中华全科医学

Current situation of primary general practitioners and demand on continuing medical education content in China

YANG Hui-min, YIN De-lu, XIN Qian-qian, YIN Tao, DING Xiao-yan, WANG Li-hong, CHEN Bo-wen

2018, 16(10): 1591-1594. doi: 10.16766/j.cnki.issn.1674-4152.000433

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Objective To investigate the current situation of primary general practitioners and demand on continuing medical education content in China, and to provide scientific evidences for general practitioners development and continuing medical education policy. Methods Cluster random sampling and convenient sampling method were used in this study. In May, 2017, a questionnaire survey was carried out among 670 general practitioners from 54 Primary health institutions of 13 Provinces in China. EpiData 3.1 was used to enter and verify data. Results It was found that the average number of general practitioners per million populations was 3.46 in institutions surveyed. The number of the eastern region was highest (4.12), whereas the central and western regions were only 1.45 and 1.93, respectively. The number also varied greatly in different provinces, which was lowest in Hunan province (0.76) while was 5.55 and 5.75 in Jiangsu and Zhejiang province respectively. Among the primary general practitioners, most aged from 30 to 50 years old. And 70.51% of the primary general practitioners were undergraduate degree, mostly with intermediate title, accounting for 43.97%. In addition, general practitioners in city had higher education degree than the rural, and proportion of general practitioners with senior titles was highest in the eastern regions. Demand on continuing medical education content survey found that the demand on continuing medical education content was concentrated in medical technology; however, the needs of general practitioners differ in different regions, educational backgrounds and professional titles. The general practitioners with higher professional title or highly educated were more willing to accept the education of new theory and new technology. Conclusions The average number of general practitioners per million populations was up to standard in China, but there were obvious regional differences. In recent years, the education level and professional title of primary general practitioner had constantly improved, but the development was also unbalanced in different areas. In addition, continuing medical education should meet different needs of the primary general practitioners in different contents.

LI Ru-yan, PAN Jia-hua

2018, 16(10): 1595-1596.

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Case-control study of microbial infection and analysis of influencing factors on stress-bearing areas of denture bases in middle-aged and elderly

WANG Jin-tao, HE Rui, WANG Wei, ZHAO Ting-ting, ZHONG Liang-jun

2018, 16(10): 1597-1599,1765. doi: 10.16766/j.cnki.issn.1674-4152.000434

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Objective To investigate the change of microbial component ratio in denture base bearing area of middle-aged and elderly, and to analyze the factors associated with Candida albicans infection. Methods A total of 72 patients were selected from January to September in 2017. They were randomly divided into two groups:36 elderly patients not wearing denture (group A) and 36 patients wearing denture (group B). Their saliva and plaque were collected and cultured. Candida and anaerobion species were identified. Univariate and Logistic regression were used to explain factors predisposing to Candida infection. Results Among the 72 patients, there were 206 strains of microbe, among which 176 were anaerobes, including 82 in group A and 94 in group B; 30 were Candida albicans, of which 8 in group A and 22 in group B. The ratio of the two groups of Candida albicans, Bacterium melanoma and and Lactobacillus in the group B was significantly higher than that in the group A (P<0.05), and the difference between the two groups was statistically significant. The ratio of Streptococcus mutans in group B was significantly lower than that in group A, and the difference between the two groups was statistically significant (P<0.05). There was no significant difference between the constituent groups of Porphyromonas gingivalis (P>0.05). Single factor analysis confirmed the correlation between smoking, wear denture at night, denture hygiene, service life of denture and Candida albicans detection, and the differences were statistically significant (P<0.05). Multi factor Logistic regression analysis showed that the main factors affecting Candida albicans infection were smoking, night wearing denture, denture hygiene and service life of denture. Conclusion The number of Candida albicans in middle-aged and elderly patients wearing dentures was significantly higher than that in elderly patients without denture. Night wearing denture and denture hygiene were the most important factors affecting Candida albicans infection, more likely to cause denture stomatitis.

Short- and long-term outcomes of primary percutaneous coronary intervention in young patients with ST-elevation myocardial infarction

ZHANG Min-xue, ZHENG Ju-ke, ZHANG Jian-liang

2018, 16(10): 1600-1603. doi: 10.16766/j.cnki.issn.1674-4152.000435

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Objective To investigate short- and long-term outcomes of primary percutaneous coronary intervention (PPCI) in young patients with ST-elevation myocardial infarction (STEMI). Methods From January, 2007 to January, 2017, a total of 1 647 patients with STEMI underwent PPCI at our hospital. Based on age when PPCI was performed, patients were divided into young (≤ 55 years) and middle-elderly (>55 years) groups. Retrospective analysis of short- and long-term outcomes of these two patient groups was conducted. Results The study population included 302 patients in the young group and 1 345 patients in the middle-elderly group. During the study period, the number of young patients with STEMI tended to increase annually. Compared with the middle-elderly patients, the young patients more often were male, smokers, and obese, and had a family history of coronary heart disease. However, hypertension, hyperlipidemia, diabetes, and history of previous MI occurred less frequently in the young group than in the middle-elderly group. Thirty-day mortality and incidence of major adverse cardiovascular events (MACE) also were lower in young patients. Long-term follow-up results showed that both overall and MACE-free survival were higher in young patients. Conclusion In summary, number of young patients with STEMI increased over the past decade, and these patients tended to be male, smokers, and/or obese, but had better short- and long-term outcomes. Hence, active weight loss and smoking cessation may be expected to reduce incidence of STEMI among young people.

Repair effect of Lycopene on liver injury induced by trans fatty acids in mice

XIE Xian, ZHU Le-mei, DING Xu, YAO Ming-yan, CENG Shu

2018, 16(10): 1604-1607,1744. doi: 10.16766/j.cnki.issn.1674-4152.000436

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Objective To investigate the protection and its probably mechanisms of Lycopene (LP) on the mice with liver injury following trans fatty acid (TFA) damage. Methods Forty KM mice (equivalent males and females) were randomly divided into five groups as follows:normal control group (normal saline), TFA group (50 mg/kg body weight TFA) and groups of TFA with low, middle and high dosages treatment LP protection group (50 mg/kg body weight TFA+5, 10, 20 mg/kg body weight LP), with 8 mice in each group (equivalent males and females). All the experimental procedures were intragastrically applied once every other day, eight weeks in total. The tissues were processed as follows:detection serum ALT, AST, TP, ALB, TG, TC, HDL-C, LDL-C content and liver tissue SOD, GSH-Px activity and MDA content. Results In the groups with TFA, the weight increasing of mice and the organ coefficient of liver, ALT, AST, TP, ALB, TG, TC, LDL-C and MDA content were higher than that in the control group (P<0.05) and TP, ALB, HDL-C content were lower (P<0.05). In the groups with TFA, the activity of liver SOD and GSH-Px was decreased (P<0.05). The livers in the TFA group were damaged to different extents. Compared with the groups with TFA, groups of TFA with low, middle and high dosages plus LP, the weight increasing of mice and the organ coefficient of liver, ALT, AST, TP, ALB, TG, TC, LDL-C and MDA content were lower (P<0.05), and TP, ALB, HDL-C content were higher (P<0.05), the activity of liver SOD and GSH-Px was higher (P<0.05). Following LP treatments, the liver damages in the LP groups with different doses were alleviated. Conclusion LP performs the repairing role for the liver via inhibiting the oxidative stress damages caused by TFA, which mechanisms might be correlated to the effects of anti-lipid peroxidation and oxygen free-radical clearing activity.

Correction of moderate to severe hallux valgus with modified offset-V distal chevron and Akin osteotomy

GU Xiao-hui, LI Ya-song, BI Qing

2018, 16(10): 1608-1611. doi: 10.16766/j.cnki.issn.1674-4152.000437

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Objective To evaluate the clinical efficacy and safety of modified offset-V distal Chevron and Akin Osteotomy in treating moderate to severe hallux valgus deformities. Methods From July, 2015 to October, 2016, 16 patients (2 men and 14 women, mean age of 38.5 years) 16 foot of moderate to severe hallux valgus deformities were treated with modified offset distal Chevron and Akin Osteotomy. The Hallux valgus angle(HVA), intermetatarsal angle (IMA), visual analogue scale(VAS) and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal Clinical Rating Score before operation were compared with that after the operation. Results All patients tolerated the procedure well. Complications such as avascular necrosis or bone nonunion were not demonstrated in the study. The HVA, IMA, VAS and AOFAS Hallux Metatarsophalangeal Interphalangeal Clinical Rating Score were improved obviously(P<0.01). Conclusion The modified Offset-V distal Chevron and Akin Osteotomy is a safe, conveniently and effective therapy for moderate to severe hallux valgus deformities.

The application of STANDING bedside algorithm in differential diagnosis of acute vertigo

LI Shan-feng, GUAN Rui-rui, SHEN Lei, HAN Yong-sheng, FAN Xi-zhen

2018, 16(10): 1612-1614,1768. doi: 10.16766/j.cnki.issn.1674-4152.000438

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Objective To assess the diagnostic performance of STANDING (spontaneous nystagmus, direction, head impulse test, standing) bedside algorithm to differentiate central form non-central acute vertigo (AV). Methods The clinical data of adult patients presenting to the emergency department with vertigo were collected and evaluated with STANDING. The sensibility and specificity of STANDING in diagnosis of central vertigo were calculated. Results A total of 85 patients who were treated in Anhui Provincial Hospital from October, 2016 to May, 2017 and met the criteria were included. And 16 cases had a diagnosis of central AV, 60 cases had a diagnosis of peripheral AV, and 9 cases were unclear. The sensitivity of STANDING in diagnosis of central vertigo is 100%, and its specificity is 87%. All the patients were divided into stroke group (9 cases,10.6%) and non-stroke group (76 cases, 89.4%). The average ages of stroke group and non-stroke group are respectively (67.3±5.7) years of age and (56.2±16.2) years of age (t=2.028, P=0.046). All stroke group patients have more than one stroke risk factor, but only 24 (31.6%) cases of non-stroke group patients do the same, which showed statistical significance between the two groups (χ²=7.413, P=0.006). Conclusion STANDING bedside algorithm can preliminarily screen central AV with a very high sensitivity in Emergency room, and central AV with many stroke risk factors have a higher possibility of stroke.

