中华全科医学

"Six precision"service research and development suggestions based on health China action

BAO Yong, BAO Xiao-qing

2020, 18(7): 1069-1072. doi: 10.16766/j.cnki.issn.1674-4152.001430

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Abstract:
The 19th National Congress of the Party has made major decision-making arrangements for the implementation of the strategy of healthy China, which fully embodies the firm determination to safeguard the health of the people. The 2016 "healthy China 2030" believes that to actively deal with the current outstanding health problems, health action must move forward, take effective interventions, and strive to make the masses not sick, less sick, improve the quality of life, and prolong the healthy life span. According to the requirements of health China action and the most advanced concept of precision medicine, this study describes the "six precision" health services. This study of the "six precision" health services are accurate prevention, accurate prediction, accurate early warning, accurate diagnosis, accurate treatment and accurate rehabilitation. Especially for the description of precision early warning, it relies on real-time and quantitative detection of a range of disease risk factors found through modern genomics, proteomics, metabolomics and immunomics studies to accurately predict the risk of illness and the degree of risk in healthy populations, so as to develop personalized health management programs that can effectively prevent or delay the occurrence of disease. In this study, the "six precision" health services not only give the concept, service, but also give the development prospects, for healthy China action to create a fine service concept and implementation path.

ZHANG Yu-hui, SONG Wei-min, LI Zhi-jun

2020, 18(7): 1073-1074.

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The diagnostic value of clamp lung biopsy and lung cryobiopsy guided by radial ultrasound in peripheral pulmonary lesions

ZHOU Xiao-yu, XUN Xia, WU Jing, XU Yuan-yuan, LI Wei

2020, 18(7): 1075-1077,1111. doi: 10.16766/j.cnki.issn.1674-4152.001431

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Objective To explore the diagnostic value and safety of clamp lung biopsy guided by intrabronchial ultrasound under fiberbronchoscope compared with frozen lung biopsy in peripheral pulmonary lesions. Methods A retrospective study was conducted on 55 patients, who received lung biopsy under the guidance of radial endobronchial ultrasound in the First Affiliated Hospital of Bengbu Medical College from December 2018 to December 2019 and were finally diagnosed. Patients were divided into transbronchial lung biopsy (TBLB) group(n=29) and transbronchial lung cryobiopsy (TBLC) group(n=26). The diagnostic rate and complications of peripheral pulmonary lesions were compared between the two groups. Results The diagnostic rates of TBLC group (80.8%, 21/26) were significantly higher than that of TBLB group (55.2%, 16/29), χ²=4.080, P=0.043. In this study, the majority of peripheral pulmonary lesions were malignant, accounting for 56.4%, among which adenocarcinoma was the most common. Among benign diseases, tuberculosis was the most common, accounting for 62.5%. Complications in the two groups:2 cases in both TBLC group and TBLC group suffered from hemorrhage, all of which were small amount of bleeding, which could be alleviated after bronchus hemostasis treatment with injection of ice saline, epinephrine or thrombin at the biopsy site. The incidence of pneumothorax in TBLB group (6 cases) was higher than that in TBLC group (2 cases), and 2 patients needed closed chest drainage, but there was no significant difference between the two groups (χ²=0.964, 0.165, all P>0.05). There were no deaths in both group. Conclusion Radial endobronchial ultrasound combined with lung cryobiopsy has a high diagnostic rate and safety for peripheral pulmonary lesions.

Correlation between thyroid hormone levels and abdominal aortic calcification in maintenance hemodialysis patients

TENG Jie, FENG Jin-hong, ZHANG Ying, ZHOU Zi-ying, WU Hui, LI Lu

2020, 18(7): 1078-1082. doi: 10.16766/j.cnki.issn.1674-4152.001432

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Abstract:
Objective To analyze the relationship between thyroid hormone levels and abdominal aortic calcification in maintenance hemodialysis (MHD) patients, and to analysis the clinical indicators which related to vascular calcification, and to provide a clinical basis for early prevention and treatment of vascular calcification. Methods Data of a 78 MHD patients treated in the Hemodialysis Center of Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2019 were collected, and the dialysis age was ≥ 3 months. The clinical data and biochemical indicators of patients were collected, and free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured. Patients were examined for abdominal aortic calcification with plain lateral X-ray films, and the patients were divided into non-calcified group and calcified group according to whether vascular calcification occurred. The clinical data between the two groups were compared, and the relationship between thyroid hormone levels and abdominal aortic calcification in MHD patients was analyzed. Results Among 78 MHD patients, 36 had abdominal aortic calcification with an incidence of 46.15%. The calcification group had significantly higher low-density lipoprotein (LDL-C), blood phosphorus (P), C-reactive protein (CRP), and calcium-phosphorus products. In the non-calcified group, albumin and FT3 were significantly lower than those in the calcified group, and the differences were statistically significant (all P<0.05). Correlation analysis between FT3 and various indicators showed that FT3 was negatively correlated with CRP, LDL-C (all P<0.05). Multivariate logistic regression analysis of related risk factors showed that elevated CRP, elevated P, and decreased FT3 were independent risk factors of abdominal aortic calcification. The area under the ROC curve of CRP, P, FT3 were 0.804, 0.704 and 0.746 respectively. Conclusion The incidence of abdominal aortic calcification in MHD patients is high. The increase of CRP, P level and the decrease of FT3 level are closely related to abdominal aortic calcification. FT3 has certain value in predicting abdominal aortic calcification in patients with MHD.

Study on the relationship between cognitive function and leukoaraiosis in different brain region of patients with Parkinson's disease

LI Jing, TONG Qiu-ling, CHEN Wei-an, ZHANG Xu

2020, 18(7): 1083-1085,1121. doi: 10.16766/j.cnki.issn.1674-4152.001433

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Abstract:
Objective To investigate the effect of leukoaraiosis (LA) in different brain regions on cognitive function in patients with Parkinson's disease (PD). Methods A total of 87 patients with PD hospitalized in the Department of Neurology of the First Affiliated Hospital of Wenzhou Medical University from 2015 to 2017 were enrolled in the study. The cognitive function was evaluated by MMSE and MoCA Scale. UPDRS-Ⅲ was used to evaluate the motor function and Hoehn-Yahr staging was used to judge the grade of illness. According to the cognitive scoring and diagnostic criteria, PD patients were divided into 3 groups:normal cognitive function group (PD-NC), mild cognitive impairment group (PD-MCI) and dementia group (PD-D). All the patients completed head MRI (3.0T) examination, and the Scheltens scale was used to evaluate the lateral and deep white matter. Results Comparison of leukoaraiosis in different parts of three groups, there were significant difference in total score of LA and LA scores in the frontal lobe, deep white matter, lateral ventricle (all P<0.05). Meanwhile there were no significant difference in LA scores in the parietal lobe, occipital lobe, temporal lobe, basal ganglia and infratentorial and white matter (all P>0.05). There was significant difference in LA scores of frontal lobe between the PD-MCI group and PD-NC group. There was significant difference in the LA scores of the lateral ventricle between PD-D group and the other two groups. Regression analysis showed that MMSE was significantly correlated with education level (P<0.001), H-Y stage (P=0.008), and deep white matter (P<0.001), in which education level was positively correlated, and H-Y stage and deep white matter were negatively correlated. MMSE was most significant with the deep white matter (β=-1.034). Conclusion There is a correlation between cognitive function of PD and LA, especially in the frontal lobe and deep white matter. The relationship between MMSE and the deep white matter in PD patients is the most significant.

Comparison of minimally invasive percutaneous plate osteosynthesis and open reduction plate internal fixation in the treatment of humeral shaft fracture

WANG Xiao-pan, WU Min, DAI Xiu-song, WANG Xu-yi, HU Hai-bei, CHEN Xiao-tian

2020, 18(7): 1086-1088,1168. doi: 10.16766/j.cnki.issn.1674-4152.001434

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Abstract:
Objective To investigate the effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of humeral shaft fracture. Methods Total 16 patients with humeral shaft fracture admitted to the Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College from February 2015 to December 2019 were randomly divided into observation group and control group. The observation group was treated with MIPPO technology, and the control group was treated with open reduction and internal fixation with plate. The operation time, bleeding volume, incision length, postoperative complications, the time of fracture healing and upper extremity function in the last follow-up were compared between the two groups. Results The operation time, incision length, and bleeding volume in the observation group were lower than those in the control group with statistically significant difference. The hospitalization time in the observation group was lower than that in the control group, but the difference was not statistically significant. In the observation group, all cases were going without complications happened, such as infection, radial nerve injury. Otherwise in the control group, there were 1 case of incision fat liquefaction, 1 case of radial nerve injury symptoms after operation, all improved after symptomatic treatment. In the two groups, all fractures were healed, but the average healing time of the observation group was lower than the control group with the statistical significant difference. At the last follow-up, the DASH score of the observation group were lower than the control group with the statistical significant difference. Conclusion MIPPO is an effective method for the treatment of humeral shaft fracture, and worthy of clinical application.

The effect of transverse abdominal plane block combined with parecoxib sodium on emergence agitation in children:a randomized clinical study

LIU Di, CHEN Nan, LI Min, ZHANG Cong-li, LI Xiao-hong

2020, 18(7): 1089-1092. doi: 10.16766/j.cnki.issn.1674-4152.001435

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Objective To discuss the effect of transverse abdominal plane block combined with parecoxib sodium on the incidence of emergency agitation (EA) in pediatric laparoscopic hernia repair surgery. Methods A total of 120 children, aged from 1 to 3 years, scheduled for hernioplasty were randomly divided into 4 groups (30 cases in each group), transverse abdominal plane block combined with parecoxib sodium group (TP group), transverse abdominal plane block group (T group), parecoxib group (P group) and control group (C group). The TP group and P group at the time of anesthesia induction were intravenously injected using 0.9 mg/kg parecoxib respectively. After the induction, the children in TP group and T group were injected with 1 mL/kg 0.25% ropivacaine in the transverse abdominal muscle plane, and the children in P group and C group were injected with the same amount of normal saline. The operation condition, emergence agitation, pain, sedation and adverse reaction after 24 h of operation were recorded. Results There was no significant difference in the duration of anesthesia, operation, respiratory recovery and extubation among the four groups (P>0.05). HR and MAP of TP group, P group and T group were lower than those of C group during the operation (P<0.05), which were lower than those of P and T groups (all P<0.05). The incidences of the agitation in P group and T group were lower than that in C group (all P<0.05). The incidence of the agitation in TP group, P group, T group and C group was 16.67%, 26.67%, 26.67% and 53.33%, respectively. There were significant differences between the four groups (all P<0.05). Compared with the FLACC and Ramsay scores in C group, which in P and T groups decreased significantly (all P<0.05). Compared with the P group and T group, the FLACC scores in groups at T5, T6 and T7 decreased (all P<0.05), and the Ramsay scores at T5 was significantly higher than that in p group and T group (all P<0.05). There were no adverse reactions such as delayed recovery and drowsiness in 4 groups. Conclusion Transverse abdominal plane block combined with parecoxib sodium can significantly reduce the incidence of EA in children, with more stable intraoperative circulation and good safety, which has important clinical reference significance.

