中华全科医学

To explore the relationship between cardio-ankle vascular index and blood pressure with age and body mass index in health examination population

WU Jijun, GUO Ming, ZHANG Zonghui, YANG Jie, HAN Weixing, HU Huaqing

2017, 15(9): 1457-1460,1498. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.001

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Objective To study the situation of overweight and obesity and explore the relationship between cardio-ankle vascular index (CAVI) and blood pressure with age and body mass index (BMI) in health examination population, analyzing the significance of BMI in the evaluation of arteriosclerosis and hypertension. Methods To choose the 941 health examination people at the Health Examination Center from the First Affiliated Hospital of Anhui Medical University between February, 2013 and July, 2013, to calculate their BMI by measuring the height and weight of this 941 health examination people and detect CAVI and blood pressure by using arteriosclerosis detector, analysis the indexes above by using analysis of variance and Logistic analysis, then do an evaluation according to the results. Results (1) In these cases, the situation of overweight and obesity is serious, the rate of overweight is 42. 3% (398 cases) and the rate of obesity is 14. 3% (135 cases). (2) Systolic blood pressure in some age groups (41-70 age group) increased (P < 0. 01), diastolic blood pressure in some age groups (18-50 age group) increased (P < 0. 05) along with age increasing in these cases. (3) CAVI increased significantly in all age groups along with age increasing in these cases. (4) Among these people, CAVI decreased along with BMI increasing in some age groups (31-50 age group), P < 0. 05. (5) Both systolic blood pressure and diastolic blood pressure increased significantly in most of these age groups (18-60 age group) along with the BMI increasing (P < 0. 05). (6) Multiple factors analysis shows that CAVI presents a positive relationship with age and blood pressure (P < 0. 05), but has no relationship with BMI (P > 0. 05). Conclusion The situation of overweight and obesity is serious; age has a certain influence on blood pressure, but presents a positive relationship with CAVI; BMI presents a positive relationship with blood pressure, but has no relationship with CAVI; BMI could not accurately reflect the situation of arteriosclerosis.

2017, 15(9): 1461-1462.

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The clinical value of deep sedation in the treatment of severe craniocerebral injury

LI Yiran, SUN Yuming, YU Weifeng, SONG Jinchao

2017, 15(9): 1463-1465. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.002

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Objective To study the effect of deep sedation on severe craniocerebral injury patients after operation. Methods Thirty-seven patients with severe traumatic brain injury from June, 2013 to June, 2016 were treated with routine treatment and deep sedation (BIS:20-40). At the same time 41 patients with severe traumatic brain injury who were not treated by deep sedation (BIS:40-60) were the control group. Two groups of patients had sedative and analgesia treatment, capacity management, mechanical ventilation, nutritional support and other treatment measures. Blood samples were taken to observe the Sj O₂, AVDO₂ and CEO₂indexes of the two groups. The ONSD values of the two groups were measured by bedside color high frequency linear array probe. The diastolic Vd and PI of the middle cerebral artery of the two groups were measured by low frequency micro-convex array probe. We compared the two groups of treatment. Results The mean ONSD (4. 98 ±0. 09) was significantly lower in the experimental group than that in the control group (5. 95 ±0. 05) at the7 th day. The difference was statistically significant (P < 0. 01). In the experimental group, Vd increased and PI decreased at the 7th day. Compared with the control group, the difference was statistically significant (P < 0. 01). In the experimental group, Sjv O₂ increased, but AVDO₂ and CEO₂decreased at the 7th day. Compared with the control group, the difference was statistically significant (P < 0. 01). Conclusion Deep sedation in severe traumatic brain injury can decrease intracranial pressure and improve cerebral oxygen metabolism, which is worth popularizing in clinic.

The protection and related mechanism of morroniside in rat model of myocardial ischemic reperfusion injury

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

2017, 15(9): 1466-1468. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.003

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Objective To investigate the effect of morroniside on myocardial ischemia reperfusion injury (MIRI) in a rat model of myocardial ischemic reperfusion injury and reveal the possible mechanisms behind it. The obvervational index mainly include the expression of the apoptosis gene Bcl-2 and Bax, the infarction area percentage, the tissue section and the myocardial enzyme. Methods Healthy male Sprague Dawley rats were randomly allocated to three groups:sham, ischemia/reperfusion (IR) and morroniside. The group of IR and morroniside are made ischemia reperfusion injury (IRI) models through surgery. Serum creatine kinase isoenzyme (CK-MB) were assayed. The infarct size was determined by triphenyl tetrazolium chloride staining. The tissue section are observed through microscope. The apoptosis gene Bax and Bcl-2 was assessed through real-time polymerase chain reaction. Results Compared with the sham group, the infarct size percentage, the serum creatine kinase isoenzyme (CK-MB) level, the damage of tissue and the Bax and Bcl-2 gene expression level were significantly raised in the IRI and morroniside group. Compared with the IR group, the infarct size percentage, the serum creatine kinase isoenzyme (CK-MB) level, the damage of tissue and the Bax gene expression level were significantly reduced in the morroniside group, while Bcl-2 gene expression level was significantly increased. Conclusion This experiment demonstrate that morroniside provides an enhanced protection against myocardial IRI and may through the Bcl-2-linked apoptotic signaling pathway.

Method and duration of limb immobilization associating with deep venous thrombosis of the lower extremity after carotid artery stenting

FU Xiaoyan, WANG Lingru, ZHOU Huadong

2017, 15(9): 1469-1471,1502. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.004

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Objective To analyze the association of the deep venous thrombosis (DVT) of the lower extremity with age and blood coagulation function of the patients and the method and duration of limb immobilization after carotid artery stenting (CAS). Methods Total 417 patients undergoing CAS in our department from January, 2010 to January, 2015 were enrolled in this study. Preoperative Doppler sonography for DVT of the lower extremity was performed. According to the results of bedside ultrasound examination at postoperative 12 hours, the patients were assigned into DVT group and non DVT group. The relevance of DVT with the age and blood coagulation function of the patients and the duration of limb immobilization was statistically analyzed by using SPSS 17. 0. Results The total incidence of DVT after CAS was 3. 8% (16/417). The patients aged over 80 years old accounted for 50. 0% (8/16) in DVT group, only for 13. 5% (54/401) in non DVT group, there was a significant difference (χ²=13. 466, P=0. 002). The patients with the duration of operated limb immobilization over 24 hours accounted for 50% (8/16) in DVT group, only for 2. 2% (9/401) in non DVT group, there was a significant difference (P < 0. 001). The patients with elevated D-dimer level accounted for 56. 3% (9/16) in DVT group, only for 2. 7% (11/401) in non DVT group, there was a significant difference (P < 0. 001). Conclusion It is important to test the coagulation function of the patients before and after CAS. The pulsation of the foot dorsal artery should be closely observed after the operation, and do some passive and active activities for the operated limbs as early to prevent and reduce the occurrence of DVT.

Expression levels and clinical significance of DKK1 in bone marrow supernatant and blood serum of patients with multiple myeloma

CHEN Shuang, ZHANG Zhenghao, ZHANG Min, HAO Jianping

2017, 15(9): 1472-1474. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.005

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Objective To study the expression levels of Dickkopf-1 (DKK1) in bone marrow supernatant and blood serum of patients with multiple myeloma (MM), and to investigate the clinical significance of DKK1 in multiple myeloma. Methods Twenty cases of multiple myeloma (MM group) and 10 cases of iron deficiency anemia (control group) in our hospital between 2014 and 2015 were enrolled into this study. The expression levels of DKK1 in bone marrow supernatant and blood serum were tested by using antibody sandwich enzyme linked immunoassay (ELISA). Results The level of DKK1 in the bone marrow supernatant of MM group was (8. 9 ±2. 8) ng/ml and of the control group was (1. 3 ±0. 9) ng/ml; in serum of MM group was (8. 7 ±2. 2) ng/ml and of the control group was (1. 0 ±0. 5) ng/ml, there was a significant difference between the two groups (P=0. 001). There was no significant difference between supernatant and blood serum in MM group (P > 0. 05). Conclusion The DKK1 levels of bone marrow supernatant and blood serum of patients with MM are all significantly higher than those in the control group. DKK1 secreted by myeloma cells is an important factor leading to the osteopathia in MM patients. The level of DKK1 is related to the osteolytic lesions.

Prostaglandin levels in vitreous of patients with rhegmatogenous retinal detachment associated with choroidal detachment

DING Nannan, ZHOU Ying, YU Jinjin, WU Zhifeng

2017, 15(9): 1475-1477,1573. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.006

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Objective To verified the changes of prostaglandin E2 (PGE2) and prostaglandin F2 (PGF2α) as potential molecular markers in rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). Methods Total 56 primary patients (26 cases of RRD associated with CD and 30 cases of RRD) undergoing pars plana vitrectomy in Nanjing Medical University Affiliated Wuxi Second Hospital between September, 2014 and October, 2015 were collected. The level of prostaglandin E2 and F2α in vitreous fluid were tested by using ELISA. Results PGE2 level in vitreous of RRD associated with CD group was lower than that in RRD group, the difference was statistically significant (P <0. 01). However, the PGF2α level was not significantly difference between the two groups (P=0. 865). In the RRD associated with CD group, the level of PGE2 and PGF2α in vitreous had no significant difference between different grades of PVR (A, B, C, D), P=0. 409, 0. 389; the level of PGE2 and PGF2α had no significant difference between mild PVR (A and B) and heavy PVR (C and D), P=0. 433, 0. 948. Conclusion The PGE2 level in vitreous of RRD associated with CD was less than RRD and this result is consistent with earlier study. It might indicate a greater consumption of PGE2 that would be stimulated by inflammation or a loss of limitation of inflammatory responses. Besides, the level of PGE2 is not correlated with PVR grades. PGF2α does not show the potential as biomarker in process of RRDCD.

Clinical study of ultrasonic evaluation of knee and ankle joints hemophilia A arthropathy

LIU Wenbin, WU Fuming, LIN Tianbao, GAO Yanting, HU Huijin, WU Dijiong, ZHOU Yuhong

2017, 15(9): 1478-1480. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.007

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Objective To investigate the characteristics and clinical significance of ultrasonography in haemophilic A arthropathy of knee and ankle joints. Methods The knee (n=55) and ankle joints (n=55) of 28 patients with the diagnosis of haemophilic A in our hospital from January, 2015 to June, 2016 were evaluated with ultrasonography and scored according to MELCHIORRE ultrasound score. The correlations between ultrasound score synovial hypertrophy, knee joints and cartilage damage, ankle joints were analyzed respectively. Results There were 28 male patients with median age33. 4 (6-69) years old enrolled in this study. The average ultrasound score of knee and ankle joints were 5. 16 ±0. 67 and 3. 87 ±0. 57 respectively, which had significant statistically (P < 0. 01), and the incidence of bone erosion of knee and ankle joints had statistical significance (P < 0. 05). The significant difference of ultrasound score was found between mild and moderate, severe haemophilia A (P < 0. 01), but had no statistical significance between moderate and severe haemophilia A (P=0. 134). The ultrasound score according to age < 18 and ≥ 18 years old groups were 3. 50 ±1. 00, 4. 87 ±0. 482 respectively, which had no statistical significance (P=0. 169). A positive correlation between knee and ankle joints of ultrasound score was demonstrated (r=0. 479, P < 0. 01); a significant positive correlation between synovial hypertrophy and cartilage damage of ultrasound score was demonstrated (r=0. 728, P < 0. 01). Conclusion Ultrasound can effectively identify haemophilia A joint lesions of knee and ankle joints, which was a fast, effective, safe and available inspection method in the assessment of haemophilia A arthropathy of knee and ankle joints and had remarkable clinical practical value.

