中华全科医学

Evaluation on the diagnostic value of body mass index in predicting diabetes in the first-degree relatives of type 2 diabetic patients

WANG Wenbo, XU Yan, LU Xiaoping, WANG Qiuli, CUI Lan, LIU Yue, WU Bin

2017, 15(8): 1275-1277,1330. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.001

166 1

Abstract:
Objective Obesity is closely related to the occurrence and development of type 2 diabetes mellitus. Body mass index (BMI) is a worldly recognized classification method for assessing the degree of obesity. To investigate the relationship between body mass index (BMI) and hyperglycemia and evaluate the diagnostic value of BMI in predicting diabetes in the first-degree relatives of type 2 diabetic patients. Methods We conducted a prospective cohort study in a sample of 296 first-degree relatives without glucose intolerance history. All adults were examined on height, weight, calculated BMI and underwent an oral glucose test (OGTT). Their level of fasting blood glucose, 30-minute postprandial plasma glucose, 60-minute postprandial plasma glucose, 120-minute postprandial plasma glucose were determined by the glucose oxidaseperoxidase method. The area under the blood glucose curve (AUCg) was calculated by the trapezoidal rule. Evaluation of the value of BMI levels in diabetes screening by receiver operating characteristic curve analysis (ROC). Results (1) The prevalence rates of impaired glucose regulation and diabetes were 30. 07% and 19. 93% in the first-degree relatives of type 2 diabetic patients respectively. From normal glucose tolerance condition through impaired glucose regulation to diabetic, the BMI progressively increased (P < 0. 001). (2) Area under the curve sugar of OGTT (AUCg) as dependent variable, age and BMI as the independent variable in normal glucose tolerance group, linear stepwise regression analysis showed that age and BMI were the independent factors (P=0. 015). (3) The optimal cutoff value of sensitivity and specificity of BMI were 24. 95 kg/m², 67. 3% and 62. 2% by receiver operating characteristic (ROC) curve. Conclusion BMI is a strong predictor for hyperglycemia in the first-degree relatives of type 2 diabetic patients. It is therefore suggested that BMI ≥ 24. 95 kg/m² be recommended as diagnostic cut-off points in the first-degree relatives of type 2 diabetic patients.

2017, 15(8): 1278-1279.

60 5

Abstract:

Suture anchor and Krackow locking stitch for distal pole patellar fractures

LI Jun, SHI Zhigang, FU Yu, HAN Bing, ZHAN Junfeng, JING Juehua

2017, 15(8): 1280-1282. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.002

215 0

Abstract:
Objective Suture after excision of inferior pole of the patella and internal fixation that reserved distal pole of the patella, the common routine therapy methods for distal pole patellar fractures, are both with some drawback. The aim of this paper is to explore the clinical efficacy of suture anchor and Krackow locking stitch in the treatment of distal pole patellar fractures. Methods The suture anchor and Krackow locking stitch were performed in 10 cases of distal pole patellar fractures, including 9 cases of closed fracture and 1 case of open fracture (Gustilo type Ⅰ), 5 male and 5 female patients, aged 23 to 75 (mean 46. 00 ±19. 48) years. Two suture anchors were twisted in the proximal section, and Krackow locking stitch was performed. Hinged knee brace was used to protect at knee extension. Knee flexion exercises protected by hinged knee brace were carried out in 3 days after the operation; Partial weight bearing exercise protected by hinged knee brace was performed at 2 weeks after the operation, and full weight-bearing ambulation without hinged knee brace protection was executed. The regularly reexamination after the operation was performed to check the position of anchors by X-ray and evaluate the healing of fractures. Results All patients were followed up, the average time was 6 to 12 months (mean7. 90 ±2. 28). The length of incision was 4 to 7 cm (mean 5. 35 ±0. 85) cm. Bostman patella fracture functional score was 22 to 30 points (mean 27. 10 ±2. 88) at 3 months after the operation and 23 to 30 points (mean 28. 30 ±2. 21) at 6 months after the operation. The bony union was showed by radiography 6 months after the operation in all fractures. Conclusion The suture anchor and Krackow locking stitch in the treatment of distal pole patellar fractures is with good early efficacy, less trauma and rapid postoperative recovery, avoiding the second operation.

Effects of Sevoflurane and propofol combined with dexmedetomidine on the postoperative cognitive function and oxidative stress response in laparoscopic gallbladder resection

CHEN Yuanliang, XU Lili, LAN Zhijian, ZHANG Lei

2017, 15(8): 1283-1285. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.003

161 1

Abstract:
Objective To explore the effects of sevoflurane and propofol combined with medetomidine in peritoneoscope gallbladder resection and postoperative cognitive function and oxidative stress response. Methods Altogether 74 cases of laparoscopic cholecystectomy were divided into two groups. All patients were given preoperative intramuscular injection of dexmedetomidine with midazolam and fentanyl for anesthesia induction. The observation group was given inhalation of sevoflurane with target controlled infusion of dexmedetomidine for maintenance of anesthesia. The control group was given propofol target controlled infusion combined with dexmedetomidine for maintenance of anesthesia. Postoperative recovery was compared between the two groups. Changes of postoperative cognitive function in patients were assessed with minimental state examination (MMSE) score. Changes of S100 beta protein and oxidative stress in patients were detected before and after surgery. Results There was no significant difference in the operation time between the two groups (P >0. 05). The observation group awake time and extubation time, recovery time were significantly lower than those in the control group. The difference was statistically significant (t=5. 870, 10. 226, 8. 527, P < 0. 05). At 6 hours, 12 hours and 24 hours after operation, the MMSE score of the observation group was significantly higher than that of the control group.The difference was statistically significant (t=3. 417, 3. 800, 3. 048, P < 0. 05). 24 h after operation, the observation group S100 beta protein was significantly lower than the control group. The difference was statistically significant (t=4. 768, P <0. 05). SOD and MDA were significantly improved after operation in two groups, and T-AOC was significantly decreased (P < 0. 05). For the observation group MDA and SOD were significantly lower than those in the control group. T-AOC was significantly higher than the control group. The difference was statistically significant (t=4. 689, 4. 073, 8. 518, P <0. 05). Conclusion Compared with propofol, sevoflurane composite dexmedetomidine can significantly reduce oxidative stress reaction for patients after a laparoscopic cholecystectomy, thus to protect cognitive functions.

Clinical analysis of 45 cases of acute pulmonary embolism

ZHI Limin, ZHANG Yujie, CAO Dalong, LI Yuncheng

2017, 15(8): 1286-1288. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.004

126 1

Abstract:
Objective To discuss and summarize the predisposing factors, clinical features and treatment methods of acute pulmonary embolism, thus to improve the understanding of acute pulmonary embolism. Methods The predisposing factors, clinical manifestations, diagnosis, treatment and prognosis of 45 cases diagnosed as acute pulmonary embolism were analyzed retrospectively from January, 2010 to December, 2016 in the first people's hospital of Bengbu. Results The clinical diagnosis of acute pulmonary embolism in 45 patients included 23 cases of male, 22 cases of female. The age of the patients ranged from 34 to 88 years, with an average age of (69. 00 ±12. 79) years, including 36 cases of internal medicine (80%), surgical patients in 9 cases (20%). The clinical manifestations were chest tightness (n=38), anhelation (n=20), shock (n=12), cough (n=10), dyspnea (n=10), chest pain (n=7), palpitations (n=7), hemoptysis (n=2), and syncope (n=1). Thirty cases had more than 2 symptoms at the same time. The risk factors were as follows:venous thrombosis of lower limbs or lower extremity varicose veins, cardiovascular and cerebrovascular diseases, fracture or fracture surgery, smoking, staying in bed for more than 3 days, diabetes and chronic obstructive pulmonary disease. In this group of patients, 39 cases were diagnosed by CTPA as pulmonary thromboembolism, 1 case was diagnosed by echocardiography, 1 case was diagnosed by surgical thrombectomy, and 4 critical condition cases were diagnosed by clinical comprehensive analysis. The positive rate of D-dimer was 93%. Electrocardiogram, echocardiography, lower limb venous ultrasonography and blood gas analysis had certain specific changes. Six cases died due to invalid rescue, one case was treated with thrombolytic therapy remain unconscious, the others were treated with thrombolytic or anticoagulant therapy, and the clinical symptoms were improved obviously. Conclusion Acute pulmonary embolism lacks specific symptoms and signs. Incidence of the disease is closely related to the susceptible factors. Thrombolysis and anticoagulation therapy can improve the survival rate in patients with acute pulmonary embolism.

Clinical effect of minimally invasive posterior lumbar interbody fusion in the treatment of lumbar spondylolisthesis

GAO Xiaoliang, YANG Xiaohui, HUANG Weimin, HU Yabin

2017, 15(8): 1289-1291. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.005

144 0

Abstract:
Objective To investigate the clinical effect of minimally invasive posterior lumbar interbody fusion (PLIF) in the treatment of lumbar spondylolisthesis. Methods Total 98 cases of lumbar spondylolisthesis were selected from our hospital from March, 2012 to March, 2015. According to the random number table method, he patients were randomly divided into observation group and control group of 49. In the observation group, there were 31 cases of male patients and 18 female patients, including 29 cases of lumbar isthmic spondylolisthesis and 20 cases of lumbar degenerative spondylolisthesis; according to the standard of Meyerding classification:Ⅰ spondylolisthesis in 23 cases, Ⅱ 26 cases of spondylolisthesis. In the control group, there were 30 cases of male patients and 19 female patients, including 30 cases of lumbar isthmic spondylolisthesis and 19 cases of lumbar degenerative spondylolisthesis; according to the standard of Meyerding classification:Ⅰ spondylolisthesis in 22 cases, Ⅱ 27 cases of spondylolisthesis. The control group received open lumbar interbody fusion therapy, while the observation group received minimally invasive posterior lumbar interbody fusion. Results The intraoperative blood loss, time to ambulation after the surgery and postoperative drainage volume in the observation group were better than those of the control group (P < 0. 05); The excellent and good rate (89. 80%) in the observation group was higher than that of the control group (63. 26%), P < 0. 05. VAS score in 1 month, 3 months, 6 months and 12 months after the treatment in the observation group was lower than those in the control group (P < 0. 05), and was reverse for JOA score and ODI score (P < 0. 05). Conclusion The minimally invasive PLIF in the treatment of lumbar spondylolisthesis has significant clinical effect, and it is of great significance.

Maintenance of PICC line in the home: a meta-analysis

WANG Pengpeng, YING Yanping, HUANG Huiqiao, LING Ying, ZHAO Huihan, ZHU Wei

2017, 15(8): 1292-1296,1381. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.006

183 1

Abstract:
Objective To compare the effectiveness of home maintenance and hospital maintenance of peripherally inserted central catheter (PICC) line in outpatients and evaluate the feasibility of maintenance in the home. Methods We searched Cochrane Library, Pub Med, Embase, CNKI, VIP, CBM, Wanfang database by computer to collect clinical controlled trials that were published at home and abroad before August 2016 on the effectiveness of home maintenance and hospital maintenance in patients with PICC. Stata 12 software was used for Meta-analysis of the data. The incidence of PICC related complications was used as outcome indicator. Results A total of 15 papers were included, with a total sample size of 1374 patients, of which 730 patients in the hospital maintenance group, 644 patients in the home maintenance group. The results of Meta-analysis showed that the rate of local infection[RR=3. 82, 95% CI (2. 51-5. 83)], phlebitis[RR=5. 51, 95% CI (2. 08-14. 61)], catheter removal[RR=2. 36, 95% CI (1. 28-4. 34)], catheter blockage[RR=1. 75, 95% CI (1. 26-2. 43)] and catheter-related thrombosis[RR=3. 77, 95% CI (1. 30-10. 90)] in the home maintenance group were lower than that in the hospital maintenance group; compared with the hospital maintenance group, the rate of catheter related infection[RR=0. 93, 95% CI (0. 57-1. 53)], catheter breakage[RR=0. 58, 95% CI (0. 15-2. 27)], skin allergy[RR=1. 08, 95% CI (0. 36-3. 28)] in the home maintenance group were not statistically significant. Conclusion The current clinical research evidence suggests that the home maintenance method in outpatients with PICC cannot increase the rate of PICC related complications compared with the method of the hospital maintenance, and the home maintenance method is feasible.

