2018 Vol. 16, No. 7

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A survey of the status quo of health resources allocation for the prevention and treatment of chronic respiratory diseases in primary medical institutes in Weifang
PENG Bo, WU Si-nan, ZHANG Peng-jun, TAN Ling-ling, ZHANG Yong, PEI Zheng-cun, XU Yang, YANG Ting, YANG Guo-ru, WANG Chen
2018, 16(7): 1045-1048,1191. doi: 10.16766/j.cnki.issn.1674-4152.000287
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Objective To understand the current situation of health resources allocation, covering human resources, equipment allocation and pharmaceutical setting for the prevention and treatment of chronic respiratory diseases in primary medical institutes in Weifang. Methods The questionnaire survey was conducted among 19 secondary hospitals, 48 community health service centers/township hospitals and 413 community health service stations/village clinics, investigating the person in charge and using stratified cluster sampling method, from December, 2015 to January, 2016 in Weifang. Results ① In terms of health manpower, in secondary hospitals, community health service centers/township hospitals and community health service stations/village clinics, workers are mainly with primary title, accounting for 43.5%, 50.2% and 63.6% respectively, who in second hospitals 41.6% are mainly with college degree, and in other institutes mainly with high school degree or below, accounting for 44.2% and 86.2%. ② In terms of the equipment for the treatment of chronic respiratory diseases, the distribution rate of respiratory function instruments are 73.7%, 4.6% and 1.0% respectively in secondary hospitals, community health service centers/township hospitals and community health service stations/village clinics, the peak flow meters are only in secondary hospitals, allocation rate is 31.6%, community health service centers/township hospitals and community health service stations/village clinics have no peak flow meters. ③In terms of the drugs for the chronic respiratory diseases therapy, in secondary hospitals, community health service centers/township hospitals and community health service stations/village clinics, the distribution rate of inhaled long-acting beta 2-agonists are 73.7%, 18.8% and 14.5%, and the distribution rate of anticholinergics are 78.9%, 10.4% and 6.8%. Conclusion Primary medical institutes in Weifang are currently lack of respiratory function instruments, peak flow meters and drugs for long management of chronic respiratory diseases, for instance, inhaled long-acting beta 2-agonists and anticholinergics, so the coverage of mini respiratory function instruments, mini peak flow meters and inhaled long-acting drugs should be expanded, and the training of knowledge about prevention and treatment of the chronic respiratory diseases and pulmonary function testing operations aimed to primary medical institutes doctors should be strengthened.
CHEN Ai-bin, MAO Shuang-gen
2018, 16(7): 1049-1050.
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A correlation research on serum PECAM-1/IGF-1 levels and clinicopathological features and prognosis of advanced gastric cancer
YUAN Mei-qin, WANG Zeng, WANG Hai-yang, SHI Zhong, LV Wang-xia, ZHONG Hai-jun
2018, 16(7): 1051-1053,1132. doi: 10.16766/j.cnki.issn.1674-4152.000288
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Objective To analyze the relationship between serum PECAM-1 and IGF-1 levels and the clinical significance and prognosis of patients with advanced gastric cancer. Methods The serum levels of PECAM-1 and IGF of 18 patients with advanced gastric cancer were detected by using ELISA before chemotherapy. T-test comparison was used to analyze the correlation between serum PECAM-1 and IGF-1 levels and clinicopathologic feature and survival. Results ① Among the 18 patients. The median overall survival time (mOS) was 460 days. ② There was no significant difference between serum PECAM-1 and IGF-1 expression levels and clinicopathologic feature, including gender (men and women), age (>60 years and< 60 years), pathological type (adenocarcinoma or Signet ring cell carcinoma), and previous radical gastrectomy. ③ No statistically significant difference between the serum mean concentrations of IGF-1 in these died and alive patients(P=0.780). The mean PECAM-1 value between survivors and the dead patients, approaching statistical differences (P=0.050). ④ According to the average level of PECAM-1, patients were divided into two groups (PECAM-1 high group, PECAM-1 low group). The results show that the mOS of the PECAM-1 high group was 283 days, significantly shorter than PECAM-1 low group, which was 484 days, P=0.035. ⑤ According to the average level of IGF-1, patients were divided into two groups (IGF-1 high group, IGF-1 low group). Similarly, the mOS of the IGF-1 high group was 226 days, significantly shorter than IGF-1 low group, which was 357 days(P=0.030). Conclusion ① Here is no correlation between serum PECAM-1 and IGF-1 expression levels and clinicopathologic feature in advanced gastric cancer patients. ② He serum PECAM-1 and IGF-1 expression levels are related to the patient's prognosis and survival in advanced gastric cancer patients. The prognosis and survival is adversely affected in patients with high serum PECAM-1 and IGF-1 concentrations.
Comparison of ambulatory blood pressure levels between obstructive sleep apnea hypopnea syndrome patients combined with primary aldosteronism and without primary aldosteronism
SHENG Hong-yu, YAO Xiao-guang, HEIZHATI Mu-la-li-bie-ke, ZHAO Xin, ABUDONGREYIMU Bu-ha-li-qian-mu, HONG Jing, ZHOU Ling, ZHANG De-lian, LI Nan-fang
2018, 16(7): 1054-1056,1084. doi: 10.16766/j.cnki.issn.1674-4152.000289
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Objective By comparing 24 h ambulatory blood pressure levels between obstructive sleep apnea hypopnea syndrome patients combined with primary aldosteronism and without primary aldosteronism, and to understand the characteristics of the ambulatory blood pressure of OSAHS patients with PA. Methods Total 57 OSAHS patients combined with PA and 477 OSAHS patients without PA in our hospital between September, 2008 and May, 2013 were enrolled into this study. All of the patients were provided with the screening and diagnosis of PA in the standardized state, polysomnography and 24-hours ambulatory blood pressure monitoring (ABPM). Twenty-four hour ambulatory blood pressure levels of the two groups were compared. Results The average 24-h systolic blood pressure, average 24-h diastolic blood pressure and average 24-h artery pressure in the OSAHS patients with PA and the patients without PA were[(147.2±17.9) mm Hg vs. (137.7±15.4) mm Hg,1 mm Hg=0.133 kPa],[(95.7±11.5) mm Hg vs. (88.4±10.7) mm Hg], and[(112.6±13.1) mm Hg vs. (106.6±50.6) mm Hg], respectively, the difference was statistically significant (P<0.05). Conclusion 24-hours ambulatory blood pressure level in OSAHS patient combined with primary aldosteronism is higher than those without PA. We should strengthen the screening of PA in OSAHS patients to provide early correct diagnosis and treatment for the special secondary hypertension patients.
Influence of heterogeneous drugs on complement activation and its clinical significance
XIANG Hui-yao, WANG Hai-yan, XIANG Xi-ying, TENG Ting-bo, LUO Chun-hua, WANG Yan-hua, CHEN Sai
2018, 16(7): 1057-1060. doi: 10.16766/j.cnki.issn.1674-4152.000290
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Objective Complement activity test is commonly used to evaluate the consistency and immune toxicity of drugs. The aim of this study is to establish a sensitive, reliable and fast evaluation criterion for the physical and chemical properties of drugs and complement activation-related pseudo-allergy (CARPA). Methods The standard reaction serum was prepared by pooling sera collected from 140 healthy blood donors in our hospital; a standard positive control was prepared by incubation with a heat-agglutinated IgG and zymosan A; SC5b-9, C5a, C4d and Bb were chosen as the test targets and evaluation criteria of the results was defined, all of these constituted the in-vitro model. By using this evaluation criterion, heterogeneous Amphotericin B and Voriconazole injection were employed to evaluate primarily their immune toxicity, imitation and consistent with commercially drugs. Results The ability of AmBisome and d-AmB activating complement was strong in the prescription of AmB liposome (Ambisome), homemade AmB cholesterol sodium sulfate complex (ABCD) group and injectable amphotericin B (d-AmB) groups. Among them, AmBisome can activate both classical pathways (CP) and alternative pathways (AP), but d-AmB can only activate the alternative pathways (AP). The level of SC5b-9 in the RLD1, RLD2 and RLD3 amphotericin B liposome of serum was the same, the average level was (22.16±0.63)μg/ml; however, the fluctuation in the level of C5a was high, average was (571.32±106.12)ng/ml. The significant difference in the levels of SC5b-9 and C5a was found between the homemade Test1 and Test2 amphotericin B liposome and the RLD1, RLD2 and RLD3 amphotericin B liposome of serum. Conclusion The evaluation criterion in vitro for immune complement activity regulation was preliminarily established by heterologous drugs.
Short and medium-term surgical treatment effects of cardiac valve disease for patients more than 68 years old
SHI Chao, LIU Xue-gang, LIU Yi-yao, LIU Ge, MENG Jin-jin, DIAO Wen-jie, YE Feng-lin
2018, 16(7): 1061-1063,1075. doi: 10.16766/j.cnki.issn.1674-4152.000291
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Objective To retrospectively evaluate the outcome of valvular surgery for the elder patients and to summarize the clinical experience of surgery and perioperative period. Methods From March, 2016 to September, 2017, 25 elderly patients (≥ 68) underwent valvular operations in our hospital, including 16 male and 9 females. There were 18 cases of rheumatic valvular heart disease, 2 cases of infective endocarditis and 5 cases of senile degenerative valvular disease. A total of 14 patients had Mitral valve replacement (MVR), 5 had aortic valve replacement (AVR), 2 had MVR plus AVR, 2 had MVR combined with coronary artery bypass grafting (CABG), 1 had AVR plus CABG combined with ascending aorta replacement, and 1 had AVR combined with mitral valve repair. The other concomitant operation included 11 cases of tricuspid valve repair, 1 atrial thrombus clearance plus resection of left atrial appendage, and 1 left atrial myxoma resection. Results The time of cardiopulmonary bypass time (CPB), aortic cross-clamp, postoperative ventilator, postoperative care, and postoperative hospital stay were (126.2±57.2) min, (72.3±48.2)min, (15.24±6.91)h, (49.12±18.82)h, and (9.5±4.2) days respectively. The operative mortality was 4%. Operation complications included 7 cases of arrhythmia, 2 pulmonary infections, 1 postoperative hemorrhage, and 1 wound dehiscence. After the operation, the cardiac function of the patients was improved significantly, and the activity ability was improved in different degrees. Follow-up time was 1-18 months, 1 patient died of pulmonary infection 7 months after MVR operation. The remaining patients survived with life quality being significantly improved. Conclusion Adequate perioperative management, good myocardial protection and improved operation are safe and effective for elderly patients with valvular heart disease.
Inhibition of miR-451 on invasion and epithelial-mesenchymal transition in osteosarcoma correlates with suppression of NF-κB signaling
CHEN Xiao-dong, DENG Min
2018, 16(7): 1064-1066,1226. doi: 10.16766/j.cnki.issn.1674-4152.000292
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Objective MicroRNA is a class of small non-coding RNAs containing about 22 nucleotides, which has been implicated in many disease including tumors. miR-451 has been shown to be downregulated in several human malignancies and correlated with tumor progression. It has been demonstrated that miR-451 was significantly decreased in osteosarcoma tissues, and the patients with low miR-451 expression have shorter overall and disease-free survival. However, the underlying molecular mechanisms by which miR-451 contributes to osteosarcoma tumorigenesis have not been elucidated yet. Methods In the present study, the effect of miR-451 overexpression on invasion and epithelial-mesenchymal transition (EMT) of osteosarcoma was investigated. First, the lentivirus carrying miR-451 mimics were constructed and transfected into U2OS cells to elevate miR-451 expression. Wound healing test and Transwell assay were conducted to examine the effects of miR-451 overexpression on the migration and invasion of U2OS cells in vitro. Western blot assay was carried out to examine the EMT-associated proteins such as E-cadherin, Vimentin and transcription factor NF-κB. Results The miR-451 overexpression suppressed cell migration and invasion, up-regulated the expression of E-cadherin, down-regulated the expression of Vimentin, and down-regulated the expression of the expression of IKK-β. Conclusion The miR-451 may suppress the migration, invasion and EMT through inhibiting the activities of NF-κB.
