中华全科医学

Current status of “1+1+1” medical institution combination signing project and its influencing factors among the outpatients of community health care center in Shanghai

ZHANG Xiao-jun, BAO Yong

2018, 16(8): 1227-1230,1382. doi: 10.16766/j.cnki.issn.1674-4152.000337

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Objective To investigate the implementation of the "1+1+1" medical institution combination signing project in Shanghai community, and to explore the willingness of community residents and its influencing factors, so as to promote the medical contract signing and improve the hierarchical medical care system in Shanghai. Methods A convenience sampling method was used to select residents from 6 community health centers in three different districts in Shanghai. A total of 1 800 people were surveyed, and 1 720 valid questionnaires were collected. SPSS 20.0 software was used to carry out Chi-square test and Logistic regression analysis. Results The rates of medical contract signing among community residents was 79.1%. Multivariate logistic regression analysis revealed that the residents with good cognition on the"1+1+1" project, high reliance on community health service center, low level of education or chronic administration preferred the medical contract signing. Conclusion At present, the "1+1+1" medical institution combination signing project is in good state of implementation, and the signing rate in the community is relatively high. To further promote the project need to continue to strengthen propaganda, enhance the awareness of residents for contracted projects; improve the service level of community health service center, enhance the trust of the residents of the community health service center, and enhance further implement and policies related to dispensation and transfer treatment in the signing system, so as to attract residents to sign contracts, and provide a good platform for subsequent development of the hierarchical medical care system.

YE Ru-yi, MAO Shuang-gen

2018, 16(8): 1231-1232.

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Promoter methylation regulates tazarotene-induced gene-1 expression in human pancreatic cancer

LI Na, LI Hui-qin, DONG Wen-jie, WU Xin-ai

2018, 16(8): 1233-1236. doi: 10.16766/j.cnki.issn.1674-4152.000338

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Objective To investigate the expression of tazarotene-induced gene-1 (TIG1) in pancreatic cancer and the methylation status of TIG1 promoter in pancreatic cancer cells. Methods Total 67 cases of pancreatic carcinoma and 67 cases of paired adjacent tissue were collected as the object of study. TIG1 protein was detected by immunohistochemical SP method to analyze the difference of expression of TIG1 in cancer tissues and paired adjacent tissue. Methylation status of TIG1 promoter in pancreatic cancer cell lines PANC1, BxPC3 and SW1990 were examined by Bisulfite sequencing PCR (BSP). The levels of TIG1 mRNA in these cells were identified by RT-PCR. PANC1 BxPC3 and SW1990 cells were treated with the demethylation agent, 5-aza-dC, at different concentrations, and the changes of TIG1 mRNA in these cells were examined by RT-PCR. Results The expression of TIG1 in cancer tissues was lower than that in paired adjacent tissue (P<0.05), and the expression of TIG1 was not correlated with size stage and lymph node metastasis of pancreatic cancer, but there was correlation with location (P<0.05). (92±2)% and (86±2)% of TIG1 CpG sites were methylated in BxPC3 and SW1990 cells respectively. While the ratio was (40±2)% in PANC1 cells. Decreased TIG1 mRNA can be restored in BxPC3 and SW1990 after treatment with 5-aza-dC, while there was no significant change in PANC1 cells. Conclusion The expression of TIG1 in cancer tissues is lower than that in paired adjacent tissue. There is difference in the expression of TIG1 in different parts of pancreatic carcinoma. Decreased TIG1 in BxPC3 and SW1990 is significantly correlated with promoter hypermethylation, suggesting that promoter hypermethylation may play an important role in the regulation of TIG1.

Tongxinluo can improve cardiac hypertrophy and Cx43 remodeling in pressure overload rats

LIU Sheng-quan, DING Sai-liang, LONG Jun-rong, TAN Wen-ting, TANG Fen, LIU Mao-jun, YANG Jun, CHU Chun

2018, 16(8): 1237-1240. doi: 10.16766/j.cnki.issn.1674-4152.000339

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Objective To observe the effects of Tongxinluo on myocardial hypertrophy, QT dispersion and connexin 43 (Cx43) expression in rats under pressure overload. Methods Total 45 male SD rats were randomly divided into three groups:control (group C), model (group M) and treatment (group T). A model of rats under pressure overload was established by abdominal aortic banding. After 12 weeks of treatment with Tongxinluo[1.5 g/(kg·d)], echocardiogram examination was conducted, and cardiac electrophysiological recorder was used to record the QT dispersion of rats. After these rats were sacrificed, HE staining was performed to observe the pathological morphology of left ventricle myocardial tissue, immunohistochemistry (IHC) was conducted to determine the expression and distribution of Cx43, and RT-PCR method was employed to determine Cx43 mRNA expression. Results A model of rats with myocardial hypertrophy under pressure overload was successfully established. Echocardiographic detection indicates that compared with group C, group M had obvious Ventricular hypertrophy, IVSs, VPWs, LIVSd and LVPWd were increased obviously (P<0.01); compared with group M, the above parameters in group T were improved (P<0.01). Compared with group C, the QT dispersion of group M was obviously increased (P<0.01), and Tongxinluo intervention could reduce the QT dispersion of rats under pressure overload (P<0.01). Compared with group C, cardiomyocyte hypertrophy and irregular arrangement could be seen in group M, and the expressions of Cx43 and Cx43 mRNA in left ventricle myocardial tissue were greatly reduced (P<0.05). Compared with group M, irregular arrangement of myocardial cells in group T was improved, and the expressions of Cx43 and Cx43 mRNA were significantly up-regulated (P<0.05). Conclusion For rats under pressure overload, Tongxinluo can improve myocardial hypertrophy, shorten QT dispersion and improve Cx43 reconstruction.

Diagnostic value and safety of percutaneous lung biopsy under CT guidance for sub-solid nodules lesions

ZHAO Cheng-ling, LI Wei, CHEN Yu-qing, LI Guo-ping, LI Chang

2018, 16(8): 1241-1243. doi: 10.16766/j.cnki.issn.1674-4152.000340

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Objective To evaluate the diagnostic value and safety of percutaneous lung biopsy under CT guidance for sub-solid nodules lesions. Methods The clinical data and follow-up data of 26 cases of pulmonary sub-solid nodules lesions that performing percutaneous lung biopsy under CT guidance in our hospital were analyzed retrospectively. The ratio of correct diagnosis of sub-solid nodules, diagnostic sensitivity diagnostic specificity of malignant sub-solid nodules and the incidence of complications were calculated. Results Each tissue was successfully obtained from 26 cases of pulmonary solid nodules by once puncture. The success rate of puncture was 100%. Twelve cases (12/26, 46.15%) of malignant tumors were diagnosed. Eight cases were adenocarcinoma, 1 case was adenosquamous carcinoma, 2 cases were squamous cell carcinoma, 1 case was poorly differentiated carcinoma, 1 case adenocarcinoma accompanied with fungal infection. Fourteen cases were benign lesions (14/26, 53.85%), 1 case of them was infiltrated with small amount of inflammatory cells and interstitial hyperplasia that diagnosed as adenocarcinoma by endobronchial ultrasonography later; 1 case was aspergillosis and 8 cases were inflammation (2 cases of patients with chronic inflammatory had progressed after the anti-inflammatory treatment and they were diagnosed as adenocarcinoma in other hospital after resection. The remaining 6 patients with chronic inflammation were all healed after anti-infective treatment); 1 case with mild interstitial vasculature dilatation and congestion was confirmed as inflammation after anti-infective treatment. One case diagnosed as a few well-differentiated squamous epitheliums, which was absorbed after anti-infection treatment. Two cases of tuberculosis were diagnosed. Small pneumothorax was found in 2 patients (7.69%). Small amount of hemoptysis occurred in 5 patients (19.29%). The ratio of correct diagnosis of sub-solid nodules performed by CT-guided percutaneous pulmonary puncture was 84.62%(22/26). The sensitivity and specificity of the diagnosis of malignant sub-solid nodules were 80% (12/15) and 100%, the incidence of complications was 26.92%, the incidence of severe complications was 0%. Conclusion CT-guided percutaneous puncture biopsy can safely and effectively diagnose pulmonary ground glass opacity lesions.

Clinical effect comparison of chimeric anterolateral thigh flap and tandem skin flap on repair of oral and maxillofacial tumors after radical surgery

SHAO Xia, TU Cheng-wei, ZHAO Lei, WANG Jing-xiao, WU Li-jun

2018, 16(8): 1244-1246,1367. doi: 10.16766/j.cnki.issn.1674-4152.000341

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Objective To analyze and compare the clinical effect of anterolateral chimeric flaps and tandem skin flap on repair of oral and maxillofacial tumors after radical surgery. Methods Total 102 patients with oral and maxillofacial tumors after radical surgery repair in our hospital between December, 2014 and December, 2016 were selected as study objects, and were divided into group A (anterolateral chimeric flaps), group B (tandem skin flap) according to the surgery methods, with 51 cases in each group. The surgical conditions (operation time, flap production and microsurgical anastomosis time, gastric tube removal time, oral feeding time), postoperative recovery (satisfaction, shape recovery, food intake, work condition, oral closure, mouth opening, chewing function, swallowing function, bite function, language function), and serum IL-2, sIL-2R and SA levels of the two groups were compared. Results The operation time, gastric tube removal time and oral feeding time of group A were significantly lower than those of group B (P<0.05) and the production time and microscopic anastomosis time of group A were significantly higher than those of group B (P<0.05). Three months after the surgery, the satisfaction, appearance repair, work condition, oral closure, masticatory function, swallowing function and language function of group A were significantly higher than those of group B (P<0.05). One month after the operation, the serum IL-2 levels of the two groups were significantly increased, and the IL-2 level of group A was significantly higher than that of group B (P<0.05). One month after the operation, the serum sIL-2R and SA levels of the two groups were significantly increased, and the level in group A was significantly lower than that in group B (P<0.05). The incidence of vascular crisis in group A was 3.92%, which was significantly lower than that in group B (17.65%, P<0.05). Conclusion The chimeric anterolateral skin flap can repair the defect of the maxillofacial tumor after radical operation, which can significantly shorten the operation time and improve the postoperative functional recovery. The incidence of postoperative complications is low.

A comparative study of safety and efficiency between LVIS stent assistant spring ring and Solitaire stent spring ring for the ruptured wide-necked intracranial aneurysm

MA Xiu-yao, REN Chao, LIU Bin, WANG Qiang, YANG Xi-lan, XIANG Xin

2018, 16(8): 1247-1249,1348. doi: 10.16766/j.cnki.issn.1674-4152.000342

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Objective To compare the safety and efficiency of Lvis stent assistant spring ring and Solitaire assistant spring ring in the treatment of the ruptured wide-necked intracranial aneurysm. Methods The clinical data of 88 patients with the ruptured wide-necked intracranial aneurysm undergoing Lvis stent assistant spring ring or Solitaire assistant spring ring in our hospital between June, 2014 and August, 2017 were analyzed retrospectively. Forty-five patients in the observation group received Lvis stent assistant spring ring, while 43 patients in the control group received Solitaire stent assistant spring ring. All the patients in the two groups were followed up to investigate the safety of the two methods by Glasgow Outcome Score (GOS). The result of computed tomography angiogram (CTA) and the Raymond-Roy Occlusion Classification (RROC) were used to compare the efficiency of two methods. Results The postoperative GOS in the observation group was higher than that in the control group (P<0.05); CTA result showed that the success rate in the observe group was higher than that in the control group (P<0.05), while the recurrence rate was lower than that in the control group (P<0.05); RROC immediate after the operation and during the follow-up in the observation group were better than those in the control group, the difference was statistically significant (P<0.05). Conclusion Livs stent assistant spring ring for intracranial wide-necked aneurysm can increase dense embolism rate, and decrease recurrence rate of arterial aneurysm and re-bleeding rate, with a better safety and efficiency level as compared with Solitaire stent spring ring.

