中华全科医学

Evaluation of validity and reliability of self-management behavior scale for community patients with osteoporosis

SHEN Qiu-ming, SHEN Tian, WANG Ze-zhou, SHI Yue, LA Ba-cang-la, YANG Ying-hua, WAN He-ping, CAI Yong, SHANG Mei-li

2018, 16(9): 1409-1413. doi: 10.16766/j.cnki.issn.1674-4152.000386

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Abstract:
Objective To construct a self-management behavior scale for patients with osteoporosis and test its validity and reliability. Methods A total of 597 osteoporosis patients were selected for questionnaire survey by convenient sampling from 20 community health service centers, which involved in the pilot project of standard treatment and management of osteoporosis in Shanghai. Results The item analysis showed that the CR value of all items was greater than 3, and the correlation with the total score was significant, with correlation coefficient greater than 0.3. The result of validity analysis showed that I-CVI was 1 for all items except for 2 items with a lower I-CVI. In the revised scale, both S-CVl/UA and S-CVI/Ave were 1. Exploratory factor analysis was used to extract three components and the cumulative variance explained was 78.373%. The results of confirmatory factor analysis showed that all goodness-of-fit statistics satisfied the model fitting requirements. The correlation coefficient between score of self-management behavior questionnaire and that of osteoporosis self-efficacy scale was 0.567, P<0.001. Reliability analysis showed that the overall Cronbach'α coefficient of this scale was 0.889 and the Cronbach'α coefficient of each dimension ranged from 0.812 to 0.928. The Spearman-Brown coefficient was 0.956. Conclusion The osteoporosis self-management behavior scale has a good reliability and validity, and would have a wide range of practical value.

LI Hai-yan, ZHANG Shi-fa

2018, 16(9): 1414-1415.

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Relationship between ADAMS12 methylation and the incidence of bird breeder’s lung among Uygur pigeon breeder

DENG Ming-qin, LENG Qiu-ping, WU Chao, YANG Xiao-hong

2018, 16(9): 1416-1418,1511. doi: 10.16766/j.cnki.issn.1674-4152.000387

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Objective To detect the ADAMS12 methylation status of peripheral blood of Uygur pigeon breeder with bird breeder's disease, and explore the relationship between ADAMS12 methylation and bird breeder's disease. Methods Twenty cases of Uygur pigeon breeder with bird breeder's disease were assigned into case group, 20 cases of Uygur pigeon breeder without bird breeder's disease were assigned into control group A, and 20 healthy controls taking a physical examination were assigned into control group B. The data of all subjects were collected. The blood samples were prepared to extract DNA, after bisulfite conversion, PCR amplification, transcription in vitro and RNase a specific enzyme cut, parallel matrix assisted laser desorption ionization time of flight mass spectrometry mass spectrometry technique was used to detect ADAMS12 gene methylation. SPSS 20.0 software was used to compare the difference in ADAMS12 methylation rate among the three groups. Results Total 5 CpG loci (CpG_1,CpG_2,CpG_3,CpG_4,CpG_5) of ADAMS12 fragment were detected, the result showed that there were no statistically significant difference in methylation distribution among the three groups (χ² value were 0.915, 1.425, 0.389, 4.204, 4.758, all P>0.05). The difference in samples methylation distribution of 5 sites between every two groups was not statistically significant (all P>0.017). Conclusion There was no correlation between the methylation of ADAMS12 and the incidence of bird breeder's disease in Uygur Pigeon breeder.

Effects of Berberine extracted from Chinese Goldthread Rhizome on the intestinal mucosal mechanical barrier in mice with ulcerative colitis

LI Si, SHEN Yan, ZHONG Ji-hong, XU Lei, WANG Zhang-liu, ZHENG Hua-jun, ZHANG Bing

2018, 16(9): 1419-1423. doi: 10.16766/j.cnki.issn.1674-4152.000388

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Objective To observe the effects of Berberine (BBR) extracted from Chinese Goldthread Rhizome on colonic mucosal mechanical barrier in mice with ulcerative colitis (UC), and to explore the possible mechanisms of BBR's therapeutic effect. Methods BALB/c mice were randomly divided into five groups:model control group, low and high dose BBR group, positive control group and blank control group. UC model was established by dextran sulphate sodium, and daily gavage administration was given for 7 days. Disease activity index (DAI) of mice were assessed, colon tissue were sectioned and HE stained, and its pathological changes were observed, the contents of claudin-1, occludin and ZO-1 were detected by immunohistochemical method, the expression levels of LGR-5 and TERT were determined by Western Blot. Results Compared with those before the treatment, the DAI of UC mice after the treatment were all decreased (P<0.01), with their pathological symptoms of colitis improving to varying degrees; compared with model control group after the treatment, the DAI of high dose BBR group were decreased obviously (P<0.01), the expression levels of claudin-1, occludin and ZO-1 in high dose BBR group were all markedly increased (P<0.01), and the contents of LGR-5 and TERT in low and high dose BBR groups were all elevated (P<0.05). Conclusion Berberine can keep the steady state of intestinal mucosal barrier by suppressing the destruction of ISCs and tight junction proteins, thus effectively inhibit the colitis in UC mice. It is then proved to have a protective effect on the pathogenesis of UC.

Application of two different free tissue flaps in maxillary tissue defect reconstruction

HU Kai, LI Jian-cheng, CHEN Mo, DONG Shun-li

2018, 16(9): 1424-1426,1486. doi: 10.16766/j.cnki.issn.1674-4152.000389

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Abstract:
Objective To evaluate and analyze the surgical features and clinical effects of free forearm flap and free posterior lateral perforator flap in maxillary tissue defect. Methods From April, 2013 to October, 2017, 24 cases of malignant tumors in the maxillary region were treated with oral and maxillofacial surgery in the first affiliated hospital of Bengbu medical college, including 13 cases of squamous cell carcinoma of the palate, 6 cases of adenoid cystic carcinoma of the palate, 4 cases of squamous cell carcinoma of the maxillary gingiva, and 1 case of squamous cell carcinoma of the maxillary sinus that had no invasion of the orbital floor. And 14 of them were repaired with forearm free flap immediately after operation. The area of the flap was 7 cm×8 cm and the smallest was 4 cm×5 cm. The rest 10 cases were repaired with the free posterior lateral perforator flap. The largest area of the flap was 13 cm×9 cm and the smallest was 5 cm×3 cm. The shape, swallowing function, voice function and prognosis of the two groups were evaluated after the operation. Results After operation, there were 22 cases of free flap survival in 24 patients in two groups and 1 case of vascular crisis after one day after operation. After two operations, 1 case had vascular crisis on three days after the operation, and the number of necrotic cases was still contradictory after the rescue. After the operation, the donor area and the operative incision were all healed at I stage. After operation, the recovery of the 24 cases, the swallowing and voice function were basically satisfactory, and there was no significant difference between the two groups. Conclusion The anatomical location of the free forearm flap is constant, the preparation is convenient, the pedicle of the blood vessel is long, the amount of cut and the length and width are flexible, the texture is soft and thin, the large soft tissue area can be provided, and the operation time can be saved by "double group operation". The posterior lateral perforator flap of the free leg has a large number of perforating vessels, a constant anatomical position, and thicker diameter of the tube, a good elastic wall, and a nerve graft with the nerve. The skin of the leg can be directly sutured. Two kinds of flaps can achieve satisfactory results in repairing maxillofacial tissue defects.

Serum iPTH, plasma BNP and NT-proBNP levels for the evaluation of cardiac function in patients with stage 5 chronic kidney disease

LIU Jun-sheng, LIU Li, YANG Li-juan, WU Xue-ping

2018, 16(9): 1427-1430. doi: 10.16766/j.cnki.issn.1674-4152.000390

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Objective To evaluate the value of serum iPTH, plasma BNP and NT-proBNP in the evaluation of cardiac function in patients stage 5 with chronic kidney disease (CKD). Methods Eighty stage 5 CKD patients with varying degrees of heart failure were selected to compare the serum iPTH, plasma BNP, NT-proBNP levels and echocardiography. Among them, there were 23 NYHA functional class Ⅰ (Group A), 40 class Ⅱ (Group B), and 17 class Ⅲ-Ⅳ (Group C). 30 healthy volunteers were selected as controls. The differences in serum iPTH, plasma BNP, and NT-proBNP levels and echocardiography among the three groups were compared, and their correlation with cardiac function was analyzed. Results Serum levels of iPTH, plasma BNP and NT-proBNP were significantly higher in patients in group A, B, and C than those in the control (P<0.01). The levels of LVEDd, LVEDs, IVST, and LVMI were significantly higher in group A, B, and C than those in the control group, and the levels of LVEF and FS were significantly lower than those in the control group (P<0.05). Serum iPTH, plasma BNP and NT-proBNP levels were all strongly correlated with cardiac function parameters, and LVEDd, LVEDs, IVST, LVMI were positively correlated with serum iPTH, plasma BNP and NT-proBNP levels. LVEF and FS were negatively correlated with serum iPTH, plasma BNP and NT-proBNP levels (P<0.05). Conclusion Serum iPTH, plasma BNP and NT-proBNP levels are closely associated with cardiac function in the patients with stage 5 CKD, with higher value in the assessment of cardiac function of patients.

Predictive factors of positive surgical margins in patients with breast invasive lobular carcinoma

JIAO Liang-he, SHEN Mei-ping

2018, 16(9): 1431-1434,1458. doi: 10.16766/j.cnki.issn.1674-4152.000391

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Objective To analyze the relationship of positive surgical margin and clinical pathological factors in patients with breast invasive lobular carcinoma (ILC). Methods Clinical data of 192 cases of patients with ILC undergoing breast conserving surgery in our hospital from January, 2010 to December, 2016 were selected, and the relationship of positive surgical margin and clinical pathological factors was analyzed by using single factor and multiple factor analysis method. Results Of the 192 patients with ILC, 47 patients had positive margins (24.48%) after the first operation, and 14 cases still had positive margins after the resection, accounted for 29.79%. Univariate analysis showed that the positive margins of ILC patients at the first operation were significantly correlated with ILC tissue type, mammography and ultrasound prompted multi center/multifocal or structural disorder were closely related with the first positive margin (P<0.05), but there was no significant correlation among age, menopause, tumor size, histological grade, TNM stage, axillary lymphatic metastasis, surgical resection range, ER, PR and HER-2 expression (all P>0.05). The positive margins of ILC patients after two resections were significantly correlated with mammography and ultrasound prompted multi center/multifocal or structural disorder were closely related with the first positive margin (all P<0.05), but there was no significant correlation between age, menopause, tumor size, histological grade, TNM stage, tissue type axillary lymphatic metastasis, surgical resection range, ER, PR and HER-2 expression (all P>0.05). Multivariate Logistic regression analysis showed that mammography and ultrasound indicated multifocal/multifocal or structural disturbances were independent risk factors for positive resection margins of patients with ILC. Conclusion The positive rate of margin resection after breast-conserving surgery in ILC patients is relatively high, and closely related to the presence of structural disorder, multifocal or multifocal presence of mammography or ultrasound. More attentions should be paid to that in clinical.

