中华全科医学

Multidimensional analysis of the function of general practice department in community and hospital——taking general practice department of Tongji university medical college as an example

PAN Ying, YU De-hua, LU Yuan

2017, 15(11): 1821-1823,1884. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.001

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Objective At present,many medical colleges have opened or plan to establish general medicine department to train general practitioners and form general practice faculties.This paper sets the general practice department of Tongji University School of Medicine as an example and establishes the system model to guide the establishment of general practice in other areas of China,not only improve the level of primary medical care,increase the cultivation of grass-roots general practitioners,but also provide guarantee for community general teachers to develop the general practice professional. Methods Based on the empirical study,this paper introduces the multidimensional role of the cooperation between the affiliated Yangpu Hospital of Tongji University School of Medicine and other affiliated hospitals with 11 community health service centers in education,scientific research and personnel training,summarizes the characteristics and builds the framework system. Results The general practice department of Tongji University School of Medicine established the perfect organizational system,formed its own model,building the communication bridge between the community and hospital,relying on the higher medical and scientific research in affiliated hospital,and promoting the development of community through the teaching resources and training of general medicine. Conclusion s The department of general practice is to play the core guiding role of teaching,to promote the development of clinical,scientific research and teaching in the community,and to train excellent general practice teachers.The department of general practice of Tongji University School of Medicine provides modeled,which guide the establishment of general practice department in other universities.However,we should see that the general medicine is still in its infancy,opportunities and challenges exist,we must go first,analyze the problems in the construction of general medical construction in China,and draw on the good experience abroad,which develop the role of general practice.

SUN Lu, ZHANG Li, YANG Xiao-hui

2017, 15(11): 1824-1825.

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Effects of coix seed triglyceride injection combined with gemcitabine on the proliferation and apoptosis of Bel-7402

YANG Ying, JIA Chun-li, LI Zhi-peng, YANG Zhi-fang, ZHANG Hua, ZHAO Hua-rong, MAO Rui, TULAHONG Ai-si-ke-er, BAO Yong-xing

2017, 15(11): 1826-1829,1855. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.002

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Objective To investigate effects and mechanism of coix seed triglyceride combined with gemcitabine on proliferation and apoptosis of Bel-7402. Methods The MTT and colony formation assay were used to detect cell inhibition and cell proliferation.Flow cytometry was used to detect the apoptosis of cells.The expression of Caspase-3 and Bcl-2 were detected by reverse transcriptase polymerase chain reaction(RT-PCR) in different group.Image-Pro Plus 6 was used to count the number of colony forming clones.SPSS 17.0 was used to analyze the experimental results. Results The cell viability and proliferation was inhibited by coix seed triglyceride and gemcitabine.And the synergistic effect of cell viability and proliferation was observed when coix seed triglyceride and gemcitabine were administered together(F=509.677,P<0.01;F=562.100,P<0.01).The apoptosis rate of Bel-7402 cells treated with coix seed triglyceride combined with gemcitabine was significantly higher than those treated with coix seed triglyceride or gemcitabine alone[(76.3±1.6)%,(53.2±2.0)%,(42.4±1.8)%,F=46.742,P<0.01].The expression of Caspase-3 was increased(F=38.264,P<0.01),but the expression of Bcl-2 was decreased(F=4.817,P<0.05) in combination group. Conclusion The inhibition of cell viability and proliferation of Bel-7402 cells can be synergistically enhanced and the rate cells apoptosis was increased by the treatment of coix seed triglyceride combined with gemcitabine,which provides reference for the clinical application of the two drugs.

Intervention effect of emodin on pancreatic acinar cell apoptosis in severe acute pancreatitis rats

SHI Zhan-li, FANG Kun, SUN Jing, LI Zhi-hui, YANG Zheng, CAI Dan-li, CHEN Zhi-yun

2017, 15(11): 1830-1834. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.003

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Objective To investigate the intervention effect of emodin on cell apoptosis in severe acute pancreatitis rats. Methods Models were induced by retrograde injection of taurocholic acid into pancreatic duct of rats.Then all the models were randomly divided into 4 groups,including control,low dose(10 mg/kg emodin),middle dose(20 mg/kg emodin) and high dose group(40 mg/kg emodin).Specimens of each group were taken at 3 h,6 h,12 h and 24 h randomly.Serum amylase,serum total calcium and pancreatic histopathologic score were measured.TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labeling) staining was applied to measure apoptosis and apoptotic index.The protein expressions of Notch-1,Hes-1and Hes-5 were detected by Western blot. Results Compared with the control group,the serum amylase of emodin treatment groups were significantly lower(P<0.01).The serum total calcium levels in each treatment group were significantly higher than those in the control group (P<0.01),The pancreatic histopathologic scores of middle dose group and high dose group were significantly improved compared with control group(P<0.01),especially in high dose group.The apoptosis index of pancreatic cells in each treatment group points was higher than control group at different time,especially in high dose group,but the index was similar between low dose group and control group(P>0.05).The Notch-1 expression of treatment groups were higher than that of control group,and more significant in middle dose group and high dose group(P<0.01).The Hes-1 expression of high dose group was significantly higher than that of control group(P<0.05),low dose group(P<0.05) and middle dose group(P<0.05).The Hes-5 expression of middle dose group and high dose group was significantly higher than that of control group,and the Hes-5 expression of high dose group was significantly higher than that of low dose group(P<0.05). Conclusion Emodin can alleviate pancreatitis by promoting apoptosis of local pancreatic cells when severe acute pancreatitis occurs.Notch-1/Hes signaling pathway is an important pathway for emodin regulating pancreatic acinar cell apoptosis.

Expression and significance of KL-6 mucin in paraquat-induced murine pulmonary fibrosismodel

ZHU Mao-zhi, ZHU He-chen, CHEN Chuan-guo, ZHOU Ping-ping, ZHOU Hong-ming

2017, 15(11): 1835-1838,1999. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.004

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Objective To investigate the expression and significance of Krebs von den Lungen-6(KL-6) mucin in rats with pulmonary fibrosis induced by paraquat poisoning. Methods Seventy male SD rats were randomly divided into four groups:paraquat poisoning 1,4,7,14,21 and 28 d group and normal saline control group.1 ml paraquat aqueous solution with the concentration of 20% was diluted with sterile isotonic saline into 100 ml,and the poisoning group was administered intraperitoneally with 18 mg/kg,the control group was given the same amount of saline intraperitoneal injection.The rats with intraperitoneal injection of drugs that did not meet the modeling standards and died were excluded,after 1,4,7,14,21 and 28 d injection,6 rats were killed in the poisoned group respectively,and 6 rats were killed in the control group,respectively.The pathological changes of lung tissue were observed.The changes of lung tissue fibrosis were observed by Masson staining.The level of KL-6 in serum was detected by enzyme-linked immunosorbent assay(ELISA) in the expression of KL-6. Results The level of KL-6 in serum of normal control group was about 11.42 ng/ml,the level of KL-6 protein in the serum of 4,7,14 and 21 d group gradually increased and was higher than that in the normal control group(P<0.05),and decreased after 21 days while they were higher than the control group.The expression of KL-6 in the lung tissue of 1,4,7,14 and 21 was significantly higher than that in the normal control group(P<0.05),and decreased after 21 days,but they were always higher than the control group. Conclusion KL-6 changes with the degree of pulmonary fibrosis in paraquat poisoning,which may be involved in the process of pulmonary fibrosis in paraquat poisoning rats.

Effect of amygdalin on expression of ASIC3 in synovial membrane of adjuvant arthritis rats

LUO De-mei, LIU Qing, DONG Xu-nan, LUO Li

2017, 15(11): 1839-1842,1866. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.005

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Objective The expression of ASICs is closely related to the destruction of articular cartilage in rats due to inflammation leading to localized acidification of the joints in the course of RA.In this study,we investigated the effect of amygdalin on the immune response of articular synovium in CIA rats,and discussed the mechanism of amygdalin against RA. Methods Forty-five Wistar female rats were randomly selected for the blank control group.Thirty-five CIA rat models were randomly divided into model group(n=5),tripterygium wilfordii polyglycoside group(ie,positive control group),high dose of amygdalin and low dose of amygdalin.Blank control group and CIA model group were given 0.9% saline,Tripterygium wilfordii polyglycoside group to give tripterygium polyglycoside 1 mg/(kg·d),amygdalin high dose group to 120 mg/(kg·d),low amygdalin low dose group to 60 mg/(kg·d),once a day after continuous administration of oral administration 28 d,by abdominal anesthesia,femoral artery blood,conventional serum for IL-1β,sICAM-1 detection;separation of the left knee synovial membrane with 40 g/L Polyoxymethylene was used as HE staining specimen.The right knee joint synovial tissue was stored at -80℃ for preservation of Western blot ASIC3 protein.Simultaneous extraction of brain tissue at -80℃ was performed as a positive control. Results HE staining showed that the synovial cells in the CIA model group showed evacuation,disorder,hyperplasia and inflammatory cell infiltration.The mild hyperplasia and inflammatory cell infiltration of the high dose group,low dose group and Tripterygium wilfordii polyglycoside group were significantly decreased(P<0.05).Compared with the blank group,the levels of IL-1β and sICAM-1 in the peripheral blood were significantly decreased,and the expression of ASIC3 protein in the synovium was significantly decreased.There was no significant difference(P>0.05). Conclusion Amygdalin can effectively inhibit the expression of inflammatory cytokines IL-1β and sICAM-1 in peripheral blood of CIA rats and down-regulate the expression of synovial membrane ASIC3 protein,interfere with the damage of synovial membrane,immunosuppressive effects,may be amygdalin anti-inflammatory analgesic and protective cartilage effect of one of the mechanisms.

Capsule endoscopy in early diagnosis and treatment of precancerous lesions in gastric mucosa

WANG Dao-rong, WANG Wei, GAO Shan, DING Xiang-wu

2017, 15(11): 1843-1845. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.006

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Objective To investigate the clinical significance of capsule endoscopy in early diagnosis and treatment of precancerous lesions in gastric mucosa. Methods Total 140 cases of suspicious precancerous lesions in gastric mucosa in our hospital between September,2012 and January,2016 were enrolled into this study.The capsule endoscopy and magnifying endoscopy were performed in all patients,and the results were compared with the pathological examination. Results All patients were completed the inspection,the average detecting times in the capsule endoscopy were (478.24±45.22) min which the average stomach time were (49.24±22.12) min;the average duration of magnifying endoscopy detecting were (75.24±19.21) min;There were no any discomfort complaint in the capsule endoscopy detecting,while there were 9 patients were with adverse reactions in the magnifying endoscopy,all adverse reactions after symptomatic treatment were improved.Capsule endoscopy detected 108 patients of gastric precancerous lesions,the detection rate was 77.1%;and magnifying endoscopy detected 111 patients,the detection rate was 79.3%,there were no statistically significant in the detection rates between the two groups(P> 0.05);And the diagnostic sensitivity and specificity of capsule endoscopy for gastric precancerous lesions were 98.2% and 100.0%,respectively,while the magnifying endoscopy were 96.7% and 100.0%,respectively,the difference was not significant(P>0.05). Conclusion Capsule endoscopy for the early diagnosis and treatment of precancerous lesions in gastric mucosa is convenient and simple,with low impact on the body,relatively high detection rate,and better qualitative diagnostic sensitivity and specificity,which has good clinical values.

