2019 Vol. 17, No. 12

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Practice and reflection on the scientific research cultivate pathway of general practitioner in community
ZHAO Xin-xin, LI Jue, WU Heng-jing
2019, 17(12): 1979-1981,2091. doi: 10.16766/j.cnki.issn.1674-4152.001107
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Improving the scientific research ability is an essential aspect of enhancing the general practitioner competences and promoting the medical care in community health center. Based on the current situation of community clinical and scientific research, Tongji University School of Medicine (TUSM) take the improvement of clinical diagnosis and treatment ability and the training of community general medical talents as the core guidance. TUSM built scientific research cultivation pathway for general practitioners by strengthening the scientific research training, improving the academic level of general practitioner, and carrying out scientific research cooperation both domestic and abroad. TUSM established innovative models of community scientific research and training, replacing indoctrination theory teaching by clinical or community-based learning. TUSM had set up a master degree of general medicine to make up for the short board of scientific research of general practitioners and improve the educational level of general practitioners. With the help of the university's international exchange platform, TUSM conducted international scientific research exchanges among community physicians, triggering the sensitivity of clinical research, gradually enhancing the self-confidence and opening new directions for community research. In order to ensure the overall healthy development of community scientific research, it should pay attention to the humanistic ethics in the process of scientific research, cultivate the ethical cognition of community general practitioners, and ensure the objective and true results of scientific research. In addition, the incentive mechanism in scientific research progress should be applied, set up start scientific research cultivation plan and special fund for general medical research, establish a benign environment of scientific research back feeding clinical, and fully enhance the level of community clinical and scientific research.
2019, 17(12): 1982-1983.
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Reversal of cisplatin resistance in human esophageal squamous cell carcinoma cell lines by verapamil
WANG Xu, MAO Yi-wen, TANG Li-li, ZHANG Teng-yue, FAN Ping-sheng
2019, 17(12): 1984-1988. doi: 10.16766/j.cnki.issn.1674-4152.001108
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Objective To the effect of verapamil on chemosensitivity of human esophageal squamous cell carcinoma cell lines and to investigate the relationship between the resistance of verapamil to reverse and P-gp. Methods The IC50 values(IC501) of three kinds of chemotherapy drugs: Adriamycin, cisplatin, and 5-fluorouracil were detected by CCK-8 method in 2 kinds of esophageal cancer cell lines ( KYSE-150 and KYSE-510). Each cell was processed by verapamil (4.91 μg /mL) combined with the chemotherapy treatment above, IC50(IC502) value was detected by CCK-8 assay combined with chemotherapy for the verapamil of the 2 esophageal carcinoma cell lines (KYSE-150 and KYSE-510) . Real-time PCR was used to measure the expression of multidrug resistance genes hMDR1 in various treatment groups of esophageal cancer cells. Expression of P-glycoprotein in esophageal cancer cells in each treatment group by Western bolt method. Results The IC50 values of adriamycin and cisplatin in KYSE-150 cells 7.33±0.67, 3.23±0.06 were both less than that in KYSE-510 cells 11.57±0.98, 17.25±0.08, while the IC50 values of 5-fluorouracil in KYSE-150 cells 24.33±1.67 was significantly higher than that in KYES-510 cells 14.67±1.02. After adding verapamil, the IC50 values of Adriamycin, cisplatin and 5-fluorouracil in two esophageal cancer cell lines (KYSE-150 and KYSE-510) all decreased to different degrees, and the above three kinds of chemotherapeutic drugs had increased their sensitivity to varying degrees. Among them, the cisplatin group before adding verapamil had different degrees of resistance compared with KYSE-150 cells and KYSE-510 cells. After joining verapamil, IC50 value change for the KYSE-510 cells multiplied for 4.7 times, suggesting that the reversal was sensitive; IC50 value change for KYSE-150 cells was 1.84 times smaller, suggesting that the reversal was tolerant. The expression of hMDR1 / P-gp in each cell group did not change significantly before and after the application of verapamil. Conclusion Tip the KYSE-510 cells (DDP) sensitivity to the reversal of verapamil, and KYSE-150 cells (DDP) reverse resistance of verapamil. Verapamil reverses drug.
The clinical study and mechanism of mirror therapy combined with extracorporeal shock wave in the treatment of upper limb spasm after stroke
GUO Jun-yi, XU Ai-hua, YE Xiao-cong, LI Ju-fang, WANG Yi-su
2019, 17(12): 1989-1992,1997. doi: 10.16766/j.cnki.issn.1674-4152.001109
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Objective To explore the rehabilitation effect of extracorporeal shock wave combined with mirror image therapy in the treatment of patients with upper limb spasm after stroke and to expound its possible mechanism. Methods A selection of 132 cases of upper limb spasm after cerebral apoplexy, out of 12 cases which were lost to follow-up of patients during January 2015 to June 2018 from the Second affiliated hospital of Wenzhou medical university nerve rehabilitation, who were randomly divided into treatment group and control group. The control group used extracorporeal shock wave treatment on the basis of comprehensive rehabilitation treatment, and the treatment group added the joint mirror extracorporeal shock wave therapy. Two groups of patients were treated by modified Ashworth scale assessment of contracture, patients' upper limb motor function was assessed by the simplified Fugl-Meyer motor function rating scale (FMA), the curative effect was assessed by BI (Barthel Index), and the curative effect was assessed by Brunnstrom stages. Results Ashworth score, FMA score and Barthel index of hemiplegic patients in both groups were significantly improved (all P<0.01). Meanwhile, Ashworth score, FMA score and Barthel index were significantly higher in the treatment group than in the control group (all P<0.01). The upper limb and hand Brunnstrom stages of the patients before and after treatment indicated significant difference before and after treatment (all P<0.05), and the upper limb function recovery of the treatment group was significantly better than that of the control group. Conclusion Extracorporeal shockwave combined with mirror image therapy can partially improve the contracture state of the upper limb after stroke, improve the function of the upper limb, promote the recovery of the upper limb function, improve the ability of the patients' daily life activities, and contribute to the recovery of stroke.
Significance of oxidative stress in acute exacerbation of bronchial asthma
MA Nan, ZHUAN Bing, LI Ping, YUAN Qun, WANG Tao, YANG Chao
2019, 17(12): 1993-1997. doi: 10.16766/j.cnki.issn.1674-4152.001110
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Objective To observe predictive significance of serum reactive oxygen species (ROS), 8-hydroxydeoxyguanosine (8-OHdG), protein carbonyls (PC), malondialdehyde (MDA), nuclear factor of kappaB (NF-κB), hydrogen sulfide (H2S), total antioxidant capacity (T-AOC) in patients with acute exacerbation of bronchial asthma. Methods Sixty patients with bronchial asthma acute exacerbation and 60 healthy individuals in Ningxia Hui Autonomous Region People's Hospital between October 2016 to March 2017 were recruited in the study. The patients were assigned into pre-treatment (A) group (further into the mild subgroup and the moderate-severity subgroup according to the severity) and post-treatment (B) group according to treatment. Sixty healthy individuals were set as control (C) group. The serum levels of ROS, 8-OHdG, PC, MDA, NF-κB, H2S and T-AOC were tested with ELISA. The pulmonary function (FEV1%pred) and asthma control test (ACT) were measured. Results ① The levels of ROS, 8-OHdG, PC, MDA and NF-κB in group C were lower than those in group B, and then group A; The levels of H2S and T-AOC were higher in group C than group B, and then group A, the difference was significant (all P<0.05). ② The levels of ROS, PC, MDA and NF-κB in the moderate to severe group were significantly higher than those in the mild group; However, the levels of H2S and T-AOC in the moderate to severe group were significantly lower as compared with the mild group (all P<0.05). ③ The serum levels of ROS, PC, MDA and NF-κB were negatively correlated with T-AOC, FEV1%pred and ACT (P<0.05), however, the serum level of H2S were positively correlated with T-AOC, FEV1%pred and ACT (all P<0.05). ④ The serum levels of PC and MDA were affected by ROS (all P<0.05), especially MDA (β=0.411). Conclusion The oxidative stress is involved in the pathogenesis of bronchial asthma. ROS may cause damage to the body through NF-κB induced protein and lipid peroxidation. Endogenous H2S may play an antioxidant role by inhibiting ROS and NF-κB activity. ROS, PC and MDA could be used as monitoring indicators for bronchial asthma severity and control level. Endogenous H2S may be a potential target for the treatment of bronchial asthma.
Study on the attentional damage of Wilson's disease patients by attentional network test
DONG Wen-wen, YANG Wen-ming, DONG Ting, WANG Han, WANG Mei-xia, WANG Xiao-yang
2019, 17(12): 1998-2000,2086. doi: 10.16766/j.cnki.issn.1674-4152.001111
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Objective To explore the attentional damage of patients with Wilson's disease (WD) by attentional network test. Methods Thirty patients with WD admitted to the First Affiliated Hospital of Anhui University of Chinese Medicine from June 2016 to June 2019 were selected to perform the attentional network test, as well as 30 gender, age, and education-matched healthy controls. The alert network efficiency, the directional network efficiency, the executive control network efficiency, the total average reaction time and the total accuracy were compared by the attentional network test. Results In WD group, the alert network efficiency, the directional network efficiency, the executive control network efficiency, the total average reaction time and the total accuracy were (21.53±8.98) ms, (30.50±10.11) ms, (104.03±18.96) ms, (601.63±75.96) ms and (97.43±2.57)%, respectively. Meanwhile, in control group, the alert network efficiency, the directional network efficiency, the executive control network efficiency, the total average reaction time and the total accuracy were (37.17±10.70) ms, (32.57±9.58) ms, (101.43±16.14) ms, (540.03±49.54) ms and (98.07±1.57)%, respectively. The alerting network efficiency of WD group was lower than that of control group (P<0.05), but the total average reaction time of WD group was longer than that of healthy control group (P<0.05). There was no significant difference in the directional network efficiency, the executive control network efficiency and the total accuracy between two groups (all P>0.05). Conclusion WD patients have attention network dysfunction, and the main performance is that the alert network is damaged, the directional network and the executive control network are normal.
