中华全科医学

Location and role of general practice in tertiary hospital

YU De-hua, PAN Ying, ZHANG Bin, LU Yuan, ZHANG Han-zhi, WANG Ming-hong, FAN Hui-qin

2016, 14(7): 1061-1063,1110. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.001

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Abstract:
In March,2010,China issued "the plan of team building of primary health care focusing on general practitioners",which forward to encourage tertiary institutions to establish general medicine.June,2014,Shanghai Municipal Commission of Health and Family Planning approved the Yangpu Hospital of Tongji University (Shanghai Yangpu Central Hospital) to establish general medical practice subject.The hospital set up general medicine,which includes a full general wards and outpatient clinics.This general medicine is the one of 2 tertiary hospitals,which had qualified general medical in Shanghai.General Medicine undertakes the health management,chronic disease management,general medical training and academic research.By introduce the clinical practice,the collaboration with the community health service centers,personnel training and scientific research with Community hospital,in the first year,which analyzed the clinical functional orientation of general medicine in tertiary hospitals,that is,providing continuous,comprehensive,the whole of general concept and humanistic care to patients.Indicating the necessary effects of general practice in the tertiary hospitals,which set up a bridge between tertiary hospitals and community health service center,and prompt two-way referral successfully;guiding general practitioners,perfect the knowledge of theory and training,it is the platform for the high-grade of general practitioners.Discussion building the model of coordinated development of regional health,emphasizing the important role of general medicine,promoting two-way referral smoothly,realizing complementary resources and resource utilization mainly,promoting mutual cooperation and development between medical institutions.

ZHANG Shi-fa, MAO Shuang-gen

2016, 14(7): 1064-1065.

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Impact of thyroid hormone levels on the early results after coronary artery bypass grafting in euthyroid subjects

WANG Heng, ZHU De-hao, YAO Yun-tai, ZHOU Cheng-hui, LI Li-huan

2016, 14(7): 1066-1069. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.002

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Objective To study the impact of different thyroid hormone levels on the early results after coronary artery bypass grafting(CABG) in euthyroid subjects by reviewing retrospectively the postoperative complications. Methods The data of 622 male patients undergoing CABG in our hospital between July,2010 and March,2014 were reciewed.The 311 patients with lower-Thyroid hormone level(FT₃:1.79-2.93 pg/ml) were assigned into in the L group,while another 311 male cases with higher-Thyroid hormone level male (FT₃:2.94-4.09 pg/ml) matched with age and left ventricular ejection fraction were assigned into H (control) group.The mechanical venitation time,length of ICU stay,length of stay after operation,new happened stroke,myocardical infartion,mortality,atrial fibrillation,hemodialysis,acute kidney injury,tracheotomy,aligent arrhythmia,intra-aortic balloon pumping(IABP) implant were comparative analyzed. Results The length of stay after operation longer in group L[6 days(6,9)] was more than that in the control[6 days(6,9)](Z=4.159,P<0.05).The IABP implant(2.6%) and incidences of acute kidney injury(17.7%) in group L were higher those(0.3% and 9.00%) in Group H(χ²=5.524,10.136,P<0.05).The incidences of new happened stroke,myocardical infarction,mortality,atrial fibrillation,hemodialysis,maligent arrhythmia,tracheotomy were not statistically significant between the two groups(P>0.05). Conclusion The lower-thyroid hormone level can significantly impact the early results after CABG.

Clinical effect of percutaneous transforaminal endoscopic discectomy in treatment of lumbar disc herniation

GAO Quan-you, HAN Kang, GAO Hao-ran, MA Qiong, HU Wei, LIN Xiao, YANG Wen-xue, FANG Zi-qiang, YANG Tao, LI Liao-bo, QIAN Ji-xian

2016, 14(7): 1069-1072,1152. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.003

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Objective To evaluate the clinical outcomes of percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation. Methods Fifty-one patients who were admitted in our hospital from 2012 to 2014 and diagnosed as lumbar disc herniation were cured by PTED between vertebral plate.The clinical outcomes were evaluated by visual analogue scale(VAS),Lehmann Lumbar function score,modified Macnab criteria and SF-36 before and after operation.All patients were followed up at least 6 months after the operation. Results The results of postoperative VAS score,lumbar function,quality of life were obviously improved when compared with preoperative evaluation(P<0.05) which were got on the day after surgery and 12 months after surgery.According to the modified Macnab criteria,the outcome showed:the excellent and good rate was 92.1%. Conclusion PTED between vertebral plate is safe and effective in the treatment of lumbar disc herniation.The pain of patients can obviously be relieved and the lumbar spinal function and quality of life of patienst can significantly be improved.

An experimental study of effect of Wenshen Yiqi medicine on expression of MMP-2 and MMP-9 in rats with severe pneumonia

WU Qing-guo, CHEN Ye, JIANG Jing

2016, 14(7): 1073-1076. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.004

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Objective To observe the effect of Wenshen Yiqi medicine on the expression of matrix metalloproteinases(MMP-2,MMP-9) in rats with severe pneumonia. Methods Total 100 SPF SD rats were randomly divided into five groups:rats in control group were given normal feeding,and rats in the other four groups made severe pneumonia model by tracheal puncture injection model were given sterile distilled water and corresponding concentration of Wenshen Yiqi drink,1 times/d,treatment for 7 d.The Lung histopathological changes were observed,leukocyte and neutrophils of bronchoalveolar lavage fluid were accounted by Blood Analyzer,and the expression of lung tissue PI3K,AKT1,P-AKT1,MMP-2 and MMP-9 were detected by Western blot test. Results When compared with control group,the markers of other groups were significantly higher(P<0.05);compared with model group,the markers of middle and high dose group were significantly lower(P<0.05),but there was no significantly different with low dose group.There were no significantly different in PI3K and AKT1 protein expression between five groups(P>0.05).But there were significantly different in P-AKT1,MMP-2 and MMP-9 expression between five groups(P<0.05);As compared with control group,the markers of other groups were significantly higher(P<0.05);as compared with model group,the markers of low,middle and high dose group were significantly lower (P<0.05),and there were significantly different in each dose group(P<0.05).The relationship of MMP-2 and MMP-9 with P-AKT1 were positive correlation. Conclusion Wenshen Yiqi method can effectively reduce the expression of MMP-2 and MMP-9 through PI3K/AKT signaling pathway,reduce the degradation of extracellular matrix and inflammatory response,which might be one of the pharmacological mechanism for the treatment of severe pneumonia.

iTRAQ technology for differentially expressed proteins screening in dysembryoplastic neuroepithelial tumor and low grade glioma

CHEN Xiao-dong, LIAO Qiu-lin, ZHANG Wei, PENG Da-yun, WANG Yu, ZHANG Hai-yan

2016, 14(7): 1077-1079,1089. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.005

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Abstract:
Objective To screen differentially expressed proteins in dysembryoplastic neuroepithelial tumor(DNT) and low grade glioma(LGG) by the proteomics analysis using isobaric tags for relative and absolute quantification(iTRAQ) combined with liquid chromatography-tandem mass spectrometry(LC-MS/MS). Methods The fresh frozen solid tissues of DNT(6 cases) and LGG(6 cases) were sampled and mixed.Then the protein extraction from admix specimens,protein concentration measurement (Bradford),SDS electrophoresis,protein enzymolysis,iTRAQ mark,SCX,2D and LC-MS/MS were performed to get the data.The MS/MS data were searched against the International UniProt-Human using the Mascot 2.3.02 for peptide identification and quantification.According to protein abundance,differentially expressed proteins were determined when difference was more than 1.3 times and P<0.05. Results Total 88 differentially expressed proteins were identified between DNT and LGG in China Yellow.44 proteins were significantly up-regulated(>1.3-fold) and also 44 were significantly down-regulated.These proteins had different of biologic activity and participated many metabolisms and signal pathways.The important proteins include aquaporin 1,serine/threonine-protein kinase,chloride intracellular channel 1,annexin A1,glutamine synthetase,chondroitin sulfate proteoglycan 4,S100A9,S100A16,S100A13,isocitrate dehydrogenase and so on. Conclusion The differentially expressed proteins of DNT and LGG identified by proteomic analysis using iTRAQ are reliable.The iTRAQ technology can provide a good platform to identify moresignificant molecule difference biomarkers of DNT and LGG.

Clinical application of 3D printing technology in adult DDH total hip arthroplasty

GUAN Jian-zhong, LIU Ya-jun, WU Min, ZHOU Jian-sheng, WANG Zhao-dong, CHEN Xiao-tian

2016, 14(7): 1080-1082. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.006

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Objective To explore the application and significance of 3D printing technology in total hip replacement surgery in patients with developmental dysplasia of hip (DDH) in adults. Methods Eight cases of DDH (end-stage osteoarthritis of types of adult DDH by Crowe),including 3 males and 5 females;aged 45-63 years with a mean age of 53.6 years,were enrolled into this study.1 case of Crowe I,3 cases of Crowe Ⅱ,3 cases Crowe Ⅲ,and 1 case of Crowe Ⅳ.3D printing technology was performed before the operation to print hip model,and based on the model,we determined acetabular sclerosis and defect,defect range,oval fossa osteophytosisn,development of pre-operative planning,simulated surgical procedure,preoperative acetabular determine the true center,the size of the acetabular prosthesis model.Then the surgery operation was performed,and the intraoperative findings of the sclerosis and acetabular defect,defect range,oval fossa osteophytes hyperplasia were documented,and the acetabular grinding range and the selected size of the prosthesis,operation time and blood loss were recorded.The hip joint activities were evaluated after the surgery. Results The intraoperative findings of acetabular defect and hardened parts,defect size,intraoperative acetabular prosthesis polished range and the determined acetabular surgery center position were fully consistent with the 3D printed prosthesis model.The operative time and blood loss significantly reduced as compared with the traditional surgery.The size of the prosthesis prepared before the surgery was full fit with intraoperative prosthesis.The hip function was improved significantly after the operation with good activity. Conclusion 3D printing technology can reduce the difficulty of total hip replacement for DDH.By using this technology in total hip replacement for DDH,we can decrease the operation time and amount of bleeding,and improve the postoperative hips activity.

The control study of ziprasidone and olanzapine in consolidation therapy of schizophrenia patients

TANG Jian-liang, JIN Wei-dong, JIANG Zhang-wang, JIANG Yong-hong

2016, 14(7): 1083-1085,1242. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.007

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Objective One hundred and ninety-seven cases were selected into the trial.All the patients were administered with ziprasidone and olanzapine within the first 5 weeks.After 5 weeks all patients were randomly divided into combination group(98 cases administered with ziprasidone and olanzapine) and single group (99 cases administered only with ziprasidone).All patients were assessed by Positive And Negative Syndrome Scale(PANSS),Clinical Global Impression Scale(CGI),Treatment Emergent Symptom Scale (TESS) before treatment and at the 1^st,5^th,7^th,9^th,12^th weekend after treatment. Results The scores of PANSS of both 2 groups started to decrease at the 1^st weekend compared with pre-treatment(t=-4.76,P=0.00;t=-8.89,P=0.00),and there was significant difference in scores of PANSS at the 5^th,7^th,9^th,12^th weekend after treatment(P>0.05) in both two groups compared with pretreatment.The scores of CGI of both 2 groups started to decrease at the 1^st weekend,but they didn't have statistical difference compared with pre-treatment(t=-1.84,P=0.10;t=-1.73,P=0.18),while there were statistical differences in scores of CGI at the 5^th,7^th,9^th,12^th weekend after treatment (P>0.05) in both two groups when compared with pretreatment.There was significant difference in scores of TESS between the 2 groups at the 7^th and 12^th weekend after treatment (P<0.05). Conclusion After 5-week treatment with ziprasidone and olanzapine,the efficacy of consolidation treatment by single ziprasidone was almost amount to that by combination of ziprasidone and olanzapine,and the use of single ziprasidone didn't have obvious adverse reaction,which could improve the patients' compliance so as to the benefit of their long-term treatment.