Efficacy of dynesys spinal system for spinal degenerative disease

ZHANG Haoshaqiang, NING Kai, WANG Lei, WANG Zhigang, LI Kun, CHE Lixin, WANG Fei

2017, 15(9): 1481-1483. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.008

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Objective To assess the indications, clinical application value and advantages of Dynesys non-fusion pedicle screw-based stabilization system in the treatment of lumbar degenerative disc disease. Methods Total 40 cases of lumbar degenerative disc disease (male 28, female 22, with an average age of 41) in our hospital between 2008 and 2015 were reviewed retrospectively. The preoperative imaging examinations included lateral and dynamic X-rays of the lumbar spine, plain scanning and 3D reconstruction for vertebrae and disc space, MRI functional score for lumbar vertebra. Posterolateral approach Dynesys non-fusion pedicle screw-based stabilization system was performed in all cases. The Japanese Orthopaedic Association (JOA) and Oswestry Disability Index (ODI) score were employed to assess the clinical efficacy and improvement rate before and after the operation. The results were put into statistical analysis. Results Fourty patients were followed up for 12 to 90 months with an average of 52. At the final follow-up, the excellent and good rate by JOA score was 80. 0%, and ODI decreased from 42. 864 ±5. 528 to 9. 438 ±2. 649, VAS for pain also decreased obviously, the difference was statistically significant (P < 0. 05). There was no intervertebral space infection, lumbar intervertebral instability and failure in internal fixation during the follow up. Conclusion Dynesys system is an effective method for lumbar spine degeneration in preventing adjacent disc degeneration, reserving lumbar physiological movement and improving lumbar instability, shows similar effect in improving the symptoms of low back pain with conventional posterior lumbar fusion surgery.

Effects of lumbar interbody fusion combined pedicle screw fixation in the treatment of lumbar spinal stenosis

HUANG Cheng, WANG Yiwei, LI Bin, JIANG Yi, ZHANG Congxiao, ZUO Rujun, SHI Yan, WU Lei, YIN Dong

2017, 15(9): 1484-1486. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.009

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Objective To investigate the effects of interbody fusion combined fusion fixation pedicle screw in the treatment of spinal stenosis. Methods A prospective study was carried out among 130 spinal stenosis patients in our hospital from August, 2011 to February, 2015. The patients were randomly divided into the treatment group and the control group with 65 cases in each group. The control group received conventional treatment of spinal arthroplasty, while the treatment group received lumbar interbody fusion combined pedicle screw fixation. Results All patients were successfully operated. The operative time, blood loss and postoperative hospital stay in the treatment group were significantly less than those in the control group (P < 0. 05). The postoperative three months of pulmonary infection, incision infection, intervertebral instability and vascular injury in the treatment group were 1 case, 0 case, 1 case, 1 case, so that were 4 cases, 5 cases, 6 cases, 7 cases in the control group, the treatment was significantly less than the control group (P < 0. 05). The postoperative (three months after operation) excellent rates in the treatment group were 93. 8%, and in the control group was 84. 6%, the excellent rate of the treatment group was significantly higher (P < 0. 05). Conclusion The lumbar interbody fusion combined pedicle screw fixation in the treatment of lumber spinal stenosis can provide strong fixation, with better efficacy and safety, thus contributes to the function of the lumbar spine recovery.

Changes of inflammatory cytokines IL-18,IL-1 beta and TNF alpha in peripheral blood of patients with gout

HUANG Jiyong, ZHANG Yan

2017, 15(9): 1487-1489. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.010

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Objective To investigate the changes of inflammatory cytokines IL-18, IL-1 beta and TNF alpha in peripheral blood in patients with gout, and explore its role in gout and high uric acid hematic disease. Methods A total 49 cases were recruited from outpatients in our hospital and ward patients between August, 2013 and October, 2014 (includes 24 cases in acute phase and 25 cases in intermission). 9 cases in normal control group came from health check-up crowd in the same period in outpatients. The fast peripheral venous blood was prepared, and the levels of blood uric acid, C-reactive protein (CRP), interleukin 1 beta (interleukin 1 beta, IL-1 beta), interleukin-18 (interleukin-18, IL-18) and tumor necrosis factor alpha (Tumor necrosis factor-alpha, TNF-α) were tested. Results The serum level of IL-18 in Gout group and the normal control group were[105. 66 (43. 32, 190. 83)]pg/ml and[0. 00 (0. 00, 0. 00)]pg/ml, respectively; levels of IL-1 beta were[0. 00 (0. 00, 0. 15)]pg/ml and[0. 03 (0. 00, 0. 30)]pg/ml, levels of TNF-α were[0. 00 (0. 00, 4. 60)]pg/ml and[0. 00 (0. 00, 6. 77)]pg/ml. When compared with normal control group, the difference in IL-18 was statistically significant (r_s=0. 497, P < 0. 001). CRP and IL-18 were positively correlated (r_s=0. 366, P=0. 010); There was no correlation between the changes of IL-18, IL-1 and TNF-α. But Uric acid and TNF-α were negative correlated (r=-0. 431, P=0. 036) in acute stage. In intermission, IL-18 and IL-1β were negative correlated (r_s=-0. 402, P=0. 046), There was no correlation IL-18, IL-1, TNF-α, CRP with Uric acid. Conclusion The level of IL-18 in the peripheral blood raise significantly in gout patients. IL-18 may participate in the process of chronic inflammatory in gout and relate to the increase of uric acid.

Long chain fatty acids on the fat cells inflammation,endoplasmic reticulum stress and insulin signaling molecules by affecting GPR120

GUO Yifei, LI Xuefeng, LI Min, WANG Nana

2017, 15(9): 1490-1492,1535. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.011

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Objective To examine the role of long chain fatty acids and GPR120 on adipocytes inflammation, endoplasmic reticulum stress and insulin signaling molecules. Methods We cultured 3T3-L1 pre-adipocytes, using 1 μM dexamethasone, 1μg/ml insulin and DMEM medium 10% fetal bovine serum inducted differentiation of 3T3-L1 adipocytes. After 2 h100 Μm PA stimulation, use western blot method to detect GPR120, XBP1 S, PERK, P-PERK, IRE-1α, P-IRE-1α, IKKβ, p-IKKβ, JNK1, P-JNK1, JNK2 and P-JNK2 protein expression levels. Add DMEM medium containing 100 ng/ml insulin, incubate 15 min, and use western blot method to detect IR, P-IR, IRS-1, p-IRS, Akt and P-Akt protein expression levels. Results Under the stimulation of PA, GPR120, XBP1 S, PERK, P-PERK, IRE-1α, P-IRE-1α, IKKβ, p-IKKβ, JNK1, PJNK1, JNK2 and P-JNK2 expression significantly increased (P < 0. 05), IR, P-IR, IRS-1, p-IRS-1, Akt and P-Akt protein levels decreased significantly (P < 0. 05), while using GPR120 LGW9508 blockers can inhibit this process. Conclusion Long chain saturated fatty acids can increase PA GPR120 protein expression, and induce fat endoplasmic reticulum stress response, inflammation and insulin resistance.

Distribution of blood clots in lung and anticoagulation therapy in patients with lower extremity deep vein thrombosis combined acute pulmonary embolism

GUO Zhiyu, LU Lei, ZHANG Hao

2017, 15(9): 1493-1495,1585. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.012

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Objective To study the distribution of blood clots in lungs in patients with lower extremity deep vein thrombosis combined acute pulmonary embolism, and explore the clinical effect of small dose urokinase thrombolysis. Methods A total of 80 cases of lower extremity deep vein thrombosis combined acute pulmonary embolism in our hospital between January, 2014 and January, 2016 were enrolled and randomly divided into observation group (40 cases) and control group (40 cases). The control group received anticoagulation with warfarin following by heparin therapy, while the observation group received additional small dose of urokinase thrombolysis treatment. The blood clots distribution in lung, laboratory test results and effective index for lower limb thrombus were compared before and after the treatment. The relief of clinical symptoms was observed at d₅ and d₁₄. Results Thrombosis in 3 branches of pulmonary artery was common, following by 2 branches of pulmonary artery, there was no significant difference between the two groups (P > 0. 05). After 5 days treatment, the remission rate of chest pain and dyspnea in the observation group was significantly higher than that in the control group, the difference was statistical significant (P < 0. 05). Two weeks after the treatment, the remission rate of chest pain and dyspnea in the observation group was similar with the control group, the difference was not statistical significant (P >0. 05); the remission rate of cough response in the observation group was significantly higher than that in the control group, the difference was statistical significant (P < 0. 05). There was significant difference in the level of D-Dimer (P <0. 05), but not in the levels of PLT, INR and NT-pro BNP (P > 0. 05), between the two groups. The effective rate for lower extremities thrombosis treatment was 34. 98% in the control group and 67. 87% in the observation group, the difference between the two groups was statistical significant (P < 0. 05). Conclusion Thrombosis can occur in 3 (most common) or 2 branches of pulmonary artery in patients with lower extremity deep vein thrombosis combined acute pulmonary embolism. The small dose of urokinase thrombolysis combined with anticoagulant therapy can effectively relieve chest pain and dyspnea in a short time as compared with anticoagulant therapy along, thrombolysis is obviously without increasing the long-term risk of bleeding. It is a highly efficient and reliable therapeutic method.

Clinical effect of irinotecan combined tegafur-gimeracil-oteracil potassium capsule on advanced gastric cancer

CHEN Xin, GU Kangsheng, LI Min

2017, 15(9): 1496-1498. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.013

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Objective Chemotherapy is the main treatment for advanced gastric cancer, and there is no universally accepted standard chemo-therapy for advanced gastric cancer. The purpose of this study is to observe the effects and adverse reactions of irinotecan combined with tegafur-gimeracil-oteracil potassium capsule (S-1) in the treatment of advanced gastric cancer. Methods Total 24 patients with advanced gastric cancer who meet the entry criteria in the First Affiliated of Anhui Medical University from May, 2013 to May, 2016 were enrolled into this study. The chemotherapy regiment was Irinotecan intravenous drip combined with oral S-1; two or more cycles of chemotherapy were conducted. All patients were expected to four to six cycles of treatment and the effect of chemotherapy was evaluated every two cycles. The efficacy and adverse effects were evaluated. The efficacy of therapy was evaluated according to RECIST, and toxicity effects. SPSS 13. 0software was used for statistical analysis. The analysis of therapy was conducted by using the χ² testing. Results All 24 patients were evaluable, 1 patient reached complete response, 7 patients with partial response, 7 patients with stable disease. The overall response rate was 33. 3%, and the disease control rate was 62. 4%. The major adverse effects were nausea and vomiting, myelosuppression and delayed diarrhea. Most adverse reactions were type Ⅰ/Ⅱ, as type Ⅲ/Ⅳ ere reduction of white blood cells (12. 5%), neutrophil (16. 7%), platelet hemoglobin and Late-onset diarrhea. Conclusion Irinotecan combined with S-1 shows good efficacy and disease control rate in treatment of advanced gastric cancer. Adverse reactions of this treatment are tolerable, and the way of drug delivery is more convenient. It is worthy of further application.

