2017 Vol. 15, No. 12

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Three-year review of Clinical Integrated Courses implementation for Beijing “3 + 2 ”assistant general practitioners
ZHANG Dong-hai, MA Xiu-hua, GANG Jun, ZHAO Liu-zhuang, XU De-ying, LIU Shuang
2017, 15(12): 2003-2007. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.001
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The "3+2" assistant general practitioners standardized training hosted by the Capital Medical University in Beijing since 2013 has been into the fourth round.The training period lasts 2 years including three stages.Phase 2(i.e.clinical training stage) was arranged in clinical training base to practice and study,and provided eight subjects,among which clinical comprehensive course accounts for 45 hours completely.The curriculum was given in the clinical training,which covers humanistic education causes as well as subordinate subjects like Internal medicine,surgery,gynecology,pediatrics and so on.It was divided into 3 types:art,disease and syndrome.①The preparatory work is to:a.To train the teachers to establish "general" concepts and set working direction;b.To organize "collective lesson preparation" and compile public teaching courseware;c.To confirm the views and thoughts of courseware compiling,thus to implement the syllabus strictly and give different teaching levels on the basis of five-year college textbooks by introducing guidelines of different diseases with the main teaching method of case-imported teaching.The teaching process should reflect the characteristics of this course:general,comprehensive and horizontal.It should be clear that the training targets are assistant general practitioners.And the teaching should focus on clinical practice work and how to treat patients in order to culture the learning and clinical practicing abilities.②The optimization curriculum:a.Teaching courseware was revised twice in 2014 and 2015;b.Every participant is given a test after finishing each round of training course.The test is to check out how the learning effect students,evaluate the teaching efficiency of the teachers and find out some problems which occur during the training;c.We made an analysis of the tests to find the differences between different teaching bases and put forward some solutions.③Curriculum research improvement:a.Improve the question types into multiple-choice questions (including type A and "brief records" questions)and try to establish test database for Clinical Integrated Courses in order to make it suitable for training "3+2" assistant general practitioner and continue the further promotion of the "Case-Import" teaching;b.Use paper analysis and further stratification (joint department,teaching units administration,teachers and students consisting a total of 4 levels) to identify and solve problems;c.Have collective lesson preparation again for further analysis and list the basic knowledge of teaching course.
SUN Lu, ZHANG Li, YANG Xiao-hui
2017, 15(12): 2008-2009.
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Effects of alternative spliced variants of VEGF on the bone destruction of radicular cyst
WANG Ting-ting, HUANG Yong-song, LIU Fang, XU Li, WANG De-shun, WANG Hai-cheng
2017, 15(12): 2010-2013,2017. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.002
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Objective This study took the radicular cyst as the model,determined the rate of bone destruction on the basis of the clinical characteristics,measured the microvessel density in interstitium by immunohistochemistry;The fibroblasts were isolated from capsule,through which the association of various VEGF isoforms with microangiogenesis and osteoclastogenesis were analyzed to investigate the role of the alternative splicing of VEGF in the process of bone destruction of odontogenic cysts. Methods We selected 19 cases of periapical cysts.The immunohistochemical staining with CD34 antibody was used to stain vascular endothelial cells,and the area of the vascular cavity was calculated.The lesion area was measured by the dental panoramic tomography.Thirteen cases of fresh specimens were prepared to culture the apical cystic fibroblasts.We prepared conditioned medium and induced osteoclasts,and extracted RNA to detect the relative expression of VEGF isoforms by real time PCR.The Chi-square test was used to assess CD34-positive vascular lumen area and clinical features.Logistic regression and Spearman's rank correlation were used to analyze the relations between vascular lumen area,the relative expression of various isomers,the rate of cyst progression and the osteoporosis induction efficiency. Results The ratio of VEGF-121a/total VEGF and VEGF-165a/total VEGF were positively associated the area of microvessels,and the area of microvessels was positively associated with bone destruction of odontogenic cysts;On the other hand,the relative quantitative expression of VEGF and VEGF-189a were positively associated with osteoclastogenesis,however,VEGF-165b/total VEGF and VEGF-189b/total VEGF were negatively associated with osteoclastogenesis. Conclusion VEGF-xxxa isoforms may promote the bone destruction,while VEGF-xxxb variants may play an inhibitory effects.
Role of CT-guided three-dimensional puncture positioning device in the management of sympathetic modulation
FEI Yong, HUANG Bing, YAO Ming, XIE Ke-yue, ZHANG Li, NI Hua-dong, GUO Jian-guo
2017, 15(12): 2014-2017. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.003
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Objective To investigate the values of CT-guided three-dimensional puncture positioning device in the management of sympathetic modulation. Methods From January,2015 to January,2016,60 patients proposed for thoracic or lumber sympathetic modulation in our hospital were enrolled into study.According to the principle of completely random digital table,one side was punctured under the guidance of CT-guided three-dimensional puncture positioning device(guided technique),while the other side was punctured under the CT-guided conventional puncture technique(conventional technique).Thoracic intervertebral puncture was performed between T3 and T4 till the needle tip reached the spot around T4 and above capitis;Lumber intervertebral puncture was performed between L2 and L3 till the needle tip reached the lateral side of L3 and anterior side of the psoas muscle.The temperature of hands or feet、the patient's finger or toe tip perfusion index were recorded before the operation(T0),10 minutes and 24 h(T1,T2)after operation.Also,the time consumed during puncture,CT scan adjusting time,the deviation of the needle from the targets and the incidence of puncture complications were recorded. Results In two Groups,perfusion index and the temperature of hands or feet raised (7.73±1.23) times and (4.97±0.94)℃ in average,respectively.All of the patients were cured within 3 months.When compared with the conventional technique,guided technique got a significantly shorter time consumed during puncture[(14.85±3.27)min vs. (35.35±3.10)min,P<0.001],the number of attempts and the deviation of the needle from the target were significantly reduced[3.25±0.91 vs. 8.65±1.79,P<0.001],[(3.70±1.22)° vs. (12.20±2.58)°,P<0.001].The procedure was successfully performed on both side in all patients without serious complications such as hemothorax and pneumothorax. Conclusion CT-guided three-dimensional puncture positioning device in the management of sympathetic modulation can shorten the puncture time,improve the success rate of puncture,it is worthy of clinical promotion.
Analysis of distribution and drug resistance of Escherichia coli in 2013—2015
GAO Yu, QIN Ting-ting, ZHAO Xiao-jie, ZHAO Shu-long, KANG Hai-quan, GU Bing
2017, 15(12): 2018-2020,2041. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.004
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Objective To investigate the distribution and drug resistance characteristic trend of Escherichia coli in the Affiliated Hospital of Xuzhou Medical University firstly isolated clinically during 2013-2015,and to provide the reference for clinical rational using of antimicrobial agents. Methods Escherichia coli isolates firstly collected clinically were identified and the data were judged with CLSI 2012 and analyzed with WHONET 5.6. Results A total of 2 426 isolates of Escherichia coli were collected from 2013 to 2015.The department distribution is dominated by ICU 466(19.2%)and Department of Urology 375(15.5%).The Escherichia coli positive specimens were mostly isolated from sputum 733(30.2%),urine 720(29.7%)and blood 447(18.4%).The prevalence of E.coli decreased with time from 19.2% in 2013 to 15.5% in 2015.Susceptibility testing showed that during the three years,the bacterium has a certain change in the resistance of all kinds of antibiotics,the resistance rates of the bacteria to the third and the fourth generation of Cephalosporin has a stable downward trend,for example,the rate to cefotaxime decreased from 82.7% to 60.5% and the rate to cefepime decreased from 71.1% to 41.2%;the rate to carbapenem stabilizes from 3.4% to 4.0%;the rates to ampicillin and piperacillin are the highest (90.7% and 89.6%). Conclusion The multiple drug resistance still exists in Escherichia coli in our hospital.The use of antimicrobial agents should be standardized continually and the prevalence and spread of Escherichia coli should be controlled.
Clinical study of bone marrow-sparing volumetric-modulated arc-radiation therapy for postoperative cervical cancer
RAN Jing-jing, ZHANG Hong-yan, XUE Xu-dong, SHEN Jian-jun, CUI Ya-yun
2017, 15(12): 2021-2023. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.005
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Objective To compare the dose -volume histogram analysis and toxicities of bone marrow-sparing volumetric-modulated arc-radiation therapy or without an intention of avoiding bone marrow for postoperative cervical cancer,and to explore the necessity of bone marrow-sparing. Methods The 52 subjects underwent radical hysterectomy and pelvic lymphadenectomy and postoperative radiation therapy for early-stage high-risk cervical carcinoma from June,2016 to January,2017 were divided into BMS-VMAT group and VMAT group randomly,pelvic bone was contoured instead of bone marrow in the BMS-VMAT group.All patients carried a week concurrently cisplatin chemotherapy with radiotherapy.We compared the PTV uniformity coefficient(HI),conformity index(CI) and other pelvic organs of the two groups,also including their hematologic toxicities,the toxicity of gastrointestinal tract and urinary system. Results All patients completed the treatment.There are no statistically significant differences between two groups for the HI(P=0.529).BMS-VMAT group has a less probability on CI(P<0.001) and hematologic toxicities(P<0.001),the other toxicities reaction are similar(P>0.05). Conclusion Bone marrow-sparing volumetric-modulated arc-radiation therapy for postoperative cervical cancer has less probability on hematologic toxicities,the other toxicities reaction are not different.We suggest the pelvis as a conventional organ to limit the dose.
The interaction of rs5417 in Glut 4 gene and blood glucose is associated with obstructive sleep apnea syndrome
LI Mei, YAO Xiao-guang, HONG Jing, WU Ting, HEIZHATI Mu-la-li-bie-ke, ZHOU Ling, ZHANG De-lian, LI Nan-fang
2017, 15(12): 2024-2027. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.006
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Objective To explore the effects of fasting blood glucose(FBG) ≥ 5.6 mmol/L plus CC genotypes of rs5417 locus in Glut4 and of FBG ≥ 5.6 mmol/L on the development of obstructive sleep apnea syndrome(OSAS). Methods Eight hundred and seventy hypertensive inpatients,who were highly suspicious of OSAS and underwent nocturnal polysomnography from January to December 2010,were available.Two hundred and four subjects had a FBG ≥ 5.6 mmol/L,of whom,non-relative 96(84 males) subjects were selected to perform sequencing of functional regions of Glut4 to screen representative mutations using Taqman-PCR methods. Results The 72.11% of subjects were confirmed to have OSAS.Detection of OSAS is significantly higher in those with FBG ≥ 5.6 mmol/L than in those with FBG<5.6 mmol/L(81.37% vs. 69.99%,P=0.001).FBG ≥ 5.6 mmol/L is in significant independent relation with OSAS,even after adjusting for confounders(OR=1.20,CI:1.02-1.42,P=0.026).rs5417 loci was successfully genotyped in 861 of the 870 subjects.Detection of OSAS was significantly higher in subjects with FBG ≥ 5.6 mmol/L than in those of FBG<5.6 mmol/L in carrier of AA+AC genotypes(81.11% vs.67.89%,P=0.003),whereas no significant differences were observed in those with CC genotypes.Risk of OSAS was significantly higher in AA+AC carriers with FBG ≥ 5.6 mmol/L than in those with FBG<5.6 mmol/L,after controlling for age,gender,systolic and diastolic blood pressure,and lipids(OR=1.88,95%CI:1.16-3.05,P=0.011).Risk for OSAS was significantly higher in carriers of CC genotype of those with FBG ≥ 5.6 mmol/L than in carriers of AA+AC genotypes with FBG<5.6 mmol/L(OR=2.02,95%CI:1.04-3.92,P=0.038). Conclusion CC genotypes of rs5417 locus in Glut4 gene and a FBG ≥ 5.6 mmol/L might interact to increase the risk of OSAS.