Correlation between pathogenesis of acute coronary syndrome and pregnancy-related plasma protein A level

LI Nan, KANG Chun-mei

2018, 16(10): 1615-1617,1622. doi: 10.16766/j.cnki.issn.1674-4152.000439

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Objective To investigate the correlation between pregnancy-related plasma protein A level and the pathogenesis of acute coronary syndrome (ACS). Methods Sixty patients with ACS in our hospital from February, 2013 to May, 2014 were enrolled in this study. Among them, 28 cases were with variant angina (UAP), 32 patients with acute myocardial infarction (AMI). Another 30 patients with stable angina pectoris (SAP) were selected as the SAP group and 30 healthy individuals as the healthy control group. The general information on the sex, age and vital signs of selected cases were recorded. On the first day after admission, fasting venous blood was collected for NTT, blood test, serum uric acid, CK-MB, hs-CRP, blood lipids and other tests. Blood samples were collected for pregnancy-related plasma protein A (PAPP-A) test. The differences of the levels of each index in each group were compared, and the correlation between pregnancy-related plasma protein A and high-sensitivity C-reactive protein was evaluated. Results There were no significant difference in the age, gender, BMI and other indicators between the three groups. PAPP-A was significantly different between those acute coronary syndrome groups and healthy control group (P<0.01). The serological indexes of each group were compared, the results showed that the overall differences were statistically significant (P<0.05), and there was significant difference between each group and the control group; and the correlation between PAPP-A and hs-CRP Sex was statistically significant (r=0.978, P<0.001). Conclusion The incidence of ACS and pregnancy-related plasma protein A has a positive correlation, the higher the concentration of PAPP-A, the greater the risk of acute coronary syndrome.

Effect of AEG-1 siRNA on proliferation and cell cycle distribution of human pancreatic cancer AsPC-1 cells

HUANG Yan, GAN Yun, QIAN Chun-yan, XU Xin-wei, DAI Dan, QI Xian-zhong, ZHU Li, CHEN Jia-li, DONG Shui-feng, REN Guo-ping

2018, 16(10): 1618-1622. doi: 10.16766/j.cnki.issn.1674-4152.000440

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Objective To explore the effect of down-regulation of astrocyte elevated gene-1 (AEG-1) expression on cell proliferation and cell cycle of human pancreatic cancer cell line AsPC-1, and its possible molecular mechanism. Methods The siRNA targeting at AEG-1 gene was transfected into AsPC-1 cells. The protein expression of AEG-1 was detected by Western blot. The AsPC-1 cells were divided into three groups:Untransfection, Lipofectamine and AEG-1 siRNA-transfected group. Cell viability and cell cycle rates were determined via MTT assay and FCM. Results After 48 hours' interference, the gray values of AEG-1 protein was 0.10±0.09, which was lower than in the untransfected group (0.69±0.24) as well as in the liposome transfected group (0.70±0.21, P<0.05). However, there was no difference between untransfected group and liposome transfected group (P>0.05). The AEG-1 expression at the gene level in AEG-1 siRNA-transfected group was reduced by 82% as compared with that in the untranfected group (P<0.05). MTT assay showed that the proliferation of AsPC-1 cells was slower than untransfected group and liposome transfected group. The percentage of cells in G₀/G₁ phase in the AEG-1 SiRNA transfection group was significantly higher and the percentage of cells in S phase was significantly decreased than those in untranfected group and liposome transfected group (all P<0.05). Conclusion The proliferation of human pancreatic cancer cell line AsPC-1 cells were inhibited by AEG-1 siRNA-transfection, changes in the distribution of the cell cycle was involved in the inhibiting effect when there was a lack of AEG-1 expression.

Serum levels of Golgi protein 73 before and after TACE in patients with primary liver cancer and its clinical significance

ZHAO Rui, WANG Qi-zhi, ZHENG Hai-lun

2018, 16(10): 1623-1625. doi: 10.16766/j.cnki.issn.1674-4152.000441

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Objective To explore the clinical significance of serum Golgi protein 73 (GP73) levels before and after transcatheter arterial chemoembolization (TACE) in patients with primary hepatocellular carcinoma (PHC), and discuss the role of GP73 in the curative effect evaluation and prognosis monitoring among the PHC patients undergoing TRAC. Methods The Enzyme-link immunosorbent assay (ELISA) was used to detect the serum levels of GP73 and AFP in 40 cases of HPC before TACE, D1 after TRAC and 4 to 6 weeks after TACE. Based on the result of TRAC, 40 patients were assigned into the improved group(28 cases) and progression group (12 cases). The relationship between the dynamic levels of GP73 and AFP and the curative effect and prognosis of the patients were analyzed. Results In the improved group, the serum GP73 level before TACE, on the first day and in four to six weeks after TACE were (0.390±0.161) IU/ml, (0.385±0.165) IU/ml and (0.187±0.125) IU/ml, respectively. The serum GP73 level on the first day after TRAC were not significantly improved(P>0.05), however, in the four to six weeks after TRAC it decreased significantly as compared with the preoperative levels (P<0.05). In the progression group, the serum GP73 level before TACE, on the first day after TACE and in the four to six weeks after TACE were (0.373±0.134) IU/ml, (0.372±0.130) IU/ml and (0.604±0.121) IU/ml, respectively. The serum GP73 level did not change significantly on the first day after TRAC(P>0.05), however, it elevated significantly in the four to six weeks after TACE (P<0.05). For the HPC patients with AFP level less than 400 ng/ml, the serum GP73 level in the four to six weeks after TACE significantly decreased in the improved group (P<0.05), but significantly increased in the progression group (P<0.05); however, the AFP level did not change significantly before and after TACE (P>0.05). Conclusion The serum GP73 could be taken as an effective indicator in monitoring the therapeutic effect of TACE in patients with PHC. The GP73 has more advantages than AFP in the monitoring the therapeutic effect of TACE while the serum AFP level is less than 400 ng/ml.

Expression of ADAM12L in the tissues of basal-like breast cancer and its clinical significance

MA Bo, XIE Shang-nao, ZHOU Juan-di, WANG Xiao-hong

2018, 16(10): 1626-1628,1705. doi: 10.16766/j.cnki.issn.1674-4152.000442

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Objective To investigate the expression of ADAM12L protein and its nucleic acid in basal-like breast cancer and analyze its clinical significance. Methods The expression of ADAM12L protein in 86 cases of basal-like breast cancer and 20 cases of benign mammary fibroma were detected by immunohistochemistry. The real-time PCR method was used to detect the expression of ADAM12L mRNA in 60 cases of basal-like breast cancer tissue and adjacent tissue. Results Immunohistochemical staining showed that the expression of ADAM12L protein (84.9%, 73/86) in basal-like breast cancer tissues was significantly higher than that in benign breast tissue samples (45%, 9/20), P<0.05. The positive rate of ADAM12L in patients without lymph node metastasis was 47.8%, it's lower than 73.8% the rate of the patients with positive lymph node metastasis (χ²=5.073, P=0.024). In clinical stage Ⅲ-Ⅳ, the positive rate of ADAM12L (74.5%, 41/55) was higher than that of clinical stage Ⅰ-Ⅱ (35.5%, 11/31), χ²=11.073, P<0.01. With real-time PCR, the expression level of ADAM12L in basal-like breast cancer tissues was 2.07±0.95, which was significantly higher than that in adjacent tissues (P<0.05). Conclusion The expression of ADAM12L protein and nucleic acid in basal-like breast cancer tissues is significantly higher than that in normal or benign breast tissues, and is closely related to lymph node metastasis and clinical stage. ADAM12L may be used as a new target for individual diagnosis and treatment of the basal-like breast cancer patients.

Clinical study of predicted the prognosis use NRS2002 score in ICU adult critically ill patients

LIU Xin-ping, ZHAO Xin-ying, DING Mei, FANG Ning-ning, OUYANG Xiu-he

2018, 16(10): 1629-1631,1666. doi: 10.16766/j.cnki.issn.1674-4152.000443

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Objective To predict the prognosis in ICU adult critically ill patients by application of Nutritional Risk Screening (NRS2002). Methods The 201 adult critically ill patients at Binzhou City People's Hospital of intensive care unit from January, 2017 to May, 2017, were used investigative research. The patients were scored NRS2002 and APACHEⅡ in 24 hours to complete the score. To give Enteral and/or Parenteral nutrition support.According to the prognosis of patients were divided into death and survival groups, to compare two groups NRS2002 score and APACHEⅡ; Observe there groups APACHEⅡand case fatality rate difference; Analysis the predictive value of NRS2002 and APACHEⅡ on prognosis. Use SPSS 16.0 statistical software for statistical analysis. Results The risk of moderate nutritional risk was 88.6% in critical patients. Death and survival groups NRS2002 and APACHEⅡ comparison difference was statistically significant (P<0.05). Different nutritional risk group APACHEⅡ and case fatality rate comparison difference was statistically significant (P<0.05). There was no statistical significance in the moderate and severe nutritional risk group (P>0.05). NRS2002 with and APACHEⅡ prognosis presented positive correlation, the correlation coefficient r of 0.269 and 0.329, respectively. The two rated ROC curves were 0.644 and 0.682 respectively, and the difference was not statistically significant (P>0.05). Conclusion There are high nutritional risks in adult critical patients. The NRS2002 reflects the severity of the patient's condition, which can predict the prognosis of a critical patient. Early nutritional support can improve patient outcomes.

Determination of the docetaxel content by ultra performance liquid chromatography technology

SONG Wen-wen, XU Jian, LIU Yan

2018, 16(10): 1632-1634,1642. doi: 10.16766/j.cnki.issn.1674-4152.000444

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Objective Ultra performance liquid chromatography (UPLC) was established to determine the content of docetaxel in docetaxel injection in order to control the quality of docetaxel and to ensure the rational use of the drug. Methods The chromatographic conditions:Hypersll BDS C18 column (2.1×100 mm, 3 μm), equilibrated with methanol-water (55:45, V/V), flow rate:0.4 ml/min, column temperature:30℃, amount of sample:10 μl, and the analysis wave length:230 nm. The standard solution of paclitaxel, docetaxel and docetaxel blanks were mixed, and the specificity was verified. The docetaxel working fluid was set up in a concentration of docetaxel, and the docetaxel standard curve was established by determining the peak area ratio of docetaxel and paclitaxel. The docetaxel Quality control samples, each concentration of 5 copies, for precision verification; in the blank material solution, add the appropriate amount of docetaxel and paclitaxel, configure the quality control samples, each concentration of 6 copies, the recovery rate verification; configuration quality control Samples were prepared at each concentration of 6 parts, were placed for 24 h, repeated freezing and thawing 3 times, -20℃ for one week after the injection determination, stability verification; The dosage of docetaxel was dispensed into 3 μg/ml solution, and 3 parts were placed in parallel. The content of docetaxel in docetaxel was measured. Results Docetaxel had a good linearity in the range of 0.06-10 μg/ml (R²=0.999 7), which was verified by specificity, precision, recovery and stability, and met the requirements. His race content was 99.4%, 98.7% and 101.5%, respectively. Conclusion UPLC method established by this experiment can be used quickly and sensitively to determine the content of docetaxel.

