2018 Vol. 16, No. 12

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Discussion on the application of translational medicine in the implementation of standardized training of general practitioners
YANG Yang, MI Man, WU Ge, LI Ya-jun, LIU Bi-bo, LI Yao-dong, CHEN Rui
2018, 16(12): 1955-1957. doi: 10.16766/j.cnki.issn.1674-4152.000533
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Translational medicine is a new cross-disciplinary medical research discipline, which could push forward and promote the transformation of medical basic research results into clinical practice application, and better make up the shortcomings of the "hard to use" under the current medical education model. Such concept has been widely recognized and better applied and practiced in recent years. General practice, as a multidisciplinary and comprehensive medical discipline, advocates community-based and family-oriented patient-centered care and aims to maintain the overall health of patients in the long term. The concept of "patient-centered" emphasized by translational medicine and its advanced concepts and methods in the field of education and training coincides with the gist of general medicine and the core content of education in varied aspects. The standardized training of general practitioners is an important part of general practice. However, the medical institutes currently undertaking standardized training of general practitioners in our country have a high degree of specialization. It is difficult for professors to grasp effective modes of general medical education. Therefore, they cannot fully realize the purpose of teaching during the limited training period. A solid grasp of the skills within the training led to the lack of their own professional positioning and professional confidence. Learning from and drawing on the concept of translational medicine into the general medical education system may help solve the above problems. Translational medicine emphasized the concept of transformation from the achievement of basic medical research into clinical practice, the effective experiences such as disciplinary construction, teaching methods, evaluation system and teacher training as well as advantages in the field, which have a positive effect on improving the implementation effect of standardized training for general practitioners' enhancement. It is worth to analyze and discuss.
DING Min, PAN Jia-hua
2018, 16(12): 1958-1959.
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The study on nasopharynx microbiome community characteristic in 72 young infants hospitalized with cough
WANG Qing, LI Dong-fang, MENG Qing-hong, GAO Wei, YUAN Lin, QIU Chuang-zhao, SHI Wei, LIU Ying, DAI Wen-kui, YAO Kai-hu
2018, 16(12): 1960-1963. doi: 10.16766/j.cnki.issn.1674-4152.000534
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Objective To study the nasopharynx microbiome community characteristics of young infants with cough, and the connection with several clinical features. Methods From 2015 to 2017, 72 young infants who had cough were enrolled. Information of gender, age, delivery mode, feeding practices, RSV as well as B.pertussis testing results were collected. Twenty-four cases were positive in B.pertussis culture, while 48 cases were negative. After extracting the genome DNA, the region of V3-V4 was amplified and sequenced. Results The nasopharynx microbiomes of 72 young infants were dominated by five distinct community pneumotypes (C1-C5). The 22 of 24 B.pertussis culture positive cases were detected with Bordetella 16S rDNA, while 34 of 48 negative cases were detected with Bordetella 16S rDNA, with a relative abundance of 0.003%-0.280%. The average relative abundance of B.pertussis in Bordetella culture positive cases (28.38%) was significantly higher than negative cases (0.03%). Besides, the average relative abundance of Staphylococcus and Bordetella in RSV positive cases was significantly lower than negative cases. Conclusion Except for Bordelella, the nasopharynx microbiomes of 72 young infants are resembled previous finding. Culture probably may not work owing to a low abundance of bacteria. RSV can significantly influence the the nasopharynx microbiome community characteristics of young infants with cough.
Clinical effect of lyophilized recombinant human brain natriuretic peptide on chronic congestive heart failure in the very old patients
ZHANG Xuan-shun, SUN Meng-wen, YAN Guang, ZHANG Wei, ZHU Chen
2018, 16(12): 1964-1966,1999. doi: 10.16766/j.cnki.issn.1674-4152.000535
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Objective To study efficacy and safety of lyophilized recombinant human brain natriuretic peptide (rhBNP) in the treatment of chronic congestive heart failure (CHF) in the very old patients. Methods Totally 47 cases of senile chronic CHF in Anhui Provincial Hospita ICU from November 2016 to November 2017 were collected. All the patients were treated with rhBNP in addition to routine heart failure therapy. The clinical effects were evaluated mainly according to the clinical symptoms before the treatment, 72 hours and 7 days after the treatment, including N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, central venous pressure(CVP), serum hypersensitive c-reactive protein(hsCRP), white blood cell count (WBC), respiratory rate (RR), heart rate (HR), urine volume and systolic blood pressure. Results Among the 47 patients, 43 of them showed obvious improvement in cardiac function, while 3 cases showed minor improvement, 1 case died of infection aggravation on the 12th day of hospitalization. The respiratory rate, heart rate, urine volume and LVEF at 72 hours after the treatment showed significant improvement, NT-proBNP, CVP, hsCRP and white blood cell count reduced greatly at 72 hours after the treatment(P<0.05). The improvement of respiratory rate, heart rate and LVEF continued 7 days after the treatment, the reduction of NT-pro BNP, CVP and hsCRP became significant after 7 days(P<0.05). The urine volume remained stable 7 days after the treatment. The white blood cell count remained stable 7 days after the treatment. There were no obvious changes in the serum creatinine, urea nitrogen and glutamic-pyruvic transaminase(P>0.05). Transient low blood pressure could be detected in the treatment, but the incidence was low. Conclusion The rhBNP on CHF in very old patients is effective and safe.
Effect of transverse radial artery forearm flap in the treatment of hand trauma
LIU Guo-bao, XU Shuo-gui, SHI Sheng-sheng, FEI Hong-liang
2018, 16(12): 1967-1969. doi: 10.16766/j.cnki.issn.1674-4152.000536
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Objective To observe the effect of radial transverse free flaps with the palmar branch of the radial artery and the thoracic and abdominal perforator flap for the treatment of hand wound tissue, and to explore the ideal surgical method for the treatment of hand wound tissue, and provide a reference for clinical practice. Methods Total 82 cases of hand trauma patients were collected from May, 2016 to May, 2017 in the emergency department. According to the random number table method, the control group (41 cases) and the observation group (41 cases) were used to repair the free flap of the transverse branch of the wrist and the palmar branch of the radial artery, and the SPSS 21.0 system was used for the data. The operation time, bleeding volume, flap survival, finger reconstruction function and patient satisfaction were compared between the two groups. Results The operation time of the observation group (90.7±20.1) min was shorter than that of the control group (134.9±24.3) min, the difference was significant (t=8.974, P<0.05), and the amount of bleeding (94.2±9.3) ml in the observation group was similar to that of the control group (97.7±6.8) ml, the difference was not significant (t=1.945, P>0.05), and the survival rate (100.0%) of the skin flap in the observation group was slightly higher than that of the control group (97.6%) the difference was not significant (P>0.05); the good rate of finger reconstruction (92.7%) in the observation group was higher than that of the control group (80.5%), and the difference was significant (χ2=2.625, P<0.05); the patient satisfaction of the observation group (97.6%) was higher than that of the control group (80.5%), and the difference was significant (χ2=4.493, P<0.05). Conclusion The transverse radial artery forearm flap for the repair of hand wound tissue is ideal, the operation time is short, the function of finger reengineering is good, the patient's satisfaction is high, and it is worthy of clinical application.
The effect of carfilzomib on rheumatoid arthritis in rats through inhibiting proliferation of FLS
ZHOU Xiao-xiao, YANG Yang, XU Zheng-feng, GAO Feng, ZHU Jia-jia, XIA Sheng-li, WANG Xiu-hui
2018, 16(12): 1970-1973,2132. doi: 10.16766/j.cnki.issn.1674-4152.000537
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Objective To observe the action of carfilzomib (CFZ) in adjuvant-induced arthritis (AIA) rat model, and explore the therapeutic effect and mechanism of carfilzomib on rheumatoid arthritis (RA). Methods Freund's adjuvants were used to induce arthritis in rats, and AIA models were successfully constructed. All rats were divided into seven groups:low-dose treatment group (1.0 mg/kg), middle-dose treatment group (1.5 mg/kg), high-dose treatment group (2.0 mg/kg), pre-treatment group (1.5 mg/kg), concurrent treatment group (1.5 mg/kg), AIA model control group and normal control group. The changes of hind feet of rats were observed and recorded. TRAP staining was used to analyses the inhabitation level of osteoclasts in different groups. ELISA was used to analyze the expression level of IL-1β, IL-6, TNF-α, and IFN-γ in peripheral blood. The CCK-8 assay was used to detect the proliferation activity of fibroblast-like synoviocytes. Results The observation on the changes of hind feet showed that the rats in all treatment group had the better joint condition than AIA model group. TRAP staining results showed that constrain of osteoclasts in the treatment group was much higher than the AIA model group. ELISA showed that level of IL-1β, IL-6, TNF-α, and IFN-γ in peripheral blood of all 5 treatment group were much lower those in AIA model group. CCK-8 results showed that low-dose, middle-dose and high-dose of carfilzomib had inhibited the proliferation activity of fibroblast-like synoviocytes significantly. Conclusion Carfilzomib is effective for the adjuvant-induced arthritis rats through suppressing the proliferation activity of fibroblast-like synoviocytes, down-regulation the expression of IL-1β, IL-6, TNF-α and IFN-γ to regulate inflammatory response, has a potential therapeutic value for RA.
Effects of Ulinastatin on apoptosis induced by ischemia in rat bone marrow mesenchymal stem cells
DONG Zhou-zhou, SHI Lin-hui, YE Long-qiang, XU Zhi-wei, ZHOU Li
2018, 16(12): 1974-1976,1988. doi: 10.16766/j.cnki.issn.1674-4152.000538
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Objective To investigate the effect of Ulinastatin on inhibiting the apoptosis of rat bone marrow-derived mesenchymal stem cells(BMSC) induced by ischemia. Methods Twenty-five SPF grade C57BL/6J male rats were randomly divided into normal control group, ischemic model group, Ulinastatin group, Ulinastatin + AKT pathway inhibitor group, Ulinastatin + ERK pathway inhibitor group, and normal control group without any pretreatment. Ischemic model group only treated with ischemia; Ulinastatin group, Ulinastatin + AKT pathway inhibitor (LY294002) group and Ulinastatin + ERK pathway inhibitor (PD98059) group were pretreated with Ulinastatin, Ulinastatin+LY294002 and ulinastatin+PD98059 respectively for 1 hour before ischemic treatment of BMSC. Ulinastatin concentration was 500 U/ml. Results After 6 hours of culture, the percentage of apoptosis was significantly higher than that at 3 hours of culture, and there was no significant difference between the other adjacent time points. There was significant difference between the apoptosis rate of normal control group and ischemic apoptosis model group. Caspase-3 of ischemic group was significantly higher than that of normal control group. Caspase-3 levels in rats treated with Ulinastatin + AKT pathway inhibitor and ulinastatin + ERK pathway inhibitor were significantly higher than those in rats treated with Ulinastatin, and caspase-3 levels in rats treated with Ulinastatin + AKT pathway inhibitor were significantly lower than those in rats treated with Ulinastatin + ERK pathway inhibitor (t=3.289, P=0.046). Conclusion The culture of 6 h is the most efficient and suitable for the best ischemia time. Ulinastatin can effectively inhibit the apoptosis of rat BMSC. Ulinastatin is more effective by ERK pathway than the AKT inhibitory pathway.
