2020 Vol. 18, No. 2

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Analysis of the practical effect transfer training program of the general practitioner under tutorial system
LI Luo-chang, CHEN Hong-yan, HE Ying, LI Bing, LUO Tian-you, CHENG Qing-feng
2020, 18(2): 167-169,216. doi: 10.16766/j.cnki.issn.1674-4152.001196
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Objective To practice the tutorial system in the general practitioners transfer training and discuss the training effect. Methods A total of 295 general practitioners who were trained in the First Affiliated Hospital of Chongqing Medical University(Chongqing general practice medical education center) from 2015 to 2017 were selected as the objects of the study, and the tutorial system was adopted for training. Before the training, the entrance examination were carried out. After the training, the Chongqing Municipal Health Committee uniformly organized the completion theory examination, cardiopulmonary resuscitation(CPR) and clinical practice skill examination of the same difficulty, which were evaluated by the percentage system, and 60 points were considered as passing. Results Before training, the failure rate of CPR and clinical practice skills was nearly 60%(59.36% vs. 57.24%), and the failure rate after training were significantly decreased(1.41% vs. 0.71%), After cardiopulmonary resuscitation and clinical practice skill training, female doctors were better than male doctors, with statistically significant difference(all P<0.05). There was no gender difference in the theoretical examination at the end of the course(P>0.05). The score of technical secondary school graduates before clinical practice skill training was significantly lower than that of college graduates and undergraduate graduates, and the increase of score after training was the highest(all P<0.05). Working years were negatively correlated with the score of CPR and clinical practice skill after training(CPR: r=-0.158, P=0.007; Clinical practice skills: r=-0.121, P=0.004). There was no correlation between education level and CPR and clinical practice skills after training(CPR: r=0.101, P=0.083; Clinical practice skills: r=0.062, P=0.293), but there was a positively correlated with theoretical test scores(r=0.282, P<0.001). Conclusion Through the transfer training program of general practitioners under the tutorial system, the trainees have significantly improved their skills in CPR and clinical practice, and passed the theoretical examination. It is suggested that the training program of general practitioner transfer under the tutorial system can effectively improve the diagnosis and treatment ability of general practitioners.
WANG Tao, LI Zhi-jun
2020, 18(2): 170-171.
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Influence of decidual natural killer cells with miR-18a on infiltration of human normal trophoblastic cells
YANG Yang, GAO Yan, YAN Jia-jia, LUAN Li-xia, ZHANG Jin
2020, 18(2): 172-176. doi: 10.16766/j.cnki.issn.1674-4152.001197
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Objective To study the possibility of decidual natural killer(dNK) cells as a potential cell medium in direct contact with trophoblast cells in the maternal-fetal interface through its secreted cytokines, and synergize with pre-eclampsia-associated microRNA-18 a(miR-18 a) affects the infiltration ability of human normal trophoblast cells(HTR8) and participates in the pathogenesis of pre-eclampsia(PE). Methods Of pregnant women with induced abortion from September 2017 to December 2017. Human normal early pregnancy decidual tissue(n=11) was collected, and dNK cells were sorted and purified by gradient density centrifugation combined with flow cytometry. The miR-18 a precursor molecules were transfected into HTR8 cells, which were divided into three groups: miR-18 a expression group, miR-18 a inhibition group and NC group(control group).The dNK was co-cultured with the above three groups of HTR8 cells. The real-time quantitative PCR(RT-qPCR) was used to detect the expression of miR-18 a mRNA in HTR8 cells after transfection. The expression of interleukin 8(IL-8) in the supernatant of each group was detected by ELISA after 24 hours. Transwell experiment was divided into 3 groups: co-culture group, simple culture group and control group. The effect of supernatant obtained from co-culturing of dNK and HTR8 cells on the infiltration ability of trophoblast cells in miR-18 a inhibition group were detected. Results Compared with the control group, miR-18 a overexpression and inhibitory effect was significant(all P<0.001); after co-cultured with dNK and control group HTR8 cells for 24 hours, the expression of IL-8 in the supernatant was lower than that of the control group [(508.35±28.22)ng/L, P<0.001]. Compared with the simple cultured group, the infiltration ability of HTR8 cells in co-cultured group was enhanced(367.11±88.26, P<0.001). Conclusion The dNK cells has certain influence on the infiltration of trophoblast cells through the secretion of the cytokine IL-8; and with the participation of miR-18 a, it may be involved in the pathogenesis of PE.
Application value of NT proBNP level in patients with acute ischemic stroke
ZHAO Xiang-mei, QIN Li-jie, YANG Xian-zhi
2020, 18(2): 177-180. doi: 10.16766/j.cnki.issn.1674-4152.001198
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Objective To investigate the role of NT-proBNP in etiology classification and risk stratification of patients with acute ischemic stroke. Methods A total of 587 patients with acute ischemic stroke admitted to Henan people's Hospital from January 2016 to December 2018 were collected prospectively. At the same time of emergency evaluation, NT proBNP was detected quickly beside the bed, and the etiology was classified. The large-artery atherosclerosis(LAA), cardioembolism(CE), small-artery occlusion(SAO), stroke of other determined etiology(SOE) and stroke of other undetermined etiology(SUE) were compared. Results There were 332 acute ischemic stroke patients met the study criteria [mean age 68.67±15.68 years, 181(54.52%) male], including 119(35.84 %) with LAA, 85(25.60 %) with CE, 91(27.41 %) with SAO and 37(11.14 %) with SOE or SUE. The age, previous cardiac disease, atrial fibrillation, SSS score on admission ≤25 and mRS ≥3 at discharge in the CE patients were significantly higher than those in other subtypes(statistics in the order were F=3.336, χ2=5.883, corrected χ2=0.015, χ2=74.755 and χ2=48.166, all P<0.001). The NT proBNP level in CE group was(798.81±347.39) pg/mL, which was significantly higher than LAA group [(421.55±178.74) pg/mL], SAO group [(390.89±195.59) pg/mL] and other group [(442.93±184.45) pg/mL, statistics in the order were t=17.163, t=20.411 and t=15.810, all P<0.001]. The optimal cut-off value of the plasma NT proBNP between CE and non-CE were 579.29 pg/mL, the sensitivity and specificity were 76.5% and 85.3%, respectively. Conclusion The level of plasma NT-proBNP of patients with CE was significantly higher than that of other subtypes. When the level of NT proBNP exceeds 579.29 pg/mL in patients with acute stroke, we should be alert to whether it is CE subtype, and the diagnosis and treatment decision should be combined with clinical comprehensive evaluation.
Analysis of electrocardiogram characteristics of apical hypertrophic cardiomyopathy and septal hypertrophic cardiomyopathy
CHOU Xin, GAO Min
2020, 18(2): 181-184. doi: 10.16766/j.cnki.issn.1674-4152.001199
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Objective To explore the electrocardiographic characteristics and clinical significance of apical hypertrophic cardiomyopathy and septal hypertrophic cardiomyopathy. Methods A total of 55 patients who met the diagnostic criteria of hypertrophic cardiomyopathy were selected from January 2017 to January 2019 in our hospital. According to different fat parts, patients were divided into apical hypertrophic group(17 cases, 30.91%) and septal hypertrophic group(38 cases, 69.09%). The clinical data, echocardiographic parameters and the parameters of Ⅲ lead, R/s, Q wave, S wave, V4-6,-aVR lead T wave were compared and analyzed. Results There was a significant difference in the interventricular septal thickness between the septal hypertrophic group [(15.71±4.88) mm] and apical hypertrophic group [(11.18±2.70) mm, t=8.701, P<0.05]. The proportion of V4-6(15 cases, 88.24%) and-aVR lead inverted T wave(16 cases, 94.12%) in apical hypertrophic group was statistically significant compared with septal hypertrophic group(χ2=7.275, 10.162, P<0.05). There was a significant difference in the proportion of R/s<1 in lead Ⅲ and main wave downward in septal hypertrophic group(21 cases, 55.26%) compared with that in apical hypertrophic group(4 cases, 23.53%, χ2=4.771, P<0.05). There was no significant difference in the other electrocardiographic parameters between the two groups(all P>0.05). Conclusion The electrocardiographic of apical hypertrophic cardiomyopathy is different from that of septal hypertrophic cardiomyopathy. It can provide a good indication for the early diagnosis of different types of hypertrophic cardiomyopathy and the location of hypertrophic sites through the T wave of lead V4-6,-AVR, the main wave direction of lead Ⅲ, combined with echocardiography and clinical data.
The clinical efficacy of closed Gartland type Ⅲ supracondylar fracture of humerus with radial nerve injury in children
YUAN Yi, JIN Rui, YAO Jie, LI Yang, SUN Jun
2020, 18(2): 185-187,276. doi: 10.16766/j.cnki.issn.1674-4152.001200
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Objective To investigate the clinical efficacy of closed reduction and percutaneous Kirschner wire fixation plus stage Ⅱ nerve exploration in the treatment of closed Gartland type Ⅲ humeral supracondylar fracture with radial nerve injury in children. Methods Closed reduction and percutaneous Kirschner wire fixation were performed in 42 children suffered from closed Gartland type Ⅲ humeral supracondylar fracture with radial nerve injury. Among them, 8 cases were underwent stage Ⅱ nerve exploration. All patients were followed up from 9 to 82 months(mean 50.3 months). The therapeutic effect was evaluated according to Flynn elbow joint function and radial nerve function assessment criteria. Results X-ray examination showed that 42 patients gained bone union without complications from 1 to 2 months after operation of fracture, and the Flynn elbow joint functional assessment criteria showed that there were 35 excellent cases, 5 good cases and 2 fair cases, with the excellent and good rate 95.23%. There were 27 excellent, 7 good and 8 poor according to the radial nerve function assessment criteria 2 to 3 months after operation of fracture, the excellent and good rate was 80.95%. Eight poor cases were underwent stage Ⅱ nerve exploration and the results were excellent after follow-up for 6 to 80 months. Conclusion It's simple and safe with small trauma and good recovery of elbow joint function to treat closed Gartland type Ⅲ humeral supracondylar fracture with radial nerve injury in children using the closed reduction and percutaneous Kirschner wire fixation. It is recommended to observe 3 months after fracture operation, the radial nerve function of most children recovered well. If the function of the radial nerve has not been restored, stage Ⅱ radial nerve exploration should be performed, and satisfactory results can be obtained.
