2020 Vol. 18, No. 10

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Emphasize the role of community prevention and control of family physicians in public health emergencies
REN Yi, MA Li
2020, 18(10): 1615-1618. doi: 10.16766/j.cnki.issn.1674-4152.001575
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Public health emergencies have the characteristics of unpredictability, extensive influence and complexity of prevention and control. Community prevention and control is an important grassroots network in the public health system. When dealing with public health emergencies, family physicians should continue to be the gatekeeper of residents' health, providing high-quality, comprehensive, continuous and individualized health care and health education services for contracted residents. Against the problems such as adjustment of medical facilities, inconvenience for patients with chronic diseases in seeking medical care special psychological problems and lifestyle changes during the epidemic period, family physicians should give full play to the advantages of contracted services of family physicians, strengthen consultation and guidance to patients, find patients health problems in time and solve them as far as possible and provide appropriate medical services. In addition, it is also necessary to be a gatekeeper for the prevention and control of public health emergencies, detective early and report early and undertake the tasks related to prevention and control, such as investigation and health guidance for key groups, standardized management of people who are quarantined or under observation, promotion of scientific protection knowledge, discovery and coordination of risk points in the community, etc. Public health emergencies will lead to some changes in family physicians' protective behaviors and medical behaviors, such as increasing of self-protection behaviors, increasing of referral patients, improving the speed of consultation, measuring body temperature and more application of information technology. At the same time, family physicians also have some problems in dealing with public health emergencies, such as lack of awareness of prevention, isolation from disease prevention and control departments and lack of initiative and standardization. To further improve and support the ability of family physicians to cope with public health emergencies, it is necessary to take the government as the main body, fully mobilize and play the collaborative role of social forces to build a grassroots governance community for community epidemic prevention and control, build the strong relationship between primary health care services and public health services, carry out targeted continuing education and establish information network, etc.
CHEN Lin-jie, LI Zhi-jun
2020, 18(10): 1619-1620.
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Prognostic value of neutrophil to lymphocyte ratio combined with C-reactive protein in patients with acute coronary syndrome
QIAN Shao-huan, LI Miao-nan, YAO Zhuo-ya, ZHANG Wei, MIN Sheng-ping, WANG Hong-ju
2020, 18(10): 1621-1624,1628. doi: 10.16766/j.cnki.issn.1674-4152.001576
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Objective To analyze the relationship between neutrophil/lymphocyte(NLR) and risk stratification and prognosis in patients with acute coronary syndrome(ACS), and to assess the prognostic value of NLR combined C-reactive protein(CRP) in patients with ACS. Methods Total 430 patients diagnosed with ACS by coronary angiography in our hospital from October 2018 to July 2019 were selected and followed up by telephone for an average of 10 months. All patients were divided into low NLR group and high NLR group according to median NLR level; low risk group, middle risk group and high risk group according to the scores of GRACE and TIMI; MACE group and Non-MACE according to follow up results. The clinical data between each group were compared and the risk factors of MACE in ACS patients were analyzed. The prognostic value of NLR combined CRP was evaluated by ROC curve. Results The proportion of male patients, serum creatinine, CRP, Gensini scores and the occurrence of MACE in the high NLR group were significantly higher than those in the low NLR group, while the left ventricular ejection fraction(LVEF) was significantly lower than that in the low NLR group(all P<0.05). The NLR level of the high risk group in risk stratification was significantly higher than that in the middle and low risk groups(all P<0.05). The area under the curve(AUC) of NLR predicted the high-risk group in GRACE risk stratification was 0.684(P<0.05). The NLR and CRP levels were significantly higher in the MACE group than those in the Non-MACE group(all P<0.05). Dual logistic regression analysis showed that NLR and CRP were an independent risk factor for the occurrence of MACE in ACS patients(all P<0.05), the ROC curve showed that the AUC of NLR combined with CRP to predict the incidence of MACE was 0.832, the sensitivity was 71%, and the specificity was 87%(P<0.001). Conclusion The level of NLR is significantly associated with risk stratification and prognosis in ACS patients. NLR combined CRP have high predictive value for the occurrence of MACE in ACS patients.
Application of intrathoracic impedance monitoring and alarm based on CorVue algorithm in patients with chronic heart failure
YU Fei, CHEN Kang-yu, SU Hao, WANG Qi, YANG Dong-mei, XU Jian, YAN Ji
2020, 18(10): 1625-1628. doi: 10.16766/j.cnki.issn.1674-4152.001577
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Objective To evaluate the effectiveness and diagnostic value of CorVue system alarm in identifying cardiac function changes and heart failure events of patients. Methods Patients with chronic heart failure with transthoracic impedance monitoring function CRT-D were enrolled in our hospital from January 2015 to May 2018. Baseline data such as age, gender, heart failure etiology, NYHA heart function class, blood biochemical indicators and therapeutic drugs were collected. At 1, 3, 6 and 12 months after surgery, routine follow-up was performed in the pacemaker clinic, and unexpected follow-up was performed in the heart failure clinic or emergency department when device alarm or cardiac function deterioration occurred. The baseline data and follow-up data of the patients were analyzed retrospectively. The effective alarm and invalid alarm were defined according to whether there was a heart failure event within 30 days of the device alarm. The predicted value of the CorVue system alarm for heart failure events was calculated, and the NT-proBNP level after the alarm was observed. Results Total 51 patients with heart failure were included in the study, with an average age of(63±8) years and women with 35.29%. A total of 73 CorVue system alarms and 23 heart failure events occurred during the 12-month follow-up. Sensitivity of CorVue alarms was 35%, specificity was 30%, positive predictive value of 11% and negative predictive value of 65%. 71% of the alarms were accompanied by an increase in NT-ProBNP level[1 623(1 160,1 902)]. After the alarm, the level of NT-ProBNP increased 32%[1 734(1 276,1 844), P=0.001]. The NT-ProBNP levels of the effective alarm group and the invalid alarm group increased by 109%(P=0.012) and 22%(P=0.029) respectively[1 623(1 049,1 902)]. Conclusion The value of CorVue alarm lies in reflecting the potential changes of cardiac function, rather than simply predicting heart failure events.
Application of the repeat plasmakinetic resection in non-muscular invasive bladder tumor
LI Li-qiang, GUO Yuan-yuan, YUE Xiao-e, WANG Cheng-yong, LI Qing-wen, LIU Jian-min, LIU Bei-bei
2020, 18(10): 1629-1632. doi: 10.16766/j.cnki.issn.1674-4152.001578
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Objective To discuss the value of the repeat plasmakinetic resection(Re-PKRBt) in non-muscular invasive bladder tumor. Methods A retrospective analysis was performed on 113 patients with non-muscular invasive bladder tumor who underwent plasmakinetic resection of bladder tumor in the Department of Urology, the First Affiliated Hospital of Bengbu Medical College from July 2017 to January 2019. Among them, 43 patients who underwent Re-PKRBt 4-6 weeks after first plasmakinetic resection were in observation group, while the remaining 70 patients who underwent single plasmakinetic resection were in control group. The following clinical data were recorded and analyzed, including the general data:gender, age, BMI, tumor size, number, preoperative staging, and pathological grading; the operation related information:indwelling catheterization time, intraoperative and postoperative complications, etc.; the postoperative pathological and prognostic data:positive rate of Re-PKRBt, postoperative pathological staging of the two groups of patients and local recurrence rate after 12 months of follow-up, etc. Results There was no significant difference between the two groups in general information and operation related information(all P>0.05). In the observation group, 3 patients(6.98%) showed urothelial tumor cells after Re-PKRBt. There was no significant difference concerning the invasion rate of muscle layer between first plasmakinetic resection in the observation group and the control group(6.98% vs. 7.14%). The invasion rate of muscle layer after secondary plasmakinetic resection in the observation group was significantly higher than that of the control group(20.93% vs. 7.14%), and the difference was statistically significant(P<0.05). The recurrence rate of the observation group was significantly lower than that of the observation group(2.94% vs. 18.46%), and the difference was statistically significant(P<0.05). Conclusion Re-PKRBt can remove tumor tissues to the maximum extent, provide accurate pathological staging and reduce recurrence rate, and increase of intraoperative and postoperative complications is insignificantly. Re-PKRBt for non-muscular invasive bladder tumors can benefit the patients and is worthy of clinical promotion.
Study of protective effect and mechanism of HSPB8 on diabetic neurons
LI Jin-feng, LI Xiao-cheng, MA Wei-guo, YIN Xiao-hong, LI Ya
2020, 18(10): 1633-1637. doi: 10.16766/j.cnki.issn.1674-4152.001579
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Objective To observe the expression of HSPB8 in spinal cord tissues of spontaneous type 2 diabetes db/db mice, and explore the neuroprotective mechanism of HSPB8. Methods Eight weeks old, male, db/m mouse(db/m group, 10 mice), db/db mouse(db/db group, 10 mice) were selectd. Body weight and fasting blood glucose were dynamical observation. HE staining was used to observe spinal cord in mice. mRNA expressions of HSPB8, Caspase-1, IL-18, P62 and LC3 were detected by qRT-PCR. For the in vitro model of diabetes, RGC-5 cells were stimulated with glucose concentrations of 11, 25, 30 and 35 mmol/L for 48 hours, respectively. RGC-5 cells were silenced by HSPB8 protein and stimulated by high glucose(35 mmol/L) for 48 h. HSPB8, Caspase-1, IL-18, P62 and LC3 were detected by western blot. Group t-test and one-way ANOVA were used for comparison between groups. Results (1)HE staining results showed that spinal cord tissue of db/db mice was damaged;(2)qRT-PCR results showed that HSPB8, Caspase-1, IL-18, P62 and LC3 were expressed in diabetic spinal cord tissues;(3)Western blotting results showed that compared with the db/m group of mice, the db/db mice were damaged spinal cord tissues HSPB8, LC3-Ⅱexpression were decreased, and the Caspase 1, IL-18, P62 expression were increased(all P<0.05). With the increase of blood glucose concentration, the expression of HspB8, LC3-Ⅱwere decreased, and the caspase-1, IL-18 and p62 were increased(all P<0.05);(4)Forty-eight hours after RGC-5 cells HSPB8 silence sugar stimulation, the Caspase 1, IL-18 and P62 protein expression were increased and LC3-Ⅱexpression were declined(all P<0.05). Conclusion HSPB8 plays an important protective role in diabetic neuropathy, and its mechanism may be related to the effect of HSPB8 on inflammatory factors and autophagy in neurons.