Diagnosis and surgical treatment for complex solitary fibrous tumor in the mediastinum

ZHANG Lei, LIU Xue-gang, LI Xiao-jun, LIU Ge, SONG Chao, GENG Yang

2016, 14(7): 1086-1089. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.008

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Objective To investigate the clinical features,diagnosis and surgical treatment of complex mediastinum solitary fibrous tumor(SFT),and analyze the conditions of treatment and prognosis of such diseases. Methods The clinical data of three complex mediastinum SFT patients confirmed by postoperative pathology and immunohistochemistry in our hospital between May 2014 and June 2015 were analyzed retrospectively.The follow-up materials were reviewed.The main clinical manifestation of these three patients included the irritating dry cough in one patients,chest tightness and shortness of breath in one patient,and chest discomfort in one case.The enhanced chest CT examination was performed in all patients before the operation.No metastasis and other surgical contraindications were found.The proper surgical method was selected according to the location of the tumor.The operation methods included:left posterior-inferior mediastinum tumor was cut via the left for tumor resection;left posterior-inferior mediastinum tumor via left for tumor resection and with left-lower lobectomy;inferior-right-posterior mediastinum tumor resection via right into the chest,mark the serious part with titanium clip,and postoperative four weeks for radiotherapy.The examinations in follow up included one month later review of chest X-ray,3 to 6 months after the operation for the chest CT,and 1 to 3 years after the operation for one time of chest CT yearly. Results All patients were operated successfully,and the tumor was resected completely.Among them,one patient had more serious chest tightness,which was improved after the symptomatic treatment.All of the 3 patients were followed up,and no recurrence and metastasis during the follow-up period. Conclusion Complex mediastinum SFT is a rare mediastinal tumor,diagnosis should be made by pathology and immunohistochemistry analysis,surgical treatment is the first choice,with complete resection and good prognosis,and close follow-up is required,for the severe postoperative invasion,neoadjuvant radiotherapy is required.

A Meta-analysis of the outcomes and postoperative complications of laparoscopic and open surgery for colonic cancer

QIAO Zheng-bo, HONG Shu-jian, PENG Hui, PANG Shan-shan, HUANG Pu, LI Qiang, HUANG He

2016, 14(7): 1090-1094,1162. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.009

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Abstract:
Objective To evaluate the outcomes and postoperative complications of laparoscopic surgery and open surgery for colonic cancer. Methods The reported randomized controlled trials on the outcomes and postoperative complications of laparoscopic versus open surgery for colonic cancer between Jan.2005 and Jan.2015 were collected by searches of CNKI and VIP.The criteria of literature enrollment and exclusion was made,strictly according to which the literatures were screened.Data were extracted from these literatures,and data analysis was performed by RevMan 4.7. Results A total of 2 766 patients from 25 literatures was selected,including 1 392 patients in the laparoscopic surgery group and 1 374 patients in the open surgery group.Except body mass index,the age and gender were similar between the two groups.The results of this Meta-analysis indicate that the operation time and number of lymph node dissection in both group had no statistical differences(P>0.05),while the intraoperative blood less,intestinal function recovery time,average time of hospital stay were evidently lower and shorter than the patients in the open surgery group(P<0.05).Moreover,the incidences of intestinal obstruction and intestinal fistula were lower than the open group(P<0.05).There was no statistically significant difference in the Long-term outcomes between the two groups(P>0.05),including recurrence rate in 5 years,survival rate in 3 years and 5 years. Conclusion The long-term outcomes of laparoscopic surgery group are similar to that of open surgery group for colon cancer,however,the laparoscopic surgery group has obvious advantages in short-term outcomes and postoperative complications.Therefore,laparoscopic surgery for colon cancer is an acceptable alternative.

Effect of suppressor of cytokine signaling 3 on insulin receptor substrate-1 and its serine phosphorylation in diabetes rat models

ZHANG Xu, CHEN Jun-guo, WU Ming, LU Yan, ZHANG Ai-lian, WANG Qiong, PING Ming-fang

2016, 14(7): 1095-1097. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.010

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Objective To observe the expression of suppressors of cytokine signaling 3(SOCS-3),insulin receptor substrate-1(IRS-1)and phospho-IRS-1(PIRS-1^Ser307)in liver and skeletal muscle,and to explore molecular mechanisms of insulin resistance in diabetes rats models. Methods Forty male SD rats were randomly divided into two groups,the control group(20 male rats)fed with standard diet,and the Diabetes group(20 male rats)were fed with high sucrose-fat diet for 4 weeks and then injected intraperitoneally with streptozotocin(STZ),16 male rats met the criteria of type-2 diabetes.The expressions of SOCS-3,IRS-1 and PIRS-1^Ser307 in liver and skeletal muscle were detected by Real-time PCR and Western blot.The data were analyzed by T-test and Pearson linear correlation analysis. Results ①AS compared with control group,diabetes group showed that mRNA and protein expression of IRS-1 of liver and skeletal muscle were decreased(P<0.05),the expression of SOCS-3 and PIRS-1^Ser307 were increased(P<0.05).②The expression of SOCS-3 in liver and skeletal muscle were negatively correlated with IRS-1(r=-0.865,-0.756,P<0.05) and positively with PIRS-1^Ser307 in diabetes group(r=0.678,0.663,P<0.05). Conclusion Diabetes rats possibly produced insulin resistance by up-regulating SOCS-3 expression,by decreasing IRS-1 and increasing its serine phosphorylation levels in liver and skeletal muscle.

Effect of statins combined with mesenchymal stem cell infusion in treatment ofautoimmune myasthenia gravis

SHA Peng, HAN Qi, WANG Yun-fu

2016, 14(7): 1098-1100. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.011

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Objective To research clinical effect of statins combined with mesenchymal stem cell infusion in treatment of autoimmune myasthenia gravis. Methods A total of 20 consecutivecasesof autoimmune myasthenia gravisbetween February,2013 and May,2014 were divided randomly into control group and experiment group with 10 cases in each group.The patients in the control group received conventional hormone and(or) immunosuppressive therapy,while the patients in the experiment group received statins combined with mesenchymal stem cell infusion.Lennon score of muscle strength,comprehensive function score of clinical symptoms including progress degree,cognitive function,motor function,self-care action and social adaptation,and CD28 expression of CD4⁺T lymphocyte cell and IL-4 level were compared between the two group. Results After about three months of follow-up, two groups of patients Lennon scores were lower, comprehensive function scores were increased, and the more obvious changes in the observation group,groups were significantly more when compared with those the control group(P<0.05).And the progress degree,cognitive function,motor function,self-care action and social adaptation scores in the experiment group were all better as compared with the control group(P<0.05).CD28 expression and IL-4 levels after the treatment were lower in both groups,especially in the experiment group(P<0.05). Conclusion The statins combined with mesenchymal stem cell infusion can greatly improve the clinical symptoms of patients with autoimmune myasthenia gravis by decreasing CD28 expression and IL-4 levels.

Long-term effects of uvulopalatopharyngoplasty in treatment of OSAHS

CAO Hai-yan, LU Hua-dong

2016, 14(7): 1101-1103. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.012

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Treatment of“High”supracondylar humerus fractures in children using closed reduction and percutaneous kirschner wire fixation

LI Yang, SUN Jun, YUAN Yi

2016, 14(7): 1104-1106. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.013

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Objective To evaluate the efficacy of closed reduction and percutaneous Kirschner wire fixation in the treatment of "High" supracondylar humerus fractures in children. Methods The closed reduction and percutaneous Kirschner wire fixation were performed in 32 children with upper supracondylar humerus fractures in our hospital between January,2013 and July,2015 After 4 weeks of plaster external fixation,the radiography was performed to confirm the condition of fractures,and the internal and external fixation were removed and functional exercise was carried out when the fractures were healed. Results All patients were followed up for 3 to 12 months.Flynn clinical functional assessment standards showed the excellent in 26 cases,good in 5 cases and general in 1 case.All cases achieved satisfactory results.Elbow movement function recovered in the shortest period of 1.5 months after the surgery,the longest period of 3 months after the surgery.There was no case with fractures displacement,functional limitations,ulnar nerve injury,and irritation of the surrounding soft tissues. Conclusion Closed reduction and percutaneous Kirschner wire fixation is effective for the supracondylar humerus fractures in children,which can avoid the surgical trauma and postoperative scar caused by open reduction,obtain strong stability and obtain a good elbow function.The operation is simple and safe with small trauma and fewer complications.It is worthy promotion in clinical application.

Clinical significance of plasma interleukin 33 changes in elderly acute coronary syndromes complicated with diabetic mellitus

ZHENG Rui, LI Miao-nan, WU Wen-ting, WANG Hong-ju

2016, 14(7): 1107-1110. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.014

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Objective To detect the interleukin 33 level in elderly acute coronary syndromes(ACS) complicated with diabetic mellitus (DM) and to explore the relationship between IL-33 level and ACS with DM in elderly patients. Methods A total of 188 patients(age ≥ 65 years) with coronary angiography in our hospital were summarized including 105 males,averaged (70.8±4.4)years old.The patients were divided into 3 subgroups:Control group(n=64 normal subjects),ACS without DM group(n=73) and ACS+DM group(n=51).Plasma IL-33 levels were measured by ELISA and the vascular stenosis degree was quantitatively calculated with Gensini score. Results The IL-33 levels in ACS+DM group were significantly higher than those in ACS without DM group(P<0.01),and the IL-33 levels in ACS without DM group were significantly higher than those in the control group(P<0.01).Compared with ACS without DM group,the ACS+DM group had more patients with multiple vascular lesions and less patients with single vascular lesions(P<0.01).The Gensini score was positively related to IL-33 level in both ACS+DM group and ACS without DM group(r=0.663,P<0.01). Conclusion The plasma IL-33 level is high in elder ACS patients and the elevation level is related to vascular lesion degree complicated with DM,which indicate that the inflammatory reaction mat be present in vascular endothelial with those patients.