One-stage treatment of long segment Hirschsprung'disease in children using laparoscopic modified Soave procedure

CHEN Fang-fang, FU Xiao-jun, JIANG Lei, XU Jian-zhong, LU Zheng

2017, 15(11): 1846-1848,1859. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.007

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Objective To study the effect of one-stage treatment of long segment Hirschsprung' disease Ⅰ children by using laparoscopic modified Soave procedure. Methods A total of 86 cases of long segment Hirschsprung' disease in our hospital between January,2009 and January,2016 were enrolled and divided randomly into control group and observation group of 43 cases with the random number table method.There were 30 boys and 13 girls in the control group,aging from 3 to 15 months,6.7±3.3 on average,weighting from 5 to 13 kg,(7.8±2.6) kg on average;there were 31 boys and 12 girls in the observation group,aging from 3.5 to 14 months,6.3±3.5 on average,weighting from 5.5 to 12.5 kg,8.6±2.8 kg on average.The control group received common transanal modified Soave operation,while the observation group received laparoscopic modified Soave procedure.The operation time,peroperative bleeding,the length of bowel removed,recovery time of bowel peristalsis(sound),fasting duration,postoperative length of hospital stay,anal function,and complications were compared between the two groups. Results The operations in the two groups were successfully without death cases.The length of bowel removed in the two groups were no statistical difference,but the operation time,peroperative bleeding,length of hospital stay,bowel peristalsis recovery time and fasting duration in the observation group were less than those in the control group(P<0.05).The excellent rate of anal function after 12 months in the observation group was significantly better(P<0.05).The early and late complication rate in the observation group were both less(P<0.05). Conclusion Compared with the traditional laparotomy,one-stage laparoscopic modified Soave procedure has the advantages of small trauma,rapid recovery,and fewer complications in treatment of long-segment Hirschsprung' disease in neonates,and the surgical mode is safe and effective.

Application analysis of VEGF and Rsf-1 in pathologic diagnosis

DU Jun-jun, ZHANG Hong-fang, ZHOU Rong-jing

2017, 15(11): 1849-1851. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.008

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Objective To study cervical carcinoma vascular endothelial growth factor(VEGF) and remodeling and spacing factor l(Rsf-1) expression in cervical cancer tissues,and to analyze the correlation of VEGF and Rsf-1 with onset age,clinical stage,histological type,pathological stage and lymph node metastasis status,to explore their combined application in pathological diagnosis of cervical carcinoma. Methods Fifty-six cases of cervical cancer were selected as observation group,which were treated by operation and pathological diagnosis.Fifty-six cases of normal cervical tissues were selected as control group.The expression of VEGF and Rsf-1 were detected by immunohistochemistry.There was no significant difference in the positive expression of VEGF and Rsf-1 in the observation group at different age stages,histological types and FIGO stages of cervical cancer. Results The positive expression of VEGF in the control group was higher than the control group(P<0.05).The positive expression of Rsf-1 in the control group was also higher than the control group(P<0.05).There was no significant difference in the positive expression of VEGF and Rsf-1 factors in the observation group at different age stages,histological types and FIGO stages of cervical cancer.But the differences were statistically significant in pathological grading and lymph node metastasis for both factors(P<0.05). Conclusion The high expressions of VEGF and Rsf-1 in cervical cancer tissues are associated with cervical cancer occurrence and development and prognosis.They may be used as prognostic indicators of cervical cancer occurrence in the laboratory and clinical pathology to diagnose and evaluate the patients with cervical cancer occurrence.

Comparison of laparoscope combined left thorax small incision and left thorax single-incision therapy for Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction

LIU Hai-feng, HAN Qian, WANG Xian-zeng, SHEN Cheng-yu, CHANG Jun-hua, FU Guang-hua

2017, 15(11): 1852-1855. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.009

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Objective To explore the feasibility of laparoscope combined left thorax small incision therapy in the treatment of Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG),and compared with the single-incision treatment in surgical trauma,safety and efficacy on tumor/lymph node dissection. Methods A retrospective analysis was done on 193 patients with Siewert Ⅱ/Ⅲ AEG in Linzhou city people's hospital from October,2014 to December,2015,including 58 cases of laparoscope combined left thorax small incision therapy and 135 cases of left thorax single-incision therapy.The operation time,intraoperative bleeding,total drainage volume,indwelling pleural catheter time,and mediastinal/celiac lymph node dissection number were compared and statistically analyzed. Results The laparoscope combined left thorax small incision treatment has a longer operation time(P<0.05).However,it has advantage on intraoperative bleeding,total drainage volume,postoperative hospitalization days,celiac lymph node dissection number,VAS pain score(P<0.05).No statistical significance was obtained in indwelling pleural catheter time and mediastinal lymph node dissection number(P>0.05).Low occurrence of postoperative implications and no perioperative period death were found in these cases. Conclusion Laparoscope combined left thorax small incision therapy in the treatment of Siewert Ⅱ/Ⅲ AEG is with the advantage of smaller wound,quicker postoperative recovery,less intraoperative pain,clearer celiac lymph node dissection,better esophagus-stomach anastomosis and more perservation of the esophagus at tumor upper margin,which is worthy of application.

Therapeutic effect of levothyroxine on ovulation disorder and metabolic abnormality in patients with polycystic ovary syndrome complicated with subclinical hypothyroidism

LI Li-feng, HUANG Xiao-xiao, WEI Ruo-han, ZHAO Xiu-min

2017, 15(11): 1856-1859. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.010

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Objective To investigate the therapeutic effect of L-thyroxine on ovulation disorder and metabolic abnormality in patients with polycystic ovary syndrome complicated with subclinical hypothyroidism. Methods Two hundred cases of polycystic ovary syndrome with subclinical hypothyroidism were selected as the polycystic ovary syndrome with subclinical hypothyroidism group,and 200 cases of polycystic ovary syndrome without subclinical hypothyroidism were selected as the polycystic ovary syndrome group in Taizhou First People's Hospital from January,2010 to December,2016.Polycystic ovary syndrome with subclinical hypothyroidism with insulin resistance patients were 120 cases,were divided into thyroxine group and control group according to random number method,each group was 60 cases.The thyroxine group was given thyroxine + metformin treatment,the control group was given metformin treatment.After 3 months of treatment,the metabolic index and ovulation rate and pregnancy rate were observed. Results The levels of FINS,HOMA-IR,TG and LDL in polycystic ovary syndrome with subclinical hypothyroidism group were higher than those in polycystic ovary syndrome group(P<0.05).The levels of T in the thyroxine group and the control group after treatment were lower than those before treatment(P<0.05).The levels of TSH in the thyroxine group after treatment were lower than those before treatment(P<0.05).The level of TSH after treatment in the thyroxine group was lower than that in the control group(P<0.05).The levels of FINS and HOMA-IR in the thyroxine group and the control group after treatment were lower than those before treatment(P<0.05).The levels of TC and LDL in the thyroxine group after treatment were lower than those before treatment(P<0.05).The levels of TC and LDL after treatment in the thyroxine group were lower than those in the control group(P<0.05).The ovulation rate and pregnancy rate of the thyroxine group were higher than those of the control group,but the difference were not statistically significant(P>0.05). Conclusion The blood glucose and lipid metabolism of polycystic ovary syndrome with subclinical hypothyroidism patients are abnormal.L-thyroxine therapy can improve the blood glucose and lipid levels of polycystic ovary syndrome with subclinical hypothyroidism patients,and improve its ovulation rate and pregnancy rate.

Inhibitory effect of DHA and NS-398 on human cholangiocarcinoma QBC939 cells

CHEN Yun-jie, JIANG Hai-tao, WANG Tian-fei, REN Feng, SU Hui

2017, 15(11): 1860-1862,1910. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.011

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Objective To investigate the effect of Docosahexaenoic acid(DHA) combined with NS-398 on inhibition of cholangiocarcinoma QBC939 cell lines and its mechanism. Methods The cultured cholangiocarcinoma QBC939 cell line was exposed to 0,15,30,45,60 and 75 μg/ml DHA with 0,25,50,100,150 and 200 μmol/L NS-398,respectively.The absorbance of the QBC939 cells was measured by CCK8 and its growth inhibition ratio was calculated.Flow cytometry and transwell migration assays were applied to detect cell apoptosis and invasion,respectively. Results Exposure to DHA combined with NS-398 could significantly suppress the growth of QBC939 cells(P<0.05).When the concentration of DHA was 45 μg/ml and NS-398 was 100 μmol/L,the relative growth inhibition rate of QBC939 cells was 90%.If two drugs concentrations were increased,the result showed no statistically significant differences.DHA combined with NS-398 could promote QBC939 cells apoptosis at the early stage.When the concentration of DHA was 15 μg/ml and NS-398 was 50 μmol/L,it had no obvious inhibitory effect on QBC939 cell growth,but could obviously inhibit cell invasion,and significant difference was observed between the experimental and control groups(P<0.01). Conclusion DHA combined with NS-398 could promote apoptosis and inhibit growth and invasion of cholangiocarcinoma cells QBC939 in vitro.

Effect of hydromorphone combined with different doses of dexmedetomidine on postoperative analgesia in elderly patients undergoing laparoscopic radical prostatectomy

CHEN Nian-ping, YU Li-jun, JIN Bao-wei, HU Shuang-yan, ZHENG Xian-he, CHEN Zhong-hua

2017, 15(11): 1863-1866. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.012

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Objective To investigate the effect of hydromorphone combined with different doses of dexmedetomidine on postoperative analgesia in elderly patients undergoing laparoscopic radical prostatectomy. Methods Seventy-five elderly patients undergoing laparoscopic radical prostatectomy were randomly divided into three groups(25 cases in each group):Group H,Group HD₁ and Group HD₂.All patients were given intravenous analgesia pump with 20 μg/kg hydromorphone by intravenous injection 30 minutes before the surgery was finished.0.1 mg/kg hydromorphone and normal saline to 100 ml for Group H,hydromorphone 0.1 mg/kg combined with dexmedetomidine 2 μg/kg and normal saline to 100 ml for Group HD₁,and hydromorphone 0.1 mg/kg combined with dexmedetomidine 4 μg/kg and normal saline to 100 ml for Group HD₂.The recovery time,time to extubation,residence time of resuscitation,VAS scores and Ramsay scores at 1 h(T₁),6 h(T₂),12 h(T₃),24 h(T₄),36 h(T₅),48 h(T₆) after the operation and adverse events were monitored and recorded.The the time to first flatus and occurrence of side reaction such as nausea and vomiting,skin pruritus,respiration inhibition,bradycardia,hypotension and dry mouth were also investigated. Results There were no statistical significance among the three groups in the difference of recovery time,time to extubation,the residence time of resuscitation and the Ramsay scores(P>0.05).The VAS scores in both group HD₁ and group HD₂ were significantly lower than that in group H.The occurrence of dry mouth and hypotension in group HD₂ was significantly higher than that of both group H and group DH1,the others about adverse reaction were on significance difference among the three Groups. Conclusion It is effective and have less adverse reactions to use hydromorphone combined with 2 μg/kg dexmedetomidine in postoperative analgesia for the elderly patients undergoing laparoscopic radical prostatectomy.We consider that it is worth recommending.

The short-term curative efficacy of laparoscopic radical gastrectomy on advanced gastric cancer patients and its effect on intraperitoneal micrometastasis

ZHANG Ying-jie, LIANG Jin-rong

2017, 15(11): 1867-1869,1890. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.013

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Objective To study the short-term curative efficacy of laparoscopic radical gastrectomy on advanced gastric cancer patients and its effect on intraperitoneal micrometastasis. Methods A total of 113 patients with advanced gastric cancer in our hospital from March,2012 to March,2016 were divided into laparoscopic group and laparotomy group according to the treatment methods.The patients in the laparoscopic group received laparoscopic radical gastrectomy,and patients in laparotomy group received traditional open stomach cancer radical surgery.The perioperative indicators,treatment situation,dopamine decarboxylase(DDC) and Carcinoembryonic antigen(CEA) of intraperitoneal washings,complications of the two groups were compared. Results The incision length,intraoperative blood loss,analgesic drugs number,anal exhaust time,firstly getting out bed time,feeding diet time,hospitalization time of laparoscopic group were significantly lower than those of laparotomy group,the difference was statistically significant(P<0.05).The swept lymph nodes number,distance from near cut to tumor,distance from far-cut to tumor of laparoscopic group had no significantly difference to laparotomy group(P>0.05).After the treatment,the DDC and CEA of the two groups were significantly increased,the difference was statistically significant(P<0.05),but DDC and CEA of intraperitoneal washings of the laparoscopic group were significantly lower than those of the laparotomy group,the difference was statistically significant(P<0.05).The complication of laparoscopic group was significantly lower than that of laparotomy group,the difference was statistically significant(P<0.05). Conclusion Laparoscopic radical gastrectomy for advanced gastric cancer is effective,with the characteristics of small surgical trauma,low incidence of peritoneal micrometastasis,and high security.

