中华全科医学

Study on the application of epidemiological thinking and methods in the training of general practitioners

CHEN Jun-hu, WANG Yan-yan, LIAO Kai-ju, XU Chao, WANG Jia-ji

2020, 18(6): 887-889. doi: 10.16766/j.cnki.issn.1674-4152.001384

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Objective Epidemiology is not only the main subject of public health, but also an applied science widely used in other disciplines. The general practice, which centers on people's health, plays an important role in disease prevention and health management, and is the "gatekeeper" of residents' health. This study analyzed the application significance of epidemiological thinking and methods in the training of general practitioners for enlightening further development of general practice education in China. Methods We searched CNKI database, Wanfang database, VIP database, and Pubmed for articles about general practice published between 1990 and 2020 using "epidemiology", "general Practice", "general practitioner", "family doctor", "team of general practitioners" and "general practice education" as terms, analyzed and summarized the main combination points of epidemiological thinking and methods based on the current situation of general practice education in China. Results At present, the teaching ideas and methods of integrating epidemiological thinking and methods were inadequate. The enlarged health conception of prevention-first should be integrated into the education and work of general practitioners, of whom be added to the training of coordinated disposal skills for public health emergencies, and so the integration effect of tertiary prevention, epidemiological investigation should be highlighted in the training of general practitioners. Conclusion The epidemiological thinking and methods should integrate into the whole process of general practice education and practice in order to training as general practitioners with enlarged health conception who maintain and promote residents' health.

MEI Yong-jun, LI Zhi-jun

2020, 18(6): 890-891,975.

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ZOU Kun, YAO Xue-quan, WU Zhen-feng, CHEN Che, WU Xiao-yu, LIU Fu-kun

2020, 18(6): 892-894,937. doi: 10.16766/j.cnki.issn.1674-4152.001385

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Objective To explore the related factors affecting postoperative blood glucose level in patients with gastric cancer complicated with type 2 diabetes mellitus, and provide reference for better selection of digestive tract reconstruction and control of postoperative blood glucose level. Methods Retrospective analysis was made on the clinical data of 179 patients with gastric cancer complicated with type 2 diabetes mellitus admitted to Gastroenterological Oncology Surgery, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2008 to December 2018. Single factor analysis was carried out on the clinical factors that might affect the postoperative blood glucose level by chi-square test, P<0.05 was considered as the relevant factor. Binary logistic regression analysis was performed on the related factors, P<0.05 was an independent factor. Results Radical resection of gastric cancer was performed in 179 patients, 4 of them were cured of diabetes after operation, 122 patients were relieved of diabetes after operation, and the effective rate of postoperative improvement of blood glucose level was 70.39%(126/179). Single factor analysis showed that the age, coronary heart disease or not, preoperative treatment of diabetes, whether to remove the whole stomach, biliopancreatic shunt loops present or absent, duration of diabetes and preoperative fasting c-peptide level were associated with postoperative blood glucose level. Binary Logistic regression analysis showed that biliopancreatic shunt loops present or absent, duration of diabetes and preoperative fasting c-peptide level were gastric cancer combined with type 2 diabetes independent influence factors of postoperative blood glucose levels. Conclusion Analysis results show that biliopancreatic shunt loops present or absent, duration of diabetes and preoperative fasting c-peptide level are gastric cancer combined with type 2 diabetes independent influence factors of postoperative blood glucose levels. For a shorter duration of diabetes, patients with normal preoperative fasting c-peptide levels roughly, digestive tract reconstruction by bile pancreatic diversion during surgery can better improve postoperative blood glucose levels.

Clinical value of monocytes and monocyte-to-lymphocyte ratio in determining the severity of ulcerative colitis

WANG Song, LIU Liu, ZHANG Kai-guang

2020, 18(6): 895-898,1065. doi: 10.16766/j.cnki.issn.1674-4152.001386

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Objective To assess the clinical value of monocytes and monocytes-to-lymphocytes ratio(MLR) in clinical and endoscopic severity of ulcerative colitis(UC). Methods Total 102 patients with UC and 100 healthy controls were enrolled in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to September 2019. The expression of monocytes and MLR in UC patients with different clinical and endoscopic severity was retrospectively analyzed. Results MLR, white blood cells, neutrophils and platelets in UC patients were significantly higher than those in the healthy controls(all P<0.05). Monocytes was positively correlated with MLR, WBC, ESR, CRP and platelets(all P<0.05), while MLR was positively correlated with WBC and CRP(all P<0.05). According to modified Truelove and Witts' s severity criteria and modified Mayo score, monocytes and MLR obviously increased in moderate and severe patients(all P<0.05). According to Mayo endoscopy subscore and Montreal classification, MLR increased in the Score 3 group compared with the 1 or 2 groups, and significantly increased in the E3 group compared with the E1 or E2 groups(all P<0.05). The ROC curve analysis showed that the area under the curve of monocytes count and MLR were 0.740(95% CI: 0.672-0.807) and 0.750(95% CI: 0.683-0.817), respectively, with statistical significance(all P<0.001). The optimal critical values of monocytes and MLR were 0.385×10⁹/L(sensitivity: 81.37%, specificity: 53.00%) and 0.235(sensitivity: 75.49, specificity: 66.00%), respectively. Conclusion Monocytes and MLR are increased in UC patients and significantly correlated with the clinical and endoscopic severity of UC.

Therapeutic effect of budesonide suspension combined with montelukast sodium in the treatment of children with chest tightness variant asthma

MA Li-juan, ZHOU Rui, WANG Xian-xian, WU Ling-qin, DAN Zi-hong, WANG Shu-ying, YANG Jun

2020, 18(6): 899-901,905. doi: 10.16766/j.cnki.issn.1674-4152.001387

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Objective To observe the clinical efficacy and safety of budesonide suspension atomized inhalation combined with oral montelukast sodium in children with chest tightness variant asthma(CTVA). Methods Thirty children with CTVA clinically diagnosed in the First Affiliated Hospital of Bengbu Medical College from September 2018 and September 2019 were enrolled. All children completed pulmonary function tests and chest tightness scores(r-ACQ) at the initial diagnosis, and all had positive bronchial challenge test or positive bronchodilator test. The children were routinely treated with inhaled budesonide suspension and/or oral montelukast sodium and revisited 2-4 weeks after treatment. The main indicators of pulmonary function before and after treatment of children [1 second forced expiratory volume(FEV₁), rate of 1 second(FEV₁/FVC%), maximum expiratory flow rate(PEF), forced exhalation 25%, 50%, 75% vital capacity peak expiratory flow rate(FEF₂₅, FEF₅₀, FEF₇₅), maximum expiratory flow rate(MMEF)] were analyzed. The clinical symptoms, r-ACQ scores and the occurrence of adverse reactions were followed up. Results The remission rate of chest tightness after treatment was 93.3%, and the r-ACQ score of chest tightness after treatment was lower than that before treatment, which was consistent with the remission of clinical symptoms. After 2-4 weeks of treatment, the lung function indexes of the children were compared with before treatment: FEV₁(F=3.623, P=0.031), FEV₁/FVC%(F=3.188, P=0.046), PEF(F=4.506, P=0.014), FEF₂₅(F=8.518, P<0.001), FEF₅₀(F=9.794, P<0.001), FEF₇₅(F=8.736, P<0.001), and MMEF(F=8.923, P<0.001). No obvious adverse reactions occurred during the treatment. Conclusion Budesonide suspension combined with montelukast sodium can effectively alleviate the clinical symptoms of children with CTVA, and no obvious adverse reactions.

Clinical analysis of 17 cases of paraneoplastic syndrome of nervous system

RONG Yu-ting, YU Feng, XU Li

2020, 18(6): 902-905. doi: 10.16766/j.cnki.issn.1674-4152.001388

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Objective To analysis the clinical characteristics of paraneoplastic syndrome of nervous system as to improve the early diagnosis and treatment of the disease. Methods The clinical feature, laboratory results and therapeutic effect of 17 patients with paraneoplastic syndrome of nervous system were retrospectively reviewed. Relevant literatures were reviewed. Results Fourteen(82.4%) cases had paraneoplastic neurological syndrom before the diagnosis of tumor and 3(17.6%) cases after tumor diagnosis. There were 4(23.5%), 3(17.6%), 2(11.8%), 2(11.8%), 2(11.8%), 2(11.8%), 2(11.8%) and 1(5.9%) positive cases of anti-Hu, anti-Yo, anti-Amphiphysin, anti-recoverin, anti-Titin, anti-Ma2, anti-SOX-1 and anti-Zic4 antibodies, respectively. There were 1 positive cases of both anti-Hu and anti-Zic4 antibodies. Neurologic changes were subacute cerebellar degeneration in 6 cases(35.2%), sensorimotor peripheral neuropathy in 3 cases(17.6%), limbic encephalitis in 2 cases(11.8%), Lambert-eaton syndrome in 2 case(11.8%), motor neuron disease in 1 case(5.9%), polymyositis in 1 case(5.9%), brainstem encephalitis in 1 case(5.9%) and subacute sensory neuronopathy in 1 case(5.9%). Conclusion Most of the patients who diagnosed as paraneoplastic syndrome of nervous system have neurological damage symptoms earlier than the primary tumor clinical manifestations, which requires tumor screening and long-term follow-up. The hormone and the gamma globulin treatment is effective.

Analysis of risk factors of pulmonary infection in patients undergoing craniotomy in department of neurosurgery

ZHANG Na-qin, WANG Jun, JI Yuan-yuan, LIU Yun-yun, XU Yue-jiao, YANG Piao, JIANG Li-dan, ZHANG Hong-qi, YU Jie

2020, 18(6): 906-908,1034. doi: 10.16766/j.cnki.issn.1674-4152.001389

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Objective To investigate the status of pulmonary infection in patients after the neurosurgery craniotomy, analyze its risk factors and provide decision-making basis for prevention and control of nosocomial infection. Methods A retrospective analysis was carried out on the clinical medical record of 1 088 patients undergoing craniotomy in the department of neurosurgery, Xuanwu Hospital of Capital Medical University between January and December 2016. Cases were divided into infection group(81 cases) and control group(1 007 cases) according to whether they were infected. Univariate analysis and multi factor logistic regression were used to analyze the risk factors of pulmonary infection in neurosurgery patients undergoing craniotomy. Results Among 1 088 patients, 81 patients had pulmonary infection after surgery, with an infection rate of 7.44%. Logistic regression analysis results showed that admission to ICU(OR=5.387, 95% CI: 1.582-18.339), mechanical ventilation(OR=3.720, 95% CI: 1.667-8.301), admission GCS 3-8 score points(OR=0.335, 95% CI: 0.148-0.760), hypothermia treatment(OR=5.945, 95% CI: 2.499-14.141) were independent risk factors for pulmonary infection in patients undergoing craniotomy. Conclusion Pulmonary infection is a common complication of craniotomy in neurosurgical patients, suggesting that pulmonary infection should be the focus of prevention of nosocomial infections. Patients with admission to ICU, mechanical ventilation, admission GCS score 3-8 points and hypothermia treatment should be paid close attention and take effective prevention and control measures in time to reduce the incidence of lung infection.

