中华全科医学

Construction and application of residents' health records based new community health information integration platform

PENG De-rong, CHEN Chen, SHI Jian-wei, WANG Chao-xin

2020, 18(4): 523-526,541. doi: 10.16766/j.cnki.issn.1674-4152.001289

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Abstract:
After 20 years of exploration and development, China has issued policies and standards to support the construction of community health informatization and residents' health records(RHR). However, there are still a series of problems, such as the lack of integration of RHR, the lack of top-level design of community informatization, and the separation of the information system from the actual business. This paper takes Pengpu Xincun Community Health Service Center in Shanghai as an example to introduce the development, application effect and future prospect of RHR-based community health informatization platform, in order to provide experience for other community information construction. Firstly, this paper summarizes the construction process of the informatization platform from infrastructure construction, interconnection, standard integration and system application, and forms a community health information platform based on RHR, which comprehensively manages the hospital's business, residents' health and management information of each department. Secondly, it introduces the application effects include the convenient query of residents' health information, enhancing the residents' experience, improving the working efficiency of community medical staff, contracted service, hierarchical diagnosis and treatment and door-to-door service, promoting comprehensive community reform and delicacy management from the aspects of performance mechanism, budget mechanism and management mechanism. Finally, the future of community health intelligence is prospected from four aspects:health risk warning, computer-assisted system of diagnosis and treatment, intelligent medical quality monitoring and community follow-up. The author believes that the construction of community health information platform needs to take the RHR as the core, emphasize the top-level design of connectivity and practical application, take the actual needs of business as the guide, improve the service experience, improve the work efficiency and enhance the management efficiency as the driving force, to realize the coordinated development of business system, information system and residents' health.

XIE Zhang-hao, LI Zhi-jun

2020, 18(4): 527-528.

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Abstract:

Clinical analysis of 3D digital printing technology in severe osteoporotic vertebral compression fractures

ZHANG Zhi-qiang, SUN Li-min, ZHANG Kai, WANG Peng, YANG Zeng-kun, LI Si-yuan, XU Zheng, HAN Kang

2020, 18(4): 529-532,546. doi: 10.16766/j.cnki.issn.1674-4152.001290

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Abstract:
Objective To explore and compare the effect and significance of 3 D digital printing technique in the treatment of severe osteoporotic vertebral compression fractures. Methods From January 2017 to January 2019, 64 cases of single thoracic SOVCFs of Shandong Provincial Third Hospital were divided into two groups with 32 cases in each groups according to random numbers method. The experimental group underwent surgery using a novel 3 D digital printing technique, while the control group underwent surgery by conventional PVP method. The clinical outcomes were evaluated by operation time, fluoroscopic frequency and the cement amount in surgery. Oswestry Disability Index(ODI), and visual analogue scal(VAS) of pain were used for comparisons between the two groups. Imaging parameter such as the vertebral body height recovery rate, the bone cement distribution, the rate of bone cement leakage and the bone density were evaluated. Results The experimental group had better results in operation score than those in control group(all P<0.05). The VAS and ODI score of two groups were significant decreased after operation. The VAS score of the observation group was better than that of the control group at 3 th day post-operation(all P<0.05), but there was no significant difference between the two groups at 6 months after operation(P>0.05). The ODI of each time point of the observation group was better than that of the control group(P<0.05). The recovery rate of vertebral height, unilateral distribution of bone cement in the observation group were better than those in the control group(all P<0.05). There were no serious complications occurred in two groups(all P>0.05). The cement leakage rate was better in the experimental group though there was no statistically significant(P>0.05). Conclusion Comparing the conventional method, using the 3 D digital printing technique can significantly shorten the puncture procedure time, reduce the intraoperative radioactive frequency, improve bilateral distribution rate of bone cement, and reduce leakage rate of bone cement, which could be further promoted in clinic.

Clinical effect of postoperative combined with Mudan Granule on diabetic foot patients undergoing tibial lateral bone transfer

ZHAO Xiao-ming, ZHANG Yin-gang

2020, 18(4): 533-536,650. doi: 10.16766/j.cnki.issn.1674-4152.001291

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Objective To investigate the clinical effect of Mudan Granule in reconstructing lower limb blood transport and nerve conduction of diabetic foot patients undergoing tibial lateral bone transfer. Methods A total of 32 patients with diabetic foot admitted to the hospital from October 2017 to December 2018 were selected and divided into control group and experimental group using random number table method, with 16 cases in each group. All patients were received transverse tibial bone transport. After operation, the experimental group were received Mudan Granule orally and the control group were received placebo for 8 weeks. Ulcer healing time, foot skin temperature, VAS pain score, blood flow velocity of dorsal foot artery, total peroneal nerve sensation, motor conduction velocity, peripheral blood VEGF and PDGF levels of patients were compared between the two groups. The complications and adverse reactions during treatment were recorded. Results All 32 cases were followed up for an average of 5.6 months(4-9 months). Compared with the control group, the ulcer healing time of the experimental group was significantly shortened. The improvement of skin temperature, blood flow velocity of dorsal foot artery and relief degree of postoperative pain symptoms of the experimental group were better than the control group. Meanwhile, the total peroneal nerve sensory, motor conduction velocity and the level of peripheral blood cytokines of the experimental group were increased compared with the control group(all P<0.05). Conclusion After tibial lateral bone transfer, oral administration of Mudan Granules can effectively relieve pain, improve the hemodynamic index and promote the nerve conduction and rapid healing of ulcer wound. Meanwhile, it has certain effect in preventing ulcer recurrence and fracture formation, which may be a good complementary and intensive treatment for diabetic foot patients after transverse tibial bone transport.

Clinical observation of second-line treatment of anlotinib combined with docetaxel on advanced non-small cell lung cancer without driver gene mutation

ZHAO Lun, ZHANG Hao-ran, SHI Mo-han, ZHAI Yun-zhi, HE Ze-lai

2020, 18(4): 537-541. doi: 10.16766/j.cnki.issn.1674-4152.001292

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Objective To observe the clinical efficacy and safety of anlotinib combined with docetaxel as the second-line therapy for patients with advanced non-small cell lung cancer(NSCLC) without driver gene mutation, and to provide theoretical basis and therapeutic strategy. Methods Thirty-six patients were selected from May 2018 to May 2019 in the First Affiliated Hospital of Bengbu Medical College. These patients were treated with anlotinib combined with docetaxel in second-line therapy of advanced NSCLC without driver gene mutation who had failed in first-line therapy. The clinical efficacy, safety and adverse reactions were evaluated. Results The median progression-free survival of anlotinib combined with docetaxel was 4.5 months(ranging from 1.5 months to 15.4 months). After treatment, the number of CR, PR, SD and PD was 0, 6, 25, 5 respectively, and DCR and ORR were 86.11% and 16.67% respectively. In 31 patients with controlled diseases, 20 patients made progress again during the observation period. Cox multivariate analysis showed that staging was an independent risk factor for prognosis(P=0.032). Common adverse reactions included hypertension, fatigue, abnormal liver function, hand-foot syndrome, etc. Conclusion The efficacy of anlotinib combined with docetaxel as second-line therapy for patients with advanced NSCLC without driver gene mutation is positive, and the incidence of adverse reactions are tolerable. This therapy can be used as second-line treatment option for advanced NSCLC patients without gene mutation.

Correlation between spinal coronal balance and static plantar pressure in children with adolescent idiopathic scoliosis

CHEN Meng-jie, LUO Yi, MA Qi-chao, YING Hao, WANG Sun, MA Feng, SHAO Wen-juan

2020, 18(4): 542-546. doi: 10.16766/j.cnki.issn.1674-4152.001293

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Objective To explore the characteristics of the plantar pressure data of the patients with adolescent idiopathic scoliosis(AIS), and evaluate the correlation between plantar pressure parameters and coronal balance status for AIS. Methods A total of 44 patients of AIS were recruited as volunteers. Radiographic studies including Cobb angle, offset between central sacral vertical line(CSVL) and C7 vertebra plumb line(C7 PL)(considered as global coronal balance, GCB), apical translation of the major curve(AT, considered as regional coronal balance) and lateral pelvic tilt(LPT) were measured. The static plantar pressure test was carried out on the subjects, and the biomechanical indexes such as the contact area and the load ratio(relative to the overall load of the feet) of the feet were tested to analyze the plantar pressure distribution characteristics of AIS patients. Results The contact area of the forefoot was significantly larger than that of the rearfoot(P<0.001) and the load ratio of the forefoot was significantly smaller than that of the rearfoot(P<0.001). The offset between CSVL and C7 PL was positively related to the contact area of the forefoot(r=0.357, P=0.019), as well as the load ratio(r=0.400, P=0.008). The AT was also positively related to the load ratio of the forefoot(r=0.331, P=0.030) but had no correlation with contact area. Conclusion In scoliosis, the coronal balance is correlated to plantar pressure distribution. The offset between CSVL and C7 PL, as well as AT are the best describers of coronal balance. These two indexes can best reflect the equilibrium state of coronary position. On the main bend side, the offset between CSVL and C7 PL is positively correlated with the contact area and the load ratio of the forefoot, and the TA is also positively correlated with the load ratio of the forefoot, which indicated that the balance characteristics of the two coronal positions are all correlated with the foot pressure.

Research on prosthesis size of Sledge unicondylar knee arthroplasty in 159 patients

WU Ke-ke, LU Yao-ming, CAO Xue-wei, YANG Wei-ming

2020, 18(4): 547-551,600. doi: 10.16766/j.cnki.issn.1674-4152.001294

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Objective To conduct a clinical study on the population of Sledge unicondylar knee arthroplasty(UKA), and provide a reference for accurately determining the size of the prosthesis and selecting a suitable prosthesis. Methods Total 159 patients with Sledge UKA from February 2016 to November 2017 were selected and the clinical data were retrospectively analyzed. The size distribution of femur and tibia in the prosthesis of UKA was analyzed. The basic data index(sex, age, BMI) of patients were recorded. According to the data, the best matching relationship between femoral and tibial prosthesis was analyzed. The influencing factors of UKA prosthesis were screened out to predict the accuracy of femoral prosthesis. Results Among the femoral prosthesis, 21.4% are medium size prosthesis, 62.8% are small size prosthesis, and 15.7% are ultra small size prosthesis. Among the tibial prostheses, large prosthesis accounted for 19.5%, medium prosthesis for 52.8%, and small prosthesis for 27.8%. The best matching scheme was follow:small size tibia matching super small size or small size femoral prosthesis, large and medium size tibia matching medium size femoral prosthesis. The age and BMI had no significant effect on the judgment and selection of femoral prosthesis(all P>0.05), but there were significant differences in gender and height(female), all P<0.05. The distribution of the related parameters of the UKA prosthesis in Sledge population was preliminarily established. According to the analysis of data, the accuracy rate of gender to select the size of femoral prosthesis before operation is increased by 88.1%, of which the accuracy rate of women combined with height is 95.0%. The accuracy rate of tibial prosthesis size is 78.6% when selecting and judging again during operation. Conclusion The size of femoral prosthesis can be predicted by preoperative height and gender in clinic. The distribution of sledge UKA prosthesis analyzed in this study has high accuracy in prediction and judgment, which can provide powerful guidance for accurate determination of prosthesis size during operation.

