中华全科医学

The development and prospect of primary care system in China

ZHAO Qian, CHEN Hua-dong, WU Jia, LIAO Xiao-yang

2020, 18(3): 341-346. doi: 10.16766/j.cnki.issn.1674-4152.001242

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Abstract:
As the foundation of the whole health system, primary care has experienced a series of changes in the reform and transformation of the health system. In the trend of deepening medical reform, the construction and development of primary care system is the cornerstone of determining the service efficiency of the whole medical system. The construction of primary care system, mostly in form of rural township hospitals and urban community health centers, has become the focus of new medical reform in China, and also an important aspect to realize "healthy China". We review the development history of the primary care system, and analyze the changes of the primary care in recent years with the development of social economy, such as service content, target population and payment method. The primary care in China started from countryside and gradually shifted its focus to city. After the new medical reform, it has experienced the overall reconstruction and realized the integrated and coordinated development. Based on the review of the construction and development of medical consortia, this paper points out that under the "healthy China" strategy, the tasks of the primary care system in China are expanding from disease diagnosis and treatment to health maintenance. The integrated medical system based on "medical association" will gradually transform into "health association". We analyze the new trend of the development of the current primary care system in China from four aspects:transformation of objectives and tasks, expansion of service content, enhancement of service capacity building and improvement of medical service supply through technological innovation, so as to make a prospect for the future development trend. It is pointed out that integrated care is the trend in the future, which needs the joint efforts of many parties, such as supply structure, personnel training, performance incentive, policy guarantee, technical support and so on, so as to truly realize "Healthy China".

WANG Jian, LI Zhi-jun

2020, 18(3): 347-348.

197 9

Abstract:

Application research of timing of removal of the nasogastric tube after laparoscopic assisted Hirschsprung's radical operation in children

LIU Xiao-tian, HAN Ding, ZHANG Zhen, LI Long, LI Qi, WU Xin-yan, PAN Shou-dong

2020, 18(3): 349-351,441. doi: 10.16766/j.cnki.issn.1674-4152.001243

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Abstract:
Objective To evaluate the safety and feasibility of removing nasogastric tube in children after laparoscopic assisted Hirschsprung's radical operation. Methods From February 2018 to February 2019, 60 children in the Children's Hospital affiliated to Capital Institute of Pediatrics diagnosed with short-segment and common type of Hirschsprung's disease and undergoing laparoscopic assisted radical operation were selected. The children were divided into study group(n=30) and control group(n=30) according to the random number table after entering the operating room. In the study group, the nasogastric tube was removed immediately after recovery of anesthesia, while in the control group, the nasogastric tube was left in place after surgery until the patient passed stool. General information, operative time, postoperative first dejection time, abdominal perimeter(prior to surgery, end of surgery, 24-hour and 48-hour post-surgery), frequency of vomiting, time to start of water and food intake, length of postoperative hospital stay, cost of hospitalization, and pediatric anesthesia emergence delirium(PAED) 30-minutes after surgery were compared between the two groups. Results The gender structure, age[5.5(3.0, 23.2) vs. 6.5(3.0, 19.5) months)], weight[(8.6±3.1) kg vs.(9.1±2.3) kg], operative time[107(97, 118) vs. 110(99, 130) min], time to start of food intake[64(52, 74) vs. 75(52, 84)], and postoperative first dejection time[24(20, 33) h vs. 25(15, 40) h] were not significantly different between the two groups(all P>0.05). Compared with control group, PAED 30-minutes after surgery[5.0(5.0, 5.0) vs. 7.0(5.0, 10.0)], frequency of vomiting[4(13%) vs. 13(43%)], time to start of water intake[30(20, 48) h vs. 48(35, 71) h], length of postoperative hospital stay[6.0(5.0, 7.0) vs. 6.6(5.6, 9.6) days], and cost of hospitalization[3.4(2.4, 3.7) vs. 4.0(3.0, 4.3)] were significantly decreased in the study group(all P<0.05). The abdominal perimeter 24-hour post-surgery was significantly higher in the study group than that in the control group(P<0.05). Conclusion Removal of nasogastric tube in children with short-segment and common type of Hirschsprung's disease after laparoscopic assisted radical operation is safe and feasible, which can improve comfort level, enhance recovery and improve clinical nursing quality.

Study on the hormone level of perimenopausal uygur women metabolic syndrome in Urumqi

HUANG Zhi-ying, DING Yan

2020, 18(3): 352-354,399. doi: 10.16766/j.cnki.issn.1674-4152.001244

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Abstract:
Objective To investigate the prevalence of metabolic syndrome(Mets) and the changes of hormone levels in perimenopausal women of uygur nationality in Urumqi. Methods A total of 367 uygur perimenopausal women who were admitted to the first affiliated hospital and physical examination center of Xinjiang Medical University from January to June 2018 were selected as research objects. According to the menstrual state, the patients were divided into pre-menopausal group(61 cases), perimenopause group(244 cases) and early postmenopausal group(62 cases). The changes of Mets hormone levels in different menstrual states were compared and analyzed. Results ① The incidence of Mets was 16.1% in uygur women aged 40-60 years in Xinjiang. The incidence rate of postmenopausal women(22.6%) was higher than that of premenopausal women(4.9%) and perimenopausal women(17.2%). ② There was no statistically significant difference in sex hormone levels between each case group and the control group before menopause. There was no significant difference in FSH, LH and T(P>0.05), while there was significant difference in E2 and E2/T(all P<0.05) between the perimenopausal metabolic group and the control group. Compared with the control group, E2/T in the Mets group and the early postmenopausal group was statistically significant by U test(P<0.05). ③ There were statistically significant differences in FSH, E2, E2/T between perimenopausal and early postmenopausal Mets groups(all P<0.05). Conclusion The prevalence of Mets increases with the change of menopause. The prevalence of postmenopausal early group is higher than that of premenopausal and perimenopausal women. The occurrence of metabolic syndrome may be related to the decrease of E2 and the increase of E2/T in the perimenopause group, and the imbalance of E2 and T in the early postmenopausal group.

Observation on the effect of minimally invasive surfactant therapy in the treatment of premature infants with respiratory distress syndrome

CHEN Yun, CHEN Xin

2020, 18(3): 355-357,391. doi: 10.16766/j.cnki.issn.1674-4152.001245

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Objective To observe the effect of minimally invasive surfactant therapy in the treatment of premature infants with respiratory distress syndrome. Methods Sixty premature infants with RDS hospitalized in the Neonatal Intensive Care Unit(NICU) of the First Affiliated Hospital of Bengbu Medical College from January 2018 to March 2019 were randomly divided into MIST group(30 cases) using minimally invasive pulmonary surfactant application technology and INSURE group(30 cases) using intubation-PS-extubation by nasal positive airway pressure ventilation. The relevant clinical data were collected and analyzed. The oxygen metabolism index, secondary PS application, pneumothorax, bronchopulmonary dysplasia(BPD), mortality rate, the proportion of mechanical ventilation within 72 hours, and hospitalization time were compared. Results At 6, 12, 24 and 48 hours, FiO₂, PaO₂, P/F, PaO₂/PAO₂ in MIST group were significantly less than those in INSURE group, while PEEP/EPAP and PaCO₂ in MIST group were significantly higher than those in INSURE group. There were significant differences in secondary PS application rate(3.33% vs. 20.00%), pneumothorax(0.00% vs.16.67%) and hospitalization time between two groups(all P<0.05). There were no significant differences in 72 h mechanical ventilation(0.00% vs.3.33%), BPD(0.00% vs.3.33%) between MIST group and INSUR group,there was no death in two groups. Conclusion Minimally invasive pulmonary surfactant therapy can significantly improve oxygen metabolism, reduce secondary PS application and pneumothorax ratio, shorten hospitalization time and improve the prognosis of premature infants with RDS.

Application of enhanced recovery after surgery in the perioperative period of pediatric colonic lesions

ZHANG Xian-wei, JIA Ying-ping, ZHANG Fei, ZHU Ying-ying, GENG He-hong, SUN Wei-sheng, HOU Guang-jun, ZHANG Wan-cun

2020, 18(3): 358-361,475. doi: 10.16766/j.cnki.issn.1674-4152.001246

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Objective To investigate the clinical values of enhanced recovery after surgery(ERAS) in the perioperative period of pediatric colonic lesions using retrospective study. Methods Thirty children with colonic polyps or duplication of colonic who underwent ERAS(ERAS group) and 30 children with colonic polyps or duplication of colonic treated by traditional methods(control group) in the second ward of general surgery of He'nan Children's Hospital from July 2013 to May 2017 were selected using random number table method. Postoperative indicators(defecation time for the first time, length of hospital stay, hospitalization fee) and postoperative relevant complications(upper respiratory tract infection, sore throat, urethral pain, adhesive intestinal obstruction, anastomotic leakage, wound infection) were compared. All data were analyzed using SPSS 17.0 statistical software. Results The defecation time for the first time, the length of hospital stay and the hospitalization fee in the ERAS group were significantly lower than those in the control group(all P<0.05)[defecation time for the first time(1.65±0.17) d vs.(2.41±0.19) d, length of hospital stay[7.00(6.00,8.00)d vs. 7.80(6.97,11.00)d], hospitalization fee(12 126.97±1 367.56) yuan vs.(14 155.67±1 686.22) yuan. At the same time, the occurrences of upper respiratory tract infection, sore throat, urethral pain, adhesive intestinal obstruction in the ERAS group were significantly lower than those in the control group(all P<0.05). The occurrences of upper respiratory tract infection 3 cases vs. 10 cases, the occurrences of sore throat 2 cases vs. 8 cases, the occurrences of urethral pain 2 cases vs. 9 cases, the occurrences of adhesive intestinal obstruction 0 case vs. 5 cases. In addition, there were no significant differences in the occurrences of adhesive intestinal obstruction, the occurrences of anastomotic leakage and incision infections(all P>0.05). Conclusion ERAS is safe and reliable in the process of pediatric colon surgery, which can effectively promote the recovery of postoperative gastrointestinal function and reduce the occurrence of complications.

