中华全科医学

The application of the new rural cooperative medical system clinic report based on “Mobile Hospital” in the family doctor surveillance service in the mountain area of Beijing

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

2018, 16(2): 167-170. doi: 10.16766/j.cnki.issn.1674-4152.000048

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Abstract:
Objective To understand the role of the new rural cooperative medical service in solving the problems such as inconvenience of medical treatment for the elderly and low-income people in the mountainous area and the economic pressure and promoting and equalization of basic medical and health services, which caused by the advance of the medical expenses in the mountainous area of Beijing, and to explore the existing problems in the existing practice and make recommendations for improvement. Methods The Family doctors in the countryside carry the HIS system and charge reimbursement system, notebook computers and invoice printers and other equipment, through the 3G network or "village" network access to the District Planning Commission information platform. In the rounds of work, general practitioners, community nurses and health workers are mainly responsible for the establishment of health records, chronic disease management, diagnosis and treatment of common diseases and family physician work, pharmacists pharmaceutical services, mainly responsible for the auxiliary examination and drug charges and drug release work and achieve immediate settlement. In the inspection of the new rural cooperative medical treatment of patients and real-time reporting situation, and the relevant data were compared with those of community health service stations. Results Patrol found that the proportion of patients with newly diagnosed, not up to pay the line to pay the proportion of newcomers were significantly higher than outpatients, and the amount of new rural cooperative advances per capita lower than outpatients. Rounds of visits and outpatient service station, improve the management of patients with chronic disease, health records and other work carried out which are higher than the number of outpatients. Conclusion In the northern mountainous area of Beijing carrying out the new rural cooperative real-time knot work is conducive to solve the medical treatment inconvenience, reduce its advance medical costs of economic pressure, thereby improving the basic medical and health services accessibility and fairness.

DONG Chuan-li, CHEN Lan-ju

2018, 16(2): 171-172.

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Abstract:

Effect of IPI-926 on proliferation of human colon cancer HT-29 cells and its mechanism

ZUO Sai, BI Yan-zhen, KONG Ling-bin, WANG Yi-bo, ZHANG Qiu-sheng, HONG Feng, ZHANG Fan, QIU Yue

2018, 16(2): 173-175,322. doi: 10.16766/j.cnki.issn.1674-4152.000049

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Abstract:
Objective To observe the effect of IPI-926 on the proliferation of human colon cancer HT-29 cells and to investigate the effect of IPI-926 on the expression of Hedgehog signaling pathway in human colon cancer HT-29 cell proliferation. Methods Human colon cancer HT-29 cells were cultured in vitro, randomly set the blank control group and different concentrations (10, 20, 30 nM) IPI-926 intervention group. The intervention time of colorectal cancer cell was 72 h. The morphological changes were observed by inverted microscope. Effects of different concentrations of IPI-926 after the intervention of 72 h on the proliferation of HT-29 cells was determined by MTT assay and the apoptotic rate calculated. Reverse transcription PCR(RT-PCR) and Western blot were used to detect the expression of Shh, Ptch, Smo and Gli-1 mRNA and its related proteins in HT-29 cells after 72 hours of culture. The independent samples t-test was used for comparison between groups, and P< 0.05 was considered statistically significant. Results Apoptosis of HT-29 cells treated with different concentrations of IPI-926 (10, 20, 30 nM) increased when compared with the control, and the apoptosis rate increased with the increase of IPI-926 concentration. The inhibitory rates of IPI-926 (10, 20 and 30 nM) on human colon cancer cell line HT-29 were (17.23±1.32)%, (38.34±1.82)% and (75.81±3.43)%, respectively, rose with the increase of the concentration of IPI-926, showed a dose-effect relationship. The expression of Shh, Ptch, Smo and Gli-1 mRNA and protein were not significantly different between the blank control group and the IPI-926 concentration of 10 nM. However, the mRNA and protein expression of Shh, Ptch, Smo and Gli-1 were significantly down-regulated at IPI-926 concentration of 20 nM and 30 nM as compared with blank control group. And the expression of Shh, Ptch, Smo and Gli-1 at IPI-926 at 30 nM was significantly higher than that at 20 nM. Conclusion Low dose IPI-926 cannot effectively inhibit the proliferation of HT-29 cells, but 20 nM or more can effectively inhibit the proliferation of HT-29 cells. The mechanism of its inhibition may be related to the expression of Shh, Ptch, Smo and Gli-1 related to Hh pathway.

Protection effect and mechanism of stem cell mobilization on pulmonary surfactant of COPD rats

ZHU Yue-yan, ZHANG Xiao-qin, LI Ya-qing, CHEN Chun

2018, 16(2): 176-179,183. doi: 10.16766/j.cnki.issn.1674-4152.000050

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Abstract:
Objective To explore the protection effect and mechanism of stem cell mobilization on pulmonary surfactant of chronic obstructive pulmonary disease (COPD) rats. Methods Forty Wistar rats were randomly divided into GOPD group (n=20) and COPD-rhG-CSF group (n=20). All the rats were prepared for COPD models by smoke and trachea injection of lipopolysaccharide (LPS); At the same time, the COPD-rhG-CSF group were injected recombinant human granulocyte-colony stimulating factor (rhG-CSF) through tail vein, and the GOPD group were injected same volume of saline. On 1st day, 14th day and 28th day after successful preparation, pulmonary tissue slices were prepared to observe the histopathological changes. Furthermore, CC16 and pulmonary surfactant protein A (SP-A) expression were observed by immunohistochemical experiment, RT-PCT assay and WB assay. Results After successful preparation, the pulmonary tissue slices showed that the alveolar reduced, the alveolar cavity extended irregularly and the alveolar interval fractured; and the COPD group was aggravating over time, but the COPD-rhG-CSF group was relieving compared to the COPD group. The immunohistochemical experiment showed that the CC16 and SP-A expression of the COPD-rhG-CSF group were higher than those of the COPD group in 1st day, 14th day and 28th day after the successful preparation, and the difference between groups had statistical significance (all P<0.05). The RT-PCR and WB assay results showed that the CC16 and SP-A expression of the COPD-rhG-CSF group were higher than those of the COPD group in 1st day, 14th day and 28th day after successful preparation, and the difference between groups had statistical significance (all P<0.05). Conclusion Stem cell mobilization can improve the CC16 and SP-A expression of COPD rats, and promote lung tissue repair, which maybe one of the important mechanisms to protect lung tissues.

Effects of Toxoplasma gondii on human semen parameters and sperm DNA integrity

YAO Rong-ping, WEI Ren-xiong, CHEN Jian-wei, WANG Li-qiong, ZHANG Xiao-xia, HONG Fei, CUI Yun

2018, 16(2): 180-183. doi: 10.16766/j.cnki.issn.1674-4152.000051

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Abstract:
Objective Toxoplasma gondii(TOX) infection is associated with male infertility. Sperm DNA integrity is an important marker of male fertility. The aim of this paper is to investigate the influence of TOX infection on the human semen parameters and sperm DNA integrity. Methods The recruited infertile patients were divided into TOX-IGG positive group, TOX-IGM positive group, other pathogens infection group and no-infection group. The recruited normal males with normal fertility were included as controls. The differences in semen quality and sperm DNA fragmentation index(DFI) were statistically analyzed between the infertile men and normal controls. The sperm concentration and vitality were analyzed by using computer assisted sperm analysis(CASA), sperm survival rate by using hypoosmotic swelling test, sperm morphology by using Diff-Qick staining, and sperm DNA damage index DFI(%) by using single cell gel electrophoresis(SCGE). Results There were statistically significant differences in semen quality parameters between the control and the infertile groups(P<0.05). Compared with the no-infection group, the rate of progressively motile sperm(PR) in TOX infection group was significantly decreased(P<0.05). The differences in mild DFI, severe DFI and total DFI were statistically significant between the TOX infection groups and normal controls. Compared with the no-infection group, the severe and total DFI in TOX infection group had statistically significant differences(P<0.05), mild DFI in TOX infection group had no significant differences(P>0.05). Compared with the other pathogens infection group, the mild, severe and total DFI in TOX infection group had no statistically significant differences(P>0.05). Compared with the TOX-IGG positive group, the severe and total DFI in TOX-IGM positive group were significantly increased(P<0.01). Conclusion TOX infection could affect human semen parameters and sperm DNA integrity. The degree of damage in new infections was more obvious compared with the past infections.

The effect of TNF-α on apoptosis and inflammation of human umbilical vein endothelial cells by NF-Κb and AP-1 signal pathway

CHEN Tie-long, ZHU Guang-li, ZHANG Xu-dong, MENG Wei-kang, WANG Yu

2018, 16(2): 184-187. doi: 10.16766/j.cnki.issn.1674-4152.000052

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Abstract:
Objective To observe the effect of tumor necrosis factor-alpha(TNF-α) on apoptosis and inflammation of human umbilical vein endothelial cells(HUVECs) and investigate the possible mechanism. Methods Cultured HUVECs were randomly divided into control group and TNF-α group. After pretreated with TNF-α for 6 hours, the apoptosis rate was tested by flow cytometry, and the expression of ICAM-1, VCAM-1, E-selectin and eNOS were detected by Western blot assay. The activation of NF-κB and AP-1 were detected by flow cytometry and Western blot. Results Compared with the control group, TNF-α significantly increased the apoptosis rate of HUVECs(P<0.05) and the expression of ICAM-1, VCAM-1, E-selectin in HUVECs(P<0.05) and inhibited the release of eNOS(P<0.05).At the same time, TNF-α activated the expressions of NF-κB and AP-1(P<0.05). Conclusion TNF-α significantly increases the apoptosis and inflammation of HUVECs. The mechanism of this injury might be related to the activation of the NF-κB and AP-1 signaling pathway and inhibiting the release of eNOS.

