中华全科医学

Study on the current situation of the diagnosis and treatment of specialist diseases by general practitioners in Shanghai

YANG Rong, FANG Ning-yuan, JIN Hua, PAN Ying, WANG Chao-xin, SHI Jian-jun, FAN Hui-qin, YU De-hua

2020, 18(8): 1251-1255. doi: 10.16766/j.cnki.issn.1674-4152.001478

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Objective To understand the current situation of general practitioners' diagnosis and treatment of specialized diseases in Shanghai Community Health Service Center by means of questionnaire survey, and to provide direction for the continuing education of community general practitioners in order to improve the clinical quality of community general medicine and further promote the development of general medicine. Methods In November 2018, the administrators of 244 community health service centers and 4 047 general practitioners working in community health service centers were distributed through the questionnaire star network using a self-designed questionnaire. Results The proportion of doctors in ophthalmology(62.82% vs. 33.13%, P<0.05) and otolaryngology(60.26% vs. 30.12%, P<0.05) in urban areas was higher than that in suburbs, and the proportion of pediatricians in suburbs was higher than that in urban areas(34.94% vs. 20.51%, P<0.05). The referral rates of otorhinolaryngologic diseases(56.15% vs. 51.87%), paediatric diseases(81.46% vs. 66.60%), dermatology diseases(23.83% vs. 19.08%) in urban areas were higher than those in suburban areas(all P<0.05), while the referral rate of gynecological diseases in suburb was higher than that in urban area(79.40% vs.74.61%, P<0.05). The proportion of services provided by urban general practitioners was higher than that provided by suburban general practitioners in chronic disease management appointments(82.55% vs. 77.47%, P<0.05), psychological counseling(73.83% vs. 66.45%, P<0.05) and nutritional counseling(72.59% vs. 61.57%, P<0.05). Conclusion General practitioner of Shanghai Community Health Service Center have urban-rural differences in the diagnosis and treatment behavior of specialized diseases, which may be due to the difference in the proportion of specialized doctors, the lack of confidence in the ability of diagnosis and treatment of specialized diseases, and the uneven distribution and development of health resources. In the future, the contents of related specialized diseases should be add to the continuing education of community general practitioners.

FAN Xiao-yun, LI Zhi-jun

2020, 18(8): 1256-1257.

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Cause and management of recurrent retinal detachment after scleral buckling in 11 cases

DONG Kai, WANG Yi-sai, DING Jie, KE Gen-jie

2020, 18(8): 1258-1260. doi: 10.16766/j.cnki.issn.1674-4152.001479

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Objective To retrospectively analyze 11 patients with recurrent retinal detachment after scleral buckling, investigate the causes and treatment of recurrent retinal detachment, and provide clinical basis for the treatment. Methods Total 11 patients(11 eyes) with recurrent retinal detachment after scleral buckling surgery in our hospital from January 2016 to December 2017 were collected. The causes of recurrence, the choice of surgical methods and the recovery of visual function were analyzed by fundus examination, reoperation and visual acuity. Results Fundus examination showed that in patients with recurrent retinal detachment, there were 3 eyes with primary tears, 8 eyes with new tears, 2 eyes with intraocular lens and 3 eyes with high myopia. PVR analysis showed that 1 eye was grade B, 8 eyes were grade C1, 2 eyes were grade C2. There were 5 cases(5 eyes) with old retinal detachment signs. Re-operation:scleral buckling was performed again in 1 eye, vitrectomy + C3 F8 filling in 1 eye, and vitrectomy + silicone oil filling in 9 eyes. The retina had been restored after operation in all patients. The average best corrected visual acuity of postoperative patients was 3.61±1.20, significantly higher than that of preoperative patients(3.26±1.14), with statistical significance(t=-3.121, P<0.05, 95% CI:-0.592 to-0.098). Conclusion The main causes of retinal detachment after scleral buckling surgery are the opening of the primary hole, retinal hole re-opening the new hole by the proliferation of the retina, and strong freezing during operation. High myopia and intraocular lens may be the risk factors. For young people without PVR, the scleral buckling surgery should be first choice to treat rhegmatogenous retinal detachment. In vitrectomy, the membrane should be stripped as clean as possible, and the laser should be used as the main method, and 360 degrees of laser therapy should consider. For patients with PVR grade C2 or above, silicone oil should be used firstly.

Efficacy and safety of left atrial appendage occlusion in the therapy for non-valvular atrial fibrillation

ZHU Jing, XU Jian, SU Hao, ZHU Hong-jun, SHEN Wei, GUO Fei, LUO Jian-feng, ZHANG Can

2020, 18(8): 1261-1264. doi: 10.16766/j.cnki.issn.1674-4152.001480

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Objective To observe the short-term curative effect and safety of therapy of left atrial appendage closure(LAAC). Methods The patients with non-valvular atrial fibrillation(NVAF) were chosen according to inclusion and exclusion criteria from Department of Cardiology in the First Affiliated Hospital of USTC from November 2018 to September 2019. The therapy for NVAF of LAAC was performed under general anesthesia and mediated by intracardiac echocardiography. The composite end point rate of device or operation related events, ischemic stroke, systemic embolism and cardiovascular death were observed 7 days and 6 months after operation. The degree of left atrial appendage occlusion at 45 days and 6 months were observed. Results Total 70 patients were selected, there was no serious adverse events such as stroke, systemic embolism and overall death observed in the early 7 days after surgery. One ischemic stroke(1.4%, 1/70) occurred during the 6-month follow-up, 48.5%(34/70) completely sealed within 45 days, 55.7%(39/70) completely sealed within 6 months by transesophageal echocardiogram. The effective LAAC rate was 100%(70/70) at both 45 days and 6 months follow-up. Conclusion The therapy for NVAF of LAAC is safe and effective. The results of this study provide new ideas for the treatment of NVAF patients in China who need oral anticoagulants for a long time.

Study on the relationship between plasma miR-21 and recurrence of atrial fibrillation after radiofrequency ablation

YU Rong-hui, YU Wei-ya, XU Dong-ling, LU Jun, WANG Wei, CAO Zhan-wei, LU Zhao-peng, HOU Cai-na, ZHAO Xin, XU Feng-qiang

2020, 18(8): 1265-1267,1336. doi: 10.16766/j.cnki.issn.1674-4152.001481

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Objective To investigate plasma levels of miR-21, miR-133, miR-328 in patients with atrial fibrillation, and explore their correlation with the recurrence of atrial fibrillation after radiofrequency ablation. Methods Total 500 patients with atrial fibrillation admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University, General Hospital of Shenma Group, the Second Hospital of Shandong University and the Affiliated Hospital of Qingdao University from September 2016 to September 2018 were selected as the study objects, and 200 healthy patients who underwent physical examination in Beijing Anzhen hospital during the same period were selected as the control group. Fasting venous blood was extracted to detect the levels of miR-21, miR-133 and miR-328. All patients with atrial fibrillation were treated with radiofrequency ablation. After the operation, oral propafenon 150 mg was taken 3 times/d for 1 month, and the patients were followed up for 1 year. MicroRNA expression levels of patients in recurrent group and the non-recurrent group were compared, and the effect of microRNA in predicting the recurrence of atrial fibrillation was analyzed. Results Postoperative recurrence occurred in 136 of the 500 patients with atrial fibrillation(27.2%). There was no significant difference in baseline data among the three groups(all P<0.05).The expressions of miR-21 and miR-328 in the recurrent group and the non-recurrent group were higher than those in the control group, while the expressions of miR-133 were lower than those in the control group(all P<0.05). However, only miR-21 in the recurrence group and the non-recurrence group showed statistical significance(P<0.05).The ROC curve for predicting the recurrence of atrial fibrillation showed that miR-21 cut-off value(1.995) had the highest diagnostic efficiency, with sensitivity, specificity, Youden index and AUC of 77.21%, 83.79%, 0.610 and 0.876, respectively. Conclusion The significantly increased expression of miR-21 in plasma is of certain reference value for predicting the recurrence of atrial fibrillation after radiofrequency ablation, it can be used as a basis for guiding clinical treatment.

