中华全科医学

A study of diagnosis and treatment process of upper respiratory tract infections in children for community health centers in China

LIU Man-ling, MI Man, LI Xue-ping, DONG Xiao-jian, WANG Bao-ji

2018, 16(4): 507-511,542. doi: 10.16766/j.cnki.issn.1674-4152.000141

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Abstract:
Objective Through the preliminary investigation and literature search, it is found that the community doctors in Xian and even the national specialists have insufficient understanding of the diagnosis and treatment of the upper respiratory tract infections (URTIs) in child, which leads to the blindness of therapy such as repeated medication, improper combination of drugs and excessive use of antiviral and antibiotics, etc. All of these lead to the result that some community hospitals were not able to fully assume the responsibility for the first diagnosis of URTIs in child. The current pediatric diagnosis and treatment process for URTIs is aimed at pediatric specialists; there are no complete rules and procedures suitable for general practitioner (GP). In order to enhance the ability of general practitioners, there is an urgent need for the diagnosis and treatment of URTIs in children. The aim of this paper is to summarize the diagnosis, treatment and management process of URTIs in children which could be applicable in community health centers in China. Methods Seven items of the latest guidelines, norms or expert consensus about the diagnosis and therapy of URTIs in children both from domestic areas and foreign countries were involved in. Upon general practitioner jobs, all of them were compared and analyzed according to the following four-dimension, such as diagnostic criteria, differential diagnosis, treatment principles and rational administration, etc. Results The process for diagnosis, treatment and management of URTIs in children suitable for General Physicians in community health centers were formed. Conclusion Following this process, an overall assessment of URTIs in children should be given by the first visited GPs, appropriated therapy could be provided depending on the different varieties, severity and course of URTIs. For the patients in acute period, the priority of therapy should be given to symptomatic treatment on the basis of clinical observation. Antibiotics can only be used if there is at least a proper indication for it. Children with influenza should accept antiviral drugs as early as possible.

ZHANG Fan, DOU Peng-fei

2018, 16(4): 512-513.

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Study on serotypes of Streptococcus pneumoniae isolated from hospitalized child in Beijing Children’s Hospital (2013-2017)

LIU Ying, DONG Fang, SHI Wei, LIU Gang, QIAN Su-yun, XU Bao-ping, WANG Qing, MENG Qing-hong, SHEN Kun-ling, YAO Kai-hu

2018, 16(4): 514-517,625. doi: 10.16766/j.cnki.issn.1674-4152.000142

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Objective To investigate the situation of serotype distribution of Streptococcus pneumoniae (S. pneumoniae) isolated from Chinese hospitalized children and to evaluate the value of pneumococcal conjugate vaccine in the prevention of S. pneumoniae infection. Methods S. pneumoniae strains isolated from clinical specimens of 751 children hospitalized in Beijing Children's Hospital between March, 2013 and December, 2017 were studied. The serum type was detected by capsule swelling experiment. Results A total of 751 isolates of S. pneumoniae were collected, including 684 non-invasive strains and 67 invasive strains. The non-invasive strains were mainly isolated from respiratory secretions (52.3%) and bronchoalveolar lavage fluid (44.4%). The invasive strains were mainly isolated from blood (50.7%), pleural effusion (25.4%) and cerebrospinal fluid (23.9%). The common serotypes of the 751 strains were 19F (37.0%), 19A (14.2%), 23F (9.5%), 14 (7.9%), 6A (7.7%) and 6B (5.2%), accounting for 81.5%. The coverage rates of PCV10, PCV13 and PPV23 were 61.5%, 84.3% and 82.6%, respectively. The most common serotypes of non-invasive strains were 19F (37.3%), 19A (13.5%), 23F (9.5%), 6A (8.0%), 14 (7.0%) and 6B (5.6%). The coverage rates of PCV10 and PCV13 were 60.8% and 83.0%, respectively. The most common serotypes of invasive strains were 19F (34.3%), 19A (22.4%), 14 (16.4%), 23F (9.0%), 6A (4.5%), 9V (3.0%) and 1 (3.0%). The coverage rates of PCV10 and PCV13 were 68.7% and 95.5%, respectively. Conclusion Serotype 19F, 19A, 23F, 14, 6A and 6B, all of which were included in PCV13, were the common types among the pneumococcal strains isolated from hospitalized children in Beijing Children's Hospital. The coverage rate of PCV13 is more than 80%, and the coverage rate is higher in the invasive infection strains, indicating the promotion of PCV13 can prevent the overwhelming majority of S. pneumoniae infection.

Analysis of diagnosis status of lung cancer in tertiary hospitals in Anhui Province

LI Qin, LI Wei, SHEN Yuan-bing, CHEN Yu-qing, LI Xiao-jun, JIANG Hao, GU Kang-sheng

2018, 16(4): 518-522. doi: 10.16766/j.cnki.issn.1674-4152.000143

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Objective To analyze the status of diagnosis of lung cancer in tertiary hospitals in our province, and provide basis for the optimization of diagnostic methods for patients with lung cancer. Methods A lung cancer diagnostic status questionnaire was designed by the expert group of lung cancer quality control center in our province. In July, 2016, the questionnaire survey of lung cancer diagnosis was conducted in 57 three level hospitals in our province. The valid data were collected and analyzed statistically. Results Among different diagnostic methods, bronchoscopy occupied the highest selection rate (20.0%, 163/816) for suspicious central lung cancer. CT- or ultrasound- guided percutaneously transthoracic lung biopsy taken up the highest selection rate for the peripheral pulmonary lesions (18.0%, 142/790). Focusing on the selection rate of a given diagnostic method for different types of lung cancer, bronchoscopy (χ²=59.305, P<0.001) and repeated sputum cytology (χ²=11.595, P=0.001) were commonly used for central lung cancer, that obviously surpassed peripheral pulmonary lesions, however, the selection rate of CT-guided or ultrasound-guided percutaneously transthoracic lung biopsy (χ²=14.477, P<0.001) and direct surgery (χ²=25.014, P<0.001) in central lung cancer was significantly higher than that in peripheral pulmonary lesions. Among the different levels of hospitals, EBUS or TBNA (χ²=9.421, P=0.002) and direct surgery (χ²=4.195, P=0.041) were most commonly used in provincial hospital, the selection rate was significantly more than that of municipal hospitals; the selection rate of R-EBUS guided bronchoscopy (χ²=5.854, P=0.016) in tertiary hospitals was significantly more than that of the three B hospitals. Conclusion Conventional bronchoscopy and percutaneous lung biopsy are the main means for the diagnosis of lung cancer in our province, but new technologies are less developed. Provincial hospitals and tertiary hospitals are superior to municipal hospitals and three B hospitals in the diagnosis level and concept of lung cancer.

Effects of centipede-scorpion powder on behavior and c-fos protein expression in spinal dorsal horn of rat with bone cancer pain

XU Long-sheng, FENG Qin-li, ZHANG Xiao-ping, YAO Ming

2018, 16(4): 523-525,537. doi: 10.16766/j.cnki.issn.1674-4152.000144

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Objective To evaluate the analgesic effects of centipede-scorpion powder(CS) on cancer-induced bone pain of rats and observe the expression of c-fos protein expression in spinal dorsal horn in rat with bone cancer pain. Methods Female Sprague-Dawley rats were randomly divided into 6 groups:Sham group(group S), Cancer group(group A), Normal saline group(group NS), 20 mg/kg CS group(group C₁), 40 mg/kg CS group(group C₂), and 80 mg/kg CS group(group C₃). The model rats were injected Hank's solution(10 μl, 2×10⁷ cells/ml) into the left tibia medullar cavity. The mechanical withdrawal thresholds were measured on left hind paws after using different doses of CS for bone cancer pain in rat for 4 days at 9th day after modeling. The L₄, L₅ segment of the spinal cord was removed for determination of the expression of c-fos by Western Blotting, and c-fos mRNA expression by reverse transcriptase-polymerase chain reaction(RT-PCR) in the spinal dorsal horn. Results Compared with group S, the mechanical pain threshold was decreased in groups A at 9th, 12th days after modeling, the difference were all statistically significant[the mechanical pain threshold at 9th day respectively:(8.69±0.53) g vs. (6.61±0.22) g, P<0.05; the mechanical pain threshold at 12th day, respectively:(8.67±0.43) g vs. (6.56±0.48) g, P<0.05]; And the expression of c-fos protein, c-fos mRNA were increased in groups A at 12th day after modeling, the difference were all statistically significant[protein level, respectively:1.46±0.19 vs. 3.61±0.51, P<0.05; mRNA level respectively:0.65±0.22 vs. 2.53±0.31, P<0.05]. Compared with group NS, the mechanical pain threshold was increased in groups C₂ and C₃ at 12th day after modeling, the difference were all statistically significant(all P<0.05); And the expression of c-fos protein, c-fos mRNA were decreased in groups in groups C₂ and C₃ at 12th day after modeling, the difference were all statistically significant(protein level respectively:3.24±0.67 vs. 2.71±0.43, 2.15±0.37, P<0.05; mRNA level respectively:2.39±0.44 vs. 1.62±0.21, 1.46±0.14, P<0.05). Conclusion Centipede-scorpion powder can alleviate hyperalgesia in bone cancer rats, its mechanism may be related to down-regulation of c-fos expression in spinal dorsal horn.

Analyze the sleep dysfunction for patients with irritable bowel syndrome and its correlation with psychiatric and gastrointestinal symptom

SHEN Xiao-ling, SONG Yu-fei, YE Hua, ZHANG Xie

2018, 16(4): 526-528. doi: 10.16766/j.cnki.issn.1674-4152.000145

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Objective To analyze the sleep dysfunction for patients with irritable bowel syndrome (IBS) and its correlation with psychiatric and gastrointestinal symptom. Methods Clinical data of patients with IBS received treatment at our hospital from 2015 to 2017 were analyzed as Group A. Healthy cases were enrolled as Group B. Pittsburgh sleep quality index (PSQI), IBS symptom severity scale (IBS-SSS), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were evaluated and analyzed. Results A total of 85 patients were analyzed, Group A 45 cases, Group B 40 cases. Group A patients had higher PSQI scores than that of Group B (9.21±2.50 vs. 5.38±0.45; t=9.547, P<0.01). The Group A patients's IBS-SSS scores was 195.8±39.7, HAMD scores was 19.2±3.6 and HAMA scores was 21.5±4.1. Correlation analysis showed that, for Group A patients, the PSQI scores had significant positive correlation with IBS-SSS (r=0.820, P<0.01), HAMD (r=0.617, P<0.01) and HAMA (r=0.697, P<0.01). Conclusion IBS patients were early suffered from sleep dysfunction and which was associated with psychiatric and gastrointestinal symptom.