The correlation between visceral fat area, lipid level and coronary heart disease in the elderly

ZOU Yi-fan, XU Tao, ZHAO Ting, JIA Jian, MEN Chen, XU Na, ZHAN Yi-yang

2020, 18(6): 909-912. doi: 10.16766/j.cnki.issn.1674-4152.001390

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Objective To investigate the correlation between visceral fat area, blood lipid level and coronary heart disease. Methods A total of 139 old people(aged ≥ 60 years) participated in physical examination in rural areas of Guangde, Anhui province in April 2018 were selected. Combined with the careful inquiry of the history of coronary heart disease in the local primary medical records, 57 physical examinee diagnosed with coronary heart disease were enrolled into coronary heart disease group(CHD), and the remaining 82 physical examinee were enrolled into the non-coronary heart disease group(NC). Venous blood was drawn on an empty stomach in the morning to determine the levels of total cholesterol, triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol. Ask client to remove crown, shoes, fasting, wearing only single clothing to measure height and weight. The obesity related indexes, visceral fat area, body fat rate, body fat content, body fat, body mass index were measured using Inbody S10 body composition analyzer based on the principle of bioelectrical impedance. The correlation between visceral fat area, lipid level and coronary heart disease were analyzed. Results The levels of visceral fat area, other obesity-related indicators and blood low density lipoprotein cholesterol in the CHD group were higher than those in the NC group. Regression analysis showed that those with increased visceral fat area and those with high low-density lipoprotein cholesterol blood level had an increased risk of coronary heart disease, which was 4.052 times and 2.348 times of that of the NC group, respectively. Correlation analysis showed that visceral fat area was positively correlated with serum triglyceride level. Conclusion Visceral fat area and low density lipoprotein cholesterol are closely related to coronary heart disease. Visceral fat area and other obesity indicators are significantly higher in elderly coronary heart disease individuals than in non-coronary heart disease individuals. When visceral fat area is increased or low density lipoprotein cholesterol is high, the risk of coronary heart disease in the elderly is significantly higher. With the increase of visceral fat area, blood triglyceride level increases. Therefore, the principle of bioelectrical impedance can be used to analyze the related indicators of obesity in the elderly and dynamically monitor the prevention and prognosis of coronary heart disease in combination with the level of blood lipid.

Study on the changes of Beclin-1 and LC3 related to autophagy in peripheral blood lymphocytes of patients with sepsis

LIU Cheng, XU Ya-qian, ZOU Qi

2020, 18(6): 913-916. doi: 10.16766/j.cnki.issn.1674-4152.001391

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Objective To observe the changes of autophagy of peripheral blood lymphocytes in patients with sepsis and explore its clinical significance. Methods Total 10 healthy people, 20 patients with common infection and 20 patients with sepsis were divided into H group, I group and S group. According to the prognosis, the S group was divided into survival group(14 cases) and death group(6 cases). General data, WBC, PLT, ALT, Cr, albumin, blood glucose and APACHE Ⅱ scores were collected. Meanwhile, lymphocytes were isolated from venous blood to detect the relative expression of Beclin-1 and LC3 mRNA. Results There were no significant differences in age, gender, primary disease and infection site among the three groups(all P>0.05), but there were significant differences in WBC, PLT, alt, Cr, albumin and blood glucose(all P<0.01). There was significant difference in APACHE Ⅱ score between I group and S group(P<0.01). There was significant difference in the relative expression of Beclin-1 and LC3 mRNA between the three groups(all P<0.01). There was significant difference in the relative expression of Beclin-1 and LC3 mRNA between the survival group and the death group(all P<0.01). There was a linear negative correlation between APACHE Ⅱ score and Beclin-1(r=-0.452, P<0.001), and the linear model equation between APACHE Ⅱ score and Beclin-1 was Y=-20.83+41.67 X. There was a linear negative correlation between APACHE Ⅱ score and LC3(r=-0.641, P<0.001), and the linear model equation between APACHE Ⅱ score and Beclin-1 was Y=-6.25+62.5 X. In the diagnosis of sepsis, Beclin-1: area under ROC curve was 0.791, standard error was 0.070(P<0.001); LC3: area under ROC curve was 0.851, standard error was 0.066(P<0.001). Conclusion The autophagy level of venous blood lymphocytes in patients with sepsis is significantly reduced, which can reflect the immune status of sepsis and provide a new way for the diagnosis of sepsis.

The biocompatibility research of adipose stem cells induced to differentiate into urothelium and bladder acellular matrix scaffolds

LIU Xiang-e, WU Tian-yu, WANG Qian-liang, XIONG Yun-he

2020, 18(6): 917-922,985. doi: 10.16766/j.cnki.issn.1674-4152.001392

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Objective To explore the feasibility of differentiation of adipose stem cells into urothelial cells, evaluate the biocompatibility of cells and scaffolds, and provide experimental basis for further construction of tissue-engineered tissue. Methods The adipose derived stem cells(ADSCs) were isolated from the inguinal adipose tissue and bladder tissue of six 8-week-old male New Zealand white rabbits by collagenase digestion, and the urothelial cells were obtained by trypsin digestion. After flow cytometry identification, the third generation adipose stem cells and urothelial cells were co-cultured indirectly for 2 weeks, and the differentiated cells were phenotyped. Then the differentiated cells were implanted on the acellular matrix of bladder. The growth of the cells on the acellular matrix of bladder was observed by scanning electron microscopy and histological section. The surface antigen CD molecules were detected by flow cytometry. Results The adipose stem cells were cultured successfully and expanded in vitro. The cells expressed CD29(99.6%), CD44(98.2%), CD31(1.9%) and CD45(1.6%). After inducing differentiation by indirect co-culture, the expression of epithelial cell marker(UP1 a) was detected by immunofluorescence and Western blotting, but the uninduced adipose stem cells did not. Scanning electron microscopy(SEM) showed that the cells grew well and adhered well on the acellular matrix of bladder after induction. Histological examination showed that the cells on the surface of acellular matrix of bladder grew horizontally. Conclusion Induced adipose stem cells can differentiate into urothelial cells that can be used as seeding cells for urinary tissue engineering, which may be another choice out of urothelial cells. The bladder acellular matrix can support the good growth of the induced stem cells, which can be used as the carrier material for the repair and reconstruction of the urinary tissue engineering.

Activation of PKC δ related signal pathway factor and its effect on cell proliferation in human growth hormone type pituitary adenoma cells

BAI Song, DU Ying-lei, WANG Yu, XIE Shan, JIANG Zhi-quan

2020, 18(6): 923-926. doi: 10.16766/j.cnki.issn.1674-4152.001393

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Objective To analyze the expression of protein kinase C(PKCs) related signal pathway factors in human growth hormone(GH) type pituitary adenoma cells and its mechanism of regulating cell proliferation. Methods Eight patients with GH type pituitary adenoma were treated with resection of tumor tissue for primary culture. The expression of PKCδ, CREB and ERK1/2 in the cells was detected by immunohistochemistry. The primary cultured cells were divided into control group(blank), agonist group(PMA), inhibitor group(rottlerin), combination group(PMA+Rottlerin), 8 cells in each group. The GH secretion level of each group was detected by ELISA, the cell activity was detected by CCK-8, the factors and phosphorylation level were detected by western blot. The data was analyzed by SPSS 21.0 software package. Results PKCδ, CREB and ERK1/2 were more common in the cytoplasm of GH pituitary adenoma. Compared with the control group, GH secretion and activity increased in the agonist group, but significantly decreased in the inhibitor group(all P<0.01). Compared with the control group, the levels of p-PKCδ, p-CREB and p-ERK1/2 in the agonist group increased, while those in the inhibitor group decreased(all P<0.01). The levels of p-CREB and p-ERK1/2 in the combined group were lower than those in the agonist group and higher than those in the inhibitor group(all P<0.01). Conclusion PKCδ, CREB and ERK1/2 are highly expressed in GH pituitary adenoma cells. Activation of PKCδ can increase the level of p-CREB and GH secretion, and increase the level of p-ERK1/2 to promote cell proliferation.

Predictive value of heparin-binding protein combined with procalcitonin in the assessment of acute pancreatitis co-infection

LI Lei, ZHENG Chuan-ming, XIA Qun, CHENG Feng, CHEN Ying, SONG Qi, XU Shu-gen, WANG Zhen-jie

2020, 18(6): 927-929,1068. doi: 10.16766/j.cnki.issn.1674-4152.001394

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Objective To explore the application value of dynamic changes of heparin-binding protein and procalcitonin in predicting acute pancreatitis co-infection. Methods A total of 64 patients with acute pancreatitis diagnosed and treated in the Emergency Department of the First Affiliated Hospital of Bengbu Medical College from December 2018 to December 2019 were collected. They were divided into simple acute pancreatitis group and acute pancreatitis co-infection group according to whether the patients were infected with peripancreatic infection during hospitalization, 32 patients in each group. The plasma concentrations of heparin-binding protein(HBP) and procalcitonin(PCT) on the day of diagnosis(D1) and the day 7(D7) after treatment were measured. Actively intervened and treatment were preformed in the acute pancreatitis co-infection group. The t test was used to compare the differences in HBP and PCT levels between the two groups. The receiver operating characteristic(ROC) curve analysis was used to calculate their threshold value, specificity and sensitivity. Results HBP levels in the simple acute pancreatitis group and the acute pancreatitis co-infection group group were as follows: D1 [(61.97±34.84) ng/mL vs.(130.12±45.76) ng/mL] and D7 [(8.60±2.91) ng/mL vs.(10.08±3.16) ng/mL, all P<0.05]. The PCT level were as follows: D1 [(1.82±0.65) ng/mL vs.(4.48±2.58) ng/mL] and D7 [(0.50±0.21) ng/mL vs.(0.64±0.37) ng/mL, all P<0.05]. The area under the ROC curve of HBP was 0.895, sensitivity 90.60%, specificity 78.10%; the area under the ROC curve of PCT was 0.899, sensitivity 81.30%, specificity 96.90%; and the area under ROC curve of HBP combined with PCT was 0.981, the sensitivity was 96.90%, the specificity was 65.60%. Conclusion HBP and PCT can be used as indicators to predict the infection of acute pancreatitis, and combined detection can significantly improve the sensitivity, which is conducive to early detection and treatment of patients with pancreatitis co-infection.