Treatment of intra-articular calcaneal fractures with steel plate internal fixation by the sinus tarsi approach combined with vacuum sealing drainage

FANG Wen-lai, SUN Liao-jun, KONG Jian-zhong

2018, 16(10): 1635-1638. doi: 10.16766/j.cnki.issn.1674-4152.000445

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Objective To observe the clinical effect and postoperative incision complications of patients with intra-articular calcaneal fractures by steel plate internal fixation by the tarsal sinus approach combined with vacuum sealing drainage. Methods Total 38 patients with 40 foots with intra-articular calcaneal fractures were admitted in our hospital. All patients aged over 18 years old, and were with closed Sanders Ⅱ, Ⅲ, Ⅳ type intra-articular fracture, without severe soft tissue trauma in ipsilateral ankle, without diabetes and lower extremity vascular disease. All patients were treated with steel plate internal fixation by the tarsal sinus approach combined with vacuum sealing drainage in 4-12 days after injury. We observed the B hler angle, Gissane angle, length of calcaneus, width of calcaneus, height of calcaneus of pre-operation, post-operation and final follow-up, Maryland score of foot at final follow-up, and the postoperative complications. Results All 38 patients were followed up for 12-24 months, the mean follow-up was 15.5 months, the B hler angle, Gissane angle, length of calcaneus, width of calcaneus, and height of calcaneus of post-operation was (32.82±5.77)°, (116.50±8.00)°, (71.05±7.49)mm, (27.64±2.12)mm and (40.31±4.52)mm, respectively, while the final follow-up was (32.27±5.23)°, (115.90±7.80)°, (72.27±6.81)mm, (27.21±2.48)mm and (39.83±4.60)mm, respectively. The excellent and good rate was 80.25%. There was no wound complication. Conclusion With good exposure of the subtalar joint by the tarsal sinus approach, the B hler angle, Gissane angle, length of calcaneus, width of calcaneus and height of calcaneus could be regained. The vacuum sealing drainage can avoid wound infection complications better, reduce the times of change dressing, and alleviate the sufferings of the patient and the burden of clinical doctors.

The effect of combination of supplemental oxygen and eszopiclone on obstructive sleep apnea hypopnea syndrome in patients with a mild upper airway collapsibility

XU Tao, WANG Hua-ying, YU Wan-jun

2018, 16(10): 1639-1642. doi: 10.16766/j.cnki.issn.1674-4152.000446

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Objective To assess the effectiveness of the combination of supplemental oxygen and eszopiclone in obstructive sleep apnea hypopnea syndrome (OSAHS) patients whose upper airway anatomy are not severely compromised. Methods Sixty cases (critical closing pressure ≤ 5 cm H₂O, age<65 years old, 1 cm H₂O=0.098 kPa) were screened out from patients diagnosed with mild to moderate OSAHS in our hospital from August, 2015 to August, 2017. The patients were randomly divided into the treatment group and control group, 30 cases in each group. The treatment group received the combination therapy of eszopiclone (2 mg) and oxygen (2 L/min), while the control group received placebo and sham air.Sleep monitoring data including apnea hypopnea index (AHI), the longest apnea time and the lowest nocturnal oxygen saturation (SaO₂) and respiratory mechanics indexes including ventilation that caused an arousal, active collapsibility, arousal threshold and loop gain were compared in two groups before and after 3 weeks of treatment. Wilcoxon rank sum test was used to evaluate the differences between two groups. Results After 3 weeks of treatment, the AHI and the longest apnea time in the treatment group was much lower than that in the control group (Z=-3.992 and Z=-4.805, P<0.001), and the lowest nocturnal SaO₂ in the treatment group was much higher than that in the control group (Z=-6.621, P<0.001). Meanwhile, the ventilation that caused an arousal was much lower than that in the control group (Z=-6.641, P<0.001) and the arousal threshold in the treatment group was much higher than that in the control group (Z=-6.303, P<0.001), the loop gain in the treatment group was reduced more greatly than that in the control group (t=-4.934, P<0.001). Conclusion The combination of supplemental Oxygen and eszopiclone has reliable curative effect on OSAHS in selected individuals, which can improve the severity of apnea and hypopnea, ventilation that causes an arousal, arousal threshold and loop gain in those patients with a mild upper airway collapsibility. The combining targeting therapy may be an effective treatment option in selected OSAHS individuals.

Efficacy of insertion of bile duct stent through endoscopic retrograde cholangiopancreatography in the treatment of advanced stage malignant obstructive jaundice

JIN Xiao-sheng, CHEN Lu-qian, JI Ting-ting, YE Fang-peng, SUN Qing-feng

2018, 16(10): 1643-1645,1649. doi: 10.16766/j.cnki.issn.1674-4152.000447

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Objective To investigate the clinical effect of insertion of bile duct stent through endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of advanced stage malignant obstructive jaundice (MOJ). Methods A total of 74 patients with advanced malignant obstructive jaundice in our hospital from February, 2013 to February, 2016 were selected, all patients were treated with insertion of bile duct stent through ERCP, and the basic situation, therapeutic effects, liver function, immune function, postoperative complications and survival time were observed. Results Among the 74 patients, 72 cases were successfully treated with biliary stent, the successful rate was 97.3%. The average hospitalization time was (14.74±4.26) days, and the average hospitalization cost was (25 446.59±3 264.55) yuan. One week after the operation, the total effective rate was 94.4%, the levels of serum direct bilirubin (DBIL), total bilirubin (TBIL), alanine glycosylase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and glutamyltranspeptidase (GGT) decreased significantly (P<0.05). One week after the operation, the levels of CD4⁺ and CD4⁺/CD8⁺ increased significantly (P<0.05) and the level of CD8⁺ decreased significantly compared with preoperative (P<0.05). The incidence of postoperative complications was 5.56% and the average survival time was (14.25±5.38) months. Conclusion The insertion of bile duct stent through ERCP in the treatment of advanced malignant obstructive jaundice has a significant effect, which can significantly improve the liver function, immune function and prognosis, and can be used as a palliative treatment for advanced malignant obstructive jaundice.

Clinical research of efficacy of ganglioside combined with nerve growth factor for acute cerebral hemorrhage

SHAO Chuan-feng, CHEN Pei-lei, WU Sai-zhen, CHEN Po

2018, 16(10): 1646-1649. doi: 10.16766/j.cnki.issn.1674-4152.000448

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Objective To investigate the efficacy and economic benefits of ganglioside combined with murine nerve growth factor in the treatment of patients with acute cerebral hemorrhage. Methods A total of 240 patients with acute cerebral hemorrhage admitted from June, 2015 to June, 2017 in our department were divided into observation group (ganglioside combined with mouse nerve growth factor) and control group (mouse nerve growth factor alone). The effective rate of clinical efficacy, quality of life and drug cost were compared between the two groups. Results The effective rate of patients in the observation group was higher than that of control group two weeks after the treatment (χ²=4.148, P=0.042). The volume of intracranial hemorrhage in the observation group and control group decreased after 2 weeks of treatment, but the reduction in the observation group was larger than that in the control group (t=13.000, P<0.001). After 2 weeks of treatment, the edema area around the hematoma of the observation group and the control group decreased, but the reduction in the observation group was larger than that of the control group (t=7.856, P<0.001). There was no significant difference in IL-6 level between the two groups before the treatment (t=0.178, P=0.867). After 2 weeks of treatment, the levels of IL-6 in both groups decreased and the decrease in the observation group was statistically significant significance of learning (t=7.170, P<0.001); There was no significant difference in ADL score between the two groups before the treatment (P>0.05). After 3 months of treatment, the ADL score of the observation group was significantly higher than that of the control group (P<0.05). The days of hospitalization in the observation group were lower than those in the control group, with significant difference[(13.9±4.2) d vs. (25.8±6.4) days, t=17.030, P<0.01). There was no significant difference in medication spending between the two groups (5 764.3±1 002.9) vs (5 499.7±998.5), t=1.875, P=0.062]. Conclusion The combination of ganglioside and murine nerve growth factor in the treatment of acute intracerebral hemorrhage can significantly improve the patient's condition and quality of life, and does not significantly increase the economic burden on patients, it is worth in the clinical application.

Clinical observation of Telbivudine and tenofovir in the treatment of chronic hepatitis B during pregnancy and reducing mother-to-child transmission of HBV

YANG Yi-de, WANG Dong-guo, HOU Wei, YU Lian-hua

2018, 16(10): 1650-1652. doi: 10.16766/j.cnki.issn.1674-4152.000449

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Abstract:
Objective To explore the efficacy and safety of telbivudine and tenofovir in the treatment of the patients with chronic hepatitis B during pregnancy and its effect on reducing mother-to-child vertical transmission of HBV. Methods From January, 2016 to December, 2017, 80 HBeAg positive pregnant women, with HBV DNA>10⁶ IU/ml, were randomly divided into two groups (n=40). The patients in the control group received telbivudine in the middle and late stages, while the patients in the research group received tenofovir in the middle and late stages. The medicines were withdrawn until three months after postpartum. All the newborns were given blockade therapy. Alanine aminotransferase (ALT) and HBV-DNA were detected before the treatment and delivery. The HBeAg, HBsAg positive and HBV DNA ≥ 100 IU/ml were detected when babies were born, seven months and one years after the birth. The biochemical indexes, virology response, infant growth and development, mother to child transmission of hepatitis B, and adverse reactions were observed and compared between the two groups. Results Before the delivery, the HBV DNA and ALT levels in the research group were less than those in the control group, the ALT normalization rate (97%) and the negative conversion rate of HBV-DNA (95%) in the research group were higher than those in the control group, the differences were statistically significant (P<0.05). There were no significant differences in the Apgar score, weight between the two groups of childbirth. The success rate of neonatal interruption in the research group (100%) was higher than that in the control group (72.5%). One year after the birth of infants, the serum HBeAg, positive rate of HBsAg and HBV DNA 100 IU/ml in the research group were lower than those in the control group, there was no obvious adverse reaction between the two groups of mothers and infants. Conclusion Tenofovir can reduce maternal serum HBV DNA levels of hepatitis B infection, improving liver function, the blocking rate of vertical transmission, reducing infant HBV infection rate, having no significant adverse reactions, good safety, and it was worth popularizing.

Application of circulating tumor cells combined with carcinoembryonic antigen in the diagnosis of stage Ⅰ and Ⅱ colorectal cancer

JIANG Xiao-fen, SHAO Chuan-feng, ZHANG Hao, YANG Li-juan, WANG Zhong-lin, PAN Jie, WU Wei

2018, 16(10): 1653-1655. doi: 10.16766/j.cnki.issn.1674-4152.000450

253 0

Abstract:
Objective To analyze the role of circulating tumor cells (CTC) combined with carcinoembryonic antigen (CEA) in the diagnosis of stage Ⅰ and Ⅱ colorectal cancer, and to provide reference for clinical treatment of patients with stage Ⅰ and Ⅱ colorectal cancer. Methods A total of 86 patients with colorectal disease were divided into observation group (stage Ⅰ and Ⅱ colorectal cancer, n=86) and control group (benign colorectal disease, n=35) who were diagnosed by pathological diagnosis in our hospital were selected from April, 2017 to September, 2017 as observation group, and 35 patients with health examination and colorectal benign in the same period were selected as control group. The level of CTC and CEA were examined. The relationship between CTC count and its clinical data was analyzed, and the diagnostic value of CEA detection, CTC detection and CEA combined with CTC detection in stage Ⅰ and Ⅱ colorectal cancer were compared. Results There were significant differences in CTC counts among patients with different CEA levels (P<0.05). The positive rate of CEA detection was 47.67% (41/86). The positive rate of CTC detection was 72.09% (62/86). The positive rate of CTC combined with CEA was 90.70% (78/86). The consistency test results showed that the sensitivity, specificity, accuracy and consistency of CTC combined with CEA detection were significantly higher than those of CEA and CTC detection. Conclusion The CTC combined with CEA has high application value in the diagnosis of colorectal cancer in stage Ⅰ and Ⅱ, which is worthy of clinical promotion.

