中华全科医学

Review and prospect of health management research in China

BAO Yong, ZHANG An

2019, 17(9): 1433-1436. doi: 10.16766/j.cnki.issn.1674-4152.000963

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The report of the 19th national congress of the communist party of China points out that the implementation of the healthy China strategy is to improve the national health policy, providing people with a full range of health services. It has been 70 years since the founding of the People's Republic of China. The development process of health cause can be divided into five stages, namely, the start-up period, the period of severe damage, the new historical period, the period of new health reform and the future of health cause development. Each period has different characteristics. In the start-up period, China established the health policy of "Integrating Chinese and western medicine, focusing on prevention", and established the medical security system framework that has affected China so far. During the period of severe damage (1966-1976), the health service system suffered from serious damage, however, barefoot doctors played a practical role in promoting cooperative medical system at this particular stage in history. In the new historical period (1978-2004), the country carried out some important issues such as the marketization of health service, medical security system, hospital management system, professionalization of hospital management personnel, public health emergencies and so on. In the new round of health reform (2005-2015), the state has carried out practice and exploration on community health service, medical expense control, new rural cooperative medical system and other issues. From 2015, China mainly focuses on hierarchical diagnosis and treatment, the implementation family doctor system, modern hospital management system, and the development of health industry under the background of big data.

XU Wen, WANG Guo-ping

2019, 17(9): 1437-1438.

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Using pancreatic stent to prevent complications after ERCP for common bile duct stones

TAO Tao, ZHANG Ming, ZHANG Qi-jie, LI Ming-dong, LI Gui-hua, TANG Bing-xi, ZHU Xiao

2019, 17(9): 1439-1442. doi: 10.16766/j.cnki.issn.1674-4152.000964

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Objective To investigate the application and value of pancreatic stents combing nasal biliary tube (NBT) after Endoscopic Retrograde Cholangiopancreatography (ERCP) for removal of difficult and large common bile duct stones and its prevention of pancreatitis and hyperamylasemia. Methods From January 2016 to April 2018 a total of 113 patients who had difficult and large common bile duct stones received ERCP procedure in endoscopy center of Zibo Central hospital. They were randomized to non-stent group (NS group), who receive nasal biliary tube (NBT) placement after ERCP procedure, and stent group (S group). Patients in the stent group were treated with pancreatic stent and NBT placement after the conventional ERCP procedure. The successful stone clearance rate, incidence of post-ERCP pancreatitis (PEP), pancreatitis severity rating, hyperamylasemia and scores of abdominal pain were analyzed using t test and χ² test. Results Of the 57 patients in NS group, 47 achieved successful stone clearance(82.46%), 10 cases PEP(17.54%), 2 severe PEP and 15 cases hyperamylasemia (26.32%). The score of abdominal pain was (4.33±1.09). There were 56 patients in S group, 45 cases (80.36%) achieved successful stone clearance, PEP and hyperamylasemia were 3 cases and 6 cases respectively (5.36%,10.71%), and no severe PEP was observed in S group.The score of abdominal pain was (3.56±1.37). There was no significant difference in the successful clearance rate and the incidence of severe PEP between the two groups (all P>0.05), while PEP, the hyperamylasemia and the scores of abdominal pain were lower in the S group (all P<0.05). Conclusion For patients with difficult and large common bile duct stones, placement of pancreatic duct stent with NBT after ERCP can reduce PEP, the hyperamylasemia and score of abdominal pain, but do not have significant influence on successful clearance rate and the incidence of severe PEP.

Analysis of the fear of cancer recurrence and contributory factors in patients with nasopharyngeal carcinoma

LI Ying-fei, LIU Yu-yao, WEI Jie-li, ZHANG Xiao-fang, YAO Qiu-yu, XU Qiong-zhu, CHEN Wen-hui

2019, 17(9): 1443-1446. doi: 10.16766/j.cnki.issn.1674-4152.000965

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Objective To investigate the fear of cancer recurrence (FCR) and its contributory factor in patients with nasopharyngeal carcinoma, and to provide evidence for targeted intervention. Methods A total of 228 patients with nasopharyngeal carcinoma who were admitted to the oncology department of two top three hospitals in our city between March to December 2018 were recruited and the FCR was surveyed by using the General Survey, Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Perceived Social Support Scale (PSSS) and Simplified Coping Style Questionnaire (SCSQ). The single factor analysis, Pearson correlation analysis and multiple stepwise regression analysis were performed to analyze the contributory factor for the FCR score of patients with nasopharyngeal carcinoma. Results The FCR score of patients with nasopharyngeal carcinoma was (37.14±9.28) points; Single factor analysis showed that the FCR scores of patients with nasopharyngeal carcinoma were different in age, education level, monthly income, and tumor clinical stage (all P<0.05); Pearson correlation analysis showed that the FCR of patients with nasopharyngeal carcinoma was negatively correlated with in-home support, out-of-home support, perceived social support total scores, and positive coping (P<0.05), and positively correlated with negative coping (all P<0.05); Multiple stepwise regression analysis showed that the positive coping, tumor clinical stage, social support, and education level entered the regression equation in turn (F=29.842, P<0.001; R²=0.368, adjusted R²=0.356). Conclusions The patients with nasopharyngeal carcinoma have higher FCR level, positive coping, clinical stage of tumors, social support, and education level are the main contributory factor of FCR in patients with nasopharyngeal carcinoma. Health care workers should pay more attentions to the FCR level of patients with nasopharyngeal carcinoma, and develop targeted interventions to help patients establish and maintain a good social support system, encourage patients to respond positively, and thus reduce and control the patient's FCR level.

Clinical and psychological characteristics of overlapping dyspepsia in patients with gastroesophageal reflux disease

HU Xiang-peng, ZHANG Shen-shen, WANG Qiao, CAO Hong-xia, LIU Jun

2019, 17(9): 1447-1449,1550. doi: 10.16766/j.cnki.issn.1674-4152.000966

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Objective Overlap of dyspeptic symptoms often leads to poor response to therapy in gastroesophageal reflux disease (GERD) patients, which may be associated with psychological factors. This study is to study the clinical and psychological characteristics of overlapping dyspepsia in patients with GERD. Methods One hundred GERD patients with typical acid reflux and heartburn symptoms were collected from the second affiliated hospital of Anhui Medical University from January to November 2018. All participants were evaluated with Reflux Disease Questionnaire (RDQ) score, Patient Health Questionnaire-9 (PHQ-9), The Generalized Anxiety Disorder 7-item scale (GAD-7) and Pittsburgh Sleep Quality Index Scale (PSQI). The scores of overlapping dyspeptic symptoms including epigastric pain, post-prandial fullness, epigastric burning, early satiation, belching and nausea were recorded. All statistical analyses were performed using SPSS software (version 17.0). Results Among the 100 GERD patients, the prevalence of GERD overlapping dyspepsia was 37%. Patients with GERD overlapping dyspepsia had higher score of RDQ, GAD-7, PHQ-9 and PSQI than GERD alone and the difference was statistically significant(all P<0.05). In patients with GERD overlapping dyspepsia, the dyspeptic symptom score was positively correlated with the severity of RDQ score and the score of GAD-7, PHQ-9 and PSQI (all P<0.05). Among dyspepsia symptoms, epigastric pain and nausea were significantly related to the score of GAD-7, early satiation and nausea were significantly related to the score of PHQ-9 and PSQI (all P<0.05). Multivariate linear regression analysis also showed that early satiation and nausea were significantly related to the score of PHQ-9 and PSQI. Conclusions Patients with GERD overlapping dyspepsia have more obvious clinical symptoms, more anxiety and depression, and worse sleep quality. Epigastric pain, early satiation and nausea may be important symptoms of mental and psychological abnormalities in patients with GERD.

Experimental study on treatment of osteoporosis with puerarin and zinc in ovariectomized rats

WANG Zhen-hao, LIN Zhang-yuan

2019, 17(9): 1450-1453. doi: 10.16766/j.cnki.issn.1674-4152.000967

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Objective To study the curative effect of puerarin combined with zinc on osteoporosis in ovariectomized rats and discuss the function of drug combination against osteoporosis in ovariectomized rats. Methods Sixty female SD rats were randomly divided into 6 groups: sham operation group, control group, zinc supplementation group, puerarin group, estradiol group and combination therapy group. The rats received bilateral ovariectomy (the other 5 groups) or sham operation (SHAM group) respectively. The rats in the zinc supplementation group, the puerarin group, the estradiol group and the combination therapy group were given zinc supplementation, puerarin, estradiol Alcohol and puerarin combined with zinc supplementation, respectively. After 10 weeks of treatment, the changes of serum zinc, calcium, phosphorus, alkaline phosphatase (ALP), osteocalcin, CTX, OPG and RANKL; lumbar 4 and femoral bone mineral density (BMD); tibial bone micro-parameters were tested and analyzed. Results BMD of puerarin group, zinc supplementation group, estradiol group and combination therapy group were significantly increased. The mean values of BV/TV, Tb.Th, Tb.Sp, and serum levels of serum zinc, calcium, phosphorus, alkaline phosphatase (ALP), osteocalcin, CTX, OPG and RANKL were improved obviously when compared with the control group (all P<0.05). Compared with the puerarin group and zinc supplementation group, the above indexes in the combination therapy group were improved more obviously (all P<0.05). Conclusion The puerarin and zinc show synergistic effects on both stimulation of bone formation and suppression of bone resorption in ovariectomized rats, thereby increase bone mass.

Effects of recombinant IL-35-BCG neonatal inoculation on Tregs/Th17 balance in experimental asthma model

PENG Wan-sheng, LYU Ping, DONG Huai-fu

2019, 17(9): 1454-1457,1462. doi: 10.16766/j.cnki.issn.1674-4152.000968

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Objective To observe the effects of recombinant IL-35-BCG(rBCG) neonatal inoculation on Tregs/Th17 balance in experimental asthma model. Methods We divided Neonatal BALB/c mice into 3 groups: IL-35-BCG, OVA and control groups. Within 2-3 days after birth, mice in IL-35-BCG group were inoculated with IL-35-BCG subcutaneously. At 4-week and 6-week, using the intraperitoneal OVA with alum sensitization protocol as mice in OVA group. Mice were used to perform asthma model and were challenged by an aerosol of OVA at 7- week for one week. Within 24 hours after the last atomization, the proportion of Th17 cells and Tregs cells was detected by flow cytometry. Results After sensitization, the proportion of Th17 cells and Tregs cells were no significant difference between the neonatal IL-35-BCG group and OVA group. After stimulation, the percentage of Th17 cells in IL-35-BCG group was significantly lower than in OVA group, while the percentage of Tregs cells was significantly higher than that in OVA group. Conclusion Tregs in IL-35-BCG group is significantly higher than those in OVA group and control group after stimulation, while the proportion of TH17 cells is significantly lower in the IL-35-BCG group than those in the other two groups. This further indicates that the anti-asthmatic effect of neonatal IL-35-BCG vaccination is mainly through changing Tregs/Th17 balance.