Analysis of the curative effect of anchor repair combined with open reduction and internal fixation in the treatment of ankle trimalleolar fracture with medial collateral ligament injury

ZHANG Guo-feng, REN Tian-tian, ZHENG Jun-shui, WEI Peng, CHEN Yu-hong, ZUO Rong-yue, CHEN Wei-wei, DONG Dong

2020, 18(7): 1093-1095,1173. doi: 10.16766/j.cnki.issn.1674-4152.001436

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Abstract:
Objective To investigate the clinical efficacy of anchor repair combined with open reduction and internal fixation in treatment of ankle trimalleolar fracture with medial collateral ligament injury, and provide reference for clinical follow-up treatment. Methods Total 77 patients with ankle trimalleolar fracture and medial collateral ligament injury treated with anchor repair combined with open reduction and internal fixation in Department of Orthopaedics, Affiliated Hospital of Medical College of Ningbo University from April 2016 to December 2017 were selected. All patients were followed up for 1.5 years. The ankle function was evaluated by Baird standard. At the same time, the incidence of mechanical ankle instability and other related complications were observed. Results Total 77 cases of ankle trimalleolar fracture with medial collateral ligament injury were successfully treated with open reduction and internal fixation, and the functional recovery was satisfactory. The excellent and good rate of ankle joint function recovery after open reduction and internal fixation for traffic accident injury, sports injury and fall injury was 100.00%, 100.00% and 90.48%, respectively. There was no significant difference in the excellent and good rate of ankle joint function recovery among the three different injury factors (χ²=5.476, P=0.144). No complications such as mechanical ankle instability occurred during the 1.5-year follow-up. Conclusion Anchor repair combined with open reduction and internal fixation for ankle trimalleolar fracture with medial collateral ligament injury can effectively improve the flexibility and stability of ankle joint, and the recovery of ankle joint is good.

Clinical characteristics of 120 children with adenovirus pneumonia

RONG Dao-xiang, XUAN Ai-li, FANG Shan-shan, ZHOU Rui, PENG Wan-sheng, XU Jia-li

2020, 18(7): 1096-1098,1142. doi: 10.16766/j.cnki.issn.1674-4152.001437

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Abstract:
Objective To analyze the clinical characteristics of adenoviral pneumonia (AP) in children, so as to improve the clinical diagnosis level of AP, diagnose AP as early as possible, reduce the incidence of short-term and long-term adverse prognosis, improve the quality of life and survival rate, and reduce the case fatality rate. Methods The clinical data of 120 hospitalized AP children in our hospital from June 2017 to June 2019 were retrospectively analyzed. AP children were divided into mild AP (90 cases) and severe/critical AP (30 cases) according to the "guidelines for the diagnosis and treatment of children with community-acquired pneumonia (2019 Edition)". Gender, age, heat course, pulmonary signs, pulmonary imaging, WBC, Hb, CK-MB, liver function and other indicators were analyzed and compared between the two groups. Results Among the 120 AP patients, 24 (20.00%) were ≥ 24 months, 96 (80.00%) were<24 months, and 90 (75.00%) were from 6 months to 24 months. The ratio of male to female was 2.53:1, and 95 cases (79.20%) were found in winter and spring. All the cases were febrile, with 84 (70.00%) cases of high fever and 62 (51.67%) cases of heat path ≥ 7 days. There were 106 cases of cough (88.33%) and 45 cases of wheezing (37.50%). Pulmonary imaging showed that the number of involved lobes ≥ 2 (macrophylla) in 16 cases (13.33%). There were 11 cases (9.20%) of lung consolidation and 7 cases (5.83%) of pleural effusion. In the comparison between the mild AP and severe/critical groups, statistical analysis was conducted for younger age, high fever ≥ 7 days, multiple organ damage, number of involved lobes ≥ 2, basic disease, and more than one pathogen (all P<0.05). The most common complications were myocardial and liver damage. Conclusion Clinically, young, in prone season, with persistent high fever>3 days, with basic diseases, more than one pathogen infection, inflammation index increased significantly, X-ray suggests involvement>2 leaves or pleural effusion, should be checked early line of adenovirus pathogens, diagnosis, treatment as soon as possible, reduce the critically ill, improve child survival quality and survival rate, reduce the case fatality rate.

Single arm clinical observation of low-dose apatinib combined with temozolomide in the treatment of relapsed small cell lung cancer

LI Yan, TAO Yu, LU Lin, LU: Dong-lai

2020, 18(7): 1099-1102. doi: 10.16766/j.cnki.issn.1674-4152.001438

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Objective To investigate the objective response, clinical efficacy and adverse reactions of low dose apatinib combined with temozolomide in the treatment of relapsed small cell lung cancer (SCLC). Methods This study was a prospective, unblinded, one-arm study. Fifteen patients with pathological diagnosis of recurrent SCLC were enrolled from June 2016 to January 2019. All patients were diagnosed with SCLC by biopsy guided by fiberoptic bronchoscope, CT or exfoliating cell biopsy by pleural effusion. The fifteen patients were treated by apatinib (125-250 mg/d) and temozolomide[200 mg/(m²·d), continuously for 5 d, one cycle every 28 d]. The dosage of apatinib can be adjusted to 125 mg according to the patient's adverse reaction. These patients were treated until the disease progressed or an intolerable adverse reaction occurred. CT was reexamined every 2 cycles to evaluate the treatment effect, and progression free survival (PFS), overall survival (OS) time and adverse events (AEs) were recorded. Results The median PFS was 7.0 months, the median OS was 10.5 months, the objective remission rate was 46.7%, and the disease control rate was 66.7% within 6 months. AEs were mainly manifested as myelosuppression, digestive tract reaction, oral mucositis, and hand-foot syndrome. Serious AEs were less. Conclusion Low dose apatinib combined with temozolomide is effective and well tolerated in the treatment of relapsed small cell lung cancer.

Clinical analysis of bone infarction of knee joint with female systemic lupus erythematosus

ZHANG Song, XIE Zhang-hao, CHEN Lin-jie

2020, 18(7): 1103-1106. doi: 10.16766/j.cnki.issn.1674-4152.001439

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Objective To investigate the clinical characteristics of female patients with systemic lupus erythematosus (SLE) and bone infarction of knee joint, in order to detect early clinical cases, timely prevention and treatment. Methods A total of 24 female patients with SLE complicated with bone infarction of the knee joint were admitted to the department of rheumatology of our hospital from May 1st, 2015 to September 30th, 2019, and 836 patients with SLE without bone infarction were selected as control group. SLE conformed to the classification criteria established by the American College of Rheumatology in 1997, and bone infarction was diagnosed by MRI. Clinical data of the two groups were collected and analyzed to understand the clinical characteristics of SLE with bone infarction of the knee joint. Results Compared with patients without bone infarction, patients with SLE combined with bone infarction of the knee joint showed statistically significant differences in rash, kidney damage, Reynolds' phenomenon, and hormone shock therapy (P<0.05), while no statistically significant differences in arthritis, serosal inflammation, and blood system involvement (P>0.05). The age of SLE patients with bone infarction was younger[(29.50±7.05) years], the difference was statistically significant between the two groups. Female patients with SLE complicated with bone infarction of the knee joint were associated with rashes, nephropathy, Raynaud's phenomenon, hormone shock therapy. The clinical characteristics of SLE patients with simple bone infarction of the knee joint and SLE bone infarction of the knee joint with other bone infarction showed no statistical significance (P>0.05). Conclusion Female patients with SLE have rash, renal involvement, Raynaud's phenomenon, and glucocorticoid shock therapy, while the age of onset is young. The occurrence of bone infarction of the knee joint should be alert.

Effect and mechanism of PCSK9 on endoplasmic reticulum stress in ischemia-reperfusion myocardium

E Lu-sha, TIAN Zhi-qiang, ZHAO Ping

2020, 18(7): 1107-1111. doi: 10.16766/j.cnki.issn.1674-4152.001440

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Objective To study the effect of Bacillus subtilis lysis converting enzyme 9 (PCSK9) on myocardial endoplasmic reticulum stress and its possible mechanism, and to provide a new research direction for clinical research. Methods Thirty healthy male SD rats were selected to establish myocardial ischemia-reperfusion model. According to the method of random number table, rats were divided into three groups:sham operation group, model group and PCSK9 group. Twenty-four hours after the successful modeling, the PCSK9 group rats were injected subcutaneously with 30 μg PCSK9, while the sham operated group rats and the model group rats were injected subcutaneously with normal saline of equal volume. LVEDP, myocardial infarct area rate, LDH, CK-MB, CK, apoptosis rate, proliferation, GRP78, CHOP, and cleaved caspase 3 levels were examined at the end of the intervention. Results The LVEDP[(8.83±0.28) mm Hg] and myocardial infarction area rate[(15.21±4.75)%] in the PCSK9 group were lower than those in the model group[(13.65±0.38) mm Hg, (37.35±8.16)%] and higher than those in the sham operation group[(7.72±0.43) mm Hg, 0%], F=731.290, t=7.420, all P<0.001. In the PCSK9 group, LVSP[(127.94±7.67) mm Hg] was higher than that in the model group[(79.84±6.44) mm Hg], lower than that in the sham operation group. The prognosis of the sham operation group was (145.53±9.08) mm Hg (F=189.830, P<0.001). The apoptosis rate, LDH, CK-MB, CK level, GRP78, CHOP and cleaved caspase-3 protein expression in the model group and the PCSK9 group were higher than those in the sham operation group, and the cell proliferation rate was lower than that in the sham operation group (all P<0.05). Conclusion PCSK9 can regulate GRP78, CHOP and caspase-3 protein, inhibit the stress of myocardial endoplasmic reticulum and improve the cardiac function and myocardial infarction.

Protective effect of SHH signaling pathway on middle cerebral artery occlusion model rats after cerebral ischemia

WANG Bao-xiang, XU Jun-jie, LU Xia, HU Min-lei, ZHU Xiao-dong, HUANG Ju-ming, HU Jin

2020, 18(7): 1112-1114,1115. doi: 10.16766/j.cnki.issn.1674-4152.001441

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Objective To investigate the protective effect of SHH signaling pathway on middle cerebral artery occlusion (MCAO) model rats after cerebral ischemia. Methods Total 30 SD rats were randomly divided into three groups:sham operation group, model group and SHH group, 10 rats each groups. The MCAO model was made by the modified longa suture method. In the SHH group, 2 μL (1 μg/μL) SHH protein was injected into the left lateral ventricle, and the same amount of PBS solution was injected into the sham operation group and the model group. Results The neurological function scores of the SHH group were lower than those of the model group at 3 days (1.23±0.16 vs. 2.10±0.25) and 7 days (0.87±0.13 vs. 2.38±0.19) after operation (t=9.269, 20.741, all P<0.05). The infarct volume of the SHH group were lower than those of the model group at 3 days (32.14±7.25 vs. 60.27±5.64) and 7 days (21.98±4.56 vs. 64.82±7.19) after operation (t=9.684, 15.912, all P<0.05. The value of cerebral blood flow in the SHH group were higher than that in the model group at 3 days[(348.92±29.38) PU vs. (163.28±26.13) PU] and 7 days[(413.24±56.29) PU vs. (130.29±23.42) PU] after operation (t=14.930, 14.676, all P<0.05). The CDK2 (27.18±3.10) and CyclinD1 (24.52±4.31) in the SHH group were lower than those in the model operation group (59.83±5.62 and 67.38±7.39), t=16.087, 15.843, all P<0.05. Conclusion SHH signaling pathway can reduce the neurological damage of cerebral infarction in MCAO model rats after cerebral ischemia, it can regulate the expression of CDK2 and CyclinD1 to achieve the neuroprotective effect.

