中华全科医学

Understanding, attitudes and demand on evidence-based medicine among general practitioner in Beijing urban area

ZHAO Xue-xue, LU Xiao-qin, LIU Yan-li, WEI Yun, ZHAO Ya-li

2018, 16(11): 1773-1776. doi: 10.16766/j.cnki.issn.1674-4152.000482

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Objective To investigate the cognition and practice on evidence-based medicine (EBM) among the general practitioners (GPs) in Beijing urban area. Methods A proportioned stratified random sampling method was used to sample among 148 community health service centers in Beijing urban area, and 26 community health service centers and 108 attached community health service stations were surveyed. A total of 477 GPs were investigated and 439 questionnaires were available. Results ①29.2% of the GPs were with a good understanding of the concept of EBM than other items, and relatively poor understanding of the procedures of EBM. Their understanding of EBM was significantly different among GPs with different ages, academic qualifications, licensed types, years of service and professional titles (P<0.05). ②The GPs had a positive attitude toward EBM. Eighty-two point two percent of the GPs agreed that the best evidence might played an important role in clinical practice, 82.2% of the GPs agreed on the important role of clinical practice guidelines for individual treatment. There was a statistically difference in the attitude of the GPs with different degrees in EBM (P<0.05). ③The GPs had a great demand for EBM. The most urgent need of GPs was to regularly participate in EBM knowledge and skills training (77.9%). Secondly, The community should provide the medical staff with the facilities for evidence-based practice (77.4%). Conclusion GPs have gradually realized the importance of EBM, and their need for EBM is also urgent. Therefore, in order to improve the current situation of GPs in practicing EBM, we should make full use of existing resources to promote EBM.

CAO Jia-ying, PAN Jia-hua

2018, 16(11): 1777-1778.

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Expression level and prognosis significance of microRNA-181b in patients with chronic lymphocytic leukemia

LIU Hong, MAO Min, WANG Xiao-min, WANG Yi-lin, HUANG Qin, WANG Zeng-sheng, WANG Yi-chun, ZHANG Yue-yue, LI Yu-tong, WANG Cai-li, LI Yan

2018, 16(11): 1779-1783. doi: 10.16766/j.cnki.issn.1674-4152.000483

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Objective To explore the differences in expression level of miR-181b (miR-181b) in CD19⁺ B lymphocytes in patients with chronic lymphocytic leukemia (CLL) and analyze its clinical significance. Methods Fifty patients with CLL, and collecting healthy controls 20 cases. All patients took 15ml of peripheral blood and the total RNA of CD19⁺ B lymphocyte was extracted after sorting with CD19 magnetic beads, and the expression lever of miR-181b was measured by TaqMan probe. The difference expression lever of miR-181b in prognostic groups were analyzed, such as clinical stages, Serological indicators, CD38, Zeta chain related protein kinase-70, immunoglobulin heavy chain variable region and Abnormal genetics. Survival analysis was performed on the above indexes. Results ① The expression lever of miR-181b in CD19⁺ B lymphocytes in Fifty patients with CLL was significantly lower than the healthy controls (P<0.01). ② The expression level of miR-181b in different groups:according to the prognosis of FISH groups, the poor prognosis group was significantly lower than the favorable prognosis group (P<0.05), ATM deletion group was significantly lower than the ATM normal group (P<0.05), There was no statistical difference in the expression level of miR-181b in other groups (P>0.05). ③ Survival analysis:The expression level of mir-181b was divided into low expression group and high expression group by median of 0.033. The comparison showed that the OS of mir-181b low expression group was shorter than the mir-181b high expression group (P<0.05). Combined COX multivariate analysis with poor prognostic factors, the results showed that the high-risk group of FISH prognosis group, P53 deletion, ATM deletion, miR181b lower expression were all independent prognostic factors affecting survival (P<0.05). Conclusion The expression level of mir-181b in CLL patients is significantly lower than normal people, and the low expression of mir-181b is an independent prognostic factor of CLL.

Correlation between retina perfusion index and degree of non-proliferative diabetic retinopathy

QIAN Li-jun, MA Jian, YIN Hou-fa, ZHU Su-ning, ZHOU Gui-zhen, ZHENG Hong-fei

2018, 16(11): 1784-1786,1803. doi: 10.16766/j.cnki.issn.1674-4152.000484

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Objective To evaluate the vessel density, flow index and foveal avascular zone of superficial and deep capillary plexus (DCP) in non-proliferative diabetic retinopathy (NPDR) patients with noninvasive optical coherence tomography angiography (OCTA), and explore the relationship between perfusion index and degree of NPDR. Methods Seventy patients with NPDR and 70 normal subjects underwent examination with OTCA. NPDR patients were divided into mild, moderate and severe group according to ETDRS grading Vessel density, flow index and foveal avascular zone (FAZ) were measured. Analyze the correlation between perfusion index and degree of NPDR. Results Parafoveal vessel density, parafoveal flow index, perifoveal vessel density and perifoveal flow index in the three NPDR subgroups were significantly lower than those of control (all P<0.05). Deep plexus perfusion indices were lower compared with superficial plexus (all P<0.05). Spearman's correlation analysis showed a negative correlation between severity of NPDR and superficial plexus perifoveal flow index, deep plexus parafoveal vessel density, deep plexus parafoveal flow index, deep plexus perifoveal vessel density, deep plexus perifoveal flow index (all P<0.05). Conclusion Deep capillary plexus perfusion index obtained by OTCA can be sued as a reliable tool to monitor the severity of NPDR.

Application of transcranial Doppler combined with P_ETCO₂ in evaluation of cerebrovascular reserve in patients with cerebrovascular stenosis

LI Song, JIA Xiao-ying, LI Li, ZHANG Xin

2018, 16(11): 1787-1789,1846. doi: 10.16766/j.cnki.issn.1674-4152.000485

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Objective To discuss the value of transcranial Doppler (TCD) combined with P_ETCO₂ in the evaluation of cerebrovascular reserve in patients with cerebrovascular stenosis. Methods Total 78 patients with cerebrovascular stenosis were divided into single vascular stenosis group (32 cases) and multiple vascular stenosis group (46 cases), and 45 normal health patients were assigned into the control group. TCD combined with P_ETCO₂ were used to evaluate the cerebrovascular reserve function. Results There was no statistically significant difference in the vasodilation reserve and the total blood vessel reserve among the three groups (both the light side and the heavy side), all P>0.05. The systolic reserve of vasorelaxation in serious side was significantly lower in the multivessel stenosis group than that in the control group (t=2.417, P<0.05). The vascular dilation reserve value and vascularity in the single vessel stenosis group were obviously lower than those in the multi-vessel stenosis group (all P<0.05). There was no significant difference in the P_ETCO₂ during terms of quiet breathing, hypocapnia, and hypercapnia among the three groups (all P>0.05). The severity of cerebral vascular disease was negatively correlated to the vascular expansion reserve value and the overall blood vessel reserve value (all P<0.05), and no correlation with vascular contraction reserve (P>0.05). Conclusion TCD combined with P_ETCO₂ is a kind of effective method to evaluate cerebrovascular reserve function. With the increase of severity of cerebral vascular stenosis, cerebral vascular reserve might significantly decrease, which will result in the alteration of risk of stroke.

Clinical application and evaluation of the improved reverse homodigital island flap

LIU Yang-yang, GUAN Jian-zhong, GAO Xu-bin, ZHU Zhong-lian, WANG Xiao-pan, CHEN Xiao-tian, ZHANG Kuan-kuan, WU Min

2018, 16(11): 1790-1792,1930. doi: 10.16766/j.cnki.issn.1674-4152.000486

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Objective To explore the method of preparing the improved retrograde inherent arterial island flap and evaluate its clinical efficacy for the defect of finger distal segment. Methods The clinical data of 11 patients undergoing repair of finger distal segment defect with the improved methods for reverse homodigital island flap in our hospital between January, 2016 and December, 2016 were reviewed. The reverse homodigital island flaps were from 1.0 cm ×1.5 cm to 2.5 cm × 2.5 cm in size. The flap ran along the axis of arterial and nerve, with the two boundaries not more than the midpoint of the dorsal of the hand, and the rotation point was marked by a quarter of the central phalange. The microscopic equipment separation was used to prepare the skin flap under the microscope. The natural surface of neural tissue was separated to make its free as the flap approached the midpoint of digital pulp, and the proper digital arteries and accompanying venous network were then indirectly isolated. The subcutaneous soft tissue in the flap area was sutured for 2 stitches to cover the exposed nerve, and the carpometacarpal full thickness graft was used to suture the skin area directly. Gypsum was used for the fixation and protection at wrist flexion for one week. The planting bags were removed one week after the surgery to promote the functional exercise in flexion and extension. After 6 months of follow-up, the patients were evaluated for their functions and appearance. Results All of the 11 cases of flaps survived without venous or arterial crisis. Postoperative follow-up showed that the appearance of the repaired finger was similar to normal finger, with satisfied sensation and movement function. Conclusion The improved reverse homodigital island flap for the defect of finger distal segment is easy to operate, which can shorten the operation time, ensure the safety of surgery (flap survival). It can effectively protect the proper digital arteries and accompanying venous network in the preparation of the flap, avoid the venous or arterial crisis, with satisfied appearance and function and minor injury, which is an ideal operation method for the repair of finger.

Clinical application of flow cytometric bead assay in detecting isoimmunization antibodies in platelet transfusion refractoriness patients

LIU Wen-bin, HU Hui-jin, WU Di-jiong, YU Qing-hong, SHEN Yi-ping, LI Qiu-shuang, YE Bao-dong

2018, 16(11): 1793-1795,1799. doi: 10.16766/j.cnki.issn.1674-4152.000487

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Objective To evaluate the clinical significance of flow cytometric bead assay (FCBA) test in diagnosis of immune-mediated platelet refractoriness (IPR) and in the differential diagnosis of IPR from non-immune mediated platelet refractoriness (NIPR). Methods FCBA was established and used to detect the HLA-Ⅰand HLA-Ⅱantibody of 107 patients with hematopathy who relied on platelet transfusion. There were 29 patients of IPR, 26 patients of NIPR and 52 patients of NPR. The sensitivity and specificity of the approach for the diagnosis of IPR were evaluated, and the correlation between the levels of anti-HLA-Ⅰ/HLA-Ⅱand 24 h corrected count increment (CCI) were analyzed. Results The positive percentage of 55 PR patients' HLA antibodies was 52.73%. The total positive rate of HLA antibodies in IPR group was 100%, which compared with the positive percentage of NIPR group (0.0%) and NPR group (13.46%) both had significant statistical difference(all P<0.01). The results showed that for the diagnosis of IPR, anti- HLA-Ⅰand HLA-Ⅱ had the sensitivity of 89.66% and 55.17%, the specificity of 85.71% and 14.29%, the positive predictive value of 96.30% and 72.72%, the negative predictive value of 66.67% and 7.14%, and the total efficiency of 90.82% and 34.73%, respectively. The concentration of anti-HLA-Ⅰand anti-HLA-Ⅱantibody both was negatively correlated with 24 h CCI(r=-0.594, P<0.05; r=-0.525, P<0.05). Conclusion Flow Cytometric Bead assay in detecting HLA-Ⅰantibody has high specificity, and it is proved to be of great value for the diagnosis of IPR and for differential diagnosis of IPR from NIPR.

