中华全科医学

The development of community health service in 70 years since the foundation of the People's Republic of China

LIU Man-ling, YAO Wen-zhu, FENG Gong

2019, 17(8): 1251-1254,1311. doi: 10.16766/j.cnki.issn.1674-4152.000914

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Beginning with the concept, location，characteristics and significance of community health service (CHS), taking the development of CHS in 70 years which is from the foundation of the People's Republic of China till now as time axis, the author of this paper focuses on the development of CHS in China, the real problems and the achievements in CHS so far. Traced back to the history of CHS in China, it has experienced the embryonic stage, pilot stage, as well as initial stage and self-rapid development stage in turn. However, there are still some existing problems, such as unbalanced development of CHS across this country, the constrained sustainable development of CHS, the constrained service for society offered by CHS. CHS is unattractive both to the staff and community residents. Some relevant policies and mechanisms have not been implemented reasonably. With the development of health in our country, our CHS meets this developing opportunity and obtains achievement, such as the increasing number of CHS institution and the gradually formed network of CHS across this country, as well as the enlarged and strengthened professional teams of CHS institutions. What's more, the professional quality of the staff in CHS, including their educational levels and their titles of technical posts is continuously promoted, and the facilities along with equipment of CHS are improved. So the service capability of CHS is obviously enhanced. The number of diagnosis and treatment services provided by CHS increases continuously. In the end, the future of community health service is also looked forward to.

WANG Qiong, WANG Guo-ping

2019, 17(8): 1255-1256.

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Abstract:

The application of an improved ureteroscope technique in the treatment of upper ureteral calculi

WU Wen-bin, ZHONG Jin-sen, DANG Rui-feng, WANG Fu, WANG Wei

2019, 17(8): 1257-1260. doi: 10.16766/j.cnki.issn.1674-4152.000915

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Objective To investigate the clinical effect of improved method with ureteral catheter-pressurized blood transfusion in the treatment of upper ureteral calculi by hard ureteroscopy. Methods A total of 130 patients with upper ureteral calculi from June 2016 to June 2018 in our hospital were included and randomly divided into two groups. In the experimental group (group A), 65 patients were treated with ureteral catheter (F4) placed above the calculi and pressurized with blood transfusion to keep instillation in the ureteroscope pneumatic lithotripsy. In Control group (group B), 65 patients were treated with conventional ureteroscope pneumatic lithotripsy and foreign body forceps. The results of operation time, stone clearance rate and postoperation complications were compared between the two groups. Results In group A, 5 patients were unable to insert ureteral catheter (F4) because of ureterostenosis. The other 60 cases were successful. Among the group of stone with diameter greater than 1 cm, a group of calculi clearance rate 92.9%, postoperative fever rate was 3.6%, and the operation time was (52.93±9.51) min. Those in group B were 70.0%, 26.7%, and (58.57±10.31) min, respectively. The above three groups of data comparison, the difference was statistically significant (all P<0.05), and perirenal fluid collection or ureteral injury incidence, the two comparison had no statistical significance (all P＞0.05). In the group with stone diameter less than or equal to 1 cm, the calculi clearance rate of group A was 100.0%, better than group B (80.0%), there was significant difference between the two groups (P<0.05). However, there was no statistical significance between the two groups in terms of operation time, postoperative fever rate, perirenal fluid collection and the incidence of ureteral injury (all P＞0.05). Conclusion The methods of ureteral catheter-pressurized blood transfusion is used in the treatment of upper ureteral calculi by hard ureteroscopy, which can effectively prevent stone drift, maintain a clear vision, shorten the operation time of large stones and reduce postoperative infection. This technology is worthy of clinical promotion in basic-level hospitals.

Dynamic changes of CD34⁺ progenitor cells and eosinophils in asthmatic mice and their relationship with CCR3/eotaxin expression

LI Xiao-bo, ZHANG Rong-ying, WANG Bin-liang, YANG Zai-xing, REN Ying-peng

2019, 17(8): 1261-1264,1326. doi: 10.16766/j.cnki.issn.1674-4152.000916

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Objective The dynamic changes of eosinophils, CD34⁺ progenitor cells, eotaxin and CCR3 expression in BALF, peripheral blood, bone marrow suspension of asthmatic mice were studied by asthma model. This study aims to investigate the relationship between airway eosinophil inflammation and CD34⁺ progenitor cells and CCR3/eotaxin in asthmatic mice. Methods C57BL/6 mice were used to establish asthma model with ovalbumin as antigen. The changes of eosinophils, CD34⁺ progenitor cells and eotaxin in BALF, peripheral blood and bone marrow were detected 6 hours, 12 hours, 24 hours and 48 hours after the last antigen challenge, and the expression of CCR3 on CD34⁺ progenitor cells was detected. Lung biopsy was used to observe eosinophil infiltration. Lung tissue CCR3 and eotaxin mRNA levels were detected by PCR. Results The results showed that eosinophils, CD34⁺ cells and CD34⁺/CCR3⁺ cells were increased in BALF, peripheral blood and bone marrow suspension. The eotaxin level of BALF in the model group increased significantly at 6 h compared with the control group (P<0.05), and lasted until 24 h. The level of eotaxin in peripheral blood and bone marrow suspension was not significantly different from that in the control group (all P>0.05). The expression of eotaxin mRNA and CCR3 mRNA in lung tissue of model group increased significantly at each time point compared with control group. The number of eosinophils in BALF was positively correlated with the number of eosinophils and CD34⁺/ CCR3⁺ cells in bone marrow, but not with the number of CD34⁺ cells in bone marrow. Conclusion ①The increase of eosinophils in airway of asthmatic mice is related to the up-regulation of CCR3 expression in bone marrow CD34⁺ progenitor cells. ②CCR3/eotaxin participates in the differentiation and chemotaxis of CD34⁺ progenitor cells. It is closely related to airway eosinophil infiltration in asthmatic mice.

Diagnosis and treatment of 22 cases of chylothorax after thoracoscopic lung cancer operation

FANG Ming, ZHANG Rong-xin, FANG Yin, REN Zi-xue, ZHANG Gan, TIAN Rui

2019, 17(8): 1265-1267. doi: 10.16766/j.cnki.issn.1674-4152.000917

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Objective To analyze clinical diagnosis and treatment of 22 patients with thoracoscopic lung cancer complicated with chylothorax, compare the difference of chylothorax after Single-operated thoracoscopic and multi-hole thoracoscopic surgery, and summarize the diagnosis and treatment of chylothorax after thoracoscopic lung carcinoma surgery. Methods The clinical data of 22 patients with chylothorax after thoracoscopic lung cancer surgery in 1 305 cases from May 2015 to May 2018 were retrospectively analyzed. Results A total of 22 patients with postoperative chylothorax were identified among 1 305 patients who underwent thoracoscopy lung carcinoma surgery (1.69%), with 9 males and 13 females, aged 36-79 years old with an average age of 66 years old; 17 cases of chylothorax after single-operated thoracoscopic surgery in 926 cases (1.84%), 12 cases on the right side, 5 cases on the left side； 5 cases on the right upper lobe lung cancer, 1 case on the right middle lobe lung cancer, 6 cases on the right lower lobe lung cancer, 2 cases on the left upper lobe lung cancer, 3 cases on the left lower lobe lung cancer；and 5 cases of chylothorax after multi-operational thoracoscopic surgery in 379 cases (1.32%), 1 case of right upper lobe lung cancer, 3 cases of right lower lobe lung cancer, 1 case of left lower lobe lung cancer； the difference was not significant (P＞0.05). And 22 patients were cured,21 cases cured by conservative treatment with nutrition support and pleural fixation, and 1 patient was cured by the thoracic ligation of the thoracic duct trunk with the effect which was not accurate after 2 days conservative treatment, with a total cure rate 100% (22/22). Conclusions There was no significant difference in chylothorax after single and multi-operational thoracoscopic for lung cancer. The diagnosis of chylothorax after thoracoscopic lung cancer is not difficult. The correct treatment should be taken after the occurrence of chylothorax. Most chylothorax can be cured by conservative treatment. Surgical treatment should be decisive for patients with inconsistent conservative treatment or poor tolerance to nutritional lose. The overall therapeutic effect was satisfactory.

Study on the risk factors of pre-thrombotic state in patients with malignant solid tumor

WANG Yu-ting, WAILI Ha-si-ye-ti, ZHANG Ze-gao, YANG Jie

2019, 17(8): 1268-1271. doi: 10.16766/j.cnki.issn.1674-4152.000918

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Objective To screening the possible risk factors of pre-thrombotic state(PTS) in patients with malignant solid tumor. Methods The clinical and laboratory data of 102 cases of malignant solid tumor in our department between December 2016 and June 2017, including 67 patients with PTS and 35 patients without PTS, were retrospectively analyzed. The stratified analyses by principal component analysis, single factor analysis and Multivariate logistic regression analysis was conducted for the risk factors of PTS in patients with malignant solid tumor. Results ①The malignant solid tumor patients in PTS were with abnormal values in laboratory routine blood and blood coagulation test; ②The single factor analysis showed that the age, tumor staging, treatment, long-term lie in bed, PICC, prophylactic anticoagulation, and laboratory parameters such as white blood cell count, hemoglobin, platelet count, erythrocyte deposited and FIB, D-D variables were all correlated with PTS (all P<0.05); ③The multivariate logistic regression analysis showed that KPS score, tumor staging, prophylactic anticoagulation, long-term lie in bed and PICC were risk factors of PTS, all P<0.05. Conclusion ①The risk factors for PTS include the WBC, PLT count, FIB, D-D, KPS score etc. The prophylactic anticoagulation is the protective factor of PTS. ②PTS varies with the location of malignant solid tumors in different parts of the body, but the difference was not statistically slgnificant (P>0.05). ③Traditional antitumor treatment can reduce the tumor load; however, it also increases the risk of PTS. ④More attentions should be paid for the long-term lie in bed patients and those patients with PICC.

Effect of Tripterygium wilfordii on levels of cytokines related to Th17/Treg cells in the peripheral blood of patients with psoriasis vulgaris

TUEKAM TUEKAM Erna Gaelle, JIANG Cong-jun

2019, 17(8): 1272-1274. doi: 10.16766/j.cnki.issn.1674-4152.000919

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Objective To investigate the effect of Tripterygium wilfordii on levels of IL-17, IL-23 and IL-10 associated with Thl7/Treg Cells in the peripheral blood of patients with psoriasis vulgaris, and analyze its therapeutic mechanism. Methods Forty one cases of psoriasis vulgaris in our hospital from December 2016 to June 2017 were orally administrated with Tripterygium wilfordii tablets (20 mg, 3 times a day, for 8 weeks). The efficacy of treatment was evaluated by using Psoriasis Area and Severity Index (PASI) scores. The serum levels of IL-17, IL-23 and IL-10 in normal controls and patients with PV before and after the treatment was tested by using ELISA. Results The serum levels of IL-17 and IL-23 in the patients were significantly higher than those in the normal controls (all P＜0.01), while the serum level of IL-10 was significantly lower in patients as compared with the normal control (P＜0.01). After the treatment with Tripterygium wilfordii, the serum levels of IL-17 and IL-23 were significantly decreased (all P＜0.01), while the serum level of IL-10 was significantly increased (P＜0.01). PASI scores were decreased significantly after the treatment. The PASI score in patient was positively correlated with serum levels of IL-17 and IL-23, and negatively correlated with the level of IL-10 (all P＜0.01). Conclusion Tripterygium wilfordii shows a remarkable curative effect on psoriasis vulgaris. Its regulation on the levels of cytokines related to Th17/Treg cells may be involved in the mechanisms of Tripterygium wilfordii action.

