中华全科医学

Achievements and prospect in prevention and treatment of infectious diseases during the last 70 years in China

HUANG Lei, LI Zhong-jie, WANG Fu-sheng, GAO Fu

2019, 17(10): 1615-1618,1748. doi: 10.16766/j.cnki.issn.1674-4152.001011

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Before the founding of the People's Republic of China, infectious diseases were one of the major threats to the lives and health of the Chinese people for a variety of reasons. After the founding of the People's Republic of China, the Communist Party of China and Chinese government attached great importance to the prevention and treatment of infectious diseases, took the prevention and treatment of infectious diseases as a political task, decided the principles of prevention and control, carried out mass movements, established a medical system, promoted immunization program, set up an early warning system for infectious diseases, implemented "Four Frees and One Care" for AIDS patients, and increased scientific research investment and trained talent echelons. After 70 years of unremitting efforts, the prevention and treatment of China's infectious diseases has achieved brilliant achievements and the life expectancy per capita of China has been greatly improved. In the 70 years since the founding of the People's Republic of China, China has eliminated smallpox, achieved a new incidence of no polio in the country, and greatly inhibited the prevalence of hepatitis B. The HIV inhibition rate of HIV antiviral therapy reached 91% in China. The cure of hepatitis C has also become a reality. In the field of emerging infectious disease prevention and treatment, China has become a "leader" from "followers". The discovery of artemisinin for malaria has won the first Nobel Prize in biomedicine for the Chinese. At the same time, Chinese infectious disease prevention and control workers have also stepped out of the country and actively participated in the global prevention and control of infectious diseases, becoming a practitioner of "building a community of human destiny". However, China's infectious disease prevention and treatment is also facing new challenges and tasks. It is necessary to establish comprehensive health concept, reform the system for the prevention and control of infectious diseases, increase the government's investment in the prevention and treatment of infectious diseases, and guide the development of infectious disease research with professional scientific research policies to meet the requirements of the new era.

XU Xiang-jun, ZHOU Zhi-ming

2019, 17(10): 1619-1620.

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Application of Raman spectroscopy and multivariate statistical analysis in serum diagnosis of coronary heart disease

YIN Xiao-jing, HU Jia-bo, HAN Chong-xu, FENG Xiu-li, FU Wei-ling, ZHANG Yang

2019, 17(10): 1621-1625,1677. doi: 10.16766/j.cnki.issn.1674-4152.001012

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Objective To discuss the application of micro-Raman confocal system in the test of serum sample of coronary heart disease (CHD). Methods The serum samples of 46 patients with coronary heart disease confirmed by coronary angiography and 50 subjects receiving healthy physical examination were selected in the First Affiliated Hospital of Army Medical University between August 2018 and January 2019. The XploRA PLUS automatic microscopic confocal Raman system was used to measure and analyze the Raman spectrum of serum. Statistical processing was performed by orthogonal partial least squares discriminant analysis (OPLS-DA) by using SIMCA-P14.1 analysis software. Results The Raman spectrum mean peak of the two groups was similar; At the displacement of 1 080.47/cm, 1 102.01/cm, 1 127.52/cm, 1 335.46/cm, 1 603.83/cm, 1 657.69/cm, the vibration intensity of the CHD group was higher than that of the control group, At the displacement of 1 154.51/cm, 1 516.81/cm, the vibration intensity results were just the opposite. The changes of these spectral peaks may be beneficial to the screening of CHD by Raman spectra; R²X (cum) of the OPLS-DA model was 0.881, R²Y (Cum) was 0.644, the predictability of the model Q² (cum) was 0.497, and the AUC based on OPLS-DA were 0.970 and 0.970, respectively. Conclusion The microscopic confocal Raman system combined with OPLS-DA analysis can quickly and conveniently distinguish the serum samples from the known coronary heart disease group and the healthy group, providing a new possibility for the detection and diagnosis of coronary heart disease as an exploratory experimental method.

Study of mechanism for catalpol suppresses osteoarthritis in rats

ZENG Yun-fu, BIAN Yang-yang, WANG Rong, PENG Lei

2019, 17(10): 1626-1630,1651. doi: 10.16766/j.cnki.issn.1674-4152.001013

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Objective To establish a IL-1β-induced rat chondrocyte inflammatory response model, and investigate the effects of catalpol (CAT) on cartilage degeneration of rats with osteoarthritis (OA). Methods To investigate the role of CAT in osteoarthritis and its specific mechanism, chondrocytes from 12 SD rats were randomly selected for primary culture. Chondrocytes were divided into four groups: control group, IL-1β group, IL-1β+CAT 10 μg/mL group and IL-1β+CAT 50 μg/mL group. In animal experiments, 12 rats were randomly divided into three groups: Sham group, OA group and OA+CAT group, with 4 rats in each group. OA group underwent right anterior cruciate ligament transection and meniscectomy. The experimental group, namely OA+CAT group, was given intraperitoneal injection of CAT [5 mg/(kg·d)] after resection of right anterior cruciate ligament transection and meniscus. Catabolic metabolism, apoptotic level and relative signaling pathway were measured by Western blotting, RT-PCR and immunofluorescence staining. We also assess the cartilage degeneration in an experimental rat model using Safranin O/fast green staining and Osteoarthritis Research Society International (OARSI) system. Results ①CAT prevented chondrocyte apoptotic level triggered by IL-1β; ②CAT suppressed the release of catabolic enzymes, and inhibited the degradation of extracellular matrix induced by IL-1β; ③CAT inhibited the nuclear factor Kappa B pathway, reduced the production of inflammatory cytokines (IL-6, TNF-α) in IL-1β-treated chondrocytes; ④CAT partially reversed cartilage degeneration in the knee joint in animal model of OA. Conclusion CAT treatment can attenuate IL-1β-induced inflammatory response and catabolism in rat chondrocytes by inhibiting the NF-κB pathway, suggesting the therapeutic potential of CAT for the treatment of OA.

Establishment and validation of Jurkat T cell lines with stable overexpression or low expression of miR-125b-5p

CAO Wen-ting, LUO Wen, LIU Xin, A Xiao, TAN Xiao-zhi, YUAN Li-mei, DENG Dan-qi

2019, 17(10): 1631-1633,1672. doi: 10.16766/j.cnki.issn.1674-4152.001014

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Objective To establish the Jurkat T cell line which stably overexpresses or down expresses miR-125b-5p. Methods The plasmid was amplified and packaged into 293T cells to produce lentiviral particles. Jurkat T cells were infected with recombinant lentivirus. The expression level of miR-125b-5p in Jurkat T cells was detected by RT-qPCR. Expression level of target gene UVRAG was detected by Western blotting. All data were analyzed by one-way ANOVA with LSD test as post-hoc test. P＜0.05 was regarded as statistically significant. Results The emition of green fluorescence was detected in both Jurkat T cells that transfected with lentivirus overexpress hsa-miR-125b-5p vector or control vector. Besides, the emition of red fluorescence was detected in both Jurkat T cells that transfected with lentivirus hsa-miR-125b-5p interferential vector and control vector. The RT-qPCR results showed that compared with the control vector group, the expression level of miR-125b-5p was significantly increased in Jurkat T cells which were transfected with hsa-miR-125b-5p lentivirus over expression vector (P<0.01). The expression level of miR-125b-5p was significantly decreased in Jurkat T cells which were transfected with hsa-miR-125b-5p lentivirus interferential vector (P<0.01). Western blotting results showed that compared with the control vector group, the protein level of UVRAG was significantly decreased in Jurkat T cells which were transfected with hsa-miR-125b-5p lentivirus over expression vector (P<0.001). The protein level of UVRAG was significantly increased in Jurkat T cells which were transfected with hsa-miR-125b-5p lentivirus interferential vector (P<0.001). Conclusion Jurkat T cell lines with stable overexpression or low expression of hsa-miR-125b-5p were successfully established.

Application of caspofungin in secondary prevention of fungus in patients undergoing allogeneic hematopoietic stem cell transplantation

ZHANG Jian-ping, LI Nan-nan, FAN Li-jun, GAO Xin-xia, YIN Dong-xu, DA Wan-ming

2019, 17(10): 1634-1636,1655. doi: 10.16766/j.cnki.issn.1674-4152.001015

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Objective To investigate the safety and efficacy of Caspofungin in secondary prevention of fungi in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The clinical data of 40 cases of allo-HSCT with fungal infection stratified according to the 2010 edition of Diagnostic Standards and Therapeutic Principles for Invasive Fungal Infection in Patients with Hematological Diseases/Malignant Tumors (Revised edition) in our hospital from January 2013 to April 2017 were reviewed. All patients were administrated with Caspofungin. The stratified diagnosis of patients was analyzed, and the clinical efficacy and adverse reactions of Caspofungin were evaluated. Results After stratified diagnosis and treatment with Caspofungin, the effective rate in the 4 confirmed patients was 100.00%, in 22 clinically diagnosed patients was 77.27%, and in 14 prospectively diagnosed patients was 71.43%. There was no significant difference in the effective rate between clinically diagnosed patients and prospectively diagnosed patients (P>0.05). In the course of treatment, the main adverse reactions were hypokalemia (9 cases) and hypoglycemia (7 cases). After symptomatic treatment, the symptoms were alleviated. Conclusion Caspofungin has good therapeutic effect, with fewer adverse reactions and high safety in allogeneic hematopoietic stem cell transplantation. It is worth popularizing in secondary prevention of bacterial infection.

Application of inferior approach and thermal insulation of the recurrent laryngeal nerve in thyroid cancer surgery

MA Xiao-peng, ZHAO Feng, PAN Wan-wan, ZOU Yuan-yuan, MA Chao, SONG Lei, HU Yuan

2019, 17(10): 1637-1639. doi: 10.16766/j.cnki.issn.1674-4152.001016

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Objective To investigate the safety and feasibility of the most inferior approach, anterograde dissection and thermal insulation protection of the cervical recurrent laryngeal nerve (RLN) in thyroid cancer surgery. Methods A retrospective analysis was performed on 53 patients with thyroid cancer who underwent right thyroidectomy and lymph node dissection in the right central region from February 2018 to January 2019. There were 24 cases with traditional method and 29 cases with new method. The changes of electrophysiological signals of the recurrent laryngeal nerve, postoperative pronunciation, incidence of postoperative hypocalcemia and the number of lymph node metastases in the central region of the neck were statistically analyzed. Results In the traditional group, there were 6 cases in which the amplitude of the RLN electrophysiological signal decreased by ＞50%, and 1 cases in the new method group, there were statistically significant differences between the two groups (P＜0.05). There were 3 cases hypocalcaemia after the surgery in the traditional group and 4 cases in the new method group, there were no statistically significant differences between the two groups (P＞0.05). There were 14 (58.3%) cases lymph nodes in the central region of the traditional group, and 18 (62.1%) cases in the new method group, there were no statistically significant differences between the two groups (P＞0.05). There were 3.1±1.8 lymph node dissections in the central zone in the traditional group and 5.0±2.4 in the new method group, the difference between the two groups was statistically significant (P＜0.05). Conclusion The technique of the most inferior approach and thermal insulation protection of recurrent laryngeal nerve is benefit to protect the RLN and improve the safety in thyroid cancer surgery.