Etiologic study on febrile respiratory illness of 120 inpatients in Fuyang

YANG Li-li, HAN Ming-feng, TENG Xiao-bao, ZHAO Feng-de, SHI Jing-feng, ZHANG Xiao-hua, LI Guo-lan

2016, 14(7): 1111-1113,1219. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.015

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Objective To investigate the composition of bacterial pathogens of the patients suffering from febrile respiratory illness(FRI) in Fuyang,and to provide a theoretical basis for the clinicians. Methods The blood,sputum and urine samples from 120 inpatient with febrile respiratory syndrome in our hospital from October,2014 to September,2015 were prepared.The sputum culture,blood culture,urine antigen test and PCR were performed to test the pathogens including Streptococcus pneumoniae(SP),Staphylococcus aureus(SA),Klebsiella pneumoniae(KP),Pseudomonas aeruginosae(PA),β-hemolytic streptococcus(β-HA),Heamophilus influenzae(HI),Mycoplasma pneumoniae(MP),Chlamy-dia pneumoniae(CT),and Legionella pneumophla(LP). Results The positive rate of this 120 cases was 43.3%,in which SP accounts for 15.8%,SA accounts for 0.8%,KP accounts for 5%,PA accounts for 7.5%,and CP accounts for 9.2%.While β-HA,CT and LP were not tested.There were 5 cases with mixed infections,and the mixed infection rate was 4.2%.All of the 120 patients were diagnosed with community-acquired pneumonia,among which 75 patients were community-acquired pneumonia,whose positive rate of pathogen infection was 38.7%,and two patients were with mixed infection,whose mixed infection rate was 2.7%.Besides,there were 45 patients who were diagnosed with chronic obstructive pulmonary disease,their positive rate of pathogen infection was 48.9%,and three patients were mixed infection,their mixed infection rate was 6.7%. Conclusions In Fuyang area,the first three pathogens of febrile respiratory illness are SP,HI and MP,and the mixed infections are more common.The principal disease of febrile respiratory syndrome is community-acquired pneumonia.There are differences in pathogen spectrum for community-acquired pneumonia and the COPD with community-acquired pneumonia.

A comparison of therapeutic effects of incision and thread-drawing technique via incision and thread-drawing technique plus selective suture in the treatment of high anal fistula

YUAN Xian-cang

2016, 14(7): 1114-1117. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.016

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Objective To compare the clinical efficacy of incision and thread-drawing technique via incision and thread-drawing technique plus selective suture in the treatment of high anal fistula,and explore the effective and reliable surgical methods for high anal fistula. Methods Total 60 patients with high complex anal fistula were randomly assigned into two groups by number table method.The observation group(n=30) received the incision and thread-drawing technique plus selective suture,while the control group(n=30) received incision and thread-drawing therapy.The healing time,curative rate,anal function score and incidence of complications were compared between the two groups. Results The healing time of the observation group was(22±4) d,of the control group was (24±5) d,the difference was statistically significant(t=3.240,P<0.01).The follow up of six months showed that the curative rate in the observation group was 96.7%,and in the control group was 86.7%,the difference was statistical significance(χ²=3.857,P<0.05).The postoperative anal function score in the observation group was 4.8±1.2,and in the control group was 6.8±1.3,and difference was statistically significant(t=2.671,P<0.01).The follow up of six months showed that there were 4 recurrence cases in the control group and 0 in the observation group,and there was no anal incontinence in both groups. Conclusion Both incision and thread-drawing technique via incision and thread-drawing technique plus selective suture are effective in the treatment of high anal fistula.The incision and thread-drawing technique plus selective suture shows more advantage in the healing time,curative rate and postoperative anal function as compared with incision and thread-drawing technique,which is a better method for high anal fistula.

Risk factors for coxa varus in intertrochanteric fracture patients performing internal fixation treatment

WANG Xian-ming, CUI Kai, CAO Yu-qiang, TAI Peng-yue

2016, 14(7): 1117-1119. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.017

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Objective To investigate the risk factors of coxa varus in intertrochanteric fracture patients treated by internal fixation to provide support for treatment and nursing on intertrochanteric fracture. Methods Total 159 cases of intertrochanteric fracture patients treated by internal fixation from January,2010 to December,2014 in our hospital were retrospectively analyzed.Inclusion criteria:diagnosed as intertrochanteric fractures by imaging;fresh closed fracture;non-pathological fracture or non-other types fracture;conscious and without mental illness.The patients were clinical treated with internal fixation for the treatment and healed at one period.Based on the postoperative varus status,patients were divided into varus group(24 cases) and non-varus group(135 cases).The risk factors questionnaire was made,and patients gender,age,body mass index,bone mineral density,fracture type,internal fixation method,lesser trochanter reseting status,loading time of two groups were selected.The Univariate and Logistic regression analysis were used to analyze the dates. Results In all 159 cases patients,24 cases were with coxa varus,and the varus rate was 15.1%.Univariate and Logistic regression analysis showed that age,body mass index,bone mineral density,fracture type,small rotor reset,load time were the risk factors of coxa varus in intertrochanteric fracture patients treated by internal fixation. Conclusion After intertrochanteric fracture fixation,coxa varus is common;and age,body mass index,bone mineral density,fracture type,small rotor reset,load time are the risk factors of coxa varus in intertrochanteric fracture patients treated by internal fixation.

Effect of Proseal laryngeal mask airway on stress reaction in patients with interventional procedures in department of neurosurgery

XU Xiao-cheng, WANG Lin, XU Jun-qin, LIN Xue-zheng

2016, 14(7): 1120-1122. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.018

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Abstract:
Objective To observe the effect of Proseal laryngeal mask(LAM) airway on the hemodynamics and stress response of patients with interventional procedures in department of neurosurgery. Methods Total 80 patients undergoing interventional surgery in our hospital from January,2015 to August,2015 were selected as the research objects.All patients met the indications for surgery treatment,ASA grade Ⅱ-Ⅲ level.According to the paired grouping method they were divided into two groups with 40 cases in each group.Two groups were given penehyclidine hydrochloride 0.5 mg/kg,midazolam 0.05 mg/kg,etomidate 0.3 mg/kg,rocuronium bromide 0.6 mg/kg,fentanyl 3 μg/kg,given oxygen mask,when muscle were relaxant,the control group were treated with endotracheal intubation while the observation group was given Proseal type laryngeal mask.The blood flow dynamics related indicators and level of cortisol at different time points were compared between the two groups. Results MAP during intubation,5 min after intubation and during extubation were (85.9±10.2)mm Hg,(83.6±9.4)mm Hg and (87.6±8.9)mm Hg in the observation group,which were lower than (95.4±9.6)mm Hg,(90.1±8.3)mm Hg and (96.4±9.3)mm Hg in the control group;HR during intubation,5 min after intubation and during extubation were (69.8±6.7)/min,(68.7±6.9)/min and (65.3±6.9)/min,which were less than (75.8±6.8)/min,(76.1±7.2)/min and(71.4±6.5)/min in the control group,the results revealed a more stable blood flow kinetics when compared with the control group.The levels of cortisol during intubation,5 min after intubation,during extubation and 5 min after the extubation in the observation group were (34.6±1.1)ng/ml,(34.1±1.2)ng/ml,(37.9±1.5)ng/ml and (37.4±1.9)ng/ml,which were lower than (35.9±1.2)ng/ml,(35.8±1.3)ng/ml,(40.3±1.6)ng/ml and (40.9±2.1)ng/ml in the control group,the difference was statistically significant,P<0.05. Conclusion Proseal type laryngeal mask insertion in patients with neurosurgical intervention were with lower level of stress response and more stable hemodynamics.It has important clinical value.

Correlation between plasma homocysteine level and neurological deficit and prognosis of cerebral infarction patients

ZHANG Yong-qiang, LI Ling-xiao, YING Xiao-wei, WANG Xi-jia, YUAN Fen-fen

2016, 14(7): 1123-1124,1137. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.019

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Objective To observe the plasma homocysteine(Hcy) level of patients with cerebral infarction in order to investigate the relationship between homocysteine(Hcy) level and the incidence and prognosis of cerebral infarction,and provide the reference for the early monitoring and treatment of cerebral infarction. Methods Ninety-two cases of cerebral infarction patients were selected as the experiment group who were treated in the Civil Aviation General Hospital from January,2013 to January,2014,and 80 healthy volunteers were selected as the control group.There was no significant difference in the age and sex between the two groups.The plasma homocysteine(Hcy) levels of the two groups were compared.The patients in the experiment group were scored according to the degree of defect of the clinical neurological function.The plasma Hcy levels and prognosis of different defect degree were compared. Results The average plasma Hcy of the experimental group was (18.13±4.51) μmol/L,significantly higher than that of the control group(9.24±2.88) μmol/L(χ²=15.712,P=0.017),and the difference was statistically significant.The plasma Hcy in the experiment group of patients with nerve defect degree of slight group,moderate group and severe group was respectively (15.83±2.51) μmol/L,(18.99±4.24) μmol/L and (13.13±3.98) μmol/L,P>0.05,and the differences between different groups were not statistically significant.Patients in the experimental group were followed up for 1 years,and the level of plasma Hcy in the no outcome patients with as (16.31±1.54) μmol/L,but the average plasma Hcy of disability or death patients was (20.43±3.01) μmol/L,and the difference was statistical significance(χ²=22.571,P=0.008). Conclusion The plasma homocysteine level in patients with cerebral infarction can significantly increase and be related to the degree of neurological deficit,which is sensitive indexes of cerebral infarction patients in the course of disease monitoring and prognosis.

Influence of different doses of Atorvastatin on high sensitivity C-reactive protein and soluble vascular cell adhesion molecule1 in patients with coronary atherosclerotic heart disease combined with hyperlipidemia

MENG Hui, WANG Yu-ping

2016, 14(7): 1125-1126,1223. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.020

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Objective To analyze the influence of different doses of Atorvastatin on high sensitivity C-reactive protein and soluble vascular cell adhesion molecule 1 in patients with coronary atherosclerotic heart disease(CHD) combined with hyperlipidemia. Methods Total 100 cases were selected and randomly divided into 40 mg Atorvastatin calcium group(A,50 cases,half unstable angina and half myocardial infarction) and 20 mg Atorvastatin calcium group(B,50 cases,half unstable angina and half myocardial infarction).Before and after 4 weeks and 12 weeks treatment,the serum total cholesterol(TC),high-sensitivity C-reactive protein(hs-CRP) and soluble vascular cell adhesion molecule 1(sVCAM-1) level was tested,and the major adverse drug reaction were recorded. Results No statistical significant difference was found about TC,hs-CRP,sVCAM-1 between group A and group B before Atorvastatin treatment(P>0.05),there was significant difference about hs-CRP,sVCAM-1 in patients with myocardial infarction compared with unstable angina before Atorvastatin treatment(P<0.05);There was significant difference about TC after 4 weeks and 12 weeks treatment compared with before treatment in each group(P<0.05).And A group had the remarkable significance with B group of TC level(P<0.05);There was significant difference about hs-CRP,sVCAM-1 after 12 weeks treatment compared with before and after 4 weeks treatment in group A(P<0.05).There was no obvious adverse drug reaction in each group. Conclusion High doses of Atorvastatin is safe and effective in patients with coronary atherosclerotic heart disease combined with hyperlipidemia,it can significantly decrease blood cholesterol and inflammatory factors levels and may stabilize atherosclerotic plaque.Atorvastatin might play a role in the prevention of CHD.