The influence of anal fistula resection of anal fistula on anal function and serum IL-4,IL-6 and IL-10 levels of patients

WANG Yongjie, LIN Xiangtao, ZHU Wangyu

2017, 15(9): 1499-1502. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.014

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Objective To investigate the influence of anal fistula resection of anal fistula on anal function and serum IL-4, IL-6 and IL-10 levels of patients. Methods Fifty-eight cases of anal fistula in anorectal department of our hospital from May, 2011 to October, 2016 were collected, and randomly divided into experimental group and control group, 29 cases in each group. The control group was given conventional incision and thread drawing therapy. The experimental group was given anal fistula resection. After the end of surgery, 2 groups of patients, maintain defecate unobstructed, appropriately laxative, the experimental group used antibiotic intravenous infusion of nutrient solution (< 72 h), and control the defecation 3 days. Postoperative 7 stitches. The control group 3-4 day tight line 1 times, 11-15 day rubber band to fall off, hang float line 9-12 day to remove the line. Two groups of patients after defecate daily to be "hemorroid lotion"treatment. After the end of treatment and follow-up according to the results, compare the clinical efficacy, anus pain score, anus function score, serum levels of inflammatory factors, the incidence of recurrence and adverse reactions. Results After treatment, compared with before treatment, 2 groups of VAS, FISI were decreased (P < 0. 05), IL-4, IL-6 and IL-10 decreased after treatment; compared with the control group, the total effective rate of treatment group was higher (P < 0. 05), VAS, FISI score was lower (P < 0. 05), RRP, ARP, AMCP level is low, higher ALCT (P < 0. 05), IL-4, IL-6 and IL-10 were lower (P < 0. 05) in 2 group the recurrence rate and the incidence of adverse events were compared, the difference was not statistically significant (P > 0. 05). Conclusion The clinical efficacy of anal fistula resection in patients with anal fistula is significant, can improve the anal function, reduce serum IL-4, IL-6 and IL-10 levels, is high safety.

Serum IL-6 as the important biomarker in disease evaluation of polymyositis

ZOU Yuqiong, JIN Weidong, LI Yasong

2017, 15(9): 1503-1505. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.015

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Objective To detect the serum concentrations of interleukin-6 (IL-6) in patients with polymyositis (PM), and to explore its clinical relationships in order to investigate the pathogenesis and treatment of PM. Methods Thirty-six patients with polymyositis were enrolled from April, 2010 to January, 2014 in our study. Serum IL-6 and TNF-α were detected using a commercially available EILSA. The statistical differences between groups were evaluated by the analysis of variance (ANOVA). The Spearman's correlation test was used to evaluate the relationship of IL-6 and clinical and laboratory data. Results Serum IL-6 concentrations were (19. 67 ±7. 16) pg/ml in active PM patients, and (15. 81 ±4. 00) pg/ml in remission, which were significantly higher than those of controls[(8. 14 ±3. 71) pg/ml, P < 0. 001]. Furthermore, IL-6 concentrations in active PM patients were significantly higher than those in remission (P=0. 043). TNF-αconcentrations were (114. 44 ±36. 04) pg/ml in active PM patients, and (97. 65 ±30. 78) pg/ml in remission, which were significantly higher than those of controls[(55. 43 ±22. 83) pg/ml, P < 0. 001]. However, there was no significant deference between PM patients in active phase and in remission. The serum IL-6 levels were positively correlated TNF-α (r=0. 709, P=0. 000), and negatively correlated with current glucocorticoid dose (r=-0. 573, P=0. 000). Conclusion IL-6 could be used as a marker of hormone dosage when evaluating and treating PM disease.

Clinical research of acupuncture therapy of Tong Du Tiao Shen for regulating mentality in post stroke aphasia patients

ZHOU Liang, YANG Ting, TIAN Liang, TIAN Zhihui, YE Xiangming

2017, 15(9): 1506-1508,1552. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.016

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Objective To observe attention network system and therapy effect of acupuncture therapy of Tong Du Tiao Shen for regulating mentality in post stroke aphasia patients. Methods Twenty cases of post stroke aphasia patients from June, 2014 to December, 2015 were randomly divided into treatment group (10 cases) and control group (10 cases). The treatment group accepted acupuncture therapy of Tong Du Tiao Shen for regulating mentality, and the control group accepted routine acupuncture therapy. hey were assessed with attention network test (ANT) and Western aphasia battery (WAB) before and 4 weeks after intervention. Results After 4 weeks, the alerting network efficiency and accuracy of ANT increased and the executive network efficiency and total reaction time of ANT decreased significantly in treatment group (P < 0. 05), and the score of aphasia quotient (AQ) increased significantly in both treatment group and control group (P < 0. 05). The alerting network efficiency, executive network efficiency, total reaction time and accuracy of ANT (P <0. 01) and the score of AQ (P < 0. 05) improved more in the treatment group than in the control group. Conclusion Acupuncture therapy of Tong Du Tiao Shen for regulating mentality is more effective on alerting network and executive network of attention network system than routine acupuncture therapy, which could promote the recovery of language function in post stroke aphasia patients.

Short term efficacy of transcatheter arterial chemoembolization of patients with mid-late stage liver cancer

LIU Jie, QIU Guangping, TU Chaoyong

2017, 15(9): 1509-1511,1538. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.017

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Objective To observe the short-term efficacy of transcatheter arterial chemoembolization (TACE) in the treatment of mid-late stage hepatocellular carcinoma (HCC). Methods Total 53 patients with mid-late stage primary liver carcinoma in the Second Hospital of Ningbo from October, 2011 to October, 2013 were selected as the research objects, according to the tumor size, they were assigned into small HCC group (less than 5 cm) and large HCC group (diameter > 5cm). All patients were treated with transcatheter arterial chemoembolization by percutaneous femoral artery puncture, the intubation inserted into the hepatic artery or right hepatic artery injection, cisplatin + fluorouracil and mitomycin + 5-FU, interval of one month before reperfusion, repeated 3-4 times. The improvement of symptoms and the effect of treatment before and after the intervention were evaluated. Results After the treatment, the appetite was improved in 30 cases, abdominal pain improved in 28 cases, weight gain in 23 cases, especially in the small HCC group, there was significant difference between the two groups (P < 0. 05); AFP decreased in 23 cases, most in small HCC group AFP (P < 0. 05); after the treatment, among 53 patients, there were 36 cases of CR + PR (67. 9%), especially in the small HCC group (83. 3%, P < 0. 05); When compared with that before the treatment, ALT and AST in 53 patients were significantly improved (P < 0. 05), the levels of ALT, AST and TBIL in large HCC group were higher than those of small HCC group (P <0. 05); Among the 53 patients, the 1-, 2-and 3-year survival rates were 60. 4%, 47. 2% and 24. 5%, respectively, the 1-and 2-year survival rates in the small HCC group was higher than that of large HCC group (P < 0. 05), however, there was no significant difference in the 3-year survival rate between the two groups (P > 0. 05). Karnofsky score in the small HCC group was higher than that of large HCC group (P < 0. 05). Conclusion The transcatheter arterial chemoembolization in the treatment of mid-late stage liver cancer can effectively improve the short-term efficacy, and the outcome is related with tumor size.

The relationship between UA and Hcy,T cell subset and blood lipid in patients with acute coronary syndrome

WANG Pinxiao, ZHANG Yunxia, XIANG Xiaojue, YE Haihao

2017, 15(9): 1512-1514. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.018

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Objective Acute coronary syndrome belong to clinical common acute cardiovascular disease that is leading causes of deaths. In order to provide a basis for clinical treatment, we investigate the relationship between UA and Hcy, T cell subset and blood lipid in patients with acute coronary syndrome. Methods A total of 84 patients with acute coronary syndrome were divided into UAP group (40 cases) and AMI group (44 cases) from April, 2015 to October, 2016, and 40 healthy subjects were selected as control group. UA, Hcy, T cell subset and blood lipid were determined and compared in3 groups, and to investigate the relationship between UA and Hcy, T cell subset and blood lipid in patients with acute coronary syndrome. Results UA and Hcy of UAP and AMI group were significantly higher than those in control group (P <0. 05), and UA and Hcy of AMI group increased more significantly (P < 0. 05); CD4⁺CD25⁺ Treg and CD4⁺CD25^high Treg of UAP and AMI group were significantly lower than those in control group (P < 0. 05), and CD4⁺CD25⁺ Treg and CD4⁺CD25 ^highTreg of AMI group decreased more significantly (P < 0. 05); TC、TG、LDL of UAP and AMI group were significantly higher than those in control group (P < 0. 05), HDL of UAP and AMI group were significantly lower than those in control group (P < 0. 05), and there was no significant difference between UAP and AMI group (P > 0. 05); Correlation analysis showed that UA positively correlated with Hcy, TC, TG and LDL in patients with acute coronary syndrome (P <0. 05), UA negatively correlated with HDL in patients with acute coronary syndrome (P < 0. 05). Conclusion Acute coronary syndrome patients with UA, unusually high Hcy levels, immune function decline, lipid metabolic disorder, and the UA levels associated with Hcy and lipid levels.

Short term efficacy and safety of laparoscopic and open rectal cancer surgery

CHEN Ce, WANG Rongyin, DING Desheng

2017, 15(9): 1515-1517. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.019

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Objective To compare the efficacy and safety of laparoscopic and open rectal cancer surgery in the treatment of rectal cancer. Methods Total 60 cases of rectal cancer in our hospital between May, 2009 and December, 2016 were enrolled and divided into conventional open surgery group (group A) and laparoscopic group (group B) according to the operation mode with 30 cases in each group. The conventional open resection was performed in the group A, while laparoscopic resection was performed in the group B. The intraoperative conditions, time to first flatus, duration of indwelling urinary catheter, and the incidence of postoperative complications were documented; The patients was followed to observe the five-year survival rate. Results The duration of hospital stays in group B was shorter than that in group A, while the time to ambulation, time to first flatus, duration of indwelling urinary catheter, and postoperative time to feeding liquid diets in group A were all shorter than in group B. The surgical incision in group B was smaller than that in the group A, and the pain score in group B was lower than that in group A. However, the hospital expenses and operation duration in group B excessed those in group A. There was significant difference in the short term efficacy between the two groups (P < 0. 05).The incidence of complication was 33. 33% in the group A and 10. 00% in the group B, the difference was significant (P < 0. 05). Conclusion The therapeutic effects of laparoscopic rectal cancer surgery for rectal cancer was remarkable, with a better short-term outcome, higher radical rate, less operation time, quick postoperative recovery, early postoperative ambulation, lower incidence of complications and higher safety.