Epidemiology analysis of hand-foot-and-mouth disease in a third level and grade A hospitals of Anhui Province from 2010-2016

SHEN Yan, ZHOU Rui, LIN Qing-hua, LU Hui-juan, JU Fang-lei, QIN Xiao-hui

2018, 16(8): 1250-1253. doi: 10.16766/j.cnki.issn.1674-4152.000343

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Objective To analyze the epidemiologic features of children hand-foot-and-mouth disease (HFMD) in a third level and grade A hospitals of Anhui Province from 2010 to 2016, and provide scientific bases for the prevention of HFMD. Methods The website information and data of children HFMD from 2010 to 2016 collected by Chinese Center For Disease Control And Prevention were analyzed with descriptive epidemiological methods; Excel and SPSS 22.0 were used for χ² test. Results Total 5 731 cases of HFMD were reported in the hospital from 2010 to 2016, from 2010-2012, it showed increased year by year, from 2013-2016, it showed an increasing trend next year. The sex ratio of men and women was 1.82:1. The prevalence of the disease was concentrated in children under the age of 3 years (78.87%, 4 520/5 731), with significant differences in the distribution of the disease by age group over the years (χ²=92.415, P=0.018). Statistical treatment of population trends by age group was performed, without statistical significance trend (χ_trend²=0.160, P=0.689). With the majority of children living in the diaspora (92.97%, 5 328/5 731), There were significant differences in the distribution of the population in each year (χ²=193.512, P<0.001), and there was no statistical significance (χ_trend²=2.546, P=0.111). Confirmed cases were reported throughout the year, with the peak in April-July (64.56%, 3 700/5 731) showing a significant 'single peak' pattern, with statistically significant differences in the number of cases in each month of the year (χ²=826.958, P<0.001), and no statistically significant trend in each month of the year (χ_trend²=0.207, P=0.649). The reporting population was concentrated in the urban areas of the city and the three counties (72.78%, 4 171/5 731). Conclusion The prevalence of HFMD shows the trend of rising every other year, seasonal obvious, the population distribution is clear. We should pay more attentions to the health education of children under 3 years old in the diaspora, in the high-risk season to do a good job in prevention and control.

Relations of serum level of bFGF with elderly medication overuse headache and curative effect

YE Jian-xin, ZHANG Dong-mei, LIN Li-hong, CHEN Jian-hong, YU Yun-hua, CUI Xiao-ping

2018, 16(8): 1254-1256,1363. doi: 10.16766/j.cnki.issn.1674-4152.000344

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Objective To investigate the relationship between serum levels of basic fibroblast growth factor (bFGF) and medication overuse headache (MOH) in the elderly patients. Methods Sixty elderly patients diagnosed with MOH were enrolled in the study group from July, 2014 to July, 2015, and 60 elderly patients who were treated with non-drug overdose were selected from our hospital The patients were divided into two groups according to the VAS score and the serum bFGF concentration. The patients in the MOH group were graded according to the degree of headache. The analgesic drugs taken by the patients were analyzed. The levels of bFGF and the degree of pain were analyzed. The patients were followed by withdrawal and prophylaxis in the MOH group. The VAS score and serum bFGF concentration were compared between 1 month, 2 months and 3 months after treatment. Results ① The VAS score and serum bFGF concentration in the MOH group were significantly higher than those in the non-MOH group (P<0.01); ②There was a positive correlation between the serum bFGF concentration and the headache grade and VAS score (P>0.05). ③ One month and two months after treatment, there were no significant differences in VAS scores between the two groups (P>0.05), and the difference was not significant (P>0.05) After 3 months, the patient's headache was relieved, the VAS score decreased, and the corresponding serum bFGF concentration decreased, the difference was statistically significant (P<0.01). Conclusion Serum bFGF can be used as a reference index for diagnosis of MOH. In elderly patients, bFGF concentration is positively correlated with MOH headache level, and it can be used as an evaluation index.

Bioinformatics analysis of predicted target genes of miRNA-143 and miRNA-221 in elderly primary rectal carcinoma

LI Zhi-xiang, QIAN Jun, JIA Jian-guang

2018, 16(8): 1257-1260,1317. doi: 10.16766/j.cnki.issn.1674-4152.000345

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Objective To explore the diagnostic value and clinical significance of miRNA-143 and miRNA-221 in older patients with rectal cancer. Methods Fifty older patients with rectal cancer were analyzed and 30 healthy individuals served as control from September 1, 2015 to December 30, 2016. We used high-throughput sequencing and fluorescence quantitative RT-PCR to detect and verify the miRNAs differential expression in the above samples. Pearson test was used to analyze the correlation between miRNA-143 and miRNA-221. The two miRNAs' target genes were predicted using the miRBase database. We used R 3.4.0 software to draw differential miRNA heat map clustering graphs. MiRNet database and cytoscape 3.5.1 were used to plot the miRNA and mRNA expression regulatory network. Results Compared with normal tissues, miRNA-143 and miRNA-221 were both down-regulated in elderly primary rectal cancer tissues (P<0.001, P=0.009), and their expression levels were positively correlated (r=0.517, P=0.003). GO functional annotation mainly enriched in biological process and molecular function, for instance, stem cell development, MAPKK activity, STAT protein tyrosine phosphorylation regulation, protein phosphorylation, tyrosine phosphorylation of amino acid binding peptide, regulating lipid kinase activity, polymerization, poly nuclear phosphoprotein mRNA A tail shortened (P<0.01). KEGG pathway analysis involved TP53 genes regulating cell death gene transcription, VEGF signaling pathway, IL-4 signaling pathway, oncostatin M signaling (P<0.01). The regulatory network indicates that there are a few target genes overlap between miRNA-143 and miRNA-221, and the two have synergistic effects. Conclusion As tumor suppressor factors of rectal cancer, miRNA-143 and miRNA-221 provide certain clinical significance for the diagnosis of senile rectal cancer.

Relationship between subcortical arousal and glucose metabolism in patients with obstructive sleep apnea hypopnea syndrome and hypertension

WANG Ying-chun, ZHANG Yu, CAO Mei, ZHANG Wei-wei, LI Nan-fang

2018, 16(8): 1261-1263,1333. doi: 10.16766/j.cnki.issn.1674-4152.000346

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Objective To investigate the effect of subcortical arousal response on glucose metabolism in patients with essential hypertension and obstructive sleep apnea hyponea syndrome (OSAHS). Methods Between October, 2015 to May, 2016, 102 patients meeting the diagnostic criteria were selected in the center of hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region. All patients underwent nocturnal polysomnography and fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c) and pulse transit time (PTT) determination. According to the apnea hypopnea index (AHI), the subjects were divided into two groups:hypertension control group and hypertension combined with OSAHS group (further divided into 3 subgroups:mild, moderate and severe). The parameters of OSAHS, PTT, FBG and HbA1c were compared among groups, and the influence factors of glucose metabolism disorder were analyzed by stepwise regression analysis. Results In the moderate and severe OSAHS with hypertensive groups, PTT arousal index increased significantly compared with mild OSAHS and control group. In the severe OSAHS group FBG significantly increased than that in other groups. Correlation analysis showed that FBG was positively correlated with PTT arousal index (r=0.253, P=0.014) and oxygen desaturation index (r=0.242, P=0.015); HbA1c were positively correlated with PTT arousal index (r=0.326, P=0.001). Stepwise multiple linear regression analysis showed that PTT arousal index was the independent factor of FBG (β=0.007, P=0.018); age and PTT arousal index were independent factors of HbA1c (β=0.018, P=0.037; β=0.005, P=0.040 respectively). Conclusion There is a significant increase in subcortical arousal in moderate and severe OSAHS with hypertension patients, which may be one of the mechanisms of glucose metabolism disorder. Glucose metabolism disorders should be routinely screened in patients with OSAHS and hypertension.

Effect of PPM1A gene modified human amniotic mesenchymal stem cell on proliferation in vitro of bladder cancer cell lines

CHEN Hai-chao, ZHANG Fei, FANG Ning-jun, MAO Qi-qi, MOU Qi-long

2018, 16(8): 1264-1267,1278. doi: 10.16766/j.cnki.issn.1674-4152.000347

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Objective To explore the influence of protein phosphatase 1A, magnesium dependent, alpha isoform (PPM1A) gene modified human amniotic mesenchymal stem cell (MSCs) on the proliferation in vitro of bladder cancer cell lines T24 and 5637 and the TGFβ/SMAD signaling pathway. Methods Bladder tumor cell lines T24 cells and 5637 cells were cultured in 96-well plates, and four groups were set up, including the control group, MSCs intervention group and PPM1A gene modified group. The cells of the control group were cultured as normal, the cells of MSCs intervention group were co-cultured with MSCs, and the cells of PPM1A gene modified group were co-cultured with MSCs infected by PPM1A over expression lentiviral vector. After 48 h co-culture, PPM1A mRNA expression was detected by RT-PCR assay, the protein expression of TGF-β pathway associated markers such as TGF-β, TGF-βⅡ receptor (TβRⅡ), p-Samd2/Samd2 and p-Samd3/Samd3 were detected by WB assay. Results Compared with the control group, the growth rate of T24 and 5637 cells of MSCs intervention group was reduced, the TGF-β, TβRⅡ, p-Samd2/Samd2 and p-Samd3/Samd3 expression levels were decreased, and compared with MSCs intervention group, the growth rate of T24 and 5637 cells of PPM1A gene modified group was reduced, the TGF-β, TβRⅡ, p-Samd2/Samd2 and p-Samd3/Samd3 expression levels were decreased, and the difference between groups was statistically significant (P<0.05). Conclusion MSCs modified by PPM1A can inhibit the expression of TGF-β pathway, thus limiting the malignant proliferation of T24 and 5637 in bladder tumor cell lines, which may be one of its important mechanisms to anti-tumor.

Risk factors of central lymph node metastasis in patients with papillary thyroid microcarcinoma

WANG Yan-yan, LI Li, PENG De-feng, ZHOU Rui, DONG Hui-ming

2018, 16(8): 1268-1270,1282. doi: 10.16766/j.cnki.issn.1674-4152.000348

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Objective To analyze the clinical characteristics of patients with papillary thyroid microcarcinoma (PTMC), and explore risk factors of central lymph node metastasis (CLNM)in patients with PTMC. Methods A total of 254 patients with PTMC from January, 2013 to June, 2016 were analyzed retrospectively, all subjects underwent central compartment lymph node dissection. The patients were assigned into positive group and negative group according to the CLNM. The risk factors for CLNM were analyzed with respect to sex, age, tumor size, tumor multifocal, microcalcification, lymphadenectasis of lateral neck. Results Among the 254 patients, the CLNM occurred in 77 patients (30.3%). The univariate analyses showed that gender of male, age of <45 years, tumor diameter ≥ 5 mm, multifocality and lymphadenectasis of lateral neck significantly increased the risk of CLNM (all P<0.05). Nevertheless, the microcalcification was not significantly related to the presence of CLNM (P>0.05). Multivariate analysis showed that gender of male, tumor diameter ≥ 5 mm multifocality, and lymphadenectasis of lateral neck were independent risk factors for central lymph node metastasis (all P<0.05). Conclusion The gender of male, age of <45 year, tumor diameter ≥ 5 mm, multifocality and lymphadenectasis of lateral neck are associated with CLNM in PTMC patients. The male patients with primary lesions ≥ 5 mm in diameter, multiple lesions and preoperative ultrasound findings of cervical lymphadenopathy are the independent risk factors for CLNM in patients with PTMC.