Comparison of the effect of ketamine and magnesium sulfate gargle in preventing sore throat after removal of a double-lumen endobronchial tube

SHEN She-liang, XIE Yi-hong, CHEN Yue

2018, 16(2): 188-191,225. doi: 10.16766/j.cnki.issn.1674-4152.000053

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Abstract:
Objective To compare the effect of ketamine and magnesium sulfate gargle in preventing sore throat after removal of a double-lumen endobronchial tube. Methods A total of 120 patients with elective thoracoscopic resection of giant bullae in our hospital between June, 2015 and April, 2016 were randomized into group C(control), group K(ketamine) and group M(magnesium sulfate). The patients rinsed their mouths out with 2 ml normal saline in group C, 30 ml ketamine gargle(0.5 mg/kg, dissolved in 5% dextrose water) in group K, and 30 ml magnesium sulfate gargle(20 mg/kg, dissolved in 5% dextrose water) in group M just 15 minutes before the operation. The incidence of sore throat by visual analogue scale(VAS), hoarseness of voice and dysphagia were recorded immediately after extubation(T₁) and then 6 h(T₂), 24 h(T₃), and 48 h(T₄) after extubation. The vocal congestion and/or vocal edema were examined by indirect laryngoscopy at T₂. The levels of TNF-α, IL-6 and IL-10 at T₀(before surgery), T₁, T₂, T₃ and T₄ were tested. Results The incidence rate and VAS of sore throat were significantly lower in group K and group M than that in group C at T₁, T₂ and T₃(P<0.05). The incidence rate and sore VAS of sore throat were significantly lower in group M than that in group K at T₁ and T₂(P<0.05). The incidence rate of hoarseness of voice and dysphagia were significantly lower in group K and group M than that in group C at T₁, T₂ and T₃ time point(P<0.05). The incidence rate of hoarseness of voice and dysphagia were significantly lower in group M than that in group K at T₁ and T₂ point(P<0.05). The incidence rate of vocal congestion and/or vocal edema was significantly lower in group K and group M than that in group C at T₂ point(P<0.05). The incidence rate of vocal congestion and/or vocal edema was significantly lower in group M than that in group K at T₂ point(P<0.05). The levels of TNF-αand IL-6 were significantly lower in group K and group M than that in group C at T₁ and T₂ point. The level of IL-10 were significantly higher in group K and group M than that in group C at T₁ and T₂ points(P<0.05). The level of TNF-α and IL-6 were significantly lower in group M than that in group K at T₁ and T₂ points(P<0.05). Conclusion Either ketamine gargle or magnesium sulfate gargle can effectively reduce the incidence and severity of sore throat after tracheal intubation using a double-lumen endobronchial tube by their anti-inflammatory effects. Comparing with ketamine gargle, magnesium sulfate gargle is more effective.

Effects of cytoplasmic polyadenylation-element binding protein-4 on the growth of glioma cells

FAN Xiao-ming, ZHOU Jia

2018, 16(2): 192-195. doi: 10.16766/j.cnki.issn.1674-4152.000054

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Abstract:
Objective To investigate the expression of Cytoplasmic polyadenylation-element-binding protein 4(CPEB4) in glioma and its effect on glioma cell growth. Methods The expression of CPEB4 protein in glioma tissues, the expression of CPEB4 mRNA in brain glioma tissues and cells, the expression of CPEB4 protein, PIK3CA protein and SMAD3 protein, cell apoptosis, cell cycle, cell proliferation and the invasion ability of cells were detected. Results The positive rate of CPEB4 protein in low-grade brain tissue and high-level brain tissue were higher than that in normal brain tissue(P<0.05). The positive rate of CPEB4 protein in high-level brain tissue was higher than that in low-grade brain tissue(P<0.05). The CPEB4 protein levels in low-level brain tissue and high-level brain tissue were higher than that in normal brain tissue(P<0.05). The level of CPEB4 protein in high-level brain tissue was higher than that in low-grade brain tissue(P<0.05). The expression of CPEB4 protein in SiRNA-CPEB4 group was lower than that in negative control group and blank control group(P<0.05). The apoptotic rate in SiRNA-CPEB4 group was significantly higher than that in negative control group and blank control group(P<0.05). The percentage of G₁ phase cells in SiRNA-CPEB4 group was higher than that in negative control group and blank control group(P<0.05). The percentage of S phase cells in SiRNA-CPEB4 group was lower than that in negative control group and blank control group(P<0.05). The OD value at 3 days and 7 days in SiRNA-CPEB4 group were lower than that in negative control group and blank control group(P<0.05). The number of invasion cells in SiRNA-CPEB4 group was lower than that in negative control group and blank control group(P<0.05). The expression levels of PIK3CA and SMAD3 in SiRNA-CPEB4 group were significantly lower than those in negative control group and blank control group(P<0.05). Conclusion The level of CPEB4 in brain glioma is increased. CPEB4 could affect the apoptosis, cell cycle, proliferation and invasion of glioma cells. The mechanism may be related to PIK3CA and SMAD3.

Biomechanical effects of Hybrid surgery on vertebral body in multilevel cervical degenerative disc disease

LAI Xian-liang, WANG Xiao-feng, CHEN Ou, SU Jia, SHEN Xin-sheng

2018, 16(2): 196-199. doi: 10.16766/j.cnki.issn.1674-4152.000055

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Abstract:
Objective To investigate the biomechanical effect of hybrid surgery on vertebral body in multilevel cervical degenerative disc disease. Methods A total of 78 patients with multilevel cervical spine degenerative disease from January, 2014 to December, 2016 in our hospital were collected prospectively and were divided randomly into observation group and control group with 39 cases in each group. The patients in the observation group underwent Hybrid surgery treatment, while the patients in the control group underwent cervical fusion surgery treatment. The operation time, intraoperative blood loss, postoperative drainage, hospital stay, Neck Disability Index (NDI), Japanese Orthopedic Association (JOA), Visual analog scale (VAS), Odom clinical satisfaction scale, C_2-7 overall mobility, Cobb angle, Superior adjacent segment ROM (SROM), inferior adjacent segment ROM (IROM) and complications in the two group were observed. Results There was no statistical difference between NDI, ODI score and C_2-7 cervical overall mobility (P>0.05). Compared with the control group, NDI score of the observation group by the end of 12 months after the operation was decreased, while the ODI score and C_2-7 cervical overall mobility was increased significantly (P<0.05). Twelve months after the operation, the excellent rate of the observation group was higher than that in the control group (P=0.017). There was no statistical significance between the VAS scores in the two group (P=0.244). Compared with the control group, VAS scores of the observation group by the end of 6 month and 12 months after the operation decreased significantly (P<0.05). There was no statistical significance in the operation time, intraoperative blood loss, postoperative drainage, hospital stay, Cobb angle before and after operation, SROM, IROM and complications between the two groups (P>0.05). Conclusion Hybrid surgery can improve the postoperative cervical mobility of the patients with multilevel cervical spine degenerative disease. The clinical effectiveness was satisfactory.

Expression of HIF-1α and VEGF in breast cancer patients with disorder of carbohydrate metabolism and its correlation with angiogenesis

SHAO Xia, DING Yun-feng, WANG Xiao-hong, SHOU Zhi-qiang

2018, 16(2): 200-203. doi: 10.16766/j.cnki.issn.1674-4152.000056

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Abstract:
Objective To investigate the expression of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in breast cancer patients with different glucose metabolic status and their correlation with microvascular production. Methods The clinical data of 187 patients with breast cancer from January, 2013 to June, 2015 were retrospectively analyzed. According to the blood glucose level, 67 patients were assigned into diabetic patients (DM group), 50 patients with impaired glucose regulation in IGR Group, and 70 patients with normal glucose tolerance in NGT group. The expression of HIF-1α and VEGF protein was detected by immunohistochemistry. The microvessel density (MVD) was measured and its correlation with the levels of HIF-1α and VEGF protein was analyzed. Results The levels of BMI, FPG, 2 h PG, HbA1C and HOMA-IR among NGT group, IGR group and DM group were significant different and the latter group was higher than the previous group (P<0.05). In IGR and DM group, the proportion of lymph node metastasis and tumor > 2 cm was significantly higher than that in NGT group (P<0.05), however, there was no significant difference between the positive rate of lymph node metastasis and the size of tumor larger than 2 cm between IGR group and DM group (P>0.05). The positive expression rates of HIF-1α and VEGF in DM group were significantly higher than those in NGT group (P<0.05), but there was no significant difference between DM group and IGR group (P>0.05). Among the three groups, the number of MVD in NGT was lowest, in DM group was highest, the differences were statistically significant (P<0.05). In HIF-1α positive patients, the positive rates of VEGF expression in NGT, IGR and DM groups were 72.0%, 84.2% and 96.7%, respectively (P<0.01), and MVD level was also increased (P<0.01). However, there was no significant difference in the expression of VEGF and MVD between NGT, IGR and DM in HIF-1α negative patients (P>0.05). Conclusion HIF-1α may play an important role in promoting the formation of microvessels in breast cancer patients with type 2 diabetes mellitus. Monitoring HIF-1α may play an important role in predicting the invasion and metastasis of breast cancer.

Relative factor analysis on anxiety and depression state of patients with chronic fatigue syndrome based on data mining

LI Zhuang, LIU Yang, GE Xin, YANG Ting, PENG Yu-qing

2018, 16(2): 204-206. doi: 10.16766/j.cnki.issn.1674-4152.000057

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Abstract:
Objective To investigate the prevalence and the relevant factors such as general status, sleep quality, mental and physical fatigue contributing to anxiety and depression of patients with chronic fatigue syndrome, and to explore new treatments. Methods We assessed the severity of anxiety and depression by self-rating anxiety scale(SDS) and self-rating depression scale(SAS) and Pittsburgh sleep quality index(PSQI) also analyzed the 302 cases of chronic fatigue syndrome treated in Dongfang Hospital of Beijing University of Chinese medicine from August, 2015 to October, 2016. SPSS 20.0 was used to make Logistic regression analysis and algorithm in Clementine 12.0 was used to make association rule analysis. Results With CFS state of anxiety, depression, mental fatigue level increasing(P<0.001), the sleep quality worsens(P<0.001), related factors influencing anxiety occurs with 10% minimum support and 60% minimum confidence and results in eight anxiety association rules ranging from moderate mental fatigue, poor sleep quality, severe physical fatigue, sleep quality, bachelor degree, women, 41 to 50 years old, 51 to 60 years old. Nine factors associated with depression association rules ranging from poor sleep quality, moderate mental fatigue, severe physical fatigue, sleep quality, bachelor degree, 41 to 50 years old, female, aged 51 to 60, manual workers. Conclusion Chronic fatigue syndrome associated with anxiety and depression is the result of many factors. With more physical fatigue, the patients emotional states can be changed, which constitute a dangerous factor and the result of fatigue. Both were closely related and highly relevant to sleep quality and degree of fatigue. Clinical diagnosis and treatment should pay attention to improve sleep quality and mental fatigue.

