中华全科医学

Evaluation of the ten-year effect of implementing national basic public health services in Shanghai

HUANG Ping, WANG Ming-han, ZHANG An, CHANG Pei-yao, LI Lian-xiang, GAO Zhong-zhi

2020, 18(12): 1979-1983. doi: 10.16766/j.cnki.issn.1674-4152.001668

209 10

Abstract:
Objective Since Shanghai began to explore the establishment of the system of basic public health services in 1997, it has gradually established and improved a network system of basic public health services. By combing the data of basic public health services in the past ten years, we can obtain a general understanding and grasp of the implementation effects of Shanghai's basic public health services. What's more, by summarizing the characteristics of Shanghai's basic public health services, we could put policy suggestions forward for more effective provision of health services in the later period. Methods Data on the implementation of basic public health services in Shanghai from 2009 to 2019 were collected. Through the annual longitudinal analysis, the icons which could directly reflect the specific changes and the overall trend of various indicators in the past ten years were obtained. The Wilcoxon rank test was used to compare the city's comprehensive promotion of family doctor system before and after the index value difference. Results The number of national basic public health services implemented by Shanghai had always been 100% over the years. In the past ten years, the number of residents filing health records had increased year by year to 19.920 1 million. The number of services for key management objects such as women and children, patients with hypertension and diabetes mellitus all reached the level required by the state. The maternal mortality rate dropped to 3.51/100 000, and the infant mortality rate dropped to 3.06‰. The management rate of children's health reached 98.47%. The management rates of hypertension and type 2 diabetes mellitus were 84.77% and 87.37%, respectively. Wilcoxon rank sum test showed that the implementation of the family doctor system was due to the reduction of maternal mortality, the decrease of infant mortality and the improvement of early pregnancy registration rate, postpartum visit rate, blood pressure control rate of hypertension management population, etc. The differences were statistically significant(all P<0.05). Conclusion Shanghai has achieved remarkable results in the implementation of basic public health service projects, but it still needs to be improved in the standardization of electronic health records, the supervision and assessment mechanism of public health funds, and the strengthening of the introduction of public health service personnel.

2020, 18(12): 1984-1985.

72 5

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Risk factors and prevention of complications after open wedge tibial high osteotomy

XU Kui-shuai, CHEN Jin-li, CHU Yan, ZHAO Xia, ZHANG Yi, XU Rui-xiang, YU Teng-bo

2020, 18(12): 1986-1988,2036. doi: 10.16766/j.cnki.issn.1674-4152.001669

180 0

Abstract:
Objective To study the occurrence of complications after opening wedge high tibial osteotomy(OWHTO), analyze the risk factors and summarize the prevention and treatment measures. Methods The medical records and imaging data of 105 patients with knee osteoarthrosis who underwent OWHTO in our hospital were retrospectively analyzed. There were 88 cases in the uncomplicated group(group A) and 17 cases in the complication group(group B). The general information(age, gender, side, course of diseases, body mass index(BMI), smoking, drinking, complications, etc.), operation time, imaging measurement, blood routine indexes of two groups were statistical analyzed. Multivariate logistic regression analysis was used to study the risk factors of perioperative complications. Results The average age of all patients was(59.92±4.81) years old, including 27 males and 78 females. The total incidence of postoperative complications was 12.38%. The results of multivariate Logistic regression analysis showed that course of disease(OR=1.636, P=0.015), operation time(OR=1.064, P=0.023), BMI(OR=1.432, P=0.042) and osteotomy space(OR=4.203, P=0.003) were independent risk factors for postoperative complications of OWHTO. Conclusion Course of disease, operation time, BMI and osteotomy space are independent risk factors for postoperative complications of OWHTO. It is of great significance to control the body weight and shorten the operation time, especially to take timely preventive measures for patients with long course of disease and large osteotomy gap to reduce the occurrence of postoperative complications.

Prevalence and risk factors of hyperuricemia in patients with chronic kidney disease

HU Yan, TAO Min, PAN Xing, MA Xiao-yan, ZHUANG Shou-gang, LIU Na, FANG Lu

2020, 18(12): 1989-1993. doi: 10.16766/j.cnki.issn.1674-4152.001670

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Objective To explore the prevalence and risk factors of hyperuricemia in patients with chronic kidney disease(CKD) hospitalized in Shanghai East Hospital and Ji'an Hospital of Shanghai East Hospital, and to provide clinical reference for the prevention and treatment of hyperuricemia in CKD patients. Methods Total 436 CKD patients hospitalized in East Hospital Affiliated to Tongji University(Shanghai) and Shanghai East Hospital Ji'an Hospital(Ji'an, Jiangxi) from January 1, 2017 to July 31, 2019 were divided into CKD 1 to 5 groups according to K/DOQI guidelines. The prevalence of hyperuricemia and related risk factors in different CKD stages were analyzed. Results The prevalence of hyperuricemia in patients with different CKD stages is different, and the difference was statistically significant(P<0.001). Multivariate logistic regression analysis showed that diastolic blood pressure(OR=1.025, 95% CI: 1.005-1.044, P=0.012) was a risk factor for hyperuricemia, while ACEI/ARB(OR=0.536, 95% CI: 0.335-0.859, P=0.009) and estimated glomerular filtration rate(eGFR, OR=0.988, 95% CI: 0.980-0.997, P=0.005) were protective factors for hyperuricemia. Compared with the CKD 1 stage group, the ORs of hyperuricemia of the CKD 4 stage group was the highest, 4.385(OR=4.385, 95% CI: 1.655-11.621, P=0.003). Conclusion Among CKD patients, the increase of diastolic blood pressure is the risk factor of hyperuricemia, while taking ACEI/ARB drugs and higher glomerular filtration rate are the protective factors for hyperuricemia. The progress of CKD is significantly correlated with hyperuricemia, suggesting that controlling blood pressure and protection of glomerular filtration rate in patients with CKD are of great significance in the prevention and treatment of hyperuricemia. Controlling the level of serum uric acid may benefit to improve the residual renal function and the prognosis of CKD.

Clinical observation of radiotherapy combined with temozolomide and radiotherapy alone for high-risk low-grade glioma

ZHANG Lei, HE Ze-lai, LI Duo-jie, ZHOU Yu-fu

2020, 18(12): 1994-1997. doi: 10.16766/j.cnki.issn.1674-4152.001671

196 1

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Objective To observe the clinical efficacy and safety of temozolomide combined with radiotherapy in patients with high-risk low-grade glioma after surgery. Methods The clinical data of 62 patients with high-risk grade Ⅱ glioma treated in our hospital from January 2015 to January 2018 were collected. All patients were treated with postoperative intensity-modulated radiotherapy. The observation group(32 patients) received concurrent chemotherapy during radiotherapy, and received temozolomide 75 mg/m² oral chemotherapy from the first day of radiotherapy, and then received oral temozolomide 150-200 mg/m² chemotherapy every four weeks after radiotherapy, 5 days a week for 6 consecutive cycles, meanwhile the control group(30 patients) only received postoperative radiotherapy. Adverse reactions, changes of cognitive function before and after treatment, 1, 2-year progression free survival rate and overall survival rate were observed and compared between the two groups. Results The main adverse reactions during the treatment were myelosuppression, gastrointestinal reaction and headache. There was no significant difference between the two groups(all P>0.05). There was no significant difference in cognitive function between the two groups before treatment(P>0.05). There was no significant change in cognitive function in the observation group after treatment(P>0.05), in the control group, there were some patients with cognitive decline, and the difference was statistically significant(P<0.05). The 1-year and 2-year progression free survival rates of the observation group were 93.8% and 81.2% respectively, and the 1-year and 2-year progression free survival rates of the control group were 66.7% and 53.3%, respectively, and the difference between the two groups was statistically significant(all P<0.05). The 1-year and 2-year overall survival rates of the observation group were 93.8% and 84.4% respectively, and the 1-year and 2-year overall survival rates of the control group were 70.0% and 60.0%, respectively, and the difference was statistically significant(all P<0.05). Conclusion The adverse reactions of temozolomide combined with postoperative precise intensity-modulated radiotherapy in the treatment of high-risk low-grade glioma patients can be significantly alleviated after symptomatic treatment, with good safety, which can effectively improve the cognitive function of patients, improve the quality of life of patients, and significantly extend the survival period of patients.

Inhibition effect of induced normal temperature control on activation of NLRP3 signaling pathway in severe multiple injury

SHI Yan-jie, ZHENG Chun-lei, ZHENG Hui, WANG Er-ling, LIU Peng-ju, LIU Xiao-gang

2020, 18(12): 1998-2001. doi: 10.16766/j.cnki.issn.1674-4152.001672

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Objective To investigate the inhibitory effect of induced normal temperature control on the activation of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3) signaling pathway in severe multiple injury. Methods Total 90 patients with severe multiple injury admitted to the emergency department of our hospital from February 2018 to January 2019 were randomly divided into study group and control group, 45 patients with each group. The two groups were given mild hypothermia control and induced normal temperature control at the same time as the conventional treatment regimen. The mortality rate of the two groups was calculated. The acute physiology and chronic health evaluation(APACHE Ⅱ), Glasgow Coma Scale(GCS), the relative expression of NLRP3 and caspase-1 in peripheral blood mononuclear cells(PBMC), IL-1β and IL-18 levels in peripheral blood were compared before and after treatment. The incidence of adverse reactions during cooling and rewarming were analyzed. Results The mortality rate in the study group was 8.89% while that in the control group was 13.33%, there was no significant difference(P>0.05). After treatment, the APACHEⅡ score of the two groups decreased, and the study group was lower than the control group(all P<0.05). The GCS scores of the two groups increased after treatment, and the study group was higher than the control group(all P<0.05). After treatment, the relative expressions of NLRP3 and caspase-1 in PBMC, the levels of IL-1 β and IL-18 in peripheral blood of the two groups were decreased, and the levels of the study group were lower than those of the control group(all P<0.05). The incidence of adverse reactions in the study group(2.22%) was lower than that in the control group(17.78%), P<0.05. Conclusion Induced normal temperature control may promote the rehabilitation of patients with severe multiple injury by activating NLRP3-caspase-1-IL-1β/IL-18 signaling pathway, reduce adverse reactions during cooling and rewarming, and have high safety.

