中华全科医学

Research on health related quality of life and its influencing factors among rural residents in Shandong province

DOU Wei-jie, HAN Zhi-yan, SONG Kui-meng, SONG Yan, ZHEN Tian-min

2017, 15(6): 911-914,992. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.001

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Objective To investigate the health-related quality of life (HRQoL) among rural residents in Shandong province and analyze the influencing factors. Methods By using stratified sampling method,the HRQoL of 1 260 rural residents in Shandong was assessed with EQ-5D scale. Results The five dimensions of EQ-5D scale can generate total of 243 answers.Our study found the study subjects produced 37 of 243 answers.The largest proportion of the study subjects'answers to health status was "no problem" in all five dimensions,accounting for 63.48% of total study population.The results showed that pain/discomfort and anxiety/depressed were the major health problems of rural residents in Shandong Province.EQ scores was 81.23±15.53,and the average health index was 0.798±0.086.Comparison of five dimension,EQ scores and health index with different age,culture,marital status,income showed statistical significance (P<0.05).The multivariate analysis showed that gender,age,cultural degree,marital status and income were influencing factors among the rural residents in Shandong Province. Conclusions The health-related quality of life among rural residents in Shandong Province is accessible.Women,older,divorced,low cultural level and low income are the risk factors.So the government should pay more attentions to people's main health problems.Health of vulnerable groups such as women,elderly,low-income people should be protected as a top priority in order to improve their health related quality of life and equity in health.

2017, 15(6): 915-916.

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Detection and significance of hydrogen-methane breath test among Crohn disease patients in remission

ZHANG Lu, WANG Shi-yi, FAN Yi-hong, CHEN Yan

2017, 15(6): 917-920. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.002

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Objective To analyze the small intestine bacterial overgrowth (SIBO) and related factors among Crohn disease (CD) patients in remission,and discuss the clinical application of hydrogen-methane breath test in CD patients. Methods The glucose hydrogen-methane breath tests was conducted among 25 CD patients in remission (CDAI<150) and 20 healthy people (control group).Based on testing result,CD patients in remission were further divided into SIBO positive and SIBO negative group.The symptom score (abdominal pain and abdominal distension),stool character,serum inflammatory markers (TNF-α,IFN-γ,IL-6 and IL-10) and oxidative stress related markers (GSH and LPO) among the three groups were compared statistically. Results ①The prevalence of SIBO (44%) among CD was significantly higher than that (5%) in control group (χ²=0.72,P<0.01).②Abdominal distension score among SIBO positive group was higher than that in SIBO negative group (P<0.05).There were no significant differences about abdominal pain score,stool frequency and character between the two groups (P>0.05),but significantly higher than that in the control group (P<0.01).Ages,course,location,behavior and CDAI scores were not correlated to SIBO.③GSH in SIBO positive group was lower than that in SIBO negative group (P<0.05).However,there were no significant differences about TNF-α,IFN-γ,IL-6,IL-10 and LPO between the two groups (P>0.05). Conclusions Compared with healthy people,the prevalence of SIBO is more common among CD patients,which may be one of reasons about the aggravation of digestive-related symptoms,especially abdominal distension.Intestinal microenvironment change and oxygen free radical removal may take part in the occurrence and development of SIBO.If patients are with positive SIBO,antibiotics and probiotics can be adopted.Because of the limited cases,more studies should be taken to identify the theory.

Role of hydrogen sulfide in endotoxinemia and inflammation in rats with intestinal ischemic-reperfusion injury

WU Zhong-ming, LU Gen-lin, WU Hai-ming, WU Ai-bing, WANG Hong-bin

2017, 15(6): 921-923. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.003

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Objective To investigate the influence of hydrogen sulfide on the levels of plasma C reactive protein (CRP),procalcitonin (PCT),endotoxin,TNF-α,IL-6 and IL-8 in rats with intestinal ischemic-reperfusion injury. Methods A total of 64 healthy male Wistar rats were randomly divided into sham operation group (A),ischemia-reperfusion group (B),ischemic-reperfusion and sodium hydrosulfide group (C),and ischemia-reperfusion and PPG group (D),n=16.The intestinal ischemic-reperfusion injury rat model was prepared as follow:used a midline incision for laparotomy,freed and clamped the superior mesenteric artery (SMF) for 60 min,and then reperfusion for 120 min.The tail vein injection of sodium hydrosulfide[100 μmol/kg]was performed 10 min prior to the onset of reperfusion,and continuous infusion[1 mg/(kg·h)]until reperfusion for 2 h in group C.The intraperitoneal injection of PPG (50 mg/kg) was performed in group D 10 min before the ischemia.The levels of CRP,PCT,endotoxin,H₂S,TNF-α,IL-6 and 8 were tested;the synchronic blood culture was performed to evaluate the endotoxemia.H₂S in the ileal homogenate was also measured. Results Compared with group A,the level of plasma endotoxin,PCT,CRP,TNF-α,IL-6 and 8 in the group B increased but H₂S decreased.Compared with group B,the level of plasma endotoxin,PCT,CRP,TNF-α,IL-6 and 8 in group C decreased.Compared with C group,the level of plasma endotoxin,PCT,CRP,TNF-α,IL-6 and 8 in the group D increased.The level of plasma H₂S in group D was significantly lower than that in group B and C.There were 14,6 and 15 blood samples respectively in group B,C and D infected by Escherichia colic.H₂S negatively correlated with the levels of CRP,CT,endotoxin,TNF-α,IL-6 and IL-8. Conclusion H₂S can decrease the level of inflammatory factor (PCT,CRP,TNF-α,IL-6 and IL-8) and attenuates endotoxinemia in rats with intestinal ischemic-reperfusion injury.

Target protein Ezrin and Lamin A/C associated with the expression and significance of ovarian cancer research

XU Hai, MA Dan-feng, ZHAO Jing-ling, MO Guo-yan

2017, 15(6): 924-926,993. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.004

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Objective To study the relationship Ezrin protein analysis (Ezrin) and lamin A/C antibody (Lamin A/C) changes in ovarian cancer tissues and clinicopathological features and patient. Methods Select the hospital pathology department collected 30 cases of normal ovarian tissues (normal group),confirmed by pathology after surgical resection specimens of 65 cases of ovarian cancer (ovarian cancer group) and 40 cases of benign ovarian tumor (benign group),using immune expression were detected three groups of specimens Ezrin and Lamin A/C protein and analyze its relationship with clinical and pathological features of patients. Results In normal group,the positive expression of ovarian tissue benign group of Ezrin and Lamin A/C protein,respectively (93.33%,87.50%,93.33%,90.00%) was significantly higher than those in ovarian cancer group (49.23%,52.31%).The difference was statistically significant (P<0.05).Ovarian tissue samples Ⅰ+Ⅱ stage,high+differentiation,Ezrin did not occur in patients with lymph node metastasis and Lamin A/C protein expression was significantly higher than that of Ⅲ+Ⅳ,the positive rate of poorly differentiated ovarian cancer lymph node metastasis,The difference was statistically significant (P<0.05). Conclusion The expression of Ezrin protein and Lamin A/C are closely associated with ovarian cancer metastasis,Ezrin and Lamin A/C protein downregulated in ovarian cancer,and the clinical and pathological characteristics of patients with a certain relationship,It also suggests that Lamin A/C and Ezrin may serve as potential prognostic and prognostic indicators for patients with ovarian cancer.

Expression and drug resistance of UTP23 in epithelial ovarian cancer

ZHANG Jie-jie, CHEN Ya-qing

2017, 15(6): 927-929,1018. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.005

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Objective To investigate the expression of UTP23 in epithelial ovarian cancer and its relationship with drug resistance to chemotherapy. Methods Using immunohistochemical method in 64 cases of epithelial ovarian cancer patients and 40 cases of ovarian tissue hyperplasia tissue of patients with protein UTP23 expression was determined,and analyze UTP23 expression level and clinicopathological characteristics,resistance to chemotherapy and prognosis of the relationship. Results UTP23 protein was expressed in the cytoplasm of epithelial ovarian cancer cells,and was stained with brown granules.UTP23 lower expression of the Epithelial ovarian cancer patients was 46 cases,significantly higher than 6 cases of benign ovarian tissue hyperplasia group,difference was statistically significant (P<0.05),UTP23 lower expression of resistance to chemotherapy patients was 29 cases,significantly higher than 17 cases of the sensitivity of chemotherapy group,difference was statistically significant (P<0.05),UTP23 low expression and age,pathological type,there was no significant relationship between ascites and other non significant (P>0.05),and differentiation degree,clinical stage,there was no lymph node metastasis,the size of residual lesions had significant relationship (P<0.05).Survival time of patients with UTP23 lower expression was significantly shorter than the group of patients,high expression difference was statistically significant (P<0.05),COX regression single factor analysis showed that UTP23 expression was associated with overall survival time[RR=0.587,P=0.032,95%CI:0.336(0.361-0.986)]. Conclusion UTP23 low expression is closely related with disease progression,chemotherapy resistance and prognosis in epithelial ovarian cancer patients,suggesting that UTP23 may be a new indicator for judging the effect of chemotherapy and evaluating prognosis.

Risk factors and clinicopathological features of triple-negative breast cancer

WANG Yan, ZHANG Nian-qing, PENG De-feng, LI Lei, XU Pei-quan

2017, 15(6): 930-933. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.006

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Objective To analyze the risk factors and clinicopathological features of patients with triple-negative breast cancer. Methods Total 180 cases of breast cancer in our hospital between February,2013 and June,2016 were enrolled into this study.The expression of ER,PR and HRE-2 was detected by immunohistochemical method.The 60 patients with triple-negative breast cancer were chosen as observation group,and the other 120 patients with non-triple-negative breast cancer were chosen as control group.The Age,smoking and drinking history,body mass index (BMI),family history,place of residence,educational background,age of menarche,lactation status,use of contraceptive drugs,parity,age at primiparity,abortion history,menopausal time of the two groups were compared.The indexes with significant differences were screened out for multivariate logistic regression analyses.The risk factors and clinicopathological features of patients with triple-negative breast cancer were analyzed. Results Statistically significant differences (P<0.05) were found in age,body mass index (BMI),lactation status,use of contraceptive drugs,parity,and menopausal time between the patients in the two groups,but not in smoking and drinking history,family history,place of residence,educational background,age of menarche,age at primiparity,abortion history (P>0.05).Multivariate logistic regression analyses showed that the ORs of under the age of 60,twice or more than twice of parity,menopausal time were 2.384,1.213 and 3.324,respectively.The corresponding P values were all greater than 0.05,and there was no statistical significance.The ORs of body mass index,lactation status,use of contraceptive drugs were 5.789,5.672 and 8.932,respectively.The corresponding P values were all less than 0.05,and there was statistical significance.BMI ≥ 25 kg/m²,suppression of lactation and the use of contraceptive drugs were risk factors of triple-negative breast cancer.The main pathological type of triple-negative breast cancer was invasive ductal carcinoma,with higher incidence of lymph node metastasis.The tumor staging and grading of triple-negative breast cancer were advanced. Conclusion The malignant degree of triple-negative breast cancer is higher than that of non-triple-negative breast cancer.Obesity,suppression of lactation and the use of contraceptive drugs is risk factors of triple-negative breast cancer.

