Entecavir on the basis of the treatment in the control group.The courses of both groups were 12 months.The liver function indexes,glucose metabolism indexes,liver fibrosis indexes and adverse reactions of the two groups were compared. Results Alb level of both groups were significantly increased,ALT and TBiL were significantly decreased after the treatment (P<0.05);After Alb treatment,the observation group was significantly higher than the control group,ALT,TBiL after the treatment was significantly lower than that of the control group (P<0.05);The fasting blood glucose,two-hour postprandial blood sugar,and HbA1c after the treatment in both groups was significantly reduced (P<0.05);Fasting blood glucose,two-hour postprandial blood sugar and HbA1c in the observation group were significantly lower than those in the control group (P<0.05);PCⅢ,HA and LN after the treatment of both groups was significantly reduced (P<0.05);PCⅢ,HA and LN after the treatment of the observation group was significantly lower than those in the control group (P<0.05);No serious adverse reactions were found in the two groups,and the liver function was not increased. Conclusion The effect of Entecavir in the treatment of liver cirrhosis and hepatogenic diabetes in patients with hepatitis B is obvious,it can significantly improve the liver function and hepatic fibrosis indexes of patients.So its clinical value is important.

Distribution and susceptibility of pathogens isolated from patients with severe liver disease

WANG Hua-fu, SHANG Zhen-qiu, GUI Zhi-hong, LIU Wu-gao, DING Ting

2017, 15(2): 240-242. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.017

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Objective To investigate the epidemiology of bacterial infections in patients with liver disease and the antimicrobial susceptibility of majority pathogens,and provides theoretical foundation for effective prevention and infection control of the clinical disease. Methods A total of 326 inpatients with liver disease in our hospital were enrolled into this study.The urine,blood and ascites were collected.After isolation and cultivation,the distribution and drug resistance of pathogenics were analyzed.Pathogenics were identified by using VITEK32 automatic bacterial identification system,and the drug susceptibility testing was performed with the use of K-B method.Results referenced to the United States Institute of clinical laboratory standards (CLSI) to determine the standard.Data was analyzed by Excel. Results Total 1 821 strains had been isolated,including 903 Gram-negative strains,accounting for 49.59%,721 Gram-positive strains,accounting for 39.59%,and 151 fungi strains,accounting for 8.29%.The three most common isolates were Escherichia coli (17.63%),Klebsiella pneumonia (14.33%) and coagulase negative Staphylococci (13.23%).The main sites of infection were abdomen (30.5%),respiratory (20.26%) and blood (18.18%).The main causative strain of respiratory infection was Candida albicans.Both Blood infection and peritoneal infection were mainly Escherichia coli.Escherichia coli showed resistant to Piperacillin-tazobactam,but less resistant to Imipenem and Meropenem.The proportion of ESBLS Escherichia coli and Klebsiella pneumonia were 37.21% and 28.62%,respectively.Staphylococcus showed highly resistant to penicillin and erythromycin,but low resistant to vancomycin and teicoplanin. Conclusion The distribution of pathogenic bacteria in patients with severe liver disease is characteristic.The study of distribution and drug resistance of main pathogenics can provide theoretical foundation for the rational use of drugs.

Comparison of efficacy of ultrasound-guided brachial plexus block between the position on the uninjured arm and the supine position

XIE Ke-yue, HUANG Bing, YAO Ming, ZHANG Li, DENG Jia-jia, FEI Yong, NI Hua-dong

2017, 15(2): 243-245,342. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.018

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Objective To compare the effect of ultrasound-guided brachial plexus block between the position on the uninjured arm and the supine position. Methods Sixty cases of frozen shoulder undergoing ultrasound-guided brachial plexus block and arthroscopic release in our hospital between March,2014 and August,2015 were enrolled and randomly divided into two groups.The brachial plexus block in Group A was performed with B ultrasound-guided needle by the position on the uninjured arm;while in Group B was performed by the supine position.When the needle point reached the plexus,10 ml drug (0.3% Ropivacaine+0.5 mg Mecobalamin) was injected.The operation time,needle adjustable angle,block efficiency and the probability of complications were compared between the two groups. Results By the position on the uninjured arm,the adjustable angle of needle was significantly increased from (123.4±4.2 vs.28.9±4.6),the operation time was reduced[(4.3±1.8) min vs.(5.2±2.0) min],the difference were statistically significant with 95% possibility.Meanwhile,the block efficiency,lasting time,sensory degree and the probability of complications remained at the same level. Conclusion The ultrasound-guided brachial plexus block from the position on the uninjured arm should increase the needle adjustable angle,shorten the operation time,and maintain the operation success rate and safety,it is more efficient and convenient as compared with the supine position,which suggests that the healthy lateral position holds a promising future of clinical utility.

Best opportunity for CRRT to treat infectious acute kidney injury

YU Jiao-yang

2017, 15(2): 246-248. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.019

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Objective To discuss the best opportunity of using continuous renal replacement therapy (CRRT) for the treatment of infective acute kidney injury,and provide certain clinical data for standard treatment in patients with acute kidney injury. Methods From January,2013 to December,2015,120 patients with acute kidney injury having CRRT treatment in our hospital were chosen and divided intoⅠ,Ⅱ and Ⅲ period group by KDIGO criteria.The hospital mortality and renal function recovery rate were compared among the three groups.The APACHE Ⅱ score,SOFA score,oxygenation index,mean arterial pressure,levels of serum creatinine and blood urea nitrogen,cases using vascular active drug were compared before and 48 h after CRRT treatment in each group. Results The mortality and renal function complete recovery rate among the three groups had statistically significant differences (χ²=10.394 and 22.200,all P<0.05).The mortality rate in phase Ⅲ group was significantly higher than that in phase Ⅰ and phase Ⅱ group,while the renal function fully recover rate in phase Ⅲ group was significantly lower than that in phase I and phase Ⅱ group,the differences was statistically significant (χ² ≥ 6.545,all P<0.017).The serum creatinine,blood urea nitrogen,oxygenation index,mean arterial pressure,APACHE Ⅱ score and SOFA score in phase Ⅰ and phase Ⅱ groups were improved significantly after the treatment (t ≥ 4.09,all P<0.05),but not in phase Ⅲ group (t ≤ 1.61,all P>0.05). Conclusion CRRT treatment can obviously improve the prognosis of period Ⅰ and Ⅱ patients,but not of period Ⅲ patients (KDIGO standard),the best opportunity for CRRT should be paid more attention in practice.

Influence of dexmedetomidine on stress response and early cognitive function of elderly patients after spinal operation

ZHANG Shu-bao, MEI Mei, LÜ Wen-yan, HU Xiao-hua

2017, 15(2): 249-251,273. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.020

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Objective To study the influence of dexmedetomidine on stress response and early cognitive function of elderly patients after spinal operation. Methods A total of 66 elderly patients undergoing spinal surgery in our hospital between February,2015 and September,2016 were enrolled and randomly divided into dexmedetomidine group (observation group) and saline group (control group) with 33 patients in each group.All patients were given same anesthesia induction and intraoperative anesthesia maintenance with same drugs and doses,but patients in the observation group were given dexmedetomidine with loading dose 0.5 μg/kg before anesthesia induction,after 15 min continuous infusion,and then at the speed of 0.3 μg/(kg·h) until 30 min before the end of surgery.The stress related index such as serum cortiso (Cor),Angiotensin Ⅱ(Ang Ⅱ),epinephrine (E),norepinephrine (NE) levels,and the cognitive function related index such as S-100β protein (S-100β),serum tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) levels were tested by ELISA;The Mini Mental State Examination (MMSE) was used to systematically assess the incidence of postoperative cognitive dysfunction (POCD). Results Cor level in the control group at 1,4,8 and 12 hours after surgery increased significantly as compared with that 10 min before anesthesia,which was significantly higher than those in the observation group (P<0.05);The levels of Ang Ⅱ,NE and E at 1,4,8,12 and 24 hours after the surgery all decreased significantly as compared with those 10 min before the anesthesia,and they were lower than those of control group with statistical significance (P<0.05);the levels of S-100β,TNF-α and IL-6 at 1,3 and 5 days after the surgery in the control observation group were significantly higher than those 1 day before the surgery (P<0.05),and they were all higher than those of observation group with statistical significance (P<0.05);The MMSE score at 1,3 and 5 days after the surgery in the control group was much lower than those 1 day before the surgery (P<0.05),and they were all lower than those of observation group with statistical significance (P<0.05);The incidence of POCD at 1 and 3 days after the surgery in the observation group were lower than control group with statistical significance (P<0.05). Conclusion The application of dexmedetomidine in elderly patients with spinal surgery can reduce the stress response in 24 hour and the incidence of early postoperative cognitive dysfunction.