Comparison of the effect of invisible braces and conventional braces in treatment of adult malocclusion

LIU Yang, CHEN Yao

2018, 16(10): 1656-1658. doi: 10.16766/j.cnki.issn.1674-4152.000451

199 0

Abstract:
Objective To compare the curative effect of invisible braces and conventional fixed appliances in the treatment of malocclusion in adults. Methods From January, 2015 to December, 2016, 122 adults with malocclusion diagnosed in our department were selected as the subjects. There were 34 males and 88 females. The average age was (28.0±4.5) years. According to the wishes of the patients, 54 cases were treated with fixed appliances (fixed appliances group), and the other 68 cases were treated with invisible orthodontic appliances (invisible orthodontic appliance group). The observation indicators included treatment completion time (tilt teeth correction, transposition teeth torsion), treatment effect and patient satisfaction. Results The correction time (week), orthodontic time (week) and the average time of treatment (week) in the fixed appliances group were 30.81±3.04), (27.46±4.22) and (76.35±8.29), respectively, which were longer than those of the invisible orthodontic appliance group[(15.96±3.03), (18.47±3.50) and (42.55±3.68)], respectively, P<0.05. In the fixed appliances group and invisible orthodontic appliance group, the total score of the correction effect (scores) were (29.36±2.21) and (29.98±2.60), respectively, the difference was not statistically significant (t=1.423, P>0.05). In the invisible orthodontic appliance group, the chewing function (8.47±1.26), language function (9.13±1.34), beauty (8.24±1.45), and comfort (9.35±0.48) were higher than those of the fixed appliances group[chewable function (6.79±1.05), language function (7.45±1.30), beauty (6.08±1.47), and comfort (9.35±0.48)respectively (all P<0.05)]. Conclusion Both invisible orthodontic appliances and conventional fixed appliances can obtain satisfactory curative effect, but the treatment time of invisible orthodontic appliance is shorter and the patient's satisfaction is higher.

Short-term efficacy and safety of laparoscopic radical resection for different stages of colorectal cancer

WANG Zheng-yu, LIU Mu-lin

2018, 16(10): 1659-1661. doi: 10.16766/j.cnki.issn.1674-4152.000452

234 0

Abstract:
Objective To study the short-term efficacy and safety of laparoscopic radical surgery for different stages of colorectal cancer. Methods A total of 50 patients with colorectal cancer from March, 2012 to May, 2017 were randomly assigned observation group (25 cases) and control group (25 cases). The patients of the observation group underwent laparoscopic surgery, while the patients of the control group underwent open surgery. The amount of perioperative bleeding, the time to passing gas after surgery, the time to postoperative ambulation, and the complications such as intestinal obstruction, incision infection, urinary tract infection and anastomotic fistula were observed and compared between the two groups. Results The mean perioperative bleeding[(35.6±16.1) ml] of the observation group was less than that of the control group[(56.2±22.7) ml], the difference was statistical significance (P<0.05); the time to passing gas after surgery[(2.7±0.3)d] in the observation group was less than that in the control group (3.6±1.0)d, with statistical significance (P<0.05); the time to postoperative ambulation (10.8±2.5)d in the observation group was significantly less than the control group[(17.0±5.7)d], with statistical significance (P<0.05). The incidence of post-operative complication (6.0%) in the observation group was significantly lower than that in the control group (22.5%), the difference was statistical significance (P<0.05). Conclusion The laparoscopic radical surgery for the patients with early stage colorectal cancer is effective and safe. However, for patients with advanced stage, more work should be done such as careful preoperative assessment and detailed prepare and selecting suitable operative procedure, all of those could improve the effects of operations.

Analysis of microbial spectrum and antibiotic resistance in 129 cases patients of peritoneal dialysis related peritonitis

SHEN Shui-juan, GUAN Ji-chao, WANG Shi-min, DONG Zhi-chao, LI Qing-hua, WANG Yan-yan, YANG Yan-ru

2018, 16(10): 1662-1666. doi: 10.16766/j.cnki.issn.1674-4152.000453

219 3

Abstract:
Objective Peritoneal dialysis related peritonitis is still an important cause of failure of peritoneal dialysis and death. To investigate the microbial spectrum and antibiotic resistance of continuous ambulatory peritoneal dialysis (CAPD) related peritonitis and guide the clinical rational use of antimicrobial agents. Methods A retrospective analysis was made of CAPD related peritonitis in 129 cases with peritoneal dialysis culture results in the Shaoxing People's Hospital from January 1, 2012 to December 31, 2016. Distribution of pathogenic bacteria and its resistance to common antibiotics were analyzed. Results In 129 cases of CAPD related peritonitis, peritoneal fluid culture was positive in 97 cases, the positive rate was 75.19%. A total of 98 strains of bacteria were isolated, gram positive bacteria infection (G⁺) in 69 cases (71.14%), gram negative bacteria infection (G^-) in 26 cases (26.80%), including 1 cases of Escherichia coli and Klebsiella pneumoniae infection, fungal infection in 2 cases (2.06%). Drug sensitivity test of Staphylococcus aureus was sensitive to vancomycin, tigecycline and linezolid, teicoplanin on a case of intermediary and drug resistance. Streptococcus were sensitive to vancomycin, chloramphenicol, vancomycin and Enterococcus were sensitive to tigecycline; G^- bacteria were sensitive to imipenem,meropenem and ertapenem. One hundred and twenty-nine cases of patients with a total of 1 cases of death, 2 cases give up the treatment, and 5 cases transferred to hemodialysis. Conclusion The main pathogen of CAPD related peritonitis is Gram-positive bacteria. Cefazoline combined with piperacillin/tazobartan, cefoperazone/Shubatan or butanamycin are recommended as empirical drugs for the treatment of peritonitis. Direct vancomycin plus cefoperazone/sulbactam may be considered for severe infection.

Effect of cluster intervention of TCM on blood pressure of the climacteric syndrome patients with stagnation of liver-QI and hypertension

CHEN Xu-feng, WEI Ye-hong, ZHOU Xian-wei, SHENG Shao-qin

2018, 16(10): 1667-1669,1729. doi: 10.16766/j.cnki.issn.1674-4152.000454

244 2

Abstract:
Objective To explore the effects of cluster intervention of TCM on blood pressure of the climacteric syndrome patients with stagnation of liver-QI and hypertension, in order to provide easy, safe and reliable treatment scheme, alleviate clinical symptoms of traditional Chinese medicine, and improve the quality of life. Methods A total of 80 hypertension patients with climacteric syndrome were randomly divided into control group and experimental group with 40 patients in each group. The control group was given routine nursing care while the experimental group was given the cluster TCM interventions. The differences in 24 h SBP, 24h DBP and TCM symptom classifying quantitative score were compared between the two groups after treatment. Results The experimental group's 24 hours average systolic blood pressure (SBP) reduced from (155.8±5.1) mm Hg (1 mm Hg=0.133 kPa) to (123.5±3.3) mm Hg, 24 hours a day on average diastolic blood pressure(DBP) reduced from (93.6±6.9) mm Hg to (70.8±3.6) mm Hg, TCM symptom classifying quantitative score from (8.2±1.3) to (1.4±0.5); Control group' SBP reduced from (155.9±5.1) to (128.2±4.4), DBP by (95.3±5.2) mm Hg to (76.4±3.7) mm Hg, TCM symptom classifying quantitative score by (9.4±1.5) to (3.7±1.1). Comparison between groups, after twenty days intervention, experimental group' SBP and DBP drop was obvious; after ten days intervention, experimental group' TCM symptom also decreased significantly. Conclusion According to the theory of Chinese medicine keeping in good health cluster change intervention can improve the menopausal liver Yang syndrome blood pressure in patients with high blood pressure, relieve clinical symptoms of traditional Chinese medicine, and improve the quality of life.

HLA-Ⅰ expression level in placenta tissue and its relationship with pregnancy outcome in patients with pregnancy-induced hypertension

ZHOU Jing, OU Rong-ying, ZHOU Mei-qian, LIN Feng

2018, 16(10): 1670-1673,1698. doi: 10.16766/j.cnki.issn.1674-4152.000455

205 0

Abstract:
Objective To explore the expression level of HLA-E, HLA-F and HLA-G in placenta tissue and its relationship with illness state and pregnancy outcome in patients with pregnancy-induced hypertension. Methods Total 81 pregnant women with preeclampsia in our hospital between January, 2016 and December, 2016 were enrolled and divided into mild preeclampsia group (32 cases) and severe preeclampsia (49 cases); 30 healthy pregnant women were selected as controls. The umbilical cord blood was extracted to detect serum HLA-Ⅰ level with ELISA kits, and the placenta tissue was extracted to test the expression levels of HLA-E, HLA-F and HLA-G by immunohistochemical method. In addition, the pregnancy outcome was record, and the difference between women with and without adverse pregnancy outcomes was compared. Results The serum HLA-Ⅰ level was successively decreased in accordance with the order of the control group, mild preeclampsia group and severe preeclampsia group, and the difference between each two groups had statistical significance (P<0.05). The positive rate and expression levels of placenta HLA-E, HLA-F and HLA-G were both successively decreased in accordance with the order of the control group, mild preeclampsia group and severe preeclampsia group, and the difference between each two groups had statistical significance (P<0.05). The rate of adverse pregnancy outcome in preeclampsia group was higher than that in the control group, the difference had statistical significance (P<0.05). The serum HLA-Ⅰ level and placenta HLA-E, HLA-F and HLA-G levels in the preeclampsia group was lower than those in the control group, the difference had statistical significance (P<0.05). Conclusion The decrease of HLA-E, HLA-F and HLA-G expression may be closely related to hypertension and adverse pregnancy outcomes during pregnancy.