Macular foveal retinal thickness changes after phacoemulsification in diabetics patients

ZHAO Si-jie, YU Zhi-hong, LI Na, WANG Jian-feng

2018, 16(11): 1796-1799. doi: 10.16766/j.cnki.issn.1674-4152.000488

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Objective To investigate the changes of macular foveal retinal thickness (FRT) after the phacoemulsification and intraocular lens implantation in type 2 diabetics patients. Methods A total of 60 cases of cataract with phacoemulsification and intraocular lens implantation were recruited. Thirty cases of 60 Patients with diabetics were in diabetic group, and others with age-related cataract were in control group. FRT were measured by using optical coherence tomography (OCT) before phacoemulsification and 1 day, 1 week, 1 month, and 3 months after the surgery. The changes of FRT were compared in the two groups. Results In the diabetic group, the preoperatively mean fovea thickness was (216.24±19.44)μm, and postoperatively mean fovea thickness was (216.20±18.94)μm at 1 day after the operation, (216.94±19.00)μm in 1 week after the operation, (235.17±24.42)μm in 1 month after the operation, and (227.52±25.36)μm in 3 months after the operation. In 1 week, 1 month and 3 months after the operation, the difference in FRT was significant(all P<0.05). In the control group, the FRT was thickened at 1 day, 1 week, and 1 month after the surgery, which decreased slightly at 3 months after the surgery, but with no statistical difference (all P> 0.05). The difference of the mean fovea thickness between the two groups at 1 month and 3 month after surgery was significant (all P<0.01). Macular edema was found in 5 eyes (5/30, 16.67%) in the diabetic group, and none (0/30) in the control group. Conclusion The thickness of the fovea of retina increases significantly after phacoemulsification in diabetics and the morbidity of macula edema increases as well.

Effect of tramadol on level of CYP450 and liver function in rats

HUANG Li-na, CHEN Cong, YI Lin-gao, WU An-sheng, CAI Xiao-jing, LOU Xiao-hui

2018, 16(11): 1800-1803. doi: 10.16766/j.cnki.issn.1674-4152.000489

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Objective To investigate the changes of hepatic CYP450 activity and liver function in tramadol dependent rats. Methods Total 30 SD rats were divided into blank group, positive control group and experimental group, with 10 rats in each group. Each group was administered with saline, 80 mg/(kg·d) phenobarbital and 60 mg/(kg·d) tramadol. The rat model of tramadol dependent rats was established. Cocktail in vitro incubation method combined with liquid mass spectrometry (LC-MS) technology were used to test the isozymes activities of CYP1A2, CYP2B1, CYP2C11, CYP2D2, CYP2E1, CYP3A1 in rat liver were measured, and RT-qPCR technique was used to detect the level of mRNA expression of the above isozymes, and the blood biochemical analyzer was used to analyze the liver function index. Results ① Compared with the blank group, the activities of CYP1A2, CYP2B1, CYP2C11, CYP2E1 and CYP3A1 in the positive control group were (190.15±33.577), (98.018±36.00), (1 348.79±40.76), (3 214.66±133.51) and (292.76±33.32) μg/ml, which were significantly higher than those in the blank group (P<0.05). The difference was statistically significant. ②Compared with the blank group, the expression of CYP1A2, CYP2B1, CYP2C11, CYP2E1 and CYP3A1 mRNA in the positive control group was significantly up, (89.88±14.22)%, (95.12±16)%, (351.25±32.33)%, (556.85±42.88)% and (52.56±11.12)%, and the difference was statistically significant, and there was no significant change in CYP2D2 mRNA. The expression of CYP1A2, CYP2B1, CYP2E1 and CYP2D2 mRNA in the experimental group was up (75.12±21.45)%, (66.32±18.14)%, (81.35±23.55)% and (382.74±33.25)%. The difference was statistically significant. There was no significant change in the expression of CYP2C11 and CYP3A1 mRNA. ③In the liver biochemical index level, compared with the blank group, the content of ALT, AST and LDH in the positive control group and the experimental group increased significantly, and the results were statistically significant. Conclusion The abuse of tramadol may induce an increased activity of CYP1A2, CYP2B1, CYP2E1 and CYP2D2 and liver injury in rats.

Analysis of clinical features and prognostic factors of 41 cases of primary intraventricular hemorrhage

ZHOU Ge-zhi, YANG Fan, TONG Min-feng, YUAN Jian-lie

2018, 16(11): 1804-1806,1923. doi: 10.16766/j.cnki.issn.1674-4152.000490

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Objective To investigate the clinical characteristics and prognostic factors of primary intraventricular hemorrhage (PIVH). Methods A retrospective study was conducted. The data of PIVH patients in Jinhua Municipal Central Hospital from January, 2011 to January, 2016, including demography, medical history, radiological imaging and prognosis, was collected to evaluate the etiological causes, clinical features and prognostic factors. Results A total of 41 patients with PIVH were enrolled in the study finally, which account for 3.8% of patients with hemorrhagic stroke. In all 41 patients, 61.0% were male (25 cases) and the mean patient age was (50.1±12.3) years. Hypertension was the most common medical history (20 cases, 8.8%) and headache was the most common initial symptom (25 cases, 61.0%). According to cause of hemorrhage, patients were divided into idiopathic group (24cases, 58.5%) and vascular structural abnormality (VSA)-related group (17 cases, 41.5%). Age, proportion of hypertension and GCS in the idiopathic group were all significantly higher than those in VSA-related group (P<0.05). According to the modified Rankin scale (mRS), 25 cases (61.0%) have favorable outcome (mRS:0-2) and 16 cases (39.0%) have unfavorable outcome (mRS:3-6) during the 6-month follow-up. The unfavorable outcome group have significantly higher Graeb score and proportion of acute hydrocephalus, and lower GCS than favorable outcome group (P<0.05). The idiopathic group has better outcome than VSA-related group (P<0.05). Conclusion PIVH is a rare type of hemorrhagic stroke with a poor outcome. We recommend routine cerebral angiography to identify etiological cause. High Graeb score, low GCS, acute hydrocephalus and VSA-related PIVH are associated with poor prognosis.

Expert tibial nail for open distal tibial fractures

WANG Hong-xing, DU Yun-feng, ZHAO Dong-hua, WANG Zhen-jie

2018, 16(11): 1807-1809,1900. doi: 10.16766/j.cnki.issn.1674-4152.000491

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Objective To evaluate the safety and efficacy of expert type intramedullary nail (expert tibial nail, ETN) in the treatment of open distal tibial fracture. Methods Total 22 cases of open distal tibial fractures in our hospital between March, 2013 and September, 2014 were enrolled into this study. There were 14 males and 8 females, with a mean age of 40.4 (from 22-56) years old, including 10 Gustilo type Ⅰ, 8 type Ⅱ and 4 type ⅢA. All patients were debrided and close reducted and fixed with ETN in the emergency treatment. The duration of surgery, blooding volume, time for clinical heal of the wound and fracture, and incidence of complications were analyzed. All patients were followed up by periodic X-ray examination. Functional outcomes were evaluated according to the Johner-Wruhs standard one year after surgery. Results All 22 patients were followed up for 9-24 months (average 16.4 months). The mean time of surgery was 75 mins (55-110 mins). The intraoperative bleeding volume was 65ml (40-100 ml). Superficial infection occurred in 2 cases with Gustilo typeⅡand healed by dressing. Two cases of type ⅢA fractures were necrotic and covered with skin flap, with deep infection in 1 case. The fractures healed 4.8 months (from 3.5-13.6 months)after surgery, Anatomical or functional reduction were achieved and maintained in all cases. Two fractures of delayed union healed by dynamization through removing the proximal locking nail. The nonunion of bone occurred in 1 case, which healed by replacing the larger diameter nail and bone graft. No nail breakage, malunion or limb shorting occurred. By Johner-Wruhs criteria, the final outcomes were excellent in 12 cases, good in 7 cases and fair in three. The good rate was 86.4%. Conclusion Expert Tibial Nail has the advantages of minimally invasive trauma, stronger fixation, better functional recovery for the treatment of open distal tibial fractures. It is safe and effective in the treatment of Gustilo type Ⅰ, Ⅱ fractures with low incidence of complications. But it is less effective for type ⅢA fractures with serious tissue injury.

Clinical efficacy of laparoscopic surgery combined with colonoscopy procedure in the treatment of early colorectal tumor

YIN Kai, JU Jian-guo, CHEN Ji-xiang, XU Min, DANG Sheng-chun, FAN Xin, CUI Lei

2018, 16(11): 1810-1812. doi: 10.16766/j.cnki.issn.1674-4152.000492

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Objective To analyze the colonoscopy-assisted laparoscopic surgery in the treatment of early colorectal tumor, and further elevate the application value of them in the treatment of early colorectal cancer. Methods From January, 2014 to May, 2017, a total of 31 early colorectal tumor patients were treated with colonoscopy-assisted laparoscopic surgery in our hospital. Locations of colorectal lesions were explored by colonoscopy. According to the rapid frozen pathological results, laparoscopic surgery was selected. Results All patients were treated with colonoscopy-assisted laparoscopic surgery successfully, with no conversion to laparotomy. Among 22 cases of preoperative diagnosis of stageⅠcolorectal cancer, there were 20 cases of intraoperative and postoperative diagnosis of stageⅠ (13 cases of T1N0M0, 7 cases of T2N0M0) and 2 cases of stageⅢ (T2N1M0). There were 9 cases of preoperative diagnosis of precancerous lesions, 2 of which were diagnosis of high grade intraepithelial neoplasia and 7 cases were diagnosis of high grade intraepithelial neoplasia with carcinogenesis.6 cases were under polypectomy at the same time, the rapid frozen pathological results proved to be a low level adenomatoid polyp during the operation, and no additional surgery was performed. All patients were examined by colonoscopy half a year after operation. After that, 1 time a year was reviewed, and tumor markers were monitored at the same time. All patients were followed up 6-42 months, with a median of 32 months.Most of the patients were alive without recurrence except one case died of cerebral infarction 2 years after operation. Conclusion Laparoscopy combined with colonoscopy in treatment of early colorectal tumor has advantages of both endoscopy, especially suitable for lesions with difficult location or complete resection, which can improve surgical accuracy and safety.

Comparison on efficacy and safety of concurrent chemoradiotherapy versus radiotherapy alone in patients with middle or late stage cervical cancer

XIAO Qun, FANG Yan-fei, KONG Yu-lan

2018, 16(11): 1813-1815,1905. doi: 10.16766/j.cnki.issn.1674-4152.000493

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Objective The effect of concurrent chemoradiotherapy on the efficacy, safety and prognosis of advanced cervical cancer was studied comparing with radiotherapy alone. The expression levels of p53 and Bax in tumor tissues were taken as the starting point to discuss the curative effect. Methods Sixty-five patients with advanced cervical cancer (stage Ⅱb~Ⅳ) who were treated by radiotherapy alone in January, 2009 January, 2013 were selected as control group. Sixty-five patients of concurrent chemoradiotherapy were selected for the same period and the same condition as the observation group. The radiotherapy scheme was the same as the control group. The chemotherapy was combined with the PF regimen, 1 times every 3 weeks, and the chemotherapy was 3 times. The short-term effect (nearly 3 months), the incidence of adverse reactions, the prognosis (3, 5 years, local recurrence, distant metastasis) were compared between the 2 groups, and the expression of P53 and Bax before and after the treatment were compared and analyzed. Results The effective rate of the observation group was higher than that of the control group (63.1% to 43.1%, P<0.05). The 3-and 5-year survival rates in the observation group were 78.5% and 63.1%, respectively, higher than those in the control group 61.5% and 40.0% (P<0.05). The local recurrence rate and distant metastasis rate in the observation group were 30.8% and 23.1% respectively, lower than those in the control group 47.7% and 43.1% (P<0.05). The incidence of bone marrow suppression and gastrointestinal reactions in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference in the incidence of liver and kidney function injury, radiation proctitis and radiation cystitis in the two groups (P>0.05), which could be tolerated in patients with adverse reactions and did not significantly affect the treatment. After the treatment, the positive rates of P53 and Bax in the two groups increased, and the increase in the observation group was higher than that in the control group (P<0.05). Conclusion Compared with radiotherapy alone, synchronous radiotherapy can improve the effectiveness of the treatment of advanced cervical cancer and improve the prognosis of patients. Although the incidence of toxic and side effects is high, the patient can be tolerated after active treatment. The mechanism may be related to the up-regulation of the expression of Bax and the inhibition of P53 process, thus improving the chemosensitivity of the patients.

