中华全科医学

Strengthen the general practice education and training and promote the team construction of general practitioner——The practice and thinking of general practice education training in Anhui province

SONG Xiang-dong, YANG Yu, YU Xian-qing, FAN Kang-yu

2018, 16(1): 1-4. doi: 10.16766/j.cnki.issn.1674-4152.000001

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Abstract:
Objective Team construction of general practitioner is one of the important content of deepening medical reform and improving hierarchical medical system. The aim of the paper is to summarize and analyze the practice of general practice education and training in Anhui province, and put forward experience references and policy suggestions for the team construction of general practitioner. Methods We reviewed the main policy, basic situation and problems for the education and training of general practice in Anhui province. Results The main problems in general practice education and training included:not obvious effect; lower training quality; delayed practice system of general practitioners; low registration rate and high turnover rate in qualified certificate personnel; low proportion of standardized training, number of applicants and admission score; insufficient policy-propaganda; lack of incentives, poor participation initiative, and so on. The main problems in general practitioner team construction included:lack of quantity and lower quality of general practitioners; lower level of social support and generally accepted by colleagues in their industry; disregard on the establishment and staffing of department because of the lack of understanding about the general practice; not perfect excitation and protection mechanism for general practitioners and unattractive jobs; difficult implementation and non-ideal result for family doctor contract service and hierarchical medical system. Conclusion The following measures should be performed to strengthen the training and team construction of general practitioner:strengthening the organization and leadership;promoting practice registration; strengthening standard training; paying more attentions to discipline construction;strengthening publicity and guidance.

XIE Huai-zhen, CHEN Lan-ju

2018, 16(1): 5-6,29.

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Infrared thermal imaging for the early diagnosis of herpes zoster

YAO Yi-bing, XIE Ke-yue, HUANG Bing, YAO Ming, ZHANG Li, DENG Jia-jia, FEI Yong, NI Hua-dong, CHEN Guo-dong

2018, 16(1): 7-9. doi: 10.16766/j.cnki.issn.1674-4152.000002

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Abstract:
Objective To investigate the role of infrared thermal imaging technology in the early diagnosis of herpes zoster, and explore the improvement of diagnosis of herpes zoster. Methods We select 20 cases of suspected herpes zoster patients whose one side of the torso area had neuralgia symptoms without herpes, then recorded the patients' pain area of the infrared thermal imaging and VAS score and measure the temperature difference of the both sides of the symmetrical area. Patients appeared herpes or not were closely followed in two weeks so as to make a definitive diagnosis. The evaluation index in the diagnostic accuracy with ROC curve analysis. The temperature difference of symmetrical area ΔT and VAS were considered as examined variable. The justified outcome of whether appear herpes in two weeks was considered as status variable. We made ROC curve analysis, calculated the area under the ROC (AUC) and Youden index, and found cut-off value. Results During the follow-up of two weeks, the patients appeared herpes zoster of related area can be diagnosed (13/20). The ROC curve results showed that:in the temperature difference of the both sides symmetrical area measured by infrared thermal imaging, the area under the ROC curve was 0.912, cut-off value was 0.85℃ and Youden index was 0.702; In VAS score, the area under the ROC curve was 0.434, cut-off value was 2.5 and Youden index was 0.176. Conclusion For those herpes zoster patients who develop neuralgia symptoms but without herpes, the infrared thermal imaging technology has additional diagnostic value, and it is easy-to-use, noninvasive, non-radiant and worthwhile for spreading in clinical practice.

Effects of HSP70 induced by heat stress intervention on atherosclerosis in rats

CHEN Fei, YANG Dan, XIN Cai-mei, CHEN Jia-ni, LU Yue, QIU Wei-jun, WENG Qi-fang

2018, 16(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.000003

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Objective To provide basic theoretical basis of atherosclerosis for the prevention and treatment of cardiovascular and cerebrovascular diseases by detecting the expression level of serum lipids, heat shock protein 70 (HSP70), radical oxygen speciesn (ROS) and oxidized low density lipoprotein (ox-LDL) in rat with heat stress pretreatment. Methods SD rats were randomly divided into control, the AS and H + AS groups. The control group with based diet, the AS and H + AS were treated with intraperitoneal injection a single dose of vitamin D₃ (6×10⁵ U/kg) in the first days of experiment began. Then, every 30 days administration of 1 times, a total of three times administration in the next time combines with high fat diet. During the AS animal modeling, the H + AS group was pretreated with heat stress intervention in every one days until the molding time end. After 14 weeks, draw blood from the common carotid artery, centrifuge, HSP70, ox-LDL and blood lipid were detected by ELISA method, ROS was detected by Fenton method and observe the arterial pathological changes. Results By one-way analysis of variance, in AS group, compared with control group, the levels of TC[(31.87 ±3.79) nmol/L vs. (14.14 ±2.95) nmol/L], TG[(226.00 ±17.09) μmol/L vs. (106.10 ±17.57) μmol/L], LDL[(169.17 ±18.75) μmol/L vs. (96.55 ±13.92) μmol/L], ox-LDL[(26.68 ±3.52) μg/L vs. (9.92 ±3.10) μg/L] increase (P<0.05), the arrangement of endothelial cells was in disorder, foam cells were observed and typical atherosclerosis developed. In H + AS group, compared with AS group, the levels of TC[(28.30 ±2.99) mmol/L vs. (31.87 ±3.79) mmol/L] decreased (P<0.05), TG[(168.68 ±26.17) μmol/L vs. (226.00 ±17.09) μmol/L] and LDL[(137.47 ±16.30) μmol/L vs. (169.17 ±18.75) μmol/L] decreased (P<0.01), HSP70[(673.39 ±130.93) ng/L vs. (324.96 ±57.34) ng/L]increased significantly (P<0.01), but ROS is also increased (P<0.01), calcium salts accumulated in the arterial endarterium, but typical atherosclerosis plaques were barely found. Conclusion The method of heat stress intervention can inhibit the formation of atherosclerotic plaque in rats which may be related to the protective effect of HSP70 in the pathogenesis of the disease.

Diazoxide prevents rat chondrocyte apoptosis via Inhibition of endoplasmic reticulum stress

GU Yun-tao, CHEN Ke-wei, BIAN Yang-yang, FU Jian, YUAN Wei, XING Kong-ming, PENG Lei

2018, 16(1): 14-18,37. doi: 10.16766/j.cnki.issn.1674-4152.000004

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Objective To research the mechanism of diazoxide on hydrogen peroxide induced chondrocyte apoptosis. Methods We obtain the carilage cells from the 3 SD rat articular cartilages. The cartilage cells were divided into six groups, namely the control group(A), the H₂O₂-injured group(B), H₂O₂ + 100 μmol/L DZ group(C), H₂O₂ + 200 μmol/L DZ group(D), H₂O₂ + 300 μmol/L DZ group(E), H₂O₂ + 400 μmol/L(F). Group A had no special treatment, group B incubated with 400 μmol/L H₂O₂ for 8 hours in 37℃ incubator, the C, D, E group were pre-incubated with 100, 200, 300, 400 μmol/L DZ in a 37℃ incubator incubated 30 minutes, then incubated with 400 μmol/L H₂O₂ solution in 37℃ incubator. The activity of chondrocytes in group A, B, C, D, E and F were detected by CCK8 method. The apoptosis of chondrocytes were detected by flow cytometry. The function of chondrocytes were detected by RT-PCR and immunofluorescence, Western blot were used to detect the expression of endoplasmic reticulum stress proteins. Results ①Using the CCK8 assay, the order of the rate of cells activity:group A > group E > group D > group F > group B. ②The apoptosis rates of cells were detected by Flow cytometer. The order of apoptosis rates of chondrocyte as follow:group B > group F > group D > group E > group A. ③The Coll-Ⅱ protein expression of chondrocyte were detected by RTPCR analysis, as follow:group A > group E > group D > group F > group B. However, the aggrecanase expression Contrary to Coll-Ⅱ. ④the expression of CHOP in each chondrocytes group detected by immunofluorescence, as follow:group B > group F > group A. ⑤The Caspase-3, Bax, CHOP protein expression of chondrocyte were detected by Westernblot analysis, as follow:group B > group F > group A. Conclusion Diazoxide prevents H₂O₂-induced rat chondrocyte apoptosis via inhibition of endoplasmic reticulum stress.

Effects of Tanreqing injection combined bridgestone on inflammation and immune function of patients with stable COPD

FU Hai-wei, LI Xiao-bo, KONG Yi-ming, GUO Wei-wei, YANG Zai-xing, DAI Yuan-rong

2018, 16(1): 19-21. doi: 10.16766/j.cnki.issn.1674-4152.000005

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Objective To investigate the effect of Tanreqing injection combined budesonide dermoterol on inflammatory factors, immune function, pulmonary function and arterial blood gas of patients with stable COPD. Methods One hundred and fifty-six patients with stable COPD were randomly divided into two groups, 78 cases in each group. The control group was given budesonide/formoterol, and the observation group was added Tanreqing injection based control group.The inflammatory factors (TNF-α, IL-8 and ICAM-1), immune function (CD3⁺, CD4⁺, CD8⁺and CD4⁺/CD8⁺), pulmonary function (FEV₁, FEV₁% and FEV₁/FEVC), arterial blood gas (PaO₂ and PaCO₂) of two groups were compared. Results After treatment, TNF-α, IL-8 and ICAM-1 levels of two groups were significantly reduced (P<0.05), and observation group was lower than the control group (P<0.05). After treatment, CD3⁺, CD4⁺and CD4⁺/CD8⁺levels of two groups were significantly increased (P<0.05), and observation group was higher than the control group (P<0.05). After treatment, FEV₁, FEV₁% and FEV₁/FVC levels of two groups were significantly increased (P<0.05), and observation group was higher than the control group (P<0.05). After treatment, PaO₂ levels of two groups were significantly increased (P<0.05), and observation group was higher than the control group (P<0.05). After treatment, PaCO₂ levels of two groups were significantly reduced (P<0.05), and observation group was lower than the control group (P<0.05). Conclusion Tanreqing injection combined budesonide dermotam could reduce the inflammatory response, improve the immune function, and improve the lung function and arterial blood gas of patients with COPD.