Evaluation of cerebral perfusion in patients with ischemic and hemorrhagic moyamoya disease by arterial spin labeling
CHEN Chuan-yu, DENG Ke-xue, QIU Jun, XIA Cheng-yu, LUO Yi, YUAN Shu-ya, YANG Hong-fen
2019, 17(12): 2001-2003,2012. doi: 10.16766/j.cnki.issn.1674-4152.001112
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Objective To evaluate the cerebral perfusion situation of the patients with ischemic and hemorrhagic moyamoya disease using arterial spin labeling. Methods Thirty-three patients with moyamoya disease, including 12 males and 21 females, aged 10-60 years old, were selected from our hospital in 2018. All patients underwent convention MRI (T1WI, T2WI, T2-FLAIR), susceptibility weighted imaging (SWI) and arterial spin labeling imaging (ASL). According to the MRI and SWI images, the patients were divided into ischemic group (16 patients) and hemorrhagic group (17 patients). CBF values in the lesion area and contralateral brain tissue were obtained, and the differences between the two groups under different post-labeling delay (PLD) settings were compared. Results When PLD=1.5 s, there were no significant differences in the CBF between two groups (ischemic 16.36±4.46 vs. hemorrhagic 17.43±4.96, t=0.649, P=0.521). When PLD=2.5 s, there were significant differences between the two group (ischemic 35.56±10.75 vs. hemorrhagic 25.97±11.04, t=2.528, P=0.017). Conclusion Arterial spin labeling perfusion imaging with different PLD times can evaluate cerebral blood perfusion in patients with different types of moyamoya disease and provide objective basis for clinicians to select appropriate treatment methods and predict outcomes.
The clinical significances of PD-1 and PD-L1 expressions in different distant tumor adjacent tissues for selecting safe surgical margins in partial nephrectomy
GAO Wu-yue, GUO Yuan-yuan, LIU Bei-bei, SUN Wei, LI Li-qiang, WANG Cheng-yong, YANG Xiao-huai, CHANG Rui, LIU Jian-min
2019, 17(12): 2004-2007,2034. doi: 10.16766/j.cnki.issn.1674-4152.001113
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Objective To explore the expressions of PD-1 and PD-L1 in renal cell carcinoma and renal tissues adjacent to the tumor (0.5 cm, 1.0 cm and 2.0 cm), and provide the theoretical basis for selecting safe margin during partial nephrectomy surgery. Methods A total of 60 renal cancer patients were selected, who underwent the radical nephrectomy and diagnosed renal clear cell carcinomas by postoperative pathology in urology department of the first affiliated hospital of Bengbu medical college between June 2014 and July 2015. General information and stages of patients were recorded. Normal renal tissues, cancer tissues and precancerous tissues with different distant to cancer were preserved. Immunohistochemistry staining was employed to detect the expressions of PD-1 and PD-L1 in renal tumors and corresponding adjacent tissues. The relationship between the expression of PD-1, PD-L1 and the safe margin of partial nephrectomy surgery was analyzed. Results The expression of PD-1 and PD-L1 in renal clear cell carcinoma was significantly higher than that in adjacent renal tissues. In adjacent tissues, the expression levels were negatively related to the distance from the carcinoma. At the distance of 0.5 and 1.0 cm, the positive rate were significant difference (all P<0.05). At the distance of 1.0 and 2.0 cm, the positive rate were not significant difference (P>0.05). The expression of PD-1 and PD-L1 in renal clear cell carcinoma had no related to tumor stage at the distance of 1.0 cm from the edge of the tumor to adjacent tissues. Conclusion The expressions of both PD-1 and PD-L1 were increased in renal clear cell carcinoma tissues than that in adjacent tissues, and furthermore the expressions in adjacent tissues were negatively associated with distance to the carcinoma tissues. A distance of 1.0 cm maybe an appropriate surgical margin for partial nephrectomy resections.
Clinical application of CT-guided 125I seed implantation for retroperitoneal lymph node metastases
LYU Yang, LYU Wei-fu, WANG Hong-mei, ZHOU Chun-ze
2019, 17(12): 2008-2012. doi: 10.16766/j.cnki.issn.1674-4152.001114
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Objective To explore the clinical efficacy of CT-guided radioactive 125I seed implantation in treating retroperitoneal lymph node metastases. Methods From April 2015 to January 2019, 35 patients pathologically confirmed malignant tumor with retroperitoneal lymph node metastasis received CT-guided radioactive 125I seed implantation. Three-dimensional images of lymph nodes were reconstructed using the treatment planning system (TPS) before treatment, and the corresponding number and distribution of 125I seeds were calculated. CT-guided percutaneous and transhepatic seed implantation. The 1-year survival rate, clinical benefit rate, response rate, and the complications were evaluated. Results Patients were followed up for 5-18 months, with an average of 7 months. Symptoms of refractory pain were significantly resolved, while the Karnofsky score was significantly increased. The 1-year survival rate of 1, 3, 6, 9 and 12 months after operation was 100.00%, 100.00%, 71.42%, 54.29% and 48.57%, respectively. The response rate was 69.49%, 79.66%, 79.49%, 82.39% and 70.97%, respectively. The clinical benefit rate was 89.83%, 91.53%, 84.62%, 85.29% and 77.42%, respectively. Eighteen patients died. There were no serious complications such as particle displacement, postoperative bone marrow suppression, massive hemorrhage, infection, radioactive peritonitis, radioactive enteritis and fistula. Conclusion CT-guided 125I seed implantation for malignant tumor with retroperitoneal lymph node metastasis is feasible, safe and effective in improving patient quality of life.
Effectiveness analysis of the local application of vancomycin powder in primary total knee arthroplasties
CHANG Wen-ju, DING Hai, ZHOU Ping-hui, ZENG Qing-liang, HE Zhen-xing, LI Xiang
2019, 17(12): 2013-2015,2019. doi: 10.16766/j.cnki.issn.1674-4152.001115
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Objective To investigate the effectiveness of vancomycin powder (VP) in the local joint in primary total knee arthroplasties (TKA), and provide a theoretical basis for clinical treatment. Methods A total of 290 patients diagnosed as end-stage knee osteoarthritis who underwent primary unilateral TKA between June 2014 and June 2018 were randomly divided into VP group (n=178) and control group (n=112) based on whether use high-dose VP before the capsule suture. In the VP group, 1 g of vancomycin was used in the powder state without solution. There were no significant difference in sex, age, body mass index, hemoglobin content, serum albumin and preoperative complications between the two groups (P>0.05). The operation time, hemoglobin and albumin levels, aseptic exudation of incision, subcutaneous hematoma, delayed healing, skin necrosis, prosthetic joint infection (PJI), deep venous thrombosis of lower limbs, pulmonary embolism and acute renal injury were recorded. Results There was no statistical difference in PJI rates between VP group (2.81%) and control group (2.68%) , χ2=0.066, P=0.947. There was no statistical difference in aseptic exudation of incision between VP group (6.18%) and control group (3.57%) , χ2=0.977, P=0.329. The rate of prolonged operative wound healing in VP group (8.99%) was higher than that in control group (2.68%) , χ2=2.114, P=0.035). There was no significant difference in the incidence of superficial skin infection, skin necrosis, deep vein thrombosis and pulmonary embolism between the two groups (all P>0.05). Conclusion Local application of VP in primary TKA cannot reduce the incidence of PJI, but increase the incidence of aseptic complications of incision, so it is not recommended to use vancomycin in the primary TKA.
Short-term effect of neck muscle vibration on the unilateral spatial neglect after stroke
MENG Qing-fu, CHEN Nan, GE Yao-qi, LI Yun-tao
2019, 17(12): 2016-2019. doi: 10.16766/j.cnki.issn.1674-4152.001116
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Objective To investigate the effect of neck muscle vibration on the unilateral spatial neglect after stroke, and to evaluate its short-term effect. Methods Fourty patients of stroke with unilateral spatial neglect, including 23 cerebral infarction and 17 cerebral hemorrhage, in Rehabilitation Department of Qixia District Hospital from December 2016 to October 2018 were randomly divided into control group (n=20) and vibration group (n=20). Both groups accepted general rehabilitation for unilateral spatial neglect, while vibration group accepted neck muscle vibration treatment in addition. The vibrator was set at frequency 108 Hz, amplitude 1.0 mm, and the vibration point was located in left trapezius for once a day, 15 minutes at a time. Before and 3 weeks after training, the patients in both groups were assessed by the Chinese behavioral inattention test-Hong Kong version (CBIT-HK) scale, after which we respectively compared routine test score, behavioral test score and total score. Results After 3 weeks, the routine score, behavior score and total score of the two groups were all improved, and the difference before and after treatment was statistically significant (all P<0.05). In the vibration group, the value of routine score difference, behavior score difference, and total score difference were 19.80±18.51, 15.40±14.82, and 35.10±29.62, respectively. Meanwhile, the corresponding scores of the control group were 10.70±12.10, 3.76±7.28 and 14.45±14.89, respectively. The t-test of inter-group comparison shown that the behavioral score difference was t=3.155, P<0.05 and the total score difference was t=2.786, P<0.05. The behavioral and total scores in vibration group were significantly increased. There was no statistically significant difference between the routine test score of the two groups (t=1.841, P=0.074). Conclusion The neck muscle vibration treatment combined with general rehabilitation treatments can improve short-term symptoms of unilateral spatial neglect after stroke.
Efficacy and safety of azithromycin in the treatment of moderate to severe bronchiolitis
ZHAO Qian, XUAN Ai-li, CHEN Hong-bing, CHEN Xin
2019, 17(12): 2020-2022,2030. doi: 10.16766/j.cnki.issn.1674-4152.001117
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Objective To investigate the efficacy and safety of azithromycin in children with moderate to severe bronchiolitis. Methods A total of 75 children with moderate to severe bronchiolitis hospitalized in the department of pediatrics of the First Affiliated Hospital of Bengbu Medical College from August 2017 to April 2018 were selected and divided into azithromycin intervention group (37 cases) and routine treatment group (38 cases) by random number table method. The routine treatment group was given routine treatment such as antiviral, budesonide combined with salbutamol atomization inhalation. The azithromycin intervention group was treated with azithromycin dry suspension [10 mg/ (kg·d)] for 3 days on the basis of the routine treatment in control group. The clinical criticality (CS) scores of the two groups were compared. The time of cough, wheezing, three concave sign and rale disappearance in lung, hospitalization time, and the adverse events such as neutropenia, thrombocytopenia, gastrointestinal symptoms, arrhythmia of heart rate and liver damage, were compared between the two groups. Results There were significant differences in CS scores before and after treatment between two groups (F=139.111, 158.341, all P<0.001). The CS score of the routine treatment group was significantly higher than that of the azithromycin intervention group (F=7.008, P=0.010). The cough, wheezing, triple concave sign, lung rale disappearance time and hospitalization time in the azithromycin intervention group were shorter than those in the routine treatment group (all P<0.05). There was no significant difference between the two groups in the occurrence of adverse events, such as liver damage, gastrointestinal symptoms and arrhythmia (all P>0.05). Conclusion Azithromycin is safe for the treatment of bronchiolitis, which significantly improve the symptoms and signs of children with bronchiolitis, shorten the course of disease, and can be applied in clinic.