Clinical efficacy analysis for treatment of moderate to high risk myelodysplastic syndrome with decitabine

HU Tong-lin, ZHENG Zhi-yin, SHEN Jian-ping, LIU Shu-yan

2020, 18(4): 552-554,689. doi: 10.16766/j.cnki.issn.1674-4152.001295

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Objective To evaluate the efficacy and safety of decitabine in the treatment of patients with moderate to high risk myelodysplastic syndrome(MDS), and to explore the clinical significance of TET2 and DNMT3 A gene mutations. Methods Clinical data of 81 patients with MDS in the First Affiliated Hospital of Zhejiang Chinese Medical University were retrospectively analysed. According to the different treatment methods, they were divided into single drug group(32 cases, decitabine) and combined chemotherapy group(49 cases, decitabine, homoharringtonine, Ara-C and Aclacinomycin). Results ① The efficacy:the complete remission(CR) rate was 25.0% and the overall response(ORR) was 53.1% in the single drug group. The CR rate was 44.9% and the ORR rate was 67.3% in the combined chemotherapy group. ② The progression-free survival time(PFS):the single drug group was 9 months, and the combined chemotherapy group was 13 months, with no significant difference(χ²=0.942, P=0.332). ③ Adverse events:the incidence of grade 3-4 hemocytopenia was 81.25% in the single drug group and 89.79% in the combined chemotherapy group. The incidence of infection was 65.63% in the single drug group and 77.55% in the combined chemotherapy group. The non-hematological toxicity was grade 1-2 in two groups. ④ There were 16 cases of TET2 gene mutation, including 5 cases in single drug group and 11 cases in combined chemotherapy group. There were 8 mutations of DNMT3 A gene, including 1 in single drug group and 7 in combined chemotherapy group. There was no significant difference between two groups. Conclusion Decitabine have good efficacy in the treatment of moderate to high risk MDS. There was no significant difference between the two treatment methods. TET2 and DNMT3 A gene mutations have no significant effect on efficacy.

Clinical study on Shugan Lidan Decoction in preventing gallstones after radical total gastrectomy

XU Ying-ping, DONG Rui-zeng, SHENG Hua-ying

2020, 18(4): 555-557,665. doi: 10.16766/j.cnki.issn.1674-4152.001296

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Objective To explore the efficacy of Shugan Lidan Decoction in preventing gallstone after radical total gastrectomy. Methods From January to December 2016, 120 patients with gastric cancer underwent radical total gastrectomy in the Department of Abdominal Surgery in Zhejiang Cancer Hospital were selected. Preoperative ultrasonography was performed to exclude diseases of biliary system(including gallbladder inflammation, gallbladder or bile duct stones). Patients with diabetes, which may affect gallbladder emptying function, were also excluded. The patients were divided into experimental group and control group according to random number table, 60 cases in each group. Routine treatment was given in both groups after operation. The experimental group was given Shugan Lidan Decoction 200 ml orally for 20 days from the 10 th day after operation. The gastrointestinal reactions of the two groups were observed. The concentration of cholecystokinin was measured 3 days before operation and 30 days after operation. The volume of gallbladder was measured by ultrasound and the emptying rate of gallbladder was calculated. The occurrence of cholecystolithiasis in the two groups was observed. Results The incidence of gastrointestinal reactions was similar between the two groups, and there was no significant difference. After operation, the serum CCK content in the two groups were increased, but it in the experimental group was significantly higher than that in the control group(P<0.05). The gallbladder emptying rate of the two groups were decreased after operation, but the emptying rate of the experimental group was higher than that of the control group(P<0.05). Cholecystolithiasis occurred in 25 patients(20.8%) including 8 in the experimental group(13.3%) and 17 in the control group(28.3%), with the statistically significant difference(χ²=4.093, P=0.043). Conclusion Shugan Lidan Decoction can improve the gallbladder emptying function and reduce the incidence of gallstones after radical total gastrectomy.

Study on the serum level of brain natriuretic peptide and its amino terminal precursor in infants with pneumonia complicated with heart failure

ZHOU Meng-zhu, SHEN Huai-yun, SUN Qi, ZHAO Wu

2020, 18(4): 558-560,592. doi: 10.16766/j.cnki.issn.1674-4152.001297

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Objective To investigate the diagnostic value of brain natriuretic peptide(BNP) and its amino-terminal precursor(NT-proBNP) in infants with pneumonia complicated with heart failure(HF). Methods Eighty infants admitted to pediatric intensive care unit(PICU) of our hospital due to severe pneumonia from November 2018 to May 2019 were selected as study subjects, who were divided into HF group(40 cases) and Non-HF group(40 cases). The serum levels of BNP and NT-proBNP in the acute phase(within 24 hours after admission) and in the recovery phase of the two groups of infants were measured and compared. Left ventricular ejection fraction(LVEF) was measured in the acute phase of the HF group and its correlation with BNP and NT-proBNP were analyzed. ROC curve was used to compare the diagnostic value of BNP and NT-proBNP for HF. Results The serum levels of BNP and NT-proBNP in the HF group were higher than those in the Non-HF group(all P<0.05), and higher in acute phase than in recovery phase(all P<0.01). Both were negatively correlated with LVEF(r=-0.646, P=0.001; r=-0.592, P=0.001). The area of BNP and NT-proBNP under the ROC curve were 0.665 and 0.683, respectively. Conclusion The serum levels of BNP and NT-proBNP increase when HF is complicated with infant pneumonia, and negatively correlated with LVEF. They have important diagnostic value for early diagnosis of HF, and their diagnostic value for HF is similar.

Efficacy analysis of recombinant human interferon α-2b spray combined with Reduning injection in the treatment of children with hand, foot and mouth Disease

WANG Kai, KONG Hui-xia, LIU Jing-yan, LIU Lei, ZHANG Yan-hua, GAO Dong-pei, XU Fa-lin

2020, 18(4): 561-563,567. doi: 10.16766/j.cnki.issn.1674-4152.001298

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Objective To investigate the effect of recombinant human interferon α-2 b spray combined with Reduning injection on immune function and serum inflammatory factors in children with hand, foot and mouth disease. Methods A total of 340 children with hand, foot and mouth disease admitted to Zhengzhou Central Hospital from February 2016 to August 2018 were randomly divided into two groups according to random number method, each group of 170 cases. The control group was treated with recombinant human interferon α-2 b spray(20 mL, 3 times/day), and the observation group was treated with Reduning injection on the basis of the control group(0.6-0.8 mL/kg, 1 time/day). SPSS 23.0 statistical software was used to process the data and compare the clinical signs, immune function and serum inflammatory factors of the two groups before and after treatment. Results After treatment, the antipyretic time of the observation group(0.97±0.16) d was lower than that of the control group(1.75±0.39) d(t=-24.125, P<0.001), and the time of rash regression, healing time of oral ulcer and hospitalization time were shorter than those of the control group(all P<0.05). The levels of CD4⁺, CD4⁺/CD8⁺, and CD8⁺ were improved in the two groups(all P<0.05), but the improvement effect was better in the observation group than those in the control group(all P<0.05). The IgM, IgG and IgA levels in the two groups were significantly increased(all P<0.05), but the levels in the observation group were significantly higher than those in the control group(all P<0.05). The serum levels of CRP, IL-4 and IL-6 in the two groups were significantly reduced(all P<0.05), but the levels in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion Recombinant human interferon alpha-2 b spray combined with Reduning injection in the treatment of pediatric hand, foot and mouth disease can significantly improve the clinical signs, enhance the immune function of children, and reduce the level of serum inflammatory factors. The curative effect is significant, conducive to the recovery of children.

Effect of continuous brain function monitoring on neonatal hypoxic-ischemic encephalopathy

CHEN Li, CHEN Xin

2020, 18(4): 564-567. doi: 10.16766/j.cnki.issn.1674-4152.001299

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Objective To observe the application effect of continuous brain function monitoring in early diagnosis of neonatal hypoxic-ischemic encephalopathy. Methods Total 60 neonates with hypoxic-ischemic encephalopathy diagnosed in our hospital from June 2018 to May 2019 were selected in this study. They were divided into control group and observation group with 30 cases in each group. Continuous brain function monitoring was used in the observation group, and Transcranial Doppler(TCD) monitoring was used in the control group. The application effect of the two groups was compared. Results The sensitivity and specificity of the two groups were 90.00% and 86.67% in the observation group, 63.33% and 60.00% in the control group, respectively(all P<0.05). The difference of the brain function between the two groups was not statistically significant(P>0.05). The Vs and Vd of the neonates with hypoxic-ischemic encephalopathy increased in a way of time dependent way. Compared with the control group, the Vs and Vd of the observation group at 24 h and 48 h were significantly reduced(all P<0.05). There was no significant difference in Vs and Vd between 2 groups at 72 h(all P>0.05), and there was no significant difference in RI between 2 groups at different times(P>0.05). There was no interaction between the parameter groups and time(P>0.05). Conclusion Continuous brain function monitoring is an objective and reliable method for the monitoring of neonatal hypoxic-ischemic encephalopathy, which can improve the accuracy of monitoring, accurately reflect the state of illness, facilitate the later treatment and guarantee the life safety of the newborn.

Effects of matrine eye drops on levels of cytokines associated with experimental uveitis in rabbits by regulating TLR4/NF-κB pathway

DENG Zhen, WU Yi-feng, JIANG Lei, TANG Dan-yan, YU Guo-xiao, YAO Li, WU Kun-lin

2020, 18(4): 568-572,669. doi: 10.16766/j.cnki.issn.1674-4152.001300

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Objective To investigate the effect of matrine eye drops on the levels of cytokines associated with experimental uveitis in rabbits by regulating toll like receptor 4/nuclear factor-κB(TLR4/NF-κB) pathway. Methods The rabbit model of experimental uveitis was established and randomly divided into model group, tobramycin-dexamethasone eye drops group, low(0.50 g/L), medium(0.75 g/L) and high(1.00 g/L) dose matrine eye drops groups, with 8 rabbits in each group. Another 8 rabbits were selected as control group. After successfully modeling, tobramycin-dexamethasone eye drops group, low, medium and high dose matrine eye drops groups were treated with tobramycin-dexamethasone eye drops and matrine eye drops respectively, rabbits in all groups were given the same dose of saline eye drops for 7 days. Slit lamp was used to observe and evaluate the inflammation of anterior segment of rabbit eyes. Hematoxylin-eosin staining(HE) was used to observe the pathological morphology of the retina of rabbits. Enzyme-linked immunosorbent assay(ELISA) was used the levels of cytokines, tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-1(IL-1) in serum and aqueous humor of rabbits, and Western blot was used to detect the expressions of TLR4/NF-κB pathway proteins TLR4, MyD88 and NF-κB p65 in retina. Results Compared with the control group, the clinical and pathological scores, the levels of IL-6, IL-1 and TNF-α in serum and aqueous humor, and the expressions of TLR4, MyD88 and NF-κB p65 in retina were significantly increased in the model group(all P<0.05). Compared with model group, the clinical and pathological scores, the levels of IL-6, IL-1 and TNF-α in serum and aqueous humor, and the expressions of TLR4, MyD88 and NF-κB p65 in retina tissue in all dose matrine eye drops groups and tobramycin-dexamethasone eye drops group were decreased, and there was a dose-dependent relationship among the dose groups of matrine eye drops(all P<0.05). There was no significant difference between the high dose matrine eye drops groups and tobramycin-dexamethasone eye drops group(P>0.05). Conclusion Matrine eye drops can reduce the levels of cytokines in serum and aqueous humor, alleviate inflammation and improve uveitis symptoms in rabbits, which may be achieved by down-regulating TLR4/NF-κB pathway.