Effect of mild hypothermia on cognitive impairment and expression of autophagy protein in rat brain after cerebral ischemia/reperfusion
LI Li-ru, HUANG Jie
2018, 16(12): 1977-1980. doi: 10.16766/j.cnki.issn.1674-4152.000539
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Objective The study found that secondary nerve injury after cerebral ischemia-reperfusion is closely related to autophagy system. The aim of the paper is to observe the effect of mild hypothermia on cognitive impairment after cerebral ischemia-reperfusion in rats by control study. Methods The left MCOR model of rats was made by using the Longa suture method on 36 male Sprague-Dawley rats. There were 16 rats in the control group and the mild hypothermia group, and the other 4 were assigned into the sham operation group. The mild hypothermia group was given hypothermia 13-14 minutes after cerebral ischemia, while the sham operation group was not treated. The behavioral test was performed. The expression levels of Beta-amyloid precursor protein lyase-1 (BACE-1) and Microtubule-associated protein-3 were tested by immunohistochemical method. The statistical analysis was carried out by SPSS 19.0 software and P<0.05 was for a significant difference. Results The results of immunohistochemistry showed that BACE-1 increased significantly at 24 h after ischemia-reperfusion, reached a peak at around 72 h (P<0.05), and then decreased. There was no significant difference in the expression of BACE-1 between the hypothermia group and the control group (P>0.05). The expression of LC-3 increased with reperfusion for 4 hours, and its expression increased gradually with the prolongation of reperfusion time (P<0.05). The expression of LC-3 in the hypothermia intervention group was significantly higher than that in the control group (P<0.05). Neurological deficit score for sham operation was 0; for the control group there was no significant difference on the reperfusion time-point 24 h and 1 w (P>0.05), and were statistically significant on the other time points (P<0.05). Y-maze results showed that there were differences between the time points in the mild hypothermia group and the sham operation group (t=6.752, P<0.05). Conclusion The mild hypothermia has a protective effect on the survival of nerve cells after cerebral ischemia, which will improve the recovery of post-cognitive impairment; this protective effect may be associated with hypothermia-promoting the expression of LC-3 and BACE-1 in the penumbra region.
Perioperative and short-term clinical efficacy comparison of pulmonary lobectomy with single-port VATS and single-operation-port VATS
WANG Wei, ZHANG Lei, TANG Zhen, LI Xiao-jun, GONG Hui-yuan, WANG Biao, SONG Chao, GENG Yang, CHEN Peng-fei
2018, 16(12): 1981-1983,2027. doi: 10.16766/j.cnki.issn.1674-4152.000540
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Objective To explore the safety and clinical significance of single-port video-assisted thoracic surgery (VATS) and single-operation-port VATS in lobectomy for pulmonary diseases. Methods We selected 76 cases of patients who underwent thoracoscopic lobectomy from January, 2017 to January, 2018 in thoracic surgery department of the first Affiliated Hospital of Bengbu Medical College. Among all the cases, 27 patients underwent single-port VATS (SP group); 49 patients underwent single-operation-port VATS (SOP group). The clinical data including operation time, intraoperative bleeding loss, the number of lymph node, the volume of drainage in the first three days, the chest tube time, postoperative hospital stay, incision pain VAS scores on postoperative day 3 and incidence of complications of the two different surgical approaches were collected and compared. Results No operative morality occurred in both groups.There were no statistical significances between the two groups in the operation time, the intraoperative bleeding loss, the number of lymph node, the chest tube time, the incidence of complications. While the SP group had significant less volume of drainage in the first three days, shorter postoperative hospital stay, incision pain VAS scores on postoperative day 3 as compared with the SOP group. No recurrence was found in both groups during a follow-up time of 6 months. Conclusion Single-port video-assisted thoracic surgery in lobectomy for benign and malignant pulmonary diseases is safe, effective and worthy of promotion.
MiR-22 regulates angiogenesis by targeting CD151 in gastric cancer model
WANG Xun, ZHANG Peng, LIU Zhi-ming, HU Yi-kui
2018, 16(12): 1984-1988. doi: 10.16766/j.cnki.issn.1674-4152.000541
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Objective To investigate the role of MiR-22 via CD151 in regulating the cancer cell proliferation and invasion, migration and angiogenesis in patients with gastric cancer. Methods The gastric cancer cell line SGC-7901 was divided into MOCK group (MOCK), miR-22 lentivirus test group (miR-22 group) and slow virus control group (miR-22/Con), and the cells were transfected. After transfection, qRT-PCR was used to verify the miR-22 situation; Western-blot was used to detect the expression of CD151 and the downstream Akt, ERK1/2, mTOR protein; MTT, cell clone formation, and Transwell migration to detect cell proliferation, invasion and migration. A transplanted tumor model in nude mice was constructed to observe the growth of transplanted tumor. Microvessel density (MVD) was detected by immunofluorescence and the distant metastasis was recorded. Results The expressions of CD151, Akt, Erk1/2 and mTOR in miR-22 group were significantly lower than those in miR-22/Con group and MOCK groups, and CD151 protein was positively correlated with downstream protein level. The cell growth rate and cell invasion ability of miR-22 group were significantly lower than those of miR-22/Con and MOCK group. Body weight of nude mice in MOCK group and miR-22/Con group decreased, while weight loss in miR-22 group was not obvious. The tumor in miR22/Con group and MOCK group was infiltrative growth with rich microvessels. The tumor size of miR-22 group was small and the distribution of cells was uniform. Only a small amount of microvasculature was found, and no obvious necrosis area was found. Conclusion MiR-22 can make an impact on the proliferation, invasion, migration and angiogenesis of gastric cancer mediated by CD151 through Akt/ERK/mTOR signaling pathway.
The expression and clinical significance of TFF3 and PDGFR in gastric carcinoma
HU Ting, WANG Zi-shu
2018, 16(12): 1989-1991,2020. doi: 10.16766/j.cnki.issn.1674-4152.000542
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Objective To investigate the expressions of TFF3 and PDGFR in human Gastric carcinoma and analyze the relationship between them and tumor clinicopathological features as well as the role of TFF3 and PDGFR in the metastasis and invasion. Methods The expression of TFF3 and PDGFR in 60 cases of gastric cancer and corresponding adjacent non tumor tissue were detected by immunohistochemistry,which were from July, 2010 to June, 2011 in the First Affiliated Hospital of Bengbu Medical College, and then the relationship between TFF3, PDGFR expressions and clinicopathology were analyzed. Results The expression of TFF3 was located in cell membrane and cytoplasm, a significant difference was observed between gastric carcinoma and in adjacent non tumor tissue(P<0.05). The expression of TFF 3 was related to tumor TNM stage(P=0.007) and lymph node metastasis(P=0.003). The expression of PDGFR was located in cytoplasm, a significant difference was observed between the groups(P<0.05). The expression of PDGFR was related to TNM stage(P=0.001), lymph node metastasis(P=0.010) and serosal layer breakthrough(P=0.004). TFF 3 expression was positive correlated with PDGFR(r=0.348,P=0.007). Conclusion There is statistically positive correlation between TFF 3 and PDGFR expression, which indicates that they may participate in the occurrence and development of gastric carcinoma. Combination of TFF3 and PDGFR detection may be helpful to evaluate the capability of the tumor invasion and diversion of gastric carcinoma.
Influence of submandibular gland contouring on the xerostomia and quality of life of patients undergoing three-dimensional intensity modulated radiotherapy for nasopharyngeal carcinoma
WANG Yu-bin, LIN Yu-cheng, WANG Jian-hua, FU Yi-mou, WU You-yi, LI Fu-yao, YOU Xiao-jing, CAO Xue-zhen, FEI Zheng-hua
2018, 16(12): 1992-1995,2009. doi: 10.16766/j.cnki.issn.1674-4152.000543
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Objective To investigate the effects of submandibular gland contouring on dry mouth and quality of life after three-dimensional intensity modulated radiation therapy (IMRT) in patients with nasopharyngeal carcinoma. Methods Total 72 patients with nasopharyngeal carcinoma who underwent radiotherapy in our hospital from April, 2015 to April, 2017 were randomly divided into the control group (36 cases) and the experimental group (36 cases). The control group received conventional IMRT, while the experimental group received IMRT on the basis of contouring the submandibular gland and limiting the dose of the submandibular gland. The average dose of the submandibular gland (D mean), the volume of the submandibular gland after radiotherapy, the classification of dry mouth symptoms and the amount of saliva secretion and quality of life after radiotherapy were compared. Results The D mean of the two groups was significantly higher than that of the healthy side (P<0.05). The volume of the submandibular gland in the control group was significantly lower than that of the healthy side after radiotherapy (P<0.05). The D mean of the healthy side and the affected side of the experimental group were significant. The volume of the submandibular gland was significantly higher than that of the control group (P<0.05). The grade of dry mouth symptoms in the experimental group was significantly lower than that of the control group (P<0.05). The basis and stimulation of saliva secretion in the experimental group were significantly higher than those in the control group (P<0.05). The quality of life and total scores in the experimental group were significantly higher than those in the control group (P<0.05). Conclusion The submandibular gland contouring in three-dimensional IMRT for nasopharyngeal carcinoma can reduce the dose of submandibular gland in patients with submandibular gland, increase the amount of saliva secretion and reduce the degree of dry mouth after radiotherapy, and significantly improve the quality of life of patients.
Effects of plasma homocysteine level on coronary atherosclerosis and left ventricular function in women with hypertension
SU Xiao-ye, LI Xiao-bo, XING Jun-wu, QIAN Chun-fa, LI Min, BO Guang-gan, ZHANG Dai-min
2018, 16(12): 1996-1999. doi: 10.16766/j.cnki.issn.1674-4152.000544
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Objective To investigate the effect of plasma homocysteine (Hcy) level on coronary atherosclerosis and left ventricular function in hypertensive female patients. Methods Total 131 cases of female patients with hypertension and coronary angiography were selected. According to the plasma Hcy levels, they were assigned into H-type hypertensive group (89 cases, Hcy ≥ 10 μmol/L) and non-H-type hypertension group (42 cases, Hcy<10 μmol/L). The general basic data of patients, clinical blood biochemistry, cardiac color ultrasound and coronary angiography between the two groups were compared and analyzed. Results The prevalence of three vascular lesions and severe stenosis lesions in the H-type hypertensive group was significantly higher than that in non-H-type hypertension group; but of single branch lesion and normal coronary artery or mild coronary stenosis in the H-type hypertension group was lower than that of non-H-type hypertension Group. The Gensini score in H-type hypertension group was higher than that in non-H-type hypertension group (P<0.05). When compared with the non-H-type hypertension group, LVMI and RWT index in the H- type hypertension group were higher, but LVEF was lower, with statistical difference (P<0.05); The peak E is H-type hypertension group was higher, but LVRT was lower, the difference between the two groups was statistical significant (P<0.05). Conclusion The severity of coronary artery disease and the degree of left ventricular dysfunction in patients with H-type hypertension were worse than non-H-type hypertension patients. Plasma Hcy levels may be a risk factor for coronary atherosclerosis and left ventricular dysfunction in women with hypertension.