Short-term effect of modified proximal femoral nailing antirotation intramedullary fixation for osteoporotic intertrochanteric fractures in elderly patients

LIU Jianfeng, WANG Chunxi, CHEN Xiaolei

2017, 15(9): 1518-1520,1638. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.020

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Objective To explore the effect of modified proximal femoral nailing antirotation (PFNA) intramedullary fixation for osteoporotic intertrochanteric fractures in elderly patients. Methods Eighty-four cases of senile osteoporotic intertrochanteric fractures in our hospital between June, 2014 and December, 2014 were enrolled and assigned into study group and control group according to the document order, with 42 cases in each group. The control group was treated with conventional proximal femoral nailing antirotation intramedullary fixation, while the study group with modified proximal femoral nailing antirotation intramedullary fixation, and all patients were followed up for 10 months. The operation, hip function, incidence of complications, the activities of daily living (Barthel Index score) and hip function score (Harris score) at admission and during the follow-up were compared between the two groups. Results The operation duration, intraoperative blood loss, time to postoperative ambulation, and time for fracture healing in the study group were less than those in the control group (P < 0. 05). There was no significant difference in BI score and Harris score between the two groups before the surgery (P > 0. 05). BI scores and Harris scores of both groups were higher than those before the operation (P <0. 05), and the BI scores and Harris scores of the study group were higher than those of the control group (P < 0. 05). The excellent and good rate of hip joint function in the study group was 92. 86% (39/42), which was higher than that in the control group (71. 43%, 30/42), P < 0. 05. The incidence of complication in the study group was 9. 52% (4/42), which was lower than that in the control group (28. 57%, 12/42), P < 0. 05. Conclusion The effect of modified proximal femoral nailing antirotation intramedullary fixation for osteoporotic intertrochanteric fractures in elderly patients is significant, it can reduce the operation duration, blood loss and rehabilitation time, improve hip function and activities of daily living, with high security.

The cerebral protection effect of parecoxib sodium in elderly patients with colon and rectum carcinoma operation

PAN Chongqin, QIAN Xiangdong, WANG Zhiguang, ZHU Lina, JIN Haifei, LEI Long

2017, 15(9): 1521-1523. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.021

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Objective To observe cerebral protection effect of parecoxib sodium in elderly patients with colon and rectum carcinoma operation. Methods Seventy-two cases of elderly patients with colorectal cancer surgery included in the study were randomly divided into 2 groups, 36 cases in each group. The observation group and control group were respectively accepted intravenous injection of parecoxib sodium of 0. 6 mg/kg before induction, normal saline after intravenous injection of 0. 3 mg Thorning, 0. 05 mg/kg midazolam, fentanyl 3 g/kg, 1-1. 5 mg/kg 0. 15 mg/kg propofol, CIS atracurium besylate for induction of anesthesia, intraoperative infusion 4-8 mg/(kg·h) propofol and intermittent intravenous fentanyl 0. 05 mg, 5 mg cis-atracurium to maintain BIS in 40-60. Two groups were recorded after the burglary, after induction of surgical 1 h after tracheal intubation, the end of surgery, hemodynamic indexes; and after the burglary, the end of surgery, postoperative 12 h, postoperative 24 h, postoperative 48 h venous blood serum S100 protein, neuron specific enolase (NSE) levels were statistically analyzed; the incidence of adverse reactions were compared between the two groups. Results The T₂, T₃ time MAP and HR level in the observation group were lower than the control group (P < 0. 05), T₂, T₃ time MAP and HR were lower than those of T₀ (P < 0. 05), the observation group was more stable hemodynamics; the observation group was given parecoxib sodium, T₁, T₂, T₃, T₄, serum S100 beta protein level of NSE were lower than the control group (P < 0. 05); and the 2 groups of T₁, T₂, T₃, T₄, serum S100 protein, NSE levels were higher than the level of T₀ (P < 0. 05). Two groups of patients with adverse reaction rate difference was significant (P > 0. 05). Conclusion For elderly colorectal cancer root treatment of patients, Pparecoxib sodium can stable blood flow dynamics, and the brain protection effect is good, safe in clinical application.

Clinical efficacy of Hongdoushan capsule combined with chemotherapy on the levels of TSGF,Cyfra21-1,CA125 and CEA for elderly patients with non small cell lung cancer

LI Jia, YANG Shaoyu, JIN Er, WANG Xiaonan, GAO Yue

2017, 15(9): 1524-1526. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.022

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Objective To study the clinical efficacy of Hongdoushan capsule combined with chemotherapy on the levels of TSGF, Cyfra21-1, CA125 and CEA for elderly patients with non small cell lung cancer. Methods Eighty-four elderly patients with non small cell lung cancer from our hospital were randomly divided into observation group and control group, 42 cases in each group. The control group was treated with GP chemotherapy, while the observation group was treated with Hongdoushan capsule on the base of control group. The effects were observed after the treatment in the two groups. The adverse reactions during the treatment were observed. Before and after treatment, the levels of TSGF, Cyfra21-1, CA125 and CEA in the two groups were detected. Results The total effective rate of the observation group was 83. 33%, which was significantly higher than that of the control group (P < 0. 05). The incidence of adverse reactions in the observation group was lower than that in the control group (P < 0. 05). After treatment, the observation group TSGF, Cyfra21-1, content of CA125 and CEA were (49. 76 ±4. 39) U/ml, (0. 36 ±0. 03) ng/ml, (16. 88 ±1. 38) U/ml and (1. 63 ±0. 36) g/L, were significantly lower than the control group (P < 0. 05). Conclusion Hongdoushan capsule combined with chemotherapy on elderly patients with non small cell lung cancer can improve the clinical efficacy and promote the levels of TSGF, Cyfra21-1, CA125 and CEA of the patients, worth to the next study.

Effect of tripterygium wilfordii polyglycoside combined telmisartan on renal function and hemorheology in patients with diabetic nephropathy

TU Chuanfa, WANG Lijun, GU Lingjia, TAO Haiying

2017, 15(9): 1527-1528,1595. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.023

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Objective To investigate the effect of tripterygium wilfordii polyglycosides combined telmisartan on renal function and hemorheology in patients with diabetic nephropathy. Methods Two hundred and sixteen cases of diabetic nephropathy were randomly divided into two groups, with 108 cases in each group. The patients in the control group received telmisartan, while the patients in the observation group received additional tripterygium wilfordii polyglycosides. Before and after the treatment, the renal function indicators (Urine β2-MG, UAER, UP and GFR), blood biochemical indicators (WBC, Scr, Bun, Hb A1c), hemorheology (PV, PF, HBV, LBV) of both groups were detected. And the total effective rate of two groups were accounted. Results After the treatment, β2-MG, UAER, UP and GFR levels of both groups were significantly improved (P < 0. 05), and the β2-MG, UAER, UP and GFR improvements of the observation group were significantly better than those of the control group (P < 0. 05). After the treatment, WBC, Scr, Bun and Hb A1 c levels of both groups were significantly improved (P < 0. 05), and the WBC, Scr, Bun and Hb A1 c improvements of the observation group were significantly better than those of the control group (P < 0. 05). After the treatment, PV, PF, HBV and LBV levels of both groups were significantly improved (P < 0. 05), and the PV, PF, HBV and LBV improvements of the observation group were significantly better 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 control group (79. 6%, P < 0. 05). Conclusion Tripterygium wilfordii polyglycoside combined with telmisartan could effectively improve the renal function and hemorheology of patients with diabetic nephropathy, with satisfactory effect.

Effect of health education based on the model of behavioral change theory on quality management of pregnant women and pregnancy outcome

HANG Xiaoping, WU Mei, YAN Jumei, ZHAO Min

2017, 15(9): 1529-1531,1615. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.024

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Objective To explore the effect of health education based on the model of behavioral change theory on the quality management and pregnancy outcome of pregnant women. Methods Eighty-four cases of pregnant women who were treated in our hospital from August, 2012 to July, 2015 were randomly divided into study group and control group, 42 cases in each group. The control group carried out routine nursing intervention, while the research group introduced the health education based on the model of behavioral change theory on the basis of the control group. Two groups of pregnant women before and after intervention were recorded in the tenth week for the specific behavior of the transition phase, comparing pregnancy outcome and body quality control between the two groups. Results In the study group, the qualified rate of body mass during the pregnancy was 78. 6% (33/42), higher than the control group which is 50. 0% (21/42), and the difference was statistically significant (P < 0. 05). There was no significant difference between the two groups before and after intervention (P > 0. 05); the proportion of pregnant women in the period of operation and maintenance period was23. 8% (10/42) and 31% (13/42), respectively, 14. 3% (6/42) and 11. 9% (5/42), thus the difference was statistically significant (P < 0. 05). The natural labor rate and normal children in the study group were significantly higher than those in the control group, and the difference was statistically significant (P < 0. 05), and the rate of cesarean section and the rate of birth rate were significantly lower than those in the control group, and the difference was statistically significant (P < 0. 05). Conclusion Applying health education strategy based on behavioral change theory to pregnant women can help to establish correct and healthy behavior, and can improve the qualified rate of body mass of pregnant women, and can improve the pregnancy outcome.

Clinical features and prognosis analysis of posttraumatic infarction in the basal ganglia in children

MA Xiuwei, GU Ruijie, HOU Yu, FENG Zhichun

2017, 15(9): 1532-1535. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.025

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Objective To explore the clinical and imaging features of posttraumatic infarction in the basal ganglia in children for improving the level of diagnosis and treatment. Methods The clinical and imaging data of 19 cases of posttraumatic infarction in the basal ganglia in our department between August, 2010 and August, 2015 were retrospectively analyzed and the follow-up was carried to evaluate the outcome. Results Among the patients, 11 were male and 8 were female. The onset age ranged from 6 months to 5 years, and 15 cases (78. 9%) were under 3 years. All patients had preceding mild head trauma. Eight cases (42. 1%) fell from bed and 6 cases (31. 6%) tumbled. Three patients (10. 5%) were hit and 2 patients were crashed. Hemiplegia occurred in all the patients. It happened in 24 hours after trauma in 7 cases (36. 8%), 24 to 48 hours in 8 cases (42. 1%), and 48 hours to 7 days in 4 cases (21. 1%). Eleven cases showed left hemiplegia and 8 cases presented right hemiplegia. Strength ranged from 0 to 2 level in 7 cases, and 2 + To 4 level in 12 cases. The accompanying symptoms involved restlessness in 7 cases, vomiting in 5 cases, alalia in 4 cases, and convulsion in 2 cases. The cranial MRI in all patients showed long T1 and long T2 signal, Fl AIR high signal, DWI obviously high signal in the basal ganglia. There were no placeholder effects. All the patients got the medicine treatment and rehabilitation training. Ten patients were hospitalized for 2 weeks and 9 for 3 weeks. Eleven patients presented normal strength when leaving hospital. Seventeen patients were followed up for 6 months to 5 years who showed normal in nervous system examination. Thirteen cases under the age of 6 years showed critical to normal by Gesell development evaluation. Conclusion Posttraumatic infarction in the basal ganglia mainly occurs in infants and young children. The cause of the head injury is usually mild. Hemiplegia is the primary symptom and the strength varies obviously. Cranial MRI plays an important role in the early identification of the lesions. Most patients have favorable prognosis with the early diagnosis and treatment.

The status and influencing factors of hypertension control under the family doctor system

SUN Lan, YE Weimin, YI Qiang, ZHAO Huilan, LIU Shuai

2017, 15(9): 1536-1538. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.026

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Objective To understand the status and influencing factors of hypertension control in H community in Minhang District, Shanghai, and to provide scientific basis for further improvement of community hypertension management under the family doctor system. Methods With the cluster sampling method, 5 558 cases of hypertension patients from managed for 1 years by 29 family doctors in H community in Shanghai were selected to get questionnaire survey, physical examination and blood biochemical tests to determine whether blood pressure were under control, and to analyze the influencing factors. Results There were 56. 37% of patients whose blood pressure were under control. Single factor Logistic regression analysis showed that gender, hypertension, hypertension management, BMI index, HDL-C for blood pressure control were the main impact factors; and unconditional Logistic regression analysis showed that gender, years of management, and BMI were the main factors for patients in our community to control blood pressure. Female patients could control blood pressure better than male (OR=0. 853, 95% CI:0. 765-0. 951); time management under the age of 5 years control was better than that over 5 years (OR=1. 274, 95% CI:1. 134-1. 431), BMI index of too light or standard control better than the overweight and obesity (OR_{too light})=1. 918, 95% CI _{too light}):1. 080-3. 406; OR_standard=1. 278, 95% CI_标准:1. 070-1. 528). Conclusion Community hypertension management in the family doctor system has certain impacts, and the community hypertension prevention work should pay more attention to the male, obesity or overweight in long term management.

