中华全科医学

Practice and development advantages of general practice of traditional Chinese medicine

LI Zi-yun, TONG Xu, LI Hai-yu

2020, 18(9): 1433-1436. doi: 10.16766/j.cnki.issn.1674-4152.001526

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Abstract:
In China, general practice of traditional Chinese medicine(TCM) starts late and is still in the stage of exploration. This paper focuses on the practice of general practice of TCM, and expounds the concept and practice mode of general practice of TCM, the application of general practice of TCM in the community, the development advantages and existing problems of general practice of TCM, so as to have a more comprehensive understanding of the development status of general practice of TCM, and to promote the development of general practice of TCM into a high practical value, strong service ability and extensive penetration of a practical medicine discipline. The concept and practice mode of general practice of TCM are characterized by advocating the holistic concept of "human centered", individualized comprehensive intervention of syndrome differentiation and treatment, prevention and health preservation concept of treating diseases before they occur, and paying attention to serving families and communities. The application of TCM general medicine diagnosis and treatment technology in community service mainly includes the management of chronic non infectious diseases(chronic diseases), the methods of physique identification and recuperation, the treatment of winter diseases with ointment in summer, the screening and application of TCM appropriate technology and other community health problems with TCM intervention. The development advantages of general practice of TCM are mainly reflected in the following aspects: it is conducive to the prevention and treatment of chronic diseases and the combination of medical treatment and maintenance; it is easy to build a harmonious doctor-patient relationship based on the community and family; it is simple, effective and cheap, which is conducive to the saving of medical costs; it is conducive to the transformation of TCM theory into clinical application and the integration of Chinese and Western medicine. At the same time, there are still some problems to be solved, such as the talent education and training system still need to be improved, the number of general practice doctors is insufficient, the structure is not perfect, and the posts are not attractive; the construction of general practice of traditional Chinese medicine is still weak; the research of general practice of TCM in community health service is still insufficient.

YANG Da-wei, LI Ying, LI Zhi-jun

2020, 18(9): 1437-1438.

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Abstract:

Clinical profiles of patients with noncompaction cardiomyopathy accompanied by chronic heart failure

AN Chun-sheng, CHEN Kang-yu, LIU Zhi-quan, XU Jian, DING Xiao-mei, HUANG Xiang-yang, YAN Ji

2020, 18(9): 1439-1442. doi: 10.16766/j.cnki.issn.1674-4152.001527

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Abstract:
Objective Imaging standards of diagnosis of ventricular noncompaction cardiomyopathy(VNC) are based on the ratio of dense layer to non-dense layer, the thickness of non-dense myocardium or the number of myocardial trabeculae. Patients have clinical manifestations, ranging from asymptomatic to arrhythmia, heart failure, thromboembolism or sudden cardiac death. The purpose of this study was to explore clinical characteristics(CCs) of patients with VNC accompanied by chronic heart failure(VNC-CHF) and their influence on prognosis. Methods From January 2001 to December 2016, the patients with VNC-CHF in the First Affiliated Hospital of USTC(n=60, as research group) and the patients with dilated cardiomyopathy(n=71, as control group) in the hospital were retrospectively studied. Their CCs were analyzed and the influence on the patients' prognosis was evaluated. Results Compared with the control group, the proportion of male patients with VNC-CHF was higher than that of female patients(68.33% vs. 47.89%, P=0.018), and they were more likely to have left bundle branch block(56.67% vs. 29.58%, P=0.002) and right bundle branch block(6.67% vs. 0.00%, P=0.043). The incidence of fragmented QRS complexes(23.33% vs. 8.45%, P=0.018) was significantly increased. Logistic regression analysis showed that gender(P=0.028) and hypertension(P=0.024) were important factors in the occurrence of ventricular arrhythmia(VA) and the composite point which was composed of VA and embolism, respectively. The incidence of VA in male patients was higher than that in female patients. Conclusion VNC patients are prone to ECG abnormalities, in which male is an independent factor of VA, with poor prognosis. Hypertension in VNC patients will increase the incidence of embolism.

The correlational research between the serum homocysteine and primary hepatic carcinom

CHEN Mo-li, XIA Li, ZHAO Wei, YANG Wu-lin, HU Zong-tao

2020, 18(9): 1443-1445,1465. doi: 10.16766/j.cnki.issn.1674-4152.001528

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Objective To research the level of the serum homocysteine(Hcy) in patients with primary hepatic carcinom(PHC), and to explore the correlation with clinical stage and Child-Pugh grade of liver function. Methods Total 115 patients of PHC who diagnosed in our hospital from June 2018 to December 2019 were collected as PHC group, and 69 cases of normal physical examination in the same period were collected as control group. The differences of serum Hcy, biochemical indexes(liver and kidney function, blood lipid, blood glucose) and tumor markers were compared. The correlation between serum Hcy and clinical stage and Child-Pugh grade of liver function was analyzed. Results The level of the serum Hcy in the PHC group [13.56(10.68, 17.96) μmol/L] was significantly higher than that in the control group [10.20(7.70, 11.89) μmol/L], and the difference was statistically significant(P<0.05). The serum Hcy level in PHC group was significantly different between different clinical stages and different liver function(all P<0.05). There was a positive correlation between the serum Hcy and the stage and Child-Pugh grade of liver function(r=0.585, P<0.05; r=0.625, P<0.05). After adjusting other risk factors of PHC, the serum Hcy level was an independent risk factor for PHC(OR=1.409, P=0.003). Conclusion The higher the serum Hcy level in PHC patients, the later the clinical stage and the more serious the liver function grade. Hcy can be used as a monitoring index with PHC, and has certain clinical significance for disease evaluation and prognosis prediction.

Study on the application of modified auriculotemporal incision combined with submaxillary incision in intracapsular condylar fracture

WANG Qian-qian, HAN Rui, DING Xiang, DING Dan-dan, XU Tao, XU Jin-cheng

2020, 18(9): 1446-1448,1461. doi: 10.16766/j.cnki.issn.1674-4152.001529

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Abstract:
Objective To investigate and discuss the efficacy of modified auriculotemporal incision combined with submaxillary incision in rigid internal fixation of intracapsular condylar fractures. Methods Total 15 patients with intracapsular condylar fractures in the Department of Oral and Maxillofacial Surgery at the First Affiliated Hospital of Bengbu medical college from January 2017 to June 2019 were selected, including 18 sides, 3 of which were treated conservatively, the rest were treated by modified auriculotemporal incision combined with submaxillary incision. The patients were followed up for 6-12 months to observe whether there were symptoms of facial nerve injury, whether there were changes of mouth opening degree and/or mouth opening type, whether there was temporomandibular joint bounce, whether there was loosening and absorption of double cortical screw. Results Total 14 patients had no facial paralysis and salivary fistula, 1 patient had a short disappearance of frontal striae, and was treated with rat nerve growth factor(2 mL of water for injection, intramuscular injection, once a day, once a branch, two courses) to restore normal within 3 months. Total 15 patients had a good restoration of occlusal system and mouth opening degree(foot measurement mouth opening degree ≥3 cm). There was no joint bounce, open deflection, malocclusion and other complications. After operation, CT showed that the double cortical screw was fixed in place without looseness, and the fracture end was restored well. After 6 months of operative, three-dimensional CT(horizontal and coronal) showed that condylar head and joint plate location relationship was good, no obvious articular adhesion, condylar head absorption, etc. Conclusion The modified auriculotemporal incision combined with submaxillary incision in rigid reduction and internal fixation of intracapsular condylar fractures has the advantages of clear visual field exposure, less facial nerve injury, less damage to articular disc and articular cartilage, which can provide certain reference for the surgical treatment of intracapsular condylar fractures.

Diagnostic analysis of the isolated anterior mitral cleft by routine transthoracic echocardiography

YANG Hao-yi, CHEN Juan, LIU Hong-jiao, REN Jie, MAO Kui, YI Hui-ming, SUN Jie

2020, 18(9): 1449-1451,1489. doi: 10.16766/j.cnki.issn.1674-4152.001530

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Abstract:
Objective To diagnose and analyze the isolated anterior mitral cleft by routine transthoracic echocardiography, and to evaluate the clinical value of routine transthoracic echocardiography in the diagnosis of the isolated anterior mitral cleft. Methods Total 108 patients with isolated anterior mitral cleft were found by transthoracic echocardiography in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and the First Hospital Affiliated to China University of Science and Technology from March 2015 to May 2020. Through parasternal left long axis section, mitral valve horizontal left ventricular short axis section, apical four-chamber section, apical two-chamber section and apical three-chamber section, the morphological characteristics, echo and location, length, width of the mitral by 2 D echocardiography, and the origin of the reflux beam and the degree of reflux by color Doppler flow imaging. The diameter of left atrium, left ventricular and left ventricular ejection fraction were measured. According to the recommendation of American Society of Echocardiography, the anterior mitral cleft were located by the mitral valve nomography proposed by Carpentier et al, and compared with the intraoperative findings. Results The echo of the mitral valve anterior lobe was interrupted and showed a "fissure" shape by 2 D echocardiography, and the reflux beam was originated from the cleft by color Doppler, which was the characteristic manifestation of the anterior mitral cleft. Of the 108 patients with the isolated anterior mitral cleft, 87 were in zone A3, 6 in zone A2, 9 in zone A1 and 6 in two or more zones; 12 with severe mitral regurgitation(MR), 9 with moderate-severe MR, 12 with moderate MR, 60 with mild-moderate MR, 15 with mild MR; 27 with mitral valve prolapse. Of the 75 patients who had previously undergone echocardiography, only a very small number were suspected the isolated anterior mitral cleft. Of the 24 patients who underwent surgery, 22 underwent valvular repair or valvuloplasty, and 2 underwent valve replacement due to serious reflux. Among the 24 patients, 17 had complete valvular fissure and 7 had partial valvular fissure. All the 24 patients who had undergone surgery were diagnosed accurately. Conclusion The incidence of the isolated anterior mitral cleft is higher, and transthoracic echocardiography can accurately diagnose the isolated anterior mitral cleft and its complications, which has important clinical value in selecting treatment plan or follow-up.

Relationship between serum PZ level and FG79A gene polymorphism and acute ischemic stroke

ZHANG Yu-hui, HUANG Qiu-li, SU Qing-jie, CHEN Bin

2020, 18(9): 1452-1454,1484. doi: 10.16766/j.cnki.issn.1674-4152.001531

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Objective To investigate the relationship between the serum protein Z(PZ) level and the polymorphism of the 79 th nucleotide of intron F(FG79 A) gene and acute ischemic stroke(AIS), and provide a reference for in-depth understanding of the pathogenesis, diagnosis and treatment of AIS. Methods Total 87 cases of AIS patients(AIS group) and 87 cases of healthy people(control group) admitted to the Department of Neurology, the Second Affiliated Hospital of Hainan Medical College from May 2017 to December 2019 were selected. The serum PZ level and FG79 A genotype distribution were compared between the two groups. The correlation between the serum PZ and the National Institutes of Health Neurological Defective Score(NIHSS) was analyzed using Pearson. Logistic multiple regression equations were used to analyze the correlation between PZ, FG79 A genotypes, alleles and AIS. The serum PZ levels of two groups of patients with different genotypes was compared. Results The serum PZ of AIS group was(953.07±126.83) μg/L, lower than that of the control group(1 204.52±357.73) μg/L(t=6.179, P<0.001). The serum PZ was negatively correlated with the NIHSS score after onset(r=-0.669, P<0.05). The allele G frequency(52.30%, 91/174) in the AIS group was higher than the control group(35.06%, 61/174), and the allele A frequency(47.70, 83/174) was lower than the control group(64.95%, 113/174, all P<0.05). The PZ, genotype AA and allele A of FG79 A were associated with AIS(all P<0.05). Conclusion The expression of PZ is low in AIS patients, which is related to the degree of neural defects after AIS. FG79 A genotype AA and allele A are related to AIS and can affect PZ expression.