AI Hui, HAN Ruo-dong, YAN Xiu-xia, ZHOU San-hua

2020, 18(4): 573-576. doi: 10.16766/j.cnki.issn.1674-4152.001301

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Objective To explore the influencing factors of early cognitive dysfunction in patients with septic shock after recovery. Methods Total 124 patients with septic shock in intensive care unit(ICU) of Bozhou people's hospital from January 2015 to December 2019 were divided into cognitive impairment group(33 cases, CI group) and non-cognitive impairment group(91 cases, NCI group) according to the Montreal Assessment Scale Cognitive(Chinese version). Data of patients were collected, which included, age, the highest acute physiology, chronic health score-Ⅱ(APACHE-Ⅱ), total norepinephrine(NE), total benzodiazepine(BZD), total propofol(PROP), total opioid dosage, time in ICU, time of mechanical ventilation, the highest content of serum high sensitive C protein(hs-CRP), the highest value of arterial blood lactic acid(LAC), and the duration of delirium. The clinical data of the two groups were compared. The single factor screening and multifactor logistic regression analysis of early cognitive impairment in patients with septic shock after ICU cure were performed. The early cognitive impairment factors in patients was analyzed by univariate screening and multivariate logistic regression analysis. Results The incidence of early cognitive impairment in post-intensive care patients with septic shock was 26.61%(33/124). The age and duration of delirium in CI group[(67.19±6.55) year,(32.97±27.59) h)] were higher than those in NCI group[(50.96±11.94) year,(3.29±4.48) h](all P<0.05). Multivariate logistic regression analysis indicated that the age(OR=1.279, 95% CI:1.128-1.451, P<0.001) and the duration of delirium(OR=1.355, 95% CI:1.69-1.571, P<0.001)) were risk factors for cognitive impairment post-intensive care patients with septic shock. Conclusion The incidence of early cognitive impairment(3 months) is higher in patients with septic shock after recovery. The age and duration of delirium are the main influencing factors of early cognitive dysfunction(within 3 months) in those patients. Clinical staff should take measures to shorten the duration of delirium as early as possible and screen for cognitive impairment in patients with septic shock who are older or have a longer duration of delirium.

A study of the influencing factors of mild cognitive impairment in perimenopausal women

MA Yue-ling, SHI Hong-xia, GUO Lei, LUO Bin

2020, 18(4): 577-580,678. doi: 10.16766/j.cnki.issn.1674-4152.001302

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Objective To understand the cognitive function and explore its influencing factors among perimenopausal women, so as to provide a theoretical basis for preventing the occurrence of mild cognitive impairment(MCI). Methods Perimenopausal women recruited from 2016-2017 in one physical examination center of Lanzhou by convenience sampling, and 1:1 matched case-control study design was conducted in this study, including 179 patients with mild cognitive impairment(MCI) screening by the simple Mini-mental State Examination(MMSE) and 179 individuals with normal cognitive function from the same population matched by age, occupation and education level as controls. Questionnaire survey, laboratory examination, electrocardiogram and imaging examination, and physical examination were applied in this study for all subjects to obtain the general demographic characteristics, the indicators of blood and angiosclerosis, and other indicators. Then, all collected data were analyzed using paired t-test, McNemar test and conditional logistic regression statistics method. Results Data from the nonparametric test analysis showed that there were significant differences in left cardio-ankle vascular index(CAVIL), left ankle-arm index(ABIL), long-term mental stress and ratio of living close to busy traffic road between the case group and control group(P<0.05). Logistic analysis showed that there were five statistically significant influencing factors, including abnormal CAVIL[OR=3.015, 95% CI(1.062, 8.559)], abnormal ABIL[OR=0.139, 95% CI(0.037, 0.526)], family history of hypertension[OR=0.482, 95% CI(0.235, 0.987)], frequent overeating habit[OR=3.768, 95% CI(1.088, 13.046)] and living close to busy traffic road[OR=14.029, 95% CI(6.125, 32.134)]. Multivariate analysis showed that living close to busy traffic road[OR=10.071, 95% CI(5.072, 19.996)] and abnormal ABIL[OR=0.205, 95% CI(0.078, 0.541)] may affect the occurrence of MCI in perimenopausal women. Conclusion Living close to busy traffic road and dysfunction of artery may be the risk factors of MCI among perimenopausal women.

Observation and evaluation of deep breathing trainer used for postoperative pulmonary complications in elderly patients with upper abdominal surgery

SHEN Xu, SHEN Qi-hong, GAO Jie-yan, ZHOU Xu-yan

2020, 18(4): 581-584. doi: 10.16766/j.cnki.issn.1674-4152.001303

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Objective To observe and evaluate the effect of a deep breathing trainer during perioperative period on postoperative pulmonary complications in elderly patients with elective upper abdominal surgery. Methods From January to December 2017, 100 elderly patients with upper abdominal surgery in our hospital were selected and randomly divided into study group and control group, with 50 cases in each group. During the perioperative period(5 days before operation-7 days after operation), the control group was given routine surgical intervention, while on the basis of the control group, the study group received intensive intervention of respiratory function exercise with deep breathing trainer 5 days before operation to 7 days after operation(6 hours after operation). Clinical observation index included forced vital capacity(FVC), 1 s expiratory volume(FEV1), maximum deep inspiration volume(IC), partial pressure of oxygen(PaO₂), partial pressure of carbon dioxide(PaCO₂), blood oxygen saturation(SaO₂) at the time points of preoperative(5 d, 1 d) and postoperative(1 d, 4 d, 7 d). At the same time, the anesthesiologist used the improved bedside ultrasound lung examination protocol(BLUE) method to dynamic examination at beside, to observe whether there were pulmonary complications such as pulmonary insufficiency and pulmonary infection. Results Compared with control group, the levels of FVC, FEV1 and IC in the observation group were significantly increased, and the indexes of PaO₂, PaCO₂ and SaO₂ were significantly improved. The incidence rate of postoperative atelectasis and pulmonary infection in the observation group was significantly less than that of the control group, and the average length of stay was shorter. Conclusion The use of deep breathing trainer in elderly patients during the perioperative period can effectively improve the lung function, reduce the incidence of postoperative pulmonary complications, improve the quality of patient's life, and has great significance to promote rapid recovery.

Effects of dexmedetomidine preconditioning on postoperative oxidative stress and intestinal barrier function in elderly patients undergoing laparoscopic surgery

LIU Hao, LU Jin-gang, ZHAO Peng-cheng, XU Kai

2020, 18(4): 585-588,604. doi: 10.16766/j.cnki.issn.1674-4152.001304

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Objective To analyze the effects of dexmedetomidine pretreatment on postoperative oxidative stress and intestinal barrier function in elderly patients undergoing laparoscopic surgery. Methods Seventy-four patients who underwent laparoscopic surgery at Xixi Hospital from January to December 2018 were divided into dexmedetomidine group(37 cases) and control group(37 cases) according to whether they received dexmedetomidine pretreatment. The general data, heart rate and blood pressure before anesthesia, 1 min, 5 min and 30 min after anesthesia were compared. The oxidative stress and intestinal barrier function were compared 24 h after surgery. Results There were no significant differences in blood pressure, heart rate, adverse reactions, preoperative oxidative stress, and intestinal barrier function between the two groups(all P>0.05). The sedative effect and the recovery time after stopping the drug of the dexmedetomidine group were significantly lower than those of the control group(all P<0.05). The Ramsay scores at 1 h and 2 h after operation of the dexmedetomidine group were significantly higher than those of the control group(all P<0.05). The dose of fentanyl of the dexmedetomidine group was significantly lower than that of the control group(P=0.001). The MDA of the two groups was increased, and the SOD, GSH-Px, TAS, I-FABP, endotoxin, DAO and D-Lactic acid was decreased after operation. The MDA, I-FABP, endotoxin, DAO and D-lactic acid of the dexmedetomidine group were significantly lower than those of the control group(all P<0.05), and the SOD, TAS, GSH-Px were significantly higher than those of the control group(all P<0.05). Conclusion Pretreatment with dexmedetomidine can effectively shorten the onset of sedation and recovery time after surgery, which can effectively improve the postoperative intestinal damage and reduce the occurrence of oxidative stress.

Effect of enalapril maleate folate tablets on Hcy in patients with H-type hypertension

DUAN Jun-cang, WANG You-peng, ZOU Nan, ZHANG Zhao-wei

2020, 18(4): 589-592. doi: 10.16766/j.cnki.issn.1674-4152.001305

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Abstract:
Objective To analyze the effect of enalapril maleate folate tablets on homocysteine(Hcy) in patients with H-type hypertension, in order to explore the effective treatment of the disease and promote the early recovery of patients. Methods A total of 86 patients with H-type hypertension diagnosed and treated in our hospital from September 2018 to September 2019 were divided into group A(43 cases) and group B(43 cases) according to the sequence of admission. Enalapril maleate tablets and enalapril maleate folate tablets were used for treatment respectively, and the blood pressure level(systolic and diastolic pressure), blood pressure reduction effect, Hcy level and carotid ultrasonography results(Intima-media thickness and plaque area of common carotid artery) of the two groups were compared. Results The systolic blood pressure and diastolic blood pressure of group B[(119.5±9.2) mm Hg,(79.5±7.0) mm Hg] were lower than those of group A[(136.3±10.4) mm Hg,(87.1±8.3) mm Hg], the difference were statistically significant(t=7.934, 4.590, all P<0.05). The total effective rate of group B(93.0%, 40/43) was higher than that of group A(76.7%, 33/43), the difference is statistically significant(χ²=4.440, P<0.05). The Hcy level of group B[(10.5±3.3) μmol/L] was lower than that of group A[(13.8±3.6) μmol/L], the difference is statistically significant(t=4.431, P<0.05). The intima-media thickness and carotid plaque area of group B[(1.13±0.16) mm,(19.87±1.82) mm²] were lower than those of group A[(1.19±0.17) mm,(21.79±1.89) mm²], the difference is statistically significant(t=1.685, 4.798, all P<0.05). Conclusion Enalapril maleate folate tablets have ideal therapeutic effect in the treatment of H-type hypertension, can reduce the water pressure and Hcy level of patients, and can improve the results of carotid ultrasonography, the total effective rate of hypotensive effect is high, which is helpful to stabilize patients' condition and promote their early recovery, which is worthy of clinical implementation.