Clinical study of tolvaptan combined with Niaoduqing granule in the treatm ent of nephrotic syndrome
WENG Yu-cai, WANG Gao-an, WANG Wei, WU Ceng-fan
2020, 18(10): 1638-1640,1773. doi: 10.16766/j.cnki.issn.1674-4152.001580
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Objective To analyze the effect of tolvaptan combined with Niaoduqing granule on improving renal function, blood lipid, blood coagulation and quality of life in patients with nephrotic syndrome. Methods From March 2016 to March 2018, 70 patients with nephrotic syndrome in our hospital were divided into two groups according to the method of random number table. Thirty-five patients in the control group were treated with tovaptan, and 35 patients in the observation group were treated with tolvaptan and Niaoduqing granules. The renal function, blood lipid, coagulation index and quality of life of the two groups were compared before and after treatment. Results After treatment, Scr[(73.16±8.82) μmol/L], BUN[(6.52±0.50) mmol/L] and 24-hour urine protein quantity[(1.21±0.44) g] in the observation group were significantly lower than those in the control group[(84.36±9.68) μmol/L,(7.28±0.67) mmol/L and(1.89±0.58) g], and ALB(39.77±4.45) g/L was significantly higher than that in the control group(34.72±4.20) g/L. After treatment, TG, TC, D-D levels of the two groups were significantly lower than before treatment. FIB of the observation group was significantly lower than before treatment, and TG, TC, D-D, FIB of the observation group were significantly lower than that in the control group(all P<0.05). The quality of life scores of the observation group were significantly higher than that in the control group(all P<0.05). Conclusion The clinical effect of tolvaptan combined with Niaoduqing granules in the treatment of nephrotic syndrome is significant, which can effectively improve the renal function, improve the blood lipid and coagulation indexes, and improve the quality of life of patients.
Experimental study on Eight Zhes Decoction in the treatm ent of nonalcoholic fatty liver fibrosis
ZHOU Yu-ping, LU: Xue-you, WEN Jin-feng, YANG Ping, ZHOU Fei, TANG Chun-lan
2020, 18(10): 1641-1644,1674. doi: 10.16766/j.cnki.issn.1674-4152.001581
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Objective To study the therapeutic effect of Eight Zhes Decoction(EZD) on nonalcoholic fatty liver fibrosis(NASF) in mice model. Methods Thirty-two male C57 BL/6 mice were randomly divided into control group, model group, EZD high dose group and EZD low dose group. The control group mice were fed with methionine-choline-supplemented diet(MCS), while the other groups with methionine and choline deficient(MCD) diet and repeated injection of carbon tetrachloride(CCl4) once a week. On the first day of the third week, the EZD group were intragastric administrated by EZD, and at the end of the sixth week, all the experimental mice were sacrificed, the serums and liver were collected. The histological analysis was conducted by HE staining, oil red O staining and Sirius red staining. The hepatic alpha smooth muscle actin(α-SMA) protein expression was detected by immunohistochemistry. In addition, serum liver function and liver triglyceride levels were measured. Results Compared with the control group, the activities of ALT, AST and TBil in serum and the triglyceride content in liver of model group mice were significantly increased(all P<0.01),which were significant reduced in the EZD group(all P<0.01). Compared with the control group, liver tissue in model group showed obvious inflammation and increased the areas of oil red O-positive staining, Masson collagen staining(all P<0.01), which were significant reduced in the EZD group(all P<0.01). In addition, model group expressed higher level of α-SMA protein(P<0.01), which were reduced in the EZD group(P<0.01). Conclusion Eight Zhes Decoction could prevent liver fibrosis in mice model of NASF. The underlying mechanism might partially lie in inhibiting the activation of hepatic stellate cells and collagen production.
Clinical distribution and antibiotics resistance mechanisms of non-baumannii Acinetobacter
WANG Mu-qun, ZHANG Yong
2020, 18(10): 1645-1648,1681. doi: 10.16766/j.cnki.issn.1674-4152.001582
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Objective To analyze the clinical distribution characteristics and drug sensitivity of non-baumannii Acinetobacter(NbA) isolates, and to detect metallo-β-lactamases and integrase genes. Methods K-B method was used to test the drug sensitivity of non-baumannii Acinetobacter isolated from various specimens collected from wards and clinics of two teaching hospitals in Anhui Province. The results were judged according to CLSI 2016 edition. Polymerase chain reaction(PCR) was used to amplify the metallo-β-lactamase gene and the integrase gene of class Ⅰ-Ⅲ integrin. Results Total 44 NbA isolates(29 A. lwoffii strains, 9 A. junii strains, 2 A. haemolyticus strains, 3 A. calcoaceticus strains and 1 Acinetobacter genomic species 13 TU strain) were potentially gathered in Cardiology Department, Respiratory Department and others, and isolated from sputum, urine, secretion and other samples. Three(6.8%) isolates(2 A. lwoffii strains, 1 A. haemolyticus strain) were multi-resistant, 17 strains(38.6%) were susceptible to all antimicrobial agents except β-lactam antibiotics, while the rest 24 isolates were fully susceptible. Nine of the 44(20.45%) NbA isolates carried SIM-1 gene, including 7 A. lwoffii strains and 2 A. junii strains. Four strains(9.09%) carried VIM-2 gene, including 2 A. lwoffii strains, 1 A. haemolyticus strain and 1 A. junii strain. IMP-4, NDM-1 gene were not detected in all NbA strains. Five(11.36%) harbored Class 1 integrase, including 3 A. lwoffii strains, 1 A. haemolyticus strain and 1 A. junii strain, 6(13.64%) isolates harbored class 2 integrase, including 3 A. lwoffii strains, 1 A. haemolyticus strain and 2 A. junii strains. No class 3 integrase were found in all the NbA isolates. Conclusion The drug resistance rate of non-baumannii Acinetobacter is relatively low, but multidrug-resistant strains have been found. The mechanism of drug resistance may be related to metallo-β-lactamase and integrase.
The clinical effects of XLIF and OLIF in the treatm ent of degenerative scoliosis and its influence of functional recovery of patients
WEI Yong-li, LUO Ke-feng, ZHAO Ji
2020, 18(10): 1649-1651,1698. doi: 10.16766/j.cnki.issn.1674-4152.001583
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Objective To explore the effects of minimally invasive extreme lateral interbody fusion(XLIF) and minimally invasive oblique lateral lumbar interbody fusion(OLIF) on the functional recovery of patients with degenerative scoliosis, and to provide a reference for the choice of treatment of degenerative scoliosis. Methods Total 100 patients with degenerative scoliosis who were operated in our hospital from January 2016 to January 2019 were divided into XLIF group(56 cases) and OLIF group(44 cases). XLIF was performed in XLIF group and OLIF in OLIF group. The clinical indexes, Cobb's angle, PI-LL, functional recovery, pain and complications were compared between the two groups. Results Six month after operation, the Cobb's angle and PI-LL[(5.00±1.10)d,(13.52±2.13)°] in the OLIF group were lower than those in the XLIF group[(5.12±1.09)°,(13.68±2.15)°], with no significant difference(t=0.544, 0.371; P=0.587, 0.712).The DOI and NRS scores(8.00±0.50, 1.13±0.02) in the OLIF group were lower than those in the XLIF group(11.27±0.68, 2.49±0.10, t=26.710, 88.740, all P<0.01). The JOA score(25.66±3.58) of the OLIF group was higher than that of the XLIF group(19.68±2.46, t=9.884, P=0.001). The incidence of operative complications in the OLIF group(2.27%) was lower than that in the XLIF group(17.86%, χ2=4.625, P=0.032). Conclusion Compared with XLIF, OLIF can significantly reduce the symptoms of lumbar pain in patients with degenerative scoliosis, promote the recovery of function, and has higher safety, which is worthy of clinical application.
Correlation between lncRNA HOTAIR and tumor markers and pathological stage of lung cancer
YANG Yu-ming, DUAN Gui-xin, WANG An-sheng
2020, 18(10): 1652-1655. doi: 10.16766/j.cnki.issn.1674-4152.001584
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Objective To observe the changes of lncRNA HOTAIR and tumor markers in different pathological stages of lung cancer, and to explore the clinical value of lncRNA HOTAIR combined with tumor markers in the diagnosis of lung cancer stages. Methods Fifty patients with lung cancer in the first affiliated Hospital of Bengbu Medical College were selected as the lung cancer group and 50 healthy volunteers as the control group. According to the T and N stages of lung cancer, 50 patients with lung cancer were divided into T1, T2, T3 and N0, N1, N2 groups. The levels of lncRNA HOTAIR in cancer and paracancerous tissues were detected by fluorescence in situ hybridization, and the levels of NSE, CEA and CYFRA21-1 in serum were detected by immunofluorescence. Results The serum levels of NSE, CEA and CYFRA21-1 in the lung cancer group were higher than those in the control group, and the expression levels of, lncRNA HOTAIR, NSE, CEA and CYFRA21-1 in the lung cancer group were significantly higher than those in the control group(all P<0.05). In the T and N stages of lung cancer, the expression levels of, lncRNA HOTAIR, NSE, CEA and CYFRA21-1 were significantly higher than those in the control group(all P<0.05). LncRNA HOTAIR concentration in paracancerous tissues was lower than that in lung cancer tissues(P<0.001), and the serum levels of NSE, CEA and CYFRA21-1 in lung cancer group were higher than those in control group(all P<0.05). The expression of lncRNA HOTAIR was positively correlated with the expression of NSE, CEA and CYFRA21-1. The expression levels of lncRNA HOTAIR in tissue and serum NSE, CEA and CYFRA21-1 in patients with lung cancer were positively correlated with T stage and N stage of lung cancer(all P<0.001), and were positively correlated with the N stage of lung cancer, and the expression levels of tissue and serum NSE, CEA, CYFRA21-1 in patients with lung cancer were positively correlated with T stage and N stage of lung cancer(all P<0.001). The sensitivity, approximate equal index and positive predictive value of combined detection were higher than those of single index. Conclusion The expression level of lncRNA HOTAIR and serum NSE, CEA, CYFRA21-1 is closely related to the pathological stage of lung cancer. lncRNA HOTAIR combined with serum tumor markers can improve the accuracy of detection of pathological stage of lung cancer.