Seasonal variation of serum TSH,TT3,TT4 in normal population in Hefei

ZHENG Ping-ping, HU Hua-qing, XU Min, DENG Da-tong, XIA Tong-jia, ZHU Dong-chun

2020, 18(8): 1268-1271. doi: 10.16766/j.cnki.issn.1674-4152.001482

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Objective To explore the seasonal changes of serum thyroid stimulating hormone(TSH), serum triiodothyronine(TT3) and serum total thyroxine(TT4) concentrations using big data obtained from the physical examination center. Methods Information of 19 434 individuals(aged>20 years) undergoing physical examination in the First Affiliated Hospital of Anhui Medical University from June 2017 to May 2019 were collected. Thyroid hormone of these subjects were detected. According to the definition of meteorological seasons, spring, summer, autumn and winter were respectively from march to May, June to August, September to November and December to February. There were 5 182 cases in spring, 5 384 cases in summer, 6 500 cases in autumn, and 2 368 cases in winter. The concentrations of TSH, TT3 and TT4 in different seasons were compared. The Spearman correlation analysis of daily TSH, TT3 and TT4 concentrations with daily maximum temperature, minimum temperature, average temperature, sunshine duration and precipitation were performed. Results Serum TSH concentration showed seasonal changes during the two years, with statistically significant difference(P<0.05). They increased in winter(2.300 μIU/mL)and spring(2.316 μIU/mL), while they decreased in summer and autumn(2.200 μIU/mL). The TT3 level was different in the four seasons, and the difference was statistically significant(P<0.05), with the highest TT3 level in autumn(1.89 nmol/L), the TT3 level in winter(1.88 nmol/L) was next. The TT4 levels in spring and summer were significantly different from those in other seasons(P<0.05), TT4 level in autumn(97.44 nmol/L) and winter(96.18 nmol/L) was the highest,and TT4 level in spring(95.76 nmol/L) was higher than that in summer(95.74 nmol/L). Spearman correlation analysis of daily TSH, TT3 and TT4 concentrations and related indicators showed that the correlation coefficients were all small, with no statistical significance(P>0.05). Conclusion The serum TSH, TT3 and TT4 concentration were significantly affected by season. The effect of seasonal change on serum TSH, TT3 and TT4 level should be considered when interpreting the results of thyroid hormone level in clinic.

Study on characteristics of brain activity and the functional connection between thalamus and whole brain in obsessive-compulsive disorder patients

NIU Qi-hui, NIU Ming-min, ZHANG Li-fang, LIU Jun-hong, CHENG Jing-liang, YANG Lei, LI You-hui

2020, 18(8): 1272-1275,1282. doi: 10.16766/j.cnki.issn.1674-4152.001483

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Objective To investigate the characteristics of brain functional activities in obsessive-compulsive disorder(OCD) patients compared with healthy controls in resting state, and to explore the functional connection patterns between bilateral thalamus and whole brain in patients. Methods According to the diagnostic criteria of OCD in ICD-10, 26 patients with OCD(OCD group) and 25 healthy volunteers(HC group) matched in gender, age and education background were selected for Y-BOCS, HAMA, HAMD scale tests and brain functional MRI scans. ReHo analysis was carried out at the whole brain voxel level, and brain regions with different ReHo values between the two groups were screened. The left and right thalamus were used as seed points for the analysis of the whole brain functional connection. Results Brain regions with different ReHo values between OCD group and HC group included left thalamus, right thalamus, right paracentral lobule, right posterior central gyrus and left angular gyrus. Taking left thalamus as the seed point for the analysis of brain functional connectivity, compared with HC group, the OCD group showed weaker functional connectivity in bilateral thalamus, left frontal middle gyrus, right hippocampus and right caudate nucleus, and showed enhanced functional connectivity in bilateral anterior central gyrus, left parietal lobe, bilateral temporal lobe, bilateral posterior central gyrus, bilateral calcarine gyrus, bilateral lingual gyrus, bilateral precuneus, bilateral cuneus, bilateral cerebellum, right fusiform gyrus and bilateral paracentral lobule. Taking right thalamus as the seed point to analyze the connections of the brain, the OCD group, compared with HC group, showed weaker functional connectivity in left medial frontal gyrus, right superior frontal gyrus, bilateral thalamus, bilateral anterior cingulate gyrus, bilateral medial cingulate gyrus, and right marginal gyrus, and showed enhanced functional connections in bilateral temporal lobe, bilateral occipital lobe, bilateral cerebellum, bilateral cuneus lobe, left fusiform gyrus, bilateral lingual gyrus and bilateral Calcarine gyrus. Conclusion Patients with OCD have abnormal functional activities in multiple brain areas, weakened functional connections in the limbic CSTC loop, and enhanced compensatory functional connections between the thalamus and the middle and posterior parts of the brain.

Extraction and identification of exosomes from human nasopharyngeal carcinoma cell lines with different metastatic habits

GUO Shu-nan, WANG Geng-ming, ZHANG Lei, YING Qiao-ling, DING Jian-ming, ZHOU Yan, ZHOU Yu-fu, JIANG Hao

2020, 18(8): 1276-1278,1340. doi: 10.16766/j.cnki.issn.1674-4152.001484

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Objective To explore the expression of exosomes in human nasopharyngeal carcinoma(NPC) cell lines SUNE-1-5-8 F, SUNE-1-6-10 B, SUNE-1 and normal nasopharyngeal epithelial cells NP69, and to provide a theoretical basis for further study of new methods of diagnosis and treatment of NPC. Methods Exosomes were isolated from SUNE-1-5-8 F, SUNE-1-6-10 B, SUNE-1 and NP69 culture supernatants using exosome extraction kits, and verified by transmission electron microscopy. The concentration of exosome protein was determined by BCA kit. Eexosome specific antigen molecule CD63 and Flotillin-1 were detected by western bolt. Results Vesicles were isolated from supernatant of three kinds of nasopharyngeal carcinoma cell lines and normal nasopharyngeal epithelial cells, showed a circular vesicle under a transmission electron microscope. The exosomal protein concentrations of SUNE-1-5-8 F, SUNE-1-6-10 B, SUNE-1 and NP69 were 0.778, 0.635, 0.788, and 0.576 μg/μL, respectively. CD63 and Flotillin-1 were expressed in all cell lineage-derived exosomes. Conclusion Three kinds of nasopharyngeal carcinoma cell lines SUNE-1-5-8 F, SUNE-1-6-10 B, SUNE-1 and normal nasopharyngeal epithelial cell line NP69 all produce exosomes.

Analysis of the epidemiology and risk factors of pterygium in 116 elderly patients in Hefei area

XING Yi, JIANG Fang-fang, JIANG Bo, SHI Chun-sheng

2020, 18(8): 1279-1282. doi: 10.16766/j.cnki.issn.1674-4152.001485

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Objective To investigate the epidemiological characteristics of pterygium patients over 50 years old in Hefei area and analyze the related risk factors affecting its incidence. Methods Using case-control study method, the clinical data of 116 elderly patients with pterygium treated by surgery in Anhui Second People's Hospital from October 2017 to October 2019 were retrospectively investigated as observation group, and 116 non-pterygium patients treated by surgery in the same period were selected as control group. The distribution characteristics of pterygium in the elderly population in this area and the related factors affecting its incidence were analyzed. Results Total 116 cases(135 eyes) of pterygium met the investigation conditions. Multiple logistic regression analysis showed that the rural population(OR=1.260, 95% CI:1.360-2.877, P<0.001), dust exposure history(OR=3.895, 95% CI:2.850-5.180, P<0.001), long outdoor activity time(OR=1.456, 95% CI:1.010-2.556, P=0.016), old age(OR=5.055, 95% CI:1.585-15.360, P=0.006), whether wearing glasses(OR=0.305, 95% CI:0.136-1.650, P=0.004) were closely related to pterygium. Conclusion Rural population, old age, long time of outdoor activities and long history of dust exposure are the independent risk factors of pterygium, while wearing glasses is the protective factor. It is possible to reduce the incidence of pterygium through proper health education to guide the elderly to carry out correct outdoor activities.

Comparison of different dosage forms of polyethylene glycol electrolytes in the bowel preparation before colonoscopy

ZHAN Jun, TANG Jin-zhi, WANG Wen-sheng, XIA Xian-ming, TANG Min

2020, 18(8): 1283-1286. doi: 10.16766/j.cnki.issn.1674-4152.001486

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Objective To compare the effect of solution-type and powder-type polyethylene glycol electrolyte in bowel preparation before colonoscopy. Methods Total 400 patients who underwent colonoscopy in the Fourth Affiliated Hospital of Anhui Medical University from October 2018 to April 2019 were selected. Patients were randomly divided into A and B groups using equidistant random sampling, 200 cases in each group. Group A was treated with solution-type polyethylene glycol electrolyte oral solution and group B with powder-type compound polyethylene glycol electrolyte powder. The cleanliness of bowel, incidence of gastrointestinal symptoms and patient satisfaction were observed. Results Both solution-type and powder-type polyethylene glycol electrolytes had good bowel cleansing effects(84.0% vs. 81.5%), and the difference was no significant(χ²=0.438, P=0.508). Two types of polyethylene glycol caused a higher incidence of nausea and bloating. The incidence of nausea and bloating in the powder-type polyethylene glycol electrolytes were higher than those of the solution-type polyethylene glycol electrolytes(14.0% vs. 7.5% and 11.0% vs. 4.5%), the differences were statistically significant(P<0.05), and the total incidence of gastrointestinal discomfort symptoms was also higher in powder-type polyethylene glycol electrolytes(27.5% vs. 9.5%, χ²=21.490, P<0.001). The satisfaction of group A patients(8.96±0.56) was significantly higher than that of group B(8.36±0.83), t=8.440, P<0.001. Conclusion Solution-type and powder-type polyethylene glycol electrolytes have comparable bowel cleansing performance, but solution-type polyethylene glycol electrolytes have a lower incidence of gastrointestinal discomfort and better patient satisfaction, which has better clinical application advantages.