Efficacy and loading dose analysis of ticagrelor in acute coronary syndrome patients with low on-clopidogrel platelet reactivity and its influence on prognosis

LIN Wei, ZHOU Rui, LIN Jian-feng, WANG Yi, JIA Zhu-yin

2017, 15(6): 934-936. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.007

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Objective To evaluate the therapeutic efficacy and influence on the prognosis of ticagrelor in acute coronary syndrome (ACS) patients with low on-clopidogrel platelet reactivity,and analyze its loading dose. Methods A total of 328 cases of ACS patients undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel 75 mg/d treatment in our hospital between September,2013 and April,2016 were enrolled into this study.The platelet aggregation was detected by thrombelastography and 110 patients with low on-clopidogrel platelet reactivity were selected.They were randomly assigned into ticagrelor group (n=54) and clopidogrel group (n=56).The clopidogrel group was continually administrated with clopidogrel 75 mg/d,while the ticagrelor group with ticagrelor 90 mg,2 times/d.The incidence of major adverse cardiac and cerebrovascular events,adverse reactions,uric acid levels and platelet aggregation after the treatment were compared between the two groups. Results After the treatment,the platelet aggregation rate on d3,d7 and d30 in ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);The incidence of UAP,AMI,TIA,heart failure and cerebrovascular accidents in the ticagrelor group was significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);The incidence of cardiogenic mortality,bleeding and stroke in the ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);Three days and 30 days after the discharge,uric acid levels in the clopidogrel group was significantly higher than that in the ticagrelor group,the incidence of gout in the ticagrelor group (3.51%) was lower than that in the clopidogrel group (18.51%),the difference was significant. Conclusion Ticagrelor therapy for ACS patients with low on-clopidogrel platelet reactivity after PCI can improve the platelet aggregation,reduce the incidence of adverse events,the curative effect is significant.

Comparison of clinical efficacy between minimally invasive surgeries combined with urokinase and craniotomy hematoma evacuation in patients with hypertensive basal ganglia hemorrhage

HU Shang-tong, ZHOU Ge-zhi, PAN Li-fei

2017, 15(6): 937-939,943. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.008

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Objective There was no golden standard for the treatment of hypertensive basal ganglia hemorrhage.The present study was to compare the clinical efficacy of minimally invasive surgical procedures combined with urokinase and craniotomy hematoma evacuation in patients with hypertensive basal ganglia hemorrhage and to provide basis for treatment of hypertensive basal ganglia hemorrhage. Methods From January,2014 to June,2016,126 cases of hypertensive basal ganglia hemorrhage in our hospital were prospectively collected.The patients were randomly divided into study group and control group with 63 cases in each group.The study group received minimally invasive surgery combined with urokinase (10 000 U/times),while the control group underwent craniotomy hematoma evacuation.The main outcome measures included the operation time,Glasgow coma score (0,1 and 14 days),hematoma clearance rate,organ failure,re-bleeding rate,intracranial infection,pulmonary infection,hospitalization time and 28-days mortality. Results There was no significant difference between the two groups in Glasgow coma score (8.52±1.78 vs.8.40±1.74,t=0.335,P=0.739) before the operation.But compared with the control group,at the first day and at the 14-days after the operation,patients in the study group got significant higher levels of Glasgow coma score[(11.06±1.94 vs.10.04±2.08,t=2.584,P=0.011) and (13.60±1.19 vs.11.90±1.87,t=5.500,P<0.001)].There was no significant difference in the rate of hematoma clearance between the two groups (93.65±7.56 vs.94.11±5.32%,t=0.375,P=0.832).But compared with the control group,the operation time of the study group was significantly shorter (135.90±17.41 vs.149.39±19.14 min,t=3.757,P<0.001).When compared with the control group,the hospitalization time of the study group was significantly shorter (21.45±5.67 vs.25.67±7.45 d,t=3.148,P<0.001).There were no significant differences between the two groups in 28-days mortality,organ failure,re-bleeding,intracranial infection and pulmonary infection between the two groups (P>0.05). Conclusion Minimally invasive surgery combined with urokinase in the treatment of basal ganglia hemorrhage is helpful to promote the recovery of neurological function,and active a good postoperative recovery.

Effects of local infiltration anesthesia with epinephrine and lidocaine on hemodynamics parameters in patients undergoing endoscopic sinus surgery

YING Jiang-ming, SI Xiao-long, LIU Xiao-nan, XU Ming

2017, 15(6): 940-943. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.009

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Objective To explore the effects of local infiltration anesthesia with epinephrine and lidocaine on hemodynamics parameters in patients undergoing endoscopic sinus surgery;and to provide clinical data for the rational use of epinephrine. Methods Total 173 patients undergoing endoscopic sinus surgery were randomly divided into group A (n=55),group B (n=66) and group C (n=52,control group).Local infiltration anesthesia method:group A was given lidocaine combined with 20 μg epinephrine;group B was given lidocaine and 40 μg epinephrine;group C was given lidocaine.The heart rate (HR),mean arterial pressure (MAP),cardiac index (CI),and acceleration index (ACI) in all three groups were measured before anesthesia and 1,1.5,2,3,4,6 min after infiltration anesthesia,respectively. Results At 1.5 and 2 min after infiltration anesthesia,HR increased in group A and group B,and MAP decreased (P<0.05);At 3 min after infiltration anesthesia,HR increased in group B (P<0.05);Compared with group A,HR and MAP decreased significantly in group B at 1.5 and 2 min after infiltration anesthesia (P<0.05).The CI and ACI of group A and group B were increased at 1.5,2,3 and 4 min after infiltration anesthesia (P<0.05);Compared with group A,the CI and ACI of group B increased significantly at 1.5,2,3 and 6 min after infiltration anesthesia,respectively (P<0.05). Conclusion Local infiltration anesthesia with epinephrine combined lidocaine has effect on hemodynamics in patients undergoing endoscopic sinus surgery;the degree of influence is related to the dose of epinephrine,and 20 μg epinephrine is recommended.

Clinical study of 13 cases of laparoscopic tension-free hernia repair of inguinal hernia after radical prostate ctomy

MAO Zu-jie, LIU Feng, QI Xiao-long, ZHENG Min, WEI Hai-bin, ZHANG Da-hong

2017, 15(6): 944-946. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.010

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Objective To compare the incidence of inguinal hernia in patients undergoing laparoscopic radical prostatectomy via different approach,and investigate the safety and efficiency of laparoscopic tension-free hernia repair for inguinal hernia after radical prostatectomy. Methods Clinical data was collected retrospectively for 312 patients received laparoscopic radical prostatectomy from November,2007 to July,2014,including 223 intraperitoneal and 89 extraperitoneal (preperitoneal) radical prostatectomy.All patients were followed up from 3 months to 2 years.If inguinal hernia occurred in the follow-up period,the patients were invited to return to the hospital for laparoscopic tension-free hernia repair.The operative duration,drainage time,hospitalization days and all perioperative complications were documented.All patients were followed up for one year,in order to observe the recurrence of inguinal hernia. Results The inguinal hernia of intraperitoneal and preperitoneal prostatectomy were 10 cases and 3 case,respectively.For intraperitoneal approach,there were 8 cases of inguinal hernia in bilateral lymphadenectomy and 2 cases in patients without bilateral lymphadenectomy.All patients of inguinal hernia underwent laparoscopic tension-free hernia repair.The mean operative time was 28 min (15 to 50 min).There was no intraoperative blood transfusion,conversion to open surgery cases or postoperative complications.Peritoneal drainage tube lasted 1-3 d,and the average hospital stay was 5 d (3 to 7 d).The patients were followed up 1-12 months with an average of 10 months,and no recurrent inguinal hernia was found. Conclusion Inguinal hernia is one of the major complications of laparoscopic radical prostatectomy.Laparoscopic approach and bilateral inguinal lymph node dissection are not influence factors of hernia;laparoscopic hernia tension repair is a safe and effective minimally invasive treatment for inguinal hernia surgery.Long-term efficacy remains to be seen for longer follow-up.

Meta-analysis of Clinic Results of Two-Way Referral of Hypertension Patients in China

HUANG Hui-hua, YU Chang-yin, HUANG Lin, CHEN Ling-li, LIU Shi-fang

2017, 15(6): 947-950,1068. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.011

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Objective To systematically evaluate and integratively analyze the relevant literature about the Clinic Results of Two-way referral of hypertension patients in China for providing evidence for two-way referral of hypertension patients. Methods The relevant literature which included Clinic Results of Two-Way Referral of Hypertension Patients in China were systematically retrieved from the datebases of PubMed,Embase,Cochrane library,CNKI,Wan Fang data,VIP and CBM to September in 2016.After the quality of literatures was evaluated according to JBI standard,the data effectively extracted and analyzed with RevMan 5.3 software. Results Totally 7 case-control studies were conducted,involving 1 639 people,including 838 cases received and 801 cases not received two-way referral.Compared with hypertension patients who not received two-way referral,the visiting time[(MD=-0.89,95%CI(-0.90,-0.88)]and average length of stay hospital[(MD=-2.04,95%CI(-2.18,-1.90)]were significantly shorten,twice visiting rate[(OR=0.16,95%CI(0.11,0.23)]and medical expense[(MD=-302.52,95%CI(-309.06,295.97)]were significantly reduced in hypertension patients who received two-way referral (P<0.01).Although the efficiency ratio of treatment[OR=2.29,95%CI(0.78,6.74)]were higher in hypertension patients who received two-way referral,but there wasn't statistical significance (P>0.05). Conclusion Hypertension patients who received two-way referral to intervene can save visiting time,shorten average length of stay hospital,reduce twice visiting rate and low down medical expense,but there are no effect on the therapeutic efficiency ratio.

Effect of dexmedetomidine on oxidative stress and inflammatory reaction in patients with orthopaedic trauma surgery

FENG Ji-bo, ZHANG Lei, WU Yang, NI Dong-liang, MA An-jun, MA Hua-ying, PENG Wen-yong

2017, 15(6): 951-953. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.012

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Objective To investigate the effect of dexmedetomidine on oxidative stress and inflammatory reaction in patients with orthopaedic trauma surgery. Methods Total 82 cases of trauma patients undergoing elective surgery in our hospital between January,2015 and April,2016 were divided into study group (n=40) and control group (n=42).All patients received Inhalation-intravenous general anesthesia.The study group was given intravenous infusion of dexmedetomidine 1 μg/kg before the induction and continuous infusion of 0.2 μg/(kg·h) dexmedetomidine,while the control group was given the same amount of normal saline.HR and MAP were recorded at T0(entering the operating room),T1(tracheal intubation was over),T2(the operation lasted for 60 min),T3(the end of the operation) and T4(extubation).The levels of SOD,cortisol,MDA,TNF-α and IL-6 at T0,T2,T3,T5(postoperative 8 h) and T6(postoperative 24 h) were compared between the two groups. Results At T1-T4,the levels of MAP and HR in the study group were significantly lower than those in the control group and the difference was statistically significant (P<0.05).At T3,T5 and T6,the level of SOD in the study group was significantly higher than that in the control group,while the levels of cortisol,MDA,TNF-α and IL-6 were significantly lower than those in the control group,the difference was statistically significant (P<0.05).The operation time and intraoperative blood loss were compared between the two group,the difference was not statistically significant (P>0.05).The time of awaking from anesthesia in the study group was significantly shorter than that in the control group,the difference was statistically significant (P<0.05). Conclusion Dexmedetomidine can maintain the stable hemodynamics of patients with orthopaedic trauma surgery,significantly reduce the oxidative stress response and inflammatory reaction of patients.