Experimental study on effect of recombinant human erythropoietin on steroid-induced osteonecrosis of the femoral head in rats induced

YAN Yong-qing, PANG Qing-jiang, XU Ren-jie

2018, 16(8): 1271-1274,1359. doi: 10.16766/j.cnki.issn.1674-4152.000349

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Objective The long-term use of glucocorticoids can lead to femoral head necrosis with high disability rate. This research is designed to explore possible methods to prevent femoral head necrosis and discuss its mechanism by using rat model with simultaneous injection of erythropoietin (EPO). Methods SD Rats were divided into 3 groups according to random number table, half male and half female. Model group:intramuscular injection of methyl prednisolone 20 mg/kg, b.i.w, for six weeks; EPO group:intraperitoneal injection of EPO, b.w 500 U/kg, q.d; Negative control group:injection of normal saline. Twelve weeks after the treatment, the femoral neck tissues were prepared for HE staining (histological examination), immunohistochemistry (PECAM-1) and Western blot (PCNA and VEGF). Main statistical methods were one-way ANOVA (under software SPSS 19.0). Results Histology:compared with experimental group, the model group had shown the sparse, fracture, irregular shape accompanied by nucleus shrinkage, dissolved and disappeared bone trabeculae. Immunohistochemical results:Negative control group was with the highest expression of PECAM-1, followed by EPO group and model group(male rats one-way ANOVA:F=45.776, female F=23.850, P<0.01. Dunnett T3 method was conducted for comparison between groups). Western Blot results:VEGF and PCNA expression in EPO group was higher as compared with the model group, there was no statistical significance when compared with Negative control group (one-way ANOVA PCNA:F=6.857, VEGF:F=7.025, P<0.05, LSD m Method was conducted for comparison between groups). Conclusion Synchronal injection of EPO can prevent steroid-induced necrosis of the femoral head.

Levels of serum high mobility group protein B1 and its related factors in patients with type 2 diabetes mellitus complicated with lacunar cerebral infarct

WU Xiao-yan, YE Cheng-cheng, YANG Hong, RUAN Yuan

2018, 16(8): 1275-1278. doi: 10.16766/j.cnki.issn.1674-4152.000350

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Objective To explore the serum high mobility group protein B1 and its related factors in patients with type 2 diabetes mellitus complicated with lacunar cerebral infarction. Methods Total 280 patients with type 2 diabetes mellitus complicated with lacunar infarction were selected as diabetes mellitus + cerebral infarction group, 280 cases of type 2 diabetes mellitus were selected as the diabetic group, and 280 cases of healthy subjects were selected as control group. The levels of serum high mobility group protein B1 and fasting blood glucose (FBG), glycated hemoglobin (HbA1c), fasting insulin (FINS), Insulin resistance index (HOMA-IR), Triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were tested. Results The level of serum high mobility group protein B1 in diabetes group and diabetes + cerebral infarction group was higher than that in the control group (P<0.05), and the blood in diabetic group + cerebral infarction group was higher than that in the diabetes group (P<0.05). FBG, HbA1c, FINS, HOMA-IR, TG, TC and LDL-C in diabetes group and diabetes mellitus + cerebral infarction group were higher than those in the control group, and their levels in the diabetes mellitus + cerebral infarction group was higher than that in the diabetic group; HDL-C level in the diabetes group and diabetes mellitus + cerebral infarction group were lower than that in the control group, and HDL-C in the diabetic group and cerebral infarction group were lower than that in the diabetic group (P<0.05). The level of serum high mobility group protein B1 in patients with diabetes and cerebral infarction was positively correlated with FBG, HbA1c, FINS, HOMA-IR, TG, TC and LDL-C levels (P<0.05), and negatively correlated with HDL-C (P<0.05). FINS, HOMA-IR, TG, TC, LDL-C, HDL-C were the factors affecting the serum high mobility group protein B1 (P<0.05). Conclusion The levels of serum high mobility group protein B1 in patients with type 2 diabetes mellitus complicated with lacunar infarction rise obviously, and can be affected by FINS, HOMA-IR, TG, TC, LDL-C and HDL-C.

Comparison of clinical effects between single-port video-assisted thoracoscopic surgery and traditional thoracoscopic surgery for spontaneous pneumothorax

ZHOU Jing, SUN Zhong-tao, CHEN Xiao

2018, 16(8): 1279-1282. doi: 10.16766/j.cnki.issn.1674-4152.000351

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Objective To compare the clinical effect between single-port video-assisted thoracoscopic surgery (SPVATS) and traditional thoracoscopic surgery(VATS) in the treatment of spontaneous pneumothorax, and discuss the key points of operation, clinical efficacy and value of popularization of SPVATS. Methods The clinical data of 106 cases of spontaneous pneumothorax in our hospital from January, 2015 to June, 2017 were reviewed. The patients were divided into SPVATS group (64 cases) and VATS group (42 cases). The operative time, bleeding during the operation, drain time, postoperative drainage volume, and length of stay, and VAS in 24 h after the operation were compared between the two groups. Results The operations were successful in both groups, and there was no conversion to thoracotomy case or perioperative death cases. The patients in SPVATS group had significantly lighter postoperative pain than patients in VATS group(t=12.740, P<0.001). The operation time(50.39±9.58)min, intraoperative blood loss (42.70±9.54)ml, chest tube drainage time (3.31±0.90)d, postoperative drainage volume (235.62±74.38)ml and postoperative length of hospital stay (4.73±1.38)d showed no significant difference between two groups (P>0.05). Conclusion Single-port video-assisted thoracoscopic surgery in the treatment of spontaneous pneumothorax has the same safety, easy operation and less pain as compared with VATS, which is worth to be promoted.

Study on the treatment course of tracheobronchial tuberculosis with local drug injection by bronchoscope

LU:Zhi-fang, PAN Qing

2018, 16(8): 1283-1285. doi: 10.16766/j.cnki.issn.1674-4152.000352

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Objective To explore the treatment course of injecting anti tuberculosis drugs into the endotracheal focus by fiberoptic bronchoscopy for the patients with tracheobronchial tuberculosis. Methods A total of 82 patients who were first diagnosed with tracheobronchial tuberculosis (type Ⅰ-Ⅲ) in the respiratory department of our hospital from January, 2014 to December, 2016 were selected, and divided into two groups by random digital table method, with 42 cases in the observation group and 40 cases in the control group. Both groups of patients were given 2HREZ/10HRE chemotherapy. At the same time, the patients in the observation group (42 cases) were injected with rifampin (0.3 g/branch) and isoniazid (0.1 g/branch) in the trachea by the bronchoscope for 8 weeks after the treatment, while the control group received 4 weeks of local injection therapy. The incidence rates of adverse reactions (which included gastrointestinal reactions, liver function damage, and anaphylaxis),the sputum negative conversion rate at end of the second month, the incidence rate of tracheal stenosis and the decline rate of pulmonary function in the two groups were observed and compared. Results There was no significant difference in the rate of gastrointestinal reaction, liver function damage and anaphylaxis in the two groups (P>0.05). The sputum negative conversion rate at end of the second month in the observation group was significantly higher than that in the control group (P<0.05), and the incidence of tracheal stenosis and the decline rate of pulmonary function were lower than those in the control group, and the differences were statistically significant (P<0.05). Conclusion Systemic chemotherapy combined with local injection by bronchoscope for 8 weeks was more effective than local injection for 4 weeks and with fewer complications in the treatment of tracheobronchial tuberculosis and it is worth recommending to use in clinical work.

The clinical analysis of the treatment of refractory nasal hemorrhage by bipolar electrocoagulation under nasal endoscope

CHEN Yan, WANG Wen-zhong, MA Shi-yin

2018, 16(8): 1286-1289. doi: 10.16766/j.cnki.issn.1674-4152.000353

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Abstract:
Objective To investigate the efficacy and safety of endoscopic bipolar electrocoagulation in the treatment of refractory epistaxis, and to analyze the common bleeding sites and gender distribution characteristics in all ages of intractable epistaxis. Methods A retrospective analysis was made on the diagnosis and treatment of 75 patients with intractable nasal hemorrhage in our department from November, 2014 to December, 2017 who were looked for blood spots for once or twice under nasal endoscope. The therapeutic effects of endoscopic bipolar electrocoagulation for refractory epistaxis were summarized and the occurrence of complications were analyzed. The common bleeding sites and gender distribution characteristics of various age groups in refractory nosebleeds were counted. The incidence of common bleeding sites and the gender distribution characteristics of various age groups were counted. Results The curative rate of bipolar electrocoagulation for refractory nasal bleeding was 100%. The complication rate was 2.67%. In 68 patients, bleeding was found under nasal endoscope (64 hemorrhages were found for the first time) and no rebleeding occurred after bipolar electrocoagulation. All were single-arterial hemorrhage, mostly located in hidden place of nasal cavity. In turn, the inferior meatus were 50.67% (38/75), the septum surface of olfactory cleft 13.33% (10/75), the middle meatus 5.33% (4/75, screen bubble 2 case, the anterior wall of ethmoid sinus 1 case, the natural mouth in maxillary sinus 1 case), the rear of nasal septum 6.67% (5/75), the sag of nasal septum 4% (3/75), the rear of nasal septum deviation 6.67% (5/75), the methyl plate of middle turbinate and the rear of middle turbinate and the axillary region of middle turbinate each 1.33% (1/75), the bleeder what was not found 9.33% (7/75). The 7 cases with no identifiable bleeding point were treated with bipolar electrocoagulation and local packing treatment with suspicious bleeding and haematic mucosa, and no rebleeding was found. All patients did not choose the coagulation (ligation) of sphenopalatine artery. The incidence of epistaxis is more common in men than in women. The incidence is increasing after the age of 40. The incidence of women is increasing after the age of 50. Conclusion The refractory nose bleed has good curative effect, less complications, high safety, and it is consistent with the concept of precision and minimal invasiveness and is worthy of clinical promotion and use. Common bleeding sites and gender distribution at different ages can guide clinical practice.

Role of systematic intervention in reducing postoperative respiratory infection in patients with oral cancer

ZHANG Lei, TONG Xi, LI Guo-min, CHEN Chun-hui, FANG Xu, CHEN Kun, LI Xiao-fang

2018, 16(8): 1290-1292,1328. doi: 10.16766/j.cnki.issn.1674-4152.000354

198 1

Abstract:
Objective To investigate the role of systematic intervention in reducing postoperative respiratory infection in patients with oral cancer, and provide a theoretical basis for the prevention and treatment of postoperative respiratory infections in patients with oral cancer. Methods A prospective research method was used to select a total of 166 patients with oral cancer admitted to the department of stomatology of Jinhua Central Hospital from February, 2013 to June, 2016, those patients were divided into intervention group (83 cases) and control group (83 cases) according to the random number table method. The patients of both groups received surgical resection, the control group received routine treatment and intervention group received systematic intervention on the basis of routine treatment. The respiratory tract infection rate, infection duration and bacterial culture were observed on d14 after the intervention. Results The respiratory infection rate in the intervention group was 2.41% and the duration of infection was (3.34±0.73) days; the respiratory infection rate in the control group was 10.84% and the infection duration was (5.75±1.27) days, the respiratory tract infection rate and infection duration of intervention group was significantly lower than that of the control group (P<0.05); Before the intervention, there was no significant difference in the semi-quantitative bacterial count between the two groups (P>0.05). After the intervention, the semi-quantitative count of bacteria of the control group had no significant change when compared with that before the intervention (P>0.05), the intervention group was significantly lower than that before the intervention (P<0.05), and the intervention group was significantly lower than the control group (P<0.05). Conclusion The effect of systematic intervention on reducing postoperative respiratory infection in patients with oral cancer is significant. Systematic intervention can inhibit bacterial growth and significantly reduce infection, which is worthy of clinical application.