Effects of miR141 on cell cycle in LNCa P human prostate cancer cells and its mechanism

YANG Sen, FAN Lai-lai, GU Xi-jie, KE Run-jiang, MU Hai-qi, WANG Yi-jun, NAN Cun-jin, CHEN Ying-he

2018, 16(1): 22-25,63. doi: 10.16766/j.cnki.issn.1674-4152.000006

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Objective To observe the effect of miR141 on the proliferation and cell cycle in LNCa P human prostate cancer cells. Methods The cancer tissues and adjacent tissues of patients with prostate cancer in our hospital from December, 2015 to June, 2017 were collected, and the miR141 expression were detected by using q PCR. The expression of miR141 in LNCa P cell was also detected. LNCa P cells were divided into LNCa P group (without transfection), mimics group (transfected with miR141-mimics) and inhibitor group (transfected with miRNA-141 inhibitor) to observe its transfection efficiency. The increment rate of the three groups was detected by MTT method, and the cell cycle was detected by flow cytometry. The expression of P27, CDK4 and Cyclin D1 were detected by WB. Results The levels of the miRNA-141 in cancer tissues were significantly higher than that of the adjacent tissues (P<0.05), and the levels of the miRNA-141 in the LNCa P cells were lower than those of the cancer tissues (P<0.05), but slightly higher than those of the adjacent tissues. After LNCa P cells transfected with miRNA-141-mimics, miRNA-141 expression was significantly increased (P<0.05). After the LNCa P cells were transfected, miRNA-141 expression of mimics group and inhibitor group were slightly higher than that of LNCa P group. When LNCa P transfected miRNA-141 mimics 48 h, the cell proliferation rate of mimics group was lower than LNCa P and inhibitor group. After LNCa P transfected miRNA-141 mimics, cell cycle was blocked in G₁ phase. Compared with LNCa P group and inhibitor group, the mimics group significantly increased P27, while CDK4 and Cyclin D1 decreased significantly. Conclusion MiR141 can affect LNCa P proliferation and block LNCa P in G₁ phase.

Effect of epigallocatechin gallate on daunorubicin-induced cardiotoxicity in mice

DING Jie, DOU Peng-fei

2018, 16(1): 26-29. doi: 10.16766/j.cnki.issn.1674-4152.000007

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Objective To observe the prevention effect of Fructose-1, 6-diphosphate (FDP) and Epigallocatechin gallate (EGCG) against the daunorubicin-induced myocardial injury in mice. Methods The Kunming mice were randomly divided into normal control group, model group, positive control group (FDP group), drug intervention group (EGCG group), with 20 mice in each group. The mice in the FDP group and EGCG group were given FDP and EGCG (40 mg/kg) by intragastric administration, and the mice in the normal control group and model group were given equal volume of normal saline. One week later, the mice in the model group, FDP group and EGCG group were given daunorubicin (20 mg/kg) by intraperitoneal injection, while in the control group were given normal saline. Forty-eight hours after daunorubicin was administrated, All the mice were taken the blood to test the levels of myocardial enzyme (CK-MB, AST, -HBDH). The experimental data were analyzed by using SPSS 19.0. Results The survival rate of normal control group was 100%, which was higher than that of the model group (60%); however, the level of myocardial enzyme in the model group was higher than that in the control group (P<0.01). The survival rate (90%) of both FDP group and EGCG group was higher than that of the model group, and the level of myocardial enzyme was decreased (P<0.01), especially in the EGCG group (P<0.05). Conclusion FDP and EGCG can depress the cardiotoxicity of daunorubicin in mice, especially the latter.

Effects of fluoxetine on the expression of FGF-2,FGFR1 and 5-HT1AR in the hippocampus of depression model rats

ZHANG Ya-ping, LIU Chun-yan, LIANG Hai-yan, TANG Wei-guo, HE Song-bin

2018, 16(1): 30-33. doi: 10.16766/j.cnki.issn.1674-4152.000008

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Objective To investigate the effect of fluoxetine on the expression of fibroblast growth factor-2, fibroblast growth factor receptor 1 and 5-hydroxytryptamine (5-HT) 1 A receptor in the hippocampus of depression model rats. Methods The behavior scores was evaluated by using open-field test. Forty healthy male SD rats weighting 210 to 290 g with the similar score were selected and randomly divided into 4 groups (8 in each group) based on the random number table, including chronic unpredictable mild stress (CUMS) group, CUMS plus fluoxetine group, control group and fluoxetine group. Chronic mild unpredicted stress was taken to establish rat depression mode1 for 21 days. The fluoxetine group and CUMS plus fluoxetine group were treated with intragastric administration of fluoxetine[5 mg/(kg·d)], meanwhile the control group and CUMS group were treated with 0.5% carboxymethyl cellulose sodium in the same way. The openfield test and sucrose consumption were used to evaluate the depression behaviors of rats. And the expression of FGF-2, FGFR1 and 5-HT1 AR in the hippocampus of rats were detected by western blot. Results ① The open-field test and sucrose consumption showed that the rat model of depression has been established successfully. Compared with the CUMS group, the sucrose consumption, crossing score and rearing score in the CUMS plus fluoxetine group were significantly increased, while the number of defecate was significantly decreased (all P<0.05). ② Compared with control group, the level of FGF-2, FGFR1 and 5-HT1 AR in hippocampus of rats were significantly decreased in CUMS group (P<0.05), while fluoxetine group showed no significant difference (P>0.05). The expression of FGF-2, FGFR1 and 5-HT1 AR in hippocampus of the CUMS plus fluoxetine group were significantly higher than the CUMS group (all P<0.05). Conclusion Fluoxetine can be used to improve depressive behaviors, which maybe associate with the increased expression level of FGF-2, FGFR1 and 5-HT1 AR protein in rat hippocampus.

Effect of minimally invasive unilateral pedicle screw fixation and bilateral decompression on lumbar spinal isolated segment stenosis

XU Qing-ping, SONG Deng-feng, HE Jian-xing, ZHU Xiao-feng, HU Xi-lian

2018, 16(1): 34-37. doi: 10.16766/j.cnki.issn.1674-4152.000009

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Abstract:
Objective To investigate the effect of minimally invasive unilateral pedicle screw fixation and bilateral decompression in the treatment of single level lumbar spinal stenosis. Methods Total 91 cases of single level lumbar spinal stenosis in our hospital between April, 2014 and March, 2016 were divided into observation group (47 cases) and control group (44 cases). The patients in the observation group were treated with minimally invasive unilateral pedicle screw fixation and bilateral decompression, while control group with open bilateral fixation and bilateral decompression.All patients were followed up for more than one year. The operation duration, intraoperative blood loss, postoperative drainage flow volume, the time from the end of operation to post-operative ambulation, length of hospital stay, Oswestry disability index (ODI), visual analogue scale (VAS) and lumbar fusion situation were compared between the two groups. Results The operation duration, intraoperative blood loss, postoperative drainage flow volume, the time from the end of operation to post-operative ambulation and length of hospital stay in the observation group were significantly less than those in the control group (P<0.05); Compared with the data before operation, ODI decreased significantly in both groups at 1 year after the operation (P<0.05), and ODI had no significant difference between the two groups at 1 year after the operation (P>0.05); Compared with pre-operative data, VAS of leg and waist decreased significantly in both groups at 1 year after the operation (all P<0.05), and VAS of leg and waist had no significant difference between the two groups at 1 year after the operation (all P>0.05); Evaluation of Bridwell intervertebral fusion showed that, class Ⅰof the observation group was 31 cases, class Ⅱwas 16 cases, and class Ⅰ of the control group was 27 cases, class Ⅱwas17 cases, there was no significant difference between the two groups at 1 year after the operation (P>0.05). Conclusion Minimally invasive unilateral pedicle screw fixation and bilateral decompression has satisfactory efficacy, and mild trauma, rapid recovery in patients with single level lumbar spinal stenosis.

Effect of radiofrequency ablation combined transcatheter arterial chemoembolization on antitumor immune status of patients with hepatocellular carcinoma

ZHU De-dong, SHI Xiao-jun, WANG Zhe, YUAN Deng-gao, CAI Ting, ZHANG Shun

2018, 16(1): 38-40,79. doi: 10.16766/j.cnki.issn.1674-4152.000010

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Objective To investigate the effect of radiofrequency ablation combined transcatheter arterial chemoembolization on the anti-tumor immune status of patients with hepatocellular carcinoma. Methods A total of 186 patients with hepatocellular carcinoma were divided into control group and observation group by random number method. The control group was treated with TACE and the observation group was treated with RFA based on control group. After treatment, the serum tumor activating factor (AFP, MMP and CA199), T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺and CD4⁺/CD8⁺), immunoglobulin (Ig A, Ig M and Ig G), life quality and short-term efficacy of two groups were compared. Results Before treatment, AFP, MMP and CA199 levels of two groups were no significantly different (P>0.05); after treatment, the AFP, MMP and CA199 levels of two groups were significantly decreased (P<0.05), and the decrease rate of observation group was higher (P<0.05). Before treatment, the CD3⁺, CD4⁺, CD8⁺and CD4⁺/CD8⁺levels of two groups were no significantly different (P>0.05); after treatment the CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺levels of two groups were significantly improved (P>0.05); and the improvement of observation group was higher than control group (P<0.05). Before treatment, Ig A, Ig G and Ig M of two groups were no significantly different (P>0.05). After treatment, Ig G and Ig M of two groups were significantly increased (P<0.05), and the improvement of observation group was higher than control group (P<0.05). Compared with control group, the body function, symptom/adverse effect and social function score of observation group were higher (P<0.05). After treatment, the overall effect of the observation group was significantly better than control group (P<0.05). After treatment, Ig G and Ig M were significantly higher than those in Ig A (P<0.05) Control group (P<0.05). Conclusion Radiofrequency ablation combined transcatheter arterial chemoembolization can significantly reduce tumor activity of patients with hepatocellular carcinoma, enhance the antitumor immune function and improve the life quality of patients.

Effect of ulinastatin combined with dexmedetomidine on oxidative stress,S100β and NSE in patients with supratentorial tumor resection

CHEN Yuan-liang, XU Li-li, ZHANG Lei, LE Xin-hui, LV Hua-yan

2018, 16(1): 41-43. doi: 10.16766/j.cnki.issn.1674-4152.000011

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Abstract:
Objective To investigate the effect of ulinastatin combined with dexmedetomidine on oxidative stress, S100β and NSE in patients with supratentorial tumor resection. Methods A total of 60 patients with supratentorial tumor resection were randomly divided into observation group (30 cases) and control group (30 cases). The patients of the control group received ulinastatin (2 000 U/kg) at time of skin incision, then received dose of 1 000 U/(kg·h) until the end of the operation. On the basis of control group, the patients of observation group received dexmedetomidine at the same time, dose of 1 μg/kg at time of skin incision, then received dose of 0.5 μg/(kg·h) until 30 min before the end of the operation. SOD, MDA, S100β and NSE of jugular venous bulb serum were tested and compared in 2 groups at the time of before induction (T0), before skin incision, after cutting epidural, end of operation and 24 h after operation. Results Compared with T0, the level of SOD decreased significantly at T2, T3 and T4 in 2 groups (P<0.05), the level of MDA increased significantly at T2, T3 and T4 in 2 groups (P<0.05), but the changes of observation group was significant smaller (P<0.05). Compared with T0, the level of S100β and NSE increased significantly at T2, T3 and T4 in2 groups (P<0.05), but the changes of observation group was significant smaller (P<0.05). Conclusion Ulinastatin combined with dexmedetomidine can obviously reduce the inhibition of SOD, MDA level and oxidative stress damage.At the same time, reduce S100βand NSE, boost brain protection in patients with supratentorial tumor resection.