Resistance mechanism and molecular epidemiology of Escherichia coli producing new delhi metal β-lactamase

SHI Yang, PENG Li-rong, HUANG Jian-sheng, DING Hui, ZHAO Yun-an, ZHAO Zhi-gang

2019, 17(10): 1640-1643. doi: 10.16766/j.cnki.issn.1674-4152.001017

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Objective To study the molecular typing, drug resistance mechanism and epidemiological characteristics of New Delhi metal β-lactamase (NDM) in Escherichia coli isolated from clinical isolates for prevention and control of nosocomial infections, and provide the basis for treatment. Methods A total of 9 NDM-producing carbapenem-resistant E. coli strains were collected from various clinical samples from June 2017 to February 2018 in the hospital, combined with clinical susceptibility testing, EDTA synergy and synergistic experiments and polymerase chain reaction (PCR) were employed to amplify and detect the blaNDM and other drug resistance gene. Finding out their NDM subtypes through sequence analysis. Analysis of homology among strains by E. coli intergenic consensus polymerase chain reaction (ERIC-PCR) and multiple site typing (MLST). Drug sensitivity experiments, conjugation experiments, PCR amplification and sequence analysis were used to study molecular typing and drug resistance molecular mechanisms of metallo-β-lactamase in E. coli. Results A total of 9 strains of E. coli producing NDM were screened out and form different wards. The NDM subtypes of all the strains were NDM-5 type, and the plasmid replicon types were all IncX3 type. Five strains conjugation test were positive,they were from gynecology, intensive care, emergency and neonatal, and PCR results show that the plasmid replicon type of zygomycetes was also IncX3 type. All the strains showed multidrug resistance. The results of MLST classification showed that there were 4 ST genotypes in 9 NDM-producing E. coli strains, including ST206 type, ST167 type, ST354 type and ST1642 type, which were consistent with ERIC-PCR results. Conclusion The results showed that the presence of E. coli carrying the blaNDM-5 gene in the region presented a certain clonal and clustered fulminant, and it could spread through the IncX3 plasmid in E. coli. In order to prevent and control the outbreak of nosocomial infection, we must pay attention to and strengthen the monitoring of the carbapenem-resistant enterobacteriaceae.

Plasma homocysteine, interleukin-6 and B-type natriuretic peptide levels relate to the severity of coronary heart disease in elderly patients

FENG Gao-ke, THANH Dinh Nguyen, JIANG Xue-jun

2019, 17(10): 1644-1646. doi: 10.16766/j.cnki.issn.1674-4152.001018

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Objective To investigate the effects of plasma homocysteine (Hcy), interleukin-6 (IL-6), and B-type natriuretic peptide (BNP) levels on the severity of coronary heart disease in elderly patients. Methods From January 2017 to December 2017, a total of 274 elderly patients with coronary heart disease were selected as the observation group, and 101 patients with normal coronary angiography were selected as the control group. According to the types of clinical diagnosis, patients were divided into stable angina pectoris group (75 cases), unstable angina pectoris group (110 cases) and acute myocardial infarction group (89 cases). The plasma levels of Hcy, IL-6 and BNP were tested, and their effects on the severity of coronary heart disease were analyzed. Results The levels of Hcy, IL-6 and BNP in the observation group were significantly higher than those in the control group (all P<0.01). The levels of Hcy, IL-6, and BNP in the stable angina pectoris group were significantly lower than those in the unstable angina pectoris group (all P<0.01), and those in the unstable angina pectoris group were significantly lower than those in the acute myocardial infarction group (all P<0.01). Conclusions The levels of Hcy, IL-6, and BNP in patients with coronary heart disease are significantly higher than those in normal people. The test of Hcy, IL-6, and BNP levels should be helpful to the clinical diagnosis of elderly coronary heart disease and its severity.

Experimental study of berberine improving insulin resistance in gestational diabetes mellitus rat model and its possible mechanisms

LIN Feng, WU Jie, WANG Xiao, HUANG Yin-ping, ZHOU Jing

2019, 17(10): 1647-1651. doi: 10.16766/j.cnki.issn.1674-4152.001019

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Objective To explore the role of berberine in gestational diabetes mellitus (GDM) rat induced by high fat diet and low-dose STZ and its possible mechanisms. Methods After female SD rats were fed with high-fat diet for 5 weeks, STZ (25 mg/kg) was intraperitoneally injected on the first day after conception to establish the GDM rat model. The treatment of berberine by intragastric injection was from 1th to 19th day of pregnancy. The changes of fasting blood glucose and insulin resistance index in each group during pregnancy were detected. Pregnancy was terminated by caesarean on the 20th day of pregnancy, fetal and placental weights were measured and liver tissues were collected. The levels of TNF-α and CRP mRNA and protein were detected by real-time fluorescence quantitative PCR and ELISA; the expression of IKKβ and NF-κB protein was detected by Western blotting. Results Compared with normal pregnancy group, the fasting blood glucose and insulin resistance index of model group was significantly higher (all P<0.05), meanwhile fetal and placental weight increased (all P<0.05), the expression of CRP and TNF-α mRNA and protein in liver tissues was significantly increased, and the expression of IKKβ protein and nuclear protein NF-κB increased (all P<0.05). After treatment of Berberine, the expression of IKKβ, nuclear NF-κB, CRP and TNF-α in liver tissues of the model group was significantly decreased, the fasting blood glucose and insulin resistance index also decreased (all P<0.05). Conclusion Berberine can reduce inflammation in liver tissues, improve insulin resistance, and lower blood glucose levels in GDM rats through the inhibition of NF-κB nuclear transfer via IKK/NF-κB signaling pathway.

Autologous bone marrow mesenchymal stem cells combined with platelet-rich plasma treats knee osteoarthritis

CHENG Wen-dan, XU Sheng-lin, WU Xiao-san, LI Zi-yu, WU Yi-bo, SUN Liang-ye, BAI Wen-yi

2019, 17(10): 1652-1655. doi: 10.16766/j.cnki.issn.1674-4152.001020

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Objective To investigate the effect of intra-articular injection of autologous bone marrow mesenchymal stem cells combined with platelet-rich plasma on the symptoms and joint function of patients with knee osteoarthritis in hopes of providing a new ideas for the treatment of patients with early knee osteoarthritis. Methods Forty patients diagnosed with knee osteoarthritis in the orthopedic clinic of Lu'an people' hospital from July 2016 to June 2017 were randomly divided into (intra-articular injection of sodium hyaluronate) and experimental group (intra-articular injection of autologous bone marrow mesenchymal stem cells combined with platelet-rich plasma). The treatment outcomes of the two groups were evaluated at 4, 12, and 24 weeks after treatment based on WOMAC and the VAS. Results The mean WOMAC scores of the two groups were significantly improved compared with those before treatment (all P<0.05), but the mean WOMAC scores of the experimental group at each time point after treatment were better than the control group (all P<0.05). There was no statistical difference in the mean VAS scores between the two groups (all P>0.05). The effective rate of the two groups was not significantly different at 12 weeks after treatment (P>0.05), but the effective rate of the experimental group was significantly better than that of the control group at 24 weeks after treatment (P<0.05). Conclusion Intra-articular injection of autologous bone marrow mesenchymal stem cells combined with platelet-rich plasma can alleviate pain and improve joint function in patients with knee osteoarthritis, and can be used as one of the treatment options for patients with early knee osteoarthritis.

MiR-486 regulates the pathogenesis of pulmonary fibrosis under hypoxia

SHI Xue-feng, JIE You-bang, ZHANG Hong-wei, YAN Xiao-jie, NIU Di, GU Yu-hai

2019, 17(10): 1656-1659. doi: 10.16766/j.cnki.issn.1674-4152.001021

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Objective MiR-486 was proved to be a hypoxia miRNA in some cells, such as bone marrow derived stem cells and hematopoietic cell. The aim of this study is to observe the effect of miR-486 on the pathogenesis of pulmonary fibrosis under hypoxia. Methods Lentivirus was used to mediate the overexpression or inhibition of miR-486 on 3T3 cells, Flow cytometry and qRT-PCR were used to check the transfection efficiency, and all the lentivirus transfection efficiency were above 85%. The expression of miR-486, FN, α-SMA, Collagen Ⅰ and Collagen Ⅲ on 3T3 cells under hypoxia, or transfected by overexpression and inhibition lentivirus were detected by qRT-PCR. Results Compared with hypoxia oh, hypoxia 6, 12, 24, 48 h miR-486 expression decreased (P<0.05), while the FN and α-SMA expression increased (P<0.05). MiR-486 expression was increased in miR-486 overexpression 3T3 cells (P<0.05). And FN, α－SMA, Collagen Ⅰ and Collagen Ⅱ expression decreased (P<0.05), they were separately (1.000±0.094 vs. 0.125±0.153, P=0.005; 1.000±0.193 vs. 0.044±0.001，P=0.010; 1.000±0.057 vs. 0.561±0.009, P=0.048; 1.000±0.105 vs. 0.275±0.045, P=0.013). FN, α-SMA, Collagen Ⅰ and Collagen Ⅱ expression in miR-486 silence 3T3 cells were 1.000±0.079 vs. 0.027±0.003，P=0.002; 1.000±0.012 vs. 48.909±0.584, P=0.005; 1.000±0.015 vs. 4.416±0.311, P=0.039; 1.000±0.270 vs. 8.892±0.484, P=0.003; 1.000±0.005 vs. 7.671±1.014, P=0.008, mean that miR-486 silence can inhibit miR-486 expression, and promote FN, α-SMA, Collagen Ⅰ and Collagen Ⅱ expression. Conclusion MiR-486 could regulate the pathogenesis of pulmonary fibrosis under hypoxia.

Application of catheter drainage in deep pelvic lymphocyst after gynecological malignancies operation

FAN Lin-yin, SHI Kai-yuan, LIU Lu-lu, WANG Yi-fan, CHEN Li-yu, XU Dong

2019, 17(10): 1660-1662,1761. doi: 10.16766/j.cnki.issn.1674-4152.001022

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Objective To evaluate the feasibility, safety and efficacy of ultrasound-guided catheter drainage via pelvic wall and deep vessels in deep pelvic lymphocyst after gynecological malignancies surgery. Methods A total of 82 deep pelvic lymphocysts in 75 patients from January 2017 to December 2018 after gynecological malignancies surgery, there is no safe catheter drainage approach via abdominal wall. Among them, there were 6 cases of lymphocyst without accompanied symptoms; 76 cases of lymphocyst with accompanied symptoms, including 45 cases of pain, 32 cases of fever, 12 cases of lower limb edema, 1 case of lower limb thrombus and 3 cases of hydronephrosis. The feasibility, success rate, complication and efficacy of the approach via pelvic wall and deep vessels were observed. Results Among 82 lymphocysts, 78 Lymphocysts had catheter drainage approach, the feasibility of this approach was 95.1%. During the operation, one case failed due to pelvic wall vessel hemorrhage and one case failed due to arteriae iliaca externa hemorrhage, the incidence of complications was 2.4%. Regarding the success rate of catheterization, all cases completed the operation except 2 bleeding cases. After catheterization, 3 patients' drainage tube were removed because of lower limb numbness, and all of them occurred in the initial stage of catheterization through this route. The success rate of catheter drainage was 93.9%. Postoperative follow-up showed that the diameter of all the asymptomatic lymphatic cysts was reduced by more than 1/2, among the symptomatic lymphatic cysts, 49 cases had disappeared symptoms, 15 cases had relieved symptoms, the effective rate of catheter drainage was 85.4%. Conclusion If there is no safe approach to catheter drainage for deep pelvic lymphocysts through abdominal wall, approach via pelvic wall and deep vessels can make most patients achieve catheter drainage, which is safe and effective, and is worthy of clinical promotion.

