2019 Vol. 17, No. 7

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The retrospect and prospect of the development of general practice research in China—the analysis of development, research fields and bottlenecks
WANG Chao-xin, CHEN Ning, LIU Qian, XU Kang-jie, YANG Yan, BO Xiao-jie, SHI Jian-wei, HUANG Jiao-ling, TANG Lan
2019, 17(7): 1069-1072,1141. doi: 10.16766/j.cnki.issn.1674-4152.000865
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Objective To analyze the development and current situation of general practice research in China and summarize the bottlenecks for enlightening further development of general practice of scientific research in China. Methods Published studies on the history and current situation of general practice research in China were systematically reviewed and analyzed. We searched CNKI database, Wanfang database, VIP database, Web of Science and Pubmed for articles about general practice published between 1990 and 2019 using "General Practice" or "General practitioner" or "Family Doctor" or "Team of General Practitioners" or "community health" as terms. Results The development of the general practice research can be divided into three stages: embryonic stage (from 1986 to 1996), initial growth stage (from 1997 to 2009) and accelerated developing stage (2010 and afterwards). Six main research fields of general practice include general practice education and training of general practitioners, models of health care in general practice, health promotion and disease prevention, disease treatment and clinical efficacy, community rehabilitation and continuous management, performance evaluation and post competency of general practitioners. The core bottlenecks in the development of general practice research include the limited research objects, the research method and ability deficiencies, and the blank areas in research fields. The general practice research should cover the fields of preventive medicine, clinical medicine, rehabilitation medicine, public health, humanities, and social science and management, which should be conducted with the core of health of community population. Conclusion The development of the general practice research should clarify its core connotation accurately, build a clinical practice-oriented general practitioners' team, and open up a scientific research road with the characteristics of general practice, so as to promote the comprehensive and sustainable development of the general practice research.
LI Rui, WANG Guo-ping
2019, 17(7): 1073-1074.
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Effect of rhG-CSF mobilization therapy on circulating lymphocyte subsets and immune function in normal stem cell donors
ZHANG Peng, OUYANG Ling, GAO Yang, LI Yong-hua, ZHANG Hang, LI Li, JIANG Zu-jun
2019, 17(7): 1075-1077,1149. doi: 10.16766/j.cnki.issn.1674-4152.000866
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Objective To investigate the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) mobilization therapy on lymphocyte subsets and immune function in peripheral blood of the normal stem cell donors. Methods Hematopoietic stem cell mobilization and collection were performed on 57 normal stem cell donors in the Department of Hematology, General Hospital of Guangzhou Military Command from January 2017 to March 2018. RhG-CSF (5-10 μg·kg-1·d-1) was administered subcutaneously for 5 days to mobilize hematopoietic stem cells (HSCs). Peripheral blood from donors was collected on the 0th, 3rd, and 5th day after the mobilization therapy. Then lymphocyte subsets were detected by using flow cytometry. Immunoglobulins and complements were detected by using automatic biochemical analyzer. Results In the peripheral blood of donors on day 0, 3, and 5 after mobilization therapy, the percentage of total lymphocytes decreased, and the decrease was particularly significant on the 5th day of mobilization (P<0.05). The proportion of total T cells (CD3+), T helper cells (CD3+CD4+), and B lymphocytes (CD19+) increased on the 3rd day of mobilization and decreased on the 5th day, but the difference was not statistically significant (P>0.05). The subpopulations of cytotoxic T lymphocytes (CD3+CD8+) and NK cells (CD3-CD56+) showed a downward trend after mobilization, but the difference was not statistically significant (P>0.05). The CD4+/CD8+ ratio showed an upward trend, but without statistically significance (P>0.05). There were no significant changes in the levels of immunoglobulins (IgA, IgG, IgM) and complements (C3, C4) in the peripheral blood of the donors on days 0, 3 and 5 of mobilization (P>0.05). Conclusion The rhG-CSF mobilization therapy does not affect lymphocyte subsets and immune function in the peripheral blood of normal stem cell donors, which can be safely applied to hematopoietic stem cell mobilization.
Analysis of the distribution of age and fracture type in proximal humeral fractures with rotator cuff tear
ZENG Yun-fu, BIAN Yang-yang, WANG Rong, PENG Lei
2019, 17(7): 1078-1080. doi: 10.16766/j.cnki.issn.1674-4152.000867
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Objective Proximal humerus fracture is prone to rotator cuff injury in different degrees. Severe rotator cuff injury is a common cause of limited shoulder movement after proximal humeral fracture surgery. The purpose of this study was to investigate the correlation between proximal humeral fractures with rotator cuff injury and Neer classification and age distribution of fractures. Methods A self-designed questionnaire was used to retrospectively analyze the clinical data of 126 patients with proximal humeral fractures who underwent surgical treatment from January 2012 to December 2016 in a third-class hospital in Haikou City. The incidence of rotator cuff injury in proximal humeral fractures with different Neer classification and age stratification was compared. Results There was no significant difference in age and type of proximal humeral fracture between different genders (χ2=0.030, P=0.985). Among 126 cases of proximal humeral fractures, 49 cases(38.9%, 49/126) were confirmed to have rotator cuff injury during operation, of which 41 cases were confirmed by MRI before operation. The average age of the patients with proximal humeral fracture combined with rotator cuff injury (76.9±9.8) was significantly different from that of the patients without rotator cuff injury (53.4±8.3, t=3.178, P=0.034). Neer classification of proximal humeral fractures had the highest incidence of rotator cuff injury in three-part fractures, accounting for 49.3% (37/67). Conclusion The proportion of patients with proximal humerus fracture combined with rotator cuff injury increases with age. Neer classification of proximal humerus fracture often combined with rotator cuff injury, which has guiding significance for clinical treatment of proximal humerus fracture.
Study of the inhibition effect of SAHA on cell proliferation and vasculogenic mimicry in pancreatic cancer PANC-1 cells
RAO Mu-sheng, XU Xing-dong, CAO Sheng-hua, WANG Gang, WANG Xue-cheng
2019, 17(7): 1081-1086. doi: 10.16766/j.cnki.issn.1674-4152.000868
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Objective To investigate the effects of suberoylanilide hydroxamic acid (SAHA), an inhibitor of histone deacetylase, on the cell proliferation, cell migration and apoptosis of pancreatic cancer PANC-1 cells. To observe the changes of vasculogenic mimicry dominated by pancreatic cancer PANC-1 cells and the expression level of matrix metalloproteinase-2 (MMP-2) in PANC-1 cells which treated with different concentrations of SAHA. Methods Inverted microscope was used to observe the effect of a series of concentrations of SAHA in cell proliferation of pancreatic cancer PANC-1 cells. MTT colormetric assay was performed to measure the inhibitory effect of different concentration of SAHA treatment for 24 h on human pancreatic cancer PANC-1 cells. Cell scratch test and was used to measure the effect of SAHA on the migration abilities of PANC-1 cells, and then, we use flow cytometry to analyze the effect of SAHA on cell apoptosis. PANC-1 cells were treated with the different concentration of SAHA for 24 h, vasculogenic-like networks were formed in three-dimensional culture in vitro, then we observe the changes in the structures of vasculogenic-like network. Western blotting was used to study the expression level of MMP-2 in pancreatic cancer PANC-1 cells with the different concentration of SAHA treatment. Results SAHA could significantly inhibit the proliferation of pancreatic cancer PANC-1 cells and showed the dose-dependent relationships. Cell scratch test showed that SAHA could effectively inhibit the migration of PANC-1 cells compared to the control group (P<0.01). Flow cytometry showed that SAHA could obviously induce the apoptosis of pancreatic cancer PANC-1 cells. Three-dimensional culture in vitro showed that SAHA could significantly inhibit vasculogenic mimicry dominated by pancreatic cancer PANC-1 cells (P<0.05). Western blotting showed that with the increase concentration of SAHA, the expression level of MMP-2 in PANC-1 cells of pancreatic cancer decreased (P<0.05). Conclusion SAHA can effectively inhibit the proliferation and migration of PANC-1 cells leads to cell apoptosis. Meanwhile, the down-regulation of MMP-2's expression caused by SAHA may be one of the mechanisms of it's anti-tumor mimicry in pancreatic cancer.
Effect of butylphthalide injection on the serum level of apoptosis-related factors in patients with cerebral infarction
ZHANG Wei-ping, QU Hong-dang, XU Li
2019, 17(7): 1087-1089,1190. doi: 10.16766/j.cnki.issn.1674-4152.000869
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Objective To investigate the effect of butylphthalide injection on the serum level of apoptosis-related factors in patients with cerebral infarction. Methods Total 106 patients with acute cerebral infarction admitted to our hospital from January 2017 to December 2017 were randomly divided into control group and observation group, with 53 cases in each group. All patients received conventional therapy and dual antiplatelet therapy after admission. On this basis, the patients in the observation group were additional administrated with butylphthalide injection. The total effective rate was compared between the two groups. The levels of Bcl-2 and CytC, serum inflammatory factors TNF-α, IL-6 and the national institutes of health stroke scale (NIHSS), Barthel index and the modified Rankin scale (MRS) scores were measured before and after the treatment. Results The total effective rate of the observation group (90.57%) was significantly higher than that of the control group (73.58%), with a statistically significant (χ2=5.194, P=0.023). After 2 weeks of treatment, the Bcl-2 level elevated and the level of CytC decreased significantly in the observation group, and the difference was statistically significant when compared with the control group (P<0.05). The serum levels of TNF-α and IL-6 were significantly decreased in both groups, especially in the observation group (P<0.05). After 4 weeks of treatment, the NIHSS and MRS scores of the observation group were significantly lower than those of the control group, but The Barthel index score was significantly higher in the observation group than that of the control group, and the difference was statistically significant (P<0.05). Conclusion Butylphthalide injection has a significant clinical effect on patients with acute cerebral infarction, which can effectively reduce serum inflammatory factor levels and improve brain cell apoptosis-related factors levels, improve neurological function scores, and is worthy of clinical use.
The relationship between blood lipid level and subclinical arteriosclerosis index among people who underwent health examination
LI Xiao-jing, HONG Hai-ou, ZHENG Hao-ran, YU Tian-yi, ZHOU Juan-juan
2019, 17(7): 1090-1092,1244. doi: 10.16766/j.cnki.issn.1674-4152.000870
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Objective To explore whether the blood lipid level is associated with subclinical arteriosclerosis index. Methods A total of 257 subjects from the Health Management Center of the First Affiliated Hospital of USTC Anhui Provincial Hospital were investigated. Their name, age, gender, height, weight, BMI, and blood pressure were collected via questionnaire. The total cholesterol, triglyceride, low density lipoprotein cholesterol, very small low-density lipoprotein cholesterol, high density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B, and lipoprotein a were tested by automatic biochemical analyzer, and the baPWV and ABI were used to evaluate arterial stiffness. The results were calculated by t test and linear regression. Results All the subjects were divided into two groups, including subclinical arteriosclerosis group and control group. Study showed that systolic pressure and diastolic pressure in the subclinical arteriosclerosis group than those in the control group(P<0.05). Both baPWV and ABI showed significant difference between the two groups (P<0.05). To compare serum lipid level, TC, TG, LDL, VLDL and Apo B were statistically significant (P<0.05), while HDL, Apo A and Lpa between two groups indicated no difference (P>0.05). The equation of baPWV is Y1=12.19X1+23.07X2+7.67X3-156.13(Y1:baPWV; X1:age; X2:TG; X3:SBP; R=0.740, R2=0.548, P<0.05). The equation of ABI is Y2=0.732+0.002X1+0.002X2 (Y2:ABI; X1 :age; X2:height; R=0.358, R2=0.128, F=18.284, P<0.01). Conclusion TC, TG, VLDL and ApoB were influence factors of subclinical arteriosclerosis, while TG is an independent risk factor in the regression equation.
