2019 Vol. 17, No. 5

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The construction and exploration of "General Practice+" medical community based on the cooperation between university and government as well as the integration between treatment and prevention
DU Qing-feng, WANG Pei-xi, MA Wen-jun, FU Can-heng, KONG Xiao-yan, CHEN Min-sheng
2019, 17(5): 705-708,804. doi: 10.16766/j.cnki.issn.1674-4152.000773
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Objective This study aims to explore a new path for the construction and sustainable development of primary medical communities and to provide a replicable reference experience. Methods The methods adopted in this study were the literature review and theoretical research methods, combined with field research and expert argumentation as well as the grassroots-oriented practice of constructing the new medical community. Results Based on the in-depth analysis of the current status and development of the medical communities in China, here we proposed the concept of "General Practice+" medical community which had been practiced in Foshan, China for more than one year. Combined with the provincial-level public health research institutions, community health service centers, and functional communities, "General Practice+" medical community emphasizes on the integration of treatment and prevention, takes the tertiary hospital as the leading regional hospital and focus on the general medicine. It was noticeable that this new pattern of the medical community was constructed under the cooperation between medical university and government. This medical community was expected to solve the problem of lacking high-quality medical resources by the cooperation between university and government, resolve the underlying contradictions in system and mechanism by "five unity principles", and promote the construction of regional medical communities by taking the general medicine as the starting point. The new pattern of the medical community uses the "General Practice+" to explore a new path of applicable and sustainable reform for popularizing healthy living, optimizing health services, improving health care, building a healthy environment, and developing a healthy industry. Conclusion The "General Practice+" medical community provides new ideas for the medical and health system reform under multi-cooperation and presents evidence for the other county-level public hospitals reform and the other medical community pilot project.
2019, 17(5): 709-713.
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2019, 17(5): 714-715.
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Association of the preoperative NLR, PLR and SII with clinicopathological characteristics in patients with papillary thyroid cancer
ZHAO Yue, HUANG Jing-hao, SUN Jia-jia, LIU Chun-rong, WANG Ning, MENG Zhen, LI Yun-chao, WU Feng-yun
2019, 17(5): 716-719,737. doi: 10.16766/j.cnki.issn.1674-4152.000774
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Objective To investigate the correlation of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) with clinicopathological characteristics in patients with papillary thyroid cancer. Methods A retrospective study was performed to analyze the clinical data of patients with thyroid papillary carcinoma who accepted surgery treatment firstly in the Affiliated Hospital of Logistics University of PAP from January 2015 to December 2017. The relationship between NLR, PLR and SII and clinicopathological characteristics of papillary thyroid carcinoma was discussed. Results The preoperative NLR significantly correlated with bilateral carcinoma (P=0.040) and multifocality (P<0.001) in papillary thyroid cancer, but not with the age, sex, tumor size, TNM staging, extrathyroidal invasion and cervical lymph node metastasis (all P>0.05). The preoperative PLR obviously correlated with the sex (P=0.019) and cervical lymph node metastasis (P=0.048) in papillary thyroid cancer, but not with the age, tumor size, TNM staging, multifocality, Bilateral carcinoma, and extrathyroidal invasion (all P>0.05). The preoperative SII correlated with multifocality (P<0.001) and bilateral carcinoma (P=0.002) in papillary thyroid cancer, but not with the age, sex, tumor size, TNM staging, extrathyroidal invasion, and cervical lymph node metastasis in papillary thyroid cancer (all P>0.05). Conclusion The preoperative levels of NLR, PLR and SII can reflect the biological characteristics of papillary thyroid carcinoma. The increased NLR, PLR and SII levels in papillary carcinomas might correlate with the poorer histopathological profile and more aggressive clinical behavior.
Effect of chest pain center on the treatment of patients with acute ST-segment elevation myocardial infarction
CHEN You, ZHAO Qian, ZHOU Xin-rong, YANG Yi-ning, MA Xiang, XIE Xiang, MA Yi-tong
2019, 17(5): 720-723,728. doi: 10.16766/j.cnki.issn.1674-4152.000775
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Objective To investigate the effect of chest pain center (CPC) on the treatment of patients with acute ST-segment elevation myocardial infarction. Methods A total of 685 patients with acute STEMI and direct percutaneous coronary intervention were enrolled in the first affiliated hospital of Xinjiang medical university for 48 months (between October 2013 and September 2017) before and after the establishment of the cpc. The acute STEMI patients were divided into 274 cases of green channel group in the hospital and 411 cases of CPC group. The total ischemic time, onset-first medical exposure (FMC) time, FMC-balloon dilatation (FMC2B) time, visit-balloon dilatation (D2B) time, informed consent time, ambulance or referral proximity to hospital, in-hospital mortality, post-PCI heart failure, CCU time, length of hospital stay, and total cost were compared. Results Compared with the green channel group in the hospital, the total ischemic time of CPC group [(322.6±112.8) min vs. (445.2±90.9) min, P<0.001], the onset to FMC time [(194.9±90.5) min vs. (270.4±112.9) min, P<0.001], FMC2B time [(118.7±68.4) min vs. (158.7±77.3) min, P<0.001], D2B [(73.2±25.4) min vs. (110.9±43.9) min, P<0.001], informed consent time [(10.9±5.2) min vs. (22.4±15.6) min, P<0.001] were significantly shortened. In-hospital mortality (1.2% vs. 3.6%, P=0.033), in-hospital heart failure after PCI (14.4% vs. 28.1%, P<0.001), CCU time [(2.6±0.8) d vs. (3.8±0.6) d, P<0.001], hospitalization time [(7.9±3.7) d vs. (9.5±3.8) d, P<0.001] were significantly shortened. Total cost [(4.6±2.1) ten thousand yuan vs. (5.1±2.0) ten thousand yuan, P=0.002] was significantly decreased. Conclusion The chest pain center can significantly improve the treatment effect of patients with acute STEMI and improve the short-term prognosis of patients.
Effects of doxorubicin on proliferation and apoptosis of gastric cancer BGC823 cells under different pH conditions and preliminary mechanism
XU Kun, ZHANG Teng-yue, HUANG Jin, LIU Miao, YANG Guo-hong, FAN Ping-sheng
2019, 17(5): 724-728. doi: 10.16766/j.cnki.issn.1674-4152.000776
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Objective To investigate the effects of doxorubicin on the proliferation and apoptosis of gastric cancer BGC823 cells under different pH conditions and the preliminary mechanism. Methods The effect of doxorubicin (ADM) cultured under different pH conditions on the proliferation of gastric cancer cell line BGC823 was detected by cell viability assay kit (CCK-8); Morphology of apoptotic cells were observed under fluorescence microscope; The apoptosis of BGC823 was assessed with Annexin V-PI; The expression of p-AKT, BCL-2 and NF-κB genes and proteins in gastric cancer cells were detected by qRT-PCR. Results ①The half-inhibitory concentration (IC50) of ADM on gastric cancer BGC823 cells was 5.277 μg/mL. Considering the toxicity of chemotherapy drugs and subsequent experiments, the ADM dose was selected to be 1/4 times the IC50 value of the cell line (1.319 μg/mL) for subsequent experiments; ②With the increase of pH, the inhibitory effect of ADM on the proliferation of BGC823 cells was enhanced. When the pH reached 7.4, the inhibition of proliferation was the most obvious. ③With the increase of pH, the apoptosis of BGC823 cells increased significantly with ADM. When the pH reached 7.4, the pro-apoptotic effect was the most obvious, and the pH concentration was further increased, and the ability to promote apoptosis was not obvious; ④Under different pH (pH 6.8-7.6) environment, the expression levels of BCL-2, NF-κB and p-AKT genes decreased significantly with the increase of pH after ADM treatment. Conclusion Increasing the extracellular pH can significantly increase the ability of ADM to inhibit cell proliferation and promote apoptosis in BGC823 cells. The anti-tumor effect of this pH-related ADM may be achieved by inhibiting the phosphorylation of AKT and preventing the expression of anti-apoptotic proteins such as NF-κB and Bcl-2.
Effect of Qianggu Paste on improving the quality of life of postmenopausal patients with osteopenia
LIANG Bo-cheng, LI Min, CHEN Wen-liang, ZHANG Jia-feng, MAO Yi-fan, LI Yan-hua, SHI Xiao-lin
2019, 17(5): 729-732. doi: 10.16766/j.cnki.issn.1674-4152.000777
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Objective To evaluate the effect of Qianggu Paste (QGP) on the quality of life of postmenopausal patients with osteopenia. Methods A total of 120 women with a mean age (57.67±2.86) years treated in the 2st affiliated hospital of zhejiang chinese medica university were enrolled in this study from October 2015 to December 2016. They were randomly divided into the QGP group (60 cases) and the alendronate (ALN) group (60 cases) and received treatment for 1 year. The BTMs such as PINP and β-CTX were measured. Lumbar and hip bone mineral density (BMD) were measured. The SF-36 was used to evaluate the improvement of patients' quality of life before treatment and after 1 year of treatment. The SF-36 consists of 36 detailed entries. Results A total of 108 patients completed the study, 56 in the QGP group and 52 in the ALN group. After 1 year of treatment, the serum levels of BTMs in the two groups were significantly lower than those before treatment, and there were significant differences in serum PINP, β-CTX levels and their mean percentages between the two groups after treatment (both P<0.001). There was no significant difference in hip and lumbar BMD before and after treatment and between the two groups (P>0.05), but between the two groups, the mean percentage change of lumbar BMD (P<0.001) and hip BMD (P=0.022) were statistically significant, and the QGP group was better than the ALN group; before the assessment of the quality of life, the SF-36 scores of the QGP group and the ALN group were (112.38±2.13) and (111.79±2.06), respectively. There was no significant difference between the two groups (P=0.147). There were significant differences after the treatment in the two groups (P<0.001). There was a statistically significant difference between the group of the QGP group and the ALN group after 1 year of treatment (P<0.001), and the quality of life score of the QGP group was significantly higher than that of the ALN group. Conclusion The treatment with QGP group could significantly reduce the serum BTMs of women with osteopenia and also could make the BMD better and significantly improve the quality of life of patients.
