中华全科医学

The intention and influencing factors of registration of practitioners in the training before transferring the post of general practitioners in Yunnan Province

LI Wei-ming, SHU Qun-qin, HUANG Qiao-yun, JIANG Yan-ling, YUAN Dan, ZHAO He-he, LIU Jin-long, ZI Rong

2018, 16(6): 863-865,1024. doi: 10.16766/j.cnki.issn.1674-4152.000236

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Objective To understand the intention and influencing factors of the practitioner registration in the transfer training for general practitioners in Yunnan province, and to make some suggestions for improving the registration intention of the general practitioner in this group, and to provide reference for the relevant departments to promote the construction of the grassroots doctors team. Methods To adopt stratified cluster sampling method, 300 cases of primary medical and health workers in 6 counties of Yunnan Province participated in the training of general practitioners for the purpose of investigation, using self-designed questionnaire and interview outline to carry out on-the-spot investigation, including normal situation, the intention of practicing registration, influencing factors, etc, using general statistical description, χ² test, Non-conditional Logistic regression analysis and other methods for data analysis. Results The students who participated in the training of general practitioners in Yunnan province accounted for 41.5% of the titles. And 29.8% of the trainee trainees are willing to register as general practitioners. The reasons of registration are accordingly to become general practitioner, job appointment needs, competent administrative departments, and so on; 70.2% of the trainees are unwilling to register as general practitioner. The primary reason is not to reach the general practitioner registration conditions, others, no confidence in the career development of general practitioners. The results of non-conditional Logistic regression analysis showed that the factors affecting the willingness of the practitioner to register for the transfer training of general practitioners had the qualifications of practicing, and the problems of poor living conditions such as inadequate wages, low salary, shabby working conditions and housing were met in the basic medical and health work. Conclusion It is necessary to strengthen the career guidance of the trainees in the transfer training, improve the conditions of career development, improve the career development and living environment of the local doctors, and further improve the selection mechanism of the trainees.

LI Yong-peng, DOU Peng-fei

2018, 16(6): 866-867.

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Expression of STC2 in hepatocellular carcinoma and its significance

LI Zhi-peng, YANG Ying, JIA Chun-li, YANG Zhi-fang, ZHANG Rui-li, BAO Yong-xing

2018, 16(6): 868-870,1007. doi: 10.16766/j.cnki.issn.1674-4152.000237

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Objective To investigate the expression of STC2 (stanniocalcin-2, STC2) in patients with hepatocellular carcinoma and analyze the clinical significance in pathological features as well as prognosis. Methods The real-time RT-PCR and immunohistochemical method was used to detect the expression of STC2 in hepatocellular carcinoma, and the relationship among STC2, clinicopathological features and prognosis of hepatocellular carcinoma of the esophagus were analyzed. Results The positive rate of STC2 expression in hepatocellular carcinoma was 82.00%(82/100), which was higher than that in the non- hepatocellular carcinoma tissues[37.00%(37/100)], there was significant difference(χ²=42.017, P<0.01). The expression of STC2 was associated with tumor size (χ²=5.978, P=0.041), differentiation grade (χ²=19.06, P=0.001), tumor TNM stage (χ²=12.348, P=0.001) and portal vein tumor thrombus (χ²=11.718, P=0.001); the expression of STC2 had no correlation with gender (χ²=0.130, P=0.719), age (χ²=2.944, P=0.080), tumor number (χ²=1.967, P=0.132), and liver cirrhosis (χ²=0.014, P=0.638). The Kaplan-Meier survival curve showed that hepatocellular carcinoma patients with positive STC2 had shorter overall survival than that of patients with negative STC2(t=5.632, P=0.017). The result of real-time PCR showed that mRNA expression of STC2 was also significantly reduced in hepatocellular carcinoma tissues (t=8.273, P<0.01). Conclusion The aberrant expression of STC2 may be related to the occurrence and development of hepatocellular carcinoma and it may be a potential molecular target for treatment.

Reliability of infrared thermal imaging in evaluating the degree of stellate ganglion block

XIE Ke-yue, FEI Yong, HUANG Bing, YAO Ming

2018, 16(6): 871-873,942. doi: 10.16766/j.cnki.issn.1674-4152.000238

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Objective To evaluate the reliability of infrared thermal imaging techniques for assessment of stellate ganglion block. Methods Total 36 patients with subjective tinnitus in our hospital were chosen as the research objects. A stellate ganglion block was performed in affected side under the guidance of ultrasound. The therapeutic effect (G) was recorded as:cure (4 points):tinnitus disappeared; significant (3 points):tinnitus alleviated dramatically; effective (2 points):minimal response; invalid (1 point):no remission or exacerbation. The degree of blepharoptosis (L):significant (3 points):can be observed to significantly ptosis; minor (2 points):to slight ptosis can be observed, but not obvious; invalid (1 point):no ptosis by comparison of left and right sides. Infrared thermal imaging instrument was used to record the face infrared thermal imaging of patients before operation (Picture 1) and 10min after operation (Picture 2). The maximum temperature difference between the symmetry facial regions was recorded as ΔT. Linear correlation of G value with L value and ΔT (℃) was analyzed. Results The therapeutic effect:cure 10/36, significant 17/36, effective 7/36 and invalid 2/36, the G w value as 2.97±0.85; The degree of upper eyelid droop (L):significant 7/36, minor 17/36 and invalid 12/36, the L value was 1.92±0.73; Postoperative ΔT was (1.27±0.51)℃. There was no correlation between value G and value L, and the correlation coefficient was 0.037 (P>0.05); There was correlation between value G and Δ T (℃), and the correlation coefficient was 14.016 (P<0.05). Conclusion Horner's syndrome cannot give an objective evaluation for the degree of stellate ganglion block; however, the infrared thermal imaging is an reliable and useful technique for assessment of the degree of stellate ganglion block.

Association study between ApoE genetic polymorphism and vascular dementia after cerebral infarction

LUO Fu-gang, CHEN Mei-fang, ZHANG Long, CHI Shu-mei, SONG Ming-fen

2018, 16(6): 874-877. doi: 10.16766/j.cnki.issn.1674-4152.000239

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Objective To study the distribution of ApoE genetic polymorphism and its influence on the latency and severity of vascular dementia after cerebral infarction. Methods Hachinski Inchemic Score Test and Mini Mental State Examination (MMSE) were performed to test the frontotemporal cerebral infarction patients. Those with Hachinski ≥ 7 and MMSE ≤ 24 were recruited in the VD group. Meanwhile, the healthy controls were included. The intervals from first episode of cerebral infarction to first diagnosis of VD were obtained and considered as the latency. MMSE scores were used as the index of severity. Blood samples from all subjects were collected for ApoE genetic polymorphism test by PCR. Chi-square test was used to compare the distributions of ApoE genetic polymorphism and student t-test was performed to analyze the difference of latency and MMSE scores between the VD group and the control group. Results The VD group had obviously higher ε4 allele frequency (30.38%, 48/158) and ε4 genotype frequency (45.57%, 36/79) as compared to those of the control group (15.62%, 25/160; 28.75%, 23/80) (P=0.002 and 0.028). ApoE ε3 allele frequency (60.76%, 96/158) and ε3 genotype frequency (45.57%, 36/79) were significant lower in the VD group as compared with the control group (77.50%, 124/160; 61.25%, 49/80, P=0.001 and 0.047). No significant difference was observed in ε2 allele and genotype frequency between the two groups. VD patients with ε4 genotype had an obviously shorter mean latency after first-onset of cerebral infarction[(13.44±6.00) months] as compared with ε2 genotype[(22.43±9.01) months] (P=0.003). However, there was no significant difference in the severity of VD among three genotypes (P>0.05). Conclusion ApoE ε4 genotype may be associated with the susceptibility of VD and it may shorten the latency of VD after cerebral infarction.

Effect of the combination of sufentanil and lornoxicam on preventing postoperative agitation in patients undergoing sevoflurane anaesthesia for endoscopic sinus surgery

LIU Gang, MENG Yan, LI Xiao-hong

2018, 16(6): 878-880,909. doi: 10.16766/j.cnki.issn.1674-4152.000240

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Objective To observe the effect of the combination of sufentanil and lornoxicam on preventing postoperative agitation in patients undergoing sevoflurane anaesthesia for endoscopic sinus surgery. Methods Total 60 patients undergoing endoscopic sinus surgery during sevoflurane anesthesia were enrolled into this study. There were 39 men and 21 women, ranging from 20 years old to 60 years old. Both of them belonged to the ASA Ⅰ or Ⅱ. The double-blind experiment design was applied. According to the random number table, these patients were divided into three groups:the sufentanil group (S group), sufentanil+lornoxicam group (SL group) and the control group (C group), with 20 patients in each group. The inhalation anesthesia was used in all the three groups. During the operation, sevoflurane combined with the remifentanil was applied to maintain depth in the whole process. These patients were injected with sufentanil 0.2 μg/kg (S group), sufentanil 0.1 μg/kg+lornoxicam 8 mg (SL group) and equivalent 0.9% sodium chloride solution (C group) through the veins before finishing surgery for 30 min. The tube drawing time, recovery time, dysphoria after tube drawing, VAS scoring and post-operative 24 h nausea and vomiting occurrence of each group were observed. Results By comparing with the C group, postoperative agitation after tube drawing in S and SL groups was obviously reduced. VAS scoring was obviously reduced (P<0.05). There was no statistical significance between S group and SL group (P>0.05). The tube drawing time and recovery time of SL group and C group were reduced. The occurrence of nausea and vomiting during post-operative 24 h was reduced (P<0.05). There was no statistical significance between SL group and C group (P>0.05). Conclusion Intravenous injection of sufentanil and lornoxicam can reduce postoperative agitation in patients undergoing endoscopic sinus surgery during sevoflurane anesthesia. And it won't affect postoperative recovery, tube drawing time, and occurrence of nausea and vomiting during post-operative 24 h.

Research of heat generation and irrigation in digital guided dental implant surgery

XU Xu, LIAO Wen-qing, JIANG Xian-feng, PENG Wei, YOU Jia

2018, 16(6): 881-884. doi: 10.16766/j.cnki.issn.1674-4152.000241

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Objective To study the Thermogenesis mechanism of bone during digital dental implant surgery with guide plates and to analyse the cooling effect of bone under three kinds of different irrigation methods (internal cooling, regular external cooling and jet cooling). Methods Using DuraForm nylon to replace cortical bone, a 2 mm diameter drill was selected to prepare a hole with depth of 10 mm, and simulating procedure of digital plant operation. A NC platform was built to control the drilling rate. At the same time, the small thermocouples were embedded at a serials deepness of 4, 6, 8 and 10 mm, and in the direction of radius the couples were distributed from 0.5 mm to 6.0 mm away from hole wall at intervals of 0.5 mm. Through temperature measurement instrument and the temperature record software,every measuring point temperature during the process of drilling was recorded, and the cooling effect between internal cooling, regular cooling and jet cooling was compared. Results When preparing a hole at the depth of 10 mm, the heat-affected zone was in the scope of 6 mm being away from hole wall(2 mm in diameter), and there was a highest temperature at the depth of 6 mm, and the highest temperature arrived 46.2℃ in regular cooling group, the highest temperature of internal cooling group and the jet cooling group was 24.6℃ and 12.5℃ respectively. Conclusion Drilling a hole with guide plates,the internal cooling have the best cooling effect, while cooling effect of the conventional drill bit is not good. But using jet cooling,combined with designed cooling channel on the guide template can be matched with obtain favorable result and significantly reduce the temperature of bone tissue in the process of drilling hole. In addition, using conventional to drill hole in the process of pulling the drill bit by several times, can get a certain cooling conditions and obtain a certain degree of cooling effect.