Effects of miR-130a on EPCs adhesion, migration, and expressions of IL-18 and TGF-β1 in peripheral blood of patients with type 2 diabetes mellitus
LU Xiang, ZHENG Le-qun, ZHENG Yi-xue
2020, 18(10): 1656-1659,1778. doi: 10.16766/j.cnki.issn.1674-4152.001585
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Objective To study the effects of miR-130 a on the adhesion and migration abilities of endothelial progenitor cells(EPCs) and the expressions of interleukin-18(IL-18) and transforming growth factor-β1(TGF-β1) in peripheral blood of patients with type 2 diabetes mellitus. Methods Peripheral blood of 60 patients with type 2 diabetes mellitus in Wenzhou Hospital of Traditional Chinese Medicine from April 2018 to August 2018 was collected. EPCs were isolated, cultured and identified by fluorescence staining. EPCs were divided into three groups:control group, mimics NC group, and miR-130 a mimics group. The control group were cultured without any treatment, the mimics NC group were transfected with mimics NC, and the miR-130 a mimics group were transfected with miR-130 a mics. The expression of miR-130 a was detected by qRT-PCR. The effects of overexpression of miR-130 a on the adhesion and migration of EPCs were observed. The expressions of IL-18 and TGF-β1 in the cell culture supernatant was detected by ELISA. Results After 48 h of culture, the cells grew adherently, and were round and small. On the 4 th day, the cell volume increased and was elliptical. On the 7 th day, the cells adhered to each other and formed clusters, the cells were round or irregular. The cells were positive for Dil-acLDL, FITC-UEA-I, and DAPI staining, which confirmed EPCs. There were no significant differences in the relative expression of miR-130 a, the numbers of adhesion and migration of EPCs, and the expression levels of IL-18 and TGF-β1 between the control group and the mimics NC group(all P>0.05). Compared with the control group and the mimics NC group, the relative expression of miR-130 a in EPCs of the mimics group increased significantly(all P<0.05), the numbers of adhesion and migration of EPCs increased(all P<0.05), the expression levels of IL-18 and TGF-β1 decreased(all P<0.05). Conclusion Overexpression of miR-130 a can improve the adhesion and migration of EPCs in peripheral blood of patients with type 2 diabetes mellitus, and inhibit the expressions of IL-18 and TGF-β1.
Protective effects of oxymatrine on LPS-induced neuronal apoptosis of hippocampal neurons
CAI Yan, MI Da-guo, JIANG Wei, ZHOU Ai-ling, JIANG Xiao-yan, ZHU Ke, CAO Gang
2020, 18(10): 1660-1662,1765. doi: 10.16766/j.cnki.issn.1674-4152.001586
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Objective to investigate the effect and mechanisms of oxymatrine(OMT) on lipopolysaccharide(LPS) induced apoptosis of hippocampal neurons. Methods According to the release rate of lactate dehydrogenase(LDH) in hippocampal neurons, the concentration of OMT was selected for experimental grouping. There were seven groups:normal group, LPS group, Aspirin+LPS group, OMT group, OMT low-dose+LPS group, OMT mid-dose+LPS group and OMT high-dose+LPS group. Apoptosis rate was detected by flow cytometry. The nuclear translocation of NF-κB/P65 was observed by immunofluorescence. The level of tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) in culture supernatants of hippocampal neurons were determined by Enzyme-linked immunosorbent assay(ELISA). Results The apoptosis rate of hippocampal neurons in the LPS group was higher than normal group(P<0.01), and OMT could significantly reduce LPS stimulated apoptosis rate of hippocampal neurons(P<0.05). LPS promoted NF-κB/P65 shifted from cytoplasm to the nucleus, and increased the level of TNF-α and IL-1β in the culture supernatant of hippocampal neuron, while OMT reduced the LPS on hippocampal neurons NF-κB/P65 nuclear translocation and reduce the level of TNF-α and IL-1β. Conclusion LPS could induce NF-κB/P65 nuclear translocation in hippocampal neurons and result in increased levels of inflammatory factors TNF-α and IL-1β. OMT could weaken the nuclear translocation of NF-κB/P65 induced by LPS and reduce the level of TNF-α and IL-1β, which in turn to inhibit apoptosis of hippocampal neurons.
The detection and diagnosis value of PCT and CRP in patients with open fracture of tibia and fibula
DENG Ya-kai, CHEN Wei-nan
2020, 18(10): 1663-1666. doi: 10.16766/j.cnki.issn.1674-4152.001587
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Objective To research the changes and diagnostic value of procalcitonin(PCT) and C reactive protein(CRP) levels in infectious patients with open fracture of tibia and fibula. Methods Total 93 patients with open fracture of tibia and fibula in our hospital from November 2016 to April 2018 were divided into the infection group(36 cases) and the non-infection group(57 cases). The levels of PCT and CRP were measured 1 day, 3 days, 5 days, 7 days and 10 days after operation, and the clinical value of PCT and CRP in the diagnosis of infection after open fracture of tibia and fibula were analyzed. Results A total of 54 pathogens were isolated from 36 patients with fracture infection. Among them, 33 strains were gram-positive bacteria(61.11%), 18 strains were gram-negative bacteria(33.33%), and 2 strains were fungi(5.56%). There were no significant differences in the levels of PCT and CRP between the two groups 1 day after operation(P>0.05). The levels of PCT and CRP in the infection group were significantly higher than those in the non-infection group 3 days, 5 days, 7 days and 10 days after operation. The PCT and CRP levels of the two groups reached the peak 3 days after operation, and then gradually decreased(P<0.05). ROC analysis showed that the AUC of PCT, CRP, and PCT+CRP were 0.863, 0.813 and 0.912, respectively. The sensitivity, specificity and accuracy of PCT+CRP were 94.44%, 92.98% and 93.55% respectively, which were higher than PCT and CRP(86.11%, 84.21%, 84.95% and 72.22%, 70.18%, 70.97%, respectively). Conclusion The levels of PCT and CRP are closely related to infection after open fracture of tibia and fibula. They can be used as an important index for clinical diagnosis of infection after open fracture of tibia and fibula, and can provide reference for early diagnosis and prevention of infection.
The advantage of percutaneous kyphoplasty in patients with Kummell's disease without symptoms of spinal cord compression
ZHANG Shun-li, GU Yun-tao, CHEN Rong, ZHAO Hai
2020, 18(10): 1667-1670,1792. doi: 10.16766/j.cnki.issn.1674-4152.001588
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Objective To investigate the advantages of curative effect of percutaneous kyphoplasty in the treatment of patients with Kummell's disease without symptoms of spinal cord compression, and provide theoretical support for the treatment. Methods Retrospective analysis of 128 cases patients with Kummell's disease without symptoms of spinal cord compression who underwent surgery treatment from January 2016 to January 2018 in our hospital. According to the operation, they were divided into control group(percutaneous vertebroplasty, PVP operation, 61 cases) and experimental group(percutaneous kyphoplasty, PKP operation, 67 cases). The statistical differences of clinical data, vertebral height improvement, Cobb Angle and complications between the two groups were compared. Results Compare of the operative time and the amount of bone cement injected, the experimental group were significantly increased than the control group(all P<0.05). After operation, the height of the anterior vertebral walls(17.14±3.36) mm and median vertebral walls(16.25±4.37) mm of the experimental group were significantly raised compared with those of the control group[(11.74±4.34) mm and(12.53±4.21) mm, P<0.05]. The difference in ODI and Cobb Angle after surgery between the two groups was statistically significant(P<0.05). There was no statistical significance in hospital stay, the height of the posterior vertebral walls, postoperative infective complications between the two groups(all P>0.05). Conclusion PKP can effectively reduce the height of vertebral body and correct the kyphosis through the combination of body position reduction and balloon dilation when treating patients with Kummell's disease without symptoms of spinal cord compression, and it is also more conducive to the full filling of bone cement in the cleft of vertebral body. PKP can increase the riveting effect of bone cement and reduce the risk of leakage of bone cement, which shows its advantages in reducing the incidence of complications of adjacent vertebral fractures and spinal cord compression.
Comparison of perforator flap and abdominal pedicled flap in the treatm ent of skin and soft tissue defect by hand traum a
LIU Zhang-song, ZHU Xi-ming, XU Qiang, DU Chun-yu
2020, 18(10): 1671-1674. doi: 10.16766/j.cnki.issn.1674-4152.001589
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Objective To investigate the clinical effect of perforator flap and abdominal pedicled flap in patients with skin and soft tissue defect resulting from hand trauma, and to explore the advantages, disadvantages and indications of the two treatment. Methods There were 42 patients suffering from skin and soft tissue defects by hand trauma from June 2017 to June 2019 in People's Hospital of Wugang. The patients were divided into two groups according to the selection of different flaps, group A(abdominal pedicled flap, n=21) and group B(perforator flap, n=21). The wound healing time, postoperative complications and functional recovery were compared between the two groups. Results All patients were followed up for 3 to 16 months, with an average of 6.8 months. The excellent and good rate in the group B(100.0%) was significantly higher than that in the group A(66.7%, χ2=6.171, P=0.013). The healing time in the group B(18.4±1.2) days was significantly shorter than that in the group A(35.9±1.4) days(t=42.895, P<0.001). The incidence of postoperative complications such as infection and flap necrosis in the group B was 4.8%, which was significantly lower than that in the group A(52.4%, χ2=11.667, P<0.001). The postoperative function was evaluated by the evaluation standard of upper limb function of hand surgery Association of Chinese Medical Association. The passing rate of functional recovery in the group A was 66.7%, and that in the group B was 95.2%(χ2=5.559, P=0.018). Conclusion Compared with the abdominal pedicled flap, perforator flap is more effective in repairing skin and soft tissue defects in hand followed by the shorter healing time and less complications, which is worthy of recommendation. However, abdominal pedicled flap can be regarded as an alternative when microsurgical technique has not been developed in some primary hospitals.
Clinical efficacy and safety of 308 nm excimer laser combined with Tuibai Decoction in the treatm ent of vitiligo
ZHAO Zhi-hao, WU Yu-han
2020, 18(10): 1675-1677,1786. doi: 10.16766/j.cnki.issn.1674-4152.001590
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Objective To investigate the clinical efficacy and safety of 308 nm excimer laser combined with Tuibai Decoction in the treatment of vitiligo. Methods Total 112 patients with vitiligo admitted to Danzhou People's Hospital from January 2017 to December 2018 were randomly divided into control group(n=56) and observation group(n=56). The control group was treated with 308 nm excimer laser, while the observation group was treated with Tuibai Decoction on the basis of the control group. The clinical efficacy of the two groups after treatment was compared. The skin pigmentation score, skin disease quality of life index(DLQI) score, peripheral blood T lymphocyte subsets, serum interleukin-2(IL-2), interleukin-6(IL-6) and tumor necrosis factor-alpha(TNF-alpha) levels were observed before and after treatment in the two groups. Results The total effective rate of the observation group after treatment was significantly higher than that of the control group(78.57% vs. 60.71%, P<0.05). After treatment, the skin pigmentation scores of the two groups were significantly higher than those of the same group before treatment, and the skin pigmentation scores of the observation group were significantly higher than that of the control group(all P<0.05). After treatment, the DLQI scores of the two groups were significantly lower than those of the same group before treatment, and the DLQI scores of the observation group were significantly lower than those of the control group(all P<0.05). The levels of CD3+, CD4+, and CD4+/CD8+ in the two groups after treatment were significantly higher than those before treatment in the same group, and the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly higher than those in the control group after treatment(all P<0.05). Conclusion Excimer laser(308 nm) combined with Tuibai Decoction has better curative effect on vitiligo, which can significantly inhibit the level of inflammatory factors, improve the life quality and immune function of patients, and has better safety.