Characteristics of inflammatory markers in patients with pulmonary thromboembolism
LI Jie, ZHOU Yue, XU Qi-xia, PANG Ying-ying, LI Xiao-qing
2019, 17(5): 733-737. doi: 10.16766/j.cnki.issn.1674-4152.000778
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Objective To investigate the characteristics of inflammatory markers in patients with pulmonary thromboembolism (PTE) and its value in clinical diagnosis. Methods Blood samples from 83 patients diagnosed with PTE from the First Affiliated Hospital of Bengbu Medical College from January 2012 to June 2017 were collected for white blood cell (WBC), Neutrophil count (NE), and Lymphocyte count (LY), Neutrophil percentage (NE%), Neutrophil to Lymphocyte Ratio (NLR), Platet to Lymphocyte Ratio (PLR) , C-Reactive protein (CRP), Temperature (T), Fibrinogen (FIB) and other indicators of inflammation compared with 64 healthy physical indicators in the same period, and the changes of inflammation indexes in the two groups were retrospectively analyzed. Patients with pulmonary thromboembolism were divided according to age and whether they had pulmonary infection at the same time, and the correlation between NLR, PLR and traditional inflammation indicators and coagulation and fibrinolysis indicators were analyzed. Results Compared with the control group, the WBC, NE, NLR and PLR in the PTE group were significantly increased, and the LY was significantly decreased (P<0.05). There was no significant difference in T, WBC, NE, CRP, NLR and PLR between PTE combined with pulmonary infection group and PTE non-infection group (all P>0.05). There was no significant difference in T, WBC, NE, CRP, NLR and PLR between PTE combined with Older PTE group and non-aged PTE group(P> 0.05); NLR values of PTE patients were positively correlated with WBC, NE and CRP levels (r values were 0.531, 0.674 and 0.408, respectively, P values were <0.01); PLR values were positively correlated with CRP levels (r=0.472, P<0.01). Both NLR and PLR in the PTE group were positively correlated with FIB (r=0.231 and 0.405, respectively, all P<0.05). Conclusion WBC, NE, NLR and PLR are significantly elevated in PTE group. It was suggested that there may be a link between inflammatory response and the development of PTE. It was suggested that the inflammatory index like NLR and PLR could not accurately identify whether the patient was a simple PTE patient or a pulmonary infection at the same time. There is a correlation between the NLR, PLR and the CRP, FIB, which can be used to monitor inflammation and coagulation and fibrinolysis in patients with PTE.
Clinical features of thyroid disease patients at different age undergoing thyroid fine-needle aspiration cytology
WANG Wei, LU Gui-zhi, GAO Yan-ming, ZHANG Jing, GAO Ying, GUO Xiao-hui
2019, 17(5): 738-741. doi: 10.16766/j.cnki.issn.1674-4152.000779
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Objective Fine-needle aspiration cytology (FNAC) is a kind of direct and accurate test for thyroid disease. The aim of this paper is to analyze the clinical features of thyroid disease confirmed by FNAC in patients at different age, and improve the understanding and clinical diagnosis and treatment of thyroid diseases. Methods FNAC results and clinical data of 579 patients with thyroid disease in Endocrinology Department Peaking University First Hospital from August 2006 to January 2010 were analyzed retrospectively. The patients according to their ages were divided into teenage (age<20 years), youth (20-39 years), middle age (40-59 years), and seniors (age≥60 years). The clinical features were compared among the four groups. Results Female patients accounted for main part in all groups, the difference in sex was especially obvious in the youth group(the ratio of male to female was 1∶20.3), not obvious in the senior group (the ratio of male to female is 1∶3.8). There were more patients who had no symptoms in teenage and seniors when compared with the other two groups that were with more obvious clinical manifestations. The incidence of thyroid carcinoma in the teenage group was the highest (13.3%) among the all four groups. The most common pathological type was goiter in seniors group; however, the most common pathological type was Hashimoto thyroiditis in the other three groups, the difference was obviously. The histologic subtype analysis for the patients with Hashimoto thyroiditis showed that the ratio of eosinophil subtype of Hashimoto thyroiditis increased and lymphocyte subtype of Hashimoto thyroiditis decreased with the age of patients increasing. Conclusion There are some differences in thyroid disease distribution and clinical feature among the different age groups. The analysis of the clinical significance will improve the accurate diagnosis of thyroid disease, which is of certain clinical significance.
Experience of continence-preserving technique in transurethral plasmakinetic enucleation of the porstate
WANG De-sheng, YIN Lei, GUAN Chao
2019, 17(5): 742-744,764. doi: 10.16766/j.cnki.issn.1674-4152.000780
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Objective To assess the effect of continence-preserving technique in transurethral plasmakinetic enucleation of the porstate. Methods The clinical data of 35 patients who received modified transurethral plasmakinetic enucleation of prostate to protect urinary control function in Bengbu Second People's Hospital from March 2017 to May 2018 were retrospectively analyzed, and the technique of protecting urinary control function was applied during the operation. The incidence of urinary incontinence at 24 h after removal of the urinary catheter, 1 week and 1 month after operation were collected, and score of quality of life (QOL)， international prostate symptom score (IPSS) and post-void residual (PVR) before and 3 months after surgery were compared. Results The operation time was (90.6±45.2) min, the prostate tissue volume was (66.3±32.2) mL, the blood loss was (42.5±10.5) mL, the bladder irrigation time was (35.5±7.5) h, the catheter indwelling time was 7 days, and the postoperative hospital stay was (8.5±2.5) d. There were no cases of electrosurgical excision syndrome, no bladder perforation, no conversion to open surgery, and no blood transfusion. The average incidence of urinary incontinence in 35 patients at 24 h after removal of the urinary catheter, 1 week and 1 month after operation were 11.4%, 2.8% and 0.0% respectively, which were significantly lower than the average incidence of urinary incontinence (22.4%-43.1%) reported in literature. After 3 months of follow-up, urination was significantly improved compared with that before operation, the score of quality of life (QOL)， international prostate symptom score (IPSS) and post-void residual (PVR) also had significant difference between that before and after operation (all P＜0.05). Conclusion To treat benign prostatic hyperplasia patients with transurethral plasmakinetic enucleation of the porstate with improved continence-preserving technique showed better void in results and lower incidence of urinary incontinence after operation, which is worthy of clinical popularizing.
The study of Sulforaphane in regulation of Nrf2/ARE signaling pathway in protecting from acute lung injury in mice
CHEN Qian-yuan, HUANG Xiao-jun, REN Zhuo-chao, JIN Xing
2019, 17(5): 745-748,783. doi: 10.16766/j.cnki.issn.1674-4152.000781
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Objective To investigate whether sulforaphane (SF) has protective effects on acute lung injury (ALI) in mice through a mechanism of reducing inflammation and oxidative stress by up regulation of transcription factor NF-E2 related factor 2 (Nrf2). Methods Thirty-six healthy mice were divided into 4 groups: the control group (group C), the ALI group, the SF vehicle group (group vehicle) and the SF group. SF group was intraperitoneally injected with SF twice a day for three days, while vehicle group was injected with vehicle. On the fourth day, C group was intraperitoneally injected with normal saline, while the other groups were injected with equal volume of LPS to induce acute lung injury. The levels of IL-6 and TNF-α in serum was measured by ELISA method 6 hours after the injection of LPS or normal saline. The mice were then sacrificed, and the pathological changes in lung tissue were observed under light microscope to get the lung injury scores. The lung W/D weight ratio of the mice in each group was calculated, and the expression of Nrf2 nucleoprotein in lung tissue was measured. The activity of MPO, iNOS and SOD was measured by a kit. Results Compared with the C group, the lung injury score, the levels of IL-6, TNF-α, MPO, iNOS and Nrf2 protein was increased, while the ratio of W/D weight and the level of SOD was decreased significantly in ALI and vehicle group (all P<0.05). The increased Nrf2 expression reduced the lung injury score, the levels of IL-6, TNF-α, MPO and iNOS, while increased the level of SOD, the W/D weight ratio in SF group (all P<0.05), compared with the ALI group, while in vehicle group all had no significant difference compared with the ALI group (all P>0.05). Conclusion SF can up regulate the expression of Nrf2. The up regulation of Nrf2 can mitigate the severity of acute lung injury induced by LPS, reduce the concentration of proinflammatory mediators in serum and the oxidative stress index in the tissues. Our data suggested that the Nrf2 transcription factor exerted its protection from the damage in ALI model through a mechanism of reducing inflammation and oxidative stress.
Effects of probiotics on eradication of Helicobacter pylori infection and subsequent pathological change of gastric mucosa
YANG Yuan-sheng, PENG Wei-bin, RONG Hai-ying, CHEN Ken, ZHU Ya-li, XIE Wen-rui, YE Dong-wen, ZHANG Wei-bin
2019, 17(5): 749-751. doi: 10.16766/j.cnki.issn.1674-4152.000782
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Objective To investigate the effect of probiotics supplementation on Helicobacter pylori eradication therapy and the outcome of gastric mucosal injury in patient with chronic gastritis. Methods One hundred and four cases of chronic gastritis with Hp infection in our hospital were collected and randomly divided into control group (n=52) and experimental group (n=52). The patients in control group received Hp eradication therapy, while the patients in experiment group were gave Hp eradication and probiotics supplement therapy. The pathological changes of gastric mucosa (including inflammation, atrophy, intestinal metaplasia and dysplasia), Hp eradication rate, gastric mucosa appearance under gastroscopy and clinical symptom were observed and compared before and after intervention for 6 months. Results To some extent, eradication of Hp improved the clinical symptom and the pathological damage of patients in two groups, but the clinical efficacy and Hp eradication rate in the experiment group were better than those in the control group (90.38% vs. 78.85%, P=0.036; 90.38% vs. 75.00%, P=0.038), and the total scores of gastric mucosal pathological change in experimental group was lower than that in the control group after intervention (4.15±1.02 vs. 5.92±1.75, P<0.05), the pathological effect of gastric mucosal inflammation and intestinal metaplasia were significantly improved in experimental group than that in the control group (0.87±0.12 vs. 1.46±0.37, P<0.05; 1.27±0.45 vs. 1.81±0.58, P<0.05). Conclusion The eradication of Helicobacter pylori infection may be benefit for most patients with chronic gastritis. Supplementation of probiotics can effectively raise the clinical efficacy and Hp eradication rate, and lessen the pathological injury of gastric mucosa of patients.
Anti-tumor effect of avasimibe on human ovarian cancer SK-OV-3 cell lines
LIANG Wei-chen, MA Ling, LIU Jian, QIAO Xu-xu, LU Xiang
2019, 17(5): 752-755,808. doi: 10.16766/j.cnki.issn.1674-4152.000783
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Objective To observe the inhibitory effect of avasimibe on the growth, metastasis invasion and the effect of ACAT-1 expression on human ovarian cancer SK-OV-3 cell line, thus reflecting the effect of avasimibe on the anti-tumor effect of human ovarian cancer SK-OV-3 cell line. Methods Avasimibe (10 μM) was applied to human ovarian cancer SK-OV-3 cell line to establish an experimental model of SK-OV-3 cell line (ACAT-1 group); avasimibe cloth was screened by CCK8 experiment (10 μM) which was applied to SKOV3 ovarian cancer cell line for the best time (72 h), i.e., ACAT-1-72 group; the control group (i.e., parental ovarian cancer SK-OV-3 cell line) and ACAT-1 were determined by scratch test. The proliferative capacity and the ability of invasion and metastasis in 72 groups were the same; the expression of ACAT-1 in the control group and ACAT-1-72 group was determined by Western blot; the control group and ACAT-1-72 group were detected by immunofluorescence assay for the difference in expression of ACAT-1. Results Compared with the control group, the proliferation ability of tumor cells in the experimental group (ACAT-1 group) was weakened in a time-dependent manner (P<0.05), and the proliferative ability of the ACAT-1-72 group in the experimental group was the most obvious. As the best experimental group for the subsequent three sets of experiments; compared with the control group, the experimental group (ACAT-1-72 group) had weaker invasion and migration ability of tumor cells in the same period of time (P<0.05); compared with the control group, the expression of ACAT-1 protein in the experimental group (ACAT-1-72 group) was decreased (P<0.05). Conclusion Avasimibe can effectively promote anti-tumor effect on ovarian cancer SK-OV-3 cell lines, and its main mechanism is related to inhibiting the expression of ACAT-1 protein.