Correlation between urinary podocalyxin and Nephrin levels and renal injury in patients with systemic lupus erythematosus nephritis
GONG Shu-wen, WANG Shi-min, SHEN Shui-juan, DAN Juan-ping, LI Qing-hua, DONG Zhi-chao, HE Jian-ling
2019, 17(12): 2023-2025,2106. doi: 10.16766/j.cnki.issn.1674-4152.001118
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Objective To investigate the correlation between urinary podocalyxin and Nephrin levels and renal injury in patients with systemic lupus erythematosus nephritis (SLE-N). Methods Eighty patients with systemic lupus erythematosus nephritis treated in our hospital from June 2017 to June 2018 were selected as study subjects (LN group), and 80 healthy people in the same period were selected as the control group. The relative indexes of urine routine were compared between the two groups. The urinary podocalyxin and the ratio of Nephrin to creatinine in LN patients with different degree of renal injury were compared. The urinary podocalyxin was analyzed by ROC curve. The ratio of Nephrin to creatinine was used to diagnose the degree of renal injury in patients with LN, and the correlation between the ratio of urinary podocalyxin, Nephrin and creatinine and the degree of renal injury in patients with LN was analyzed by regression analysis. Results Urinary podocalyxin, Nephrin, urine protein and creatinine in LN group were significantly higher than those in the control group (all P<0.05), and the levels of complement C3 and C4 were significantly lower than those in the control group (all P<0.05). The UPx/Cr of LN patients increased significantly with the increase of ISN/RPS score. There was a significant positive correlation between UPx/Cr, UN/Cr with ISN/RPS, AI and CI score in patients with LN. The results of ROC curve analysis showed that the AUC of UPx/Cr was the highest, and the difference was statistically significant compared with the zero hypothesis (P<0.05). Regression analysis showed that UPx/Cr was a significant predictor of renal injury in LN patients. Conclusion The levels of urinary podocalyxin and Nephrin in patients with systemic lupus erythematosus nephritis are significantly higher than those in patients with systemic lupus erythematosus glomerulonephritis and may be a potential predictor of the severity of renal injury in patients with systemic lupus erythematosus nephritis.
Analysis of nutritional status and influencing factors of malnutrition before dialysis in chronic kidney disease patients
ZHU Jin-cheng, ZHAO Cun-xi, ZHANG Hai-feng
2019, 17(12): 2026-2030. doi: 10.16766/j.cnki.issn.1674-4152.001119
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Objective To investigate the nutritional status of chronic kidney disease (CKD) patients before dialysis and the influencing factors of malnutrition. Methods A total of 134 patients with pre-dialysis CKD patients in the nephrology department of the First Affiliated Hospital of Bengbu Medical College from September 2018 to March 2019 were selected as the study subjects. Subjective Global Assessment (SGA) and laboratory tests were used to assess the nutritional status of CKD patients. Patients were grouped according to the results of SGA and the clinical data, including general information, medical history, nutrition education and treatment, were collected. Multivariate logistic regression analysis was used to screen the risk factors of malnutrition in CKD patients. Results Among 134 patients, 107(79.9%) were well-nourished, 20(14.9%) were moderately malnourished, 7(5.2%) were severely malnourished. The incidence of CKD stage 1-5 malnutrition was 6.9%, 5.4%, 30.4%, 39.1% and 31.8%, respectively. There were significant differences in hemoglobin, albumin, prealbumin, creatinine and urea among the three groups (all P<0.05). Multivariate logistic regression analysis showed that age (> 65 years old), C-reactive protein (≥3 mg/L), CKD 3-5 stage and diabetes mellitus were risk factors for malnutrition in CKD patients. Conclusion The prevalence of malnutrition in pre-dialysis CKD patients is high, especially in CKD 3-5 stage. The age (≥65 years old), C-reactive protein (≥3 mg/L), CKD 3-5 stage and diabetes mellitus are independent risk factors for malnutrition in pre-dialysis CKD patients. Therefore, we should strengthen the understanding of malnutrition in pre-dialysis CKD patients, pay attention to screen the above risk factors, take active nutritional treatment measures, reduce the incidence of malnutrition in CKD patients before dialysis, and improve the quality of life of patients.
Clinical study on the treatment of refractory pneumothorax by injecting autologous blood through PICC catheter fistula under medical thoracoscopy
WANG Zhen, YAN Dong-mei, QI Chun-chao, LIU Hai-feng, HAO Jing-duo
2019, 17(12): 2031-2034. doi: 10.16766/j.cnki.issn.1674-4152.001120
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Objective To investigate the clinical effect of occlusion with autologous blood injected through peripherally inserted central venous catheter (PICC) fistula under thoracoscope in the treatment of intractable pneumothorax. Methods Ninety patients with refractory pneumothorax treated in Ningbo Seventh Hospital between June 2014 and February 2018 were selected as the research subjects with 45 cases in each group. The study group received the autologous blood injection occlusion through PICC fistula under medical thoracoscope, while the control group received the routine thoracoscopic surgery. The operation time, incision length and intraoperative bleeding, volume of thoracic drainage, drainage time, hospitalization time, pain score (VAS) before the operation and on the 1st, 3rd and 5th day after the operation, pulmonary function and clinical efficacy of the two groups one month after operation were compared between the two groups. Results The operation time, intraoperative bleeding volume, thoracic drainage volume, drainage time and hospitalization time of the study group were lower than those of the control group (all P<0.05). There was no significant difference in the length of incision between the study group and the control group (P>0.05); there was no significant difference in the VAS score between the two groups before operation (P>0.05); on the 1st, 3rd and 5th day after the operation, the VAS score of the study group was lower than that of the control group (all P<0.05). Compared with the control group, the FEV1, FVC, MVV and RV of the study group had no significant difference (all P>0.05) one month after operation; and there was no significant difference in the clinical efficacy between the two groups one month after operation (Z=-0.989, P>0.05). Conclusion The occlusion with autologous blood injected through PICC fistula is effective for intractable pneumothorax, with fewer traumas and less pain after the operation.
Predictive value of serum platelet factor 4 (PF4) for the efficacy of new multiple myeloma patients treated with thalidomide combined VCD
CAI Xiao-ping, SHI Yue-jian, ZHENG Cui-ping, WENG Shan-shan, FAN Yu-fang, CHEN Yue-miao, ZHOU Wen-jin
2019, 17(12): 2035-2037,2078. doi: 10.16766/j.cnki.issn.1674-4152.001121
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Objective To explore the predictive value of serum platelet factor 4 (PF4) for the efficacy of new multiple myeloma (MM) patients treated with thalidomide combined VCD. Methods A total of 120 MM patients in Wenzhou Central Hospital from January 2016 to December 2018 were selected as study subjects. All patients were treated with thalidomide combined with VCD for 4 courses, and then divided into reaction group and control group according to the therapeutic response after treatment. The general data, blood biochemical examination and PF4 level of the two groups were compared. Logistic regression was used to analyze independent risk factors for treatment response. ROC curve was used to evaluate the predictive efficacy of different indicators on treatment response. Results Eighty-eight patients (73.33%) responded to the treatment. There were significant differences in ISS grading and Del17p between the reaction group and the control group (P<0.05). The levels of β2 microglobulin and serum creatinine in the reaction group were significantly lower than control group (t=3.841, 2.430, all P<0.05). The level of PF4 in the response group was significantly higher than the control group (t=5.556, P＜0.001). Multivariate logistic regression showed that low levels of β2 microglobulin were independent protective factors for treatment response (OR=0.062, P=0.005), and low levels of PF4 were independent risk factors for treatment response (OR=1.107, P=0.001). The best cut-off points of PF4 and β2 microglobulin for predicting treatment response were ＞736.29 ng/L and ≤3.597 mg/dL, and the AUC were 0.874 and 0.756, respectively. PF4 was significantly better than β2 microglobulin (Z=2.097, P=0.036). PF4 had better sensitivity and β2 microglobulin had better specificity (P＜0.05). Conclusion PF4 has predictive value for the efficacy of new MM treated with thalidomide combined VCD, with the best cut-off points of ＞736.29 ng/L.
Relationship between serum cystatin C level and clinical features in patients with neurosyphilis
ZHOU Jia-jun, LUO Lian, GUO Li-li, MA Lan, ZHU Zhou, LI Kun, SHAO Sen
2019, 17(12): 2038-2041. doi: 10.16766/j.cnki.issn.1674-4152.001122
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Objective To study the relationship between serum cystatin C (Cys C) level and clinical features in patients with neurosyphilis, and evaluate its clinical significance. Methods We collected 30 patients as neurosyphilis group, 30 patients as syphilis (non-neurosyphilis, N-NS) group and 20 healthy as control group between September 2016 and May 2018. The levels of serum Cys C were tested by using immunology turbidimetric method. The clinical and laboratory characteristics were compared among the three groups. Results The patients with neurosyphilis had higher serum Cystatin C levels as compared with the patients with syphilis and healthy control (P＜0.05); however， no significant difference between the N-NS and control group (P>0.05). Serum Cystatin C level was significantly decreased in neurosyphilis group after the antisyphilitic treatment (P<0.05). The mean ROC-plot AUC for Cys C was 0.71 [P=0.022, 95% CI(0.53，0.89)]. The optimal threshold value for Cys C was 1.09 mg/L with the sensitivity of 55% and specificity of 90%. The correlation analysis showed that the serum Cys C levels were positively associated with CSF protein levels and MMSE score (r=0.232, P=0.012; r=0.273, P=0.003), but not associated significantly with RPR titer, CSF cell count and CSF pressure (r=0.413, P=0.154; r=0.313, P=0.446; r=-0.124, P=0.142) in patients with neurosyphilis. Conclusion The levels of serum Cys C is significantly associate with neurosyphilis. To test the levels of Cys C can evaluate the severity of the disease and predict the risk of getting neurosyphilis.