Expression and significance of cathepsin-L in papillary thyroid carcinoma

LI Zhi-ping, ZHU Jian-dong, ZHUO Wen-fang

2018, 16(6): 885-888. doi: 10.16766/j.cnki.issn.1674-4152.000242

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Objective To investigate the expression of cathepsin L (CTSL) in papillary thyroid carcinoma (PTC), and analyze the relationship between the expression of CTSL and the clinicopathological parameters or the prognosis in patients. Methods Total 100 cases of PTC tumor tissue and non-tumble tissue were studied. Immunochemistry was used to detect the expression of CTSL protein in cancer tissues, and the relationship between PAGE4 protein and parameters or prognosis of patients was analyzed. Results The positive rate of CTSL expression in cancer tissues was 100.00%, which was significantly higher than that in adjacent normal tissues 5.00%, the difference was statistically significant (χ²=87.947, P<0.001). The high expression rate of CTSL was 50.00%, 80.00%, 100.00%, 100.00% in TNM stage Ⅰ, Ⅱ, Ⅲ, Ⅳ, respectively. There were significant difference among the four groups (χ²=16.875, P=0.001). The high expression rate of CTSL was 97.06% in lymph node metastasis, which was significantly higher than that without lymph node metastasis 57.69%, the difference was statistically significant (χ²=11.916, P=0.001). The high expression rate of CTSL in the primary tumor was 82.35%, which was significantly lower than that in the lymph node metastasis 97.06%, the difference was statistically significant (χ²=2.548, P=0.110). Conclusion The up-regulation of CTSL expression in PTC tumor tissue is closely related to the pathological parameters such as TNM stage and lymph node metastasis, and it can used as a predictor of disease progression and lymph node metastasis potential.

Causes and prognosis analysis of postoperative severe infection in the kidney transplantation

LI Quan-yuan, YAN Li-qin, WEI Jian, SHI Xiu-yan

2018, 16(6): 889-891. doi: 10.16766/j.cnki.issn.1674-4152.000243

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Objective To explore the causes of postoperative severe infection in the kidney transplantation and evaluate the prognosis of patients. Methods The clinical and follow up data of 125 kidney transplantation patients in our hospital between September, 2005 and February, 2015 were studied. All patients were given perioperative immune inhibiting intervention; the induction regimen was 20 mg qd basiliximab for injection before the operation and 4 days after the surgery. The postoperative severe infection was observed, and possible etiologic factors were explored and analyzed. The clinical outcome of patients was recorded. Results Among the 125 recipients, 22 were with positive reactive antibody. Thirty-one patients were with severe infection (24.8%), among them, 4 patients died (3.2%). The isolated 35 strains of bacteria from these 31 patients included 7 strains of pseudomonas aeruginosa, 6 strains of Klebsiella pneumoniae, 4 strains of Haemophilus influenzae, 3 strains of Escherichia coli, 3 strains of acinetobacter Baumann/hemolysis, 2 strains of enterobacter cloacae, 2 strains of pseudomonas maltophilia, and 8 strains of staphylococcus epidermidis. Univariate analysis showed that the primary disease, history of cardiopulmonary resuscitation and history of antibiotic of donors, the age of recipient, the number of transplants were related to the postoperative severe infection (P<0.05). Binary Logistic regression analysis showed that the number of transplants and history of antibiotic of donor were the major independent risk factors for the postoperative severe infection (P<0.05). The antibiotics and symptomatic treatment can improve the prognosis of patients. Conclusion The postoperative severe infection in the kidney transplantation is common, the number of transplants and donor history of antibiotic are the main causes for the postoperative severe infection. The effective clinical measures should be taken to prevent and control the infection.

Application of ¹⁸F-FDG, PET-CT, and CIK in the treatment of diffuse large cell lymphoma in patients with newly diagnosed diffuse large B cell lymphoma

SHEN Xiao-dong, WANG Xi, QIAN Shen-xian

2018, 16(6): 892-895. doi: 10.16766/j.cnki.issn.1674-4152.000244

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Objective To observe the application of ¹⁸F-FDG PET-CT-CIK in the treatment of diffuse large ¹⁸F-FDG cell lymphoma in patients with newly diagnosed diffuse large B cell lymphoma. Methods From the Department of Hematology in our hospital patients with diffuse large B cell lymphoma in 140 cases, all patients were given high CIK cells combined with R-CHOP chemotherapy before chemotherapy and after 3 cycles of chemotherapy, the traditional CT and ¹⁸F-FDG PET-CT scan on patients before treatment, compared with the traditional ¹⁸F-FDG PET-CT CT examination results, and according to the response to chemotherapy were divided into complete response group, partial response group and non-response group three groups, each group of patients before and after treatment were the maximum standard uptake(SUV_max), and the rate of complete remission. Results Before treatment, compared with the traditional CT, the sensitivity of ¹⁸F-FDG PET-CT in the diagnosis of lymph node region and extranodal lesions, the accuracy is significantly higher, the difference was statistically significant (P<0.05). After the treatment, the complete response group, partial response in group SUV_max was significantly lower (P<0.05); the SUV_max value before treatment compared. Complete response group, partial response group, non-response group (P<0.05); compare the value of SUV_max after treatment, complete response group < partial response group < non response group, the difference was statistically significant (P<0.05). Three groups of patients with complete remission rate, complete response group, partial response group, non-response group, the difference was statistically significant (P<0.05). Conclusion ¹⁸F-FDG PET-CT diagnostic sensitivity of diffuse large B cell lymphoma, the accuracy is higher than that of the traditional CT, ¹⁸F-FDG, PET-CT examination in the autologous CIK cells combined with chemotherapy treatment period, can clear to treatment with drug reaction, predictive value of the therapeutic effect and prognosis.

Predictive value of left atrial volume index in atrial fibrillation after off-pump coronary artery bypass grafting surgery

JIN Qi-lin, ZHANG Liang

2018, 16(6): 896-898. doi: 10.16766/j.cnki.issn.1674-4152.000245

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Objective To investigate the relationships between left atrial volume index (LAVI) and atrial fibrillation (AF) after off-pump coronary artery bypass (OPCABG) and evaluate the predictive value of LAVI. Methods The clinical data of 97 cases of OPCABG from January, 2016 to December, 2017 were collected, they were examined preoperatively on transthoracic echocardiography, The left atrial volume was measured by three-dimensional ultrasound, and the height and weight were measured, and the Standardized Surface Area was calculated. All patients were divided into atrial fibrillation group and non-atrial fibrillation group. By compared the clinical relative factors of the two groups patients, analyzed the factors of LAVI, age, medical history, Premedicate, with AF after OPCABG According to LAVI ≥ 32 ml/m², the occurrence of atrial fibrillation between the two groups was compared. Results Univariate analysis showed that the age, left atrial volume index, in the AF group were significantly higher than that of the non-AF group, left ventricular ejection fraction in the AF group were significantly lower than that of the non-AF group (P<0.05). Multifactor analysis showed that the left atrial volume index was an independent predictor of atrial fibrillation after OPCABG. In patients with LAVI ≥ 32 ml/m², the incidence of atrial fibrillation increased significantly after OPCABG. Conclusion LAVI was an independent predictor of atrial fibrillation after OPCABG, effective prevention and timely treatment of postoperative atrial fibrillation, shortened hospital stay and improved prognosis.

Expression and correlation of miR-19a and TNF-α in patient with oral lichen planus

WANG Liang, WU Wei, CHEN Ji-jun, ZHANG Shun, LI You-hua, XU Ming, CAI Ya-wei

2018, 16(6): 899-902. doi: 10.16766/j.cnki.issn.1674-4152.000246

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Objective To investigate the expression of miR-19a and TNF-α in patients with Oral lichen planus (OLP), explore the relation to each other, and analyze the relationship between them and clinicopathological parameters. Methods From January, 2015 to January, 2016, 43 cases of oral mucosal tissue from OLP patients (study group), 30 cases of oral squamous cell carcinoma specimens (carcinoma gorup) and 30 cases of normal oral tissue samples (control group) were collected. The expression of miR-19a and TNF-α mRNA in different tissues from the three groups was detected by real-time quantitative PCR (qRT-PCR), and the relationship between the expression of miR-19a and TNF-α mRNA and the clinical parameters of patients with oral lichen planus was analyzed. Results Compared with the control group, the expression levels of miR-19a(t=5.912, P<0.001) and TNF-α mRNA (t=21.938, P<0.001) in the study group were significantly increased. Compared with carcinoma group, the expression levels of miR-19a (t=3.980, P<0.001) and TNF-α mRNA(t=6.052, P<0.001) in the study group were significantly lower. The expression of miR-19a and TNF-α was correlated with age, sex, course of disease and clinical phenotype (P<0.05). TNF-α mRNA level increased with the expression level of miR-19a in oral mucosal tissue from OLP patients, there was an positive correlation (r=0.495,P<0.05). Conclusion The expression of miR-19a and TNF-α mRNA in oral mucosal tissue from OLP patients was significantly increased, which was related to age, sex, duration and clinical phenotype.

Clinical efficacy of mouse nerve growth factor in the treatment of acute cerebral infarction

YANG Fan, CHEN Jun-liang, ZHOU Ge-zhi, TONG Min-feng

2018, 16(6): 903-905. doi: 10.16766/j.cnki.issn.1674-4152.000247

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Objective To evaluate the clinical efficacy of mouse nerve growth factor (NGF) in the treatment of acute cerebral infarction. Methods A total of 100 cases of acute cerebral infarction were included in this study and randomized divided into treatment group (n=50) and control group (n=50). All the included patients were given regular treatment, including antiplatelet, lipid-regulating, blood glucose and pressure controlling, rehabilitation. The patients in the treatment group were given NGF 18 μg for injection based on regular treatment, once a day, for 4 weeks. Two weeks and 1 month after the treatment, the date of clinical efficacy was compared between the two groups. The clinical efficacy was evaluated according to modified Rankin scale (mRs), Barthel index (BI) and National Institute of Heath Stroke Scale (NIHSS). Results Significant difference in mRs (2.75±0.19 vs. 3.12±0.23) and BI (46.22±5.41 vs. 42.95±6.72) were noted between the treatment group and control group after 2 weeks treatment (P<0.05). Significant difference in mRs (2.23±0.15 vs. 2.78±0.18) and BI (59.56±4.28 vs. 53.21±6.45) were noted between the treatment group and control group after 1 month treatment (P<0.05). The clinical efficacy in the treatment group was better than that in the control group, 84.0% vs.66.0% at two weeks, and 96.0% vs.82.0% at one month according to NIHSS. Conclusion Mouse nerve growth factor combined with regular treatment can significantly improve the neurological defects in the patients with acute cerebral infarction and improve the efficacy of the treatment.

Comparison of different antithrombotic therapies in patients with atrial fibrillation coronary artery disease after percutaneous coronary intervention

DONG Ling-ling, LIU Jun, WU Ji-xiong, ZHOU Li-min, LIU Yu

2018, 16(6): 906-909. doi: 10.16766/j.cnki.issn.1674-4152.000248

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Objective Comparison of different strategies in patients with atrial fibrillation (AF) complicated coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI). Methods A total of 90 AF+CAD patients undergoing PCI were divided into trigeminy antithrombotic therapy group (TT group, n=30), bigeminy antithrombotic therapy group[DT group, n=30] and warfarin and clopidogrel group (WS group, n=30) based on the antithrombotic therapies after discharge; Other secondary preventions were the same in these groups. These patients were followed up around 12 months for clinical outcome events the data of which were recorded and analyzed. Results The overall patients had higher risk of stroke (CHA2DS2-VASc score ≥ 2, 58%) and a slightly lower risk of bleeding(HAS-BLED score ≥ 3, 49%), but there was no significant statistical difference (P>0.05). Patients with triple antithrombotic therapy had a significant reduction in stroke and major adverse cardiac and cerebral events (MACCE, 6.7%, χ²=6.193, P=0.045). Bonferroni pairwise comparison indicated that TT and DT groups showed statistical significance(χ²=5.454, P=0.021) while the other two groups had no significant difference(P>0.05). The results showed that there was a difference between TT group and DT group (χ²=5.454, P=0.021) by Bonferroni method, but there was no statistical difference between the other two groups (P>0.05).The incidences of major bleeding among three groups had no statistical significance (χ²=0.000, P=1.000). The TT group had a high rate of secondary bleeding(13.3%) but the three groups had no significant difference (χ²=1.098, P=0.577). Conclusion For patients with atrial fibrillation complicated with coronary heart disease after PCI, the rate of ischemic stroke and MACCE in TT group was better than that in other group, and there was no difference between WS group and DT group.