Retrospective study of the clinical characteristics of ERCP and LCBDE in treatment of gallbladder stones and stone recurrence
WU Yan-yan, YAN Shan-jun, LI Da-peng, ZHENG Hai-lun, XUE Yong-ju, DENG Xiao-jing, WANG Qi-zhi, WANG Qiang-wu, WANG Jian-chao
2020, 18(2): 188-190,207. doi: 10.16766/j.cnki.issn.1674-4152.001201
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Objective To study the clinical characteristics and the stone recurrence of endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic common bile duct exploration(LCBDE), and to evaluate the advantages and disadvantages of the two methods. Methods Clinical data of patients with choledocholithiasis admitted to our hospital from January 2012 to December 2015 were retrospectively analyzed. Among them, 184 cases had complete clinical data and were divided into ERCP group(94 cases) and LCBDE group(90 cases) according to surgical methods. The gender, age, maximum diameter of common bile duct, maximum diameter of calculi, number of calculi, recurrence of calculi(the first recurrence of common bile duct calculi in patients), length of stay, hospitalization costs and other related indicators were analyzed between two groups. Results There were significant differences in age, stone diameter and length of hospital stay between the two groups(all P<0.05). There were no significant differences in gender, the maximum diameter of common bile duct, number of stones and hospital expenses(all P>0.05). The first recurrence rate of choledocholithiasis was 9(9.57%) in ERCP group, and 10(11.11%) in LCBDE group, but the difference was not statistically significant(P>0.05). Conclusion The two methods are effective for the treatment of choledocholithiasis. Elderly patients(>75 years) tend to choose ERCP, while patients with large stone diameter(≥1.5 cm) tend to choose LCBDE. The hospitalization time of ERCP group is shorter, and the recurrence of ERCP group is lower, but there is no statistical difference. The peak of the recurrence rate of the two types of operation is within one year after the operation.
Influence analysis of ductus arteriosus diameter on complications of HsPDA in premature infants
CHEN Chao, ZHANG Lan, LI Deng-feng, PAN Jia-hua
2020, 18(2): 191-193,223. doi: 10.16766/j.cnki.issn.1674-4152.001202
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Objective To investigate the difference of the complications between hemodynamic significant patent ductus arteriosus(HsPDA) and non-hemodynamic PDA(nHsPDA) in premature infants, and the complications of HsPDA in different diameter groups. Methods Using the method of retrospective analysis, 71 premature infants with PDA hospitalized in NICU of the First Affiliated Hospital of University of science and technology of China from January 2017 to December 2018 were divided into HsPDA group and nHsPDA group according to the hemodynamic changes. Among them, HSPDA group was divided into large, medium and small groups according to the diameter of the ductus arteriosus. Data were analyzed using Fisher test for independence in a contingency table and t-test. Results There were 20 cases in nHsPDA group and 51 cases in HsPDA group, which included 15 cases in large HsPDA group(>3 mm), 34 cases in medium HsPDA group(1.5-3.0 mm), and 2 cases in small HsPDA group(<1.5 mm). There was significant difference in the diameter of ductus arteriosus between HsPDA group [(2.67±0.97) mm] and nHsPDA [(1.77±0.75) mm, P<0.001]. There was no significant difference in gender, age distribution, body weight, Apgar score, multiple births and intervention(PS, mechanical ventilation) between HsPDA group and nHsPDA group(all P>0.05). There was no significant difference in the incidence of complications between HsPDA group and nHsPDA group(P>0.05). There was no significant difference in the incidence of complications between the large, medium and small HsPDA groups(P>0.05), but the incidence of ROP(7/15, 46.67%) and IVH(4/15, 26.67%) in the large HsPDA group were higher than those in the small and medium HsPDA group. There was no significant effect of different diameter on closure of ductus arteriosus before discharge of HsPDA. Conclusion The average diameter of ductus arteriosus in HsPDA group is larger than that in nHsPDA group, but there is no significant effect on complications. There is no significant effect on complications of HsPDA with different diameter of ductus arteriosus. Patients with PDA should be treated with conservative support, and drug or surgical closure should be used if necessary.
Analysis of the clinical efficacy of single-operation thoracoscope bypass surgery with beating heart in the treatment of atrial septal defect repair
WANG Peng, LIU Xue-gang, DIAO Wen-jie, LIU Ge, LI Hai-hui, SHI Chao, LIU Yi-yao, MENG Jin-jin, SHI Yu
2020, 18(2): 194-196,212. doi: 10.16766/j.cnki.issn.1674-4152.001203
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Objective To evaluate the clinical efficacy of single-operated thoracoscopic cardiopulmonary bypass surgery with beating heart and conventional thoracotomy for atrial septal defect repair. Methods A total of 52 patients with congenital cardiac malformations diagnosed with atrial septal defect from September 2015 to December 2018 in the Cardiac Surgery Center of the First Affiliated Hospital of Bengbu Medical College were divided into observation group(single operation thoracoscopy group, 25 cases) and control group(conventional thoracotomy, 27 cases) according to different surgical methods. The general conditions of patients, extracorporeal circulation time, total operation time and other perioperative indicators, postoperative complications, and postoperative follow-up were analyzed. Results The operations of the two groups were successfully completed. There was no significant difference in the operation time, CPB time, upper and lower cavity block time, and postoperative complications between the two groups(all P>0.05). There were significant difference in postoperative ventilator assist time [(10.80±4.70) h vs.(14.28±6.13) h, t=2.282, P=0.027], ICU time [(28.19±9.15) h vs.(46.54±21.51) h, t=4.053, P<0.001], intraoperative blood transfusion volume [(216.00±172.43) mL vs.(366.67±227.02) mL, t=2.679, P=0.010], 24 hours postoperative drainage [(146.32±157.78) mL vs.(315.37±251.87) mL, t=2.893, P=0.006], and length of hospital stay [(14.84±3.33) d vs.(19.48±7.46) d, t=2.933, P=0.006]. The patients in the two groups were followed up for 2 to 36 months after operation without residual shunts and other abnormalities, and the results were satisfactory. Conclusion The single-hole thoracoscopic atrial septal repair with beating heart is safe, effective and feasible for the treatment of atrial septal defect. The trauma is small, the postoperative recovery is quick, and the incision is more beautiful. It is worthy of popularization and application.
Effect of serum containing Yishen Juanbi method on OPG/RANKL/RANK signaling pathway in osteoblasts and osteoclasts of rats
SHEN Li-ying, LI Ya-song, ZHANG Ying-ying, ZOU Yu-qiong, HAO Gui-feng, WANG Tian-le
2020, 18(2): 197-201. doi: 10.16766/j.cnki.issn.1674-4152.001204
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Objective To explore the effect of serum containing Yishen Juanbi method on the signal pathway of bone metabolism. Methods SD rats were randomly divided into control groups and Yishen Juanbi Decoction groups. The two group rats were given saline solution and Yishen Juanbi Decoction by gavage, respectively, and the serum containing Yishen Juanbi decoction was collected. The osteoblasts were isolated and verified by Van kossa staining and ALP staining, and the osteoclasts were isolated and verified by TRAP and toluidine blue staining. Both cell types were separated into four groups: control group, low, medium and high doses of serum containing Yishen Juanbi decoction groups. The immunoblotting assay was utilized to measure the expression of osteoprotegerin(OPG), receptor activator of nuclear factor-κB ligand(RANKL) and osteoclast receptor activator of nuclear factor-κB(RANK). Results Compared to control group, the expression of OPG and RANKL in osteoblasts induced by low, medium and high concentrations of serum containing Yishen Juanbi decoction were 97%(P=0.710), 122%(P=0.005) and 155%(P<0.001) respectively, and the expression of RANKL was 81%(P<0.001), 63%(P<0.001) and 53%(P<0.001) respectively. The results indicated that the expression of OPG was positively correlated with the concentration of serum and the expression of RANKL was negatively correlated with the concentration of serum. Meanwhile, the expression of RANK in osteoclasts was regulated to 75%(P<0.001), 50%(P<0.001) and 46%(P<0.001) compared to the control group, suggesting that the expression of RANK was negatively correlated with the concentration of serum. Conclusion The serum containing Yishen Juanbi decoction may play a prevention role in the process of bone loss by regulating OPG/RANKL/rank signal axis.
Saponins of Aralia Taibaiensis inhibits invasion and migration of HEC-1B cell line through down-regulating the expression of Sirtuin 1
YANG Wen-teng, WANG Meng, YE Wei-jian
2020, 18(2): 202-207. doi: 10.16766/j.cnki.issn.1674-4152.001205
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Objective To explore the effects of Saponins of Aralia Taibaiensis(SAT) on the proliferation, migration and invasion of endometrial cancer cell HEC-1 B, and to provide a theoretical basis for the treatment of endometrial cancer. Methods HEC-1 B cells were treated with different concentrations SAT(0, 10, 20, 30 μmol/L). CCK8 assay was used to detect the cell proliferation, plate cell clone formation assay was used to detect colony formation, transwell chamber test was used to detect migration and invasion, and real-time PCR was used to detect the expression of sirtuin-1. The protein expressions of sirtuin 1, MMP-2 and MMP-9 were detected by Western Blotting. Results Compared with the control group, the cell proliferation, invasion and migration in SAT treatment group and the positive control group decreased significantly(all P<0.05), which was dose-dependent. Compared with the positive control group, the cell proliferation, invasion and migration in 20 and 30 μmol/L SAT group decreased significantly(all P<0.05). Compared with the control group, the levels of sirtuin 1 mRNA and protein, MMP-2 and MMP-9 protein in SAT treatment group and the positive control group decreased significantly, which was dose-dependent. Compared with the positive control group, the levels of sirtuin 1 mRNA and protein, MMP-2 and MMP-9 protein in 20 and 30 μmol/L SAT group decreased significantly(all P<0.05). Conclusion SAT can inhibit the migration and invasion of HEC-1 B cells, which may be related to the down-regulation of sirtuin-1 expression, and may provide a new possibility for the treatment of endometrial cancer.