The influence of tegafur combined with capecitabine on inflammatory factors and lymphocyte function of patients with gallbladder cancer

SHI Hua, PAN Jun-di, YE Bin

2017, 15(6): 954-956. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.013

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Objective Lymphoid cells and inflammatory factors in patients with gallbladder were abnormal expression,this research study the influence of tegafur combined capecitabine on inflammatory factors and lymphocyte function of patients with gallbladder cancer,to explore its clinical mechanism. Methods Eighty-four cases of patients with gallbladder cancer were divided into experimental group (n=42) and control group (n=42) according to random number table method.The control group treated with oral capecitabine,1.5 g/m²,2 times/day.The experimental group was given tegafur 50 mg/m²,2 times/day combined with oral capecitabine,1.5 g/m²,2 times/day.After 8 weeks,the clinical efficacy,clinical benefit,toxic and side reaction of two groups of patients would be observed.Serum TNF alpha,IL-6,IL-8 levels of inflammatory factors were detected by ELISA.T cell subgroup CD4⁺,CD8⁺ cells were detected by Flow cytometry.The clinical effect,inflammatory factors and cellular function were analyzed. Results The total effective rate 52.38%(22/42) of experimental group,and the control group was 33.33%(14/42),the differences were no statistically significant of rank sum test (P>0.05).The tumor control rate 78.57%(33/42) of experimental group was higher than the control group 57.14%(24/42),and the differences were statistically significant (P<0.05).Eight weeks after treatment,the levels of TNF alpha),IL-6 and IL-8 in the experimental group were lower than the control group,the differences were statistically significant (P<0.05).The T cell subgroup CD4⁺,CD8⁺ cells in the experimental group were higher than the control group,the differences were statistically significant (P<0.05).Two groups of patients main adverse reactions were rash,nausea,vomiting,liver function damage.There was no statistically significant difference between the two groups (P>0.05). Conclusion Treatment methods of tegafur combined capecitabine for Patients with gallbladder had good recent curative effect,can reduce inflammatory reaction,enhance the body's immune function,had a lighter side reaction.It was Worthy of clinical popularization and application.

Effect of dexmedetomidine on visfatin and high sensitive C reactive protein in patients with acute brain injury

WANG Wei, PENG Wen-yong, ZHAO Dong, HU Chong-hui, LAN Zhi-jian

2017, 15(6): 957-959. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.014

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Objective To investigate the effect of dexmedetomidine on visfatin and high sensitive C reactive protein (hs-CRP) in patients with acute brain injury. Methods Total 76 cases of acute brain injury were divided into study group (n=36) and control group (n=40) according to the type of anesthesia.All the patients underwent craniotomy and evacuation of hematoma by general anesthesia.Before the induction of anesthesia,intravenous infusion of dexmedetomidine was performed in the study group,instead,saline in the control group.the serum levels of visfatin,hs-CRP,neurone specific enolase (NSE) and S-100β before the operation (T0),60 minutes after the operation (T1),the end of operation (T2),24 hours after the operation (T3),3 days after the operation (T4),5 days after the operation (T5) in the two groups were detected.At 6 months follow-up,the prognosis of the patients was assessed by the Glasgow Outcome Scale (GOS). Results The levels of visfatin and hs-CRP in the two groups were significantly higher than those in the same group at the time of T2 to T5,the difference was statistically significant (P<0.05).The levels of visfatin and hs-CRP at T2 to T5 in the research group was significantly higher than those in the control group,the difference was statistically significant (P<0.05).The level of NSE and S-100β in the two groups was significantly higher than those in the same group at the time of T1 to T5,the difference was statistically significant (P<0.05).At T3 to T5,NSE and S-100β in the study group were significantly higher than those in the control group,the difference was statistically significant (P<0.05).After 6 months follow-up,the prognosis of the study group was significantly better than that of the control group,the difference was statistically significant (P<0.05). Conclusion Dexmedetomidine anesthesia for surgery in patients with acute brain injury can reduce inflammation and brain injury,and improve the prognosis of patients.

Effect of infusion of dexmedetomidine on postoperative patients with upper abdominal surgery after fentanyl for patient-controlled intravenous analgesia

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

2017, 15(6): 960-962. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.015

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Objective To investigate the effect of infusion of dexmedetomidine on postoperative patients with upper abdominal surgery after fentanyl for patient-controlled intravenous analgesia. Methods Seventy-four patients in our hospital were divided into observation group and control group.Postoperative patient controlled intravenous analgesia.The observation group with dexmedetomidine combined with fentanyl.The control group was only used fentanyl.After 1,6,12,24,48 hours,compared with two groups of MAP,HR,SpO₂,VAS score,Ramsay score.Compared with two groups of effective pressing times,fentanyl dose and adverse reactions. Results In the observation group,the effective pressing times and the dose of 48 h fentanyl were significantly lower than those of the control group.The difference was statistically significant (P<0.05).The observation group 1,6,12,24 hours of MAP,HR was significantly lower than the control group.The difference was statistically significant (P<0.05).There was no significant difference in SpO₂ levels between the two groups at each time point (P>0.05).After 1,6,12 and 24 hours,the VAS score of the observation group was significantly lower than that of the control group,the Ramsay score was significantly higher than that of the control group.The difference was statistically significant (P<0.05).The incidence rate of adverse reaction in the observation group (8.11%) was significantly higher than that in the control group (29.73%).The difference was statistically significant (χ²=5.638,P<0.05). Conclusion The effects of dexmedetomidine combined with fentanyl in patients undergoing upper abdominal surgery postoperative patient-controlled intravenous analgesia,and independent use than fentanyl,can achieve better analgesic and sedative effect,reduce the dose of fentanyl and the occurrence of adverse reactions,effectively.

Effect of intra-aortic balloon pump assisted percutaneous coronary intervention in patients with acute myocardial infarction and heart failure

CHEN Guo-fan, WANG Li

2017, 15(6): 963-964,985. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.016

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Objective To investigate the clinical effect of intra-aortic balloon pump (IABP) assisted percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and heart failure. Methods Eighty cases of AMI with and heart failure in our hospital between January,2013 and August,2016 were selected as the research object,and were divided into two groups by single-blind randomized method (n=40).The patients in control group received the interventional therapy,while the patients in the observation group received the balloon pump-assisted coronary intervention.The clinical total effective rate,cardiac blood flow recovery,hemodynamics and NT-proBNP of both groups were accounted,and the date were analyzed by statistical software to investigate the clinical effect of balloon pump-assisted coronary intervention in AMI patients with heart failure. Results The clinical total effective rate in the observation group was 90%,which was significantly higher than that in the control group (70.00%,P<0.05).The proportion of level 3 TIMI blood of the observation group was significantly higher than that of the control group (P<0.05).The LVEF and SV of the two group were significantly increased,LVEF and SV of the observation group were significantly higher than those of the control group (P<0.05);The NT-proBNP of the two group were significantly decreased,and NT-proBNP of the observation group were significantly lower than that of the control group (P<0.05). Conclusion Based on interventional therapy,intra-aortic balloon counterpulsation therapy could effectively improve heart function and hemodynamics of AMI patients with heart failure,which is conducive to improvement of the prognosis.

Effect analysis of unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in patients with lumbar degenerative disease

TANG Xu-ri, MA An-jun, FU Chi, YE Bi-qian, LI Xing-zhong, WU Yang

2017, 15(6): 965-967. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.017

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Abstract:
Objective To investigate the effect of unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in patients with lumbar degenerative disease,aims to explore the treatment of lumbar retrograde changes effective treatment,to provide basis for clinical treatment. Methods A total of 117 lumbar degenerative disease patients were divided into unilateral fixation group (52 cases) and bilateral fixation group (52 cases) from October,2010 to June,2014.All patients were followed up for more than 2 years.To compare operation time,intraoperative blood loss,lumbar spine fusion,complications,degeneration of adjacent segments and Cobb angle of lumbar vertebrae in 2 groups. Results The operation time and intraoperative blood loss of unilateral fixation group were significantly less than those in bilateral fixation group (P<0.05);There was no significant difference in fusion rate between 2 groups at 6 months,1 year and 2 years after operation (P>0.05).There was no serious complication in the two groups.At the last follow-up,the degeneration rate of adjacent segments of unilateral fixation group was 33.93%,and the degeneration rate of adjacent segments of bilateral fixation group was 65.57%,the degeneration rate of adjacent segments of unilateral fixation group was lower than that in bilateral fixation group (P<0.05),and the rate was significantly lower than that of bilateral fixation group (P<0.05);There was no significant difference in the Cobb angle between 2 groups at end of operation,3 months after operation,6 months after operation and 2 years after operation (P>0.05). Conclusion Unilateral and bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in patients with lumbar degenerative disease,can obtain satisfactory treatment,but unilateral pedicle screw fixation has short,operation time,little blood loss,adjacent segment degeneration was significantly more low.

Expression and significance of D-two polymer,LTB4 and IL-23 in peripheral blood of children with Henoch Schonlein purpura

ZHONG Hua-jie

2017, 15(6): 968-970. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.018

97 3

Abstract:
Objective To study the clinical value of the expression of D-two polymer,serum leukotriene B4(LTB4) and interleukin-23(IL-23) in the acute peripheral blood of children with Henoch-Schonlein purpura (HSP). Methods Forty-seven patients with acute HSP who were treated in our hospital from January,2015 to October,2016 were selected as observation group,at the same time,45 normal children were selected as control group.The levels of D-two polymer,LTB4,IL-23 and the levels of IgA,IgM and IgG in the peripheral blood of the 2 groups were compared;the correlation between D-two polymer,LTB4,IL-23 and IgA in peripheral blood of children in the observation group was analyzed. Results The levels of D-two polymer,LTB4,IL-23 and IgA in the peripheral blood of the observation group were significantly higher than those in the control group,the difference was statistically significant;with Pearson test the correlation between IgA and D-two polymer (r=0.531,P<0.001),LTB4(r=0.487,P<0.001) and IL-23(r=0.351,P<0.001) in the peripheral blood of the observation group was positively correlated with that of the correlation analysis. Conclusion D-two polymer,LTB4 and IL-23 expression levels in acute peripheral blood of children with HSP were increased significantly,and the serum IgA was positively related,that children with acute HSP humoral immunity hyperfunction occurred,D-two polymer,LTB4 and IL-23 are involved in the pathogenesis of HSP and pathologic process,and provide reference and guidance significance for the early diagnosis and treatment of HSP.