Risk factors associated with intracranial infection after surgery for intraventricular hemorrhage

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

2018, 16(9): 1435-1437. doi: 10.16766/j.cnki.issn.1674-4152.000392

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Objective To investigate the risk factors associated with ventriculostomy-associated infections (VAI) after intraventricular hemorrhage (IVH) and provide basis for the prevention of intracranial infection. Methods The clinical data of patients with intracranial infection after surgery for intraventricular hemorrhage in our hospital from August, 2013 to August, 2016 were reviewed retrospectively. Logistic regression analysis was used to evaluate possible risk factors associated with VAI after IVH. Diagnosis of intracranial infection was confirmed by clinical manifestations and laboratory tests. Results Total 276 patients were enrolled in the study, including 184 male (66.7%) and 92 female (33.3%), ranged from 32 to 79 years with an average age of (65.9±8.1) years. According to the postoperative intracranial infection, the patients were divided into VAI group (31 cases, 11.2%) and non-VAI group (245 cases, 88.8%). Multivariate Logistic regression analysis showed that bilateral ventricular drainage (OR=1.213, 95% CI:1.003-1.632, P=0.023), subcutaneous tunnel length<5 cm (OR=1.821, 95% CI:1.554-2.232, P<0.001) and duration of ventricular drainage>7 d (OR=2.658, 95% CI:1.813-3.223, P<0.001) were the independent risk factors of VAI. Conclusion VAI is a common complication after intraventricular hemorrhage. Bilateral ventricular drainage, subcutaneous tunnel length<5 cm, duration of ventricular drainage>7 d are the independent risk factors of VAI in patients after intraventricular hemorrhage. We should pay more attentions to these patients.

The clinical application of bone traction in the treatment of distal fractures of tibia and fibula fracture with minimally invasive percutaneous locking plate

DONG Lei, JING Jue-hua, WANG Hong-liang

2018, 16(9): 1438-1440. doi: 10.16766/j.cnki.issn.1674-4152.000393

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Objective To explore the clinical effect of bone traction in the treatment of distal fractures of tibia and fibula fracture with minimally invasive percutaneous locking plate. Methods From January, 2013 to December, 2017, there were 46 cases with distal fractures of tibia and fibula fracture treated in the department of orthopedics in Fuyang people's hospital. According to the different methods of preoperative fixation, they can be divided into calcaneal traction group (20 cases) and conventional plaster external fixation group (26 cases). Furthermore, operation time, blood loss was calculated, and the patients were followed up for fracture healing time and postoperative complications, tibia fracture Johner-Wruhs AOFAS rating score and ankle function. Results All patients were followed up for 6 to 12 months, with an average of (8.0±2.3) months. All patients had a closed wound, no wound infection occurred, no wound skin necrosis, nor exposed steel plate. Compared with the gypsum fixation group, the operation time could be shortened by (8.0±2.5) minutes, with significant difference (P<0.05), but no significant effect on the time of fracture healing and bleeding amount (P>0.05). According to shin Johner-Wruhs scoring criteria, 15 optimal cases, 8 improved cases, 3 acceptable cases in observation group and 13 optimal cases, 5 improved cases, 2 acceptable cases in control group, without statistical difference between the groups (P>0.05); according to AOFAS rating standards, the ankle joint function after surgery included 14 optimal cases, 10 improved cases, 2 acceptable cases in the observation group, and 12 optimal cases, 7 improved cases, and 1 acceptable case in the control group, with no statistical difference between the two groups(P>0.05). Conclusion The treatment of distal fracture of tibia fibula fracture can shorten the operation time and improve the quality of reduction of the distal fracture of tibia fibula fracture with bone traction assisted percutaneous locking plate, which can reduce the difficulty of the operation.

Effects of gypenosides on proliferation and apoptosis of oral squamous cell carcinoma

WANG Liang, WU Wei, CHEN Long, PAN Ling-feng, LI You-hua, XU Ming, WANG Liu-jing, CAI Ya-wei

2018, 16(9): 1441-1445. doi: 10.16766/j.cnki.issn.1674-4152.000394

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Objective To investigate the effect of gypenosides (Gyp) on proliferation and apoptosis of oral squamous cell carcinoma cell line SCC9 and to explore its underlying mechanism. Methods SCC9 cells were cultured with different concentrations of Gyp (70, 85 and 100 μg/ml), the untreated with Gyp as a control group (Ctrl group). Cell proliferation was detected by MTT assay. Apoptosis was detected by flow cytometry. The mRNA and protein expression of Notch1 and Jagged1 were detected by real-time PCR and Western blot. Results The proliferative rates of SCC were 62.15±8.13, 50.08±7.14 and 24.83±5.63 at Gyp concentrations of 70, 85 and 100 μg/ml, respectively, which were significantly lower than those in Ctrl group (P<0.05); the apoptotic rates were 23.54±2.17, 37.01 3.62 and 60.03±7.85, respectively, which were significantly higher than that of the Ctrl group (P<0.05); Notch1 mRNA expression was 2.24±0.17, 2.46±0.23, 2.97±0.31; the protein expression was 0.98±0.08, 1.26±0.09 and 1.71±0.13, respectively, which were significantly higher than that of the Ctrl group (P<0.05); Jagged1 mRNA expression were 0.94±0.11, 0.51±0.09, 0.26±0.06; the protein expressions were 1.43±0.15, 0.73±0.08 and 0.24±0.06, respectively, which were significantly lower than those in the Ctrl group (P<0.05); the fluorescence intensity of SCC9 cells were 65.69±11.32, 113.12±15.94 and 163.32±19.48 respectively, which were significantly higher than that of the Ctrl group (P<0.05). Conclusion Gyp can inhibit the proliferation and induces apoptosis of OSCC cell line SCC9 in a dose-dependent manner. Notch signaling pathway activation plays an important role in this process.

Effect of different liquid resuscitation strategy on the complications and prognosis of patients with hemorrhagic shock

WANG Jun-jie, ZHOU Juan-di

2018, 16(9): 1446-1448. doi: 10.16766/j.cnki.issn.1674-4152.000395

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Objective To explore the effect of different liquid resuscitation strategy on the complications and prognosis of patients with hemorrhagic shock. Methods We selected 120 cases of with hemorrhagic shock in our hospital from January, 2015 and June, 2016 as the research object, divided them into observation group(60 patients) and control group(60 patients) by random number table method. The patients in the observation group were given a limited fluid resuscitation, and the patients in the control group received traditional full recovery. The changes of Lac, Hct, INR, plasma TNF-α and IL-6 levels in two groups were observed before and after the treatment, and the incidence of complications and mortality between the two groups were compared. Results After the treatment, the input of recovery fluid, the MAP and INR in the control group were significant higher than those in the observation group, the difference was statistically significant(P<0.05). The level of Lac in the observation group was declined much more significantly than the control group, which had statistical significance(P<0.05). Hct were significantly decreased in both groups after the treatment, and the control group decreased much more, the differences were statistically significant(P<0.05). The plasma levels of TNF-α and IL-6 in the two groups were significantly increased, and the levels of plasma TNF-α and IL-6 in the observation group were significantly lower than those in the control group after the treatment, the difference was statistically significant(P<0.05). The incidences of MODS, ARDS and the mortality in the observation group were 18.3%, 25.0% and 6.7%, respectively, significantly lower than those in the control group(40.0%, 40.0% and 41.7%, respectively), the difference was statistical significant(P<0.05). Conclusion Limited fluid resuscitation can effectively improve the coagulation function of hemorrhagic shock, inhibit the inflammatory reaction, thereby reducing the incidence of complications, and improve the prognosis of patients.

Clinical value analysis and detection of inflammatory factors and transforming growth factor levels of serum and middle ear effusion in patients with secretory otitis media

XIE Xiao-xing, XIONG Gao-yun, GE Yan-ping, GUO Li-ming, LIN Wei

2018, 16(9): 1449-1451,1478. doi: 10.16766/j.cnki.issn.1674-4152.000396

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Objective To investigate the levels of inflammatory and transforming factors in serum and auricular fluid in patients with secretory otitis media (SOM) and to analyze the correlation between the level of the index and the SOM. Methods Patients with SOM in our hospital from October, 2015 to January, 2017 were selected as the observation objects. They were divided into acute group, subacute group and chronic group, each group of patients with 30 cases, at the same time 30 healthy persons were selected as control group. The levels of inflammatory factors and transforming factors in the serum and ear fluid were compared between the groups, and the correlation between the indexes and SOM was analyzed. Comparison of multi-group index level was used a single factor analysis of variance levels between the two groups were compared with t test and the correlation analysis was analyzed by Spearman. Results The levels of inflammatory and transforming factors in the serum and middle ear effusion between the SOM patients and the control group were statistically significant (all P<0.05). Compared with the control group the levels of TNF-α, IL-5, IL-8, TGF-β1 and TGF-β2 were significantly increased in SOM patients the difference was statistically significant (all P<0.05). Compared with the acute group levels of TNF-α, IL-5, IL-8, TGF-β1 and TGF-β2 in serum and middle ear effusion of subacute group and chronic group were significantly increased, and the indexes of chronic group were significantly higher than those in subacute group, the difference was statistically significant (all P<0.05). The correlation analysis showed that levels of TNF-α, IL-5, IL-8, TGF-β1 and TGF-β2 levels in serum and middle ear effusion were positively correlated with SOM (all P<0.05). Conclusion Levels of serum inflammatory factors and transforming growth factors in patients with SOM are abnormal, and the inflammatory factors and transforming growth factor levels in serum and ear effusion are closely related to the severity of SOM.