Evaluation of the patency of the hand collateral arteries with thumb perfusion index test:comparison with themodified Allen's test

WU Yang, LIU Song, HU Jun, ZHAO Ru-you, CUI Xin-liang

2017, 15(2): 252-254. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.021

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Objective To evaluate the patency of the hand collateral arteries and to compare modified Allen's test (MAT) with thumb perfusion index (PI) test before radial artery puncture. Methods Patients scheduled to undergo selective major surgery were prospectively examined with MAT and thumb PI test before radial artery puncture.Two tests'Results were either positive or negative.Results of both tests were compared in 1 108 patients. Results Among 1 108 patients,two tests both negative was in 1 033 cases;two tests both positive was in 16 cases;the MAT positive,thumb PI test negative was in 57 cases;the MAT negative,thumb PI test positive was in 2 cases,with Chi-square test (χ²=51.27,P<0.05).It meant that there was statistical differences used to evaluate the patency of the hand collateral arteries.The influencing factors were analysed by stepwise logistic regression analyses found that positive rate is related to age and gender by using both Methods (P<0.05). Conclusion The result of thumb PI test show more sensitive than MAT.When applied to radial approach screening,1.62% of patients were not suitable candidates for radial artery puncture.Furthermore,thumb PI test is simpler and convenient compared with MAT in the evaluation of hand collateral arteries,which can replace MAT in clinical application.

Influence of combined general-epidural anesthesia on hemodynamic parameters after surgery for fractures of the lower extremity in elderly patients by using pulse-indicated continuous cardiac output monitoring

WANG Li-jun, YING Jiang-ming, SI Xiao-long

2017, 15(2): 255-257,285. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.022

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Objective To assess the advantage of combined general-epidural anesthesia in the surgery for fractures of the lower extremity in elderly patients by using pulse-indicated continuous cardiac output (PICCO) monitoring. Methods Eighty-there elderly patients with lower limb fracture undergoing prosthetic replacement surgery were enrolled and divided into 2 groups.The general anesthesia was performed in the control group,while the combined general-epidural anesthesia was performed in the observation group.PICCO was used to monitor the changes of hemodynamic parameters,such as cardiac index (CI),global end-diastolic volume index (GEDVI),intrathoracic blood volume index (ITBVI) and extra-vascular lung water index (EVLWI).The normal physiological indexes such as heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and central venous pressure (CVP) were also compared between the two groups.And the incidence of complication in the follow-up was recorded too. Results The normal physiological indexes and hemodynamic indexes were difference between difference group and time points (P<0.05),and there was no interaction between group factor and time factor (P>0.05).At the time of T0 and T4,there was no significant difference in HR,SBP,DBP and CVP between the two groups (P>0.05);from T1 to T3,the level of HR,SBP,DBP and CVP in the observation group were all lower than those in the control group (P<0.05).At the time of T0,there was no significant difference in CI,GEDVI,ITBVI and EVLWI between the two groups (P>0.05);from T1 to T4,the level of CI,GEDVI and ITBVI in the observation group were all higher than those in the control group,and the level of EVLWI in the observation group was lower than that in the control group (P<0.05).Furthermore,the incidence of deep vein thrombosis and cognitive impairment in the observation group were both lower than those in the control group (P<0.05). Conclusion The combined general-epidural anesthesia can stably maintain hemodynamic parameters in elderly patients undergoing the surgery for fractures of the lower extremity when compared with general anesthesia,which is more conducive to the improvement of prognosis of patients.

Correlation between the degree of obstructive sleep apnea-hypopnea syndrome and blood pressure variability and serum leptin level

HE Qun, LI Ming-hui

2017, 15(2): 258-260. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.023

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Objective To investigate the correlation between degree of obstructive sleep apnea hypopnea syndrome (OSAHS) and blood pressure variability and serum level of leptin. Methods A total of 118 patients with OSAHS were enrolled,and the sleep apnea hypopnea index (AHI) was measured by polysomnogram (PSG) examination.According to the AHI,they were divided into the mild group,the moderate group and the severe group;while 40 healthy persons were included as the control group.The 24 hours ambulatory blood pressure (ABP) and the serum level of leptin were tested by Enzyme-linked immunosorbent assay (ELISA). Results ①As the aspects of index of AHI and serum level of leptin,the control group,the mild group,the moderate group,and the severe group were all gradually increased with a statistically significant differences (P<0.05).②When compared with the control group,SBP_day and DBP_night levels of OSAHS groups'were higher than those of the control group,and the SBP_night level of the moderate group and the severe group were higher than those of the control group (P<0.05).As compared with the mild group,the SBP_day,SBP_night,DBP_night level of the moderate group and the severe group were higher than those of the mild group (P<0.05).As compared with the moderate group,the severe group's SBP_day and DBP_night were higher than those of the moderate group (P<0.05).③The degree of disease was positively correlated with index of AHI,serum level of leptin,level of SBP_day,SBP_night,and DBP_night,and there was a significant difference among these groups (P<0.05). Conclusion The severity degree of OSAHS is closely related to blood pressure variability and serum leptin,which provides a new way for the classification of patients with OSAHS,and it has guiding significance for the diagnosis and treatment of this disease.

Efficacy of TCM reducing fever and promoting blood circulation method combined with celecoxib on Gouty Arthritis and its influence on VAS score

WANG Guo-fen, CHEN Shi-hong, SHI Chun-juan, YING Wei-hong

2017, 15(2): 261-263. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.024

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Objective To evaluate the efficacy and safety of TCM reducing fever and promoting blood circulation method combined with celecoxib in the treatment of gouty arthritis. Methods Total of 104 patients with gouty arthritis in our hospital were selected and randomly divided into two groups with 52 cases in each group.The control group received celecoxib treatment,while the treatment group received additional TCM reducing fever and promoting blood circulation method.The course was 7 days in both groups.After the treatment,the curative effect,VAS score on d1,d3,d5 and d7,joint swelling and pain lasted time were observed,and the WBC count,levels of tumor necrosis factor-α and C reactive protein,and incidence of adverse reaction were compared. Results The cure rate,excellence rate and overall response rate were 26.9%,46.2% and 96.2%,respectively,which were significantly higher than those in the control group (P<0.05).The VAS score at d5 and d7 were 1.31±0.31 and 0.41±0.13 in the treatment group,respectively,which was significantly lower than those in the control group (P<0.05).WBC counts,the levels of tumor necrosis factor and C reactive protein were (6.82±1.53)×10⁹/L,(63.2±4.4) pg/ml and (12.9±1.6) mg/L in the treatment group,respectively,which were obviously lower than those in the control group (P<0.05).There was no serious adverse action in both two groups. Conclusion TCM reducing fever and promoting blood circulation method combined with celecoxib in the treatment of gouty arthritis is effective and safe,which worth to be studied in clinic.