Effect of S-1 capsule in the treatment of elderly patients with gastric cancer on serum sICAM-1,Survivin and tumor markers

LIN Yong, LI Rong-zhou, SONG Sheng-jiang, ZHANG Wu, SHI Zheng-chao

2017, 15(6): 971-973. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.019

81 0

Abstract:
Objective To explore the effect of S-1 capsule in the treatment of senile gastric cancer patients on apoptosis in serum inhibition protein (survivin) and soluble intercellular adhesion molecule-1(sICAM-1) and the influence of tumor markers. Methods Sixty-two elderly patients with gastric cancer were randomly into two groups in our hospital from May,2013 to November,2015.The control group (31 cases) was treated with oxaliplatin and 5-fluorouracil (5-Fu) and leucovorin regimen,the observation group (31 cases) were treated with S-1 and oxaliplatin treatment,they were treated for 3 courses.The clinical efficacy and adverse reactions were compared between the two groups.The vascular adhesion factor (sVCAM-1),sICAM-1,Survivin levels and tumor markers were compared before and after treatment in the two groups. Results There was no significant difference in the levels of sICAM-1,sVCAM-1 and Survivin between the two groups before chemotherapy (P>0.05);The levels of sICAM-1,sVCAM-1 and survivin in the observation group were lower than those in the control group (P<0.05);After 3 courses of chemotherapy,the levels of CEA,CA125 and CA19-9 in the observation group were lower than those in the control group (P<0.05);There was no significant difference between the two groups (P>0.05);The incidence of gastrointestinal reaction and reduction of WBC in the observation group was lower than that in the control group (P<0.05). Conclusion Elderly patients with gastric cancer using chemotherapy S-1 combined with oxaliplatin is effective and can effectively reduce the sVCAM-1,sICAM-1,survivin,reduce the levels of tumor markers,and has high safety.

Clinical analysis of effect of interventional embolization and intracranial clamp operation in patients with high-grade aneurysmal subarachnoid hemorrhage

HE Shi-ke

2017, 15(6): 974-976. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.020

65 2

Abstract:
Objective High-grade aneurysmal subarachnoid hemorrhage (aSAH) has high morbidity and mortality,craniotomy and interventional operation is the main treatment,but their effect is still controversial.The aim of this study is to explore the efficacy of interventional embolization,and to provide the basis for clinical treatment in patients with aSAH. Methods A total of 90 patients with high-grade aneurysmal subarachnoid hemorrhage were divided into observation group (49 cases) and control group (41 cases) from June,2011 to May,2016.The patients of the observation group received interventional embolization,while the control group received surgical clipping of a cerebral aneurysm.The levels of IgA,IgG and IgM,hospitalization time,complications and short-term efficacy were compared between 2 groups. Results The levels of IgA,IgG and IgM had no significant difference between the two groups before the operation (P>0.05);as compared with the levels before operation,the levels of IgA,IgG and IgM decreased significantly at 24 h after the operation in both groups (P<0.05),and the control group decreased more significantly than those of the observation group (P<0.05).The hospitalization time and cerebral vasospasm incidence in the observation group was significantly lower than that in the control group (P<0.05),but the incidence of rehemorrhage,hydrocephalus and intracranial infection had no significant difference between the two groups before the operation (P>0.05);The short-term better prognosis rate of the observation group was 71.43%,which was significantly higher than that of the control group (48.78%),P<0.05. Conclusion Interventional embolization has better short-term efficacy on high grade aneurysmal subarachnoid hemorrhage with less influence on immunologic function.It can shorten the length of hospital time,reduce the incidence of cerebral vasospasm.

Clinical analysis of single port thoracoscopy in the treatment of patients with early non-small cell lung cancer

WENG Xian-wu, LIANG Cheng-zhi, LIN Pei-feng, ZHANG Jian-hai, MOU Shou-shi, WU Hai-fan

2017, 15(6): 977-979. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.021

65 0

Abstract:
Objective Thoracoscopy is widely used in the treatment of lung cancer.There is little research on the efficacy of single-port and three-port methods in the treatment of patients with early non-small cell lung cancer.The clinical efficacies of the two methods are still controversial. Methods We collected 116 cases of early non-small cell lung cancer patients admitted to our hospital from January,2015 to June,2016.According to the treatment methods,they were divided into the single-port and the three-port group.The 52 cases in single-port group was given radical resection of pulmonary carcinoma with single port thoracoscopy,while the 64 patients in the three-port group was treated with radical resection of pulmonary carcinoma with three-port thoracoscopy.Comparative analysis of operation time,intraoperative blood loss,number of lymph node dissection,the total length of the incision,converted to open surgery,postoperative drainage,drainage time,hospitalization time,patient satisfaction score,postoperative pain score of first days,third day postoperative pain score and postoperative complication rate was made between the two groups. Results All patients underwent surgery successfully.Compared with those of the three-port group,the operation time and the amount of bleeding were significantly more,the total length of the incision was shorter,postoperative drainage was less,satisfaction score was higher,postoperative first day and third days pain scores were lower,with statistical significance (P<0.05),while the number of lymph node dissection,the number of cases converted to open surgery,the incidence of thoracic drainage time,hospitalization time and postoperative complications showed no significant difference between the two groups (P>0.05). Conclusion The ideal clinical effect can be achieved with both single-port and three-port thoracoscopic radical resection of pulmonary carcinoma,and the safety of the operation can be guaranteed,with less postoperative pain and better incision appearance,which is worthy of further clinical application.

Clinical value of high-sensitivity cardiac troponin T and Heart-type fatty acid-binding protein for early heart dysfunction assessment in patients with acute exacerbation of COPD

ZHANG Xiao-shuang, JI Shuang, FEI Guang-he

2017, 15(6): 980-982,1005. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.022

110 0

Abstract:
Objective To explore clinical value of high-sensitivity cardiac troponin T (hs-cTnT) and Heart-type fatty acid binding protein (H-FABP) in assessing the early heart dysfunction in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) by comparing the levels of hs-cTnT and H-FABP before and after treatment. Methods Total 110 patients with clinician-diagnosed AECOPD in our hospital were prospectively studied from December,2015 to June,2016.Among them,80 eligible patients,including 35 patients with mild-to-moderate acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and 45 ones with severe-to-very severe AECOPD were enrolled,and 40 control subjects were recruited.The serum hs-cTnT and H-FABP levels were tested by electrochemiluminescence method and enzyme-linked immunosorbent assay,respectively.The pulmonary function,arterial blood gas,AST,LDH,CK,CKMB,cTnI and myoglobin were evaluated. Results There was a significantly higher levels of hs-cTnT and H-FABP in AECOPD patients compared with the control group (P<0.01).The levels of hs-cTnT and H-FABP were significantly decreased in severe-to-very severe AECOPD group after the treatment (P<0.01).There was no significant difference in AST,LDH,CK,CKMB,cTnI and myoglobin before and after treatment (P>0.05). Conclusion Compared with the traditional myocardial biomarkers,hs-cTnT and H-FABP are more sensitive to myocardial damage and could guide early clinical intervention in patients with acute exacerbation of COPD.

Analysis of serum Leptin and Insulin levels in simple obesity of the preschool children

JIA Kun-peng

2017, 15(6): 983-985. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.023

113 0

Abstract:
Objective To investigate the levels of serum Leptin,Insulin and the correlation between them and the body mass index (BMI) in simple obesity of the preschool children. Methods We selected 56 cases of simple obesity of the preschool children in health physical examination as the obesity group,which were from three kindergarten of Yan'an from March to July 2015.At the same time,56 children with the same age,gender,similar height and normal body mass were selected as the control group.Then we determined and analysed serum Leptin and Insulin levels in two groups by radioimmunoassay. Results The level of serum Leptin and Insulin in the obesity group were significantly higher than those in the control group (P<0.01).However,there were not significantly difference of the Leptin and Insulin levels in two groups when compared between male and female (P>0.05).There were positive correlation between serum Leptin,Insulin levels and BMI in the obesity group (P<0.05).Serum Leptin and Insulin levels were higher in the older age group than those in the younger age group of obese children (P<0.05). Conclusion The level of serum Leptin and Insulin in simple obesity of the preschool children are significantly higher than those in healthy children.The results show that simple obese children have a resistance of Leptin and Insulin.Periodically determined the level of serum Leptin and Insulin in simple obese children has certain significance in the guiding of early intervention in simple obesity of the preschool children.

The levels of S-100β MBP and NSE in cerebrospinal fluid of children with benign infantile convulsions associated with mild gastroenteritis

CHEN Jun-guo, WU Ming, ZHANG Xu, LU Yan, WANG Qiong, PING Ming-fang

2017, 15(6): 986-988. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.024

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Abstract:
Objective To explore the role in the pathogenesis of benign infantile convulsions with mild gastroenteritis (BICE) by study the changes of S-100β,myelin basic protein (MBP) and neuron-specific enofase (NSE) levels in cerebrospinal fluid. Methods Total 38 cases of children with BICE in our hospitalized were recruited,they were set to observe group.Eighteen children admitted due to acute upper respiratory infection were recruited to the control group.Convulsion occurrences are divided into two groups,the observation group 1(seizure frequency less than twice) in 16 cases,observation group 2(seizure frequency greater than or equal to twice)22 cases.The S-100β,MBP and NSE levels of each group in cerebrospinal fluid and serum were measured by ELISA. Results Levels of S-100β and NSE in cerebrospinal fluid and serum in BICE patients were higher than those of the control group (P<0.01),and these items in observation group 2 were found to be higher than those in observation group 2(P<0.01).There were no significant differences in MBP levels in cerebrospinal fluid and serum between BICE patients and control group (P>0.05),and these items were found no significant differences in two observation groups (P>0.05).The levels of S-100β and NSE in serum after treatment were significantly decreased than those before treatment in two observation groups (P<0.01). Conclusion level of S-100β and NSE were correlated well with the severity of BICE children.With an increase of seizure number,the damage of nerve cells increased in BICE patients.There were no pathological changes in myelin structure in BICE patients.

Effects of Huayu Sanjie TCM therapy on expression of Bcl-2 in patients with endometrial polyps

ZHANG Yu-ling, ZHAO Shan-qiong, ZHANG Yi-qun

2017, 15(6): 989-992. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.025

68 0

Abstract:
Objective To observe the changes of Bcl-2 in the endometrium before and after the therapy,and to explore the mechanism of Huayu Sanjie TCM therapy on prevention of the recurrence of endometrial polyps (EP). Methods Total 147 postoperative patients caused by endometrial polyps were selected from June,2015 to June,2016,they were randomly divided into the Chinese herbal group,the western medicine group and the control group,with 49 cases of each group by single-blind method.The Chinese herbal group received Huayu Sanjie TCM staging therapy by internal and external use;the western medicine group was treated with Marvelon cycle therapy;the control group was not given any drugs.After three months,the improvement of the TCM Syndromes,the changes of endometrium under ultrasound,and the expression of Bcl-2 in endometrium was detected by immunohistochemical assay. Results After the treatment,the TCM syndrome integral and the endometrial condition were all significantly improved than before in each groups (P<0.01).The Chinese herbal group were better than the other two groups (P<0.05),there were no significant difference between the western medicine group and the control group (P>0.05).After the treatment,the expression of Bcl-2 in endometrium were all significantly improved than before in the Chinese herbal group (group Z=-5.690,P<0.01) and the western medicine group (Z=-5.477,P<0.01),and there was no significant difference in the control group (Z=-1.732,P=0.083).There was a significant difference among the three groups (χ²=31.143,P<0.01),the Chinese herbal group were better than the other two groups (P<0.05),and the western medicine group were better than the control group (P<0.05). Conclusion The Huayu Sanjie TCM therapy can obviously improve the clinical symptoms of endometrial polyps,and effectively prevent the recurrence of endometrial polyps.The mechanism might be related to the inhibition of excessive expression of Bcl-2.