Effects of airway humidification with different doses of ambroxol to tracheotomy
ZHOU Qing, XIE Bo, XU Ling-fen, CENG Shi-yin, ZHANG Li-xiu, WU Wei, WANG Yong-bin
2018, 16(7): 1067-1070,1200. doi: 10.16766/j.cnki.issn.1674-4152.000293
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Objective To clarify the clinical value of using Ambroxol in tracheotomy, and investigate the effects of different doses of Ambroxol to airway humidification for tracheotomy, and provide a new idea for the scientific, wholesome, systematic humidification solutions. Methods A total of 80 tracheotomy patients in our hospital between January, 2016 and January, 2017 were divided into group A (no Ambroxol), group B (30 mg/d Ambroxol), group C (60 mg/d Ambroxol), group D (90 mg/d Ambroxol) according to random number table, with 20 cases in each group. The effects of airway humidification among the four groups in the 3rd, 5th and 7th day were compared. Results In the 3rd, 5th and 7th day after humidifying, there was no statistically difference (P>0.05) in the viscosity of sputum among the four groups. The rising sputum pH value and reducing sputum Ca2+ value and α1-Acid glycoprotein value in the group B (30 mg/d), group C (60 mg/d)and group D (90 mg/d) which contained Ambroxol were better than that in group A (no Ambroxol), P<0.05. The higher dose of the Ambroxol used, the stronger effect it would be, but the number of sputum aspiration was increased. In the incidence of stimulating choking cough and airway mucosa bleeding, there was no statistically difference (P>0.05) among the four groups. Group D (90 mg/d) might have the risk of medication side effects. Conclusion For tracheotomy, it is effective to use Ambroxol to continuous airway humidification by micro pump. The dose of 30 mg/d is suitable for patients who have a long-stay. The dose of 60 mg/d is suitable for patients who have a short-stay or need to achieve effects as quickly as possible. The dose of 90 mg/d is suitable for patients who need to be rescued instantly or whose airway is easy to be blocked by the plugs of sputum, and monitoring uric acid of patients during the airway humidification is necessary.
Effect of ultrasound-guided thoracic paravertebral block with dexmedetomidine and ropivacaine on postoperative analgesia in open liver surgery
XI Biao, LI Xiao-hong, CHENG Xiang-yang
2018, 16(7): 1071-1075. doi: 10.16766/j.cnki.issn.1674-4152.000294
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Objective To investigate the effect of ultrasound-guided thoracic paravertebral block with dexmedetomidine and ropivacaine on postoperative analgesia in open liver surgery. Methods Total 40 patients with ASA Ⅰ to Ⅱ in our hospital between January, 2016 and January, 2017 were randomly divided into two groups. In group D, 0.5% ropivacaine 20 ml with 1 μg/kg dexmedetomidine were injected into thoracic paravertebral space guided by ultrasound. In group C, 0.5% ropivacaine were injected into thoracic paravertebral space. The mean arterial pressure (MAP) and heart rate were recorded before the induction of general anesthesia, immediate after the tracheal intubation, the beginning of the operation, 30 minutes after the operation and the end of the operation. The visual analogue scale (VAS) of pain at rest and physical activity state and the Ramsay scores were recorded immediate after extubation, 4 h after operation, 12 h after operation, 24 h after operation, and 48 h after operation. The effective pressing numbers and the adverse reactions were recorded. Results Immediate after the extubation, the Ramsay scores of group D was significantly higher than that in the group C; there was no significant difference in the VAS of pain at rest or physical activity state between the two groups. Four, twelve and twenty-four hours after the operation, the Ramsay scores of group D was significantly higher than those in the group C, and the VAS of pain at rest and physical activity state was significantly lower than that in the group C. There was no significant difference in MAP and HR between the two groups at every time of anesthesia; there were no nausea and vomiting, respiratory depression and other adverse reactions in the two groups. Conclusion 0.5% ropivacaine 20 ml with 1 μg/kg dexmedetomidine can safely enhance the effect of thoracic paravertebral nerve block (TPVB) and prolong the duration of analgesia in open liver surgery.
Correlation between serum prealbumin level and early prognosis in patients with acute myocardial infarction
JU Zhang-lin, ZHOU Yu, XIE Xiang-rong, RUI Shi-bao, CAO Heng
2018, 16(7): 1076-1077,1223. doi: 10.16766/j.cnki.issn.1674-4152.000295
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Objective Acute myocardial infarction (AMI) is a serious disease with high mortality rate, and the detection of risk factors will contribute to the prognosis of patients with AMI. The aim of this study is to determine the serum levels of prealbumin (PA) in patients with AMI and investigate the relationship between the levels of PA and the prognosis of patients with AMI. Methods Total 140 cases of AMI patients, from January, 2014 to December, 2016 in our hospital inpatients, according to the hospital survival or death, were divided into survival group (AS, n=90) and death group(AD, n=50 AMI) and another 60 cases with negative underwent coronary angiography as normal control group(NC). The difference analysis among the three groups were compared the level of PA using ANOVA, and t test was used between the two groups. The factors that may affect the Pearson test to explore PA, Logistic regression analysis of independent risk factors of death of AMI patients. Results PA in group AD was significantly lower than that of NC group and AS group(respectively, P<0.05); PA was related with blood cholesterol esters(r=-2.353, P=0.022), triglycerides(r=1.572, P=0.001), low density lipoprotein(r=3.959, P<0.001) and apolipoprotein A1(r=5.446, P<0.001). Logistic regression analysis showed that PA and age were independent risk factors of death in patients with AMI. Conclusion The decrease of serum PA level is one of the early prognostic factors in patients with AMI, and is an independent risk factor of death in AMI patients.
Effects of dexmedetomidine on stress response and intestinal mucosal barrier function in patients undergoing heart valve replacement
ZHANG Ying, ZHAO Qi-hong, ZHANG Yun-chun, LI Xiao-hong, LI Xiao-li, LIU Gang
2018, 16(7): 1078-1080,1136. doi: 10.16766/j.cnki.issn.1674-4152.000296
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Objective To study the effects of Dexmedetomidine on stress response and intestinal mucosal barrier function in patients undergoing heart valve replacement under cardiopulmonary bypass (CPB). Methods Forty patients with rheumatic heart disease who were scheduled for cardiac valve replacement at the First Affiliated Hospital of Bengbu Medical College from January, 2016 to December, 2016 were randomly divided into control group (group C) and Dexmedetomidine group (group D) according to a random number table, with 20 cases in each group. Before the induction of anesthesia, the patients in group D were intravenously infused with 1 μg/kg of Dexmedetomidine for 10 min followed by continuous infusion at the rate of 0.3 μg/(kg·h) until the end of operation. While the patients in group C were given intravenously with the equal volume of normal saline. The methods of induction and maintenance of general anesthesia are the same in both two groups. Arterial blood samples were collected before administration (T0) and just the initiation of CPB (T1), 30 min after CPB (T2), at the end of CPB (T3), 4 h (T4) and 24 h (T5) after surgery to measure concentrations of cortisol and glucose, and the activity of diamine oxidase (DAO). Results Compared with T0, concentrations of cortisol and blood glucose on T1-T5, and the activity of DAO on T2-T5 were significantly increased (P<0.05) in both two groups. Compared with group C, the concentration of cortisol on T1-T5 and blood glucose on T1-T4, and the activity of DAO on T2-T5 were significantly decreased (P<0.05) in group D. Conclusion Dexmedetomidine is capable to improve the intestinal mucosal barrier function in patients undergoing heart valve replacement under CPB, which may be related to the reduction of stress response.
Clinical curative effect of rhBNP in treatment of senile intractable heart failure
HU Ye-mei, SHI Yu-lu, GUAN Xin, GU Pan-pan, XUAN Ling
2018, 16(7): 1081-1084. doi: 10.16766/j.cnki.issn.1674-4152.000297
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Objective To observe the clinical efficacy of rhBNP in the treatment of senile patients with refractory heart failure. Methods Total 94 patients with refractory heart failure in the second hospital of Bengbu from March, 2015 to February, 2017 were enrolled into this study. The patients were randomly divided into observation group and control group according to random number table, with 47 cases in each group. The control group was adopted routine treatment for heart failure, such as dopamine or digitalis, angiotensin inhibitors, furosemide diuretics. The observation group was given rhBNP based on the control group. The clinical symptoms, signs and cardiac function were observed before and after the treatment. The levels of serum of NT-proBNP, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), heart rate and adverse drug reactions were observed in both groups before and after the treatment for 7 days. Results After the treatment, the effective rate of ameliorating refractory heart failure was significantly higher in the observation group than that in the control group (P<0.01), and the difference was statistically significant. Compared with the control group, the NT-proNBP value of the observation group was significantly decreased, the EF was significantly increased and the heart rate was significantly decreased, and the difference was statistically significant (P<0.05). There was no significant difference in adverse reaction rate between the two groups (P>0.05). Conclusion RhBNP treatment of elderly patients with refractory heart failure can significantly improve the clinical symptoms and cardiac function of patients with heart failure, significantly reduce the level of serum NT-proNBP, increase LVEF, reduce heart rate, while no significant adverse drug reaction. The curative effect of rhBNP is good on senile refractory heart failure, and it can significantly improve the hemodynamic parameters without obvious significant adverse reactions.
Clinical application of 3D printing plate in unicompartmental knee arthroplasty
FAN Zong-qing, NIE Yu, FU Dong-lin, LIU Chao-yu, LI Li, LI Yi-fan, ZHANG Feng
2018, 16(7): 1085-1087,1215. doi: 10.16766/j.cnki.issn.1674-4152.000298
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Objective To explore the short-term outcome of unicompartmental knee arthroplasty (UKA) with 3D print positioning osteotomy guide plate in treatment of end-stage medial compartment osteoarthritis (MCOA). Methods From June, 2016 to October, 2016, 25 patients with MCOA were treated in our department. The patients were divided into 3D group and conventional group according to the different surgical methods. The operation time, volume of bleeding (Intraoperative volume of bleeding with postoperative drainage), postoperative tibial prosthesis deviation (the coronal angle between perpendicular line of tibial prosthesis and tibial mechanical axis) and postoperative 1, 3, 6 months HSS score were recorded and compared separately to evaluate the efficacy of UKA with 3D printing guild plate. Results All patients were followed up to 6-10 months (average of 8 months). The amount of bleeding, tibial prosthesis deviation in 3D group[(237.1±143.7)ml, 1.5±0.9] was superior to the conventional group[(391.2±163.8)ml, 2.9±1.6], the operation time between the two groups[3D group:(89.2±19.0)min, conventional group:(94.2±30.3)min] was no significant difference. The differences in HSS score before the operation, 1, 3 and 6 months after the operation in the same group compared to each other were statistically significant. The HSS score had developed in a good way over time. However, the differences of postoperative HSS score between the two groups at the same period were not significant (P>0.05). Conclusion UKA with 3D print positioning osteotomy guide plate in treatment of MCOA has a good short-term outcome with less bleeding, accurate osteotomy and individualized treatment.