Analysis of clinical and imaging features of primary Sjogren's syndrome complicated with interstitial lung disease

WANG Jian-jun, LYU Qun, GONG Ling, RUAN Zhao-yang, DAI Yi-fan

2019, 17(8): 1275-1278. doi: 10.16766/j.cnki.issn.1674-4152.000920

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Objective To investigate the clinical and imaging features of patients with primary Sjogren's syndrome (pSS) complicated with interstitial lung disease (ILD). Methods The clinical and imaging data of 148 cases of pSS were reviewed in last 6 years. Thirty nine patients with -ILD were assigned into ILD group, and 109 patients with pSS without ILD into the control group. The clinical manifestations, immunological parameters and lung function were compared between the two groups. The imaging findings in ILD group were studied. Results ①The mean age and age of onset in the ILD group were significantly higher than those in the control group (P<0.05). ②The incidence of dry cough, shortness of breath, fatigue and psychiatric symptoms in ILD group was significantly higher than that the control group (all P<0.05). ③The positive rates of ANA, anti-SSA antibody and rheumatoid factor in ILD group were higher than those in the control group, the difference was statistically significant (all P<0.05). ④DLCO% of the predicted value in the ILD group was significantly lower than that in the control group (P<0.05). The mean pulmonary artery pressure and the proportion of pulmonary hypertension in the ILD group were higher than those in the control group (all P<0.05). ⑤Ground-glass opacity was the most common manifestation in ILD group, followed by mesh shadow and traction bronchiectasis. Conclusion ILD was a common manifestation of pSS with various clinical manifestations. The serum antinuclear antibody, anti-SSA antibody and rheumatoid factor positive rate were higher in pSS-ILD patients. The incidence of pulmonary hypertension was higher in pSS-ILD patients. Ground-glass opacity was the most common manifestation in pSS-ILD patients.

Effect of Wu-Ling Powder therapy on cognition, Aβ_1-42 and p-Tau expression in APP_swe/PS1_dE9 double transgenic AD mice

WANG Hai, ZOU Xiao-dong, YANG Qin-qin, ZHANG Yong-le, GUO Deng-jun

2019, 17(8): 1279-1281,1395. doi: 10.16766/j.cnki.issn.1674-4152.000921

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Objective To explore the effect of Wu-Ling Powde therapy on cognition, Aβ_1-42 and p-Tau expression in APP_swe/PS1_dE9 double transgenic AD mice. Methods Twenty APP_swe/PS1_dE9 double transgenic AD mice, half male and half female, were randomly divided into disease model group, Wu-Ling Powder group [at the dosage of 100 mg/(kg·d)]. Additionally,10 normal C57BL/6 mice (half male and half female) were used as the healthy control group. The disease model group and the healthy control group were given the same volume of normal distilled water,and the Wu-Ling Powder group was administrated by gavage for 30 days, respectively. All animals were fed normally.The behavioral tests such as Morris water maze test, place navigation test and probe trial testing were carried out in these groups. All the mice in three groups were killed in one hour after the last medication,hippocampus of these mice were separated for the detection of Aβ_1-42 and p-Tau by enzyme-linked immunosorbent assay (ELISA). Results ① Compared with the healthy control group, the latent period of the Wu-Ling Powder group in water maze test, target quadrant swimming time, effective zone residence time and platform times were increased significantly (all P<0.01); compared with the disease model group, the latent period in water maze test, target quadrant swimming time, effective zone residence time and platform times of the Wu-Ling Powder group were decreased significantly (all P<0.01). ② Compared with the healthy control group, the expression levels Aβ_1-42 and p-Tau in hippocampus of the Wu-Ling Powder group were increased significantly (all P<0.01); compared with the disease model group, the expression levels Aβ_1-42 in hippocampus of the Wu-Ling Powder group were decreased significantly (P<0.01). Conclusion Wu-Ling Powder has an effect on improving learning and memory ability, it may reduce the formation of Aβaggregates by decreasing the content of Aβ_1-42 in the hippocampus of mice, and thus reducing the generation of senile plaques.

Impact of different routes of administrations of dexmedetomidine on children during the process of recovery from anesthesia

XU Bing, WANG Di, GAO Wei, SHAO Chun-xiao, ZHANG Li-li, CHAI Xiao-qing

2019, 17(8): 1282-1284,1316. doi: 10.16766/j.cnki.issn.1674-4152.000922

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Abstract:
Objective To compare the impacts of intranasal and intravenous administration of dexmedetomidine on the process of recovery from general anesthesia with sevoflurane inhalation in pediatric patients undergoing laparoscopic inguinal hernia ligation. Methods A total of 90 patients undergoing laparoscopic inguinal hernia ligation in the First Affiliated Hospital of University of Science and Technology of China between October 2017 to December 2018 were randomly divided into intravenous administration group (VD group), intranasal administration group (ND group), and control group (C group), with 30 cases in each group. Before anesthesia Induction, the VD group received intravenous administration of dexmedetomidine (0.5 μg/kg) combined with intranasal administration of 0.5 mL saline; The ND group received intravenous administration of 0.5 mL saline combined with intranasal administration of dexmedetomidine (2.0 μg/kg); The C group received intravenous administration of 0.5 mL saline combined with intranasal administration of dexmedetomidine (2 μg/kg). The operation time, the time to extraction of laryngeal mask and the time stay in recovery room were recorded. The Pediatric anesthesia Emergence Delirium Scale (PAED) score and Ramsay score were used to evaluate the levels of sedation at 5 min, 10 min and 30 min after waking up. The blood pressure, heart rate, oxygen saturation and adverse reactions of patients were also recorded before surgery, 10 min after surgery, and at the end of the surgery. Results There were no significant differences in the operation time and PACU stay time among the three groups. The PAED scores in group C were higher than group VD and group ND at 5 min, 15 min and 30 min after the patients waking up (all P＜0.05), and the levels of sedation in VD and ND decreased. The Ramsay scores of group C were lower than group VD and group ND (all P＜0.05). The heart rate at 10 min after surgery and the end of surgery in VD group decreased more obviously as compared with ND group and C group (all P＜0.05), but still within the safe range. No respiratory depression occurred in all the three groups. Conclusion Administration of dexmedetomidine via venous and nasal can provide a satisfactory sedation and delirium effect for children with laparoscopic hernia surgery. Intranasal administration of dexmedetomidine had fewer side effects on heart rate as compared with intravenous administration.

Morbidity rate of hyperuricemia and the prevalence of HLA-B*5801 allele in southern Zhejiang

LIU Si-yu, PEI Li-hong, ZHANG Xiao-mei, XU Su-ting, SHI Yang, ZHAO Zhi-gang

2019, 17(8): 1285-1288. doi: 10.16766/j.cnki.issn.1674-4152.000923

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Objective To explore the morbidity rate of hyperuricemia and the prevalence of HLA-B*5801 allele in southern Zhejiang, and discuss the necessity of screening HLA-B*5801 allele for preventing serious adverse skin reactions caused by allopurinol medication. Methods Total 289 cases of hyperuricemia taking allopurinol in our hospital were enrolled into this study, and their blood samples were prepared for HLA-B*5801 allele test by using the Sequence-Specific Oligonudeotide (SSO) technique. The blood samples of 11 344 healthy subjects in southern Zhejiang were randomly sampled from medical repository for the overall incidence of hyperuricemia. Results Among 289 patients taking allopurinol, the allele frequency of HLA-B*5801 was 20.7% (60/289), there was no significant difference in gender, age and diseases (P>0.05); The average blood uric acid level of 11 344 healthy subjects was (339.38±95.93)μmol/L, for difference gender, the level in men was (381.88±90.58)μmol/L, and in women was (294.79±78.51)μmol/L, the difference was statistically significant (t=54.609，P<0.001). Male aged 20 to 30 years old taken up the highest incidence of 37.28% (χ²=71.171, P<0.05), however, female ager over 70 years old reached the highest incidence of 29.83% (χ²=168.400, P<0.05), the difference was statistically significant(P<0.05). Among them, the incidence of hyperuricemia was 30.75%(1 786/5 808)in man and 16.31%(903/5 536) in women, the difference was statistically significant(χ²=326.800, P<0.05). Conclusion The incidence of hyperuricemia in southern Zhejiang is high, and the incidence in males is higher than that in females. The onset age in man tends to be younger, which reminds clinicians to pay more attentions. At the same time, before the patients taking allopurinol, to analyze the frequency of HLA-B*5801 gene is necessary to prevent the serious adverse skin reactions caused by allopurinol medication.

Effects of subgingival glycine powder air polishing on molar class Ⅱ furcation involvement

SUN Xiao-yu, ZHANG Lei, HE Xin, CHENG Nan, HONG Biao

2019, 17(8): 1289-1291,1432. doi: 10.16766/j.cnki.issn.1674-4152.000924

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Objective To evaluate the clinical effect of subgingival ultrasonic scaling and subgingival glycine powder air polishing in the treatment of class Ⅱ furcation involvement. Methods Sixty-four class Ⅱ furcation involvement molars from thirty-two severe chronic periodontitis patients in Stomatological Hospital of Anhui Medical University from May 2017 to May 2018 were selected. Everyone had two class Ⅱ furcation involvement molars at least. One week after the supragingival scaling, the clinical index were taken as the baseline data. The principle of oral control design was adopted. One side of the same patient's teeth was randomly designed as experimental group, subgingival scaling and subgingival glycine powder air polishing was performed, the other side as control group, subgingival scaling was performed. After 4 weeks and 12 weeks, the periodontal clinical indicators, inflammatory factor from gingival crevicular fluid and BANA test were reviewed to evaluate the clinical effects. Results The differences between the two groups in baseline were not significant (all P>0.05). The data of 4 weeks and 12 weeks after the treatment were analyzed using repeat measurement test, except CAL, the other observed periodontal clinical index were all significantly improved after the treatment (all P<0.05). The level of tumor necrosis factor-α and interleukin-6 were all lower as compared with those at baseline. BANA results showed that the overall quantity of pathogens decreased in both groups after 4 weeks of treatment (all P<0.05). Twelve week later, the overall quantity of pathogens in the experimental group was still lower than that in the control group, and the difference was significant (P<0.01). Conclusion During 12 weeks of follow-up, subgingival ultrasonic scaling combine subgingival glycine powder air polishing can effectively improve the clinical symptoms and inflammatory response of class Ⅱ furcation involvement, which can maintain the long-term therapeutic effect when compared with subgingival scaling only.

Comparison of the effect be hypofractionated -simultaneous integrated boost-intensity modulated radiotherapy and conventional radiotherapy in early-stage breast cancer after breast conserving surgery

WANG Sheng-ye, DU Xiang-hui, FENG Wei, BAI Xue, CHEN Jian-xiang, ZHENG Yuan-da, JI Wen-hao, KONG Yue, MO Wen-ju, LOU Jian-lin

2019, 17(8): 1292-1295. doi: 10.16766/j.cnki.issn.1674-4152.000925

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Objective To compare the clinical efficacy and safety of hypofractionated -simultaneous integrated boost-intensity modulated radiotherapy (HF-SIB-IMRT) and conventional radiotherapy for early-stage breast cancer patients after breast-conserving surgery. Methods From August 2015 to August 2017, 60 patients with early-stage invasive ductal breast cancer (cT1-T2N0M0 staging) underwent breast conserving surgery in a hospital were enrolled. According to the random number table method, they were divided into HF-SIB-IMRT group (30 cases) and conventional radiotherapy group (30 cases). After operation, the HF-SIB-IMRT group received total breast irradiation for 15 times, and simultaneous integrated boost of tumor bed for 24 days. The routine radiotherapy group received 25 fractions of total breast irradiation followed by sequential irradiation, and local total irradiation 60.0 Gy in the tumor bed. The total course of treatment was 44 days. The local control rate, cosmetic effect, incidence of radiation-related side effects and recurrence rate were compared between the two groups. Results Both groups were followed up for at least 1.5 years. During the follow-up period, there was no recurrence in both groups. The local control rate was 100% and the one-year survival rate was 100%. There was no significant difference in cosmetic effect between HF-SIB-IMRT group and conventional radiotherapy group at the end of 1 month,6 months (all P>0.05). There was no significant difference between HF-SIB-IMRT group and routine radiotherapy group in the incidence of acute adverse events (P>0.05). Conclusion Whole breast hypofractionated intensity modulated radiotherapy with simultaneous integrated boost of tumor bed after breast conserving surgery for early breast cancer patients can obtain satisfactory short-term curative effect, without increasing the toxicity and side effects of radiotherapy, and can shorten the total course of radiotherapy after breast conserving surgery, which is its clinical advantage.