Analysis of lymphocyte subsets in bronchoalveolar lavage fluid of patients with dermatomyositis/polymyositis-associated interstitial lung disease
JIANG Zhen, ZUO Ting, PAN Wen-you, LI Xiang-pei
2018, 16(12): 2000-2002,2062. doi: 10.16766/j.cnki.issn.1674-4152.000545
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Objective To explore the cell counts and distribution features of lymphocytes in bronchoalveolar lavage (BAL) fluid of the patients with dermatomyositis/polymyositis-associated interstitial lung disease (DM/PM-ILD). Methods Total 16 patients with DM/PM-ILD underwent BAL and got BAL fluid. The cells in BAL fluid were counted in all and in differentiation. The lymphocyte subsets in BAL fluid and peripheral blood were detected by flow cytometry. The lymphocyte subsets included CD3+ total T cells, CD3+CD4+ T cells, CD3+CD8+ T cells, CD3-CD16+CD56+ NK cells, and CD3-CD19+ B cells. The counts of total cells and the percentages of lymphocyte subsets in BAL fluid were compared between DM/PM-ILD group and normal control. The percentages of lymphocyte subsets were compared between BAL fluid and peripheral blood in DM/PM-ILD patients. Results The percentages of different lymphocyte subsets in peripheral blood were normal except lowered percentages of CD4+ T cell, NK cell, and B cell in one patient. There were more cells in BAL fluid of DM/PM-ILD group than in normal control. Moreover, lymphocytes significantly predominated (by 15%). The percentages of CD3+ total T cell and CD8+ T cell in BALF of DM/PM-ILD patients were more than those in normal control, and more than those in peripheral blood of patients significantly; the percentage of NK cell was less than in normal control; and the difference of B cell percentages was not significant between DM/PM-ILD group and normal control. The percentages of NK cell and B cell in BALF were all less than those in peripheral blood in DM/PM-ILD patients. Conclusion There are significantly elevated lymphocytes and the imbalance of lymphocyte subsets in BAL fluid of DM/PM-ILD patients, especially for CD8+ T lymphocytes, which may play an important role in the development of ILD in DM/PM.
Prevention and treatment of deep venous thrombosis in gynecologic surgery
ZHANG Rong, YU Min-min, WANG Yong-zhen, TANG Juan, HU Bin, XUE Song-lin
2018, 16(12): 2003-2005. doi: 10.16766/j.cnki.issn.1674-4152.000546
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Objective To evaluate and reduce the risk of deep venous thrombosis (DVT) after gynecological surgery, G-Caprini (gynecological caprini) risk classification was used to select preventive measures, and to investigate the effects of intermittent pneumatic compression (IPC) and low molecular weight heparin (LMWH) on DVT prevention in patients with medium-high risk. Methods This case control study consisted of ninety-two postoperative patients with medium-high risk of DVT with rating scale of G-Caprini (G-Caprini score is greater than 1), ICP or/and LMVH were used to prevent postoperative DVT. D-dimer detection was performed on day 2 and day 5 in all patients, ultrasound examination of vascular compression of lower extremity was performed on the fifth day after surgery.The incidence of DVT after operation was calculated for the two groups. Results There were 2 cases of DVT in the observation group (IPC+LMWH) and the incidence was 4.00%. However,in the control group (IPC), there were 7 cases of deep venous thrombosis, and the incidence rate was 16.67%. The incidence of DVT in the observation group was significantly lower than that in the control group,and the difference was statistically significant (P<0.05). The d-polymer was significantly lower than the control group for the 5th day after surgery, and the difference was statistically significant (P<0.05). Conclusion Low molecular heparin (IPC+LMWH) can reduce the incidence of deep venous thrombosis after gynecological peration. D-dimer can monitor DVT fluctuation dynamically.
Relationship between TSH level and risk factors for cerebrovascular disease in subclinical hypothyroidism patients
XUAN Li-ping, YANG Zhen-xing, YU Mei, HUANG Yong-min, DONG Su-qin, CHEN Bin
2018, 16(12): 2006-2009. doi: 10.16766/j.cnki.issn.1674-4152.000547
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Objective To explore the relationship between thyroid stimulating hormone (TSH) level and risk factors for cerebrovascular disease in subclinical hypothyroidism (SCH) patients and its significance. Methods According to the TSH level, the 160 cases of newly diagnosed SCH in our hospital between June, 2016 and July, 2017 were divided into group A (90 cases, 4.95 mIU/L10.00 mIU/L). And 50 healthy people with normal thyroid function were assigned into the control group. The levels of the serum TSH, blood pressure, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), carotid intima-media thickness (CIMT), waist circumference (WC), body mass index (BMI), homocysteine (Hcy), and other risk factors for cerebrovascular disease were measured. The relationship between thyroid stimulating hormone (TSH) level and risk factors for cerebrovascular disease was analyzed. Results The levels of BMI, TC, TG, LDL-C, Hcy, TSH and CIMT in group A and B was significantly higher than those in the control group (P<0.05). Meanwhile, the levels of TC, TG, LDL-C, Hcy, TSH and CIMT in group B was higher as compared with those in group A and control group (P<0.05). In SCH patients, TSH was positively correlated with the levels of BMI, TC, TG, LDL-C, Hcy and CIMT, and negatively correlated with HDL-C (all P<0.05). Multiple linear regression analysis showed that TSH was an independent risk factor for the elevated LDL-C, Hcy, and CIMT (all P<0.05). Conclusion TSH is closely related to the risk factors for cerebrovascular disease, and is one of the factors that affect the occurrence and development of cerebrovascular disease.
Prognostic value of liver-specific multiple organ failure score in patients with alcoholic liver cirrhosis
ZHOU Wen-hong, YAN Hua-dong
2018, 16(12): 2010-2012,2135. doi: 10.16766/j.cnki.issn.1674-4152.000548
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Objective To evaluate the prognostic value of liver-specific multiple organ failure (MOF) score in patients with alcoholic liver cirrhosis. Methods From January, 2012 to June, 2017, 126 patients with alcoholic liver cirrhosis and liver failure admitted to the Second hospital of Ningbo were retrospectively collected. The patients were followed up for one year. According to whether the patients died within one year or not, the patients were divided into a death group (n=34) and a survival group (n=92). The differences of CLIF-COFs, APACHE Ⅱ, SOFA, end-stage liver disease model-sodium and end-stage liver disease model scores between the two groups were analyzed. The ROC curve was used to analyze the value of these indexes in the diagnosis of death in alcoholic liver cirrhosis within one year. Results When compared with the survival group, the CLIF-COFs in the death group were significantly higher (11.35±3.15 vs. 6.46±2.61, P<0.001); the APACHE Ⅱ score was significantly higher (15.85±6.37 vs. 12.01±5.65, P=0.001); the SOFA score was significantly higher (6.62±1.74 vs. 4.22±1.63, P<0.001); the sodium score in the end-stage liver disease model was significantly higher (25.41±4.29 vs. 21.25±4.07, P<0.001); the score of end-stage liver disease model was significantly higher (22.94±5.07 vs. 17.88±6.20, P<0.001); Maddery score increased significantly (63.37±18.47 vs. 49.82±19.67, P=0.001). CLIF-COFs, APACHE Ⅱ score, SOFA score, end-stage liver disease model-sodium score, end-stage liver disease model score and Maddery score were 0.875, 0.672, 0.831, 0.751 and 0.728 under the diagnostic curve of death in alcoholic cirrhosis patients within one year, respectively, of which CLIF-COFs was the highest[0.875 (0.811-0.939), P<0.001]. Conclusion Liver-specific multiple organ failure score is valuable in predicting the prognosis of alcoholic liver cirrhosis, and can be further applied.
Characteristics of pathogenic bacteria and serum IL-2, IL-6, CRP, PCT levels in postoperative wound infection of calcaneal fractures
LUO Bin, GAO Zhi-yang, LI Wei, SHEN Peng, WU Meng, YING Jin-he
2018, 16(12): 2013-2015,2066. doi: 10.16766/j.cnki.issn.1674-4152.000549
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Objective To investigate the characteristics of pathogenic bacteria and serum IL-2, IL-6, CRP, PCT levels in postoperative wound infection of calcaneal fractures. Methods From January, 2012 to December, 2017, 300 patients with calcaneal fractures in Huzhou Central Hospital and Zhuji People's Hospital were selected. The etiology and drug resistance of exudates or secretions at the incision site after the acquisition were determined. The serum IL-2, IL-6, CRP and PCT levels were measured. Results In the 300 patients with calcaneal fractures, 49 cases had postoperative wound infections, and the infection rate was 16.33%. A total of 78 strains of pathogenic bacteria were cultivated in 49 cases of postoperative wound infections. There were 31 strains Gram-positive bacteria,accounting for 39.74%; 42 strains Gram-negative bacteria, accounting for 53.85%; and 5 strains fungi,accounting for 6.41%. The gram-positive bacteria were mainly Staphylococcus aureus, accounting for 24.36%; the Gram-negative bacteria were mainly Escherichia coli, accounting for 29.49%. The Staphylococcus aureus was highly resistant to penicillin G, oxacillin, ampicillin, erythromycin and ciprofloxacin, the drug resistance rates were 94.74%, 89.47%, 84.21%, 78.95% and 73.68%, respectively, the drug resistance rates to vancomycin, teicoplanin and linezolid was 0.00%. The resistance rates of Escherichia coli to ampicillin, cefazolin, ceftazidime,cefepime and cefotaxime were high, the drug resistance rates were 100.00%, 86.96%, 82.61%, 78.26% and 73.91%, respectively, the drug resistance rates to imipenem and meropenem were 0.00%. The serum levels of IL-2, IL-6, CRP and PCT in the incision infection group were higher than those in the control group (t=22.580,48.129,32.237,83.116, P<0.001). Conclusion The main pathogens of incision infection after calcaneal fractures are gram-negative bacteria. The main pathogens are Escherichia coli and Staphylococcus aureus.The main pathogens have serious drug resistance. The serum IL-2, IL-6, CRP, PCT levels in patients with incision infection after calcaneal fractures are increased.