Application of low-dose misoprostol in labor induction in patients with severe preeclampsia

DONG Jin-hua, WU Wei-wei, AI Ling

2017, 15(6): 993-995. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.026

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Abstract:
Objective To investigate the efficacy and safety of low-dose misoprostol in the labor induction in patients with severe preeclampsia. Methods A total of 60 severe preeclampsia women with an unfavourable cervices (Bishop Score ≤ 5 scores) were collected for retrospective analysis.They were randomized for labor induction with either low-dose misoprostol (30 cases) or dinoprostone (30 cases).The rate of vaginal delivery and the maternal-neonatal adverse reactions between the two groups were compared. Results The vaginal delivery rate in low-dose misoprostol group and dinoprostone group were 76.67% and 73.33%,respectively,there was no statistically difference (P>0.05).They were both effective in promoting cervical ripening,the increase in Bishop score was 2.84±0.74 vs.2.68±0.88,P>0.05.The induction-to-labor interval was longer in the misoprostol group[(11.13±2.02) h]than that in the dinoprostone group[(9.43±1.72) h]when the Bishop score<4,P<0.01,and there were no difference between the two groups[(6.67±2.53) h vs.(6.34±2.12) h]when the Bishop score ≥ 4,P>0.05.The difference of total stages of labor were not significant[(6.33±1.04) h vs.(6.20±1.22) h],P>0.05.Compared with the misoprostol group,the blood pressure were higher in the dinoprostone group when being in labor.There was no difference in the rate of asphyxia,postpartum hemorrhage and other adverse reactions between the two groups (P>0.05). Conclusion Low-dose misoprostol is safe and effective in the labor induction in patients with severe preeclampsia.The blood pressure can maintain relatively stable during the induction of labor,and the maternal tolerance is better.It can improve the rate of vaginal delivery,and is worthy of clinical application.

Effects of different clamping time of umbilical cord on serum bilirubin and hemoglobin in premature infant

LAN Xiao-hong, YAN Gui-zhen, WU Jie

2017, 15(6): 996-998. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.027

118 2

Abstract:
Objective To investigate the effects of different clamping time of umbilical cord on serum bilirubin and hemoglobin in premature infant. Methods A Total of 70 cases of premature infants in our hospital from December,2013 to December,2014 were randomly divided into two groups with 35 cases in each group.Late umbilical group was given late umbilical after pulsation arrest,and early umbilical group was given early clamping in 10s after birth.Percutaneous bilirubin values and high blood bilirubin rate,hemoglobin levels and hematokrit of two groups were recorded and compared. Results Hb and HCT of premature infants in late umbilical group at birth and after 3 d of birth were (168.25±13.73) g/L,(184.52±15.95) g/L,(0.51±0.04)%,(0.57±0.05)% respectively,while in the early umbilical group were (157.65±16.82) g/L,(165.04±17.31) g/L,(0.46±0.04)%,(0.50±0.04)%,with statistically significant difference (P<0.05).Percutaneous bilirubin values and high blood bilirubin rate showed no significant difference in two groups (P>0.05). Conclusion The late umbilical method can not only improve the blood volume of preterm infants and hemoglobin content,prevent premature anemia,also would not increase the incidence of high blood bilirubin,worthy of further clinical discussion and promotion.

The effect of induced ovulation combined with follicular puncture on patients with ovulatory dysfunction of polycystic ovary syndrome

PAN Yi-hong, JU Xiang-dong, WANG Han, LIN Hui-min, CHENG Ya, LIN Wei-ping, LIU Shuang-shuang, LI Hai-feng

2017, 15(6): 999-1001. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.028

74 0

Abstract:
Objective To investigate the effect of ovulation induction combined with follicular puncture on patients with ovulatory dysfunction of polycystic ovary syndrome. Methods According to the random number table,140 patients with polycystic ovary syndrome were randomly divided into two groups (n=70).The patients of control group were given ovulation induction treatment.On the Fifth days of menstruation,with oral cyproterone and after 3 cycles,on the fifth day of the menstrual cycle,with oral clomiphene as well as vaginal ultrasound monitoring,and when the emergence of follicle diameter was about 16 mm,intramuscular HCG,5 000 U,inform patients of intercourse on the next day when the follicle was nearly mature;The patients in control group were given follicular puncture when the follicle was nearly mature and were informed of intercourse on the next day.Compare clinical pregnancy rate and safety. Results The total treatment period in the observation group was 147 cycles,the dominant follicle was 97.3%(143/147),patients in the control group treatment period of 202 cycles,the dominant follicle was 97%(196/202),P>0.05;The ovulation rate in observation group was 100%,the pregnancy rate was 34.2%,higher than that of the control group 68.4% and 10%,P<0.05;In observation group,69 cases of mild OHSS,accounting for 98.6%,higher than that of the control group 87.1%,and the incidence of OHSS had statistically significant difference between groups (P<0.05),There was no statistical difference of OHSS occurrence between groups,P>0.05. Conclusion Induction ovulation combined with follicular puncture can effectively improve the incidence of dominant follicles in patients with polycystic ovary syndrome,improve the clinical pregnancy rate,and has a certain clinical value.

Investigation and analysis on status of vaginitis among the postmenopausal women in a community in Pudong new area of Shanghai

LIU Wei, ZHU Wen-kui, LUAN Zhao-hua, XU Qi

2017, 15(6): 1002-1005. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.029

150 1

Abstract:
Objective To understand vaginitis prevalence of women after menopause in a community,and to explore the influencing factors. Methods From June to September in 2014,cluster random sampling method was used to extract 670 cases of postmenopausal women in one of Pudong New Area community which was divided into 33 residents'committee.A self-designed questionnaire was used to survey while the women's vaginal secretions were detected.The questionnaire included:economic status,menopause span,the history of premenopausal and postmenopausal vaginitis. Results A total of 693 women were enrolled and 670 were eligible for analysis.The prevalence rate of vaginitis of 670 women was 39.0%,including atrophic vaginitis accounted for 208 cases (79.7%).By examining vaginal secretions,147 women were diagnosed with vaginitis (21.9%).The attack rate of vaginitis among the women who had history of postmenopausal vaginitis was 29.89%,while the rate of vaginitis among the women without history of postmenopausal vaginitis was 16.87%.There were no significant differences in prevalence rates of vaginitis between the women with different academic education,medical insurance,family income status,menopause span (χ²=2.126,P=0.547;χ²=1.916,P=0.590;χ²=2.010,P=0.366;χ²=0.062,P=5.573).The women who once suffered from vaginitis in her premenopause and postmenopause had higher risk of suffering from vaginitis than those who had no history of vaginitis.There's significant difference in both prevalence rate and attack rate (χ²=45.223,P<0.001;χ²=15.757,P<0.001). Conclusion The atrophy vaginitis is the disorder that most commonly occurs in postmenopausal women in the community.Health care providers of the community should help the postmenopausal women who suffered from the vaginitis,especially the atrophic vaginitis,to promote the life quality and to give treatment options by giving health education,suitable treatment and regular follow-up.

A comparative analysis of physician-patient relationship and moral environment between township health centers and village clinics

PENG Ying-chun

2017, 15(6): 1006-1009,1031. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.030

141 0

Abstract:
Objective To investigate the typical physician-patient relationship and moral environment that medical personnel in township health centers and village clinics are facing,explore the ethical problems,and put forward the appropriate ethical improvement measures combined with the specific situation of the local community. Methods There townships in north suburbs in Beijing were sampled by stratified sampling method.The field observation study was carried out.48 villagers or patients in township health centers were interviewed;a questionnaire survey was conducted among 350 villagers or patients in township health centers.The physician-patient relationship and moral environment that medical personnel in township health centers and village clinics have been facing were analyzed from a demand-side point of view.The ethical problems were discussed. Results The respondents believe that the current rural physician-patient relationship is based on diagnosis and treatment,and followed by the relationship between folks at the village level (11.79%),which was significantly higher than the results of the township (1.10%).The villagers'trust in township hospitals and village clinics were 78.69% and 80.67%,respectively,and the trust degree to township medical staff and village doctors was 81.88% and 85.55%,respectively. Conclusions The moral environment faced by medical staff in township health centers and village clinics is different.The professional ethics of the medical staff in the village is influenced by the family morality and public morality,while the township medical staff show more occupation moral appearance.The level of trust in the village clinics is slightly higher than the level of trust in the township level.Rural medical staff who want to establish a lasting trust relationship between patients should strengthen their own medical service skills and improve their moral character at the same time,to enable patients build trust from their ability to a lifetime of moral trust.

Variation of serum pepsinogen in gastric cancer patients and its relation to Helicobacter pylori infection

WU Jie, LUO Ji-cai, ZHANG Jian-ying, ZHANG Yi-min, PAN Zhi-wen, LIU Peng, XU Xiao-hong

2017, 15(6): 1010-1012,1050. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.031

89 0

Abstract:
Objective To investigate the variation of pepsinogen (PG)Ⅰ,pepsinogen (PG)Ⅱ and ratio of PGⅠ/PGⅡ(PGR) in serum of gastric cancer patients and its relation to Helicobacter pylori infection,and discuss its role in clinicopathologic study of this disease. Methods A total of 250 gastric cancer patients were selected as study group,and 120 healthy people were selected as control group in our hospital from January,2015 to June,2016.The serum levels of PGⅠ,PGⅡ,PGR were tested by chemical luminescence method and the serum level of Helicobacter pylori (Hp) IgG antibody was tested by latex immunoturbidimetry method to detect Hp infection.The results were compared between the two groups,the values of PGⅠ,PGⅡ,PGR to the diagnosis of gastric cancer were evaluated by ROC curve and the levels of PGⅠ,PGⅡ and PGR of different gender and age were compared both in study group and control group,and the relation between the levels of PGⅠ,PGⅡ,PGR and clinicopathologic features of the disease was analyzed. Results The levels of PGⅡ and positive rate of Hp in gastric cancer group were significantly higher than those in control group,while PGR in gastric cancer group was significantly lower (P<0.05).The area under ROC curve of PGR was 0.803,which was higher diagnostic value of gastric cancer than PGI or PGII.The levels of PGⅠ,PGⅡ in male or ≥ 60 years were significantly higher than female or <60 years in control group,and the level of PGI in advanced cancer was significantly lower than those in early cancer (P<0.05),and the level of PGR was correlated with Hp infection status. Conclusion The serum levels of PGⅠ,PGⅡ and PGR may be valuable to the diagnosis of gastric cancer,and PGⅠ may be useful to the TNM classification of gastric cancer.