Expression and its significance of exosomal miR-27a in gastric cancer

XU Zhen, WANG Yong, ZHANG Li-jiu

2019, 17(8): 1296-1298. doi: 10.16766/j.cnki.issn.1674-4152.000926

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Abstract:
Objective The exosome has absorbed much attention in the study of cancers in recent years, and exosomal miRNAs have been validated to play important roles in variety of tumors. This study aimed to invest the serum exosomal miRNA-27a expression and its significance in gastric cancer. Methods By using real-time fluorescence quantitative PCR (QPCR), the serum exosomal miRNA-27a levels of both 40 gastric cancer and 20 normal people who were cured in our hospital from January 2015 to December 2017 were investigated; the serum exosomal miR-27a expression levels between the cancer group and control group were compared. Meanwhile, the change of serum exosomal miR-27a expression level of the 40 patients after the operation was compared with that before the surgery. The relevance of the expression level of serum exosomal miR-27a to the clinical pathological characteristics (sex, age and tumor grade) was invested, and the relationship between serum miR-27a and the prognosis of patients were analyzed based on the follow-up information. Results The serum exosomal miR-27a expression level of the 40 patients (0.153±0.092, before the surgery) was significantly lower than that of 20 normal control (0.823±0.125), the difference was statistically significant (P<0.001). After the operation, the level of serum exosomal miR-27a expression was 0.505±0.143, which was definitely up-regulated (P<0.05). Also, the expression level of serum exosomal miR-27a in the Ⅰ/Ⅱ grade patients was 0.179±0.102, and in the Ⅲ/Ⅳ grades patients was 0.102±0.076 (P<0.05), which revealed that the expression level of serum exosomal miR-27a was negatively correlated with the tumor grade in gastric cancer. Conclusion The expression level of miRNA-27a is definitely down regulated in gastric cancers and negatively correlated with its grade. The test of serum miR-27a level can provide an innovative target for the early scanning and treatments of gastric cancer.

Clinical analysis of risk factors for and complications of patent ductus arteriosus and hemodynamically significant patent ductus arteriosus in premature infants

ZHANG Lan, SHEN Wei, CHEN Chao, PAN Jia-hua

2019, 17(8): 1299-1301,1367. doi: 10.16766/j.cnki.issn.1674-4152.000927

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Abstract:
Objective To study the risk factors for patent ductus arteriosus (PDA), especially hemodynamically significant patent ductus arteriosus (HsPDA) and the related complications. Methods A case-control study was conducted retrospectively on the clinical data of 149 preterm infants hospitalized in our NICU between January 2017 and January 2018. The patients were assigned into HsPDA, nHsPDA and nPDA according to the diagnostic criteria for PDA and HsPDA. The single factor analysis was conducted among observed variables, and then logistic regression was performed to conclude the independent risk factors for PDA/HsPDA. We also analyze the related risk factors of complications with PDA/HsPDA and ductal closure time. Results There were 23 patients in the HsPDA group, 11 patients in the nHsPDA group and 115 patients in the nPDA group, and no statistical significant difference for the general information was found among the three groups (P>0.05). Single factor analysis showed that PDA/HsPDA was significantly associated with gestational age, multiple pregnancy, Apgar scores and birth weight, the difference among the three groups was significantly (P>0.05); the logistic regression analysis showed that multiple pregnancy (P=0.009), and Apgar scores (for ≤3 scores, P=0.010; for 3 to 7 scores, P=0.036) were the independent risk factor for PDA/HsPDA. Among the three kinds of complications, the relationship between intraventricular hemorrhage (IVH) and HsPDA (R₂=0.884), the relationship between retinopathy of prematurity (ROP) and nHsPDA (R₃=0.841) were the most significant, the correlations for IVH was more obvious in the HsPDA group when compared with the nHsPDA group, for ROP was contrary to it. The bronchopulmonary dysplasia (BPD, R₁=1.308, R₂=1.174) and ROP(R₁=1.308, R₂=1.161) showed more significant relationship to the time of ductal closure, especially in the HsPDA. Conclusion Multiplets and lower Apgar scores are the independent risk factors for PDA/HsPDA. IVH and BPD show more significant relationship with HsPDA when compared with nHsPDA. The ductal closure time correlates closely with BPD and ROP.

Clinical research of DC-CIK on regulating cellular immune in patients with diffuse large B cell lymphoma

ZHANG Man, ZHAO Xu-lin, XU Quan-xiao, YANG Wei, LIANG Ling-xia, XU Guo-chang

2019, 17(8): 1302-1304,1391. doi: 10.16766/j.cnki.issn.1674-4152.000928

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Abstract:
Objective To investigate the effect of autologous dendritic cells and cytokine-induced killer cells transfusion therapy on the improvement of immune function in patients with diffuse large B-cell lymphoma (DLBCL). Methods Total 23 cases of diffuse large B-cell lymphoma confirmed by histological and immunohistochemical were selected from Nanyang First People Hospital during April 2012 to April 2015. All of the patients attained to at least partial remission. Peripheral blood mononuclear cells were isolated by Cobe Spectra blood cell separator, and induced into DC-CIK cells by conventional methods. DC-CIK cells were intravenous injected into patients twice every 15 days, a total of 4 times. The changes of absolute lymphocyte count were detected by hematology analyzer and peripheral lymphocyte subsets were detected by flow cytometry. The levels of INF-γ, IL-2 in serum were detected by Elisa. Meanwhile, the adverse reactions were observed. Results After 4 times DC-CIK cells transfusion therapy, the level of ALC [ (2.17±1.58)×10⁹/L] were significantly higher than those before treatment level [(0.83±0.79)×10⁹/L], P<0.05. The ratio of Treg cell was significant decreased [(4.92±2.38)% vs. (6.01±2.07)%], P<0.05. It was found that numerical value of T, Th, Ts, CD3⁺ T, CD3⁺CD4⁺ T, CD3⁺CD8⁺ T, NK cell, IL-2 and INF-γ was not statistically difference before and after treatment (P>0.05). Conclusion Autologous DC-CIK cell immunotherapy can improve the DLBCL patients' cellular immune function by improving ALC and reducing Treg.

Effect of all-ceramic inlay on the treatment of postoperative root defects in patients with curative effect and prognosis

GAO Yue-zhong, LI Li

2019, 17(8): 1305-1307. doi: 10.16766/j.cnki.issn.1674-4152.000929

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Abstract:
Objective To study the clinical therapeutic effect and prognosis of patients with posterior tooth defects treated with all-ceramic inlays. Methods A total of 56 patients with posterior tooth defects who were treated in the department of stomatology in our hospital from March 2015 to December 2017 were randomly selected as the study subjects. According to the different treatment methods adopted by the patients, they can be divided into the control. The patients in the group and the observation group were treated with conventional repair. The observation group was treated with all-ceramic inlays to repair the root canal. The clinical treatment effect, chewing ability, gums and life of the patients were observed. Quality and patient satisfaction with treatment. Results After treatment, the masticatory ability of the patients in the observation group was significantly higher than that in the control group, and the gingival index and bleeding index were significantly lower than those in the control group (P<0.05). The total effective rate of the observation group (96.43%) was significantly higher than that of the control group (39.29%), χ²=20.959, P<0.001. The quality of life score (90.53±9.20) of the observation group was significantly higher than that of the control group (73.42±4.61), t=8.516, P<0.001, and the treatment satisfaction level (92.86%) was significantly higher than that of the control group (50.00%), χ²=12.600, P<0.001. Conclusion From this we can see that there is no significant difference in the chewing ability, gingival condition, gingival index and bleeding index and porcelain fused metal full crown method in patients with posterior tooth defects treated with all-ceramic inlays. However, the all-ceramic inlay repair root canal treatment can improve the clinical effect of patients after treatment, so it should be promoted clinically.

Effect of ginseng polysaccharide on chemotherapy efficacy and MDSCs, Treg cell and Immune factors in patients with advanced lung cancer

ZHANG Xiao-qin, YU Sa, WU Sheng-chang

2019, 17(8): 1308-1311. doi: 10.16766/j.cnki.issn.1674-4152.000930

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Abstract:
Objective To analyze the effect of Ginseng polysaccharide on the chemotherapy efficacy and the levels of myeloid-derived suppressor cells (MDSCs), regulatory T cells (Treg) and immune factors in advanced non-small cell lung cancer (NSCLC). Methods Sixty-three patients with advanced NSCLC in Zhejiang Provincial People's Hospital between June 2014 and December 2015 were selected as the subjects, and randomly divided into the Ginseng polysaccharide group and the control group. The two groups were treated with GP or DP chemotherapy, and Ginseng Polysacchride Injection was added to the Ginseng polysaccharide group. The clinical efficacy, quality of life and adverse reaction of the patients in the two groups were compared. The MDSCs, Treg cell and the correlation between the two groups were compared. and the arginase and various cytokines (VEGF, TGF-β, IL-10, IFN-γ, TNF-α) in the two groups were compared. Results The rate of disease control and quality of life in the Ginseng polysaccharide group were both significantly higher than that in the control group (all P<0.05). leukocyte reduction, nausea and vomiting in Ginseng polysaccharide group were significantly lower than those in the control group (all P<0.05). There was no significant difference in the percentage of MDSCs and Treg cells between the 2 groups before treatment (all P>0.05). The percentages of MDSCs and Treg cells in the 2 groups were significantly higher than those in the control group after treatment (all P<0.05). Treg cells were positively correlated with MDSCs (P<0.05). After the treatment, compared with the control group, the arginine, VEGF, TGF-β, and IL-10 decreased significantly (all P<0.05), and IFN-γ, TNF-α increased significantly in the Ginseng polysaccharides group (all P<0.05). Conclusion By affecting the MDSCs, Treg and immune factors, Ginseng polysaccharide can improve the immune function, the efficacy and quality of life, and reduce the adverse reactions of advanced NSCLC patients receiving chemotherapy.