The study on the correlation between serum substance P level and risk of diabetic foot in patient with diabetic foot

WU Zhi-hao, LI Wei, KONG Xiang

2020, 18(7): 1115-1117. doi: 10.16766/j.cnki.issn.1674-4152.001442

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Objective To research the correlation between substance P (SP) of serum neuropeptide and diabetic foot in diabetic patients, and to make early diagnosis and clinical intervention. Methods Total 96 cases diabetic patients with complete information were chosen in Department of Endocrinology of the 3rd People's Hospital of Bengbu from September 2017 to November 2018, in which there were 60 cases in diabetic foot group (DF) and 36 cases in non-diabetic foot (NDF) group. The data of patients' sex, smoking, glycosylated hemoglobin (HbA1c) levels, diabetes duration and SP level were collected. Multiple factors logistic regression analysis was used to screen out independent predictive factors of DF. Serum SP levels in the two groups were tested and compared. Results Multivariate logistic regression analysis indicated that smoking (OR=8.250, 95% CI:3.201-21.265, P<0.001) and SP levels (OR=9.000, 95% CI:3.466-23.370, P<0.001) were risk factors for DF. The SP level of DF group was (54.47±16.72) pg/mL, and that of NDF group was (116.47±19.00) pg/mL. The serum SP level of DF group was significantly lower than that of NDF group (P<0.05). In the DF group, the serum SP level in severe and moderate patients groups were lower than that in the mild group (all P<0.05).The AUC of SP was 0.994, which had a strong significance for the diagnosis of diabetic foot (P<0.05), and the cut off value was 83.30. Conclusion The smoking and SP level are the risk factors for DF, and SP level is negatively correlated with DF severity.

Application of preoperative NLR,PLR and MLR in the prognosis of patients with glioma

HOU Shi-qiang, JIN Chun-jing, SHI Bei-tian, YAO Guo-quan, XIAO Bo, CHEN Yi-nan

2020, 18(7): 1118-1121. doi: 10.16766/j.cnki.issn.1674-4152.001443

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Objective To assess the application value of preoperative blood inflammatory index neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) in the prognosis of patients with glioma. Methods The clinical data of 236 patients with glioma treated at the Affiliated Hospital of Nantong University from January 2013 to December 2018 was analyzed retrospectively. The application value of preoperative NLR, PLR, MLR in prognosis of patients with glioma wad assessed by ROC curve, Kaplan-Meier survival curve, univariate and multivariate analysis. Results The expressions of NLR, PLR and MLR were correlated with tumor grade (all P<0.05). The best cutoff values for survival predict were 2.40, 127 and 0.24 respectively. The survival curve showed the median survival time in the high NLR group, high PLR group, and high MLR group was significantly shorter than that in the low NLR group, low PLR group, and low MLR group (all P<0.001). Multivariate analysis showed that preoperative NLR was an independent risk factor for predicting prognosis (P=0.008). Conclusion Preoperative blood inflammatory index NLR test is convenient and fast, which is an independent risk factor that affects the prognosis of glioma patients and has an important clinical value for prognosis of glioma patients.

Observe on the clinical effect of oxycontin combined with flurbiprofen axetil in the treatment of pain of bone metastasis from moderate to severe tumors

CAI Yun-fang, LIU Chun-xi, LIU Xin-yi, FANG Jun

2020, 18(7): 1122-1124,1146. doi: 10.16766/j.cnki.issn.1674-4152.001444

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Objective To observe the effect of oxycontin combined with flurbiprofen axetil in the treatment of bone metastasis pain from moderate to severe tumors. Methods Total 100 patients with moderate or severe tumors pain and bone metastasis (NRS ≥ 4) were divided into study group and control group according to random number table method, 50 patients in each group. The patients in the control group were given oxcontin analgesia, and the patients in the study group were given oxcontin combined with flurbiprofen axetil analgesia. The dosage, times of pain outbreak and adverse drug reactions were recorded, the level of serum stress-response factors were measured, and the analgesic effect was evaluated. Results The levels of serum E, NE and Cor in the study group[(37.28±4.85) ng/mL, (41.08±5.74) mg/mL, (12.05±1.96) μg/dL] were lower than those in the control group[(49.57±5.72) ng/mL, (66.63±6.55) mg/mL, (16.37±2.21) μg/dL)], all P<0.001. The total effective rate of pain relief in the study group (92.00%) was significantly higher than that in the control group (76.00%), χ²=4.762, P=0.029. The dosage of oxycontin[(407.59±52.61) mg] was significantly lower than that in the control group[(486.40±73.83) mg], and the number of outbreaks of pain in the study group (6.82±1.09) was significantly lower than that of the control group (12.74±2.31), t=-6.198, -15.776, all P<0.001. There was no significant difference in the overall incidence of adverse drug reactions (44.00% vs. 52.00%) between the two groups, χ²=0.641, P=0.432. Conclusion Oxycontin combined with flurbiprofen axetil can effectively alleviate the stress response of patients with moderate or severe bone metastasis pain, reduce the dosage of analgesic drugs, improve the analgesic effect level, and do not increase the adverse drug reactions.

Relationship between the level of plasma lipoxin A4 and prognosis in patients with sepsis

JIANG Yong-po, CHEN Nan-jin, YU Yu-long, ZHANG Meng-qin, CAI Min-jie, ZHANG Sheng, CUI Ke, LIN Rong-hai

2020, 18(7): 1125-1127,1250. doi: 10.16766/j.cnki.issn.1674-4152.001445

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Objective To explore the prognostic value of lipoxin A4 in patients with sepsis. Methods From June 2017 to March 2018, 40 patients with sepsis were admitted to the Department of Critical Care Medicine,Taizhou Hospital of Zhejiang Province.The general information, severity score, biochemical parameters, ICU stay, hospital stay and 28-day survival were collected. Plasma levels of lipoxin A4, TNF-α, IL-6, TGF-β1, ANG-1 and ANG-2 were detected by ELASA. The prognostic value of lipoxin A4 in patients with sepsis was analyzed by ROC and Kaplan-Meier. Results According to the expression level of lipoxin A4, sepsis patients were divided into L group (lipoxin A4 ≤ 55 ng/mL, n=21) and H group (lipoxin A4 > 55 ng/mL, n=19). APACHEⅡ, ANG-2 and ANG-2/ANG-1 in L group were significantly higher than those in the H group (all P<0.05). The TGF-β1, ANG-1 in H group were higher than the L group (all P<0.05). ROC curve showed that lipoxin A4 has a good predictive value for 28-day mortality in patients with sepsis (AUC:0.824; P=0.003). Kaplan-Meier survival method shown that the 28-day cumulative survival rate of patients in H group was significantly higher than that of the L group (log-rank test P=0.045). Conclusion The expression level of lipoxin A4 has a good predictive effect on the risk of death from sepsis.

Analysis of etiology and risk factors of wound infection after closed pelvic fracture

CHEN Gang, HUANG Ming-wei, KONG Lai-fa, SHI Tao, FANG Hao

2020, 18(7): 1128-1130. doi: 10.16766/j.cnki.issn.1674-4152.001446

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Abstract:
Objective To analyze and explore the pathogenic risk factors of incisional infection in patients with closed pelvic fractures to guide clinical treatment, in order to reduce the incidence of postoperative wound infection. Methods A total of 406 patients with closed pelvic fractures admitted to Jinhua Central Hospital of Zhejiang Province from April 2013 to May 2019 were enrolled. Twenty-nine patients with postoperative incision infection were enrolled in the infection group, and 377 patients were treated. Patients who did not have a wound infection were placed in the uninfected group. Statistics were performed on acetabular fractures, abdominal injury, BMI, trauma severity score (ISS), operative time, intraoperative blood loss, combined brain trauma, and diabetes mellitus, and were determined by single factor and multivariate analysis. Risk factors for wound infection after closed pelvic fracture, and bacterial culture results were recorded. Results There were 29 cases of incisional infection in 406 patients with closed pelvic fracture, the incidence rate was 7.14% (29/406). Univariate and multivariate logistic regression analysis showed that acetabular fractures (OR=3.111), abdominal injury (OR=3.475), BMI (OR=2.053), and ISS (OR=2.443) The operation time (OR=2.366), intraoperative blood loss (OR=2.777), combined brain trauma (OR=2.254), and diabetes mellitus (OR=3.521) were risk factors for wound infection after closed pelvic fracture. Conclusion Combined with acetabular fracture, abdominal injury, BMI, ISS, operation time, intraoperative blood loss. Volume, combined with traumatic brain injury, and diabetes mellitus are risk factors for postoperative incision infection in patients with closed pelvic fractures. Risk factors should be paid attention to in clinical practice, and preventive treatment should be done early to avoid the occurrence of wound infection after closed pelvic fracture.

Curative effect observation of microsurgery for hypertensive basal ganglia cerebral hemorrhage

YAO Guo-quan, HOU Shi-qiang, LIN Ning

2020, 18(7): 1131-1133. doi: 10.16766/j.cnki.issn.1674-4152.001447

189 2

Abstract:
Objective To investigate the clinical effect of microsurgery for hypertensive basal ganglia cerebral hemorrhage and provide theoretical basis for clinical application. Methods Total 62 patients with hypertensive basal ganglia cerebral hemorrhage who underwent surgery at the First People's Hospital of Chuzhou from November 2016 to September 2019 were selected as research subjects. They were simply and randomly divided into observation group and control group, and 32 cases in the observation group were treated with microscope, 30 patients in the control group were treated with traditional craniotomy. χ² test and t test were used to compare the general clinical data of two groups, t test was used to compare the operation time and intraoperative blood loss of the two groups, and χ² test was used to compare common complications (rebleeding, pulmonary infection, cerebral infarction, stress ulcers, and epilepsy) during postoperative hospitalization, and the Glasgow outcome scale (GOS) at 3 months after surgery in the two groups. Results The operation time in the observation group was (171.18±38.65) minutes, which was shorter than that in the control group[(183.67±33.50) minutes], the difference was not statistically significant (P=0.181). The intraoperative blood loss in the observation group was (164.06±36.71) mL, which was less than that in the control group[(178.67±38.48) mL], the difference was not statistically significant (P=0.131). The incidence of common complications during the postoperative hospital stay in the observation group was 40.63%, which was significantly less than 70.00% in the control group, the difference was statistically significant (P=0.020). The good prognosis of GOS classification in the observation group was 65.63% at 3 months after operation, which was significantly higher than that in the control group (40.00%), the difference was statistically significant (P=0.043). Conclusion Compared with traditional surgery, microsurgery for hypertensive basal ganglia cerebral hemorrhage has the characteristics of low complication rate and better recent prognosis, which is worthy of clinical application.