Modified positioning instruments improve the accuracy of interlocking intramedullary nail placement

LU Cheng, ZHONG Wen-jun, YANG Jing-song, XUE Tian-le

2018, 16(8): 1293-1295,1307. doi: 10.16766/j.cnki.issn.1674-4152.000355

225 0

Abstract:
Objective To improve the accuracy and efficiency of the distal tibial locking nail placement by improving the interlocking intramedullary nail positioning apparatus. Methods Total 37 cases of tibial fractures undergoing internal fixation with interlocking intramedullary nailing in our hospital from March, 2006 to August, 2016 were selected. There were 26 males and 11 females aged 20 to 71 years old, with an average age of 46.2 years. There were 15 cases of left tibia fracture and 22 cases of right tibial fracture. All operations were performed by the same surgeon. The improved positioning instruments were used to help determine the distal locking hole. The time and success rate of locking nails were recorded. Statistical methods were used to judge statistically significant. Results All the subjects were successfully placed in a total of 74 distal locking nails, 30 on the left and 44 on the right. The success rate of two screws was 98.7% and the success rate of the second remote locking nail was 100%. The success rate has been significantly increased (no cases failed with two or more times of locking nails). The average use time of locking the first distal lock was 5.5 min, and the average time required to lock in the second lock was 3.2 min, two screws were used within 4-15 min and the average time was 8.7 min. The time of the lock was significantly less than the time before the improvement. Conclusion The modified location pressure bar can significantly improve the accuracy of interlocking intramedullary nail distal locking, reduce the operative time and improve the quality of operation, and it has the advantages of economical and low cost. It is suitable for popularization and application in primary hospitals.

Laparoscopic versus open peritoneal dialysis catheter insertion in treatment of aging patients with end stage renal disease

SHEN Wei, JIN Juan, JIANG Xin-xin, LI Yi-wen, HE Qiang

2018, 16(8): 1296-1299,1354. doi: 10.16766/j.cnki.issn.1674-4152.000356

175 2

Abstract:
Objective To compare the therapeutic effect and prognosis of two peritoneal dialysis catheter placement techniques in aging patients with end stage renal disease (ESRD):laparoscopic and open peritoneal dialysis techniques. Methods A total of 86 aging patients (over 45 years of age) with ESRD were reviewed between April, 2011 and April, 2016 in Zhejiang Province People's Hospital. Of 86 patients, the open technique was utilized in 54 (group A) and advanced laparoscopy in 32 (group B). Demographic data, medical, operative, postoperative findings, and information about complications 6 months after peritoneal dialysis were compared between these two groups. Results The mean age of patients was (63.6±10.9) years in A group and (57.7±8.7) years in B group (P=0.011). Patients in A group versus B group demonstrated no significant difference in gender, primary disease, diabetes, or hypertension.Patients with past abdominal operation history accounted for 1.9% (1/54) in group A and 18.8% (6/32) in group B (P=0.018). The average hospitalization time after operation was significantly longer in A group than in B group[(12.95±7.10) days vs. (8.93±4.03) days], P=0.001. The incidence of catheter migration was 16.7% (9/54) in A group and 0% (0/32) in B group (P=0.038). Estimated catheter survival at 5 years was 66.2% in the A group compared to 78.7% in the B group respectively, with no significant difference (P=0.852). Conclusion Laparoscopic PD catheter implantation significantly decreased the probability of migration and shortened hospitalization time. Thus, laparoscopic catheter placement may be superior to open surgery in peritoneal dialysis catheter placement of aging patients with past abdominal operation history.

The efficacy of ultrasound guided radiofrequency ablation for chronic renal failure with secondary hyperparathyroidism

CHENG Yan, SUN Zhang-li, FAN Yi-yun, SUN Yong-qiang, CHEN Zheng-lei

2018, 16(8): 1300-1302. doi: 10.16766/j.cnki.issn.1674-4152.000357

165 0

Abstract:
Objective To explore the effectiveness and safety of ultrasound guided radiofrequency ablation for chronic renal failure with secondary hyperparathyroidism (SHPT). Methods Thirty SHPT patients treated in our hospital were selected. All patients were confirmed with 1-4 hyperplasia parathyroid tissues by ultrasound,and accepted ultrasound guided radiofrequency ablation.Serum parathyroid hormone, serum calcium, and serum phosphorus were measured before and after radiofrequency ablation for 10 minutes, one day, one week, one month, six months and one year. Their clinical symptoms and complications were recorded. Results ① Serum PTH after radiofrequency ablation for 10 minites, one day, one week, one month, six months and one year were (533.4±101.1)pg/ml, (461.2±125.8)pg/ml, (302.3±99.8)pg/ml, (311.6±138.1)pg/ml, (201.9±115.7)pg/ml and(189.4±162.9)pg/ml, decreased as compared with those before radiofrequency ablation(P<0.05); Serum Ca after radiofrequency ablation for 10 minites, one day, one week, one month, six months and one year were (2.31±0.13)mmol/L, (1.76±0.97)mmol/L, (1.99±0.54)mmol/L, (2.00±0.11)mmol/L, (2.05±0.10)mmol/L and (2.16±0.59)mmol/L decreased as compared with thosed before radiofrequency ablation (P<0.05); and Serum P after radiofrequency ablation for 10 minites, one day, one week, one month, six months and one year were (2.23±0.22)mmol/L, (2.01±0.11)mmol/L, (1.99±0.32)mmol/L, (1.87±0.97)mmol/L, (1.68±0.77)mmol/L and (1.65±0.15)mmol/L, decreased as compared with thosed before radiofrequency ablation (P<0.05). ② After radiofrequency ablation, bone pain, itching, weakness, anorexia, improved rapidly. Hoarseness was found in 3 cases in postoperative period, the occurrence rate was 10.0%, and improved spontaneously within one week. Hypocalcemia was found in 2 cases, the occurrence rate was 6.6%, and effectively controlled by calcium infusion in time. No case relapsed after radiofrequency ablation. Conclusion Ultrasound guided radiofrequency ablation is a safe and effective measure for the treatment of SHPT. It can improve symptoms and life quality of SHPT patients.

Effects of spironolactone on cardiac and residual renal function in patients with peritoneal dialysis

WANG Chao-chao, LIN Yong-qiang, ZHAO Run-ying, CHEN Qi

2018, 16(8): 1303-1307. doi: 10.16766/j.cnki.issn.1674-4152.000358

261 18

Abstract:
Objective To investigate the effect of spironolactone on cardiac and residual renal function (RRF) in patients with peritoneal dialysis (PD). Methods A total of 96 patients with end-stage renal disease (ESRD) who underwent PD in our hospital from January, 2015 to December, 2016 were randomly divided into experimental group and control group (n=48). The control group was treated with angiotensin converting enzyme inhibitor (ACEI)/agonist receptor antagonist (ARB). The experimental group was treated with spironolactone on the basis of the control group. Left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), RRF index[residual urea clearance index (KT/V), residual renal creatinine clearance (Ccr)], nutritional anemia, 24 h urine output, peritoneal ultrafiltration and calcium and phosphorus metabolism changes were compared. Results After 6 months and 12 months, the LVMI of the two groups was significantly lower than that before treatment, and the experimental group was lower than the control group. The LVEF of the two groups was significantly higher than that before the treatment, and the test group was higher than the control group (P<0.05). After 6 months and 12 months, the levels of KT/V and Ccr in the control group tend to decrease with statistical significance (P<0.05). There was no significant difference in the levels of KT/V and Ccr in the experimental group (P>0.05). After 6 months and 12 months, the urine output within 24 hours gradually decreased (P<0.05), and the control group decreased more significantly than the experimental group. After 6 months of treatment, the urine output within 24 hours of the experimental group was significantly higher than that of the control group (P<0.05). After 12 months of treatment, the products of serum phosphorus and calcium phosphorus of both groups were lower than those before treatment and the experimental group was lower than the control group. The serum phosphorus was higher than that before treatment, and the experimental group was higher than that before treatment, with significant difference(P<0.05). Conclusion Spironolactone can improve the cardiac function of PD patients, protect patients with RRF, effectively control calcium and phosphorus metabolism, and basically does not affect the nutritional status of patients and peritoneal ultrafiltration, thus worthy of further promotion.

Effects of insulin combined with Danhong injection on foot dorsal hemodynamics, markers of serum inflammation and endothelial function in patients with diabetic foot

PAN Ye, GAO Qian, ZHANG Wen-jun, SUN Qi-hua, CHEN Nai-jun, WANG Qi-hong

2018, 16(8): 1308-1310. doi: 10.16766/j.cnki.issn.1674-4152.000359

238 0

Abstract:
Objective To explore the effect of insulin combined with Danhong injection on foot dorsal hemodynamics, markers of serum inflammation and endothelial function in patients with diabetic foot. Methods From February, 2015 to February, 2016, 108 patients with diabetic foot ulcers were selected in the hospital, according to the order of admission and random control table, the patients were divided into the observation group and the control group, with 54 cases in each group. The control group was treated with insulin to control blood sugar and anti infection; meanwhile, insulin, anisodamine and normal saline were applied to the affected part. The observation group was treated with Danhong on the basis of the control group and intravenous drip of Danhong injection. The course of treatment was 4 week, 1 time a day. The hemodynamics of the dorsalis pedis artery, serum inflammatory markers, endothelial function, ulcer area and side effects were observed in the two groups. Results After treatment, the vascular diameter and blood flow in the observation group were significantly greater than those in the control group (P<0.01), and the peak flow velocity was significantly lower than that in the control group (P<0.01); the levels of TNF-α and IL-6, ET and vWF in the observation group were significantly lower than those in the control group, and the difference between the two groups was statistically significant (P<0.01). The ulcer area in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P<0.01). Neither group had significant adverse reactions. Conclusion The combination of insulin and Danhong injection has some effect on foot dorsal hemodynamics, markers of serum inflammation and endothelial function in patients with diabetic foot, which may be of certain clinical value for the treatment of diabetic foot. In the future work, it should be expanded in the sample size and combined with other indicators to carry out a more in-depth study.