Comparison of thromboelastography and standard coagulation tests guided perioperative period transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass
XIE Yi-hong, DAI Bei-jun, SHEN She-liang
2019, 17(5): 756-760. doi: 10.16766/j.cnki.issn.1674-4152.000784
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Objective To compare the effect and safety of thromboelastography and standard coagulation tests guided perioperative period transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods Ninety-six patients undergoing cardiac surgery with cardiopulmonary bypass were randomly divided into group TEG (group T, n=48 ) and group SCT (group C, n=48). The perioperative period transfusion in Group T was guided by TEG, and in Group C by SCT. The volume of haemorrhage and the consumption of different blood components during perioperative period were recorded; the incidence of reoperation or die, and the intubation time and length of ICU stay and hospitalization time of both groups were also observed. Results There were no difference in the volume of haemorrhage, the consumption of fluid crystalloid and colloid, the consumption of autologous blood and allogeneic RBC between the two groups (all P>0.05). The consumption of allogeneic FFP and PLT were significant decreased in Group T as compared wht Group C(all P<0.05). There were no difference in the incidence of reoperation or die and the intubation time and length of ICU stay and hospitalization time between the two groups (all P>0.05). Conclusion Compared with SCT, TEG guided transfusion algorithm may reduce the consumption of allogeneic FFP and PLT, while not elevate the volume of haemorrhage and RBC input and not decrease the clinical efficacy.
Decline of blood pH may increase risk of death in H7N9 infected patients
LANG Guan-jing, SU Jun-wei, XU Ming-ming, HAO Shao-rui, LI Lan-juan
2019, 17(5): 761-764. doi: 10.16766/j.cnki.issn.1674-4152.000785
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Objective Epidemic of influenza A H7N9 occurs in mainland China during the annual winter and spring seasons. The increasing tendency of human infection and high mortality leads to a growing focus on the exploration of prognostic factors associating with risk of death in H7N9 human infection. Our research is to explore the prognostic factors associating with risk of death in H7N9 infection cases, to decrease the mortality of severe H7N9 patients and to increase their life qualities. Methods A total of 121 laboratory-confirmed patients were divided into survival and death groups. Clinical data of enrolled patients were compared between two groups. Logistics regressions were conducted to explore the association of death risk and potential prognostic factors. Results Lower level of GFR, PCT, low value of calcium and low value of blood pH were found in death group (all P<0.05). However, higher level of age, CRP, BNP, peak and low value of sodium, chlorine and low value of potassium were also found in death group (all P<0.05). Larger proportion of death cased were given intubation, ECMO and CRRT (all P<0.05). Logistics regression further validated low value of blood pH was associated with death risk (P<0.001). When 0.1 unit of the minimal value of blood pH decrease, the risk of death increased 0.304 folds. Conclusion Decline of blood pH is an independent risk factor associating with death in H7N9 infection, indicating that monitoring blood pH and keeping acid-base balance in H7N9 infected patients maybe a key therapeutic strategy in clinic.
Serum neurofilament light chain level and its clinical correlation in patients with optic neuromyelitis spectrum disease
LI Yu-yu, SUN Hui, XU Li, QIAN Wei-dong
2019, 17(5): 765-767. doi: 10.16766/j.cnki.issn.1674-4152.000786
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Objective To investigate the serum neurofilament light chain (sNFL) levels in patients with neuromyelitis optica spectrum disorder (NMOSD), and to analyze the correlation between the sNFL levels and severity of disease. Methods Forty-two patients with acute phase of NMOSD hospitalized in the first affiliated hospital of Bengbu medical college were enrolled as the NMOSD group from July 2015 to December 2018, and 42 healthy subjects as the normal control group during the same period. Extended disability status scale (EDSS) was used to evaluate the severity of disease with the NMOSD group, and the levels of sNFL were detected with electrochemiluminescence immunoassay (ECLIA). The sNFL levels of NMOSD group and control group, and the sNFL levels of different subtypes of NMOSD were compared. Simple linear regression was used to analyze the correlation between the sNFL levels and the EDSS scores. Results The sNFL level [(81.69±35.49) pg/mL] in the NMOSD group was significantly higher than that in the normal control group [(16.00±5.61) pg/mL], and the difference was statistically significant (t'=11.848, P<0.001). The sNFL level [109.86±31.45)pg/mL] in the AQP4-Ab (+) group was significantly higher than that in the AQP4-Ab(-) group [(67.61±28.62)pg/mL], and the difference was statistically significant (t=4.365, P<0.001). The sNFL level of NMOSD group was positively correlated with the EDSS score (t=9.108, P<0.001). Conclusion The level of sNFL increased in the acute phase of NMOSD is positively correlated with the severity of the disease.
Cantharidin regulates the apoptosis, migration and invasion of cervical cancer cells via inhibiting MAPK signal pathway
YU Ru-fen, CAI Li-mei, WU Xue-qing
2019, 17(5): 768-772. doi: 10.16766/j.cnki.issn.1674-4152.000787
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Objective Cervical cancer is the fourth most common cancer in women (behind breast, lung and bowel). Cervical cancer threatens seriously the health of women and the quality of life. China is one of the high-risk areas of cervical cancer. Cantharidin, in the form of the dried body of the Chinese blister beetles Mylabris phalerata or M. cichorii, displays certain antitumor activity and induces apoptosis in many types of tumor cells. This study aims to explore the effect of cantharidin on the apoptosis, migration and invasion in Hela cervical cancer cells. Methods Cell viability was detected by CCK-8. Flow cytometry was used to analyze the apoptosis of Hela cells. Migration was tested by wound healing assay. Transwell was performed to measured invasion. The expression of P38, P-P38, P-MAPKAPK and P-Hsp27 was detected by western blot. Results The low concentration (<20 μM) of cantharidin has no obvious effect on cell viability of Hela cells, and the viability of Hela cells was above 80% after the treatment with low concentration (< 20 μM) of cantharidin. The high concentration (>20 μM) of cantharidin reduced the viability of Hela cells and the viability of Hela cells was under 80% after the treatment with high concentration (>20 μM) of cantharidin. Compared with the control group, the apoptosis in 5 μM cantharidin groups were obviously increased (P<0.05). Apoptosis in 10 μM cantharidin groups were remarkably increased (all P<0.01). Apoptosis in 20 μM cantharidin groups were significantly increased (P<0.001). After the administration with cantharidin, the migration and invasion of Hela cells in cantharidin (5, 10 μM) groups were obviously decreased (P<0.05) and the migration and invasion of Hela cells in 20 μM cantharidin group were remarkably decreased (P<0.01). Compared with the control group, the rate of P-P38/P38 and expression of P-MAPKAPK and P-Hsp27 in 5 μM cantharidin group were obviously alleviated (all P<0.05). The rate of P-P38/P38 and expression of P-MAPKAPK and P-Hsp27 in 10 μM cantharidin group were remarkably alleviated (all P<0.01). The rate of P-P38/P38 and expression of P-MAPKAPK and P-Hsp27 in 20 μM cantharidin group were significantly alleviated (all P<0.001). Conclusion Cantharidin can elevate the apoptosis and reduces migration and invasion of Hela cells by suppressing MAPK signal pathway.
Risk of catheter-related deep vein thrombosis in non-cancer hospitalized patients with PICC
XU Yi-cheng, WANG Gui-hua, WANG Pei-fu, LI Shuo-dan, GAO Jie, MIAO Feng-ru, DU Ji-chen
2019, 17(5): 773-775. doi: 10.16766/j.cnki.issn.1674-4152.000788
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Objective The recent studies focused mostly on the risk of peripherally inserted central catheters -related deep vein thrombosis (PICC-DVT) in cancer patients. However, with the development of PICC, it is thought to be necessary to determine the risk of PICC-DVT in hospitalized non-cancer patients. The aim of this paper is to answer this question. Methods The clinical and lab data of non-cancer inpatient undergoing PICC in our hospital between January 2009 and December 2018 were reviewed. The statistical analysis was conducted on the catheterization environment, catheter outcomes and patient outcomes. The risk of PICC-DVT in non-cancer hospitalized patients was explored. A systematic literature study on the risk of PICC-DVT in Chinese inpatient was carried out by searching Chinese biomedical literature database, CNKI, Chinese medical journal database, Wang Fang Database, PubMed, EMBASE and so on. Results There were 341 PICCs were placed, among them, 199 PICC were inserted in general wards, 142 PICC were inserted in neurological intensive care unit. A total of 262 had urinary catheters, and 90 had received mechanical ventilation. Of the patients with PICCs, 17 patients developed a symptomatic PICC-DVT with an incidence of 4.9%. Thirteen articles were included and all were written in Chinese. Systematic review found that the domestic studies evaluating the risk of symptomatic PRDVT in non-cancer patients had large diversity (0.3% to 28.5%). The risk of PICC-DVT in critically patients and elderly patients was higher than that in the mild patients and young patients. Conclusion The risk of symptomatic PICC-DVT in non-cancer patients seems not higher than cancer patients. Future researches were needed to validate this conclusion.
Clinical significance of urine NGAL and MMP-9 in the patients of ulcerative colitis
LIU Hai-yan, CHEN Jun-xian, XU Ping-zhen
2019, 17(5): 776-778. doi: 10.16766/j.cnki.issn.1674-4152.000789
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Objective To observe the difference of urinary levels of neutrophil gelatinase-associated apolipoprotein (NGAL) and matrix metalloproteinase-9 (MMP-9) in patients with ulcerative colitis and healthy volunteers. To explore the clinical significance of detection of NGAL and MMP-9 in urine of patients with ulcerative colitis. Methods The levels of NGAL and MMP-9 in urine of patients with ulcerative colitis were detected by double antibody sandwich enzyme linked immunosorbent assay (ELISA). The changes of urinary NGAL and MMP-9 levels in active and remission patients were observed and compared with those in healthy controls. Results The levels of urinary NGAL in the patients of active ulcerative colitis were significantly higher than those in healthy controls [(37.71±12.69)ng/mL vs. (19.27±5.34)ng/mL, P<0.01]. The difference was statistically significant. The levels of urinary MMP-9 in the patients of active ulcerative colitis were significantly higher than those in healthy controls [(5.14±1.25)ng/mL vs. (1.06±0.32)ng/mL, P<0.01]. The difference was statistically significant. After treatments, the levels of urinary NGAL in patients with ulcerative colitis was significantly lower than those in active phase [(36.34±11.83)ng/mL vs. (25.13±5.76)ng/mL, P<0.05]. The difference was statistically significant.After treatments, the levels of urinary MMP-9 in patients with ulcerative colitis was significantly lower than those in active phase [(5.38±1.62)ng/mL vs. (3.09±0.67)ng/mL, P<0.05]. The difference was statistically significant. Conclusion The levels of urinary NGAL and MMP-9 in patients with active ulcerative colitis are significantly higher than those of control group. After treatments, the levels of urinary NGAL and MMP-9 in patients with ulcerative colitis are significantly lower than those in active phase. The detection of urinary NGAL and MMP-9 is convenient, non-invasive and no pain to the patient. It can be used as one of the monitoring methods of the ulcerative colitis.