Clinical significance of phlegm detoxification on survival with tumor in advanced NSCLC patients based on the phlegm-poison theory
ZHANG Tian-wei, CHEN Wei-jian, ZHANG Rong-ying, MAO Li-qun, BAO Jian-min
2019, 17(12): 2042-2045,2150. doi: 10.16766/j.cnki.issn.1674-4152.001123
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Objective To explore the effect of phlegm detoxification on the short-term curative and long-term survival with tumor in qi phlegm-poison type or yin phlegm-poison type patients with advanced non-small cell lung cancer (NSCLC). Methods From August 2015 to July 2016, 207 advanced NSCLC patients, including 116 patients with qi phlegm-poison type and 91 patients with yin phlegm-poison type, were collected and divided into control group with western medicine treatment (n=80) and treatment group (n=127) with Yiqi Huatan Jiedu Decoction (for qi phlegm-poison type) or Yangyin Sanjie Decoction (for yin phlegm-poison type). After 4 courses of treatment, the short-time efficacy, TCM syndrome scores, Karnofsky scores were evaluated. The Kaplan-Meier curve were performed. Results There was no significant difference in the total effective rate between the control group (45.00%) and the treatment group (51.97%, χ2=0.954, P=0.329). The response rates of patients in treatment group with qi phlegm-poison party or yin phlegm-poison party were 89.55% and 83.33%, respectively, higher than that of control group (P<0.05). The TCM syndrome score and Karnofsky score were gradually decreased, and lower than before treatment and control group (all P<0.05). The survival rate (OS) of patients in treatment group with qi phlegm-poison type were 49.25%, higher than that in control group (all P<0.05), while the OS of patients in treatment group with yin phlegm-poison type were 61.67%, there was no difference with control group (P=0.080). Conclusion Based on the phlegm-poison theory, phlegm detoxification would improve TCM syndrome and promote the life quality of NSCLC patients with qi phlegm-poison type and yin phlegm-poison type. Meanwhile, Yiqi phlegm jiedu decoction can prolong the survival with tumor of patients of qi phlegm-poison type.
Analysis of main risk factors and countermeasures of chronic diseases based on systems archetypes
GAN Yong, YANG Ting-ting, YANG Yu-di, LIU Jian-xin, WANG Chao, XU Hong-bin, LI Li-qing, LU Zu-xun
2019, 17(12): 2046-2050,2054. doi: 10.16766/j.cnki.issn.1674-4152.001124
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Objective To understand the epidemic trend of chronic diseases in China, explore the main risk factors affecting chronic diseases, and put forward management strategies and measurements to prevent chronic diseases, and provide reference for the prevention and control of chronic diseases in China. Methods Based on the data of "China Health and Family Planning Statistical Yearbook 2015", trend of chronic diseases was analyzed using SPSS 17.0 software. From the perspective of system engineering, the archetypes of the main risk factors was constructed using the systems archetypes analysis of Peter St. Gill. The causal structure was systematically analyzed, and the corresponding management countermeasures and suggestions were put forward. Results The prevalence of chronic diseases in China was 33.1% in 2013, which was higher than that in 2003 (15.1%). Increasing prevalence of hypertension (9.89% in 2013 vs. 1.19% in 2003) and diabetes (2.65% in 2013 vs. 0.22% in 2003) was one of the main reasons for the rapid growth of chronic diseases. Chronic diseases have become the main cause of death for urban and rural residents in China. Environment, life and behavioral factors, population ageing, and genetic factors were the main influencing factors of chronic diseases. Conclusion The prevalence of chronic diseases in China has increased significantly and shown a younger trend, which brings challenges to China's social and economic development. Analyzing the risk factors of chronic diseases by using the system archetypes method can reflect the dynamic and integrity of the feedback structure and behavior of the system. This is not only the further development of the methodological research, but also the specific application of the archetypes analysis method in the field of chronic diseases. It is suggested to increase government policy and financial support, strengthen community health education and health promotion, and promote the health management of bad lifestyles.
Effect of Qili Qiangxin capsule combined with high-dose atorvastatin on inflammation and vascular microcirculation in patients with hypertension and atherosclerosis
ZHOU Wei, WANG Yan-hua, ZHANG Shuai, SUN Jun-bo, YU Feng, ZHENG Yi-min, YUAN Zhi-jun, WU Feng
2019, 17(12): 2051-2054. doi: 10.16766/j.cnki.issn.1674-4152.001125
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Objective To investigate the effects of Qili Qiangxin capsule combined with high-dose atorvastatin on inflammatory response and vascular microcirculation in patients with hypertension and atherosclerosis. Methods A total of 192 patients with hypertension and atherosclerosis admitted to our hospital from January 2015 to December 2018 were randomly divided into two groups, 96 in each group. The control group was treated with atorvastatin, and the combined group was treated with Qili Qiangxin capsule on this basis. After treatment, inflammatory response (hs-CRP, TNF-α, IL-6), blood lipids (TG, TC, HDL-C, LDL-C), blood pressure (SBP, DPB), hemorheology (Nbh, Nbl, Np, Fh), endothelial function (NO, H2S, ICAM-1) and changes in plaque conditions (IMT value, PV) were compared between the two groups. Results After treatment, the inflammatory response, blood lipids (TG, TC, LDL-C), blood pressure and hemorheology of two groups were significantly decreased (all P<0.05), and the combination group was significantly lower than the control group (all P<0.05). The levels of HDL-C, NO and H2S in the two groups were significantly increased (all P<0.05), and the combination group was significantly higher than the control group (all P<0.05). The levels of ICAM-1 in the two groups were significantly decreased, and the combination group was significantly lower than the control group (all P<0.05). After treatment, there was no significant change in IMT and PV levels in the control group (all P>0.05), while IMT and PV levels in the combined group were significantly decreased (all P<0.05). The total effective rate in the combined group (88.5%) was significantly higher than that in the control group (70.8%), χ2=9.299, P=0.002. Conclusion Compared with atorvastatin alone, Qili Qiangxin capsule combined with high-dose atorvastatin can more effectively reduce the inflammatory response and regulate the vascular microcirculation in patients with hypertension and atherosclerosis. The therapeutic effect is more significant.
Effects of diet and exercise interventions under TTM on weight gain and perinatal outcomes during pregnancy
XING Xian-jing, LIN He-xian, QIU Xiao-cui
2019, 17(12): 2055-2058. doi: 10.16766/j.cnki.issn.1674-4152.001126
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Objective To investigate the effects of diet and exercise intervention on body weight and perinatal outcome in patients with gestational diabetes mellitus (GDM) under TTM model. Methods A total of 124 pregnant women with GDM who were admitted to our hospital from December 2015 to December 2017 were enrolled and divided into the conventional group (n=63) and the intervention group (n=61) according to the random number table method. Among them, the conventional group were given regular intervention guidance, while the intervention group were given diet and exercise intervention under the TTM model. The knowledge of the disease-related knowledge during the investigation, the general situation before childbirth, the laboratory test indicators after the intervention, the perinatal outcome, and the general condition of the newborn of the two groups were observed and compared. Results The increase of BMI and BMI before childbirth in the intervention group were significantly lower than that in the conventional group [(25.37±0.93) kg/m2 vs. (26.14±1.04) kg/m2, (4.12±1.24) kg/m2 vs. (5.37±1.03) kg/m2; t=4.341, 6.144, all P<0.001]. The number of insulin users and the re-admission with poor control of sugar were significantly less than those in the conventional group (6 vs. 15, 9 vs. 23; χ2=4.301, 7.659, P=0.038, 0.005). The number of pregnant women with hypertension and polyhydramnios in the intervention group was significantly lower than that in the conventional group (4 vs. 12, 2 vs. 13, P=0.031, 0.007). Conclusion Diet and exercise interventions under the TTM model can effectively reduce the increase in BMI during pregnancy, improve blood sugar levels and reduce adverse outcomes, thus promoting maternal and infant health.
Efficacy of Zishui Qinggan Decoction in treatment of perimenopause women with syndrome of renal deficiency and hepatic stagnation and impact on relevant indexes
SHI Ming-qing, XU Xiao-fei, CHEN Li-ping, LAN Guan-cui, JIANG Wei-hua, WANG Jin, ZHOU Hui-fang
2019, 17(12): 2059-2062. doi: 10.16766/j.cnki.issn.1674-4152.001127
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Objective To investigate the effect of Zishui Qinggan decoction on perimenopausal syndrome (MPS) women with syndrome of renal deficiency and hepatic stagnation. Methods Sixty-four MPS cases were selected in our hospital and divided into the control group and the observation group with 32 cases in each according to random number table method. Control group was treated with the routine therapy according to the guideline. On basis of control group, the observation group was treated with Zishui Qinggan decoction (1 dose / d and 2 times / d). Both groups were treated for 3 months. Scores of symptoms of syndrome of renal deficiency and hepatic stagnation and Kupperman index (KI), blood lipid levels, the efficacy, vascular endothelial function, and serum levels of adiponectin, Kisspeptin-10, and estradiol were compared between two groups. Results After 3 months treatment, scores of symptoms of syndrome of renal deficiency and KI, levels of triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (LDL-C) were significantly lower than those of the control group, while high-density lipoprotein cholesterol (HDL-C) were significantly higher than the control group (all P<0.01). Total effective rate of observation group (96.88%) was obviously higher than the control group (75.00%) , P<0.05. Serum levels of vascular hemophilia factor (vWF) and endothelin-1 (ET-1) in the observation group were significantly lower than those in the control group (P<0.01). Serum levels of adiponectin, Kisspeptin-10, and estradiol [(8.69±0.92) mg/L, (2.31±0.27) ng / L, (72.45±8.9) pmol/L] in the observation group were higher than those in the control group (all P<0.01). Conclusion The efficacy of Zishui Qinggan decoction in the treatment of perimenopause female patients with kidney deficiency and hepatic stagnation is significant. Up-regulation of serum levels of adiponectin, Kisspeptin-10, and estradiol may be one of the effective ways.
Study on admittance and exit criteria of palliative care in community
MOU Jun, ZHANG Rui-yun, CAO Wen-qun, SHEN Tian-han
2019, 17(12): 2063-2068. doi: 10.16766/j.cnki.issn.1674-4152.001128
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Objective To build the admittance and exit criteria of palliative care in community, so that to guide the communities to screen people who really belong to the area of peace care and need the palliative care most. Methods Through the literature review and focus group interviews, it got the dimensions of the admittance and exit criteria for palliative care in community. Deeply, executive and managerial representatives from six pilot units of palliative care in Shanghai were invited to participate in the two rounds of Delphi consultation, which was designed to collect the opinion on the admittance and exit criteria for palliative care in community from them. Results The four dimensions of admittance criteria for palliative care in community were disease, survival, symptom, subjective intention of patients and their families. The three dimensions of exit criteria were subjective intention of patients and their families, symptom and the death of patients. Compared with the admittance criteria for palliative care at home, the palliative care in institutions showed the difference in the admittance criteria of disease, survival, and symptom. In terms of access requirements for the disease, the palliative care in institutions allowed the cerebrovascular disease while the palliative care at home did not. In terms of survival, the palliative care in institutions tended to accept patients with a survival period of less than 90 days, while the palliative care at home tended to accept patients with a survival period of less than 180 days. Conclusion Compared with the original criteria, the admittance and exit criteria of palliative care in community in this study complements the other requirements of the survival time, defines the range of the disease, and takes into account the service capacity of the pilot units and the expression of the willingness of the client. What's more, it adds the exit criteria, which could lay the foundation for the orderly referral among the palliative care at home, the palliative care in institutions and general hospitals.