Effect of delayed cord clamping on neonatal jaundice

LU Qiu-jing, QIAN Yi-yu, WANG Pei-xin, LU Zhe, HUA Ying

2018, 16(8): 1311-1313. doi: 10.16766/j.cnki.issn.1674-4152.000360

261 1

Abstract:
Objective Immediate cord clamping (ICC) is a routine clinical practice after delivery of the fetus, however, delayed cord clamping (DCC) can make the fetal blood in placenta flow back sufficiently to collect more flood, and has positive effects on the prevention of neonatal anemia. No study has confirmed the risk of DCC on neonatal jaundice. The aim of this study is to explore the effects of DCC on neonatal jaundice in full term vaginal delivery neonates through comparing ICC and DCC. Methods A total of 1 867 cases with full term vaginal delivery were selected in the second hospital affiliated to Wenzhou city in Zhejiang province July, 2017 to September, 2017, they were divided into observation group and control group randomly. Nine hundred infants in observation group received delayed cord clamping and 967 infants in control group received routine cord clamping. Umbilical cord of infants in the observation group was clamped from 30 s to 180 s after delivery, then umbilical cord in the control group was clamped in 30 s after delivery. They were monitored and compared in two groups that the level of neonatal daily transcutaneous bilirubin, the incidence of neonatal jaundice, the incidence of high blood bilirubin, bilirubin encephalopathy incidence index. Results The level of neonatal daily transcutaneous bilirubin in 1-5 day were examined, they were (3.43±0.76), (7.15±0.85), (11.23±0.74), (12.37±1.04) and (13.68±1.49) mg/dl in observation group and which were (3.12±0.43), (7.07±0.74), (11.11±0.68), (12.01±1.13) and (12.96±1.58) mg/dl. The level of neonatal daily transcutaneous bilirubin in observation group was higher than that in control group, but no significant difference was found between the two groups (P>0.05). There were the same results in the incidence of neonatal jaundice, the incidence of high blood bilirubin and blue light treatment. And there were no bilirubin encephalopathy in the two groups. Conclusion Delayed cord clamping has no significant effect on neonatal jaundice, and does not increase incidence of neonatal jaundice, It is safety and feasible, deserve the clinical expansion.

Risk factors and prevention measures of multiple drug-resistant infections in neonatal intensive care unit

XU Li, WANG Ren-yuan, CHEN Bei-bei, XIE Man-fang, FU Zeng-zhen

2018, 16(8): 1314-1317. doi: 10.16766/j.cnki.issn.1674-4152.000361

208 1

Abstract:
Objective To investigate the risk factors of multiple drug-resistant infections(MDRO) in neonatal intensive care unit (NICU), and to provide scientific evidence for clinical prevention and control measures. Methods From January, 2012 to December, 2016 in Hainan Province Maternal and child health hospital treated 326 cases of NICU infection in children, according to the results of drug sensitive test for MDRO infection group (102 cases) and non MDRO infection group (224 cases), analysis of prevalence of multidrug-resistant bacteria. Single factor and multi factor Logistic regression analysis were used to analyze the risk factors of NICU multiple drug-resistant infections. Results From 2012 to 2016, the number of NICU multiple drug-resistant infections in our hospital showed an increasing trend year by year. One hundred and fifty-six strains of MDRO were detected in 102 children with MDRO infection. The number of MDRO detected in the top three was MDR/PDR-PA 60strain (38.46%), MRSA 45 strain (28.85%), CR-AB 37 strain (23.72%). The main sites of MDRO infection are respiratory tract infection and bloodstream infection. Univariate and multivariate Logistic regression analysis showed that birth weight (OR=2.581, P=0.026), coma (OR=3.846, P=0.038), invasive mechanical ventilation (OR=4.317, P<0.001), types of antibacterial drugs (OR=5.218, P<0.001) and antimicrobial use time (OR=2.615, P=0.032) were independent risk factors multiple drug-resistant infections in NICU. Conclusion There are many risk factors for multiple drug-resistant infections in children with NICU, and prevention and control measures should be taken as early as possible to reduce the incidence of multiple drug-resistant infections.

The analysis of vitamin D deficiency with children in PICU

TONG Liu-sai, GUAN Xuan, YANG Shu-qin, ZHANG Dan-ru, JIN Ru

2018, 16(8): 1318-1320. doi: 10.16766/j.cnki.issn.1674-4152.000362

208 0

Abstract:
Objective To study the serum vitamin D levels in children who were send to PICU because of infection, analyze the relationship between vitamin D levels and disease outcome and explore its clinical significance. Methods Three hundred and seventy-eight cases of patients who were sent to PICU because of infection were included, and the main types of infection were ensured when they hospitalized. The 25-(OH)D level in serum was detected and compared with 350 cases of healthy children, who come to body check or vaccination in our outpatient service at the same term. Meanwhile, PICU patients were divided into two groups according to their 25-(OH)D level:normal 25-(OH)D group 264 cases and lack 25-(OH)D group 114 cases. General condition, hospital length of stay (HLOS), PRISM score and prognosis were compared between the two groups. Results The main infection that cause children hospitalized into PICU were septic shock, serious respiratory or digestive system infection. Serum 25-(OH)D in PICU children (63.5±19.9) nmol/L was lower than healthy children (76.8±17.1) nmol/L (P<0.01), and the ratio of 25-(OH)D lacking (30.2%) was also higher than healthy children(18.6%), P<0.05. In PICU patients, lack 25-(OH)D group children were elder than normal 25-(OH)D group (P<0.01). HLOS was longer in lack 25-(OH)D group (P<0.01). But 25-(OH)D level was neither related to PIRSM score (P>0.05) nor correlated to children death (P>0.05). Conclusion Children hospitalized into PICU because of infection are lacking 25-(OH)D obviously, lack of 25-(OH)D leads to slow recovery of infection diseases, but does not affect the severity of diseases or mortality in children.

Effect of ADRB2 silencing on the cisplatin-resistance and related biological behavior of epithelial ovarian cancer

HU Fei-jun, ZHANG Xia, QI Wei-zhen, WU Yan-dan, LI Song-yi

2018, 16(8): 1321-1324. doi: 10.16766/j.cnki.issn.1674-4152.000363

160 1

Abstract:
Objective To investigate the effect of ADRB2 silencing on the cisplatin-resistance and the cell proliferation and apoptosis of epithelial ovarian cancer cells. Methods Human epithelial ovarian cancer cell line SKOV3/DDP was selected for the study and small RNA interference technology was used for silencing the expression of ADRB2. The experiment was divided into 4 groups:ADRB2 shRNA1 group, ADRB2 shRNA2 group, negative control group and blank control group. Cells were treated with different concentration of cisplatin (0, 2.5, 5, 10, 20, 40 μmol/L). Cell proliferation was measured by CCK-8 assay, cell apoptosis was measured by flow cytometry, the expression of caspase-9, Bcl-2 and Bax were measured by western blot. Data was analyzed by t test. Results Cell growth inhibitory rate was significantly upregulated in a dose depend manner upon cisplatin treatment in four groups. The IC50 of two ADRB2 shRNA group were (29±8)μmol/L and (32±11)μmol/L, significantly lower than those of negative control group[(104±15)μmol/L, P<0.01] and blank control group[(112±10)μmol/L, P<0.01]. Cell apoptosis rate was upregulated in an dose depend manner upon cisplatin treatment in four groups. Cell apoptosis of two ADRB2 shRNA group were significantly higher than those of negative control group and blank control group (P<0.01). The caspase-9 and Bax expression were increased upon cisplatin treatment. The levels in two ADRB2 shRNA group were significantly higher than those of negative control group and blank control group (P<0.05). The Bcl-2 expression was decreased upon cisplatin treatment. Its level in two ADRB2 shRNA group were significantly lower than those of negative control group and blank control group (P<0.05). Conclusion ADRB2 silencing significantly increase cisplatin-induced apoptosis and reduce the cell proliferation induced by cisplatin in SKOV3/DDP cells through regulating caspase and Bcl-2 apoptosis signaling pathway.

Analysis of the influence factors and correlativity between ankle-brachial index and cardio cerebrovascular diseases and related factors

WU Jun-ying, XU Lin, LIANG Wei-gen, SU Peng, XIE Yu-ru

2018, 16(8): 1325-1328. doi: 10.16766/j.cnki.issn.1674-4152.000364

281 0

Abstract:
Objective To investigate the prevalence of hypertension, stroke, coronary heart disease and diabetes in the community health physical examination population and to analyze the relationship between ankle-brachial index and cardiovascular and cerebrovascular diseases and related influencing factors, so as to provide theoretical basis for prevention and treatment of atherosclerotic diseases in community population. Methods A total of 456 community residents who received physical examination in community health service center from March to May 2016 were selected as the research objects. The age, gender, height, weight, SBP, DBP, heart rate, blood biochemical indexes, and the body mass index (BMI) and pulse pressure (PP) are calculated by the formula. The prevalence of hypertension, stroke, coronary heart disease and diabetes were collected and investigated at the same time; All subjects underwent ABI testing and divided into normal group (>0.9) and abnormal group (≤ 0.9) according to ABI value. Results Comparative ABI normal and abnormal group, age, SBP, PP, creatinine were statistically significant (P<0.05); The prevalence rates of hypertension, stroke, coronary heart disease and diabetes in the normal ABI group were 52.50%, 31.43%, 31.79%, 24.64%, and the prevalence rates of hypertension, stroke, coronary heart disease and diabetes in ABI abnormal group were 63.64%, 64.20%, 72.16% and 39.20%. The difference between the two groups was statistically significant(P<0.05). Multivariate Logistic regression analysis showed that age, PP and coronary heart disease were independent risk factors for ABI abnormalities (P<0.05), and the coronary heart disease with abnormal ABI was significantly correlated (β=1.666, P<0.001). Conclusion ABI detection in community residents found that age, PP, coronary heart disease are the independent risk factors for ABI decreased. Coronary heart disease is strongly positive correlated with ABI decreased, we should increase the screening of coronary heart disease in community physical examination crowd, and actively control blood pressure, prevent and delay the occurrence and development of arterial disease.

Implementation on hierarchical medical system in Futian taking the hospital for prevention and treatment of chronic disease as the bridge

CHEN Wen-ru, ZHANG Xue-jiao, ZHOU Zhi-heng, WU Jin-xia, ZHOU Ya, CHEN Bao-xin, DONG Hong-wei

2018, 16(8): 1329-1333. doi: 10.16766/j.cnki.issn.1674-4152.000365

313 1

Abstract:
Objective To implement and evaluate hierarchical medical system in Futian taking the hospital for prevention and treatment of chronic disease as the bridge. Methods To establish the hierarchical medical system by series of measures:building regional medical association, promulgating hierarchical medical programme, taking the Futian hospital for prevention and treatment of Chronic Disease as the bridge, Setting up a discipline alliance, Enhancing the ability of health care, modifying two-way referral service process, information construction. The overall situation effect of the hierarchical medical system was evaluated. Results Hierarchical medical system in Futian has been established successfully since June, 2016. Evaluation shown that the hierarchical medical system was running well, the priority registration, priority admission, priority examination, and priority hospitalization service for the patients were implemented, and collaboration between general practitioners and specialists were significantly was improved. The number of patients with hypertension and diabetes attending community health center increased by 18.2% and 26.9% compared with the same period before implementation of hierarchical medical system. The increment speed of standardized management for hypertension and diabetes patients were more than 3 times and 2.18 times compared with the same period before implementation of hierarchical medical system. There were 3 057 patients referral to the community health center from hospital, while there was no patients' referral to the community health center before June, 2016. Conclusion The effect of the hierarchical medical system in Futian taking the hospital for prevention and treatment of chronic disease as the bridge is Satisfied, which is worth extending.