Effect of butylphthalide on the clinical symptoms of patients with Parkinson's disease

ZHOU Hai-yan, CHENG Xun-kuang, XU Wen-fang, LI Yan, PAN Pan

2020, 18(8): 1287-1289,1323. doi: 10.16766/j.cnki.issn.1674-4152.001487

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Objective To investigate the efficacy of butylphthalide(NBP) in improving the motor and non-motor symptoms of patients with Parkinson's disease(PD). Methods A total of 103 PD patients admitted to the First Affiliated Hospital of Bengbu Medical College from September 2014 to December 2016 were selected and randomly assigned to NBP treatment group(43 cases) and control group(60 cases). All patients continued their initial prescribed drug regimen, with NBP administered at 200 mg per dose, 3 times per day, orally, for 24 weeks in the NBP group. Tremor score, motor retardation enhancement direct score, MoCA score, and adverse events(AEs) were compared between the two groups before treatment and at 12, 24, and 48 weeks of treatment. Results There were statistically significant differences between the two groups in motor retardation enhancement direct score, tremor score and MoCA score before and after treatment(all P<0.05). There was no statistical significance in the enhancement of motor retardation direct score, tremor score and MoCA score before treatment in the two groups(all P>0.05). At 12, 24 and 48 weeks, the enhancement of motor retardation direct score in the NBP group(26.26±13.57, 21.72±11.71, 20.52±11.77) were significantly lower than that in the control group(33.03±18.24, 30.55±18.02, 26.78±16.57), and the score of tremor(31.42±22.66, 27.23±18.15, 25.33±18.18) were also significantly lower than that of control group(47.43±28.88, 41.08±28.07, 37.55±28.61). The MoCA score of the NBP group(20.37±3.45, 25.03±3.26, 28.36±3.38) were significantly higher than that of the control group(18.98±3.22, 20.03±3.51, 24.43±3.34), all P<0.05. NBP-related adverse events were uncommon. Conclusion Butylphthalide can improve the motor and non-motor symptoms of PD patients safely and effectively.

A multicenter clinical study of titanium clip combined with tissue adhesive in the treatment of gastric varices

WANG Min, LI Hui-xian, YE Dong, LI Ping, KONG De-run

2020, 18(8): 1290-1293,1379. doi: 10.16766/j.cnki.issn.1674-4152.001488

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Objective To compare the efficacy and safety of titanium clip combined with tissue adhesive α-n-butyl-cyanoacrylate and α-n-butyl-cyanoacrylate alone in the treatment of isolated gastric variceal bleeding. Methods Data of 96 patients admitted to the First Affiliated Hospital of Anhui Medical University, Infectious Diseases Hospital of Handan City and Beijing Ditan Hospital from March 2015 to April 2017 were collected retrospectively. According to the treatment, 46 patients in the group 1 were treated with titanium clamp before the injection of α-n-butyl-cyanoacrylate, 50 patients in the group 2 were treated with α-n-butyl-cyanoacrylate only intravascularly. CTA was performed before treatment to evaluate whether gastro-renal shunt(GRS) existed. The baseline data and treatment effect of the two groups were compared. The data were analyzed by SPSS 16.0 statistical software. Results GRS was found in 59 patients among 66 patients. There was no significant difference in baseline data between the two groups. All patients achieved successful hemostasis under primary endoscopy. The dose of α-n-butyl-cyanoacrylate was(3.39±1.20) mL in group 1 and(2.53±1.05) mL in group 2(P=0.031). The incidence of rebleeding was 4.35% in group 1 and 18.00% in group 2(P=0.036). The disappearance rate of varicose veins was 100.00% in group 1 and 72.00% in group 2(P=0.001). The incidence of complications, fever, abdominal pain, spontaneous bacterial peritonitis, ulcer after treatment, hepatic encephalopathy, ectopic embolism and death in the two groups was not statistically significant, but one case of cerebral embolism occurred in group 2. Conclusion Endoscopic titanium clip clamping of varicose veins may be safer and more effective for treatment of isolated gastric varices bleeding before tissue adhesive injection.

Clinical efficacy of mouse nerve growth factor on the elderly patients with herpes zoster and variations of serum IgG,IgM and IgA

TAO Xue-qin, CUI Hui-xin, WANG Da-wei

2020, 18(8): 1294-1296,1430. doi: 10.16766/j.cnki.issn.1674-4152.001489

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Objective To observe the clinical efficacy of mouse nerve growth factor on the elderly patients with herpes zoster and the influence of serum IgG, IgM and IgA. Methods Using a prospective case-control study, 100 elderly patients with herpes zoster in Dermatology Department of our hospital from January 2016 to October 2018 were randomly divided into observation group(treated with mouse nerve growth factor plus conventional antiviral therapy, n=50) and control group(treated with conventional antiviral therapy, n=50). The difference of effective rate, scores of simplified McGill pain questionnaire(SF-MPQ) before and after treatment, and changes of serum IgG, IgM and IgA were observed. Results The effective rate was 96.00% in the observation group and 74.00% in the control group, with a significant difference between the two groups(P<0.05). The SF-MPQ scores of the observation group before treatment, after treatment and one month after discharge were 28.60±6.35, 10.50±1.60 and 3.16±0.70, while the control group were 27.90±6.70, 15.15±2.35 and 7.50±1.96, respectively. After treatment, the serum IgG, IgM and IgA indexes of the observation group were significantly better than those of the control group(18.60±2.55 vs. 15.50±2.16, 2.06±0.60 vs. 1.43±0.46, 3.20±0.56 vs. 2.80±0.76). The SF-MPQ scores of both groups were significantly lower than those before treatment, and the serum IgG, IgM and IgA indexes were significantly higher than those before treatment at different periods after treatment(all P<0.05). The SF-MPQ scores and serum IgG, IgM and IgA indexes in the observation group were significantly better than those of the control group at different periods after treatment(all P<0.001). There were no serious side effects in both groups. Conclusion Mouse nerve growth factor combined with conventional antiviral therapy is a safe and effective treatment for elderly patients with herpes zoster. It can significantly improve the level of IgG, IgM and IgA in patients, and enhance the humoral immune response. It may be one of the mechanisms for the treatment of herpes zoster.

Clinical effect of warm acupunctrue method at acupoints based on syndrome differentiation in the treatment of early knee osteoarthritis patients

LI Yun, SONG Shuang-lin, ZHANG Di, CHEN Li-li, HUANG Zhen

2020, 18(8): 1297-1299,1303. doi: 10.16766/j.cnki.issn.1674-4152.001490

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Objective To investigate the efficacy of warm acupunctrue method at acupoints based on syndrome differentiation in the treatment of early knee osteoarthritis(KOA) patients and its effect on joint fluid levels of matrix metalloproteinase(MMP)-3 and MMP-13. Methods Ninety early KOA patients admitted to the hospital from April 2018 to October 2019 were screened and divided into control group(45 cases) and observation group(45 cases) by the random number table method. Patients in the control group were orally given with glucosamine sulfate capsules(500 mg/time and 3 times/d). Based on the basis of the control group, the observation group was treated with syndrome differentiation point treatment of warm acupunctrue method(1 time/d and 5 times/week). Both groups were treated for 6 weeks. Scores of the western Ontario and McMaster university osteoarthritis index(WOMAC index) and knee motor function Lysholm scale(LKSS) were employed to evaluate the function of knee joint before and after treatment. Score of visual analogue scale(VAS) was used to evaluate the ache pre-post treatment. The clinical efficacy was compared for both groups after treatment. The levels of MMP-3 and MMP-13 were detected between the two groups pre-post treatment. Results After treatment, scores of the WOMAC and VAS of the observation group were significantly lower, while LKSS score was significantly higher, than those of the control group(P<0.01). The total effective rates of the observation group and the control group were 95.56% and 77.78%, respectively, and the differences were statistically significant(P<0.05). After treatment, the levels of MMP-3 and MMP-13 in the observation group were significantly lower than those in the control group(P<0.01). Conclusion The efficacy of warm acupunctrue method at acupoints based on syndrome differentiation in the treatment of early KOA is significant. It can improve joint function and relieves pain, which may be related with down-regulation of the levels of MMP-3 and MMP-13 in joint fluid.