Study of ECG criterions for the diagnosis of left ventricular hypertrophy

WU Jian-min, LIN Jia-feng

2018, 16(6): 910-912,1039. doi: 10.16766/j.cnki.issn.1674-4152.000249

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Objective To explore the ECG criterions for the diagnosis of left ventricular hypertrophy. Methods In the Second Affiliated Hospital of Wenzhou Medical University from June, 2015 to June, 2016,166 patients with high voltage left ventricle were diagnosed by electrocardiogram, and the sensitivity and specificity of different morphological ECG criteria were evaluated by echocardiography as the "gold" standard. Results Echocardiography revealed 81(48.79%) of left ventricular hypertrophy in 166 patients who were diagnosed by electrocardiogram (ECG) as left ventricular high voltage. Among them, there were 126 cases of Sokolow index, 75 cases were left ventricular hypertrophy, and the positive rate was 59.52%. The diagnostic accuracy, specificity and sensitivity were 62.66%, 40%, 92.59% respectively, and 82 cases conformed to the Sokolow index with ST-T change, and the positive detection rate was 70.73%, higher than Sokolow. The positive detection rate, accuracy, specificity and sensitivity of ECG were 71.69%, 71.76% and 71.60% respectively. There were 91 cases of Sokolow index with ST-T and Cornell index. The positive rate was 83.52%, which was significantly higher than the positive rate of the previous two methods. The accuracy, specificity and sensitivity of Sokolow index with ST-T and Cornell index were 87.95%, 82.35%, and 93.82% respectively. Compared with the accuracy, specificity and sensitivity of the former method, the difference was statistically significant(P<0.05). Conclusion Electrocardiogram Sokolow index combined with ST-T changes and Cornell index can greatly improve the accuracy, sensitivity and specificity of diagnosing left ventricular hypertrophy, and even to a certain extent, assess the degree and severity of hypertrophy, which is worthy of clinical application and promotion.

Effect of Shuxuetong injection on acute cerebral infarction and its influence on the reconstruction of collateral circulation infarction area

LU Xu-dong, WANG Yan-ping

2018, 16(6): 913-915,968. doi: 10.16766/j.cnki.issn.1674-4152.000250

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Objective To explore the curative effect of Shuxuetong Injection on the treatment of acute cerebral infarction and its effects on the reconstruction of collateral circulation in the infarcted area. Methods Ninety patients with acute cerebral infarction who had been seeking treatment in the hospital from April, 2015 to August, 2016 were selected and randomly divided into control group and observation group according to the random number table, with 45 cases in each group. Patients in the control group were given routine treatment plus Ozagrel Sodium Chloride Injection for treatment, whereas those in the observation group were treated additionally with Shuxuetong Injection based on the treatment given to the control group. The clinical effects, adverse reactions, hs-CRP in serum (C-reactive protein) before and after treatment, TNF-α, IL-6 (interleukin-6), daily living ability, microvascular display grading of collateral circulation and safety in the two groups were compared. Results The total effective rate of treatment in the observation group was (91.11%) shown to be significantly higher than that (71.11%) in the control group, and the difference was statistically significant (P=0.038). There was no significant difference in the levels of serum inflammatory cytokines, ADL score and display grading of collateral vessels in the two groups before treatment (P>0.05). After treatment, the levels of hs-CRP, TNF-α and IL-6 in the observation group were all shown to be significantly lower than those in the control group, and the difference was statistically significant (P<0.05). The ADL score in both groups was improved after treatment, with improvement in the observation group more significant than that in the control group, and the difference was statistically significant (P<0.05). In the observation group, there were 8 cases (17.78%) whose collateral vessels displayed at grading 2, and the figure was 2 (4.44%) in the control group, where the difference between the two groups was statistically significant (P<0.05). There was no obvious adverse reaction in the two groups during the treatment. Conclusion Shuxuetong Injection has significant curative effect in the treatment of acute cerebral infarction, which can effectively improve the clinical efficacy and the serum levels of inflammatory factors, and enhance their ability of daily living, playing an important role in the reconstruction of collateral circulation in the infarcted area; therefore, it is of significant value to be popularized in clinical application.

A retrospective analysis of 78 cases of diffuse large B-cell lymphoma treated with CHOP chemotherapy regimen combined with rituximab

WANG You-qun, TANG Xiao-wan

2018, 16(6): 916-918. doi: 10.16766/j.cnki.issn.1674-4152.000251

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Objective To investigate the effect of CHOP chemotherapy regimen combined with rituximab on diffuse large B-cell lymphoma (DLBCL). Methods A total of 78 patients with DLBCL were divided into two groups according to the different treatment plan:observation group (n=41) and control group (n=37). The control group was given CHOP chemotherapy with cyclophosphamide 750 mg/m², intravenous drip, 1 times/day, d1; epirubicin 50 mg/m², intravenous drip, 1 times/day, d1; vincristine 1.4 mg/m², intravenous drip, 1 times/day, d1; dexamethasone 15 mg/m², intravenous drip, 1 times/day, d1-5, the observation group based on the control group combined with rituximab 375 mg/m², intravenous drip, 1 times/day, d0. When compared the clinical curative effect between the two groups, the level of inflammatory factors and adverse reaction conditions. Results The effective rate of TNF-α in the observation group(78.05%) was significantly higher than that in the control group(59.46%), P<0.05. After treatment, the level of TNF-α in the observation group was significantly higher than that in the control group (P<0.05), but the increase in the control group was not significant (P>0.05). The decrease in the observation group was significantly stronger than that in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion CHOP regimen combined with rituximab therapy can improve the clinical efficacy of DLBCL patients, the level of anti-inflammatory factor was increased and the expression of proinflammatory cytokines was decreased. The safety of anti-inflammatory factor was not significantly different from that of CHOP alone, worthy of clinical promotion.

Efficacy and safety of minimally invasive percutaneous interbody fusion in the treatment of single segmental Ⅰ and Ⅱ degenerative lumbar spondylolisthesis

WANG Ji-xin, LAN Si-heng, LIU Hua-fei, LI Fang-cai

2018, 16(6): 919-921. doi: 10.16766/j.cnki.issn.1674-4152.000252

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Objective To investigate the clinical effect and safety of minimally invasive transforaminal interbody fusion in the treatment of single segment Ⅰ and Ⅱ degenerative spondylolisthesis. Methods A total of 92 patients with degenerative lumbar spondylolisthesis were selected from June, 2015 to June, 2017. They were randomly divided into 46 cases in the control group and 46 cases in the observation group.The control group was treated by conventional open surgery,and the observation group received minimally invasive transforaminal interbody fusion. The operative related indicators,lumbar function, pain degree and postoperative complications of the two groups were observed. Results Intraoperative blood loss and postoperative drainage volume in the observation group were significantly less than those in the control group. Postoperative hospitalization time was shorter than that in the control group, and the operative time was significantly longer than that in the control group. The difference was statistically significant (P<0.05). There was no significant difference in lumbar function and pain between the two groups before operation (P>0.05). After 3 months, the JOA score in the observation group was significantly higher than that in the control group,and the ODI index and VAS score were significantly lower than those in the control group. The difference was statistically significant (P<0.05). The incidence of complication was 2.17% in 1 case of incision infection, 3 cases of incision infection, 1 case of dural capsule tear, 1 case of fusion device were poor, and the incidence of complication was 17.39%, the difference was statistically significant (P<0.05). Conclusion Minimally invasive intervertebral foramen interbody fusion for treatment of single segmental Ⅰ and Ⅱ degenerative lumbar spondylolisthesis can effectively relieve pain in patients. It can reduce bleeding during operation and reduce complication risk. It is worth popularizing.

Clinical observation of the treatment of posterolateral tibial plateau fractures guided by four-column classification system

YE Zhang-qing, YANG Yang, WANG Tao, ZHANG Bao-liang, ZHANG Hai-lin, LIN Hua, LIANG Jun-bo

2018, 16(6): 922-924,928. doi: 10.16766/j.cnki.issn.1674-4152.000253

235 0

Abstract:
Objective To observe the effect of posteromedial approach and posterolateral approach for posterolateral tibial plateau fractures guided by four-column classification system. Methods From January, 2014 to June, 2016, 14 cases of tibial plateau fracture merge with articular surface collapse were included in the group. There were 11 males and 3 females. The average age was (42.3±8.1) years. The patient had ligamentous injuries, but no meniscus injury. The types of Schatzker fracture were as the follows:8 cases of type Ⅴ, and 6 cases of type Ⅵ. The patients were treated with internal fixation and internal fixation through both posterior and posterior lateral approach. To evaluate the clinical effect of the operation, the fracture healing, HSS knee joint score, and the occurrence of complications were investigated. Results All the 14 patients successfully completed the operation without complications. The average operation time was (3.44±0.85) h. The average amount of bleeding was (352.05±103.68) ml during the operation. The patients received bone healing (X-ray confirmed healing), the healing time was 11-19 weeks, and the average healing time was (14.7±1.6) weeks. Clinical effect:9 cases were excellent, 4 cases were good, the total excellent rate was 92.86%. Until June 30 in 2017, the follow-up times was 12-28 months, the average follow-up time was (18.1±3.9) months. And the average HSS score of the knee joint function was (86.4 ± 3.1) scores. No postoperative complications and follow-up period. Conclusion This study has been operated on the posterior lateral column fracture of tibial plateau by the four-column classification system, which makes the patients get better rehabilitation and limb function recovery.

Changes of balance function and related factors in patients with Parkinson's disease

CHEN Fang-ping, ZHU Xue-jiao

2018, 16(6): 925-928. doi: 10.16766/j.cnki.issn.1674-4152.000254

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Abstract:
Objective To investigate the change of balance function and its related factors in Parkinson's disease, the aim is to provide reference value for clinical prevention and treatment. Methods Two hundred and seventy-nine patients with Parkinson's disease who were admitted to our hospital from January, 2015 to January, 2017 were selected, in terms of balance dysfunction was divided into 90 cases of normal balance function group and 189 cases of balance dysfunction group. The factors such as gender, age, course of disease, educational level and visual condition were investigated. Results Two hundred and seventy-nine patients with Parkinson's disease showed balanced dysfunction in 189 cases (balanced dysfunction group), the incidence was 67.74%; 90 patients with normal balance function (balanced function normal group) 32.26%. The Berg balance scale (BBS) score and Dynamic fall risk index (DFI) score of the balanced dysfunction group were lower than that of the normal group, and the Static fall risk index (SFI) score was higher than that of the normal group with balanced function (P<0.05). After the intervention, the BBS score and DFI score were higher than those before intervention, and the SFI score was lower than that before intervention (P<0.05). The single factor analysis showed that there was no significant difference in gender, education level, Parkinson family history, antidepressants and sedative drugs in the balance dysfunction group and the normal balance function group (P>0.05), while the age, course of disease and visual condition were statistically different (P<0.05). Multivariate regression analysis was used to analyze the univariate analysis. Age, duration and visual condition were independent risk factors of balance dysfunction. Conclusion Patients with Parkinson's disease have higher balance dysfunction. After intervention. The balance function can be improved obviously. Age, duration of disease and visual condition are independent risk factors of balance dysfunction, precautionary measures should be taken in accordance with relevant risk factors to reduce the balance of dysfunction.