Radiolabeling of exendin-4 and its biodistribution in mice

JIANG Ying, QI Yong-shuai, HUANG Bao-dan, HUANG Kai, CHI Xiao-hua, LI Gui-ping

2018, 16(4): 529-532,662. doi: 10.16766/j.cnki.issn.1674-4152.000146

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Objective To establish the radiolabeling method of exendin-4, an glucagon-like peptide 1 (GLP-1) receptor agonist, with ¹³¹I and observe the biodistribution of ¹³¹I-exend in-4 in normal mice. Methods Radiolabeling of exendin-4 with ¹³¹I was performed by chloramine-T method. The labeling ratio and radiochemical purity were determined using paper chromatography and TLC. The octanol-water partition coefficient and stability in vitro in saline and normal human serum of labeled polypeptide were also determined. The biodistribution of ¹³¹I-exendin-4 in normal mice were measured at 1, 3, 6, 12, 24 h after intravenous injection. SPECT was performed in 3 male mice after injection of ¹³¹I-exendin-4 to observe the dynamic distribution of the labeled exendin-4. Results The labeling yield of ¹³¹I-exendin-4 was more than 85%. The ¹³¹I-exendin-4 had good stability in saline and normal human serum. The octanol-water partiton coefficient lg P=-1.002. The biodistribution in mice showed that ¹³¹I-exendin-4 had rapid blood clearing, and the radioactivity in kidney was obviously higher than that of other organs as indicated by their uptake of (51.54±13.51)%ID/g at 1 h and (11.61±0.94)%ID/g at 12 h, respectively. Organs such as stomach, lung, intestine and bone had transient radioactive uptake, and then after 3 h the radioactivity in those organs rapidly decreased. The radioactivity in other organs always kept at a low level. Conclusion ¹³¹I-exendin-4 can be easily labeled with a high labeling ratio with stability in vitro. It has good distribution characteristics in vivo, and is cleared mainly by renal excretion due to its hydrosolubility.

Clinical comparative study of breast-conserving surgery and modified radical mastectomy for early breast cancer

DENG Jun, JIA Jian-guang, GAO Yuan, CHEN Chen

2018, 16(4): 533-537. doi: 10.16766/j.cnki.issn.1674-4152.000147

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Objective To investigate the clinical effect of breast-conserving surgery and modified radical mastectomy in the treatment of early breast cancer. Methods The clinical data of 88 patients with early breast cancer from January, 2012 to June, 2016 in our hospital were analyzed retrospectively. Forty-four patients in the breast-conserving group received the breast-conserving surgery, while 44 patients in the modified radical group received the modified radical mastectomy. The operative time, intraoperative blood loss, hospitalization time, postoperative period cosmetic effect, recurrence rate, metastasis rate and survival rate were compared between the two groups in order to assess the efficacy of two surgical methods. Results ①The operation time and hospitalization time of the patients in the breast-conserving group were significantly shorter than those in the modified radical group, and the intraoperative blood loss was significantly less than that of the modified radical group. The difference between the two groups in the operation time, intraoperative blood loss and hospitalization time was statistically significant. ②At the end of follow-up, 1 case of recurrence occurred in the breast-conserving group, 1 case of metastasis, no death occurred. There were 2 cases of metastasis and 1 case of death in the modified radical group, and no local recurrence. There was no significant difference in recurrence rate, metastasis rate and survival rate between the two groups. ③ After the decision, 39 cases in the breast conserving group were excellent, 3 cases were general, 2 cases were poor. The excellent rate of breast-conserving patients was 88.6%. The cosmetic effect in the modified radical group was judged as poor because of the implementation of the whole mastectomy surgery, and the postoperative cosmetic effect of breast-conserving group was significantly better than that in the modified radical group, the difference was statistically significant. Conclusion In the treatment of early breast cancer, breast-conserving surgery is with the advantage of short operation time, less intraoperative bleeding, short hospital stay, good cosmetic effect and rapid postoperative recovery when compared with the modified radical surgery. There is no significant difference in the local recurrence rate, distant metastasis rate and survival rate between the two groups, which is worthy of clinical promotion.

Protective effect of Ebselen on myocardial ischemia reperfusion injury through regulating MAPK pathway

WU Hua-jun, ZHAI Chang-lin, HUANG Ming-de, SHEN Wei-feng, ZOU Hong-xing, SHAO Ping-yang, LOU Yong-liang

2018, 16(4): 538-542. doi: 10.16766/j.cnki.issn.1674-4152.000148

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Objective To research the correlation between the protective effect of Ebselen on myocardial ischemia reperfusion injury and MAPK pathway. Methods Thirty-six male Wistar rats were randomly divided into sham operation group(Sham), Ischemia reperfusion group (IR-Control), Ebselen + ischemia reperfusion group (Ebselen+IR) and Ebselen group (Ebselen). The myocardial ischemia reperfusion rat model was established. The myocardial apoptosis and necrosis were evaluated by injury score and observed by HE staining; The expression of serum TNF-α, IL-6, and tissue TGFβ1 were detected by ELISA, and the expression of MAPK pathway related proteins were detected by Western blotting. Results Compared with ischemia reperfusion group, Ebselen pretreatment significantly decreased myocardial necrosis, inflammation and edema, histological injury score, Ebselen pretreatment significantly reduced TNF-α induced by ischemia reperfusion (P<0.05) and also IL-6, TGFβ1 (P<0.01). Besides, ischemia reperfusion + Ebselen group reduced the level of ERK1/2 and reduced the expression of phosphorylation of JNK and p38 induced by ischemia reperfusion injury, p-JNK increased by 0.34±0.06, p-p38 increased by 0.42±0.10, p-ERK1/2 decreased by 0.35±0.07, P<0.001. Ebselen + ischemia reperfusion group increased the level of ERK1/2 and reduce the phosphorylation of JNK and p38 caused by ischemia reperfusion injury, p-JNK decreased by 0.17±0.05 (P<0.001), p-p38 decreased by 0.16±0.03 (P<0.01), p-ERK1/2 increased 0.09±0.02 (P<0.05). Conclusion Ebselen treatment played a protective effect on myocardial ischemia reperfusion injury and its mechanism may be related to the MAPK pathway.

Application of medical and nursing combination mode in postoperative rehabilitation of elderly patients in orthopedics department

ZHAO Zhi, ZHOU Huan, WANG Min, GUAN Jian-zhong, WU Min, JIANG Yong

2018, 16(4): 543-545,610. doi: 10.16766/j.cnki.issn.1674-4152.000149

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Objective To explore the application of the mode of combination of medical care and rehabilitation in elderly patients in orthopedics department and its influence on the quality of life and well-being index of elderly patients. Methods Eighty cases of elderly patients operated in orthopedics department from February, 2016 to February, 2017 were randomly divided into the study group and the control group with 40 cases in each group. The study group received medical support combined with rehabilitation mode after operation, while the control group received the conventional mode of rehabilitation. One months, 3 months and 6 months later, postoperative self-care ability, score by simple health measurement scale (SF-36), overall well-being scale (GWB loneliness) and UCLA Loneliness Scale, and satisfaction of patients on postoperative rehabilitation were compared between the two groups. Results After the implementation of mode of combination of medical care and rehabilitation for 1 months, 3 months and 6 months, medical self-care ability and SF-36 evaluation between the two groups (P<0.05).The overall well-being scores in the study group were higher than those in the control group (P<0.05). The satisfaction to postoperative rehabilitation in the study group was 95%, which was significantly higher than that of the control group (89%). Conclusions The application of medical and nursing combination mode in postoperative rehabilitation of elderly patients in orthopedics department is an extension and upgrade of existing models, which pays more attentions to particularity of pension services and life care and health care of the aged patients. This mode is an endowment service model integrating medical rehabilitation service, health examination consultation, rehabilitation of large diseases and hospice care. The postoperative rehabilitation based on combination of medical care model can greatly reduce the incidence of postoperative complications in elderly patients in orthopedics department, improve self-care ability, the quality of life and patients' satisfaction, reduce their loneliness, and enhance the happiness index of the elderly patients.

Effect of topical application of minocycline hydrochloride ointment assisted with subgingival scaling and root planing on periodontium of patients with chronic periodontitis

GAO Yun-yun, ZHOU Shu-zhen, CHEN Jian, ZHANG Xiao-hong

2018, 16(4): 546-548. doi: 10.16766/j.cnki.issn.1674-4152.000150

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Objective To investigate the effect of topical application of minocycline hydrochloride ointment assisted with subgingival scaling and root planing on periodontium of patients with chronic periodontitis. Methods Total 152 patients with chronic periodontitis in the First Affiliated Hospital of Wenzhou Medical University were selected and divided into two groups according to the random number method, each group 76 cases. All patients were given subgingival scaling and root surface roughness. The control group was given iodine glycerol, and the observation group was given intravenous minocycline ointment. After the treatment, the periodontium related indexes[periodontal pocket depth (PD), attachment level (AL), plaque index (PLI), gingival bleeding index (SBI)], the inflammatory factor[interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor (TNF)-α], clinical efficacy and adverse reactions of the two groups were compared. Results The total effective rate of the observation group was 94.74%, which was significantly higher than that of the control group (75.00%), P<0.05. After the treatment, PD, AL, PLI, SBI of the two groups were significantly decreased (P<0.05), and the observation group was significantly lower than the control group (P<0.05). After the treatment, there were no significantly difference on IL-6 levels in both two groups (P>0.05). The CRP and TNF-α of the observation group were significantly reduced (P<0.05), and significantly lower than that of the control group (P<0.05). The adverse reaction rate of the observation group and control group were 6.58% and 5.26%, respectively, which were not statistically significant (P>0.05). Conclusion Local application of minocycline hydrochloride ointment assisted with subgingival scaling and root canal surgery has a significant effect on chronic periodontitis. It can improve periodontal symptoms, the mechanism might be related to the regulation of the levels of CRP and TNF-α.