Changes of lower-extremity function and peroneal nerve function at different recovery phase in patients with post-stroke hemiplegia

XU Jin-yuan, GONG Min-chao, YE Xiao-ju, PEI Jun, QIU Tao

2017, 15(11): 1870-1872. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.014

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Objective To investigate the changes of lower-extremity function and peroneal nerve function at different recovery phase in patients with post-stroke hemiplegia. Methods A total of 74 post-stroke hemiplegia patients were selected in our hospital from October,2015 to September,2016.The conventional medical treatment and rehabilitation training were performed in all patients.The lower-extremity function of patients was assessed with the Fugl-Meyer Assessment scaly after 1,3 and 6 months.The peroneal nerve function of patients was assessed by using common peroneal nerves conduction velocity.The difference in the functions after 1,3 and 6 months were compared.The correlation between lower-extremity function and common peroneal nerves conduction velocity was observed. Results Among the three recovery phases,Lower-extremity function had significant difference(F=53.950,P<0.001);peroneal nerve function of affected side had significant difference(F=3.241,P=0.045);peroneal nerve function of uninjured side had no significant difference(F=1.017,P=0.432).After 1 month and 3 months recovery,12 cases were with Grade 1 velopharyngeal function,14 cases with grade 2,and 3 cases with grade 3.The peroneal nerve function of affected side was significantly lower than that of uninjured side(t=-2.751,P=0.007;t=-2.540,P=0.012);After 6 months recovery,there was no significant difference between affected side and uninjured side(t=-1.371,P=0.173).FMA-L score increased with the extension of recovery time,there was a positive correlation(r=0.181,P=0.007);As the extension of recovery time,the common peroneal nerves conduction velocity accelerated,there was a positive correlation (r=0.181,P=0.007).There was a positive correlation between FMA-L score and common peroneal nerves conduction velocity(r=0.148,P=0.028). Conclusion As the extension of recovery time,lower-extremity function and peroneal nerve function can be gradually improved.The lower-extremity function is closely related to peroneal nerve function in patients with post-stroke hemiplegia.The combining monitoring on the lower-extremity function and peroneal nerve function will be helpful to the evaluation of prognosis of patients.

Therapeutic effect of the fixed-removable partial denture repair for dentition defect and the investigation of oral health related quality of life

PU Li-li, CHEN Chun-hui, LI Guo-min, FU Bo-ping

2017, 15(11): 1873-1875. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.015

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Objective To explore the therapeutic effect of the fixed-removable partial denture repair for dentition defect and investigate the oral health related quality of life,and provide the basis for better repair effect. Methods Total 113 patients with dentition defect treated in our department from January,2012 to January,2014 were enrolled in this study and divided into observation group and control group.The observation group was repaired with the fixed-removable partial denture and the control group was repaired with the removable partial denture.Six months after the treatment,the oral health related quality of life(OHRQOL) was enquired by the OHIP-14.After two years,the therapeutic effect and the gingival bleeding index(GBI) were evaluated by dentition defect standard of American public health association. Results The total scores of the OHIP-14 in the observation group was significantly lower than that in the control group(P<0.05).After two years,the ranked data(effective,effective and ineffective) had no statistically significant difference between the two groups(Z=0.825,P=0.409).Compared with that before the installation of denture,GBI of both groups were significantly decreased(P<0.05).Compared with the control group,the GBI was decreased more significant in the observation group(P<0.05). Conclusion The fixed-removable partial denture repair can be more effective than the removable partial denture repair in the treatment of the dentition defect,and patients would have a better long-term oral health and OHRQOL.

Effect of fiberoptic bronchoscopy with bronchoalveolar lavage in the treatment of bronchiectasis complicated with pulmonary infection

DAI Xiao-qiao, JIANG Hui, ZHONG Ping

2017, 15(11): 1876-1878,1921. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.016

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Objective To evaluate the efficacy of fiberoptic bronchoscopy with bronchoalveolar lavage in the treatment of bronchiectasis complicated with pulmonary infection,so as to provide a clinical basis for the treatment of bronchiectasis with pulmonary infection. Methods Total 40 cases of bronchiectasis with pulmonary infection were randomly divided into 2 groups,the control group received routine medical treatment,such as oxygen,asthma,expectorant and anti-infection;the observation group received bronchoalveolar lavage based on routine treatment.The clinical efficacy,complications,pulse blood gas analysis index,respiratory rate changes and the improvement of clinical symptoms and signs were compared between the two groups. Results In the observation group,5 cases were invalid,the total efficiency of clinical treatment was 75%;9 cases were ineffective in the control group,the clinical total effective rate was 55%,the difference was statistically significant(P<0.05).After the treatment,PaO₂,PaO₂/FiO₂ and respiratory rate in the two groups were no statistical significance(P>0.05).The cough disappeared time and hospitalization time in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).In the observation group,there was 1 case of sinus tachycardia,the heart rate was up to 100-150 times/min,and recovered after the operation;there were 3 cases of decreased oxygen saturation,and 90% of them recovered rapidly after the operation with a complication incidence of 20%.In the control group there were 3 cases of cough,and the symptoms of cough and expectoration disappeared after symptomatic treatment by oxygen inhalation machine.The incidence of complication was 15%.The difference in the incidence of complication between the two groups was not statistically significant(t=6.955,P<0.05). Conclusion Bronchoalveolar lavage is effective in the treatment of bronchiectasis complicated with pulmonary infection.It can obviously improve the inflammatory reaction and promote the recovery of heart and lung function.

Effect and complications of laparoscopic abdominal wall hernia repair for incisional hernia

YU Zhe-ke, WANG Jing-jing, ZHAO Zheng-zheng, QIU Zhen-ming, ZHENG Yong-hua, XIE Xiao-long, WANG Wei-jun

2017, 15(11): 1879-1881. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.017

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Abstract:
Objective To investigate the effect and complications of laparoscopic abdominal wall hernia repair for incisional hernia,and provide reference for clinical surgical treatment. Methods A total of 97 cases of incisional hernia in our hospital from December,2012 to December,2015 were selected and divided into laparoscopic group(n=49)and open group(n=48) according to the random number table method.The laparoscopic group received laparoscopic abdominal wall hernia repair,while the open group received the open abdominal hernia repair.The operation time,abdominal wall defect,the amount of intraoperative bleeding,postoperative hospital stay,postoperative complications and recurrence of 12 months follow-up were compared between the two groups. Results The operative time of the laparoscopic group[(59.83±3.56)min] was shorter than that in the open group[(72.35±5.16)min],the amount of bleeding[(32.40±5.47)ml] was less than that in the open group[(71.32±7.69)ml],the postoperative hospitalization time[(6.48±1.35)d] was shorter than that in the open group[(9.24±2.18)d],and the difference was statistical significant(P<0.05).The abdominal wall defect area in the laparoscopic group was (65.08±6.34)cm²,in the open group was (66.42±7.18)cm²,there was no significant difference(P>0.05).The incidence of postoperative complications of the laparoscopic group(6.12%) was lower than that of the open group(22.92%,P<0.05).The recurrence rate in the laparoscopic group during the 12 months follow-up was 4.08%,and in the control group was 8.33%,and there was no statistical difference(P>0.05). Conclusion The efficacy of laparoscopic abdominal wall hernia repair is superior to the open surgery for patients with incisional hernia,with lower incidence of postoperative complications.,it has important research value and is worthy of further clinical application.

Expression and clinical significance of CRP and ESR in elderly patients after lumbar surgery

DAN Xian-zhen, WANG Yin-hai, ZHOU You-long, YANG Cheng-lin

2017, 15(11): 1882-1884. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.018

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Abstract:
Objective To investigate the changes of C reactive protein(CRP) and erythrocyte sedimentation rate(ESR) in elderly patients after lumbar surgery and their clinical significance. Methods A total of 176 elderly patients undergoing lumbar surgery in our hospital from May,2016 to June,2017 were selected. Fifteen patients,got postoperative infection,which were included as infection group; 161 patients without postoperative infection were included as the control group.The levels of CRP and ESR in 1,3,5,7,14 and 21 d in serum before and after operation were detected. Results The CRP level of the infection group and the control group of patients before lumbar operation were (9.5±2.6) mg/L and (9.8±1.9) mg/L,there was no statistically significant difference(t=0.565,P=0.573);The CRP level after lumbar operation of two groups were (121.80±3.2) mg/L and (35.0±4.3) mg/L,the difference was statistically significant.The ESR level of the infection group and the control group of patients before lumbar operation were (16.3±3.2) mm/h and (16.6±2.9) mm/h,there was no statistically significant difference; The ESR level after lumbar operation of two groups were (75.4±6.8) mm/h and (36.0±4.6) mm/h,the difference was statistically significant(t=21.947,P<0.001).The average level of CRP3 and ESR in the infection group after lumbar surgery in 21d was significantly higher than that in the control group,which showed an increasing trend with time,and reached the peak value at 3d after the operation,and then decreased gradually.CRP and ESR peak of the infection group of patients were significantly higher than that of control group. Conclusion The elderly patients undergoing lumbar surgery after treatment was detected in the CRP level and ESR level can more effectively judge the postoperative infection,so that early detection and early treatment.

Effect of preemptive analgesia with parecoxib sodium at different time-point on postoperative analgesia elderly patients undergoing radical resection of gastric cancer

SUN Qian, ZHANG Ting

2017, 15(11): 1885-1887. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.019

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Objective To observe the effect of preemptive analgesia with parecoxib sodium at different time-point on postoperative analgesia elderly patients undergoing radical resection of gastric cancer,and to evaluate the security. Methods We retrospectively analyzed the clinical data of 78 patients undergoing radical surgery in elderly patients with gastric cancer.They were randomly divided into observation group(A) and control group(B).Intravenous parecoxib sodium 40 mg was performed in Group A before the induction of anesthesia,and in the Group B at the end of operation.Then the patient-controlled intravenous analgesia pump was used in both groups at the end of the operation:Sufentanil 0.8 g/(kg·d),ondansetron 16 mg and dezocine 10 mg were configured for 100 ml with saline;Parameters:speed 2 ml/h,automatic control 15 min,2 ml/time.The mean arterial pressure(MAP) and heart rate(HR) at the end of operation,6 h,24 h and 48 h after the surgery were compared between the two groups.The visual analogue scale(VAS),pressing times of the patient-controlled intravenous analgesia pump within 24 h after the operation,and the total dose of Sufentanil were recorded.The incidence of adverse reactions of the two groups was observed. Results MAP and HR in the observation group at the end of operation and 24 h after the operation were lower than those in the control group(P<0.05),with more stable hemodynamics;VAS of the patients in the observation group at 6 h,12 h and 24 h after the operation was lower than the control group(P<0.05).The total pressing times and the total dose of Sufentanil in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse effects between the two groups(P>0.05). Conclusion The preemptive analgesia with parecoxib sodium before the induction of anesthesia can effective reduce the postsurgical pain in elderly patients undergoing radical resection of gastric cancer,with stable hemodynamics,lower incidence of adverse effect and good safety.