Effects of cinaciguat on function of human umbilical vein endothelial cells injured by high glucose
LI Yan-ying, ZHANG Mei, LI Ya-nan, BAN Bo
2019, 17(7): 1093-1096. doi: 10.16766/j.cnki.issn.1674-4152.000871
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Objective Nitric oxide (NO) and soluble guanylate cyclase (sGC) are both oxidized under the condition of diabetes, resulting in abnormal conduction of the nitric oxide/soluble guanylate cyclase/cyclic guanosine monophosphate (NO-sGC-cGMP) signaling pathway, which is the important pathological basis of diabetic endothelial dysfunction. Cinaciguat (CIN) is a soluble guanylate cyclase (sGC) activator that can protect endothelial cells by activating sGC. In the present study, we investigated the effect of Cinacigua on human umbilical vein endothelial cells (HUVECs) treated with high glucose in vitro. Methods The cultured HUVECs were divided into the normal control group, high glucose group and CIN group, with 6 cases in each group. High glucose group and CIN group were treated with high glucose (33.3 mmol/L), and the CIN group was also given CIN. The levels of NO and nitric oxide synthase (NOS) were measured after the intervention with 6 h, 24 h, 48 h. Forty-eight h after the intervention, mRNA expression eNOS and iNOS were examined by using RT-PCR, and the expression of ICAM-1 and VCAM-1 were examined by using Western blotting. Results Compared with normal control group, the levels of NO and NOS in the high glucose group increased at early stage and decreased at later stage (P<0.05), but CIN could balance the levels of NO and NOS (P<0.05). In the same time, the expressions of eNOS mRNA was down-regulated, In addition, ICAM-1 and VCAM-1 were up-regulated in the state of high glucose, but the level of eNOS mRNA in CIN group was higher than that in high glucose group, and the level of iNOS mRNA, ICAM-1 and VCAM-1 decreased obviously (P<0.05). Conclusion CIN can balance the activity of NOS, adjust the expression of NO, ICAM-1 and VCAM-1 of HUVECs induced by high glucose, and improve function of injured HUVECs.
Effect of artemisinin on the release of inflammatory mediators of LPS-activated microglia
ZHENG Yun-qiu, QU Hong-dang, XU Zhi-ben, LI Yun-yun
2019, 17(7): 1097-1100. doi: 10.16766/j.cnki.issn.1674-4152.000872
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Objective To investigate the effect of artemisinin (ART) on the release of inflammatory mediators induced by lipopolysaccharide (LPS) in microglia, and to investigate the inhibitory effect of artemisinin on the inflammatory response of neurons in Parkinson' s disease and its mechanism. Methods The concentration of ART on BV2 microglia was detected by CCK8 method. LPS-induced microglia was treated with a given ART drug concentration. The effects of ART on the proinflammatory factors interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were detected by quantitative PCR and ELISA. Western blot was used to detect the expression of NF-κB protein (P65) and IKBα, and the effect of ART on the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX-2) genes. Results A dosage range of 0.1 to 10 μmol/L ART did not show a significant toxicity to BV2 cells, so 1 μmol/L ART was selected for further experiments. Quantitative PCR results showed that the expression of pro-inflammatory factors IL-1β and TNF-α mRNA was significantly decreased in the ART pretreatment group. The results of Western blotting showed that the expression levels of NF-κB and IKBα in the ART pretreatment group were significantly increased, and the expression levels of inflammation-inducing enzymes iNOS and COX-2 were significantly decreased. Conclusion ART can regulate the expression of inflammatory factors and inflammation-inducing enzymes in LPS-activated BV2 microglia and exert anti-inflammatory effects, which may be achieved by regulating NF-κB signaling pathway.
Protective effect of erythropoietin derived peptide on heart in rats with acute myocardial infarction
WANG Shi-xiang, WANG Bin, GUO Guo-feng, XU Wei, CHEN Yong-quan, CHEN Xi-ming
2019, 17(7): 1101-1104,1233. doi: 10.16766/j.cnki.issn.1674-4152.000873
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Objective To investigate the protective effect of helix B surface peptide (HBSP) on the heart of rats with acute myocardial infarction (AMI). Methods Thirty 8-week-old male SD rats were randomly divided into 3 groups: sham operation group (sham group), AMI group and HBSP group. The AMI rat model was established by ligating the anterior descending coronary artery. The treatment group was intraperitoneally injected with HBSP (90 μg/kg), the sham operation group and AMI group were intraperitoneally injected with the same amount of normal saline. Cardiac function was detected by color Doppler echocardiography 24 hours after operation. The myocardial signal transduction and transcription activator 3 (STAT3), B lymphocytoma 2 gene (Bcl-2) were detected by Western blotting in each group of rats. Apoptosis was detected by expression of Bcl-2, Bax protein (BCL2 associated X protein) and detection of myocardial fineness by in situ Nick end labeling (TUNEL). Results Compared with AMI group, myocardial infarction size and cardiac function of rats in HBSP group were significantly improved. STAT3, Bcl-2 expression in AMI group was significantly lower than that in sham operation group (P<0.01). In HBSP group, STAT3 was significantly higher than that in sham operation group (P<0.01). In HBSP group, the expression of Bcl-2 was significantly higher than that of AMI, while the expression of Bax was significantly decreased (P<0.01). Compared with the sham operation group, the cardiomyocyte apoptosis rate in the AMI group was significantly increased, while that in the HBSP group was significantly lower than that in the sham operation group (P<0.01). AMI model group was significantly lower than that in the sham operation group. The cardiac function in HBSP group was significantly higher than that in AMI model group (P<0.01). Conclusion HBSP can increase the expression of STAT3, Bcl-2 and inhibit the apoptosis of myocardial cells in rats with acute myocardial infarction, thereby protecting myocardial tissue and improving cardiac function in rats.
Eperythrozoon infection and related infection factors in patients with tumors
ZHOU Lian-lian, LI Fang, LI Mian-mian, CHEN Xiao-jian
2019, 17(7): 1105-1108. doi: 10.16766/j.cnki.issn.1674-4152.000874
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Objective To investigate the epidemic status of Eperythrozoon infection and related infection factors in patients with tumors. Methods A total of 106 patients with cancer and 114 patients of healthy physical examination were recruited by random sampling method from August 2016 to July 2018. The EDTA-K2 anticoagulant whole blood were collected and stained by Wright staining and acridine orange fluorescence staining to determine the infection of Eperythrozoon. Both of them were positive for Eperythrozoon infection and all the relevant information (age, gender, whole blood count, treatment etc) was collected. Chi-square test were applied to analyze the difference of positive rates. Results The corresponding infection rates in the patients group and health control group were 33.02% and 11.40%, and there were significant statistical difference among them (χ2=15.045, P<0.001). There was no significant difference in the infection rate of Eperythrozoon in tumor patients in different systemic tumors, intervention treatment, erythrocyte blood count, platelet count, age distribution and gender distribution (all P>0.05). The trend of increased rates of infection in increased white blood cell count group was reflected (χ2=2.885, P=0.089). The infection rate of Eperythrozoon in healthy persons has no statistical significant difference between children and adults (χ2=0.492, P>0.05). Conclusion There was mild infection of Eperythrozoon in patients with tumor and healthy people, but the infection rate of patients with tumor was significantly higher than that of healthy people; The tumor patients with the increased WBC count maybe infected with human eperythrozoon; The infection rate of human erythrocyte in patients with tumors is not related to the factors of intervention treatment, tumor system, red blood count, platelet count, age, gender etc. The infection rate of human erythrocytes in healthy subjects was not related to age.
Relationship between HCY level and no-reflow phenomenon in patients with acute ST segment elevation myocardial infarction after primary PCI and its mechanisms
GENG Xu, ZHANG Heng, MA Bin, WANG Hong-ju, TANG Bi, ZHU Jian, WU Shi-li, KANG Pin-fang, WU Yue
2019, 17(7): 1109-1111,1177. doi: 10.16766/j.cnki.issn.1674-4152.000875
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Objective To detect plasma homocysteine (Hcy) levels in patients with acute ST segment elevation myocardial infarction (STEMI), explore the relationship between Hcy level and no-reflow phenomenon after primary percutaneous coronary intervention (PPCI), and analyze the possible mechanism influencing its occurrence and development. Methods The basic clinical data, laboratory test results, data of coronary angiography and primary interventional therapy of 113 acute STEMI patients treated with PPCI in our hospital from April 2016 to April 2018 were retrospectively analyzed. The no-reflow phenomenon during the operation was observed in 33 patients, and blood flow was normal in the others 80 patients. Meanwhile, the plasma samples of the patients were collected to test the level of Hcy. The possible metabolism that Hcy leads to no-reflow phenomenon was analyzed statistically. Results The plasma levels of Hcy, NLR and CRP in patients with normal blood flow were all lower than those in the group with no-reflow, while there was no apparent statistical difference in traditional danger factors such as occurrence of hypertension, diabetes and cholesterol level. Conclusion The Hcy level in plasma is associated with the occurrence of no-reflow phenomenon during PPCI in acute STEMI patients. Hcy level in plasma of the NRF group is higher than that of normal blood flow group, meanwhile NLR and CRP level is higher too in NRF group; so the pathogenesis of NRF in acute STEMI after PPCI may be related to the inflammatory response associated with NLR and CRP.