Relationships study of endothelial progenitor cells and the neurologic impairment symptoms of acute cerebral infarction

ZHONG Ping, LIU Shihua, CHENG Yan, WANG Guosheng, MA Zhengfei, ZHANG Lei

2017, 15(8): 1297-1300. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.007

113 0

Abstract:
Objective To observe the changes of peripheral blood endothelial progenitor cells (EPCs) in patients with acute cerebral infarction (ACI). To investigate the predictive value of EPCs in the neurologic impairment symptoms of acute cerebral infarction. Methods Consecutive 72 patients with acute ischemic stroke within 24 hours were enrolled in the study, and all patients were diagnosed acute ischemic stroke for the first time. At the same time to choose our stroke screening outpatient 50 cases as control group. To within 1 week of the highest of the National Institute of Health stroke scale (NIHSS) scores as the evaluation criteria for the severity of the neurologic impairment symptoms of acute cerebral infarction. As CD133⁺KDR⁺ cells as a sign of EPCs, using flow cytometry in patients with acute cerebral infarction incidence 1, 5, 10 days the number of peripheral blood EPCs. Results In patients with acute cerebral infarction 1 d, 5 d, 10 d number of EPCs in 1 d reduce 5 d increased 10 d downward trend, and were significantly lower than the control group (all P < 0. 05). Severe group 1 d, 5 d, 10 d number of EPCs were lower than that of mild group, and a statistically significant differences (all P < 0. 05). Cerebral infarction in patients with acute phase NIHSS score and the onset of EPCs negatively correlated with the number 1 d, 5 d, 10 d (r₁=-0. 762, r₅=-0. 622, r₁₀=-0. 414, all P < 0. 05). Conclusion Baseline level of EPCs was significantly lower in patients with ACI than control group, EPCs may be an risk factor for acute cerebral infarction. Cerebral infarction in patients with acute phase, the lower the number of EPCs and the heavier of the neurologic impairment symptoms. EPCs in patients with cerebral infarction in acute stage of the neurologic impairment symptoms assessment has a guiding significance.

Role of corneal confocal microscopy in diagnosis and treatment of fungal keratitis

WU Bole, HU Xiayun

2017, 15(8): 1301-1304. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.008

154 0

Abstract:
Objective To study the confocal microscopy imaging of the cornea with fungal keratitis and its treatment outcome, explorer its role in the early diagnosis and appropriate treatment of fungal keratitis. Methods Between April, 2012 and April, 2013, 38 patients (38 eyes) suffered with fungal keratitis were examined in our hospital by corneal smears, fungal culture and corneal confocal microscopy before the treatment. All patients received natamycin eyedrop, amphotericin B eyedrop and fluconazole antifungal therapy. The confocal microscopy laser scanning was performed again to observe the density of hyphae and inflammatory cells in the corneal lesion at 7, 14 and 21 d after treatment and 7 d after drug withdrawal, and the treatment plan was adjusted based on the curative efficacy. All patients were followed up for one month to observe the relapse of fungal infection. Results Confocal microscopy detected the hypha in 34 patients with a positive rate of 89. 47%. The fungal hyphae was characterized by high refractive filaments which had branch. Fourteen cases (41. 18%) were in accordance with the characteristics of Fusarium spp. (branch angle 90°); 10 cases (29. 41%) in accordance with the characteristics of aspergillus (branch angles 45°); 2 cases (5. 88%) in accordance with the characteristics of yeast (slender granular). Thirty-one cases were cured with a rate of 81. 58%, 7 cases were improved; there was no worse and relapse cases. The average course was 19 days. The hyphae and inflammatory cells gradually reduced after treatment and disappeared after cures. Conclusion Confocal microscopy plays an important role in the early diagnosis of fungal keratitis, preliminary identification of strains and dynamic follow-up of treatment outcome. This is also a valuable objective tool in directing antifungal medication.

Clinical application of CT-guided percutaneous lung biopsy in the diagnosis of pulmonary tuberculosis in high altitude area

GE Sangdeji, LI Wei, YU Xiaohua, XUN Xia, JIANG Aciren, CI Renzhuoga, YAO Yanpeng

2017, 15(8): 1305-1307. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.009

98 0

Abstract:
Objective To explore the clinical value of CT-guided percutaneous lung biopsy in the diagnosis of pulmonary tuberculosis in high altitude area. Methods The clinical data of 22 cases of pulmonary tuberculosis confirmed by CT-guided percutaneous lung biopsy between October, 2016 and March, 2017 were retrospectively analyzed. Results There were 15 males and 7 females, aged 28-71 years, with an average age of (44. 7 ±14. 8) years. 11 cases complicated with the history of COPD (50%), 10 cases with high altitude heart disease (45. 5%), 9 cases with type 2 diabetes mellitus (40. 9%), and 7 cases with hypertension (31. 8%). The clinical manifestation included 7 cases of fever (31. 8%), 12 cases of cough and sputum (54. 5%), 8 cases of hemoptysis (36. 4%), 8 cases of chest pain (36. 4%), 7 cases of night sweats (31. 8%), 10 cases of loss of weight (45. 5%), 8 cases of loss of appetite (36. 4%), 9 cases without symptoms (physical examination found, 40. 9%). All the 22 patients had successful puncture, and the success rate of CT-guided percutaneous lung biopsy was 100% (22/22). The positive rate of pathologic diagnosis was 90. 90% (20/22). The positive rate of acid-fast staining for puncture fluid was 18. 2% (4/22). There was significant difference between the two groups (χ²=20. 625, P < 0. 05). A total of 5 patients with mild complication were observed. The incidence of pneumothorax was 9. 1% (2/22), pneumothorax were automatically absorbed after oxygen uptake and rest. The incidence of hemoptysis was 13. 6% (3/22), and no fatal hemoptysis occurred. Conclusion The CT-guided percutaneous lung biopsy is a safe and effective means in the diagnosis of pulmonary tuberculosis in high altitude area.

Effects of Cyclin D1 gene silencing on apoptosis and proliferation of chondrocytes in osteoarthritis:an in vitro study in rats

ZHAO Zhi, WU Min, GUAN Jianzhong, ZHU Zhonglian, LAI Guihua, CHEN Chuanhao

2017, 15(8): 1308-1312,1391. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.010

155 3

Abstract:
Objective To investigate the effects of Cyclin D1 silencing on proliferation and apoptosis of chondrocytes in osteoarthritis(OA). Methods Chondrocytes were separated from healthy SD rats and cultured. Toluidine blue staining and type Ⅱ collagen immunohistochemical staining were used to identify chondrocytes. Cyclin D1 -siRNA expression plas- mid was constructed and OA model was induced byIL-1 βin chondrocytes. Chondrocytes were divided into the blank group, IL-1 β-induced group(OA model group), IL-1 β-induced experimental group(OA trial group, transfected withCyclin D1 - siRNA), IL-1 β-induced negative control group(OA negative control group, transfected with negative control sequence). Cells in each group were incubated for 24 h,48 h,72 h and 96 h and cell proliferation was measured by CCK-8. Flow cy- tometry was used to detect cell cycle and apoptosis. qRT-PCR and Western blotting were used to detect Cyclin D1 mRNA and protein expressions in cells. Results Cell proliferation assay results showed that the proliferation after chondrocytes were incubated for 72 h and 96 h increased significantly in each group compared to those incubated for 24 h. When com- pared with the blank group, cell proliferations in OA model, OA trial and OA negative control groups decreased distinctive- ly at 72 h and 96 h. The cell proliferation at 48 h,72 h and 96 h were significantly lower in the OA model group than in the OA trial and OA negative control groups. Flow cytometry showed that compared with the blank group, higher apoptosis rate was found in the OA model, OA trial and OA negative control groups. In comparison to the OA model group and OA negative control group, the OA trial group had increased apoptosis rate. Relative Cyclin D1 mRNA and protein expressions in OA experimental group was significantly lower than the blank and OA negative control and OA model groups. Conclusion Cyclin D1 gene silencing can suppress proliferation and enhance apoptosis of chondrocytes in OA.

Effect of BRAF^V600E mutations on the expression of HMGB1 in papillary thyroid cancer

GUAN Xiaolei, WANG Ping, YU Qing, LI Peng, CHI Jingwei, WANG Fei

2017, 15(8): 1313-1316,1439. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.011

98 0

Abstract:
Objective In recent years, the incidence of papillary thyroid carcinoma (PTC) increased gradually and the recurrence and metastasis of PTC patients are also increasing. The aim of this study was to investigate the effect of BRAF^V600E mutation on the expression of HMGB1 in PTC, to explore the mechanism of BRAF gene affecting the development and prognosis of PTC, and then guiding clinical practice of precise therapy. Methods The preoperative serum and postoperative fresh tissue were collected from 44 cases of PTC patients in our hospital from September, 2015 to December, 2015. According to BRAF^V600E mutations divided into positive group and negative group. Western blot, immunohistochemistry and fluorescence quantitative PCR were used to detect the level of HMGB1 in cancer tissues. The level of HMGB1 in serum was tested by ELISA method. Western blot was performed using Image J software. The relative quantitative method was used to calculate the fluorescence quantitative PCR data. The concentration of HMGB1 protein in serum was calculated by ELISA Calc regression/fit calculation program. All the data were analyzed by SPSS 20. 0. Western blot, fluorescence quantitative PCR and ELISA data were analyzed by Chi-square test, Mann-Whitney-Wilcoxon test and independent sample t test. The relationship between lymph node metastasis and extrathyroid infiltration and the occurrence of BRAF^V600E mutation was analyzed by chi-square test. Results In PTC cancer tissues, HMGB1 was mainly located in the cytoplasm, the levels of HMGB1 mRNA and protein in positive group were lower than that of the negative group (Z=2. 117, P < 0. 01, χ²=19. 989, P < 0. 05), and the change did not show in peripheral blood (t=1. 135, P > 0. 05). The expression of HMGB1 mRNA and protein in PTC with lymph node metastasis was lower than those without lymph node metastasis (Z=-2. 216, P < 0. 05; t=-2. 217, P < 0. 05), and so as in the extrathyroid infiltration (Z=-2. 267, P < 0. 05; t=-3. 885, P < 0. 01). Conclusion BRAF^V600E mutations may accelerate the malignant development of PTC by down regulating the expression of HMGB1.