Investigation of suicide attitudes and its relationship with illness conditions and coping styles in patients with depression combined with anxiety disorder
LI Hong, LYU Qin-yu, YI Zheng-hui
2019, 17(12): 2069-2071,2134. doi: 10.16766/j.cnki.issn.1674-4152.001129
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Objective To investigate the suicide attitudes in patients with depression combined with anxiety disorder, and to explore the relationship with illness conditions and coping styles. Methods One thousand depressive patients with depression combined with anxiety disorder from June 2015 to June 2018 were selected as the combination group. In addition, 600 patients with depression and 600 patients with anxiety were selected as depression group and anxiety group. All the patients were investigated with QSA, SCSQ, SDS and SAS. The scores of suicide attitudes, illness conditions and coping styles among the 3 groups were compared. Pearson correlation analysis was used to explore the correlation between suicide attitudes, illness conditions and coping styles in the combination group. Results The scores of suicide attitudes and positive coping in the combination group (19.43±2.01, 20.07±2.11, 11.06±2.01, 11.01±1.85, 17.12±2.07)were significantly lower than those in the depression group and the anxiety group (all P<0.05). The SDS (65.85±3.95) and SAS (65.38±3.37) in the combination group were lower than those in the depression group and the anxiety group (all P<0.05). The negative coping score (13.56±1.50) in the combination group was higher than those in the depression group and the anxiety group (all P<0.05). There were negative correlations between suicidal attitudes in F1, F2, F3 and F dimensions with SDS, SAS and negative coping (all P<0.05). There were positive correlations between the above dimensions of suicide attitudes and positive coping (all P<0.05). Conclusion Understanding of suicidal behavior, attitude toward suicide, attitude toward suicide family members, and attitude rejection toward euthanasia of depressive patients with anxiety disorder are not obvious, which are significantly correlated with illness conditions and coping styles.
Application of comprehensive evaluation in elderly patients with COPD complicated with anxiety/depression
YANG Sai-juan, XIANG Min, WEI Ji-zhen, ZHONG Ju-ying, LI Ming-hui
2019, 17(12): 2072-2074. doi: 10.16766/j.cnki.issn.1674-4152.001130
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Objective To observe the nursing intervention effect of Comprehensive Age Assessment (CGA) in elderly patients with COPD combined with anxiety/depression. Methods From June 2015 to December 2017 in Department of Respiratory Medicine in Shaoxing People's Hospital, 128 elderly patients (≥60 years old) with anxiety/depression status were included. All patients were divided into control group (64 cases) and observation group (64 cases) by random number table method, and routine nursing and CGA mode nursing were performed, respectively. The daily living ability, social activity ability and anxiety/depression state of the two groups before and after nursing were compared. Results After the nursing, the daily life ability score (2.55±0.16) and the improvement of the social activity ability score (1.97±0.34) in the observation group were all significant improvement than those of the control group [(1.78±0.30)and (1.47±0.24)] (t=12.348, 9.611, all P<0.001). The anxiety/depression symptom scores were improved [(2.31±0.36)/(2.93±0.52)]in the observation group than those in the control group (1.65±0.30) scores/(1.97±0.24) scores] (t=11.267, 13.410, all P<0.001). Conclusion The comprehensive age assessment intervention for elderly patients with COPD complicated with anxiety/depression can effectively relieve the adverse mood of anxiety/depression and improve their quality of life.
Effect of individualized health education on treatment compliance and frequency of asthma attack in school-age children with asthma
NI Yi-ping, SHEN Shuang-shuang, WANG Wen-juan
2019, 17(12): 2075-2078. doi: 10.16766/j.cnki.issn.1674-4152.001131
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Objective To explore the effect of personalized health education on treatment compliance and asthma attack frequency of school-age children with asthma. Methods A total of 110 school-age children with asthma were selected from May 2017 to March 2019. They were divided into observation group and control group according to random number table method, 55 cases in each group. The patients in the control group were given routine nursing, while the patients in the observation group were given individualized health education on the basis of the control group. Compare the treatment compliance, asthma attack frequency, self-management ability and pulmonary function before and after intervention between the two groups. Results After intervention, Daily dosage score, Medication time score, Number of medications score and compliance behavior score in the observation group were (4.06±0.11), (4.21±0.13), (4.15±0.27) and (3.98±0.46), respectively, which were significantly lower than that in the control group (3.21±0.17), (3.09±0.40),(3.22±0.16) and (3.02±0.41), the frequency of asthma attack in the observation group was (0.85±0.12) times per month, significantly lower than that in the control group which was (1.54±0.34) times per month, the difference was significant (all P＜0.05). Total score of self-management ability in the observation was (138.76±15.46), significantly higher than the control group (128.47±14.55), the difference was significant (P＜0.05). The scores of pulmonary function of children in the observation group were significantly higher than those in the control group (P<0.05). Conclusion Individualized health education can significantly improve the treatment compliance and self-management ability of school-age children with asthma, effectively reduce the frequency of asthma attack and improve pulmonary function, which is worthy of clinical application.
Effectiveness of contrast-enhanced ultrasound quantitative analysis in the diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma
WANG Hai-yan, ZHU Lin-lin, ZHOU Ru-hai, LI Jia-gen
2019, 17(12): 2079-2082. doi: 10.16766/j.cnki.issn.1674-4152.001132
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Objective To explore the effectiveness of contrast-enhanced ultrasound (CEUS) quantitative analysis in the diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer (PTC). Methods A retrospective analysis was made on 90 patients with PTC who underwent surgical treatment in our hospital from January 2017 to January 2018. The patients were divided into metastasis group (40 cases) and non-metastasis group (50 cases) according to whether cervical lymph node metastasis occurred after operation. The size of cancer nodules, CEUS characteristics (perfusion intensity, uniform intensity, perfusion defect and perfusion mode), CEUS quantitative parameters [rise time (RT), Peak intensity (PI), mean transit time (MTT), area under curve (AUC), peak halving time (TPH), wash in slope (WIS) and time to peak (TTP)] were compared between the two groups. The ROC curve was used to analyze the diagnostic value of CEUS related indicators for different cut-off values. Results Seventy-six percent of 100 cancer nodules showed low enhancement, 89.00% showed non-uniform perfusion intensity, and the size of cancer nodules in metastatic group was significantly higher than that in non-metastatic group (P=0.002). PI, AUC and WIS in the marginal area of cancer nodules in the two groups were significantly higher than those in central area (all P<0.05), while PI, AUC in the marginal area in the metastatic group were significantly higher than those in the non-metastatic group (all P<0.001). The ROC curve showed that the edge AUC, edge PI and AUC of nodule size were 0.866, 0.869 and 0.720, respectively. The diagnostic efficiency of the edge AUC and PI for cervical lymph node metastasis was higher than that of the size of the cancer nodule (P=0.026, 0.018). Youden index indicated that the accuracy, sensitivity and negative predictive value of edge AUC and edge PI were significantly higher than those of nodule size at the best cut-off point (PAUC = 0.042, 0.001, 0.019, PPI= 0.018, 0.003, 0.022). Conclusion In the diagnosis of cervical lymph node metastasis in patients with PTC, the CEUS quantitative parameters PI and AUC in the margin of cancer nodules have high accuracy and sensitivity, which have important clinical significance.
Comparison of barium X-rays and electronic gastroscopy in the diagnosis of gastric ulcer
XIE Ping-kun, HU Yan-biao, CHEN Xu-dong, ZHOU Jing-jing
2019, 17(12): 2083-2086. doi: 10.16766/j.cnki.issn.1674-4152.001133
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Objective To investigate and compare the clinical value of barium X-ray and electronic gastroscopy in the diagnosis of gastric ulcer. Methods One hundred patients with gastric ulcer diagnosed by barium X-ray and electronic gastroscopy from January 2014 to December 2016 were enrolled in the retrospective analysis of clinical data. Based on the final clinical diagnosis results of gastric ulcer, the efficacy of these two methods was investigated, and their respective imaging characteristics were summarized. Results The coincidence rate in the diagnosis of gastric ulcer of barium X-ray examination was 63.00% (63/100), and 100.00% (100/100) of Electronic gastroscopy, There was significant difference in the coincidence rate between the two groups in the diagnosis of gastric ulcer (χ2= 28.970, P<0.05). The coincidence rate of the two methods in the diagnosis of malignant gastric ulcer was 100.00% (5/5). The characteristics of gastric ulcer showed by barium X-ray examination: 80.95% had niches, 9.52% had thin barium-filled niches, 41.27% had "ring" signs at the bottom of niches, 15.87% had bilateral signs, 50.79% had mucosal convergence signs, and 6.35% had transparent thin lines. The characteristics of gastric ulcer by electronic gastroscopy: 64.00% of ulcer basal coating was thick and dirty, mucosal congestion and edema around the lesion; 35.00% of ulcer lesion epithelial regeneration formed red halo, folds concentrated to ulcer; 11.00% of ulcer basal coating was thin, red halo or folds concentrated around the lesion; 5.00% of ulcer basal coating disappeared, leaving a pink or white flat depression/scar in the central area. Conclusion Electronic gastroscopy, compared with barium X-ray, is more accurate in the diagnosis of gastric ulcer; however, barium X-ray is more specific. The sensitivity of the two methods is similar. The barium X-ray and electronic gastroscopy have their own advantages in the diagnosis of gastric ulcer, the latter is more accurate. In clinical work, each patient's specific conditions should be combined with their respective clinical advantages.