Incidence of sodium disorder in the moderate-severe traumatic brain injury patients and its relationship with prognosis and the injured part
DAI Jin-long, LI Ji-bo, DU Xiang-yang, XU Li, YIN Liang
2018, 16(7): 1088-1090. doi: 10.16766/j.cnki.issn.1674-4152.000299
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Objective To determine the incidence of sodium disorder in the moderate-severe traumatic brain injury patients and its association with the location of intracranial hematoma and mortality of patients. Methods A total of 452 patients faced moderate and severe traumatic brain injuries diagnostic criteria in our hospital from January, 2014 to May, 2017 were enrolled into this study. The patient's general information was recorded after admission. All the patients underwent cerebral computed tomography to locate intracranial hematoma and received GCS. The serum sodium level immediate after admission and duration the stay in hospital, the degree of conscious disturbance and mortality were as research variable. SPSS 20.0 was used to analyze the relationship between the incidence of sodium disorders and the location of intracranial hematoma and mortality. Results The incidence of sodium disturbances was 45.1%(204/452):128 patients were with hypernatremia and 76 with hyponatremia. Sodium disturbances were detected in the first sample in 50% of the patients. The serum sodium level in 50% of the patients with hyponatremia was less than 125 mmol/L by a series of tests. There was significant difference in the incidence of sodium disorders among the patients with different location of injury (P<0.5). The patients who got subdural hematoma, the brain hematoma and diffuse axonal injury would have a better chance of sodium disorders. The mortality of patients with abnormal blood sodium was higher than that in the normal group. Conclusion The incidence of sodium disorder in the moderate-severe traumatic brain injury patients is higher, especially in the patients get a subdural hematoma, brain hematoma and diffuse axonal injury. Abnormal blood sodium may be associated with mortality.
Effect of preemptive analgesia with dexmedetomidin on the postoperative pain in patients undergoing upper limb fracture surgery
ZHAN Lin-sen, LAN Yun-ping, XIA Chang-xing, YU Gong-min, SHAO Xue-quan
2018, 16(7): 1091-1093. doi: 10.16766/j.cnki.issn.1674-4152.000300
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Objective To explore the application value of preemptive analgesia with dexmedetomidin in the operation of upper limb fracture. Methods A total of 106 patients with upper limb fractures who underwent surgical treatment between March, 2015 and June, 2017 were selected as the subjects. They were randomly divided into control group and observation group with 53 cases in each group. The two groups were treated by general anesthesia with tracheal intubation. The control group was injected with isodose saline for 10 min before anesthesia, while the observation group pumped 0.5 g/kg right Dexmedetomidine for 10min before anesthesia and intraoperative pump injection right beauty pyrimidine 0.3 μg/kg, and the hemodynamic parameters at 15 min before operation(T1), 3 h after operation(T2), 6 h after operation(T3) and 12 h after operation(T4), pain degree at T2, T3 and T4, and the adverse reactions were observed. Results At T1, there was no significant difference in hemodynamic indexes between the two groups (P>0.05), There was no significant difference of MAP and HR between the T2, T3, T4 and T1 in the observation group (P>0.05). At T2, T3 and T4, MAP and HR in the control group were significantly higher than those in the observation group, and the difference was statistically significant (P<0.05). At T2, T3 and T4, VAS score of the observation group was significantly lower than that of the control group. The number of times of postoperative patient-controlled analgesia pump was significantly less than that of the control group (P<0.05). The incidence of adverse reactions in the observation group was 9.43%, compared with 24.53% in the control group, the difference was statistically significant (P<0.05), and no serious adverse reactions occurred in the two groups. Conclusion The application of Dexmedetomidine preemptive analgesia in patients with upper limb fracture surgery can effectively reduce postoperative pain, maintain hemodynamic stability and reduce the dosage of postoperative patient-controlled intravenous analgesia, and it is safe and worthy of promotion.
Clinical effects of locking plate fixation of proximal humerus fracture
HOU De-sheng, LU Cheng, XUE Tian-le, LIU Lei, ZHONG Wen-jun, DU Jun, YANG Jing-song
2018, 16(7): 1094-1096,1147. doi: 10.16766/j.cnki.issn.1674-4152.000301
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Objective To explore the clinical effect of locking plate fixation of the proximal humeral fractures. Methods Total 32 cases of proximal humerus fracture treated with locking plate in orthopedics department of the First People's Hospital of Chuzhou from December, 2013 to June, 2016. The block anesthesia or general anesthesia was carried out during the operation. Via intermuscular space between pectoralis major and deltoid muscle, deltoid muscle partial insertions were loosen, and the end of the fracture was exposed, the large and small nodules and long head tendons of the biceps brachii were identified. The suture stitched in the joint of the tendon and bone of the size nodules was used as a traction line. After the fracture reduction is satisfactory, the proximal locking plate of the humerus was placed. After the operation, the function of the shoulder joint function was individualized according to the type of fracture and the fixation of the bone. Function, motion range and anatomical position were evaluated by Neer scoring system. Results The X-ray film was reviewed after the operation:31 patients were satisfied with fracture reduction, and one case was not well restored. All 32 patients were followed up for 10 to 16 months. The fracture healing time was 4-8 months. All 32 patients had bone healing, 31 patients were satisfactory reduction and one patient had poor reposition. There was no shoulder peak impact, no reset loss, no humeral head necrosis, no incision infection, no screw loose and wear the humeral head. The function of shoulder joint was evaluated by the Neer scoring method which postoperative pain (35 points), function (30 points), motion range (25 points), and anatomical position (10 points). Twenty-eight cases got excellent result, 2 cases good and 2 case poor. Conclusion The locking plate inserted into the path through the pectoralis major deltoid muscle for proximal humerus fractures has the advantages of fixed firmness, good postoperative function and few complications.
EEG grading in patients with severe cerebrovascular disease and its relationship with clinical prognosis
XU Jin-yuan, GONG Min-cao
2018, 16(7): 1097-1099,1157. doi: 10.16766/j.cnki.issn.1674-4152.000302
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Objective To investigate the EEG grading (EEG) of severe cerebrovascular disease (SCVD) and to analyze its relationship with clinical prognosis, with a view to provide a reference for the clinical prognosis of SCVD. Methods A total of 102 SCVD patients were selected from June, 2015 to March, 2017 and treated in neurology department of Traditional Chinese Medical Hospital of Zhejiang Province. EEG was monitored for these patients, including the Glasgow Coma Scale (GCS) and EEG Surveillance, to analyze the relationship between EEG classification and prognosis, GCS score and prognosis; the relationship between the related factors and the prognosis of patients with SCVD was studied by Logistic regression analysis. Results All 102 patients were followed up for 7 days and 48 patients survived and 54 patients died; EEG grade Ⅰ patients in 51 cases, 43 cases of survival, 8 cases of death, grade Ⅱ patients in 9 cases, 5 cases of survival, 4 cases of death, Ⅲ, Ⅳ, Ⅴ, Ⅵ grade patients all died, the mortality rate was 100%, EEG grading prognosis was 48 cases of survival, 54 cases died; Through the GCS score scale, found in 102 patients, the score was less than 3 points in 60 cases, GCS score was 2.63±0.32, the score was greater than 3 points in 42 cases, GCS score was 5.98±0.86; The area under the ROC curve (AUC) of EEG and GCS were 0.882 and 0.715, and the AUC values of the EEG and GCS were significantly different (P<0.05); SCVD prognosis was associated with GCS score and EEG grade. Conclusion EEG monitoring and grading results used in clinical can better reflect the severity of SCVD, and can better predict the prognosis, and it is worthy of clinical application.
Effect of Sevoflurane inhalation in different time course on liver ischemia reperfusion injury in patients with partial liver resection
WU Yan-wu, CAI Chang
2018, 16(7): 1100-1103. doi: 10.16766/j.cnki.issn.1674-4152.000303
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Objective To investigate the effect of Sevoflurane inhalation in different time history on liver ischemia-reperfusion injury in patients with partial liver resection. Methods Ninety cases of partial hepatectomy in our hospital from January, 2016 to December, 2017 were divided into Sevoflurane pre-treatment group, Sevoflurane after-treatment group and Sevoflurane whole course inhalation group, with 30 cases in each group. Blood samples were taken at preoperative (T0), end (T1), postoperative 24 h (T2), postoperative 3 D (T3), and postoperative 5 D (T4) and postoperative 8 D (T5). Serum SOD, MDA, IL-6, IL-10 and TNF-alpha were detected, and the number of interruption, blocking time, bleeding volume and postoperative hospitalization time were recorded. Results ALT, AST, IL-6, TNF-alpha, IL-10 and SOD levels of pre-treatment group at different time points of T2, T3, T4 and T5 were higher than those of after-treatment group and while course inhalation group (P<0.05); ALT, AST, IL-6 and TNF-alpha levels of after-treatment group at different time points of T2, T3, T4 and T5 were lower than those of while course inhalation group (P<0.05); IL-10 and SOD levels of while course inhalation group at different time points of T2, T3, T4 and T5 were lower than those of after-treatment group (P<0.05). MDA levels of pre-treatment group at different time points of T2, T3, T4 and T5 were lower than those of after-treatment group and while course inhalation group (P<0.05); MDA levels of while course inhalation group at different time points of T2, T3, T4 and T5 were lower than those of after-treatment group (P<0.05). Conclusion The Sevoflurane pre-treatment can reduce hepatic ischemia reperfusion injury in patients with liver resection, probably through the IL-6 and TNF- alpha activation and release to inhibit the production of free radicals and lipid peroxidation, activate and release IL-10, and reduce the liver organ and tissue damage.
Clinical research of intratympanic triamcinolone acetonide for otitis media with effusion
LIU Guang-hua
2018, 16(7): 1104-1106. doi: 10.16766/j.cnki.issn.1674-4152.000304
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Objective Oral corticosteroids are commonly used to administrate otitis media with effusion (OME), which majorly caused by mechanical obstruction and infection was routinely treated by tympanic membrane puncture with oral corticosteroids. In this study, triamcinolone acetonide infusion were employed to search for a more effective therapeutics. And the effects were compared with the aformentioned routine therapeutics. Methods A total of 100 cases of OME were randomly divided into experimental group and control group. After auripuncture, the experimental group received intratympanic injection of triamcinolone acetonide, while the control group received oral glucocorticoids treatment. All patients were administrated with Cefaclor Sustained Release Tablets, 0.375 g, b.i.d and ambroxol, 30 mg, t.i.d, for 10 days, and Xylometazoline Hydrochloride Nasal Spray (b.i.d) for 1 week. Pure tone test and acoustic immittance were performed in 2 weeks and 1 month later. All patients were followed up for 3 to 6 months to observe the recurrence rates. Results One month after the treatment, the cure rate in the experimental group and control group was 75.00% (45/60) and 51.85% (28/54); the follow-up showed that the recurrence rate was 6.67% (3/45) in the experimental group and 25.00% (7/28) in the control group. The cure rate was higher in the experimental group than in the control group, the difference in curative effect (cured, effective or not) between the two group was statistically significant (P<0.05). The recurrence rate decreased in the experimental group and the difference was not statistically significant (P>0.05). No complications occurred in both groups. Conclusion Intratympanic triamcinolone acetonide in the treatment of OME is easy to operate, with reliable curative effect and highly safe. It is worthy of clinical promotion.