Effect of abdominal girth and vertebral column length on predicting the dose of isobaric plain bupivacaine for spinal anesthesia

PEI Daqing, XIAO Wangpin, LU Jian, ZHOU Hongmei, ZHOU Qinghe

2017, 15(8): 1317-1319. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.012

107 0

Abstract:
Objective Some study shows that abdominal girth and vertebral column length could predict the suitable intrathecal bupivacaine dose for T₁₀ block level to a great extent, but the clinical evidence is lack. This study is to evaluate the accuracy of regression equation between abdominal girth, vertebral column length and the dose of 0. 5% plain bupivacaine for T₁₀ block level. Methods Two hundred ASA physical statusⅠ-Ⅲ patients, aged 19-65 years, scheduled for lower limbs surgery undergoing spinal anesthesia were enrolled. The patients were placed in the supine position, and at the level of the umbilicus, the abdominal girth was measured at the end of expiration, and the vertebral column length was measured from the C₇ vertebra to the sacral hiatus, with the patient placed supine on the operation table. After abdominal girth and vertebral column length obtained, the L_3/4 interspace was entered, 0. 5% plain bupivacaine with room temperature was injected intrathecally at a speed of approximately 2 ml in 10 s when free flow of the cerebrospinal fluid was obtained. The dose of bupivacaine was based on the regression equation expounded in reference. Block level was measured 30 min after spinal anesthesia. The upper block level for loss of pinprick discrimination, age, height, weight, abdominal girth and vertebral column length were recorded. Results A total of 198 patients were enrolled in this study finally. Two patients were excluded from this study because of unsuccessful puncture at L_3/4 intervertebral space. The average dose of 0. 5% plain bupivacaine was (3. 2 ±0. 4) ml. One hundred and fifty-nine cases of patients were with the block level T₁₀, accounted for 80. 3% of all patients. The upper block level was T₈, and the lowest block level was T₁₂. Conclusion The regression equation between abdominal girth, vertebral column length and the dose of 0. 5% plain bupivacaine for T₁₀ block level during spinal anesthesia can apply for clinic accurately.

Diagnosis and treatment of 23 cases of cerebral infarction after craniocerebral trauma

WANG Xue, WANG Zhenjie

2017, 15(8): 1320-1322. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.013

97 0

Abstract:
Objective To analyze and summarize the pathogenesis of craniocerebral trauma complicated with cerebral infarction and effective preventive measures and individualized comprehensive treatment plan to improve the therapeutic effect and reduce the mortality and morbidity. Methods Twenty-three patients of merger of cerebral infarction after craniocerebral trauma in our hospital from December, 2011 to November, 2016 were selected as the research object. In this group, there were 13 cases of serious brain contusion, for the patients with intracranial hematoma combined elevated intracranial pressure or cerebral hernia, the drilling hematoma drainage or craniotomy hematoma removal was performed (including decompressive craniectomy in 6 cases). There were 2 cases of cerebral infarction after traumatic brain injury, the cerebral angiography was performed to confirm the cerebral infarction that was caused by thrombosis after trauma, and active thrombolysis intervention was given. There were 8 cases of cerebral infarction with stable condition, lighter brain contusion or small intracranial hematoma, without significantly elevated intracranial pressure, the conservative methods of internal medicine was administrated. All the patients in this group received calcium antagonists, free radical scavengers and other drugs; the early limited fluid resuscitation and late active fluid resuscitation, early hyperbaric oxygen and rehabilitation therapy were performed in patients with traumatic hemorrhagic shock. Individualized comprehensive treatment was carried out, and the therapeutic effect was observed. Results Among the 23 cases of craniocerebral trauma combined with cerebral infarction patients, according to Glasgow Outcome Scale (GOS) standard evaluation after active rescue, 14 cases recovered well, mild disability in 6 cases, severe disability in 1 case, and 2 cases died; of those who died, 1 died of traumatic hemorrhagic shock, 1 died of multiple organ dysfunction syndromes (MODS). Conclusion Early prevention and diagnosis, timely diagnosis of the cerebral infarction after craniocerebral trauma, and positive and effective early individualized comprehensive treatment can effectively reduce the mortality and morbidity.

Role of elastosonography in evaluating hemiplegic limb hardness and improving the prognosis of spastic hemiplegia patients

FAN Liubo, HAN Wensheng, JIANG Yingying, LIU Baohua, TANG Yan

2017, 15(8): 1323-1325,1354. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.014

95 0

Abstract:
Objective To assess the prognostic effect of the change of hemiplegic limb hardness by using elastosonography in spastic hemiplegia patients. Methods The strain of vastus lateralis, vastus medialis, rectus femoris and biceps femoris in healthy subjects of control group (n=20) and spastic hemiplegia patients of observer group (n=20) before and after the rehabilitation treatment in Taizhou Hospital of Zhejiang Province from July, 2013 to December, 2015 were observed by elastosonography. The influence of the changes of the muscles strain of spastic lower limb after 4 weeks of rehabilitation treatment on the prognosis of patients were evaluated. Results Before the treatment, there was statistically difference in the longitudinal strain between the normal limbs and spastic limbs in the observation group (P < 0. 01), and the longitudinal strain of vastus lateralis, vastus medialis, rectus femoris and biceps femoris of spastic limbs in the observation group were significantly higher than those in the control group (P < 0. 01). After the treatment for 4 weeks, the longitudinal strain of vastus lateralis, vastus medialis, rectus femoris and biceps femoris of spastic limbs at knee flexion was decreased significantly in the observation group (P < 0. 05). When compared with the control group, the longitudinal strain of vastus lateralis, vastus medialis and rectus femoris of spastic limbs decreased (P < 0. 05), but not of biceps femoris (P > 0. 05). At knee extension, the strain ratio of vastus lateralis, vastus medialis and rectus femoris of spastic limbs was lower than that of normal limbs and the control group (P < 0. 05), but the difference between biceps femoris of spastic limbs and the control was not significant (P > 0. 05). Conclusion The elastosonography can qualitatively detect the changes of muscle strain of spastic limbs in stroke patients with spastic hemiplegia, which can be used as the rehabilitation evaluation method for the prognosis of spastic hemiplegia patients.

miR-125b regulates invasion and migration by targeting ETV6 in Hs578T breast cancer cells

HONG Liquan, PAN Feng, JIANG Huifen, ZHANG Lahong, LIU Yuhua, CAI Chengsong, HUA Chunzhen, LUO Xian, SUN Jinhua, CHEN Zhaojun

2017, 15(8): 1326-1330. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.015

56 3

Abstract:
Objective To analyze miR-125 b expression in breast cancer, specifically its effects on cell migration and invasion and to explore the mechanism of this process. Methods (1) Real-time PCR was used to detect the expression level of miR-125b and ETV6 in tumors and adjacent non-tumor breast cancer samples; (2) Real-time PCR and dual-luciferase reporter assay were used for target identification. (3) The migration and invasion ability in vitro and the change of epithelialmesenchymal transition were detected by wound healing assay, transwell migration and invasion assay and western blot respectively after instantaneously transfected with miR-125b mimics; (4) The knockdown assay was used for further confirmation. Results (1) As compared with adjacency non-tumor tissues, the expression level of miR-125b in breast cancer tissues was down-regulated (P < 0. 001) and ETV6 was up-regulated significantly (P < 0. 05); (2) ETV6 is the target gene of miR-125b; (3) Compared to control group, the migration and invasion of miR-125b overexpressing Hs578T cells was obviously inhibited in vitro (P < 0. 001), so was epithelial-mesenchymal transition; (4) The effect of ETV6 down-regulation was consistent with miR-125 b overexpression in Hs578T cells. Conclusion miR-125b was downregulated in breast cancer. It remarkably inhibited migration, invasion and EMT of Hs578 T cells by suppressing the expression of ETV6 through targeting its 3'UTR. In general, miR-125b possibly played a role as antioncogene in breast cancer.

Clinical analysis of 212 patients with fever of unknown origin

WU Qumei, ZHAO Jiufa

2017, 15(8): 1331-1333,1357. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.016

112 3

Abstract:
Objective To analyze the etiology and diagnosis of fever of unknown origin (FUO), and improve the early diagnosis and treatment of FUO. Methods Total 212 patients met FUO diagnostic criteria in our hospital between January, 2012 to January, 2015 were enrolled into this study. All the patients were grouped by gender and age. The distribution of etiology in gender and age was analyzed. The data was analyzed by SPSS 19. 0, Chi-square test and T test were used to compare the differences between different groups of qualitative or quantitative data. The p-value of 0. 05 was considered on the borderline of statistical significance. Results A total of 171 cases (80. 66%) were confirmed with FUO by relevant examination or diagnostic treatment, and 41 cases (19. 34%) still to be confirmed. The overall etiology distribution was as follows:98 (57. 31%) were infectious diseases (72. 45% bacterial infection and 25. 51% tuberculosis); 27 (15. 79%) were connective tissue diseases (CTD) in which adult-onset Still's disease accounted for 44. 44% (12/27); 17 (9. 94%) were tumor in which lymphoma accounted for 35. 29% (6/17); 29 were other diseases in which drug fever accounted for 41. 38% (12/29) and necrotizing lymphadenitis for 24. 14% (7/29). There was a higher incidence of CTD in women and of tumor diseases in men, the difference was statistically significant (P < 0. 05), But the incidence of infectious disease, other diseases, and uncertain diagnosis cases among the different gender group was not statistically significant (P > 0. 05).The infectious diseases in all age groups were the primary cause, especially in 60 or over age group; The CTD was common in 30 to 59 age group, malignant tumor diseases were common in 60-86 age group, the difference was statistically significant among the different age groups (χ²=17. 521, P=0. 025). Conclusion The etiology of FUO is complex, infectious diseases are common. The bacterial infection and infection of mycobacterium tuberculosis accounted for an important position, in which the diagnosis of extrapulmonary tuberculosis is focal and difficult point; the percentage of the CTD and tumor are also relatively high. FUO can be generally diagnosed definitely in most cases through detailed history and necessary physical examination.

Resveratrol protects against apoptotic cell death induced by cisplatin in renal tubular epithelial cells in vitro

SHAN Juanping, DONG Liang, DONG Zhichao, GUAN Jichao, GONG Shuwen

2017, 15(8): 1334-1336,1432. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.017

88 0

Abstract:
Objective To observe the expression of Bcl-2、Bax and caspase-3 in mouse tubular epithelial cells after cisplatin-induced cytotoxicity, before and after the treatment with resveratrol, and to explore the underlying mechanism of resveratrol against cisplatin-induced cytotoxicity. Methods Mouse proximal tubular cells (m Prox) cultured in vitro were divided into 4 groups, controls (C), cisplatin alone at 25 μM (CIS), cisplatin 25 μM plus resveratrol 100 μM (CV + RES), and resveratrol alone 100 μM (RES), 25 μM cisplain, pretreated with 100 μM resveratrol for 3 hours, cells were stimulated for 24 hours. Cell proliferation activity was detected by Trypan Blue Assay, analysis of cell apoptosis by Tunel Assay, Bcl-2, Bax and caspase-3 were detected by using Westernblot. Results Compared with the control group, cellular viability in the cisplatin group was decreased (P < 0. 05), cell apoptosis was increased (P < 0. 05), the expression of Bax, caspase-3 were increased (P < 0. 05) and the expression of Bcl-2 was decreased in the cisplatin group; resveratrol can increase cellular viability, restrain cell apoptosis (P < 0. 05), lower the activity of Bax and caspase-3 (P < 0. 05) and increase the activity of Bax (P < 0. 05). Conclusion Resveratrol can effectively increase cell viability, minimize apoptosis in mouse proximal tubular cells. The mechanism may be via down-regulating the expression of Bax, caspase-3 and increasing the expression of Bcl-2.

Clinical efficacy of tacrolimus/mycophenolate mofetil combined with steroid on children with nephrotic syndrome

TONG Kezhen, MAO Jianhua, WU Boying, FU Haidong, SHEN Huijun

2017, 15(8): 1337-1339,1364. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.018

173 1

Abstract:
Objective To compare the clinical efficacy of tacrolimus (FK506) and mycophenolate mofetil (MMF) combined with steroid respectively in the treatment of steroid dependent/frequent relapsing nephrotic syndrome (SDNS/FRNS) in children. Methods Forty-nine cases of Children with SDFN/SDNS from January, 2009 to July, 2015 were recruited, 21 cases in tacrolimus group, 28 cases in mycophenolate mofetil group, and the 28 cases were divided to MMFlow-concentration group[MPA-AUC < 30 μg/(ml·h)]and MMF-high-concentration group[MPA-AUC ≥ 30 μg/(ml·h)]according to the area under the curve of mycophenolic acid (MPA-AUC). The therapeutic effect of the groups were compared. Results (1) Steroid dosage:The steroid dose was reduced more significantly at 6-month follow-up (P <0. 01). The MMF-high-concentration group's was reduced the most, and it had significant difference compared with MMFlow-concentration group (P < 0. 05). No significant difference among the groups hormone dosage at 12-month follow-up (P > 0. 05). (2) Relapse episodes:The number of relapse episodes was reduced more significantly at 6-month follow-up (P < 0. 05) except MMF-low-concentration group. MMF-low-concentration group had the most number of relapse episodes during 6-month follow-up, and the result was significantly compared with MMF-high-concentration group (P < 0. 05). No significant difference occured in the relapse episodes of the groups at 12-month follow-up (P > 0. 05). Conclusion There is no significant difference in the clinical efficacy between FK506 and MMF combined with steroid respectively in the treatment of children with SDNS/FRNS. After 6 months of treatment, MMF-high-concentration can obtain a satisfactory therapeutic effect. For the children receiving low concentration MMF, the clinical effect can be similar with other patients if the disease did not frequently relapse in one year.