Value of "Bian Que Flying Rescue" system for acute myocardial infarction patients with ST-segment elevation
JIANG Hai-bin, LIU Xiao-xiao, YE Xin-he, YANG Cheng-jian
2018, 16(12): 2016-2020. doi: 10.16766/j.cnki.issn.1674-4152.000550
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Objective To observe the value of "Bian Que Flying Rescue" system for acute ST segment elevation myocardial infarction (STEMI) patients by observing change of myocardial reperfusion time and prognosis with this system. Methods Total 70 STEMI patients who were transported to Wuxi Second People's Hospital by "Bian Que Flying Rescue" system between January, 2015 to January, 2016 were selected as Bian Que Flying Rescue Group, meanwhile, 70 STEMI patients who were transported before the system operating assigned into Control Group. All of patients were accepted emergency PCI. Features like first medical contact to balloon (FMC2B) time, door to balloon (D2B) time, average hospitalization days, and LVEF were collected. All patients were followed up for 6 months to observe the prognosis. Results Compared with Control Group, FMC2B time and D2B time were significantly shorter and attainment rates were higher, a downward trend had shown in hospitalization days and LVEF was improved in Bian Que Flying Rescue Group, and Kaplan-Meier survival analysis found that the non-MACE survival rate was significantly higher in Bian Que Flying Rescue group than control group, Logistic regression analysis revealed that FMC2B time>120 min and D2B time>90 min were independent risk factor for MACE, the odds ratio (OR) (95% CI) were 2.64 (0.75-9.33) and 1.01 (0.99-1.03); all of P value were less than 0.05. Conclusion "Bian Que Flying Rescue" system can significantly cut down the treatment delay, improve clinical prognosis for the patients with STEMI.
Comparative analysis of effects of propofol and sevoflurane on inflammatory factors and pulmonary function in patients undergoing thoracic surgery with one lung ventilation
HE Yong-jun, JIN Wei-yu, FANG Hong-wei
2018, 16(12): 2021-2023,2031. doi: 10.16766/j.cnki.issn.1674-4152.000551
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Objective To compare the effects of propofol and sevoflurane on inflammatory factors and pulmonary function in patients undergoing thoracic surgery with one lung ventilation,and to provide a reference for the choice of clinical anesthesia. Methods Total 264 patients with thoracic surgery admitted to our hospital were enrolled, who were divided into group A used propofol in anesthesia (130 cases), group B used sevoflurane (134 cases) according to the random number table rule.All patients underwent One Lung Ventilation (OLV) during general anesthesia.Interleukin-1 (IL-1), nuclear factor-κB (NF-κB) DNA binding activity,alveolar-arterial oxygen partial pressure difference (PA-aO2),respiratory index (RI), and oxygenation index (OI) were measured at 5 min before induction (T0), immediately after OLV (T1), 45 min after OLV (T2), 90 min after OLV (T3), and after surgery (T4). Results At the time of T2, T3 and T4, the IL-1 and NF-κB DNA binding activities of the two groups were higher than those of T0 and T1 (all P<0.05), and the IL-1 and NF-κB DNA binding activities in group A at T2, T3 and T4 were lower than those in group B (all P<0.05). At the time of T2, T3 and T4, both PA-aO2 and RI of the two groups were higher than those of T0 and T1 (all P<0.05), and PA-aO2 and RI of group A at T2, T3 and T4 were higher than those of group B (all P<0.05). At the time of T2, T3 and T4, the OI of the two groups decreased compared with T0 and T1 (all P<0.05), and the OI of group A at T2, T3 and T4 was higher than thoseof group B (all P<0.05). Conclusion For patients undergoing thoracic surgery with one lung ventilation, the use of propofol in anesthesia has less inflammatory response induced by lung injury,and has less effect on lung function.
Clinical analysis of blood glucose monitoring by real-time insulin pump system
ZHANG You-you, TAO Hai-ying, JIN Dou, TU Chuan-fa, YANG Hong-wei, WANG Li-jun
2018, 16(12): 2024-2027. doi: 10.16766/j.cnki.issn.1674-4152.000552
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Objective To investigate the effect of real-time dynamic insulin pump on blood glucose monitoring in patients with type 2 diabetes mellitus. Methods From January, 2013 to December, 2016, 210 patients with type 2 diabetes were selected as the subjects. All the patients were divided into observation group (152 cases, Medtronic monitoring blood sugar) and control group (58 cases, blood sugar was monitored by traditional method). The indicator for further observation included the blood glucose data of patients monitored by different monitoring methods; the monitoring of blood glucose by Medtronic on first days and third days, the tolerance of patients during monitoring blood glucose. Results During the monitoring of blood glucose, the blood sugar changes in the two groups were all controlled, and the dynamic blood glucose curve showed that the blood glucose data value gradually stabilized. The time of blood glucose reaching the standard in the observation group was (3.52±1.40)days and that in the control group was (6.03±1.51) days. The difference between the two groups was significant (t=10.985, P<0.05). The area under the blood glucose curve of observation group was (88.43±11.15) and that of control group was (99.48±15.26). The difference between the two groups was statistically significant (t=5.026, P<0.001). While the observation group found that 4 patients had low blood sugar in the next morning and adjusted the insulin dosage accordingly. The number of hyperglycemia monitoring for third days was (25.60±15.88) times, compared with first days (40.33±25.17) decreased significantly (t=6.102, P<0.001). The Medtronic insulin pump was well tolerated in the observation group, while in the control group, 70.69% patients (41/58) were found in the subcutaneous of insulin infusion, and there were 3 cases in the control group. Conclusion Medtronic can monitor the blood glucose level of type 2 diabetic patients in real time and realize the function of insulin infusion in the islet pump. The immediate monitoring of the continuous 72 h of the blood glucose level in the patients can help to find the early warning of hyperglycemia and the real time fluctuation of blood sugar so as to facilitate the clinical treatment and adjust timely the insulin regimen and dosage during the monitoring period of the blood sugar.
Effect of short course radiotherapy on the recovery of early breast cancer after breast conserving surgery
LI Qi, WU Wei-zhu
2018, 16(12): 2028-2031. doi: 10.16766/j.cnki.issn.1674-4152.000553
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Objective To analyze the curative effect of breast cancer combined with three dimensional conformal radiotherapy on breast conserving surgery for early breast cancer. Methods According to the number of admission cases, 170 patients with early breast cancer who were admitted to hospital from January, 2013 to December, 2015 were divided into two groups randomly. The control group and the observation group (85 cases each) were treated with breast conserving surgery. After operation, two-field tangent whole breast irradiation was given.The control group was treated with conventional tumor bed electron line, and the observation group was treated with tumor bed volume plus three dimensional conformal radiotherapy. The patients were followed up for 36 months. The target homogeneity index (HI), target conformity index (CI), skin cosmetic effect and adverse reaction were observed and compared between the two groups. The local recurrence rate and distant metastasis rate were also compared. Results The target homogeneity index (HI) and target conformity index (CI) of the observation group were better than those of the control group (t=8.746, P<0.05; t=8.005, P<0.05). No grade 3-4 skin adverse reactions occurred in the observation group,and the incidence of acute and late skin adverse reactions was lower than that in the control group (χ2=7.784, P<0.05; χ2=5.749, P<0.05). The excellent and good rate of cosmetic effect in the observation group was higher than that in the control group,with statistical significance (Z=4.181, P<0.05). There was no significant difference in the local recurrence rate and distant metastasis rate between the two groups (χ2=2.024, P>0.05; χ2=0.206, P>0.05;). Conclusion Tumor bed dosage combined with three-dimensional conformal radiotherapy has a uniform measurement, a good target conformity, a low incidence of skin adverse reactions,a good cosmetic effect,more in line with the aesthetic needs of women with breast cancer.
Clinical analysis of serum anti-CCP antibodies in 153 elderly patients with rheumatoid arthritis
MOU Xiao-yue, LIANG Yi-min, TAO Hai-ying, JIN Dou
2018, 16(12): 2032-2034,2041. doi: 10.16766/j.cnki.issn.1674-4152.000554
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Objective To analyze the level of serum anti-CCP antibody in 153 elderly patients with rheumatoid arthritis and evaluate the application value of anti-CCP antibody detection in elderly patients with rheumatoid arthritis, and to provide reference for clinical diagnosis of this disease. Methods Total 153 elderly patients with rheumatoid arthritis admitted to our department from June, 2014 to June, 2018 were selected as the study group. Total 153 patients with other rheumatoid arthritis and 153 patients with routine physical examination in the physical examination center were selected as the control group and the healthy group, respectively.The serum anti-CCP antibody level was detected by the test method, and the results were compared, to evaluate the clinical value of serum anti-CCP antibody in the detection of rheumatoid arthritis. Results The levels of serum anti-CCP antibodies in the study group were significantly higher than those in the control group and the healthy group (P<0.05). The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of anti-CCP antibody were 77.8%, 65.3%, 84.9%, 71.2% and 81.0%, respectively.The number of joint swelling,joint tenderness,DAS28 score and invasive bone destruction rate in anti-CCP positive group are higher than those in anti-CCP negative group (P<0.05). Conclusion The serum anti-CCP antibody level and positive detection rate of elderly patients with rheumatoid arthritis are significantly higher than those of other rheumatoid patients and healthy people.
Efficacy and safety of long term high-dose atorvastatin in elderly patients with hypertension complicated with coronary heart disease
YANG Xiao-ming, WANG Shen
2018, 16(12): 2035-2038. doi: 10.16766/j.cnki.issn.1674-4152.000555
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Objective To evaluate the efficacy and safety of 40 mg/d and 20 mg/d's atorvastatin lasted 24 months for elderly hypertension combined with coronary heart disease, and to provide a new reference for rational use of drug. Methods From January, 2016 to June, 2018, 150 patients with hypertension and coronary heart disease above 60 years old were randomly assigned to a high dose group and a conventional dose group, with 75 cases in each group. The high dose group was given 40 mg/d of atorvastatin, and the routine dose group was given 20 mg/d of atorvastatin, and two groups were measured before, twelfth months and twenty-fourth months after treatment. Blood pressure, blood lipids, carotid in-middle membrane thickness (IMT) and plaque area were recorded, and possible adverse drug reactions were analyzed by SPSS 21.0. Results There were significant differences in blood pressure, blood lipid, carotid artery and middle membrane thickness (IMT) and plaque area at the three time points before treatment, 12 and 24 months after treatment about the high dose group and the routine dose group (P<0.05). Compared with systolic pressure, blood lipid, IMT and plaque area, there were significant differences between the high dose group and the routine dose group at 12 and 24 months after treatment(P<0.05),but the diastolic pressure difference was not statistically significant (P>0.05), and there was no significant difference in adverse reaction rate between the two groups (P>0.05). Conclusion Forty mg/d and 20 mg/d atorvastatin can effectively remedy blood pressure, blood lipid, IMT and plaque area in patients with hypertension and coronary heart disease, and the effect of high dose improvement is better than that of the conventional dose group. There is no evidence that 24 months large dose of atorvastatin can increase the incidence of adverse reactions, and the results need further validation by high-quality multicenter randomized controlled trials.