Short-term curative effect comparison of clavicular hook plate placement and coracoclavicular ligament reconstruction on acromioclavicular joint dislocation

XUE Zhi-xing, LI Xu, ZHANG Hai-long

2019, 17(10): 1663-1665,1700. doi: 10.16766/j.cnki.issn.1674-4152.001023

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Objective To compare the short-term curative effects of clavicular hook plate placement and coracoclavicular ligament reconstruction on acromioclavicular joint dislocation. Methods The clinical data of 200 patients with acromioclavicular joint dislocation who were treated with clavicular hook plate placement and coracoclavicular ligament reconstruction in Beijing Tongren Hospital and Beijing Jishuitan Hospital Affiliated to Capital Medical University from August 2016 to August 2018 were retrospectively analyzed. According to the treatment method, they were divided into group A (clavicular hook plate placement, n=108) and group B (coracoclavicular ligament reconstruction, n=92). The operation conditions and hospitalization time of the two groups were compared. The follow-up lasted for 6 months after surgery. The range of motion, score of visual analogue scale (VAS), score of Constant-Murley shoulder joint function and excellent rate of Karlsson grading were compared between the two groups. Results The operation time of group B was significantly longer than that of group A, while intraoperative blood loss was significantly less than that of group A. The hospitalization time was significantly shorter than that of group A (P<0.05). The follow-up last for 6 months. The range of motion of group B was significantly greater than that of group A. The VAS score was significantly lower than that of group A. The prognosis was significantly better than that of group A (P<0.05). The difference in Constant-Murley score and excellent rate of Karlsson grading between the two groups was not statistically significant (P>0.05). Conclusion The surgical injury of coracoclavicular ligament reconstruction is less for patients with acromioclavicular joint dislocation, and the recovery of shoulder joint function and prognosis are better. It is an effective and safe method for the treatment of acromioclavicular joint dislocation with high clinical value.

Clinical analysis of 68 patients with cerebral venous sinus thrombosis

YAO Li, LIU Jiao, ZHANG Hong, ZHANG Gui-lian

2019, 17(10): 1666-1668,1788. doi: 10.16766/j.cnki.issn.1674-4152.001024

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Objective To investigate the clinical presentations, pathogenic factors, treatment and prognosis of the 68 patients with cerebral venous sinus thrombosis. Methods The clinical data of 68 patients' diagnosis of cerebral venous sinus thrombosis from January 2011 to May 2018 was collected and analyzed retrospectively. Results Sixty-eight patients (30 male,38 female), were recorded with mean age of (35.5±12.4) year-old. Forty-seven out of 68 cases had causes with pregnancy, puerperium, and Long-term drinking, autoimmune disease et al. Headache attack (58 cases, 85.3%) is the most common first clinical sign. Neuroimaging data showed that there were 54 cases (79.4%) with more than one cerebral venous thrombosis, only 14 cases (20.6%) had brain lesion. Thrombosis occurred most frequently in the order of lateral sinus in 106 cases, superior sagittal sinus thrombosis in 30 cases, straight sinus thrombosis in 12 cases, 2 case of deep vein and 4 cases involving internal jugular vein. Sixty-four patients (97.0%) had increased intracranial pressure, and 38 patients (57.6%) had greater than 300 mm H₂O(1 mm H₂O=9.8 Pa). Only 26 of 68 patients (38.2%) had elevated D-dimer. The patients in our group received good prognosis after anticoagulation, partial combination of intravenous sinus thrombolysis and stenting, and 6 of them relapsed in follow-up and relieved after retreatment. Conclusions Cerebral venous sinus thrombosis mainly affects young female adults and headache attack is the most common first clinical sign. Neuroimaging shows that most common affected sites are lateral sinus and superior sagittal sinus. Most cases have more than one site of thrombosis, and have intracranial hypertension and no brain lesion. The diagnosis cannot be ruled out if D-dimer is normal. Most patients get good prognosis after active treatment.

Effect of parecoxib pretreatment on inflammatory cytokines and hemodynamics in patients undergoing craniotomy

YUAN Hai-jun, FU Li, HUANG Xiao-xia, LE Xin-hui, ZHAO Dong

2019, 17(10): 1669-1672. doi: 10.16766/j.cnki.issn.1674-4152.001025

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Objective To analyze the effect of parecoxib pretreatment on inflammatory cytokines and hemodynamics in patients undergoing craniotomy. Methods A total of 84 patients undergoing selective craniotomy in our hospital from January 2018 to January 2019 were enrolled in the control group and the observation group according to different preoperative pretreatment methods, with 42 cases in each group. Patients were treated with 5 mL saline in the control group and 5 mL parecoxib in the observation group. Inflammatory cytokines (serum central nerve specific protein, neuron specific enolase, neuron specific enolase) were compared between the two groups. Interleukin 6, tumor necrosis factor-alpha, superoxide dismutase, hemodynamics (mean arterial pressure, heart rate), postoperative pain (VAS score) and postoperative complications (hypertension, chills, arrhythmia, restlessness). Results The levels of inflammatory cytokines in both groups were significantly different from those before operation, and the levels of serum central nervous specific protein, neuron specific enolase, interleukin-6 and tumor necrosis factor-alpha in the observation group were lower than those in the control group, while the levels of superoxide dismutase were higher than those in the control group, all P<0.05. The mean arterial pressure and heart rate of the observation group at 1 and 6 hours after operation were lower than those of the control group (all P<0.05); the mean arterial pressure and heart rate of the two groups at 1 and 6 hours after operation were lower than those before operation (all P<0.05). The VAS scores of the observation group at 1, 6, 12 and 24 hours after operation were lower than those of the control group (all P<0.05); the VAS scores of the observation group at 6, 12 and 24 hours after operation were higher than those of the one hour after operation (all P<0.05). The incidence of postoperative complications in the observation group (14.3%) was lower than that in the control group (35.7%), P<0.05. Conclusion Pretreatment with parecoxib has a positive effect on patients undergoing craniotomy. It can reduce the influence of operation on serum inflammatory cytokines. The hemodynamics of patients is stable. The pain is mild and the incidence of complications is low. It is worth clinical application.

Clinical observation of lung protective ventilation in elderly patients undergoing laparoscopic colorectal cancer surgery

LI Ying, ZHANG Tie-feng, JIANG Hai-bin, CHAI Jin-hua

2019, 17(10): 1673-1677. doi: 10.16766/j.cnki.issn.1674-4152.001026

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Objective To probe into the effect of lung protective ventilation strategy (LPVS) on improving pulmonary function and occurrence of postoperative pulmonary complications (PPCS) in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods The clinical data of 60 elderly patients undergoing laparoscopic colorectal cancer surgery in the First People's Hospital of Lanzhou city and Shaanxi provincial Cancer Hospital from October 2017 to October 2018 were retrospectively analyzed. Both the observation group and the control group included 30 cases. During the pneumoperitoneum period, the observation group was ventilated with VT 6 mL/kg combined with 5 cm H₂O positive end-expiratory pressure (PEEP) and received lung recruitment every 30 minutes, while the control group was ventilated with VT 6 mL/kg mode ventilation. The oxygenation indexes were recorded 1 minute after tracheal intubation (T1), establishment of artificial pneumoperitoneum 60 minutes (T3), 5 minutes before the end of operation (T4) and 10 minutes after extubation (T5). Respiratory mechanics indexes were recorded at T1, establishment of artificial pneumoperitoneum 5 minute (T2), T3, T4.The PPCs were recorded within 48 hours and 7 days after surgery. Results Compared with T1, the partial pressure of O₂ (PaO₂) values of both groups were significantly decreased at T4 and T5. Compared with control group, the PaO₂ values was significantly increased, calculated alveolar-arterial oxygen partial pressure(PA-aCO₂) was significantly decreased, whereas the oxygenation index (OI) was significantly increased in observation group at T3. T1, dynamic lung cdyniance (Cdyn) of both groups were significantly decreased and the airway peak pressure (Ppeak) of both groups were significantly increased at T2 and T3, end-tidal carbon dioxide pressure (P_ETCO₂) of control group was significantly increased at T2 and T3. Compared with control group, Cdyn was significantly increased in observation group at T2 and T3, Ppeak was significantly decreased in observation group at T2, T3 and T4. The incidence of pulmonary infection and hypoxemia in observation group was significantly lower than that in control group 48 hours after operation, and there was no significant difference in atelectasis and delayed extubation between the two groups. There was no significant difference in PPCs between the two groups on the 7 day after operation. Conclusion For elderly patients undergoing laparoscopic colorectal cancer surgery, LPVS can improve pulmonary function and significantly reduce the incidence of PPCs.

Efficacy of subcutaneous injection of Nadroparin calcium after replantation of digits on venous congestion of patients and complications

HUA Zu-guang, WEI Peng, WU Yi-bing, WANG Yang-jian, YE Chao-hui, REN Tian-tian, SONG Qing-hua

2019, 17(10): 1678-1680,1784. doi: 10.16766/j.cnki.issn.1674-4152.001027

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Objective To investigate the efficacy of subcutaneous injection of Nadroparin calcium after replantation of digits on venous congestion of patients and complications. Methods Forty six patients (62 fingers) undergoing replantation of digits in our hospital between February 2016 and September 2018 were enrolled and divided into experimental group (23 cases) and control group (23 cases) by random number table method. Nadroparin calcium was injected subcutaneously on the right or left side of the abdominal wall in the control group and on the replanted fingers in the experimental group. The swelling diameter and pain visual analogue scores (VAS) at 1 d, 5 d and 7 d after the surgery were compared between the two groups. The incidence of complications such as embolism, vasospasm and skin flap necrosis was compared. The levels of prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (thrombin time, TT), fibrinogen (Fibrinogen, FIB) and other coagulation indicators were compared between the two groups before and after treatment. Results The swelling diameter of the two groups at each time point was significantly lower than that before the treatment (P<0.05). Among them, the degree of swelling of the fingers in the experimental group was lower than that of the control group at 5 d and 7 d after the operation. VAS scores at 1 d, 5 d and 7 d of the experimental group were lower than those of the control group at the corresponding time points, and the difference was statistically significant (all P<0.05). The incidence of venous and total complications were significantly lower in the group than in the control group (all P<0.05). After the treatment, the levels of PT, APTT and TT in the control group increased significantly (all P<0.05). There was no significant difference in PT, APTT, TT and FIB in the experimental group before and after the treatment (all P>0.05). After the treatment, PT, APTT and TT in the control group were significantly higher than those in the experimental group (all P<0.05). There was no significant difference in FIB between the two groups before and after treatment (P>0.05). Conclusion Low-molecular-weight heparin calcium subcutaneous injection is effective in the treatment of venous congestion after replantation of severed fingers, which can significantly reduce the incidence of complications and has little effect on coagulation.