The value of different inflammatory indicators in children with Kawasaki disease

CHEN Yu-ping, ZHANG Lan

2020, 18(3): 362-364. doi: 10.16766/j.cnki.issn.1674-4152.001247

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Objective To analysis the results of white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT) and erythrocyte sedimentation rate(ESR) in children with Kawasaki disease(KD), and to explore its value in diagnosis of KD and prediction of KD with coronary artery injury(CAL) damage. Methods From July to December 2018, 56 children with KD in our Hospital were selected as KD group, including 31 children with coronary artery lesion(CAL) and 25 children with non coronary artery lesion(NCAL). Children with pneumonia who had a fever for 5-7 days in the same period were selected as the infection group(40 cases), and 32 healthy children received health screening were selected as the health group. The levels of WBC, CRP, PCT and ESR were measured by automatic white blood cell count、immunofluorescence dry quantitative method and Westergren, respectively. The relationships between those indicators and CAL were analyzed. Results The levels of WBC, CRP, PCT and ESR in children of KD group were significantly higher than those in infection group and health group[WBC(×10⁹/L):19.22±6.43 vs. 10.89±4.56, 8.48±2.15; CRP(mg/L):100.29±75.86 vs. 17.03±18.79, 3.94±1.91; PCT(g/L):3.22±6.83 vs. 0.69±1.06, 0.14±0.25; ESR(mm/h):73.36±28.57 vs. 27.45±13.37, 8.59±4.32, all P<0.05]. The levels of WBC, CRP, PCT and ESR in CAL group were significantly higher than those in NCAL group[WBC(×10⁹/L):23.26±6.19 vs. 15.96±4.53; CRP(mg/L):161.11±73.15 vs. 51.24±26.45; PCT(g/L):5.59±9.54 vs. 1.30±2.06; ESR(mm/h):95.20±23.23 vs. 55.74±18.62, all P<0.05]. Conclusion The early elevation of WBC, CRP, PCT and ESR are closely related to KD. The detections of those inflammatory indicators are of important value for predicting CAL, and have great guiding role in early clinical treatment and prognosis evaluation.

Exploration of mechanism of bortezomib on side population cell from multiple myeloma based on PI3K/AKT/mTOR

LIU Shu-yan, ZHANG Yun, LIN Sheng-yun

2020, 18(3): 365-369. doi: 10.16766/j.cnki.issn.1674-4152.001248

229 1

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Objective To investigate the mechanism and drug resistance of 26 S proteasome inhibitor bortezomib on multiple myeloma cell line RPMI8226 and myeloma side population(SP) cells. Methods The effect of bortezomib on the phosphorylation of PI3 K/AKT/mTOR signaling pathways was detected by Western blotting. The mechanism of resistance to bortezomib in RPMI8226 and SP cells was explored. Results The relative cell viability of SP cells at 48 h(3.62±0.28) was significantly higher than that of RPMI8226 cells(2.81±0.24, P=0.028). The clone formation ability results showed that SP cells were significantly stronger than RPMI8226 cells(P<0.05). Flow cytometry showed that bortezomib increased the S phase of both cells and decreased the G₂/M phase. The pro-apoptotic rate of RPMI8226(51.23±5.35) was significantly higher than that of SP cells(29.62±2.61, P=0.008). Western blotting results showed that bortezomib significantly reduced the phosphorylation levels of ART, mTOR and 4 E-RP1 in RPMI8226 and SP cells. The drug resistance results showed that SP cell resistance-related proteins P-gp, Caveolin-1(Cav-1), Fatty acid synthase(FASN) and CYP3 A4 expression were higher than those in RPMI8226 cells. Conclusion The inhibitory activity of bortezomib on RPMI8226 and SP cells is exhibited by cell apoptosis and phosphorylation levels of AKT and mTOR signaling proteins. The resistance is developed by the high expression of P-gp, CYP3 A4, Cav-1 and FASN.

Clinical study on ointment rubbing combined with intra-articular sodium hyaluronate injection in the treatment of knee osteoarthritis

LI Ying-chun, ZHU Jun-chen, WANG Chao, MA Xing-fu, NIE Yong, SU Yi, XIONG Ying-zong, ZHENG Zhi-wen

2020, 18(3): 370-373,487. doi: 10.16766/j.cnki.issn.1674-4152.001249

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Abstract:
Objective To investigate the clinical effect of ointment rubbing combined with intra-articular sodium hyaluronate injection in the treatment of knee osteoarthritis. Methods Total 90 patients met the inclusion criteria were randomly divided into treatment group(ointment rubbing combined with intra-articular sodium hyaluronate injection) and control group(intra-articular sodium hyaluronate injection), with 45 cases each group. The treatment group was treated with knee ointment rubbing once a day for 20 minutes. Both groups were treated with intra-articular sodium hyaluronate injection, once a week for five times. The course of treatment in both groups was 5 weeks. All the patients received rehabilitation treatment at the same time during hospitalization, including acupuncture treatment once a day for 20 minutes and massage treatment once a day for 20 minutes. WOMAC score and knee flexion and extension activity were observed before and 1, 3 and 6 months after treatment. The changes of scores and joint mobility of the two groups were compared. The clinical effects were compared, and the adverse reactions were observed at the same time. Results The WOMAC for pain, stiffness and function were improved in both groups(P<0.05), and the WOMAC of treatment group were better than that of control group(P<0.05). Through the measurement of knee joint activity, the flexion activity of knee joint in both groups was improved(P<0.05), and there was no statistical significance in the change of extension activity(P>0.05). There were no difference between the two groups(P>0.05). Conclusion The ointment rubbing combined with intra-articular sodium hyaluronate injection in the treatment of knee osteoarthritis can improve the joint pain, stiffness and functional state, and improve the flexion activity of the patients' joints. The long-term effect is stable, and there is no obvious adverse reaction.

Clinical observation on "Bushen Huoxue Method" in the prevention of peripheral neuropathy induced by bortezomib for multiple myeloma patient

LIU Yong-hua, JIANG Jin-hong, ZHANG Qiao-lei, JIN Wei-mei, LAN Yi-fen, ZHOU Ze-ping, FANG Bing-mu

2020, 18(3): 374-376. doi: 10.16766/j.cnki.issn.1674-4152.001250

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Abstract:
Objective To observe the different incidence of peripheral neuropathy(PN) after bortezomib treatment of patients with multiple myeloma(MM), and to investigate the efficacy of traditional Chinese medicine compound for "Bushen Huoxue Method" in preventing PN caused by bortezomib. Methods A total of 40 patients with primary MM in our hospital from June 2015 to December 2017 were screened as treatment group. Bortezomib-based chemotherapy was used, and the Chinese medicine compound of "Bushen Huoxue Method" was added. At the same time, 42 patients with simple chemotherapy were observed as control group. After 6 cycles of treatment, the incidence of peripheral neuropathy and the overall efficacy were observed. Results ①After 6 cycles of treatment, 9 cases(22.5%) of grade 1-2 PN occurred in the treatment group, significantly lower than 42.8% in the control group. At the same time, the total incidence of PN was 27.5% in the treatment group and 57.1% in the control group, with statistically significant difference(P=0.007). ②After 6 cycles of treatment, there were 6 CR cases, 20 VGPR cases and 0 PR cases in the treatment group. The total effective rate of the treatment group and the control group were 90% and 69%, respectively, with statistically significant difference(P=0.019). Conclusion The traditional Chinese medicine compound for "Bushen Huoxue Method" can significantly reduce the incidence of PN caused by bortezomib and improve the efficacy of bortezomib in the treatment of MM.

Correlation between clinical classification and TGFBI gene mutation in patients with corneal dystrophy in Hainan

TANG Ping, WANG Ling, CHEN Zhi, LU, Bo-qi

2020, 18(3): 377-379,495. doi: 10.16766/j.cnki.issn.1674-4152.001251

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Abstract:
Objective To analyze the correlation between clinical classification and TGFBI gene mutation in patients with corneal dystrophy in Hainan, and understand the type and hot spot of TGFBI gene mutation. Methods Total 32 patients with different types of corneal dystrophy admitted to the outpatient clinics and ophthalmology departments of Hainan province from August 2012 to February 2019 were collected and given clinically analyzed. The family status of the patients was investigated and the blood TGFBI gene mutations in the family were detected and analyzed. Results Among 32 patients, 6 were epithelial lamellar corneal dystrophy, 22 stromal corneal dystrophy and 4 posterior corneal dystrophy. A total of 88 members of the family were retrospectively surveyed and there were 40 members of TGFBI gene mutation, with the mutation rates 45.5%. There were 24 patients of TGFBI gene mutation in corneal dystrophy patients, with the mutation rates 75.0%. In the 32 patients, the TGFBI gene mutations in epithelial lamellar corneal dystrophy, stromal corneal dystrophy, and posterior corneal dystrophy were 83.3%, 68.2%, and 100.0%, respectively, with no statistically significant(P>0.05). Conclusion The clinical classification of corneal dystrophy in Hainan is mostly stromal corneal dystrophy. The incidence of TGFBI gene mutation is relatively high, and most of them are occurring in the fourth exon. There is no significant correlation between the clinical classification and TGFBI gene mutation.

Clinical analysis of 25 cases of interstitial pneumonia with autoimmune features

TANG Pan, LU, Cheng-na, WU Ting-ting, DENG Zai-chun

2020, 18(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.001252

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Objective To analyze the clinical features, natural course, risk factors and prognosis of interstitial pneumonia with autoimmune features(IPAF). Methods The Clinical manifestations, serological features, morphological features, lung function and inflammatory markers of 25 patients with IPAF in the Affiliated Hospital of Medical School of Ningbo University from September 2015 to March 2018 were retrospectively investigated. Results There were 9 males and 16 females, aging 41 to 84 years(mean 58.8±13.0), and 6 patients had a history of smoking. The most common initial symptoms were cough(21/25), expectoration(16/25), and shortness of breath(18/25). The most prevalent systemic symptoms were inflammatory arthritis and polyarticular morning joint stiffness(6/25), followed by Raynaud`s phenomenon(5/25). More than half of the serological manifestations were ANA ≥ 1:320(13/25). Nonspecific interstitial pneumonia(NSIP, 10/25) was the most common chest high resolution CT(HRCT) pattern, followed by organic pneumonia(OP, 5/25). Pulmonary function was mainly diffuse dysfunction(15/22) and/or restrictive ventilatory dysfunction(16/22). In the initial diagnosis of IPAF, there was a significant increase in inflammatory markers, erythrocyte sedimentation(ESR, 20/25), hypersensitive C-reactive protein(13/25), and leukocyte count(6/25). Conclusion IPAF are more common in non-smoking women, and NSIP is the most common HRCT pattern. The clinical manifestations are complex and diverse, but lack of specificity, sometimes it is difficult to distinguish from pulmonary infection. The correct diagnosis should be based on extrapulmonary manifestations, serological and imaging features.