Correlation between bone density and serum leptin, leptin receptor levels in patients with lumbar compression fracture
LIN Li-xing, YU Lei-jun, LIU Liang-le, HE Shao-qi
2018, 16(7): 1107-1109. doi: 10.16766/j.cnki.issn.1674-4152.000305
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Objective To investigate the correlation between bone mineral density and leptin, leptin receptor in patients with lumbar compression fracture. Methods From January, 2016 to January, 2017, 50 patients with single lumbar vertebral compression fracture were selected as an observation group, and 50 healthy adults were selected as a control group. The bone mineral density of the fractured vertebral body, the upper and lower vertebral body, leptin and soluble leptin receptor were detected, and the correlation between the corresponding vertebral body and leptin, soluble leptin receptor were analyzed. Results When compared with the control group, the observation group got a decreased bone mineral density of the fracture vertebral[(0.42±0.17) g/cm2 vs. (0.67±0.18) g/cm2, P<0.001]; a lower level of bone mineral density of the upper vertebral[(0.48±0.12) g/cm2 vs. (0.61±0.15) g/cm2, P<0.001]; and a reduction in bone mineral density of the lower vertebral[(0.51±0.14) g/cm2 vs. (0.66±0.17) g/cm2, P<0.0001]; a decrease in leptin[(2.28±0.42) μg/ml vs. (2.74±0.71) μg/ml, P<0.001]; and an increase in soluble leptin receptor[(25.57±7.48) kU/L vs. (21.62±8.12) kU/L, P=0.013]. Bone mineral density of the fractured vertebral body, the upper and lower vertebral were positively correlated with serum leptin (r=0.197, 0.214 and 0.211, P<0.05). Conclusion The serum leptin level is significantly decreased in patients with lumbar compression fracture, which is related to the loss of vertebral bone density.
Clinical efficacy of modified lauromacrogol tissue glue sandwich injection combined with esophageal variceal ligation in treatment of esophagogastric varices
CHENG Ming, LOU Miao-zi
2018, 16(7): 1110-1112,1124. doi: 10.16766/j.cnki.issn.1674-4152.000306
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Objective To evaluate the clinical efficacy and safety of modified lauromacrogol tissue glue sandwich injection combined with esophageal varices ligation in treatment of esophagogastric varices. Methods From January, 2016 to December, 2017, 82 inpatients were enrolled in the study. 41 patients were classified as the control group from January, 2016 to December, 2016, while other 41 cases were classified as the observation group from January, 2017 to December, 2017. The observation group received the modified lauromacrogol tissue glue sandwich injection combined with esophageal varices ligation, while the control group was treated by tissue glue sandwich injection combined with esophageal varices ligation. The rate of re-bleeding, improvement of esophagogastric varices and complications were observed after the treatment. The data were analyzed by suing SPSS 21.0 statistical software. Results After the treatment, the hemostatic success rate of the observation group was higher than that in the control group, with statistical significance (χ2=4.493, P=0.034). There was no significant difference in the early re-bleeding rate (P>0.05) and in the rate of delayed re-bleeding (P>0.05). There was no statistical difference in esophageal varices and gastric fundus vein varices between the two groups (P>0.05); there was no statistical difference in the postoperative fever, post sternal pain or discomfort and the total incidence of complications between the two groups (P>0.05). Conclusion Modified lauromacrogol tissue glue sandwich injection combined with esophageal varices ligation is a relatively simple, safe and effective method for esophagogastric varicose, with some advantages. The longer term efficacy and safety need to be further evaluated by multicentre randomized controlled clinical trials and lengthening the survey cycle.
Efficacy of concentrated growth factors combined with Bio-Oss in the treatment of bone defect after jaw cyst surgery
LI Yong, CHENG Ru-yu, PENG Xue-sheng, LI Da-yu, ZHAI Shi-ying, WU Qian, XU Jin-cheng
2018, 16(7): 1113-1115. doi: 10.16766/j.cnki.issn.1674-4152.000307
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Objective To observe the clinical effect of concentrated growth factors (CGF) combined with Bio-Oss in the treatment of bone defect after jaw cyst surgery, and to provide reference for its popularization and application. Methods A total of 30 cases of medium and large bone defect after jaw cyst surgery in our hospital between July, 2016 and October, 2017 were selected and treated with concentrated growth factors combined with Bio-Oss. The surface of bone defect was covered with double layer concentrated growth factors membrane. The postoperative follow-up was performed at third, sixth, twelfth months after the operation, and the curative effect was evaluated by clinical and imaging examinations. Results All 30 cases were grade I healing after the operation. The imaging examination showed that a large number of new bone formed after 3 months, the bone defect area decreased obviously than preoperative; After 6 months, the new bone density was increased and a large number of bone trabeculae were formed; besides, the new bone was indistinct with the surrounding bone; After 12 months, the density of the bone area was close to the surroundings, the boundary disappeared. The filling material, new bone and surroundings grew well, and the bone defect area was completely repaired, showing good soft tissue and bone tissue effect. Conclusion The concentrated growth factors combined with Bio-Oss can effectively repair the bone defect after jaw cyst surgery and promote soft tissue healing. It is expected to be a new and effective way to apply in clinic.
Trans-foraminal and inter-laminar percutaneous endoscopic lumbar discectomy treatment for L4-5 down-migrating disc herniating
ZHU Min-yu, LI Chi, TENG Hong-lin, WANG Jing, WANG Yu, ZHOU Yang, HUANG Ke-lun, LIN Chao-wei, WU Shi-yang
2018, 16(7): 1116-1120. doi: 10.16766/j.cnki.issn.1674-4152.000308
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Objective To compare advantages and disadvantages of trans-foraminal (TF) and inter-laminar (IL) percutaneous endoscopic lumbar discectomy (PELD) for the treatment of down migrating L4-5 lumbar disc herniation. Methods A total of 55 consecutive patients with down-migrated lumbar disc herniation at L4-5 level who were treated percutaneous transforaminal and interlaminar endoscopic discectomy from June, 2014 to December, 2016 were included in this retrospective study. The patients were divided into two groups according to the treatment they received. Group A was treated by percutaneous interlaminar endoscopic discectomy and group B was treated by percutaneous transformational endoscopic discectomy. The age, sex, degree of herniated disc migration, surgical time, length of hospital stays and related surgical outcomes were all reviewed. Clinical outcomes were measured using pre-operative and post-operative visual analogue scoring (VAS), Oswestry Disability Index (ODI) and Macnab's scoring. The MRI characteristic of different migration degree was also compared. Results The average follow-up time for the 55 patients was 6 month. Compared with group A, group B showed a shorter operative time (P<0.05). The mean VAS and ODI after surgery were improved dramatically in both groups (P<0.05). However, the rate of this change was better in group B as compared group A (P<0.05). There was no significant difference in average rate of change in VAS and ODI score among low-grade down migrating disc herniation group (AL vs. BL), P<0.05. However, among the high grade down migrating disc herniation (AH vs. BH), average rate of change in VAS and ODI score was better in BH than AH group (P<0.05). There were no complications such as dural tear, nerve root injury, infection and hematoma formation in both groups. Conclusion TF and IL PELD are safe and effective surgical approach for down migrating L4-5 lumbar disc herniation. Compared with TF-PELD, IL-PELD can be more effective treatment for high grade down migrating disc herniation, and it is associated with potential advantages, including surgical time and average rate of change in VAS and ODI score.
Study on the effect of Huangqi Xilingpi Decoction combined with Huoxuetongmai Tablet in the treatement of hypercoagulant of nephrotic syndrome on serum C-reactive protein, tumor necrosis factor-α and hemorheology
DUAN Xue-feng, WANG Shuang-zhu, YE Hua-mao, YANG Hai-hua, CHEN De-jun, LI Chun-ping
2018, 16(7): 1121-1124. doi: 10.16766/j.cnki.issn.1674-4152.000309
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Objective To investigate the effects of Huangqi Xianlingpi decoction combined with HXTMT syndrome in patients with high serum CRP on the coagulation effect of nephropathy, TNF-alpha and blood rheology. Methods From March, 2014 to February, 2016, in our hospital inpatient or outpatient treatment of nephrotic syndrome in patients with high blood coagulation in 78 cases, were randomly divided into 2 groups, 39 cases in each group, the control group was given prednisone, low molecular weight heparin treatment; observation group on the basis of Huangqi Xianlingpi Decoction Combined with Huoxue Tongmai tablet the treatment, were treated for 2 months for a course of treatment, compared the clinical efficacy of the two groups before and after treatment, blood rheology, CRP, NO, TNF-α, ET-1 and renal function index, and record adverse events. Results Compared with before treatment, the two groups after treatment hematocrit, erythrocyte aggregation index, whole blood viscosity, plasma viscosity decreased, serum CRP, TNF-α, ET-1, 24 h Pro, elevated serum NO, BUN, Scr levels decrease, increase the total protein level (P<0.05). Compared with the control group, the observation group after treatment hematocrit, erythrocyte aggregation index, whole blood viscosity, plasma viscosity, low serum CRP, TNF-alpha, low ET-1, high serum NO, 24 h Pro, BUN, Scr level is low, the total protein levels were higher (P<0.05). The control group had no difference with the observation of non-performing rate of 17.95% group 23.08% non-performing rate comparison (P>0.05). Conclusion Huangqi Xianlingpi decoction combined with Huoxue Tongmai Tablet on blood coagulation in patients with nephrotic syndrome with high curative effect, and no increase in adverse reactions, and reduce CRP, TNF-α, improve endothelial and blood rheology.
The investigation of prevalence and risk factors of prediabetes among the middle-aged and elderly people in Humen area
ZHANG Yan-he, CENG Zhi-qiang, HUANG Jian-sheng, YANG Yuan-sheng
2018, 16(7): 1125-1127. doi: 10.16766/j.cnki.issn.1674-4152.000310
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Objective The incidence of prediabetes is increasing year by year in recent years, this paper is to investigate the prevalenc of prediabetes and its related risk factors among the middle-aged and elderly people in Humen area to provide the evidence for prevention and cure strategy of prediabetes. Methods One thousand and fifty volunteers were collected by stratified sampling randomly in Humen from January to December in 2016, who were divided into normal glucose tolerance (NGT) group, pre diabetes (PD) group and diabetes (DM) group according to their blood glucose levels. The demography and medical examination databases of volunteers were gathered by questionnaire, The levels of blood-fasting sugar, triglyeride (TG), low density lipoprotein (LDL), serum uric acid (SUA) and glycosylated hemoglobin 1c (HbA1c) in serum were tested by automatic biochemistry analyzer. The prevalence of prediabetes and diabetes mellitus were analyzed by rate, the risk factors of prediabetes were analyzed Logistic regression. Results One thousand and two people had completely finished the questionnaire, the qualified rate was 95.43%, the prevalencs of prediabetes, diabetes mellitus were and HbA1c step up in prediabetes were 23.95%, 7.88% and 55.00% respectively. The levels of SUA, TG, LDL and HbA1c in patients with PD were higher than that in NGT people (P<0.05). Logistic regression analysis showed that aging, family income, past history of illness, body mass indexes (BMI), waistline, TG, LDL and SUA were the independent risk factors for prediabetes. However, the educational level and physical exercise were the protective factors factor for prediabetes. Conclusion The prediabetes is highly prevalent in the middle-aged and elderly population in Humen. We should make the prevention and cure schema as early as possible according to the prediabetes risk factors and protective factors so as to stop diabetes and it's complications happen.