The value of serum anti-phospholipase A2 receptor antibody in idiopathic membranous nephropathy and its clinical relevance
JIN Juan, REN Yan, GONG Jian-guang, ZHAO Li, HE Qiang
2020, 18(2): 208-212. doi: 10.16766/j.cnki.issn.1674-4152.001206
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Objective To investigate the value of serum anti-phospholipase A2 receptor antibody(anti-PLA2 R antibody) in the diagnosis of idiopathic membranous nephropathy(IMN), and to explore the correlation between the its titer and clinical indexes such as the level of proteinuria, estimated glomerular filtration rate, renal function and pathological stage of IMN patients. Methods The clinical and laboratory data of 79 patients with IMN diagnosed by renal biopsy from January 2014 to October 2018 in our hospital with serum anti-PLA2 R antibody test results were retrospectively analyzed. Results There were 49 cases of anti PLA2 R antibody positive in IMN patients(62.0%). The levels of total protein and albumin in positive patients were lower than those in anti-PLA2 R antibody negative IMN. Compared with the low titer anti-PLA2 R antibody group, the patients in the high titer group were older, the 24-hour urinary protein was more, and the estimated glomerular filtration rate, total protein and albumin levels were lower. Compared with the mild urinary protein group, the severe group had higher anti-PLA2 R antibody ratio, higher serum creatinine, total cholesterol, low density lipoprotein, lower estimated glomerular filtration rate, total protein and albumin. Compared with young IMN patients, the middle-aged and elderly IMN patients had higher rates of female, high titers of anti-PLA2 R antibodies, urea nitrogen, estimated glomerular filtration rate, total cholesterol and low density lipoprotein levels.The titers of serum anti-PLA2 R antibody and other laboratory indexes were not correlated with pathological stages. Conclusion The titer of serum anti PLA2 R antibody is closely related to age, urinary protein, renal function, serum total cholesterol, low density lipoprotein, serum total protein and albumin, and has a high specificity in the diagnosis of IMN.
The effect of stent combined with laparoscopic surgery on prognosis of colorectal cancer patients with obstruction
YANG Lei-lei, LAN Yue-fu, ZHOU Shen-kang, ZHANG Rui-li, BI Tie-nan, FANG Cheng-feng
2020, 18(2): 213-216. doi: 10.16766/j.cnki.issn.1674-4152.001207
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Objective To investigate the effect of stent combined with laparoscopic surgery on the prognosis of colorectal cancer patients with obstruction. Methods According to the different operation methods, 98 colorectal cancer patients with obstruction admitted in our hospital from January 2009 to January 2013 were divided into the stent group(stent placement first, followed by laparoscopic one-stage anastomosis) and the control group(conventional emergency laparotomy), 49 cases each group. The stoma rate, intraoperative condition, postoperative condition, complications and 5-year survival rate were compared between the two groups. Results Compared with the control group, the stent group had lower stoma rate(4.0% vs. 91.8%), shorter operation time(P<0.001), smaller incision(P<0.001), less bleeding(P<0.001), more lymph node dissection(P=0.020), shorter postoperative exhaust time(P=0.024), earlier fluid intake time(P=0.009), shorter painkiller use time(P<0.001), shorter postoperative hospital stay(P<0.001), fewer complications of stoma(P=0.027) and fewer complications of wound infection(P=0.031). The tumor size(P=0.398), hospitalization cost(P=0.498), postoperative bleeding(P=0.495), anastomotic leakage(P=0.320), intestinal obstruction(P=0.204) and 5-year survival rate(P=0.527) were similar in the two groups. Conclusion Stent combined with laparoscopic treatment of colorectal cancer patients with obstruction has obvious short-term efficacy, similar long-term efficacy, and does not increase the risk of tumor spread and metastasis. It is recommended for the treatment of obstructive colorectal cancer.
Efficacy of olanzapine and ziprasidone in the treatment of schizophrenia and their effect on glucose and lipid metabolism
CAO Feng, XIE Wei-gen
2020, 18(2): 217-219,232. doi: 10.16766/j.cnki.issn.1674-4152.001208
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Objective To investigate the efficacy of olanzapine and ziprasidone in the treatment of schizophrenia and their effects on glucose and lipid metabolism. Methods Ninety patients with schizophrenia admitted in our hospital from March 2014 to January 2017 were divided into group A and group B according to the random number table method, 45 patients in each group. Group A was treated with ziprasidone, and Group B was treated with olanzapine. The efficacy, glucose and lipid metabolism were compared between the two groups at 6 weeks after treatment. Results There was no difference in PANSS and CGI-S scores between the two groups before and 2, 4, and 6 weeks after treatment(all P>0.05). The scores of positive symptoms, negative symptoms, general spirit and PANSS of group A and group B treated for 4 and 6 weeks were lower than those before treatment(all P<0.05). The effective rate of treatment in group A was 97.78%, higher than 82.22% in group B(P<0.05). After 6 weeks of treatment, the FBS decreased, and INS, LDL, HDL, CHOL, TG increased in group A; the FBS, INS, LDL, CHOL and TG increased in group B; the FBS, INS, and LDL levels in group B were higher than those in group A; the differences were statistically significant(all P<0.05). Conclusion There was no significant difference between ziprasidone and olanzapine in treatment of schizophrenia, but the effect of ziprasidone on glucose and lipid metabolism is relatively small.
The effect of transverse abdominal plane block combined with parecoxib sodium in preemptive analgesia on postoperative analgesia in patients with colon cancer
LE Xin-hui, ZHAO Dong, ZHANG Yu-fan, LU
2020, 18(2): 220-223. doi: 10.16766/j.cnki.issn.1674-4152.001209
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Objective To explore the effect of transverse abdominal plane(TAP) block combined with parecoxib sodium preemptive analgesia on postoperative pain, inflammatory factors and recovery in patients with colon cancer. Methods Seventy-two patients with colon cancer admitted to our hospital from September 2018 to September 2019 were divided into TAP group and combination group according to the method of random number table, 36 cases in each group. Two groups were treated with TAP block and TAP block combined with parecoxib sodium for preemptive analgesia respectively. The degree of postoperative pain, inflammatory factor level and postoperative recovery were compared between the two groups. Results The VAS score of the combined group was lower than that of TAP group(P<0.05). The VAS score of the two groups decreased gradually(P<0.05). There was interaction effect between groups and time points. The levels of TNF-α, IL-6, IL-10 [(19.3±3.1) ng/L,(18.8±3.3) ng/L,(171.3±13.0) ng/L] of the combined group were lower than that of the TAP group [(23.6±4.0) ng/L,(21.7±3.6) ng/L,(185.5±14.3) ng/L], there was statistically significant difference(t=5.098, 3.563, 4.408, all P<0.001). The postoperative bed time, first exhaust time, hospitalization time [(31.8±12.4) h,(41.2±11.9) h,(17.0±2.6) d] of the combined group were shorter than the TAP group [(40.1±13.2) h,(49.6±13.6) h,(19.6±3.1) d, t=2.750, 2.789, 3.856, all P<0.05]. Conclusion The application of TAP block combined with parecoxib sodium preemptive analgesia in the anesthesia of patients undergoing colorectal cancer surgery has significant effect. It can significantly reduce postoperative pain, reduce the level of inflammatory factors, and promote the early recovery of patients after surgery, which is worthy of clinical implementation.
Application of color Doppler ultrasound in patients with hypertensive intracerebral hemorrhage after decompressive craniectomy
ZHUO Ming, ZHU Jian, YAN Xiu-xia, SONG Ke-yi, MA Jing-he
2020, 18(2): 224-228. doi: 10.16766/j.cnki.issn.1674-4152.001210
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Objective To analyze the application and value of bedside craniocerebral color Doppler ultrasonography in patients with hypertensive intracerebral hemorrhage after decompressive craniectomy. Methods A retrospective analysis of 32 cases from January 2017 to December 2018 in Bozhou People's Hospital of Anhui Province underwent decompressive bone flap decompression and routinely performed real-time monitoring of vital signs, bedside craniocerebral ultrasonography and regular skull CT review Patients with hypertensive cerebral hemorrhage were the experimental group. A total of 32 patients with hypertensive cerebral hemorrhage who had not undergone craniocerebral ultrasonography after decompressive decompression of the bone flap were selected as the control group, and the reoperation, recovery and prognosis of the two groups were compared. Results Patients with intracranial pressure> 20 mm Hg(1 mm Hg=0.133 kPa) in the experimental group after surgery had decreased end-diastolic flow velocity and increased pulsatility index, which was significantly different from those with normal intracranial pressure(all P<0.05). In the experimental group, 9 cases of intracranial lesions were found by bedside cranial color Doppler ultrasound. CT results were used as the gold standard. The coincidence rate of postoperative complications was 81.82%. In the experimental group, 6 patients underwent reoperation, and the intracranial hematoma volume and the lateral ventricle width on the ipsilateral side of the hematoma were highly consistent with CT examination(t=0.155, 0.147, P= 0.880, 0.886). Compared with the control group, the second operation time in the experimental group was faster, the GCS score increased at 1 week postoperatively, the discharge mRs score decreased, and the incidence of cerebral hernia was lower at 90 days after surgery(all P<0.05). Conclusion The use of bedside craniocerebral ultrasound after decompression of hypertensive intracerebral hemorrhage and decompression of bone flaps can monitor the postoperative condition of the patient in time and guide the second operation.
Effect of gamma globulin on immune status and serum inflammatory factors in patients with sepsis
ZHOU Ting, FANG Jian-jiang, LI Zeng-pan, ZHOU Yi-xia, JIANG Li, HAN Wen-wen, DONG Ming-jun, YU Jun-wei, YUAN Jie
2020, 18(2): 229-232. doi: 10.16766/j.cnki.issn.1674-4152.001211
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Objective To investigate the application value of gamma globulin in the treatment of sepsis. Methods A total of 118 cases of sepsis patients in our hospital were randomly divided into two groups, 59 cases each group. The control group was received basic treatment, and the observation group was treated with gamma globulin on the basis of the control group. The changes in clinical indicators(SOFA score, APACHE Ⅱ score, WBC, HR), T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+), immunoglobulin(IgG, IgM, IgA) and serum inflammatory factors(CRP, TNF-α, IL-10) were compared between the two groups before and after treatment. Results Compared with the control group after treatment, the SOFA score(6.72±1.25), APACHE Ⅱ score(11.19±2.09), WBC(7.82±1.32) and HR(83.29±15.35) in the observation group were significantly reduced(all P<0.001). After treatment, the level of T lymphocyte subsets(CD4+, CD8+ and CD4+/CD8+) in the observation group was significantly improved(all P<0.05), and the improvement effect was significantly better than that in the control group(all P<0.05). Meanwhile, in the control group, CD4+ and CD4+/CD8+ were significantly improved(all P<0.05). IgG levels in the observation group were significantly increased(P<0.05) and significantly higher than those in the control group(P<0.05). There was no significant change in humoral immunity in the control group(all P>0.05). After treatment, the levels of pro-inflammatory factors(CRP, TNF-α) in the two groups were significantly decreased, and those in the observation group were lower than those in the control group(P<0.05). The level of anti-inflammatory factor IL-10 in the two groups significantly increased(all P<0.05), and that in the observation group was significantly higher than that in the control group(all P<0.05). Conclusion Gamma globulin adjuvant therapy can significantly enhance the cellular immunity and humoral immunity of patients with sepsis, improve the level of serum inflammatory factors, and contribute to the improvement of patients' condition.