Magnetic resonance diffusion tensor and perfusion-weighted imaging for grading of cerebral gliomas

LI Zhang-yu, QIAN Hai-feng, SUN Sheng-jie, PAN Feng

2017, 15(6): 1013-1015. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.032

106 0

Abstract:
Objective To study the application of magnetic resonance (MR) perfusion-weighted imaging (PWI) and diffusion tensor imaging (DTI) in grading of gliomas. Methods MRI diffusion tensor imaging (DTI) and perfusion weighted imaging (PWI) were performed in 78 cases of cerebral gliomas (35 low-grade and 43 high-grade ghomas) in our hospital.The average apparent diffusion coefficient (ADC),fractional anisotropy (FA),relative ADC (rADC),relative FA (rFA),relative cerebral blood flow (rCBF),relative cerebra blood volume (rCBV),relative regional cerebral blood flow (rrCBF),relative regional cerebra blood volume (rrCBV) of peritumoral regions and analogous locations in the contralateral white matter (WM) corresponding to the tumor were measured on corresponding parameter maps generated from DTI or PWI.SPSS was used in comparative study on differentiation among different area and different grading of gliomas.Receiver operating characteristic (ROC) analyses was also conducted to explore optimum thresholds for tumor grading.The sensitivity and specificity were also discussed. Results ADC,rCBF and rCBV values of tumor were greater than those of the peritumoral regions tissues and contralateral white matter;FA of tumors was less than that of the peritumoral regions tissues and contralateral white matter,the differences had statistical significance (P<0.05);rrCBV and rrCBF in the high-grade glioma tumors and peficancerous tissues were higher than those in the low-grade glioma,respectively (P<0.05),however,rADC value was lower than that in the low-grade glioma (P<0.05);According to the ROC curve analysis,rrCBF and rrCBV area under the curve were 95.4% and 90.2%,the sensitivity and specificity for tumor grading were 87.0%,95.2% and 85.3%,89.2%,respectively. Conclusion Magnetic resonance PWI and DTI can be used for preoperative grading of glioma,and rrCBF is one of the important indicators for the diagnosis of cerebral gliomas.

Ultrasound-guided percutaneous radiofrequency ablation of liver neoplasms:a clinical study

XU Chang-liang, JING Yuan-ming

2017, 15(6): 1016-1018. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.033

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Objective To study the clinical application of percutaneous radiofrequency ablation (FRA) under ultrasound guidance in the treatment of liver tumors. Methods The clinical data of 50 patients with liver neoplasms in our department from January,2014 to June,2016 were analyzed retrospectively.All patients underwent ultrasound guided percutaneous radiofrequency ablation for 3 months.The complete ablation rate of the lesion after ablation,the rate of increase of tumor markers,and the incidence of complications were evaluated. Results The total effective rate of radiofrequency ablation was 86.0%,and 43(86.0%) of the tumors were necrotic and 7(14.0%) of them were still remained after contrast-enhanced ultrasonography.Forty-one of 50 patients were with increased tumor markers before the surgery (82.0%).After the therapy,the levels of markers in 30 patients was reduced,11 patients (22.0%) was still with elevated AFP,6 cases (12.0%) still with elevated AFP 2 months later,however,there was cases with elevated AFP after the second ablation.After the operation,7 cases were with a pain and were relieved after the injection of analgesic;4 cases with the decrease in heart rate,10 patients (42.0%) with post-ablation syndrome.No serious complications occurred.Thirty-four patients had elevated transaminases after the operation. Conclusion Ultrasound-guided percutaneous radiofrequency ablation in the treatment of liver tumors is effective,safe and reliable,without serious complication.It can eliminate tumor tissue and the remains,reduce the relapse rate,and is worthy of promote in clinic.

2017, 15(6): 1019-1021. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.034

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Analysis of prognostic factors of pulmonary thromboembolism

LI Xiao-qing, XU Qi-xia, PANG Ying-ying

2017, 15(6): 1022-1026. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.035

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With the increase of knowledge and the improvement of diagnostic techniques nowadays,the morbidity of pulmonary thromboembolism (PTE) is obviously on the rise.Moreover,a growing number of people are concerned about PTE prognosis,which shows great differences.It can be asymptomatic in less severe cases,but it may be recurrent after cure.In severe cases,it can develop into chronic thromboembolic pulmonary hypertension (CTEPH),or even death,with high case fatality rate.So promptly recognizing the risk factors of prognosis is of great significance in improving the prognosis of patients with PTE.Through retrieving literature from PubMed,CNKI and so on,this review focused on the factors affecting prognosis of PTE.Various factors affect the prognosis of PTE.The prognosis of PTE is closely relevant to PESI scoring system,PTE risk stratification,treatment options and complications of treatment.And it also has inevitable connection with serum markers such as BNP or NT-proBNP,troponin and D-dimer.PESI scoring system is the most widely and effectively used indicator to evaluate the prognosis of PTE,among which elder patients and patients with malignant tumor have more incidence rate of adverse events.So advanced age and malignant tumor may be independent risk factors which affect the prognosis of PTE.Clinically for those PTE patients with prognostic risk factors,we should be on high alert,adopt individualized treatment,and strengthen the standardized management of patients,thus improving the prognosis and increasing the survival rate.

The research progress on mechanisms of cancer multidrug resistance

WANG Ting-feng, DU Xing-long, WEI Jie

2017, 15(6): 1027-1031. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.036

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Currently,malignancy is one of the serious threats to human health and life.In China's urban population,tumor-induced deaths account for 25% of all diseases.Clinical treatment of malignant tumors commonly used three kinds of methods of surgical treatment,radiotherapy and chemotherapy,chemotherapy play an irreplaceable role in the treatment of malignant tumors.Some patients after the effective chemotherapy will continue to relapse,the most important reason is that the formation of multidrug resistance (MDR) to limit the efficacy of chemotherapy.Clinical application of combined chemotherapy can play the largest cytotoxic effect,but also because of the production of MDR failed.Therefore,overcome the multidrug resistance of tumors is an key to future research on tumor therapy.The mechanism of MDR is a very complicated process,influenced by many factors.Tumor cells cause multidrug resistance in a variety of ways,including drug-related proteins,DNA damage and repair dysfunction,cell autophagy,reduced drug accumulation and increased drug output,metabolic detoxification,drug targets and signal transduction molecules changes and other mechanisms.Tumor multidrug resistance is associated with P-glycoprotein,breast cancer resistance protein,multidrug resistance-associated protein,lung resistance protein,topoisomerase and apoptosis-related proteins.There are many reversal agent used in clinical,but the effective and toxic side effects of small MDR reversal agent remains to be further studied.Therefore,to study the mechanism of MDR and tumor cells produce resistance to drugs will be helpful to develop more effective antitumor drugs.This paper presents a review on the current research of molecular mechanism of MDR.

Advance in diagnosis and treatment of patellofemoral osteoarthritis

XU Wen-di, ZHU Xun-bing, HAN Guan-sheng

2017, 15(6): 1032-1036. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.037

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Knee osteoarthritis is a common clinical degenerative diseases,accounting for more than half of osteoarthritis.Patellofemoral osteoarthritis occupies a large proportion of knee arthritis,and also a common disease at orthopedic clinic.According to Chinese statistics (2010 census statistics),China's population was more than 1.34 billion,peoples over 60 years old was more than 167 million,it is estimated that the number of symptomatic knee osteoarthritis among the population more than 60 years of age has tens of millions of people.The high cost of treatment for osteoarthritis will bring a huge burden to the society.Therefore,in order to prevent knee osteoarthritis and improve people's health,it is significant to understand the patellofemoral arthritis for the early prevention and treatment of patellofemoral arthritis.Many scholars believe that poor patellofemoral alignment leads to patellar and femoral trochlea cartilage surface lesions,and then the emergence of various clinical symptoms.Total knee arthroplasty in the elderly patients with patellofemoral arthritis is a more appropriate treatment;total knee replacement with the application of the development of patellofemoral arthroplasty is gradually reduced.For young and early patients,with lesions limited in the patellofemoral joint,total knee replacement surgery is generally not as preferred.This paper reviews the literatures on the diagnosis and treatment of patellofemoral arthritis at home and abroad,hoping to help us research the development of the diagnosis and treatment of this disease.

Effect of clearing away heat and promoting blood circulation therapy on wound healing of perianal abscess

FANG Zheng-yu, PAN Zhi-yun, LI Qian-yuan, DONG Yun-fei

2017, 15(6): 1037-1039. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.038

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Objective To investigate the effect of clearing away heat and promoting blood circulation therapy on wound healing of perianal abscess after operation. Methods A total of 40 cases of patients with perianal abscess in our hospital from June,2014 to March,2015 were selected as the research objects.All patients underwent elective surgery for anal abscess.All patients were randomly divided into experimental group (20 cases) and control group (20 cases).After the operation,the control group was injected with conventional intravenous antibiotics,and daily dressing change,on the basis of which the experimental group was treated with oral Xianfanghuomingyin with Huanglian Jiedu decoction.The prescription containing 12 grams honeysuckle,6 grams angelica,6 grams saposhnikovia divaricata,9 grams red peony root,9 grams Chinese angelica,6 grams Fritillaria,15 grams Scutellaria,6 grams Coptis,9 grams dried tangerine peel,10 grams Radix,6 grams Gleditsia sinensis,6 grams pangolin,6 grams myrrh,6 grams frankincense,9 grams gardenia,10 grams phellodendron bark,6 grams licorice.The curative effects and the wound healing were compared between the two groups.Based on observation of wound healing of patients,we compared wound healing rates of the two groups.Carrion shedding time,emergence time,healing time of epithelium of both groups was recorded.According to surface of the wound of the patients,we gave secretion score,granulation shape score,pain score and swelling score.Corresponding indicators of two groups were statistically analyzed. Results The healing rate of experimental group was significantly higher than that of the control group,while the carrion shedding time,emergence time and epithelial healing time were significantly lower than those in the control group with statistical significance (t=2.743,4.483,2.361,3.237,P<0.05).The curative effect of the experimental group was significantly better than that of the control group and the difference had statistical significance (Z=2.759,P<0.05).In the experimental group,the discharge score,granulation score,pain score,and swelling score were significantly lower than those in the control group.The differences were statistically significant (t=2.682,2.686,3.255,2.741,P<0.05). Conclusion The clearing away heat and promoting blood circulation therapy can significantly improve the clinical symptoms of patients with perianal abscess,and accelerate the healing of the wound.

Preventive effect of modified Yupingfeng powder decoction on cracked nipple in Breastfeeding women

FENG Guo-fang, FENG Su-wen, HUANG Fei-xiang, SI Qi, GU Wen-ping, HUANG Yan-fei, XU Mei-hua

2017, 15(6): 1040-1043,1090. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.039

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Objective To evaluate the preventive effectiveness of modified Yupingfeng powder decoction (astragalus root,atractylis ovata,radix sileris,the root bark of white mulberry,liquoric root,etc.were included) smearing on cracked nipple and pain during breastfeeding in in Chinese breastfeeding women. Methods Using the randomized control design,279 primipara in our hospital between December,2014 and June,2015 were enrolled and randomized into control group,pre and postnatal intervention group and postnatal intervention group.Women in pre and postnatal intervention group were treated with modified Yupingfeng powder decoction twice a day on the morning and night started from 37 gestation weeks till 7 days postpartum,while the postnatal intervention group were started from 2 hours after delivery till 7 days postpartum,and the control group were treated with plain water or colostrums if it was available.Breastfeeding skills were implemented under the supervision of midwives.Nipple trauma and pain intensity were evaluated by nipple trauma score and visual analog scale (VAS) every day after 12 hours postpartum.Baby feeding condition was followed up by phone calls 6 months after delivery. Results The incidence of cracked nipple were 10.53%,21.28% and 25.56% in the pre and postnatal intervention group and control group,respectively,with significant difference (P<0.05).There was no significant difference among the three groups in severity.There were 17 cases (17.89%) in pre and postnatal intervention group,30 cases (31.91%) in postpartum intervention group and 35 cases (38.89%) in control group suffered from severe nipple pain,and the difference among the three groups was significant (P<0.05). Conclusion The use of modified Yupingfeng powder decoction from 37 gestation weeks to 7 days postpartum is effective on preventing nipple cracks and relieving nipple pain in Chinese Breastfeeding Women.The treatment may indirectly increase the rate of pure breastfeeding in 6 months.