Effect of Shenmai injection with hemoperfusion in treatment of myocardial depression in septic shock

LU Di, YU Guo-feng, LÜ Tie, YING Li-jun

2018, 16(6): 929-931,973. doi: 10.16766/j.cnki.issn.1674-4152.000255

205 0

Abstract:
Objective To investigate the effect of Shenmai injection with hemoperfusion on myocardial depressant factor(MDF) and cardiac function in septic shock. Methods In this study, 60 patients with septic shock in our Department were randomly divided into 3 groups with 20 cases in each group:the control group, the Shenmai injection group and the Shenmai injection with hemoperfusion group. All the patients received regular therapy. The patients in the Shenmai injection group were treated with Shenmai injection on the basis of the control group. The patients in the Shenmai injection with hemoperfusion group were treated with hemoperfusion(HA330) on the basis of the Shenmai injection group. The levels of APACHEⅡ score, cardiac index(CI), brain natriuretic peptide(BNP), high mobility group protein B1(HMGB-1), leukotriene(LT) and endothelin1(ET-1) before treatment and after seven days of treatment were observed. Results APACHEⅡ score, CI, BNP, HMGB-1, LT and ET-1 among the three groups were not significantly different from each other before the treatment(P>0.05). Compared with those before the treatment, APACHEⅡ score, BNP, HMGB-1, LT and ET-1 in all the three groups decreased after the treatment, CI increased after the treatment, and it was statistically significant(P<0.05). Compared with the control group and the Shenmai injection group, APACHE Ⅱ score, BNP, HMGB-1, LT and ET-1 in the Shenmai injection group were decreased after treatment, and CI was increased, and it was statistically significant(P<0.05). Compared with the Shenmai injection group and the Shenmai injection with hemoperfusion group, APACHE Ⅱ score, BNP, HMGB-1, LT and ET-1 in the Shenmai injection with hemoperfusion group were decreased after the treatment, and CI was increased, and it was statistically significant(P<0.05). Conclusion Shenmai injection with hemoperfusion can reduce the level of myocardial depressant factors, improve the ability of cardiac function and the survival rate of patients in septic shock.

Risk factors of pulmonary infection in chronic renal failure patients undergoing maintenance hemodialysis

YE Hong-ying, YING Jun, FANG He-jing, HUANG Jian

2018, 16(6): 932-934. doi: 10.16766/j.cnki.issn.1674-4152.000256

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Abstract:
Objective To investigate the risk factors for pulmonary infection in chronic renal failure patients undergoing maintenance hemodialysis. Methods A total of 344 patients undergoing maintenance hemodialysis with a duration of more than 6 months from January, 2011 to December, 2016 in the department of blood purification center in Jinhua Municipal Central Hospital were reviewed retrospectively. Among them, 179 cases (52.0%) were male and 165 cases (48.0%) were female. The mean age was (56.7 ± 16.3) years. The 344 patients were dichotomized into the pneumonia group (52 cases, 15.1%) and the non-pneumonia group (292 cases, 84.9%), based on whether or not suffering pneumonia on the duration of hemodialysis. The data of the two groups, including demography, medical history, and renal function before the first time of hemodialysis, the level of calcium phosphorus metabolism and anemia, proportion of kidney disease were analyzed. Logistic regression analysis was applied to reveal the risk factors of pneumonia in patients undergoing hemodialysis. Results Multivariate Logistic regression analysis revealed that age ≥ 60 years (OR=1.833, 95% CI:1.216-2.521, P=0.023), diabetes mellitus (OR=1.542, 95% CI:1.178-2.934, P=0.035), cardiac functional grading (OR=3.325, 95% CI:2.154-5.243, P<0.001) and hemoglobin (Hb) <70 g/L (OR=2.119, 95% CI:1.745-3.634, P=0.014) were independent risk factors. Conclusion Pneumonia is a common complication in the patients undergoing hemodialysis. Age ≥ 60 years, diabetes mellitus, cardiac functional grading and Hb < 70 g/L are independent risk factors of pneumonia in the patients undergoing hemodialysis, which need the early assessment and intervention.

Effects of water birth in deep water level on maternal and newborns

ZHANG Yin-xue, ZHOU Li-qun, ZHANG Hui-zu, ZHANG Xue-mei, ZHANG Zhi-qun

2018, 16(6): 935-937. doi: 10.16766/j.cnki.issn.1674-4152.000257

244 1

Abstract:
Objective To study the effects of water birth in deep water level on maternal and newborns. Methods One hundred and thirty-two primiparous women adopting water birth in our hospital from April, 2014 to May, 2016 were divided into low water level group (62 cases) and deep water level group (70 cases) according to the level of water level during delivery, water level to the waist in the low water level group, and water level to the chest in the deep water level group, and choose the same period in our hospital for routine delivery of maternal 65 cases, recorded as the control group, comparison of the threegroups of total stage of labor, 24 h bleeding volume, perineal injury and pain, at the same time, the Apgar score was used to evaluate the newborns health status and the newborns NICU occupancy rate and newborns infection rate were recorded. Results There was no significant difference in blood loss between the three groups (P>0.05), there was statistically significant in total labor and perineum injury between the three groups (P<0.05), the total stage labor of the deep water level group was significantly lower than that of the low water level group and control group (P<0.05), the total stage labor of the low water level group was significantly lower than that of the control group (P<0.05), the degree of perineum injury in the deep water level group was significantly lower than that in the low water level group and control group (P<0.05), the degree of perineum injury in the low water level group was significantly lower than that in the control group (P<0.05). Seventeen cases of grade Ⅰ pain, 33 cases of grade Ⅱ pain, 16 cases of grade Ⅲ pain, 4 cases of grade Ⅳ pain in the deep water level group, 6 cases of grade Ⅰ pain, 17 cases of grade Ⅱ pain, 31 cases of grade Ⅲ pain, 8 cases of grade Ⅳ pain in low water level group, 4 cases of grade Ⅰ pain, 10 cases of grade Ⅱ pain, 24 cases of grade Ⅲ pain, 27 cases of grade Ⅳ pain in low water level group, the degree of pain in the deep water level group was significantly lower than that in the low water level group and control group(P<0.05), the degree of pain in the low water level group was significantly lower than that in the control group (P<0.05); There was no significant difference in Apgar scores between the three groups at 1 min and 5 min (P>0.05), and there was no significant difference between the threegroups in NICU occupancy rate and neonatal infection rate (P>0.05). Conclusion Deep water level in the delivery of water is better than low water level in childbirth, can significantly shorten the labor, reduce the degree of perineal injury, reduce maternal pain, and no serious adverse effects on neonatal.

The expression and mechanisms of RNA-9 and RNA-210 in human ovarian cancer cell lines SKOV-3 and SKOV-3/DDP

WEI Jun, JIN Yue, XU Shao-ting, GUAN Fang, YIN Li-jun, ZHU Hai-bin

2018, 16(6): 938-942. doi: 10.16766/j.cnki.issn.1674-4152.000258

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Abstract:
Objective To detect the expression of RNA-9 and RNA-210 in human normal ovarian cell line IOSE80, cancer cell line SKOV-3 and its cisplatin-resistant cell line SKOV-3/DDP; To investigate the effects of RNA-9 and RNA-210 on cell multiplication, apoptosis, migration and invasion on SKOV-3 and SKOV-3/DDP; Discuss probable functional mechanisms of RNA-9 and RNA-210 in serous ovarian cancer and provide a way for ovarian cancer targeted therapy finally. Methods Using quantitative real-time PCR to assess the expression of RNA-9 and RNA-210 in normal ovarian cell line, ovarian cell line SKOV-3 and SKOV-3/DDP; Transfect RNA-9 mimics and RNA-210 mimics and its corresponding mimics negative control (mimics NC) into SKOV3 and SKOV-3/DDP respectively. CCK-8 assay, Annexin V/PI assay, Cell scratch experiment, cell invasion experiment were performed to evaluate the influence of overexpression of RNA-9 and RNA-210 on cell multiplication, apoptosis, migration and invasion. Results Compared with normal ovarian cell, the expression of RNA-9 in SKOV-3 and SKOV-3/DDP was higher, and the expression of RNA-210 was lower; CCK-8 assay indicated that the ability of cell multiplication was decreased, Annexin V/PI assay indicated that the ability of cell apoptosis was promoted. Cell scratch experiment showed that the ability of cell migration were significantly decreased, the same with the ability of cell invasion, after Overexpressed either RNA-9 or RNA-210. Conclusion Inclusions miR-9 and miR-210 plays a role of tumor suppressor gene in ovarian cancer cells; The ability of cell apoptosis can be increased by overexpressing the miR-9 or miR-210, and the cell multiplication, migration and invasion can be inhibited not only in ovarian cancer cell but also its cisplatin-resistant cell; miR-9 and miR-210 could be seen as new new potential therapeutic targets for ovarian cancer and recurrent ovarian cancer.

Study on the correlation between spontaneous abortion and thyroid autoantibody

WANG Xiao-xie, HUANG Xiao-hong, JIN Yan-hui

2018, 16(6): 943-945. doi: 10.16766/j.cnki.issn.1674-4152.000259

205 0

Abstract:
Objective To investigate the correlation between spontaneous abortion and thyroid autoantibody. Methods Seventy cases of primary abortion were selected as primary abortion group, seventy cases of recurrent miscarriage were selected as recurrent miscarriage group treated in department of Obstetrics and Gynecology of Central Hospital of Huzhou, and seventy cases of healthy subjects were selected as control group from January, 2012 to December, 2016. The serum TSH, FT3, FT4, TPO-Ab, TG-Ab levels were determined. Results The positive rate of TA, TPO-Ab and TG-Ab in patients of recurrent spontaneous abortion group were higher than those in control group (P<0.05). There were no significant difference in the positive rate of TA, TPO-Ab and TG-Ab between recurrent spontaneous abortion group and the primary abortion group (P>0.05). The positive rate of TG-Ab in primary abortion group was higher than that in control group (P<0.05); the positive rate of TA and TPO-Ab showed no significant difference compared with the control group (P>0.05). The lg (TPO-Ab) in the recurrent abortion group was higher than that in the control group (P<0.05). There was no significant difference in the lg (TPO-Ab) between recurrent abortion group and primary abortion group (P>0.05). There was no significant difference in the lg (TPO-Ab) between the primary abortion group and the control group (P>0.05). There was no significant difference in lg (TG-Ab) among three groups (P>0.05). In the recurrent abortion patients, there was no significant difference in TA, TPO-Ab and TG-Ab positive rate between secondary abortion group and secondary abortion group (P>0.05); there was no significant difference in TA, TPO-Ab and TG-Ab positive rate between early abortion group and advanced abortion group (P>0.05). There was no significant difference in TA, TPO-Ab and TG-Ab positive rates between primary abortion group and secondary abortion group (P>0.05). Conclusion The positive rate and levels of serum TA, TPO-Ab and TG-Ab in patients with recurrent spontaneous abortion increase. Thyroid autoantibody is related to recurrence abortion.