Influence of cognitive behavior intervention on quality of life and prognosis of ACS patients with anxiety and depression

XIANG Wei, HUANG Yu-li, MA Bin, YAO Hui-qiang, LI Dong-ge, XUAN Ling

2018, 16(2): 207-209,304. doi: 10.16766/j.cnki.issn.1674-4152.000058

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Abstract:
Objective To investigate the influence of cognitive behavior intervention on quality of life and prognosis of ACS patients with anxiety and depression. Methods Cognitive behavior intervention on ACS patients with anxiety and depression was started in January, 2016 in our hospital. We selected the patients before and after implementation of six months, and separately defined them as control group and experiment group; the SAS scores, SDS scores and SAQ scores before and after intervention, the incidence of adverse cardiovascular events and nursing satisfaction of both groups were compared. Results The SAS scores and SDS scores before intervention of control group were (51.46±4.87) points, (55.23±6.91) points separately. The SAS scores and SDS scores before intervention of experiment group were (52.07±4.93) points, (54.95±6.77) points separately. The SAS scores and SDS scores after intervention of control group were (45.43±3.67) points, (48.33±5.10) points separately. The SAS scores and SDS scores after intervention of experiment group were (40.08±2.43) points, (41.59±3.44) points separately. The SAS scores and SDS scores after intervention of experiment group were statistically significant lower than control group and before intervention (t=2.473, 2.911, 2.582, 3.172, all P<0.05). The SAQ scores before and after intervention of control group were (55.60±4.90) points, (71.17±6.08) points separately. The SAQ scores before and after intervention of experiment group were separately (54.18±4.65) points, (84.94±7.75) points. The SAQ scores after intervention of experiment group were statistically significant higher than control group and before intervention(t=2.762, 3.553, P<0.005, P<0.001). The incidence of adverse cardiovascular events of experiment group were significantly lower than that of the control group (χ²=8.232, 9.113, 8.062, all P<0.005). The nursing satisfaction of experiment group were statistically significant higher than control group (Z=-3.235,P<0.005). Conclusion Cognitive behavior intervention on ACS patients with anxiety and depression can effectively alleviate negative mood, improve the quality of daily life, reduce the risk of adverse cardiovascular events and be helpful to establish the harmonious relationship between doctors and patients.

Heart rate variability and target organ damage in patients with H-type hypertension complicated with acute cerebral infarction and their correlations

LEI Shu-fen, PING Yong-mei, SHI Xia-qing

2018, 16(2): 210-213. doi: 10.16766/j.cnki.issn.1674-4152.000059

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Abstract:
Objective To investigate the heart rate variability and target organ damage in patients with H-type hypertension complicated with acute cerebral infarction and their correlations. Methods From January, 2016 to January, 2017, 92 patients with hypertension complicated with cerebral infarction were prospectively collected in our hospital. According to the level of homocysteine (Hcy) on admission, all patients were assigned into observation group (Hcy ≥ 10 mmol, n=42) or control group (Hcy < 10 mmol/L, n=50). The heart rate variability and organs damage of the both groups were observed. Results When compared with the control group, the patients in the observation group got decreased level of SDNN, SDANN, SDNN-Index and PNN50 (%), P<0.05. There was no significant difference between the two group in rMSSD (P>0.05). The intima media thickness, arteriosclerosis index, coronary artery disease index, Cystatin C and 24 h systolic pressure variability in the observation group were significantly higher than those in the control group (P<0.05). Pearson linear correlation analysis showed that SDNN, SDANN and PNN50 (%) were negatively correlated with intimia-media thickness (IMT), cystatin C and 24 h systolic pressure variability (P<0.05); SDNN-Index was negatively related to cystatin C and 24 h systolic pressure variability (P<0.05). There was no significant correlation between rMSSD and IMT, arteriosclerosis index, coronary artery disease index, Cystatin C and 24 h systolic blood pressure variability (P>0.05). Conclusion Patients with H-type hypertension complicated with acute cerebral infarction get decreased heart rate variability and worse target organs functions, the decrease of heart rate variability may be related to the impairment of target organ function.

Effect of [Gly14]-Humanin on NF-κB p65 inhibition, inflammatory response and apoptosis after cerebral ischemia reperfusion injury

YU Zhi, YU Min, SHAO Xiao-li, HONG Xiao-qin, JIANG Hui-hua, GU Su-bing

2018, 16(2): 214-217,256. doi: 10.16766/j.cnki.issn.1674-4152.000060

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Abstract:
Objective To investigate the effects of[Gly14]-Humanin(HNG) pretreatment on NF-κB p65 inhibition, inflammatory response and apoptosis in the rats with focal cerebral ischemia-reperfusion injury. Methods Eighty healthy male Sprague-Dawley rats were randomly divided into sham-operation, modelp, normal saline and HNG groups, with 20 rats in each group. A rat model of acute middle cerebral artery occlusion(MCAO) and reperfusion was established by suture embolism, relevant medicines(normal saline in the rats of the sham-operation group and normal saline group, HNG in the rats of the HNG group) were given to rats 3 days before operation respectively(iv, three times, qd). After cerebral ischemia 3 h and 24 h of reperfusion, neurological deficit score(NDS) were performed for each group. ELISA was respectively used to detect levels of NF-κB p65 and IFN-γ in cerebral tissue. HE staining is used to observe morphologic changes of neuron cells in ischemia region. TUNEL staining was used to detect the neuron apoptosis. Then the linear correlation analysis was used to determine the correlation between the levels of IFN-γ and NF-κB p65 in cerebral tissue with HNG group. Results Compared with sham-operation group, the NDS, the levels of NF-κB p65, IFN-γ and the number of neurocyte apoptosis were significantly increased in the other three groups(P<0.05); Compared with model group and normal saline group, the NDS, the levels of NF-κB p65, IFN-γ and the number of neurocyte apoptosis were significantly decreased in HNG group(P<0.05); The levels of IFN-γ and NF-κB p65 in HNG group were perfect positive correlations(r=0.739, P<0.001). Conclusion [Gly14]-Humanin can alleviate the inflammation in the process of the focal cerebral ischemia reperfusion, resistance the neurocyte apoptosis of ischemic area, thus mitigate the neurologic deficit. Its mechanism is probably through to down-regulating NF-κB p65 levels and then to reduce the release of IFN-γ.

The clinical research of catgut-embedding therapy combined with biofeedback on the treatment of functional constipation

HONG Xia, JIANG Qing, TANG Xiao-qin, YU Yin-hua

2018, 16(2): 218-221. doi: 10.16766/j.cnki.issn.1674-4152.000061

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Abstract:
Objective To observe the comprehensive clinical efficacy of catgut-embedding therapy combined with biofeedback on the treatment of functional constipation(FC), and provide a more comprehensive treatment method for them. Methods The 80 cases of FC were selected from March, 2014 to March, 2016 in Anorectal department in Tongde Hospital of Zhejiang Province. They were randomly divided into control group and observation group according to their hospital admission orders. Biofeedback therapy was given to 40 cases in control group once a day, with 30 days as 1 course. Catgut-embedding therapy combined with biofeedback was given to 40 cases in observation group 15 days 1 time, cv 2 times for 1 course. After the treatment, we compared with the clinical efficacy of the two groups, and observed the improvement of main clinical symptoms before and after treatment. The evaluation of quality of life were based on the health survey questionnaire(SF-36). We used statistics software SPSS 22.0 for the research of statistical data. Results After treatment, the clinical total effective rate of the observation group and the control group were 89.74% and 71.05% respectively, and there were significant differences(P<0.05). The main symptoms of the two groups were significantly improved after treatment(P<0.05), and the improvement rate of the observation group was significantly better than the control group(P<0.05). After treatment each dimension score of two groups were obviously improved(P<0.05). In addition to the physiological function and body pain, the observation group improvement were significantly better than that of control group(P<0.05). Conclusion Catgut-embedding therapy combined with biofeedback in the treatment of functional constipation is better than biological feedback. They can effectively improve the patient's clinical symptoms, and can also improve the quality of life of the patients.

Therapeutic effect of different endoscopic sinus surgery on nasal inverted papilloma

LAI Chen, ZHENG Man-li, YANG Guo-bing, ZHENG Bin

2018, 16(2): 222-225. doi: 10.16766/j.cnki.issn.1674-4152.000062

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Abstract:
Objective To explore the treatment of nasal inverted papilloma by simple endoscopic sinus surgery, nasal endoscopy+Ke-Lu surgery and nasal endoscopic transnasal approach. Methods In this study, 80 patients with nasal inverted papilloma underwent endoscopic sinus surgery were selected as the endoscopic surgery group, 80 patients with nasal endoscopy+Ke-Lu surgery were treated as nasal endoscopy+Ke-Lu surgery group, and 80 patients with nasal endoscopic transnasal approach were selected as nasal endoscopic transnasal approach group in our hospital from January, 2011 to December, 2015. The intraoperative blood loss, operation time, hospitalization time, postoperative recurrence and postoperative complications were collected of the three groups. Results The intraoperative blood loss, operation time and hospital stay of nasal endoscopy+Ke-Lu surgery group and nasal endoscopic transnasal approach group were higher than that in endoscopic surgery group (P<0.05). There were no significant difference in the recurrence rate of stage Ⅰ and stage Ⅱ nasal inverted papilloma among endoscopic sinus surgery, nasal endoscopy+Ke-Lu surgery group and nasal endoscopic transnasal approach group (P>0.05). The recurrence rate of stage Ⅲ nasal inverted papilloma in endoscopic sinus surgery group was higher than that of nasal endoscopy+Ke-Lu surgery group and nasal endoscopic transnasal approach group(P<0.05). The recurrence rate of stage Ⅲ nasal inverted papilloma of nasal endoscopy + Ke-Lu surgery group was lower than that of the nasal endoscopic transnasal approach group, but the difference was not statistically significant(P>0.05). The nasal inverted papilloma after surgery of nasal endoscopic surgery group, nasal endoscopy+Ke-Lu surgery group and nasal endoscopic transnasal approach group stage Ⅰ patients were all 0 cases. There were no significant difference in the incidence of postoperative complications of stage Ⅱ and stage Ⅲ patients among the three groups(P>0.05). Conclusion The intraoperative blood loss, operation time and hospital stay of simple endoscopic surgery for stage Ⅰ and Ⅱ patients with nasal inverted papilloma are less, but the postoperative recurrence rate of the treatment of stage Ⅲ nasal inverted papillomais is high. The stage Ⅲ patients with nasal inverted papilloma is suitable for endoscopy+Ke-Lu surgery and nasal endoscopic transnasal approach.

Clinical comparative analysis of laparoscopic combined choledochoscope and traditional open surgery in the treatment of cholecystolithiasis complicated with choledocholithiasis

CHEN Tie-jiong, ZHENG Jun

2018, 16(2): 226-228. doi: 10.16766/j.cnki.issn.1674-4152.000063

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Abstract:
Objective To compare the clinical effectiveness of laparoscopic combined choledochoscope and traditional open surgery in the treatment of cholecystolithiasis complicated with choledocholithiasis. Methods Total 92 patients with cholecystolithiasis combined with choledocholithiasis in our hospital between December, 2014 and December, 2016 were enrolled into this study and divided into group A and group B with 46 cases in each group according to the random number table method. Group A was treated with laparoscope combined with choledochoscopy, and group B was treated with open surgery. The amount of bleeding, time to first flatus, operation time, the length of stay, success rate of operation, and the changes of liver function indexes before and after the operation were compared between two groups. Results The intraoperative blood loss, time to first flatus, operation time and length of stay in group A were better than those in group B (P<0.05); The operation time of the two groups had no statistical difference (P>0.05). The success rate of operation in both two groups was high, there was no statistical difference between them (P>0.05); The levels of ALP ALT, TBIL and AST increased after the treatment in both groups (group A:t=13.277, 11.276, 7.030, 9.805, group B:t=31.329, 20.858, 19.024, 21.154, all P< 0.05). The levels of ALP, ALT, TBIL and AST in group A were lower than those in group B (t=21.720, 11.340, 11.588, 11.277, all P<0.05). Conclusion The clinical effect of laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis combined with choledocholithiasis is better than open surgery. The research significance deserves attentions.