Effect of high-dose gamma globulin combined aspirin on vascular endothelial factor, resistin and visfatin of children with Kawasaki disease

WANG Xin-fang, HUANG Xian-mei, WANG Yue-sheng, ZHANG Zhi-qun

2018, 16(10): 1674-1676. doi: 10.16766/j.cnki.issn.1674-4152.000456

171 0

Abstract:
Objective To investigate the effect of high-dose gamma globulin combined aspirin on vascular endothelial factor,resistin and visfatin of children with Kawasaki disease and observe its clinical efficacy. Methods A total of 62 patients with Kawasaki disease in Hangzhou First People's Hospital from January, 2015 to December, 2016 were selected as the observation group and treated with large doses of gamma globulin and aspirin.High-dose gamma globulin was 2 g/(kg·d),intravenous injection,and aspirin enteric-coated tablets. 30-50 mg/(kg·d) was given orally 3 times,reduced to 3-5 mg/(kg·d) 3 days after antipyretic therapy,and administered orally once a day for 2 months. Another 62 healthy children who had physical examination in our hospital during the same period were selected as the control group.Before and after treatment,the levels of inflammatory factors (hs-CRP, TNF-α) and vascular endothelium-related markers (VEGF, eNOS, ES) were measured by enzyme-linked immunosorbent assay, PCT levels were measured by double-antibody sandwich assay, resistin and visfatin levels were measured by double-antibody enzyme-linked immunosorbent assay. The therapeutic effect was compared with the control group. Results After treatment,the PCT, hs-CRP and TNF-α levels of observation group were significantly reduced (P<0.05). After treatment, VEGF, ES, resistin and visfatin levels of observation group were significantly decreased (P<0.05), and the eNOS level was significantly increased (P<0.05). The total effective rate of treatment was 91.93%. Conclusion High-dose gamma globulin combined with aspirin can significantly reduce the inflammatory response of children with Kawasaki disease and reduce vascular endothelial injury. The mechanism may be related to the large dose of gamma globulin combined with aspirin can effectively regulate the resistin and visfatin in children.

Effect of low molecular weight heparin combined with magnesium sulfate on fetal growth restriction and its effect on perinatal outcome

JIN Yan, ZHU Min, NIU Yan-xin, DAI Xi-wang

2018, 16(10): 1677-1679. doi: 10.16766/j.cnki.issn.1674-4152.000457

232 0

Abstract:
Objective To explore the effect of low molecular weight heparin combined with magnesium sulfate on fetal growth restriction and the effect of perinatal prognosis. Methods Total 200 pregnant women with restricted fetal growth were selected in the obstetrics department of Jinhua People's Hospital in February, 2016 to February, 2018, and divided into the observation group (100 cases) and the control group (100 cases) according to the random digital table method. The control group was treated with low molecular weight heparin on the basis of routine treatment, while the observation group was treated with magnesium sulfate on the basis of the control group. The average weekly uterine height and fetal growth, amniotic fluid index and biophysical score, neonatal outcome (neonatal asphyxia rate, perinatal mortality, neonatal Apgar score, Full moon sample, premature infant incidence) were compared between the 2 groups of parturients. Results The average weekly uterine growth and fetal growth (fetal head circumference, abdominal circumference, biparietal diameter and long increase of femur) were higher in the observation group than in the control group, P<0.05. There was no significant difference between the 2 groups of amniotic fluid index and biophysical score before the treatment, P>0.05; the amniotic fluid index and Biophysics in the observation group were better than the control group after treatment. The score of the neonatal Apgar in the observation group was higher than that of the control group, and the neonatal asphyxia rate and perinatal mortality in the observation group were 1.0% and 0.0%, in the control group were 7% and 4%, respectively, P>0.05. The incidence of Full moon sample in the observation group was 2% lower than that in the control group (9%), P<0.05; the incidence of morning infants in the observation group was 4%, which was lower than that in the control group (12%), P<0.05; The neonatal weight and gestational age of the observation group were better than those in the control group, P<0.05. Conclusion Low molecular weight heparin combined with magnesium sulfate is effective in the treatment of fetal growth restriction. It can effectively promote fetal growth and development, and has high safety. It is worthy of clinical application.

Clinical and laboratory studies on HDN of maternal and child blood type incompatibility

CHEN Ming, CHEN Xiao-he, CENG Jue, CHEN Fan, ZHU Fa-ming

2018, 16(10): 1680-1682. doi: 10.16766/j.cnki.issn.1674-4152.000458

182 1

Abstract:
Objective The clinical and laboratory studies on hemolytic disease of newborn (HDN) of maternal and child ABO blood type incompatibility were discussed, and to provide a more effective prediction of ABO blood group incompatibility HDN detection method. Methods Serological methods were applied from May, 2014 to September, 2016 in our hospital to check the 600 couples' and newborns' ABO and RhD blood type, the postnatal neonatal umbilical cord blood was collected for HDN three trials (direct antiglobulin test, serum free antibody assay and erythrocyte antibody release test), and the indirect antiglobulin assay was used to determine the titer of anti-A (B) IgG in postpartum serum of pregnant women. Results The number of cases of HDN was 357, and the total positive rate was 59.5%; Maternal-husband-neonatal blood type which was O-A-A type had 168 cases (three positive cases in 49 cases, two positive in 7 cases, 49 cases of positive single, a total of 105 cases showed positive, the total positive rate was 62.50%), O-B-B type had 127 cases (71 cases were three positive, the total positive rate was 62.50%), O-AB-A type had 182 cases (three positive cases in 75 cases, two positive in 37 cases, 70 cases of positive single, a total of 112 cases showed positive, the total positive rate was 61.54%), O-AB-B type had 123 cases (three positive cases in 41 cases, two positive in 14 cases, 14 cases of positive single, a total of 69 cases showed positive, the total positive rate was 56.10%), and the total positive rate was O-A-A> O-AB-A> O-AB-B> O-B-B in order from large to small; The incidence of HDN was also increased as the titer of anti-A (B) IgG in postpartum serum of pregnant women increased. Conclusion ABO HDN has a higher incidence, especially when the mother's blood type is O, the most common neonatal blood type is type A, and antibody release test can effectively detect ABO HDN; maternal IgG anti-A (B) antibody titers can be used to assess the incidence of HDN, which is an important clinical significance for the effective prediction and diagnosis of HDN.

The common deafness gene test results analysis of 131 deaf children in Shaoxing area

YU Hong, YANG Jing-qun, WU Zhang-hua, WU Zhi-qiang

2018, 16(10): 1683-1685. doi: 10.16766/j.cnki.issn.1674-4152.000459

264 0

Abstract:
Objective Through detecting the common deafness genes in patients, we discover the mutation chart of the hereditary deafness gene and the mutation frequency in the region in order to provide scientific evidence for deafness prevention. Methods The 20 spot mutations of the common deafness genes of GJB2, SLC26A4, 12srRNA and GJB3 were detected by using MALDI-TOF-MS technique for 131 patients from 2 deaf children rehabilitation center and out-patients. Results Sixty-three cases were detected with mutation among 131 patients, and the detection rate was 48.09%. Twenty cases were homozygous mutation, and the ratio was 15.27%. 51 cases were heterozygous mutation, and the ratio was 38.93%. Thirty-eight cases were GBJ2 mutation, and the ratio was 29.01%. Twenty-five cases were SLC25A4 mutation, and the ratio was 19.08%. The highest detection frequency spots are GJB2 235delC spot and IVS7-2A>G spot from SLC26A4, and the corresponding detection rates are 26.72% and 12.98%. GJB3 gene and mt DNA mutation were not detected.60.1% patients with family hereditary deafness was detected, and no statistical significance is discovered compared with detecting ratio of patients without family hereditary deafness (χ²=0.752, P>0.05). Conclusion The detection rate of the common deafness genes among the patients is relatively high in this region, and the major mutations are GJB2 and SLC26A4. 12srRNA may not be the major pathogenic genes of deafness in this region. Detecting the deafness genes can help determine the cause of deafness, and has significance on the family re-birth risk analysis.

Status survey and demand analysis on osteoporosis of postmenopausal women in a certain community of Xuhui district of Shanghai

KANG Jing, WANG Qing-qing, JU Jun-qiang, LIU Bei, JIANG Dan-ma, CHEN Yan, JU Jun, CHEN Bi-hua

2018, 16(10): 1686-1689. doi: 10.16766/j.cnki.issn.1674-4152.000460

172 2

Abstract:
Objective To understand the current situation and demand of postmenopausal women with osteoporosis and to provide references for health intervention. Methods A total of 316 postmenopausal women with osteoporosis in the community were investigated by cluster random sampling, and EpiData 3.1 and SPSS 22.0 were applied for data entry and statistical analysis. Results There were significant differences in the number of families and the family history of osteoporosis in patients with varying degrees of osteoporosis (χ²=7.436, P=0.024 and χ²=8.415, P=0.015); no significant differences were observed in behavior habits, exercise and diet among patients with different severity of osteoporosis (all P>0.05); the proportion of tooth loosening and shedding in patients with severe osteoporosis was higher than who were in general condition, and statistic difference was found between them as well (31.6% vs. 17.5%, χ²=7.970, P=0.019). In patients with severe osteoporosis, the proportion of patients with knowledge of falls was lower than those who did not know fall related factors in terms of the number of falls and had a statistically significant difference (13.5% vs. 33.3%, χ²=4.571, P=0.033); the primary source of the knowledge of osteoporosis comes from television or radio (98.3%). The most desirable form of health education are expert lectures for patients (91.1%). The most anticipated content is the knowledge of preventive health care (66.4%). The most desirable way of community is the cooperation between doctors and patients (60.1%). Conclusion Further measures should be adopted to reduce the effects of risk factors of osteoporosis and fracture based on the needs of patients.

Doctor-patient relationship, doctor-patient trust status and influencing factors in township health centers in Beijing

WANG Zhe, PENG Ying-chun

2018, 16(10): 1690-1693. doi: 10.16766/j.cnki.issn.1674-4152.000461

236 0

Abstract:
Objective To fully understand the current situation of doctor-patient relationship and doctor-patient trust in township hospitals in suburbs of Beijing, and to analyze the existing problems and its influencing factors. Methods Using stratified random sampling, in the outer suburbs of Beijing in accordance with the geographical position and the actual level of development of medical and health institutions, stratified, T, C, H, D and M5 counties, 3 villages and towns of each county in stratified, a total of 15 townships, each township hospital stratified according to the Department of medical 10-12 conducted a questionnaire survey, a total sample of 184 medical staff; and at the same time in each township in stratified sample of 3 administrative villages, a total of 45 administrative villages. About 9-10 villagers were randomly selected in each village. A total of 423 villagers were selected to carry out a questionnaire survey. The results of the data are analyzed by SPSS 17.0 software. Descriptive statistical analysis, chi square test, rank sum test are used in the analysis. Results According to the 5-point scale, the average score of doctor-patient relationship was 3.33 and 3.56 respectively. The trust degree of medical staff in the township health center and satisfaction are "general"; the main reasons that affect the doctor-patient relationship and doctor-patient trust in township hospitals are:the technical level of medical staff in township hospitals, the service attitude of medical staff and the credibility of medical staff. Conclusion The general performance of the relationship between doctors and patients in township hospitals is generally better than that of urban doctors and patients, but it is worse than that of doctors in village clinics. Township hospitals should improve the level of medical technical services, the introduction of excellent talents, improve the hardware facilities, improve the service attitude, pay attention to humanistic care and build a harmonious relationship between doctors and patients.