Predictive diagnosis value of peripheral blood inflammation index for infection after transcatheter arterial chemoembolization

MA Ming, MA Ying, MENG Yuan, CHEN Xiong

2018, 16(4): 549-551. doi: 10.16766/j.cnki.issn.1674-4152.000151

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Objective To analyze the Predictive diagnosis value of peripheral blood inflammation index for infection after transcatheter arterial chemoembolization (TACE) and provide reference for clinical diagnosis and treatment of primary hepatic carcinoma. Methods The clinical data of primary hepatic carcinoma patients undergoing transcatheter arterial chemoembolization treatment in our hospital from 2015 to 2017 were analyzed. The patients were divided into two groups by postoperative infection, Group A:infection, n=18; Group B:without infection, n=96. The levels of CRP, IL-10 and IL-8 were tested and compared between the two groups at 24 hours after TACE. The infection predictive diagnosis value was analyzed by ROC. Results Twenty-four hours after TACE, Group A had higher level of CRP than that of Group B, the difference was statistically significant[(26.5±5.2) mg/L vs. (19.7±4.6) mg/L; t=5.638, P<0.01]; Group A had higher level of IL-8 after 24 h than that of Group B, the difference was statistically significant[(39.6±7.3) ng/L vs. (16.9±3.8) ng/L; t=19.600, P<0.01]; however, there was no significant difference in the level of IL-10 between the two group[(16.1±4.6) ng/L vs. (17.3±5.2) ng/L; t=0.914, P=0.363]. ROC analysis showed that the IL-8 for the prediction of infection after TACE using optimal cut-off point (22.14 ng/L) provided a sensitivity of 83.33% and a specificity of 89.58%, with an AUC of 0.926, which was better than these of CRP. Correlation analysis showed that, for Group A patients, the levels of CRP had significant positive correlation with IL-8 (t=0.352, P<0.01). Conclusion The level of IL-8 showed a well value of postoperative infection predictive diagnosis for primary hepatic carcinoma patients undergoing TACE.

Status of tumor infiltrating dendritic cells in glioma tissue and the expression levels of MHC-Ⅱ and CD54 in such cells

SHEN Gang, SHEN Hong, HU Wei-wei, ZHU Guang-yao, WANG Bo-ding, SUN Cheng-feng

2018, 16(4): 552-554,653. doi: 10.16766/j.cnki.issn.1674-4152.000152

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Objective To investigate the number of tumor infiltrating dendritic cells in glioma tissue and the expression levels of MHC-Ⅱ and CD54 in such cells. Methods Total 70 cases of glioma tissue specimens were taken as glioma tissue group, and 70 cases of normal brain tissue specimens were taken as normal brain tissue group in Ningbo Lihuili Hospital from January, 2013 to June, 2017. The glioma group was divided into low grade glioma group (grade Ⅰ + grade Ⅱ, 19 cases) and high grade glioma group (grade Ⅲ + Ⅳ, 51 cases) according to WHO pathological grade. The number of TIDCs in brain glioma tissues and the number of dendritic cells (DCs) in normal brain tissues were measured by immunohistochemistry. The expressions of MHC-Ⅱ and CD54 on the surface of DCs were detected by flow cytometry in TIDC and normal brain tissues. Results The nuclei appear as brown particles were S-100 positive staining DC cells. The number of TIDCs in glioma tissue was lower than that in normal brain tissue (P<0.05). The number of TIDCs in high-grade gliomas was lower than that in low-grade gliomas (P<0.05). The expression of MHC-Ⅱ and CD54 on the surface of TIBC was lower than that in normal brain tissue (P<0.05). The expression of MHC-Ⅱ and CD54 on the TIDC membrane in high-grade gliomas tissue was higher than that in the low-grade glioma tissue (P<0.05). Conclusion TIDC cells in brain glioma tissue is less than normal brain tissue DC cells. With the increase of glioma grade, TIDC cell infiltration decreases. The presence of antigenic presentation in the glioma is absent or decreased.

Relationship between 24-hour ambulatory blood pressure variability and homocysteine in patients with H-type hypertension

PAN Ting-ting, ZHOU Jian-mei

2018, 16(4): 555-557,658. doi: 10.16766/j.cnki.issn.1674-4152.000153

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Objective To explore the relationship between 24-hour ambulatory blood pressure variability and homocysteine in patients with H-type hypertension. Methods Total 90 patients with primary H-type hypertension (homocysteine ≥ 10 μmol/L) were treated as H-type hypertension group, and 90 patients with primary simple hypertension (homocysteine<10 μmol/L) were treated as control group in Zhejiang Hospital from February, 2014 to November, 2016. Twenty-four hours ambulatory blood pressure monitoring was performed in both groups by using 24 h ambulatory blood pressure meter, and the blood pressure variability was compared between the two groups. Blood homocysteine levels were determined by enzyme cycling. Results The homocysteine level in H-type hypertensive group was higher than that in the control group (P<0.05). There were no significant difference in fasting blood glucose, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein, serum creatinine and hemoglobin level between the two groups (all P>0.05). The variability of 24 h systolic blood pressure, the variability of 24 h diastolic blood pressure, the variability of daytime systolic blood pressure, the variability of daytime diastolic blood pressure, the variability of nighttime systolic blood pressure and the variability of night diastolic blood pressure in the H-type hypertensive group were higher than those in the control group (all P<0.05). The variability of 24 h systolic blood pressure, the variability of 24 h diastolic blood pressure, the variability of daytime systolic blood pressure, the variability of daytime diastolic blood pressure, the variability of nighttime systolic blood pressure and the variability of night diastolic blood pressure were positively correlated with homocysteine in the H-type hypertensive patients (all P<0.05). Conclusion Twenty-four-hour dynamic blood pressure variability increases obviously in patients with H-type hypertension, 24 h dynamic blood pressure variability is positively correlated with homocysteine.

Effects of doxofylline on oxidative stress and inflammatory factors in patients with esophageal cancer radical surgery

CHEN Bo, ZHU Dan, ZHAO Dong

2018, 16(4): 558-560,645. doi: 10.16766/j.cnki.issn.1674-4152.000154

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Objective To investigate the effects of doxofilate on oxidative stress and inflammatory factors in patients with esophageal cancer radical surgery in order to provide a clinical reference for the rational use of doxophylline. Methods Total 80 patients with esophageal cancer radical surgery in our hospital from May, 2014 to June, 2015 were randomly divided into observation group and control group, the patients in both groups were treated with the same amount of saline and Doxofloxacin after intubation of the double-lumen bronchus, the changes of the intraoperative indicators in the two groups were recorded, the levels of oxidative stress and the level of inflammatory factors were compared between the two groups, and the incidence of adverse reactions was observed. Results There was no significant difference in intraoperative indexes (P>0.05); At the time of the T₁ to T₃, the levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in the two groups were significantly lower than those in the T₀ time (P<0.05), and the malonaldehyde (MDA) level was significantly higher than that of the T₀ (P<0.05), and the levels of SOD and GSH-Px in the observation group were significantly higher than those in the control group (P<0.05), MDA level was significantly lower than that in the control group (P<0.05); At the time of the T₁ to T₃, the levels of tumor necrosis factor (TNF)-α, interleukin (IL-6) and IL-10 in the two groups were significantly higher than those at the T₀ time (P<0.05), the level of IL-10 was significantly higher (P<0.05) and the levels of TNF-α and IL-6 were significantly lower in the observation group as compared with the control group (P<0.05); The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). Conclusion Doxofylline can significantly inhibit the oxidative stress response and inflammatory response of the radical patients with esophageal cancer, and reduce the incidence of postoperative adverse reactions, which is worthy of clinical promotion.

Effect and mechanism of Omega-3 polyunsaturated fatty acids in the treatment of ulcerative colitis

XU Zai-ling, SHI Hua, LIU Jun-wei, ZHAO Zhong-wei, PEI Li-hong

2018, 16(4): 561-563,596. doi: 10.16766/j.cnki.issn.1674-4152.000155

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Objective To observe the clinical efficacy of Omega-3 polyunsaturated fatty acids (omega-3PUFAs) in the treatment of ulcerative colitis (UC) and its influence on peripheral blood Th17/Treg cell balance and the levels of cytokines IL-10 and IL-17. Methods A prospective randomized controlled study was conducted. Fifty patients with UC were enrolled from Lishui Central Hospital in Zhejiang province from January, 2014 to December, 2016. The time and place of the study were added. The patients were divided into 2 groups by random number table. Twenty-five cases in Control group, mesalazine 1 g 4 times a day orally; 25 cases in Observation group, mesalazine 1 g 4 times a day orally and ω3-PUFAs 100 ml 1 times a day intravenous drip. Other nonspecific treatment measures were the same in the two groups, and the course of treatment was one weeks. The expressions of serum IL-10 and IL-17 were detected by ELISA, and the proportion of Treg cells and Th17 cells in peripheral blood was detected by flow cytometry. The clinical effective rates of the two groups were compared. The levels of serum IL-10 and IL-17, the ratio of Treg cells and Th17 cells in peripheral blood before and after the treatment were compared. Results There was no significant difference between the two groups in age, sex, course of disease and severity of the disease (P>0.05). The total effective rate of clinical symptom improvement in the observation group (88%) was obviously better than that of the control group (68%), the difference was statistically significant (P<0.05). Compared with the same group before treatment, the proportion of Treg cells and IL-10 levels in peripheral blood of both groups increased significantly, while the proportion of Th17 cells and the level of IL-17 were significantly decreased, the difference was statistically significant (P<0.05). Compared with Control group, the proportion of Treg cells and IL-10 levels in peripheral blood of the observation group increased more significantly, but the proportion of Th17 cells and the level of IL-17 decreased more significantly, the difference was statistically significant (P<0.05). Conclusion ω-3 PUFAs has good clinical efficacy in the treatment of UC, and its mechanism may be related to regulating the balance of Treg/Th17 and alleviating the inflammatory reaction of UC.

Clinical assessment of minimally invasive approach biodegradable screw and protection of the lateral calcaneal bone flap in the treatment of calcaneal fracture

ZHANG Yong, YANG Li-feng, ZHUANG Yun-qiang, XIAO Bai-ping, YING Ji-chong, MA Wei-hu, HU Yong, XU Rong-ming

2018, 16(4): 564-567,670. doi: 10.16766/j.cnki.issn.1674-4152.000156

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Objective To explore the efficacy and safety of minimally invasive approach biodegradable screw and protection of the lateral calcaneal bone flap in the treatment of calcaneal fracture with the lateral displaced articular fragments. Methods A retrospective study was conducted to analyze the 37 patients of calcaneal fracture with the lateral displaced articular fragments who had been treated with invasive approach biodegradable screw and protection of the lateral calcaneal bone flap at our hospital from January, 2010 to January, 2014. The data were analyzed concerning age, gender, complications of different systems, smoke history, damage factor, fracture type, operation time, bleeding volume, complications of operation, fracture heeling and functional recovery. Results Thirty-seven patients were followed up for 24 to 38 months, average 12 months. The pre-post-operative Bohler's angle and Gissane's angle was significant difference(P<0.05). The degree of postoperative Bohler's angle and Gissane's angle have large than peroperative angles. There were no problems with wound healing or necrosis during the follow-up. The excellent and good rate was 87.8%. Conclusion In treatment calcaneal fracture with the lateral displaced articular fragments, the minimally invasive approach biodegradable screw and protection of the lateral calcaneal bone flap is a successful treatment. The advantages include shorter operation time, limited trauma, and reduced postoperative complications. This technique can be considered in patients who are not suitable for an extensile lateral approach and internal fixation.