Effects of Esmolol on hemodynamics and myocardial injury in patients undergoing laparoscopic radical gastrectomy

LE Xin-hui, HUANG Xiao-xia, ZHANG Lei, ZHAO Dong

2018, 16(2): 229-231,242. doi: 10.16766/j.cnki.issn.1674-4152.000064

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Abstract:
Objective To investigate the effects of Esmolol on hemodynamics, myocardial injury and postoperative analgesia in patients undergoing laparoscopic radical gastrectomy. Methods Eighty-four patients with laparoscopic radical gastrectomy in our hospital between September, 2014 and September, 2016 were enrolled into this study and divided into group A (n=42) and group B (n=42) according to random number table. Group A received intravenous injection of Esmolol 0.3 mg/kg 3 min before intubation, intraoperative continuous intravenous infusion of Esmolol until the time to extubation, group B received saline instead of Esmolol. The postoperative intravenous analgesia was performed. The changes of mean arterial pressure (MAP) and heart rate (HR) were observed before anesthesia induction (T0), at the time of injection of Esmolol (or saline) (T1), tracheal intubation (T2), extubation (T3), 10 min after extubation (T4), 20 min after extubation (T5). The levels of lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and serum troponin I (cTnI) were measured before and 5 hours after anesthesia. VAS analgesia scores were compared between the two groups. Results At the time of T1, T2, T3, T4 and T5, there was statistically significant in MAP and HR between the two groups (P<0.05), and there was no significant difference in MAP and HR between T5 and T0 in group A (P>0.05), and there was significant difference in MAP and HR between T5 and T0 in group B (P<0.05); The levels of LDH, CK, CK-MB and cTnI in 5 hours after the operation in the two groups were significantly lower than those before the operation (P<0.05). There was no significant difference in group A at 8 hours after operation as compared the preoperative results (P>0.05), however, there was significant difference in group B (P<0.05). The resting pain and exercise pain VAS score on d1 and d2 in group A were significantly lower than those in group B after the operation (P<0.05), however, there was no statistically significant difference on d3 after the operation (P>0.05). Conclusion For laparoscopic radical gastrectomy patients, Esmolol can make hemodynamic more stable, effectively reduce the degree of myocardial injury, with good postoperative analgesic effect.

Risk factors for nosocomial infection and death in patients with sepsis

QIAN Xing-er, ZHENG Min, DAI Xiao-wei, HUANG Zhang-shun

2018, 16(2): 232-235. doi: 10.16766/j.cnki.issn.1674-4152.000065

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Abstract:
Objective To research the risk factors for nosocomial infection and death in patients with sepsis and provide reference for the rapid diagnosis and early treatment of sepsis. Methods A total of 74 patients with sepsis admitted to hospital from January, 2014 to June, 2015 were collected to analyze the relationship between nosocomial infection and mortality in 22 related factors. Results Nosocomial infection in sepsis patients was related to 11 risk factors:age, septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, duration of operation, use of corticosteroids, central venous catheterization, more than three catheterizations, more than 2 kinds of bacterial infection, duration of infection ≥ 5 d and et al. Mortality of patients was associated with 12 risk factors:diabetic history, septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, blood sugar ≥ 8.3 mmol/L, duration of operation ≥ 3 h, more than three catheterizations, more than 2 kinds of bacterial infection, duration of infection< 5 d, hospital stay < 20 d and et al. Septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, more than three catheterizations, more than 2 kinds of bacterial infection were the common risk factors of nosocomial infection and death of patients with sepsis. The patients with the above 5 factors should be transferred to the ICU for intensive treatment. Conclusion The patients with 5 common risk factors (Septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, more than three catheterizations, more than 2 kinds of bacterial infection) should be paid more attentions on their treatment to improve the prognosis. If APACHE score ≥ 20 points and SOFA score ≥ 2 points, anti-infective therapy should be performed immediately, and start the standard process for the treatment of sepsis. Most of sepsis patients died less than 5 days after infection, the early diagnosis and treatment is very important for the prognosis of sepsis.

Clinical observation of 62 patients with early stage digestive tract tumors undergoing endoscopic diagnosis and treatment

ZHANG Yan, WU Jing-jing, ZHENG Jia, WANG Yang, SHENG Xian-cang

2018, 16(2): 236-238. doi: 10.16766/j.cnki.issn.1674-4152.000066

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Abstract:
Objective To investigate the value of digestive endoscopy in the diagnosis and treatment of early digestive tract cancer. Methods From January, 2014 to May, 2016, 62 patients with early stage digestive tract tumors were selected from Department of Gastroenterology, Taizhou First People's Hospital. They were divided into control group (n=30) and observation group (n=32) according to random number table method. The control group received traditional white light endoscope and conventional surgical treatment, while the observation group (32 cases) received electronic gastroscope and ultrasonic gastroscope to assist in the diagnosis and treatment. After the treatment, the clinical detection rate, image quality score, clinical efficacy, operation related indexes and postoperative complications were compared between the two groups. Results ① The detection rate of the observation group (87.5%, 28/32) was significantly higher than that of the control group (63.33%, 19/30), P<0.05. ② The scores of image quality in the observation group were higher than those in the control group, P<0.05. ③ After the treatment, the efficient and disease control rates in the observation group were 43.75% (14/32) and 90.63% (29/32), which were significantly higher than those in the control group[23.33% (7/30) and 73.33% (22/30)], P<0.05. ④ The relative indexes of the observation group after operation were better than those in the operation, P<0.05. ⑤ After the treatment, the complication rate of the observation group (3.13%, 1/32) was significantly lower than that in the control group (20.00%, 6/30), P<0.05. Conclusion Digestive endoscopy can improve the detection rate of early digestive tract cancer, image quality score and diagnostic accuracy; the early treatment of digestive tract cancer by gastrointestinal endoscopy can also improve the therapeutic efficiency ratio and disease control rate, optimize the postoperative surgical indicators, and reduce the postoperative complications.

Clinical application of endoscopic sphincterotomy in combination with endoscoopic papillary balloon dilatation in the treatment of common bile duct stones

ZHANG Yu-hui, DONG Jin-liang, FEI Dai-liang, XIAO Ning-bo, LIANG Jin-rong

2018, 16(2): 239-242. doi: 10.16766/j.cnki.issn.1674-4152.000067

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Abstract:
Objective To investigate the clinical value of endoscopic sphincterotomy (EST) in combination with endoscoopic papillary balloon dilatation (EPBD) in the treatment of common bile duct stones. Methods Endoscopic retrograde cholangio pancreatography (ERCP) was performed in 160 cases of common bile duct stones in our hospital between January, 2014 and June, 2016. The patients in EST group (n=80) received EST, while the patients in EST+EPBD group (n=80) received EST and EPBD. The operation time, intraoperative blood loss, the success rate of lithotomy and the incidence of postoperative complications were compared between the two groups. Results Compared with EST group, postoperative bleeding, acute pancreatitis and hyperamylasemia, biliary tract infection, postoperative pain, postoperative complications and the total complications decreased in the EST+EPBD group (P=0.043; P=0.030; P=0.009; P=0.030; P=0.016; P<0.001); the residual stones, mechanical lithotripsy, stone recurrence, recurrence time and stone time shortened or reduced in the EST+EPBD group (P=0.086; P=0.035; P=0.001; P=0.739; P=0.283), success rate to remove stones increased in the EST+EPBD group (P=0.029); intraoperative time, intraoperative blood loss, length of stay, defecation days shortened or reduced in EST+EPBD group (P=0.029; P<0.001; P=0.013; P=0.002); but the cost of hospitalization in the EST+EPBD group was slightly higher (P=0.323). Conclusion EST in combination with EPBD can increase the success rate of removing stones and reduce the incidence of postoperative complications, with advantage in operation duration, time to postoperative defecation and so on. It deserved to be promoted clinically.

Efficacy of TCM modified Qinggan Runfei Decoction combined with Western Medicine for chronic obstructive pulmonary disease with pneumonia in patients with Qi-Yin Deficiency syndrome

LOU Yan, WANG Xiao-yu, CHEN Min-hua

2018, 16(2): 243-246,263. doi: 10.16766/j.cnki.issn.1674-4152.000068

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Abstract:
Objective To investigate the clinical efficacy and mechanism of TCM modified Qingzao Jiufei decoction combined with western medicine on Qi and Yin deficiency patients with chronic obstructive pulmonary disease (COPD) and pneumonia. Methods Total 98 cases of Qi and Yin deficiency patients with acute exacerbation of COPD and pneumonia were randomly divided into control group (n=49) and observation group (n=49). The control group was given conventional anti-infective, bronchodilator, expectorant and other treatment for 2 months, while the observation group was given TCM Qingzao Jiufei decoction oral, one dose a day for 2 months. The clinical efficacy, TCM syndrome score, dyspnea score (mMRC), 6-minute walk test (6MWT), lung function and peripheral blood T lymphocyte subsets, natural killer cells, IgG, IgA, IgM (IL-8), tumor necrosis factor-α (TNF-α), MMP, TIMP, TGF-β1 and VEGF were measured. Results The total effective rate was 91.84% in the observation group, which was significantly higher than that in the control group (77.55%, P<0.05). The scores of TCM syndromes were significantly lower in the observation group than in the control group (P<0.05). After the treatment, the pulmonary function indexes, mMRC score and 6 MWT of the two groups were better than those before the treatment (P<0.05). CD8⁺, CD4⁺, CD4⁺/CD8⁺, NK cells were significantly increased and CD8⁺ levels were significantly decreased in the two groups (P<0.05). The levels of IgA and IgM in the observation group were significantly increased (P<0.05), but there was no significant difference (P>0.05). IL-8, TNF-α, MMP, TIMP, TGF-β1 and VEGF were significantly decreased in both groups (P<0.05). And the observation group after the treatment were significantly better than the control group after the treatment (P<0.05). The number of acute exacerbations and the number of hospitalizations in the observation group were significantly lower than those in the control group (P<0.05). Conclusion The therapeutic effect of TCM Qingzao Jiufei decoction combined with western medicine on qi and yin deficiency syndrome in patients with chronic obstructive pulmonary disease and pneumonia is obvious, and the mechanism may be related to stop cascade of inflammation and improve the immune function and airway remodeling state.