Clinical analysis of therapeutic effect of argatroban for acute cerebral infarction: a report of 52 cases
LI He-xia, LIU Hui-juan, YIN Wei, XU Li, ZHANG Jun-li
2019, 17(7): 1112-1114,1170. doi: 10.16766/j.cnki.issn.1674-4152.000876
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Objective To evaluate the clinical efficacy of the argatroban in the treatment of acute cerebral infarction (ACI). Methods Total 52 cases of ACI in our hospital from June 2014 to June 2016 were enrolled and randomly divided into two groups with 26 cases in each group. The conventional drugs (bayaspirin, atorvastatin, safflower Injection and deproteinized hemoderivative of calf blood) were administrated in the control group, and additional argatroban (60 mg/day, continuous pump for 48 hours; then 10 mg/time, bid, pump for 5 days). The levels of lactic acid, hs-CRP, TNF-α and IL-6 were tested, and National institutes of health stroke scale(NIHSS) score and BI scale were conducted to evaluated the therapeutic efficacy at different time points. Results In the treatment group, NIHSS score decreased significantly, however, BI score increased significantly on d10 after the treatment, there were statistically difference when compared with the control group (P<0.05). There was no significant difference in the levels of lactic acid, hs-CRP, TNF-α and IL-6 before the treatment between the two groups (P>0.05). On 48 h and 7 d time points, these levels in the treatment group was significantly lower than that of the control group, there was significant difference between the two groups (P<0.05). The serum APTT on each time points were significantly different between the two groups (P<0.01), but there was no significant difference on 10 d after the treatment (P>0.05). Conclusion Argatroban can effectively improve the blood supply of brain tissue, relieve tissue hypoxia, reduce the release of inflammatory mediators, and improve survival. As one good choice for the ACI patients, the curative effect of argatroban is significant.
Comparison of the efficacy of video-assisted thoracoscopic surgery and thoracotomy in the diagnosis and treatment of pulmonary nodules
WANG Yi, JIE Ming-ran, WANG Shu-jun, ZHANG Dao-zhong, LIU Jin-shan
2019, 17(7): 1115-1117. doi: 10.16766/j.cnki.issn.1674-4152.000877
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Objective To compare the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and thoracotomy in the diagnosis and treatment of pulmonary nodules, and evaluate the clinical feasibility and application value of VATS. Methods We collected 50 patients with pulmonary nodules from January 2015 to May 2018. The patients with obvious signs of malignancy by preoperative imaging findings or required surgery, without surgical contraindications, were recruited and divided them into two groups according to the patients' wishes. They were informed about the risks and benefits from different surgical methods before surgery. Twenty-five cases underwent traditional open access, and other 25 cases underwent VATS. In VATS group, one patient was with low lung function and other one was with advanced age. In the VATS group, the "single-hole method", "two-hole method" and "three-hole method" were selected according to the location of the pulmonary nodules and the nature of intraoperative freezing. Data analysis was performed using SPSS 18.0 statistical software. The measurement data were expressed by (ｘ±s), and the count data were analyzed by χ2 test. The operation time, intraoperative blood loss, chest tube indwelling time, postoperative hospital stay, etc. were compared between the two groups. Results The relevant observation indexes of VATS group vs thoracotomy group were as follows: operation time: (116.12±46.28) min vs. (142.96±46.27) min, intraoperative blood loss: (55.80±54.86) mL vs. (172.4±102.48) mL, indwelling time of chest tube: (3.40±0.65) d vs. (4.28 ±0.46) d, postoperative hospital stay: (6.12 ±4.28) d vs. (7.92 ±1.66) d, the index of the VATS group was significantly lower than those in the thoracotomy group, and the difference was statistically significant (P<0.05). Conclusion VATS has the advantages of quick recovery, less complications and high safety when compare with traditional open thoracotomy. It is helpful for clear diagnosis, early detection of cancer, improvement of surgical resection rate and improvement of cure rate. So it has positive clinical significance.
Immune function of patients with prostate cancer and its relationship with clinicopathological characteristics of prostate cancer
LUO Xiao, LU Hong-sun, LI Yao-jun, WANG Shi-jian, XIA Li-qun
2019, 17(7): 1118-1120,1145. doi: 10.16766/j.cnki.issn.1674-4152.000878
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Objective To explore the immune function of prostate cancer patients and its relationship with clinicopathological features of prostate cancer. Methods Total 60 cases of patients with prostate cancer in our hospital from January 2014 to December 2016 were assigned into the prostate cancer group, and 60 healthy subjects into the control group. The levels of CD4+, CD8+, CD4+/CD8+ and natural killer cells (NK) were detected by using flow cytometry. Results The levels of CD3+, CD4+, and CD4+/CD8+ in prostate cancer group were lower than those in the control group (P<0.05), the levels of CD8+ and NK cells were higher than those in the control group (P<0.05). There was no significant difference in the levels of CD3+, CD4+, CD8+, NK and CD4+/CD8+ between the prostate cancer patients with volume≥60 mL and volume <60 mL (P>0.05). The CD3+, CD4+ and CD4+/CD8+ in the medium-poorly differentiated prostate cancer patients were significantly lower than in well differentiated patients (P<0.05), the CD8+ and NK cells were higher than those in well differentiated patients (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ in the stage Ⅰ-Ⅱ prostate cancer patients were lower than those in the stage Ⅰ-Ⅱ patients (P<0.05), the CD8+ and NK cells were higher than those in stage Ⅰ-Ⅱ patients (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ in patients with lymph node metastasis were lower than that in patients without lymph node metastasis (P<0.05), the CD8+ and NK cells were higher than those without lymph node metastasis (P<0.05). Conclusion The immune function in prostate cancer patients is low. The low immune function of prostate cancer patients is related to prostate cancer differentiation, clinical stage and lymph node metastasis, and is not related to tumor volume. The lower differentiation, higher clinical stage and lymph node metastasis are closely correlated with the higher degree of immune dysfunction.
Relationship among smoking before disease, duration of untreated psychosis and the cognitive function in male first-episode schizophrenic patients
SUN Ji-jun, ZHU Chun-yan, WANG Zhuo, FANG Ling, ZHANG Jun, LIU Jun-yun, PAN Sheng-ming
2019, 17(7): 1121-1124. doi: 10.16766/j.cnki.issn.1674-4152.000879
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Objective To explore the relationship among smoking before disease, duration of untreated psychosis (DUP) and the cognitive function in male first-episode schizophrenic patients. Methods A total of eighty-six first episode patients were divided by DUP into short DUP group(n=39) and long DUP group (n=47). Investigate the age at starting smoking, smoking years and smoking amount, the FTND, WCST and P300 were used to evaluate smoking severity and cognitive function and contrasted with 40 health controls. Chi-squared Test, t-test and ANOVA was used to analyze the data. The Pearson correlation analysis was used to analyze the correlation between smoking behavior and cognitive function. Results ①Comparing with controls, the age at smoking in two patient groups were earlier (each P<0.001), smoking amount were higher (each P<0.05), the scores were higher (each P<0.05), and the rate of smoking were higher(each P<0.05). Comparing with short DUP group, smoking amount and scores of FTND were higher (each P<0.05), and the rate of smoking were higher (P<0.05). ②Comparing with controls, there were significantly differences in two patient groups in cognitive function (each P<0.001), and there were significantly difference between two patient groups in cognitive function (each P<0.05) except classification completion number of WCST and latency of P300 (each P>0.05). ③In all patients, the age at start smoking were negatively correlated with the DUP and total number of tests in WCST (r=-0.256, -0.224， each P<0.05), and positively correlated with amplitude of P300 (r=0.274, P=0.011); smoking years was positively correlated with latency of P300 (r=0.225, P=0.037); smoking amount and FTND score were positively correlated with DUP (r=-0.739, 0.720, each P<0.001); FTND score was positively correlated with the Correct Number (r=-0.271, P=0.012). Conclusion Smoking before disease is a risk factor for schizophrenia, which may prolong DUP and eventually lead to cognitive decline.
Gene mutation screening in three families with generalized epilepsy with febrile seizures plus
WU Guang-sheng, ZHU Ya-fei, LI Shan, LIANG Zhen-ming, XIAO Yun-bin
2019, 17(7): 1125-1127,1240. doi: 10.16766/j.cnki.issn.1674-4152.000880
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Objective To summarize the phenotypes and identify gene mutation in families with generalized epilepsy with febrile seizures plus (GEFS+). Methods Genomic DNA was extracted from peripheral blood lymphocytes of the proband and available members in the GEFS+ families. The phenotypes of the affected members were analyzed. Illumina HiSeq 2000 series of high throughput sequencing screening for all epilepsy related genes in children. the gene locus of the mutant gene was verified by other members of the family when the suspected mutant gene was found. Results Nine members affected in three families. Their phenotypes included 3 cases of febrile seizures (FS), 3 cases of febrile seizures plus (FS+), 2 cases of afebrile generalized onic-clonic seizures (AGTCS). One case of childhood absence epilepsy with FS+. The family was found with SCN5A and ABCC6 mutations, including exon 28 mutations (c.2592G>A) of SCN5A and exon 10 Shear site variation(c.1338+1G>A) of ABCC6. The unaffected grandfather had the mutation of SCN5A gene, and the affected grandmother had the mutation of ABCC6 gene. Conclusion One unreported suspected pathogenic gene, ABCC6, is found in this study, and we did not find the gene mutation of which had been reported. GEFS+ is a polygenic hereditary disease. Genetic mechanism is complex in GEFS+ families that needs further research.
Relationship between fQRS before emergency PCI and severity of STEMI and postoperative MACE
LIU Ri, WANG Yong-shun
2019, 17(7): 1128-1131. doi: 10.16766/j.cnki.issn.1674-4152.000881
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Objective To investigate the value of preoperative fragmented QRS (fQRS) in prediction of the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods A total of 100 patients with STEMI who underwent electrocardiogram (ECG) examination and emergency PCI in the hospital from April 2013 to May 2017 were enrolled in the study. Routine 12-lead dynamic ECG detection was performed before surgery and at 2 hours after surgery. According to the presence of fQRS on preoperative ECG, the patients were divided into fQRS group (42 cases) and nfQRS group (58 cases). The clinical data, laboratory parameters and ECG indicators were compared between the two groups. All patients were followed up for at least 1 year. The incidence of major adverse cardiac events (MACE) was recorded and statistical analysis was performed with occurrence of MACE as poor prognosis. Results Compared with the nfQRS group, the peaks of troponin (cTnI) and creatine kinase isoenzyme (CK-MB) were significantly higher in fQRS group. The preoperative QRS interval was significantly longer, the postoperative ST segment elevation was significantly greater, and ST segment drop rate was significantly lower (P<0.05). The incidence of MACE in fQRS group during 1-year follow-up after PCI was significantly higher than that in nfQRS group (40.48% vs. 13.79%), and the MACE free survival curve of fQRS group was lower than that of nfQRS group (P<0.05). Cox risk regression analysis showed that preoperative QRS interval, postoperative ST segment elevation, postoperative ST segment drop rate and fQRS were independent risk factors for poor prognosis (P<0.05). Conclusion The presence of fQRS before emergency PCI may indicate that patients with STEMI are seriously ill, which is closely related to postoperative MACE and can be used to predict the prognosis of patients.