Expression of lncRNA SOX2OT in ovarian cancer cell lines and its effect on biological behavior of ovarian cancer

YAN Chun-hong, YANG Wei-li, LI Xue-he

2020, 18(6): 930-933. doi: 10.16766/j.cnki.issn.1674-4152.001395

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Objective To explore the relative expression of lncRNA SOX2 OT in ovarian cancer cell lines and evaluate its effect on the biological behavior of ovarian cancer. Methods Total 112 patients with ovarian cancer in Ningbo Yinzhou People's Hospital from April 2017 to April 2019 were selected as the research objects. The expression of lncRNA SOX2 OT in ovarian cancer, ovarian cancer adjacent tissues and ovarian cancer cell lines were analyzed. The effects of lncRNA SOX2 OT on the proliferation, cycle and migration status of ovarian cancer cells were tested. Results The expression of SOX2 OT mRNA in ovarian cancer tissue(3.50±0.13) was higher than that in adjacent tissues(1.59±0.21, t=81.045, P<0.01). The expression of lncRNA SOX2 OT in HO-8910 PM cell line(5.78±0.04) was higher than that in HO-8910 cell line(1.05±0.11, t=405.918, P<0.01). The number of cloned cells, number of migrated cells, and number of invaded cells in the blank control group were higher than those in the siSOX2 OT-1 and siSOX2 OT-2 groups; the number of cloned cells, number of migrated cells and invasion cells in the negative control group were higher than those in the siSOX2 OT-1 and siSOX2 OT-2 groups(all P<0.05). The expression of lncRNA SOX2 OT in endometrioid carcinoma, serous ovarian carcinoma, and mucinous ovarian carcinoma were 4.12±0.25, 3.68±0.42, 3.44±0.31, respectively, there was no statistically significant difference between the 3 groups(all P>0.05). Conclusion lncRNA SOX2 OT is abnormally high expressed in ovarian cancer cell lines. Knocking down lncRNA SOX2 OT expression can inhibit the proliferation, migration and invasion of ovarian cancer cells, and accelerate the apoptosis of ovarian cancer cells.

Therapeutic effect of pazopanib combined with radiotherapy on cervical cancer and its effect on serum levels of vascular endothelial growth factor receptor

LU: Hong-qing, ZHANG Lin, NI Juan

2020, 18(6): 934-937. doi: 10.16766/j.cnki.issn.1674-4152.001396

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Objective To explore the effect of pazopanib combined with radiotherapy on the level of vascular endothelial growth factor receptor(VEFGR) in patients with cervical cancer. Methods From June 2017 to June 2018, 160 patients with cervical cancer who were treated in Jinhua Municipal Central Hospital and Zhejiang Cancer Hospital were randomly divided into radiotherapy group and combination group with 80 cases in each group. Radiotherapy group received radiotherapy and combination group received pazopanib combined radiotherapy. The levels of carcinoembryonic antigen(CEA), cytokeratin 19 fragment antigen(CYFRA21-1), carbohydrate antigen 125(CA125) were detected by immunoturbidimetry; the level of serum VEFGR was detected by enzyme-linked immunosorbent assay; the level of T-lymphocyte subpopulation was measured, and the therapeutic effects and adverse reactions were compared between the two groups. Results After treatment, CEA, CYFRA21-1, CA125, CD3⁺, CD4⁺, VEFGR1, VEFGR2, VEFGR3 and the incidence of adverse reactions in the combined group were lower than those in the radiotherapy group, CD8⁺ and the total effective rate of treatment(85.00% vs. 71.25%) were higher than those in the radiotherapy group(all P<0.05). Conclusion Pazopanil combined with radiotherapy can inhibit CEA, CYFRA21-1 and CA125 levels, regulate VEFGR level, and have a significant therapeutic effect. However, the combination of pazopanib and CA125 will have an impact on the immune capacity of the body. Therefore, further analysis and study of the treatment plan should be carried out to provide help for the clinical application of the treatment plan.

The comparative study on restoring pulpless posterior tooth defect with two kinds of ceramic onlays

ZHANG Wei-bo, CHEN Jia-long, CAO Ying

2020, 18(6): 938-941,1024. doi: 10.16766/j.cnki.issn.1674-4152.001397

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Objective To compare the clinical efficacy of Lava Ultimate porcelain onlays and IPS e.max lithium disilicate glass ceramic onlays on restoring pulpless posterior teeth defect. Methods A total of 89 posterior teeth were selected as the research object from 68 patients with posterior tooth defect after complete root canal therapy(RCT) from January 2017 to December 2017 in Dental Hospital of Anhui. The type of tooth defect was the most common mesio-occlusal defect in the clinic(Black Ⅱ), of which 42 teeth were restored with Lava Ultimate porcelain onlays(Ultimate porcelain group), 47 teeth were restored with IPS e.max lithium disilicate glass ceramic onlays(Glass ceramic group). The preparation of buccolingual margin of the prosthesis was designed as plane butt joint form, and the occlusal surface was designed as full coverage or partial coverage according to the amount of residual tooth tissue. The two groups were followed up for observation after the restoration treatment. According to the revised evaluation standard of the United States public health service(USPHS), eight clinical indicators of the two kinds of ceramic onlays, including the integrity of the restoration, surface abrasion, color matching, margin staining, retention, secondary caries, marginal adaptation and periodontal status, were evaluated 12 months later. Statistical analysis was carried out by χ² test. Results According to the revised evaluation standard of USPHS, the success rate of the two groups in the integrity of the restoration, surface abrasion, color matching, margin staining, retention, secondary caries, marginal adaptation and periodontal status were more than 90% during the observation period. Among them, the success rate of various clinical indicators in the Ultimate porcelain group was 92.86%-97.62%, and that in the glass ceramics group was 91.49%-100.00%. There were no significant differences between the two groups(all P<0.05). Conclusion Lava Ultimate porcelain onlays and IPS e.max lithium disilicate glass ceramic onlays, as minimally invasive methods, both have ideal short-term effects, and can be used as the choice for the restoration of posterior tooth defect after root canal therapy.

Value of elevated blood cytoplasm actin-1 in early diagnosis of acute cerebral infarction

KOU Xue-lian, CHEN Lin-di, GUAN Shu-yi, TANG Wei-guo, HE Song-bin

2020, 18(6): 942-946. doi: 10.16766/j.cnki.issn.1674-4152.001398

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Objective To explore blood biomarkers in the early stage of acute cerebral infarction using iTRAQ technology. Methods Forty patients with acute cerebral infarction admitted in Zhoushan Hospital of Zhejiang Province from July 2016 to July 2018 were selected and divided into 5 groups according to the onset time: cerebral infarction group 1(onset<2 h), group 2(onset 2 to 4 h), group 3(onset 4 to 6 h), group 4(onset 6 to 24 h), and group 5(onset 24 to 72 h), with 8 cases in each group. There were another 3 groups: transient cerebral ischemic attack group(onset<2 h), acute cerebral hemorrhage group(onset<2 h), and the control group, with 8 cases in each group. The iTRAQ technique was used to detect the serum and screen out clinically significant biomarkers. Results ① Multiple differential proteins were found in the acute phase of cerebral infarction, mainly involved in 165 biological processes, 35 cellular components, and 38 molecular functions. ② These differential proteins mainly involve 3 types of biological metabolic pathways: complement regulation pathway, blood coagulation pathway and cell signal transduction pathway. Cell components included extracellular space, platelet a particle, lipoprotein complex, and secretory granules. Molecular functions included enzyme activity, ionics, etc. ③ The unique biomarkers of cerebral infarction included actin, cytoplasmic 1, serum amyloid P-component, properdin, C-reactive protein, serum amyloid A-1 protein, glyceraldehyde-3-phosphate dehydrogenase. Actin and cytoplasmic 1 were the most meaningful. Conclusion The tight blood-brain barrier tight junction damage within 2 h of acute cerebral infarction is a characteristic change, which can effectively distinguish acute cerebral infarction with transient ischemic attack and cerebral hemorrhage. Actin and cytoplasmic 1 may be a specific marker that can be used for acute cerebral infarction.

Retrospective analysis of regular treatment or acid suppressive drugs therapy for patients with leukoplakia of vocal cord

CAO Xiao-juan, LUO Yun-zhen, XU Bin

2020, 18(6): 947-949. doi: 10.16766/j.cnki.issn.1674-4152.001399

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Objective To explore the necessity of acid suppressive drugs therapy and the recurrence of vocal leukoplakia in patients with leukoplakia of vocal cord. Methods The clinical data of 100 patients with leukoplakia of vocal cord were analyzed retrospectively. All the patients were treated with leukoplakia of vocal cord under fiber support laryngoscope. According to whether to carry on the acid suppression therapy, the patients were divided into observation group(28 cases, given rabeprazole enteric coated capsule acid suppression treatment and postoperative routine treatment) and control group(72 cases, given postoperative routine treatment). Before and after treatment, the patients were assessed by electronic laryngoscopy, voice disorder index-10(VHI-10), reflux symptom index(RSI) and reflux finding score(RFs). The therapeutic effect of the two groups, the results of VHI-10 scale, RSI scale and RFs scale before and after treatment, and the recurrence rate after treatment(half a year) were compared. Results The electronic laryngoscope was reexamined in two groups, and their leukoplakia of vocal cord disappeared completely and were cured. After treatment, the scores of RFS in the two groups were significantly improved compared with those before treatment, and the scores in the observation group had more significant than those in the control group(all P<0.05). Half a year after treatment, the difference of the total recurrence rate of vocal leukoplakia in the two groups has no statistically significant(χ²=0.004, P>0.05). Conclusion Acid suppression therapy with proton pump inhibitor can reduce the symptoms of laryngopharyngeal reflux, reduce the the scores of RFS.