Changes of T-lymphocyte subsets, immune globulin and matrix metalloproteinase in chronic heart failure patients with pulmonary infection

CHEN Zi-an, CHEN Jin-qiang

2018, 16(2): 247-249,267. doi: 10.16766/j.cnki.issn.1674-4152.000069

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Abstract:
Objective To investigate the changes of T-lymphocyte subsets, immune globulin (Ig) and matrix metalloproteinase (MMP) in chronic heart failure patients with pulmonary infection and assess the prognosis of patients. Methods A total of 120 chronic heart failure patients in our hospital between September, 2015 and December, 2016 were divided into infection group (n=49) and non-infection group (n=71) according to the condition of pulmonary infection. The levels of white blood cell count, neutrophils percentage, percentage of lymphocytes, cardiac parameters, inflammatory factors, T-lymphocyte subsets, immune globulin and matrix metalloproteinase and prognosis were compared between the two groups. Results The levels of white blood cell count, neutrophils percentage and percentage of lymphocytes of the infection group were significantly higher than those of non-infection group (P<0.05); The levels of BNP, LVEDVI and LVESDVI of lymphocytes of the infection group were significantly higher than those of non-infection group (P<0.05); The levels of IL-6 and TNF-α of the infection group were significantly higher than those of the non-infection group (P<0.05); The level of CD4⁺ had no significant difference between the infection group and non-infection group (P>0.05), the level of CD8+ of the infection group was significantly higher than that of the non-infection group (P<0.05), and the level of CD4⁺/CD8⁺ of the infection group was significantly lower than that of the non-infection group (P<0.05); The level of Ig A had no significant difference between the infection group and non-infection group (P>0.05), and the levels of Ig G and Ig M of the infection group were significantly lower than those of the non-infection group (P<0.05); the levels of MMP-2 and MMP-9 of infection group were significantly higher than those of the non-infection group (P<0.05); the length of hospital stay and mortality of the infection group was significantly higher than that of the non-infection group (P<0.05). Conclusion The chronic heart failure patients with pulmonary infection have low immunity and high level of MMP. The infection will aggravate heart function damage, and lead to a poorer prognosis of patients.

Effects of compound Danshen dripping pills combined omeprazole on peptic ulcer with diabetes mellitus and its impact on the hemorheology

LI Qian-qian, CHEN Xia, XIA Chen-mei, JIN Ling-xiao, LIN Pei-li

2018, 16(2): 250-252. doi: 10.16766/j.cnki.issn.1674-4152.000070

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Abstract:
Objective To investigate the effects of Danshen Dripping Pill combined Omeprazole on hemorheology, Nitric oxide (NO) and Endothelin (ET) of patients with diabetes mellitus and peptic ulcer. Methods Total 132 cases of peptic ulcer with diabetes mellitus in our hospital between January, 2015 and June, 2017 were randomly divided into two groups, with 66 cases in each group. The control group was given omeprazole, and the observation group was added compound Danshen Dripping Pill. After 4 week's treatment, the clinical efficacy, hemorheology[whole blood high shear viscosity, low blood viscosity, plasma specific viscosity], serum NO and serum ET levels of the two groups were compared. The effects and potential mechanism of Danshen Dripping Pill combined Omeprazole on patients with diabetes mellitus and peptic ulcer were analyzed. Results The total effective rate of the observation group was 95.45%, which was significantly higher than that of the control group (83.33%), P<0.05. Before the treatment, there was no significantly difference in hemorheology, NO and ET between the two groups (P>0.05). After the treatment, the high shear viscosity, low blood viscosity and plasma specific viscosity of the two groups were significantly decreased (P<0.05), and high shear viscosity, low blood viscosity and plasma specific viscosity of the observation group were significantly lower than those of the control group (P<0.05). After the treatment, the serum NO levels of both groups were significantly increased (P<0.05), and NO level of the observation group was significantly higher than that of the control group (P<0.05). After the treatment, the serum ET levels of the two groups were significantly decreased (P<0.05), and ET level of the observation group was significantly lower than that of the control group (P<0.05). Conclusion Danshen Dropping Pill combined Omeprazole can effectively improve peptic ulcer with diabetes mellitus. The mechanism might be related to the improvement of microcirculation and regulation of serum NO and ET.

Application of HPV E6/E7 mRNA test combined with Thinprep cytologic test in early screening of cervical lesions

WU Ping, WANG Lin, ZHANG Qiu-hong, XIE Ai-lan

2018, 16(2): 253-256. doi: 10.16766/j.cnki.issn.1674-4152.000071

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Abstract:
Objective To investigate the significance of HPV E6/E7 mRNA test combined with Thinprep cytologic test (TCT) in the early screening of cervical lesions in rural middle-aged women. Methods The early screening for cervical cancer and precancerous lesions by using HPV E6/E7 mRNA test and TCT was performed in 360 rural middle-aged women in our hospital between April, 2015 and December, 2016, in which the histological examination was used as the gold standard to evaluate the effect of the combined test. Results The positive rate of HPV E6/E7 mRNA in CIN group was 86.18%, which was significantly higher than that of chronic inflammation group (29.33%), χ²=114.074, P<0.05. The positive rate of HPV E6/E7 mRNA for CIN1, CIN2, CIN3 and patients with cervical cancer were 79.59%, 86.84%, 88.46% and 100.00%, respectively, which showed an increased trend. The positive rate by TCT test in CIN group was 68.42, which was significantly higher than that of chronic inflammation group (22.12%), χ²=77.476, P<0.05. The positive rate by TCT test in CIN1, CIN2, CIN3 and cervical cancer was 57.14%, 68.42%, 76.92% and 76.92%, respectively, which showed an increased trend. The mean test positive rate of HPV E6/E7 mRNA (54.17%) and TCT (38.89%) had consistency (r=0.428, P<0.05). The sensitivity and negative predictive value of HPV E6/E7 mRNA test combined with TCT were significantly higher than the result by one of them (P<0.05). There was no significant difference in the specificity and positive predictive value among the three methods (P>0.05). The diagnostic accuracy of the combined test was 80.83%, which was higher than that by TCT test. Conclusion E6/E7 mRNA test combined with TCT can improve diagnostic efficiency, and advantage of noninvasive test. It is worthy of popularization and application in the screening of precancerous cervical lesions.

GUO Ping, YAO Huan-ying

2018, 16(2): 257-259,295. doi: 10.16766/j.cnki.issn.1674-4152.000072

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Abstract:
Objective To retrospective analysis the clinical data of children with iron deficiency anemia (Nutritional iron deficiency anemia in children, IDAC), investigate the incidence and related factors of the disease, and to explore the clinical effects of health management intervention and necessary treatment for IDA children. Methods The 350 children patients diagnosed as IDA were excepted with the persistent health management intervention, and necessary treatment. Investigate the incidence of IDAC; to study the relevant factors of children with IDA disease by the single factor analysis; compare the clinical effect before and after the health management intervention (the changes of clinical symptoms and signs, and weight), laboratory (hemoglobin, blood iron) and the necessary treatment. Results ① 51 cases (14.57%, 51/350) were diagnosed as IDAC, their laboratory examination of peripheral blood and ferritin levels in the blood hemoglobin were lower than the normal reference of the same age, same sex children in the lower limit, the difference was statistically significant compared with non IDA patients (P<0.05). The IDA incidence is the highest in 1-3 year old children. ② The single factor analysis result showed that age, irrational dietary structure, and digestive system diseases were all related factors of IDAC. ③ After the health management intervention and necessary treatment, the hemoglobin, blood ferritin and weight of the children in the laboratory indexes of the majority of IDA children were basically restored to the normal reference range of our laboratory. In most (96.08%,49) children, the anemia and clinical symptoms or abnormal signs were improved effectively. Conclusion IDA in children aged 1-3 years is the highest, and the main causes of disease are irrational dietary structure and digestive system. By reasonable and continuous health management intervention and necessary treatment for IDA children, more satisfactory clinical results can be obtained.

The correlation research of Toll-like receptors in PNS children

LUO Fang, WU Zhi-fei, TU Lin-xiu

2018, 16(2): 260-263. doi: 10.16766/j.cnki.issn.1674-4152.000073

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Abstract:
Objective To explore the correlation of Toll-like receptors TLR4 and TLR7 and kidney injury markers, and inflammatory factors, so as to clear out its clinical value. Methods Ninety-two cases of pathological sections extracted from PNS children were used as the observation group, while 37 cases of healthy kidney tissue were used as the controls. TLR4 and TLR7 expression levels were detected with immunohistochemistry assay. The PNS children were divided into 3 groups according to TLR4 and TLR7 expression levels:both TLR4 and TLR7 expression increased were called Group A (n=33), only one of them increased were called Group B (n=29), and both TLR4 and TLR7 expression decreased were call Group C (n=30). The urinary NGAL, KIM-1 levels, and the serum IL-1β, IL-6, TNF-α levels were detected by ELISA kits. Results The TLR4 and TLR7 expression levels of the observation group were both higher than the controls, and the difference had statistical significance (P<0.05). There was significant difference between groups in urinary NGAL and KIM-1 levels between groups, and those of Group C were higher than Group B, and those of Group B were higher than Group A, the difference had statistical significance (P<0.05). Pearson correlation analyse results showed that there was positive correlation between TLR4/TLR7 and KIM-1 (R²=0.627, 0.682, P<0.05). There was significant difference between groups in serum IL-1β, IL-6, TNF-α levels, those of Group C were higher than Group B, and those of Group B were higher than Group A, the difference had statistical significance (P<0.05). Pearson correlation analyse results showed that there was positive correlation between TLR4/TLR7 and IL-6/TNF-α levels (R²=0.586-0.655, P<0.05). Conclusion The TLR4 and TLR7 expression levels of PNS Children are closely related with kidney injury and inflammatory reaction, which has disregardful value.

