中华全科医学

Exploration and evaluation of a new model of community popular science of lung cancer prevention and treatment

DAI Xiao-ya, JIAO Xiao-dong, ZANG Yuan-sheng, ZHENG Xing-dong

2018, 16(5): 681-685. doi: 10.16766/j.cnki.issn.1674-4152.000187

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Abstract:
Objective To evaluate the influence of two models of popular science (popular film mode and expert lecture mode) on community residents' awareness rate of lung cancer prevention and treatment, as well as their feedback on different models. Methods A total of 10 communities from 5 different districts in Shanghai were selected, and they were randomly divided into two groups, expert lecture mode group and popular film mode group (five communities in each group). All the communities being included have similar population sizes and demographic structure, and have reached the same economic level as well. By principles of systematic sampling, a total of 500 residents were randomly selected from the 10 communities (50 residents each). During the process of research, participants were provided scientific knowledge education and asked to complete questionnaires. The content of questionnaires includes the basic information of participants, the prevention and treatment knowledge of lung cancer and feedbacks from residents on popular science activities. Results The overall awareness rate of knowledge about lung cancer among community residents is fairly low. After the scientific knowledge education, their general knowledge rate of lung cancer (the expert lecture mode group 67.3% vs. 76.0%, P<0.001; the popular film mode group 67.2% vs. 81.1%, P<0.001), their awareness rate of early lung cancer screening knowledge (the expert lecture mode group 48.5% vs. 70.0%, P<0.001; the popular film mode group 47.9% vs. 70.4%, P<0.001) and their understanding of lung cancer treatment(the expert lecture mode group 35.9% vs. 46.1%, P<0.001; the popular film mode group 37.2% vs. 70.7%, P<0.001) improved significantly. In a total of 15 knowledge points of lung cancer, it is clear to see that the awareness rates of 14 knowledge points increased obviously in popular film group (P<0.05), while expert lecture group only had 9 knowledge points enhanced remarkably (P<0.05). In terms of their knowledge understandability (P=0.001), artistry (P=0.002), convenience (P=0.003) and residents' intention of recommendation (P=0.002), popular film mode is significantly better than expert lecture mode, and the former is more popular with the community residents. Conclusion Both models of popular science can effectively enhance community residents' prevention and treatment knowledge of cancer. However, popular film mode works better compared with expert lecture mode, which is more likely to be accepted by residents and worth further research and promotion.

LIU Man-man, DOU Peng-fei

2018, 16(5): 686-687.

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Effect of Brefeldin A in acute lung injury induced by lipopolysaccharide

WANG Xue-feng, CHEN Feng, SONG Shun-de, ZHANG Zhe-wen, TANG Hui-fang

2018, 16(5): 688-692,720. doi: 10.16766/j.cnki.issn.1674-4152.000188

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Abstract:
Objective To explore the effect of Brefeldin A in acute lung injury induced by lipopolysaccharide. Methods Mice alveolar macrophages (MH-S) and epithelial cells (MLE-12) were treated with Brefeldin A of 1, 10, 100 μM respectively, and then treated with LPS 500 ng/ml. The cell supernatants of 3, 6, 9 and 24 h were collected and the content of tumor necrosis factor-α (TNF-α) in MH-S and the chemokine KC in MLE-12 were determined. ICR mice were randomly divided into normal saline control group (group Normal), model group (group LPS), dexamethasone group (group Dex, 5 mg/kg) and brefeldin A group (group BFA, 10 mg/kg). Each group had 12 mice. The ALI mouse model was induced by instilling intratracheally LPS 2 mg/kg. The physiological saline group was given equal volume of normal saline. After 6 h, lung tissue and alveolar lavage fluid (BALF) were harvested, lung pathology changes were observed, white blood cell and albumin content and tumor necrosis factor α (TNF-α),interleukin-1β (IL-1β), interleukin 6 (IL-6) in BALF were determined, myeloperoxidase (MPO) activity, cAMP content and the changes of phosphorylation levels of protein kinases of ERK, p38 and JNK in MAPK signaling pathway in lung homogenates were detected by ELISA. Results BFA significantly reduced the release of TNF-α in MH-S and the production of KC in MLE-12 cells (P<0.001). BFA could significantly improve the pathological changes of lung tissue and decrease the content of white blood cells(P<0.001) and TNF-α content (P<0.05). However, there were no significant effects on albumin, IL-1β and IL-6 in BALF, and the activity of MPO in lung tissue was significantly decreased (P<0.05), the level of cAMP was significantly increased (P<0.001). Brefeldin A could significantly inhibit the phosphorylation of ERK (P<0.05). Conclusion Brefeldin A may have a protective effect on acute lung injury, and its mechanism may be related to inhibiting the release of related inflammatory factors, increasing intracellular cAMP content and inhibiting the phosphorylation of ERK.

Association between white matter lesions and motor impairment in patients with Parkinson's disease

PENG Ze-yan, DONG Shu-yang, ZHOU Hua-dong

2018, 16(5): 693-696. doi: 10.16766/j.cnki.issn.1674-4152.000189

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Objective To investigate the association between white matter lesions (WML) and motor impairment in patients with Parkinson's disease (PD). Methods A total of 281 patients with PD over 60 years old were enrolled in this study. Diagnosis of severity of motor impairment in patients with PD was based on Hoehn & Yahr staging scale. The patients with PD were divided into mild PD group and moderate/severe PD group according to the severity of motor impairment. The severity of WML was divided into 3 grades according to the modified visual scale of Fazekas. The association between WML and moderate/severe PD and main symptoms of motor impairment were analyzed. Results Multifactorial logistic regression analysis showed that the association between age, PD pathogenesis>3 years, hypertension, diabetes, metabolic syndrome, WML and moderate/severe PD was statistically significant (all P<0.05). Meanwhile, WML was significantly associated with tremor at rest, rigidity, and postural/gait instability (all P<0.05). In addition, moderate and severe WML were the independent risk factors for tremor at rest (all P<0.05), and different severities of WML were the independent risk factors for rigidity and postural/gait instability (all P<0.05). Conclusion WML might increase the risk of severe motor impairment in patients with PD, and WML was associated with major symptoms of motor impairment in patients with PD.

Expression of HMGB1 in lung tissues of silicotic fibrosis rats and effectiveness of TCM lumbricus medicine intervention

YU Ting, LI Guo-hui, JIA Yang-min, CHEN Su-zhen, YAN Wei-wei, LOU Yi, HE Fei

2018, 16(5): 697-700,707. doi: 10.16766/j.cnki.issn.1674-4152.000190

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Objective To observe the expression of high mobility group protein B1 (HMGB1) in the lung tissues of silicotic fibrosis rats, and explore the effectiveness of TCM Lumbricus medicine intervention. Methods A total of 45 rats were randomly divided into control group, model group and Lumbricus group with 15 rats in each group. The rats in model group and Lumbricus group received silica exposure to develop a silicotic fibrosis rat model, while the control group received intratracheal instillation of saline. The Lumbricus group received earthworm decoction 4 ml/kg by gavage, while the control group and model group received the same volume of normal saline. Five rats in each group were sacrificed on 7th, 14th and 28th days at a time. The lung coefficient was measured. The development of alveolitis and pulmonary fibrosis were compared among the three groups. The expression of HMGB1 was observed by immunohistochemistry. Results The lung coefficient of model group on the 7th, 14th and 28th days was 6.48±0.19, 6.71±0.14, 7.01±0.33, respectively, which were increased as compared with the control group (4.36±0.13, 4.52±0.33, 4.56±0.10), respectively, all P<0.01; The lung coefficient of Lumbricus group on the 7th, 14th and 28th days was 5.07±0.17, 5.38±0.05, 5.53±0.08, respectively, which was decreased as compared with model group, P< 0.01; The optical density of HMGB1 of model group on the 7th, 14th and 28th days was 0.31±0.03, 0.35 ±0.03, 0.38 ±0.02, respectively, which was increased as compared with control group (0.20±0.02, 0.21±0.04, 0.20±0.03), P< 0.01; The optical density of HMGB1 of the Lumbricus group on the 7th, 14th and 28th days was 0.30±0.02, 0.29±0.02, 0.27±0.03, respectively, the difference on the 7th days was not significant as compared with the model group (P=0.507), but decreased obviously on the 14th and 28th days (P<0.05). Conclusion The pulmonary fibrosis and progressive elevated HMGB1 can be observed in rats after exposure to dust, which can be improved by TCM Lumbricus medicine intervention, the mechanism may associate with inhibition of TCM Lumbricus on the expression of HMGB1.

Different venous drainage impact on the recover of eyeball movement in patients with traumatic carotid-cavernous fistula

KANG Wei-min, YIN Long, TONG Xiao-guang, TIAN Hui-ming, XUE De-you, WANG Shi, JIAO De-rang, BO Hai, ZHAO Gui-feng

2018, 16(5): 701-703,764. doi: 10.16766/j.cnki.issn.1674-4152.000191

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Objective To explore the effect of single eye vein drainage and multiple venous drainage on proptosis, conjunctival congestion, edema, limited eyeball movement, diplopia, impaired vision in patients with traumatic carotid-cavernous fistulas (TCCF). Methods Total 93 cases of TCCF were divided into single venous drainage group and multiple venous drainage group. The distribution of ophthalmic symptoms, such as proptosis, conjunctival congestion, edema, limited eyeball movement, diplopia, impaired vision and the outcome were compared between the two groups. Results The symptoms of proptosis, conjunctival congestion, edema, diplopia, impaired vision of these two groups had no difference (P>0.05). But there were 15 cases of limited eyeball movement in multiple venous drainage after the treatment, and there was a significant difference in these two groups (P<0.05). Conclusion Different venous drainage for TCCF can make difference in eyeball movement. The recovery of ocular symptoms (especially limited eyeball movement) of TCCF patients has relationship with the improvement of abnormal blood flow within the cavernous sinus, also with vein expansion and deep vein drainage during multiple venous drainage procedure. So we should choose suitable venous drainage in the treatment.

Etiological analysis of acute small-bowel obstruction in adults

TIAN Jing, KANG Xing, WANG Hao, GUAN Wen-xian, HE Jian, WANG Jun

2018, 16(5): 704-707. doi: 10.16766/j.cnki.issn.1674-4152.000192

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Objective Many causes can lead to small bowl obstruction (SBO). The aim of this paper is to explore the characteristics of etiological spectrum of SBO and its relation with strangulated small bowel obstruction (SSBO), and provide scientific basis for the management of SBO. Methods The clinical data of 320 adult patients with SBO in our hospital between June, 2010 and September, 2016 were reviewed retrospectively. According to the degree of intestinal ischemia and the pathogeny, the patients were divided into the simple group (non-strangulated group) and the strangulation group (including necrosis subgroup and non-necrosis subgroup). The pathogeny distribution and its relationship to the intestinal strangulation were analyzed. Results Of 320 cases, 107 (33.4%) had adhesions, 73 (22.8%) had external hernias, 46 (14.4%) had volvulus, 32 (10.0%) had internal hernias, 28 (8.8%) had intussusceptions, 7 (2.2%) had tumors, and 27 (8.4%) had other causes. The patients caused by volvulus and intussusceptions in the strangulated group were significantly more than that in the simple group(P<0.05). The patients caused by tumor in the strangulated group were less than that in the non-strangulated group(P<0.05). The number of patients with necrosis caused by external hernias and internal hernias were significantly more than that without necrosis(P<0.05). Conclusion Adhesions is the principal cause of SBO in adults, following by external hernias. Volvulus and intussusceptions tend to cause SSBO in adults. External hernias and internal hernias easily lead to the small intestine necrosis.