Therapeutic effect of low-dose azithromycin combined with montelukast sodium on children with recurrent lower respiratory tract infection

ZHAO Ming-lei, CENG Chun-ye, ZHAO Yong, PENG Wan-sheng

2020, 18(4): 593-596. doi: 10.16766/j.cnki.issn.1674-4152.001306

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Abstract:
Objective To observe the clinical efficacy of low-dose azithromycin combined with montelukast sodium in the treatment of recurrent lower respiration tract infection(RLRTI) in children. Methods Total 80 children with recurrent lower respiratory tract infection diagnosed as bacterial pneumonia admitted to the Department of Pediatrics of Huaibei People's Hospital from January 2017 to December 2018 were selected as the RLRTI group. They were divided into low-dose group and normal dose group according to the dose of oral azithromycin, 40 patients in each group. Forty children diagnosed with bacterial pneumonia in the same period were selected as control group. The low-dose group was given 5 mg/kg azithromycin and 4 mg of montelukast sodium granules on the basis of the control group. The normal dose group was treated with 10 mg/kg azithromycin and montelukast sodium granules 4 mg orally. The laboratory data of the three groups were counted. All the children's data were included in the Excel database for statistical analysis. SPSS 22.0 software was used. Statistical analysis was performed to observe the clinical symptoms, signs and prognosis of the children. Results At admission, there was a statistically significant difference in eosinophils(EOS) and total IgE between the RLRTI group and the control group(all P<0.05). After treatment, the differences in white blood cell(WBC), neutrophil(N), hypersensitive C-reactive protein(hs-CRP), procalcitonin(PCT), total IgE and hospitalization between the two groups were statistical significance(all P<0.05), and there was no significant difference in EOS(P>0.05). There was significant difference in the total effective cases between the three groups(χ²=18.813, P<0.001). There was a statistically significant difference in total adverse reactions between the low-dose group and the normal dose group(χ²=16.241, P<0.001). There was a statistically significant difference in the number of total recurrences after discharge from the three groups(χ²=9.279, P=0.010). Conclusion Low-dose azithromycin combined with montelukast sodium can significantly shorten the length of hospital stay in children with RLRTI, reduce the adverse reactions and recurrence rate of children, and reduce the time of intravenous antibiotic use and the number of hospitalizations.

Analysis of influence factors of cholesterol and glycosylated hemoglobin concentration in infant

DAI Fang-di, LI Yan-hua, GAO Li-juan

2020, 18(4): 597-600. doi: 10.16766/j.cnki.issn.1674-4152.001307

257 1

Abstract:
Objective To explore the correlation of infant cholesterol and glycosylated hemoglobin concentration with maternal factors and infant dietary factors. Methods A total of 524 children from January 2016 to January 2019 were selected from the outpatient clinic of Zhoushan Maternal and Child Health Hospital. According to the criteria, 143 cases were eventually included, of which 84 were born 6 months and 59 were born 12 months. Dietary survey was conducted between the infants and their mothers, and the levels of total cholesterol(TC) and glycosylated hemoglobin(HbA1 c) were measured by intravenous blood. The influence factors of TC and HbA1 c in infants were analyzed by multivariate regression. Results The TC level of infants varied from 2.3 to 6.6 mmol/L with an average concentration of(4.1±0.8) mmol/L. Spearman correlation analysis showed that maternal TC level and dietary protein of infants were positively correlated with TC level of infants(r=0.391, 0.279, all P<0.05). After multivariate regression, maternal TC level and dietary protein of infants were independently correlated with TC of infants(P<0.05). The level of HbA1 c in infants ranged from 3.7 to 6.0 mmol/L with an average concentration of(4.9±0.4) mmol/L. There was no correlation between maternal factors, diet and HbA1 c of infant(P>0.05) by univariate and multivariate regression analysis. Conclusion Maternal TC level and infant dietary protein ratio can affect infant TC level, so it is necessary to control maternal TC level and infant dietary protein ratio to reduce the incidence of infant TC.

Observation on the clinical efficacy of pituitrin combined with hysteroscopic negative pressure hysteroscopy in the treatment of type Ⅱ cesarean scar pregnancy

DONG Li-shu, SHEN Xiang

2020, 18(4): 601-604. doi: 10.16766/j.cnki.issn.1674-4152.001308

205 1

Abstract:
Objective To observe the effect of pituitrin combined with hysteroscopic negative pressure cleaning on the recovery and adverse reactions of type Ⅱ cesarean scar pregnancy. Methods A total of 180 cases of type Ⅱ cesarean scar pregnancy whom were admitted to obstetrics department of Luzhou maternal and child health hospital from April 2017 to April 2019 were as the research object, all the patients were divided into control group(n=90) and research group(n=90) according to random number table method. The patients in the control group were treated with bilateral uterine artery embolization combined with hysteroscopy negative pressure uterine clearance, while the patients in the study group were treated with pituitrin injection combined with hysteroscopy negative pressure uterine clearance. The operation duration, intraoperative bleeding volume, postoperative vaginal bleeding duration, hospitalization time, β-hCG recovery time, postoperative menstrual recovery time, menstrual recovery cycle and menstrual duration were counted, and the adverse reactions were observed. Results The amount of bleeding during uterine clearance in the study group[(23.67±3.47)mL] was significantly less than that in the control group[(34.81±6.95)mL], the duration of vaginal bleeding after operation[(5.84±1.62)d] and the length of hospitalization[(5.07±1.38)d] were significantly shorter than those in the control group[(9.36±2.49) d and(8.42±2.01) d, all P<0.001].The recovery time of menstruation in the study group[(37.96±3.85)d] were significantly shorter than those in the control group[(42.72±4.03)d, t=-8.825, P<0.001]. The incidence of the adverse reactions of the study group(1.11% and 0.00%) was significantly lower than that of the control group(8.89% and 6.67%, χ²=4.211, 4.310, P=0.040, 0.038). Conclusion Compared with bilateral uterine artery embolism, hysteroscopic negative pressure hysteroscopy after pituitrin injection can significantly reduce intraoperative bleeding, shorten the recovery period after operation, promote menstruation and ovulation recovery, reduce the incidence of adverse reactions after operation, which is safe and worthy of clinical application.

Observation on the clinical effect of local injection of lauromacrogol and methotrexate under ultrasound intervention in the treatment of cesarean scar pregnancy in the elderly

XU Chen, LI Ming-zhu, LOU Ye-lin, FENG Bei

2020, 18(4): 605-608,633. doi: 10.16766/j.cnki.issn.1674-4152.001309

165 1

Abstract:
Objective To observe the clinical effect of local injection of lauromacrogol and methotrexate under ultrasound intervention in the treatment of cesarean scar pregnancy(CSP) in the elderly. Methods Total 170 elderly patients with CSP were divided into control group(n=85) and research group(n=85) according to random number table method. The patients in the research group were treated by vacuum curettage after local injection of lauromacrogol and methotrexate, while the patients in the control group were treated by uterine artery embolization and vacuum curettage. The amount of intraoperative bleeding, length of stay, time of β-hCG turning negative, time of menstrual recovery and time of ovulation recovery were recorded. The changes of serum FSH, LH, E2 and AMH levels before and after treatment were measured. The adverse reactions and complications were observed. Results There was no significant difference between the two groups in the amount of intraoperative bleeding, the length of stay, the time of β-hCG turning negative and the time of focus disappearance(all P>0.05). The total treatment cost of the research group[(5 967.34±384.96)yuan] was significantly lower than that of the control group[(12 236.51±795.02)yuan, t=-12.985, P<0.001]. The menstrual recovery time[(36.82±3.93)d] and ovulation recovery time[(96.37±12.84)d] in the research group were significantly shorter than those in the control group[(40.69±4.31)d and(114.19±15.62) d, t=-4.196,-6.803; P<0.001]. The level of FSH in the study group was significantly lower than that in the control group, and the level of AMH and E2 was significantly higher than that in the control group at 1 months after operation(t=-3.796~2.972, all P<0.05). The overall incidence of short-term adverse reactions and long-term complications in the research group(12.94%) was significantly lower than that in the control group(27.06%), χ²=5.294, P=0.021. Conclusion Compared with uterine artery embolization, local injection of lauromacrogol combined with methotrexate under ultrasound intervention has less influence on ovarian function of elderly CSP patients, which is conducive to promoting the recovery of menstruation and ovulation function, reducing postoperative adverse reactions and complications, and reducing medical costs.

Analysis of fertility status, complications and adverse pregnancy outcomes in 310 elderly parturient wome

WANG Hai-na, GU You-fei, LU Jing-jing, ZHANG Shu-zhen

2020, 18(4): 609-611. doi: 10.16766/j.cnki.issn.1674-4152.001310

321 3

Abstract:
Objective To analyze the fertility status of elderly parturients, and compare with the complications and adverse pregnancy outcomes of parturients in the same period. Methods From July 2018 to October 2019, 310 elderly parturients who delivered in the Department of Obstetrics and Gynecology of Putuo District People's Hospital of Zhoushan City were selected as the observation group, and 310 suitable age parturients who delivered in our hospital at the same period were selected as control group. The delivery mode, complications and adverse pregnancy outcomes of the two groups were compared. Results The cesarean section rate in the delivery mode of the observation group(20.00%) was significantly higher than that of the control group(6.45%), P<0.05. The adopted natural delivery was 54.19% and 65.16% in the observation group and the control group, the painless delivery was 25.81% and 28.39%. The incidence rate of complications of preeclampsia, postpartum hemorrhage, placenta previa and hypertensive disorder complicating pregnancy in the observation group was significantly higher than those in the control group(all P<0.05), and the most typical one was preeclampsia. The incidence rates of the observation group and the control group were 19.03% and 5.16%, respectively, with significant difference(χ²=9.047, P=0.003). The incidence of adverse pregnancy outcomes of macrosomia, low birth weight infants and neonatal asphyxia in the observation group was significantly higher than those in the control group(all P<0.05). Conclusion Elderly parturients are more prone to complications such as preeclampsia, postpartum hemorrhage, placenta previa and hypertensive disorder complicating pregnancy. Newborns often suffer from macrosomia and low body weight. Painless delivery or cesarean section is usually selected for delivery methods. Therefore, perinatal health care should be done for elderly parturients to reduce the incidence of complications and adverse pregnancy outcomes as much as possible to ensure the safety of mothers and infants.