A prospective cohort study on the efficacy of different treatment regimens in patients with chronic hepatitis B complicated with pulmonary tuberculosis

CAI Ling-zhi, LI Qian

2018, 16(11): 1816-1818,1882. doi: 10.16766/j.cnki.issn.1674-4152.000494

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Objective To explore the efficacy and safety of different treatment regimens in patients with pulmonary tuberculosis combined with hepatitis B, and to provides an objective evidence for the choice of treatment regimens. Methods A prospective cohort study was used to select 126 patients of tuberculosis combined with hepatitis B in our hospital from January, 2016 to January, 2017, according to the random number table, the subjects were randomly divided into A (control) group, B (lamivudine group) and C (entente Cave) group, 42 cases in each group for 6 months according to different treatments, the liver function, HBV DNA negative conversion rate, the effect of pulmonary tuberculosis and the occurrence of adverse reactions were observed in all groups, and the data were analyzed by SPSS 21.0 statistics software. Results After 6 months of treatment, the level of ALT, AST and TBIL in group B and C was significantly lower than that in group A (P<0.05). The ALT and TBIL levels of C group were lower than that of B group (P<0.05). The absorption of chest lesions and the rate of HBV DNA turned negative conversion rate in group C were significantly higher than those in the A group (P<0.05), the incidence of total adverse reactions in group B and C was lower than that in group A (P<0.05). Conclusion The anti-tuberculosis regimen combined with lamivudine and entecavir has a certain advantage in reducing the liver damage and protecting the liver function of anti-tuberculosis drugs. It may be more beneficial to the treatment effect of anti-tuberculosis drugs on the premise of normal liver function. The indexes of liver function and HBV DNA negative conversion rate in entecavir group were better than those in lamivudine group, and the safety of the two drugs is acceptable.

Association of fetal congenital heart diseases with methylenetetrahydrofolate reductase gene polymorphisms

WANG Mian-mian, WU Jie-li, DONG Xue-qin, XU Xue-qin, LYU Xiao-juan, LI Hai-feng

2018, 16(11): 1819-1821,1867. doi: 10.16766/j.cnki.issn.1674-4152.000495

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Objective To investigate the polymorphism of folate metabolism pathway genes in pregnant women with congenital heart diseases(CHD), and to explore the relationship between the gene polymorphisms and the susceptibility to CHD. Methods According to the inclusion criteria, Collected 320 cases of fetal congenital heart disease diagnosed by color Doppler echocardiography. From peripheral venous blood, PCR-RELP method was used to detect the polymorphism of MTHFR677 and MTHFR1298 loci. Results ①Gene loci polymorphism:In the control group and CHD group, C and T allele、A and C alleles all have differences in the 2 groups was statistically significant(χ²=16.589, P<0.001; χ²=5.078, P=0.020); ②Genotype polymorphism:In the control group and CHD group, CC, CT, TT genotype have differences in the both groups was statistically significant(χ²=15.282, P<0.001). AA, AC and CC genotype have no statistically significant difference in 2 groups(χ²=5.092, P=0.080); ③In the study of stratified:Tetralogy of fallot group CC, CT and TT genotype and AA, AC and CC genotype, with the control group there were statistical significance (χ²=7.794, P=0.020; χ²=8.998, P=0.010); Ventricular septal defect group CC, CT, TT genotype, with the control group there were statistical significance(χ²=10.407, P<0.001), And AA, AC and CC genotype, with the control group there were no statistical significance(χ²=0.667, P=0.720). Conclusion The MTHFR C677T polymorphism of mother is associated with congenital heart disease in children. Hierarchical research tips that the MTHFR C677T polymorphism of mother is associated with occurrence of tetra logy of fallot and ventricular septal defect in children. The other results in the case group and the control group MTHFR A1298C genotype although no obvious difference, but the A/C allele is having the significant difference, prompt allele A/C to children is A risk factor of CHD.

Screening and analysis of 616 cases of retinopathy of prematurity

LI Dan, PAN Jia-hua, PAN Hui

2018, 16(11): 1822-1825. doi: 10.16766/j.cnki.issn.1674-4152.000496

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Objective To investigate the incidence of retinopathy of prematurity (ROP) in our hospital and the risk factors of the disease. Methods A total of 616 preterm infants who were admitted to our hospital from November, 2015 to June, 2017 and met the 2014 screening criteria for retinopathy of prematurity were selected. All the subjects were screened for fundus diseases in preterm infants. The results were divided into ROP group and non-ROP group. The ROP group was graded and the incidence of ROP was calculated. The clinical data of all subjects were collected. The general conditions, clinical diagnosis and treatment status, complications, and maternal related conditions were compared between the two groups. Univariate analysis and Logistic regression analysis were used to analyze the risk factors for ROP. Results In 616 preterm infants, there were 47 patients with ROP and the incidence was 7.7%. According to the international ROP classification criteria, 3 cases were in zone Ⅰ, 27 cases were in zone Ⅱ, 18 cases were in zone Ⅲ. And 21 cases were in stage 1, 13 cases in stage 2, 12 cases in stage 3, 1 case in stage 4A, 1 case in additional lesions of zone Ⅱ and 1 case in aggressive posterior RO (AP-ROP). The general gestational age, birth weight, head circumference, 5 min Apgar score, and asphyxia were statistically significant between the two groups (P<0.05); oxygen and oxygen inhalation time, PS, EPO, blood transfusion, the use of aminophylline and caffeine showed statistical significance between the two groups (P<0.05); among the complications, bronchopulmonary dysplasia, patent ductus arteriosus, and intraventricular hemorrhage were statistically different between the two groups (P<0.05); the use of hormones and magnesium sulfate in the maternal condition was statistically significant between the two groups (P<0.05). Multivariate Logistic regression analysis showed the differences between ROP and non-ROP groups in gestational age (OR=0.730, 95% CI:0.658-0.815, P<0.001), oxygen intake (OR=0.159, 95% CI:1.050-37.468, P=0.044), intracranial hemorrhage(OR=0.018, 95% CI:0.001-0.621, P=0.026) and the use of caffeine (OR=0.049, 95%CI:0.003-0.754,P=0.031) were statistically significant. Conclusion The incidence of ROP is 7.7%. The gestational age, oxygen consumption, use of caffeine, and important complications (intracranial hemorrhage) are related to the occurrence of ROP.

Effect of ultrasound-guided thoracic paravertebral block on perioperative stress reaction in patients undergoing esophageal carcinoma surgery

WU Jia, CHEN Long, CHEN Yue, QIAN Jun, HU Shuang-fei

2018, 16(11): 1826-1828,1842. doi: 10.16766/j.cnki.issn.1674-4152.000497

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Objective To observe the effect of ultrasound-guided thoracic paravertebral block (TPVB) on perioperative stress response in patients undergoing radical surgery for esophageal carcinoma, and evaluate the safety and effectiveness of TPVB. Methods Total 60 patients with esophageal carcinoma surgery in People's Hospital of Hangzhou Medical College from December, 2017 to May, 2018 were selected and divided into control group and observation group. The control group was treated with general anesthesia merely, while the observation group was treated with general anesthesia combined with TPVB. The intraoperative blood volume, operative time, anesthesia recovery time, tube drawing time and dosage of anesthetic drugs were compared between the two groups. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SpO₂) were observed before anesthesia induction, endotracheal intubation, during the operation process and after surgery. VAS pain scores were recorded and compared immediately after tube drawing and 1, 3, 5, 12, 24 h later. Before anesthesia induction, entrance the breast, close the breast, 1 h and 2 h after surgery, the concentration of stress-related serological indexes such as peripheral blood sugar, epinephrine (E), serum inflammatory factor interleukin-6 (IL-6) and interleukin-10 (IL-10) were detected. Results When compared with control group, the intraoperative blood volume, operative time, anesthesia recovery time, tube drawing time and dosage of anesthetic drugs in observation group were superior; the changes of SBP, DBP, HR and SpO₂ were stable during perioperative period. The VAS pain score at each time was lower than that in control group. Peripheral blood sugar, epinephrine (E), IL-6 and IL-10 were lower than that in control group. Conclusion Ultrasound-guided thoracic paravertebral block can improve the anesthetic effect, reduce anesthetic sum, inhibit the stress reaction in patients with esophageal carcinoma surgery and improve analgesic effect after surgery, which is worthy of popularization in clinical application.

The role of NLRP3 in myocardial function injury in patients with hypertension

CHEN Chen, JIANG Ru-hong

2018, 16(11): 1829-1831. doi: 10.16766/j.cnki.issn.1674-4152.000498

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Abstract:
Objective To study the role of NLRP3 in myocardial function injury in patients with hypertension. Methods A total of 118 patients with hypertension were included in the observation group, and 100 healthy people in Taizhou Hospital were selected as the control group. We collected basic information of the two groups (sex, age, systolic pressure, diastolic blood pressure, mean arterial pressure), detected the level of NLRP3, IL-1β, IL-6 and NT-proBNP, counted the white blood cells, lymphocytes, monocytes, and measured LVEF by cardiac color ultrasound. Results In the observation group, systolic pressure, diastolic pressure, mean arterial pressure, the level of NLRP3, IL-6, IL-1β and NT-proBNP, count of white blood cells, lymphocytes and monocytes were significantly higher than those in the control group, while LVEF was significantly lower than that in the control group. The expression level of IL-6, IL-1β in patients with mild hypertension was not significantly different from that in the control group, and the expression level of IL-6, IL-1β in patients with moderate and severe hypertension was significantly higher than that in the control group. The level of NLRP3 was positively correlated with NT-proBNP and the count of white blood cell, lymphocyte and monocyte, but negatively correlated with LVEF. Conclusion NLRP3 inflammasome is highly expressed in patients with early hypertensive myocardial dysfunction, and its expression level is positively correlated with the degree of myocardial impairment in patients with hypertension.

Preventive value of Shenmai injection on venous thromboembolism in hospitalized patients with acute ischemic stroke

LUO Xiao-chun, CHEN Juan, ZHU Heng-ya, GONG Wen-jian

2018, 16(11): 1832-1835. doi: 10.16766/j.cnki.issn.1674-4152.000499

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Abstract:
Objective To observe the effect of Shenmai injection on blood coagulation index and deep venous thrombosis in patients with acute ischemic stroke, and to provide reference for the clinical application of Shenmai injection. Methods From January, 2016 to December, 2017, 106 patients with acute ischemic stroke were randomly assigned to the control group and observation group, with 53 cases in each group, the control group was given routine and symptomatic treatment, and the observation group added Shenmai injection on the basis of routine treatment, before and one week after treatment, the two groups of human fibrinogen, packed cell volume, plasma viscosity, D-Dimer content and double leg blood vessel color Doppler ultrasonography were examined, and the possible adverse drug reactions were recorded. SPSS 21.0 statistical software was used to carry out statistical analysis. Results The human fibrinogen, packed cell volume, plasma viscosity, D-Dimer content in the control group and the observation group were decreased (P<0.05). After the treatment, human fibrinogen, plasma viscosity, D-Dimer content in the observation group were decreased as compared with the control group (P<0.05), the suspected symptoms and signs of deep vein thrombosis of the legs and the proportion of thrombus by the Doppler examination in the observation group were lower than that of the observation group (P<0.05). There was no obvious adverse drug reaction in the two groups. Conclusion Shenmai injection has a certain improvement on blood coagulation indexes in patients with acute ischemic stroke, and has certain preventive value for the formation of deep venous thrombosis, however, this study only evaluated the short-term effect, and the observation index is limited, and the exact effect expected a more large-scale and in-depth study.