Analysis of prognostic factors of mechanical thrombectomy in acute ischemic stroke patients

LI Rui, GUO Ling-ling, WANG Li, ZHANG Chao, SONG Jian-long, LIU Tian-long, ZHU Yu-you, WANG Guo-ping, HU Wei

2020, 18(9): 1455-1457. doi: 10.16766/j.cnki.issn.1674-4152.001532

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Objective Mechanical thrombectomy is a new method of endovascular therapy, with good effect in the treatment of acute ischemic stroke. To explore the clinical prognostic factors of acute ischemic stroke patients after mechanical thrombectomy. Methods Total 87 patients with mechanical thrombectomy in our hospital from January 2017 to December 2018 were included in our research. The modified Rankin Scale(mRS) scores was regarded as prognosis assessment at 90 days. The mRS scores ≤ 3 points were considered good prognosis(44 cases), mRS scores 4-6 points were considered poor prognosis(43 cases). Multivariate Logistic regression was used to investigate the prognosis. Results There were significant differences in age and National Institutes of Health Stroke Scale(NIHSS) scores(both baseline and 24 h post-operative) of the patients between the good and the poor prognosis group(all P<0.05). Multivariate Logistic regression analysis showed that the age, baseline and 24 h post-operative NIHSS scores were risk factors for poor prognosis of mechanical thrombectomy(Baseline NIHSS score: OR=1.820, 95% CI=1.19-2.77, P=0.005; Post-operative NIHSS score: OR=2.006, 95% CI=1.30-3.10, P=0.002; Age: OR=1.102, 95% CI=1.04-1.17, P=0.001). Conclusion NIHSS scores and age are independent risk factors for prognosis of acute ischemic stroke patients treated with mechanical thrombectomy.

Effect of early enteral nutrition on intestinal barrier function and prognosis in patients with severe pneumonia combined gastrointestinal dysfunction

LIU Qing, LI Fang, LI Bo-en, HE Xian-di, ZHENG Hai-lun

2020, 18(9): 1458-1461. doi: 10.16766/j.cnki.issn.1674-4152.001533

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Objective To observe the influence of early enteral nutrition(EEN) on intestinal barrier function and prognosis in patients with severe pneumonia(SP) combined acute gastrointestinal injury(AGI). Methods Total 60 patients with SP and AGI Ⅱ admitted to the ICU of the Second Affiliated Hospital of Bengbu Medical Collage from January 2018 to December 2019 were randomly divided into observation group(EEN group) and control group(LEN group), 30 cases in each group. The observation group received EN within 24-48 hours, while the control group received EN after 72 hours. The feeding intolerance rate, length of ICU stay, length of mechanical ventilation, APACHE Ⅱ score, 28-days mortality(20.00% vs. 23.3%), and levels of D-lactate, diamine oxidase(DAO), procalcitonin(PCT), C-reactive protein(CRP) were compared between the two groups. Results No significant differences were found on feeding intolerance rate and 28-days mortality between the two groups(all P>0.05). The length of ICU stay, length of mechanical ventilation, APACHE Ⅱ score after treatment in the observation group were shorter than those in the control group(all P<0.05). After treatment, the levels of serum D-lactate, DAO, PCT and CRP decreased in both groups, and those in the observation group was obvious lower than those in the control group(all P<0.05). Conclusion EEN can improve intestinal barrier function, reduce inflammation, and with a low incidence rate of feeding intolerance in patients with SP combined AGI. However, it has no ameliorative effect on short-term prognosis.

Clinical study on the treatment of intussusception in children by warm saline enema guided by color doppler ultrasound

ZHOU Kai, LI Yang, HUAI Yu-shui, ZUO Lu-gen, ZHANG Da-kun

2020, 18(9): 1462-1465. doi: 10.16766/j.cnki.issn.1674-4152.001534

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Objective To investigate the clinical therapeutic effect of warm saline enema reduction in the treatment of intussusception in children under the guidance of color ultrasound monitoring. Methods A retrospective analysis of our hospital in recent years do colour to exceed monitoring guided by salt water enema reduction treatment of the clinical data of 112 cases of children with intussusception, in colour to exceed guided by monitoring safety pressure within insufflate the saline injection temperature, high frequency and low frequency alternating colour to exceed to observe intestinal reset, colour to exceed shows blind valve open, back bag piece disappear and small intestine fill three images are confirmed reset indicators of success, with the above three indicators are confirmed one or more restoration success. Results The reduction success rate was 95.54% in 107 cases. The failure rate of reduction was 4.46% in 5 cases. The average length of stay was(3.26±0.18) d. After the reduction, the children were given oral carbon tablets, which were discharged through anus, and the reduction was confirmed again. There was no recurrence at 2 weeks' follow-up. Among the 8 cases with fever(>37.3 ℃) after successful reduction, 23 cases had diarrhea after surgery. All of them were cured and discharged after receiving corresponding symptomatic support treatment. Five cases were treated by open abdominal surgery in time and all recovered. The patients were followed up within 2 weeks after discharge, and there was no recurrence. Conclusion The reduction success rate of children intussusception treated by warm saline enema under the guidance of color ultrasound monitoring is high, which has the advantages of safety, reliability, high reduction success rate and no radiation.

The effect of discectomy with different surgical approaches on the efficacy and safety of thoracolumbar disc herniation

LUO Yu-xiao, LU Jian-min, FANG Xin, SHEN Xiao-qiang, GU Xiao-min

2020, 18(9): 1466-1469,1473. doi: 10.16766/j.cnki.issn.1674-4152.001535

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Objective To compare the effects of discectomy with lateral anterior approach and lateral posterior approach on the efficacy, trauma and prognosis of patients with thoracolumbar disc herniation, in the hope of providing a basis for the reasonable choice of surgical approach. Methods Total 136 patients with thoracolumbar disc herniation to be treated by discectomy in our hospital from January 2016 to March 2019 were selected as the research objects, who were randomly divided into group A and group B with random number table method, 68 cases in each group. In the selection of surgical approach, the group A adopted lateral anterior approach, and the group B adopted lateral posterior approach. The information of perioperative period was recorded, and followed up for 6 months. The Visual analogue score (VAS) and Oswestry disability index (ODI) of the two groups were compared, and the complications was observed. Results The hospital stay of group B was (10.81±2.04) d, shorter than that of group A (13.57±2.79) d, intraoperative blood loss was (550.18±32.27) mL, less than group A (746.81±23.29) mL, the drainage volume was (144.75±30.92) mL, less than group A (214.01±21.89) mL, and the differences were statistically significant (t=6.593, 40.738, 15.076, all P<0.001). All patients were followed up, the VAS score and ODI index of the two groups at 1 and 6 months after the operation were significantly reduced compared with those before the operation, the change trend was the same. All patients successfully completed the operation, the symptoms were significantly relieved, and there were no neurological complications and recurrence cases, the incidence of complications in group B was 11.76%, significantly lower than 25.00% in group A (P<0.05). Conclusion The treatment of thoracolumbar disc herniation by lateral anterior approach and lateral posterior approach can achieve satisfactory results, and the latter has advantages in reducing surgical trauma and complications, which is worthy of clinical attention.

The value of methylenetetrahydrofolate reductase A1298C gene polymorphism detection in the treatment of hyperhomocysteinemia

XU Bing-xin, ZHAO Yan, DUAN Shu-juan, JU Chun-yang, YU Yang

2020, 18(9): 1470-1473. doi: 10.16766/j.cnki.issn.1674-4152.001536

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Objective To investigate the value of methylenetetrahydrofolate reductase A1298 C(MTHFR A1298 C) gene polymorphism in the treatment of hyperhomocysteinemia(Hcy). Methods According to the results of MTHFR A1298 C gene detection, 236 patients of Han people with ischemic stroke complicated with HHcy in Xuchang Central Hospital from February 2017 to September were divided into three groups: A(type AA gene), B(type AC gene) and C(type CC gene). There were 146 cases(61.86%), 68 cases(28.81%) and 22 cases(9.32%) in the group A, B and C respectively. The three groups were treated with folic acid tablets to reduce Hcy treatment on the basis of the routine treatment of ischemic stroke. The changes in plasma Hcy were recorded before and 3 months and 6 months after the treatment of folic acid. Results The plasma Hcy in 3 months and 6 months of the group A were(22.21±4.62) μmol/L and(13.63±4.15) μmol/L,which was significantly lower than that before taking medicine(27.92±5.24) μmol/L. The plasma Hcy in 6 months of the group B and C were(18.58±5.43) μmol/L and(21.05±6.12) μmol/L respectively, which was significantly lower than that before taking medicine(29.13±6.82) μmol/L and(31.82±4.48) μmol/L. After taking folic acid tablets for 6 months, the plasma Hcy decline rate in group A was(51.39±9.47)%, which was significantly higher than that in group B [(37.42±11.46)%] and C [(34.19±10.53)%]. Conclusion MTHFR A1298 C gene polymorphism significantly affects the therapeutic effect of folic acid on the reduction of plasma Hcy, and the detection of MTHFR A1298 C gene polymorphism is of certain guiding value in the treatment of hcy.

Electrocardiogram analysis of high risk patients with acute pulmonary embolism

LIU Ji-chun, FU Cong, XIE Xiang-rong

2020, 18(9): 1474-1476,1477. doi: 10.16766/j.cnki.issn.1674-4152.001537

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Objective To retrospectively analyze the electrocardiogram(ECG) manifestations of acute pulmonary embolism(APE) patients, aiming to explore the relationship between ECG manifestations and risk stratification of APE. Methods A total of 74 patients with APE in the First Affiliated Hospital of Wannan Medical College from February 2017 to January 2020 were collected. According to the "2019 ESC/ERS Guidelines for the diagnosis and management of APE", they were divided into high-risk group(21 cases) and medium-low risk group(53 cases). ECG manifestations and other auxiliary examination results of the two groups were compared. Results Compared with APE in High-risk and medium-low risk group, there were significant differences in the sinus tachycardia, S_ⅠQ_ⅢT_Ⅲ, right bundle branch block, V1 in Qr, V1-V4 NTW, and QTC interval prolongation(P<0.05). Multivariate logistic regression analysis was performed on the number of six ECG manifestations, age, gender, history of venous thrombosis, history of surgery/rauma, history of tumor, troponin I positive, BNP and d-dimer, the results showed that the odds ratio of six ECG manifestations for high-risk APE was 6.445(P<0.05, 95% CI: 2.688-15.453). ROC curve was drawn according to the distribution of the number of different ECG findings in the medium-low risk groups and the high risk groups, the results showed that the area under the ROC curve(AUC) was 0.912, Youden index was 0.772, sensitivity was 90.48, specificity was 86.79, and cutoff value was greater than 1. Conclusion Compared with APE in the low-risk group, sinus tachycardia, S_ⅠQ_ⅢT_Ⅲ, right bundle branch block, V1 showed Qr, V1-V4 NTW, and QTC interval prolongation are more common in the high-risk group. The more the number of six ECG manifestations, the greater the risk of high-risk APE.