Role of lncRNA GIHCG in the development of primary liver cancer by regulating miR-429
CHEN En-li, LOU Jun-xiao, WANG Zhen, HUANG Ying, HAO Jing-duo
2019, 17(5): 779-783. doi: 10.16766/j.cnki.issn.1674-4152.000790
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Objective To investigate the role of lncRNA GIHCG in the development of primary liver cancer by regulating miR-429. Methods The hepatocellular carcinoma and adjacent tissues of 60 cases of liver cancer in our hospital were prepared from January 2017 to December 2017. HepG2 cells were randomly divided into the blank control group, negative control group and lncRNA GIHCG-siRNA group with random number method. The levels of lncRNA GIHCG mRNA and miR-429 in the tissues and cells were determined by RT-PCR. The proliferations of cells were determined by WST-1. The invasion and migration ability of cells were determined by Transwell method. Results In the hepatocarcinoma tissues, the level of lncRNA GIHCG mRNA was higher than that in the adjacent tissues (P<0.05), however, the level of miR-429 was lower than that in the adjacent tissues (P<0.05). The level of lncRNA GIHCG mRNA of the liver cancer cells were higher than that of the normal hepatocytes (P<0.05), however, the level of miR-429 of the liver cancer cells were lower than that of the normal hepatocytes (P<0.05). There were negative correlation between lncRNA GIHCG mRNA and miR-429 in the liver cancer tissues and liver cancer cells (P<0.05). On D3 and D5, the OD value of cells in the GIHCG-siRNA group were lower than those in the blank control group and the negative control group (all P<0.05). When compared with the blank control group and the negative control group, the lncRNA GIHCG mRNA level, cell invasion and migration ability of the lncRNA GIHCG-siRNA group were decreased (all P<0.05), the miR-429 level was increased (all P<0.05). Conclusion The level of lncRNA GIHCG is elevated in primary liver cancer tissues, and lncRNA GIHCG may promote hepatoma cell proliferation and invasion and migration through regulating the expression of miR-429.
Clinical value of D-dimer and cystatin C in predicting restenosis after cerebrovascular intervention
SUN Meng-fang, JIN Meng-hao, WANG Feng, XIA Qing-chun
2019, 17(5): 784-786,812. doi: 10.16766/j.cnki.issn.1674-4152.000791
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Objective To investigate the clinical value of D-dimer (D-D) and cystatin C (CysC) in predicting restenosis after cerebrovascular intervention. Methods Total 118 patients with ischemic cerebrovascular disease in our hospital from April 2015 to September 2017 were treated with endovascular stent implantation. Venous blood samples were collected on the day after admission and 3 days after surgery. Serum DD and CysC levels were measured, restenosis conditions of all patients within 1 year after operation were counted. They were divided into restenosis group and non-stenosis group. The predictive ability of postoperative restenosis with serum DD and CysC was analyzed. Results Of the 118 patients,there were 16 cases of restenosis within 1 year after operation, the restenosis rate was 13.56%. There were no significant differences in preoperative basic data and serum DD and CysC levels between the restenosis group and the non-stenosis group (all P>0.05). There was no significant change in serum DD and CysC levels in the non-stenosis group (all P>0.05), serum DD and CysC levels were significantly increased in the stenosis group (all P<0.05), serum DD and CysC levels were significantly higher than those in the non-stenosis group at 3 days after surgery (all P<0.05). Multivariate logistic regression analysis showed that high D-D and CysC levels were independent risk factors for postoperative restenosis (all P<0.05). The areas under the working characteristic curve (ROC) of predicting postoperative restenosis by serum DD, CysC and the combination of the two were 0.786, 0.825 and 0.907, respectively. The optimal cut-off value of serum DD and CysC were 356.22 μg/L, 1.41 mg/L, the sensitivity and specificity of predicting postoperative restenosis by the combination of DD and CysC were 87.50% and 93.14%, respectively. Conclusion High DD and CysC levels after cerebrovascular intervention are risk factors for restenosis. It has a high predictive effect on postoperative restenosis. Close monitoring of serum DD and CysC levels can help to assess the risk of restenosis and timely develop individualized prevention and treatment countermeasures.
Clinical classification and management of angle-closure glaucoma
LIU Qing-lin, WU Bo-le, YE Xin-ming, GAO He-xiang, SUN Long-fei
2019, 17(5): 787-789,880. doi: 10.16766/j.cnki.issn.1674-4152.000792
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Objective To study the clinical classification diagnosis of angle-closure glaucoma and its reference value for clinical treatment. Methods A total of 120 patients with angle-closure glaucoma admitted to our hospital from May 2016 to May 2018 were studied. According to the disease status, they were divided into acute group (pre-clinical A1 group and A2 remission period) and chronic group (early B1 disease, B2 progress period), and selected 60 healthy people who were admitted to the hospital for the same period as the healthy control group, the eyes of the enrolled subjects were examined, and the intraocular pressure of the patients was measured. Because the difference in eye pressure of glaucoma patients between day and night was relatively large，the time points were selected to measure at 5 o'clock 、14 o'clock and 22 o'clock respectively. The anterior segment of the patient's eye was examined using a slit lamp. The patient's field of vision was examined using a Humphrey field of view analyzer. The patient's refractive, fundus, and UBM angle were directly examined. By comparing ACW (anterior chamber width), AOD (angle opening distance), TISA (trabecular iris space area), CLR (crystalline lens rise), and IT (iris thickness) and other data, analysis of clinical scores Type and its clinical reference value. Results AOD, TISA and ACW in both acute and chronic groups were lower than those in the control group (all P<0.05), and CLR and IT in both acute and chronic groups were higher than those in the control group (all P<0.05). AOD and TISA were lower in A2 group than A1 group (all P<0.05), CLR and IT were higher in A2 group than A1 group (all P<0.05), AOD and TISA were lower in B2 group than B1 group (all P<0.05), CLR and IT were higher in B2 group than B1 group (P<0.05), AOD and TISA were higher in B2 group than A2 group (all P<0.05), and CLR and IT were lower in B2 group than A2 group (all P<0.05). Conclusion Through the analysis of different types of glaucoma eyes front section parameters, found eyes front section parameters have differences between acute stage glaucoma and chronic glaucoma， and acute stage glaucoma and chronic glaucoma eyes section parameter change is more obvious, is one of the most severe episodes of acute glaucoma, effective classification diagnosis more conducive to the choice of treatment and operation.
Analysis of clinical characteristics and long-term recurrence of different types of parotid tumors
JIANG Xiao-yong, YANG Zhi-hui, CHEN Xi-xi, YANG You-ping
2019, 17(5): 790-792,796. doi: 10.16766/j.cnki.issn.1674-4152.000793
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Objective To analyze the clinical characteristics and long-term recurrence of different types of parotid tumors. Methods A retrospective analysis of 157 patients with primary parotid tumors treated in our hospital from March 2011 to December 2015 was performed. All patients were taken tumor resection, intraoperative frozen tissue biopsy sent to pathological examination. The clinical data of different types of patients were compared, the incidence of postoperative complications and postoperative recurrence, and Cox regression model was used to analyze the risk factors of relapse. Results A total of 142 benign tumors were detected, of which, pleomorphic adenoma (PA) and Warthin's tumor (WT) were relatively high (63.06% and 24.20%). There were 15 malignant tumors were detected. Malignant and WT patients were both significantly higher than patients with PA in age (all P<0.05). The proportion of smoking, the index of smoking and the diameter of tumor were significantly higher than those in patients with PA and malignant tumor (all P<0.05). The incidence of postoperative complications in patients with malignant tumors and WT was higher than patients with PA. During 28 to 60 months of follow-up, 10 patients with WT and 11 patients with malignant tumor developed recurrence without relapse in patients with PA, and the risk of recurrence in patients with WT was significantly lower than that in patients with malignancy [HR=0.132, 95% CI (0.041, 0.425), P<0.001]. Cox regression showed that postoperative smoking was an independent risk factor for recurrence in patients with WT [HR=2.794, 95% CI (1.304, 9.625), P<0.001]. Conclusion PA and WT are the most common types of primary parotid tumors, of which, the age at onset, the male ratio and the smoking index of Warthin's tumor are obviously higher, and the patients with WT and malignancy have a higher incidence of postoperative complications, postoperative smoking is an independent risk factor for recurrence in patients with WT.
Effect of Duhuo Jisheng decotion assisted treatment for rheumatoid arthritis
WANG Guo-fen, LI Xian, YING Wei-hong, TONG Xiao-jun, ZHU Xiang-shun, ZHAN Ya-ping
2019, 17(5): 793-796. doi: 10.16766/j.cnki.issn.1674-4152.000794
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Objective To evaluate the clinical effect of Duhuo Jisheng decotion assisted treatment for rheumatoid arthritis(RA) on effect of serum matrix metalloproteinase-2(MMP-2), inflammatory cytokines and coagulation function. Methods A total of 86 consecutives as RA active stage from June 2017 to June 2018 were enrolled and divided randomly into control and observation groups, each of 43 cases. The control group received oral Tripterygium Glycosides 20 mg/d, tid; the observation group adopted Duhuo Jisheng decotion at the mean time, the course was one month. Then, the DAS28 score, serum MMP-2 level, inflammatory cytokines CRP and IL-6, coagulation function including D-dimer(D-D), fibrinogen(FBG), prothrombin time(PT)and partial thromboplastin time (APTT)and clinical effect were compared. Results The DAS28 score, levels of MMP-2, CRP and IL-6 in the two groups after treatment were lower than before, and they in observation group were significantly less than control group(all P＜0.05). The same to D-D, FBG, PT and APTT values, too(all P＜0.05). What's more, the clinical total efficacy rate in observation group was significantly higher(P＜0.05). There were no serious adverse reactions in both groups and the drug was not interrupted. Conclusion It can furtherly improve serum MMP-2, inflammatory cytokines and coagulation function in RA active stage with Duhuo Jisheng decotion assisted treatment in order to improve clinical effect.