Analysis of anxiety and depression and influencing factors of patients with chronic hepatitis B virus infection

ZHENG Zi-mei, HE Na, XU Zhen, LIANG Jing, CUI De-zhen, LI Xin-hua

2020, 18(7): 1134-1138. doi: 10.16766/j.cnki.issn.1674-4152.001448

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Abstract:
Objective To investigate the anxiety and depression status of patients with different clinic type of chronic hepatitis B virus infection (HBV) and its influencing factors, and to analyze the influence of disease severity on patients' anxiety and depression status. Methods A total of 257 cases of patients with chronic HBV infection in the Third Affiliated Hospital of Sun Yat-sen University Infectious Diseases department from Oct-2018 to Mar-2019,including chronic hepatitis B (83 cases), liver failure (38 cases), cirrhosis (107 cases), liver cancer (29 cases). SAS and SDS Depression Scale anxiety assessment were given, basic socio-demographic characteristics, biochemical markers and ultrasound data were collected. Single factor analysis method was used to analyze the influencing factors of anxiety and depression in HBV infected patients. Results The incidence of anxiety and depression in patients with different types of chronic HBV infection was 24.5% and 45.9% respectively, especially in patients with liver failure (the incidence of anxiety and depression was 36.9% and 73.7% respectively). The incidence of depression and anxiety in patients with different chronic HBV infection was significantly different. The proportion of moderate & severe depression and anxiety in liver failure patients was significantly higher than others. Among them, mild depression accounts for 50.0%, moderate and major depression accounts for 23.7%, and moderate and major anxiety accounts for 15.8%; The severity of liver disease MELD and child-pugh scores were positively correlated with SAS and SDS, and there were statistically significant differences in depression scores among child-pugh grades A, B and C (all P<0.05), or MELD hierarchy (P<0.05). In addition, gender, cultural level, Medicare payments method and household income was also correlated with the occurrence of depression and anxiety. Conclusion Anxiety or depression in patients with chronic HBV infection are very common, and the severity of the disease is related to anxiety and depression. Women, low educational background, low self-pay and low family income are the influencing factors of anxiety and depression in HBV-infected patients, which should be paid more attention in clinical practice.

Correlation between depression and different time points blood pressure in elderly patients with essential hypertension

FANG Hong-wei, ZHANG Qiu-shi, LIN Ding, XIE Xiao-lin, WANG Ya-jie

2020, 18(7): 1139-1142. doi: 10.16766/j.cnki.issn.1674-4152.001449

211 3

Abstract:
Objective To analyze the correlation between depression and different time points blood pressure in elderly patients with essential hypertension. Methods Total 90 elderly patients with essential hypertension who visited our hospital from May 2018 to August 2019 were selected as the research subjects. The ratio of male to female was 1:1, and the average age was (66.2±4.3) years. The patient's 24 h ambulatory blood pressure was monitored. Patients were screened for depressive symptoms according to the Hamilton Depression Scale (HAMD), and divided into depression groups (n=52, depression score ≥ 7) and control group (n=38, depression score<7) based on quantitative assessment. The blood pressure, depression degree, and laboratory tests were compared between two groups. Results There was no significant difference in mean systolic and diastolic blood pressure in daytime, mean systolic and diastolic blood pressure at night, and prevalence of non dipper type blood pressure in the 24-hour mean blood pressure between the two groups (all P>0.05). The morning peak of blood pressure in the depression group[(29.58±3.36) mm Hg] was significantly higher than that in the control group[(16.12±3.67) mm Hg, P<0.05]. The morning peak of blood pressure in the depression group was significantly higher than that in the control group (P<0.05). The correlation analysis showed that the patient's depression level was positively correlated with the morning blood pressure peak, and the regression equation was Y=17.830+0.192X, which was statistically significant (r=0.387, P<0.01). Conclusion There is a correlation between the depression of elderly essential hypertension patients and their morning blood pressure peaks, which should be paid attention in clinical diagnosis and treatment to improve the treatment effect of patients.

Comparison of the relieving effects of different doses of colchicine on pain and inflammation in patients with acute attack of gout

JIN Dou, LIANG Yi-min, MOU Xiao-yue

2020, 18(7): 1143-1146. doi: 10.16766/j.cnki.issn.1674-4152.001450

400 2

Abstract:
Objective To compare the relieving effects of different doses of colchicine on pain and inflammation in patients with acute attack of gout, and to explore the best dose of colchicine in the treatment of gout. Methods A total of 94 patients with gout acute attack admitted to Taizhou First People' s Hospital from January 2019 to January 2020 were randomly divided into two groups:group A (47 cases) and group B (47 cases). Both groups were treated with routine therapy and colchicine. The initial dose of colchicine in group A was 1 mg, then 0.5 mg/h or 1 mg/h, and the maximum dose on the first day was 6 mg. The initial dose of colchicine in group B was 1 mg, then 0.5 mg/time, 3 times/d. The efficacy, pain relief (VAS score, pain relief time), and inflammation relief were compared (IL-1, IL-6, CRP) and adverse reactions (gastrointestinal symptoms, abnormal blood routine, abnormal blood pressure, liver function damage). Results The total effective rate of group B (89.4%) was similar to that of group A (93.6%), P>0.05. The VAS score in group B[(2.4±0.8) points] was lower than that in group A[(3.2±1.1) points], and the time of pain relief[(26.1±9.7)h] was shorter than that in group A[(37.5±10.4)h], all P<0.05. The IL-1, IL-6 and CRP in group B[(18.2±3.7)pg/mL, (41.4±7.6)pg/mL, and (6.3±2.0)mg/L] were lower than those in group A[(26.4±4.5)pg/mL, (53.2±9.4)pg/mL, and (9.4±2.6)mg/L], all P<0.05. The incidence of adverse reactions in group B (17.0%) was lower than that in group A (36.2%), P<0.05. Conclusion Colchicine can relieve the pain and inflammation of patients with gout acute attack in a small dose. The total effective rate of clinical effect is the same as that in a large dose, and the incidence of adverse reactions is significantly reduced, which is worth popularizing.

Characteristics analysis of wechsler intelligence scale in 73 preschool children with attention deficit hyperactivity disorder

CHEN Min, ZHANG Lei, HU Yao-fang, XU Qu, WANG Jing, YANG Lei, HONG Qin, CHI Xia, CUI Yan

2020, 18(7): 1147-1149,1164. doi: 10.16766/j.cnki.issn.1674-4152.001451

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Abstract:
Objective To explore the characteristics of Wechsler Intelligence Scale in preschool children with attention deficit hyperactivity disorder (ADHD). Methods From January 2018 to December 2018, 73 preschoolers meeting the diagnostic criteria of DSM-5 ADHD were selected from the psychological behavior clinic, and Wechsler Preschool and Primary Scale of Intelligence -Fourth Edition (WPPSI-Ⅳ) was adopted for testing. Results There were significant differences in scores of each subscale among preschool ADHD children (F=4.770, P=0.001), among which the score of visual space was higher than that of other subscales, while the score of processing speed was lower than that of language comprehension, visual space and working memory, showing statistically significant differences (all P<0.05). The non-verbal index of preschool ADHD children was lower than the verbal reception index (t=2.342, P=0.021), and the cognitive efficiency index was lower than the general ability index (t=2.339, P=0.021), with statistically significant differences (P<0.05). There were differences in the scores of the whole scale among different types of ADHD. The standard score of the whole scale for children with attention deficit type was lower than that for children with hyperactivity impulse type and mixed type (P<0.05). Conclusion Preschoolers with ADHD have certain visual cognitive advantages and cognitive inefficiencies. Through the analysis of WPPSI-Ⅳ, the cognitive development status of children can be understood, so as to carry out targeted cognitive behavior intervention training and provide some help for behavioral therapy.

Effect of different doses of methylprednisolone on refractory Mycoplasma pneumoniae pneumonia in children

CENG Zhao-bin, WANG Qi-wei, LIU Ding-li, ZHU Zhan-kui, PENG Wan-sheng

2020, 18(7): 1150-1152,1226. doi: 10.16766/j.cnki.issn.1674-4152.001452

330 5

Abstract:
Objective To investigate the therapeutic effect of different doses of methylprednisolone on refractory Mycoplasma pneumoniae pneumonia in children. Methods Total 120 children diagnosed as refractory Mycoplasma pneumoniae pneumonia in children's Hospital of Fuyang City from January 2018 to December 2018 were selected as the study object. They were divided into small dose group, medium dose group and large dose group according to the dose, 40 cases in each group. Each group was treated with azithromycin, and corresponding symptomatic support treatment was given, such as antipyretic, cough, phlegm, etc. On this basis, methylprednisolone was given 2 mg/(kg·d) in the low dose group, 5 mg/(kg·d) in the medium dose group, 10 mg/(kg·d) in the high dose group, once a day by intravenous drip. The total efficiency, normal time of body temperature recovery, cough improvement time, time of absence of lungs, time of hospitalization, improvement of chest film, index of inflammatory reaction and occurrence of adverse reactions were compared among the three groups. Results The total effective rate of the large dose group was higher than that of the medium dose group and the small dose group. The time of heat retreat, loss of cough, loss of lung voice, time of hospitalization, of the large dose group were significantly shorter than those in the medium dose group and the small dose group. The absorption rate of lung lesions in the large dose group was significantly higher than that in the medium dose group and the small dose group. After treatment, the C-reactive protein (CRP), IL-6, IL-10, and TNF-α were reexamined. The large dose group was the lowest, followed by the middle dose group and the low dose group. There was no statistically significant difference in adverse reactions among the three groups (P>0.05). Conclusion The treatment of refractory Mycoplasma pneumoniae pneumonia in children with large dose of methylprednisolone can significantly improve symptoms, improve curative effect, and have low adverse reaction and high safety factor, which is worthy of clinical promotion.

Comparison of seven bile acids in intrahepatic cholestasis by HPLC-MS/MS at different gestational stages and the clinical significance

YU Li-ming, SHI Xin-yan, CHEN Yi-ming, SHEN Yong-hai, WANG Qiu-meng, HU Wen-sheng

2020, 18(7): 1153-1156,1157. doi: 10.16766/j.cnki.issn.1674-4152.001453

311 4

Abstract:
Objective To compare the serum levels of seven bile acid subtypes at different gestational stages among pregnant women with intrahepatic cholestasis of pregnancy(ICP), pregnant women with abnormal liver function and normal pregnant women as well as the relationship between bile acid serum level with pregnancy outcomes so as to investigate value of bile acids analysis in clinical application. Methods A retrospective analysis of totally 84 ICP cases, 20 abnormal liver function cases and 30 normal cases underwent routine check-up and delivery in our hospital was collected from September 2018 to February 2019. At 9-13⁺⁶ weeks, 15-20⁺⁶ weeks and 28-40 weeks respectively, the venous serum samples of each case were collected and determined by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to come to measure the serum level of cholic acid (CA), chenodeoxycholic (CDCA) acid, glycocholic acid (GCA), taurocholic acid (TCA), glycochenodeoxycholic acid (GCDCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA). The relationship with the corresponding pregnancy outcomes was analyzed. Results The levels of bile acid subtypes in ICP pregnant women in early, middle and late gestational stages were significantly higher than those in normal pregnant women and pregnant women with abnormal liver function, mainly GCA and TCA. The bile acids serum levels in ICP group significantly increased with the gestational week increasing. The seven bile acid subtypes varied differently in the three gestational stages. GCA level was negatively related to the gestational age of childbirth. The levels of GCA, LCA and GCDCA were negatively related to the weight of the newborn, and other bile acids were not significantly related to clinical outcomes. Conclusion The bile acid profiles of three groups vary with gestational weeks. The CA/CDCA ratio is expected to be an indicator to distinguish ICP pregnancy women from abnormal liver function ones. The increase of LCA, GCA, and GCDCA may be related to poor prognosis. Detecting seven bile acids by HPLC-MS/MS can be used for clinical diagnosis and therapeutic effect evaluation of ICP.