Effects of enhanced recovery after surgery on early cognitive function and recovery in elderly patients after laparoscopic gastric cancer surgery

JIANG Hua-yong, JIANG Zong-ming, ZHENG Xian-he, CHEN Zhong-hua

2018, 16(9): 1452-1454,1578. doi: 10.16766/j.cnki.issn.1674-4152.000397

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Objective To investigate the effects of enhanced recovery after surgery (ERAS) pathway on early cognitive function and postoperative recovery in elderly patients after laparoscopic gastric cancer surgery. Methods Sixty patients undergoing elective laparoscopic radical operation for gastric cancer surgery were randomly assigned into two groups:group Ⅰ and group Ⅱ, n=30 in each group. Patients in group Ⅰ received perioperative and anesthetic optimization of enhanced recovery after surgery pathway, and patients in group Ⅱ received conventional perioperative treatment. The mini-mental state examination (MMSE) was used to test the cognitive function of the patients one day before operation (T0), 24 h (T4), 72 h (T5) and 120 h (T6) after operation, and the blood concentrations of IL-6, TNF-α and IL-10 were assayed before anesthesia induction (T0), 24 h (T4), 72 h(T5) and 120 h(T6) after surgery. Results Compared with group Ⅱ, MMSE scores in group Ⅰ were increased at T4 and T5 (P<0.05), the blood levels of IL-6, TNF-α and IL-10 were decreased at T2, T3 and T4 (P<0.05). Compared with T0, MMSE scores were decreased at T4 in group Ⅰ and decreased at T4, T5 in group Ⅱ, the blood levels of IL-6, TNF-α and IL-10 in two groups were increased at T2-T4; the postoperative lengths of stay in group Ⅰ were shortened. Conclusion Enhanced recovery after surgery pathway is helpful in improving early postoperative cognitive function and decreasing the length of stay in elderly patients after laparoscopic gastric cancer surgery, and the mechanism may be related to decreased the blood levels of IL-6, TNF-α and IL-10.

The value of bone metabolic indexes in the diagnosis, treatment and prognosis evaluation of bone metastases in patients with lung cancer

FANG Mei-qun, SUN Ya-xun

2018, 16(9): 1455-1458. doi: 10.16766/j.cnki.issn.1674-4152.000398

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Abstract:
Objective To explore the value of bone metabolic indexes in the diagnosis, treatment and prognosis evaluation of bone metastases in patients with lung cancer. Methods A total of 108 patients with lung cancer in Yongkang Hospital of Traditional Chinese Medicine were selected, 58 patients with bone metastasis of lung cancer were included in the bone metastasis group, 50 patients without bone metastases were included in the boneless metastasis group, and 50 healthy people in the same period were included in the control group. The levels of total type procollagen Ⅰ amino-terminal propeptide (TPINP) and N-terminal molecular fragments of osteocalcin (N-MID) before and after treatment in the three groups were compared. Results The levels of TPINP and N-MID in the bone metastasis group and boneless metastasis group were significantly higher than those in control group (P<0.05), and the levels of TPINP and N-MID in bone metastasis group were significantly higher than those in boneless metastasis group (P<0.05). The AUC of TPINP and N-MID in the diagnosis of bone metastases in patients with lung cancer were 0.887 and 0.701 respectively, there was a significant difference between the two groups (P<0.05). The levels of TPINP and N-MID in relieved patients after treatment were significantly lower than those before treatment (P<0.05). There was no significant difference in TPINP and N-MID levels between patients without remission or worsening before and after treatment (P>0.05). The levels of TPINP and N-MID in relieved patients were significantly lower than those of patients without remission or worsening (P<0.05). The median survival time of patients with TPINP>72.36 μg/L was significantly higher than that of patients with TPINP ≤ 72.36 μg/L (P<0.05). There was no significant difference in the median survival time between the patients with N-MID>17.58 μg/L and N-MID ≤ 17.58 μg/L. Conclusion The levels of TPINP and N-MID can be used as effective indicators for the diagnosis and treatment evaluation of bone metastases in patients with lung cancer, and TPINP has a certain effect on the prognosis of patients with lung cancer.

A comparative study of one-stage transanal modified Soave pull-through procedure and radical operation via abdominal and perineal approach for Hirschsprung’s disease in children

LU: Liang-feng, LIU Shi-hui, WU Qi, HU Cheng-wen, ZUO Lu-gen

2018, 16(9): 1459-1461. doi: 10.16766/j.cnki.issn.1674-4152.000399

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Objective To investigate the clinical effect and safety of one-stage transanal Soave pull-through procedure (modified Soave procedure) and radical operation via abdominal and perineal approach in the treatment of congenital megacolon (Hirschsprung's disease). Methods The clinical data of 52 children with Hirschsprung's disease in our hospital from October, 2014 to August, 2017 were reviewed. The patients were randomly divided into observation group and control group with 26 cases in each group. The control group underwent the radical operation via abdominal and perineal approach, while the observation group received the modified Soave procedure. The operation time, the amount of bleeding in the operation, the recovery time of gastrointestinal function and the time of hospitalization were compared between the two groups. The postoperative defecation and complications were compared between the two groups. The children were followed up 6 months after the operation to evaluate their quality of life and parents' satisfaction. Results The operative time, intraoperative blood loss, gastrointestinal function recovery time and hospitalization time in the observation group were significantly shorter than those in the control group, the differences were statistically significant (P<0.05). The postoperative defecation and complications of the children in the observation group were significantly better than those in the control group, and the difference was statistically significant (P<0.05). The quality of life and the satisfaction of the parents in the 6 months of the observation group were significantly better than those in the control group, and the difference was statistically significant (P<0.05). Conclusion For the treatment of congenital megacolon, the modified Soave procedure is our preferences. When compared with the radical operation via abdominal and perineal approach, the children with modified Soave procedure will have good postoperative recovery, the improved quality of life, and the higher satisfaction of parents. It is worthy of extensive popularization and application.

The effects of body mass index and gender difference on the prevalence of chronic kidney disease in rural residents in north-central of Zhejiang

HUANG Fu-han, ZHAO Xiang, YAO Jiong, JI Shui-yu, JIN Wei, CHEN Yong, ZHOU Lian-fen, YANG Yuan, ZHANG Jia-ming, SHI Xiang-dong

2018, 16(9): 1462-1466,1557. doi: 10.16766/j.cnki.issn.1674-4152.000400

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Objective To observe the effects of body mass index (BMI) and gender difference on the prevalence of chronic kidney disease (CKD) of rural residents in north-central of Zhejiang. Methods In four different villages of north-central of Zhejiang, 118 villagers groups of inhabitants (more than 5 years) age more than 18 years old were sampled to receive a questionnaire survey in chronic kidney disease, and to test BMI, kidney damage index and related risk factors. Results Screening from 1 627 cases of residents with complete information, there were 851 cases of normal weight, 54 patients in low weights groups, 578 cases of overweight, 144 cases of obesity. Peak incidence of ACR and CKD in patients with BMI of 18.5-23.9 kg/m². According to the data of rural population distribution in the sixth census of Zhejiang province and after age gender standardized, ACR prevalence was 7.88%, eGFR decline prevalence was 2.37%, the total prevalence of CKD was 9.21%, Binary classification Logistic regression analysis showed that gender, age, history of hypertension, FBG, UA, BMI were the independent risk factors of chronic kidney disease. Conclusion The prevalence of CKD of rural residents in north-central of Zhejiang has a growth trend as BMI increased, the prevalence of female was significantly higher than male.

Effect of Shenqijianwei Granule on chronic atrophic gastritis of motilin and gastrin and immune function

ZHOU Ji-wang, WANG Qiao-ming, WANG Chang-xiong, ZHENG Feng-min

2018, 16(9): 1467-1469,1549. doi: 10.16766/j.cnki.issn.1674-4152.000401

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Objective To investigate the effect of Shenqijianwei Granule on chronic atrophic gastritis of motilin and gastrin and immune function. Methods Sixty-eight patients with chronic atrophic gastritis were divided into observation group and control group, each group of 34 cases. The control group was given conventional western medicine symptomatic treatment. The observation group in the control group based on the given Shenqijianwei granules. Comparison of the two groups before and after treatment of TCM symptom score. Changes of motilin and gastrin and T lymphocytes in the two groups before and after treatment were detected. Results The curative effect of the observation group was significantly better than that of the control group.The difference was statistically significant (Z=2.421, P<0.05). Two groups after the treatment of epigastric pain, epigastric fullness distension, lassitude,anorexia, total score decreased significantly (P<0.05). After treatment,the observation group of epigastric pain, epigastric fullness distension, lassitude, anorexia, the total score was significantly lower than the control group. The difference was statistically significant (P<0.05). After treatment, CD4 and CD4/CD8 in the observation group were significantly increased, CD8 was significantly lower (P<0.05). After treatment, the CD4 and CD4/CD8 in the observation group were significantly higher than those in the control group, CD8 was significantly lower than that in the control group. The difference was statistically significant (P<0.05). The two groups after treatment of motilin and gastrin increased significantly (P<0.05). After treatment, the observation group of motilin and gastrin was significantly higher than the control group. The difference was statistically significant (P<0.05). Conclusion Shenqijianwei granule can improve the patients of chronic atrophic gastritis of motilin and gastrin levels, improve immune function.

Clinical characteristics and antibiotic sensitivity analysis of streptococcus pneumoniae pneumonia in children

HE Lin, YUAN Yi, CAO Ling

2018, 16(9): 1470-1474. doi: 10.16766/j.cnki.issn.1674-4152.000402

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Objective The clinical characteristics and antibiotic sensitivity of children with Streptococcus pneumoniae (SP) pneumonia were analyzed to provide reference for the diagnosis and treatment of SP pneumonia. Methods The clinical data and antibiotic sensitivity results of children with SP pneumonia hospitalized in the Children's Hospital affiliated to the Capital Institute of Pediatrics from March, 2016 to March, 2018 were collected and analyzed with χ² test. Results A total of 250 cases with SP pneumonia were enrolled, including 99 mild cases and 151 severe cases. Two hundred (80%) cases were under 5 years old. Cough and fever were the main clinical manifestations, and unilateral lung infection were more common. In severe cases, the percentage of neutrophil ratio>60% (76.20%), CRP>50 mg/L (24.00%) and D-dimer ≥ 0.243 mg/L (57.00%) were significantly higher than that in mild cases. In cases with mixed mycoplasma infection, the percentage of cases with pleural effusion, atelectasis and massive lung consolidation were 36.20%, 18.80%, 27.50% respectively, which were significantly higher than that of patients without mixed mycoplasma infection. In cases with mixed parainfluenza infection, the percentage of wheezing cases was 53.30%, which was significantly higher than that of patients without parainfluenza infection.The resistance rate of SP to erythromycin was 99.59%. SP was not resistant to linezolid, ofloxacin, moxifloxacin, teliomycin, vancomycin or levofloxacin. The multidrug resistance rate of SP was 72.00%. The main multidrug resistance models contained two or more kinds of antibiotics among β-lactam antibiotics, macrolides, tetracyclines and sulfonamides. Conclusion Most of the SP pneumonia cases are children under 5 years old. The clinical manifestations of SP pneumonia are nonspecific so etiological examinations is necessary for making a definitive diagnosis. Mixed infection is common in children with SP pneumonia. SP pneumoniae cases present with pleural effusion, atelectasis or massive lung consolidation should consider mixed mycoplasma infection, and those present with wheezing should consider mixed parainfluenza infection. SP pneumoniae with higher neutrophil ratio, CRP or D-dimer might be severe cases. Sp is highly resistant to erythromycin, tetracycline and trimethoprim/sulfamethoxazole. SP multidrug resistance is common. Regular monitoring of SP drug sensitivity should be strengthened.