Changes of glucose and lipid metabolism in children with obstructive sleep apnea hypopnea syndrome

HE Meng-zao, ZHAO Ye-jun, JIN Jian, TENG Yi-qun

2017, 15(2): 264-266,281. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.025

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Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on glucose and lipid metabolism in children. Methods A total of 52 OSAHS children and 30 normal children recruited as control group in our hospital were evaluated by polysomnography during sleep.According to the PSG results,OSAHS patients were divided into mild group (n=39) and moderate-to-severe group (n=13).The levels of fasting plasma glucose (FPG),fasting insulin (FINS),insulin resistance index (HOMA-IR),total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C) were tested.The partial correlation analysis was performed to compare the glucose and lipid profiles and the indexes acquired from PSG monitoring. Results One way ANOVA showed statistically significant difference among BMI,AHI,OAI and LSaO₂.BMI of the two group OSAHS children was higher than control group (P<0.05),but LSaO₂ was significantly lower (P<0.01).OAI of mild OSAHS group was higher than that of the control group (P<0.01).Moderate-to-severe group children had hyperinsulinemia and insulin resistance,but the blood glucose maintained the normal level,FPG,FINS and HOMA-IR of this group were higher than that of mild OSAHS group and control group (P<0.05).There were no significant differences (P>0.05) in lipid metabolism index among the groups.After controlling the influence of BMI,there were significant positive correlations indicated between FINS,HOMA-IR and AHI.FPG had no correlation with AHI,OAI,and LSaO₂. Conclusion Moderate-to-severe group OSAHS can induce glucose metabolism disorder in children,AHI is an independent risk factor for the disorder of glucose metabolism,indicators of lipid metabolism in children with OSHAS did not change significantly.

Umbilical artery blood gas analysis and Apgar score for multiple organ damage after neonatal asphyxia

ZHAO Yan-feng, ZHANG Zhi-qun, LU Hui, MO Yu-nong, YAO Qiang

2017, 15(2): 267-269. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.026

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Objective To study the value of umbilical artery blood gas analysis combined with Apgar score in the diagnosis of multiple organ damage after neonatal asphyxia. Methods From November,2014 to March,2016,136 patients with neonatal asphyxia were chosen as study patients,and the umbilical artery blood gas analysis as well as Apgar score was performed in all of them.The ROCs of Apgar score,pH and BE were depicted,and the critical values of Apgar score,pH and BE were confirmed.The specificity,sensitivity and AUC were compared among different indicators. Results In 136 patients with neonatal asphyxia,32 patients (23.52%) were diagnosed with multiple organ damage.The rate of multiple organ damage had significant difference between patients with severe and mild asphyxia (P<0.05),the rate of metabolic acidosis had no significant difference between different patients (P>0.05).The rate of multiple organ damage in patients with severe acidosis was 87.87%(29/33),and in the patients with non-severe acidosis was 6.90%(2/29),that in the patients without acidosis was 1.35%(1/74).One min Apgar score,pH and BE had significant difference between patients with or without multiple organ damage (P<0.05),the difference of 5 min Apgar score had no statistical significance (P>0.05).ROC analysis:The AUC of 1 min Apgar was 0.535,the critical value was 3,the sensitivity was 78.13%,the specificity was 65.38%;these of pH were 0.712,7.05,90.63% and 96.15%,respectively;these of BE were 0.627,-15.23 mmol/L,78.13% and 88.46%,respectively. Conclusion Compared with Apgar score along,the pH and BE of umbilical artery blood could evaluate multiple organ damage after neonatal asphyxia more accurately,which would help increase the accuracy rate of diagnosis.

Factors affecting pelvic lymph node metastasis and prognosis of patients undergoing radical surgery for cervical cancer

LU Jie, WU Xiao-jie, ZHU Wei-li

2017, 15(2): 270-273. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.027

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Objective To explore the factors affecting pelvic lymph node metastasis and 5-year survival rate of patients undergoing radical surgery for cervical cancer. Methods The clinical and pathological data of 225 cases of stage 1A-2B cervical cancer undergoing radical surgery in our hospital between January,2007 and December,2012 were reviewed and analyzed respectively. Results Among 225 cases of cervical cancer,there were 54 cases of lymph node metastasis with a rate of 24.0%.The patients with hemoglobin level<110 g/L before the treatment,FIGO stage Ⅱ,depth of myometrial invasion ≥ 1/2,parametrial invasion,lymph-vascular space invasion,tumor diameter ≥ 4 cm usually had high metastasis rate of lymph node when compare with the patients with the hemoglobin level ≥ 110 g/L before the treatment,FIGO stage Ⅰ,myometrial invasion<1/2,no parametrial invasion,without lymph-vascular space invasion,tumor diameter <4 cm patients (P<0.05).Hemoglobin level before the treatment,FIGO stage,parametrial invasion,lymph-vascular space invasion and tumor diameter were the independent factors of cervical lymph node metastasis (P<0.05).The 5-year survival rate of cancer patients was 83.7%.The 5-year survival of patients with age ≥ 45 years,hemoglobin level<110 g/L before treatment,FIGO stage Ⅱ,depth of myometrial invasion ≥ 1/2,parametrial invasion,lymph-vascular space invasion,tumor diameter ≥ 4 cm,non-squamous cell carcinoma and lymph node metastasis were lower than the patients with age <45 years of age,hemoglobin level ≥ 110 g/L before the treatment,FIGO stage Ⅰ,myometrial invasion<1/2,no parametrial invasion,without lymph vascular space invasion,tumor diameter <4 cm,squamous cell carcinoma,without lymph-node metastasis patients (P<0.05).Hemoglobin level before the treatment,lymphatic vascular space invasion,non-squamous cell carcinoma and lymph node metastasis were the independent predictors of 5-year survival rate of patients with cervical cancer (P<0.05). Conclusion Hemoglobin level before the treatment,FIGO stage,parametrial invasion,lymph-vascular space invasion,tumor diameter were the independent factors of cervical lymph node metastasis.Hemoglobin level before the treatment,lymphatic vascular space invasion,non-squamous cell carcinoma and lymph node metastasis were independent predictors of 5-year survival rate of patients with cervical cancer.

Effect of trace elements and nutritional intake on height and weight in preschool children

LAN Jian-fang

2017, 15(2): 274-276. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.028

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Objective To investigate the effect of trace elements and nutritional intake on height and weight in preschool children. Methods Total 300 preschool children in different kindergarten from September,2013 to September,2014 were chosen and divided into excess group,good group,middle group and low group according to the diet intake for 3 days,with 75 cases in each group.The dietary status of children was followed up for 12 months.The growth indexes in different groups were compared and the correlation was analyzed. Results The numbers of children in each group were 48 cases,56 cases,57 cases and 47 cases,respectively.The height and the height increment of the good group were higher than those in other groups (P<0.05)12 months later;there was no significant difference in height and height increment between the excess group and the middle group (P>0.05),while either of them was higher than the low group (P<0.05).The weight and the weight increment of the excess group were higher than those in other groups (P<0.05)12 months later;there was no significant difference in weight and weight increment between the good group and the middle group (P>0.05),while either of them was higher than the low group (P<0.05).There were positive correlation between the growth index (height and the weight) and the nutrition (protein,energy,calcium,iron,zinc,all P<0.05),and calcium,iron,zinc and protein and caloric intake was positively correlated (P<0.05). Conclusion The trace elements and nutrition of rational consumption in preschool children has a positive role in growth and development,and deficiency or excess of nutritional intake have a negative impact on its height growth.It's necessary to develop individualized intervention according to the lack of nutrition conditions.

The investigation of current situation of application on WeChat public platform by community health services centers in Shanghai

XU Zhi-jie, LIU Xin-ran

2017, 15(2): 277-281. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.029

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Objective To investigate the current situation of application on WeChat public platform by community health services centers to publish information and educate health in Shanghai,and propose the countermeasures to strengthen the centers'publicity. Methods The openness,use and fans'engagement of WeChat public platform of 245 community health services centers in Shanghai were investigated by utilizing the function of searching on WeChat APP and Sogou Search Engine.Data of the investigation Results were processed by SPSS 18.0,and a P value of <0.05 was considered statistically significant.In addition,one of the relative successful WeChat public platform of the community health services center have been studied and its main characteristic of operation was analyzed,the line graph was used to show the relationship between the update and reading quantity of the platform on average. Results Only 57(23.3%) community health services centers in the city had their own WeChat public platform,in which the rate of central city area and rural area were relatively 32.8%(39/119) and 23.3%(18/126).And the publications and attention were not unsatisfactory,of which urban area was significantly better than suburbs'(P<0.01);the current problems of operating the WeChat public platform included the deficiency of the interactive functions,update not timely,little attention,unreasonable content,and so on.Besides,High-frequency update and long-term operating time,were the precondition to operate a public platform successfully. Conclusion Basic medical institutions including the community health services centers are at the start in information publishing and health education by using social media platforms at present.Therefore,they ought to promote their attention to it,learn from and draw upon the operation experience of excellent platforms,and seek the third party service for assistance actively as well.