Efficacy of TEVAR interventional therapy on patients with acute Stanford type B aortic dissection

LIANG Kai, CUI Ming-zhe, MA Jin-hui, ZHAI Shui-ting

2020, 18(9): 1477-1479,1533. doi: 10.16766/j.cnki.issn.1674-4152.001538

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Objective To investigate the clinical effects of thoracic endovascular aortic repair(TEVAR) interventional therapy on patients with acute Stanford type B aortic dissection(TBAD). Methods A total of 112 TBAD patients admitted to Henan Provincial People' s Hospital from January 2014 to September 2017 were selected. All patients received TEVAR interventional therapy, and they were divided into acute group(disease onset<14 d, 65 cases) and non-acute group(disease onset ≥ 14 d, 47 cases) according to the interventional therapy time. The time from onset to TEVAR treatment, hospital stay, hospitalization cost, postoperative complications and false lumen thrombosis were compared between the two groups. The aortic true lumen/aortic diameter ratio(TLi) and false lumen/aortic diameter ratio(FLi) were observed before and after surgery. Follow-up for 2 years, the survival was analyzed. Results The time from onset to TEVAR treatment and hospital stay in the acute group were shorter than those in the non-acute group, the hospitalization cost was lower than that in the non-acute group(t=20.686, 8.090, 3.071, P<0.05), and the complete absorption rate of false lumen thrombosis was higher than that in the non-acute group(χ²=5.993, P<0.05). Three months after surgery, the TLi in the two groups was increased compared with that before surgery, while the FLi was decreased compared with that before surgery, and the improvement in the acute group was higher than that in the non-acute group(t=5.268, 14.098, P<0.05). The overall survival rate in the acute group was higher than that in the non-acute group(92.31% vs. 85.11%, Log-rank χ²=1.479, P>0.05). Conclusion TEVAR for patients with acute TBAD has high complete absorption rate of false lumen thrombosis and good postoperative aortic remodeling, and it can shorten hospital stay and reduce hospitalization cost, and it is a better treatment timing.

Clinical effect of medial support combine with rotator cuff suture for treating proximal humeral fracture

FANG Wu-zhou, NIU Guo-qi, LIAO Shi-ping, SHU Fang-fang, ZHOU Jun, ZHU Xun-bing

2020, 18(9): 1480-1484. doi: 10.16766/j.cnki.issn.1674-4152.001539

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Objective To explore the advantages of the technique of medial humeral screws and rotator cuff suture in the treatment of proximal humeral fracture and its influence on the functional recovery of shoulder joint. Methods Total 33 patients with proximal humeral fractures treated by surgery from June 2017 to March 2019 were retrospectly analyzed. All patients were treated surgically through the deltoid approach of pectoralis major muscle. The proximal humerus anatomical locking plate for internal fixation was used, and the medial support of calcar screw and the rotator cuff suture technique were implanted into the plate foramen. All patients were followed up. The fracture type, age, hospital day, operation time, incision length, operative bleeding volume, incidence of complications were analyzed. Results Thirty-three cases of proximal humeral fractures were treated with medial support of calcar screw combined with rotator cuff suture technique: 16 cases of Neer type Ⅱ, 13 cases of Neer type Ⅲ and 4 cases of Neer type Ⅳ. The average age of the patients was(59.8±12.3) years, the average operation time was(102.6±29.2) minutes, the average intraoperative bleeding volume was(167.6±121.5) mL, the average incision length was(12.5±2.6) cm, the average length of hospital day was(13.3±6.3) days, the incidence of complications was 6.1%, and the excellent rate of Constant-Murley shoulder function score was 87.9%. Conclusion Clinical effect of medial support combine with rotator cuff suture for treating proximal humeral fracture is effective. Advantages: ① It can effectively reduce and stabilize the fracture of large and small tubercles; ② It repairs the injured rotator cuff, reduces the varus stress of rotator cuff on the humeral head, thereby reducing the risk of screw cutting out; ③ The humeral calcar screw is located in the high bone density area, with good screw holding force and stability, which can reduce the chances of humeral head varus and screw cutting out; ④ Shoulder joint function exercise can be performed early after operation and the recovery of shoulder joint function is satisfactory.

The influence of Wuqinxi on disease activity and quality of life of the rheumatoid arthritis patients

SUN Li, ZHANG Yu-hui, SONG Wei-min, FAN Yun, ZHAO Hui

2020, 18(9): 1485-1489. doi: 10.16766/j.cnki.issn.1674-4152.001540

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Objective To explore the influence of Wuqinxi on disease activity level, activity of daily living and self-rating depression and anxiety scale of the rheumatoid arthritis(RA) patients. Methods Total 100 patients with RA admitted to our hospital from January 2018 to January 2019 were randomly divided into control group(50 cases) and Wuqinxi group(50 cases). The control group was given routine interventions(stable dose of glucocorticoid and remission of disease anti-rheumatic drugs), and the Wuqinxi group was given Wuqinxi twice a day for 30 minutes on the basis of the routine interventions. After 2 months of follow-up, the disease activity DAS28, activity of daily living, self-rating depression and anxiety scale of the two groups were analyzed. Results Total 100 patients with RA admitted to our hospital from January 2018 to January 2019 were randomly divided into control group(50 cases) and Wuqinxi group(50 cases). The control group was given routine interventions(stable dose of glucocorticoid and remission of disease anti-rheumatic drugs), and the Wuqinxi group was given Wuqinxi twice a day for 30 minutes on the basis of the routine interventions. After 2 months of follow-up, the disease activity DAS28, activity of daily living, self-rating depression and anxiety scale of the two groups were analyzed. Conclusion The application of Wuqinxi in RA patients does not cause aggravation of disease activity, but it can improve patients' activity of daily living, anxiety and depression scores, and quality of life.

Comparison of the efficacy of EPOCH regimen and CHOP regimen in the treatment of non-specific peripheral T-cell lymphoma

YANG Yu-hong, LOU Da-yong

2020, 18(9): 1490-1492,1499. doi: 10.16766/j.cnki.issn.1674-4152.001541

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Abstract:
Objective To retrospectively analyze the clinical benefits of the first-line treatment of non-specific peripheral T cell lymphoma(PTCL-NOS) patients with EPOCH chemotherapy or standard CHOP chemotherapy. Methods The clinical data of 84 newly treated patients with PTCL-NOS from January 2014 to December 2016 were collected and analyzed retrospectively. According to different chemotherapy regimen, they were divided into EPOCH group(39 cases, treated with EPOCH regimen) and CHOP group(45 cases, treated with standard CHOP regimen). The short-term clinical efficacy(objective response rate ORR), long-term clinical efficacy(1-year, 2-year, 3-year survival rate OS) and safety of PTCL-NOS patients treated with two chemotherapy regimens were investigated and compared. Results The CR rate of EPOCH group was 53.85%, ORR rate was 76.92%, while the CR rate of CHOP group was 26.67%, ORR rate was 66.67%. There was significant difference in CR rate between the two groups(χ²=6.470, P=0.011), and no significant difference in ORR rate(χ²=0.030, P=0.872). There was no significant difference in ADR incidence rate between the two groups(all P>0.05), including neutropenia, gastrointestinal reaction, thrombocytopenia, anemia and liver function damage. There was no significant difference between the two groups in 1-year OS rate(P>0.05). The 1-year, 2-year and 3-year OS rate of EPOCH group were 74.36%, 69.23% and 64.10%, and those of CHOP group were 68.89%, 53.33% and 46.67%, there was no significant difference between the two groups in 1-year(χ²=0.010, P=0.932) 2-year OS rate(χ²=0.050, P=0.818) and 3-year OS rate(χ²=0.060, P=0.804). Conclusion The first-line treatment of PTCL-NOS patients with EPOCH chemotherapy regimen can obtain the same clinical effect as the standard CHOP chemotherapy regimen, patients can tolerate adverse reactions, and EPOCH regimen combination drugs are commonly used clinical drugs, so it is recommended as the first-line treatment of PTCL-NOS patients.

The clinical research of PFNA-Ⅱ and Inter Tan in the treatment of elderly unstable intertrochanteric fractures

CAO Jian-guo, DENG Dun, CHEN Yu, CHEN Wen-hui, LONG Zhi-qiang, JIN Wen-jin

2020, 18(9): 1493-1495,1598. doi: 10.16766/j.cnki.issn.1674-4152.001542

306 1

Abstract:
Objective To explore the clinical effect of Asian type PFNA-Ⅱand new Inter Tan in the treatment of elderly unstable intertrochanteric fractures. Methods Sixty patients with unstable intertrochanteric fractures admitted in the Orthopaedic Department of Yuhuan People's Hospital from January 2017 to January 2018 were randomly divided into two groups. Group A were used PFNA-Ⅱinternal fixation, while group B were used Inter Tan internal fixation. The operation time, intraoperative blood loss, intraoperative fluoroscopy time, post-operative drainage volume, the time of postoperative onset, the last follow-up of hip joint function Harris score, fracture healing time, after three months thigh pain, femoral neck shortening, complications were compared between two groups. Results The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative drainage volume in the group A were better than those in the group B, while the time of postoperative onset, fracture healing time, complications, after three months thigh pain, femoral neck shortening, complications in the group B were better than those in the group A(P<0.05). There were no significant differences in the last follow-up of hip joint function Harris score between two groups. Conclusion PFNA-Ⅱand Inter Tan are minimally invasive intramedullary fixation, each has its advantages in the elderly patients with unstable intertrochanteric fracture. The PFNA-Ⅱ has the advantages of short operation time, simple operation, less trauma and less bleeding, while Inter Tan is more reliable, with good compression effect, good biomechanical advantage and stability, less early complications and short fracture healing time, which is conducive to rapid recovery.

Application of embracing fixator combined with intercostal nerve block in multiple rib fractures

ZHANG Bao-you, KONG Jing-song, LU Hai-bin, LI Zhao-yong, ZHANG Yi, ZHANG Lei

2020, 18(9): 1496-1499. doi: 10.16766/j.cnki.issn.1674-4152.001543

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Abstract:
Objective To investigate the clinical effect of intercostal nerve block and rib embracing fixator in the treatment of multiple rib fractures. Methods A total of 90 patients with multiple RIB fracture were randomly divided into ABC group(30 cases in each group). Patients in Group A were treated with external fixation, patients in Group B were treated with internal fixation of memory alloy embracing fixator, and patients in Group C were treated with internal fixation of rib embracing fixator combined with intercostal nerve block, there was no significant difference in age and other general conditions(P>0.05). The changes of PaO₂ and PaCO₂, the time of movement, the incidence of chest complications and pain in one week after treatment in A, B, C group were compared with those in the two groups at 24 hours after operation. Results The changes of PaO₂ and PaCO₂ in Group B and Group C were significantly better than those in group A after one week treatment(all P<0.01). The pain score of Group C, PaO₂ and PaCO₂, 24 hours after treatment were significantly higher than those of Group B(all P<0.01). At the same time, the incidence of thoracic complications in Group B and C was significantly lower than that in Group A, and the incidence of thoracic complications in Group C was further lower than that in group B. Conclusion The treatment of multiple rib fractures with rib embracing fixator is effective, safe and reliable, and combined with intercostal nerve block can further reduce the postoperative pain symptoms and speed up the recovery of lung function, and further reduce the incidence of thoracic complications, worthy of clinical application and promotion.