Clinical observation of immunosuppressive therapy for myasthenia gravis with thymus abnormalities

WANG Mei-ping, ZHANG Zhe-yu, ZHANG Sheng, GENG Yu, GUO Shun-yuan, ZHANG Qing-chen, JIN Bo, WANG Yi-qi

2020, 18(12): 2002-2005. doi: 10.16766/j.cnki.issn.1674-4152.001673

218 1

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Objective To investigate the clinical effect of immunosuppressant in the treatment of myasthenia gravis(MG) with thymus abnormalities. Methods The clinical data of 106 patients with MG admitted to the Department of Neurology of Zhejiang Provincial People's Hospital from January 2017 to December2018 were included for retrospective analysis. All patients received immunosuppressant treatment. The patients were divided into two groups: group A(MG with abnormal thymus, 81 cases) and group B(MG without abnormal thymus, 25 cases). The clinical data, laboratory biochemical examination results, glucocorticoid dosage and combination with other immunosuppressive agents, the myasthenia gravis composite(MGC) score and myasthenia gravis absolute score(MGAs) were compared between the two groups. Results There was no significant difference in general clinical data, including sex ratio, average age, course of disease, MGC, MGAs, blood glucose and blood lipid levels before treatment between the two groups(all P>0.05). After treatment, 82.72%(67/81) of patients in the group A were sensitive to immunotherapy, and 100%(25/25) in the group B, there was statistical difference between the two groups(χ²=5.330, P=0.013). The proportion of patients treated with other immunosuppressants in the group A was 93.83%(76/81), and that in the group B was 40.0%(10/25), the difference was statistically significant(χ²=36.160, P<0.001). After 1.5 years of follow-up, 2-h postprandial blood glucose, glycosylated hemoglobin, total cholesterol and triglyceride in the group A were higher than those in the group B(t=2.139, 2.625, 2.010, 2.086, all P<0.05). After 3 months of treatment, the average daily dose of prednisone in the group A was higher than that in group B(P<0.05). After 6 months of treatment, the MGC score and MGAs score of the group A were higher than those of group B(all P<0.05). Conclusion The response of MG patients with thymus abnormalities to immunosuppressive therapy is relatively poor, and the amount of glucocorticoid needed to be used is large, and other immunosuppressants should be used in combination. It is suggested that the thymus of MG patients should be evaluated in detail before treatment, as it can facilitate the formulation of clinical treatment plan and the judgment of prognosis.

The predictive value of preoperative neutrophil-to-lymphocyte ratio for central node lymph node metastasis in cN0 patients with papillary thyroid microcarcinoma

SUN Jia-he, LIU Yuan, LI Zhi-xiang, QIAN Jun

2020, 18(12): 2006-2009. doi: 10.16766/j.cnki.issn.1674-4152.001674

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Objective To explore the clinical features of cN0 patients with papillary thyroid microcarcinoma(PTMC) and the risk factors of central lymph node metastasis in cN0 patients PTMC, and whether preoperative NLR can be used as one of the indicators to predict central lymph node metastasis of PTMC. Methods The clinical and pathological data of 120 cN0 patients with PTMC admitted to the Department of Oncology, the First Affiliated Hospital of Bengbu Medical College from January 2018 to December 2018 were retrospectively analyzed. The clinical characteristics of cN0 patients with PTMC and the risk factors of central lymph node metastasis were analyzed. The ROC curve was used to predict the effect of preoperative NLR on central lymph node metastasis, and the relationship between preoperative NLR and clinicopathology of PTMC and the relationship between preoperative NLR and tumor size were analyzed. Results In 120 cN0 patients with PTMC, 51(42.5%) central lymph node metastases was occurred. Univariate analysis showed the tumor size, capsule invasion, multifocality, preoperative NLR and preoperative PLR were related to central lymph node metastasis(all P<0.05), but not related to gender, age and primary tumor location(all P>0.05). Multivariate analysis found that the tumor size, multifocality, capsule invasion and preoperative NLR were the risk factors for central lymph node metastasis of cN0 patients with PTMC. Univariate analysis showed preoperative NLR was related to tumor size(P<0.05), but not related to gender, age, primary tumor location, multifocality and capsule invasion(all P>0.05). Spearman's correlation coefficient for ranked data showed preoperative NLR related to tumor size(r=0.434, P<0.001). Conclusion The central lymph node metastasis of cN0 patients with PTMC is related to many factors. For patients with these high-risk factors, prophylactic central node lymph node dissection should be performed. NLR can predict the central lymph node metastasis of cN0 patients with PTMC, which is related to the tumor size.

Observation of phacoemulsification combined with intraocular lens implantation in the treatment of angle-closure glaucoma complicated with cataract

ZHANG Hong, WU Zi-dong

2020, 18(12): 2010-2012,2028. doi: 10.16766/j.cnki.issn.1674-4152.001675

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Abstract:
Objective To explore the clinical effect of phacoemulsification combined with intraocular lens implantation in the treatment of angle closure glaucoma combined with cataract, and to provide theoretical basis for the clinical treatment of angle closure glaucoma combined with cataract. Methods From January 2016 to December 2018, 50 patients(68 eyes) with angle closure glaucoma and cataract who underwent phacoemulsification and intraocular lens implantation in the Second Affiliated Hospital of Hainan Medical College were included in the study to observe the postoperative complications and compare the intraocular pressure, the best vision, the opening distance of 500 m angle and the depth of anterior chamber before and after surgery changes. Results The best preoperative visual acuity was<0.1 in 12 eyes, 0.1≤vision<0.3 in 21 eyes, 0.3≤vision<0.5 in 25 eyes and ≥ 0.5 in 10 eyes. The best postoperative visual acuity was<0.1 in 2 eyes, 0.1≤vision<0.3 in 10 eyes, 0.3≤vision<0.5 in 20 eyes and ≥ 0.5 in 36 eyes. One month after operation, the best visual acuity of the patients was significantly higher than that before operation, the difference was statistically significant(Z=5.024, P<0.001), and the intraocular pressure of the patients before operation was significantly higher than that after operation. There was significant difference between the two groups(P<0.05), and the opening distance of 500 μm chamber angle and the depth of anterior chamber were significantly higher than those before operation(all P<0.05). The probability of postoperative complications was about 10.29%(7/68). Conclusion Phacoemulsification combined with intraocular lens implantation can reduce the intraocular pressure, deepen the anterior chamber, increase the open distance of the room angle, improve the vision and reduce the use of the medicine.

Analysis of risk factors for hemorrhage transformation and establishment of risk prediction model after mechanical thrombectomy in acute large vessel occlusion

HE Shi-wei, WANG Chao-chao, PAN Di-di, WANG Da-wei, ZHANG Hui, WANG Hao, SHU Han-sheng

2020, 18(12): 2013-2016,2046. doi: 10.16766/j.cnki.issn.1674-4152.001676

205 1

Abstract:
Objective To explore the risk factors and the establishment of a risk prediction model for the hemorrhagic transformation after mechanical thrombectomy in acute large vessel occlusion. Methods A total of 110 patients with successful recanalization of responsible blood vessels after stent embolization from acute large vessel occlusion in Second Affiliated Hospital of Bengbu Medical College from February 2017 to November 2019 were selected and divided into a bleeding group and a non-bleeding group. Among them, 30 cases of the bleeding group and 80 cases of the non-bleeding group, the general clinical data, imaging data and operation related data of the two groups were counted. The collected data were analyzed by single factor analysis and multiple factor logistic regression analysis. Results The results of single factor analysis showed that the drinking habits, antiplatelet, occluded vessels, whether the contrast agent oozes out, time from onset to recanalization(OTR), time from puncture to recanalization(PTR), early CT score of Alberta stroke project(ASPECT), the National Institutes of Health Stroke Scale(NIHSS) score 24 h after surgery had statistical difference between the two groups(P<0.05). Multi-factor analysis results showed that middle cerebral artery occlusion(OR=24.130, P=0.030), PTR(OR=0.555, P=0.008) were risk factors, and the ASPECT score(OR=0.345, P=0.001) was the protective factor, and whether intracranial hemorrhage after mechanical thrombectomy for acute cerebral infarction mainly depended on the ASPECT score, followed by whether the brain occurs middle arterial occlusion, and finally PTR size. Conclusion Middle cerebral artery occlusion, ASPECT score and PTR are independent influencing factors of intracranial hemorrhage after mechanical thrombectomy for acute cerebral infarction.

Changes and significance of heparin binding protein level in cerebrospinal fluid in patients with intracranial infection after craniocerebral surgery

DUN Shi-juan, ZOU Qi, WU Qiang, QIN Su-hui, LU Kun, YANG Mei, WANG Hua-xue

2020, 18(12): 2017-2020. doi: 10.16766/j.cnki.issn.1674-4152.001677

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Objective To investigate the changes and clinical significance of cerebrospinal fluid heparin binding protein(HBP) in patients with secondary intracranial infection after craniocerebral surgery. Methods A total of 61 patients with intracranial infection after craniocerebral surgery in the First Affiliated Hospital of Bengbu Medical College from January 2019 to June 2020 were enrolled. According to the outcome after treatment, they were divided into cured group(42 cases) and unhealed group(19 cases). The body temperature, Glasgow score(GCS score), white blood cell(WBC) counts, lactic acid(Lac) and HBP levels in cerebrospinal fluid and the levels of WBC and HBP in serum were compared before and after anti-infection treatment. The ROC curve was drawn to calculate the specificity and sensitivity of the indicators with statistical significance. The significance of each index in predicting the severity of infection and prognosis during treatment was analyzed and compared. Results Before treatment, the cerebrospinal fluid lactic acid and HBP levels of the unhealed group were significantly higher than those of the cured group(all P<0.05), and there was no statistical difference in the other indicators. After 7 days of treatment, the body temperature, GCS, cerebrospinal fluid WBC, Lac and HBP were significantly higher than the cured group(all P<0.05). After treatment, the area under the ROC curve of cerebrospinal fluid HBP was 0.930, and its specificity and sensitivity were 0.976 and 0.895, respectively. The area under the ROC curve of cerebrospinal fluid Lac was 0.650, and its specificity and the sensitivity was 0.833 and 0.579, respectively. The area under the ROC curve of cerebrospinal fluid WBC was 0.702, and its specificity and sensitivity were 0.140 and 0.737, respectively. There was no statistical difference in serum WBC and HBP between the two groups before and after treatment. Conclusion The changes in cerebrospinal fluid HBP levels after treatment have clinical significance in the evaluation of the severity and prognosis of patients with intracranial infections after craniocerebral surgery. Compared with traditional indicators such as cerebrospinal fluid WBC, the change of cerebrospinal fluid HBP level can better reflect the condition and predict the prognosis, which is conducive to timely assessment of the condition and improvement of clinical treatment effects.