Clinical significance of EV71-IgM antibody in early diagnosis, treatment and control of enterovirus infection in infants and young children

SHEN Yan, CHEN Zhong-xin, HU Jian-guo, ZHOU Rui, JU Fang-lei, QIN Xiao-hui

2018, 16(5): 708-711. doi: 10.16766/j.cnki.issn.1674-4152.000193

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Objective To explore the significance of diagnostic kit for IgM antibody to human EV71 in early diagnosis, treatment and control of enterovirus infection in infants and young children. Methods The colloidal gold method EV71-IgM antibody test was performed in 101 infants and young children with fever and/or rash in our hospital between April and September, 2017. According to the test result, the triage, disinfection and isolation was conducted to control the source of infection, cut off the means of transmission, protect susceptible children, and avoid nosocomial cross infection. The targeted treatment was performed to the confirmed cases on the basis of test results, medical history and clinical manifestation. And the direct network reporting of infectious disease was also finished. A total of 101 cases were also grouped by gender, age of the patients and test month, the positive rate of EV71-IgM antibody was compared between each groups. Results There were 17 cases of EV71-IgM antibody positive in 101 patients, and the EV71 infection rate was 16.83%; positive detection rate in male patients was 20.69% (12/58), and in female patients was 11.63% (5/43), with no statistically significant difference (χ²=1.448,P>0.05). There was significant difference in positive detection rate between age groups (χ²=9.166,P<0.05). Positive cases were detected in each month, and the positive detection rate was a seasonal trend. The patients with positive EV71-IgM antibody were immediately separated and isolated. Fourteen cases were diagnosed as HFMD with EV71 infection; 3 cases of herpes simplex laryngitis with EV71 infection. Thirteen patients were treated in the outpatient clinic and 3 patients were hospitalized. All the positive children were cured and received outpatient or telephone follow-up, with good prognosis. The infectious disease epidemic situation of this 14 EV71 infected children was uploaded to the hospital preventive and health department. The cases were classified as laboratory confirmed cases. Conclusion EV71-IgM test can promote the early identification of EV71 infection, early screening, early diagnosis and treatment and early intervention, which shows a good application value for early diagnosis of HFMD.

The expression and clinical significance of p15 and SOCS1 methylation in myelodysplastic syndrome

DENG Chun-yang, CHEN Shuang, JIANG Ming, CHEN Rong, TUERXUN Ni-luo-pa-er, WANG Huan, HAO Jian-ping

2018, 16(5): 712-715. doi: 10.16766/j.cnki.issn.1674-4152.000194

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Objective To investigate the expression and clinical significance of p15 and SOCS1 methylation in myelodysplastic syndrome. Methods We examined 67 MDS patients (39 male and 28 female) with the median age of 59 years (21-83). Of them, 34 cases were the relatively low risk groups (low-risk 6 cases, intermediate-Ⅰ 28 cases), 33 cases were the relatively high risk groups (intermediate-Ⅱ 16 cases, high risk 17 cases). Methylation-specific PCR (MSP) was used to detect the methylation of the above two genes in 67 patients with MDS and 18 patients with iron deficiency anemia as controls, to analyze the relationship between p15 and SOCS1 methylation and the clinical indexes. Results The methylation rates of p15 and SOCS1 were 37.3% and 47.8% in 67 MDS patients, while 0% and 5.6% in the control group (P<0.05). The methylation of p15 and SOCS1 were correlated with different clinical indexes, but both increased along with the increase of International Prognostic Scoring System (IPSS) scores (P<0.05). The median overall survival of patients with p15 methylation were 8(95% CI:5.2-10.8) months, which was significant different with that of the patients without methylation 26 (95% CI:15.8-36.2) months (P< 0.05). The median overall survival of patients with SOCS1 methylation were 7(95% CI:5.0 -9.1) months, which was significant different with that of the patients without methylation 26(95% CI:18.2-33.8) months (P<0.05). Patients with 2 genes methylation had shorter survival time in all patients, the relatively low risk groups and the relatively high risk groups (P<0.05). In multivariate analysis, p15 and SOCS1 remained negative prognostic factors. Conclusion The methylation of p15 and SOCS1 were independent prognostic factors for overall survival in MDS.

Effect of silencing COX-2 Gene by siRNA on radiosensitivity of glioma cells

ZHENG Yi, ZHANG Fan

2018, 16(5): 716-720. doi: 10.16766/j.cnki.issn.1674-4152.000195

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Objective The small interfering RNA (siRNA) technology is used to silence the expression of COX-2 gene in human glioma cells in vitro, to explore its influence on radiosensitivity in order to provide new ideas and methods for the treatment of glioma. Methods Glioma U251 cells were cultured in vitro and siRNA-based COX-2 gene silencing model was constructed. The expression of COX-2 protein in transfected cells was detected by Western blot, and the optimal sequence was screened out. The experiment was divided into control group and transfection group. Four dose groups of 2, 4, 6, and 8 Gy were respectively irradiated with X-rays, and the experiment was repeated three times. The inhibition of cell proliferation after irradiation was detected by MTT assay and plate colony formation assay was used to detect cells. Survival fractions (SF) and sensitization ratio (SER) were calculated by clicking on a multi-target fit curve, and apoptosis was measured by flow cytometry. Results The expression of COX-2 protein in the transfection group was lower than that in the control group, and the siRNA600 sequence was the most obvious, the difference was statistically significant (P<0.05). The subsequent experiments were all transfected with the siRNA600 sequence. The inhibition rate of cell proliferation in the transfected group was (84.87±3.50)%, (63.62±035)%, (55.05±4.87)%, and (36.85±3.00)%, respectively. The proliferation inhibition effect of the transfected group was significantly higher than that of the control group. The radiation dose increased and the difference was statistically significant (P<0.05). The SF of the transfected group was lower than that of the control group, and the D0 of the transfection group was 4.110, Dq was 1.387, which was lower than that of the control group; in the control group, D0 was 6.908, the Dq was 2.772, and the radio sensitivity ratio SER was 1.680, with significant difference (P<0.05). After irradiation, the apoptosis rate of the transfected group was (3.63±0.45)%, (6.08±0.87)%, (47.97±2.13%), (59.56±3.07)%, respectively, which were all higher than those of the control group, and increased more obviously after 6 Gy and 8 Gy irradiation. Conclusion The silencing of COX-2 gene expression in human U251 glioma cell line U251 by siRNA can improve the radio sensitivity of cells, increase the apoptosis rate and proliferation inhibition of cells after radiotherapy, and reduce the clonogenic rate.

A study on the preparation of ⁹⁹Tc^m-MIBI nanoliposomes and its biodistribution in mice

YUAN Chao, LI Hui, SHEN Yong, LI Wei-peng, SUN Jun-jie

2018, 16(5): 721-724. doi: 10.16766/j.cnki.issn.1674-4152.000196

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Objective To explore the method of preparing ⁹⁹Tc^m-MIBI liposome nanoparticles, investigate its' physical, biological characterization and stability in vitro, and study its biological distribution characteristics in mice. Methods The ⁹⁹Tc^m-MIBI liposome nanoparticles were prepared by the ethanol infusion-ultrasonic dispersion process. The particle size and encapsulation efficiency were measured. The radioactivity purity and stability of ⁹⁹Tc^m-MIBI liposome nanoparticles in normal human serum and normal saline(NS) at different time points were observed under the condition of 37℃ in vitro. The distribution characteristics of 15, 60, and 120 min in mice were studied. Results The ⁹⁹Tc^m-MIBI liposome nanoparticles prepared by ethanol infusion-ultrasonic dispersion method were spherical and homogeneous under the electron microscope, with an average diameter of (168.2±18.6) nm. In vitro stability test showed that ⁹⁹Tc^m-MIBI liposome nanoparticles incubated 15, 30, 60, 120 min in normal serum and NS respectively, and their radiochemical purity was 96%, 93%, 90%, 89% and 92%, 89%, 86% and 85%, respectively. In vivo biodistribution experiment showed that compared with 99mTc-MIBI, after intravenous injection of ⁹⁹Tc^m-MIBI liposome nanoparticles, the spleen uptake was significantly observed and the radioactivity uptake rate of kidney was low during the observation time. Conclusion The preparation method of ⁹⁹Tc^m-MIBI liposome nanoparticles is simple and has ideal physical, biological characterization, and the stability in serum is good. Compared with ⁹⁹Tc^m-MIBI the kidney uptake rate was low, and the circulation time in vivo of the mice was prolonged.

Effects of the aqueous extract of Prunella vulgaris on Th1/Th2 equilibrium in rats with experimental autoimmune thyroiditis

YU Ling-ying, FU Xiao-dan, ZHANG Xiao-fang, ZHANG Xian-feng, JI Wei-qin, ZHUO Guang-chao, ZHANG Chu, MA Li-zhen

2018, 16(5): 725-728,743. doi: 10.16766/j.cnki.issn.1674-4152.000197

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Objective To observe the effects of the aqueous extract isolated from Prunella vulgaris (PVAE) on thyroid inflammation and Th1/Th2 equilibrium in rats with experimental autoimmune thyroiditis (EAT). Methods Lewis rats were randomly divided into 5 groups:normal control group (C), EAT model control group (M), PVAE preventive treatment group (P), low dose of PVAE treatment group (TL) and high dose of PVAE treatment group (TH). Rats were challenged with porcine thyroglobulin (pTg) for immune sensitization except those of group C. Rats of Group P and group TH received 10 g/kg bodyweight per day of crude drugs by ig, and 2.5 g/(kg·d) in group TL, while those in control groups were given normal saline. The thyroid pathologies, serum autoantibody level and cytokine levels were examined. Results ①Compared with the group C, both the serum levels of autoantibodies and TSH were higher, while the level of TPOAb in rats of group P were lower than those in group M post treatment (P=0.037). ②The serum cytokine levels produced by T helper 1 and 2 were increased in rats with EAT, PVAE modulated the imbalance of Th1 and Th2 cytokine responses in EAT rats by reducing the levels of Th1 cytokines (IFN-γ and IL-12), but increasing Th2 cytokine (IL-4 and IL-10), while reducing the ratio of Th1/Th2. The serum interleukin-12 concentration and the ratio of IL-12/IL-10 were significantly lower in rats of group P than those in group M after the test (P<0.05). Serum IL-12 concentration was also significantly lower in rats of group TL than those in group M after test (P=0.018). Additionally the Serum IL-4 concentration was significantly higher in rats of group TH than those in group M after test (P=0.021); while the ratio of IFN-γ/IL-4 was lower (P=0.018). ③The correlation analysis showed that the levels of antibodies and T-helper cytokines were all significantly correlated with TSH (P<0.001). The level of TPOAb, IL-10 and TgAb may contribute in the modulation of the concentration of TSH (R²=0.868, F=191.389, P<0.001). Conclusion Our research suggesting PVAE as a promising drug for intervention of autoimmune thyroiditis, especially for the prevention treatment of PVAE.