Effect of hs-TnI on the prognosis of patients with acute ischemic stroke and its predictive value
ZHAO Dong-qin, ZHAO Ke, LOU Jing-jing, YANG Yue, CHEN Miao, GU Da-dong
2020, 18(2): 233-235,246. doi: 10.16766/j.cnki.issn.1674-4152.001212
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Objective To explore the effect of hypersensitive troponin I(hs-TnI) on the prognosis of patients with acute ischemic stroke and its predictive value. Methods A total of 100 patients with acute ischemic stroke who were admitted to the Department of Neurology, the People's Hospital of Zhuji from January to March 2018 were included as the objects of study retrospectively. According to the mRS score of 90 days follow-up, the patients were divided into good prognosis(mRS 0-2) group and poor prognosis(mRS 3-6). Clinical data and laboratory examination indicators of all patients before treatment were compared. The relationship between hs-TnI level and 90-day prognosis was analyzed by binary logistic regression. The predictive value of hs-TnI in the prognosis of patients with acute ischemic stroke was analyzed by receiver operating curve(ROC). Results The age, female ratio, NIHSS score, proportion of disease history, systolic blood pressure and hospitalization time in poor prognosis group were significantly higher than those in good prognosis group(all P<0.05). There were no significant differences in proportion of disease history, smoking history, diastolic blood pressure, heart rate, and the levels of fasting blood glucose, low density lipoprotein and serum creatinine between two group(all P>0.05). The leucocyte count and hs-TnI in the poor prognosis group was significantly higher than that in the good prognosis group(all P<0.05). The levels of hemoglobin and hematocrit were significantly lower than those in the good prognosis group(all P<0.05). The results of binary logistic regression analysis showed that women, age, history of stroke, NIHSS score at admission and hs-TnI were independent risk factors for poor prognosis, while hemoglobin was a protective factor for good prognosis(all P<0.05). The AUC value of hs-TnI was 0.818. Conclusion The increase of hs-TnI is an independent risk factor for patients with acute ischemic stroke.
The role of adapted Johns-Hopkins cognitive exam in assessing the end of physical restraint in severe patients with cerebral hemorrhage
TAO Qin-qin, LU Jin-zhu, XU Sun-yan, ZHANG Lu, CHEN Qian, HE Ping
2020, 18(2): 236-238. doi: 10.16766/j.cnki.issn.1674-4152.001213
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Objective To analyze the role of adapted Johns-Hopkins cognitive exam(ACE) in assessing the end of physical restraint in severe patients with cerebral hemorrhage. Methods A total of 91 severe patients with cerebral hemorrhage diagnosed in our hospital were selected from March 2017 to September 2017, who were divided into directional force normal group(38 cases) and directional force abnormal group(53 cases). The normal group was released from restraint, and the abnormal group was continued to be restrained. The incidence of unplanned extubation and cognitive function score were compared between the two groups, and the correlation between orientation and cognition score were analyzed. Results The incidence of unplanned extubation in directional force normal group(0.00%) was significantly lower than that in directional force abnormal group(16.98%, P<0.05). The score of imitation ability, language competence, attention and calculation, memory and cognition in normal group was significantly higher than the abnormal group(all P<0.05). The results of Spearman analysis showed that the patient's directional power was positive correlated with the total score of cognition(r=0.839, P<0.001). Conclusion ACE can provide reference for severe cerebral hemorrhage patients to relieve physical restraint by evaluating cognitive function and directional ability.
Effect of autogenous dentin particles combining platelet rich plasma on guided bone regeneration in the treatment of periodontal bone defect
PAN Ling-feng, ZHANG Jing-kui, WANG Jia-han, WANG Liang
2020, 18(2): 239-242. doi: 10.16766/j.cnki.issn.1674-4152.001214
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Objective To investigate the effect of autogenous dentin particles combining platelet rich plasma in treatment of periodontal bone defect. Methods A total of 84 cases of single tooth loss and horizontal bone defect in the anterior maxilla require single implantation and guided bone regeneration patients in our hospital from October 2016 to February 2018 were divided into research group(42 cases) and control group(42 cases). The patients in research group received autogenous dentin particles combining platelet rich plasma, while the patients in control group received connective tissue graft re-establish treatment. All patients were tested by the Cone Bean Computed Tomographies(CBCT) at following time: T0(before surgery), T1(2 weeks after surgery), and T2(1 year after surgery). The buccal soft tissue profile(BSP), buccal bone thickness(BB), buccal soft tissue thickness(BST), repair success rate, complication rate, and pink esthetic score(PES) of the two groups were compared. Results There were statistically significant differences in BSP, BB, and BST between the two groups and time points(all P<0.05). The BB of the control group was larger than that of the research group at T1(P<0.05). The BSP of the research group at T2 was larger than that of the control group(P<0.05), and there was no significant difference in BB, BST between two groups(all P>0.05). There was no significant difference in repair success rate, complication rate and PES between the two groups(all P>0.05). Conclusion Autogenous dentin particles combined with platelet rich plasma have significant efficacy in guiding bone regeneration for the treatment of periodontal bone defects, doing well in aesthetic requirements of single anterior implants.
The correlation between serum cystatin C and cerebral microhemorrhage in patients with acute ischemic stroke
XIE Zeng-hua, CHEN Qiang, XIAO Yuan
2020, 18(2): 243-245. doi: 10.16766/j.cnki.issn.1674-4152.001215
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Objective To explore the risk factors of cerebral microhemorrhage(CMB) in patients with acute ischemic stroke and the correlation between the level of serum cystatin C(Cys-C) and the severity of CMB. Methods From October 2016 to July 2019, 120 patients with acute ischemic stroke hospitalized in the Department of Neurology of Beilun District People's Hospital were selected. After 7 days of hospitalization, MRI-SWI sequence was performed. According to the results, the patients were divided into CMB group(39 cases) and non-CMB group(81 cases). The differences of clinical data and test results between the two groups were compared. Taking statistically significant variables as independent variables, multivariate logistic regression was used to analyze the risk factors of CMB, and Spearman correlation was used to analyze the relationship between Cys-C level and the number of CMB. Results The age, SBP, DBP and hs-CRP of CMB group were higher than those of non-CMB group(all P<0.05). The Cys-C level of CMB group was(1.23±0.11) mg/dL, and that of non-CMB group was(1.02±0.11) mg/dL, the difference was statistically significant(t=9.754, P<0.05). The eGFR level of CMB group was(63.52±18.02) mL/(min·1.73 m2), and that of non CMB group was(76.44±18.42) mL/(min·1.73 m2), the difference was statistically significant(t=3.624, P<0.05). The result of Multivariate logistic regression showed that SBP, eGFR, Cys-C were independent risk factors of CMB in patients with acute ischemic stroke, and the Spearman correlation analysis showed that Cys-C level was positively correlated with the number of CMB(r=0.482, P<0.001). Conclusion Serum Cys-C has a positive correlation with CMB in patients with acute ischemic stroke, which can be used as an independent risk factor for CMB.
Clinical characteristics and relative factors of cognitive dysfunction in diffuse axonal injury
SHEN He-ping, WANG Geng-huan, YIN Han-kui
2020, 18(2): 246-248. doi: 10.16766/j.cnki.issn.1674-4152.001216
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Objective To investigate the clinical characteristics and related factors of cognitive impairment secondary to diffuse axonal injury(DAI) and provide clinical basis for early intervention. Methods Eighty-five patients with DAI conforming to the standard were included, and baseline information including demographic information, admission glasgow coma scale(GCS), coma time, operation,combination of other injuries, hypertension, diabetes, smoking, drinking, and nosocomial infection were collected. Montreal Cognitive Assessment(MoCA) was performed 3 months after injury to evaluate cognitive function in 85 patients with DAI. The analysis was done by t-test,χ2-test and logical regression analysis. Results Cognitive dysfunction occurred in 62 patients with DAI(72.9%). Cognitive dysfunction mainly manifested in attention, abstraction and memory(with t values respectively 9.004, 2.424, 7.423, P values below 0.001). logistic regression analysis showed that age and coma time were the risk factors for cognitive dysfunction(OR values respectively 1.842, 3.013, 95%CI values 1.211-4.323, 1.872-6.214, P values 0.034, 0.013). Conclusion Cognitive dysfunction in DAI mainly manifest in attention, abstraction and memory damage. Age and coma time are risk factors of cognitive dysfunction.