Clinical evaluation and analysis of acute phorate poisoning

LIANG Shao-qin, HAN Ruo-dong, SONG Ke-yi

2018, 16(4): 568-569,641. doi: 10.16766/j.cnki.issn.1674-4152.000157

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Objective To compare the clinical features of acute severe poisoning of phorate and other non-phorate pesticide. Methods There was a retrospective analysis of 50 cases of patients with severe organophosphorus poisoning in our hospital from March, 2014 to March, 2017,which were divided into phorate poisoning group (22 cases) and other non-phorate poisoning group (28 cases) according to different toxicity of pesticide. The intermediate syndrome cases, cholinesterase recovery time, the total amount of penehyclidine hydrochloride dosage, tracheotomy cases, hospitalization time and fatality rate were observed. Results Compared with other non-phoratepoisoning group:①phorate poisoning group has a higher incidence of intermediate syndrome (14 vs. 0); ②longer cholinesterase recovery time[(330.55±8.64) h vs. (67.71±6.42) h]; ③higher penehyclidine hydrochloride dosage[(58.00±12.92) mg vs. (8.35±2.66) mg]; ④more cases of tracheotomy (18 vs. 2); ⑤longer hospitalization period[(19.50±6.39) d vs. (10.57±3.54) d]. There was a significant difference in above clinical observation indexes between the two groups (P<0.05); ⑥The fatality rate of phorate poisoning group was 4.54%, and the fatality rate of non-phorate poisoning group was 7.14%. There was no difference in fatality rate between the two groups (P>0.05). Conclusion Acute phorate poisoning has many complications, long hospitalization time and heavy follow-up treatment burden.

Value of urinary BLCA-4 in diagnosis and detection of recurrence of bladder cancer

JIANG Ming-you, WAN Ming-fa, HONG Zhong-liang

2018, 16(4): 570-572. doi: 10.16766/j.cnki.issn.1674-4152.000158

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Abstract:
Objective To explore the value of urine bladder cancer associated protein-4 (BLCA-4) in the diagnosis and detection of the recurrence of different stages of bladder transitional cell carcinoma (BTCC). Methods Between January, 2016 to November, 2017, 50 cases of bladder cancer, 40 healthy individuals and 40 cases of bladder stones in our hospital were enrolled into this study. ELISA was used to detect the levels of BLCA-4 and BLCA-1 in the urine of the subjects in all the three groups. The difference in the expression of BLCA-4 and BLCA-1 between recurrent bladder cancer patients and other patients without recurrent cancer was compared. Results The levels of BLCA-4 and BLCA-1 in the bladder cancer group were higher than those of healthy group and bladder calculi group; and the levels of BLCA-4 and BLCA-1 in patients with metastasis to lymph nodes and distant organs were significantly higher than other patients without metastasis to lymph nodes and distant organs. The sensitivity and specificity of BLCA-4 for the diagnosis of bladder cancer were 84% and 94%, and those of BLCA-1 were 86% and 92%, respectively. The levels of BLCA-4 and BLCA-1 in the patients without recurrent cancer decreased obviously one year after the operation, but in the patients with recurrent cancer increased significantly, the difference was significant (P<0.05). Conclusion BLCA-4 and BLCA-1 are sensitive to the diagnosis of bladder cancer and may be a new tumor marker for BTCC screening and postoperative follow-up.

The awareness of knowledge and medical burden of hepatitis C on patients with chronic hepatitis C in hospital

LI Yang, CHU Liang, TIAN Cong

2018, 16(4): 573-575,579. doi: 10.16766/j.cnki.issn.1674-4152.000159

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Abstract:
Objective To find out the awareness of knowledge and medical burden of hepatitis C on patients with chronic hepatitis C in hospital. Methods Patients with chronic hepatitis C from 4 hospitals in Beijing, Henan, Jilin and Liaoning province were surveyed by questionnaires,from July to October 2016, to investigate their demographic characteristics, awareness of hepatitis C, as well as medical burdens of hepatitis C. Results A total of 359 cases, including 171 males (47.6%), and 188 females (52.4%), were under investigation, with the average age of (55.1±11.9) years. Among them, only 7.5% correctly answered all questions, 11.1% did not know anything about hepatitis C knowledge, and only 17.8% of the participants answered correctly to all five questions about transmission route of hepatitis C. The correct rate of hepatitis C knowledge in different regions, sex, age, educational level and national chronic hepatitis C patients was different, and the difference was statistically significant, but the difference between marital status, occupation and family per capita monthly income was not statistically significant. And 186(51.8%) participated in the town health insurance and 126(35.1%) participated in the new rural cooperative medical system. For 176(49.0%), the total cost of hepatitis C treatment was more than 30 000 yuan. There were significant differences in the total cost of treatment in different areas and different types of medical insurance. The treatment effect of hepatitis C has no improvement in 120(33.4%), general improvement in 165(46.0%), obvious improvement in 62(17.3%), and only 12(3.3%) recovery. Conclusion The patients of hepatitis C were barely aware of knowledge of hepatitis C. More efforts for hepatitis C education are wanted. There is less cost for treatment in economically disadvantaged areas. New rural cooperative patients with low proportion of hepatitis C reimbursement, and the cost of treatment is high. We should increase the support for farmers and other low income people, and it may help reduce the medical burden.

Application of triple viable bifidobacterium powder combined with triple therapy in chronic gastritis with Helicobacter pylori infection

DING Jian, ZHANG Jun, NIU Ping-ping, SHI Jie-min, ZHONG Jing

2018, 16(4): 576-579. doi: 10.16766/j.cnki.issn.1674-4152.000160

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Objective To investigate the clinical efficacy and safety of Bifidobacterium triad combined with triple therapy in the treatment of chronic gastritis with Helicobacter pylori (Hp) infection. Methods Total 178 cases of chronic gastritis with Hp infection in our hospital were selected and randomly divided into control group (89 cases, treated with triple therapy) and study group (89 cases, received additional Bifidobacterium triple viable powder). The clinical symptom score and serum gastrin level were observed, the curative effect was compared between the two groups. Results The total efficiency of the control group was 84.27% and of the study group was 95.51%, the difference was statistical significant. After the treatment, the score of stomachache and stomach bloating, dryness and bitterness of the mouth, belching and acid regurgitation in the study group were lower when compared with the control group; the levels of serum interleukin-8(IL-8), white interleukin-17(IL-17), interleukin -6(IL-6), transforming growth factor beta 1 (TGF-beta 1), serum gastrin in 17(G17), pepsinogen Ⅰ(PG Ⅰ) adn pepsinogen Ⅱ (PG Ⅱ) of the study group were lower when compared with the control, the difference was statistical significant (P<0.05); The main adverse reactions during the treatment were nausea, vomiting, dizziness, diarrhea, the incidence of adverse reactions in the study was 4.49%, which was significantly less than the control group (13.48%), the difference was statistical significant. Conclusion Bifidobacterium triple viable powder combined with triple therapy is effective in the treatment of chronic gastritis with Hp infection. It can effectively reduce the clinical symptoms, reduce serum cytokines levels, and inhibit gastrin 17 and pepsin release, with high safety.

Effect of Bufei Yishen Huayu decoction on airway function of stable COPD patients and its mechanism

PAN Min, LIN Xiao-yang, CHEN Xia, DONG Meng-qian

2018, 16(4): 580-582. doi: 10.16766/j.cnki.issn.1674-4152.000161

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Abstract:
Objective To study the effect of Bufei Yishen Huayu Decoction on airway function of chronic obstructive pulmonary disease (COPD) patients and its mechanism. Methods One hundred and sixty-six patients with stable COPD were randomly divided into two groups, each group 83 cases. The control group was treated with salbutamol and ipratropium bromide inhalation. The observation group was treated with Bufei Yishen Huayu Decoction based on the control group. After treatment, clinical symptoms, pulmonary function[FEV%, FEV1/FVC], serum TNF-α and TGF-β1, and clinical efficacy of two groups were compared. Those data were analyzed by SPSS soft to analyze the effect of Bufei Yishen Huayu Decoction on airway function of COPD patients and its mechanism. Results After treatment, the total effective rate of observation group was 92.77%, which was significantly higher than that of control group (77.11%, P<0.05). After treatment, clinical symptoms scores of two groups were significantly decreased (P<0.05), and the observation group was significantly lower than the control group (P<0.05). After treatment, FEV% and FEV1/FVC of two groups were significantly increased (P<0.05), and the observation group was significantly higher than the control group (P<0.05). After treatment, the TNF-α and TGF-β1 levels of observation group were significantly reduced (P<0.05), and lower than those of control group (P<0.05). Conclusion Bufei Yishen Huayu Decoction could significantly improve the clinical symptoms and pulmonary ventilation function of patients with stable COPD. The internal mechanism of airway remodeling may be related to reduce airway inflammation and reduce TGF-β1.

Efficacy and safety of lactoferrin combined with triple therapy in the treatment of Helicobacter pylori-associated gastropathy in children

XU Ba-qun, LI Zhi-fei, YANG Qi-hua, WANG Bo-jun

2018, 16(4): 583-585,677. doi: 10.16766/j.cnki.issn.1674-4152.000162

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Abstract:
Objective To study the efficacy and safety of the combination of lactoferrin and triple therapy in the treatment of Helicobacter pylori (H. pylori)-associated gastropathy in children. Methods Total 100 children with H. pylori infection in our hospital between January, 2014 and December, 2016 were enrolled in this study and divided into observation group and control group according to the double-blind randomized method with 50 cases in each group. A standard triple therapy (taking 20 mg omeprazole enteric on an empty stomach, b.i.d; taking 500 mg clarithromycin after a meal, b.i.d; taking aromoline 1 g after a meal, q.d) was performed in both groups. The observation group was additionally given 0.024 g lactoferrin, taking at a draft, q.d. The course was 2 weeks in both groups. The incidence of adverse reactions, symptoms improvement, HP eradication rate and recurrence rate with six months were observed. Chi-square test was performed by SPSS. Results The total curative rate in the observation group after one and two weeks treatment was 90.0% and 94.0%, in the control group was 72.0% and 78.0%. HP eradication rate after the treatment in the observation group was 92.0%, which was significantly higher than 72.0% in the control group (P<0.05). The incidence of adverse reactions in the observation group was 8%, which was significantly lower than 33.3% in the control group (P<0.05). The recurrence rate within six months was 22.0% in the observation group and 42.0% in the control group (P<0.05). Conclusion The clinical efficacy of Lactoferrin combined with triple therapy in the treatment of HP infection-related stomach disease in children is better than triple therapy alone, which can decrease HP positive rate and eradicate Helicobacter pylori effectively, with a lower recurrence rate and higher safety.