Effects of vitamin D combined with siglitatin on urinary protein level, bone mineral density and bone metabolism in patients with type 2 diabetic nephropathy
YING Yi-ying, CHEN Jie, BAO Bei-yan
2019, 17(5): 797-800,840. doi: 10.16766/j.cnki.issn.1674-4152.000795
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Objective To explore the effect of vitamin D combined with Siglitatin on urinary protein level, bone mineral density and bone metabolism in patients with type 2 diabetic nephropathy. Methods From January 2016 to January 2018, 114 patients with type 2 diabetic nephropathy in our hospital were divided into two groups according to the random number table method, 56 cases in the control group and 58 cases in the experimental group. All patients were given routine treatment such as hypoglycemia. On this basis, the control group was given vitamin D treatment, and the experimental group was given vitamin D combined with Siglitatin treatment. The urinary albumin excretion rate (UAER), urinary beta 2-microglobulin (beta 2-MG), urinary microalbumin (mA1b), bone mineral density (L2-L4, femoral neck, Ward triangle, femoral trochanter, hip joint), serum calcium, phosphorus, 25-hydroxyvitamin D (25-OH-D3), parathyroid hormone (PTH), bone gla protein (BGP), procollagen type I N propeptide (PINP) and C-terminal telopeptides of type I collagen (β-CTX) were compared between the two groups after treatment. Results After treatment, UAER, urinary beta 2-MG and 24-hour urinary albumin levels in the experimental group were lower than those in the control group (P<0.05). After treatment, the bone mineral density of each detection site in the experimental group was higher than that in the control group (P<0.05). The serum calcium of the experimental group were higher than those of the control group , and the serum phosphorus of the experimental group were lower than those of the control group (P<0.05). After treatment, the levels of 25-OH-D3 and PINP in the experimental group were significantly higher than those in the control group (P<0.05), and PTH, BGP and beta-CTX in the experimental group were significantly lower than those in the control group (P<0.05). The total incidence of adverse reactions in the control group and the experimental group were 8.93% and 12.07%, respectively, with no significant difference (P=0.585). Conclusion In the treatment of type 2 diabetic nephropathy, vitamin D combined with Siglitatin can effectively reduce urinary protein, increase bone mineral density and improve bone metabolism in patients with better safety.
The application of resting state functional magnetic resonance in neonatal acute bilirubin encephalopathy
LI Xiao-yan, ZHU Ya-fei, WU Guang-sheng, XIAO Yun-bin, ZANG Yu-feng, GENG Qiu
2019, 17(5): 801-804. doi: 10.16766/j.cnki.issn.1674-4152.000796
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Objective Acute bilirubin encephalopathy (ABE) is an important factor affecting the quality of life of newborns. Early symptoms are not significant, so clinical diagnosis is difficult. This paper discusses the application value of resting-state functional magnetic resonance imaging in neonatal bilirubin encephalopathy. Methods Fifteen children with acute bilirubin encephalopathy and 14 full-term normal infants were selected from the Affiliated Hospital of Hangzhou Normal University from December 2015 to December 2017. Two groups of newborns were examined by resting MR imaging. The images were processed by MATLAB, SPM and DPARSF software. At last, the changes of brain function were compared by low frequency amplitude method, differential brain regions of ALFF values were obtained in two groups. Results Compared with normal full-term infants, acute bilirubin encephalopathy children showed abnormal increase in peak intensity of low-frequency amplitude in temporal lobe, anterior central gyrus and frontal pole (all P<0.05), and significant difference in peak intensity of ALFF in occipital lobe, parietal lobe, left cerebellum and right cerebellum, which were 6.85, 5.02 and 3.34 respectively, compared with normal control group. The peak value of ALFF intensity decreased (all P<0.05), and the difference was statistically significant. Conclusion Compared with normal newborns, bilirubin encephalopathy children have abnormal brain function changes in temporal lobe, anterior central gyrus, frontal pole, occipital lobe, parietal lobe and cerebellum, which may be related to the location of clinical phenotypes in the brain of bilirubin encephalopathy children. Resting-state functional magnetic resonance imaging has important value in early diagnosis of neonatal bilirubin encephalopathy.
A study on predicting indicators for complicating pregnancy in the pregnancy women with early-onset pre-eclampsia
YU Xiao-hong, ZHAO Jing, ZHANG Cui-ling
2019, 17(5): 805-808. doi: 10.16766/j.cnki.issn.1674-4152.000797
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Objective To investigate the significances of Serum cystatin C(CYS-C), Uric Acid (UA), Creatinine (CREA) and Urea Nitrogen (BUN) and the change and correlation of the numerical for complicating pregnancy with early-onset preeclampsia. Methods Total of 64 cases of mild early-onset with preeclampsia (mild group), 55 cases of severe early-onset with preeclampsia (severe group) and 55 cases of healthy pregnant women randomly selected in the same period (28-34 weeks, normal group) admitted in the Zhangqiu District People's Hospital Affiliated to Jining Medical University from January 2015 to December 2016 was enrolled for the study. Results There was no statistical significant difference in age and gestational age (P>0.05). Serum Cystatin C(CYS-C), Uric Acid (UA), Creatinine (CREA) and Urea Nitrogen (BUN) in case group were significantly higher than the control group, differences were all statistical significant (P<0.01). ROC curve indicated that the best critical value of predictors in Early- onset Pre- eclampsia for complicating pregnancy were Serum CYS-C≥1.29 mg/L, UA≥420.00 μmol/L, CREA≥59.10 μmol/L, BUN≥5.94 mmol/L; their sensitivity were 90.1%, 73.4%, 68.3% and 42.3%, respectively; specificity were 99.8%, 99.8%, 88.2%, and 77.8%, respectively; Youden index maximum were 89.9%, 73.2%, 56.5%, and 20.1%, respectively; OR value were 16.50, 1.05, 1.25 and 18.67, respectivel; r value were 0.841, 0.741, 0.751, 0.413, 0.118, 0.345 and 0.112, respectively (all P<0.01). Conclusion Serum CYS-C, UA, CREA and BUN may reflect the progression of the disorder of severity in Early-onset Pre-eclampsia. Serum CYS-C, UA, CREA have best diagnostic efficiency. Serum BUN has poor diagnostic efficiency. There is a positive correlation between them. It is the risk factor respectively and combined the predictors have a higher predictive value. In Sever Early-onset Pre-eclampsia, the number CYS-C≥1.29 mg/L, UA≥420.00 μmol/L, CREA≥59.10 μmol/L, BUN≥5.94 mmol/L, can serve as good indicators for complicating pregnancy. Complicating pregnancy at the right time by clinical comprehensive assessment is necessary.
Analysis of the application value combined detection of FBG, HbA1c, TC and TG in diagnosis of GDM in early pregnancy
LOU Gong-xian, LOU Shi-xian, CHENG Miao-yuan, SU Ai-fang, LI Yi-pei, XU Ling-yan
2019, 17(5): 809-812. doi: 10.16766/j.cnki.issn.1674-4152.000798
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Objective To explore the application value combined detection of fasting blood glucose (FBG), hemoglobin A1c (HbA1c), total cholesterol (TC) and triglyceride (TG) in diagnosis of gestational diabetes mellitus (GDM) in early pregnancy. Methods A total of 117 GDM high-risk pregnant women were selected in our hospital from July 2016 to August 2017 in the obstetrics department, and they were divided into GDM group and normal group according to GDM diagnostic criteria, the levels of glucose and lipid metabolism were compared between the two groups, at the same time, the levels of glucose and lipid metabolism were detected in early pregnancy (within 12 weeks of pregnancy), and compared with the diagnosis results of GDM, the diagnostic value of each glycolipid metabolism index alone and the combined detection in GDM were compared. Results According to the GDM diagnostic criteria, the results showed that of the 117 pregnant women, 62 were pregnant with GDM and 55 were normal; The levels of FBG, HbA1c, TC and TG were significantly higher in the GDM group than in the control group (all P<0.05). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of HbA1c detection were the highest (88.71, 72.73, 81.20, 78.57, 80.85 and 0.619, respectively). The AUC values of FBG, HbA1c, TC and TG were 0.868, 0.885, 0.681 and 0.688, respectively, and the AUC value of the joint detection was 0.958, the AUC values of the joint detection were compared with the AUC values of FBG, HbA1c, TC and TG, the differences were statistically significant (P<0.05). Conclusion In the early stage of pregnancy, the joint detection of glucose and lipid metabolism in GDM has high diagnostic value, which can provide a reference for the diagnosis and treatment of GDM in the early stage of pregnancy.
SWOT analysis on community health service center with the mode of hospital management-People's Hospital of Longhua in Shenzhen as an example
LUO Xin-le, SU Zhen-zhen, XIANG Li-qiang, QIN Liang-yu, WANG Pei-xi, ZHANG Yu-cai
2019, 17(5): 813-816. doi: 10.16766/j.cnki.issn.1674-4152.000799
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Shenzhen has been the first city in Guangdong province to explore the mode of hospital-managed community health service, which is different from other grassroots medical service units in China. Since the establishment of the first community health service center in 1996, Shenzhen has always adopted the operation system of " hospital management ". Performance distribution is a reform mechanism to ensure the high speed operation of community health service centers and an important measure to improve the enthusiasm of medical staff. With the development of community health service, the hospital-managed community health service has been optimized and improved, but the performance distribution of community health service center still has disadvantages. It is more important for the community health service center to solve the problems it faces in the process of development to improve the service quality and level of the community health service center. Therefore, it is extremely urgent to establish a suitable and efficient performance distribution system for Shenzhen community health service centers. The author takes 27 community health service centers of Shenzhen Longhua District People's Hospital as an example, analyzes the advantages and disadvantages of the performance distribution system of community health service centers, considers the opportunities and threats in the external environment, and identifies the main problems in the establishment and development of the performance distribution system. SWOT analysis method is used to analyze the problems in detail, and puts forward the problems and countermeasures, which provides reference for the methodological research of performance distribution and promotes the establishment of a more fair and effective performance distribution system.
Canonical correlation analysis of the personality trait and psychological health status of medical students
CHEN Zhen-yu, JI Zhong-chun, ZHENG Jie-hua, HUANG Ben-zhao, LIN Ting-ting, ZENG Yang, XIAO Ying-jie
2019, 17(5): 817-820,872. doi: 10.16766/j.cnki.issn.1674-4152.000800
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Objective Medical students, as the predecessors of doctors, not only require superb professional skills, but also demand good psychological qualities. To investigate the personality trait and psychological health status of nowadays medical students and to analyze their characteristic and investigate their relationships to develop mental health education and further research and provide the basis for designing psychological intervention plans. Methods Between August and November 2017, students of grade 2014 to grade 2017 in a medical college of a university in East Guangdong were involved as the research subject. Symptom Check List 90 (SCL-90) was used to evaluate their psychological health status and Big Five Inventory Scale (BFIS) was applied to investigate their personality trait. All these questionnaires were anonymous. Excel 2016 and SPSS 20.0 were used in data entry and analyzing. Canonical correlation analysis was used to analyze the association between personality trait and psychological health status in nowadays medical students. Results Compared to the national university student norm, the score of SCL-90 shows that there is significant difference except for obsessive-compulsive, depression and psychoticism (all P<0.05). In canonical correlation analysis, the correlation coefficient of canonical variables U1, V1 is 0.675 (P<0.001) and of canonical variables U2, V2 is 0.485 (P<0.001). The result of canonical correlation analysis shows that Neuroticism and Agreeableness are the main features to reflect the medical students' personality trait while Hostility and Paranoid are the main features to reflect the medical students' psychological symptoms. The research also points out that Agreeableness will improve psychological symptoms and Neuroticism will make it worse. Conclusion To guide the formation and development of positive personality traits like agreeableness is very helpful for improving medical students' psychological health level and promoting their comprehensive development.