Analysis of the causes of death in 98 preterm infants

NI Wen-quan, CHEN Ming-wu, PAN Jia-hua, ZHANG Hui, FANG Tao, ZHANG Tian

2018, 16(9): 1475-1478. doi: 10.16766/j.cnki.issn.1674-4152.000403

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Objective To explore the causes of death of the neonatal nearly 4 years hospitalized premature infants in the Anhui Provincial Hospital,ensure effective measures to reduce the mortality of premature infants. Methods Through the collection of Anhui Provincial Hospital from January 1, 2013 to December 31, 2016 of 98 neonatal death cases of preterm infants (male, female) sex, birth (birth, cesarean section), gestational age (<28 weeks, 28-31⁺⁶ weeks, 32-33⁺⁶ weeks, 34-36⁺⁶ weeks), birth weight (<1 000 g, 1 000-1 499 g, 1 500-1 999 g, 2 000-2 499 g, 2 500 g, etc.), the cause of death were retrospectively analyzed. Results ① nearly 4 years a total of 2 794 cases of hospitalized premature infants, 98 cases died, the total Mortality rate was 3.51% (98/2 794); the annual mortality rate in each year was 4.36% (in 2013, 25/573), 3.79% (in 2014, 24/633), 3.48%(in 2015, 23/660), 2.80% (in 2016, 26/928); the total number of preterm infants has increased, the mortality rate was decreasing the trend, but each year the mortality rate difference. ② the mortality rate of premature infants with different gestational age was statistically significant (P<0.05). There was a significant difference in mortality between different body weight (P<0.05). The smaller the gestational age, the lower the body weight and the higher the fatality rate. ③ the leading causes of death in preterm infants were lung hyaline membrane disease 27.55% (27/98), infectious diseases 20.41% (20/98), asphyxia 14.29% (14/98), congenital birth defects 11.22% (11/98), and pulmonary hemorrhage 9.18% (9/98). Conclusion The main causes of premature death in preterm infants with gestational age, body weight, and there is a close relationship between hyaline membrane disease, infectious disease, asphyxia, congenital birth defects, pulmonary hemorrhage and other complications; through strengthen prenatal screening and prevention of perinatal health care, improve the premature infant resuscitation rescue level, strengthen the management of respiratory tract infection and preterm infants in order to reduce the mortality of premature babies.

Effect of nebulized magnesium sulfate combined with salbutamol in the treatment of moderate to severe asthma attacks in children

WENG Yu-qi, XIE Wen-long, HU Wen-hui

2018, 16(9): 1479-1482. doi: 10.16766/j.cnki.issn.1674-4152.000404

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Objective To evaluate the effect and safety of nebulized magnesium sulfate (MgSO₄) combined with albuterol sulfate in the treatment of moderate to severe asthma attacks in children. Methods Ninety-nine children with acute attack of bronchial asthma were randomized into three groups:MgSO₄ nebulization (group M), salbutamol nebulization (group S), and combination (group M+S). The aerosol inhalation based on the routine treatment was performed in all groups. The FEV1, PEF, FEV1% and PEF%, clinical efficacy, time of mechanical ventilation and ICU treatment, hospital stay and the incidence of adverse reactions were compared among the three groups. Results After the treatment, the absolute values (FEV1 and PEF) and the predicted percentage (FEV1% and PEF%) in all the three groups were significantly increased, among which the improvement of the group M+S was the largest, followed by the group S, and the group M were the smallest. The total effective rates of group M, group S and group M+S were 66.67%, 69.70% and 93.94%, the effective rate of group M+S was significantly higher than those of group S and group M (P<0.016 7), but no significant difference between group S and group M (P>0.016 7). The hospitalization time, the use rate and use time of mechanical ventilation and ICU treatment were significantly lower in the group M+S than group M and group S (P<0.05). There were no significant differences in the treatment-related adverse effects rates three groups (12.12%, 9.09% and 18.18%, P>0.05). Conclusion In the treatment of moderate to severe asthma attacks in children, the use of magnesium sulfate combined with salbutamol sulfate inhalation has a better effect and good safety, can significantly improve lung function, and reduce the use of mechanical ventilation.

Clinical comparison of 59 cases of ovarian cysts treated with laparoscopy combined with trans-abdominal operation during pregnancy

ZHANG Tian-jiao, WU Da-bao, ZHANG Ai-jun, HU Wei-ping, LI Hong, LI Jia

2018, 16(9): 1483-1486. doi: 10.16766/j.cnki.issn.1674-4152.000405

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Objective To investigate the feasibility and efficacy of laparoscopy in pregnancy with ovarian cysts by comparison of the clinical data obtained from laparoscopic and transabdominal surgery. Methods A retrospective analysis was made of 59 cases of ovarian cysts in pregnancy was treated in gynecology and obstetrics department of Anhui Provincial Hospital from February, 2015 to February, 2018, including 36 cases of laparoscopic surgery group and 23 cases of open surgery group with 9 cases of early pregnancy, 49 cases of mid pregnancy and 1 case of late pregnancy. Insufficient data in early pregnancy and late pregnancy made statistical analysis impossible to be carried out. Thus, clinical data was analyzed in the cases of middle pregnancy, including age, gestational weeks, cyst diameters, operation time, bleeding in operation, postoperative ventilation time, and average length of stay and abortion rate. The measurement data were expressed by x±s, and t test was used. Results All 59 patients successfully completed the operation, and all patients were discharged on schedule, without postoperative complications. And 36 cases of laparoscopic surgery were without conversion to open surgery. In the middle pregnancy group, the age of patients in laparoscopic surgery group was (26.2±3.4) years of age, gestational age (16.8±2.6) weeks, and cyst diameter (7.9±2.5) cm. The operative time of laparoscopic surgery group was (62.08±20.70) min, intraoperative bleeding (20.24±13.42) ml, postoperative ventilation time (21.78±8.45) h, and the average hospitalization stay was (6.48±1.77) days. The age of patients in abdominal operation group was (26.1±4.1) years of age, gestational age (17.2±3.2)weeks, and cyst diameter (8.2±3.1) cm. The operative time of abdominal operation group was (94.61±16.62) min, intraoperative bleeding (27.16±23.53) ml, postoperative ventilation time (40.79±10.53) h, and average hospitalization stay (8.55±1.97) days. There was no significant difference in age, gestational age and cyst diameter between the two groups (P>0.05). There was a significant difference between the two groups in the operation time, the postoperative ventilation time and the average hospitalization days (P<0.05). Conclusion Laparoscopic surgery in pregnancy with ovarian cysts has the characteristics of quick recovery and short hospitalization. It is feasible and can be used clinically. It is necessary to strengthen the monitoring of anesthesia. And it is essential to strengthen the postoperative nursing and tocolytic therapy.

Clinical observation of female overactive bladder patients through electrical stimulation on pudendal nerve by percutaneous puncture

WANG Wen-zhi, YAO Yong, XIANG Xiao-tian, HU Qing, ZHANG Jie

2018, 16(9): 1487-1489. doi: 10.16766/j.cnki.issn.1674-4152.000406

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Objective The incidence of overactive bladder (OAB) is increasing year by year, but the treatment of it is single. This study is intended to investigate the clinical efficacy of electrical stimulation on pudendal nerve by percutaneous puncture in female OAB patients. Methods Sixty cases of OAB patients were randomly divided into an observation group and a control group, 30 cases in each group. The control group was used oral tolterodine treatment, while the observation group was used electrical stimulation on pudendal nerve by percutaneous puncture as well as oral tolterodine treatment. After 3 months, the average urination and urinary incontinence times of 24 hours, overactive bladder syndrome score (OABSS), self-rating anxiety scale (SAS) and life index score of two groups were observed. SPSS 22.0 statistical software was applied to analyze the data. Results All therapeutic effect index of observation group and control group are improved compared to that before treatment. And the average urinary incontinence times of 24 hours, OABSS, SAS and life index score in observation group were significantly better than those in the control group (P<0.05). Conclusion Electrical stimulation on pudendal nerve by percutaneous puncture can effectively relieve symptoms of OAB and anxiety status. It is worth promoting for curative effect and high security.

Study on the involvement of MEK/ERK signaling pathway in cisplatin-resistance in ovarian cancer

ZHANG Dong-ya, GUO Hong-jun, FENG Wei, QIU Hai-feng

2018, 16(9): 1490-1492. doi: 10.16766/j.cnki.issn.1674-4152.000407

200 0

Abstract:
Objective The present research tried to explore the involvement of MEK/ERK signaling pathway in cisplatin-resistance in ovarian cancer. Methods 92 cases of cisplatin-resistance ovarian cancer patients in our hospital from February, 2015 to August, 2017 were enrolled in this part.The expression of MEK/ERK signaling pathway related proteins was detected by ELISA. Ninety cases of ovarian cancer patients without cisplatin-resistance at the same period were taken as control. Results The result revealed that the expression of MEK/ERK signaling pathway related proteins Ras, Raf, MEK and ERK1/2 as well as PI3K/AKT proteins were increased in observation group than control (P<0.05). At the mean time, the Bcl2 were increased (P<0.05) while the expression of Bax and caspase-9 were decreased (P<0.05) in observation group than control with statistical differences. Conclusion MEK/ERK signaling pathway as well as abnormal expression of PI3K and AKT are involved in cisplatin-resistance in ovarian cancer patients.

