中华全科医学

Enlightenment and references of NHS Clinical Commissioning Groups medical reform

QUAN Shi-chao, JU Shu-jing, CHEN Su-xiu, ZHAO Xi-hua, PAN Jing-ye, HUANG Yue-yue

2017, 15(3): 365-368. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.001

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Objective To discuss the concerned and controversial medical reform by National Health Service (NHS) Clinical Commissioning Group (CCG) in UK,explore the background and reasons of the reform,and evaluate the reference point for the medical reform in China. Methods Through what I saw and investigate in UK,literature search and other information on WEB of British government and healthcare sites,We gain some insight into National Health Service in UK,understand its operation mode and advantages,study the evolution and the present progress of UK medical reform,and the specific measures on reform by CCG. Results Strategic Health Authority and Primary Care Trust were replaced by NHS Executive Committee and 211 CCG which leaded by GP,80% budget of NHS was taken over by CCG.CCG would purchase service from secondary care and determine the flow of funds from the bottom up.But the reform did not go well with frequent controversy.The courses of medical reform getting a bloody nose might be misconduct in guideline on the range and degree of autonomy enjoyed by the patients,the introduce of private medical institutions affecting the quality of medical service,and the doubt on long established doctor-patient relationships may be damaged. Conclusion CCG reform can improve the operation efficiency of the health care system,but it cannot be transplanted completely in China medical reform because the grading diagnosis and treatment system and patients ordered distribution has not been completed.Chinese health care reform need to balance the public interest with the market,both needs planned economy and market economy.

2017, 15(3): 369-370.

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Observation on the Clinical Analgesic efficacy of parecoxib sodium and lidocaine in the perioperative period of Lumbar Open Surgery

DANG Pei-ye, YANG Zhi-quan, WANG Yan-dong, XING Yong-jun, LIU Zeng-liang, MA Qiong, HAN Kang, LI Yao-zhang

2017, 15(3): 371-374. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.002

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Objective Basing on the concept of multimodal analgesia and preemptive analgesia,we evaluated the effect of parecoxib sodium preemptive analgesia and lidocaine combined with patient-controlled intravenous analgesia (PCIA) on postoperative pain,analgesic use,function recovery,inflammatory and stress response and perioperative safety after TKA and THA. Methods One hundred and thirty-six patients who were admitted and had the open operation in our hospital from January,2015 to January,2016 were randomly divided into 2 groups.The study group received a single 40 mg dose of parecoxib sodium 30 minutes before incision,the night on the operation day and 24 hours after the operation along with PCIA morphine,who has the injection of lidocaine on the subcutaneous tissue of incision before the end of the operation.The control group received only saline and PCIA morphine for postoperative pain management.Clinical outcomes were evaluated by visual analogue scale (VAS)(3,12,24,48 h after the operation) and the index like body temperature,leukocyte count,hypersensitive C reactive protein (hs-CRP),and blood glucose. Results VAS were improved significantly in the study group compared with the control group at all the observation points in the 48 h after surgery (P<0.05).The body temperature,leukocyte,hs-CRP and the blood glucose were also significantly decreased in the study group.There was no difference between the two groups in the incision healing rate,volume of drainage,blood transfusion rate and complications. Conclusion The multimodal analgesia regime combining parecoxib sodium,lidocaine and PCIA significantly can improve postoperative VAS,reduce morphine consumption and decrease inflammatory response without increasing the risks of bleeding and other adverse events,which should be further application and promotion in clinic.

Changes and clinical significance of HMGB1 and neutrophil elastase in elderly patients with COPD

WANG Qiang, TANG Xiao-fang, WANG Yin, SUN Ai-hua

2017, 15(3): 375-377. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.003

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Objective To investigate the dynamic changes and clinical significance of high mobility group box 1(HMGB1) and neutrophil elastase (NE) in the elderly patients with both acute stage COPD and stable COPD. Methods Fifty-six elderly patients with both acute stage COPD and stable COPD were investigated as the study group,while thirty-five elderly healthy people were investigated as the control group.The expression of serum HMGB1 and NE were measured by ELISA in the three groups. Results ①The level of HMGB1 in three groups were (12.86±3.81) ng/ml,(6.37±1.86) ng/ml,(4.13±0.87) ng/ml,and the level of NE in three groups were (5.67±0.87) nmol/L,(2.71±0.72) nmol/L,(0.86±0.12) nmol/L.②The level of HMGB1 and NE in the elderly patients with acute stage COPD was significantly higher than the elderly patients with stable COPD and the control group,which had statistical significance (P<0.05).③The level of HMGB1 and NE in the elderly patients with stable COPD were higher than that in the control group,with statistical significance (P<0.05).④The level of HMGB1 and NE was in significantly positive correlation (r=0.918,P<0.05).The level of HMGB1 was inversely related to pulmonary function index (r=-0.923,-0.929,P<0.05).The level of NE was inversely related to pulmonary function index (r=-0.927,-0.912,P<0.05). Conclusion Inflammatory mechanisms played an important role in the pathogenesis of the COPD.Detecting the change of HMGB1 and NE in elderly COPD patients played very important basis on the clinical diagnose and the pathogenic mechanism.

Dose-response relationship of ropivacaine for brachial plexus block in frozen shoulder guided by ultrasound

FEI Yong, DENG Jia-jia, XU Ming-min, NI Hua-dong, ZHANG Li, XIE Ke-yue, GUO Jian-guo, HUANG Bing, YAO Ming

2017, 15(3): 378-380. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.004

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Objective To determine the dose-response relationship of ropivacaine for brachial plexus block in frozen shoulder guided by ultrasound. Methods One hundred frozen patients,aged 43-71 years,duration of 2 months-5 years,undergoing shoulder lysis under brachial plexus block guided by ultrasound,were randomly divided into 5 groups (n=20 each) using a random number table:group R₁-R₅.Interscalene brachial plexus root positions were determined guided by ultrasound,mixing liquid 0.10%(group R₁),0.15%(group R₂),0.20%(group R₃),0.25%(group R₄),0.30%(group R₅),mecobalamin injection 0.5 mg,betamethasone 1 ml and 0.9% saline total 10 ml were injected into the brachial plexus around.The onset time of anesthesia,pain disappeared time,duration of analgesia,incidence of adverse reactions,before and after treatment pulse oximetry were recorded,and the treatment were evaluated.The response to ropivacaine for brachial plexus block was defined as positive when pain disappeared time was more than 10 min.The ED₅₀,ED₉₅ and 95% confidence interval (CI) of ropivacaine for brachial plexus block guided by ultrasound were calculated by probit analysis. Results The onset time of anesthesia and pain disappeared time shortened,duration of analgesia prolonged,following ropivacaine concentration gradient increasing,the difference was statistically significant (P<0.05).The effective rate (cure and improvement) of the treatment was 100%,no significant adverse reactions occurred.The ED₅₀ and ED₉₅(95%CI) of ropivacaine for brachial plexus block guided by ultrasound were 0.167%(0.153%-0.180%) and 0.217%(0.199%-0.251%),respectively. Conclusion Ropivacaine for brachial plexus block guided by ultrasound is effective for frozen shoulder,with no significant adverse reactions.The ED₅₀ and ED₉₅ of ropivacaine for brachial plexus block in frozen shoulder guided by ultrasound were 0.167% and 0.217%,respectively.

Influence of target controlled infusion of etomidate and sufentanil on hemodynamic stability during general anesthesia induction and endotracheal intubation in elderly patients

XIA Feng-na, DU Wei, DU Ping-jun, WANG Hong, ZHANG Xiao-ran, WANG Yue-lan, TANG Nan

2017, 15(3): 381-383,490. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.005

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Objective To study the effect of balanced anesthesia with different concentration of chamber etomidate and sufentanil (target controlled infusion,TCI) on hemodynamic stability during general anesthesia induction and endotracheal intubation in elderly patients. Methods Fifty two patients undergoing elective surgery and general anesthesia were enrolled and randomly divided into three groups according to the different target concentration of etomidate:low concentration group (target concentration 0.40 μg/L,17 cases),moderate concentration group (0.50 μg/L,17 cases) and high concentration group (0.60 μg/L,18 cases).The mean arterial pressure (MAP),heart rate (HR),bispectral index (BIS),cardiac output (CO),cardiac index (CI) and stroke volume (SV) were determined at T0(prior to the induction of general anesthesia),T1(chamber and plasma etomidate concentration balanced),T2(chamber and plasma sufentanil concentration balanced),T3(during endotracheal intubation),T4(1 min after intubation),T5(2 min after intubation) and T6(3 min after intubation) time points.The total amount of etomidate and sufentanil were recorded.The data were compared among different groups. Results ①HR decreased while CO and SV increased in the high concentration group at each time points when compared with the data at T0,P<0.05;At T2 point,HR,CO and CI were all decreased in the three groups (P<0.05);At T3 and T4 point,CO,CI and SV were all increased (P<0.05),the value of MAP,HR,CO,CI and SV in all three were higher than those at T2 point (P<0.05);At T5 point,MAP decreased in all three groups (P<0.05),HR,CO,CI and SV decreased only in the medium and high concentration groups (P<0.05);At T6 point,MAP decreased in all three groups (P<0.05),CO,CI and SV decreased only in the high concentration groups (P<0.05);②There was no significant in the average total dose of sufentanil during induction among the three groups (P>0.05),but significant for etomidate. Conclusion The target controlled infusion of 0.50 μg/L of etomidate and 0.4 μg/L of sufentanil will minimize the affection on hemodynamic stability during general anesthesia induction and endotracheal intubation in elderly patients.

Effects of Shen Fu Injection on serum levels of NSE and S-100B protein and prognosis in patients with cardiac arrest after cerebral resuscitation

FEI Min, ZHANG Mei-qi, ZHENG Yue-liang, TU Jian-feng, XU Qiu-ran

2017, 15(3): 384-386,400. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.006

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Objective To investigate the effect of Shen Fu Injection in the treatment of cardiac arrest (cardiac arrest,CA) in patients with cerebral resuscitation after serum neuron specific enolase (NSE) and S-100B protein,and evaluate its effect on prognosis. Methods One hundred and six cases of patients with spontaneous circulation recovery after cardiac arrest in our hospital were divided into two groups,53 cases in each group.The control group was used conventional cerebral resuscitation,maintain low body heat.On the basis of the control group,the treatment group was treated with Shen Fu injection.0.5,2,12 and 24 hours after cardiopulmonary resuscitation,the serum levels of NSE and S-100B in the two groups were detected by ELISA.12,24,48,72 hours after cardiac arrest,the changes of cerebral oxygen metabolism were detected in two groups of patients.Glasgow Coma Scale (GCS) was used to assess coma status.The recovery rate and mortality rate of the two groups were recorded. Results After cardiopulmonary resuscitation,the levels of NSE and S-100B were significantly increased in the two groups (P<0.05).The levels of NSE and S-100B in the treatment group were significantly lower than those in the control group at 2,12 hours and 24 hours after cardiopulmonary resuscitation.The difference was statistically significant (P<0.05).12,24,48 and 72 hours after cardiac arrest,two patients with arteriovenous oxygen content difference (Ca-jvO₂),cerebral oxygen uptake rate (CERO₂) decreased significantly,jugular bulb oxygen saturation (SjvO₂),GCS score increased significantly (P<0.05).Ca-jvO₂,CERO₂ and GCS scores of the treatment group were significantly higher than those in the control group at 48 hours and 72 hours after cardiac arrest.SjvO₂ was significantly lower than that in the control group.The difference was statistically significant (P<0.05).The effective rate (67.92%) in treatment group was significantly higher than that in control group (45.28%),and mortality (69.81%) was significantly lower than that in control group (88.68%).The difference was statistically significant (χ²=5.530,5.736,P<0.05). Conclusion The serum levels of NSE and S-100B in patients with cardiac arrest after cerebral resuscitation can be decreased significantly by the injection of Shen Fu injection,which is helpful to improve the prognosis of patients.