Effect of non-surgical periodontal treatment on serum biochemical indexes and inflammatory cytokines in patients with type 2 diabetes mellitus and chronic periodontitis
WU Wei, HAO Shu-li, ZHOU Yu-sen, MEI Yan-jie, LIU Zhen-fei
2020, 18(2): 249-251,281. doi: 10.16766/j.cnki.issn.1674-4152.001217
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Objective To analyze the effect of non-surgical periodontal treatment on biochemical indexes and inflammatory cytokines in serum of patients with type 2 diabetes mellitus and chronic periodontitis through carrying out non-surgical periodontal treatment and routine treatment in patients with type 2 diabetes mellitus and chronic periodontitis. Methods A total of 120 cases of type 2 diabetes mellitus with mild to moderate chronic periodontitis in Bozhou People's Hospital from August 2017 to February 2019,58 males and 62 females,aged(56.63 ± 10.96) years were collected. According to random number table,patients were divided into the non-surgical periodontal treatment group and the routine treatment group,60 cases each group. The non-surgical periodontal treatment group were received the routine treatment of diabetes,including diabetes education,periodontal health education,diet guidance,blood glucose control,and the non-surgical periodontal treatment,including plaque control,scaling and subgingival scaling(root planning),postoperative chlorhexidine gargle(3 times/d). The routine treatment group were only received the routine treatment of diabetes. The serum biochemical indexes(blood glucose,blood lipid,ratio of glycosylated hemoglobin,blood calcium,blood phosphorus,Creactive protein and inflammatory cytokines(TNF-α,IL-1β,IL-6,IL-10) before and after 3 months of treatment were compared. Results There was no significant difference in age,gender,BMI,waist circumference,fasting C-peptide,periodontitis condition,biochemical indexes and inflammatory factors between the two groups before treatment(all P>0.05). After 3 months of treatment,the blood glucose,glycosylated hemoglobin ratio,triglyceride,the levels of TNF-αand IL-1β in the non-surgical periodontal treatment group were significantly lower than those in the routine treatment group(all P<0.05). The levels of IL-10 in the non-surgical periodontal treatment group were significantly increased compared with those in the routine treatment group(all P<0.05). Conclusion Non-surgical periodontal treatment can improve the glucose and lipid metabolism and inflammatory state of patients with type 2 diabetes mellitus and chronic periodontitis by reducing the patients' level of blood glucose,blood lipid and adjust inflammatory cytokines.
Study on the relationship between the expression of microRNA-133,microRNA-208 and microRNA-499 in plasma and the severity of coronary artery stenosis
WANG Meng, HU Fang, CENG Li-rong, WU Jin-jia, HUANG Yi-fang, SU Bing-sen, MO Yan-ling
2020, 18(2): 252-254,321. doi: 10.16766/j.cnki.issn.1674-4152.001218
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Objective To explore the correlation between the expression levels of microRNA-133, microRNA-208 and microRNA-499 in plasma of patients with coronary heart disease and the degree of coronary artery stenosis, so as to provide reference for further judging the degree of coronary artery stenosis in patients with coronary heart disease. Methods From January 2017 to December 2018, 150 patients with coronary heart disease who were hospitalized in the Department of Cardiology of Zhongshan Torch Development Zone Hospital of Guangdong Province were randomly selected as the observation group, while 150 patients with non-coronary heart disease were selected as the control group. Gensini scores and the expression levels of microRNA-133, microRNA-208 and microRNA-499 in plasma of the two groups were compared. The data were analyzed by SPSS 22.0. Results The plasma levels of microRNA-133, microRNA-208 and microRNA-499 in the observation group were higher than those in the control group(all P<0.05). According to Gensini score, 150 patients with coronary heart disease were further divided into three groups: 45 cases of mild stenosis group, 72 cases of moderate stenosis group, 33 cases of severe stenosis group. The expression levels of microRNA-133, microRNA-208 and microRNA-499 in plasma of three groups were significantly different(all P<0.001), mild stenosis group was lower than moderate stenosis group and severe stenosis group, moderate stenosis group was lower than severe stenosis group(all P<0.05), and the expression levels of microRNA-133, microRNA-208 and microRNA-499 in plasma of patients with coronary heart disease were positively correlated with Gensini score(all P<0.05). Conclusion The expression levels of microRNA-133, microRNA-208 and microRNA-499 in peripheral blood circulation have potential clinical value in monitoring the degree of coronary artery stenosis.
Clinical effect of Danggui Shaoyao powder in the treatment of pelvic inflammation patients
CHEN Xiang-yi, HU Xin-xin
2020, 18(2): 255-257,261. doi: 10.16766/j.cnki.issn.1674-4152.001219
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Objective To explore the therapeutic effect of Danggui Shaoyao powder on pelvic inflammation and its influence on fibrinogen, hematocrit, ESR and inflammatory factors of patients. Methods A total of 96 patients with pelvic inflammatory disease admitted to our hospital from December 2008 to December 2018 were randomly divided into two groups according to the digital table method. The control group was treated with metronidazole, and the observation group was treated with Danggui Shaoyao Powder. The fibrinogen, hematocrit and erythrocyte sedimentation rate of patients were measured by automatic biochemical analyzer. The levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and C-reactive protein(CRP) were detected by enzyme-linked immunosorbent assay. The total effective rate, hemodynamics, and inflammatory factor levels in the two groups were compared. Results The clinical effective rate of the observation group(97.9%) was higher than that of the control group(72.9%, χ2=12.042, P=0.001). After treatment, the fibrinogen(2.5±0.1) g/L, hematocrit(34.9±1.3)% and erythrocyte sedimentation rate(11.9±1.7) mm in the observation group were all lower than those in the control group[(3.1±0.1) g/L,(40.2±1.3)%,(24.2±1.1) mm, t=33.516, 19.825, 41.714, all P<0.001]. Meanwhile, the levels of IL-6(59.2±4.9) ng/mL, CRP(5.1±1.2) ng/mL and TNF-α(3.2±1.2) mg/mL in the observation group were all lower than those in the control group [(88.5±4.9) ng/mL,(8.6±0.8) ng/mL,(7.1±1.0) mg/mL, t=36.460, 24.115, 23.169, all P<0.001]. Conclusion The treatment of pelvic inflammatory disease with Danggui Shaoyao powder can effectively improve the inflammatory factors such as IL-6, CRP and TNF-α, and promote the hemorheological indexes such as fibrinogen, hematocrit and erythrocyte sedimentation rate. It improves the therapeutic effect, which is worth popularizing.
Clinical significance and expression of glucocorticoid receptor α,β mRNAs in infant wheezing
YAO Huan-yin, MA Lan, DONG Hong, TONG Hai-ming, WANG Xiao-xian, CHEN Xiao-hong, LIU Shu-mei
2020, 18(2): 258-261. doi: 10.16766/j.cnki.issn.1674-4152.001220
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Objective To study the changes of the expression of GRα, β mRNAs in peripheral blood mononuclear cells(PBMC) and provide scientific basis for the selective application of GC and early rational intervention in infant wheezing. Methods All subjects were taken 2 mL peripheral venous blood to separate PBMC in the morning after admission. PBMC was separated by Ficoll-Hypaque method. The expression levels of GRαand GRβ mRNAs in PBMC were identified by RT-PCR. Results The expression of GRα mRNA in severe cases were significantly higher than that in the control group(median value 2.870×10-2 vs. 0.266×10-2,U=2.204, P=0.028), and no significant difference compared with the mild group(median value 0.865×10-2, U=0.650, P=0.516). The expression of GRβ mRNA in severe group was significantly higher than that in mild group and control group(median value 0.057×10-2 vs. 0.003×10-2 vs. 0.001×10-2, U=3.388, P<0.001; U=3.969, P<0.001). The ratio of GRα/β in severe group was significantly lower than that in mild group and control group(median value 25.900×10-2 vs. 780.800×10-2 vs. 98×10-2, U=2.708, P=0.007; U=2.192, P=0.028), while in recovery phase was significantly higher than in acute stage(median value 253.500×10-2 vs. 51.100×10-2, U=2.084, P=0.037). There was a significant positive correlation between clinical severity score and GRβmRNA(r=0.762, P=0.029), and a significant negative correlation with GRα/β ratio(r=-0.760, P=0.037). Conclusion The expression of GR is mainly showed the increase of GRβmRNA and the decrease of GRα/βratio in severe children. With the increase of clinical symptom score, the expression of GRβmRNA increased, and the ratio of GRα/β decreased in infant wheezing.
Correlation between optimal placement length of PICC catheter and body weight of preterm infants
HUANG Hai-ying, LIU Mei
2020, 18(2): 262-264,337. doi: 10.16766/j.cnki.issn.1674-4152.001221
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Objective To analyze the correlation between optimal catheter placement length of peripherally inserted central catheter(PICC) and body weight of preterm infants. Methods The clinical data of 150 preterm infants who underwent PICC catheterization in the neonatal intensive care unit of the hospital from May 2018 to May 2019 were retrospectively analyzed. The position of catheter tip was measured by chest radiography and the optimal placement length of PICC catheter on chest radiograph was obtained within 24 h of catheterization, and the weight data on the day of catheterization was obtained. The PICC catheterization and catheter vein distribution were described. Pearson correlation analysis and unitary linear regression analysis were used to explore the correlation between optimal placement length of different catheterization veins and body weight. Results Of the 150 preterm infants, there were 89 cases(59.33%) with PICC catheter tip reaching the optimal position, 28 cases(18.67%) with catheter placed too deep, 12 cases(8.00%) with catheter placed too shallow and 21 cases(14.00%) with abnormal catheter pathway. The arrival rate of optimal position of basilic vein was the highest(66.22%), and the incidence rate of deep placement of basilic vein was also the highest(22.97%), and the incidence rate of shallow placement of great saphenous vein was the highest(20.00%), and the incidence rate of abnormal pathway of cephalic vein was the highest(32.00%). Pearson correlation analysis showed that there was a positive correlation between optimal placement length and body weight of different PICC catheterization veins in preterm infants(all P<0.05). Unitary linear regression analysis showed that there was a linear relationship between the optimal placement length and body weight of different PICC catheterization veins in preterm infants(all P<0.05). Conclusion The incidence rate of PICC catheter ectopy is higher in preterm infants, and there are some differences in the distribution of ectopic conditions in different catheterization veins. Clinically, the appropriate catheterization veins should be selected in combination with the specific circumstance of preterm infants. The optimal placement length of PICC catheter in preterm infants has a certain correlation with body weight and can be used to guide PICC catheterization, but the specific regression equation is subject to further clinical validation.