Efficacy of a single -lumen central venous catheter in treatment of the first unilateral spontaneous pneumothorax in young- and middle-aged adults

JU Fang-he, WANG Zhen, XIAO Zu-ke

2018, 16(5): 729-731. doi: 10.16766/j.cnki.issn.1674-4152.000198

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Objective To evaluate the efficacy and value of a single -lumen central venous catheter in the treatment of the first unilateral spontaneous pneumothorax in young- and middle-aged patients. Methods The clinical data of 115 young- and middle-aged patients with developed first unilateral spontaneous pneumothorax in our hospital between January, 2013 and June, 2017 were retrospectively analyzed. The patients were divided into three groups based on the different treatment styles. Group A (n=45) underwent the placement of a single-lumen central venous catheter connected to a water seal bottle and cured with closed thoracic drainage; Group B (n=36) received single-lumen central venous catheter to extract gas; and group C (n=34) underwent traditional thoracic closed-chest drainage. The differences in therapeutic effects and complications including pleural reaction, blockage, lumen loss, infection, bleeding, subcutaneous emphysema, pain, air leakage among the three groups were analyzed. Results The effective rate was 6.67%, 5.56%, 32.35% in group A, group B and group C, respectively, there was no significant differences (P>0.05). The total incidence of complications of groups A, B, and C were 97.78%, 100.00%, and 97.06%, respectively. The incidence in groups A and B were significantly lower than that in group C, and the difference was statistically significant (P<0.05). Conclusion The single -lumen central venous catheter has important application in young- and middle-aged patients with first unilateral spontaneous pneumothorax. Its curative effect rate is similar to that of traditional thoracic closed-chest drainage, but the total incidence of complications is significantly lower. Besides, it has many advantages such as small wound, simple operation and easy accepted by patients, and its application value in clinic is worth further study.

The clinical effect of serum thymidine kinase 1 levels in esophageal squamous cell carcinoma cases treated with radiotherapy

DU Xing-long, XU Yuan-su, WEI Jie

2018, 16(5): 732-735. doi: 10.16766/j.cnki.issn.1674-4152.000199

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Objective To evaluate the relationship between serum thymidine kinase 1(TK1) and esophageal squamous cell carcinoma (ESCC) treated with radiotherapy. Methods Via the enzyme-linked immunosorbent assay (ELISA) for the detection of the TK1 levels in 50 healthy cases and 50 ESCC cases, we analyzed the difference between the two groups. The positive rate of TK1 in ESCC cases was detected, and the relationship with TNM staging, differentiation degree, length of lesion and type of angiography was evaluated. The TK1 level variation of 50 patients with ESCC were compared before and after 1 week and 1 month treatment. The relationships between TK1 and radiotherapy Dose, treatment modalities and clinical therapeutic efficacy were evaluated. Results The TK1 (pmol/L) concentration in ESCC group was 3.14±1.70, and the healthy group was 1.29±0.66, P<0.05. The positive rates of serum TK1 in well differentiated group, moderately differentiated group, low undifferentiated group were 36.4%, 84.4% and 71.4% respectively, P<0.05. In stage Ⅱ, Ⅲ and Ⅳ, they were 62.5%, 64.9% and 40.0%, P>0.05. The cases with lesion length >6 cm and ≤ 6 cm accounted for 63.9% and 57.1%, P>0.05. And medulla type, ulcer type, narrow type and cavity type cases were 68.7%, 57.1%, 62.5%, 66.6% (P>0.05). The concentrations of TK1 (pmol/L) in the groups with concurrent chemoradiotherapy and the radiotherapy were 2.35±0.86, 1.81±0.57, 1.13±0.46, 2.60±1.43, 1.59±0.64, 1.10±0.56 (P<0.05) before treatment, 1 week and 1 month after the end of radiotherapy. In the groups of 54-59 Gy and 60-66 Gy, TK1(pmol/L) levels were 2.33±0.91, 1.83±0.55, 1.07±0.33, and 2.57±1.34, 1.63±0.63,1.12±0.57 respectively, P>0.05. In the CR, PR and SD groups TK1 (pmol/L) were 2.33±0.96, 1.84±0.57, 1.03±0.32; 4.89±1.37, 1.64±0.65, 1.13±0.59; 2.63±0.51, 1.44±0.19 and 1.22±0.32, respectively, P>0.05. Serum TK1 concentrations in each group before treatment, after 1 week, 1 month after treatment showed no significant differences (P>0.05). Conclusion The monitoring of TK1 levels has significance in the clinical diagnosis and treatment of ESCC.

Effect of resectional therapy combined with radiofrequency ablation on clinical indicators, safety and prognosis of patients with colorectal liver metastasis

LU Li-feng, SHENG Qin-song, ZOU De-sheng, LIU Guang, BIAN Yuan, MENG Xing-cheng

2018, 16(5): 736-739. doi: 10.16766/j.cnki.issn.1674-4152.000200

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Abstract:
Objective To investigate the effect of resectional therapy combined with radiofrequency ablation on clinical indicators, safety and prognosis of patients with colorectal liver metastasis, and provide evidence for the clinical application of this therapy. Methods A retrospective analysis of 48 cases of colorectal liver metastasis in our hospital from January, 2011 to December, 2013 was performed. All the patients were divided into observation group (22 cases) and control group (26 cases) according to the treatment methods. The control group underwent eradicative resection for colorectal cancer and liver metastases, while the observation group underwent resection combined with radiofrequency ablation. T-test was used to compare the clinical relevant indicators and the incidence of complications; Kaplan Meier progression-free survival curve and overall survival curve were done, and Log rank test was used to compare the prognosis of patients between the two groups. Results The levels of alanine aminotransferase (ALT) and aspertate aminotransferase (AST) after the treatment in both groups increased obviously, but the levels of the serum albumin (ALB) and cholinesterase (CHE) decreased in different degree. Three days and seven days after the operation, ALT, AST, ALB and CHE in the observation group were improved significantly as compared with the control group. All the above differences were statistically significant (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The progression-free survival rate of the observation group was significantly higher than that in the control group (HR=0.420, 95% CI:0.131-0.971, P=0.025), while the overall survival rate of the observation group was similar to that of the control group (HR=1.623, 95% CI:0.748-3.519, P=0.190), and there was no statistical difference (P>0.05). Conclusion The resectional therapy combined with radiofrequency ablation for colorectal liver metastasis can reduce the damage of cancer to the liver function, although the overall survival rate in patients is no significant difference as compared with surgical excision. So the new treatment option is available for patients who cannot undergo resectional therapy, which has a certain clinical value.

Application of new biological dressing type Ⅱ in the second degree burn wounds

LIU Ji-song, SONG De-heng, ZHAO Gang-hong, LI Yong, ZHANG Xiang-zhou, CHENG Xiu

2018, 16(5): 740-743. doi: 10.16766/j.cnki.issn.1674-4152.000201

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Objective To investigate the effect of New Biological Dressing Type II in the treatment of second degree burn wounds. Methods A total of 36 cases second degree burns in our hospital between November, 2015 and October, 2016 were enrolled into this study and randomly divided into observation group and control group. The observation group was treated with a new biological dressing type Ⅱ, while the control group was treated with silver zinc cream skin and mucous membrane antibacterial agent. The number of dressing, wound healing time, hospitalization time, degree of secondary dressing wound, comfort during changing dressing, comfort to dressing and the wound scar within six months after the discharge were compared between the two groups. Results The number of dressing sessions in the observation group[(4.39±1.14) times] was significantly less than that in the control group[(10.72±3.39) times]; the incidence of fever on day 7 in the observation group was 11.11%, which was significantly lower than that in the control group (50.00%); the wound healing time[(15.67±5.05) days] and hospital stay[(17.22±6.46) days] in the observation group were significantly lower than those in the control group[(21.94±5.47) days and (26.06±10.07) days), respectively]; the degree of secondary dressing wound, comfort during changing dressing and comfort to dressing in the observation group were significant better than those in the control group, the difference was statistically significant (P<0.05); Vancouver Scar Scale scores were 3.44±0.98 in the observation group and 4.94±1.55 in the control group, the difference was statistically significant (P<0.05). Conclusion The new biological dressing type II for second degree burn wounds can reduce the number of dressing, accelerate wound healing, reduce hospital stay, reduce the pain of patients, and reduce the wound scar hyperplasia, worthy of clinical application.

Effect of Tiaozhiji Granules on intestinal flora structure in patients with metabolic syndrome and syndrome of intermingled phlegm and blood stasis

LUO Ke-xue, PAN Zhi-min, ZHANG Yong-le, LI Hong-chun, JIA Xiao-yan

2018, 16(5): 744-747. doi: 10.16766/j.cnki.issn.1674-4152.000202

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Abstract:
Objective To study the effect of Tiaozhi Recipes on intestinal microflora of patients with metabolic syndrome (MS) with phlegm and blood stagnation. Methods Fifty-seven patients with metabolic syndrome with phlegm, blood stasis and cross-over syndrome treated in our hospital from April, 2016 to March, 2017 were divided into two groups according to different treatment methods:Tiaozhiji group (27 cases) and western medicine group (30 cases). The Tiaozhiji group was treated with Tiaozhi capsule, Western medicine group treated with metformin tablets, while 30 healthy volunteers were selected as blank control group. Fluorescent quantitative PCR method was used to quantitatively analyze the changes of intestinal flora in three groups. Results The Lactobacillus, Bifidobacterium, butyrate-producing bacteria in MS group were significantly lower than those in the control group (P<0.05). Enterobacter, sulfate-reducing bacteria was significantly higher than the control group (P<0.05), the total intestinal bacterial content between the two groups was no significant difference (P>0.05); Lactobacillus, Bifidobacterium content in both groups after treatment were significantly higher than those before treatment (P<0.05), Enterobacteriaceae, sulfate-reducing bacteria were significantly decreased than those before treatment (P<0.05), there were no significantly difference about butyrate-producing bacteria, intestinal bacteria than before treatment (P>0.05), the content of Lactobacillus in the Tiaozhiji group was significantly higher than that in the western medicine group (P<0.05), and the content of Enterobacter in the Tiaozhiji group was significantly lower than that of western medicine group (P<0.05), Bifidobacterium, butyrate-producing bacteria, sulfate-reducing bacteria and intestinal bacteria was not statistically difference significant between the two groups (P>0.05). Conclusion The structure of intestinal microflora in patients with metabolic syndrome has been changed, and Tiaozhiji granules can promote the growth of Lactobacillus and Bifidobacterium, inhibit the growth of sulfate-reducing bacteria and Enterobacteriaceae. It can improve the structure of intestinal flora, and play its role in the treatment of metabolic syndrome, worthy of clinical application.

Effect of Shengmai powder combined with tilt training on the curative effect and prognosis of the elderly patients with vasovagal syncope in cardiology department

LUO Li-hong, MA Xu-hui, FANG Tian-fu, CEN Ming-qiu

2018, 16(5): 748-751. doi: 10.16766/j.cnki.issn.1674-4152.000203

317 1

Abstract:
Objective To explore the effect of Shengmai powder combined with tilt training on the curative effect and prognosis of the elderly patients with vasovagal syncope (VS) in Cardiology Department. Methods Total 80 patients with VS in Xixi hospital between 2015 and 2017 were enrolled into this study and randomly divided into two groups with 40 cases in each group. The control group was given routine symptomatic treatment, while the observation group was additionally given Shengmai powder combined with tilt training treatment, the course was 3 months in both group. The results of sublingual nitroglycerin tilt table test, the levels of plasma catecholamine and the changes in hemodynamics were compared before and after the treatment. All patients were followed up to observe the side effects of drugs and recurrent rate of VS. Results In the observation group, the systolic pressure, diastolic pressure and heart rate before the tilt table test did not changed obviously after the Shengmai powder combined with tilt training treatment (P>0.05), however, the systolic pressure, diastolic pressure and heart rate when syncope or at end of the tilt table test elevated obviously after the treatment (P<0.05). Before the treatment, there was an obvious increment in the levels of plasma epinephrine and norepinephrine when syncope as compared with those at supine (P<0.05); however, after the treatment, there was no significant difference (P>0.05). After 3 months of treatment, HUTT test negative rate in the observation group was significantly higher than that in the control group, there was significant difference (P<0.05); Six months follow-up showed that the recurrence rate and the average time of syncope were significant differences between the two groups (P<0.05). Conclusion Shengmai powder combined with tilt training for senile vasovagal syncope can improve hemodynamics, reduce plasma catecholamine levels, reduce syncope episodes, prevent the recurrent of syncope. It is worthy of promotion.