Analysis of colorectal cancer screening and risk factors assessment for community residents in Hefei

HU Yi-ran, ZHAO Hui-ling, ZHANG Hong-yan, WEI Dong-hua

2017, 15(2): 282-285. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.030

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Objective To investigate risk factors of colorectal cancer in community residents,and provide the basis for the early cancer detection. Methods A self-administered questionnaire based on cancer risk assessment systems that modified from Harvard Cancer Risk Index were used in the survey.The community residents aged 40 to 69 of seven administrative region of Hefei were assessed.The high-risk population were then suggested to do further colonoscopy check and clinical screening to detect colorectal cancer or precancerous lesions.Disease or health as the dependent variable,the related risk factors were analyzed by binary logistic regression method. Results Total 4 696 people (15.78%) in 29 750 cases were detected for colorectal cancer risk factors by Harvard Cancer Risk Index evaluation.There were significant differences between the sexes,and between the age groups in 40-44 and 65-69 year (P<0.05).The prevalence in group of 40-and 50-were significantly higher than group 60-.One colon cancer and eighty-six precancerous lesions cases were found by clinical colonoscopy examination.Multivariate logistic regression analysis showed that chronic colonic enteritis,gastrointestinal disease,hepatitis C,high blood pressure were the risk factors,and service industry,passive smoking,hepatitis B were protective factors. Conclusion It is conforming to the principle of early disease prevention and health economics with assessing risk of colorectal cancer by disease health index of lifestyle and then doing clinical examination for the high-risk,which promote the residents'attention of early detection and treatment.Treating chronic colonic enteritis,hepatitis,especially hepatitis C actively,learning healthy lifestyle could be beneficial to the prevention of colorectal cancer.

Association of post-stroke depression with demographic factors,vascular risk factors and stroke features in Chinese elderly population

WANG Ling-ru, FU Xiao-yan, WANG Hua, MA Rui-xue, TAN Qing-hua, DONG Mao-yu, ZHOU Hua-dong

2017, 15(2): 286-288. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.031

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Objective To study the association of post-stroke depression (PSD) after first-ever ischemic stroke with demographic factors,vascular risk factors and stroke features in a large stroke cohort of China. Methods From January,2010 to December,2014,a total of 304 consecutive patients with a first episode of ischemic stroke within 7 days were enrolled in this study and divided into PSD group and non-PSD group according to Self-rating Depression Scale (SDS) at the third month after stroke.The association of PSD with demographic factors,vascular risk factors,and stroke features were analyzed by univariate analysis and the risk factors of PSD were found by multivariable logistic regression analysis. Results The incidence of PSD after first-ever stroke was 41.1%.When compared with the patients without PSD,those with PSD reported adverse life events more frequently,and more subjects with PSD lived alone,had left carotid artery infarction and cortical infarction,history of insomnia,hypertension,aphasia,dyskinesia,and high National Institute of Health Stroke Scale (NIHSS) scores and low Barthel Index (BI) scores (P<0.05).The risk factors associated with PSD in logistic regression analysis were aphasia (OR=1.82,95%CI:1.17-2.35),insomnia (OR=1.85,95%CI:1.20-2.42),NIHSS score (OR=2.19,95%CI:1.36-3.18) and Bathel Index score (OR=2.27,95%CI:1.51-3.36). Conclusion PSD is common in three months after stroke.The risk factors of PSD after the first-ever stroke are aphasia,insomnia,and neurological deficit degree.

Effects of low-frequency repetitivetranscranial magnetic stimulation on cognitive function and life ability of children with depressive disorder

FENG Hong, XU Jiong-jiong, QIN Guo-xing, GAN Jian-guang, WANG Tie-feng

2017, 15(2): 289-291. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.032

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Objective To investigate the effects of low-frequency repetitive transcranial magnetic stimulation on the cognitive function and life ability of children with depressive disorder. Methods A total number of 60 children with depression were divided into two groups with 30 cases in each group.The control group treated with Paroxetine,while the experimental group received transcranial magnetic stimulation therapy.The incidence of adverse reactions and the score of HAMD,MMSE,Barthwl index,ASHQ and TESS were compared between the two groups. Results The grade data of the two groups were similar and the difference was not statistically significant (P>0.05).The total efficiency of the experimental group was 93.33%,which was higher than 83.33% of the control group,the difference was not statistically significant (χ²=1.455,P>0.05).After the treatment,the HAMD score and ASHQ score of the two groups were significantly decreased,and the MMSE score and Barthwl index were significantly increased (P<0.05).The HAMD score and ASHQ score of the experimental group were significantly lower than those of the control group after the treatment,the MMSE score and Barthwl index improved significantly,the difference was statistically significant (t=6.451,2.306,6.319,8.819,all P<0.05).The TESS score (2.19±0.65) in the experimental group was significantly lower than that in the control group (3.81±1.27),there was a significant difference (t=6.219,P<0.05).The incidence of adverse reactions in the experimental group (16.67%) was significantly lower than the control group (43.33%),there was a significant difference (χ²=3.889,P<0.05). Conclusion The low frequency transcranial magnetic stimulation in children with depressive disorder can significantly improve the cognitive function and life ability,and the low incidence of adverse reactions.

Study on health related quality of life and influencing factors in seborrheic dermatitis patients

DAI Ruo-yi, GU Xiao-hong

2017, 15(2): 292-294. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.033

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Objective To study the health related quality of life (HRQOL) score in seborrheic dermatitis patients,and to study the influencing factors on health related quality of life,at last to analysis the major and minor relationship of the factors. Methods A total of 314 patients with seborrhric dermatitis in our hospital were analyzed form February to August in 2015.The short form 36 questionnaire (SF-36) scale was used to assess the HRQOL.The general conditions of seborrheic dermatitis patients were counted.The one-way ANOVA and stepwise regression analysis were used to study the influence factors of HRQOL. Results The average score of SDS was 51.45±9.42.About 56.1% of respondents were no depression.The mild depression accounted for 33.1%,moderate depression for 7%,and severe depression for 3.8%.The difference of HRQOL scores between different seborrheic dermatitis course,age and sleep time had statistical significance (P<0.05).The spicy food,drinking,smoking,doing exercise,treatment Results leaded to the differences of the HRQOL scores (P<0.05).The HRQOL scores of the seborrheic dermatitis patients with long duration,older age and lack of sleep were lower.Spicy food,drinking and smoking reduced the HRQOL scores.Exercise and treatment could improve the HRQOL scores.Stepwise regression analysis showed that:treatment,SDS scores,spicy diet,course of seborrheic dermatitis,physical exercise,drink wine and sleep time were the main influencing factors.HRQOL score was positively correlated with treatment,physical exercise and sleep time (P<0.05),and was negatively correlated with SDS score,spicy food,course of seborrheic dermatitis and drink wine (P<0.05). Conclusion The HRQOL of seborrheic dermatitis patients is poor.More attentions should be paid to the patients with psychological depression,suffered seborrheic dermatitis more than 3 years,divorced or widowed patients.We should take active treatment with combined Chinese and western medicine to patients,encourage patients to get rid of spicy diet and drink,encourage patients to exercise and ensure adequate sleep time.The above measures all can significantly improve the HRQOL of seborrheic dermatitis patients.