Effect of high expression of Klotho gene on the growth of gastric cancer cell line

SONG Sheng-jiang, LI Bo

2018, 16(1): 44-46. doi: 10.16766/j.cnki.issn.1674-4152.000012

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Abstract:
Objective To observe the effect of Klotho gene on the growth of gastric cancer cell line GC-7901. Methods Klotho vector was constructed. Gastric cancer GC-7901 cells were divided into Klotho group (GC-7901 cells were transfected with p Zs Green1-C1-Klotho vector), negative control group (GC-7901 cells were transfected with empty virus vector), blank control group (GC-7901 cells). The expression of Klotho protein was detected by Western blot. The cell proliferation was detected by CCK-8 assay. The cell apoptosis and cell cycle were determined by flow cytometry. Results The expression of Klotho protein in gastric cancer cell line GC-7901 was lower than that in normal gastric cell line GES-1 (0.19 ±0.01), P<0.05. The expression of Klotho protein in Klotho group (0.81 ±0.12) was significantly higher than that in the negative control group (0.24 ±0.06) and the blank control group (0.22 ±0.04), P<0.05. The gastric cancer cell proliferation rate of the Klotho group[(62.26 ±13.24)%] was significantly lower than that in the negative control group[(99.14 ±21.53)%] and the blank control group[(100.00 ±1.03)]%, P<0.05. The apoptosis rate of gastric cancer cells in the Klotho group[(23.31 ±2.54)%] was significantly higher than that in the negative control group[(4.76 ±0.15)%] and the blank control group[(4.67 ±0.13)%], P<0.05. The percentage of G0/G1 phase in gastric cancer cells in the Klotho group[(25.26 ±2.63)%] was significantly higher than that in the negative control group[(4.91 ±0.17)%] and the blank control group[(4.83 ±0.16)%], P<0.05. Conclusion Klotho protein in gastric cancer cells are low expression. The high expression of Klotho gene can reduce the proliferation of gastric cancer cells, promote the apoptosis of gastric cancer cells and inhibit the cell cycle.

Laparoscopic assisted transanal cylindrical resection of low rectal cancer

ZHANG Tian-ming, DU Jin-lin, ZHONG Zhi-feng, DAI Zhi-hui

2018, 16(1): 47-49. doi: 10.16766/j.cnki.issn.1674-4152.000013

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Abstract:
Objective To investigate the clinical value of laparoscopic assisted transanal cylindrical resection in patients with low rectal cancer. Methods Total 56 patients with low rectal cancer in our hospital from September, 2014 to August, 2015 were selected as the research object and divided into observation group (n=26) and control group (n=30) according to the surgical methods. The observation group received laparoscopic assisted transanal cylindrical resection, while the control group received laparoscopic abdominoperineal resection. The operation time, blood loss, number of lymph nodes and drainage volume were compared between the two groups. The number of cases with positive resection margin and perforation in the two groups were recorded. All patients were followed up for 12 months; the incidence of complications (Presacral hematoma, urinary retention, and lower extremity venous thrombosis), relapse rate, and 1-year survival rate were compared between the two groups. Results The operation time[(179.38 ±28.17) min] in the observation group was significantly higher than that in the control group[(150.46 ±21.35) min], and the blood loss[(121.52 ±32.63) ml]was significantly lower than that of the control group[(172.41 ±43.17) ml], the difference was statistically significant (P<0.05). There was no significant difference in the number of lymph nodes and volume of drainage between the two groups (P>0.05). Positive circumferential resection margin (0%) and rectal perforation (0%) in the observation group were significantly lower than those in the control group (20% and 23.33%), the difference was statistically significant (P<0.05). The incidence of complications in the observation group was 11.54% and in the control group was 13.33%, the 1-year survival rate in the observation group was 84.62% and in the control group was 76.67%, there was no significant difference (P>0.05). The relapse rate in the observation group (7.69%) was significantly lower than that of the control group (33.33%), the difference was statistically significant (P<0.05). Conclusion Laparoscopic assisted transanal cylindrical resection of rectal cancer can reduce the incidence of positive circumferential resection margin and rectal perforation, which is helpful to decrease the relapse rate of rectal cancer.

The impact of compliance on residual renal function in maintenance hemodialysis patients

LIN Xiao-min, MA Lu-lu, CHEN Xin-xin, YE Yi-bei, LIN Xiao-xia, SHI Yan-ling

2018, 16(1): 50-53. doi: 10.16766/j.cnki.issn.1674-4152.000014

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Abstract:
Objective More and more researches have proved that residual renal function has a great influence on the prognosis of patients. This study will examine the impact of compliance on residual renal function in patients with maintenance hemodialysis. Methods Sixty-two cases of maintenance hemodialysis patients whose 24-hour urine outputs were equal to or more than 200 ml during dialysis interphase in the First Affiliated Hospital of Wenzhou Medical University from February, 2015 to May, 2016 were enrolled. Due to transplantation, transfer, infection and surgery, 10 patients drop out during follow-up. Patients were divided into two groups (good compliance group and bad compliance group, with 26 cases in each group) according to the compliance evaluation criteria. The 24-hour urine outputs during dialysis interphase, creatinine and blood urea nitrogen before and after dialysis, hemoglobin, parathormone, potassium, calcium, phosphorus, iron, ferritin, transferring saturation, albumin, C reactive protein, Kt/V, weight growth rate during every dialysis interphase, blood pressure before dialysis were compared at the beginning of follow-up and a year later. Results The good compliance group had more 24-hour urine outputs, better parathormone and ferritin, higher vitamin D, less weight growth rate during dialysis interphase compared with bad compliance group after one year, which had statistical significance (P<0.05). Conclusion Improved compliance can reduce weight gain during hemodialysis interval, maintain urine output and protect the residual renal function, delay the reduce of residual renal function in maintenance hemodialysis patients.

Roles of serum procaleitonin in the diagnosis and severity evaluation of pnemnonia in elderly patients

WEI Ping, LIU Xiao-xiang, ZHU Han-jun, SUN Ai-hua

2018, 16(1): 54-56. doi: 10.16766/j.cnki.issn.1674-4152.000015

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Abstract:
Objective To evaluate the usefulness of the serum procalcitonin (PCT) level as a predictor of diagnosis in elderly patients with pneumonia and to discuss the value of the serum PCT in the severity assessment of bacterial pneumonia. Methods A total of 314 pneumonia patients were respectively reviewed and assigned into bacterial pneumonia group (121 cases), viral pneumonia group (97 cases) and mycoplasma pneumonia group (96 cases) according to the diagnostic criteria for pathogens causing pulmonary infections treated from January, 2015 to June, 2016 in our hospital, and100 healthy elderly healthy people without infection at the same period were selected as the control group. The 121 bacterial pneumonia patients were grouped according to the severity of illness. All patient groups and control group were respectively detection PCT and CRP in serum. PCT and CRP contents in patients of each group were summarized and data were processed by statistical software SPSS 17.0. Results The levels of PCT and CRP in bacterial pneumonia group were significantly higher than viral pneumonia group, mycoplasma pneumonia group and control group (P<0.05); the level of PCT and CRP increased along with the severity of bacterial pneumonia. The threshold of PCT and CRP were 0.5μg/L and 10 mg/L, respectively. The sensitivity of the serum PCT and CRP were 90.9% and 86.8%, respectively, the sensitivity is no statistical different (P>0.05); the specificity of the serum PCT and CRP were 90.4% and 77.5%, respectively, the specific of serum PCT is obviously higher than that CRP (P<0.01). Conclusion PCT may have a role to predict the etiological diagnosis in patients and the severity in the bacterial pneumonia. The specific of serum PCT in the diagnosis of bacterial pneumonia was obviously higher than that of serum CRP.

Effect of hemorrhoid artery ligation and rectal anal repair under Doppler ultrasound guidance and its effect on anal pressure of hemorrhoids patients

HONG Chen, LIU Wei, WANG Hong-zhi, YANG Peng, GU Wei-jun, LI Yu-hong

2018, 16(1): 57-59. doi: 10.16766/j.cnki.issn.1674-4152.000016

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Abstract:
Objective To investigate the effect of hemorrhoid artery ligation and rectal anal repair under Doppler ultrasound guidance and its effect on anal pressure of hemorrhoids patients. Methods Two hundred and six patients with stage Ⅲ-Ⅳhemorrhagic disease were randomly divided into two groups, each 103 cases. The control group was treated with external stripping ligation, and the observation group was treated with hemorrhoid artery ligation and rectal anal repair under Doppler ultrasound guidance. After treatment, the clinical efficacy, postoperative complications (bleeding, edema, urinary retention, bulging sense), postoperative VAS score, anorectal manometry (ARP, RRP, AMCP) and recent recurrence of the two groups were compared. Results After treatment, the total effective rate of observation group was 97.06%, which was significantly higher than that of control group (89.32%), P<0.05. The bleeding, edema, urinary retention and bulging scores of observation group were lower than those of control group, the difference was statistically significant (P<0.05). After operation, the VAS score of observation group was significantly lower than that of control group, the difference was statistically significant (P<0.05). After treatment, the ARP, BRP and AMCP levels of two groups were significantly reduced (P<0.05), and observation group was significantly higher than those of control group, the difference was statistically significant (P<0.05). There was no significant difference in the recurrence rate between the two groups (P>0.05). Conclusion Hemorrhoid artery ligation and rectal anal repair under Doppler ultrasound guidance could treat hemorrhoid disease significantly, significantly reduce the postoperative complications, reduce pain, and stable normal anal contraction function.