Role of cone beam CT scan in evaluating of alveolar bone changes in chronic periodontitis patients after periodontal therapy

LIN Li-yao, LIU Kai, TOU Min-zhi, ZHONG Zheng-chao, ZHAO Bin-ya

2017, 15(3): 387-389. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.007

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Objective To study the alveolar bone changes before and after periodontal treatment via measuring the changes in alveolar bone height and density by cone beam CT (CBCT) in patients with chronic periodontitis. Methods We selected 100 cases of chronic periodontitis patients in Lishui city second people's hospital from January,2013 to December,2015 for the study.All patients were given periodontal treatment.The changes in alveolar bone height and density were measured by using CBCT. Results The alveolar bone density of mild periodontitis patients were higher than those of moderate periodontitis and severe periodontitis patients both before and after the treatment (P<0.05).The alveolar bone density all increased after the treatment in mild,moderate,and severe periodontitis patients (P<0.05).Both before and after treatment,the alveolar bone loss of mild periodontitis patients was less than that of moderate periodontitis (P<0.05),and moderate periodontitis less than severe periodontitis (P<0.05).The alveolar bone loss after the treatment in mild periodontitis,moderate periodontitis and severe periodontitis patients were marginally higher than those before the treatment,but the difference was not statistically significant (P>0.05).The anterior alveolar bone density after the treatment was not improved significantly,the difference was not statistically significant (P>0.05).The premolars and molars alveolar bone density after the treatment were improved significantly (P<0.05).The alveolar bone loss of anterior teeth,premolars and molars after the treatment were not improved significantly (P>0.05). Conclusion The periodontal treatment can improve alveolar bone density in patients with chronic periodontitis.CBCT scan can be used to assessing alveolar bone mass before and after the periodontal treatment.

The relationship between the neutrophil-lymphocyte ratio and endoscopic activity in ulcerative colitis

CAO Ming-wei, WU Dan-dan, JI Meng-yao, MA Jing-jing, DONG Wei-guo

2017, 15(3): 390-392,536. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.008

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Objective To evaluate the relationship of neutrophil-lymphocyte ratio (NLR) and Mayo endoscopic score in ulcerative colitis (UC). Methods Ninety-eight patients with UC and 59 patients with irritable bowel syndrome (IBS) were compared for the differences of NLR between the two groups and in different stages of UC.The ROC curve was used to evaluate the optimal cutoff value of NLR and the area under curve (AUC).Furthermore,we compared the diagnostic efficiency of NLR and C-reactive protein (CRP) in predicting endoscopic activity in UC. Results The NLR value in UC group was significantly higher than that in IBS (2.689 vs.1.865,P<0.001),and the active stage is higher than the healing stage (3.375 vs.1.867,P<0.001).The optimal cutoff value of NLR is 2.473 with 71.0% sensitivity and 75.9% specificity along with a 0.84 AUC.When Mayo ≥ 2,there are 81% patients whose NLR>2.473 while 67% of CRP is positive (P>0.05). Conclusion The difference of NLR value in active and healing stage of UC has statistical significance,positively correlated with CRP.NLR works better than CRP in predicting endoscopic activity in UC.NLR can serve as an objective,convenient,economic indicators to monitor endoscopic activity as well as one of key indexes in colonoscopy screening.

The clinical study of the electroacupuncture for treatment of amnestic mild cognitive impairment

XU Jian-guo, PENG Cong-bin

2017, 15(3): 393-396. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.009

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Objective To observe the curative effect of electric acupuncture treatment on aMCI patients and to explore its possible mechanisms. Methods Sixty patients got randomly assigned to treatment group or control group,and each group contained 30 cases.The patients in treatment group received electric acupuncture treatment,and the patients in control group were treated with oral nimodipine.The total score of MOCA,MMSE,CDT and ERP check were used to assess the patient's cognitive function before and after treatment with the level of high sensitivity C-reactive protein (hs-CRP) and interleukin-6(IL-6) in serum were checked.Meanwhile,the DTI and rs-fMRI were applied to measure FA value and ADC value on patients'ROI. Results The total score of MOCA,MMSE and CDT significantly increased after treatment (P<0.05).ERP demonstrated that the cognitive function in patients of two groups were improved and the level of hs-CRP and IL-6in serum decreased significantly (P<0.05).DTI indicated that FA value rose after the treatment. Conclusion Electric acupuncture treatment can significantly improve the cognitive function on aMCI patients and the mechanism may be associated with lower serum IL-6.

Effects of autophagy on myocardial injury induced by limb ischemia reperfusion in ischemic preconditioning in rats

FAN Li-hua, CHEN De-yuan, WU Yi-ni, YU Xiao-yan, LI Dong-li

2017, 15(3): 397-400. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.010

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Objective To investigate the role of autophagy in the reduction of myocardial injury induced by ischemia and reperfusion in rats. Methods Twenty-eight SD male rats (8 weeks old,weight 200-250 g) were divided into 4 groups using random number table method (n_i=7):sham operation group (group S),limb ischemia reperfusion group (group IR) limb ischemia reperfusion preconditioning group (group IPR),Autophagy inhibitor treatment group (group 3-MA).A limb ischemia reperfusion model was established by using the method of reperfusion 4 h after clamping bilateral femoral artery ischemia 4 hours.A limb ischemia reperfusion model was implementing Ischemia for 5 minutes and reperfusion for 5 minutes,after 3 cycles remaining,before closing femoral artery clamp 30 minutes.Group 3-MA was given intraperitoneal injection of 10% 3-MA 1.5 ml/kg before ischemic preconditioning 30 minutes.After reperfusion 4 h,rats were killed and took the apical tissue,observed the formation and pathological changes of the cell bodies under electron microscope,detected apoptosis by HE staining and TUNEL assay,measured the expression of LC3 by western blot. Results Compared with group S,the proportion of myocardial cell apoptosis was significantly increased,the expression of LC3-Ⅱ/LC3-Ⅰ was up regulation on group IR,group IPR and group 3-MA (P<0.05). Conclusion with the group IR,the proportion of myocardial cell apoptosis was significantly reduced,the expression of LC3-Ⅱ/LC3-Ⅰ was down regulation on group IPR (P<0.05).Compared with the group IPR,the proportion of myocardial cell apoptosis was significantly increased,the expression of LC3-Ⅱ/LC3-Ⅰ was down regulation on group 3-MA (P<0.05).

Application of vacuum sealing drainage in sequential treatment of trauma

ZHANG Rui, WEN Ke, YANG Yan-qiu, CHEN Wen-hai, FU Kang, ZHANG Rui-fang, LIU Yue-ming, LIU Wei-hua, LIU Yi-lun

2017, 15(3): 401-403,445. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.011

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Objective To investigate the application of vacuum sealing drainage in sequential treatment of trauma,and discuss the influence of vacuum sealing drainage (VSD) on blood pressure,hematology indexes,provide the basis of the clinical application. Methods Total 35 cases of skin and soft tissue defect resulted by trauma that were unsuitable of one-stage surgical operation in our hospital between 2009 and 2015 underwent a sequential treatment with simple debridement-vacuum sealing drainage (VSD)-phase Ⅱ operation.The duration of VSD was adjusted according to the wound condition,and dressings were changed every 3 to 7 d in according with wound healing progress.And the phase Ⅱ operation,skin or the skin flap transplantation,were designed also according to the wound condition.At the same time,hematology indexes and blood pressure were monitored. Results After the treatment of VSD,all wounds gradually formed fresh granulation tissue,without purulent exudate,and the wound area reduced apparently.All the patients were cured post-sequential treatment.Among them,29 patients were cured after once operation,and 6 cases were cured after twice operation.Hemoglobin of one patient with VSD area of 10% decreased from 117 g/L to 61 g/L after simple debridement and Vacuum Sealing Drainage,however,the levels of hemoglobin recovered and the wound was healed after the symptomatic treatment,VSD for 2 weeks and dermepenthesis. Conclusion Sequential treatment of simple debridement-Vacuum Sealing Drainage-phase Ⅱ operation could obviously promote wound granulation tissue growth,effectively control the wound infection,provide a good blood supply,improve the success rate of the skin or skin flap graft,was beneficial for the treatment of wounds unsuitable of one-stage surgical operation.Patients whose vacuum sealing drainage area arrived 10%,the first time debridement may affect hematology indexes,at a controllable scope.

The value of the application of tigecycline in the treatment of severe hospital acquired pneumonia caused by multiple or pan drug resistant Acinetobacter baumannii

XIA Pin-jiang, ZHANG Ge

2017, 15(3): 404-406. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.012

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Objective To explore the value of the application of tigecycline in the treatment of severe hospital acquired pneumonia caused by multiple or pan drug resistant Acinetobacter baumannii. Methods Sixty-four cases of severe hospital acquired pneumonia caused by multiple or pan drug resistant Acinetobacter baumannii were divided into two groups,32 cases in each group.The control group was used Cefoperazone/sulbactam in the treatment.Observation group was added tigecycline in the control group on the basis of the treatment.Compared with the two groups of clinical treatment effect,bacterial clearance,adverse reaction,disease and inflammatory index changes. Results The total effective rate of the observation group was significantly higher than that of the control group There was a significant difference (Z=2.099,P<0.05).The bacterial clearance rate (71.87%) and weaning success rate (62.50%) in the observation group were significantly higher than those in the control group (43.75% and 34.37%),and the hospitalization time of ICU was significantly lower than that of the control group.The difference was statistically significant (χ²=5.189,5.067,t=4.467,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Ⅱ APACHE score,PCT,CRP were significantly decreased (P<0.05) after treatment in the two groups.After treatment APACHEⅡ score,PCT,CRP levels in the observation group were significantly lower than those in the control group after treatment.The difference was statistically significant (t=5.079,8.156,8.633,P<0.05). Conclusion The curative effect of the treatment of severe hospital acquired pneumonia caused by multiple or pan drug resistant Acinetobacter baumannii is significant,and the bacterial clearance rate is high.