Application of hand-to-hand rotating fetal head processing technique in difficult labor of occipital transverse position and occipital posterior position

CAI Lu, ZHENG Fei-yun, ZHENG Ling-zhi

2018, 16(9): 1493-1495. doi: 10.16766/j.cnki.issn.1674-4152.000408

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Objective To explore the effect of the technique of the free hand rotating fetal head on the final delivery mode, the maternal complications and the infant complications of dystocia in occipital transverse position and occipital posterior position. Methods Eighty patients with dystocia in occipital transverse position or occipital posterior position were randomly divided into two groups:the control group (37 cases) and the observation group (43 cases). The control group was given routine self-identification delivery method, no special intervention to maintain uterine contraction, and oxytocin to maintain labor force when the labor force weakened, according to the natural rotation of labor. The observation group was treated with free-hand rotating fetal head.The final delivery mode, maternal complications and infant complications were compared between the two groups. Results Observation group of patients with vaginal delivery in 35 cases (81.39%), significantly higher than that in the control group of 19 patients (51.35%), the difference was significant, P<0.05; observation group cesarean section in 8 cases (18.6%) was significantly lower than the control group of 18 cases (48.65%), the difference was significant (P<0.05). The incidence of complications such as birth injury and postpartum hemorrhage was lower in the observation group than that in the control group, P<0.05; the total incidence of neonatal complications (distress, placental abruption, neonatal asphyxia, and neonatal scalp injury) in the observation group was 23.26%, less than 45.95% of the control group, P<0.05. Conclusion The technique of hand-rotating fetal head treatment can increase the rate of spontaneous delivery in patients with dystocia in occipital and posterior position, and reduce the incidence of complications of mother and child, which is worth popularizing in clinic.

A comparison of delivery modes for subsequent pregnancy after the first cesarean section

LU Yi-hong, FU Juan-juan, WEI Bing

2018, 16(9): 1496-1499. doi: 10.16766/j.cnki.issn.1674-4152.000409

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Objective To evaluate the feasibility of vaginal delivery for subsequent pregnancy after the first cesarean section and investigate the related factors. Methods The clinical data of 275 subsequent pregnancy after the first cesarean section in our hospital between January, 2015 and December, 2017 were reviewed. 133 cases of successfully vaginal delivery were assigned into vaginal birth after the first cesarean section group (VBAC group, observation group); 29 cases of failed vaginal delivery were assigned into failed trial of labor after the first cesarean section group (TOLAC group, failure group); 113 patients underwent directly the secondary cesarean section after admission were assigned into elective repeat cesarean section group (ERCS group). The age, gestational age, height, admission weight, weight change during pregnancy, cervical bishop score, amount of intrapartum hemorrhage, amount of postpartum hemorrhage at 24 hours and weight of newborn infants were compared among the three groups. Results Compared with the failed group, the weight gain and bishop score of the VBAC group were significant, however, there was no significance in the other indicators. The VBAC group had a relatively smaller weight gain and higher bishop score. There was significant difference in the bishop score, the amount of intrapartum hemorrhage and the amount of postpartum hemorrhage at 24 hours between ERCS group and VBAC group, and the rest of the indicators were not significant. The VBAC group had a relatively high bishop score, a relatively small amount of intrapartum hemorrhage and amount of postpartum hemorrhage at 24 hours. Conclusion The vaginal delivery can be conducted in women with subsequent pregnancy after the first cesarean section on the base of reasonable management during pregnancy and adequate assessment before delivery, which will appropriately decrease the rate of the cesarean section.

Analysis of prevalence and influencing factors of depression in the elderly in Chengdu community

WANG Hong-yan, WU Ping, LIN Qin, ZHOU Hai-yan, ZHANG Xian-geng

2018, 16(9): 1500-1503. doi: 10.16766/j.cnki.issn.1674-4152.000410

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Objective To explore the prevalence of depression in the elderly in Chengdu community and to analyze the influencing factors, and provide scientific basis for improvement of depressive symptoms and to formulate the corresponding measures. Methods By the method of layered, random and total sampling, we selected three representative communities in Chengdu, randomly selecting 400 elderly people from those communities which match the inclusion and exclusion criteria. All of them were investigated with self-designed General Condition Questionnaire and the Geriatric Depression Scale (GDS), by analyzing the data to sum up the incidences of depressive symptoms in the elderly population and logistic regression analysis was used to analyze the influence factors. Results Among the 399 elderly people, there were 145 elderly showing depressive symptoms. The incidence of depressive symptoms was 36.3%, 110 (27.6%) with mild depressive symptoms and 35(8.8%) with moderate or severe depressive symptoms. The GDS scores ranged from 0 to 30, with an average of (9.61±6.92). Binary Logistic regression indicated that the occurrence of negative events was the risk factor of depressive symptoms in the elderly, and regular exercise, high satisfaction with their lives in their own social and families and optimism were the protection factors of depressive symptoms in the elderly. Conclusion The incidence of depressive symptoms among the elderly in the community of Chengdu was in high proportion and related with life style, self-evaluation, life events and other factors. Community institutions should strengthen the monitoring of psychological health problems of elderly people and effective measures of intervention on the influencing factors should be taken to reduce the incidence of depression and improve the mental health and quality of life of the elderly.

Analysis of screening results and cost of high risk population of stroke by family doctors in urban areas

SUN Lan, WAN Yu-jing, YAO Ting, ZHANG Xiao-yan

2018, 16(9): 1504-1506,1582. doi: 10.16766/j.cnki.issn.1674-4152.000411

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Abstract:
Objective To screen the high-risk population of stroke by family doctors in Shanghai Xinhong Community, to analyze the screening results and the cost, and to provide the policy basis for community prevention and control of stroke in urban areas. Methods According to the jurisdiction area of each family doctor, 100 families with hypertension were randomly selected, and 2 760 residents aged 35 years and above were investigated. Using the unified screening questionnaire to survey risk factors, 2 693 people completed the questionnaire, with 868 high risk population to further complete assessment questionnaire and exam on the serum homocysteine (Hcy) and the bilateral carotid ultrasonography in hospital. Results A total of 868 high-risk population people were screened by questionnaire, the detection rate was 32.23%. Serum Hcy test results:low Hcy 140 people (16.13%), middle Hcy 424 people (48.85%), and high Hcy 304 people (35.02%). The bilateral carotid ultrasonography results:fresh arterial plaque for 548 people (63.13%), carotid artery stenosis and 19 (2.19%).The average cost of screening 1 case was 16.54 yuan; the average cost of 1 high-risk groups was 51.32 yuan; the average cost of screening 2 items was 93.54 yuan. Conclusion The risk factors of stroke in hypertension family members were exposed to a higher level; Family health management of people with chronic diseases should be the focus by family doctors, especially on the male residents over the age of 50.The cost management should be strengthened to improve the profit of screening.

A study on the effect of the group interpersonal psychotherapy in the regulatory emotional self-efficacy of social phobia adolescents

LIN Zi-jiang, WANG Chang-lyu, LIN Hai-xi, YANG Chuang

2018, 16(9): 1507-1511. doi: 10.16766/j.cnki.issn.1674-4152.000412

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Objective To discuss the regulatory emotional self-efficacy (RESE) of social phobia in adolescents, analyze the correlation between the RESE and the syndromes of social phobia, and observe the pre-post change in the RESE after group interpersonal psychotherapy. Methods Patients were recruited from July to August, 2016, by outpatient clinics at the Psychiatric Department of The First Affiliated Hospital of Wen zhou Medical University. Patients were diagnosed as "social phobia" by the psychiatrist. They were randomly divided into placebo group and treatment group.The treatment group and the placebo group were both assessed with the Social Avoidance and Distress Scale, the RESE Questionnaire before and after 12 weeks treatment. Results On the perceived self-efficacy in expressing positive affect (POS) dimension, the score was (13.91±3.2). On the perceived self-efficacy in managing despondency/distress (DES) dimension, the score was (9.80±3.25). On the perceived self-efficacy in managing anger/irritation (ANG) dimension, the score was (9.77±3.96). The POS was significantly negatively correlated with the social avoidance and distress total scores (P<0.05). The POS was significantly negatively correlated with social avoidance (P<0.05). The DES was significantly negatively correlated with the social avoidance and distress total scores (P<0.05), social avoidance (P<0.05) and the social anxiety (P<0.05). The ANG was significantly negatively correlated with the social avoidance and distress total scores (P<0.05), social avoidance (P<0.05) and the social anxiety (P<0.05). After therapy, POS was significantly improved (P<0.05). In the placebo group, there was no significant change in RESE (P>0.05). After therapy, there was significant difference between the treatment group and the placebo group in POS (P<0.05). Conclusion The level of the RESE of the social phobia adolescents is low. There is significant correlation between the RESE and the syndromes of social phobia. The RESE is significantly improved after the group interpersonal psychotherapy.

The clinical value of respiratory tract pathogenic gene detection in the diagnosis of Streptococcus pneumoniae infection in children

QIAN Jing, ZHU Chun-mei, CAO Ling

2018, 16(9): 1512-1514,1525. doi: 10.16766/j.cnki.issn.1674-4152.000413

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Abstract:
Objective To explore the application value of the detection of respiratory tract pathogenic gene for the diagnosis of Streptococcus pneumoniae infection in children. Methods From June, 2016 to June, 2017, 224 cases who were newly diagnosed with bacterial pneumonia hospitalized in the Department of respiration, Capital Institute of Pediatrics were collected. Each case was collected deep sputum or bronchoalveolar lavage specimens, according to the traditional bacterial culture was divided into non Streptococcus pneumoniae group 136 cases and 88 cases of Streptococcus pneumoniae group. The pathogens in the two groups were detected by respiratory tract gene detection kit (loop mediated isothermal amplification). The detection efficiency of the two detection methods was compared by SPSS 17.0 software and Kappa test. Results The detection of respiratory pathogens were detected in Streptococcus pneumoniae gene of Streptococcus pneumoniae in 40 cases, including deep sputum samples were detected in 32 cases, bronchoalveolar lavage fluid were detected in 8 cases. Streptococcus pneumoniae was detected in the detection of respiratory pathogens gene of Streptococcus pneumoniae in 80 cases, including deep sputum samples were detected in 52 cases, bronchoalveolar lavage fluid were detected in 28 cases. Compared with traditional pathogen culture, the sensitivity, specificity, total coincidence rate, positive predictive value and negative predictive value of respiratory tract pathogen gene detection for Streptococcus pneumoniae were 90.9%, 74.4%, 80.3%, 66.7% and 92.3%, respectively. The two detection methods were consistent with the detection rate of Streptococcus pneumoniae (Kappa>0.4). Conclusion Respiratory tract pathogen gene detection has the advantage of fast, specific and sensitive. It has high consistency with traditional pathogen isolation and culture test, and it can provide reliable diagnosis and treatment basis for clinicians.