Therapeutic effect of dapagliflozin on patients with type 2 diabetes with poor glycemic control and the risk of hypoglycemia

XU Ai-hua, HUANG Jian-sheng, HE Yin-hui, MAO Hao-yu, LU Le

2020, 18(9): 1500-1503,1526. doi: 10.16766/j.cnki.issn.1674-4152.001544

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Abstract:
Objective To explore the efficacy and safety of dapagliflozin in patients with type 2 diabetes mellitus(T2 DM) with poor glycemic control. Methods Ninety-six T2 DM patients who had poor glycemic control were enrolled in our hospital from January 2017 to December 2018, and divided into observation group and control group by simple random, 48 cases in each. The control group was treated with metformin combined with acarbose, and the observation group treated with dapagliflozin on the basis of control group. The FBG, 2 hPBG, and HbA1 c at different points were tested by variance. The body weight, waist circumference, TC, TG, LDL-C, HDL-C, SBP and DBP, and the daily dose of insulin were tested by t test, while HbA1 c compliance rate, composite endpoint compliance rate, incidence of adverse reactions were tested by χ² tests. Results Overall comparison: the interaction between FBG, 2 hPBG, HbA1 c, time point, grouping and time was statistically significant(F=79.576, 85.433, 43.369, all P<0.05). When the grouping factor is fixed, the comparison of FBG, 2 hPBG and HbA1 c at different time points is statistically significant(F=127.830, 151.870, 97.566, all P<0.05); when the time factor is fixed, the comparison of FBG, 2 hPBG and HbA1 c between groups It has statistical significance(F=45.652, 61.546, 21.006, all P<0.05). Compared with before treatment, the FBG, 2 hPBG and HbA1 c of the two groups at 4 weeks, 8 weeks and 16 weeks of treatment were significantly reduced(all P<0.05). The compliance rates of HbA1 c in the observation group and the control group were 60.42% and 56.25%, and the difference was not statistically significant(χ²=0.171, P>0.05). The composite endpoint compliance rate in the observation group was 45.83%, which was higher than the control group by 25.00%(χ²=4.554, P<0.05). The incidence of hypoglycemia in the observation group was 4.17%, which was lower than the control group by 18.75%(χ²=5.031, P<0.05). Conclusion Dapagliflozin is ideal for treating hypoglycemic T2 DM patients with hypoglycemic effect, can reduce the amount of insulin, and has high safety.

Effect of Yiqi Huayu decoction on microvascular injury,ventricular remodeling and metabolic remodeling in treatment of chronic heart failure patient

CHEN Yuan-yuan, LIU Qing-sheng, PENG Wei-xian, WU Jia-le, WANG Guo-dong, YU Meng-ying, LAI Dong-wu

2020, 18(9): 1504-1507,1550. doi: 10.16766/j.cnki.issn.1674-4152.001545

255 1

Abstract:
Objective To observe the clinic effect and possible mechanism of Yiqi Huayu decoction in treatment of chronic heart failure(CHF) patient with Qi deficiency and blood stasis syndrome. Methods A total of 120 CHF patients with Qi deficiency and blood stasis syndrome in Hangzhou Hospital of Traditional Chinese Medicine from May 2017 to February 2019 were enrolled and randomly divided into control group and treatment group with 60 cases in each group. Based on conventional treatment, 60 patients in the treatment group received trimetazidine and Yiqi Huayu decoction, while 60 patients in control group received trimetazidine for 6 months of treatment. Traditional Chinese medicine(TCM) syndrome efficacy, vascular endothelial function indexes, ventricular remodeling indexes and energy metabolism remodeling indexes were detected and compared between the two groups. Results After 6 months of treatment, the TCM symptom efficacy rate of patients in the treatment group was 80.00%, better than that in the control group 58.33%(χ²=6.604, P=0.010). Moreover, the endothelin 1(ET-1), Angiotensin Ⅱ, aldosterone, left ventricular ejection fraction(LVEF), circumferential end-systolic wall stress(cESS), and myocardial energy expenditure(MEE) in the treatment group and the control group were(68.42±21.95) ng/L,(77.53±35.28) pg/mL,(197.38±71.84) pg/mL,(125.69±21.84) g/m²,(130.75±18.93) kdyne/cm²,(92.67±9.83) kcal/min and(82.68±22.53) ng/L,(101.14±36.11) pg/mL,(262.33±95.83) pg/mL,(131.47±25.36) g/m²,(144.58±21.63) kdyne/cm²,(101.28±11.45) kcal/min, respectively. The above indexes in the treatment group were lower than those in the control group(all P<0.05). Conclusion Yiqi Huayu decoction combined with trimetazidine in the treatment of CHF patients with Qi deficiency and blood stasis syndrome can inhibit the process of microvascular injury, ventricular remodeling and metabolic remodeling, correct the pathological state and symptoms of traditional Chinese medicine, so as to achieve the purpose of "symptomatic treatment" and "syndrome differentiation treatment".

Study on expressions of GAS5 and PTEN in serum of elderly patients with hypertension and their relationships with endothelial function

DUAN Jun-cang, ZOU Nan, WANG You-peng, WANG Fei

2020, 18(9): 1508-1511. doi: 10.16766/j.cnki.issn.1674-4152.001546

234 3

Abstract:
Objective To analyze the relationships between lncRNA GAS5 and PTEN protein expressions and endothelial function in elderly patients with hypertension. Methods A total of 87 elderly hypertensive patients admitted to Jinhua Central Hospital from May 2018 to May 2019 were selected, and another 87 healthy persons were selected as control group during the same period. Real-time fluorescence quantitative(qRT-PCR) was used to detect the expression of lncRNA GAS5, and ELISA was used to detect the expression of PTEN. Meanwhile, the change rate of vascular diameter(FMD), systolic blood pressure(SBP) and diastolic blood pressure(DBP) were measured by electronic sphygmomanometer, and endothelium-dependent vasodilation rate(FMD) was measured by ultrasound diagnostic instrument, and the correlations between GAS5 and PTEN levels and the above indexes were analyzed. Results Systolic blood pressure and diastolic blood pressure in elderly patients with hypertension were significantly higher than those in the control group(all P<0.05). The level of vWF in elderly patients with hypertension was significantly higher than that in control group(P<0.05), and the FMD value and NO level in elderly patients with hypertension were significantly lower than those in control group(all P<0.05). The levels of serum lncRNA GAS5 and PTEN protein in elderly patients with hypertension were significantly lower than those in the control group(all P<0.05). Serum lncRNA GAS5 and PTEN protein levels were positively correlated with NO levels in elderly patients with hypertension(r=0.563, P=0.005; r=0.507, P=0.006), and negatively correlated with vWF(r=-0.457, P=0.004; r=-0.426, P=0.008). There was a positive correlation between serum GAS5 and PTEN level in elderly patients with hypertension(r=0.484, P<0.05). Conclusion The expressions of GAS5 and PTEN in serum of elderly patients with hypertension are down-regulated, which are related to the injury of vascular endothelial cells and the decrease of vascular relaxation function.

Clinical analysis of 27 cases of severe perineal laceration

CHENG Ji, CHEN Lei, TAO Feng, FANG Zhang-hua, CHEN Hong-bo

2020, 18(9): 1512-1515. doi: 10.16766/j.cnki.issn.1674-4152.001547

254 2

Abstract:
Objective To explore the high-risk factors of severe maternal perineal tears by analyzing the clinical data of 27 cases. Methods The case group enrolled 27 cases of severe maternal perineal tear after a vaginal delivery in Anhui Maternal and Child Health Hospital from February 2016 to April 2019. A total of 54 pregnant women who has adjacent hospitalization number as a control group according to 1∶2 ratio. The clinical data of case and control group were compared by two-sample t-test, χ² test and binary logistic regression. Results The incidence of severe perineal tears was 27/28 334(95.29/100 000). The Bleeding volume after delivery and incidence of postpartum urinary retention in study group was higher than that in the control group(P<0.05), the severe maternal perineal tear in study group were repaired immediately, and guided defecation, used antibiotic after surgery. The long-term prognosis of them are good. The single factor analysis showed that there were statistically significant differences in Maternal BMI(OR=7.552, 95% CI: 2.136 to 26.696) and neonatal weight(OR=20.511, 95% CI: 4.552 to 92.421) between the two groups(P<0.05). There was no statistically significant difference in age, forceps delivery, episiotomy, labor analgesia, midwife's seniority and delivery period between the two groups(all P>0.05). Conclusion High maternal BMI and neonatal weight are the high-risk factors of severe maternal perineal tears. Pregnant women increase their weight reasonably and control neonatal weight has a positive effect on reducing the occurrence of severe perineal tears.

Clinical Effect of Kangfuxin Liquid on Children with Recurrent Oral Ulcer

QIN Ai-li, ZHENG Lei, JIANG Hai-xiao, ZHANG Ya-qin, MA Peng-tao, QI Jin-lian

2020, 18(9): 1516-1518,1522. doi: 10.16766/j.cnki.issn.1674-4152.001548

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Abstract:
Objective To investigate the effects of Kangfuxin Liquid on inflammatory factors, oral microecology, immune function and quality of life in children with recurrent oral ulcer. Methods A total of 102 children with recurrent oral ulcer who were treated in our hospital from January 2017 to April 2019 were enrolled in the study. The 102 children were randomly divided into two groups by random number method, 51 cases in each group. The control group received multivitamin B treatment. The observation group was given Kangfuxin Liquid. After treatment, changes in inflammatory factor levels, oral flora, immune indicators, and quality of life in the two groups were observed. Results After treatment, the serum levels of TNF-α, IL-6 and IL-2 in both groups were decreased(all P<0.05), and the levels in the observation group were lower than those in the control group(all P<0.05). After treatment, the content of virogenes in the observation group increased from(7.54±1.43)lg copies/mL to(8.86±1.64)lg copies/mL, higher than that in the control group(8.15±1.57)lg copies/mL(t=2.233, P=0.028), and the content of streptococcus increased from(6.98±1.2)lg copies/mL to(8.15±1.58)lg copies/mL, Higher than the control group(7.46±1.40)lg copies/mL(t=2.334, P=0.022). After treatment, the levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺, CD8⁺, SF-36 and OHIP-14 in both groups were improved, and the improvement effect in the observation group was better than that in the control group(all P<0.05). Conclusion Kangfuxin Liquid can effectively improve inflammatory factor levels, oral micro-ecological balance, immune function and quality of life in children with recurrent oral ulcer.

