中华全科医学

The evaluation index system of Chinese universities'health industry

BAO Yong

2017, 15(4): 547-549,680. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.001

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Objective "Health Chinese 2030" policy has been formed and the countries stressed that the people's health on the priority development of strategic position,and protected people's health to fully cycle and developed the health industry as the focus.Therefore,for colleges and universities to carry out the health industry theoretical and practical research,this research is to establish the evaluation index system of Chinese universities'health industry initially. Methods With a large number of relevant literature,we started from the elements make up of Chinese universities'health industry in making reference to the other industry.By using Delphi method among 13 experts,we initially established the evaluation index system of Chinese universities'health industry. Results After two rounds of expert consultation,an index system of 5 primary indicators,16 secondary indicators and 37 three indicators were formed. Conclusion In the process of the establishment of the index system,the experts enrolled were representative,had a high degree of authority and initiative and were concentrated on advice.The evaluation index system of Chinese universities'health industry we formed was to some degree scientific and practical,and may provide a theoretical basis for our further assessment tools of healthy industry.

2017, 15(4): 550-551.

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

ZHANG Jun, CHEN Xiao, CAO Lie-hu, WENG Yu-zong, ZHOU Qi-rong, JI Fang, SU Jia-can

2017, 15(4): 552-554. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.002

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Objective The effects of micro-locking plate and headless compression screw in oblique fracture of the medial malleolus were compared to provide optimal therapeutic plans. Methods A total of 44 medial malleolus fracture in our hospital from April,2013 to January,2015,including 27 males and 17 females,age raged from 20 to 67 years old with average of (42.6±26.3) years old,were retrospectively analyzed.The causes of fracture included sprain (n=23),sports injury (n=16) and traffic injury (n=5).For combined injuries,there were 7 cases with double ankle fractures and 5 cases with trimalleolar fracture.All fractures were close injuries.The durations from injuries to operations were 4 h to 3 d.Based on different options for internal fixation,the patients were divided into two group,Group A (n=18;fixation with micro-locking plate) and Group B (n=26;fixation with headless cannulated screw).The fracture healing rate,incidence of complications,and the American foot and Ankle Society ankle hindfoot score (AOFAS Ankle-Hindfoot Scale) were evaluated by outpatient follow-up and X-ray. Results All 44 patients were followed up for 12-18 months[an average of (13.9±3.4) months].The fracture healing time was 10-16 weeks with an average of (12.4±0.9) weeks.There was no case with wound infection and poor healing and no complications,such as breakage or Loosening of internal fixation,and nonunion of fractures.According to AOFAS ankle and hindfoot score,the average score of group A and group B was 92.8±5.6 and 93.0±4.7 points respectively.Compared with the preoperative,the functional score significantly increased.But it showed that there was no statistically significant difference between the two groups (P>0.05). Conclusion For oblique fracture of the medial malleolus,both micro-locking plate and headless compression screw can provide effective stump pressure and better clinical results.However,screw technique shows superiorities of low cost,feasibility of percutaneous fracture reduction and less dissection of soft tissue.It is a safe and effective method,which is worth of clinical application.

Influence of neoadjuvant chemotherapy of TAC on curative effect,cellular immunity and Ki-67 expression in early breast cancer patients

YANG Hui, JIANG Hao

2017, 15(4): 555-557,671. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.003

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Objective Neoadjuvant chemotherapy can improve the breast cancer patients'survival,but its immunological mechanisms was not clear,the purpose of this paper was study the influence of neoadjuvant chemotherapy of TAC on cellular immunity and Ki-67 expression in early breast cancer patients. Methods Ninety patients with early breast cancer patients were divided into control group 45 cases and treatment group 45 cases according to random number table method.The control group was used by CEF regimen,and the treatment group was used by TAC methods,3 weeks/courses,and a total 4 courses.The clinical efficacy and adverse reactions of two groups of patients were observed.The level of CD3,CD4,CD8 and natural killer cells (NK) of whole blood were tested by flow cytometry.The level of tumor necrosis factor alpha (TNF-α),interleukin 2(IL-2),interleukin 6(IL-6) and interleukin 10(IL-10) were detected by ELISA.The expression of Ki-67 was examined by immunohistochemistry. Results The total effective rate 86.67%(39/45) in treatment group was higher than that of control group 68.89%(31/45),P<0.05.After treatment the level of CD3,CD4,CD8 and NK in the experimental group were significantly lower than before treatment,and the the level of CD3,CD4,CD8 were lower than the control group (P<0.05).The level of TNF-α and IL-2 in the treatment group were significantly higher than the control group,and IL-6 and IL-10 were significantly lower than that of control group (P<0.05).After treatment,the positive rate of Ki-67 53.33%(24/45) and 57.78%(26/45) were significantly lower than before treatment 88.89%(40/45) and 84.44(38/45),χ²=0.997,0.402,allP<0.01,but no difference between the two groups (χ²=0.180,P=0.671).The incidence of adverse reaction 37.78(17/45) in the treatment group was lower than the control group 60.00%(27/45),χ²=4.447,P=0.035. Conclusion Neoadjuvant chemotherapy TAC scheme can improve the cellular immune function in patients with early breast cancer,reduce the positive expression of Ki-67,has a good clinical curative effect.

Analysis on the judgment values of three non-invasive score systems (LIF-5,APRI and FIB-4) for treatment indication in chronic HBV infected patients with ALT less than two times of upper limits of normal

JIANG Su-wen, HU Ai-rong, YAN Hua-dong, JIN Shan-shan, HU Yao-ren

2017, 15(4): 558-561. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.004

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Objective To comparatively analyze the judgment values of three non-invasive score systems (LIF-5,APRI and FIB-4),which were based on common indicators,for treatment indication (≥ G2 or ≥ S2) in chronic HBV infected patients with ALT less than two times of upper limits of normal (ULN). Methods The data of liver pathology and clinical characteristics in 1 135 chronic HBV infected patients with ALT<2×ULN were analyzed retrospectively.Patients were divided into (Results There were 505 cases (44.49%) with liver inflammation pathological grading ≥ G2 or fibrosis stage ≥ S2.The constituent ratios of male patients and HBeAg negative,the average age,the average values of ALT,AST,APRI and FIB-4 in (≥ G2 or ≥ S2) group were higher than those in (P<0.01).The diagnostic model (LIF-5)=0.725+0.005×age (y)+0.003×ALT+0.004×AST-0.201×(A/G)-0.002×PLT (10⁹/L).The concentration degree and the judgment value of LIF-5 were higher than APRI and FIB-4.The cutoff values for treatment indication of LIF-5,APRI and FIB-4 were 0.46,0.53 and 1.22,respectively.When the LIF-5 was ≤ 0.30 for treatment indication,the sensitivity and negative predictive value (NPV) were 96.8% and 91.8%.When the LIF-5 was >0.75 for treatment indication,the specificity and positive predictive value (PPV) were 97.3% and 87.1%. Conclusion There are still structural damage with liver inflammation ≥ G2 or fibrosis ≥ S2 in 44.49 per cent chronic HBV infected patients with ALT<2×ULN.The non-invasive score system with LIF-5 could predict treatment indication (≥ G2 or ≥ S2) with high accuracy,and is worth promoting.

Effects of fluid resuscitation under the guidance of PICCO on the immune function and inflammatory mediator in patients with septic shock

LU Lu, PAN Guo-quan, TANG Lu-ming, WANG Lin-xia, WANG Zhi-yi, PAN Xiao-dong, SUN Lai-fang

2017, 15(4): 562-564. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.005

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Objective To investigate effects of fluid resuscitation under the guidance of pulse indicator continuous cardiac output (PICCO) on the immune function,inflammatory mediator and organ function in patients with septic shock. Methods Total 180 patients suffering from septic shock in ICU of our hospital from 2012 to 2015 were enrolled and divided into PICCO group (n=94) and conventional group (n=86).The fluid resuscitation procedure was performed in the PICCO group guided by PICCO for adjusting really time the hemodynamic parameters,and in the control evaluated by central venous pressure and vital signs.The vital signs,the level of ET-1,lactate and IL-10,T cells and microRNA-155 were compared between the two groups. Results There were no significant difference between the two groups in sex,age,APACHE Ⅱ scores,mean arterial pressure and state of shock (P>0.05).After the fluid resuscitation,the blood pressure fluctuations,levels of BNP,IL-10 and ET-1 of PICCO group were significantly lower than that in the conventional group (P<0.05).The microRNA-155 and T cells of PICCO group were significantly higher than those in the conventional group (P<0.05). Conclusion The liquid recovery under the guidance of PICCO can make blood pressure recovery smoothly,reduce cardiac load,decrease inflammation medium and improve immune function.

A comparative study of curative effect between cholecystolithotomy with gallbladder reservation by laparoscopy and choledochoscope and laparoscopic cholecystectomy in patients with cholecystolithiasis

LI Qiao-deng, CHEN Guang-bin, LIU Zhi-gang, LING Lin, LIU Dan-feng, HU Yu-zhi, LIU Chang-kuo, SUN Li-xia

2017, 15(4): 565-567,696. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.006

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Objective To compare the therapeutic effectiveness between cholecystolithotomy with gallbladder reservation by laparoscopy and choledochoscope and laparoscopic cholecystectomy in the treatment of cholecystolithiasis. Methods The clinical data of 80 cases of cholecystolithiasis in our hospital between January,2014 and January,2016 were analyzed retrospectively.Thirty-seven patients in the gallbladder-preserving surgery (GPS) group received cholecystolithotomy with gallbladder reservation by laparoscopy and choledochoscope,while 43 patients in the laparoscopic cholecystectomy (LC) group underwent laparoscopic cholecystectomy surgery.The difference between the two groups in the total successful rate,incidence of complication,total and postoperative hospitalization time,perioperative bleeding,cases with postoperative drainage,time to first flatus passage,cases with postoperative complication,postoperative pain intensity within 24 hours,recurrence rate of cholecystolithiasis,and gallbladder shrinking functions were compared. Results There were no statistically significance in total successful rate,incidence of complication,total and postoperative hospitalization time and perioperative bleeding between two groups (P>0.05),but the postoperative drainage cases in GPS group was significant more than that in LC group,while the time to first flatus passage,cases with postoperative complication,postoperative pain intensity within 24 hours in GPS group were significant less than those in the LC group (P<0.05).The follow-up showed that there was no recurrent choledocholithiasis in both groups,and the gallbladder shrinking functions at 6 months and 1 year after the operation in GPS group were improved (P<0.05). Conclusion The treatment effectiveness on choledocholithiasis of both GPS and LC is good,safe and feasible.GPS surgery can retain the function of the gallbladder,and improve the patient's quality of life,which is an alternative effective surgical procedure for gallstones.The personalized treatment can be performed on the basis on assessment of gallbladder condition and systemic state and willingness of patients.