Relationship between the expression of inflammatory related factors and HMGB1 protein in patients with unexplained recurrent early abortion
DONG Yun, XU Xin, KE Li-na, LI Bin
2018, 16(12): 2039-2041. doi: 10.16766/j.cnki.issn.1674-4152.000556
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Objective To investigate the correlation between the expression of inflammatory related factors and HMGB1 protein in patients with unexplained recurrent early abortion. Methods From February, 2013 to July, 2017, 172 cases of pregnant women with unexplained recurrent early abortion were selected as abortion group, and the other pregnant women with not unexplained recurrent early abortion were selected as the control group accorded to the 1:1 matching principle, the serum inflammation related factors and the expression of HMGB1 in the two groups were detected and were given correlation analysis. Results The serum IL-6, TNF-α and HMGB1 levels in the abortion group were (49.22±10.39)pg/L, (82.49±10.11)pg/L and (99.02±21.49)ng/ml that were significantly higher than the control group of (27.33±9.82)pg/L, (30.19±6.88)pg/L and (47.99±10.53)ng/ml (P<0.05). Pearson analysis showed that the serum IL-6, TNF-α were positive correlation to the HMGB1 in the abortion group(r=0.562, 0.672, P<0.05). Multivariate Logistic regression analysis showed that IL-6, TNF-α and HMGB1 were the main risk factors of unexplained early recurrent spontaneous abortion (P<0.05). Conclusion The inflammatory factors IL-6, TNF-α and HMGB1 in the unexplained recurrent early abortion are showed high expression, and can influence each other, they are independent risk factors of spontaneous abortion.
Benign infantile convulsions with mild gastroenteritis: clinical analysis and long-term follow-up research of 111 cases
CHEN Hao, PAN Yang-qiong, ZHANG Xiang-min, ZHANG Xiao-li, DU Kai-xian, JIA Tian-ming, LI Xiao-li
2018, 16(12): 2042-2044,2076. doi: 10.16766/j.cnki.issn.1674-4152.000557
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Objective To investigate the clinical characteristics and long-term prognosis of benign infantile convulsions associated with mild gastroenteritis (BICE). Methods One hundred and eleven children with BICE in our hospital from July, 2013 to July, 2015 were enrolled. According to the frequency of convulsions, the patients were divided into single group (n=56, convulsion once), and multiple group(n=55, convulsions ≥ 2 times). According to convulsion duration, the patients were divided into short-term group (n=81, convulsions duration <5 minutes), and long-term group (n=30, convulsion duration ≥ 5 minutes). The clinical data obtained during hospitalization and follow-up were analyzed. Results The retrospective analysis showed that the onset age ranged from 13 months to 24 months accounted for 56.7% in all children. It occured at all seasons of the year, the highest incidence was in autumn/winter, The seizure of 82 cases occurred in the first 3 day, 73.9% of all children. The seizures were generalized in 99 cases(89.2%), focal and secondarily generalized in 12 cases(10.8%). Sixty-two cases (55.9%) fecal rotavirus antigen positive. The differences of sex, age of onset, positive rate of stool rotavirus between single group and multiple group, between short-term group and long-term group with BICE were not statistically significant (P>0.05). Blood biochemical examination, cerebrospinal fluid routine, biochemical and culture tests, brain imaging were all normal. Interictal monitoring as EEG, 11 cases changed in sleep spindles and slow wave, 4 cases appeared sharp slow wave or spike slow wave at central top area, the other cases were normal. Two years follow-up research showed that 9 cases (8.1%)were relapsed and 6 cases (6.15%) developed epilepsy. Conclusion The 13 months-24 months old children have high incidence of BICE, and it occured at all seasons of the year, the highest incidence is in autumn/winter. Prognosis is good for most of the cases, a few cases may develop into epilepsy, long-term prophylaxis of antiepileptic treatments is not necessary, it is very necessary to followed up for a long time.
Rotavirus infection and associated influence factors in neonates in Urumqi from 2009 to 2010
ZHENG Ling-ling, LI Shi-xian, LI Qian-qian, ZHANG Yan-jun, YANG Xue-lei
2018, 16(12): 2045-2048,2071. doi: 10.16766/j.cnki.issn.1674-4152.000558
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Objective To investigate the epidemiology and influencing factors of RV infection in neonates, provide the theoretical basis for effective prevention and treatment of neonatal RV infection. Methods Total 2 026 stool specimens were collected from neonates with diarrhea or non-diarrhea hospitalized in the Neonatology Department of People's Hospital of Xinjiang Uighur Autonomous Region during January, 2009 to December, 2010. RV was detected by ELISA. Clinical data were collected from the neonates to analyze the influence factors associated with rotavirus infection with SPSS 17.0 statistical software. Results RV detection rate was 14.22% (288/2 026) during the monitoring period.It was 17.78% (176/990) in 2009, and it was 10.81% (112/1 036) in 2010. Nosocomial infection accounted for 60.07% (173/288). RV detection rate in diarrheal neonates(48.68%) was significantly higher than that in non-diarrhea neonates (11.42%), P<0.001. Unvaried analysis associated with neonatal rotavirus infection showed that the difference in rotavirus infection incidence had no statistically significant in genders, nationalities and the modes of delivery (P>0.05). Rotavirus detection rates in different gestational ages, birth weights, ages, feeding modes and wards had all significant differences (P<0.001). Logistic regress analysis showed that the premature neonates were not easier to infect RV than the full-term neonates. The neonates with age of 8-14 days, or artificial feeding,or in general wards were significantly easier to infect RV than that within the first 7 days and 22-28 days, and with breast feeding, and in NICU, respectively. Conclusion RV was the main cause for diarrhea and nosocomial infection in newborns.Full-term, 8-14 days' age, artificial feeding and in general wards were susceptible factors for RV infection in newborns. Reasonable prevention and control strategy are to be made to effectively prevent neonatal RV infection.
Effect of dexamethasone adjuvant therapy on immune function and liver function in patients with intrahepatic cholestasis of pregnancy
LIU Li-ping, XUAN Rong-rong, ZHU Hong, ZHOU Ning, ZHANG Yan-ke, ZHANG Ying-zhi
2018, 16(12): 2049-2051,2091. doi: 10.16766/j.cnki.issn.1674-4152.000559
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Objective To investigate the effect of dexamethasone adjuvant therapy on immune function and liver function in patients with intrahepatic cholestasis of pregnancy. Methods A total of 86 patients with intrahepatic cholestasis of pregnancy treated in the Affiliated Hospital of Medical School of Ningbo University from May, 2015 to May, 2017 were randomly divided into control group (n=43) and observation group (n=43) according to the random number table method. The patients in the control group were treated with adenosine methionine, and the patients in the observation group were treated with dexamethasone on the basis of the control group. The clinical efficacy, pregnancy outcomes and neonatal status, the changes of immune function and liver function were compared between the two groups. Results The total clinical efficiency of the observation group was significantly higher than that of the control group (P<0.05). The incidence of neonatal asphyxia and fetal distress in the observation group were significantly lower than those in the control group (P<0.05). The Apgar score of the observation group was significantly higher than that of the control group (P<0.05). After treatment, the levels of interleukin-12 (IL-12) and tumor necrosis factor- α(TNF-α) in both of two groups were significantly decreased than those before treament (P<0.05), and the levels of IL-12 and TNF-α in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in both of two groups were significantly decreased than those before treament (P<0.05), and the levels of ALT and AST in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Dexamethasone is effective in the treatment of intrahepatic cholestasis of pregnancy. It can significantly improve the outcome of pregnancy and neonatal status, and improve the immune function and liver function of patients. It is worthy of promotion in clinical practice.
Correlation between expression of placental abcb4 gene and prognosis of perinatal infants in patients with intrahepatic cholestasis of pregnancy
HE Jing-yuan, LAI Ceng-zhen, XU Ya, WEI Qin, DING Wu-wu
2018, 16(12): 2052-2055. doi: 10.16766/j.cnki.issn.1674-4152.000560
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Objective To analyze the correlation between expression of placental abcb4 gene and prognosis of perinatal infants in patients with intrahepatic cholestasis of pregnancy (ICP). Methods Sixty cases of ICP pregnant women who were regularly given production inspection in our hospital from May, 2015 to May, 2017 were set as ICP group, including 36 cases of mild ICP and 24 cases of severe ICP. Another 30 cases of pregnant women with normal checkups were selected as control group. The expressions levels of abcb4 mRNA and abcb4 protein in placenta were determined by RT-PCR and immunohistochemistry, and their relationship with amniotic fluid contamination, neonatal Apgar score and poor prognosis were analyzed. Results Compared with control group, the amniotic fluid contamination rate was significantly higher in ICP group while the neonatal Apgar score was significantly lower, and the incidence rates of premature delivery, neonatal asphyxia and low birth weight infants were significantly higher (P<0.05). There were statistically significant differences in the amniotic fluid contamination rate, neonatal Apgar score, incidence rates of premature delivery and neonatal asphyxia between mild ICP patients and severe ICP patients (P<0.05). Compared with control group, the abcb4 mRNA level in ICP group was significantly decreased, and the abcb4 protein expression intensity was significantly decreased (P<0.05). Compared with mild ICP patients, the abcb4 mRNA level was significantly decreased in severe ICP patients, and the abcb4 protein expression intensity was significantly decreased (P<0.05). Pearson correlation analysis showed that abcb4 mRNA level and abcb4 protein expression intensity in placenta of ICP patients were negatively correlated with amniotic fluid contamination rate, Apgar score and incidence rates of premature delivery and neonatal asphyxia (P<0.05). Conclusion The expression level of abcb4 gene in placenta of ICP patients is closely related to the prognosis of perinatal infants. Especially the decrease of abcb4 gene expression level can increase the risk of amniotic fluid contamination, premature delivery and neonatal asphyxia.
The influence of family doctor's psychological counseling on the psychological status of type 2 diabetes mellitus with 1+1+1 contracted service in the community
XU Xin, HUANG Qian, SHOU Juan, BAI Lu
2018, 16(12): 2056-2058,2084. doi: 10.16766/j.cnki.issn.1674-4152.000561
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Objective To understand the psychological status of patients with type 2 diabetes in Weifang community, and to analyze the changes of mental state of diabetic patients after psychological counseling. Methods A total of 476 patients who live in Weifang community from 2010 till now and have already enrolled in "1+1+1" contracted service were surveyed by systematic sampling method and health questionnaire of Symptom Checklist 90 (SCL-90) and social support revalued scale. At the same time, the psychological status and social support condition of contracted type 2 diabetes were analyzed. The General Practitioner was engaged in a 3-month psychological counseling and healthy education, and compared the psychological status changes, social support condition changes and blood glucose control of contracted type 2 diabetes before and after psychological counseling and healthy education. Results In this study, all the factorial scores of patients with type 2 diabetes mellitus in contracting community health service were higher than the national norm. The glycosylated hemoglobin of patients before psychological counseling was (7.99±2.08)% and (6.95±0.84)% after psychological counseling, with a statistical difference. After psychological counseling, the total scores of SCL-90 and the scores of each factor were lower than that before psychological counseling, and the social support score was higher than that before psychological counseling. The difference was statistically significant. Conclusion The psychological health of the contracted patients with type 2 diabetes mellitus is not optimistic. The General Practitioner's psychological counseling on "1+1+1" contracted service for Type 2 diabetes patients is helpful to improve their blood glucose control, psychological status and social support. It can improve the quality of life of patients.