Correlation research between family care and alexithymia in community empty-nest elderly

MENG Wei, MA Xin-li, HUANG Zi-qi

2020, 18(4): 612-614. doi: 10.16766/j.cnki.issn.1674-4152.001311

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Abstract:
Objective To survey the current status of family care and alexithymia of community empty-nest elderly in Changchun, explore the correlation, and provide reference for improving the level of family care and reducing alexithymia. Methods A questionnaire survey was conducted among 538 empty-nest elderly in Changchun by stratified sampling. The questionnaire includes general demographic data questionnaire, family care scale, Toronto Alexithymia Scale. The data were analyzed by SPSS 20.0, including descriptive analysis, t-test and analysis of variance, Pearson correlation analysis. Results The family care score of community empty-nest elderly in Changchun was(6.81±2.15), the scores of long empty nest time, no children in the same city, living alone elderly is lower(F=6.280, t=3.884, t=3.012, all P<0.01). The score of alexithymia was(59.05±5.67), 64(11.89%) without alexithymia, 304(56.51%) with possible alexithymia, 170(31.60%) with alexithymia. The scores of the elderly in community with older, childless in the same city, living alone and dissatisfied with community health services were higher(F=44.400, t=11.104, t=8.066, t=3.875, all P<0.01). There was a significant negative correlation between family care and alexithymia in community empty-nest elderly(r=-0.279, P<0.01). Conclusion The level of community empty-nest elderly's family care in Changchun needs to be improved. The level of alexithymia is relatively high, and improving family care could reduce the level of alexithymia.

Effect of family physicians involved community-based comprehensive psychological intervention on the quality of life of type 2 diabetics

ZHENG Dong-peng, LU Ai-min

2020, 18(4): 615-618. doi: 10.16766/j.cnki.issn.1674-4152.001312

235 2

Abstract:
Objective To study and evaluate the effect of intervening measures on the mental health, quality of life and blood glucose by conducting both routine treatment and community-based psychological intervention on type 2 diabetics. Methods A group of 180 type 2 diabetics was recruited from chronic disease management information system in Kangjian community service center in Shanghai from January 2018 to January 2019. These diabetics were divided into intervention group and control group randomly with random number table method. Besides routine treatment, chronic disease management and health education, the intervention group received periodical community-based psychological intervention that was conducted by family physicians and national psychological consultants biweekly on group and monthly on each individual. All subjects of the two groups were assessed with the methods of SCL-90 and diabetes-specific quality of life scale(DQOL), and their levels of FPG, PPG,HbA1 C were tested before and after the treatment. Results All factors of SCL-90 were statistically significant different from the national norm(all P<0.05). Firstly, we compared the pre-and post-treatment results within the same group. As for SCL-90, in control group the factors except interpersonal sensitivity were statistically significant(all P<0.05), while in intervention group none of the factors was statistically significant(all P<0.05). As for DSQL, in control group, the dimensions except treatment dimension were statistically significant(all P<0.05), while in intervention group none of the dimensions was statistically significant(all P<0.05). Secondly, we compared post-treatment results of the two groups. All the factors of SCL-90 were statistically significant except compulsion, interpersonal relationship and psychosis factors. All the dimensions in DSQL were statistically significant except physiological dimension, and the differences in PPG between the two groups was also statistically significant. Conclusion Family physicians involved community-based comprehensive psychological intervention could improve the mental health and blood glucose, and the quality of life of type 2 diabetics.

Research on the effect of health education based on WeChat public platform "little course assistant" in IVF-embryo transfer patients

FANG Li-zi, LU Xiao-sheng, QIU Shi-mei, HUANG Chao-xia

2020, 18(4): 619-622. doi: 10.16766/j.cnki.issn.1674-4152.001313

213 1

Abstract:
Objective To study the effect of health education based on the WeChat public platform "Small Course Assistant" in IVF-ET patients. Methods A total of 200 patients who underwent IVF-ET for the first time at the Reproductive Center of the Second Affiliated Hospital of Wenzhou Medical University from June to December 2018 were selected. According to the time of admission, there were 100 cases in the control group and 100 cases in the research group. The control group was given routine education in the reproductive center. The observation group used a small assistant based on WeChat public platform for education. The negative emotion and disease awareness of the two groups of patients before and after the intervention, and patient compliance were compared. Results After the intervention, the anxiety self-assessment scale(SAS) and depression self-assessment scale(SDS) of the study group were(38.61±5.83) points and(37.78±4.29) points, significantly lower(45.22±6.15) points and(42.16±5.03) points in the control group. The difference was statistically significant(t=-7.802,-6.624, all P<0.05). After the intervention, the disease awareness of the study group was significantly higher than that of the control group. The difference was statistically significant(Z=-5.000, P<0.05). In the study group, the four compliance scores of reasonable diet, medical examination, regular medicine and regular rest and exercise were(5.79±0.39) points,(3.96±0.13) points,(5.97±0.18) points, and(3.90±0.28) points, respectively. Significantly higher than(5.51±0.60) points,(3.90±0.22) points,(5.89±0.28) points,(3.72±0.41) points in the control group. The difference was statistically significant(t=3.912, 2.348, 2.404, 3.626, all P<0.05). Conclusion Health education based on WeChat public platform "Small Course Assistant" can significantly improve the negative emotions of patients with IVF-ET, increase patient awareness and compliance, recommended.

The study of CT radionics in assessing the efficacy of pulmonary adenocarcinoma chemotherapy before treatment

YU Ye-zhou, ZHAO Hong, WANG Long-sheng, BAO Fang, ZOU Li-wei, DUAN Shao-feng, YANG Jin

2020, 18(4): 623-626,701. doi: 10.16766/j.cnki.issn.1674-4152.001314

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Abstract:
Objective To discuss the value of CT soft tissue window radionics in assessing the efficacy of pulmonary adenocarcinoma chemotherapy. Methods Images and case materials of 105 patients pathologically diagnosed with pulmonary adenocarcinoma in our hospital from December 2015 to December 2018 were retrospectively collected. After half-year chemotherapy, the patients were assigned to the response group(35 cases) and non-response group(70 cases) according to RECIST. The non-response group was divided into the stable group(35 cases) and progression group(35 cases). For all patients, their CT soft tissue images before chemotherapy were obtained, and the lesions were manually segmented using ITK-SNAP software. The focal features of those CT soft tissue images analyzed by AK analysis software were extracted using radionics methods, and then subjected to Lasso dimensionality reduction and RTree modeling. The model for comparison between the response group and the non-response group was calculated using the receiver operating characteristic curve(ROC) and image omics model to assess the diagnostic efficiency of chemotherapy efficacy. Results Based on the images of response group and the non-response group, 12 significant texture features were extracted, including 5 co-occurrence matrices(GLCM) and 7 run-length matrices(RLM). The training group's AUC, diagnosis sensitivity and specificity were 0.80, 0.68 and 0.80, respectively. The validation group's AUC, diagnosis sensitivity and specificity were 0.74, 0.70 and 0.81, respectively. The AUC values of both groups were between 0.7-0.9, which also achieved good diagnostic value. The decision curve of image omics model had a good clinical practicability in the range of 0.18-0.76. Conclusion Radionics based on the CT images before chemotherapy may help exactly assess the efficacy of pulmonary adenocarcinoma chemotherapy before treatment.

The value of low dose perfusion CT in evaluating the prognosis of ischemic stroke in recovery period

ZHANG Ya-ping, CHEN Bing, QIAN Wei-yong, XU Xiao, ZHAO Zhen-hua

2020, 18(4): 627-629,693. doi: 10.16766/j.cnki.issn.1674-4152.001315

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Abstract:
Objective To explore the application value of routine CT and perfusion CT in evaluating the prognosis of ischemic stroke in recovery period, and to clarify the application advantage of low dose perfusion CT. Methods A total of 80 patients in the recovery period of ischemic stroke diagnosed and treated in our hospital from May 2018 to May 2019 were included in the study by retrospective analysis. All patients underwent routine CT scan and perfusion CT scan. At the same time, according to different doses of perfusion scan, they were divided into routine dose group and low-dose group with 40 cases in each group. The results of the two groups were compared, and the prognosis evaluation of low-dose perfusion CT was analyzed. Results The old infarcts were detected by regular CT scan in 80 patients. The old infarcts were detected by perfusion CT in 57 patients, including 28 by conventional dose perfusion CT and 29 by low dose perfusion CT. There was no significant difference between the two groups in the detection of cerebral blood flow, cerebral blood volume, mean transit time and local perfusion peak time in infarct center and ischemic area(all P>0.05). Under low dose perfusion CT examination, the detection values of cerebral blood flow and cerebral blood volume in ischemic area[(0.79±0.30) mL/(min·g),(0.93±0.22) mL/g] were higher than those in infarct center area[(0.22±0.19) mL/(min·g),(0.27±0.13) mL/g], and the detection values of mean transit time and local perfusion peak time[(12.7±3.1) s,(22.1±4.0) s] were lower than those in infarct center area[(18.8±3.9) s,(24.4±3.7) s], with statistical difference significance(t=10.152, 16.335, 7.744, 2.670, all P<0.05). The radiation dose of low dose group[(1.50±0.27) mSv] was significantly lower than that of conventional dose group[(3.48±0.61) mSv], with the significant difference(t=18.772, P<0.001). Conclusion The perfusion CT is helpful to evaluate the prognosis of patients in the recovery period of ischemic stroke, and it can accurately evaluate the improvement degree of local blood flow perfusion in the ischemic area, and low dose perfusion CT can reduce the radiation dose, which has an important guiding significance for clinical diagnosis and treatment.

Application of liver and spleen volume measurement in assessing the degree of liver fibrosis in patients with HBV infection

SONG Chun-yao, WANG Zi-rong, TANG Dong

2020, 18(4): 630-633. doi: 10.16766/j.cnki.issn.1674-4152.001316

179 1

Abstract:
Objective To evaluate the value of liver spleen volume measurement in assessing the degree of liver fibrosis in patients with hepatitis B virus(HBV) infection. Methods Total 110 HBV-infected patients with cirrhosis diagnosed at the Hangzhou Normal University Affiliated Hospital from February 2015 to August 2018 were enrolled. The 42 healthy adults treated in our hospital were selected as the control group. Spiral CT scans were performed to measure the volume of each hepatic lobe and the volume of spleen. The ratio of each hepatic lobe volume/total liver volume and the ratio of total liver volume/spleen volume were calculated and compared with the pathological results. Results The volume of the left lateral lobe, the volume of the caudate lobe and their ratio to the whole liver volume were the smallest in the control group, and increased gradually with the progress of liver fibrosis, and the volume of the left lateral lobe was the largest in the cirrhosis group(all P<0.05). The right lobe, quadrate lobe and total liver volume were the largest in stage S2 and then decreased with the progress of liver fibrosis, and the smallest in cirrhosis group(all P<0.05). The volume of spleen increased continuously with the progress of liver fibrosis, and its volume was the largest in the subgroup of cirrhosis. The value of whole liver volume/spleen volume decreased continuously with the progress of liver fibrosis, and was the smallest in the cirrhosis group(all P<0.05). The values of left lateral lobe volume/total liver volume, tail lobe volume/total liver volume were positively correlated with liver fibrosis(all P<0.05), while the values of total liver volume/spleen volume were negatively correlated with left lateral lobe volume/total liver volume, and liver fibrosis(all P<0.05). Conclusion Measuring the volume of liver and spleen by spiral CT is a non-invasive and reliable method to evaluate the degree of liver cirrhosis after HBV infection. With the progress of liver fibrosis, the volume of liver and spleen has different degrees of correlation with it, among which the volume of left lateral lobe, caudate lobe and spleen is higher correlation with fibrosis.