Application of repeated respiratory mask with carbon dioxide concentration monitoring function in hyperventilation syndrome

CHEN Wei, JIA Ya-ping, WU Jian-xiang, YU Li-ping, SHEN Hui, CAI Zhe-qing, LU Lei, TANG Ying, YU Jia-yin, WANG Jia

2020, 18(8): 1300-1303. doi: 10.16766/j.cnki.issn.1674-4152.001491

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Objective To investigate the application of repeated respiratory mask with carbon dioxide concentration monitoring function in hyperventilation syndrome(HVS),in order to provide more reference for clinical rescue of HVS patients. Methods From December 2017 to December 2018, 60 HVS patients admitted to the emergency department of our hospital were randomly divided into observation group(n=30) and control group(n=30) according to the random number table methods. The observation group received repeated respiratory mask with carbon dioxide concentration monitoring function, while the control group received plastic bag instead of nasal/mouth mask. Then the symptom remission time, Nijmegen score, blood gas analysis index, treatment effect, satisfaction and nursing cost were observed and compared between the two groups. Results The symptom remission time of the observation group was significantly shorter than that of the control group[(0.52±0.36) h vs.(1.13±0.42) h, t=6.040, P<0.001]. The Nijmegen score of the observation group was significantly lower than that of the control group[(7.23±3.56) scores vs(11.57±3.84) scores, t=4.540, P<0.001]. Blood pH was decreased in both groups after treatment, and was more obvious in the observation. PCO₂ level was increased in both groups after treatment, and was more significant in the observation group than in the control group. The clinical efficacy of the observation group was higher than that of the control group(93.33% vs. 66.67%, χ²=6.667, P=0.010). The satisfaction rate of the observation group was significantly higher than that of the control group(96.67% vs. 60.00%, χ²=11.882, P=0.001). The nursing cost of the observation group was significantly lower than that of the control group[(551.23±24.26) yuan vs.(875.42±26.87) yuan, t=49.050, P<0.001]. Conclusion The repeated respiratory mask with carbon dioxide concentration monitoring function is safe, effective and cheap for HVS patients, which can significantly shorten the time of disease onset and reduce the cost, so it is worthy of clinical promotion.

Effect of laparoscopic hepatectomy and open hepatectomy on T lymphocyte subsets in peripheral blood of patients with primary hepatocellular carcinoma and its clinical effect

WANG Yong, HUANG Wei, FU Li-yun, LIN Hai-jun, ZHOU Xiao-shuai

2020, 18(8): 1304-1306. doi: 10.16766/j.cnki.issn.1674-4152.001492

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Objective To investigate the clinical effects of laparoscopic hepatectomy and open hepatectomy. Methods A total of 120 patients with primary liver cancer in our hospital from February 2015 to July 2017 were randomly divided into A group and B group by random number method. A group was given laparoscopic hepatectomy, and B group was given open hepatectomy. The perioperative indicators, peripheral blood T lymphocyte subsets, and short-term and long-term effects of two groups were compared. Results The intraoperative blood loss, eating time, getting out bed time, hospital stay, and analgesic dose of A group[(145.48±12.59) mL,(1.65±0.52) d,(4.60±0.78) d,(10.07±1.17) d,(139.24±62.47) mg] were significantly lower than B group[(202.56±13.68) mL,(2.73±0.75) d,(6.84±0.90) d,(13.22±1.36) d,(282.79±80.01) mg], t=23.782, 9.166, 14.596, 13.601 and 10.954, all P<0.05. After one week, the CD3⁺ and CD4⁺ of A group[(55.33±5.70),(46.18±7.33)] were significantly higher than B group[(51.97±3.29),(41.60±6.53)], t=3.955, 3.614, all P<0.05, the CD8⁺ of A group(30.07±3.26) was significantly lower than B group(33.60±3.31), t=5.886, P<0.05. The complications incidence of A group(3.33%) was significantly lower than B group(13.33%), χ²=3.927, P<0.05. Conclusion Compared with open hepatectomy, laparoscopic hepatectomy could effectively treat primary liver cancer.

Analysis of the relative factors of pituitary and thyroid hormones in ICU critical patients

DING Zhi, WU Qiang

2020, 18(8): 1307-1309. doi: 10.16766/j.cnki.issn.1674-4152.001493

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Objective To investigate the difference of pituitary and thyroid hormone levels in ICU critical patients and further analyze the relationship between hormone levels and gender, brain lesions, acute physiology and chronic health status(APACHE Ⅱ) scores. Methods A total of 120 critically ill patients admitted to the ICU ward of our hospital from January 2013 to June 2018 were enrolled. The APACHE Ⅱscore was used to assess the severity of the disease. The thyrotropin(TSH), free triiodothyronine(FT3), free tetraiodothyronine(FT4), and growth hormone(GH) in the serum were tested. The hormone levels of the male group and the female group, brain lesion group and non brain lesion group, Apache Ⅱ scores ≤ 15 group and Apache Ⅱ scores>15 group were compared according to gender, presence or absence of brain injury and cerebrovascular disease, Apache Ⅱ score. The correlation between hormone level and gender, brain lesions, Apache Ⅱ score in critical patients were analyzed by Pearson correlation coefficient analysis. Results The FT3 of the male group were higher than that of the female group(P<0.05). The FT3 and FT4 of the craniocerebral injury group were higher than those in the non craniocerebral injury group(P<0.05). The FT3 and FT4 levels in the APACHE Ⅱ scores>15 group were lower than those of APACHE Ⅱ scores ≤ 15 group(P<0.05). The results of correlation analysis showed that FT3 was correlated with the gender and craniocerebral injury of ICU critical patients, and negatively correlated with their APACHE Ⅱ scores. Conclusion In addition to gender differences, FT3 is related to the brain lesions and APACHE Ⅱ scores of ICU critical patients. The FT3 can indirectly reflect the severity of the disease and predict the high-risk risk. Thyroid hormone can be used as the evaluation indexes of the severity of craniocerebral injury.

Risk factors analysis of pneumoconiosis complicated with chronic obstructive pulmonary disease

WU Jia-ping, LU Xiao-ling

2020, 18(8): 1310-1312. doi: 10.16766/j.cnki.issn.1674-4152.001494

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Abstract:
Objective To analyze the data of pneumoconiosis complicated with chronic obstructive pulmonary disease and investigate the risk factors. Methods A total of 109 patients with pneumoconiosis complicated with chronic obstructive pulmonary disease admitted to our hospital from March 2015 to April 2018 were selected as observation group. Total 105 patients with pneumoconiosis without chronic obstructive pulmonary disease were selected as the control group. The age, sex, dusting age, pneumoconiosis stage, smoking history, BMI, family history of COPD, and living environment were counted, and the risk factors of pneumoconiosis complicated with chronic obstructive pulmonary disease were determined by single factor and multivariate analysis. Results Univariate analysis showed that there are significant different between two group on age, dusting age, pneumoconiosis, smoking history, family history of COPD, and living environment. And multivariate logistic regression analysis showed that age(OR=3.005, P=0.016), dusting age(OR=2.443, P=0.023), pneumoconiosis(OR=2.699, P=0.028), smoking history(OR=2.419, P=0.008), family history of COPD(OR=3.036, P=0.008), and living environment(OR=2.668, P=0.014) were risk factors for pneumoconiosis with chronic obstructive pulmonary disease. Conclusion Age, dusting age, pneumoconiosis stage, smoking history, family history of COPD and living environment are risk factors for pneumoconiosis complicated with chronic obstructive pulmonary disease. These risk factors should be paid attention to in clinical practice, and patients should be examined regularly to improve patients. Quality of life to prevent the occurrence of chronic obstructive pulmonary disease.

Analysis of nutritional status in 135 patients with acute exacerbation of COPD and its relationship with acute exacerbation

LIU Kui, QIAN Hui, HAN Ke-xing, RONG Ling, TANG Chao

2020, 18(8): 1313-1315,1347. doi: 10.16766/j.cnki.issn.1674-4152.001495

292 4

Abstract:
Objective To analyze the nutritional status of patients with acute exacerbation of COPD(AECOD) and its relationship with acute exacerbation so as to provide guidance for evaluating nutritional status and acute exacerbation risk in the future clinical work. Methods The clinical data of 135 patients with AECOPD admitted to the Respiratory Department of our hospital from September 2018 to May 2019 were analyzed retrospectively. Patients were divided into acute exacerbation low risk group(n=20) and high risk group(n=115). The age, ideal body mass percentage(IBW%), body mass index(BMI), hemoglobin(Hgb), serum albumin(ALB), serum prealbumin(PA), mMRC and their relationship with acute exacerbation was analyzed. Results ①The sensitivity of each nutritional index ideal to evaluate nutritional status of AECOPD patients was different, the proportion of undernutrition was 22.22%(30/135) of IBW%, 28.15%(38/135) of BMI, 2.96%(4/135) of Hgb, 57.03%(77/135) of ALB, and 43.70%(59/135) of PA respectively. ② There were statistically significant differences in the number of patients with respiratory failure(1 vs. 43, χ²=8.136, P=0.004), the level of ALB, PA and the index of acute exacerbations per year between the low-risk group and the high-risk group(all P<0.05). ③ There were statistically significant differences in PA and the index of acute exacerbations per year between the non-respiratory failure group and the respiratory failure group(all P<0.05). ④ The level of PA was negatively correlated with the index of acute exacerbations per year(P<0.05), while the mMRC score was positively correlated with the index of acute exacerbations per year(P<0.05). Conclusion PA levels can effectively assess the nutritional status of patients with AECOPD and predict the risk of acute exacerbation.