Effect of TNF-α antagonist on quality of life of patients with ankylosing spondylitis who respond poorly to traditional treatments

CHENG Peng, ZHU Qi, JIANG Ting, HE Hui-zhong, DING Qin, SHEN Yi, HONG Meng-jie, CHENG Qing-qing

2020, 18(3): 384-387,431. doi: 10.16766/j.cnki.issn.1674-4152.001253

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Abstract:
Objective To observe the effect of TNF-α antagonist on quality of life of patients with ankylosing spondylitis(AS) who lacked response to traditional treatments. Methods Sixty patients with AS who met the criteria were randomly selected and observed by non-blind self-controlled trials from May 2015 to October 2016 in the Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine. All patients were treated with Yisaipu for 24 weeks and continued to follow up to 48 weeks. SF-36 scale, hospital anxiety and depression scale(HADS), Pittsburgh sleep quality index scale(PSQI) and disease activity were observed and the efficacy of ASAS20 and ASAS40 criteria were evaluated. Results After treatment for 24 weeks, 50 patients(83.3%) have met ASAS20 efficacy criteria and 36 patients(60.0%) achieved ASAS40 efficacy criteria. Some patients still maintained a stable efficacy after the reduction of Yisaipu during the following 24 weeks. While the disease activity and pain of patients were fully improved, the SF-36 scale(except MH) and PSQI scores were significantly improved(all P<0.01), especially BP and sf36-pcs improved the most obviously. Although the scores of HA and HD of patients before treatment were higher than those of healthy controls, there was no significant improvement at 24 and 48 weeks after treatment(all P>0.05). The disease activity indicators such as ASDAS-CRP and BASDAI indexes were negatively correlated with some dimensions of SF-36, but not with HA, HD, MH. Conclusion Yisaipu is effective and safe in treating AS patients who lack response to traditional therapy. It can significantly improve their quality of life and sleep, but has no effect on HADS and MH.

Effects of oxycodone and parecoxib sodium on restlessness, post-operative pain and serum inflammatory factors in patients undergoing nasal endoscopic surgery during anesthesia recovery period

WANG Wei-juan, LIU Ying, DAI Ren-feng, WANG Chang-xiong, CHEN Wei-kang

2020, 18(3): 388-391. doi: 10.16766/j.cnki.issn.1674-4152.001254

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Objective To study the intervention effect of oxycodone and parecoxib sodium on patients undergoing nasal endoscopic surgery, and to provide data reference for clinical application. Methods Eighty patients who underwent endoscopic sinus surgery in our hospital from April 2016 to April 2018 were selected and randomly divided into parecoxib sodium group and combined group with 40 cases in each group. The parecoxib sodium group was given parecoxib sodium(40 mg) 30 minutes before induction of anesthesia, and the combined group was given oxycodone(10 mg) on the basis of parecoxib sodium group. The indexes of entering the operating room(T0), at the end of operation(T1), at the end of extubation(T2), and when leaving the operating room(T3) were counted. Results In the T3 period, HR(61.75±12.18) times/min, SBP(106.62±10.63) mm Hg, DBP(66.62±8.15) mm Hg, SPO₂(94.89±0.84)%, IL-2(15.16±1.92) pg/L, IL-4(20.12±2.22) pg/L, IL-5(42.86±2.82) pg/L, and IL-17(3.51±1.16) pg/L of the combined group were lower than those of the parecoxib group(79.45±10.15) times/min,(124.86±11.45),(76.62±8.96) mmHg,(98.78±1.26)%,(21.45±2.10),(29.26±2.45),(48.98±3.89),(5.95±1.31) pg/L(all P<0.001). The score of agitation, VAS score and extubation time in the combined group were lower than those in the parecoxib group(all P<0.05). Conclusion Oxycodone combined with parecoxib sodium can reduce restlessness during anesthesia recovery, improve pain and serum inflammatory factors levels.

Prognostic value of pneumonia severity score and CURB-65 score for elderly community acquired pneumonia in different age groups

SUN Zhen, XIA Li, YU Hong-mei

2020, 18(3): 392-395,407. doi: 10.16766/j.cnki.issn.1674-4152.001255

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Objective To compare the ability of pneumonia severity score(PSI) and CURB-65 scores in assessing the severity and prognosis of elderly community acquired pneumonia(CAP) in the elderly aged 65-79 years and ≥ 80 years. Methods A retrospective study of 98 consecutive inpatients with elderly CAP was performed in the First Affiliated Hospital of Chongqing Medical University from September to October 2018. According to the age of patients, they were divided into low age group(65-79 years old, 54 cases) and high age group(≥ 80 years old, 44 cases). We analyzed the general clinical data, calculated the scores of each case and compared the differences in 28-day mortality among patients with different risk stratification of two rules. We drew the receiver-operating characteristic(ROC) curves of the two scoring systems and compared their area under the curve(AUCs) to evaluate the predictive value of severity. Results The 28-day mortality rate was 13.0% in the lower age group and 15.9% in the high age group. The AUCs of the CURB-65 and PSI scores in the low age group was 0.843(95% CI:0.700-0.987) and 0.775(95% CI:0.618-0.932), respectively. Meanwhile the AUCs of the CURB-65 and PSI scores in the high age group was 0.653(95% CI:0.418-0.887), 0.651(95% CI:0.451-0.850), respectively. Conclusion The predictive efficacy of the two scoring systems for mortality in elderly CAP patients decreases with age. In low age patients, the high specificity of CURB-65 score is helpful for selecting high-risk patients for intensive treatment and monitoring and the scoring system is relatively simple, it is more suitable for clinical. Both scoring systems have shown poor prognostic value in older patients.

Curative effect of conservative treatment of vocal nodules

HUANG Fang-ming, LI Zhong-wen, LI Dong-hai

2020, 18(3): 396-399. doi: 10.16766/j.cnki.issn.1674-4152.001256

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Objective To explore the etiology, development and treatment of vocal nodules, and provide a basis for the treatment of vocal nodules. Methods Total 63 patients with vocal nodules in the Department of Otolaryngology, the Third People's Hospital of Bengbu from January 2014 to January 2018 were selected as treatment group. The control group consisted of 60 patients with vocal nodules excised under fibro laryngoscopic under local anesthesia. All patients did not have acute laryngitis, epiglottic cyst and Renke's edema of vocal cord. There was no clinical difference between the two groups in age, sex and accompanying diseases. Results The treatment group received conservative treatment with less speech, avoiding loud voice, inhalation and Chinese patent medicine. After 12 months, the vocal nodules disappeared and the first third mucosa became slightly thicker. The control group underwent fibro laryngoscopic excision of vocal nodules. No new biological recurrence was found after 12 months' follow-up. A little white scar was found in the first third of the vocal cords. There was no significant difference in the effective rate and recurrence rate between the two groups(all P>0.05). The clinical concomitant symptoms of the two groups were statistically different(P<0.05). Conclusion There is no statistical significance in the changes of voice, the disappearance of tumor and the changes of clinical symptoms after vocal nodule conservative treatment and fibro laryngoscope excision. Therefore, the indications and contraindications of vocal nodule operation must be strictly controlled to avoid the flooding of operation.

Clinical efficacy and safety of otoendoscopic minimally invasive surgery in the treatment of tympanic membrane rupture caused by different causes

LI Xia, XU Long, WANG Dan

2020, 18(3): 400-402. doi: 10.16766/j.cnki.issn.1674-4152.001257

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Objective To observe the clinical effect of tympanoplasty assisted by otoendoscopy in the treatment of tympanum rupture. Methods A total of 72 patients with tympanic membrane rupture were divided into observation group(tympanic membrane repair under otoendoscopy) and control group(tympanic membrane repair under microscope) with 36 cases in each group. The pain and hearing improvement after operation were assessed. The differences of intraoperative bleeding, operation time and hospitalization time between the two groups were compared. The success rate of operation was counted and the complications were observed. Results After surgical, the degree of pain(1.82±0.44 and 3.25±0.52), point and pneumatic hearing(17.35±2.25 and 28.35±3.68) dB in two groups were significantly lower than those before operation[observation group:(5.25±1.26) and(41.05±5.21) dB, control group:(5.31±1.28) point and(41.22±5.28) point, t=19.803-27.125, all P<0.001], and the degree of pain and pneumatic hearing in the observation group were significantly lower than those in the control group(t=12.596, 15.164, all P<0.001). The one-time success rate of operation in observation group(97.22%) was significantly higher than that in control group(77.78%, χ²=4.571, P=0.033). The overall incidence of complications in the observation group(0.00%) was significantly lower than that in the control group(16.67%, χ²=4.545, P=0.033). Conclusion Minimally invasive tympanoplasty under otoendoscope can effectively improve the hearing of tympanic membrane rupture caused by various reasons. It has little iatrogenic trauma and can reduce the degree of pain response. It has a definite effect and is worthy of clinical application.

The predictive value of 25-(OH)D in early rheumatoid arthritis and its correlation analysis with disease activity and immune function indicators

HUA Li, SHI Xiao-yu, FAN Jia, HONG Xue-lian, WANG Liu-qing, DU Hong-wei

2020, 18(3): 403-407. doi: 10.16766/j.cnki.issn.1674-4152.001258

251 1

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Objective To investigate the predictive value of 25-hydroxyvitamin D[25-(OH)D] in early rheumatoid arthritis(RA) and its correlation with disease activity and immune function indicators. Methods A total of 100 patients with early RA who came to Jinhua Municipal Central Hospital from March 2016 to May 2018 were selected as research objects, and 100 healthy patients were selected as control group. The predictive value of 25-(OH)D for early RA was evaluated using the area(AUC) under the receiver operator characteristics curve(ROC). Patients with RA were divided into the following groups according to the level of 25-(OH)D:50 cases in the deficient group, 30 cases in the unsufficient group, and 20 cases in the normal group. Clinical indicators[joint tenderness number, joint swelling number, C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), visual analogue score(VAS)] were compared between each groups. Spearman correlation analysis was used to analyze the correlation between 25-(OH)D and disease activity and immune function indicators. Results The AUC value predicted by 25-(OH)D for early RA was 0.904. There were statistically significant differences in the number of joint tenderness number, joint swelling number, ESR and VAS in the three groups(all P<0.05). The number of joint tenderness number, ESR and VAS in normal group were significantly lower than those in deficient group and unsufficient group(all P<0.05). The number of joint swelling and CRP in normal group were obviously lower than those in the deficient group(P<0.05). The VAS in the unsufficient group was significantly lower than that in the deficient group(P<0.05). The level of 25-(OH)D in early RA patients was negatively correlated with disease activity score-28(DAS28 score). The 25-(OH)D in early RA patients was positively correlated with regulatory T cells(P<0.05), but not correlated with immune function indicators(P>0.05). Conclusion 25-(OH)D has a high predictive value for early RA, which may play an important role in assessing the pathogenesis of RA.