Effects of TCM Qing Fei Hua Zhuo Xing Xue Kuan Zhong prescription on pulmonary histopathology and serum IL-8 and TNF-α level in rats with chronic bronchitis caused by PM2.5
ZHANG Jin-bo, WANG Xin-lu, SUN Li, SUN Heng-hu, SUN Rong, GAO Bo, SHANG Li-zhen, LIANG Hao
2017, 15(12): 2028-2031. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.007
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Objective To develop a rat model of particulate matter 2.5 microns (PM2.5) related chronic bronchitis,and study the effect of TCM Qing Fei Hua Zhuo Xing Xue Kuan Zhong prescription on lung histopathology and serum IL-8 and TNF-α levels in model rats. Methods Forty rats were randomly divided into control group,model group,low dose TCM group and high dose TCM group (10 rats in each group).The rats in the control group did not receive any treatment for 60 days;the rats in other three groups received post nasal drip of PM2.5 suspension(40 mg/kg once a day) for 60 days to develop an animal model.Then,the control group and model group received intragastric administration of 0.9% NaCl,the low-dose TCM group received intragastric administration of TCM Qing Fei Hua Zhuo Xing Xue Kuan Zhong prescription liquid medicine at a dose of 0.825 g/ml,and the high-dose TCM group received intragastric administration of TCM Qing Fei Hua Zhuo Xing Xue Kuan Zhong prescription liquid medicine at a dose of 1.65 g/ml,once a day for 15 days.After the treatment,the morphological changes of lung tissue were observed under light microscope,and the levels of serum IL-8 and TNF-α were tested. Results The levels of serum IL-8 and TNF-α in the model group were statistically different from those in the control group(P<0.05).After the treatment,the levels of serum IL-8 and TNF both in the low-dose and high-dose TCM group were decreased as compared with the model group (P<0.05).The pathologic findings showed that the pathological damage of lung tissue was repaired at different levels both in the low-dose and high-dose TCM group (P<0.05). Conclusion TCM Qing Fei Hua Zhuo Xing Xue Kuan Zhong prescription can repair the damaged lung tissue and improve the space of gas exchange in rats with chronic bronchitis caused by PM2.5,which may be related to the decrease of serum IL-8 and TNF-α.
Significance of high-density lipoprotein in ankylosing spondylitis
ZHOU Ying, LI Zhi-jun, CHEN Lin-jie, XIE Zhang-hao, FAN Xiao-yun
2017, 15(12): 2032-2034. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.008
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Objective To study the clinical significance of high-density lipoprotein(HDL) level in ankylosing spondylitis(AS) patients. Methods 102 Ankylosing spondylitis patients of Department of Rheumatology and Immunology,The First Affiliated Hospital of Bengbu Medical University were enrolled in the study.The level of HDL in the peripheral blood were detected to analyze the relation of clinical and laboratory indicators. Results ①84 patients (82.35%) had lower HDL level.②Compared with normal HDL AS patients,the lower HDL AS patients was younger(27.51±11.08 vs. 36.90±10.78,P=0.017),with higher BASMI score (4.61±1.83 vs. 3.63±1.20,P=0.04),IgG (14.62±5.05 vs. 10.04±2.6,P=0.027),ESR(38.19±30.64 vs. 21.56±14.36,P=0.018),TG/HDL(4.49±1.16 vs. 3.51±1.01,P=0.011),LDL/HDL(2.65±0.81 vs. 2.05±0.89,P=0.006) and lower TG(3.59±0.87 vs. 4.95±1.50,P=0.019),LDL(2.14±0.66 vs. 3.19±1.09,P=0.014).③The level of HDL in AS patients was negative correlated with ESR(r=-0.29,P=0.004),CRP(r=-0.29,P=0.003) and IgG(r=-0.28,P=0.043). Conclusion HDL may have been associated with excess cardiovascular risk,and plays a role in long-term prognosis and chronic inflammation of development of AS.
Changes of drug resistance of 1 939 strains of clinical isolated Klebsiella pneumoniae in a hospital of Traditional Chinese Medicine
LEI Xiao-ting, LI Min, LIN Hong, SUN Hui, ZHOU Jiang
2017, 15(12): 2035-2037. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.009
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Objective To study the distributions and drug resistance of clinical isolated K.pneumoniae from a hospital of Traditional Chinese Medicine(TCM),and provide scientific evidence for anti-infective therapy and nosocomial infection control. Methods The K.pneumoniae strains were isolated from clinical specimens between January,2013 and December,2015 in a hospital of TCM.The drug sensitivity test was performed by using K-B method and MIC method,and all of data was analyzed by using WHONET 5.6 software. Results A total of 1 939 strains of K.pneumoniae were isolated from clinical specimens.The top three clinical specimens were sputum(72.98%),urine(12.74%) and blood(4.74%).Department of Respiratory(15.58%),Department of Gerontology(10.83%),Nephrology Department(7.43%) and ICU(6.45%)accounted for the highest proportion.The drug resistance rates of K.pneumoniae to piperacillin were highest(36.62%),and the rates to cefuroxime,cefotaxime,ceftriaxon,SMZ-TMP and ampicillin/sulbactam were all more than 30%.The resistance to carbapenem and β-lactamase inhibitor compound were less than 15%.The resistant rates to imipenem were 10.30%,9.70% and 11.81% respectively in recent 3 years,and to Meropenem were10.41%,10.00% and 10.94%,respectively. Conclusion Klebsiella pneumoniae isolated from this hospital of TCM shows a elevated resistance rates to second and third generation cephalosporins,and the resistance rates to carbapenems have a trend of escalation.To reduce the production of multi-drug resistant bacteria,antibiotics,especially carbapenems,should be used cautiously and rationally.
Clinical analysis of endoscopic treatment of 291 cases of submucosal tumors in digestive tract by miniprobe endoscopic ultrasonography
HUANG Jun, ZHENG Hai-lun, WANG Qi-zhi, WANG Qiang-wu, WANG Jian-chao, DENG Min
2017, 15(12): 2038-2041. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.010
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Objective To explore the diagnostic and diagnostic accuracy of endoscopic ultrasonography (EUS) in the diagnosis and localization of submucosal masses in digestive tract and the safety and efficacy of minimally invasive treatment under the guidance of endoscopy. Methods A total of 291 patients underwent gastrointestinal miniprobe sonography from May,2015 to April,2017 in Bengbu Medical College.According to the results,the endoscopic surgical procedures,such as endoscopic submucosal tunnel resection(STER),endoscopic resection(EFR),endoscopic mucosal dissection(ESD),and so on,were selected.The pathological results were recorded and compared with the results of ultrasonography.The success rate of treatment,the presence of laparoscopic or laparotomy,the postoperative complication and its treatment were observed.The effectiveness of endoscopic ultrasonography and endoscopic treatment were evaluated.The postoperative regular endoscopic follow-up was carried out. Results The accuracy of miniprobe sonography diagnosis was 70.43%,and the accuracy of localization was 87.90%.There were 6 cases of intraoperative perforation,1 case of pulsatile bleeding,and 1 case of mucosal laceration in gastric cardia,which were all closed with titanium clip.One case of pulsatile bleeding during EFR surgery was stopped by hot spoon forceps.Four cases of subcutaneous emphysema during STER disappeared after conservative treatment.Four cases of intraoperative active bleeding,with fail hemostasis or unclear vision,were converted to laparotomy surgery.One case of tumor could not be dissected during STER surgery and be sampled for a biopsy,and the examination showed it was squamous cell carcinoma,which was suspected to be tumor metastasis on the basis of history.Other tumors were successfully removed,without significant postoperative complications.The endoscopic resection rate for complete tumor was 97.45%. Conclusion Gastrointestinal miniprobe sonography has a high degree of qualitative and localized diagnostic accuracy for digestive tract submucosal masses.In particular,the diagnosis of localization is helpful for safe selection of endoscopic minimally invasive treatment.
Influence of oxycodone hydrochloride injection on the recovery and hemodynamics in patients with general anesthesia for laparoscopic operation
YUAN Xiao-hong, LIAN Yan-hong, FANG Jun, ZHENG Xue-yong
2017, 15(12): 2042-2044,2082. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.011
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Objective To investigate the effect of oxycodone hydrochloride injection on the recovery and hemodynamics in patients with general anesthesia for laparoscopic operation. Methods Total 95 patients undergoing laparoscopic abdominal surgery in Zhejiang Cancer Hospital between July,2015 and July,2016 were enrolled and randomly divided into observation group(49 cases) and control group(46 cases).Both groups received the same anesthesia induction and maintenance of anesthesia,postoperative discontinuation of remifentanil.The observation group was given 0.1 mg/kg oxycodone hydrochloride injection,while the control group received 1 mg/kg tramadol.The recovery,intraoperative hemodynamics,agitation sedation after extubation(RASS),pain score(VAS) and adverse reactions were compared between the two groups. Results There was no significant difference in the recovery time,time to extubation,time for the recovery of spontaneous breathing,and time for fully restored sanity between the two groups(P>0.05).The preoperative heart rate and mean arterial pressure before operation had no significant difference between the two groups(P>0.05).The heart rate and mean arterial blood pressure immediately after the operation,immediately after extubation,and 10 min after extubation were significantly higher than those before the operation in both groups(P<0.05),which were all obviously lower than those of the control group(P<0.05).The RASS score and VAS score of the observation group were significantly lower than those of the control group at 10,30,60 and 120 min after the extubation. Conclusion Oxycodone hydrochloride injection is helpful to hemodynamic stability of patients with general anesthesia for laparoscopic operation,with ideal postoperative analgesia which will decreased the incidence of agitation and ensure the quality of anesthesia during extubation.It is is worthy of clinical application.
Influence of intensity-modulated radiation therapy on postoperative quality of life of cervical cancer patients with intermediate-risk factors
ZHANG Xia, WANG Yun, YU Qing-miao, GUO Jin-fang, HU Xiao-li
2017, 15(12): 2045-2047,2144. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.012
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Objective To evaluate the influence of intensity-modulated radiation therapy on postoperative quality of life (QOL) of cervical cancer patients with intermediate-risk factors. Methods The static IMRT (1.8 Gy per fraction,total 45 Gy) was performed in the patients meeting the inclusion criteria of cervical cancer patients with intermediate-risk factors.The targets included internal iliac lymph nodes,external iliac lymph nodes and obturator lymph nodes.EORTC QLQ-CX24 survey was performed among all patients before the radiation therapy,immediately after the radiation therapy,3 months,6 months,9 months and 12 months after the radiation therapy.The questionnaires included 3 Multi-Dimensional and 6 unidimensionality items. Results Between October,2006 and October,2015,total 79 cervical cancer patients were enrolled into this study.Median follow-up time was 18.2 months.The postoperative QOL of cervical cancer patients with intermediate-risk factors was associated with the ways of operation and ECOG score(P<0.05),however,not with age,marital status,educational level(P>0.05).The symptom dimension score rose immediately after the radiation therapy and 3 months after the radiation therapy(P<0.05),and then decreased significantly at 9 months after radiotherapy(P<0.05);Sex functional dimensions,lymphedema dimension,peripheral nerve dimension,menopause dimension and fear dimension at each time points showed no significant difference(P>0.05);the sex dimensions in quality of life was improved at 9 months after radiotherapy(P<0.05). Conclusion QOL of cervical cancer patients with intermediate-risk factors with small-volume-target IMRT was decreased mainly in body dimension and symptom dimensions,and could be improved 6 months after the radiation therapy.