Influences of Runfei Pingchuan Prescription combined with salbutamol on short-term efficacy,serum VEGF level and tidal volume per kilogram of body weight of children with bronchial asthma

QIU Xiao-fen, LI Xin-min

2020, 18(9): 1519-1522. doi: 10.16766/j.cnki.issn.1674-4152.001549

198 1

Abstract:
Objective To investigate the influences of Runfei Pingchuan Prescription combined with salbutamol on short-term efficacy, the level of serum vascular endothelial growth factor(VEGF) and tidal volume per kilogram of body weight of children with bronchial asthma. Methods Total 112 children with bronchial asthma received in Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from June 2017 to February 2019 were divided into two groups according to the random number table method. The control group(56 cases) were treated with salbutamol, while the study group(56 cases) were treated with Runfei Pingchuan Prescription combined with salbutamol. The short-term efficacy was evaluated, and the disappearance time of symptoms was recorded. The levels of serum VEGF, C-reactive protein(CRP) and interleukin-10(IL-10) were measured. The tidal breathing parameters and incidence of adverse reactions were compared. Results The total effective rate of the control group was significantly(76.79%) lower than that of the study group(94.64%, P<0.05). The disappearance times of wheezing, pulmonary wheezing, chest tightness and cough in the control group were significantly longer than those in the study group(t=10.333, 9.488, 10.784, 5.917, all P<0.05). After treatment, the levels of serum VEGF and CRP in the study group were significantly lower than those in the control group(t=15.753, 7.213, all P<0.05), and the serum IL-10 level was significantly higher than that in the control group(t=4.763, P<0.05). The respiratory rate of the study group was significantly lower than that of the control group(t=3.638, P<0.05). The tidal volume, peak time ratio, and peak volume ratio per kilogram of body weight were significantly higher than those of the control group(t=4.496, 4.005, 5.257, all P<0.05). The incidence of adverse reactions in the study group was 3.57%, which was significantly lower than that in the control group 16.07%(P<0.05). Conclusion On the basis of salbutamol treatment, Runfei Pingchuan Prescription can not only disperse lung Qi and relieve cough but also resolve sputum and relieve asthma. It can eliminate clinical symptoms in children with bronchial asthma in a short time, improve levels of serum VEGF, CRP and IL-10, make tidal breathing pulmonary function normal, and have higher security.

Effect of emergency drills of critical emergency on the improvement of the ability of obstetric rapid response team

XIANG Jin-cao, CHEN Jun-hu, TANG Sai-li, WANG Yan-yan

2020, 18(9): 1523-1526. doi: 10.16766/j.cnki.issn.1674-4152.001550

240 2

Abstract:
Objective To evaluate the ability of the obstetric rapid response team to deal with emergencies through the emergency plan drill, and provide scientific basis for improving the ability of the obstetric rapid response team. Methods Thirty-six medical staff of obstetrics department of a hospital from March to September 2019 were selected as the research object. The emergency drill expert group and obstetric rapid response team were established. The emergency drill expert group prepared a drill program to simulate the emergency rescue process such as postpartum hemorrhage rescue and neonatal resuscitation. Six groups of obstetric rapid response teams participated in the exercise at the same time. The individual ability, team ability change, the satisfaction and effect of the exercise were evaluated before and after the exercise. Results In individual abilities, the highest score of the doctor's theoretical knowledge assessment was 94.26±2.99 after the drill, while the scores of proficiency and correctness were the lowest(86.27±2.81). The individual ability was higher than the pre-drill score after exercise, and the difference was statistically significant(P<0.05). Among the team's ability, the performance of the emergency plan after the exercise was the highest(95.14±0.76). The difference of the team's ability index before and after the exercise was statistically significant(P<0.05). The overall satisfaction of the doctors, nurses and midwives after the drill was 4.65±0.19, 4.60±0.15 and 4.75±0.12, respectively. Before and after the exercise, the participants had statistically significant differences in the overall and dimensional satisfaction of the exercise program(P<0.05). Conclusion The emergency drill improves the individual ability and teamwork ability of the critical emergency of the obstetric rapid response team, and the satisfaction of the drill is higher.

Serum IL-34 level in neonates with hypoxic-ischemic encephalopathy and its correlation with Th17-related cytokines and NABA scores

ZHOU Jia-xing, WU Nai-sheng

2020, 18(9): 1527-1529. doi: 10.16766/j.cnki.issn.1674-4152.001551

221 1

Abstract:
Objective To study the serum IL-34 level of neonatal hypoxic-ischemic encephalopathy(HIE) and explore its clinical significance in HIE. Methods Eighty children with HIE were selected as the HIE group and 80 healthy newborns were selected as the control group from January 2017 to December 2019 in Ningbo Women's and Children's Hospital. The serum IL-34, IL-17 and IL-23 levels were measured using double-antibody sandwich enzyme-linked immunosorbent assay. NABA scores were used to assess the severity of brain damage. Results The serum levels of IL-34 [(24.36±2.41)ng/L], IL-17[(118.79±9.76)ng/L] and IL-23[(63.24±3.46)ng/L] in the HIE group were higher than those in the control group[(13.25±2.02)ng/L,(47.53±8.02)ng/L,(15.42±3.12)ng/L], all P<0.05, and the NABA score[(30.25±2.02)scores] was lower than that in the control group [(37.86±1.74)scores],P<0.05. There were significant differences in serum levels of IL-34, IL-17, IL-23 and NABA scores in children with different severity of HIE(all P<0.05): with the increase of severity of HIE, serum IL-34, IL-17 and IL-23 levels increased, and NABA score decreased. There were significant differences in serum IL-34, IL-17 and IL-23 levels in children with different NABA scores(all P<0.05): with the abnormal degree of NABA score increasing, serum IL-34, IL-17, IL-23 levels decreased. The level of serum IL-34 in children with HIE was positively correlated with the levels of IL-17 and IL-23(all P<0.05). NIE scores in children with HIE were negatively correlated with serum IL-34, IL-17 and IL-23 levels(all P<0.05). Conclusion The serum IL-34 level of HIE neonates is increased, and IL-34 may participate in the brain damage process of children through interaction with Th17-related cytokines.

Effect of endometrial pretreatment on ovulation induction in infertile patients with polycystic ovary syndrome

YE Ya-qiong, JIANG Yao-zhi, CHEN Jun-xia, ZHOU Jing

2020, 18(9): 1530-1533. doi: 10.16766/j.cnki.issn.1674-4152.001552

213 2

Abstract:
Objective To analyze the effect of endometrial pretreatment on ovulation function and pregnancy outcome in infertile women with polycystic ovary syndrome(PCOS). Methods A total of 100 patients with PCOS enrolled in the Second People's Hospital of Linhai from March 2015 to December 2017 were divided into control group and observation group according to the method of random number table, with 50 cases in each group. The control group was given clomiphene, and the observation group was pretreated with Diane 35 and metformin before clomiphene. Before and after treatment, the levels of sex hormone(serum LH, FSH, T, E2) and fasting insulin level(FINS) were compared between the two groups. Results After treatment, the difference of endometrial blood flow perfusion type(Hc=10.100, P=0.006) and thickness(t=7.203, P<0.001) between the two groups was statistically significant. The improvement of LH(t=5.012, P<0.001), FSH(t=2.088, P=0.037), T(t=2.360, P=0.018), E2(t=3.743, P<0.001) and FINS(t=3.442, P=0.001) in the observation group was better than those in the control group(P<0.05). The cycle ovulation rate(χ²=11.600, P=0.001) and pregnancy rate(χ²=6.620, P=0.010) in the observation group were higher than those in the control group(P<0.05). Conclusion The treatment of infertility patients with PCOS can improve the level of serum related hormones and fasting insulin level, thus improve the endometrial receptivity, and improve the ovulation rate and pregnancy rate.

The application and problems of the standard chemical quantity method in the performance evaluation of the community health service institutions in the suburb of Beijing

CHEN Jing-jing, WANG Hai-li, PENG Ying-chun

2020, 18(9): 1534-1538. doi: 10.16766/j.cnki.issn.1674-4152.001553

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Abstract:
Objective To understand the situation of performance evaluation of community health service institutions in the suburb of Beijing, analyze the effect and influencing factors, and put forward countermeasures. Methods When the total amount of performance pay is limited, the performance pay that can be used for independent distribution can be divided into single assessment part and monthly assessment part. Then, the monthly assessment part is divided into work quantity, work quality and satisfaction according to the assessment items. Each item corresponds to a certain performance pay and is paid according to the assessment results. In the part of work quantity, the standardized work quantity of medical service projects with high consistency is directly linked to the performance salary, while in the part with large post difference, the standardized work quantity value is transformed into the qualitative index linked to the performance salary. Results For three years, the number of contracted family doctors increased by 4.68% annually. The standard management rate of hypertension increased by 25.96% every year. The standard management rate of diabetes increased by 27.37% every year. Annual growth of outpatient visits 31.26%. The workload of prevention and health care staff increased by 94.5%, 41.5% increase in contracted work of family doctors. The workload of medical staff increased by 48.0%, 83.1% increase in contracted work of family doctors. Conclusion Using the method of standard chemical work quantity to carry out performance appraisal in community health service institutions in mountainous areas can arouse the enthusiasm of workers. To promote the implementation of various work. But the standard chemical work quantity method develops the performance appraisal work to classify medical service items. Therefore, in mountainous areas with fewer medical staff, high consistency in signing up services for family doctors and standard agreed services can directly link the standard chemical work volume value with the performance salary. For services with large differences, quantitative data can be transformed into qualitative data to fully reflect the enthusiasm of performance appraisal, promote management and improve comprehensive service level.

Epidemiological investigation of cardiovascular and cerebrovascular diseases in Tongling Yaoshan community and discussion on prevention and treatment mode

LIU Wei-zhou, HU Jing-ting, YANG Yun-fang, LIANG Jing, LUO Jun, XIONG En-lai, CHEN Jia, ZHANG Jie-qiong, PAN Hua

2020, 18(9): 1539-1542. doi: 10.16766/j.cnki.issn.1674-4152.001554

333 3

Abstract:
Objective To know the epidemiology of cardiovascular and cerebrovascular diseases in Yaoshan community of Tongling City, and explore the integrated prevention and treatment mode of cardiovascular and cerebrovascular diseases in Tongling city community. Methods The Yaoshan community in Tongguan District of Tongling City was identified as a screening point by convenient sampling method. The residents over 40 years old were listed as targets for screening and intervention. The number of screening and comprehensive interventions was determined to be 6 182. An epidemiological survey of cardiovascular and cerebrovascular diseases was conducted for all residents(32 487 person-time) of the community in 2015-2017. Results Among residents over 40 years old in Yaoshan Community, proportion of population with hypertension, hyperlipemia, diabetes, smoking, overweight, history of stroke, auricular fibrillation, history of transient ischemic attack(TIA) were 24.44%, 7.78%, 6.94%, 24.20%, 11.36%, 1.78%, 0.26%, 0.10%, respectively. The average incidence of stroke in residents of Yaoshan community was lower than that in Tongguan District, the difference was statistically significant(χ²=9.734, P=0.002). The stroke mortality rate was consistent with that in Tongguan District, and the incidence and mortality did not increase or decrease year by year. From 2015 to 2017, the incidence rate and mortality rate of heart disease were consistent with that of Tongguan district, and the incidence rate showed an increasing trend year by year(χ²=12.570, P=0.002). Conclusion The prevalence characteristics of cardiovascular and cerebrovascular diseases among the people over 40 years old in Yaoshan community were consistent and different from that of the general population of Tongguan District in Tongling City. Different prevention and control programs can be developed for different communities through integrated screening. Finally, the integrated prevention and treatment mode of cardiovascular and cerebrovascular diseases will be formed.