Effect of dietary nutritional intervention on pregnancy outcomes of patients with gestational diabetes mellitus

NIU Yang, LI Ji, SHENG Jin-ye, TANG Qing-ya

2017, 15(2): 295-297. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.034

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Objective To investigate the dietary nutritional intake status of women with gestational diabetes mellitus (GDM),and study the influence of nutritional intervention to the pregnancy outcomes. Methods The clinical data of 142 pregnant women in our hospital were collected and divided into the GDM group (74 cases) and the healthy control group (68 cases).The basic information,pre-pregnancy BMI and dietary nutrition status of women,the born weight and health status of neonates were compared between the two groups. Results ①The age of pregnant women,nutritional intake (total calories,lipid,dietary fiber,calcium and zinc) and the percentage of fat in the GDM group were lower than those in the control group,however,the prepregnant BMI was higher than that in the control group,and the difference was significant between the two groups (P<0.05).②There were no significant differences in born weight,the incidence of SGA,AGA and macrosomia between the two groups (P>0.05).There were significant differences in gestational age[(38.03±2.08) m vs.(38.86±1.96) m],cesarean section rate (76.9% vs.79.4%) and LGA (16.6% vs.11.61%),all of them were lower in the GDM group (P<0.05).The Apgar score of neonates in both groups were in regular range,and they had no history of rescue. Conclusion The unbalanced nutrients intake in patients with GDM is common,and pre-pregnant obesity is one of the important factors.The nutrition intervention should be done as early as it could be to decrease the negative pregnancy outcomes.

Clinical value of Virtual Touch Tissue Quantification for evaluating early alcoholic liver cirrhosis

TANG Xiao-fei, WEI Lin, LIU Fang, WANG Shan-shan, PAN Lin, HUANG Bin

2017, 15(2): 298-301. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.035

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Objective To investigate the diagnostic value of virtual touch tissue quantification (VTQ) technique for early alcoholic liver cirrhosis. Methods The right lobes of liver of 154 people in three groups (63 patients with alcoholic liver disease,41 patients with early liver alcoholic cirrhosis and 50 healthy controls) were checked and recorded by VTQ technique.One week later,all the patients underwent liver biopsy.The pathological examination result was used as the gold standard to evaluate the diagnostic value of VTQ technique for early alcoholic liver cirrhosis.The cut-off value was determined by an analysis of receiver operating characteristic curve (ROC). Results The average velocity of VTQ was (1.14±0.14) m/s,(1.48±0.27) m/s,(2.33±0.48) m/s in control,ALD and early alcoholic liver cirrhosis group,respectively.Significant difference were found among these three groups (P<0.001).The area under the ROC curve was 0.955 by using the VTQ technique in the assessment of early alcoholic liver cirrhosis.The VTQ value of 1.78 m/s was used as cut-off value to distinguish between ALD and early liver cirrhosis.The sensitivity (Se) and specificity (Sp) to diagnose early cirrhosis was 85.7% and 95.1%. Conclusion VTQ technique can quantitatively reflect liver tissue stiffness information,which has high value to diagnose early alcoholic liver cirrhosis.

Change and significance of ghrelin/obestatin in elderly patients with coronary heart disease complicated with obstructive sleep apnea hypopnea syndrome

YAN Ai-fen, WU Wei-ping, CHEN Jie, CHEN Yu-ting

2017, 15(2): 302-303,307. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.036

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Objective To investigate the change and clinical significance of ghrelin/obestatin in elderly patients with coronary heart disease complicated with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods We collected 112 cases of coronary heart disease patients in the people's hospital of Yuyao as research subjects and divided them into coronary heart disease complicated with OSAHS group (n=48) and simple coronary heart disease group (n=64) according to the complication of OSAHS from January,2014 to December,2015.40 cases of healthy people were selected as a control group at the same period.ELISA was used to determine serum Ghrelin and obestatin levels.Gensini score was used to evaluate the extent of coronary lesions according to the Results of coronary angiography,and polysomnography (PSG) monitoring was used to the diagnosis of OSAHS. Results The ghrelin/obestatin ratio of coronary heart disease complicated with OSAHS group and simple coronary heart disease group were significantly lower than that of the control group,the difference were statistically significant (P<0.05 or P<0.01).The Gensini score of coronary heart disease complicated with OSAHS group were significantly higher than that in the simple coronary heart disease group,the difference were statistically significant (P<0.05).The ghrelin/obestatin ratio of patients with coronary heart disease complicated with OSAHS was negatively correlated with Gensini score and AHI (r=-0.72,-0.55,P<0.05). Conclusion Ghrelin/obestatin ratio is closely related to the degree of coronary artery disease in patients with coronary heart disease complicated with OSAHS.Ghrelin/obestatin ratio could one of indicator for prediction of coronary heart disease complicated with OSAHS.

Susceptibility of Klebsiella pneumoniae clinical strains isolated from 2010 to 2014 in Sir Run Run Shaw hospital of Hangzhou

XU Mao-yu, WU Sheng-jun

2017, 15(2): 304-307. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.037

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Objective To investigate the resistance to antibiotics of Klebsiella pneumoniae among clinical isolates in recent years. Methods Vitek2 compact and K-B method were applied to analyze the drug susceptibility,the productive rate of ESBLs and the difference of drug sensitivity result between ESBLs negative and ESBLs positiveof the 2 296 strains of Klebsiella pneumoniae isolated from Sir Run Run Shaw hospital from 2010 to 2014.In the meantime thedouble-disk synergy test was used to confirm the ESBLs. Results The resistance rates of Klebsiella pneumoniae to most of the β-lactamases antibiotics rose year by year.The resistance rates toampicillin kept stable and high to 98% in the five years,but the one to Aminoglycosides,Quinolones and SMZ-TMP showed little changed during the five years.The resistance rate also had an upward trend to the carbapenems and comprised β-lactamases antibiotic.During the last five years,the positive rate of the ESBLs was high,and the resistance rate to most of the experimental antibiotics of ESBLs positive strains was obviously higher than that of thenegative one (P<0.05). Conclusion The resistance rate of the Klebsiella pneumoniae to most antibioticsincreases year by year during the past five years.The ESBLs positive strains have higher resistance rate as compared with ESBLs negative.We should choose the rational antibiotics according to the characteristic of the strain as well as the test report of the drug sensitivity.

Value of serum insulin-like growth factor-binding protein-2 in early diagnosis of rectal cancer

CAI Wen-pin, LIANG Shi-zhou

2017, 15(2): 308-310. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.038

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Objective To evaluate the role of insulin-like growth factor binding protein-2(IGFBP-2) in the diagnosis for early stage rectal cancer. Methods The patients with early stage rectal cancer (n=84),age and sex matched patients with benign rectal lesion (n=50) and healthy controls (n=32) were recruited.The serum IGFBP-2 was determined by enzyme-linked immunosorbent assay (ELISA).The levels of IGFBP-2 among the patients with different gender,age,invasive depth,differentiation grade,diameter and clinical stage were compared.Pearson correlation analysis was performed to study the correlation between serum IGFBP-2 and clinicopathological parameters.ROC curve analysis was used to assess the sensitivity and specificity of IGFBP-2 in the diagnosis stage 1 and 2 rectal cancer. Results The level of serum IGFBP-2 in early stage rectal cancer group,benign rectal lesion group and healthy control group were 223.7-360.9,158.2-199.6 and 135.6-184.5 ng/ml,respectively,the cancer group was significantly higher than the other two groups (P<0.05).There was no significant difference between the benign rectal disease group and control group.The serum IGFBP-2 levels was different between different invasion depth,T3-T4 rectal cancer was higher than T1-T2 cancer,in Mann-Whitney teat Z value was 2.28(P=0.02).The AUC for diagnosis pTNM Ⅰ phase cancer and pTNM Ⅱ phase cancer were 0.701 and 0.753,respectively.When IGFBP-2 short-cut process 197.33 ng/ml on diagnosis pTNM Ⅰ phase cancer,the sensitivity and specificity were 0.874 and 0.643,and on pTNM Ⅱ phase cancer the short-cu process 242.17 ng/ml,the sensitivity and specificity were 0.786 and 0.655. Conclusion The serum IGFBP-2 levels are significantly related to the degree of tissue differentiation,and will make a distinction between malignant pathological changes and benign lesion,the low diagnosis specificity limited the clinical application.