Effect and mechanism of ω-3 fatty acids on factors in arterial blood in heat stroke rats

HU Liang-ying, SHOU Fei-yan, JIANG Jing-hua, SUN Hong-hua, LI Yu-hong

2018, 16(5): 752-753,808. doi: 10.16766/j.cnki.issn.1674-4152.000204

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Abstract:
Objective To investigate the effect of ω-3 fatty acids (Fat Emu Ision Injection) on factors in arterial blood and its mechanism. Methods Ninety SD rats were randomly divided into normal control group, heat stroke model group, heat stroke Omega-3 fish oil Fat Emulsion Injection treatment group, with 30 rats in each group. The rats were placed in the constant temperature box at 40℃ and 60% relative humidity for one hour to established heatstroke model. The Omega-3 fish oil fat emulsion injection treatment group received tail vein injection of Omega-3 fish oil Fat Emulsion 1.67 ml/(kg·d) after molding. Normal control group and model group received the same dosage of normal saline of tail vein injection. One time per day for both group and continued for 3 days. The body temperature, heart rate, and mean arterial pressure (MAP) were recorded separately for 3 groups after 12 hours, 24 hours and 48 hours; At three different time point, abdominal aorta blood in 10 rats from each group w was drawn to prepare serum, and the levels of lipopolysaccharide (LPS), nuclear factor kappa B (NF-kappa B) and P53 were tested by ELISA. Results Compared with normal control group, the heatstroke body temperature, heart rate, LPS, NF-B, P53 at three time points in model group were significantly increased (P<0.05), MAP decreased obviously (P<0.05); compared with the model group, the above indexes in the Omega-3 fish oil fat emulsion injection treatment group at the three time points was improved obviously (P<0.05). Conclusion Omega-3 fish oil fat emulsion injection can significantly improve the expression level of LPS, NF-kappa B and P53 in heat stroke rats, suggesting that it can inhibit LPS entry into blood and may affect vascular endothelial cells.

Effect of radiofrequency ablation combined with sorafenib on liver function in patients with advanced hepatic carcinoma

YU Nan-song, YAN Pei-jun, ZHENG Yuan-yuan, LU Bao-chun

2018, 16(5): 754-756. doi: 10.16766/j.cnki.issn.1674-4152.000205

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Abstract:
Objective To investigate the clinical effect of radiofrequency ablation combined with sorafenib in the treatment of advanced hepatic carcinoma. Methods Total 46 patients with advanced primary liver cancer who were treated in our hospital from February, 2013 to November, 2015 were selected and randomly divided into control group (n=23) and observation group (n=23). The control group was treated with radiofrequency ablation alone, and the observation group was treated with sorafenib on the basis of the control group. The total effective rate, the changes of liver function indexes before and after treatment, and the survival rate of the 1 and 2 years after treatment were observed between the two groups. Results The total effective rate of the observation group was 91.30%, which was significantly higher than that of the control group (65.22%), P<0.05. No significant liver function index before treatment between the two groups (P>0.05), the two groups after treatment of Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and total bilirubin (TBiL) were increased, but the observation group after treatment. The above index level is lower than the control group (P<0.05). The observation group after treatment for 1 years and 2 years survival rates were 86.96%, 78.26%, the control group after treatment for 1 years and 2 years survival rates were 60.87% and 47.83%. The observation group was significantly higher than the control group (P<0.05). Conclusion Radiofrequency ablation combined with sorafenib in the treatment of advanced liver cancer, can obtain accurate curative effect, long-term survival rate is higher, and can reduce liver function damage, has higher clinical application value.

Prognostic analysis of different surgical approaches in treating colorectal cancer peritoneal metastasis

YIN Jie-feng, ZHANG Zhe, LIN Cong-li

2018, 16(5): 757-760. doi: 10.16766/j.cnki.issn.1674-4152.000206

213 0

Abstract:
Objective To analyze the different surgical methods on the prognosis of patients with peritoneal metastasis of colorectal cancer. Methods Retrospective analysis of 98 cases of peritoneal metastasis in patients with rectal cancer from May, 2010 to June, 2014 in our hospital, they were devided into complete resection group (35 cases), incomplete resection group (34 cases) and subtraction surgery group (29 cases) according to the different surgical methods, the clinicopathological data and postoperative survival of the three groups were analyzed, and Cox proportional risk model was used to analyze the prognosis of patients with colorectal cancer. Results In this study, 98 patients were followed up, and the follow-up rate was 100%, the follow-up time was 0.5-40.0 months, the mean survival time was (16.9±4.5) months, and the total survival rate was 40.8% (40/98) and 18.4% (18/98) in 1 year and 3 years respectively; Complete resection group average survival time was (28.6±6.2) months, the total survival rate was 71.4% (25/35) and 45.7% (16/35) in 1 year and 3 years, incomplete resection group average survival time was (11.2±4.1) months, the total survival rate was 26.5% (9/34) and 0 in 1 year and 3 years, subtraction surgery group average survival time was (10.9±3.2) months, the total survival rate was 13.8% (4/29) and 0 in 1 year and 3 years, the mean survival time, 1 year and 3 years of total survival rate in complete resection group were significantly higher than those in incomplete resection group and subtraction group (P<0.05), the mean survival time, 1 year, 3 years of total survival rate in incomplete resection group were not statistically significant with subtraction surgery group (P>0.05); Cox analysis showed that differentiation degree, PCI, primary stage T stage and operation mode were the main factors affecting the prognosis of patients with peritoneal metastasis of colorectal cancer. Conclusion Peritoneal metastasis of colorectal cancer patients with complete resection of the prognosis is better, and it is worthy of clinical application.

Analysis of the risk factor of gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction in elderly patients

JIN Zhi-gang, ZHANG Hao, GUO Zhi-yu, ZHU Dan

2018, 16(5): 761-764. doi: 10.16766/j.cnki.issn.1674-4152.000207

201 2

Abstract:
Objective To analyze the risk factors of gastrointestinal bleeding after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in elderly patients, and to provide a reference for the clinical treatment of AMI patients. Methods Ninety elderly patients with AMI were diagnosed in our hospital were selected from January, 2016 to March, 2017. The patients with gastrointestinal hemorrhage after PCI were included in the observation group (n=47), and the normal gastrointestinal patients were included in the control group (n=43). The general data (gender, age, the time of diagnosis and therapy, Killip rating of myocardial infarction, blood vessel length, hypertension, peptic ulcer and renal function), clinical index (triglycerides, plasma cholesterol, albumin, c-reactive protein, activated partial thromboplastin time, prothrombin time and left ventricular ejection fraction) and surgical data (surgical time, the number of scaffolds, the use of tirofiban, thrombus aspiration and the level of preoperative and postoperative TIMI blood) were compared between the two groups, and analyze the risk factors of gastrointestinal bleeding after PCI in elderly patients with AMI by binary logistic. Results The length of blood vessel, peptic ulcer, the function of renal, the level of albumin and c-reactive protein, the number scaffolds and the use of tirofiban in observation group were significantly differences with control group (P<0.05). The binary logistic showed that the main risk factors of gastrointestinal bleeding are the renal function, c-reactive protein level and the use of tirofiban. Conclusion The renal function, c-reactive protein level and the use of tirofiban are the risk factors of gastrointestinal bleeding after PCI in AMI elderly patients.

Analysis of the influence factors of therapeutic compliance of palmitone palmitate in schizophrenic patients

LIANG Sheng-lin, FENG Hong

2018, 16(5): 765-767,780. doi: 10.16766/j.cnki.issn.1674-4152.000208

293 1

Abstract:
Objective To explore the main factors that affects the therapeutic compliance of palmitone palmitate injection in schizophrenic patients. Methods A total of 123 patients with schizophrenia were selected from June, 2013 to July, 2015 at the seventh people's hospital for treatment of palmitone palmitate injection, the clinical data of patients were collected and the dosage and combination of drug administration of palmitate were calculated, and single factor analysis and Cox multifactor regression analysis were carried out on the factors affecting the compliance of palmitone palmitate injection therapy for schizophrenic patients. Results During the follow-up of 1 year, 10 of 123 patients had lost their visit, of which 86 patients were treated with long lasting injection, and 27 patients were interrupted; The average dose of the third dose of palmitone palmitate was (101.6±21.6) mg, the average dose of the last one was (95.6±18.5) mg. Schizophrenia patients combined with benzhexol 17 cases, propranolol 14 cases, aripiprazole 19 cases, paliperidone 13 cases, sedative hypnotics 23 cases, other antipsychotics 37 cases. After the third injection, the patient's PANSS score was (92.7±7.2), and the patient's PANSS score was (90.6±6.9) after one year, and the PANSS score reduction was (2.1±0.3). A total of 39 cases of adverse events such as sit-ins, prolactin and and insomnia were recorded during the treatment of the patients with schizophrenia. Cox multifactor regression analysis found that gender, PANSS subtraction, propranolol and sedative hypnotic drugs were the main factors that affect the therapeutic compliance of palmitone palmitate injection in schizophrenic patients. Conclusion Selecting the right patient, emphasizing the improvement of the early symptoms of the patient and the combination of medication are key to reducing the interruption treatment.

Diagnostic value of double staining endoscopy in early digestive tract cancer

WANG Wang-yue, YE Jie-tong, YE Guo-liang

2018, 16(5): 768-770. doi: 10.16766/j.cnki.issn.1674-4152.000209

226 1

Abstract:
Objective The application value of double staining endoscopy in the diagnosis of early digestive tract cancer by grouping comparison. Methods Total 752 cases of gastrointestinal endoscopy patients were selected from May, 2015 to June, 2017, and divided into groups according to different examination methods. The control group (490 cases) received routine endoscopic examination, suspicious lesions were detected by biopsy, and the observation group (262 cases) underwent double staining under endoscopy, two groups of patients with colorectal mucosa, gastric mucosa, esophageal mucosal lesions, early detection of cancer were compared. Data processing with SPSS 19.0 software. Results A total of 57 cases of colorectal lesions were detected in the observation group, the detection rate was 80.28%, 37 cases of colorectal mucosa lesions were detected in the control group, the detection rate was 25.52%, the difference between the two groups was statistically significant (P<0.05); The detection rate of colorectal early cancer was 5.63%, and no early colorectal cancer was found in the control group. The difference between the two groups was statistically significant (P<0.05); A total of 56 cases of gastric mucosal lesions were detected in the observation group, the detection rate was 64.37%, and 24 cases of gastric mucosal lesions in the control group were detected, the detection rate was 14.81%, the difference between the two groups was statistically significant (P<0.05); The detection rate of early gastric cancer was 4.60%, and the early gastric cancer was not detected in the control group. The difference between the two groups was statistically significant (P<0.05); A total of 19 cases of esophageal mucosa lesions were detected in the observation group, the detection rate was 18.27%, and 8 cases of esophageal mucosal lesions in the control group were detected, the detection rate was 4.37%, the difference between the two groups was statistically significant (P<0.05); The detection rate of early esophageal cancer was 3.85%, and no early esophageal cancer was found in the control group. The difference between the two groups was statistically significant (P<0.05). Conclusion Double staining endoscopy can significantly improve the detection rate of early digestive tract cancer. Provide effective guidance for the diagnosis and treatment of disease, and is worthy of promotion.