Effect of combined multiple self-check parameters on management of patients with chronic heart failure
LI Zhi-qiang, FU Yong-hua, WANG Chun-yan, JIANG Qing-yuan, CENG Hong-jun, HU Chun-yan
2018, 16(7): 1128-1132. doi: 10.16766/j.cnki.issn.1674-4152.000311
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Objective To manage the patients with chronic heart failure (CHF) through combining the multiple self-check parameters of body weight, 6-minute walk test (6-MWT), resting heart rate (RHR), plasma brain natriuretic peptide (BNP), evaluate the effect of combined multiple self-check parameters on cardiac function status, re-hospitalization, the prognosis of patients, and discuss the correlations between the parameters. Methods Total 207 patients with CHF of New York Heart Association (NYHA) cardiac function grade Ⅱ-Ⅳ in Pudong hospital from February, 2015 to April, 2016 were recruited. The patients were randomly divided into the special messenger follow-up management group (manage group) and routine follow-up visit group (control group) according to the date of discharged from hospital after the patient's state was improved by treatment. All patients were followed up for 12 months. The body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral white blood cell (WBC), hemoglobin (HB), platelet (PLT) count, fasting plasma glucose (FPG), alanine transaminase (ALT), total bilirubin (TBIL), serum creatinine (SCr), potassium (K+), natrium (Na+), chlorine (Cl-), BNP, NYHA cardiac function grade, left ventricular ejection fraction (LVEF), 6-MWT, sleep heart rate (SHR) and morning RHR were recorded. Results ① After one year follow-up, the body weight, BNP, SHR and RHR of the manage group patients were significantly lower than those in the control, the LVEF and 6-MWT were significantly higher than those in the control (P<0.05), the SCr, K+, Na+, Cl- and NYHA cardiac function grade were not different statistically between the two groups (P>0.05). ② The re-hospitalization, mean hospitalization day and death after one year follow-up between the groups were different statistically (P<0.05). ③ There were good correlations between the multiple self-check parameters of body weight, 6-MWT, RHR, BNP and LVEF (P<0.05). Conclusion The program of combining multiple self-check parameters to manage the patients with chronic heart failure all-the-way can improve the patient's cardiac function status, reduce hospital readmission and hospitalization day, decrease mortality, reduce the consumption of medical resources effectively, and had significantly medical and social effects.
Application of uterine artery embolization in midtrimester termination of placenta previa
ZHANG Hong, CHEN Qin-fang, QIN Xiao-li
2018, 16(7): 1133-1136. doi: 10.16766/j.cnki.issn.1674-4152.000312
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Objective To evaluate the role of uterine artery embolization in midtrimester termination of placenta previa. Methods A retrospective analysis was performed for 33 women with complete placenta previa in midtrimester termination in the International Peace Maternity and Child Health Hospital from January, 2007 to June, 2017. Eleven women induced by prophylactic UAE and MTX therapy as observation group;the other 22 women induced without prophylactic UAE as control group. We compared patient characteristics, intraoperative blood loss and and outcomes. For outpatient, the menstruation recovery was follow-up by telephone after termination of pregnancy. SPSS 23.0 was used to analyze data. Results ① There was no significant difference between the observation group and the control group in the age, gravidity, parity, placenta previa position, previous cesarean section, induced labor method, infection, success rate of induction and placental adhesion(P>0.05). Comparing the two groups, the prophylactic UAE and MTX therapy can reduce the amount of bleeding effectively (P=0.031) and increase induction time significantly (P=0.021). ② The emergency UAE is a very efficacious method during excessive intrapartum bleeding in 4 cases of control group. ③ Menstrual recovery time:uterine artery embolization group (lost 1 case) was (51.93±21.24) days, non-uterine artery embolization group (lost 4 cases) was (40.29±11.43) days, P=0.093. Conclusion Uterine artery embolization is relative safe and effective in the induction of second trimester termination with completely placenta previa. Uterine arterial embolization had no effect on menstrual recovery and fertility after induction of labor.
The efficacy of asarone injection combined with bronchoalveolar lavage for refractory Mycoplasma pneumonia in Children
WANG Qing-qing, SU Wei-dong, ZHANG Wei-wei, LAN Yin-le
2018, 16(7): 1137-1140. doi: 10.16766/j.cnki.issn.1674-4152.000313
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Objective To explore the efficacy of asarone injection combined with bronchoalveolar lavage for refractory mycoplasma pneumonia (RMPP) in children, thus to provide reference for optimizing treatment. Methods A total of 86 cases of RMPP children from January, 2015 to January, 2016 in our hospital were divided into the control group (n=43) and the treatment group (n=43) by a randomized way. The children were given regular treatments including anti-infection and spasmolysis. The control group was given bronchoalveolar lavage; the treatment group was given asarone injection on the basis of control group. The clinic effects of two groups were compared. Before and after the treatment, the levels of PaCO2, PaO2, pH, CRP, ESR and classification of neutrophils were detected in the two groups. The release time of lung shadow, high fever, cough and lung sound in the two groups were observed. The rates of complication and adverse action were observed. Results In the treatment group, the total effective rate was 90.7%, significantly higher than 69.8% in the control group (P<0.05). The levels of PaO2 and PH were (73.64±7.74) mm Hg and (7.35±0.15) in the treatment group, significantly higher than that in the control group (P<0.05), while the level of PaCO2, CRP, ESR and classification of neutrophils were (49.45±6.78) mm Hg, (23.38±3.36) mg/L, (32.87±4.62) mm/h and (43.62±6.72)%, significantly lower than the control group (P<0.05). The release time of symptom were significantly shorter in the treatment group than which in the control group (P<0.05). There were no serious complication and adverse actions occurred in the patients. Conclusion The effect of asarone injection combined with bronchoalveolar lavage for RMPP in children is affirmative and worth to the next research.
Clinical effects of hysteroscopy combined with vaginal surgery versus hysteroscopy combined with laparoscopy on cesarean section scar diverticulums
LIU Jin-yu
2018, 16(7): 1141-1143. doi: 10.16766/j.cnki.issn.1674-4152.000314
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Objective To compare the clinical effects of hysteroscopy combined with vaginal surgery and hysteroscopy combined with laparoscopy in the treatment of cesarean section scar diverticulums, and explore the best method for cesarean section scar diverticulums. Methods Total 62 cases of cesarean section scar diverticulums confirmed by transvaginal sonography, with prolonged menstrual periods after the caesarean, were treated in our hospital between February, 2012 and September, 2015. The patients were divided into two groups according to the operation. Thirty-three patients in group A received hysteroscopy combined with vaginal surgery, while 29 patients in group B received hysteroscopy combined with laparoscopy surgery. There were no significant difference in the age and pregnant times. The operative time, hospitalization cost, intraoperative blood loss and postoperative vaginal bleeding time and hospitalization time were analyzed. Results In group A and B, there were significant difference in the operative time[(42.9±15.7)min vs. (60.5±12.5)min], hospitalization cost[(5 962±538.4)yuan vs. (12 013.4±680.2)yuan], intraoperative blood loss[(24.9±16.0) ml vs. (35.1±17.8) ml] and postoperative vaginal bleeding time[(9.6±3.6)days vs. 8.0±2.2)days], all P<0.05. There were no significant different between the two groups in the hospitalization time[(8.7±1.3) days vs. (9.08±1.08) days], amelioration of postoperative menstrual cycle (93.94% vs 93.1%), postoperative secondary pregnancy rate (66.67% vs. 71.43%) and postoperative recurrence rate (11.11% vs. 9.5%), P>0.05. Conclusion Both hysteroscopy combined with vaginal surgery and hysteroscopy combined with laparoscopy are suitable for Cesarean section scar diverticulums, however, transvaginal operation might be recommended for its short operation time, low hospitalization cost and less trauma, though the surgical field of transvaginal operation is narrow and surgical skills of the surgeon must be sophisticated.
Influences of salvia miltiorrhiza injection combined with labetalol hydrochloride on serum hcy/β2-mg levels and outcome of maternal and infant in patients with gestational period hypertension
WEI Na, MAO Ya-ping, SHANG Qian-nan
2018, 16(7): 1144-1147. doi: 10.16766/j.cnki.issn.1674-4152.000315
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Objective To investigate the clinical efficacy and safety of Labetalol Hydrochloride combined with salvia miltiorrhiza injection in treatment of patients with gestational period hypertension. Methods Total 78 cases of gestational period hypertension in our hospital from November, 2015 to April, 2017 were randomly divided into control group (n=39) and study group (n=39) according to random number table. The control group was treated with labetalol hydrochloride and the study group was treated with labetalol hydrochloride combined with salvia miltiorrhiza injection. The course was 10 days. The clinical efficacy, DBP, SBP, serum β2-MG and Hcy levels, the maternal and infant outcomes and rate of adverse reactions were compared between two groups. Results The total effective rate of the study group was 94.87%, which was higher than that in the control group (74.36%), P<0.05. After the treatment, the DBP and SBP in the two groups were decreased, and the changed degree of DBP and SBP in study group were lower than those in control group (t=15.760, P<0.001; t=10.708, P<0.001). After the treatment, the level of β2-MG and Hcy in two group were decreased compared with before treatment, and the decreased degree of study group was lower than those in control group (t=21.121, P<0.001; t=22.803, P<0.001). The rate of adverse pregnancy outcome in study group (23.08%) was lower than that in control group (46.15%, χ2=4.588, P=0.032). The incidences of adverse reactions in study group (15.38%) was not statistically significant compared with the control group (10.26%),χ2=0.459, P=0.458. Conclusion Labetalol hydrochloride combined with Salvia miltiorrhiza injection in the treatment of gestational period hypertension can effectively reduce the blood pressure, improve the treatment effect, improve serum Hcy, β2-MG levels and maternal and child outcomes. It has high efficiency and safety, and is worthy of clinical promotion.
Observe on the clinical efficacy of combination of traditional Chinese and Western medicine in the treatment of early cesarean scar pregnancy
WANG Lu-lu, SHENG Shao-qin, YE Hui-ling
2018, 16(7): 1148-1150. doi: 10.16766/j.cnki.issn.1674-4152.000316
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Objective To observe the clinical effect of combination of traditional Chinese and Western medicine in the treatment of early cesarean scar pregnancy. Methods A total of 148 cases of early cesarean scar pregnancy were as research object whom received treatment in our hospital from September, 2015 to September, 2017, all the patients were divided into the control group (n=74) and the research group (n=74). The control group were given western medicine treatment. The study group were given combination of traditional Chinese and Western medicine. The efficacy of drug conservative treatment in two groups was statistically analyzed. The serum β-hCG levels at different times were compared between the two groups. The hospitalization time and symptom relief time were recorded, and the adverse drug reactions during treatment were observed. Results The success rate of embryo treatment (78.38%) and the total success rate of conservative treatment (95.95%) in the study group were significantly higher than those in the control group (52.70% and 85.14%, χ2=10.800, 5.049; P=0.001, 0.025). After the treatment of 7, 14 and 28 d, the level of serum β-hCG in the patients of the study group was significantly lower than that of the control group (P<0.05). The time of β-hCG level arrival, the time of abnormal echo disappearance, and the time of disappearance of gestational sac in the study group were significantly shorter than those in the control group (P<0.05). The incidence of adverse reactions in the study group (13.51%) was significantly lower than that in the control group (28.38%, χ2=4.937, P=0.026). Conclusion Combined therapy of gestational sac puncture injection of methotrexate + mifepristone combined embryocide Xiaozheng decoction of traditional Chinese medicine and Western medicine, can significantly reduce the early cesarean scar pregnancy with β-hCG secretion, improve the success rate of conservative treatment, shorten the recovery period, reduce adverse drug reactions during the treatment period.