The analysis on the effect of the general practitioner-led on campus health management
LIU Yu-chang, DONG En-hong, WANG Feng, XU Wei-ping, BAO Yong
2018, 16(12): 2059-2062. doi: 10.16766/j.cnki.issn.1674-4152.000562
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Objective A comprehensive analysis on the effect of the general practitioner-led (GP-led) campus health management. Methods We established electronic health record (HER) for 7 875 students from Longbai District, who come from primary and secondary schools in 2015, and performed statistical analysis on Health Card and accompanying visitors. Results Student EHR coverage:100%; standard disease control:98.96%. Statistic significance (χ2=645.551, P<0.001; χ2=398.089, P<0.001, respectively) has been reached through comparing the effects of accumulative interventions from different diseases, as well as the latest intervention. Meanwhile, independent sample t test and rank sum test has concluded that neither of these interventions has made statistical significance on disease control when exerting to the same disease. In addition, logistic regression analysis has suggested that educated services, campus health advisory, family attention affect disease control with a statistical significance[OR=0.112 (0.086, 0.367), P<0.001; OR=6.231 (3.086, 10.300), P<0.001; OR=2.564 (1.665, 10.675), P<0.001, respectively]. Conclusion The approach of GP-led campus health management had regulated the disease control rate so that it improved the health administration among students. It has also spread the modern concept of knowledge-attitude-belief into health management among teenagers, which would propel the development of GP practice and general communal services.
Application of digital tomosynthesis in the imaging diagnostics of skeletal trauma
SHEN Jun-jie, WANG Dong-sheng, WANG Hong-mei, CHEN Liu-cheng
2018, 16(12): 2063-2066. doi: 10.16766/j.cnki.issn.1674-4152.000563
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Objective To study the application of Digital Tomosynthesis (DTS) based on flat panel detector (FPD) in the detection of skeletal trauma. Methods From May, 2014 to May, 2015, 60 cases of skeletal trauma admitted to our hospital emergency all received the examination with Digital Radiography, who received the examination with Digital Tomography if the radiological diagnosis was not clear. The original data of every layer were calculated and processed. Two radiologists reviewed all the images and diagnosed in consensus. Results The good rate of DR images were 44.61% (29/65), while DTS images were 64.62% (42/65). Of the 60 patients who could not be diagnosed clearly by DR, 13 cases were diagnosed with subtle occult fracture by DTS technique, and 37 cases had no definite fracture, and the other 10 patients were still unable to determine whether or not they were fractured. Further examination was needed to confirm the diagnosis. In addition, the artifacts due to external fixation plaster and metal implants were significantly reduced in the DTS films from 5 patients after fracture surgery. Conclusion Digital Tomosynthesis (DTS) can not only improve the quality of images, but also improve the diagnostic rate of occult fractures in bone trauma examination, compared with conventional DR examination. And the artifacts of metal implants or other external fixators can be reduced significantly for patients after fracture surgery. Therefore, DTS has important application value in preoperative examination and postoperative reexamination of patients with bone trauma.
The diagnosis and treatment of carcinoma of unknown primary
WANG Jin-yan, ZHONG Yue-jiao, CHEN Ling-xiang, LI Yun-tao
2018, 16(12): 2067-2071. doi: 10.16766/j.cnki.issn.1674-4152.000564
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Carcinoma of Unknown Primary (CUP) is defined as a heterogeneous group of tumors with unique biological characteristics. Adenocarcinoma is the most common pathology type. CUP is the 6th to 8th most common cancers worldwide, accounting for 2.3%-5.0% of all tumors, and the 3rd to 4th most common cause of death from cancer. The primary site of CUP is difficult to detect. The diagnostic methods include physical examination, laboratory and imaging examination, endoscopies, immunohistochemistry (IHC) and gene expression profiling techniques (GEP). Pathology and IHC are the gold standard of diagnosis. The incidence of CUP has decreased in recent years with the development of diagnostic techniques. The prognosis of CUP patients are affected by various factors, such as the primary site, metastases and number, pathological type, treatment, physical status, and LDH. Due to its unique biological characteristics, the clinical trials are difficult to develop, and the overall prognosis of CUP patients is poor.15%-20% of CUP patients have a good prognosis, 80%-85% have a poor prognosis and the median survival is less than 1 year. Traditional empirical treatments include platinum or paclitaxel-based chemotherapy, radiation therapy, and surgery. It does not improve the prognosis of CUP patients. Molecular diagnostic techniques such as GEP can identify the molecular characteristics of CUP patients. Molecular profiling provides a practical and useful complement to histomorphology, making targeted therapy possible and opening up a new approach therapy of CUP. The specific therapy, targeted therapy and immunotherapy under the guidance of molecular diagnosis are expected to make the treatment individualized and precise, which is conducive to improving the quality of life and survival of patients. The diagnosis and therapy of CUP are still controversial at present. This article reviews the common diagnostic methods and treatment of CUP.
Diagnosis and treatment of comorbidity of heart disease and mental illness by using integrated traditional Chinese and Western medicine
WANG Chun-yan, YAN Xiao-qin, HU Chun-yan, LI Zhi-qiang
2018, 16(12): 2072-2076. doi: 10.16766/j.cnki.issn.1674-4152.000565
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Many studies have shown that the clinical symptoms of cardiovascular diseases overlap with the symptoms of mental and psychological diseases in a considerable part, that is, cardiovascular diseases often coexist with mental and psychological diseases, which makes it difficult for a single treatment to achieve good results, and causing the concern by medical community in recent years for both heart and psychological, that is "comorbidity of heart disease and mental illness". However, traditional Chinese medicine advocates the concept of "comorbidity of heart disease and mental illness" from the perspective of the whole. It holds that the shape and function of the heart are closely related to psychology, and is closer to the current concept of "comorbidity of heart disease and mental illness". However, most clinical cardiologists do not have the ability to diagnose and treat heart disease and mental illness because of the limitations of their specialties. On the other hand, due to the existing psychiatric drug adverse reactions, and most patients are psychologically resistant to psychiatric treatment, which makes the " heart disease and mental illness " in the clinical diagnosis and treatment of difficulties. In order to explore the clinical characteristics of "comorbidity of heart disease and mental illness", some epidemiologists in China have carried out epidemiological studies. The results support the view that cardiovascular disease is accompanied by psychological disorders, and confirm the real situation of "heart disease and mental illness ". In the clinical diagnosis and treatment of this type of disease, there are great differences between traditional Chinese medicine and Western medicine in the treatment of ideas and ideas. This difference is reflected in the concept and methods of diagnosis and treatment of multiple differences, how to integrate the advantages of traditional Chinese and Western medicine in the treatment of "comorbidity of heart disease and mental illness" to improve clinical diagnosis and treatment capacity and accuracy is the important problems to be solved. In view of the clinical progress in the diagnosis and treatment of "comorbidity of heart disease and mental illness", this article will review the ideas and specific measures of Chinese and Western medicine for "heart disease and mental illness " in order to provide more reference for clinical practice.
Application of whole-process network management mode in rehabilitation of cerebral apoplexy
WANG Qing-hua, CHU Zhao-hu, XU Ye-song, SUN Ai-ping, ZHAO Li, ZHANG Xue, WANG Li-zong, ZHAO Shou-cai, FAN Xiao-li, ZHU Yu-juan
2018, 16(12): 2077-2079,2127. doi: 10.16766/j.cnki.issn.1674-4152.000566
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Objective To observe and evaluate the application of the whole process network management mode in stroke rehabilitation. Methods From November, 2016 to January, 2018, 100 patients who met the criteria of stroke in Wuhu City and its surrounding areas were selected for graded rehabilitation. The patients were randomly divided into experimental group and control group, with 50 patients in each group. The experimental group was rehabilitated by the management mode of "whole process network". In the control group, the management mode of "family tradition" was used for rehabilitation. Patients in both groups were evaluated 1 day after enrollment, 1 month and 3 months after discharge. Frenchay activity scale was used to assess the self-care ability of daily life; the special quality of life scale for stroke (SS-QQL) was used to evaluate the patients' satisfaction with quality of life; and the social support scale (SSQ) was used to assess the degree of social support of the patients. Results Compared with control group, scores of Frenchay activity scale, SS-QOL scale and SSQ scale of the experimental group at 1 month (FFrenchay=12.563, FSS-QOL=23.738, FSSQ=85.388) and 3 months (FFrenchay=37.180, FSS-QOL=60.889, FSSQ=192.023) after discharge were significantly higher (P<0.05). Compared with experimental group before test, scores of Frenchay activity scale, SS-QOL scale and SSQ scale of the experimental group at discharge1 month after discharge and 3 months after discharge were significantly higher (P<0.05). Conclusion The "whole process network" management mode can improve the daily living self-care ability, quality of life satisfaction and social support status of patients with stroke rehabilitation during hospitalization and after discharge. It further promotes the three-level diagnosis and treatment management of stroke rehabilitation in Anhui Province to the greatest extent.
Effects of core stability training in patients with non-specific low back pain
CHEN Zheng-yi, GONG Jian-qiu, ZHANG Fang
2018, 16(12): 2080-2084. doi: 10.16766/j.cnki.issn.1674-4152.000567
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Objective To analyze the rehabilitation effect of core stability training in patients with chronic non-specific low back pain, providing a more reasonable therapeutic regimen for patients with low back pain in clinic. Methods A total of 80 patients with non-specific low back pain in our hospital from January, 2017 to January, 2018 were divided into control group and observation group according to different training modes. Control group received conventional training, while observation group received core stability training based on control group. The treatment of both groups lasted for 3 months. Back pain VAS scores, the activity range of trunk, oswestry disability index (ODI) scores and muscle strength of back extensor were compared between two groups before treatment (T1), at the end of treatment (T2) and 3 months after treatment (T3). And the satisfaction of rehabilitation training at the end of treatment (T2) and 3 months after treatment (T3) were compared, too. Results Compared with control group, the pain VAS scores of patients in observation group reduced significantly (P<0.05); the enhancement of muscle strength of back extensor was more obvious (P<0.05); the activity range of trunk in all sides were significantly enlarged (P<0.05); ODI score was decreased (P<0.05); and the satisfaction of rehabilitation training was higher (P<0.05). Conclusion Compared with conventional training, core stability training reduced pain, enhanced back muscle strength, and enlarged the range of body motion, effectively and respectively. Every patient were more willing to adapt core stability training with an obviously improvement of daily life quality.
Clinical analysis of rapid treatment of otolith with manual reduction combined with acupuncture
LI Li-bin, SUN Ju-guang, SHI Jiang-feng
2018, 16(12): 2085-2087. doi: 10.16766/j.cnki.issn.1674-4152.000568
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Objective To explore the clinical effect of Epley manual reduction combined with acupuncture in the treatment of posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) patients, and the remission rate and remission time of vertigo symptoms. Methods From April, 2017 to March, 2018, 86 PC-BPPV patients in the department of neurology of Xuzhou hospital of traditional Chinese medicine were selected as study objects, and 86 patients were randomly divided into the treatment group and the control group, each with 43 patients. The two groups were treated with Epley manipulation for reduction. In the treatment group, rapid acupuncture was added on the basis of Epley manipulation, and acupoints such as Taiyang, Yintang, Baihui, Sishencong and Zusanli were treated. The control group was treated with Epley reduction. The two groups were treated once every other day and 6 times were the course of treatment. This observation was made immediately after the first treatment to compare the rate of delay of vertigo symptoms and the time of remission of vertigo symptoms. The cure rates, total effective rates were compared after 3 months. Recurrence rates were compared after 6 months. Results After the first treatment, the remission rate of vertigo symptoms was 93.02%, the average time of remission of vertigo symptoms was 8.5 minutes, the cure rate was 83.72% after 3 months, and the total effective rate was 97.67%. The relapse rate after June was 11.62%. The remission rate of vertigo symptoms was 74.41% in the control group after the first treatment, and the average remission time of vertigo symptoms was 22.5 minutes. the cure rate was 69.77% after march, the total effective rate was 79.06%, and the recurrence rate was 37.20% after June. There were significant statistical differences in all the groups (P<0.05). Conclusion Epley manipulation manual reduction combined with acupuncture can rapidly improve the symptoms of vertigo in PC-BPPV patients with high cure rate and low recurrence, which is considered excellent single Epley manipulation treatment.