Study on the effect of aloe extract on blood pressure in treating NG-Nitro-L-arginine hypertension rats

HE Yi-hong, HU Zhan-hao, FU Yu, GAO Xiao-mei, HE Shi-ze, FU Mi-ye, GUO Ying-nan, JI Li-min

2017, 15(3): 407-410,474. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.013

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Objective To study the basis of Aloe extract in treating hypertension in animal experiments. Methods Hypertensive rats were given NG-Nitro-L-arginine (L-NNA) for 4 weeks to produce hypertensive model.Fifty hypertension rats were randomly divided into five groups:model group,the high,middle,low dosage group of the Aloe extract[300,150,75 mg/(kg·d)]and Enalapril Maleate tablets group[20 mg/(kg·d)],with 10 rats in each group.additional 10 rats were chosen as control group.Given rats corresponding intragastric administration daily,while the the control group and model group with distilled water.Non-invasive blood pressure measurement was used to detect SAP,DAP,MAP and heart rate once a week for 4 weeks.After four weeks of treatment,blood was collected from the rat abdominal aorta for determination of serum nitric oxide NO and superoxide dismutase SOD activity and level of Endothelin.At the same time,heart tissue was embedded in 10% neutral buffered formaldehyde fixation,paraffin and sectioned,and then to observe the histopathological changes after HE staining. Results After four weeks of treatment,the high,middle and low dosage group of the Aloe extract and Enalapril Maleate tablets group significantly lowered the SAP (t=4.648,P<0.01),DAP (t=6.469,P<0.01),MAP (t=8.731,P<0.01) and heart rate of rats compared to the model group (t=4.390,P<0.01).Meanwhile,the Aloe extract and Enalapril Maleate tablets can significantly increase NO (t=6.183,P<0.01) and SOD (t=8.502,P<0.01) content,markedly decrease the content of ET (t=5.719,P<0.01),but they have no significant difference.The treatment groups decreased heart thickening and kidney weighting,and could moderate damage of heart and kidney. Conclusion Aloe extract could reduce blood pressure in L-NNA induced hypertensive rats,and the results suggested that the antihypertensive mechanism may reduce blood pressure by improving NO availability and decreasing the content of ET.

Experiment research in the regulation of Maspin gene promoter methylation targeted by short hairpin RNAs on HN13 cells migration and invasion ability

LUO Jun, YING Yu-kang, WU Wei-li, ZHU Hai-qian

2017, 15(3): 411-414. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.014

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Objective To observe the effect of Maspin gene promoter methylation targeted by short hairpin RNAs on HN13 cells migration and invasion ability. Methods Both specific (sequence 1,sequence 2,sequence 3,sequence 4) and nonspecific (sequence 0) shRNA sequences were designed in view of the Maspin gene promoter region methylation site,which were soon used to conduct recombinant adenovirus and transfected to HN13 cells,using no-load adenovirus as the controls.The transfection rate,cell growth curve and the degree of methylation were observed;At the same time,the mRNA and protein expression level were detected by RT-PCR and WB assay,the HN13 cells migration and invasion ability were detected by Transwell chamber experiment. Results The transfection efficiency of Maspin-shRNA recombinant adenovirus was above 95%.After the transfection,the cell growth rate of sequence 1,2,4 increased,which was obviously different to the controls,and their methylation levels were higher than the controls too (P<0.05).After 7 days'culture,the Maspin mRNA and protein expression level of sequence 0 were both higher than the controls,and the Maspin mRNA and protein expression level of sequence 1,2,4 were both lower than the controls,all the difference had statistical significance (P<0.05).The number of cell migration and invasion of sequence 0 were both lower than the controls,and the number of cell migration and invasion of sequence 1,2,4 were both higher than the controls,all the difference had statistical significance (P<0.05). Conclusion Maspin gene promoter methylation could promote the migration and invasion ability of HN13 cells.

Value of MRI of hands in diagnosis of early rheumatoid arthritis and bone joint injury

WU Ying, XU Sheng-qian, PENG Li-ping, LIU Wen, QI Shan, XU Jian-hua

2017, 15(3): 415-417. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.015

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Objective To explore the value of MRI of both hands in the diagnosis of early RA,bone and joint damage in RA. Methods A total of 111 patients with early RA (disease duration less than 1 year) was recruited.All the clinical and laboratory parameters in all the patients were recorded.BMD of femur and lumbar vertebrae in RA were detected.Radiographs for two hands were evaluated according to the Sharp's method.MRI of hands was executed in early RA patients and MRIS were used to assess changes of MRI in 37 patients. Results ①Results of X-ray examination and MRI of both hands scan showed:according to classification standard of X-ray examination,73.87% with RA was classified as Ⅰ stage and 26.13% as Ⅱ stage,whose sharp scores were all within 10 score.The manifestation of 37 patients with early RA patients on MRI scan for two hands demonstrated bone erosion in 33 cases,synovitis in 31 cases,bone marrow edema in 21 cases and tendinitis in 11 cases.Positive rate of either indicator among above manifestations on MRI was 36 cases.②Results of bivariable correlation analysis showed that tendinitis score was positively correlated with bone marrow edema score (P<0.05) and synovitis score (P<0.05).③Correlation analysis found bone erosion score of MRI scan positively correlated with sharp score (P<0.05) and negatively correlated with BMD at greater trochanter (P<0.05),total hip (P<0.05).Tendinitis score of MRI scan positively correlated with CRP (P<0.05),swollen joint count (P<0.05) and tender joint count (P<0.05). Conclusion The positive rate is higher on MRI scan than that in X-ray examination.MRI scan has good diagnostic value in early RA.Manifestations of MRI scan are correlated with BMD and sharp score,and tendinitis on MRI scan may have a certain diagnostic value.

Effects of sevoflurane combined with propofol intravenous-inhalation anesthesia on SEP and MEP in patients with scoliosis correction surgery

CHEN Yan-chun, WEI Fa-quan, KONG Fei-juan

2017, 15(3): 418-420,527. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.016

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Objective To explore the effects of sevoflurane combined with propofol intravenous-inhalation anesthesia on somatosensory evoked potential (SEP) and motor evoked potential (MEP) in patients with scoliosis correction surgery and compared with the propofol intravenous anesthesia. Methods Total 60 cases of adolescent idiopathic scoliosis with scoliosis correction surgery in our hospital from January,2013 to January,2016 were recruited and randomly divided into group A (propofol intravenous anesthesia) and group B (sevoflurane combined with propofol intravenous-inhalation anesthesia) with 30 cases in each group.The general condition (weight,operative time,bleeding loss volume),hemodynamics parameters (heart rate and arterial pressure at each time point),success rate of SEP and MEP,as well as the time to anesthetic awareness and extubation were recorded.The independent-samples T test was performed for data comparison and analysis by SPSS 19.0. Results There were no statistical difference in the operation time (t=0.15,P=0.87),blood loss (t=0.33,P=0.74),success rate of MEP (t=0.00,P=1.00) and SEP (t=0.00,P=1.00) between the two groups.The time to anesthetic awareness (t=4.47,P=0.00) and extubation (t=3.60,P=0.00) in group B were shorter than those in the group A. Conclusion The patients undergoing sevoflurane combined with propofol intravenous-inhalation anesthesia during scoliosis correction surgery may recovery from anesthetic quickly,which is beneficial to the evaluation of the postoperative neurological function.

Differential expression of chromatin-remodeling complex subunit SNF5 in serum and its role in early diagnosis of breast cancers

HUA Ke-jun, HU Xian-jie, ZHOU Mei-qi, ZHANG Xing, CHEN Wen-zhong, WANG Hui, ZHAO Qin-ming

2017, 15(3): 421-423. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.017

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Objective To explore the feasibility of chromatin-remodeling complex subunit SNF5 in the early diagnosis of breast cancer. Methods A total of 196 cases of breast cancer (0 stage 23 cases,Ⅰ stage 46 cases,Ⅱ stage 29 cases,Ⅲ stage 67 cases,Ⅳ stage 31cases,average age of 36.3) confirmed by pathological examination in Yinzhou people's Hospital Affiliated to Ningbo University from August,2010 to August,2015 were selected as study subject,and 64 cases of volunteer with health examination (average age of 37.9) in the same period were selected as control group.The peripheral blood serum SNF5 levels of two groups were detected with real-time quantitative PCR.The SNF5 levels of two groups were statistical analyzed by statistical software,and the diagnosis of SNF5 in breast cancer was analyzed by ROC curve to explore the feasibility of SNF5 in the early diagnosis of breast cancer by chromosome remodeling. Results The peripheral blood serum level of SNF5 in breast cancer patients were significantly higher than that in the control group (P<0.05),and the SNF5 level of five stage breast cancer patients were 13,15,15,16 and 23 times higher than that of control group,respectively (P<0.05).ROC curve results showed that sensitivity and specificity of SNF5 in diagnosis of in breast cancer were 82% and 93%,the area under the curve was 0.8734(95% confidence interval:0.923-0.944). Conclusion The high expression of SNF5 was commonly in breast cancer,and could be used as the biomarkers for early diagnosis of breast cancer with high sensitivity and specificity.

Expression and clinical significances of microRNA-371-5p in serum of patients with colorectal cancer

ZHAO Jian-pei, XIE Yang-yang, XU Yi-dong, DAI Xiao-yu, ZHOU Hai-ping, WU Zhou

2017, 15(3): 424-426. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.018

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Objective To investigate the expression difference and clinical significances of microRNA-371-5p in serum of patients with colorectal cancer. Methods The expression levels of microRNA-371-5p in the plasma of 50 colorectal cancer patients and 40 healthy controls were detected by qRT-PCR,and its correlation with clinical pathological parameters was analyzed.Receiver operating characteristic curve (ROC) analysis and the area under curve (AUC) was performed to estimate the diagnostic value of tumor markers. Results The expression level of microRNA-371-5p in colorectal cancer plasma (3.03±0.55) was significantly lower than that in the in serum of healthy people (3.98±0.47),t=-4.93,P<0.05.The expression level of microRNA-371-5p in colorectal cancer plasma was well correlated with the TNM stages and the metastasis of lymph node (P<0.05),but not with the age,gender and CEA level (P>0.05).AUC was 0.894,the specificity was 87%,and the sensitivity was 86%. Conclusion The microRNA-371-5p presents a low expression in the patients with colorectal cancer,so it might be involved in initiation and progression of colorectal cancer,thus it might be one of biomarkers of colorectal cancer.

Curative effect of lipo prostaglandin E1 combined with cilostazol on senile arteriosclerosis obliterans of the lower limbs

MOU Cai-guo, CAI Yang-yang, WANG Yi-ping, SHEN Jie

2017, 15(3): 427-430. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.019

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Objective To investigate the curative effect of Lipo prostaglandin E1(Lipo-PGE1) combined with cilostazol on senile arteriosclerosis obliterans of the lower limbs. Methods The 160 cases of elderly patients with arteriosclerosis obliterans of the lower limbs were divided into Lipo-PGE1 group (n=53),cilostazol group (n=52),combined group (n=55) according to the random number table.After 2 courses of treatment,the clinical efficacy,hemodynamic changes,and the improvement of nailfold microcirculation,ankle brachial index (ABI) and inflammatory factors were compared among the three groups. Results Curative effect and The total effective rate of the combined group,which was better than both of cilostazol group and Lipo-PGE1 group (P<0.05),the difference between cilostazol group and Lipo-PGE1 group was not statistically significant (P>0.05);After the treatment,the peak systolic velocity,blood flow pulsation index and resistance index in dorsalis pedis artery was lower than those of cilostazol group and Lipo-PGE1 group (P<0.05),those of Lipo-PGE1 group were lower than those in the cilostazol group (P<0.05);Nailfold microcirculation integral and ABI of the combination group were better than those of cilostazol group and Lipo-PGE1 group (P<0.05),those of Lipo-PGE1 group were better than those of cilostazol group (P<0.05);The levels of C-reactive protein,TNF-α,IL-6 and ICAM-1 of the combination group were lower than those of cilostazol group and Lipo-PGE1 group (P<0.05),those of Lipo-PGE1 group were lower than those in the cilostazol group (P<0.05). Conclusion Lipo-PGE1 combined with cilostazol can increase cooperatively the curative effect of arteriosclerosis obliterans of the lower limbs in elderly patients,effectively improve the patients'hemodynamic parameters.