Expression level and prognostic significance of receptor tyrosine kinase in gastric cancer patients

HUANG Guo-qiang, HUANG Yi-bo, ZHANG Hai-qiang, XU Guo-fu

2019, 17(9): 1458-1462. doi: 10.16766/j.cnki.issn.1674-4152.000969

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Objective To explore the expression of EGFR, c-Met, PDGFR and VEGFR in gastric cancer tissues and its prognostic significance. Methods One hundred and eighteen cases gastnic cancer patients in our hospital between January 2012 to August 2015 were selected. The levels of EGFR, c-Met, PDGFR and VEGFR in gastric cancer tissues were tested. The clinical and pathological differences among the patients with different levels of receptor tyrosine kinase were studied. The influence of the levels of receptor tyrosine kinase was evaluated. Results No significant difference in tumor location, diameter and pT stage were found between EGFR positive and negative group (all P>0.05), while the differentiated degree of cells was significantly lower and pN stage was significantly high in EGFR positive group (all P<0.05). No significant difference in tumor location and tumor diameter were found between c-Met positive and negative group (all P>0.05), while differentiated degree of cells was significantly lower, pT and pN stag were significantly higher in c-Met positive group (all P<0.05). No significant difference in tumor location, differentiated degree, tumor diameter and pT stage were found between PDGFR positive and negative group (all P>0.05), while pN stage was significantly higher in PDGFR positive group (P<0.05). No significant difference in tumor location, differentiated degree and diameter were found among VEGFR positive and negative group (all P>0.05), while pT and pN stage were significantly higher in VEGFR positive group (all P<0.05). The death risk of negative group of these four index were significantly lower than the matching positive group (all P<0.05). pT stage and pN stage were risk factors for bad prognosis of gastric cancer. Conclusion The positive expression of EGFR, c-Met, PDGFR and VEGFR may result in a bad prognosis. pT stage and pN stage are the risk factors for bad prognosis of gastric cancer.

The predictive value of total IgE, IgA and complement C3 for prognosis in children with Henoch-Schonleinpurpura

LIU Na-na, DING Zhou-zhi, CHEN Qiong, XU Jing, JU Se-hua, PENG Wan-sheng, XU Jia-xin

2019, 17(9): 1463-1466. doi: 10.16766/j.cnki.issn.1674-4152.000970

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Objective To investigate the relationship between hospital stays or duration of clinical symptoms and total immunoglobulin E levels in children who were diagnosed allergic purpura. To study the changes of total IgE, IgA and complement C3 in children with allergic purpura. Methods The hospitalized children diagnosed with allergic purpura in the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2018 were selected as research objects, and the serum allergen total IgE, IgA and complement C3 levels in children with allergic purpura were retrospectively analyzed. T-test of two independent samples was used for analysis, and multivariate regression analysis was performed. SPSS 22.0 software was used for data analysis. Results The total IgE levels with the length of hospital stay longer than the total IgE level of normal children, and skin rashes, joints, and the digestive tract symptoms last longer. The hospital stays and symptoms duration of children with reduced complement C3 levels were significantly higher than those with normal complement C3 levels. Children with elevated IgA levels had longer hospital stays than those with normal IgA levels, and the rash, gastrointestinal and joint symptoms lasted longer. The multiple regression analysis showed that the total IgE level had a significant positive correlation with the number of days of hospitalization, rash, abdominal pain and joint pain duration in children with allergic purpura, while the complement C3 level had a significant negative correlation with the number of days of abdominal pain duration, while the IgA level had no significant correlation with the number of days of hospitalization, rash, joint pain and abdominal pain duration. Conclusions The total IgE level of children with allergic purpura can be used as one of the indexes to evaluate and predict the disease outcome. Compared with IgA and C3, the total IgE of children with allergic purpura is more predictive of prognosis. The levels of IgA and IgE are increased in HSP children, while the levels of complement C3 are decreased.

Effects of different doses of dexmedetomidine on agitation after ketamine anesthesia in children

ZHU He-ye, XU Jun-mei, RUAN Wei, XU Xia, XU Jing-hong

2019, 17(9): 1467-1469,1473. doi: 10.16766/j.cnki.issn.1674-4152.000971

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Objective To investigate the effects of different doses of dexmedetomidine on restlessness after ketamine anesthesia in children undergoing short-term surgery. Methods From January 2017 to June 2017, 90 pediatric patients aged 11-15 years who underwent ketamine anesthesia and minor surgery in the Department of Pediatrics, Xiangya Second Hospital of Central South University were divided into group A, B and C according to the random number table method. Thirty patients in each group were given ketamine intravenously at a dose of 1 mg/kg at the beginning of operation, and then group A received intravenous maintenance anesthesia at a rate of 0.2 μg/(kg·h) of dexmedetomidine. Group B was anesthetized at a rate of 0.4 μg/(kg·h). Group C was anesthetized at a rate of 0.8 μg/(kg·h). The patients had the same operation mode. The recovery time and extubation time of the children were compared. Malviya score was used to evaluate the incidence of restlessness after the operation, Ramasy sedation score was used to evaluate the condition of the children after the operation, and finally vision was used. The analogue scale (VAS) was used to evaluate the pain level of children 1 and 2 hours after operation. Results The shortest wake-up time and extubation time were found in group A, followed by group B, and the longest was in group C, with statistical significance (all P<0.05); the restlessness rate in group A was higher than that in group B and C, and that in group C was higher than that in group B, with statistical significance (all P<0.05); Ramasy sedation score in group A was (1.32±0.21), group B was (3.14±0.51), and group C was (4.22±0.61). Significance (P<0.05), in which group C was higher than group A and B, and group B was higher than group A (all P<0.05); VAS score of group A was the highest at 1 h and 2 h after operation, followed by group B, and VAS score of group C was the lowest, with statistical significance (all P<0.05). Conclusion The use of 0.4 μg/(kg·h) dexmedetomidine in children undergoing minor surgery after anesthesia with low dose ketamine can shorten the recovery time and extubation time, reduce the occurrence rate of restlessness and pain, and reduce the occurrence rate of sequelae such as sleepiness after surgery.

Clinical study of the role of ulinastatin in perioperative period of pancreatic cancer

YU Zhi-long, RONG Ze-yin, DOU Jin, HUANG Ke-jian, QIU Zheng-jun, HUANG Chen

2019, 17(9): 1470-1473. doi: 10.16766/j.cnki.issn.1674-4152.000972

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Objective To study the effects of Ulinastatin on the incidence of pancreatic fistula, levels of inflammatory mediators, immune function and prognosis in patients with pancreatic cancer during perioperative period. Methods A total of 90 patients with pancreatic cancer admitted to our hospital from March 2015 to December 2017 were enrolled and divided into Ulinastatin group A, Ulinastatin group B and control group according to the perioperative management plan, with 30 cases in each group. Ulinastatin was given to Ulinastatin group A for 5 days before and after the surgery. Group B was treated with Ulinastatin for 3 days before and after the surgery, while the control group was given for 3 days before and after the surgery. The peritoneal fluid drainage, amylase content of the drainage fluid, inflammatory mediators, immune index and prognosis of patients were compared among the three groups. Results The intraperitoneal drainage and amylase content of Ulinastatin group A and group B were lower than those of the control group, the difference was statistically significant (all P<0.05), but there was no significant difference between group A and group B. The levels of inflammatory mediators in group A and group B were lower than those in the control group (all P<0.05), but there was no significant difference between group A and group B. The ratio of CD4⁺ lymphocytes to all lymphocytes and the ratio of CD4⁺/CD8⁺ lymphocytes in Ulinastatin group A and group B were significantly higher than those in the control group (all P<0.05). There was no significant difference in CD3⁺ and CD8⁺ among the three groups. The survival rate of Ulinastatin group A and group B was higher than that of the control group. The survival rate of group A was slightly higher than that of group B, which was not statistically significant. Conclusion Ulinastatin can reduce the exudation of pancreatic juice and the incidence of pancreatic fistula in perioperative pancreatic cancer patients, and improve the survival rate and prognosis of patients.

Effect of miR-634 level on the growth of nasopharyngeal carcinoma cells and its mechanism

PU Li, JIANG Xue-fan, YU Yun, SU Li-zhong, FANG Lian

2019, 17(9): 1474-1477. doi: 10.16766/j.cnki.issn.1674-4152.000973

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Objective To investigate the level of miR-634 in nasopharyngeal carcinoma and its effects on the cell growth and MEK/ERK signaling pathway in nasopharyngeal carcinoma, and discuss the possible mechanism. Methods Total 60 specimens of nasopharyngeal carcinoma and 60 specimens of nasopharyngeal non-cancerous tissue were collected. The level of miR-634 in nasopharyngeal carcinoma tissues and nasopharyngeal carcinoma cells were determined by reverse transcription-polymerase chain reaction (RT-PCR). Human nasopharyngeal carcinoma CNE-1 cells were divided into blank control group, negative control group and overexpressed miR-634 group. The cell proliferation was measured by MTT. The cell apoptosis was detected by flow cytometry. The levels of extracellular regulated protein kinase (ERK), phosphorylated extracellular regulated protein kinase (p-ERK), mitogen-activated protein kinase (MEK) and phosphatiated mitogen-activated protein kinase (p-MEK) proteins in nasopharyngeal carcinoma cells were determined by Western blotting. Results The level of miR-634 in nasopharyngeal carcinoma tissues was lower than that in the adjacent tissues (P<0.05). The level of miR-634 in nasopharyngeal carcinoma cells was lower than that in normal nasopharyngeal epithelial cells (P<0.05). Compared with the blank control group and the negative control group, the level of miR-634 and the apoptosis rate in the overexpressed miR-634 group were increased (P<0.05); the levels of p-ERK, p-MEK mRNA and protein were decreased (P<0.05). After transfection for 3 d and 5 d, There was significant difference in OD values among the three groups (P<0.05), compared with the blank control group and the negative control group, the OD value of the overexpress miR-634 group was decreased (P<0.05). Conclusion The level of miR-634 is decreased in nasopharyngeal carcinoma, and overexpression of miR-634 can inhibit the proliferation of nasopharyngeal carcinoma and promote apoptosis. The mechanism may be related to MEK/ERK signaling pathway.