The curative effect of desonide cream combined with Multi embellish skin care agent for chronic eczema

CHEN Tian-zhu, PAN Xiao-wen, JIA Tian-jian

2016, 14(7): 1127-1128,1168. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.021

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Objective To evaluate the curative effect of desonide cream combined with Multi embellish skin care agent for chronic eczema. Methods Seventy-eight patients were randomly divided into treatment group and control group.Forty-two cases in treatment group were treated with desonide cream and Multi embellish skin care agent,each twice a day.Thirty-six cases in control group were trated with desonide cream,twice a day,two groups are using 4 weeks.Before and after treatment,the total score of the site,symptoms and skin lesions were evaluated according to EASI score.Adverse drug reactions were observed and recorded during the course of treatment.The recurrence rate of cured cases was assessed after 2 months. Results In the treatment group of 42 cases,28 cases were cured,10 cases had marked effect;In the Control group of 36 cases,15 cases were cured,9 cases had marked effect.Two groups of curative effect comparison difference was statistically significant(Z=-2.759,P<0.05).The recurrence rate of cured cases was assessed after 2 months,In treatment group of 28 cases,2 cases of recurrence,the recurrence rate was 7.1%.In the control group of 15 cases,5 cases of recurrence,the recurrence rate was 33.3%.The recurrence rates in the two groups had statistically significant difference(the use of Fisher's exact probability method,P<0.05).There were no obvious adverse reaction in two groups. Conclusion Desonide cream combined with Multi embellish skin care agent in the treatment of chronic eczema has better curative effect and high safety.

Effect of modified electroconvulsive therapy on thyroxine and sex-hormone of patients experiencing an episode of depression

TANG Chen-dong, SHEN Xiao-yan, ZHENG Yao, CHA Xian-you, LI Ya-ling, LI Guo-rong, TANG Jian-liang

2016, 14(7): 1129-1131. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.022

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Objective To explore the effect of modified electroconvulsive therapy(MECT) on thyroxine and sex-hormone of the of patients experiencing an episode of depression. Methods Fifty-seven patients meeting the criteria of ICD-10 for depression episode were enrolled into the study.The levels of serum free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),triiodothyronine(T3),thyroxine(T4),testosterone(T),estradiol(E2) and prolactin(PRL) were tested at 30-minutes after the treatment and the end of treatment.Hamilton Depression Rating Scale(HAMD) was performed before and after the treatment to assessseverity of symptom.The correlations among thyroxine,sex-hormone and scores of HAMD were analyzed. Results Thyroxine had no significant changes,E2 was significantly decreased 30-minutes after the treatment(P<0.01),while PRL was significantly increased after that(P<0.01).T3,FT3 and E2were significantly increased at the end of the treatment(P<0.01).There was significant negative correlation between level of T3 and scores of retardation factor before and after the treatment(r=-0.480,r=-0.471,P<0.01).There was significant negative correlation between level of T and scores of retardation factor before and after the treatment(r=-0.412,r=-0.385,P<0.01) while no correlation among other thyroxine,Sex-hormone and scores of HAMD. Conclusion The clinical doctors can evaluate the efficacy and adjust treatment plan based on the levels of thyroxine and sex-hormone in depressive episodes patients receiving MECT.

Clinical observation of the joint BIS for ultra slow induction of general anesthesia in elderly patients

YANG Heng, ZHENG Han, ZHANG Yun-yun, HU You-yang, LUO Hong

2016, 14(7): 1132-1133,1181. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.023

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Objective To observe the clinical effects of the joint BIS monitoring and etomidate,remifentanil,cis-atracurium total intravenous anesthesia on general anesthesia in elderly patients. Methods Thirty cases required general anesthesia for elective ultra elderly critically ill patients were randomly divided into group A and group B by using a random number table,15 cases in each group.Group A were induced analgesia slow endotracheal intubation with amnesia,group B with quick tracheal intubation.Record respectively before anesthesia induction(T₀),after induction(T₁),intubation immediate(T₂),after intubation 3 min(T₃),surgery(T₄) at the end of the two groups of patients with MAP,HR,SpO₂ and PETCO₂.Record two groups of patients after extubation agitation score,adverse reactions and dosage of anesthetics. Results Compare with before induction MAP,HR ison,group B at T1 decreases in T₂,T₃ point increased,the difference was statistically significant(P<0.05);Compare with group A MAP,HR group B at T₁ decrease in T₂,T₃ point increased,the difference was statistically significant(P<0.05).After surgery extubation restlessness score,the number of cases of adverse reactions in group A was significantly lower than group B,the difference was statistically significant(P<0.05);The dosage of etomidate and cis atracurium was reduced in group A than group B. The difference was statistically significant(P<0.05).Intraoperative each time SpO₂ and PETCO₂ difference has no statistically significant(P>0.05). Conclusion Joint BIS-induced amnesia and analgesia slow etomidate,remifentanil,cis atracurium total intravenous anesthesia can be safely and effectively used in very elderly patients.

Correlation analysis of plasma Hcy and QRS duration in coronary heart disease patients with heart failure

CHOU Xiao-min, HU Xiao-sheng, PU Jian-fen, YE Ling-ling, YU Bing-kui

2016, 14(7): 1134-1137. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.024

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Objective To explore the levels of plasma Hcy and QRS duration in coronary heart disease (CHD) patients with heart failure(HR),and analyze the correlation between them. Methods Total 110 cases CHD patients with heart failure in the observation group were divided into Ⅱ,Ⅲ,Ⅳ subgroups according to the NYHA class.The patients with stable coronary artery disease angina were selected as the CHD control group,the non-CHD patients with heart failure were selected as the heart failure control group,and the healthy volunteers were as healthy control.The cardiac function index,levels of brain natriuretic peptide(BNP) and Homocysteine(Hcy),and QRS wave duration of all the subjects were measured. Results The levels of BNP and Hcy,LVEDD and QRS duration in the observation group,HF control group and CHD control group were significantly higher than that of healthy control group,LVEF was significantly lower than that in the healthy control group,the differences were statistically significant(P<0.05);the levels of Hcy and QRS duration with Ⅲ and Ⅳ heart function class were significantly higher than that with the Ⅱ heart function class,Hcy level and QRS duration in Ⅳ heart function class were significantly higher than the Ⅲ heart function class,the differences were statistically significant(P<0.05);Pearson correlation analysis showed that Hcy level and QRS duration were significantly positive correlation(P<0.001;Hcy level and QRS duration were positively related to BNP level and LVEDD,and negative correlated with LVEF. Conclusion The level of plasma Hcy is significantly high in CHD patients with heart failure,and increase with the NYHA class.Hcy level is significantly positively related to QRS duration.The combined tests of Hcy level and QRS duration can be used as an important index in evaluating the cardiac function status of CHD patients with heart failure.

Changes of blood coagulation function in patients with acute pancreatitis and its relationship with the severity and prognosis of disease

CHENG Yan-dong, ZHENG Shao-jun, YANG Qin, CUI Wei

2016, 14(7): 1138-1140. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.025

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Objective To explore the changes of blood coagulation function in patients with acute pancreatitis and its clinical significance. Methods Total 67 cases patients with acute pancreatitis in our hospital from January,2013 to June,2014 were enrolled and assigned into observation group,and further divided into mild group(MAP group),severe group(SAP group),multiple organ dysfunction syndrome(MODS) and non-MODS group.35 healthy volunteers at the same period in our hospital were recruited as control group.Prothrombin time(PT),part of the activation of prothrombin time(APTT),concentration of fibrinogen(FIB) and D-dimer(D-D) were tested and compared.The relevance to acute physiology and chronic health evaluation(APACHEⅡ) was analyzed. Results The blood coagulation function index and APACHEⅡ score in the observation group were significantly higher than that in the control group,the BPC was significantly lower than that in the control group,the difference was statistically significance(P<0.05);The blood coagulation function index and APACHEⅡ score in SAP group were significantly higher than that in MAP group,the BPC was significantly lower than that in MAP group,the blood coagulation function index and APACHEⅡ score in MODS group were significantly higher than that in non-MODS group,the BPC was significantly lower than that in non-MODS group,the difference was statistically significance(P<0.05);Pearson correlation analysis showed that blood coagulation function index of PT,APTT,FIB and D-D were positively related to the APACHEⅡ score,while BPC was significantly negative related to the APACHEⅡ score(P<0.05). Conclusion There is blood coagulation dysfunction in patients with acute pancreatitis,it's closely associated with the severity and prognosis of diseases.

Relationship between serum indoxyl sulfate level and indices associated with cardiovascular disease in patients with chronic kidney disease

BAI Yun-huan, YANG Yuan-yuan, JIANG Ya-fen, JIANG Yun-sheng

2016, 14(7): 1141-1143. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.026

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Objective To explore the relationship between serum indoxyl sulfate(IS) levels indices associated with cardiovascular disease(CVD) in patients with chronic kidney disease(CKD),and to provide clinical reference for the prevention of cardiovascular events in CKD patients. Methods Total 112 cases of CKD was recruited and divided into stage 3 group,stage 4 group and stage 5 group,and 40 normal subjects were assigned into the control group.The general clinical data were recorded.The serum IS level was detected by high performance liquid chromatography.CVD indices such as LVDd,IVST,LVPTW,EF,A,E and A/E were measured by Color Doppler echocardiography.The relation between IS and CVD indices were analyzed statistically. Results The biochemical indices and the serum level of IS of all patients in CKD groups were obviously higher than that of the control group.The serum level of IS was (0.08±0.06) μg/ml in the control group,and (0.13±0.12) μg/ml,(0.48±0.53) μg/ml and (2.74±2.49) μg/ml(P<0.05) in CKD 3/4/5 groups,respectively;serum IS was increased with the decreased renal function(P<0.05);the abnormal cardiac structure and function were shown in CKD patients,while interventricular septum and the ventricular wall were thicken and ventricular diameter were increased,the A/E>1,the ejection fraction were declined,significantly positive correlation were detected among serum IS and CVD indexes (systolic pressure,diastolic blood pressure,TC,TG,LDL-C,P,iPTH,IVST,LVPWT). Conclusion IS can be accumulated in serum along with the decline of renal function in CKD patients;patients with CKD and CVD always has myocardial hypertrophy and ventricular systolic and diastolic dysfunction;IS may play an important role in the development of CVD in CKD patients.