Screening results and influencing factors of osteoporosis in postmenopausal women in community

SONG Hui-jiang, LIU Huai-lei, YANG Li-ping

2020, 18(7): 1157-1160. doi: 10.16766/j.cnki.issn.1674-4152.001454

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Abstract:
Objective To analyze the results and influencing factors of osteoporosis screening in postmenopausal women, and to evaluate the predictive power of OSTA scores on the risk of osteoporosis in postmenopausal women, so that to provide experience for peers to identify community-related osteoporosis. Methods A total of 5 191 postmenopausal women who participated in osteoporosis screening at Caolu Community Health Service Center in Pudong New Area, Shanghai were enrolled from March to April 2019. Osteoporosis screening was performed using a questionnaire combined with calcaneus bone mineral density by quantitative ultrasound system. Data analysis was performed using SPSS 24.0 software. Results Of the 5 191 postmenopausal women, 1 502 (28.93%) had intermediate and higher risk of osteoporosis, and the results of calcaneus ultrasound showed that the number of people whose T value ≤ -2 reached 1 280 (24.66%). The older the age, the smaller the BMI and the lower the OSTA score, the lower the T value (P<0.05). Whether the postmenopausal women were with low body weight, fragility fracture history, low back pain, history of falls, Parkinson's, uterus and ovarian cancer or not, and different osteoporosis risk rank, and the difference in T values measured by calcaneus ultrasound was statistically significant (P<0.05). Whether the OSTA score was ≤ -1, and whether the T value measured by the ultrasound of the calcaneus was ≤ -2, there was a poor consistency (Kappa=0.197<0.4, P<0.05). Conclusion The identification of community osteoporosis risk population could be evaluated by OSTA assessment, calcaneus ultrasound, in conjunction with other personal health history such as BMI or low body weight, fragility fracture history, low back pain, history of falls, Parkinson's, uterus and ovarian cancer.

Exploration and observation of contract management for community osteoporosis patients under the family doctor system

YANG Jing, TENG Bin, WANG Tai-rong

2020, 18(7): 1161-1164. doi: 10.16766/j.cnki.issn.1674-4152.001455

344 5

Abstract:
Objective According to the requirements of family doctor system, to standardize the management of the community osteoporosis patients who signed the contract of "1+1+1", and observe and explore the effective methods of chronic disease management in the community. Methods Total 226 cases of permanent residents in this street diagnosed as "osteoporosis" in the Outpatient Clinic of Wuliqiao Sub-district Community Health Service Center from December 2016 to December 2018 were randomly selected and divided into signed groups and non-signed group. The signed group was given health education, doctor-patient interaction and appointment follow-up. The changes in bone turnover markers, dual-energy X-ray absorptiometry, and Chinese osteoporosis-specific quality of life scales were observed after one year. Results The bone turnover markers β-collagen degradation products, type I procollagen amino terminal propeptide, osteocalcin, parathyroid hormone in the signed group were decreased significantly (all P<0.05), while the hydroxyvitamin D and calcium elevation were increased (all P<0.001). The bone density of waist 1, femoral neck and hip in the signed group were improved (all P<0.05). The Chinese People's Osteoporosis Special Quality of Life Scale (COQOL) in the signed group was significantly lower than that in the non-signed group (all P<0.05). Conclusion Family doctor "1+1+1" contract management not only provides convenient and cheap medical services for patients, but also improves the comprehensive management effect of osteoporosis patients.

Value of preoperative magnetic resonance imaging in the protection of pituitary function in transsphenoidal pituitary adenoma

WANG Hong-mei, XIA Cheng-yu, DENG Ke-xue, LU: Yang, CHEN Chuan-yu, LIAO Qin

2020, 18(7): 1165-1168. doi: 10.16766/j.cnki.issn.1674-4152.001456

298 2

Abstract:
Objective To explore the clinical value of preoperative magnetic resonance imaging data measurement and tumor constitution evaluation for guiding application and protection of pituitary function in transsphenoidal pituitary adenoma resection. Methods The clinical data of 80 patients with pituitary tumor who underwent transsphenoidal pituitary adenoma resection from January 2017 to September 2019 in the First Affiliated Hospital of USTC were retrospectively analyzed. MRI imaging and pituitary hormone levels were detected before and after surgery. Results In 80 patients, the distance between the nasal columella and the midpoint of the anterior sellar floor was (71.32±2.04) mm in the sagittal position, the angle between the above measurement line and the nasal floor plane was (31.24±5.8)°, and the distance between the cavernous sinus segment of the superior internal carotid artery was (20.74±0.48) mm in the coronal position. Soft texture showed high signal intensity, while neutral texture showed low signal intensity, which was obviously enhanced after enhanced scanning. Applying the measured values to the operation, all patients successfully reached the sellar floor to remove the mass. Postoperative MRI revealed total resection in 63 cases, subtotal resection in 13 cases and partial resection in 4 cases. Conclusion The application of MRI before transsphenoidal pituitary adenoma resection can help to accurately locate, safely and maximize open sellar floor bone, and clarify texture and size of pituitary tumors. It helps the surgeon to completely remove the tumor and reduce the damage to the normal pituitary function, so that the patients' hormone can return to normal levels. This would be helpful for the future clinical application.

The value of ECG Peguero-Lo Presti voltage standard in the diagnosis of hypertension associated left ventricular hypertrophy in adults

WU Jian-min, LIN Jia-feng

2020, 18(7): 1169-1173. doi: 10.16766/j.cnki.issn.1674-4152.001457

218 7

Abstract:
Objective To analyze and evaluate the advantage and value of the Peguero-Lo Presti voltage standard in the electrocardiographic criteria for the diagnosis of hypertension associated left ventricular hypertrophy (LVH) in adults. Methods Total 138 hypertensive patients were selected from the Second Affiliated Hospital of Wenzhou Medical University from September 2016 to September 2017 to evaluate the accuracy, sensitivity and specificity of traditional Sokolow voltage standard, Cornell voltage standard and Peguero-Lo Presti voltage standard in the diagnosis of LVH based on the echocardiography as the "gold" standard. Results The accuracy of three voltage standards for LVH diagnosis was the highest in Peguero-Lo Presti standard (77.54%), the specificity was the highest in Cornell standard (88.33%), and the sensitivity was the highest in Peguero-Lo Presti standard (82.05%). The Chi square test showed that Peguero-Lo Presti standard had the best accuracy and sensitivity (P<0.05), the difference was statistically significant, but in the specificity, although Cornell standard was the highest, the three standards had no significant difference in diagnosis specificity (P=0.068). The Kappa test showed that the highest kappa value of Peguero-Lo Presti standard was 0.540, which was consistent with the gold standard. The AUC value of Peguero-Lo Presti standard was 0.886, which was the most significant for the diagnosis of LVH. Conclusion According to all the indexes, Peguero-Lo Presti voltage standard is the most valuable and simple in diagnosis of LVH, which is worthy of clinical application and promotion.

The image tracking and evaluation by using multi-slice spiral CT for esophageal cancer patients after different surgical procedures

XU Wei, LI Jun, DU Xing-long, WANG Su-bo, ZHANG Yi-yang, MENG Qing-tao, LIU Wen-jing, WU Chun-mao

2020, 18(7): 1174-1176,1213. doi: 10.16766/j.cnki.issn.1674-4152.001458

215 3

Abstract:
Objective To study the value of multi-slice spiral CT in tracking and evaluating the postoperative images of esophageal cancer patients treated with different surgical procedures. Methods Total 60 patients with esophageal cancer were selected from the First People's Hospital of Chuzhou City from April 2014 to June 2018. The patients were divided into two groups and were treated with left and right thoracic approach, which includes 30 cases respectively. The treatment was followed-up with multi-slice spiral CT 1 to 3 days, or 1 week after operation and multi-slice spiral CT was performed for the patients every 3 months within the next two years after discharge. The types and cases of short-term and long-term complications were analyzed. The incidence and imaging characteristics in the two groups of different complications after operation were also analyzed. Multiple regression analysis was used to analyze the relationship between different surgical procedures and short-term and long-term complications. Results On 128-slice spiral CT scans, there were 28 cases of pulmonary inflammation, 58 cases of pleural effusion, 36 cases of atelectasis, 22 cases of hydropneumothorax, 36 cases of subcutaneous emphysema of chest wall, 7 cases of pneumomediastinum, 7 cases of anastomotic fistula, long-term anastomotic stenosis occurred in 6 cases, tumor recurrence in 7 cases, metastasis in 44 cases (including lymph node, bone, liver, lung, brain, adrenal, pleuroperitoneum and other organs). The incidence of pulmonary infection and anastomotic fistula in the right thoracic approach group of esophageal cancer were lower than those in the left thoracic group (all P<0.05). There was no difference in the incidence of the other complications among the groups (all P>0.05). There was a correlation between operation mode and pulmonary infection and anastomotic fistula (all P<0.05), no significant correlation with other recent and long-term complications (all P>0.05). Conclusion The incidence of pulmonary infection and anastomotic fistula in the right thoracic group are lower than those in the left thoracic group. CT could evaluate the common postoperative complications, and provide evidence for clinical active treatment directly and accurately.

Advances in the evaluation of anorectal function

WANG Yan, YU Ting, TANG Yu-rong, LIN Lin

2020, 18(7): 1177-1180,1189. doi: 10.16766/j.cnki.issn.1674-4152.001459

376 15

Abstract:
Functional anorectal diseases such as fecal incontinence and evacuation disorders are common. Reliance on symptoms alone for diagnosis is inadequate and skilled application of anorectal function test is important. There is widespread discordance in understanding and practices among institutions. The International anorectal physiology working group (IAPWG) issued the expert consensus on the advance in the evaluation of anorectal function in 2018 and standardized testing protocol and the London classification for disorders of anorectal function in 2019 (referred to as the "London Consensus"). London Consensus aimed to provide indications, study performance characteristics, clinical utility, advantages and limitations of each anorectal test. Anorectal disorders were classified based on the objective examinations. The IAPWG proposed that anorectal manometry is mainly used to evaluate anal motor function, and that endoanal ultrasonography is suitable for anal structure. Tests of evacuation-balloon expulsion and both barium and magnetic resonance defecography were also included. Simple balloon distension and rectal barostat are tests of rectal sensory and motor function. No single test can fully characterize the causes of fecal incontinence or evacuation disorders. Instead, several tests are used to assess anorectal structure, motor and sensory function. Major findings not seen in healthy controls defined by the classification are as follows:rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity and hypersensitivity. The London classification for anorectal functional disorders was divided into four parts:the rectoanal inhibitory reflex, anal tone and contractility, anorectal coordination, and rectal sensation. The London Consensus provided framework for clinicians performing and interpreting tests of anorectal function, which is helpful to the standardization of the testing protocol and results.