The effect of multiple factors on depression in patients with acute cerebral infarction

ZHENG Lifeng, YANG Kairen, LAN Zhiyong, MAO Zhifang

2017, 15(9): 1539-1541. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.027

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Abstract:
Objective To explore the effects of multiple factors on depression in patients with acute cerebral infarction. Methods A total of 352 cases of acute cerebral infarction in our hospital from January, 2014 to January, 2015 were selected and divided by gender into control and experimental group. Male patients are in the control group, and the experimental group consists of female patients. The degree of anxiety and depression mental status after the two groups of patients learned their disease (one/three month later) was evaluated by self-rating depression scale (SDS); some factors leading to depression was analyzed with single factor analysis and multivariate analysis the effect of gender on depression in patients with acute cerebral infarction was analyzed with reference to the results of single factor and multiple factors analyses. Results In one month and three months after the patients learned their disease, the SDS score of the experimental group was significantly higher than that of the control group:SDS scores of patients in the experimental group was (81. 86 ±4. 45); SDS score was (58. 48 ±4. 38). Data show that women with anxiety and depression situation is more severe than men and the two groups had statistical significance (P < 0. 05); the survey found that for the incidence of depression in patients with cerebral infarction, there is no difference in the age of the patients (P > 0. 05). Degree of education, marital status and other data have statistical significance (P < 0. 05). That except for age, economic sources, degree of culture factors may lead to the occurrence of depressive disorder in patients with acute cerebral infarction; regression analysis of depression in patients with cerebral infarction incidence found that educational level, marital status, sleep quality, physical exercise and social support are main factors for patients with depressive disorder (P < 0. 05). Conclusion The incidence of depression in women with acute cerebral infarction was greater than that of men, and the main factors were educational level, marital status, hobbies, sleep quality, physical exercise and social support for patients with depression.

Analysis on the medical students' professional identity status quo

WU Qi, ZHOU Jun, HUANG Xiangjin, HUANG Min, FANG Yanjun

2017, 15(9): 1542-1545. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.028

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Objective By empirical research of the professional identity of medical students, we aim to understand the status and influencing factors, thus to provide a basis for improvement of medical students' professional identity. Methods According to literature and interviews, we made a questionnaire about' the research on professional identity of medical students', including five dimensions, i. e. vocational condition, vocational value, vocational cognition, vocational emotion and vocational behavior. We surveyed clinical medical students in Medical College of Shantou University by cluster and simple randomization method and did single factor t-test, independent sample t-test and multiple factors t test to the survey results via SPSS 20. 0. Results The professional identity of medical students in Medical College of Shantou University in a whole scoring above 3 accounts for 96%, with vocational value having the highest level, while vocational behavior and condition having relatively lower levels. Students majoring in medical by their own wills have higher professional identity in all dimensions; student cadres have higher professional identity in vocational value, emotion and behavior, with statistical significance (P < 0. 05). Conclusion Medical students' professional identity as a whole remained in the medium level.The current professional environment interfered with medical students' professional identity, and professional behavior choice was negative; with the deepening of professional learning, professional identity was decreased; organization ability strengthened medical students' professional identity. Vocational condition, interest in medicine, consciousness of responsibility and service as well as spirit of dedication are factors that influence the professional identity of medical students. The government should strengthen the supervision, and schools should strengthen guidance, thus to enhance the students' professional identity, and to increase the confidence of the students.

Clinical value of inflammatory cytokine detection in predicting and staging of primary liver cancer patients

TANG Yuxia, JIN Huiying, XIA Yuhong, ZHONG Jihong

2017, 15(9): 1546-1548,1622. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.029

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Objective To study the clinical value of IL-1β, IL-17 A, IL-27, IFN-γ, TNF-α detection in predicting and staging of primary liver cancer patients. Methods Ninety-six primary liver cancer patients (stage Ⅰ and Ⅱ 35 cases, stage Ⅲ 29 cases, stage Ⅳ 32 cases) were selected as research subjects from August, 2012 to December, 2015. Thirty-five cases of normal healthy people were chosen to be as the control group. The serum IL-1β, IL-12p70, IL-17 A, IL-22, IL-23, IL-27, IL-2, IL-4, IL-12, IFN-γ level were detected and compared in the liver cancer group and the control group. The ROC curves were used to assess the effect of each cytokines above in predicting the primary liver cancer stages. Results The area under the ROC curve of IL-1β, IL-17 A, IL-27, TNF-α to diagnose primary liver cancer patients were 0. 857, 0. 998, 0. 982, 0. 982. The effect of forecasting the primary liver cancer patients' stage was the best, with the AUC 0. 940, cut-off value 307. 05 pg/ml, the sensitivity 87. 50%, specificity 89. 06%, positive predictive value 83. 56%, negative predictive value 75. 50%, and Youden index 0. 77. Conclusion The levels of IL-1β, IL-4, IL-17 A, IL-27, IFN-γ, TNF-α are significantly different (P < 0. 05) between the primary liver cancer patients and healthy people, and IL-27 has a good future in diagnosing the stage of primary liver cancer patients.

Characteristics of carbapenem-resistance Enterobacteriaceae infection in our hospital and genotypic analysis of carbapenemase genes

DING Hui, WU Daying, JIANG Lili, LI Aifang, LI Guoxiong, ZHAO Zhigang

2017, 15(9): 1549-1552. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.030

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Objective To investigate the characteristics and drug sensitivity of carbapenem-resistance Enterobacteriaceae (CRE) infection in our hospital, and study the genotypic analysis of carbapenemase genes. Methods A total of 140 strains of CRE were collected and the epidemiological date were analyzed. CRE were identified by using VITEK 2-Compact bacterial identification system, the antibiotics-sensitivity were tested by kirby-bauer disk susceptibility test, carbapenemase production was detected by the Modified Hodge Test (MHT), and the carbapenemase genes (KPC, IMP, VIM, NDM, OXA-48) were detected by PCR technology. Results Klebsiella pneumoniae was dominated in all CRE, accounting for 70. 71%, followed by Enterobacter aerogenes (6. 44%) and Enterobacter cloacae (5. 71%). CRE samples were mainly isolated from sputum, accounting for 69. 29%, followed by urine (12. 86%), secretion (4. 29%) and blood (4. 29%). The most of the patients were from ICU, accounting for 44. 29% and followed by neurosurgery (18. 57%) and hematology (5. 00%). The drug sensitivity test showed CRE were high resistant to most of β-lactam antibiotics, the resistant rate was higher than 80%, the resistant rate to minocyline and amikacin were 14. 78% and 35. 43%, respectively.Modified Hodge test showed 127 strains were positive. PCR and gene sequencing showed 99 strains CRE carrying KPC-2, 14 strains carrying IMP-4, 2 strains carrying IMP-1 and 13 strains carrying NDM-1. Conclusion CRE is highly resistant to most antibiotics in our hospital, and the main resistant gene is KPC, followed by IMP and NDM. According to susceptibility test, the hospital should enhance the drug-resistance surveillance and use antibiotics reasonable to control the multi-drug resistance and the prevalence of resistant strains.

The role of reactive oxygen species in platelet storage lesion-induced GPIbα ectodomain shedding

CHEN Xiushan, HU Ping, JIANG Haoqin, CHEN Shuying, HU Lingling, WANG Zhicheng, CAI Feng

2017, 15(9): 1553-1555,1619. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.031

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Objective To investigate the role and the mechanism of reactive oxygen species (ROS) in PSL-induced GP Ibα ectodomain shedding. Methods We took apheresis-derived platelet from healthy volunteers, concussed at 22℃, saved a certain amount of platelets with a sterile tubing machine at 1, 3 and 5 days, respectively. We used flow cytometry to detect cell ROS, mitochondrial membrane potential depolarization, phosphatidylserine (PS) eversion and P-selectin expression. We detected the glycocalicin (GC), a soluble N-terminal fragment of GPIbα that is released during ectodomain shedding. We used western blot to test p38 mitogen-activated protein kinase (MAPK) phosphorylation. Results With the extension of storage time, platelet activation and apoptosis occurred gradually, p38 MAPK phosphorylation gradually increased, the content of GC in plasma gradually increased, ROS antagonist inhibited platelet intracellular ROS, and the phosphorylation of p38 MAPK, the content of plasma GC was reduced. P38 MAPK inhibitor inhibited p38 MAPK phosphorylation and reduced the content of GC in plasma, and did not inhibit ROS concentration. Conclusion ROS plays an important role in the PSL-induced GPIbα ectodomain shedding, and ROS may thereby cause GP Ibα ectodomain shedding by activating p38 MAPK.

Study of resistance-related genes protein expression in lung carcinomas tissue

SU Liqing, FU Xiuhua, SUN Qinnuan, GUO Liping

2017, 15(9): 1556-1558,1628. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.032

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Abstract:
Objective Through detection drug resistance gene expression and development of drug sensitivity to provide clinical personal chemotherapy. Methods We choose 50 lung tumor patients in 2008-2009 from the affiliated hospital of Inner Mongolia medical college. Thirty-two cut off by surgery, 18 from bronchoscopy. MTT assay was employed to determine the drug sensitivity. The expression levels of drug resistance genes were detected by immunohistochemistry. Results (1) The expression rates of MRP1, P-gp, and Topo II genes in the 50 cancer tissues (but 10 tissues were contaminated) were 72. 5% (29/40), 67. 5% (27/40) and 50. 0% (20/40), respectively. The expression rate of MRP1 in the adenocarcinoma, squamous and small-cell lung cancer 76. 2%, 80%, 55. 6%, but the expression rate of P-gp and TopoⅡare 80. 9%, 80%, 22. 2% and 42. 9%, 60. 0%, 55. 6%, respectively. No significant statistical difference was observed in the expression of MRP1, P-gp, and Topo II between human adenocarcinoma and squamous cell carcinoma (P > 0. 05), but a significant statistical difference was found in P-gp expression between human adenocarcinoma or squamous carcinoma cell and small-cell lung cancer (P < 0. 05). (2) A significant positive correlation was noted between MRP1 expression and the development of resistance to cisplatin, gemcitabine and vinorelbine (P < 0. 05), but no significant correlation was observed between MRP1 expression and the development of resistance to paclitaxel and ifosfamide (P > 0. 05); A significant positive correlation was observed between P-gp expression and the development of resistance to the studied drugs, namely, cisplatin, gemcitabine, vinorelbine and paclitaxel (P < 0. 05), however, no significant correlation was found between P-gp expression and the development of resistance to ifosfamide (P > 0. 05); The positive correlation expression of TopoⅡ and the degrees of chemoresistance to the cisplatin, gemcitabine paclitaxel and iphspamide were significant, respectively (P <0. 05), but there is no significant difference in the drug tolerance of vinorelbine (P > 0. 05). Conclusion Lung cancer resistance is the role of many drug resistance gene.