Expression of microRNA-155 and Th17 in rats with sepsis caused by Acinetobacter baumannii and their relationship

ZHANG Xia-zi, HE Xian-di, WANG Hua-xue, ZOU Qi, QIN Su-hui

2019, 17(9): 1478-1481. doi: 10.16766/j.cnki.issn.1674-4152.000974

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Objective To investigate the percentage of T helper 17 (Th17) and miR-155 level in peripheral blood of rats with sepsis caused by Acinetobacter baumannii, and explore their relationships. Methods Total 32 clean SD rats were randomly divided into normal control group (N group), and 6 h, 12 h and 24 h sepsis group, with 8 rats in each group. The sepsis rat model was established by intraperitoneal injection with Acinetobacter baumannii suspension, while the rats in N group were injected with normal saline. The serum and lymphocyte were separated from peripheral blood of rats. The fluorescence quantitative rt-PCR was used to detect expression of miR-155. Flow cytometry was used to detect the ratios of Th17 cells over CD4⁺ T cells in peripheral, enzyme-linked immunosorbent assay (ELISA) was used to measure the serum level of interleukin-10 (IL-10). The difference among N group and 6 h, 12 h and 24 h sepsis group were analyzed. Pearsons correlation analysis was used to evaluate the relationship between miR-155 and Th17. Results Serum level of miR-155 was significantly higher in rats with sepsis than that in normal group (all P<0.05). Th17 cells was significantly higher in rats with sepsis than that in normal group (all P<0.05). Pearsons correlation analysis showed that the serum level of miR-155 was positively correlated with Th17 cells (all P<0.05). Conclusion The expression of Th17 and miR-155 is increased in Acinetobacter baumannii sepsis rats. The serum level of miR-155 is positively correlated with Th17 cells, which can used as the target in the early diagnosis and treatment of Acinetobacter baumanni.

Prognostic value of initial blood lactate level and SOFA score in patients with intra-abdominal infection

ZHU Hai-ping, YANG Mei, ZHANG Yan-jie, DONG Li

2019, 17(9): 1482-1484,1494. doi: 10.16766/j.cnki.issn.1674-4152.000975

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Objective The high blood lactic acid level in critically ill patients is an important indicator of the severity of the disease. The purpose of this study was to explore the relationship between the blood lactic acid level and SOFA score, and provide a reference for the assessment of the severity of the illness and prognosis of patients with intra-abdominal infection. Methods Total 63 patients with intra-abdominal infection admitted to the first affiliated hospital of Wen-Zhou Medical University in February 2015 to October 2017 were enrolled into this study. The general information, acute physiology and chronic health evaluation (APACHE) Ⅱ score, SOFA score were recorded. The initial blood lactate level was recorded, the clinical data were compared between the hyperlactatemia group (Lac > 2 mmol/L) and the normal group (Lac≤2 mmol/L). By using the area under the ROC curve to calculate the cut-off point of the initial lactic acid， APACHE Ⅱ, and Sequential Organ Failure Assessment (SOFA) score. Pearson analysis was conducted to analyze the correlation between lactic acid, APACHE Ⅱ score and SOFA score. logistic regression analysis was performed to analyze the risk factors affecting the prognosis. Results Among the 63 patients, the incidence of hyperlactic acidemia rate was 77.8%. The APACHE Ⅱ score and SOFA score in the hyper-lactic acid group were significantly higher than that in the normal group [15.00(12.00, 20.25) vs. 10.00(10.00, 12.75), 7.00(6.00,9.00) vs. 5.00(3.00,6.00), all P<0.05)]. The AUC among lactic acid, APACHE Ⅱ score and SOFA score were 0.692, 0.787, 0.726 respectively (P=0.022, 0.002, 0.041). The optimal cut-off point of them were 5.0 mmol/L, 13.5 and 6.5, respectively. Pearson correlation analysis showed that blood lactate was positively correlated with APACHE Ⅱ and SOFA scores (r=0.594, P<0.001; r=0.562, P<0.001). Logistic regression analysis showed that the level of lactic acid and APACHE Ⅱ score were independent risk factors for the prognosis of patients with intra-abdominal infection disease (P=0.003,0.015). Conclusion High blood lactic acid on admission in patients with intra-abdominal infection is an independent risk factor for assessing prognosis. Besides, it is an important quantitative indicator in assessing the severity of the disease, if combined with the APACHE Ⅱ and SOFA score.

Clinical study of left ventricular endocardial pacing in cardiac resynchronization therapy

CHEN Dong, SU Hao, XU Jian, CHEN Kang-yu, GUO Fei, YAN Ji

2019, 17(9): 1485-1490. doi: 10.16766/j.cnki.issn.1674-4152.000976

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Objective To evaluate the efficacy, safety of cardiac resynchronization therapy (CRT) with atrial septal or ventricular septal puncture implanted into the left ventricular endocardial electrode. Methods A retrospective analysis of 6 heart failure patients with coronary venous malformation or CRT nonresponse diagnosed at the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China from August 2014 to October 2018, with left ventricular endocardial electrodes implanted through atrial septal or ventricular septal puncture. Among them, 4 patients underwent atrial septal puncture and 2 patients' ventricular septal puncture. The QRS width was got before and after operation, and left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left atrial anterior and posterior diameter (LAD) and cardiac function grading were measured, and parameters of left ventricular electrode(threshold, impedance) were measured after 3, 6, 12 and 24 months. Results Six patients underwent successful implantation of left ventricular endocardial electrodes through atrial septal or ventricular septal puncture. There were no serious complications during operation. The QRS width was significantly narrower than before. LVEF was significantly increased and LVEDD was significantly reduced within 24 months; LVESD and LAD were unchanged, and parameters of left ventricular electrodes (threshold, impedance) were relatively stable, no obvious abnormal events such as diaphragmatic stimulation, thromboembolism, hemorrhage and ventricular arrhythmia, and the patient's heart function was significantly improved. None was deaths. Conclusion The left ventricular endocardial electrode is successfully inserted through the atrial septal or ventricular septal puncture, and certain clinical efficacy is obtained.

Clinical analysis of lacrimal passage combined with indwelling probe applied gatifloxacin gel in the treatment of infants older than 6 months with complicated nasolacrimal duct obstruction

HE Li-ying, LIU Ya, TAO Xue-ying, CEN Chao

2019, 17(9): 1491-1494. doi: 10.16766/j.cnki.issn.1674-4152.000977

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Objective To investigate the short-term clinical efficacy and related influencing factors of lacrimal passage exploration combined with indwelling probe application of gatifloxacin gel in the treatment of infants older than 6 months with complicated nasolacrimal duct obstruction. Methods Retrospective analysis of the clinical information of 123 cases (123 eyes) from June 2014 to February 2017 of infants (age>6 months) with complicated nasolacrimal duct obstruction, follow-up children's short-term efficacy and complications of treatment. Results After a short-term follow-up, 115 eyes of 123 eyes reached the cure standard, and the overall cure rate was 93.4%. There were no serious intraoperative and postoperative complications except for 12 cases of orbital edema. Among different age groups [6-12 months group (96.8%) vs. 12-24 month group (91.1%) vs. >24 month group (86.7%)], among different blockage groups [upper segment group, (92.1%) vs middle segment Group (85.7%) vs. lower group (97.5%) vs. 2 or more sites (95.8%)], and between different obstructive groups [bone group (95.8%) vs. membranous group (85.7%)], there was no significant difference in cure rate respective (P>0.05). Conclusion Lacrimal passage combined with indwelling probe application of gatifloxacin gel is a simple, safe and effective new method for the treatment of complicated nasolacrimal duct obstruction in infants. It is suitable for a variety of clinical classification.

Comparison of therapeutic effects of single and multiple hemoperfusion on severe acute organophosphorus poisoning

WANG Dou, YUE Ya-jie, SONG Ke-yi, YAN Xiu-xia

2019, 17(9): 1495-1497,1599. doi: 10.16766/j.cnki.issn.1674-4152.000978

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Objective To compare the clinical efficacy of hemoperfusion (HP) times in patients with severe acute organophosphorus poisoning. Methods Eighty-six patients with severe acute organophosphorus poisoning (AOPP) admitted to intensive care unit from January 2014 to July 2018 were divided into 3 groups basing on times of hemoperfusion (HP), including a HP0 group of 26 cases received no hemoperfusion treatment, a HP1 group of 31 cases received once hemoperfusion treatment, and a HP2 of 29 cases received twice or more hemoperfusion treatments. Then the total dose of atropine and pralidoxime, recovery of 80% serum cholinesterase activity, duration of coma, hospital stay, time of mechanical ventilation, acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) score at 72 h after admission, and incidence of complications (intermediate syndrome, poisoning rebound, arrhythmia, organ dysfunction syndrome) and mortality of the 3 groups were compared. Results Hemoperfusion treatment was correlated with total dose of atropine and pralidoxime, recovery of 80% serum cholinesterase activity, duration of coma, hospital stay, time of mechanical ventilation, acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) score at 72 h after admission, the incidence of complications (intermediate syndrome, poisoning rebound, organ dysfunction syndrome) in HP2 was less than the others and mortality (P<0.05 for all), the incidence of arrhythmia in HP1 and HP2 was less than the HP0. Conclusion Multiple times of hemoperfusion is a supplement to conventional treatment showed significant efficacy for AOPP patients.

Complications and clinical rehabilitation of gluteal muscle contracture in adults

SUN Wei, CHEN You-yan, YE Bin, XIE Wei, LIU Wei, LI Jun-bing, SUN Hong-wei

2019, 17(9): 1498-1501. doi: 10.16766/j.cnki.issn.1674-4152.000979

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Abstract:
Objective To analyze the pathogenesis of the complications of gluteal muscle contracture (GMC) in adults and provide basis for the management of complications. Methods The clinical data and pathogenesis of the complications of type C1 GMC in 1 000 adult patients were analyzed retrospectively. Results ① 1 000 patients suffered from varying degrees of greater trochanteric bursitis, gluteal myofascitis and lumbar back myofascitis, and these complications disappeared after receiving the minimally invasive procedure method invented by Prof. Ye and 6-8 weeks of clinical rehabilitation. ② 762 patients suffered from varying degrees of wear-and-tear arthritis of the knee joint; 168 suffered from varying degrees of wear-and-tear arthritis of hip joint; 12 patients suffered from varying degrees of wear-and-tear arthritis of ankle joint. The arthritis pain and activity limitations disappeared after the minimally invasive procedure method and 6-8 weeks of clinical rehabilitation. The snapping sound of joints did not disappear, but had not developed. ③ 586 patients suffered from varying degrees of pelvic obliquity, leg length discrepancy and scoliosis. These conditions were cured after receiving the minimally invasive procedure and 6-10 weeks of clinical rehabilitation. ④ Three patients suffered from bilateral aseptic necrosis of femoral head; 329 patients suffered from varying degrees of lumbar disc herniation. ⑤ 560 patients were with depression tendency, Hamilton Depression Scale (HDC) score was 12.9±4.1; 182 patients suffered from depression, with HDC score of 21.4±2.6; 6 patients suffered from severe depression, with HDC score over 24. Their depression disappeared after receiving the minimally invasive procedure and 6-10 weeks of clinical rehabilitation. Conclusions The complications of AGMC can be classified as two categories: reversible complications and irreversible complications. The minimally invasive procedure method and clinical rehabilitation technique invented by Prof. Ye can cure reversible complications. It can stop or control the development of irreversible complications, but cannot correct the damage which already occurred. The early surgery and clinical rehabilitation are very important for treating AGMC in order to reduce and ease the irreversible complications.