Imaging diagnosis of 1,2-Dichloroethane subchronic toxic encephalopathy

ZHANG Zhi-jing, WU Ai-qin, ZHENG Wen-long, DUAN Wei-min, FU Yao, YANG Zhong-fu, CENG Rui-min, YANG Yu-bing

2017, 15(2): 311-313. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.039

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Objective To investigate imaging characteristics in patients with subchronic toxic encephalopathy induced by 1,2-dichloroethane (1,2-DCE) and to improve the understanding of this disease. Methods CT and MRI findings of 12 patients with toxic encephalopathy induced by 1,2-DCE in the Second Affiliated Hospital of Wenzhou Medical University and Cangnan Hospital were retrospective study. Results CT manifestations:bilateral hemisphere white matter showed generalized and symmetry low density,blurred edge,not clear boundary between cortex and medulla,swelling gyrus,shallow groove;decreased density of bilateral globus pallidus,hind limb of the internal capsule,external capsule and thalamus;swelling brain stem and decreased density,the surrounding cisterns get narrowed by the compression;Bilateral cerebellar dentate nuclei presenting patchy and low density.MRI performance:bilateral subcortical arcuate fasciculus showed generalized and symmetric "U" shape T₁WI low signal,and T₂WI,T₂-FlAIR high signal,with gyrus narrowed and sulcus variable shallow or disappeared.Centrum semiovale was not involved in.Bilateral lentiform nucleus,external capsule,cerebellar dentate nuclei also showed that T₁WI has stripes or small flake signal,T₂WI and T₂-FLAIR had high signal.The signal of lesions area was significantly high and boundary was relatively clear in DWI sequence,whose signal was low in ADC. Conclusion The onset of Subchronic 1,2-DEC toxic encephalopathy has a specific environmental and clinical symptoms of sudden headache and the disturbance of consciousness.MR is more sensitive to the involved parts,scope,type and severity of edema as compared with CT.The certain characteristics will provide important evidence for the accurate diagnosis in time.

Comparative study of CT coronary angiography in patients with chest pain and patients without chest pain

TONG Kai-jun, SHU Rong-bao, NI Qing, HE Yong-sheng, JIN Yuan-zhen

2017, 15(2): 314-317. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.040

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Objective To explore clinical application value of 64-slice CT coronary angiography (CTCA) in diagnosis of coronary artery diseases with chest pain as the chief complaint. Methods In accordance with the chief complaint with or without chest pain,105 hospitalized patients with CTCA examination were divided into chest pain group and non-chest pain group.In addition to the general information of patients,the difference in coronary artery diseases such as the positive rate,the plaque composition,the plaque segment quantity and the degree of stenosis between two groups was compared retrospectively. Results Among 56 patients with chest pain,45 cases were diagnosed with coronary artery plaque as 176 segments in total were observed,including 77 non-calcified plaques,64 calcified plaques and 35 mixed plaques.Insofar as stenosis was concerned,11 patients were found at level 0,33 patients at level 1,6 patients at level 2 and 6 patients at level 3.Among 49 patients without chest pain,23 cases were diagnosed with coronary artery plaque as 69 segments in total were observed,including 44 non-calcified plaques,17 calcified plaques and 8 mixed plaques.Insofar as stenosis was concerned,26 patients were found at level 0,18 patients at level 1,1 patients at level 2,4 patients at level 3.Gender between two groups had no significant statistical difference (χ²=3.26,P=0.07);the average age between two groups had no significant statistical difference (t=0.64,P=0.52);the positive rate of chest pain group were higher than non-chest pain group (χ²=12.79,P<0.001);plaque composition had significant statistical differences (χ²=8.03,P=0.02);the plaque segment quantity had significant statistical differences (Z=-3.71,P<0.001);the degree of luminal stenosis had significant statistical differences (Z=-3.33,P<0.001),the mean rank of chest pain group was 61.48,higher than 43.31 of non-chest pain group. Conclusion CTCA showed that the positive plaques,the plaque segment quantity and the degree of luminal stenosis in patients with chest pain were higher than those in patients without chest pain.In addition,plaque composition between two groups had significant statistical difference.Therefore,CTCA has important clinical value in diagnosis of coronary artery diseases with chest pain as the chief complaint.

Clinical features and homological analysis of fungemia among neonates caused by candida haemulonii

YANG Hai-yu, LIU Cai-xia, LI Fang-qu, ZHU Min-li, XIE Wei-wei, YANG Jin-hong

2017, 15(2): 318-320,330. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.041

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Objective To investigate the clinical features of fungemia among neonates caused by Candida haemulonii,perform the homological analysis of the strains,provide guidance for prevention of the C.heamulonii infection,and improve the diagnosis and treatment level. Methods The clinical data of 15 infants with Candida haemulonii was retrospectively analyzed from May to October in 2014.The isolates were identified by standard laboratory procedures,including the use of Vitek2-Compact YST card systems and sequence analysis of 18S rRNA.Homological analysis was performed by using random amplified polymorphic DNA assay to explore the epidemiological characteristics of this nosocomial infection.According to hospital infection epidemiological characteristics,the samples were isolated from the surrounding environment,object surface,equipment and the hands of medical staff. Results All the patients were in the NICU for 12-39 days before they developed fungemia due to C.haemulonii.All infected neonatal had received central venous catheter.Five infants were healed after a therapy of fluconazole for 20-30 days.After 15-20 days of voriconazole treatment,the other eight cases recovered well and subsequent blood cultures were negative for yeasts.Two cases were given up.The isolates were identified and confirmed as C.haemulonii.RAPD genotyping Results showed that all strains were from the same clone.C.heamulonii were not detected in the samples from the surrounding environment,object surface,equipment and the hands of medical staff.No similar casesoccurred after positive control measures despite a negative epidemiological sampling. Conclusion C.haemulonii may transmit horizontally among the hospitalization neonates,causing neonatal hospital infections.PICC is the independent risk factor of causing neonatal hospital infections.It is necessary to take comprehensive prevention measures to cut off the transmission route.

Research progress of preventing CINV caused by cis-platinum with traditional Chinese and western medicine

MAO Yong-min, WANG Yi-hong, XIE Teng, WU Jian-gang, PAN Feng, LI Chao-yang, HUANG Chang-xin

2017, 15(2): 321-324. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.042

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Chemotherapy-induced nausea and vomiting (CINV) is the most common adverse reaction,especially in chemotherapy containing cisplatin.The incidence rate nearly reaches 100%.The lasting intolerable reaction of alimentary canal,particularly the delayed nausea and vomiting,made the patients have a fear of chemotherapy,and even bring the treatment to a halt,or even if the treatment continued,the syndrome,caused by uncontrolled vomiting,hypo-alimentation,and inordinate water-electrolyte metabolism,would lead to a lower quality of life,decrease the medication compliance and influence the healing effect.Recently,based on CINV mechanism,modern medicine mainly use neurotransmitter receptor antagonist combined with hormone therapy to prevent CINV,and have already obtained certain result.Along with the comprehensive application of antiemetic like 5-HT receptor antagonist,NK-1 receptor antagonist,etc.,the incidence and severity of CINV was markedly reduced,but the delayed nausea and vomiting was not well-controlled.According to Traditional Chinese Medicine (TCM),the pathogenesis of CINV caused by cisplatin is the syndrome of qi asthenia (deficiency of vital energy) and the weakness in the stomach,i.e.,exogenous pathogenic agents invade stomach,which can result in stomach qi upward reverse and cause the disorder of the stomach qi.So,it is highly recommended to apply the therapy of "strengthening the body resistance to eliminate pathogenic factors" so that to "descend adverse qi and settle stomach" ,and it has determined curative effect clinically.Meanwhile,because of less adverse effect,easy to operate,and determined curative effect,external treatment of Traditional Chinese Medicine is gradually attracting the attention of doctors and patients.More and more patients accept acupuncture,moxibustion,and umbilical compress therapy.This kind of external treatment of TCM has been practiced for more than 2,000 years,and proved working well in regulating the function of the spleen and stomach.Researchers from domestic and abroad carried out massive investigation to study the mechanism of acupuncture and the analogue external treatment of TCM,as well as its clinical efficacy.They recommended the acupuncture and the analogue external treatment of TCM as the complementary and substitutive therapy for prophylaxis and treatment of CINV.In this paper,we review research advances in recent years.