Differential diagnosis and misdiagnosis of benign and malignant breast cancer by shear wave elastography

SHEN Chao-ming, CHEN Shu-xia, WU Wu-long, YAN Cao-xin

2020, 18(4): 634-637. doi: 10.16766/j.cnki.issn.1674-4152.001317

239 1

Abstract:
Objective To analyze the differential diagnosis and misdiagnosis of benign and malignant breast cancer by shear wave elastography. Methods A total of 146 patients with microscopic lesions of the breast who were treated in our hospital from January 2017 to January 2019 were enrolled, including 48 malignant tumors and 98 benign tumors. All patients underwent shear wave elastography and ultrasonography. The diagnostic efficacy of two methods for benign and malignant breast lesions was compared. Univariate and multivariate logistic regression models were used to analyze the misdiagnostic factors affecting small breast lesions by shear wave elastography. Results The diagnostic efficiency of shear wave elastography for breast small lesions was higher than that of B-ultrasound(all P<0.05). Univariate and multivariate logistic regression analysis showed that lesions<8 mm(OR=11.284, P=0.006) and carcinoma in situ(OR=8.402, P=0.044) were independent risk factors leading to false negative test results; distance from the skin>9 mm(OR=8.116, P=0.006), distance from the shallow chest wall<2 mm(OR=11.831, P=0.002), breast thickness>24 mm(OR=10.032, P=0.006) were independent risk factors leading to false positive test results. Conclusion Shear wave elastography can qualitatively and quantitatively analyze the benign and malignant lesions of breast microscopic lesions, and has high diagnostic efficiency, but there are still some factors leading to misdiagnosis.

Research current and Future of Biomarkers of brain injury

XIE Feng-xin, ZHANG Dong-yun, FU Wei-ling, ZHANG Yang

2020, 18(4): 638-641,661. doi: 10.16766/j.cnki.issn.1674-4152.001318

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Abstract:
Traumatic brain injury(TBI) is the most common acquired brain injury. About 43% of TBI survivors are also accompanied by chronic disabilities, and their death and disability rates are high. Neuronal cell death could be induced by the following mechanisms,such as direct attack,hypoxic-ischemic brain injury, cytokines,inflammatory mediators after TBI. How to diagnose TBI early, quickly and accurately plays an extremely important role in guiding clinical treatment and judging prognosis. The current clinical diagnosis mainly depends on Glasgow Coma Score(GCS) and clinical imaging such as craniocerebral CT and magnetic resonance imaging(MRI).But in recent years, with the development of disease markers and liquid biopsy technology, TBI related biomarkers are expected to clinical application, providing important diagnostic value for early diagnosis, dynamic monitoring and evaluation the prognosis. A large number of bio-molecular markers are generated during the development of TBI,Biomedical markers of TBI appear early in the serum and cerebro-spinal fluid with a higher sensitivity and specificity than image examination. An intensive study of the change regularity of biomarkers after TBI is of important significance for clinical therapy.It provides a new basis and clue for the treatment of TBI. Some promising TBI biomarkers are summarized in this paper, including conventional biomarkers, brain tissue injury markers, secondary injury markers, and emerging molecular diagnostic markers such as susceptible genes and cell free nucleic acids. And, the development direction of accurate laboratory diagnosis of TBI is also forecasted. This review is organized in order to provide reference for TBI related biomarkers and development for new clinical laboratory diagnostic techniques.

Progress in the efficacy and safety of calcium and vitamin D in the treatment of primary osteoporosis

FENG Cheng-zhen, LI Jun-wei, LI Yan-hua

2020, 18(4): 642-645. doi: 10.16766/j.cnki.issn.1674-4152.001319

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Abstract:
Osteoporosis(OP) is a skeletal disorder characterized by decreased bone strength and increased risk of fractures. With the aging of population structure in China, the incidence of osteoporosis is increasing year by year. Primary osteoporosis is a systemic bone disease common in the elderly, women than men, common in postmenopausal women and the elderly, mainly including Ⅰ postmenopausal osteoporosis and Ⅱ senile osteoporosis. In order to improve the quality of life, reduce the economic burden of medical care and promote the rational allocation of resources, prevention and treatment of osteoporosis has become the key. And how to effectively treat osteoporosis has become a problem that our country and even the whole world have to face. In recent years, with the joint efforts of experts and scholars from various countries, more and more methods can be used to treat osteoporosis. Among them, calcium and vitamin D are the most commonly used drugs in the treatment of patients with osteoporosis. Before the introduction of evidence-based medicine, calcium and vitamin D supplements have been used as the basis for the treatment of osteoporosis. However, adverse reactions of oral calcium and vitamin D, such as gastrointestinal discomfort, kidney stones and cardiovascular adverse events, have begun to raise questions about the effectiveness of calcium in the treatment of osteoporosis. After the introduction of evidence-based medicine, many experts and scholars at home and abroad began to study calcium and vitamin D, and their effectiveness and safety deserve our attention. Based on the related literature, this paper reviews the research progress on the efficacy and safety of calcium and vitamin D in the treatment of osteoporosis in recent years. Conclusion:calcium and vitamin D have definite effects on osteoporosis, and active vitamin D is better than simple vitamin D. The combination of calcium and vitamin D is more effective than the single drug, and is recommended for the treatment of osteoporosis when adverse reactions are controlled.

Research progress on the treatment of erectile dysfunction with traditional Chinese medicine

HUANG Feng-xian, LI Pei-lun, LIU Qing, TAO Fang-ze, GAO Dou

2020, 18(4): 646-650. doi: 10.16766/j.cnki.issn.1674-4152.001320

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Abstract:
Erectile dysfunction is a common male disease. The patient's penis cannot continuously get a full erection, and it is difficult to complete satisfactory sexual intercourse, which has a great negative impact on the normal life. The patients also suffer from great mental stress, a significant reduction in life satisfaction, prone to depression and other adverse emotions, so this kind of disease should be paid attention to. Clinical treatment of erectile dysfunction is mainly aimed at the prevention and treatment of primary disease and psychological guidance, its long-term efficacy is not ideal, which seriously affects quality of life, reduces work efficiency, and increases medical costs. This not only has a serious impact on the physical and mental health of the patients, but also brings severe challenges to clinical treatment. Therefore, it is urgent to provide effective treatment. With the research on erectile dysfunction, traditional Chinese medicine has been widely applied to the treatment of erectile dysfunction, achieving a more significant clinical efficacy. The literatures of Chinese medicine in treating erectile dysfunction in recent years from China National Knowledge Infrastructure were searched, summarized and analyzed. This paper briefly overviews the development of etiology and pathogenesis of traditional Chinese medicine, syndrome differentiation and treatment, special medicine use, Chinese patent medicine treatment and other therapies. It points out the advantages and disadvantages of traditional Chinese medicine in treating this disease. By analyzing the literature on the status of traditional Chinese medicine treatment for erectile dysfunction in recent years, it is found that the clinical efficacy of traditional Chinese medicine treatment is clear, with unique advantages and small adverse reactions.

Research progress of low magnesium hemorrhage in dialysis patients

YU Meng, ZHANG Yan-lin

2020, 18(4): 651-653,697. doi: 10.16766/j.cnki.issn.1674-4152.001321

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Abstract:
Magnesium(Mg) is an essential cationic for a variety of processes in the human body. It is critical to the function of ATP and the synthesis of DNA and RNA, and is an auxiliary factor for more than 300 enzymatic reactions. Magnesium not only plays an important role in neuromuscular processes, but also regulates mineral bone metabolism, adenosine triphosphate metabolism, neurotransmitter release, vascular tension, heart rhythm and platelet activating thrombosis. The kidney plays a major role in regulating magnesium balance, and the plasma magnesium concentration in patients with advanced chronic kidney disease(CKD) usually shows a high magnesium trend due to the decrease of glomerular filtration. Therefore, for a long time, the general policy of dialysis patients is to avoid magnesium load. However, hypomagnesemia is relatively common, especially in intensive care units, where the prevalence of low-magnesium disease is high, but is often undetected. For nearly 5 years, some cohort studies have reported that lower levels of serum magnesium are associated with an increased risk of total and cardiovascular death in hemodialysis patients, and increase the risk of a variety of diseases, such as type 2 diabetes, hypertension, atherosclerosis, etc. In addition, many studies have shown beneficial effects of magnesium supplements or increased magnesium concentrations in dialysis fluids, but more prospective studies are needed to confirm these effects. Although, magnesium is of physiological importance, its clinical importance is often underestimated. In fact, magnesium disorders are rarely mentioned in most medical books. In this review, we will discuss the causes of magnesium in dialysis patients, related diseases, and the treatment, in order to provide reference for follow-up research and clinical treatment.

Observation on therapeutic effect of Bushen Zhuangyao extractum combined with Bushen Quyu acupuncture on acute onset of lumbar intervertebral disc herniation

TENG Jin-yan, DING De-guang, HUANG Guo-fu, PAN Hong-ling, MA Fei, SHAO Yi-yan

2020, 18(4): 654-656,685. doi: 10.16766/j.cnki.issn.1674-4152.001322

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Abstract:
Objective To study the therapeutic effect of Bushen Zhuangyao extractum combined with Bushen Quyu acupuncture on acute onset of lumbar intervertebral disc herniation. Methods A total of 120 patients with lumbar disc herniation admitted to Hubei Provincial Hospital of TCM due to acute onset from October 2016 to December 2018 were included in the study, who were divided into the observation group and the control group by random number table method, 60 cases in each group. Among them, the control group was treated with Bushen Quyu acupuncture, and the observation group was treated with Bushen Zhuangyao extractum orally on the basis of the control group. The curative effect was observed after 2 weeks of continuous treatment, and the changes of JOA low back pain score, ODI score, serum inflammatory factors and pain-related mediators before and after treatment were compared. Results The total effective rate of the observation group after treatment was 88.3%, which was significantly better than that of the control group(75.0%, χ²=5.604, P<0.05). There were no statistically significant differences in JOA low back pain score, ODI score, the inflammatory factor levels of IL-1β, IL-6, IL-10, TNF-α and the levels of pain-related mediator PGE2, 5-HT, BK, NPY between the two groups before treatment(all P>0.05), which were comparable. Compared with before treatment, the above indicators were significantly improved in both groups after treatment(all P<0.05). Compared with the control group, the above indicators in the observation group were also significantly improved after treatment(all P<0.05). Conclusion Bushen Zhuangyao extractum combined with Bushen Quyu acupuncture for the treatment of acute onset of lumbar intervertebral disc herniation has a significant effect, which can significantly improve the clinical symptoms of patients and reduce the level of inflammatory reaction and pain mediators.