Correlation analysis of serum uric acid levels and carotid atherosclerosis in patients with acute cerebral infarction

MENG Ying, WANG Da-wei

2019, 17(10): 1681-1683,1752. doi: 10.16766/j.cnki.issn.1674-4152.001028

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Abstract:
Objective To explore and analyze the correlation between blood uric acid and carotid atherosclerosis in patients with cerebral infarction. Methods A total of 90 patients with acute cerebral infarction in our hospital from January 2016 to July 2018 were enrolled as the research participants. General data were recorded. All patients were examined by carotid artery color Doppler ultrasonography. According to the presence and stability of plaque, they were divided into three groups: stable plaque group, unstable plaque group and non-plaque group. The blood uric acid level and C-reactive protein level related indicators in different group were measured, and the effect of uric acid on plaque formation was analyzed. Results There were significant differences in serum uric acid levels among the three groups (P<0.05) with significant difference between the non-plaque group and the stable plaque group and the unstable plaque group (all P<0.05). There was no significant difference between stable plaque group and unstable plaque group (P>0.05). There were significant differences in C-reactive protein levels among the three groups (P<0.05), among which there were significant differences between the non-plaque group and the stable plaque group and the unstable plaque group (all P<0.05); there was no difference between the stable plaque group and the unstable plaque group (P>0.05). Conclusions The level of hyperuricemia in patients with acute cerebral infarction is closely related to the occurrence of carotid atherosclerotic plaque, but the stability of carotid atherosclerotic plaque has no significant correlation with the level of serum uric acid. The elevated serum uric acid level suggests that patients have the risk of carotid atherosclerosis plaque formation. Clinically, appropriate intervention can be given in time according to the serum uric acid level.

Accuracy of different guiding templates for immediate implant placement in partially edentulous patients

JIANG Xiong-ying, YAO Hua, JIN Can, ZHOU Guan-hua

2019, 17(10): 1684-1686,1792. doi: 10.16766/j.cnki.issn.1674-4152.001029

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Abstract:
Objective To compare the accuracy of pilot-drill guided and fully-guided immediate implant surgery in partially edentulous patients. Methods Forty-five partial edentulous patients (56 implants) in our hospital between January 2017 and June 2018 were randomly allocated to pilot-drill guided (PG) group (28 implants) and fully-guided (FG) group (28 implants) according to random number table. Cone beam CT (CBCT) was performed before the operation to collect data for three-dimensional reconstruction of teeth and jaw, simulation of implant 3D image design and producing guiding templates. PG and FG were performed in the two groups respectively. After implant insertion, CBCT was performed again for three-dimensional reconstruction. The deviations of positions and angulations of the implants were determined and calculated. The safety and stability (ISQ) of the implant were investigated at 4 w and 24 w after the operation. Results All 56 implants were successfully implanted under the guidance of template. AGD, AD, CGD, CLD, CVD, ALD and AVD in FG group were all lower than those in the PG group (all P<0.01). There was no significant difference in the safety and ISQ value between the two groups at 4 and 24 weeks after the operation (all P>0.05). Conclusions Digital template can provide a good technical support for immediate implant surgery. A higher degree of accuracy can be achieved by fully-guided surgery in immediate implant surgery of partially edentulous patients. PG and FG surgery demonstrate a similar safety and stability.

The theories and fundamental research on chronic atrophic gastritis

SHI Xiao-hong, ZHOU Li-min

2019, 17(10): 1687-1690,1707. doi: 10.16766/j.cnki.issn.1674-4152.001030

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Abstract:
Objective Via discussion of the immunological basis of apoptosis and atrophy to gastric gland cell and gastric mucosal induced by deficiency of spleen and stomach qi, to detect the changes of small molecular protein in blood and urine of patients with chronical atrophic gastritis. Methods The proteins, including IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12,IL-15, IL-17, IL-1β, IL-1Ra, MIF, IFN-γ, SCF, were chosen. A total of 111 patients with CAG were selected as study objects and were classified by TCM syndrome type. The distribution of syndromes were 32 cases of deficiency syndrome of spleen and stomach qi, 33 cases of damp-heat syndrome of spleen and stomach, 46 cases of disharmony syndrome of liver and stomach. The 33 cases were included in the control group. The supernatant of blood and urine were collected before and after treatment for three months. Syndrome-related proteome of CAG possessing good specificity and susceptibility will be determined by liquid suspended bio-chip fluorescence detection technique. Results First before treatment, protein change of CAG TCM Syndrome compared with control group were as follows： in blood of CAG patients, the expression of IL-2, IL-12, IL-17 were decreased, and increased with IL-4, IL-7, IL-8, IL-1β, IL-1Ra, MIF, IFN-γ. The expression were decreased with IL-6, IL-12, IL-15, IL-17 in urine, and increased with IL-2, IL-4. Due to few patient case data with drug intervention, large sample test results will be published after the test completion. Conclusions Cytokine network is unbalanced between proinflammatory and anti-inflammatory based on deficiency of spleen and stomach qi. That state of human body makes the immune cell immunocompromised or immune incompetence. The expression of cytokine network tends to shift to type Th2 between Th1 and Th2 balance. After the intervention of Chinese medicine, the immune function of cell will be enhanced. The stomach mucosa of some patients with mild atrophy returns to normal. Spleen and stomach qi deficiency is the main pathological factor of inducing apoptosis and atrophy to gastric gland cell and gastric mucosa on an immunological basis.

The observation on curative effect of 12 weeks intensive insulin analogues treatment for newly diagnosed type 2 diabetes patients

HU Chen-liang, XI Yu, WANG Yu-chan, YAO Xin-ming

2019, 17(10): 1691-1693,1721. doi: 10.16766/j.cnki.issn.1674-4152.001031

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Abstract:
Objective To observe therapeutic efficacy of intensive therapy with insulin analogues on newly diagnosed type 2 diabetes. Methods We select 58 newly diagnosed type 2 diabetes patients in hospital from 2013 to 2016. ALL 58 newly diagnosed type 2 diabetic patients were treated by insulin aspart before 3 meals combined with insulin glargine at bedtime. The dosage of insulin was adjusted according to blood sugar for 12 weeks. After 10-14 days of hospitalization, the patients' blood sugar reached the standard (fasting blood sugar<7 mmol/L, postprandial blood sugar<10 mmol/L) and were discharged. After discharge, the original regimen was continued for 12 weeks. The fasting blood glucose, fasting insulin, HbA1c, HOMA-IR, HOME-β, △I₃₀/△G₃₀, TCH, TG, LDL, HDL, systolic blood pressure, diastolic blood pressure, BMI and waist to hip ratio was observed at the baseline and the end of the trail. The change of each index was analyzed by paired t-test. Results After treatment, the levels of fasting blood glucose, fasting insulin, HbA1c, TCH, TG and LDL were significantly lower than those before treatment (all P<0.05); After treatment with HOME-β and △I₃₀/△G₃₀ increased significantly than before (all P<0.05); There was no statistical significance in the changes of systolic pressure, diastolic pressure, HDL, HOMA-IR, BMI and waist to hip ratio before and after treatment. Conclusion For the newly diagnosed type 2 diabetic patients, taking 12 weeks intensive insulin analogue therapy can control blood glucose well, improve the function of β-cells, and at the same time, it is safe and reliable.

Effect of different diastolic blood pressure levels on the prognosis of elderly patients with heart failure with preserved ejection fraction

FENG Li, LIN Ping, XIE Xiao-feng, WANG Qin, LIANG Li-zhen

2019, 17(10): 1694-1696,1704. doi: 10.16766/j.cnki.issn.1674-4152.001032

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Abstract:
Objective To analyze the cardiac function and the adverse outcomes in elderly HFpEF patients with different diastolic blood pressure，and explore the risk factors of death. Methods A total of 207 participants enrolled in this study from March 2015 December 2016 were divided into LDBP group (24 h mean diastolic blood pressure <60 mm Hg, 1 mm Hg=0.133 kPa, n=98) and HDBP group (24 h mean diastolic blood pressure ≥60 mm Hg, n=109). NYHA function classification Ⅲ or Ⅳ, all-cause death, the incidence of non-fatal myocardial infarction and cardiac shock were analyzed. The patients were followed up for 1.5 years with the end point of all-cause death. Risk factors of death were analyzed by Cox regression. Results The severity of cardiac function, mortality, non-fatal myocardial infarction and cardiogenic shock in the LDBP group were higher than those in the HDBP group (all P<0.05). A total of 105 deaths (death group) were observed in 1.5 years of follow-up, and 102 in the survival group. Univariate analysis showed that there were differences in DBP, BMI, COPD, NT-proBNP and IVST levels between the death group and the survival group (all P<0.05). Multivariate Cox regression analysis showed that diastolic blood pressure <60 mm Hg and high IVST level were independent risk factors for death (all P<0.05). Conclusion Low DBP and high IVST increase the risks of death in HFpEF patients.

The discussion on comorbidity of erectile dysfunction and depression in male patients with type 2 diabetes mellitus

CAO Jiang, ZHOU Dong-sheng, ZHANG Yan, ZHU Gui-dong, YUAN Na-hua, YU Chang

2019, 17(10): 1697-1700. doi: 10.16766/j.cnki.issn.1674-4152.001033

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Abstract:
Objective To investigate the comorbidity of diabetes mellitus erectile dysfunction and depression in male patients with type 2 diabetes mellitus. Methods One hundred and fifty-six male DMED patients in our hospital from November 2015 to November to 2018 were enrolled, who were divided into group A (DMED with depression,105 cases) and group B (DMED without depression,51 cases) according to the results of Self-rating depression scale (SDS). The co-morbidity of DMED and depression was calculated, and the differences of baseline index, blood sugar control index, sex hormone index and lipid biochemical index between the two groups were compared. Pearson correlation analysis was used to evaluate the correlation between SDS scale score and these indexes, and Logistic regression analysis was carried out. Results Among 156 male patients with T2DM, 105 had depression, with a total incidence of 67.31%. The age of group A was significantly higher than that of group B, the duration of T2DM was significantly longer than that of group B, FPG, FIns and HbA1c were higher than that of group B, TT was lower than that of group B, LH and FSH were higher than that of group B, the difference was statistically significant (all P<0.05). Pearson analysis showed that SDS score was positively correlated with age, course of T2DM, FPG, Fins, HbA1c, LH and FSH, and negatively correlated with TT level (all P<0.05). Logistic regression analysis showed that age, duration of T2DM and TT level were independent risk factors for comorbidity of DMED and depression (all P<0.05). Conclusions In male T2DM patients, DMED has a comorbid condition with depression. Old age, long course of T2DM and low TT may be the independent risk factors for the comorbidity.