Clinical significance of transesophageal echocardiography in the evaluation of left auricular volume and function in patients with atrial fibrillation

CHEN Jing-wan, YANG Dao-ling

2020, 18(3): 408-411. doi: 10.16766/j.cnki.issn.1674-4152.001259

205 1

Abstract:
Objective To investigate the evaluation and clinical significance of esophageal echocardiography on left auricular volume and function changes in patients with atrial fibrillation. Methods A total of 60 patients with atrial fibrillation admitted to Jinhua Central Hospital from May 2018 to May 2019 who underwent transesophageal echocardiography were selected as study group. Sixty patients with other heart diseases without atrial fibrillation who underwent transesophageal echocardiography in our hospital during the same period were selected as control group. Transesophageal echocardiography was performed in the same manner in two groups. Results The level of LAD in the study group(41.8±5.6) mm was significantly higher than that in the control group(30.2±4.1) mm(t=12.950, P=0.001). The weight distribution of SEC in the control group was significantly better than that in the study group(all P<0.05). In the control group, MA level was(2.8±1.3) cm, MD level was(3.0±0.4) cm, ESV level was(1.6±0.7) mL, EDV level was(3.3±1.1) mL, EF level was(59.1±15.2)% and PEV level was(67.5±15.9) cm/s. In the study group, MA level was(5.1±2.0) cm, MD level was(3.8±0.6) cm, ESV level was(4.1±2.6) mL, EDV level was(6.3±2.2) mL, EF level was(40.2±13.0)%, PEV level was(44.8±12.7) cm/s. The levels of MA, MD, ESV and EDV in the study group were significantly higher than those in the control group(all P<0.05). The EF and PEV levels in the study group were significantly lower than those in the control group(all P<0.05). Conclusion Transesophageal echocardiography can be used to observe the changes of left auricular function and volume in patients with atrial fibrillation, and more clearly display the physiological structure of the patient's left auricular.

The diagnostic significance of miRNA-27a and miRNA-146a in patients with osteoarthritis

SHI Li-hua, LI Heng, GUO Pan, ZHANG Zhan-feng

2020, 18(3): 412-414,418. doi: 10.16766/j.cnki.issn.1674-4152.001260

179 1

Abstract:
Objective To explore the relationship between the expression of miRNA-27 a and miRNA-146 a in serum and the pathogenesis of osteoarthritis(OA). Methods A total of 75 patients with OA in our hospital were selected from May 2017 to December 2018, meanwhile 63 non-OA patients and 44 healthy people who were treated at the same time were selected as the study objects according to gender and age as matching factors. The expression of miRNA-27 a and miRNA-146 a in synovial tissue and plasma were detected by RT-qPCR. The factors influencing the expression of miRNA and the diagnostic value of OA patients were observed. Results The expression of miRNA-27 a and miRNA-146 a in synovial tissue and plasma of OA patients was significantly higher than that of other patients(P<0.05), with a better correlation(r=0.425; r=0.622, all P<0.05). The relative expression of miRNAs in synovial tissue and plasma was significantly increased in OA patients with aged> 65 years, female, advanced and obese(P<0.05). The diagnostic accuracy, sensitivity, specificity and Kappa values of plasma miRNA-27 a were 80.8%, 90.7%, 73.8% and 0.619, respectively. The diagnostic results of plasma miRNA-146 a were 76.9%, 86.7%, 70.1% and 0.544, respectively. The tandem diagnostic results were 90.6%, 86.3%, 93.5%, and 0.803, respectively. Conclusion miRNA-27 a and miRNA-146 a are highly expressed in OA patients, which has better diagnostic value. The expression trend in plasma and synovium is the same. Women, old age, advanced OA and obesity may be responsible for the elevation of both miRNAs.

Effect of interventional intraoperative cerebral oxygen saturation monitoring on postoperative delirium in elderly patients with spinal tuberculosis

CHEN Yuan-hui, WAN Hai-fang, ZHANG Yi-xiao

2020, 18(3): 415-418. doi: 10.16766/j.cnki.issn.1674-4152.001261

186 0

Abstract:
Objective Intraoperative cerebral regional oxygen saturation monitoring(rSO₂) was monitored in elderly patients with spinal tuberculosis surgery in order to investigate the relationship between intraoperative rSO₂ and postoperative delirium(POD). Methods Sixty patients with thoracolumbar spine tuberculosis surgery from January to December 2017 in Hangzhou Red Cross Hospital were selected, and divided into POD group(13 patients) and non-POD group(47 patients) according to whether or not POD occurred. Sixty patients with elderly thoracolumbar spine tuberculosis from July to December 2018 were selected, and divided into intervention group and non-intervention group accorded to the random number method with 30 cases in each group. The delirium evaluation scale was used for evaluation of POD. In the intervention group, the cerebral perfusion was adjusted according to the intraoperative rSO₂ value to make the left brain rSO₂ not lower than 20% of the preoperative value. The preoperative and intraoperative left and right brain rSO₂ values were monitored. Results There were no significant differences in the values of left and right brain rSO₂ between the two groups before surgery(P>0.05). During the operation, the proportion of left brain rSO₂ decreased by 20% in the POD group(38.46%) was higher than that in the non-POD group(χ²=5.863, P<0.05). There was no significant difference in the proportion of rSO₂ in the right brain between the two groups(P>0.05). There were no significant differences in the values of left and right brain rSO₂ scores between the two groups before surgery(all P>0.05). During operation, the lowest rSO₂ in the left brain of the intervention group[(68.08±6.68)%] was higher than that in the non-intervention group(t=17.597, P<0.05). There were no significant difference in the lowest rSO₂ between the two groups(P>0.05). The incidence of POD(3.33%) was lower than that of the non-intervention group(χ²=6.405, P<0.05). Conclusion Intraoperative rSO₂ is associated with postoperative POD in elderly patients with spinal tuberculosis. Intervention of rSO₂ can effectively reduce postoperative POD.

The expression and significances of PD-1 and PD-L1 in peripheral blood T cells of patients with acute exacerbation of chronic obstructive pulmonary disease

ZHANG Zhi-yuan, JIN Hai-zhen, YU Xin-yi

2020, 18(3): 419-422,426. doi: 10.16766/j.cnki.issn.1674-4152.001262

221 1

Abstract:
Objective To investigate the expression of PD-1 and PD-L1 in peripheral blood T cells of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and its relationships with clinical indicators and prognosis. Methods A total of 79 patients with AECOPD and 30 healthy examiners in our hospital from May 2017 to May 2018 were enrolled as the subjects. The expression levels of PD-1 and PD-L1 in peripheral blood CD4⁺ T cells and CD8⁺ T cells were detected by flow cytometry, and the relationships with clinical indicators were analyzed. The prognostic factors were analyzed by Cox regression model. Results Compared with healthy subjects, CD4⁺ T in peripheral blood of patients with AECOPD increased significantly, CD8⁺ T decreased significantly(all P<0.05). The expression levels of PD-1 and PD-L1 in AECOPD patients were higher than that of healthy people(P<0.05). The expression levels of PD-1 and PD-L1 were correlated with smoking, expectoration volume, bronchial infection, shortness of breath, PaO₂, PaCO₂, and antioxidant use(all P<0.05). Smoking, expectoration volume, degree of bronchial infection, shortness of breath, PaO₂, PaCO₂, antioxidant use or not, and the expressions of PD-1 and PD-L1 were independent prognostic factors in AECOPD patients(all P<0.05). Conclusion The levels of PD-1 and PD-L1 in peripheral blood CD4⁺ T cells and CD8⁺ T cells are increased in AECOPD patients, and they are closely related to clinical indicators and prognosis. It is speculated that PD-1 and PD-L1 may be involved in the occurrence and development of AECOPD patients.

Clinical analysis of 13 cases macrophage activation syndrome complicating adult-onset Still's disease

WU Jia-biao, SHI Ye-qing, ZHAO Dong-bao

2020, 18(3): 423-426. doi: 10.16766/j.cnki.issn.1674-4152.001263

222 2

Abstract:
Objective To analyze the clinical characteristics and laboratory data of Adult-onset Still's Disease(AOSD) complicated with macrophage activation syndrome(MAS). Methods A retrospective analysis of 13 cases of AOSD, complicated by MAS diagnosed in Changhai Hospital of Shanghai from July 2011 to August 2015. Results Among 13 patients, 3 cases were male, 10 cases were female, age(44.1±16.9) years. The main clinical features were fever, high ferritin(more than 2 000 μg/L) with 92% incidence rate(n=12).Rash occurred rate was 85%(n=11) and liver function damage incidence(n=10) 77%, joint pain 54%(n=7), multiple lymph node enlargement of 54%(n=7), incidence of sore throat was 46%(n=6), hepatosplenomegaly incidence rate of 31%(n=4), blood system involvement, anemia incidence rate was 85%(n=11). Blood cells decreased 62%(n=8), when MAS occurs, bone marrow cytology clearly is seen in 3 cases, the treatment of glucocorticoid and CsA delays the disease process. All of the 13 patients were treated with glucocorticoid, 11 cases were treated with cyclosporine, 6 cases were treated with immunoglobulin, 62%(8/13) patients after treatment was alleviated, 5 cases died. The causes of death include mixed infection of the lungs appeared acute cardiopulmonary circulation failure(1 case), interstitial pneumonia associated with infection leaded to respiratory failure(1 case), acute pulmonary edema, heart failure and pulmonary infection after hospital discharge(1 case), multiple organ dysfunction syndrome(1 case), pneumonia associated with infection leaded to respiratory failure(1 case). Conclusion It indicates that MAS complicated when AOSD has high fever, ESR and fibrinogen decreased. Guarding against that infection is the cause of AOSD to induce MAS. Glucocorticoid combined with IVIG and CsA can control the disease development.

Changes of aromatic hydrocarbon receptor and cyclooxygenase-2 levels in bronchial lavage fluid of patients with chronic obstructive pulmonary disease and its clinical significance

HOU Si-cong, GAO Chun-rong, LI Yan, PU Ai-hua

2020, 18(3): 427-431. doi: 10.16766/j.cnki.issn.1674-4152.001264

173 0

Abstract:
Objective To investigate the changes of aromatic hydrocarbon receptor and cyclooxygenase-2 levels in bronchial lavage fluid of patients with chronic obstructive pulmonary disease and its clinical significance. Methods Ninety-four COPD patients diagnosed in respiratory department of our hospital were selected as case group and 88 healthy persons as control group. The levels of aromatic hydrocarbon receptor(AHR), cyclooxygenase-2(COX-2), CD44, Th17, IL-4, IL-8, IL-10, TNF-α and hs-CRP in bronchial lavage fluid were measured. Pearson correlation analysis and logistic regression analysis were used to explore the diagnostic and prognostic significance of AHR and COX-2 in COPD patients. Results The levels of AHR and IFN-γ in bronchial lavage fluid of the case group were lower than those of the control group, and the levels of COX-2, CD44, IL-4, IL-8, IL-10, TNF-α, hs-CRP and TH17 were higher than those of the control group(all P<0.05). The negative correlation between AHR and CD44, IL-4, IL-8, IL-10, TNF-α, hs-CRP, TH17 were significant, and the positive correlation between COX-2 and CD44, IL-4, IL-8, IL-10 were significant(all P<0.05). The TNF-α, hs-CRP and TH17 were positively correlated with IFN-γ(all P<0.05). High levels of COX-2, TH17 and low level of AHR were risk factors for death in patients with COPD(P<0.05). The AUC of COX-2 and AHR were similar, both were less than that of AHR + COX-2. The sensitivity and specificity of COX-2 and AHR in diagnosis of COPD were similar(P>0.05). They were all less than that of AHR + COX-2(P<0.05). Conclusion The level of AHR in bronchial lavage fluid of COPD patients decreased, and the level of COX-2 increased. The imbalance of a series of inflammatory factors may be the pathogenesis of COPD. AHR + COX-2 has high sensitivity and specificity in the diagnosis of COPD, and is worthy of clinical application.