Effect of miR-1301 on proliferation and migration of oral squamous cell carcinoma

ZHAO Cong, XIAO Jia-ling, XU Guo-chao

2020, 18(12): 2021-2024. doi: 10.16766/j.cnki.issn.1674-4152.001678

225 2

Abstract:
Objective To investigate the effect of miRNA-1301 on the proliferation and migration of oral squamous cell carcinoma(OSCC) cells. Methods Human normal oral epithelial cell line(HGF-1) and oral squamous cell carcinoma cell line(YD-38, MK-1) were purchased from American typical culture library(ATCC). The level of miR-1301 in the oral squamous cell carcinoma tissue and cancer cells was detected by real-time quantitative PCR(RT-PCR), and the proliferation of OSCC cells after regulating the expression of miR-1301 was detected by cell counting kit-8(CCK-8). Scratch healing test was used to detect the migration ability of cells after regulating the level of miR-1301. Results The level of miR-1301 in YD-38(2.25±0.24) and MK-1(3.32±0.85) of OSCC cells were decreased significantly compared with HGF-1(4.32±0.86), P<0.05. The cell proliferation level in the miR-1301 group was 0.26±0.02, 0.32±0.03 and 0.42±0.04, and that in the miR-NC group was 0.30±0.02, 0.52±0.05 and 0.89±0.07 respectively. After transfection of miR-1301 mimics, the cell proliferation was significantly decreased(P<0.05), but there was no significant difference between the two groups at 12 h(P>0.05). The migration of YD-38 cells was significantly decreased after transfection of miR-1301 mimics compared with the miR-NC group(P<0.05), however, transfection of miR-1301 inhibitor had the opposite effect. Conclusion MiR-1301 is significantly down regulated in OSCC tissues and cells. Transfection of miR-1301 can inhibit the proliferation and migration of OSCC cells. MiR-1301 may provide a new molecular target for the treatment of OSCC.

Expression of pDC,TLR7 and TLR9 in labial salivary glands of patients with in primary Sjögren’s syndrome

LIANG Bing-xue, FU Ping

2020, 18(12): 2025-2028. doi: 10.16766/j.cnki.issn.1674-4152.001679

166 0

Abstract:
Objective To detect the expression of plasma cell dendritic cell(pDCs), Toll-like receptor 7(TLR7), Toll-like receptor 9(TLR9) in labial glands of patients with primary Sj9 gren's syndrome(pSS). Methods The expression of pDC specific antigen CD123, TLR7 and TLR9 in labial gland tissues of 25 female patients diagnosed as pSS in the outpatient and inpatient departments of the Department of Rheumatology and Immunology of the Second Affiliated Hospital of Kunming Medical University from January 2018 to December 2019 were detected by immunohistochemical method. Four visual fields were randomly selected under low magnification(10×20) and analyzed by Image pro plus 6.0 software and SPSS 17.0 software. Results pDC, TLR7 and TLR9 positive cells were mainly distributed in acinar, ductal epithelial cells and lymphocyte infiltration foci in labial glands of patients with pSS. The expression of CD123⁺ pDC(3.47±0.26)% was higher than that of the normal control group(2.36±0.15)%, TLR7(2.06±0.37)% was higher than that of the normal control group(0.14±0.05)%, TLR9(1.80±0.26)% was significantly higher than that of the normal control group(0.84±0.08)%, all P<0.05. Conclusion pDC, TLR7 and TLR9 are highly expressed in labial glands(epithelial cells of glandular ducts and acini) and infiltrating foci of lymphocytes in patients with pSS.

Mutation characteristics and drug resistance of rifampicin gene of Mycobacterium tuberculosis in patients with pulmonary tuberculosis

ZHANG You-lei, ZHOU Xiao, WU Ling-jun, BO Xu-fen, CHEN Yi, WANG Yu-qing

2020, 18(12): 2029-2031,2139. doi: 10.16766/j.cnki.issn.1674-4152.001680

268 2

Abstract:
Objective To explore the mutation characteristics of rifampin gene of Mycobacterium tuberculosis in patients with pulmonary tuberculosis, and analyze the drug resistance, so as to provide scientific basis for the prevention and treatment of drug-resistant tuberculosis. Methods Total 532 patients with pulmonary tuberculosis admitted to the Affiliated Hospital of Hangzhou Normal University from June 2016 to December 2018 were divided into drug-resistant strains(n=218) and sensitive(n=314) strains according to the drug resistance of Mycobacterium tuberculosis in sputum. The rpoB gene sequence and minimal inhibitory concentration(MIC) value were determined. Results Among the 218 resistant strains, 180 were single mutation resistant strains. The mutation codon with the highest rate of rpoB gene structure analysis was 526(13.2%) and 531(74.4%). Total 206(94.5%) resistant strains showed at least one mutation site, and all of them were located in the rifampicin resistant decision region(RRDR), and 12(5.5%) resistant strains were outside RRDR. Four resistant strains had synonymous mutation in RRDR and 4 resistant strains had synonymous mutation outside RRDR. There was no mutation in H37 Rv codon. Eight sensitive strains had synonymous mutations outside RRDR. The RIF MIC level of the single-mutated strain was(47.34±2.04) μg/mL, which was significantly lower than that of the mutant strain(118.24±3.95) μg/mL(t=107.636, P<0.001). There was no significant difference between the MIC level of single codon 526 and single codon 531 mutant strains(P>0.05). The MIC level of the multicodon mutant was(116.03±5.06) μg/mL higher than that of the single codon(47.08±1.31) μg/mL(t=85.530, P<0.001). Conclusion The mechanism of rifampicin resistance may be related to the mutations at 531 and 526 of the start of rpoB gene. The rpoB gene sequence can be used to predict the resistance and phenotype of rifampicin in Mycobacterium tuberculosis.

The effect of continuous adductor canal block on postoperative analgesia in patients undergoing total knee arthroplasty

YING Ting-ting, ZHOU Gang, HE Ru-yi, CHENG Ying, CAO Jian-bin, CONG Hai-tao

2020, 18(12): 2032-2036. doi: 10.16766/j.cnki.issn.1674-4152.001681

192 1

Abstract:
Objective To analyze the analgesic effect of continuous adductor canal block with lidocaine, ropivacaine and sufentanil in patients undergoing total knee arthroplasty, so as to provide a reference for clinical analgesia after total knee arthroplasty. Methods From January 2016 to January 2019, 100 patients who underwent total knee arthroplasty in Taizhou Hospital of Zhejiang Province were randomly divided into two groups according to the random number table method: femoral nerve block group(50 cases) and adductor canal block group(50 cases). The pain, knee joint range of motion and other indicators were compared between the two groups at different time points. Results The scores of resting pain at 24, 48 and 72 hours after treatment in adductor canal block group were(1.37±0.18),(0.97±0.10),(0.72±0.10) points, which were lower than those of the femoral nerve block group [(1.58±0.20),(1.12±0.24),(0.98±0.16) points], the difference was statistically significant(t=5.519, 4.079, 9.744, all P<0.001). The activity pain scores of the adductor canal block group were(2.29±0.05),(2.03±0.18),(1.67±0.25) points at 24, 48, and 72 h after treatment, all of which were lower than the femoral nerve block group [(3.28±0.26),(2.54±0.34), and(2.00±0.15) points], with statistically significant differences(t=26.440, 9.374, 8.004, all P<0.001). knee joint range of motion in adductor canal block group was(83.84±3.67)°,(100.76±6.05)° and(113.51±6.53)° at 24, 48 and 72 hours after treatment, which were higher than those in femoral nerve block group [(75.47±2.84)°,(91.74±3.87)°and(105.67±3.79)°], the difference was statistically significant(t=12.750, 8.881 and 7.333, all P<0.001). Conclusion Continuous adductor canal block with lidocaine, ropivacaine and sufentanil in total knee replacement can relieve postoperative pain with good analgesic effect.

Study on the efficacy and safety of preoperative injection of razumab in patients with diabetic retinopathy and neovascular glaucoma

WANG Qiong, ZHANG Li, LUO Man, CHEN Wei

2020, 18(12): 2037-2039,2064. doi: 10.16766/j.cnki.issn.1674-4152.001682

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Abstract:
Objective To explore the efficacy and safety of preoperative injection of razumab in patients with diabetic retinopathy(DR) and neovascular glaucoma(NVG). Methods A total of 80 patients with DR and NVG who were treated in our hospital from July 2017 to June 2019 were selected as the study subjects, they were divided into observation group(44 cases) and control group(36 cases) according to different treatment schemes. The control group was treated with pars-plana vitrectomy(PPV), while the observation group was treated with preoperative injection of razumab on the basis of the control group. The clinical operation conditions of the two groups were compared, including the operation time, intraoperative bleeding times and electrocoagulation times; the best corrected visual acuity(BCVA) and intraocular pressure were measured and compared before operation, 1 week after PPV, 1 month after stage Ⅱ surgery, and stage Ⅱ. The macular foveal retinal thickness was measured one month after Ahmed aqueous humor drainage valve implantation. The incidence of PPV complications was compared between the two groups. Results The operation time, bleeding times and electrocoagulation times in the observation group were significantly lower than those in the control group(all P<0.05). The levels of BCVA and intraocular pressure in the observation group were significantly lower than those in the control group one week after PPV operation and one month after stage Ⅱ operation(all P<0.05). The thickness of the macular foveal retina in the observation group was(259.42±33.78) m one month after the stage Ⅱ Ahmed aqueous drainage valve implantation, and the control group was(281.64±36.97) m, the observation group was significantly lower than that in control group(P<0.05). The incidence of postoperative complications in the observation group was 9.09%, and that in the control group was 30.56%, the observation group was significantly lower than that in control group(P<0.05). Conclusion Preoperative injection of razumab has a good clinical effect on DR patients with NVG, which is conducive to the recovery of visual acuity and intraocular pressure after operation, and reduces the damage to retina, and has high safety.

Expression and clinical significance of serum soluble intercellular adhesion molecule-1 and galactosan-3 in patients with chronic heart failure

WANG Jian-feng, LING Hua

2020, 18(12): 2040-2042,2143. doi: 10.16766/j.cnki.issn.1674-4152.001683

190 0

Abstract:
Objective To analyze the expression and clinical significance of serum soluble intercellular adhesion molecule-1(sICAM-1) and galectin-3 in patients with chronic heart failure. Methods A total of 452 patients of with chronic heart failure admitted to Chun'an Branch of the First People's Hospital of Hangzhou from March 2016 to March 2019 were divided into NYHA Ⅱ group(151 cases), NYHA Ⅲ group(164 cases), and NYHA Ⅳ group(137 cases) according to NYHA classification. According to the occurrence of major adverse cardiovascular events(MACE) during the follow-up period, the patients were divided into MACE group and non-MACE group, another 73 cases of physical examination in our hospital during the same period were selected as the control group. The serum levels of sICAM-1 and galectin-3 were measured. Results The expression levels of sICAM-1 in the chronic heart failure group was(771.08±186.54) μg/L and galectin-3 was(21.26±4.35) ng/mL, there were significantly higher than those in the control group(all P<0.05). The expression levels of sICAM-1 and galectin-3 in the NYHA grade Ⅳ and NYHA grade Ⅲ groups were significantly higher than those in the NYHA grade Ⅱ group(all P<0.05), and that in the NYHA grade Ⅳ group was significantly higher than that in the NYHA grade Ⅲ group(P<0.05). The expression levels of sICAM-1 and galectin-3 in the MACE group on the next day of admission and the day of discharge were significantly higher than those of the non-MACE group(P<0.05). The expression of sICAM-1 and Galectin-3 on the day of discharge in the non-MACE group was significantly lower than that on the day after admission(P<0.05). There was a significant positive correlation between sICAM-1 and galectin-3 in patients with chronic heart failure(r=0.671, P=0.004). Conclusion The expression of sICAM-1 and galectin-3 in serum is related to the cardiac function and prognosis in patients with chronic heart failure.