Clinical diagnosis and treatment of pulmonary thromboembolism

CHEN Zong-yu, DU Juan, ZHANG Xian-ming

2020, 18(7): 1181-1184. doi: 10.16766/j.cnki.issn.1674-4152.001460

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Abstract:
Pulmonary thromboembolism (PTE) is the most common type of pulmonary embolism. It refers to a series of clinical manifestations caused by obstruction of pulmonary artery or its branches after the detachment of vein or right heart thrombus. When the obstruction reaches a certain extent, it causes respiratory and circulatory system disorders, such as cardiopulmonary function, hemodynamics and so on. In the past, PTE was easily misdiagnosed and missed due to the backwardness of diagnosis and treatment technology and the poor knowledge of clinicians about PTE, especially neglected by young doctors lacking clinical experience, which was once considered a rare disease. In recent years, a large number of evidence-based medical evidence shows that PTE has become a common disease in China. PTE has the characteristics of high morbidity, high recurrence rate, high disability rate, high mortality rate and high economic burden of disease. It has become a major health problem and one of the clinical emergencies that seriously threaten the health of the public. It has been reported that PTE is a common cause of death following coronary heart disease and stroke. With the innovative development of diagnosis and treatment technology and the continuous exploration of clinical workers, whether it is the understanding of the risk factors of inducing PTE, or the choice of clinical diagnostic thinking or treatment options of PTE, it shows that modern medical practitioners have a deeper understanding of PTE. However, there are still some problems in the diagnosis and treatment of PTE, especially in the treatment of middle-risk PTE patients, there is no unified and standardized diagnosis and treatment program. This review summarizes the progress of diagnosis and treatment of PTE.

New progress in clinical application of magnetic stimulation acupoint intervention

ZHU Fen, WANG Dan, CHEN Ming-bo, CHEN Shang-jie

2020, 18(7): 1185-1189. doi: 10.16766/j.cnki.issn.1674-4152.001461

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Abstract:
In the treatment system of traditional Chinese medicine meridian theory, acupuncture, moxibustion and other methods for acupoints have been widely known and applied. Magnetic stimulation is a new type of stimulation therapy, which owns various advantages, including painlessness, non-invasiveness, simple operation, easy repeatability and deep stimulation. It is mostly used and played a great role in the brain functional area or in stimulating peripheral nerves and muscles, considered as one of the four brain technologies. In recent years, magnetic stimulation technology has also been gradually applied and received certain achievement in acupoint intervention. To this end, we have done a literature review on domestic and foreign literatures during the past ten years. In the clinical treatment of sleep disorders, cerebral fatigue, depression, post-stroke hemiplegia, lumbar spinal surgery failure syndrome, muscle fatigue and some other diseases, magnetic stimulation acupoints have a certain role and can partially replace or even replace the conventional treatment. However, most of the current studies display a small sample size. Multi-center prospective randomized controlled studies and medical evidence are also insufficient. In this way, clinical studies with higher quality are greatly needed in the future. In terms of mechanism, most researches mainly focus on the changes of cerebral cortex of magnetic stimulation intervention in different acupoints, different parameters, and different states. At present, most of the main methods focus on EEG evoked potentials and brain networks, and then explores how to optimize the magnetic stimulation system to achieve better results. In addition to researchers from traditional Chinese medicine and acupuncture, researchers from engineering promote the multidisciplinary interdisciplinary in this area. This review shows that the combination of modern magnetic stimulation technology and traditional acupuncture theory is a new development of magnetic stimulation technology in the medical field, which has promoted the clinical application of traditional Chinese medicine and acupuncture and is also beneficial to the promotion of acupoints in general medical treatment.

Application of three-dimensional reconstruction and 3D printing in minimally invasive lung surgery

LI Xiao-jun, ZHU Xiao, XING Fu-bao, GAO Xiong, ZHANG Lei

2020, 18(7): 1190-1194. doi: 10.16766/j.cnki.issn.1674-4152.001462

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Abstract:
With the increasing incidence rate of lung cancer and the popularization of low-dose spiral computed tomography (LDCT) examination, more and more patients with pulmonary nodules are diagnosed in time. Thoracoscopic surgery is safe and feasible for such patients, its advantages are small trauma, less pain, fast recovery, and does not increase the occurrence of surgical complications, nor reduce the long-term effect. The popularization of the concept of precision surgery is mainly reflected in the subpulmonary lobectomy under thoracoscopy, which has become the development trend of pulmonary surgical treatment. However, the vessels and bronchi in the pulmonary segment are all embedded in the lung tissue, and the anatomical structure is relatively complex. The anatomical variation has obvious individual difference. During the operation, the wrong judgment of the pulmonary segment bronchus, pulmonary vessels and other anatomical structures will cause tracheal injury, hemoptysis, atelectasis and other complications. Traditional lung surgery programs and surgical procedures are based on imaging data such as chest CT and years of practical experience accumulated by the surgeon, relying on their knowledge of anatomy and space imagination in the brain to build three-dimensional structure of the lungs, but ordinary CT is two-dimensional images, bronchi and vessels for precise positioning and judgment anatomical variation, special course details such as difficult. In this case, in recent years, the three-dimensional reconstruction and 3D printing technology which based on medical imaging and digital medicine has developed rapidly, which can directly reflect the anatomical structure, shape and size of pulmonary lesions and the relationship with adjacent tissues and organs, and can carry out preoperative planning and intraoperative navigation, and plays an important role in the thoracoscopic subpulmonary lobectomy which has complex anatomical structure and individual differences. At the same time, three-dimensional reconstruction and 3D printing technology also play an active role in doctor-patient communication, interpretation of the disease, clinical teaching and so on.

Research progress of Zika virus and Microcephaly

TIAN Ya-nan, XU Peng, ZHAO Wei, LI Li-yang, GAO Shuang, GUO Yu, KUANG Ye

2020, 18(7): 1195-1199. doi: 10.16766/j.cnki.issn.1674-4152.001463

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Zika virus was originally identified in a sentinel rhesus monkey in the Zika Forest of Uganda in 1947. The virus is a member of the Flavivirus genus in Flaviviridae and is classified as "torch pathogen". It is mainly transmitted to humans by Aedes species mosquitoes.As the symptoms of infection were mild, Zika virus began to be little known. Only after the outbreak in Brazil in 2015 did people realize the spread of Zika virus and the serious disease consequences. Zika virus is transmitted to the fetus during the mother's pregnancy, resulting in microcephaly of the fetus. Microcephaly is the first congenital abnormality related to Zika virus infection. Microcephaly is a serious disease. Fetal brain development causes the head to be smaller than normal size, usually accompanied by cognitive and physiological delays. Microcephaly is an important sign of nervous system malformation and a predictor of future disability. However, the vertical transmission mechanism of Zika virus is still largely unknown. The suspicious link between Zika virus infection and microcephaly is an urgent global health problem. Besides microcephaly, Zika virus can also cause other diseases such as Guillain-Barré. However, there is currently no Zika virus vaccine. The current treatment guidelines are based on limited evidence and mostly symptomatic treatment. However, the World Health Organization has made the development of Zika virus vaccine a top priority. This is the first major infectious disease related to human birth defects in more than half a century. The World Health Organization (WHO) has issued a global warning and announced this public health emergency that has aroused international concern. This review describes the origin, prevalence and spread of Zika virus infection, fetal microcephaly, the relationship between Zika virus and microcephaly and other diseases, as well as the treatment status and progress of Zika virus.

Effect of Jianpi Hewei Granule on symptoms,psychological and immune status in patients with chronic non-atrophic gastritis of spleen deficiency and Qi stagnation

HUANG Xiao-ying, CENG Yao-ming, HE Fan

2020, 18(7): 1200-1203. doi: 10.16766/j.cnki.issn.1674-4152.001464

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Objective To investigate the effects of Jianpi Hewei Granule combined with conventional western medicine on symptoms, psychology and immune status in patients with chronic non-atrophic gastritis of spleen deficiency and Qi stagnation. Methods A total of 97 patients with spleen-deficiency Qi stagnation type CNAG who were diagnosed in our hospital from June 2018 to April 2019 were enrolled. All patients were divided into a combination group (48 cases) and a control group (49 cases) according to the random number table method. All patients underwent Helicobacter pylori examination after diagnosis. The positive patients received rabeprazole+amoxicillin+clarithromycin+colloidal pectin quadruple therapy, while the negative patients received rabeprazole + colloidal pectin. The treatment time was 2 weeks, and the combined group was given Jianpi Hewei Granules. The difference between the two groups of patients after treatment, the difference between symptom score, psychological function score, immune function index and adverse reaction rate before and after treatment. Results After treatment, the combined group efficacy was better than the control group, the difference was statistically significant (P<0.05). After treatment, the combined gastroscope pathological score was better than the control group, the difference was statistically significant (Z=4.370, P=0.038). The HAMA score and HAMD scores of the patients in the combined group (8.74±1.19 and 8.03±1.14) were lower than those in the control group (11.32±2.47 and 11.04±2.98), and the difference was statistically significant (t=-6.531, -6.544; all P<0.05). The proportions of NK, CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ in the combined group were significantly higher than those in the control group (all P<0.05). There was no statistically significant difference in the occurrence of various adverse reactions between the two groups of patients (all P>0.05). Conclusion Jianpi Hewei Granules can be used to treat patients with spleen deficiency and Qi stagnation type CNAG. It can improve the patient's anxiety and depression, improve immune function and safety.

The clinical efficacy of Yellow soup of paeoniae combined with human chorionic gonadotropin in the treatment of female infertility caused by luteal phase defect

YANG Shi-hui, WANG Wei

2020, 18(7): 1204-1206. doi: 10.16766/j.cnki.issn.1674-4152.001465

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Objective To explore the clinical efficacy of Yellow soup of paeoniae combined with human chorionic gonadotropin in the treatment of female infertility caused by luteal phase defect and its influence on endometrial development, hormone levels and ovarian arterial blood rheology parameters. Methods Eighty-six cases of luteal infertility women treated in Wenzhou City Hospital of Integrated Traditional Chinese and Western Medicine, from January 2017 to March 2019, were divided into 2 groups by random number method, 43 cases in each group. The main follicles were detected human chorionic gonadotropin, and the observation group was given the treatment of Yellow soup of paeoniae and human chorionic gonadotropin. The two groups were treated for one course of treatment, and the treatment was followed for three months. After treatment, the clinical efficacy and symptom score, endometrial thickness and changes of hormone levels in ovarian arterial blood rheology parameters (pulsation index, resistance index, end-diastolic velocity and peak systolic velocity) between observation group and control group were compared. Results After treatment, the total effective rate of the control group was 79.07%, the total effective rate of the observation group was over 95.34%, and the total effective rate of the observation group was higher than that of the control group (χ²=5.108, P=0.024). The total effective rate of the observation group was significantly higher than that of the control group (P<0.05). After treatment, the uterus thickness and main follicle diameter of both groups were significantly increased (all P<0.05), and the endometrial thickness and main follicle diameter of the observation group were significantly higher than the control group (P<0.05). After treatment, the pulsation index, end-diastolic velocity and peak systolic velocity of the two groups were improved (all P<0.05), and the improvement degree of the observation group was significantly better than that of the control group (P<0.05). Conclusion The use of Yellow soup of paeoniae combined with human chorionic gonadotropin in the treatment of luteal phase defect infertility has a significant effect. The clinical symptom score is significantly improved, the regulation function of the hypothalamic-pituitary-ovarian axis is improved, and the function of the corpus luteum and endometrial thickness are improved, effective regulation ovarian artery blood flow parameters.