Clinical study of traditional Chinese medicine therapy of promoting blood circulation and removing stasis for the recurrence of endometrial polyp after hysteroscopic therapy

LIN Jing, ZHANG Yi-qun

2018, 16(6): 946-948,960. doi: 10.16766/j.cnki.issn.1674-4152.000260

309 2

Abstract:
Objective To conduct the traditional Chinese medicine (TCM) therapy of promoting blood circulation and removing stasis in patients with endometrial polyp after hysteroscopic therapy, observe the changes of Ki-67 positive expression level in endometrium and TCM syndrome score before and after treatment, evaluate the effect of traditional Chinese medicine therapy of promoting blood circulation and removing stasis in decreasing the recurrence of endometrial polyp after hysteroscopic therapy and possible mechanism, and provides a new choice for reducing postoperative relapse rate. Methods Total 147 cases of endometrial polyp after hysteroscopic therapy met the diagnosis criteria in our hospital between June, 2015 and June, 2016 were enrolled into the study, and randomly divided into traditional Chinese medicine, western medicine group and control group. The traditional Chinese medicine group received the traditional Chinese medicine therapy of promoting blood circulation and removing stasis(oral Chinese medicine and external treatment); the western medicine group received oral administration of Marvelon; the control group did not receive any treatment. Before and after the treatment, quantification of TCM syndrome score table was used to assess the TCM syndrome scores, the immunohistochemical method was used to test the expression of Ki-67 in endometrial tissue. Results After the treatment, TCM syndrome scores of traditional Chinese medicine group was obviously lower than western medicine group and control group, the difference was statistically significant; however, there was no statistically significant difference between the western medicine group and the control group. Ki-67 positive expression decreased obviously in the Traditional Chinese medicine and western medicine group, and the difference had statistical significance as compared with the control group; the expression level of Ki-67 in the traditional Chinese medicine group was lower than that in the western medicine group, the difference was statistically significant. In the control group, the level of Ki-67 did not change obviously before and after the treatment, there was no statistically significant difference. Conclusion Traditional Chinese medicine therapy of promoting blood circulation and removing stasis can significantly reduce TCM syndrome score and Ki-67 positive expression in endometrium in patients with endometrial polyp after hysteroscopic therapy, which may be the possible mechanisms of reducing postoperative recurrence rate.

Practice and discussion of two-way referral for prevention and treatment of cervical diseases in the region based on the information platform

JIN Long-mei, XIAO Li-ping, ZHANG Xiao-hua, YANG Hui-bin, ZHANG Lin-lin, ZHANG Lei, XU Ling, XU Jun

2018, 16(6): 949-952,1014. doi: 10.16766/j.cnki.issn.1674-4152.000261

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Abstract:
Objective To explore the establishment of two-way referral for the prevention and treatment of cervical diseases based on information platform in Minhang district to reduce the morbidity and mortality of cervical cancer, thus to manage high risk population of cervical disease effectively for early diagnosis and treatment of cervical precancerous lesions and early cervical cancer patients. Methods We established a cooperation group for two-way referral of cervical diseases with Minhang District maternal and child health hospital as the main body. Women with high risk of cervical disease screening were included in the referral target. From the pilot to the all 13 community health service centers, we set up two-way referral on information platform to support the screening, health education, professional training, two-way referral, diagnosis and treatment, follow-up as one of the prevention and treatment of cervical diseases with the two or three level general hospitals in the district. Two-way referral set up a information database, system, process, specification, detailed examination rules, assessment index, and also included into the community public health funds. Results The two-way referral rate increased year by year. From 2014 to 2017, 604 cases of cervical lesions were diagnosed as precancerous lesions. The rate of early diagnosis of cervical lesion was 91.56% and rose year by year; the rate of early detection of cervical cancer was 86.27%. There were significant differences in the awareness rate of cervical diseases of transferred population (P<0.01) and the object satisfaction was 96.75%. Conclusion Minhang district established the two-way referral for prevention and treatment of cervical diseases between the regional community health service centers and hospitals based on the information platform and financial support for public health. It also established an effective referral mechanism and information database. It increased the detection rate of precancerous lesions of the cervix, and ensured the purpose of health management of community women's health care.

Research on chronic kidney disease patients' knowledge of nephropathy and their demands on medical service in community

REN Tao, XIE Jian-fang, YANG Yong-feng, ZHOU Fang, LIANG Yan

2018, 16(6): 953-956. doi: 10.16766/j.cnki.issn.1674-4152.000262

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Abstract:
Objective To learn the situation of chronic kidney disease (CKD) patients' knowledge of nephropathy and their demands on medical service in community, in order to provide basis for community management of CKD. Methods In July 2017, questionnaire was adopted to do the investigation on 1 471 CKD patients, and we actually investigated 1 349 CKD patients (occupying 91.71% of people who shall be investigated) in 57 villages in both Jinze community and Huaxin community in Qingpu District in Shanghai, and SPSS 21.0 statistical software was used to analyze the results of investigation. The measurement data was represented in the form of mean or minus standard deviation and T-test and variance analysis were used. The counting data was represented as a percentage (%) and descriptive statistics were used. When P<0.05, the difference in date is statistically significant. Results The average score of 1 349 CKD patients' knowledge of nephropathy is (60.05±10.83) and the highest score is 90 points and the lowest one is 25 points. And the percentage of pass is 59.30%. The highest rate of hypertension is 76.87%, and the lowest rate is 13.05%. Gender, age, aging, professions and marital status have no statistical significance (P>0.05); different degrees of education and date of making a definite diagnosis have statistical significance (P<0.05). The number of CKD patients who need related knowledge about treatment of disease is the most which is 1 007 (74.65%), and the number of CKD patients who require service of knowledge publicity through internet is the least which is 338(25.06%). Conclusion Chronic kidney disease (CKD) patients in community do not have complete knowledge on nephropathy and demand for medical services is high. The medical staff needs to intervene and knowledge education held for CKD patients shall be enhanced, overall cognition shall be improved and medical service system shall be perfected. We should regularly organize medical workers to visit the community and carry out follow-up visit to patients with CKD to promote the risk factors of kidney disease to prevent chronic kidney disease and nip nephropathy in the bud.

Effect of group psychotherapy on cognitive, social functions and curative efficacy in first-episode schizophrenia patients

SHI Yin-yan, XIA Yong

2018, 16(6): 957-960. doi: 10.16766/j.cnki.issn.1674-4152.000263

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Abstract:
Objective To investigate the effect of group psychotherapy on cognition, social function and psychiatric symptoms in patients with first-episode schizophrenia administrated with olanzapine for two months. Methods A total of 100 patients were diagnosed with schizophrenia who are in the Seventh People's Hospital of Hangzhou from December, 2015 to March, 2017 were divided into study group (n=50) and control group (n=50) according to random number table. The study group was given 8 weeks group psychotherapy. At baseline, at 8 weeks WCST was used to assess cognitive function, PSP to assess social function, PANSS to assess psychiatric symptoms, and analyze the results. Results Before treatment, there was no significant difference in cognitive function, social function and mental symptoms between the two groups. After 8 weeks of group psychotherapy, total response, the number of error response, continuous error and non-continuous error in the study group decreased compared with that before treatment, the number of correct responses and the number of completed classification increased. Compared with the control group, total response, the number of correct responses and the number of incorrect responses. The number of continuous errors, the number of non-continuous errors, the number of completed classification differences were statistically significant (P<0.05). After treatment, the total score of PSP in the study group was higher than that in the control group. The scores of beneficial activities, social relations and self-care factors were lower than those in the control group (P<0.05), but there was no significant difference between the groups>0.05. After treatment, the scores of negative symptoms decreased in the study group, and the difference of negative symptoms between the two groups was statistically significant (P<0.05). Conclusion Group psychotherapy can effectively improve cognitive function, social function and negative symptoms in first episode schizophrenia patients.

Relative analysis of serum uric acid and anxiety symptoms of youth and middle age patients

WANG Dai-yan, ZHANG Wei, ZHENG Tian-sheng, ZHOU Na-dan, ZHU Lu-jun, BAO Qiong-qiong

2018, 16(6): 961-963. doi: 10.16766/j.cnki.issn.1674-4152.000264

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Abstract:
Objective In order to study whether serum uric acid level has a certain effect on anxiety symptoms in young and middle-aged people, the changes before and after treatment were compared and the correlation was analyzed. Methods We selected 82 cases of anxiety patients from July, 2015 to January, 2017 in outpatient of our hospital. HAMA was carried out at first by professional psychological physician. Then according to score of HAMA, they were divided into 7-13 scores group (26 cases), 14-20 scores group (21 cases), 21-28 scores group (18 cases) and ≥ 29 scores group (17 cases). Drug therapy or assistant psychological therapy was applied, and serum uric acid and HAMA were tested after 1 month and 3 months of therapy. Results Serum uric acid were significantly decreased in each group after therapy (P<0.05), and which of 3 month therapy was significantly decreased than which of 1 month therapy (P<0.05). HAMA scores were significantly decreased in each group after therapy (P<0.05), and which of 3 month therapy was significantly decreased than which of 1month therapy except 7-13 group (P<0.05). And we found significantly positive relative existed between serum uric acid and HAMA scores. Coefficient of association were 0.730, 0.751 (P=0.031), 0.815 (P=0.022) and 0.728 (P=0.043) respectively of each group (all P<0.05). Conclusion We found significantly positive relation between serum uric acid and anxiety symptoms of youth and middle age patients, which may hint possible nutrition metabolism indexes including uric acid level which significantly influences the assessment of treatment effects of anxiety.

Role of dynamic contrast-enhancement combined with intravoxel incoherent motion diffusion-weighted MRI at 3.0T in differentiating benign from malignant breast lesions

ZHAO Xiao-jun, LIU Kun, ZHANG Xian, XIE Xiao-xiao, YE Xin-jian, ZHOU Zhong-jie, YAN Zhi-han

2018, 16(6): 964-968. doi: 10.16766/j.cnki.issn.1674-4152.000265

326 1

Abstract:
Objective To evaluate dynamic contrast-enhancement combined with intravoxel incoherent motion (IVIM) diffusion-weighted (DW) MRI for differentiating benign from malignant breast lesions. Methods The clinical data of 60 cases of breast diseases confirmed by pathology in our hospital from October, 2016 to September, 2017 were retrospectively analyzed (benign:25 cases, malignant:35 cases). Conventional MRI, dynamic contrast enhancement and IVIM-DWI (b=0-1 200 s/mm²) examination were performed in all patients. Lesion morphology, enhancement pattern, time signal curve and the relevant parameters of IVIM model were analyzed to evaluate the differential diagnostic value between breast benign and malignant lesions respectively. Results The irregular margin with or without spiculation and heterogeneous enhancement were mostly seen in breast cancer (P=0.003, 0.004, respectively). TIC type Ⅲ was mostly seen in breast cancer, TIC type Ⅰ and Ⅱ were mostly seen in breast benign (χ²=19.272, P<0.01). Except D^* value, there were statistically significant differences among the IVIM related parameters (t=3.301, -5.247, 3.899, all P<0.05). ROC analysis showed that the AUC of D value was 0.873 which was the highest one. AUC was increased to 0.941 by combining D with f value for diagnosis. Conclusion Magnetic resonance dynamic contrast enhancement combined with IVIM model related parameter values can improve the value of differentiating benign from malignant breast lesions, and shows a higher diagnostic efficiency.