Pranoprofen combined Flumetholon for severe dry eye:an analysis of 106 cases

WANG Ling, YU Ji-bing, HAO Jing-fang, YANG Hong

2017, 15(3): 431-433,482. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.020

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Objective To evaluate the clinical efficacy of Pranoprofen combined Flumetholon in treatment of severe dry eye. Methods Two hundred and twelve patients with severe dry eye were randomly divided into two groups by random number method with 106 cases in each group.The control group was administrated with Flumetholon,while the observation group with additional Pranoprofen based on the treatment in the control group.Before and after the treatment,the SPEED score for dry eye symptoms,fluorescein staining (FLS) score,tear film break-up time (BUT),Schirmer test (SchirmerⅠ),levels of inflammatory cytokines indicators[interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor α(TNF-α)]of the two groups were tested,and the efficacy of the two groups were compared. Results After the treatment,SPEED score,FLS scores of both groups were significantly reduced (P<0.05),and the SPEED score,FLS scores of the observation group were significantly lower than those of the control group (P<0.05).After the treatment,BUT and SchirmerⅠof both groups were significantly increased (P<0.05),and those of the observation group were significantly higher than those of the control group (P<0.05).After the treatment,levels of IL-6,IL-10 and TNF-α of the two groups were significantly reduced (P<0.05),and those of the observation group were significantly lower than those of the control group (P<0.05).After the treatment,the total effective rate of the observation group was 90.6%,which was significantly higher than that of the control group (77.4%),P<0.05.After the treatment,the incidence of adverse reactions of the observation group was 5.7%,which was significantly lower than 14.2% in the control group (P<0.05). Conclusion For the severe dry eye patients,Pranoprofen combined Flumetholon can effectively improve the symptoms,enhance tear film stability,and reduce the ocular surface damage,with satisfaction efficacy.

Effect of butylphthalide sequential therapy on neurological function,inflammatory factors,Hcy and NSE levels in patients with acute progressive cerebral infarction

SONG Xiao-ming, ZHENG Zhen-jie, SU Li-jing, YAN Ying-ying

2017, 15(3): 434-436. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.021

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Objective To investigate the effect of butylphthalide sequential therapy on neurological function,inflammatory factors,and Hcy and NSE levels in patients with acute progressive cerebral infarction. Methods A total of 86 patients with acute progressive cerebral infarction in our hospital from January,2014 to June,2016 were enrolled and randomly divided into control group (43 cases) and observation group (43 cases).The patients of the control group received anti-platelet therapy,etc.,while the patients of the observation group received conventional therapy and additional butylphthalide sequential therapy.The treatment time was 4 weeks in both groups.The effect of butylphthalide on neurological function,inflammatory factors,and Hcy and NSE levels were compared before and after treatment between the two groups. Results The NIHSS scores were significantly reduced at 2 and 4 weeks after the treatment in both groups (P<0.05).The NIHSS scores of both groups were significantly reduced at 4 weeks after the treatment than that at 2 weeks after the treatment (P<0.05).The NIHSS scores of the observation group were significantly reduced than that in control group after the treatment (P<0.05);Compared with the levels before the treatment,the serum levels of IL-6 and TNF-α decreased significantly at 4 weeks after the treatment in both groups (P<0.05),and the serum levels of IL-6 and TNF-α of the observation group decreased more significantly than those in the control group (P<0.05).Compared with that before treatment,the serum levels of Hcy and NSE decreased significantly at 4 weeks after the treatment in both groups (P<0.05),and the serum levels of Hcy and NSE of the observation group decreased more significantly than those in the control group (P<0.05). Conclusion The butylphthalide sequential therapy can significantly improve neurological function,restrain inflammation,and reduce the levels of Hcy and NSE in patients with acute progressive cerebral infarction.

Short-term clinical result of bilateral knee replacement surgery for severe osteoporosis

YE Zhan, CHEN Jian-jun, LI Xiang, WANG Min

2017, 15(3): 437-439,486. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.022

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Objective To investigate the short-term clinical result and prognosis of patients with severe osteoporosis after bilateral knee joint replacement. Methods The clinical data of 32 cases of severe osteoporosis undergoing bilateral knee joint replacement in our hospital from January,2011 to December,2014 were analyzed retrospectively.Among the patients,12 cases were male and 20 were female.Mean age was (64.5±6.5) years old.Mean course of disease was 5.8 years.All patients were completed the operation according to the routine procedures of knee arthroplasty.After the operation,the comprehensive rehabilitation measures were performed.The range of motion (ROM),HSS scores,bone density and quality of life of patients before and after the surgery were compared. Results All operations were successful;there were no complications during the operation.After the operation,one case (1 knee) was with peroneal nerve paralysis,one case (2 knees) was with poor range of motion,both those cases recovered after the symptomatic treatment.The knee prosthesis was implanted satisfactorily.All patients were with good rehabilitation through comprehensive rehabilitation intervention.6 month follow-up showed that the quality of life score and HSS score were significantly improved (P<0.05),but bone density and ROM did not (P>0.05).The osteoporosis drugs were well tolerated by patients.At the end of this study,the limb function of patients recovered well,the pain was significantly reduced,and all patients achieved independent walking ability (50-100 m) without using external force.No long-term complications such as prosthesis loosening,fracture,and cardiac and cerebral vascular accident occurred. Conclusion The comprehensive evaluation of the patient's condition before the bilateral knee joint replacement surgery was necessary.The bilateral knee joint replacement for patients with severe osteoporosis can reach a satisfactory short-term clinical result and prognosis.The postoperative individual rehabilitation plan may promote the efficacy of operation,improve the result of rehabilitation.

Clinical value of ECG and cardiac markers detection in the diagnosis and treatment of infantile viral pneumonia

YANG Hui, ZHOU Peng, CHEN Yong-hua

2017, 15(3): 440-442. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.023

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Objective To investigate the clinical value of ECG and cardiac markers detection in the diagnosis and treatment of infantile viral pneumonia. Methods A total of 90 cases of infantile viral pneumonia in our hospital from June,2015 to May,2016 were enrolled and divided into common group[n=43,male 23 cases and female 20 case,average age (2.8±1.3) years]and severe group[n=47,male 25 cases and female 22 case,average age (2.7±1.4) years]according to disease severity,while 40 health individuals[male 20 cases and female 20 case,average age (2.3±1.3) years]during the same period were selected as control group.The treatment course was 7 d in the common and severe group.The ECG and levels of cardiac markers (CK,CK-MB,CTnT) were tested and compared among the three groups before and after the treatment. Results Before the treatment,62.79% of infantile pneumonia patients appeared abnormal electrocardiogram in the common group,and 87.23% in severe group;the levels of CK,CK-MB and CTnT of the common and severe group were significantly higher than those in the control group (P<0.05),and the severe group increased more significantly than those in common group (P<0.05);After the treatment,ECG was improved in most cases,and the levels of CK,CK-MB and CTnT decreased significantly in common and severe group (P<0.05),the levels of CK,CK-MB and CTnT recovered to normal range in the common group (P>0.05),and levels of CK,CK-MB and CTnT of the severe group were significantly higher than those in the common and the control group (P<0.05). Conclusion There were abnormalities in ECG and cardiac markers in patients with infantile pneumonia.ECG and cardiac markers detection mat contribute to the diagnosis and prognosis of infantile pneumonia.

Efficacy evaluation of vacuum sealing drainage combined with open bone grafting for tibial traumatic osteomyelitis

HUANG Yan-yong, YE Jia-kuan, ZHENG Bo, YE Fu-sheng, HONG Jun-yi

2017, 15(3): 443-445. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.024

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Objective To observe the efficacy of vacuum sealing drainage (VSD) combined with open bone grafting for tibial traumatic osteomyelitis (TTO). Methods A total of 96 TTO patients in Xiaoshan hospital from June,2012 to March,2016 was selected,and the patients were randomly divided into observation group and control group,each with 48 cases.The observation group were treated with VSD combined with open bone grafting;while the control group were treated first with infection control and wound repair,and then treated by second-stage bone grafting after 3-6 months.Time of infection control,covering the granulation time,fracture healing time as well as comprehensive efficacy were evaluated and complications were observed and compared between the two groups. Results Time of infection control,covering the granulation time,fracture healing time was (13.2±1.7) g,(32.2±7.4) d and (6.3±1.6) months in observation group,while the control group was (20.7±2.2) d,(48.8±8.1) d and (8.7±2.0) months.Time of infection control,covering the granulation time,fracture healing time was significantly less in observation group than the control group (P<0.05);the efficient rate was 91.7%(44/48) in observation group,while 77.0%(37/48) in the control group.The observation group was significantly higher (P<0.05);complication rate in observation group was 6.3%(3/48),while in the control group was 8.3%(4/48).The difference was not statistically significant (P>0.05). Conclusion VSD combined with open graft on the TTO has significant effect,and can cover significantly granulation time and fracture healing time,worthy of further promotion in clinical practice.

Relationships between liver function changes and peripheral neuropathy in patients with type 2 diabetes

LI Qing, WANG Si-hu, WU Fang-lai, YANG Xiu-feng, ZHANG Zong-lan, ZHANG Jing

2017, 15(3): 446-448. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.025

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Objective To study the changes of liver function of type 2 diabetes patients with diabetic peripheral neuropathy (DPN). Methods The levels of ALT,AST and γ-GT of 100 cases of T2DM with DPN (DPN group),100 cases of T2DM without DPN (non-DPN group),and 200 healthy control subjects (control group) were tested by biochemical test. Results The cases with elevated ALT and γ-GT both in DPN group and non-DPN group were more than that in the control group,and the rate was more higher in the DPN group as compared with non-DPN group.The difference in the cases with elevated AST was not significant among the three groups.The levels of ALT and γ-GT both in DPN and non-DPN group were higher than that in the control group (P<0.05),while the levels of ALT and γ-GT in DPN group was higher than that in the non-DPN group (P<0.05),with a tendency to rise as the disease got worse.The multiple logistic regression showed that the levels of ALT and γ-GT were the risk factors for T2DM combined with DPN. Conclusion The function of liver is closely related with DPN in patients with T2DM.To monitor and control the levels of ALT and γ-GT will be beneficial for the effective intervention and improvement of the outcome of DPN patients.

Clinical effect of immune therapy on 72 cases of cirrhosis complicated with infection

CHEN Yan-qiu

2017, 15(3): 449-451. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.026

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Objective To investigate the clinical effect of immunotherapy on patients with liver cirrhosis complicated with infection,so as to improve its prevention and treatment. Methods Total 72 cases of liver cirrhosis combined infection in our hospital between January,2015 and January,2016 were enrolled and randomly divided into control group (36 cases) and observation group (36 cases).Both group received the routine antibiotic treatment,while the observation group received additional immune agents.The liver function and biochemical markers before and after treatment,and the early control rate of infection and incidence of complications were observed.SPSS 17.0 statistical software was used for data analysis,when P<0.05,the difference was statistically significant. Results After the treatment,the total bilirubin,albumin,alanine aminotransferase,total cholesterol,prothrombin time and other indicators were significantly improved in both groups (P<0.05);there was no significant difference between the two groups (P>0.05).After the treatment,the early infection control rate of the observation group was 83.33%,of the control group was 47.22%,the difference was statistically significant (P<0.05).The incidence of complication of the observation group was 5.56%,of the control group was 19.44%,and the difference was statistically significant (P<0.05).During the follow-up,there was 1 patient died (2.78%) in the observation group and 3 patients died in the control group (8.33%),the difference was statistically significant (P<0.05). Conclusion The combination of immune agents and antibiotics for patients with liver cirrhosis complicated with infection can significantly improve the early infection control rate,decrease the incidence of complications such as double infection,and has high clinical application value.