Clinical application of tip-apex distance rule in treatment of unstable intertrochanteric fractures using proximal femoral nail antirotation
ZHANG Jing, ZHOU Jun-wu, FANG Wu-zhou, CHEN Xiao-dong
2017, 15(12): 2048-2052. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.013
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Objective To assess the value of tip-apex distance(TAD) rule and complications in treatment of unstable intertrochanteric fractures using proximal femoral nail antirotation(PFNA). Methods A study of sixty-two patients with unstable intertrochanteric fractures treated with the PFNAs in our department between January,2014 and November,2016 was performed.Forty patients had been followed up clinically.By means of surgical operation records,radiographs of intraoperative and immediate postoperative and during follow-up periods,we analyzed and evaluated the general results,quality of fractures reduction,the location of the blade within the head was recorded as per the Cleveland Method and tip-apex distance(TAD),implant-related complications.Clinical outcomes were measured with the Oxford hip score. Results There was no patients exhibited postoperative nonunion,the fracture healing time averaged was 3.8 months.The surgery incision length was average (67±18)mm,the mean operative time was (95.1±28.2) min,the mean intraoperative blood loss was (230±148)ml,and the mean hospitalization was (17.8±7.3)d.According to the Oxford hip score,the excellent and good cases accounted for 95%.There were two cases of implant-related failures that the helical blades cut out from the femur heads.The two cut-outs both occurred with tip-apex distance less than 20 mm and tip of helical blades located in Cleveland zone 1 and 5.There were no cut-out in case where the tip-apex distance was between 20-30 mm.Intraoperative femur head fracture and periprosthetic fracture had not occurred. Conclusion The PFNA is an appropriate internal fixation material for the treatment of unstable intertrochanteric fractures.There are a number of cut-outs if we handled the PFNA with TAD less than 20 mm according to the previous rule demonstrated with dynamic hip screw.We suggest and recommend that the tip-apex distance should be revised between 20-30 mm that the cut-out could be effectively avoided.
Effects of recombinant human interferon α-2b on severe hand-foot-and-mouth disease
JU Se-hua, ZHOU Rui
2017, 15(12): 2053-2055. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.014
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Objective To investigate the clinical effects of recombinant human interferon α-2b on hand-foot-and-mouth disease(HFMD) in children,and outcome assessment of the diseases caused by different viral infection. Methods A total of 150 children with severe HFMD were enrolled and randomly divided into control group and observation group with 75 cases in each group.The children in the control group received the routine antiviral therapy with intensive oral and skin care,while the children in the observation group received the routine therapy as well as recombinant human interferon α-2b dilution for topical external treatment.The clinical efficacy was compared between the two groups. Results The clinical efficiency of the observation group was superior to the control group,the difference was significant(P<0.05).The fever duration,deflorescence and oral herpes fading,and the length of stay were obviously shorter as compared with the control group(P<0.05);After the treatment,the levels of WBC,CRP,AST,ALT and CK-MB were all decreased,especially in the observation group,the difference was statistically significant(P<0.05);EV71 and CA16 were more sensitive to recombinant human interferon alfa-2b than other virus in patients with HFMD(P<0.05). Conclusion The curative effect of recombinant human interferon α-2b dilution(topical external treatment or oral application) on HFMD patients is obviously.It can relieve the clinical symptoms,shorten the duration of hospital stays,improve the liver function and alleviate myocardial damage,especially in the children caused by EV71 and CA16.The anti-inflammatory effect of recombinant human interferon α-2b is dramatically,and no adverse reactions have been found.
The associations of Th17 cell-relevant cytokines IL-17/IL-23 with the pathogenesis and disease severity of eczema
MAI Wei-hua, LIU Yue-hua, LU Dong-qing
2017, 15(12): 2056-2058,2132. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.015
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Objective It is revealed that Th17 cells and their relevant cytokines interleukin-17(IL-17) and interleukin-23(IL-23) play crucial roles in the inflammatory allergic skin diseases.But their roles in eczema are still unidentified.We aim to investigate the possible roles of Th17 cell-relevant cytokines IL-17/IL-23 for the pathogenesis and severity assessment of eczema in this study. Methods Sixty cases of patients with eczema and 28 sex- and age-matched healthy controls were recruited.According to eczema area and severity index(EASI) score,patients with eczema were divided into mild,moderate and severe ones(20 cases respectively).Concentrations of IL-17 and IL-23 in serum were assessed by enzyme-linked immunosorbent assay(ELISA),and their associations with EASI score,eosinophil(EOS) count and total IgE level were analyzed. Results Compared with healthy controls,serum concentrations of IL-17 and IL-23 in patients with eczema were significantly elevated.And the level of IL-17 correlated positively to that of IL-23.The serum levels of IL-17 and IL-23 in patients with mild,moderate,severe eczema and healthy controls were significantly different,severe eczema higher than mild and moderate ones,moderate eczema higher than mild ones;and mild ones higher than controls(P<0.05).Meanwhile,serum levels of IL-17 and IL-23 in patients with eczema positively correlated to EASI scores,indicating that IL-17 and IL-23 levels were associated with disease severity of eczema.The levels of IL-17 and IL-23 in eczema patients with elevated EOS count were significantly higher than that of normal EOS count.Beside,IL-17 and IL-23 levels of patients with eczema showed positive correlations to EOS count.Enhanced IL-17 and IL-23 levels were observed in eczema patients with elevated total IgE than that of normal IgE,but with no significant differences. Conclusion IL-17 and IL-23 may play synergetic roles in the pathogenesis and severity assessment of eczema.IL-17/IL-23 are probably correlated to the elevated EOS count in eczema,but the relationships with total IgE need further studies.
Effects of dexmedetomidine on the protection of lung in lung cancer patients with single lung ventilation
MA Wei-bin, ZHU You-cai, SUN Hao-tian, QIU Can-jin, LIU Xiao-guo
2017, 15(12): 2059-2061,2092. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.016
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Objective To analyze the effect of dexmedetomidine on the protection of lung in lung cancer patients with single lung ventilation. Methods Eighty-two lung cancer patients who received surgical treatment under single lung ventilation anesthesia,and the patients were randomly divided into the control group(n=40) and the observation group(n=42).Before anesthesia induction,the patients in the observation group received intravenous injection of dexmedetomidine hydrochloride with the loading dose of 0.5 μg/kg,and finished infusion within 10 minutes,then received intravenous infusion at 0.25 μg/(kg·h) till 30 minutes before surgery;and the patients in the control group received intravenous infusion of physiological saline solution with the same volume.The number of neutrophils(PMN),serum xanthine oxidase(XOD) and myeloperoxidase(MPO) levels before anesthesia induction(T0),at the moment of single lung ventilation(T1),30 minutes after single lung ventilation(T2),60 minutes after single lung ventilation(T3),30 minutes after lung expansion(T4) and 24 hours after surgery were compared between two groups.The surgical condition and the amount of various narcotic drugs were compared between two groups. Results The PMN,XOD and MPO levels in two groups at T2,T3,T4 and T5 time points were significantly higher than those at T0 time point(P<0.05).The PMN,XOD and MPO levels at T2,T3,T4 and T5 time points in the observation group were significantly lower than those in the control group(P<0.05).There were no significant differences in intraoperative blood loss,24-hour urine output and fluid volume between two groups(P>0.05).The recovery time of the observation group was significantly longer than that of the control group,and the difference was statistically significant(P<0.05).The remifentanil and propofol dosage in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in cisatracurium dosage(P>0.05). Conclusion Dexmedetomidine can reduce the PMN count and serum XOD,MPO expression level in lung cancer patients with single lung ventilation,which have a positive protective effect on lung tissues.
Curative effect of olanzapine combined with aniracetam in treatment of senile dementia
LEI Na, SUN Xiao-hua
2017, 15(12): 2062-2064. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.017
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Objective To observe the curative effect of olanzapine combined with aniracetam in treatment of senile dementia with mental symptoms and its improvement on quality of life of patients. Methods A total of 62 cases of senile dementia with behavioral and psychological symptoms were randomly divided into control group and observer group with 21 cases in each group.The control group was given olanzapine,while the observation group received olanzapine and aniracetam.Before the treatment and 8 weeks after the treatment,Mini Mental State Scale(MMSE) was performed to assess the behavioral and psychological symptoms,and the positive and negative symptom scale(PANSS) was used to assess the therapeutic efficacy;The quality of life of patients was compared between the two groups;the adverse reactions were recorded. Results After the treatment,in the observation group,9 cases were cured,10 cases were complete response(CR),11 cases partial response(PR),and 1 case no response(NR);in the control group,5 cases cured,7 cases CR,12 cases PR,and 7 cases NR.The total effectiveness in the observation group was 96.8%,which was significantly higher than that(77.4%) in the control group(P<0.05).After the treatment,the scores for hostile suspicion,thought disorder,conduct disorder,anxiety,depression and paranoia were all decreased in both groups,and more obviously in the observation group as compared with the control group(P<0.05).After the treatment,the scores for the quality of life,vitality,physical function,emotional function and social function were all improved in both groups,especially in the observation group(P<0.05).The adverse reactions in the observation group included 2 cases of insomnia,2 cases of drowsiness,1 case of extrapyramidal reactions,1 case of headache and 2 cases of nausea;in the control group included 1 case of insomnia,3 cases of drowsiness,2 cases of headache,12 cases of nausea,and 1 case of skin pruritus.There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion The olanzapine combined with aniracetam is effective and safe for senile dementia with behavioral and psychological symptoms,and can effectively improve the quality of life of the patients.
Effects of different anesthesia methods on perioperative coagulation in unilateral lower extremity bone and joint surgery
WANG Lin, LUO Yu, QIAN Jia-shu, LI Gao-wei, LIU Jiang-tao, LIN Xue-zheng
2017, 15(12): 2065-2067,2140. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.018
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Objective To explore the effects of general anesthesia,combined spinal-epidural anesthesia and epidural anesthesia on perioperative coagulation in unilateral lower extremity bone and joint surgery. Methods One hundred and eighty cases of unilateral lower extremity bone and joint surgery patients in the Taizhou Central Hospital from January,2012 to December,2016 were selected,and were divided into general anesthesia group,lumbar combined anesthesia group and epidural anesthesia group according to the random number method,each group was 60 cases.The VAS scores were performed at 6,24 and 48 h after operation.The coagulation function before anesthesia,6 h after anesthesia,24 h after operation were determined.The incidence of thrombotic complications during perioperative period was recorded. Results The VAS score at 6,24 and 48 h after operation of the combined spinal anesthesia group and the epidural anesthesia group were lower than that of the general anesthesia group(P<0.05) The VAS score at 6,24 and 48 h after operation of the combined spinal anesthesia group were lower than that in the epidural anesthesia group(P<0.05).The values of PT and TT in general anesthesia group,lumbar combined anesthesia group and epidural anesthesia group at 6 h after anesthesia,24 h after operation were significantly higher than those before anesthesia(P<0.05),the values of APTT at 6h after anesthesia were significantly higher than those before anesthesia(P<0.05),at 6 h after anesthesia,24 h after operation were significantly lower than those before anesthesia(P<0.05).The incidence of thrombotic complications in the combined spinal epidural anesthesia group and epidural anesthesia group were lower than that in the general anesthesia group(P<0.05). Conclusion The analgesic effect combined spinal epidural anesthesia and epidural anesthesia for unilateral lower extremity bone and joint surgery is good,and combined spinal epidural anesthesia and epidural anesthesia can improve the perioperative hypercoagulable state of blood,reduce the incidence of perioperative thrombotic complications,the effect of combined spinal epidural anesthesia is better.