Efficacy of Sinupret drops therapy in children with rhinosinusitis and its influence on inflammatory factors

YANG Jing-min, MENG Xiang-tao, YANG Xiao, LI Chuan

2018, 16(4): 586-588,592. doi: 10.16766/j.cnki.issn.1674-4152.000163

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Abstract:
Objective To investigate the efficacy of Sinupret drops in treatment of children with rhinosinusitis and the effects of the levels of interleukin-10 (IL-10), interleukin-2 (IL-2), C reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels. Methods Three hundred cases of children with rhinosinusitis were randomly divided into the observation group (n=150) and the control group (n=150). The observation group was treated with Sinupret Drops and the control group with oral ambroxol syrup, were 3 times/day, 2 weeks. The two groups respectively before and after treatment by visual analogue scale (VAS) and nasal outcome test-20 (SNOT-20) scale were used to assess the degree of children with disease, and the ELISA were used to detect the serum IL-2 and IL-10, TNF- alpha and CRP level change. Results The nasal congestion, cheek pain or pain, headache, hyposmia score in the two groups after treatment were significantly lower than those before treatment (P<0.05), and the observation group was significantly lower than the control group (P<0.05). The nasal symptoms, associated symptoms, sleep disorder and affective outcome scores in two groups after treatment were significantly lower than those before treatment (P<0.05), and the observation group was significantly lower than the control group (P<0.05). The total effective rate of the observation group was significantly higher than that of the control group (χ²=12.997, P<0.001). The serum IL-10, IL-2, CRP and TNF-α levels in two groups after treatment were significantly lower than those before treatment (P<0.05), and the serum IL-10 (241.18±26.37 vs. 310.25±30.64), IL-2(24.37±4.42 vs. 30.08±4.35), CRP(3.05±0.26 vs. 4.92±0.48) and TNF-α(1.08±0.20 vs. 1.95±0.41) levels in observation group were significantly lower than those in the control group(P<0.05). Conclusion Sinupret Drops has better effect in treatment of children rhinosinusitis, and it can relieve the children's inflammation.

Influence of pre-pregnancy body mass index on STAT3-SOCS3-leptin insulin signal pathway in offspring

ZHU Wen, ZHANG Xu, SHEN Fang-fang, YING Qin-lai, TENG Yi-qun

2018, 16(4): 589-592. doi: 10.16766/j.cnki.issn.1674-4152.000164

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Abstract:
Objective To investigate the effect of pre-pregnancy body mass index on STAT3-SOCS3 -leptin insulin signal pathway. Methods Ninety cases of newborns of obese/overweight pregnant women were selected as obese/overweight group, and 90 cases of newborn infants of pregnant women with normal body mass index were selected as normal group from January, 2016 to December, 2016 in Jiaxing Second Hospital. The newborn body mass index after birth 42 days, 6 months and 12 months were calculated. The blood leptin, fasting blood glucose, insulin, triglyceride, total cholesterol were detected. The expression of LepR, SOCS3, STAT3, IR, IRS1 mRNA levels were detected by reverse transcription-polymerase chain reaction (RT-PCR) assay. The LepR, SOCS3, STAT3, IR, IRS1 protein levels were detected by Western Blot. Results The body mass index of obese/overweight group infants at 42 days, 6 months and 12 months were higher than that of the normal group (P<0.05). At 12 months, the levels of serum leptin, fasting blood glucose, insulin, triglyceride and total cholesterol in the obesity/overweight group were higher than those in the normal group (P<0.05). The levels of LepR, STAT3, IR and IRS1 mRNA in the obese/overweight group were lower than those in the normal group (P<0.05), SOCS3 mRNA level was higher than that of the normal group (P<0.05); The protein levels of LepR, STAT3, IR and IRS1 in the obesity/overweight group were lower than those in the normal group (P<0.05), SOCS3 protein level was higher than that of the normal group (P<0.05). Conclusion Pre-pregnancy obesity/overweight affects the metabolic characteristics of offspring. The mechanism may be pre-pregnancy obesity/overweight affect STAT3-SOCS3-leptin insulin signaling pathway.

Construction and application prospect of bone health management system for Shanghai residents based on PTM method

DONG En-hong, LIU Hua-li, SHI Hui-peng, XIE Yun-geng, WANG Tao

2018, 16(4): 593-596. doi: 10.16766/j.cnki.issn.1674-4152.000165

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Objective This paper aims to construct the bone health management system of community residents and to promote its application in Shanghai. Methods With the method of patient tracking management (PTM), the study objective was to reverse track from the clinical diagnosis of patients admitted to the department of orthopedics, hospital intervention of inpatients, follow-up management of discharged patients, to radiation screening of residents with high risk of osteoporosis in community, thus to prepare for the construction and application of community residents bone health management system in Shanghai. Results The study team conducted health management MDT (Multidisciplinary Team) and bone health communication base. The former constructed the MDT which consisted of technicians from the department of orthopedics, emergency, bone relaxation, endocrine, rehabilitation, Chinese traditional medicine, nursing and nutrition and implement the bone health multidisciplinary join intervention to general residents with high-risk of fracture according to the selected standard for high risk of osteoporosis before constructing medical system and popular science system. The latter set up a bone health communication base in the community with join intervention of the MDT in communities, buildings and schools, and brought the bone health-related knowledge to public with medical, community, enterprise and media resources,making them accept the healthy lifestyle and disease prevention and control knowledge, so as to promote the bone health. The system could be evaluated finally. Conclusion The resident bone health management system for Shanghai residents has been applied in the medical, population science system and achieved good results. Although the system has some limitations, the countermeasures have been put forward to improve the system for the relevant government departments to maximize its function.

Investigation on the satisfaction of community health service among elderly population in a district in Chengdu

LI Yang-qiu, ZHANG Min, SUN Ding

2018, 16(4): 597-599. doi: 10.16766/j.cnki.issn.1674-4152.000166

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Abstract:
Objective To investigate the satisfaction of community health service among community elderly population in a district in Chengdu, to find out the existing deficiencies and to analyze the influencing factors of the satisfaction, thus to provide a basis for further improvement of community health services. Methods Via self-made questionnaire, a total of 910 elderly clients above 60 years who had portfolio in all the 14 community health service centers in a district in Chengdu from June to December 2016 were randomly selected to conduct the face-to-face investigation. And 864 questionnaires were recovered, with an effective recovery rate of 94.4%. The date was logged by Epidata 3.1 and analyzed by SPSS 20.0. Descriptive statistical analysis, ANOVA, and T test were used to analyze satisfaction and influencing factors of the satisfaction of community health service. Results The overall satisfaction rate of community health service was 78.4%, and the satisfaction degree of each item from high to low was service attitude (95.2%), explanation and communication (89.5%), queuing time (86.1%), medical treatment (84.9%), service price (76.8%), technical level (75.7%), and medical equipment (74.4%). The main factors that affect the satisfaction of community health service are age, marital status, whether suffering from chronic diseases, medical insurance type, self-assessment of health status, self-assessment of economic conditions and other factors. Conclusion The overall satisfaction of community health services is high in the elderly, but there are also weak links. To start with relevant influencing factors, we can take corresponding measures to improve the satisfaction of the elderly on the community health service.

The relationship between self-management with health locus of control and copy style among coronary heart disease patients complicated with heart failure

SU Xiao-ping, CHEN Rui-min, SUN Wei, LU Yang-yang

2018, 16(4): 600-602,633. doi: 10.16766/j.cnki.issn.1674-4152.000167

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Abstract:
Objective To describe the relationship between self-management with health locus of control and copy style among coronary heart disease patients complicated with heart failure and to provide a basis for the targeted interventions. Methods From May, 2015 to November, 2016, totally 152 patients were invited to complete demographic questionnaire, coronary heart disease self-managements scale, multidimensional health locus of control scale, and medical coping modes questionnaire. Results The average score of self-management was 58.90±10.19, at moderate level. IHLC, DHLC, OHLC and confronce have a positive correlation with self-management, and the correlation coefficient was 0.498, 0.263, 0.310 and 0.525 respectively (P<0.05); CHLC, avoidance and resignation have a negative correlation with self-management, and the correlation coefficient was -0.250, -0.248 and -0.468 respectively (P<0.05). Conclusion Self-management among coronary heart disease patients complicated with heart failure was not optimistic and it needs more attention. Nurses can do more targeted health education based on health locus of control and copying style, improve patients' IHLC level and provide more knowledge of disease rehabilitation to patients. They also need encourage patients to take a positive coping style and teach patients how to do and explain the importance of the behavior. Besides, nurses need to pay attention to the changes of attitude of patients, establish confidence of rehabilitation, and improve self-management behavior finally.