Analysis of medical students mental stress state of self-perception and influencing factors

WANG Su-ping, NI Yang, ZHOU Dong, TANG Hua

2018, 16(8): 1334-1337,1378. doi: 10.16766/j.cnki.issn.1674-4152.000366

257 3

Abstract:
Objective The research concerning stress status of medical students and its influencing factors provides a data support for pressure relief and for the promotion in physical and mental health of medical students as well as medical school management. Methods A self-designed questionnaire was used for the research, involving a total of 498 graduate and undergraduate students of Shanghai Jiao Tong University School of Medicine and its affiliated teaching hospital, the content of which includes basic demographic information, pressure feelings and their influencing factors both subjectively (ability and habit) and objectively. Besides, 10 graduate students and 20 undergraduates were interviewed by means of focus group interview. Results Demographic basic information and stress perception have no statistical significance. The stress perception is related to the individual ability of subjective factors and to all the objective factors. The backward regression method was used to analyze the stress sensitivity and the stress. The highest β coefficient absolute value is learning adaptability (0.383), followed by time management ability (0.137), course setup (0.107), course duration schedule (0.100) and length of sleep (0.097). The interview results show that the stress comes along with study and scientific research as well as interpersonal relationships. A number of senior students advocate the cultivation of humanistic quality. Conclusion The promotion of mental health among medical students and the quality of education by medical school should be a joint effort of 3 aspects:effective help and instructions provided by school, nurturing atmosphere created by family members, good habits and abilities developed by students themselves.

Evaluation of automatic enzyme-free analyzer in the application of hepatitis enzyme-linked immunosorbent assay

FANG Xiang, XIANG Guo-qian, SHOU Ming-xia, SHAO Wen-xia, JIANG Chun-ming, BIAN Zhen-yu

2018, 16(8): 1338-1341,1371. doi: 10.16766/j.cnki.issn.1674-4152.000367

195 0

Abstract:
Objective To compare the differences in the detection of performance among the automatic enzyme-free analysis system and the imported enzyme-free analysis system and the manual method. Methods A total of 196 hepatitis B/C negative serum samples, 20 hepatitis B positive serum samples, 20 hepatitis C positive serum samples randomly collected in Hangzhou First People's Hospital in 2016. To compare the sensitivity, precision, accuracy and specificity of the three methods, we use 1 set of Zhuhai Lizhu company hepatitis B detection kit and a set of Beijing Kang Chester anti-HBV national standard material, a set of Beijing million Thai hepatitis C kit and a set of Beijing Kang Chester anti-HCV national standard substances, respectively. Data were analyzed by SPSS 17.0 software. Results Abbott i2000SR system sensitivity was significantly higher than Addcare ELISA 600 system and manual method, Addcare ELISA 600 system sensitivity higher than manual method, the difference was statistically significant (P<0.05). The test CVs of the standard materials of the hepatitis B and the hepatitis C antibody were 14.5%> 12.3%>2.1%, 17.0%>12.5%>3.5%, 10.8%>8.4%>3.0%, 24.4%>19.6%>4.4%, 20.0%>19.4%>2.0%, 12.7%>11.1%>3.2%, respectively. The CV of the manual method is greater than that of the domestic automatic enzyme-free analysis system. The CV of the system is greater than that of the Abbott. The CV of the i2000SR system was statistically significant (P<0.05). The coincidence rate of the three methods was 100.0% for HBV and anti-HCV kit positive and negative reference. The specificity of the three methods was 100.0% for 176 negative specimens. Conclusion The automatic enzyme-free analysis system and the Abbott i2000SR system are more reproducible than manual operation, and the coincidence rate and specificity of the three are consistent. The domestic automatic enzyme-free analysis system can replace the manual operation Clinical routine specimen testing.

The application value of CD80, CD83, CD86 in patients with non-small cell lung cancer

YU Zhang-fa, YE Li-jun, CAI Sha-sha, BAO Jian-min, ZHANG Shao-wen

2018, 16(8): 1342-1344,1408. doi: 10.16766/j.cnki.issn.1674-4152.000368

276 1

Abstract:
Objective To investigate the clinical significance of CD80, CD83 and CD86 of non-small cell lung cancer (NSCLC) patients. Methods One hundred and thirteen cases of patients with NSCLC and 30 cases of healthy controls from January, 2012 to December, 2015 in the first people's hospital of Taizhou were collected.The expression of CD80, CD83 and CD86 in the peripheral blood of patients with NSCLC and healthy controls were analyzed by flow cytometry. Comparisons were made using the t test and variance test. Kaplan-Meier plots and log rank analysis were applied to determine the significance of differences in patient's survival time. Results The levels of CD80, CD83, CD86 in NSCLC patients were significantly lower than those of normal controls (t=10.026, 4.963, 4.870, all P<0.05), and CD80, CD83 were significantly difference in different TNM stage (F=12.750, 9.481, all P<0.05). The levels of CD80, CD83 and CD86 in NSCLC patients after operation were significantly improved than that before operation (t=-3.648, -4.621, -4.257, all P<0.05). The NSCLC patients with high level of CD80 had better survival rate (P=0.040), while CD83 and CD86 had not (P=0.118, 0.084). Conclusion The detection of CD80, CD83 and CD86 may be valuable in NSCLC patients. CD80, CD83 are closely associated with TNM stage, and CD80 is an independent predictor of survival time.

Predictive value of electrocardiogram test for malignant ventricular arrhythmia in patients with variant angina

TANG Bin-bin, CHEN Ai-min

2018, 16(8): 1345-1348. doi: 10.16766/j.cnki.issn.1674-4152.000369

289 1

Abstract:
Objective To investigate the predictive value of electrocardiogram (ECG) test for malignant ventricular arrhythmia (MVA) in patients with variant angina (VA), and to provide reliable monitoring basis for the occurrence of MVA in VA patients. Methods A total of 90 patients with VA were admitted to our hospital from June, 2013 to June, 2017, and 67 patients with VA were selected to VA group and 23 patients with VA combined with MVA were selected to MVA group. Logistic regression analysis was used to explore the relationship between ECG parameters and MVA. The area under the curve (AUC) of ROC was used to analyze the predictive value of ECG parameters on MVA. Results In the acute episode, cQTd, cTp-e, Tp-e/QT, cTp-ed and STE of MVA group were significantly higher than those of VA group (P<0.05). The AUC value of cTp-e, cTp-ed, Tp-e/QT and STE were significantly higher than that of cQTd (P<0.05), the AUC value of Tp-e/QT, cTp-ed were significantly higher than those of cTp-e and STE (P<0.05); There was no significant difference on the AUC between Tp-e/QT and cTp-ed (P>0.05), and there was also no significant difference on the AUC between cTp-e and STE (P>0.05). Logistic regression analysis showed that there was a close correlation between cQTd/QT, cTp-ed, STE and MVA in VA patients (P<0.05). Conclusion ECG detection can effectively predict MVA in patients with VA. Tp-e/QT and cTp-ed are relatively stable and have higher predictive value, which can be used as a valid indicator of the risk of MVA in patients with VA.

Clinical characteristics and progress in diagnosis and treatment of left ventricular aneurysm after myocardial infarction

ZHOU Sheng-hui, MOU Huang-tai, NIE Shao-ping

2018, 16(8): 1349-1354. doi: 10.16766/j.cnki.issn.1674-4152.000370

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Abstract:
Left ventricular aneurysm (LVA) is one of the mechanical complications of acute myocardial infarction. LVA can destroys the normal structure of the ventricle, affect ventricular systolic and diastolic function, which can lead to repeated angina, malignant arrhythmia, heart failure, left ventricular thrombus and other complications, seriously affecting the prognosis of patients. With the progress of early reperfusion technology and the development of drug therapy, the incidence of LVA after AMI gradually decreased. ECG is an important examination of screening the LVA after myocardial infarction, but the ECG is not specific. Echocardiography is a common method for the diagnosis of LVA, and the progress of real-time three-dimensional echocardiography improves the accuracy of LVA diagnosis. Cardiac magnetic resonance is more accurate than echocardiography in diagnosing LVA, and delayed enhancement cardiac magnetic resonance imaging can also identify viable myocardium. Radionuclide ventricular imaging can accurately determine the left ventricular capacity, ejection fraction and wall motion, the accuracy of diagnosis LVA is good. X-ray left ventricular angiography is the gold standard of diagnosis left ventricular aneurysm, but it is not commonly used. Early reperfusion after acute myocardial infarction can reduce the incidence of LVA. Most LVAs can choose conservative treatment of internal medicine, inhibition of ventricular remodeling drugs is the basis of LVA drug treatment. Percutaneous ventricular restoration is a new technique for the treatment of LVA in recent years and has achieved good results. When the LVA patients with complications, such as heart failure, the malignant arrhythmia cannot control by drug, thromboembolism, may be consider the surgical treatment. Cell transplantation treatment is a promising approach after treatment of resection of LVA. This review summarizes the clinical characteristics and progress in diagnosis and treatment of post-myocardial infarction left ventricular aneurysm.

Research progress of platelet antigen antibody detection during pregnancy

WANG Cai-lian, ZHANG Jun

2018, 16(8): 1355-1359. doi: 10.16766/j.cnki.issn.1674-4152.000371

308 0

Abstract:
Numerous studies have found that pregnancy has a close relationship with platelet antibody. Due to alloimmune or autoimmune factors, pregnant women may produce platelet antibodies, which can make their way through the placental barrier into fetal blood circulation and cause antigen antibody response combined with fetal platelet, which leads to a series of fetal thrombocytopenic hemorrhagic disease and eventually makes the pregnant women in early abortion,recurrent miscarriage or the newborn in immune thrombocytopenia. Neonatal alloimmune thrombocytopenia is a neonatal hemorrhagic disease caused by alloimmune factors. The incidence of this disease in Caucasian population is about 0.1%, and the incidence rate in Japanese population is about 0.15%, but there is no statistical data in China in this field. The disease is urgent, which can cause extensive hemorrhage in overall skin and organ. Serious case can appear intracranial hemorrhage or even death. Therefore, platelet antigen antibody detection during pregnancy is of great significance,which can efficiently explore the etiology of recurrent miscarriage, early predict and prevent the occurrence of neonatal alloimmune thrombocytopenia. At present, the detection technology of platelet antigen antibody mainly includes serology and molecular biology technology, and a series of advanced detection technology have been developed at home and abroad. This paper presents the latest research progress on the classification of platelet antigen antibody, the generation and pathogenesis of platelet antibodies, the latest detection methods of platelet antigen antibody, and the research status of neonatal alloimmune thrombocytopenia, in order to arouse the attention of clinicians and pregnant women,in order to provide important reference basis for promotion of platelet antigen antibody detection in pregnant women in daily prenatal.

Analysis of the application of acupoint acupuncture therapy on recurrent trigeminal neuralgia accompanied by anxiety and depression patients

LUO Feng-qin, GUO Xiao-wen, ZHANG Juan, WANG Shi-ping, YE Ling

2018, 16(8): 1360-1363. doi: 10.16766/j.cnki.issn.1674-4152.000372

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Abstract:
Objective To analyze the application of acupoint acupuncture therapy on recurrent trigeminal neuralgia accompanied by anxiety and depression patients, and to provide reference for clinical treatment of the recurrent trigeminal neuralgia accompanied by anxiety and depression. Methods A total of 84 patients with recurrent trigeminal neuralgia accompanied by anxiety and depression who were diagnosed and inclusion criteria in our hospital were selected from February, 2015 to September, 2017, and they were randomly divided into observation group (n=42) and control group (n=42) according to the random number table method. The control group was treated with traditional Chinese medicine, and the observation group was treated with acupoint acupuncture therapy based on the control group. The clinical effect, pain degree, vasoactive intestinal peptide level, anxiety and depression score and adverse reaction rate were compared between the two groups. Results The total effective rate of clinical treatment in observation group was significantly better than that of the control group (P<0.05). Before treatment, there were no significant differences in the score of visual analogue scale (VAS) and the level of vasoactive intestinal peptide between the two groups (P>0.05). After treatment, the score of VAS and the level of vasoactive intestinal peptide were significantly lower than those before treatment (P<0.05), and the observation group was significantly lower than the control group (P<0.05). Before treatment, there were no significantly differences in the score of hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), P>0.05. After treatment, the score of HAMA and HAMD were significantly lower than those before treatment (P<0.05), and the observation group was significantly lower than the control group (P<0.05). There was no significant difference in adverse reactions rate between the two groups (P>0.05). Conclusion The acupoint acupuncture therapy can obviously improve the degree of pain, anxiety and depression on recurrent trigeminal neuralgia accompanied by anxiety and depression patients, clinical curative effect is remarkable and adverse reaction is rare, which has high clinical application value.