Application value of Bosniak classification system in multislice CT diagnosis of renal cystic lesion

YAO Wen-jun, ZHANG Tao, WANG Long-sheng, GU Kang-chen, ZHENG Sui-sheng

2018, 16(9): 1515-1517,1529. doi: 10.16766/j.cnki.issn.1674-4152.000414

172 1

Abstract:
Objective To explore the application value of Bosniak classification system in CT diagnosis of renal cystic lesions, and summarize CT features according to the item specifics. Methods A total of 39 cystic renal masses of 38 patients underwent surgical treatment and were confirmed by histopathological examination in our hospital. The multislice CT (MSCT) features of cystic masses such as the size of the capsule, the thickness of the capsule wall, the quantity and thickness of the separation, the reinforcement of the separation, calcification, solid components and their enhancement were used for Bosniak classification, and compared with the histopathological results. Results Among the 39 lesions, 10 were classified as Bosniak Ⅰ (benign by histopathological examination); 6 as Bosniak Ⅱ and IIF (benign by histopathological examination); 6 as Bosniak Ⅲ (3 lesions were malignant by histopathological examination, including 2 cases of clear cell carcinoma and 1 case of mucinous tubular and spindle cell carcinoma, with a malignancy rate of 50%); 11 as Bosniak Ⅳ (10 lesions were malignant by histopathological examination, with a malignancy rate of 91%). Conclusion The Bosniak classification system has high application value in diagnosing cystic renal masses with MSCT, which can provide meaningful reference value in clinical diagnosis and treatment. The rate of malignancy will increase with Bosniak classification, especially for Ⅰ and Ⅳ. But the items of level Ⅱ, ⅡF and Ⅲ are tedious, the diagnostic criteria are intersecting, and the observer's subjectivity has a great influence on it. We need to observe the fine structure of the capsule carefully use thin scanning when we make the diagnosis. For lesions that cannot be accurately classified, they should be classified into higher categories, followed up closely or punctured biopsy if necessary.

Diagnostic value of transvaginal ultrasonography in early pregnancy abortion

FENG Bei, LOU Ye-lin, XU Chen

2018, 16(9): 1518-1521. doi: 10.16766/j.cnki.issn.1674-4152.000415

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Abstract:
Objective To observe the diagnostic value of transvaginal ultrasonography in early pregnancy abortion. Methods A total of 500 cases of early pregnancy women who were admitted to our hospital and underwent prenatal examination in our hospital were selected as research subjects. The transvaginal color Doppler ultrasound, corpus luteum morphology, blood flow and ultrasound echo were detected, the outcome of early pregnancy were tracked, and the size, character, ultrasonic echo, PSV and RI of corpus luteum flow were observed between the normal pregnancy, the threatened abortion and the unavoidable abortion. Results The overall incidence of threatened abortion was 22.60%; The corpus luteum in normal early pregnancy was thick walled and round, while the percentage of rods and spots in corpus luteum was the highest among the 3 groups (35.71% and 21.43%). The echo of corpus luteum in normal early pregnancy group was the main type of strong echo (84.50%), but the incidence of luteal inhomogeneous hypoechoic in the abortion group was the highest (52.28%), and the abnormal rate of corpus luteum (26.76%) in the threatened abortion group was significantly lower than that of the free abortion group (83.33%, χ²=33.850,P<0.001). The PSV value of luteal blood flow in normal early pregnancy group and threatened abortion continued pregnancy group was significantly higher than that in inevitable abortion group (P<0.05), and the RI values of luteal blood flow were significantly lower than those of patients with inevitable abortion (P<0.05), the luteal flow rate in the normal early pregnancy group and the threatened abortion group (100.00% and 88.72%) were significantly higher than those in the free abortion group (71.43%, P<0.05). Conclusion There are significant changes in the morphology and blood flow status of the corpus luteum in early pregnancy abortion patients, and there are also significant differences between the patients with early pregnancy abortion with different pregnancy outcomes. The diagnosis of early pregnancy abortion by transvaginal ultrasound is of certain value in the diagnosis of early pregnancy abortion.

Clinical application of simultaneous amplification and testing method for detection the RNA of Mycoplasma pneumoniae

XU Chen, LIU Zhou, LIANG Wei, HUANG Ling-ling, LI Xin, TONG Yang, YANG Kai, CHEN Li-wen

2018, 16(9): 1522-1525. doi: 10.16766/j.cnki.issn.1674-4152.000416

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Objective To evaluate the clinical application of simultaneous amplification and testing method for detection the RNA of mycoplasma pneumoniae (MP) in diagnosis of MP infection in pediatric patients. Methods During October, 2016 to July, 2017, Throat swab/sputum and serum specimens were collected from children with acute respiratory infections in inpatient departments. Among them, throat swab/sputum specimens were used to detect MP-DNA and MP-RNA, while serum specimens were used to detect MP-Ab. According to the children's course, Group A(disease course ≤ 10 d) and Group B (disease course>10 d) were divided, Based on the results of MP-Ab and MP-DNA detection, the difference of the positive rates of MP-RNA between each group was compared, while the sensitivity, specificity, positive predictive value and negative predictive value of MP-RNA were evaluated. Data were analyzed using SPSS 21.0. Results Compared with the positive rate of MP-DNA, MP-Ab and MP-RNA, there was no significant difference among them. In Group A, the positive rate of MP-RNA (37.8%) was higher than MP-Ab (22.9%), and in Group B, the positive rate of MP-RNA (10.6%) was lower than MP-Ab (23.1%). The difference between the two groups was statistically significant (P=0.003, P=0.001, respectively). Compared with the results of MP-DNA, there was no significant difference in the positive rate of MP-RNA between the two groups. Compared with MP-Ab and MP-DNA, the sensitivity of MP-RNA was 0.63/0.79, the specificity was 0.91/0.96, the positive predictive value was 0.67/0.85, and the negative predictive value was 0.89/0.94. In group A, the sensitivity and specificity of MP-RNA were 0.94/0.88 and 0.79/0.90, respectively. Conclusion Simultaneous amplification and testing Method for detection the RNA of MP has high sensitivity and specificity, and this method for early diagnosis of MP infection had better clinical diagnostic efficiency. It is a new method for the early diagnosis of MP infection.

Study on the value of CD4⁺T cell miR-29 family and target gene IFN-γ in the diagnosis of sputum negative pulmonary tuberculosis

XIA Xiao-xue, WANG Bin, XIA Jia-yun, LU Huo-quan, LIU Hua, CAO Da-xing, WANG Ying, ZHU Yu-cai

2018, 16(9): 1526-1529. doi: 10.16766/j.cnki.issn.1674-4152.000417

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Objective To investigate the application of the expression of the miR-29 family of CD4⁺ T cells and the expression of target gene IFN-γ in the diagnosis of sputum negative pulmonary tuberculosis. Methods From January to December, 2017, using convenient sampling methods, in our hospital treatment of patients with 60 cases of sputum negative pulmonary tuberculosis (negative group), 60 cases of sputum positive pulmonary tuberculosis (positive group), 35 cases of latent tuberculosis infection (infection group) were selected in our hospital physical examination and 42 healthy people for the control group were selected at the same time. CD4⁺ T cells from peripheral blood of 4 groups were separated and purified. The expressions of miR-29a, miR-29b and miR-29c in CD4⁺ T cells were detected by nucleic acid hybridization and fluorescence quantitative PCR,and the expression of miR-29 target gene IFN-γ was detected by quantitative PCR. Results The expression level of miR-29a, miR-29b and miR-29c in the negative group, positive group, latent infection group and control group in CD4⁺ T cells were different (P<0.05). The expression of miR-29b and miR-29c in negative group and positive group were higher than that in the control group, and miR-29a, miR-29b and miR-29c in the negative group, positive group were lower than the latent infection group (P<0.05); the expression level of target gene IFN-γ in the 4 groups were also different (P<0.05). Conclusion The miR-29a, miR-29b and miR-29c in CD4⁺ T cells may play an important role in the pathogenesis of phlegm negative active tuberculosis, which provides a potential target and a new strategy for the diagnosis and treatment of tuberculosis.

Research advance in etiological diagnosis of community-acquired pneumonia

SONG Yuan-lin, HOU Dong-ni

2018, 16(9): 1530-1534. doi: 10.16766/j.cnki.issn.1674-4152.000418

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Community-acquired pneumonia (CAP) is one of the worldwide diseases with high morbidity and mortality worldwide. To identify the pathogenic microorganisms for CAP can provide the best therapeutic strategies of antimicrobial agents; improve the outcome of patients, with great importance for epidemiology monitor and public health planning. Traditional microbiological techniques such as microbiological culture and urinary antigen tests are simple and convenient, but limited by its imperfection in timeliness and sensitivity, which prone to be affected by sample management and cultural conditions. Microbial nucleic acid detection got rapidly development in recent years. The nucleic acid amplification tests (polymerase chain reaction, PCR) can identify pathogenic genetic materials quickly with high sensitivity and specificity. Next-generation sequencing had revolutionized the identification of microbes in respiratory tract, which detects conserved gene sequence of multiple pathogens simultaneously,and provides unprecedented depth and width for respiratory microbiome analysis. The improvement of traditional microbiological methods and advance in nucleic acid detection methods, as well as optimal combination of multiple techniques will provide comprehensive and accurate pathogenic information for CAP diagnosis. In addition, the investigation on the characteristics of microbiome makes promise to reveal the relation between CAP and dysbiosis of microbiome in lower respiratory tracts, and brings novel insights for better management of CAP patients.

The clinical spectrum of Streptococcus pneumoniae infections

MENG Qing-hong, YAO Kai-hu

2018, 16(9): 1535-1539,1544. doi: 10.16766/j.cnki.issn.1674-4152.000419

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Abstract:
Streptococcus pneumoniae is an important pathogen that threats human health. People of all ages could be infected by the bacterium, especially the children under 5 years old and the olds over 65 years old, as well as those with the underlying disease. It causes non-invasive infection such as otitis media. Furthermore, it causes invasive pneumococcal diseases (IPD), such as bacteremia.Streptococcus pneumoniae, a common etiologic agent of pneumonia with bacteremia, pyothorax and meningitis, is also responsible for a remarkable array of unusual and uncommon clinical manifestations. The researchers had reviewed 95 different types of unusual pneumococcal infections representing 2 064 cases. In recent years, some new forms of performance or underlying diseases are reported in the literature. Streptococcus pneumoniae can invade all the tissues and organs, and there are various types of clinical infection. The different types of infection may occur at the same time or in sequence. Most of the rare IPD types reported in the literature were not examined and reported in domestic cases. These suggested that there has been insufficient attention given to etiology detection in domestic clinical practice, or the clinical type of streptococcus pneumoniae infection may be confined to the definite diagnosis, ignoring other types that exist at the same time. Maybe, there is also lack of knowledge about whether streptococcus pneumoniae could cause the corresponding infection or not. In this paper, we summarized the clinical infection types of streptococcus pneumoniae in the literature, especially the IPD case report including endophthalmitis, lacrimal abscess, pericarditis, hemolytic-uremic syndrome, acute necrotizing fasciitis. Austrian syndrome and hemophagocytic syndrome. It is hoped that clinicians pay close attention to streptococcus pneumoniae infection, especially the diagnosis and treatment of IPD, and the relevant research will be carried out. This could provide systematic and comprehensive evidence for the prevention and treatment of streptococcus pneumoniae infection in our country in the future.