Application of low-dose Ropivacaine combined Sufentanil on combined spinal-epidural anesthesia in painless childbirth

FANG Jian, ZHAO Ji-rong

2018, 16(2): 264-267. doi: 10.16766/j.cnki.issn.1674-4152.000074

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Abstract:
Objective To investigate the feasibility and safety of low-dose Ropivacaine combined Sufentanil on combined spinal anesthesia in painless childbirth. Methods Sixty primipara requiring analgesia childbirth with ASA of Ⅰ-Ⅱ, uterus opening of 2-3 cm, no contraindications to spinal anesthesia, and no obstetric pathological factors from May, 2016 to May, 2017 were selected and divided into group A and group B by randomized double-blind method, with 30 cases in each group. Group A was given combined spinal-epidural anesthesia (CSEA) in painless childbirth, while group B was given epidural anesthesia in painless childbirth. The anesthesia onset time, improved Bromage score, VAS score at 3 min, 5 min, 10 min, 30 min, 60 min after anesthesia, birth process, neonatal Apgar score at 1 min and 5 min after delivery, anesthetic amount, oxytocin using, bleeding, intraoperative cesarean section rate, and related complications of the two groups were compared. Results The anesthesia onset time of group A was (3.2±1.4) min, which was significantly shorter than that of group B (6.3 ±3.5) min. The VAS scores of group A at 3, 5, 10, 30 and 60 minutes after anesthesia were (3.2 ±1.3), (2.3 ±1.1), (1.5 ±0.4), (1.2 ±0.6) and (1.8 ±0.5), respectively, which were lower than those of group B (7.3±1.7), (6.6±1.3), (4.5±0.6), (1.7 ±0.5) and (3.6 ±1.2), P<0.05. The local anesthetic dosage of group A was (9.5 ±4.7) mg, which was significantly lower than that of group B (P<0.05). The cesarean section rate of group A was 6.7%, which was significantly lower than that of group B 26.7% (P<0.05). But the skin pruritus incidence of in group A was higher than that of group B (P<0.05), there were no significant difference in other index between the two groups (P>0.05). Conclusion The combined spinal-epidural anesthesia with low-dose Ropivacaine combined Sufentanil for painless childbirth had the advantage of rapid onset, analgesic satisfactory and less dosage, and was an ideal anesthetic mode for painless childbirth.

Research on Current Situation and Problems of Family Doctor Service in Beijing Suburbs from Medical Perspective

LV Lu-dan, PENG Ying-chun, WANG Zhe

2018, 16(2): 268-271. doi: 10.16766/j.cnki.issn.1674-4152.000075

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Abstract:
Objective To understand the status quo and problems of family doctor service in Beijing suburbs and to give corresponding countermeasures and suggestions. Methods The survey was conducted from September, 2016 to October, 2016 in Beijing, and 10 community health service centers in two suburban districts of Miyun and Huairou were surveyed. Results A total of 200 questionnaires were issued and 185 valid questionnaires were recovered. The effective rate of the questionnaire was 92.5%. And 160 people (86.5%) whose organization have established family doctor service teams, 167 people (90.3%) have established medical service work systems and responsibilities, and the current institutions to carry out the comprehensive family doctor service 55 people (29.7%); At present, there are 26 people (14%) who can meet the needs of residents' medical service in the community, and the technical level can meet the needs of residents of 55 people (29.7%); there were 52 people (28.1%) in the institution who had incentives to carry out the home medical service, the main motivation mode is oral motivation, which were 25 (48.1%) of these incentives to mobilize the enthusiasm of medical staff; 58 (31.4%) were reluctant to become involved a medical service team. The main reason is that the work is difficult to carry out and the existing workload is great, community medical staff considered suitable for suburbs residents service is the main way of booking services, telephone consultation, and in clinic. Conclusion At present, there are still many obstacles to the operation of the family doctor service in the suburbs of Beijing. In order to better realize the full coverage of the family doctor service, the following countermeasures are put forward:to make the content and mode of family doctor service according to local characteristics;to improve the training mechanism of family doctors; and to explore effective family doctor service incentive mechanism.

Effect evaluation of health promotion intervention among different types of employees

ZHOU Jian-fang, REN Xue-lei, YU Hua, ZHAO Jian-xin

2018, 16(2): 272-275. doi: 10.16766/j.cnki.issn.1674-4152.000076

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Abstract:
Objective To evaluate the health status of employees among different types in the high-tech enterprises and to understand the risk factors of health.To explore effective intervention for different types of employees after evaluating the difference between the intervention group and the control group. Methods The investigations were conducted twice among the employees of two high-tech institutes in Shanghai Caohejing Development Zone respectively. A series of targeted health education and health services were carried out in the intervention group. A total of 1 022 effective questionnaires were collected in the baseline survey conducted in 2012. A total of 1 113 effective questionnaires were collected in the final survey in 2014. Results After the intervention, the mental health of productive staffs was improved significantly. Some work related factors and health behavior were also improved significantly(P<0.05). The self-rated health and mental health of non-productive employees were improved significantly after the intervention(P<0.05). However, there was no significant difference in work related factors and health behavior. Most of work related factors and health behaviors appeared even worse. For the productive employees in control group, there was no significant difference in self-rated health, mental health and health behaviors. However, some work related factors have been improved. For the non-productive employees in control group, there was no difference in self-rated health, mental health, work related factors and health behavior(P>0.05). Conclusion The intervention effects differ by work types. Considering the characteristics of employees, more targeted health promotion should be developed.

The role of intestinal flora in the pathogenesis of schizophrenia and its relationship with inflammatory factors

SHEN Bian-hong, TAO Yun-hai, ZHU Chun-yan

2018, 16(2): 276-278. doi: 10.16766/j.cnki.issn.1674-4152.000077

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Objective To explore the role of intestinal flora in the pathogenesis of schizophrenia and its relationship with inflammatory factors. Methods Seventy cases of first episode schizophrenia were selected as schizophrenia group, and 70 cases of healthy subjects were selected as control group in Hangzhou seventh people hospital psychiatric from January, 2014 to December, 2016. The number of Bacteroides, Bacteroides and Bifidobacterium were determined by gradient dilution method. The levels of interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10(IL-10) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA). Results The number of bacillus in the schizophrenia group was higher than that in the control group (P<0.05). The number of bifidobacteria in the schizophrenia group was lower than that of the control group (P<0.05). There was no significant difference in the number of lactobacilli between the schizophrenia group and the control group (P>0.05). The Bifidobacterium/Bacteroides and Lactobacillus/Bacteroides in the schizophrenia group were lower than that in the control group (P<0.05). The levels of IL-2, IL-6, IL-10 and TNF-α in the schizophrenia group were higher than those in the control group (P<0.05). The levels of IL-2, IL-6, IL-10 and TNF-α in patients with schizophrenia were positively correlated with Pseudomonas aeruginosa (P<0.05). The Bifidobacterium was negatively correlated with serum IL-2, IL-6, IL-10 and TNF-α (P<0.05). Conclusion Patients with schizophrenia have intestinal flora imbalance and serum IL-2, IL-6, IL-10, TNF-α level increase. Intestinal flora and serum levels of inflammatory factors are closely related, Both may be involved in the pathogenesis of schizophrenia.

CT findings of pulmonary cryptococcosis in immunocompetent patients

YANG Hai, LIU Zi-shan, CHEN Ying, LI Xin, XU Cheng, FAN Heng-xin, XIE Ji-cheng, FAN Shu-feng

2018, 16(2): 279-282,290. doi: 10.16766/j.cnki.issn.1674-4152.000078

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Objective To analyze the CT findings of pulmonary cryptococcosis in immunocompetent patients. Methods CT features and clinical data of 32 immunocompetent patients with histopathologically-proven pulmonary cryptococcosis were retrospectively and analyzed. Results Of the 32 immunocompetent patients, there were mass/nodule pattern(75.0%, n=24), pulmonary consolidation pattern(21.9%, n=7) and the mixed type(3.1%, n=1). In mass/nodule pattern, the occurrence rate of single solitary mass/nodule was 66.7%(n=16), and the multiple mass/nodule was 33.3%(n=8);in pulmonary consolidation pattern, the occurrence rate of single solitary was 14.3%(n=1), and the multiple was 85.7%(n=6). Of all the 15 multiple patients, the occurrence rate of unilateral lobar distribution was 66.7%(n=10). In all sixty-nine measurable lesions, the peripheral distribution(66.7%, n=46) and lower pulmonary distribution (50.7%, n=35) were seen more. In 48 mass/nodule pattern, the occurrence rate of air-bronchogram sign was 62.5%(n=30), include ⅢA(n=13), ⅢB(n=5), Ⅴ(n=10), Ⅳ(n=2), without Ⅰ/Ⅱ;Other findings included halo sign (41.6%), lobulation sign(29.2%), spicule sign(16.7%), cavity or vocule sign(12.5%) and pleural change(25.0%). In 21 pulmonary consolidation pattern, the CT findings included halo sign(85.7%, n=18), pleural incrassation sign(76.2%, n=16), cavity or vocule sign(38.1%, n=8) and air-bronchogram sign(81.0%, n=17), include ⅢA(n=3), ⅢB(n=12 patients), Ⅴ(n=12), without Ⅰ/Ⅱ/Ⅳ. Conclusion The pulmonary cryptococcosis in immunocompetent patients usually occurs in lower lobe near pleural, the mass/nodule pattern is the prevalent CT manifestation, the air-bronchogram sign(type ⅢA, Ⅴ) is the most common CT finding;the air-bronchogram sign(type ⅢB) is the characteristic findings of CT manifestationgs in pulmonary consolidation pattern.

Correlation between CT perfusion parameters and VEGF in postoperative recurrence of laryngeal cancer

XIANG Jun-yi, LI Yuan, HUANG Feng, ZHAO Kai-yue, YANG Wen-jun, QI Le

2018, 16(2): 283-285. doi: 10.16766/j.cnki.issn.1674-4152.000079

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Objective To observe the correlation between the CT perfusion parameters and the expression of vascular endothelial growth factor(VEGF) in postoperative recurrence of laryngeal cancer. Methods Forty postoperative recurrence of laryngeal cancer were scanned by spiral CT, and to calculate the perfusion parameters with perfusion functional software. The parameters included blood flow(BF), blood volume(BV), mean transit time(MTT) and permeability surface(PS). And the serum VEGF specimens were detected by sandwich enzyme-linked immunosorbent assay(ELISA) and 20 non-postoperative recurrence of laryngeal cancer as contrast. The correlation between the CT perfusion parameters and VEGF was studied. Results CT perfusion parameters(BF, BV, MTT and PS) were difference between non-postoperative recurrence and postoperative recurrence lesions of laryngeal cancer. BF of postoperative recurrence group was higher than that of postoperative recurrence lesions group(P<0.05). In postoperative recurrence, BF and BV was positively correlated with VEGF(r=0.471, 0.389, P<0.05), MTT and VEGF showed a negative correlation(r=-0.427, P<0.05), there was not correlative between PS and VEGF(r=0.302, P>0.05). Conclusion CT perfusion parameters of postoperative recurrence of laryngeal cancer are correlated with VEGF, which may reflect the expression of VEGF. The CT perfusion should be helpful to diagnosis and treatment postoperative recurrence of laryngeal cancer.