The research of risk factors in chronic hepatitis B patients with osteoporosis

ZHANG Dong-chu, DENG Dun, TONG Yu, XU Kai

2020, 18(3): 432-434,445. doi: 10.16766/j.cnki.issn.1674-4152.001265

183 3

Abstract:
Objective To investigate the changes of bone mineral density, bone metabolism and risk factors in chronic hepatitis B patients with osteoporosis. Methods From June 2017 to Jan 2019, two hundred chronic hepatitis B patients in Wenzhou people's hospital who had been tested by bone mineral density and bone metabolism indicators were divided into two groups according with or without osteoporosis. The patients who diagnosed osteoporosis were belong to the research group, while the patients without osteoporosis were belong to the control group. Each group has one hundred cases. The age, sex, body mass index, lifestyle(history of tobacco and alcohol, diet and activity), liver function, history of liver disease, long term of using anti-hepatitis drugs and corticosteroids, history of fragility fractures, liver disease and osteoporosis history were observed in the two groups. The relationship between osteoporosis index and the above indicators were analyzed. Results The ratio of female(76% vs. 54%), ≥ 60 years old(78% vs. 31%), low body mass index, child-Pugh C grade(62% vs. 26%), long term of using anti-hepatitis virus drugs(70% vs. 55%), appetite tobacco and alcohol(82% vs. 57%), history of chronic hepatitis B(80% vs. 30%) in the research group were higher than those in the control group. The differences were statistically significant(all P<0.05). The above factors were positively correlated with the incidence of osteoporosis, which were risk factors. Regular using calcium tablets, activity were negatively correlated with the incidence of osteoporosis, which were protective factors. Conclusion The risk factors of chronic hepatitis B with osteoporosis are female, older age, lower BMI, child-Pugh C grade, long term of using anti-hepatitis drugs and corticosteroids and unhealthy life style. Avoiding these risk factors can reduce the incidence rate.

Value study of combined detection of cTnT, CRP and NT-proBNP in early diagnosis of chronic heart failure

LONG Jing-wei, LI Ping

2020, 18(3): 435-437. doi: 10.16766/j.cnki.issn.1674-4152.001266

271 4

Abstract:
Objective To explore the clinical value of combined detection of troponin T(cTnT), C-reactive protein(CRP) and amino-terminal brain natriuretic peptide(NT-proBNP) in early diagnosis of chronic heart failure(CHF), and provide reference for early diagnosis of CHF. Methods Ninety patients with CHF in Haikou Third People's Hospital from May 2015 to May 2017 were selected as observation group. Sixty healthy people were selected as control group during the same period. The levels of cTnT, CRP and NT-proBNP of the two groups were measured, and the differences of three indicators in different NYHA grades with CHF patients were compared. Results The higher the NYHA grade, the higher the content of the three indicators. There were significant difference among different grades(all P<0.05). The CRP and NT-proBNP indicators of NYHA-I patients were significantly higher than those of healthy group(P<0.05), and there was no significant difference in cTnT indicators between the two groups(P>0.05). Spearman rank correlation analysis indicated that the cardiac grading showed a significant positive correlation with NT-proBNP, CRP and CTnT(r=0.875, 0.412, 0.312, all P<0.05). Conclusion NT-proBNP is an important indicators for evaluating cardiac function. Combined detection of cTnT, CRP and NT-proBNP can accurately diagnose CHF patients, and can grade different degrees of disease, providing reliable basis for clinical treatment.

Expression of miR-155 in villus tissues and its relationship with TIM3 level in patients with recurrent abortion

WEN Hai-yan, WANG Jing, QIAN Min, LI Xiao-hong

2020, 18(3): 438-441. doi: 10.16766/j.cnki.issn.1674-4152.001267

218 2

Abstract:
Objective To investigate the expression of miR-155 in villus tissues of recurrent abortion patients and its relationship with TIM3 level. Methods From August 2016 to March 2018, 63 cases of recurrent abortion patients underwent complete curettage of uterine cavity in Gynecology and Obstetrics Clinic of Hangzhou gynecology and obstetrics hospital were selected as the study group, at the same time, 57 cases of normal early pregnancy women who terminate the pregnancy by complete curettage of uterine cavity were selected as control group. The villus tissues of the two groups were collected to detect the expression levels of miR-155, TIM3, INF-γ, IL-4 and IL-13, and the relationship between miR-155 and TIM3, INF-γ, IL-4 and IL-13 of the study group were analyzed. Results The expression levels of miR-155, IL-4 and IL-13 mRNA in the study group were lower than those in the control group(all P<0.05), and the expression levels of TIM3, INF-γ and IL-2 mRNA were higher than those in the control group(all P<0.05). The expression level of TIM3 protein was higher than that of the control group(P<0.05). The miR155 of the study group was negatively correlated with TIM3, INF-γ and IL-2(r=-0.687,-0.636,-0.602, P<0.05), and positively correlated with IL-4 and IL-13(r=0.574, 0.498, P<0.05). TIM3 was positively correlated with INF-γ and IL-2, respectively(r=0.713, 0.644, P<0.05), and negatively correlated with IL-4 and IL-13(r=-0.615,-0.597, P<0.05). Conclusion The expression of miR-155 in villus tissues of patients with recurrent spontaneous abortion is decreased significantly, it is significantly negatively correlated with TIM3, they may interact with each other in the process of recurrent spontaneous abortion.

Study on prevention of recurrence after transcervical resection of polyp by Huayu Sanjie therapy

ZHANG Yi-qun, ZHAO Shan-qiong

2020, 18(3): 442-445. doi: 10.16766/j.cnki.issn.1674-4152.001268

203 2

Abstract:
Objective To investigate the effect of Huayu Sanjie therapy on the expression of progesterone receptor(PR), proliferating cell nuclear associated antigen Ki-67(Ki-67), B-cell lymphoma/leukemia-2 gene(Bcl-2) in endometrium of patients after transcervical resection of polyp(TCRP). Methods A total of 216 patients admitted by Ningbo Hospital of Traditional Chinese medicine from May 2016 to May 2018 were divided into A, B and C groups according to the random number method, with 72 case each group. Group A was given Huayu Sanjie prescription oral plus external application, group B was given marvelon, group C was not given any drugs. The changes of TCM syndrome score, serum estradiol(E2), progesterone(P), estrogen receptor(ER), progesterone receptor(PR), ki-67 and Bcl-2 before and after treatment were compared in the three groups. Results After treatment, the scores of TCM syndromes in the three groups were reduced, and group A was lower than group B and C. In group A and B, the expression of PR were increased(all P<0.05), the expression of Ki-67 and Bcl-2 were decreased(all P<0.05). The improvement of group A was better than that of group B and C(all P<0.05). Conclusion Huayu Sanjie therapy can reduce the clinical symptoms of patients with endometrial polyps after hysteroscopic resection and effectively prevent recurrence of endometrial polyps. Its mechanism may be related to that this method can improve the expression of endometrial PR and inhibit the over-expression of endometrial Ki-67 and Bcl-2 in endometrium.

Study on the relationship between IRAKM gene polymorphism and preterm birth

YING Yan-fen, YANG Yang-hong, XIAO Ming-shu, WANG Li-zhen

2020, 18(3): 446-448. doi: 10.16766/j.cnki.issn.1674-4152.001269

168 1

Abstract:
Objective To study interleukin-1 receptor-related kinase M(IRAKM) gene polymorphism in neonates and its relevance to premature delivery. Methods From January 2017 to December 2018, 1 300 pregnant women in our hospital were selected. A total of 300 premature infants were randomly selected as the preterm group and 50 as the control group. The general data of the two groups were collected, the expression of serum IRAKM mRNA in the two groups was detected, the IRAKM genotype was detected, and the correlation between the IRAKM gene polymorphism and preterm birth was analyzed. Results There was no significant difference between the two groups(all P>0.05). The expression of IRAKM mRNA in premature group was lower than that in control group, the difference was statistically significant(all P<0.05). There was significant difference in the frequency of IRAKM+22148 genotype and allele in preterm birth(all P<0.05). The results of logistic regression analysis showed that g was the risk factor of premature delivery. Conclusion The polymorphism of IRAKM+22148 locus in neonates is associated with premature delivery, and carrying allele G may be a susceptible gene for premature delivery.

Comprehensive application and evaluation of multiple chronic disease management models in elderly patients with hypertension in community

ZHOU Xiao-li, LIU Man-ling, JIAO Yan-hui

2020, 18(3): 449-453. doi: 10.16766/j.cnki.issn.1674-4152.001270

195 6

Abstract:
Objective To analyze the effect of comprehensive application of multiple chronic disease management models in elderly hypertension patients in community, and provide basis for improving the effect of community prevention and control of chronic diseases. Methods According to the simple random sampling method, 120 elderly patients with hypertension were selected from the newly established chronic disease management files in the community health service center. The patients were randomly divided into intervention group(n=60) and control group(n=60). The control group was managed according to the Health Management Service Standard of Hypertension patients, on the basis of which the intervention group was integrated into self-management, group management, family intervention and peer education. Six months later, the self-management behavior scale of hypertension patients, hypertension self-efficacy scale, self-rating anxiety scale and hypertension related knowledge questionnaire were used to evaluate two groups of patients. Results The awareness rate of hypertension-related knowledge in the intervention group was higher than that in the control group. The total score of self-management behavior evaluation(124.50±17.32), self-efficacy score(63.33±7.02) in the intervention group were higher than those in the control group(113.77±20.65, 58.12±8.68). The average blood pressure in the intervention group[(132.63±7.14)/(74.40±7.46)] was lower than that in the control group[(140.48±10.69)/(78.53±7.58)], and the anxiety score in the intervention group(54.15±8.40) was lower than that in the control group(59.41±9.10), the above difference was statistically significant(all P<0.05). The self-efficacy of the intervention group was negatively correlated with anxiety level(r=-0.288, P=0.025) and positively correlated with self-management behavioral capacity(r=0.382, P=0.003). The most influential factor for self-efficacy was the level of self-management(P<0.01), followed by anxiety(P<0.05). Conclusion The comprehensive application of multiple chronic disease management models in the daily management of elderly patients with hypertension will help them master the knowledge of disease, promote their emotional improvement, improve their self-management ability, and promote the long-term improvement of healthy behavior through the promotion of self-efficacy.