Effect of hyperbaric oxygenation assisted standard large craniotomy on hemodynamics and serum inflammatory factors of patients with severe traumatic brain injury

WAN Yu-lin, XU Qian

2017, 15(4): 568-570,711. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.007

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Objective To investigate the effect of hyperbaric oxygenation assisted standard large craniotomy on hemodynamics and serum inflammatory factors of patients with severe traumatic brain injury (STBI). Methods Fifty-six severe traumatic brain injury patients with intracranial hemorrhage from June,2014 to June,2015 were randomly divided into 2 groups,each 28 cases.The control group was treated with standard large craniotomy,the observation group was treated with standard large craniotomy combined with hyperbaric oxygen therapy.The hemodynamics[cerebral blood flow (CBF),time to peak (TTP),mean transit time (MTT),cerebral blood volume (CBV),inflammatory factor tumor necrosis factor alpha (TNF-α) and interleukin-4(IL-4),IL-2]and metabolic status indicators (brain metabolism,protein metabolism) were made detection and comparison.And the glasgow prognosis scale (GOS) was used to evaluate the prognosis of both groups.The hemodynamic and metabolic parameters of the two groups were compared.And the GOS was used to evaluate the prognosis of both groups. Results The levels of CBF and CBV in the observation group were significantly higher than those in the control group at 1 week and 1 month after operation (P<0.05).The levels of TTP and MTT in the observation group were significantly lower than those in the control group (P<0.05).The level of CBF,CBV,TTP and MTT in the control group was significantly higher than that in the control group at 1 month after operation (P<0.05).The levels of TNF-α and IL-2 in the observation group were significantly lower than those before operation (P<0.05) and the levels of IL-4 were significantly higher than those before operation (P<0.05).And the effect was better than the control group (P<0.05).The levels of RBP,TRE and PA in the two groups were significantly lower than those before operation (P<0.05),and the levels of CEO₂ and SVO₂ were significantly higher than those before operation (P<0.05);The levels of RBP,TRE,PA,CEO₂,SVO₂ in the observation group were significantly higher than those in the control group at 5 days (P<0.05).The good prognosis rate (42.7%) in the observation group was significantly better than that in the control group (14.3%),P<0.05. Conclusion Standard large craniotomy combined with hyperbaric oxygen therapy can improve the serum inflammatory factors and hemodynamics in patients with severe head injury,and can improve the prognosis and improve the metabolic status of patients.

The changes of T lymphocytes blocking efficiency after active immunotherapy in recurrent spontaneous abortion patients

MA Chao, HAN Wei-tian, FENG Wen-hua

2017, 15(4): 571-573. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.008

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Objective To detect the changes of T lymphocytes CD3⁺,CD4⁺ and CD8⁺ blocking efficiency after initiate immunotherapy,monitor the effect of immunotherapy and explore the immunological occurrence mechanism of RSA. Methods A total of 82 patients with three times or more than 3 times unexplained recurrent spontaneous abortion patients were selected.Flow cytometry was used to measure T lymphocytes CD3⁺,CD4⁺ and CD8⁺ blocking efficiency of these 82 patients,Wilcoxon rank sum test were used to analyze the difference between two groups,Chi-square test was used to analyze the relationship between positive changing of T lymphocytes blocking efficiency and the result of pregnancy. Results The level of CD3⁺,CD8⁺ T lymphocytes blocking efficiency was significantly increased in peripheral blood of unexplained recurrent abortion patients after initiate immunotherapy (Z=-2.147,-2.622,P<0.05),CD3⁺ T lymphocytes blocking efficiency before active immunotherapy were 0.31(-0.51 to 1.09),CD3⁺ T lymphocytes blocking efficiency after active immunotherapy were 1.02(0.09 to 2.33);CD8⁺ T lymphocytes blocking efficiency before active immunotherapy were 0.47(-0.53 to 1.83),CD8⁺ T lymphocytes blocking efficiency after active immunotherapy were 1.39(0.55-2.88),while there is no significantly differences in CD4⁺ although blocking efficiency were slightly unregulated (Z=-0.552,P>0.05),CD4⁺ T lymphocytes blocking efficiency before active immunotherapy were-0.04(-1.40 to 1.30),CD4⁺ T lymphocytes blocking efficiency after active immunotherapy were 0.52(-1.10 to 1.35).After active immunotherapy,the pregnancy rate of positive blocking efficiency is 42.9%.he pregnancy rate of negative blocking efficiency is 19.4%.The pregnancy rate was higher in the RSA patients with positive blocking efficiency than the patients with negative blocking efficiency (P<0.05). Conclusion After active immunotherapy,T lymphocytes blocking efficiency of peripheral blood recurrent spontaneous abortion patients were unregulated,T lymphocytes blocking efficiency increasing after active immunotherapy in recurrent abortion patients may be helpful to maintain pregnancy.

Correlation between serum S100B and IL-6 levels and intracranial pressure in patients with severe craniocerebral injury

ZHOU Hai-hang, ZHANG Li-tao, SHEN Jian-guo, CHU Zheng-min, CHU Wen-lai

2017, 15(4): 574-576. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.009

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Objective To detect the changes of intracranial pressure and the level of S100B and IL-6 in the serum of the patients with severe brain injury after injury,and to analyze the relationship between the changes of serum S100B and IL-6 levels and intracranial pressure. Methods A total of 88 patients with severe brain injury in our hospital from January,2012 to April,2016 were selected as the research subjects.The intracranial pressure of patients was monitored continuously.The venous blood of patients was prepared at 6,12,24,48 and 72 h after the admission.The serum S100B protein and IL-6 levels at different time points were tested by enzyme-linked immunosorbent assay.The relationship between the changes of serum S100B and IL-6 levels and intracranial pressure was analyzed statistically.The t test was performed to compare the means of two groups.Spearman correlation analysis was performed for pairs of quantitative data.When P<0.05,the difference was statistically significant. Results The level of S100B in patients with severe craniocerebral injury increased gradually after the operation,and reached the peak within 24 hours,then decreased gradually;while patients with IL-6 and intracranial pressure after injury gradually increased,serum IL-6 and S-100B levels were significantly associated with intracranial pressure (r=1.933,r=4.859,P<0.05).But the peak value of S100B appeared earlier than that of intracranial pressure;however,the trend of IL-6 was consistent with the change of intracranial pressure. Conclusion The changes of intracranial pressure in patients with severe head injury is proportional to the serum S100B and IL-6 levels.Thus S100B and IL-6 levels can reflect the degree of injury and provide clinical basis for evaluation of patients.

Risk factor analysis on severe head injury caused by falls in the elderly

GONG Qin-feng, HU Yong, TU Yao-ran, PENG Xiao-ling

2017, 15(4): 577-579. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.010

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Objective To understand the epidemiology and risk factors of brain injury caused by falls in elderly people in this area. Methods The clinical data of 77 cases of senile severe head injury caused by falls in hospitals of Nanchang City between January 1,2013 and December 31,2014 were analyzed retrospectively.The criteria for the inclusion of patients:①aged 60 years or over;②there is a clear history of head injuries caused by falls;③the initial CT scanning clearly confirmed trauma craniocerebral damage.The criteria for the exclusion of patients:①the age of <60 years old;②does not meet the diagnostic criteria for brain injury;③brain injury was not caused by falls.The related single factors were tested by χ² test,and the significant factors were entered into the Logistic regression model to analyze the statistical software by using SPSS 17.0. Results Single factor analysis showed that severe craniocerebral injury caused by falls in the elderly correlated with gender,admission time,falls plane,landed on occipitotemporal sulcus,cardio cerebral vascular elementary disease (P<0.05),not with the age and associated injury (P>0.05).Logistic regression analysis showed that the cardiovascular disease (OR=5.555),landed on occipitotemporal sulcus (OR=4.420) were the high risk factors of severe brain injury caused by falls in the elderly. Conclusion For the old patients with severe head injury caused by falls,especially with cardio cerebral vascular elementary disease,we should observe closely the changes of condition,implement intervention as soon as possible,thereby control risk factors,reduce secondary brain injury and reduce the incidence of severe brain,improve the prognosis of patients.The community education should concern the contents of craniocerebral injury caused by falls,improve the understanding of the elderly to craniocerebral injury,and prevent the occurrence of severe brain injury.

Effect of epidural block combined with general anesthesia on early postoperative cognitive function in elderly patients with hip fracture

WANG Xiang-lin, WAN Ling-feng, YUAN Gui-hua

2017, 15(4): 580-582. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.011

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Objective To investigate the effects of epidural block combined with general anesthesia on early postoperative cognitive function in elderly patients with hip fracture. Methods From February,2012 to February,2016,88 cases of elderly patients with hip fracture were selected as the study subjects.According to the age and educational level,the patients were randomly divided into the observation group and the control group,with 44 cases in each group.The observation group received epidural block and general anesthesia,while the control group was given general anesthesia,and the effect of the two groups were compared and analyzed. Results There was no significant difference in HR,DBP and SBP between the two groups before,during and after the operation (P>0.05).There was no statistical significance in effects of hemodynamic indexes (SBP,DBP,HR) at different time points (P>0.05).The postoperative MMSE scores at the time of 6,24 h,3 days and 7 days after the operation in the observation group were better than those in the control group (P<0.05);The incidence of cognitive dysfunction at the time of 3,6,24 h and 3 days in the observation group was significantly lower than those of the control group (P<0.05).The post-anesthesia awaking time,time to extubation,and response time were (12.3±3.5) min,(13.5±3.1) min and (15.3±4.4) min in the observation group,which were shorter than (17.4±2.8) min,(20.4±2.8) min and (20.8±4.1) min of the control group,respectively (P<0.05). Conclusion The epidural block combined with general anesthesia for elderly patients with hip fracture surgery has better clinical effect and little influence on hemodynamics parameters;With mild influence on the cognitive function,patients can recover quickly from anesthesia.The wildly application can be tried in clinic.

Changes of perioperative D-dimer in patients with spinal degeneration and its predictive value for deep venous thromboembolism

YANG Zhi-hua, LI Qing, FENG Jian, CHEN Guo-fang, YING Jin-he

2017, 15(4): 583-585. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.012

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Objective To investigate the changes of perioperative D-dimer in patients with spinal degeneration and its predictive value for deep venous thromboembolism. Methods A total of 200 patients with spinal degenerative disease undergoing surgical treatment in our hospital from January,2013 to December,2015 were enrolled and assigned into observation group (deep vein thromboembolism group) and control group (without deep venous thromboembolism).The plasma D-dimer levels were tested and the deep venous thrombosis was detected by color Doppler ultrasonography. Results The levels of plasma D-dimer on d₁,d₃ and d₇ after the operation were (1.76±0.23)μg/ml,(2.32±0.41)μg/ml and (1.67±0.35)μg/ml in the observation group,and (1.28±0.31)μg/ml,(1.26±0.27)μg/ml and (1.31±0.23)μg/ml in the control group,which were higher than those before the operation[(0.68±0.14)μg/ml in the observation group and (0.74±0.15)μg/ml in the control group],P<0.05.There was no significant difference in the plasma D-dimer level before the operation between the two groups (P>0.05).The plasma D-dimer level at d1,d3 and d7 after the operation in the observation group were significantly higher than those in the control group,the difference was significant (P<0.05).The ROC curve of D-dimer level in diagnosis of deep venous thromboembolism showed that the cutoff value was 1.17 μg/ml,the area under the ROC curve was 0.928,the 95% confidence interval had a lower limit of 0.890 and an upper limit of 0.966.When D-dimer ≥ 1.17 μg/ml was as deep vein thrombosis positive,D-dimer<1.17 μg/ml as deep vein thromboembolism negative for diagnosis of deep vein thromboembolism,the sensitivity was 92.9%,the specificity was 79.1%,the misdiagnosis rate was 20.9%,the missed diagnosis rate was 7.1%,the total compliance rate was 13.0%+68.0%=81.0%,Youden index was 72.0%,positive predictive value was 41.9% and negative predictive value was 98.6%. Conclusion The postoperative level of D-dimer in patients with spinal degeneration will increase,and the level of D-dimer has some prognostic value for deep venous thromboembolism.