Advances of drug-coated balloon in percutaneous coronary intervention
ZHANG Hai-fu, ZHANG Yuan-yuan, ZHANG Qin-xia, ZHANG Xing-wei
2019, 17(12): 2087-2091. doi: 10.16766/j.cnki.issn.1674-4152.001134
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Percutaneous coronary intervention is a novel therapy aiming to expand the narrow coronary arteries, relieving stenosis and improving myocardial blood supply with the usage of various techniques. Interventional materials evolve from bare metal stents to drug-eluting stents and, more recently, drug-coated balloons. Though metal stents largely solve the problem of coronary artery stenosis, long-term anti-platelet therapy and stent restenosis remain troubling. The drug coated balloon (DCB) platform offers several theoretical benefits over stent-based technologies. It has emerged as an additional tool in the arsenal of interventional cardiology devices. It allows the homogenous transfer of an anti-proliferative drug to reduce neo-intimal hyperplasia whilst potentially maintaining normal vessel anatomy and function, leaving no implant behind. The body of evidence supporting the role of DCB in the treatment of in-stent restenosis is more substantial and appears to yield similar results to DES without the introduction of an additional stent layer. Therefore, the concept of permanent implantation of stents can be better represented by the treatment of drug coated balloon. Meanwhile, DCB exerts beneficial effects in the treatment of some lesion subsets, including small vessel diseases, side branch bifurcations, chronic total occlusions and diffuse lesions. This review focuses on the rationale for DCB usage, effectiveness of DCBs in different clinical and lesion settings, and provides practical tips for their correct use in everyday clinical practice.
Clinical observation on obesity and hyperlipidemia in patients treated by acupoint catgut-embedding therapy based on the theory of "Interconnection of Zang-Fu Viscera"
CHEN Yi-tian, CHEN Ze-li, FENG Zhen-gen, ZHANG Hao, SUN Yu-yuan, XU Ling-juan
2019, 17(12): 2092-2095. doi: 10.16766/j.cnki.issn.1674-4152.001135
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Objective To observe the effect of the acupoint catgut-embedding therapy which based on the theory of "interconnection of Zang-Fu viscera"on patients ' percentage(F%), body mass index(BMI) and serum total cholestrerol(TC), triglyceride(TG), high densitylipoprotin-cholesterol(HDL-C) of who with obesity and hyperlipidemia, and to observe the total effective rate and observed the recurrence rate after 3 months, meanwhile, to compare with the control group. Methods Seventy patients with obesity and hyperlipidemia were selected who were diagnosed in Jinhua hospital of traditional Chinese medicine from January 2016 to October 2018, and randomly divided into the embedding group and the control group. Embedding group acupoints were selected Wangu, Sanjiaoshu, Geshu, Daimai, Tianshu, Shuidao, Fenglong, and was treated by sterilized No.2-0 catgut embedding once per week, 2 times per course. Control group acupoints were selected the same as embedding group, filiform needles were sticked into acupoints 5 times per week, 10 times per course. After 3 courses of treatment, F%, BMI, values of serum TC, TG, HDL-C were evaluated and compared. We also compared the total effective rate and observed the recurrence rate after 3 months. Results After treatment, the embedding group's total effective rate and recurrence rate were obviously better than those of control group (P<0.05). The values of BMI, F%, TC, TG of embedding group were lower than those of control group (P<0.05), which of the HDL-C were higher than control group (P<0.05). Conclusion The acupoint catgut-embedding therapy which based on the theory of "interconnection of Zang-Fu viscera", can effectively reduce the values of weight, BMI, F%, TC, TG, up-regulate HDL-C of patients with obesity and hyperlipidemia, which has better clinical efficacy, and can effectively reduce the recurrence.
Effect of Yiqi Shengjiang Decoction assisted therapy on postoperative function of patients with colon cancer
TONG Lin-ping, PAN Yi-hong, TAO De-you
2019, 17(12): 2096-2098,2154. doi: 10.16766/j.cnki.issn.1674-4152.001136
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Objective To investigate the effect of Yiqi Shengjiang Decoction on gastrointestinal motility, immune function and quality of life in patients with colon cancer. Methods A total of 178 patients with postoperative colon cancer who were treated in our hospital from January 2016 to January 2018 were randomly divided into two groups, 89 cases in each group. The control group was given XELOX regimen chemotherapy, and the observation group was supplemented with Yiqi Shengjiang Decoction on the basis of the control group, both groups were treated for 3 cycles. After treatment, the changes of gastrointestinal motility recovery (first bowel sound time, anal exhaust time, defecation time, hospital stay) and immune function (CD3+, CD4+, CD8+, CD4+/CD8+) and peripheral blood cell levels (RBC, WBC, PLT, HB), quality of life (SF-36) were compared between the two groups. Results The first bowel sound time, anal exhaust time, defecation time and hospital stay in the observation group were significantly lower than those in the control group (all P<0.05). After treatment, the levels of CD3+, CD4+, CD8+ and CD4+/CD8+ in the control group did not change significantly (all P>0.05), the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly increased (all P<0.05), and the level of CD4+ was significantly decreased (P<0.05), and all of them were significantly better than the control group (all P<0.05). After treatment, the levels of RBC, WBC, PLT and HB in the observation group did not decrease significantly (all P>0.05), and the levels of RBC, WBC, PLT and HB in the control group decreased significantly (all P<0.05), and the observation group was significantly higher than the control group (all P<0.05). After treatment, the physiological function, psychological function, physical pain, health status, social function, energy, mental health and emotional function scores of the two groups were significantly increased (all P<0.05), and the observation group was significantly higher than the control group (all P<0.05). Conclusion Yiqi Shengjiang Decoction can significantly promote the recovery of gastrointestinal motility in patients with postoperative colon cancer, enhance the immune function of patients, reduce the hematological toxicity of patients after chemotherapy, and thus help to improve the patients' quality of life.
Summary of the rule of Zhou Yuhong's prescription for immune thrombocytopenia by data mining
LAI Zheng-qing, WANG Qing, LING Jian-rong, ZHOU Yu-hong
2019, 17(12): 2099-2101,2158. doi: 10.16766/j.cnki.issn.1674-4152.001137
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Objective To analyzing and summarize the rule of Zhou Yuhong's herbal prescription for immune thrombocytopenia (ITP). Methods A total of 1 102 prescriptions of Professor Zhou Yuhong for ITP disease in the outpatient department of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine between January 2010 and December 2015 were collected; the patients included 46 males and 71 females. On the platform of the software of Chinese Medicine Inheritance System (V2.5), the prescriptions were entered by specialists and checked by two persons to establish the database. The association rule mining (Apriori algorithm), entropy of complex system and other data mining methods were used to count the frequency of the herbs in prescriptions, analyze the association rules between traditional Chinese medicine, and mine core prescription herbs combinations and new prescriptions. Results According to the analysis of the prescriptions, the top five herbs were Agrimonia pilosa, Astragalus membranaceus, Radix rubiae, Poria cocos and Radix lithospermi. The association rule analysis for drugs-selecting revealed that the top five pairs were "Astragalus membranaceus and Agrimonia pilosa", "Radix rubiae and Agrimonia pilosa", "Roasted licorice and Agrimonia pilosa", "Astragalus membranaceus and Radix rubiae", "Poria cocos and Fried malt". The TCM synergy rules showed that the top five pairs of Chinese medicines were "Angelica sinensis and Astragalus membranaceus", "Codonopsis pilosula and Agrimonia pilosa", "Roasted licorice and Agrimonia pilosa", " Atractylodes macrocephala and Agrimonia pilosa", "Semen ziziphi spinosae and Agrimonia pilosa". Relevance analysis of traditional Chinese medicines showed that the top five were "Astragalus membranaceus and Peony bark", "Paeonia lactiflora and Radix lithospermi", "Poria cocos and Buffalo horn", "Cortex Phellodendri and Eclipta", "Paeonia lactiflora and Reed rhizome". Thirty core herbs combinations including 4-5 Chinese medicines were excavated and nine new prescriptions were obtained on this basis. Conclusion Professor Zhou Yu-hong has a rich experience in the treatment of ITP with traditional Chinese medicine. She do well in use of Chinese medicines such as benefiting Qi and nourishing YIN, nourishing Qi and blood, regulating liver and spleen, clearing heat and cooling blood, warmly invigorating spleen and kidney.
Effect evaluation and demand analysis of compulsory course training for community health technicians in Beijing
PENG Ying-chun, HE Yong-jie, LI Yu-jie, WANG Cai-hua, ZHOU Jiao-jiao, LYU Lu-dan
2019, 17(12): 2102-2106. doi: 10.16766/j.cnki.issn.1674-4152.001138
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Objective To understand the current situation of the compulsory training project of continuing medical education for community technical and health personnel in Beijing, and to consult the requirement of training course content, training teachers and training methods and to provide countermeasures and suggestions for the future development of the project. Methods Based on the baseline data of the compulsory training program of continuing medical education for community health technicians in Beijing and the interview results of key insiders, the questionnaire was prepared. A total of 1 410 participants in 6 districts of Beijing were selected from 10 community health service centers in 6 districts of Beijing by stratified random sampling method. Results Participants were more satisfied with the practicality and necessity of the courses included in the training program, and prefered online teaching in terms of training forms. It was urgent to enhance practical operation skills, professional basic knowledge and clinical thinking methods through training. There were also more expectations for policy interpretation, real-time politics and medical humanities courses. Conclusion The compulsory course training of continuing medical education in Beijing has played a great role in promoting the service ability and service concept of community health technicians, but it still needs to guide the reasonable expectation of participants, stimulate their endogenous motivation and mobilize their learning initiative. Policy guidance and application of technology should be combined to properly deal with conflicts between work and study, and to continuously improve the convenience of participating students. Focus on demand-oriented, parallel online and offline training, and create a new teaching model of compulsory courses. Participation in the training of students initiative, training form and strengthen teaching management, improve the evaluation system and other aspects of continuous improvement. It is expected to meet the learning needs of the participants and further promote the healthy and sustainable development of the compulsory training program of continuing medical education for community health technicians in Beijing.