Effect of urokinase thrombolysis on coagulation function,D-dimer and NT-pro BNP in deep vein thrombosis patients with acute pulmonary embolism
YUAN Wu-feng, JIANG Lei, ZHENG Su-jie
2017, 15(12): 2068-2070,2105. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.019
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Objective To investigate the effect of urokinase thrombolysis on coagulation function,D-Dimer(D-D) and N-terminal pro-brain nitric peptide(NT-proBNP) in deep vein thrombosis patients with acute pulmonary embolism. Methods A total of 86 deep vein thrombosis patients with acute pulmonary embolism were randomly divided into observation group(43 cases) and control group(43 cases) from July,2014 to October,2016.The patients of the control group received initial low-molecular-weight heparin(LMWH) administration followed by warfarin therapy,while the patients of the observation group received additional low dose urokinase thrombolysis based on the control group.The course in both groups was 14 d.The clinical effect,coagulation function,D-D and NT-proBNP in both groups were observed. Results The effective rate of the observation group was significantly higher than that in control group(P<0.05).After the treatment,the levels of Platelet(PLT) and Fibrinogen(FIB) were not improved in both groups(P>0.05).The level of international normalized ratio (INR) increased significantly after treatment (P<0.05),however,there was no significant difference in the levels of INR,PLT and FIB between the two groups (P>0.05).After the treatment,the levels of D-D and NT-proBNP decreased significantly(P<0.05),and more significantly in the observation group(P<0.05).After the treatment,the circumference difference of knee above 20 cm and below 15 cm of the two groups decreased significantly(P<0.05),especially in the observation group (P<0.05). Conclusion Urokinase thrombolysis is effective in deep vein thrombosis patients with acute pulmonary embolism,maintaining coagulation function indexes within the normal range,and no bleeding.It can also improve the levels of D-D and NT-proBNP.
Effect of calcitonin as an adjuvant therapy on pain,bone mineral density and bone metabolism indexes in senile osteoporosis patients with low back pain
NI Zeng-yao
2017, 15(12): 2071-2073. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.020
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Objective The low back pain commonly occurs in patients with senile osteoporosis.The patients often refuse to exercise due to fear of fracture and back pain,thus exacerbating osteoporosis.This study aims to investigate the effect of calcitonin as an adjuvant therapy on pain,bone mineral density(BMD) and bone metabolism indexes in senile osteoporosis patients with low back pain. Methods A total of 80 senile osteoporosis patients with low back pain were divided into observation group(40 cases) and control group(40 cases) from February,2016 to January,2017.The patients of the control group received conventional therapy,while the patients of the observation group additionally received calcitonin therapy based on control group.The treatment time was 6 weeks.The clinical effect and changes of pain,BMD and bone metabolism indexes were compared between the two groups before and after treatment. Results The total effective rate of the observation group was 92.50%,and of the control group was 75.00%,total effective rate of the observation group was significantly higher than that of the control group(P<0.05);The VAS score of low back pain decreased significantly after treatment in both groups(P<0.05),and VAS score of the observation group decreased more significantly than that of the control group(P<0.05);The BMD of L2-4 and femoral neck increased significantly after the treatment in both groups(P<0.05),and the BMD of L2-4 and femoral neck of the observation group increased more significantly than that of control group(P<0.05);The level of 1,25-(OH)2D3 of bone metabolism indexes increased significantly after the treatment in both groups(P<0.05),the level of PTH decreased significantly after the treatment in both groups (P<0.05),and the difference in the level of 1,25-(OH)2D3 and PTH between the two groups was significant(P<0.05). Conclusion Calcitonin as an adjuvant therapy can improve the clinical curative effect,reduce low back pain,and regulate BMD and bone metabolism in senile osteoporosis patients with low back pain.
Role of serum alanine aminotransferase level combined with emergency bedside ultrasound in diagnosis of blunt hepatic trauma
CHEN Gang-hong, JIANG Ke-xiang, ZHU Tie-ming
2017, 15(12): 2074-2076. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.021
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Objective To evaluate the clinical value of alanine aminotransferase(ALT) test combined with emergency bedside ultrasound in the diagnosis of closed rupture of liver,and explore the early effective diagnosis. Methods A total of 105 cases of suspected blunt hepatic trauma from January,2013 to May,2015 in our hospital were enrolled into this study and received emergent ALT,bedside sonography and abdominal CT examinations,and 79 of them were confirmed by CT or operation(75.2%).The sensitivity,specificity and accuracy of ALT alone,bedside sonography,and a combination of those two methods for the diagnosis of blunt hepatic trauma were compared. Results The levels of ALT at 6 h,12 h and 24 h after admission in blunt hepatic trauma group were all significantly higher than those in the non-hepatic trauma group(t=8.43,9.17,7.54,P<0.05);The sensitivity,specificity and accuracy(area under curve) of ALT along by receiver operating curve(ROC) analysis were 88.6%,84.6% and 0.866;of single bedside sonography were 79.7%,92.3% and 0.860;and of the combined group were 98.7%,77.0% and 0.891,respectively. Conclusion ALT combined with emergency bedside ultrasound can greatly improve the diagnostic accuracy of blunt hepatic trauma,which shows an important role in the early diagnosis and treatment of blunt liver injury.
The occurrence and risk factor analysis of restenosis in patients with cerebral artery stenosis stent implantation
LIU Xiao-bo, BAO Xiang, JIANG Feng-feng, YE Zhi-jun, ZHOU Ge-zhi
2017, 15(12): 2077-2078,2155. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.022
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Objective To investigate occurrence condition and risks of restenosis in patients with cerebral artery stenosis stent implantation. Methods Clinical data of 162 patients with cerebral artery stenosis stent implantation from August,2010 to December,2014 were analyzed retrospectively.According to restenosis condition,all the patients were divided into restenosis group and non-restenosis group.Hypersensitive c-reactive protein(hs-CRP) and interleukin 6(IL-6) levels before operation and six months after operation were tested and compared between 2 groups,and then we analyzed risk factors of postoperative restenosis in patients with cerebral artery stenosis stent implantation. Results Among 162 patients with cerebral artery stenosis stent implantation,31 cases had postoperative restenosis,and the restenosis rate was 19.14%.Age,diabetes mellitus,hypertension,hyperlipaemia and smoking had significant differences between restenosis group and non-restenosis group(P<0.05).Before operation,the levels of hs-CRP and IL-6 showed no significant difference(P>0.05),but decreased significantly at 6 months after operation(P<0.05),and the levels of hs-CRP and IL-6 of non-restenosis group decreased more significantly than those in restenosis group(P<0.05).Binary logistic multi-factor regression analysis results showed that hypertension,smoking and hs-CRP and IL-6 levels at 6 months after operation are risk factors of restenosis in patients with cerebral artery stenosis stent implantation. Conclusion Hypertension,smoking and hs-CRP and IL-6 levels at 6 months after operation are risk factors of restenosis in patients with cerebral artery stenosis stent implantation.Accordingly,measures can be taken to avoid or reduce rate of postoperative restenosis.
Clinical effect and prognostic factors of micro-incision phacoemulsification and aspheric intraocular lens in 89 cases of primary angle-closure glaucoma
WU Ke-wei
2017, 15(12): 2079-2082. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.023
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Objective To explore the clinical effect and prognostic factors of micro-incision phacoemulsification and aspheric intraocular lens on primary angle-closure glaucoma. Methods Ninety-five eyes of 89 cases admitted to our hospital from September,2014 to July,2016 were randomly divided into observation group(n=45,49 eyes) and control group(n=44,46 eyes).The observation group received micro-incision phacoemulsification combined with aspheric intraocular lens,while the control group received compound trabeculectomy.The best corrected visual acuity,intraocular pressure,anterior chamber depth and postoperative complications in the two groups were compared before and after the treatment,and the related factors affecting the treatment outcome were analyzed. Results After the treatment,the best corrected visual acuity and anterior chamber depth were significantly increased and the intraocular pressure decreased in both groups(P<0.05).The best corrected visual acuity and anterior chamber depth in the observation group were significantly higher than those in the control group,and intraocular pressure was significantly lower than that in the control group(t=5.391,P<0.001;t=-5.484,P<0.001;t=2.048,P=0.043).The incidence of postoperative complications in the observation group was 26.53%,which was lower than 32.61% in the control group,but there was no statistical difference between the two groups(χ2=0.422,P=0.516).The age,lens thickness and angle of attachment were the factors which associated with treatment outcome. Conclusion Micro-incision phacoemulsification combined with aspheric intraocular lens has a significant clinical efficacy in the treatment of primary angle-closure glaucoma,which can effectively improve the vision,deepen the anterior chamber depth,reduce intraocular pressure,with high safety.The age,lens thickness and angle of attachment are closely related to the treatment outcome.
Clinical effect of rehabilitation therapy on patients with cerebrovascular disease complicated with limb movement dysfunction
MENG Xiang-bo, YANG Jia-liang, CHEN Tian-xiao, CHEN Li-na
2017, 15(12): 2083-2085. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.024
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Objective To study and discuss the effect of rehabilitation training on recovery of cerebrovascular disease in patients with limb motor dysfunction.To make patients recover as soon as possible. Methods According to the clinical data of 120 patients treated in our hospital,120 patients were divided into control group(60 cases) and experimental group(60 cases) according to random table method.The control group was the conventional treatment group,that is,drug therapy plus muscle electrical stimulation therapy.The experimental group was treated with rehabilitation exercises on the basis of routine treatment,including bed rest training,sitting and standing training,walking training,daily life training,speech function training.The treatment lasted for 12 weeks,and the experimental group received rehabilitation exercises 5 days a week,twice a day,and 45 min/times.Before and after treatment,the motor function of limbs was assessed by Fugl-Meyer integral evaluation method and the daily life ability was evaluated by the Modified Barthel index scoring method,and the related data were recorded. Results The results of data analysis showed that limb motor function and ADL scores are both improved in the experimental group and the control group(P<0.01),before and after the treatment.But the experimental group data is significantly better than the control group,and there is a significant difference between the two groups of data(P<0.01). Conclusion Early rehabilitation training for patients with cerebrovascular disease is beneficial for the reconstruction of the motor reflex arc,which can significantly improve the recovery of patients and reduce the treatment time and economic costs.Rehabilitation training is very important for patients to recover their living ability at an early date.
Relationship between bone mineral density and serum hormone levels in patients with osteoporosis
LIU Yue, GU Hai-feng
2017, 15(12): 2086-2088. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.025
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Objective To investigate the relationship between bone mineral density and serum estradiol,parathyroid hormone,calcitonin and 25-hydroxyvitamin D in osteoporosis patients. Methods Seventy cases of osteoporosis were selected as the osteoporosis group and 70 healthy subjects were selected as control group in the First People's Hospital of Fuyang District of Hangzhou from January,2014 to December,2016.The bone mineral density of L2-4 lumbar vertebrae and left femoral neck were measured in both groups.The serum estradiol,parathyroid hormone,calcitonin and 25-hydroxyvitamin D were measured in both groups. Results The levels of serum parathyroid hormone in patients of the osteoporosis group were higher than those in the control group(P<0.05).The levels of serum estradiol,calcitonin and 25-hydroxyvitamin D in the osteoporosis group were lower than those in the control group(P<0.05).The lumbar vertebrae bone mineral density and femoral neck bone mineral density in the osteoporosis group were lower than in the control group(P<0.05).The bone mineral density of lumbar vertebrae was positively correlated with serum estradiol,calcitonin and 25-hydroxyvitamin D(P<0.05),and negatively correlated with parathyroid hormone(P<0.05).The femoral neck bone mineral density was positively correlated with serum estradiol,calcitonin and 25-hydroxyvitamin D(P<0.05),and negatively correlated with parathyroid hormone(P<0.05). Conclusion The serum level of parathyroid hormone in patients with osteoporosis increases,the serum estradiol,calcitonin and 25-hydroxy vitamin D levels decrease.The bone mineral density of osteoporosis patients is positively correlated with serum estradiol,calcitonin and 25-hydroxyvitamin D,and is negatively correlated with parathyroid hormone.