Analysis of histopathologic subtypes and CT characteristics of lung adenocarcinomas presenting as pure ground-glass nodule around 1-3 cm in maximal diameter

YANG Hai, CHEN Ying, LI Xin, QI Feng, ZHANG Dao-chun, FAN Shu-feng, FAN Heng-xin, XIE Ji-cheng, JI Wen-bin

2018, 16(6): 969-973. doi: 10.16766/j.cnki.issn.1674-4152.000266

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Abstract:
Objective To evaluate the correlations between CT features and histopathologic subtypes of lung adenocarcinomas presenting as pure ground-glass nodules (pGGN) around 1-3 cm in maximal diameter. Methods CT appearances, pathology and clinical data of 192 patients (192 lesions). To be divided three classes, including 31 preinvasive lesions 4 atypical adenomatous hyperplasia, 27 adenocarcinoma in situ, 71 minimally invasive adenocarcinoma (MIA) and 90 invasive pulmonary adenocarcinoma (IPA) who underwent curative resection of lung adenocarcinomas presenting as 1 ≤ pGGN ≤ 3 cm in diameter from October, 2013 to December, 2016 were retrospectively analyzed in our hospital. Via SPSS 22.0 statistics software, age and gender of patients, lesion size, density, lesion location, shape, presence of bubble-like sign, air bronchogram, pleural tag, vessel changes, margin, tumor-lung interface and uniformity were compared among histopathologic subtypes. Results There were no significant differences among histopathologic subtypes in terms of gender of patients, lesion location, tumor-lung interface, and shape. There were significant differences among lesion preinvasion, MIA and IPA in terms of age, lesion size and density. There were statistically significant differences among histopathologic subtypes in terms of vessel changes, presence of bubble-like sign, air bronchogram and pleural tag. With the increasing degree of invasiveness, the homogeneous uniformity of lesions tend to lessen; Compared with preinvasive lesions and MIA, IPA was more inclined to present as speculated or speculated plus lobulated. There were statistically significant differences among histopathologic subtypes in terms of uniformity and margin. The optimal cutoff value of lesion density for differentiating preinvasive lesions from invasive lesions was -549.35 Hu (sensitivity, 74.50%; specificity, 71.00%). Conclusion Age of patients, lesion size, density, margin, vessel changes, uniformity, presence of bubble-like sign, air bronchogram and pleural tag may indicate the invasiveness of lung adenocarcinoma presenting as pGGNs of 1 to 3 cm in diameter.

Analysis on the test results of microelements for 2 236 preschoolers in the city of Hangzhou

WANG Hai, ZHOU Lei, LIU Qin, CHEN Ling-mei

2018, 16(6): 974-976. doi: 10.16766/j.cnki.issn.1674-4152.000267

239 3

Abstract:
Objective To detect the microelements content of whole blood in preschoolers of Hangzhou and to understand the current situation of the microelement content of whole blood for preschoolers to provide basis for targeted nutritional guidance. Methods A total of 2 236 cases of preschoolers, who received physical examination and nutrition consultation in the department of pediatrics from Tongde Hospital of Zhejiang from January, 2014 to June, 2016, were selected and divided into infant group (328 cases), young children group(732 cases) and preschool children group (1176 cases) according to their ages. Six elements includingcopper, zinc, calcium, magnesium, ferrum, plumbum in all blood were determined by the Jinan Qili QL8000 automatic microelement analyzer. The results were counted, compared and analyzed. Results The abnormal rates of iron, zinc, calcium, magnesium, copper and plumbum were 14.4%, 29.6%, 20.6%, 0.7%, 4.6% and 1.5% respectively. Comparison of the determination of the value of these elements in different age groups were statisticallydifferent (all P<0.01). The most of microelements deficiency were about ferrum, zinc, and calcium, while the lack of rate of copperand plumbum poisoning rate were lower. The highest rate of ferrum and zinc deficiency were in the infants group, and the deficiency rate of ferrum in young children group was higher than that in preschool children group (P<0.05). The deficiency rate of ferrum and zincin whole bloodhad statistical significance in different gender groups (all P<0.01). However, the deficiency rate of calcium, magnesium, copper and plumbum poisoning had no statistical significance (all P>0.05). Conclusion In the period of fast growth and development of children, it is prone to trace unbalance of microelements. Therefore, it is necessary to strengthen the nutrition management of preschool children by supplied microelements reasonably and prevented plumbumpoisoning actively.

The application and clinical study of three dimensional contrast enhanced ultrasound in spatial imaging of gallbladder bed

ZHENG Yuan-yuan, JIN Yan-yan, YUAN Cai-di

2018, 16(6): 977-979. doi: 10.16766/j.cnki.issn.1674-4152.000268

233 0

Abstract:
Objective To investigate the application and clinical study of three dimensional contrast enhanced ultrasound (CEUS) in the space imaging of gallbladder bed, the purpose is to provide a certain reference value for clinical. Methods One hundred patients with acute cholecystitis underwent laparoscopic cholecystectomy from December, 2015 to December, 2016 were selected from our hospital. According to the random number table method, divided into observation group 50 cases and control group 50 cases. The control group was treated with conventional two-dimensional ultrasound, and the observation group was examined by three-dimensional ultrasound. The amount of intraoperative blood loss, the display of blood vessels in the arterial phase and the effusion of the gallbladder were compared between the two groups. Results The amount of intraoperative bleeding (14.38±3.15) ml less than that of the control group (27.84±5.46) ml (P<0.05). The observation group showed arterial vascular score of 1 was significantly less than the control group, and the 3 was more than the control group (all P<0.05). The gallbladder fossa fluid incidence rate in observation group of (2.00%) was less than that in the control group (20.00%), P<0.05. Conclusion Three dimensional ultrasound technology is a new technique for noninvasive, safe and efficient in gallbladder bed imaging, can be repeated, can reduce the amount of bleeding, reduce gallbladder fossa hydrops, has important diagnostic value.

Value of contrast-enhanced ultrasonography in the diagnosis of rheumatoid arthritis wrist

SHAO Ke-zhong, CHEN Li-min, LI Su-pin, JIN Zhen-mu, HE Jun, CHEN Bei-lei

2018, 16(6): 980-982,1035. doi: 10.16766/j.cnki.issn.1674-4152.000269

393 4

Abstract:
Objective To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in the pathogenesis of rheumatoid arthritis. Methods Total 30 patients (54 wrist joints) of rheumatoid arthritis treated with wrist pain were selected from January, 2015 to November, 2016. The patients were treated with the same time. There were 23 healthy patients (46 wrist joints) in the hospital. The color Doppler ultrasonography was used to detect the synovial thickness of the wrist joint in the two groups. The correlation between DAS28, EST, CRP and RF was analyzed by ultrasonography (CEUS) in the wrist of the observation group. Results ①There were 51 (94.44%), 33 cases (61.11%) of joint effusion, 29 (53.73%) of bone lesions and 46 wrist There were 3 (6.52%), synovial fluid (7.14%) and joint erosion (2.17%), and the difference was statistically significant (P<0.05). The mean synovial thickness of the observation group was (3.23±1.27) mm, and the mean synovial thickness was (1.37±0.65) mm in the group. The difference was statistically significant (t=15.731, P<0.001). ②In the observation group, 52 cases of synovial thickening were detected. The detection rate was 82.35%, among which 17 were Grade Ⅰ, 18 were Grade Ⅱ and 7 were Grade Ⅲ. The detection rate was 33.33% and the signal intensity was grade Ⅰ, and the difference was statistically significant (P<0.001). ③There was no correlation with RF and Anti-CCP. Ultrasound contrast TIC quantitative grading was positively correlated with synovial thickness and CEUS perfusion grade. Conclusion Ultrasonography can clearly show the changes of synovial membrane in the wrist, and quantitatively analyze the perfusion of synovial fluid. It is positively correlated with serological parameters and disease activity. In the early diagnosis of rheumatoid arthritis wrist activity has a high clinical value.

Analysis of current situation in medical staff stress sources and countermeasures

YANG Yan-qing, ZHENG Hong, WANG Hui-yan, BO Yong-hai

2018, 16(6): 983-988. doi: 10.16766/j.cnki.issn.1674-4152.000270

489 12

Abstract:
With the change of medical model to bio psycho social medical model, and the increase of social demand for medical services, the occupational stress faced by medical staff is growing gradually. However, there is lack of targeted coping strategies, this can cause more job burnout, doctor-patient tension, and demission. This article analyzed the stressors of various clinical departments in hospital by searching the recent domestic literature, to summarize the characteristics and causes of occupational stress among medical staffs, including:① emergency departments and intensive care units are the most frequently and most important departments where the pressure created among the medical staff, which have the greatest impact, and the pressure of clinical departments is affected by the characteristics of their respective departments; ② job burnout manifested by nurses was more pronounced than physicians; ③ medical staff are confronted with the characteristics of the times, the pressure from medical and health care reform, they have to adjust frequently when the job focus changes, and they lack a stable medical environment. To analyse the main sources of occupational stress including occupational risk, work load, social environment, doctor-patient communication, cognition and organizational management. And then improve the hospital management model and social support, and develop a psychological intervention program (including rational emotive therapy, Battling group, mindfulness decompression therapy, expert guidance, lectures, group discussions, scenario simulation analysis, decompression yoga, etc). To put forward positive coping strategies, in order to solve the job burnout caused by the pressure of medical staff, to develop a better physical and mental health of doctors and nurses, to improve the relationship between doctors and patients, to reduce demission, and to raise the quality of medical service.

Progress of antidiabetic drugs in non-alcoholic fatty liver disease

JIN Shan-shan, JIANG Su-wen, HU Ai-rong, LI Hong-shan

2018, 16(6): 989-992,997. doi: 10.16766/j.cnki.issn.1674-4152.000271

207 5

Abstract:
Non-alcoholic fatty liver disease (NAFLD) is a multi-system metabolic disorder and is closely associated with insulin resistance and type 2 diabetes. It has become a common and frequently occurring disease that seriously affects health. Drugs have not been approved for the treatment of NAFLD. Antidiabetic drugs are one of the most promising drugs, including thiazolidinediones(TDZs), peroxisome proliferators-activated receptor(PPAR) agonists α/γ and α/δ, biguanides (metformin), human glucagon-like peptide-1 (GLP-1) analogues, and sodium glucoseco-transporter 2 (SGLT2) inhibitors, etc. These drugs have certain positive roles in controlling body weight, reducing liver fat content, improving hepatic steatosis and balloon degeneration, improving non alcoholic steatohepatitis (NASH), reducing inflammation, lowering blood sugar, lowering blood lipids, improving liver function, and improving antioxidant capacity. TDZs (pioglitazone) have the most adequate clinical evidences and the most clear treatment mechanisms, but are limited by their safety and tolerability. Metformin is a safe drug, but the role of NAFLD is controversial. New drugs such as PPAR-α/γ and α/δ double agonists (saroglitazar and GFT505), liraglutide (GLP-1 analogue) are in clinical trials. The data show that they have good effects on NAFD and NASH, and the securities are good. NAFLD and NASH have favorable improvement, and good safety. It should be emphasized that measures such as changing unhealthy lifestyles and weight control are still the basic treatment measures for NAFLD.

The latest treatment progress of diabetic foot

LI Xiao-hui, ZHANG Yong-hong

2018, 16(6): 993-997. doi: 10.16766/j.cnki.issn.1674-4152.000272

388 17

Abstract:
Diabetic foot (DF) is one of the serious complications of the late diabetes. The incidence rate of DF increased year by year, and it has high disability and mortality rate with complex pathogenesis mainly involving long-term hyperglycemia leading to foot neuropathy which causes the deficiency of foot protective function and microcirculatory disturbance which is induced by ischemia and hypoxia. Other factors such as trauma, infection, smoking, hypertension, and hyperlipidemia also have important influence. The therapy of DF is one of the medical challenges. The main treatment methods include foot prevention, medical comprehensive treatment, such as blood glucose control, infection control, the nerves, improvement of circulation, and auxiliary measures which include debridement, hyperbaric oxygen and closed negative pressure drainage technology, and artery bypass grafting, artery balloon dilatation, stent implantation as well as biotechnology targeting at the vascular lesions. However, none of these methods could effectively improve microcirculation, increase foot blood supply and promote peripheral nerve functional recovery. The foot ulcers and infections still unhealed and even relapsed again. Transverse tibial bone transport technology, which is one of clinical application of Ilizarov technology in tissue regeneration(blood vessels and nerve regeneration areas), can activate the regeneration system of the human body, promote microcirculation regeneration, improve peripheral nerve function, control of local infection, and promote ulcer healing to reduce the possibility of recurrence. It is a major breakthrough in the field of micro blood vessels, and brings new hope for the treatment of diabetic foot. The present situation of diabetic foot treatment is summarized, with a view to developing a more reasonable and effective treatment plan for clinicians.