Clinical efficacy of candesartan combined with hydrochlorothiazide for moderate to severe hypertension
WANG Qing-fei, GAO Jia-rong, ZHANG Pei
2019, 17(7): 1132-1134. doi: 10.16766/j.cnki.issn.1674-4152.000882
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Objective To analyze the effects of Candesartan or Benazepril combined with Hydrochlorothiazide in the treatment of moderate to severe hypertension. Methods Eighty-six patients with moderate to hypertension who were treated in the Second Affiliated Hospital of Bengbu Medical College between June 2016 and July 2018 were enrolled in the study, and were randomly divided into a study group (n=43) and a control group (n=43) according to the random number table. The control group was treated with Benazepril (Specification: 10 mg*10 s, starting dose of 5mg each time, once a day) combined with Hydrochlorothiazide (Specification: 25 mg*100 s, once a day, 25 mg each time). The study group was given Dexartan (Specification: 4 mg*14 tablets, once a day, 8 mg each time) combined with Hydrochlorothiazide for treatment. The blood pressure, blood potassium and renal function, and adverse reactions were observed and compared between the two groups. Results Before treatment, there was no significant difference in blood pressure between the two groups (P>0.05). After treatment, both diastolic blood pressure and systolic blood pressure were improved in the two groups(P<0.05), with the diastolic blood pressure and systolic blood pressure in the study group, which were(77.42±8.53) mm Hg and (121.31±15.84) mm Hg, significantly better than the control group (P<0.05). The level of uric acid in the study group was (368.46±98.79) μmol/L, lower than that in the control group, which was (412.36±102.14) μmol/L, and the difference was statistically significant (P<0.05). The incidence of adverse reactions such as hypokalemia and headache in the study group was 6.98%, significantly lower than that in the control group, which was 23.26%, and the difference was statistically significant (P<0.05). Conclusion Compared with Benazepril combined with Hydrochlorothiazide, Candesartan combined with Hydrochlorothiazide is more effective in the treatment of moderate to severe hypertension, which can significantly control the blood pressure level, protect renal function, and yet incur less adverse reactions.
The effects of continuous blood purification on inflammatory factors and immune function in elderly patients with renal failure and systemic inflammatory response syndrome
CHEN Tian-tian, CHEN Yi
2019, 17(7): 1135-1137. doi: 10.16766/j.cnki.issn.1674-4152.000883
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Objective To analyze the effect of continuous blood purification (CBP) on inflammatory factors and immune function in elderly patients with acute renal failure (ARF) and systemic inflammatory response syndrome (SIRS), and to provide reference for improving the treatment of elderly patients with ARF and SIRS. Methods From March 2017 to June 2018, 78 elderly patients with ARF and SIRS were divided into 2 groups, experimental group, 40 cases were given CBP therapy, and control group, 38 cases were given routine treatment. Inflammatory factors, immune function before and after treatment, hospital mortality and average hospitalization days were evaluated. SPSS 20.0 statistical software was used to statistical analysis. Results On the third day after treatment, the levels of IL-6, IL-8 and TNF-α in the two groups were lower than those before treatment (P<0.05), and the experimental group were lower than those in the control group (P<0.05). On the third day after treatment, the ratio of CD4+ and CD4+/CD8+ increased (P<0.05) and CD8+ decreased (P<0.05) in the experimental group, and the ratio of CD4+and CD4+/CD8+ in the experimental group was higher than that in the control group (P<0.05), while the ratio of CD8+ was lower than that in the control group (P<0.05). The mortality rate in the control group was higher than that in the experimental group (P<0.05), but there was no significant difference in the average length of stay between the two groups (P>0.05). Conclusion On the basis of routine treatment, CBP has a positive effect on reducing inflammatory factors, improving immune function in elderly patients with ARF and SIRS.
Correlation research between serum hs-CRP, Hcy, UA and carotid atherosclerosis of patients with essential hypertension
GE Jun, WANG Chao-hui, XUAN Ling
2019, 17(7): 1138-1141. doi: 10.16766/j.cnki.issn.1674-4152.000884
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Objective To investigate the correlation between serum hs-CRP, Hcy, UA and carotid atherosclerosis in patients with hypertension. Methods Total 120 patients with hypertensive in our hospital from January 2015 to August 2017 were selected as research object and divided into carotid atherosclerosis group (60 cases, IMT>0.9 mm) and normal group (60 cases, IMT≤0.9 mm) according to carotid artery intima-media thickness (IMT). The carotid atherosclerosis group was divided into intimal thickening group (30 cases, 0.9 mm Results The blood glucose, TG, TC, HDL and LDL levels of carotid atherosclerosis group were not significantly different compared with those of normal group (P>0.05). The hs-CRP, Hcy, UA levels of carotid atherosclerosis group were significantly higher than those of normal group (P<0.05).The levels of hs-CRP, Hcy and UA in intimal thickening group were significantly lower than those of intimal plaque group (P<0.05). The hs-CRP, Hcy and UA levels of intimal stable plaque group were significantly lower than those of intimal unstable plaque group (P<0.05). Conclusion Serum hs-CRP, Hcy and UA levels could reflect the carotid atherosclerosis severity of patients with hypertension. The higher the serum hs-CRP, Hcy and UA levels, the severer carotid atherosclerosis in patients. The three indexes have predictive value on the hypertensive neck.
Clinical observation of Xinmaitong capsule combined with atorvastatin calcium tablet in the treatment of hypertension with elevated plasma lipoprotein phospholipase A2
QI Xing-ping, ZHOU Li-min, YUAN Xian-zhuo, YAO Dong-mei
2019, 17(7): 1142-1145. doi: 10.16766/j.cnki.issn.1674-4152.000885
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Objective To analyze the efficacy and safety of Xinmaitong capsule combined with Atorvastatin calcium tablets in the treatment of hypertension with elevated plasma lipoprotein-associated phospholipase A2 (Lp-PLA2), and to provide a new method for the treatment of hypertension with elevated plasma Lp-PLA2. Methods Total 126 cases of hypertension with elevated plasma Lp-PLA2 in our hospital between January 2017 and June 2018 were enrolled into this study and randomly divided into experimental group and control group, with 63 cases in each group. In the experimental group, the patients received Xinmaitong capsules (3 pills every time, tid.) and Atorvastatin calcium tablets (10 mg/time, qd.); in the control group, the patients were given Atorvastatin calcium tablets (10 mg/time, qd.). After 8 weeks of treatment, the values of Lp-PLA2, low density lipoprotein cholesterol (LDL-C) and arteriosclerosis in the two groups were determined, and adverse drug reactions were recorded. SPSS 20.0 statistical software was used to analyze the data. Results The levels of Lp-PLA2, LDL-C and atherosclerosis in the experimental group and the control group decreased at week 8 after treatment compared with those before the treatment, especially in the experimental group, the difference was statistically significant (all P<0.05), while the rates of adverse drug reactions in both groups were not statistically significant (P>0.05). Conclusion The Lp-PLA2, LDL-C and atherosclerosis index of patients with hypertension can be significantly improved by Xinmai tong capsule combined with Atorvastatin calcium tablets, without obvious increase in the incidence of adverse reactions.
Therapeutic effect of recombinant human growth hormone on the growth hormone deficiency in children with different bone age
LIN Yang, JIANG Shi-suo, PAN Jia-hua, YE Shan-dong
2019, 17(7): 1146-1149. doi: 10.16766/j.cnki.issn.1674-4152.000886
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Objective The effectiveness of recombinant human growth hormone (rhGH) in the treatment of dwarf disease has been widely verified. The bone age, treatment course and dose can affect the therapeutic effect of rhGH. The purpose of this study was to investigate the effect of rhGH on children with growth hormone deficiency (GHD) and to observe the effect of bone age at the beginning of treatment on the efficacy of rhGH. Methods Total 42 cases of prepubertal GHD children admitted to Department of Pediatrics of Anhui Provincial Hospital from August 2012 to August 2017 were divided into two groups according to bone age, 23 cases of bone age<8 years old (<8 y group) and 19 cases of bone age older than or equal to 8 years old (≥8 y group). They accepted 6-month treatment of rhGH (0.1 IU·kg-1·d-1). The height, growth velocity (GV), height-standard deviation score (HtSDS) were compared before and after the treatment. △GV and △HtSDS were compared between the two groups after the therapy. The paired t test was used to compare the difference between the two groups before and after the treatment. The independent sample t test was used in the comparison between the two groups, and the correlation analysis between the two variables was performed by Pearson correlation analysis. Results After 6 months of treatment, the height, GV, HtSDS were improved in both groups (P<0.05). The △GV and △HtSDS in the <8 y group were (6.17±1.44) cm/y and 0.50±0.13, while in ≥8 y group were (5.28±0.69)cm/y and 0.23±0.17, respectively. There were significant differences between the two groups (P<0.05). Meanwhile, △GV and △HtSDS were negatively related with the chronological age and bone age at the beginning of treatment. Conclusion The effect of rhGH on GHD is certain, furthermore, the smaller the bone age at the beginning of treatment, the better the effect.
Evaluation of the efficacy and safety of patient-controlled intravenous analgesia with remifentanil during labor
XU Ya-xiong, CAO Jing, YING Xiao-yan
2019, 17(7): 1150-1153,1248. doi: 10.16766/j.cnki.issn.1674-4152.000887
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Objective This paper evaluates the efficacy and safety of patient-controlled analgesia (PCA) with remifentanil during labor. Methods From February 2017 to March 2018, a total of 201 cases of parturients who delivered in Second Affiliated Hospital of Nanjing Medical University and Nanjing Medical University Sir Run Run Hospital were enrolled as subjects. According to the analgesic techniques, the 201 parturients were divided into the PCIA Group (n=110), the Epidural Anesthesia Group (n=35) and the Control Group (n=56). The parameters include pain scale of parturients, which is the scale of the Chinese version of the Short Form-McGill Pain Questionnaire (SF-MPQ), side effects, the vital signs during labor, rate of caesarean section, the newborns' one-minute and five-minute Apgar Score, and the DST result of newborns' at infancy stage. Results In comparison to the Control Group, there was a significant decrease of pain scores both in the Remifentanil Group and the Epidural Group(all P<0.05), but with higher pain scores in the Remifentanil Group. After the administration of the medication, subjects in both the Remifentanil group and the Epidural group experienced lowering in blood pressure, especially those in the Epidural group, and the difference was statistically significant (all P<0.05). Since epidural analgesia is more effective in pain relief than remifentanil, its administration is more effective in decreasing the risk of pain-induced hypertension during labor. But Epidural analgesia could extend the duration of the second stage of the labor. Compared with the PCIA Group and the control group, The duration in the Epidural Group is statistically significantly longer (all P<0.05). The incidence of side effects in Epidural Group was far higher than that in the other two groups, and the difference was statistically different(all P<0.05).There was no significant difference in the vital signs, the cesarean section rate, and forceps delivery rate among all three groups. There was no significant in the 1min Apgar score and 5min Apgar score of the newborns(all P>0.05) among all three groups. In addition, there was no significant difference in the newborns' the DST result(all P>0.05). Conclusion Compared to epidural anesthesia, which has more advanced analgesic effect, the patient-controlled intravenous analgesia with remifentanil, as a new analgesic technique, is still an effective and safe procedure which significantly relieves pain, has less impact on the duration of the second stage of labor, has less side effects on the parturients, and is simple to operate.