Iron overload condition and its influencing factors in patients with aplastic anemia

ZHOU Miao, REN Fu-peng, ZHANG Zhi-ye, ZHANG Ping

2018, 16(11): 1836-1838. doi: 10.16766/j.cnki.issn.1674-4152.000500

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Objective To investigate the iron overload and its influencing factors in patients with aplastic anemia (AA). Methods A total of 200 adult AA patients were selected in Department of Hematology of the First Hospital of Ningbo, the Second Hospital of Ningbo City and the Fuyang Hospital Affiliated to Anhui Medical University from March, 2014 to March, 2018. The clinical data of patients were collected. The serum ferritin (SF) levels were measured by radioimmunoassay. The levels of total iron binding force (TIBC) and serum iron (SI) were determined by the colorimetric method of ferrozine. The levels of soluble transferrin receptor (sTfR) and transferrin (Tf) were determined by immunoturbidimetry. The transferrin saturation (TS) was calculated. Results In 200 patients with AA, the SF was 1 253.25(519.06, 1 757.17) μg/L, SI was 33.31 (21.60, 56.66) μmol/L, TS was 62.02%(30.88%, 74.60%), the Tf was 1.87 (1.60, 2.71)g/L, and the sTfR was 0.93 (0.54, 2.10)mg/L. In 200 patients with AA, iron overload occurred in 29 patients, with an overload rate of 14.5%. The proportion of iron overload in males, heavy AA, blood transfusion >8 U and coinfection were higher than that of without iron overload (P<0.05). The age, etiology and course of disease were not associated with iron overload in AA (P>0.05). Logistic regression analysis showed that men, blood transfusion >8 U and coinfection were independent risk factors for iron overload in AA (P<0.05). Conclusion The incidence of iron overload in AA patients is high. Males, blood transfusion >8 U and coinfection are independent risk factors for iron overload in AA patients.

Accumulation of regulatory T cells and myeloid derived suppressor cells in breast cancer and its significance

LI Mao, SI Cheng, CHEN Bai-song

2018, 16(11): 1839-1842. doi: 10.16766/j.cnki.issn.1674-4152.000501

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Abstract:
Objective To investigate the infiltration of regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs) in breast cancer and discuss its and significance. Methods From January 2017 to February 2018, 150 cases of breast cancer treated in our hospital were prospectively collected. Modified radical mastectomy was performed. Breast cancer specimens were taken during the operation. The expression of regulatory T cells and myelinated suppressor cells in breast cancer tissues were detected, and the correlation with the clinicopathological features was analyzed. Results There was no significant difference in the distribution of regulatory T cells and myeloid derived suppressor cells in breast cancer patients of different ages. The regulatory T cells of TNM stage for stage Ⅰ, stage Ⅱ and stage Ⅲ were 6.72±1.86, 9.61±2.45 and 12.05±2.81, respectively; and myeloid derived suppressor cells were 2.81±1.32, 4.92±1.92 and 6.01±2.65. With the increase of TNM stage, myeloid derived suppressor cells and regulatory T cells gradually increased (P<0.001). When compared with patients without lymph node metastasis, regulatory T cells and myeloid derived suppressor cells in patients with lymph node metastasis were significantly higher (P<0.001). The regulatory T cells of the patients with high differentiation, medium differentiation and low differentiation were 8.94±1.98, 9.83±2.05 and 10.99±2.42; and myeloid derived suppressor cells were 4.03±1.65, 4.87±1.91 and 6.22±1.89. All the differences were statistically significant (P<0.05). Pearson linear correlation analysis showed that myeloid derived suppressor cells and regulatory T cells were significantly positively correlated (r=0.271, P<0.001). Conclusion The expanses of regulatory T cells and myeloid derived suppressor cells in breast cancer is related to TNM staging, Lymph node metastasis and differentiation of tumor cells, and regulatory T cells and myeloid derived suppressor cells have synergistic effects.

Curative effect and safety of danshen injection combined with febuxosta in the treatment of chronic uric acid nephropathy

SHAO Si-si, HUANG Yu-xia, XIANG Xie-long, FENG Ru-liu, CHEN Chun, HU Zhen-fen

2018, 16(11): 1843-1846. doi: 10.16766/j.cnki.issn.1674-4152.000502

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Abstract:
Objective To observe the curative effect and safety of danshen injection combined with febuxostat in the treatment of patients with chronic uric acid nephropathy. Methods Ninety-four patients with chronic uric acid nephropathy were randomly divided into control group and treatment group with forty-seven cases per group. The control group was given febuxostat 40 mg, qd, po, and the treatment group was given danshen injection 30 ml, qd, ivgtt + febuxostat 40 mg, qd, po. After 8 weeks treatment, the clinical efficacy and occurrence of adverse drug reactions were observed. The levels of renal function, blood lipids and sex hormones were compared. Results The total effective rate 91.49% in treatment group was higher than the control group (P<0.05). The levels of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), 24 h urine protein (UPRO), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), estradiol (E2) and testosterone (T) in treatment group were lower than the control group, and the levels of glomerular filtration rate (eGFR) and high-density lipoprotein (HDL) were higher than the control group (P<0.05). The levels of prolactin (PRL) in treatment group and control group was no significant (P>0.05). The adverse drug reactions were mainly abnormal liver function, nausea, joint pain and rashes, the incidence of adverse drug reactions in treatment group and control group were 12.77% and 8.51%, respectively (P>0.05). Conclusion The danshen injection combined with febuxostat in the treatment of chronic uric acid nephropathy have significantly curative effect, can protect renal function, improve the blood lipid index and sex hormone levels, and have no increasing the adverse drug reactions.

Variation of T helper cell 17/regular T cell balance in inflammatory process of hepatitis B virus infection and effect of entecavir

LIU Yi-hui, FENG Hui, LIU Li, ZHOU Hong-juan, ZHANG Yong-hua

2018, 16(11): 1847-1850,1874. doi: 10.16766/j.cnki.issn.1674-4152.000503

167 0

Abstract:
Objective To observe the variation of Th17/Treg balance in different ALT levels of chronic hepatitis B and effect of entecavir. Methods Eighty-five CHB patients in Hangzhou Red Cross hospital during June, 2012 to October, 2012 were divided into three groups; mildly, moderately, significantly elevated ALT and 30 healthy volunteers were enrolled as healthy controls. The peripheral blood Th17, Treg of 30 patients from the above cases were measured after entecavir antiviral treatment for 24 weeks. Results Th17 cell levels, Treg cell levels and Th17/Treg ratio of CHB patients were significantly different than those of healthy volunteers (P<0.05). The difference in Th17/Treg ratio between 3 groups of CHB patients with different ALT levels was statistically significant (P<0.05). Th17 was positively correlated with ALT, and Treg was negatively correlated with ALT. At 24 weeks after entecavir antiviral treatment, the differences of ALT level, HBV-DNA load and Th17/Treg were statistically significant (P<0.05). The ratio of Th17/Treg in patients with Normal ALT and HBV-DNA (22 cases), ALT and/or HBV-DNA abnormality (8 cases) was significantly lower than that of baseline (P<0.05). There was no statistical difference in the comparison of the baseline Th17/Treg ratio and the comparison of the two groups after the treatment (P>0.05). Conclusion Th17/Treg was unbalanced in CHB patients and correlated with the ALT levels. Entecavir treatments was beneficial to the balance of Th17/Treg.

Analysis of the distribution of late-onset sepsis pathogens and the influence factors of late-onset sepsis on very low and extremely low birth weight infants

LI Yong-pei, ZHU Yun-xia, WU Ting, CHEN Ling, REN Jing-jing

2018, 16(11): 1851-1853. doi: 10.16766/j.cnki.issn.1674-4152.000504

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Abstract:
Objective To analyze the distribution of late-onset sepsis (LOS) pathogens and the influence factors of LOS on very low and extremely low birth weight infant, and to provide reference for the clinical treatment. Methods The clinical data of 166 cases of very low and extremely low birth weight infant in our hospital from December, 2014 to September, 2017 were retrospectively analyzed, and they were divided into non-LOS group (74 cases) and LOS group (92 cases) according to the occurrence of LOS. In the LOS group, 55 cases was diagnosed LOS and 37 cases were confirmed. The clinical features and mortality were compared between the two groups. The distribution of pathogens in LOS group was analyzed, and the influencing factors of LOS were assessed by binary logistic analysis. Results There were significantly differences in the small for gestational age (SGA), neonatal asphyxia, neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus (PDA), peripherally inserted central catheter (PICC), mechanical ventilation, gestational age, weight, duration of parenteral nutrition and hospital time between the two groups (P<0.05). The rate of fatality in LOS group was 14.13% (13/92), and the non-LOS group was 4.05% (3/74), and there were significantly differences in the rate of fatality by comparison (P<0.05). The pathogens of the children in LOS group were 45 strains, among which, the gram-positive bacteria accounted for 31.11% (14/45), the gram-negative bacteria accounted for 62.22% (28/45), and the fungi accounted for 6.67% (3/45).The binary logistic analysis showed that the main influencing factors of LOS were the neonatal asphyxia, PICC, gestational age and duration of parenteral nutrition. Conclusion Gram-negative bacteria are common pathogenic bacteria of LOS on very low and extremely low birth weight infant, and the neonatal asphyxia, PICC, gestational age and duration of parenteral nutrition were the main influencing factors of LOS.

Distribution of pathogenic bacteria and levels of serum CRP, TNF-α, IL-6 and IL-10 in postnatal puerperal infections

ZHU Ying, ZHANG Zi-juan, WANG Dan-yang, ZHU Hong, YING Liu-qing, QI Feng

2018, 16(11): 1854-1856,1863. doi: 10.16766/j.cnki.issn.1674-4152.000505

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Abstract:
Objective To investigate the distribution of pathogenic bacteria in postpartum puerperal infections and the serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10) and procalcitonin (PCT) levels. Methods Total 6 632 cases of mothers of natural delivery were selected in hospitals from January, 2017 to December, 2017. Etiological culture and drug susceptibility tests were performed on specimens of puerperal fluid, perineal incision secretions, cervical secretions, etc. of suspected maternity-infected mothers. The level of serum CRP was measured by immunoturbidimetry. The serum TNF-α, IL-6 and IL-10 levels were determined by enzyme-linked immunosorbent assay (ELISA). Results There were 246 cases of maternal puerperal infection in 6 632 cases, the infection rate was 3.71%. Postpartum puerperal infection sites were perineal wound infections, respiratory infections, and breast infections. The constituent ratios were 73.98%, 17.07% and 8.94%, respectively. Among 246 cases of puerperal infection, 297 strains of pathogenic bacteria were cultivated. The main pathogens were Escherichia coli, Streptococcus agalactiae, and Enterococcus faecalis, accounting for 45.12%, 23.91% and 15.82%, respectively. The resistance rates of Escherichia coli to penicillin, lincomycin, azithromycin, cefazolin, and compound sulfamethoxazole were relatively high, and the drug resistance rates were 100.00%, 95.52%, 85.07%, 83.58% and 80.60%, respectively. The resistance rates of Streptococcus agalactiae to penicillin, piperacillin, ciprofloxacin and lincomycin were relatively high, and the drug resistance rates were 100.00%, 100.00%, 98.59% and 97.18%, respectively. Enterococcus faecalis had high resistance rates to penicillin and lincomycin, and the resistant rates were 100.00% and 89.36%, respectively. The serum levels of CRP, TNF-α, IL-6 and IL-10 in the puerperal infection group were higher than those in the puerperal uninfected group (P<0.05). Conclusion The most common pathogens for postpartum puerperal infections of natural labor are Escherichia coli, Streptococcus agalactiae, and Enterococcus faecalis. The main pathogens are highly resistant, and maternal serum levels of TNF-α, IL-6 and IL-10 are increased.