The effects of health management on the body composition of patients with nonalcoholic fatty liver disease

FENG Yu-ting, YU Xiao, RU Qing-jing

2020, 18(3): 454-456,500. doi: 10.16766/j.cnki.issn.1674-4152.001271

210 3

Abstract:
Objective Health management is the preferred therapy for nonalcoholic fatty liver disease(NAFLD). There are limitations in judging the effect of health management only by changes in body weight. Therefore, this study used bioelectrical impedance analysis to observe the changes of body composition in patients with NAFLD by health management in more detail, and to provide basis for the treatment of NAFLD. Methods A total of 50 patients with NAFLD were visited the fatty liver disease clinic. There were 38 male and 12 female, with the mean age of(39.70±13.59) years. They all received 6 months' health management(diet and exercise intervention). Before and after the health management, using the body composition analyzer to measure body composition. Body weight, body mass index(BMI), body muscle, inorganic salt, body fat, body fat percentage, visceral fat index, visceral fat area and waist-hip ratio were measured. The percentage of body muscle, inorganic salt and weight loss were calculated. Data before and after intervention were analyzed by paired t-test. Results After 6 month's health management, NAFLD patients' body weight, BMI, body fat, body fat percentage, visceral fat index, visceral fat area were decreased,body muscle percentage were increased(all P<0.05). The male patients' body weight, BMI, body fat, visceral fat index, visceral fat area were decreased(all P<0.05). The female patients' body weight, BMI, body fat, body fat percentage, visceral fat index, visceral fat area were decreased, body muscle percentage were increased(all P<0.05). Conclusion Health management changes the body composition of patients with NAFLD. There are some differences between men and women.

Clinical application effect comparison of ultrasound-guided biopsy and intraoperative frozen tissue biopsy in pathological diagnosis of breast masses

WANG Xiao-jie, ZHANG Li-yuan, CHEN Xiang-yi, JI Li-li

2020, 18(3): 457-459. doi: 10.16766/j.cnki.issn.1674-4152.001272

198 0

Abstract:
Objective To observe the accuracy of ultrasound-guided biopsy and intraoperative frozen tissue biopsy in the diagnosis of breast masses. Methods A total of 138 patients with breast masses admitted in our hospital from June 2018 to June 2019 were enrolled in the study. Ultrasound-guided needle biopsy and intraoperative rapid frozen biopsy were performed on all subjects. The paraffin pathological examination results were used as the gold standard to compare the difference between ultrasound-guided biopsy and intraoperative frozen tissue biopsy in the diagnosis of breast masses. Results Sixty-two cases(44.93%) were diagnosed as malignant tumor, 53 cases(38.41%) as benign tumor and 23 cases(16.67%) as non-tumor. There was no significant difference between the diagnostic specificity of intraoperative frozen tissue biopsy(96.05%) and ultrasound-guided biopsy(90.79%, χ²=1.713, P=0.191), while the diagnostic sensitivity(93.55%) and accuracy(94.93%) of frozen tissue biopsy were significantly higher than those of ultrasound-guided biopsy(80.64% and 86.23%, χ²=4.593, 6.114; P=0.032, 0.013). Conclusion Compared with ultrasound-guided biopsy, intraoperative frozen tissue biopsy has more advantages in reducing the missed detection rate of breast malignant tumors and improving the diagnostic accuracy of breast mass characteristics, which is worthy of clinical application.

Application of human cytomegalovirus DNA detection in diagnosis of human cytomegalovirus infection in children

ZHU Yan, ZHOU Ling-ling, LAN Jun-wei, LIU Si-yu, HUANG Jian-sheng, ZHAO Zhi-gang

2020, 18(3): 460-462,466. doi: 10.16766/j.cnki.issn.1674-4152.001273

294 1

Abstract:
Objective To investigate the diagnostic value of human cytomegalovirus(HCMV) DNA detection results in children's blood, urine and mother's breast milk in HCMV infection. Methods A total of 328 children with suspected HCMV infection who were admitted to the hospital from 2017 to 2018 were enrolled. Blood, urine and corresponding breast milk samples were collected for real-time fluorescent quantitative PCR to detect the HCMV-DNA load. Serum HCMV-IgM was detected by chemiluminescence method. The positive rates of different methods in different samples were compared. For positive children, the distribution of different clinical symptoms was analyzed. Results The total positive rate of 328 children was 71.04%, and the positive rates of male and female children were 71.02% and 69.74%, respectively, with no statistically significant(χ²=0.065, P=0.799). The positive rates in blood, urine and milk were 49.09%, 70.43% and 58.23%, respectively, and the positive rate of urine was the highest, with statistically significant(χ²=31.147, P<0.001). The positive rate of milk(72.41%) in the neonatal group was the highest. The positive rate of urine was highest in children between 28 days and 1 year old and 1 year old. The positive rate was statistically different among all age groups(all P<0.05). The positive rates of blood HCMV-DNA and serum HCMV-IgM were 49.09%(161/328) and 16.16%(53/328), respectively. The positive detection rate of the combined detection of the two methods was 49.69%. There was no statistically difference significant between combined detection and single blood DNA detection method(P>0.05). The main clinical symptoms were jaundice and diarrhea in children under one year old, and liver damage and pneumonia in children over one year old. Conclusion The detection of urine HCMV-DNA has a better clinical value in the diagnosis of HCMV. At the same time, urine is convenient to take, and urine HCMV-DNA detection should be promoted in children with small age.

Analysis of the value of serum γ-GT, CHE, Apelin and visfatin in the diagnosis and treatment of patients with nonalcoholic fatty liver disease

HONG Wen-zhong, LI Yi-ping

2020, 18(3): 463-466. doi: 10.16766/j.cnki.issn.1674-4152.001274

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Objective To explore the clinical diagnostic value of serum gamma-glutamine transferase(γ-GT), cholinesterase(CHE), Apelin and visfatin for nonalcoholic fatty liver disease(NAFLD), and the effect of the changes of Apelin and visfatin on the levels of γ-GT and ChE in serum. Methods Fifty patients with NAFLD diagnosed in the Department of Gastroenterology in our hospital from June to September 2019 were selected as NAFLD group. A total of 50 healthy subjects who underwent physical examination in our hospital at the same time were selected as control group. Patients received venous blood and blood biochemical tests, and the differences in blood biochemical tests(γ-GT, CHE, Apelin, and Visfatin) were compared between the two groups. The Apelin(γ-GT, CHE) and Visfatin(γ-GT, CHE) four sets of random variables were used to perform pairwise-pairwise Person linear test. Results ① The levels of serum γ-GT, CHE and Apelin in the NAFLD group were higher than those in the control group. The serum visfatin level in the NAFLD group was lower than that in the control group(t=35.294, 29.373, 50.727, 37.009, all P<0.001). ② The level of Apelin in NAFLD group was significantly positively correlated with the changes of γ-GT(r=0.676) and CHE(r=0.699, all P<0.05). The visfatin level was negatively correlated with the γ-GT(r=-0.731), the CHE(r=-0.698, all P<0.05). Conclusion The levels of γ-GT, CHE, Apelin and visfatin in patients with NAFLD have reference value for the clinical diagnosis of NAFLD. Apelin is a possible inducer of NAFLD, while visfatin is a protective factor of NAFLD, and also has clinical value for the prevention and treatment of NAFLD.

Research progress of IL-33 in gynecological tumors

ZHAO Wei, XU Peng, TIAN Ya-nan, KUANG Ye

2020, 18(3): 467-470,491. doi: 10.16766/j.cnki.issn.1674-4152.001275

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Interleukin-33(IL-33) was originally described as a high-endothelial intravenous nucleoprotein that was steadily expressed in the nuclei of various cell types in human and mouse tissues, including endothelial cells, epithelial cells and fibroblast-like cells. IL-33 forms IL-33/ST2 signaling pathway by binding to suppression of tumorigenicity2(ST2) and IL-1 receptor accessory protein(IL-1 RAcP), and plays a variety of important roles in immune-mediated diseases such as infection, allergy and autoimmune diseases.In recent years, some studies have shown the potential role of IL-33 in regulating anti-tumor immunity and tumor growth, but its exact function and its potential mechanism in tumor development are still unclear. Ovarian, cervical and endometrial cancers are common gynecologic malignancies. Despite recent advances in surgical resection and systemic chemotherapy of gynecologic tumors, the prognosis of malignant tumors is still poor. In order to further individualize treatment, other prognostic markers and potential therapeutic targets for clinical course prediction are needed. The research on the molecular mechanism of invasive growth and metastasis of malignant tumors may provide new ideas for the treatment of gynecological malignant tumors. This article mainly reviews the biological functions of il-33 and its research progress in gynecological tumors.

Research Progress on informal care of the elderly living with multiple disease in a community home

DAI Fu-min, LIU Si-yu, ZHANG Xi

2020, 18(3): 471-475. doi: 10.16766/j.cnki.issn.1674-4152.001276

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In the developed countries of Europe and the United States, which have entered in aged stage earlier, there are mature and perfect systems and management models of formal and informal care mechanism after decades of operation in the classified treatment, classified diagnosis and treatment and social integration services for the elderly living in the community with multiple diseases. However, China's aging is relatively late, but progresses rapidly, accompanied by the ageing, empty nest and the weakening of traditional family care functions. The multiple diseases, the increasing proportion of disabilities and dementia, and the start of social services, a shortage of human resources in medical and nursing professional services and daily life care services have made the community home care for the elderly with multiple diseases become the root of self-anxiety and the important livelihood issues concerned by the government. It not only affects the quality of life of individuals, but also brings heavy care and economic burden to the family and society. Due to the different educational level, occupational experience, economic status and self-care ability of the elderly individuals with multiple diseases, there are great differences in the content, form and delivery of care services. How to provide individualized, targeted, appropriate health care and daily care services is a serious challenge for service providers, service organizations and government management. Drawing on the experiences and models of developed countries, we should rationally replicate and adaptably innovate the informal care services suitable for local culture, break through the bottleneck constraints of the shortage of personnel, management to be standardized and economic conditions in formal care. We should guide and promote the orderly and standardized development of informal care, and make up for the deficiencies of informal care undertaken by traditional families, to enhance their acquisition and happiness for the elderly with multiple disease living at home in community.