Effect of vitamin A and E levels on preeclampsia pregnancy outcome
WANG Lu, HUANG Li
2019, 17(7): 1154-1156. doi: 10.16766/j.cnki.issn.1674-4152.000888
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Objective To investigate the effects of different vitamin A and E levels on pregnancy outcome in pregnant women with preeclampsia. Methods One hundred and twenty cases of preeclampsia pregnant women admitted to our hospital from March 2017 to March 2018 in Ukrainian Maternal and Child Health Hospital Obstetrics and Gynecology were selected as experimental subjects. The serum vitamin A and E levels were determined according to their 12-20 weeks. Vitamin A and E were normal. 30 patients in the group (control group), 30 patients with normal vitamin/E deficiency (observation group a), 30 patients with vitamin A deficiency/E normal group (observed group b), and 30 patients with abnormal vitamin A and E (observation group), comparing the preterm birth rate, induction rate, stillbirth and neonatal asphyxia in 4 groups of pregnant women. Results The preterm birth rate of the observation group was higher than that of the other 3 groups. The induction/abortion rate was slightly higher than that of the observation group a, the observation group b and the control group (all P>0.05). The neonatal asphyxia rate in the observation group was significantly higher than that in the other 3 groups. The significance of learning (all P<0.05); 6 cases (20.00%) of postpartum hemorrhage in the control group, 11 cases (36.67%) in group a, 13 cases (43.33%) in group b, and 17 cases (56.67%) in observation group, observed The bleeding volume of the patients in the group was higher than that in the other 3 groups. The average blood loss of the group a and the b group was not significantly different from that of the control group. The neonatal Apgar score control group was higher than the other 3 groups. Conclusion Serum vitamin A and E levels in patients with preeclampsia have a greater impact on pregnancy outcomes. Pregnant women with normal vitamin levels have higher maternal and child safety.
Analysis of risk factors related to the prognosis of inhaled nitric oxide in persistent pulmonary hypertension of newborn
DING Dan, WANG Shi-jie, PAN Jia-hua
2019, 17(7): 1157-1160. doi: 10.16766/j.cnki.issn.1674-4152.000889
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Objective To investigate the risk factors and preventative measures for inhaled nitric oxide in persistent pulmonary hypertension of newborn (PPHN). Methods A retrospective study was conducted at the neonatal department of the Anqing Municipal Hospital in 42 infants with persistent pulmonary hypertension treated by inhaled nitric oxide from August 2014 to October 2018. They were divided into two groups, namely 27 patients with good prognosis and 15 patients with poor prognosis according to the prognosis of patients. Analysis of factors including gender, birth weight, gestational age, delivery way, amniotic fluid pollution, history of suffocation, fetal distress, use of pulmonary surfactant and complications, immediate arterial blood for neonatal asphyxia(the pH value, the BE value, PaO2, PaCO2), blood sugar level, blood calcium, age of mother, pulmonary artery wedge pressure, time of mechanical ventilation, and time of inhaled nitric oxide, etc. The data were compared by univariate and multivariate logistic regression analysis. Results Univariate analysis showed that preterm delivery, fetal distress, weight, time of mechanical ventilation, time of inhaled nitric oxide, use of pulmonary surfactant and complications were the risk factors (P<0.05). Logistic regression analysis showed that preterm delivery, time of inhaled nitric oxide, complications and use of pulmonary surfactant were the main risk factors. Conclusion Patients with premature delivery, time of inhaled nitric oxide and complications with persistent pulmonary arterial hypertension were treated by inhaled NO had poor outcomes. The application of pulmonary surfactant can improve the outcome .
Observe on the clinical effect of Qianzhi capsule combined with Gynecological Qianjin capsule on the treatment of abnormal vaginal bleeding after IUD implantation
WU Lan-lan, WANG Zhi-ying
2019, 17(7): 1161-1163. doi: 10.16766/j.cnki.issn.1674-4152.000890
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Objective To observe on the clinical effect of Qianzhi capsule combined with Gynecological Qianjin capsule on the treatment of abnormal vaginal bleeding after IUD implantation. Methods A total of 135 patients with abnormal vaginal bleeding after IUD implantation were researched from February 2016 to February 2018. All the patients were divided into the control group(n=45), the study group 1(n=45) and the study group 2(n=45). The control group were not given medication. The study group 1 were given Gongxuening capsule orally. The study group 2 were given Qianzhi capsule and Gynecological Qianjin capsule orally. The levels of hemoglobin and serum TNF-α, IL-6 and IL-8 were compared between the different groups before and after treatment. The adverse drug reactions during treatment were recorded and the improvement of abnormal vaginal bleeding and the removal of IUD were observed. Results The serum levels of TNF-α, IL-6 and IL-8 in study group 2 were significantly lower than those in study group 1 and control group after treatment (P<0.05). The level of hemoglobin in study group 2 was significantly higher than those in study group 1 and control group after treatment (P<0.05). After treatment, the duration of menstruation was significantly shorter than those of study group 1 and control group, and the amount of menstrual bleeding was significantly less than those of study group 2 and control group (P<0.05). The improvement rates of abnormal vaginal bleeding (100.00% and 97.78%) in study group 1 and study group 2 were significantly higher than that in control group (80.00%), P<0.05, and the removal rate of IUD (0.00% and 2.22%) was significantly lower than that in control group (20.00%), P<0.05. There was no significant difference in the overall incidence of adverse drug reactions among the groups (P>0.05). Conclusion Qianzhi capsule combined with Gynecological Qianjin capsule can significantly reduce the intensity of inflammation in patients with abnormal vaginal bleeding after IUD implantation, increase the content of hemoglobin, shorten the improvement cycle of abnormal vaginal bleeding symptoms, improve the continuation rate of patients with IUD, and do not increase adverse drug reactions.
Analysis of factors influencing community diabetic patients on the compliance of tiered medical services
WANG Su-ping, MA Jia-li, ZHU Wei-jun, GONG Rui-jie, MA Jin, NI Yang
2019, 17(7): 1164-1166,1221. doi: 10.16766/j.cnki.issn.1674-4152.000891
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Objective From demographic factors and self-awareness level, this paper analyzed the influencing factors of the compliance of community patients with type 2 diabetes in tiered medical services, taking diabetes as an example, and explored effective measures to improve the tiered medical services of chronic diseases in China. Methods Convenient sampling was used to conduct a questionnaire survey on type 2 diabetic patients who met the inclusion criteria in four community health service centers in Qingpu District, Xuhui District and Fengxian District of Shanghai. T-test, one-way ANOVA and Pearson correlation analysis were used to analyze the factors affecting the patients' compliance with tiered medical services. Finally, a multivariate hierarchical regression model was established. Results In this study, 536 questionnaires were collected, with a recovery rate of 92.41%, of which 518 were valid, with an effective rate of 96.64%. Among the valid questionnaires collected, the elderly were the main ones, with an average age of (70.41±10.37) years. There were 42.1% of the respondents had had diabetes more than 10 years, and 73.0% of them had signed a family doctor. Univariate analysis showed that the course of the disease, whether to sign a family doctor and severity of illness were related to the compliance of diabetic patients with tiered medical services. The correlation analysis showed that self-efficacy, self-judgment and cognitive level of tiered medical services were the factors influencing the compliance of diabetic patients with tiered medical services. Multivariate regression model showed that age, insulin using, self-efficacy and cognitive level of tiered medical services were the main factors predicting patient compliance. Specifically, the older the patients were, the less insulin they were suitable, the higher their self-efficacy, and the higher their cognitive level of tiered medical services, the better their compliance with tiered medical services. Conclusion The compliance of community type 2 diabetic patients with tiered medical services is still acceptable. In order to improve the compliance, we should respect the wishes of the masses, actively publicize and guide, deepen inter-agency cooperation, clarify the referral criteria, improve grass-roots service ability and train excellent general practitioners.
Evaluation on community internship of clinical medicine undergraduates from general practitioner trainers' perspectives
XU Xiao-jing-yuan, LIU Ying-jie, JIANG Ai-feng, WANG Mei-rong, CHEN Xiao-lei, DU Juan
2019, 17(7): 1167-1170. doi: 10.16766/j.cnki.issn.1674-4152.000892
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Objective To investigate the status quo and problems in community internship of clinical medicine undergraduates and to provide suggestions for the internship. Methods From June to November, 2016, a questionnaire survey and personal in-depth interview were conducted among the general practitioner (GP) trainers who undertook community internship teaching of clinical medical undergraduates entered Capital Medical University in 2011. Understanding of community internship syllabus, teaching plan formulating, teaching contents, teaching methods and the difficulties in teaching were investigated by questionnaire. The results were analyzed by descriptive statistics. The personal in-depth interviews focused on the problems in community internship, the difficulties of teaching and the suggestions for community internship. Content analysis was used to analyze the interview materials. Results A total of 79 questionnaires were sent out and 72 valid questionnaires were returned. It showed that 70.8% of the GP trainers who participated in the survey understood the syllabus of community internship, 84.7% of them had a teaching plan, and 54.2% of them considered that the time arrangement of the internship was reasonable. The most common teaching contents were chronic disease management, health records establishment, medical history taking and filling medical records. The most frequently used teaching method was demonstrating method while role-playing was the least. The most serious problem in the teaching process was the lack of detailed community internship teaching manual. The 12 GP trainers who participated in the personal in-depth interview thought the time arrangement for community internship was inappropriate, the community teaching work was lack of training and evaluation system, the GP trainers needed a detailed teaching manual for community internship, and incentive mechanism for the GP trainers participated in teaching needed to be established. Conclusion Colleges should attach importance to the community internship of clinical medical undergraduates, put the time of entering community forward and extend the length of the internship, and carry out teaching ability training for GP trainers with community institutions. At the same time, community health institution can reward and assess GP trainers' teaching work through appropriate forms to ensure the teaching level of GP trainers.
The correlational study between childhood trauma and self-stigma in depression
XIE Jun, GENG Feng, DONG Yi, ZHOU Shan-shan
2019, 17(7): 1171-1173. doi: 10.16766/j.cnki.issn.1674-4152.000893
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Objective To investigate the characteristic of childhood trauma in depression,and to explore the relationship between childhood trauma and self-stigma in depression. Methods A total of 171 patients with depression in accordance with ICD-10 diagnostic criteria were assessed with Childhood Trauma Questionnaire (CTQ), Stigma Scale for Mental Illness (SSMI-C) and Beck Depression Inventory (BDI). A total of 200 healthy controls were assessed with CTQ. Results ① Compared with health controls, the depression group showed significantly higher total score and all dimensional scores of CTQ (P<0.05). ② The scores of emotional abuse of CTQ were significantly correlated with onset age of depression patients (r=-0.243, P<0.05). ③ Correlation analysis indicated that the total score and the scores of three factors of SSMI-C among depression patients were significantly positively correlated with BDI scores (r=0.246-0.603, all P<0.05), also the scores of EN, PN and total score of CTQ were significantly positively correlated with BDI scores (r=0.424-0.453, all P<0.01). ④ The scores of PA, EN, PE and total score of CTQ in depression patients were positively correlated with the discrimination factor, positive effect factor and total score of SSMI-C (r=0.261-0.413, all P<0.05). Conclusion Depression patients may have more childhood trauma experiences than healthy people, and the experiences will have negative effect on self-stigma of depression.