Retrospective analysis of 62 cases of early precancerous lesions by diagnostic and therapeutic gastrointestinal endoscopies

CHEN Wei, HUANG Hui-feng, XIA Tai-jun, XU Yong-fei, CAO Chun-yu, MEI Li-hong

2017, 15(11): 1888-1890. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.020

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Abstract:
Objective To evaluate the effect and outcome of endoscopic submucosal dissection(ESD) in the diagnosis and treatment of early gastrointestinal precancerous lesions. Methods From 2013 to 2016,62 cases of suspected gastrointestinal cancer patients in our hospital were enrolled into the study,including 41 cases of male and 21 cases of female.The average age was (58.5±6.2) years.All patients were diagnosed and treated by ESD,which were confirmed by pathological findings as early precancerous lesions.The effect of ESD in the diagnosis and treatment was evaluated;the complications and prognosis of patients were observed. Results The lesions were all located in the mucosa and submucosa.The lesions were located in esophagus(17 cases,27.42%),stomach(29 cases,46.77%) and colon(16 cases,25.81%),respectively.Most of them were middle esophagus(10 cases,58.82%).The pathological type Ⅰ was 4.84%(n=3) and type Ⅱ was 95.16%(n=59),in most of the patients it was of Ⅱb(28 cases,45.16%).The total resection rate was 95.16%(59/62),and the cure rate was 90.32%(56/62).The incidence of the complications was bleeding in 1 case(1.61%),perforation in 2 cases(3.23%),postoperative chest pain in 2 cases(3.23%),abdominal pain in 1 case(1.61%),they were all cured after anti-infection and antacid treatment.The sixth months follow-up showed that there was no lost patients,the patients with eating discomfort and dysphagia symptoms were obviously relieved(21 cases,33.87%;18 cases,29.03% respectively).Recurrence was found in 1 case(1.61%),and was cured after ESD. Conclusion ESD is effective in the diagnosis and treatment of early gastric precancerous lesions,with the low incidence of the complications and postoperative recurrence rate.It can be used as the first choice for minimally invasive diagnosis and treatment of precancerous lesions of digestive tract.

Role of calcaneus quantitative ultrasound in screening osteoporosis in elderly female patients with knee osteoarthritis

LIANG Xiao-hong

2017, 15(11): 1891-1893. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.021

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Objective To analyze the correlation of calcaneus quantitative ultrasound with dual-emission X-ray absorptiometry(DXA) in detecting bone mineral density(BMD) of elderly female patients with knee osteoarthritis. Methods One hundred and one elderly female patients with knee osteoarthritis were divided into 3 groups according to the age:<65,n=38;65-75,n=48;>75,n=15.The calcaneus quantitative ultrasound and DXA were performed in all the patients to detect BMD,the correlation between the results of calcaneus quantitative ultrasound and DXA was analyzed.Furthermore,with DXA T value as the standard,the diagnostic efficiency for osteoporosis and bone mineral density decreased of BUA,SOS,T-score and SI was analyzed. Results The DXA T of patients >75 was higher than that of patients <65 or 65-75,and the difference between groups had statistical significance(P<0.05).The BUA,T-score and SI of patients 65-75 were both lower than those of patients <65,and those of patients >75 were both lower than those of patients 65-75,and the difference between groups had statistical significance(P<0.05).BUA,T-score and SI were both had positive correlation with DXA T(R²=0.3154,0.3207,P<0.05),and both of them had good diagnostic performance for osteoporosis and BMD decrease.The best working point for osteoporosis was:BUA=55.205 dB/MHZ;T-score=-2.47;SI=65.635.The best working point for BMD decrease was:BUA=60.725 dB/MHZ;T-score=-1.605;SI=79.196. Conclusion BUA,T-score and SI by calcaneus quantitative ultrasound are closely related to BMD of women patients with knee osteoarthritis,which has prediction effect for osteoporosis,and is expected to become a clinical screening tool.

Effects of ceftazidime combined amikacin on serum levels of hs-CRP,PCT,IL-6 and prognosis of patients with leukemia after leukemia chemotherapy

DU Xiao-hong, ZHANG Pi-sheng, ZHUANG Xian-xu, CHEN Zhe

2017, 15(11): 1894-1896. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.022

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Objective To investigate the effects of ceftazidime combined amikacin on serum levels of hs-CRP,PCT,IL-6 and prognosis of patients with leukemia after leukemia chemotherapy. Methods Sixty-two patients with leukemia after leukemia chemotherapy in Ningbo Yinzhou people's hospital from March,2013 to April,2015 were selected and randomly divided into two groups.The control group was given ceftazidime,and research group was given amikacin combined ceftazidime.Both groups were treated for 1 week.The clinical efficacy,serum hs-CRP,IL-6 and PCT levels,adverse reactions incidence,survival rate after 12 months of two groups were compared. Results The effective rate of research group was 83.87%(26/31),which was significantly higher than that of control group[61.29%(19/31)],P<0.05.After treatment,the serum hs-CRP,IL-6 and PCT levels of two groups were significantly reduced(P<0.05),and serum hs-CRP,IL-6 and PCT levels of research group were significantly lower than control group(P<0.05).The adverse reaction incidence of research group was 12.90%(4/31),and adverse reaction incidence of control group was 9.67%(3/31),there was no significant difference between two groups.The survival rate of research group was 87.10%(27/31),which was significantly higher than that of control group 64.52%(20/31),P<0.05. Conclusion Amikacin combined ceftazidime could effectively reduce serum hs-CRP,PCT and IL-6 levels of patients with leukemia after leukemia chemotherapy,enhance the therapeutic effect and survival rate,improve the prognosis.

Association of Homocysteine with Early Renal Damage in Essential Hypertension in Ethnic Uyghurs and Hans from Xinjiang

CHEN Hong-li, LI Yu, WANG Hong, SHI Qing-ping, OUYANG Ju-yan, LU Yan-xia, CHEN Cheng

2017, 15(11): 1897-1900. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.023

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Objective To investigate plasma homocysteine(Hcy) levels and early renal damage in essential hypertension in ethnic Uyghurs and Hans patients,and to explore the difference of early renal damage in the two ethnics. Methods Eight hundred and twelve cases with essential hypertension were included and divided into two groups:H-type hypertension group(Hcy ≥ 10 μmol/L,254 cases were Uyghurs and 294 cases were Hans) and non H-type hypertension group(Hcy<10 μmol/L,149 cases were Uyghur and 115 cases were Hans).The plasma levels of Hcy and creatinine were measured.The correlation between Hcy and early renal damage and the difference of early renal damage in the two ethnics were analysed. Results Compared with the non H-type hypertension group,the levels of creatinine,cystatin C,and the early renal damage prevalence were statistically higher in H-type hypertension group in both ethnic Uyghurs and Hans(P<0.05),while eGFR was significantly lower(P<0.05).There were no difference of early renal damage prevalence in the two ethnics in both H-type hypertension group and non H-type hypertension group(P>0.05).Logistic regression analysis indicated that LnHcy(OR=2.201,95% CI:1.066-4.543,P=0.033),cystatin C(OR=1.475,95% CI:1.303-1.699,P<0.001),low HDL-C(OR=2.475,95% CI:1.436-4.268,P=0.001),BUN(OR=1.277,95% CI:1.054-1.547,P=0.013) were independent risk factors for early renal damage in essential hypertension among ethnic Uyghurs.While LnHcy(OR=3.804,95% CI:1.855-7.798,P<0.001),cystatin C(OR=1.655,95% CI:1.433-1.911,P<0.001),low HDL-C(OR=2.059,95% CI:1.208-3.509,P=0.008),BUN(OR=1.222,95% CI:1.018-1.468,P=0.032),cigarette(OR=1.993,95% CI:1.082-3.671,P=0.027) were independent risk factors for early renal damage in essential hypertension among ethnic Hans. Conclusion Plasma levels of Hcy is associated with early renal damage in essential hypertension in both ethnic Uyghurs and Hans patients,there were no difference of early renal damage prevalence in the two ethnics.

Risk factors of osteoporosis in maintenance hemodialysis patients and its relationship with serum calcium,phosphorus and parathyroid hormon levels

SHEN Ying, LIANG Shi-kai

2017, 15(11): 1901-1903. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.024

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Objective To observe the risk factors of osteoporosis and the relationship between osteoporosis and serum calcium,phosphorus and parathyroid hormone levels in maintenance hemodialysis patients. Methods We selected 200 patients with maintenance hemodialysis in the Department of Nephrology of Shaoxing Traditional Chinese Medicine Hospital from January,2012 to December,2015 for the study.The 200 patients were divided into osteoporosis group(n=93) and non-osteoporosis group(n=107).The clinical data of the patients were collected and the calcaneus bone mineral density,serum calcium,phosphorus and parathyroid hormone levels were measured. Results The proportion of men in the osteoporosis group(33.3%) was lower than that in the non-osteoporosis group(62.6%,P<0.05).The proportion of patients older than 60 years(63.4%) in the osteoporosis group was higher than that in the non-osteoporosis group(29.9%,P<0.05).The body weight,height and body mass index of patients in the osteoporosis group[(59.34±10.27)kg,(1.62±0.08)m,(20.89±1.34)kg/m²] were significantly lower than those in the non-osteoporosis group[(67.35±12.63)kg,(1.67±0.06)m,(22.14±2.54)kg/m²],P<0.05.The levels of serum phosphorus and parathyroid hormone in osteoporosis group[(1.64±0.52)mmol/L,(243.64±64.35)ng/L] were higher than those in non-osteoporosis group[(1.91±0.57)mmol/L,(381.34±77.36)ng/L],P<0.05.There was no significant difference of blood calcium between the two groups(P>0.05).Logistic regression analysis showed that the gender,age and serum phosphorus were independent factors of osteoporosis in maintenance hemodialysis patients(P<0.05).Women,older age,elevated serum phosphorus were independent risk factor for osteoporosis in maintenance hemodialysis patients.There was no significant correlation between bone mineral density and calcium,phosphorus,and parathyroid hormone levels in maintenance hemodialysis patients(P>0.05). Conclusion Female,aged,hyperphosphatemia are independent risk factors for osteoporosis in maintenance hemodialysis patients.There is no significant correlation between bone mineral density and calcium,phosphorus and parathyroid hormone levels in maintenance hemodialysis patients.

Clinical research of uterine arterial embolization combined with levonorgestrel releasing intrauterine system in the treatment of adenomyosis

CHEN Yu-huan, LI Jing-wen, YAO Heng, ZHANG Hui-li, YANG Xiao-hong

2017, 15(11): 1904-1906. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.025

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Abstract:
Objective To investigate the clinical effect of uterine artery embolization combined with Levonorgestrel(LNG)-releasing intrauterine system in the treatment of adenomyosis,and explore a conservative effective therapy of uterine adenomyosis. Methods Total 78 inpatients with histologically confirmed adenomyosis in hospital undergoing percutaneous common femoral artery(CFA) puncture for uterine artery embolization with the 4F Cobra catheter 3-7 days after their menstruation cycle.And the LNG-releasing intrauterine system was placed in two months after operation.The degree of dysmenorrhea,volume of menstrual flow,the size of the uterus and changes of the endometrial thickness by pelvic ultrasound,the level of serum CA125,and the function of ovary were evaluated on the regular follow-up evaluation. Results In 3,9 and 12 months after uterine artery embolization combined with LNG-releasing intrauterine system therapy,the dysmenorrhea score,PBAC score,endometrial thickness,CA125 level and the size of the uterus were improved as compared with those before the treatment,the difference was statistically significant(P<0.05).The volume of uterine after the placement of Mirena was not changed obviously,the difference was no significant(P>0.05).After the treatment,a small amount of vaginal bleeding occurred in a few patients,but the ring did not move down or fall off in any cases.The serum sex hormone levels(LH,E2 and FSH) before the uterine artery embolization,2 months after the surgery,and 3 and 12 months after LNG-releasing intrauterine system placement did not changed obviously,there were no significant differences(P>0.05),which did not show the reduced ovarian reserve function. Conclusion Uterine artery embolization combined with LNG-releasing intrauterine system for adenomyosis has the advantages of small trauma,high safety,not affecting ovarian function.