The role of human placental growth factor and human heme oxygenase-1 in the pathogenesis of preeclampsia

WU Hong-lian, CHEN Yan, HUANG Zhi-hua, YAN Gui-zhen, XIA Wei-lan, WANG Shuang-hu

2018, 16(11): 1857-1859. doi: 10.16766/j.cnki.issn.1674-4152.000506

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Abstract:
Objective To investigate the role of human placental growth factor and human heme oxygenase-1 in the pathogenesis of preeclampsia. Methods Ninety cases of mild preeclampsia pregnant women were selected as mild preeclampsia group 90 cases of severe preeclampsia pregnant women were selected as severe preeclampsia group and 90 healthy pregnant women were selected as control group from January, 2014 to January, 2017 in Lishui City People's Hospital obstetric. The serum levels of placental growth factor and heme oxygenase-1 were determined by enzyme-linked immunosorbent assay (ELISA). Results The levels of 24 h urinary protein mean arterial pressure serum placental growth factor and heme oxygenase-1 among the three groups were statistically significant (P<0.05). The 24 h urinary protein and mean arterial pressure in mild preeclampsia group and severe preeclampsia group were significantly higher than that in control group (P<0.05). The 24 h urinary protein and mean arterial pressure in severe preeclampsia group were significantly higher than that in mild preeclampsia group (P<0.05). The levels of serum placental growth factor and heme oxygenase-1 in mild preeclampsia group and severe preeclampsia group were lower than those in control group (P<0.05). The levels of serum placental growth factor and heme oxygenase-1 in severe preeclampsia group were lower than those in mild preeclampsia group (P<0.05). The level of serum placental growth factor and heme oxygenase-1 in pregnant women with preeclampsia were negatively correlated with 24 h urinary protein and mean arterial pressure (P<0.05). There was positive correlation between serum placental growth factor and serum heme oxygenase-1 in pregnant women with preeclampsia (P<0.05). Conclusion Preeclampsia maternal serum placental growth factor and serum heme oxygenase-1 levels decrease.The serum placental growth factor and serum heme oxygenase-1 level are related to the severity of preeclampsia both may interact during the onset of preeclampsiainvolved together the development of preeclampsia.

Observation on the clinical effect of Manpenxiaoyan decoction combined with metronidazole and levofloxacin in the treatment of endometritis

ZHAO Xiao-ying, CAI Ping-sheng

2018, 16(11): 1860-1863. doi: 10.16766/j.cnki.issn.1674-4152.000507

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Abstract:
Objective To observe the clinical effect of Manpenxiaoyan decoction combined with metronidazole and levofloxacin in the treatment of endometritis, and effect on the level of inflammatory factors in patients. Methods Total 190 cases of endometritis patients were studied, and all the patients were randomly divided into the study group (95 cases) and the control group (95 cases). The patients in the control group were treated with metronidazole and levofloxacin intravenously, and the patients in the study group were increased the Manpenxiaoyan decoction on the basis of the control group. The adverse reactions during treatment were observed, the time of symptom disappearance was recorded, the curative effect level was evaluated, and the recurrence of inflammation within 1 years was counted. Results The serum MMP-9 and IL-4 levels of the study group were significantly lower than those of the control group after treatment, while IL-2 and IL-10 levels were significantly higher than those of the control group (P<0.05). The time of pelvic area pain and leucorrhea disappeared in the study group[(9.31±2.63)d and (13.72±3.27)d] were significantly shorter than those in the control group[(14.28±3.51) d and (20.43±4.16)d], P<0.05. The total effective rate of the treatment of patients with endometritis in the study group (94.74%) was significantly higher than that of the control group (85.26%, χ²=4.737, P=0.030). Within 1 years after treatment, the recurrence rate of endometritis in the study group (11.58%) was not significantly different from that in the control group (24.21%, χ²=5.158, P=0.023). During the treatment, the overall incidence of adverse drug reactions (10.53%) in the study group was not significantly different from that in the control group (7.37%, χ²=0.581, P=0.446). Conclusion Compared with simple western medicine, Manpenxiaoyan decoction combined with metronidazole and levofloxacin can significantly inhibit the inflammation of the endometrium, shorten the recovery cycle, improve the level of curative effect, prevent the recurrence of the inflammation, and do not increase the adverse drug reaction.

Clinical observation of auricular point combined therapy in patients with transvaginal oocyte retrieval for in vitro fertilization-embryo transfer

WANG Mei-xia, TENG Yi-li

2018, 16(11): 1864-1867. doi: 10.16766/j.cnki.issn.1674-4152.000508

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Abstract:
Objective To evaluate the analgesic effect, the incidence of adverse reactions and the influence on the inflammatory factors of the auricular point combined therapy in patients with transvaginal oocyte retrieval for in vitro fertilization-embryo transfer (IVF-ET). Methods Total 78 cases of IVF-ET in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January, 2013 to December, 2014 were selected, and were randomly divided into treatment group and control group. The control group was given propofol anesthesia, while the treatment group received additional ear acupuncture therapy. The ovulation time, recovery time, postoperative pain score and propofol dosage, laboratory egg rate, fertilization rate, cleavage rate, clinical pregnancy rate, interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α), and the incidence of adverse events were analyzed and evaluated. Results There was no significant difference in the ovulation time between the two groups (P>0.05). The recovery time, propofol dosage and postoperative pain score in the treatment group were superior to the control group (P<0.05). There was no significant difference in egg rate, fertilization rate, cleavage rate, clinical pregnancy rate and abortion rate between the two groups (P>0.05). There was no significant difference in IL-6, IL-8 and TNF-α level between the two groups before the treatment (P>0.05). After the treatment, the levels of IL-6, IL-8 and TNF increased obviously in both groups, but those levels in the treatment group was significantly lower than those in the control group, the difference was statistically significant (P<0.05). The incidence of body movement was significantly lower in the treatment group than in the control group (P<0.05). There was no significant difference in the incidence of vertigo, respiratory depression and nausea and vomiting between the two groups (P>0.05). Conclusion Auricular acupuncture combined with anesthesia can reduce the dosage of western medicine, enhance the analgesic effect, reduce the incidence of complications, reduce the incidence of adverse reactions such as nausea and vomiting, reduce the expression of inflammatory factors, reduce the stress response.

Analysis on the psychological status of patients with type 2 diabetes mellitus in contracting community health service

XU Xin, HUANG Qian, SHOU Juan, BAI Lu

2018, 16(11): 1868-1871,1878. doi: 10.16766/j.cnki.issn.1674-4152.000509

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Objective To understand the psychological status of patients with type 2 diabetes in Weifang community, and to analyze the factors affecting the psychological status of patients with type 2 diabetes mellitus in contracting community health service and to provide evidence for general practitioners having more targeted psychological counseling for patients with type 2 diabetes. Methods A total of 529 patients who live in Weifang community from 2010 till now and have already enrolled in community health service were surveyed by systematic sampling method and health questionnaire for Symptom Checklist 90 (SCL-90), social support revalued scale and a questionnaire involving population characteristics. At the same time, the influencing factors and social support condition of psychological status of patients with type 2 diabetes mellitus in contracting community health service were analyzed. Results In this study, total score and each factor score in SCL-90 of patients with type 2 diabetes mellitus in contracting community health service were higher than the national norm. Age, job, income, and occupation of patients with type 2 diabetes mellitus have effects on some factors of SCL-90. The course of diabetes has an effect on all factors of SCL-90, and a few have significant effects. There was a significant negative correlation between social support and factors in SCL-90 of type 2 diabetes mellitus in contracting community health service. Conclusion The psychological health of the patients with type 2 diabetes mellitus in contracting community health service is not optimistic. Different demographic factors can have different effects on the psychological condition of type 2 diabetes mellitus in contracting community health service. General practitioners should give more effective psychological counseling and social support to patients with type 2 diabetes mellitus in contracting community health service who have different demographic characteristics.

Analysis of the consulting tendency and referral reasons of patients with diabetes mellitus

FAN Ai-qing, HOU Jin, SU Qi, PAN Zhi-gang, ZHANG Shao-chen

2018, 16(11): 1872-1874. doi: 10.16766/j.cnki.issn.1674-4152.000510

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Abstract:
Objective To analyze the tendency of diabetes mellitus patients in choosing the first-contact medical institution and reason for referral and to provide evidences for hierarchical medical service implementation. Methods We compared the seeking tendency and referral reasons between the two groups of diabetes mellitus patients, including signed group and ambulatory group, in the suburban community of Shanghai Pudong District. Descriptive statistical methods, χ² test, constituent ratio, and percentage were applied to analyze the quantitative data. Thematic frame analysis and SWOT method were adopted to analyze the qualitative data. Results We enrolled 496 diabetes mellitus patients in the signed group, and 464 patients in the ambulatory group. The tendencies between two groups of patients in choosing the first-contact medical institution showed no statistical significance (P>0.05). The reasons for referral included medical technical level, drug or laboratory test deficiency, travel distance to facility, medical service quality, further examinations, and other reasons. Comparing the two groups, there were statistically significant difference among medical service quality and other reasons(P<0.05 or P<0.001, respectively). Conclusion The results revealed that the contracted mode is more effective and sustainable to manage and serve the patients. Equipping the ancillary departments, sharing the pharmacy information and laboratory results, three-level linkage, and government support are key points to improve the ability of first-contact and continual treatment of the community hospitals and to implement the hierarchal medical service.

Expression and significance of IFN-γ and IL-17 in γδ T cells of tuberculosis patients

SHENG Ling-ling, JIN Hui, LIU Dong-hong, LI Bo-qing

2018, 16(11): 1875-1878. doi: 10.16766/j.cnki.issn.1674-4152.000511

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Abstract:
Objective To investigate the effects of Mtb-HAg on the production of IFN-γ and IL-17 in γδ T cells from peripheral blood of peripheral blood mononuclear cell (PBMCs) from normal people (HC) and tuberculosis patients (TB). Methods PBMCs were isolated from the peripheral blood of 12 HC and 12 TB patients and cultured for 12 days. The cells in the experimental group were stimulated by using Mtb-HAg for 2 h and then further cultured for 4 h in Monensin; while the cells in the negative control group without receiving the stimulation with Mtb-HAg. The cells were harvested and labeled with fluorescent-labeled McAb for surface and intracellular staining. The γδ T cells in both groups were assayed by flow cytometry for the production of IFN-γ and IL-17 cells relative proportions. Results The γδ T cells in both experimental group and negative control group were able to produce IFN-γ. IFN-γ produced by γδ T cells stimulated by Mtb-HAg was significantly higher than that by cells without receiving stimulation with Mtb-HAg (P<0.001), and there was significant difference between TB group and HC group (P<0.001). In HC group,the rate of γδ T cells producing IL-17 decreased in both experimental group and negative control group without statistical significance difference, however, in TB group, the same trend showed significant difference between the experimental group and negative control group. Conclusion The γδ T cells from PBMCs in TB patients are sensitive to the stimulation with Mtb-Hag,but its ability to produce IL-17 decreases obviously.

The value of low-tube voltage and low contrast agent concentration for head and neck CT angiography

WU Li-you, CHEN Shi-bao, CAI Zong-qing, ZHAO Ru, ZOU Li-wei, ZHOU Hai-qiong, WEI Wen-han, DENG Yin-jun

2018, 16(11): 1879-1882. doi: 10.16766/j.cnki.issn.1674-4152.000512

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Abstract:
Objective To evaluate the image quality and radiation dose of craniocervical CT angiography (CTA) using low-tube voltage and low volume of contrast material(CM). Methods A total of seventy-five patients who underwent craniocervical CTA in the Taihu county people's hospital were randomly assigned into four groups. The number and dosage of each group were as follows. Group A include 20 cases with 100 kV and 1.0 ml/kg iodine and (1.2-1.0)ml/kg 0.9% normal saline; Group B include 19 cases with 100 kV and 0.8ml/kg iodine and (1.2-0.8)ml/kg 0.9% normal saline; Group C include 18 cases with 80 kV and 1.0 ml/kg iodine and (1.2-1.0)ml/kg 0.9% normal saline; Group D include 18 cases with 80 kV and 0.8 ml/kg iodine and (1.2-0.8)ml/kg 0.9% normal saline; The imaging quality score, dose-length product(DLP), effective dose(ED), the CT value of carotid artery and the CT value of sternocleidomastoid and also the volume of contrast agent were recorded. Results The image quality score of the four groups all reached the diagnostic requirement. The radiation dose of group C and group D was significantly lower than that of group A and group B. The volume of contrast agent in group B and group D was lower than that of group A and C, and the CT value of total carotid artery in group C was significantly higher than those of group A and group B, and there was no significant difference in CT value of the sternocleidomastoid muscle in the four groups. Conclusion Using low-tube voltage and and low volume of CM not only provide images of diagnostic quality but also reduce both radiation dose and iodine intake in craniocervical CTA.