Effects of surgery at different opportune moment on postoperative knee joint function in patients with anterior cruciate ligament injury

FAN Li-bei, JIN Xian-zheng, JIA Bin

2018, 16(1): 60-63. doi: 10.16766/j.cnki.issn.1674-4152.000017

196 0

Abstract:
Objective To explore the influence of surgery at different opportune moment on postoperative knee joint function in patients with anterior cruciate ligament injury. Methods The clinical data of 76 patients with unilateral anterior cruciate ligament (ACL) injury treated in our hospital from January, 2012 to June, 2015 were analyzed, 35 patients who underwent surgery within 3 weeks after admission were assigned into the observation group, and 41 patients who underwent surgery over 3 weeks after admission were assigned into the control group. The range of motion, Tegner, Lysholm and IKDC scores of the two groups before and after the operation were compared. The anteroposterior distances of the tibia were measured by Kt2000 instrument before and after the operation, and the complications of both groups were followed up regularly, and the postoperative complications were compared. Results The difference in Tegner, Lysholm and IKDC score before and after the surgery in each group was not statistically significant (P>0.05). The activity, Tegner, Lysholm and IKDC scores in the observation group were significantly higher than those in the control group, the difference was statistically significant (P<0.05); the tibial anteroposterior movement distance by using Kt2000 knee joint arthrometers at 30° and 90° of flexion with a force of 133.32 N in both groups were significantly smaller than the preoperative level, the differences were statistically significant (P<0.05). After the operation, there was no significant difference in the tibial anteroposterior movement distance at 30° and 90° of flexion with a force of 133.32 N, (P>0.05). The incidence of postoperative complications in the control group was significantly higher than that in the observation group, the difference was statistically significant (1/35, 2.86% vs 5/41, 12.20%; log-rank χ²=3.891, P=0.048). Conclusion Anterior cruciate ligament reconstruction surgery can effectively protect the activity and stability of the knee joint patients within 3 weeks after injury, it can effectively avoid the occurrence of meniscus injury of knee joint and knee joint adhesion after operation.

Effect of inflammatory media on bone marrow mesenchymal stem cell transplantation in leukemia patients

YANG Tian-xin, LAN Jian-ping, JIN Xing

2018, 16(1): 64-66. doi: 10.16766/j.cnki.issn.1674-4152.000018

162 6

Abstract:
Objective To investigate the effect of proinflammatory cytokines on the outcome and prognosis of bone marrow mesenchyma stem cells (BMSCs) transplantation in leukemia patients. Methods A total of 82 patients with leukemia who underwent treatment from our hospital from 3 November, 2015 to 3 May, 2017 were randomized to A (conventional supportive therapy) according to the random number table method. IL-1, IL-6, IL-4 and IL-12 were detected by ELISA before and after treatment, and the levels of IL-1, IL-1, IL-6, IL-6 and IL-12 were detected by ELISA And the changes of bone marrow hyperplasia before and after treatment in group B patients. Results The levels of IL-1 and TNF-α in the serum of the two groups were significantly lower than those in the control group (P<0.001), and the difference was statistically significant (t=13.652, P<0.001). IL-1, TNF-α, IL-6, IL-4 and IL-12 were significantly decreased in the B group after treatment, and the expression of IL-1 was significantly lower than that of IL-6 (t=12.247, P<0.001). The percentage of active myeloproliferation in group B was significantly higher than that before treatment (before treatment vs. before treatment:43.9% vs. 2.4%), and the difference was significant (χ²=6.276, P=0.022); the percentage of myeloproliferation was significantly reduced after treatment (before treatment vs. 19.5% vs. 43.9%), the difference was statistically significant (χ²=5.632, P=0.032). Conclusion Bone marrow mesenchymal stem cell transplantation can effectively reduce the inflammatory response, enhance myeloproliferative activity, improve the hematopoietic environment, and can be used as an adjunctive treatment for leukemia.

Dermatology experience with liquid nitrogen cryotherapy for dermatofibroma: 206 cases

CHEN Wei, HUANG Jiang-ying, ZHANG Wen-xia, TAN Yan-na, ZHU Jiang

2018, 16(1): 67-68,166. doi: 10.16766/j.cnki.issn.1674-4152.000019

276 2

Abstract:
Objective To study and evaluate the effect of liquid nitrogen freezing on the treatment of skin lesions in various sites and the adverse reactions. Methods A total of 206 patients with skin tumor treated in our hospital from May, 2015 to May, 2017 were included in the study. The patients were divided into groups according to gender and age. A total of 55 people in 35-50 years of age group. A total of 151 people in 51-72 years old group. Cryotherapy was performed by applying liquid nitrogen with cotton swabs. The therapeutic effect was evaluated by the treatment of the skin loss after treatment. After the treatment, the lesion was observed and the patients were asked to evaluate the adverse effects of liquid nitrogen cryotherapy. Results The data measured by age and sex groups were statistically analyzed. The P value was 0.217 and 0.789, and there was no significant difference (P>0.05). Age and sex are not the key factors that influence the treatment outcome. According to the treatment results, cryotherapy skin tag has good curative effect.The one-time cure rate reached 114 cases, accounting for 55.3%. The total effective rate (including cure, significant and effective therapeutic class three) reached 202 cases, accounting for 98.1%. Adverse reaction results show that the existence of adverse reactions of edema, blisters, bleeding blister, scar and infection after cryosurgery, the higher incidence of edema and blisters, respectively accounting for 69.9% and 63.1%. Conclusion Cryotherapy of skin neoplasm with high cure rate and significant effect, but this method also has certain adverse risks such as edema, blisters and lesions, etc. Observation is needed for the subsequent processing and timely medical treatments. But overall effect and adverse reaction is low. The treatment has the advantages of simple operation as well as low cost, which is worthy of promotion and further research.

Comparative analysis of the effect of minimally invasive internal fixation and open reduction internal fixation on thoracolumbar spine fracture

CHENG Zhen-yu, JIANG Ding-hua, REN Hong

2018, 16(1): 69-71,93. doi: 10.16766/j.cnki.issn.1674-4152.000020

165 1

Abstract:
Objective To compare the effect of minimally invasive internal fixation and open reduction internal fixation on thoracolumbar spine fracture. Methods Total 150 cases of thoracolumbar spine fracture from May, 2016 to May, 2017 year in May in our hospital were selected and randomly divided into two groups, the control group received open reduction internal fixation treatment, while the study group received minimally invasive internal fixation, The surgical results, imaging indexes and VAS score were compared between the two groups. Results There was no significant difference in operation time between the two groups (P>0.05). The incision length, bleeding volume, postoperative drainage volume and hospitalization time in the study group were significantly lower than those in the control group (P<0.05);before the treatment, there was no significant difference in Cobb 's angle, anterior height of vertebral body and vertebral sagittal index between the two groups (P>0.05); after the treatment, Cobb's angle in the study group was significantly lower than that in the control group, however, the anterior height of vertebral body and vertebral sagittal index were significantly higher than that in the control group (P<0.05); there was no significant difference in visual analogue score (VAS) before the treatment between two group (P>0.05), however, VAS after the treatment at different time points in the study group was significantly lower than the control group (P<0.05). Conclusion Thoracolumbar spine fractures are usually induced by high energy force, and cauda equina and spinal cord can be affected in case of serious injury, the internal fixation can improve the clinical treatment effect and imaging index, reduce the pain of patients, worth to be popularized in clinic.

Efficacy of post auricular injection of methylprednisolone on treatment of idiopathic deafness and its effect on hemorheology and plasma Hcy

LI Xiao-na, LI Yu-jie, YU Min, HUANG Wei, LI Dong-zhi, ZHU Xiao-feng, FAN Kai-hui, ZHAO Zi-bo, MA Qiong-jie

2018, 16(1): 72-74. doi: 10.16766/j.cnki.issn.1674-4152.000021

220 0

Abstract:
Objective To investigate the clinical efficacy of post auricular injection of methylprednisolone on treatment of idiopathic deafness and its effects on hemorheology and plasma Hcy. Methods A total of 106 patients with idiopathic deafness in our hospital from February, 2016 to February, 2017 were randomly divided into two groups according to random number method, 53 cases in every group. The control group was given dexamethasone, and observation group was added post auricular injection of methylprednisolone based on control group. After treatment, the pure tone threshold, hemorheology (plasma viscosity, hematocrit, platelet aggregation rate), plasma Hcy level, clinical efficacy of two groups were compared. Results Before treatment, there was no significant difference on pure tone threshold between the two groups (P>0.05). After treatment, the pure tone threshold of two groups were significantly decreased (P<0.05), and pure tone threshold of observation group was lower than that of control group (P<0.05). Before treatment, there was no significant difference on plasma viscosity, hematocrit, platelet aggregation rate between the two groups (P>0.05). After treatment, the plasma viscosity, hematocrit, platelet aggregation rate of two groups were significantly decreased (P <0.05), and plasma viscosity, hematocrit, platelet aggregation rate of observation group were lower than those of control group (P<0.05). Before treatment, there was no significant difference on Hcy level between the two groups (P>0.05).After treatment, the Hcy level of two groups were significantly decreased (P<0.05), and Hcy level of observation group were lower than that of control group (P<0.05). The total effective rate of observation group was 96.23%, which was significantly higher than that of control group (81.13%), P<0.05. Conclusion The post auricular injection of methylprednisolone on treatment of idiopathic deafness could improve the hemorheology and plasma Hcy level of the patients, is very worth for clinical recommendation.

A preliminary study on the relationship between noninvasive ventilation and the number and duration of acute exacerbation of chronic obstructive pulmonary disease

WANG Tong-sheng, SU Xiu-li, SUN Yu-xia, MAO Yi-min

2018, 16(1): 75-79. doi: 10.16766/j.cnki.issn.1674-4152.000022

198 1

Abstract:
Objective To assess the efficacy of noninvasive positive pressure ventilation (NPPV) on the number and duration of acute exacerbation of chronic obstructive pulmonary disease (COPD) and on the expressions of C-reactive protein (CRP) and interleukin-6 (IL-6). Methods This study included 98 stable hypercapnic COPD patients whose age were over 65 years old. The 98 patients who met the study criteria were randomized into the no NPPV group maintained on standard treatment and the NPPV group received bi-level positive pressure ventilation added to their standard treatment. Serum Brain Natriuretic Peptide (BNP), CRP and IL-6 levels were detected, to check lung function, arterial blood gases, 6-minute walking distance and record Saint George respiratory questionnaire (SGRQ), all patients were followed-up 12 months. Results After 12 months of NPPV, forced expiratory volume in one second (FEV₁% pred), arterial partial pressure of oxygen (PaO₂), SGRQ, 6 MWD were significantly higher in patients with NPPV than those in patients without NPPV, with statistically significant difference (P<0.05). Decrease in partial pressure of arterial carbondioxide (PaCO₂), number of acute exacerbation of COPD, mean duration of each exacerbation, BNP in patients with NPPV, and there was a statistically significant difference (P<0.05). The expressions of CRP and IL-6 in patients with no NPPV were significantly higher than those in patients with NPPV (P<0.05). There were significant positive correlations between the number of acute exacerbation of COPD and the level of CRP, and of IL-6 in the whole study groups (P<0.05). The frequency of acute exacerbation was significantly associated with COPD classification, which was negatively correlated with drugs before and after the FEV₁ (%), P<0.05. Multiple linear stepwise regression analysis showed that the number of acute exacerbation of COPD was associated with no NPPV, and the severity of COPD. Conclusion NPPV bears well tolerance. It can reduce the frequency of acute exacerbation of COPD and mean duration of each exacerbation, because of its relevance to the express of CRP, IL-6.