Application of CPBL teaching model combined with 3D-Body anatomy software in orthopedic clinical teaching
ZHANG Heng, LIU Yang, JIANG Jing-ling, GUAN Jian-zhong, ZHOU Jian-sheng
2018, 16(12): 2088-2091. doi: 10.16766/j.cnki.issn.1674-4152.000569
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Objective To explore the teaching efficiency of case and problem based learning (CPBL) teaching model combined with 3D-Body anatomy software in orthopedic clinical teaching. Methods During January, 2017 to December, 2017, 76 undergraduates who majored in five-year clinical medicine in our hospital for orthopaedic practice were selected in the research. These students were randomly divided into lecture based learning (LBL) teaching mode group and CPBL teaching model group. Each group had 38 students. Orthopedic clinical teaching was carried out respectively with two teaching modes. After the clinical practice teaching, teaching models were evaluated by comparing examination results of basic clinical knowledge, cases analysis, cases history-taking, clinical manipulative skills of students in two groups and teaching efficiency was evaluated via questionnaire involving four aspects which contained learning interest stimulation, self-study ability promotion, and improvement of clinical thinking ability and clinical manipulative skills. Teaching satisfaction was evaluated via questionnaire of teaching model and efficiency. Results The scores of student's basic clinical knowledge, cases analysis, cases history-taking, clinical manipulative skills in CPBL teaching model group were higher than those in LBL teaching model group (P<0.05). The improvement of student's learning interest, self-study ability, clinical thinking ability and clinical manipulative skills in CPBL teaching model group were better than those in LBL teaching model group (P<0.05). The teaching satisfaction of CPBL group was higher than that of LBL group (P<0.05). Conclusion The application of CPBL teaching model combined with 3D-Body anatomy software in orthopedic clinical teaching can effectively stimulate students' learning interest and initiative, improve the students' self-study ability and enhance the ability of solving problem independently. CPBL teaching model is one of good methods for orthopedic clinical teaching for its excellent teaching effect.
Construction of General Medical Reinforcement of Residents Based on Blackboard Network Teaching Platform
GAO Wei-fei, LI Yan-hua, LI Jun-wei
2018, 16(12): 2092-2094,2110. doi: 10.16766/j.cnki.issn.1674-4152.000570
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Objective To enhance the effect and quality of general practitioners standard training and to solve the contradiction between insufficient general medicine faculty, students'thirst for knowledge and the limit of time and site, in order to provide effective reference for Education reform of general practitioners by constructing general medical reinforcement of residents based on Blackboard network teaching platform. Methods We launched the course on the basis of operating feature and standardized training requirement of general practitioners based on blackboard network teaching platform of Zhejiang Chinese Medical University. Six modules including notification, teaching team, the warm-up,learning guidance, teaching unit,discussion were established. And we constructed the six modules through content of courses,course tools, and test tools. Statistics were made on the click volume of each section, and questionnaire survey and analysis were carried out on the learning effect and feedback of the students after the course. Results During the construction of the course, 129 students were enrolled. The total click of the course was 5 653 times, among which the the highest click was the teaching unit, 1 468 times, accounting for 25.97 percent. In the questionnaire survey, 67.3 percent of the students believed that this course was of great help to their clinical knowledge and skills improvement, 26.6 percent think it was helpful, and the remaining 6.1 percent think it was of little help. Conclusion The Blackboard network teaching platform can cultivate students'interest on learning,improve their autonomous learning ability due to convenience, usability and the personalized learning, so as to improve the teaching effect.
Application of Plan-Do-Check-Act cycle in improving the quality of antitumor drugs intravenous admixture services
LI Jing, SHI Qing-ping, PENG De-feng
2018, 16(12): 2095-2097,2101. doi: 10.16766/j.cnki.issn.1674-4152.000571
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Objective To explore the effect of Plan-Do-Check-Act (PDCA) circulation in improving the quality of anti-tumor drug configuration in pharmacy intravenous admixture services (PIVAS), and provide reference for improving the quality of anti-tumor drug configuration. Methods The pharmacists and nursing staff of the First Affiliated Hospital of Bengbu Medical College from February, 2016 to March, 2018 were enrolled into this study and assigned into the control group (February 2016-February 2017) and the study group (March 2017-March 2018) according to the time point. The control group was managed with the conventional drug allocation, while the study group with the PDCA cycle. The incidence and types of unreasonable anti-tumor drug allocation were compared between the two groups. Results The incidence of unreasonable anti-tumor drug allocation in the study group was 0.51% and in the control group was 0.88%, the difference was statistical significant (P<0.05). There was no significant difference between the study group and the control group in the unreasonable allocation of the selection of solvent, the dosage of drugs, the incompatibility of drugs and the selection of containers (P>0.05). The proportion of the unreasonable allocation solvent dose and drug storage conditions in the study group were both significantly lower than those of the control group, and the difference were statistically significant (P<0.05). Conclusion The PDCA cycle is an ideal management for PIAS, which can reduce the incidence of unreasonable anti-tumor drug configuration in the PIAS, including dose and storage conditions. It can promote the improvement of the configuration quality of anti-tumor drugs, and is worthy of application in the PIAS.
Observation on the effect of high-dose ambroxol combined with acetylcysteine in the early treatment of paraquat-induced pulmonary fibrosis
HUANG Ming, HUANG Wei
2018, 16(12): 2098-2101. doi: 10.16766/j.cnki.issn.1674-4152.000572
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Objective To observe the effect of high-dose ambroxol combined with acetylcysteine on pulmonary fibrosis in patients with paraquat poisoning. Methods A retrospective analysis was made on 90 patients with paraquat poisoning treated in the Third People's Hospital of Wuxi City from May, 2016 to May, 2017. The patients were randomly divided into control group by random number table method (using Dan red injection) and observation group (large dose ammonia bromine joint acetylcysteine group). General information of the two groups were comparable. All patients were given symptomatic support treatment, prevent related complications, such as a sedative and analgesic, oral care, etc. At the same time, large doses of ambroxol were added to all patients on the basis of methylprednisolone treatment, and acetylcysteine effervescent tablets were administered to the observation group on the basis of the control group. The respiratory function of the patients was closely observed, and the renal function, urine and feces of the patients were monitored. Survival rate, incidence of pulmonary fibrosis and degree of pulmonary fibrosis were observed. Results According to the analysis of patients' inpatient registration, the difference in survival rate between the observation group and the control group at the same time point was not statistically significant (P>0.05), and the difference in incidence of pulmonary fibrosis between the two groups at the same time point was not statistically significant (P>0.05). The degree of pulmonary fibrosis in the observation group was significantly lower than that in the control group,and the difference was statistically significant (P<0.05). Conclusion Comparing with Danhong injection alone, the survival rate is not significantly improved in the group of high-dose ambroxol combined with acetylcysteine in the early clinical treatment of paraquat-induced pulmonary fibrosis patients, the incidence of pulmonary fibrosis is not significantly reduced.However, the degree of clinical symptoms can be improved. It is worthy to be promoted due to high safety and efficacy.
Analysis of sleep quality of adults with sleep disorders in a single center: 2013-2017
LYU Xiao, LU Xiao-dong
2018, 16(12): 2102-2105. doi: 10.16766/j.cnki.issn.1674-4152.000573
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Objective To analyze the sleep quality of adults with sleep disorders in a single center from 2013 to 2017, so as to understand their continuous dynamic changes. Methods Adult sleep disorder patients who visited the hospital from 2013 to 2017 were studied, the sleep quality was assessed with the Pittsburgh sleep quality index (PSQI), and the data were statistically analyzed via SPSS 21.0. Results A total of 2 112 patients with sleep disorders were diagnosed from January, 2013 to December, 2017. The ratio of male to female was about 0.81:1, age ranging from 20 to 39 accounting for the most. In general, the score of the partial PSQI questionnaire and the total score of PSQI was increased yearly. Comparison between men and women, the total score of PSQI about women in 2013, 2014 and 2017 was higher. The PSQI scores of >60 years old group were the highest among different age groups. Conclusion The number of cases of sleep disorders in adults increased year by year from 2013 to 2017, with 20-39 years old as the main group of patients with sleep disorders. From 2013 to 2017, the sleep quality of the patients with sleep disorders was generally declining. The sleep quality of women >60 years old group had worse sleep quality. The object is from a single center, the representativeness of samples is limited, and the evaluation index is limited. There is still a big gap in the study of quality of sleep. In the future investigation, more factors should be considered and verified and explored in a larger sample population.
Research about the risk assessment of hyperglycemia based on multiple imputation and generalized estimating equation
MA Qing-hua, MAO Jian-liang, XU Wen-xin, SUN Hong-peng, LAO Ya-qin
2018, 16(12): 2106-2110. doi: 10.16766/j.cnki.issn.1674-4152.000574
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Objective To apply multiple imputation and generalized estimating equation to the risk assessment of hyperglycemia. Methods On the basic of the elderly health management archives data from The 3rd People's Hospital of Xiangcheng District from 2011 to 2015(except 2013), multiple imputation was used to solve the data missing problem and generalized estimating equation was used to solve the repeated measurements problem. Finally, comprehensive results of risk factors for hyperglycemia would be calculated. Results This study gathered 8 325 different elderly health management archives data and accumulated 23 195 observational data. In all contained indicators, there were only variables as gender and age without missing. The ranges of miss rate of the rest of variables were 0.06% to 18.44% and the actual effective rate of the sample was 76.99%. All the data sets had an arbitrary missing pattern, and 10 different complete data sets were produced after using multiple imputation. All variables' relative efficiency was above 0.97. Hyperglycemia multi-factor comprehensive inference showed that the OR values (95% CI):high blood pressure 1.272(1.201-1.361), overweight 1.251(1.162-1.341), obesity 1.649(1.481-1.852), a racing heart 1.679(1.581-1.792), hypercholesterolemia 1.178(1.060-1.311), combined-hyperlipidemia 1.170(1.021-1.332), low density lipoprotein cholesterol 1.112(1.040-1.171), high blood uric acid 1.172(1.089-1.271), high alanine transaminase 1.180(1.032-1.351), high aspartate transaminase 1.191(1.032-1.391). After the multiple imputation, the statistical significance of combined hyperlipidemia and high aspartate transaminase changed. The γ and r values showed that missing data had the greatest impact on the parameter estimation of body mass index. Conclusion The problems of data missing and repeated measurements can be solved effectively by multiple imputation and generalized estimating equation when assessing the risk factor for hyperglycemia, the departments of public health should strengthen the surveillance for related factors which may cause the hyperglycemia and enhance health education aiming at the elderly.