Advances of microcirculatory disturbance in acute pancreatitis

ZHOU Yu, WANG Weixing

2017, 15(9): 1559-1562. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.033

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Acute pancreatitis (AP) is an inflammatory disease of the pancreas, characterized by the activation of various inflammatory factors, followed by local inflammation of pancreas, and some serious patients can occur in systemic inflammatory response syndrome (SIRS). As one of the most common acute and severe diseases in digestive system diseases, AP has been received much attention because of its rapid onset, severe illness, easily complicated with multiple organ dysfunction, and there is an increasing trend in the incidence, causes higher mortality in critically ill patients. However the etiology and pathogenesis of AP has not yet been fully clarified. The traditional view is that there is a close correlation between the pancreas self digestion, the body's excessive inflammatory response, systemic microcirculation disturbance and intestinal flora translocation and the occurrence and development of acute pancreatitis. In recent years, it has gradually become one of the hottest spots to explore its pathogenesis from the point of view of microcirculation disturbance. The changes of microvascular structure and function, blood rheology and release of vasoactive mediators play an important role in the occurrence and development of microcirculatory disturbance in acute pancreatitis. Various factors separately and jointly promote the initiation and progression of the disease. Although acute pancreatitis originated in the pancreas, it can cause multiple organ damage, and the disturbance of microcirculation is the important cause of the injury of the pancreas and the external organs. In this review, the advances of mechanism of microcirculation disturbance in acute pancreatitis and the related microcirculation disturbance of main organs are reviewed in order to provide a basic understanding for the majority of scholars on the microcirculation disturbance in acute pancreatitis related research, then seek the exact mechanism of microcirculation disturbance in acute pancreatitis, to bring the gospel to many of the patients with acute pancreatitis.

The application status of Baduanjin qigong in the nursing field

WU Jiaojiao, MA Hongmei, LIAO Chunxia, JIA Yuling, CHEN Yuan

2017, 15(9): 1563-1566. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.034

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Baduanjin qigong is one of the traditional Chinese exercises, which fitness effect is remarkable, making great development in the field of Chinese medicine. In recent years, the exercise effect of Baduanjin qigong has attracted the attention of nurses, and nurses applied this during nursing. his study discussed and summarized the application status of Baduanjin qigong in the nursing field, containing the application in patients and medical staffs, in order to provide reference for clinical application. On the one hand, Baduanjin qigong applied in the patients is mainly manifested in the following four aspects:firstly, Baduanjin qigong can enhance the overall quality of life and obvious effect quality of sleep for the patients.After doing Baduanjin qigong, patient's scores of quality of life scale improved and sleep quality is also improved. Secondly, this qigong can promote patients' recovery effect, containing those four specific aspects such as the limb rehabilitation, disease rehabilitation, cognitive function and activity function rehabilitation. In addition, Baduanjin qigong can help patients ease the bad feelings such as depression. What's more, this qigong can be used in blood sugar control, prevention of falls and joint pain relief, which effect is also significant. On the other hand, this kind of exercise can be applied in medical staffs, which improve the sub-healthy state of the night nurse, and beneficial medical staffs on the physical and mental health. However, the study about using this exercise in medical staffs is less, which can become the direction of future research. Above all, application of Baduanjin qigong has made significant achievements in the field of nursing, but there are still some shortages. he sample size of most studies is small, which results may be controversial. he object of each study is not identical, and evaluation index is numerous, which is hard to do evidence-based analysis, so it is difficult to evaluate the application effect of Baduanjin qigong systematically, which will become the focus of future research.

Effect of Huoxue Huazhuo capsules on C-reactive protein,platelet aggregation rate and symptom scores in patients with unstable angina

CAO Changxia, ZHANG Hongwu, YANG Ruyi, SUN Zhao, WANG Jun

2017, 15(9): 1567-1569,1631. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.035

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Objective To observe the effect of Huoxue Huazhuo capsule on C-reactive protein (CRP), platelet aggregation rate and symptom scores in patients with unstable angina (UA). Methods Total 60 patients meeting the inclusion criteria of unstable angina were assigned by the random number table into treatment group and control group with 30 cases in each group. All the patients received the basic treatment and intravenous drip 40 mg isosorbide mononitrate once a day, and the treatment group received additional Huoxue Huazhuo capsule 3 pills and 3times once a day. The efficacy indicators were observed after the treatment. Student t-test and Ridit analysis were used to statistical analysis of the data. Results The total effective rate of the treatment group was better than the control group (P < 0. 05), which had statistical significance.ECG:there was no significant difference between the treatment group and the control group (P > 0. 05). There were significant differences between the TCM syndrome scores before and after the treatment (all P < 0. 05). There was a significant difference in CRP between the two groups before and after the treatment (P < 0. 05):the treatment group was superior to the control group (P < 0. 05). There was significant difference in platelet aggregation rate between the two groups before and after the treatment (P < 0. 01):the treatment group was better than the control group (P < 0. 01). Conclusion Huoxue Huazhuo capsule can reduce C-reactive protein, stabilize plaque, improve platelet aggregation rate, prevent thrombosis, strengthen the role of anti-atherosclerosis, prevent from angina pectoris.

Evaluation on QOL of elderly patients with hypertension adopting TCM constitution-based health management

WEI Minqi, ZHOU Rena, WANG Jian, SUN Lan, YAN Jin, LI Yan

2017, 15(9): 1570-1573. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.036

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Abstract:
Objective To evaluate the effect of TCM (Traditional Chinese Medication) constitution-based health management on QOL (quality of life) of elderly patients with hypertension, and to explore the practical health management method for the local elderly patients with hypertension. Methods Through multistage stratified sampling and cluster randomization grouping method, 808 elderly patients with hypertension from three communities of Shanghai from July, 2014 to June, 2015 were included into the study on the basis of informed consent and voluntary participation. Regular health education and standardized community follow-up was conducted in the control group (400 cases), and on the basis of that, an additional one-year intervention of TCM constitution-based health management was conducted in the intervention group (408 cases). And the statistical analysis software was used to analyze the difference of the QOL of the participants between intervention group and control group. Results On either baseline or final survey, no significant difference among the demographic characteristics was found between intervention group and control group. All QOL scores of the control group participants at the final survey were lower than those at the baseline, so was the intervention group. But the decreased range of intervention group was less than that of control group, especially for the scores of overall life quality, psychology and environment domain. Conclusion Either in intervention group or in control group, the QOL scores of the participants tended to decline. TCM constitution-based health management could delay the declining range of QOL of elderly patients with hypertension. Applying the theory and methods of TCM constitution identification to the health management of elderly patients with hypertension, observing and analyzing QOL of patients while preventing and treating disease, and appropriately adjusting patients' psychological, social relations and support factors would be more conducive to control patients' blood pressure and improve their prognosis and quality of life.

Effect of Yiqi Jianpi method combined with probiotics on serum inflammatory factors in patients with inflammatory bowel disease

WANG Hui, HUANG Haitao, LIANG Sanhong, LV Wen

2017, 15(9): 1574-1576. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.037

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Objective To investigate the effect of Yiqi Jianpi method combined with probiotics on serum inflammatory factors in patients with inflammatory bowel disease. Methods A total of 114 cases of inflammatory bowel disease were selected from April, 2015 to September, 2016 in our hospital as the research object. All patients were divided into study group and control group according to the random number table method, with 57 cases in each group. The study group received Yiqi Jianpi method combined with triple viable capsule of bifidobacterium. The control group was treated with triple viable capsule of bifidobacterium. Observe the improvement of clinical symptoms in the two groups, and the TCM symptom score, disease activity (DAI) index, mucosal image score. Before and after treatment, the level of C reactive protein (CRP), tumor necrosis factor A (TNF-α), interleukin 6 (IL-6), interleukin 1 beta (IL-1 beta) were compared between the two groups. Results The efficacy of the study group was significantly better than that of the control group, and the difference was statistically significant (P < 0. 05). After treatment, the TCM symptom score, DAI index, and mucosal image score of the two groups were significantly decreased (P < 0. 05). After treatment, the TCM symptom score, DAI index, mucosal image score in the study group were significantly lower than those in the control group, with statistically significant difference (P < 0. 05). After treatment, CRP, TNF-α, IL-6, IL-1 of the both groups were significantly reduced (P < 0. 05).After treatment, the CRP, TNF-α, IL-6 and IL-1 in the study group were significantly lower than those in the control group and the difference had statistical significance (P < 0. 05). Conclusion Yiqi Jianpi method combined with probiotics can significantly improve the clinical symptoms in patients with inflammatory bowel disease as well as inflammatory reaction.

Practice and experience of two-way evaluation of teaching quality in standardized resident training program in primary hospital

ZHANG Xiaoping, MA Yu

2017, 15(9): 1577-1581. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.038

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Objective To investigate the main problems existing in the standardized resident training and to improve the resident-clinical teacher two-way evaluation system. Methods Two-way evaluation was adopted using two-way appraisal scale to assess the performances of both clinical teachers and residents involving in standardized resident training program from October, 2012 to March, 2016 in a Grade 3 Class B hospital. Results Residents' evaluation on clinical teachers:teachers' dignity of manner or appearance, medical ethics and moral, and being demanding and being concerned about residents gained the highest scores, but the ability of scientific research and academic writing the lowest. Residents' evaluation on the departments' teaching quality:clinical teachers allocation as required and departments' directors' paying much attention to teaching gained the highest scores, but departments orientation training the lowest score. Clinical teachers' evaluation on residents:medical ethics and moral and professional attitudes were on the top of the list, but the clinical skills, analyses and decision making hit the bottom. Conclusion Clinical teachers' teaching ability and methods need further improvement. Cultivation of students' scientific research ability and academic writing skill should be emphasized.Much attention should be paid to the orientation training and residents' clinical skills cultivation. Two-way evaluation system could improve the teaching quality.

Relationship between nutritional status and incidence of nosocomial infection in patients with high risk acute lymphoblastic leukemia

NING Fangying, LAN Jianping, CHEN Yirui, JIE Hongxiang

2017, 15(9): 1582-1585. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.039

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Objective To investigate the relationship between nutritional status and the incidence of nosocomial infection in patients with high risk acute lymphoblastic leukemia. Methods A self-designed questionnaire was used to collect relevant data of 286 cases of high risk patients with acute lymphoblastic leukemia in, Zhejiang Provincial People's Hospital from January, 2013 to June, 2016. Subjective global assessment (PG-SGA) method was used to evaluate the nutritional status of patients with maintenance treatment phase, analysis of the infection rate of correlation between nutritional status and hospital patients. Results Two hundred and eighty-six cases of high-risk acute lymphoblastic leukemia patients do not need nutritional support in 104 cases, the need for nutritional support in 182 cases, including 98 cases of hospital infection, accounting for 34. 27% (98/286) in patients with acute lymphoblastic leukemia; hospital infection rate and nutritional status were negatively correlated (r=-0. 724, P < 0. 01); Univariate analysis showed that significant length of time, the intensity of chemotherapy, hemoglobin, leukocyte count, neutrophils, species, application of antibiotics, antibiotic use time, albumin PG-SGA score difference (P < 0. 05). There was no significant difference in age, sex, glucocorticoid use (P >0. 05). Logistic regression analysis showed that the PG-SGA score, the intensity of chemotherapy, neutrophil count, hemoglobin, albumin, antibiotic use time are the risk factors of nosocomial infection in patients with high-risk acute lymphoblastic leukemia. Conclusion The nutritional status of high risk acute lymphoblastic leukemia patients is closely related to the incidence of nosocomial infection and the nutritional status of the patients is a risk factor for the occurrence of hospital infection.