Clinical analysis of 48 cases of neonatal necrotizing enterocolitis on the Tibetan Plateau, China
DA Wa-qu-zhen, DAI Li-ying, GE Sang-de-ji, CENG Chuan-wen, PU Bu-zha-xi, WANG Hai-tao
2018, 16(7): 1151-1153. doi: 10.16766/j.cnki.issn.1674-4152.000317
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Objective To study the clinical features, ways of treatment and prognosis of neonatal necrotizing enterocolitis (NEC) on the Tibetan Plateau, improve awareness and prevention of the disease. Methods Forty-eight newborns suffering from NEC who were medically treated in our hospital from January, 2015 to December, 2017 were analyzed in this test.All cases were categorized by modified Bell's classification standard. We compared and analyzed clinical data of these NEC patients including general information, clinical manifestation, treatment, etc. Results Newborns receiving Zanba feeding were 38 cases, there were 20 preterm newborns and 21 male cases in this group. The average birth weight and day of onset were (2 105.53±713.42) g and (7.53±9.26)d. The main clinical features were abdominal distention, abdominal rumbling sound weakening or disappearance and bloody stools. There were 10 newborns with abnormality of leukocyte count, 15 infants with increased CRP, and 6 infants with diminished of blood platelets count. The most common of erect abdominal plain radiograph was bowel dilatation. There were 4 newborns received surgical intervention beside conventional medical treatment. Finally, 38 newborns (79.2%) were cured and 10 newborns (20.8%) were died (including parents giving up). Conclusion Early feeding of Zanba is an important disease factor in NEC on the Tibetan Plateau. The disease is more difficult to treat. We should enhance the understanding and judgment of radiographic features, establish guidelines of anti-infection, strengthen the prevention and early diagnosis.
Study on knowledge and understanding of chronic kidney disease in Shanghai suburban family doctor team
WU Lian-ye, XIE Jian-fang
2018, 16(7): 1154-1157. doi: 10.16766/j.cnki.issn.1674-4152.000318
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Objective To understand the situation to the family doctors' knowledge of chronic kidney disease (CKD) in the outer suburbs of Shanghai, and to provide basis for carrying out the CKD training in family doctor system and promoting the service ability of community team. Methods A questionnaire survey through the mobile WeChat was used to investigate 694 medical staff in family doctor team from ten community health service centers in Qingpu District. The survey included the basic situation of the research objects and the questions about CKD, 694 valid questionnaires were finished with the effective rate of 100%. The quantitative data were shown as x±s, and t-test and ANOVA were used among the two groups, and the quantitative data were expressed as percentage or rate(%) in a descriptive statistical way. Results The average score of CKD knowledge among the 694 objects was 52.31±15.83, with a pass rate of 32.71%. As a result, the CKD scores didn't show any significant difference (P>0.05) in members with different gender and different working years. Among others with different age, occupation and titles, however, the CKD scores were significantly different (P<0.01). Interestingly, the scores were lower in staff less than 30 years old, and the scores of GP were significantly higher compared with other types of medical staff, and the scores from intermediate title and above were also higher than junior titles. Conclusion The CKD knowledge is very poor and need to be further improved in community family team. We should improve the propaganda of CKD basic knowledge, and move forward the disease prevention and control, and decrease the disease harm to human health, and also cut down the medical cost in CKD patients at the same time.
Investigation of the satisfaction degree of residents on community health services and its influential factors in Shanghai Pudong Huamu area
YIN Hua-qing
2018, 16(7): 1158-1160. doi: 10.16766/j.cnki.issn.1674-4152.000319
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Objective To investigate the satisfaction degree of residents on community health services in Shanghai Pudong Huamu area and analyze the factors affecting health service satisfaction so as to know the disadvantages of community health services and provide evidence for improving the patients'satisfaction. Methods A total of 550 community residents in Huamu area were investigated by using a self-designed community health service questionnaire from June, 2015 to April, 2016. And 502 valid questionnaires were obtained. The effective recovery rate was 91.27%. Data were analyzed by EpiData software and SPSS 19.0 statistical software and the satisfaction and influential factors of community health service were analyzed by multivariate logistic regression. Results Among the 502 residents, 28 (5.58%) were very satisfied with community health services and 227 (45.22%) were satisfied, with 50.80% overall satisfaction rate. The satisfaction rates of operating hours (74.70%), distance (76.90%), department settings (55.38%), number of doctors (54.19%), privacy protection (69.12%), drug quality (57.57%) and basic drug types (55.77%) were high, while the satisfaction rates of waiting time (39.04%), service attitude (41.83%), technical level (43.82%), interpretation of communication (47.01%), health education (46.02%), drug prices (43.03%) and equipment (44.02%) were low. Logistic regression analysis showed that the waiting time(OR=1.672,95% CI:1.142-2.678), service attitude (OR=2.948, 95% CI:1.694-5.134), technical level (OR=1.923, 95% CI:1.272-3.158), explanation communication (OR=2.399, 95% CI:1.460-4.013) and drug prices (OR=1.574, 95% CI:1.042-2.379) were independent risk factors for residents' satisfaction. Conclusion Residents in Shanghai Pudong Huamu area have a relatively high degree of satisfaction about community health services. However, the community health service centers should try to shorten the waiting time, change the attitude of service, improve the technical level, strengthen communication, to achieve civilian drug prices, and further improve the residents of community health service work satisfaction.
The influence of the common psychological intervention in depression anxiety on elderly patients with chronic diseases and their caregivers
YU Ping, CUI Hai-song, DONG Chen-jie, XU Dong-jian
2018, 16(7): 1161-1164. doi: 10.16766/j.cnki.issn.1674-4152.000320
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Objective To explore the influence of the common psychological intervention in depression anxiety on elderly patients with chronic diseases and their caregivers. Methods The method of random sampling was adopted, the anxiety depression self rating scale (SDS), self rating scale (SAS), Hamilton depression rating scale (HAMD-24) 24 version, Hamilton anxiety scale (HAMA) and the MOS item short from health survey (SF-36) were used. From October to December, 2014, a household survey was carried out about 50 elderly patients with chronic diseases suffering from depression anxiety and their caregivers in Shanghai Nanxiang Town, Jiading District. The patients and their caregivers have been involved in psychological intervention for 2 years and the variance analysis has been used to evaluate the changes of depression anxiety and their quality of life. Results ① Most of the patients have more than one disease, and 92% of the caregivers are spouses or children of the patients; ② For elderly patients with chronic diseases and their caregivers, SAS, SDS, HAMD-24, HAMA scale score, 1 or 2 years before intervention are declining year by year, with statistically significant difference (P<0.01). ③ For elderly patients with chronic diseases and their caregivers, SF-36 scale of eight dimensions, 1 or 2 years before intervention are increasing year by year, with statistically significant difference (P<0.01). Conclusion It shows that the coexistence of multiple chronic diseases is serious, and the family members become the main caregivers of patients. For elderly patients with chronic diseases and their caregivers, psychological intervention is necessary, which can not only alleviate anxiety depression of elderly patients with chronic diseases, but also can alleviate that of caregivers to improve the quality of life.
Clinical application of low-dose coronary computed tomography angiography based on iterative reconstruction algorithm and body weight index
HU Li-xia, ZHENG Xiao-li, GONG Jing-shan, XIONG Wei, ZHOU Yang-yang, LI Sheng-feng, XU Jian-min
2018, 16(7): 1165-1167,1174. doi: 10.16766/j.cnki.issn.1674-4152.000321
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Objective To evaluate the radiation dose levels and image quality of personalized ECG-gated low-dose coronary computed tomography angiography (CCTA) based on iterative reconstruction algorithm (IRA) and body weight index (BMI). Methods One hundred patients with heart rate less than 65 bpm were randomly divided into conventional group (n=50) and low dose group (n=50). In the conventional group, CCTA was performed at regular dose (a voltage of 120 kV and a currency of 800 mAs) and images were reconstructed using filter back projection (FBP). In the low dose group, CCTA was performed at a currency of 280 mAs and a voltage of 80-120 kVp tailored to BMI. The images were reconstructed with FBP and iterative reconstruction algorithm (IRA) at iDOS-5. In both groups, prospective ECG-gated CCTA was employed. CT dose index volume (CTDI), dose-length product (DLP), effective radiation dose (ED), and image quality were compared between conventional group and low dose group. Results Compared with conventional group, CTDI, DLP and ED of the low dose group decreased obviously with statistical significance (P<0.01). The image quality of the low dose group with FBP was 3.72±0.24, which was statistically less than 3.86±0.23 of the conventional group (P<0.01). Using IRA with iDOS-5, the image quality of low dose group increased to 3.81±0.20, which was less than the conventional group with no statistical significance (P>0.05). Conclusion Personalized ECG-gated low-dose CCTA based on IRA and BMI can decrease radiation dose without sacrifice of image quality significantly. It is a cost-effective technique and worth recommending.
Dynamic evaluation of neovascularization in plaques of different stages in a rabbit model of atherosclerosis during contrast-enhanced ultrasonography
LI Yang, SUN Yi-xue, SHI Yan, ZHANG Juan, MAO Yu-hang, ZHU Ying
2018, 16(7): 1168-1170,1207. doi: 10.16766/j.cnki.issn.1674-4152.000322
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Objective To evaluate the neovascularization in plaques of different stages in a rabbit model of atherosclerosis during contrast-enhanced ultrasonography (CEUS). Methods Abdominal aortic atherosclerosis was induced in 30 rabbits, and animals underwent standard ultrasonography and CEUS imaging of abdominal aorta at the end of the atherosclerotic induction period. The animals were euthanized after CEUS, and plaque specimens were harvested for histological staining of CD31. Results The late-stage plaques exhibited a higher serum lipids level, an increased intimal-medial thickness, an increased thickness of the plaques, a higher enhanced intensity, a higher ratio of enhanced intensity in the plaque to the lumen of the abdominal aorta, and an increased histological neovascularization density than early-stage plaques (P<0.001 for all). There is a good correlation between the enhanced intensity of atherosclerotic plaques and the histological neovascularization density (r=0.795, P<0.001). A significant correlation was also found between the ratio of enhanced intensity in the plaque to the lumen of the abdominal aorta (r=0.704, P<0.001). Conclusion CEUS imaging can be used to access intraplaque neovessels in real-time in vivo. Neovascularization density increased as atherosclerosis progressed on both the CEUS measurements and histological evidence, which may be associated with the maximum thickness of the plaques and serum lipids level.