Visualize the health education program on postoperative recovery of patients with radical surgery of lung cancer under the thoracoscope

DU Fei, YE Feng-lin, HAN Feng-qing, ZHOU Huan-huan, WANG Lin, ZHANG Li-ping, LIU Xue-gang

2018, 16(4): 603-605,629. doi: 10.16766/j.cnki.issn.1674-4152.000168

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Abstract:
Objective To discuss the role of visualization health education plan to help patients recover from radical surgery of lung cancer. Methods A total of 61 patients with radical surgery of lung cancer under thoracoscope were randomly divided into observation group with 31 cases and control group with 30 cases. For the control group was treated with routine health education, including health education, perioperative nursing and such clinical routine nursing measures. The observation group was given visualized health education program on the basis of the control group. Comparisons were made of postoperative recovery index (antibiotic use time, oxygen time, ambulation time, extubation time, length of hospital stay)and complications (The chest leakage, pulmonary atelectasis and infection, the pendant pneumonia, the hemorrhage) probability, as well as the the differences between the postoperative satisfaction. Results After implementation of visualization education plan, in observation group the oxygen time, hospitalization days, ambulation time, extubation time were significantly shorter than the control group(P<0.05); the occurrences of postoperative pleural leakage, hypostatic pneumonia, bleeding complications in observation group were significantly lower than those in the control group(P<0.05); In terms of patient satisfaction, the observation group is significantly higher than control group(P<0.05). Conclusion Visualization of preoperative education can make the patient and family build a comprehensive understanding of thoracoscope surgery, eliminate their concerns and fear, help build up the confidence to conquer the disease; Strengthen before and after operation, supervise the respiratory function exercise, earnestly implement the respiratory tract management, promote the recovery of patients with lung function, reduce postoperative complications and so on. The visualization of health education nursing scheme significantly shortens the hospitalization time of thoracoscope lung cancer patients with radical prostatectomy and reduces the probability of the occurrence of postoperative complications and improve the patients in the treatment of nursing cooperation degree and satisfaction degree, reduces the postoperative complications, and reduces the patient's pain to the largest extent, greatly improves the curative effect and postoperative satisfaction. In the clinical nursing work it has a certain application and popularization value.

Correlations between of MRI quantitative perfusion parameters with MVD, VEGF and Ki-67 in uterine fibroids

XU A-qiao, ZHAO Zhen-hua, YANG Jian-feng, ZHENG Jing, KONG Jian-guo, ZONG Fei, WEI Ming-zhu, SUN Ai-jing, RUAN Ya-wen, HU Hong-jie

2018, 16(4): 606-610. doi: 10.16766/j.cnki.issn.1674-4152.000169

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Abstract:
Objective To investigate the value of dynamic enhanced magnetic resonance imaging (DCE-MRI) quantitative perfusion parameters in differentiate uterine fibroids subtypes and analyze whether there is correlations between the perfusion parameters and micro vascular density (MVD), vascular endothelial growth factor (VEGF), and Ki-67. Methods Sixty-three patients underwent hysteromyoma resection between October, 2015 and September, 2016 were divided pathologically in three groups:classical(29 cases), cellular(12 cases)and degenerative (22 cases). All patients performed DCE-MRI preoperative, double-chamber model Extended-tofts was used to calculate the parameters (K^trans, K_ep, V_e, V_p) and depict the parameters map. Immune-histochemical methods were used to measure the expression of MVD, VEGF, and Ki-67. The parameters, MVD, VEGF and Ki-67 were compared in the three groups. The correlations between parameters and immune-histochemical fractions were also explored. Results The value of K^trans, K_ep and Vp were higher in the cellular group than in the classical group and the degenerated group (P<0.05); K^trans, K_ep, V_e and V_p were positively associated with MVD(r=0.770, r=0.524, r=0.276, r=0.472; P<0.05). K^trans, K_ep, V_p were positively as sociated with Ki-67(r=0.637, r=0.421, r=0.439; P<0.05). While Ki-67 and MVD also showed apositive correlation (r=0.681, P<0.001), there were no correlation between quantitative perfusion indexes and VEGF. Conclusion Quantitative perfusion parameters derived DCE-MRI contribute to differentiation varies pathological subtypes of uterine fibroids, and these parameters can be used as predictors to evaluate uterine fibroids microvascular and cell proliferative activity.

CT and MRI imaging manifestations of uncommon type of chondrosarcoma

ZHAO Yu-ying, MAO Xin-feng, LI Xiong-feng

2018, 16(4): 611-614,637. doi: 10.16766/j.cnki.issn.1674-4152.000170

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Abstract:
Objective To explore the CT and MRI findings of uncommon type of chondrosarcoma (uCHS), and improve the diagnosis and treatment of uncommon type of chondrosarcoma. Methods CT and MRI imaging features of 14 cases of uCHS confirmed by surgery or needle biopsy and pathological examination were retrospectively analyzed. The imaging data included plain CT (n=6) and contrast enhanced CT (n=4), as well as plain and contrast enhanced MRI (n=9). Results Total 14 lesions were respectively located in posterior peritoneum, anterior mediastinum, posterior mediastinum, left thigh, atlas, left ischium, left pubis, right parasellar region, right petrosum, right cotyle, thoracic vertebras, left parietal bone, left rib, left scapula respectively. ①Myxoid chondrosarcoma in 5 cases:Mild expansive or osteolytic bone destruction accompanies extraosseous lobulated or irregular soft tissue masses with few calcifications were showed on CT imaging. MRI scanning showed obviously heterogeneous long T₁ long T₂ signal and heterogeneous enhancement after contrast administration. One case associated hemorrhage. ②Mesenchymal chondrosarcoma in 4 cases:All of the lesions were located outside bones accompany soft tissue masses with scattered grit calcification. Two cases exhibited open-herding appearance. ③Clear cell chondrosarcoma in 3 cases:The lesions showed osteolytic bone destruction combined with extraosseous tissue masses included rarely calcification on CT imaging. The hypo-intense septa were seen on T₂WI and the peripheral and septal enhancement with wreath- or shell-like appearance was showed on post-contrasted MRI. Two cases demonstrated fluid-fluid level because of hemorrhage. ④Dedifferentiated chondrosarcoma in 2 cases:Two lesions showed "bimorphic features" with different tumors features mixed within the lesion. The tumors constituted by low-grade chondrosarcoma and high-level sarcomas variability, demonstrated osteolytic destruction with unmineralized soft-tissue mass. Conclusion CT and MR imaging features of uCHS have no obvious specificity, but the examinations play important roles in depicting the location, internal structure and its correlation with the adjacent structures, as well as in formulating the plan of treatment and assessing the efficacy of treatment. The final diagnosis should be relied on pathologic and immunohistochemical examinations.

New oral anticoagulants clinical application progress

REN Xiao-chan, LUO Xuan-juan, YANG Huan, YAO Hong, LIU Xiao-ting, WANG Xiao-chuang

2018, 16(4): 615-619,666. doi: 10.16766/j.cnki.issn.1674-4152.000171

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Abstract:
Anticoagulants are drugs that prevents blood coagulation by inhibiting or blocking certain parts of the organism's physiological coagulation mechanism, which are mainly used in the prevention and treatment of thromboembolic diseases. Traditional oral anticoagulants can interfere with multiple targets in the coagulation mechanism, represented by warfarin. Although warfarin has remarkable advantages on the prevention and treatment of thromboembolic disease, the disadvantages of it also limited the popularity among both doctors and patients in clinical practise. Compared with traditional oral anticoagulants, New oral anticoagulants (NOACs) inhibit blood coagulation pathways in particular of the clotting factors, for example thrombin inhibitors (dabigatran etexilate) and blood coagulation factor X inhibitors (rivaroxaban apixaban; edoxaban; the Ⅲ clinical study of betrixaban), NOACs work fast, metabolic quickly, do without regular monitoring of blood coagulation indexes, interact less with food and drug, risk less bleeding events, especially intracranial hemorrhage. At present, NOACs have been widely used in nonvalvular atrial fibrillation of anticoagulant therapy, prevention of deep vein thrombosis and the secondary prevention of acute coronary syndrome. So more clinical studies about NOACs were conducted to further define the scope of its indications, dosage adjustment, optimization of individual application. These new progress makes the new oral anticoagulants walking in the forefront of the times, provided more choices to make the best treatment plans for patients in need of anticoagulation. Here we provide a brief overview in the drug characteristics and clinical research progress of NOACs to promote standardized application of NOACs.

The clinical application and research progress of procalcitonin in infectious diseases

SHI Ting-ting, LI Shuang-qing, LIANG Li-bo

2018, 16(4): 620-625. doi: 10.16766/j.cnki.issn.1674-4152.000172

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Abstract:
As an systemic inflammatory mediator, procalcitonin (PCT) is one of the new inflammatory markers which have been studied recently. Compared with other biological markers, PCT has higher sensitivity and specificity, and can be more effective to distinguish bacterial infection from other inflammatory processes. PCT is not only a good indicator screening for infectious diseases, because of serum PCT having different concentrations in viral infection, bacterial infection (including Gram-positive bacteria and Gram-negative bacteria), fungal infection or other atypical pathogens infection, it is also effective index that can identificate different pathogenic bacteria infection. The initial serum concentration of PCT has some guiding significance for antibiotic therapy, and in the whole course of treatment, it is important to monitor and manage PCT for evaluating if continuing or discontinuing antibiotics. Moreover, the dynamic changes of PCT are of great significance in evaluating the severity and prognosis of infection, and judging the treatment effectiveness. At the same time, PCT-guided antibiotic treatment can reduce the use of antibiotics, shorten the hospitalization time of patients and reduce the hospitalization costs, thereby reducing the incidence of antibiotic resistance, social cost and increasing social benefit in the whole. Although there were many studies about PCT in different types, different experimental design methods and that had selective biases, the cut-off values or threshold of PCT is difficult to define in identification of infection types, assessment of disease severity and prognosis. Up to date, evidence of very low to moderate quality, with insufficient sample power per outcome, does not clearly support the use of procalcitonin-guided antimicrobial therapy to minimize mortality, clinical severity,reinfection or duration of antimicrobial therapy of patients. It still needs further study.This artical reviewed the clinical application and research progress of procalcitonin.

Effects of different Chinese medicine prescriptions treating at different stages of menstrual cycle on ovarian function and pregnancy in infertile women with polycystic ovary syndrome

XU Yun-jian, JIN Da-na, XUE Ya-dong

2018, 16(4): 626-629. doi: 10.16766/j.cnki.issn.1674-4152.000173

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Objective To observe the efficacy of different Chinese medicine prescriptions treating at different stages of menstrual cycle on ovarian function and pregnancy in infertile women with polycystic ovary syndrome. Methods Ninety patients with infertility PCOS who were diagnosed and met in our hospital from February, 2013 to February, 2015 were divided into control group (45 cases) and combined group (45 cases) according to the random number table method. Two groups of patients began oral estradiol cyproterone at 5th day of menstrual cycle, continuous taking 21 days, then stopping for 7 days, insisting on taking 3 menstrual cycle. After that, the control group started using citrate clomiphene tablets at 5th day of 4th menstrual cycle, insisting on taking 3 menstrual cycles. The combined group was supplemented by different Chinese medicine prescriptions according to menstrual cycle on the basis of the control group. The Sex hormone level, TCM syndrome score, endometrial thickness, dominant follicular rate, pregnancy rate and clinical efficacy between two groups were compared. Results After treatment, the levels of LH, T, FSH and E₂ in the control group were not statistically significant compared with those before treatment (P>0.05), the levels of LH, T and E₂ were significantly decreased in the observation group (P<0.05), and the FSH level was significantly increased (P<0.05), and the differences between the two groups were statistically significant (P<0.05). The clinical efficacy of the combined group was significantly higher than that of the control group (P<0.05), the endometrial thickness, the dominant follicular rate and the pregnancy rate were significantly higher than those in the control group (P<0.05). Conclusion The use of different traditional Chinese medicine prescriptions in the different stages of the menstrual cycle for the treatment of PCOS infertility has certain advantages, can improve the patients' ovarian function, improve pregnancy rate. It is worthy of clinical application.