Heart rate variability in patients with type 2 diabetes and the effect of epalrestat on cardiac autonomic neuropathy

TAO Shao-ping, HANG Yu, CHEN Xue-feng, ZHOU Bei

2018, 16(1): 80-82. doi: 10.16766/j.cnki.issn.1674-4152.000023

202 3

Abstract:
Objective To investigate the changes of heart rate variability (HRV) in patients with type 2 diabetes mellitus and the effects of epalrestat on HRV. Methods Twenty-four hour Holter monitoring was conducted in 46 type 2 diabetic patients and compared with that in 28 healthy controls. All the 46 type 2 diabetic cases were randomly divided into conventional treatment group and epalrestat group. The epalrestat group was given epalrestat in addition to conventional treatment. HRV was observed after 6 months. Indices of HRV, including time domain indices and frequency domain indices, were observed. The time domain indices were as follows:24 h standard deviation of all normal to normal RR intervals (SDNN), standard deviation of 5 min mean RR intervals (SDANN), the square root of the mean of the sum of the squares of differences between adjacent NN intervals (rMSSD), percentage of successive normal RR intervals exceeding50 ms (p NN50). The frequency domain indices were as follow:LF, HF and LF/HF. Results There were significant difference in the time domain indices and frequency domain indices of HRV between healthy controls and type 2 diabetic patients (P<0.01). After 6 months of treatment, SDNN, SDANN, rMSSD, PNN50, LF, HF and LF/H were not improve in the control group (P>O. 05), however, all the time domain indices and frequency domain indices in the epalrestat group were all significantly improved, the differences were statistically significant (P<0.05). Conclusion The HRV decreases and the function of autonomic nervous system was impaired in patients with diabetic mellitus. Epalrestat may improve the function of autonomic nervous system in patients with diabetic patients.

Effect of improved umbilical vein catheterization combined with PICC in infants with extremely low birth weight

LIU Cheng-zhi, ZHOU Xiong-ying, YU Jun, WANG Yue-hua, ZHANG Zhi-qun

2018, 16(1): 83-85. doi: 10.16766/j.cnki.issn.1674-4152.000024

165 0

Abstract:
Objective The infants with extremely low birth weight often require a longer period of intravenous nutrition to ensure their normal growth and development. The aim of this paper is to observe the effect of improved umbilical vein catheterization combined with PICC in the intravenous nutrition management of infants with extremely low birth weight. Methods A total of 48 infants with extremely low birth weight were divided into control group (28 cases) and observation group (20 cases) from March, 2015 to February, 2017. The infants of the control group received traditional umbilical vein catheter and PICC, while the infants of the observation group received the improved umbilical vein catheterization and PICC. The umbilical vein catheter indwelling time, incidence of umbilical bleeding, incidence of accidental catheter detachment, PICC indwelling time, rate of once puncture success, incidence of planned extubation, time to total gastrointestinal nutrition and hospital stay were observed. Results Umbilical vein catheter indwelling time of the observation group was significantly longer than that in the control group (P<0.05), the incidence of umbilical bleeding and accidental catheter detachment had no significant difference between the two groups (P>0.05); PICC indwelling time of the observation group was significantly longer than that in the control group (P<0.05), and incidence of once puncture success and planned extubation had no significant difference between the two groups (P>0.05); The time to total gastrointestinal nutrition and hospital stay of the observation group was significantly lower than those in the control group (P<0.05). Conclusion The improved umbilical vein catheterization combined with PICC can markedly prolong indwelling time, reduce the occurrence of adverse events, and shorten the time to whole gastrointestinal nutrition and hospital stay in infants with extremely low birth weight.

Characteristics of automatic dysfunction in pregnant women with gestational hypertension and its clinical significance

CHENG Jian-xia, KONG Jian-ping, ZHANG Run

2018, 16(1): 86-88,129. doi: 10.16766/j.cnki.issn.1674-4152.000025

179 0

Abstract:
Objective To explore the characteristics of automatic dysfunction in pregnant women with gestational hypertension and its clinical significance. Methods Eighty-two pregnant women with gestational hypertension (observation group) and 50 healthy pregnant women (control group) in our hospital from January, 2016 to January, 2017 were prospectively collected. The heart rate variability of both groups was observed. The correlation between the heart rate variability and pregnancy outcome was studied. Results Compared with the control group, 24 h standard deviation of sinus R-R intervals of the observation group decreased significantly[(97.54 ±9.63) ms vs. 110.92 ±9.21 ms, P<0.001];each 5 min mean standard deviation of sinus R-R interval decreased significantly (101.56 ±9.47 vs. 109.32 ±9.42 ms, P<0.001); 24 h continuous 5 min standard deviation of sinus R-R interval decreased significantly[(41.47 ±8.83) vs. 45.82 ±8.71 ms, P=0.007]; all near the sinus R-R interval difference decreased significantly (27.82 ±9.23 vs.31.91 ±9.55 ms, P=0.016); a percentage of all the number of heart beat the number of all the two adjacent sinus RR interval difference was greater than 50 ms, which decreased significantly (10.21 ±2.38 vs. 13.38 ±4.91, P<0.001). The decrease of heart rate variability of the pregnant women in the observation group was divided into normal, mild, moderate and severe, and the value was 50.00%, 39.02%, 8.54% and 2.44%, respectively, and in the control group was 80.00%, 18.00%, 2.00% and 0.00%, respectively, P=0.006. According to the analyses of sub-group, the cesarean section rate, premature rate and 24-hour urinary albumin content in the gestational hypertension pregnant women with decreased heart rate variability increased significantly (P<0.05). Conclusion The automatic functional impairment in the pregnant women with hypertension is serious, which can lead to poor pregnancy outcome.

The current status and influencing factors of care burden among the family caregivers of the disabled elderly in Shanghai

LI Yan, HUANG Yong-xia, ZHAO Ai-ping

2018, 16(1): 89-93. doi: 10.16766/j.cnki.issn.1674-4152.000026

257 6

Abstract:
Objective To investigate the care burden level and influencing factors among the family caregivers of the disabled elderly in communities in Shanghai and to provide insights for further intervention approaches. Methods A crosssectional survey based on convenience sampling was conducted among 440 family caregivers in Pudong district in Shanghai between July, 2016 and December, 2016. All subjects were investigated using the Zarit Burden Interview (ZBI), Social Support Ratings Scale (SSRS), Geneml Self-Efficacy Scale (GSES), Medical Coping Modes Questionnaire (MCMQ) and the general social and demographical material lists. Results The total score of care burden among family caregivers was a moderate burden level, scoring 47.93 ±13.03; Univariate analysis showed that the burden of caregivers was statistically significant in chronic disease and disability time (month), Barthel index, caregiver age, caregiver education level, marital status, the relationship between the caregiver and the disabled elderly, the daily care of time, caregiver's health, family income and other variables on the distribution difference. Multiple regression analysis displayed that the main factors affecting caregiver burden were coping modes score, social support level, self-efficacy level of the caregivers, Barthel index score, the relationship with the disabled elderly, the family caregivers education status, the number of chronic diseases of the disabled elderly and the daily caring time. The multiple correlation coefficient R=0.812, and the determination coefficient R²=0.659. Conclusion The care burden of family caregivers was in a moderate level and was influenced by diverse care receiver's and caregiver's characteristics. The community nurse should comprehensively assess the disabled elderly and their family caregivers, according to the influencing factors providing targeted measures to reduce the burden of caregivers.

Investigation on Medical Staff' Cognition of Family Doctor Signing Service

WANG Rong-ying, ZHANG Jin-jia, HE Zhen-yin, WANG Qian, WANG Ya-yi, WANG Jin-yan, ZHI Xiao

2018, 16(1): 94-96,138. doi: 10.16766/j.cnki.issn.1674-4152.000027

201 4

Abstract:
Objective To investigate the cognitive status of medical staff about family doctor signing service and suggestions for the construction of basic health system in order to provide suggestions for further promotion of the family doctor service. Methods A total of 492 medical staff were asked to fill in the questionnaire survey. Results ①The majority staff were between 30 and 50 years old (321, 64.46%), in possession of bachelor's degree (233, 47.35%), with intermediate professional title (196, 39.84%), majoring in general practitioner (244, 49.00%), and from community service centers and township hospitals (200, 40.16%). ②A total of 156 staff (31.33%) were involved in the family doctor service, and 218 staff (43.78%) were willing to participate in the family doctor signing service. The reasons of reluctance mainly included:106 staff (21.29%) thought that residents didn't recognize it, 96 staff (19.28%) thought that national policy could not motivate staff enthusiasm. According to 215 staff (43.17%), the signed service objects were patients with chronic diseases. And 432 staff (86.75%) and 404 staff (81.12%) believed that the main content of family doctor signing service was the diagnosis and treatment of common diseases and the management of chronic disease respectively. The main problem in the promotion of family doctor signing service was the improvement of medical performance of basic general practitioners (453, 90.96%). Problem that required government focus was that the quality and quantity of family doctor signing service should be commensurated with the doctor's income (455, 91.37%). ③ Besides, 289 staff (58.03%) thought they knew the family doctor signing service. Medical staff thought the problems of the basic health system were the poor medical skills of the community doctors (453, 90.96%) and the residents' distrust of the community doctors (402, 80.72%). ④ Suggestions for improvement of the basic health system were to strengthen the hospitals' support and training for the basic health system and to improve the treatment of the basic medical staff. Conclusion The government should continue to strengthen the policy support, the comprehensive hospitals' support for basic medical institutions and the construction of basic health system in order to improve the ability of general practitioner services and ensure that the family doctor signing service goes smoothly.