Observation of curative effect of Baoshi forefront enema combined with Qianlie Huichun capsule on chronic nonbacterial prostatitis

CHEN Wang-qiang, YU Jia, DING Cai-fei, HU Hui-min

2017, 15(2): 325-327. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.043

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Objective To investigate the clinical effect of Baoshi Forefront Enema combined with Qianlie Huichun Capsule on chronic nonbacterial prostatitis. Methods A total of 126 patients with chronic non-bacterial prostatitis were divided into two groups at random,63 in each group.Patients in control group were given Qianlie Huichun Capsule,and patients in observation group were given extra Baoshi Forefront Enema.The chronic prostatitis symptom index score (NIH-CPSI),TCM symptom score,EPS-lecithin corpuscle and white blood cells,serum IL-1β,IL-2,IL-10 levels of two groups were under observation before and after the treatment.And the clinical efficacy of two groups was observed. Results After treatment,all indexes in NIH-CPSI of two groups were significantly decreased (P<0.05),and all indexes in NIH-CPSI of observation group were significantly lower than those of the control group (P<0.05).After the treatment,TCM symptom scores of two groups were significantly decreased (P<0.05),and TCM symptom score of observation group was significantly lower than that of the control group (P<0.05).After treatment,EPS-lecithin corpuscle and white blood cells counting were significantly improved (P<0.05),and also worked better than control group (P<0.05).After treatment,IL-1β,IL-2,IL-10 levels of two groups were significantly decreased (P<0.05),and IL-1β,IL-2,IL-10 levels of observation group were significantly lower than that of the control group (P<0.05).The total effective rate of observation group was 88.9%,which was significantly higher than that of the control group (61.9%,P<0.05). Conclusion Baoshi Forefront Enema combined with Qianlie Huichun Capsule could effectively improve clinical symptoms and inflammatory levels of chronic nonbacterial prostatitis with satisfactory effect.

2017, 15(2): 328-330. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.044

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Application of PBL model in nursing bilingual teaching in medicinal colleges and universities

WANG Si-ting, LI Chao-hui, MA Qiu-ping

2017, 15(2): 331-333. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.045

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Objective Problem-Based Learning (PBL),created by Howard Barrow who was an American professor of neurology in McMaster university in Canada in 1969,is a very popular teaching model all around the world.The core of PBL is "student-centered,problem-based",it targeted at "autonomic learning,lifelong learning",PBL has been generalized and applied popularly in academic activity since it had been introduced in nursing education 1970s.This article is to explore application of PBL model in nursing bilingual teaching,for the purpose of consideration and recommendation could be made for medical college to introduce PBL to nursing bilingual teaching. Methods On basis of theoretical and practical study on PBL teaching model from oversea and abroad,as well as the purpose of extending and deepening reform direction and characteristic of nursing bilingual teaching,the study focus on application of PBL model in nursing bilingual teaching. Results In consideration of current educational background,as well as integrating native and foreign PBL model into medical education,some problems have been identified for application of PBL model in terms of learner,learning instructor,learning tools and learning environment,in order to explore new model of independent and cooperative nursing bilingual teaching which is adaptable to the need of medical college. Conclusion Consideration has been taken to cultivate traditional teaching method,formulate teaching training program,compile bilingual teaching textbook,enhance hardware construction,in order to widen and intensify nursing bilingual teaching based on characteristic of nursing science in new era.

Difference among firs-year preventive medicine students in awareness and satisfaction to their specialty and interactions

FAN Xiao-yu, XIA Yan-chang, YANG Shuang-bo, CHEN Peng, CHEN Jiang-lan, QIN Xing-xing, SUN Ye-sheng, GONG Lei, LIU Hong

2017, 15(2): 334-337. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.046

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Objective To investigate the difference among the first-year preventive medicine preventive medicine undergraduate students with different demographic information in awareness and satisfaction to their specialty,analyze the influence of the basic situation of students on the specialty satisfaction score,and discuss the role of increasing the awareness of students to their specialty in improving the specialty satisfaction. Methods A survey on the basic information,awareness and satisfaction to specialty was performed with a self-made questionnaire"Rating Scale for Awareness and Satisfaction to Preventive Medicine Specialty"among the five consecutive years freshmen in our school between 2009 and 2013,and 316 completed questionnaires were returned.F test or t test was used to analyze the influence of single demographic factor on the awareness and satisfaction to their specialty;the fitted binary logistic regression equation was used to explore the major factors for specialty satisfaction;the bivariate correlation and regression analysis were used to investigate the relationship between awareness and satisfaction to specialty. Results The average score of the first-year preventive medicine students for the awareness and satisfaction to their specialty were 60.78±13.02 and 71.86±11.02,respectively,the difference in both awareness and satisfaction was statistically significant from 2009 to 2013(all P<0.01),and the satisfaction to specialty increased year by year.The urban students were with higher score when compared with the rural students (P<0.05);Lots of demographic information factors,especially grade (Exp=8.93) and domicile (Exp=7.52) factors had significantly influence on the specialty satisfaction,the fitted regression data have statistical significance (χ²=42.45,P<0.01).The awareness to their specialty was closely related to the satisfaction (R=0.47,P<0.01). Conclusion The satisfaction of the first-year preventive medicine students in this school had been improved obviously recent year,however,the general condition still to be increased,the attentions should be paid to the rural students,high grade students,and the students with a poor awareness to their specialty or their parents with low-education.The various measures should be taken to strengthen the awareness education,establish their correct awareness to specialty,and improve their satisfaction to specialty.

SWOT analysis and countermeasure research of Ningbo cloud hospital

ZHANG Jing, SHUI Li-ming, JIANG Zhi-qin, LAI Dai-dai

2017, 15(2): 338-342. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.047

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With the development of cloud technology,cloud computing,Internet of things and big data,every kind of cloud hospitals and online hospitals spring up,to meet the demand of the masses as a breakthrough and integrate regional health resources,causing a big shock to traditional hospitals in all aspects.This paper focus on the basis of knowing operations of current cloud hospitals in Ningbo,makes a systematic analysis of the advantages and disadvantages in the interior cloud hospitals,plus the opportunities and threats of the exterior conditions,insight into the deep problem of the ownership,the advantages of developing Ningbo cloud hospital include amplifying medical resources,reducing Health care costs,optimizing medical procedures,advancing tiered medical treatment,improving grass-roots level,promoting self-management,and perfecting doctor-patient relationship;the disadvantages include that health insurance payments have not yet been realized,the medical information is only partly shared,there is no legislation on online practice,pharmaceutical machinery management is not standardized,and health check Results cannot be mutually recognized;Opportunities refer to the government's support in policy,changes in aging and disease history,the foundation of medical and health information,the rapid development of Internet technology,people's increasing attention to health.Threats consist of the influence of traditional ideas,the lack of government supervision,the competition in the medical market,the risk of revealing data,the adjustment of revenue pattern.The SWOT analysis model shows how to maintain sustainable development of the very first cloud hospital.These instructions include sticking to demands in order to deepen the service function of cloud hospital,perfecting policy security to standardize this industry,rebuilding medical ecology to form a team of cloud hospitals with shared profits,strengthening supervision of this industry to promote the brand construction of cloud hospital.