Impact of "mobile assistance doctors" stage dynamic missions on in vitro fertilization embryo transfer patients

QIU Shi-mei, FANG Li-zi, ZHOU Dao-qiu, LIU Xiao-ming, HUANG Chao-xia

2020, 18(9): 1543-1546,1569. doi: 10.16766/j.cnki.issn.1674-4152.001555

210 1

Abstract:
Objective Build a "mobile medical assistant" stage dynamic missionary education model, and apply it to patients with in vitro fertilization and embryo transfer, To further improve the quality of health education in reproductive centers. Methods Total 340 patients undergoing IVF-embryo transfer admitted to the Reproductive Center of the Second Affiliated Hospital of Wenzhou Medical University were selected by convenient sampling. According to the time of admission, they were divided into control group and observation group, 170 cases in each group. The control group performed routine mission, and the observation group based on the control group combined with the "mobile assistance doctors" module to implement periodic dynamic mission. The intervention effects of the two groups were compared. Results At the pregnancy confirmation day, the scores of anxiety, depression and negative coping style in the observation group were(36.46±3.79) points,(35.90±3.39) points,(22.15±4.48) points, significantly lower than the control group [(40.07±4.43) points,(40.84±4.17) points,(25.09±5.13) points], and the observation group's positive coping style score was(40.15±5.56) points, significantly higher than the control group(37.53±6.02) points, the differences were statistically significant(all P<0.05). At the embryo transfer day, the cortisol level in the observation group was(49.12±4.11) pg/mL, significantly lower than that in the control group(52.30±4.53) pg/mL, the difference was statistically significant(all P<0.05). At the pregnancy confirmation day, the health knowledge awareness rate in the observation group(90.59%) was significantly higher than that in the control group(80.59%), and the health education satisfaction of the observation group(95.88%) was significantly higher than that of the control group(89.41%), the differences were statistically significant(all P<0.05). Conclusion "Mobile assistance doctors" stage dynamic mission can significantly improve the negative emotions, psychological stress and coping styles of patients with IVF-embryo transfer, and improve patient satisfaction.

Predictive Value of TEE in evaluating LAA function in monitoring recurrence of AF after RFCA

WANG Yu-ting, SU Hao, YANG Hao-yi, HUANG Xiang-yang, YANG Dong-mei, GAO Li-fu

2020, 18(9): 1547-1550. doi: 10.16766/j.cnki.issn.1674-4152.001556

314 1

Abstract:
Objective To investigate the role of transesophageal echocardiography(TEE) in evaluating the left atrial appendage(LAA) function in monitoring recurrence of atrial fibrillation(AF) in patients after radiofrequency catheter ablation(RFCA). Methods A total of 84 patients in the First Affiliated Hospital of University of Science and Technology of China diagnosed with AF and undergoing RFCA for the first time were retrospectively collected from June 2016 to October 2019. After follow-up,patients were divided into the relapse group(n=19) and non-relapse group(n=65) accordingly. The clinical data of patients were collected, and TEE was used to measure relevant parameters of LAA function. In addition, the various indexes of patients between the relapse group and non-relapse group were followed-up and compared, aiming to identify risk factors. Results The diameter of left atrial antero-Posterior, the diameter and depth of the LAA in the relapse group were greater than those in the non-relapse group(all P<0.01), while the area change rate, emptying rate and filling rate were smaller in the relapse group than those in the non-relapse group(all P<0.01).The area change rate is positively related to reciprocal time(r=0.685,P=0.001), emptying rate(r=0.562,P=0.012),filling rate(r=0.627,P=0.004) and is negatively related to BNP(r=-0.558,P=0.013),depth of the LAA(r=-0.496,P=0.031).In addition, the area change rate predicted the AUC of relapse after RFCA is 0.933(0.875-0.991).The area change rate was an independent predictive factor for relapse after RFCA, and area change rate<40.95% as the cutoff value could generate the optimal predictive performance of relapse after RFCA. Conclusion Evaluation of LAA functions via TEE is of predictive value for relapse after RFCA. Moreover, the decreased area change rate is an independent predictive factor for relapse after RFCA.

Application and research progress of interspinous dynamic system Coflex

DU Ming-rui, ZHOU Cheng-pei, WEI Fei-long, ZHU Kai-long, QIAN Ji-xian

2020, 18(9): 1551-1554. doi: 10.16766/j.cnki.issn.1674-4152.001557

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Abstract:
Lumbar disc herniation, lumbar spinal stenosis and other interverbral degenerative diseases are the main causes of low back pain. For patients who have failed conservative treatment, fusion is the main way to treat this type of disease. Coflex is a kind of dynamic stabilization system between spinous processes. The device realizes the dynamic stability of the degenerative segment and retains the motion of lumbar spine. Compared with fusion, it cannot only relieve the clinical symptoms of patients, but also avoid the occurrence of fusion-related complications such as the disappearance of surgical segment mobility and the degeneration of adjacent segments. For multi-segment lumbar degeneration, the Topping-off procedure shows a unique advantage, which can reduce the risk of disc degeneration in adjacent segments. In recent years, research on Coflex has been deepened and the safety and effectiveness of the Coflex system have been continuously recognized, but there is still a lack of high-level, large-sample and multi-center clinical research as a support. Clinicians have continuously improved Coflex in their applications and developed new interspinous process dynamic stabilization devices. Therefore, in order to provide a reference for the clinical application of the Coflex system, this article reviews the indications and contraindications of the Coflex system, biomechanical characteristics, clinical efficacy, postoperative complications, and the development of new dynamic stabilization devices.

Research status of myocardial bridge

DONG Xiao-ge, WU Zi-jian, FU Zhi-tian, CHEN Yu-jie, JIN Juan

2020, 18(9): 1555-1559. doi: 10.16766/j.cnki.issn.1674-4152.001558

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Abstract:
Myocardial bridge is the most common congenital coronary artery anomaly, the morbidity of autopsy was 42%, more in female patients(74.5%), mainly involves the left anterior descending branch(77.2%). The presence of myocardial bridge may be associated with various complications, such as angina pectoris, acute myocardial infarction, and even lead to severe clinical symptoms in early childhood. The possible damage mechanisms of myocardial bridge include myocardial ischemia, coronary spasm and coronary atherosclerosis. However, recent studies have considered the existence of the myocardial bridge may play a potential protective effect on the patients, and speculated that may be due to myocardial bridge near the adipose tissue and other connective tissue, form "coronary artery fat pad", helps blood vessels fight systolic bundle compression, myocardial bridge contraction stimulating anticoagulant and growth factor release, protection of mural coronary artery atherosclerosis. Myocardial bridge is caused by abnormal development of embryo, so it cannot be prevented in clinic. At present, there are mainly drug,surgery or interventional therapy. Interventional therapy is controversial, and surgical treatment is recommended, but there is no unified standard. For patients with depth>2 mm, length>25 mm and myocardial bridge compression persisting until diastolic phase cannot fully recover, coronary artery bypass surgery is recommended. In rare cases, emergency treatment may be needed, and even surgical intervention in early childhood is needed. This article reviews the research status of physiology, pathology, examination methods and treatment of myocardial bridge.

Effect of Tongqiao Huoxue Decoction on cognitive dysfunction in patients after stroke

LIU Ya-li, GUO Jian, SUN Wei-juan, BAI Yan-jie, ZHANG Ming, WANG Lei, FENG Xiao-dong

2020, 18(9): 1560-1562,1576. doi: 10.16766/j.cnki.issn.1674-4152.001559

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Abstract:
Objective To observe the clinical efficacy and safety of Tongqiao Huoxue Decoction in the treatment of patients with cognitive dysfunction after stroke, and to seek evidence-based evidence for its application in the treatment. Methods Sixty patients with post-stroke cognitive dysfunction admitted to the Rehabilitation Center of Henan University of Traditional Chinese Medicine from January 2017 to June 2018 were selected as the research subjects. According to the random number table, they were divided into experimental group and control group with 30 cases in each group. The control group was given only regular rehabilitation functional training, and the experimental group was given Tongqiao Huoxue Decoction addition and subtraction treatment based on the control group. Before and after 4 weeks of treatment, the Montreal Cognitive Assessment Scale(MoCA) and daily living ability(ADL) scores, vital signs and liver and kidney function indicators of the two groups were measured and compared. Results Before treatment, the baseline data such as MoCA and ADL scores were balanced and comparable. After 4 weeks of treatment, the MoCA and ADL scores of the two groups were improved compared with before treatment. The MoCA score of the experimental group was increased from 16.91±6.13 to 24.07±5.89, and that of the control group was increased from 16.73±6.15 to 20.14±6.21. The ADL scores of the experimental group was increased from 35.16±7.14 to 69.73±9.73, and that of the control group was increased from 35.72±9.22 to 51.26±8.46. Moreover, the increase in the experimental group was more significant, the differences were statistically significant(all P<0.05). Conclusion Tongqiao Huoxue Decoction is effective in treating post-stroke cognitive dysfunction, tonifying the deficiency and opening the orifices, which is worthy of further clinical promotion.

Therapeutic effect observation of Xingnao Kaiqiao acupuncture combined with neuromuscular electrical stimulation on dysphagia after stroke

LI Hong-rui, XU Lei, FAN Lian-bin, ZHANG Qing-ping, LI Fei

2020, 18(9): 1563-1565. doi: 10.16766/j.cnki.issn.1674-4152.001560

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Abstract:
Objective To explore the effect of Xingnao Kaiqiao acupuncture combined with neuromuscular electrical stimulation on dysphagia after stroke. Methods Total 64 patients with post-stroke dysphagia admitted to Fuyang People's Hospital from January 2017 to October 2019 were randomly divided into control group and experimental group. Patients in the control group were treated with neuromuscular electrical stimulation. On the basis of the control group, the patients in the experimental group were treated with Xingnao Kaiqiao acupuncture. Both groups were treated for two courses for a total of 8 weeks. After the treatment, the treatment efficiency of the two groups was compared. The changes in the standard swallowing assessment scale(SSA) before and after treatment and the National Institutes of Health Stroke Neurological Deficit Rating Scale(NIHSS) were observed. Results The effective rate of the experimental group was 93.75%, significantly higher than that of the control group 71.88%(P<0.05). There was no significant difference in the pre-treatment scores of SSA scale and NIHSS scale between the two groups(all P>0.05). After treatment, the SSA scale and NIHSS scale scores of both groups were lower than those before treatment, the difference was statistically significant(all P<0.05).The scores of the experimental group SSA scale and NIHSS scale were lower than the control group at 8 weeks after treatment, the difference was statistically significant(all P<0.05). Conclusion The effect of Xingnao Kaiqiao acupuncture combined with neuromuscular electrical stimulation on dysphagia after stroke is significant, and the clinical symptoms of patients with dysphagia are improved.