Incidence and influencing factors of myasthenia gravis after thymectomy
XU Bo, WANG Ye-ping, CHEN Xian-guo, ZHANG Xiao-ling
2020, 18(10): 1678-1681. doi: 10.16766/j.cnki.issn.1674-4152.001591
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Objective To analyze the incidence and influencing factors of myasthenia gravis after thymectomy, in order to provide reference for clinical prevention of myasthenia gravis. Methods Ninety-two patients with thymectomy in our hospital from March 2019 to March 2020 were selected to observe and record the incidence of myasthenia gravis after operation. The patients were divided into group A and group B according to whether myasthenia gravis occurred after operation. The general data of the two groups were collected by questionnaire survey, the clinical data were sorted out, and the general data and clinical data of the two groups were compared. The risk factors of myasthenia gravis were analyzed by logistic regression analysis. Results There were 11 cases of myasthenia gravis(12.0%) after operation in 92 patients. The course of disease, combined immune disease, operation route, combined anterior mediastinal fat dissection, postoperative pulmonary infection, postoperative radiotherapy and chemotherapy were compared between the two groups, and the difference was statistically significant(all P<0.05). The results of multivariate logistic regression analysis showed that the course of disease(>12 months), combined immune disease, surgical route(open chest) and postoperative pulmonary infection were the risk factors of myasthenia gravis, and the combined anterior mediastinal fat dissection, postoperative radiotherapy and chemotherapy were the protective factors. Conclusion The incidence of myasthenia gravis after thymectomy is relatively high, and there are many influencing factors, such as long course of disease, combined with immune diseases, thoracotomy, postoperative pulmonary infection, etc. Therefore, we should take symptomatic treatment measures according to the risk factors of patients during thymectomy to reduce the incidence of myasthenia gravis and improve the effect of surgery.
Efficacy analysis of tranexamic acid in the ankle joint fracture surgery with grade Ⅳ supination external rotation type
YANG Zhi-tao, JIAO Yi, HAN Nan-ying, LI Xu, LUO Lun, WANG Xu-yi
2020, 18(10): 1682-1684,1714. doi: 10.16766/j.cnki.issn.1674-4152.001592
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Objective To explore the application of tranexamic acid(TXA) in the ankle fracture fixation surgery with grade Ⅳ supination external rotation type. Methods Total 80 cases with grade Ⅳ supination external rotation ankle fractures from February 2015 to December 2019 were retrospective analyzed. According to whether the use of intraoperative tourniquet or preoperative tranexamic acid, patients were divided into three groups, group A(26 cases):the tranexamic acid was employed in preoperative and intraoperative tourniquet was not used, group B(29 cases):the tranexamic acid was not employed and intraoperative tourniquet was used, group C(25 cases):the tranexamic acid and tourniquet were not used. The total blood loss, overt blood loss, hidden blood loss and postoperative VAS score were gathered. The blood loss and related complications was comparative analysis between the three groups. Results The general information preoperative of three groups were not statistically significant(all P>0.05). The total blood loss, hidden blood loss, and overt blood loss in the group A were(170.6±12.2) mL,(89.8±7.0) mL,(80.8±11.1) mL respectively, in the group B were(215.4±39.5) mL,(187.8±39.9) mL,(27.6±7.4) mL respectively, and in the group C were(298.8 31.2) mL,(143.3 22.4) mL,(155.5 19.1) mL respectively. The total amount of blood loss in group A and group B were significantly lower than group C, the amount of the hidden blood loss of group A was significantly lower than group B and group C, and the amount of overt blood loss of group B was significantly lower than group A and group C(all P<0.05). The VAS scores 1, 2, 3 days after surgery of group A were significantly lower than group B and group C(all P<0.05). Followed up for 3 months, there were 1 poor healing of incision case in group B and 3 poor healing of incision cases in group C, and the wound healed well after strengthening dressing change. Conclusion The tranexamic acid used in the ankle fracture fixation surgery with the grade Ⅳ rotation of external rotation type can reduce the total amount of blood loss and postoperative blood loss, does not increase the incidence of postoperative related complications, and can reduce the postoperative pain score. It is in line with the concept of rapid rehabilitation actively advocated by the state, and has a good application prospect in the traumatic orthopedics.
Correlation study between orthostatic hypertension and urinary albumin excretion rate and left ventricular mass index in middle-aged and elderly patients
MA Jing, FANG Hong-wei, XIE Xiao-lin, ZHANG Qiu-shi, LIN Ping, WANG Ya-jie
2020, 18(10): 1685-1687,1694. doi: 10.16766/j.cnki.issn.1674-4152.001593
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Objective To analyze the correlation between orthostatic hypertension and urinary microalbumin excretion rate and left ventricular mass index in middle-aged and elderly patients. Methods From January 2018 to July 2019, 556 middle-aged and elderly patients with essential hypertension who were treated in the Third People's Hospital of Hangzhou were selected as the research subjects. The observation group(n=125) was orthostatic blood pressure increase(orthostatic hypertension) patients. The patients whose systolic blood pressure change less than 20 mm Hg, were considered with normal orthostatic blood pressure, served as the control group(n=431). The evaluation included 24 h urine microalbumin excretion rate and left ventricular mass index and association of patients with orthostatic hypertension. Results The urine microalbumin excretion rate[(22.3±3.1) mg/24 h] and the left ventricular mass index[(111.3±5.8) g/m2] in the observation group compared with the control group[(14.2±3.7) mg/24 h and(94.8±5.7) g/m2]. All of them increased significantly, and the differences were statistically significant(all P<0.001). Correlation analysis showed that orthostatic systolic blood pressure and orthostatic diastolic blood pressure had a linear positive correlation with urinary microalbumin excretion rate and left ventricular mass index. There were statistical significances(all P<0.05). The regression equations were Y=30.62+0.40 X; Y=25.95+0.90 X; Y=26.02+0.53 X; Y=27.88+1.33 X. Conclusion There may be a correlation between orthostatic blood pressure elevation in middle-aged and elderly patients with essential hypertension and abnormalities in urinary microalbumin excretion and abnormal left ventricular mass index, suggesting that target organ damage may be present. Early intervention should be considered in clinical practice.
An analysis of deafness genes screening in 42708 newborns
GENG Guo-xing, LIN Cai-juan, HUANG Xiao-tao, LI Wei, FAN Xin, CHEN Shao-ke, ZOU Ru
2020, 18(10): 1688-1690. doi: 10.16766/j.cnki.issn.1674-4152.001594
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Objective To understand the mutation type and mutation carrying rate of the common deafness genes of the newborn in Nanning City, evaluate the detection results of deafness genes, and provide the basis for the long-term prevention and clinical diagnosis of hereditary deafness. Methods A total of 42 708 newborns were collected in Obstetric, Paediatric Clinic and Otolaryngology Clinic of Guangxi Maternal and Child Health Hospital from January 2016 to December 2018. Four common genes in China were screened by Matrix assisted laser desorption ionization time of flight mass spectrometry, including 20 mutation loci of GJB2(35 delG, 176-191 del16, 167 delT, 299_300 delAT, 235 delC), GJB3(538 C>T, 547 G>A), SLC26 A4(281 C>T, 589 G>A, 1174 A>T, 1226 G>A, IVS7-2 A>G, 1229 C>T, 1975 G>C, 2162 C>T, 2027 T>A, IVS15+5 G>A, 2168 A>G), and Mt12 SrRNA(1555 A>G, 1494 C>T). Results Among 42 708 newborns, 940 had gene mutation, with a total positive detection rate of 2.201%, including 492 GJB2 mutations(1.152%), 61 GJB3 mutations(0.143%), 320 SLC26 A4 mutations(0.749%) and 57 Mt12 SrRNA mutations(0.133%). Meanwhile 1 compound heterozygote and 9 double heterozygotes were founded. Conclusion In this study, GJB2 and SLC26 A4 were the major mutations, and 235 delC and IVS7-2 A were the major loci. The combined screening of newborn hearing and deafness gene is important to prevention of deafness, especially the prevention of drug-induced deafness, and is the great significance in reducing the occurrence of deafness and birth defects.
The analysis of HPV infection of genitals among heterosexual couples
WANG Guang-yan, GU Hang-zhi, LIN Feng, HU Yan
2020, 18(10): 1691-1694. doi: 10.16766/j.cnki.issn.1674-4152.001595
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Objective To investigate Human papilloma virus(HPV) prevalence and genotype distribution of males whose female partners with cervical HPV infection and the HPV type-specific concordance between heterosexual couples. Methods A total of 443 heterosexual couples, among whom female partners had cervical HPV infection, were enrolled in our hospital from November 2017 to April 2019. The swab samples from males' external genital epithelial cells and females' cervical exfoliated cells were collected and 27 HPV subtypes both high-risk and low-risk types were detected. The results were analyzed. Results Among 443 males, HPV infection was positive in 216 with an infective rate of 48.76%. The top three HPV subtypes in males were 53, 52, 16, while the top three HPV subtypes among their wives also were 53, 16, 52. The prevalence of low-risk HPV subtypes between couples was different, the top two in men were HPV43, 61, while HPV81, 6 in women. Among 216 both HPV positive sexual partners the complete and partial concordance rate of HPV were 26.39%(57/216) and 36.11%(78/216), the total concordance rate was 62.50%(135/216), most of concordant subtype was single type, especially in high-risk HPV. Conclusion The HPV infective rate of males' external genital was slightly high among whose female partners had cervical HPV infection. The concordance rate of HPV subtypes in which both couples had HPV infection was high, especially in high-risk subtypes. We recommend to detect HPV among males whose female partners had cervical HPV infection and to cure, so that to improve the HPV clearance rate.