Effect of TCM acupuncture therapy combined with rehabilitation exercise on limb motor dysfunction among patients in convalescent stage of ischemic stroke

JING Fu-quan, ZHOU Yu, NIU Xiang-lai, WANG Zeng-liang

2018, 16(8): 1364-1367. doi: 10.16766/j.cnki.issn.1674-4152.000373

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Abstract:
Objective To explore the effect of TCM acupuncture therapy in combination with exercise rehabilitation on the recovery of limb motor dysfunction in patients with hemiplegia caused by cerebral ischemic stroke (CIS), and to provide new ideas for improving the clinical curative effect of this disease. Methods Total 80 cases of limb motor dysfunction caused by CIS in our hospital between January, 2015 and January, 2017 were enrolled and divided into acupuncture combined rehabilitation group (40 cases) and rehabilitation control group (n=40). The curative efficacy was observed after two courses. All patients were evaluated by FMA scale and Berg balance before and after treatment, and the serum levels of Hcy were measured. The randomized controlled clinical research methods were employed in this study, and SPSS 17.0 statistical analysis software package was used for statistical analysis of the data, P<0.05 was statistically significant. Results Before the treatment, the statistical analysis showed that there was no significant difference in the general data, FMA and Berg score, and Hcy level (P>0.05). After the treatment, FMA and Berg score were improved in both groups (P<0.05), and more obvious in the acupuncture combined rehabilitation group. The Hcy level of the acupuncture combined with rehabilitation group was significantly higher than that of the control group. The total effective rates were 92.5% in the acupuncture combined rehabilitation group and 75.0% in the control group. Conclusion TCM acupuncture therapy combined with exercise rehabilitation for ischemic stroke hemiplegia patients was safe, reliable, cost-effective, and worthy of more clinical application.

Clinical effect of TCM Liqi Dredge Decoction on postpartum galactostasis

HUANG Dong-mei, CONG Jing, ZHANG Hui, LI Li-rong

2018, 16(8): 1368-1371. doi: 10.16766/j.cnki.issn.1674-4152.000374

221 0

Abstract:
Objective To explore the effect of TCM Liqi Dredge Decoction on pain, milk deposition and treatment in the patients with postpartum galactostasis. Methods Seventy cases of postpartum galactostasis in our hospital between January, 2015 and January, 2017 were enrolled into this study and were randomly divided into control group and TCM group with 35 cases in each group. The control group received hot compress treatment and breast point massage, 30 minutes each time, 1 time a day for 3 days; while the TCM group received TCM Liqi Dredge Decoction (a dose of herbal medicine each day for 3 days) and breast point massage therapy (same as the control group). The pain, milk deposition and therapeutic efficacy were observed and compared. Results After the treatment, VAS decreased in both groups, and VAS (2.26±1.12) in TCM group was obviously lower than that (3.11±1.08) in the control group, the difference was statistically significant (P<0.05). The milk deposition in both groups was improved, more significantly in the TCM group when compared with the control group, the difference was statistically significant (P<0.05). The total effective rate of TCM group was 97.14%, which was higher than 82.86% of the control group, and the difference was statistically significant (P<0.05). Conclusion TCM Liqi Dredge Decoction combined with breast point massage therapy for postpartum galactostasis can effectively dredge the duct milk deposition, dissipate agglomeration, improve the milk deposition, reduce VAS, and relieve the pain of patients. It is more effective for postpartum galactostasis as compared with hot compress combined breast point massage therapy, which is worthy to be popularized.

Clinical effect of Xiangsha Liujunzi Decoction combined with proton pump inhibitors in the treatment of elderly peptic ulcer with weak spleen and stomach

SHEN Zheng, ZHANG Jun-liang, HUANG Chun-xia

2018, 16(8): 1372-1374. doi: 10.16766/j.cnki.issn.1674-4152.000375

185 0

Abstract:
Objective To investigate the clinical value of Xiangsha Liujunzi Decoction combined with proton pump inhibitors in the treatment of elderly peptic ulcer with weak spleen and stomach. Methods A total of 112 elderly patients with peptic ulcer with spleen and stomach admitted from September, 2015 to December, 2017 were selected as study subjects. Randomized digital table was used to divide the control group with 56 cases and observation group with 56 cases. Basic treatment was performed in both groups. The control group received proton pump inhibitor treatment. The observation group was treated with Xiangsha Liujunzi Decoction on the basis of the control group. The treatment effects, disappearance of clinical symptoms, and occurrence of adverse reactions were observed in both groups. Results After treatment, the total effective rate in the observation group reached 94.64%, and the total effective rate in the control group was 82.14%. The observation group was significantly higher, and the difference was statistically significant (P<0.05).After treatment in the observation group, the disappearance time of symptoms of abdominal pain, acid reflux, hernia and epigastric cauterization was significantly shorter than that of the control group,[(3.01±0.48) vs. (4.22±0.53); (4.54±0.51) vs. (5.89±0.57); (5.12±0.63) vs. (6.34±0.69); (3.98±0.49) vs. (4.93±0.56)] and the difference was statistically significant (P<0.05); The incidence of adverse reactions was 10.71% in the observation group and 16.07% in the control group. There was no significant difference between the two groups (P>0.05), and no serious adverse reactions were observed. Conclusion In the treatment of elderly peptic ulcer with weak spleen and stomach, the application of Xiangsha Liujunzi Decoction combined with proton pump inhibitors can obtain the exact curative effect, promote the elimination of the symptoms of patients, and have high safety, and it is worthy of promotion.

Current status of continuing medical education for primary general practitioners in China

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

2018, 16(8): 1375-1378. doi: 10.16766/j.cnki.issn.1674-4152.000376

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Objective To investigate current status including teachers, forms and contents of continuing medical education for primary general practitioners in China, and provide scientific evidences for continuing medical education policy. Methods Cluster random sampling and convenient sampling method was used in this study. In May 2017, a questionnaire survey was carried out among 670 general practitioners from 54 Primary health institutions of 13 Provinces in China. Epidata 3.1 was used to enter data and all analyses were conducted with SAS 9.1 statistical package. P<0.05 was considered statistically significant. Results Continuing medical education teachers were mainly from tertiary hospitals or specialized hospitals, accounting for 49.8%, and only 9.88% of the teachers came from the primary health institutions. Compared with other regions, the eastern region had more teachers who came from primary health institutions, accounting for 11.98%. Continuing medical education for primary general practitioners was mainly carried out in the form of academic lectures, training class and online education; and operation practice and field visit was less, only 8.96%. Online education was conducted more in western region and rural area. In addition, the content of continuing medical education concentrated in the rational use of drugs and disease diagnosis and treatment, etc. It was also found that the rate of teacher satisfaction was 59.28%, teaching form was 49.32%, and content was 53.07%. Moreover, the satisfaction of general practitioners differs in different regions, educational backgrounds and professional titles. Conclusion The overall continuing medical education satisfaction was at a low level. The results indicated that to improve the quality of continuing medical education for general practitioners in primary health institutions it is necessary to strengthen the teacher cultivation, enrich the forms and broaden the contents to meet the different needs of primary general practitioners.

Exploration and practice of clinical basic skills simulation training and knowledge intensive education precise course for general practitioners

LI Yan-ping, LUO Liang, JIN Feng-juan, NIE Hong-yu, CHEN Hong, GAO Yuan, GAO Jie, LI Tong

2018, 16(8): 1379-1382. doi: 10.16766/j.cnki.issn.1674-4152.000377

280 1

Abstract:
Objective To develop the basic clinical skills simulation training and knowledge intensive education precise course for general practitioners(GP), so as to improve their job competency. Methods The methods of expert interview, literature review and questionnaire survey were adopted. The 20 participants were interviewed according to the theory of knowledge group, single skill group, clinical thinking ability and attitude group and 99 GP students were investigated. According to the views of the expert group and characteristics and training needs of GP, we developed training curriculum system accurately. Results The results of 20 experts at 2/3 frequency on the course classification opinions are four categories:GP theories, individual skills, diagnosis and management of common community diseases and chronic diseases (clinical thinking), humanities and medical ethics regulations. General training requirements of the GP students:students think the main purpose of the training is to improve the clinical competency; clinical skills are the most needed knowledge and skills; video and teaching combined with practice is the preferred way of training; the most favorite humanity course is the doctor-patient communication. The projects which reach 2/3 frequency focused on the clinical skills and clinical thinking in common, which mainly include:basic diagnostic skills, basic puncture surgery, basic skills in surgery, gynecology, obstetrics, pediatrics, critical care rescue and nursing, clinical thinking and comprehensive knowledge etc. According to the survey results, a standard curriculum targeting at GP trainees was made with clear orientation. The system contains three levels involving knowledge, skills and attitudes. It concerned internal medicine, surgery, gynecology, pediatrics, emergency treatment, nursing, general clinical thinking and the related theory. Conclusion The curriculum system promotes the competency of general practitioners, and achieves the standardization, normalization and homogenization of clinical basic skills.

Positive effects of nutrition and social support on quality of life in patients with colorectal cancer

XU Yu-fen, SONG Bin-bin, LI Xia, WANG Ai-fen, XU Xiao-fang, ZHOU Qiang, JIANG Yi-ming, YANG Xin-mei

2018, 16(8): 1383-1385,1395. doi: 10.16766/j.cnki.issn.1674-4152.000378

176 0

Abstract:
Objective To summarize and analyze the influence of nutrition and social support on the quality of life in patients with colorectal cancer. Methods In our hospital from January, 2012 to January, 2015, 128 cases of patients with advanced colorectal cancer were chosen as the research object, whose clinical data were analyzed, the relationship between nutritional status during chemotherapy, social support, quality of life (physical function, emotional function, role function, cognitive function, social function and the secondary reaction was summarized. Results ① The nutritional status score, the score of subjective support and social support scores in the group under 60 were higher than those 60 years old or above. The nutritional status score, the score of objective support, subjective support and support availability score and total score of social support were higher in male group than those in the female group. The nutritional status score, the score of subjective support and support availability of social support score and total score were higher in radical surgery group than in palliative group. The nutritional status of patients with chemotherapy group was lower than those without chemotherapy, while the total score of social support in group with chemotherapy was higher than that in the non-chemotherapy group, with statistical significance (P<0.05). ② And 25.78% scores 15 or more in the nutritional quality of life, which was significantly higher than those less than 15 scores (P<0.05); social support evaluation above 40 group whose life quality was assessed as good accounted for 27.34%, significantly higher than scores less than 40 (P<0.05). Conclusion The nutritional status of patients with colorectal cancer and the status of social support will directly affect the quality of life, improve the nutrition and improve social support, and improve their quality of life. For the elderly, retirement, chemotherapy, advanced patients, social support is very important to raise awareness of clinical treatment and nursing care.