The effect of maternal emotion and psychological status on the Toddler social emotional development situation

SUN Ping, QU Yun-xia, ZHANG Ce, ZHANG Hong

2018, 16(10): 1694-1698. doi: 10.16766/j.cnki.issn.1674-4152.000462

202 1

Abstract:
Objective To know the social emotional development of toddler and explore the influence of maternal emotion and psychological status on toddler's social emotional development situation. Methods Take random samples (toddler of 12 to 36 months whose major caretaker in family is mother) from two separate communities based in Dalian. Children's mothers were asked to fill in three questionnaires:Toddler Social-emotional Assessment, Background Questionnaire of Children and Symptom Checklist 90. Statistical methods were used to analyze collected data to seek how mothers' emotional and psychological status makes a difference to their children's inner development. Results Fifty children's positive rates from four dimensions (externalizing, internalizing, deregulation and competence) were 24%, 14%, 20% and 22% respectively. 52% mothers reported overall positive mother-child experience while the rest describe overall negative feelings. The unpleasant mothers perform relatively higher scores in comparison to their pleasant counterparts in Symptom Checklist 90 test and meanwhile their children also got higher disorder rate in "children's externalizing behaviors, internalization and behavior disorder". Statistics also showed that children's emotional disorder rate in externalizing is inversely proportional to mothers' educational levels. The difference in family structure appeared irrelevant to children's emotional status. The final noteworthy point was that children with mother whose monthly income was below 1 000 yuan had difference in response ability was significant. Conclusion Measurement of toddler's social emotional development and maternal emotion and psychological status is necessary, especially to children with emotional problems, for early professional intervention means more timely support.

Effects of aerobic combined impedance on executive function and anxiety and depression of brain injury patients with cognitive impairment

GUAN Yu-qing, YU Hong-li, ZHAO Jing-kun

2018, 16(10): 1699-1701,1752. doi: 10.16766/j.cnki.issn.1674-4152.000463

275 0

Abstract:
Objective To investigate the effect of aerobic combined impedance on executive function and anxiety and depression of patients with traumatic brain injury. Methods From August, 2014 to February, 2016, 144 brain injury patients with cognitive impairment by the rehabilitation treatment in our hospital were selected as the study subjects and were equally divided into observation group and control group accorded with block randomization method.The control group was given conventional rehabilitation intervention, the observation group was given the aerobic combined impedance based on the control group, and the intervention periods in the two groups were 4 weeks. Results The NIHSS scores in the observation group and control group after intervention were 2.94±1.43 and 4.20±1.98 respectively that were significantly lower than the before intervention of 6.02±1.45 and 6.02±1.97 (P<0.05), and the observation group was significantly lower than that of the control group (P<0.05). The compliance of the observation group was 98.6%, while that of the control group was 88.9%. The compliance of the observation group was significantly higher than that of the control group (P<0.05). The SDS and SAS scores of the observation group and the control group after intervention were significantly lower than those before the intervention, and the SDS and SAS scores in the observation group after intervention were significantly lower than those in the control group (P<0.05). Conclusion The application of aerobic combined impedance in brain injury patients with cognitive impairment can improve neurological function, improve the training executive function, and relieve anxiety and depression that has good application values.

The effect of Cortex Phellodendri extract on the macrolides-resistant Mycoplasma pneumoniae

ZHANG Wei-ying, ZHANG Yi, YU Dao-jun, CHEN Yue-ming

2018, 16(10): 1702-1705. doi: 10.16766/j.cnki.issn.1674-4152.000464

240 0

Abstract:
Objective To explore Cortex Phellodendri extract antibacterial activity against macrolides resistant mycoplasma pneumoniae (MP) in vitro, and to analyze its effect on the expression change of resistance gene MPN421 of MP. Methods The 23S rRNA mutations of 45 clinical isolated MP strains were determined by real-time PCR which were related to macrolides resistant. In further, MICs of 45 MP strains for Cortex Phellodendri extract were tested by serial dilution method. The MPNA421 mRNA expression change was measured with real-time PCR before and after being effected by Cortex Phellodendri extract. Results From 45 clinical isolated strains, there were 30 strains detected 23 s rRNA mutations, no mutations were detected in the other 15 strains. The MICs of 15 wild-type MP strains were 0.036-0.576 mg/ml for Cortex Phellodendri extract; the MICs of 30 resistant strains were 0.036-1.152 mg/ml. Combined with the MICs of berberine hydrochloride for most of the common bacteria and fungi were in range of 0.5-1.0 mg/ml. The results showed that 45 strains of MP for Cortex Phellodendri extract all were sensitive. On the condition without Cortex Phellodendri extract effect, the relative expressions of MPN421 mRNA of 15 wild-type MP strains and 30 MP resistant strains were 0.079 (0.071, 0.089), 0.083 (0.062, 0.084), P>0.05, respectively. After administration of Cortex Phellodendri extract for 6 hours or 9 hours, the relative expression of MPN421 mRNA of both wild-type strains and resistant strains were decreasing significantly (all P<0.01). Conclusion Both wild-type MP strains and macrolides-resistant strains were sensitive to Cortex Phellodendri extract. Cortex Phellodendri extract could decrease the relative expression of MPN421 mRNA, which mean that it could be used in treatment of the macrolides-resistant MP strain infection.

Role of cerebral hemodynamic parameters by transcranial Doppler in diagnosis and treatment of intracranial tuberculosis

ZHANG Han-zhi, MAO Min-jie, YANG Gao-yi, ZHANG Song, SHI Xu-hua

2018, 16(10): 1706-1709. doi: 10.16766/j.cnki.issn.1674-4152.000465

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Abstract:
Objective To study the transcranial Doppler (TCD) -derived cerebral hemodynamic parameters in patients with intracranial tuberculosis, explore the characteristics of cerebral blood flow dynamics and its correlation with intracranial pressure (ICP), and evaluate the role of TCD in the diagnosis and treatment of intracranial tuberculosis. Methods The TCD were performed beside beds one day before the lumbar puncture for pressure testing in 52 patients with intracranial tuberculosis in our hospital between March, 2016 and September, 2016. The spectral atlas systolic peak velocity (Vs), mean velocity (Vm) and end of diastolic velocity (Vd), pulsatility index (PI), and resistance index (RI) of the basilar artery (BA), vertebral artery (VA), anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA) of both sides were determined. The results and ICP were analyzed statistically. Results Compared with control group, the blood flow velocity of anterior cerebral artery (ACA) and middle cerebral artery (MCA) by TCD in patients with intracranial tuberculosis decreased, the blood flow velocity of basilar artery (BA), vertebral artery (VA) and posterior cerebral artery (PCA) were significant decreased, while the pulsatility index (PI) increased. The result of correlation analysis was positive between PI and ICP. Conclusion All internal carotid artery and vertebral basilar artery system were involved in the abnormal changes caused by intracranial tuberculosis. The blood flow velocity of anterior cerebral artery (ACA) and middle cerebral artery (MCA) is faster relatively, which is associated with increased intracranial pressure and PI, and the faster the flow velocity, could demonstrate the more serious the condition, and the worse prognosis. The blood flow velocity of basilar artery and vertebral artery slows down may associate with TB exudate of base of Skull.

The current status and progress of laboratory diagnosis technology of allergens in childhood allergic diseases

MIAO Qing, XIANG Li

2018, 16(10): 1710-1713,1761. doi: 10.16766/j.cnki.issn.1674-4152.000466

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Allergic diseases with their early onset and clinical complexity have been increasing in prevalence worldwide and have now become a serious public health problem. The laboratory diagnosis of allergen is pivotal for clinicians to the identification of the environmental causes of allergic diseases, in addition to provide a rational basis for personalized treatments. The laboratory diagnosis technology of allergens includes in vivo test (Epicutaneous skin test) and in vitro testing (Quantitative measurement of circulating IgE antibody). Once a reasonable suspicion is established, a laboratory confirmation with a high accuracy can be obtained utilizing a proper laboratory diagnosis technology (in vivo tests and/or in vitro test), the right types of allergens (seasonal or perennial allergens) as well as a complete medical history. Component resolved diagnostics (CRD) utilizes individual natural or recombinant allergenic components that are contained in the whole complex allergen source. By focusing on the individual major or minor allergens and controlling for allergen concentration, CRD promises a more precise and individualized (clinically relevant for the patient) measurement of allergen-specific IgE antibodies. Therefore, this article reviews the application status, clinical interpretation and latest research progress on laboratory diagnosis technology of allergens in children allergic diseases.

The role of enhanced recovery after surgery in preserving gut microbiota

LUO Dong-ming, HUANG Shi-feng, XU Jun-yi, SONG Xue-min, WU Jun-yi

2018, 16(10): 1714-1717. doi: 10.16766/j.cnki.issn.1674-4152.000467

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Abstract:
The human microbiome is composed of a variety of bacteria, archaea, microeukaryotes and viruses. They are widely distributed in organs and tissues in which the human body is exposed to the outside world, and most of them live in the human digestive tract. The microbiota in gastrointestinal tract not only participated in the metabolic process of macro nutrient (sugar, fat and amino acids), but also participated in the metabolism process of some micronutrients (vitamins, iron and zinc). Not only that, they also play an important role in maintaining intestinal biological barriers, fighting inflammation, regulating cell necrosis, and initiating immune related processes. Such factors as prohibition of drinking, fasting, trauma, Surgical stress and other factors in clinical practice are likely to lead to intestinal microflora disturbance, intestinal barrier function damage and intestinal mucosal permeability increase, leading to intestinal flora shift and intestinal infection. Subsequent systemic inflammatory response syndrome and multiple organ failure followed. How to maintain the stability of intestinal microflora and protect intestinal function barrier has become a problem for medical workers. The enhanced recovery after surgery is a set of effective measures to reduce the surgical stress and trauma and accelerate the postoperative recovery of the patients during the perioperative period. Because of its concept and some relevant measures, such as shorten preoperative fasting time, non mechanical enema, early postoperative diet can better maintain the intestinal microflora stability, protect the intestinal function barrier, promote the recovery of gastrointestinal function. Therefore, the implementation of enhanced recovery after surgery provides a way for us to better protect and utilize the gastrointestinal tract during the perioperative period. Here, we reviewed the composition of intestinal microflora and its functions in nutrition metabolism, the concept of enhanced recovery after surgery, the relationship between enhanced recovery after surgery and intestinal microflora.

Effect of deep pharyngeal nerve stimulation on swallowing function and nutritional status in patients with dysphagia after stroke

SUN Jie, LI Ze-heng, WEI Tao, HUANG Ying, CHEN Guo-fang

2018, 16(10): 1718-1721. doi: 10.16766/j.cnki.issn.1674-4152.000468

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Abstract:
Objective To investigate the effect of deep pharyngeal nerve stimulation on swallowing function and nutritional status of patients with dysphagia after stroke. Methods A total of 166 cases of post-stroke dysphagia patients from January, 2016 and January, 2018 in our hospital were random divided into two groups, 83 cases in each group. The control group was given rehabilitation treatment, and the observation group was treated with deep pharyngeal nerve stimulation therapy based on control group. After treatment, Putian drinking water test scores, standard swallowing function score (SSA), X-ray swallowing angiography test score (VFSS), life quality (SWAT-QOL), daily living activity (MBI), and nutritional status (Hb, ALB, PAB), aspiration pneumonia and malnutrition occurrence, and clinical efficacy of two groups were compared. Results After treatment, the drinking water test and SSA score of two groups were significantly decreased (P<0.05), and the observation group was significantly lower than control group (P<0.05). The VFSS scores of two groups were significantly increased (P<0.05). The observation group was significantly higher than control group (P<0.05). After treatment, the SWAT-QOL and MBI scores of two groups were significantly increased (P<0.05), and the observation group was significantly higher than control group (P<0.05). After treatment, Hb, ALB and PAB levels of two groups increased significantly (P<0.05), and the observation group was significantly higher than the control group (P<0.05). After treatment, the incidence of inhalation pneumonia of observation group was 8.43%, which was significantly lower than that of the control group (19.28%), P<0.05. The incidence of malnutrition was 10.84%, which was significantly lower than that of the control group (26.51%), P<0.05. After treatment, the total effective rate was 89.17% in the observation group, which was significantly higher than 68.87% in the control group (P<0.05). Conclusion Deep pharyngeal nerve stimulation can significantly improve the swallowing function of patients with dysphagia after stroke, improve their daily activities and quality of life, improve their nutritional status, and reduce the occurrence of complications such as abscess pneumonia and malnutrition.