Effects of three hemostatic methods of electrocoagulation,suturing and oppression on ovarian function after laparoscopic ovarian endometriosis cystectomy
LANG Yue-hua, LOU Cai-hong, LI Yun, WU Ya-qi, WANG Fang-fang
2017, 15(12): 2089-2092. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.026
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Objective To investigate the effect of three kinds of hemostatic methods of electrocoagulation,suturing and oppression on the ovarian function after laparoscopic ovarian endometriosis cysts. Methods Two hundred and ten cases patients of laparoscopic ovarian endometriosis cystectomy in the First People's Hospital of Jiande City from January,2011 to December,2016 were selected,and were divided into compression group(pressure to stop bleeding),suture group(suture hemostasis) and electrocoagulation group(coagulation hemostasis).The levels of E2,T,FSH,LH and the number of follicles were measured before and after surgery at menstrual cycle 2-4 days.The levels of P was measured before surgery,1 month after surgery and 6 months after surgery at menstrual cycle 21 days. Results In compression group and suture group,the level of E2 at postoperative 1 month was lower than that in preoperative and postoperative 6 months(P<0.05),the FSH and LH levels were higher than those preoperative and 6 months after operation(P<0.05),there was no significant difference in E2,FSH and LH between the two groups at 6 months after operation(P>0.05).In electrocoagulation group,the levels of E2 at 1 month and 6 months after operation were lower than those before operation(P<0.05),the FSH and LH levels at 1 month and 6 months after operation were higher than those before operation(P<0.05),the level of E2 at 6 months after operation was lower than that before operation(P<0.05),the FSH and LH levels at 6 months after operation were higher than those before operation(P<0.05).The premature ovarian failure rate of electrocoagulation group was higher than that of compression group(P<0.05).In compression group and control group,the number of follicles at 1 months after operation was less than that before operation(P<0.05),there was no significant difference in the number of follicles between 1 months after operation and 6 months after operation(P>0.05),and was higher than 1 month after operation(P<0.05).In electrocoagulation group,the number of follicles after 1 month and 6 months after operation were lower than that before operation(P<0.05),the number of follicles at 6 months after operation was higher than 1 months after operation(P<0.05).At 1 month after surgery and 6 months after surgery,the number of follicles in electrocoagulation group was lower than that in compression group and suture group(P<0.05). Conclusion In laparoscopic ovarian endometriosis,the effect of press to stop bleeding on ovarian function is the least,the suture hemostasis on ovarian function is quite to oppression hemostasis,the electrocoagulation hemostasis has the greatest impact on ovarian function.
Effects of music relaxation therapy on improving maternal negative emotions and delivery quality
SHENG Xia, ZHAO Shu-hua, WANG Zhan-yun
2017, 15(12): 2093-2095,2181. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.027
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Objective To explore the role of music relaxation therapy interventions in improving maternal negative emotions and delivery quality. Methods We retrospectively analyzed 60 cases of maternal clinical data admitted to the First Affiliated Hospital of Harbin Medical University from October,2014 to October,2015.The control group including 30 cases was given a simple relaxation therapy,on the basis of which,the intervention group including 30 cases was given music therapy.We conducted comprehensive evaluation and comparison of HAMA,HAMD score,childbirth,pain rating and pregnancy outcomes as well as maternal satisfaction between these two groups before and after treatment. Results The scores of HAMA and HAMD before intervention in intervention group and control group have no statistical difference(P>0.05).The scores after the intervention have statistical significance(P<0.05);the first and second stage of labor,and the average hospital stays of pregnant women in the intervention group were significantly lower than those in the control group(P<0.05);postpartum hemorrhage in the intervention group was significantly less than that in the control group(P<0.05);and Apgar scores in the intervention group were significantly higher than those in the control group(P<0.05);there were 2 cases of cesarean section,and cesarean section rate was 6.7% in the intervention group;and there were 8 patients underwent cesarean section,with 26.7% cesarean section rate in the control group,which had statistical significance(P<0.05),and postpartum hemorrhage and neonatal asphyxia in the intervention group were significantly lower than those in the control group(P<0.05);pain rating and pregnancy outcomes were better than those in the control group(P<0.05). Conclusion Maternal music therapy combined with relaxation therapy intervention can effectively improve the quality of negative emotions and maternal childbirth,which can be widely popularized in clinical medicine.
Relationship between telomere length in cumulus cells and pregnancy outcome following in vitro fertilization-embryo transfer
CAO Wen-li, XIA Bang-shi, ZHANG Yan-pu, JIANG Yan, YE Fei-jun, FANG Jian-wei
2017, 15(12): 2096-2098,2108. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.028
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Objective Granulosa cell apoptosis has a direct impact on the quality of embryos,and the telomere was involved in the regulation of cell proliferation.The aim of this paper is to explore the relationship between telomere length in the cumulus cell and pregnancy outcome following in vitro fertilization-embryo transfer(IVF-ET),and provide ideas for the evaluation of embryos and oocytes. Methods A total of 87 patients undergoing IVF-ET in our hospital between June,2015 and December,2016 were enrolled in this study.The patients were divided into four groups according to their ages:20-25 years old(21 cases);26-30 years old(24 cases);31-35 years old(23 cases);over 35 years old(19 cases).According to the maturation of oocyte,the patients were divided into immature granulosa cell group(45 cases) and mature granulosa cells group(42 cases).On the basis of vaginal ultrasound examination of pregnant bursa after embryo transplantation,the patients were divided into pregnancy group(43 cases) and non-pregnancy group (44 cases).The age of patients,the maturation of oocyte,telomere length in cumulus cells were compared among different groups;the levels of anti-Mullerian hormone(AMH) in follicular fluid of oocytes with different maturation and the apoptosis of granulosa cells in different pregnancy outcome group were analyzed.All data processing and analysis were performed using SPSS 22.0 statistical software. Results There were obvious difference in the telomere length in cumulus cells and maturation of oocyte among the 20-25 years group,31-35 years group and over 35 years group;and telomere length in cumulus cells around mature oocytes shortened gradually with age,the telomere length was negatively correlated with the age of patients(P<0.05).The telomere length of granulosa cells in the non-pregnancy group was shorter than that in the pregnancy group,the difference was statistically significant(P<0.05).The levels of AMH in follicular fluid of immature oocytes were significantly higher than that in mature oocytes,and the difference was statistically significant(P=0.007).The difference in the apoptotic rate of ovarian granulosa cells was statistically significant between non-clinical pregnancy group and the clinical pregnancy group(P<0.05). Conclusion The length of telomere shortens with age of patients,more obviously in non-pregnancy patients.The telomere length of cumulus cells is closely related with oocyte maturation and pregnancy outcome,with an important clinical research value.
Efficacy of TCM Pinggan Ditan prescription on severe preeclampsia and its mechanism
QIU Er-juan, GU Yue-li, LIU Shu-hua, GUO Jun-ling, WANG Yu, CHEN Juan, GU Jiang-hong, WANG Shi-qiang
2017, 15(12): 2099-2101. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.029
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Objective To investigate the efficacy of TCM Pinggan Ditan prescription in treatment of severe preeclampsia and its effect on serum hs-CRP,Hcy,Apelin and LIF. Methods Total 158 patients with severe preeclampsia in our hospital between January,2015 and December,2016 were randomly divided into two groups with 79 cases in each group.The control group was given magnesium sulfate,and the observation group was given TCM Pinggan Ditan prescription.The blood gas indexes(SBP,DBP,HR),serum indexes(hs-CRP,Hcy,Apelin,LIF) of the two groups were compared. Results After the treatment,SBP and DBP levels of both groups were significantly decreased(P<0.05),and SBP and DBP levels of the observation group were lower than those of the control group(P<0.05).After the treatment,the serum hs-CRP and Hcy levels of both groups were significantly decreased(P<0.05),and hs-CRP and Hcy levels of the observation group were lower than those of the control group(P<0.05).After the treatment,the serum Apelin level of the two groups were significantly decreased(P<0.05),and Apelin level of the observation group were lower than that of the control group(P<0.05);the serum LIF level of both groups were significantly increased(P<0.05),and LIF level of the observation group were higher than that of the control group(P<0.05). Conclusion TCM Pinggan Ditan prescription is effective method for the severe preeclampsia and might play the role through regulating serum hs-CRP,Hcy,Apelin and LIF.
Effectiveness evaluation of Contasure Needleless~ needleless used in female patients with stress urinary incontinence
XU Qin-xian, XU Jia-ling, ZHUANG Xie-yan, FU Lang-jing, GE Li-hong, JIANG Ben-gui
2017, 15(12): 2102-2105. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.030
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Objective To investigate the clinical efficacy of Contasure Needleless® platinum needleless sling in the treatment of female stress urinary incontinence(SUI) in women. Methods Total 148 cases women with SUI in our hospital between March,2014 and February,2016 were enrolled and randomly divided into two groups by random number table method.The observation group was treated with Contasure-Needleless system,while the control group received the tension-free vaginal tape-obturator (TVT-O).The clinical effectiveness,perioperative indicators(operating time,blood loss,postoperative pain in 24 h,length of hospital stay,postoperative infections,urinary retention and hematoma),postoperative QOL of patients and incidence of complication were compared between the two groups. Results ①The curative effect:in the observation group,85.7% of patients were cured,8.6% were PR,5.7% were NR,while in the control group were 89.7%,5.9%,4.4%,respectively.There was no significant difference in the total effective rate between the two groups(P>0.05).②perioperative indexes:the operation time,intraoperative blood loss and postoperative 24 h pain scores in the observation group were significantly better than those of the control group(t=21.602,6.147,3.470,P<0.05).③postoperative quality of life:after the operation,the difference of ICIQ-SF,IIQ-7,UDI-6 and other quality of life scoring indicators in the two groups had not statistically significant (P>0.05).④The incidence of complications:the total incidence of complications in the observation group was 8.11%(6/74),and in the control group was 17.57%(13/74),the difference between the two groups was statistically significant(χ2=4.000,P=0.045). Conclusion The curative effect of Contasure-Needleless sling for female SUI patients in China was the same as the TVT-O,with the clinical advantages of shorter operative time,less bleeding in operation and pain postoperative in the groin area,it is worthy of popularization in hospitals of our country.
The changes of inflammatory factors,oxidative stress,bone mineral density and bone metabolic indices in children with ulcerative colitis
YU Hong-fen
2017, 15(12): 2106-2108. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.031
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Objective Ulcerative colitis is a chronic non-specific inflammatory disease of the colorectum with obscure etiology,which lesion is confined to the mucosa and submucosa with long and recurrent course of the disease.The purpose of this study is to investigate the changes of inflammatory factors,oxidative stress,bone mineral density(BMD) and bone metabolic indices in children with ulcerative colitis. Methods We selected 58 children with ulcerative colitis who treated in our hospital from April,2015 to August,2016 as observation group,and 40 healthy check-up children as control group to compare inflammatory factors,oxidative stress,bone mineral density and bone metabolic indices between 2 groups. Results CRP,TNF-α and IL-6 levels of observation group were significantly higher than those in control group(P<0.05);NO level of observation group was significantly higher than that in control group(P<0.05),SOD level of observation group was significantly lower than that in control group(P<0.05);BMD of observation group was significantly lower than that in control group(P<0.05),but BGP and BLAP levels showed no significant difference(P>0.05). Conclusion The levels of inflammatory factors and oxidative stress were significantly increased,BMD was significantly decreased in children with ulcerative colitis.Clinical test of the changes of inflammatory factors,oxidative stress and BMD were helpful to the diagnosis and treatment of ulcerative colitis in children.