Drug utilization review and drug utilization evaluation for evaluation of usage of hepatoprotective drugs in hospitalized patients with Chronic hepatitis B

SHEN Bin, JIANG Li-ya, CHEN Meng, ZHOU Mei-hua, ZHOU Yue-hong

2016, 14(7): 1144-1146. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.027

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Objective To evaluate the status quo and the rationality of the drug utilization in hospitalized patients with chronic hepatitis B,and provide reference for rational clinical usage of drugs. Methods The methods of drug utilization review(DUR)and drug utilization evaluation(DUE) were used to analyze the drug utilization index(DUI),drug application situation,monitoring of therapeutic process as well as therapeutic outcome of chronic hepatitis B hospitalized in our hospital. Results Total 97 cases of patients with hepatoprotective 17 species and 21 varieties and specifications,DDDs of the top 3 drugs were polyene phosphatidylcholine injection,injection with succinic acid adenosine methionine and injection with compound glycyrrhizin.The DUIs of 5 kinds of drugs were more than 1,DUI=1 was found in 13 kinds;and DUI<1 was found in 3 kinds.Single,double,triple and quadruple drug constituent ratio were 30.93%(30/97),46.39%(45/97),17.53%(17/97)and 5.15%(5/97),respectively,corresponding to the recovery or improvement of liver function in patients with constituent ratio were 70.00%(21/30),91.11%(41/45),82.35%(14/17)and 60.00%(3/5).The study subjects were in line with the pathogen and clinical stage,and only 3.09%(3/97)were confirmed by pathological stage.97 patients had abnormal liver function,the monitoring rate of liver function was 100.00%(97/97),93 patients with the clinical symptoms improved after treatment with anti-inflammatory and hepatoprotective,liver function was restored to normal in 79 patients. Conclusion DUR combined with DUE can be more comprehensive evaluation of drug utilization of the patients with chronic hepatitis B.The usage of hepatoprotective drugs in hospitalized patients with chronic hepatitis B in our hospital is basically reasonable,and double therapy may achieve a good therapeutic effect.

Effects of Shenshuaining granules and calcium dobesilate on the chronic kidney disease

SHEN Shui-juan, HU Zuo-xiang, LI Qing-hua, GUAN Ji-chao

2016, 14(7): 1147-1148,1209. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.028

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Objective CKD failed to get timely and effective treatment,and ultimately into the end of end-stage renal failure will require long-term renal replacement therapy.Calcium dobesilate was first used in diabetic retinopathy,and it was found to be effective for diabetic nephropathy.Renal Failure Granules used to renal insufficiency patients caused by various reasons.To observe the effects of Renal Failure Granules and calcium dobesilate on the chronic kidney disease. Methods One hundred and twenty patients with stage 3-4 CKD caused by primary chronic glomerulonephritis were put into three groups including 40 patients taking calcium dobesilate.Thirty-eight patients took Renal Failure Granules and 42 patients took Renal Failure Granules and calcium dobesilate.The patients took 500 mg of calcium dohesilate two times a day,one pack of Renal Failure Granules three times a day.day.Then observe the levels of serum creatinine(Cr).Urea nitrogen(BUN) and glomerular filtration rate(GFR) before treatment and after four weeks of treatment and eight weeks of treatment. Results ①Cr,eGFR,and BUN were not significantly different in the 3 groups before treatment,the Cr and BUN were decreased after 4 weeks,8 weeks after treatment,and eGFR was increased,and it was statistically significant(P<0.01).②Compared with the combined treatment group and calcium dobesilate group,the Cr and BUN in the combined treatment group were decreased after 4 weeks,8 weeks after treatment,and eGFR was increased,and it was statistically significant(P<0.05).③Compared with the combined treatment group and Renal Failure Granules group,the BUN in the combined treatment group were decreased and eGFR was increased after 4 weeks,8 weeks after treatment,and it was statistically significant(P<0.05).The Cr in the combined treatment group was decreased after 8 weeks. Conclusion Separate use of calcium dobesilate and renal failure granules can improve renal function of patients with stage 3-4 CKD,but the two drug combination therapy is more significant.

Effect of ganciclovir on improving listening comprehension in infants with cytomegalovirus infection and Connexin 26 gene mutation

LIN Hai-long, ZHOU Jian, LIU Xue-jun, LIN Kai-chun, LU Chao-sheng

2016, 14(7): 1149-1152. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.029

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Objective To study on the effect of ganciclovir on the hearing in the infants with cytomegalovirus(CMV) infection and Connexin 26 gene mutations,and its role in improving the hearing impairment of such infants. Methods The infants with positive CMV-DNA in blood and urine were screened.RT-PCR and DNA sequencing were performed and Connexin 26 gene mutations were found in 70 infants.22 infants with hepatic injury were assigned into Group Ⅰ(22 cases,receiving ganciclovir treatment),while 48 infants without liver function damage were divided into ganciclovir treatment group(Group Ⅱ,24 cases) and non ganciclovir treatment group (Group Ⅲ,24 cases).The treatment induced the induction dose of 5 mg/kg Ganciclovir,q12h,continuous 14 days,and then changed to QD maintenance therapy with same dose,continuous 7 days.The liver function index and CMV-DNA copy number were re-detected.The changes of brainstem auditory evoked potential were tracked.The liver function,CMV-DNA copy number and brain stem evoked potential between the two groups were compared. Results After ganciclovir treatment,the liver function in Group Ⅰ was improved obviously(ALT:t=8.610 9,P<0.000 1,AST:t=15.007 7,P<0.000 1,TBil:t=10.993 3,P<0.000 1),CMV-DNA copy number in both Group Ⅰ and Group Ⅱ decreased significantly(t=5.460 4,P<0.000 1),but the hearing impairment by BAEP was improved,even worse in some children,while the infant hearing impairment in Group Ⅲ had no significant deterioration. Conclusion Ganciclovir treatment is effective on the hepatitis caused by cytomegalovirus infection and other inflammatory diseases,but cannot improve the sensorineural hearing loss(neurosensory deafness),especially the hearing impairment associated with Connexin 26 gene mutation in infants.

Current characteristics of Hand-foot-mouth disease and relationship with meteorological factorsin Hangzhou in 2014

LIN Xian-yao, ZHAO Shi-yong, QI Zheng-hong, WU Yi-dong, SONG Wen, WEI Yi, LAO Qun

2016, 14(7): 1153-1155,1158. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.030

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Objective To investigate the epidemiological characteristics and etiological characteristics of hand-foot-mouth disease in Hangzhou in 2014,andstudy on the relationship between morbidity and seasonal influences on the distribution of pathogens. Methods The epidemiological featuresof hand-foot-mouth disease patients in Hangzhou area in 2014 were analyzed.The real-time fluorescence quantitative polymerase chain reaction was performed to detect the levels of virus nucleic acid from throat swab specimens.The correlations of time-place clustering with the local weather were analyzed. Results A total of 6 640 cases of hand-foot-mouth disease were reported,the ratio of male to female was 1.44:1,age 1-3 years old,and the mainpopulation were local scattered children,in Hangzhou,2014.The tests for 2 370 specimens showed that Coxsackie virus type A16(CA16) accounted for 242 cases with a positive rate of 10.2%,enterovirus 71(EV71) for 936 cases with a positive rate of 39.5%,other intestinal virus for 1 192 cases with apositive rate of 50.3%.The peak period for cluster of hand-foot-mouth disease was during May and July with EV71 as the main pathogens.The morbidity and distribution of pathogen were positively correlated with the average temperature,rainfall and relative humidity(P<0.05).And EV71 distributed mainly in the months of the high average temperature,rainfall and relative humidity,however,the universal enterovirus mainly distributed in the months of lower average temperature,rainfall and relative humidity. Conclusion The hand-foot-mouth disease mainly attack the scattered boy aged 1 to 3 years old in Hangzhou in 2014,EV71 and universal enterovirus are themainpathogens.The peak period for cluster of hand-foot-mouth disease was during May and July.The morbidity and distribution of pathogen were positively correlated with the average temperature,rainfall and relative humidity.

Effectiveness of Parecoxib sodium combined with Tramadol for postoperative analgesia in gynaecological laparoscopic surgery

CUI Han, LU: Jie-qiang

2016, 14(7): 1156-1158. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.031

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Objective To explore the preventive effect of Parecoxib sodium(Par) combined with Tramadol (TR) for postoperative analgesia in Gynaecological Laparoscopic surgery(LS). Methods Total 82 cases undergoing surgical treatment in our hospital from August,2014 to March,2016 were selected,and randomly divided into the observation group and the control group with 41 cases in each group.The control group was intravenous injected 2 mg/kg Tramadol at 30 min before the end of surgery,while the observation group was treated with 40 mg Par 30 min before surgery on the basis of control group.The visual analog scale(VAS) at 0.5 h,4 h,12 h and 24 h postoperative,spontaneous breathing recovery time,consciousness recovery time,time to extubation,and incidence of adverse reactions of two groups were recorded and compared. Results VAS score at 0.5 h,4 h,12 h and 24 h after surgery in observation group were (1.7±0.5) points,(1.9±0.8) points,(1.7±1.0) points and (1.2±0.4) points,respectively,while in the control group were (3.2±0.6) points,(3.4±1.0) points,(3.1±0.8) points and (1.9±0.6) points,respectively,VAS scores of each check-point in the observation group were significantly lower than the control group(P<0.05);there was no significant difference in the recovery time of spontaneous breathing,consciousness recovery time and time to extubation between the two groups(P>0.05);the incidence of adverse reaction was 7.3%(3/41) in the observation group,while was 9.7%(4/41) in the control group,the difference between the two groups was not statistically significant(P>0.05). Conclusion Par combine with TR in LS has a significant preventive effect for early postoperative pain,and with high safety,worthy of further promotion in clinical practice.

Clinical comparison between laparoscopic assisted vaginal hysterectomy and vaginal hysterectomy

KAN Hua-wei, WAN Min

2016, 14(7): 1159-1162. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.032

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Objective To compare the clinical efficacy of laparoscopic assisted vaginal hysterectomy(LAVH) and vaginal hysterectomy,and to choose best surgical method for improving the prognosis of patients. Methods From February,2014 to January,2016,forty-eight patients with gynecologic disease undergoing hysterectomy were divided into two groups.The control group(32 cases) received vaginal hysterectomy,while the experimental group(16 cases) received LAVH.The clinical data of the two groups were analyzed retrospectively.The clinical curative effect of both groups was observed.The operational time,bleeding amount,postoperative anal exhaust time,postoperative hospital stays and the incidence of complications were compared between the two groups. Results The operational time in the experimental group was (130.00±32.96) min,which was longer than (81.72±28.67) min in the control group,that related to the establishment of carbon dioxide pneumoperitoneum,serious pelvic adherence,surgical difficulty,and lack of skills by laparoscopy.But the bleeding amount,postoperative anal exhaust time and postoperative hospital stays in the experimental group[(143.75±93.83) ml,(30.06±4.11) h,(5.06±1.24) d] was better than that of the control group[(214.69±68.81) ml,(44.84±5.51) h,(6.16±0.63) d],and the incidence of complications(6.25%) in the experimental group was significantly lower than of the control group(40.63%),the differences were significant(P<0.05). Conclusion The LAVH belongs to minimally invasive operation.It has limpid visual field,can find and deal with other pathological changes in pelvic cavity.It is worthy of clinical application with less blood loss,quick recovery,short hospitalization time,fewer complications and higher safely compared with the vaginal hysterectomy.In clinical practice of hysterectomy,the clinical effect of LAVH treatment compared with vaginal hysterectomy is significant,and it is a reliable clinical implementation of hysterectomy.