Influence of infliximab combined with azathioprine on immune function and cytokines in Crohn's disease

LIU Fang, LI Jing-tao, SONG Zhen-mei, LIU Ji-xi, WU Xiao-min

2017, 15(4): 586-588,592. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.013

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Objective To evaluate the clinical efficacy of infliximab combined with azathioprine in treatment of Crohn's disease and its effect on immune function and cytokines level. Methods One hundred and seventy patients with Crohn's disease were randomly divided into 2 groups with 85 cases in each group.The patients in the control group were given azathioprine,while the patients in the observation group were given additional infliximab based on the treatment in the control group.The biological indicators counting[white blood cell (WBC),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) and serum total protein (STP)],immune function indexes[peripheral blood T lymphocyte subsets (CD4 percentage,CD4/CD8 and CD8 percentage),and immunoglobulin (IgA,IgG,IgM)],inflammatory cytokines[tumor necrosis factor alpha (TNF-α) and interleukin-10(IL-10),interleukin-12(IL-12),transforming growth factor beta (TGF-β)],clinical effect and adverse reactions of the two groups were compared. Results After the treatment,WBC,ESR,CRP,STP,CD4,CD4/CD8,CD8,IgA,IgG,IgM,TNF-α,IL-12,TGF-β and IL-10 levels of the two groups were significantly improved when compared with those before the treatment (P<0.05),and those indicators levels of the observation group were significantly better than those of the control group (P<0.05).The total effective rate in the observation group was 92.9%,which was significantly higher than 80.0% in the control group,P<0.05.There was no significant difference in the adverse reactions between the two groups (P>0.05). Conclusion Infliximab combined with azathioprine can effectively improve the immune function and inflammatory cytokines of patients with Crohn's disease,the curative effect is satisfactory.

Application and effect of multivesicular liposomal ropivacaine in non-intubated thoracoscopy surgery

ZHANG Yi-wei, HUANG Zhang-shun, WANG Jue, YANG Qiu-hong, ZHU Hao

2017, 15(4): 589-592. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.014

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Objective To investigate the application and effect of multivesicular liposomal ropivacaine in non-intubated thoracoscopy surgery and the incidence of perioperative complications. Methods A total of 60 patients undergoing non-intubated thoracoscopy surgery in our hospital between January,2016 to September,2016 were enrolled and randomly divided into group A (0.2% ropivacaine),group B (0.2% ropivacaine and multivesicular liposomal ropivacaine) and group C (0.1% ropivacaine and 0.4 μg/ml sufentanil) with 20 cases in each group.Epidural catheter was placed at the T₆-T₇ level before the surgery,and 2 mg morphine was injected for analgesia.The propofol and dexmedetomidine were given by a infusion pump during the operation.The patients breathe independently via face mask.The changes of respiration and blood circulation were observed among the three groups.Postoperative VAS pain score at 1,4,8 and 24 hours after the operation were recorded.The complications such as intraoperative cough,hypoxemia,hypercapnia and postoperative nausea and vomiting were also recorded.The multivesicular liposomal ropivacaine was prepared with 0.2% ropivacaine,phospholipid,cholesterol,three oleic acid glyceride and L-lysine as materials by multiple emulsion process.The multivesicular liposomal ropivacaine was a spherical body,its internal structure consisted of the polycystic bubble,the size was of 7-30 μm,the average particle size was (15.36±7.87)μm;The release rate of drug was 65% at 6 hours,90% at 24 hours,and complete within 48-60 hours. Results In terms of blood pressure in surgery,there was significant difference between group A compared with group B and group C (P<0.05).In terms of respiratory frequency,the respiratory rate of group A and group B were lower than that in group C when artificial pneumothorax and 30 minutes after artificial pneumothorax (P<0.05);In group A,4 and 8 hours after surgery were higher than those in group B and group C (P<0.05).In terms of complications,the incidence of nausea and vomiting in group A was higher than that in group B during surgery (P<0.05).In terms of the resting and cough pain VAS score,B group was lower than A and C group after surgery 4 and 8 hours (P<0.05). Conclusion The multivesicular liposomal ropivacaine can reduce the perioperative complications of non-intubated thoracoscopy surgery and achieve accurate quantitative release of anesthetic drugs,and has the characteristics of sustained release and quantitative release,which is worthy of clinical application.

Clinicopathological characteristics of primary malignant neoplasms of the appendix

ZHAO Fu-guang, ZHOU Juan-di, CHEN Jie, SHI Yi-jun, CAI Yuan-jie, XIE Shang-nao

2017, 15(4): 593-596. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.015

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Objective To explore the clinicopathologic features and prognosis of primary malignant tumors of the appendix,assess the factors affecting the prognosis,and provide a reference for the development of treatment programs and evaluation of patients'prognosis. Methods This analysis included cases of malignant tumors of the appendix reported to the National Cancer Institute's Surveillance,Epidemiology and End-results (SEER) program between 2004 and 2010.Adenocarcinoma,mucinous adenocarcinoma,signet ring cell carcinoma and neuroendocrine tumor were included according to WHO Classification of Tumors of the Digestive System (Fourth Edition).Data analysis was performed using IBM SPSS software for Windows,version 19.0.Disease-specific survival was calculated according to the Kaplan-Meier method,and differences between curves were tested by the log-rank test,using P<0.05 as the limit of significance.Cox's proportional hazard regression analysis was performed using a multivariate analysis to identify independent prognostic factors in cancer patients. Results Between 2004 and 2010,3 967 malignant tumors of the appendix were reported to the SEER program,of which 3 159 cases were included in the analysis.The annual age-adjusted incidence of cancer of the appendix was 0.7 cases per 100 000 people.The survival rate was inversely proportional to age;African Americans had a worse prognosis than others.The higher the degree of tumor invasion,the worse the prognosis was.The disease specific survival rate of patients with signet ring cell carcinoma was lower than that of other types of tumors in all histological types (P<0.001).The patients with neuroendocrine tumors had a better prognosis (P<0.001). Conclusion The demographics of patients with primary malignant tumors of the appendix vary by histological classification.The race,age of diagnosis,grade,and histological types,the extent of the tumor at the time of diagnosis and tumor size were independent prognostic factors for primary neoplasms of the appendix.

Clinical application of dexmedetomidine in anesthesia for functional neurosurgery

ZHOU Yu-lan, HUANG Xiao-xia, LE Xin-hui

2017, 15(4): 597-599,728. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.016

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Objective To investigate the effect of dexmedetomidine in anesthesia for functional neurosurgery,and to provide scientific theoretical basis for clinical selection of anesthesia. Methods A total of 337 patients undergoing functional neurosurgery in our hospital from May,2015 to May,2016 were randomly divided into observation group (n=169) and control group (n=168).The observation group received dexmedetomidine intravenous injection (1 μg/kg,10 min),continuous intravenous infusion of 0.4 μg/(kg·h),while the control group was given normal saline by intravenous injection.Both groups were given intravenous anesthesia induction and maintenance with propofol.The level of MAP,HR,SpO₂,Ramsay sedation score,RR,OAA/S sedation score at the time points before the induction,after the surgery and awareness recovery were recorded and compared.The response capability during wake-up period and adverse reactions were also compared between the two groups.SPSS 19 was used for statistical data processing. Results The level of MAP and HR in the observation group were all statistically lower than those of in the control group after the surgery and awareness recovery (P<0.05),and the Ramsay sedation score of the observation group were all statistically higher than that of the control group respectively (P<0.05).After the surgery,the OAA/S sedation score was statistically less in the observation group than that in the control group.However,OAA/S sedation score during awareness recovery was statistically greater in the observation group than that of in the control group (P<0.05).One hundred and forty-eight cases (87.57%) were response significantly during wake-up period in the observation group and which was higher than that in the control group (121 cases,72.02%)P=0.021.7 cases (4.14%) with adverse reactions in the observation group was lower than 11 cases (6.55%) in the control group of,and there was no statistical difference (P=0.326). Conclusion The clinical efficacy of dexmedetomidine in anesthesia for functional neurosurgery is obvious.It can effectively play a sedative effect,and increase the response ability during wake-up period.It is worthy of popularization and application.

Role of erythrocyte sedimentation rate combined C reactive protein in the diagnosis of subacutethyroiditis

SUN Xiu-qin, ZHAO Yi, BAO Bing-nan

2017, 15(4): 600-601,629. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.017

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Objective To study the value of erythrocyte sedimentation rate (ESR) combined C reactive protein (CRP) in the diagnosis of subacutethyroiditis (SAT). Methods Two hundred and fourteen cases of SAT from January,2011 to December,2015,and 288 cases of Graves disease in the same period were selected.The thyroid related indicators (FT3,FT4,TSH,TRAb,TPOAb and Iodine uptake rate),CRP and ESR levels were detected and statistical compared.The ROC curve of CRP,ESR and CRP combined ESR on diagnosis of subacute thyroiditis were made,and the sensitivity,specificity,and area under curve (AUC) were compared. Results The FT3 and FT4 levels of the observation group were significantly higher than those of the control group,the difference was statistically significant (P<0.05).The TSH,TPOAb and Iodine uptake rate of the observation group were significantly lower than those of the control group,the difference was statistically significant (P<0.05).The CRP and ESR levels of the observation group were significantly higher than those of the control group,the difference was statistically significant (P<0.05).The sensitivity of CRP combined ESR on the diagnosis of SAT was 96.7%,which was higher than that of CRP (92.5%) and ESR (86.5%),but the difference was not statistically significant (P>0.05).The AUC of CRP combined ESR on the diagnosis of SAT was 0.804,which was higher than that of CRP (0.755) and ESR (0.804). Conclusion Erythrocyte sedimentation rate combined C reactive protein could be used as the effective diagnosis indicators of subacutethyroiditis,and the effect was better than only erythrocyte sedimentation rate or C reactive protein.