Research progress of HOX transcript antisense RNA in clinical diagnosis and treatment of breast cancer

YE Liu-qing, DING Jin-wang, ZHANG Min, LUO Zhong-yao, ZHOU Guo-ming, FENG Wei-liang

2018, 16(2): 286-290. doi: 10.16766/j.cnki.issn.1674-4152.000080

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HOX transcript antisense RNA (HOTAIR) is the first long chain non-coding RNA to be found with transcription regulation effect. As antisense RNA, HOTAIR itself does not encode proteins, but it acts as a transcription regulatory factor by effecting on different chromosomes of HOX gene cluster, thus playing an important role in the genomic control and development of tumor. Studies have shown that HOTAIR is dysregulated in several human cancers, such breast cancer, colorectal cancer, liver cancer, pancreatic cancer, laryngeal cancer, etc. High expression of HOTAIR can inhibit the expression of tumor suppressor genes, which will promote the tumor recurrence and metastasis, however down-regulated expression of HOTAIR will reduce the invasive ability of tumor cell. Researches in recent years have confirmed that HOTAIR expression is abnormal in breast cancer tissues, cell lines and peripheral blood, which is helpful to illuminate the mechanism of breast cancer development and the mechanism of drug resistance. Clinical studies further show that the detection of HOTAIR expression level is not only helpful to improve the diagnostic capability of breast cancer, but also helpful to promote clinical condition evaluation, prognosis judgment, curative effect evaluation and dynamic monitoring of tumor recurrence. In addition, HOTAIR expression may be related to biological behavior of breast cancer in different hormone receptor types. Exploration studies also shown that antitumor drugs designed according to carcinogenesis of HOTAIR will be able to bring light to the treatment of some refractory breast cancer, such as tamoxifen resistant breast cancer. This paper will review the research progress in recent years.

Research progress on diagnosis and treatment of gastrointestinal stromal tumor

LIAO Yan-ting, WANG Zi-an

2018, 16(2): 291-295. doi: 10.16766/j.cnki.issn.1674-4152.000081

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Gastrointestinal stromal tumor (GIST) is the most common type of gastrointestinal mesenchymal tissue tumors, originated in Cajal cells or gastrointestinal pacing cells. It can grow in any part of the gastrointestinal tract, where the stomach and small intestine are multiple, followed by colorectal. The pathogenesis of GIST is associated with activation of c-kit and platelet-derived growth factor receptor-alpha (PDGFRA). Due to its lack of characteristic clinical manifestations, the final diagnosis depends on pathology, and the pathologic diagnosis depends on morphological and immunohistochemical results. The feasible genetic analysis that tests the expression of CD117 and DOG1 will contribute to the diagnosis of special genotype GIST if necessary. At present, surgery combined with targeted therapies is the popular solution for GIST. With the development of new surgical instruments, the laparoscopic surgery has also been gradually recognized by the people in recent years. Imatinib, as a tyrosine kinase inhibitor, can specifically inhibit the expression fo kit, PDGFRA and bcl-al, it had been approved for use in 2001. Sunitinib, when compared with Imatinib, is with more targets, which is applied as the second-line drugs for GIST. The action mechanism of the two drugs is similar. Molecular targeting drugs, represented by Imatinib, is effective in the treatment of GIST and improving the prognosis of patients, which represents milestone significance in molecular targeted therapy of tumors. However, with the increase of drug time, GIST resistance gradually becomes one of the important factors affecting the prognosis of patients with GIST. The pathogenesis of GIST is complex and the variety of gene mutations is diverse, so it is more important to develop specific treatment regimens based on the individual patient's condition. Risk grading is widely used to determine prognosis and to guide molecular bio-targeted therapy. In this paper, the progress of diagnosis and treatment of gastrointestinal stromal tumors at this stage is reviewed.

Effect of Ling Gui Ba Fa combined with TCM fire-needle acupuncture therapy for insomnia due to heart-spleen deficiency

HONG Qiu-yang, YANG Hui-min, ZHAO Ji-ping, WANG Shi-guang, LIU Xiao-jing, YAO Jin

2018, 16(2): 296-298,312. doi: 10.16766/j.cnki.issn.1674-4152.000082

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Objective To observe the clinical efficacy of Ling Gui Ba Fa combined with TCM fire-needle acupuncture therapy in improving the quality of sleep in patients with insomnia due to heart-spleen deficiency. Methods Seventy-two cases of patients with Heart-spleen deficiency insomnia in our hospital from January, 2016 to January, 2017 were randomly divided into group A (36 cases) and group B (36 cases); there were 1 case of lost follow-up in each group, and 35 cases in each test group were finally completed. Group A received Ling Gui Ba Fa combined with TCM fire-needle acupuncture therapy (Xinyu and Piyu acupoints), while group B received conventional acupuncture therapy (Zhaohai, Sishencong and Sanyinjiao acupoints), one time a day for 5 times a week. Pittsburgh sleep quality index (PSQI), TCM symptom score were evaluated before treatment, 2 weeks, 4 weeks and one month after the treatment. Data were analyzed by SPSS soft. The therapeutic efficacy was compared between the two groups. Results There was no obvious difference in the scores of PSQI and TCM symptoms after 2 weeks of treatment between the two groups (P>0.05); the difference in PSQI score and TCM symptom score between the two groups at the end of the 4 week treatment and during the follow-up was significant (P<0.05). At the end of 4 week treatment, the total effective rate of group A was 94.3% (33/35), which was better than that of B group (29/35, P<0.05). Conclusion The long term effect of Ling Gui Ba Fa combined with TCM fire-needle acupuncture therapy for insomnia due to heart-spleen deficiency is better than ordinary acupuncture, and can improve the symptoms of insomnia and sleep quality of the patients.

Effect of PBL teaching method on clinical practice of medical anesthetic students

LIANG Qi-sheng, LI Yu-zhen, ZHU Chen-chen, ZHANG Xue-qin, LING Yun-zhi, LIN Xue-wu

2018, 16(2): 299-301,329. doi: 10.16766/j.cnki.issn.1674-4152.000083

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Objective To evaluate the teaching effect of applying problem-based learning (PBL) method to anesthesia specialty medical students in clinical practice. Methods A total of 24 anesthesia students were divided into two groups, namely the PBL teaching mode group and traditional LBL teaching model group, with 12 students in each group. After one month of relatively concentrated teaching every Thursday afternoon eight weeks in a row, according to the requirements of practice outline of teaching the same teaching content, the main contents include clinical skills teaching and case discussion and case analysis, and we evaluate students by teaching content and student satisfaction of teaching method. Results The examination paper evaluation result and the questionnaire results showed that PBL teaching group for examination and assessment of students' comprehensive proficiency (90 points) or higher 91.7%, 50.0% respectively, the students' satisfaction survey in two kinds of teaching, accounted for 83.3% and 41.7% respectively, with significant difference (P<0.05). In particular, students learn other knowledge related to the teaching content in the study, and feel that the students' clinical anesthesia philosophy is broadened, the thinking is clear, the speech is positive, and even some problems are more advanced. Teaching teachers also achieve certain knowledge updates. Conclusion PBL teaching method is a kind of teaching method which is based on the problem, and under the guidance of the teacher, students' independent analysis, independent discussion and autonomous learning. These measures have a good effect on the clinical practice ability of further training students of anesthesiology and improve the teaching quality of clinical practice, and achieve the goal of teaching.

Risk factor of deep venous thrombosis in lower extremity after pericardial devascularization and splenectomy

WU Zhong-ming, WU Hai-ming, WU Ai-bing

2018, 16(2): 302-304. doi: 10.16766/j.cnki.issn.1674-4152.000084

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Objective To investigate risk factor of deep venous thrombosis in lower extremity after pericardial devascularization and splenectomy. Methods A total of 600 patients with pericardial devascularization and splenectomy in yiwu central hospital and the hospital Affiliated to Guangdong Medical College from January, 2008 to July, 2016 was admitted. The clinical medical history included age,sex,hyperlipidemia,arteriosclerosis,body mass index,smoking history,varicosis of great saphenous vein,hemostatics. Results There were 85 case of deep venous thrombosis in lower extremity among 600 patients with pericardial devascularization and splenectomy. Age beyond 48 years old[OR=4.12, 95%CI(1.07-12.31), P=0.007],triglyceride more than 2.3 mmol/L[OR=3.67, 95%CI(1.24-18.32), P=0.013], body mass index over 28 kg/m²[OR=6.25, 95%CI(1.67-20.35), P=0.001] and use of hemostatics[OR=4.43, 95%CI(2.37-18.36), P=0.006] were independent risk factor of deep venous thrombosis in lower extremity after pericardial devascularization and splenectomy. Conclusion The patients with pericardial devascularization and splenectomy was susceptible to deep venous thrombosis in lower extremity,whose age was beyond 48 years old, plasma triglyceride was more than 2.3 mmol/L, body mass index was over 28 kg/m², and hemostatics was used during perioperative period. Healthy knowledge education, low-fat diet, physical exercise and good living habit is essential for us to keep fit.

The effect of lipopolysaccharide on the expressions of TLR4 and CD14 in salivary gland epithelial cells

ZHANG Dong-xia, PAN Hong, HE Jun, GUO Wei-min

2018, 16(2): 305-308. doi: 10.16766/j.cnki.issn.1674-4152.000085

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Abstract:
Objective To study the role of LPS-TLR4-CD14 signal transduction pathway in the pathogenesis of Sjogren's syndrome. Methods ①The salivary glands cell of patients were cultured in vitro. After one week, the neonatal cells and labial gland cells were stained with anti-cytokeratin 19 monoclonal antibody PAP to identify neonatal cell sources. ②LPS was added to the cultured neonatal cell and the control group cell at the concentration of 1 μg/ml. Total RNA was extracted at 1, 8, 12, 24, 48 and 72 h after culture. The expression of TLR4 and CD14 mRNA was detected by RT-PCR. ③10, 100, 10³, 10⁴ and 10⁵ ng/ml of LPS were added to the newborn cells pSS group respectively. The LPS was not added to the control group. After 24 h of culture, TLR4 and CD14 mRNA expression were detected respectively. Results ①The results showed that the epithelial cells in the labial glands and neonatal cells were stained;lymphocytes and acinar cells in the labial glands were negative, this proved that the cultured new cells were derived from the duct epithelial cells of the labial gland tissue. ②The expression of TLR4 and CD14 mRNA increased after 1 h of LPS addition, and reached the peak at 8 and 12 h, and significantly decreased after 72 h. ③The expression of TLR4 and CD14 mRNA in pSS neonatal cells was significantly increased by LPS at the concentration of 1ng/ml With the increase of LPS concentration, TLR4 and CD14 mRNA expression continued to increase, When the concentration of LPS reached more than 10⁴ ng/ml, TLR4 and CD14 mRNA expression was plateau, the change was not significant. Conclusion After LPS stimulation, the expression of TLR4 and CD14 mRNA were highly increased in the labial ductal epithelium cell, the expression of TLR4 and CD14 mRNA increased with the increase of the LPS concentration and action times, within a certain range. The above study show that LPS-TLR4-CD14 signal transduction pathways is an important factor in the pathogenesis of SS, and thus reveal the infection participate the incidence of SS.