Effect of dual PBL and LBL teaching method on the teaching quality of pediatric interns

ZHANG Zhen, CHEN Xin, WU Yu-meng, PENG Wan-sheng, SANG Xu

2020, 18(7): 1207-1209,1221. doi: 10.16766/j.cnki.issn.1674-4152.001466

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Objective To investigate the effect of dual problem-based learning (PBL) and lecture based learning (LBL) teaching method on the teaching quality of pediatric interns and to provide strategic basis for training more professional medical personnel. Methods A total of 83 pediatric interns from January 2018 to September 2018 in the First Affiliated Hospital of Bengbu Medical College were selected as the study objects. According to the principle of random distribution, the interns were divided into study group (n=44) and control group (n=39). The study group received PBL combined with LBL dual track teaching, and the control group received LBL teaching. At the time of graduation, the scores of assessments (theory score, operation score, comprehensive ability score), total score of teaching effect and satisfaction of teaching method were compared. Results There was no significant difference between the two groups (P>0.05). The results of theoretical knowledge, basic operation and comprehensive performance of pediatric specialty in the study group were higher than those in the control group (P<0.05). The interns of the research group thought that the dual track teaching was more conducive to the systematic and comprehensive mastery of knowledge, the cultivation of independent thinking and self-study ability, the active and attractive classroom atmosphere, the improvement of language organization and expression and self-confidence, the mastery and memory of knowledge, the strengthening of paediatric work flow, the increase of learning pressure and the improvement of practical operation ability. The total score of the research group teaching effect and the implementation of teaching related content The score of international application effect and teaching satisfaction were higher than that of the control group (P<0.05). The combination mode could cultivate the judgment thinking and clinical ability of the interns, effectively stimulate the spontaneous learning motivation of the interns, improve the communication ability, and cultivate the communication and cooperation ability. Conclusion PBL combined with LBL dual track teaching can improve the teaching quality of paediatric interns, help them master the relevant theoretical knowledge and skilled in various operations, play a positive role in training better talents, and be easily accepted by interns.

The practice and thinking of"clinical characteristic technique of acupuncture and moxibustion"in basic traditional Chinese medicine training

QIAO Min, GAO Xi-yan, ZHOU Yan-li, ZHANG Da-wei

2020, 18(7): 1210-1213. doi: 10.16766/j.cnki.issn.1674-4152.001467

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Objective To discuss the feasibility, training method, improving training efficiency and effect method of "clinical characteristic technique of acupuncture and moxibustion" in the training of basic-level Chinese medicine doctors. Methods The featured clinical experience of famous acupuncture and moxibustion doctors in our school was made into a multilingual micro-video online course-"featured acupuncture and moxibustion clinical technology". Each micro-video took 15 to 18 min to design, including three parts:theory, technology and operation. From the perspective of recording techniques, it includes acupuncture, moxibustion, acupoint embedding, acupuncture and bloodletting, fire needle, acupoint, acupoint and manipulation, etc. From the disease, involving asthma, insomnia, stroke, lumbago, cervical spondylosis, knee osteoarthritis, rheumatoid arthritis, obesity, facial paralysis, cerebral palsy, milk addiction, dysmenorrhea, dysmenorrhea, periarthritis of shoulder and other internal and external maternal and child basic clinical diseases. The training of Chinese medicine doctors at the grass-roots level was carried out by combining theoretical explanation, live video broadcast and on-site practical operation. Results Two hundred and forty students planned to attend the training, 262 students actually attended the on-site class, 262 questionnaires were distributed after class, and 262 questionnaires were recovered. The 95.2% of them were satisfied with the training method and 98.1% with the training content. The 92.2% of the course content met my work and personal development needs. This training was 90.3% of my urgent need. After training, 87.2% of them were ready to carry out relevant techniques in clinical practice. Conclusion The contents and methods of the training provide effective and safe new technologies for primary doctors and provide more intuitive learning experience for learners. The course can improve the training effect and efficiency, and enable grassroots doctors to master more useful techniques in a short time, which is worth promoting and applying in the grassroots. Through the training of grassroots Chinese medicine doctors, the effective clinical acupuncture technology will be brought to the grassroots, to provide more simple, convenient, inexpensive, inexpensive medical technology for grassroots Chinese medicine doctors, so that more grassroots people benefit.

Application effect of CBL combined with seminar teaching mode in clinical teaching of critical medicine

LIU Cheng, WU Xue-ping

2020, 18(7): 1214-1216,1233. doi: 10.16766/j.cnki.issn.1674-4152.001468

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Objective To explore the application effect of case-based learning (CBL) combined with seminar teaching in clinical teaching of critical medicine. Methods From October 2018 to March 2019, clinical graduate students in the Department of critical medicine of the First Affiliated Hospital of Bengbu Medical College were selected.Eight students were randomly selected to join the group for one month, and the teaching effect was evaluated at the end of each month. In the first three months, a single CBL teaching was used (24 students in the control group). In the last three months, CBL combined with seminar teaching was used (24 students in the experimental group). Results In terms of total score and case analysis,the scores of group D were significantly higher than group S(81.9±4.0 vs. 77.4±5.3 and 31.0±2.6 vs. 24.5±2.1),had a statistically significant difference (P<0.01);In terms of choice questions and noun explanation questions,the scores of group D was slightly higher than group S,had no statistically difference(P>0.05).In terms of interest in learning critical medicine,enthusiasm for literature review and thinking mode of critical medicine in the practice assessment, the scores of group D were significantly higher than group S(6.0 vs. 4.0、6.0 vs. 4.0 and 6.5 vs. 4.0),had a statistically significant difference (P<0.01). The evaluation of teaching mode in department:Group D was better than Group S,with statistical difference (P<0.05).Disadvantages of teaching mode:①a long teaching time;②inadequate opportunities for hands-on operation; ③ inadequate understanding of knowledge points,there was no statistical difference between the two groups (P>0.05). Conclusion In clinical teaching of critical medicine, CBL combined with Seminar teaching method is helpful to improve the teaching effect of professional postgraduates, and it is worth popularizing in this field.

Investigation on the standardization of blood pressure measurement of general nurses in primary medical institutions in Sichuan Province

LIU Li-di, LIAO Xiao-yang, WU Jia, ZOU Chuan, ZHAO Qian, LI Zhi-chao

2020, 18(7): 1217-1221. doi: 10.16766/j.cnki.issn.1674-4152.001469

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Objective To understand the configuration of sphygmomanometer in primary medical institutions of Sichuan province and the standardization of sphygmomanometer and measurement methods used by general nurses. Methods Convenient sampling was adopted and self-made questionnaire was used to investigate the configuration of sphygmomanometers in general nurses' organizations and the sphygmomanometers and measurement methods for screening, diagnosis and follow-up of patients with hypertension. Results A total of 258 valid responses were received. The allocation rate of mercury column sphygmomanometer, electronic sphygmomanometer and ambulatory blood pressure monitor were 97.3%, 96.5% and 34.5% respectively. When screening patients with hypertension, 68.2% of the general nurses used electronic sphygmomanometer, of which 50.6% used wrist electronic sphygmomanometers, and the utilization rate of mercury column sphygmomanometer and ambulate blood pressure monitor accounted for 31.4% and 0.4% respectively. When diagnosis people with hypertension, the utilization rate of mercury column sphygmomanometer, electronic sphygmomanometer and ambulate blood pressure monitor were 67.1%, 24.8% and 8.1% respectively. In the follow-up management of hypertensive patients, the above three types of sphygmomanometer utilization rate were 36.8%, 62.4% and 0.8% respectively. When screening patients with hypertension, 90.3% of general nurses chose office blood pressure measure, followed by ambulatory blood pressure measurement (5.4%) and home blood pressure measurement (4.3%). When diagnosis and follow-up people with hypertension, the above three blood pressure measure accounted for 81.0%, 16.7%, 2.3% and 68.6%, 2.7%, 28.7%, respectively. Conclusion The ratio of mercury sphygmomanometer and electronic sphygmomanometer in primary medical institutions in Sichuan province is high and the ambulatory blood pressure monitor is less. The blood pressure measurement of general nurses is not standardized, the use of electronic sphygmomanometer and ambulatory blood pressure monitor needs to be popularized, and the method of blood pressure measurements outside consulting room should be paid great attention.

The study on the development of scientific research work in a newly-established local college affiliated hospital

LIU Ying, ZHAO Da-hai, LI Dan, CHENG Pan

2020, 18(7): 1222-1226. doi: 10.16766/j.cnki.issn.1674-4152.001470

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Objective To provide the basis for formulating scientific research policies and improving the quality of scientific research management through analyzing the development of scientific research in The Second Hospital of Anhui Medical University from 2015 to 2019. Methods The number, source, and funding of longitudinal scientific research projects in each year were descriptively analyzed. This study focused on the subject distribution of national, provincial and ministerial projects, as well as the age, title, degree (education) of the leader of these projects, and to find out problems and propose improvement measures and suggestions from the data analyze. Results The hospital longitudinal projects come from the national, provincial, and municipal levels, accounting for 9.7%, 23.6%, and 66.7%, respectively, and the high-level and high-quality subjects were few. The funding had increased from 2.961 million RMB in 2015 to 5.087 million RMB in 2019. Although it showed a rapid growth trend, there were also large fluctuations among these years. Among national and provincial projects, the provincial key specialty and school level research center departments account for 67.4%. Young and middle-aged doctoral talents and the introduction of talents were the main groups to enhance the scientific and technological strength of the hospital. Conclusion Through data analysis, we find some deficiencies in scientific research work which are mainly in the unbalanced development between disciplines, such as the gap between key disciplines and general disciplines, few high-quality projects and high-quality achievements, lack of scientific research team striving for major projects, lack of long-term and stable clinical research direction and insufficient research funding. It is suggested that we should focus on the construction of disciplines and strengthen the construction of the talent team, improve the ability and level of scientific research with the support of the construction of the scientific and technological platform, innovate the scientific research management mechanism to promote the improvement of the quality of scientific research projects and achievements, implement effective incentive measures to promote the comprehensive capacity of scientific research management, and carry out high-quality scientific research project incubation plan and increase investment in scientific research funds.

Effect of"Internet+"management on blood pressure variability of hypertensive encephalopathy in Taizhou

XIE Hong-yan, YING Li, CUI Ying

2020, 18(7): 1227-1229,1244. doi: 10.16766/j.cnki.issn.1674-4152.001471

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Objective To explore the effect of "Internet +" management on emergency hypertensive encephalopathy patients, and to provide effective methods for improving out-of-hospital management of hypertensive encephalopathy. Methods One hundred and sixteen patients with emergency hypertensive encephalopathy who were hospitalized and registered in telemedicine center from January 2017 to August 2018 were selected. According to the random number table method, they were divided into the study group (58 cases) and the control group (58 cases). The control group received routine nursing in hospital and regular follow-up visits outside the hospital. The study group was based on "slow health" Internet platform on the basis of the control group. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood pressure variability (BPV) of the two groups were compared for 12 months. Results There was no loss of follow-up in the study group, and 2 cases in the control group did not respond, and 114 cases were finally included, including 58 cases in the study group and 56 cases in the control group. For 12 months, the level of SBP and DBP in the study group were lower than those in the control group (all P<0.05). The 24-hour SBP BPV in the study group was (10.20±2.13), and that of the control group was (16.64±4.36), the difference was statistically significant (t=10.073, P<0.05). The 24-hour DBP BPV in the study group was (5.26±1.06), and that of the control group was (7.44±1.35), and the difference was statistically significant (t=9.164, P<0.05). The excellent and good compliance rate of the study group was 81.04%, much higher than that of the control group (44.64%), χ²=16.216, P<0.05. The satisfaction rate of the study group was 96.55%, and that of the control group was 66.08% (χ²=17.614, P<0.05). Conclusion Based on the "slow health" Internet platform, hypertensive encephalopathy can effectively control blood pressure level, stabilize blood pressure variability, improve patient compliance and nursing satisfaction through routine nursing.