A study of serum lipid levels in patients with different degrees of Alzheimer’s disease

QIU Cong-long, ZHANG Yi, CHEN Shou-lin, SHAO Li, ZOU Chen-jun, ZHANG Ying-zhong, ZHOU Dong-sheng

2020, 18(12): 2043-2046. doi: 10.16766/j.cnki.issn.1674-4152.001684

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Abstract:
Objective To study the blood lipid level [total cholesterol(TC), triglyceride(TG), serum high-density lipoprotein(HDL) and serum low-density lipoprotein(LDL)] of Alzheimer's disease(AD) patients before different degrees of drug treatment for the first time. Methods A total of 128 cases of AD patients(observation group) and 84 cases of healthy persons(control group) who were admitted to our hospital for the first time from January 2018 to September 2019 were selected as the research objects. According to the CDR score, the observation group was divided into mild AD group(CDR=1), moderate AD group(CDR=2) and severe AD group(CDR=3). The blood lipid levels of all subjects were detected by automatic biochemical analyzer. Results There was no significant difference in gender composition(χ²=0.716, P=0.398) and age(t=0.117, P=0.907) between the two groups(P>0.05). The TG level in the severe AD group was lower than that in the control group(Z=2.598, P=0.009). The TC level in the mild, moderate and severe AD group was higher than that in the control group(LSD-t=5.185, 3.837, 3.701, all P<0.001). The HDL level in the moderate AD group was lower than that in the control group(LSD-t=3.997, P<0.001). The TG level in the mild AD patients was higher than that in the severe AD patients(Z=2.633, P=0.008), the HDL level was higher in the moderate AD patients(LSD-t=2.450, P=0.015), and the HDL level in patients with moderate AD was lower than that in patients with severe AD(LSD-t=2.288, P=0.023). The correlation analysis between blood lipid level and mini mental state examination(MMSE) score showed that TG was positively correlated with MMSE score(r=0.287, P=0.001). Conclusion The levels of TC and HDL in AD patients without drug treatment are different from those of normal people. It is confirmed that AD disease itself can affect some blood lipid levels, especially in moderate and severe AD patients. With the decline of cognitive function, the level of TG in AD patients decreased, but there was no significant difference between AD patients and normal people.

Analysis of the relationship between optimistic coping style,social support,nutrition evaluation and quality of life in elderly patients with chronic heart failure

GUO Juan, BI Qing-quan

2020, 18(12): 2047-2050,2135. doi: 10.16766/j.cnki.issn.1674-4152.001685

135 0

Abstract:
Objective To analyzes the relationship between optimistic coping style, social support, nutrition evaluation and the quality of life of elderly patients with chronic heart failure(CHF). Methods The general condition, coping style, social support, nutritional status and quality of life of 312 elderly patients with chronic heart failure were investigated by the general situation questionnaire, the Chinese version of the Jalowiec coping scale, Social Support Rating Scale, and Mini-Nutrition Assessment Special for Heart Failure and Heart Failure and Minnesota Living with Heart Failure Questionnaire(MLHFQ). Results The average age of the 312 CHF patients in this study was(73.63±6.81) years old, and the quality of life scores was(40.80±11.94). The results of analysis of variance or t-test showed that the higher the age(t=5.400), the higher the education level(F=2.147), higher per capita monthly income(F=6.302), and lower cardiac function classification(F=9.530) have higher quality of life scores, and the differences are statistically significant(P<0.05). Among marital status, unmarried patients had the highest MLHFQ scores, and the differences were statistically significant(F=4.141, P<0.05). The results of multiple linear regression analysis showed that cardiac function classification(β=-0.159, P<0.001), optimism-coping style(β=0.144, P<0.01) and nutritional evaluation(β=0.417, P<0.001) were influencing factors of the life quality. The results of the mediation analysis showed that the nutritional evaluation of patients played a part of the mediation effect in the impact of optimism-coping and quality of life, with a mediation effect value of 0.063, accounting for 31.99% of the total effect. Conclusion The quality of life of elderly patients with CHF is at a low level, and the cardiac function classification, optimistic-coping style and nutritional evaluation are important influencing factors. Medical staff should formulate targeted nursing intervention measures, pay attention to the nutritional status and improve patients' optimistic coping level, to improve patients' quality of life.

Significance of determination of bile acid spectrum in early stage of neonatal breast milk jaundice by UPLC-MS/MS

SHEN Ren, YANG Shan-pu, LIU Hong-yan, XU Min, XIANG La-li, LI Su-qin

2020, 18(12): 2051-2053. doi: 10.16766/j.cnki.issn.1674-4152.001686

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Abstract:
Objective To understand the characteristics of serum bile acid spectrum, and to explore the value of bile acid spectrum in predicting breast milk jaundice. Methods Total 320 normal neonatus delivered in our hospital were selected. According to the hourly bilirubin chart of newborns, newborns whose bilirubin level was below 75% were collected at 72 hours after birth. The blood samples were sealed and refrigerated for inspection and follow-up. According to the follow-up results, the neonatus were divided into breast milk jaundice group(n=36) and normal neonatal group(n=48). The concentrations of 15 kinds of bile acids were measured by ultra high performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS). Results There were some differences in blood bile acid profiles between the two groups. The difference of glycine cholic acid [(0.41±0.31) nmol/L and(0.58±0.39) nmol/L], the ratio of glycine cholic acid to ursodeoxycholic acid(0.11±0.19 and 0.30±0.51) and the ratio of ursodeoxycholic acid to total ursodeoxychol(0.28±0.23 and 0.19±0.14) were statistically significant(all P<0.05). There was no significant difference in the levels of cholic acid, deoxycholic acid, lithocholic acid, anthropodesoxycholic acid, ursodeoxycholic acid, glycocholic acid, glycodesoxycholic acid, glycochenodeoxycholic acid, glycine ursodeoxycholic acid, cholaic acid, taurodeoxycholic acid, taurolithocholic acid, taurine goose deoxycholic acid, tauroursodeoxycholic acid, total bile acid and cholic acid/anthropodesoxycholic acid between the two groups(all P>0.05). Conclusion UPLC-MS/MS method can sensitively detect the changes of blood bile acid spectrum in neonatal breast milk jaundice before the occurrence of hyperbilirubinemia, which is helpful to predict hyperbilirubinemia and its etiology in the early stage.

Investigation on refractive error and related factors of myopia among primary and middle school students in Xuzhou City

SUO Qian, ZHANG De-yong, CAI Wen-qian, SUN Li, ZHANG Bo, YAN Xiao-ling, GUO Bao

2020, 18(12): 2054-2056. doi: 10.16766/j.cnki.issn.1674-4152.001687

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Abstract:
Objective To explore and study the incidence of refractive error among primary and secondary school students in Xuzhou City, and to understand the related factors of myopia, so as to provide theoretical reference for the prevention and treatment of myopia. Methods stratified cluster sampling method was used to select 2 primary schools, 2 junior high schools and 2 senior high schools in Xuzhou from September 2019 to October 2019. A total of 1 321 students in 2 classes were randomly selected from each school as the research objects, and visual screening and questionnaire survey were conducted. SPSS 19.0 statistical software was used to process and analyze the data, and the related factors affecting visual acuity were summarized. Results Total 1 321 students received valid questionnaires in 1 312 cases. The incidence of hyperopia was 1.52%, strabismus 0.61%, amblyopia 1.60% and myopia 45.96%. The survey showed that children and parents had low awareness and protection awareness of vision problems, family history, daily homework and reading time of more than 8 h, use of electronic products for more than 3 h, and incorrect posture of writing and holding pen were the influencing factors of myopia(all P<0.05). Conclusion Children and parents in Xuzhou have low awareness of vision problems and low awareness of protection. Parents and students have low awareness of knowledge related to vision protection, and there are some adverse factors that may cause myopia, such as excessive use of eyes. Some students are not clear about the influence of myopia on body and mind and the prevention and treatment measures. With the increase of grade, it is gradually clear that myopia has some adverse effects on body and mind. The incidence of myopia is high among primary and middle school students, so it is necessary to identify the risk factors of myopia in a timely manner, formulate relevant measures for students, develop good habits of using eyes, and promote visual health care.

Evaluation of application effects of electronic clinical pathways for type 2 diabetes mellitus in community

DAI Hui-min, CHENG Yuan, LI Ya-ling, ZHOU Jian-min, SHEN Ao, MI Yi-kai, DU Zhao-hui

2020, 18(12): 2057-2059,2155. doi: 10.16766/j.cnki.issn.1674-4152.001688

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Abstract:
Objective To explore the empirical effect of electronic clinical pathway for type 2 diabetes mellitus, and to provide basis for its further promotion and use in the community. Methods A total of 264 patients with type 2 diabetes mellitus who have signed a family doctor contract with our general practitioners in Weifang Community Health Service Center from March to May 2010 were selected as study subjects. They were randomly divided into electronic clinical pathway group(132 cases) and control group(132 cases) by random number method. One year later, signs and metabolic indexes of the patients before and after intervention were compared. Results After 1 year of standardized management of electronic clinical pathway, fasting blood glucose [(6.29±0.76) mmol/L], HbA1 c [(6.76± 0.36)%], and low-density lipoprotein [(2.65±0.88) mmol/L] in the electronic clinical pathway group were lower than that before intervention [(7.80± 0.65) mmol/L,(7.72±0.41) %, and(2.81±0.93) mmol/L, respectively], with statistically significant differences(all P<0.05). After intervention, fasting blood glucose [(7.40±0.52) mmol/L], HbA1 c [(7.29±0.49)%], and low-density lipoprotein [(3.07±0.80) mmol/L] in the electronic clinical pathway group were all lower than those in the control group, with statistically significant differences(all P<0.05). Conclusion Electronic clinical pathway can not only standardize the diagnosis and treatment of general practitioners, strengthen the follow-up management of patients with diabetes, but also improve the compliance and satisfaction of patients. Comprehensive use of electronic clinical pathways for the management of type 2 diabetes mellitus could be considered and extended to other communities.