Effect of escitalopram and sertraline on inflammatory factors,NSE and NPY in patients with post-stroke depression

LU Weiming

2017, 15(8): 1340-1341,1401. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.019

74 0

Abstract:
Objective Post-stroke depression was a serious threat to patient safety, which not only increased stroke symptoms, but also increased the patients' mental anguish. In order to reduce the patient's depressive symptoms, and to enhance the effect of prognosis to discover better drug treatment is very important. Thus, the effect of escitalopram and sertraline on inflammatory factors, NSE and NPY was investigated in patients with post-stroke depression in this study. Methods A total of 98 patients with post-stroke depression were divided into control group (49 cases) and observation group (49 cases). The patients in 2 groups received the conventional therapy, and patients in control group were additionally given sertraline therapy, and patients in observation group were additionally given escitalopram therapy. The treatment time was 8 weeks in 2 groups. To observe clinical effect, and effect of treatment on inflammatory factors (TNF-α and IL-6), NSE and NPY were compared before and after treatment in 2 groups. Results Total effective rate of observation group was 89. 80%, total effective rate of control group was 79. 59%, and there was no significant difference between observation group and control group (P > 0. 05). Compared with those before treatment, the levels of TNF-α and IL-6 decreased significantly at 8 weeks after treatment in 2 groups (P < 0. 05), and the levels of TNF-α and IL-6 of observation group decreased more significantly than those in control group (P < 0. 05). Compared with that before treatment, the level of NSE decreased significantly at 8 weeks after treatment in 2 groups (P < 0. 05), the level of NPY increased significantly at 8 weeks after treatment in 2 groups (P < 0. 05), and the changes of NSE and NPY of observation group were significantly more than those in control group (P < 0. 05). Incidence of adverse reactions of observation group was 24. 49%, incidence of adverse reactions of control group was 32. 65%, and incidence of adverse reactions had no significant difference in two groups (P > 0. 05). Conclusion Treatment with escitalopram and sertraline has reliable efficacy with mild adverse reactions, but escitalopram has better effect on IL-6, TNF-α, NSE and NPY in patients with post-stroke depression.

Curative effect and safety evaluation of tacrolimus combined with methylprednisolone in the treatment of lupus nephritis

ZHANG Xingzhen, ZHOU Zhihong

2017, 15(8): 1342-1344. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.020

108 0

Abstract:
Objective To investigate the curative effect and safety of tacrolimus combined with methylprednisolone analysis in the treatment of lupus nephritis. Methods Total 64 cases of lupus nephritis in our hospital between November, 2012 and October, 2015 were enrolled and divided into study group and control group, 32 cases in each group. The study group received tacrolimus combined with methylprednisolone, while the control group received cyclophosphamide and methylprednisolone treatment. The remission rate, incidence of adverse reactions was compared between the two groups.The levels of 24-hour urine protein, serum creatinine (Scr), C3, serum albumin (ALB), and systemic lupus erythematosus disease activity index (SLEDAI) score were recorded before and after treatment in both groups. Results The effect in the study group was significantly better than that in the control group, the difference was statistically significant (Z=2. 223, P < 0. 05). After the treatment, the levels of 24-hour urine protein, Scr and SLEDAI decreased, and levels of C3 and ALB significantly increased in both groups, the difference was statistically significant (P < 0. 05). The levels of 24-hour urine protein and SLEDAI in the study group were lower than those in the control group, but the levels of Scr, C3 and ALB were significantly higher than those in the control group, the difference was statistically significant (t=4. 538, 3. 896, 2. 287, 5. 492, 6. 342, P < 0. 05). The incidence rate of adverse reaction in the study group (15. 62%) was significantly lower than that (40. 62%) of the control group, the difference was statistically significant (χ²=4. 947, P < 0. 05). Conclusion Tacrolimus combined with methylprednisolone has definite efficacy for lupus nephritis, which can significantly reduce the urinary protein level, effectively control of the disease, and with a high safety.

Effects of intravenous thrombolysis with alteplase on neurological function,inflammation and oxidative stress in patients with acute cerebral infarction

ZHAO Hong, WANG Lisong, TONG Qiaowen

2017, 15(8): 1345-1347. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.021

85 0

Abstract:
Objective To investigate the effects of intravenous thrombolysis with alteplase on neurological function, inflammation and oxidative stress in patients with acute cerebral infarction. Methods A total of 142 cases of acute cerebral infarction patients in our hospital from January, 2013 to June, 2016 were retrospectively analyzed. The patients in the observation group (79 cases) were received intravenous alteplase therapy, while the patients in the control group (63 cases) received routine therapy. After the treatment, the neurological function[National Institute of Health Stroke Scale (NIHSS), Modified Rankin 's Scale (mRS)], inflammation[hypersensitive C-reactive protein (hs-CRP), interleukin-1β (IL-1β), tumor necrosis factor (TNF-α)], oxidative stress[superoxide dismutase (SOD), malonaldehyde (MDA), glutathione peroxidase (GSH-px)], and clinical effect of the two groups were compared. Results After the treatment, NIHSS levels of the observation group and control group were significantly reduced (P < 0. 05), and NIHSS level of the observation group was significantly lower than that of control group (P < 0. 05). After the treatment, mRS level of the observation group was significantly lower than that of the control group (P < 0. 05). After the treatment, hs-CRP, IL-1β and TNF-α levels of the observation group and control group were significantly reduced (P < 0. 05), and hs-CRP, IL-1β and TNF-α levels of the observation group were significantly lower than that of the control group (P < 0. 05). After the treatment, SOD and GSH-px levels of the observation group and control group were significantly increase (P < 0. 05), and MDA levels of the observation group and control group were significantly reduced (P < 0. 05); and SOD and GSH-px levels of the observation group were significantly higher than that of the control group (P < 0. 05), MDA level of the observation group was significantly lower than that of the control group (P < 0. 05). The total effective rate of the observation group was 81. 0%, significantly higher than that (63. 5%) of control group (P < 0. 05). Conclusion Intravenous Alteplase thrombolysis could improve the neurological function, inflammation and oxidative stress in patients with acute cerebral infarction.

Expression of CXCL16 mRNA and CXCL6 mRNA in peripheral blood mononuclear cells of patients with active ankylosing spondylitis and its effect on lymphocyte proliferation

GAO Jun, JIANG Xuesheng, SHENG Xiang, ZHU Shengling, ZHAO Zhen

2017, 15(8): 1348-1350. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.022

89 1

Abstract:
Objective To observe the expression of CXC tchemokine ligand (CXCL) 16 and CXCL6 in peripheral blood mononuclear cells of activities ankylosing spondylitis patient, to explore the impact of CXCL16 on lymphocyte proliferation. Methods Sixty-two cases of patients with activities ankylosing spondylitis were selected as the experimental group and 62 cases of healthy as control group in Jinhua City Chinese medicine hospital from January, 2014 to December, 2015.The levels of serum CXCL16, the level of CXCL16 mRNA and CXCL6 mRNA in peripheral blood mononuclear cells, lymphocyte proliferation, and the culture supernatant RANKL levels were detected. Results The serum CXCL16 level[(2. 47 ±0. 97) ng/ml]of experimental group was higher than that of control group[(1. 87 ±0. 64) ng/ml], t=4. 375, P=0. 009. The CXCL16 mRNA and CXCL6 mRNA relative expression (0. 063 ±0. 004, 0. 047 ±0. 008) of experimental group were higher than that of control group (0. 034 ±0. 003, 0. 020 ±0. 005), t=5. 274, 6. 252, P=0. 003, P < 0. 001.In the role of recombinant CXCL16 protein, the lymphocyte proliferation rate[(169. 23 ±34. 26)%] and the optical density value (0. 038 ±0. 002) of the experimental group were higher than that of control group[(116. 45 ±23. 54)%, 0. 021 ±0. 002], t=6. 847, 6. 035, P < 0. 001. The levels of lymphatic cells secrete RANKL[(1. 794 ±0. 315) pmol/L]of experimental group was higher than that of control group (0. 957 ±0. 264 pmol/L), t=5. 264, P=0. 002. The lymphocyte p-ERK1/2, p-Raf-1 protein expression of CXCL16 group were higher than other three groups (P=0. 013, 0. 017, 0. 008; 0. 011, 0. 012, 0. 001). The S phase and G₂/M phase cells ratio of CXCL16 group were higher than other three groups (P=0. 021, 0. 018, 0. 009; P < 0. 001). Conclusion CXCL16 and its receptor CXCL6 may involve the pathogenesis of ankylosing spondylitis, its mechanism may be associated with CXCL16 promoting lymphocyte proliferation.

A clinical study of intensity-modulated radiation therapy combined with folfox4 regimen as neoadjuvant therapy for locally advanced rectal cancer

QIU Xueke, LIU Luying

2017, 15(8): 1351-1354. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.023

99 0

Abstract:
Objective To investigate the efficacy and safety of neoadjuvant radiotherapy combined with FOLFOX4 regimen in the treatment of locally advanced rectal cancer. Methods Total 63 patients who met the inclusion criteria were randomly assigned to intensity-modulated radiation therapy (IMRT) combined with capecitabine group (control group, n=31) and IMRT combined with FOLFOX4 regimen group (experimental group, n=32). The efficacy and incidence of adverse reactions at the end of neoadjuvant therapy were evaluated. The radical operation was performed 6 weeks after neoadjuvant therapy, the pathological complete remission rate and anus preservation rate were analyzed and compared. Results The curative effect could be evaluated in all 63 patients. The total effective rate of the experimental group was 84. 4% and of the control group was 74. 2%, the total effective rate of the experimental group was higher than that in the control group, but there was no significant difference between two groups (P > 0. 05); The pathological complete remission rate of the experimental group was 34. 4%, and of the control group was 12. 9%, the rate of experimental group was higher than that in the control group, there was significant difference between two groups (P < 0. 05). The anal preservation rate of the experimental group was 81. 3%, and of the control group was 58. 1%, the rate of experimental group was higher than that in the control group, there was significant difference between two groups (P < 0. 05). The toxicity of the two groups were relatively light, with grade1 and grade2, there was no significant difference between two groups (P > 0. 05). Conclusion Intensity-modulated radiotherapy combined with FOLOFX4 regimen as neoadjuvant therapy for locally advanced rectal cancer can improve the response rate, pathologic complete response rate and anal preservation rate, not increasing the incidence of adverse reactions and complications, worthy of clinical application.