Establishment and assessment of an autoverification system in a clinical chemistry laboratory
YAN Shao-rong, HE Ling-wei, QIAN Ding-liang, DING Ji-guang
2018, 16(7): 1171-1174. doi: 10.16766/j.cnki.issn.1674-4152.000323
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Objective With the development of medical science and technology, the results of laboratory tests have become more and more significant for most clinical decisions. Therefore, under the premise of ensuring the accuracy and reliability of the test results, shortening the turnaround time (TAT) is one of the focuses of current clinical laboratories. The purpose of this study is to establish an autoverification system for clinical biochemistry tests in our laboratory. Methods An autoverification system was established according to the documents of the AUTO-10A guideline of Clinical Laboratory Standards Institute (CLSI), the checklist of the College of American Pathology (CAP) and the ISO 15189 rules. This system was applied in our laboratory information system (LIS), the Abbott C1600 biochemistry analyser and its managing software IM. This autoverification system consisted of five domains for every test:autoverification limits, critical value, delta check, quality control and algorithms for special tests. A flowchart was constructed to summarize this system. Turnaround time (TAT) before and after using this system was compared. Consistency rate between autoverification and manual verification was analysed. Results A total of 435 rules were released and a flowchart was constructed. Autoverification rate in 325 000 specimens was 52.3%. The TAT of the outpatients and hospital samples before and after using this system was statistically significant (all P<0.05). The TATs for specimens of outpatients and inpatients was shortened to 43 and 60 minutes. The most frequent reasons for autoverification failure were autoverification limit and delta check. The consistency rate between autoverification and manual verification was 99.98%. Conclusion An autoverification system that is suitable for our laboratory has been established. This autoverification system can significantly shorten the TAT. The system is very safe and worthy of promotion and application in the laboratory.
Preliminary application of three-dimensional arterial spin labeling MRI in diagnosis and treatment of hyperacute cerebral infarction
WANG Li-tong, HE Ling, GU Jia-he, WANG Wei, LI Cheng
2018, 16(7): 1175-1178,1196. doi: 10.16766/j.cnki.issn.1674-4152.000324
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Objective To investigate the application of 3D pseudo-continuous arterial spin labeling (3D-pcASL) perfusion MRI in the diagnosis and thrombolytic therapy of hyperacute cerebral infarction. Methods The clinical data of 7 cases of hyperacute cerebral infarction in our hospital between September, 2014 and April, 2016 were analyzed retrospectively. The magnetic resonance angiography (MRA), diffusion weighted imaging (DWI) and 3D-pcASL perfusion imaging were performed before and after thrombolysis in all cases. Before thrombolysis, the size of lesions and signal characteristics, artery occlusion and blood perfusion was observed; the relationship between blood perfusion and offending artery was evaluated; the scope of lesions on 3D-pcASL and DWI was compared to identify their matching conditions and ischemic penumbra. After thrombolysis, the occluded artery recanalization, size of lesions and blood perfusion change, low or high perfusion was observed. The correlation between blood perfusion, size of lesions and degree of artery recanalization was evaluated. Results Before thrombolysis, MRA displayed middle cerebral artery M1 segment occlusion in 7 cases, ipsilateral internal carotid artery occlusion in 1 case. DWI showed ipsilateral massive hemispheric high signal area in 7 cases. 3D-pcASL showed large low perfusion area in 7 cases, low perfusion area and artery occlusion was consistent, but it was larger than high signal area on DWI, ischemic penumbra existed. After thrombolysis, MRA displayed middle cerebral artery M1 segment and its branches recanalization in 5 cases, middle cerebral artery recanalization and distal branches undeveloped in 1 case, middle cerebral artery M1 segment and ipsilateral internal carotid artery recanalization, middle cerebral artery distal branches undeveloped in 1 case. High signal area reduced on DWI in 7 cases. 3D-pcASL displayed massive hemispheric high perfusion area in 3 cases, low perfusion area reduced in 4 cases, including patchy high perfusion area in 1 case. High or low perfusion area narrowing, high signal area narrowing and degree of artery recanalization was consistent. Conclusion 3D-pcASL can reliably reflect the low blood perfusion of hyperacute cerebral infarction, evaluate ischemia reperfusion and effect of thrombolytic therapy. It is a completely non-invasive magnetic resonance perfusion imaging method.
Present status of surgical diagnosis and treatment of incidental gallbladder cancer
TIAN Jia, CAI Bing, GU Cheng-yu, AN Fang-mei
2018, 16(7): 1179-1182,1219. doi: 10.16766/j.cnki.issn.1674-4152.000325
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The incidental gallbladder cancer (IGBC) is defined as the gallbladder cancer, which is diagnosed during or following cholecystectomy by pathological examinations, preoperatively considered as benign gallbladder disease. IGBC is usually not associated with readily discernible clinical signs and combined with other benign lesions. And the early clinical manifestations are usually non-specific. It is more difficult to diagnosis before operation. With the extensive operation of laparoscopic cholecystectomy, the patients with IGBC have increased. Modern imageology can improve the preoperative diagnosis of gallbladder cancer and reduce the incidence of IGBC. TNM staging system (AJCC 8th) for gallbladder cancer has an important guiding significance for treatment selection and prognosis of IGBC. Comprehensive treatment based on radical surgery is the most effective therapeutic option for IGBC. Secondary radical surgery appears to have a clear therapeutic effect in T2 and T3 patients with IGBC. Single surgical approach does not apply to the patients with IGBC in each stage, and the specific surgical approach should be based on TNM staging. Chemotherapy and radiotherapy has achieved certain results in the case of IGBC, but the overall effect is not satisfactory. There is a lack of attention to the research on IGBC at present. Clinically, there is still a lack of effective guidelines to treat IGBC, and the standard surgical regimens for IGBC remained controversial. In this paper, the authors give a brief overview of the research progress and doubtful points in the treatment of IGBC.
Analysis about combination and quantification on clinical indexes of low back pain with acupuncture treatment from 2014 to 2016 in China
CHEN Fei-yu, LIU Xiao-ping, XU Fu, BAO Ye-hua, CHU Jia-mei
2018, 16(7): 1183-1187. doi: 10.16766/j.cnki.issn.1674-4152.000326
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Objective To provide references for choice of observation indexes and the therapeutic evaluation in studies about low back pain with acupuncture treatment and the suggestion about improvement of observation indexes, clinical indexes and the therapeutic evaluation of low back pain with acupuncture treatment were analyzed from 2014 to 2016 in China. Methods Clinical indexes of low back pain with acupuncture treatment from 2014 to 2016 were retrieved, from which the articles about literature review, summary of experiences and case reports were removed. The character and the evaluation content they focus on, composite application of observation indexes using in each type and the proportion of them were also analyzed, descriptive statistical methods were used. Results A total of 47 articles meeting the requirements were found, which involved indexes about pain, activity function of lumbar vertebrae, quality of life, Cytokines and other indexes in it. The former two were the most general, VAS were used most in indexes about pain,22 times were found, JOA were used most in activity function of lumbar vertebrae,10 times were found. Conclusion For choice of observation indexes in studies about low back pain with acupuncture treatment, the evaluation on pain and activity function of lumbar vertebrae is the most basic, but some researchers often choose one, which is incomplete. Quantitative analysis of cytokines can also be added, which can reduce the distraction of subjective factors. Observation indexes about low back pain constituted by orthopedic surgery can be appropriately changed, when used in studies about low back pain with acupuncture treatment.
Clinical observation on 38 cases of postmenopausal osteoporosis treated with Jinggu Bugu granule
XU Yu-lu, WANG Qun, XING Ya-qun, WANG Di-sheng
2018, 16(7): 1188-1191. doi: 10.16766/j.cnki.issn.1674-4152.000327
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Objective Previous experimental studies have confirmed the therapeutic effect of Jinggu Bugu granule on dexamethasone-induced osteoporosis in rats. The study aims to verify the clinical value of the drug, and observe the clinical effect of Jinggu Bugu granule on postmenopausal osteoporosis. Methods A total of 80 patients with postmenopausal osteoporosis were collected from May, 2016 to April, 2017 in the Department of traditional Chinese Medicine of the second affiliated Hospital of Bengbu Medical College. With the informed consent of the patients,they were randomly divided into control group (40 patients in basic treatment group) and observation group (40 patients in Jinggu Bugu granule group). There was no statistical difference in the age and course of the two groups. Both groups were given 0.50 μg/d of oscitictriol in two doses. The observation group was treated with Jinggu Bugu granule once a day for 6 months. Bone pain score was observed by visual method, bone mineral density was measured by BMD and estradiol was measured by chemiluminescence. The changes in the values of the two groups were recorded and the traditional Chinese medicine score was recorded to judge the curative effect. We used SPSS 23.0 software to carry on statistics. Results One case was lost in the control group and 2 cases in the observation group. In both groups, the bone pain score decreased and the bone mineral density increased significantly. The bone pain score and bone mineral density in the observation group were significantly better than those in the control group (P<0.001). The estradiol in the observation group was significantly higher than that before the treatment (P<0.001), but the improvement of estradiol was not obvious in the control group. In improving the curative effect of TCM syndromes, the total effective rate of Jinggu Bugu granule group was 94.7% and that of the basic treatment group was 74.4%. The difference between the two groups was statistically significant (P<0.05). Conclusion Jinggu Bugu granule has good therapeutic effect on postmenopausal osteoporosis of liver and kidney yin deficiency type.
Survey on training needs for general practice trainers in Northern Anhui Province
YIN Man-man, WANG Zai-biao, LI Dong-xiao, XIA Ling-xia
2018, 16(7): 1192-1196. doi: 10.16766/j.cnki.issn.1674-4152.000328
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Objective To investigate the training needs for general practice trainers. To provide reference and basis for the development of more targeted teacher training programs in the future. Methods The survey was conducted among participants of the training course for general practice trainers hold on August 2016 in Anhui Bozhou according to the cross section research testing method. The contents of questionnaire used for the survey included training needs of general practice relevant knowledge, teaching ability and modes of assessment and training mode and training form. The differences in training needs between general practice trainers from community teaching bases and hospital teaching bases were also analyzed. Results According to the survey, "general practice clinical thinking"(69.5%, 66/95) was the most required relevant knowledge, while "general practice basic concept" was least required 32.6% (31/95). The rate with need of "general practice clinical thinking" in hospital trainers was higher than that in community teaching base trainers (78.8%/58.1%, χ2=4.759, P<0.05). For teaching methods, teaching assessment and evaluation methods, the participants showed more interesting in new-type teaching and evaluation methods, such as PBL (82.1%, 78/95), mini-CEX (52.6%, 50/95) and OSCE (64.2%, 61/95). Teaching experience exchange (85.3%, 81/95), teaching demonstration (73.7%, 70/95), and teaching practice (64.2%, 61/95) were the three most interested modes in current training. Conclusion According to the survey, there are different needs for general practice trainers from hospital and community teaching bases in general practice relevant knowledge, teaching ability and modes of assessment. To meet the different requirements, the focused training course and training method should be adapted targetedly.