Risk factors analysis and nursing strategies of COPD patients with pulmonary fungal infection

SHI Yan, FANG Ying, LI Yun-na, WANG Shi-qiang, LI Yan-fang, YIN Cui-ying

2018, 16(2): 309-312. doi: 10.16766/j.cnki.issn.1674-4152.000086

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Objective To investigate the risk factors and nursing strategies of patients with chronic obstructive pulmonary disease (COPD) with pulmonary fungal infection. Methods A total of 84 patients with COPD complicated with pulmonary fungal infection treated from May, 2016 to January, 2017 were selected as the infection group, and 210 patients with COPD without pulmonary fungal infection were selected as uninfected group. The risk factors questionnaire was made, and the age, sex, smoking history, long hospital stay, diabetes mellitus, mechanical ventilation, antibiotic use time, long-term use of glucocorticoids, hypoproteinemia, respiratory failure of two groups were accounted. The univariate and multivariate analysis were used to determine the risk factors for COPD patients with pulmonary fungal infection. Results Univariate results showed that age, hospitalization time, diabetes mellitus, mechanical ventilation, antibiotic use time, long-term use of glucocorticoid, hypoproteinemia and respiratory failure were the risk factors of pulmonary fungal infection in COPD patients. Multivariate logistic regression analysis showed that age, length of stay, diabetes mellitus, mechanical ventilation, antibiotic use time, long-term use of glucocorticoid, hypoproteinemia and respiratory failure were risk factors for pulmonary fungal infection in COPD patients. Conclusion COPD patients are prone to pulmonary fungal infection. age, length of hospital stay, diabetes mellitus, mechanical ventilation, antibiotic use time, long-term use of glucocorticoids, hypoproteinemia, respiratory failure are risk factors for pulmonary fungal infection in patients with COPD. So those risk factors should attract attention and treatment and nursing should be done well to prevent the occurrence of fungal infection.

Influencing factors of anxiety and depression in postoperative patients with laryngeal carcinoma

HAN Jing, XU Rui, WANG Chao

2018, 16(2): 313-315. doi: 10.16766/j.cnki.issn.1674-4152.000087

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Objective Early laryngectomy is the main method in the treatment of laryngeal carcinoma which is effective to certain extent. But the surgical trauma is relatively large, which can cause serious respiratory physiological pronouncing and swallowing dysfunction, and it may cause permanent tracheostomy, appearance change and other issues. It can induce patients'anxiety and depression and seriously affect the prognosis and rehabilitation the quality of life. Thus the study of the influencing factors of anxiety and depression in postoperative patients with laryngeal carcinoma is significant. This study is to investigate and analyze the influencing factors of anxiety and depression in postoperative patients with laryngeal carcinoma. Methods The anxiety and depression scores in the 92 postoperative patients were (46.40±5.30) points and (48.25±4.14) points, the incidence of anxiety was 23.9%, and the incidence of depression was 33.7%. Logistic regression analysis showed that age, education level, surgical method, clinical stage and marital status were the main independent risk factors for anxiety and depression(P<0.05). Total laryngectomy, clinical stage Ⅳ, the education level of high school and above, unmarried, aged 60 years significantly increased the incidence of anxiety and depression in patients. Conclusion Anxiety and depression are common in postoperative patients with laryngeal carcinoma, age, education level, surgical method, clinical stage and marital status are the main influencing factors.

Influences of predictive nursing intervention on the quality of life of patients with gastric cancer after radical gastrectomy

LANG Xiao-hui, LIU Lei

2018, 16(2): 316-318. doi: 10.16766/j.cnki.issn.1674-4152.000088

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Objective To explore the influences of predictive nursing intervention on the quality of life of patients with gastric cancer after radical gastrectomy. Methods From August, 2012 to February, 2016, 132 patients with gastric cancer in our hospital for diagnosis and treatment were selected and randomly divided into observation group and control group, with 66 patients in each group. All patients received laparoscopic radical gastrectomy, while the control group was given routine nursing care in the perioperative period, and the observation group was given nursing intervention based on the control group. We observed and recorded recovery of patients in both groups. Results All patients had successfully completed surgery and no serious complications occurred during the operation. The postoperative bowel sound recovery exhaust time, hospitalization time and anal exhaust time in the observation group[(19.03±5.23) h, (76.76±22.30) h, (12.29±1.84) d respectively] were significantly less than those in the control group[(25.98±6.76) h, (89.55±21.84) h, (16.39±1.73) d]respectively(P<0.05). One month after the operation, complication rate of anastomotic fistula, incision infection, pulmonary infection, intestinal obstruction and fever in the observation group was 4.5%, which was significantly less than 21.2% in the control group(P<0.05). One month after the operation, the scores of cognitive function, physical function, role function, emotional function, and social function of the observation group were significantly higher than those of the control group(P<0.05). Conclusion The predictive nursing intervention can promote the recovery of patients with gastric cancer after radical gastrectomy, reduce the incidence of postoperative complications, and the patients can benefit from the surgery to maximize the quality of life.

Application of intelligent dress in the patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy

JIANG Qing-yu, LI Xiang, FU Gui-fen, HUANG Xiao-yan, ZHANG Jin-tao, WEI Jia-zhang

2018, 16(2): 319-322. doi: 10.16766/j.cnki.issn.1674-4152.000089

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Objective This study is based on the purpose of "high-quality nursing service"(close to the clinical, close to the patient, close to the community, to provide patients with safe, effective, whole-course, seamless, satisfactory care services), to design an intelligent dress for the patients with nasopharyngeal carcinoma. It mainly aims to explore the application of intelligent dress as a new method for the nursing care of the patients with nasopharyngeal carcinoma, and to observe its clinical application effects. Methods A total of 213 cases of nasopharyngeal carcinoma patients from February, 2015 to January, 2016 were divided into two groups. Collected from February, 2015 to July, 2015, 107 cases provided with traditional dress were used as the control group, and 106 cases provided with intelligent dress collected from August, 2015 to January, 2016 were used as the intervention group. Comparisons of the satisfaction for nurses, incidence of grade-Ⅲ radiation dermatitis, incidence of grade-Ⅳ radiation dermatitis were performed between the two groups. Results The satisfaction rate[104(98.1%) vs. 6(5.6%), χ²=178.78, P=0.001] and nurse satisfaction rate[106(100.0%) vs. 3(2.8%), χ²=200.39, P=0.001] were significantly increased in the intervention group. The incidence of grade-Ⅲ radiation dermatitis[3(2.8%) vs. 15(14.0%), χ²=7.23, P=0.007] was significantly lower in the intervention group than those in the control group(P<0.05). Conclusion Intelligent dress can effectively meet the needs of the nursing care for the patients with nasopharyngeal carcinoma, and the process of wearing off is convenient. Intelligent dress is also convenient for medical care operation and observation, improve the satisfaction, and reduce the incidence of grade-Ⅲ radiation dermatitis, with low economic costs. It is worthy of promoting the use of intelligent dress in head and neck cancer ward.

Comparative analysis of the effects of high quality nursing and routine nursing for cataract patients after phacoemulsification

ZHANG Jia-hui, WANG Lin

2018, 16(2): 323-325. doi: 10.16766/j.cnki.issn.1674-4152.000090

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Objective To compare the effects of high quality nursing and routine nursing for cataract patients after phacoemulsification. Methods Used a prospective study, From August, 2013 to February, 2016, 150 cataract patients undergoing phacoemulsification in our hospital were selected and randomly equally divided into observation group and control group with 75 patients in each group accorded to the envelope principles. The control group was given routine nursing, while the observation group was given high quality nursing. The nursing observation was conducted in the two groups for 1 month, and the compliance, satisfaction, changes in visual acuity and complications were recorded. Results During the period of nursing, the compliance of the observation group was better than that of the control group(P<0.05). The postoperative 1 month best corrected visual acuity in the observation group and the control group were 0.87±0.08 and 0.67±0.13 that were significantly higher than that of postoperative 1d of 0.14±0.09 and 0.15±0.11(P<0.05), the postoperative 1 month best corrected visual acuity in the observation group was also significantly better than the control group(P<0.05). The corneal edema, secondary glaucoma anterior chamber exudation, intraocular infection and complication rate in observation group during the nursing was 8.0%, so that was 30.7% in the control group, the observation group was significantly less than the control group(P<0.05). The nursing satisfaction scores in the observation group and control group were (92.25±5.66) points and (84.69±5.96) points, the observation group of nursing satisfaction was significantly higher than that of the control group(t=7.966, P<0.05). Conclusion Compares with routine nursing, phacoemulsification after application of high quality nursing care can improve patient compliance, reduce complications, improve the best corrected visual acuity, which will be helpful to improve the relationship between nurses and patients.

Effects of continuous care on psychological state and medication compliance of patients with acute myocardial infarction after PCI

FU Yong-jun, JIAN Ying, HU Hui-qun

2018, 16(2): 326-329. doi: 10.16766/j.cnki.issn.1674-4152.000091

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Objective To investigate the effects of continuous care on psychological state and medication compliance of patients with acute myocardial infarction after percutaneous coronary intervention (PCI), thus to choose the optimal nursing strategies. Methods We selected 90 patients with acute myocardial infarction after PCI from January, 2016 to May, 2017 treated in the cardiology department in the affiliated hospital of Hangzhou Normal University and randomly divided them into two groups, with 45 cases in each group. The control group received routine care, on the basis of which the observation group received continuous care including regular follow-up, medication guide, and health education. The scores of anxiety, depression, nursing satisfaction and medication compliance were compared between the two groups at the time of discharge 3 or 6 months after discharge. Results By comparison, the anxiety and depression scores when discharged from hospital displayed no significant difference between groups. After 3 months' discharge, the anxiety and depression scores of the observation group were (35.76±6.54), (32.21±5.55), and the control group were (38.15±2.32), (35.78±2.17). After 6 months of discharge from hospital, those in observation group were (32.51±2.54), (30.21±4.45), and the control group (35.45±4.02), (34.78±2.03) in the observation group, which were lower than those in the control group. Medication compliance scores in the observation group at discharge, 3 months and 6 months after discharge from hospital were (9.3±1.3), (12.3±1.4), (14.2±0.4) respectively; those in the control group were (8.3±2.6), (9.6±2.3), (10.3±1.9). And 6 months after discharge, the satisfaction of the observation group was 95.6%, and that of the control group was 77.8%. The two groups had statistical significance (P<0.05). Conclusion Continuous care of patients with acute myocardial infarction after PCI could improve patient compliance together with patients satisfaction, reduce depression, anxiety and other negative emotions, and help to promote the rehabilitation of the patients, which is worthy of promotion.

LOU Da-jun, ZHU Qi-qian, SI Xu-wei, PAN Xiao-jie

2018, 16(2): 330-332. doi: 10.16766/j.cnki.issn.1674-4152.000092

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2018 Vol. 16, No. 2

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