Epidemiological investigation of thyroid nodules among middle school students in a middle school in Hangzhou

LIU Qiao-yong, ZHU Ji-ming, SHEN Li-jun, ZHU Xiao-yan, LU Jia-jia

2020, 18(9): 1566-1569. doi: 10.16766/j.cnki.issn.1674-4152.001561

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Abstract:
Objective In order to learn about the thyroid nodule detection rate and epidemiological characteristics of middle school students in hangzhou, and to analyze the relevant factors. Methods In October 2018, high-frequency ultrasound was used to perform thyroid ultrasound examinations on 596 middle school students in a middle school in Hangzhou. The internal echoes of thyroid nodules were analyzed, and univariate and multivariate linear regression analyses were performed between thyroid nodules and factors like age, sex, BMI or Tvol. Results In 596 middle school students, 369 were detected to have Thyroid nodules, the overall detection rate was 61.9%(369/596). There were 363 cases of cystic nodules and 5 cases of hypoechoic nodules. Among them, 201 cases were females with a detection rate of 69.1%(201/291) and 168 were males with a detection rate of 55.1%(168/305). The female thyroid nodule detection rate was higher than that of males, and the difference was statistically significant(χ²=12.360,P<0.001). The thyroid nodule detection rate did not increase with the increase of age(χ <mathml id="6"> <mrow><msubsup><mrow /><mrow><mtext>t</mtext><mtext>r</mtext><mtext>e</mtext><mtext>n</mtext><mtext>d</mtext></mrow><mn>2</mn></msubsup></mrow></math>" role="presentation" style="position: relative;"> <nobr aria-hidden="true"> 2trend </nobr> <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup> <mrow></mrow> <mrow> <mtext> t </mtext> <mtext> r </mtext> <mtext> e </mtext> <mtext> n </mtext> <mtext> d </mtext> </mrow> <mn> 2 </mn> </msubsup> </mrow> </math> <script type="math/mml" id="MathJax-Element-3"><math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mrow></mrow><mrow><mtext>t</mtext><mtext>r</mtext><mtext>e</mtext><mtext>n</mtext><mtext>d</mtext></mrow><mn>2</mn></msubsup></mrow></math></script> </mathml>=2.738, P=0.098) as well as the increase of BMI(χ <mathml id="7"> <mrow><msubsup><mrow /><mrow><mtext>t</mtext><mtext>r</mtext><mtext>e</mtext><mtext>n</mtext><mtext>d</mtext></mrow><mn>2</mn></msubsup></mrow></math>" role="presentation" style="position: relative;"> <nobr aria-hidden="true"> 2trend </nobr> <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup> <mrow></mrow> <mrow> <mtext> t </mtext> <mtext> r </mtext> <mtext> e </mtext> <mtext> n </mtext> <mtext> d </mtext> </mrow> <mn> 2 </mn> </msubsup> </mrow> </math> <script type="math/mml" id="MathJax-Element-4"><math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mrow></mrow><mrow><mtext>t</mtext><mtext>r</mtext><mtext>e</mtext><mtext>n</mtext><mtext>d</mtext></mrow><mn>2</mn></msubsup></mrow></math></script> </mathml>=1.152, P=0.131). There was a significant difference in the detection rate of unilateral and bilateral thyroid nodules between different genders(χ²=7.866, P=0.005). There was no statistical difference in the detection rate of single and multiple thyroid nodules between different genders(χ²=2.136,P=0.144). Conclusion The detection rate of thyroid nodules in a middle school student in Hangzhou is 61.9%, with a high detection rate, mainly bilateral, multiple, cystic nodules ≤ 0.5 cm.

Study on the optimization of fire dragon moxibustion based on evaluation of analgesic effect of cold and wet lumbar disc herniation

ZHOU Xiao-fang, FANG Qun, ZHANG Xu-ping, LUO Han-bing, GU Min-jie, GUO Fang-fang

2020, 18(9): 1570-1572. doi: 10.16766/j.cnki.issn.1674-4152.001562

304 1

Abstract:
Objective To study the main mechanism of cold and wet lumbar disc herniation and TCM syndrome differentiation, and choose a therapeutic effect suitable for the analgesic effect of fire dragon moxibustion. Methods Seventy-two patients with cold and wet lumbar disc herniation who met the inclusion criteria and received fire dragon moxibustion at the Third Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January to June 2019 were selected and divided into three groups according to the completely random method, each group has 24 cases, for 30 min, 40 min and 50 min treatment group, respectively. After 4 weeks of continuous treatment and follow-up for 3 months, the visual analog scoring(VAS) and the modified Japan Orthopaedic Association lower back pain score(M-Joint Operation Agreement, M-JOA) were used to compare the three groups Pain relief, improvement of symptoms and clinical treatment effect. Results VAS score was lower than before treatment after treatment in three groups(all P<0.05), the VAS score of 40 min group was significantly lower than the other two groups in 4 weeks and 3 months of follow-up(all P<0.001). After treatment, the M-JOA score was higher than that before treating(all P<0.05), the score of M-JOA of 40 min group was significantly higher than that of the other two groups in all time points(all P<0.05). The clinical efficiency of 40 min treatment group was significantly higher than that of the other two groups(all P<0.05). Conclusion When using fire dragon moxibustion to treat cold and wet lumbar disc herniation, 40 min treatment can effectively relieve the patient's symptoms, improve the clinical effect. The long-term effect is significant, and it is not easy to relapse.

Application of BOPPPS combing with CBL method in experimental teaching of physical diagnosis under the background of "Internet+"

CHENG Cheng, HE Fei, WANG Tong

2020, 18(9): 1573-1576. doi: 10.16766/j.cnki.issn.1674-4152.001563

227 2

Abstract:
Objective Physical diagnostics is an important theoretical and practical convergence discipline. To investigate the effect of BOPPPS combined with CBL method in experimental teaching of physical diagnosis under the background of "Internet+". Methods The undergraduate-master General Medical students of Anhui Medical University were randomly divided into two groups according to the class. Class Ⅰ was experimental group(n=36) and Class Ⅱ was control group(n=32). The experimental group used BOPPPS+CBL under the background of "Internet+" teaching method. The control group used the traditional teaching method. After the course, the two groups of students were tested on theory and skills, and the questionnaire were used to investigate the students' interest in learning, autonomous learning ability, clinical thinking ability, teamwork, and satisfaction with teaching methods to evaluate their teaching effect. Results The theoretical scores and skill operation scores of the experimental group were significantly better than those of the traditional teaching group( theory scores: 80.37±8.97 vs. 73.81±9.97,t=2.850, P=0.006; skill operation scores: 81.88±7.29 versus 75.06±8.87,t=3.749, P=0.001). The results of the questionnaire survey showed that compared with the traditional teaching group, BOPPPS and CBL group's evaluation of learning interest, autonomous learning ability, clinical thinking, teamwork, and teaching satisfaction were also significantly better than those of the traditional teaching group(all P<0.05). Conclusion The teaching method of BOPPPS+CBL under the background of "Internet+" teaching method is superior to the traditional one. The new teaching method can not only improve study interest, develop self-learning and clinical thinking ability, enhance communication between teachers and students, but also enhance the teaching quality of the experimental physical diagnosis course.

Development of patient’s usage intention towards diabetes applications scale

BIAN Mao-mao, SONG Jian, WANG Wen-juan, ZHANG Yan-fang, XIE Hong

2020, 18(9): 1577-1580. doi: 10.16766/j.cnki.issn.1674-4152.001564

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Abstract:
Objective To develop patient's usage intention towards diabetes applications scale and test its reliability and validity,in order to provide tools for further research on the intention of using diabetes application in patients. Methods Based on the Unified Theory of Acceptance and Use of Technology, the items were collected based on semi-structured interviews and consultations of diabetic patients were experted. After the formal questionnaire was formed, a total of 430 patients with diabetes were surveyed in three general hospitals in Bengbu city, Anhui Province from July to October 2019. After item analysis, the database was divided into two parts, of which database 1(n=201) was used for exploratory factor analysis. In order to determine dimensions and items, database 2(n=201) was used for confirmatory factor analysis and to examine the reliability and validity. The correlation validity of the diabetes application intention scale was verified by analyzing the correlation degree between patients' mobile medical use behavior and the total score of diabetes application intention. Results The final version of the scale contains 18 items,3 dimensions. The cumulative variance contribution rate was 71.191%, and the confirmatory factor analysis indicated that: χ²/df=2.060, GFI=0.858, AGFI=0.816, CFI=0.944, RMSEA=0.073, the correlation coefficient between the total intention score of diabetic application use and the use of diabetes mobile medical behavior r=0.683, P<0.01. The Cronbach's α coefficient of the total scale is 0.930, and the Cronbach's α coefficients of the performance expectations, effort expectations, and social impact dimensions were 0.906, 0.919,and 0.888, respectively. The test-retest reliability of the total scale was 0.934, and the retesting reliability of performance expectations, effort expectations, and social impaction dimensions were 0.900, 0.897, and 0.857, respectively. Conclusion The scale has good reliability and validity and can be a tool for assessing the intention of diabetes applications.

A meta-analysis of the efficacy and safety of paclitaxel-coated balloon and ordinary balloon in the treatment of femoral popliteal arteriosclerosis obliterans

YIN Xiao-liang, GAO Yong, LANG De-hai, YU Zuan-biao

2020, 18(9): 1581-1584,1611. doi: 10.16766/j.cnki.issn.1674-4152.001565

244 2

Abstract:
Objective To analyze the efficacy and safety of drug coated balloon in the treatment of femoral popliteal arteriosclerosis obliterans. Methods The randomized controlled trial literature on the treatment of femoral popliteal arteriosclerosis obliterans by drug coated balloon was retrieved and collected at domestic and abroad. The retrieval years were established to June 2018. Review Manager 5.1 software was used to carry out Meta analysis on the data collected and collated, compared with drug coated balloon and common balloon treatment stock. Postoperative patency and complications of popliteal arteriosclerosis obliterans. Results According to the inclusion criteria, 12 articles were included in the statistical analysis and 2 373 cases were included in the statistical analysis. The results of Meta analysis showed that the late lumen loss and restenosis at 6 months after the operation were all lower than that of the common balloon(all P<0.05). The two groups were compared with the 12-month primary patency rate, and the heterogeneity test showed significant difference(χ²=13.660, P<0.05, I²=71%). The random effect model was used to analyze the patency rate of the drug coated balloon significantly better than that of the common balloon(P<0.05). The longest follow-up to 12 months after the operation was compared with the rate of amputation, and there was no significant difference in the heterogeneity test(χ²=0.420, P=0.510, I²=0%). The amputation rate of two groups was not significantly different(P=0.710). After follow up to 24 months, the drug coated balloon was significantly better than that of the common balloon(P<0.05). Conclusion The drug coated balloon in the treatment of femoral popliteal arteriosclerosis obliterans has better clinical advantages than common balloon, which can help to reduce the incidence of restenosis and restenosis after operation, and improve the long-term patency rate.

Study on the prevalence of anemia and its risk factors in Beijing health examination population

LIU Yan-li, CHEN Shuo, SUN Chen, CHEN Wei-ting, WANG Qi, CHEN Si-yu, HAI Peng-cheng, ZHAO Yu, MA Li

2020, 18(9): 1585-1587,1614. doi: 10.16766/j.cnki.issn.1674-4152.001566

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Abstract:
Objective Anemia is a global public health problem, especially in low-and middle-income countries, which imposes a heavy economic burden on patients' families and society. We conducted this study to understand the prevalence of anemia in population of health examination in Beijing in 2018 and analyze the factors association with anemia to provide reference for the prevention and management for patients with anemia. Methods The health examination population at the Beijing Municipal Medical Examination Center from June to September in 2018 were selected as subjects. Subjects were selected for on-site investigation according to the inclusion and exclusion criteria. The main contents of the survey included the demographic characteristics and living habits of the subjects, and the results of their physical examination were collected. Chi-square test was used for univariate analysis, and variables with statistical significance in univariate analysis were included in logistic regression analysis to explore the influencing factors of anemia. Results The prevalence of anemia was 1.8%(163/8 913), 3.8% in the female, and 0.3% in the male. Univariate analysis showed that gender, age, education, smoking, alcohol consumption, BMI, blood pressure, fasting blood glucose, total cholesterol, triglycerides, low density lipoprotein, and uric acid were the influencing factors of anemia. Multivariate logistic regression analysis showed that gender and age were positively correlated with anemia, with the OR(95% CI) of 6.405(3.260-12.583) and 1.019(1.004-1.035), respectively. Total cholesterol levels and uric acid levels were negatively correlated with anemia, with the OR(95% CI) of 0.316(0.175-0.569) and 0.994(0.991-0.997), respectively. Conclusion Females, advanced age, total cholesterol and uric acid levels are association with anemia in Beijing's health examination population. Effective interventions for these risk factors play an important role in the prevention and management of anemia.