Immune response to streptococcus pneumonia infection

LIU Li-pin, WANG Xiao-chuan

2018, 16(9): 1540-1544. doi: 10.16766/j.cnki.issn.1674-4152.000420

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Streptococcus pneumonia (SP) is a common pathogen in children with acute otitis media, community-acquired pneumonia (CAP), bacteremia, and purulent meningitis. It is a normal colonizing bacterium in the human oral and nasopharyngeal tissues. When the body's immune system is weakened, it can cause IPD, and severe SP infection can lead to serious complications such as septic shock, necrotizing pneumonia, respiratory distress syndrome and acute cardiovascular events, which is the leading cause of severe pneumonia and death in children and the elderly. The prognosis of the disease and the intensity of the inflammatory response are determined by three main factors, namely, the microorganism, the host, and the treatment. The most important is the SP serotype. Avoiding its risk factors is the key to effective prevention and control of infection. Even in the era of vaccination for children and adults, IPD remains an important cause of morbidity and mortality. Therefore, understanding the impact of SP on the human immune system is crucial for the prevention and treatment of SP and the development of new vaccines. The innate immune system plays an important role in the development of SP infection, and its basic mechanism has become clear. The immunological mechanisms of antibody-dependent control of SP colonization have been well described. Capsular-specific antibody IgG inhibits bacterial colonization through antibody-mediated bacterial agglutination and opsonophagocytosis. Recent studies have found that SP can induce strong initial and memory helper T cells 17 (Th17) anti-SP immune responses in local mucosa, and the mechanism of mucosal immunity mediated by Th17 cells remains unclear. The further study of the immune mechanism after SP infection contributes to the prevention and diagnosis of SP infection.

Progress in early exercise rehabilitation of mechanical ventilation patients

MAO Jing, WU Jian-xian, ZHANG Jin-niu, HONG Yong-feng

2018, 16(9): 1545-1549. doi: 10.16766/j.cnki.issn.1674-4152.000421

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Abstract:
With the rapid progress of modern medical technology, especially in critical care medicine, the survival rate of patients with acute respiratory failure(ARDS) with mechanical ventilation in the intensive care unit(ICU) has increased significantly, followed by the increase of the survivors' functional prognosis and the quality of life. In order to improve the functional prognosis of these patients and improve the quality of life of the survivors, early prevention and rehabilitation are particularly important. Early rehabilitation for critically ill patients is beneficial to preventing and treating complications, reducing heart and lung function decline and skeletal muscle weakness in bed. Early rehabilitation treatment can also help shorten the time of mechanical ventilation, realize early withdrawal of mechanical auxiliary ventilation, and achieve the goal of reducing medical expenditure and improving the post-life quality of the survivor. Intensive care unit-acquired weakness(ICU-AW) is a common and serious complication of patients in ICU. It is also one of the hot spots of research and attention of many domestic and foreign scholars in recent years, but there is no special drug for treatment at present. This article is based on the ICU-AW, its pathogenesis and risk factors, illness condition assessment, the feasibility and the clinical benefit of the early rehabilitation of the patients with mechanical ventilation, the treatment timing of early rehabilitation intervention, the status and implementation of early rehabilitation in the world, early rehabilitation methods, the adverse events are all reviewed in this paper. These studies indicate that early rehabilitation of patients with mechanical ventilation is safe and effective, and the incidence of adverse events in early rehabilitation is low. It has the great significance to prevent complications, shorten the time of mechanical ventilation and hospital stay, and improve the prognosis and quality of their life.

Research progress on correlations between intestinal microbiota and epilepsy

LU Yan, LIU Zhan-li

2018, 16(9): 1550-1553,1569. doi: 10.16766/j.cnki.issn.1674-4152.000422

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Abstract:
Gut microbiota is a complex community which plays an important role in the normal physiological functions of human beings. The normal gut microbiota has many important functions which involving host nutrient metabolism, drug metabolism, maintenance of structural integrity of the intestinal mucosal barrier, immunomodulation, protection against pathogens, etc. Gut microbiota exerts effects on the brain which not only through the nervous system, but also through the endocrine system, immune system and metabolic system. A bidirectional communication between the gut and the brain is referred to as the brain-gut axis. The brain-gut axis may be a key regulatory pathway between the brain and the gastrointestinal tract, while gut microbiota is an important participant in this pathway. The changes in gut microbiota can act on the central and peripheral nervous system through immunologic mechanism, which leading to changes in the brain function, and consequently participating in the pathogenesis of various central nervous system diseases, such as Parkinson's disease, Alzheimer's disease, schizophrenia, and multiple sclerosis, etc. Epilepsy is a chronic neurologic disease characterized by a persistent tendency to cause epileptic seizures. Immunologic mechanism plays an important role in the generation and development of epilepsy, especially autoimmune epilepsy. Autoimmune epilepsy is one of immune-mediated epileptic diseases characterized by repeated and continuous epileptic onset, its clinical features includes frequent onset of focal seizures, encephalopathy, progressive cognitive impairment, focal neurological injuries and/or other central neurologic deficits. The excessive activation of immune response(the innate and acquired immunity)participates in the pathogenesis of autoimmune epilepsy, the neural-specific antibodies can be detected in the cerebrospinal fluid of the patient with autoimmune epilepsy. Anti-inflammation or immune therapy may have a good clinical therapeutic effect in some drug resistance epilepsy, especially in diagnosed autoimmune epilepsy. Immune therapy and the reconstruction of intestinal microbiota may be a promising strategy for treatment of epilepsy in the future.

Epidemiological analysis of severe hand-foot-mouth disease in Nanning from 2012 to 2016

LI Dong-ming, LIN Ming, LI Ying-feng, SHE Shang-yang

2018, 16(9): 1554-1557. doi: 10.16766/j.cnki.issn.1674-4152.000423

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Abstract:
Objective To study the clinical and epidemiological features of severe hand-foot-mouth disease (HFMD) cases from maternal and child health care hospital of Guangxi Zhuang Autonomous Region from 2012 to 2016, distribution of etiology and their changes in order to control and prevent the disease. Methods The clinical data were collected from HFMD cases in department of pediatrics in our institution from 2012 to 2016. Epidemiological characteristics of severe HFMD, including years, ages, genders and regions were retrospectively analyzed. EV71, CoxA16 and enterovirus were detected via RT-PCT. Results A total of 52 861 cases were reported during 2012 to 2016, among which 870 (1.65%) cases were severe cases. The results showed that two seasonal peaks appeared between April to July and August to October. The proportion of 1 to 2-year-old children was the largest, accounting for 45.40% of all cases, and it was 21.15% in children aged 2 to 3 years old. Children aged under 5 constituted 97.59% of all cases. There was a male predominance of severe HFMD cases, with a male-to-female ratio of 2.25:1. The majority (88.15%) of cases occurred in those children who stayed at home. The percentage of children in kindergartens was 10.47%. The proportion of cases from Xixiangtang and Jiangnan region was 21.98% and 16.46% respectively. Among the 870 samples, 704 (80.92%) were tested positive for EV, including EV71(40.34%), Cox A16(6.39%) and other EV (53.27%)type. Out of 14 fatal cases, EV71 was identified in 85.71% of all death cases. Other EV was identified in 7.14% of all death cases. The prevalent strain was EV71 in 2012 and in 2014, and it was other EV in other years. Conclusion There was a seasonal fluctuation about the epidemic severe HFMD. Severe HFMD was more likely to occur in children under five years old. High-risk populations were scattered children and children in childcare, and boys were more easily affected than girls. EV was the major pathogen causing severe HFMD, and EV71 was the predominant pathogen leading cause of severe and death cases. EV71 showed popular superiority strains every one or two years.

Reform and practice for the Course of Social Medicine and Health Management in the context of cooperation between medicine and education

RONG Sheng-zhong, ZOU Li-na, HE Ying-juan, ZHAO Fu-yang, CUI Xin-gang, GUO Yu-peng, LIU Feng-hai, LIU Jun-feng, LI Xiao-xia

2018, 16(9): 1558-1561. doi: 10.16766/j.cnki.issn.1674-4152.000424

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Abstract:
Objective The Course of Social Medicine and Health Management was reformed to cultivate general medical thinking and ability of medical students. Methods Comprehensive reform including teaching content, teaching plan, syllabus, teaching and assessment methods was conducted. Data about teaching content arrangement, teaching method, general medical thinking and ability of the test group (252 students) and the control group (307 students) was collected. Results The satisfaction rate of students in the test group (85.95%) was significantly elevated compared to control group (75.91%) in teaching content arrangement (χ²=8.600, P=0.003); the satisfaction rate of teaching method in control group (79.87%) was obviously lower than that in the test group (91.32%, χ²=13.810, P<0.001); the satisfaction rate of students in the test group (81.40%) was significantly higher than that in control group (58.41%) in cultivating general medical thinking and ability (χ²=33.024, P<0.001); compared to the control group, the score of students from the test group in case analysis about the ability of solving the community problem based on the population, clinical diagnosis and treatment on the basis of the overall medical concept, maintaining healthy and health management and first-aid was significantly increased (all P<0.001). Conclusion We provide some instructions for cultivating general medical ability and thinking of medical students on the basis of the reform for the Course of Social Medicine and Health Management in the context of cooperation between medicine and education.