High strength wires hang together with autologous tendon to reconstruct coracoclavicular ligment for elderly patients with acromioclavicular joint dislocations

CHEN Sun-yu, LI Jian, XIAO Zhan-hao, ZHUO Hong-wu

2018, 16(6): 998-1000. doi: 10.16766/j.cnki.issn.1674-4152.000273

234 0

Abstract:
Objective To determine the functional outcome of high strength wires hang together with autologous tendon to reconstruct coracoclavicular ligment for elderly patients with acromioclavicular joint dislocations. Methods This study is retrospective study, examined elderly patients with acromioclavicular joint dislocations from June, 2014 to January, 2016. Twenty-five elderly patients of Rockwood Ⅲ-Ⅳ acromiocluv, cular joint dislocation were observed, the mean patient age at the time of surgery was 64.3 years (range, 62 to 71 years). All patients were treated with two high strength wires and autologous tendon to reconstruct coracoclavicular ligment. The shoulder joint range of motion before treatment and post treatment were recorded, we compared VAS scores, UCLA scores, ASES scores to determine the function of shoulder joint. Results All were available for follow-up at a mean of 1.5 years. Overall, functional outcome was improved from baseline compared with final follow-up for VAS scores[(4.3±1.2) points vs. (0.8±0.3) points, P<0.01], ASES scores[(64.1±7.4) points vs. (92.3±3.2) points, P<0.01], and UCLA scores[(22.1±3.9) points vs. (34.8±2.4) points, P<0.01]. The shoulder joint range of motion was improved. Conclusion High strength wires hang together with autologous tendon to reconstruct coracoclavicular ligment for elderly patients with acromioclavicular joint dislocations is a good method which has less damage, it can obtain a favorable clinical effect, and have good functional rehabilitation.

Efficacy observation on cervical spondylosis of vertebral artery type treated by Fu's subcutaneous needling combined with reperfusion activity

HU Zheng-xi, CHEN Li-qiu, LI Xin-wei

2018, 16(6): 1001-1003. doi: 10.16766/j.cnki.issn.1674-4152.000274

255 1

Abstract:
Objective To observe the therapeutic effect on cervical spondylosis of vertebral artery type treated by Fu's subcutaneous needling (FSN) combined with reperfusion activity (RA). Methods A total of 60 cases of patients with cervical spondylosis of vertebral artery type in our hospital from January, 2015 to July, 2017 were selected as the research objects.All patients were randomly divided into experimental group (30 cases) and control group (30 cases). The control group with muscle palpation results as the basis, according to the sternocleidomastoid, trapezius, splenius capitis, scalene muscle order, simple using Fu's subcutaneous needling, while the experimental group combined with reperfusion activity based on the therapy in the control group. The whole course of reperfusion takes about 10 seconds, and each muscle or muscle group takes 2-3 times. The two groups were 1 times a day, 3 times for 1 courses, treatment interval between 1 days, after 3 courses of treatment statistics curative effect, less than 1 courses of treatment in accordance with 1 courses of statistics, observe the clinical efficacy of the 2 groups of patients. Using SPSS 17 statistical software for data analysis, the rank sum test was used in the evaluation of the curative effect, P<0.05 for the difference was statistically significant. Results The curative and remarkably effective rate in treatment group was 70% (21/30) and the total effective rate in it was 93.3% (28/30), which were much superior to 40% (12/30) and 73.3% (22/30) in control group separately. By the rank sum test, the difference of the two groups was statistically significant compared with the recovery rate and total effective rate (Z=-2.48, P=0.013). The results showed that the curative effect of the treatment group was obviously better than that of the control group. Conclusion FSN combined with RA and only FSN both can treat cervical spondylosis of vertebral artery type, and FSN combined with RA was better than only RA.

Effect of acupuncture treatment on the recovery of gastrointestinal function in parturients after cesarean section

WANG Chong-min, SHEN Xing-hang, WANG Yan-wu, CHU Jia-mei

2018, 16(6): 1004-1007. doi: 10.16766/j.cnki.issn.1674-4152.000275

260 0

Abstract:
Objective To explore the effect of acupuncture treatment on the recovery of gastrointestinal function in parturients after cesarean section. Methods From August, 2012 to August, 2015 year in August in Hangzhou Traditional Chinese Medical Hospital obstetric cesarean section in 320 cases, were randomly divided into 4 groups with 80 cases in each group. Routine acupuncture treatment, treatment group A acupuncture Zusanli and Shangjuxu, treatment B group acupuncture Zusanli and Quchi, treatment C group acupuncture Zusanli and Chize. cesarean section after all women underwent routine obstetric care, the treatment group based on 12 h after operation for acupuncture treatment, to observe the curative effect after one treatment. All patients were observed and recorded the first postoperative anal exhaust time, postoperative defecation time, postoperative recovery time of bowel sounds for the first time, the disappearance time, before and after treatment for 24 h, 48 h, abdominal pain, gastrointestinal reaction and postoperative curative effect. Results All the indexes after treatment in group A after operation were significantly better than the treatment group, B treatment group, C normal group (P<0.05); after treatment, the effective rate of A group was significantly higher than the treatment group, B treatment group, C normal group (P<0.05). Conclusion The cesarean section, Quchi, Zusanli and Shangjuxu chize can promote the parturient women after cesarean section gastrointestinal function recovery, shorten the recovery time of bowel sounds, reduce abdominal distension, abdominal pain, gastrointestinal reaction, the best effect of acupuncture at Zusanli and Shangjuxu.

The study on the therapeutic effect of manual separation and adhesion combined positiontraining in patients with frozen shoulder

CHENG Hong-se, JIN Min-min

2018, 16(6): 1008-1010,1028. doi: 10.16766/j.cnki.issn.1674-4152.000276

230 0

Abstract:
Objective The therapeutic effect of manual separation and adhesion combined positiontraining was discussed in order to provide a reference for the rehabilitation of patients with frozen shoulder. Methods A total of 110 cases of frozen shoulder inpatients who were treated in our hospital from June, 2013 to September, 2017 were divided into observation group (55 cases) and control group (55 cases) according to the random number table method, the control group adopted themanual separation and adhesion, and the observation group was treated with position training on the basis of the control group (including doctors' involvement in training, patient independence or training with family assistance), the clinical efficacy of the two groups was compared, and the degree of pain and function of shoulder joint was compared between the two groups. Results The total effective rate of observation group was 90.9%, and the total effective rate of control group was 76.4%. The total effective rate of observation group was significantly higher than that of control group (P<0.05). Before treatment, the VAS score of the two groups showed no significant difference (P>0.05). After treatment, the VAS score of two groups were significantly lower than those before treatment (P<0.05), and the VAS score of the observation group was significantly lower than that in the control group (P<0.05). The pain, shoulder joint activities, daily life activities ability, muscle and joint local form scores of observation group were significantly higher than that of control group (P<0.05), the total score of shoulder joint function was (84.62±9.56) in observation group and (71.42±8.37) in control group, the total score of shoulder joint function of observation group was obviously higher than that of control group (P<0.05). Conclusion Manual separation and adhesion combined position training can markedly improve the patient's clinical curative effect, reduce the pain degree of patients, can greatly improve the shoulder joint function in patients, and it has positive guiding significance for the recovery of disease.

GP undergraduates'narrative competency development via reflective writing

XUE Ying-li, XUE Ting, TANG Zhen-na, WU Ge, LIU Bi-bo

2018, 16(6): 1011-1014. doi: 10.16766/j.cnki.issn.1674-4152.000277

310 2

Abstract:
Objective To develop GP majors' narrative competency and mental health service and foster narrative therapy and empathetic care in the community to meet the increasing need of primary care and rehabilitation therapy. Methods Qualitatively, we adopted content analysis and thematic analysis to explore general GP majors' narrative competency cultivation. Totally, 60 GP clerkship undergraduates, 60 hospitalized patients and 60 doctors from the teaching hospital named the1st Affiliated Hospital of Xi'an Medical University co-participated in reflective writing concerning their clinical training, medical treatment and doctoring experiences respectively. Results Doctors, GP undergraduates and patients all value such themes as self-reflection, doctor-patient empathy and communication. Both doctors and patients value illness narration. Comparatively, doctors attach greater importance to clinical competency, self-health and resilience, patients to doctors' behavior, family support, hospital humanistic care and service, GP undergraduates to professional competency and development and getting to know patients. A narrative model was constructed to develop GP majors' narrative competency, namely, the combination of narration from doctors, patients, family and hospital. Significantly, doctors, GP clerkship majors and patients all value such factors as doctor-patient empathy and communication and reflection. Conclusions Undoubtedly, the essence of medicine is the care of body and mind. GP majors should develop collaborative patient-centered care, get to know patients and improve doctor-patient communication and empathetic competency and self-reflection, skills, self-health management and resilience, ultimately clinically competent for not handling disease, but also take good care of both body and mind. GP majors are expected to develop their insight into narrative therapy and nurture humanism to better primary care in the community. Narrative competency cultivation of clerkship GPs by reflective writing plays an important role in fixing doctor-patient relationship, rebuilding doctor-patient community and improving body and mind care and personalizing and customizing the patients care.

Clinical analysis on the immunohistochemical characteristics of the pathological biopsy specimen in 65 SCLC patients

CHEN Zhen, CHEN Xue-yuan, WANG Gui-hua

2018, 16(6): 1015-1017. doi: 10.16766/j.cnki.issn.1674-4152.000278

278 0

Abstract:
Objective To study the immunohistochemical characteristics of the bronchofiberscope-guided pathological biopsy specimen in small cell lung cancer (SCLC) patients. Methods A total of 65 SCLC patients confirmed from January, 2014 to January, 2017 in our hospital were selected. The clinical pathological results and immunohistochemical characteristics were analyzed. Results The SCLC occurred in 42 male cases and 23 female cases, respectively. The age was (57.1±2.6) years old. 45 cases had the smoking history. The male ratio was significantly higher than that of female ratio (P<0.05); the histological types, age, positions of tumor and pathological staging for the different genders of patients were not significantly different (P>0.05). The positive rate of CD56, TTF-1, CK and Syn in the SCLC patients was 90.77% (59/65), 81.53% (53/65), 69.23% (45/65) and 73.8% (48/65), respectively. The patient's ratio with Ki-67 index ≥ 60% was 76.9% (50 cases). The patient's ratio with Ki-67 index ≥ 60% was 51.6% (16 cases) at the limited stage and 82.35%(28 cases) at the extensive stage. The related percentage at the limited stage was significantly higher than that at the extensive stage (P<0.05); the positions of tumor, histological types and pathological staging in the other phenotypes of SCLC patients were not significantly different (P>0.05). Conclusion Smoking is one of the major risk factors of SCLC that is majorly occurred at the extensive stage. The immunohistochemical index of TTF-1, CK, CD56, Ki-67 and Syn are of great importance to the final diagnosis of SCLC. The majority of the SCLC patients have the Ki-67 index ≥ 60%, that are majorly occurred at the extensive stage. Therefore, the Ki-67 index ≥ 60% can be considered as the important prediction indicators on the clinical assessment and prognosis of SCLC. It shall be recommended in clinical practice.