Investigation and analysis on the knowledge of novel coronavirus pneumonia among community residents in Beijing

LI Wei, SUN Yu-mei, SU Li, DING Yan-ming, CHI Chun-hua

2020, 18(12): 2060-2064. doi: 10.16766/j.cnki.issn.1674-4152.001689

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Abstract:
Objective To investigate the knowledge status of novel coronavirus pneumonia(NCP) among community residents in Beijing, explore its influencing factors, and provide clues and evidences for popular science or training in public health emergency prevention and control. Methods Cross-sectional design, self-designed questionnaire was used to conduct the online survey of 2 626 residents in 8 districts of Beijing from March 15 to 24, 2020. SPSS software was used to data statistical analysis. Results A total of 2 626 questionnaires were collected and 2 622 were valid. The average score of NCP among community residents was(85.9±11.8). The questionnaire includes 4 dimensions, 35 items. The scores of the four dimensions from high to low were: daily protection(94.1±11.9), isolation measures(91.3±10.4), clinical manifestations and diagnosis and treatment(77.1±20.9), pathogen and epidemiology(75.2±21.2). Multiple linear regression analysis showed that age, education level, doctors and nurses, gender were the influential factors, the difference was statistically significant(all P<0.01). The correct answer rates of different items in the four dimensions were as follows: daily protection was 99.0%-56.7%, isolation measure was 98.1%-58.1%, clinical manifestations and diagnosis and treatment was 96.8%-44.9%, pathogen and epidemiology was 97.4%-34.4%. Conclusion The knowledge of NCP among community residents in Beijing is well mastered, and the work of popular science in Beijing has achieved remarkable results, but the knowledge of etiology, epidemiology, clinical manifestations, diagnosis and treatment needs to be further strengthened. It is suggested that using information technology to carry out prevention and control work, communities should accurately analyze and interpret knowledge, formulate specific plans, guide correct knowledge orientation, and play a greater role in prevention and health education.

Analysis on the psychology,life and sleep quality of patients with chronic gastritis

LIU Jie, ZHANG Jian, XUE Xian-min, NIE Yan, SHI Yong-quan

2020, 18(12): 2065-2070. doi: 10.16766/j.cnki.issn.1674-4152.001690

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Abstract:
Objective To analyze the psychosocial characteristics, life and sleep quality of chronic non-atrophic gastritis(CNAG), chronic atrophic gastritis(CAG) and intestinal metaplasia(IM) patients and their related factors. Methods A total of 671 patients with chronic gastritis who visited the outpatient department of Xijing hospital from June to December 2019 were enrolled. According to biopsy pathological diagnosis, they were divided into CNAG group(136 cases), CAG group(180 cases) and IM group(355 cases). Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA), quality of life scale(SF-36), Pittsburgh sleep quality index(PSQI) and coping style(TCSQ) were used for assessment and analysis. Results The incidence rates of anxiety and depression in the IM group were significantly higher than those in the CNAG group and the CAG group(all P<0.05). The scores of all factors of the quality of life scale of the three groups were lower than the national norm scores in three groups. The scores of physiological function, body pain and general health condition of the IM group were significantly lower than those of the CNAG group and the CAG group(all P<0.05). The total score of sleep quality in both the IM group and the CAG group was significantly higher than that in the CNAG group(all P<0.05). The positive coping scores of both the CAG group and the IM group were significantly lower than those of the CNAG group(all P<0.05). The negative coping score of the IM group was significantly higher than that of the CNAG group and the CAG group(both P<0.05). Further analysis found that the patient's age, gender, education level, HP infection status and course of disease could affect the anxiety and depression incidence and sleep quality of patients with chronic gastritis, age, education level and gender may be related to the patient's quality of life. Among them, education level and age were related to changes in patients' active coping style. Conclusion With the aggravation of chronic gastritis mucosal lesions, the incidence of anxiety and depression in patients significantly increased, the quality of life and sleep quality significantly decreased, and the way of coping with things tends to be negative. It is suggested that clinical attention should be paid to the mental state, life and sleep quality of patients with chronic gastritis, and appropriate intervention should be given when necessary.

The value of quantitative contrast-enhanced ultrasound in the evaluation of blunt splenic trauma

DING Gao-feng, QIAN Ji-jiang, NIU Si-hua, SITU Ming-zhu, YAN Jia-mei, SHEN Rui-wei

2020, 18(12): 2071-2074. doi: 10.16766/j.cnki.issn.1674-4152.001691

227 0

Abstract:
Objective To explorer the value of quantitative contrast-enhanced ultrasound in the prediction of blunt splenic trauma. Methods A total of 86 patients who were suspected of blunt splenic trauma from January 2015 to August 2018 in our hospital were chosen and underwent CE-MDCT, CEUS and US. All the patients were divided into blunt splenic trauma group and non-blunt splenic trauma group based on CE-MDCT results. The differences of clinical information between patients were compared. The receiver operating characteristic curves(ROC) were plotted and the diagnostic efficiency of CEUS and US in predicting blunt splenic trauma were evaluated. Results They showed significantly increase in US value, AT, TTP and WT and decrease in PI in blunt splenic trauma group compared with non-blunt splenic trauma group(all P>0.05). The ROC curve showed that the AUC of AT, TTP, WT and PI in predicting blunt splenic trauma were significantly higher than US, of which the best cut-off points were AT≥8.187 s, TTP≥61.482 s, WT≥88.351 s, PI≥18.731 db. The sensitivity of AT, TTP, WT and PI in evaluating blunt splenic trauma were significantly higher than US. Conclusion Quantitative CEUS is valuable in the evaluation of blunt splenic trauma. AT≥8.187 s, TTP≥61.482 s, WT≥88.351 s and PI≥18.731 db can be used as reference indexes for spleen frustrgot injury.

Clinical value of hemorheology test in the diagnosis of cardiovascular diseases

XU Yi-na, YUAN Hai-jun, HU Yi-fei, ZHAO Dong

2020, 18(12): 2075-2077. doi: 10.16766/j.cnki.issn.1674-4152.001692

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Abstract:
Objective To analyze the application value of hemorheology test in the diagnosis of cardiovascular diseases, and to explore the correlation between hemorheology indexes and the occurrence and development of cardiovascular diseases. Methods A total of 62 cases of cardiovascular disease patients in our hospital from June 2019 to June 2020 were selected and included in the study group. Meanwhile, 62 healthy volunteers who underwent routine physical examination in our hospital at the same time were selected as the control group. The whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity, erythrocyte aggregation index, erythrocyte rigidity index, red blood cell fineness index were measured by automatic hemorheology analyzer. The hemorheology indexes such as cell deformation index, hematocrit, erythrocyte sedimentation rate, plasma fibrinogen were compared between the two groups. Pearson correlation analysis method was used to analyze the correlation between hemorheology indexes and cardiovascular disease. Results Before treatment, the whole blood high shear viscosity, whole blood low shear viscosity, erythrocyte aggregation index, erythrocyte rigidity index, erythrocyte deformation index, hematocrit and plasma fibrinogen test levels of the study group were higher than those of the control group, and the ESR test level was lower than that of the control group(P<0.05). The plasma viscosity of the study group before treatment was similar to that of the control group(P>0.05). After treatment, the above indexes in the study group were compared with those in the control group(all P>0.05). After treatment, the whole blood high shear viscosity, whole blood low shear viscosity, erythrocyte aggregation index, erythrocyte rigidity index, erythrocyte deformation index, hematocrit and plasma fibrinogen test levels in the study group were lower than those before treatment, and the ESR test level was higher than that before treatment(P<0.05). The plasma viscosity was similar to that before treatment(P>0.05). Pearson correlation analysis showed that cardiovascular disease was positively correlated with whole blood high shear viscosity, whole blood low shear viscosity, erythrocyte aggregation index, erythrocyte rigidity index, erythrocyte deformation index, hematocrit and plasma fibrin, and negatively correlated with ESR, but not with plasma viscosity. Conclusion Hemorheology indexes are abnormal expression in cardiovascular diseases. Hemorheology test can be used as an auxiliary reference for clinical diagnosis of cardiovascular diseases, and it is of great significance to improve the accuracy of the diagnosis results.

Clinical application progress of transcranial magnetic stimulation in spasticity after stroke

MEI Sheng-rui, XU Qing, YUAN Peng, XU Lei, LIU Xiao-man

2020, 18(12): 2078-2081,2098. doi: 10.16766/j.cnki.issn.1674-4152.001693

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Abstract:
Post-stroke spasticity(PSS) is one of the common manifestations of dyspraxia after stroke, with a high incidence. The main clinical manifestation is the enhancement of the muscle tension of the flexor group of the upper limb and the extensor group of the lower limb. The treatment of PSS includes drug therapy, manual stretching, nerve block therapy, etc. The treatment methods have their own advantages and disadvantages. Currently, there is no unified treatment for PSS, which is mainly based on comprehensive treatment. Transcranial magnetic therapy(TMS) is a non-invasive magnetic stimulation technique based on electromagnetic induction which change the cortical excitability. It has been widely used in nervous system diseases. TMS can be applied to the central nervous system and the peripheral nervous system. When applied to the central nervous system, treatment modes include low-frequency rTMS, high-frequency rTMS, and patterned TMS. In most studies, 1 Hz-rTMS was applied to the non-affected cerebral hemisphere. In a few studies, iTBS was applied to the affected cerebral hemisphere, and 10 Hz-rTMS was applied to the affected cerebral hemisphere. The application of high frequency rTMS and iTBS in the affected cerebral hemisphere can improve the cortical excitability, strengthen the control of the upper center on the spinal motor neurons, reduce the excitability and muscle spindle sensitivity of the motor neurons, and improve the symptoms of spasticity. Low-frequency rTMS are applied to the non-affected cerebral hemisphere to reduce the excitability of the non-affected cerebral hemisphere, reduce the inhibitory effect of the non-affected cerebral cortex on the affected cerebral cortex, restore the balance between the two hemispheres, and indirectly strengthen the control of the affected cerebral hemisphere on the spinal motor neurons. The current research applied to the periphery basically uses high-frequency rTMS treatment. The purpose of this review is to describe the clinical application progress of TMS in the treatment of spasticity after stroke.