Risk factors analysis of 68 cases of children with cerebral palsy

PENG Su-hua, LI Jing, WU Fan, WANG Dong-mei

2016, 14(7): 1163-1165. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.033

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Objective To investigate the risk factors of children with cerebral palsy and provide reference data for clinical treatment. Methods Total 68 cases of children with cerebral palsy in our hospital from August,2014 to August,2015 were assigned into observation group,and 136 healthy children in medical and health department for health examination in the same period were recruited into control group.This study was carried out by ways of 1:2 matched methods.The factors of father smoking status,mother childbearing age,family history,pregnancies number,production times,pre-pregnancy menstrual status,nutritional status,pregnancy disease status,delivery mode,premature birth,birth weight,neonatal asphyxia,neonatal infection,kernicterus,and neonatal hypoxic-ischemic encephalopathy of two groups were accounted and analyzed by univariate and multivariate analyzes. Results Univariate analysis results showed:mother childbearing age,family history,premature birth,birth weight,neonatal asphyxia,kernicterus,and hypoxic-ischemic encephalopathy were the independent risk factors for children with cerebral palsy.Multivariate Logistic regression analysis results showed:mother childbearing age,family history,premature birth,birth weight,neonatal asphyxia,kernicterus,and hypoxic-ischemic encephalopathy are the multivariate risk factors for children with cerebral palsy. Conclusion In recent year,incidence rate of children cerebral palsy is increasing year by year,children cerebral palsy is caused by collective effect of variety factors in clinical.The mother childbearing age,family history,premature birth,birth weight,neonatal asphyxia,kernicterus,and hypoxic-ischemic encephalopathy are the risk factors for children with cerebral palsy.This show the high incidence population of cerebral palsy and provide an epidemiological evidence for early rehabilitation on them.

ZHU Bin, XU Mei-ling, CHE Qun-feng, YANG Hong-rui, YANG Li-mei

2016, 14(7): 1166-1168. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.034

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Surrey of TCM differentiation of symptoms and signs on hypertension in elderly from suburban community of Shanghai

HAN Wei-bin, LIU Mu-song

2016, 14(7): 1169-1171. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.035

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Abstract:
Objective To investigate the distribution of TCM syndromes on hypertension in the elderly from suburban community of Shanghai through the clinical epidemiology cross-sectional survey,so as to provide the objective evidence for TCM syndrome differentiation classification of hypertension,and further understand the differences of dangerous risks among different syndrome patterns to improve the preventive and curative effects of modern Chinese medicine for hypertension. Methods The cluster random sampling was used to survey among the hypertensive patients of 65 years old.The clinical symptoms,signs,tongue and pulse of patients were observed and documented,and the epidemiological questionnaire for the distribution of syndrome of hypertension and related factors were filled.Referencing to the diagnostic criteria of Clinical Research Guiding principles of Chinese Medicinals and New Drugs in 2002,the TCM syndrome types were divided into four groups:liver-fire hyperactivity syndrome group,yin deficiency with yang hyperactivity syndrome group,phlegm-dampness exuberance syndrome group and yin and yang deficiency syndrome group.The relative files about patients like TCM syndromes,gender and age were analyzed,and statistical analysis of all data was conducted by SPSS 20.0. Results In 1 741 subjects,yin deficiency with yang hyperactivity syndrome accounted for the largest share,followed by yin and yang deficiency syndrome,phlegm-dampness exuberance syndrome,and liver-fire hyperactivity syndrome.The proportion of men and women in yin deficiency with yang hyperactivity syndrome and phlegm-dampness exuberance syndrome had significant difference(P<0.05).The single factor analysis showed that living alone,obesity,physical exercise,cardiovascular disease,drinking and smoking were related with TCM syndromes. Conclusion The distribution of TCM syndrome types in old patients with hypertension has a certain regularity,yin deficiency with yang hyperactivity syndrome and yin and yang deficiency syndrome is the most rare,TCM differentiation of symptoms and signs can provide more evidence to set up the preventive strategy for hypertension.

Current health condition of perimenopausal women in community and countermeasure research

ZHANG Qin, CHEN Si-lu, ZHANG Jie-qiong, MENG Li, FAN Xia, DAI Xiao-tian

2016, 14(7): 1172-1174. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.036

81 2

Abstract:
Objective To survey the health condition of perimenopausal women in community and its related factors,and provide the basis for the health care of perimenopausal women in community. Methods The cluster sampling and questionnaires were employed to survey the health condition of perimenopausal women in Jingan District between March 2013 and February 2015.The multivariate linear regression analysis was used in the analysis of healthrelated factors. Results Among the 1518investigated patients,the average age of menopause was (50.45±3.34) years old.The incidence of perimenopausal syndrome was 15.3%(233 cases).Hot flushes and sweating(64.7%),fatigued(55.8%) and sexual dysfunction(48.81%) were the most common symptoms of themenopausal transition period.The top three of chronic diseasesin turn were cervical spondylosis(11.53%),mammary gland hyperplasia(8.37%) and vaginitis (7.97%).The age was not the significant factor of the Kupperman value for perimenopausal syndrome(t=-0.009,P=0.992).The age of menopause(t=7.083,P<0.001),depression scale(t=2.016,P=0.044) and anxiety scale(t=8.429,P<0.001)were significant positive for the Kupperman value. Conclusion s The pausimenia age,depression and anxiety scale are associated to the higher Kupperman value,which reveal a severeperimenopausal syndrome.The health care for perimenopausal womenneeds urgently to be strengthened;and the menopause health care network managementrelying on the community is surely an effective approach.

A survey of the depression status and the influencing factors of the hospitalized breast cancer patients' primary relatives

LIU Shu-ying, YANG Fang-ying, WU Wan-ying, LIU Xiao-ling, JIANG Zi-fang, LIANG Guan-mian, DAI Qin

2016, 14(7): 1175-1177,1230. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.037

178 0

Abstract:
Objective To investigate the depression level of the daughters or sisters of the hospitalized breast cancer patients,and provide the scientific bases for the prevention and cure of depression. Methods We finally investigated 105 female person,who was the daughter or sister of the hospitalized breast cancer patients,with the Self-rating Depression Scale(SDS).The collected data was analyzed by descriptive/chi-square test/Logistic analysis. Results There were 100 effective responses.The main depression scoreof these 100 person was 44.61±11.29,which compared with the domestic norm(41.88±10.57/41.54±10.54)had statistical significance(P<0.05).Twenty cases were with depression,the prevalence rate was 20%.The single-factor logistic regression showed that the patient's treatment stage,age,role;Binary Logistic regression indicated that age,the patient's treatment stage were the risk factors,and the regression equation can explain 14.7% of the variance. Conclusion The depression of the breast cancer patients' primary relatives have the poor status.The nurse or the community nursing care workers should pay more attention on the psychological health of such a target group.

Influence of targeted nursing intervention on anxiety of gastric cancer patients undergoing postoperative chemotherapy

LI Ling-ling, LU: Dong-mei, YANG Hai-ying

2016, 14(7): 1178-1181. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.038

128 2

Abstract:
Objective The systemic chemotherapy,as an mainstay of treatment for patients with cancer,can improve the survival rate and quality of life.However,the overall survival rate and quality of life of gastric cancer patients is not satisfactory during the chemotherapy.The patients usually suffer from extreme body and mind pain,particularly the anxiety.This paper investigated the influence of targeted nursing intervention on the anxiety in gastric cancer patients with postoperative chemotherapy,so that improve clinical effectiveness and significantly decline the incidence of complication. Methods Total 98 gastric cancer patients undergoing postoperative chemotherapy in our hospital from Feb.2014 to Feb.2015 were randomly divided into control and observation group(49 cases in each group) according to the nursing methods,their clinical data were reviewed.The control group was given regular nursing care,while the research group was given targeted nursing interventions based on regular nursing care including the cognitive intervention,dietary intervention,psychological intervention,environmental interventions,exercise intervention and the intervention of daily life.The anxiety score and nursing satisfaction of the two groups were compared based on the follow up results. Results SAS and HAMA score in both groups were significantly decreased.SAS and HAMA score in the observation group were significantly lower than those of the control group,there was significant difference between the two groups(P<0.05).The nursing satisfaction of intervention group was significantly higher than that of the control groups,there was significant difference(P<0.05). Conclusion The targeted nursing intervention can effectively relieve the anxiety of gastric cancer patients with postoperative chemotherapy,and improve the nursing satisfaction.

Evaluation of quality of randomized controlled trials research papers among Chinese abstracts for breast cancer

TIAN Jin-hui, HUANG Zi-han, GE Long, PEI Gai-qin, QIU Xia, LIU Rui-feng, ZHANG Qiu-ning, WANG Xiao-hu, ZHANG Hong

2016, 14(7): 1182-1185. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.039

120 1

Abstract:
Objective To assess the quality of randomized controlled trials research papers among Chinese abstracts for breast cancer. Methods A systematical databases search was conductedto identify papers about RCT of breast cancer published in China."Abstract-CONSORT" statement was used to assess the quality of reporting.Statistical analysis was performed using Meta-Analyst software. Results A total of 965 RCT were identified.The serious reporting flaws were appeared for RCT abstract of breast cancer,especially,regarding following items:thestudy identified as randomized in title(1.1%,95%CI:0.6%-2.0%),randomization 3.8%,95%CI:2.8%-5.2%),blinding(1.0%,95%CI:0.6%-1.9%),statistical methods(11.5%,95%CI:9.6%-13.7%),numbers randomized(7.5%,95%CI:6.0%-9.3%),participants (12.2%,95%CI:10.3%-14.4%),trial registration(13.1%,95%CI:11.1%-15.3%),funding (8.1%,95%CI:6.5%-10.0%).The improvements in participants,intervention,statisticalmethods,results and conclusions were increased when abstract CONSORT was published.There was statistical significant difference in study identified as randomized in title,randomization,and participants and funding betweenRCT abstract recorded by CSCD andnon-CSCD (international papers). Conclusion The serious reporting flaws were appeared for RCT abstract of breast cancer published in Chinese.More attentions should be made for editors and authors.