The application effect of group counseling combined with peer education in patients with interstitial lung disease

WANG Lu, ZHAO Nan, LV Si-hui, XU Jin-zhi

2018, 16(1): 97-99. doi: 10.16766/j.cnki.issn.1674-4152.000028

208 0

Abstract:
Objective To explore the application effect of group counseling combined with peer education in patients with interstitial lung disease. Methods Altogether 134 cases with interstitial lung disease from March, 2015 to June, 2016 in our hospital were selected and randomly divided into control group and experimental group with 67 cases in each group;the control group was treated with conventional methods of care, including diet and drugs prescribed to care, providing relevant knowledge, and conventional oxygen therapy and respiratory function training; the patients in the experimental group had group psychological counseling combined with peer education based on the control group patients nursing which mainly includes the establishment of group psychological counseling and peer education group, with formal training before the experiment; psychological counseling to patients, monthly "experience exchange meeting " among peer education group to share the experience; after 3 months of nursing, the quality of life, anxiety, and depression status and nursing satisfaction of the two groups were observed and compared. Results After 3 months of nursing care, SAS, SDS scores of patients in the control group were higher than those in experimental group (P<0.05); quality of life score in control group was lower than that in the experimental group with statistical significance (P<0.05); nursing satisfaction of patients in experimental group was 97.01% (65/67), nursing satisfaction of patients in the control group was 79.10% (53/67), thus the experimental group was higher than control group (χ²=7.332, P=0.026). Conclusion Group counseling combined with peer education can improve the quality of life of patients, improve the patient'mental state, and the application effect is significant.

Clinical effect analysis of family planning technical services education for abortion patients

YOU Ai-xia, DENG Zhi-feng

2018, 16(1): 100-102. doi: 10.16766/j.cnki.issn.1674-4152.000029

105 0

Abstract:
Objective To analyze clinical effect analysis of family planning technical services education for abortion patients. Methods From January, 2014 to October, 2016, 110 cases of abortion in our center were selected as our research object, and randomly divided into control and observation group. The control group received routine postoperative health instruction, on the basis of which the observation group got guidance for family planning education. We compared two groups of patients in the hospital review of contraceptive knowledge and active contraceptive rates, and conducted follow-up of patients after one year postoperative incidence of unintended pregnancy rates and abortion rates again. Results Before surgery, there was no statistical significance between study group and the control group in contraceptive knowledge and active contraceptive prevalence rate. After implementation of family planning service guidance education, hospital review average score of the observation group on contraceptive birth control knowledge was (9.12 ±1.06), far above control group (6.03 ±2.15). Active contraceptive rate of observation group was 94.5%, and that of control group was 76.4%. Follow-up of one year showed that post operation accidental pregnancy rate and the ratio of abortion surgery of observation group were 2.1% and 0, far below control group of 16% and 12%. Comparisons between the two groups were statistically significant. Conclusion Family planning technical service of abortion patients is clinically effective, promoting contraceptive knowledge, correct active contraceptive method, and reducing postoperative incidence of unintended pregnancy rates and abortion rates again, thus greatly improving the reproductive health of patients, which is worth spreading.

High expression of DNA repair factor BRCA2 promotes epidermal growth factor inhibitor resistance in diffuse large B cell lymphoma

ZHUANG Shun-hong, HU Hui-xian, ZHANG Jing-cheng

2018, 16(1): 103-106. doi: 10.16766/j.cnki.issn.1674-4152.000030

193 0

Abstract:
Objective To investigate the relationship between DNA repair factor BRCA2 and epidermal growth factor inhibitor resistance in diffuse large B cell lymphoma. Methods Single cell cloning experiment was used to screen inhibitors of epidermal growth factor resistant cells. Western blot experiment was used to detect the expression of BRCA2 molecules in the resistant cells. RNA interference was used to specifically downregulate the expression of drug resistance BRCA2 cells. Proliferation and apoptosis of cells on BRCA2 expression and cell apoptosis and resistance to wash it well with new relationship between the ability of self. Results The successful selection of diffuse large B cell lymphoma cells resistant to inhibitors of epidermal growth factor. Western blot experiment, diffuse large B cell lymphoma epidermal growth factor inhibitor resistant cells with high expression of BRCA2; to explore the expression of BRCA2 and diffuse large B cell lymphoma by sub epidermal growth inhibitor resistance between the cell clone formation experiment showed that compared to the normal the number of clones resistant cells, down-regulation of BRCA2 cells 6 orifice hole single cell clone greater than 20 cells decreased 5 times; and the apoptosis of Tunel cells showed the resistance compared to normal cells, optical fluorescence microscopy observation of BRCA2 apoptosis ratio increased 6 times. Conclusions In this study, for the first time, we found that the expression of BRCA2 was highly expressed in the epidermal growth factor receptor (BRCA2) in diffuse large B cell lymphoma, and the down-regulation of the drug resistance in the resistant cells could promote the cell apoptosis and self-renewal ability. The relationship between DDR (DNA damage response) and EGFR was found by using the DNA damage response molecule as the breakthrough point, in order to provide more theoretical basis for the clinical treatment of diffuse large B cell lymphoma in the future.

Analysis and interpretation of the type of pulmonary embolism complicated with deep venous thrombosis of the lower extremities

WANG Ying, WANG Xiao-gao, SONG Tao, GAO Yong, YU Chao-wen, NIE Zhong-lin, CHEN Shi-yuan, LU Ran

2018, 16(1): 107-109. doi: 10.16766/j.cnki.issn.1674-4152.000031

262 0

Abstract:
Objective To analyze the clinical symptoms and lower extremity anterograde venography imaging, to sum up the clinical features of pulmonary embolism complicated with deep venous thrombosis of the lower extremities, and to provide guidance for clinical diagnosis and treatment. Methods The clinical symptoms and anterograde lower extremity venography imaging of 43 cases who were diagnosed as pulmonary embolism at the first Affiliated Hospital of Bengbu Medical College from October, 2013 to October, 2016 were retrospectively analyzed. Results There were 27 patients with lower extremity mild swelling, 10 patients with lower extremity severe swelling, 8 patients without lower extremity swelling in clinical symptoms. The percentages were 60.0%, 28.9% and 11.1%, respectively. The patients of calf deep vein thrombosis with popliteal vein, femoral vein and iliac vein patency was 9 (20% of the total number); the patients of popliteal vein and femoral vein thrombosis with iliac vein patency was 19 (42.2% of the total number); the patients of iliac vein thrombosis was 10 (22.2% of the total number) by anterograde lower extremity anterograde venography imaging. The deep venous thrombosis of lower extremity with thrombosis of inferior vena cava is 7 (15.6% of the total number) by vena cava angiography. There are 45 cases with iliac vein patency or incomplete occlusion in all patients, most patients with mild to moderate swelling or no swelling. Conclusion The patients of lower limb swelling of the lower extremities deep vein thrombosis are more easily complicated by pulmonary embolism; iliac vein patency and thrombosis of inferior vena cava is very dangerous in the disease of venous thromboemlism through anterograde vein venography.

Clinical analysis of depressive state score and related gene protein expression in breast cancer patients

LING Ying-chun, ZHOU Yue-qin, SHEN Qun-di, DONG Ying-ying, SHEN Jun-jun

2018, 16(1): 110-112. doi: 10.16766/j.cnki.issn.1674-4152.000032

281 1

Abstract:
Objective To analyze the depressive state of breast cancer patients, investigate its correlation with the expression of related genes and the practical implications for clinical practice. Methods From January, 2015 to December, 2016, a total of 112 female patients diagnosed with breast cancer were selected as the subjects. Age was 32-68 years old, the average age was (48.0 ±5.5) years. To evaluate the patients' depression using the Hamilton Depression Scale (HDMD), according the results all the patients were divided into depression group and non-depression group. Using the method of real-time fluorescent quantitative PCR detection, analysis and purificate the total mRNA of cells, and compared with the differences between the two groups in the expression of microRNA-320 a, microRNA-17-5 p, microRNA-223-3 p, microRNA-451 a, microRNA-223, microRNA-452 gene protein. The correlation between depression and depression was analyzed. Results The HAMD score in the depressive patients was (13.7 ±1.6) scores, it was significantly higher than that in the non-depressive patients[(3.6 ±1.1) scores] (t=39.516, P<0.05). Compared with the differences between the two groups in the expression levels of microRNA-320 a, microRNA-451 a and microRNA-223, it was statistically significant (statistic value Z were respectively 6.252, 5.183, 7.904, all P<0.05). Pearson correlation analysis results showed that in breast cancer patients the depression status was related to age distribution (R=0.420, P=0.040), clinical stage (R=0.610, P=0.013), and the gene expression changes of microRNA-320 a (R=0.500, P=0.023), microRNA-451 a (R=0.430, P=0.034), microRNA-223 (R=0.660, P=0.010) and other. Conclusion The clinic could monitore the HAMD score, and pay attention to the expression of microRNA-320 a, microRNA-451 a, microRNA-223 and other microRNA expression, it can be used to evaluate the depressive state of breast cancer patients, and provide guidance for the later treatment.

Research progress in orthostatic hypotension with Parkinson's disease

ZHOU Pei-xuan, LI Shuang-qing

2018, 16(1): 113-117,163. doi: 10.16766/j.cnki.issn.1674-4152.000033

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Abstract:
Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder characterized by a variety of motional and non-motional features (sleep disorder, cognitive dysfunction, autonomic dysfunction, etc.), involving many neuroanatomic areas. Orthostatic hypotension (OH) occurs when cardiovascular adaptive mechanisms fail to compensate for the reduction in venous return when transforming from supine to erect position. It is associated with significantly increased risk of coronary heart disease and stroke incidence. OH, as one of the common autonomic dysfunction symptoms of PD, may cause other symptoms like dizziness, syncope, generalized weakness, muscular pain and so on. OH can result in falls and trauma, which have a strong impact on the quality of life of PD-patients. A degree of damage to the postganglionic sympathetic nerves is suggested as the main cause of OH, with some other factors including age increasing, disease severity or duration. In addition, Vitamin D deficiency, low leptin level and low BMI are also associated with OH in PD patients, according to some recent studies. Removing some predisposing factors and adopting non-pharmacological intervention are the first steps in treatment, while pharmacological treatments can also help with symptomatic relief. But none of them is specifically treating OH in PD patients. Medication management of OH in PD-patients should be guided by specific factors of the patients. Although effective, pharmacological treatments can also lead to or exacerbate supine hypertension (SH) -a common complication of OH, which can complicate the treatment. In this review, we intend to summarize the progress on different aspects of OH in PD-patients including diagnosis, pathogenesis, management and treatment.