Epidemiologic investigation and analysis of gastroesophageal reflux disease in the population of Golmud in Qinghai Province

YAO Xiao-jun, WANG Chen, CHENG Chuan-bin, ZHANG Peng, CHEN Liang-liang, YI Yun-qiang, SHI Yi

2018, 16(8): 1386-1388. doi: 10.16766/j.cnki.issn.1674-4152.000379

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Abstract:
Objective To investigate the prevalence of gastroesophageal reflux disease (GERD) in the population of Golmud in Qinghai Province. Methods From June, 2014 to May, 2015, a random sampled investigation was applied by using Reflux Disease Questionnaire (RDQ) in Golmud area. A face-to-face interview was applied to residents over 18 and living here more than 3 years in the urban area, urban fringe area and agricultural and pastoral area. All data were entered in excel and the SPSS 16.0 software was carried out to perform the data analysis. Results A total of 3 015 valid questionnaires were retrieved and the response rate was 91.36%. The prevalence of GERD in Golmud area was 9.41% (284/3 015) according to the definition (RDQ score ≥ 12). The prevalence of GERD in male was higher than in female with 9.51% vs. 9.03%, respectively, and no significant difference was found between the two groups (P>0.05). The prevalence of GERD among people aged 18-44 years old, 45-59 years old, 60-74 years old and aged over 75 were 8.04%, 11.59%, 10.34% and 8.14% respectively, without statistical difference among groups (P>0.05). The prevalence rates of Han, Hui, Tibetan and Mongolian were 9.51%, 11.07%, 6.52% and 9.09%, respectively. There was no significant difference between minorities and Han (P>0.05). The prevalence of GERD was positively correlated with BMI, especially when BMI ≥ 35, the GERD prevalence was significantly increased. Logistic regression analysis showed that high risk of GERD was caused by satiety, high-fat diet, spicy food, high alcohol consumption, sleeping within 2 hours after eating, psychentonia and constipation (P<0.05), while high-salt diet, sugar confectionery, strong tea and coffee had no significant correlation with GERD (P>0.05). Conclusion The prevalence of GERD in the population of Golmud area was significantly higher than that in Beijing and Shanghai. Satiety, high-fat diet, sugar confectionery, spicy food, high alcohol consumption, sleeping within 2 hours after eating, psychentonia, constipation and obesity may be associated with the higher incidence of GERD in high altitude.

Cleaning methods improvement and cleaning effect evaluation of reused ophthalmic microsurgery instruments

WANG Si-xiu, ZHAO Jun, XIA Xiao

2018, 16(8): 1389-1391,1402. doi: 10.16766/j.cnki.issn.1674-4152.000380

151 3

Abstract:
Objective To discuss the effect of the improved methods of reused ophthalmic microsurgery instruments and to improve the cleaning quality of the instrument for preventing infection in hospital. Methods The methodology used in this research is to distribute 600 instruments which are chosen from operation room from September to October in 2016 into two groups randomly, namely, the regular group and improved group, with 300 devices in each group. The routine cleaning method used by the regular group from sterilization and supply center (multi-enzyme ultrasonic cleaning) will be used to compare the method adopted by the improved group which comprises pretreatment (put multi-enzyme solution) ultrasound, acid cleaning agent as well as lubricant oil for medical devices cleaning. The qualified rate after cleaning, comparison of bacteriological examination and flexibility and loss rate of device will be compared between two methods. Results Although there is no significant qualified rate difference between regular group and improved group in terms of visual method (P>0.05), the qualified rate of microscopic examination in the improved group is significantly superior to the regular group (P<0.05). In addition, the improved group is better than the regular group in regard to the flexibility (P<0.05), and the loss rate of improved group is lower than that of the regular group (P<0.05). It should be noted that there is also an obvious difference between two groups in regard to positive rate of bacterial test after cleaning (P<0.05). Conclusion In the improved group, the flexibility of ophthalmic microsurgical instruments was increased by 9%, the loss rate was decreased by 2%, the bacterial test negative rate was increased by 6%, and the pass rate of microscopy was increased by 18.3%. Improved group which used pretreatment, ultrasonic and enzyme washing, acid detergent and medical lubricant can effectively improve the reuse of the ophthalmic microsurgery instrument, promote small rust stains and spots to be removed, enhance the cleaning quality the reuse of the ophthalmic microsurgery device and increase the flexibility of utilization of devices and decrease the loss rate.

Study of self-compassion’s regulating effect on emotional labor strategy and burnout among cardiovascular nurses

ZHANG Wen, WANG Yu-yin, ZHENG Ying, TAN Miao-na, YU Xiao-man, ZHANG Xi, LIU Yun-qi

2018, 16(8): 1392-1395. doi: 10.16766/j.cnki.issn.1674-4152.000381

164 0

Abstract:
Objective To investigate the relationship between different emotional labor strategies and burnout in cardiovascular nurses and to explore the regulating effect of self-compassion on two kinds of emotional labor strategies and burnout. Methods From October, 2016 to January, 2017,154 nurses in Guangzhou were invited to complete the questionnaires in paper. It includes basic demographic information, emotional labor strategy scale, Chinese Maxlach Burnout Inventory and self-compassion scale. Finally, the data were entered and analyzed by statistics. Results ①Surface acting in emotional labor strategy has a significant positive influence on burnout(r=0.404, P<0.001). Meanwhile, deep acting(r=-0.345, P<0.001) and self-compassion(r=-0.356, P<0.001) are negatively correlated with burnout. ②There is a significant positive correlation between deep acting and self-compassion(r=0.340, P<0.001). There is no significant correlation between surface acting and self-compassion, but the direction is negatively correlated(r=-0.083). ③Self-compassion is found to play a regulating role on surface acting and burnout, as well as an intervention role on deep acting and burnout. Self-compassion has no moderating effect on the relationship between deep acting and burnout. Conclusion Nurses with high self-compassion prefer deep acting, followed with lower burnout. For whom choosing surface acting, highly self-compassion can reduce their burnout. Besides, high self-compassion can significantly alleviate burnout. Thus, an effective way to reduce the level of nurses' burnout is by guiding nurses to use deep acting to regulate emotions and improve their self-compassion level.

Study on the application of different sputum suction methods in mechanical ventilation patients with severe traumatic brain injury

LIU Xiang-yu, SONG Ke-yi, XIA Ling-xia, HAN Ruo-dong

2018, 16(8): 1396-1398. doi: 10.16766/j.cnki.issn.1674-4152.000382

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Abstract:
Objective To compare the effect of closed sputum suction method and open sputum suction method in patients with severe traumatic brain injury with mechanical ventilation. Methods Strictly according to the standard of admission, 60 patients in the intensive care unit of the Bozhou People's Hospital with severe traumatic brain injury treated by mechanical ventilation from February, 2015 to November, 2017 were selected and numbered according to the order of admission, and randomly divided into observation group with 28 cases and control group with 32 cases, using closed sputum suction method and open sputum suction method respectively in the two groups. The amplitude of pulse oxygen saturation (SPO₂) and heart rate (HR) before and after phlegm suction, number of cases of ventilator-associated pneumonia (VAP) within 1 week, duration of ventilator use, and number of deaths within 28 days were observed and recorded in the two groups. Results There was no significant difference in age distribution, male/female ratio, coma severity (Glass score), and the maximum difference of acute physiological health score (APACHE Ⅱ score) in 24 h between the two groups (P>0.05). SPO₂ decreased and heart rate increased after both methods of phlegm aspiration, but the range of oxygen saturation and heart rate fluctuation was smaller in the observation group (P<0.05). There was no statistical significance in the number of cases of VAP within 1 week, the time spent on ventilators, and the number of deaths within 28 days (P>0.05). Conclusion When the conditions permit, it is recommended to use the closed phlegm suction method for patients with severe craniocerebral injury, because the oxygen saturation and heart rate fluctuated less before and after phlegm. Application of this method may be more conducive to the prognosis of patients with severe craniocerebral injury, and is worthy of promotion.

Effect of targeted nursing on restoration of pelvic floor exercises in elderly women with stress urinary incontinence

SHU Xiao-min, HUA Yan, ZHANG Wei-zhen, WU Hai-yan

2018, 16(8): 1399-1402. doi: 10.16766/j.cnki.issn.1674-4152.000383

197 1

Abstract:
Objective To investigate the effect of targeted nursing on restoration of pelvic floor exercises in elderly women with stress urinary incontinence (SUI). Methods The clinical data of 96 elderly female patients with SUI treated in our hospital from May, 2015 to June, 2017 were retrospectively analyzed. The patients were divided into the observation group and the control group with 48 cases in each group according to the different nursing methods. The control group was given routine care and the observation group was given with targeted nursing intervention on the basis of the control group. The 1h urine pad test, self efficacy score, ALPP, maximum urethral closure pressure and quality of life score were compared between the two groups before and 3 months after intervention. Results The result of 1 h urine pad test in two groups at 3 months after the intervention was significantly decreased compared with before intervention and the self-efficacy scores were significantly increased compared with before intervention(P<0.05). The decreased degree of 1 h urine pad test in observation group was significantly higher than that in the control group and the increased degree of self-efficacy scores in observation group was significantly higher than that in the control group (P<0.05). The ALPP and maximum urethral closure pressure in two groups at 3 months after the intervention were significantly increased compared with before intervention (P<0.05). The increased degree of ALPP and maximum urethral closure pressure in the observation group were significantly higher than that in the control group (P<0.05). Each dimension of physiology, psychology, environment and social relations and total score of quality of life in two groups at 3 months after the intervention were higher than that before the intervention (P<0.05). Each dimension of physiology, psychology, environment and social relations and total score of quality of life in observation groups were higher than that of control group (P<0.05). Conclusion Targeted nursing can effectively promote pelvic floor function recovery in elderly women with SUI, increase their compliance with exercise, and improve the symptoms and quality of life in patients with SUI.

The influencing factors and nursing countermeasures of the compliance behavior of patients with ovarian cancer after operation

ZHAO Hong-mei, DONG Zhuo, XU Ai-li

2018, 16(8): 1403-1405. doi: 10.16766/j.cnki.issn.1674-4152.000384

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Objective To study the influencing factors and nursing countermeasures of the compliance behavior of patients with ovarian cancer after operation. Methods We chose 107 cases of ovarian cancer resection patients in our hospital from June, 2014 to February, 2016, collected statistics of all the patients' age, income, education level, clinical stage, drug adverse reactions, medical costs, social support and negative emotion information, evaluated the compliance behavior of patients using univariate and multivariate logistic regression analysis of factors influencing the compliance behavior after operation, and investigated the clinical nursing countermeasure. Results Univariate analysis showed that age, junior high school level of education and below, low monthly income, adverse drug reactions, uncovered medical expenses, poor social support, anxiety and depression, the relevant factors of lack of knowledge and other factors are the compliance behavior of ovarian cancer after operation (P<0.05); multivariate logistic regression analysis showed that the older age (OR=3.71, P=0.011), anxiety and depression (OR=3.34, P=0.002), self-paid medical expenses (OR=2.93, P=0.020), poor social support (OR=3.16, P=0.015), low monthly income (OR=3.09, P=0.005), lack of related knowledge (OR=3.25, P=0.012) are independent factors influencing the compliance behavior of ovarian cancer patients after operation. Conclusion There are many factors affecting the compliance behavior of patients with ovarian cancer, commonly involving age, social support, negative emotions, adverse drug reactions, income and other factors. To take effective nursing intervention for each factor can significantly improve the compliance behavior of patients, and has important clinical values.

WANG Sen, QIAN Jin, XIA Li-li, PANG Si-si

2018, 16(8): 1406-1408. doi: 10.16766/j.cnki.issn.1674-4152.000385

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Abstract:

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2018 Vol. 16, No. 8

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