Regulating neuropeptides may be a new breakthrough point in the treatment of neuropsychiatric symptoms of Parkinson’s disease

LI Yuan, WANG Shun, BAI Yan

2018, 16(11): 1883-1885,1909. doi: 10.16766/j.cnki.issn.1674-4152.000513

238 1

Abstract:
Parkinson's disease (PD) is a kind of extrapyramidal nervous system denatured disease, which is mainly manifested as motor symptoms and non-motor symptoms. Among them, motor symptoms mainly include non-autonomous tremor, slow movement, walking balance dysfunction and muscle rigidity. In recent years, the quality of life of PD patients after treatment is directly affected by non-movement symptoms and more and more scholars at home and abroad attaches importance to it. At present, the related pathogenesis of non-movement symptoms have not been clarified. Some scholars pointed out that the occurrence of non-movement symptoms is controlled by multiple factors, and it is not appropriate to use a single factor perspective to observe the disease. In addition, due to the inconsistency of disease evaluation methods, many results before and after treatment are difficult to be compared with each other, which further aggravates the difficulty of mechanism research. It is worth noting that neuropsychiatric symptoms of Parkinson's disease are one of the most common non-motor symptoms, mainly including emotional disorders, intellectual cognitive disorders and impulse control disorders. At present, most of the neuropsychiatric symptoms of Parkinson's disease are symptomatic treatment, and long-term medication may interfere with the normal operation of other nervous systems, and there is a risk of liver and kidney damage. Neuropeptide is a kind of bioactive peptide widely existing in various tissues of the body, which can strengthen the connection between the nervous system and various systems of the body, and has a good regulation effect on many central nervous system diseases. Among them, substance P, neuropeptide Y, brain-derived nutritional factor, nesfatin-1 and other neuropeptides are closely related to the pathogenesis of neuropsychiatric symptoms in Parkinson's disease. According to their correlation, regulating neuropeptide may be a new breakthrough in the treatment of PD neuropsychiatric diseases.

Research progress in upstream treatment of atrial fibrillation

LIU Song-tao, LUO Xiao, LI Ping

2018, 16(11): 1886-1889. doi: 10.16766/j.cnki.issn.1674-4152.000514

230 4

Abstract:
Atrial fibrillation (AF) is a clinically common arrhythmia, characterized by rapid and disordered atrial electrical activity, with high risk of morbidity and stroke, ventricular dysfunction, heart rate formation damage and atrial thrombi is the main pathophysiological mechanisms leading to progression of symptoms in patients with atrial fibrillation and disease. The incidence of atrial fibrillation reconstructs atrial electrical remodeling and structure, while the atrial remodeling makes the occurrence and maintenance of AF worse. Epidemiological investigation suggests that the incidence of atrial fibrillation is increasing year by year, and often accompanied by thromboembolism and heart failure, with a high clinical fatality rate. At present, the main clinical treatment of atrial fibrillation is rhythmic control, ventricular rate control and stroke prevention. Studies have shown that when patients in the clinical stage of atrial fibrillation, the fatality rate and total medical resources than prevention interventions for atrial fibrillation were significantly increased. Therefore, it is very important to actively control the risk factors of atrial fibrillation. In recent years, the upstream treatment of atrial fibrillation has drawn increasing attention from many scholars. The upstream treatment of atrial fibrillation is a pointer to the etiology and mechanism of AF early intervention, so that the source is cut off or the formation and progression of atrial fibrillation is delayed. The current research on upstream atrial fibrillation treatment focused on angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor block (ARB), aldosterone antagonists (Ald), statins, polyunsaturated fatty acids (PUFA) and other drugs. Recent studies have pointed out that the Chinese medicine treatment of three Fuin AF can also play an important role in in the upstream treatment. The researches on upstream atrial fibrillation treatment discussions will be reviewed in this paper.

Research progress of primary cardiac tumors

AI Feng-ying, WANG Da-xin, GENG Tong, SU Yan-jie

2018, 16(11): 1890-1893. doi: 10.16766/j.cnki.issn.1674-4152.000515

257 2

Abstract:
Primary cardiac tumors are rare, and clinical epidemiological statistics of the circulatory system is the lowest compared with other systems. Due to the particularity of age, primary cardiac tumors in infants and children are extremely rare, with an estimated incidence of 0.2% according to echocardiographic studies and the autopsy rate in the population is lower. Primary cardiac tumors include benign and malignant:according to statistics, about 90% of primary cardiac tumors are benign, with myxoma the most common and more common with rhabdomyoma; whereas malignant tumors are common with sarcomas. Its incidence is low, but with the progress of clinical auxiliary examination, the prenatal diagnosis rate increases, detection rate of heart damage also increased year by year. Between 1995 and 2005, echocardiography was the most widely used instrument as a non-invasive test. And 2005 CT began to be used in clinical application, while MRI in 2010 can be more effectively detected and assessed of the prognosis and efficacy of cardiac tumors. Occurring in children with heart tumors are mostly primary or no obvious clinical symptoms, but surgery is required only in a minority of cases. Patients with primary cardiac tumors often show as nonspecific symptoms of dyspnea, chest pain, heart palpitations, fever, and weight loss and so on; severe cases can also cause heart rupture, heart and kidney failure, neurological symptoms. Most heart lumps are not suitable for percutaneous biopsy, but pathological findings after surgical resection can prompt a clear diagnosis. At present, the clinical diagnosis mainly depends on echocardiography (transthoracic or transesophageal echocardiography) and cardiac magnetic resonance (MR), and there are some limitations in the rapid and accurate diagnosis of cardiac tumors, which, to some extent also limits the diagnosis of treatment programs, and timely and effective treatment of prognosis is particularly important. However, clinical diagnosis and treatment is still more difficult and timely and effective treatment of prognosis is particularly important. Because of its low incidence, the current reports of the disease are mostly case reports. This article focuses on the classification, diagnosis and treatment of primary cardiac tumors.

Effect of Fuyuan Huoxue Decoction combined with western medicine on preventing hemorrhage after mammotome operation and its effect on postoperative pain

LOU Chao-sheng, WU Xian, SU Wei-min, SHI Zhong-yi, JU Jin-miao

2018, 16(11): 1894-1896. doi: 10.16766/j.cnki.issn.1674-4152.000516

207 0

Abstract:
Objective To investigate the effect of Fuyuan Huoxue Decoction Combined with western medicine on preventing hemorrhage after mammotome operation and its effect on postoperative pain, so as to improve the clinical effect of benign breast swelling. Methods In this study, 80 women with mammotome breast nodules in our hospital during the period of June, 2016 to October, 2017 were selected as the subjects. According to the simple randomization group (1:1), they were divided into the control group and the observation group, and the two groups were 40 cases each. The control group was given the elastic bandage pressure thin wrapping 48 h treatment and the static drip of hemostatic medicine. On the basis of the control group, the observation group was treated with 3D combined with Fuyuan Huoxue Decoction. The operation time, the amount of bleeding, the time of hospitalization and the cost of the two groups were compared, and the postoperative pain visual analogue score (VAS) and the related complications were observed. Results Two groups of patients were successfully completed surgery, no withdrawal case. The amount of operation bleeding[(5.1±1.5) ml], hospital days[(3.4±1.3) days] and hospitalization expenses[(8 970.2±921.3) yuan] were lower than that of the control group[(6.8±1.7) ml], hospitalization days[(4.1±1.1) days] and[(9 452.6±845.2) yuan], and the difference was statistically significant (P<0.05). The postoperative hematoma rate 2.50% (1/40) was significantly lower in the observation group. The difference was statistically significant in the control group 22.50% (9/40), and the difference was statistically significant (P<0.05). The VAS scores of 2D and 3D[(3.2±1.0) and (2.5±0.9)] in the observation group were lower than those of the control group[(3.8 ±1.2) and (3.1± 1.1)] respectively, and the difference was statistically significant (P<0.05). Conclusion Fuyuan Huoxue Decoction can help reduce the risk of bleeding and complication of hematoma, reduce the patient's physical pain and hospitalization expenses, and the clinical application value is remarkable.

Curative effect observation of Zishen Liangxue Tiaozhou method in the treatment of endometriosis with infertility patients and effect of VEGF in serum

ZHANG Yu-ling, ZHAO Shan-qiong

2018, 16(11): 1897-1900. doi: 10.16766/j.cnki.issn.1674-4152.000517

198 1

Abstract:
Objective To observe the clinical effect of Zishen Liangxue Tiaozhou method in the treatment of endometriosis with infertility patients,and to explore the mechanism of this method to improve the pregnancy rate of patients. Methods According to the r-AFS staging method, 146 patients were divided into the mild group 64 cases (32 cases of the chinese herbal group and the control group) and the moderate to severe group 82 cases (41 cases of the Chinese herbal group and the control group). The mild group:the chinese herbal group were treated with Liangxue Zishen Tiaozhou method from the beginning of the first menstruation for three menstrual cycle, and then observed three menstrual cycle; the control group were observed six menstrual cycles without medication after surgery. The middle to severe group:the Chinese herbal group and the control group were both injected subcutaneously with GnRH-a 3.6 mg on the first day of menstruation, once every four weeks, a total of three needles, and the next treatment were the same as the mild group. Before and after treatment, to compare the improvement of the TCM syndromes, the change of serum levels of VEGF, and the condition of pregnancy within six months after treatment. Results ① The TCM syndrome integral all significantly improved than before in each groups (P<0.01), and between the groups, the Chinese herbal group were both better than the control group (P<0.05). ② The serum of VEGF were all significantly lower than before in each groups (P<0.01), and between the groups, the Chinese herbal group were both better than the control group (P<0.05). ③ The pregnancy rate:the mild group:the chinese herbal group was 46.88%, the control group was 21.88%; the moderate to severe group:the chinese herbal group was 43.90%, and the control group was 21.95%; and between the groups, the Chinese herbal group were both higher than the control group (P<0.05). Conclusion The Liangxue Zishen Tiaozhou method can significantly improve the clinical symptoms of endometriosis with infertility patients, obviously decrease the serum levels of VEGF, and increase the pregnancy rate. The mechanism might be inhibiting excessive expression of VEGF and blocking the formation of neovascularization with ectopic foci.

Randomized, double-blind, controlled study on the effect of integrated traditional Chinese and Western Medicine on patients with acute ischemic stroke

CHENG Yi-sheng, WU Ling-kang

2018, 16(11): 1901-1905. doi: 10.16766/j.cnki.issn.1674-4152.000518

158 0

Abstract:
Objective To observe the effect of Dengzhan Shengmai capsule combined with tirofiban on ischemic stroke, and to provide reference for the combination of traditional Chinese and Western medicine in the treatment of ischemic stroke. Methods From January, 2017 to April, 2018, 112 patients with acute ischemic stroke were randomly assigned to the control group or the observation group, with 56 cases in each group. The control group was given routine and symptomatic treatment, tirofiban intravenous infusion and Dengzhan Shengmai placebo capsule were given, too. The treatment method of the observation group changed the placebo to Dengzhan Shengmai capsule. Before and after treatment, the two groups were measured by the National Institutes of Health Stroke Scale (NIHSS), the Modified Rankin scale (MRS) and the Barthel scale (BS) to the patients. At the same time, the coagulation function indexes were detected, the possible adverse drug reactions were recorded, and the SPSS 22.0 statistical software was used for statistical analysis. Results There was no statistical difference in general clinical data between the two groups (P>0.05). After treatment,the score of NIHSS and MRS in the observation group were lower than that of the control group (P<0.05), and the score of BS was higher than that of the control group (P<0.05). After the treatment, the activated partial thromboplastin time (APTT) and the international standardized ratio (INR) in the observation group were higher than those of the control group (P<0.05). No serious adverse reactions were found in the two groups. Conclusion The combination of Dengzhan Shengmai capsule combined with tirofiban can play a good role in promoting the recovery of nerve function and improving the index of coagulation function in the patients with ischemic stroke,and the adverse drug reaction is less.