Role of ATF4 in cancer progression and treatment resistance

LIN Hao, ZHANG Jie, GUO Jun-bin, LIU Tai-ran, SU Mei-yun, SHAN Shun-lin

2018, 16(1): 118-121,159. doi: 10.16766/j.cnki.issn.1674-4152.000034

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Abstract:
The occurrence and development of carcinoma depend on a number of factors and multiple genetic changes and is a multi-step process. Besides cancer tissue itself, the hypoxia, low glucose, low amino acids and low PH value of the cancer microenvironments were also interacted with cancer, these cancer microenvironments resulted in stress response, including stabilization of hypoxia-inducible factors (HIFs), induction of the unfolded protein response (UPR) and activation of the AMP-activated protein kinase (AMPK) pathway, which was also involved in cancer progression, angiogenesis, invasion, metastasis and therapeutic resistance. Activating transcription factor 4 (ATF4) belongs to the activator of transcription family (ATF) with the basic region leucine zipper (b ZIP) that is involved in protein-protein interactions.ATF4 plays important role in regulating the survival, growth and development of normal tissue, and involved in autophagy, redox and apoptosis. The recent study shows that the expression of ATF4 increase in various cancer tissues, especially in cancer microenvironment (region lacking of nutrients), suggesting that ATF4 in cancer microenvironment is involved in the maintenance of cancer metabolism, the survival of cancer cell in the lack of nutrition, and is related with cancer progression and drugs resistance. This paper mainly summarizes about the sources and role of ATF4 in cancer cell growth and development and in cancer biology, and its mechanism in cancer progression and drug resistance, the paper also prospects the role of ATF4 related cancer treatment, and provide ideas for anti-cancer research targeting the ATF4 pathway.

Effects of TCM Zishen Liangxue cycle therapy on the expression of ER,PR and VEGF in endometrium of patients with endometriosis-related infertility and the correlation with endometrial receptivity

SONG Qiao-yu, ZHAO Shan-qiong

2018, 16(1): 122-125,134. doi: 10.16766/j.cnki.issn.1674-4152.000035

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Abstract:
Objective Many study focus on the low pregnancy rate in patients with endometriosis-related infertility. The key treatment for increasing the pregnancy rate is to improve the endometrial receptivity. The aim of this study is to observe the effect of TCM Zishen Liangxue cycle therapy on the the expression of ER, PR and VEGF in endometrium of patients with endometriosis-related infertility, and explore the clinical efficacy of TCM Zishen Liangxue cycle therapy in improving the pregnancy rate and the endometrial receptivity. Methods Total 130 patients with endometriosis-induced infertility in our hospital from July, 2015 to September, 2016 were enrolled into this study. Among them, 60 patients were defined as mild group, and other 70 cases were assigned into moderate-to-severe group. The patients in the mild group were randomly divided into TCM group (TCM Zishen Liangxue cycle therapy for continuous three months) and control group (without treatment), the clinical efficacy was observed for six menstrual cycles. The patients in the moderate-tosevere group were randomly divided into treatment group and western medicine group. All the patients in both groups received GnRH-a injection on the first day of menstruation after the operation, one injection every 4 weeks for three courses, then the treatment group continuous received treatment of TCM Zishen Liangxue cycle decoction for three menstrual cycles, while the western medicine group was only treated with GnRH-a. The expression of ER, PR and VEGF in endometrium before and after the treatment in all groups was tested by immunohistochemistry. Thee pregnancy rate were also observed. Results ① in the mild group:there were significantly lower expression of ER and VEGF in endometrium after treatment in TCM group as compared with the control group (P<0.05). There were no significantly change in the expression of PR (P<0.05). ② in moderate-to-severe group:significantly lower expression of ER, PR and VEGF in endometrium in the treatment group were observed after the treatment (P<0.05). ③ Significant increase of pregnancy rate were found in both TCM group and treatment group when compared with the contrast groups, the difference was statistical significant (P<0.05). Conclusion TCM Zishen Liangxue cycle therapy can improve the expression of ER, PR and VEGF in endometrium and increase the pregnancy rate of patients with endometriosis-related infertility. It has a close relationship with the improvement of the endometrial receptivity.

Application of mind map in rehabilitation guidance of laryngeal carcinoma patients after total laryngectomy

ZHANG Li-na

2018, 16(1): 126-129. doi: 10.16766/j.cnki.issn.1674-4152.000036

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Abstract:
Objective To explore the application and effect of mind map in the rehabilitation guidance in laryngeal carcinoma patients after total laryngectomy. Methods Total 84 laryngeal carcinoma patients undergoing total laryngectomy were selected from January 2012-2014 year in January in our hospital. According to the random number table, the patients were divided into control group and experimental group with 42 cases in each group. The control group received routine discharge guidance, while the experimental group received rehabilitation guidance with mind map. The discharge guidance effect was investigated by using self-designed questionnaire and the satisfaction of patients for the referral and rehabilitation guidance were recorded and analyzed. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was used to evaluate the quality of life of patients, and the Hamilton Anxiety Rating Scale (HAM-A) was used to assess the psychological condition of patients. Results The cases with a good awareness of prevention of the complications, medication administration, diet and living habits during the recovery period, revisiting time and key points 32 cases, 34 cases, 34 cases and 40 cases in the experimental group, which were significantly higher than the control group (21 cases, 26 cases, 23 cases and 31 cases), the difference was statistically significant (P<0.05). The revisiting rate was 88.1% in the experimental group, which was significantly higher than 69.0% in the control group; the satisfaction of patients to the rehabilitation guidance was 71.4% in the experimental group, which was higher than 52.4% in the control group, with statistically significant differences between the two groups of data (P<0.05). The score for the quality of life by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire were as follow:the overall function was (90.1 ±2.4), emotional function (89.9 ±3.2), physical function (86.4 ±1.7), role function (94.1 ±2.7), cognitive function (90.8 ±3.0) points in the experiment group, and were (82.8 ±1.6), (81.4 ±2.1), (80.8 ±2.5), (86.6 ±3.1) and (83.4 ±2.6). The state of the heart was significantly better than the control group, the experimental group of patients with normal heart state patients accounted for 81.0%, the control group of patients with normal heart state patients accounted for 38.1%, the difference was statistically significant (P<0.05). Conclusion The mind map used in the rehabilitation guidance in laryngeal carcinoma patients after total laryngectomy can improve the awareness rate of patients with the rehabilitation related knowledge, increase patient satisfaction and improve the quality of life of patients, worthy of clinical application.

Analysis on family physician education in Canada

LI Lun, WANG Chen

2018, 16(1): 130-134. doi: 10.16766/j.cnki.issn.1674-4152.000037

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Abstract:
Canada has a long history of family medicine. The analysis and introduction of the Canadian training system of family physicians focus on the description of the"4 + 4 + 2"training pattern, full-time education in institutions of higher learning and professional norm training of resident physicians. Through many layers, Canada improves its training system of family physicians, continuous professional development, promotion and implementation of a series of strict standards to ensure the high quality of primary health care. Using the successful experience of Canada's family medical education, with the combination of domestic situation, the paper discusses and compares the features, teaching and organizing patterns and faculty sizes of family physicians training between the two countries. The advantages of the Canadian system show in the following aspects:firstly, clear training steps, target and approaches. Secondly, supportive the college of family physicians of Canada (CFPC), organized government 's program, university training and helpful cooperation.Thirdly, excellent family medical students resources, ample and committed faculty resources, and favourable conditions for family medicine development. The training features of Canadian family physicians lie in the structural integrity and continuity, starting from medical school's education, and focusing on the training for the normalization of resident physicians of family medicine, and through continuing medical education connecting education and training with lifelong career. In contrast, the realization of training target of domestic family physicians and rational development of family medicine still faces challenges. Learning from the successful experience and state-of-the-art education ideas of Canadian family physicians training system is conducive to the construction and improvement of the domestic system with Chinese characteristics and means significantly to easing the urgent demand of professional family physicians in community health services.

Application of GC-MS technique to determination of malnutrition in elderly patients plasma small molecule metabolites qualitative research

YANG Wei-jia, YANG Min-chun, YAO Hui, WANG Li-jun, ZHENG Pei-fen

2018, 16(1): 135-138. doi: 10.16766/j.cnki.issn.1674-4152.000038

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Abstract:
Objective To determinate small molecules in elderly patients with malnutrition plasma metabolic substances by using GC-MS method, looking for is closely related to the malnutrition in elderly patients with development of small molecule metabolites; to discuss application of metabonomics in elderly patients with malnutrition. Methods From February, 2015 to February, 2016 in our hospital diagnosis and treatment of 30 cases of malnutrition in elderly patients were selected as experimental group, during the same period by age, gender, match the old people in 30 cases of normal nutritional status as the control group. Acquisition of both groups respectively since morning fasting venous blood 5 ml, let stand separation blood plasma, repackaging kept at low temperature. The two groups was evaluated by GC-MS method plasma small molecule metabolic substances. Using principal component analysis and discriminant analysis on two groups of minimum variance research object plasma statistical analysis of small molecules metabolic substances small molecules and compare the two groups of plasma metabolic material level. Results Both groups blood plasma total ion current chromatogram basic similar. The chromatographic retention time are mainly concentrated in 5-15 min, The experimental group was significantly lower than the control group. The experimental way and the control sample principal component score chart can clearly distinguish. The experimental group and control group permutation test intercept R²=0.668, Q²=0.309. glycine, aspartic acid. Sue sugar acid response values of the experimental group were higher than the control group, while ornithine, oleic acid, uric acid, D-talose, N-methyl-DL-alanine, mannose, D-glycerophosphate, alpha and beta alanine glutaric response values to lower (P<0.05). Conclusion GC-MS method can detect small molecules related to the elderly patients with malnutrition metabolic material types, Prompt GC-MS method can be used as in elderly patients with malnutrition screening of small molecule metabolites detection method.

The clinical features of Clostridium difficile infection in patients with septic shock

LU Xiao-zhen, ZHANG Yi, CHEN Tong-en, XU Zhao-jun

2018, 16(1): 139-141. doi: 10.16766/j.cnki.issn.1674-4152.000039

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Abstract:
Objective Clostridium difficile was a major factor leading to poor prognosis and prolonged hospital stay in critically ill patients. The present study was to investigate the clinical features of Clostridium difficile infection in patients with septic shock. Methods From January, 2015 to December, 2016, 218 consecutive cases of patients with septic shock in our hospital were collected. According to the development of Clostridium difficile infection or not, all patients were assigned into an infection group (n=56) or a control group (n=162). The clinical features of the both groups were compared. Results Compared with the control group, patients in the infection group got higher rates of APPACHEⅡ ≥ 20 (57.14% vs. 31.48%, P=0.001), lactate ≥ 4 mmol/L (67.86% vs. 46.91%, P=0.007), acute kidney injury (71.43% vs. 46.30%, P=0.001), acute lung injury (75.00% vs. 54.32%, P=0.007), multiple organ failure (51.79% vs. 30.86%, P=0.005), antibiotics usage ≥ 14 days (60.71% vs. 41.98%, P=0.015), proton pump inhibitor ≥ 14 days (60.71% vs. 44.44%, P=0.036), vasoactive drugs ≥ 7 days (41.07% vs. 25.93%, P=0.033), mechanical ventilation (62.50% vs. 40.74%, P=0.005) and hemofiltration (50.00% vs. 34.57%, P=0.041). Multivariate logistics regression analysis revealed that APPACHE score ≥ 2 0 and lung failure were risk factors for Clostridium difficile infection in septic shock patients (P<0.05). Conclusion APPACHE score ≥ 20 and lung failure were risk factors for Clostridium difficile infection in septic shock patients. Intensive care and prevention should be taken to reduce the infection rate of Clostridium difficile in these critically ill patients.