Professor Cui Yun's experience of paired drugs and the three drugs pairing in treating oligoasthenospermia

LI Pei-lun, CUI Yun, TAO Fang-ze, ZHENG Jun-zhuang, LIU Bing, LIU Qing, FANG Teng-duo, REN Guo-qing, QIN Pei-zhi, LIU Qing-hua

2020, 18(4): 657-661. doi: 10.16766/j.cnki.issn.1674-4152.001323

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Abstract:
Objective To summarize Professor Cui Yun's experience of paired drugs and the three drugs pairing in treating oligoasthenospermia. Methods The clinical cases of oligoasthenospermia treated by Professor Cui Yun were collected. Professor Cui Yun's experience of paired drugs and the three drugs pairing in treating oligoasthenospermia were comprehensively analyzed on the basis of fully understanding the etiology and pathogenesis. The medication thinking and theory of Cui Yun's experience in treating oligoasthenospermia were discussed, and a case was given to prove it. Results Professor Cui Yun thought that the cause of oligozoospermia was closely related to kidney, liver, heart, spleen, lung organs, qi and blood, damp-heat and turbidity toxin. In view of the characteristics of pathogenesis, we taken paired drugs and the three drugs pairing such as "treatment of liver and kidney" "pleasant the heart and tranquilizing the mind" "smoothing the liver and regulating the stomach" "generation between the metal and water" "regulation of qi and blood", and "detoxification and dispel turbidity". "Nvzhenzi-Hanliancao" "Chaihu-Xuduan" "Shengdihuang-shanyao-Shanzhuyu" "Wuweizi-Fuling" "Yuanzhi-Shichangpu" "Dazao-Huangqin" "Shengguya-Shengmaiya" "Shanzha-Wuweizi" "Maidong-Wuweizi" "Huangqi-Dangshen-Danshen" "Danggui-Chuangxiong" "Diyu-Huzhang" "Guanzhong-Shengma-Xixiancao" were the most common used herb pairs and the three drugs pairing in practice. Professor Cui Yun was good at theoretical innovation in treating oligoasthenospermia based on syndrome differentiation according to the theory of liver and kidney. The treatment methods included that strengthening the body resistance to eliminate pathogenic factors, therapy of supplementation and draining and therapy of reinforcement and elimination in combination. The drugs for oligoasthenospermia therapy was warm but not dry, nourishing but not greasy. The experience of paired drugs and the three drugs pairing in treating oligoasthenospermia was not only profound but also the mechanism, method, prescription and drug of discriminating was unique. Conclusion The thought of Professor Cui Yun about mechanism and treatment of oligoasthenospermia is profound. It is worth learning and using for reference.

Clinical observation on the treatment of chronic prostatitis with prostate decoction number 2 combined with clysis and acupoint application

SUN Tao, HUANG Xin-fei, YAO Shi-qing, ZHOU Lan, HE Lei, WANG Chao, LIU Wen

2020, 18(4): 662-665. doi: 10.16766/j.cnki.issn.1674-4152.001324

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Abstract:
Objective To observe the curative effect of prostate decoction number 2 combined with clysis and acupoint application on chronic prostatitis(CP). Methods Total 60 patients with type ⅢA CP admitted to the First Affiliated Hospital of Bengbu Medical College from February 2018 to May 2019 were randomly divided into control group(n=30) and observation group(n=30) by simple randomized grouping method. The control group was given one prostate decoction number 2 of 400 mL(take orally twice in the morning and in the evening). The observation group on the basis of the medication of the control group was given prostate moxibustion type Ⅱ applied Shenque, Qihai, Zhongji alternately, twice a week, once for 12 hours; the rectal drip of traditional Chinese medicine(TCM) was used for treatment, enema was performed continuously in the first 15 days of each month, and then rest for 15 days. The two groups were treated for one month as a course of treatment, three courses in a row. Results The main symptoms of TCM in the two groups was of no significant difference before treatment(all P>0.05). After treatment, compared with those in the control group, the scores for main symptoms like frequent urination, urinary urgency, urinary pain, bulge feeling of perineum, aching feeling of perineum in the observation group were decreased(all P<0.05). The scores of NIH-CPSI and SAS in the two groups had not significantly difference before treatment(all P>0.05). After treatment, compared with those in the control group, the scores of NIH-CPSI and SAS were decreased in the observation group(all P<0.05). The leukocyte count and lecithin body in prostate fluid count of the two groups had no statistically significant differences before treatment(all P>0.05). After treatment, the leukocyte count of prostate fluid in observation group significantly was decreased, while the lecithin body count was increased(all P<0.05). Total effective rate had statistically significant differences(χ²=5.079, P=0.024). Conclusion The effect of prostate decoction number 2 combined with clysis and acupoint application have better effect in treating CP than prostate decoction number 2 alone.

Clinical efficacy of oral and external use of traditional Chinese medicine combined with fasudil in treatment of lower extremity arteriosclerosis obliterans in elderly patients

XU Yi, LYU Shuang-yan, WANG Hai-min, YE Hai-dong

2020, 18(4): 666-669. doi: 10.16766/j.cnki.issn.1674-4152.001325

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Abstract:
Objective To investigate the Clinical efficacy of oral and external use of traditional Chinese medicine combined with fasudil in the treatment of lower extremity arteriosclerosis obliterans in elderly patients and its effect on ABI, serum CRP and Hcy. Methods One hundred and four elderly patients with lower extremity arteriosclerosis obliterans admitted to Wenzhou Hospital of Traditional Chinese Medicine from August 2016 to August 2018 were studied. They were randomly divided into control group and observation group, 52 cases in each group. The control group was treated with fasudil. The observation group was combined with traditional Chinese medicine Simiao Yongan Decoction on the basis of the control group.The two groups were treated for one month. The levels of ABI, CRP and Hcy before and after treatment were compared and analyzed. The indexes of dorsal pedal artery(vessel diameter, peak velocity and blood flow) were measured. The clinical efficacy and adverse reactions were observed. Results The total effective rate of the observation group was higher than that of the control group(94.23% vs. 76.92%, χ²=6.310, P=0.012). After treatment, the vessel diameter and blood flow of the two groups significantly increased, and the peak flow rate significantly decreased(P<0.05). Compared with the control group, the observation group had a higher level of blood vessel diameter and blood flow and a lower peak flow velocity(P<0.05).The levels of ABI, CRP and Hcy after treatment in the two groups were significantly improved compared with before treatment, and the ABI levels in the observation group were higher than those in the control group, while the levels of CRP and Hcy were lower than those in the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(11.54% vs. 13.46%, χ²=0.088, P=0.767). Conclusion The combination of oral and external use of traditional Chinese medicine and fasudil has definite curative effect on elderly ASO. It can effectively inhibit inflammation, improve blood flow of lower limbs, increase ankle-brachial index and reduce the level of Hcy. There is no obvious adverse drug reactions. It is an effective treatment program.

Exploration and preliminary practice of cultivating humanistic qualities of general discipline students

WEN Ting-yu, LIANG Bing, LI Miao

2020, 18(4): 670-673. doi: 10.16766/j.cnki.issn.1674-4152.001326

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Objective To explore the method and significance of cultivating humanistic qualities of general discipline students in standardized resident training. Methods A total of 29 general discipline students of grade 2015-2016 who were trained in the first affiliated hospital of Bengbu medical college were selected as research objects. The classroom teaching, special lectures, grassroots practice, clinical teaching were used to develop the humanistic quality training of the whole disciplines. Based on the questionnaire and scale survey of the 29 trainees before the training, after the training, the trainees will be surveyed and scaled. Self-designed open questionnaire, Caring Characteristics Scale(CAS), Caring Ability Inventory(CAI), SEGUE Framework(SEGUE) and General Doctor Competency Questionnaire(GDCQ) were used to evaluate the effects of humanistic quality training. Results The participation rate of the training of the humanities quality of the students is 100.0%. There were 89.7% of the general discipline students believed that cultivating humanistic quality is very important for clinical work. The knowledge of humanistic quality of general discipline students comes from the highest proportion of clinical teaching accounting for 81.6%, followed by grassroots practice and special lectures, accounting for 70.7% and 60.3%, respectively, while the proportion from classroom teaching is the lowest, accounting for 53.4%. Before and after the training of humanistic quality, the humanistic care consciousness, caring ability, doctor-patient communication ability and post competence of the general discipline students were significantly improved, and the differences were significant(all P<0.05). Conclusion Cultivating humanistic quality for all disciplines and training students can be carried out through classroom learning, special lectures, social practice, clinical practice, etc., and classroom teaching has the greatest proportion of the improvement of comprehensive humanistic quality.

Surveying the rural residents' willingness of primary diagnosis in eastern, central and western provinces of China

NIU Dan-dan, LI Meng-lei, WANG Gui-xia, LYU Ben-yan

2020, 18(4): 674-678. doi: 10.16766/j.cnki.issn.1674-4152.001327

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Abstract:
Objective To analyze the willingness of rural residents' primary diagnosis in eastern, central and western provinces of China and relevant influencing factors to further promote primary diagnosis. Methods A total of 6 500 rural residents from Shandong, Henan and Sichuan provinces were selected as survey samples by multi-order sampling method, and questionnaires from July to September were designed by ourselves for field investigation. Univariate analysis and multivariate logistic regression analysis were mainly used. Results There were 97.05% rural residents with minor diseases choosing primary diagnosis, 41.96% rural residents with chronic diseases choosing primary diagnosis, and 4.73% rural residents with serious diseases choosing primary diagnosis. Gender, education level, occupation type, social insurance type, family economic status, experience of not seeking medical treatment for illness and experience of buying drugs by oneself(all P<0.05) were influencing factors of residents' willingness of primary diagnosis. Factors such as age, education level, occupation type, social insurance type, the influence of reimbursement ratio for medical treatment, the cost less than 500 yuan in the past year, and the health status of patients(all P<0.05), etc., affected residents with common diseases on residents' willingness of primary diagnosis. When residents were seriously ill, social insurance type, annual affordable medical expenses, patients' health status and reimbursement ratio(all P<0.05) affected residents' willingness of primary diagnosis. Conclusion Social insurance type and disease burden are important factors affecting residents' willingness of primary diagnosis, family economic status on residents' willingness of primary diagnosis is limited, the reimbursement ratio is the primary influencing factor of residents with common and serious diseases on residents' willingness of primary diagnosis.