Clinical significance of PPARγ in patients with colorectal cancer with hyperlipidemia

DA Miao, WU Wei, MAO Xin-feng, ZHOU Qing, XIE Xin-fang, LIU Min

2019, 17(8): 1312-1316. doi: 10.16766/j.cnki.issn.1674-4152.000931

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Abstract:
Objective To investigate the clinical significance of the changes of PPARγ gene expression in colorectal cancer patients with or without hyperlipidemia, and to further clarify the significance of the PPARγ gene expression in the development and prognosis of colorectal cancer. Methods The lipid metabolism levels of 315 colorectal cancer patients and 109 healthy people from June 2016 to June 2018 were retrospectively investigated, and the lipid metabolism levels of the two groups were statistically analyzed. Eighty-three patients with colorectal cancer from July 2017 to May 2018 were recruited. PCR and ELISA were used to determine the expression of PPAR gamma gene and protein in 51 colorectal cancer patients with hyperlipidemia and 32 colorectal cancer patients without hyperlipidemia, respectively. The PPAR gamma gene expression and protein expression levels of 35 colorectal cancer patients with liver metastasis and 48 colorectal cancer patients without liver metastasis were further determined by PCR and ELISA. Results In the retrospective study,colorectal cancer patients with hyperlipidemia patients and more healthy people, and the difference had statistical significance(P<0.05). The PPAR gamma gene expression level and protein expression level in serum and tumor tissues of patients with colorectal cancer complicated by hyperlipidemia were higher than those of the group without hyperlipidemia in colorectal cancer (P<0.05). PPAR gamma gene expression and protein expression levels were lower in patients with colorectal cancer with liver metastasis than those in colorectal cancer without liver metastasis (P<0.05). Conclusion The expression of PPAR gamma gene and protein is higher in serum and tumor tissue of patients in colorectal cancer with hyperlipidemia. The expression of PPAR gamma gene and protein is lower in colorectal cancer complicated with liver metastasis. PPARγ gene plays an important role in colorectal cancer with hyperlipidemia.

Explore the normal range of intra-abdominal pressure with direct measurement and the relationship between ascites quantitation and intra-abdominal pressure

XU Fang-yuan, ZHU Yuan-zhen, WANG Hong, FANG Ping, WU Yi-qing, WU Peng-fei, ZHANG Mu-cheng, WANG Gen-he

2019, 17(8): 1317-1319,1343. doi: 10.16766/j.cnki.issn.1674-4152.000932

186 1

Abstract:
Objective To explore the normal range of intra-abdominal pressure (IAP) using direct measurement, and discuss the relationship between ascites quantitation and intra-abdominal pressure. Methods A prospective cohort study was conducted. We acquire the normal range of IAP in patients without ascites using direct measurement. Meanwhile, we compared the IAP of ascites group with non-ascites group. Then, we injected different volume of normal saline containing chemotherapeutics drugs into the abdominal cavity of non-ascites, monitor the change of IAP, and found the relationship between them. Results ① The 95% confidence interval of the IAP measuring by direct measurement in non-ascites was 4.99-6.11 mm Hg (1 mm Hg=0.133 kPa). ②The IAP of non-ascites was significant lower than ascites group (t=-2.188, P=0.031). ③A significant linear correlation was observed between the volume of normal saline and IAP (R=0.113, t=5.206, P<0.01), the regression equation was Y=7.651X+1.491 (P<0.01). ④The range of IAP after injecting normal saline was 4-19 mm Hg. Among them, there were 52 between 12 and 15 mm Hg and 5 between 16 and 20 mm Hg. There were no patients between 21 and 25 mm Hg and >25 mm Hg. All the patients had no organ dysfunction or organ failure. Conclusion The normal range of IAP measuring by direct measurement is 4.99-6.11 mm Hg, which different from Kron technique in numerical, more studies are needed to explore the relation between them. An increase in ascites can lead the increase in IAP, and there is a linear correlation between them, so we should worry about intra abdominal hypertension (IAH) or abdominal compartment syndrome (ACS) when increase in ascites. The happen of ACS has relationship with the duration of high pressure caused by ascites, so reduce IAP timely has important significance in precention an treatment ACS.

The predictive value of coronary artery CTA quantitative indexes on long-term cardiovascular events in patients with coronary heart disease

LIU Shuai, LIN Min-jiang, XU Ya-fei

2019, 17(8): 1320-1322,1407. doi: 10.16766/j.cnki.issn.1674-4152.000933

121 0

Abstract:
Objective To investigate the value of computed tomography (CTA) quantitative indexes in predicting major adverse cardiovascular events (MACE) in patients with coronary heart disease. Methods From September 2016 to November 2017, 251 patients with coronary heart disease diagnosed and treated in our hospital were selected and followed up for 1 years, they were divided into observation group and control group according to whether MACE occurred, Coronary CTA indexes of the two groups were compared, including the total plaque volume (TPV), calcified and non-calcified plaque volume (CPV/NCPV), lesion length, plaque burden and napkin-ring sign. Cox regression was used to analyze the independent risk factors of MACE, and ROC curve was used to evaluate the diagnostic efficacy of CTA quantitative indicators on MACE. Results In this study, 47 patients (19.67%) developed MACE. There were significant differences in TPV, CPV, NCPV, lesion length, plaque burden and napkin-ring sign between the two groups (all P＜0.05). TPV and plaque burden were independent risk factors for MACE (OR=1.137，P＜0.001；OR=1.075，P=0.002). ROC curve showed the AUC areas single diagnosed of TPV and plaque burden in MACE were 0.764, 0.796, the combined diagnosis was 0.860, diagnostic efficacy and sensitivity were significantly better than single one (all P＜0.05). Conclusion TPV and plaque burden in coronary artery CTA have good predictive value for the occurrence of MACE in patients with coronary heart disease.

Application of the preservation of the left colonic artery in laparoscopic low anterior resection for rectal cancer

CHEN Zheng-min, ZHOU Shao-bo, WANG Fa-bao, CHU Liang

2019, 17(8): 1323-1326. doi: 10.16766/j.cnki.issn.1674-4152.000934

189 0

Abstract:
Objective To investigate the clinical efficacy and feasibility of preservation of the left colonic artery (LCA) in laparoscopic anterior resection of low rectal cancer. Methods The clinical data of 52 patients treated with laparoscopic anterior resection in our hospital from September 2014 to February 2018 were analyzed retrospectively and 52 patients were divided into two groups according to the operation method, including 26 cases with preservation of the LCA and 26 cases with high ligation group in inferior mesenteric artery (IMA). The differences of two groups on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, postoperative anal exhaust time, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months were analyzed and compared. Results There were no differences between LCA group and IMA group on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months (all P>0.05). In IMA group, the postoperative anal exhaust time was (2.80±0.52)d, and postoperative anastomotic leakage number was 6 cases; in LCA group, the postoperative anal exhaust time was (2.44±0.44)d, and postoperative anastomotic leakage number was 0 case; the differences between the two groups were statistically significant (all P<0.05). Conclusion The clinical efficacy of preservation of the left colonic artery (LCA) in laparoscopic anterior resection is equivalent with high ligation group in inferior mesenteric artery. And preservation of LCA could effectively reduce the anal exhaust time and anastomotic fistula rate.

Application experience of double incisions in prone position for treatment of trimalleolar fracture

PAN Shou-feng, YAN Wei, LU Cheng

2019, 17(8): 1327-1330. doi: 10.16766/j.cnki.issn.1674-4152.000935

160 0

Abstract:
Objective To study the application of anterolateral approach to ankle joint under prone position to assist medial incision in the treatment of trimalleolar fracture. Methods Thirty-nine patients with trimalleolar fracture admitted to the Department of Orthopedics, Chuzhou First People's Hospital, Anhui Province from September 2015 to November 2018 were selected. According to Lauge-Hanse classification, 24 cases were supination-abduction type, 10 cases were supination-abduction type, 3 cases were supination-abduction type, 1 case was supination-adduction type, and 1 case was vertical compression type. All patients were treated with medial incision internal fixation assisted by lower posterolateral approach in prone position. The operation position is prone position. The lateral malleolus is firstly restored and fixed through the posterolateral approach. After the restoration of lateral malleolus, it is relatively easy to restore and fix the posterior malleolus due to the stretching effect of the posterior joint capsule. During the operation, the stability of the lower tibiofibular syndesmosis is checked by "hook test". If necessary, the lower tibiofibular syndesmosis is fixed by 3-layer cortical bone screws at the lateral malleolus. The internal fixation sequence is the lateral malleolus and the posterior malleolus. Finally, the medial incision is assisted to restore and fix the medial malleolus, and the steel plate is placed at the posterior side or lateral side of During the operation, the anatomical reduction and internal fixation of trimalleolar fracture were confirmed by screen monitoring of C-arm X-ray machine. The fracture reduction, healing and ankle joint function were observed after operation. Results All 39 patients were followed up for an average of 13 (4-26) months. Baird-Jackson ankle joint scoring system was used in all six months after the operation, with 10 cases (25.6%) with more than 95 points, 23 cases (59.0%) with 91-95 points, 5 cases with 81-90 points, and 1 case with less than 80 points, with a total excellent and good rate of 84.6%. Conclusion Prone lower posterolateral approach assisted with medial incision for trimalleolar fracture is simple and convenient to operate. It can reduce and fix the posterior malleolar fracture block under direct vision. At the same time, lateral malleolus and medial malleolus can also be well exposed, reduced and fixed. It has definite clinical effect and is suitable for trimalleolar fracture surgery.

The analysis of outcomes and dropout causes in peritoneal dialysis patients in a medical center

SHEN Shui-juan, WANG Shi-min, GUAN Ji-chao, DONG Zhi-chao, LI Qing-hua, WANG Yan-yan, YANG Yan-ru, DAN Juan-ping

2019, 17(8): 1331-1334. doi: 10.16766/j.cnki.issn.1674-4152.000936

95 2

Abstract:
Objective To discuss the countermeasures for the peritoneal dialysis (PD) drop-out by analyzing the reason for the patients who have withdrawn from PD. Methods The clinical data of patients at our hospital who started with PD because of chronic renal failure from August 2005 to March 2018 were collected，and the proportions and reasons for dropouts were analyzed. Results A total of 299 patients were recruited in this study. Among them, 143 cases were transferred out of the follow-up system of PD. In detail, 69 cases (48.3%) were transferred to other hospitals for regional or medical reasons, 30 cases (21.0%) were switched to hemodialysis (HD), 16 cases (11.2%) underwent kidney transplantation, and 28 cases (19.6%) died. The first cause of death was cardiovascular and cerebrovascular events (12 cases, 42.9%)，followed by malnutrition (6 cases, 21.4%), infection (5 cases, 17.9%) and tumor factors (5 cases, 17.9%). Higher levels of TC, LDL,DBP and lower levels of total kt/v were found in patients switcher to HD, while higher levels of CRP and PTH, as well as lower levels of residual renal kt/v and total kt/v, were found in patients who switched to HD compared with patients still undergoing PD. Moreover, in death group, patients had significant lower levels of Alb, PTH, DBP, Scr, residual renal Kt/v and total Kt/v, and higher levels of TC, TG and LDL (all P＜0.05). Logistic analysis showed that residual renal Kt/v was inversely correlated with possibility for patients switching to HD (P＜0.05). Cox analysis showed that advanced strating age of PD, high levels of serum CRP, calcium and phosphorus, and low levels of Scr and residual kidney Kt/v were risk factors for mortality in PD patients. Conclusion changing from PD to hemodialysis is the most common cause of dropout in PD patients,followed by death. Peritonitis is the main cause in patients change to HD.cardiac-cerebral vascular is the major cause for death, followed by malnutrition.the lese residual renal Kt/v at the time of catheterization, the easier it is to transfer hemodialysis. Therefore, timely dialysis, standard operation, improvement of nutrition, and control of cardiovascular risk factors are measures to improve the long-term survival of peritoneal dialysis patients.