Research progress of venous thromboembolism in patients after traumatic brain injury

YU Peng, WU Si-rong

2020, 18(12): 2082-2085. doi: 10.16766/j.cnki.issn.1674-4152.001694

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Abstract:
Venous thromboembolism(VTE), including deep venous thrombosis(DVT) and pulmonary thromboembolism(PE), is an important cause of unexpected death and disability of inpatients. Traumatic brain injury(TBI) patients are at high risk of VTE because of many factors such as consciousness disorder, operation, deep vein catheterization, dehydration treatment, systemic infection, long-term bed rest and limb dysfunction, but VTE can be prevented. The current preventive measures for VTE in TBI patients include basic prevention, physical prevention, drug prevention, and prevention of inferior vena cava filter implantation. Because it does not increase the risk of bleeding, the physical prevention measures of VTE are more widely used and safe, and have become an important part of standardized prevention of thrombosis. Anticoagulation therapy is relatively safe and effective as a basic treatment to prevent VTE. However, for patients with TBI, most neurosurgeons are more inclined to delay VTE drug prevention in patients with TBI due to concerns that anticoagulant drugs will lead to a new bleeding process or the initial development of intracranial hemorrhage(ICH). It is a major issue for clinicians to correctly assess the VTE risk of patients and give effective antithrombotic treatment in a timely manner to maximize the benefits of antithrombotic/bleeding risk. This article reviews the incidence, risk factors, diagnosis and prevention of VTE after TBI.

Clinical efficacy of acupuncture myofascial trigger point in the treatment of low back myofascial pain syndrome based on infrared thermal imaging technique

XIE Gui-xin, LIU Jian-hang, GAO Qian-qian, WANG Hao, XU Zhi-wei, LIU Hao

2020, 18(12): 2086-2089,2161. doi: 10.16766/j.cnki.issn.1674-4152.001695

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Abstract:
Objective To observe the clinical efficacy of acupuncture myofascial trigger point in the treatment of low back myofascial pain syndrome(MPS) based on infrared thermal imaging technique. Methods According to the inclusion criteria and exclusion criteria, 60 patients with MPS were randomly divided into treatment group(n=30) and control group(n=30). The treatment group was treated with infrared thermal imaging to locate and acupuncture the trigger points of inactivated muscle and fascia, while the control group was treated with acupuncture at traditional acupoints. Patients were treated once every other day, 3 times a week for 2 weeks. After the course of treatment, the infrared thermal imaging distribution map, McGill simplified scale pain score and clinical curative effect analysis were observed before and after treatment. Results There was no significant difference in PRI score, VAS score and PPI score between the two groups before treatment(t=-0.399,-0.454,-0.210), all P>0.05. The scores of PRI, VAS and PPI in the two groups after treatment were significantly lower than those in the same group before treatment, and there were significant differences in the scores of PRI, VAS and PPI between the two groups after treatment, and the degree of improvement in the treatment group was more obvious than that in the control group. At the same time, the high temperature area of low back in the treatment group was significantly lower than that before treatment, and the distribution of the high temperature area in the control group was also lower than that before treatment, but there was still a certain gap between the treatment group and the observation group. Conclusion Acupuncture inactivation after locating the myofascial trigger point by infrared thermography is an effective, rapid and accurate method for the treatment of low back myofascial pain syndrome, which is worthy of clinical application.

Clinical effect of self-made new Chinese medicine hydrogel ointment combined with transcutaneous electrical nerve stimulation in the treatment of discogenic low back pain

HE Li-hong, LI Guo-song, NI Yan-hong, HAN Xiao, ZHUANG Wei

2020, 18(12): 2090-2093. doi: 10.16766/j.cnki.issn.1674-4152.001696

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Abstract:
Objective To observe the clinical effect of a self-made new Chinese medicine hydrogel ointment combined with transcutaneous electrical nerve stimulation(TENS) in the treatment of discogenic low back pain. Methods Total 46 patients with discogenic low back pain in Jiangnan Hospital Affiliated to ZheJiang University of Traditional Chinese Medicine from May 2017 to June 2019 were selected and divided into shock wave group(23 cases) and combined treatment group(23 cases) according to the random number table method. Shock wave and shock wave combined with Chinese medicine hydrogel ointment and TENS were respectively treated. The VAS score, Tampa score, JOA score, ODI score, range of motion and clinical efficacy were recorded and compared between the two groups at the time of pre-treatment and 4 weeks after treatment. Results After 4 weeks of treatment, the scores of the two groups were statistically significant compared with those of the same group before treatment(all P<0.05), and the scores of the combined treatment group were all better than those of the shock wave group at the same time(all P<0.05). After 4 weeks of treatment, the anterior flexion and posterior extension mobility of the combined treatment group were better than that of the shock wave group, with statistically significant differences(t=-7.693,-5.274, all P<0.05). Two groups of patients compared the efficacy of the last follow-up, the combined treatment group total effective rate was higher than the shock wave group, but no statistical difference(t=1.000, P>0.05), and the proportion of "excellent" in the combined treatment group was better than that in the shock wave group(Z=-2.008, P<0.05). Conclusion The new Chinese medicine hydrogel ointment combined with TENS can effectively relieve the lower back pain, reduce the fear of movement, improve the lumbar mobility and improve the quality of life of patients.

Research on the influencing factors of community practice preceptors’teaching needs based on the perspective of students

TAO Lin, LIU Su-zhen, FU Lan, ZHANG Xiao-xia, YI Qiong

2020, 18(12): 2094-2098. doi: 10.16766/j.cnki.issn.1674-4152.001697

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Abstract:
Objective To explore the influencing factors of community practice preceptors' teaching needs based on the perspective of students. Methods A total of 889 students in Sichuan province were selected with methods of convenience sampling from June 2017 to November 2017. The sample came from community health service centers, medical schools and hospitals' general medicine training center burdened with community practice teaching task in Sichuan province. Results Single factor analysis showed that the gender, age, education, specialty, type, area, internship time, learning effects, preceptors' practical teaching ability and preceptors' training needs were statistically significant factors(all P<0.05). Ordinal regression analysis showed that students from provincial capital cities believe that preceptors ' teaching needs are lower(OR=0.643, 95% CI: 0.463-0.891). Compared with the students who have poorer evaluation of their practical learning effects, students whose the evaluation was very good(OR=0.385, 95% CI: 0.220-0.675), good(OR=0.659, 95% CI: 0.433-1.002) and general(OR=0.732, 95% CI: 0.518-1.034) had lower levels of teaching needs. Compared with the students who have poor evaluation of teachers' teaching ability, students whose the evaluation was very good had lower levels of teaching needs(OR=0.527, 95% CI: 0.301-0.923). Conclusion Community practice preceptors should pay attention to the students' personal experience and learning background, focus on students' evaluation of practical learning and their teaching ability, and optimize teaching behavior according to students' evaluation.

Investigation on the needs of training of community doctors in the diagnosis and treatment of heart failure in Dongcheng District of Beijing

LIN Xue, DENG Hong-yue, WANG Fang, SHA Yue, CENG Xue-jun, FANG Li-gang

2020, 18(12): 2099-2102. doi: 10.16766/j.cnki.issn.1674-4152.001698

185 1

Abstract:
Objective To investigate the training demand of community doctors Dongcheng District of Beijing in order to promote the linkage management of the "technical scheme for grading diagnosis and treatment of heart failure" in different medical institutions(tertiary hospitals, secondary hospitals and primary health units). Methods According to the technical scheme of grading diagnosis and treatment of heart failure, a quantitative questionnaire was designed, which included 47 questions and were sent to Dongcheng Community doctors working group by Health Management Center. Results A total of 178 community doctors answered the questionnaire, with an average age of 36 years(32-47 years) and 10 years of community service(5-13 years). The percentage of the community doctors willing to take care the patients with heart failure was 88.2%; 73.6% of the community doctors thought that the patients had accepted the treatment of high-risk factors of heart failure; 52.2% of the doctors were not confident heart sounds auscultation. In the daily management of heart failure, the biggest problem was the lack of heart failure guideline training(72.5%), leading to about 75.8% doctors could not follow the guidelines, and about 79.8% doctors could not identify the indications of heart assist devices. In terms of heart failure referral, 79.8% doctors did not know the number of heart failure patients in their community, and 75.3% doctors could not contact the specialists of referral units to obtain patients' diagnosis and treatment information. As to the patients' education, 72.5% of patients could not carry out self-management and 71.3% refused to follow medical advices in terms of follow-up training, 92.7% of community doctors hope to be able to discuss patients with specialists in a team way. Conclusion In order to promote the treatment and referral in community, it is necessary to strengthen the training of heart failure guidelines for community doctors, strengthen patient self-management, and establish a diagnosis and treatment platform between physicians in community and tertiary hospitals.

Research on Status of Resident Physician-Patient Communicating Training in Standardized General Practice Training in Chengdu

TANG Zhen-hai, ZOU Chuan, DAI Hong-xun, DENG Li-li, LIU Li-di, XIANG Hong-yu

2020, 18(12): 2103-2105,2116. doi: 10.16766/j.cnki.issn.1674-4152.001699

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Objective To investigate the demands and willingness of Resident Physician-Patient Communicating Training in Chengdu, to design a demand-oriented training system in order to provide references and suggestions based on its demands. Methods Questionnaires were utilized to conduct a cross sectional survey of 386 resident physicians in Chengdu during March 2019 who are undergoing Standardized General Practice Training. Results The 359 individuals(93.0%) believed starting Resident Physician-Patient Communicating Training course during Standardized General Practice Training is needed among all 386 respondents. The 342 individuals(88.6%) were willing to attend such course. The Top three of the demands of students in Resident Physician-Patient Communicating Training were: how to communicate with angry patients 86.3%(333/386), how to explain and inform conditions of patients 81.6%(315/386), and how to inform bad news 78.2%(302/386). The top three of training forms were: clinical practice teaching 73.8%(302/386), simulation teaching 67.6%(261/386), and lecture 60.9%(235/386). The difference between the number of previous respondents and the expected number in each form was statistically significant(all P<0.05). Conclusion The demanding of Resident Physician-Patient Communicating Training in Standardized General Practice Training is dramatically increasing. It is suggested to add the content, such as 'communicate with angry patients', 'explain and inform conditions of patients' and 'inform bad news' into the Training. Meanwhile, improving the clinical practice and simulated teaching as well as decreasing pure theory teaching is needed in order to enhance the results of the Training.