Nursing in patients with coronary artery disease and diabetes intervention on the complications of coronary artery interventional therapy

WU Yu-ping, LIN Xiao-jie, CENG Min

2018, 16(1): 142-144. doi: 10.16766/j.cnki.issn.1674-4152.000040

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Abstract:
Objective To explore effect of the nursing intervention for patients with coronary heart disease, diabetes mellitus coronary artery interventional treatment on complications. Methods From January, 2014 to October, 2014, 114 cases of hospitalized patients with interventional therapy of coronary artery disease patients with diabetes as the main object of observation were randomly divided into observation group and the control group, with 57 cases in each group. Apply nursing intervention to observation group, and control group using conventional care. After 1 year of follow-up, we compared the incidence of complications and clinical indicators (systolic blood pressure and fasting blood sugar) between the two groups of patients after coronary artery intervention treatment. And quality of life of patients is evaluated; the results were statistically analyzed via t-test. Results We observed a complication rate of 45.61% in observation group which was obviously lower than 94.74% in the control group with statistical significance (t=-2.409; P=0.0085). Systolic blood pressure in patients with nursing intervention of observation group was obviously lower. Fasting glucose values were significantly closer to normal. The clinical index in observation group outperformed that in the control group (P<0.05). With diabetes specific evaluation of the quality of life scale, the total score and several dimensions in observation group were significantly lower than the control group after evaluation, with statistical significance (P<0.05). Conclusion Nursing intervention can effectively avoid the incidence of the complications after coronary artery intervention in patients with risk, maintain systolic blood pressure, make fasting blood glucose value return to normal, lower systolic blood pressure and fasting blood sugar, and improve the quality of life of patients with diabetes. It helps to improve the rehabilitation status and social function recovery, and the application effect is good, with lower clinical medical cost.

Effect of collaborative care model on the toxicity of chemotherapy combined with TACE in the treatment of gastric cancer with liver metastasis

WANG Cai-xia, LIU Lei

2018, 16(1): 145-147,150. doi: 10.16766/j.cnki.issn.1674-4152.000041

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Abstract:
Objective To study the effects of collaborative nursing model on the toxicity of chemotherapy combined with TACE in the treatment of gastric cancer with liver metastasis. Methods From January, 2014 to March, 2016, 80 cases of patients with liver metastases from gastric cancer were diagnosed in our hospital. All patients were treated with unified chemotherapy and TACE treatment. The patients were randomly divided into observation group (40 cases) and control group (40 cases). Via SPSS 22.0, the depression before and after the treatment, toxic and side effects of the treatments were compared with t test. And the satisfaction of nursing work was analyzed with variance analysis. Comprehensive evaluation of collaborative care model on the incidence of adverse reactions in patients with liver cancer was made. Results The depression score of patients in the observation group after 14 days of treatment had significant difference compared to that before admission (P<0.05); depression scores of the observation group and those of the control group after 14 days of treatment had significant difference (P<0.05); between collaborative care group and routine nursing group, nausea and vomiting, mucositis, renal dysfunction, infection, bone marrow suppression rate were lower, with statistical significance (P<0.05); the satisfaction rate of 36 cases in the observation group was 90%, significantly higher than that of 29 cases in the control group which was 72%, and the difference was statistically significant (P<0.05). Conclusion Collaborative nursing model of chemotherapy combined with TACE in the treatment of gastric cancer with liver metastasis can reduce the negative emotions of patients, reduce the adverse reaction rate, reduce the pain of patients, provide high compliance of the patients and help patients smoothly complete treatment plan.

Analysis of perioperative high risk factors and nursing countermeasures for elderly patients in thoracic surgery

CHEN Hai-yan, ZHENG Yi-feng

2018, 16(1): 148-150. doi: 10.16766/j.cnki.issn.1674-4152.000042

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Abstract:
Objective To explore the risk factors of perioperative period in elderly patients with thoracic surgery and to develop some reasonable care strategies to reduce the risk of postoperative infection. Methods Totally 432 cases of chest surgery in elderly patients with clinical data were analyzed. The 432 patients, which were treated in Huzhou central hospital of Zhejiang from May, 2015 to May, 2016, were divided into two groups, nosocomial infection (36 cases) and uninfected group (396 cases). Statistical analysis runs to analyze the correlation between the patients' infection and clinical data, thus to make corresponding nursing treatment. Results Thirty-six patients (8.3%) out of 432 the elderly patients after thoracic surgery were infected and the rest did not show infection (91.7%). Among them, the lower respiratory tract infection occurred in 24 cases, accounting for about 58.5% of the cases of infection. And 5 cases infections occurred in the upper respiratory tract (12.2%); 3 cases infections occurred in the epidermal incision (7.3%); 4 cases infections occurred in the deep incision (9.9%); 3 cases infections occurred in the pleural cavity (7.3%); 2 cases infections occurred in the urinary tract (4.8%). Through single factor analysis, we found that infection of patients were related with age, smoking history, duration of hospital stay and risk factors score (χ²=5.527, 8.569, 4.159, 7.421, respectively), and the difference was statistically significant (P<0.05); and the statistical analysis showed infections had no correlations with gender, surgery time, blood loss (P>0.05). Conclusion Age, history of smoking, duration of hospital stay and risk factors score were high risk factors for elderly patients of thoracic surgery in the perioperative period. Comprehensive improvement of nursing measures can effectively reduce the incidence of postoperative infection and complications. And it had important guiding significance to the success of surgery.

Effect of PDCA circulation model on the standardization of emergency treatment in department of neurosurgery

XU Rui-qi, YANG Shuo, SHAN Dan, HUANG Shuang

2018, 16(1): 151-153. doi: 10.16766/j.cnki.issn.1674-4152.000043

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Objective To explore the effect of PDCA circulation model on the standardization of emergency treatment in department of neurosurgery and seek the way to improve the nursing. Methods Altogether 273 emergency cases treated in the department of neurosurgery in our hospital from January, 2015 to June, 2015 were selected as control group, with emergency 243 cases from July, 2015 to December, 2015 in the department of neurosurgery in our hospital as the experimental group, and the control group received routine emergency care. The experimental group received PDCA on the basis of the emergency rescue and nursing care. We compared the nursing plan and implementation plan, the content mismatching the medical record time inconsistency, or summary of event reporting errors, temperature and care records in a few cases, the amount of volume which did not match record and did not match the comparison at the same time, the rescue of the two groups of patients with the comparison between success rate and satisfaction rate. Results Two groups of patients with nursing defects of comparison, The test group, planning and implementation plan, record the content does not match the medical record time inconsistency, or summary of event reporting errors, temperature and amount of care records do not coincide, the amount of record does not match, surgical patient information, surgical site identification, surgery patients, surgical site and surgical identification error rate 8.1%, 10.6%, 6.6%, 5.5%, 13.9%, 7.3%, 2.9%, 0%, 3.7% patients, patients in the control group were 11.9%, 14.0%, 9.9%, 8.2%, 18.9%, 17.3%, 10.7%, 9.9%, with significant differences (P<0.05). The comparison of the retained foreign body between the two groups were not significant (P>0.05). The rate of successful rescue and patients satisfaction were 72% (175 cases) and95.9% (233 cases) respectively in the experimental group, and 55.7% (152 cases) and 82.1% (224 cases) in the control group, with statistical significance (P<0.05). Conclusion The PDCA cycle model can make the emergency rescue record more standardized, and improve the quality of nursing.

Self-efficacy and influence factors in elderly patients after knee arthroplasty surgery

HONG Yi

2018, 16(1): 154-156. doi: 10.16766/j.cnki.issn.1674-4152.000044

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Abstract:
Objective Self-efficacy is the belief of the patient to complete the relevant target, and the effect of self-efficacy is very important for the recovery of knee joint function in patients undergoing knee replacement. The aim of this paper is to investigate the influence factors of postoperative self-efficacy in elderly patients with knee arthroplasty. Methods According to SER scores, A total of 92 elderly patients with knee arthroplasty in our hospital between January, 2014 and December, 2015 were enrolled and divided into pass group (52 cases) and fail group (40 cases) according to the Self-Efficacy for Rehabilitation Outcome Scale (SER). The anxiety scores, depression scores and social support scores were compared between the two groups. The risk factors of self-efficacy in elderly patients with knee arthroplasty were analyzed. Results The age of patients in the pass group was significantly lower than that in the fail group (t=-2.325, P=0.022), cultural degree and per capita monthly income of the pass group was significantly higher than those in the fail group (Z=-2.070, -2.274; P=0.038, 0.023); Anxiety scores and depression scores were significantly lower than those in the fail group (t=-6.972, -6.142; P<0.001), and social support scores was significantly higher than that in the fail group (t=8.683, P<0.001); Binary Logistic multi-factor regression analysis showed that age, anxiety and social support were the independent risk factors for the self-efficacy in elderly patients with knee arthroplasty. Conclusion The elderly patients with knee arthroplasty are usually with a low level of postoperative self-efficacy.The age, anxiety and social support are the independent risk factors of self-efficacy. Some targeted nursing program should be formulated to standardize the nursing care and strengthen the postoperative rehabilitation education, so as to improve the self-efficacy of patients.

YIN Qing-ming, DONG Wei-guo, TIAN Shan, LIAO Fei

2018, 16(1): 157-159. doi: 10.16766/j.cnki.issn.1674-4152.000045

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WANG Cheng-yin, HUANG Jian-hong

2018, 16(1): 160-163. doi: 10.16766/j.cnki.issn.1674-4152.000046

177 2

Abstract:

SUN Chuan-tao, TONG Qiang, LI Sheng-bao, DENG Wei-ping, LI De-ping, YANG Fan, DAN Bao-zhen

2018, 16(1): 164-166. doi: 10.16766/j.cnki.issn.1674-4152.000047

176 0

Abstract:

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2018 Vol. 16, No. 1

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