Efficacy of needle warming moxibustion combined with celecoxib on knee osteoarthritis and its effects on levels of serum MMP-3, TIMP-1, TMP-1 and IGF-1

LIN Shu-liang, YE Ming

2020, 18(3): 476-479. doi: 10.16766/j.cnki.issn.1674-4152.001277

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Objective Anti-inflammatory drugs are the main drugs for the treatment of knee osteoarthritis(KOA), but the drugs have obvious toxic and side effects. Traditional Chinese medicine needle warming moxibustion is used in the treatment of KOA for a long time.The following research aimed to study the efficacy of needle warming moxibustion combined with celecoxib on KOA. Methods Eighty patients with KOA were divided into control group(n=40, 0.2 g/time, once/d, two weeks) and observation group(n=40, 2-week needle warming moxibustion on the basis of control group) according to the random assignment principle. After 1 week and 2 weeks of treatment, the osteoarthritis index, degree of knee joint pain,levels of serum related substances, treatment effects and safety were evaluated. Results After 1 week and 2 weeks of treatment, the scores of items of WOMAC scale and degree of knee joint pain in the two groups were significantly lower than those in the same group before treatment(all P<0.05), and the scores of items of WOMAC scale and degree of knee joint pain after treatment in observation group were significantly lower than those in control group(all P<0.05). After 1 week and 2 weeks of treatment, the levels of TGF-β and IGF-1 in observation group were significantly higher than those before treatment(all P<0.05) while the levels of MMP-3 and TIMP-1 were significantly lower than those before treatment(all P<0.05), and the levels of serum MMP-3 and TIMP-1 in control group after treatment were significantly lower than those before treatment(all P<0.05), and the levels of serum TGF-β and IGF-1 in observation group after treatment were significantly higher than those in control group at the same time while the levels of MMP-3 and TIMP-1 were significantly lower than those in control group at the same time(all P<0.05). The effective rate of treatment in observation group was significantly higher than that in control group(P<0.05). There were no significant differences in adverse treatment reactions between the two groups(P>0.05). Conclusion Needle warming moxibustion combined with celecoxib can effectively improve the clinical symptoms and repair the damaged soft tissues of knee joints of KOA patients, with high treatment safety.

Clinical study of Tianma Gouteng Decoction combined with betahistine in patients with vertigo

JIN Li-hua, LOU Hang-fang, LIAN Jian-wei, SHENG Shao-qin, ZHOU Xian-wei, LIU Jia-li

2020, 18(3): 480-483. doi: 10.16766/j.cnki.issn.1674-4152.001278

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Objective To explore the curative effect of Tianma Gouteng Decoction combined with betahistine on vertigo patients and its influence on transcranial doppler(TCD) parameters, Hemorheology and endothelin-1(ET-1). Methods The 142 patients with vertigo admitted to our hospital from March 2018 to March 2019 were randomly divided into control group(71 cases) and treatment group(71 cases) by random number table method. The patients in the control group were treated with betahistine and the patients in the treatment group were treated with Tianma Gouteng Decoction on the basis of the control group. Both groups were treated for 14 days. The therapeutic effects, DHI score, vertigo symptom score, TCD parameters, Hemorheology and ET-1 level changes, and adverse reactions were compared between the two groups before and after treatment. Results The total effective rate of the treatment group(92.96%) was higher than that of the control group(73.24%)(P<0.05). After treatment, DHI score and vertigo symptom score in the two groups were lower than those before treatment(P<0.05); DHI score and vertigo symptom score in the treatment group were lower than those in the control group(all P<0.05); the cerebral blood flow velocity of basilar artery, left vertebral artery and right vertebral artery in the two groups were higher than that before treatment(all P<0.05). After treatment, the cerebral blood flow velocity of basilar artery, left vertebral artery and right vertebral artery in the treatment group were higher than that in the control group(all P<0.05); the plasma viscosity, hematocrit and erythrocyte aggregation index in the two groups were lower than those before treatment(P<0.05), while the plasma viscosity, hematocrit and erythrocyte aggregation index in the treatment group were lower than those in the control group(all P<0.05). The serum ET-1 level in the two groups was lower than that before treatment(P<0.05), and the serum ET-1 level in the treatment group was lower than that in the control group(P<0.05). Conclusion Tianma Gouteng Decoction combined with betahistine has a good effect on vertigo patients. It can improve cerebral hemodynamics and hemorheology, and reduce the level of ET-1, which is worthy of clinical reference.

Clinical study of Heshi Yulin Recipe combined with traditional Chinese medicine fumigation treatment for recurrent implantation failure of kidney deficiency and blood stasis type

HUANG Yue-ying, TIAN Lei, CHEN Zhong-ju

2020, 18(3): 484-487. doi: 10.16766/j.cnki.issn.1674-4152.001279

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Objective Observe the clinical efficacy of Heshi Yulin Recipe combined with traditional Chinese medicine fumigation treatment for recurrent implantation failure(RIF) of kidney deficiency and blood stasis type, and to explore its influence on patients ' clinical pregnancy rate, embryo implantation rate, hormone level and uterine artery flow. Methods A total of 62 patients who were diagnosed as RIF of kidney deficiency and blood stasis type in Ningbo Women and Children's Hospital from February 2017 to September 2018 were divided into control group and observation group by random number table method with 31 cases each group. There was no statistically difference significant in basic information between two groups(P>0.05). The patients in the control group were given only oral treatment with aspirin enteric-coated tablets for 3 times a day, 1 tablet each time and 25 mg per tablet. The patients in the observation group were given treatment combining water decoction of Heshi Yulin Recipe for one potion per day, two times on each morning and evening, 200 mL per time, and once every other day with traditional Chinese medicine fumigation. All patients were treated continuously for 3 menstrual cycles. The clinical effects after treatment of the two groups were compared. The clinical pregnancy rate, embryo implantation rate, monitored the blood hormone levels, endometrial thickness and type, and uterine artery blood flow in mid-secretory phase were calculated. Results The clinical pregnancy rate of the observation group was 51.61%, which was obviously higher than that of the control group(25.81%), P<0.05. The embryo implantation rate of the observation group was 31.67%, which was obviously higher than that of the control group(15.25%), P<0.05. The blood estradiol E2, P level and uterine B-ultrasound of the observation group were significantly better than those in the control group(all P<0.05). Conclusion Heshi Yulin Recipe combined with traditional Chinese medicine fumigation has exact curative effect, it is beneficial to improve the clinical pregnancy rate and embryo implantation rate of patients who are diagnosed as RIF of kidney deficiency and blood stasis type. The synergistic use of Heshi Yulin Recipe and fumigation can improve the endometrial receptivity, lower the uterine artery blood flow resistance, regulate hormone level and improve endocrine.

Improvements on the general practice clinic reception table and the mentoring method as well as its effect on standardized training of general practice

XU Song-ao, ZHANG Ling-fang, YU Hui-jie

2020, 18(3): 488-491. doi: 10.16766/j.cnki.issn.1674-4152.001280

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Objective To observe the effect of an improved general practice clinic reception table and mentoring method on the mentoring effectiveness of the outpatient clinic resident physicians under the standardized training procedure. Methods The improvement on the reception table included tabletop lengthening by 60 cm and keyboard tray lengthening by 50 cm, which made it suitable for the resident physicians and the mentors to sit side by side while receiving patients. The computer monitors, keyboards, and mice could also be moved freely between the resident physicians and their mentors. Subsequently, 60 resident physicians in the second year of standardized training in the department of general practices of hospital to which the author is affiliated were selected and randomly divided into Group A and Group B, with 30 people in each group. Group A and B were respectively mentored with the improved mentoring method and the traditional mentoring method, respectively. Before and 1 month after outpatient clinic mentoring, the mentors in both groups were evaluated by 3 examination stations(the cases assigned differ from station to station) using the Mini-CEX scale. Finally, the resident physicians of the standardized training procedure and the mentors scored the satisfaction of two rounds of evaluations. Results After outpatient clinic mentoring, however, the Mini-CEX scores in both groups have improved significantly compared with that beforehand, showing statistically significant differences(all P<0.05). The resident physicians in Group A scored higher than those in Group B in terms of the medical interview skills, communication skills, organization/efficiency, and clinical comprehensive ability(all P<0.05). No statistically significant differences were found in the physical examination skills, humanistic quality/professionalism, or clinical judgment between both groups(all P>0.05). The level of satisfaction in both Mini-CEX evaluations between the resident physicians of the standardized training procedure and the mentors showed no statistically significant differences(all P>0.05). Conclusion The improvement on the clinic reception table and the mentoring method in the department of general practices is conducive to the skill development of the general practices resident physicians in the aspects of humanistic care, communication and expression, inquiry skills, medical record writing, and organizational efficiency. This proved that the improvements can achieve a better mentoring effect.

Meta-analysis of the efficacy of Chinese medicine care in patients with coronary heart disease and anxiety and depression

LI Hai-yan, ZUO Yao-yao, CHEN Shou-qiang

2020, 18(3): 492-495. doi: 10.16766/j.cnki.issn.1674-4152.001281

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Objective To retrieve the randomized controlled trials of traditional Chinese medicine nursing intervention for patients with coronary heart disease and anxiety and depression published in recent years, and systematically evaluate the efficacy of traditional Chinese medicine nursing intervention for patients with coronary heart disease and anxiety and depression. Methods Through electronic and manual searches, we searched the published literature on clinical research of patients with coronary heart disease and anxiety and depression in TCM nursing intervention from 2009 to 2018, screened the literature, formulated inclusion and exclusion criteria, and included qualified clinical studies according to the criteria, and determined the total effective rate, SAS score, SDS score and HAMD score as outcome indicators. Review Manager 5.3 software and Stata 14.0 software were used to test the heterogeneity of the data, merge the effects, publication bias analysis, and complete meta-analysis. Results A total of 176 relevant literatures were retrieved. According to the inclusion criteria and exclusion criteria, 11 studies were finally included. A total of 1079 cases were included, including 560 cases in the experimental group and 519 cases in the control group. The quality of the literature was evaluated, and the results showed that the quality of the literature was general. Meta-analysis results showed that the levels of Total efficiency(OR=4.23, 95% CI:2.36 to 7.60, P<0.001), SAS(WMD=-8.70, 95% CI:-14.74 to-2.66, P=0.005), SDS(WMD=-9.11, 95% CI:-11.36 to-6.85, P<0.001), HAMD(WMD=-5.41, 95% CI:-6.07 to-4.74, P<0.001]. All the results were statistically significant. Heterogeneity test results showed that the total effective rate and HAMD score for each study were P>0.10, which was homogenous. SAS score and SDS score were P<0.10 for each study, which was heterogeneous. Egger test showed that P=0.092, indicating that there was less possibility of publication bias. Conclusion Chinese medicine nursing has obvious improvement effect on patients with coronary heart disease and anxiety and depression. However, due to the quality of the included literature, further improvement in quality is needed to confirm.