Clinical efficacy and safety analysis of human interferonα-2b atomized inhalation combined with budesonide in the treatment of infantile bronchitis

ZHU Zhan-kui, WANG Qi-wei, LIU Ding-li, CENG Zhao-bin, CHEN Xin

2020, 18(8): 1316-1319,1357. doi: 10.16766/j.cnki.issn.1674-4152.001496

366 3

Abstract:
Objective To explore the method of budesonide combined with recombinant human interferon α-2 b(rhIFNα-2 b) aerosol inhalation in children with bronchiolitis, and to observe its clinical efficacy and safety analysis, so as to provide theoretical basis for the diagnosis and treatment of children with bronchiolitis. Methods A total of 205 children with bronchiolitis admitted to Fuyang women's and children's Hospital from January to December 2018 were randomly divided into treatment group(103 cases) and control group(102 cases). The control group was treated with inhaled budesonide; the treatment group was treated with rhIFNα-2 b 200 000 IU/(kg·time) on the basis of the control group, and the two groups were given appropriate symptomatic support treatment. The clinical symptom scores of the two groups before and 7 days after treatment were dynamically observed, the improvement rate of each clinical performance was recorded, and the therapeutic effects of the two groups were compared. Results The score of asthmatic suffocation in the treatment group was significantly lower than that in the control group on the 5 th to 7 th day(P<0.05). The score of cough and wheezing in the treatment group was significantly lower than that in the control group on the 4 th to 7 th day(P<0.05). The score of three concave signs in the treatment group was significantly lower than that in the control group on the 2 nd to 5 th day(P<0.05). The score of four concave signs in the treatment group was significantly lower than that in the control group on the 4 th to 7 th day(P<0.05). The difference was statistically significant(P<0.05) d. The improvement of cough, wheezing and wheezing sound in the treatment group was significantly higher than that in the control group, the difference was statistically significant(P<0.05). On the 7 th day of treatment, the total improvement of the treatment group was higher than that of the control group[(95.68±18.71) scores vs.(76.57±21.73) scores], the difference was statistically significant(t=6.750, P<0.001), no serious adverse reactions occurred in the two groups. Conclusion Budesonide combined with rhIFNα-2 b aerosol inhalation can significantly improve the therapeutic effect of bronchiolitis in children, rapidly improve the clinical symptoms, and has high safety, which is worthy of clinical promotion.

Analysis of myopia and influencing factors in children aged 6-11 in Aksu area of Xinjiang

WU Ze-yong, CHEN Zhe, YANG Ya-xin, XIONG Yuan-shan, YANG Lu

2020, 18(8): 1320-1323. doi: 10.16766/j.cnki.issn.1674-4152.001497

193 5

Abstract:
Objective To explore and study the myopia status and its related influencing factors of children aged 6-11 in Aksu area of Xinjiang, so as to provide a theoretical basis for the prevention and treatment of myopia. Methods Using stratified cluster sampling method, all primary schools in Aksu area of Xinjiang were defined as a group, and five primary schools were randomly selected as the sample source. In this study, 6 439 students aged 6-11 in grade 1-5 in this area were selected as the research objects. The myopia of the research objects was investigated by questionnaire. Logistic regression analysis was used to analyze the related factors of myopia. Results Among 6 439 children aged 6-11 years, 1 153 cases of myopia were screened, with a myopia rate of 17.91%. Among them, mild myopia was the most common, accounting for 85.08%(981/1 153) of the total number of myopia, 172 cases of middle and high myopia, accounting for 14.92% of the total number of myopia. The results of single factor analysis showed that the factors related to children's myopia included age, grade and parents' myopia(P<0.05), but there was no statistical difference with gender(P>0.05). The results of multivariate logistic regression analysis showed that age, grade, parents' myopia and preference for mobile phone/computer games were independent factors of myopia in children(P<0.05). Conclusion The prevalence of myopia in children aged 6-11 years old in Aksu area of Xinjiang is relatively high. The occurrence of children's myopia is significantly associated with age, grade, parents' myopia, preference for mobile phone/computer games. It can be managed from the above aspects to achieve the secondary prevention of early discovery, early diagnosis, early treatment, so as to comprehensively improve the visual quality of children.

Correlation between gut microbiota diversity and Treg-Th17 in children with autism spectrum disorder

ZHANG Jing, WANG Kai-xuan, SHENG Fang, LOU Wen-ji, LI Xiao-bing, LAI Pan-jian

2020, 18(8): 1324-1326,1330. doi: 10.16766/j.cnki.issn.1674-4152.001498

256 3

Abstract:
Objective To investigate and analyze the diversity of intestinal flora in children with autism spectrum disorder(ASD), to explore its correlation with Treg-Th17. Methods Forty-nine cases of children with autism spectrum disorder admitted to Jinhua Central Hospital from October 2016 to April 2019 were included in the study.Another 50 normal children who underwent physical examination in our hospital were selected as healthy controls. The content of Treg, Th17 cells and Treg/Th17 in peripheral venous blood PBMC(mononuclear cells) were measured by flow cytometry and detected by ELISA method. The serum levels of TGF-β1 and IL-17 in children were observed to correlate the diversity of intestinal flora in ASD with Treg-Th17. Results The number of Bifidobacterium and Escherichia coli gene copies and B/E values in the intestinal tract of the ASD group were lower than those of the healthy control group(all P<0.05). The number of Treg cells and Treg/Th17 value in PBMC of ASD group were lower than those of healthy control group, but the number of Th17 cells in PBMC was higher than that of healthy control group(all P<0.05). The plasma IL-17[(311.28±29.83) ng/L] in the ASD group was higher than that in the healthy control group[(104.96±17.51) ng/L], and the plasma TGF-β1 level[(28.33±8.14) ng/L] was lower than that in the healthy control group[(101.84±12.76) ng/L, t=42.070, 34.095, all P<0.05]. Pearson correlation analysis found that intestinal B/E value and Treg, Th17 and Treg/Th17 values showed a positive correlation(r=0.522,0.416,0.323, all P<0.05). Conclusion The intestinal mucosal barrier dysfunction in children with acute autism spectrum disorder is mainly due to weakened immune barrier, intestinal micro-ecological imbalance, and intestinal flora-mediated tolerance, which runs through the pathological process of autism spectrum disorder.

Effects of modified preoperative bowel preparation in patients undergoing laparoscopic hysterectomy in gynecology department

ZHOU Ai-mei, CHEN Xiu-fang, CHEN Li-li, YAN Xiao-jian, CHEN Xiu-xiu, HUANG Li-li, ZHOU Qing, LIU Dan

2020, 18(8): 1327-1330. doi: 10.16766/j.cnki.issn.1674-4152.001499

206 1

Abstract:
Objective To analyze the effects of modified preoperative bowel preparation in patients undergoing laparoscopic hysterectomy in gynecology department. Methods Ninety-six patients who underwent laparoscopic hysterectomy were enrolled in the study. They were divided into observation group and control group according to the random number table method, with 48 cases in each group. And they were given modified preoperative bowel preparation and routine preoperative bowel preparation respectively. The satisfaction of surgeons, perioperative parameters, occurrence of gastrointestinal symptoms, intestinal function recovery and levels of serum electrolytes before surgery and at 1 d after surgery were compared between the two groups. Results There was no significant difference in the satisfaction of surgeons between the two groups(all P>0.05). There were no significant differences in the incidence rate of involuntary defecation, intraoperative blood loss and operative time between the two groups(P>0.05), and the postoperative hospital stay was shorter than control group(P<0.05). There was no significant difference in the incidence rate of abdominal distension between the two groups(P>0.05), and the incidence rates of diarrhea, nausea and vomiting with 0.00%(0/48), 2.08%(1/48) and 4.17%(2/48) in observation group were lower than those in control group[10.42%(5/48), 12.50%(6/48) and 16.67%(8/48), χ²=5.275, 3.852, 4.019, all P<0.05]. There was no intestinal obstruction in the two groups, and the postoperative first intestine peristalsis time, postoperative first defecation time and postoperative first anal exhaust time with(15.16±1.79)h,(41.71±5.83) h and(18.26±2.78) h in observation group were shorter than those in control group with(17.35±1.58) h,(49.09±6.31) h and(21.12±2.97) h(t=6.355, 5.952, 4.871, all P<0.001). There were no significant changes in the levels of serum Na⁺, K⁺ and Cl^- in observation group at 1 d after surgery compared with those before surgery(all P>0.05). The levels of serum Na⁺, K⁺ and Cl^- in observation group were higher than in control group(all P<0.05). Conclusion Modified preoperative bowel preparation for gynecological laparoscopic hysterectomy can promote the recovery of intestinal function, and it is beneficial to patients with postoperative recovery, it is safe and feasible.