Functional magnetic resonance imaging for neurological rehabilitation during acute stage after cerebral infarction

QI Li, TANG Yonggang, NIE Rongrong, MO Biwen, JIANG Wei, WEN Hui, LI Fengyan, ZHAI Lijuan, FU Wenbin

2017, 15(9): 1586-1588. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.040

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Objective To observe the effect of neurological rehabilitation on brain tissue remodeling, body function and quality of life of patients during the acute stage after cerebral infarction. Methods Total 72 patients during acute stage after cerebral infarction were randomly divided into observation group and control group. The control group received simple drug therapy (intracranial decompression, antiplatelet aggregation, plaque stabilization, scavenging oxygen free radicals, improving microcirculation and nerve nutrition, maintaining a stable internal environment, etc.); while the observation group received drug therapy and neurological rehabilitation (postural training, passive exercise, roll exercise, bridge exercises, stretching exercise, balance training and walk training, etc.). The course of treatment was 4 weeks. Blood oxygen level dependent functional magnetic resonance imaging (BOLD-f MRI) was used to detect the ADC and FA values, the activation area and the size of the cerebral cortex in the two groups after the treatment, to evaluate objectively the changes of brain tissue remodeling. At the same time, The Fugl-Meyer Assessment of Motor Recovery after Stroke and Nottingham Health Profile (NHP) were used to evaluate the clinical efficacy. Results After the treatment, f MRI indicated that ADC and FA values in the observation group were increased significantly as compared with those in the control group, the difference was statistically significant (P < 0. 05). The increase of the activation area and the size of the cerebral cortex in the observation group was greater than that in the control group, the difference was statistically significant (P < 0. 05). The clinical effects were compared between the two groups through Fugl-Meyer Assessment of Motor Recovery after Stroke and Nottingham Health Profile (NHP), the difference was statistically significant (P < 0. 05). Conclusion The neurological rehabilitation during the acute stage after cerebral infarction can further improve the brain function of patients. The functional magnetic resonance imaging can give a quantitative, sensitive and accurate evaluation on the clinical efficacy.

Correlation factor analysis of nutritional status for esophageal cancer patients receiving chemoradiotherapy

SHAO Qiuyue, XIE Shuping, SHEN Jiaqin, WANG Jin

2017, 15(9): 1589-1591,1608. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.041

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Objective To explore the related factors of the increasing nutritional risk in esophageal cancer patients receiving chemoradiotherapy by means of nutrition assessment, facilitating the timely nutrition monitoring and intervention, and providing scientific basis for individualized nutritional support. Methods Between July, 2014 and July, 2015, 97 patients with esophageal cancer who were screened for nutritional risk were selected as the subjects. We used the European nutritional risk screening tool (NRS-2002) to screen nutrition risk of patients at admission and during the first to sixth week of radiotherapy, and then analyzed their correlation, as well as evaluating the nutritional status of those patients. Results Twenty-seven percent of the subjects had nutritional risk before chemoradiotherapy. This risk was gradually increased during chemoradiotherapy, reaching 44. 8% at the sixth week. For patients whose NRS-2002 score was ≤ 3 point and ≥ 4point at admission, 1 year overall survival rate was 91. 1% and 61. 9% respectively (P=0. 010). For patients whose highest NRS-2002 score was ≤ 2 point and ≥ 3 point during treatment, 1 year overall survival rate was 94. 2% and77. 5% respectively (P=0. 012). For patients whose lowest NRS-2002 score was ≤ 3 point and ≥ 4 point during treatment, 1 year overall survival rate was 93% and 55% respectively (P=0. 009). The NRS-2002 score at admission and the first week of radiotherapy was associated with the pre-albumin level (P=0. 000, 0. 002). The NRS-2002 score was associated with albumin at the third week of radiotherapy (P=0. 036). Conclusion Esophageal cancer patients who receive chemoradiotherapy have higher nutritional risk, influencing the treatment process and effect. Therefore, timely and effective nutrition assessment and intervention is very important.

Experimental study on the treatment of cerebral infarction rabbits by ultrasound mediated targeted micro bubbles

SUN Quan, GAO Feng, CHENG Zhengcai, CHEN Tingting, YU Da

2017, 15(9): 1592-1595. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.042

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Objective To investigate effect of animal experiment by ultrasound combined targeted microbubbles[homemade, consist of contrast medium (fluorocarbon), vascular endothelial growth factor₁₆₅ complementary deoxyribose nucleic acid (VEGF₁₆₅ c DNA), anti-intercellular adhesion molecule (ICAM-1) monoclonal antibody]mediated therapy for cerebral infarction, and to observe effect by VEGF₁₆₅ c DNA gene transfection for improving damaged endangium. Methods A total of 60 New Zealand white rabbits were taken into high fat dietingcerebral infarction model, and randomly divided into three groups. They respectively received ultrasound combined targeted microbubbles (group A), actilyse (group B), and normal saline (control gorup) for treatment. Revascularization, neutrophil infiltration in infarction necrotic zone, and infarction area quality proportion were observed in each group. Results After treatment, groups A and B had better revascularization condition than control group (P < 0. 05), while there was no statistically significant difference of revascularization condition between groups A and B (P > 0. 05). Group A had obviously less average neutrophil count in infarction necrotic zone than group B after treatment (P < 0. 05), but the difference of average neutrophil count in infarction necrotic zone had no statistical significance between group B and control group (P > 0. 05). Infarction area quality proportion after treatment was much lower in group A than in group B (P < 0. 05), and that in group B was also lower than that in control group (P <0. 05). Conclusion Ultrasound combined targeted microbubbles mediated provides precise effect in adjuvant therapy for VEGF₁₆₅ c DNA gene transfection in animal experiment of cerebral infarction. This method can remarkably improve revascularization, decrease inflammatory reaction in infarction area, neutrophil infiltration and infarction area quality proportion.It is beneficial for cerebral infarction treatment.

Effect of pretreatment with parecoxib sodium on emergence agitation during recovery from anesthesia in elderly patients undergoing radical resection of rectal cancer

PANG Xiyou

2017, 15(9): 1596-1598. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.043

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Objective To investigate the effect of pretreatment with parecoxib sodium on emergence agitation during recovery from anesthesia in elderly patients undergoing radical resection of rectal cancer. Methods Seventy-two elderly patients undergoing radical resection of rectal cancer in Jinhua Central Hospital from January, 2014 to October, 2016 were randomly divided into observation group and control group. Intravenous injection of 0. 6 mg/kg parecoxib sodium was performed in the patients of observation group, while isodose saline for the patients of control group. The intravenous 0. 3 mg, 0. 05 mg/kg midazolam, fentanyl of 3 penehyclidine hydrochloride g/kg, (1-1. 5) mg/kg of propofol, 1 mg/kg atracurium was administrated in both groups for anesthesia induction. After successful endotracheal tube (ET) placement, propofol via an infusion pump, and intermittent intravenous fentanyl and CIS atracurium to maintain the EEG double frequency index (BIS) at 40-60 until the skin was sutured. The general condition, time to extubation, recovery time, stay in post anesthesia care unit (PACU), hemodynamics at each time points, and emergence agitation during recovery from anesthesia, PARD score and the incidence of adverse reactions were compared between the two groups. Results The stay in PACU of the observation group was shorter than that of the control group (P < 0. 05), however, there were no significant difference in the time to extubation and recovery (P > 0. 05); the MAP and HR levels at T2 and T3 of the observation group were lower than those of the control group; in the control group, MAP and HR levels at T2 and T3 were lower than that at T0 (P < 0. 05). The levels of MAP and HR at T0, T1 had no statistical significance between the two groups (P > 0. 05);PARD score, incidence of agitation and adverse reaction of the observation group were lower than those of the control group (P < 0. 05). Conclusion The pretreatment with parecoxib sodium can reduce the incidence rate of agitation and adverse reaction, and maintain the stable hemodynamics with a better safety elderly patients undergoing radical resection of rectal cancer.

The cognition and experience of concurrent radio-chemotherapy in patients with nasopharyngeal carcinoma (NPC):a qualitative research

LIU Dan, GAO Wen, WEI Yiping, LIAO Haitao

2017, 15(9): 1599-1601,1634. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.044

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Objective To investigate concurrent radio-chemotherapy patients with NPC over the same cognition and experience in order to provide effective intervention and implementation measures of improving the patients physical and mental rehabilitation. Methods Semi-structured interviews were conducted to a total of 13 patients with NPC in a major hospital in Nanning and the data were explored via Colaizzi seven-step analysis. Results The perception of concurrent radiochemotherapy patients could be classified into 3 themes:the cognitive confusion by knowing the nature of concurrent radio-chemotherapy; experiencing fear by the same period of concurrent radio-chemotherapy patients; expecting treatment because of effective treatments of other patients. The experience of concurrent radio-chemotherapy could be extracted into 6themes:taking active measures to prevent the toxic and side effect; having great pressure of the concurrent radio-chemotherapy; unable to finish the whole therapy; hoping for a quick end; looking forward to exchanges with the outside; expecting information of the progress and prognosis. Conclusion The concurrent radio-chemotherapy patients have continuous and dynamic cognition coexisting with various experience. The patients' mental state and quality of life lowered along with the toxic and side effects in concurrent radio-chemotherapy, so nursing staff should provide individualized, comprehensive supportive care to eliminate the patient's fear, anxiety and help shift patients mood from negative to positive; strengthen the protection and the treatment of patients with education, establishing the confidence of patients; enhance the effect of family, society and medical support system, encouraging family members to participate, thus to promote the patients' psychological health and improve their quality of life.

Effect of oral cavity flushing and nursing on postoperative recovery of oral and maxillofacial region

YU Jun, LI Ling, WANG Lin, ZHU Guifen, YANG Fengying, PANG Guangming

2017, 15(9): 1602-1604. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.045

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Objective To study the effect of oral cavity irrigation nursing in transfusion room on postoperative recovery of oral and maxillofacial region. Methods From July, 2014 to July, 2016, 136 cases of oral and maxillofacial surgery in our hospital were randomly divided into observation group and control group. The control group received routine oral rinse nursing, the observation group received oral transfusion room nursing. Comfort, oral cleanliness and oral care satisfaction were observed, recorded and compared between the two groups after oral rinse. Results In the observation group, 59 cases were comfortable, 6 cases were general comfortable, 3 cases were uncomfortable, total comfort degree is 95. 59%. In the control group, 21 cases were comfortable, 21 cases were general comfortable, 26 cases were uncomfortable, the total comfortable degree was 61. 76%, there was statistically significant difference (P < 0. 05). Patients in the observation group were 3 cases of oral cleanliness of the patients, accounting for 80. 88% of the control group, oral cleanliness of the patients with a total of 3 cases, accounting for 50%, the difference was statistically significant (P < 0. 05). The observation group of oral rinse very satisfactory in 37 cases, 19 cases were satisfactory, 11 cases were basically satisfied, 1 case was unsatisfied, the total satisfaction rate was 98. 53%, the control group of oral rinse very satisfactory in 13 cases, 14 cases were satisfactory, 10 cases were basically satisfied, not satisfied with 19 cases, 12 cases were unsatisfied, the total satisfaction was 54.41%. There was statistically significant difference (P < 0. 05). Conclusion The effect of infusion irrigation on postoperative recovery of patients with oral and maxillofacial surgery is significant, which can effectively improve the comfort degree of patients and the degree of oral cleanliness, and improve the satisfaction rate of nursing care.