Effect of Tongxinluo capsule combined atorvastatin on blood lipids and inflammatory factor in patient with coronary heart disease

PAN Jia-xi, ZHANG Min-xue, ZHENG Ju-ke, JIANG Jin-ke, CHEN Shi-zhi, WANG Wei-wei

2017, 15(3): 452-453,478. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.027

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Objective To compare the effect of Tongxinluo capsule combine with atorvastatin and atorvastatin alone on the levels of blood lipids and inflammatory factors in patient with coronary heart disease. Methods One hundred and seventy-two cases of coronary heart disease in our hospital from March,2014 to March,2016 were randomly divided into two groups by random number method with 86 cases in each group.The patients in the control group were given atorvastatin,while the patients in the observation group were added Tongxinluo capsule based on the treatment of the control group.Before and after the treatment,the levels of blood lipids (TG,TC,LDL-C and HDL-C) and inflammatory factors (IL-4,IL-10,and IL-18) of the two groups were tested,and the efficacy and adverse reaction were compared between the two groups. Results The total effective rate of the observation group was 74.4%,which was significantly higher than 51.1% of the control group (P<0.05).Before the treatment,the difference in the levels of TG,TC,LDL-C and HDL-C between the two groups were not significantly (P>0.05).After the treatment,the levels of TG,TC,LDL-C and HDL-C of both groups were significantly improved (P<0.05),especially in the observation group (P<0.05).Before the treatment,the difference in the levels of IL-4,IL-10 and IL-18 between the two groups were not significantly (P>0.05).After the treatment,the levels of IL-4,IL-10 and IL-18 of both were significantly improved (P<0.05),and there was also significant difference in the levels of IL-4,IL-10 and IL-18 between the observation group and the control group (P<0.05).There was no serious adverse reaction in both groups. Conclusion Compared with atorvastatin alone,Tongxinluo capsule combined atorvastatin can more effectively improve the levels of blood lipid and inflammatory factor of patient with coronary heart disease,and the efficacy is satisfied.

Effect of high-dose gamma globulin combined aspirin on T lymphocyte subsets,vascular endothelial growth factor,and inflammatory factors of children with Kawasaki disease

QIAN Ying, WANG You-cheng, FANG Xiao-dan, YAO Jing-chan, CHOU Hui-xian

2017, 15(3): 454-456. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.028

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Objective To investigate the effect of high-dose gamma globulin (IVIG) combined aspirin (ASP) on T lymphocyte subsets,vascular endothelial growth factor,and inflammatory factors of children with Kawasaki disease. Methods A total of 36 cases of children with Kawasaki disease patients treated with high-dose IVIG combined ASP were assigned into observation group,and 36 cases of healthy children in the same period into control group.The T lymphocyte subsets[CD4⁺、CD4⁺/CD8⁺、CD8⁺)],vascular endothelial related indicators[vascular endothelial growth factor (VEGF),endostatin (ES),endothelial nitric oxide synthase (eNOS)],and serum inflammatory cytokines[tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein (hs-CRP),interleukin-10(IL-10),serum procalcitonin (PCT)]of both groups were tested and compared.The clinical effect was evaluated and compared. Results After the treatment,CD4⁺ and CD4⁺/CD8⁺ of the observation group were significantly decreased as compared with those before the treatment (P<0.05),CD8⁺ level was significantly increased (P<0.05).After the treatment,VEGF and ES levels of the observation group were significantly decreased as compared to those before the treatment (P<0.05),eNOS level was significantly increased (P<0.05).After the treatment,the levels of TNF-α,hs-CRP,IL-10 and PCT were decreased significantly (P<0.05).After the treatment,the total effective rate was 88.9%. Conclusion High-dose gamma globulin combined aspirin can improve immune function,vascular endothelial growth factor and inflammation factor of children with Kawasaki disease,and slow the progression of disease with a satisfaction effect.

A clinical analysis of gestational trophoblastic disease:report of 155 cases

WU Long-ying, WEI Wen-wen, YAN Shi-jie

2017, 15(3): 457-459. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.029

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Objective To investigate the clinical features,treatment and outcome of the gestational trophoblastic disease (GTD). Methods The clinical date of 155 in-patients with GTD in our hospital between January,2008 and October,2013 were retrospectively analyzed and summarized.There were 99 cases of hydatidiform mole and 56 cases of trophoblastic tumor.35 patients were less than 25 year-old,49 patients were between 25 and 35 years of age,71 patients aged above 35.The cases with first,second,third or more pregnancies were 20,48,55 and 32,respectively. Results The age of patients were 17 to 52 year-old with an average of 31.7,among them,the patients aged above 35 year-old accounted for 45.8%,which was obviously higher than the proportion of the patients aged less than 25 year-old and between 25 and 35 years old.The incidence of GTD in patients with 2,3 and 4 and more pregnancies was significantly higher than that in patients with the first pregnancy (P<0.05).Among 99 cases of hydatidiform mole,51 patients underwent the dilatation and evacuation,32 cases underwent second curettage,8 patients underwent preventive chemotherapy combined with evacuation,and 8 patients underwent preventive chemotherapy combined hysterectomy.Among 56 cases of gestational trophoblastic neoplasia (GTN),9 patients received single-agent of Methotrexate,12 patients received 5-FU,9 cases received multiple-agent of EMA-Co,8 patients received BEP,2 patients received VP+DDP,and 16 patients received 5-FU+KSM.Chemotherapy courses were 3 to 11,averaged 5.47.The incidence of malignant transformation among hydatidiform mole was 12.1%.The cure rate of GTN was 85.7%. Conclusion The age and times of previous pregnancies are related to the occurrence of GTD.Women aged above 35 will be with a higher risk of GTD.The risk for GTD in women with a reproductive experience is higher than that in first-time moms.The hydatidiform moles tend to undergo malignant transformation.The early diagnosis,treatment and closely follow-up should be paid more attentions to the patients with GTD.

Study on the risk factors of poor prognosis of infant purulent meningitis

ZHENG Fei-xia, LIN Zhong-dong, YE Xiu-yun, SHI Xu-lai

2017, 15(3): 460-462. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.030

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Objective To investigate the risk factors of poor prognosis of infant purulent meningitis. Methods Ninety cases of infant with purulent meningitis were selected and divided into the good prognosis group and the poor prognosis group according to the clinical outcome.All patients were followed up for one to four years.In the two groups,early clinical manifestations,laboratory parameters and treatment,etc.were recorded and compared by using univariate and multivariate Logistic regression analysis. Results In the good prognosis group (68 cases) muscle tension change rate,seizures incidence of anterior fontanelle change rate,pupil changes incidence and diminished consciousness incidence of anemia were all significantly higher than those indexes in the good prognosis group (22 cases);In the poor prognosis group white blood cell count abnormal incidence,cerebrospinal fluid culture positive rate,cerebrospinal fluid white blood cell count>1 500×10⁶/L incidence and cerebrospinal fluid protein concentration of>2 000 mg/L the incidence were significantly higher than those indexes in the good prognosis group (all P<0.05);In the poor prognosis group calcitonin original and CRP were significantly higher than those in the good prognosis group (all P<0.05).Multivariate Logistic regression analysis showed that CSF protein concentration>2 000 mg/L,CSF leukocyte count>1 500×10⁶/L,convulsions,and reduced consciousness were all independent prognostic factors for adverse infant purulent meningitis (P<0.05). Conclusion Factors including CSF protein concentration of>2 000 mg/L,CSF leukocyte count>1 500×10⁶/L,convulsions and decreased consciousness are all independent risk factors for adverse infant purulent meningitis poor prognosis.

Clinical effect and influence on T cell subsets of Yinzhihuang oral solution combined Bifico in patients with neonatal jaundice

LUO Jing, LU Hong-ping

2017, 15(3): 463-465. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.031

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Objective To investigate the clinical effect and influence on T cell subsets of Yinzhihuang oral solution combined Bifico in patients with neonatal jaundice. Methods A total of 200 patients with neonatal jaundice in our hospital from February,2016 to July,2016 were randomly divided into control group (100 cases) and observation group (100 cases).The patients of the control group,including 58 male and 42 female,gestational age 36-42 weeks,average gestational age (39.1±1.7) weeks,received conventional treatment (Blue-ray et al.);The patients of the observation group,including 59 male and 41 female,gestational age 36-42 weeks,average gestational age (39.1±1.7) weeks,received conventional treatment and additional Yinzhihuang oral solution combined Bifico.The clinical effect and influence on T cell subsets were compared before and after the treatment between the two groups. Results The total effective rate of the observation group was 95.00%,of the control group was 80.00%,the difference between the two groups was significant (χ²=10.286,P<0.05);The time of phototherapy,jaundice and hospitalization of the observation group was significantly lower than those in the control group (t=7.982,7.698,5.580,P<0.05),and daily average bilirubin decline value was significantly higher than that in the control group (t=7.491,P<0.05);Compared with the levels before the treatment,the levels of CD3⁺,CD4⁺,CD4⁺/CD8⁺ increased significantly at 7 d after the treatment in both groups (observation group:t=7.929,16.561,8.433,control group:t=1.978,6.015,3.409,P<0.05),and the levels of CD3⁺,CD4⁺,CD4⁺/CD8⁺ of the observation group increased more significantly at 7 d after the treatment (t=4.975,9.835,5.085,P<0.05);Incidence of adverse reactions of the observation group was 5%,and of control group was 9%,there was no significant difference between the two groups (χ²=1.229,P>0.05). Conclusion Yinzhihuang oral solution combined with Bifico has obvious clinical effect on neonatal jaundice.It can significantly improve T cell subsets status,and enhance immune function of patients with neonatal jaundice.

2017, 15(3): 466-467,544. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.032

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Effects of TCM insomnia clinic on community management of elderly patients with insomnia

ZHANG Zheng-yu, CHEN Wen-yu, ZHANG Zhao-he, ZHOU Ji-wang, ZHENG Jiu-ling

2017, 15(3): 468-470,511. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.033

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Objective To explore the effects of insomnia clinic of traditional Chinese medicine (TCM) on community management of elderly patients with insomnia. Methods Total 90 elderly patients with insomnia admitted in TCM insomnia clinic of community health service centers of Qingtian TCM Hospital and Hangzhou Xiaohehushu Street from January,2015 to January,2016 were selected as the observation group,while 100 elderly patients with insomnia admitted in normal outpatient of Lishui TCM and Jiaxing First Hospital in the same period were selected as the control group.The control group of the normal outpatient in tertiary hospitals was given regular anti-insomnia treatment,while the observation group of the community TCM insomnia clinic was given comprehensive treatments including TCM,acupuncture,physical therapy and psychological support,etc.,and healthy document was also set for unified management.The clinical curative effects and satisfaction were compared one month later between the two groups. Results The efficiency of sleep improvement was superior in the observation group than that in the control group after the treatment,with statistically significant differences (u=-2.93,P=0.042).SRSS score was 35.11±6.18 in the observation group while 34.93±7.07 in the control group before the treatment,and there were no statistically significant differences (t=2.37,P>0.05);and after the treatment,SRSS score was 17.24±5.01 in the observation group,which was lower than that (23.44±7.52) of control group,and the differences were statistical significance (t=6.91,P<0.05).The observation group had higher satisfaction scores in 6 items including therapeutic effect,treatment experiences,doctors'attitude,diagnosis and treatment technology,schedule,and disease knowledge education than the control group,with statistically significant differences (t:14.73,11.67,7.02,6.39,16.88 and 21.49;P<0.05 or <0.01). Conclusion Setting insomnia clinic of traditional Chinese medicine in community can effectively manage elderly patients with insomnia in community,fully improve the sleep quality of these patients,and improve their satisfaction with treatment.