Quantitative evaluation of intravoxel incoherent motion diffusion-weighted imaging in proliferation of brain gliomas
SUN Man-yi, DONG Hai-bo
2019, 17(7): 1174-1177. doi: 10.16766/j.cnki.issn.1674-4152.000894
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Objective To investigate the value of quantitative parameters derived from intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) in proliferation (Ki-67LI) of brain gliomas. Methods A retrospective analysis of 42 cases of gliomas confirmed by surgical pathology from December 2016 to June 2018 were performed. All patients underwent conventional magnetic resonance imaging (MRI) and IVIM-DWI before operation, then measured the true water diffusion coefficient (D),microcirculation perfusion coefficient (D*) and perfusion fraction (f) in the tumor solid area. Spearman' s correlation was used to analyze the correlation between the quantitative parameters and Ki-67LI. Those parameters and the Ki-67LI were compared between the low- and high- grade gliomas with Mann-Whitney U test. The ROC curve was used to assess the diagnostic efficacy of parameters in the grading assessment of gliomas. Results There was a moderate negative correlation between D, f and Ki-67LI(r=-0.514, -0.462, P<0.05). There was no significant correlation between D* and Ki-67LI (P=0.573). The D and f of the high-grade gliomas were lower than those of the low-grade gliomas， whereas D* and Ki-67LI were higher (P<0.05). The area under the curve (AUC) for identifying high- and low-grade gliomas by D, D* and f was 0.963, 0.745, and 0.841, respectively (P<0.05). Conclusion D and f can be used for quantitative prediction of proliferation. IVIM-DWI is helpful in the grading assessment of gliomas, and the diagnostic efficiency of D is the highest.
The diagnostic value of combined detection of NO, ET-1 and Hcy in coronary heart disease
ZOU Yun-fa, YU Wen-hua, XU Li-jun, QIU Xiu-jun, ZHENG Zhe, WEI Wei
2019, 17(7): 1178-1180. doi: 10.16766/j.cnki.issn.1674-4152.000895
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Objective To investigate the diagnostic value of nitric oxide (NO), endothelin-1 (ET-1) and homocysteine (Hcy) combined detection in coronary heart disease. Methods A total of 232 coronary heart disease patients as observation group were selected from March 2017 to September 2017 in our hospital, and 128 healthy subjects as control group. The levels of NO, ET-1 and Hcy in the two groups were compared. The detection value of NO, ET-1, Hcy and combined detection of NO, ET-1 and Hcy to coronary heart disease were compared by using the area (AUC) under the receiver operator characteristics curve (ROC). The univariate analysis and logistic regression analysis were used to analyzed risk factors affecting coronary heart disease. Results The level of NO in the observation group was significantly lower than that in the control group, but the level of ET-1 and Hcy in the observation group was significantly higher than those in the control group (all P<0.05). The AUC value of combined detection is significantly higher than the AUC value of NO, ET-1 and Hcy alone (all P<0.05). The incidence of hypertension, diabetes, dyslipidemia, smoking and obesity in the observation group was significantly higher than that in the control group (all P<0.05). Whether as the coronary heart disease as dependent variable, the high blood pressure, diabetes, dyslipidemia, smoking, obesity and ET-1, Hcy, NO as independent variables, multivariable logistic regression analysis, the results showed that the factors in addition to hypertension, dyslipidemia, smoking, obesity, ET-1, Hcy, NO also could be used as evaluating a risk factor for coronary heart disease (all P<0.05), and the correlation strength with coronary heart disease from high to low is ET-1, Hcy, NO. Conclusion The combined detection of NO, ET-1 and Hcy can effectively diagnose the occurrence of coronary heart disease, and it can be used as an effective indicator of the risk of coronary heart disease attack.
Research progress on the correlation between circRNAs and tumors
ZHENG Yuan-yuan, LI Wei, CHEN Yu-qing
2019, 17(7): 1181-1185. doi: 10.16766/j.cnki.issn.1674-4152.000896
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Circular RNA (circRNA) is a novel non-coding RNA with unique characteristics. It is a closed circular molecule formed by a covalent bond without 5' end cap and 3' end tail. CircRNA has certain stability due to its resistance to exonuclease. It is widely expressed in mammals, and express differently in diverse tissues and development stages. CircRNA has become a research hotspot in recent years due to its special characteristics. At present, a large number of studies have found that circRNA is involved in cell senescence, proliferation, apoptosis, inflammation and other pathophysiological processes, and plays an important role in the occurrence and development of a variety of diseases. Of course, circRNA in tumor research is also starting. Many researches have confirmed that the expression levels of circRNA in tumor tissues and adjacent normal tissues are significantly different, and the relevant circRNA expression levels are correlated with the malignancy and invasiveness of tumor cells. Currently, most studies have confirmed that circRNA has the response element of miRNA, which can be used to adsorb the related miRNA like a sponge through the principle of complementary base pairing, so as to regulate the expression of downstream genes. Especially in various tumors, the mechanism of sponge-like action has been increasingly mature. In addition, circRNA can also be translated into protein or polypeptide to regulate gene expression. The mechanism of circRNA is complex and diverse, and its specific molecular mechanism has become the research direction of many scientific researchers. CircRNA is not only expressed specifically in tissues, but also in plasma and exosomes, and the expression levels are different, which further confirmed that circRNA can be used as a potential biomarker. In this paper, a large number of literatures were reviewed to briefly review the biological characteristics and mechanism of circRNA and its research progress and application value in various tumor diseases.
Advances in research on cardiovascular diseases in patients with rheumatic diseases
SHANG Li-min, ZHOU Zi-hui, LIU Ping, GUO Zheng-xin, HAN Guang-ming
2019, 17(7): 1186-1190. doi: 10.16766/j.cnki.issn.1674-4152.000897
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Rheumatic diseases are a group of chronic diseases that mainly affect joints, tendons, ligaments, bones and muscle tissues. These diseases can become an important public health problem because they can lead to physical disability. Although the mortality of patients with rheumatic diseases has decreased significantly over the past few decades due to early diagnosis and active and effective treatment, the mortality of patients with rheumatic diseases is still high compared with the normal population. Epidemiological evidence supports a higher mortality may be attributed to higher comorbidity in patients with rheumatic diseases, especially cardiovascular complications such as ischemic heart disease, heart valve disease, cardiomyopathy, pericardial disease and abnormalities in the heart conduction system. Although the mechanism of cardiovascular disease in patients with rheumatic diseases is not fully understood, the risk factors of traditional cardiovascular diseases such as smoking, lack of exercise, high blood pressure, high blood fat, high blood sugar, and persistent chronic inflammation in patients with rheumatic diseases, and side effects of drugs, such as long-term use of glucocorticoids, may be the main cause of cardiovascular diseases in patients with rheumatic diseases. Rheumatic diseases increase the risk of cardiovascular diseases, which is the leading cause of death in patients with rheumatic diseases. Therefore, it is very important to effectively prevent and treat cardiovascular complications. Understanding the comorbid condition of cardiovascular diseases in patients with rheumatic diseases can better help patients to prevent these complications, prolong life and improve their quality of life. Here, we mainly review the common comorbidity of cardiovascular diseases in patients with rheumatic diseases in recent years and the research progress of the pathogenesis and preventive treatment of these comorbid conditions.
Efficacy of self-made traditional Chinese medicine decoction on the clinical symptoms and inflammatory reaction in patients with low level perianal abscess in an early stage
LI Qian-yuan, ZHOU Xiu-kou, FANG Zheng-yu
2019, 17(7): 1191-1193,1217. doi: 10.16766/j.cnki.issn.1674-4152.000898
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Objective To treat the early low perianal abscess patients with self-made traditional Chinese medicine decoction, observe the signs score and the levels of inflammatory cytokine before and after the treatment, and explore the clinical effect of self-made traditional Chinese medicine decoction in the treatment of early low perianal abscess, so as to provide a new choice for clinical treatment. Methods A total of 120 cases of early low perianal abscess in our hospital between October 2013 and October 2018 were selected and divided into observation group (n=63) and control group (n=57) according to the different treatment methods. The patients in the control group took orally 0.2 g of levofloxacin and metronidazole, three times a day, while the patients in the observation group took orally self-made traditional Chinese medicine decoction on the basis of the control group, and one dose of self-made traditional Chinese medicine decoction a day. All patients were treated for 14 days. The clinical effect, the symptoms and signs score of two groups were compared before and after the treatment. And the levels of high sensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) and prostaglandin E2 (PGE2) were detected by enzyme-linked immunosorbent assay before and after the treatment. Results The clinical effect in the observation group was significantly higher than that in the control group (P<0.05); After the treatment, the scores of anal pain, general symptom, tumor size and texture in both groups were significantly lower than those before the treatment (P<0.05), and the observation group were significantly lower than those of control group (P<0.05); The levels of TNF-α, PGE2 and hs-CRP in both groups were significantly lower than those before the treatment (P<0.05), and the observation group were significantly lower than those of control group (P<0.05), the level of IL-10 in both groups was significantly higher than that before treatment (P<0.05), and the observation group was significantly higher than that of control group (P<0.05). Conclusion The self-made traditional Chinese medicine decoction for early low perianal abscess has remarkable clinical effect, which can effectively improve the symptoms and signs of patients and reduce the inflammatory response.
Efficacy of Yishen Huoxue decoction combined with electroacupuncture on memory dysfunction after cerebral infarction
GAO Qing-yuan, CHEN Xiao-cheng, ZOU Wei-bing, CAI Xue-li
2019, 17(7): 1194-1197. doi: 10.16766/j.cnki.issn.1674-4152.000899
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Objective To investigate the efficacy of Yishen Huoxue decoction combined with electroacupuncture on memory dysfunction after cerebral infarction. Methods According to the digital table method, 84 patients with memory dysfunction after cerebral infarction were divided into control group (42 cases) treated with routine western medicine and donepezil, and combined group (42 cases) treated with Yishen Huoxue Decoction combined with electro-acupuncture on the basis of control group. The differences between TCM syndrome scores, memory scale score, memory quotient, serum MDA, SOD level, mean blood flow velocity of cerebral arteries, clinical efficacy and adverse reactions were compared between the two groups. Results The scores of TCM syndromes in the two groups were lower than those before treatment (all P<0.05), and the decrease in the combination group was more obvious than that in the control group (all P<0.05). After treatment, the scores, recognition, regeneration scores, total scores and memory quotient were significantly higher than those before treatment (all P<0.05). After treatment, the combined group was recorded, recognized, regenerated, counted 1-100, Back number, total score and memory quotient were higher than those before treatment, the difference was statistically significant (all P<0.05). In the combined group, the increase in the scores, recognition, regeneration, count 1-100, back number, total score and memory quotient was more significant than those in the control group (all P<0.05). The levels of MDA and SOD in the two groups were significantly different from those before treatment (all P<0.05). The difference in the changes after treatment in the combined group was more significant than that in the control group (all P<0.05). The blood flow velocity of MCA, ACA, PCA and BA in the combined group were significantly faster than those in the control group (all P<0.05). The clinical effective rate (92.86%) in the combined group was significantly better than that in the control group (71.43%). Conclusion Yishen Huoxue decoction combined with electroacupuncture is a safe and effective treatment for memory dysfunction after cerebral infarction.