Analysis of Rh negative blood security in Zhejiang Province from 2014 to 2018

ZHENG Yin-hong, LI A-zhong, LI Yin-fang, HAN Wen-juan

2020, 18(4): 679-681. doi: 10.16766/j.cnki.issn.1674-4152.001328

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Abstract:
Objective To explore the effective management mode of Rh negative blood security by investigating the supply and regulation of Rh negative blood in Zhejiang Province. Methods The supply of RBC, the supply and the regulation of Rh negative RBC in Zhejiang province from 2014 to 2018 were analyzed retrospectively. Results In the whole province, the supply of RBC and Rh negative RBC, as well as the total amount of Rh negative RBC regulation among cities in the Zhejiang province showed an increasing trend year by year(r=0.987, 0.989, 0.949; P=0.002, 0.001, 0.051). The first two were highly correlated(r=0.979, P=0.004), while the latter two were not statistically significant(r=0.703, P=0.186). In the whole province, the proportion of Rh negative RBC supply in RBC supply increased year by year, which was 0.531%, 0.565%, 0.591%, 0.599% and 0.602% respectively. The RBC supply in each city showed an upward trend year by year, but fluctuated in Rh negative RBC supply and Rh negative RBC dose regulation between cities in the province, and there were great differences among cities. Conclusion The supply of Rh negative RBC in different cities is fluctuating, the overall supply in the province is increasing year by year, and the regulation within the province is becoming more and more active and important. Therefore, it is of great significance to strengthen regional linkage guarantee, establish and improve the cross regional coordination mechanism of Rh negative blood.

The municipal third-level hospital exploration and practice of health promotion technology promotion work in Anhui Province

CHEN Guang-bin, SUN Li-xia, LIU Dan-feng, HU Ming-hua, LIU Chang-kuo, JI Xue-lei

2020, 18(4): 682-685. doi: 10.16766/j.cnki.issn.1674-4152.001329

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Objective Taking the municipal third-level hospital Wuhu City Second People's Hospital as an example, to summarize its experience and practices in the implementation of health promotion technology promotion in Anhui Province, analyze some existing problems, and provide reference suggestion for the next stage of health-profit technology promotion. Methods The current situation of health promotion technology promotion work in China and Anhui Province was summarized and analyzed.A retrospective analysis of the second batch of appropriate health and family planning technology projects in Anhui Province was declared by the Second People's Hospital of Wuhu City in 2017, the implementation of measures and methods in the promotion work included ideological construction, project selection, organizational security, project implementation and promotion. The existing problems and propose continuous improvement were analyzed. Results The second batch of appropriate health and family planning technology promotion projects in Anhui Province "Clinical strategy and individualized treatment of gallbladder stones"(Item Number:2017-RK05) was successfully completed. In the process of project promotion and implementation, gained certain experience and proposed the next stage of improvement suggestions for health promotion technology promotion:① pay attention to administrative intervention, strengthen supervision and coordination; ② develop network resources and enrich learning methods; ③ Establish demonstration bases, play demonstration radiation; ④ strengthen assessment and evaluation, establish evaluation system; ⑤ establish incentive and punishment mechanisms and strengthen incentive measures. Conclusion The municipal top three hospital explored and practiced the health promotion technology promotion work in Anhui Province, analyzes the existing problems, summarizes the experience in the work, improves the efficiency of health appropriate technology transformation, improves the level of primary medical services and technology, and provides certain reference and reference for the comprehensive promotion of health appropriate technology.

Observation and intervention effect on stress response of patients before otolaryngology operation

LU Hai-bin, SIMA Guo-qi, DONG Wei-jie, LUO Yun-zhen

2020, 18(4): 686-689. doi: 10.16766/j.cnki.issn.1674-4152.001330

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Objective To investigate the stress response of patients undergoing otorhinolaryngologic surgery and the effect of clinical intervention. Methods From January to February 2017, 100 cases of otorhinolaryngologic surgery were included in the Department of Otolaryngology of Jiaxing first hospital to observe the occurrence of stress reaction and the effect of clinical intervention. Results The operation completed successfully, the average time was(21.23±5.66) min. No complications occurred in the follow-up. Pain comparison:the VAS pain scores at 1 hour after operation(before intervention) was(4.69±1.42) scores and in 1 th day, 3 th day and 7 th day(1 week) after operation were(2.75±1.03) score,(1.63±0.84) score,(0.59±0.45) score,the difference was statistically significant(F=308.951, P<0.001). There was statistically significant difference in VAS pain level at 1 hour after operation(before intervention) with Grade 0 of 10 cases, grade Ⅰ of 23 cases, grade Ⅱ of 54 cases, grade Ⅲ of 13 cases, and 7 th day(1 week) after operation with Grade 0 of 40 cases, grade Ⅰ of 49 cases, grade Ⅱ of 10 cases, grade Ⅲ of 1 case, the difference was statistically significant(Hc=67.920, P<0.001).The SAS scores before the operation and at the 1 th day, 3 th day and 7 th day(1 week) after operation were(56.42±9.78) score,(46.30±7.98) score,(40.12±10.47) score, and(33.25±8.45) score, respectively.There were statistically significant differences in SAS score(F=113.671, P<0.001). There SDS scores before the operation and at the 1 th day, 3 th day and 7 th day(1 week) after operation were(48.55±6.59) score,(46.20±5.33) score,(35.89±4.60) score, and(34.70±4.52) score, respectively. There were statistically significant differences in SDS score(F=175.614, P<0.001). Conclusion Most of the patients with otorhinolaryngologic surgery have stress reaction. The clinical intervention such as pain intervention and psychological counseling can reduce their bad mood, relieve and improve the postoperative pain feeling.

Application of DTI to evaluate the mT BI value of different social supports

HU Mei, HU Xiao-jing, WU Chao-hui, YIN Bo

2020, 18(4): 690-693. doi: 10.16766/j.cnki.issn.1674-4152.001331

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Objective To explore the value of diffusion tensor imaging(DTI) in evaluating the prognosis of mild traumatic brain injury(mTBI) patients with different social support. Methods From January 2016 to January 2018, 99 patients with mTBI in the departments of emergency surgery and neurosurgery of the Second Affiliated Hospital of Wenzhou Medical University, were divided into high social support group(54 cases) and low social support group(45 cases) according to their social support rating scale(SRSS) score(>20). The scores of Easy Mental State Examination Scale(MMSE) and Montreal Cognitive Assessment Scale(MoCA) were measured by DTI. Anisotropic score(FA) and apparent diffusion coefficient(ADC) were recorded and compared. Results ①The scores of MMSE and MoCA in patients with high social support were higher than those in patients with low social support(all P<0.05); ②The FA values of frontal lobe, medial temporal lobe and knee of corpus callosum in patients with low social support decreased significantly(all P<0.05). ③The ADC values of left white matter of frontal lobe, right white matter of frontal lobe, left white matter of temporal lobe and right white matter of temporal lobe in patients with low social support were higher than those in patients with high social support(all P<0.05). Conclusion The cognitive status and cognitive function of mTBI patients with different social support levels are significantly different, and the FA and ADC values of DTI are also partly different. Cognitive impairment is closely related to the impairment of white matter in frontal lobe, temporal lobe and corpus callosum.

Evaluation on the effect of specialist nurse-led multidisciplinary collaboration in promoting the comprehensive ability of nurses in department of gynecological oncology

WANG Chun-lan, XIA Li-yao, HUANG Jing, PAN Zhen, CHEN Xue-feng

2020, 18(4): 694-697. doi: 10.16766/j.cnki.issn.1674-4152.001332

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Objective To explore the application and effects of specialist nurse-led multidisciplinary collaboration nursing model in promoting the comprehensive ability of nurses in Radiotherapy Department of Gynecological Oncology in cancer hospital. Methods A total of 34 formal nurses were selected, who were given routine nursing management(control group) from January to December 2017 and multi-disciplinary cooperation mode management(observation group) led by specialized nurses from January to December 2018. The ability to master the professional knowledge, the degree of mastering the disease, the understanding of MDT, the amount of regional nursing consultation and nursing satisfaction were compared between the two groups. Results The observation group:the image data interpretation(2.64±0.81), treatment guide application(2.25±0.76), special nursing guide(2.69±0.78), correct care of skin lesions(3.23±0.69), understanding of tumor stage(2.64±0.81), treatment means(2.82±0.62), nursing focus(2.91±0.77), scientific evaluation of nutrition(2.71±0.52) and psychology(2.53±0.59) and MDT comprehensive ability(2.82±0.62) were significantly higher than those of the control group[(1.94±0.64),(1.87±0.62),(2.31±0.65),(2.61±0.58),(2.20±0.76),(2.44±0.74),(2.52±0.61),(2.38±0.40),(2.21±0.55),(2.47±0.52)](all P<0.05). The nursing satisfaction(99.14±0.19) score was significantly higher than that of the control group(94.98±2.02), t=11.956, P<0.05. The amount of nursing consultation(42 cases) and the direction of consultation(9 cases) in the observation group were significantly increased compared with those in the control group(7 cases, 5 cases). Conclusion Specialist nurse-led multidisciplinary collaboration model can promote the comprehensive ability of nurses in specialized hospital.

Study on the preventive effect of root cause analysis on reducing complications in respiratory sleep apnea syndrome

YU Min-min, GONG Xiao-li, LU Hua-dong, XU Zhen, ZHANG Li

2020, 18(4): 698-701. doi: 10.16766/j.cnki.issn.1674-4152.001333

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Objective To explore the preventive effect of root cause analysis on reducing complications in the nursing process of sleep apnea syndrome(SAS). Methods A retrospective analysis of 50 SAS patients who came to Huzhou central Hospital for treatment from March 2018 to March 2019 as the observation group, the 50 patients were all taken the new root cause analysis method introduced by our hospital, and then a retrospective analysis of 50 SAS patients who came to Huzhou central Hospital for treatment from January 2017 to January 2018 as the control group, to compare the effect of the two groups after care and the incidence of complications. Results The blood oxygen saturation, times of apnea, time of apnea and heart rhythm of the two groups were significantly improved after the treatment, and the difference was statistically significant(all P<0.05). After treatment, we found that the blood oxygen saturation and heart rhythm of the patients in the observation group were significantly better than those in the sleeping state(all P<0.05). After treatment, the incidence of complications in the control group was 26.0%(13/50), and in the observation group it was 6.0%(3/50). The incidence of nursing adverse events decreased from 2.5% to 0.5%, and the incidence of infection events decreased from 21.2% to 5.8%. Conclusion Taking root cause analysis is beneficial to promote the recovery of patients and effectively reduce the incidence of complications.

CUI Xiao-ling, HUANG Yi-ze, LU Hou-qing, LIN Jian, HU Xiao-chun, SONG You-liang

2020, 18(4): 702-704. doi: 10.16766/j.cnki.issn.1674-4152.001334

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Abstract:

About Journal

2020 Vol. 18, No. 4

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