Expression and significance of placenta-specific protein 1 mRNA in placenta and peripheral blood of patients with fetal growth restriction
ZHU Hui, SUN Dan-dan
2020, 18(10): 1695-1698. doi: 10.16766/j.cnki.issn.1674-4152.001596
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Objective To detect the abnormal expression of placenta-specific protein 1(PLAC1) of patient with fetal growth restriction(FGR), and discuss its significance. Methods Forty FGR pregnant women who were hospitalized and delivered in Jiaxing Maternal and Child Health Hospital from April 2017 to January 2020 were selected as the FGR group, and 40 normal pregnant women who were hospitalized and delivered during the same period were selected as the control group. The placental thickness, placental mass and neonatal weight were measured. Reverse transcription-polymerase chain reaction(RT-PCR) was used to determine PLAC1 mRNA levels in placenta and peripheral blood. The t-test was used to analyze the differences of the indicators between the two groups. Correlation between indicators was analyzed using Pearson. Results The placental thickness, placental mass and neonatal weight in the FGR group were lower than those in the control group(all P<0.05).The level of PLAC1 mRNA in the placenta of the FGR group(0.47±0.09) were lower than that of the control group(1.00±0.07), t=29.399, P<0.05.The level of PLAC1 mRNA in the peripheral blood of the FGR group(1.54±0.11) was higher than that of the control group(1.00±0.08), t=25.109, P<0.05. The placental PLAC1 mRNA level in FGR pregnant women was positively correlated with placental thickness, placental mass and neonatal weight(all P<0.05). The peripheral blood PLAC1 mRNA level in FGR pregnant women were negatively correlated with placental thickness, placental mass and neonatal weight(all P<0.05).There was negatively correlation between PLAC1 mRNA levels in the placenta and peripheral blood of FGR pregnant women(r=0.602, P<0.001). Conclusion The level of PLAC1 mRNA in placenta and peripheral blood can reflect the severity of FGR.
Serum CTRP6 level in pregnant women with diabetes during pregnancy and its significance
HE Xin-mei, CHEN Dan-qing
2020, 18(10): 1699-1701. doi: 10.16766/j.cnki.issn.1674-4152.001597
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Objective To study the serum C1 q/tumor necrosis factor-related protein 6(CTRP6) level in pregnant women with gestational diabetes mellitus(GDM) and its relationship with insulin resistance and inflammatory cytokine levels, and to explore the role of CTRP6 in GDM. Methods A total of 86 patients with GDM who were hospitalized and delivered in Quzhou Maternal and Child Health Hospital from January 2019 to December 2019 were selected as group B, and 86 normal pregnant women who were hospitalized and delivered during the same period were selected as group A. The fasting blood glucose(FPG), glycated hemoglobin(HbA1 C), fasting insulin(FINS) and high-sensitivity-C reactive protein(hs-CRP) levels were measured. The islet-β cell function index(HOMA-β) and insulin resistance index(HOMA-IR) were calculated. The levels of serum CTRP6, interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were measured by enzyme-linked immunosorbent assay(ELISA). Results The serum CTRP6, FPG and HbA1 C levels in group B were higher than those in group A(all P<0.05). FINS and HOMA-IR in group B were higher than those in group A(all P<0.05), and HOMA-β was lower than that of group A(P<0.05). The levels of serum hs-CRP and TNF-α in group B were higher than those in group A(all P<0.05). The serum CTRP6 level was positively correlated with FPG, HbA1 C, FINS, HOMA-IR, hs-CRP, IL-6 and TNF-α levels(all P<0.05), and was negatively correlated with HOMA-β(P<0.05). Conclusion The serum CTRP6 level in GDM patients is elevated, and its level is closely related to insulin resistance and serum inflammatory cytokine levels.
Investigation on influencing factors of self-management of pregnancy weight and general self-efficacy of pregnant women in community
LIU Wei, LUAN Zhao-hua, GONG Ding-hong, WEI Su-ping, XU Qi
2020, 18(10): 1702-1706. doi: 10.16766/j.cnki.issn.1674-4152.001598
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Objective To explore the self-management, self-efficacy and social support of pregnant women during pregnancy, and to provide evidence for effective control of weight gain during pregnancy. Methods A total of 1 041 pregnant women with early pregnancy in a community in Shanghai from January 2017 to April 2018 were selected as the research object. General self-efficacy scale and social support rating scale were conducted in early pregnancy. After delivery, according to the weight gain guidelines of the American Institute of Medicine(IOM), they were divided into two groups:the group with excessive weight gain during pregnancy and the group with normal weight gain. The self-designed questionnaire of weight management in pregnancy was used to investigate and analyze the factors influencing weight growth. Results Total 900 cases were investigated effectively. There were 507 cases(56.3%) with normal weight gain, the score of general self-efficacy scale was 2.83±0.53, and the score of social support rating scale was 36.28±5.23. There were 393 cases(43.7%) with excessive weight gain, the score of general self-efficacy scale was 2.49±0.58, the score of social support rating scale was 34.07±5.80. Logistic regression analysis showed that general self-efficacy, the status of social support, whether the medical examiner was fixed, the degree of cooperation with the guidance of the physicians, the pregnancy week of the cessation of work and age, the level of concern about weight gain by obstetrical physician and pre-pregnancy body mass index were the influencing factors of whether the weight gain was excessive during pregnancy(all P<0.05). Conclusion Community doctors should strengthen the standardized weight management of pregnant women in early pregnancy, and evaluate the general self-efficacy and social support, which can provide basis for effective weight management.
Construction and application of internet-based combining with patient-family-general practitioner group co-management model for diabetes
ZHOU Zhi-heng, HUANG Zhi-jie, ZHENG Xiao-fen, CHEN Bao-xin, ZHANG Xue-jiao, QIU Kai, WANG Hao-xiang, CHEN Wen-ru
2020, 18(10): 1707-1710. doi: 10.16766/j.cnki.issn.1674-4152.001599
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Objective To implement and evaluate the effect of internet-based combining with patient-family-general practitioner group Co-management model for diabetes. Methods The management guide and flow chart were set up by series of methods including literature research, personal in-depth interviews, expert consultations and field investigations. A total of 650 patients with diabetes as experimental group were managed by internet-based technology combining with patient-family-general practitioner group Co-management. Another 650 diabetes patients were set as control group according to the 1:1 match, received conventional management. The blood glucose, health behaviors were compared between the two groups to evaluate the effect for 10 months. Results After 10 months intervention, the times of self-test blood glucose in two week in experimental group was significantly increased from 1.12±0.46 to 2.45±0.65, which was better than that of control group(P<0.001). Among the experimental group, 84% of the patients completed more than 5 health education courses. Diabetes knowledge awareness rate was increased from 48% to 88%, the difference was statistically significant(P<0.001). Some patients improved their exercise(59.8%) and diet behaviors(68.5%), and their medication compliance increased from 52.1% to 91.8%. The mean levels of fasting glucose(FBG), 2-hour postprandial blood glucose(2 hPG) of experimental group were significantly reduced from 7.41 mmol/L and 10.59 mmol/L to 6.47 mmol/L and 8.24 mmol/L. The control rate of blood glucose was increased from 36.15% to 69.08%, the difference was statistically significant(all P<0.001).The blood glucose results of experimental group was much better than that in the control group(P<0.05). Conclusion Internet-based combining with patient-family-general practitioner group Co-management model for diabetes is effective. It's worthy of further application and promotion in China to improve the management effect of diabetes.
Application value analysis of pulmonary ultrasound score in evaluating the severity of neonatal infectious pneumonia
XIAO Yan, YAN Yuan-yuan, LOU Jun-ge
2020, 18(10): 1711-1714. doi: 10.16766/j.cnki.issn.1674-4152.001600
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Objective To evaluate the clinical value of pulmonary ultrasound score in evaluating the severity of neonatal infectious pneumonia(IPN). Methods From July 2017 to July 2019, 150 cases of children with IPN confirmed in our hospital neonatal intensive care unit were selected. According to the presence of respiratory failure, they were divided into no respiratory failure group(62 cases) and respiratory failure group(88 cases). According to neonatal critical illness score(NCIS), children with respiratory failure group were divided into critical group(26 cases), critical group(33 cases) and extremely critical group(29 cases). Pulmonary ultrasound examination and pulmonary ultrasound score were performed on the children, and the pulmonary ultrasound score, oxygenation index(OI), respiratory index(RI) and NCIS indexes were compared among and within the groups, and the correlation between pulmonary ultrasound score and NCIS score, OI and RI was analyzed. Results The pulmonary ultrasound score and OI indexes in the respiratory failure group were significantly lower than those in the non-respiratory failure group(all P<0.01), and the RI indexes were significantly higher than those in the non-respiratory failure group(P<0.01). In the respiratory failure group, the pulmonary ultrasound score, NCIS score and OI index decreased significantly and RI index increased significantly with the aggravation of the disease(all P<0.01). According to ROC curve analysis, the optimal prediction value of pulmonary ultrasound score in IPN children with respiratory failure was 31 points, the sensitivity and specificity were 85.8% and 76.9%, respectively. The optimal prediction value of critical condition was 27 points, the sensitivity and specificity were 86.3% and 85.7%, respectively. The optimal prediction value of extremely critical condition was 17 points, the sensitivity and specificity were 76.9% and 91.8%, respectively. Pearson analysis showed that the pulmonary ultrasound score of children with respiratory failure was positively correlated with NCIS score and OI index(all P<0.05), and negatively correlated with RI(P<0.05). Conclusion Pulmonary ultrasound score can effectively assess the severity of newborn IPN, and provide a reference for clinicians to understand the severity of the disease and reasonable treatment of the children, which has high clinical application value.
Diagnostic value of infrared thermography in deep venous thrombosis of lower extremities
LIU Xia-tian, ZHENG Yuan-yuan, JIANG Zhen-zhen, LU Jian-xing, MA Cai-ye, ZHU Lei, SHEN Hua-liang, HUANG Yan-hua
2020, 18(10): 1715-1717. doi: 10.16766/j.cnki.issn.1674-4152.001601
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Objective To analyze the diagnostic value of infrared thermography in deep venous thrombosis of lower extremities, in order to provide reference for clinical diagnosis and improve the accuracy of diagnosis. Methods Ninety-two patients with suspected lower extremity deep venous thrombosis were selected from September 2018 to September 2019 in Shaoxing People's Hospital. All patients underwent color Doppler ultrasonography and infrared thermography. Both examinations were performed in the same time period(interval time was controlled within 30 minutes). The detection results of central, peripheral and mixed deep vein thrombosis of the lower extremity were compared and analyzed. The diagnostic results of color Doppler ultrasound were gold standard. The diagnostic value of infrared thermography was analyzed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Results Fifty-four cases of deep venous thrombosis of lower limbs were detected by color Doppler ultrasound, the detection rate was 58.7%. Fifty-eight cases of deep venous thrombosis of lower limbs were detected by infrared thermography, the detection rate was 63.0%. The detection rates of the two groups were similar, the difference was not statistically significant(χ2=0.365, P=0.546). With the diagnostic results of color Doppler ultrasound as the gold standard, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of infrared thermography in the diagnosis of lower extremity deep venous thrombosis were 71.7%, 74.1%, 67.6%, 79.6% and 60.5%, respectively. Conclusion Infrared thermography has certain application value in the diagnosis of lower extremity deep venous thrombosis. The detection rate is similar to that of color Doppler ultrasound. It has the advantages of short examination time and large-scale examination. It can be used as an auxiliary means for clinical screening of suspected lower extremity deep venous thrombosis and is worth promoting.