Clinical effect analysis of vinpocetine combined with calf serum deproteination in the treatment of lacunar infarction

SHI Wan-rong, QI Jin-wei, CHEN Jian, HU Pan-pan

2019, 17(9): 1502-1504,1511. doi: 10.16766/j.cnki.issn.1674-4152.000980

266 1

Abstract:
Objective To evaluate the clinical effects of vinpocetine combined with calf serum deproteination in the treatment of lacunar infarction. Methods A total of 150 patients with acute lacunar infarction who underwent emergency medical clinic in our hospital from January 2015 to August 2018 were randomly divided into observation group (n=75) and control group (n=75). The observation group received intravenous injection of vinpocetine 30 mg/d, intravenous infusion of calf serum deproteinized injection 20 mL/d for 10 days, and other conventional treatments; the control group received intravenous infusion of calf serum deproteinized injection. Twenty mL/d for 10 days, as well as other conventional treatments. Patients were assessed for the mini mental state scale (MMSE), the national institutes of health stroke scale (NIHSS), the Modified Rankin Scale, and the Barthel index (BI) scores at 7, 14 and 90 days after treatment. Results Compared with the control group, the MMSE, NIHSS and BI scores of the observation group increased significantly after 90 days of treatment (both P<0.05), suggesting that the cognitive function, neurological function and quality of life of the observation group were significantly improved. There were no significant differences of the scores of MMSE, NIHSS and BI tests, as well as the drug side effects between the two groups of patients. Conclusion As part of the treatment of acute lacunar infarction, vinpocetine combined with calf serum deproteinization can significantly improve the cognitive function, neurological function and quality of life of patients, and it is an effective and safe treatment.

Clinical effect of microscopic tumor resection on prognosis of glioma patients

YE Cheng, MAO Jie, WU Hao, HUANG Xiao-fei

2019, 17(9): 1505-1507,1546. doi: 10.16766/j.cnki.issn.1674-4152.000981

221 1

Abstract:
Objective To explore the clinical effect of microsurgical tumor resection on the prognosis of patients with glioma. Methods A total of 51 cases of glioma in the Department of Neurosurgery of Anqing First People's Hospital, from January 2016 to May 2018, were selected as the research objects. According to the different treatment methods, they were divided into the observation group (treatment with microsurgery) 33 cases or the control group (treatment with routine craniotomy) 18 cases, and a retrospective analysis was made regarding to their clinical data. Results The bleeding volume, operation time, incision length and hospitalization time in the observation group were less than those in the control group, and the difference was statistically significant (all P<0.05). Compared with those pre-operation, the scores of orientation, memory, language ability and ADL in the two groups increased significantly in half a year after operation, and the scores in the observation group were higher than those in the control group ,and the difference was statistically significant (all P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group, but there was no significant difference (P>0.05). The effective rate of treatment in the observation group was higher than that in the control group, and the recurrence rate in the first half a year after operation was lower than that in the control group, and the difference was statistically significant (all P<0.05). Conclusion Microsurgery treatment in glioma should strictly grasp the indications of treatment which is safe and feasible, which not only involves less trauma, fewer complications after operation, but also makes patients have better cognitive function and daily living ability. It has a definite clinical effect and is worthy of clinical promotion.

Evaluation of short-term chemotherapy regimen in the first recurrence pulmonary tuberculosis

JIN Ling-ling, SHI Ji-chan, JIANG Xian-gao, NING Hong-ye, XIE Jun-ping

2019, 17(9): 1508-1511. doi: 10.16766/j.cnki.issn.1674-4152.000982

224 1

Abstract:
Objective To evaluate the clinical efficacy of short-course chemotherapy in the treatment of primary recurrence of smear-positive pulmonary tuberculosis. Methods A total of 213 patients with primary recurrent smear-positive pulmonary tuberculosis who were hospitalized in Wenzhou Central Hospital from January 2012 to January 2015 were randomly assigned to a short course (105 patients) and a standard course (108 cases), patients in the short course of treatment were treated with 5MRftPZ regimen, and patients in the standard course of treatment were treated with 2HREZS/6HRE regimen. The negative conversion rate of sputum smear was compared between the two groups at the end of the second month and 9 months after treatment. The total effective rate, lesion diameter and lesion improvement rate were compared between the two groups receiving 9 months of treatment, and the course of treatment was recorded together with adverse reactions. Results There was no significant difference in the sputum smear conversion rate between the two groups (χ²=3.367, P=0.066) and 9 months (χ²=3.045, P=0.080); 9 treatments were treated. The lesion diameter of the short-term treatment group was significantly smaller than that of the standard treatment group (t=7.442, P<0.001). The total effective rate of the short-course group (χ²=4.478, P=0.034) and the improvement rate of the lesion (χ²=6.115, P=0.013) were significantly higher than the standard course of treatment; and the adverse reactions during the treatment of both groups improved after symptomatic treatment, and no serious adverse reactions occurred. Conclusion 5MRftPZ short-course chemotherapy can effectively improve the clinical symptoms, reduce the diameter of tuberculosis patients, improve the clinical treatment efficiency, without obvious adverse reactions, which is safe and effective.

Effects of rehabilitative new fluid combined with ozone on recurrent aphtha ulcer saliva EGF， serum IL-6， SOD， SIgA

HU Xu, CHEN Jing-jing

2019, 17(9): 1512-1514. doi: 10.16766/j.cnki.issn.1674-4152.000983

263 2

Abstract:
Objective To investigate the pathogenesis and treatment of recurrent aphthous ulcer, and to discuss the therapeutic effect of rehabilitation new fluid combined with ozone, and to discuss salivary epidermal growth factor (EGF) and serum interleukin-6. The effects of (IL-6), superoxide dismutase (SOD), and secretory immunoglobulin A (sIgA) were investigated. Methods Sixty-four patients with recurrent aphthous ulcer admitted to our hospital from January to February 2018 were randomly divided into two groups. The control group was treated with ozone. The study group was applied on the basis of the control group. Rehabilitation new fluid treatment. The changes of IgG, SIgA, SOD, VAS score, ulcer duration and serum level were compared before and after treatment. Results The changes of IgG and SIgA in the study group were significantly higher than those in the control group (all P<0.05). The IgG, SIgA and SOD values of the study group were (23.5±6.4) g/L, (64.6±11.2) g/L and (290.2±57.3 ) g/L, respectively. The difference was statistically significant. The VAS score (2.01±0.23) and the ulcer persistence score (3.25±0.96) were lower in the study group than in the control group (all P<0.05).The TNF-α, IL-6 and EGF indexes in the study group were respectively determined. The scores were (134.02±20.15) ng/mL, (73.23±8.73) ng/mL and (3.2±0.6) ng/mL, which were lower than the control group (all P<0.05). The difference was statistically significant. Conclusion For patients with recurrent aphthous ulcer, the treatment of rejuvenating new fluid combined with ozone is not only effective, but also promotes the regeneration and repair of damaged epidermis, effectively improving the saliva EGF of patients and serum IL-6, SOD, sIgA levels.

Effect of ultrasound-guided posterior rectus sheath and transverse abdominis block on stress response in patients undergoing open colorectal cancer

ZHU Li-jun, YU Yu-long, WANG Yu, RAO Su-huan, LI Jun, CHEN Yi-bo

2019, 17(9): 1515-1517. doi: 10.16766/j.cnki.issn.1674-4152.000984

235 2

Abstract:
Objective To investigate the effect of ultrasound-guided posterior rectus sheath and transverse abdominis block in patients with open colorectal cancer and its effect on stress response. Methods Eighty-two patients with open colorectal cancer were enrolled between January 2017 and June 2018. They were divided into control group and observation group with 41 cases in each group. The control group was given general anesthesia. On the basis of which, the observation group was given the ultrasound-guided posterior rectus abdominis and the transverse abdominis block. The anesthesia effect was evaluated after the operation. The number of analgesic pump presses, the total dose of sufentanil, the time of anal exhaust, and the time of getting out of bed were counted. Serum cortisol (CORT) and catecholamine (CA) were obtained by enzyme-linked immunosorbent assay (ELISA). Plasma glutamate (GLU) levels, the incidence of nausea and vomiting, hepatic contusion, spleen contusion, puncture infection, chills and bradycardia in the two groups were counted and recorded, comparing the effects of anesthesia and stress on the two groups. Results The number of analgesic pump presses, the total dose of sufentanil, the time of anal exhaust, and the time of getting out of bed were all less (shorter) than the control group (all P<0.05); the observation group and the control group T1, T2 The levels of CORT, CA and GLU were higher than the T0 time point (all P<0.05). The levels of CORT, CA and GLU in the observation group at T1 and T2 were lower than those in the control group (all P<0.05). There was no significant difference in the incidence of nausea and vomiting, headache, dizziness, puncture infection, chills and bradycardia after anesthesia (all P>0.05). Conclusion Ultrasound-guided posterior rectus sheath combined with transverse abdominis block can shorten the symptom improvement time and reduce the dose and stress response of sufentanil in patients with open colorectal cancer. It is worth promoting.

Study on the correlation between Ki-67, P53 and CA153 and axillary lymph node metastasis of breast cancer

WANG Hui, ZHANG Hui-fang, ZHOU Jin-qiang, LI Na, LI Yang, CUI Hui-zhuan, WANG Xuan-jiu

2019, 17(9): 1518-1520. doi: 10.16766/j.cnki.issn.1674-4152.000985

255 1

Abstract:
Objective To investigate the predictive value of Ki-67, P53 and CA153 in axillary lymph node metastasis of breast cancer. Methods We selected 168 breast cancer patients admitted to Zhuozhou hospital from January 2015 to June 2018. They were divided into lymph node metastasis group (n=116) and no lymph node metastasis group (n=52) according to whether they had axillary lymph node metastasis, and the expressions of ki-67, P53 and CA153 in each group were detected. Analysis of risk factors of axillary lymph node metastasis in breast cancer was made via univariate and multivariate logistic regression. Results Univariate analysis showed that clinical stage, tumor diameter, Ki-67, P53 and CA153 positive expression were correlated with axillary lymph node metastasis of breast cancer (P<0.05), while age, BMI, clinical stage and pathological type were not correlated with axillary lymph node metastasis of breast cancer (P>0.05). Multivariate logistic regression analysis showed that clinical stage (OR=2.307, 95% CI: 1.485-5.452), tumor diameter (OR=1.725, 95% CI:1.118-2.974), Ki-67 (OR=3.320, 95% CI: 2.907-10.781), P53 (OR=1.864, 95% CI: 1.206-3.224) and CA 153 (OR=2.113, 95% CI: 1.390-4.942) positive expression were risk factors for axillary lymph node metastasis. Conclusion Clinical stage, tumor diameter, positive expression of Ki-67, P53 and CA153 are risk factors for axillary lymph node metastasis of breast cancer, which had certain value in predicting axillary lymph node metastasis.