Clinical efficacy of in situ skin grafting in a zigzag pattern combined with vacuum sealing drainage for retrograde skin avulsion injury in limbs

ZHANG Heng, GUAN Jian-zhong, ZHOU Jian-sheng

2017, 15(4): 602-604. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.018

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Objective To discuss the clinical efficacy of in situ skin grafting in a zigzag pattern combined with vacuum sealing drainage (VSD) in the treatment of retrograde skin avulsion injury of limbs. Methods Total 15 patients with retrograde skin avulsion injury of limbs,9 males,6 females,average age 32.5 years (19 to 52 years),underwent in situ skin grafting in a zigzag pattern combined with VSD in our hospital between February,2014 and March,2015.There was no peripheral vascular disease among these patients,all skin avulsion was retrograde skin avulsion and complete,area of the avulsion skin was from (4 cm×5 cm) to (15 cm×18 cm),without or only with mild contusion,the subcutaneous soft tissue bed was good,or could be restored though accompanied by muscle rupture,without large area exposed bone and tendon.The antibiotics,anticoagulation and antispasmodic therapy were applied after the operation.The negative pressure was adjusted to keep unobstructed VSD dressing continuous drainage.The color,tube type and smell of VSD were observed after the operation.The VSD dressing was removed one week after the operation to assess the survival situation of the skin by recording the color,texture,elasticity and sensation of the flap. Results All 15 flaps survived uneventfully.Two cases were lost in the follow up of 3 months to 20 months.Three cases with distal partial blackened flap were healed by dressing.Compared with normal skin,there was no difference in the color,texture,elasticity and sensation of the proximal and central part of survival flap.However,the distal part of survival flap was dark,thin,poor elasticity,dysaesthesia or anesthesia. Conclusion The in situ skin grafting in a zigzag pattern combined with VSD show the advantages of simple and easy technique,short learning curve and satisfactory clinical efficacy,it is one of effective procedures in management of retrograde skin avulsion of limbs.

Risk factors and prognosis of lower limb deep vein thrombosis after hip fracture among elderly patients

WU Li-mei

2017, 15(4): 605-607,703. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.019

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Objective To investigate the clinical characteristics and risk factors of lower limb deep vein thrombosis (DVT) after hip fracture among elderly patients. Methods Sixty elderly patients suffered from hip fracture in our hospital from October,2012 to April,2016 were recruited.There were 28 cases of femoral neck fracture and 32 cases of intertrochanteric fracture.The color Doppler flow imaging (CDFI) was used to detect DVT of bilateral lower extremities in all patients before orthopedic surgery and on the 3^rd and 7^th days post-operatively.The age,sex,fracture type,hospital-to-operation time and fracture-to-operation time were used to analyze the risk factors of Preoperative DVT.The age,sex,fracture type,hospitalization to operation time,fracture to operation time,anesthesia,Time,surgical method and operation time were used to analysis risk factor of postoperative DVT.The perioperative DVT formation and risk factors were observed and analyzed. Results Among 60 patients,there were 21 cases of DVT (35.0%).There were 9 patients (15.0%) who developed DVT preoperative and 12 patients (20.0%) after the operation.86.7% DVT were found in fracture legs.Logistic regression analysis demonstrated a definite association of intertrochanteric fracture with DVT with odds ratio of 6.0(P<0.05).Logistic regression analysis showed that the fracture type was an independent risk factor of deep vein thrombosis in elderly patients with hip fracture (OR=5.977,P<0.05). Conclusion There is higher perioperative DVT incidence on the injured side than the uninjured side.Intertrochanteric fracture is the risk factor for DVT after operation.In addition,the preoperative DVT incidence is relative high which justified early CDFI examination after admission.

Effects of oxidative stress on neuronal apoptosis and protein expression of c-myc after intracerebral hemor rhage

WANG Li-song, ZHANG Yong-qiang, FENG Zhong, YING Xiao-wei, WANG Xi-jia, HUO Xin-long

2017, 15(4): 608-610,676. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.020

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Abstract:
Objective To investigate the relationship between oxidative stress and neuronal apoptosis after intracerebral hemorrhage (ICH),and the influence of oxidative stress on c-myc expression. Methods Eighty-four male SD rats of 7-week-old were selected and randomly divided into sham operation group,model group,MPEG-SOD group,with 28 rats in each group.Intracerebral hemorrhage model was induced by autologous blood injection.Rats in MPEG-SOD group were injected with MPEG-SOD before modeling.The neurological deficit score (NDS) was measured at 12 h,1 d,3 d and 7 d after the operation.The water content of brain tissue was measured,and the content of malondialdehyde (MDA) and superoxide dismutase (SOD) in brain was measured by spectrophotometric method.The expression of nuclear factor-kappa B (NF-κB) p65 positive cells was detected by immunohistochemistry.The apoptosis of neurons was measured by TUNEL and the expression of c-myc protein was detected by Western blot. Results Compared with the sham-operated group,the NDS score and SOD activity at each time points were obviously decreased,while the water content in the brain tissue,MDA content,c-myc protein expression,NF-κB p65 and TUNEL-positive cells in the model group were significantly increased (P<0.05),which reached the peak 3d after the operation.Compared with the model group,the NDS score,SOD activity,water content in the brain tissue,MDA content,c-myc protein expression and TUNEL,NF-κB p65 positive cells in the MPEG-SOD group were significantly decreased (P<0.05).The expression of c-myc protein and TUNEL-positive cells in the brain tissue was correlated (R=0.83 in model group,as well as r=0.91 in MPEG-SOD group,P<0.05). Conclusion The oxidative stress-induced apoptosis of neurons may be related to the initiation of apoptosis-related gene c-myc after intracerebral hemorrhage.

Effect and outcome of appropriate brace-wear in patients with adolescent idiopathic scoliosis

CAO Bin-hao, WANG Min, YE Zhan, CHEN Jian-jun, WANG Xiang-yang

2017, 15(4): 611-613. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.021

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Objective To investigate the effect appropriate brace-wear in patients with adolescent idiopathic scoliosis. Methods Total 18 cases of adolescent idiopathic scoliosis in our hospital from January,2016 were divided into treatment group (n=9) and control group (n=9).The treatment group received appropriate brace-wear treatment,while the control group received electrical stimulation therapy.Nine months later,the influence of Risser sign and Cobb angle on the result of correction was analyzed The total effectiveness and life quality satisfaction were compared between the two groups. Results Total effective rate was 88.89% in the treatment group,which was better than that of control group (66.67%),P>0.05.The incidence of complications were 11.11% and 33.33% in treatment group and control group,respectively,there was no significant differences between the two groups (P>0.05).The lower the Risser grade was,the higher first diagnosis correct rate and side convex progress rate develop.The first diagnosis correct rate,but not side convex progress rate and top cone rotation correction rate,were differently between the patients with different Risser grade (P<0.05).The function/mobility,pain,mental health and satisfaction score of the treatment group were higher than those of control group (P<0.05). Conclusion Brace treatment can reduce side convex progression and improve the quality of life in patients with adolescent idiopathic scoliosis,especially the patients with mild-to-moderate AIS.

Correlation of mild cognitive impairment with middle cerebral artery stenosis and the risk factors in patients with hypertension

YU Ke, QI Feng, LIU Zu-you, XU Song-hu, MO Qi-xian

2017, 15(4): 614-616. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.022

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Objective To investigate the correlation of mild cognitive impairment (MCI) and asymptomatic middle cerebral artery (MCA) stenosis and the mild cognitive impairment risk factors in patients with hypertension. Methods Two hundred and ten patients with hypertension,who received transcranial color Doppler ultrasound (TCD) in our hospital between April,2012 and April,2013 were enrolled into this study.The simple mental state examination (MMSE) and clinical dementia rating scale (CDR) were used for cognitive function assessment. Results ①Among the 210 patients,28 patients were with MCI,36 patients with MCAS;9 of 36 cases of MCAS were with MCI,the prevalence was 25.0%;there were 27 cases of NMCAS patients with MCI,the prevalence was 10.9%,the difference in prevalence between the two groups was statistically significant.②Age,history of smoking and systolic blood pressure between the two groups was statistically significant.③The stepwise logistic regression analysis showed that:MCAS,systolic blood pressure and age were independent risk factors for MCI. Conclusion MCAS,systolic blood pressure and age are independent risk factors for MCI in patient with hypertension.The examination for intracranial vascular should be performed actively in patient with hypertension,and the early intervention may delay the occurrence of cognitive impairment.

A comparative study of combination therapy with Shexiang Baoxin pill and simvastatin and simvastatin alone on coronary artery disease with hyperlipidemia

SONG Wei, LIN Zu-jin, CAI Hai-peng, XU Yu-shun

2017, 15(4): 617-619,633. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.023

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Objective To investigate the clinical effect of Shexiang Baoxin pill combined with simvastatin on coronary artery disease with hyperlipidemia,and compare with simvastatin alone. Methods Total 192 cases of coronary heart disease with hyperlipidemia were randomly divided into two groups by random number method with 96 cases in each group.The patients in the control group were given simvastatin,while the patients in the observation group received additional Shexiang Baoxin pill.Before and after the treatment,the lipid levels (TC,TG,LDL-C,HDL-C),cardiac function parameters (LVEF,CO,CI,LVEDD),blood viscosity indicators (HBV,LBV,MBV,PV,FIB),endothelin-1(ET-1) of both groups were tested,and the clinical effects of the two groups were observed. Results After the treatment,TC,TG,LDL-C levels of the two groups were significantly decreased (P<0.05),and HDL-C levels were significantly increased (P<0.05);and before and after treatment,the levels of TC,TG,LDL-C,HDL-C levels of the observation group were significantly higher than those of the control group (P<0.05).After the treatment,LVEF,CO and CI of both groups were significantly increased (P<0.05),and LVEDD levels were significantly decreased (P<0.05);and before and after the treatment,changes of LVEF,CO,CI,LVEDD levels of the observation group were significantly higher than those of control group (P<0.05).After the treatment,HBV,LBV,MBV,PV,FIB levels of the two groups were significantly decreased (P<0.05);and before and after the treatment,the changes of HBV,LBV,MBV,PV,FIB levels of the observation group were significantly higher than those of the control group (P<0.05).After the treatment,ET-1 levels of the two groups were significantly decreased (P<0.05),and before and after the treatment,the change of ET-1 level of the observation group was significantly higher than that of the control group (P<0.05).The total effective rate of the observation group was 94.8%,significantly higher than 86.5% of the control group (P<0.05). Conclusion Shexiang Baoxin pill combined with simvastatin is effective on coronary artery disease with hyperlipidemia through improve the condition of blood lipid,cardiac function and blood rheology parameters.The clinical effect of Shexiang Baoxin pill combined with simvastatin was better than that of simvastatin alone.

Analysis of prognostic factors in childhood immune thrombocytopenia

CHEN Tao, LI Fan-fan, ZHANG Zhao-hua, LIU Jie, RUAN Ji-chen, SHU Kuang-yi, JIANG Wei-yan, LI Shan-shan, JIANG Ming-hua

2017, 15(4): 620-622,720. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.024

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Objective Investigating the clinical characteristics of children immune thrombocytopenic purpura and analyzing relevant factors that cause immune thrombocytopenic purpura,in order to provide reference for predicting to the result of ITP. Methods Select cllildren with ITP who were hospitalized in the Second Affiliated Hospital of Wenzhou Medical University from October,2015 to January,2005,and conduct retrospective analyses for 1 150 cases meeting the inclusion criteria for patient.Collect basic information、clinical features,laboratory test results and other data to conduct univariate and multivariate analyses.To make statistical analysis according gender,age,initial platelet count,drug use,curative effect and so on. Results A total of 1 150 cases include 712 cases of male and 438 cases of female.The result between sex and prognosis of ITP was χ²=1.719,P>0.05,age groups were divided into 1 year,1 to 7 years,more than 7 years.The result between age and prognosis of ITP was χ²=2.970,P>0.05,the initial value of platelet,glucocorticoid and immunoglobulin were significant difference (P<0.05) in the prognosis of patients.According to the multivariate logistic regression analysis,the effect factors in the prognosis of the role of are initial value of platelet,corticosteroids and gamma globulin.P=0.000,0.042,0.049 respectively. Conclusion Initial platelet numerical,glucocorticoid hormone and immune globulin protein have positive significance in predicting in immune thrombocytopenia.The Initial platelet value can be used as an independent risk factor for prognosis.When necessary to give early glucocorticoid and gamma globulin therapy has a positive impact on children's immune thrombocytopenic purpura prognosis.This has a positive significance for the future clinical work.