The value of different ultrasound parameters in evaluation of endometrial receptivity in IVF-ET patients
CHEN Shu-xia, YAN Cao-xin
2019, 17(5): 821-824. doi: 10.16766/j.cnki.issn.1674-4152.000801
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Objective To investigate the value of color ultrasound Doppler (CDFI) and contrast-enhanced ultrasound (CEUS) parameters in assessing endometrial receptivity in patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Methods Eighty-six patients with IVF-ET in our hospital from June 2016 to June 2018 were analyzed. According to whether they reached clinical pregnancy, they were divided into pregnancy group (32 cases) and unsuccessful group (54 cases). The pulsatility index (PI) and resistance index (RI) of the endometrial CDFI and the CEUS index between the rise time (RT), peak time (TTP), peak intensity (PI), and area under the curve (AUC) were compared between the two groups. Differences were analyzed to investigate the correlation between different ultrasound parameters and endometrial micro-vessel density (MVD), and to compare the predictive power of different ultrasound parameters for pregnancy success. Results The CDFI-PI and RI and CEUS-RT and TTP in the endometrium of the pregnant group were significantly lower than those in the unsuccessful group, while CEUS-PI was significantly higher than the unsuccessful group (all P<0.05). There was no statistical difference between the groups of CEUS-AUC (P>0.05). The MVD of the pregnant group was significantly higher than that of the unsuccessful group (P<0.05). Correlation analysis showed that PI and RI of CDFI, CEUS RT and TTP were negatively correlated with endometrial MVD and positively correlated with CEUS PI. In predicting pregnancy outcomes, CEUS-PI has the highest area under the curve, followed by CDFI-PI and RT, and lower TTP and RI. The optimal cut-off value of CEUS-PI for predicting clinical pregnancy is ≥4.75 dB, with a predictive sensitivity of 68.75% and a specificity of 92.59%. Conclusion The peak intensity of endometrial contrast-enhanced ultrasound is positively correlated with the micro-vessel density. The use of CEUS-PI to predict IVF-ET pregnancy outcome has a high diagnostic specificity.
Advances in Application of Glucocorticoids in Perioperative Degenerative Cervical Myelopathy
WANG Ming-qi, CHEN Xu, ZHOU Cheng-pei, GAO Hao-ran, QIAN Ji-xian
2019, 17(5): 825-828,833. doi: 10.16766/j.cnki.issn.1674-4152.000802
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Degenerative cervical myelopathy is the most common cause of spinal cord dysfunction in adults. The efficacy of decompression surgery has been demonstrated in both anterior and posterior approaches. While paying attention to the curative effect of surgery, its complications are also getting more and more concern. Whether perioperative glucocorticoid use can reduce the incidence of decompression complications in degenerative cervical myelopathy has been a controversial topic. In the field of basic research, neurological decline after decompression has been confirmed to be related to ischemia-reperfusion injury and immune system activation. In addition, methylprednisolone reduces perioperative neurological complications following decompressive surgery for degenerative cervical myelopathy by protecting neurons from inflammation, without compromising the composition of circulating immune cells. However, in clinical studies, there is still a lack of high-level evidence. Experts in China jointly completed the expert consensus on perioperative application of adrenal glucocorticoids (2017 version), which provides norms and guidance for Chinese physicians in the application of perioperative glucocorticoids. However, this consensus mainly aims at general surgery, and the perioperative application of degenerative cervical myelopathy is not detailed. In this review, the author summarized the advances of glucocorticoids in dysphagia, auxiliary analgesia and C5 nerve root palsy, in perioperative period of Degenerative cervical myelopathy, combined with relevant literature.
Pathogenesis and risk factors of cardiac rupture after acute myocardial infarction
GUO Guo-feng, SONG Dai-fu, GAO Jia-xin, ZHANG Xue-huang, CHEN Xi-ming
2019, 17(5): 829-833. doi: 10.16766/j.cnki.issn.1674-4152.000803
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Acute coronary syndrome (ACS) is an acute manifestation of ischemic heart disease (IHD), with a high risk of death. Acute myocardial infarction(AMI) is the main type of acute myocardial infarction. Cardiac rupture (CR) is a serious complication of AMI, which is difficult to predict in time and has no effective treatment. The mortality rate was very high. In this review, we summarized the prevention and treatment of CR in terms of its mechanism, clinical manifestations, relevant detection methods, risk factors and so on. Based on baseline data, biochemical indicators, clinical characteristics, blood revascularization, past history, and combined with the risk prediction model put forward by existing research, we put forward the use of age, sex, heart rate and myocardial infarction site, respectively. It was suggested that CR in patients with AMI could be predicted by hemoglobin count, leukocyte count, admission time, etc. The main risk factors are elderly women, basal heart rate >80 times/min, anterior wall myocardial infarction. Hemoglobin <120 g/L, white blood cell >109/L, admission time >12 h, these indexes are more likely to cause cardiac rupture. In addition, primary PCI treatment can reduce the risk of CR, while thrombolysis may increase the risk of CR. Using risk prediction model and relevant inspection methods, we can predict the occurrence of CR timely from mechanism and source. CR is a difficult problem in clinical practice because of its sudden and high mortality. Therefore, a series of risk prediction models are established to evaluate CR, through early prediction factors. For early recognition, it is important to take preventive measures to prevent heart rupture as early as possible.
Effect and prognosis of acupuncture on polycystic ovary syndrome
XIE Kai, WANG Ling-ling
2019, 17(5): 834-836. doi: 10.16766/j.cnki.issn.1674-4152.000804
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Objective To analyze the effect of acupuncture treatment on the levels of sex hormone, insulin, Cor, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEA-S) and pregnancy rate, ovulation rate and abortion rate in patients with polycystic ovary syndrome. Methods A total of 100 cases of patients with polycystic ovary syndrome were selected in the Affiliated Hospital of Ningbo University Medical College treated from August 2016 to September 2017 and divided into 2 groups, with 50 cases in each group. The control group was treated by routine therapy, with oral progestin after withdrawing medicinal bleeding caused by 5 d oral clomifene citrate, 1 time/d. On the basis of conventional treatment, the observation group patients were given acupuncture treatment, mainly involving chung chi, uterus, Shenyu plus Xuehai points, such as acupuncture needling nourishing flat after catharsis, retaining needle for 30 min, 10 min a row needle, electrochemical luminescence to test sex hormones, INS, Cor, 17-OHP, DHEA-s level, pregnancy rate, ovulation rate and abortion rate. Results The total effective rate of the observation group was 92.0%, and that of the control group was 76.0%. The total effective rate of the observation group was higher than that of the control group (P<0.05).After treatment, luteinizing hormone (LH), testosterone (T), INS, 17-OHP,DHEA-s level in the observation group decreased compared with those before treatment, and Cor level increased compared with that before treatment. After treatment, LH, T, INS, 17-OHP and DHEA-17 level in the observation group were lower than those in the control group, and Cor level was higher than that in the control group. However, the difference in serum follicle-stimulating hormone (FSH) and estradiol (E2) level was not statistically significant (all P>0.05).The pregnancy rate of the observation group was higher than that of the control group, but the abortion rate was not statistically significant (P>0.05). Conclusion Acupuncture on polycystic ovary syndrome improves reproductive endocrine, ovulation and rate of pregnancy.
The clinical research of lumbar intervertebral disc herniation treated by multi-needling and sticking of needle in muscle meridian focus
ZHANG Chun-xia, TANG Wei, XU Hai, YUE Jian-xing, LI Yan-xia, HU Zheng-xi, CHEN Li-qiu
2019, 17(5): 837-840. doi: 10.16766/j.cnki.issn.1674-4152.000805
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248 1
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Objective To observe and investigate the clinical efficacy of multi-needle sticking in rows acupuncture in protrusion of lumbar intervertebral disc. Methods A total of 90 patients of protrusion of lumbar intervertebral disc who were treated in the Second Affiliated Hospital of Bengbu Medical College from August 2014 to August 2018 were included in the experiment and were randomly and equally divided into 3 groups, with 30 cases in each group. Ninety patients of protrusion of lumbar intervertebral disc were included in the experiment and were randomly and equally divided into 3 groups, with the multi-needle sticking in rows acupuncture as treatment group, and conventional sticking acupuncture and multi-needling acupuncture as controls respectively. The clinical therapeutic effect was assessed by evaluating the clinical symptom, physical sign and symptom pain by VAS (visual analogue scale/score) and JOA (Japanese ortho-paedic association scores) before and after 2 weeks of continuous treatments. The datum were compared among three groups. Results After treatment, the VAS of three groups decreased significantly than that before treatment, with 0.30±0.60 in the multi-needle sticking in rows acupuncture group, 1.43±0.82 in conventional sticking acupuncture group and 1.60±0.77 in multi-needling acupuncture group(all P＜0.01). The VAS of the multi-needle sticking in rows acupuncture group was significantly lower than that in the other groups after treatment(all P＜0.05). In addition, the JOA scores of the multi-needle sticking in rows acupuncture group were 27.73±2.24, which was significantly higher than that in conventional sticking acupuncture group with 23.33±3.37 and multi-needling acupuncture group with 24.10±2.71(all P＜0.01). The JOA scores of all groups after treatments increased significantly than that before treatment(all P＜0.05). With regard to the total therapeutic efficacy, the multi-needle sticking in rows acupuncture group with 90.0% therapeutic efficacy rate was more effective than conventional sticking acupuncture group and multi-needling acupuncture with the therapeutic efficacy rates of 60.0% and 60.0% respectively (all P＜0.05). Conclusion The multi-needle sticking in rows acupuncture with higher therapeutic efficiency in protrusion of lumbar intervertebral disc can effectively relieve the clinical symptom, alleviate uncomfortableness and improve the life quality of patients. Therefore, the popularization of the multi-needle sticking in rows acupuncture will benefit greatly for protrusion of lumbar intervertebral disc patients in clinic.