Prevalence and associated risk factors of hyperuricemia and gout in Han,Uygur,Kazak,Xibe of Xinjiang Ili Kazak Autonomous Prefecture

LIU Xin-qiong, WANG Xiao-peng, GUAN Li-qing, JIN Hai-xia, HE Hai-rong, ZHANG Xuan

2016, 14(7): 1186-1188,1192. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.040

207 2

Abstract:
Objective To investigate prevalence and associated risk factors of hyperuricemia and gout in the Han,Uygur,Kazak,Xibe of Ili Kazak Autonomous Prefecture and gout. Methods From December 2014 to January 2016,3 500 cases of Xinjiang Ili Kazak Autonomous Prefecture occupants epidemiological survey,the overall prevalence of blood uric acid level,the prevalence of gout,hyperuricemia prevalence influencing factors analysis. Results ①3 318 cases included in the survey,a total of 662 cases of hyperuricemia in patients with total prevalence rate was 19.95%(662/3 318);male prevalence rate was 23.45%,female prevalence rate was 16.78% (292/1 740);male hyperuricemia prevalence was significantly higher than females(P<0.01);②the average male serum uric acid level was (382.17±56.37) μmol/L,women (290.09±39.77) μmol/L,male serum uric acid levels were significantly higher than females(P<0.05);③in this study included 3 318 cases of the survey,the number of 52 cases occurred gout,gout prevalence rate of 1.57% total,of which men suffering disease was 2.79%,0.46% prevalence of women,the prevalence of gout in men was significantly higher than females(P<0.05).Han gout prevalence was significantly higher than that of other minorities(P<0.05);④by Pearson univariate analysis,patient and control groups in smoking,drinking,regular exercise,obesity,dyslipidemia,hypercholesterolemia,high aspirin and blood pressure differences were statistically significant aspects(P<0.05-0.01);multivariate Logistic regression analysis,and ultimately determine the relevant factors for the prevalence of hyperuricemia:drinking,obesity,dyslipidemia,hypertension and oral aspirin. Conclusion The factors affecting the prevalence of hyperuricemia and gout are more to address these factors were observed,and take appropriate measures to reduce the prevalence of hyperuricemia and gout.

The current status of sleep disorders and related factors among the relatives of ICU patients

SUN Xia, SHAO Xiao-fang, XU Hong-yan, ZHOU Yu-yi

2016, 14(7): 1189-1192. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.041

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Abstract:
Objective To investigate the present situation level and influence factors of sleep disorders among the families of ICU patients,and provided a reference basis for clinical nurses to take targeted intervention to reduce the sleep disorders in families of ICU patients. Methods A total of 183 families of ICU patients were recruited from three first-class hospitals in Hangzhou by convenience sampling method.They were investigated with a self-designed information questionnaire,pittsburgh sleep quality index,mishel uncertainty in illness scale-family and beck anxiety inventory of ICU families.Mean,standard deviation and percentage were used for statistical description in general data of ICU families.The influence factors of sleep disorders among the relatives of ICU patients were analyzed using multiple stepwise regression analysis. Results The total score of pittsburgh sleep quality index among the families of ICU patients was 12.56±5.52,the total score of mishel uncertainty in illness scale-family among the families of ICU patients was 85.29±13.80,the total score of beck anxiety inventory among the families of ICU patients was 50.39±8.48.Pearson correlation analysis showed that pittsburgh sleep quality index among the families of ICU patients has a positive correlate between mishel uncertainty in illness scale-family and beck anxiety inventory,the correlation coefficient between pittsburgh sleep quality index and mishel uncertainty in illness range from 0.112 to 0.328,the correlation coefficient between pittsburgh sleep quality index and beck anxiety inventory range from 0.115 to 0.285,Multiple linear regression analysis showed that the ICU patients' intubation or not,payment method,families of ICU patients' education degree,occupation,level of uncertainty in illness and level of anxiety were influence factors of sleep disorders among the families of ICU patients,totally explained 42.8% variance sleep disorders among the families of ICU patients. Conclusion Clinical nurses should pay more attention to the sleep disorders among the families of ICU patients,reduce level of uncertainty in illness and level of anxiety may promote the level of sleep disorders among the families of ICU patients.

Role of contrast-enhanced ultrasound in biopsy for tuberculous abscess of the abdominal walls

ZHANG Wen-zhi, YANG Gao-yi, PEI Yu, XU Jian-ping

2016, 14(7): 1193-1195. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.042

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Abstract:
Objective To study the application value of contrast-enhanced ultrasound in biopsy for tuberculous abscess of the abdominal walls and improve the rate of intact tissue and positive pathology results. Methods The 66 hospitalized patients(24 male cases,42 female cases)with abdominal mass in our hospital were selected in September,2013 to November,2015 and divided into 2 groups.The group A(23 patients including 8 male and 15 female cases) received the real-time ultrasound guided biopsy between September,2013 and February,2014.The group B(43 patients including 16 male and 27 female cases) received contrast-enhanced ultrasound to determine the materials area and then the ultrasound guided biopsy between February 2014 and November 2015.Target areas were contrast enhanced filling area and small part of no enhance area for abdominal mass part enhanced;contrast enhancement area for bump completely enhanced.All data was analyzed using SPSS version 13.0 software.The qualitative data were analyzed with chi-square test;P values less than 0.05 were reported as statistically significant. Results Group A included 1 case of metastatic carcinoma,1 case of hematoma,21 cases of abdominal wall tuberculosis,the rate of intact tissue was 47.8% and the positive results of pathology examination was 82.6%;Group B included 2 cases of metastatic carcinoma,1 cases of abdominal wall sebaceous glands cyst with infection,and 40 cases of abdominal wall tuberculosis;The contrast-enhanced ultrasound prompted the abdominal masses enhanced all in 8 cases,abdominal mass enhanced partly in 35 cases.The rate of intact tissue was 90.7% and the positive results of pathology examination was 100%,which was obviously improved as compared with group A.Chi square value were 15.00 and 5.20,P<0.05. Conclusion The application of contrast-enhanced ultrasound before the biopsy for tuberculous abscess of the abdominal walls can obviously improve the rate of intact tissue and positive pathology results.

Application value of 256-slice spiral CT scan using 100kV tube voltage and iDose4 reconstruction in cervical and cranial computed tomographic angiography

YAO Jin-long, ZOU Guo-lin, BAO Yi-hong, YAO Wei-jia, LUO Lei-long, ZHOU Zhang-qing

2016, 14(7): 1196-1198. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.043

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Abstract:
Objective To research radiation dose and CT image quality by using 100 kV tube voltage CT Scan and iDose⁴ reconstruction in cervical and cranial computed tomographic angiography(CTA). Methods Total 102 patients were scanned using 100 kV tube voltage and iDose⁴ reconstruction in cervical and cranial.CTA images were grouped into A,B,C and D according to BMI,where Group A included 22 cases (BMI ≤ 18.5 kg/m²),Group B 34 cases(18.5 kg/m²2),Group C 35 cases(25 kg/m² ≤ BMI<28 kg/m²),Group D 11 cases(BMI ≥ 28 kg/m²),and rated 1 to 5 scores to all cases by CTA image quality.These average score of 4 groups were compared using analysis of variance and SNK-q test. Results The dose-length product(DLP) was (380.53±10.40)mGy·cm,and the effective dose was 1.18 mSv.CTA image quality scores in each group were 4.55±0.60 in group A,3.88±0.77 in group B,3.31±0.53 in group C,and 2.73±0.47 in group D,the difference was statistically significant(F=27.4433,P<0.0001);The image quality between groups compared by using SNK-q test was significant(P<0.01).The score decreased with the increase of BMI,but CTA image quality of all cases met clinical requirement.Among the 102 patients examined by CTA,there were 371 segments for the head and neck artery stenosis,which distributed 251 in neck(67.7%) and 120 in head(32.3%).Among these,244 were the mild stenosis,67 were moderate stenosis,33 were severe,and about 27 segments were occlusion.Besides,there were 10 cases were with artery aneurysms (13 gold),and 5 cases with the variation in opening of left vertebral artery and common carotid artery. Conclusion The cervical and cranial computed tomographic angiography using 100 kV tube voltage CT scan and iDose⁴ reconstruction can get good lesion display,while significantly reduce the radiation dose.

FANG Xin, HAO Yan-hua, WU Qun-hong, JIAO Ming-li, SUN Hong, XU Wei-lan, HAN Xiao-nan, ZHAO Xi-yan

2016, 14(7): 1199-1201,1213. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.044

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Abstract:

WEN Chuan-song, TONG Jin-yi

2016, 14(7): 1202-1205. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.045

62 0

Abstract:

PANG Xue-rui, QIAN Wei-dong

2016, 14(7): 1206-1209. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.046

47 0

Abstract:

BAI Li-jun, LI Huai-fang

2016, 14(7): 1210-1213. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.047

73 3

Abstract:

Effect of Tiaozhong decoction on motilin and stem cell factorslevels in the spleen deficiency with liver hyperactivityyoung rats with functional dyspepsia

LIAN Jun-lan, SHAO Zheng-yang, ZHOU Hong, ZHAN Lu, ZHANG Zhi-guo

2016, 14(7): 1214-1216. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.048

139 2

Abstract:
Objective To study the impact of Tiaozhong decoction on motilin(MTL)and Stem Cell Factor(SCF) levels in the spleen deficiency with liver hyperactivity young rats with functional dyspepsia(FD),and discuss the possible mechanism of action. Methods Total 36 clean grade SD young rats,age 21-28 d,weighing 50-70 g,were randomly divided into 6 groups:the normal control group,the model control group,the high dose group of Tiaozhong decoction,the middle dose group of TiaoZhong decoction,the low dose group of TiaoZhong decoction and the domperidone group,with 6 rats in each group.These young rats were fed regularly on the 1th week to adapt to the environment,then from the 2nd week,the rats(except for the normal control group) were fed irregularly,administrated with ice water(4℃) and received tail clamp stimulation to develop a rat model.The drugs were administered continuously for 14 days after the model was successfully established.The young rats in each group were fed nothing except water for 12 hours before the administration of medicine.Then,blood samples were collected from abdominal aortic and the he levels of SCF were tested by ELASE method.Afull thickness of gastric antrum wall was sampled to determine the MTL level by using immunohistochemistry method. Results The SCF level in serum of the high and middle dose group were significantly higher than that in the model group(P<0.01);The MLT level of the high dose group was significantly higher than that in the model group(P<0.01),the levels between the middle dose group and the model group was statistically significant(P<0.05). Conclusion The model rat was successfully developed.Tiaozhong decoction can significantly improve the level of SCF in serum and MTL in gastric antrum.The up-regulation of MT and SCF may be the proper mechanism of Tiaozhong decoction in the treatment of spleen-deficiency with liver-hyperactive young rats with functional dyspepsia.

Clinical study of heat sensitive moxibustion combined with relative acupuncture on the treatment of knee osteoarthritis

ZHOU Xiao-ping, DONG Jia-ming, MAO Mei, ZHU Fen, LIANG Ming-hua, CHEN Shang-jie

2016, 14(7): 1217-1219. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.049

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Abstract:
Objective Heat sensitive moxibustion on knee osteoarthritis has good effect,but it is time-consuming. Therefore, heat sensitive moxibustion is often operated only for local in patients, without more time for overall adjustment. This study uses heat sensitive moxibustion combined with relative acupuncture in order to treat combination of local and global. The effect will be observed if they are better than only heat sensitive moxibustion. Methods All of the subjects were from outpatient in January,2014 to January,2015.Sixty cases eligible patients with osteoarthritis of the knee were randomly divided into treatment group and control group,30 cases in each group.The control group was treated with the method of simple heat sensitive moxibustion,which was used to heat sensitive moxibustion at inside and outside xiyan points in the around the affected side of the knee.The treatment group were treated with heat sensitive moxibustion combined with relative acupuncture,first using of relative acupuncture method,which select four pairs of points such as inside and outside xiyan points,Xuehai and Liangqiu,Yanglingquan and yinlingquan,Taichong and Taixi,retaining needle for 30 min,and then heat sensitive moxibustion.Five times treatment were operated each week, but rest at the weekend,totalled 3 courses.Effect,visual pain score (visualanalogscale,VAS) and Lysholm knee score (Lysholm knee score,LKSS) were observed before and after treatment. Results The total efficiency of treatment group was 93.33%,but 76.67% in the control group.The difference was statistically significant(P<0.05) using the rank sum test.VAS and Lysholm knee score after treatment were significantly improved compared with before treatment,and it in the treatment group was statistically significant difference with control group(P<0.05). Conclusion There were good role in effect,relieving pain and improving functional activity for heat sensitive moxibustion on the intervention of knee osteoarthritis.But heat sensitive moxibustion combined with relative acupuncture has a more synergistic effective than simple heat sensitive moxibustion on the intervention of knee osteoarthritis.