Inhibit the activity of CD4⁺CD28^null T cells to alleviate diabetic microvascular damage by blocking Kv1.3 channel

YU Xiao-yan, TANG Ke-ke, LYU Di

2019, 17(8): 1335-1339,1412. doi: 10.16766/j.cnki.issn.1674-4152.000937

112 0

Abstract:
Objective To explore the feasibility of remitting diabetic microvascular damage by blocking CD4⁺CD28^null T cell viability used Kv1.3 channel blocker. Methods Total 80 cases diabetes mellitus in the Affiliated Hospital of Medical School of Ningbo University from January 2016 to December 2017 were selected, including diabetes mellitus (DM group), diabetic retinopathy (DR group), diabetic nephropathy (DN group) and diabetic retinopathy and nephropathy (DR+DN group), with 20 cases in each group. Meanwhile, 20 healthy volunteers were selected as the control group. Their CD4⁺CD28^null T cell proportion of peripheral blood was detected and extracted. Human vascular endothelial cells were cultured with 96-well plates, and divided into 5 groups: control group, CD28^null T intervention group, Kv1.3 block group 1, group 2, and group 3. In addition to the control group, CD4⁺CD28^null T cells were co-cultured with all groups. At the same time, Kv1.3 block group 1, group 2, and group 3 were interfered by 2 μL ADWX-1, with a concentration of 0.5 mg/mL, 1.0 mg/mL, and 2.0 mg/mL successively. The peak Kv1.3 potassium current, apoptosis rate of endothelial cells and concentration of INF-γ and TNF-α were measured 48 h later. Results The proportion of CD4⁺CD28^null T cells was increased successively in the order of the control group, DM group, DR group, DN group and DR+DN group, and the difference was statistically significant among the groups (all P<0.05). Compared with the control group, the endothelial cell apoptosis rate, INF-γ and TNF-α concentration of CD28^null T in the intervention group were significantly higher, compared with CD28^null T intervention group, those indexes in Kv1.3 block group 1, group 2 and group 3 was lower, and the difference was statistically significant among the different groups (all P<0.05). Conclusion Blocking Kv1.3 channel can inhibit the inflammatory damage to vascular endothelial cells induced by CD4⁺CD28^null T cells, which is of positive significance to alleviate diabetic microvascular disease.

Study of inflammatory intervention in neonatal necrotizing enterocolitis with erythropoietin

ZHOU Li, LIN Zhen-lang

2019, 17(8): 1340-1343. doi: 10.16766/j.cnki.issn.1674-4152.000938

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Abstract:
Objective To study the clinical effect of neonatal necrotizing enterocolitis (NEC) with erythropoietin and the influences of inflammation and toll like receptor(TLR)4/NF-κB signal pathway. Methods A total of 94 consecutives as NEC from August 2016 to August 2018 were enrolled and divided into control group (n=42) and observation group (n=52) ; those in control group received standard medical treatment plan and those in observation group adopted recombinant EPO intramuscular injection (dosage of 200 IU/kg, twice per week) at the same time for the course of one week. Then to compare differences of complications and mortality incidences, serum levels of TNF-α and IL-6,TLR-4 and NF-κB mRNA before and after treatment. Results In the control group, 21 patients had complications, including 7 cases sepsis, 6 cases acute intestinal perforation, 6 cases infectious peritonitis, and 2 cases other cases. There were 15 cases in the observation group, including 5 cases sepsis and 5 cases acute intestinal perforation, 4 cases infectious peritonitis, 1 other case, The complications and mortality incidences in observation group were both significantly lower than control group (all P＜0.05). What's more, the levels of TNF-α and IL-6 after treatment in observation group were both lower than before, and less than control group (all P＜0.05). The levels of TLR-4 and NF-κB mRNA after treatment in observation group were both lower than before, and less than control group, too (all P＜0.05). Conclusion It can reduce inflammation TNF-α and IL-6 levels by TLR-4/NF-κB signal pathway with EPO in order to improve NEC clinical symptoms and prognosis.

Effect of group B streptococci on pregnancy and pregnancy outcome in late pregnancy women

YE Zhi-yun, LIANG Hui-biao, XU Qun, WU Tian-xia

2019, 17(8): 1344-1346,1359. doi: 10.16766/j.cnki.issn.1674-4152.000939

92 1

Abstract:
Objective To observe the carriage of group B streptococcus (GBS) in pregnant women and its effect on the pregnancy outcome of the mother and fetus. Methods A total of 966 cases of late pregnancy women were as research subjects. Vaginal and rectal secretion of GBS were detected in all subjects. The carrying status of GBS were observed. The pregnancy outcomes of different groups were traced. The difference of pregnancy outcome between the maternal and fetal groups was analyzed statistically. Results The GBS infection rate of all 966 subjects in this study was 9.52%, and there was no significant difference in the rate of GBS infection among the subjects of different ages, abortion history and reproductive history (all P>0.05). The incidence of premature rupture of membranes, amnionitis, intrauterine infection, puerperium infection, neonatal infection, fetal distress and neonatal asphyxia were significantly higher in GBS positive group than in the GBS negative group (all P<0.05). The incidence of amnionitis, intrauterine infection, puerperium infection, neonatal infection, fetal distress and neonatal asphyxia in GBS positive intervention group were significantly lower than that of GBS positive group (all P<0.05). The incidence of amniotic inflammation, intrauterine infection and neonatal infection in GBS positive intervention group was significantly higher than that in GBS negative group (all P<0.05). There was no significant difference in the Apgar score, preterm delivery, cesarean section and postpartum hemorrhage between the three groups (all P>0.05). Conclusion GBS infection in pregnant women in late pregnancy can lead to premature rupture of membranes, amnionitis, intrauterine infection, puerperal infection, neonatal infection, fetal distress and neonatal asphyxia. The incidence of maternal and fetal adverse pregnancy outcomes is increased. The incidence of maternal and infant undesirable pregnancy outcomes can be reduced on a certain course and late pregnancy in the late pregnancy by the implementation of antibiotic prophylactic treatment. Prenatal GBS screening for pregnant women is of high clinical value.

Evaluating the effect of laparoscopic endometriosis operation

WANG Run-qiu, PENG Cheng, FANG Qian-jin, WU Hai-hong, SANG Lin, DU Shi-hua

2019, 17(8): 1347-1349,1371. doi: 10.16766/j.cnki.issn.1674-4152.000940

135 0

Abstract:
Objective To investigate the treatment of endometriosis by laparoscopic surgery, and to evaluate and analyze the therapeutic effect of laparoscopic surgery on endometriosis. Methods A total of 81 cases of endometriosis treated by laparoscopic surgery in our hospital from January 2015 to June 2018 were included as the observation group and 40 cases of endometriosis treated by open surgery in our hospital during the same period were the control group. Retrospective analysis was made to compare two groups in operative time, intraoperative blood loss, postoperative hospitalization days, incidence of adverse reactions, such as postoperative pain of differences. Patients in the two groups were treated with subcutaneous injection of leuprorelin acetate microspheres for 4-6 months after surgery, followed up for 36 months, and the recurrence rates of endometriosis in the two groups were compared, as well as the pregnancy rates of women under 40 years old in the two groups. Results The operative time (56.23±8.59) min, intraoperative blood loss (65.42±6.54) mL, and days of hospitalization (5.23±1.24) days in the observation group were significantly different from those in the control group (100.45±10.03) min, (105.63±8.26) mL, and (7.24±2.56) days (all P<0.05). After 36 months of follow-up, the recurrence rate of 3.70% (3/81) in the observation group was significantly lower than 25.00% (10/40) in the control group, and the pregnancy rate of 56.52% (35/62) in the observation group was significantly higher than 15.00% (3/20) in the control group (P<0.05). Conclusion In the surgical treatment of endometriosis, laparoscopic surgery has the advantages of short operation time, less blood loss, fewer days in hospital, low incidence of adverse reactions, low recurrence rate and high pregnancy rate, which can be considered as the preferred surgical treatment for endometriosis.

Clinical study on umbilical combining infrared therapy for spleen deficiency diarrhea in children

TANG Qin-qin

2019, 17(8): 1350-1352. doi: 10.16766/j.cnki.issn.1674-4152.000941

98 2

Abstract:
Objective To investigate the therapeutic effect of umbilical cord combined with infrared treatment on spleen deficiency diarrhoea in children, thus to find the best treatment for children with diarrhea due to spleen deficiency. Methods A total of 150 children with spleen deficiency diarrhea who were treated in our hospital from January 2017 to January 2018 were selected as study subjects. Digital table method was divided into treatment group and control group, with 75 patients in each group, and the control group were treated with oral bifidus viable triple bacteria capsules. Patients in the treatment group were treated with spleen deficiency and combined with infrared rays for treatment. The group intervention time was 14 days. After the intervention, the treatment efficiency of the two groups was compared. The clinical symptom scores of the two groups before the intervention, the first 4 days of intervention, the first 10 days of intervention and the 14th day of intervention were compared. The number of daily stools before and after the intervention was compared. Results After treatment, the effective rate of treatment was 89.33%, which was significantly higher than that of the control group (68.00%), and the difference was statistically significant (P<0.05). The difference of contrast was not statistically significant (P>0.05). The scores of the treatment group on the 4th, 10th and 14th day after intervention were lower than the corresponding scores of the control group (all P<0.05). After the evaluation, the recovery time of the stool in the treatment group was shorter than that of the control group (P<0.05). There was no significant difference in the number of daily bowel movements between the two groups before intervention (P>0.05). The number of stools per day in the treatment group was lower than that in the control group (P<0.05). Conclusion Umbilical infrared welding joint has a good effect in the treatment of infantile diarrhea spleen disease, which can improve the clinical effect and shorten the treatment time.

Correlation between vitamin C and vitamin E levels and preeclampsia

DONG Lin-na, SHU Lian-ting, WANG Yu-ling

2019, 17(8): 1353-1355,1402. doi: 10.16766/j.cnki.issn.1674-4152.000942

105 0

Abstract:
Objective To analyze the correlation of vitamin C and E levels in pregnant women with pre-eclampsia by using receiver working curve (ROC curve). Methods A total of 412 pregnant women who were initially examined and delivered in our hospital from January 2016 to January 2017 were analyzed. According to whether or not eclampsia occurred after 20 weeks of gestation, they were divided into preeclampsia group (PE group, 68 cases) and the control group (344 cases). High performance liquid chromatography and enzyme immunoassay for serum vitamin C, vitamin E, pregnancy-related plasma protein A (PAPP-A) in the two groups of pregnant women and pre-pregnancy placental growth factor (PLGF) were tested and compared, and the diagnostic value of pre-eclampsia was predicted by ROC curve analysis of vitamin C and E. Results PAPP-A in the early pregnancy was significantly higher in the two groups than in the second trimester. PLGF was lower than the second trimester (P<0.05), and the PAPP-A in the PE group was significantly higher than that in the control group (t=5.333, 6.225, all P<0.05), PLGF was lower than the control group (t=4.398, 7.771, all P<0.05). The vitamin C and E levels in the second trimester of pregnancy were significantly lower in the two groups than in the first trimester, and the PE group was significantly lower than the control group (all P<0.05); different indicators in the second trimester predict the preeclampsia ROC curve showing that the area under the curve of vitamin E is 0.929 which is significantly higher than vitamin C, PLGF and PAPP-A (AUC=0.836, 0.813, 0.756, all P<0.05), the optimal cut-off point of vitamin E at this time is ≤15.003, the sensitivity is 97.0%, and the specificity is 80.6%. Conclusion The levels of vitamin C and E in pregnant women are significantly decreased in the second trimester, which can effectively predict the occurrence of preeclampsia, and has a higher diagnostic efficiency, while the diagnostic efficacy of vitamin E is higher.