Clinical observation of classic prescriptions Shegan Mahuang decoction on cough after infection patients with wind-cold stay in the lung

WANG Shi-qiang, LOU Li-ming, ZHANG Hong, CHEN Su-zhen, HUANG Hui-xian, XU Yi-kai

2017, 15(6): 1044-1046. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.040

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Objective To investigate the clinical effect of classic prescriptions Shegan Mahuang decoction on cough after infection patients with wind-cold stay in the lung. Methods Sixty cases of cough after infection patients with wind-cold stay in the lung in our hospital from November,2014 to August,2015 were randomly divided into 2 groups,each 30 cases.The control group was given Fufang Methamidophos Capsule,while the treatment group was given Shegan Mahuang decoction.The clinical TCM syndrome score,Leslie cough quality of life questionnaire (LCQ),symptom improvement time and clinical effect of both groups were analyzed to evaluate the efficacy of Shegan Mahuang decoction.The inflammatory factors (TNF-α,IL-4),inflammatory mediators[substance P (SP) and neurokinin A (NKA)]in sputum of both groups were analyzed. Results After the treatment,the TCM syndrome score of the two groups were significantly reduced (P<0.05),and the TCM syndrome score of the treatment group was significantly lower than that in the control group (P<0.05).After the treatment,the LCQ indicators of the two groups were significantly increased (P<0.05),and the LCQ indicators of the treatment group was significantly higher than that in the control group (P<0.05).After the treatment,symptom onset time and symptom disappearance time of the treatment group were significantly lower than that in the control group (P<0.05).The total effective rate of the treatment group was 93.3%,which was significantly higher than 76.7% in the control group (P<0.05).After the treatment,the TNF-α and IL-4 levels of the two groups were significantly reduced (P<0.05),and the TNF-α and IL-4 levels of the treatment group was significantly lower than those in the control group (P<0.05).After the treatment,the SP and NKA levels of the two groups were significantly reduced (P<0.05),and the SP and NKA levels of the treatment group was significantly lower than those in the control group (P<0.05). Conclusion Shegan Mahuang decoction could effectively improve the clinical symptoms and life quality of cough after infection patients with wind-cold stay in the lung,and its treatment mechanism might be related to the improvement of airway neurogenic inflammation.

Application of PBL teaching method in mental health education of medical students

CHEN Xiao-dong, DENG Min, WANG Hong-yu, CHEN Xiao-bin

2017, 15(6): 1047-1050. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.041

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Objective To understand the status of mental health of medical students,compare the effect of PBL teaching method and traditional teaching method in improving the mental health of medical students,and to provide a basis for the effective teaching strategies in mental health education. Methods Via the convenient cluster sampling method and the SCL-90 scale to investigate the students in a medical school,357 valid samples were obtained and randomly divided into the control group (n=178) and experimental group (n=179),who received 16 weeks of teaching experiment.The independent sample t-test and chi-square test were used for intergroup comparison. Results The total score of SCL-90 was 129.44,with a 15.97% positive rate,and the average score of all the factors were between 1.21 and 1.81,which were lower than the national norm level.After the experiment,the total score of the control group decreased by 4.93%,the positive rate decreased by 2.99%,and the average score of all the factors reduced between 0.04 and 0.09 scores,among which somatization,interpersonal sensitivity,anxiety and hostility factors has statistical significance (P<0.05).The total score of the experimental group decreased by 6.31%,and the positive rate decreased by 7.51%,with a significant difference (P<0.05) and except for depression,the average score of all factors reduced between 0.06 and 0.11 scores,with a significant difference (P<0.05). Conclusion Compared with that of the national college students'norm,the mental health of medical students is better.Both the traditional teaching method and PBL teaching method can reduce the self-evaluation score of psychological symptoms,but the latter can have a better effect.

Investigation and Analysis on the satisfaction degree of the teachers'professional ability to the standardized training of resident doctors in Guangxi

WEI Yan-ni, PAN Xiao-yan, WANG Shi-yi, LI Qiu-hua

2017, 15(6): 1051-1054,1061. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.042

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Objective To investigate the rate of satisfaction of teachers from 7 national resident standardized training based hospitals of Guangxi to student's comprehensive vocational abilities,to find out the possible problems and discuss feasible countermeasures. Methods With a self-designed questionnaire,we conducted a survey in 533 teachers from 7 of the first national standardized residency training bases.The questionnaire includes two parts:general situation (gender,age,education,etc.) and evaluation content (professional ethics,interpersonal communication and teamwork ability,clinical professional ability,teaching and research capacity,etc.).With 5 Likert scale method,the responses to the questions were given 5 to 1 score points from positive to negative.The data were collected using Epidata 3.1 to establish the database,and using SPSS 20.0 statistical software for statistical description,t test and variance analysis. Results A total of 560 questionnaires were distributed,and we recovered 535,with a recovery rate of 95.5%.The number of valid questionnaire was 533 with an effective rate 99.6%.The survey indicated that 533 teachers thought highly of the comprehensive occupation ability of residents,and the average was 4.17 points.Professional ethics scored 4.44 points.Communication skills scored 4.15 points.Clinical ability scored 4.04 points.Scientific research ability scored 3.64 points.Different gender,age,education,professional title,hospital and department of the overall satisfaction score were different,and P values were 0.474,0.328,0.872,0.945,0.466,0.123 via t test and analysis of variance,and the difference was not statistically significant. Conclusion The overall satisfaction of professional ethics of Guangxi hospital training physicians is high.Interpersonal communication and coordination ability is relatively strong,clinical professional ability is passable,while teaching and scientific research ability is weak.

The application of problem-based teaching method in surgery teaching

HANG Qun, JIANG Cong-qiao, LI Shi-qing, LIU Mu-lin, LI Duo-jie

2017, 15(6): 1055-1057,1078. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.043

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Objective To discuss the application value of problem-based teaching method in surgery teaching. Methods Apply "the traditional teaching method" to the control group,and introduce the problem-based teaching method in the experimental group.According to the syllabus,we prepare the lesson carefully,grasp the essence of the teaching contents,set delicate,novel,various and sufficient topics as far as possible,let every students have the chance to answer the question,distribute the students the task to solve problem ahead of time,give the students sufficient time to prepare in the latter group.The students answer questions based on accurate basis and reason,and the teachers'comments must be accurate and encourage students to take part in actively.Compare the final theory results of students in two groups and students'satisfaction survey. Results The scores of surgery theory of two groups have statistical significance (P<0.05).The results in experimental group is better than those in the control group.The problem-based teaching method used in surgery teaching,can not only improving learning initiative but also promote the students'ability to solve problems with scientific clinical thinking,thus laying a solid foundation for their future learning and sustainable development. Conclusions Problem-based teaching method improves the students'learning autonomy and creativity and highlights the students-centered awareness.Problem-based teaching method is conducive to the cultivation of students'scientific thinking,which can help students improve and innovate problem solving skills.It enables students to learn sustainably via teaching methods in an equal environment.To apply problem-based teaching method in surgery teaching,we can provide a platform for students to think independently,voice frankly and seek for questions,thus cultivating students'ability of clinical thinking,actual problem-solving and sustainable learning to grow healthily and become a man of tremendous promise.Introducing the problem-based teaching method in surgical teaching can make the teaching effect remarkable,which is worth promoting.

Effect of miR-16 on SERT expression in the rapheal nuclei of brain stem of neuropathic pain rat

LUO Feng-qin, ZHANG Juan, GUO Xiao-wen, WANG Rui

2017, 15(6): 1058-1061. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.044

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Objective To explore the mechanism of the affection of miR-16 on 5HT reuptake in the neuropathtic pain by studying the miR-16 regulating SERT expression. Methods Forty adult male SD rats were randomly divided into control group (C group),sham operation group (S group),chronic constriction injury group (CCI group),chronic constriction injury plus fluoxetine group (CCI/F group),10 rats per group.Left sciatic nerve of rats in CCI group were freed and loosely compressed by sutures,while rats in the S group were only freed the neurilemma.The mechanism withdraw threshold (MWT) was test in the preoperative day and the day 1,3,5,7,14 after surgery.Fourteen days after surgery,the rats were sacrificed,and the rapheal nuclei of brain stem were taken.The miR16 expression was tested by qRT-PCR,and SERT was tested by western blot.The 5HT level in the tissue homogenate was analyzed by ELISA assay. Results Compared with the S group,the MWT in the CCI group was significantly declined in the first day after surgery (t=5.167,P<0.001),but the value was increased in the CCI/F group (t=28.640,P<0.001).SERT in the rapheal nuclei of CCI group was increased but decreased in the CCI/F group as shown by western blot.Compared with the S group,5HT in the rapheal nuclei of CCI group was significantly decreased (t=17.92,P<0.001),but increased in the CCI/F group (t=7.232,P=0.002). Conclusion miR-16 can regulate the expression of SERT in the rapheal nuclei,thereby affect the reuptake of 5HT to influence the neuropathic pain.

Effect of radiation therapy on immune function of patients with lung cancer

LIU Xue-xiao, ZHU Hong, DU De-xi, TIAN Zhi-feng, CHENG Hui-fei, WU Li-xian

2017, 15(6): 1062-1064. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.045

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Objective To explore the influence of radiation therapy on CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺ in patients with lung cancer. Methods The clinical data of 90 patients with lung cancer undergoing radiotherapy in Lishui Central Hospital were studied.The radiation dose and target volume were recorded.The CD3⁺,CD4⁺,CD8⁺ and CD4⁺/CD8⁺ in peripheral blood were determined by flow cytometry. Results After radiotherapy,the CD3⁺[(61.48±1.86)%]was no significant difference with that before radiotherapy[(61.12±1.83)%],P>0.05,the levels of CD4⁺ and CD4⁺/CD8⁺[(26.85±1.28)%,0.71±0.06]were significantly lower than those before the treatment[(36.24±1.25)%,1.22±0.08](P<0.05),the CD8⁺ content[(37.92±1.66)%]was higher than that before the treatment[(29.79±1.12)%],P<0.05.After radiotherapy,CD3⁺ abnormality ratio (32.2%) was no significant difference with that before radiotherapy (34.4%),P>0.05,the percentage of abnormal CD4⁺,CD4⁺/CD8⁺(85.6%,67.8%) was lower than that before the treatment (53.3%,31.1%),P<0.05.The CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺ radiation therapy dose ≥ 60 Gy patients[(63.43±1.85)%,(27.23±1.28)%,(37.53±1.17)%,0.72±0.07]was not statistically significant with radiation dose<60 Gy[(61.12±1.77)%,(26.77±1.31)%,(38.08±1.36)% and 0.69±0.05],P>0.05.There was no significant difference of CD3 between target volume>440 cm³[(61.88±2.23)%]and target volume ≤ 440 cm³[(59.99±2.17)%],P>0.05,the CD4⁺,CD4⁺/CD8⁺[(24.37±1.68)%,0.68±0.06]were significantly lower than those with target volume ≤ 440 cm³,the CD8 content[(41.46±2.59)%]was higher than that of target volume ≤ 440 cm³[(34.27±2.13)%],P<0.05. Conclusion The immune of lung cancer patients before radiotherapy is dysfunction.The immune function after radiation therapy decreases further.The immune function of patients with lung cancer is related to radiation target volume,the larger the target volume,the lower the immune function.