The influence of the key knowledge guide of hypertension prevention and control provided by the family physician on the signed patients'cognition

XU Xue-fan, ZHANG Yin, LIU Yi

2017, 15(3): 471-474. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.034

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Objective To explore the influence of the key knowledge guide of hypertension prevention and control provided by the family physician on the signed patients'cognition,which includes normal blood pressure values of human body,daily salt intake,the need for taking antihypertensive medication after reaching normal blood pressure level and whether it is advisable to prevent and control blood pressure as soon as possible. Methods On the basis of informed consent,accepting monitoring management of hypertension in Shanghai Tianmuxi community health center more than one year,405 signed patients with hypertension constitute the study group,while 276 hypertensive patients who continue to maintain the original public health personnel telephone or on-site follow-up make up the control group.In accordance with the requirements of the revised edition of "Chinese Hypertension Prevention Guide 2010",both groups received blood pressure monitoring and hypertension knowledge guidance according to the study of blood pressure grades and risk stratification factor group management. Results The age composition of the patients,gender,severity of the hypertension of 681 subjects shows no statistical differences between the two groups (P>0.05) by means of t test,indicating that the background of the two groups has no difference.But the understanding of the study group about the four most critical prevention knowledge was higher than that of the control group,with statistical significance (P value <0.01 or <0.05) via chi-square test. Conclusion The family doctor can help guide the key to prevention and treatment of high blood pressure,have a positive impact on the promotion of their own blood pressure control.At the same time,it helps to promote the further development of Shanghai family doctor system.

Efficacy of ziprasidone on elderly patients with organic mental disorders and its effect on internal environment

ZHU Yun-long, ZHANG Zhi-hua, YU Shan-shan, XU Jia-ting

2017, 15(3): 475-478. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.035

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Abstract:
Objective To observe the therapeutic effect of ziprasidone on senile organic mental disorders and its effect on glycolipid metabolism,leptin and prolactin. Methods We selected 170 patients with organic mental disorders as the subjects,and divided them into two groups:the observation group (ziprasidone group) and the control group (Olanzapine group),with 85 cases in each group.The positive and negative symptoms scale scores (PANSS),glycolipid metabolism,leptin and prolactin levels were measured before and after treatment. Results The total effective rate of the observation group and the control group had no statistically significant difference (P>0.05).The PANSS scores after treatment of the two groups were lower than those before treatment (P<0.05),and the PANSS scores of the observation group were lower than those of the control group after treatment (P<0.05).After treatment,the body mass index,fasting blood glucose,high density lipoprotein,low density lipoprotein,total cholesterol and triglyceride in the control group were higher than those before treatment (P<0.05).There were no significant differences of body mass index,fasting blood glucose,high density lipoprotein,low density lipoprotein,total cholesterol and triglyceride with those before treatment in the observation group (P>0.05).The body mass index,fasting blood glucose,high density lipoprotein,low density lipoprotein,total cholesterol and triglyceride in the control group were higher than those in the observation group (P<0.05).After treatment,the level of leptin in the control group was higher than that before treatment (P<0.05),the level of prolactin was lower than that before treatment (P>0.05).There was no significant difference of leptin and prolactin in observation group before treatment (P>0.05).The level of leptin in control group was higher than that in observation group (P<0.05),and the level of prolactin was lower than that in observation group (P<0.05). Conclusion The effect of ziprasidone on the treatment of organic mental disorders in elderly patients is significant,and there is no significant effect on the glycolipid metabolism,leptin and prolactin

Effects of three atypical antipsychotics on blood glucose and lipids,prolactin and thyroid hormone in firste-pisode schizophrenic patients

MO Ya-li, XIA Yong, TAO Yun-hai, JIN Man, HE Cao

2017, 15(3): 479-482. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.036

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Abstract:
Objective To investigate the effects of three atypical antipsychotics on blood glucose and lipids,prolactin and thyroid hormone in patients with first-episode schizophrenia. Methods Altogether 85 patients with first-episode schizophrenia were randomly assigned into olanzapine group (n=29),paliperidone group (n=28) and aripiprazole group (n=28) for 8 weeks.The serum levels of fasting blood glucose (FBG),triglyceride (TG),total cholesterol (TC),high density lipoprotein (HDL),low density lipoprotein (LDL),prolactin (PRL),thyroid stimulating hormone (TSH),triiodothyronine (T3),thyroxine (T4),free triiodothyronine (FT3) and free thyroxine (FT4) were measured before and after treatment. Results ①The levels of FBG,TG,and TC in olanzapine group after treatment were significantly higher than those before treatment (P<0.05),HDL was significantly lower than that before treatment (P<0.05);TG in paliperidone group was significantly higher than that before treatment (P<0.05),and no statistical difference was found in blood glucose and lipids compared with those before treatment of aripiprazole group (P>0.05).②The serum PRL of olanzapine group and paliperidone group was significantly higher than those before treatment (P<0.05) with paliperidone group which was found to be increased more significantly (P<0.05),and the PRL of aripiprazole group was decreased but without significant difference (P>0.05).③The levels of T3 and T4 in olanzapine group were significantly lower than those before treatment (P<0.05),and the levels of T4 and FT4 in paliperidone group and aripiprazole group were significantly lower than those before treatment (P<0.05).④PANSS scores of three groups were significantly lower than those before treatment (P<0.05). Conclusion Olanzapine,paliperidone and aripiprazole have significant therapeutic effect on first-episode schizophrenia.Olanzapine affects blood glucose and lipids significantly,paliperidone affects triglycerides significantly,and effects of aripiprazole are not obvious on blood glucose and lipids.All three can affect prolactin and thyroid hormone,and paliperidone is found to significantly increase prolactin.

Impact of social relational quality on early posttraumatic stress disorder among young and middle aged patient with first stroke

LI Xue-jun, ZHANG Wei-wei, FU Jin-ying, WANG Yuan-jiao

2017, 15(3): 483-486. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.037

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Abstract:
Objective To investigate the degree and influencing factors of social relational quality and early posttraumatic stress disorder (PTSD) among young and middle aged patient with first stroke,and to provide the different communities evidence for improving the quality of life of patients after discharge. Methods From January to December in 2015,total 226 young and middle aged patient with first stroke in Zhejiang province people's hospital were investigated by the social relational quality scale (SRQS) and PTSD Checklist-Civilian Version.A database of survey questionnaire was established with SPSS 16.0 software was used for date management and analysis,and then the multiple regression analysis was used to analyze the influencing factors of early posttraumatic stress disorder. Results The scores of PTSD was 58.08±12.47,and 43.36%(98 cases) of patients with first stroke was positive.There was negative correlation between PTSD and social relational quality,and the difference was statistically significant (P<0.05).The income,BI index,family intimacy,family commitment and friend relationship were the main influencing factors for PTSD (P<0.01). Conclusion The early PTSD is negatively correlated with the social relational quality among the young and middle aged patient with first stroke.The higher level of social relational quality will lower PTSD.The family intimacy,family commitment and friend relationship should be paid more attention during the intervention to reduce the level of early PTSD after the discharge.

Analysis on the present situation of hypertension,hyperglycemia and hyperlipidemia from A College Teachers in Anhui Province

HUAI Yu-shui, PAN Fa-ming, PENG Wan-sheng

2017, 15(3): 487-490. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.038

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Abstract:
Objective To explore the distribution and present situation of the"three high "(hypertension,hyperglycemia and hyperlipidemia) from college teaching staff,and analysis its main related factors,in order to provide the basic data for prevention and control college teaching staff" three high ". Methods Collected a college teaching staff health examination report 1 500 copies in 2015,summary the blood pressure,blood glucose and blood lipid,blood lipids mainly include total cholesterol,glycerin three fat,low density lipoprotein and high density lipoprotein,and the results were analyzed retrospectively,at the same time,the general demographic data were collected;The statistical methods of chi square test and chi square trend test were adopted,P<0.05 was considered to be statistically significant. Results In collection of 1 500 college teaching staff,blood pressure,blood glucose and blood lipid in at least one value is not in the normal range for 1 163,accounting for 77.5% of the total.Among them,706 of the 835 men were abnormal,the abnormal detection rate was 84.6%,457 of the 665 women were abnormal,the abnormal detection rate was 68.7%.The total detection rate of male was higher than that of female,dyslipidemia detection rate was in the highest in the" three high ";Secondly,the detection rates of hypertension,hyperglycemia and hyperlipidemia were higher in the male than in the female,and the difference was statistically significant (P<0.05);With the increase of age,the abnormal detection rate of" three high "rise. Conclusion abnormal detection rate of" three highs"in College teaching staff is higher,especially in males.How to reduce the levels of blood pressure,blood glucose and blood lipid effect on physical health,reduce the incidence of chronic diseases,improve the quality of life,it is worthy of attention.

Application of fused DWI-T₂WI imaging in target delineation for central-type lung cancer combined with pulmonary atelectasis

LI Zhong-xue, ZHANG Wen-bao, ZHAO Lin, FANG Jian-qiang, XU Yu-jin

2017, 15(3): 491-494. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.039

136 1

Abstract:
Objective To explore the values of fused DWI-T₂WI imaging in target delineation for central-type lung cancer (CTLC) combined with pulmonary atelectasis. Methods Total 60 cases of central-type lung cancer confirmed by bronchoscopy or biopsy in our hospital from May,2015 to October,2016 were recruited.CT and MRI images were positioning,and we use T₂WI and DWI technology to fusion the images by to by Pinnacle³9.6 radiotherapy planning system.We can compared the the tumor target (GTV),and we analysis the enhanced CT and DWI-T₂WI image fusion images and distinguished the border,and we check out the lymph node,the result of the analysis with pulmonary merger or no merger with atelectasis,GTVt differences in quantitative analysis,the matching pair four tables χ² test.The GTVt differences influence factors we used logistic regression analysis. Results DWI-T₂WI fusion images were more easily to distinguish the borderline between pulmonary atelectasis and tumor differentiated as compared with contrast-enhanced CT (χ²=8.47,P<0.05);Both DWI-T₂WI fusion images and enhanced CT showed positive lymph nodes in 32 cases,the difference was not statistically significant (χ²=0.40,P=0.53).The cumulative GTV of central-type lung cancer combined with pulmonary atelectasis differed greatly,the difference was significant (t=7.22,P<0.05),the factors including the combining atelectasis (Wald=12.58,P<0.05) and tumor pathologic type (Wald=5.22,P<0.05). Conclusion DWI-T₂WI image fusion can differentiate pulmonary atelectasis from tumor boundary in target delineation for central-type lung cancer combined with pulmonary atelectasis during the radiotherapy.