Influencing factors of decision-making for diabetic patients to choose family doctors as providers of chronic disease management services

HOU Jin, CAI Li-qiang, KANG Jian-zhong

2020, 18(8): 1331-1336. doi: 10.16766/j.cnki.issn.1674-4152.001500

221 3

Abstract:
Objective To investigate the current situation of diabetes management in community, to clarify the decision-making factors of patients choosing family doctors as disease management service providers, and to provide suggestions for the implementation of family doctors' contracted services. Methods In May 2018, a simple random sampling method was used to select 500 diabetes patients diagnosed in a community in Shanghai. The questionnaire was designed by ourselves. With Likert's 5-level scoring method, 30 items from 7 dimensions were used to investigate the decision-making influencing factors of patients choosing family doctors as disease management providers, and 22 items from 6 dimensions were used to investigate that of patients not choosing family doctors. Results For 500 patients who met the inclusion criteria, the five items that had the greatest impact on the selection of family doctors as disease management service providers were as follows:good service attitude(mean value of influencing factors evaluation is 1.17); family members are easy to accompany and take care of(mean value is 1.15); doctors are familiar with and understand the situation of patients(mean value is 1.08); chronic diseases are stable(mean value is 1.07); close to home, easy to use(mean 1.06). Among the factors that didn't choose family doctors, the top five items that had the greatest influence were as follows:not providing expert outpatient service(the average value of influencing factor evaluation is 0.96); worrying that one visit can't solve the problem(the average value is 0.87); no significant change in the proportion of medical insurance payment(the average value is 0.80); reimbursement policy does not specify preferred community(the average value is 0.77); community medical equipment can't meet the demand(the average value is 0.76). Conclusion Due to the advantages of distance and time, low cost and good service, family doctor service is the main factor for residents to choose providers of chronic disease management services. However, medical technology, equipment, drug supply and current health policy factors still have certain constraints on residents to choose family doctors to provide chronic disease management services preferentially.

Effect of health management combined with calcitriol based on progressive resistance training on CTX,BAP and Fall Risk in postmenopausal osteoporosis women

YU Xiao-hong, WANG Hong-ya, FU Hua-jun

2020, 18(8): 1337-1340. doi: 10.16766/j.cnki.issn.1674-4152.001501

191 2

Abstract:
Objective To explore the effect of health management combined with calcitriol based on progressive resistance training on CTX(type I procollagen peptide), BAP(bone specific alkaline phosphatase) and fall risk in postmenopausal osteoporosis women. Methods Total 96 postmenopausal osteoporosis patients treated in our hospital from March 2018 to May 2019 were included in the study. They were divided into two groups according to the digital random table method. The observation group(48 cases) took health management based on progressive resistance training combined with calcitriol intervention. The control group(48 cases) received calcitriol intervention. The changes of BAP and CTX and the fall risk score before and after the intervention in the two groups were observed. Meanwhile, the changes of hip BMD and femoral trochanter BMD before and after the intervention in the two groups were counted. Results There was no significant difference in BAP and CTX levels between the two groups before and after intervention(all P>0.05). After the intervention, the lumbar bone density of the observation group was significantly increased(P<0.05), but the lumbar bone density of the control group was not significantly increased(P>0.05), and the lumbar bone density of the observation group after the intervention was better than that of the control group(P<0.05). There was no significant difference in hip bone density and femoral trochanter bone density between the two groups before and after the intervention(all P>0.05). After 6 months of intervention, the fall index in the observation group was significantly better than that in the control group(P<0.05). BAP, CTX were significantly positively correlated with fall index score(all P<0.05). Conclusion Health management based on progressive resistance training combined with calcitriol has a good improvement effect on CTX, BAP and fall risk of postmenopausal osteoporosis women, and can enhance the prevention of fall risk compared with conventional drugs. It has high clinical application value and is worthy of clinical promotion and wide application.

The value of anti-Epstein-Barr virus capsid antigen IgM,EBV DNA and atypical lymphocyte in the diagnosis of infectious monocytosis in children

WU Fei, LIU Miao

2020, 18(8): 1341-1343,1383. doi: 10.16766/j.cnki.issn.1674-4152.001502

268 1

Abstract:
Objective To analyze the clinical value of anti-EBV capsid antigen IgM antibody(VCA-IgM), EBV DNA and peripheral blood atypical lymphocyte in diagnosing infectious mononucleosis(IM) in infants. Methods Total 32 children with IM(observation group) and 33 children with non-IM(control group) in the First Affiliated Hospital of USTC from October 2017 to March 2019 were retrospectively analyzed. ELISA, quantitative PCR and smear microscopy of peripheral blood anticoagulant samples were used to detect the VCA-IgM, serum EBV DNA and the percentage of atypical lymphocyte in the whole blood, and the differences between the two groups were compared. The diagnostic value of each index and the combined detection of the three indicators were evaluated by ROC curve. Results The positive rates of VCA-IgM, EBV DNA and atypical lymphocytes in the observation group were significantly higher than those in the control group(P<0.05). The sensitivity of combined detection of the three indicators(97.43%) was significantly higher than that of the three indexes alone. The area under the curve(AUC) of combined detection of the three indicators(0.975) for diagnosing IM was higher than that of EBV CA-IgM(0.723), EBV DNA(0.928) and atypical lymphocytes(0.961). Conclusion The detection of EBV VCA-IgM, EBV DNA and atypical lymphocytes can be used as important indicators for the diagnosis of IM in children, and the combined detection can significantly improve the sensitivity. It is helpful for the early diagnosis of IM and reduce the misdiagnosis rate.

Clinical effect of detection of fetal nuchal translucency in early pregnancy combined with maternal serum biochemical markers for diagnosis of fetal dysplasia

YAN Jing-bin, YAN Xiu-mei, YANG Jian-xiang, CHEN Xian-qiu, LIANG Bi-rong, LUO Jian-feng, DAI Miao-lei, BAI Xiao-hui

2020, 18(8): 1344-1347. doi: 10.16766/j.cnki.issn.1674-4152.001503

269 1

Abstract:
Objective To observe the detection effect of prenatal grade Ⅲ ultrasound on fetal congenital heart disease, and to evaluate its clinical value in screening congenital heart disease. Methods A total of 5 000 cases of pregnant women in the second trimester in Wenzhou integrated hospital of traditional Chinese and western medicine affiliated to Zhejiang university of traditional Chinese medicine were as research subjects. All subjects were examined by prenatal grade Ⅱ ultrasound detection from March 2016 to March 2019. Prenatal grade Ⅲ ultrasound detection and prenatal fetal echocardiography. All the subjects were followed up to delivery or autopsy of aborted fetuses to determine the actual incidence of fetal congenital heart disease, the sensitivity, accuracy, specificity, positive predictive value and negative predictive value of different detection techniques for fetal congenital heart disease were assessed. Results The actual incidence of congenital heart disease was 2.14%. The detection rates of prenatal grade Ⅱ ultrasound detection, prenatal grade Ⅲ ultrasound detection and prenatal fetal echocardiography were 2.46%, 1.94% and 2.02% respectively. The missed rates of prenatal grade Ⅱ ultrasound detection, prenatal grade Ⅲ ultrasound detection and prenatal fetal echocardiography were 42.06%, 11.22% and 6.54%, respectively. Kappa values of prenatal grade Ⅱ ultrasound detection, prenatal grade Ⅲ ultrasound detection and prenatal fetal echocardiography with gold standard were 0.502, 0.930 and 0.961. Conclusion The detection rate of prenatal grade Ⅲ ultrasonography for fetal congenital heart disease is high, which is consistent with the gold standard. It can effectively reduce the rate of fetal missed detection of cardiac dysplasia and is suitable for large-scale prenatal screening of fetal congenital heart disease.

The role of metabolism in macrophage in Kidney diseases

WANG Xing-yue, JIANG Lei, YANG Jun-wei

2020, 18(8): 1348-1352. doi: 10.16766/j.cnki.issn.1674-4152.001504

284 7

Abstract:
Macrophages are an important component of the human immune system, and they are widely involved in multiple pathophysiological processes such as systemic inflammatory response and tissue damage repair. Kidney macrophages play an important role since the early stages of kidney development, and continue to participate in subsequent inflammatory infiltration, tissue damage, repair and fibrosis, affecting the long-term prognosis after kidney injury. Macrophages can be broadly classified into two different subtypes, depending on their local microenvironment, classically activated(M1) and alternatively activated(M2) macrophages. M1 macrophages are produced by exposured to interferon(IFN)-γ or lipopolysaccharide(LPS) and are considered pro-inflammatory due to their capacity to release certain cytokines. IL-4, IL-10 and TGF-β1 can induce macrophages to M2 polarization, which have anti-inflammatory functions. There have been many studies show that the phenotype and function of macrophages are closely related to their metabolism patterns, and the changes in their metabolism patterns will further affect their biological function, then lead to series of changes in process of pathophysiological in the kidney. Therefore, studying the different phenotypes of kidney macrophages and the mechanisms of their physiological effects under different metabolism patterns will help to further clarify the kidney outcomes in pathological conditions, and guiding the further development of immunotherapy in the future.