Relationship between laryngopharyngeal reflux diseases and persistent wheezing in infants and young children

LIN Li-hua, CHEN You-fen, SUN Qiu-feng, CHEN Li-li, CHEN Li-xian, WU Jin-zhun, YANG Yun-gang

2019, 17(10): 1701-1704. doi: 10.16766/j.cnki.issn.1674-4152.001034

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Abstract:
Objective To investigate the relationship between laryngopharyngeal reflux diseases and persistent wheezing in infants and young children, and develop a new method for the diagnosis and therapy of persistent wheezing. Methods Total 60 infants suffering from persistent wheezing more than one month without remission after Pulmicort inhalation therapy in clinic were admitted. There were 45 males and 15 females, with a mean age of (9.93±0.82) months. The fiberoptic bronchoscopy and 24-hour laryngopharynx pH monitoring were performed in all patients. According to laryngopharyngeal reflux criteria, the infants were divided into the laryngopharyngeal reflux group and the non-reflux group, meanwhile, according to trachea under the bronchoscope, the patients were also divided into the tracheomalacia group and the non-tracheomalacia group. Results ①Bronchoscopy examination showed that all patients had endobronchial inflammation. The mean age of 22 cases of tracheobronchomalacia (tracheomalacia group) was (8.13±5.65) months, and of 38 cases of non-tracheobronchomalacia (non-tracheomalacia group) was (10.92±5.59) months, there was no significant difference in age of patients between the two group. ②According to the index of Ryan, 36 cases were with laryngopharyngeal reflux, and the incidence rate of laryngopharyngeal reflux was 60%. ③In the Tracheomalacia group, Ryan index was in the upright position (197.67±228.19), which was significantly higher than that of non-tracheomalacia group (33.76±49.64), the difference was statistically significant (t=3.324, P=0.003). ④ There were 38 patients meeting the diagnostic criteria of laryngopharyngeal reflux (18 cases in each group) with the incidence of 81.8% and 47.4%, respectively, the difference was significant m (χ²=6.890, P=0.009). Conclusion Laryngopharyngeal reflux is an important cause of persistent wheezing in infants and children. The incidence of laryngopharyngeal reflux is higher in children with persistent tracheomalacia.

Clinical diagnositic value of neutrophil CD64 for development of maternal puerperal infections

ZHANG Qin-wei, BIAN Jia, LIN Ai-bao

2019, 17(10): 1705-1707. doi: 10.16766/j.cnki.issn.1674-4152.001035

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Abstract:
Objective To investigate clinical diagnositic value of neutrophil CD64 development of maternal puerperal infections, to provide evidence for its early diagnosis. Methods The clinical data of 167 patients with puerperal fever treated in our hospital from December 2015 to February 2016 were analyzed. The patients were divided into two groups with maternal puerperal infections: infection group were 34 cases and non-infection group were 133 cases. The neutrophil CD64 were detected with puerperal fever at 0, 12, 24, 48 h and 72 h, to evaluate the risk of maternal infection. The receiver operating characteristic (ROC) curves for the significant parameters were generated to evaluate the diagnostic value of neutrophil CD64 at different time points. Results There were 34 patients in the case group, with an average age of 29.03±1.07 years and an average gestational age of 39.01±1.11 weeks. In the control group, 133 subjects had an average age of (28.88±1.71) years and an average gestational age of 39.49±1.31 weeks. There was no significant difference in age, gestational age and body mass index (BMI) between the two groups (all P>0.05). The neutrophil CD64 in the infected group were no significant difference than the non-infected group in postpartum fever at 0 h, 12 h (all P>0.05). The neutrophil CD64 in the infected group were significantly higher than the non-infected group in postpartum fever at 24 h, 48 h and 72 h (all P<0.05). The ROC curve analysis showed that area under the ROC curve of postpartum fever at 24, 48 h and 72 h of neutrophil CD64 were 0.803, 0.879 and 0.947, the sensitivity was 76.7%, 81.3% and 83.3%, the specificity was 84.8%, 88.3% and 89.1%, respectively. Conclusion The elevated abnormally of neutrophil CD64 has major detective value for the development of maternal puerperal infections with puerperal fever at 24-72 h.

Blood sugar level correlated with inflammatory reaction and oxidative stress in children with sepsis

LYU Zhuo-chao, QIAN Li-jun

2019, 17(10): 1708-1710,1713. doi: 10.16766/j.cnki.issn.1674-4152.001036

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Abstract:
Objective To investigate the relationship between inflammatory response, oxidative stress and blood glucose levels in children with sepsis. Methods From August 2016 to July 2017, 79 children with sepsis in our hospital were enrolled and assigned into control group and study group according to the blood glucose level. The patients in the control group were with normal blood glucose and the study group with elevated blood glucose. The level of inflammatory response factors was tested by using enzyme-linked immunosorbent assay; SOD, GSH-PX, AOPPS and CAT were tested by using automatic biochemical analyzer; ALT, GGT and TB were detected by using radioimmunoassay; T lymphocyte was measured by Flow cytometry. Results The levels of sTNF-RI, IL-13 and IL-10 in the study group were lower than those in the control group (all P<0.05). The levels of IL-8, TNF-α and IL-1β in the study group were higher than those in the control group (all P<0.05); SOD, AOPPS and CAT in the study group were higher than those in the control group (all P<0.05); the GSH-PX level in the study group was lower than that in the control group (all P<0.05); the levels of GGT and TB in the study were higher than those of the control group (all P<0.05). The levels of CD3⁺, CD4⁺ and CD8⁺ in the study group were higher than those in the control group (all P<0.05). The level of CD4⁺/CD8⁺ in the study group was lower than that in the control group (P<0.05). Conclusion The blood glucose level in children with sepsis is closely related to the occurrence of inflammatory reaction and oxidative stress, which shows a positive correlation.

The value of detecting coagulation function in patients with pregnancy-induced hypertension syndrome and pregnancy-induced diabetes mellitus

ZHU Hong, XUAN Rong-rong, LIU Li-ping, WANG Lin, JIANG Wei-chun, ZHOU Ning

2019, 17(10): 1711-1713. doi: 10.16766/j.cnki.issn.1674-4152.001037

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Abstract:
Objective To explore the value of blood coagulation function test in patients with pregnancy-induced hypertension syndrome and gestational diabetes mellitus. Methods From January 2016 to January 2018, 338 cases of gestational diabetes admitted to our hospital were used as diabetes group, 188 cases of hypertensive syndrome of pregnancy were used as hypertension group, and 360 cases of normal pregnant women admitted to hospital at the same time were selected as normal group. All patients and their families had informed consent to the study. The changes and adverse outcomes of plasma prothrombin time (PT), fibrinogen (FIB), activated partial thromboplastin time (APTT) and D-dimer (DD) in different pregnancy stages were observed and analyzed. Results In the first trimester, PT, APTT, FIB, and D-D were not significantly different between the three groups (F=0.804, 0.401, 1.115, 0.813, P=0.528, 0.754, 0.359, 0.809). In the second trimester, the PT and APTT in the diabetic group and the hypertension group were significantly lower than those in the normal group. The FIB and D-D in the diabetic group and the hypertension group were significantly higher than those in the normal group. In the third trimester, the PT and APTT in the diabetic group and the hypertension group were significantly lower than those in the normal group; the FIB and D-D in the diabetic group and the hypertension group were significantly higher than those in the normal group. The incidence of adverse outcomes was statistically significant among the three groups (χ²=15.449, P=0.001). The incidence of adverse outcomes was significantly higher in the diabetic group and the hypertension group than in the normal group. Conclusion GDM patients and hypertensive patients with gestational age are in a relatively hypercoagulable state during the middle and late pregnancy, and it is of great significance to dynamically detect various coagulation indexes.

A Study of the diagnostic perception of the primary care physicians in Xi'an city concerning of the common cold among the children and the influencing factors

FAN Li-ping, MI Man, LI Xue-ping, LIU Man-ling

2019, 17(10): 1714-1717. doi: 10.16766/j.cnki.issn.1674-4152.001038

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Abstract:
Objective To investigate the mastery degree of community-based general practitioners of Xi'an City on diagnosis and treatment knowledge of common colds in children and their attitude to improve diagnosis and treatment level, analyze related influencing factors and then further determine the causes of nonstandard diagnosis and treatment of common colds in children in the communities and seek corresponding solutions. Methods The method of cross-sectional study was employed to carry out a questionnaire survey on 118 general practitioners from 49 community health service centers in 6 districts of Xi'an City from February to March 2017. The survey contents cover general conditions, diagnosis and treatment knowledge related to common colds in children and willingness to improve diagnosis and treatment level. Results ①47.5% of the general practitioners of Xi'an City had poor knowledge about diagnosis and treatment of common colds in children and 52.5% of them had a good grasp. ②There was difference in the cognition degree of general practitioners with different years of clinical work experience on the concepts of cold, flu and common cold (P<0.05); the preferred treatment options determined by general practitioners with different titles were also significantly different (P<0.05). ③76.3% of the general practitioners held positive attitudes towards the improvement of diagnosis and treatment level of common colds in children while 23.7% were negative; among them, general practitioners with different educational background and income levels had different attitudes towards the improvement of diagnosis and treatment level of common colds in children (P<0.05). ④Multi-factor logistic regression analysis shows that educational background is the factor influencing the attitudes of the general practitioners towards the improvement of diagnosis and treatment level of common colds in children, and general practitioners with low educational background held relatively negative attitudes. Conclusion General practitioners of Xi'an City should improve their mastery degree on diagnosis and treatment knowledge of common colds in children. They hold a relatively positive attitude towards the improvement of diagnosis and treatment level of common colds in children, especially general practitioners with higher educational background; attention should be paid to continuing education of general practitioners, to give full play to their initiatives to improve the quality of diagnosis, treatment and prevention services for common colds in children in the communities.

A survey and analysis on family beds for patients who receive home care services of community health service centers in suburban of Shanghai in 2017

GAO Yan, LIU Deng, PAN Yi-hui, LIU Yu-jie, DING Yan, HE Qiao, PAN Xiao-ye, LIU Zheng-qing, WANG Li-ping, DI Chun-ming, AI He-ling

2019, 17(10): 1718-1721. doi: 10.16766/j.cnki.issn.1674-4152.001039

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Abstract:
Objective To investigate and analyze the situation of family beds for patients who receive home care services of community health service centers in suburban of Shanghai in 2017, and provide suggestions for further improving the service model. Methods A retrospective investigation was performed among 164 community health service agencies in 9 suburbs of Shanghai to investigate the service status of family sickbeds and the basic situation of the main patients admitted. Results ①Bed-building rate: 8 762 beds were there at the beginning of 2017, and 22 229 new beds were built during 2017. The average bed-building rate of each community center was 3.728‰ and 124 beds were built for the elderly over 60 years old. ②In-bed patients in family beds: 24 014 patients were in bed, the proportion of men is greater than that of women, with elderly patients over 60 years old accounting for 94.058% of the total, with elderly patients over 80 years old accounting for 45.544%. ③Family health services: Total family health services were 263 280, with an average of 1 605 family health services per center; ④Disease types of newly built beds: Cardiovascular patients accounted for 55.312%, and stroke patients accounted for 23.423%. ⑤Outcomes of patients who have been discharged from bed: 89.971% of patients were cured, stable and improved; ⑥ Family Bed-building rate of Traditional Chinese Medicine: The family beds of Chinese medicine accounted for 13.691% of the family beds. Conclusion The government should further strengthen the construction of family beds in the suburbs to play its important role in medical care for the elderly, promote family doctors'signing services and improve the quality of family bed services. We should also pay more attentions to Chinese medicine services and improve the application of traditional Chinese medicine in family beds.