SCCmec genotypes and drug resistance analysis of isolated MRSA in children
ZHANG Xiu-fang, CHAI Jie, TAN Xue-feng, GUO Pu
2020, 18(10): 1718-1721. doi: 10.16766/j.cnki.issn.1674-4152.001602
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Objective To investigate the SCCmec genotypes and drug resistance of methicillin-resistant staphylococcus aureus(MRSA) isolated from children in Bozhou, Anhui province. Methods From December 2018 to March 2019, 89 MRSA strains isolated from 6 pediatrics wards in the People's Hospital of Bozhou were collected. The SCCmec genotypes of MRSA strains were detected by PCR. Antimicrobial susceptibility test was performed by VITEK 2 compact. Statistical analysis was performed using WHONET 5.6 software. Results Among 89 MRSA strains, SCCmec Ⅳa was the main type, accounting for 55.1%(49/89) of the total strains, followed by SCCmec type Ⅲ 12.4%(11/89), SCCmec type 1.1%(1/89), respectively. Untyped 31.4%(28/89)and SCCmecⅠ and Ⅴ type were not detected. All MRSA strains were resistant to penicillin and the resistance rates to erythromycin and clindamycin were higher, which was 87.6% and 62.9% respectively. The resistance rates to quinolones, gentamicin and trimethoprim/sulfamethoxazole were less than 10%. The resistance rates of the 49 strains of SCCmec type Ⅳa to erythromycin and clindamycin were slightly increased, which was 91.8% and 77.6%, respectively, while the resistance rate to quinolones was 4.1%, and all of the 49 strains were susceptible to gentamicin and trimethoprim/sulfamethoxazole. None of the MRSA strains were found to be resistant to vancomycin, linezolid, quinupristin/dalfopristin and tigecycline. Conclusion The prevalence of MRSA isolated from children in Bozhou was mainly SCCmec Ⅳa type strains, and they showed various degrees of resistance to different antimicrobial agents.
Analysis of pathogenic strains and distribution of blood culture microorganism in a second grade hospital
ZHANG Hai-ping, HUANG Xi-tong, JIA Hong-fei, SUN Qiao-yan
2020, 18(10): 1722-1724,1734. doi: 10.16766/j.cnki.issn.1674-4152.001603
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Objective To explore the distribution and drug resistance of pathogenic bacteria in blood culture microorganism test, so as to provide reference for effective control of the occurrence and spread of blood stream infection. Methods A total of 4 790 inpatients in Yuhuan People's Hospital from July 2018 to June 2019 were selected, 4 790 blood samples were collected and sent for examination. BacT/Alert was used 3 D type automatic blood culture instrument and its supporting culture bottle were used for blood culture, and positive strains were smeared and transferred in time. Vitek-2 compact automatic microbial analysis system was used for strain identification and drug sensitivity test, and the isolated bacterial strains and drug resistance were analyzed. Results In 4 790 blood samples, 523 pathogenic bacteria were isolated, the positive rate was 10.92%, including 283 gram-negative bacteria(54.11%), 230 gram-positive bacteria(43.98%), 8 fungi(1.53%), and 2 anaerobes(0.38%). The distribution of pathogenic bacteria was mainly in ICU(25.91%), general surgery(22.75%), and infection department(13.77%). The drug resistance of gram-negative bacteria and gram-positive bacteria were significantly different. The resistance of Escherichia coli and Klebsiella pneumoniae to ampicillin was high(>82.00%), to imipenem was low(<5.00%). The resistance of Acinetobacter baumannii to furantoin, ampicillin, aztreonam, and cefazolin were high(100.00%), and to tobramycin was low(27.27%). The resistance of gram-positive bacteria to erythromycin and penicillin were generally high(>76.00%), but not resistant to linezolid and vancomycin(all 0.00%). Conclusion There are many kinds of pathogenic strains in the blood culture microorganism test, the departments are widely distributed, and the situation of drug resistance is severe. Clinicians should pay more attention to the results of early detection and drug resistance analysis of pathogenic strains in blood culture microorganism test, so as to improve clinical diagnosis and application of antibiotics.
Advances in research on pre-dialysis patient education in the management of patients with end-stage renal disease
HUANG Ze-hui, LIU Ying-li
2020, 18(10): 1725-1728,1749. doi: 10.16766/j.cnki.issn.1674-4152.001604
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The number of patients with end-stage renal disease(ESRD) continues to increase all over the world, and both developed and developing countries will face the huge economic burden brought by ESRD. Therefore, it is urgent for us to formulate effective prevention strategies to reduce the disease burden according to different economic development and resources. More and more attention has been paid to the role of multi-disciplinary teamwork in pre-dialysis patient education,which has become a key point in ESRD patient management. Patient education is the main bridge between doctors and patients which can improve patients' medical knowledge and the ability of disease self-management. Patients entering ESRD stage inevitably need to choose the method of RRT(Renal Replacement Therapy), while the difference of patients' personal situation, education provider or social support system will influence them to make reasonable choices according to their own needs. Previous studies have shown that rational and standardized pre-dialysis patient education can improve patients' self-management ability and increase their medical-related knowledge, and these efforts will delay disease progression, avoid emergency dialysis and reduce early mortality. If patients choose more peritoneal dialysis as RRT program, it will directly or indirectly save social medical costs. This review aims to discuss the effects and significance of pre-dialysis patient education on the social economy and patient's personal health. We also discuss the factors that influence patient education, and we expect to make full use of the mobile network and community management platform for the patient follow-up and guidance. At the end, we will summarize the experiences of other chronic diseases management, gradually improve the model of patient education which enabling patients to obtain sufficient medical knowledge and participate in medical decisions actively, and will establish a patient-centered medical management model in the future.
Research progress of oxidative stress on male infertility
LI Yang, JIN Lei, ZHOU Yun
2020, 18(10): 1729-1734. doi: 10.16766/j.cnki.issn.1674-4152.001605
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Due to the influence of many factors, such as aging, lifestyle, environment and working pressure, the semen quality of male has been decreasing, the incidence rate of infertility has been increasing year by year. The causes and influence factors of infertility have become the research focus in global reproductive medicine. Reactive oxygen species is essential for many physiological reactions. Reactive oxygen species plays an important role in the production and maintenance of male reproductive physiological processes, such as sexual hormone secretion, sperm capacitation and motility, acrosome reaction, etc. It is not only an important regulator of sperm function, but also a second messenger of many cells involved in extracellular signal regulation. There are many exogenous and endogenous factors that can lead to the production of reactive oxygen species beyond the antioxidant capacity of cells, damage the body's oxidative defense system, cause oxidative stress damage, and have adverse effects on signal pathway, energy metabolism, gene expression and protein structure, thus causing damage to reproductive organs and sperm functions, reducing the fertilization potential and the ability of gametes to support normal embryonic development. It may directly or indirectly induce infertility by affecting the hypothalamic pituitary gonadal axis and/or interfering other hormone axis. This paper reviews the essence and source of oxidative stress, the important external and internal factors that affect the production of oxidative stress in male reproductive system, expounds the physiological effect of oxidative stress on male reproductive system, and analyzes the destructive effect and possible mechanism of oxidative stress on male reproductive system from organ at cellular and molecular levels. Finally, the countermeasures are put forward to explore the standardized application of antioxidant therapy in clinical, to prevent and treat oxidative stress injury of male reproductive system, and to provide reference for the treatment of male infertility.
Summary of professor Zhang Minghes clinical experience in the treatment of rheumatoid arthritis
ZHAO Yang-han, XU Yun-sheng
2020, 18(10): 1735-1737,1745. doi: 10.16766/j.cnki.issn.1674-4152.001606
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Objective To summarize professor Zhang Minghe's clinical experience in the treatment of rheumatoid arthritis. Methods Followed professor Zhang Minghe's clinical consultation, collected relevant medical cases, and sorted out professor Zhang Minghe's prescriptions and comments, with 1 case of complete clinical diagnosis and treatment. By referring to relevant literature and adopting qualitative research method, the prescription characteristics of patients with different syndrome types were summarized, and the clinical experience of professor Zhang Minghe's dialectical treatment and characteristic therapy of rheumatoid arthritis was explored. Results Professor Zhang Minghe's clinical experience in rheumatoid arthritis includes four aspects:clinical dialectical treatment, drug application, and prevention and treatment of joint deformation. Dialectical clinical pyretic arthralgia for the most part, early should pay attention to the weight of rheumatic heat evil comparison, assisted by huoxue to remove blood stasis, nourishing Yin clearing heat, later to support the main, nourishing the liver and kidney, clearing the residual poison. Professor Zhang Minghe pay attention to its regression and special function in the application of drugs, and had his unique views on the selection of clinical drugs for rheumatoid arthritis. The use of plant drugs was frequent, emphasizing that different drugs can be used for the corresponding symptoms and the location of disease. Insect drugs were seldom used, but they have a punchline effect in the treatment of collaterals. At the same time, rheumatoid arthritis should be combined with prevention and treatment, standardized drug use. For patients with deformities of joints but not yet bone fusion, a method of traction orthopedic treatment was proposed, which significantly improved the quality of life of the patients. Conclusion On the basis of the theory of traditional Chinese medicine system macro analysis rheumatoid arthritis treatment experience of TCM. Compared with other Chinese medicine treatment experience, pyretic arthralgia theory and drug laws in the process of clinical dialectical treatment have made significant efficacy, reflect the traditional Chinese medicine "nature and humanity, three due to the following" thinking, in order to the reference when the doctor of traditional Chinese medicine treatment of rheumatoid arthritis.