Effects of TCM comprehensive intervention on liver and kidney Yin deficiency patients with perimenopausal syndrome
ZHANG Zhe, LIN Juan, YANG Jin-lu, YU Jian-feng, TANG Wei, LU Ping, GE Ling-yu, CHEN Run, HUANG Mei-ying, CAI Yi-sheng
2017, 15(12): 2109-2111,2162. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.032
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Objective To investigate the effect of TCM comprehensive intervention in improving the symptoms of liver and kidney Yin deficiency patients with perimenopausal syndrome. Methods Total 180 liver and kidney Yin deficiency patients with perimenopausal syndrome from 6 communities(30 cases in each) in Jiading District of Shanghai city between February,2016 and August,2016 were enrolled and randomly divided into control group and intervention group.All patients received the routine treatment.The patients in the control had their personal profile,received psychological guidance and health education once a month;while the patients in the intervention group received the TCM comprehensive interventions including traditional Chinese medicine,acupuncture,otopoint pressure-massage and the eight-section brocade exercise.After 3 months of treatment,the modified Kupperman index score of the patients was compared between the two groups and the clinical efficacy was evaluated. Results At the end of treatment,Kupperman scores of both groups were improved obviously as compared with those before the treatment(P<0.01),and the difference between the two groups was statistically significant(P<0.01).The total effective rate was 85.71% in the intervention group and 0 in the control group,the difference was statistically significant(P<0.01).The incidence of sweating,insomnia,irritability,depression,fatigue and palpitations in the intervention group were improved obviously after the treatment,the difference was statistically significant(P<0.01),and so of vertigo(P<0.05);The incidence of irritability and depression in the control group were improved obviously after the treatment with significant differences(P<0.01). Conclusion TCM comprehensive intervention model has obvious curative effect on liver and kidney Yin deficiency patients with perimenopausal syndrome,which can improve many symptoms of patients,and worth of popularizing in community health service center.
Effect of psychological intervention on serotonin and anxiety scores in patients with ulcerative colitis
CHEN Yuan-e, GUO Xu-ri, GAO Cong-ying, JIANG Yi
2017, 15(12): 2112-2114. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.033
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Objective To observe the effect of psychological intervention on serotonin and anxiety scores in patients with ulcerative colitis,thus to guide the treatment. Methods All 72 cases were selected from January,2016 to December,2016 diagnosed in our hospital as digestive ulcerative colitis,and were randomly divided into observation group and control group.Based on different symptoms and severity of the disease,we made individualized medication plan.The observation group had psychological intervention in addition to clinical medication.With 36 cases in each group,after 14 days of treatment we used SAS and SDS scales to compare anxiety and depression before and after treatment,and serotonin expression in mucosal mucosa before treatment and 2 months after treatment. Results There was no significant difference in SAS scores between the two groups before treatment(P>0.05).SAS scores were lower in both groups after treatment(P<0.05).The improvement rate of SAS in the observation group was better than that in the control group(P<0.05).There was no significant difference in the scores of SDS scores between the two groups before treatment(P>0.05).The scores of SDS in the observation group and the control group were lowered after treatment(P<0.05).And the level of improvement in the observation group outperformed that in the control group(P<0.05).There was no significant difference in the expression of serotonin between the two groups before treatment(P>0.05).The levels of serotonin in both groups were lowered after treatment(P<0.05).The improvement level of the observation group was better than that of the control group(P<0.05). Conclusion Psychological intervention can alleviate the anxiety of patients with ulcerative colitis and improve the symptoms of gastrointestinal dysfunction by inhibiting the expression level of serotonin in the intestine,which is worthy of clinical application.
Investigation on attitude and cognition of unpaid blood donation among college students in some medical colleges in Nanjing
XING Qing-qing, DONG Yin-feng, CHANG Yao, QIN Xue
2017, 15(12): 2115-2117,2128. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.034
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Objective To understand the attitudes and cognition of unpaid blood donation in medical college students,to analyze the influencing factors,and to improve the participation of college students in voluntary blood donation. Methods We made the questionnaire which included basic information,blood donation experience,attitudes and influencing factors,cognition of blood donation and its related laws.Questionnaires were randomly distributed to the college students,and filled in anonymously.Then,the questionnaires were collected,and the data was sorted and analyzed. Results The survey results showed that 19.36% students experienced blood donation.Among them,there were much more male students than the females(P<0.001).In addition,we also analyzed the grade difference.The results demonstrated that the most participants were postgraduate students(42.1%),the next was the junior(27.5%) and sophomore students(22.4%).The motivation of college students to donate blood was different,and the most important reason was that their body was good so they should help others.Nearly 80% of the students thought that the voluntary blood donation was necessary,and 67.54% of them had a sense of admiration towards the blood donors.But most of them concerned for blood donation,and they mainly worried about their own safety and distrust of blood donation institutions.In addition,some students did not have the opportunity to donate blood for lack of opportunities.If safety and other conditions allowed,86.1% of the students would be willing to do it.They had acquired the knowledge of unpaid blood donation which mainly came from the network media,and most of the non-medical students do not understand the benefits of blood donation to the body,including the blood circulation and blood regeneration. Conclusion The results revealed that medical college students'attitude toward unpaid blood donation was positive.Some of them are lack of understanding on blood donation.Besides,safe and convenient environment is one of the important reasons that limited their enthusiasms of participation.
Investigation and analysis of nurses' cognition on standardized blood glucose monitoring in diabetes mellitus from non-endocrinology departments
WANG Li, HU Xiao-lei, REN Qi-fang, ZHANG Yan-li, SHI Fei-fei, HU Hong-yan
2017, 15(12): 2118-2119,2172. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.035
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Objective To investigate and analyze the attitudes and cognitions of nurses from non-endocrinology departments on standardized blood glucose monitoring in diabetic patients,and to analyze the related factors and countermeasures. Methods From May to June 2017,58 nurses from non-endocrinology departments(58 clinical departments)were surveyed by using the questionnaire,which was designed in reference to "Chinese blood glucose monitoring clinical application guide(2011 Edition)".Statistical analysis was applied by SPSS 13.0 software. Results Among the nurses,79.3% nurses didn't know the normal working environment of the blood glucose meter and test paper in the standardized blood glucose monitoring,58.6% nurses didn't know the test range of the blood glucose meter,70.7% nurses didn't know the validity period of each test paper bottle after opening,86.2% nurses didn't know the glycemic control standards for the special populations,and 50.0% nurses didn't know the critical value of blood glucose.The results showed that the differences in the scores of nurses with different titles,different seniority and different times of training were statistically significant (P<0.05).The scores decreased with the increase of professional titles,decreased with the extension of working years and increased with the times of training.The scores had no significant difference in nurses' educational background(P>0.05). Conclusion The nurses from non-endocrinology departments pay insufficient attention to blood glucose monitoring,and lead to lack of guidance and education for blood glucose monitoring.Therefore,the glycemic monitoring programme needs to be deepened according to the guideline,the medical staffs need to be further trained,the importance and attention of standardized blood glucose monitoring of the nurses from non-endocrinology departments need to be increased,and the levels of specialized nursing need to be improved continuously.In view of the existing problems,the knowledge levels of the nurses from non-endocrinology departments need to be improved through special training for regulating blood glucose monitoring,providing a brief standardized blood glucose monitoring knowledge booklet for nurses at any time,and sharing standard blood glucose monitoring cases.
Assessment of the multi-target detection in the diagnosis of myelodysplastic syndrome
WU Yu, GU Jian, NI Jun, SUN Xing, WANG Hong, MA Li, FANG Yue-zhi
2017, 15(12): 2120-2123,2151. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.036
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Objective To explore multi-target joint detection in the diagnosis and classification value for myelodysplstic syndrome(MDS),and assess each experiment index preliminarily. Methods Eighty-nine MDS patients admitted in our hospital from January,2010 to December,2014 were analyzed,89 patients with bone marrow morphology and chromosome karyotype analysis;among them,44 patients were analysed by FISH,62 patients by bone marrow biopsy,and 50 patients were analysed immunophenotype by flow cytometry. Results ①Morphological features and the diagnosis coincidence rate of MDS subtypes was 59.6%(53/89),which showed significant difference between each subtypes in MDS(P<0.05);②The detection rate of R banding karyotype analysis was 67.1%(53/79),which showed no significant difference between each subtypes in MDS(P>0.05);③The detection rate by R banding karyotype analysis and FISH was 59.5%(22/37),the rate was 54.1%(20/37) only by karyotype analysis,and the rate was 48.6%(18/37) only by FISH.The coincidence rate of the two methods was 78.4%(29/37);④By bone marrow biopsy,the diagnosis coincidence rate of MDS was 72.6%(45/62);by FCM,32%(16/50) patients were detected abnormal cells;⑤The diagnosis coincidence rate of morphologic and genetic features were higher than that of single morphological features(P<0.05);and the coincidence rate of combining morphology,biopsy and genetics were higher than single morphological features(P<0.05).⑥The diagnosis coincidence rate of combining morphologic and biopsy and that of single morphology showed no significant difference(P>0.05). Conclusion Combined a number of measurements can obviously promote the diagnostic rate of MDS;Morphology,bone marrow pathology,cytogenetics and immunophenotype detection indexes has important application value on diagnosis and classification of MDS.
Review of research progress and drug intervention of endoplasmic reticulum stress in diabetic cardiomyopathy
ZHOU Yang, WU Wei
2017, 15(12): 2124-2128. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.037
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Diabetic cardiomyopathy(DCM)is defined as the presence of left ventricular dysfunction beyond that which can be accounted for by arterial hypertension,coronary artery disease or evidence of any other structural cardiac disease in individuals with diabetes.DCM is a common consequence of longstanding type 2 diabetes mellitus and encompasses structural,morphological,functional and metabolic abnormalities in the heart.Endoplasmic reticulum(ER) is an organelle entrusted with lipid synthesis,calcium homeostasis,protein folding,and maturation.Perturbation of ER-associated functions results in an evolutionarily conserved cell stress responses,which is called ER stress.ER stress is aimed initially at compensating for damage through three transmembrane proteins including IRE-1,ATF6,PERK and their downstream pro-survival signals,but can eventually trigger cell death if ER stress is excessive or prolonged via apoptotic pathways mediated by CHOP,Caspase-12 and JNK.The mechanisms of the development of diabetic cardiomyopathy are still highly elusive.Now it is known that apoptosis induced by ER stress has been considered to play a role in DCM.Moreover,hyperglycemia,FFAs and inflammation may be the triggers of ER stress.In order to explore the specific therapies for DCM,in recent years scientists from different countries have found that many drugs could alleviate cardiomyocyte apoptosis and improve the function of heart by inhibiting ER stress.Therefore,this paper will summarize the information focused on mechanisms of ER stress in the development of diabetic cardiomyopathy and several drug interventions which can reduce the ER stress by different ways.
Efficacy of TCM Xiaopi five-point acupuncture therapy on gastric motility and quality of life in elderly patients with functional dyspepsia
LI Gui-min, TAN Tao
2017, 15(12): 2129-2132. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.038
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Objective To analyze the application value of TCM Xiaopi five-point acupuncture therapy in the treatment of functional dyspepsia(FD) at gastric motility and quality of life points. Methods Total 103 patients with FD were randomly divided into 2 groups.The patients in the control group were given mosapride citrate dispersible tablets,while the patients in the observation group were given TCM Xiaopi five-point(Pishu,Weishu,Jianli,Taiyi and Zusanli) acupuncture therapy.The TCM clinical symptoms score and efficiency were evaluated.Before and after the treatment,the mean frequency of contraction(MFC) and amplitude contraction(AC) were detected by electrogastrogram,and the life quality of patients were assessed by the 36-item short-form health survey(SF-36) and Quality of life in reflux and dyspepsia(QOLRAD). Results Before the treatment,there was no significant difference in TCM clinical symptoms score between the two groups(P>0.05).After the treatment,the primary symptom score,subordinate symptom score,and total TCM score of both groups decreased,and those of the observation group were lower than those of the control group,the difference was statistical significance(P<0.05).The clinical effective rate of the observation group was higher than that of the control group(P<0.05).Before the treatment,there was no significant difference in MFC and AC between the two groups(P>0.05).After the treatment,the MFC and AC of both groups increased,and those of the observation group were higher than those of the control group,the difference was statistical significance(P<0.05).Before the treatment,there was no significant difference in life quality score between groups(P>0.05).After the treatment,both SF-36 and QoLRAD score of patients in the two groups increased,and those of the observation group were higher than those of the control group,the difference was statistical significance(P<0.05). Conclusion TCM Xiaopi five points acupuncture therapy can obviously improve the gastric motility and quality of life points of FD patients,which is positive thing for the therapy of FD.