Clinical study of preconditioned combined intraoperative recovering autologous blood transfusion in patients with elective surgery

HU Ru-xue, XU Jian-qiang, LU Gen-jie

2017, 15(6): 1065-1068. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.046

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Objective To investigate the clinical effect of preconditioned combined intraoperative recovering autologous blood transfusion in patients with elective surgery. Methods Eighty-four patients with elective surgery were randomly divided into two groups,each group 42 cases.Patients in control group were given allogeneic blood transfusion,and patients in observation group were given preoperative combined intraoperative recovery of autologous blood transfusion.Before and after treatment,the blood related indicators (Hb,Hct,PLT,PT,APTT),inflammatory mediators (TNF-α,complement C3),peripheral blood T lymphocyte subsets (CD4,CD4/CD8,CD8) and NK cells,immunoglobulin (IgA,IgG,IgM) of patients were detected,and the adverse reactions were accounted. Results After treatment,Hb,HCT,PLT,PT and APTT levels of observation group had no significantly differences compared to before treatment (P>0.05).Hb,HCT,PLT,PT and APTT levels of control group were significantly decreased compared to before treatment (P<0.05).After treatment,Hb,HCT,PLT,PT and APTT levels of observation group were significantly higher than those of control group (P<0.05).After treatment,complement C3,CD4,CD4/CD8,NK cells,IgA,IgG,IgM of observation group were significantly higher than those of before treatment (P<0.05).After treatment,complement C3,CD4,CD4/CD8,NK cells,IgA,IgG,IgM of control group were significantly lower than those of before treatment (P<0.05).After treatment,complement C3,CD4,CD4/CD8,NK cells,IgA,IgG,IgM of observation group were significantly higher than those of control group (P<0.05).After treatment,TNF-α of observation group was significantly lower than that of before treatment (P<0.05).After treatment,TNF-α of control group was significantly higher than that of before treatment (P<0.05).After treatment,TNF-α of observation group was significantly lower than that of control group (P<0.05).The adverse reaction rate of observation group was 0.0%,which was significantly lower than that of control group (14.3%,P<0.05). Conclusion Compared to allogeneic blood transfusion,preoperative combined intraoperative recovery of autologous blood transfusion could effectively regulate the inflammation and immune function,is helpful for prognosis recovery.

Influence of continuing care based on WeChat on mental health status of the dementia caregivers

LI Fang-ying, XIN Hong-ju, LOU Gao-bo, TANG Xiao-fang

2017, 15(6): 1069-1071. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.047

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Objective To discuss the influence of continuing care based on WeChat on mental health status of the dementia caregivers,and to improve mental health status of the dementia caregivers. Methods A total of 65 dementia patients and their caregivers from elderly comprehensive ward of Zhejiang Hospital from February,2015 to April,2016 was included in the study and divided into two groups,with 32 in treatment group and 33 in control group.Routine health education including daily life,medicine,safety instruction,etc.was given to the control group during hospitalization,together with regular telephone follow-up in 3 months after discharge.The patients in the treatment group received continuing care based on WeChat for three months on this basis,including the establishment of WeChat follow-up team,regular release disease related knowledge on the official account,and arrangement for the team members to participate in WeChat group chat,etc.The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to measure the mental health status of the dementia caregivers before and after 3 months of the intervention. Results The caregivers level of anxiety,depression in the treatment group were 37.30±5.45 and 39.14±7.76,respectively,and in the control group were 41.73±6.39 and 43.15±7.13,after the inspection.The differences were significant (t=-2.998,-2.170,all P<0.05). Conclusion WeChat,as a simple and convenient way for dementia patients'caregivers to provide professional knowledge and psychological support,provided a communication platform for different caregivers.Continuing care based on WeChat has a significant effect on improving mental health status of the dementia caregivers,and could be further promoted in clinical practice.

The application effect of Orem self-care theory in the esophageal cancer patients with radiation and chemotherapy

CHEN Qing-qing, CHEN Jin-hui, XU Li-wei, MAO Xin-li

2017, 15(6): 1072-1074. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.048

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Objective To discuss the effects of Orem self-care theory in the esophageal cancer patients with radiation and chemotherapy in terms of quality of life,curative effect,nursing satisfaction,incidence of toxic and side effects before and after nursing. Methods We selected 108 esophageal cancer patients and divided them into the research group and the control group,with 54 cases in each group.The differences of gender,disease duration,age and other general information of two groups were not statistically significant (P<0.05).Routine nursing was used in the control group,on the basis of which the research group received Orem self-care theory oriented nursing including complete compensatory nursing,partial compensatory nursing and support education,The life quality of patients with cancer were respectively accessed before and after the care with reference to life quality criteria of cancer patients.The therapeutic efficacy was measured with reference to tumor response evaluation criteria of National Cancer Institute to compare the quality of life,curative effect,nursing satisfaction and the incidence of adverse reaction of the two groups before and after the nursing. Results After the nursing,the scores of body function,emotional function,cognitive function,the role function,the social function and overall health of the research group were higher than those in the control group (P<0.05);the curative effect and nursing satisfaction of the research group was higher than the control group (P<0.05),and the incidence of adverse reaction was lower than the control group (P<0.05),all with statistically significances. Conclusion Orem self-care theory used in the esophageal cancer patients with radiation and chemotherapy can arouse the self care enthusiasm of patients,increase patient's confidence and their subjective initiative,and improve their quality of life.Meanwhile,it can reduce workload of nurses,thus reduction of medical resources waste can be achieved.

Study on the effect of comprehensive nursing intervention on insomnia and anxiety in patients after cerebral apoplexy

YU Ling-ping, XIE Ling-min, WANG Wei-zhen, GE Qiu-hua

2017, 15(6): 1075-1078. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.049

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Objective To investigate the effect of comprehensive nursing intervention on insomnia and anxiety in patients after cerebral apoplexy. Methods Altogether 168 patients with insomnia and anxiety after cerebral apoplexy from the department of neurology in our hospital were selected and divided into 2 groups,with 84 cases in the control group receiving conventional nursing and 84 cases in the experiment group receiving comprehensive nursing intervention on the basis of the control group,including psychological care,rehabilitation training,diet care,bedtime care and drug care.The psychological state,sleep quality,cognitive function,neural function and motor function,and the clinical efficacy were compared after intervention. Results Compared with those in the control group,the Hamilton Anxiety Scale (HAMA),depression scale (HAMD),Zung's self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) scores were lower after intervention,the number of wake up,sleep latency and Pittsburgh sleep quality index (PSQI) score were lower,the total sleep time and sleep efficiency were higher after intervention,the condensed mental state scale (MMSE),simple Fugl-Meyer motor function score (FMA) scores were higher,and the stroke neural function defect scale (CNS) score was lower after intervention (P<0.05) in the experiment group.The effective rate in the control group (82.14%) was lower than that in the experiment group (95.24%),with significant difference (P<0.05). Conclusion The comprehensive nursing intervention can effectively relieve the anxiety in patients with insomnia and anxiety after cerebral apoplexy,improve sleep quality,cognitive function,neural function and motor function,and improve the quality of life of patients,with exact nursing effect

Application and effectiveness of dual track interactive nursing intervention of three subjects on elderly patients with COPD

GUO Ya-nan, ZHANG Ting-ya, LIU Yun-feng

2017, 15(6): 1079-1082. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.050

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Objective To explore the effectiveness of dual track interactive nursing intervention of three subjects on elderly patients with chronic obstructive pulmonary disease (COPD). Methods A total of 132 cases of COPD in our hospital between December,2013 and December,2015 were enrolled and were divided into intervention group and control group by simple random sampling.The control group received the routine nursing care,all the patients in this group were followed up with a t revisiting through telephone after the discharge to provide the knowledge of self-management and publicity and education;while the intervention group received dual track interactive nursing intervention of three subjects.The hospital extended care interventions track with elderly COPD patients and specialist nurses of hospital as the main body,and community care intervention track with elderly COPD patients and community nurses as the main body were built and run in the intervention group.The quality of life,SAS/SDS score in 3 months after the treatment,overall response rate and satisfaction were compared between the two groups. Results Dryprognosis of patients in the experimental group and the control group of patients with general health scores were 61.6±4.6,53.6±3.7,scores of patients in the experimental group than control group,the difference of experimental data with statistical significance (P<0.01);after intervention,there were 33 markedly effective cases,28 effective cases,5 ineffective cases in the experimental group and 23 markedly effective cases,17 effective cases,26 ineffective cases in the control group,the curative effect in the experimental group was better than that in the control group,the difference of experimental data with statistical significance (P<0.01);patients satisfaction were 97.0%,72.7% of the patients in the experimental group was higher than that of the control group experimental data differences were statistically significant (P<0.01). Conclusion The dual track interactive nursing intervention of three subjects on COPD can stimulate the patient's subjective initiative,improve psychological state and quality of life of patients.

Application of comprehensive individual nursing intervention on bipolar of depressive episode affective disorder

XIE Xiao-ying, CAI Jing, FENG Hong

2017, 15(6): 1083-1085. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.051

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Objective To investigate the effects of comprehensive individual nursing intervention on bipolar of depressive episode affective disorder.And we can use it to provide higher quality nursing service to patients. Methods Altogether 60 cases patients received by our hospital from 2014 to 2015 with bipolar of depressive episode affective disorder were randomly divided into control group and observation group,with 30 cases in each case.The control group was treated with normal treatment.On the basis of normal treatment,the observation group was treated with comprehensive individual nursing.The treatment cycle is five weeks.After five weeks we evaluated the grade of MMSE and HAMD of the patients before and after treatments.And we compared the satisfaction rate after experiment. Results Before our intervention,the MMSE and HAMD scores of two groups have no significant difference (P>0.05).After the intervention,the score of MMSE in observation group was higher than that in the control group (P<0.05).The grade of HAMD of observation group was lower than that in the control group (P<0.05).The nursing quality success rate of observation group is 86.67% which is obviously higher than the 50.00% of control group. Conclusion The comprehensive individual nursing intervention can have an obviously well effect on bipolar of depressive episode affective disorder.It can steadily control the depression and improve the cognitive ability of the parents.The comprehensive individual nursing intervention can also improve the compliance of patients who can enjoy more comfortable nursing process and the satisfaction rate of nursing improved obviously.Comprehensive individual nursing intervention should be promoted in clinical work.

2017, 15(6): 1086-1087. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.052

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2017, 15(6): 1088-1090. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.053

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2017, 15(6): 1091-1092. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.054

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2017 Vol. 15, No. 6

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