Effect of Yifeng acupoint application combined with warm acupuncture on idiopathic facial paralysis
ZHU Qiao-ai, ZHAN Jian-hua, YAN Qiong, SHANG Miao-wei
2020, 18(10): 1738-1740,1782. doi: 10.16766/j.cnki.issn.1674-4152.001607
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Objective To analyze the effects of Yifeng acupoint application combined with warm acupuncture on the facial Portmann score, House-Brackmann rating, SF-36 score and time to recovery of symptoms in patients with idiopathic facial paralysis. Methods Total 76 patients with idiopathic facial paralysis admitted in Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine from February 2017 to February 2019 were included in this study. They were divided into the control group(38 cases) and observation group(38 cases) according to the digital random table method. The control group was given prednisone acetate tablets, mecobalamin capsules combined with traditional acupuncture treatment, and the observation group was treated with Yifeng acupoint application combined with warm acupuncture. The improved facial symptoms and the time to recovery of the two groups were compared. The facial dysfunction was counted. The quality of life and treatment effect were observed. Results The RPA score of patients in the control group was significantly lower than that in the observation group, and the time to recovery of symptoms was longer than that in the observation group(t=7.717, 7.180, all P<0.05). The H-B classification of patients in the control group was significantly worse than that in the observation group, and the difference was statistically significant(P<0.05). The SF-36 score of the control group was lower than that of the observation group, and the difference was statistically significant(P<0.05). The total effective rate of clinical treatment in the control group was 71.05%, which was significantly lower than that in the observation group 97.37%, and the difference of curative effect between two groups was statistically significant(Z=10.396, P<0.05). Conclusion In the treatment of patients with idiopathic facial paralysis, the clinical effect of Yifeng acupoint application combined with warm acupuncture is better, which can significantly improve the quality of life of patients, and is worth promoting in clinical treatment.
The role of scenario simulation in the training of airway management in residents
XU Yi-qiong, YAN Jun, TAO Lei, GUO Qian, SHI Ting, LUO Yan
2020, 18(10): 1741-1745. doi: 10.16766/j.cnki.issn.1674-4152.001608
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Objective Airway management is a common challenge for every resident, which is also one of the essential skills. We added scenario simulation to the training of airway management and evaluated the results, which might help residents to master the skills and accumulate the experiences of the airway management. Methods A total of 64 trainees from Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were involved in the standardized resident training, who were divided into two groups, 21 trainees attended cases sharing(traditional teaching group), while 43 trainees experienced scenario simulation(simulation group). All the participants finished course questionnaire, tests and the confidence scoring about airway management before and after the course. They also attended the intubation simulated-test after the training. SPSS 20.0 was used to process the data. Paired sample t-test, group t-test, rank sum test and Chi-squared test were used to analyze the specific data. P<0.05 was considered as statistically significant. Results After training, 93.8% trainees thought the course was quite helpful, and 96.9% trainees could accomplish intubation in 2 minutes. The score of theory tests(t=-4.663, P<0.001) and the self-assessment of airway management confidence(t=-11.015, P<0.001) in all trainees before and after training were different. There was no difference in the time-spending of intubation and the scores of theory test in the two groups, however, the trainees in the simulation group had a higher confidence scoring of airway management(t=-2.193, P=0.032). Conclusion The scenario simulation could help trainees to accumulate the experiences and become more confident. The scenario simulation is worth using in the training of airway management, whereas more experiences are needed to accumulate in teaching and assessment.
Application of CBL combined with 3-min+task teaching method for clinical teaching in department of cardiology
WANG Juan, XING Shi-feng, LU: Zhong-ying, LI Hong-jian
2020, 18(10): 1746-1749. doi: 10.16766/j.cnki.issn.1674-4152.001609
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Objective To explore the teaching effect of CBL combined with 3-min+task teaching method on clinical teaching in department of cardiology. Methods From January 2017 to June 2019, 60 undergraduates majored in five-year clinical medicine who interned in the department of cardiology of the fifth affiliated hospital of Xinjiang Medical University were selected as the research objects, and were randomly divided into a double-blind control group(n=30) and observation group(n=30). In the control group, the traditional teaching method was used for clinical teaching, which was conducted by general ward rounds and knowledge lectures. The observation group adopted the CBL combined with 3-min+task teaching method. The two groups were compared for their theory and manipulation examination. The teaching efficiency and satisfaction of students on clinical teaching were surveyed by using questionnaire. Results There was no significant difference between the basic knowledge and electrocardiogram reading(P>0.05), the scores of student' s cases analysis and clinical manipulative skills(including consultation techniques, cardiac physical examination, cardiopulmonary resuscitation and electrical defibrillation) in observation group were higher than those in control group(all P<0.05). The questionnaire showed that the improvement of student's professional knowledge, clinical thinking ability, clinical skills, learning interest, self-study ability, ability of solving problems and physician-patient communication ability in observation group were better than those in control group(all P<0.05), the satisfaction of teaching methods was also higher than that of the control group. Conclusion The application of CBL combined with 3-min+task teaching method can effectively stimulate students' interest in learning, improve the students' professional knowledge and manipulative skills, which is an effective and satisfying method for clinical teaching, and is worth promoting and applying in the teaching of clinical interns.
Meta analysis of the add-on effect of combined fire needle on alopecia areata
DAI Ting, SONG Ning-jing, XU Jin, SUN Xiao-ying, LI Fu-lun, LI Xin, LI Bin
2020, 18(10): 1750-1752,1796. doi: 10.16766/j.cnki.issn.1674-4152.001610
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Objective To systematically evaluate the add-on effect of fire needle therapy compared to conventional treatment on alopecia areata. Methods Retrieval of CNKI, VIP, WF and PubMed databases to January 16, 2019 was included in control trial to evaluate the add-on effect of combined fire needle therapy on alopecia areata. The data were collected and analyzed by CMA software. Results A total of 73 literatures were retrieved, of which 7 control studies met the inclusion criteria. There were 490 cases included(263 cases in the combined fire needle group and 227 cases in the control group). Overall, add-on therapy of combined fire needle showed consistent benefit in the cure rate[RR=1.456, 95% CI(1.171, 1.810)], apparent efficiency[RR=1.199, 95% CI(1.055, 1.364)] and effective rate[RR=1.101, 95% CI(1.041, 1.165)]. According to subgroup analysis, when the basic treatment was local therapy, fire needle showed add-on effect on increasing the fire needle treatment can significantly improve the cure rate, apparent efficiency and effective rate;when the basic treatment were systemic therapy, fire needle only showed add-on effect on effective rate. There was no significant difference in the incidence of adverse events between the two groups[RR=1.040, 95% CI(0.267, 4.055)]. No serious adverse events were found. Conclusion Compared with the control group, the add-on effect of combined fire needle on alopecia areata is significant and safe.
Systematic evaluation of butylphthalide soft capsule in the treatment of cognitive dysfunction in Parkinsons disease
ZHANG Yu-yu, WU Jia-ying, MA Kui-fen, ZHOU Hua
2020, 18(10): 1753-1757. doi: 10.16766/j.cnki.issn.1674-4152.001611
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Objective To systematically evaluate the efficacy of butylphthalide soft capsule in the treatment of cognitive impairment in Parkinson's disease. Methods Randomized controlled trials of butylphthalide soft capsules in the treatment of cognitive impairment in Parkinson's disease were retrieved from domestic and foreign databases. Revman 5.1 was used for meta-analysis. Results A total of 9 articles and 755 subjects were included. Compared with the control group, butylphthalide soft capsules could significantly reduce UPDRS score[MD=-11.16,95%CI(-14.07 to-8.25), P<0.001], and increase MoCA score[MD=3.22, 95% CI(2.39-4.05), P<0.001], MMSE score[MD=3.05, 95% CI(2.24-3.87), P<0.001], and ADL score[MD=13.05, 95% CI(11.53-14.57, P<0.001]. It could significantly reduce CRP level[MD=-2.69, 95% CI(-2.69 to-2.27), P<0.001] and PARK7 level[MD=-10.88, 95% CI(-12.35 to-9.40), P<0.001], and significantly increase NT-3 level[MD=8.48, 95% CI(7.35-9.61), P<0.001]. Conclusion Butylphthalide soft capsule can significantly improve the cognitive impairment of Parkinson's disease. However, there are some limitations in this study, which still need to be verified by a better clinical randomized controlled study.
The current situation and influence factors of mental workers'occupational stress
XU Ai-xian, HU Zu-ying
2020, 18(10): 1758-1761. doi: 10.16766/j.cnki.issn.1674-4152.001612
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Objective To understand the current situation of mental workers' occupational stress, and to discuss the factors affecting mental workers' occupational stress. Methods From 2018 to 2020, a total of 1 260 city's medical staff, teachers, ordinary civil servants, accountants, administrators, designers and other knowledge workers were randomly selected as the research object by random cluster sampling method. The occupational stress inventory(OSI-R) was used to investigate the occupational stress status mental labor population. The t test, analysis of variance, and logistic regression analysis were used to analyzed current situation and influence factors of occupational stress. Results The scores of mental workers in the occupational task questionnaire(except the working environment), the individual stress response questionnaire, the individual coping resources questionnaire and the three dimensions were all higher than the norm. Male, graduate student, high salary, 10-20 years of service, administrative position, night shift frequency had high occupational task score(all P<0.05). Male, length of service 10-20 years, graduate degree, working time >40 hours per week, high frequency of night shift, intermediate job title, had strong stress response(all P<0.05). The scores of coping resources were higher in males, undergraduates, junior professional titles and short working years(all P<0.05). The results of logistic regression analysis showed that gender, length of service, educational background and frequency of night shift were the risk factors affecting the occupational stress of mental workers. Conclusion Gender, length of service, frequency of night shift and educational background are the main influence factors for the serious degree of occupational stress of mental workers.
Study on the value and optimal cut-off value of infrared forehead therm ometer for fever screening in the fever clinic
LIU Cai-hong, LIN Ke-ke, LI Xiao-guang, JI Yan-bo
2020, 18(10): 1762-1765. doi: 10.16766/j.cnki.issn.1674-4152.001613
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Objective To evaluate the value and the optimal cut-off value of infrared forehead thermometer for fever screening. Methods Body temperatures of 1 176 patients who visited the fever clinic from June 1 st to August 30 th 2018 were measured using both infrared forehead thermometer and mercury thermometer. Results Among 1 176 patients, 529(45%) were males and 647(55%) were females, with the mean age of 36.91±16.46 years old. Bland-Altman results showed that the consistency of frontal temperature and axillary temperature was relatively good. The average temperature measured by the mercury thermometer was(38.31±0.67)℃, while the average temperature measured by the infrared forehead thermometer was(37.30±0.77)℃. The mean difference was(1.01±0.64)℃. Paired t-test showed that t value was 53.774, P<0.001. The mean difference between the two types of temperatures for the normal temperature group, low fever group, moderate fever group and high fever group were(0.25±0.55),(0.83±0.50),(1.08±0.66) and(1.33±0.70)℃, respectively. The t values were 2.180, 35.721, 36.760 and 25.710, respectively, P<0.05. The sensitivity and specificity of using the infrared forehead thermometer to measure the body temperature were 0.482 and 0.913, respectively. The area under the ROC curve was 0.73, P<0.001, the 95% confidence interval was 0.650~0.811. The maximum value for the Youden index was 0.477, and the corresponding temperature was 37.05℃. Conclusion There is statistically significant difference between the body temperatures measured by the infrared forehead thermometer and the mercury thermometer, with the former lower than the latter. The higher the body temperature is, the more difference is. Since the temperature reading of infrared frontal thermometer can only be read to one decimal place in clinical practice, 37.0℃ should be used as the basis for preliminary determination of whether the patient has fever.