Effects of Renshen Hajie power combined acupoint injection on immune function, IL-2 and sIL-2R of patients with stable COPD

WEN Xiu-mei, ZHAO Jun-feng, CHEN Zhong-ming

2018, 16(4): 630-633. doi: 10.16766/j.cnki.issn.1674-4152.000174

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Objective To investigate the effect of Renshen Hajie power combined acupoint injection on immune function, IL-2 and sIL-2R of patients with stable COPD. Methods A total of 130 patients with stable COPD were randomly divided into two groups, each group 65 cases. The control group was given Western medicine treatment, and the observation group was given Renshen Hajie power combined acupoint injection based on control group. The lung function, immune function, IL-2 and sIL-2R, and life quality of two groups were compared. Results After treatment, FEV1, FEV1% and FVC of two groups were significantly increased (P<0.05), and observation group was higher than control group (P<0.05). After treatment, CD3⁺, CD4⁺, CD4⁺/CD8⁺ of two groups were significantly increased (P<0.05), and the observation group was higher than control group (P<0.05). After treatment, IL-2 of two groups were significantly increased (P<0.05), and the observation group was higher than control group (P<0.05). After treatment, sIL-2R of two groups were significantly decreased (P<0.05), and the observation group was lower than control group (P<0.05). After treatment, the respiratory symptoms, activities status, disease influence and total score of two groups were significantly reduced (P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusion Renshen Hajie power combined acupoint injection could effectively improve the immune function of patients with stable COPD. The mechanism might be achieved by improving IL-2 and sIL-2R, thereby enhancing lung function and life quality of patients.

Clinical study on the effect of ciluxiaozhongyin on upper limb lymphedema after breast cancer surgery

WANG Miao-miao, ZHOU Lan

2018, 16(4): 634-637. doi: 10.16766/j.cnki.issn.1674-4152.000175

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Objective To observe the effect Ciluxiaozhongyin on upper limb lymphedema of patients with breast cancer after surgery. Methods A total of 60 patients with upper limb lymphedema after breast cancer surgery were selected in the First Affiliated Hospital of Bengbu Medical College, Chinese medicine oncology department, tumor surgery and radiotherapy department from August, 2016 to December, 2016, which were divided into the observation group and the treatment group by simple random grouping, with 30 cases in each group. And 30 cases in the observation group were given Diosmin 0.5 orally two times a day, limb function exercise and local massage; the treatment group of 30 cases in the observation group on the basis of such treatment were given Ciluxiaozhongyin, decoction two times a day morning and evening for 4 weeks. T test and rank sum test were used to observe the changes of upper limb edema, upper limb pain and clinical curative effect of TCM in the two groups. Results Compared with the observation group with 56.7% efficiency in upper limb edema, the treatment group with 83.3% efficiency was improved significantly (P<0.01); Compared with the observation group, with 53.3% efficiency, in upper limb pain the treatment group with 86.7% efficiency was better, the difference was of significance in statistics science (P<0.05); Without treatment the difference in comparison of TCM syndrome integral was not of significance in statistics science (P>0.05), while after treatment the result is opposite(P<0.05). TCM syndrome integral of treatment declined more apparently than the observation group, with statistical significance (P<0.05). Conclusion Ciluxiaozhongyin can significantly promote breast cancer postoperative upper limb lymphedema, relieve the pain, and improve the quality of life of patients.

Effect of compound Maxing Shigan decoction on lung injury induced by radiotherapy and chemotherapy in non-small cell lung cancer and its effect on TGF-β1

HUANG Li-ping, YU Da, SHAO Li-li, LI Hong, LU Jian

2018, 16(4): 638-641. doi: 10.16766/j.cnki.issn.1674-4152.000176

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Objective To investigate the protective effect of compound Maxing Shigan decoction on lung injury induced by radiotherapy and chemotherapy in non-small cell lung cancer and its effect on TGF-β1. Methods A total of 120 patients with stage Ⅲ non-small cell lung cancer were randomly divided into two groups by random number method, with 60 cases in each group. Patients in control group were treated with concurrent chemoradiotherapy and patients in observation group were treated with compound Maxing Shigan decoction during concurrent chemoradiotherapy. The incidence and classification of radiation-induced lung injury, the tumor curative effect, KPS scores at 1 week before concurrent chemoradiotherapy, end of the concurrent chemoradiotherapy, and 5 weeks after concurrent chemoradiotherapy, and the serum TGF-β1 levels of two groups were compared. Results After concurrent chemoradiotherapy, the radiation-induced lung injury rate of observation group was 11.67%, which was significantly lower than that of control group (35.00%, P<0.05). The radiation-induced lung injury rate ≥ 2 levels of observation group was 6.67%, which was significantly lower than that of control group (28.33%, P<0.05). The short-term effect of observation group was 70.00%, and short-term effect of control group was 63.33%, without significant difference between two groups (P>0.05). The KPS scores at end of concurrent chemoradiation and 5 weeks after concurrent chemoradiotherapy of observation group were significantly higher than those of control group (P<0.05). After concurrent chemoradiotherapy, serum TGF-β1 levels of two groups were significantly increased (P<0.05), and TGF-β1 level of control group was higher than that of observation group (P<0.05). Conclusion Compound Maxing Shigan decoction could protect the radiation-induced lung injury, reduce the incidence and severity of radiation-induced lung injury caused by concurrent chemoradiotherapy, and improve the life quality of patients. Its mechanism might be related to its improvement of serum TGF-β1 production.

Advantages of translational medicine combined with case discussion in clinical teaching of gastrointestinal surgery

XU Li, HU Kai-feng, HUANG Xiao-xu, CHENG Ping, XIA Ya-bin

2018, 16(4): 642-645. doi: 10.16766/j.cnki.issn.1674-4152.000177

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Objective To explore the advantages of the concept of transformation medicine and case discussion in the clinical teaching of gastroenterological surgery. Methods A total of 120 of gastrointestinal surgery interns from June, 2016 to May, 2017 in our hospital were randomly divided into control group and experimental group, with 60 cases in each group. The students in the control group took traditional teaching methods, and experimental students in the experimental group carried out the concept of translational medicine combined with case discussion and clinical practice teaching mode. After one month of teaching, two teaching forms were evaluated by questionnaire and theoretical examination, and to observe and compare the average scores and other related indicators of the students in the two groups. Results There was no significant difference in the comparison of the basic data between the two groups of students (P>0.05); The test scores of the students in the experimental group was significantly higher than the control group(P<0.05); The students in the experimental group increased the ability to explore the clinical interest, refine the ability of scientific research thinking, increase the depth and breadth of learning, and promote the ability of independent thinking and self-learning were higher than those of the control group, with statistically significant difference (P<0.05); The teaching effect of the experimental group students interested in teaching mode and approving case discussion was higher than that of the control group, and the difference was statistically significant (P<0.05). Conclusion Translational medicine combined with case discussion in clinical teaching of gastrointestinal surgery enjoys a significant advantage, breaks through the shortcomings of the traditional teaching method, suitable for the modern clinical practice teaching, to adapt to the modern medical teaching requirements, teaching advantages, improves the exam results, increasing the ability to explore clinical interests, refining research ideas, increasing the depth and breadth of learning, and promoting independent thinking and autonomous learning, strengthens the cultivation of innovative thinking and is of great significance to enhance the clinical skills of medical students, and is worthy of popularizing in clinical use in the teaching of gastrointestinal surgery.

An introduction to general practitioner training programme in the uk and reflection on its application

YU Hui-jie, XU Jun, CAO Wei-zhong

2018, 16(4): 646-649,680. doi: 10.16766/j.cnki.issn.1674-4152.000178

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To improve the quality of primary medical care, it is crucial to strengthen the general practitioner (GP) training and modify the training methods. As one of the first batch of participants receiving the RCGP (Royal College of General Practitioners) International (China) Training, I hereby give a brief introduction to the forward-looking ideas and advanced technology of the GP training in the UK and shared my experience of its primary application. The GP training programme focuses on cultivating one's learning ability in five steps:learning facts guiding cause factor analysis Q&A about general processing principle praise and approval independent thinking about solutions. The establishment of adult learning pattern can help GPs to develop continuous learning ability and thus trainees having different learning styles will be assigned to form a study group to carry out various activities, such as role playing, group discussion and videotaping, in order to produce better learning outcomes. Clinical teachers play an important role in the GP training programme. They are responsible for formulating clinical teaching syllabuses, developing individualized teaching methods according to the trainees' learning styles and establishing a feedback system (trainee to trainee, trainee to clinical teacher and between clinical teachers) that is effective in identifying problems in clinical teaching and bettering teaching skills. The diagnostic kit is usually applied to the clinical reception training so as to increase the reception efficiency and cultivate more and younger GPs. Considering the differences in national situations and traditions between China and the UK, both of the Chinese clinical teachers and trainees are required to adapt themselves to the UK's GP training programme for practical use. To be specific, clinical teachers should pay attention to the shift from the role of an instructor towards a guide and co-participant. Since the optimized training techniques, such as role playing, videotaping and diagnostic kit training are widely recognized by the GP trainees, these techniques can be extensively applied to the GP training in China. With regard to trainee appraisal, clinical teachers should value their trainees' performance on cultural science, morality, legal compliance, learning ability, collaboration ability and leadership, as well as their understandings of theories and command of techniques. To learn from the UK's GP cultivation and training is beneficial to standardize domestic GP training and cultivation.