Effects of immediate and delayed placement and restoration of a single anterior tooth implants on soft tissue around implant and subjective satisfaction

LUO Qifeng

2017, 15(8): 1355-1357. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.024

94 0

Abstract:
Objective To compare the effect of immediate and delayed placement and restoration of a single anterior tooth implants on soft tissue around implant and subjective satisfaction. Methods Sixty-one patients undergoing anterior single tooth replacement with immediate implants in our hospital were divided into immediate placement and restoration group (n=33) and delayed placement and restoration group (n=28). After the treatment, soft tissue around the implant was evaluated by the pink esthetic score (PES). The vertical resorption of alveolar bone was measured. The subjective satisfaction (color, attachment height, denture chewing function and overall appearance) were evaluated by visual analogue scale (VAS). And the statistical data were analyzed by statistical software to investigate the effects of immediate implantation and delayed implantation on the soft tissue and subjective satisfaction. Results The success rate of the two groups were 100% (P < 0. 05). PES of immediate group was significantly higher than that of delayed group (P < 0. 05). One year later, the PES of both groups were significantly improved (P < 0. 05), and the PES of the immediate group was higher than that of the delayed group (P < 0. 05); the vertical bone resorption distance of immediate group was significantly lower than that of the delayed group (P < 0. 05); the dentition height, chewing function of denture, overall aesthetic score of the immediate group were significantly higher than those of the delayed group (P < 0. 05). Conclusion The success rate and PES of immediate placement and restoration is match to that of delayed implantation, but the immediate implantation and restoration could improve the vertical absorption and satisfaction of alveolar bone.

Clinical study of dexmedetomidine in rescue of septic shock patients

ZHANG Yougui, HUANG Yunhong, SUN Jie, LI Gen, SONG Keyi

2017, 15(8): 1358-1360. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.025

84 0

Abstract:
Objective To explore the clinical application of dexmedetomidine in the rescue of septic shock patients. Methods Twenty patients with septic shock admitted in intensive care unit (ICU) ward of Bozhou People's Hospital from June, 2015 to October, 2016 were included in the study. All patients were randomly divided into dexmedetomidine group 10 cases and control group 10 cases, All patients were treated with guideline and positive EGDT fluid recovery, In the dexmedetomidine group, intravenous infusion of dexmedetomidine 0. 2-0. 7 μg/(kg·h), heart rate control in the 60-100 beats/min, the control group on the heart rate is not particularly intervene in the control group. The changes of HR, MAP, stroke volume index (SVI), central venous oxygen saturation (ScvO₂) and blood lactate (Lac) were measured before and 24, 48 and 72 h after treatment. Results Dexmedetomidine group after treatment slowed heart rate, There was significant difference (P < 0. 05) before and after treatment. at the same time compared with the control group, the difference was statistically significant (P < 0. 05). There was no significant difference in the mean arterial blood pressure between the two groups, and there was no significant difference before and after treatment in the dexmedetomidine group.Dexmedetomidine treatment 24 hours ScvO₂ increased, 48 hours SVI increased, There was significant difference (P <0. 05) before and after treatment. at the same time compared with the control group, the difference was statistically significant (P < 0. 05). Dexmedetomidine treatment significantly decreased lactic acid after 48 hours, the difference was statistically significant (P < 0. 05) before and after treatment in the dexmedetomidine group, at the same time compared with the control group, the difference was statistically significant (P < 0. 05). Conclusion In the group of dexmedetomidine, the HR gradually began to slow down, SVI, ScvO₂ gradually increased, Lac gradually decreased, while the MAP no significant change. Compared with the control group, dexmedetomidine treatment significantly reduced HR after 24 hours, ScvO₂ began to rise, 48 h from the ScvO₂ increased significantly, Lac decreased significantly. Dexmedetomidine can improve the oxygen metabolism of the organism by inhibiting sympathetic nerve activity and stabilizing hemodynamics in patients with septic shock.

A prospective study of the effect of rosuvastatin on carotid artery plaque and cerebral ischemic events in patients with hypertension and carotid atherosclerosis

YAN Hongjuan, WANG Junwei, GUO Jianhua, HOU Bo, WANG Shuai, JIANG Linna, LUO Qiuhua, XUE Zhanhe

2017, 15(8): 1361-1364. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.026

83 1

Abstract:
Objective To investigate the effect of rosuvastatin intervention on blood lipid level, carotid artery plaque and cerebral ischemic events in patients with hypertension and carotid atherosclerosis. Methods A total of 255 hypertensive patients with carotid plaques in our hospital between May, 2013 and May, 2015 were prospectively included, and randomly divided into control group, low dose rosuvastatin group (observation group 1) and routine dose group (observation group 2), with 85 cases in each group. All the three group were given antihypertensive therapy and lifestyle intervention, while the control group received 1 tablet of placebo which had the same the appearance of rosuvastatin, the observe group 1 received rosuvastatin 5 mg/day, and the observe group 2 received rosuvastatin 10 mg/day. The follow up was 6 months. Before and after the treatment, the blood lipids levels, blood pressure and carotid artery intima media thickness (IMT), plaque area and Crouse plaque score were detected. The incidence of ischemic events after 6 months of treatment was compared. Results The indexes of the control group showed no significant difference before and after treatment (P > 0. 05);after treatment, the systolic blood pressure and diastolic blood pressure observation of group 1 and observation group 2 decreased compared with prior treatment, but there was no statistical significance (P > 0. 05); the level of TC, LDL-C in Observation group 1, Observation group 2 was declined than before; the level of IMT, plaque area, Crouse plaque score, The rate of vulnerable plaque were elevated than before, with statistical significance (P < 0. 05). The index improvement is obvious in Observation group 2 than Observation group. Conclusion In addition to hypolipidemic effects, Rosuvastatin can also reverse and stabilize the plaque, reduce the incidence of ischemic stroke, and is positively correlated with the dose.

Effect and mechanism of terazosin hydrochloride combined Mecobalamin on diabetic neurogenic bladder

YE Fagen, LIAO Jiezhi, ZHOU Xiaohui, SHEN Jianqiang, XIE Yufang, CHEN Hong

2017, 15(8): 1365-1367. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.027

172 1

Abstract:
Objective To investigate the effect and mechanism of terazosin hydrochloride combined Mecobalamin on diabetic neurogenic bladder. Methods Ninety cases of diabetic neurogenic bladder in our hospital from March, 2015 to June, 2016 were randomly divided into 2 groups, with 45 cases in each group. The patients in the control group received alpha lipoic acid, while the patients in the treatment group received terazosin hydrochloride combined with Mecobalamin based on alpha lipoic acid. Before and after the intervention, serum oxidative stress indices, neural activity index, early renal injury index were tested. Urodynamic were analyzed, and the clinical efficacy and adverse reactions were compared. Results The effective rate of the treatment group was 88. 89%, which was higher than that (71. 11%) of control group (P < 0. 05). After the intervention, maximum urinary flow rate, detrusor pressure at maximum urinary flow rate, glutathione (GSH), superoxide dismutase (SOD), brain derived neurotrophic factor (BDNF) of the treatment group were significantly increased, and significantly higher than those of the control group (P < 0. 05). After the intervention, bladder residual urine volume, bladder maximum pressure capacity, oxygen activity (ROS), malondialdehyde (MDA), substance P (SP), neuropeptide Y (NPY), cystatin C (CysC), gamma glutamyl-transferase (γ-GT) of the treatment group were significantly reduced, and significantly lower than those of the control group (P < 0. 05). There was no significant difference on the incidence of adverse reaction between the two group (P > 0. 05). Conclusion Terazosin hydrochloride combined Mecobalamin have exact efficacy on patients with diabetic neurogenic bladder, it can reduce the CysC andγ-GT level, improve the oxidative stress and neural activity, with high safety.

A comparative study of dilation and curettage for cesarean scar pregnancy in different time after uterine arterial embolization therapy

SHEN Jiehong, ZHU Yusheng, XU Guiying, YIN Pingping, YE Guoliu

2017, 15(8): 1368-1370. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.028

68 1

Abstract:
Objective To compare the clinical outcomes of dilation and curettage at different stages after uterine arterial embolization therapy in the treatment of cesarean scar pregnancy (CSP). Methods The uterine artery embolization (UAE) was performed in 20 cases of CSP in our hospital between March 2014 and December 2016. According to the time performing uterine curettage after embolization, the patients were divided into Group A (within 24 h), Group B (24 h to 48h) and Group C (48 h to 72 h). The dilation and curettage surgery was performed under the guidance of colored ultrasound. The intraoperative blood loss, length of hospital stay, time to β-HCG recovery and uterine recovery were monitored and analyzed. Results All cases underwent a successful embolization. The intraoperative blood loss of Group A, B and C were (9. 3 ±1. 9) ml, (17. 1 ±3. 9) ml and (110. 0 ±54. 4) ml, respectively. The length of hospital stay of Group A, B and C were (7. 0 ±2. 4) d, (5. 9 ±2. 7) d and (11. 1 ±2. 1) d, respectively; The time to β-HCG recovery in Group A, B and C were (18. 6 ±5. 2) d and (19. 0 ±3. 3) d, (21. 2 ±4. 4) d, respectively; The time to uterine recovery in Group A, B and C were (41. 1 ±1. 1) d, (41. 1 ±1. 1) d and (41. 5 ±1. 0) d, respectively. The intraoperative blood loss of Group A and Group B were significantly lower than that of Group C (P < 0. 01); the length of hospital stay in Group A and B were significantly shorter than that in Group C (P < 0. 01). There were no significant differences in the time to β-HCG recovery and uterine recovery among three groups. Conclusion Uterine artery embolization combined with ultrasound guided curettage for uterine scar pregnancy is with less trauma, less complications and curative effect, and can retain the uterus; uterine artery embolization within 24 h after curettage is the best time for the treatment of CSP.

A correlation research of the relationship between serum retinol-binding protein 4 levels with Glucose and Lipid metabolism and body weight of the newborn in women with gestational diabetes mellitus

XUE Lili, DONG Jinhua

2017, 15(8): 1371-1373. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.029

78 0

Abstract:
Objective To explore the correlation between serum retinol-binding protein 4 (RBP4) level with glucose and lipid metabolism and body weight of the newborn in women with gestational diabetes mellitus (GDM). Methods Forty pregnant women with GDM were collected as GDM group, and 40 normal pregnant women were collected as normal glucose tolerance (NGT) control group. Fasting blood glucose (FPG), fasting insulin (Fins), fasting blood lipid and serum RBP4 levels before the delivery were detected, and HOMA-IR was calculated. And the birth weight (BW) of newborns and the cord serum RBP4 levels were determined. Results The maternal and cord serum RBP4, FPG, TG, HOMA-IR, and BW of newborns in GDM group were significantly higher than those in NGT group (P < 0. 05). There were no significantly differences in the levels of Fins and TC between the two groups (P > 0. 05). The correlation analysis showed that the serum RBP4 level in pregnant women was positively correlated with TG (r=0. 489, P < 0. 01); the maternal and cord serum levels of RBP4 were positively correlated with BW of newborns (r=0. 488, P < 0. 01; r=0. 327, P < 0. 05, respectively). Conclusion RBP4 is involved in glucose and lipid metabolism regulation and fetal growth, it maybe one factor contributing to GDM.