Interaction of rumination meditations in purpose and family environment on psychological pain in elderly patients with first diagnosed bone metastasis of prostate cancer

LIU Hui-jing, LIU Wei, DONG Jian-qing, TAO Xiao-feng, WANG Xiao-xi

2019, 17(10): 1722-1725. doi: 10.16766/j.cnki.issn.1674-4152.001040

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Abstract:
Objective To investigate the influence of interaction of rumination meditations in purpose and family environment on psychological pain in elderly patients with first diagnosed bone metastasis of prostate cancer, so as to provide insights for further intervention approaches foe reducing the psychological pain of patients. Methods We selected 471 cases of elderly patients with first diagnosed bone metastasis of prostate cancer from December 2015 to December 2017 treated in Tangshan People's Hospital and they were divided into mild-moderate psychological pain group (n=212) and severe psychological pain group (n=259) according to the scores of distress thermometer (Distress Thermometer，DT). Meanwhile, all subjects were investigated using the Chinese Version of Event Related Rumination Inventory (C-ERRI), Family Adaptability and Cohesion Scale Ⅱ (FACES Ⅱ), Visual Analog Scale (VAS) and the general material lists. Results Univariate analysis showed that the psychological pain was statistically significant in patients age, Gleason score, pain score, ruminant meditation level and family environment on the distribution difference (all P<0.05). Multiple regression analysis displayed that after adjusting age, pain score, combined with chronic disease, low level of ruminant meditation and general family environment significantly increased the risk of severe psychological pain in patients and the OR (95%CI) respective 2.944(1.891-4.584) and 3.670(2.347-5.737). Additive interaction analysis showed that those with low level of ruminant meditations and general family environment increased the risk of severe psychological pain than those with high level of ruminant meditations and good family environment OR(95%CI)=12.252(7.660-13.691). The synergy index (SI) and attributable proportion due to interaction (AP) were 11.322(7.242-12.622) and 19.710%, respectively. Conclusion Low level of rumination meditations in purpose and general family environment are risk factors of psychological pain in patients with first diagnosed bone metastasis of prostate cancer, and there might be interaction between them.

The clinical application of doppler ultrasonography assisted pituitary neoplasms transsphenoidal resection

ZHAO Jian-xiang, WANG Kai-yu, YU Rong-guo, LI Xiao-yan

2019, 17(10): 1726-1728. doi: 10.16766/j.cnki.issn.1674-4152.001041

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Abstract:
Objective To explore the clinical application and auxiliary significance of doppler ultrasonography assisted pituitary neoplasms transsphenoidal resection. Methods Twelve patients' clinical data was analyzed retrospectively who with pituitary adenoma treated by transsphenoidal approach assisted by color doppler ultrasound from March 2014 to March 2017, including 8 males and 4 females, aged 35-65 years, with an average age of 49.2 years. The characteristics of the tumors were as follows, the length ranged from 0.8 cm to 4.6 cm, 2 cases of pituitary microadenomas, 10 cases of pituitary macroadenomas, 2 cases of hormone secreting pituitary adenomas (including 1 case of growth hormone adenoma, 1 case of adrenocorticotropic hormone shorted for ACTH adenoma), and 10 cases of non-functional pituitary adenomas. The advantages and disadvantages of transsphenoidal ultrasound in all of the patients' operation were summarized and analyzed. Results The average operation time of twelve cases was 92 minutes. One case which considered as ACTH pituitary microadenomas according to endocrinological findings, there was no pituitary space-occupying lesions found on preoperative cranial MRI, and also no lesions found by intraoperative ultrasound microprobe. The remaining eleven pituitary adenoma lesions were detected by intraoperative ultrasonography, of which two cases were excised according to the guidance of ultrasonography. However, two other cases which involved the internal carotid artery were still impossible to remove the residual tumor tissue further, although the residual tissue had been found by intraoperative ultrasonography. After a 3 months follow-up, 9 patients (9/12, 75%) have attained the clinical cure or remission according to the biological and screening standard. Conclusions There is a good clinical application value of doppler ultrasonography assisted pituitary neoplasms transsphenoidal resection, because of its very clear imaging, more accurate anatomical location for important nerves and blood vessels during operation. Therefore, pituitary neoplasms can be removed without key anatomic site injury under the help of transsphenoidal ultrasonography.

Application and accuracy of spiral CT in the measurement of orbital volume

SUN Man-yi, WANG Bo, DONG Hai-bo

2019, 17(10): 1729-1731. doi: 10.16766/j.cnki.issn.1674-4152.001042

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Abstract:
Objective To investigate the application and accuracy of spiral CT in the measurement of orbital volume. Methods A total of 32 non-ophthalmic patients (64 eyes) admitted to our hospital from September 2016 to October 2018 were selected. Volume Rendering (VR) imaging was performed on the bilateral orbits of all the patients, and the VR detection value level was used as the gold standard for comparison. At the same time, 32 cases and 64 eyes were reconstructed at different thickness/spacing: 2 mm/2 mm, 2 mm/4 mm, 2 mm/5 mm, 3 mm/3 mm and 3 mm/5 mm parameters by spiral CT, and the images were taken screenshots. The measurement level and error rate range of orbital volume of 64 eyes in different thickness/width conditions; Accuracy of orbital volume detection in 64 eyes under different thickness/width conditions. Results During VR detection, the average orbital volume value was (22.9±2.6) cm³. At 2 mm/2 mm, the orbital volume value detected was (22.4±2.3) cm³, which had no significant difference with VR detection value (P>0.05). There was statistically significant difference between orbital volume value level and VR detection value under other thickness/interval parameters (all P<0.05). To take the error rate <5% as the criterion of accuracy evaluation; under the condition of 2 mm/2 mm, the accuracy rate reached 100.0%, followed by 2 mm/4 mm,with the accuracy rate of 89.1%, and the lowest was 3 mm/5 mm, with the accuracy rate of 10.9%. The difference between groups was statistically significant (all P<0.05). Conclusion Spiral CT was used to measure orbital volume when the thickness/interval was set to 2 mm/2 mm, with the minimum error rate. The level of orbital volume can be accurately and objectively measured, and the changes, outcomes and curative effects of related diseases can be evaluated by referring to its level.

An exploration of the significance and application of reproductive medicine in general practice after comprehensive second child policy

CHEN Han-xiao, DU Ze, QIN Lang, GAO Rui

2019, 17(10): 1732-1735,1780. doi: 10.16766/j.cnki.issn.1674-4152.001043

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Abstract:
The population problem is the key problem of the development of our country. With the release of a comprehensive second child policy, there is an increase in the number of women who want to have a second child. The age of women who have the need to reproduce is increasing with the influence of multiple factors such as social pressure. Older women with infertility become the most important component of infertile women, for the rate of female infertility increases with age. How to implement comprehensive second child policy and help the infertile couples, especially the older infertile couples, becomes a new challenge. Due to regional and quantitative limitations, specialized hospitals have been unable to meet the consultation and treatment needs of infertile patients. A general practitioner, as a physician who is based on the community and provides comprehensive services for individuals, families and communities, plays an important role in maintaining the health of the community. However, the knowledge and technology of infertility and assisted reproductive technology (ART) are still limited to specialized hospitals. Also, the knowledge and technology in this field mastered by general practitioners serving the community cannot meet the needs of infertile patients. If the general practitioner is able to understand the relevant knowledge of infertility and assisted reproductive technology, monitor the conditions of patients in time, provide consulting services and counsel patient psychology, also recommend patients to the professional institutions of reproductive medicine for more effective treatments. After that, they can play important roles in the second child policy and lay a solid foundation for the policy promotion. The purpose of this review is to systematically explore the clinical application of infertility and assisted reproductive technology, and to sort out relevant knowledge, so as to make general practitioners pay attention to and understand reproductive medicine, and to meet the needs of diagnosis, treatment and consultation for infertile patients in the community.

Advances in the application of stem cells in peripheral nerve regeneration

YE Gang, LI Yu-hong

2019, 17(10): 1736-1741,1772. doi: 10.16766/j.cnki.issn.1674-4152.001044

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Abstract:
Peripheral nerve injury is a very common disease with varying degrees of clinical severity, but it has a great impact on patients' work efficiency and quality of life. As the first choice of surgical treatment in many cases does not provide satisfactory functional recovery, how to treat peripheral nerve injury has always been a difficult subject in the medical profession at present. In the study of nerve repairing mechanism, it was found that peripheral nerve injury was accompanied by complex regeneration process, including Waller degeneration, axonal sprouting and myelin regeneration. Schwann cells (SCs) are supporting cells of the peripheral nervous system and play an indispensable role in physiological response and regeneration of nerve injury. Limitations of autologous SCs include difficulty in acquisition, often accompanied by certain invasiveness and donor complication, limited proliferative ability and limited sources, which limit their clinical application. With the development of biomedicine, people turn their attention to stem cells. Experiments have found that stem cells are pluripotent cells with self-renewal ability, which is expected to improve the functional recovery after nerve injury. Stem cells can differentiate into SCs-like cells, enhance the neurotrophic effect and promote myelin sheath formation, but do not have the disadvantages of self-SCs, providing a way to improve the existing treatment. According to the source of stem cells, there are bone marrow mesenchyma stem cells, fat mesenchymal stem cells, dental pulp mesenchymal stem cells, nerve stem cells, embryonic stem cells, induced pluripotent stem cells, skin derived cells precursor cells and myogenic stem cells. This review summarizes the recent advances in above mentioned stem cells in peripheral nerve regeneration.

Effect of constraint-induced movement therapy during acute rehabilitation to reduce arm impairment after ischemic stroke

LI Xin-ying, NIU Yang, WU Xiao-yu

2019, 17(10): 1742-1744. doi: 10.16766/j.cnki.issn.1674-4152.001045

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Abstract:
Objective To investigate whether the constraint-induced movement (CIM)therapy is more effective than traditional upper-extremity therapies after ischemic stroke. Methods Forty patients with ischemic stroke involving persistent hemiparesis, evidence of preserved cognitive function, and presence of a protective motor response, persons were enrolled in a pilot randomized, controlled trial that compared CIM with traditional therapies for 10 days, 2 hours a day. Patients in the CIM group wore cotton pad gloves for at least 6 hours a day during the 10-day treatment period, encouraging the patients to use their hemiplegic arms to complete daily tasks. Patients in the traditional treatment group received standard rehabilitation treatment. Differences of ARAT, Barthel Index and FIM between the groups were compared by using student's t tests, constituent ratio by using Chi square tests. Results No subject withdrew because of pain or frustration. The CIM treatment group had significantly higher scores on total ARAT and pinch subscale scores (all P<0.05). Differences in the mean ARAT grip, grasp, and gross movement subscale scores did not reach statistical significance. Conclusions A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatment. Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies.