Clinical observation on treatment of lumbar disc herniation by Shengyu Decoction and Duhuo Jisheng Decoction combined with Chinese medicine directed permeation therapy

SUN Ming-liang, GAO Xiang, LI Li, ZHANG Yi-yi, JIANG Hong-jun, GAN Xiao-fang, CHEN Xiao-yan, CAO Zhi-hua

2019, 17(8): 1356-1359. doi: 10.16766/j.cnki.issn.1674-4152.000943

182 1

Abstract:
Objective To observe the clinical efficacy of Shengyu Decoction and Duhuo Jisheng Decoction combined with Chinese medicine directed permeation therapy in the treatment of lumbar disc herniation. Methods From January 2017 to December 2017, Hongqiao community health service center, Changning district Shanghai for Chinese medicine patients with low back and leg pain special diseases, 120 cases of lumbar disc herniation were collected. According to the random number table method, divided into two groups: treatment and control. The treatment group was treated with Shengyu Decoction and Duhuo Jisheng Decoction combined with Chinese medicine directed permeation. The control group was treated with diclofenac sodium double-release enteric capsule combined with Intermediate frequency pulse. All patients were treated for one months. And continue to follow up for 3 months. Analysis from visual pain simulation scores, JOA waist and leg pain score and efficacy criteria. Statistical analysis of the results using SPSS 21.0 software. Results The visual pain simulation scores of the two groups were significantly lower than those before the treatment (all P<0.05), and the treatment group decreased significantly (all P<0.05). The scores of JOA waist and leg pain after treatment was higher than those before treatment (all P<0.05), and the treatment group increased significantly (all P<0.05). The total effective rate of the treatment group was significantly higher than that of the control group (P<0.05). The treatment group was better than the control group. After 3 months of follow-up, the visual pain simulation scores of both groups were increased, but the treatment was still lower (P<0.05). The JOA scores were decreased, but the treatment was still higher, and the difference was statistically significant (P<0.05). Conclusion Shengyu Decoction and Duhuo Jisheng Decoction combined with Chinese medicine directed permeation therapy for the treatment of lumbar disc herniation has better clinical efficacy. It is worth promoting in the community.

The integration of community and family management model in rural areas in the secondary prevention of coronary heart disease

LI Fu-jun, YANG Li-juan, HUANG Xiao-ou, LIU Li-ying, KANG Lin, ZHAO Yu, WANG Li-xin

2019, 17(8): 1360-1362. doi: 10.16766/j.cnki.issn.1674-4152.000944

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Abstract:
Objective To explore and establish a new mode of secondary prevention of coronary heart disease with assistant general practitioners as the main body, community health service centers and patients' family members conducting continuous management of coronary heart disease discharged patients, which is suitable for the current rural grassroots medical and health conditions. Methods A total of 100 cases of coronary heart disease patients diagnosed in Beijing Yanqing district hospital from June 2016 to June 2017 were selected as experimental group into "the integration of community and family management" model for secondary prevention of coronary heart disease management and follow-up of 12 months. A review was made of 100 cases of coronary heart disease (CHD) patients with secondary prevention effect 1 year earlier (from June 2015 to June 2016) treated in Beijing Yanqing district hospital who was selected as the control group. A comparative analysis was made regarding to coronary heart disease knowledge awareness (questionnaire) and evidence-based medicine compliance (families of patients with medication type and number of records), coronary heart disease risk factors (every 3 months 1 time of blood pressure measurement), the control of blood glucose, lipids, body weight and smoking cessation rate and the incidence of adverse cardiovascular events. Results Via the "integration of community and family management" model for secondary prevention of coronary artery disease patients, 74% (control, 38%) for coronary heart disease knowledge rate, medication adherence by 88% (control, 46%) were significantly increased (P<0.05); smoking, control weight and lifestyle improvement were not obvious (P>0.05); low density lipoprotein, blood pressure, blood glucose were significantly improved (all P<0.05). There was no significant difference in the incidence of adverse cardiovascular events between the two groups(P>0.05). Conclusion The "integrated community and family management" mode of secondary prevention of coronary heart disease ensures the continuous management of discharged patients, significantly improves the awareness of patients with coronary heart disease, effectively controls the risk factors of coronary heart disease, and improves the compliance of evidence-based drug treatment.

Impact of WeChat education mode on mental health of family members of cancer pain patients

SHUI Xiao-fang, CHEN Wen-yu, LYU Xiao-dong, FANG Zhi-xian, YANG Qi, LU Wei-fen, XU Yu-fen, YAO Ming

2019, 17(8): 1363-1367. doi: 10.16766/j.cnki.issn.1674-4152.000945

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Objective To discuss the impact of WeChat education mode on mental health of family members of cancer pain patients, with the final purpose to improve the mental health level of patients' family members. Methods One hundred cases of family members of cancer pain patients who accepted hospitalization in Respiration Department and Oncology Department of the First Hospital of Jiaxing and discharged with stable condition from February 2014 to December 2014 were divided into control group and observation group according to random number table and each group had 50 cases. Family members in control group accepted the regular health education and those in observation group accepted both regular healthy education and the WeChat health education. WeChat education mode includes establishing WeChat education groups who jointly compile WeChat education contents, sending education contents in WeChat groups regularly, arranging team members to participate in group chat in WeChat, etc. Also, Symptom Check List (SCL-90) and Simplified Coping Style Questionnaire (SCSQ) were adopted to comparatively assess the two groups before education and 5 months after education. Results After education, family members in observation group exhibited no significant difference with those in control group in terms of factor score of phobia and psychoticism (all P>0.05). Factor scores of somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and paranoid ideation in observation group were obviously lower than those in control group, and difference was statistically significant (all P<0.05). Factor scores of self-accusation, illusion, and retreating in observation group were lower than those in control group, and difference was statistically significant (all P<0.05). Factor scores of seeking help and solving problems in observation group were higher than those in control group, with difference exhibiting statistical significance (all P<0.05). Conclusion The application of WeChat mode on mental health education of family members of cancer pain patients obviously improves the perception of family members on cancer pain caused by malignant tumor. Family members can maintain optimistic emotions and conduct normalized management on cancer pain patients. Therefore, both the living quality of cancer pain patients and the mental health level of their family members are improved.

Diagnostic value of serum Copeptin, BNP and cTnI in elderly patients with acute ST segment elevation myocardial infarction

WU Zhong-jing, XIA Ke-hui, ZHONG Shu-gang

2019, 17(8): 1368-1371. doi: 10.16766/j.cnki.issn.1674-4152.000946

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Abstract:
Objective To investigate the value of serum peptide (Copeptin), brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) in the diagnosis of acute ST segment elevation myocardial infarction (STEMI) in the elderly. Methods The changes in the levels of Copeptin, BNP and cTnI were detected in 120 cases of STEMI patients with chest pain within 4 hours (4 h), 12 hours, 24 hours, 48 hours, 5 days and healthy controls. The value of Copeptin, BNP and cTnI in the diagnosis of AMI was evaluated by ROC. Pearson correlation was used to analyze the correlation between serum Copeptin level and BNP, cTnI levels in STEMI patients. Results Serum Copeptin, BNP and cTnI levels in STEMI group at 4 hours, 12 hours, 24 hours, 48 hours and 5 days were significantly higher than those in control group (all P<0.05). In STEMI group, serum Copeptin, BNP and cTnI levels in 4 hours, 12 hours, 24 hours and 48 hours were significantly higher than 5 days (all P<0.05). In STEMI group, serum cTnI levels in 12 hours, 24 hours were significantly higher than 4 hours and 48 hours (all P<0.05). The ROC curve analysis showed that the best cut-off values of serum Copeptin, BNP and cTnI for diagnosis of elderly STEMI were 19.38 pmol/L, 1 560.74 ng/L, 6.75 ng/mL, and three combined diagnosis of senile STEMI were the highest sensitivity and specificity, 96.5% and 93.6%. Correlation analysis showed that serum Copeptin level in STEMI patients were positively correlated with BNP and cTnI levels (r=0.792, P<0.01; r=0.857, P<0.01). Conclusion Serum Copeptin, BNP and cTnI levels in elderly patients with STEMI increase significantly, the three joint detection of elderly STEMI diagnosis has high value.

Application of noninvasive genetic testing combined with ultrasound soft index in fetal chromosome screening

XUE Yong-ming, CHEN Yi-bo

2019, 17(8): 1372-1374. doi: 10.16766/j.cnki.issn.1674-4152.000947

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Objective To discuss the guiding significance of noninvasive genetic testing combined with single ultrasound soft index abnormality in fetal chromosome screening and its influence on perinatal outcome. Methods A total of 410 pregnant women with abnormal soft index of ultrasound were selected from January 2018 to December 2018 in our hospital. As the subjects of this study, 410 pregnant women with positive soft index of ultrasound were tested for non-invasive genes, and pregnant women with high risk of non-invasive gene detection were tested for invasiveness, and chromosome karyotype analysis of villus tissue and amniotic fluid was carried out. The accuracy of diagnosis, chromosome abnormalities and positive distribution of indicators, and perinatal outcomes of high-risk pregnant women in non-invasive gene test results were observed. Results A total of 11 non-invasive high-risk fetuses were detected in 410 pregnant women with positive single ultrasound soft index, and 8 of 11 non-invasive high-risk fetuses showed abnormal trisomy 21. Compared with other abnormal karyotypes, the incidence of abnormal karyotypes in non-invasive high-risk pregnant women was higher. Karyotype abnormalities in non-invasive high-risk pregnant women included trisomy 13, trisomy 18, trisomy 21 and trisomy 21. Abnormal pregnant women choose full-term delivery. Conclusion On the basis of three-dimensional ultrasound, prenatal screening for pregnant women with abnormal ultrasound soft indicators can be detected by non-invasive gene method, which can effectively improve the accuracy of screening, and the use of non-invasive gene detection also has a relatively high quality screening effect. It can effectively reduce the probability of clinical use of invasive screening, and significantly reduce the risk of abortion of pregnant women. It is worth popularizing and applying in clinic.

The application of Xpert MTB/RIF combined with GenoType MTBDRplus in the rapid diagnosis of MDR-TB in Quzhou

YU Xu-liang, HU Chang-di, JIN Ju-xian, LU Jun, XU Li-feng, BAI Yong-feng, ZHU Jin

2019, 17(8): 1375-1378. doi: 10.16766/j.cnki.issn.1674-4152.000948

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Abstract:
Objective To evaluate the value of Xpert MTB/RIF combined with GenoType MTBDRplus in the rapid diagnosis of MDR-TB in Quzhou. Methods Xpert MTB/RIF detection and solid culture were performed in the county level laboratory, GenoType MTBDRplus detection of rifampicin resistant sputum, gene chip identification were performed in municipal laboratory from January 2016 to 2017 December. The sensitivity, specificity,positive predictive value, negative predictive value and Kappa value of Xpert MTB/RIF combined with GenoType MTBDRplus in the rapid diagnosis of MDR-TB in Quzhou. Results When solid culture and liquid drug sensitivity as the gold standard, Xpert MTB/RIF combined with GenoType MTBDRplus in diagnosis of multi drug resistant tuberculosis sensitivity was 82.76% (48/58), the specificity was 99.50% (1 380/1 387), the positive predictive value was 87.27% (48/55) and the negative predictive value was 99.28%(1 380/1 390), Kappa was 0.84. XpertMTB/RIF combined with GenoType MTBDRplus in diagnosis of MDR-TB time was averaged 3.15 days. Xpert MTB/RIF combined with GenoType MTBDRplus detection 1 cases of MDR-TB was 5 470. Conclusion Xpert MTB/RIF and GenoType MTBDRplus have high sensitivity and specificity in the rapid diagnosis of MDR-TB. They can be used for early diagnosis and early treatment of MDR-TB.