Effects of transcatheter arterial chemoembolization combined with radiofrequency ablation on cellular immune function in patients with hepatocellular carcinoma

HUANG Yan-hua, XU Feng, ZHONG Li-yun

2019, 17(9): 1521-1523,1614. doi: 10.16766/j.cnki.issn.1674-4152.000986

170 1

Abstract:
Objective To observe the effects of transcatheter arterial chemoembolization (TACE) alone and radiofrequency ablation (RFA) on serum T lymphocyte subsets and transforming growth factor-β1 (TGF-β1) levels in patients with hepatocellular carcinoma (HCC) after treatment, so as to provide reference for further improving the therapeutic effect of HCC patients. Methods Seventy-two patients with HCC admitted to our hospital from January 2016 to June 2018 were randomly divided into two groups. The control group was TACE group and the observation group was TACE combined with RFA group. The changes of T lymphocyte subsets (CD4⁺, CD8⁺, CD4⁺/CD8⁺) and TGF-β1 in peripheral blood of the two groups before and after treatment were detected respectively. The data were analyzed by SPSS 23.0 statistical software. Results There was no significant difference in serum CD4⁺, CD8⁺, CD4⁺/CD8⁺ between the control group and the observation group before treatment (all P>0.05). At the 2nd and 4th weeks after treatment, the serum CD4⁺ and CD4⁺/CD8+ of the observation group were higher than those of the control group (all P<0.05), while CD8+ was lower than that of the control group (all P<0.05). Before treatment, there was no significant difference in the level of serum TGF-β1 between the control group and the observation group (P>0.05). At the 2nd and 4th weeks after treatment, the level of serum TGF-β1 in the observation group was lower than that in the control group (all P<0.05). The total effective rate of the control group was 72.22%, while that of the observation group was 91.67%. The total effective rate of the observation group was higher than that of the control group (P<0.05). Conclusion TACE treatment can temporarily inhibit the cellular immunity of patients with hepatocellular carcinoma. With the prolongation of time, the cellular immune function of patients recovers to a certain extent, while TACE combined with RFA treatment can enhance the cellular immune function.

Effects of dexmedetomidine infusion during one-lung ventilation on oxygenation and respiratory mechanics in elderly patients undergoing thoracoscopic lung surgery

LYU Jiang-jun, YU Li-jun, LYU Xiao-ling

2019, 17(9): 1524-1526,1570. doi: 10.16766/j.cnki.issn.1674-4152.000987

229 2

Abstract:
Objective To investigate the effects of dexmedetomidine infusion during one-lung ventilation (OLV) on oxygenation and respiratory mechanics in elderly patients undergoing thoracoscopic lung surgery. Methods A total of 158 elderly patients undergoing video-assisted thoracoscopic surgery (VATS) from November 2015 to November 2018 for lobectomy were selected and divided into observation group (80 cases) and control group (78 cases) according to the principle of random number method. The observation group was given dexmedetomidine hydrochloride pump during operation, while the control group was given physiological salt pump. The differences of oxygenation index, respiratory mechanics index and hemodynamics index at different time between the two groups were analyzed. The hypoxemia during operation and pulmonary complications after operation were observed. Results PaO₂/FiO₂ at T1 and T2 were significantly higher in the observation group than in the control group， There was no statistical significance (all P>0.05). There were no cases of hypoxemia in the two groups, and the incidence of pulmonary complications in the observation group (0.00%) was significantly lower than that in the control group (11.54%, χ²=7.758, P=0.005). Conclusion The infusion of dexmedetomidine during OLV in elderly patients undergoing VATS is helpful to improve respiratory mechanics, increase oxygenation capacity and reduce the incidence of pulmonary complications. It is worthy of clinical application.

The correlation between serum IL-31 expression level and severity, pruritus and quality of life in patients with chronic spontaneous urticaria

GU Feng, SHEN Yun-liang

2019, 17(9): 1527-1529. doi: 10.16766/j.cnki.issn.1674-4152.000988

244 3

Abstract:
Objective To investigate the correlation between serum IL-31 expression level and severity, pruritus and quality of life in patients with chronic spontaneous urticaria. Methods A total 180 patients with chronic spontaneous urticaria and 60 health examinees admitted to dermatology department of our hospital from December 2015 to December 2018 were selected as the research objects. According to the patient's condition, the patients were divided into mild group (60 cases), moderate group (60 cases) and severe group (60 cases). The difference of serum IL-31 levels in each group was compared. The patients were scored with 7-day comprehensive symptom score, VAS and CU-Q2oL score. The correlation between serum IL-31 level and 7 d symptom score, VAS score and CU-Q2oL score was tested. Results The serum level of IL-31 in healthy subjects (7.63±0.85) pg/mL was significantly lower than that in patients with chronic spontaneous urticaria (25.14±3.50) pg/mL (P<0.05). The serum IL-31 levels in the mild, moderate and severe groups increased in turn Serum IL-31 levels in mild, moderate and severe groups increased in turn (17.66±2.05, 23.70±3.13 and 28.77±3.62) pg/mL, with statistical significance (P<0.05). Person correlation analysis showed that serum IL-31 level was positively correlated with 7-day syndrome score, VAS score and CU-Q2oL score in patients with chronic spontaneous urticaria (r=0.658-0.795, all P<0.05). Conclusion IL-31 may play an important role in the itching mechanism of patients with chronic spontaneous urticaria, and may affect the severity of the lesion and the quality of life after the disease.

The effect of different delivery methods on pelvic organ prolapse in early postpartum period and the correlation between obstetric delivery factors and early pelvic organ prolapse

WANG Li-hui, SHEN Xiao-fang, XU Ya-ping, WANG Lu-lu

2019, 17(9): 1530-1532. doi: 10.16766/j.cnki.issn.1674-4152.000989

271 1

Abstract:
Objective To observe effect of different delivery methods on pelvic organ prolapse in early postpartum period and the correlation between obstetric delivery factors and early pelvic organ prolapse. Methods A total of 489 pregnant women who gave birth in our hospital from January to December in 2017 were selected as subjects. According to the different delivery methods, 245 women were divided into vaginal delivery group and 244 cases in cesarean section. The χ² test was used to analyze different delivery methods. The effect of pelvic organ prolapse in early maternal gynecology, and the use of χ² test, logistic regression analysis of obstetric delivery factors (common birth factors include age, BMI, parity, pregnancy, neonatal gender, weight gain during pregnancy, gestational weeks of delivery, fetal weight, and the early maternal pelvic organ prolapse, etc.). Results There were 79 cases of early pelvic organ prolapse in 489 cases, the incidence rate was 16.16%, the incidence of pelvic organ prolapse in vaginal delivery was 22.86%, which was higher than 9.43% of cesarean section. According to the χ² test, the number of vaginal prolapse, vaginal posterior wall prolapse, and uterine prolapse in the vaginal delivery group was significantly higher than that in the cesarean section (P<0.05). Test and logistic regression analysis showed that age, neonatal gender, and increased body weight during pregnancy had no effect on pelvic organ prolapse in early postpartum period, BMI≥24 kg/m², birth>2, number of pregnancies>2, gestational weeks ≥37 weeks, fetal weight≥4 kg are among risk factors affecting pelvic organ prolapse in the early postpartum period. Conclusion Different modes of delivery, maternal BMI, parity, pregnancy, gestational weeks and fetal weight have a greater impact on the incidence of postpartum pelvic organ prolapse. In clinical practice, it is recommended that women pay attention to BMI, parity, and pregnancy. Second, delivery gestational age and fetal weight, without excessive intake of nutrition during pregnancy to cause oversized fetus, in order to reduce the probability of pelvic organ prolapse after maternal postpartum.

Cook balloon and misoprostol in full-term pregnant women with hypertension and maternal and child outcomes

HU Li-wen, YU Hui, ZHANG Cheng-cheng, ZHENG Hai-xue, CHEN Ru

2019, 17(9): 1533-1535,1542. doi: 10.16766/j.cnki.issn.1674-4152.000990

208 2

Abstract:
Objective To explore the value of cook cervical dilatation balloon versus misoprostol for induction of labour in full-time pregnancy hypertensive women. Methods From June 2017 to May 2018, 110 hypertensive parturient women of full-time pregnancy who plan to delivered in our hospital were randomly divided into balloon group (55 cases) and misoprostol group (55 cases) and were given cook cervical dilatation balloon and oral misoprostol respectively for induction. The delivery situation, the information of induction to vaginal birth, complication of induction and birth, newborn information and complication after induction. Results No significant difference in Rupture of membranes, first stage of labor and second stage of labor between the two group (P>0.05) and the cases of vaginal birth, effective cervix mature improving, cases of oxytocin usage and artifact rupture of membranes were significantly higher in balloon group than those in misoprostol group and time from induction to parturient in balloon group were lower than those in misoprostol group (P<0.05). The total cases of induction to vaginal birth in balloon group (74.54%) was significantly higher than that in misoprostol group (52.72%) and total time from induction to birth in balloon group was significantly lower than that in misoprostol group (P＜0.001). The total rate of complication in balloon group (43.64%) was significantly higher than that in misoprostol group (65.45%)， P=0.035. Apgar score, newborn death, cases admitted to nursery, given oxygen and complication were no significant different between two group (P>0.05). No significant difference were found in dizziness, nausea, vomit and long pain during incubation between two group (P>0.05). Conclusion For hypertensive parturient women of full-time pregnancy, comparing with oral misoprostol, cook cervical dilatation balloon can short the stage of delivery, increase success rate of induction, reduce delivery complication and has high safety.