A survey of mental health knowledge and training demands of community medical staff in C district of Beijing under the background of medical treatment partnership system
XU Hui-li, ZHOU Ya-ting, DENG Ming, XIN Yuan-yuan, MA Liang, ZHU Qing-sheng, XU Wei, ZHANG Xuan, ZHANG Ning
2020, 18(2): 265-268,317. doi: 10.16766/j.cnki.issn.1674-4152.001222
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Objective To understand the level of mental health knowledge of community medical staff after the establishment of Medical Treatment Partnership System(MTPS) in C district of Beijing, analyze the training demands of medical staff, and provide decision reference for improving the mental health service ability of community medical staff. Methods A total of 575 community medical staff in 37 communities of C district in Beijing were participated in the questionnaire survey, the descriptive statistical analysis was used to describe the mastery degree of mental health and training demands of community medical staff. The analysis of variance and chi-square test were used to compare the relative variables of different characteristic population, and binary logistic regression model was used to analyze the factors influencing the cognitive differences of community medical staff in providing mental health services in the community. Results The average mental health awareness rate is 87.5%. There are significant differences in the degree of mental health knowledge among the medical staff in different posts(F=8.220, P<0.001), and the scores of the preventive health care workers were the highest(90.1%), the lowest was nurses(83.2%). The 82.8% respondents thought that the training were helpful for them, the demands for training content of community medical staff were different(χ2=185.074, P<0.001). The demands for identification and diagnosis of mental illness knowledge was ranked on the top. The 86.0% respondents believed it is necessary to provide mental health services in community. The work position was the influencing factor of the knowledge on mental health service supply(χ2=10.416, P=0.015). Conclusion In order to further play the role of community in the construction of mental health service system, it is necessary to set up individualized training project for different positions of medical staff in the community, and improve their awareness and ability to provide mental health services through training.
Amplitude of low-frequency fluctuation(ALFF) in adolescent and adult major depression:a resting-state functional MRI study
KANG Jia-hui, KONG Ling-tao
2020, 18(2): 269-272. doi: 10.16766/j.cnki.issn.1674-4152.001223
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Objective To study the changes of brain activity in adolescent and adult patients with major depressive disorder(MDD), and to explore the commonness and difference of pathophysiological basis and pathogenesis between them for providing basis for accurate diagnosis and specific treatment of adolescent depression. Methods The volunteers were collected by means of advertisement recruitment, outpatient recommendation, and so on. After the demographic data collection and the evaluation and diagnosis of the scale, 30 first untreated adolescent depressive patients and 28 healthy controls, as well as 31 first untreated adult depressive patients and 34 healthy controls, were scanned for head resting state functional magnetic resonance(fMRI), and two samples of t test(GRF correction, P<0.05) were performed on 2 groups of adolescents and 2 adult groups of standard ALFF brain maps, respectively. The brain regions with significant difference were compared. Results Compared with the adolescent health control, the ALFF of Frontal_Sup_R(aal), Frontal_Sup_Medial_R(aal), Frontal_Mid_R(aal), Frontal_Sup_Orb_R(aal) were significantly increased in the adolescent depressive patients, no regions decreased. Compared with the adult health control, the ALFF of Insula(aal), Frontal_Inf_Oper(aal), Rolandic_Oper_R(aal),Precentral_R(aal), Putamen(aal) were significantly increased in adult depressive patients, no regions decreased. Conclusion Both Adolescents depression and adult depression have their own specific brain dysfunction, which showed increased activity, but no decreased activity. However, there still have some difference between them, suggesting that the neurobiological basis and pathogenesis of adolescent depression may be different from adult depression.
The value research of diffusion kurtosis imaging parameters in diagnosing Parkinson's disease
ZHANG Zhong-wei, LI Yang-fei, PAN Jing-li, LIU Su-zhi, HUANG Pei-yu, FAN Shu-feng, RAO Qin-pan
2020, 18(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.001224
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Objective Using diffusion kurtosis imaging(DKI) to assess the microstructure change of substantia nigra in Parkinson's disease patients so as to explore the value of diffusion kurtosis imaging parameters in diagnosing Parkinson's disease. Methods A total of 45 Parkinson's disease patients(PD group) and 39 healthy controls(HC group) with age and gender matched were recruited in August 2017 to June 2018 from Taizhou hospital affiliated to Wenzhou medical university, underwent structural MRI and DKI examination to all participants. Fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD), radial diffusivity(RD), fractional anisotropy of kurtosis(FAk), mean kurtosis(MK), axial kurtosis(AK) and radial kurtosis(RK) parametric images were obtained by postprocessing with DKI data. Manually drew the outline of substantia nigra as the region of interest(ROI), then statistically compared all the parameters of substantia nigra between PD group and HC group. By using receiver operating characteristic(ROC) curve to evaluate the diagnosis efficacy of parameters with statistically significant difference. Results FA, FAk, MK and AK value of substantia nigra had significant difference between the groups(all P<0.05). FA value of substantia nigra was lower in PD group, while FAk, MK and AK value of substantia nigra were higher in PD group. Area under curve(AUC) of ROC among FA, FAk, MK and AK value of substantia nigra were 0.754, 0.875, 0.654 and 0.818, respectively. Conclusion Diffusion kurtosis imaging parameters were valuable in diagnosing Parkinson's disease, FAk value of substantia nigra had the best diagnosis efficacy.
CT features of primary hepatic carcinosarcoma
LU Li-jian, HUANG Lu
2020, 18(2): 277-281. doi: 10.16766/j.cnki.issn.1674-4152.001225
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Objective Purpose We studied the CT features of primary liver carcinosarcoma in order to raise the awareness of it. Methods Clinical and CT data of 7 cases of liver carcinosarcoma proved by operation and pathology were collected, and retrospectively analyzed. Results A total of 7 patients were included in this study from January 2009 to February 2018, 6 of whom were male and 1 female. The patient's age range was 42-64. All patients were treated with abdominal pain as the main clinical symptom. Three patients had a history of cirrhosis. Four patients had a history of chronic hepatitis B. CA199 and AFP were positive in 3 patients and CA125 positive in one patient. The inner diameter of the tumor was 7.0-27.0 cm. Four cases of showed pseudocapsular formation of fibrous tissue around the tumor. Tumor tissues in 7 cases were composed of carcinomatous components and sarcomatous components. The carcinomatous components included 5 cases of hepatocellular carcinoma and 2 cases of cholangiocarcinoma. The components of sarcoma included fibrosarcoma in 4 cases, angiosarcoma in 2 cases and malignant fibrous histiocytoma in 1 case. All 7 patients underwent plain CT scan and three phase contrast enhanced scan. All 7 cases of tumor were single lesions with huge volume. Of them, 3 cases had protruding hepatic contour and 4 cases had tumor localized in the contour of liver. Three cases of tumors were round, four cases of tumors were irregular. On plain CT scan, the tumor showed inhomogeneous and low density. Large flake or thick-walled septal multilocular cystic areas can be seen in the lesion. In contrast, enhanced CT scan, the lesions showed gradual enhancement of the edge to the center on the three phase of contrast enhanced imaging. At arterial stage, the tumor's parenchyma presented as mild and moderate enhancement. In portal and delayed phase, the density of tumor parenchyma was slightly lower in 4 cases and equal in 3 cases. Conclusion Primary liver carcinosarcoma is a rare malignant tumor in clinic. These CT signs such as large mass from the liver, large flake or thick-walled septal multilocular cystic areas, on the three phase enhanced images, the lesion were gradually filled and enhanced from edge to the center, at portal vein phase and delayed stages, the tumor's parenchyma showed slightly lower densities, and so on, which will contribute to the diagnosis of liver carcinosarcoma.
Study on relation between CT three-dimensional reconstruction of diaphragm morphology and CAT score in patients with COPD
ZHANG Ye-na, ZHAO Wei-he, CHEN Jing-lu, DU Xue-kui, HUA Qi-feng, SUN Shou-zhong
2020, 18(2): 282-285. doi: 10.16766/j.cnki.issn.1674-4152.001226
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Objective To obtain the three-dimensional shape of the diaphragm in patients with COPD by three-dimensional reconstruction with 64-slice spiral CT, and to explore the relationship between the morphological indexes of diaphragm and the COPD Assessment Test(CAT). Methods The subjects of outpatient and inpatient in Ningbo No.2 Hospital from December 2010 to October 2014 were divided into the COPD group(30 patients) and the control group(20 patients) according to the 2007 criteria of Chinese Respiratory Society for the diagnosis and treatment guidelines of COPD. All the subjects were taken pulmonary function test, CAT and lung CT scan. The main morphological indexes of the diaphragm after CT three-dimensional reconstruction including the total diaphragm length(Ldi), the total diaphragmatic area(Adi), and the surface areas of the zone of apposition(Aap) were obtained and compared between patients with different severity in the COPD group. The correlation between these morphological indexes and CAT scores were analyzed. Results ① With the increase of the severity of COPD, the coronary Ldi and sagittal Ldi, the total diaphragmatic area and surface areas of the zone of apposition decreased gradually, and the CAT scores increased gradually, and there was significant difference among different COPD severity groups(all P<0.05). ② The total diaphragm length, the total diaphragmatic area, and Aap were negatively correlated with the CAT scores of COPD(all P<0.05). Conclusion CT three-dimensional reconstruction is a reliable method for evaluating the functional anatomy of the diaphragm, which can be used to evaluate the function of the diaphragm in COPD patients.
Targeted treatment of ALK-rearranged advanced NSCLC
ZHAO Mei, ZHANG Yi-ruo, DU Ying-ying
2020, 18(2): 286-290. doi: 10.16766/j.cnki.issn.1674-4152.001227
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Lung cancer is one of the most common malignant tumors in the world, more than 80% of whom are non-small cell lung cancer. Due to the insidious onset and lack of specific symptoms, most patients are diagnosed at an advanced stage, thus chemotherapy and molecular targeted therapy have become main treatment. The EML4-ALK fusion gene is one of the therapeutic targets for non-small cell lung cancer. It binds the intracellular tyrosine kinase domain to the extracellular ligand binding domain, resulting in the activation and expression of tyrosine kinase, toobtain carcinogenic effects. ALK fusion gene-positive lung cancer accounts for 3%-5% of non-small cell lung cancer and generally be in response to ALK tyrosine kinase inhibitors(TKIs). Crizotinib, as the first ALK inhibitors used in treatment of patients with advanced ALK-rearranged lung cancer, is well tolerated, benefits more than traditional chemotherapy, and improves objective response rateand quality of life. Ceritinib, alectinib, brigatinib, and lorlatinib also achieved considerable clinical benefit and were superior to crizotinib in clinical trials. The resistance of ALK inhibitors develops subsequently, including intrinsic resistance and acquired resistance, of which the most common mechanism is ALK-secondary mutations. The L1196 M mutation and the G1202 R mutation are the most common resistance mutations for crizotinib and second-generation ALK inhibitors, respectively. Currently, the first choice for drug resistance is the next-generation ALK inhibitors, and other treatments include combination with HSP90 inhibitor or pemetrexed. Fully understanding of the different mechanisms of resistance will help us to exploit personalized approaches overcoming resistance. This review aims to describe the key clinical trials of targeted therapy for ALK-positive advanced non-small cell lung cancer, and introduce advances in the diagnosis and treatments of drug resistance.