Application effects of comprehensive nursing intervention on patients with radiation and chemotherapy for non-small cell lung cancer

LIU Yajing, MING Bangchun

2017, 15(9): 1605-1608. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.046

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Abstract:
Objective To investigate the effects of comprehensive nursing intervention on patients with radiation and chemotherapy for non-small cell lung cancer. Methods We chose 160 patients with non-small cell lung cancer from our hospital between January, 2013 and June, 2014, and randomly divided them into observation group and control group with each group 80 cases. Patients of control group were given routine nursing care, while patients of observation group were given targeted nursing intervention based on routine nursing care. Complications, quality of life and satisfaction with care were compared between the two groups. Results Compared with the treatment before, the appetite score and fatigue score of the control group increased significantly (P < 0. 001), the general health score, cognitive function score, role function score, physical function scores of the control group were significantly lower (P < 0. 001). The appetite score and fatigue score of the observation group also increased significantly (P < 0. 001). The overall health score, cognitive function score, role function score, physical function scores of the observation group were significantly lower (P < 0. 001). Compared with the observation group, the overall health score, cognitive function score, role function score, physical function scores after nursing of the control group were significantly lower than the observation group (P < 0. 001). The appetite scores and fatigue scores after nursing were higher (P < 0. 001). Compared with the control group, the incidence of complications in the observation group was significantly lower, and the difference was statistically significant (P=0. 009), and the nursing satisfaction was significantly higher, and the difference was statistically significant (P=0. 028). Conclusion Implementing nursing intervention on the basis of conventional nursing can reduce complications of patients with radiation and chemotherapy for non-small cell lung cancer and improve their quality of life and nursing satisfaction, which is worth clinical promotion.

Application effect of routine nursing combined with early activities to prevent the delirium in patients with mechanical ventilation in ICU

RAO Qiaoying, YIN Zhiqin, HU Haihong, LIU Yao

2017, 15(9): 1609-1611. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.047

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Objective To explore the effect of routine nursing combined with early activities in the prevention of delirium in patients with mechanical ventilation in intensive care unit (ICU). Methods We collected 180 patients receiving mechanical ventilation in ICU from July 2014 to June 2016 in the Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital). The patients were randomly divided into intervention group and control group. The control group was given conventional care, and the intervention group was given early movement on the basis of routine care. The clinical data of the two groups were collected. Results There was no significant difference in the incidence of delirium into the ICU < 8 h between the intervention group and the control group (P > 0. 05). The incidence of delirium into the ICU 8-48 h, 48 h-out ICU of the intervention group (8. 9%, 2. 2%) were lower than those in the control group (25. 6%, 14. 4%), P < 0. 05. The total delirium rate of the intervention group (20. 0%) was lower than that in the control group (50. 0%), P < 0. 05. There was no significant difference in the proportion of delirium reduced activity type, increased activity type and mixed type between the intervention group and the control group (P > 0. 05). In 63 patients with delirium, there were 4 cases of reduced activity, 37 cases of increased activity, and 22 cases of mixed type. There was no significant difference in the delirium occurring time between the intervention group[(2. 32 ±1. 46) days] and the control group[(2. 41 ±1. 54) days], P > 0. 05. The duration of delirium in the intervention group[(1. 87 ±1. 25) days]was shorter than that in the control group[(3. 06 ±1. 69) days], P < 0. 05. The duration of ventilation, treatment cost, hospital stay[(91. 23 ±43. 26) h, (1. 58 ±0. 87) ten thousand yuan, (6. 32 ±4. 31) days]in the intervention group were lower than those in the control group[(122. 25 ±51. 27) h, (2. 12 ±1. 24) ten thousand yuan, (8. 67 ±4. 65) days], P < 0. 05. Conclusion The combination of routine care and early intervention can reduce the incidence of delirium in patients with ICU mechanical ventilation, reduce delirium duration and ICU stay, reduce treatment costs, and have no significant effect on delirium classification and ventilation time.

Rapid detection of enterovirus IgM improve the nursing management of children with hand-foot-mouth disease

HUANG Jihong, HUANG Leting, JIN Jie, XU Wuxiu, LIN Hailong

2017, 15(9): 1612-1615. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.048

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Abstract:
Objective To investigate the role of rapid detection of enterovirus Ig M on improving the nursing management of children with hand-foot-mouth disease. Methods Total 126 patients who met the diagnostic criteria for hand-footmouth disease in May, 2015 were enrolled into this study with randomized controlled trials (RCTs). All the patients were assigned into non-pathogenic rapid diagnosis group (Group Ⅰ, 62 cases) and pathogenic rapid diagnosis group (GroupⅡ, 64 cases). In group I, the stool and throat swabs specimen were prepared for PCR test; the patients were uniformly assigned into wards and received the routine nursing care. In group Ⅱ, the tests for Ig M antibody (colloidal gold assay) were additionally performed, and the patients were assigned into isolation ward according to the different pathogens, and received individualized care. The differences of pathogen, results of PCR and antibody tests, hospitalization time and rate of re-infection within two weeks were compared. Results There was no statistical difference of pathogen between the two groups (P=0. 927), and the corresponding accuracy rate of between PCR and antibody tests was 98. 4%. The hospitalization time of Group Ⅱ was shorter than that of Group Ⅰ (P < 0. 001). There were 8 re-infection cases in Group Ⅰ, while 0 cases in Ⅰ group, the difference was significant differences (P < 0. 001). Conclusion The colloidal gold assay method is effective in the detection of hand-foot-mouth disease virus Ig M. According to the results of rapid pathogenic tests, the medical personnel can assign patients with different pathogens into isolation wards, and provide individualized care and treatment, thus will improve the pertinence of treatment and care and the quality of nursing management, shorten the hospitalization time, also reduce secondary infection in the ward.

The postoperative temperature nursing intervention for the congenital heart disease children by the cardiopulmonary bypass based on the ulinastatin

LIU Yang

2017, 15(9): 1616-1619. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.049

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Abstract:
Objective To explore the postoperative temperature nursing intervention and its value based on the ulinastatin (UTI) for the congenital heart disease children by the cardiopulmonary bypass. Methods We selected 78 congenital heart disease children admitted to our hospital from August, 2011 to April, 2015 and randomly divided into the observation group and control group, with 38 patients in each group. Both groups were given cardiopulmonary bypass, on the basis of which the observation group was given the UTI infusion of lung preservation solution together with positive nursing intervention. Results The observation group 2 h postoperative body temperature[(37. 46 ±0. 43)℃]and 24 h postoperative body temperature[(38. 28 ±0. 56)℃] were significantly higher than that of the control group[(36. 12 ±0. 48)℃, (36. 78 ±0. 46)℃], P < 0. 05. The ventilation time[(27. 45 ±5. 33) d] and postoperative hospital stay[(23. 45 ±4. 31) d] in the observation group were significantly less than the control group[(41. 98 ±6. 13) d and (27. 93 ±4. 09) d, P < 0. 05]. The postoperative 24 h Sjv O₂ values and serum TNF-α values in the two groups were significantly higher than the preoperative (P < 0. 05), but the postoperative 24 h SjvO₂ values[(72. 48 ±6. 09)%]and serum TNF-α values[(7. 98 ±2. 14) pg/ml] in the observation group were significantly lower than the control group[(84. 20 ±5. 68)%, (8. 89 ±1. 54) pg/ml, P < 0. 05]. Conclusion Postoperative temperature nursing intervention based on the UTI for the congenital heart disease children by the cardiopulmonary bypass can effectively inhibit the release of pro-inflammatory cytokines and reduce brain oxygen metabolism, thus it is beneficial to maintain postoperative temperature and promote the rehabilitation of children.

Effect of optimized nursing process on compliance behavior and prognosis of patients with coronary heart disease

HE Jianyang

2017, 15(9): 1620-1622. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.050

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Abstract:
Objective To analyze the effect of optimized nursing process on compliance behavior and prognosis of patients with coronary heart disease. Methods One hundred cases of patients with coronary heart disease admitted in a hospital from May, 2013 to September, 2015 were selected as the research object. With informed consent of patients, the object was randomly divided into control group and study group, 50 cases in each group. The routine nursing care was applied to the control group and optimized nursing process intervention to the study group, to compare two groups of patients' satisfaction to nursing care, compliance behavior and prognosis. Results The difference of nursing satisfaction between the two groups was statistically significant (Z=3. 025, P=0. 002). The comparison of compliance behavior between the two groups, the patients in the study group diet (χ²=5. 263, P=0. 022), exercise (χ²=5. 198, P=0. 023), ban alcohol and tobacco (χ²=5. 741, P=0. 017), take medicine on time (χ²=5. 316, P=0. 021) four aspects was significantly better than the control group, the difference was statistically significant. In terms of prognosis, the number of cardiac death, myocardial infarction, coronary restenosis and stroke in the study group was less than that in the control group. The incidence of cardiovascular events was compared, the study group was significantly better than the control group, the difference was statistically significant (χ²=9. 013, P=0. 003). Conclusion Optimized nursing process can significantly improve the coronary heart disease patients' compliance behavior and prognosis, thus it has important clinical value.

Clinical nursing care of patients with lower limb ischemic disease after amputation

WANG Nana, SHI Tangwang, HAN Mei, ZONG Xiaoling

2017, 15(9): 1623-1625. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.051

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Objective To investigate the clinical nursing experience of patients with amputation of toe necrosis after surgery because of acute lower limb ischemia. Methods The nursing data of 18 cases with toe necrosis and amputation as a result of acute arterial ischemia of the lower extremity who were admitted to the First affiliated hospital of Bengbu medical college, department of vascular surgery from January, 2015 to January, 2016, were retrospectively analyzed, including positive psychological counseling, intensive care of the amputation ending, a healthy diet instruction and rehabilitation training. The undesirable wound surface of the first stage was treated via a period of debridement for fresh granulation tissue growth and then underwent vacuum sealing drainage (VSD) for one week. The healing of the amputation ending as well as the patients' recovery was observed. Results There were twelve patients with amputated wounds who were healed in the first stage, five patients who suffered from postoperative fat liquefaction, partly with unhealed incisal margin, after strengthening medicine combined with VSD and sutured in the second stage, three patients suffered from pulmonary infection, four cases patients had heart failure symptoms. After comprehensive treatment and nursing, seventeen cases of patients with amputation wound healed, limb functional exercise is good, pulmonary infection, heart failure symptoms get effective control and postprandial blood glucose levels were below the 9. 0 mmol/L. One case of elderly patient died of heart and lung failure four days after operation. Conclusion The patients with toes amputation surgery because of the acute arterial ischemia of the lower extremity need to cooperate with security, careful nursing and diet health guidance, which is of great significance to promote the rehabilitation, wound healing, reduce complications and improve the quality of life of the patients.

2017, 15(9): 1626-1628. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.052

76 3

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2017, 15(9): 1629-1631. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.053

67 1

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2017, 15(9): 1632-1634. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.054

130 0

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2017, 15(9): 1635-1638. doi: 10.16766/j.cnki.issn.1674-4152.2017.09.055

144 1

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2017 Vol. 15, No. 9

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