Clinical epidemiological study on suspected acute myocardial infarction patients in outpatient and emergency department
ZHANG Sheng, SUN Shi-kun, YUAN Jia-min, QI Song-nan, LIU Lu, HAN Qing-zhen, YU Jia-jia, ZHANG Li, DONG Jing, LIU Dong-mei
2019, 17(12): 2107-2110. doi: 10.16766/j.cnki.issn.1674-4152.001139
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Objective To investigate the clinical treatment of suspected acute myocardial infarction (AMI) patients in outpatient and emergency departments in Suzhou area, and provide reliable clinical epidemiological theoretical basis for the prevention and treatment of AMI in the future. Methods The suspected AMI patients of the first affiliated hospital of Soochow university in 2018 year were selected as the research object. The clinical data of patients and the detection results of high-sensitivity troponin T (hs-cTnT) were analyzed retrospectively by using Excel database and SPSS statistical software, so as to further clarify the characteristics of clinical population distribution, the peak period of treatment and the clinical application value of hs-cTnT. Results A total of 13 709 patients were admitted to the outpatient and emergency department for treatment mainly due to self-induced chest pain, chest tightness, palpitations, dyspnea and other discomfort. A total of 3 585 cases (26.15%) with suspected AMI were detected, including 2 170 (60.53%) males and 1 415 (39.47%) females. The ratio of male to female was 1.5∶1. The age ranged from 11 to 100 years old, and the median age was 72 years old, and there were significant differences among all age groups (all P<0.05). Among them, 279 (7.78%) cases were young people (<40 years old). In the 3 306 (92.22%) middle-aged and elderly (>41 years old) cases, especially 2 757 (76.90%) >61 years old cases, there was statistically significant (P<0.05). The seasonal detection was statistically significant (P<0.05), mainly in winter (especially 1-2 months) and spring (3-5 months). The overall detection rate of male patients was always higher than that of female patients. The hs-cTnT level of the patients increased with age, and the level of male patients in the same age group was higher than that of female patients, and the hs-cTnT detection line of male patients (≥51 years old) and female patients (≥61 years old) was higher than the baseline level of the overall population. Conclusion The detection rate of suspected AMI in our hospital is relatively high, mainly in the middle-aged and elderly people, and the intensity and scope of seasonal hs-cTnT screening should be strengthened in high-risk groups with chest pain, palpitations and other self-conscious symptoms.
Relation among positive feelings, adult attachment, social support of the primary caregivers of cancer patients
DING Xiao-tong, DING Ya-ping, XU Qin, LI Hui-ping
2019, 17(12): 2111-2114. doi: 10.16766/j.cnki.issn.1674-4152.001140
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Objective To explore the positive feelings of the primary caregivers of cancer patients and their relationship with adult attachment and social support. Methods A total of 200 primary caregivers of cancer patients from a Third Grade Class hospital of AnHui Province were investigated with General Information Questionnaire, Positive aspects of caregiving, Experiences in Close Relationships Inventory, Social support rating scale from January to December 2017. Results A total of 200 questionnaires were distributed and 190 valid questionnaires were recovered, with an effective recovery rate of 95.0%. The scores of positive feelings, attachment anxiety, attachment avoidance, social support were (34.04±7.64), (72.09±14.92), (47.67±16.13) and (41.51±7.43), respectively. Partial correlation analysis revealed that positive feelings had positive related with attachment anxiety, social support (r=0.188-0.368, P<0.01), and had negative related with attachment avoidance (r=-0.239, P<0.01). The multiple linear regression revealed that attachment anxiety and social support can positively predict the positive feelings of caregivers. Conclusion Health professionals should be based on attachment theory and influencing factors of positive feeling, build appropriate intervention strategies to enhance caregivers' positive feeling and improve care quality.
Investigation on the status of supportive care needs of patients with lung cancer during hospitalization and analysis of influencing factors
LI Yan, HUANG Yong-xia, LU Qing, LI Ya-mei
2019, 17(12): 2115-2118. doi: 10.16766/j.cnki.issn.1674-4152.001141
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Objective To investigate the current status of supportive care needs for lung cancer patients during hospitalization. Methods From July 2017 to March 2018, 178 lung cancer patients in the oncology wards and thoracic surgical diseases at three hospitals in Shanghai were selected by convenient sampling method. A total of 178 lung cancer patients were investigated with Supportive Care Needs Survey (SCNS-SF34), Hospital Anxiety and Depression Scale (HADS), MD Anderson Symptom Inventory (MDASI) and self-made general demographic disease-related medical data. Results The lung cancer patients all reported moderate to high level supportive care needs. The unmet needs were based on the health system information dimension and psychological dimension. The symptom scores of lung cancer patients were positively correlated with 5 dimensions of supportive care needs. Anxiety, depression and supportive care needs were positively correlated. Symptom scores were the common influencing factors of the five dimensions. Cancer stage, disease month, and family monthly income entered into the regression model of psychological dimension. Anxiety score, treatment method, and age entered the regression model of physiological and daily life dimensions. Treatment method and education level entered into the regression model of health system information dimension. Treatment method, family monthly income, disease course and cancer stage entered into the regression model of patient care and support dimension. Total score of depression, and age were included in the regression model of the sexual dimension. Conclusion Somatic symptoms, anxiety and depression were factors that affecting the lung cancer patients' needs. In the future, it is necessary to make a good assessment of symptoms and psychological state, to provide symptom management and psychosocial support to meet the supportive care needs of lung cancer patients and to improve their quality of life.
Relationship between the Fear of Cancer Recurrence and Quality of Life among Patients with Gynecology Cancer: Mediating Effect of Spouse Support
ZHANG Hua, LUO Mei, DONG Yin-feng, YUAN Meng-mei, ZHANG Yu-jing, MOU Tong
2019, 17(12): 2119-2122,2130. doi: 10.16766/j.cnki.issn.1674-4152.001142
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Objective To explore the relationship between the fear of cancer recurrence and quality of life, and mediating effect of spouse support on the relationship between the fear of cancer recurrence and quality of life among patients with gynecology cancer. Methods A Total of 187 pathologically diagnosed gynecology cancer patients were selected and assessed by using the questionnaires of self-developed sociodemographic data questionnaire， Chinese version of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Spouse Support Inventor, and Functional Assessment of Cancer Therapy-Generic scale (FACT-G) between May 2017 and October 2018. Results For all the participants, the mean scores of FoP-Q-SF was 37.02±8.52, the mean score of physical health was (19.53±4.01), and the mean score of social and family was (17.42±4.61). The mean scores were (57.26±17.26), (29.40±9.56) and (27.88±8.39) for Spouse Support, subjective support and objective support, respectively. The mean score of FACT-G was (48.83±10.78). The results of correlation analysis revealed that the total score and all domain scores of FoP-Q-SF were negatively correlated with total score and domain scores of Spouse Support (all P＜0.05) and total score of FACT-G (all P＜0.01). The total score and all domain scores of Spouse Support were positively correlated with total score of FACT-G (all P＜0.01). The analysis results by Bias Corrected Bootstrap showed that Spouse Support played a partial mediation effect between the fear of cancer recurrence and the quality of life [(a×b=-0.230, 95% CI:-0.346,-0.141]. Conclusion Patients with gynecology cancer have high degree of fear of cancer recurrence. Fear of cancer recurrence can directly influence the quality of life and indirectly influence the quality of life through Spouse Support.
Evaluation of environmental contamination of centralized preparation of cytotoxic drugs and the application of closed-system drug transfer device
YU Bo, ZHU Bin, DU Qiong, YE Xuan, LIU Ying-ying, YOU Yu-fang, GUO Zi-han, GAO Fei-fei, ZHAI Qing
2019, 17(12): 2123-2126. doi: 10.16766/j.cnki.issn.1674-4152.001143
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Objective To evaluate the effect of closed system drug transfer device (CSTD) on the residual amount of cytotoxic drugs in the pharmacy intravenous admixture services (PIVAS). Methods Using cyclophosphamide as an example drug, WIPE samples and High performance liquid chromatography (HPLC) are used to quantitatively detect the residual of cyclophosphamide in the PIVAS of Fudan University Shanghai Cancer Center. Three batches of samples were taken before and after-cleaning at the end of one working day of dispensing in a conventional formulation method, and also after three weeks of continuous application of CSTD for dispensing. The samples were taken from 19 positions including the working surfaces of three biological safety cabinet, transport cart and export table. The residual amount of cyclophosphamide in the three batches of samples was compared. Results The median value of monitoring points before decontamination was 1.30 (IRQ: 0.24, 2.60) ng/cm2, and the median value after decontamination was 0.22 (IRQ: 0.08, 0.53) ng/cm2. There were significant differences between before and after decontamination (P<0.001). After implementation in the CSTD, the median value of monitoring points before decontamination was 0.06 (0.02, 0.88) ng/cm2, which was significantly lower than that before the regular decontamination (P<0.001), and also lower than the after regular decontamination, but the difference was not significant (P=0.299). Conclusion The application of CSTD can effectively reduce environmental contamination of cytotoxic drug in the process of dispensing and transportation, thus significantly reduce occupational exposure to toxic drugs by relevant medical staff.
Effect of parenteral and enteral nutrition support therapy on the nutritional status and quality of life of patients with diarrhea predominant irritable bowel syndrome
YAO Jing-yan, ZHENG Qiu, LIU Jin-li, LIU Shu-yan
2019, 17(12): 2127-2130. doi: 10.16766/j.cnki.issn.1674-4152.001144
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Objective To compare the effects of parenteral and enteral nutrition support therapy on the nutritional status and quality of life of the patients with diarrhea predominant irritable bowel syndrome. Methods A total of 160 cases of diarrhea predominant irritable bowel syndrome (IBS-D) in the Fourth Hospital Affiliated to Harbin Medical University from March 2015 to January 2018 were randomly divided into control group and observation group by random digital table, with 80 cases in each group. The control group received routine parenteral nutrition support, while the observation group took parenteral nutrition and enteral nutrition support. The clinical efficacy of the two groups, the changes of nutritional indexes before and after the treatment and the quality of life of the patients were observed and compared. Results The total effective rate in the observation group was 91.2%, which was higher than that in the control group (80.0%), the difference was statistically significant (P<0.05); Before the treatment, the levels of serum albumin, prealbumin and hemoglobin between the two groups were no statistical significance (all P>0.05); after the treatment, the levels of serum albumin, prealbumin and hemoglobin in the observation group were higher than those in the control group, the difference was statistically significant (all P<0.05). Before the treatment, there were no statistical significance between the two groups in the daily social, emotional and mental state, and the energy of patients (all P>0.05); however, after the treatment, the daily social, emotional and mental state, and the energy of patients were improved obviously as compared with the control group, the difference was statistical significance (all P<0.05). The incidence of complications in the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05). Conclusion Nutritional support therapy has significant effect on nutritional status and quality of life in patients with diarrhea predominant irritable bowel syndrome, and enteral nutrition is more effective as compared with the parenteral nutrition support. It can improve nutritional indicators and quality of life of patients, reduce the incidence of complications, and is worthy of clinical promotion.