Mechanism and significance of angiopoietin-Tie pathway in coronary heart disease

MA Yi-chao, LU Yan, JIA Yong-ping

2019, 17(8): 1379-1383. doi: 10.16766/j.cnki.issn.1674-4152.000949

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Abstract:
As a common cardiovascular disease, coronary heart disease (CHD) continues to be the leading cause of mortality as well as morbidity. The prevention and treatment of coronary heart disease (CHD) has become an important topic in the whole society. It is of great clinical significance to associate angiogenesis with the pathogenesis of coronary atherosclerosis, acute myocardial infarction (AMI), and cardiogenic shock after AMI. Therapeutic angiogenesis may provide new treatment options for patients with coronary heart disease. Angiopoietin (Angiopoietins, Angs)-Tie pathway is an important signal transduction pathway involved in angiogenesis, including Ang1, Ang2, Ang3, Ang4 and its receptor Tie1, Tie2. At present, there are more studies on Ang1, Ang2 and Tie2, in which Ang1-Tie2 mainly maintains vascular system stability, and Ang2-Tie2 is closely related to vascular remodeling. Both plaque growth and instability in atherosclerosis involve neovascularization. Angs is a key factor from the initial stage of plaque formation to the occurrence of acute cardiovascular events. Angs also plays a key role in the pathogenesis of unstable angina pectoris cardiogenic, AMI, and cardiogenic shock after AMI. Angs can become a new indicator of the occurrence and development of these diseases. In treatment, Angs-Tie pathway is a potential therapeutic target for early prevention of coronary atherosclerosis, improvement of cardiac perfusion and function after myocardial infarction, and promotion of collateral circulation. This article reviews the mechanism and significance of Angs-Tie pathway in coronary heart disease.

Research progress on the role of exosomes in metastases and drug resistance of osteosarcoma

CHEN Cheng-long, HAN Peng-fei, SUN Xiao-juan, FENG Yi, LI Peng-cui, LYU Zhi

2019, 17(8): 1384-1387. doi: 10.16766/j.cnki.issn.1674-4152.000950

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Abstract:
Osteosarcoma is a malignant tumor with a poor prognosis, and it has become the leading cause of cancer-related deaths in adolescents. However, due to its early high rate of lung metastasis and extensive resistance to chemotherapeutic drugs, clinical treatment of osteosarcoma remains a huge challenge. At present, advances in the early diagnosis and gene therapy of osteosarcoma have achieved some progress in fundamental researches and clinical applications worldwide. Among them, exosomes have great research prospects in the diagnosis and treatment of osteosarcoma.Exosomes are nanoscale microvesicles(40-100 nm) that can be secreted by a variety of living cells and have the ability to transmit multiple messages and functional substances such as mRNA, miRNA, DNA, and proteins.It can be produced and secreted by a variety of living cells and is present in a variety of body fluids and intercellular fluids. Because of its special existence and transfer form, as well as the information and substances it carries, osteosarcoma-derived exosomes can promote the tumorigenesis, invasion, metastasis, drug resistance, and immune escape of osteosarcoma in many ways. Using above characteristics, exosomes can be artificially loaded with targeted drugs or therapeutic genes, or they can be regulated in various ways to adjust the secretion and release in multiple tumor cells. In recent years,research on the role and application of exosomes in osteosarcoma has become a hotspot, but it still remains in basic research and has not yet been applied in clinical diagnosis and treatment. This article aims to summarize the functional mechanisms of exosomes on the invasion, metastasis and drug resistance in osteosarcoma, as well as the research progress in clinical diagnosis and treatment, hoping this will contribute to develop novel strategies to diagnose, treat and improve the prognosis in osteosarcoma.

Effect of Yijinjing on muscle strength of senile patients with sarcopenia

ZHU Gao-feng, LUO Kai-tao, SHEN Zhi-fang, GAO Feng, FU Yuan-xin, SHEN Qing-he

2019, 17(8): 1388-1391. doi: 10.16766/j.cnki.issn.1674-4152.000951

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Abstract:
Objective To study the effect of Yijinjing on muscle strength of senile patients with sarcopenia. Methods Between January 2015 and December 2016, sixty-five senile patients with sarcopenia from acupuncture and rehabilitation department of traditional Chinese medicine Hospital of Jiaxing were randomly divided into the exercise (Yijinjing) group including 33 senile patients and the blank control group including 32 senile patients in a random number table. The exercise group was intervened for 12 weeks Yijinjing exercise, and then the measuring of handgrip strength, as well as muscle strength of skeletal muscle in lower limbs was performed before the exercise and 4 weeks, 8 weeks, 12 weeks after the exercise. The blank control group only carried out the relevant knowledge of education and guidance, without Yijinjing exercise, but the relevant data collection and recording was made at the same time as Yijinjing exercise group. Then data within and between two groups were collected and ran statistical analysis. Results There was no statistically significant difference between the two groups before the intervention in the handgrip strength and the frequency of sitting up from the chair and squat standing up in 15 s, which was used to measure muscle strength of skeletal muscle in limbs (all P>0.05); After 12 weeks, the handgrip strength, the frequency of sitting up from the chair and squat standing up increased significantly compared with those before the intervention in the exercise group (all P<0.05). And we also got the same results between the two groups after 12 weeks, which were statistically significant (all P<0.05). Yet, there was no significant change in the four strength test results of the blank control group (all P>0.05). Conclusion Yijinjing exercise can significantly improve the elderly skeletal muscle strength and the quality of life of the senile patients.

Application of pig heart anatomy combined with virtual reality simulator in arrhythmia intervention training

SU Hao, CHEN Dong, SHEN Wei, HU Kai, LIU Zhi-quan, XU Jian, YAN Ji

2019, 17(8): 1392-1395. doi: 10.16766/j.cnki.issn.1674-4152.000952

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Abstract:
Objective To study the effect of pig heart anatomy combined with virtual reality simulator in arrhythmia intervention training. Methods A total of 52 arrhythmia intervention refresher doctors were selected in department of cardiology of The Affiliated Provincial Hospital of Anhui Medical University and were divided into the observation group (n=22) and control group (n=30). Doctors in observation group were trained by pig heart anatomy combined with virtual reality simulator while those in control group were taught by traditional teaching method. Theory examination and skill examination in real environment were performed after the training and achievement differences were compared between 2 groups. Results There was no statistical significance in such baseline as gender, age, certificates, working experience and years working in vascular intervention between the two groups(all P>0.05). Theory examination average score in observation group was significantly higher than that in control group (P<0.05). Skill examination average score in observation group was higher than that in control group (P<0.05). Compared with control group, the incidence rate of operative complication was lower in the observation group. Conclusion Teaching method of pig heart anatomy combined with virtual reality simulator can help arrhythmia intervention training, which is worthy of clinical promotion.

The application of CBL combined with PBL in thoracic surgery clinical teaching

LI Xiao-jun

2019, 17(8): 1396-1398. doi: 10.16766/j.cnki.issn.1674-4152.000953

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Abstract:
Objective To explore the application of case teaching method (CBL) combined with problem oriented teaching method (PBL) in clinical teaching of thoracic surgery. Methods A total of 68 clinical medical undergraduate interns who interned in the department of thoracic surgery of the First affiliated hospital of Bengbu medical college from April 2016 to February 2018 were selected as the research objects, and were randomly divided into a double-blind control group and an observation group, with 34 interns in each groups. There was no statistically significant difference in age, gender, education background and other general data between the two groups (P>0.05), which were comparable. Approval was accessed from the ethics committee of Bengbu medical college and informed consent was gained. In the control group, the traditional teaching method was used for clinical teaching, which was conducted by general ward rounds, guiding the removal of drainage tube for surgical dressing change and knowledge lectures. The observation group adopted the dual-track teaching method of CBL and PBL. The two groups were compared for their examination results and the recognition and satisfaction of the teaching methods of the interns. Results There was no significant difference between the theoretical knowledge score of the control group (90.36±3.38) and the observation group (91.84±3.54), P>0.05, while the skill operation score (89.31±3.18) and case analysis score (90.57±3.24) of the observation group were significantly higher than those in the control group (83.14 ±2.27, 84.21±2.38), all P<0.05. The recognition degree of the observation group was higher than that of the control group (all P<0.05). Conclusion The application of CBL combined with PBL in the clinical teaching of thoracic surgery is helpful to improve the performance of skill operation and case analysis of intern students, and the teaching results are well received.

The cultivation of innovative consciousness through the patent application and conversion

WU Qiang, MU Lin-lin, ZHAO Xiao-yan, WANG Hua-xue, HE Xian-di, FANG Qiang

2019, 17(8): 1399-1402. doi: 10.16766/j.cnki.issn.1674-4152.000954

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Abstract:
Encourage people to start their own businesses and to make innovations is one of the national strategies of our country. Colleges and universities are the gathering place of national talents, important places for the country to train talents, and the main bases for undergraduates to receive innovative consciousness training. Undergraduates should become an important subject of national science and technology innovation. They are full of vigor, active thinking, easy to accept new ideas, new things, and are prone to generate some unique ideas and insights in the process of receiving professional knowledge training. Teachers should regard the cultivation of innovative consciousness as a crucial teaching task. Guiding students to apply for patents is an important teaching method to cultivate students' innovative consciousness. This article takes the author's patent as an example to discuss the cultivation of college students' innovative consciousness from the following four aspects. ①Patent proposal. The presentation of a problem is inherently innovative. When college students have questions about a certain problem, which is based on the mastery of professional knowledge and the perception of the lack of existing technology. This requires teachers to help students analyze problems at a higher level of knowledge. ②The design of the patent is the process of solving the problem. The process of solving problems is the process of innovation, which is the embodiment of the ability of college students to innovate and practice. The design of patents should follow three basic conditions: novelty, creativity and practicality. ③The declaration of patents helps to cultivate the innovation ability and intellectual property awareness of college students. ④The patent conversion realizes innovative value. The patent conversion is an important part of innovation system, but it is also the weakest link. Colleges and universities should take countermeasures to help teachers and students smoothly carry out patent conversion. Teachers should help undergraduates reflect their innovative ideas in the form of patents. Through the patent application and conversion, college students' innovative awareness and ability will be more comprehensive training and exercise.

The study of clinical characteristics and prognosis in acute ischemic stroke patients with paroxysmal atrial fibrillation

LI Xin-yan, TANG Ying, SUN Hong-wei, LI Fang, WANG Ping, ZHAO Jing-bo

2019, 17(8): 1403-1407. doi: 10.16766/j.cnki.issn.1674-4152.000955

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Abstract:
Objective To investigate clinical characteristics and prognosis in acute ischemic stroke (AIS) patients with paroxysmal atrial fibrillation (AF). Methods We prospectively collected 731 patients with AIS who were hospitalized in the Stroke Unit, First Affiliated Hospital of Harbin Medical University from January to December in 2017. AF and its type were defined according to the patient's disease history, admission electrocardiogram and cardiac monitoring during hospitalization. Follow-up prognostic status at discharge and three months. The clinical features and prognosis of paroxysmal AF group and non-AF group, paroxysmal AF group and persistent AF group were compared. Results ①Compared with AIS patients without AF, patients with paroxysmal AF had more severe neurological impairment at admission (P<0.001). A higher proportion of patients with severe neurological impairment(P=0.002). The proportion of heart failure, coronary heart disease, myocardial infarction, and abnormal renal function was higher (all P<0.05). Increased risk of adverse prognosis at discharge and three months [OR(95% CI)：2.190 (1.111, 4.316), 3.399 (1.701, 6.791)] in patients with paroxysmal AF. ②Compared with AIS patients with persistent AF, patients with paroxysmal AF had a lower proportion of heart valvular disease (P<0.001), and a significantly higher rate of remission during hospitalization (P=0.017). Conclusion Paroxysmal AF patients with AIS have more serious neurological deficits, more associated diseases than AIS patients without AF. Only patients with paroxysmal AF had a lower proportion of valvular heart disease compared with patients with persistent AF. Comparing with patients without atrial fibrillation, paroxysmal atrial fibrillation was a risk factor for discharge and three-months poor prognosis in AIS patients.