Efficacy and safety of levodopa/benserazide combined with pramipexole in Parkinson’s disease:a meta-analysis

ZHANG Yan, DAI Xin-yu, TANG Zhong-quan, OU Ting, ZHAO Xiao-min, CHEN Xian-hua, YAO Jing-qing, TIAN Xue, DAI Yue, HUANG Liu, LI Yun-tao

2020, 18(12): 2106-2111. doi: 10.16766/j.cnki.issn.1674-4152.001700

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Objective To systematically evaluate the efficacy and safety of levodopa/benserazide combined with pramipexole in the treatment of Parkinson's disease(PD). Methods Randomised control trials(RCTs) of levodopa/benserazide combined with pramipexole for treating PD patients were searched from computerised databases, including PubMed, Cochrane Library, Chinese National Knowledge Infrastructure database(CNKI), VIP database for chinese technical periodical(VIP) and Wanfang Data. According to the included and excluded criterias, Meta-analysis was performed using Review Manager 5.3 software. Results Thirty trials with 3 041 patients were included. The Meta-analysis showed that compared with levodopa/benserazide alone, levodopa/benserazide combined with pramipexole could significantly improve the overall efficacy of clinical treatment [OR=5.05, 95% CI:(3.75, 6.78), P<0.01], at the same time, decrease the scores of UPDRS total [MD=-7.31, 95% CI:(-9.74,-4.89), P<0.01]. UPDRS part Ⅱ [MD=-2.23, 95% CI:(-3.17,-1.30), P<0.01] and UPDRS part Ⅲ [MD=-4.88, 95% CI:(-6.01,-3.74), P<0.01]. The results show that levodopa/benserazide combined with pramipexole significantly improved the overall of PD, quality of life and motor symptoms. Safety analysis showed that the incidence of adverse reactions such as nausea and vomiting, hypotension, dizziness, drowsiness and insomnia in patients of levodopa/benserazide combined with pramipexole group were not decreased compared with that in levodopa/benserazide alone(all P>0.05). However, the incidence of hallucination was increased in the combination group [OR=4.03, 95% CI:(1.37, 11.87), P=0.01], and the difference was statistically significant. Conclusion The treatment of levodopa/benserazide combined with pramipexole for PD has better curative effect, which can significantly improve the UDPRS score of patients, and the safety is reliable.

Investigation on the supply and development of traditional Chinese medicine health service institutions in two county-level cities of Jiangxi Province

AN Qi, LI Qi, LI Rui-feng

2020, 18(12): 2112-2116. doi: 10.16766/j.cnki.issn.1674-4152.001701

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Objective To investigate the status and problems of the development of medical and health services in counties, and to promote the development of traditional Chinese medicine(TCM) and health services. Methods The health care service institutions of traditional Chinese medicine and health service supporting industries of traditional Chinese medicine in A and B county-level cities of Jiangxi Province in 2017 were taken as the object of study. Taking the streets of A and B county-level cities as the units, firstly, according to the scale and type of enterprises, the cluster stratified sampling method was used to select 105 TCM health care service institutions and 38 TCM health service supporting industries in the two cities at the ratio of 1:15. Then, the number of service personnel, organization area, income cost, service personnel and other data were analyzed. SPSS 25.0 software was used to analyze the maximum, minimum sum, median and upper and lower quartiles of each index. Results The development of health care service of traditional Chinese medicine in city A and city B was good, but there were differences between the health care service market of traditional Chinese medicine in medical and non-medical institutions in city A and city B. The development scale of traditional Chinese medicine industry and the industry of diagnosis and treatment equipment of traditional Chinese Medicine had great development potential. In city A and city B, there were 87.2% and 92.0% of enterprises, respectively, complained that talent introduction was difficult. The main reasons in city A were the compensation for job seekers High expectations(88.24%), insufficient TCM talents(70.59%), and limited space for job development(52.94%). In city B, the total numbers of TCM talents were insufficient(94.12%), the higher expectation of job seekers' salary(76.47%), and the geographical location of enterprises(52.94%). Conclusion Traditional Chinese medicine health care service institutions complement each other's advantages, traditional Chinese medicine health service supports the diversified development of the industry, but the increase of traditional Chinese medicine service personnel is insufficient. Strengthening the training of traditional Chinese medicine personnel is an important measure to promote the development of traditional Chinese medicine health service industry.

Practice of infection prevention and control in non-designated three grade general hospital during COVID-19 epidemic period

ZHONG Xia, LI Wei, GUO De-ying, WANG Jia-liang, SHEN Shi-hua

2020, 18(12): 2117-2119,2148. doi: 10.16766/j.cnki.issn.1674-4152.001702

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Objective To explore the practice of infection prevention and control in non-designated three grade general hospital during COVID-19 epidemic period, further reduce the new coronavirus transmission risk, provide reference for epidemic prevention and control for non-designated hospitals. Methods Based on the diagnosis and treatment and prevention and control plan of the National Health Commission, combined with the actual situation of epidemic prevention and control in our city, the prevention and control strategy of non-designated general hospital infection was formulated from the establishment of hospital emergency prevention and control organization system, personnel and material reserves, multi-level and multi-channel training, formulation and update of system and process, multi department cooperation and district management. Results From January 22 to May 31, 2020, 467 165 outpatients and 8 346 fever outpatients were visited. There were 16 positive patients detected by nucleic acid test and sent to the designated hospital. During the novel coronavirus pneumonia epidemic, patients were screened and received for medical treatment. After training and guidance, the medical staff could effectively instruct and explain, and achieved zero detection, zero missing and zero cross infection. During this period, 54 working systems and processes were accumulated, which accumulated experience for dealing with public health emergencies in the future. Conclusion Novel coronavirus pneumonia is a severe epidemic situation. Under the situation of severe acute outbreak of coronavirus pneumonia, medical institutions should clearly define the division of labor through compacting responsibilities, establish and improve emergency response mechanisms, formulate system processes, implement feasible preventive and control measures, and think in many ways, intervene in various fields and cooperate in many departments, so that the spread and spread of the epidemic can be effectively prevented.

The current situation of intellectual property rights of traditional Chinese medicine in medical vocational colleges from patent analysis

ZHANG Jing, LI Xiu-ming, HAN Gui-xiang, FANG Ming-ming

2020, 18(12): 2120-2124. doi: 10.16766/j.cnki.issn.1674-4152.001703

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Objective The rapid spread of Chinese medicine culture in the context of "the Belt and Road Initiative" initiative, and the low value of Chinese medicine patents will not only affect the promotion and recognition of Chinese medicine in the international community, but also cause inestimable economic losses to the Chinese medicine industry in China. Higher vocational colleges of medicine, as the subject of intellectual property invention of traditional Chinese medicine, must strive to improve the quality and value of traditional Chinese medicine patents. Methods Descriptive statistical analysis was used to analyze Chinese medicine related patents applied by higher vocational colleges in China from 2000 to October 2019. Results In terms of the number of patent applications, vocational colleges and universities had accumulatively applied for 1 321 TCM patents. Judging from the contents of patent applications for Chinese medicine in higher vocational colleges, the top three were patents for Chinese herbal medicine formulations, patents for Chinese medicine production and processing equipment, and patents for traditional Chinese medicine health products. From the perspective of the type of patent applicants, various types of vocational colleges had patents for Chinese medicine. The most numerous of them were comprehensive vocational colleges, science and engineering colleges, and agricultural and forestry colleges. Medical vocational colleges ranked fourth. From the data of patent invalidation, as of 2017, the invalidation rate of TCM related patents is 41.52%, of which the invention patent invalidation rate was 28.00%. The utility model patent failure rate was 52.08%. Conclusion Medical vocational colleges have prominent problems in protecting the intellectual property rights of Chinese medicine, such as the small number of patents granted, low patent value, and high patent failure rate. We should give full play to the role of higher vocational colleges in serving local economic development, make full use of the patent information service function of college libraries, timely adjust the patent award funding policy and incentive mechanism, and vigorously promote traditional Chinese medicine on campus, start with the construction of intellectual property culture and other aspects, and take a multi-pronged approach to improve the quality and value of traditional Chinese medicine patents in medical vocational colleges.

Discussion on the role of strengthening quality control and continuous improvement in infection prevention and control of disinfection supply center

WEI Juan-qing, JIANG Mei-na

2020, 18(12): 2125-2127. doi: 10.16766/j.cnki.issn.1674-4152.001704

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Objective To strengthen the quality control and continuous improvement of disinfection supply center and analyze its role in infection prevention and control. Methods In August 2018, strengthened quality monitoring and continuous improvement activities were carried out in the disinfection supply center of Shaoxing Seventh People's hospital. The hospital infection rate, B-D test qualification rate of sterilized articles, qualified rate of work quality and delivery time of articles were compared before the implementation of enhanced quality control and continuous improvement activities(May 2017-May 2018) and after(August 2018-August 2019). Results After implementation, the incidence of nosocomial infection in patients treated with medical devices issued by the disinfection supply center was 1.1%, lower than 2.6% before implementation, and the pass rate of B-D experiment was 98.8%, higher than 95.4% before implementation, with statistically significant difference(all P<0.05). The qualified rate of work quality of the disinfection supply center after implementation, including cleaning quality, disinfection and sterilization, packaging quality, recovery, acceptance, classification and distribution, was higher than that before implementation, and the difference was statistically significant(all P<0.05). After implementation, the delivery time of conventional goods and urgently needed goods was(45.25±10.71) min and(9.64±1.17) min, both shorter than that before implementation(51.26±10.33) min and(12.37±2.28) min, with statistically significant difference(all P<0.05). Conclusion Strengthening quality control and continuous improvement can effectively improve the prevention and control of infection in the disinfection supply center, improve the qualified rate of goods in the supply room, and shorten the delivery time of goods, which is worthy of clinical application.

Relationship between perceived organizational support and professional identification of new nurses in tertiary hospital:the mediating effect of transition shock

LIN Cheng-cheng, WANG Shu-min, HUANG Xiao-yan, SHANGGUAN Wang-ning, JIN Qian-qian

2020, 18(12): 2128-2131. doi: 10.16766/j.cnki.issn.1674-4152.001705

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Objective To explore the relationship among transition shock, perceived organizational support and professional identification of new nurses in tertiary hospital, and provide some reference for helping the new nurses to pass through the transition period smoothly. Methods A total of 421 qualified new nurses were recruited from tertiary hospitals of Zhejiang province between January and June, 2019 by convenience sampling method. The Transition Shock of Newly Graduated Nurses Scale, Professional Identification Scale for Nurses and Perceived Organizational Support Scale for Nurses were used in the investigation. The SPSS 22.0 was used for data analysis, and the Amos 17.0 was used for mediating effects test. Results The score of transition shock was 100.57±13.64, with the scoring rate of 74.5%, and the subscale scoring rates from high to low were physical aspect, knowledge/skills aspect, sociocultural and development aspect, psychological aspect. The score of professional identification was 2.81±0.61, with the subscale scores from high to low were career self-concept, sense of career gain and sense of career motivation. The score of perceived organizational support was 3.19±0.53, with the subscale scores from high to low were emotional support and instrumental support. A significant correlation was found between the transition shock, professional identification and perceived organizational support(all P<0.01). Mediating effect analyses revealed that transition shock exerted a partial mediating effect between perceived organizational support and professional identification, with the mediating effect of 43.3%. Conclusion Nursing managers should strengthen their support to new nurses according to the hospital reality, improve their perceived organizational support, take targeted measures to help them through the transition period in order to strengthen their professional identification and stabilize the clinical nursing team.