Study on the effect of rapid rehabilitation nursing mode in patients after repair of rotator cuff injury under arthroscope

WANG Jia, CHENG Shao-wen, SUN Guang-xiao

2020, 18(7): 1230-1233. doi: 10.16766/j.cnki.issn.1674-4152.001472

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Objective To explore the effect of rapid rehabilitation surgical nursing on postoperative pain and shoulder joint function of patients with rotator cuff injury repair under arthroscope. Methods From April 2015 to June 2018, 84 patients underwent arthroscopic repair in the First Affiliated Hospital of Hainan Medical College were divided into observation group (rapid rehabilitation nursing mode, 42 cases) and control group (general routine nursing mode, 42 cases) by single blind method, and the above-mentioned different nursing modes were adopted during the perioperative period. To evaluate the effect of rapid rehabilitation nursing mode on the postoperative pain and shoulder function of patients with rotator cuff injury repair under arthroscopy, we compared the basic data of the two groups before operation, pain relief time in hospital, VAS score, Rom score of shoulder joint function during postoperative follow-up, hospitalization time and satisfaction score of patients. Results Compared with the conventional nursing mode, the rapid rehabilitation nursing mode (24.83±2.57 days) could significantly reduce the postoperative pain relief time (37.02±5.42 days, P<0.05) and reduced the the VAS pain score at 4, 8 and 12 weeks after operation(P<0.05). In the half year after operation, the angles of shoulder joint flexion, extension, internal rotation and external rotation in the rapid rehabilitation nursing mode were higher than those in the routine nursing group(P<0.05), leading to the improvement of satisfaction score (P<0.05). Conclusion The rapid rehabilitation nursing mode can improve the curative effect of arthroscopy in the treatment of rotator cuff injury, reduce postoperative pain, promote the recovery of shoulder joint function and reduce the length of hospitalization, and ultimately increase the satisfaction of patients with the curative effect.

The influence of evidence-based clinical nursing path on the treatment of placenta previa patients undergoing cesarean section

CHEN Xiao-yan, CHAI Ze-ying

2020, 18(7): 1234-1236,1240. doi: 10.16766/j.cnki.issn.1674-4152.001473

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Objective To explore the application of evidence-based clinical nursing pathway in patients undergoing cesarean section with placenta previa. Methods A total of 140 patients with placenta previa who underwent cesarean section in the lower part of the uterus admitted to our hospital from July 2017 to July 2019 were selected and divided into control group and observation group, 70 cases in each group, according to the random number table. The control group received routine nursing care, and the observation group received evidence-based clinical nursing path on the basis of the control group. Pregnancy outcome, neonatal outcome, complication rate and nursing satisfaction were compared between the two groups. Results The amount of postpartum bleeding in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). The uterine resection rate, allogeneic blood transfusion rate and incision infection rate of the observation group were 0.00% (0/70), 2.86% (2/70) and 4.29% (3/70), respectively, which were all lower than that of the control group[5.71% (4/70), 11.43% (8/70), 15.71% (11/70)], with statistically significant differences (all P<0.05). The Apgar score of neonates in the observation group was higher than that of the control group, and the incidence of neonatal asphyxia and the NICU transfer rate of neonates were 4.29% (3/70) and 2.86% (2/70), respectively, lower than that of the control group[17.14% (12/70) and 14.29% (10/70)], with statistically significant differences (all P<0.05). The incidence of postoperative complications was 4.29% (3/70) in the observation group, 14.29% (10/70) in the control group, 92.86% (65/70) in the observation group, and 81.43% (57/70) in the control group, with statistically significant differences (all P<0.05). Conclusion The clinical nursing pathway based on evidence can effectively improve the pregnancy outcome and neonatal outcome of patients undergoing cesarean section with placenta previa, reduce the occurrence of postoperative complications, and improve nursing satisfaction, which is worthy of clinical application.

Effect of shortening perioperative fasting time on rapid recovery of thyroid surgery

CAI Ming, ZHOU Qian, YOU Wei

2020, 18(7): 1237-1240. doi: 10.16766/j.cnki.issn.1674-4152.001474

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Objective To explore the effect of shortening preoperative fasting time on rapid recovery of thyroid surgery. Methods A total of 120 cases of patients who underwent thyroid cancer surgery in our hospital from June to December 2016 were selected and divided into observation group and control group according to the operating time sequence, 60 cases in each group. In the control group, patients were undergoing routine fasting 12 h and forbidden to drink 10 h before surgery, they were allowed to eat if backward choking did happen when they drank 6 h after surgery. In the observation group, according to the theory of fast-track surgery, patients were forbidden to eat 6 h and to drink 4 h before surgery, they were allowed to eat if backward choking did happen when they drank 4 h after surgery. The levels of cortisol and blood sugar in peripheral blood of the two groups were measured one day before operation, during operation and one day after operation. The stress reaction during the observation period was analyzed by χ² test, t test and F test. Results There was no significant difference in intraoperative vomiting/aspiration[0(0.00%)vs. 0(0.00%)], postoperative nausea[7 (11.67%) vs. 5 (8.33%)] and vomiting[3 (5.00%) vs. 4 (6.67%)] between the two groups (χ²=0.370, 0.152, all P>0.05). The incidence of thirst and hunger in the observation group[3 (5.00%), 2 (3.33%)] was lower than those in the control group[55 (91.67%), 58 (96.67%)] before and after operation, and postoperative hospital stay[(5.1±1.3) d] was less than that of the control group[(6.3±1.1) d], with the statistically significant difference (χ²=90.234, 104.530, t=5.165, all P<0.05). The intraoperative cortisol levels in the observation group[(493.6±116.7) ng/L] was significantly lower than that in the control group[(548.1±116.4) ng/L, t=2.327, P<0.05]. The level of cortisol in peripheral blood of the observation group[(500.2±121.3) ng/L] was significantly lower than that of the control group[(592.4±119.2) ng/L] one day after operation (t=2.906, P<0.05). One day after operation, the fasting blood glucose in the observation group[(5.5±0.8 mmol/L] was significantly lower than that in the control group[(7.3±1.0) mmol/L, t=10.887, P<0.05]. Conclusion It is safe and feasible to shorten the fasting time during thyroid cancer surgery in the theory of fast-track surgery, which not only can reduce the discomfort of patients and promote the early recovery of the patients, but also shorten the length of hospital stay. At the same time, it provides evidence for experts of thyroid and further the process of the use of FTS in thyroid disease.

Study on the effect of reasonable behavior replacement nursing on the compliance behavior of the elderly patients after prostatectomy

LI Hui-lin, LOU Ping, SHOU Ji-yu, FENG Jian-ju

2020, 18(7): 1241-1244. doi: 10.16766/j.cnki.issn.1674-4152.001475

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Objective To explore the intervention effect of rational behavior replacement nursing on the elderly patients with BPH. Methods From January 2018 October 2018, 73 patients with BPH were admitted to ZhuJi People's Hospital Jiangdong Branch Urology. According to the method of random number table, the patients were divided into observation group (37 cases) and control group (36 cases). The nursing effect of the two groups was compared. The outcome measures included:compliance rate, postoperative complications. Results In the observation group, the compliance score[2.54±0.61, 2.74±0.52, 2.83±0.66, 2.75±0.28] and compliance rate (94.60%) were higher than those in the control group[2.11±0.53, 2.16±0.39, 1.97±0.45, 2.14±0.37, 77.78%]. There was a statistically significant difference between the two groups in scores of self-reported mood, reasonable daily activities, scientific diet and adequate water intake (all P<0.05), and the incidence of postoperative complications such as bladder spasm and urinary tract infection (5.41%) were significantly higher than those in the control group (19.44%) There was no statistical significance (χ²=2.155, P=0.142). Conclusion Reasonable behavior replacement nursing can improve the compliance behavior of elderly patients with BPH, reduce the incidence of postoperative complications, and has the value of clinical application.

Effect of intermittent pinch valve combined with anal levator movement on urination function after removal of catheter in patients with gynecological tumor

CHEN Lin, ZHOU Li-hua

2020, 18(7): 1245-1247. doi: 10.16766/j.cnki.issn.1674-4152.001476

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Objective Patients with early stage gynecological tumors need indwelling catheterization during operation to ensure smooth urinary drainage during and after surgery. However, difficulty urinating or even urinary retention often occur due to various reasons after surgery. This study aims to explore the effect of intermittent pinch valve combined with anal levator movement on urinary function after urinary catheter removal in gynecologic tumor patients. Methods Ninety patients with gynecologic tumors were enrolled from January 2018 to June 2019 in this study. Patients were randomly divided into experimental group (45 cases) and control group (45 cases) according to the random number table method. Patients in control group were nursed according to the nursing routine of indwelling catheterization, and that in experimental group were nursed with intermittent pinch tube combined with anal movement on the basis of routine nursing, and the catheter was removed when the bladder was full or the patient complained of obvious urinary intention. Rank sum test was used to compare the waiting time for the first urination after extubation. Chi-square test was used to compare the distribution of urinary tract irritation and urination. Results The first urination time in control group was[105.0(35.2,210.4)]min after extubation, and the experimental group was[30.0(10.5,65.7)]min, the difference was statistically significant (U=506.000; P<0.01). Totally, 3 (6.7%) patients in experimental group had urinary tract irritation signs, and 12 (26.67%) in the control group had urinary tract irritation signs. The chi-square value was 6.480, and the difference was statistically significant (P<0.05). Totally, 43 (95.56%) patients in experimental group vomited spontaneously after surgery, 2 (4.44%) patients needed to induce urination, and no patients needed re-catheterization. Totally, 34 (75.56%) patients in the control group spontaneously urinate after surgery, and 7 (15.55%) patients needed induce urination, and 4 (8.89%) needed to urinate again. The chi-square value was 7.830, and the difference was statistically significant (P<0.05). Conclusion Intermittent pinch tube combined with levelling anus exercise, when the bladder filling or the patient complained of obvious urinary tract, the urethral tube can be removed, which can significantly reduce the waiting time for the first urination, promote the patient to resume spontaneous urination as soon as possible, reduce the chance of re-conducting. The nursing intervention measures are simple and effective, worthy of clinical promotion and application.

TIAN Jing-yi, SUN Jing-wei, DONG Nan, LIAO Shu-li

2020, 18(7): 1248-1250. doi: 10.16766/j.cnki.issn.1674-4152.001477

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2020 Vol. 18, No. 7

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