Investigation and analysis of first aid knowledge amongpolice officers in Yinchuan
XIAO Gang, WANG Yu-huan, WANG Yan-rong
2018, 16(7): 1197-1200. doi: 10.16766/j.cnki.issn.1674-4152.000329
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Objective The key to the success of pre hospital care lies in the rapid and accurate implementation of on-site medical rescue personnel. In order to improve the success rate of pre hospital emergency rescue in our city,shorten the emergency rescue time, reduce the death rate and disability rate, this study aims to investigate the mastery and training of pre hospital emergency knowledge and skills among police officers in Yinchuanand to analyze the influencing factors, as well asto put forward training suggestions and suggestions on the basis of in-depth analysis, thus to provide reliable basis for improving the success rate of pre hospital emergency care in our city. Methods A new questionnaire was designed according to a questionnaire designed by Li Wentao and part of the 2015 edition of the international CPR guidelines. The questionnaire was divided into general information and first aid knowledge and skills. The general information includespolice classification, gender, age, years of service, rank, and the highest degree. First aid knowledge and skills include investigations into trauma first aid,cardiopulmonary resuscitation, drowning, first aid, poisoning, first aid, and heatstroke self-assessment, self-testing and training. The Cronbach's coefficient Cronbacha of scale=0.791. Under the premise of the informed consent of the respondents, 160 police officers in Yinchuan were selected to conduct a questionnaire survey, and a questionnaire survey was conducted to investigate the knowledge and skills of first aid among 160 police officers in Yinchuan. Results The rates of hospital trauma emergency and cardiopulmonary resuscitation were only 67.6% and 23.23% respectively. In the self-assessment, the police officers have more control over the first aid to the poisoning victims, and less knowledge about the trauma,cardiopulmonary resuscitation,poisoning, drowning, heatstroke, first aid, knowledge and skills; 66.9% of them had no training in relative emergency knowledge and skills. Those received first aid training more than 2 times within 5 years accounted for only 8.4%. Conclusion The police officers in our city do not have a good grasp of pre hospital emergency knowledge, and there is fewer related training. Training should be strengthened to improve the knowledge and skills of pre hospital emergency medical personnel.
Influence of two cleaning and disinfection methods for salivary suction pipes on air quality in consulting room for stomatology
YANG Jing, WANG Fang-yun
2018, 16(7): 1201-1203. doi: 10.16766/j.cnki.issn.1674-4152.000330
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Objective A large number of bacteriological and viral aerosols in oral diagnosis and treatment are easy to cause the surrounding environment and the infection of the patients' wounds. The effective and timely absorption of saliva is an effective method to control aerosol pollution in oral clinic. The purpose of this study was to explore the effect of two kinds of cleaning and disinfection methods on air quality. Methods From July, 2016 to June, 2017, two methods were used to clean the pipe. July-December 2016, the routine cleaning and disinfection method was used in the control group. January-June 2017, the test group was based on the control group, during the second flush, the pipe was cleaned with 3 000 ml 1:200-multienzyme cleaning agent. The air in consulting room and the interface of the siphon was sampled a month. After the cleaning and disinfection, the cleanliness and odour of the suction pipe were observed. Results After cleaning and disinfection, the number of air colonies cultured in the two groups were as follows:(2.667±0.970)CFU/(dish·5 min), (5.222±2.579) CFU/(dish·5 min). The test group was lower than the control group, the difference was statistically significant (t=-3.934,P<0.05). The colony number of the salivary suction interface was cultured as follows:(1.889±1.745)CFU/cm2, (4.667±3.125)CFU/cm2. The test group was lower than the control group, the difference was statistically significant (t=-3.293, P<0.05). The cleaning degree and smell degree of salivary hose in the test group were better than those in the control group. The difference was statistically significant(χ2=10.395, P<0.05). Conclusion The improved cleaning and disinfection method can effectively reduce the number of bacteria in the room air and sideshow, and effectively increase the cleanliness of the suction hose and reduce the odor of the pipe. The improved clean and disinfectant method is simple and easy to use, which is convenient and reliable.
The identification, evaluation and improvement strategies of pediatric nursing risk events in a city of Shandong Province based on the Kaiser model
DONG En-hong, LIU Hua-li, QIAN Zhi-wang, DONG Jing-jing, BAO Yong, YANG Ai-ping
2018, 16(7): 1204-1207. doi: 10.16766/j.cnki.issn.1674-4152.000331
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Objective The purpose of this paper is to identify and assess the nursing risk events in a city of Shandong province of China, and to find the main risk factors for the controlling pediatric nursing risk events. Methods A questionnaire survey was conducted among 109 doctors, nurses, technicians and middle administrators from hospitals in Shandong province. A nursing expert team was set up before revising contents of the original Kaiser model on risk event identification and made it suitable for pediatric nursing. And then the questionnaire was prepared for data collection, identification and assessment of pediatric nursing risk events. Results The six events of main risks of pediatric nursing faced were:sharp stab (51.48%), family complaints (51.00%), legal disputes between nurses and patients (47.13%), mass injury events (40.82%), infection (40.76%), and epidemic outbreak (40.64%). Conclusion Medical institutions and health decision makers should develop appropriate measures by analyzing results to guarantee safety of patients and nurses and improve nursing service quality by establishing the risk consciousness, settling reasonably patient-nurse disputes, improving the emergency response capacity of several contradictions, and standardizing the nursing infection management in the department emergency. It is important to reduce occurrence of the risk events of pediatric nursing, strengthen the following pediatric nursing risk management, risk control and risk assessment and other aspects, and safeguard the legitimate rights and interests of the pediatric patients and nursing staff to provide a reference to improve the service quality of pediatric nursing.
Nursing care of patients with malignant obstructive jaundice treated by biliary stent implantation via ERCP
YAO Xiang-li, QIANG Hua-long, XU Wen-qing, LIU Hui-chun, WANG Ji-sheng, XU Lu-bai
2018, 16(7): 1208-1211. doi: 10.16766/j.cnki.issn.1674-4152.000332
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Objective To evaluate the clinical efficacy and to summarize the nursing experience of biliary stent placement via ERCP approach in the treatment of malignant obstructive jaundice. Methods The postoperative nursing experience of 101 patients with malignant obstructive jaundice treated with biliary stent placement via ERCP from January, 2010 to September, 2016 was summarized. In addition, we observed the changes of serum total bilirubin(TBIL), direct bilirubin (DBIL), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) after the operation.Patients were followed up until September, 2017 or death. The survival time was recorded and the survival curve was drawn. Results In the study, all patients had a success operation. The symptoms such as itching were significantly improved after the operation. Compared with the preoperative levels, the levels of TBIL, DBIL, ALP, ALT, and AST significantly decreased 1 week and 1 month after the operation, and the differences were statistically significant (P<0.001). In addition, the level of albumin (ALB) significantly increased 1 week and 1 month after the operation, with statistical significance (P<0.001). The overall complication rate was 42.6% (43/101) and all of them cured after the symptomatic treatment and meticulous care. The average survival time was (8.96±1.02) months, and the median survival time was 9 months. Conclusion ERCP-based biliary stents are effective in the treatment of malignant obstructive jaundice. However, strict observation and careful nursing after operation are very important.
The application effect of dialectic nursing combined with level three ladder analgesic therapy in the treatment of severe cancer pain
ZHOU Li-qun, CAI Hui-feng, XIE Shu-jun, XI Qian-lan, LIN Cai-pin, CAO Yan-wen, LING Yun-qiao
2018, 16(7): 1212-1215. doi: 10.16766/j.cnki.issn.1674-4152.000333
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Objective To explore the application effect of dialectical nursing combined with level three ladder analgesic therapy in the treatment of severe cancer pain. Methods From June, 2014 to June, 2016, 102 patients with moderate to severe pain hospitalized in our hospital were selected, including 30 cases of pulmonary cancer, 24 cases of gastric cancer, 26 cases of liver cancer, 16 cases of colorectal cancer, and 6 cases of cervical cancer. According to the random number table method, the patients were divided into observation group and control group, with 51 cases in each group. Patients in the control group received routine nursing and level three ladder analgesic therapy, and the observation group was treated with the combination of dialectic nursing and level three ladder analgesic therapy. After two months of treatment, the pain relief, side effects and nursing satisfaction were observed and compared between the two groups. Results The pain relief rate in the observation group[86.27% (44/51)] was significantly higher than that in control group[26.78% (33/51)], and the difference was statistically significant (χ2=8.513, P=0.004); the adverse reactions incidence of nausea (χ2=9.543, P<0.01), vomiting (χ2=6.095, P<0.05), dizziness (χ2=5.830, P<0.05) and insomnia (χ2=8.947, P<0.01) in the observation group were significantly lower than those in the control group, with statistical significance; nursing satisfaction in the observation group was significantly higher than that in the control group, and the difference was statistically significant (Z=3.509, P<0.001). Conclusion The dialectic nursing combined with level three ladder analgesic therapy can relieve the cancer pain, and reduce the side effects of the drug, which is worthy of promotion.
Effect of standardized continuity nursing on discharged children with bronchial asthma
SHANG Qi-yun, ZHAO Yan, YANG Fei, LV Min
2018, 16(7): 1216-1219. doi: 10.16766/j.cnki.issn.1674-4152.000334
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Objective To discuss the impact of standardized continuity nursing on discharged children with bronchial asthma. Methods Sixty children with bronchial asthma hospitalized from January, 2015 to October, 2017 were selected. The odd-numbered mantissa numbers were included into control group and even numbers were divided into experimental group, with 30 cases in each group. Control group was provided with routine care, discharge guidance and telephone follow-up the first week after discharge, while the observation group extended to 24 weeks after discharge based on the telephone follow-up, every 4 weeks with a total of 7 times, and answer questions encountered in the family management. At the time of discharge, the first week of discharge and the 24th week of discharge, both groups were scored according to the Asthma Control Test (ACT), and daily variation rate monitored by the peak expiratory flow (PEF). ACT scores and daily variation of PEF were compared between the two groups. Results The differences of ACT score and PEF diurnal variability between the two groups at 24 weeks after discharge were statistically significant. The ACT score of the observation group was higher than that of the control group, while the PEF diurnal variation rate was significantly lower than that of the control group(P<0.05). Conclusion Standardization of continuous nursing can significantly improve the ACT score of discharged children with bronchial asthma, reduce the daily variability of PEF, reduce the risk of asthma recurrence and improve children's quality of life.
Value of clinical pathway in the management of adverse effects of terlipressin in the treatment of cirrhosis complicated with bleeding from esophageal varices or gastric varices
ZHANG Ling, XUN Yun-hao, GUO Jian-chun
2018, 16(7): 1220-1223. doi: 10.16766/j.cnki.issn.1674-4152.000335
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Objective To investigate the value of clinical path in the management of adverse effects of terlipressin for cirrhosis complicated with Bleeding from esophageal varices (EVs) or gastric varices (GVs). Methods Seventy-two cases of cirrhosis with bleeding from esophageal varices or gastric varices received terlipressin in our hospital between December, 2015 and December, 2016, and were divided into observational group (n=38) and normal group (n=34) randomly. The observational group was managed by clinical path, whereas the normal group received the conventional measures. The incidence of adverse effects related to terlipressin, treatment compliance, nursing satisfaction index and bleeding control in one week were compared between the two groups. The differences about the four aforementioned parameters were statistically analyzed. Results The incidence of adverse effects (abdominal pain, diarrhea, increased blood pressure, bradycardia and hyponatremia) in the observational group was similar to those in the normal group (44.7% vs. 44.1%, P>0.05); while treatment compliance, nursing satisfaction and bleeding control were all higher than those in the normal group significantly (97.4% vs. 82.4%, 89.5% vs. 70.6%, and 100% vs. 85.3%), respectively, the difference was statistical significant, P<0.05. Conclusion The adverse effects of terlipressin in the treatment of cirrhosis with esophageal and gastric variceal bleeding are relatively common. Clinical path intervention fails to reduce the incidence of those adverse effects, but can improve treatment compliance and nursing satisfaction of the patients, thus benefits the early control of bleeding significantly.
MAO Dong-feng, WU Tao, MAO Jun-feng, BAI Hai, WANG Cun-bang
2018, 16(7): 1224-1226. doi: 10.16766/j.cnki.issn.1674-4152.000336
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