Application of PBL combined with CBL and LBL in clinical probation in endocrinology department

GAO Jia-lin, XIA Li-bin, LU Mei-qin, ZHANG Bin-hua, CHEN Yue-ping, CHEN Bin, SHI Liang-hui, TONG Jiu-cui

2016, 14(7): 1220-1223. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.050

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Abstract:
Objective To assess the teaching effects of the competitive teaching methods that Problem Based Learning(PBL) combined with Case Based Learning(CBL) and Lecture Based Learning(LBL) on students undergoing clinical probation of endocrinology. Methods Sixty-eight students in the endocrinology department were allocated randomly to experimental and control.The experimental group received PBL,CBL and LBL teaching(PCL),whereas the controls were given CBL and LBL teaching(CL).The teaching effects were assessed by written questionnaire basis at the end of the tasks in the two groups. Results The classroom atmosphere was better in PCL group than that in CL group,which including better interaction,positively speaking and discussion.Questionnaire survey results show that students in the PCL groups had a higher satisfaction(94.4%) with the teaching than that in CL group(71.8%),P<0.05.On self-evaluation in students its self,the performance from the PCL group were significantly better than CL group on ability acquisition of the establishment of clinical thinking mode (positive rate 77.7% vs. 50.0%),to strengthen the understanding of clinical theory (positive rate 66.6% vs. 40.6%),improving of the ability in autonomous learning (positive rate 91.6% vs. 56.2%),improving of expression ability (positive rate 80.5% vs. 40.6%),communication skills improving (positive rate 75.0% vs. 37.5%),All P<0.05.However,there was no significant difference between the two groups in the three items about the clinical interest in learning,the ability of solving problems and the expansion of knowledge. Conclusion The teaching effectiveness of PCL(PBL,CBL and LBL) teaching methods is better than that in LBL only combined with CBL teaching methods.It was deserve popularizing in clinical probation teaching.

Ideas for clinical teaching of neurology

QU Hong-dang

2016, 14(7): 1224-1226. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.051

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Abstract:
As a clinical medicine second level discipline,Neurology is based on the characteristics of the anatomy of the nervous system and the function of the complex diversity,there are different in the teaching methods and contents from other disciplines,such as Internal Medicine and other clinical disciplines;it is a highly professional clinical disciplines.Neurology is one of the emphases and difficulties in clinical teaching,because of its abstract concept,kinds of diseases and different textbook knowledge point dispersion,it is difficult for students to understand and grasp.Therefore,it is the majority of medical students think the most difficult to learn a clinical discipline.How to develop neurological physicians have a higher clinical thinking ability and solve the practical problems of application ability,and the common and frequently occurring disease in neurology correct diagnosis and treatment,we have been exploring the direction,but also the teaching of Neurology in a major issue.In particular,with the improvement of standardized training of resident doctors in recent years and the enrollment expansion of clinical graduate students,this has put forward higher requirements for our clinical teaching work.In the clinical teach process,not only needs the young physician master the elementary knowledge of Neuroanatomy and pathological physiology,but also to develop their clinical thinking,improve the positioning,qualitative and differential diagnosis of diseases of the nervous system.This requires we usually take to teach in the disease concept,pathology,clinical manifestation,auxiliary examination,diagnosis,differential diagnosis and therapeutic principle of speaking more detailed and thorough,take a variety of teaching methods,and fully mobilize students learning enthusiasm and initiative of,make them by passive listening to active thinking to practical,thereby we can achieve the goal of teaching and develop high quality professional medical workers.

Practice and exploration of the centralized skills training for general practitioners based on the demand oriented in Tianjin city

GAO Jie, LI Yan-ping, LI Tong, HAN Tao

2016, 14(7): 1227-1230. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.052

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Abstract:
Objective To explore the centralized skills training and assessment methods for the first year standardized training of general practitioners based on the need of the trainers. Methods Total 99 first year clinical medical staffs who received standardized training in a Tianjin physician training medical practice skills training center were enrolled into this study.According to the general practitioners standardized training detailed requirements,combined with professional characteristics of general practitioners,through the questionnaire survey analysis,we determined the clinical skills of general practitioners simulation training and intensive knowledge demands,and assessed the training effect.All trainees were examined by the theory and clinical skills before and after the training so that to evaluate of the teaching effect. Results Among 99 subjects,the main purpose of them were to better qualify for the job(68/99),finish the standardized learning(58/99) and improve clinical skills(58/99);The main needed knowledge and skills were clinical operation skill(95/99) and clinical diagnosis ability (88/99);They enjoyed the training model combined the video,lecture and operation(68/99);The favorite course of the humanities was the doctor-patient communication accounting(51/99).After the training,their clinical operation skills and comprehensive evaluation were improved significantly(P<0.001). Conclusion The standardized training that based on the demand oriented standard training courses combined with scientific evaluation system can significantly improve the efficiency of basic clinical skills and relevant theory of training for general practitioners.

Effects of phased nursing intervention on the compliance of exclusive breastfeeding

LIANG Yu-ming, LU Mei-li, PAN Ying-chun, HU Ling

2016, 14(7): 1231-1233. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.053

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Abstract:
Objective To investigate the positive effect and clinical implication of phased nursing intervention on exclusive breastfeeding and its compliance by analyzing the exclusive breastfeeding rate and contributing causes of exclusive breastfeeding at the 1st weeks,the 4th months and the 6th months after delivery. Methods Totally 200 cases of hospitalized pregnant women in our hospital from Jan.2015 to Oct.2015 were enrolled in this study.All cases were divided into control group(n=97)and phased nursing intervention group(n=103).The women in control group were given routine admission education and nursing,while the women in the intervention group were subject to periodic nursing intervention,including timely health education,breastfeeding position guidance,on-demand breastfeeding,maternal nipple retraction correction and timely breast duct dredging,on the basis as carried in the control group.The rate of exclusive breastfeeding in the 2 groups was recorded at 1st week,4thmonth and 6th month after delivery. Results At the 1st week,exclusive breastfeeding rate in the intervention group was significantly higher than that of control group(χ²=79.629,P<0.01),exclusive breastfeeding rate in the intervention group reached 94.17%,while exclusive breastfeeding rate in the control group only 34.02%,additionally,mixed feeding and artificial feeding ratio reached 60.82% and 5.16% in the control group,which was significantly higher than that in the intervention group;At the 4thmonth,exclusive breastfeeding rate in the intervention group remained 96.12%,exclusive breastfeeding rate in the control group raised to 67.01%,the difference between the two group was significant(χ²=28.768,P<0.01),again,mixed feeding and artificial feeding rate was 20.62% and 12.37% respectively,which was significantly higher than that in the intervention group.At the 6th month,exclusive breastfeeding rate in the intervention group remained 93.20%,exclusive breastfeeding rate in the control group decent to 30.93%,the difference between the two group was significant(χ²=83.333,P<0.01),in addition,mixed feeding and artificial feeding rate was 49.48% and 19.59% respectively,which was significantly higher than that in the intervention group. Conclusion The phased nursing intervention can improve the understanding and the compliance of exclusive breastfeeding;it is a promising measure to improve the physical and mental health of pregnant women and infant that worth popularizing.

Clinical curative effect of continuous blood purification with nursing intervention in the treatment of severe acute pancreatitis

SONG Jia-wei, YIN Zhi-qin

2016, 14(7): 1234-1236. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.054

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Abstract:
Objective To investigate the clinical effect of continuous blood purification(CBP) combined with nursing intervention in the treatment of severe acute pancreatitis(SAP). Methods The clinical data of 40 cases of SAP in our hospital from June,2013 to June,2014 were reviewed.All patients received the conventional therapy combined with blood purification treatment and nursing intervention.The temperature,blood pressure,breathing and other vital signs were recorded before and after the treatment.APACHE Ⅱ score was performed to predict the condition of patients.The serum amylase,liver and kidney function,and arterial blood gas analysis were compared before and after the treatment. Results Thirty-five of 40 cases were cured and discharger,5 cases died,with a survival rate of 87.5.The duration of blood purification was (73.8±6.2) h.After the blood purification and nursing care,the vital signs and APACHE Ⅱ score were improved,the difference was significant(P<0.05).The serum biochemical indexes such as TB and AMS were decreased obviously,the difference was statistically significant(P<0.05).The acid base imbalance was corrected and electrolyte disorders were improved. Conclusion CBP combined with nursing intervention in the treatment of SAP is effective and satisfactory.The coordination from nursing staffs is essential in the treatment procedure.

Effect of trying a good posture before the operation on the experience of patients undergoing general anesthesia in a lateral decubitus position

XU Li, PAN Ru-sheng, FENG Qing-mei, HAN Ke, CHEN Xiao-wei, ZHANG Yun-lei, TENG Yu

2016, 14(7): 1237-1239. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.055

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Abstract:
Objective To investigate the effect of trying a good posture before the operation on the experience of patients undergoing general anesthesia in a lateral decubitus position,carry our individualized nursing in the surgery room,and improve the patients satisfaction. Methods Total 80 patients undergoing general anesthesia in a lateral decubitus position in our hospital between March,2013 and January,2015 were randomly divided into experimental group and control group with 40 cases in each group.The personalized trying a good posture before the operation was performed in the experimental group,while the control group received the traditional nursing.The self-made questionnaire was used to survey patient satisfaction. Results The satisfaction of patients in the experimental group for "pressurized skin and organ"(97.5%) and "the physical sensations"(97.5%) was significantly higher than 70% and 50% in the control group,the difference was statistical significant(P<0.01);The patients in the experimental group were not t satisfied with 4 items(0.67%),while in the control with 49(8.16%),the differences between the two groups was statistical significant(P<0.01). Conclusion The implementation of trying a good posture before the operation can improve the experience of patients undergoing general anesthesia in a lateral decubitus position,and be benefit for the implementation of individualized nursing in the surgery room.

LIU Yong-hua, JIANG Jin-hong, WU Qin-li, ZHANG Qiao-lei, XU Ye-hui, JIN Wei-mei, QU Zhi-gang, MA Guang-li, WANG Xiao-qiu, WANG Xiao-li, FANG Bing-mu

2016, 14(7): 1240-1242. doi: 10.16766/j.cnki.issn.1674-4152.2016.07.056

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2016 Vol. 14, No. 7

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