The value of neutrophil CD64 index, PCT and CRP in diagnosis of infection in burn patients

LIAO Mi-rong, TU Wei-wei, CAI Li-zhen

2020, 18(6): 950-953. doi: 10.16766/j.cnki.issn.1674-4152.001400

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Objective To study the diagnostic value of CD64 index of neutrophils, PCT and CRP in burn patients. Methods Total 117 patients with suspected burn infection admitted to our hospital from August 2018 to March 2019 were selected as the study subjects. According to the infection situation, the patients were divided into uninfected group(61 cases), infection group(39 cases) and sepsis group(17 cases). Another 40 healthy people in the same period were selected as control group. CD64 index, CD64 positive rate, PCT and CRP were detected. The expression levels of infection indicators in each group were compared. The indicators of gram-positive bacteria and gram-negative bacteria were compared. The ROC curve was drawn to compare the efficacy of infection indicators in diagnosis of burn infection and sepsis. Results The indicators of burn patients of the three groups were significantly higher than those in the control group(all P<0.05). The CD64 index, CD64 positive rate and PCT in the infected group were significantly higher than those in the uninfected group(all P<0.05). The indicators in the sepsis group were significantly higher than those in the infected group(all P<0.05). PCT of gram-negative bacterial infections was significantly higher than that of gram-positive bacterial infections(P<0.05). CD64 index has the best diagnostic efficiency for burn infection, with sensitivity 82.14%(46/56), specificity 88.52%(54/61) and Yoden index 0.707. Yoden index of CD64 index for sepsis(0.780) is the largest, and the AUC(0.896) for PCT is the highest. When CD64 index and PCT were combined to diagnose infection and sepsis, the sensitivity and Yoden index were higher than those of single index. Conclusion CD64 index combined with PCT has good sensitivity and specificity in the diagnosis of burn infection and sepsis, and has good clinical application prospects.

Changes of miR-15a, miR-16 and miR-20b in patients with type 2 diabetes mellitus and their relationship with diabetic retinopathy

LIU Lin-ping, WU Bo-le, NI Li-sha, ZHANG Li-na, HU Xia-yun, WANG Zong, CHEN Ling

2020, 18(6): 954-958. doi: 10.16766/j.cnki.issn.1674-4152.001401

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Objective To investigate the changes of microRNA-15 a(miR-15 a), microRNA-16(miR-16), microRNA-20 b(miR-20 b) and their relationship with diabetic retinopathy(DR) in patients with type 2 diabetes mellitus(T2 DM). Methods A total of 105 patients with T2 DM admitted to Lishui People's Hospital from May 2017 to May 2019 were divided into non-DR group(32 cases), non-proliferative diabetic retinopathy(NPDR) group(39 cases) and proliferative diabetic retinopathy(PDR) group(34 cases), and 40 cases of simple cataract patients in the same period were selected as control group. The levels of miR-15 a, miR-16 and miR-20 b in aqueous humor were detected by direct determination of miR-derived fragment length polymorphism(miRFLP). The levels of miR-15 a, miR-16 and miR-20 b in serum were measured by real-time fluorescence quantitative PCR(qRT-PCR). The predictive value of miR-15 a, miR-16 and miR-20 b levels in aqueous humor and serum for PDR was analyzed by ROC curve. Results The levels of miR-15 a, miR-16 and miR-20 b in aqueous humor and serum were PDR group, NPDR group, non-DR group and control group respectively, with significant differences(all P<0.05). There was a positive correlation between aqueous humor and serum levels of miR-15 a, miR-16 and miR-20 b in DR patients(all P<0.05). The area under the curve of predicting PDR was 0.912 and the sensitivity was 91.20%, the area under the curve of predicting PDR was 0.931 and the specificity was 92.30%, the predictive value was better than that of single application. Conclusion The increased levels of miR-15 a, miR-16 and miR-20 b in aqueous humor and serum of patients with T2 DM are associated with DR.

Levels of fibroblast growth factor 21 in serum of patients with type 2 diabetic retinopathy and its clinical significance

XUE Li-zhi, TAN Huan-teng, ZHANG Si-quan, LIU Fang

2020, 18(6): 959-961,1029. doi: 10.16766/j.cnki.issn.1674-4152.001402

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Abstract:
Objective To investigate the level and significance of serum fibroblast growth factor 21(FGF-21) in patients with type 2 diabetic retinopathy. Methods A total of 120 healthy subjects in Hangzhou Xixi Hospital and Tongde Hospital of Zhejiang province from January 2016 to December 2018 were selected as group A, 120 cases of type 2 diabetic patients without retinopathy were selected as group B and 120 cases of type 2 diabetic retinopathy were selected as group C. Clinical and biochemical data were collected. The level of serum FGF-21 was measured by enzyme-linked immunosorbent assay. Results The FPG, FINS, HbA1 c, HOMA-IR, TG, TC, LDL-C and FGF-21 of group B and group C were higher than those of group A(all P<0.05), and HDL-C level was lower than that of group A(P<0.05).FGF-21 in group C [(3.47±0.51)μg/L] was higher than that in group B [(2.91±0.48)μg/L, P<0.05].There were no significant differences in glucose and lipid metabolism indexes between group B and group C(all P>0.05).There was positive correlation between serum FGF-21 level and FPG, FINS, HbA1 c, HOMA-IR, TC and LDL-C in patients with type 2 diabetic retinopathy(r=0.623, 0.652, 0.547, 0.633, 0.534, 0.242, all P<0.05).The results of multiple stepwise regression analysis showed that FPG(95% CI: 0.052-0.373), FINS(95% CI: 0.156-0.441) and TC(95% CI: 0.047-0.164) were independent influencing factors of serum FGF-21(all P<0.05). Conclusion Serum FGF-21 level is related to type 2 diabetic retinopathy, which is closely related to glucose and lipid metabolism, and may be involved in the development of type 2 diabetic retinopathy.

Relationship between vascular cognitive impairment after cerebral infarction and intravenous thrombolysis by rt-PA

ZHU Heng-ya, SUN Xiao-yan, HU Zheng-gang, LUO Xiao-chun, WANG Zhuang, FENG Qi

2020, 18(6): 962-964. doi: 10.16766/j.cnki.issn.1674-4152.001403

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Objective To investigate the relationship between vascular cognitive impairment and rt-PA intravenous thrombolysis after cerebral infarction. Methods Forty-six patients with cerebral infarction treated from January 2016 to February 2018 were enrolled. All patients were treated with rt-PA intravenous thrombolysis. The patients were completed with MMSE, NIHSS and MoCA scores after admission. They were divided into cognitive dysfunction group and a cognitive function normal group. The data of the two groups were reviewed. The age, infarction, education level, poor glycemic control, rt-PA intravenous thrombolysis, history of hypertension, alcoholism, left infarction, and single factor and multivariate logistic were recorded. The effective measures for the patient's cognitive function risk factors were analyzed, established and intervened. Results In 46 patients with cerebral infarction, 29(63.04%) had vascular cognitive impairment. The results of single factor analysis showed that the incidence and age of vascular cognitive impairment after cerebral infarction(t=2.244, P=0.030), infarction in key position(χ²=4.313, P=0.038), education level(U=8.092, P=0.003), rt-PA intravenous thrombolysis(χ²=7.558, P=0.006) were statistically significant(all P<0.05). The results of multi factor logistic analysis showed that the incidence of vascular cognitive impairment after cerebral infarction was statistically significant(P<0.05). There were significant differences in the birth rate and age(P=0.042), critical site infarction(P=0.025), education level(P=0.041), rt-PA intravenous thrombolysis(P=0.030). Conclusion The incidence of vascular cognitive impairment after cerebral infarction is high, and there are many influencing factors. Early administration of rt-PA intravenous thrombolytic therapy can improve the cognitive function and reduce the patient's condition.

The application of neuromuscular activation in chronic nonspecific low back pain

JI Jing, CHEN Shi-xuan, ZHU Bin, WANG Ce, LIN Da-yang, WANG Song-bo

2020, 18(6): 965-967,979. doi: 10.16766/j.cnki.issn.1674-4152.001404

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Objective To analyze the effect of neuromuscular activation on the clinical treatment of chronic nonspecific low back pain, and to explore the improvement of low back pain, lumbar function and lumbar muscle endurance. Methods A total of 96 patients with chronic nonspecific low back pain admitted to our hospital from August 2018 to August 2019 were selected and divided into group A and group B according to different therapies, 48 in each group. The patients in Group A received routine rehabilitation training and group B received rehabilitation training with neuromuscular activation technology. The clinical effect, VAS score, ODI index and lumbar muscle endurance of the two groups were compared. The data were analyzed by SPSS 22.0 software. Results The total effective rate of group B was 97.92%(47/48), higher than 83.33%(40/48) of group A, the difference was statistically significant(χ²=6.008, P=0.014). The VAS score of the two groups after treatment was lower than that before treatment, the difference was statistically significant(all P<0.05). The VAS score of group B after treatment(1.27±1.16) was lower than that of group A(3.56±1.21), the difference was statistically significant(t=9.465, P<0.001). The ODI index of the two groups after treatment was lower than that before treatment(P<0.05). The ODI index of group B after treatment(9.81±1.33) was lower than that of group A(13.59±1.47), the difference was statistically significant(t=13.211, P<0.001). The static and dynamic lumbar muscle endurance of the two groups were stronger than that of the group before treatment, the difference was statistically significant(all P<0.05). The static and dynamic lumbar muscle endurance of group B after treatment [(84.18±13.05)s,(26.83±7.87)times] was stronger than that of group A [(67.45±15.62)s,(21.47±8.63)times],the difference was statistically significant(t=5.695, 3.179; all P<0.05). Conclusion Neuromuscular activation technology has a significant effect on chronic nonspecific low back pain, which can obviously alleviate the low back pain, improve the lumbar function and improve the endurance of the low back muscle, and it is worthy of clinical application.

Diagnostic efficacy and economic analysis of cell-free DNA screening for trisomy 21 syndrome

ZHOU Zheng, JIN Hai-hua, XU Yue-dan, CENG Jiang-zhong, CAI Xiao-he, CHEN Yang-ping

2020, 18(6): 968-971. doi: 10.16766/j.cnki.issn.1674-4152.001405

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Abstract:
Objective To evaluate the diagnostic efficacy and economic value of cell-free DNA screening for newborns with trisomy 21 syndrome. Methods Pregnant women who met the research criteria for routine delivery and delivery at Wenzhou Central Hospital and Taizhou Hospital of Zhejiang Province from January 2017 to December 2018 were included in the study. They were divided into routine screening group and cell-free DNA group by random number table method. Routine triple screening tests detected the levels of free human chorionic gonadotropin, alpha-fetoprotein and free estriol at 15-20 weeks of pregnancy, and used professional calculation software to calculate the risk of maternal delivery of children with trisomy 21. Cell-free DNA screening was performed in the 15-20 weeks of pregnancy to assess the risk of maternal birth of children with trisomy 21. Amniocentesis was performed for high-risk groups with the consent of pregnant women and their families to confirm the diagnosis. The diagnostic efficacy and economic benefits of cell-free DNA screening for trisomy 21 were analyzed. Results There were no significant differences in general information such as age and gestational age between the two groups(both P>0.05). The diagnostic sensitivity of the routine screening group was 100%, the specificity was 99%, and the sensitivity of the cell-free DNA group was 100%, specificity is 100%, the false-positive rate in the cell-free DNA group is 0.00%, which was significantly lower than that in the conventional screening group by 0.85%(χ²=6.026, P=0.014). The cost of confirming a fetus in the routine screening group was 70 860.35 yuan, and the cell-free DNA group was 58 027.81 yuan. The cost/benefit value of the screening of the cell-free DNA group was 0.012, which was lower than that of the conventional screening group by 0.017. Conclusion Cell-free DNA testing has a high diagnostic efficacy in screening trisomy 21, is relatively safe and non-invasive, and has low social cost.