Clinical study and literature review of bronchiolitis obliterans in children

PING Ming-fang, WU Ming, CHEN Jun-guo

2017, 15(11): 1907-1910. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.026

190 3

Abstract:
Objective To analyze the clinical features,etiology,pulmonary function,chest CT scans,diagnosis and prognosis of bronchiolitis obliterans(BO) in children. Methods We retrospectively analyzed 17 children with BO in Jiaxing Second Hospital,including their age,gender,etiology,clinical manifestations,changes in lung function,changes in imaging,treatment and outcome. Results All BO cases(10 boys and 7 girls)occurred following lower respiratory tract infection and adenovirus,measles virus and mycoplasma were major pathogens.The lung function test demonstrated that moderate obstructive ventilatory dysfunction happened in 4 cases,and a negative response to the bronchodilator reversibility testing.High-resolution computerized tomography(HRCT)showed mosaic perfusion in a11 cases,lung consolidation in 5 cases,atelectasis in 3 cases,bronchiectasis in 2 cases and bronchial wall thickening in 1 case.All cases received systemic and inhaled corticosteroid treatment and were provided with strengthened lung physiotherapy,a suitable nutrition,and enhanced overall growth and followed up for 3 to 27 months.And 13 cases received chest CT scan and demonstrated that no change was found in 6 cases,2 cases were progressed while 5 cases were improved,and no single case was completely absorbed. Conclusion Low respiratory infection is the most common cause of pediatric BO and adenovirus,measles virus and mycoplasma are major pathogens.The lung function test cannot provide enough early diagnostic value for BO.Classical"mosaic perfusion"with pulmonary HRCT imaging is important for early diagnosis and follow-up of BO.Systemic and inhaled corticosteroid treatment may relieve clinical symptoms,The key to the prognosis of BO is the early diagnosis,early intervention and the overall development of children.

Effect of high-dose vitamin D on prevention and treatment of gestational diabetes mellitus in obese pregnant women

ZHOU Hai-xian, XU Qun, CAI Ping-sheng

2017, 15(11): 1911-1914. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.027

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Abstract:
Objective To investigate the preventive and therapeutic effects of high dose vitamin D(VD) during gestation on gestational diabetes mellitus in obese women. Methods One hundred and eighteen pregnant women were randomly divided into two groups:the experimental group and the control group,59 cases in every group.The experimental group were given vitamin D 30 million IU intramuscular injection in the pregnant 16-20 weeks.In the control group,VD drops capsule(400 IU) was orally administered once a day for 16-20 weeks.The clinical data of 25(OH)D₃,PTH,Ca,P,HbA1c and BMI and the improvement of vitamin D deficiency were compared between the two groups. Results After intervention,the levels of 25(OH)D₃ and serum Ca in test group were significantly higher than those before treatment,PTH concentration was significantly decreased(P<0.01).In the trial group,the ratio of patients with moderate to severe vitamin D deficiency was significantly lower after treatment(P<0.01).The incidence of GDM in pregnant women was significantly lower than that in the control group(P<0.05),and the incidence of GDM in pregnant women was significantly lower than that in the control group(P<0.01).The cesarean section was significantly lower in the test group than in the control group(P<0.01).The incidence of neonatal stillbirth,neonatal asphyxia,premature infants and macrosomia in the experimental group was significantly lower than that in the control group(P<0.05). Conclusion The single dose can effectively improve the VD deficiency state of obese pregnant women,and can effectively reduce the incidence of GDM of obese pregnant women,reduce the rate of cesarean section,reduce the risk of adverse pregnancy outcome.

A preliminary study on the timing of an emergency hysterectomy in patients with postpartum hemorrhage caused by dangerous placenta praevia

JIANG Ling-ling, LIU Ying-lei, LIU Man-hua, CHEN Li-ping, QIAO Hai-feng

2017, 15(11): 1915-1917. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.028

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Abstract:
Objective To investigate the timing of an emergency hysterectomy in patients with postpartum hemorrhage caused by dangerous placenta praevia. Methods Seventy patients with placenta praevia and postpartum hemorrhage in our hospital from January,2013 to January,2016 were divided into observation group(22 cases) and control group(48 cases) according to the treatment.The patients in the control group received uterine resection on account of the bleeding did not stop after promoting uterine contractions in the cesarean section.The hysterectomy was carried out in patients in the observation group after uterine artery embolization was invalid and the bleeding volume exceeded more than 1 000 ml.The general information of the patients,the amount of bleeding before hysterectomy,the total amount of blood loss,the amount of blood transfusion,the time of operation,the time of hospitalization,the time of antibiotic application and the occurrence of complications were observed and compared between the two groups. Results There was no significant difference in the general information of the patients between the two groups(P>0.05).The total amount of bleeding before and during the hysterectomy in the observation group was significantly higher than those in the control group(P<0.05).The fresh frozen plasma infusion in the observation group was significantly higher than that in the control group(P<0.05).The operation time of the observation group was longer than that of the control group,the difference was statistically significant(P<0.05).However,there was no significant difference between the two groups in hospitalization time and antibiotic application time(P>0.05).There was no significant difference in postoperative complication rate and mortality between the two groups(P>0.05). Conclusion The conservative treatment can be conducted before the hysterectomy in the patients with postpartum hemorrhage caused by dangerous placenta praevia when the blood supply can be ensured and family of informed consent,so as to reduce as much as possible the harm caused to patients by hysterectomy,and retain the fertility function of patients.During the treatment process,the bleeding should be closely monitored,and the hysterectomy should be performed as soon as possible if the conservative treatment is still unable to stop bleeding.

Clinical value of Ju Yuan granule combined with biofeedback and electrical stimulation in the treatment of postpartum pelvic floor dysfunction

WANG Lu-lu, JIANG Xi-jing, HU Ting, SHEN Xiao-fang

2017, 15(11): 1918-1921. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.029

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Abstract:
Objective To investigate the clinical efficacy of JuYuanJian combined with biofeedback and electrical stimulation in the treatment of postpartum pelvic floor dysfunction(PFD) and its effect on pelvic floor muscle strength. Methods Total 605 cases of puerperae with the level of pelvic floor muscle strength ≤ 3 in our hospital were collected and assigned into the observation group(298 cases) and the control group(307 cases)in accordance with the voluntary principle.The puerperae in the observation group received JuYuanJian combined with Biofeedback and electrical stimulation,while the control group received only biofeedback and electrical stimulation.The difference of vaginal contraction electromyogram,vaginal contraction duration and vaginal dynamic pressure were compared between the two groups,and the changes of stress urinary incontinence symptoms and deficiency syndrome were analyzed. Results After the treatment,the incidence of stress urinary incontinence in the observation group was 0.34%(1/298) and in the control group 0.98%(3/307),which was significantly lower than 6.38%(19/298) and 7.17%(22/307) before the treatment(P<0.05),but there was no significant difference between the two groups after the treatment(P>0.05).The level of vaginal contraction electromyogram,vaginal contraction duration and vaginal dynamic pressure after the treatment were significantly higher than those before the treatment(P<0.05),and there was significant difference between the two groups after the treatment(P<0.05).After the treatment,the score for every Qi-deficiency syndrome(TCM) were significant improved in both groups(P<0.05),the score for spiritlessness and spontaneous perspiration in the observation group were significantly lower than those in the control group(P<0.05),but the score for breathe hard,lacking in strength and emaciation were not significant difference between the two groups(P>0.05).The overall quantization scores for Qi-deficiency syndrome in the observation group was significantly lower than the control group(P<0.01). Conclusion JuYuan granule combined with biofeedback and electrical stimulation in PFD can effectively promote postpartum pelvic floor muscle function recovery,improve the treatment of postpartum PFD,which is better than only biofeedback and electrical stimulation,and it is worthy of further application.

The effect of combined treatment with gravitational tube feeding and oral motor in treatment of feeding intolerance in preterm

NIE Li-li, DENG Chun-gui, HE Jian-long, LIN Xue-mei, WU Feng-lin, QIU Jian-wu

2017, 15(11): 1922-1924,1974. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.030

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Abstract:
Objective To observe the therapeutic effect of gravitational tube feeding together with oral motor in premature infants with feeding intolerance,and to provide evidence for the preterm infant feeding. Methods A total of 122 premature infants diagnosed as feeding intolerance were randomly divided into control group A,control group B and observation group C.The control group A with 40 cases received conventional tube feeding,the control group B with 38 cases were given conventional tube feeding combined with Fucile's Oral Motor Interventions,the observation group C with 44 cases was treated with gravitational tube feeding and Fucile's Oral Motor Interventions.We observed when gastric retention disappeared,when gastro-esophageal reflux disappeared,when birth weight regained,and the oral feeding time as well as hospital stay.Variance analysis was used to compare the nursing effect of the three groups,with P<0.05 showing statistical significance. Results All indexes in observation group C were significantly shorter those in control group A and B(P<0.05).Gastro-esophageal reflux,birth weight regain and the length of hospitalization in control group B is superior to those in control group A. Conclusion Combined treatment with gravitational tube feeding and oral motor can effectively reduce the rate of feeding intolerance in preterm.It is beneficial to shorten the time necessary to switch from tube feeding to per-oral feeding,and reduce the duration of hospital stays.It is valuable to widely popularize this method in clinical practice.

Changes and its significance of soluble E-selectin in patients with community acquired pneumonia

CHEN Ying, XIA Yi-zi, GONG Yu-qiang, CHEN Gang

2017, 15(11): 1925-1927,1947. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.031

129 0

Abstract:
Objective To investigate the changes of soluble E-selectin(sE-selectin) levels in patients with community acquired pneumonia and its significance. Methods We collected 50 patients with community-acquired severe pneumonia as severe pneumonia group,50 patients with community-acquired non-severe pneumonia as non-severe pneumonia group,and 50 healthy subjects as control group.The severe pneumonia group patients were divided into multiple organ dysfunction group and non-multiple organ dysfunction group.The serum sE-selectin,C-reactive protein,and white blood cell count were measured. Results The serum sE-selectin,C-reactive protein and white blood cell count in severe pneumonia group,non-severe pneumonia group and control group were (41.23±10.78)ng/ml,(85.47±21.14)ng/ml,(18.35±4.21)×10⁹/L;(13.25±3.84)ng/ml,(43.25±12.15)ng/ml,(12.01±2.87)×10⁹/L;(5.64±1.42)ng/ml,(2.12±0.89)ng/ml,(6.57±2.02)×10⁹/L,and the difference among the groups were significant(P<0.05).The serum sE-selectin in the multiple organ dysfunction group and non-multiple organ dysfunction group were (53.14±12.53)ng/ml and (37.28±8.21) ng/ml,with statistical significance among groups (P<0.05).The levels of serum sE-selectin,C-reactive protein and white blood cell count before and after treatment in severe pneumonia group were (41.23±10.78)ng/ml,(85.47±21.14)ng/ml,(18.35±4.21)×10⁹/L;(18.74±5.84)ng/ml,(12.96±5.12)ng/ml,(8.83±2.52)×10⁹/L respectively,and the difference between the two groups were significant(P<0.05).The serum sE-selectin,C-reactive protein and white blood cell count in the non-severe pneumonia group before and after treatment were (13.25±3.84)ng/ml,(43.25±12.15)ng/ml,(12.01±2.87)×10⁹/L;(9.13±1.56)ng/ml,(9.16±2.04)ng/ml,(6.85±2.31)×10⁹/L,and the difference between the two groups were significant(P<0.05).The serum sE-selectin was positively correlated with C-reactive protein and white blood cell count(P<0.05). Conclusion The serum sE-selectin level is elevated in patients with community-acquired pneumonia,and the serum sE-selectin level is associated with the severity of community-acquired pneumonia and the therapeutic effect.