To explore the value of arterial blood lactate level and early lactate clearance rate in the severity and prognosis of neonatal asphyxia

LUO Hou-jiang, WANG Rui, CHEN Ru-ru, JIA Wen-ting, WANG Ling-zhi, FAN Min, GUO Hong-hui

2019, 17(9): 1536-1538. doi: 10.16766/j.cnki.issn.1674-4152.000991

247 2

Abstract:
Objective To explore the value of arterial lactate level and early lactate clearance in the severity and prognosis of neonatal asphyxia. Methods A total of 134 neonatal asphyxia patients enrolled in our department from August 2017 to August 2018 were selected as study subjects, and arterial blood lactate levels at the initial admission and 6 h after treatment were recorded. Two times of grouping and data comparison analysis were performed: ①Apgar score 1 minute after delivery of neonates was divided into groups: 0-3 for severe asphyxia group and 4-7 for mild asphyxia group. To compare the initial level of arterial blood lactic acid between the two groups and the level of arterial blood lactic acid after 6 h of treatment, and to compare and analyze the differences.②According to the 6 h arterial blood lactic acid clearance rate, it was divided into the high lactic acid clearance rate group (lactic acid clearance rate is more than 10%) and the low lactic acid clearance rate group (lactic acid clearance rate < 10%). To observe the poor prognosis of the two groups of children with multiple organ injuries during subsequent treatment and analyze and evaluate the value of early lactate clearance rate in the severity judgment and prognosis evaluation of neonatal asphyxia. Results There were statistically significant differences between the two groups in the initial concentration of arterial blood lactic acid and the concentration after 6h of treatment (all P<0.05). In the lactate high clearance group, multiple organ injuries occurred in 26 cases, but did not occur in 65 cases, with an incidence rate of 28.6%. Furthermore, 29 cases of multiple organ injuries occur in the low lactic acid clearance rate group, while 14 cases didn't occur (67.4%). The chi-square test showed statistical significance (χ²=18.233，P<0.001). Conclusions The level of arterial blood lactic acid in asphyxiated neonates is correlated with the degree of asphyxiation. The higher the level of lactic acid in arterial blood, the more severe the degree of asphyxiation of neonates. The early (6 h) lactate clearance rate is of great significance in the prognosis evaluation of neonatal asphyxia with multiple organ damage. The higher the lactate clearance rate in the early stage (6 h), the lower the possibility of multiple organ damage.

Effect of pelvic floor reconstruction for pelvic floor disease and inflammatory and stress reactions in patients

ZHOU Mei-fang, XU Qun, WU Li-qun, ZHOU Hai-xian, WANG Lu-lu

2019, 17(9): 1539-1542. doi: 10.16766/j.cnki.issn.1674-4152.000992

224 1

Abstract:
Objective To explore the effect of pelvic floor reconstruction in the treatment of pelvic floor disease and the inflammatory and stress reactions of patients. Methods One hundred and six patients with pelvic floor dysfunction treated in our hospital from January 2016 to July 2017 were selected, the patients were divided into observation group (n=56) and control group (n=50) according to the final operation, the observation group was treated with pelvic floor reconstruction, while the control group was treated with sacrospinous ligament fixation, the curative effect of the two groups was observed, the quality of life of the patients was evaluated by PFDI-20, and the indexes of inflammation and stress reaction were detected before and after treatment. Results POP-Q grading in the observation group and the control group at one year after treatment were significantly better than that before treatment (all P<0.05). The POP-Q grading of the observation group at one year after treatment was significantly better than that of the control group, the difference has statistical significance (P<0.05), and the proportion of POP-Q grade 0 to I was 92.86%. The PFDI-20 scores of the observation group and the control group after treatment were lower than those before treatment (all P<0.05). The PFDI-20 score of the observation group at 3 months after treatment was (13.24±3.10) points, which was significantly lower than that of the control group, the difference had statistical significance (P<0.05). There was no significant difference in cortisol (COR), norepinephrine (NE) and prostaglandin E₂ (PGE₂) between the two groups at 24 hours after treatment (all P>0.05). There was no significant difference in interleukin-6 (IL-6) and C reactive protein (CRP) between the two groups at 24 hours after treatment (all P>0.05). Conclusion Pelvic floor reconstruction has a better effect in the treatment of pelvic floor disorders, and has no significant effect on inflammation and stress response.

Turnover intention and related factors among general practitioners in China

ZHENG Yan-ling, YU Fang, CHEN Yan-li, YU Min-yi, LIU Ling, YANG Yu-di, GAN Yong, LI Li-qing, LU Zu-xun

2019, 17(9): 1543-1546. doi: 10.16766/j.cnki.issn.1674-4152.000993

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Abstract:
Objective To investigate the prevalence of turnover intention among general practitioners (GPs) in China and explore its influencing factors. Methods A stratified random sampling method was used to conduct a WeChat questionnaire survey on 3 244 GPs working in community health centers in China (East, Beijing, Shanghai, Guangdong, and Zhejiang; Central, Hubei, Heilongjiang, Henan, and Anhui; Western, Sichuan, Guizhou, Yunnan, and Inner Mongolia) between October 2017 and January 2018. The questionnaire of occupational attractiveness of GPs was self-designed. It included basic information of GPs job satisfaction, burnout, and turnover intention. The Chinese version of the turnover intention scale was modified according to the studies by Mickael and Spector. The chi-square test was conducted to compare the differences of the turnover intention in different groups, and multivariable logistic stepwise regression analysis was used to analyze the influencing factors for turnover intention among GPs. Results The results showed that 35.20% of the general practitioners had higher intention to leave their present positions, including 33.69% in the Eastern China, 39.24% in the Central China, and 33.20% in the Western China. Multivariable logistic stepwise regression analysis showed that male GPs, the Central China region, the younger, a higher educational level, with administrative responsibility, at a higher professional title, at a lower level of material satisfaction, at a lower level of relationship satisfaction, at a lower level of growth satisfaction, at a higher scores on serious emotional exhaustion, and at a higher scores on depersonalization were the significant factors associated with turnover intention. Conclusion The overall willingness of GPs to leave general practices is high in China, and the associated factors for turnover intention among GPs are complex. Actions such as expanding the career prospects of GPs, increasing the wages of GPs, enhancing the occupational attractiveness, and improving the occupational mental health of GPs, are needed to reduce the turnover intention of GPs.

Control study of exercise' influence on depression's symptom, cognitive function and GABA

DU Yuan, WANG Long, ZHANG Xu-lai, LIU Bao-gui, DAI Jing, WU Hui-ling, XUE Yang, HU Hong-yan, LIU Jin-tong

2019, 17(9): 1547-1550. doi: 10.16766/j.cnki.issn.1674-4152.000994

301 4

Abstract:
Objective To explore the effects of exercise on the symptoms, cognitive function and GABA in depression, as well as the possible biochemical mechanisms of exercise intervention in depression. Methods A total of 65 adult patients with depression from Anhui Mental Center were selected and numbered. Then the numbers were randomly divided by the lottery method. Patients (n=65) were divided into intervention group (n=35) and control group (n=30).5 patients in intervention group became detached. The intervention group took aerobic exercise on a treadmill about 35 minutes per day in a frequency of 3 to 5 times a week for 6 weeks. The whole exercise included a warm-up exercise for about 10 minutes before exercise, jogging for about 20 minutes, and a slow-down exercise for about 5 minutes. The heart rate of the patient was measured by using a treadmill before and after exercise, and the patient's highest training heart rate was controlled at (220-age)×70%. Besides, both of the intervention and the control group were treated with antidepressant sertraline (maximum dose of 150 mg/d). Depression symptoms were assessed by the Hamilton Depression Rating Scale. Cognitive function was assessed by the Montreal Cognitive Rating Scale. The GABA levels in human plasma were measured by enzyme-linked immunosorbent assay. The t-test of independent samples was used to compare sample data before and after treatment for the same group, while the t-test of paired samples were adopted for inter-group data. Different data were compared by the obtained means and variances. Results The difference of HAMD reduction scores were (-32.73±4.71) for the control group and (-24.23±8.95) for the intervention group. Total score of MoCA in the control group was (21.77±1.47), and in the intervention one was (25.23±1.16). The difference of GABA concentration in the control group before and after treatment was (0.32±1.54) mg/L, and in the intervention group was (1.87±0.73) mg/L. Exercise combined with antidepressant drugs significantly relieves depressive symptoms (P<0.01). Conclusion Exercise can relieve depressive symptoms and improve cognitive function of depression and increase the GABA levels in human plasma of depression.

High frequency color doppler ultrasound in differentiating benign and malignant breast tumors: analysis based on gray scale ultrasound and blood flow characteristics

LIU Hai-yan, ZHENG Hui

2019, 17(9): 1551-1553. doi: 10.16766/j.cnki.issn.1674-4152.000995

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Objective To investigate the characteristics of gray scale ultrasonography and blood flow in benign and malignant breast tumors by high frequency color Doppler ultrasound. Methods A retrospective analysis was made on 60 patients with breast tumors who underwent high frequency color Doppler ultrasonography from November 2016 to May 2018. According to the results of pathological examination, they were divided into malignant group (30 cases) and benign group (30 cases). In order to explore the value of high frequency color Doppler ultrasonography in the differential diagnosis of breast tumors, the gray scale ultrasonographic features of breast tumors (tumor shape, boundary, gravel calcification, longitudinal/transverse ratio, posterior echo) and blood flow grading and spectrum characteristics were compared and analyzed. Results ①Compared with benign group, the following gray scale ultrasonographic features of malignant group were more significant showing irregular shape of tumors (25/30 vs. 3/30), burr-like or crab-foot-like changes at the edge (23/30 vs. 5/30), gravel-like changes (16/30 vs. 4/30), longitudinal/transverse ratio >1(13/30 vs. 1/30), posterior echo attenuation (11/30 vs. 2/30),and the differences were statistically significant (all P<0.05); ②Compared with the benign group, the following blood flow characteristics of malignant group were more significant indicating blood flow distribution II, III (26/30 vs. 4/30), hemorrhagic flow spectrum (27/30 vs. 10/30), peak flow velocity≥20 cm/s (18/30 vs. 2/30), resistance index≥0.7 (25/30 vs. 2/30). The above differences were statistically significant (all P<0.05). Conclusion High-frequency color Doppler ultrasound has distinct manifestations in the gray scale and blood flow characteristics of benign and malignant breast tumors, and has high value in differential diagnosis.