Effect of early warning and graded management on hospital transit time and adverse events of critical premature infants

SHAO Fang-ping, QI Yong-e, CHAI Rong, CHEN Ling, GUO Ying, QIU Shen-zhong

2020, 18(6): 972-975. doi: 10.16766/j.cnki.issn.1674-4152.001406

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Objective To explore the effect of early warning and graded management on hospital transit time and adverse events of critical premature infants, so as to improve the clinical outcomes of patients. Methods A total of 40 critical premature infants from March to June, 2019 were selected as control group and 40 critical premature infants from July to October, 2019 as observation group. The control group was transported by conventional transfer method, while the observation group was transported by early warning and grading management method on the basis of the conventional transport method. The transit time, incidence of adverse events and incidence of adverse outcomes were recorded and compared between the two groups. Results The transit time of the observation group was(12.29±2.14) min, which was evidently lower in comparison with the control group(18.65±3.37) min(P<0.05). The occurrence rate of adverse events was 2.50%(1 case of tracheal intubation disconnection) in the observation group, which was obviously reduced in contrast to the control group(20.00%; 2 cases of tracheal intubation disconnection, 2 cases of venous catheter blockage, 1 case of oxygen deficiency, 2 cases of monitor lead disconnection, and 1 case of instrument failure), P<0.05. The occurrence rate of poor outcomes was 7.50%(1 case of abnormal breathing, 1 case of hypothermia and 1 case of hypoxia) in the observation group, which was visibly lower than the control group(47.50%; 4 cases of abnormal breathing, 4 cases of abnormal heart rate, 5 cases of hypothermia and 6 cases of hypoxia), P<0.05. Conclusion Early warning and graded management has a good effect on in-hospital transport of critically ill premature infants, which can not only effectively shorten transit time, reduce the incidence of adverse events, but also improve the outcomes of premature infants.

Study on the application value of Chinese medicine five in one in type 2 diabetes patients signed by family doctors

SHEN Ying, SHEN Lin, WU Ying, LU Ping

2020, 18(6): 976-979. doi: 10.16766/j.cnki.issn.1674-4152.001407

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Abstract:
Objective To study the effect and value of the five in one management of traditional Chinese medicine for type 2 diabetes patients signed by family doctors, and to provide theoretical support for clinical application. Methods From January 2018 to December 2018, 300 patients with type 2 diabetes who visited our center and signed a contract with a family doctor were selected and divided into control group and intervention group according to the random number method, 150 cases each. The control group adopted the family doctor contract system, and the intervention group joined the five-in-one service of traditional Chinese medicine on the basis of the control group. The blood sugar, blood lipid, liver function and kidney function were measured, and body mass index(BMI), knowledge of traditional Chinese medicine, awareness rate of traditional Chinese medicine service, contract rate and utilization rate of contract service were counted. Results The levels of TG, TC, HDL-C and LDL-C in the intervention group were lower than those in the control group(all P<0.05). The levels of FPG, 2 hPBG, HbA1 c and BMI in the intervention group were lower than those in the control group(all P<0.05). The levels of ALT, AST, serum creatinine and urea nitrogen in the intervention group were lower than those in the control group(all P<0.05). The awareness rate of TCM service in the intervention group was 88.67% higher than that in the control group 80.00%(χ²=4.264, P=0.039). In the intervention group, the 1+1+1 signing rate was 90.00% and the signing service utilization rate was 84.00% higher than that in the control group 81.33% and 67.33%(all P<0.05). Conclusion The application value of Chinese medicine five in one in type 2 diabetes patients signed by family doctors is significant. It can improve the level of blood glucose, blood lipid and liver function, improve the patients' cognition level of Chinese medicine, improve the signing rate and disease control rate.

Investigation and analysis of the difference between the expectation value and the actual value of the family doctor contract service of the elderly over 60 years old

CAI Li-qiang, HOU Jin

2020, 18(6): 980-983. doi: 10.16766/j.cnki.issn.1674-4152.001408

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Abstract:
Objective To analysis the existing problems of the contracted service of family doctors and put forward countermeasures and suggestions through the evaluation of the expected value and the actual value of the family doctor contract service of the elderly over 60 years old. Methods Using the convenient sampling method, 420 contracted residents over 60 years old who admitted in the community health service center of Datuan, Pudong New Area from February to April 2018 were selected as the survey objects. A self-designed questionnaire was used to investigate the expected and actual values of the contracted residents' family doctor contract service. The data were statistical analyzed. Results Total of 420 questionnaires were issued, 400 questionnaires were recovered, with an effective recovery rate of 95.24%. In 400 cases, the awareness rate of family doctors signed by family doctors was 91.75% and satisfaction was 90.25%. For the 12 services of basic medical treatment, public health and agreed health management provided by family doctors, the expected score was more than 8 in 10 items(83.33%), and the actual perception was more than 8 in 6 items(50.00%). The top 5 service items with the largest difference were long prescription(9.27±1.35 vs. 6.81±1.79), on-site service(9.40±1.42 vs. 7.50±2.52), family sickbed(9.24±1.30 vs. 7.57±2.51), extended prescription(9.16±1.13 vs. 7.60±1.33), and health education(9.34±1.45 vs. 8.02±2.03). Conclusion The actual value of 12 basic medical services, public health services and agreed health management services provided by the respondents to the family doctors was higher, but there was a certain gap between them and the expected value.

Investigation on the knowledge, attitude and practice of oral health and the influencing factors among medical college and university undergraduate in Anhui Province

LIAO Xin, LIAO Sheng-kai, WU Jun-jie, HAN Qian-qian, JIANG Sheng, XU Zhi-jia, LU Tong

2020, 18(6): 984-988. doi: 10.16766/j.cnki.issn.1674-4152.001409

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Objective To investigate the current situation of knowledge, attitude and practice(KAP) of oral health among medical college and university undergraduates in Anhui Province,and provide baseline information for oral health education. Methods A total of 1 672 undergraduates from 6 medical colleges and universities in Anhui Province were randomly selected as the subjects. A self-designed questionnaire was used to investigate the KAP of oral health among these undergraduates. Results The correct answer rate for oral health knowledge was 63.8%, the positive attitude of oral health care was 68.8%, and the correct rate of oral hygiene practice was 44.1%. The oral health KAP level of the stomatology undergraduates were higher than those of other professional students(all P<0.05), and those of the non-medical students were the lowest. The oral health KAP level of the town students were higher than those of the rural undergraduates(P<0.05). The oral health KAP level of the female undergraduates were higher than those of male undergraduates(P<0.05).There was a statistically significant difference in knowledge and attitude between the grades(all P<0.05), but the difference in practice was not statistically significant(P>0.05). The score of knowledge, attitude and practice of oral health among undergraduates were positively correlated to each other(r=0.285, 0.220, 0.143, all P<0.05). Gender, place of origin, grade and profession were the influencing factors of the oral health knowledge. Gender, grade and profession were the influencing factors of the oral health attitude. Gender, place of origin and profession were the influencing factors of oral health practice. Conclusion The knowledge and attitude of oral health among medical college and university undergraduates in Anhui Province are at medium level, and the practice of oral health is at a low level. It is suggested that various forms of the oral health education should be carried out in colleges and universities.

CT differential diagnosis of hypervascular early-stage ultra small renal cell carcinoma and renal angiomyolipoma with minimal fat

WANG Xu, SONG Ge, WANG Zong-ping, ZHU Shao-xing, SHAO Guo-liang

2020, 18(6): 989-993,1017. doi: 10.16766/j.cnki.issn.1674-4152.001410

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Objective To compare the imaging features and difference of hypervascular early-stage ultra small renal cell carcinoma(usRCC) and angiomyolipoma with minimal fat(mfAML), and to improve the accuracy of differential diagnosis. Methods The CT images of hypervascular usRCC(47 cases) and hypervascular mfAML(22 cases) both with diameter of 2 cm or less confirmed by pathology in Cancer Hospital of University of Chinese Academy of Sciences(Zhejiang Cancer Hospital) from January 2014 to May 2019 were compared and analyzed retrospectively, including traditional imaging features and CT dynamic enhanced parameters, meanwhile receiver operating characteristic curves were drawn to evaluate the diagnostic efficacy. Results Traditional imaging features: the sex, cystic degeneration or necrosis, pseudocapsule sign, and enhance uniformity in parenchymal phase had significant differences between usRCC and mfAML(all P<0.05); the age, shape, location, tumor central point, wedge sign, cortex set off sign, black star sign, enhance uniformity in cortical phase and enhancement mode had no significance difference between usRCC and mfAML(all P>0.05). CT dynamic enhanced parameters: the CT value, NEV and REV of usRCC were all higher than those of mfAML in both cortical phase and nephrographic phase(all P<0.01). The area under the ROC curve was 0.748, 0.779, 0.787, 0.844, 0.800 and 0.789, respectively. The sensitivity and specificity of RCC were 85.1% and 77.3% respectively when the NEV of nephrographic phase was 73.6 as the critical value. Conclusion Morphological features in the traditional diagnosis of small renal carcinoma(diameter of 4 cm or less) have certain significance in differentiating hypervascular usRCC and mfAML at the early stage, but the diagnostic efficacy was limited. The CT quantitative parameters have relatively important value in differential diagnosis, among which the NEV in nephrographic phase have better diagnostic efficacy.