The investigation and analysis of comprehensive management in middle aged diabetes mellitus in a Shanghaibased community

XU Qi, XUE Jinhua, LIU Lianyong, ZHANG Linying, ZHU Wenkui, QIAO Huihua

2017, 15(8): 1374-1377. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.030

134 1

Abstract:
Objective To reveal and analyze the current situation of comprehensive management among 45 to 59 years diabetes mellitus in Hudong community. Methods From October, 2013 to May, 2014, we selected permanent residents aged 45 to 59 as subjects from Shanghai Hudong community service center. According to the principle of cluster sampling, the survey was conducted 8 from 33 neighborhood committees, thus it enrolled altogether 1 104 subjects. The study included questionnaire survey (gender, age etc), physical examination (body mass index, blood pressure) and laboratory exanimation (blood glucose, blood lipid etc). We judged the subjects by comprehensive control target based on the "Chinese type 2 diabetes prevention guides (2013 Edition) ". Results The study finally enrolled 1 018 subjects. The prevalence of diabetes was 12. 38% and the awareness rate was 73. 81%. The compliance rate of Fasting blood glucose and glycosylated hemoglobin in female were both lower than those in male, and the differences were statistically significant (P < 0. 05). The compliance rate of combined hypertension, blood lipid and body mass index had no difference in different genders. With the increasing of BMI, the prevalence of diabetes mellitus also increased, with statistical significance (P < 0. 01). The smoking rate was higher in male than that in female among pre-diabetic group, and the difference was statistically significant. We divided the subjects as non diabetic group, pre-diabetic group and diabetic group, and analyzed by Cochran-Armitage trend test, then found that the smoking rate gradually increased, while the compliance rate of BMI gradually decreased, and the difference was statistically significant (P < 0. 01). Conclusion We need to improve the management rate of fasting blood glucose in middle aged female diabetic patients in our community. The Prevalence of pre-diabetic was 13. 06%, and we need to strengthen the intervention of unhealthy lifestyle such as smoking and overweight among them.Our investigation indicated that the primary prevention of diabetes mellitus should be stricter. In order to promote effective community management based on the guideline both domestic and abroad, general practitioners should pay more attention to pre-diabetics, and intervention of related risk factors.

Effect of acupuncture of Soothing-Liver and Nourishing-Heart Method combined with venlafaxine on residual symptoms and serum monoamine neurotransmitter of depressive disorder patients

LIU Yi, FENG Hui, LIU Wenjuan, MAO Hongjing, ZHANG Yonghua, HU Linlin, YIN Yan, XU Lianlian

2017, 15(8): 1378-1381. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.031

108 2

Abstract:
Objective Residual symptoms are principal elements of symptoms recurrence and diseases relapse in the treatment of depressive disorder, the aim of this article is to explore effects of acupuncture of soothing-liver and nourishingheart method combined with venlafaxine on residual symptoms, clinical recovery and serum monoamine neurotransmitter level in depressive disorder patients. Methods Total 91 depressive disorder patients were randomly divided into drug group (only venlafaxine) and acupuncture-drug group (acupuncture combined with venlafaxine), all of them were treated for 8 consecutive weeks. Hamilton Depression Scale (HAMD) was used to assess residual symptoms and clinical recovery after the treatment, the level of serum monoamine neurotransmitter was tested before and after the treatment. Residual symptoms, clinical recovery and serum 5-HT, NE and DA levels in the two groups were analyzed statistically by χ² test, independent sample t test and one-way analysis of variance (ANOVA). Results HAMD total score, anxiety/somatization, weight, cognitive disorder, retardation and sleep disorder of drug group and acupuncture-drug group decreased after the treatment (P < 0. 01). As compare with the drug group, HAMD total score, anxiety/somatization and sleep disorder factor scores after the treatment in the acupuncture-drug group were lower (P < 0. 01 or P < 0. 05), however, the clinical recovery rate was higher (P < 0. 05). After the treatment, levels of 5-HT, NE and DA of both groups were decreased (P < 0. 01).When compare with drug group, levels of 5-HT, NE and DA after the treatment in the acupuncture-drug group were higher (P < 0. 01). Conclusion Acupuncture of soothing-liver and nourishing-heart method combined with venlafaxine for depressive disorder can promote the remission of residual symptoms and improve clinical recovery rate, the mechanism may relate to the elevated serum levels of 5-HT, NE and DA.

Correlation analysis of risk factors in mild cognitive impairment combined with metabolic syndrome in elderly patients

ZHANG Ning, JIA Jian, TANG Yayu, DING Haixia, YE Xiaoman, ZHAN Yiyang

2017, 15(8): 1382-1384,1406. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.032

49 0

Abstract:
Objective To analyze the clinical features and high-risk metabolic factors of metabolic syndrome (MS) combined with mild cognitive impairment (MCI) in elderly patients, in order to reduce the incidence of MS combined with MCI. Methods A total of 493 elderly patients who did health examinations in Nanjing community health service centers including Xianlin and Huaqiao road from November, 2015 to November, 2016 was divided into MS combined with MCI group (group A, 58 patients), MS group (group B, 79 patients), MCI group (group C, 103 patients) and control group (group D, 253 patients). Age, smoking history and past history were recorded. The systolic blood pressure (SBP), diastolic blood pressure (DBP), levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were detected. Body mass index (BMI) was calculated. All subjects were evaluated with regards to the scores of Mini-Mental Status Examination (MMSE), daily living skills assessment (ADL), Hospital Anxiety and Depression scale (HAD). Make use of multivariable logistic regression analysis to analyze related risk factors of MS combined with MCI. Results (1) Levels of SBP, FBG, TG and BMI were significantly higher in group A than in group D. Levels of FBG, TG and BMI were significantly higher in group B than in group D, but HDL-C level was lower than that in group D. Levels of SBP were significantly higher in group C than that in group D, and TG were significantly lower in group C than that in group D (all P < 0. 05). (2) Multivariate Logistic regression analysis showed that obesity (BMI ≥ 28 kg/m², OR=3. 685, 95% CI:1. 663-8. 167), hypertension (blood pressure ≥ 140/90 mm Hg, 1 mm Hg=0. 133 kPa, OR=2. 669, 95% CI:1. 247-4. 598), and high TG (≥ 1. 7 mmol/L, OR=5. 920, 95% CI:3. 064-11. 438) were the independent risk factors in mild cognitive impairment combined with MS (all P < 0. 05). Conclusion Mild cognitive impairment is affected by multiple metabolic abnormalities of MS in elderly patients. Obesity, high blood pressure, and hypertriglyceridemia are closely related to mild cognitive impairment combined with MS in the elderly.

To investigate the value of the specific spectrum of hypertrophic obstructive cardiomyopathy in the accurate assessment of the pressure difference across the left ventricular outflow tract

XIE Xiang, JIANG Fan, ZHANG Xinshu, SHI Kaihu, LAN Xiaofeng, LIU Hongjiao

2017, 15(8): 1385-1387. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.033

61 0

Abstract:
Objective The value of left ventricular outflow tract pressure gradient (LVOTG) was accurately assessed by studying the Doppler spectrum of left ventricular outflow tract in hypertrophic obstructive cardiomyopathy (HOCM), and then use echocardiography to evaluate the effect of percutaneous septal chemical ablation on the treatment of hypertrophic obstructive cardiomyopathy. Methods Retrospective analysis of January, 2012 to March, 2017 due to chest tightness, dyspnea and other clinical symptoms to our hospital, transthoracic ultrasound examination for hypertrophic obstructive cardiomyopathy in 19 patients, LVOTG was calculated according to the anterior and posterior peak flow rates of the specific"crab-like"spectrum of the left ventricular outflow tract, and PTSMA treatment of intracardiac catheter pressure and echocardiography measured LVOTG values were compared. The frequency of second peak flow and mitral regurgitation were analyzed in 12 patients without PTSMA and 7 patients underwent PTSMA, and patients with PTSMA before and after the"crab like"second peak flow rate and the mitral regurgitation velocity were compared and analyzed to evaluate the effect of PTSMA. Results All patients with left ventricular outflow tract were measured specific"crab-like"spectrum and ventricular septal thickening (13-23 mm) are accompanied by varying degrees of mitral regurgitation (mild to moderate) and the forward movement of the valve (SAM sign). The results of the second peak flow velocity measured by echocardiography were analyzed by the paired sample t test. The difference between the pressure gradient and the left ventricular catheterization was not statistically significant. After PTSMA treatment of patients, the LVOTG and obstruction decreased, mitral regurgitation rate is also accordingly reduced. Conclusion The second peak velocity of the"crab like"spectrum measured by the velocity of the left ventricular outflow tract can be used to measure the pressure difference, and to select the appropriate treatment for the clinical treatment of HOCM.

Analysis and study of drug resistance in HIV patients complicated with tuberculosis infection

ZHANG Wei, CUI Zhongfeng

2017, 15(8): 1388-1391. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.034

61 1

Abstract:
Objective To investigate the distribution of pathogenic bacteria in HIV patients complicated with tuberculosis infection, and to analyze the drug resistance of the patients. Methods One hundred and thirty-six cases of patients with HIV/MTB double infection and simple tuberculosis treated in our hospital from January, 2014 to January, 2016 were divided into three groups according to the patient's infection, which is 56 patients with HIV/MTB double infection as HIV/MTB group, 40 cases of tuberculosis patients as MTB group, and 40 cases of AIDS patients as HIV group. Three groups of patients were collected before carry out the corresponding pre treated inoculation in the MGIT tube, and using the absolute concentration method for the culture of the positive strains of drug resistance testing. Distribution of pathogenic bacteria in patients with statistics and evaluate the properties of the comparison, record the experimental results, statistical analysis, were conducted. Results The general clinical data of the three groups had no history of tuberculosis and diabetes, and no history of anti TB treatment. The gender and age of the three groups were not statistically significant (P > 0. 05). HIV/MTB group of patients with isolated strains in 38 cases, the positive rate was 67. 86%, 83 strains were isolated. Compared with the MTB group and the HIV group, there were significant differences in the distribution of the pathogenic bacteria (P < 0. 05). MTB group and HIV group were successfully isolated strains in 22 cases, 24 cases, the positive rate were 56. 41%, 58. 54%, a total of 39 strains and of bacteria were isolated and 41 strains. The two groups of patients were susceptible to Gram-negative bacteria, and the HIV/MTB group was different, and the gram positive bacteria in the three groups of patients with low infection ability. In HIV/MTB group, 2 cases (3. 57%) were resistant to RFP, INH, OFL and KAN, but not in MTB group and HIV group. The total initial drug resistance (including INH, resistant to SM) in the HIV/MTB group was significantly different from that in the MTB group and the HIV group (P < 0. 05). Conclusion In the treatment of HIV patients with tuberculosis infection, the use of antimicrobial agents should choose a combination of medication treatment. In order to aim at the gram negative pathogenic bacteria, we should also consider the fungi, viruses and other pathogens.

MRI and clinical diagnosis of central neurocytoma

WU Chunmao, LI Jun

2017, 15(8): 1392-1394,1446. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.035

96 0

Abstract:
Objective to investigate the MRI features of the central neurocytoma and its clinical characteristics, in order to improve the understanding of the disease. Methods MR imaging of 6 patients with central neurocytoma confirmed surgically and pathologically were retrospectively reviewed. Conventional plain and enhance MR scan were performed in all patients. Results The tumors in 5 cases located in the lateral ventricle monro, 1 case was located in the left lateral ventricle triangle, including 2 males and 4 females, aged from 16 to 38 years old, with an average age of 25. Tumors were connected to the septum pellucidum with wide base, a kind of round or irregular mass. Five cases were presented as cystic or solid mixed lesions, tumor of 1 case was solid, associated with different degree of hydrocephalus, 1 case of lesion invasion, adjacent brain parenchyma. There were 1 cases of invasion of adjacent brain parenchyma, and the growth of the tumor in 1 cases in the third ventricle. Cystic changes could be seen in larger lesions, but in smaller lesions, as well as there were multiple stripe-like structures in the periphery, which adhered to the ventricle walls, septum pellucidum and callus. Circuity blood vessels were found in partial lesions. All lesions were not seen bleeding, presented as equal or isointensity signal on T₁WI, hyperintensity or equal signal on T₂WI and DWI, and the internal signal of some tumors was inhomogeneous and honeycomb, mild to marked enhancement. Pathology showed, CNC in tumor tissue cell morphplpgy, centered round nucleus, transparent cytoplasm, was made up of characteristic fiber matrix cell free belt and "fake chrysanthemum group "signs. Immunohistochemical study suggests the 6 cases of synaptic element (Syn) are positive results. Conclusion Intraventricular CNC had characteristics of "peripheral cyst-spicules sign"and "snake-like flow void sign", combined with DWI signal characteristics can help improving central nervous cell tumor of the preoperative diagnostic accuracy and clinical treatment.