Correlation between fetal ultrasound parameters and adverse pregnancy outcomes in late pregnancy and its predictive value

ZHU Xiao-qing, LI Yong-pei, ZHAO Li-yan, DING Yan-hua, ZHANG Li-dan, GAO Jian-song, JIN Ju, SHI Xiao-chun

2019, 17(9): 1554-1556,1608. doi: 10.16766/j.cnki.issn.1674-4152.000996

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Objective To investigate the correlation between different fetal ultrasound parameters and neonatal adverse outcomes in the third trimester and its application value in predicting neonatal adverse outcomes. Methods A retrospective analysis of 300 pregnant women who underwent routine prenatal ultrasound examination and finally delivered in our hospital from January 2017 to May 2018 was divided into adverse outcome group and no adverse outcome group according to whether there were adverse outcomes in neonates. The value of ultrasound detection indicators in predicting neonatal adverse outcomes. Results The incidence of gestational hypertension, gestational diabetes, and gestational subclinical hypothyroidism was higher in the adverse outcome group than in the non-adverse outcome group (all P<0.05). The fetal middle cerebral artery and umbilical artery S/D values in the third trimester pregnancy group were higher than those without adverse outcomes (all P<0.05). The fetal thyroid volume and fetal physical and physical scores in the adverse outcome group were significantly different from those without adverse outcomes (all P<0.05);Multivariate analysis showed that hypertensive disorder of pregnancy, fetal thyroid volume, umbilical artery S/D value, and middle cerebral artery S/D values were the relevant factors leading to neonatal adverse outcomes (all P<0.05). The sensitivity was 82.11% and the specificity was 41.83%. The sensitivity of umbilical artery S/D was 74.44% and the specificity was 51.22% in predicting neonatal adverse outcome. The sensitivity of thyroid volume in predicting neonatal adverse outcome was 66.70%, specificity is 46.35%. Conclusion The umbilical artery S/D value>2.975 and thyroid volume>0.424 in the fetal blood flow parameters and thyroid parameters in the third trimester can be used as an early evaluation index for predicting neonatal adverse outcomes in the third trimester.

Application of pelvic floor ultrasound in female stress incontinence and evaluation of efficacy of postpartum pelvic floor muscle training

SHAN Hua-ying, XU Ya-fen, LU Yan, LI Qiu-ling, FEI Jing-ying, CHA Yi-bao, HU Yang

2019, 17(9): 1557-1560. doi: 10.16766/j.cnki.issn.1674-4152.000997

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Objective To study the application of pelvic floor ultrasound in female stress urinary incontinence (SUI) and evaluate the effect of pelvic floor muscle training. Methods From April 2017 to December 2017, 1 000 primipara who were examined in our hospital were selected. The diagnostic efficacy of pelvic floor ultrasound was counted. Pelvic floor muscle training program was formulated. After 6 months, all SUI patients were divided into control group and treatment group. Pelvic floor ultrasound was used to observe the pelvic floor and peri-bladder structure data of the two groups, and the therapeutic effect was compared. Results The specificity, sensitivity and accuracy of pelvic floor ultrasonography diagnosis were higher; in resting state, the urethral inclination angle and posterior angle of bladder and urethra in treatment group were smaller than those in control group, the position of bladder neck and bladder was higher than that in control group, and the formation rate of funnel in urethra was lower than that in control group (all P<0.05); under maximum Valsalva maneuver, the descending distance of bladder neck, the rotation angle of urethra and bladder urine in the incidence of funnel formation was lower in the treatment group than in the control group (all P<0.05), and the total effective rate in the treatment group was higher than that in the control group (P<0.05). Conclusion Pelvic floor ultrasound has a high diagnostic efficiency for SUI symptoms, and can clearly show the pelvic floor structure. According to the specific conditions of patients with SUI, appropriate treatment methods are selected to provide help for early diagnosis and treatment of SUI patients.

Advance on mathematical models in inflammatory bowel disease

CHEN Si-jin, DAI Shi-xue

2019, 17(9): 1561-1565,1595. doi: 10.16766/j.cnki.issn.1674-4152.000998

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A mathematical model (MM) is a tool that imitates reality by using the language of function. It is often represented as a scoring system in medicine. The efficiency of MM is directly reflected in its specificity and sensitivity. In the field of inflammatory bowel disease (IBD), MM, such as the Best CDAI, HBI, CDISS, SES-CD, Lewis score, Rutgeerts score, MaRIA, and Clermont score, can assist in the diagnosis, evaluation and prognosis. However, these models are dependent on clinical symptoms, endoscopy and imaging findings, which are also limited to subjective experience of clinicians. There are also defects such as difficulty in obtaining indicators or high expense. A few peripheral blood markers that are easy to obtain, especially immunologic markers, aren't included in the variables for modeling, which affects the efficiency of MM. It was found in the previous series of studies on animals and humans that peripheral blood CD8⁺CD28⁺/CD8⁺CD28^- T cell ratio (equilibrium) showed a powerful efficiency in predicting the stage for experimental colitis rats. Clinical studies also found that the decrease of this ratio could accurately predict the active stage of IBD, and that this ratio could sensitively predict whether Crohn's disease progresses from non-stricturing and non-penetrating (type B1) to stricturing (B2) or penetrating (B3). Since the immunological mechanisms are vital for the pathogenesis of IBD, we summarize the current major MMs and combine our previous research foundations and thus propose that an immunology-combining MM could be more powerful in diagnosing and predicting outcomes for IBD.

Actions of orexin in the regulation of energy balance metabolism

LI Yan, CUI Yu, HUANG Shu-ming

2019, 17(9): 1566-1570. doi: 10.16766/j.cnki.issn.1674-4152.000999

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Orexin, also known as hypocretin, is a neuropeptide which is expressed by the neurons in the lateral hypothalamic area. The orexinergic nerve fiber terminals project widely in the brain and its receptors also widely distribute in the brain. The signal of orexin involves the integration of many physiological processes, such as arousal, feeding, spontaneous activity, reward seeking, as well as function control of autonomic nerve. Orexinergic nerve participates in the energy metabolism of the body through the regulation of multiple physiological activities. Based on the research progress on physiological functions of orexin and regulations of orexin neuron excitation, we have analyzed and explored the regulatory role of the orexin nerve in the balance of energy metabolism. Orexin is regulated by blood glucose, ghrelin and leptin. The decrease of blood glucose or the increase of ghrelin when an individual is hungry or decreases of leptin in an emaciation patient can all enhance excitability of orexin neurons, so as to promote awakening, activities and motivation of ingestion. Meanwhile, orexin makes the individual prepare for gaining food by increasing blood pressure, heart rate and the use of glucoses through sympathetic nerves. It can also make the digestive system ready for digesting food by promoting gastric acid secretion and gastric motion through vagus nerves. After feeding, following the increase of blood glucose and accumulation of adenosine which occurs while energy is consumed during activities, the excitability of orexin neurons decreases and the secretions of orexin reduces, leading to low desire, less movement and sleep of the individual, so as to save and store energy. Thus, orexinergic system has integrated a mechanism for the individual to intake and apply energy, and is maintaining the necessary balance of energy metabolism for life activities.

Research progress on drug therapy of mild cognitive impairment

ZHANG Hui, ZHANG Shao-wei, YU De-hua, LU Yuan

2019, 17(9): 1571-1574,1591. doi: 10.16766/j.cnki.issn.1674-4152.001000

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Mild cognitive impairment(MCI) is now a common condition in older people. It's a clinical condition between normal aging and mild dementia. Therefore, early intervention for mild cognitive impairment to improve cognitive decline and delay its transition to dementia is particularly important. In recent years, people around the world have been exploring ways to better prevent and treat MCI through drug and nutrient intervention, physical exercise, life behavior intervention and cognitive training. Whether those drugs and nutrients that can prevent and control the risk factors of mild cognitive impairment can be used in the prevention stage of MCI is worthy of attention and needs further research and confirmation. This paper will expound the research on the treatment of mild cognitive impairment drugs and nutrients in recent years, providing a basis for further exploring the drug treatment of mild cognitive impairment.

Treatment effect of Jiawei Suanzaoren decoction on insomnia of senior high school students and influence of 5-HTTLPR genetic polymorphism on the efficacy

FANG Fang, LUO Fu-gang, LI Jing, SHAO Qiong-yan, CHEN Li-qiong, LIU Yi, LIU Wen-juan, HU Lin-lin, ZHANG Yong-hua, SONG Ming-fen

2019, 17(9): 1575-1578. doi: 10.16766/j.cnki.issn.1674-4152.001001

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Objective To evaluate the treatment effect of Jiawei Suanzaoren Decoction on insomnia of senior high school students and to identify the association between serotonin transporter-linked promoter region (5-HTTLPR) genetic polymorphism and its efficacy. Methods Senior high school students with insomnia (50 cases for the control group and 47 cases for the Jiawei Suanzaoren Decoction group) were recruited.Participants in the control group only required to adjust their rest time, and those in the Jiawei Suanzaoren Decoction group also received Jiawei Suanzaoren Decoction for 1 week. Pittsburgh Sleep Quality Index (PSQI) before and after treatment was tested and compared by paired-t test. Blood was collected for 5-HTTLPR genotype determination and their associations with different responses were analyzed by χ² test. Results After treatment with Jiawei Suanzaoren Decoction, the scores of subjective sleep quality (2.17±0.38 vs. 0.77±0.48), sleep latency (2.11±0.37 vs. 0.68±0.52), sleep duration (1.43±0.50 vs. 0.89±0.37),habitual sleep efficiency (1.51±0.51 vs. 0.87±0.40), sleep disturbances (1.40±0.54 vs. 0.85±0.42), daytime dysfunction (1.70±0.46 vs. 0.89±0.37), and total score (10.32±1.07 vs. 4.96±0.95) of PSQI were obviously decreased as compared those of baseline(all P<0.001). The treatment effectiveness rate in the Jiawei Suanzaoren Decoction group (72.34%,34/47) was obviously higher than that of the control group (6.00%,3/50), P<0.001. LL genotype frequency and L allele frequency in the marked effective patients and effective patients treated with Jiawei Suanzaoren Decoction were significantly increased as compared with those of the ineffective patients(P=0.007, P<0.001). Conclusion Jiawei Suanzaoren Decoction has the treatment effect on insomnia of senior high school students and 5-HTTLPR genotypes may influence its efficacy.

Clinical application of comprehensive rehabilitation in patients with craniocerebral trauma

LI Qun, YAO Guo-quan, XU Li-lin, SHI Bei-tian, LU Cheng, HOU Shi-qiang, LIN Ning

2019, 17(9): 1579-1581. doi: 10.16766/j.cnki.issn.1674-4152.001002

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Objective To investigate the application value of comprehensive rehabilitation in patients with craniocerebral trauma. Methods A total of 104 patients with craniocerebral trauma who were treated with emergency surgery in our hospital from October 2016 to May 2018 were selected as subjects. They were randomly divided into observation group (51 patients) and control group (53 patients). The observation group was treated with comprehensive rehabilitation and routine rehabilitation in the control group. The χ² test was used to compare the incidence of common complications during hospitalization between the two groups. The t-test was used to analyze the FMA motor function score (Fugl-Meyer, FMA) and BI Daily living Ability Score (Bathel Index, BI) of the two groups after half a year，then the application value of comprehensive rehabilitation treatment programs was evaluated. Results The incidence of common complications during hospitalization was 27.45% in the observation group and 54.72% in the control group. After half a year of rehabilitation, the FMA score and BI score of the observation group were 83.18±2.24 and 72.71±2.99, and the control group was 76.15±2.33 and 63.60±3.31. χ² test showed that the incidence of common complications in the observation group was significantly lower than that of the control group (P=0.039). While the t-test showed that the FMA score and BI score in the observation group were significantly higher than the control group (P=0.032, 0.044). Conclusion Comprehensive rehabilitation treatment can significantly reduce the incidence of common complications in patients with craniocerebral trauma, and also promote the recovery of function and improve the quality of life, which has a certain clinical application value.