Study on the technique of constipation in excess syndrome children with Daozhi Tongbian manipulation

CHEN Mei-lan, LAI Qing-zhong, DONG Yi-qi

2018, 16(11): 1906-1909. doi: 10.16766/j.cnki.issn.1674-4152.000519

198 0

Abstract:
Objective To investigate the clinical efficacy on the treatment of Daozhi Tongbian manipulation for treating children constipation with excess syndrome. Methods Random number method was used to divide 120 cases of constipation in our hospital from December, 2015 to December, 2017 into two groups, 60 cases in each group. The control group was treated with Medilac-Vita medicine and the observation group was treated with Daozhi Tongbian manipulation. Comparing the scores of TCM syndromes before and after treatment in the two groups (defecation difficulty, stool quality, defecation interval, abdominal distention and abdominal pain, refraining from feeding, feverish palms and soles, sleep disturbance, upset, short yellow urine and thick red tongue coating). Clinical efficacy and incidence of adverse reaction during treatment. The effect of guiding Daozhi Tongbian manipulation on children constipation with excess syndrome was analyzed, through the analysis of prognostic data of two groups. Results After treatment, the total scores of TCM symptoms in the two groups decreased significantly (P<0.05), and the observation group was significantly lower than the control group (P<0.05). After treatment,the degree of difficulty in defecation, the quality of constipation,and the time between defecations were significantly decreased in both groups (P<0.05), and the observation group was significantly lower than the control group (P<0.05). After treatment, abdominal distention and abdominal pain in the groups, refraining from feeding, feverish palms and soles, sleep disturbance, upset, short yellow urine and thick red tongue coating were significantly lower (P<0.05), and the observation group was significantly lower than the control group (P<0.05). After treatment,the total effective rate of the observation group was 96.67%, which was significantly higher than that of the control group (71.67%, P<0.05). No obvious adverse reaction were seen during the treatment of both groups. Conclusion Compared with oral drug therapy, Daozhi Tongbian manipulation can significantly improve the clinical symptoms of children constipation with excess syndrome.

Application of flipped classroom based on micro-lecture in physiology teaching of higher vocational nursing specialty

QIN Yong-ting, WANG Xiao-jun, CHEN Qin, CHEN Pei, WANG Shi-zhen, ZHANG Xiao-lei

2018, 16(11): 1910-1912. doi: 10.16766/j.cnki.issn.1674-4152.000520

183 0

Abstract:
Objective Considering the poor teaching effect of traditional teaching mode of physiology in classroom, we studied the influence of flipped classroom teaching mode based on micro-lecture on physiology teaching, so as to further improve the teaching effect of physiology in higher vocational nursing specialty, and to provide reference for the future teaching and the study of flipped classroom teaching mode based on the micro-lecture. Methods A total of 108 students of higher vocational nursing specialty of 2016 grade from Jiangsu College of Nursing were chosen as objects of analysis. They were randomly divided into control class (54 persons) and experimental class (54 persons). Students were divided into 9 groups (6 person/group) in experimental class and practiced with flipped classroom teaching mode based on micro-lecture. Students were divided into 9 groups (6 person/group) in control class and practiced with traditional teaching mode. There were four main steps in the flipped classroom teaching mode based on micro-lecture:teacher's preparation before class; students' autonomous learning before class; seminar in class; consolidation after class. After teaching, two classes were given the same test questions in final examination, and the scores of the exam were analyzed. At the same time, the effects of teaching were evaluated according to the questionnaire survey. All data were processed by SPSS 19.0. The means of groups were compared by t test, and the enumeration data were compared by χ² test. Results The average score of the final examination of the experimental class (80.96±10.48) was significantly higher than that of the control class (71.72±13.11), and the difference was statistically significant (P<0.01). Compared with control class, the learning interest (P<0.05), learning initiative (P<0.01), knowledge understanding ability (P<0.01) and learning efficiency (P<0.01) of students were significantly improved in experimental class. Conclusion The flipped classroom teaching mode based on micro-lecture can effectively improve the teaching effect of physiology, and improve students' interest in learning, learning initiative, knowledge understanding ability and learning efficiency. Therefore, it deserves further study and promotion.

The exploration and practice of general practice residents standardized training in Peking University Health Science Center

DONG Ai-mei, QI Zhen-nan, QI Jian-guang, YAO Mi, SHEN Yang, MIAO Yi-de, CHI Chun-hua, ZHENG Jia-qiang

2018, 16(11): 1913-1915. doi: 10.16766/j.cnki.issn.1674-4152.000521

231 5

Abstract:
With the introduction of the national opinion on deepening the reform of health care system reform, improving the basic medical service system is an important measure to deepen medical reform. The development of general practice is the key to the implementation of hierarchical medical system and talent training is the key link of the disciplinary development. General practitioners are interdisciplinary clinical medical talents with a high degree of integration. It has undertaken continuous medical services such as diagnosis and treatment of common diseases, preventive health care and chronic disease management. The people management involves different ages of sex and their physical, psychological and social health problems. Therefore, the training of general practitioners should cover many fields related to medicine. At present, China has basically established a general practitioner training model with "5+3" as the main part and "3+2" as the supplement. General practice residences standardized training is the best way to train high quality general practitioners. Since 2011,the department of general practice in Peking University has carried out standardized training for general practitioners, actively committed to exploring ways to train general practitioners in line with China's national conditions, adapt to the characteristics of the industry and meet the needs of patients. After nearly eight years of practice, we accumulated rich experience and achieved good results in the management system construction, the optimization training strategy and competency based training. The training system has been improved from the establishment project committee of general practitioners to management team construction and strict selection of faculties. We improved the training quality from tutor management and optimized hospital/community rotation program through the feedback of trainees. A characteristic and diversified evaluation method combining formative assessment and finalization assessment was adopted, in order to steadily improve the skills of the students, and training excellent general practitioners with the aim of "competency based". The department of general practice in Puking University had explored the general practice residences standardized training system with high quality and can be generalized and duplicated. It has been made beneficial exploration to achieve sustainable development in train qualified general practitioner.

The investigation and analysis of radiation protection of ionization contact personnel in the medical institutions of Hefei City

ZHANG Lu, ZHANG Yun, HU Cheng-yang, GAO Bin, LI Feng-li, JIANG Wen, HUA Xiao-guo, ZHANG Xiu-jun

2018, 16(11): 1916-1919. doi: 10.16766/j.cnki.issn.1674-4152.000522

192 1

Abstract:
Objective Via the investigation and analysis of the status of radiation protection of ionization contact personnel in Hefei city, this study aims to find out problems and affecting factors of radiation protection, to intervene and to provide a basis for improving the radiation safety and personnel health. Methods By stratified cluster sampling of radiation protection, we collected 347 ionization contact personnel from September, 2015 to November, 2015 using the descriptive statistics, t test, variance analysis,rank sum test and other statistical analysis methods on the valid data. Results The scores of radiation protection cognition from 347 ionization contact personnel range from 5-19 points, and the average score is (14.38±2.12) points. The cognition statuses differ from levels of hospital (t=-4.854,P<0.001), types of job (Hc=8.039, P=0.018), different types of occupational exposure (F=4.631, P=0.003), which have statistical significance. Among the 347 ionization contact personnels, 175 (50.4%) attended over twice radiological training, 255(73.5%) radiologists regarded their institutions have safety organization management system, 44(12.7%) reported that they did not wear dosimeters, 11(3.2%) were even not equipped with dosimeter, 162(48.2%) did not know the result of the dosimeter, 72(20.8%) sometimes or never used the protection equipment, 15(4.3%) were not equipped with any protection methods, 335(96.5%) regard occupational health examination necessary, and 12(3.5%) regard the occupational health examination meaningless. Conclusion The 347 ionization contact personnel have insufficient radiological protection to some degree. The relevant management should strengthen the training of ionization contact personnel, together with strict supervision, health examination and protective articles, to improve the radiation safety and lower the health hazard risk of the ionization contact personnel.

Analysis on prevalence of anemia among children under 12-year-old in Yinzhou District, Ningbo city

PEI Ren-zhi, LI Shuang-yue, LU Ying, ZHANG Pi-sheng, MA Jun-xia, LIU Xu-hui, DU Xiao-hong

2018, 16(11): 1920-1923. doi: 10.16766/j.cnki.issn.1674-4152.000523

260 4

Abstract:
Objective To understand the prevalence of anemia in Yinzhou district, Ningbo and to find out its related affecting hemoglobin level of children so as to search for proper intervention. Methods One thousand six hundred and fifty children under 12 years old and their families from 11 towns in Yinzhou district were studied using stratified random sampling from June, 2012 to May, 2014. Physical examination, hemoglobin test and feeding habit survey were done. Results The anemia rate of 1 650 children was 7.6%(126/1 650),it was 7.3%(57/779) in female children,while 7.9%(69/871) in male children.Many factors were associated with children's anemia, the incidence of anemia of 1-6 year-old children was significantly higher than those of 0-1 year-old children and 6-12 year-old children (P<0.05). The incidence of anemia in rural areas was higher than those in urban areas (P<0.05), and the incidence of anemia in single parent families was higher than that in two-parent families (P<0.05), the incidence of anemia in children with stable and highly educated caregivers is relatively low (P<0.05), but it has nothing to do with sex, the number of compatriots, and the time for breastfeeding. The main causes of 126 cases of children with anemia were iron deficiency anemia and megaloblastic anemia. The concentration of peripheral blood SF, ZnPP, FA and VitB₁₂ in children with anemia were detected, SF in the 1- year-old children was significantly lower than the other two groups. ZnPP was normal in 0-year-old children, but was significantly higher than the other two groups. FA and VitB₁₂ concentrations were normal in three age group, but the concentration of FA in the 6-year-old children was higher than the other two groups. Conclusion The anemia rate of children in this area is still high. The incidence of children in the 1-6 year-old group is the highest, and iron deficiency anemia and megaloblastic anemia are the main reasons. It is necessary to intervene from many aspects simultaneously.

Construction of a full-time reservation system for large-scale three-level public hospitals

WU Hui-jing, CHEN Lan, ZHONG Li-wei, HUANG Chen

2018, 16(11): 1924-1926,1942. doi: 10.16766/j.cnki.issn.1674-4152.000524

208 2

Abstract:
Objective As the demand for medical care continues to grow, quality medical resources cannot fully meet the growing needs of the general public. How to provide convenience for patients and save patient's waiting time to improve outpatient work efficiency is the most concerned issue for patients and is a common problem faced by large public hospitals. Methods Based on the background of ‘Internet+’, this article explores the daily consultation time by half hour as a unit according to the time-based full appointment medical treatment. According to the characteristics of different departments, the number of theoretical consultations per unit time is set to the patient's visit time which can be specific to the minute, and through the provision of an appointment registration, the patient can know the time of his/her visit when making an appointment, understand the registration expert's clinic time, reduce the concentration and detention of the patient, and further protect the patient's medical safety as well as to achieve the diversion of the visiting population and improve the medical environment. Results In the southern part of our hospital, the current situation of supply and demand of hospital outpatient clinics, after the appointment registration, based on the summary of this experience, we proposed a time-based full appointment registration system, which through the nearly half a year of exploration and practice, achieved good results. The system can effectively improve the appointment rate of outpatients, optimize the time distribution of outpatients, and effectively facilitate patients to seek medical treatment. Conclusion The implementation of the multi-channel model with full-schedule appointments has effectively changed the patient's registration habits and improved the appointment rate. At the same time, it has also improved the medical environment and rationalized the allocation of medical resources, which is conducive to the long-term development of the hospital.