Effects of taurine on endoplasmic reticulum stress in rats with acute stress skeletal muscle injury

ZHAO Peng, ZHANG Shui-jun, WANG Li-xiang, SHEN Feng, YU Wang-fen, LIU Hui

2018, 16(6): 1018-1020. doi: 10.16766/j.cnki.issn.1674-4152.000279

210 0

Abstract:
Objective To study the effect of taurine on GRP78, MAD, GADD153 and SOD in rats with eccentric exercise, in order to explain the mechanism of taurine protecting skeletal muscle injury by reducing endoplasmic reticulum oxidative stress. Methods A total of 36 adult SD rats were randomly divided into blank control 1 group(group A), blank control 2 group(group B), 1 day eccentric exercise group(group C), 2 days eccentric exercise group(group D), 1 day eccentric exercise+taurine group(group E), 2 days eccentric exercise+taurine group(group F). The skeletal muscle of 6 groups rats were collected, and the contents of SOD, MAD, GRP78 and GADD153 were measured. The content of SOD and MAD were measured by xanthine oxidase method and thiobarbituric acid method, respectively. The expressions of GRP78 and GADD153 were measured by Western blotting method. The differences of SOD, MAD, GRP78 and GADD153 among the 6 groups were compared. Results The SOD in group A and group B was higher than that in group C, group D, group E and group F, there was significant statistical difference compared with group C, group D(P<0.05), but there was no difference compared with group E and group F(P>0.05). The SOD in group E and group F was higher than that in group C and group D, there was no statistically significant difference(P>0.05). The MDA in group C and group D was higher than that in group A, group B, group E and group F(P<0.05). The MDA/SOD value in group A, group B, group E and group F was greater than group C and group D(P<0.05). The MDA/SOD value in group E and group F was lower than that in group A and group B(P<0.05). GRP78, GADD153 expression in group C and group D were higher than that in group A and group B(P<0.05), but was lower than that in group E and group F(P<0.05). GRP78, GADD153 expression in group E and group F were higher than that in group A and group B(P<0.05). Conclusion Taurine may be maintain the antioxidant capacity of skeletal muscle by improving the ability of endoplasmic reticulum oxidative stress, which can accelerate the elimination of oxygen free radicals in skeletal muscle and decrease oxidative stress in skeletal muscle after strenuous exercise. It is conducive to the recovery of skeletal muscle function.

Effect of five regular methods management model combined with humanized nursing measures applied to hypertensive intracerebral hemorrhage

XIE Hui-rong, WU Yuan-cong, LIU Xiu-mei, SU Dan, CAI Xue-li

2018, 16(6): 1021-1024. doi: 10.16766/j.cnki.issn.1674-4152.000280

214 1

Abstract:
Objective To evaluate the effect of five regular methods management model combined with humanistic nursing on serum inflammatory factors in patients with hypertensive cerebral hemorrhage and its prognostic impact. Methods A total of 46 hypertensive intracerebral hemorrhage patients who underwent cerebellar decompression in our hospital from May 1, 2014 to June 1, 2017 were selected as study subjects. The study was randomized, blinded, and controlled. According to the random number table method, they were randomly divided into two groups:A (user-friendly nursing) and B (five regular methods nursing management mode combined with humanized nursing). We selected 23 healthy people who received physical examination in our hospital at the same time as group C(healthy control group), observed the changes of the vital signs at different time after operation in A and B groups; observed the expression levels of postoperative pro-inflammatory factors in A and B groups; observed the simple mental status checklists (Minimum mental state examination, MMSE) in patients A, B, and C scores. Results The changes of related vital indexes in group B were more stable than those in group A. Serum inflammatory cytokines IL-1, IL-6, IL-10 and TNF-α were significantly elevated at 24 h after operation in group B, but the levels of IL-1, IL-6 and TNF-α were significantly lower than those in group A (P<0.05). After 24 hours, the directional ability, memory ability, recall ability, and attention calculation ability of group B patients were significantly lower than those of group C, but still higher than those of group A patients, with statistical significance (P<0.05). There was a significant negative correlation between MMSE scores and IL-1, IL-6 and TNF-α, and no correlation with IL-10. Conclusion The five regular methods nursing management combined with humanized nursing measures can improve the quality of nursing and stabilize the high expression of serum-related inflammatory factors in patients with hypertensive cerebral hemorrhage, thus having certain effects on vital signs and consciousness recovery.

Effect of empathy mental intervention on the level of hope and cancer related fatigue in the nursing of autologous DC/CIK cells maintenance in the treatment of advanced pulmonary adenocarcinoma

ZHONG Zi-wai, LU Hua-dong, LU Chen, QIU Guo-qin, WANG Bin

2018, 16(6): 1025-1028. doi: 10.16766/j.cnki.issn.1674-4152.000281

268 1

Abstract:
Objective To investigate the effect of empathy mental intervention on the level of hope and cancer related fatigue in the nursing of autologous dendritic cells (DC)/cytokine-induced killer (CIK) cells maintenance in the treatment of advanced pulmonary adenocarcinoma. Methods A total of 100 patients with advanced pulmonary adenocarcinoma who were given the treatment of autologous DC/CIK cells maintenance in Central Hospital of Huzhou from January, 2015 to March, 2017 were selected, and divided into two groups by random number table (n=50):The control group received routine nursing care; the observation group was given empathy mental intervention based on empathy nursing in the control group. The self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, piper fatigue scale (PFS) score, Herth hope index (HHI) score and nursing satisfaction were compared between the two groups before and after nursing. Results After nursing, the ASA scores and SDS scores of observation group were significantly lower than those of the control group, with statistical significance (all P<0.05); The PFS score and cognition, feeling, emotion, behavior scores of observation group were significantly lower than those of the control group (all P<0.05); The HHI score and close relationship with others, attitudes towards taking positive action, attitude to the reality and future scores of observation group were significantly higher than those of the control group (all P<0.05); The satisfaction rate of observation group was 96%, which was significantly higher than 82% of control group (P<0.05). Conclusion Empathy mental intervention in the nursing of autologous DC/CIK cells maintenance in the treatment of advanced pulmonary adenocarcinoma can reduce cancer-related fatigue and negative emotion, and obviously improve the patient's level of hope.

Application and clinical value of systematic nursing based on music therapy in patients with severe pneumonia

ZHU Li-hong, LIN Juan, CHEN Shang-zhong

2018, 16(6): 1029-1031. doi: 10.16766/j.cnki.issn.1674-4152.000282

237 0

Abstract:
Objective To discuss the application and clinical value of systematic nursing based on music therapy in patients with severe pneumonia. Methods A total of 120 patients with severe pneumonia were selected and randomly divided into the observation group and the control group, with 60 cases in each group. The control group was given routine nursing measures. The observation group received systematic nursing intervention on the basis of routine nursing measures, i.e. providing the patients with music therapy and playing different music to relax them. The mental state and night sleeping quality of both groups were compared and the immune level and inflammatory factors were analyzed. Results The scores of SAS (39.83±5.24) and PSQI (9.52±1.89) in the observation group were significantly lower than the control group (47.46±5.69) and (10.21±2.36), the differences were statistically significant(all P<0.05). The levels of CD4⁺CD25⁺ Treg cell (2.79±1.23)% and CD8⁺CD28^-Treg cell (6.76±4.27)% in the observation group were significantly higher than the control group (2.21±0.98)% and (4.54±2.66)%, and the levels of TNF-α (62.32±10.48) ng/L and IL-10 (37.56±13.43) ng/L in the observation group were significantly lower than the control group(71.51±11.78) ng/L and (59.32±16.91) ng/L, the differences were statistically significant(all P<0.05). Conclusion Systematic nursing based on music therapy can significantly improve the mental state and sleep quality of patients with severe pneumonia, in addition to lowering inflammatory factors, thus improving inflammatory reaction in patients.

Effect of comprehensive nursing intervention on the quality of life and mental state of patients with chronic obstructive pulmonary failure

LUO Jie-ping, SHEN Ai-juan, DONG Yan-ping, ZHANG Rui-yun

2018, 16(6): 1032-1035. doi: 10.16766/j.cnki.issn.1674-4152.000283

239 1

Abstract:
Objective To explore the clinical effect of comprehensive nursing intervention on the quality of life and psychology of patients with chronic obstructive pulmonary disease (COPD) with respiratory failure. Methods A total of 90 COPD patients with respiratory failure were selected in our respiratory department from January, 2016 to October, 2017. They were randomly divided into observation group (45 cases) and control group (45 cases). The control group was given conventional COPD combined with respiratory failure nursing, and the observation group applied comprehensive nursing intervention on the basis of routine nursing. The treatment effects of 2 groups of patients and the changes of blood gas indexes before and after nursing were compared, and the quality of life and mental state of 2 groups of patients were compared before and after nursing by the WHO quality of life measurement scale (WHOQOL-BREF) and symptom self-assessment scale (SCL-90) score. Results There was no statistically significant difference between blood gas index and SCL-90 score in 2 groups of patients before nursing intervention, P>0.05. After nursing intervention, the total effective rate of treatment was 93.3% in the observation group and 77.8% in the control group; the blood gas index of 2 groups was obviously improved, but PaO₂ in the observation group significantly higher than that in the control group, while PaCO₂ was lower in the control group, P<0.05. The WHOQOL-BREF score and SCL-90 score of the 2 groups were increased, but the score of the observation group was higher than that of the control group, and the nursing satisfaction of the observation group was 95.6%, which was higher than 82.2% of the control group, P<0.05. Conclusion Comprehensive nursing not only improves the quality of life of patients with COPD combined with respiratory failure, but also adjusts the psychological state of patients, increases the confidence of patients, strengthens the cooperation between nurses and patients, and is worthy of clinical application.

Rehabilitation nursing for 10 cases of chronic achilles tendon rupture undergoing transplantation of flexor hallucis longus and plantaris tendon and gastrocnemius fascia flap repairing

HUA Fei, FAN Yan-hong, ZHANG Lan, LIANG Yu-xia, MAO Hai-jiao

2018, 16(6): 1036-1039. doi: 10.16766/j.cnki.issn.1674-4152.000284

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Abstract:
Objective To evaluate the effect of rehabilitated nursing in patients undergoing the transplantation of flexor hallucis longus and plantaris tendon and gastrocnemius fascia flap repairing. Methods From January, 2012 to January, 2015, 10 cases was observed with using psychological nursing, limb care, physical therapy, and rehabilitation training and recovery guide, including 8 males and 2 females with a median age of (35.3±1.32) years (range, 22-54 years). The score was (69.5±2.07) according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. The interval time was (5.31±1.04) months(range, 4-8 months) from injury time to intervene time. Results Ten patients were followed up 12-36 months (mean, 13.7 months). NO any complication was occurred and all incisions were primary healing. The average interval to return to work was (5.03±1.03) months (range from 3 to 12 months) and recovery to sports (8.31±1.30) months (range from 6 to 18 months). At 12 months after operation, the AOFAS ankle and hindfoot score was 96.3±1.6, showing significant difference when compared with that before operation. These Results were excellent in 6 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 90.0%. Conclusion The self-management ability of Achilles tendon rupture was improved with scientific rehabilitation nursing mode, reducing the occurrence of Achilles tendon rupture, providing a positive Method to the rehabilitation of the Flexor Hallucis Longus transfer with turndown gastrocnemius fascia flap and reinforced with plantaris tendon repairing for chronic Achilles tendon rupture.

PANG Fei, ZHOU Ping

2018, 16(6): 1040-1042. doi: 10.16766/j.cnki.issn.1674-4152.000285

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Abstract:

CHENG Ru-yu, XU Jin-cheng

2018, 16(6): 1043-1044. doi: 10.16766/j.cnki.issn.1674-4152.000286

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Abstract:

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2018 Vol. 16, No. 6

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