Clinical efficacy of ultrasound-guided percutaneous microwave ablation therapy in the treatment of thyroid nodules

XU Changliang, JING Yuanming

2017, 15(8): 1395-1397. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.036

120 0

Abstract:
Objective To investigate the clinical efficacy and adverse reaction of ultrasound-guided percutaneous microwave ablation (PMWA) in the treatment of thyroid nodules, and provide a theoretical basis and guidance for the clinical treatment. Methods Total 128 patients with benign thyroid nodules in our hospital from January, 2015 to August, 2016, were enrolled and randomly divided into control group (n=64) and study group (n=64). The control group was treated with conventional surgical resection, while the study group received ultrasound-guided PMWA. The success rate, nodular reduction and incidence of complication were compared between the two groups. Results The success rate of the control group was 99. 13%, and of the study group was 96. 12%, the other 3. 88% received the secondary ablation and also reached the goal of elimination. The number of thyroid nodules decreased with the time of microwave ablation, 98 nodules disappeared completely in 12 months after the operation. The mean volume of nodules decreased gradually with the extension of time. After one month, three months, six months and twelve months, the nodules reduce by 17. 65%, 40. 69%, 72. 55% and 88. 73%, respectively. The total adverse effect was 31. 25% in the control group, which was significantly higher than that in the study group (4. 69%). Conclusion Ultrasound-guided PMWA for thyroid nodules can achieve the similar therapeutic effect of surgical resection, effectively prevent the damage of surgery to the patients and reduce the incidence of adverse reactions, it is worth further clinical research and application, which will be a new approach for patients with contraindications to surgery

Correlation between 3D-PDU,PLGF and sFlt-1 expression in placenta of patients with preeclampsia

LIU Liu

2017, 15(8): 1398-1401. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.037

80 0

Abstract:
Objective To explore and analyze the correlation between 3D-PDU, PLGF and sFlt-1 in placenta of preeclampsia patients. Methods From September, 2015 to September, 2016, 100 patients with preeclampsia and eclampsia were divided into mild group and severe group according to severity, 50 cases in each group, 50 cases in our hospital from other health expectant mothers, as compared to the control group. All pregnant women prenatal three-dimensional power Doppler ultrasound (3D-PDU) examination, and the use of 3D reconstruction technology and VOCAL software to measure the vascular index (VI), flow index (FI) and vascularization flow index (VFI), detection of placental growth factor after delivery (PLGF) and soluble vascular endothelial growth factor receptor-1 (sFlt-1) level, and statistical analysis of correlation between the results of 3D-PDU and PLGF in placenta and the level of sFlt-1. Results In mild group and severe group, FI and VI in placenta of patients with VFI were significantly lower than that of control group (P < 0. 05). In severe group, FI and VI in placenta of patients with VFI were significantly less than mild group (P < 0. 05), with the aggravation of disease, VI, FI, placenta VFI decreased; mild group and severe group of patients with placenta PLGF were significantly lower than the control group (P < 0. 05), severe group was significantly lower than that of PLGF in placenta of patients with mild group (P < 0. 05), with the aggravation of disease, placenta PLGF decreased; mild group and severe group of patients with placenta sFlt-1 were significantly higher than the control group (P < 0. 05), severe group was significantly higher than that of SFLT-1 in placenta of patients with mild group (P < 0. 05), with the sicker patients, placental SFlt-1 increased, with statistical significance. Pearson correlation analysis showed a significant correlation between placental VFI and placental PLGF (P < 0. 01), which was positively correlated with statistical significance. There was a significant correlation between placental VFI and placental sFlt-1 (P < 0. 01), and there was a negative correlation between them. Conclusion There is a significant correlation between the detection of 3D-PDU and the expression of PLGF and sFlt-1 in placenta of preeclampsia, which may provide some help for the clinical diagnosis of preeclampsia.

Application of mindfulness training intervention in patients with insomnia

TAO Jingjing, CHEN Fang, PEI Dajun

2017, 15(8): 1402-1406. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.038

102 5

Abstract:
Insomnia is the most common sleep disorder, which may affect the patients' emotional state and quality of life.The current treatment methods mainly include pharmacotherapy, Chinese traditional treatment and cognitive behavior therapy. Mindfulness training is the category in cognitive behavior therapy which is a kind of psychological intervention method and based on mindfulness. This type of therapy emphasized acceptance and no comments, and mainly contained three aspects:purpose, awareness and attitude. This article summarized the concept and classification of mindfulness training, mindfulness training mechanism and model, and intervention in patients with insomnia caused by different reasons, mainly covered three types:physical diseases, mental factors and primary chronic insomnia. In patients with insomnia caused by physical diseases, this article summarized the application of cancer, hypertension and part of the postoperative patients, which found that mindfulness training may improve the patients' cognitive and thinking mode, enhance sleep quality, reduce the postoperative pain intensity of patients. In patients with insomnia caused by mental factors, this paper summarized the application of depression, anxiety, psychological and occupational burnout, which found that mindfulness training may enhance individual's positive emotions, reduce perceived stress, increase total sleep time and efficiency of patients, finally improve sleep quality. In the application of primary chronic insomnia, it's concluded that mindfulness training keep patients with peaceful attitude to accept what happened now, thus reduce the average sleep time, improve sleep quality and has good long-term curative effect. In the future nursing service, the nursing workers need to pay more attention to the patients of insomnia and effectively use right mindfulness training method, in order to improve sleep quality of patients with insomnia.

Research progress of non-vasomotor mechanism for cirrhosis complicated by kidney injury

LI Yumei, ZHOU Fangfang, LUO Qun

2017, 15(8): 1407-1410. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.039

59 1

Abstract:
Acute kidney injury (AKI) is a common complication of advanced cirrhosis with high mortality and high morbidity, often experience poor prognosis. It is characterized by a sudden drop in glomerular filtration rate, retention of metabolic waste products, water-electrolyte imbalance, and acid-base disturbance. The pathogenesis of advanced cirrhosis complicated by acute kidney injury is complicated and not completely understood, and the therapeutic approaches are limited.Therefore, to improve the understanding of the pathophysiological mechanisms involved in renal dysfunction occurring on a background of cirrhosis is the key to develop the effective treatment strategies, improve QOL and prognosis of patients, and reduce the economic burden of family. Traditionally, it is believed that the decreased effective circulating blood volume resulted in the renal artery hypoperfusion (vasomotor mechanism). The AKI is due to the combination of an impaired effective arterial blood volume secondary to arterial vasodilation and the effects of excessive activation of the rennin-angiotensin-aldosterone system, with increased intrarenal vasoconstriction and impaired renal autoregulation that predisposes to renal dysfunction. In recent years, more and more studies have found that the activation of different inflammatory factors, such as mediators of inflammation (tumor necrosis factor-α, Interleukin-6, Toll-like receptor 4, Interleukin-17A), increased the intra-abdominal pressure resulted by cirrhotic ascites, the increased the concentration of serum bilirubin and bile acids caused by the dysfunction of bilirubin uptake, combination and excretion, the relative adrenal insufficiency leaded by anomaly expression level of serum cortisol and the endotoxin play an important role in AKI in cirrhosis. This paper will summarize the recent advances in understanding the nonvasomotor mechanism of AKI in end-stage liver disease.

The latest pharmacological strategies for the management of levodopa-induced dyskinesias

BAI Yujie, TANG Shiqi, WU Liuxin, XIA Hongmiao, SHI Xiaoxue

2017, 15(8): 1411-1414. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.040

124 2

Abstract:
Levodopa-induced dyskinesias (LID) is the most common side effect in Parkinson's disease (PD) treatment with dopaminergic and it seriously affect the patients' living quality. The underlying mechanism and pathological substrate of LID are not fully understood but animal models of parkinsonism with LID have provided important knowledge about the mechanisms underlying LID. Now in addition to adjust the treatment plan there is only a few drugs can relieve symptoms of LID and these drugs can not delay the course of the disease. So there is an urgent need for research on new drugs to make an intervention on its progress. Here we review the most relevant advances in relation to the dopaminergic system, the glutamatergic system, the serotonergic system, the opioid system, the GABAergic system, the adenosine system, the adrenergic neurotransmission and the related newly studied medicines to treat LID. Some of these drugs are not used clinically and only studied on animal models. Except for the classic medicines for LID treatment amantadine and morphine, there are also newly studied medicines such as mavoglurant and caffeine. For the classic druges there are newly studied dosage form for the sake of control the LID symptom rapidly or remission the pulsatile stimulation of DA receptors. The ultimate aim of this review is provide more choices for LID treatment and control the process of LID as soon as possible.

Immunological role of Treg cells in vitiligo and autoimmune thyroid diseases

Reziwanguli·wumaier, Mijiti·wupuer, Abulimiti·juma

2017, 15(8): 1415-1418. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.041

103 1

Abstract:
Vitiligo is a hypomelanotic autoimmune skin disease, commonly in young people under the age of 20 years old, and mainly affects the appearance and psychology. The pathogenesis of vitiligo is not clear now; the immune mechanism theory is better one of lots related pathogenesis theory, which has the strongest of persuasion. The pathogenesis of vitiligo may involve immune tolerance damage and some substance from autoimmune reactions produce a harmful effect on the normal metabolism of melanoma cells, thus lead to loss of damage of melanin that result in the development of vitiligo.Regulatory T cells (Treg) can inhibit autoimmune reaction, inhibit the excessive immune response of normal T cells of pathogenic factors, prevent the occurrence of autoimmune diseases, and maintain immune tolerance of body, and avoid the damage of own tissues and organs during immunological process. Many studies focused on the role of Treg in the pathogenesis of vitiligo and autoimmune thyroid disease. The antigen-specific human Treg cells are important cells in the process of the immune system repairing by itself, and play an important role in protecting melanoma and thyroid follicular cell from excessive immune response during the pathogenesis of autoimmune thyroid disease and vitiligo, preventing the occurrence of these diseases. So, vitiligo and some autoimmune diseases may have a common intersection point on the etiology. The treatment for vitiligo and other autoimmune diseases based on Treg cell may bring new opportunities to the patients. So, the further study of the immunologic mechanism of Treg involved in vitiligo and other autoimmune diseases shows important significance in the new treatment and development of new drugs. This paper will investigate the immune mechanism of Treg cells in the pathogenesis of vitiligo and autoimmune thyroid disease, and further clarify the relationship between vitiligo and autoimmune thyroid disease.

Effect of warm acupuncture combined with distinctive traditional Chinese medicine practices on knee function and bone metabolism in patients with knee osteoarthritis

ZHOU Shuxin

2017, 15(8): 1419-1421,1443. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.042

79 2

Abstract:
Objective To investigate the clinical effect of warm acupuncture combined with distinctive traditional Chinese medicine practices on knee function and bone metabolism in patients with knee osteoarthritis. Methods One hundred and eight patients with knee osteoarthritis were randomly divided into two groups, with 54 cases in each group. The patients in the control group were given diclofenac sodium; while the patients in the observation group were given warm acupuncture combined distinctive traditional Chinese medicine practices. Before and after the treatment, the renal function indicators (HSS), bone metabolism (OPG, CT, BGP), serum-related factors in cartilage repair (TGF-β, IGF-1, FGF-2), inflammatory factor (TNF-α, IL-1) of the two groups were detected. And the total effective rate of two groups were accounted. Results After the treatment, the HSS indexes of the observation group were significantly increased (P < 0. 05), and significantly higher than those of control group (P < 0. 05). The OPG and BGP levels of both groups were significantly improved (P < 0. 05), and the OPG and BGP levels of the observation group were significantly higher than those of control group (P < 0. 05). After the treatment, TGF-β, IGF-1 and FGF-2 levels of the observation groups were significantly increased (P < 0. 05), and significantly higher than those of control group (P < 0. 05). After the treatment, TNF-αand IL-1 levels of the two groups were significantly improved (P < 0. 05), and the TNF-αand IL-1 levels of the observation group were significantly higher than those of the control group (P < 0. 05). The total effective rate of the observation group was 90. 7%, which was significantly higher than that of the control group (68. 5%, P < 0. 05). Conclusion The warm acupuncture combined with distinctive traditional Chinese medicine practices could effectively improve the inflammation, knee function and bone metabolism of patients with knee osteoarthritis, with satisfactory effect.