Effects of aromatherapy on sleep quality and anxiety level of patients undergoing abdominal operation

YU Ya-bo, XU Feng, MA Gang, TAO Guo-quan

2017, 15(11): 1928-1931. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.032

228 4

Abstract:
Objective Sleep is essential for maintaining physical and mental health,and sleep disorders are often present in hospitalized patients in the ICU,and aromatherapy is one of the non-pharmacological treatments for sleep disorders.This study aimed to investigate the effect of lavender essential oil on the sleep quality and anxiety level of patients in Hepatobiliary Surgery ICU. Methods A randomized controlled study was conducted with 60 patients in Hepatobiliary Surgery ICU.After informing the patients in both groups about the study,they were administered with two questionnaires,Pittsburgh Sleep Quality Index(PSQI) and the Self-Rating Anxiety Scale(SAS).The patients in the intervention group were given 2% lavender essential oil via inhalation for 15 days after which they were administered the same scales again to evaluate the sleep quality and anxiety.As for the control group,they were administered the same scales again after 15 days without the inhalation of lavender essential oil. Results The general situation of the intervention group and control group were compared and no statistical differences were found between the two groups;By comparison of sleep quality scores and anxiety scores before and after the treatment in the intervention group and the control group,the sleep quality value(8.68±2.96 vs. 6.80±2.83,t=2.514,P=0.015) and the anxiety score(56.43±9.48 vs. 47.93±7.70,t=3.812,P<0.001) of intervention group of patients were improved significantly after the treatment,while in the control group,the sleep quality scores and anxiety scores had no obvious improvement;furthermore,by comparison of the intervention group and the control group after the treatment,the intervention group's sleep quality score(6.80±2.83 vs. 8.48±2.60,t=2.394,P=0.020) and anxiety score(47.93±7.70 vs. 54.65±6.54,t=3.643,P<0.001) were improved significantly. Conclusion Lavender essential oil can improve quality of sleep and reduce the level of anxiety in patients in Hepatobiliary Surgery ICU.As a non-invasive,cheap,easily applicable,cost-effective,independent nursing intervention and appropriate for patients in Hepatobiliary Surgery,lavender essential oil could be applied in ICUs.

Different emotional facial stimuli in patients with major depressive disorder by event-related potential P300

LIU Ji-meng, ZHANG Wen-wu, FANG Ze-zhong, LIU Shi-yan, ZHOU Dong-sheng

2017, 15(11): 1932-1934. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.033

181 1

Abstract:
Objective To explore the effects of three kinds of emotional facial stimuli(happy,neutral and sad) on P300 in patients with depressive episode during continuous attention task. Methods Thirty-three cases of 18-58 years old patients with depression(case group,the stress group 17 cases,16 cases of non stress group) and 18 aged 20-58 years old healthy subjects(control group) were detected in brain visual evoked potentials participants were asked to perform tasks in the attention and selection after happy,sad and neutral emotional faces of stimuli were randomly presented.The latency and amplitude of P300 were observed in the case group and the control group in different emotional faces evoked by stimulation.P300 latency and amplitude differences were assessed by the two way ANOVA statistics between the groups; The correlation of HAMA,HAMD total scores and P300 latency and amplitude were assessed respectively by person correlation analysis in the case group. Results The stress group and non stress group were in happy and neutral faces after the stimulation of the amplitude of P300 is lower than that of the control group,the difference was statistically significant(P<0.05),stress group and non stress groups were in sad faces after the stimulation of the amplitude of P300 is lower than that of the control group,but only the non stress group and control group of the difference was statistically significant(P<0.05);stress group and non stress group in the happy,neutral and sad faces after the stimuli of P300 latency were higher than the control group,and there is statistically significant(P<0.05). Conclusion The patients with major depressive disorder in the implementation of sustained attention task for the happy,neutral facial emotion recognition ability have weakened.Emotional bias has influence on depression in patients with sustained attention to cognition.

Analysis of 72 cases of forensic psychiatric disability identification for diffuse axonal injury due to traffic accident

JIANG Hong-xia, LI Guo-rong, TANG Chen-dong, LI Ting, LI Ya-ling, TANG Jian-liang

2017, 15(11): 1935-1937,1958. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.034

194 3

Abstract:
Objective To explore the characters of disability determination of forensic psychiatry for diffuse axonal injury(DAI) due to traffic accident and its influence on degree of disability so as to provide better clues for such similar cases. Methods From January 2014 to June 2015,total 530 cases of disability determination for craniocerebral injury due to traffic accident were collected and divided into experimental group(combined with DAI,72 cases) and control group(not combined with DAI,458 cases).The sex,age,occupation,degree of education,time interval from injury to determination,Glasgow Coma Scale scores after injury,coma time after injury,head CT and electroencephalogram when determination,the diagnosis of determination and degree of disability were investigated.The retrospective analysis was done by t-test,χ²-test and multi-linear regression. Results There was no statistical differences in age,degree of education,time interval from injury to determination and head CT at the determination between the two groups(P>0.05).There were statistical differences in GCS(Glasgow Coma Scale)scores,coma time,electroencephalogram(EEG) at determination and degree of disability(P<0.05).The degree of disability of the experimental group was 7.92±1.39,and of the control group was 8.72±1.51.There was statistical difference in degree of disability between the two groups(P<0.05).The mild and moderate abnormal EEG,coma time and GCS scores by multiple linear regression analysis were the relative factors for the degree of disability in the experimental group,which accounted for 70.6% of the variety of the degree of disability.The moderate abnormal EEG,coma time and GCS scores were the relative factors for the degree of disability in control group according to multiple linear regression analysis,which accounted for 81.6% of the variety of the degree of disability. Conclusion There are higher degree of disability in craniocerebral injury combined with DAI,which had relations to the mild and moderate abnormal EEG,coma time and GCS scores.There would be positive influences on disability determination if the DAI are better identified.

The relationship between bone mineral density and bone metabolism in postmenopausal patients with type 2 diabetic nephropathy

YU Ying

2017, 15(11): 1938-1940. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.035

149 0

Abstract:
Objective To investigate the relationship between bone mineral density(BMD) and bone metabolism in postmenopausal patients with type 2 diabetic nephropathy and to analyze influencing factors of BMD. Methods According to urinary albumin excretion condition,a total of 94 patients with type 2 diabetic were divided into pure diabetes group(53 cases) and diabetic nephropathy group(41 cases) from Oct.2014 to Sep.2016 admitted in our hospital.To survey clinical data,BMD and bone biochemical markers were determined and BGP,PTH,PINP,β-CTX were compared in 2 groups.At the same time,to investigate the relationship between BMD and bone metabolism. Results Course,parathormone(PTH) and Type I collagen peptide carboxyl end beta special sequence(β-CTX) of diabetic nephropathy group were significantly higher than those in pure diabetes group(P<0.001).BMD,bone gla protein(BGP) and Type I collagen amino terminal before the peptide(PINP) of diabetic nephropathy group were significantly lower than those in pure diabetes group(P<0.01);to control age,course,menopause age and body mass index,partial correlation analysis showed that BMD were negatively correlated with PTH,PINP and β-CTX in post menopausal patients with type 2 diabetic nephropathy(P<0.05);Multi-factor linear regression analysis showed that,body mass index,menopausal period,PINP,β-CTX are the main influencing factors of BMD in postmenopausal patients with type 2 diabetic nephropathy(P<0.05). Conclusion Compared with postmenopausal pure diabetes patients,postmenopausal patients with type 2 diabetic nephropathy patients had longer duration of existence,low BMD,bone metabolic abnormalities,PTH,PINP,and beta CTX,which can more sensitively reflect the BMD,and the BMD of patients with type 2 diabetic nephropathy can be evaluated via body mass index,duration of menopause,PINP,and beta CTX.

Expression of circulating miRNAs in active pulmonary tuberculosis and its prognostic value

CHEN Xue-fang, XU Wen-fang, WANG Jian-hua

2017, 15(11): 1941-1943,1996. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.036

166 5

Abstract:
Objective To study the expression level of circulating miRNA in active pulmonary tuberculosis patients and its predictive value for disease. Methods One hundred and ten patients with active pulmonary tuberculosis from January,2015 to December,2016 were selected as the observation group.At the same time,45 cases of other pulmonary diseases were selected as the control group.Forty-five cases of healthy physical examination in our hospital were selected as a healthy control group.Patients with active pulmonary tuberculosis were treated with 2H3R3Z3E3/4H3R3 or 2HRZE/4HR standard regimen.The expression of miR-155-5p,miR-21-5p,miR-29a and miR-142-5p were detected by qRT-PCR. Results miR-155-5p,miR-21-5p and miR-29a in the active tuberculosis group were significantly higher than those in the healthy control group and other lung disease control group(P<0.05).MiR-155-5p,miR-21-5p and miR-29a in the other lung disease control groups were significantly higher than those in the healthy control group(P<0.05).However,there was no significant difference in the expression of miR-142-5p between the three groups(P>0.05).MiR-155-5p,miR-21-5p and miR-29a were significantly decreased in patients with active tuberculosis after standardized anti-tuberculosis treatment(P<0.05).The expression of miR-142-5p was not statistically significant before and after treatment(P>0.05).The miR-155-5p,miR-21-5p and miR-29a have good diagnostic significance,sensitivity and specificity for active pulmonary tuberculosis by ROC curve analysis. Conclusion miR-155-5p,miR-21-5p and miR-29a can be used as a useful marker for the evaluation of anti-tuberculosis efficacy in the course of treatment of active pulmonary tuberculosis.

Diagnostic value of serum miR-29a,COX-2 and MMP2 in patients with liver metastases from colorectal cancer

ZHOU De-jun, YUAN Hang

2017, 15(11): 1944-1947. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.037

187 0

Abstract:
Objective To explore the diagnostic value of the serum miR-29a,COX-2 and MMP2 in patients with liver metastases from colorectal cancer. Methods The blood samples from 73 patients with colorectal cancer,who were divided into liver metastasis(LM) group and non-liver metastasis(NLM) group,were collected,and 30 volunteers with benign diseases were also enrolled and assigned into control(CTRL) group.The serum levels of miR-29a,COX-2 and MMP2 were tested by using RT-qPCR or Elisa assay. Results The serum levels of miR-29a,COX-2 and MMP2 of the LM group was significantly higher than those of the NLM group (t=4.122,P=0.000;t=3.008,P=0.004;t=2.376,P=0.011) and CTRL group(t=2.174,P=0.021;t=3.135,P=0.001;t=2.228,P=0.013),and the three indexes of the NLM group were significantly higher than those of the CTRL group (t=3.339,P<0.001;t=1.873,P=0.035;t=2.432,P=0.009).Logistic c regression analysis showed that the expression levels of the three indexes had the positive association with the liver metastasis of colorectal cancer(P<0.05).AUC value from ROC curve of miR-29a,COX-2,MMP2 and Y were 0.852 0.04,0.715 0.03,0.738 0.03,and 0.903 0.05,respectively(P<0.05).The combined three indexes had higher sensitivity,specificity and accuracy in diagnosing liver metastasis of colorectal cancer as compared with single index,which was 72.1%,94.6% and 96.8%(P=0.002). Conclusion The expression level of miR-29a,COX-2 and MMP2 have the positive association with disease status of colorectal cancer,and a high value in the diagnosis of liver metastasis.The mechanism between them may accelerate the deterioration of colorectal cancer.

Application of non-invasive brain stimulation technique in rehabilitation of neurological diseases

ZOU Jian-peng, BI Hong-yan, PENG Wei

2017, 15(11): 1948-1951. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.038

249 5

Abstract:
There are many types of neurological diseases,which often cause different degrees of dysfunction,such as movement disorders,emotional and behavioral disorders,cognitive impairment,affecting the quality of life of patients and social participation.Neurological rehabilitation intervention can improve the functional level,reduce secondary damage and improve quality of life.Neurological rehabilitation treatment is developing rapidly at present;many new concepts of rehabilitation intervention are applied.Noninvasive brain stimulation(NBS) has attracted the attention of rehabilitation scholars in recent years,based on the development of new techniques in neurophysiology.NBS selects cerebral cortex-related functional areas as the target of action,through the electrical and magnetic stimulation caused by the relevant neurophysiological changes,to achieve the purpose of improving function.The repeated transcranial magnetic stimulation(rTMS) and transcranial direct current stimulation(tDCS) are most representative.rTMS,based on the principle of electromagnetic induction,Causes neuronal action potential changes in Cerebral cortex region by generating induced current and promotes cortical metabolism and improvement of brain function.T DCS uses a constant,low-intensity direct current(1-2 mA) through the electrode acting on the target cortex above the skull region,and then regulate the physiological activity of cerebral cortical neurons,induced benign brain function changes.Although specific stimulation patterns are slightly different,both achieve the overall improvement of brain function through the micro-role,with the characteristics of noninvasive,safe,good curative effect.So the clinical application prospect is broad.They both have been widely used in the rehabilitation of neurological diseases in recent years,and have become an important intervention in clinical rehabilitation.At present,the mechanism of action has been studied deeply and clinical application research has been carried out.This article,combined with domestic and foreign research,reviews related research of noninvasive brain stimulation techniques and their application in the rehabilitation of neurological diseases.