Progress on prenatal maternal stress among pregnant women in China

ZHU Cai-yun, JIN Feng-juan, HU Min-min, ZHENG Hong, LI Li-ya

2020, 18(8): 1353-1357. doi: 10.16766/j.cnki.issn.1674-4152.001505

470 17

Abstract:
In order to cope with population and economic development, the Chinese government implemented a comprehensive "two child policy" in 2015, with a significant increase in the number of re-pregnant women. Pregnancy is an important event and special stage in women's life course. During the whole process from pregnancy to delivery, with the changes of body, psychology, economy and society, various contradictions and problems will interact with each other, as a result, there are different degrees of pregnancy pressure among pregnant women. In China, pregnant women generally have different levels of prenatal maternal stress. Prenatal maternal stress will have a negative impact on the mother and the baby or the whole family. Prenatal maternal stress will lead to premature birth or miscarriage of the fetus and other adverse outcomes. At the same time, pregnant women are prone to pregnancy complications, depression or anxiety and other psychological problems, which will also have a negative impact on the whole family function. Therefore, how to implement the comprehensive two child policy, help pregnant women and their families through the whole pregnancy, reduce the pressure of pregnant women during pregnancy, improve the functions of pregnant women and their families, and promote the physical and mental health outcome of mothers and infants, has put forward a new challenge to the medical staff of obstetrics and gynecology. However, at present, there is a lack of intervention research on the management of pregnant women's stress during pregnancy in China. At the same time, due to the different methods of stress measurement and the standards of defining the stress level, the stress level of pregnant women in different parts of China is also different. Therefore, this paper systematically combs the current situation of prenatal maternal stress level of pregnant women in China, and summarizes its influencing factors. It aims to provide theoretical basis for establishing a scientific evaluation and management system of pregnancy stress, in order to alleviate the pressure of pregnancy, improve the quality of life of pregnant women, and promote the physical and mental health of pregnant women and fetus.

Clinical research of professor Cai's menstruation periodic treatment in obese patients with polycystic ovary syndrome

XU Hua-yun, KONG Shi-lu, FU Jin-rong, WANG Guo-zeng

2020, 18(8): 1358-1361. doi: 10.16766/j.cnki.issn.1674-4152.001506

235 3

Abstract:
Objective To observe the clinical effect of the Cai's menstruation periodic treatment in obese patients with polycystic ovary syndrome(PCOS). Methods Total 119 cases of obese patients with PCOS were selected from Shanghai General Hospital and Longhua Hospital Shanghai University of TCM from July 2016 to June 2019. According to non randomized concurrent controlled method, the patients were divided into treatment group(n=59) and control group(n=60). The treatment group was treated with Duonang Decoction after menstruation and in the mid-menstrual period, and before menstruation it was treated with Duo Nang Decoction which was removed spina gleditsiae and increased curculigo, purple quartz and antler frost. The control group was treated with metformin. The two groups were treated for 3 months, and waist-hip ratio(WHR), body mass index(BMI), testosterone(T), follicle stimulating hormone(FSH), luteinizing hormone(LH), LH/FSH ratio, glucose metabolism, TCM syndrome score, basal body temperature(BBT) and related safety indexes before and after treatment were observed. Results After treatment, 22 cases were cured, 4 cases were significantly effective and 25 cases were effective in the treatment group, while 9 cases were cured, 8 cases were significantly effective and 25 cases were effective in the control group. The curative effect of the treatment group was significantly better than that of the control group, and the difference was statistically significant(Z=-2.658, P=0.008). After treatment, the recovery rate of BBT and the pregnancy rate in the treatment group were better than those in the control group(all P<0.05), and the scores of kidney deficiency and phlegm stasis syndrome and LH, LH/FSH ratio in the treatment group were significantly lower than those in the control group(all P<0.05). After treatment, BMI, WHR, fasting insulin and insulin resistance index in the two groups were significantly lower than those before treatment(all P<0.05), but there was no statistical difference between the two groups(all P>0.05). Conclusion The Cai's menstruation periodic treatment can improve the sex hormone level well in obese PCOS patients, effectively regulate the disorder of glucose metabolism and reduce body weight, thus to promote ovulation, recover regular menstruation and prevent forward complications. In addition, the periodic treatment can also significantly improve the symptom of kidney deficiency and blood stasis, and the overall clinical effect is better.

Observation on the curative effect of warming acupuncture in the treatment of knee osteoarthritis

PAN Sheng-lian, WANG Qing-lai, ZHOU Xia-hui

2020, 18(8): 1362-1364. doi: 10.16766/j.cnki.issn.1674-4152.001507

389 6

Abstract:
Objective To explore the clinical effect of warm acupuncture on knee osteoarthritis(KOA) and its influence on the changes of patients' score of osteoarthritis(WOMAC), health survey(SF-36) and pain visual analogue(VAS). Methods Total 80 patients with KOA in Wenzhou Traditional Chinese Medicine Hospital from January to October 2018 were selected as research object, who were divided into control group and observation group according to the random number table method, 40 cases in each group. The control group was treated with conventional acupuncture, and the observation group was treated with warm acupuncture. The two groups needed continuous treatment for 28 d. The curative effects of the two groups were recorded. Before treatment, immediately after treatment and 6 months after treatment, VAS score and WOMAC score were used to evaluate the improvement of symptoms in the two groups. SF-36 score was used to evaluate the changes of quality of life(QOL). Results The total effective rate of KOA in the observation group was 90.0%, which was significantly higher than that in the control group(50.0%), the difference was statistically significant(χ²=15.238, P<0.001). The VAS score, WOMAC score and SF-36 score of the two groups were significantly improved at each time point after treatment, and the difference was statistically significant(all P<0.05). VAS scores, WOMAC scores and SF-36 scores in the observation group(3.20±0.98, 10.96±1.89, 96.83±2.96) were significantly better than those of the control group(4.30±0.99, 27.56±7.20, 80.03±3.20), and the difference was statistically significant(all P<0.01). Conclusion The warm acupuncture has good clinical treatment effect for treating the KOA. It can effectively relieve the pain of the patient and improve the activity of the bone joint of the patient, improve the quality of life of the patient, and has the clinical application value.

Effect of functional acupuncture combined with continuous passive hand movement on rehabilitation quality of hand dysfunction after stroke

ZHANG Lu, MAO Zhi-fang

2020, 18(8): 1365-1368. doi: 10.16766/j.cnki.issn.1674-4152.001508

214 1

Abstract:
Objective To analyze the etiology and mechanism of hand dysfunction after stroke, summarize the effect of functional acupuncture and hand continuous passive movement in the treatment of hand dysfunction after stroke, and find the best way for clinical treatment of hand dysfunction. Methods Total 70 patients with hand dysfunction after stroke were selected to be treated in our hospital from January 2018 to February 2019. The patients were divided into control group and combined group with 35 cases in each group. The control group was given continuous passive hand training, and the combined group was given combined functional acupuncture on the basis of the control group. The scores of Fugl-Meyer's upper extremity, hand function and Barthel ADL were counted. Results At 8 and 12 weeks, the scores of Fugl Meyer(55.64±3.47 and 64.45±5.18) in the combined group were higher than those in the control group(40.25±2.32 and 46.42±3.37), t=21.811, 17.262, all P<0.001. The scores of hand function(67.86±6.06 and 85.14±7.46) were higher than those of control group(58.49±5.51 and 70.18±6.89), t=6.768, 8.715, all P<0.001. Barthel ADL(62.03±10.86 and 88.57±12.59) was higher than that of the control group(49.08±8.54 and 62.75±9.64), t=5.545, 9.633, all P<0.001. Conclusion Functional acupuncture combined with hand continuous passive movement can improve hand dysfunction after stroke, and promote the functional recovery of upper limbs and hands, which is worth popularizing.

Effect of acupuncture on respiratory disorder index,blood oxygen saturation and serum inflammatory factors in patients with obstructive sleeping apnea hypopnea syndrome

YUAN Shu-fen, LIU Hong, LIU Xiao-jing

2020, 18(8): 1369-1372. doi: 10.16766/j.cnki.issn.1674-4152.001509

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Objective To investigate the effects of acupuncture on respiratory disturbance index, oxygen saturation and serum inflammatory factors in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods A total of 172 OSAHS patients admitted to Lishui Hospital of Traditional Chinese Medicine from January 2016 to December 2018 were randomly divided into the nCPAP group and the acupuncture group, with 86 patients in each group receiving transnasal continuous positive airway pressure ventilation and acupuncture respectively. The two groups of patients before and after the treatment of sleep disordered breathing index, blood oxygen saturation and serum cytokine concentration and clinical efficacy. Results After treatment, the indexes of sleep and respiratory disorders in both groups improved(all P<0.05), and the improvement effect of acupuncture group was better than that of nCPAP group(all P<0.05). The AHI level in the acupuncture group(14.35±1.21) was lower than that in the nCPAP group(16.49±1.08, t=12.240, P<0.001). After treatment, LSaO₂ and MSaO₂ increased in the two groups(P<0.05), and the acupuncture group was higher than the nCPAP group(all P<0.05), and the SaO₂< 90% time, TRTSaO₂<90%, TNF-α, CRP, IL-8, aICAM-1, and NF-κB decreased in the two groups(all P<0.05), and the acupuncture group was lower than the nCPAP group(all P<0.05). The effective rate was 91.86% in the acupuncture group and 94.19% in the nCPAP group(χ²=0.358, P=0.549). After treatment, the syndrome score of acupuncture group at each time point was lower than that of nCPAP group(all P<0.05). Conclusion Acupuncture and nCPAP therapy in the treatment of OSAHS can improve the respiratory disturbance index and blood oxygen saturation of patients, and reduce the concentration of serum inflammatory cytokines. The therapeutic effect is significant, and the effect of acupuncture therapy is more lasting.