Research progress of learning and memory and neurotoxicity mediated by NMDA receptor

WEN Jian-xia, WEI Na

2020, 18(6): 994-997. doi: 10.16766/j.cnki.issn.1674-4152.001411

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N-methyl-D-aspartic acid receptor(NMDAR) is a glutamatergic excitatory neuroreceptor, which is transformed into a mandatory heterotetramer by a variety of subgroups. Excitatory glutamatergic neurotransmission of NMDAR is essential for synaptic plasticity and survival of neurons. Synaptic plasticity in hippocampus and striatum is closely related to learning and memory. Long-term potentiation(long-term potentiation, LTP), the prototype form of synaptic plasticity in cavernous body, is involved in the maintenance and consolidation of learning and memory, while synaptic plasticity in striatum is the cellular basis of learning and memory. The subunits of NMDAR in physiological state can promote the production of learning and memory. However, excessive activation of NMDAR subunit can cause learning and memory impairment, induce excitatory neurotoxicity and promote nerve cell death. In addition, the normal activation of NMDAR in synapses initiates synaptic plasticity and stimulates cell survival. On the contrary, the overactivation of extracellular NMDAR can induce Ca²⁺ overload, mediate excitatory neurotoxicity and promote neuronal death. However, more and more studies have shown that NMDAR in synapses can also induce excitatory neurotoxicity and cause neuronal death while promoting neuronal survival. The mainstream view is that excitatory neurotoxicity is mainly mediated by Ca²⁺ overload, while some think that NMDAR can also mediate excitatory neurotoxicity through Ca²⁺ overload and Nonionic channels at the same time. This paper mainly reviews the research progress of the promoting and inhibitory effect of NMDAR on learning and memory and its excitatory neurotoxicity.

Thoughts on the role of psychosomatic medicine in general practice

YANG Yan-qing, TAO Ying, LI Da, LIU Huan, SUN Wen-jiang, BO Yong-hai

2020, 18(6): 998-1001. doi: 10.16766/j.cnki.issn.1674-4152.001412

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Abstract:
With the development of psychosomatic medicine, most of today's diseases can be classified into psychosomatic diseases, and are in a high incidence state. China has put forward the service mode of "first visit at the grass-roots level", but general practice is still in the stage of development. There are problems of uneven medical level among general practitioners in primary health services, and their post competence needs to be improved, especially in the level of psychosomatic disease diagnosis and treatment ability. Combining psychosomatic medicine with general practice medicine can improve the general practitioner's cognitive and coping ability to psychosomatic diseases, improve the status quo of general practitioner's inadequate post competency, and promote the mental health of community residents, fully reflecting the role of general practitioner's "health gatekeeper". This paper expounds the current situation of the late start and high demand of general practice medicine in China, summarizes the recognition of psychosomatic medicine at home and abroad, and reveals the phenomenon that the supply of mental health resources in China exceeds the demand. According to the problems of low clinical diagnosis rate of psychosomatic diseases, lack of psychosomatic intervention technology, lack of diagnostic evaluation criteria suitable for China's national conditions and so on, the author believes that it should be promoted from various perspectives. From the aspects of formulating relevant policies by government departments, improving the education and training system of general practitioners in colleges and universities, and combining with the characteristics of local general practice of traditional Chinese medicine, the author proposes to strengthen general practice. Three suggestions on physician's ability to diagnose and treat psychosomatic diseases. The combination of psychosomatic medicine and general practice medicine meets the needs of the development of medical services in China. By strengthening the general practitioner's cognitive and coping ability of psychosomatic diseases in the first diagnosis, it has significant promotion significance for improving the ability of primary medical services, controlling medical insurance costs and reducing the economic burden of patients and society, thus better realizing the goal of "Health 2030".

Prediction of Uterine Artery Doppler for Preeclampsia

DENG Chen-chen, TAO Feng, CHEN Hong-bo

2020, 18(6): 1002-1005. doi: 10.16766/j.cnki.issn.1674-4152.001413

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Preeclampsia is one of the serious obstetric complications. The basic pathophysiological changes are systemic vasospasm and vascular endothelial injury. Decreased blood perfusion of organs and systems can cause maternal eclampsia and impairment of important organ functions. On the other hand, insufficient blood perfusion of uterus and placenta, iatrogenic premature birth, fetal distress, fetal growth restriction, etc. Increased risk is one of the main causes of maternal and perinatal morbidity and mortality. At present, the prevention and treatment of preeclampsia has not yet achieved definite results. Once preeclampsia occurs, termination of pregnancy is the only effective treatment. Therefore, early identification of high-risk preeclampsia patients and active intervention measures can help reduce the risk of adverse perinatal outcomes of mothers and infants. At present, the main indicators for predicting preeclampsia include maternal characteristics, serological examination and Doppler ultrasound. The maternal characteristics mainly include high-risk factors of preeclampsia, such as maternal age, body mass index, mean arterial pressure and past history of preeclampsia. Serological indicators include triple indicators of second-trimester prenatal serum screening, as well as other specific serum markers such as soluble tyrosine kinase receptor 1, placental growth factor, pregnancy-related plasma protein A and placental protein 13. Doppler ultrasound indicators include fetal umbilical artery, middle cerebral artery, venous catheter and maternal uterine artery and other blood flow parameters. These three indicators can be used for early identification of preeclampsia alone or in combination. Doppler ultrasound, as a simple, safe and non-invasive detection method, has attracted more and more attention in clinic. The predictive effect of Doppler ultrasound on maternal uterine artery blood flow on preeclampsia has been verified in many studies. The purpose of this article is to review the application of uterine artery Doppler ultrasound in predicting preeclampsia in recent years, and to provide reference for follow-up clinical research.

General situation of Traditional Chinese Midicine treatment of transient synovitis of the hip in children

HAN Fei, LIANG Bo-cheng, DONG Yan, FAN Wei-xing, LIU Jun

2020, 18(6): 1006-1009. doi: 10.16766/j.cnki.issn.1674-4152.001414

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Transient synovitis of the hip in children(TSH) is common and frequently occurring diseases in children. It is the most common cause of hip pain and claudication in children. At present,there is no consensus on the cause of the disease at home and abroad,there is also no uniform standard of treatment. Western medicine believes that the cause of this disease is related to many factors such as bacterial or viral infection, hip joint trauma, fatigue and allergy reaction, the commonly used treatment methods are antibiotics or antiviral drugs, skin traction, physical therapy,etc. For patients to whom conservative treatment is in effective, arthroscopic surgery can be used. The clinical efficacy of the above treatment methods is worthy of affirmation, but the negative problems such as drug toxicity, side effects and surgical risks are gradually receiving the attention of scholars. Traditional Chinese Medicine(TCM) believes that the cause of this disease lies in the deficiency of healthy atmosphere of children, feeling external injuries influences,Bi-syndrome occurs in the hip. It belongs to the category of "Bi-syndrome" in TCM. TCM has a variety of methods for treating this disease, such as internal, external administration(Traditional Chinese medicine fumigation, Plaster topical, Ointment inunction, etc) or the combination of them. The author has checked and summarized the relevant valuable literature in recent years, the conclusion of the study suggests that TCM mainly treats children's hip synovitis with remarkable effect, safety and simplicity, and has unique advantages in treatment methods and curative effects. This article summarized from the etiology, pathogenesis and diagnosis of children's hip synovitis, the main treatment of TCM internal treatment, the treatment of TCM external treatment, the main aspects of traditional Chinese medicine, internal and external treatment in order to provide reference for clinical treatment.

Intervention study of ear point pressing beans combined with directional Chinese medicine penetration on early pain after total knee arthroplasty

SUN Guo-li, JIN Ying, HU Xue-rong

2020, 18(6): 1010-1013. doi: 10.16766/j.cnki.issn.1674-4152.001415

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Objective To explore the effect of ear point pressing beans combined with directional penetration of traditional Chinese medicine on early pain and knee motion after total knee arthroplasty. Methods Total 60 patients with total knee arthroplasty in Department of Orthopedics and Arthrology, the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from November 2017 to April 2019 were randomly divided into group A, group B and group C, with 20 cases in each group. On the basis of routine postoperative analgesia, group C was treated with traditional Chinese medicine directed penetration, group B with auricular point pressing, group A with traditional Chinese medicine directed penetration and auricular point pressing. Pain, joint activity and therapeutic effect were evaluated. Results On 7 d after treatment, PRI, VAS and PPI scores of group A(5.46±0.15, 1.12±0.04, 0.89±0.04) were lower than those of group B(6.24±0.10, 2.49±0.21, 1.16±0.17) and group C(6.21±0.50, 2.67±0.26, 1.26±0.24, F Between the three groups/P Between the three groups=29.024/0.001, 42.990/0.001, 10.371/0.001). The total effective rate in group A(95.00%) was significantly higher than that in group B(55.00%) and group C(50.00%), with statistically significant difference(χ²=10.950,P=0.004). Conclusion The combination of ear point pressing and traditional Chinese medicine directional penetration can relieve the pain of patients after total knee replacement and promote the recovery of joint function.

Clinical Observation of Medical Ozone Water Acupoint Injection combined with Cervical Traction on Treatment of Vertebral Artery Cervical Spondylosis

WEI Ying-cheng, WU Xiao-mei, LIANG Xiao-xing, HUANG Ye-cheng, TAN Xi-yang, YANG Xian, ZHANG Xue-ping

2020, 18(6): 1014-1017. doi: 10.16766/j.cnki.issn.1674-4152.001416

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Objective To observe the clinical effect of medical ozone water point injection combined with cervical traction on the treatment of cervical spondylosis of vertebral artery type. Methods A total of 70 patients were randomly divided into treatment group and control group, 35 cases in each group. The treatment group was treated by acupoint injection of medical ozone water combined with cervical traction, while the control group was treated by cervical traction. The acupoint injection of medical ozone water was given every other day; the cervical traction was given once a day, 15-20 minutes each time; two weeks was a course of treatment. Before and after treatment, the scores of symptoms and signs, and the curative effect index were used to evaluate, respectively. Mean blood flow velocity(Vm) of bilateral vertebral artery(VA), basilar artery(BA) and bilateral posterior cerebral artery(PCA) were measured by transcranial Doppler(TCD), and then analyzed and evaluated. Results Compared with the control group, the treatment group(cure and effective) rate was 91.43% and the total effective rate was 100% better than the control group(all P<0.05). There was no significant difference in the scores of symptoms and signs between the two groups before treatment(all P>0.05). Compared with the same group, the scores of symptoms and signs in both groups were improved after treatment(all P<0.05), and the treatment group was better than the control group(all P<0.05). There was no significant difference in Vm of VA, PCA and BA between the two groups before treatment(all P>0.05). Compared with the same group, the Vm of VA, PCA and BA in both groups increased significantly after treatment(all P<0.05), and the treatment group was better than the control group(all P<0.05). Conclusion The technique of "medical ozone water point injection combined with cervical traction" is effective in treating CSA. It can improve the blood flow velocity of patients with bilateral VA, bilateral PCA and BA.