Analysis of hospitalization and medicare payments of monopathy patients-A case study of a county in Shaanxi province

YANG Yue, XIONG Lin-ping, ZHU Yan-gang

2018, 16(4): 650-653. doi: 10.16766/j.cnki.issn.1674-4152.000179

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Objective To study the effect of monopathy payment through comparing the hospitalization and medicare payments of monopathy and non- monopathy in Shaanxi province, put forward policy recommendations targeting the existing problems in single disease payment, and provide a basis for the improvement of payment methods in China. Methods The participants in Shaanxi Province between 2007 and 2012 were enrolled into this study and assigned into monopathy group and non- monopathy group according to the monopathy payment (whether or not single disease). The number of inpatients, hospitalization expenses, hospital details and compensation costs were compared between the two groups. The Mann-Whitney U test was performed by SPSS statistical software. Results ①Between 2007 and 2012, the average hospitalization cost of monopathy was lower than that of non- monopathy, especially in 2011, the hospitalization cost of monopathy was 1 323 yuan, and non- monopathy was 3 467 yuan. ②The hospital days of monopathy was generally less than 7 days, however, non- monopathy was usually higher than 9.3 days. ③ Between 2007 and 2009, the ratio of monopathy patients accounted for more than 12%, but the proportion decreased to 8.89% in 2010, and further to 5% in 2011 and 2012. ④From the year 2011, the actual compensation ratio (50.45%) for monopathy was lower than that for non- monopathy (67.82%). Conclusion ①From the average hospitalization costs and hospital days, the effect of local NCMS single disease payment method is obvious. ②The reduction in the proportion of single disease patients prompted that the local monopathy payment model still needs some improvement. It is recommended to gradually expand the coverage of monopathy, the implementation of disease diagnosis related classification (DRGs). ③The proportion of monopathy payment that is higher than non- monopathy is not conducive to the promotion of single disease model. It is recommended that the local need to pay more attentions to the improvement of the actual compensation ratio of single disease, and explore the promotion of payment reform.

Nicotinamide regulates blood glucose level and affects mitochondrial superoxide level in gestational diabetes mellitus rats

ZHANG Xia, CHEN Xu-wei, YU Qing-miao, GUO Jin-fang, LIANG Chao-xia

2018, 16(4): 654-658. doi: 10.16766/j.cnki.issn.1674-4152.000180

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Objective To investigate the effects of nicotinamide on blood glucose control in gestational diabetes mellitus (GDM) rats by detecting the mitochondrial superoxide level and anti-oxidative enzymes. Methods Diabetes Mellitus (GDM) rats were administered nicotinamide at daily doses of 50, 100 or 200 mg/kg body weight by oral gavage from gestation days 6 through 20. Blood glucose level was measured on gestation day 21. Brain tissue of the fetus rat and skeletal muscle of GDM rats in each group were collected. The expression and activity of anti-oxidative enzymes, including SOD1, SOD2 and Catalase were measured by RT-PCR and Western blot. Results Nicotinamide significantly lowered the blood glucose in GDM rats and decreased mitochondrial superoxide level in the fetus neurons. Superoxide dismutase 2 (SOD2) was induced by nicotinamide in GDM rats (P<0.05). Nicotinamide also promoted SIRT3 activity and deacetylated SOD2 in GDM rats (P<0.05), which enhanced SOD2 activity and altered mitochondrial ROS. Conclusion Nicotinamide promoted SIRT3 activity to deacetylate SOD2, which activated SOD2 and affected the mitochondrial ROS in GDM rats. Therefore, nicotinamide could potentially treat GDM patients in clinical application.

Study on current status and influencing factors of occupational low back pain among ICU nurses

YE Lei, WU Liang

2018, 16(4): 659-662. doi: 10.16766/j.cnki.issn.1674-4152.000181

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Objective To understand the condition of low back pain and analyze the influencing factors related to low back pain among nurses in intensive care unit (ICU),so as to supply evidence for reducing and preventing occupational injuries. Methods This was a cross-sectional study. From June, 2015 to August, 2015, we investigated 202 ICU nurses from 4 hospitals in Zhejiang province, which were selected by convenience sampling method. General social demographic characteristics, condition of low back pain and the relevant influencing factors of low back pain were investigated. The mean±standard deviation, composition ratio and rate were used to describe the condition of low back pain. Multivariate unconditional logistic regression analyses were used to explore the relevant influencing factors of low back pain. Results The 143 of 202 participants had a vocational low back pain. The prevalence of occupational low back pain among ICU nurses was 70.8%. Among ICU nurses who had lower back pain, in the past year, 40.1% of them had a total duration of illness more than 30 days, 19.3% of them reduced daily activities time for more than 30 days, and 21.8% of them had received examination and treatment. The main factors, which were related to occupational low back pain among ICU nurses were working years (OR=2.17, 95% CI:1.38-3.66), times of lifting heavy loads(OR=2.14, 95% CI:1.18-4.35), occupational stress (OR=1.83, 95% CI:1.24-2.99), physical exercise (OR=0.62, 95% CI:0.41-0.86) and moonlit night shift (OR=2.37, 95% CI:1.53-3.72). Conclusion The condition of low back pain among ICU nurses was serious. Interventions related to influencing factors, such as strengthening the training to correct bad posture, strengthening physical exercise and making scientific work scheduling, should be taken to reduce the incidence of low back pain.

Psychological resilience of ICU nurses in three grade general hospital and its influencing factors

FU Chun-hua, WU Yuan, XIN Ruo-mei, LV Jin-fang, CHEN Xi-zhu, YOU Jing-yan, CHEN Zhi-lin

2018, 16(4): 663-666. doi: 10.16766/j.cnki.issn.1674-4152.000182

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Objective To explore the psychological resilience of nurses in intensive care unit (ICU) in three grade general hospital and its related influencing factors, so as to provide evidence for psychological intervention of ICU nurses. Methods Connor-Davidson psychological scale was used to investigate the psychological elasticity of 1 082 ICU nurses in three general hospitals in Hainan Province from January, 2017 to March, 2017, and the influencing factors were analyzed by multiple Logistic regression. Results The average score of resilience of ICU nurses (57.61±14.16) was significantly lower than that of the national norm (65.4±13.9), and the difference was statistically significant (P<0.01). Correlation analysis showed that resilience and its 3 dimension scores were positively related to ICU nurses' educational background, working years and night shift (P<0.05). There were significant differences in psychological resilience scores of ICU nurses between different gender, educational background, professional title, working years, night shift status, employment characteristics, workplace violence experience, and workplace tension (P<0.05). Multivariate Logistic regression showed that educational background, working years and night shift were the main factors influencing the resilience of ICU nurses[OR=1.928, 95%CI:1.214-3.013; OR=1.627, 95%CI:1.085-2.683; OR=2.064, 95%CI:1.542-3.117]. ROC curve was used to evaluate the effect of logistic regression model, and its AUC (95%CI) was 0.924 (0.875-0.996). Conclusion The psychological resilience of ICU nurses is low, and there are many factors affecting their resilience. The nursing managers should intervene according to the corresponding factors so as to improve the psychological status of ICU nurses.

Multiple effects of comfortable nursing intervention on patients with polysomnography sleep apnea syndrome

HE Jian, QIU Guo-qin, LU Hua-dong

2018, 16(4): 667-670. doi: 10.16766/j.cnki.issn.1674-4152.000183

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Objective To explore the nursing intervention for multiple effects on polysomnography in patients with sleep apnea syndrome. Methods A total of 162 cases of the patients with polysomnography sleep apnea syndrome in respiratory medicine department of our hospital were randomly divided and all patients underwent polysomnography examination. The control group of 81 cases treated with conventional symptomatic nursing, 81 cases of the study group to monitor the whole process of nursing intervention, observe and record the two groups of monitoring and monitoring the success rate of failure, the score of anxiety, comfort, knowledge awareness, comparison of nursing satisfaction rate at the same time. Results In the control group, the success rate of monitoring (85.19%) was lower than that in the study group (95.06%), with statistical significance (P<0.05); the main reasons for the failure of the monitoring include environment change leading to less sleep time, the electrode off without timely recovery, shedding gas off, the SPO₂ signal getting lost, diarrhea at night. That the control group did not timely remedy electrode loss was significantly higher than that in study group, with statistical significance (all P<0.05); compared with the control group, after polysomnography nursing anxiety score was lower in study group, comfort degree, knowledge degree is higher, with statistical significance (all P<0.05); nursing satisfaction rate of the control group (79.01%) was lower than the study group (97.53%), with statistical significance (P<0.05). Conclusion Nursing intervention can improve the sleep apnea syndrome patients underwent polysomnography comfort and relevant knowledge, alleviate the anxiety of patients; improve nursing satisfaction rate as well as success rate of monitoring.

Effects of time theory based rehabilitation training on cardiac function and quality of life in patients with unstable angina pectoris

ZHANG Xiao-fang, JIN Yu, WU Ya-fang

2018, 16(4): 671-674. doi: 10.16766/j.cnki.issn.1674-4152.000184

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Objective To investigate the effects of time theory based rehabilitation training on cardiac function and quality of life in patients with unstable angina pectoris. Methods A total of 100 patients with unstable angina pectoristreated in our cardiology department were selected as subjects from March, 2015 to February, 2017. They were divided into training group (50 cases) and control group (50 cases) according to the random number table method. The control group was given routine nursing method, the training group gave the time theory based rehabilitation training. left ventricular ejection fraction (LVEF), 6 min walking distance (6 MWD), New York Heart Association Functional Classification (NYHA), Seattle angina questionnaire (SAQ) score and 6 months of dysmenorrhea were compared between the two groups. Results The levels of LVEF and 6MWD in the two groups after 6 months discharge were significantly higher than those before the intervention (all P<0.05). The NYHA classification in two groups 6 months after discharge was significantly lower than that before intervention (P<0.05). The levels of LVEF and 6MWD in the training group 6 months after discharge were significantly higher than those in the control group (all P<0.05). The NYHA classification in the training group 6 months after discharge was significantly lower than the control group (all P<0.05). The score of frequency of angina pectoris in the control group 6 months after discharge was significantly higher than that before the intervention (P<0.05). All quality of life scores in the training group 6 months after discharge were significantly higher than those before the intervention (all P<0.05). The quality of life scores in the training group were significantly higher than those in the control group 6 months after discharge (all P<0.05). The incidence of adverse events in the training group was significantly lower than that in the control group (all P<0.05). Conclusion The time theory based rehabilitation training can effectively improve the cardiac function and quality of life of patients with unstable angina pectoris, which is worthy of clinical application.

WU Xian-dan, WANG Pei-en, ZHANG Jin-bo, JIN Xiao-hong, XU Guo-bin, ZHU Jin-qiang

2018, 16(4): 675-677. doi: 10.16766/j.cnki.issn.1674-4152.000185

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LI Yan, FAN Xi-zhen

2018, 16(4): 678-680. doi: 10.16766/j.cnki.issn.1674-4152.000186

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2018 Vol. 16, No. 4

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