Application research of PBL combined with CBL in clinical teaching of gastrointestinal surgery

ZHAO Jun, ZHAO Haiyuan, ZHAO Guohai

2017, 15(8): 1422-1425. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.043

82 4

Abstract:
Objective To discuss the application effect of "problem-based learning (PBL) "teaching model combined with "case-based learning (CBL) "teaching model in gastrointestinal surgery interns teaching activities. Methods A total of 96 class 2012 undergraduate clinical interns of Wannan Medical College in Yi Jishan Hospital were randomly divided into research group and control group, each group containing 48 cases. PBL combined with CBL teaching model were given in research group while LBL teaching model was conducted in control group to compare the differences of application effect. Questionnaire survey and theory test were carried out to evaluate the teaching effect. With SPSS 15. 0 statistical analysis package and mean ±standard deviation representing measurement data, we compared by one-way analysis variance between groups and by chi-square test for enumeration data. Results The theory test score, comprehensive ability score and total score in research group were all higher than those in control group, and the differences between two groups were statistically significant (all P < 0. 05). The self-study ability, clinical thinking ability, problem analysis and solving skills, communication skills, teamwork ability and data query efficiency of the interns in research group were better than those in control group, and the differences between two groups were statistically significant (all P < 0. 05). Conclusion PBL combined with CBL teaching model has obvious advantages in gastrointestinal surgery clinical intern teaching, which can arouse studying initiative, develop ability to analyze and solve problems and improve the comprehensive quality of interns.So PBL combined with CBL teaching model is worth taking in clinical teaching.

The dilemmas and the strategy in the clinical teaching of Brugada syndrome

LIU Jinjun, ZHANG Heng, SHI Xiaojun, WANG Hongju, ZHANG Ningru

2017, 15(8): 1426-1428. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.044

126 0

Abstract:
Objective to study the further improve the effect of Brugada syndrome clinical teaching method. Methods Brugada syndrome is an important disease in modern clinical medicine category, is one of the important disease in cardiology, the mortality and disabled rate are high, although Brugada syndrome often with severe clinical harm and frightening.But in clinical teaching, the students have to acknowledge the severity of the disease harmfulness and serious deficiencies, vigilance and clearly is not high, so in the diagnosis and treatment of the disease in the process of medical risk prevention awareness is relatively insufficient, plus most of the students the relevant basic knowledge of the disease is relatively weak. So in the process of clinical teaching of Brugada syndrome corresponding clinical very difficult, the interpretation of the content to students are hard to understand, so learning the enthusiasm and interest is low. Results according to the above a series of problems existing in clinical teaching and the reality and the related difficulty. Based on value theory, combined with clinical practice, the detailed teaching plan, according to the clinical characteristics of Brugada syndrome, its pathogenesis, etiology, etc. As a main content of teaching, and the clinical electrocardiogram (ecg) as the teaching emphasis and difficulties, to focus on the teaching time. The theoretical interpretation of the combined with case teaching, aiming at different levels of students using one by one, the layering teaching and management mode, attach importance to the basic theory and fully arouse the enthusiasm of students. On the basis of the traditional clinical teaching mode, make full use of modern network multimedia teaching tools such as a powerful graphics processing power, noise, the ability of simulating the mutual change ability and strong intuitive vividly recreates the Brugada syndrome pathogenesis process, greatly improve the clinical teaching efficiency and effect of Brugada syndrome. Conclusion through the implementation of these measures, we found that in the different sources of students have achieved good effect in the teaching work, and improved the Br S clinical teaching efficiency, but also improve the accuracy of clinical diagnosis of BrS.

Influence of acetylcysteine combined glucocorticoids on immune function and inflammation of patients with severe asthma

BAO Zhijian

2017, 15(8): 1429-1432. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.045

80 0

Abstract:
Objective To investigate the clinical effects of acetylcysteine combined glucocorticoids on severe asthma and its influence on the immune function and inflammation, respiratory of patients. Methods Total 70 patients with severe asthma were randomly divided into two groups, with 35 cases in each group. The patients in the control group were given corticosteroids, while the patients in the observation group were given acetylcysteine combined glucocorticoids. Before and after the treatment, the immune function, inflammatory cytokines, respiratory function of the patients in the two groups were detected and the clinical efficacy was assessed. Results After the treatment, CD3, CD4, CD4/CD8, IgA, IgG and IgM levels of both groups were significantly increased (P < 0. 05), CD8 levels of both groups were significantly decreased (P <0. 05); CD3, CD4, CD4/CD8, IgA, IgG and IgM levels of the observation group were significantly higher than those of the control group (P < 0. 05), CD8 level of the observation group was significantly lower than that of the control group (P <0. 05). After the treatment, TNF-α, hs-CRP and IL-8 levels of both groups were significantly decreased (P < 0. 05), and TNF-α, hs-CRP and IL-8 levels of the observation group were significantly lower than those of the control group (P <0. 05). After the treatment, PaO₂, FVC, FEV1, FEV1%, FEV1/FVC of the two groups were significantly increased (P <0. 05), PaCO₂ levels of both groups were significantly decreased (P < 0. 05); PaO₂, FVC, FEV1, FEV1%, FEV1/FVC levels of the observation group were significantly higher than those of the control group (P < 0. 05), PaCO₂ level of the observation group was significantly lower than that of the control group (P < 0. 05). The total effective rate in the observation group was 91. 3%, which was significantly higher than that in the control group (74. 3%, P < 0. 05). Conclusion Acetylcysteine combined glucocorticoids could significantly improve immune function, inflammation, respiratory function of severe asthma patients, with satisfaction treatment.

A study of hospitalization costs and influencing factors based on analysis of 1389 breast cancer patients

MA Jingbo, CENG Wei, LI Xiaojun

2017, 15(8): 1433-1435. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.046

151 3

Abstract:
Objective To analyze the influencing factors of hospitalization costs of patients with breast cancer, and provide the basis for allocating medical resources, reducing medical expenses and establishing reasonable medical insurance system. Methods The expenditure pattern of hospitalization costs of 1 389 cases of breast cancer in a third grade hospital in Anhui Province between January, 2011 and December, 2016 were retrospectively analyzed. The hospital information of all patients was got from hospital HIS system. ANOVA and multivariate Logistic regression analysis by SPSS 16. 0 were conducted for the related factors of hospitalization cost. The effective intervention strategies were put forward according to the results. Results Among 1 389 breast cancer patients, the average hospitalization cost was (31 425. 8 ±357. 3) yuan, the hospitalization cost was mainly composed of drug fee (42. 4%), operation fee (24. 8%), treatment fee (9. 1%) and other expenses (16. 5%). The single factor analysis showed that the number of hospitalization, days of hospitalization, mode of payment, clinical stage and treatment methods were the affecting factors of hospitalization cost (P < 0. 01). Multivariate Logistic regression analysis showed that the number of hospitalization, days of hospitalization, and clinical stage were the main factors that affecting hospitalization costs (P < 0. 05). Conclusion There are many factors that may affect hospitalization cost of patients with breast cancer, analysis of the influencing factors of hospitalization cost of breast cancer patients has great significance to control the unreasonable growth of medical cost. Health administrative department and hospital should intervene in the unreasonable growth of medical cost, so as to reduce the cost of medical treatment and economic burden of patients.

Application of swallowing assessment based on the theory of DMAIC

ZHOU Yulan, CHEN Li, DENG Ying, CAO Yingchun, YANG Zhihua

2017, 15(8): 1436-1439. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.047

56 1

Abstract:
Objective To evaluate the application of swallowing assessment based on the theory of DMAIC. Methods From March, 2015 to September, there were 161 medical nurses as the research object, based on the definition, measurement, analysis, improvement and control of the five steps, to establish the key factors to improve the nurses' bedside swallowing assessment, strengthen training and develop process guidelines, thus promoting the compliance of the nurses as well as sustaining quality control. he degree of grasping the swallowing assessment along with the ability of clinical nursing was compared before and after the application of DMAIC, which serves to analyze the efficacy of DMAIC-based swallowing assessment. Results The bedside swallowing assessment score before intervention was (1. 95 ±1. 12), after was (2. 59 ±1. 00), and the difference was statistically significant (t=-5. 339, P < 0. 001). The clinical nursing skill was increased in which the nurses pay close attention to the patient before feeding, the level of consciousness and the higher brain functions (t=-3. 834, P < 0. 001); focus on eating posture, way, content, time, food intake (t=2. 313, P=0. 021); observed after eating whether there were choking, cough, throat clearing situation (t=4. 884, P < 0. 001); to observe the oral food residues, chest food blockage (t=2. 588, P=0. 010); attention to the strange sensation of the throat, saliva secretion (t=-2. 839, P=0. 005); pay attention to reflux (t=4. 671, P < 0. 001). Conclusion The application of DMAIC can promote the improvement of clinical swallowing assessment technology, and has achieved good results, which is worthy of popularizing and applying.

The compliance effects of comprehensive intervention combined cognitive behavioral therapy for the treatment of thyroid cancer patients after surgery

LI Tong

2017, 15(8): 1440-1443. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.048

88 0

Abstract:
Objective Surgery is the main methods in the treatment of thyroid cancer, which can effectively improve the prognosis, but will also bring great negative impact to the patients. Therefore, it is necessary to strengthen postoperative treatment and nursing. Cognitive behavioral therapy is in line with the modern concept of nursing method, which can change the concept and behavior of the patients and to promote health condition. This study is to investigate the compliance effects of comprehensive intervention combined cognitive behavioral therapy for the treatment of thyroid cancer patients after surgery. Methods We selected 130 patients with thyroid cancer after surgery treated in our hospital from February, 2011 to February, 2015, and randomly divided into the treatment group and the control group with 65 patients in each group. All patients were given oral radionuclides iodine-131 treatment, the control group received routine care during treatment, and the treatment group was given the positive cognitive behavioral therapy intervention. The nursing observation period was three months. Results The serum TT3 and TT4 values in the two group after care were significantly higher than those before treatment (P < 0. 05), while the serum TT3 and TT4 values in the treatment group after care were significantly higher (P < 0. 05). The recurrent laryngeal nerve injury, hypocalcemia, hypoparathyroidism, wound infection and other complications during care in the treatment group were significantly less than those in the control group (P < 0. 05).The compliance in the treatment group during care was significantly superior to the control group (P < 0. 05). The physical function, physiological function, social function, emotional function, mental health, bodily pain, general health, vitality and other scores after care in the treatment group were significantly higher than those in the control group (P < 0. 05). Conclusion Comprehensive intervention combined cognitive behavioral therapy for the treatment of thyroid cancer patients after surgery can improve compliance and the body's secretion balance of thyroid hormone, reduce the incidence of complications, thereby improve the quality of life of patients.

2017, 15(8): 1444-1446. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.049

45 2

Abstract:

2017, 15(8): 1447-1448. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.050

35 0

Abstract:

2017, 15(8): 1449-1450. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.051

39 0

Abstract:

2017, 15(8): 1451-1453,1456. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.052

32 0

Abstract:

2017, 15(8): 1454-1456. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.053

49 1

Abstract:

About Journal

2017 Vol. 15, No. 8

Submission System