Meta-analysis of efficacy of pneumococcal vaccination in patients with chronic obstructive pulmonary disease

ZHOU Zhi-qiang, QU Jian-wei, XIAN Ben-song, QU Jian-hui, QU Jian-jiao

2018, 16(9): 1562-1565,1574. doi: 10.16766/j.cnki.issn.1674-4152.000425

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Abstract:
Objective To systematically evaluate the efficacy of pneumococcal vaccine in patients with chronic obstructive pulmonary disease, providing evidence-based evidence for the prevention and treatment of chronic obstructive pulmonary disease. Methods We retrieved the randomized controlled research literature about pneumococcal vaccine efficacy of patients with chronic obstructive pulmonary disease from Cochrane library, Pubmed, Weipu database (VIP), China journal full-text database (CNKI) and WANFANG med online. Two researchers extracted data from the included research literature. The extracted contents included the study site, years of follow-up, interventions, and outcome measures (number of acute attacks, days of hospitalization, and interval between attacks). The Cochrane Collaboration Network bias risk assessment criteria were used to evaluate the quality of the included literature. Meta data analysis was made by RevMan 5.3 software. The standardized mean difference was used as the combined statistic. Hypothesis testing of combined statistics used 95% confidence interval, with Chi-square test for heterogeneity test. Results Nine studies were included, which are the Chinese research literatures. According to the results of the heterogeneity test of the three outcomes (P<0.050), with the random effects model for Meta analysis, the results of Meta analysis showed that pneumococcal vaccination of patients with chronic obstructive pulmonary disease in acute attack times[SMD=-5.070, 95% CI (-8.900,-1.230), P=0.010] and hospitalization days[SMD=-2.560,95% CI (-3.620,-1.500), P<0.001] were lower than patients without pneumococcal vaccination,and the difference was statistically significant. The duration of the attack was longer than that of patients who were not vaccinated with pneumococcal vaccine[SMD=1.040, 95% CI (0.850,1.230), P<0.001], and the difference was statistically significant. Conclusion Pneumococcal vaccine could effectively reduce the number of attacks and average hospitalization days in patients with chronic obstructive pulmonary disease, and extend the onset time interval. Pneumococcal vaccine was suggested to be used in patients with chronic obstructive pulmonary disease.

Analysis of risk factors for PICC related thrombosis in esophageal cancer patients with chemotherapy

QIU Cheng-li, PAN Qiao-ling, XU Guo-dong, WANG Yan-fei, SHEN Li-yue, LIU Chun-na

2018, 16(9): 1566-1569. doi: 10.16766/j.cnki.issn.1674-4152.000426

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Abstract:
Objective Peripherally inserted central catheter (PICC) is a common way of intravenous administration in patients with malignant tumors. This study was designed to investigate the risk factors of PICC related thrombosis in esophageal cancer patients with chemotherapy. Methods From January 1, 2012 to December 31, 2016, a retrospective study was conducted on 306 cases of esophageal cancer patients with chemotherapy after PICC placement. The general data (including gender, age, surgery history of esophageal cancer, pathological type, TNM staging of esophageal cancer, radiotherapy history, history of venous thrombosis and history of diabetes) and catheterization data (including the puncture limb and the types of PICC catheter) were recorded and analyzed by single factor analysis, and the measurement data and numeration data were statistically analyzed with t test and χ² test respectively. The factors that had statistical differences were assigned and enrolled in the multiple factor logistic regression analysis. Results A total of 25 patients developed PICC related thrombosis in 306 cases, and the incidence was 8.2%. The single factor analysis showed that TNM staging of esophageal cancer, history of radiotherapy,history of venous thrombosis and types of PICC catheter were related with the occurrence of PICC related thrombosis. Multiple factor logistic regression analysis showed that venous thrombosis (OR=5.048, 95% CI:1.712-14.835), type of the catheter (OR=3.764,95% CI:1.239-11.985) and TNM staging (OR=2.879,95% CI:1.135-3.486) were risk factors of catheter related thrombosis in esophageal cancer patients. Conclusion The TNM staging of esophageal cancer, history of venous thrombosis and types of PICC catheter were independent risk factors with PICC related thrombosis. For these patients,taking effective preventive measures can reduce the occurrence of PICC catheter related thrombosis.

The relationship between self-perceived burden and self-efficacy and quality of life among hospitalized stoma patients after operation

QIU Pei-hong, XIE Hong-yan, RONG Fang

2018, 16(9): 1570-1574. doi: 10.16766/j.cnki.issn.1674-4152.000427

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Abstract:
Objective To describe the level and influence factors of self-perceived burden among hospitalized stoma patients after operation and analyze the correlation of self-efficacy and quality of life and it's influencing factors. Methods This is a descriptive correlational study. From January, 2016 to June, 2017, 151 stoma hospitalized patients were invited to complete demographic questionnaire, self-perceived burden (SPB) scale, and strategies used by people to promote health and stoma quality of life scale. General data of stoma patients were described by mean standard deviation and frequency. Univariate analysis was done by t-test and ANOVA. The relationship of SPB, self-efficacy and quality of life was assessed by Pearson correlation analysis. Statistically significant variables were introduced into the regression model as independent variables for multiple linear regression analysis. Results All of the patients got the average score (39.64±8.83) on SPB scale, among moderate level, with 50.3% patients among high level. The self-efficacy and quality of life have a negative relationship with SPB, and the correlation coefficient was -0.441 and -0.459 respectively. The influencing factors of SPB of stoma hospitalized patients include educational level, stool leak and stink rate and self-efficacy. Conclusion Stoma patients have serious level of self-perceived burden. Nurses should encourage patients to face difficulties and challenges, learn stoma care skills and communicate with others actively. Besides, stoma patients who have lower educational level should be taken into consideration.

Effects of comfort care in operation room on postoperative analgesia and satisfaction of patients with intercostal nerve block combined with controlled analgesia

LIANG Yao-bin, ZHU Jun-hong, SHI Xiao-ya

2018, 16(9): 1575-1578. doi: 10.16766/j.cnki.issn.1674-4152.000428

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Abstract:
Objective To investigate the effects of comfort care in operation room on postoperative analgesia and satisfaction of patients with intercostal nerve block combined with controlled analgesia. Methods From January, 2013 to February, 2017, 140 cases of breast cancer patients in our hospital were selected as the subjects, and all the patients were randomly divided the observation group and control group with 70 cases in each group. All patients were given intercostal nerve block combined with controlled analgesia, the control group received routine nursing in operation room, and the observation group was given comfortable nursing in operation room nursing based on the control group. We recorded anesthesia, pain, quality of life and satisfaction of nursing care of the two groups. Results All the patients successfully completed anesthesia block without serious complications. The analgesia onset time, perfect time compared between the two groups were not significantly different (P>0.05). The immediate and postoperative pain scores in the observation group were (1.55±0.45) points and (0.56±0.55) points which were significantly lower than (2.76±1.22) points and (1.43±0.82) points of the control group (P<0.05). The postoperative satisfaction degree in the observation group and the control group were 100.0% and 88.6% respectively, and the observation group was better than that of the control group (P<0.05). After 6 months follow-up, the scores of psychological health, mental health, physical pain and social support in the observation group were significantly higher than those of the control group (P<0.05). Conclusion There is a good anesthetic effect of intercostal nerve block combined with controlled analgesia in patients with breast cancer. Application of comfort care in the operation room can enhance the analgesic effect, improve the nurse patient relationship, and promote the survival quality.

Risk factors of neonatal nosocomial infection and effect of cluster nursing intervention

XU Li, WANG Ren-yuan, CHEN Bei-bei, XIE Man-fang, FU Zeng-zhen

2018, 16(9): 1579-1582. doi: 10.16766/j.cnki.issn.1674-4152.000429

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Objective To investigate the risk factors of neonatal nosocomial infection and effect of cluster nursing intervention, and to provide reference for clinical treatment. Methods A total of 826 cases of neonates were selected from Hainan maternal and child health care hospital. They were divided into hospital infection group (52 cases) and non hospital infection group (774 cases) according to the occurrence of hospital infection. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of nosocomial infection in neonates. Fifty-two cases of hospital infection were randomly divided into the control group and the observation group, with 26 cases in each group. The control group was given routine care, the observation group was treated by cluster nursing on the basis of routine care, and the intervention effect between the two groups was compared. Results There were 52 cases of nosocomial infection in 826 neonates, the infection rate was 6.30%, and the main infection site was respiratory tract, accounting for 53.85%. A total of 58 strains of pathogenic bacteria were isolated from 52 children with nosocomial infection, mainly Gram negative bacteria (65.52%) and gram positive bacteria (31.03%). Univariate and multivariate Logistic regression analysis showed that birth weight (OR=2.704, P=0.021), invasive operation (OR=5.206, P<0.001), Apgar score (OR=1.947, P=0.036) and antimicrobial use time (OR=3.126, P<0.001) were neonatal nosocomial infection independent risk factors. The hospitalization time, hospitalization expenses, mechanical ventilation time, white blood cell count, ventilator use rate and complication rate of the observation group were significantly lower than those in the control group(P<0.05). The effective rate of observation group was significantly higher than that of the control group (P<0.05). Conclusion The pathogens of neonatal infection are quite extensive, and the risk factors of nosocomial infection are varied. Cluster nursing intervention can improve the treatment effect among children.

Differences of accompany needs cognition in ICU unattended ward among patients, families and nurses

ZHANG Hai-yan, GAN Yan-qun, SHEN Xin, WU Liang

2018, 16(9): 1583-1585. doi: 10.16766/j.cnki.issn.1674-4152.000430

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Abstract:
Objective To explore the differences of accompany needs in ICU unattended ward among patients, families and nurses, and provide guidance to the reform of ICU unattended ward or the implementation of unattended ward in other department. Methods There were 298 patients, 356 family members and 63 nurses recruited from Intensive Care Unit of Zhejiang Hospital in Hangzhou between May and September 2017 by convenience sampling. The Inpatients Accompany Needs Questionnaire was used to collect data. Analysis of variance and SNK pairwise comparison were used for statistical analysis. Results The cognition of accompany needs in patients, families and nurses were different (F=4.091,P<0.05). The score in families was higher than families and nurses (P<0.05). The differences were mainly in physical needs and esteem needs subscales. Families' score of physical needs was higher than patients and nurses. Scores of esteem needs in families and nurse were higher than patients. All the top score in subscales is physical needs, lowest score is self-actualization needs subscale. The rankings of safety needs, love and belonging needs and esteem needs subscales were different, safety needs>esteem needs>belongingness and love needs in patients, and esteem needs>safety needs> belongingness and love needs in families and nurses. Conclusion There are differences of accompany needs cognition in ICU unattended ward among patients, families and nurses. These differences should be emphasized and corrected in the promotion of unattended ward and establish the most suitable unattended ward system.

CHU Wen-lai, WANG Geng-huan, CHU Zheng-min, SHEN Jian-guo

2018, 16(9): 1586-1587,1590. doi: 10.16766/j.cnki.issn.1674-4152.000431

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XU Tao, WANG Hua-ying, YU Wan-jun

2018, 16(9): 1588-1590. doi: 10.16766/j.cnki.issn.1674-4152.000432

122 2

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About Journal

2018 Vol. 16, No. 9

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