Application observation of holistic nursing intervention in thoracoscopic treatment of solitary benign pulmonary nodules

ZHOU Xiu-juan, WANG Lin-fei, ZHANG Jing-xiong, TANG A-mao

2020, 18(12): 2132-2135. doi: 10.16766/j.cnki.issn.1674-4152.001706

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Objective To compare the clinical effect of thoracoscopic surgery(TS) on benign pulmonary nodules. Methods From July 2017 to December 2018, 130 patients with solitary benign pulmonary nodules who underwent TS were enrolled in the thoracic surgery of Hangzhou first people's Hospital for clinical observation. According to different nursing methods, they were divided into control group and observation group, 65 cases in each group. The control group received routine nursing measures, including strengthening preoperative nursing, preparing respiratory tract, observing vital signs after operation, and managing respiratory tract. The observation group was given holistic nursing intervention, focusing on emotional counseling and psychological nursing of patients in perioperative period. After the intervention, the scores of self-rating Anxiety Scale(SAS) and self-rating Depression Scale(SDS), incidence of complications, average length of stay and patient satisfaction were compared between the two groups. Results After the intervention, the SAS and SDS scores of the observation group were significantly different from those of the control group(all P<0.05). The average hospitalization time of the observation group was(7.13±2.05) days, and that of the control group was(14.05±2.23) days. The difference between the two groups was statistically significant(t=18.418, P<0.05). The total complication rate of the observation group was 4.62%(3/65) and that of the control group was 16.92%(11/65). The difference between the two groups was statistically significant(χ²=4.000, P<0.05). The satisfaction score of observation group(95.77±2.69) was higher than that of control group(80.45±2.10), t=36.193, P<0.05. Conclusion Holistic nursing can improve the negative emotions of patients with solitary pulmonary nodules treated by thoracoscopic surgery, shorten the length of hospital stay, reduce the incidence of postoperative complications, so the level of patient satisfaction is improved.

Investigation and analysis of influencing factors of diabetes distress in type 2 diabetic patients

GAO Shuang, ZHANG Yan-li, WU Shan-shan, GU Juan

2020, 18(12): 2136-2139. doi: 10.16766/j.cnki.issn.1674-4152.001707

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Objective To understand the current status of diabetes pain in type 2 diabetes patients and analyze its influencing factors. Methods A total of 200 cases of patients with type 2 diabetes in the First Affiliated Hospital of Bengbu Medical College were chosen as the research object. The diabetes patients pain scale, general information questionnaire family per capita income, course, cultural degree, whether suffering from complications, age, sex, occupation, marital status, medical expense payment factors were analyzed. Results A total of 200 questionnaires were issued, 200 of which were valid. There were 87 cases under 45 years of age and 113 cases between 45 and 65 years of age. There were 88 cases with junior high school education or below, 75 cases with senior high school and technical secondary school education, and 37 cases with university education or above. There were 98 cases with a per capita monthly income of 3 000 yuan or less, and 102 cases with a per capita monthly income of 3,000 yuan or more. There were 66 patients with the course of disease less than 5 years, 70 patients with 5-10 years, and 64 patients with the course of disease more than 10 years. There were 132 cases with complications, and 68 cases without complications. Among the 200 subjects, more than half of the patients(55.41%) had diabetes pain of varying degrees(average score of diabetes pain≥2). In this survey, the pain score of diabetes was(2.600±1.040), which was in the middle level of the pain of diabetes. There were statistically significant differences in the average monthly income, course of disease, educational level and complications of diabetic patients(all P<0.05). Family per capita monthly income, course of disease, educational level and complications were the influencing factors of psychological distress score of patients with diabetes(all P<0.05). Conclusion Patients with type 2 diabetes have varying degrees of diabetes pain, and monthly income per family, course of disease, educational level and complications are the influencing factors of diabetes pain.

Effect of psychological nursing based on family counseling on psychological status of patients with breast cancer after modified radical mastectomy

ZOU Yun-yan, MA Yan, MA Bo, WU Yue-jing

2020, 18(12): 2140-2143. doi: 10.16766/j.cnki.issn.1674-4152.001708

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Objective To explore the application effect of psychological nursing based on family counseling in patients with breast cancer undergoing modified radical mastectomy. Methods A total of 140 patients with breast cancer undergoing modified radical mastectomy in Zhejiang hospital from January 2018 to December 2019 were selected as the research objects. They were randomly divided into intervention group and control group, with 70 cases in each group. The control group was given routine postoperative care, and the intervention group was given psychological nursing based on family counseling on the basis of the control group. Self-rating depression and anxiety scale(SAS, SDS), simplified quality of life scale(SF-36), Pittsburgh sleep quality index(PSQI) and self-made questionnaire were used to compare the psychological status, quality of life, sleep quality and nursing satisfaction between the two groups. Results Before the intervention, there was no significant difference in the scores of depression and anxiety and sleep quality between the two groups(all P>0.05). After the intervention, the scores of depression and anxiety in the intervention group were(24.37±2.21),(26.58±2.71), and(2.3±1.4) on the 7 th day after the operation, which were significantly lower than those of the control group(35.01±5.02),(37.12±3.55) and(4.6±1.3) and lower than those of the control group before and after the intervention. Before and after the end of the intervention, the quality of life scores of patients in the intervention group(85.74±6.27, 85.37±6.33, 86.72±6.22, 87.12±6.74, 85.78±6.52, 87.01±6.34, 85.87±6.67, and 86.75±6.71) in the intervention group were significantly higher than those in the control group(65.36±4.75, 66.27±5.08, 64.37±4.27, 64.31±4.73, 64.21±4.78, 64.25±5.02, 65.11±5.23, and 65.62±5.37) scores of the control group(all P<0.05). After treatment, the nursing satisfaction of the intervention group was 92.85%, and that of the control group was 78.57%. The intervention group was significantly higher than the control group(P<0.05). Conclusion Psychological nursing based on family counseling can effectively improve the psychological status of patients with breast cancer after modified radical mastectomy, which is worthy of clinical research and application.

The application of personalized diet nursing in elderly patients with advanced esophageal cancer treated with radiotherapy

GAO Bei-bei, XIN Ling, BIAN Wei-feng, WEI Jie, DU Xing-long

2020, 18(12): 2144-2148. doi: 10.16766/j.cnki.issn.1674-4152.001709

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Objective To explore the effect of personalized diet nursing for elderly patients with advanced esophageal cancer. Methods A total of 54 elderly patients with advanced esophageal cancer in our hospital from January 2018 to December 2019 were divided randomly into control group(27 cases,routine diet nursing) and observation group(27 cases,routine diet nursing + personalized diet nursing). The personalized diet nursing measures were designed based on the patients' clinical symptoms, personality, communication ability and related basic disease, then the nursing effect of the two groups was compared. Results The clinical efficacy rate in the observation group was 81.5%,which was higher than that of the control group(74.1%),but the differences between the two groups showed no statistical significance(P>0.05). The radiation esophagitis and myelosuppression were 44.4% and 18.5% in the observation group,51.9% and 25.9% in the control group,which was also no significant difference between two groups(all P>0.05). On anorexia,the observation group(40.7%) was better than the control group(70.4%, P<0.05). The life qualities of the patients were evaluated according to 5 functional areas and 1 overall life quality area of EORTC QLQ-C30. It showed that the physical function,role function and cognitive function in the observation group were all significantly higher than those in the control group(all P<0.05). On nursing satisfaction,the observation group(92.6%) was higher than the control group(70.4%, P<0.05). Conclusion Personalized diet nursing intervention applied to the elderly patients with advanced esophageal cancer can reduce the adverse reaction of radiotherapy,improve the quality of life,and promote the compliance and nursing satisfaction.

Study on the effect of paternal participation in nursing on maternal breastfeeding self-efficacy and behavior

SHI Yin-jun, WU Fen-ying, YE Hou-mei, WU Lan-mei, ZHU Lin-jie

2020, 18(12): 2149-2152. doi: 10.16766/j.cnki.issn.1674-4152.001710

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Objective To explore the effect of father-participated nursing interventions on self-efficacy and behavior of breastfeeding mothers based on self-efficacy theory. Methods A total of 250 pregnant women in Shaoxing Central Hospital from January 2018 to January 2019 were divided into control group and observation group according to the random number table method, 125 cases in each group. In the control group, the parturients were given routine nursing. In the observation group, the parturients were given father's participation nursing based on self-efficacy theory. The self-efficacy score happiness score and nursing satisfaction of the two groups were compared by various scales, and the rates of exclusive breastfeeding were calculated. Results At 3 days, 1 month, and 3 months postpartum, the maternal breastfeeding self-efficacy scores in both groups were significantly higher than that before nursing(all P<0.05). At 1 and 3 months postpartum, the maternal breastfeeding self-efficacy scores in both groups significantly higher than that at 3 days postpartum(all P<0.05). At 3 months postpartum, the breastfeeding self-efficacy scores of the two groups were significantly higher than that at 1 month postpartum(all P<0.05). At 3 days, 1 month and 3 months postpartum, the breastfeeding self-efficacy scores in the observation group were significantly higher than that in the control group(P<0.05). At 3 months postpartum, the rate of exclusive breastfeeding of the parturients in the two groups was significantly lower than that of the 3 d postpartum(P<0.05); at 3 days postpartum and 3 months postpartum, the rate of exclusive breastfeeding of the observation group was significantly higher than that of the control group(P<0.05). At 3 months postpartum, maternal happiness score of the two groups was significantly higher than that before nursing(all P<0.05). At 3 months postpartum, the scores of independence, personal growth, self-acceptance, life goals, good relationship and environmental control of parturients in the observation group were significantly higher than those in the control group(all P<0.05). After nursing, the satisfaction rate of the parturients in observation group(96.8%) was significantly higher than that in the control group(81.6%, P<0.05). Conclusion Participatory nursing of fathers based on self-efficacy theory can significantly improve the self-efficacy of breastfeeding and the rate of exclusive breastfeeding, and enhance maternal well-being and satisfaction with nursing.

PAN Gong-yi, YU Qing-lu

2020, 18(12): 2153-2155. doi: 10.16766/j.cnki.issn.1674-4152.001711

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CAO Hong-bo, SUN Jing-wei, WANG Juan, LI Jia-chen, TIAN Jing-yi

2020, 18(12): 2156-2158. doi: 10.16766/j.cnki.issn.1674-4152.001712

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WU Rui-xuan, XIANG Xie-long

2020, 18(12): 2159-2161. doi: 10.16766/j.cnki.issn.1674-4152.001713

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About Journal

2020 Vol. 18, No. 12

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