Current situation and countermeasure of prevention and treatment of intracranial atherosclerotic diseases in China

JIA Ze-jun, ZHAI Cheng-cheng, WANG Di, DENG Xiao-qun, YIN Cha, YANG Zhi-gang

2020, 18(3): 496-500. doi: 10.16766/j.cnki.issn.1674-4152.001282

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Objective To analyzes the development trend of global research on intracranial atherosclerotic diseases based on the bibliometric method, analyzes the current situation and shortcomings of relevant research in China, and explores the appropriate coping strategies. Methods Relevant literatures of global research on intracranial atherosclerotic diseases from 1900 to 2018 in SCI expanded database were retrieved and quantitatively analyzed by the software of web of science, Excel 2007 and other software. The indicators included literature quantity, cited frequency, h-index, fund paper ratio, high contribution institutions, etc. Relevant literatures from China were separately analyzed and compared with those from the United States, Japan and Germany. Results There were 8 468 articles related to intracranial atherosclerotic diseases published in the world from 1900 to 2018, with a total citation frequency of 189 950, all of which were cited with a frequency of 22.43 and h-index 155. The output of related papers in China(excluding Taiwan, China) was on the rise as a whole. The total output of related papers was 1 157, ranking second in the world. In 1991, the first paper was published, reaching 14 in 2003, in 2014 it reached 105, in 2018 it reached 189, only 8 fewer than the United States, showing a momentum of rapid development. Among them, Capital Medical University had the largest contribution, ranking first in the global output of papers. However, the research quality of papers in China was still lower than that in the United States, which need to be further improved. Conclusion The research on intracranial atherosclerotic diseases in China starts late, but it has made rapid development in recent years. It has more and more influence in the world, and there is still a lack of high influence. In the future, it is necessary to further strengthen the hot research such as RCT, etiology, imaging diagnosis and treatment, from quantity improvement to quality improvement.

Clinical analysis of the fever patients about early identification and precautionary measures of sudden death in hospital

LI Gang, ZHANG Ke, HAN Nan-nan

2020, 18(3): 501-504. doi: 10.16766/j.cnki.issn.1674-4152.001283

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Objective Statistical analysis of common features of cardiac arrest in patients with fever, to study the early identification and prevention of cardiac arrest in patients with fever. Methods Retrospective review of 32 cases of fever was the first symptom from 2008 January to 2018 October in Zhejiang Province People's Hospital through the electronic medical record database. Those included the data of before the fever, arrived at the hospital, 1 hour before sudden death, the change of Na⁺, K⁺, PH, Lac, breathing frequency, heart rate, blood pressure, SPO₂, consciousness, treatment, antipyretic drugs, volume of liquid, ever used diuretics. Through the analysis of the above data, the common characteristics of patients with fever before sudden death in hospital were summarized. Results The change of conscious were happened in all patients, 81.25% of patients have used different types of antipyretic drugs, only one patient Intravenous fluid supplementation 1 000 mL after antipyretic drug, seven peoples ever used diuretics, 21.88%. The heart rate of 1 hour before sudden death increased significantly compared to before the fever and arrived at the hospital, and sinus arrhythmia, increased heart rate was not proportional to increased body temperature. Breathing frequency increased significantly. No significant difference between blood pressure and SPO₂. The PH,BE, Lac of 1 hour before sudden death increased significantly compared to before the fever and arrived at the hospital. No significant difference between Na⁺ and K⁺. The incidence of "Moore's death"(A triangle of Na⁺, K⁺ and PH) was significantly increased. Conclusion Sudden death in hospital of Fever patient has very high risk of doctor-patient disputes, early detection and prevention through the changes in the patient's vital signs and test results. These results may help us reduce medical interventions that may increase the risk of sudden death and deduce the incidence of sudden hospital deaths in such patients.

Effect observation of cognitive intervention nursing combined with functional training in treatment of sudden deafness patients

BO Fang, HUO Zi-rong, ZHOU Jie-yu, WANG Zhen-tao, XU Yun-xia, XU Jia-ming

2020, 18(3): 505-508,512. doi: 10.16766/j.cnki.issn.1674-4152.001284

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Objective To explore the nursing strategy and effect of cognitive nursing intervention combined with functional training in patients with sudden deafness(SSHL), and to evaluate the clinical application effect. Methods A total of 80 patients with sudden deafness and tinnitus in department of otorhinolaryngology head and neck surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from December 2017 to December 2018 were randomly divided into study group and control group according to the date of hospitalization. Both groups were given antiviral drugs, microcirculation improvement drugs, hyperbaric oxygen therapy and hormone tympanic injection therapy. The control group was given routine nursing of otorhinolaryngology head and neck surgery. In the study group, the implementation of combined cognitive nursing intervention under the basic routine functional training was compared between the two groups in terms of the improvement of negative emotions, curative effect and overall quality of life of sudden deafness patients after intervention. Results The effective rate of the study group was 90.0%, which was significantly higher than 67.5% of the control group. The difference of the hearing effect between the two groups was statistically significant(P<0.05). The SCL-90 symptom checklist scores of sudden deafness patients with tinnitus after intervention in the study group were significantly lower than those in the control group(1.55±0.96 vs. 1.95±0.78, P<0.05). The air conduction threshold levels of sudden deafness patients with tinnitus after intervention in the study group were significantly lower than those in the control group(26.08±3.29 vs. 31.03±4.06, P<0.05). The scores of daily activities, psychological state, sleep disorders, social relations and quality of life in the study group were significantly lower than those in the control group(all P<0.05). Compared with the control group, the difference was statistically significant(all P<0.05). Conclusion The application of cognitive intervention combined with functional training nursing strategy in sudden deafness patients can effectively alleviate the negative emotions of patients, improve the compliance of patients with treatment, help the recovery of disease, improve the level of patients' hearing threshold, and improve the quality of life of patients.

Effect of respiratory trainer on lung function recovery in patients after thoracic surgery

YUAN Guo-qin

2020, 18(3): 509-512. doi: 10.16766/j.cnki.issn.1674-4152.001285

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Objective To observe the improvement of respiratory training interventions by respiratory trainer on lung function indicators such as forced vital capacity and the quality of life in patients after thoracic surgery. Methods Eighty-four patients who underwent thoracotomy in the department of thoracic surgery, First People's Hospital of Hangzhou from July 2016 to September 2018 were enrolled. They were randomly divided into intervention group and control group according to the random number table method. Patients in the control group received routine care, and the intervention group received respiratory training interventions by respiratory trainer based on routine care. The intervention was last for 2 weeks. Results Compared with the control group, pulmonary function indexes, one-second forced expiratory volume(FEV1, 2.23±0.26 vs. 2.03±0.33, P=0.003), forced vital capacity(FVC, 3.25±0.37 vs. 3.01±0.39, P=0.005), and exercise tolerance indexes, blood carbon dioxide partial pressure(PaCO₂, 65.34±3.75 vs. 63.77±3.24, P=0.043) and blood oxygen partial pressure(PaO₂, 46.95±4.26 vs. 48.92±3.69, P=0.026), and the quality of life(66.27±4.36 vs. 63.18±5.31, P=0.005), the difference between the two groups was statistically significant(P<0.05), but the difference in the ratio of forced expiratory volume to vital capacity(FEV1/FCV)in one second was not statistically significant. Conclusion The use of respiratory trainers after thoracic surgery can effectively improve the lung function of patients and improve their quality of life.

Analysis of the effect of phase Ⅰ cardiopulmonary nursing on enhancing the cardiopulmonary function of CABG under the theory of precise nursing

WU Yan, SU Ying-jie

2020, 18(3): 513-516,520. doi: 10.16766/j.cnki.issn.1674-4152.001286

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Objective To explore the clinical effects of nursing measures in phase Ⅰ cardiopulmonary rehabilitation on cardiopulmonary function in patients undergoing coronary artery bypass grafting(CABG) on the basis of precision nursing theory. Methods A total of 114 patients with CABG who were treated in our hospital from August 2017 to April 2018 were selected by convenient sampling method. The patients were divided into experimental group and control group by random number grouping, 57 cases in each group. The patients in the control group underwent routine treatment and nursing. The experimental group implemented the phase Ⅰ cardiopulmonary rehabilitation care measures under the theory of precision nursing, including advanced sports rehabilitation program, respiratory exercise and health education in cardiac rehabilitation. Both groups were nursed for one month. The patients in the two groups were examined by ultrasound before operation and before discharge, and evaluated by 6-minute walking test(6 MWT) before discharge. Results There were significant differences in left ventricular diameter, left ventricular ejection fraction, 6 MWT, and maximum oxygen uptake(VO_{2 max}) between the experimental group and the control group[(43.87±6.84)mm,(71.32±8.37)%,(265.31±75.27)m,(14.76±3.64)mL/(kg·min) vs.(49.36±6.51)mm,(66.93±8.97)%,(235.48±60.54)m,(10.97±2.35)mL/(kg·min), all P<0.05)]. Conclusion Under the theory of precision nursing, phase Ⅰ cardiopulmonary rehabilitation can significantly improve the maximum oxygen uptake of CABG patients, enhance the cardiopulmonary function and the actual endurance of aerobic exercise, which is worthy of clinical promotion.

Application of fine nursing in patients with mechanical ventilation weaning

WANG Ya-ping, WANG Dan-qiong, XU Fang-fang, WU Xia-yun, LU Jun-mei, PANG Lu, ZHENG Li-fang

2020, 18(3): 517-520. doi: 10.16766/j.cnki.issn.1674-4152.001287

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Objective To study the application experience of fine nursing in weaning of mechanical ventilation and its influence on the time of mechanical ventilation, the success rate of one-time evacuation and complications. Methods Total 92 patients who were treated by mechanical ventilation in Quzhou people's hospital from June 2016 to June 2018 were divided into two groups according to the different nursing methods, 46 cases in each group. The routine group was given routine nursing, and the fine nursing group was given fine nursing on the basis of the routine group. The nursing effect, complication rate and patient compliance rate were counted. Results After 4 weeks of nursing, the levels of PaO₂ and SaO₂ in the fine nursing group were higher than those in the routine group, and the scores of PaCO₂, HR, RR, SAS, SDS and Apache were lower than those in the routine group(all P<0.05). The mechanical ventilation time of the fine nursing group was(4.89±1.02) d, shorter than that of the routine group(10.52±1.62) d(t=19.950, P<0.001). The one-time weaning success rate of the fine nursing group was 78.26%(36/46), higher than that of the routine group 58.70%(27/46), χ²=4.079, P=0.043. The complication rate of the fine nursing group was 10.87%(5/46), significantly lower than that of the routine group 28.26%(13/46), χ²=4.420, P=0.036. The compliance rate of the fine nursing group was 95.65%(44/46), higher than that of 82.61%(38/46) in the control group(χ²=4.039, P=0.044). Conclusion Fine nursing can reduce the time of mechanical ventilation, improve the success rate of one-time weaning and reduce complications.

LI Ying, LIU Xian-feng, JI Qiong, LIU Ying

2020, 18(3): 521-522. doi: 10.16766/j.cnki.issn.1674-4152.001288

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About Journal

2020 Vol. 18, No. 3

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