Clinical study of warm acupuncture and moxibustion in the treatment of shoulder periarthritis

TANG Ming-han, SONG Hao, WEI Zhi-zhong

2019, 17(10): 1745-1748. doi: 10.16766/j.cnki.issn.1674-4152.001046

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Abstract:
Objective To study the clinical effect of warming needle moxibustion on scapulohumeral periarthritis and provide corresponding treatment reference. Methods A total of 120 patients with scapulohumeral periarthritis admitted to traditional Chinese medicine of Jiangsu Province from January 2018 to January 2019 were selected and randomly divided into control group and combined group with 60 cases in each group. The patients in the control group were treated with routine western medicine, while the patients in the combined group were treated with Warming Acupuncture and moxibustion on the basis of the control group. VAS visual pain score, Melle score and activity of daily living scale were used to evaluate the pain, joint activity and activity of daily living of the two groups before and after treatment. The shoulder joint function of the two groups was evaluated. The changes of serum calcitonin gene-related peptide (CGRP) and substance P (SP) levels were detected before and after treatment. The treatment of the two groups was measured. The results were compared between groups. Results There was no significant difference in pain score, shoulder joint function score, joint activity score, daily living ability score, serum CGRP and SP level between the two groups before treatment (all P>0.05); after treatment, the pain score, joint activity score, serum CGRP and SP level in the combined group were lower than those in the control group, while the shoulder joint function score and daily living ability score were significantly higher than those in the control group (all P<0.05). The total effective rate of the combined group was significantly higher than that of the control group (P<0.05). Conclusion Warm acupuncture and moxibustion can inhibit the abnormal expression of pain inflammatory factors, relieve pain symptoms of patients with scapulohumeral periarthritis, restore shoulder joint function, and have a better therapeutic effect.

Application of organ-systems-centered joint teaching rounds in the practice and teaching of general practice under the mode of curriculum integration

LIANG Bing, WANG Min, LI Yi-wen, GAO Fang, WANG Chan

2019, 17(10): 1749-1752. doi: 10.16766/j.cnki.issn.1674-4152.001047

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Abstract:
Objective To explore the application of organ-systems-centered joint teaching rounds in the practice and teaching of general practice under the mode of curriculum integration. Methods A total of 51 students from the general medical department of the First Affiliated Hospital of Bengbu Medical College from 2013 to 2015 were selected as the research subjects. They were divided into two groups, 25 students in the experimental group and 26 students in the control group. In the control group, conventional teaching method were carried out, the experimental group conducted the organ-systems-centered joint teaching rounds, then the examination results, patients' evaluation of interns, teachers' evaluation and students'self-identification were compared by means of examination and questionnaire survey. Results The comparison of test scores showed that the theoretical scores (62.76±3.23), skills scores (24.48±2.25) and overall scores (87.32±4.18) of the experimental group were significantly higher than those of the control group (all P<0.05). The results of the evaluation form showed that the experimental group was superior to the control group in professional knowledge (19.52±1.85), communication ability (19.44±2.10) and clinical thinking ability (19.64±1.89) all P<0.05. The results of the patient evaluation form showed that the professional quality (26.04±1.51) and humanistic care (25.96±1.97) of the experimental group were better than those of the control group(all P<0.05).The results of self-evaluation form showed that the experimental group is superior to the control group in professional quality (14.08±1.04), humanistic care (13.88±6.75), teamwork (14.12±1.36) and future planning(14.44±1.26), all P<0.05. Conclusion The application effect of organ-systems-centered joint teaching rounds is better in the practice and teaching of general practice.

Thinking and prospect about base construction of general practice

TANG Hao, CHEN Shu-ying, WU Jing-guo, MA Zhong-fu

2019, 17(10): 1753-1757. doi: 10.16766/j.cnki.issn.1674-4152.001048

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Abstract:
Objective To develop general practice and train general practitioners is an important part of establishing a hierarchical medical system in line with China's national conditions, accelerating the development of medical and health services, and deepening the reform of medical and health services. Methods This paper summarizes the experience of general practice resident standardized training and general practice trainner training in general practice base of the first affiliated hospital of Sun Yat-sen university First, We adopted the training management mode of "coordination between medical and education" "three-ring management" and "linkage up and down" in the standardized training of general residents, emphasized on humanistic education, actively used social resources to improve the level of diagnosis and treatment of regional general practitioners and adopted the tutor responsibility system to train the high level professional scientific research ability of general practitioners to achieve the unity of five certificates. Secondly, we enriched clinical teaching methods and improved clinical teaching skills through the clinical teacher-funded curriculum training system, and signed a cooperation agreement with the university of Birmingham to set up the "Guangzhou-Birmingham medical consortium" to conduct personalized teaching and convey the educational concept of "self-oriented learning". In addition, 5-year clinical medicine undergraduates were offered the course to introduce the general medicine. The combination of theoretical teaching and community hospital internship enables medical students to have a perceptual and rational understanding of the concept, work nature and practical application of general practice. Results We have set up a special training base for general practitioners and built a team of high-quality general practitioners with teacher resources for south China and aroused the interest of medical undergraduates to train future general practitioners for society. Conclusion Through our efforts, we shall build high-quality general practice bases and train more general practice talents for the country.

The application of multidisciplinary cooperative teaching in the clinical teaching of general practitioners

QIN Fu-fang, ZHANG Si-sen, WANG Liu-yi, SHEN Feng-juan, GENG Juan-juan, LI Yin

2019, 17(10): 1758-1761. doi: 10.16766/j.cnki.issn.1674-4152.001049

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Abstract:
Objective The main problem in general practice teaching is the lack of general practice thinking and the connection between subjects. Therefore, this study is designed to explore the practical effect of multidisciplinary disciplinary collaboration (MDT) teaching model in the clinical teaching of training trainees of general practitioner. Methods A total of 52 general practice trainees from our hospital in 2017 were selected as the research objects and randomly divided into experimental group and control group, with 26 people in each group. The control group adopted conventional teaching method in clinical teaching, i.e., problem-based learning (PBL), and the experimental group adopted the multidisciplinary cooperation PBL teaching method, for a period of 2 months. The results of the two groups were compared by testing on completion of a course including theory examination, skill examination and questionnaires. Results Students in the experimental group scored (92.7±2.5) in theoretical examination and (91.4±3.3) in clinical skills examination, while students in the control group scored (80.3±5.3) in theoretical examination and (81.2±5.2) in clinical skills examination, with statistical significance (all P<0.05). Students in the experimental group following the MDT-oriented PBL teaching method was better than students in the control group following the single PBL teaching method, and the difference between the two groups was statistically significant (all P<0.05). In the 360-ways evaluation, the satisfaction of patients and medical staff to students in the experimental group was better than that in the control group, and the difference was statistically significant (all P<0.05). There was no significant difference between the two student evaluations of each other in groups (P>0.05). The number of people who volunteered questions was higher in the experimental group than in the control group, and the difference was statistically significant (P<0.05). Conclusion Multidisciplinary PBL teaching method can improve the academic performance of general practitioners, and is beneficial to the cultivation of general practitioners' thinking ability and comprehensive quality.

Prevalence and risk factors of sarcopenia in urban area of Chongqing

LIU Li-li, ZHAO Ke-xiang, LUO Cheng, XIAO Qian, ZHOU Jing

2019, 17(10): 1762-1767. doi: 10.16766/j.cnki.issn.1674-4152.001050

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Abstract:
Objective At present, studies on sarcopenia China is still a little, and there are fewer such studies in Chongqing. And most of the previous study included no middle-aged population. We speculate whether certain factors in the middle-aged period will be related to the disease of sarcopenia. In order to explore the risk factors and the prevalence of sarcopenia in Chongqing, and provide a reliable basis for the strategies for the prevention and treatment of sarcopenia, this investigation was carried out. Methods The physical examiners of the First Affiliated Hospital of Chongqing Medical University from December 2017 to January 2018 whose age ≥ 40 years old was included in the study. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia. Skeletal muscle mass was obtained from the bioelectrical impedance analysis (BIA), muscle strength was assessed with handgrip strength (HS), and physical function was assessed with gait speed (GS). On-site questionnaires to collect suspected risk factors.And related laboratory biochemical indicators were collected. According to the results, the populations were divided into the sarcopenia group and the non- sarcopenia group, and the multivariate and independent variable logistic regression analysis was performed to obtain the suspected risk factors. Results A total of 769 physical medical examiners were collected, including 416 males and 353 females. There were 32 patients with sarcopenia, the prevalence of sarcopenia was 4.16%, for male was 2.88%, and for female was 5.67%, 5.67% for aged＞60 years old. logistic regression analysis showed that risk factors for sarcopenia included: body mass index (OR=0.374, 95% CI:0.270-0.517), body water (OR=0.784, 95% CI:0.665-0.924). Conclusion Body mass index is associated with sarcopenia, as well as body water. They are negatively correlated with sarcopenia. For the middle-aged and elderly population, ensuring adequate water intake and maintaining a normal body mass index is the key to preventing sarcopenia.

Analysis on subsidy policy of multi-drug resistant tuberculosis among patients in Lishui City

GUO Jing, LIU Zhong-da, ZHANG Zun-jing, YE Chun-fu, KONG Yue-juan, ZHOU Guang-nao

2019, 17(10): 1768-1772. doi: 10.16766/j.cnki.issn.1674-4152.001051

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Abstract:
Objective To analyze on subsidy policy of multi-drug resistant tuberculosis(MDR-TB) among patients in Lishui City. Methods A total of 71 MDR-TB patients diagnosed from 2011 to 2017 were enrolled and interviewed with a structured questionnaire covering personal information, diagnosis and treatment procedure and relevant cost. And the effect of relief policy on the outcome of treatment was also analyzed by multivariate logistic regression. Results All 71 MDR-TB patients diagnosed during 2011 and 2017 received actual subsidy, and total subsidy amount was 2.192 million RMB. Subsidy per capita was 29 650 RMB and the subsidy proportion median was 73.7%. Subsidy per capita and proportion of MDR-TB patients with age less than 53 years old (30 650 RMB)was higher than patients with age more than 53 years old (25 813 RMB, Z=-2.654, P=0.008). Subsidy per capita of MDR-TB patients with monthly income more than 2 000 RMB (30 650 RMB)was higher than patients with monthly income less than 2 000 RMB(22 887.5RMB, Z=-2.479, P=0.013).Subsidy per capita of MDR-TB patients who had been hospitalized(31 650 RMB)was higher than patients in no hospitalized group RMB (29 694.5 RMB, Z=-3.403, P=0.001).In the multivariate logistic regression analysis, subsidy per capita which was less than 29 650 RMB (OR=11.056, 95% CI: 2.793-43.769, P=0.001) and subsidy proportion less than 73.7% (OR=4.881, 95% CI: 1.156-20.606, P=0.031) were factors negatively affecting success of MDR-TB treatment. Conclusion In Lishui City, the current subsidy policy for MDR-TB patients had fundamentally relieved patients' economic burden. It is recommended that the implementation be sustained.