The curative effect analysis of integrative traditional Chinese medicine and Western medicine in treating ovulatory dysfunctional bleeding

ZHANG Qin-fen, JIANG Han

2017, 15(4): 623-625. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.025

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Objective To observe the clinical effect of integrative traditional Chinese medicine and Western medicine in treating ovulatory dysfunctional bleeding (ODB),so as to improve its prevention and treatment. Methods We selected 92 cases of ODB patients in our hospital from July,2014 to December,2015.According to the ratio of 1:1,we divided randomly them into control group and observation group,46 cases per group.Control group accepted western medicine therapy,and control group accepted integrative traditional Chinese medicine and Western medicine.We observe the therapeutic effect of two groups,and compare endometrial thickness of two groups,using SPSS 19.0 software to analyze data,Measurement data using t test,counting data using 2 inspection,P<0.05 indicating that the difference is statistically significant. Results The total effective rate of observation group was 100.0%,and the control group 91.3%.Observation group was obviously higher than control group,and the difference had statistical significance (χ²=4.182,P<0.05).Observation group and control group before treatment in patients with endometrial thickness was (13.8±0.4) mm,(13.7±0.6) mm,and there was no statistically significant difference (P>0.05).After treatment,the observation group and control group patients with endometrial thickness was (6.3±1.1) mm and (8.5±1.4) mm,which were significantly improved,compared with those before treatment,and the difference was statistically significant (P<0.05).But observation group was obviously better than control group,with statistical significance (P<0.05). Conclusion The clinical effect of integrative traditional Chinese medicine and Western medicine was obviously better than that only used Western medicine in treating ODB.Endometrial thickness was improved significantly;therefore,it deserves to be used widely.

Study on satisfactory degree and influencing factors of patients with chronic diseases in Hangzhou community health services

WANG He-mei, LOU Yan, FAN Min-hua, XU Hua-ping, YANG Fang-ying

2017, 15(4): 626-629. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.026

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Objective To investigate the satisfactory degree of patients with chronic diseases in Hangzhou community health services and its influencing factors so as to know the disadvantages of community health services and provide evidence for improving the patients'satisfaction. Methods A total of 651 patients with chronic diseases sign in a certain community health center of Hangzhou from September 1st,2013 to March 1st,2014 was selected for questionnaire research by random sampling in Hangzhou city.A number of 610 questionnaires was recovered,with a 93.7% effective recovery rate.The date was logged by Epidate and analyzed by Stata 12.0.Satisfactory degree and its influencing factors were analyzed with descriptive methods and univariate logistic regression. Results The satisfaction rates on attitude of medical personnel,medical cost,medical environment were the highest,and they were 86.56%,82.79% and 80.81%.While the lowest rate was health education,medical technology,positively provided service,only 71.14%,73.28%,74.10% respectively.Univariate logistic regression showed that satisfactory degree was correlated with profession. Conclusion In order to improve patient satisfaction,community health services centers should implement differentiated services based on characteristics of different patients.Meanwhile,we should improve the level of medical techniques,change the service concept of medical personnel and strengthen communication.

SWOT analysis of transitional care for third-level hospitals and community health service institutions

WANG Jin-ming, WU Sheng-mei, OU Wei-lin, WU Wen-lin, OU Wen-sen, WANG Yan, WANG Jia-ji

2017, 15(4): 630-633. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.027

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Abstract:
Objective To explore the advantages,disadvantages,opportunities and challenges of the third-level hospitals and community health service institutions on carrying out transitional care,to provide ideas and references for the sustainable development of transitional care and the promotion of the two-way referral and grading treatment. Methods Using SWOT analysis method,we made from the theoretical perspective an in-depth analysis of the feasibility and dilemmas in the transitional care between the third-level hospital;community health service organization.And we made a further illustration based on the practical experience of a first-class hospital at Grade 3 in Yichang since May,2012. Results Transitional care can effectively integrate and use the existing health resources under the conditions that the third-level hospitals lacking sickbeds while the community health services sparing lots of sickbeds.It can promote the rational distribution of patients and improve the sickbed turnover of third-level hospitals,improve the level of medical personnel of the community health service institutions and the degree of trust of patients on the community health service institutions,and promote the implementation of grading treatment.However,the social awareness of the transitional care is still inadequate,two-way referral mechanism and transitional care system is not still perfect,community nursing is still with weak abilities and unable to undertake all the referral patients from the third-level hospitals,all these factors are the key to restrict transitional care. Conclusion Under the attention and support of the government,we can fully use the local medical resources,overcome the disadvantages,utilize the external opportunities and resolve various challenges,carry out the transitional care between third-level hospitals and community health service institutions,ensure the sustainable development of nursing,and lay the foundation for the promotion of two-way referral and grading treatment work.

Clinical outcome and quality of life of patients with earlobe keloids after a multimodal therapy approach

ZHANG Yi, ZHANG Li, LIN Xiao-hua, LI Zhi-ming, ZHANG Qi-yu

2017, 15(4): 634-636. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.028

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Objective To investigate the clinical effects of early postoperative magnet application and triamcinolone acetonide injection in patients with earlobe keloids after surgery,and the role in improving the quality of life. Methods A total of 56 patients with 64 earlobe keloids were enrolled in a prospective cohort study.All the patients underwent intramarginal keloid excision followed by triamcinolone acetonide injection (20-40 mg,one time 1 every 2 weeks,total 5 times) and post-excisional pressure therapy with magnetic disks (8 hours every day for total 6 months).The follow up was 12 to 36 months.The quality of life of patients evaluated. Results Four patients (with 5 keloids) were lost in the follow-up.6 of 59 keloids recurred with a rate of 10.2% and 1 mean time of 9±9 months.The itching and pain after the treatment were improved significantly.The score for the itching and pain both before and after the treatment were not statistically significant.The quality of life after the treatment was improved,the mean GBI score was 29.98±16.97,18.13±11.13 in the recurrence group and 32.14±17.04 in the non-recurrence group (P<0.05).The size of the keloids with a relapse was (5.53±4.88) cm³,without a relapse was (5.32±3.87) cm³,there was no statistical significant between the two groups (P>0.05).The relapse rate in patients with a positive family history was 15% and in patients without a positive family history was 15.6%,the different was not significant.The mean score for satisfaction was 3.54±0.73 and the satisfaction rate was 90.4%,the score for satisfaction in the recurrence group was 2.88±1.13,which was lower than 3.66±0.57 in the non-recurrence group (P<0.05);The mean score for the comfortability of magnetic disk was 3.62±0.53,3.70±0.46 in the non-recurrence group which was higher than 3.13±0.83 in the recurrence group (P<0.05). Conclusion The early postoperative magnet application and triamcinolone acetonide injection in patients with earlobe keloids is effective and safe,which can reduce the relapse rate of earlobe keloid and improve the quality-of-life of patients.

Quality of life and the influencing factors in the newly diagnostic patients with pulmonary tuberculosis

MA Chun-yan, SHI Chun-lei, HAN Qin, SHEN Ling-ling, SANG Xing-wang, FANG Gui-hua, LIU Hai-ying, LOU Pei-an

2017, 15(4): 637-640. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.029

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Objective To explore the influencing factors affected quality of life in patients with pulmonary tuberculosis,and provide the theoretical basis for improving their quality of life of patients with pulmonary tuberculosis. Methods The patients with pulmonary tuberculosis who were newly diagnosed and administered from January,2012 to January,2013 in Kuitun City of Xinjiang autonomous region and Gulou district of Xuzhou City in Jiangsu province and matched control were enrolled.The self-designed questionnaire and SF-36 quality of life (QOL) measurement scale,anxiety and depression self-rating scales,the Pittsburgh sleep quality index scale were used face to face to investigate.The linear regression was used to analyzed risk factors affected the quality of life of the newly diagnostic patients with pulmonary tuberculosis. Results Three hundred and fifty-four patients whose average age is 45.21±18.71 were investigated,of them,207(58.47%) are males,147(41.53%) are females;708 subjects whose average age is 45.26±18.56 were investigated in control group,of them,414(58.05%) are males,294(41.53%) are females;QOL was 51.35(42.85,63.31) in patients group,and was 86.60(79.80,89.75) in control group,there was a significant difference between the two groups (Z=-15.93,P<0.05).The different dimensions of QOL,the physical component summary (PCS) and the mental component summary (MCS) of the patients group were all lower than that of the control group (all P<0.05).Linear regression analyzing the factors of the newly diagnostic patients with pulmonary tuberculosis showed that age,exercise,medical insurance and living in dark and damp environment,anxiety,depression and sleep quality were the factors affecting of QOL (P<0.05),and old age,living in dark and damp environment,anxiety,depression and poor sleep quality are risk factors,while long-term training and medical insurance are protective factors (P<0.05).Co-occurrence risk factors affected PCS and MCS including living in dark and damp environment,anxiety,depression,and poor-quality sleep as risk factors (P<0.05). Conclusion The newly diagnostic patients with pulmonary tuberculosis have lower quality of life.While treating patients with pulmonary tuberculosis,anxiety and depression and sleep quality should be screened and intervened,in order to improve the quality of life of patients.

Epidemiological study of thyroid nodules for the medical working staffs in a grade 3 hospital

LIU Qiao-yong, SU Hong

2017, 15(4): 641-643. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.030

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Objective To investigate the detection rate and characteristics of thyroid nodules in a grade 3 hospital staff,and to analyze the related factors. Methods From November,2015 to March,2016,color Doppler frequency probe was used to inspect the thyroid in the medical staff of a the first People's hospital of Xiaoshan.he subject with the surgical indications received fine-needle aspiration or surgical treatment,and then the pathology of tissue was examined. Results Of 1343 subject,628(505 female and 123 male) were positive for thyroid nodules with a detection rate of 46.8%.The detection rate was significantly higher in female than that of male (49.6% vs.37.8%).At the age of 21 to 50,the detection rate in female was significantly higher than that in male (P<0.05).The detection rate of nodule showed a significant upward trend with the increase of age (Male:χ²_trend=24.78,P<0.001;Female:χ²_trend=30.16,P<0.001).The position of thyroid nodules were statistically significant in different genders (χ²=6.594,P<0.05).he incidences of solitary nodule and small nodules were higher.Of 391 cases,16 cases were suspected thyroid cancer,of which 8 cases were confirmed thyroid cancer by surgical resection or biopsy after pathological examination. Conclusion The detection rate of thyroid nodules is high and 46.8% in a grade 3 hospital.he thyroid nodules are mainly small and solitary nodule,thyroid ultrasound examination should be paid attention to in heath examination.