Effect of "Xiaokebizu Bath Prescription" combined with cilostazole in the treatment of diabetic peripheral neuropathy

LAN Jing, DING Shi-ling, LAI Li-ying, ZHANG Zheng-yu

2020, 18(6): 1018-1020. doi: 10.16766/j.cnki.issn.1674-4152.001417

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Objective To observe the clinical effect of Xiaokebizu Bath Prescription combined with cilostazole on diabetic peripheral neuropathy(DPN) and the effect on motor nerve conduction velocity. Methods A total of 112 patients with DPN admitted to our hospital from January 2017 to March 2019 were selected and divided into cilostazol group(56 cases) and combination group(56 cases) according to the different treatment methods. Both groups were given routine basic intervention and cilostazol treatment. The combined group was treated with Xiaokebizu Bath Prescription. Both groups were treated for 8 weeks. The therapeutic effects and adverse reactions of the two groups were observed. Toronto Clinical Score Scale(TCSS) was used to evaluate the severity of symptoms before and after treatment. The motor nerve conduction velocity(MNCV) and sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve were compared between the two groups before and after treatment. Results The TCSs score of the combined group was significantly lower than that of the cilostazol group [(4.95±1.37) scores vs.(6.38±2.02) scores]. The MNCV [(50.97±4.28) m/s vs.(47.43±14.15) m/s] and SNCV [(46.05±14.24) m/s vs.(50.44±15.27) m/s] of the median peroneal nerves, the MNCV [(45.27±14.11) m/s vs.(42.34±13.93) m/s] and SNCV [(39.92±15.17) m/s vs.(43.02±15.62) m/s] of the nervus peroneus communis and total effective rate(94.64% vs. 73.21%) in the combined group were significantly higher than those in the cilostazol group(all P<0.05). Conclusion Xiaokebizu Bath Prescription combined with cilostazol can effectively alleviate the clinical symptoms of DPN patients and improve the conduction velocity of diseased nerves. The clinical effect is remarkable and the safety is good.

Compiling key points of teaching to promote the homogenization of teaching effects on integrated clinical curriculum

WANG Ying, GANG Jun, ZHANG Dong-hai, CHEN Yi, MA Xiu-hua, ZHAO Liu-zhuang

2020, 18(6): 1021-1024. doi: 10.16766/j.cnki.issn.1674-4152.001418

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Objective Based on the current situation of Beijing "3+2" assistant general practitioner training in Beijing distributed in 10 teaching hospitals in the suburbs, we discuss how to improve the teaching level between different teaching hospitals, in order to achieve the homogenization of teaching effects. Methods From 2013 to 2018,the clinical comprehensive course joint teaching and research section conducted a test paper analysis of the completion test papers of the "3+2" assistant general practitioner "Clinical Comprehensive Course" trained in 10 teaching hospitals in the suburbs and searched according to the results of the test paper analysis. The difference points of teaching effects, and took measures such as organizing collective preparation for common corrections, establishing and enriching test questions, compiling "exercise set", and revising teaching courseware, were analyzed and evaluated. At the same time, in 2015, the relevant teachers were compiled and confirmed by the group discussion, and the "Key Points of Teaching Key Points" was published as the teacher's teaching support manual. The manual was implemented in the 2016 teaching process, with the aim of making different teaching units. In the teacher's teaching process, while exerting personal subjective initiative, uniformly teach the key teaching content, pay attention to the difficulty of the course, and jointly evaluate the teaching implementation effect. Results The difference in teaching effect between the 10 teaching hospitals was reduced from 40% in 2013-2015 to 17%-18% in 2017-2018 by compiling and using the key points of the course teaching. Conclusion Compiling and using the key points of teaching points has effectively promoted the overall improvement of teaching level of 10 teaching hospitals. At the same time, it can serve as a reference for teaching reference, focus on reviewing and reviewing students, correcting teaching deviations, and as a basis for assessing and understanding the knowledge of students. In order to further improve the teaching level and give full play to the effective role of key points in teaching, the key points of teaching points also need to be refined and sublimated through use and argumentation.

Discussion on the training mode of professional ability of master’s degree in oncology and its innovative research

YU Jia-wei, LIU Bo, PANG Rui, ZHANG Jie-wu

2020, 18(6): 1025-1029. doi: 10.16766/j.cnki.issn.1674-4152.001419

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Objective This paper aims to analyze the science, necessity and feasibility of the reform of the training mode of the master degree in oncology, and to provide a theoretical basis for cultivating high-quality innovative talents in oncology. Methods Combining multidisciplinary cooperation with clinical practical ability training to build a practical education platform, reform the teaching model, modularized curriculum system, attach importance to the combination of clinical and scientific research methods, and strengthen the humanities quality and medical literacy of medical graduate students. Building the pre-clinical laboratory practice teaching platform, clinical comprehensive practicing platform and extracurricular practicing platform. Through exploration and practice, a unique three-year medical personnel training model for cancer graduates has been formed. Results Through the combination of theory, research and practice, the postgraduate students' ability to discover problems, think about problems, solve problems and innovate was cultivated, the interest and initiative of postgraduate in studying effectively stimulated. We should strengthen the cultivation of students' professional literature self-study ability, team communication and expression ability, scientific research practice and team cooperation ability, and advocate the concept of students' independent learning and research-based learning. In the process of clinical practice teaching, combined with the teaching of medical psychology and medical ethics, the concept of medical ethics education and humanistic care is rooted in the heart of the trained graduate students. It has improved the comprehensive quality level of the master's degree and master's degree in oncology, and trained the oncology professional talents to meet the requirements of the new era. Conclusion In the process of clinical practice teaching, the traditional teaching and teaching through the clinical teaching teacher is improved to focus on clinical case teaching, combined with multi-disciplinary and multi-module teaching system, adapting to the needs of modern medicine, and having observation for social training. Master's degree in high quality oncology with outstanding comprehensive qualities such as ability, self-learning ability, practical ability, scientific research and innovative ability.

Analysis of prognostic factors for Merkel cell carcinoma based on SEER database

PAN Ru-jing, ZHANG Li, LIN Xiao-hua, LI Zhi-ming, LIU Jing-jing

2020, 18(6): 1030-1034. doi: 10.16766/j.cnki.issn.1674-4152.001420

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Objective To identify prognosis factors and construct a nomogram for predicting cancer-specific survival in patients with resected Merkel cell carcinoma. Methods A total of 1 271 patients were extracted from the Surveillance, Epidemiology and End Results database and randomly divided into training cohort(n=891) and validation cohort(n=380). Univariable and multivariable cox analysis were used to determine prognostic factors, and these factors were used to construct a nomogram for predicting cancer-specific survival in patients with resected Merkel cell carcinoma. Model performance was evaluated by Harrell's concordance index(C-index), the area under the time-dependent receiver operating characteristic curve(AUC) and calibration plots. The predictive power of the model was compared with the traditional TNM staging system. Results Cox analysis indicated age, sex, tumor size, N stage, M stage were associated with cancer-specific survival, while race, marital status and radiation therapy did not show a significant effect on outcomes. The above positive factors were employed to build a nomogram and the nomogram was superior to the 8 th TNM staging system. The C-index of the new model was 0.761, while that of the TNM staging system was 0.711. The AUC of the new model was significantly higher than that of the TNM staging system in both cohorts. Also, the nomogram displayed a good calibration. Conclusion The nomogram is superior to the 8 th TNM staging system in predicting cancer-specific survival of patients with Merkel cell carcinoma and may help doctors to evaluate the prognosis of each patient and facilitate personalized treatments.

The correlation between sleep duration、sleep quality and cardiovascular disease risk factors in elderly

ZHOU Li, RUAN Chun-yan, ZHOU Xiao-li, WENG Shu-qing, HU Cai-bao, ZHAO Jing

2020, 18(6): 1035-1039. doi: 10.16766/j.cnki.issn.1674-4152.001421

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Objective To investigate the correlation between sleep status and cardiovascular disease risk factors in the elderly and provide reference for the prevention and treatment of cardiovascular disease. Methods From February 2018 to June 2019, 1 061 elderly people who underwent physical examination in the department of health management of our hospital were selected as research subjects, including 473 males and 588 females, aged ≥ 60 years. Subjects were given a questionnaire, physical examination, and biochemical examination. Sleep duration and sleep quality were assessed on a self-reported basis. Results The incidence rate of diabetes, hypertension and dyslipidemia in at least one diseases in sleep group <7 h and >9 h were 57.2% and 63.4% respectively, significantly higher than those in the 7-8 h group(P<0.05). Multivariable logistic regression analysis results showed that compared to sleep 7-8 h group, the sleep group <7 h, 8-9 h and > 9 h of the elderly, at least one type of diabetes, hypertension and dyslipidemia OR values were 2.493(95%CI:1.207-4.934, P<0.05), 1.093(95%CI:0.762-1.874, P>0.05) and 1.258(95%CI:1.074-2.706, P<0.05). Compared with the elderly with good sleep, the risk OR value of at least one of diabetes, hypertension and dyslipidemia in those with poor sleep was 1.817(95%CI:1.024-3.272, P<0.05). Conclusion There is a "U" relationship between the duration of sleep and cardiovascular disease risk factors in elderly people. The reduction and extension of sleep time can increase cardiovascular disease risk factors. Sleep quality is also closely related to cardiovascular disease risk factors.

Investigation and consideration of the management of logistics socialized staff in a new tertiary hospital in Shanghai

SUN Zhe, LIU Xia, WANG Luan, DUO Qi, YE Mao

2020, 18(6): 1040-1043,1058. doi: 10.16766/j.cnki.issn.1674-4152.001422

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Objective To understand the management status of logistics socialized staff in a new tertiary hospital in Shanghai, and research countermeasures to strengthen the cohesion construction. Methods Total 350 logistics socialized staff of the hospital were selected by convenient sampling and random sampling to conduct a questionnaire survey on management status in July 2018. The survey included the values of logistics socialized employees, work life learning status, unit identity and so on, with a total of 20 items. Statistical analysis was used to study the management status of logistics socialized staff. Results The comprehensive statistical analysis showed that under the new situation, the management of logistics socialized staff was different from that of the formal staff in the hospital. They paid great attention to the work objectives of their hospital and company: 94.85% of the staff were clear about the work objectives of their hospital and company; 70.10% of the staff had a "confident" attitude towards the development of the hospital, but 29.90% of the staff still thought that "it doesn't matter, they don't care"; 92.78% of the staff thought that they can "give full play" or "basically give play" to their work enthusiasm; 89.00% of the staff thought that the salary system of their company is reasonable, but only 61.51% of the staff thought that the current salary matches their work quality. Their awareness of theoretical business learning was not unified, 95.88% of the staff had the idea of further study, 43.29% of the staff had the attitude of "feel necessary, take the initiative to learn" towards the learning of rules and regulations, another 34.36% of the staff were "not interested, seldom learn". Conclusion After the reform of logistics socialization, under the new management system, the relationship between logistics staff and hospital is looser. We should strengthen the education and guidance of logistics socialization staff, combine with many measures such as gathering logistics staff with true feelings and family feelings, strengthen the recognition of logistics socialization staff to hospital, and the construction of cohesion.