Nursing exploration of patients with esophageal and gastric varices treated by endoscopy
YANG Zhao-yun, ZHANG Wei-ping, KONG De-run
2020, 18(10): 1766-1769. doi: 10.16766/j.cnki.issn.1674-4152.001614
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Objective To investigate the effect of nursing intervention on patients with liver cirrhosis accompanying esophageal and gastric varices treated by endoscopy. Methods A total of 70 cases of patients who treated by endoscopy in the First Affiliated Hospital of Anhui Medical University from October 2017 to January 2019 were selected as the objects. They were randomly divided into control group(routine nursing group) and observation group(meticulous nursing group), 35 cases in each group. Scores were compared between the two groups on the quality of life SF-36, self-rating anxiety scale(SAS), self-rating depression scale(SDS), postoperative complications and average postoperative hospitalization time. Results The scores of physical functioning, bodily pain, vitality, social role functioning, mental health and general health in the observation group were higher than those in the control group(t=3.522, 2.036, 3.748, 2.205, 2.094, 5.455, all P<0.05). The SAS score of the observation group was lower than that in the control group(t=2.879, P<0.05). The incidence of complications in the observation group(8.57%) was lower than that in the control group(28.57%), χ2=4.377, P<0.05. The duration of postoperative hospitalization of the patients in the observation group[(4.43±1.17) days] was significantly shorter than that in the control group[(6.66±1.37) days, t=7.315, P<0.01]. Conclusion For patients with liver cirrhosis combined with esophageal and gastric varices treated by endoscopy, meticulous nursing intervention can improve the quality of life, reduce the anxiety, decrease the postoperative complications and reduce hours of postoperative hospitalization. It has good application value.
A study on the correlation between psychological violence and coping style in the workplace of clinical nurses in Grade-A Tertiary hospitals
CHEN Huan-huan, XU Yun-yun, XU Xiao, YU Ke-he, HU Miao-ye
2020, 18(10): 1770-1773. doi: 10.16766/j.cnki.issn.1674-4152.001615
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Objective To explore the current situation of psychological violence in the workplace of clinical nurses in Grade-A Tertiary hospitals, and to analyze the relationship between it and coping methods, so as to provide reference for nursing managers to formulate protective measures. Methods This study was a survey study. Convenience sampling method was adopted. From March 2019 to June 2019, 344 clinical nurses in three Grade-A Tertiary hospitals of Zhejiang Province were surveyed by using general situation questionnaire, Workplace Sychologically Violent Behaviours instrument and Simple Coping Style Questionnaire. After data collection, SPSS statistical software was used for statistical analysis. Results In the past 6 months, the score of psychological violence suffered by clinical nurses was 15(5,32), of which 24.42% had experienced psychological violence. There were statistically significant differences in the incidence of psychological violence in the workplace of clinical nurses among the forms of employment, years of nursing work and technical titles(all P<0.01). Psychological violence in the workplace of clinical nurses was positively correlated with negative coping style(P<0.05), and negatively correlated with positive coping style(P<0.05). Conclusion The incidence of psychological violence in the workplace of clinical nurses in Grade-A Tertiary hospitals has certain opportunities for improvement. Prompt nursing managers should give them short working time, low technical titles and contract system nurses more psychological counseling, by organizing team building activities, to encourage prompt reporting violence, to set up psychological counseling team, to reduce the level of psychological violence, so as to improve the coping styles, actively into clinical nursing work.
Application of the concept of enhanced recovery after surgery in free flap repair of oral cancer patients
LIU Lu-lu, LI Xiu-chuan, YUAN Feng, LIANG Hua-kun, ZHANG Kai, LI Jian-cheng
2020, 18(10): 1774-1778. doi: 10.16766/j.cnki.issn.1674-4152.001616
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Objective To evaluate efficacy and safety of enhanced recovery after surgery in free flap repair of oral cancer patients. Methods In the Department of Oral and Maxillofacial Surgery of our hospital, 32 patients who received satisfaction survey before the implementation of ERAS scheme(from August 2018 to March 2019) were selected as the control group, and 32 patients after the implementation of ERAS scheme(from April 2019 to January 2020) were selected as the ERAS group. The control group was used conventional nursing care, and ERAS group was used perioperative nursing scheme for patients under enhanced recovery after surgery. The preoperative interventions include diversified health mission, nutritional screening, fitness training, and shortening the time of water fasting. Postoperative rehabilitation promotion includes multi-mode pre-analgesia, early feeding, early activity, early removal of urinary catheter, airway management, swallowing training, etc. Results The repeated measures ANOVA was used for the pain scores at 6, 24, 48 and 72 h after surgery. The difference between the time effect and the group effect was statistically significant(all P<0.01), and there was no interaction between the time effect and the group effect(F=1.157, P>0.05). The score of "pain" in the postoperative 6, 12, 48 and 72 h were compared between the two groups, there were statistically significant(all P<0.05). In ERAS group, the postoperative hospital stay was(16.72±2.13) days, the control group was(13.75±2.50) days, the average time was shortened by 3 days, the difference had statistical significance(t=5.113, P<0.01). The gastric tube indwelling time reduced by 2 days on average. The overall incidences of complications were significantly reduced, and the incidences of pulmonary infection, gastrointestinal reaction and pressure ulcer were statistically significant(all P<0.05). The incidence of skin flap crisis had no statistically significant difference(P>0.05). The satisfaction rate of patients in ERAS group was significantly improved, and the difference was statistically significant(P<0.05). Conclusion The perioperative ERAS nursing scheme for patients with oral cancer can reduce postoperative pain, reduce the incidence of complications, shorten the length of stay, and improve patient satisfaction. It is safe and effective in clinical application.
Psychological Nursing Effect of the Solution-Focused model on Elderly Patients with Hypertension and generalized Anxiety Disorder
WANG Chun-yan, ZHANG Xue-ping
2020, 18(10): 1779-1782. doi: 10.16766/j.cnki.issn.1674-4152.001617
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Objective The focus resolution model is not clear for the prognosis of elderly patients with generalized anxiety disorder(GAD) comorbid hypertension. The focus resolution model is used as a psychological care method to explore its advantages in this population. Methods A total of 80 elderly patients with generalized anxiety disorder comorbid hypertension who were hospitalized in Hangzhou Seventh People's Hospital from June 2018 to June 2019 were selected and divided into a research group(40 cases) and a control group(40 cases) according to the random number table. The two groups received routine nursing combined with the Solution-Focused model(study group) or only received routine nursing(control group) intervention for 4 weeks. The Hamilton Anxiety Scale(HAMA), Insight and Treatment Attitudes Questionnaires(ITAQ), and blood pressure monitoring were used to assess the changes in anxiety, self-perception, adherence to treatment, and blood pressure levels of the two groups. Results After the intervention, the HAMA score level, ITAQ score level, systolic and diastolic blood pressure of the two groups were lower than before intervention, and the differences were statistically significant(all P<0.05). After 4 weeks of intervention, the HAMA score of the patients in the study group was 8.20±2.77, and the HAMA score of the control group was 10.00±2.75. The difference was statistically significant(t=-2.921, P<0.05). The ITAQ score of the study group was 19.02±1.97, the control group was(18.05±2.19)points, the difference was statistically significant(t=2.098, P<0.05).The differences in systolic blood pressure and diastolic blood pressure between the two groups were statistically significant(all P<0.001). Conclusion Compared with routine nursing, psychological care of the Solution-Focused model for elderly patients with anxiety and hypertension can reduce anxiety more effectively, improve self-awareness and control the level of hypertension.
Observation on the effect of stroke nurses participating in the reconstruction of thrombolysis treatment process in patients with ischemic stroke
LUO Guo-ying, CHEN Xiu-fang
2020, 18(10): 1783-1786. doi: 10.16766/j.cnki.issn.1674-4152.001618
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Objective To investigate the effect of stroke nurses' participation in venous thrombolysis treatment process reengineering in patients with ischemic stroke and to propose effective process optimization measures. Methods From January 2018 to February 2020, 128 patients with ischemic stroke in Shaoxing People's Hospital were analyzed retrospectively. According to the time of admission, 64 patients with routine intravenous thrombolysis from January 2018 to January 2019 were included in the control group, and 64 patients with stroke nurses' participating in the reconstruction of intravenous thrombolysis from February 2019 to February 2020 were included in the study group. The therapeutic effects of the two groups were compared. Results The time from diagnosis to CT examination, from CT examination to thrombolysis and from diagnosis to thrombolysis were(12.05±6.23) min,(18.89±9.21) min, and(30.52±8.01) min in the study group, which were shorter than those from the control group(15.85±7.51) min,(28.62±8.75) min, and(45.62±9.51) min, respectively(t=3.115, 6.127, 9.715, all P<0.05). Two weeks after thrombolysis, the NIHSS and mRS scores of the study group were(9.21±3.52) points and(1.92±0.52) points, which were lower than those of the control group(10.54±4.24) points and(2.25±0.66) points, respectively(t=1.931, 3.142, P=0.028, 0.001). The incidence of venous thrombolytic complications in the study group was 1.56%, lower than that in the control group 12.50%(χ2=4.302, P=0.038). The mortality rate was 1.56% in study group and 4.69% in control group(χ2=0.258, P=0.611). The nursing satisfaction in the study group was 98.44%, higher than 85.94% in the control group(χ2=6.942, P=0.008). Conclusion The reconstruction of thrombolysis treatment process involved by stroke nurses can shorten the time of thrombolysis, improve the effect of treatment, reduce complications, improve the satisfaction of patients, and reduce the mortality.
CHOU Yue, WANG Jie-ping, DU Xue-ping
2020, 18(10): 1787-1789. doi: 10.16766/j.cnki.issn.1674-4152.001619
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DAN Hong-mei, ZHAO Li, CHENG Yu
2020, 18(10): 1790-1792. doi: 10.16766/j.cnki.issn.1674-4152.001620
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ZHANG Jun, DING Jie, YANG Xian-feng, SUN Qi, DAI Jing-hong, DING Jing-jing
2020, 18(10): 1793-1796. doi: 10.16766/j.cnki.issn.1674-4152.001621
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