Spiritual care competence and its associated factors in oncology clinical nurses of tertiary hospitals
YANG Qun-cao, ZHANG Hao, HAO Nan, KANG Xiao-yun
2018, 16(12): 2111-2114. doi: 10.16766/j.cnki.issn.1674-4152.000575
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Objective To investigate the spiritual care competence of oncology clinical nurses, to analyze related influencing factors, and to provide reference for nursing managers to improve the spiritual care competence of oncology clinical nurses. Methods There were 316 participants recruited from 2 tertiary hospitals in Xi'an by convenience sampling from December, 2017 to January, 2018. Basic data questionnaire, spiritual care competence scale and Chinese big five personality inventory-brief version were used to collect data. Pearson correlation analysis, univariate ANOVA and Kruskal-Wallis H rank-sum test were used for univariate analysis. Stepwise regression analysis was used to analyze the influencing factors of spiritual care competence. Results The score of spiritual care competency was 69.48±12.32 with the highest score in subscale of "spiritual attitude towards patients" and the lowest score in subscale of "ability of professional development and quality improvement". The score of Big Five Personality was 163.16±22.04 with the highest score in subscale of "pleasant" and lowest score in subscale of "open". After hierarchical stepwise regression analysis, age, spiritual care training experience, agreeableness and seriousness were associated with the spiritual care competency, which could explain 53.4% of the total variation. Conclusion Nursing managers should arrange spiritual care work according to the personality, invite senior nurses to discuss or give a speech on spiritual care on a regular basis, create more opportunities for oncology nurses to participate in spiritual care training and improve the overall level of spiritual care in the department.
The effect of clinical nursing pathway applied in the artificial liver plasma exchange
WU Shan-shan, XU Kui-hua, SONG Wei-qin
2018, 16(12): 2115-2117. doi: 10.16766/j.cnki.issn.1674-4152.000576
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Objective To explore the application methods and effect of clinical nursing pathway (CPN) applied in the artificial liver plasma exchange (PE). Methods From March, 2014 to November, 2016, 80 Liver failure patients with artificial liver plasma exchange were randomly divided into experimental group and control group, with 40 cases in each group. Patients in experimental group were treated with clinical nursing pathway, while patients in control group were treated with routine nursing. The satisfaction, the qualification rate of health education, the complication rate, and the effective rate were observed in both groups. All the data were analyzed with SPSS 17.0. A descriptive analysis of the percentage and rate of the data was used, and chi-square test was used, with P<0.05 indicating statistical significance. Results The satisfaction and the qualification rate of health education in experimental group were 85% and 90%, significantly superior to 55% and 65% of the control group (P=0.003, P=0.007). The complication rate in experimental group was 12.5%, inferior to those of the control group (35.0%, P=0.018). The treatment efficacy rate was 80% in the experimental group and 72.5% in the control group, without statistical significance (P=0.431). Conclusion Application of clinical nursing pathway improves patients' satisfaction and qualification rate of health education, and reduces complication rate.
A preliminary study on the method of relieving oropharyngeal dryness in patients during nasal tamponade
CHEN Li, XU Hong, CAO Xiu-hong, QIU Yue, HUAI De
2018, 16(12): 2118-2120. doi: 10.16766/j.cnki.issn.1674-4152.000577
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Objective To evaluate the effect of new methods in improving the oropharyngeal dryness of patients during nasal tamponade. Methods From December, 2016 to May, 2017, 118 patients who underwent general anesthesia under otolaryngology and underwent nasal tamponade were randomly divided into control group and the observation group, with 59 patients in each group. The control group implemented the traditional routine nursing method, and the observation group used the improved oropharyngeal humidification method, i.e., the conventional oxygen-absorbing device was not humidified, but cut the two oxygen absorbing tubes first, and then connected the two cut oxygen absorbing tubes and the atomizer connecting tube with the infusion tee. One end is connected to the oxygen absorbing device, one end is connected to the humidifier, and one end is connected to the complete oxygen absorbing tube to supply oral oxygen. The incidence of oropharyngeal dryness and the incidence of sore throat and satisfaction with nursing were compared between the two groups. Results The incidence of oropharyngeal dryness was 40.68% in the observation group and 89.83% in the control group. The incidence of oropharyngeal dryness in the observation group was significantly lower than that in the control group (P<0.05). The incidence of sore throat was 8.47% in the observation group and 62.71% in the control group. The sore throat in the observation group was significantly lower than that in the control group (P<0.05). The nursing satisfaction of the observation group was 91.52%, the nursing satisfaction of the control group was 76.27%, and the nursing satisfaction of the observation group was significantly higher than that of the control group, and the difference was statistically significant (P<0.05). Conclusion The improved method can reduce the dry sensation of mouth and pharynx caused by mouth respiration during nasal tamponade, improve the comfort of pharynx, improve the satisfaction of pharyngeal care, and promote the patients' appetite.
Effect analysis of perioperative predictive nursing to reduce the incidence of lower extremity deep venous thrombosis in patients with lower extremity fracture
SHUAI Jian-ping
2018, 16(12): 2121-2123. doi: 10.16766/j.cnki.issn.1674-4152.000578
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Objective Deep venous thrombosis of lower extremity occurs in patients with lower extremity fractures. Although conventional nursing can reduce the incidence of deep venous thrombosis of lower extremities, the nursing method is single and the prognosis is poor. This study focused on the nursing effect of perioperative predictive nursing in the prevention of deep venous thrombosis of lower extremities. Methods A total of 102 patients with lower extremity fractures who were treated from October, 2015 to October, 2017 were enrolled and randomly divided into control group (n=48) and observation group (n=54). The control group received routine nursing, and the observation group used perioperative predictive nursing intervention. After 15 days of nursing, the patient's nursing effect was evaluated. The incidence of deep venous thrombosis of the lower extremities was recorded in the two groups. The serum was separated and the two groups were measured by turbidimetry. Pre- and post-treatment 15 d D-dimer levels in the two groups were compared; color Doppler was used to detect venous blood flow velocity in lower limbs, and the incidence of deep venous thrombosis, coagulation function, and blood flow velocity were compared between the two groups. Results The incidence of deep venous thrombosis of the lower extremity was 1.85% in the observation group after perioperative care,which was lower than 18.75% in the control group (P<0.05). There was no significant difference in the D-dimer levels between the two groups before surgery(P>0.05); the level of D-dimer in the observation group was lower than that in the control group (P<0.05). There was no significant difference in blood flow velocity before treatment (P>0.05). The blood flow velocity level at 15 d was lower than that of the control group (P<0.05). Conclusion Perioperative predictive nursing can help reduce the incidence of deep venous thrombosis of lower extremities, improve blood coagulation and blood flow velocity, and is worthy of popularization and application.
Prognostic value and nursing highlights of vasoactive inotropic score on septic shock in children
YANG Shu-qin, LIN Wei, TONG Liu-sai, ZHANG Dan-ru
2018, 16(12): 2124-2127. doi: 10.16766/j.cnki.issn.1674-4152.000579
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Objective By observing the VIS score and related inflammatory mediators in children with septic shock (SS), the prognostic value and nursing highlights of septic shock in children were discussed, in order to provide reference for clinical diagnosis and treatment. Methods Children with SS decompensated children who were admitted to PICU from January, 2012 to December, 2017 in our hospital were divided into observation group (survival) and control group (death) according to the final outcome of the disease, with 68 patients in the observation group and 42 patients in the control group. The VIS, BL levels, and procalcitonin (PCT) levels in the two groups were compared to determine the prognostic value of the disease and the nursing highlights. The correlation between VIS, BL, and PCT in the observation group was also analyzed. Results In the observation group, the first 24-hour VIS (29.2±4.2 vs. 11.4±3.3, t=23.36, P<0.01), BL level[(4.7±1.6) mmol/L vs. (5.9±2.1) mmol/L, t=3.385, P<0.01] and PCT levels[(7.8±1.5) ng/ml vs. (5.6±2.1) ng/ml, t=5.916, P<0.01] were significantly higher than those of the control group (all P<0.05). There was a statistically significant positive correlation between VIS and BL (r=0.493, P<0.001) and PCT (r=0.574, P<0.001) in the observation group. ROC curve analysis showed that with 20.3 as the cutoff value, VIS had a sensitivity of 85.71% and a specificity of 72.06% for predicting poor prognosis of SS, and the area under the curve was 0.804, which was better than BL and PCT. Conclusion VIS has a certain predictive value for the prognosis of children with SS, and nursing work also plays an important role in the process of diagnosis and treatment.
Analysis of preventive effect of modified posture combined with 0.02% chlorhexidine oral care on ventilator-associated pneumonia in critically ill patients
HUANG Qi, WANG Jian-lin, HOU Ju-hua
2018, 16(12): 2128-2130. doi: 10.16766/j.cnki.issn.1674-4152.000580
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Objective To study the preventive and curative effects of improved posture combined with 0.02% chlorhexidine oral care on ventilator-associated pneumonia (VAP). Methods Totally 170 patients with mechanical ventilation time >48 h after breath tube intubation who were treated in the ICU of our hospital from February, 2016 to February, 2018 were selected. Regular oral cavity nursing was given to patients in the routine nursing group, and improved position in combination with concentration of 0.02% chlorhexidine acetate solution for oral care to patients in the combined nursing group. Pulmonary infection after nursing, length of stay in ICU, oral inflammation, mechanical ventilation time and GCS score, incidence of patients with bacteria, sputum scab formation rate, and incidence of VAP were calculated. Results The pulmonary infection score and length of stay in ICU in the combined care group were significantly lower than those in the conventional care group (P<0.05). The incidence of oral inflammation in the combined care group was significantly lower than that in the conventional care group (P<0.05). The incidence of oropharyngeal and intratracheal colonization in the combined care group was significantly lower than that in the conventional care group (P<0.05). The sputum scab formation rate and VAP incidence in the combined nursing group were significantly lower than those in the conventional nursing group (P<0.05). Conclusion The use of modified postures and concentration of 0.02% chlorhexidine solution can better reduce the incidence of ventilator-associated pneumonia in severe patients under the condition of mechanical ventilation, providing great help for patients' rehabilitation and disease treatment.
DAI Xiang-yun, SHI Jing-yun, WU Tao, MAO Dong-feng, BAI Hai
2018, 16(12): 2131-2132. doi: 10.16766/j.cnki.issn.1674-4152.000581
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CAO Jia-ying, PAN Jia-hua
2018, 16(12): 2133-2135. doi: 10.16766/j.cnki.issn.1674-4152.000582
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AI Ling, ZHAO Yu, SU Zhi-wei, WU Han-bing, SUN Xian-jun
2018, 16(12): 2136-2137. doi: 10.16766/j.cnki.issn.1674-4152.000583
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