Effect of root cause analysis on cleaning and sterilization effect of orthopedic implantable instruments and postoperative infection of patients

ZHANG Ye, YUAN Shuo-hui

2020, 18(6): 1044-1046,1050. doi: 10.16766/j.cnki.issn.1674-4152.001423

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Objective To investigate the effect of root cause analysis on cleaning and sterilization effect of orthopedic implant devices and postoperative infection of patients. Methods A total of 524 patients undergoing orthopaedic surgery treated in the Zhejiang Zhuji People's Hospital from May 2017 to May 2019 were selected. The patients were treated with orthopaedic implant machine, according to the time order were divided into two groups, control group, 260 cases of patients with for our patients before returning for analysis, 264 patients with the team for our patients after the implementation of returning for analysis, analysis in the implementation of returning for analysis before and after the orthopaedic implant machine clean and sterilization condition, and infections in patients with conditions for record. Results A total of 524 patients were included in this study, among which 46 were infected, 63 strains were detected, among which 41 strains were gram-positive bacteria, accounting for 65.1%. Staphylococcus aureus(18 strains, accounting for 28.6%) was the largest among gram-positive bacteria, and pseudomonas aeruginosa(9 strains, accounting for 14.3%) was the largest among gram-negative bacteria. The incidence of besmirch instrument, rusty instrument and backwash instrument in the research group was all higher than that in the control group(all P<0.05), and the total qualified instrument rate in the research group was higher than that in the control group(P<0.05). The infection rate of the study group was 6.8%, and that of the control group was 15.8%. The infection rate of the study group was lower than that of the control group(P<0.05). Conclusion In patients with orthopedic infection, the main infection strains are gram-positive bacteria. In the treatment of surgical instrument implantation, the use of root cause analysis method to evaluate the sterilization quality of the instrument can effectively improve the cleaning and sterilization quality of orthopedic instrument implantation, and reduce the postoperative infection rate of patients. It can be further popularized and applied in clinic.

Expression and significance of Smad signal pathway and coagulation factor in patients with diabetes mellitus and breast cancer after ultrasound-guided catheter infection

CENG Yi-lin, YUAN Shuai, TANG Yan, SUN Yan, CHEN Chun-ya, CENG Zhi-hong

2020, 18(6): 1047-1050. doi: 10.16766/j.cnki.issn.1674-4152.001424

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Objective To investigate the expression and significance of Smad signal pathway and coagulation factor in patients with diabetes mellitus and breast cancer after ultrasound-guided catheter infection. Methods A total of 176 patients with stroke diabetes mellitus and breast cancer diagnosed by breast surgery who were admitted to the second people's Hospital of Yuyao City from January 1, 2013 to December 31, 2017 were divided into infection group and control group according to the occurrence of ultrasound-guided catheter infection. There were 21 patients in infection group and 155 in control group. The expression of plasminogen activator(t-PA), plasminogen activator inhibitor(PAI-1), interleukin-6(IF-6), serum prothrombin time(PT), vascular endothelial growth factor(VEGF), transforming growth factor-β(TGF-β), thrombin time(TT), fibrinogen(FIB), Smad signaling pathway related proteins and postoperative complications were compared between the two groups. Results One week after operation, FIB [(3.24±0.16) g/L], PAI-1 [(42.47±2.52) g/L], TGF-β [(0.61±0.13) μg/L], VEGF [(0.59±0.12) ng/L], IF-6 [(0.57±0.12) pg/mL], Smad1 [(0.54±0.11) ng/L], Smad2 [(0.53±0.10) ng/L] and Smad3 [(0.69±0.15) ng/L] in the infection group were significantly higher than those in the control group(all P<0.05), while t-PA [(20.28±2.91) ng/L] was significantly lower than that in the control group [(24.24±3.03) ng/L, P<0.05]. Conclusion Ultrasound-guided catheterization can activate Smad signal pathway and cause coagulation disorder.

Application of a continuous nursing program for elderly maintenance hemodialysis patients based on comprehensive geriatric assessment

LIANG Gui-lan, WAN Mei-qing, YIN Gui-lan, ZHANG Qing-yan

2020, 18(6): 1051-1054. doi: 10.16766/j.cnki.issn.1674-4152.001425

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Objective To explore the continuous nursing practice program of maintenance hemodialysis(MHD) patients based on comprehensive geriatric assessment and evaluate its effect. Methods From January to December 2018, 94 elderly patients with MHD in Nanjing Drum Tower Hospital were enrolled in this study. According to the random number table method, they were divided into two groups, 47 cases in each group. Routine hemodialysis nursing was carried out in both groups during dialysis. During the non-dialysis period, the control group was given routine continuous nursing, and the observation group was given personalized continuous nursing based on the comprehensive geriatric assessment results of the elderly. Blood biochemical test indexes, complications, quality of life score and ADL score of the two groups were compared before and 6 months after intervention. Results Before intervention, there was no statistically significant difference in the above indexes between the two groups(all P>0.05). After intervention, the total protein [(69.59±14.39) g/L], [hemoglobin(100.34±9.49) g/L] of the observation group were higher than those of the control group [(60.22±16.73) g/L,(88.51±10.39) g/L], urea nitrogen [(100.21±4.43) mg/dL], serum creatinine [(878.50±117.18) μmol/L] were lower than those of the control group [(110.79±5.47) mg/dL,(1 012.23±61.92) μmol/L], the difference was statistically significant(t=18.524, 18.336, 18.471, 18.549, all P<0.05). The incidence of hypertension in the observation group was lower than that in the control group, and the difference between the two groups was statistically significant(P<0.05). The improvement of quality of life scores(72.44±4.82, 67.84±11.42, 63.72±11.37, 74.79±9.68) and ADL score(87.82±9.14) in the observation group were better than those in the control group(60.43±5.69, 54.63±5.67, 58.42±9.91, 68.73±9.38, 54.56±5.47), respectively(t=7.542, 6.770, 8.613, 7. 243, 6.770, all P<0.05). Conclusion The continuous nursing of MHD patients based on the comprehensive geriatric assessment is beneficial to improve the prognosis of patients, reduce the occurrence of complications, and improve the self-care ability and quality of life of patients.

Effect of the continuous nursing combined with ultrasonic and electroacupuncture in old CSVD patients

WANG Ai-ping, LI Bin, LI Ben-ying

2020, 18(6): 1055-1058. doi: 10.16766/j.cnki.issn.1674-4152.001426

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Objective To study the effect of the continuous nursing combined with ultrasonic and electroacupuncture in old Cerebral small vessel diseases(CSVD) patients. Methods From April 2018 to December 2018, 54 old CSVD patients form internal neurology department of Anhui No 2 Provincial People`s Hospital were chosen and randomly divided into the control group(n=27) and research group(n=27).The control group was used continuous nursing,while the research group was used the continuous nursing combined with ultrasonic and electroacupuncture.The maximun walking speed within 10 m(10 m MWS),the life quality scores,the lower and upper limb functions scores were compared between the two groups. Results There were no statistically significant in 10 m MWS, limb functions scores, life quality scores between the two groups while discharge, all P>0.05. Two months and six months after discharge, the 10 m MWS of the control group [(27.3±2.8)m/min,(31.1±2.9)m/min] and the research group [(30.7±3.1)m/min,(35.9±3.5)m/min] were better than that of the discharge [(22.2±2.4)m/min,(21.9±2.1)m/min, all P<0.01], and the increase of 10 m MWS of the research group was significantly better than that of the control group. Two months and six months after discharge, the limb functions scores of the control group and the research group were better than those at discharge(all P<0.01), and at two and six months after discharge, the limb functions scores in the research group were significantly better than those in the control group(all P<0.01); Two months and six months after discharge, the quality of life scores of the two groups were better than that of the discharge(all P<0.01), and the increase of the quality of life scores of the research group was significantly greater than that of the control group(all P<0.01). Conclusion The continuous nursing combined with ultrasonic and electroacupuncture can improve 10 m MWS, the life quality scores,the lower and upper limb functions scores in old CSVD patients, which is worthy of clinical application.

Effect of TCM Syndrome Differentiation and Pain Management on Sleep Quality and Psychological Status of Patients with Clavicular Fracture

YANG Chang, WANG Yong

2020, 18(6): 1059-1062. doi: 10.16766/j.cnki.issn.1674-4152.001427

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Objective To investigate the effect of TCM syndrome differentiation combined with painless management on sleep quality in patients with clavicular fracture, and to analyze the effect of post-traumatic stress disorder. Methods Eighty-four patients with clavicular fractures treated in our hospital from March 20 to March 2019 were enrolled in the study. The Excel random function method was used to divide into the control group and the observation group, and the routine nursing intervention and TCM syndrome differentiation were combined. Painless management of nursing intervention, comparing the sleep quality and psychological status of the two groups of patients. Results The PSQI scores of the control group after intervention were significantly lower than those before the intervention, and there were statistically significant differences(all P<0.05). The PSQI scores of the observation group after intervention were significantly lower than those before the intervention, and there were statistical differences between the groups(all P<0.05), the total score(8.13±2.24) after the intervention was lower than that before the intervention(14.46±3.77), and the difference was statistically significant(t=9.355,P<0.05).After the intervention, the PSQI scores of the observation group were lower than those of the control group in all seven aspects. The total score of the observation group(8.13± 2.24) was lower than the control group(11.85± 2.71, t=6.846, P<0.05). In terms of psychological status, the scores of post-traumatic stress disorder in the observation group were lower than those in the control group(all P<0.05), and the total score of the observation group(36.40±6.77) was significantly lower than that of the control group(62.77±8.94, t=15.239, P<0.05). Conclusion Applying TCM syndrome differentiation and painless management to patients with clavicle fracture can improve their sleep quality, reduce post-traumatic stress disorder and improve their psychological status. It is worthy of clinical application.

MA Yan-hong, LI Ying-lan

2020, 18(6): 1063-1065. doi: 10.16766/j.cnki.issn.1674-4152.001428

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SUN Jia-wei, HUANG Kai

2020, 18(6): 1066-1068. doi: 10.16766/j.cnki.issn.1674-4152.001429

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2020 Vol. 18, No. 6

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