Research on the Th1/ Th2 immune drift intervention of benefit stomach blood method in the treatment of precancerous lesions of gastric cancer

JIN Jin-jin, TENG Wei-jun, CHEN Yan-ping

2018, 16(10): 1722-1725. doi: 10.16766/j.cnki.issn.1674-4152.000469

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Abstract:
Objective To analysis the application value and Th1/Th2 immune drift of Benefit stomach blood method in the treatment of precancerous lesions of gastric cancer, clearing the positive clinical significance of TCM on precancerous lesions of gastric cancer. Methods One hundred precancerous lesions of gastric cancer patients were randomly divided into two groups, 50 cases in each group. Giving rabeprazole sodium enteric-coated tablets and capsule of teprenone for control group, while above medicine and combined benefit stomach blood decoction for observe group. Then the clinical curative effect, stomachoscopy and Th1/Th2 immune index changes of the two groups were analysed. Results After 12-week treatment, the score of stomach pain/bloting/anorexia were obviously lower in treatment group (1.52±1.03), (1.33±1.05), (1.38±1.01) than those in control group (2.01±1.16), (2.32±1.18), (2.28±1.17), all P<0.05. The score of inflammation pathological/gland atrophy/IM/Dys were obviously lower in treatment group (1.39±1.01), (1.37±1.03), (1.39±1.06), (1.27±1.06) than those in control group (2.33±1.17), (2.51±1.18), (2.09±1.05), (2.03±1.26), all P<0.05. The value of IL-2 and INF-γ were obviously higher in treatment group[(9.52±1.46)pg/ml, (20.37±5.20)pg/ml] than those in control group[(5.92±1.46)pg/ml, (14.89±4.92)pg/ml], all P<0.05. The value of IL-4 and IL-6 were obviously lower in treatment group[(4.85±1.93)pg/ml, (50.43±13.51)pg/ml] than those in control group[(8.74±1.84)pg/ml, (80.16±11.36)pg/ml], P<0.05. Conclusion Benefit stomach soup of blood can not only effectively regulate the precancerous lesions of gastric cancer patients' Th1/Th2 balance, at the same time also can effectively improve the clinical therapeutic effect.

Clinical observation of acupuncture combined core muscle training on early balance function of ischemic stroke patients with hemiplegia

CONG Wen-jie, JIN Zhen-zhen, DONG Hai-xin, LIU Shuang, XIE Wen-xia, LI Li-hong

2018, 16(10): 1726-1729. doi: 10.16766/j.cnki.issn.1674-4152.000470

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Abstract:
Objective To investigate the effect and mechanism of acupuncture combined core muscle training on early balance function of ischemic stroke patients with hemiplegia. Methods A total of 192 cases of ischemic stroke patients with hemiplegia were randomly divided into two groups, 96 cases in each group. The control group was given core muscle training, and the observation group was added Dialectical stage acupoints acupuncture based on control group. The trunk control ability (PASS score), lower limbs function (FMA score), balance ability (BBS score), walking ability (Holden score), life quality (SF-36 health questionnaire), Middle cerebral artery pulsatility index (PI), resistance index (RI) and mean blood flow velocity (Vm) of two groups were compared. Results After treatment, PASS score and FMA score of two groups were significantly increased (P<0.05), and PASS score and FMA score of observation group was significantly higher than control group (P<0.05). After treatment, BBS score and Holden score of two groups were significantly increased (P<0.05), and BBS score and Holden score of observation group were significantly higher than control group (P<0.05). The physiological function, physiological functions, body pain, health status, energy, social functions, emotional function, versus, mental health of observation group were lower than those of control group (P<0.05). After treatment, the RI and PI of two groups were significantly reduced (P<0.05), and the RI and PI of observation group were lower than that of control group (P<0.05); the Vm of two groups were significantly increased (P<0.05), and the Vm of observation group were higher than that of control group (P<0.05). Conclusion Acupuncture combined core muscle training could significantly improve the balance function and life quality of patients with ischemic stroke, and its mechanism may be related to the improvement of cerebral hemodynamics by dialectical stage acupoints acupuncture combined core muscle training.

Comparison and implication of general practice system in China and Australia

GE Yao-qi, LI Yun-tao, JI Guo-zhong

2018, 16(10): 1730-1733,1756. doi: 10.16766/j.cnki.issn.1674-4152.000471

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Abstract:
Objective To put forward new ideas and measures after field investigation for the actual situation of the Australian general practice system and compare with our present practice for insights and reference. Methods A postgraduate and a graduate of the standardized training of general practitioners who was working in Community Health Service were sent to attend field trip and intensive learning about general practice for 7 weeks in the University of Sydney, who attended general practice academic lectures, visited the Royal Australian College of General Practitioners, apprenticed in general practice clinics, visited the hospital and nursing home and observed medical students' general practice professional courses and assessments. Then we compared and analyzed the similarities and differences between Chinese and Australian general practice systems. Results There are some differences of general practice between China and Australia in aspects of the role of general practice in hierarchical medical system, personnel training mode of general practice, self-identification and career path of general practitioner and system of exam and assessment. Conclusion It needs to further improve the referral procedures, intensify the connection between the general practitioner and the specialist, and strengthen the cooperation between the general practitioner and the nursing home, increase the proportion of general clinic services in hospitals, set up general practice course during the undergraduate, strengthen the training of doctor-patient communication ability, learn the thinking of diagnosis and treatment from the Australian general department, enrich the teaching model in class and probation, adjust the evaluation index of medical insurance scientifically, optimize the promotion system, encourage general practitioners to participate in collaborative research projects, further promote multi-site practice and encourage excellent doctors to choose general practice proactively on the basis of the development of general practice in China.

Practice and discussion on training mode of rural order-directed tuition-free general medical practitioner

CAI Yu, MI Man, LI Ya-jun, WU Ge, ZHANG Ye, CHEN Rui

2018, 16(10): 1734-1736,1772. doi: 10.16766/j.cnki.issn.1674-4152.000472

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Abstract:
Objective This paper takes the reform of the main training mode of the general practitioner in western China as the starting point and combines the policy of national excellent doctor education and training program, in which the author will share the education experience of general medicine and introduce the practice of constructing "Training Mode of Rural Order-directed Tuition-free General Medical Practitioner" in Xi'an Medical University. Methods We reviewed the specific implementation process of "Training Mode of Rural Order-directed Tuition-free General Medical Practitioner", which mainly involves the formation of a special working group, the revision of the talent training program, and creation of an excellent teaching team. Meanwhile, the author suggests that we should exchange experience on practice-oriented teaching, strengthen practice evaluation and foster the construction of practice base. Results In order to cultivate a general practitioner who is suitable for the grassroots and qualified for the post, the most important feature of the revised talent training program is to highlight the development of students' comprehensive health care services at the grassroots level. Combined with the professional characteristics of the general medical talents, the proportion of the courses is further optimized, and the proportion of professional courses is as high as 79%. Under the premise of reducing the total number of hours, the theoretical and probationary time ratio of the main courses is 1:1. The implementation of the "3.5+1.5" training mode, via overall extension of the teaching time to enhance the student's job competency, laid the foundation for students to adapt to the primary health care work as soon as possible after graduation. In 2017, the pass rate of the first-year graduates to take the National Medical Licensing Examination was 99.4%. Conclusion This paper can provide reference for the units and departments of the rural order orientation free medical student training, and it has certain guiding significance for the promotion of medical education and medical reform. In order to further improve the "Training Mode of Rural Order-directed Tuition-free General Medical Practitioner", we will continue to carry out practical work from the three aspects of the construction of "Four-in-one education and teaching platform", the repair of "Clinical teaching quality assurance system", and the creation of "Intelligent medical training platform".

The practice and experience of safe mode of outpatient chemotherapy under non-cash payment

WU Hui-jing, CHEN Lan, ZHONG Li-wei, HUANG Chen

2018, 16(10): 1737-1739,1748. doi: 10.16766/j.cnki.issn.1674-4152.000473

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Abstract:
Objective Via an outpatient chemotherapy model supported by hospital information system, taking into account patient safety and satisfaction effectively release the resources of the ward and the day medical department, to solve the problem of long patient hospital stay, cumbersome hospital admission procedures, etc., on the premise of safety and patient satisfaction, chemotherapy patients in inpatient wards and day medical wards are gradually transferred to outpatient clinics to further regulate the limited hospital bed resources so as to meet the hospitalization needs of more surgical and critically ill patients, resulting in "major surgery in the inpatient, minor operations in the day ward, and micro-surgery in the outpatient", and then explore the importance of establishing safe outpatient chemotherapy to improve the efficiency of hospital services, optimize the supply of medical resources, and strengthen the service orientation of tertiary comprehensive hospitals. Methods This article analyzes the effect and significance of outpatient chemotherapy in four dimensions:total cost of treatment, time of hospitalization, cost of medical resources, and patient satisfaction through the gradual transfer of chemotherapy patients from inpatient wards to daytime medical wards to outpatient clinics. Results The development of outpatient chemotherapy can shorten the patient's hospital stay, reduce the patient's medical expenses, and improve the patient's satisfaction. It can help improve the hospital's service efficiency, optimize the supply of medical resources, and help strengthen the three-level comprehensive hospital's medical service positioning. Conclusion Outpatient chemotherapy not only provides safe, comfortable, convenient and economical treatment for patients, but also saves limited medical resources and reduces treatment costs. It is a medical model worthy of being widely promoted, which improves the efficiency of hospital services and optimizes medical resources. The supply and strengthening of the three-level comprehensive hospital service positioning have certain significance.