Artistic utilization of the balance philosophy in the teaching of hematological diseases
CAI Shao-zhe, JIAN Cui, LI Deng-ju
2017, 15(12): 2133-2135. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.039
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The characteristics of hematological system disorders have determined that hematopathy is the key and difficult point in the clinical teaching,and how to impart these boring and lengthy knowledge to medical students and let them understand and master these knowledge is worthy of discussion.Balance describes a specific state of contradiction,which shows stability and contains the tendency of development.The fusion of knowledge about hematological system disorders and the concept of balance,which are both difficult to understand,and the balance between teaching and learning facilitate the understanding and master which needs the help of artistic methods which itself is essentially the art.Integrating the concept of balance into the teaching of hematology is a great "catalyst" for the instructional activities and clinical practicum.Combining the concept of balance and the teaching contents and the teaching approaches organically and artistically can not only improve the efficacy of teaching,but also show the charm of traditional Chinese culture and philosophy indirectly and contribute to the enhance of humanities.With the help of the concept of balance,questions such as how to treat both the symptoms of a disease and its causes,how to balance the effects and the side-effects of a drug,how to keep the hemostasis of internal environment,and how to reverse the mental disequilibrium and calm down the negative emotion of the patients can be taught more easily.In the knowledge impartment,lecturers should pay attention to the balance maintenance between the depth and breadth of the knowledge and whether this knowledge can fit the understandability of the students.Also,in teaching approaches,via the modern technologies and addition of some closely related concepts from our traditional culture,inducing-mode teaching based on "cases and problems" will help the final integration of theories and practice in the teaching of hematological diseases.
The practice of hospital research refinement management
SHENG Wen-qi, ZHANG Xue-jing, LI Zhi-guang, LIANG Ning-xia
2017, 15(12): 2136-2140. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.040
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Objective With the rapid development of science and technology,scientific research management occupies an increasingly important position in modern hospital management.The scientific level of its management has an important influence on the overall scientific research strength of the hospital.Via the analysis of the specific practice of scientific research refinement management,we aim to explore a more effective model and long-term mechanism. Methods In this paper,refined management philosophy is introduced to the basic elements of the whole process of the scientific research activities in hospital:talent,project,capital,facilities,achievements and so on.The initiative of implementation of scientific research refinement management is to divide such refined content into scientific research platform management,scientific research personnel management,research project management,research funding management,scientific research management and other specific practices and analysis. Results Taking the scientific and technological innovation and talent development obtained by the construction of "the 12th Five-year Plan" of the hospital as an example,we conclude that the concept of refined management is implemented in every aspect of scientific research management,which is of great significance to improving the overall scientific research level and achieving a virtuous circle of scientific research. Conclusion The refinement management plays an important role in hospital scientific research management.Introducing refinement management in scientific research management will help to improve the quality of hospital scientific research and achieve sustainable development.It should be valued and widely used,requiring coordination and cooperation among departments.Hospital should guarantee culture,system,personnel and technology.At the same time,the scientific research management department should also strengthen the building of the management team,transform from the routine scientific research management to innovative services,and realize the refinement of scientific research services:initiative,optimization,tracking,innovation,thus to constantly improve the level of research refined management.
Effect of press-needle acupuncture analgesia combined with rehabilitation training on knee pain and dysfunction of patients with knee osteoarthritis
XU Wei, SUN Dan, CHEN Na, ZHANG Da-tong
2017, 15(12): 2141-2144. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.041
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Objective To observe press the effect of needle-embedding therapy combined with rehabilitation training on the knee joint pain and dysfunction in patients with knee osteoarthritis. Methods By using random numbers table,40 patients with knee osteoarthritis in our hospital between January,2016 and June,2016 were randomly divided into observation group and the control group with 20 cases in each group.The observation group received needle-embedding therapy combined with rehabilitation training,while the control group only received conventional rehabilitation training.The function of knee joint pain,stiffness and degrees of knee extension were evaluated by using western Ontario and McMaster osteoarthritis index(WOMAC) in both groups before the treatment,immediately after the first therapy.0ne month after the treatment,and three months after the treatment during the follow-up.The visual analogue scale(VAS) was conducted for the score in all patients.The range of motion(ROM) by common protractor and the knee joint function assessment were performed before the treatment and one month after the therapy to make curative effect evaluation. Results At the end of the first treatment,WOMAC scores in the observation group was improved significantly,the difference was statistically significant(P<0.05),but not in the control group(P>0.05);One month after the therapy,WOMAC score in both groups was improved obviously,so for each item,the difference was statistical significance(P<0.05);After one month treatment,the difference in WOMAC score between two groups was statistical significant(P<0.05).The total effective rate of the observation group was 95% and of the control group was 70%,the difference was statistically significant(P<0.05);After 3 months follow-up,the WOMAC score of the two groups increased as compared with the data at 1 month after treatment,and significantly higher than that before the treatment(P<0.05),the WOMAC score between the two groups had statistically significant difference(P<0.05). Conclusion Needle-embedding analgesic therapy combined with joint rehabilitation for the patients with knee osteoarthritis can effectively improve the knee arthritis pain and dysfunction.
Efficacy analysis of the clinical application of ERAS nursing concept in patients with percutaneous nephrolithotomy
ZHOU Hong-xia, LIU Jian-min
2017, 15(12): 2145-2147. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.042
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Objective To investigate the clinical nursing efficacy of the ERAS nursing concept in perioperative period of percutaneous nephrolithotomy. Methods We selected 32 patients with nephrolith treated in the surgical urology department of the first affiliated hospital of Bengbu medical college from January,2016 to April,2017.Among these cases,there were 20 males,22 females,with an average age of 54.5 years.The mean stone size was 2.1 cm×5.6 cm.There were 6 cases of multiple calculus,26 cases of solitary calculus,and 4 cases accompanying hydronephrosis.These patients were randomly divided into the ERAS and the control group,with 16 cases in each group.There were no statistical differences in gender,age and severity between the two groups.All 32 patients received percutaneous nephrolithotomy.The control group adopted the traditional nursing mode for perioperative nursing.The ERAS group adopted the hierarchical holistic nursing model for perioperative nursing under the guidance of the ERAS concept.Doctors,nurses and patients communicated closely in ERAS group,paying attention to the improvement of the medical personnel's responsibility consciousness and harmonious medical relationship.In ERAS group,patients participated actively.The ERAS group paid attention to nursing feedback and managed dynamically and pertinently.The incidence of adverse events,patient satisfaction and hospital stays were compared between the two groups.We conducted a statistical analysis for the collected data by using SPSS 19.0 statistical software(when P<0.05,the difference is statistically significant). Results Compared with the control group,the incidence of adverse events was lower,the hospital stays was shorter and the patient's satisfaction was higher in the ERAS group(P<0.05). Conclusion The perioperative nursing of percutaneous nephrolithotomy under the guidance of the ERAS can accelerate the recovery of patients.
Effect of super-early rehabilitation nursing on motor function recovery and nursing compliance of stroke patients
ZHENG Xiao-li, YAO Mei-qi
2017, 15(12): 2148-2151. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.043
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Objective To analyze the effects of super-early rehabilitation nursing on motor function recovery and nursing compliance of stroke patients. Methods Totally 162 patients with stable stroke were randomly divided into observation group(super-early nursing care) and control group(general neurology nursing).The Barthel index and Fegl-Mevyer Score were recorded after admission and before discharge.We compared care compliance in both groups. Results On admission,the Barthel index of the two groups lower than 40(χ2=0.15,P=0.70),40-60(χ2=0.04,P=0.83) and more than 60(χ2=0.15,P=0.699) which had no significant difference between the two groups (P>0.05).There were more patients in the observation group than in the control group(χ2=19.56,P<0.01).On admission,the Fegl-Mevyer scores of the two groups were less than 50(χ2=0.10,P=0.75),50-84(χ2=0.65,P=0.42),85-95(χ2=0.15,P=0.70).And 96-99 data were not different between the groups;pre-discharge observation group less than 50 were more than that in the control group(χ2=4.84,P=0.028).There was no statistically significant difference between the two groups in terms of medication compliance(χ2=1.22,P=0.27),but in the rehabilitation exercise group,and the patients in the high compliance group were higher than the control group,with statistical significance(χ2=10.06,P=0.02). Conclusion The use of super-early nursing intervention in stroke patients can promote the recovery of motor function and life ability of patients,and can improve the compliance of patients with rehabilitation therapy,thus providing positive significance for the rehabilitation of patients.
Curative effect observation and nursing care of winter disease cured in summer acupoint sticking therapy to treat stabilization COPD
ZHANG Shu-yan, ZHANG Zhen-zhen, ZHANG Xiao-zhen, YAO Shi-qing
2017, 15(12): 2152-2155. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.044
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Objective To observe curative effect of the winter disease cured in summer acupoint sticking combined with TCM syndrome differentiation nursing in treating stabilization chronic obstructive pulmonary disease(COPD). Methods We selected 33 COPD patients from outpatient clinics in July 2016,with 19 cases of men,14 cases of women,an average duration of (20.35±9.43) years,and the mean age of (62.13±9.25) years old.On the first day of every dog days,acupoint sticking was applied,generally for 2-4 hours,with a total of 3 times.Appropriate amount of white mustard,asarum,yanhusuo,and euphorbia kansui were proportionally grounded into fine powder,sieving and adding fresh ginger and making into herbal cake.Then we selected bilateral shenshu,pishu,and feishu to attach,when necessary applying to dazhui acupoint.We observed clinical comprehensive curative effect before and after our therapy and TCM symptom scores before and after the treatment of cough,sputum,and the changes of breathing.Using SPSS 13.0 statistical analysis software we compared mean with paired t test data before and after the treatment,and continuous variable data with x±s. Results After treatment we got 8 cases under clinical control,16 cases markedly effective,7 cases effective,and 2 cases ineffective,with total an effective rate of 93.94%.After treatment patients with cough,cough accompanying phlegm obviously improved compared with those before treatment,P<0.05,and the symptoms of integral was statistically significant;the symptom integral of breathing space before and after the treatment has improved,but without statistical significance.It may be relative to cases being selected and observation evaluations,thus pending further study. Conclusion Chinese medicine acupoint sticking combined with TCM syndrome differentiation nursing in treating stabilization COPD stabilization can effectively improve patients with pulmonary function,and improve the patients quality of life.