Correlation of cardiovascular factors and elevated serum cysteine level with one-year mortality risk in patients with cerebral infarction

YANG Jun, NI Gui-lian

2018, 16(5): 771-772,801. doi: 10.16766/j.cnki.issn.1674-4152.000210

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Abstract:
Objective To study the cardiovascular factors of one-year mortality risk in patients with cerebral infarction and analyze the correlation between one-year mortality risk and serum cysteine (Hcy) level. Methods The clinical study was carried out in 185 patients with cerebral infarction admitted in our hospital between September, 2013 and September, 2016. The patients were followed up for one year to collect the data for observing the survival of the subjects. By comparing the general data of death patients and survival patients, we calculated the risk factors of one-year mortality of patients with cerebral infarction according to the Logistic regression equation, and discussed the relationship between the increase of serum cysteine level and the one-year mortality risk of patients with cerebral infarction. Results In one year follow-up, 21 of 185 patients died and 164 survived, with a survival rate of 88.65%. The different in cardiac morphology, carotid plaque and Hcy level were noted between survival patients and died patients, P<0.05. Logistic regression equation showed that the morphological structure of heart (OR:0.126), carotid plaque (OR:0.142) and Hcy level (OR:0.151) were the risk factors of one-year mortality risk in patients with cerebral infarction (P<0.05). Conclusion The risk factors of cerebral infarction within one year include the cardiac morphology, carotid plaque and Hcy levels; with the increase of Hcy levels, the death rate of cerebral infarction patients will increase obviously.

Clinical observation of combing the four column classification theory with minimally invasive percutaneous plate osteosynthesis in treatment of senile tibial plateau fractures

CHEN Xiang-fu, NI Wei-yu, WANG Wu-qi, TONG Pei-jian

2018, 16(5): 773-776. doi: 10.16766/j.cnki.issn.1674-4152.000211

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Abstract:
Objective To evaluate the clinical effect of combing the four column classification theory with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and anti-osteoporosis in the treatment of senile tibial plateau fractures. Methods From January, 2014 to August, 2015, sixty patients with tibial plateau fractures in our hospital were enrolled and randomly divided into two groups (n=30). The control group received the open reduction and internal fixation, while the research group received four column classification theory and MIPPO technique. Anti-osteoporosis and infection treatment were used during the peroperative period. The tibial plateau angle, posterior tibial plateau angle, femoral tibial angle, knee joint, incision length, intra operative hemorrhage, fracture healing, bone density improvement, visual analogue scale, knee joint function score, complication rate so on operation index were compared between the two groups. Results The knee joint (119.36±6.47) °, HSS[(85.39±9.86) scores], fracture healing[(3.12±0.64) months], intra operative hemorrhage[(62.63±9.58) ml], incision length[(5.17±1.89) cm], complication rate (6.7%) in the research group were better than those in the control group, the differences were statistically significant (P<0.05). The differences in TPA, PA and FTA between the two groups were no statistically significant (P>0.05). Conclusion Combing the four column classification theory with MIPPO technique in the treatment of senile tibial plateau fractures had advantages of less trauma, good reduction, stable and durable internal fixation, good joint function recovery and fewer complications. The effect was good, and it was worth popularizing.

Effect of irisin gene polymorphism on target organ dysfunction in young and middle-aged hypertensive patients

SHOU Xiao-ling, REN Ai-hua, ZHU Li-yue, WANG Yan, ZHOU Rong-fang, WANG Qi-nan

2018, 16(5): 777-780. doi: 10.16766/j.cnki.issn.1674-4152.000212

252 1

Abstract:
Objective To investigate the effect of irisin gene polymorphism on target organ dysfunction in young and middle-aged hypertensive patients. Methods From June, 2016 to August, 2017, 100 young and middle-aged hypertensive patients in our hospital were selected as an observation group, and 100 healthy adults were served as a control group. The polymorphic distributions of irisin genes between the two groups were compared. At the same time, the relationship between target organ dysfunction and irisin gene polymorphism in young and middle-aged hypertensive patients were analyzed. Results When compared with the control group, the observation group patients got decreased serum irisin expression[(2.52±0.75) μg/ml vs. (2.97±0.80) μg/ml, P<0.001]. The cases of rs16835198 genotype TT, GT and GG in the observation group were 20, 38 and 42, respectively, while they were 29, 48 and 23 in the control group with a statistically significant difference (P=0.015). When compared with the patients with irisin ≥ 3 μg/ml, patients with Irisin<3 μg/ml got increased thickness of carotid artery intima[(1.27±0.17) mm vs. (1.19±0.16) mm, P=0.019)] and decreased level of ejection fraction[(59.88±4.87)% vs. (63.28±5.29)%, P=0.001]. The carotid artery intima in young and middle-aged hypertensive patients with GG, GT and TT of rs16835198 were (1.32±0.18) mm, (1.16±0.17) mm and (1.21±0.18) mm, and there was a statistically significant difference (P<0.05). Conclusion The irisin gene is polymorphic distribution in young and middle-aged hypertensive patients, which is related to the impairment of target organ function in patients.

Risk factors analysis of diabetic peripheral neuropathy in patients with type 2 diabetes

HU Fang-zhou, YANG Wen-yue, XIE Xiao-hong, YE Jian-hua, CHEN Ken

2018, 16(5): 781-784. doi: 10.16766/j.cnki.issn.1674-4152.000213

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Abstract:
Objective To investigate the relevant clinical data in a hospital and analyze the risk factors of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM). Methods By adopting the method of retrospective investigation and analysis, 240 hospitalized patients from January, 2016 to December, 2016 were collected in Guangdong pharmaceutical university. According to the merger of DPN, the patients were divided into DPN group and NDPN group. The data were compared between two groups, including demographic data (gender, age, course of the disease, smoking history, drinking history, marital status, account type, payment method), physical examination data(BMI, SBP, DBP), the relevant biochemical information(FBG, 2 h PG, HbA1c, FC-P, 2 h C-P, TC, TG, LDL-C, HDL-C, FFA, BUN, UA, Scr) and whether merger of complications(HTN, CHD, DR, DN, PVD) via multivariable Logistic regression method to analyze the risk factors of T2DM patients with DPN. Results The age, course, CHD, DR, FBG, FFA in DPN group were significantly higher than those in NDPN group (P<0.05); 2 h C-P, BUN, UA were significantly lower than those in NDPN group (P<0.05). The logistic regression analysis showed that age(OR=1.558, 95% CI:1.051-2.310), course of disease(OR=1.758, 95% CI:1.078-2.866), FBG(OR=1.091, 95% CI:1.006-1.183), 2 h C-P(OR=0.643, 95% CI:0.352-0.843) and DR (OR=2.649, 95% CI:1.422-4.934) were closely correlated with DPN occurrence. Conclusion Age, course of disease, FBG and DR are the high risk factors of DPN occurrence in patients with T2DM, and 2 h C-P is the protective factor of DPN.

The role of NLRP3 inflammasome in patients with type 2 diabetes with diabetic foot

WANG Xian-feng, LI Li-hong, HONG Bao-jian

2018, 16(5): 785-787. doi: 10.16766/j.cnki.issn.1674-4152.000214

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Abstract:
Objective To investigate the role of NLRP3 inflammasome in type 2 diabetes mellitus with diabetic foot. Methods From June, 2016 to June, 2017, 100 patients with type 2 diabetes mellitus and diabetic foot treated in our hospital were selected as an observation group, and 50 patients with type 2 diabetes mellitus (without diabetic foot) were selected as a control group. The expression of NLRP3 between the two groups were observed. In addition, the main clinical features of the patients in the observation group were collected, and the correlation between the NLRP3 inflammasome and the clinical features of diabetic foot were analyzed. Results When compared with the control group, the relative expression of mRNA of the NLRP3 inflammasome increased significantly in the observation group(4.12±0.88 vs. 2.73±0.92, P<0.001), and the relative expression level of NLRP3 inflammasome protein increased significantly(12.48±2.81 vs. 9.89±2.65, P<0.001). The NLRP3 inflammasome mRNA expression in patients of 0-1, 2-3 and 4-5 Diabetes severity grading were 3.27±0.78, 3.87±0.83 and 4.83±0.92, the difference was statistically significant (P=0.002). NLRP3 inflammasome protein expression levels were 9.65±2.12, 11.32±2.54 and 15.49±2.98, the difference was statistically significant (P<0.001). Pearson linear correlation analysis showed that the relative expression level of NLRP3 mRNA and the relative expression of NLRP3 inflammasome protein were all directly proportional to the diabetic foot severity score and glycosylated hemoglobin (P<0.05). Conclusion The activation of NLRP3 inflammasome in patients with type 2 diabetes mellitus combined with diabetic foot is related to the development of diabetic foot.

Effect of different dissection level of para-aortic lymph nodes on the recurrence of endometrial cancer

ZHANG Jing-fan, DU Shun-lan, ZHU Bin, GUO Xiao-li, ZHUANG Xiao-ping

2018, 16(5): 788-791. doi: 10.16766/j.cnki.issn.1674-4152.000215

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Abstract:
Objective To explore the safety and efficacy of different dissection level of para-aortic lymph nodes in the patients with endometrial cancer (EC). Methods This study was a prospective follow-up study which included subjects with endometrial cancer between January 1, 2010 and December 31, 2015. These subjects were divided into inferior mesenteric artery (IMA) group and renal vein (RV) group randomly. The para-aortic lymph nodes were dissected to the level of inferior mesenteric artery and the renal vein in the IMA group and the RV group, respectively. The intraoperative and postoperative complications were recorded. The main form of follow-up was telephone follow-up. Follow-up endpoint was cancer recurrence. Kaplan-Meier method was used to estimate survival rate. The survival difference between the two groups was compared using the log-rank test. Results There was no significant difference in the incidence of intraoperative complications and postoperative complications between the two groups (χ²=0.110, 0.107; P=0.740, 0.744). A total of 49 cases relapsed in the both groups. Twenty-nine and 20 patients relapsed in the IMA group and the RV group, respectively. Kaplan-Meier curve didn't show the difference between the two groups. A total of 20 cases relapsed in Ⅰ stage patients in the both groups. Eleven and 9 patients relapsed in the IMA group and the RV group, respectively. Kaplan-Meier curve didn't show the difference between the I stage subjects in the two groups.A total of 29 cases relapsed in Ⅱ-Ⅳ stage patients in the both groups. Eighteen and 11 patients relapsed in the IMA group and the RV group, respectively. Kaplan-Meier curve showed the significant difference between the Ⅱ-Ⅳ stage subjects in the two groups. Conclusion Para-aortic lymph node dissection to the level of renal vein is safe and effective, especially in patients with advanced endometrial cancer, which can help to reduce tumor recurrence and improve long-term prognosis.