Effect of continuous nursing intervention based on Wechat platform on post-operative psychological elasticity and shame of breast cancer patients

ZHOU Ling, KONG Hong-wu

2019, 17(10): 1773-1776. doi: 10.16766/j.cnki.issn.1674-4152.001052

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Abstract:
Objective To explore the effect of continuous nursing intervention based on Wechat platform on psychological resilience and stigma of breast cancer patients. Methods Sixty cases of patients with radical mastectomy were divided into observation group (July to December 2017) and control group (January to June 2017) according to the order of admission. The control group was given continuous nursing by telephone after discharge, while the observation group was given continuous nursing by Wechat platform. Psychological resilience, stigma score and quality of life were compared between the two groups. Results The scores of CD-RISC in the observation group at 3 months and 6 months after discharge were 60.87±4.82 and 67.46±5.68, higher than those in the control group which were 54.36±4.78 and 53.25±4.73, respectively. The scores of SIS in the observation group were 61.37±10.32 and 55.89±11.21, lower than those in the control group which were 69.85±12.04 and 70.31±11.94, respectively (all P<0.05). The quality of life scales (FACT-B) of breast cancer in the observation group for one month, three months and six months after discharge were 105.26 ±14.71, 114.21 ±14.08, 120.91±14.07, higher than those in the control group which were 92.26±19.42, 104.23±16.85, 109.02±13.78, with significant difference (all P<0.05). Conclusion Continuous nursing based on Wechat platform can improve the psychological resilience level, reduce the sense of shame and improve the quality of life of patients with breast cancer after radical mastectomy.

Effect of systematic nursing intervention on maternal related indicators of group B Streptococcus Infection

SHU Fang-lian, ZHOU Su-fang

2019, 17(10): 1777-1780. doi: 10.16766/j.cnki.issn.1674-4152.001053

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Abstract:
Objective To explore the effect of systematic nursing intervention on the related indicators of pregnant women infected with group B Streptococcus (GBS). Methods A total of 140 parturients with GBS infection who were treated in our hospital from May 2016 to May 2017 were selected and divided into general nursing group and systematic intervention group according to random number method. Routine nursing was given to general nursing group and systematic nursing intervention group. The psychological status, quality of life and self-care ability of the two groups before and after nursing were evaluated, and the hospitalization time, nursing quality, adverse pregnancy outcomes, adverse neonatal outcomes and satisfaction degree of patients' family members were statistically compared between the two groups. Results The scores of HAMD and HAMA in the systemic intervention group were (13.88±4.13) and (12.61±4.11) respectively, lower than those in the general nursing group (17.65±4.56), (16.58±4.46). The scores of quality of life were (64.63±5.06), higher than those in the general nursing group (60.54±4.97, all P<0.05). The scores of self-care ability in the intervention group after nursing were higher than those in the general nursing group (all P<0.05). The average hospitalization time in the systemic intervention group was (4.56±0.38) days, which was shorter than that in the general nursing group (5.32±0.57) days. The nursing quality score was (93.53±7.21), which was higher than that in the general nursing group (86.77±6.59, all P<0.05). The incidence of adverse pregnancy outcomes in the intervention group was 4.29%, lower than that in the general nursing group 17.14%(P<0.05). The incidence of adverse neonatal outcomes in the intervention group was 13.51%, which was lower than that in the general nursing group 34.25% (P<0.05). The total satisfaction rate of family members in the intervention group was 95.71%, higher than that in the general nursing group 84.29% (P<0.05). Conclusion Systematic nursing intervention for GBS infected parturients can improve patients' life and psychological status, enhance patients'self-care ability, improve patients' pregnancy outcomes, and make patients and their families more satisfied.

Nursing value of comprehensive nursing intervention on psoriasis patients treated with traditional Chinese medicine

LING Ai-xiang, WENG Yuan-ying, CAI Tian-guo, CHEN Jin-guang

2019, 17(10): 1781-1784. doi: 10.16766/j.cnki.issn.1674-4152.001054

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Abstract:
Objective To analyze the effect of comprehensive nursing intervention on Chinese medicine treatment of patients with psoriasis, and provide clinical reference. Methods A total of 102 patients with psoriasis admitted to our hospital from August 2017 to May 2018 were enrolled in the study. They were divided into two groups using a random number table method, with 51 patients in each group. Among them, patients with psoriasis in the routine nursing group were given routine nursing intervention, and patients in the comprehensive nursing group were given comprehensive nursing. The patient's treatment comfort, self-efficacy, stress, coping style, quality of life and social anxiety were compared and analyzed. Results The comfort level of patients with psoriasis in the comprehensive nursing group (8.71±0.66) was higher than that in the conventional nursing group (6.87±0.57), and the self-efficacy (35.11±5.12) was higher than that in the conventional nursing group (30.87±6.22), all P<0.05; the comprehensive nursing group patients'stress level (30.76±1.55) points was lower than the conventional nursing group (37.87±1.78) points, and the various dimensions of the stress source were lower than the conventional ones. In the nursing group, the scores of the coping styles were lower than the conventional nursing group, all P<0.05; the total quality of life and the dimensions of the psoriasis patients in the comprehensive nursing group was higher than the quality of life and psoriasis of psoriasis patients in the routine care group, all P<0.05; the social anxiety level of the comprehensive nursing group (35.53±8.12) was significantly lower than that of the conventional nursing group (41.44±7.54), P<0.05. Conclusion Comprehensive nursing can improve the comfort of patients with psoriasis during TCM treatment, improve self-efficacy, reduce stress level and social anxiety, and further improve the quality of life of patients with psoriasis. It is worth applying.

Preoperative psychological state analysis and nursing intervention of skin cancer patients

SHANG Qiong-qiong, LIU Li

2019, 17(10): 1785-1788. doi: 10.16766/j.cnki.issn.1674-4152.001055

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Abstract:
Objective By analyzing the preoperative psychological state of skin cancer patients and put forward nursing counter measures, to create conditions for the smooth operation of the operation and the smooth recovery after surgery. Methods Forty skin cancer patients admitted and treated in our hospital from January 2017 to December 2017 were selected as the research objects. Symptom self-rating scale (SCL-90), self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to assess the preoperative psychological state of these patients. The result was compared with Chinese norm. Results The total mean score of symptom self-rating scale, self-rating anxiety scale score and self-rating depression scale score of the patients in this group were all higher than the domestic norm, and had significant difference (all P<0.05). During the SCL-90 screening, fourteen patients had psychotic symptoms, SAS screening had 14 positive cases and SDS screening had 15 positive cases. The scores of compulsive symptom, somatization and hostility were the highest in SCL-90. The average score of all the factors in this scale is higher than the domestic norm, and had significant difference (all P<0.05). Conclusion The head and face are the predilection areas of skin cancer. Preoperative psychological stress, anxiety, depressed mood is outstanding in skin cancer patients. We need to give assessment in time and undertake necessary nursing intervention, to create conditions for the smooth operation of the operation and the smooth recovery after surgery.

Application value of predictive nursing in puncture biopsy of lung lesions with COPD

SUN Yong-yan, WANG Zhou, YIN Yan-hua, CHEN Na, RONG Ling

2019, 17(10): 1789-1792. doi: 10.16766/j.cnki.issn.1674-4152.001056

178 2

Abstract:
Objective To discuss the application of predictive nursing in ultrasound-guided puncture biopsy for patients with peripheral pulmonary disease and COPD. Methods A total of 84 patients with peripheral pulmonary disease and COPD were selected as the research objects from those admitted in Bozhou People's Hospital between March 2015 and November 2017. The patients were given ultrasound-guided puncture biopsy after signing the informed consent. Patients were randomly divided into the control group and the experimental group using random number table, with 42 cases in each group. The control group was given conventional nursing while the experimental group was given predictive nursing. The two groups were analyzed for the success rate of sampling, the success rate of puncture, the incidence of postoperative complication and nursing satisfaction. Results Both of the two groups were successfully completed biopsy. A total of 129 biopsies were performed in the experimental group, where 3 biopsies were unsatisfied, with the success rate of sampling as 97.67%; finally, 41 cases were correctly diagnosed, and 1 case was unclear, with the success rate of puncture as 97.62%. The success rate of sampling and the success rate of puncture were both 85.71%, which were significantly lower than those in the experimental group, with statistically significant difference (P<0.05). After puncture, 3 cases occurred mild complications in the experimental group (the incidence of complication=7.1%), and 8 cases occurred complications in the control group (the incidence of complication=19%). The incidence of complication was obviously higher in the control group than in the experimental group, with statistically significant difference (P<0.05). In terms of nursing satisfaction, the nursing score was 96.31±3.26 points in the experimental group, while 85.02±4.02 in the control group. The satisfaction of patients in the experimental group was significantly higher than that in the control group, and the difference between the two groups was statistically significant. However, there was no significant difference in pathological results between the two groups (P>0.05). Conclusion For patients with peripulmonary lesions combined with COPD, the application of predictive nursing in the ultrasound-guided puncture biopsy can effectively reduce complications and improve the success rate of puncture and nursing satisfaction.

Clinical features and genetic analysis of three patients with Gitelman syndrome and literature review

ZHANG Xiao-fang, ZHANG Chu, YU Ling-ying

2019, 17(10): 1793-1796. doi: 10.16766/j.cnki.issn.1674-4152.001057

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Abstract:
Objective To analyze the clinical phenotype and gene mutation types in 3 patients with Gitelman syndrome and summarize the clinical features of Gitelman syndrome. Methods The clinical data of 3 inpatients clinically diagnosed as Gitelman syndrome (GS) were collected. The genomic DNA was isolated from the peripheral blood and performed high throughput sequencing and bioinformatics analysis to analysis the all exons of 36 genes related with hypohalemia. Furthermore, Direct sequencing of PCR products in the mutation sites was performed in all patients and their parents. Meanwhile the Gitelman syndrome diagnosed by gene mutation analysis was searched in Wanfang database and China Knowledge Network to compare the differences of serum potassium and blood magnesium between different gene mutations. Results Three patients manifested with recurrent hypokalemia, metabolic alkalosis, but normal blood pressure. Gene sequencing results showed that compound heterozygous mutation of SCL12A3 in case 1 and homozygous mutation of SCL12A3 in case 2. Heterozygous mutation of SCL12A3 and CLCNKB were found in case 3. A total of 79 cases of Gitelman syndrome with complete clinical data were included in the analysis. The results showed that there was no significant difference in serum potassium and blood magnesium between different gene mutations. Conclusions Gitelman syndrome have diverse phenotype and the final diagnosis still requires genetic mutation analysis. There was no significant difference in serum potassium and blood magnesium between different gene mutations. The blood magnesium reduction group has a serious clinical phenotype

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2019 Vol. 17, No. 10

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