Chinese literature analysis and consideration of cesarean scar pregnancy

ZHANG Hong-hui, LUO Wen-xiang, LAI Xue-jun, CUI Xiang-hua, SUN Chao, WANG Ai-li, SHI Li-fang, YANG Xiu-lan, LIU Jie-na, ZHANG Jian

2018, 16(10): 1740-1744. doi: 10.16766/j.cnki.issn.1674-4152.000474

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Abstract:
Objective To investigate the present situation of Chinese literature on cesarean scar pregnancy. Methods We conducted an electronic based search on Wanfang Data to learn all the articles on CSP. Statistical analysis was conducted according to the province or municipality of the author's institution, the year of publication time, the rank of hospital of the author's institution and related complications. Results ① There were 4 784 CSP literatures in the Wanfang data, enrolling 138 188 cases, originally published in 1999, the number of literatures and cases increased rapidly year by year according to the year of the publication time. ② The author's unit covered 30 provinces or municipalities, accounting for 88.24% (30/34). The top five provinces are Henan, Guangdong, Jiangsu, Zhejiang and Hubei, and the last five are Heilongjiang, Hainan, Ningxia, Gansu and Qinghai. ③ Statistics analysis was conducted according to the rank of hospital of the author's institution, including tertiary hospitals, secondary hospitals, primary hospitals, other medical institutions like family planning guidance service station and unclear rank of author's institution. The number of literatures were 59.39%, 31.00%, 2.72%, 1.44% and 5.45%, respectively. Meanwhile, the number of cases were 59.68%, 31.35%, 2.74%, 1.22% and 5.01%, respectively. Conclusion Improving the understanding of CSP, controlling the rate of cesarean section (CSR), especially CSR due to social factors,enhancing the quality of operation, finding the etiology and risk factors of CSP to reduce the occurrence, avoiding iatrogenic complications, and improving the physical and psychological health of women are all important issues obstetrician are facing.

The establishment and application of neonatal eye disease screening information system

LOU Zhi-wu, TANG Jian-bo, LONG You-bing, ZHANG Su, XUE Min, LIANG Yuan-bo

2018, 16(10): 1745-1748. doi: 10.16766/j.cnki.issn.1674-4152.000475

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Abstract:
Objective To develop the neonatal eye disease screening information system and explore its significance in neonatal eye disease screening, referral, information feedback and follow-up management. Methods Because the regional neonatal eye disease screening rate was low at present and many problems were faced to the information management of screening data, and the city, county, township three class neonatal eye screening network was relied, so the neonatal eye disease screening information system was developed and increased in child health care information system. According to the technical specifications of children's eye and vision health care, the contents and methods of neonatal eye disease screening were unified and standardized. This system was used to enter the neonatal eye screening results, diagnosis, treatment of neonatal ophthalmopathy, referral, information feedback and follow-up data through the network platform of city maternal and child health care information system. Those screening abnormal newborns were transferred through this system, and the information of children without timely review were displayed on the main interface. At the same time, the system was used to statistical analysis and management of neonatal eye screening in this region. Results The neonatal eye disease screening information system was simplicity of operator. The regional network management of neonatal eye screening was realized and standardized by using data query, statistical reports, network referral, information feedback and management functions, so more neonatal ophthalmopathy be found, diagnosed and treated early. Conclusion The integrated network management function of neonatal eye disease screening-diagnosis-intervention-follow-up-quality control would be met. It is of great significance to establish and apply the neonatal eye screening, because the screening rate and follow-up management would be improved in this region, and each screening unit can realize the construction and sharing of complete screening data resources.

Correlation research between emotional intelligence and core competence in registered nurses in the Three-A hospitals of Anhui

YANG Cong-yan, ZHANG Xiu-jun, ZHOU Ying, DUAN Huan, ZHAO Mei-jun, ZHANG Pei-pei

2018, 16(10): 1749-1752. doi: 10.16766/j.cnki.issn.1674-4152.000476

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Abstract:
Objective To know about the status quo of core competence in registered nurses in the three-A hospitals of Anhui, to analyze the relations between emotional intelligence and core competence, and to explore the influence factors of the core competence from the two aspects of the general information and emotional intelligence, so as to provide the basis for improving their emotional intelligence and core competence. Methods A total of 880 registered nurses received survey by using Wong and Law Emotional Intelligence Scale (WLEIS) and Competency Inventory for Registered Nurse Scale (CIRNS). Descriptive analyst test, ANOVA, Pearson correlation and multiple linear regression were performed to analyze general information, emotional intelligence and core competence of registered nurses. Results The single factor analysis showed statistical significance in the core competence among, position, professional title, nursing satisfaction, fields of interest, engagement in further studies, teaching activities and hobby (P<0.01); The Pearson correlation analysis results indicated that the total emotional intelligence and each dimension had positive correlation with core competence (P<0.01); Multiple linear regression analysis results indicated that, position, professional interest, teaching activities, emotion appraisal, emotion regulation, emotion use, appraisal of others, emotions were the influence factors of the core competence. Conclusion Position, professional interest, teaching activities, emotion appraisal, emotion regulation, emotion use, appraisal of others' emotions were predictor variables of core competence in clinical registered nurses. The higher the emotional intelligence of clinical registered nurses, the more prominent the performance of core competence. The nursing managers should intervene to cultivate the emotional intelligence of nurses, so as to improve their level of core competence.

Sentinel lymph node biopsy combined with mastectomy for the perioperative nursing observation of early breast cancer patients

BAO Yan, JIA Jian-guang, ZHU Jing

2018, 16(10): 1753-1756. doi: 10.16766/j.cnki.issn.1674-4152.000477

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Abstract:
Objective To investigate the difference and advantages of breast conservation surgery and segmental mastectomy[also known as breast-conserving surgery (BCS)] and traditional modified mastectomy for early stage breast cancer. Methods One hundred and twenty breast cancer patients admitted in our hospital from 2012 to 2013 were randomly divided into control group and observation group, with 60 cases in each group. The patients in the control group were treated with traditional modified mastectomy. The patients in the observation group were treated with BCS and exclusion of axillary lymph node biopsy, which were performed sentinel lymph nodes (SLN) biopsy with intraoperative frozen section (FS) and proved negative on FS. The patients in the postoperative group were treated with adjuvant chemotherapy, endocrine therapy or radiotherapy according to the postoperative pathology, lymph node metastasis (observation group only) and immunohistochemistry. And the patients in the observation group were also treated with adjuvant radiotherapy. The operation time, intraoperative blood loss, postoperative complications and postoperative rehabilitation, as well as the survival rate, recurrence rate and metastasis rate of 3-year were compared between the two groups. Results The operation time, intraoperative blood loss, postoperative hospitalization time, postoperative complication rate and postoperative rehabilitation time were significantly lower in the observation group than those in the control group (P<0.01). There was no significant difference in survival rate,recurrence rate and metastasis rate of 3-year between the two groups (P>0.05). Conclusion Compared with traditional modified mastectomy, breast conservation surgery and segmental mastectomy can effectively reduce the operation time, intraoperative blood loss, at the same, it does not decrease the postoperative survival rate and not increase the recurrence and transfer rate. It is a great therapy and worthy of clinical promotion.

Application value of routine nursing combined with evidence-based nursing in nursing care of patients with bladder cancer after abdominal stoma

ZHANG Wei-li, ZHANG Jie, ZHU Zheng, YU Fei-xia

2018, 16(10): 1757-1761. doi: 10.16766/j.cnki.issn.1674-4152.000478

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Abstract:
Objective To explore the application value of evidence-based nursing in nursing care of patients with bladder cancer after abdominal stoma. Methods A total of 170 cases of bladder cancer who were treated in our hospital from November, 2015 to November, 2017 were randomly divided into two groups with 85 cases in the combined nursing group and the conventional nursing group respectively and the two groups were treated with abdominal wall stoma. The patients in the routine nursing group received routine nursing care, and the combined nursing group used evidence-based nursing on the basis of the routine nursing group. The expression of Bax protein and Bcl-2 protein were detected, SAS and SDS were scored before and after nursing in the two groups, and the knowledge familiarity and quality of life of the abdominal stoma before and after the nursing of the two groups were evaluated. The time of hospitalization, the quality of nursing and the satisfaction of the family members were compared. Results After nursing, the level of Bcl-2 in the combined nursing group was lower than that of the conventional nursing group (P=0.001), and the level of Bax was higher than that of the conventional nursing group (P=0.003); the SAS and SDS scores of the patients in the combined nursing group after nursing were lower than those of the conventional nursing group (P=0.004), and the degree of knowledge of abdominal stoma related knowledge in the patients after nursing was better than that of the conventional nursing group (P=0.016). The quality of life of the combined nursing group was higher than that of the conventional nursing group (P=0.004), the hospitalization time of the combined nursing group was lower than that of the conventional nursing group (P=0.012), and the nursing quality of the combined nursing group was better than that of the conventional nursing group (P=0.002), and the family satisfaction of the patients with the joint nursing group was higher than that of the conventional nursing group (P=0.039). Conclusion Evidence-based nursing can significantly improve the quality of life of patients with bladder cancer after abdominal stoma, and promote the recovery of patients' body, which has a high clinical value.

Effect of psychological intervention on patients with systemic lupus erythematosus of reproductive age

ZHANG Xue, SUN Juan, XIE Zhang-hao, LI Zhi-jun

2018, 16(10): 1762-1765. doi: 10.16766/j.cnki.issn.1674-4152.000479

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Abstract:
Objective To explore the effect of psychological intervention on the curative efficacy, compliance and psychological status of patients with systemic lupus erythematosus (SLE). Methods Total 64 SLE patients in our hospital between June, 2015 and December, 2016 were divided into psychological intervention group and control group. The control group received medical routine nursing, while the other group received psychological intervention. Before and after the treatment, SLE disease activity score (SLEDAI), Hamilton anxiety scale (HAMA) and depression scale (HAMD) scores, and the Pittsburgh sleep quality index scale (PSQI) were compared between the two groups. Results HAMA (12.14±3.68 vs. 9.29±3.43, P<0.001), HAMD (11.32±3.86 vs. 9.70±3.01, P=0.04), the SLEDAI score (10.29±4.60 vs. 9.46±5.56, P<0.001) of psychological intervention group were lower than those of the control group, the difference was statistically significant; The treatment adherence was higher, and the SLEDAI and disease recurrence rates were lower than those in the control group. The score of the control group was not statistically significant. After 6 months of treatment, the treatment compliance in the psychological intervention group was higher than that in the control group (χ²=4.947, P=0.025); the SLEDAI (t=-3.410, P=0.039) and disease recurrence rate (χ²=4.433, P=0.032) of the psychological intervention group was lower than those of the control group, the difference was statistically significant. C3, C4 and ESR, CEP were no statistically significant different between the two groups. Conclusion The psychological intervention can relieve the anxiety and depressed mood, improve the treatment compliance of patients, promote the remission and reduce the recurrence, improve the therapeutic effect, prognosis and QOL of patients with SLE.

MA Jing, CHEN Ai-hua, ZHENG Chen-guo, YU Hui, HUANG Chong-jie

2018, 16(10): 1766-1768. doi: 10.16766/j.cnki.issn.1674-4152.000480

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LEI Zhen, LIN Rong, SUN Chuan-zhong, XU Lei

2018, 16(10): 1769-1772. doi: 10.16766/j.cnki.issn.1674-4152.000481

224 5

Abstract:

About Journal

2018 Vol. 16, No. 10

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