Effects of staged cognitive behavioral intervention on the quality of life and psychological state of patients with bronchogenic carcinoma undergoing chemotherapy

PENG Qiao-ling, SHI Peng, MA Jia-qin, FENG Cui-ying, LIU Li-yuan

2020, 18(9): 1588-1590. doi: 10.16766/j.cnki.issn.1674-4152.001567

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Abstract:
Objective To explore the effect of staged cognitive behavioral intervention on patients with bronchogenic carcinoma undergoing chemotherapy. Methods A total of 72 patients with bronchogenic carcinoma treated by chemotherapy at the Medical Oncology of Bozhou City People's Hospital from August 2017 to December 2018 were randomly divided into group routine nursing(Group RN, 36 cases) and group cognitive behavioral intervention(Group CBI, 36 cases).Both RN group and CBI group were given routine nursing of chemotherapy. On this basis, the CBI group were received cognitive behavioral intervention through three stages: cognitive correction, behavior therapy and consolidation exercise. The quality of life and psychological status of patients in two groups were evaluated and compared at the time of admission and discharge. Results After intervention, SF-36 in CBI group got better scores in the psychological states, physiological ability, adaptive capacity to environment and social capacity than those in RN group(48.53±2.34 vs. 45.69±2.18,46.89±2.81 vs. 42.15±2.26, 44.65±2.45 vs. 41.23±2.56, 58.65±2.44 vs. 54.35±2.64, respectively, all P<0.01),and the scores of SAS and SDS in CBI group decreased significantly after intervention(58.79±5.66 vs. 39.05±4.11, 61.76±4.87 vs. 38.03±4.05, respectively, all P<0.01). Conclusion After the staged cognitive behavioral intervention applying to patients with bronchogenic carcinoma undergoing chemotherapy, the quality of life is significantly increased and the state of anxiety and depression is improved.

Intervention effects of TCM nursing in tumor patients undergoing continuous chemotherapy

CENG Shan, ZHOU Mei-fang, FANG Gui-xiang, LI Gao-hua, CHEN Ying, JIANG Jin-fang

2020, 18(9): 1591-1594. doi: 10.16766/j.cnki.issn.1674-4152.001568

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Abstract:
Objective To observe the effects of integrated traditional Chinese medicine(TCM) nursing intervention on continuous chemotherapy-induced nausea and vomiting(CINV) in patients with malignant tumors. Methods Seventy patients with malignant tumors who underwent continuous chemotherapy in Affiliated Tumor Hospital of Guangxi Medical University from June 2017 to December 2018 were randomly divided into control group(35 cases) and observation group(35 cases). The control group were given routine nursing in Oncology Department and routine prevention of CINV, while the observation group were given integrated TCM nursing on the basis of control group. The occurrence of CINV, compliance of chemotherapy, Chinese version of Positive and Negative Affect Schedule(PANAS) scores, quality of life-core questionnaire(QLQ-C30) assessment results and nursing satisfaction were compared between the two groups. Results The incidence rate of CINV in the observation group was significantly lower than that in the control group(45.71% vs 71.43%), and CINV in the observation group was milder than that in the control group(P<0.05). The compliance of chemotherapy in the observation group was significantly better than that in control group(P<0.05). After intervention, the positive emotion score of PANAS scale in the observation group [(24.12±4.68) points] was significantly higher than that in the control group [(17.23±4.26) points, P<0.05], while the negative emotion score [(35.75±4.86) points] was significantly lower than that in control group [(40.25±4.64) points, P<0.05]. The assessment results of QLQ-C30 scale of the observation group were significantly better than those of the control group(P<0.05). The nursing satisfaction of the observation group was significantly better than that of the control group(P<0.05). Conclusion Integrated TCM nursing intervention can significantly reduce the occurrence of CINV in patients with malignant tumors undergoing chemotherapy, improve the patient's compliance of chemotherapy, psychological status and quality of life.

Analyzing the complications and quality of life of patients receiving VAP and PICC after breast cancer surgery

YANG Gui-li, CENG Hui-hui, HAN Zheng-quan, MAO Yan, XUE Dan-dan

2020, 18(9): 1595-1598. doi: 10.16766/j.cnki.issn.1674-4152.001569

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Abstract:
Objective To analyze the complications and quality of life of patients receiving VAP and PICC after breast cancer surgery, and to provide clinical evidence. Methods A total of 120 patients who received adjuvant chemotherapy after breast cancer surgery in the First Hospital of Bengbu Medical College from January 2013 to December 2018 were divided into the experimental group(58 cases) and the control group(62 cases) by different of infusion tools. The incidence of complications such as venous thrombosis, catheter infection and catheter blockage after catheterization and the quality of life of the patients in the two groups were compared. Results There was no venous thrombosis, infection or infusion obstruction in the experimental group, with 1 case(1.7%) of venous thrombosis, 3 cases(4.8%) of venous thrombosis in the control group, 4 cases(6.4%) of venous thrombosis, 5 cases(8.1%) of infection, and 2 cases(3.2%) of infusion obstruction. Complications occurred in 1 case(1.7%) in the test group and 14 cases(22.6%) in the control group, χ²=11.918, P=0.001, the difference was statistically significant. The scores of patients in the VAP group in the physiological field, psychological field, social relation field and environmental field were all better than those in the PICC group(P<0.01), with statistically significant differences. Conclusion Compared with PICC, the incidence of VAP in patients with breast cancer is lower than that of PICC in terms of venous thrombosis, catheter infection and tube plugging, and it also improves the quality of life of patients, which is worthy of clinical promotion and application.

The role of path nursing intervention in thrombolytic patients with deep vein thrombosis

SUN Guo-fang, XU Yu, MENG Li-ping, GUO Hang-yuan, HUANG Ling-juan

2020, 18(9): 1599-1602. doi: 10.16766/j.cnki.issn.1674-4152.001570

246 1

Abstract:
Objective To analyze the application effect of path-based nursing intervention in patients with deep vein thrombosis catheter thrombolysis of lower extremity, aiming to provide basis for improving the effect of catheter thrombolysis. Methods A total of 84 patients with deep venous thrombosis of lower extremities admitted in our hospital from July 2017 to December 2019 were selected and divided into two groups according to the digital random table method, that is, 42 cases in the control group and routine care, 42 cases in the observation group and pathology Nursing intervention. The rehabilitation status of the two groups of patients(detection of patients' rehabilitation time, hospitalization time, hospitalization cost), health knowledge level(health education knowledge scale made by our hospital department), coagulation function(determination of fibrinogen, thrombin time, Prothrombin time) and satisfaction rate were compared. The incidence of postoperative complications of patients(catheter blockage, catheter shedding, wound infection, bleeding, etc.) were analyzed. SPSS 23.0 statistical processing data was used for the specific data of the two groups. Results The recovery time and hospitalization time of the observation group were shorter than that of the control group(t=6.972, 5.245, all P<0.05). The hospitalization cost was lower than that of the control group(t=5.997, P<0.05). The content of posterior fibrinogen was lower than that of the control group(t=7.441, P<0.05). Thrombin time, prothrombin time, APTT were longer than the control group, the difference was statistically significant(t=11.121, 11.387, 6.355; all P<0.05). The observation group's post-nursing health education knowledge score was higher than that of the control group(t=5.835, P<0.05). The incidence of complications in the observation group was 2.38%, lower than that of the control group, 23.81%, the difference was statistically significant(χ²=8.372, P=0.004). The nursing satisfaction rate in the observation group was 97.62%, higher than that in the control group, 76.19%, the difference was statistically significant(P<0.05). Conclusion Path-based nursing intervention can reduce the incidence of complications in patients with deep vein thrombosis catheter thrombolysis of lower extremities, improve the rehabilitation effect, and improve the coagulation function of the body, which is worthy of application.

Analysis of risk factors and nursing strategies for children with diabetic ketoacidosis complicated with cerebral edema

BAO Jing, GAN Dong-mei

2020, 18(9): 1603-1605,1608. doi: 10.16766/j.cnki.issn.1674-4152.001571

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Abstract:
Objective To count the clinical data of diabetic ketoacidosis(DKA)children and DKA with cerebral edema, analyze the risk factors of DKA with cerebral edema, and summarize the nursing countermeasures. Methods The data of 189 cases of DKA without cerebral edema and 27 cases of DKA with cerebral edema were collected in Ningbo Women and Children Hospital from July 2014 to February 2019. The age, blood glucose, pH value, blood sodium slow rising, persistent hyponatremia, blood urea nitrogen elevating, and bicarbonate concentration were counted, and single factor and logistic regression analysis were used to determine the risk factor of DKA with cerebral edema. Results Univariate analysis showed that the difference between two groups was significant on age, blood glucose, pH value, blood sodium slow rising, persistent hyponatremia, blood urea nitrogen elevating, and bicarbonate concentration. Logistic analysis showed that age≤6 years(OR=3.456, P=0.002), blood glucose>20 mmol/L(OR=3.331, P=0.001), pH≤7.35(OR=3.543, P=0.004), blood sodium slow rising(OR=2.543, P=0.004), persistent hyponatremia(OR=2.112, P=0.019), blood urea nitrogen elevating(OR=2.400, P=0.021), and bicarbonate concentration>10 mmol/L(OR=2.732, P=0.048) were risks factors of DKA with cerebral edema. Conclusion Age≤6 years, blood glucose>20 mmol/L, pH value≤7.35, blood sodium slow rising, persistent hyponatremia, blood urea nitrogen elevating, and bicarbonate concentration>10 mmol/L were risks factors of DKA with cerebral edema. The risk factors should be emphasized in clinical practice, and sexual treatment and nursing should be done to prevent the occurrence of cerebral edema.

SHEN Ping-qun, YE Ying-jun, XIE Shu-ping, YE Qing

2020, 18(9): 1606-1608. doi: 10.16766/j.cnki.issn.1674-4152.001572

187 3

Abstract:

LAN Qiu-li, LI Hui, NING Yu-zhi, SUN Yu-xuan, FU Xiao-dong

2020, 18(9): 1609-1611. doi: 10.16766/j.cnki.issn.1674-4152.001573

145 3

Abstract:

AN Lan-fen, JIN Zhi-shan, LIU Xiao-xia, ZHANG Qi, ZHAO Yin, ZOU Li

2020, 18(9): 1612-1614. doi: 10.16766/j.cnki.issn.1674-4152.001574

177 4

Abstract:

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2020 Vol. 18, No. 9

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