Effects of family nursing on depression,life quality,serum estradiol,progesterone and serotonin of postpartum depression patients
ZHAO Hui-jun, GUO Hua-feng, QIAO Peng-miao
2017, 15(12): 2156-2158. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.045
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Objective To investigate the effects of family nursing on depression,life quality and serum estradiol,progesterone and serotonin of postpartum depression patients. Methods A total of 138 cases of postpartum depression patients were randomly divided into two groups,with 69 cases in each group.The control group was given routine care and the observation group was given family care.The depression(EPDS score),life quality(GQOLI-74 score),serum estradiol,serum progesterone and serum serotonin levels of two groups were compared. Results Before nursing,the EPDS and GQOLI-74 scores of two groups had no significant differences(P>0.05);after nursing,the EPDS score of two groups was significantly reduced(P<0.05),and the EPDS score of observation group was significantly lower than that of the control group(P<0.05).The body function dimension,social function dimension and psychological function dimension of two groups were significantly increased(P<0.05),and each indicator score of observation group was significantly higher than that of the control group(P<0.05).Before nursing,the estradiol,progesterone and serotonin levels of two groups had no significant difference(P>0.05);after nursing,the estradiol levels of two groups were significantly increased(P<0.05),and estradiol levels of observation group was significantly higher than that of the control group(P<0.05);after nursing,the progesterone levels of two groups were significantly reduced(P<0.05),and progesterone level of observation group was significantly lower than that control group(P<0.05);after nursing,the serotonin levels of two groups were significantly increased(P<0.05),and serotonin levels of observation group was significantly higher than that of the control group(P<0.05). Conclusion Family nursing could improve the depressive status and life quality of postpartum depression patients and improve the estrogen and neurotransmitter levels.
The research on elastic bandage applied to elderly aspirin takers receiving blood sampling
WANG Dan, CHEN Jin, YU Zhi-hong, ZHU Li-yue, JIN Hai-yan, YING Xiao-qing
2017, 15(12): 2159-2162. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.046
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Objective To study the effect of using self adhesive elastic bandage to stop bleeding in the elderly patients with coronary heart disease after taking aspirin for a long time,and to analyze its advantages. Methods Totally 120 elderly patients with coronary disease who did physical examination in department of geriatrics in Zhejiang hospital during September,2014 to June,2016 were randomly divided into experimental group(60 cases)and control group(60 cases).The experimental group was given the self adhesive elastic bandage for 5 minutes.The control group was given the traditional infusion plaster with additional pressure for 5 minutes.The bleeding of puncture and surrounding skin,hematoma,24 h congestion,the degree of comfort,the whole blood sampling and pressing time were compared between the two groups.Two independent samples t-test was used in the measurement data,the numeration data was analyzed with χ2 test and expressed as a percentage.Mann-Whitney U test was used for ranked data.With P<0.05,there was a statistically significant difference. Results There were 5 cases of bleeding in the experimental group accounting for 8.3,less than 15 cases in the control group.No hematoma was found in the experimental group which was significantly less than 6 cases in the control group.The 24 h congestion incidence rate of the experimental group was 0,significantly less than that in the control group(P<0.05).The comfort degree of the experimental group was significantly better than that of the control group(P<0.05).The blood sampling time in the experimental group was significantly shorter than that in the control group(P<0.01). Conclusion Using the self adhesive elastic bandage can reduce the bleeding,congestion incidence and other complications of elderly patients who took aspirin for a long time.It also improves the working efficiency of nurses,makes the patient feel comfortable and satisfied.It is worthy of clinical promotion.
The effect of comfortable nursing on psychological status and quality of life in patients with rheumatoid arthritis
LI Yan-li, SUN Juan, MA Ling, XIE Zhang-hao
2017, 15(12): 2163-2165. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.047
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Objective To analysis the effect of comfortable nursing on psychological status such as anxiety,depression and the quality of life in patients with rheumatoid arthritis(RA). Methods A total of 86 cases of RA patients in our hospital between March,2014 to July,2014 were recruited,and comfortable nursing was conducted since 2015 January 1,depending on this time line,41 patients from January,2015 to July,2015 were set as comfortable nursing group,including the body comfort nursing,psychological comfort nursing,social comfort nursing and others comfortable nursing method;while 45 patients between March,2014 to December,2014 were still implemented routine nursing and set as routine nursing group.Self-evaluation of anxiety scale(SAS) and depression self rating scale(SDS) was carried out to evaluate the mental health status,using brief life quality scale(SF-36) to analyze the quality of life,interviewed on admission and one day before leaving hospital respectively.SPSS statistical software was used to compare the difference of SAS,SDS and SF-36 before and after nursing between two groups. Results There had no obvious difference of SAS,SDS and SF-36 score between two groups before nursing intervention(P>0.05).Compared with the value before intervention,the SAS and SDS scores dropped in both groups after intervention,with statistically significance(P<0.05),while the SF-36 scores increased(P<0.05).In addition,the SAS,SDS and SF-36 score in comfortable nursing group after intervention were better than the routine nursing group,with statistical significance(P<0.05). Conclusion Comfortable nursing can help to regulate the psychological status,relieve the anxiety and depression caused by long time pain,and build up healthy and optimistic perspective,also help to improve the quality of life in RA patients,which is worthy of clinical promotion.
Value analysis of PDCA circulation management method in improving flawed ICU nursing in hospital
LI Ling, ZHENG Hua-wei, GE Mei, ZHANG Juan, LI Dong-mei, GOU Fang
2017, 15(12): 2166-2168. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.048
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Objective To explore the value of PDCA cycle management method in improving the hospital ICU nursing defects,thus to provide reference for the improvement of the quality of hospital care. Methods Using the method of retrospective study,we selected 160 ICU patients from January,2014 to December,2014 in our hospital as control group,and 160 cases from January,2015 to December,2015 as the observation group.Then we compared gender,age,body mass index,disease types between the two groups and found no statistical significance(P>0.05);the control group received traditional nursing experience,and the observation group was given nursing intervention based on PDCA cycle.There was no significant difference in the number,academic structure,professional title,age distribution and other indicators between the nursing staff in the two groups(P>0.05).We recorded nursing defects and nursing quality of the two groups. Results One case of mistaken identification and one case of drug dispensing errors happened in the observation group and the nursing defect occurrence rate was 1.3%.For the control group,it had 3 cases of identification error,3 cases of transfusion management defects,4 cases of drug dispensing errors,2 cases of other errors,and nursing defect occurrence rate was 7.5%.The observation group was significantly lower than that of the control group(P<0.05).The two groups were inspected 30 times,the rates of items in good condition in the observation group and the control group were 99.27±0.94 and 84.97±2.35 respectively,and the observation group was significantly higher than the control group(P<0.05).Via the questionnaire,156 cases were satisfied with nursing service in the observation group,with 97.03±3.80 satisfaction rate,and 138 cases in the control group,with 83.84±4.52 satisfaction rate.The observation group was significantly higher than the control group(P<0.05). Conclusion The application of PDCA circulation management method can reduce the incidence of ICU nursing defects,improve the integrity rate of ICU items,improve the relationship between nurses and patients,improve the overall quality of hospital services,and has a good application value.
Application of evidence-based nursing in the treatment of nasal polyps
ZHANG Pei-pei, ZHOU Ying, ZHAO Mei-jun, YANG Xue-mei, MA Shi-yin
2017, 15(12): 2169-2172. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.049
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Objective To study the application of evidence-based nursing(EBN) in the treatment of nasal polyps. Methods Total 320 cases of nasal polyps from June,2015 to June,2016 in our hospital were divided into drug treatment group(196 cases) and surgical treatment group(124 cases),and each group was divided into 2 sub-groups according to the nursing methods (drug treatment group 1 and 2,surgical treatment group 1 and 2).Drug treatment group 1 and surgical treatment group 1 were given routine nursing care during therapy,while the drug treatment group 2 and surgical treatment group 2 were given evidence based nursing model during therapy.The changes of negative emotions on admission and at discharge were observed in all groups,the degree of mastering disease knowledge,satisfactory degree of nursing and the treatment effect of the patients were evaluated. Results There were significant decreases in self-rating depression scale and self-rating anxiety scale scores decreased prominently at discharge than those on admission,which were obviously lower in the evidence based nursing group as compared with the routine nursing group(P<0.05).At discharge,the degree of mastering disease knowledge and satisfactory degree of nursing in the evidence based nursing group was apparently higher than those in the routine nursing group(P<0.05).The treatment efficiency with evidence based nursing model were significantly higher than that of the routine nursing model in both drug treatment group(drug treatment group 1 and 2) and surgical treatment group(surgical treatment group 1 and 2). Conclusion Evidence-based nursing model possess good effect and high clinical value in the clinical treatment of patients with nasal polyps.
Risk factors analysis and nursing of acute respiratory failure after trauma
XIE Chan-chan, LI Ji, CHEN Ya-li, WANG Chun-fen, WU Zong-lin, LOU Li-na
2017, 15(12): 2173-2175. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.050
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Objective To investigate the risk factors and nursing of acute respiratory failure after trauma. Methods Two hundred and fourteen patients admitted to our hospital from May,2014 to May,2016 were selected.And according to the presence or absence of respiratory failure,the patients were divided into observation group(with acute respiratory failure,61 cases) and control group(without acute respiratory failure,153 cases).The risk factors questionnaire was made,and the age,smoking history,diabetes mellitus and hypertension,respiratory disease history,shock duration time,trauma index and APACHE score of two groups were collected.The data were analyzed by univariate and logistic regression analysis. Results In all 214 trauma patients,61 had ARF,the incidence rate was 28.5%(61/214).Univariate analysis showed that age,diabetes mellitus and hypertension,respiratory disease history,shock duration time,trauma index and APACHE score were the single factor risk factors for ARF after trauma.Logistic regression analysis showed that age,diabetes mellitus and hypertension,respiratory disease history,shock duration time,trauma index and APACHE score were independent factor risk factors for ARF after trauma. Conclusion Trauma patients easily had ARF,and age,diabetes mellitus and hypertension,respiratory disease history,shock duration time,trauma index and APACHE score were the risk factors of ARF after trauma.Risk factors in clinical should be judged,and good treatment and nursing of disease should be done.
Effect of ICU special care combined with oxygen driven aerosol inhalation on inflammatory factors in patients with severe pneumonia
PANG Lu, WU Xia-yun, LU Jun-mei, XU Fang-fang, ZHENG Li-fang, WANG Ya-ping
2017, 15(12): 2176-2178. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.051
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Objective To investigate the ICU special nursing combined with oxygen atomizing inhalation effects on inflammatory factors in patients with severe pneumonia. Methods Eighty-six cases of severe pneumonia patients in our hospital ICU from August,2014 to August,2016 were selected and randomly divided into 2 groups.Forty-three cases in control group were treated with conventional ICU nursing and routine treatment,and 43 cases in experimental group were treated with conventional ICU nursing combined ICU special nursing and oxygen-driven aerosol inhalation therapy.Before and after treatment,the serum IL-6,CRP,TNF-α,metal matrix protein function,VC,FVC,FEV1,FEV1/FVC,and clinical symptoms disappearing time of two groups were observed.And the results were analyzed using statistical software SPSS 19.0. Results Compared with those before treatment,serum IL-6,CRP,TNF-α,MMP-9 of two groups were significantly decreased (P<0.05),VC,FVC,FEV1 and FEV1/FVC levels of two groups were significantly increased (P<0.05).Compared with those in the control group,serum TIMP-1 VC,FVC,FEV1 and FEV1/FVC of experimental group were significantly higher than those of control group (P<0.05),serum IL-6,CRP,TNF-α,MMP-9 levels and improving elapse of clinical symptoms of experimental group were significantly lower than those of control group (P<0.05). Conclusion ICU special nursing combined with oxygen atomizing inhalation could effectively reduce the serum IL-6,CRP,TNF-αof patients with severe pneumonia,improve lung function,reduce the time to improve clinical symptoms,and has better effect than conventional treatment.
HUANG Yun-xia, CHEN Xue-liang, ZHU Xiao-feng, JIN Wen
2017, 15(12): 2179-2181. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.052
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CHEN Yun-jie, JIANG Hai-tao, GAO Guo-sheng, WANG Tian-fei
2017, 15(12): 2182-2183. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.053
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JIANG Bo, LI Shuai-rong, HE Na, WEI Wen-bo, YU Jian-she, TAO Li-jun
2017, 15(12): 2184-2185. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.054
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