Correlative analysis of marital quality and depression in maintenance hemodialysis patients

XIE Li, ZHENG Shu-ying, XIE Qi-peng

2018, 16(11): 1927-1930. doi: 10.16766/j.cnki.issn.1674-4152.000525

211 0

Abstract:
Objective To investigate the effect of marital quality on the level of depression in maintenance hemodialysis patients in order to provide a reference for clinical nursing managers to take interventions to reduce the level of depression in hemodialysis patients. Methods A total of 176 hemodialysis patients were recruited from the Second Affiliated Hospital of Wenzhou Medical University, between February, 2016 and February, 2017. They were investigated with the general information questionnaire, marriage perception scale and Chinese version of the Beck depression inventory-Ⅱ. Statistical analysis was conducted using univariate analysis, Pearson correlation analysis to understand the status of the patient's marriage quality and depression level, and to explore the relationship between the two. Results The total score of depression in maintenance hemodialysis patients was (25.88±5.94) points, and the total score of marriage quality was (50.18±12.86) points. Single factor analysis showed that the literacy, duration, and marital quality were the influencing factors of depression in maintenance hemodialysis patients. The quality of marriage in patients with maintenance hemodialysis was negatively correlated with their depression level (r=-0.362, P<0.001). Conclusion Depression is a common psychological disease in maintenance hemodialysis patients. This study shows that the quality of marriage can predict the depression level of maintenance hemodialysis patients, and improving the marital quality of maintenance hemodialysis patients will help improve the depression level of patients.

Effect of sensory integration training combined with psychological and behavioral interventions on children with attention deficit hyperactivity disorder

FU Chan-rong, LYU Lan-qiu, REN Ying-ying, HU Su-jun, ZHOU Li-li, HU Yan-li

2018, 16(11): 1931-1933. doi: 10.16766/j.cnki.issn.1674-4152.000526

248 6

Abstract:
Objective To observe the application effect of sensory integration training (SID) combined with psychological behavior intervention in children with attention deficit hyperactivity disorder (ADHD). Methods Ninety-six patients with attention deficit hyperactivity disorder were enrolled in our hospital from September, 2017 to June, 2018. According to the random number table method, 96 patients were divided into observation group and control group with 48 cases in each group, and all patients in both groups were treated with western medicine. The control group used psychological behavior intervention, while the observation group received additional sensory integration training combined with psychological behavior intervention. The sensory integration scores, Patient Satisfaction Questionnaire (PSQ) scores, and visual and auditory attention scores were tested and compared. Results Before the intervention, there were no statistically significant scores of sensory integration scores and PSQ scores between the two groups (P>0.05). After 3 months of continuous intervention, the scores of sensory integration in the observation group were all higher than that in the control group, and the scores of PSQ were lower than those of the control group, P<0.05. The results of attention test showed that the response time (50.83±0.57) s, number of errors (54.32±0.81) and missing number (67.23±0.56) of the observation group were lower as compared with the control group[(55.69±0.46)s, (60.23±0.77), (69.79±0.68, respectively)], P<0.05.

Effect of clinical pharmacists in the antimicrobial management: a systematic review and meta-analysis

LI Feng, HE Mei, SHAO Xin, LIU Fu

2018, 16(11): 1934-1938. doi: 10.16766/j.cnki.issn.1674-4152.000527

250 3

Abstract:
Objective To investigate the effectiveness of pharmacists' interventions on antibiotic use, so as to provide reference for the development of pharmaceutical care by clinical pharmacists. Methods We searched PubMed, the Cochrane Library, Embase, CNKI, Wanfang, VIP, CBM to June in 2017 for RCTs about pharmacists' interventions on antimicrobial management. Relevant data and carried out risk-of-bias assessments were extracted by two reviewers working independently. The Meta analysis was performed by using RevMan 5.3 software. Results Total 8 RCTs involving 2 737 patients were analyzed. The meta-analysis indicated that the pharmacists' intervention teams may shorten length of hospitalization[WMD=-1.96, 95% CI(-3.39, -0.52), P=0.007], improve the proportion of appropriate antimicrobial prescriptions[RR=2.09, 95% CI(1.15, 3.79), P=0.021], reduce the cost of antibiotics[WMD=-125.51, 95% CI(-172.49, -78.52), P<0.001], compared with the control teams. But there was no significant difference in the duration of antibiotics therapy between the two teams[WMD=-1.3, 95% CI(-2.77, 0.17),P=0.082]. Conclusion pharmacists' intervention may significantly shorten length of hospitalization, improve the proportion of appropriate antimicrobial prescriptions, and reduce the cost of antibiotics.

Influence of team nursing on risk of deep vein thrombosis in patients with lower limb fractur

ZHENG Ling-ling, YANG Jin-ji, SU Zheng, WU Miao-miao, YU Hua-chen

2018, 16(11): 1939-1942. doi: 10.16766/j.cnki.issn.1674-4152.000528

155 5

Abstract:
Objective To observe the effect of team nursing on the risk of deep venous thrombosis (DVT) and patient satisfaction in patients with fracture of lower limb. Methods Total 118 cases of fracture of lower limb in the Second Affiliated Hospital of Wenzhou Medical University between January, 2015 and December, 2015 were enrolled and randomly divided into routine group and treatment group with 59 cases in each group. The patients in the routine group received routine nursing, while the patients in the treatment group were managed with team nursing. After the nursing intervention, the risk of DVT and patient satisfaction compared between the two groups. The t-test and Chi-square test were performed by using SPSS 21.0 statistical software. Results The risk assessment rate of thrombosis, early detection rate of ultrasound and abnormal rate of D-dimer screening in treatment group was 74.58% (44/59), 76.27% (45/59) and 93.22% (55/59), respectively, which was significantly higher than those in the routine group[(44.07% (26/59), 45.76% (27/59) and 30.51% (18/59)]. The rate of thrombosis in the treatment group was 1.69& (1/59), which was significantly lower than that in the routine group (13.56%, 8/59). The patient satisfaction in the treatment group was 98.31%, which was significantly higher than that of the routine group (88.14%), the difference was statistically significant (P<0.05). Conclusion The team nursing management in patients with fracture of lower limb can improve the positive rate of various indicators for DVT early detecting, reduce the incidence of DVT, shorten the length of hospital stay and improve patient satisfaction.

Application of WeChat follow-up nursing in improving bad emotion and family care capability of adult epilepsy

ZHANG Xu-fen, YAN Yu-kui

2018, 16(11): 1943-1945. doi: 10.16766/j.cnki.issn.1674-4152.000529

170 0

Abstract:
Objective This article aims to investigate the clinical effects of the WeChat follow-up care to alleviate the negative emotions in adult patients with epilepsy and to strengthen the care of patients with family members. Methods A total of 100 patients with epilepsy in our emergency department and neurology outpatient department from 2015 to 2017 were divided into control group and observation group based on random number method, with 50 cases in each group. Patients in the control group were followed up by phone and outpatient clinic while in the observation group, by telephone and out-patient follow-up, plus WeChat follow-up. On the patient's enrollment day, 1 month after hospital discharge, 3 months, the patients took anxiety assessment form(SAS) prepared by ZUNG, patients and their families' knowledge about disease questionnaire, family members nursing ability, patients satisfaction with the work of health care workers. Results There was no statistically significant significance (P>0.05) on the above-mentioned data. However, after 1 month and 3 months of follow-up with WeChat, the prevalence of SAS, relatives ‘ability to take care of patients, level of awareness and patients’ satisfaction with the work of medical staff were significantly better than those of the control group, and the difference was statistically significant(P<0.05). Conclusion WeChat follow-up care in improving the bad mood in adults with epilepsy and family members have a significant clinical effect, which is worth in the major medical institutions for a wide range of implementation and use.

Clinical efficacy and nursing of Mecobalamine Combined with hemoperfusion for uremic peripheral neuropathy

CENG Hui, ZOU Yi, CHENG Zong-hua, CENG Hong

2018, 16(11): 1946-1949. doi: 10.16766/j.cnki.issn.1674-4152.000530

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Abstract:
Objective To observe the clinical efficacy and nursing of Mecobalamine Combined with hemoperfusion in uremic peripheral neuropathy. Methods 120 patients with uremic peripheral neuropathy admitted to Luzhou People's Hospital from March, 2016 to March, 2017. Were randomly divided into 2 group,The control group was given 1 hemoperfusion every week on the basis of 2 routine hemodialysis once a week. The experimental group was given subcutaneous injection of mecobalamine twice a week, 0.5 ml/time, On the basis of the treatment of the control group. Check the changes of nerve reflex and sensory nerve conduction velocity. During the treatment period, patients were given hemoperfusion, daily nursing and psychological nursing. Results After 8 weeks of treatment, the total effective rate of the treatment group was 90.00%. The clinical symptoms such as limb pain, sensory disturbance, numbness and restless leg syndrome were significantly improved. The respective effective rates were 89.47%, 80.00%, 85.71% and 87.50% respectively. The disappearance of nerve reflex (upper limb tendon reflex disappearance, knee limb tendon reflex disappearance) was significantly alleviated, and the nerve conduction speed (median nerve, common peroneal nerve, tibial nerve) was significantly faster than that of the control group. No blood coagulation, hemolysis, allergy, bleeding, bleeding, skin damage and other conditions were found during blood perfusion. Conclusion Uremia patients are treated with hemodialysis for a long time. Hemoperfusion on the basis of dialysis can purify the blood more fully. The application of mecobalamine can repair injured nerves and promote the excretion of toxins, which can alleviate the condition of uremic peripheral neuropathy in patients.Mecobalamine Combined with hemoperfusion can effectively improve peripheral neuropathy.

To investigate the effectiveness of standardized emergency care procedures in emergency treatment of patients with ST-segment elevation myocardial infarction

MENG Xiao-qin, JIA Ya-ping, ZHANG Xu, CHEN Guo-wei

2018, 16(11): 1950-1952. doi: 10.16766/j.cnki.issn.1674-4152.000531

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Abstract:
Objective To explore the rescue effect of standardized emergency care procedures on ST segment elevation myocardial infarction patients. Methods A total of 110 patients with ST-segment elevation myocardial infarction diagnosed and treated in the emergency department of the Second Hospital of Jiaxing City from January, 2016 to March, 2018 were randomly divided into observation group and control group with 55 cases in each group. Patients in the control group were treated with routine emergency care procedures and patients in the observation group were treated with standardized emergency care procedures. The first-aid related indicators (ECG time, venous opening time, emergency stay time, first balloon dilatation time, and length of hospital stay) of the 2 groups were observed, the ST segment reduction rate and the nursing satisfaction degree within 3 hours. All patients were followed up for 6 months. The incidence of acute cardiac events (myocardial infarction, postinfarction angina, heart failure) and cardiac death was recorded in both groups. Results The patients in the observation group had shorter electrocardiogram time, intravenous opening time, emergency detention time, first balloon dilatation time, and hospitalization time than the control group (P<0.05). The rate of ST segment depression within 3 hours in the observation group was 63.6% (35/55), higher than 40.0% (22/55) of the control group, and the satisfaction rate of the observation group was 90.9% (50/55) higher than 74.5% (41/55) of the control group (P<0.05); after 6 months of follow-up, the incidence of acute cardiac events in the observation group was 12.7% (7/55) and the incidence of cardiac death was 0, while the control group were 29.1% (16/55) and 7.3% (4/55), respectively, P<0.05. Conclusion The standard emergency care procedure in ST segment elevation myocardial infarction patients can improve the patient's rescue effect, shorten the patient's rescue time, improve the patient's prognosis and nursing satisfaction, and is worthy of clinical application.

WANG Wei, WANG Fu-rong, ZHONG Gan-ping

2018, 16(11): 1953-1954. doi: 10.16766/j.cnki.issn.1674-4152.000532

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2018 Vol. 16, No. 11

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