Research progress of pathogenesis and resistance mechanism of vulvovaginal candidiasis

ZHANG Si-si, XIA Wei-ting, ZHOU Zhi-yang, XU Xin-xin, WU Xue-qing

2017, 15(11): 1952-1955. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.039

342 33

Abstract:
Vulvovaginal candidiasis(VVC),a kind of opportunistic mucosal infection caused by candida albicans infection,is one of the leading causes of infection diseases in women's vagina,with shoddy school sample leucorrhea and vulvar itching.It is estimated that VVC affects about 75% reproductive women during their lifetime,among which approximately half will experience further episodes.In addition,a small percentage of women(5%-8%) will develop the recurrent vulvovaginal candidiasis(RVVC).In recent years,the incidence rate of VVC has been obviously increased because of the abuse of antibiotics and immunity inhibitors.Several strategies have been adopted at clinical in order to prevent and cure the vulvovaginal candidiasis.However,most of candida species have been shown to develop resistance to the conventional antifungal drugs,posing a serious threat to the health of patients.Therefore,revealing the pathogenesis of vulvovaginal candidiasis and its drug resistance mechanism has important guiding significance for its prevention and control.

Role of Xiaoyaosan powder in increasing sensitivity and reducing side effects of adjuvant radiotherapy in breast cancer patients with liver stagnation and spleen deficiency

CHEN Chao, LI Hua-feng, XIE Hong-ling

2017, 15(11): 1956-1958. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.040

182 0

Abstract:
Objective To study the role of Xiaoyaosan powder in increasing sensitivity and reducing side effects of adjuvant radiotherapy in breast cancer patients with liver stagnation and spleen deficiency. Methods From February,2015 to January,2016,88 breast cancer patients with liver stagnation and spleen deficiency in our hospital were enrolled and randomly divided into observation group and control group with 44 cases in each group.After the operation,the control group received the conventional radiotherapy,while the observation group received additional TCM Xiaoyaosan powder based on the conventional treatment.The immunological indexes,inflammatory indexes,liver function indexes and adverse reaction were compared between the two groups. Results Before the treatment,there was no significant difference in CD3⁺ and CD8⁺ levels between the two groups.After the treatment,the CD4⁺ level of the treatment group was (41.2±2.9)%,which was significantly higher than the control group (34.1±2.7)%,the difference was statistically significant (P<0.05).After the treatment,IL-1,IL-6 and TNF-α levels in both groups were significantly improved,and IL-1,IL-6 and TNF-α levels in the observation group were significantly lower than those in the control group,the differences were statistically significant (P<0.05).The incidence of blood system disease,gastrointestinal toxicity and radiation dermatitis in the observation group were 6.82%,4.55% and 2.27%,respectively,which were lower than those in the control group,the differences were statistically significant (P<0.05). Conclusion TCM Xiaoyao powder in the treatment of breast cancer patients with liver stagnation and spleen deficiency can effectively improve the immunologic function of patients,reduce inflammation,and decrease the side effects of radiotherapy,with a good safety.

Effectiveness evaluation of case teaching method in the teaching of Health Law in clinical medicine

YAN Xing, XIAO Shuang

2017, 15(11): 1959-1961. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.041

144 0

Abstract:
Objective With the progress of the legal system and the intense relationship between doctors and patients in China,law education in medical schools becomes urgent and important.This paper aims to investigate and analyze the effectiveness and problems of case teaching method in teaching Health Law,thus to promote its application as well as the learning efficiency of medical students. Methods Test scores of 7 classes which received case teaching and lecture teaching method in Health Law respectively were analyzed with t-tests to compare and analyze the final examination results.Effectiveness and satisfaction were discovered by group discussion. Results Scores of the total,essay and case analysis had statistical significance in the two groups(P<0.05).Scores of noun explanation and short-answer had no statistical significance(P>0.05).The teaching atmosphere,students' involvement and satisfaction rate in the case teaching group were better than those in the traditional teaching group. Conclusion To students of clinical medicine,recognition and interest in Health Law is lower than academic courses.With remaining problems,effectiveness evaluation of case teaching method in the teaching of Health Law is superior to traditional teaching,for both teachers and students.We should keep exploring the case teaching method in Health Law,thus to improve the students' enthusiasm and initiatives as well as the ability to solve problems.

Bacterial community characterization of intestine and its influence on the occurrence and development of colorectal cancer and precancerous lesions in Ningbo population

QIN Wen-yan, CAO Qun-fen, LIN Qi, XU Chun-fang

2017, 15(11): 1962-1966. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.042

174 1

Abstract:
Objective To compare the different of bacterial community structure in the intestinal ecosystem of normal subjects with patients with colorectal carcinoma or polyps,and explore the effects of gut microbiota on the occurrence and development of colorectal cancer and precancerous lesions. Methods DNA samples were collected from the stool of volunteers undergoing colonoscopy.The participants were assigned into healthy group,polyps group and colorectal adenocarcinoma group according the colonoscopy.Taking high blood pressure as an independent factor,the participants of both healthy group and polyps group were assigned into hypertension subgroups and non-hypertension subgroups.DNA was prepared for PCR amplification of 16S rRNA genes and its V3-V4 regions.Then the DGGE was used to pre-evaluate DNA quality.The species and abundance of bacteria in each sample were analyzed by high-throughput sequencing.The differences of bacterial diversity and community structure of different groups were analyzed by principal component analysis. Results The intestinal bacteria among these groups had higher diversity.Based on the obtained operational taxonomic units(OTUs),Firmicutes(44.9%),Bacteroidetes(28.4%),Proteobacteria(18.6%) and Fusobacteria(5.5%) accounted for 97.4% of total OTUs,and made up the predominant bacteria in most samples,but the composition of the dominant bacteria in different samples was significantly different.The diversity index of each group showed no significant difference among different groups.The bacterial community structure of intestinal bacteria in healthy people was significantly different from that in cancer patients.The intestinal bacterial community structure of colon polyp was significantly different from the intestinal bacterial community structure of healthy people.There was no significant difference in the bacterial community structure between the non-hypertensive and hypertensive groups from the healthy group.There was no significant difference in colonic structure between the non-hypertensive and hypertensive groups. Conclusion The changes of intestinal microflora may affect or lead to the occurrence and development of colonic polyp and colonic tumors.It is helpful to study the microenvironment and mechanism of colonic cancer development,and the effect of hypertension on intestinal microflora of healthy people and intestine has no significant difference.

Meta-analysis on the association TLR4 Asp299Gly polymorphism with ankylosing spondylitis

LI Chao-ding, XU Jie, WANG Xi-an, SHI Chao

2017, 15(11): 1967-1970. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.043

178 2

Abstract:
Objective To investigate the association of Asp299Gly polymorphism in toll-like receptor 4(TLR4) gene with ankylosing spondylitis(AS) through meta-analysis for supplying evidences with evidence-based medicine in research of the genetic background of AS. Methods Literatures were initially retrieved from CBM disc,CNKI,WANGFANG DATA and PubMed by key words of "ankylosing spondylitis","toll-like receptor 4/TLR4 and polymorphism",and articles related to TLR4 Asp299Gly polymorphism and AS were available by July 2015.Eligible studies were defined as case-control study on full data included in the paper basis,and subjected to meta-analysis.Fixed effects model was used to pool the odd ratio(OR) by homogeneity in the data.Publication bias among the enrolled studies was evaluated using Egger' test to measure the funnel plot asymmetry.Systematic review was performed to estimate the relation of TLR4 Asp299Gly polymorphism with AS. Results Six studies related to TLR4 Asp299Gly polymorphism and AS were finally enrolled for current meta-analysis,involving 851 AS cases and 842 controls.The healthy controls in the 6 studies were agreed on Hardy-Weinberg equilibrium.Genotype distribution(AG+GG vs.AA) for TLR4 Asp299Gly allele was 5.82 by Q-test and I² statistic to estimate the degree of heterogeneity(I²=48.5%,P>0.05).Fixed effects model estimation indicated pooled OR=1.04(95% CI=0.70-1.54,P>0.05).The difference was not significant.No publication bias was found by examining the funnel plot asymmetry using Egger' test(P>0.05).As for the allele G/A in TLR4 Asp299Gly,Q-test and I² statistics showed 6.80(I²=55.9%,P>0.05).Fixed effects model revealed no significant difference(OR=1.02,95% CI=0.70-1.50,P>0.05).No publication bias occurred on allele G/A as the funnel plot asymmetry measured by Egger' test. Conclusion Current findings appear hard to determine the association of TLR4 Asp299Gly polymorphism with AS.

The analgesic effect of Ultrasound guided transversus abdominis plane block of ropivacaine with different concentrations in laparoscopic radical rectal cancer in elderly patients after surgery

GUO Jian-tao, LIN Han, LI Mei, WANG Wen-wei

2017, 15(11): 1971-1974. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.044

129 2

Abstract:
Objective To observe the effect of ultrasound guided transversus abdominis plane block of ropivacaine with different concentrations in laparoscopic radical resection of rectal cancer in elderly patients with postoperative analgesia. Methods The clinical data of 90 elderly patients treated in our hospital from January,2013 to January,2017 which underwent laparoscopic radical resection of rectal cancer were enrolled in the study. According to anesthesia method they were divided into three groups,all in the induction of general anesthesia after ultrasound-guided bilateral transversus abdominis plane block.A,B,C three groups were injected with 0.10%,0.25%,0.50% ropivacaine hydrochloride 25 ml; postoperative intravenous analgesia pump:sufentanil 0.8 g/kg+ondansetron 16 mg+butorphanol 10 mg saline configured for 100 ml,set the background dose of 2 ml/h.Controlled time 15 min,self-control dose 2 ml.The two groups were observed mean arterial pressure(MAP) and heart rate(HR) level changes Before anesthesia(T0),1 h after surgery(T1),12 h after surgery(T2),24 h after surgery(T3)and 48 h(T4) after surgery; visual analogue score were compared between the three groups after operation(VAS score) were recorded after 24 h; The use of sufentanil analgesia pressing times and total; adverse reactions were compared between the three groups. Results Group A MAP and HR at 1 h after surgery(T1),12 h after surgery(T2),24 h after surgery were higher than group B,group C and group A MAP and HR at T1,T2,T3 were higher than that of T0 moment(P<0.05);group B MAP,HR at T1 were higher than that of group C(P<0.05),group B had more stable hemodynamics.Group A VAS scores at T1,T2,T3,T4 time were lower than the group B,group C(P<0.05),and there was no significant difference in VAS score between group C and group B(P>0.05);Group A 24 h analgesia the presses of the pump and the total sufentanil were higher than B group,C group(P<0.05);the incidence of complications in group C was higher than that of group A and group B(P<0.05). Conclusion Ultrasound guided transversus abdominis plane block with 0.25% ropivacaine used in laparoscopic radical resection of rectal cancer patients with postoperative analgesia in the elderly is better,and the incidence of adverse reactions is low.