Protective effect of Dongsheng Fusang decoction on endothelial function in phlegm-dampness type erectile dysfunction patient
WANG Qing, FAN Qian, ZHOU Zheng-guo, YANG Kun
2019, 17(5): 841-843,861. doi: 10.16766/j.cnki.issn.1674-4152.000806
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175 1
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Objective To explore the protective effect of Dongsheng Fusang decoction on endothelial function in phlegm-dampness type erectile dysfunction patients. Methods A total of 60 patients with phlegm-dampness type erectile dysfunction in our hospital were selected from March 2018 to July 2018,and they were randomly divided into control group (n=30) and observation group (n=30) according to the random number table method. The control group was treated with Tadalafil, and the observation group was took the Dongsheng Fusang decoction on the control group. The clinical efficacy, endothelial function related indexes and incidence of adverse reactions were compared between the two groups before and after treatment. Results Before treatment, there was no statistically significant difference in international erectile function scale (IIEF-5) score, TCM symptom score and maximum erectile hardness between the two groups (P>0.05), after treatment,the IIEF-5score, TCM symptom score and maximum erectile hardness of the two groups were significantly better than those before treatment(P<0.05), and the above indexes in the observation group were obviously better than those in the control group (P<0.05). Before treatment, there was no statistically significant difference in the levels of vasodilatory function (FMD), nitric oxide (NO) and endothelin-1 (ET-1) between the two groups (P>0.05), after treatment, the levels of FMD and NO in the two groups were significantly higher than those before treatment (P<0.05), and the levels of these two indexes in the observation group were significantly higher than those in the control group (P<0.05), the level of ET-1 in the two groups was significantly lower than that before treatment (P<0.05), and the level of ET-1 in the observation group was significantly lower than that in the control group (P<0.05). No obvious adverse reactions such as headache, blurred vision and drug allergy were observed in either group during the treatment. Only one patient in the observation group presented mild gastrointestinal discomfort symptoms, adverse reactions in the two groups were not statistically significant (P>0.05). Conclusion Dongsheng Fu sang Yin can significantly improve the clinical efficacy of phlegm-dampness type erectile dysfunction patients and it has certain protective effect on endothelial function of patients, which is worth popularizing in clinical treatment, and has a high safety.
The application of applied anatomy in the introduction of surgery for otolaryngology head and neck surgeons
WANG Qin, LIU Ye-hai, WU Kai-le, ZOU Ming-ming
2019, 17(5): 844-847. doi: 10.16766/j.cnki.issn.1674-4152.000807
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Objective To explore the application effects of applied anatomy in the teaching of ENT surgery. Methods In 2017, we selected 10 graduate students from the 2015 Department of Otorhinolaryngology Head and Neck Surgery of Anhui Medical University, and ordered 10 students according to the ranking of the test results, the singular was the control group and the double number was the experimental group, with 5 people in each group. On the basis of traditional teaching, the experimental group physicians additionally offered courses such as viewing surgery, anatomical video and hands-anatomy to strengthen the study of applied anatomy. The two groups of students in the control group used experimental teaching to complete a nasal endoscopic sinus opening operation. Test the teaching effect and conduct a questionnaire survey to understand the students' experience of the two teaching methods. Results The results of the surgical examination showed that the average scores of the experimental group and the control group were 82.52 points and 61.02 points. There was a significant difference between the two groups (P<0.05). The scores of the surgical evaluation of the experimental group were significantly higher than those of the control group. The independent completion degree of the operation, the treatment of the sudden situation, the protection of the surrounding tissue, the amount of bleeding, and the operation time were better than the control group. The average teaching evaluation scores of the experimental group and the control group were 25 points and 24 points, respectively. There was no significant difference in the evaluation scores of the two teaching modes (P>0.05), and 90% (9/10) of the students believed that the new teaching methods would help beginners improve their learning satisfaction, learning interest, understanding and learning efficiency of teaching content. Conclusion The course of viewing anatomical video and autopsy anatomy in the teaching of otolaryngology head and neck surgery is a better teaching method and can be further promoted and applied.
Application of clinical cases combined with clinical pathways in teaching hematological tumors
LI Jia-jia, ZHANG Feng, ZHU Jun-feng, XIA Yang
2019, 17(5): 848-850. doi: 10.16766/j.cnki.issn.1674-4152.000808
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226 2
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Objective To explore the application of clinical cases combined with clinical pathways in the teaching of hematological tumors. Methods Fifty disciplines and postgraduates from the Department of Hematology were selected as subjects. They were randomly divided into the experimental group and the control group, with 25 patients in each group. The experimental group was combined with the clinical path teaching group and the control group was the traditional teaching group. The group members performed the teaching in January according to the above method. After the teaching, the questionnaire was completed and the theoretical examination was compared to compare the teaching effects. Results The results of the questionnaire showed that the scores of the experimental group were significantly better than those of the control group, both in terms of improved clinical thinking ability, interest in hematology, and teaching methods of satisfied teachers. The differences were statistically significant (all P<0.05). The results of the theoretical test showed that the scores of the experimental group were significantly better than the control group, and the differences were statistically significant (all P<0.05). Conclusion The clinical practice teaching of hematology has achieved satisfactory results by organically combining clinical cases with clinical pathways. By selecting typical cases of hematological patients, the theoretical knowledge of hematology is integrated into typical cases under the guidance of clinical pathways, thus cultivating students' clinical logic thinking ability and inspiring students' interest in learning hematology. Students' understanding and understanding of the content they have learned, and cultivate students' self-learning ability, standardize the teaching process, and enhance the systematic and rigorous content of the teaching content. Therefore, it is feasible to combine clinical cases with clinical path methods in blood system tumor teaching. It is worthy of promotion in practice teaching, which is a better clinical teaching mode.
Systematic evaluation and control measures of factors influencing prehospital delay in patients with acute myocardial infarction
LI Pan, LU Guan-zhen, ZHANG Li, ZHAN Shu-yu, WANG Xiao-yi, HU Yu-li
2019, 17(5): 851-856. doi: 10.16766/j.cnki.issn.1674-4152.000809
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214 3
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Objective To explore the influencing factors of prehospital delay in patients with acute myocardial infarction, and to identify strategies to reduce pre-hospital delay. Methods The relevant literature was searched by the top ten databases such as Pubmed and Embase, and the 19 articles included in the NOS scale were used only for epidemiological investigation and statistical analysis by RevMan 5.3 software. Results The meta-analysis was used to classify the influencing factors into three categories. ①Social factors:age [OR=1.090, 95% CI (1.060-1.130), P＜0.001], gender [OR=1.180, 95% CI (1.050-1.330), P=0.006], cultural level [OR=1.410，95%CI(1.190-1.670)，P＜0.001], residential area [OR=1.350, 95% CI (0.990-1.840), P=0.060]; ②Clinical factors: history of diabetes [OR=1.380, 95% CI (1.220-1.560), P＜0.001], history of angina [OR=1.370, 95 %CI=1.050-1.770, P=0.020], history of myocardial infarction [OR=1.080, 95% CI (0.640-1.830), P=0.760], PCI history [OR=0.760, 95% CI (0.670-0.860), P＜0.001]; ③Other factors: nocturnal onset [OR=1.630, 95% CI (1.340-1.970), P＜0.001], treatment mode [OR=0.640, 95% CI (0.570-0.710), P＜0.001] The symptoms were not attributed to the heart [OR=3.100, 95% CI (1.620-5.94), P＜0.001 ]. Conclusion Age, female, history of diabetes, history of angina pectoralis, nocturnal morbidity, failure to attribute symptoms to the heart are risk factors. High academic background, PCI history, EMS visit are protective factors. The residential area, history of myocardial infarction and the previous delay of acute myocardial infarction patients are irrelevant. Effective and effective interventions can reduce pre-hospital delays and decrease out-of-hospital mortality.
Cognition and application of Helicobacter pylori infection among medical specialist in Anhui
ZHANG Yu-ting, WANG Jian-chao, WANG Qi-zhi, ZHENG Hai-lun, LI Da-peng, WANG Qiang-wu
2019, 17(5): 857-861. doi: 10.16766/j.cnki.issn.1674-4152.000810
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Objective To survey the cognition and application of Helicobacter pylori (Hp) infection among medical specialist in Anhui. Methods From May 2018 to October 2018, a questionnaire survey was conducted among 1 200 medical specialist in Anhui, including 281 gastroenterologists (GI), 588 general practitioners (GP), and 256 gastroenterology nurses (GN). There were 5 parts in the questionnaire, including the knowledge and performance of the Consensus (9 questions), the indications of Hp eradication (6 questions), detection methods of Hp (8 questions), the therapy of Hp eradication (5 questions) and how to treat the screening and negative effects of Hp eradication therapy (3 questions). Results Total 1 125 valid questionnaires were received with a response rate of 93.75% (1 125/1 200). The awareness rate of the Consensus in GI, GP and GN groups was 80.43% (226/281), 55.95% (329/588) and 27.34% (70/256), respectively (χ2=152.956, P＜0.001). Ninety-one point one zero percent (256/281) GI, 68.20% (401/588) GP and 67.19% (172/256) GN groups considered that "confirmed Hp infection" was the indications of Hp eradication therapy, respectively (χ2=58.679, P＜0.001). Conclusion The fifth consensus has not been fully applied to the clinical diagnosis and treatment by medical specialist in Anhui Province. Gastroenterologists are more likely to adhere with the Consensus than general practitioners and gastroenterological nurses in the management of Hp infection. We need to further strengthen the learning and applicating of medical specialist on consensus.
Effects of immunosuppressive agents combined with biological agents on nutritional status and inflammatory factors in patients with inflammatory bowel disease
HUANG Hui-feng, ZHANG Yan, CHEN Wen-xiao, PENG Xuan-jie, YE Ke-ping
2019, 17(5): 862-864. doi: 10.16766/j.cnki.issn.1674-4152.000811
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Objective To analyze the effects of immunosuppressive agents combined with biological agents on nutritional status and inflammatory factors in patients with inflammatory bowel disease. Methods Seventy-two patients with inflammatory bowel disease in our hospital from January to December 2018 were selected. According to different therapies, 36 patients in the control group and 36 patients in the observation group were included. The control group was treated with azathioprine, an immunosuppressant, and the observation group was treated with azathioprine combined with infliximab, a biological agent. The clinical efficacy, nutritional status, inflammatory factors and adverse reactions of the two groups were compared. Results The total effective rate of the observation group (94.4%) was higher than that of the control group (77.8%). After treatment, the serum albumin, transferrin, prealbumin and hemoglobin in the observation group [(42.1±5.0)g/L, (2.8±0.5)g/L, (251.7±51.3)mg/L, (133.5±19.5)g/L] were better than those in the control group [(36.9±5.2)g/L, (2.5±0.3)g/L, (232.4±44.8)mg/L, (120.4±10.7)g/L], TNF-alpha, IL-4, IL-10, IL-17 in the observation group [(117.3±19.0)pg/L, (11.0±1.8)pg/L, (7.4±1.1)pg/L, (187.3±38.2)pg/L] was superior to the control group [(186.6±38.3)pg/L, (16.5±2.4)pg/L, (10.9±1.7)pg/L, (285.4±32.7)pg/L]. There were significant differences among the groups (all P<0.05). The incidence of adverse reactions in the observation group (16.7%) was similar to that in the control group (13.9%). There was no significant difference between the two groups (P>0.05). Conclusion Immunosuppressive agents combined with biological agents are effective in the treatment of inflammatory bowel disease, which can significantly improve the nutritional status of patients and reduce the level of inflammatory factors, and high safety.