The role of exosomes in the pathogenesis of bronchial asthma
LI Zhu-ying, WANG Ting, LI Han-mei
2020, 18(2): 291-294. doi: 10.16766/j.cnki.issn.1674-4152.001228
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Asthma is a chronic inflammatory disease characterized by high airway reactivity. Eosinophils, neutrophils and mast cells can secrete inflammatory cytokines to induce inflammatory responses, mediate the destruction of surrounding tissues, and induce high secretion of airway mucus to increase airway hyperresponsiveness. Fibroblasts stimulate chronic airway inflammation for a long time, which leads to narrow lumen and high airway reactivity. The role of epithelial cells in regulating airway smooth muscle tone stimulates the flow of inflammatory cells and secretes a large number of inflammatory and nutrient mediators during injury and inflammatory stimulation. Bone marrow mesenchymal stem cells can rapidly differentiate and repair damaged lung cells and improve airway inflammation in asthma. Micrornas(miRNAs) are widely involved in cell proliferation and differentiation, transporter regulation, and progression and metastasis of a variety of diseases. Exosomes have been found to be associated with the pathogenesis of asthma, cancer, cardiovascular disease and other inflammatory diseases. Exosomes are nano-sized vesicles, widely distributed in the secretion of saliva, blood, breast milk, cerebrospinal fluid, urine and bronchoalveolar lavage fluid, contains many proteins, DNA, mRNA, miRNAs and lipid. Exosomes can inflammation, cell proliferation, migration, differentiation, apoptosis, regulate the body's immune response, transportation, nucleic acid involved in intercellular communication etc. Different cells can secrete exosomes containing specific inclusions and can participate in intercellular substance transfer and signal transduction. In recent years, it has been gradually recognized that exosomes from different cell sources and their related miRNAs play an important role in the pathogenesis of asthma. In this paper, the studies on the pathogenesis of asthma of exosomes and exosomal miRNAs from different cell sources above were reviewed, providing new targets for the prevention and treatment of asthma.
Expression of Ring Finger Protein 43 Gene in Cancers
ZHU Lin-bo, LI Peng-fei, ZHANG Peng-bin, CHEN Jian-wei
2020, 18(2): 295-297,310. doi: 10.16766/j.cnki.issn.1674-4152.001229
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RNF43(ring finger protein 43) is a member of proteins of Goliath and Godzilla families, which bears the characteristic sequence of an ubiquitin ligase and of a trans-membrane region, encoding E3 ubiquitination kinase and with the activity of E3 ubiquitin protein ligase. RNF43 has attracted much attention in the study of Wnt/β-catenin signaling pathway because of its high structural homology with ZNRF3(zinc and ring finger protein 3). RNF43 inhibits Wnt/β-catenin signalling by ubiquitinating Frizzled receptor and targeting it to the lysosomal pathway for degradation. Loss of function of RNF43 results in decrease or lack of degradation of Frizzled with enhancement of Wnt/β-catenin signalling pathway. The scavenging effect of RNF43 on Wnt membrane receptor is mediated by its binding to membrane receptors, so many studies have suggested that RNF43 is localized on the cell membrane. However, some scholars believe that RNF43 is located in the nucleus, even without specific organelles, but scattered in the cytoplasm. The abnormal expression and mutation of RNF43 gene are thought to be closely related to the occurrence and development of many cancers. Now there are many studies about the relationship between RNF43 gene and cancers, involving serrated colorectal lesions, gastric adenocarcinomas, pancreatic cystic lesions and adenocarcinomas, hepatic carcinoma, ovarian mucinous tumours, endometrial adenocarcinomas, neuroglioma and so on. Although large part of studies support that RNF43 is a tumor suppressor gene, a small number of studies suggest that RNF43 might be an oncogene. We make a review about the basic structure, location, biological function and expression of RNF43 gene in some cancers.
Research progress on the relationship between vitamin D and fetal growth restriction
WANG Zhi-hui, SHEN Xu-na, CHEN Xin-xiao, YAN Yu-hong
2020, 18(2): 298-302. doi: 10.16766/j.cnki.issn.1674-4152.001230
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Fetal growth restriction(FGR) is a common pregnancy complication that is closely associated with adverse outcomes, such as high perinatal mortality, adolescents' major health problems, and chronic adulthood diseases(e.g., cardiovascular and metabolic diseases). Although FGR affects up to 5% to 10% of pregnancies worldwide, there is currently no reliable and effective prevention and treatment method. Vitamin D is one of the fat-soluble hormones pivotal for body health. In addition, 1,25(OH)2D, which is biologically an active form of vitamin D, exerts a broad range of biological functions by specifically binding to vitamin D receptor(VDR), playing an important role in the maintenance of normal pregnancy, as well as the growth and development of the fetus. Moreover, VDR is a member of the nuclear superfamily receptor, as well as being an important component of the vitamin D metabolic pathway. VDR also mediates virtually all of the known biological actions of the hormonal ligand 1,25-dihydroxyvitamin D3[1,25(OH)2D3]. These actions are directed toward the nucleus, where the VDR binds to the regulatory regions of target genes, and modulates their transcriptional output. The polymorphisms of the VDR are associated with the genetic susceptibility of various diseases by affecting the transcriptional activity of VDR, altering the function of VDR protein, and directly or indirectly influencing the functions of vitamin D. Evidences of human and animal studies have shown that VDR is expressed in endometrial stroma and early decidual cells, VDR proteins are involved in the immune regulation of early embryo implantation, and VDR expression is decreased in the placenta of FGR patients. Therefore, the status of vitamin D and VDR gene polymorphism during pregnancy may be associated with FGR and low-birth-weight newborns. This article reviews the relationship among vitamin D, VDR gene polymorphism, and FGR.
Efficacy of needle warming moxibustion combined with massage manipulation on cold-dampness type of knee osteoarthritis
SHEN Lin-xing, WANG Ju-yan, QIAN Feng, HUANG Yao-zhen, WANG Yang
2020, 18(2): 303-306. doi: 10.16766/j.cnki.issn.1674-4152.001231
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Objective To observe the efficacy of needle warming moxibustion combined with massage manipulation on cold-dampness type of knee osteoarthritis. Methods Two hundred and twenty patients with cold-dampness type of knee osteoarthritis admitted to Tongxiang Hospital of Traditional Chinese Medicine and the First Hospital of Jiaxing from January 2017 to December 2018 were divided into observation group and control group by the random number table method, with 110 cases in each group. Both groups were treated with needle warming moxibustion, and observation group was additionally treated with massage manipulation. Both groups were treated for 2 courses. The clinical efficacy, pain degree, knee function and quality of life evaluated with health survey scale MOS SF-36 were compared between the two groups, and the incidence rate of adverse reactions was recorded. Results The clinical cure rate of observation group was significantly higher than that of control group(34.55% vs. 20.00%, χ2=5.866, P=0.015). After treatment, the scores of pain rating index(PRI), visual analogue scale(VAS) and present pain intensity(PPI) of both groups were decreased, and the scores of observation group were lower than those of control group(t=-6.912,-10.364,-8.975, all P<0.001). The scores of different dimensions and total score of knee function, scores of different dimensions and total score of quality of life of both groups were increased after treatment. Besides, the scores of different dimensions and total score of knee function(t=5.465, 5.059, 3.863, 6.014, 13.852, all P<0.001), scores of different dimensions of quality of life(t=8.777, 9.877, 2.963, 5.553, 5.799, 2.127, 5.714, 4.403, all P<0.05) in observation group were higher than those in control group. Conclusion Compared with simple needle warming moxibustion for cold-dampness type of knee osteoarthritis, combined application of massage manipulation can further optimize clinical efficacy, relieve pain, and improve knee function and quality of life, with safety.
Application of formative assessment in standardized resident training of thoracic surgery
XU Guang-wen, XU Shi-bin, XU Mei-qing, LI Ping, SONG Gui-qi, JIE Ming-ran
2020, 18(2): 307-310. doi: 10.16766/j.cnki.issn.1674-4152.001232
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Objective To explore the application effect of formative assessment in standardized resident training of Thoracic Surgery. Methods A total of 60 residents who attended the Department of thoracic surgery from Jan to Jun 2019 during surgery resident standardized training in The First Affiliated Hospital of University of Science and Technology of China were selected as subjects and randomly divided into observation group and control group, with 30 in each group. After the Thoracic Surgery training, training effect was evaluated by examination and questionnaire survey. Results The scores of theoretical examination(91.57 ±3.09 vs. 87.87±3.20) and skill examination(91.17±2.35 vs. 86.93±2.38) in observation group were higher than those of control group. The difference was statistically significant(all P<0.05). The ability of self-learning、 clinical thinking, clinical operation and evaluation teaching methods were higher than those of control group, the differences were statistically significant(all P<0.05). There was no significant difference between the two groups in the ability of communication(P>0.05). Conclusion Formative assessment used in thoracic surgery training during surgery resident standardized training is beneficial to improve training effect and the quality of teaching.
The influence of preparedness and adult attachment on care ability in stroke patients' main caregivers
TIAN Xing, ZHUANG Li-ying, ZHOU Hai-yan
2020, 18(2): 311-313,340. doi: 10.16766/j.cnki.issn.1674-4152.001233
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Objective To explore the current status of care ability in stroke patients' main caregivers and the effect of care preparedness and adult attachment. Methods There were 223 qualified caregivers collected from Department of Neurology of two tertiary hospitals in Zhejiang province between July 2018 and January 2019 by convenience sampling. The basic data questionnaire, care preparedness scale, experiences in close relationships questionnaire and comprehensive care ability questionnaire of stroke patients' caregivers were used in the investigation. The data were imported into SPSS 22.0 software. T-test and ANOVA were used to analyze the influencing factors of care ability, and the statistically significant variables were included in multiple linear regression analysis. Results The score of care preparedness was 15.31±4.87. The scores of attachment anxiety and attachment avoidance were 3.28±0.76 and 3.52±0.83 respectively. The number of safe attachment was 102(45.7%). The score of care ability was 95.64±23.47. The regression results showed that care preparedness, total time of care, self-care degree of patients, safe attachment and educational level could affect the care ability of the main caregivers of stroke(F=28.442, P<0.001), which could explain 55.3% of the total variation. Conclusion Medical staff should pay attention to the care ability of the main caregivers of stroke patients, help them improve care preparedness, adopt individualized training methods according to their different types of attachment and educational level, and improve the quality of life of stroke patients' and caregivers.