Analysis of long non-coding RNA expression profile in papillary thyroid carcinoma

GUO Run-sheng, WANG Yuan-qiang, SHI Pei-dong, SHEN Na

2019, 17(8): 1408-1412. doi: 10.16766/j.cnki.issn.1674-4152.000956

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Abstract:
Objective Long noncoding RNAs (lncRNAs) play an important role in cancer growth and development. Gene chip technology was used in this study to screen the differential expression lncRNA in papillary thyroid cancer. Targeted genes regulated by these lncRNA were predicted and analyzed. Methods Microarray was used in this study to investigate the lncRNA expression in three paired samples of papillary thyroid cancer (PTC) and paired adjacent noncancerous thyroid tissue. Gene function was evaluated by Gene Ontology (GO) and pathway analysis. Potential target genes of lncRNAs were also predicted. Results Compared with the adjacent noncancerous thyroid tissue, a total of 855 lncRNAs displayed differential expression in tumor tissues, including 195 up-regulated lncRNAs and 660 down-regulated lncRNAs (FC>2, P<0.05). 2 370 differently expressed mRNAs were found of which 801 were upregulated and 1 569 were downregulated (FC>2, P<0.05). Among them, the more differential expression lncRNAs were 23, while mRNA were 79 (FC>4). lncRNA-SLC34A2 with its related mRNA GRCh38 (NM_001177998) was the most dysregulated lncRNA and mRNA with a FC of 23.5. Significantly enriched GO terms and pathways among differentially expressed mRNAs were identified. Some were related to cancer, such as "Focal adhesion", "ECM-receptor interaction", "MAPK signaling pathway" and "PI3K/AKT signaling pathway". Forty-two pathways were significantly enriched among the differentially expressed transcripts showed by pathways analysis (P<0.05). Among them, 'Focal adhesion' (P=8.499×10^-7) was the most enriched pathway which was directly associated with 47 differential expressed genes. In all, 239 lncRNAs with its related mRNAs may be associated with cis-regulation. The relative positional relationship between the locus of lnRNAs and mRNAs were in different site of the gene. Conclusions Our study is the supplement to the related lncRNA profile of thyroid tumor. We found certain numbers of differentially expressed lncRNAs and predict its functional targeted genes and pathways. In the future, we will select greater numbers of samples to deepen the research into the lncRNA molecular mechanism and biochemical function, in order to provide a novel accurate method for the early diagnosis and therapy of thyroid cancer.

Recognition of primary healthcare workers on gatekeeping and influencing factors in Shandong

NIU Dan-dan, LYU Ben-yan

2019, 17(8): 1413-1416. doi: 10.16766/j.cnki.issn.1674-4152.000957

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Abstract:
Objective To investigate the recognition of primary healthcare workers (PHWs) on the gatekeeping and its influencing factors. Methods From June to September 2016, eight hundred and seventy-nine PHWs were surveyed with stratified cluster sampling method in Qingdao, Zibo and Heze, Shandong province. The multivariate logistic regression analysis was used to analyze the factors that influenced primary healthcare workers on gatekeeping. Results About 59.50% of primary healthcare workers approved of the implementation of gatekeeping. They believed that it played a positive role in guiding residents to seek medical treatment at the grassroots level, improved the consultation rate at the primary level and conducive to chronic disease management (48.46%), believed that medical resources could be optimized and rationally utilized (36.52%), reduced the cost of diagnosis and treatment of patients (35.15%). Lack of medical equipment (48.24%), shortage of general practitioners (36.86%), relatively low residents' trust in grassroots medical and health institutions (36.41%) were main obstacles to the implementation of the gatekeeping. The result shows that the differences exist in length of employment and average monthly earnings of PHWs, the proportion of reimbursement for medical treatment in primary medical and health institutions, professional training, the professional competence of the primary medical and health. And the difference of recognition of gatekeeping by PHWs was statistically significant (all P<0.05). Conclusion The PHWs have a higher recognition of gatekeeping. This suggests that from the point of view of PHWs it is feasible to implement the gatekeeping.

Risk factors of hypoglycemia in patients with type 2 diabetes mellitus treated with insulin for the first time and nursing countermeasures

ZHANG Ling-fei, ZHANG Wei, WU Tian-feng

2019, 17(8): 1417-1420. doi: 10.16766/j.cnki.issn.1674-4152.000958

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Abstract:
Objective To explore the high risk factors of adverse reactions such as hypoglycemia in patients with type 2 diabetes mellitus after initial insulin treatment, and to put forward suggestions on nursing measures. Methods The clinical data of 90 inpatients with type 2 diabetes mellitus who first used insulin in our hospital from January 2017 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to the occurrence of hypoglycemia during the follow-up period of one year after discharge, and according to the occurrence of hypoglycemia, they were divided into two groups. The basic data, state-trait anxiety and insulin treatment knowledge questionnaire scores, biochemical indicators and oxidative stress indicators were collected to identify the high-risk factors for adverse reactions, and nursing intervention was given. The occurrence of hypoglycemia and changes of related indicators were observed after intervention. Results There were significant differences in body mass index, S-AI, T-AI, insulin treatment knowledge score, albumin, serum creatinine, triglyceride, fasting C-peptide, urinary protein, glycosylated hemoglobin and 8-carboxydeoxyguanosine levels between the two groups (all P<0.05). Body mass index, insulin therapy knowledge assessment and glycosylated hemoglobin content were independent protective factors for preventing hypoglycemic reaction, while serum creatinine level, urinary protein quantification and S-AI, T-AI were high risk factors for hypoglycemic reaction (all P<0.05); after targeted nursing intervention, the incidence of hypoglycemia in the observation group decreased from 39 cases to 10 cases (χ²=46.163, P<0.05). After intervention, the ST-AI of observation group was lower than that before intervention, while the score of insulin therapy knowledge questionnaire was higher than that before intervention (all P<0.05). Conclusion In the first intensive insulin therapy for type 2 diabetes mellitus, for type 2 diabetes mellitus patients with low body weight, low glycosylated hemoglobin content and initial insulin treatment, more attention should be paid to the knowledge of insulin use, trial teaching and the occurrence of hypoglycemic reaction after insulin treatment, so as to obtain better clinical prognosis.

Evaluation of seamless butt nursing in improving the nursing effect of emergency digestive endoscopy

ZHANG Qing, YAO Ai-qun, LIU Yin-ge, ZHENG Hai-lun

2019, 17(8): 1421-1423. doi: 10.16766/j.cnki.issn.1674-4152.000959

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Abstract:
Objective To investigate the application effects and the characters of seamless butt nursing in acute digestive endoscopy nursing, with a view to provide better basis and foundation for the application of seamless butt nursing in emergency digestive endoscopy diagnosis and treatment. Methods Seventy-eight cases underwent acute digestive endoscopy in our hospital were selected as the research object, and according to the random number table method divided into observation group and control group. For the control group, 39 patients was given routine nursing, and for the observation group, 39 patients was implemented additionally seamless docking nursing. The two groups were observed and compared after treatment of anxiety self-rating scale (SAS) and self-rating depression scale (SDS) score, the incidence rate of adverse reaction and nursing satisfaction. Results The SAS and SDS scores were 48.3±5.1 and 48.9±6.2 before nursing in the patients of the observation group, and the SAS and SDS scores were 24.1±4.9 and 25.8±3.1 after nursing. The SAS and SDS score of the patients in the observation group after nursing were decreased. The SAS and SDS score were 49.6±4.7 and 48.5±6.7 before nursing in the patients of the control group, and the SAS and SDS score were 37.8±5.0 and 35.3±6.2 after nursing. The SAS and SDS score scales of the patients in the control group after nursing were decreased. The two scores in the patients in the observation group after nursing were significantly lower than those in the control group, and the above data within and between groups were significantly higher (all P<0.05). The degree of nursing satisfaction in the observation group (97.44%) was significantly higher than that of the control group (82.05%). The incidence of adverse reactions was significantly lower than that in the control group (5.13% vs. 12.82%), but the difference between the two groups were no significant difference (P=0.235). Conclusion Implementation of seamless docking nursing effect in the acute treatment of gastrointestinal endoscopy in patients can significantly alleviate the negative emotions of patients, improve the clinical nursing satisfaction, shorten treatment time.

Analysis of the application effect of Orem self-care mode in the nursing of elderly patients with diabetes

FANG Yuan, WANG Xiao-ling, XU Shan-shan, REN Yu-zhen, WU Mei, GUAN Xue

2019, 17(8): 1424-1426. doi: 10.16766/j.cnki.issn.1674-4152.000960

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Objective To explore the application effect of Orem self-care mode in nursing care of elderly patients with diabetes. Methods Sixty-four elderly patients with diabetes treated in department of geriatrics of the first affiliated hospital of USTC from December 2017 to September 2018 were selected as samples. The total cases were divided into observation group and control group according to the random digital table method, with 32 cases in each group. The observation group received Orem self-care nursing intervention, while the control group only received routine nursing. The quality of life and self-care ability of the two groups before and after intervention were compared based on Adjusted Diabetes-specific Quality Of Life Scale (A-DQOL) and Activity of Daily Living Scale (ADL). Results After Orem self-care mode nursing intervention, the A-DQOL grades of the observation group and the control group were (66.11±4.48) and (80.88±4.38), respectively. The difference was statistically significant(t=-13.336, P<0.05); the Barthel grades of the observation group and the control group were (83.24±3.65) and (72.61±3.35), respectively. The difference was statistically significant (t=12.137, P<0.05); The knowledge awareness rate about diabetes and health behavior rate in the observation group were better than those in the control group, and the difference was statistically significant (all P<0.05). Conclusion The application of Orem self-care mode can significantly improve the survival quality, self-care ability and cognitive ability of patients with disease knowledge, and promote patients to choose a healthier behavior pattern, which is conducive to blood sugar control and prognosis rehabilitation.

Risk factors analysis of postoperative delirium in elderly patients with hip fracture and nursing strategies

ZHANG Cui-qin, JIN Qian-kun

2019, 17(8): 1427-1429. doi: 10.16766/j.cnki.issn.1674-4152.000961

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Abstract:
Objective To investigate the risk factors of postoperative delirium in elderly patients with hip fracture and the nursing strategies. Methods Seventy-four patients with postoperative hip fractures who underwent senile hip fracture between January 2016 and September 2018 were enrolled in the sputum group. One hundred and ninety-eight patients who had no sputum after hip fracture in the elderly were the sputum group. Two groups of gender, previous history of rickets, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, operation time, postoperative hypoxemia, severe pain after surgery The situation was statistically analyzed, and single factor and multivariate analysis were used to determine the risk factors for postoperative delirium in elderly patients with hip fracture. Results Univariate results showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Multivariate logistic regression analysis showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Conclusion The previous history of rickets, use of antipsychotics before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, postoperative hypoxemia, postoperative severe pain is elderly hip Risk factors for postoperative delirium in patients with fractures, risk factors should be emphasized in the clinic, and treatment and care should be done to prevent postoperative delirium.

2019, 17(8): 1430-1432. doi: 10.16766/j.cnki.issn.1674-4152.000962

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2019 Vol. 17, No. 8

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