Relationship between trigeminal nerve and its adjacent vessels by 3D-CE-TOF-SPGR sequence in Enshi Tujia nationality population without trigeminal neuralgia

HU Xing-rong, QIU Ni-ni, XIANG Hai-bo, CHEN Hua-dong, ZHANG Li-jun

2017, 15(4): 644-646. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.031

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Objective To explore relationship between trigeminal neuralgia in the cisternal segment and its adjacent vessels by 3D-CE-TOF-SPGR sequence in Enshi Tujia nationality population without trigeminal neuralgia. Methods The enhanced axial 3D-TOF-SPGR combined multiplanar reconstruction (MPR) were performed in 50 Enshi Tujia nationality subjects without trigeminal neuralgia to observe the relations between cisternal segment of the trigeminal nerve and its adjacent vessels and the existence of vascular compression.The result was compared with the data from literatures. Results Among the 50 patients,the trigeminal nerve and adjacent vessels were shown clearly.The trigeminal nerve and adjacent vessels were discrete in 74 sides (74%),contact in 24 sides (24%) and oppressive in 2 sides (2%).When compared with literatures (77% and 23%),the difference was not significant (χ²=0.243,P=0.622). Conclusion The 3D-CE-TOF-SPGR sequence could be used to investigate relationship between trigeminal nerve and its adjacent vessels.There is no significant difference for rate of contact and compression between microvascular and trigeminal nerve in Enshi Tujia nationality population without trigeminal neuralgia.The results may become basis to research etiology of trigeminal neuralgia of Enshi minority groups.

Assessment of efficacy by color ultrasound in breast cancer patients with neo-adjuvant chemotherapy

FENG Ya-qin

2017, 15(4): 647-649. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.032

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Objective The pathological examination did not provide the basis of lesion changes after chemotherapy in patients with breast cancer.The aim of this paper is to investigate the clinical application value of color ultrasound in breast cancer patients with neo-adjuvant chemotherapy. Methods A total of 84 breast cancer patients were selected in our hospital from April,2014 to August,2016.All of breast cancer patients received treatment with neo-adjuvant chemotherapy.To compare lesion changes,hemodynamic index changes of lesion and hemodynamic index changes of abnormal axillary lymph nodes before and after chemotherapy. Results After the neo-adjuvant chemotherapy,the lesion volume decreased significantly (P<0.01),there was significant difference on lesion morphology,border,peripheral vocal cords,peripheral echo and blood flow classification (P<0.05);The pathological evaluation as the gold standard,the sensitivity was 83.02%,the specificity was 63.96% through color ultrasound;consistency of pathological evaluation and color ultrasound:Kappa=0.390,P<0.01;When compared with the values before neo-adjuvant chemotherapy,Vmax and RI of the richest Blood vessels section of lesion decreased significantly in the effective (CR+PR) group (P<0.01),there was no significant difference on Vmax and RI in the invalid (SD+PD) group (P>0.05),and Vmax and RI of the effective group was significantly lower than those in the invalid group (P<0.01);After the neo-adjuvant chemotherapy,Vmax and RI of the richest Blood vessels section of abnormal axillary lymph nodes decreased significantly in the effective group (P<0.01),there was no significant difference on Vmax and RI in the invalid group (P>0.05),and Vmax and RI of the effective group was significantly lower than those in the invalid group (P<0.01). Conclusion Color ultrasound can provide a valuable method for the assessment of efficacy in breast cancer patients with neo-adjuvant chemotherapy.

A comparative study of contrast-enhanced spectral mammography and magnetic resonance imaging in breast cancer diagnosis

XU Hai-dong

2017, 15(4): 650-653. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.033

156 1

Abstract:
Objective To compare the utility of contrast-enhanced spectral mammography (CESM) and magnetic resonance imaging (MRI) in the diagnosis of breast cancer. Methods From January,2016 to September,2016,a total of 40 women with breast cancer confirmed by pathology were enrolled as research object to performed with CESM and BMRI.Age ranged was from 32 to 76 years,with an average age was (48.6±11.7) years.No pregnant,without receiving the mastectomy,or breast reconstruction,without chemotherapy,or shown to iodine contrast agent or other contrast agent allergy.There were 53 piece of lesions in 40 patients,including 32 piece of lesions in 22 cases of infiltrating ductal carcinoma;7 piece of lesions in 7 cases of mixed tumor;5 piece of lesions in 5 cases of invasive lobular carcinoma;3 piece of lesions in 3 cases of invasive adenocarcinoma;2 piece of lesions in 1 cases of intraductal carcinoma;2 piece of lesions in 1 cases of leaf tissue tumor of the breast meat;2 piece of lesions in 1 cases of papillary carcinoma.The average maximum dimensions of the lesions were measured.The differences in sensitivity,specification,accuracy,positive predictive value and negative predictive value were compared between the two methods. Results Fifty-there lesions were identified.The mean size of lesions tested by CESM and MRI were (32.7±27.7) mm and (33.4±29.5) mm,which show no differences between the two methods (P>0.05).CESM sensitivity was 100%(vs.97.4% for MRI),specificity was 66.7%(vs.53.3% for MRI),accuracy was 90.6%(vs.84.9% for MRI),positive predictive value was 88.4%(vs.84.1% for MRI),and negative predictive value was 100%(vs.88.9% for MRI) for breast cancer diagnosis.There was no statistically significant difference between the two methods for the diagnostic indexes (P>0.05). Conclusion Compared with MRI,CESM can provide great sensitivity,specification,accuracy,PPV and NPV,which has potential application value in breast cancer detection.

2017, 15(4): 653-654,692. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.034

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Research progress of tumor gene therapy

XU Jian-ji, WANG Shuang, KOU Bu-xin, CHEN De-xi, LIU Xiao-ni

2017, 15(4): 655-658. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.035

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Abstract:
Gene therapy is one of biological treatment methods that exogenous normal gene is transferred into target cells by gene transfer technology to correct or compensate for genetic defects or abnormality of diseases in order to achieve the treatment purpose.In this paper,research and development status of tumor gene therapy in recent years were reviewed from suicide gene,gene silencing,tumor suppress gene,immune gene and anti-angiogenesis gene.Suicide gene therapy system include:HSV-tkGCV system,H19 RNA,hTERT,etc.HSV-tkGCV system is one of the most studied suicide gene therapy system.TK gene is drug sensitivity gene and tumor cells will be kill by GCV or ACV after transfect with TK gene.RNA interference is a major mode of gene silencing therapy.The growth of tumor was inhibited obviously when silent tumor related genes (IDO2,DUSP6,IGF1R,ORAOV1,etc.).Activation or overexpression of tumor suppress genes can also suppress tumor growth,such as p53 and PTEN gene.Cytokines or costimulatory molecules were used to activate immune functions of body to kill tumor cells in immune gene therapy.Common immunologic effector cells were TIL,CTL,LAK,NK,etc.and target genes were TNFIL,CSF,IFN,CF,etc.Anti-angiogenesis gene by suppressing anti-angiogenesis in tumors for stopping tumor growth and metastasis.VEGF-Trap,PEDF,ES can significantly inhibit tumor growth by transfected with adenovirus.The problems such as specificity,safety and targeting still exist in current cancer gene therapy.

Epidemiological Characteristics and Therapeutic Progress of Pregnancy-related Low Back Pain

SONG Cheng-xian, WANG Run-mei, LI Tai-liang, LIU Juan

2017, 15(4): 659-662. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.036

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Pregnancy-related low back pain (PLBP) is a common complaint among maternal.Pain and dysfunction are the main clinical manifestations.PLBP is considered to be normal and expected status during pregnancy by many patients,their families or doctors.And they think treatment is not needed.PLBP has been ignored and untreated.However,PLBP may have many negative impacts on their daily life,work,social communications or psychological health,which poses a serious care and economic burden to their family and the society.Since research for the prevalence of PLBP is no unified understanding.And there exists great difference among different study.Research on the prevalence of PLBP has not been carried out yet in China.At present,there is some difference about the risk factors of PLBP.The study about the pathogenesis of PLBP is not deep and complete that mainly concentrates on the change of lumbar physiological curvature,intervertebral disc,core muscles and relaxin.Although,there are a number of treatments,such as obstetric care,TENS,chiropractic treatment,exercise,drugs,and acupuncture.They cannot produce a recognized the best treatment plan.In particular,there are many restrictions on the treatment of low back pain during pregnancy.This article reviews the epidemiological characteristics and treatment progress of PLBP.We hope to provide more information for prevention and treatment of PLBP.

The balance of HGF and TGF-β1 in the remodeling of chronic rhinosinusitis

SHA Min, LI Yong, LI Jing

2017, 15(4): 663-666. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.037

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Abstract:
Chronic rhinosinusitis (CRS) often presents as the inflammation of the nose cavity and the mucous membrane lining of the sinuses for up to three months.Meanwhile CRS is a common health problem of otorhinolaryngology-head and neck surgery,it has a high prevalence rate that leads the treatment unsatisfactory for most of patients in the clinical efficacy with the effects of the recurrence of the drug treatment and the complications after surgical treatment.Due to the long-term chronic inflammation stimulation,the remodeling of CRS is an inevitable result and eventually leads to the changes in mucosal structure and function.The changes of mucosal structure is hard to be irreversible,thus this increases the difficulty of the treatment,at the same time leads to chronic and refractory of disease further.The remodeling of CRS has not yet been clearly defined in the studies of the medical community,which is considered to be a result of the combination of various factors.Cytokines play vital role in the process of inflammation and remodeling processes in CRS,so far multiple cytokines have been found to be closely related to the remodeling of CRS,one of cytokines with the hottest study is called as Transforming growth factor-beta1(TGF-β1),that is commonly recognized as the strongest factor in the fibrosis,involved in the regulation of remodeling processes of multiple organ tissue.TGF-β1 has been demonstrated as an indispensable role in remodeling processes in CRS,and Hepatocyte growth factor (HGF) exerts various biological effects in multiple cells and tissues by binding to its receptor c-Met.TGF-beta1 has been demonstrated as a crucial regulatory factor in this process in CRS as well.Furthermore,(HGF) can affect the expression of TGF-beta1 and play a role in anti-fibrosis.The balance of HGF and TGF-beta 1 plays a key role in regulating in CRS.This review aims to summarize the current findings on the mechanisms of two factors in CRS,so as to state the role of TGF-beta1 and HGF in the regulation of remodeling.

Progress of cognitive dysfunction after sepsis

ZHANG Er-fei, LI Nan, ZHAO Xiao-ying, YAN Jin-qi, TU Ke, LI Xiang-rui, YIN Wan-wan, YAN Ru-hu, HOU Li-chao

2017, 15(4): 667-671. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.038

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Sepsis is a systemic disease with life-threatening organ dysfunction due to a dysregulated host response to infection,and characterized by high morbidity,high mortality and high cost.Despite of the fact that large number of studies has confirmed the beneficial therapeutic strategy,clinical results are not very satisfactory,and the overall mortality rate of sepsis has not been significantly improved.And organ damage induced by sepsis,especially cognitive dysfunction caused by brain injury resulting from sepsis is increasingly prominent in the clinic.Cognitive dysfunction caused by sepsis is performed by decline and executive dysfunctions in memory,attention,visuospatial ability and etc,thus it makes the patient's quality of life declined,makes the medical and social care costs increased,which is becoming a great burden for families and society.Therefore,the emphasis on prevention and treatment to sepsis brain injury is of great significance.This paper reviews the research on cognitive dysfunction resulting from sepsis,epidemiology,hazards,pathogenesis and treatment of the status quo to discuss this issue in order to provide reference for readers.