Surveillance of multi-drug-resistant bacterial infections in patients with malignant tumors in a hospital and analysis of risk factors
HONG Yan, GUO Hai-ping, CHEN Jin-lian, HUANG Wei-fen, LI Jun-hua
2020, 18(2): 314-317. doi: 10.16766/j.cnki.issn.1674-4152.001234
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Objective To investigate the infection status and risk factors of multidrug resistant bacteria(MDRO) in patients with malignant tumors in a hospital. Methods A total of 1 280 patients with malignant tumor infection admitted to a hospital from January 2014 to December 2017 were divided into MDRO infection group(n=270) and non-MDRO infection group(n=1 010). Risk factors for MDRO infection in malignant tumor patients were analyzed by univariate and multivariate logistic regression. Results The incidence of MDRO infection was 21.09%(270/1 280) in 1 280 patients with malignant tumors. A total of 295 strains of multidrug-resistant bacteria were detected in 270 patients with MDRO infection. The top three strains were Acinetobacter Baumannii(31.19%), Pseudomonas Aeruginosa(23.05%) and Escherichia coli(19.32%). Univariate and multivariate logistic regression analysis showed that long-term bedridden(OR=2.804, 95% CI:1.725-4.364), invasive operation(OR=3.907, 95% CI:2.914-7.523), types of antibiotics used(OR=5.306, 95% CI:4.105-9.248), time spent using antibiotics(OR=3.117, 95% CI:2.208-6.731) and low albumin level(OR=2.105, 95% CI:1.286-3.740) were risk factors for MDRO infection in patients with malignant tumors. Conclusion There are many risk factors for MDRO in patients with malignant tumors. Effective prevention and control measures should be taken against these risk factors to reduce the incidence of MDRO infection.
Effect of cognitive behavioral therapy for insomnia on sleep quality and mood in patients with alcohol dependence
WANG Xiao-jiao, SHEN Bian-hong
2020, 18(2): 318-321. doi: 10.16766/j.cnki.issn.1674-4152.001235
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Objective To explore the effects of cognitive behavioral therapy for insomnia on sleep quality, depression and anxiety in patients with alcohol-induced mental and behavioral disorders. Methods A total of 66 patients with alcohol-induced mental and behavioral disorders who met the inclusion criteria were enrolled from May 2017 to December 2018, and randomized into observation group(33 patients) and control group(33 patients). Patients in the control group received routine treatment and nursing intervention. On this basis, the observation group further accepted cognitive behavioral therapy intervention for insomnia. The total intervention time lasted for 4 weeks. The time of sleep onset, total sleep time, sleep efficiency, sleep quality, depression and anxiety of the two groups were measured before and after treatment. Results There were no significant differences in demographic data and baseline Pittsburgh Sleep Quality Index scores, depression self-rating scale scores and anxiety self-rating scale scores between the two groups(P>0.05). After 4 weeks of intervention, the observation group's time of sleep onset(1.77±0.52 vs. 2.21±0.67, P=0.004), total sleep time(1.26±0.83 vs. 1.72±0.95, P=0.040), sleep efficiency(0.76±0.84 vs. 1.26±0.75, P=0.013), Pittsburgh Sleep Quality Index questionnaire score(observation 9.38±6.29 vs. 13.54±6.85, P=0.013), depression self-rating scale score(36.81±7.76 vs. 45.47±8.25, P<0.001), and anxiety self-rating scale score(33.18±6.73 vs. 42.26±11.48, P<0.001) were significant lower than those of the control group(all P<0.05). Conclusion Cognitive behavioral therapy for insomnia can effectively improve the quality of sleep, depression and anxiety in patients with mental and behavioral disorders caused by alcohol, reduce the sleep time of patients alcohol-induced mental and behavioral disorders, increase their total sleep time, improve their sleep efficiency, improve sleep quality, and help patients recover from their illness.
Study of carotid artery stenting with high perfusion syndrome
FU Xiao-yan, WANG Ling-ru, JIANG Li, LI You-you, YU Gang-lian, ZHOU Hua-dong
2020, 18(2): 322-324. doi: 10.16766/j.cnki.issn.1674-4152.001236
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Objective To investigate the association of cerebral hyperperfusion syndrome(CHS) with age and vascular stenosis severity in patients with carotid artery stenting. Methods From January 2011 to December 2015, 257 patients with carotid artery stenting were selected as the subjects. Before operation, transcranial Doppler ultrasound was used to investigate the basic blood flow of the patients, the postoperative 1, 12, 24 h and the bedside TCD examination were compared with the preoperative examination results, According to the results of TCD examination, 257 patients were divided into CHS group(13 cases) and control group(244 cases) without CHS group, to analyze the correlation between the incidence of high perfusion syndrome after carotid artery stenting and age, systolic blood pressure and vascular stenosis. Results The incidence of CHS was 5.1%(13/257) in patients with carotid artery stenting, with the increase of age, systolic blood pressure and vascular stenosis, the incidence of CHS increased gradually(χ2=17.973, 24.357, 23.488, all P<0.001). Conclusion High perfusion syndrome is a rare but serious complication after carotid artery stenting. The patients who are older, more than 170 mm Hg(1 mm Hg=0.133 kPa), and the degree of stenosis more than 90% are more likely to occur. In clinical work, the change of blood pressure should be closely observed and strict control of blood pressure, especially in elderly patients with stenosis of blood vessels, is the nursing key to prevent and reduce the occurrence of high perfusion syndrome.
Application of evidence-based perioperative nursing in laparoscopic radical resection of colorectal cancer
WANG Shao-hua, LU Yao, LI Man-lin, ZHAO Hui, LIANG Qi-sheng, LIU Wei
2020, 18(2): 325-328. doi: 10.16766/j.cnki.issn.1674-4152.001237
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Objective To investigate the application value of perioperative evidence-based nursing on enhanced recovery after surgery in patients undergoing laparoscopic surgeries for colorectal cancer. Methods Eighty patients undergoing selective radical resection of colorectal cancer under laparoscope were enrolled in this study from January 2017-May 2018 in Bozhou City People's Hospital. All of patients were randomly divided into evidence-based nursing group and control group, 40 patients in each group. Usual care was applied into patients in control group, and usual care combined with evidence-based nursing was applied into patients in evidence-based nursing group. The mental state and surgical incision healing after operation were evaluated in both two groups. The time to get out of bed after operation and postoperative complications as well as the mean hospitalization time were compared in two groups. Results There were no significances of SAS and SDS scores between control group and evidence-based nursing group. The mental state in both two groups were improved after nursing interventions; moreover, the mental state in evidence-based nursing group were superior to these in control group. Compared to control group, postoperative complications including abdominal hemorrhage, abdominal infection, subincision hemorrhage and incision infection were decreased in observation group, but they didn't achieve statistical threshold. Surgical incision healed better in evidence-based nursing group. Additionally, the time to get out of bed after operation and the mean hospitalization time in evidence-based nursing group were significantly shorter than these in control group(t=-10.304,-9.157, all P<0.001). Conclusion Perioperative evidence-based nursing can decrease incidences of abdominal hemorrhage, abdominal infection, subincision hemorrhage and incision infection, and improve surgical incision healing as well as enhanced recovery after surgery.
Application of phlegm and blood stasis therapy combined with nursing intervention in patients with hypertensive headache
YE Yu-zhu, PAN Quan
2020, 18(2): 329-331,334. doi: 10.16766/j.cnki.issn.1674-4152.001238
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Objective To explore the clinical efficacy of phlegm and blood stasis therapy combined with nursing intervention in the treatment of hypertensive headache and its impact on patients' quality of life and nursing satisfaction. Methods Eighty-six patients with hypertensive headache admitted to Lishui Hospital of Traditional Chinese Medicine from March 2017 to March 2019 were randomly divided into control group(n=43) and observation group(n=43). The control group was treated with routine treatment, while the observation group was treated with Sheyi rubbing therapy. Two groups of patients were given comprehensive nursing intervention. The clinical efficacy of the two groups and the blood pressure, the frequency of headache attacks, and the brachial artery blood flow-mediated diastolic function were compared before and after treatment. The health status survey form(SF-36) was used to evaluate the quality of life of patients before and after treatment. Results The total effective rate was significantly higher in the observation group than that in the control group(95.35% vs. 81.40%, χ2=4.074,P<0.05). The frequency of headache attacks after treatment in the observation group [(1.85±1.02) times/month vs.(2.96±1.36) times/month], diastolic blood pressure [(76.93±8.66) mm Hg vs.(84.36±7.15) mm Hg] and systolic blood pressure [(126.18±13.29) mm Hg vs.(132.45±14.45) mm Hg] was significantly lower than that of the control group, and the brachial artery blood flow-mediated diastolic function rate [(6.48±1.25)% vs.(5.32±1.62)%] was significant higher than that of the control group(all P<0.05). The scores of the SF-36 scale in the observation group were significantly higher than those in the control group(all P<0.05). Conclusion The combination of phlegm and blood stasis therapy in the treatment of hypertensive headache is effective, which can significantly reduce the headache frequency, improve hypertension and vascular endothelial dysfunction, and improve the quality of life.
MEI Dao-qi, WANG Yuan, MEI Shi-yue, ZHANG Yao-dong, CHEN Guo-hong
2020, 18(2): 332-334. doi: 10.16766/j.cnki.issn.1674-4152.001239
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LUO Fa-xin, XIANG Zhang-yi, NING Zong, ZHU Ji-jin
2020, 18(2): 335-337. doi: 10.16766/j.cnki.issn.1674-4152.001240
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CAO Zhong-yu, WU Tao, HAN Ying, XUE Feng, MAO Dong-feng, PAN Yao-zhu, WANG Cun-bang, BAI Hai
2020, 18(2): 338-340. doi: 10.16766/j.cnki.issn.1674-4152.001241
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