The status quo, problems and countermeasures of standardized training for specialists in Shanghai

CHEN Li-hong, TIAN Hong, DAN Jiong, SHEN Hui-qing

2019, 17(9): 1582-1585. doi: 10.16766/j.cnki.issn.1674-4152.001003

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Objective To understand the status quo, provide policy evidence and improve the standardized training program for specialists in Shanghai. Methods Via questionnaires and training base interviews, 881 specialized training physicians who participated in the comprehensive assessment and were going to complete the training were selected as the respondents. The survey included the general information of the respondents, the evaluation of the training process, assessment and results, satisfaction evaluation and suggestions. Results According to the investigation, the trainees had the highest satisfaction with teachers, and lower satisfaction with salary and training duration. The programs has achieved certain results, but it still needs improvement in supporting policies, guarantee mechanisms, specialist settings, quality control, assessment systems, and teacher management. Conclusions It is recommended to improve the supporting system to form a scientific, standardized, systematic and rigorous institutional system; add the specialist settings, refine the training programs and standards; strengthen the cooperation and division of management system, establish a collaborative education mechanism between medical school and training hospitals; establish a training base evaluation index system, strengthen the construction of training base and quality control; improve the exam system based on specialist's position competency; strengthen the construction of teaching staff and establish a clinical teaching incentive mechanism.

The clinical efficacy of direct lateral approach versus traditional posterior approach for the treatment of total hip arthroplasty: a meta-analysis

CHE Xian-da, HAN Peng-fei, GU Xiao-dong, GAO Yang-yang, CHEN Tao-yu, LI Peng-cui, WEI Xiao-chun

2019, 17(9): 1586-1591. doi: 10.16766/j.cnki.issn.1674-4152.001004

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Objective To compare the clinical efficacy between direct lateral approach and traditional posterior approach in the treatment of total hip arthroplasty by Meta-analysis. Methods The study included clinical trials published both at home and abroad from August 2008 to August 2018. The retrieval was performed in the online databases include Embase, Pubmed, PQDT, China National Knowledge Infrastructure (CNKI), CQVIP, Wanfang Data, CBM, etc. Statistical software Review Manager 5.3 was used for data-analysis. Results Based on the above search strategy to search papers, a total of 441 relevant literatures were retrieved, and eventually 12 literatures were included. The outcome measurements include 5 aspects such as harris hip score, range of motion, complications, time of surgery, trendelenburg test. Results The analysis showed that the direct lateral approach was inferior to Traditional Posterior Approach in Hip extension activity[95% CI (-10.93- -7.01), P<0.001], and the Direct Lateral Approach was superior to Traditional Posterior Approach in Hip flexion activity[95% CI (8.87-12.70), P<0.001], Trendelenburg test[95% CI (1.53-13.68), P=0.007]. But in Harris hip score [95% CI (-0.14-0.62), P=0.21]; Complications [95% CI (0.29-1.07), P=0.08]; Time of surgery [95% CI (-7.31-5.94), P=0.84], there was no significant differences between the two procedures. Conclusions Both the direct lateral and traditional posterior approach in total hip arthroplasty can achieve good effect, and the complications and harris hip score are comparable. Although the direct lateral approach group is superior to the traditional posterior approach group in trendelenburg test, the direct lateral approach is still a safe and feasible treatment option.

Application of evidence-based medicine training in improving the quality of graduate school diagnostics methodology

LIU Ya-li, XU Zhi-wei, WANG Xue-mei, ZHANG Yi-nong, LIU Guang-zhi

2019, 17(9): 1592-1595. doi: 10.16766/j.cnki.issn.1674-4152.001005

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Objective To Understand the quality of graduation thesis of medical graduate students, and find ways to improve the quality of graduate thesis through systematic training of clinical epidemiology and evidence-based medical knowledge. Methods Taking the graduate students of a medical school in Zhengzhou from 2014 to 2017 as the survey object, using the STARD (2003) report specification of the diagnostic test to evaluate the clinical epidemiological and evidence-based medical knowledge system before and after training, the graduate diagnostic test paper STARD (2003) reported 25 items in line with the situation, and judged the effect of clinical epidemiology. Results A total of 77 postgraduate diagnostic test papers that met the inclusion criteria, of which 23 were not trained in clinical epidemiological methods, 54 were trained in clinical epidemiological methods, and received clinical epidemiology and follow-up. After the training of the relevant knowledge system of the medical science, the coincidence rate of the STARD report items of the graduate diagnostic test papers was significantly improved, and the average number of entries increased from 9.36±2.25 to 18.64±2.46. The difference was statistically significant (t=15.527, P<0.001), and the entries rate was higher than the pre-training study, and the 80% entry rate difference was statistically significant (P<0.05). The compliance rate of the 15th item increased by 72.7%. Conclusion Systematic training of clinical epidemiology and evidence-based medical knowledge can significantly improve the quality of graduate thesis and is worthy of further application and promotion.

Preoperative application of standardized pain management in patients with osteoporotic vertebral compression fractures

HU Ting-ye, LU Yu-he, WANG Kai, ZHOU Xiao-xing, WANG Min, ZHANG Shan-shan, XIA Lei

2019, 17(9): 1596-1599. doi: 10.16766/j.cnki.issn.1674-4152.001006

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Objective Investigate the effect of standardized pain management on preoperative application in patients with osteoporotic vertebral compression fractures. Methods Patients with osteoporotic vertebral compression fractures were divided into two groups according to the patient's admission time. The 50 patients admitted from February to November 2017 were the control group, and 50 patients admitted from December 2017 to July 2018 were the observation group. There was no statistical significance on the difference of patients' gender, age, fracture segment and pain at admission between the two groups. All 100 patients were treated with Percutaneous vertebroplasty (PVP). The control group was treated with the routine pain care, giving health education, psychological counselling, pain assessment, non-drug care intervention, and drug analgesia. The observation group used standardized pain care, which assessed the patient's pain and recorded objectively and accurately, enhancing pain education and psychological care, advanced analgesia, timely analgesia, individualized analgesia and multimodal analgesia. Compare the pain care quality and analgesic effect of the preoperative pain intervention in two groups. Results There was statistical significance between the preoperative pain status of the two groups, the number of cases of intramuscular injection of analgesic drugs, the degree of pain affecting sleep, the degree of pain knowledge and the adequacy of pain selection methods, and the satisfaction of pain control, with statistical significance (all P<0.05). In contrast, there was no significant difference in the effect of pain on the turn-over between the two groups and the pain intensity recorded by digital assessment or descriptive method (all P>0.05). Conclusion The implementation of standardized pain management is helpful to improve the quality of preoperative pain care and analgesia in patients with osteoporotic vertebral compression fractures.

Development and reliability and validity tests of the ICU nurse's KAP scale in the general hospital

NING Li, LU Jun, LI Yi-min, LIN Li-jun, LIU Qin, TANG A-mao

2019, 17(9): 1600-1604. doi: 10.16766/j.cnki.issn.1674-4152.001007

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Objective To Develop the ICU nurse's KAP scale in the general hospital and test its reliability and validity, in order to assess the subsyndromal delirium in ICU. Methods The subsyndromal delirium scale framework and items was initially built through literature reviewed and integrated，combined with expert opinion and knowledge theory. The reliability and representativeness of expert consultation are tested with expert authority coefficient, positive coefficient, coordination coefficient and coefficient of variation. After the formation of the questionnaire, we investigated 510 nursing staff working in ICU at 7 tertiary A hospitals and 2 tertiary B hospitals in Zhejiang province from July to August 2017, with the above questionnaire, filter items by project differentiation analysis, correlation analysis, exploratory factor analysis prevention; Cronbach's a coefficient, retest reliability, content validity and structural validity analysis were used to determine the feasibility and validity of the questionnaire. Results The participation in expert consultations is 100% and the authoritative coefficient is 0.87, the consistency of the experts in the two rounds of correspondence is 0.75 and 0.89. The ICU nurse's KAP scale in the general hospital contains 3 dimensions of knowledge, attitude and care behavior, including 32 items, using Likert 5-grade scoring method. The total Cronbanch's α coefficient of the questionnaire is 0.964, the Cronbanch's α coefficient for each dimension is 0.900-0.976, the test reliability is 0.985, the retest reliability for each dimension is 0.836-0.952, the content validity indicator S-CVI is 0.97, I-CVI is 0.97-1.00; the cumulative contribution rate for each dimension is 69.38%.The confirmatory factor analysis shows that the questionnaire has a good structural validity. Conclusion This scale has good reliability and validity, and can be used to investigate the status of subsyndromal delirium of nurses in ICU.

Risk factors analysis and nursing strategies for patients with intestinal obstruction after radical resection of cervical cancer

YI Liu-na, WEI Hui-qin, ZHANG Xiao-qin

2019, 17(9): 1605-1608. doi: 10.16766/j.cnki.issn.1674-4152.001008

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Objective To analyze the risk factors and nursing strategies of patients with intestinal obstruction after radical resection of cervical cancer. Methods A total of 146 patients who underwent radical resection of cervical cancer in our hospital from March 2016 to July 2018 were enrolled. Patients with intestinal obstruction after radical resection of cervical cancer were included in the observation group (n=14), and 132 patients without intestinal obstruction after radical resection of cervical cancer were included in the control group. In order to ensure the authenticity and effectiveness of the collected data, the risk factors were collected by professional doctors and nurses. The age, BMI, history of pelvic and abdominal surgery, preoperative bowel preparation, surgical procedure, anesthesia, operation time, postoperative blood K-level, postoperative fasting time, postoperative infection, etc. were statistically analyzed, and single factor and logistic regression analysis were used to determine the risk factors for intestinal obstruction after radical resection of cervical cancer. Results Univariate and logistic regression analysis showed that age, history of pelvic and abdominal surgery, preoperative bowel preparation, surgical procedure, anesthesia, operation time, postoperative potassium level, postoperative fasting time, postoperative infection were the influencing factors of intestinal obstruction after radical resection of cervical cancer. Conclusion In the clinic, we should pay attention to these factors, improve the quality of care, do preventive treatment and care, minimize the occurrence of complications, improve patient satisfaction, and prevent the occurrence of intestinal obstruction.

2019, 17(9): 1609-1611. doi: 10.16766/j.cnki.issn.1674-4152.001009

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2019, 17(9): 1612-1614. doi: 10.16766/j.cnki.issn.1674-4152.001010

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About Journal

2019 Vol. 17, No. 9

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