Application of role playing in clinical teaching of cardiology in general practice
XUAN Ling, TANG Bi, ZHANG Heng, SHEN Hui, KANG Pin-fang, LI Miao-nan, WU Shi-li, LIANG Bing
2019, 17(7): 1198-1200. doi: 10.16766/j.cnki.issn.1674-4152.000900
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Objective General practice is a new comprehensive medical clinical discipline with human as the main body. General practitioners are the main body providing general medical services. General practice education is mainly to train compound talents who master basic medical knowledge and clinical skills. Clinical teaching is the continuation of basic medical teaching, is an indispensable part of general practice teaching. This paper makes a preliminary exploration on the application of role-playing in clinical teaching of cardiology in general practice specialty, so as to provide references for future teaching. Methods A total of 100 students majoring in general practice were randomly divided into 50 students in the experimental group and 50 students in the control group. Students in the experimental group used role playing method in clinical teaching, while students in the control group used conventional teaching method. The assessment method of this teaching mode is the evaluation of students' after-class examination results and the questionnaire survey. Results The scores of subjective questions and total scores in the experimental group were significantly higher than those in the control group (42.61±7.36 vs.37.86±6.72, 84.53±4.48 vs. 80.67±5.12, P<0.05). There was no significant difference between the objective test scores of the experimental group and the control group (P>0.05). The results of skill operation in the experimental group were significantly higher than those in the control group (46.18±3.26 vs. 42.38±5.02,P<0.05). The questionnaire survey showed that the experimental group was satisfied with role-playing teaching method in all aspects. Conclusion Role-playing method can stimulate students' learning initiative, create a good learning atmosphere, improve students' thinking ability and clinical skills, enhance the ability of teamwork and doctor-patient communication, which is a clinical teaching method suitable for general practice students and worth promoting in the future clinical teaching.
Investigation on the effect of nutritional intervention on patients with type 2 diabetes exercise therapy in outpatients
DONG Hai-yun, ZHANG Wen-yang, LU Wei
2019, 17(7): 1201-1203,1212. doi: 10.16766/j.cnki.issn.1674-4152.000901
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Objective To explore the influencing factors and effects of nutritional intervention on type 2 diabetes mellitus combined with exercise therapy. Methods From October 2014 to October 2016, 105 patients who met the inclusion criteria in the Ruijin Hospital Endocrine Clinic were randomly divided into the experimental group (53 cases) and the control group (52 cases). The control group received routine treatment with exercise therapy, and the experimental group underwent nutritional therapy intervention on the basis of the control group. After three years of intervention, fasting blood glucose, postprandial blood glucose, and glycated hemoglobin levels in each of the two groups were compared. The demographic indicators (gender, group, year, education, place of residence and course of disease) were used as independent variables. The multiple regression analysis was done using fasting blood glucose, postprandial blood glucose and glycosylated hemoglobin as dependent variables. Results The values of FBG, PBG and HbA1c in the experimental group and the control group were different in 2015 and 2016 compared with 2014 (P<0.001). From 2014 to 2016, the FBG, PBG and HbA1c of the experimental group were lower than those in the control group and had statistical significance (P<0.05). Multiple regression analysis showed that FBG, PBG and HbA1c were the influencing factors on gender, intervention, year, education, place of residence and age. The decline trend of blood glucose indicators in the experimental group was significantly higher than that in the control group, which proved that nutrition intervention for patients with type 2 diabetes exercise therapy can control blood glucose more effectively. Conclusion Good nursing nutrition intervention is an effective measure to control blood glucose index.
Relationship between lipid accumulation product and the risk of diabetes in adults of a region of Bengbu
SUN Liang-liang, XIE Hong, ZHANG Yan-fang, WANG Li-hua
2019, 17(7): 1204-1208. doi: 10.16766/j.cnki.issn.1674-4152.000902
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Objective To explore the relationship between lipid accumulation product (LAP) and the risk of diabetes in adults, and to compare the predictive value of various obesity indicators in diabetes. Methods A multi-stage stratified random sampling method was used to select 3 115 permanent residents aged 18 or above in Longzihu district of Bengbu city from July to August 2015, and questionnaire survey, physical examination and biochemical examination were conducted. (Kruskal-Wallis H) and unconditional logistics regression were used to investigate the relationship between LAP and various physical examination indices and the risk of diabetes. Receiver operating characteristics curve was used to evaluate the predictive value of various obesity indicators in diabetes. The best cut-off point of LAP in prediction of diabetes was determined by the maximum Youden index. Results There were significant differences in physical examination indices between different LAP groups (all P<0.001). Compared with the lowest tertile group, the OR (95% CI) for diabetes in the group with highest tertile LAP was 2.00 (1.38,2.89) in men, and 3.82 (2.46,5.93) in women, respectively. Receiver operating characteristics curve found that in men the area under curve (AUC) of LAP predicting the risk of diabetes was higher than other obesity indicators, but only had statistical significance compared with WHR(P<0.05). In women, the AUC of LAP predicting the risk of diabetes was significantly higher than other indicators (all P<0.05). The best cut-off point for LAP in predicting diabetes was 51.63 cm·mmol/L for men and 37.24 cm·mmol/L for women. Conclusion The elevated level of LAP is associated with an increased risk of diabetes. Compared with the traditional indicators, especially for women, LAP is a better obesity indicator reflecting the impact of obesity on diabetes.
Association of serum matrix metalloproteinase-13 levels and gene promoter -77A/G functional polymorphism with asymptomatic carotid stenosis
HU Xiao-fei, ZHU Xian-hua, LIU Peng, JIN Xiao-ping
2019, 17(7): 1209-1212. doi: 10.16766/j.cnki.issn.1674-4152.000903
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Objective To explore the association of serum matrix metalloproteinase-13 (MMP-13) levels and the gene promoter -77A/G functional polymorphism with asymptomatic carotid stenosis(ACS). Methods A total of 621 ACS patients in Taizhou Hospital from June 2015 to December 2017 were divided into stenosis group (n=117,stenosis≥50%) and the control group (n=504, stenosis<50%) according to carotid ultrasound examination. Serum MMP-13 levels were measured by enzyme linked immunosorbent assay, and MMP13-77A/G genotypes were determined by polymerase chain reaction-restriction fragment length polymorphim. Results The difference of serum MMP-13 levels between stenosis group and the control group were significant(P<0.01). The A allele frequency (MMP13-77A/G polymorphism) was higher in the stenosis group [OR=1.861; 95%CI(1.398-2.478)]. After adjustment for vascular risk factors binary logistic regression analysis showed that both AG and AA genotypes in stenosis group were significantly higher than those in the control group [AG:OR=1.833, 95% CI(1.108-3.033); AA:OR=3.197, 95%CI:1.777-5.792)]. Conclusion The serum level of MMP-13 and the gene-77A/G polymorphism are closely related to the risk of ACS with carotid stenosis≥50%, -77A allele may be a genetic predisposing factor for ACS.
Epidemiological characteristics of blood-borne occupational exposure among healthcare workers
LIU Zheng-hui, CUI Li-li, CUI Zhuo, ZHU Xia-yun, ZHU Jing-rui
2019, 17(7): 1213-1217. doi: 10.16766/j.cnki.issn.1674-4152.000904
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Objective To understand the current distribution of blood-borne occupational exposure among healthcare workers and analyze the risk factors and regular pattern of exposure, providing evidence for prevention and control measures. Methods According to the blood-borne pathogen occupational contact registration form filled out by nosocomial infection department workers from January 2014 to June 2018, the total cases who had blood-borne occupation exposure were investigated and verified by retrospective survey, and the statistical analysis was performed with the use of SPSS 20.0 software. Results A total of 234 cases of blood-borne occupational exposure occurred in the hospital. Among them, the proportion of under 30 years old was the highest (75.64%), and the working age less than 5 years was the largest (68.80%). The main personnel category was nurses (53.42%), followed by clinicians and practice nurses and exposure occurred in a wide range of departments, including the operating room (17.95%) and the emergency department (8.12%). Besides, needle stick injury was the mainly exposure method. In addition, the operation process was the main part of the exposure (38.03%), followed by the needle removal and disposal of the needle (32.05%). It was the main exposure reason that unskilled factors cause the improper operation and the rebound of infusion blood collection needle. The positive exposure accounted for 62.82%, and the hepatitis B was the most pathogen (49.57%), while the wearing rate of suitable protective equipment was only 36.32%. The actual preventive drug use rate after exposure was 80.77%. Conclusion It is of great significance to formulate targeted prevention and control measures according to the exposure characteristics, and strengthen occupational protection training to effectively prevent occupational exposure and reduce occupational injuries.
Intervention effect of new pharmaceutical care model on drug safety and compliance of patients
QIAN Hua, ZHU Ya-fang, WANG Jia-liang, LIU Xin-wen
2019, 17(7): 1218-1221. doi: 10.16766/j.cnki.issn.1674-4152.000905
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Objective To investigate the effect of the implementation of new pharmaceutical care model on drug use in patients. Methods From June to August 2018, 200 patients in Shaoxing Municipal Hospital were enrolled for clinical observation. Ages ranged from 18 to 75. Men and women were not limited. All patients were divided into Traditional Model Group and New Model Group according to random number table method. There were 100 cases in each group. There was no statistical difference in baseline data such as age, sex ratio and education level between the two groups (P>0.05). For the Traditional Model Group, clinical pharmaceutical care for patients is mainly based on the prescription content of doctors, dispensing drugs, auditing special prescriptions, guiding patients to follow doctor's instructions or use drugs correctly according to drug instructions, providing drug guidance for consulting patients, and carrying out pharmaceutical care for special patients in outpatient clinics. For the New Model Group, applying new pharmaceutical care mode to carry out clinical pharmaceutical care, the main content of which is not only traditional pharmaceutical care, such as dispensing drugs, dispensing drugs, but also requiring clinical drug noise to provide patients with clinical drug counseling and other pharmaceutical care. Comparison was made regarding to the drug compliance rate, the incidence of drug errors and adverse drug reactions between the two groups. Results The compliance rate of the observation group was 100.0%,which was significantly higher than that of the control group (92.0%, χ2=11.020,P=0.001). The incidence of drug errors in the observation group (2.0%) was significantly lower than that in the control group (9.0%, χ2=8.320, P=0.004). There was no significant difference in the incidence of adverse drug reactions between the observation group (11.0%) and the control group (28.0%, χ2=0.090, P=0.762). Conclusion The implementation of the new pharmaceutical care model can improve the drug compliance of patients and reduce the incidence of drug errors. It has a positive significance in clinical practice.