Research progress of the correlations between mitochondria and type2 diabetes mellitus

FAN Run-ping, XU Xiao-hong

2017, 15(4): 672-676. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.039

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Abstract:
The essence of life is the interaction of structure and energy.However,in modern medicine,little is known about the defects in energy metabolism in the disease.Energy is mainly produced in mitochondrion,which generates ATP that can be used directly by the oxidation of respiratory chain and generates harmful reactive oxygen species (ROS) at the same time.From the perspective of genes,there are hundreds of copies of mitochondrial DNA in each cell.And the mitochondrial DNA encoded proteins form part of the respiratory chain,which is essential for energy production.Mitochondrial dysfunction is associated with the occurrence and development of many diseases.Different tissues differ in the number of mitochondria due to different energy requirements.When the energy which produced by mitochondria is unable to meet the needs of the body,disease will occur.For example,type 2 diabetes mellitus (T2DM),high blood pressure,deafness,etc.At present,the incidence of T2DM is increasing by years,and previous research has shown that it is related to the occurrence and development of mitochondria.Therefore,this paper gives a general review of research on the risk of T2DM from the change of the structure and function of mitochondria,energy metabolism,mitochondrial DNA variants and haplogroups.

Clinical effect analysis of Jiawei Bufei decoction on COPD 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(4): 677-680. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.040

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Abstract:
Objective To investigate the clinical effect of Jiawei Bufei decoction on chronic obstructive pulmonary disease (COPD) with depression and its influences on TCM syndrome score,depression status,serum inflammatory factors and immune function. Methods Two hundred and fifty-six cases of COPD with depression patients from January,2015 to June,2016 were randomly divided into two groups,with 128 cases in each group.he control group was treated with conventional western medicine,and the observation group was added with Jiawei Bufei decoction.Before and after treatment,the TCM syndromes scores,depression scores,serum inflammatory factors,and immune function of two groups were detected.And the clinical curative effect was accounted. Results After treatment,the TCM syndrome scores of two groups were significantly reduced (P<0.05),and the TCM syndrome scores of observation group were significantly lower than those of the control group (P<0.05).After treatment,HAMA and HAMD of two groups were significantly reduced (P<0.05),and HAMA and HAMD of observation group were significantly lower than those of control group (P<0.05).After treatment,TNF-α and IL-6 of two groups were significantly reduced (P<0.05),and TNF-α and IL-6 of observation group were significantly lower than those of control group (P<0.05).After treatment,IgM,IgG and IgA levels of two groups were significantly increased (P<0.05),and IgM,IgG and IgA levels of observation group were significantly higher than those of control group (P<0.05).The total effective rate of observation group was 89.7%,which was significantly higher than that of control group 77.0%(P<0.05). Conclusion Based on routine western medicine treatment,Jiawei Bufei decoction could effectively reduce the serum inflammatory factors,improve immune function and alleviate the clinical symptoms of COPD with depression patients.

Clinical research on the acupuncture therapy of insomnia by sticking and vibrating of needle at Anmian point

FU Yun-qi, XIE Hong-kang, YAO Xiao-ping, ZHANG Hang-man

2017, 15(4): 681-684. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.041

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Abstract:
Objective To observe curative effect of acupuncture therapy with sticking and vibrating of needle at Anmian point in the treatment of insomnia,and evaluate its value for extension and application. Methods One hundred and nineteen cases with insomnia in our hospital between January,2015 and February,2016 were enrolled and randomly distributed into two groups:observation group (62 cases) and control group (57 cases).The observation group was received sticking and lifting of needle plus vibrating technique at Anmian point,while the control group was received conventional Electroacupuncture treatment after arrival of Qi at Zhaohai (KI6),Shenmai (BL62),Zusanli (ST36),Sanyinjiao (SP6),Shenmen (HT7),Baihui (DU20),Neiguan (PC6),Sishencong (EX-HN1).The clinic effect was evaluated with the Pittsburgh Sleep Quality Index (PSQI) by comparing the rating score of each factor and total score. Results The total effective rate was 88.7% in the observation group and 71.9% in the control group,there were significant differences between two groups (Z=-2.634,P<0.05).Comparing the scores of each factor and total scores between pre and post acupuncture treatment,there were statistically significant differences in the scores of each factor and total scores in PSQI in the observation group (P<0.05).There were statistically significant differences in the scores of sleep quality,sleep latency,sleep duration,sleep efficiency factors in PSQI in control group (P<0.05).Comparing the scores between two groups,there was no statistically significant difference in the scores of each factor and the total scores before the acupuncture treatment (P>0.05),however,there were statistically significant differences in the scores of sleep quality,sleep disturbance,daytime dysfunction factors and total scores in PSQI after the treatment (P<0.05),and there was no statistically significant difference in the scores of sleep latency,sleep duration,sleep efficiency,use of sleep medication factor in PSQI after the acupuncture treatment (P>0.05). Conclusion The curative effect of the treatment on insomnia by Sticking and lifting of needle plus vibrating technique at Anmian point is more significant than the conventional treatment method.This technique is worth promoting in clinic.

Practical study of uniform final examination for general practitioner's in-service training

LI Luo-chang, CHEN Hong-yan, HE Ying, ZHOU Yong-fen, DENG Hui-sheng, LUO Tian-you, HUANG Ying, LU Zhi

2017, 15(4): 685-686,707. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.042

144 0

Abstract:
Objective To investigate the effectiveness and existing problems with in-service training for general practitioner,and provide the basis for the improvement of training method and quality. Methods The uniform final examination was performed in all general practitioners who finished the in-service training.The reliability,distinction and validity of the tests were evaluated by a team of experts.The results of the final examination were analyzed statistically with Kruskal Wallis Test (α=0.05). Results Between 2012 and 2015,the median score for theory test,basic skills,physical examination and cardiopulmonary resuscitation was 60.0 to 82.5,and the interquartile range was 55.2-66.7,64.3-77.2,61.5-82.5 and 69.0-87.0,respectively.The median score for reception was 65.0 to 76.0,and the interquartile range was 60.0-80.0.All the test results were improved as compared with the year before,the difference was statistically significant (P<0.05). Conclusion The uniform final examination showed that the levels of basic theory and basic skills of general practitioner can reach the general qualifications after the training,but the reception ability is still low,and there is still gap from the ideal in the ability to deal with the common diseases in grass-roots hospitals and health care.The individual differences are significant among the trainees.The reception ability of general practitioner should be pay more attentions in the future training to strength the practice activity,and try SP simulation teaching and layered individualized training mode.

The relationship between the risk of osteoporotic fracture and spine activity and spine curvature in the elderly

HE Li-yu, XU Yu, YAN Cheng, CHEN Wei, RUAN Jian-wei

2017, 15(4): 687-689,723. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.043

122 2

Abstract:
Objective To investigate the relationship between the risk of osteoporotic fracture and spine activity and spinal curvature in the elderly. Methods A total of 90 cases of elderly patients who met the inclusion criteria was collected.he probability of hip fractures and the probability of osteoporotic fracture were evaluated by using the fracture risk assessment tool.Spinalmouse was used to measure the trunk inclination angle,curvature of spine,angle of intervertebral space of spine of upright position,forward flexion,backward extension,and weight-bearing position. Results The risk probability of hip fracture was positively correlated with trunk tilt angle and T_7/8 angle (P<0.05).The risk probability of main osteoporotic fracture was positively correlated with trunk tilt angle and T_7/8 angle (P<0.05).The risk probability of hip fracture was positively correlated with upright lumbar curve and upright thoracic curve (P<0.05).The risk probability of main osteoporotic fracture was positively correlated with the upright to forward flexion lumbar curvature and upright thoracic curve (P<0.05).The risk of hip fracture was negatively correlated with the change of the upright to forward flexion thoracic curve (P<0.05),but there was no significant correlation with the changes of the upright to forward flexion lumbar curvature,the upright to backward extension lumbar curvature and the upright to backward extension thoracic curve (P>0.05).The risk probability of the main osteoporotic fracture was negatively correlated with the change of the upright to forward flexion thoracic curvature (P<0.05),but there was no significant correlation with the changes of the upright to forward flexion lumbar curvature,the upright to backward extension lumbar curvature and the upright to backward extension thoracic curve (P>0.05).There was positive correlation between hip fracture and weight-bearing anteversion change and weight-bearing chest bending change (P<0.05),but there was no significant correlation with the weight-bearing lumbar curve change (P>0.05).The risk probability of main osteoporotic fracture was positively correlated with the changes of weight-bearing anteversion and weight-bearing chest bending (P<0.05),but there was no significant correlation with the weight-bearing lumbar curve change (P>0.05). Conclusion The risk of osteoporotic fractures in the elderly is related to spinal capacity and spinal curvature.Spinal activity and spine morphology can reflect the risk of osteoporotic fractures.

2017, 15(4): 690-692. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.044

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Abstract:

The impact of social capital and perceived professional benefits on work alienation among nurses

CHEN Xiao-he, YAO Ming-ya, CHEN Zhi-min, YE Ping, RUAN Lin-hui

2017, 15(4): 693-696. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.045

139 2

Abstract:
Objective To investigate the current situation of social capital,perceived professional benefits and work alienation among nurses and to analyze the impact of social capital and perceived professional benefits on nurses work alienation. Methods A total of 3 684 nurses in five large three level hospital in Zhejiang by convenient sampling was selected to get the scores of the questionnaire by general situation questionnaire,the Chinese workplace social capital scale,and the questionnaire of Nurses'perceived professional benefits and nurses'work alienation.A database of survey questionnaire was established with SPSS 12.0 software which was used for date management and analysis,and then multiple regression analysis was used to analyze the influencing factors of nurses'work alienation. Results ①The score of social capital was 25.79±5.12,the score of professional benefits was 122.45±13.55 and the score of work alienation was 43.69±8.62;②The work alienation was in negative correlation with social capital and professional benefits,and the difference was statistically significant (P<0.05);③Professional titles,incomes,social capital and professional benefits are factors account for nurses'work alienation with statistical significance (P<0.05). Conclusion The work alienation was correlated with social capital and professional benefits.The higher the level of social capital and professional benefits in nurses,the lower the sense of work alienation,reflecting in their feeling of frustration,helplessness and meaninglessness.Nursing managers should take active and effective measures to improve the level of social capital and professional benefits in nurses,aiming to reduce the level of work alienation and to improve the job satisfaction of nurses and the quality of nursing work.