Expression and significance of neutrophil extracellular traps in patients with Candida vaginitis

LIN Zhen-yun, FEI Xiao-yang, CHEN Hao, CHEN Lin-jie, YANG Yang

2018, 16(5): 792-794. doi: 10.16766/j.cnki.issn.1674-4152.000216

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Abstract:
Objective To study the difference of extracellular traps (NETs) between VVC and RVVC and whether the amount of NETs would have influence on the cure time of VVC. Methods This study was conducted between January, 2016 and October, 2016 on women suffering from Candida vaginitis at Hangzhou Maternity Hospital. Total 193 patients were recruited, including 120 VVC and 73 RVVC. Results NETs were found in all samples. The grade of NETs were rated as +, ++ and +++. In the group of VVC, 41 samples were rated as +, 60 samples were rated as ++ and 19 were rated as +++ before treatment. In the group of RVVC, 50 samples were rated as +, 20 samples were rated as ++ and 3 were rated as +++. The NETs formation in VVC group was stronger than that in RVVC group, the difference was statistically significant (Z=-9.732, P<0.05). The VVC group patients came back to hospital 7 days after treatment, 30 cases of Candida turned negative among NETs + patients, negative rate is 73.17% (30/41), 56 cases of Candida turned negative among NETs ++ patients, negative rate is 93.33% (56/60), 18 cases of Candida turned negative among NETs +++ patients, negative rate is 94.73% (18/19), the negative rate in NETs ++, +++ patients was higher than that in NETs+ patients, the difference was statistically significant (χ²=6.317 and 6.774, P<0.05). Conclusion Our results indicated that NETs were involved in the immune response in Candida vaginitis. The responses to antifungal therapy showed a close correlation between the cure time and the degree of NETs formation in Candida vaginitis.

The risk factors analysis of HELLP syndrome of severe preeclampsia

ZHANG Cai-ping, XU Qiu-lian, ZHU Min

2018, 16(5): 795-797. doi: 10.16766/j.cnki.issn.1674-4152.000217

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Abstract:
Objective To investigate the incidence and risk factors of HELLP syndrome of severe preeclampsia, and provide clinical data for reduce the HELLP syndrome. Methods The clinical data of 182 patients with severe preeclampsia from January, 2007 to January, 2017 in Obstetrices and Gynecology of Jin Hua. The patients were divided into HELLP group and non- HELLP group, according to the HELLP syndrome. The related factors which may be induced HELLP syndrome were analyzed, and the related factors was analyzed by logistic regression analysis. Results In 182 cases of severe preeclampsia patients,including 36 cases of patient with HELLP syndrome, the incidence was 19.78%. Single factor analysis and multi-factor logistic regression analysis shows that the early onset preeclampsia (OR=3.533, P=0.012, 95% CI:1.421-9.744), maternal age (OR=4.995, P=0.003, 95% CI:1.671-10.651) was risk factors of severe preeclampsia complicated with HELLP syndrome. Regular examination (OR=0.241, P<0.001, 95%CI:0.080-0.721) was protective factor for severe preeclampsia complicated with HELLP syndrome. Conclusion HELLP syndrome was the complications of and the elderly women with early onset preeclampsia should be regularly examined, screening high-risk factors, in order to reduce the incidence of HELLP syndrome.

Clinical study of the second stage of labor stage free position delivery

JIANG Xiao-xia, XU Jie, XIE Li-jun, WENG Qian-ying, CHEN Dan, LEI Xia

2018, 16(5): 798-801. doi: 10.16766/j.cnki.issn.1674-4152.000218

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Objective To investigate the clinical effect of the second stage of labor stages by free delivery position. Methods One hundred and twenty cases of primipara accepted natural childbirth were selected according to the order of admission were randomly divided into observation group (n=60) and control group (n=60), the observation group at the beginning of the second stage of labor by standing, half sitting, squatting three vertical position childbirth, maternal according to their own subjective hope free alternative selection adjustment delivery the position of the second stage of labor; at the end of the fetal head exposed after taking lateral position shifting production; the control group in the second stage of labor throughout the supine lithotomy position delivery. The birth outcomes, length of the second stage of labor, postpartum hemorrhage and neonatal asphyxia rate 2 h, perineal laceration, comfort and satisfaction of delivery in the two groups were compared. Results In the observation group, the vaginal delivery rate was higher than the control group, the difference was statistically significant (P<0.05). The neonatal asphyxia, postpartum hemorrhage 2 h comparison in the two groups had no statistically significant difference (P>0.05). The second stage of labor time length in the observation group was lower than the control group, the difference was statistically significant (P<0.05). The perinaeum integrity and episiotomy rate in the observation group were better than the control group, the difference was statistically significant (P<0.05). The maternal comfort and satisfaction in the observation group were higher than the control group, the differences were statistically significant (P<0.05). Conclusion The second stage of labor stage free position childbirth way of birth is safe and effective. It can improve the rate of natural childbirth, shorten the second stage of labor, reduce perineal injury, improve maternal comfort and have good effects on maternal and neonatal outcomes are, with clinical application.

Changes of intestinal microbiota in children with benign infantile convulsions associated with mild gastroenteritis

LU Le-sheng, XU Zhi-fang, BAI Xing, JIN Wei-min, HUANG Yu-mao, JIN Guo-xin, WU Hao-cheng

2018, 16(5): 802-804. doi: 10.16766/j.cnki.issn.1674-4152.000219

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Objective To explore the changes of intestinal microbiota in children with benign infantile convulsions associated with mild gastroenteritis (BICE). Methods Forty-five cases of BICE diagnosed in our hospital between January, 2013 and December, 2016 were the study group. Forty-five cases of acute gastroenteritis diagnosed in our hospital between January, 2013 and December, 2016 were the control group. Fecal rotavirus was detected and Escherichia coli, Enterococcus, Lactobacillus and Bifidobacterium were cultured in the two groups. Fasting venous blood was phlebotomized and intestinal mucosal barrier indexes including diamine oxidase (DAO), nitric oxide (NO) and D-lactic acid were measured. Results The positive rate of fecal rotavirus in the study group (48.9%) was significantly higher than that in the control group(26.7%), P<0.05. The amounts of Escherichia coli[(7.8±2.3) CFU/g], Enterococcus[(6.0±2.3) CFU/g], Lactobacillus[(4.9±1.7) CFU/g] and Bifidobacteria[(5.1±1.5) CFU/g] in the study group were lower than the amounts of Escherichia coli[(8.8±2.2) CFU/g], Enterococcus[(7.3±2.8)]CFU/g, Lactobacillus[(6.0±2.5) CFU/g] and Bifidobacteria[(5.9±1.9) CFU/g]in the control group (P<0.05). The serum level of DAO[(9.84±4.17) U/L], D-lactic acid[(0.92±0.39) mmol/L] and NO[(126.8±48.1) μmol/L] in the study group were significantly higher than the serum level of DAO[(7.49±2.73) U/L], D-lactic acid[(0.73±0.25) mmol/L] and NO[(0.73±0.25) μmol/L] in the control group. Conclusion Rotavirus is closely associated with the pathogenesis of BICE. Probiotics in intestinal tract of BICE children reduce and intestinal mucosal barrier function decrease, which means supplement of probiotics may help to prevent and treat BICE.

Analysis of present implementation situation and countermeasures of the two-way referral in Xi'an

WEI Wei, LI Ya-jun, LIU Shun-zhi, YAN Qin-qin, ZHOU Lian-suo, WANG Xiao-ping, ZHANG Bei

2018, 16(5): 805-808. doi: 10.16766/j.cnki.issn.1674-4152.000220

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Objective In order to put forward some suggestion to solve the existing problems, five community health service centers and five general corresponding hospitals were selected to understand the status of two-way referral by questionnaire survey, thus to optimize the design and implementation of the system. Methods A randomized cluster sampling was taken in each institution in Xi'an during August, 2015 to November, 2015. We collected 951 valid ones from 1 000 questionnaires for doctors, patients and administrators in each community hospital and the general hospital. Results Different educational backgrounds, professions and income levels had significant differences. The main reasons why patients didn't want to transfer to the general hospitals WERE cumbersome referral procedures, lack of recognition of the seriousness about their diseases, economic difficulties, no medical insurance, traffic inconvenience, etc; on the other hand, the main reasons why patients didn't want to go to the communities were cumbersome referral procedures, distrust in the doctors and medicine in communities, the small gap between Medicare reimbursement proportion, economic difficulties, lack of recognition of the necessity of continuing treatment, the lack of family beds and rehabilitation, etc. Medical workers believed that the main reasons why the two-way referral operation impeded were as follows, unclear referral criteria, unclear referral regulatory institutions and mechanisms, lack of basic medical insurance support, interest conflicts between medical institutions, incomplete information platform of two-way referral, and lack of recognition of two-way referral etc. Conclusion The present situation of the two-way referral is not ideal in Xi'an, and most of the referrals are from communities to the general hospitals. We should establish and improve two-way referral system, strengthen the leverage of medical insurance on two-way referral, and then we will have a better situation.

Impact of the number of children and physical condition of the elderly on willingness of elderly support in rural areas in Bengbu

CONG Xiang-feng, JIA Xian-jie, LIANG Nan-nan, GUO Xiao-lei, WU Tao, LUO Ke-bin

2018, 16(5): 809-812. doi: 10.16766/j.cnki.issn.1674-4152.000221

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Objective With aging population, this paper aims to study the impact of the number of children and physical condition of the elderly on the willingness of elderly support in rural areas and provide scientific basis for making elderly-support policy. Methods A stratified random sampling method is used to investigate the rural elderly (≥ 60) with questionnaires in Lilou Township, Bengbu City in 2016. A total of 249 valid questionnaires were collected and 244 were included in the study. To study impact of the number of children and physical condition of the elderly on willingness of elderly support, one-way χ² analysis(or Kruskal-Wallis rank sum test) is adopted for single factor analysis while logistic regression analysis is adopted for multiple factors analysis. Results The elderly having 4 children are accounting for the majority 70 (28.7%) and their health condition is in middle level. The willing to be supported by the family is the highest, which is 178 (73.0%) 95% CI:67.2% -78.3%. According to single factor analysis the number of children (χ²=2.803, P=0.246) and physical condition (self-evaluation:χ²=5.385, activities of daily living (ADL):χ²=2.987, life satisfaction:χ²=2.111, with P >0.05) had no statistically significant impact on the willingness of elderly support. According to multiple factors logistic regression analysis, the number of children's impact on the willingness of elderly support isn't statistically significant (P>0.05). Among the independent variables of physical condition, only when elderly evaluate themselves healthy (P<0.05) is statistically significant and OR=8.802, 95% CI:1.030-75.210. Conclusions The number of children has no impact on the willingness of elderly support. Researches, henceforth, should be transferred from the number of children into social economic status (e.g, economic condition of children, marital status, and so on). Support from family remains favorable to the elderly. The elderly with poor health self-evaluation tends to be supported by family. Hence, improving home care can offer them more satisfied lives.

The effect of social support intervention on the care of the family members of patients with acute myocardial infarction

YANG Ting-ting, ZHAO Zhen-juan

2018, 16(5): 813-815,819. doi: 10.16766/j.cnki.issn.1674-4152.000222

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Objective To explore the effects of social support intervention on the care of the family members of patients with acute myocardial infarction via correlation analysis. Methods From February, 2014 to December, 2016, 88 family members of patients with acute myocardial infarction in our hospital were selected as the observation group, and the other 88 locals with healthy family members were selected as the control group. Via CBI, SSRS and SCL-90, the two groups were given investigation and analysis of the relationship among the social support, quality of life and care burden. Results The time dependent burden, the limited development burden, the physiological burden, the social burden and the emotional burden scores in the observation group were significantly higher than those of the control group (P<0.05). The objective support, subjective support, utilization degree of social support in the observation group were significantly lower than those in the control group (P<0.05), and somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression and anxiety score quality of life scores in the observation group were significantly higher than those in the control group (P<0.05). Spearman correlation analysis showed that the dimensions of social support scores, quality of life scores were positively correlated to the time dependency burden scores (P< 0.05), the dimension of social support scores, somatization, obsessive-compulsive symptoms, depression scores were positively correlated to the emotional burden (P<0.05), the social support utilization scores were positively correlated with social burden (P<0.05), the objective support scores were correlated with the limited development burden (P<0.05). Conclusion The burden of family members of patients with acute myocardial infarction is relatively heavy, together with low social support and quality of life. We should strengthen the social support intervention that can improve the patient's family care ability and quality of life.