Application of ABC analysis management model in operating room nursing management

LEI E, GUO Ying, GUI Heng, WANG Jun-jie

2017, 15(2): 343-345. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.048

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Objective To investigate the application values of ABC analysis management model in the operating room nursing management. Methods From September,2012 to September,2013,884 patients in our hospital were divided into treatment group (444 cases) and control group (440 cases) accorded to a random number table.The control group received the traditional nursing management,while the observation group was given the ABC analysis management model. Results The qualified rate of basic nursing and nursing documents in the observation group were 99.8% and 99.5%,which were higher than 92.6% and 92.1% in the control group.The nosocomial infection incidence in the observation group was 0.7% which was lower than that (7.2%) in the control group,the differences between the two groups were statistically significant (P<0.05).The discharge survey showed that the patients satisfaction (score) with professional and technical (98.45±4.08),nursing process (98.87±3.13) nursing cognition (95.34±3.98) scores were higher than those (90.34±3.78,88.93±4.10,85.03±3.34) in the control group,the differences between the two groups were statistically significant (P<0.05);The score for ward environment was 95.34±3.12 in the observation group and 94.09±4.00 in the control group,the difference was not statistically significant (P>0.05).Three month follow-up showed that the score for physiological (18.18±4.00),psychology (22.57±3.18),social (19.30±3.10) and environment (12.88±2.45) in the observation group were higher than those (16.88±4.04,17.88±3.20,16.00±2.99,10.85±2.36) in the control group,and the differences between the two groups were statistically significant (P<0.05). Conclusion ABC analysis in the operating room nursing management can effectively improve the quality of care and patients'satisfaction,thus improve the quality of life of patients.

The applying of positive reinforcement theory of nursing in the cervical spine orthopedic rehabilitation patients

ZHAO Nan, XU Rui-feng, JIANG Yu, ZHAO Yan-bin

2017, 15(2): 346-348. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.049

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Objective To investigate the applying values of positive reinforcement theory of nursing in the cervical spine orthopedic rehabilitation patients to provide reference for the popularization and application of positive reinforcement theory. Methods A total of 1 500 postoperative cervical spondylosis rehabilitation patients registered in our hospital from August,2013 to July,2015 were selected and randomly divided into the observation group and control group,with 750 cases in each group.The control group received conventional intervention,while the observation group was added the positive reinforcement theory of nursing.The rehabilitation observation periods were two weeks,and the prognosis of recovery was observed. Results The pain scores of the two groups after rehabilitation were (1.22±0.34) points and (2.86±0.45) points (P<0.05) which were significantly lower than the (6.89±0.26) points and (6.91±0.45) points before rehabilitation;the activities of daily living scores in the observation group and control group after rehabilitation were (69.44±9.13) points and (62.42±9.14) points (P<0.05) that were significantly higher than before rehabilitation of (57.24±8.44) points and (57.94±9.41) points.Meanwhile,the comparison between two groups were all statistically significant (P<0.05).The total effective rates in the observation group and the control group after rehabilitation were 97.3% and 84.0% respectively that the observation group were significantly were higher (P<0.05). Conclusion Positive reinforcement theory of rehabilitation care in the patient's cervical spine orthopedic applications can effectively relieve the patient's pain and improve daily living skills,promote the improvement of the cervical range of motion,and thus help to improve the overall efficacy.

Effect of comprehensive nursing intervention on emergency treatment of severe trauma patients in emergency department

XIE Jian-mei

2017, 15(2): 349-351. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.050

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Objective To analyze the clinical effect of comprehensive nursing intervention in the rescue of patients with severe trauma,refine the comprehensive nursing intervention methodology and improve nursing quality,thus to provide evidence in future emergency rescue work. Methods A total of 220 newly admitted severe trauma patients in our hospital between April,2014 to August,2015 was divided into the control group and the observation group according to the time of admission,110 patients in each group.Altogether 110 patients with severe trauma treated from April,2014 to December,2014 were treated as control group,which got routine emergency care;another 110 patients with severe trauma treated from January,2015 to August,2015 were treated as observation group,which got comprehensive nursing intervention.With SPSS 17.0 software,we analyzed and compared the rescue reaction time,the rescue treatment outcome and adverse events in the transshipment en route between the two groups. Results After different nursing intervention,observation group patients presenting to the emergency department with retention time,special inspection time,to the emergency operation time and admission to operation time,respectively (6.86±2.08) min,(13.07±2.81) min,(7.01±1.57) min and (27.69±6.05) min,which were significantly shorter than that of the control group,and the difference was significant (P<0.01).The rate of successful rescuing achieved 90% in the observation group,higher than that of the control group (63.64%),and disability rate,mortality and complication rates were significantly lower than those in the control group,with a significant difference (P<0.05).The adverse events in the transshipment en route of the observation group was 3.64%,which was significantly less than that of the control group 9.09%,and the difference was statistically significant (P<0.05). Conclusion Comprehensive nursing intervention can significantly shorten the rescue reaction time,improve the rescue treatment outcome,and reduce adverse events in the transshipment en route,thus it is worthy of clinical promotion.

The application of quality control circle and deming circle in nursing quality management

YIN Guo-hua, TAO Ying-ge, CHEN Lei

2017, 15(2): 352-354. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.051

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Objective To study the application of quality control circle and deming circle application in nursing quality management. Methods QCC activity was studied in eight pilot departments form July,2013 in the second affiliated hospital of Mudanjiang Medical College.The PDCA cycle was used in clinical nursing quality management and achieved a good result.All nursing unit carried out QCC activity from December,2015.This study randomly selected hospitalized 600 patients as control group during 1-6 month in,2013 randomly selected hospitalized 600 patients as observation group from during 7-12 months after hospital treatment,and compared two groups of patient care quality management effect. Results Forty-five nursing unit has established 68 QCC groups.The complete target set was 65,and reaching standard was 95.59%,the number of standardized work processes and rules was 51,and formed a long-term quality of care management mechanism.After QCC activity,the hospital health education in nursing documents writing,ward management,awareness,technical operation level were significantly higher than the activities before QCC activity;the rate of nursing mistakes and accidents decrease 2.33% to 0.83%;the rate of patient satisfaction increase 95.33% to 97.83%,U=3.226,P<0.05.The differences of implement QCC activity of two groups in patients before and after the nursing quality management effect were statistically significant (P<0.05). Conclusion The effect of qc circle and deming circle joint application in nursing was beneficial to enhance nurses consciousness of management,promote the initiative of nurses work and creativity,improve the comprehensive quality of nurses,and gradually improve the quality management system,create a new situation of the nursing quality management,it is worth to promote the use in the clinical nursing work.

The effect of the application of risk aversion model on the incidence of injury and the degree of satisfaction of nursing staff in emergency department

FENG Lin-fang, XU Fen

2017, 15(2): 355-357. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.052

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Objective To study the application of the risk aversion model in emergency department staff,and to observe the situation of nursing staff's injury rate and nursing satisfaction after the application of the model. Methods Sixty-two cases in our hospital emergency department nursing staff were selected from December,2013 to December,2015 as the research object.There were 4 males and 58 females,which aged between 23 and 47 years old and whose average age is (30.1±12.6) years old,with one to 25 service years and (10.3±8.7) average working years.With the application of risk aversion model to the high-risk groups,we investigate 62 cases of emergency department nurses suffered damage details (including extent of injury and frequency of clinic visits),occurrence rate and patient satisfaction with nursing personnel service. Results Comparison of high-risk groups one month before and after the application of risk aversion model shows that before the application of injuries in a damage,secondary injury and hurtful words were higher than those after the application (P<0.05),suggesting that high-risk aversion model for emergency department injury event number of dodge.Relatively high-risk groups to avoid mode before and after the application of emergency department visits and injury occurrence,and calculate the damage rate,use of high risk population aversion mode after damage rate dropped to 9.9%,below the high-risk groups to avoid application mode before damage rate of 26.7%(P<0.05),suggesting that high-risk population evading model for emergency department can help avoid injury event numbers.Before and after the application of the model,the satisfaction rate of emergency patients to nursing staff was 72.6%,far higher than the rate before the application of risk aversion model 54.8%(P<0.05). Conclusion The application of risk aversion model in emergency nursing staff can effectively reduce the incidence of injury,and effectively increase the satisfaction of patients to nursing service,which is worthy of clinical application.

2017, 15(2): 358-360. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.053

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2017, 15(2): 360-362. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.054

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2017, 15(2): 362-364. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.055

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2017 Vol. 15, No. 2

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