The correlation between diffusion weighted imaging with cervical cancer cell proliferation activity of PCNA and Ki-67

WEI Ming-zhu, ZHAO Zhen-hua, SUN Ai-jing, WANG Dan-dan, RUAN Ya-wen, YANG Li-ming

2017, 15(3): 495-497. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.040

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Abstract:
Objective To evaluate the difference of diffusion weighted imaging (DWI) ADC value and rADC value of different degree of differentiation cervical cancer and correlation with cervical cancer cell proliferation activity (PCNA and Ki-67). Methods Forty patients with pathological diagnosis for cervical cancer were selected for this study.Preoperative magnetic resonance imaging (MRI) and DWI was performed before operation.Meanwhile,the PCNA and Ki-67 immunohistochemical staining were performed.The expression of PCNA and Ki-67 in different differentiation degree of cervical cancer were analysed by analysis of variance,and the correlation with ADC and the rADC value were also analysed by Pearson correlation methods.SPSS 20.0 was used to calculated the relevant data and significance was set at <0.05. Results The ADC values and rADC value in poorly differentiated group is less than high differentiation group,and the difference was statistically significant (t=2.118,P<0.05).There was no significant difference between the poorly differentiated group and middle differentiated group (P>0.05).With the degree of differentiation is reduced,the expression of PCNA and Ki-67 is increased.With the increase of the degree of expression of PCNA and Ki-67,ADC values and the rADC value decreased,the difference had statistical significance (P<0.05).Pearson correlation test showed that ADC values to be inversely associated with the degree of Ki-67 and PCNA expression. Conclusion DWI imaging and the ADC,rADC value measurement for cervical cancer can help to evaluate the cervical cancer with different pathological level and has the potential to be a non-invasive method for identifying tumor proliferation.

Diagnostic value of serum procalcitonin detection for infection diagnosis in patients with heart failure

ZHONG Yi-fang, RAO Hai-ying, DAI Shu

2017, 15(3): 498-500. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.041

187 0

Abstract:
Objective To explore the significance of serum procalcitonin (PCT) abnormal level for the diagnosis of infection in patients with heart failure,and provide reliable evidence for the infection treatment. Methods Ninety patients with heart failure were randomly selected from our hospital and were divided into infection group and non-infection group,with 45 cases in each group.Serum PCT levels in two groups were detected and the sensitivity,specificity and positive predictive value of PCT detection were compared. Results Serum PCT level in the infection group (10.34±2.64) ng/ml was significantly higher than non-infected group (0.23±0.05) ng/ml before the treatment (P<0.05).There was no significant difference in serum PCT levels between two groups after the treatment (P>0.05).Infection diagnosis sensitivity (91.11%),specificity (95.56%),positive predictive value (88.89%) in the infected patients were significantly higher than non-infected patients (48.89%,55.56%,62.22%),P<0.05. Conclusion Serum PCT detection exerts obvious effect for the infection diagnosis of heart failure patients and produces high PCT level in the infected patients,which indicates the possibility of infection and needs active measures.This detection has a high sensitivity,accuracy and positive predictive,so it is of great clinical significance.

Comparison of the effects of micro-locking plate and headless compression screw in oblique fracture of the medial malleolus

ZHANG Jun, CHEN Xiao, ZHANG Rong-jia, CAO Lie-hu, JI Fang, SU Jia-can

2017, 15(3): 501-504. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.042

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Abstract:
Spinal cord injury is a serious injury of the nervous system.It results in higher disability and mortality.With the development of transportation and construction industry,the incidence of spinal cord injury is increasing year by year.Because the pathological and physiological mechanism of spinal cord injury is complex,the effect of treatment is bad and it brings heavy burden to the family and the society.In order to further understand the pathogenesis of spinal cord injury and improve the level of clinical treatment,it is necessary to develop the research of animal model of spinal cord injury.At present,there are various animal models,such as contusion model,compression model,ischemic injury model,transection injury model,distraction model and so on.As it is unable to precisely control the degree and range of spinal cord injury,no one can completely simulate the clinical pathogenesis of spinal cord injury.In order to study the pathogenesis of spinal cord injury and the methods of repairing,the animal model of spinal cord injury should have clinical similarity,repeatability and regulation.For providing the reference for choosing appropriate model and making the models more closed to the clinical pathogenesis of spinal cord injury,in this paper,the research progress of animal models of spinal cord injury is to be reviewed.

Analysis on characteristics of Chinese medicine constitution in COPD patients with depression

CHEN Su-zhen, WANG Shi-qiang, HU Dan-dan, HUANG Li-sou, YANG Kai, ZHANG Hong, LOU Li-ming, HUANG Hui-xian, XU Yi-kai, ZHANG Qian

2017, 15(3): 505-507. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.043

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Abstract:
Objective To investigate the distribution of the TCM constitution types in COPD patients with depression and its relationship with COPD exacerbation,providing evidence for the prevention and treatment of COPD and COPD exacerbation. Methods Five hundred cases COPD with depression patients in outpatient and hospitalization of the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine and Hangzhou Zhoupu community health service center from June,2014 to December,2016 were selected.Patients were composed by 260 cases male and 240 cases female with age range from 40 to 85.Based on TCM constitution theory,questionnaire was designed and data were collected from 500 patients of COPD with depression to investigate the relationship with COPD exacerbation. Results In all 500 patients,gentleness type patients were 20 cases (4.0%) and biased constitution were 480 cases (96.0%) including 112 cases of Qi asthenia (22.4%),97 cases of phlegm-dampness (19.4%),88 cases of Yang asthenia (17.6%),73 cases of damp-heat (14.6%),42 cases of Yin asthenia,33 cases of blood stasis,24 cases of Qi Stagnation,and 11 cases of special inherited type.Among the nine types of TCM Constitution in COPD patients with depression,Qi asthenia,phlegm-dampness,Yang asthenia and damp-heat were significantly correlated. Conclusion Qi asthenia,phlegm-dampness,Yang asthenia and damp-heat were the predominant constitution types in COPD patients with depression.It conformed to the pathological characteristics of deficiency essence with virtual reality and to provide clinical basis for the practice of "treating disease" in TCM.

Application of case-based learning method in internal medicine teaching of general family medicine

XUAN Ling, ZHANG Heng, WU Shi-li, TANG Bi, KANG Pin-fang, LI Yi-wen, LI Jing-jing, WANG Hong-ju, HUANG Yu-li

2017, 15(3): 508-511. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.044

95 3

Abstract:
Objective General medicine is a comprehensive new clinical discipline,focused on human body.The general practitioner is the main body to provide general medical services.General medicine education aims to cultivate talents familiar with general medical diagnosis and treatment patterns and master the basic knowledge as well as clinical skills in general medicine.Internal medicine,for medical students,is a must professional knowledge,thus an indispensable part of the general medical teaching.This paper is a preliminary exploration for the methods of case-based learning in internal medicine teaching of general family medicine so as to provide references for future instruction. Methods Introduced in internal medicine teaching of general family medicine,the case-based learning method is guided by the teacher who selects and presents authentic cases.The teacher gives a lecture on internal medicine theory,on the basis of which the students are familiar with and grasp the knowledge and then the case is introduced,while students discuss around the case and every student get involved in the discussion,during which the students exercise their abilities.The teacher organizes the students in class discussion,provides guidance,and makes conclusions in the end.The teaching effectiveness is assessed by the results of test and the evaluation of the students. Results Case-based learning method could promote the students'learning interest and learning enthusiasm,improve students'learning initiative and enthusiasm,train the students'ability of language and words,enhance team collaboration and mutual assistance,and cultivate the students'clinical thinking ability and comprehensive ability. Conclusion Case-based learning method is suitable for internal medicine teaching in general medicine in general medical colleges and universities and to cultivate qualified general practitioners,which can be promoted in the future.

Application of case study and plan-do-check-action cycle in etiological diagnosis and treatment of Fever of unknown origin:One case report

HE Qin, LIU Yuan-yuan, LEI Fei-fei, LI Ru-gui, TAN Hua-bing

2017, 15(3): 512-514. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.045

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Abstract:
Objective To analyze the diagnosis course and treatment procedure of a patient with fever of unknown origin (FUO) by adopting case analysis combined with the plan-do-check-action (PDCA) cycle,which demonstrates the circuit diagram of diagnosis and treatment for FUO.The procedure and effectiveness of PDCA for FUO was evaluated by one case study. Methods The case study combined PDCA cycle was performed in one case of FUO to analyze the medical history materials,physical examination results,auxiliary examination reports and prevention of complications,and this FUO case was diagnosed as infective fever;then eliminating viruses and bacterial infections and it was suspected to be histoplasmosis or parasitic diseases;the marrow biopsy and blood rK39-Test confirmed it input Kala-azar;the therapeutic efficacy was predicted and complication was prevented based on analysis of previously literature,diagnostic criteria and therapeutic method. Results The case analysis combined with PDCA cycle improved the diagnosis of pathogenic causes and therapeutic effect of FUO. Conclusion The case analysis combined with PDCA cycle is helpful to improve the diagnosis and therapy level of FUO.

Influence of duodenoscopy with repeated disinfection on postoperative cholangitis incidence after ERCP

HUANG Yan-ling, LI Jun-ling, GAO Rui, FENG Bai-sui

2017, 15(3): 515-517. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.046

165 1

Abstract:
Objective Study the treatment effects of ERCP in the duodenoscopy with repeated high-quality disinfection,as well as its influence on the incidence of postoperative cholangitis. Methods This study selected 721 cases of from ERCP operations in our hospital,ranging from June,2013 to December,2015,and randomly divided into two groups,including normal group with 354 cases,using duodenoscopy with conventional disinfection and repeated disinfection group with 367 cases,using duodenoscopy with the repeated high-quality disinfection.Compare two groups of patients with endoscopic disinfection effect and the incidence of postoperative cholangitis. Results Repeated disinfection group lumen colony count (8.6±9.1) cfu/parts,lifting clamp colony count (10.0±4.8) cfu/parts,routine disinfection group lumen colony count (12.6±8.2) cfu/parts,lifting clamp colony count (15.1±8.2) cfu/parts,repeated disinfection within the group of duodenoscopy cavity flushing fluid and a cotton swab cultivate up pliers colony count group is significantly higher than the conventional disinfection duodenoscope (P<0.05).For repeated disinfection patients the incidence of postoperative cholangitis was 2.23%,significantly less than 5.36% of the conventional disinfection group (P<0.05).And there were no statistical difference between the two groups in operative types,the qualification rates and lens colony (P>0.05). Conclusion In ERCP treatment of duodenoscopy repeated high-qulaity disinfection has obvious effect,which can significantly reduce the incidence of postoperative cholangitis ERCP,worthy of widespread popularization and application in clinic.