Effect of team work management mode on nursing care of patients with renal carcinoma after operation

LI Jia, LIU Dan

2017, 15(4): 697-699. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.046

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Abstract:
Objective To explore the effect of team work management mode on nursing care of patients with renal carcinoma after operation and improve the quality of clinical nursing. Methods Ninety-two cases of renal carcinoma treated in our hospital were selected from December,2013 to December,2014,and divided into the control group and the experimental group according to the simple random sampling.Two groups of patients discharged after the implementation of the continuation of regular nursing,including the community referral and follow-up 4-5 weeks postoperative follow-up CT/MRI,outpatient visits,seminars etc.Experimental group based on this implemented team work management mode on nursing care,mainly including:psychological consulting group,peer volunteer groups,six groups of collaborative care;measurement scale by the world health organization quality of life (WHOQOL-100) was used to evaluate the quality of life of the patients when discharged and 6 months after discharge,thus to compare the intervention effect. Results The survival quality score of patients after six months'of discharge in the experimental group and the control group was 41.22±3.87,71.17±3.82 respectively;experimental group is higher than that of the control group,and the data difference has statistical significance (P<0.05);experimental group and the control group of SAS/SDS score respectively 27.78±3.67,28.28±4.73,58.48±4.39,56.28±4.73;experimental group scores were lower than the control group and the differences were statistically significant (P<0.05). Conclusion The team work management mode can improve the quality of life of patients,reduce the negative emotions of patients.Postoperative care effect is significant,and has important clinical values.

Effects of synergistic nursing model on IL-23,IL-17 inflammatory factors and psychological and physical condition in patients with ulcerative colitis

DU Li-yun, ZHU Qin, LIN Ling-ping, NI Li-ping

2017, 15(4): 700-703. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.047

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Abstract:
Objective To observe the effect of synergistic nursing model on IL-23 and IL-17 inflammatory factors and psychological and physical condition in patients with ulcerative colitis. Methods From January,2013 to December,2014,88 patients with ulcerative colitis in Zhejiang hospital were divided into observation group and control group.he patients in the two groups were given different treatments according to the different conditions.he control group was given routine nursing.he observation group was given the model of synergetic care on the basis of routine nursing.he IL-17 and IL-23 expression in the two groups were observed before and after the treatment,meanwhile two groups were given SF-36 and depression self-rating survey. Results Compared with those before treatment,the levels of IL-17 and IL-23 in the observation group and the control group decreased significantly after treatment (P<0.05).The decrease of the above indexes in the observation group was higher than that in the control group (P<0.05),Mental health,social function,emotional function,energy,physical pain,health status,physiological function and psychological function scores of the observation group and the control group were all higher than those before treatment (P<0.05).The score of quality of life,mental health,social function,emotional function,energy,physical pain,health status,physiological function and psychological function of the observation group were higher than those of the control group (P<0.05) The difference was not statistically significant (P>0.05).In the observation group,the self-rating depression score of the treatment group was lower than that of the control group (P<0.05).Before the treatment,the self-rating score of the two groups was significantly lower than that of the control group.he difference was not statistically significant (P>0.05). Conclusion Collaborative nursing model can effectively improve the peripheral IL-17 and IL-23 expression in patients with acute pancreatitis.It is also targeted to fully mobilize the patient's initiative,participate in self-behavior management and health decision-making,improve the patient's quality of life,and reduce the incidence of depression,thus worthy of clinical use.

The clinical effect of health education combined with continuous nursing on rehabilitation of patients after traumatic brain injury

YANG Xiao-yan, YANG Jian, SHOU Ji, MAO Zhi-fang, XU Min

2017, 15(4): 704-707. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.048

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Abstract:
Objective To explore the rehabilitation effect of health education combined with continuous nursing on post-traumatic brain injury patients. Methods From December,2014 to June,2016,120 cases of patients undergoing traumatic brain injury were randomly divided into control group and observation group.he control group was treated with health education,and the observation group was treated with continuous nursing on the basis of the control group.he cognitive impairment was assessed by LOTCA and MMSE.he neurological deficits and self-care ability scores were evaluated by NIHSS and BI.he nursing satisfaction of the two groups was evaluated. Results The scores of LOTCA and MMSE in the two groups were not significantly different (P>0.05).The scores of LOTCA and MMSE in the observation group increased 6 months after admission,and the scores of LOTCA and MMSE scores in the observation group were significantly higher than those in the control group (P<0.05).There was no significant difference in neurological deficit scores and self-care ability scores between the two groups on admission (P>0.05).Six months after admission,the scores of the two groups were significantly improved,and the observation group improved more significantly than the control group,with a statistical significance (P<0.05).he satisfaction rate of the observation group was 100.00%,significantly higher than 71.67% of the control group (χ²=-2.836,P<0.05). Conclusion The use of health education combined with continuous nursing for the recovery of patients after traumatic brain injury can be significantly improved,which serves to improve nerve defects and improve self-care ability to improve care satisfaction,thus worthy of clinical application.

The analysis of related factors about Alzheimer's disease patients of aspiration/suffocation

HE Wen-wen

2017, 15(4): 708-711. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.049

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Objective To explore the influence factors of aspiration on patients with Alzheimer's disease. Methods The patients with Alzheimer's disease in our hospital from January,2013 to December,2014 were applied with agitation questionnaire,mini mental state intelligence screening scale,ADL rating scales,dementia behavioral pathology evaluation table,general questionnaire and aspiration/suffocation risk assessment,and record the patients'gender,age,marital status,education level,eating posture,aspiration history,the use of sedative/antiepileptic and total aspiration/suffocation risk assessment,all undergoing the drinking test,via the analysis method of Pearson multiple stepwise regression and correlation. Results Aspiration/suffocation risk assessment score was related to the patient's age,eating posture,aspiration history and the use of sedation/antiepileptic drugs,but had no significant correlation with patient's sex,marital status,degree of education.Drinking water test (P<0.001),mini-mental state examination (MMSE,P=0.005),activities of daily living (ADL,P<0.001),Cohen-Mansfield agitation inventory (CMAI,P=0.020),and the circadian rhythm (P=0.008) were significantly associated with the risk of aspiration and asphyxia.Drinking test,aspiration/asphyxia,eating posture,age,drug are independent factors of aspiration/suffocation in patients with Alzheimer's disease. Conclusion The following factors on patients with Alzheimer's disease misinhalation/suffocation risk has great referential value,which mainly include positive drinking water test,supine and eating,elderly,low self-care ability and anti-psychotic drugs or the use of sedative drugs.

Observation and countermeasure of perioperative nursing for patients with severe craniocerebral injury

LI Fei

2017, 15(4): 712-714. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.050

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Abstract:
Objective To summarize the main nursing measures for patients with severe craniocerebral injury during perioperative period and explore its clinical effect,thus exploring the nursing experience for clinical reference. Methods The clinical data of 79 patients with severe craniocerebral injury in our hospital from June,2015 to June,2016 were analyzed retrospectively.All the patients were treated by the operation of intracranial hematoma,and the specialized nursing staff in perioperative period.Nursing interventions for patients included psychological nursing before and after operation,special nursing care (symptomatic nursing,prevention of complications,emergency nursing) and postoperative rehabilitation training.We aim to investigate the clinical treatment and nursing intervention in patients with total effective rate,KPS score,daily life ability score,the incidence of complications. Results Before treatment the KPS score was (62.3±5.1) points,and the daily life ability score was (52.3±6.0) points;after treatment,the KPS score was (86.8±6.9) points,the daily life ability score was (52.3±6.0) points.After operation,the KPS score (t=10.50,P<0.05) and daily life ability score (t=13.22,P<0.05) of the patients were all significantly improved compared with those before treatment.he average hospital stay was 45 days.Among 79 patients with severe craniocerebral injury,49 cases were cured (62.03%),21 cases were improved (26.58%),9 cases (11.39%) were stable,and the total effective rate was 88.61%(70/79).The incidence of perioperative complications was 11.39%(9/79). Conclusion For severe brain injury patients,the clinical needs to attach importance to the implementation of professional care of the perioperative period,especially psychological care and special care,which will help patients to get better treatment effect.

Risk factors of depression in patients with hospitalized viral hepatitis cirrhosis and the effect of psychological nursing intervention

XU Meng

2017, 15(4): 715-717. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.051

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Objective To analyze the risk factors of depression in patients with hospitalized viral hepatitis cirrhosis,and investigate the effects of psychological nursing intervention. Methods Two hundred cases of hospitalized viral hepatitis cirrhosis patients in our hospital from January,2014 to December,2015 were retrospectively analyzed.The depression status of patients was detected by self-rating depression scale (SDS),and the risk factors were analyzed by univariate analysis.And the depression patients were randomly divided into two groups.Observation group was given psychological nursing intervention,and control group was given routine nursing.The depression changes of patients were detected by psychosomatic symptoms self-rating scale (SCL-90) and SDS to evaluate the effect of psychological nursing. Results The depression incidence of hospitali zed viral hepatitis cirrhosis patients was 47.0%,mainly including mild and moderate depression.Younger age,lower degree,smaller family income,severe liver cirrhosis,time of Hepatitis B infection>5 year were the risk factors of depression in patients.After psychological nursing intervention,the each index in SCL-90(somatization,coercion,interpersonal relationship,depression,anxiety,hostility,horror,mental symptoms) and SDS scores of observation group were significantly reduced compared to that before psychological nursing (P<0.05),and significantly lower than those of control group (P<0.05). Conclusion Hospitalized viral hepatitis cirrhosis patients easily occurred depression,and younger age,lower degree,smaller family income,severe liver cirrhosis,time of Hepatitis B infection>5 year were its risk factors.Psychological nursing intervention could effectively improve their depression.Therefore,risk factors of depression in Hepatitis B cirrhosis patients should be draw attention,and psychological nursing should be carried out to improve the patient's psychological state.

The application values of standardized communication for the cardiovascular disease patients in the intensive care unit

DAI Guo-li, YAN Zhong-hui

2017, 15(4): 718-720. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.052

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Objective To investigate the application values of standardized communication for the cardiovascular disease patients in the intensive care unit. Methods Ninety-two cardiovascular disease patients in the intensive care unit of Huzhou Central Hospital from August,2012 to February,2015 were selected and randomly divided into treatment group and control group,with 46 cases in each group.Patients in control group were given conventional nursing of CCU,and patients in treatment group were added SBAR communication system based on control group.Patients in two groups were nursed for 14 d,then the depression score changes,complications incidence,and nursing satisfaction of the two groups were recorded. Results After treatment and nursing,the depression scores of two groups were significantly improved,compared to those before treatment (treatment group:6.44±1.67 vs.20.44±1.87;control group:10.49±1.89 vs.20.33±2.09),and the differences were statistically significant (P<0.05).The treatment group (6.44±1.67) was more significantly improved compared to that of the control group (10.49±1.89),with a statistical difference (P<0.05).The nursing satisfaction of treatment group were higher than that of control group (100.0% vs.84.8%),and the differences were statistically significant (P<0.05). Conclusion Standardized communication for the cardiovascular disease patients in the intensive care unit could help to alleviate depression symptoms,reduce the incidence of cardiovascular events,promote nurse-patient relationship,and improve nursing service satisfaction.

2017, 15(4): 721-723. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.053

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2017, 15(4): 724-726. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.054

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2017, 15(4): 727-728. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.055

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2017 Vol. 15, No. 4

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