Investigation and analysis of the clinical characteristics of infective endocarditis and the treatment of antiseptic drugs
LUO Li-hong, FANG Tian-fu, CEN Ming-qiu
2019, 17(5): 865-868. doi: 10.16766/j.cnki.issn.1674-4152.000812
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Objective To strengthen the understanding of the treatment of infective endocarditis, andprovide a theoretical basis for improving the level of diagnosis and treatment of infective endocarditis by retrospective analysis of pre-infection symptoms, pathogen detection and antibiotic treatment in patients with infective endocarditis. Methods The 173 cases of infective endocarditis patients admitted to our hospital from January 2013 to December 2017, according to the Diagnostic Criteria of Infectious Endocarditis of the Chinese Medical Association,were reviewed.Sexual analysis of clinical features of patients with infective endocarditis(general information, pre-infection, pathogen detection results, underlying diseases and susceptibility factors) and antibiotic treatment. Results Among 173 patients with infective endocarditis, the incidence rate of males was higher than that of females. The average age of onset was (9.13±3.19) years old, and the average length of hospital stay was (8.41±1.23) days. Among them, 75 cases (43.35%) had obvious symptoms of prodromal infection, mainly pulmonary infection (33.53%), and some cases had two infections. A total of 113 cases(65.32%) were positive for blood culture. A total of 118 pathogens were cultured. The highest proportion of streptococci was 60 (50.85%), 37 strains of Staphylococcus (31.36%) and 4 strains of Gram-bacillus (3.39%), 8 strains of fungi (6.78%). Common antibiotics mainly include penicillin antibiotics, vancomycin antibiotics and cephalosporin antibiotics. The use rate of penicillin antibiotics has decreased year by year (from 82.71% to 54.21%), and the use rate of vancomycin antibiotics and cephalosporin antibiotics has increased year by year, rising from 53.66% and 49.54% to 89.15% and 74.63%, respectively. Conclusion The pre-infection symptoms of infective endocarditis are mainly pulmonary infections, streptococcus and staphylococcal infections, including Gram-bacillus and fungi. The use rate of penicillin antibiotics has been decreasing year by year, and the use rate of vancomycin antibiotics and cephalosporin antibiotics has increased year by year.
Effect of humanistic nursing combined with heparin on venous thromboembolis in severe patients
WANG Hui-wen, LI Su-yun, CHU Jie
2019, 17(5): 869-872. doi: 10.16766/j.cnki.issn.1674-4152.000813
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Objective To study the intervention effect of humanized nursing on patients with severe venous thromboembolism. Methods Two hundred patients with venous thromboembolism treated in our hospital from March 2016 to March 2018 were selected and divided into routine nursing group and humanized nursing group by random number table method. The routine nursing group was intervened by routine nursing, while the humanized nursing group was intervened by humanized nursing. Heparin was selectively injected according to the expression level of D-dimer in the two groups. The quality of life and psychological status after nursing were evaluated, and nursing satisfaction was counted. Results The total effective rate of humanized nursing group after nursing intervention (87.00%) was significantly higher than that of routine nursing group (76.00%, P<0.05); the scores of quality of life items in humanized nursing group after nursing intervention were significantly higher than those in routine nursing group (P<0.05); the scores of SDS and SAS in humanized nursing group after nursing intervention were significantly lower than those in routine nursing group (P<0.05); The satisfaction of patients after nursing intervention was significantly higher than that of patients in routine nursing group (P<0.05). Conclusion Humanistic nursing can improve the clinical symptoms of patients with severe venous thromboembolism, and selective use of heparin for anticoagulant treatment after d-dimer detection can play a better antithrombotic effect, significantly improve the quality of life of patients and improve their adverse emotions.
The observation of clinical nursing pathway in aging patients with osteoporotic vertebral compression fracture
HUANG Yun-ping, DENG Dun, CHEN Li-qiu
2019, 17(5): 873-876. doi: 10.16766/j.cnki.issn.1674-4152.000814
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Objective To observe the application of CNP in OVCF patients with PKP operation. Methods From January 2015 to January 2017, 100 OVCF patients in the first people's hospital of Wenling city were randomly divided into two groups according to the random number table. The two groups were given PKP operation. The control group were given routine nursing treatment, while the study group were treated by CNP. The hospitalization, hospitalization costs, VAS score, complication, brittle fracture incidence during the study period, the excellent rate of ODI score, bone mineral density T value, self-care ability score, SAS, SDS, quality of life score and satisfaction rate were reviewed and compared in the two groups. Results The hospitalization [(6.13±1.49) d vs. (11.48±2.76) d], VAS score [(2.53±0.46) score vs. (6.48±1.09) score], hospitalization costs [(1.66±0.41) ten thousands yuan vs. (2.59±0.87) ten thousands yuan], SDS [(39.17±3.56) score vs. (50.86±4.92) score], SAS [(41.27±4.93) score vs. (52.93±5.67) score], complication (0.0% vs. 5.0%) in the research group were less than those in the control group, the excellent rate of ODI (92.0% vs. 62.0%)，T value(-2.57±0.53 vs. -3.18±0.68)，self-care ability score[(119.19±5.48) score vs. (92.62±4.98) score], the quality of life scores [(77.89±8.25) score vs. (58.06±9.41) score], satisfaction rate (94.0% vs. 68.0%) in the research group were higher than the control group. The differences were statistically significant (P<0.05). Conclusion The application of CNP in OVCF patients with PKP operation can reduce the hospital stay, hospitalization costs, complications, relieving pain, anxiety and depression, improving self-care ability and life quality.
Study on the effect of individualized nursing intervention on patients with thyroid micro-papillary carcinoma
RANG Jia-xi, CHEN Yu, HE Li-ping
2019, 17(5): 877-880. doi: 10.16766/j.cnki.issn.1674-4152.000815
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Objective To explore the effect of individualized nursing intervention on patients with thyroid papillary microcarcinoma. Methods A total of 120 patients with thyroid papillary microcarcinoma treated in our hospital from January 2016 to August 2018 were selected. The patients were randomly divided into routine group and individualized group, with 60 cases in each group. The routine group received routine nursing care, while the individualized group received individualized nursing care. The self-rating anxiety scale (SAS) of the two groups was counted. Self-rating Depression Scale (SDS) score, quality of life, nursing quality score, hospitalization time and nursing satisfaction of the two groups were statistically analyzed. Results There was no significant difference in the scores of SDS and SAS before nursing between the two groups (all P>0.05). The scores of SDS and SAS in personalized group after nursing intervention were significantly lower than those in routine group (all P<0.05). There was no significant difference in the quality of life score between the two groups before nursing (all P>0.05); after nursing intervention, the quality of life score of the individualized group was significantly higher than that of the conventional group, and the difference was statistically significant (all P<0.05). The average hospitalization time of individualized group was significantly lower than that of routine group, and the quality of nursing was significantly higher than that of routine group. The difference was statistically significant (all P<0.05). The total satisfaction of individualized group was 95.00%, which was significantly higher than that of routine group (73.33%). The difference was statistically significant (P<0.05). Conclusion Individualized nursing mode for patients with thyroid papillary microcarcinoma nursing intervention can significantly improve the psychological status of patients, promote physical recovery of patients and improve the quality of life of patients, so patients and their families are more satisfied.
Study on the effect of high-quality nursing based on humanistic care in the diagnosis and treatment of patients with digestive endoscopy
WANG Xue-fei, WANG Jun-fen, ZHANG Ke-hui, HE Cai-di
2019, 17(5): 881-883. doi: 10.16766/j.cnki.issn.1674-4152.000816
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Objective To explore the application effect of high quality nursing intervention based on humanistic care for patients with digestive endoscopy. Methods A total of 200 patients who underwent diagnosis and treatment in the digestive endoscopy room of our hospital from February 2017 to August 2018 were enrolled. According to the random number table method, the patients were divided into observation group and control group, with 100 cases in each group. The patients in the control group were treated with routine care, and the observation group was based on the quality control intervention based on human care. The nursing efficiency of the two groups of patients included: psychological state score before and after nursing, incidence of adverse reactions, incidence of adverse care events and satisfaction of nursing. Results At admission, the psychological status scores (SAS, SDS scores) of the two groups were not statistically significant (P>0.05); 10 minutes before anesthesia, the psychological status scores of the observation group were significantly lower than the control group(P<0.05); The incidence of reaction was 4.0%, which was lower than that of the control group (13.0%, P<0.05). The incidence of nursing adverse events in the observation group was 3.0%, which was much lower than that of the control group (P<0.05). The nursing satisfaction of the observation group was 96.0%, higher than 84.0% of the control group (P<0.05). Conclusion The application of high-quality nursing based on humanistic care in patients with digestive endoscopy can effectively improve the quality of nursing, reduce the incidence of adverse reactions and nursing adverse events, alleviate patients' nervous and anxiety, and effectively improve nursing satisfaction, which is worthy of clinical application.
Study on the effect of risk nursing in obstetrics
YAO Jiao-xian, CHEN Fang-jian, ZHU Xia-jun, ZHOU Ying, XU Shun
2019, 17(5): 884-886. doi: 10.16766/j.cnki.issn.1674-4152.000817
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Objective To study the effect of risk nursing in obstetrics and its effect on postpartum infection. Methods A total of 90 pregnant women who were admitted to the department of obstetrics and gynecology of our hospital from March 2015 to March 2016 were selected. According to the method of random numbers, they were divided into routine nursing group and risk nursing group, with 45 cases in each group. The routine nursing group adopted the routine nursing method, and the risk nursing group adopted the risk prevention method for nursing. Anxiety self-rating scale (SAS) and depression self-rating scale (SDS) were used to evaluate the psychological status of parturients, and nursing satisfaction was investigated to calculate the hospitalization time, medical error rate and postpartum infection of the two groups. Results The SAS and SDS scores of the conventional nursing group and the risky nursing group were significantly lower than those before nursing, showing statistical difference (P<0.05). After nursing, the SAS and SDS scores of the risky nursing group were lower than those of the conventional nursing group, showing a statistical difference (P<0.05). The hospitalization time of the routine nursing group was higher than that of the risk nursing group, showing statistical difference (P<0.05). The rate of medical error in the conventional nursing group was higher than that in the risk nursing group, showing statistical difference (P<0.05). The total nursing satisfaction of the risky nursing group was significantly higher than that of the conventional nursing group, showing a statistical difference (P<0.05). The total infection rate of parturients in the risky nursing group was lower than that in the conventional nursing group, showing a statistical difference (P<0.05). Conclusion The effect of risk nursing in obstetric application is remarkable. It can reduce the occurrence of maternal depression, shorten the hospital stay and reduce the incidence of postpartum infection.

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