Investigation on the ability of pre-examination and triage of emergency nurses and analysis of influencing factors
WANG Xiao-yan, SHEN Xiao-ling
2019, 17(12): 2131-2134. doi: 10.16766/j.cnki.issn.1674-4152.001145
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Objective To investigate the ability of pre-examination and triage of emergency nurses, to explore the influencing factors, and to provide reference for the training of nurses in emergency department. Methods A random sample method was used to select 177 emergency pre-examination nurses from the top three hospitals in our city. The pre-examination and triage ability were investigated, and the influencing factors affecting the pre-examination ability of emergency nurses were analyzed. Results The total score of 177 emergency nurses was 101 points, the maximum value was 214 points, and the average score were (157.80±26.42) points. Cognitive behavior, experience and technical confidence, intuition and critical thinking were scored (35.09±7.11), (47.37±7.29), (27.54±6.43) and (47.78±8.50), respectively. Univariate analysis showed that the length of emergency work, the length of pre-screening and triage work, educational background, professional title, whether to obtain emergency related certificates, whether to receive formal training in emergency triage. Participation in case discussion and examination interval were the main factors influencing the ability of pre-examination and triage of emergency nurses (P<0.05). Logistic multivariate regression analysis showed that the pre-examination work years, academic qualifications, professional titles, whether the formal training was conducted through emergency triage, whether the participation in the case discussion and the assessment interval were independent influencing factors of the pre-examination ability of the emergency nurses (all P<0.05). Conclusion The pre-examination ability of emergency nurses is generally at a general level, especially for nurses with short working hours, low academic qualifications and professional titles, formal training without emergency triage, non-participating case discussion and long interval between assessments.
Value of comprehensive nursing intervention in patients with lung injury treated by respiratory therapy
HUANG Yue, WANG Qiu-shi
2019, 17(12): 2135-2137,2146. doi: 10.16766/j.cnki.issn.1674-4152.001146
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Objective To explore the value of comprehensive nursing intervention for patients with lung injury undergoing respiratory therapy. Methods A total of 120 patients with lung injury who received respiratory treatment in our hospital from June 2016 to June 2017 were selected and divided into general nursing group and comprehensive intervention group according to the random number method, 60 cases in each group. The general nursing group were given medication guidance, dietary nursing and other helpful nursing. The comprehensive intervention group were given comprehensive nursing intervention. Psychological status, quality of life, self-care ability and degree of lung injury were evaluated before and after nursing, and hospitalization time, nursing quality and satisfaction of patients' families were compared. Results The scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the comprehensive intervention group were lower than that in the general nursing group (all P<0.05). After nursing, the quality of life in the comprehensive intervention group was better than that in the general nursing group (all P<0.05). The self-care ability of the comprehensive intervention group was better than that of the general nursing group (all P<0.05). The lung injury score of the comprehensive intervention group was lower than that of the general nursing group (P<0.05). The hospitalization time of the comprehensive intervention group was shorter than that of the general nursing group, and the nursing quality was better than that of the general nursing group (all P<0.05). The total satisfaction of family members in comprehensive intervention group was higher than that in general nursing group (P<0.05). Conclusion Intervention with comprehensive nursing can help patients improve their self-care ability and living standard, improve their psychological status, effectively alleviate the severity of lung injury, help patients recover quickly, and make patients and their families more satisfied.
Effect of improved oral care in EICU using ventilator to treat patients with clustering Nursing
ZHANG Fei-fei, LU Ping, CHEN Wei, JIN Yan-yan, LU Yi
2019, 17(12): 2138-2141. doi: 10.16766/j.cnki.issn.1674-4152.001147
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Objective To investigate the effect of improved oral care in EICU using ventilator to treat patients with clustering nursing. Methods Randomized digital method was used to divide 138 patients with EICU admitted to Ningbo Huamei Hospital into two groups, 69 cases in each group. The control group was given clustering care, and the observation group was given clustered care for improved oral care. The improvement of oral hygiene (bad breath, swollen gum bleeding, oral ulcer) after 3 days and 7 days of nursing care, the number of pathogenic bacteria and the occurrence of ventilator-associated pneumonia (VAP) after nursing, and EICU hospitalization time, mechanical ventilation time in the two groups were compared. Results After 3 days of nursing, the improvement rate of bad breath in the observation group was 55.56%, which was significantly better than that in the control group (30.19%， P<0.05). After 7 days of nursing, the improvement rates of bad breath, swollen gums and oral ulcer in the observation group were 94.44%, 80.56% and 54.17%, which were significantly better than that of the control group (66.04%, 39.47% and 24.00%， all P<0.05). After the nursing, 29 strains of the pathogens were detected in the observation group, and 50 strains were detected in the control group (P<0.05). The hospitalization time and mechanical ventilation time of the EICU in the observation group were significantly shorter than those in the control group (all P<0.05). After the nursing, the incidence of VAP in the observation group was 4.35%, which was significantly lower than that in the control group (17.39%， P<0.05). Conclusion The clustering care with improved oral care can significantly shorten the EICU hospitalization time and mechanical ventilation time in the EICU using ventilator treatment, which can significantly improve the patient's oral hygiene and reduce the incidence of VAP.
The effect of comprehensive nursing in multimodal analgesia during perioperative period of total hip arthroplasty
WANG Jian, ZHANG Hai-jing, WANG Wen-jing, QI Min, FU Hong-xia
2019, 17(12): 2142-2146. doi: 10.16766/j.cnki.issn.1674-4152.001148
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Objective To explore the effect of comprehensive nursing on multimodal analgesia during perioperative period of total hip arthroplasty (THA). Methods Fifty patients with THA admitted to our department from January 2015 to December 2016 were selected as the control group. Multimodal analgesia plus routine nursing was performed. Fifty patients with THA admitted to our department from January 2015 to December 2016 were selected as the observation group, who were used multimodal analgesia plus comprehensive nursing. The pain of patients at 6, 12, 24 and 48 hours after operation were investigated by digital scoring method. The adverse reactions and the use of additional analgesics at 48 hours after operation were counted. The hip flexion, abduction and Harris score were recorded at 1, 3 and 5 days after operation, and the patient's satisfaction with analgesia was investigated. Results The pain score of the observation group at 6, 12, 24 and 48 hours after operation was lower than that of the control group, and the addition of analgesics was less than that of the control group (all P<0.05). The flexion activity and abduction activity of the hip in the observation group were greater than those in the control group on the 1, 3 and 5 day after operation (all P<0.05). The Harris score of the observation group was higher than that of the control group one month after operation (P<0.05). Postoperative analgesia-related adverse reactions in the observation group were less than those in the control group, and the degree of satisfaction with analgesia was higher than that in the control group (all P<0.05). Conclusion The comprehensive nursing can improve the analgesic effect of multi-mode analgesia in total hip replacement, reduce the adverse reactions of analgesia, and promote early joint activity after operation.
Application of Nursing Path Based on Goal Management Optimization in Hysteroscopic Endometrial Polypectomy
ZHOU Jing, DING Xiao-ping, CHEN Jun-xia
2019, 17(12): 2147-2150. doi: 10.16766/j.cnki.issn.1674-4152.001149
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Objective To study the effect of optimized nursing path based on goal management on the patients undergoing hysteroscopic endometrial polypectomy. Methods A total of 170 patients who underwent hysteroscopic endometrial polypectomy were selected. According to the random number table method, the patients were divided into observation group and control group, 85 cases in each group. The patients in the control group were given routine nursing pathway, while the patients in the observation group were given optimized nursing pathway. The operation time, hospitalization time, incidence of complications during hospitalization, nursing quality score and quality of life score before and after nursing were compared between the two groups. All patients were followed up for 6 months, and the recurrence rate after operation was counted. Results The operation time of the observation group was (24.56±6.73) min, shorter than that of the control group (38.41±5.22)min (t=14.992, P＜0.05), the length of stay in the observation group was (2.57±1.33) days, which was also shorter than that in the control group (4.26±1.27) days (t=8.473, all P＜0.05)；The incidence of complications in the observation group was 3.5%, lower than 11.7% in the control group (χ2= 4.680, P＜0.05).The scores of operation skill level, problem-solving ability, nursing preciseness and nurse patient communication ability were all higher than those of the control group (t=15.421, 17.561, 11.128.13.153, 28.150, all P＜0.05); after nursing intervention, the scores of quality of life in the observation group included physiological function, physiological function, physical pain and general health.Health status, vitality, social function, emotional function and mental health were all higher than those of the control group (t=12.171, 6.292, 9.724, 15.958, 12.323, 32.562, 9.410, 6.947, all P＜0.05); the recurrence rate of the observation group was lower than that of the control group (χ2= 4.224, P＜0.05). Conclusion The optimized nursing path based on objective management can effectively reduce the operation time and hospitalization time of patients undergoing hysteroscopic endometrial polypectomy, improve the quality of nursing, reduce complications and recurrence rate, and is conducive to improving the quality of life of patients, which is worthy of clinical application.
Application effect of prospective nursing intervention on patients with FFA examination in ophthalmology clinic
MOU Cha-ying, LUO Man, CHEN Wei
2019, 17(12): 2151-2154. doi: 10.16766/j.cnki.issn.1674-4152.001150
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Objective To investigate the effect of prospective nursing intervention on fundus fluoroscopy (FFA) in ophthalmology clinics and to provide reference for clinical nursing of ophthalmology. Methods A total of 140 patients who underwent FFA examination in the ophthalmology clinic from June to September 2019 were enrolled in the study. According to the random number table method, 70 patients were divided into observation group and control group. Patients in the control group were treated with routine nursing intervention, and the observation group was treated with prospective nursing intervention on the basis of the control group. The incidence of adverse reactions after contrast, the psychological status scores of the two groups before and after intervention, the quality of nursing score and the satisfaction of nursing were compared. Results The incidence of adverse reactions after angiography in the observation group was 10.0% (7/70), which was lower than that in the control group (25.7%, 18/70), χ2=5.892, P<0.05. Before the nursing intervention, the mental state scores of the two groups (SAS, SDS)had no statistical significance, P>0.05. After nursing intervention, the SAS and SDS scores of the two groups were lower, but the scores of the observation group were significantly lower than those of the control group[(14.52±2.13) vs.(17.66±2.85), (15.37±2.81) vs. (18.26±2.76)], t=7.384, 6.139, all P<0.05. Compared with the control group, the nursing satisfaction of the observation group was 95.7% (67/70), which was higher than that of the control group (82.9%,58/70), χ2=6.048, P<0.05. Conclusion Prospective nursing intervention can effectively reduce the incidence of post-contrast adverse reactions in patients with FFA examination in ophthalmology clinics, which is beneficial to alleviate patients' bad mood, improve nursing quality and nursing satisfaction, and is worthy of clinical application.
2019, 17(12): 2155-2158. doi: 10.16766/j.cnki.issn.1674-4152.001151
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2019, 17(12): 2159-2161. doi: 10.16766/j.cnki.issn.1674-4152.001152
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