The value of differential diagnosis of multiple ultrasonography in the detection of benign and malignant thyroid nodules

JIA Ying-chao, YANG Zhang-hui, LÜ Xin-xiao, YANG Chong-ze, ZHANG Sheng-le, LIANG Bin

2018, 16(5): 816-819. doi: 10.16766/j.cnki.issn.1674-4152.000223

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Abstract:
Objective To investigate the differential value of multiple ultrasonography in the detection of benign and malignant thyroid nodules with diameter. Methods Total 1 393 patients with thyroid nodules were examined by ultrasound. The ultrasound features (Nodular nature, margins, calcifications, nodule morphology, type of echoes, signs of lymph node metastasis, and blood flow) were analyzed by TI-RADS classification system and compared with the pathological results for statistical analysis. Results Of the 1 393 patients, 913 were malignant and 479 were benign. More malignant nodules showed irregular nodules, unclear boundaries, the internal hypoechoic or hypoechoic low echo, aspect ratio ≥ 1, tiny calcification, nodules can be seen inside the rich blood flow. Logistic regression analysis showed irregular nodules, unclear boundary, internal hypoechoic or hypoechoic echo, A/T>1, microcalcifications and blood flow (Ⅲ) as the dangerous ultrasound signs of malignant nodules. The results showed that the diagnostic specificity, sensitivity, positive predictive value and negative predictive value were 78.3%, 82.4%, 72.3%, 84.5%, respectively, according to any of the 6 signs in the combined detection of multiple ultrasonographic signs. Its accuracy reached 79.1%. Conclusion Combined detection of multiple ultrasonographic signs can significantly improve the specificity of diagnosis of malignant nodules and reduce the incidence of misdiagnosis. In clinical application, if any combination of three ultrasound signs is found, malignant thyroid nodules should be highly suspected, so patients should be advised to do Further examination.

Clinical characteristics for Clostridium difficile-associated diarrhea among malignant tumor patients

JIN Li-min, SHEN Yu-hong, CAO Chen-xi, RUAN Ling-juan, HENG Xiang, SHAO Ping-yang, CHEN Song-jing

2018, 16(5): 820-822,834. doi: 10.16766/j.cnki.issn.1674-4152.000224

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Abstract:
Objective The incidence rate of diarrhea in patients with malignant tumor is high. The Clostridium difficile infection is an important cause. However, it is difficult to distinguish clinically. This study intended to investigate the clinical characteristics for Clostridium difficile-associated diarrhea among cancer patients in China. Methods We investigated the prospective clinical database for cancer patients combined with diarrhea, and a total of 472 patients included in this study, who were divided into 2 groups depending on whether or not Clostridium difficile infection:Clostridium difficile infection group (Group A, n=95) and Non-Clostridium difficile infection group (Group B, n=377). Polymerase chain reaction (PCR) was used to detect the Clostridium difficile poisonA (tcdA) and Clostridium difficile poison B (tcdB). The patient general information was recorded, blood routine examination and biochemical test were performed. The ECOG score was recorded before chemotherapy and during diarrhea. The side effects, chemoradiotherapy, proton pump inhibitor and antibiotic therapy within 4 weeks before diarrhea, the time of antibiotic therapy were also recorded. Propensity score matching analysis with preset caliper width 0.1 was used to keep the equilibrium in general information between groups, and the two groups were matched with 1:1. The general information and malignant tumor treatment information of the patients were recorded. Results A total of 91 matched pairs were selected from the patients after the propensity score matching analysis, and no difference was found in general information between Group A and Group B (P>0.05). Compared with Group B, the level of plasma albumin decreased in Group A (P<0.01), the proportion of antibiotic application, proton pump inhibitor, positive fecal occult blood test and ECOG score after chemotherapy were increased in Group A (P<0.05 or P<0.01). No difference was found in side effects between two groups. Conclusion The level of plasma albumin decreased and the incidence of positive fecal occult blood test increased in patients with malignant tumor associated diarrhea of Clostridium difficile infection. The use of antibiotics, chemotherapy and proton pump inhibitors may increase the risk of Clostridium difficile infection in patients with malignant tumors.

Clinical application of contrast-enhanced ultrasonography in the diagnosis of hepatic hemangioma

YU Da, WANG Zi-rong, SUN Quan, WANG Xiao-man, TANG Dong, GAO Feng

2018, 16(5): 823-825. doi: 10.16766/j.cnki.issn.1674-4152.000225

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Abstract:
Objective To evaluate the clinical value of contrast-enhanced ultrasonography in the diagnosis of hepatic hemangioma. Methods A total of 82 patients with suspected hepatic hemangioma received from February, 2015 to February, 2017 were enrolled in this study. All patients were diagnosed by enhanced CT or MRI, followed by conventional ultrasound and ultrasonography. Test diagnosis, observation of diagnostic sensitivity, specificity, misdiagnosis rate, missed diagnosis rate and Youden index, observe the image diagnosis performance. Results Totally 64 lesions were identified by pathology in 57 patients. The sensitivity, specificity and specificity of contrast-enhanced ultrasound in the diagnosis of hepatic hemangiomas were 87.72%, 80.00%, 0.68 for Youden index and 0.662 for Kappa, respectively. The sensitivity of routine ultrasound was 59.65% Degree of 68.00%, Youden index of 0.28, Kappa value of 0.237; contrast-enhanced ultrasound in the diagnosis of hepatic hemangiomas sensitivity was significantly higher than conventional ultrasound, the difference was statistically significant (χ²=11.581, P<0.001); conventional ultrasound in 34 cases 8 cases were misdiagnosed and missed by 23 cases. Among the 59 lesions found by contrast-enhanced ultrasound, CEUS showed two enhancement modes:① the perimeter was completely filled to the center and 35 lesions; ② filling time is shortened, the overall enhancement, 14 lesions, at the same time found 4 low-echo lesions, 5 patients were misdiagnosed, 7 patients were missed. Conclusion Ultrasonography can be used to diagnose hepatic hemangioma with high sensitivity and specificity. The rate of missed diagnosis and misdiagnosis rate is low, which can effectively distinguish between high and low echo foci and deserve clinical promotion.

Research progress on Micro RNA in early diagnosis and prognosis of ovarian cancer

MA Han-bo, LI Huai-fang

2018, 16(5): 826-829. doi: 10.16766/j.cnki.issn.1674-4152.000226

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Abstract:
Gynecological malignancies are detrimental to women's health, among which ovarian cancer has the highest mortality rate. It is characteristic of high morbidity rate, insidious process, early diagnosis difficulty and poor prognosis. Though great breakthrough has been made in the study of the cellular and molecular biology of ovarian cancer, the survival rate of this malignancy has not changed greatly since platinum-based-treatment was introduced to treat ovarian cancer more than thirty years ago. One reason for this high mortality rate is the lack of effective tools for detection in early stage of ovarian cancer. Hence, a high specific and sensitive biomarker is necessary. Recent studies mainly focus on MicroRNA (miRNA). miRNA is a class of endogenous non-coding RNA molecule, which plays an important role in gene expression by degradation or translation inhibition through base-pairing to complementary sites on the target mRNAs, usually in the 3'untranslated region. miRNA participates in almost all biological processes, including cell cycle regulation, cell proliferation, inflammation and tumorigenesis. Multiple studies show that plasma miRNA expression profiles can distinguish different types, stages and differentiation of ovarian cancer. For example, compared with healthy individuals, patients with endometriosis associated ovarian cancer, patients with endometriosis and patients with epithelial ovarian cancer have different plasma miRNA expression profiles. What's more, miRNA can regulate the tumorigenesis, progression, metastasis, drug resistance and recurrent of ovarian cancer, which closely correlate with survival rate of patients and offers abundant information for the treatment as well as prognostic evaluation. In conclusion, miRNA plays a key role in ovarian cancer, and it is an excellent biomarker for early diagnosis and prognosis evaluation of ovarian cancer.

Analysis of curative effect of Zhengan Xifeng decoction in patients with early ovarian dysfunction of kidney Yin deficiency

XU Dao-fen, CHEN Shu, HU Xin-xin, CHEN Xiang-yan, SUN Yun

2018, 16(5): 830-834. doi: 10.16766/j.cnki.issn.1674-4152.000227

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Abstract:
Objective To observe the efficacy of traditional Chinese medicine decoction (Zhengan Xifeng Decoction) in patients with kidney-yin deficiency type premature ovarian insufficiency (POI) and its effects on follicle stimulating hormone, luteinizing hormone and estradiol. Methods From January, 2015 to December, 2016, 64 patients with kidney-yin deficiency type POF were randomly divided into control group and experimental group (32 cases in each group). Patients were treated with hormone replacement therapy (HRT) and Tranquilizing Liver-wind decoction combined with HRT. The symptom scores, hormone (such as FSH, LH and E₂), antral follicles count (AFC) were comparatively analyzed. Results After treatment, the sweating, mood swings, fatigue, headache, skin ants, sexual life, less/amenorrhea syndrome scores and total score in the experimental group were significantly lower than those in the control group (P<0.05). There was no significant difference in menstrual status (such as the number of busts, menstrual cycle, and passage time) after treatment. The total effective rate of the control group and the experiment were 93.75% and 75.00% respectively (P<0.05). After treatment, FSH and LH levels were significantly decreased in both groups, E₂ and AFC were significantly increased, and the improvement of the experimental group was more obvious than the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the control group and the experimental group (18.75% and 9.38%, P>0.05). Conclusion Compared with simple hormone replacement therapy, combined with Zhengan Xifeng decoction in patients with kidney-yin deficiency type premature ovarian failure has a high clinical efficacy, can effectively regulate the hormone levels, and promote the recovery of ovarian reserve function.

Epidemiology of hand foot mouth disease in Bengbu city, 2008-2016

CHENG Xiao-lian, LIANG Yin-sheng, LI Yuan-li, CHEN Guo-ping, FU Guang-lin

2018, 16(5): 835-837,841. doi: 10.16766/j.cnki.issn.1674-4152.000228

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Abstract:
Objective To explore epidemiological characteristic of hand foot and mouth disease (HFMD) in Bengbu city by analyzing the report and monitoring data for providing scientific basis for prevention and control strategies. Methods We analyzed the monitoring data from 2008 to 2016 in the National Disease Surveillance Information Management System. The swabs of some cases were collected by the sentinel hospital and the detection of intestinal virus nucleic acid was carried out using the method of RT-PCR by the Bengbu center for disease control (CDC). Results A total of 65 464 HFMD including 33 severe cases and 6 fatal cases were reported in Bengbu city from 2008 to 2016, with an average annual incidence rate of 218.48/100 000, 271.32/100 000 in the city and 194.98/100 000 in the country. The city is higher than rural (χ²=189.35, P<0.01). The majority of cases were children below 5 years old, accounting for 96.67% (63 286/65 464). Children under 3 years old accounted for 74.09%(48 502/65 464). There are 13 laboratory diagnosed cases among 33 severe cases. The proportion of cases which had been diagnosed as enterovirus 71 (EV71) positive was 76.92%(10/13). Moreover, the death cases were all confirmed as EV71. Before 2013, EV71 was the only major etiological agents of HFMD in children in every odd-numbered year and in every even-number year EV71 and Cox-A16 were all the major etiological agents of HFMD. However, from 2014 to 2016 the detection rate of other enterovirus increased gradually. The positive rate of nucleic acid detection in clinical cases was 46.62% (1 588/3 406), and there was a statistical difference between the positive rate and the sampling time (χ²=104.292, P<0.01). Conclusion HFMD in Bengbu city has higher level of prevalence, as well as obvious regional, seasonal and crowd high-risk characteristic. EV71 is still the main cause of severe disease and death in HFMD and other intestinal viruses is increasingly becoming the epidemic strain. Case specimens should be collected and submitted as soon as possible.