Effect of intercostal nerve block with ropivacaine followed by patient-controlled analgesia infusion pump on postoperative pain and cognitive function in elderly patients with esophageal carcinoma

XU Hong-liang, ZHU Ye-jing, LIU Wei, FANG Jun

2017, 15(11): 1975-1977. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.045

146 2

Abstract:
Objective To explore the effect of intercostal nerve blockade with ropivacaine followed by patient-controlled analgesia(PCA) infusion pump on postoperative pain and cognitive function in elderly patients with esophageal carcinoma. Methods Ninety-two elderly patients clinical diagnosed with esophageal carcinoma in our hospital were selected as the clinical research subjects,and the patients were numbered according to treatment order,and divided into two groups according to odd and even number.The 46 cases in the control group(odd) were treated with postoperative intravenous analgesia pump,and the other 46 cases in the observation group(even) received intercostal nerve blockade with ropivacaine followed by analgesia infusion pump.Intelligence examination scores (MMSE),pain score (VAS),comfort score (BCS) and incidence of cognitive impairment (POCD) were compared between the two groups. Results The MMSE score(24.79±2.66) and POCD incidence(8.70%) in the observation group was significantly better than those in the control group[MMSE score(20.87±2.43) and POCD incidence(26.09%)],and the differences were statistically significant(P<0.05).The VAS at rest(0.44±0.08),VAS at movement(1.42±0.36),and BCS(3.76±1.95) in one hour after awakening,the VAS at rest(2.23±1.92),VAS at movement(3.79±2.66),and BCS(2.55±1.43)% in 24h after awakening in the observation group recovered significantly better than the control group[VAS at rest(1.78±1.28),VAS at movement(3.47±1.23),and BCS(2.56±1.88) points in one hour after awakening,the VAS at rest(4.18±1.88),VAS at movement(6.87±2.43),and BCS(1.83±1.12) points in 24 h after awakening],and the differences were statistically significant(P<0.05). Conclusion Postoperative intercostal nerve blockade with ropivacaine followed by patient-controlled analgesia infusion pump for elderly patients with esophageal carcinoma can effectively reduce postoperative pain,significantly improve postoperative cognitive function,and improve the overall life quality of patients.

Cost-effectiveness analysis of Baofukang suppository and Zaoshiqingdu decoction in the treatment of cervicitis with HPV infection

ZHU Jia

2017, 15(11): 1978-1980. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.046

149 0

Abstract:
Objective To analyze the clinical value of Baofukang suppository and Zaoshiqingdu decoction in the treatment of cervicitis with human papillomavirus(HPV) infection by pharmacoeconomic evaluation methods. Methods Total 213 patients with cervicitis as well as HPV infection were divided into 2 groups according to treatment methods,and all the patients were given human recombinant interferon alpha 2b gel,1 g every time,qid.In addition,the patients in Group A were given Zaoshiqingdu decoction,400 ml/d,each 200 ml morning and night,and those in Group B were given Baofukang suppository,one grain every day.All the patients were treated for 3 days after menstruation,and treated for 2 courses every month used 10 d as a course of treatment,and the total treatment time was 3 months.The clinical effect between groups was compared,at the same time,cost-effectiveness analysis was completed to calculate cost effectiveness ratio(AC/E) and incremental cost effectiveness ratio(△AC/△E). Results There was significant difference in age of patients and vaginal cleanness between the two groups(P<0.05);but there was no significant difference in disease course,TCM score,HPV-DNA expression and HPV types(P>0.05).The clinical effective rate of Group A was higher than that of Group B(Z=-3.240,P=0.001),the incidence of complications of Group A and Group B was respectively 4.9% and 1.9%,and there was no statistical significance between groups(χ²=0.780,P=0.377).The AC/E of Group A and Group B was 17.03 and 14.34,respectively,and the △AC/△E was 25.81.The sensitiveness was analyzed by 3 cycles Bootstrap method,and got an average △AC/△E level of 27.61,which was similar with the results of cost-effectiveness analysis. Conclusion The clinical effect of Zaoshiqingdu decoction can get higher effective rate in the treatment of cervicitis with HPV infection,but Baofukang suppository get higher cost performance,and we can choice flexible according to the needs of patients.

The effect of extended care on cancer-related fatigue and quality of life in the postoperation patients with laryngeal carcinoma

ZHAO Mei-jun, ZHOU Ying, YANG Cong-yan, ZHANG Pei-pei, YU Lu-hua, BAO Li

2017, 15(11): 1981-1983. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.047

157 1

Abstract:
Objective To explore the effect of continuous nursing model on the quality of life of patients with laryngeal cancer after operation,and to provide the basis for the corresponding nursing measures to improve the quality of life of patients with laryngeal cancer. Methods We selected 60 patients with laryngeal carcinoma conformed by pathology for surgery who came from the otolaryngology head and neck surgery department of the First Affiliated Hospital of Bengbu Medical College from June,2014 to June,2015.The experimental group of 30 cases of laryngeal cancer patients with glottic type in 12 cases,17 cases of supraglottic,glottic type in 1 cases,29 cases were male,1 was female,the average age was (61.56±8.67) years,18 cases of partial resection of laryngeal surgery and total laryngectomy in 12 cases;30 cases of laryngeal cancer patients in the control group glottic type in 11 cases,19 cases of supraglottic type,30 cases were male,mean age (62.73±8.14) years,21 cases of partial laryngectomy in vocal cord resection and total laryngectomy patients for 9 cases.We used the standard control and self control,nursing with laryngeal carcinoma,experimental group implemented extended care mode on the basis of conventional nursing,using the Piper fatigue scale(R-PFS) and Chinese quality of life instrument for cancer patients-head and neck cancer(QLICP-HN) to assess the effect of intervention. Results Related fatigue score in the experimental group of patients with laryngeal cancer was lower than that in the control group,with statistical significance(P<0.05);the quality of life of patients with laryngeal cancer score in experimental group were improved to varied extent,higher than that in the control group,and the difference was statistically significant(P<0.05). Conclusion Use of extended care model can improve the fatigue symptoms of patients with laryngeal cancer,relieve psychological pressure,for the rehabilitation and treatment of patients with tumor provides a good guarantee,and improve the patients'quality of life.

The neurological deficits and daily living ability effects of emergency nursing process applying to patients with cerebral infarction thrombolysis

JIANG Dong-hui, SONG Zhen-hua

2017, 15(11): 1984-1986. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.048

134 0

Abstract:
Objective To explore the neurological deficits and daily living ability effects of emergency nursing process applying to patients with cerebral infarction thrombolysis. Methods We used a retrospective study method and selected from February,2014 to February,2016 altogether 172 cases of acute cerebral infarction patients in our hospital as the research object.According to nursing methods,the patients were equally divided into the observation group and the control group,with 86 patients in each group.Both groups were given the thrombolytic therapy,while the control group was given the conventional nursing process during the treatment period and the observation group was given emergency care process intervention,with 21 days treatment cycles.We recorded blood collection time,referral time and rescue time,survey and evaluation of the NIHSS score and Barthel score before and after treatment and carried out the satisfaction rating. Results The blood sampling time,the time of referral and the rescue time of the observation group were significantly shorter than those in the control group(P<0.05).The NIHSS score and Barthel score in the observation group after treatment were (7.98±2.14) points and (54.30±9.24) points,while those in the control group were (10.15±2.65) points and (48.20±8.19) points,with statistical significance between the two groups(P<0.05),and all the points compared to those before treatment were statistically significant(P<0.05).The scores for nursing service attitude,nursing operation technology,nurse patient communication satisfaction in the observation group were significantly higher than those in the control group(P<0.05). Conclusion The emergency nursing process applying to patients with cerebral infarction thrombolysis can improve the emergency rescue efficiency,promote recovery of neurological function and daily living ability of the patients and improve patients' satisfaction of nursing work,hence with very good application values.

The Nursing of Radiofrequency thermocoagulation of extracranial non-semilunar ganglion for trigeminal neuralgia

REN Xiao-mei, SHEN Xiu-hua, HUANG Bing, LUO Yong-xiang

2017, 15(11): 1987-1989. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.049

162 0

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Objective To investigate the nursing approach for patients who receive radiofrequency thermocoagulation of extracranial non-semilunar ganglion through percutaneous puncture guided by CT to treat primary trigeminal neuralgia. Methods Retrospective analysis and summary have been carried out for clinical operations and nursing documentation of 218 cases of radiofrequency thermocoagulation of extracranial non-semilunar ganglion to treat primary trigeminal neuralgia in department of pain management in the First Hospital of Jiaxing from January,2013 to June,2015.The operations were conducted by percutaneous puncture under CT guidance through the foramen supraorbitale,foramen ovale,or foramen rotundum.We focused on preoperative nursing preparation,intraoperative nursing cooperation and postoperative nursing observation and treatment,in order to summarize the best nursing program and improve the treatment effect and patient satisfaction. Results The 218 cases of primary trigeminal neuralgia were divided into 17 cases of pain from Ⅰ,89 cases of Ⅱ,74 cases of Ⅲ,13 cases of Ⅰ+Ⅱ,25 cases of Ⅱ+Ⅲ,receiving radiofrequency thermocoagulation of extracranial non-semilunar ganglion following CT guided percutaneous puncture through foramen supraorbitale,foramen rotundum,foramen ovale,foramina supraorbitale plus rotundum,and foramina rotundum plus ovale respectively.The pain disappeared immediately after single treatment in 215 cases.There were 3 patients who had residual pain,which disappeared after second radiofrequency treatment.Various degree of numbness in the original pain area after treatment was reported in all cases.Various degree of difficulty in opening the mouth was observed after radiofrequency thermocoagulation of Ⅲ nerve.Facial swelling was observed in 29 cases after operation,and was timely detected by nursing care of postoperative,which disappeared after sequential hot and cold compression therapy.There were no reports on the damage to the other trigeminal nerve branches responsible for the pain or other complications. Conclusion The analgesic effectiveness of CT guided radiofrequency thermocoagulation of extracranial trigeminal nerve non-semilunar ganglion has been confirmed.Complications are limited to facial swelling and feeling numbness in the original pain area.The psychology nursing care and adequate preparations before the operation,vital sign monitoring during the operation,careful observation on the patient's condition after medication and operation,and good health communication and education are key methods to ensure the effective therapy and patient satisfaction.

Observation on effect of whole course nursing mode on patients with coronary heart disease combined with diabetes during the interventional therapy

MA Chun-ming

2017, 15(11): 1990-1992. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.050

180 0

Abstract:
Objective With increasing aging population in our country,the number of cases of coronary heart disease with diabetes increased,seriously affecting the physical health and quality of life of the residents.This article is to investigate the effect of whole course nursing mode on patients with coronary heart disease combined with diabetes during the interventional therapy. Methods A total of 96 patients with coronary heart disease combined with diabetes from January,2012 to May,2016 in our hospital were selected and divided into control group and observation group according to its clinical characteristics with 48 cases in each group.The control group was nursed with general nursing mode based on coronary heart disease and diabetes treatment and the patients in observation group were given the whole nursing intervention model.The changes of blood glucose and pressure,lipid level and symptomatic treatment of disease were observed and compared.The levels of FPG and TC were measured by automatic biochemical analyzer.The incidence of compliance behavior,quality of life and adverse events were compared between two groups after the intervention.All the data in this group were analyzed by SPSS 18.0 software.The measurement data were expressed as mean ±standard deviation(x±s).The t test was used to calculate the data.The χ² test was used to compare the data,with P<0.05 indicating statistical significance. Results ①After nursing,the systolic blood pressure,FPG and TC of two groups significantly lowered than before nurse and the reduction degree in the observation group were greater than that in the control group(t=3.254,P=0.002;t=7.019,P<0.001;t=8.029,P<0.001);②The scores of treatment compliance and quality of life of two groups after nurse were higher than those before nurse and the degree of elevation in observation group were higher than that in the control group (t=3.685,P<0.001;t=2.238,P=0.030);③The incidence of adverse events in the observation group was significantly lower than that in the control group(4.17% vs. 20.83%) with statistical significance(χ²=6.095,P=0.014). Conclusion The whole nursing intervention model can reduce systolic blood pressure,FPG and TC of patients with coronary heart disease combined with diabetes during the interventional therapy and can significantly improve the compliance behavior and their quality of life.The incidence of adverse events is greatly reduced.It can be used as a clinical nursing model for wide selection.

CHEN Zhong-ying, ZHU Mei-li, SHEN Yan

2017, 15(11): 1993-1996. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.051

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WU Shi-quan

2017, 15(11): 1997-1999. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.052

114 4

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WANG Shu-fang, WANG Ze-hua, YU Hao, ZHANG Li-xiang, YE Lu:-ju

2017, 15(11): 2000-2002. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.053

54 0

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2017 Vol. 15, No. 11

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