Cause analysis and removal strategy of difficult retrieve filters
CHEN Guang, SHEN Yang, CHEN Ya-hong, ZHAO Wen-jun
2019, 17(7): 1222-1224. doi: 10.16766/j.cnki.issn.1674-4152.000906
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Objective To study the causes of difficult retrievable inferior vena cava filter and its removal strategies. Methods A retrospective analysis was made of 405 DVT patients admitted to Taizhou Hospital of Zhejiang Province from January 2017 to October 2018. Among them, 232 cases underwent filter implantation in the simple filter implantation group, 173 cases were treated in the endovascular treatment group. One hundred and one cases in the filter implantation group and 160 cases in the endovascular treatment group underwent filter removal treatment. There were 30 cases with inferior vena cava filter implantation could not be successfully removed by conventional trap technique in these two groups. Ten cases with tilted filter or adherent filter, and 2 cases with thrombus captured were found in the simple filter implantation group. In the endovascular treatment group, 17 cases were found filter tilted or displaced and 1 case was found with thrombus captured in the filter. For patients captured thrombus in filter, catheter thrombolysis assisted with conventional trap technique and catheter suction assisted with conventional trap technique were used to remove filers. For the patients with tilted filter or adherent filter, catheter assisted with conventional trap technique and Ring-assisted stiff wire pulling hook end method were used to retrieve filters. Results One case was removed by catheter thrombolysis assisted with conventional trap technique, 2 cases by catheter suction assisted with conventional trap technique, 24 cases by catheter assisted with conventional trap technique, and 2 cases by Ring-assisted stiff wire pulling hook end method, 1 case with filter adhered severely to the vena cava could not remove the filter. Successfully retrieved 29 filters, the technical success rate was 96.7%. Conclusion Inclination, adherence and thrombus capture are the main causes for the difficulty of removal of inferior vena cava filters. The recovery rate can be improved by using various assistant trapping techniques.
Meta-analysis of chemical-mechanical oral decontamination techniques for dental caries
XUE Yi-zhuo, SONG Jing, ZHANG Wen-xin, HU Shuai, PENG Gan, MENG Xian-bin, TIAN Zhuang-zhuang
2019, 17(7): 1225-1229. doi: 10.16766/j.cnki.issn.1674-4152.000907
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Objective To evaluate the application value and effect of chemical- mechanical detoxification in the treatment of rickets. Methods Firstly, the computer was used to search the digital journal full-text database, the Chinese journal full-text database and the Chinese biomedical literature database. Then the manual examination method was used to supplement the reference documents and conference papers attached to the computer. In this paper, the effect of chemical- mechanical decontamination technology in the treatment of rickets is mainly analyzed. The paper confirmed the application prospect of new chemical-machinery decontamination. The literature included in the study was evaluated using the Cochrane systematic review method and Meta-analysis was performed using RevMan 5.2. The evaluation indexes of chemical-mechanical decontamination include postoperative complications, time of decontamination, decontamination effect and degree of pain, and 1-year success rate. Results When compared chemical-mechanical decontamination and the conventional decontamination, the decontamination effect [OR=1.12, 95% CI: (0.71, 1.78), P=0.063], incidence of secondary sputum [OR=0.64, 95% CI: (0.36, 1.15), P=0.13], P>0.05, the difference was no statistical significance. The decontamination time [OR=2.77, 95% CI: (2.35, 3.18), P<0.05], incidence of pain [OR=0.13, 95% CI: (0.10, 0.16), P<0.05], incidence of pulp complications [OR=0.24 95% CI: (0.08, 0.72), P<0.05], the incidence of dental anxiety [OR=0.19, 95% CI: (0.12, 0.28), P<0.05], 1-year success rate [OR=1.81, 95% CI: (1.08, 3.04), P<0.05], the difference were all statistically significant. Conclusion As compared with conventional mechanical decontamination, chemical-mechanical decontamination has no significant difference in the treatment effect. Through the treatment time is increased, but it can reduce the incidence of pain, pulp complications and dental anxiety, and increase the success rate of one year.
Effect of 3D printing model assisted health education on nursing in patients with thoracolumbar tuberculosis
LIU Jing, ZHANG Li-juan, WEI Fen-fen, XIA Li-li, WANG Yi-fan, YING Xiao-zhang
2019, 17(7): 1230-1233. doi: 10.16766/j.cnki.issn.1674-4152.000908
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Objective To investigate the effect of 3D printing model assisted Health education on improving bed compliance and Mental state in patients with thoracolumbar tuberculosis. Methods One hundred and four patients with thoracolumbar tuberculosis in our department from January 2018 to August 2018 were divided into two groups, 52 in each group. The control group was given routine health education in nursing intervention, and the observation group was added 3D printed model assisted nursing intervention. Both groups were nursed to the beginning of surgery. Before and after nursing, the Morisky-Green assessment form was used to evaluate the absolute bed compliance and related health knowledge. The depression self-rating scale (SDS) and the anxiety self-rating scale (SAS) questionnaire were used to evaluate the depression and anxiety of the two groups. So, to investigate the effect of 3D printing model assisted Health education on improving bed compliance and Mental state in patients with thoracolumbar tuberculosis. Results After nursing, the absolute bed compliance of the observation group was 96.15%, and the absolute bed compliance of the control group was 67.31%, the difference between the two groups was statistically significant (P<0.05). After the nursing, the total health knowledge awareness rate of the observation group was 98.08%, and the total health knowledge awareness rate of the control group was 73.08%, the difference between the two groups was statistically significant (P<0.05). After nursing, the SDS and SAS scores of the two groups were significantly decreased (P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusion Bed rest is the basis for the treatment of thoracolumbar tuberculosis and the basic method of treatment. Using 3D printed model assisted in health education can significantly improve the absolute bed compliance and the awareness of tuberculosis-related health knowledge, stabilize the patient's psychology, and is helpful for the follow-up treatment.
Risk factors analysis and nursing strategies for patients with colon cancer complicated with anemia
WANG Yue-chun, MA Bo
2019, 17(7): 1234-1236. doi: 10.16766/j.cnki.issn.1674-4152.000909
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Objective To investigate the risk factors and nursing strategies for patients with colon cancer complicated with anemia. Methods A total of 198 patients with colon cancer who were admitted to our hospital from September 2016 to July 2018 were enrolled in the anemia group. One hundred and twenty-six patients with colon cancer who did not have anemia were anemia. The age, history of hypertension, history of diabetes, TNM stage, degree of pathological differentiation, vascular tumor thrombus, tumor diameter, tumor type, cancerous intestinal obstruction and hypoproteinemia of the two groups were counted, and single factor and Multivariate analysis identified risk factors for anemia in colon cancer patients. Results Univariate and multivariate logistic regression analysis showed that age, TNM stage, pathological differentiation, vascular tumor thrombus, tumor diameter, tumor type, cancerous intestinal obstruction and hypoproteinemia were associated with anemia in colon cancer patients. Conclusion Age, TNM stage, pathological differentiation, vascular tumor thrombus, tumor diameter, tumor type, cancerous intestinal obstruction and hypoproteinemia are risk factors for anemia in colon cancer patients. Risk factors should be emphasized in clinical practice. Good treatment and care to prevent the occurrence of anemia.
Application of continuous care in patients with coronary heart disease after PCI in rural areas
ZHANG Sa-ran, YI Min, TAO Hua
2019, 17(7): 1237-1240. doi: 10.16766/j.cnki.issn.1674-4152.000910
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Objective To explore the application value of continuing care in patients with coronary heart disease after PCI in rural areas. Methods A total of 120 patients with coronary heart disease in rural areas who underwent PCI in our hospital from February 2017 to February 2018 were selected and randomly divided into general nursing group and continuing care group, with 60 cases in each group. The general nursing group was given routine clinical nursing intervention, and the continuing care group was given continuing care on this basis. The patients' quality of life was evaluated by quality of life evaluation table, the patients' sleep quality was evaluated by PSQI scale, the patients' psychological depression was assessed by HAMD scale, and the patients' anxiety was assessed by HAMA scale. The incidence of complications and the satisfaction of family members were compared between the two groups. Results The scores of quality of life in patients with continuing care after nursing were higher than those in general nursing group, with statistical significance (P<0.05); the scores of sleep quality in patients with continuing care after nursing were lower than those in general nursing group, with statistical significance (P<0.05); and the scores of HAMA and HAMD in patients with continuing care after nursing were lower than those in general nursing group, with statistical significance (P<0.05). The incidence of complications in the continuing care group was lower than that in the general care group, with statistical significance (P<0.05); the total satisfaction rate of family members in the continuing care group was significantly higher than that in the general care group, with statistical significance (P<0.05). Conclusion Continuous care for patients with coronary heart disease after PCI in rural areas can significantly improve their quality of life and sleep, relieve their negative emotions, reduce the incidence of complications, and make their families more satisfied.
Application of drug identification in nursing management of leukemia patients undergoing chemotherapy
XI Min, CHEN Zhao-jun
2019, 17(7): 1241-1244. doi: 10.16766/j.cnki.issn.1674-4152.000911
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Objective To explore the application of drug identification in the management of leukemia patients undergoing chemotherapy. Methods A total of 41 nursing staff working in the hematology department of Hangzhou Dingqiao hospital from June 2016 to June 2017 were selected as research objects, including 18 nursing staff from June 2016 to December 2016 as the control group and 23 nursing staff from January 2017 to June 2017 as the observation group. In the control group, drug identification was not implemented, while in the observation group drug identification was managed. The work efficiency of nurses, incidence of adverse reactions and patient satisfaction were compared between the two groups. Results The rate of error event for medicine was 3.55% and the drug configuration time (9.26±2.17) min in the observation group, 19.72% and (18.95±3.56) s in the control group, respectively. The rate of error event for medicine and drug configuration time in the observation group was significantly lower than those in the control group (P<0.05); Three cases in the observation group were with adverse reactions (phlebitis, oral ulcer, nausea and vomiting) with an incidence of 5.26%; 10 cases were with the adverse reactions in the control group, with an incidence of 24.39%; the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05); The patients satisfaction of the observation group was 92.98%, and that of the control group was 73.17%, the satisfaction of observation group was significantly higher than that of control group (P<0.05). Conclusion Drug identification can significantly improve the working efficiency of nursing staff, improve patient satisfaction and reduce the incidence of adverse reactions, and it is worthy of clinical promotion.
2019, 17(7): 1245-1248. doi: 10.16766/j.cnki.issn.1674-4152.000912
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2019, 17(7): 1249-1250. doi: 10.16766/j.cnki.issn.1674-4152.000913
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