Medical Integration curriculum and PBL Teaching in UCLA David Geffen Medical School and Its Enlightenments on Clinical Education of Geriatrics

ZHU Hong, MA Li-na, QIAN Yu-ying

2018, 16(5): 838-841. doi: 10.16766/j.cnki.issn.1674-4152.000229

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With the development of medical education reform, organ-based and system-centered medical integration courses and problem-based learning (PBL) teaching methods have been paying more and more attention to clinical teaching. PBL is an important product and milestone in the reform and development of clinical medicine education in the United States. Its core content is problem-based learning. Its goal is to cultivate students' self-learning ability, practice thinking ability and innovation ability. The author introduced the development of American clinical medicine education reform and PBL teaching method in detail, and the advanced experience of clinical medicine education of David Geffen School of Medicine, University of California, Los Angeles, especially PBL teaching method. Geriatric medicine has not been paid much attention in clinical teaching for a long time in China. The author brought the enlightenments to the clinical education of Geriatrics in China:to strengthen the clinical education of Geriatrics, optimize the curriculum and introduce PBL in clinical teaching, increase the guiding role of teachers, introduce humanities education and enhance students self-learning ability, problem-exploring, problem-solving ability and innovation ability. Meanwhile it introduces the humanistic education to the specialized courses in order to cultivate outstanding geriatrician.

Clinical analysis of anaphylaxis in chemotherapy of paclitaxel in cancer patients

HUA Yu-hui, WANG Wei-jia, ZHANG Hong-fang

2018, 16(5): 842-844,848. doi: 10.16766/j.cnki.issn.1674-4152.000230

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Abstract:
Objective To analyze the causes of the anaphylaxis of paclitaxel in the chemotherapy of cancer patients, and discuss the reasonable treatment measures that can be taken in clinic. Methods In 2017 in the cancer ward of Hangzhou Tumor hospital, the data of lung cancer patients who were treated with paclitaxel were analyzed retrospectively. A total of 223 patients were included, including 130 males and 93 females. The age ranged from 43 to 71 years old, and the average was (57.6±6.4) years old. There were 120 cases of central lung cancer and 103 cases of peripheral lung cancer. The pathological types were squamous cell carcinoma in 124 cases, adenocarcinoma in 84 cases, and squamous cell carcinoma in 15 cases. All the patients were used with paclitaxel for the first time, without any history of allergy. According to the manufacturer's instructions, the drug pretreatment (dexamethasone + diphenhydramine +cimetidine) was made before the treatment of Paclitaxel. Methods of paclitaxel administration:dosage 135-175 mg/m², intravenous infusion, at the first days of chemotherapy, or docetaxel 75 mg/m², intravenous infusion, at the first days of chemotherapy, 4 weeks for 1 course, and chemotherapy was for 4-6 courses. The data of medical records were collected, and the anaphylaxis of paclitaxel preparations in chemotherapy of tumor patients was analyzed. The causes and preventive measures for clinical application were discussed. Results The main reasons for anaphylaxis in paclitaxel chemotherapy were:inappropriate infusion set, lack of paclitaxel medication, mental stress and allergic constitution. Conclusion The standardization of paclitaxel can prevent and reduce the occurrence of anaphylaxis. Monitoring and standardizing the allergic reaction can improve the safety of paclitaxel chemotherapy.

Pharmacoeconomic evaluation of two quadruple therapies on peptic ulcer

LIU Mei, XU Duo, MA Xiao-fen, LIU Zi-xiu, LU Yu

2018, 16(5): 845-848. doi: 10.16766/j.cnki.issn.1674-4152.000231

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Abstract:
Objective To analyze and contrast the curative effect, safety and pharmacoeconomics meaning of OME (omeprazole) quadri-combination therapy and Lansoprazole quadri-combination therapy on treating peptic ulcer, which could provide reference for clinical use. Methods We collected 136 patients, treated in No.454 Hospital from January, 2015 to December, 2016, who suffered from gastric or duodenal ulcer, with positive results from C4-urea breath test and rapid urease test. The patients were randomly divided into OME group and Lansoprazole group, with 68 patients in each group. The two groups were given combined colloidal bismuth pectin, 200 mg/time, 3 times/d, amoxicillin and potassium clavulanate, 600 mg/time, 2 times/d, and clarithromycin, 500 mg/time, 1 time/d treatment. We added OME to the patients in OME group, 20 mg/time, 1 time/day. and Lansoprazole to the patients in Lansoprazole group, 30 mg/time,1 time/day, and then evaluated the curative effect and did the cost-effect analysis after one course of treatment (30 days). Results In OME group, the curative rate of treating ulceration is 94.12%, negative rate of C4-urea breath test is 92.65%, and negative rate of rapid urease test is 92.65%; in Lansoprazole group the curative rate of treating ulceration is 89.71%, negative rate of C4-urea breath test is 89.71%, and negative rate of rapid urease test is 91.18%; The curative rate of Lansoprazole quadri-combination therapy is higher than OME quadri-combination therapy, without significant difference. The additional expenditure could be accepted by patients who pay 215.38 RMB for improving one effective unit. Conclusion Lansoprazole quadri-combination therapy is better than OME quadri-combination therapy.

The clinical research of combing VSD with clinical nursing pathway in chronic osteomyelitis

ZHOU Xue-lai, SHEN Bin, XU Zhong-xiang, ZHANG Shi-shi, ZHANG Lan, TONG Pei-jian

2018, 16(5): 849-852. doi: 10.16766/j.cnki.issn.1674-4152.000232

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Objective To observe the application of CNP in combing flap transplantation with VSD in chronic osteomyelitis. Methods From May, 2013 to May, 2015,100 patients in TCM of Wenzhou hospital with chronic osteomyelitis were randomly divided into two groups and were given flap transplantation and VSD treatment. The control group was given routine nursing treatment, while the study group was treated by CNP. The hospitalization, wound healing time, VAS score, full weight-bearing time, dressing change times, catheterization time, hospitalization costs, recurrence rate, satisfaction rate, SAS, SDS, quality of life scores and curative effect were reviewed and compared in the two groups. The criteria for efficacy evaluation refer to the WHO's chronic osteomyelitis standard. Results The hospitalization[(5.29±1.31) weeks], wound healing time[(4.36±1.25) weeks], VAS score[(2.53±0.46) score], full weight-bearing time[(4.95±1.83) months], dressing change times (3.05±0.82), catheterization time[(9.65±1.82) day], hospitalization costs[(1.16±0.83) ten thousands yuan], SDS[(32.19±5.48) score], SAS[(37.24±5.06) score] in the research group were less than those in the control group without recurrence while the quality of life scores[(77.89±8.25) score], satisfaction rate (94%) and curative effect (94%) in the research group were higher than those in the control group with statistical significance (P<0.05). Conclusion The application of CNP in combing flap transplantation with VSD in chronic osteomyelitis can regulate the behavior of doctors and nurses, effectively control infection, repairing bone and skin soft tissue defect, promoting wound and fracture healing, relieving pain, shorten the hospital stay, improving nursing quality and reducing recurrence rate. The curative effect was promising.

Efficacy of the rehabilitation nursing with the seasons' change of time combined with psychological counseling in treating patients with depression of stroke hemiplegia

ZHANG Jian-guo

2018, 16(5): 853-855,859. doi: 10.16766/j.cnki.issn.1674-4152.000233

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Abstract:
Objective To investigate the efficacy of the rehabilitation nursing with the seasons' change of time combined with psychological counseling in treating patients with depression of stroke hemiplegia. Methods One hundred-four patients with post-stroke depression were chosen and randomly divided into control group and treatment group. All cases were given routine treatment referring to "Chinese stroke rehabilitation treatment guidelines". We regulated their blood sugar and blood fat level and blood pressure, corrected water electrolyte disorder, treated them with neurotrophic drugs, used oxygen uptake and infection prevention if necessary, and took orally aspirin enteric-coated metformin hydrochloride. Control group received Flupentixol and Melitracen every day with 1 tablet in morning. Based on the control group, treatment group was treated with the rehabilitation nursing with the seasons' change of time (on the day of admission, 2 days in hospital, and post-discharge) combined with psychological counseling according to the patient's individual differences. Efficacy was evaluated after 6 weeks. Scores of SDS, HAMD scale, and CSS were compared between two groups. Efficacy was analyzed in both groups. Results SDS score of treatment group was evidently lower than control group after 3 and 6 weeks' treatment (P<0.01). After treatment, scores of HAMD scale factors of treatment group were lower than those in control group (P<0.01). Total efficacy rate of treatment group was 92.31%, which was higher than control group as 76.92% (P<0.05). CSS score of treatment group was obviously lower than control group after 6 and 12 weeks' treatment (P<0.01). Conclusion Rehabilitation nursing with the seasons' change of time combined with psychological counseling in treating patients with depression of stroke hemiplegia can improve depression, and promote recovery of neural function.

Research of cluster intervention strategy on postoperative bleeding of elderly patients undergoing transurethral resection of the prostate and its prevention on bladder spasm

YANG Hui-mei, ZHAO Ya-ru, WANG Yu, LUO Xiao-hui, ZHANG Mei-xia

2018, 16(5): 856-859. doi: 10.16766/j.cnki.issn.1674-4152.000234

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Abstract:
Objective To investigate the preventive effect of cluster intervention strategy on postoperative bleeding of elderly patients undergoing transurethral resection of the prostate (TURP) and its prevention on bladder spasm. Methods A total of 86 elderly patients with BPH undergoing TURP in our hospital from January, 2015 to June, 2016 were selected and randomly divided into control group and intervention group, with 43 cases in each group. The control group received routine TURP perioperative nursing, and intervention group received cluster intervention strategy. The urodynamic indicators of two groups were monitored, the life quality and prostate symptom of two groups were assessed, postoperative bleeding, bladder spasm, and clinical effect of two groups were accounted. The data was analyzed to assessed the effect of cluster intervention strategy on postoperative bleeding of elderly patients undergoing TURP and its prevention on bladder spasm. Results After nursing, the Qmax levels of two groups were significantly increased (P<0.05), the RU, IPSS scores of two groups were significantly reduced (all P<0.05); the Qmax level of intervention group was significantly higher than that of control group (P<0.05), and RU,IPSS scores of intervention group was significantly lower than that of control group (all P<0.05). After nursing, physical function, psychological function and social function scores of intervention group were significantly higher than those of control group (all P<0.05). After nursing, hemorrhage and bladder spasm of intervention group were significantly better than those of control group (all P<0.05). The total clinical efficiency of intervention group was significantly better than that of control group (P<0.05). Conclusion The cluster intervention strategy could effectively improve the clinical effect of elderly patients undergoing TURP, improve postoperative urination disorders, and reduce postoperative bleeding, bladder spasm and other complications, thereby improving the life quality, and worthy of promotion.

XU Tao, CHEN Xian, DAI Zhen-zhen, WENG Xu-dong, YU Wan-jun

2018, 16(5): 860-862. doi: 10.16766/j.cnki.issn.1674-4152.000235

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2018 Vol. 16, No. 5

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