Epidemiology and risk factors of Pseudomonas aeruginosa infection in patients with severe thoracic trauma and mechanical ventilation

LIN Xia, SUN Cheng-chao, ZHANG Xiang-yan, TU Shao-song, HUANG Jin-wei

2017, 15(3): 518-520. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.047

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Abstract:
Objective Pseudomonas aeruginosa is the main strain of nosocomial infection with a high drug resistance.The aim of this paper is to investigate the epidemiology and risk factors of Pseudomonas aeruginosa infection in patients with severe thoracic trauma and mechanical ventilation,so as to provide basis for clinical prevention and treatment of ventilator-associated Pseudomonas aeruginosa. Methods Total 218 patients with severe chest trauma and mechanical ventilation in our hospital from January,2012 to January,2016 were prospectively collected.The primary outcomes included the epidemiology and risk factors of Pseudomonas aeruginosa infection,and the secondly outcomes included drug resistance of Pseudomonas aeruginosa. Results A total of 21 cases (9.63%) developed Pseudomonas aeruginosa infection.The diagnosis was confirmed at 3 to 47 days after mechanical ventilation,and the average infection days was (19.57±6.38) days after mechanical ventilation.When compared with the control group,patients in the study group got a significantly longer duration of mechanical ventilation,a higher rate of open injury,a higher level of APACHEⅡ score,a higher rate of more than 3 kinds of antibiotics usage,a higher rate of thoracotomy,a higher rate of hematopneumothorax and a higher rate of multiple injuries (P<0.05).Single factor and multi factor regression analysis showed that the duration of mechanical ventilation,APACHE score and thoracic surgery were risk factors of Pseudomonas aeruginosa infection in severe thoracic trauma patients with mechanical ventilation (P<0.05).In the 21 strains of Pseudomonas aeruginosa,18 strains were multi-drug resistant bacteria,2 strains were extensively drug resistant bacteria.The drug resistance rate of Pseudomonas aeruginosa resistant to imipenem and meropenem were lower (14.29%). Conclusion The Pseudomonas aeruginosa infection rate and drug resistance rate in patients with severe thoracic trauma and mechanical ventilation are high,and duration of mechanical ventilation,APACHE score and thoracic surgery were risk factors of Pseudomonas aeruginosa infection in severe thoracic trauma patients with mechanical ventilation.The prevention and treatment of this type of Pseudomonas aeruginosa may improve patients'outcomes.

A Meta-analysis of the diagnosis value of latex agglutination test for the pulmonary cryptococcosis

LV Qun

2017, 15(3): 521-523. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.048

185 2

Abstract:
Objective At present,the diagnosis of pulmonary cryptococcosis is lack of gold standard.The aim of this study is evaluating the diagnostic value of latex agglutination test in the diagnosis of pulmonary cryptococcosis so as to provide reference for clinical. Methods The research about the diagnosis value of latex agglutination test for the pulmonary cryptococcosis on the domestic and overseas data bases or search engines were searched and screened,which included CNKI,VIP,WANFANG DATA,Pubmed,EMbase,Web of Science,Sumsearch,TRIP,Evidence Based Medicine Center,CATbank,Cochrance organization,Evidence-based health,Netting the Evidence,Guide for community preventive services and National Guideline Clearinghouse.The quality of articles was evaluated and the essential data was extracted from the eligible articles for the meta-analysis. Results A total of 287 articles were retrieved,and there were 7 eligible trials were analyzed in all.Five of them were from China,and 2 from Japan.The time of publication was from 1993 to 2012.A total of 686 subjects were included.Among them,152 cases were pulmonary cryptococcosis and 534 cases were non pulmonary cryptococcosis.The QUADAS standard were used to evaluate the quality of the articles enrolled in this study,and all the articles enrolled in this study got a QUADAS score ≥ 9.Clinical value of latex agglutination test in the diagnosis of pulmonary cryptococcosis were analyzed by Rev-Man 5.3 software.The sensitivity of the 7 articles were 60%-100%(P<0.001).The sensitivity of each study was statistically heterogeneous.The specificity of the 7articles were 85.71%-100.00%,the P value<0.001.And the specificity of each study was statistically heterogeneous.The results of Meta-analysis showed that the sensitivity was 0.80[0.72,0.86],specificity was 0.99[0.98,1.00]. Conclusion Meta analysis shows that it is not recommended for antibiotic using in pre-ERCP routinely.

The clinical effect of pain education on postoperative pain control in urological patients

XU Fei, WANG Chen, LIU Min-jun

2017, 15(3): 524-527. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.049

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Abstract:
Objective To investigate the effect of pain education on postoperative pain control in urological patients. Methods From February,2015 to June,2016,120 patients undergoing urological surgery were divided into control group and observation group according to the random number table.Two groups of patients were treated by the same group of medical staff.The patients in the control group were given routine nursing care,and the patients in the observation group were treated with routine nursing and combined with pain teaching.The visual acuity scale (VAS) was used to evaluate the postoperative pain degree of the two groups.The comfortable comfort degree scale developed by Kolcaba in the United States was used to evaluate the comfort degree of the two groups.The postoperative recovery and the postoperative recovery of the two groups were observed with Pain pump number of times to evaluate the two groups of patients with care satisfaction. Results The VAS scores of the two groups were significantly lower than those of the control group at each time point (P<0.05).The scores evaluating patients'comfort degree at 24 hours after the operation in observation group were lower than those in the control group (P<0.05).The time of getting out of bed,postoperative eating time and hospital stay were shorter in the observation group than those in the control group,and the number of times of pressing pump within 48 hours after operation was significantly lower than that of the control group (P<0.05).The total satisfaction degree of the observation group was 100.00%,significantly higher than the control group 80.00%(χ²=13.33,P<0.05). Conclusion The use of pain teaching to reduce the pain of urological patients has a significant role in improving comfort degree,shortening the postoperative recovery time and improving care satisfaction,which is worthy of clinical application.

Application effect of responsibility nursing group in patients with esophageal carcinoma concurrent chemotherapy

XU Nan, TONG Qiang

2017, 15(3): 528-530. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.050

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Abstract:
Objective To investigate the effect of the nursing team in the treatment of esophageal carcinoma patients with concurrent chemotherapy,thus to explore the performance and merits and demerits of this treatment. Methods A total of 266 patients with esophageal carcinoma registered from September,2013 to September,2014 were randomly divided into groups,control group and observation group,with 133 cases in each group.The control group received traditional nursing model while the observation group was given responsibility nursing model.The nursing satisfaction and clinical nursing quality of the two groups were compared,and the effect of this kind of nursing method on the disease was analyzed. Results ①Three surveys conducted in the first day,during and after the treatment showed that activities,daily life,health,family support,feeling of life score of 5 the observation group were higher than those of the control group,with statistical significance (P<0.05);②in the control group and the observation group satisfaction rate of nursing care and esophageal cancer awareness rate of the questionnaire survey results showed that nursing satisfaction rate of observation group was 97.0%,and that of the control group was only 82.0%;esophageal cancer awareness rate of the observation group was as high as 94.7%,and that of the control group is only 85.0%,and it had statistical significance (P<0.05);③The analysis of hospital nursing showed that the arrival time of the patient's call of the control group was significantly lower than those in the observation group,while the control infusion group number of calls was also significantly lower than those in the observation group,with statistical significance (P<0.05). Conclusion The care system model of responsibility of the group contract,better than traditional nursing mode,can effectively improve the satisfaction of patients,improve the quality of life of patients and promote the doctor-patient relationship.

Comparative analysis of effective nursing intervention on functional recovery of patients with severe traumatic brain injury

JIA Xue

2017, 15(3): 531-533. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.051

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Abstract:
Objective To investigate comparative effects of the functional recovery with different nursing interventions for the severe traumatic brain injury patients with sober. Methods We selected 120 sober patients of severe traumatic brain injury treated in our hospital from July,2011 to February,2015,and randomly divided into the observation group and the control group with equal subjects in each group.The control group was given daily routine care and simple routine nutrition intervention,while the observation group was given the quality care and early intestinal nutrition intervention based on probiotics,with 14 days of care and observation. Results The activity of daily living (ADL) and Karnofsky performance status scale (KPS) scores after care were shown clear upward trend (P<0.05),while the ADL and KPS scores after care in the observation group were significantly higher (P<0.05).The lung infection,blood infection,urinary tract infection,wound infection and other complications during the care in the observation group were significantly less than those in the control group (P<0.05).The IFN-γ contents after care in the two groups were significantly increased,while the IL-4 contents were significantly decreased (P<0.05),while differences between the two groups were statistically significant (P<0.05).The ICU stay time and 28 days hospital mortality rate in the observation group were (7.82±1.23) d and 1.7%,while the control group were (11.94±2.91) d and 10.0%,hence the ICU stay time and 28 days hospital mortality rate in the observation group were significantly lower than those in the control group (P<0.05). Conclusion The quality care and early intestinal nutrition intervention based on probiotics for sober patients with severe traumatic brain injury can improve immune function and reduce the incidence of secondary infection,help patients recover body functions,serving as an important tool to reduce death.

Application of peer education system in enhancing the effect of functional exercise on patients with breast cancer

YU Dong-bo, CHEN Li-qin, MOU Yan

2017, 15(3): 534-536. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.052

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Abstract:
Objective To investigate the effects of peer education system on postoperative recovery,postoperative daily exercise and life quality of patients with breast cancer,and to determine its effect. Methods Altogether 80 patients underwent breast cancer surgery in Linhai First People's Hospital from June,2014 to May,2015 were selected as study subject and were randomly divided into two groups.Patients in observation group were given peer education system,and patients in control group were given routine health education.The functional exercise compliance situation,daily activities,and complications of two groups were compared. Results The functional exercise compliance situation of observation group was significantly higher than that of control group,the compliance rate of observation group was 92.5%,the compliance rate of control group was 67.5%,and the difference was statistically significant (P<0.05).The brushing,dressing,eating and combing hair ability of observation group were significantly higher than those of control group,and there was significant difference between the two groups (P<0.05).Four patients in observation group had flap necrosis (10.0%),three patients in control group had flap necrosis (7.5%);three patients in observation group had flap necrosis (7.5%),five patients in control group had subcutaneous fluid (12.5%),and there were no significant differences in the flaps necrosis and subcutaneous fluid between the two groups (P>0.05).Four patients in observation group had upper extremity edema (10.0%),17 patients in control group had upper extremity edema (42.5%),and the upper extremity edema rate of observation group was significant lower than that of control group.Therefore,there were significant differences between two groups (P<0.05). Conclusion Peer education system could effectively improve the functional exercise compliance rate of patients with breast cancer after operation,improve some basic daily activities,and reduce edema of upper limbs incidence rate,worthy of clinical popularization.

Compliance and efficacy of health belief model-based nursing intervention on empty nest elderly patients with ischemic strok

LI Shu-hong, ZHANG Bin-bin, WANG Bo, SANG Wen-xu

2017, 15(3): 537-539. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.053

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Objective To investigate compliance influence of care treatment led by the health belief model in the empty nest elderly stroke patients. Methods We select 156 cases of empty nest elderly stroke patients treated in our department from October,2011 to October,2015,and randomly divide into study group and control group with 78 cases in each group.Routine care was applied to the control group,on the basis of which health belief model-based nursing practice was implemented in the study group.Compliance and satisfaction degree were compared between the two groups after the treatment;Mini-Mental State Examination on cognitive function in patients before and after treatment was evaluated and activities of daily living (ADL) and quality of life score of the two groups were compared. Results The compliance of the study group was better than that of the control group,and the difference was statistically significant (P<0.05).The performance of the nursing satisfaction was significantly better than that of the control group (P<0.05).ADL score showed that the study group was superior to the control group (P<0.05).After treatment,the scores of physical function,psychological,social and daily life of the study group were significantly lower than those of the control group (P<0.05). Conclusion The nursing practice led by health belief model of care can improve empty nest elderly stroke patients'compliance,satisfaction degree and ADL,so that cognitive function and quality of life are both improved.

2017, 15(3): 540-541. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.054

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2017, 15(3): 542-544. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.055

116 2

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2017, 15(3): 545-546. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.056

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2017 Vol. 15, No. 3

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