Effect of comprehensive health care intervention of traditional Chinese medicine on bone mineral density and bone metabolic markers in postmenopausal women with low bone mineral density

LIN Yi-huai, WANG Shi-chao, LU Cun-xian, WANG Qing-lai

2020, 18(8): 1373-1375,1408. doi: 10.16766/j.cnki.issn.1674-4152.001510

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Objective To explore the effect of comprehensive health care intervention of traditional Chinese medicine on the improvement of bone mineral density in postmenopausal women with low bone mineral density. Methods Total 124 postmenopausal patients with low bone mineral density in our hospital from January 2016 to January 2018 were randomly divided into observation group and control group, 62 cases in each group. The control group was given calcium carbonate D3 + regular diet and activities for 6 months. The observation group was given comprehensive health care intervention of traditional Chinese medicine for 6 months. The differences of bone mineral density and bone metabolic markers between the two groups before and 6 months after treatment were compared. Results Compared with that before treatment, the bone mineral density of the control group(0.57±0.07) was significantly higher(P<0.05), and the bone mineral density of the 1 st-4 th lumbar vertebrae(0.77±0.06), femoral neck(0.75±0.07), femoral trochanter(0.61±0.08) and wards triangle(0.60±0.09) in the observation group were significantly higher(P<0.05). In the control group,the levels of carboxy terminal peptide β special sequence[(0.49±0.06)ng/mL], blood calcium[(2.28±0.07) mmol/L] and bone specific alkaline phosphatase[(326.37±100.82) U/L]were significantly higher than that before treatment(P<0.05). In the observation group, the levels of amino terminal peptide[(50.13±12.76) ng/mL], middle molecular fragment of osteocalcin[(21.24±6.77) ng/mL], and bone specific alkaline phosphatase[(418.72±129.90) U/L] were significantly higher(all P<0.05), while the levels of carboxy terminal peptide β special sequence[(0.43±0.09) ng/mL] and blood calcium[(2.21±0.07) mmol/L] were decreased significantly(P<0.05). Compared with the control group, the bone mineral density and bone metabolic markers of the observation group were significantly improved(all P<0.05). Conclusion The comprehensive health care intervention of traditional Chinese medicine can improve the bone mineral density of postmenopausal patients with low bone mineral density in a short time, and improve the expression level of bone formation markers and bone resorption markers.

Application of 3D printing technology combined with CBL teaching mode in clinical teaching of orthopedics

ZHOU Ping-hui, ZHANG Yi-wen, MAO Ying-ji, GUAN Jing-jing, LIU Xiang-yu, BAO Zheng-qi, GUAN Jian-zhong, ZHANG Zhang-chun

2020, 18(8): 1376-1379. doi: 10.16766/j.cnki.issn.1674-4152.001511

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Objective To improve the clinical teaching efficiency of orthopedics, this study tries to adopt the new teaching method of 3 D printing technology and CBL teaching mode to explore the effect of the new teaching mode. Methods Total 50 students from the second class of clinical undergraduate class of 2017 of Bengbu medical college were selected as experimental subjects. According to the parity of the last two digits of the student number, they were divided into new teaching method group and traditional teaching method group, with 25 students in each group. The new teaching method adopted 3 D printing technology combined with CBL teaching model for clinical teaching, while the traditional teaching method group adopted the traditional teaching method. The 3 D printing technology combined with CBL teaching mode was used to teach and 50 experimental subjects were surveyed with evaluation scale to evaluate the application effect of the new teaching mode. After the completion of the lecture, a unified assessment test was conducted to analyze whether there were statistical differences between the two groups of students' academic performance scores and the degree of self-assessment. Results In the 50 valid questionnaires, the theoretical average score of the control group was 69.84±12.52, and the clinical average score was 68.96±12.65. The theoretical average score of the experimental group was 83.16±10.46, and the clinical average score was 83.48±8.89. The scores and self-assessment of students who studied with the new teaching method were significantly higher than those of the traditional teaching method group(all P<0.05). Conclusion Compared with the traditional teaching mode, the application of 3 D printing technology combined with CBL teaching mode in clinical teaching of orthopedics embodies abstract knowledge, increases students' interest in orthopedics learning, deepens their understanding of theoretical and experimental knowledge, and improves teaching efficiency.

Analysis of the results of the general surgery examination of Guangdong Medical University in the 2016-2018 academic years

HAN Xiao-ling, CHEN Jun-hu, ZHOU Zhong-wei, LIN Hong-cheng

2020, 18(8): 1380-1383. doi: 10.16766/j.cnki.issn.1674-4152.001512

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Objective To analyze the results of the general surgery examination of Guangdong Medical University in the 2016-2018 academic years, in order to explore the effectiveness of the reform and provide a reference for further improving the quality of teaching. Methods The final exam scores of classes in the general surgery course offered by Guangdong Medical University since the 2016 academic year was collected and analyzed. The differences between the overall assessment scores, roll scores, and time grades in different academic years, grades, majors, and genders were analyzed. The linear mixed model was used to analyze the roll score. Results A total of 1 359 people took the general surgery examination in the 2016-2018 academic years. The average scores of the usual scores, roll scores, and overall assessment scores were 85.28±3.98, 68.29±8.55, and 73.50±6.22, respectively. The pass and excellent rate were 84.69%(95% CI:82.78-86.60) and 43.34%(95% CI:40.71-45.97). The results of the generalized linear mixed model showed that female, the specialty is clinical medicine, and the 2017 and 2018 academic years have a higher roll score of the general review of surgery is higher, with OR values of 5.492(95% CI:3.146-9.586),9.575(95% CI:1.561-58.720),14.211(95% CI:6.075-33.243)and 2 157.272(95% CI:1 062.993-4 378.034), respectively. Conclusion A series of clinical teaching reforms that have been implemented since 2016 have achieved certain results, but students' grasp of theoretical knowledge still needs to be improved.

Analysis of rumination level and its influencing factors in patients after total hip arthroplasty

CHEN Li-hong, XU Hua-liang, XU Fu-rong, YE Jie-yu

2020, 18(8): 1384-1387. doi: 10.16766/j.cnki.issn.1674-4152.001513

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Objective To investigate the status of rumination in patients after total hip arthroplasty, analyze its influencing factors, and provide reference for further development of intervention measures. Methods A total of 245 patients after total hip arthroplasty who were treated in the orthopaedics department of two tertiary Class A hospitals in Guangzhou from March to November 2019 were selected and investigated using the general situation questionnaire, Event Related Rumination Inventory, Social Support Rating Scale and Herth Hope Index. The t-test, analysis of variance, Pearson correlation analysis and multiple linear regression analysis were used to analyze the rumination level in patients after total hip arthroplasty. Results The scores of intrusive rumination and deliberate rumination of patients after total hip arthroplasty were(14.56±4.57) and(13.29±4.48). Multivariate linear regression analysis showed that education level, Harris hip score, social support, and level of hope were the main influential factors for invasive rumination(F=26.533, P<0.001; R²=0.326, adjusted R²=0.314);Educational level, monthly household income, social support, and level of hope were the main influencing factors of deliberate rumination(F=41.964, P<0.001; R²=0.534, adjusted R²=0.522). Conclusion The rumination of patients after total hip arthroplasty are at a moderately low level. Clinical medical staff should adopt individualized intervention according to the patient's situation, pay attention to the impact of social support and hope levels on their rumination, guide patients to change to positive cognitive processing, and ultimately promote the postoperative rehabilitation.

A study on the economic burden of psoriasis vulgaris inpatients with zero price difference policy

NI Yang, MA Jia-li, WANG Su-ping, HU Peng, CHEN Zhong-jian

2020, 18(8): 1388-1391. doi: 10.16766/j.cnki.issn.1674-4152.001514

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Objective To study the changes of all kinds of expenses among psoriasis vulgaris inpatients after the implementation of zero price difference policy in order to provide a better basis for optimization of the policy. Methods Total 749 cases of psoriasis vulgaris inpatients in Shanghai skin Disease Hospital from January 1 st, 2015 to June 20 th, 2017 were selected. The general information of patients and information on total expenses during hospitalization were collected. SPSS 19.0, univariate and multivariate regression analysis were used to analyze the relevant data to explore the impact of general factors and zero price difference policy on various types of costs. Results Univariate analysis showed that medical expenses of males were higher than females(P=0.003), the higher inspection fees of older(P=0.009), the higher various types of expenses of more hospitalization days(P<0.001). The price difference policy had a significant effect on the total cost, drug cost and treatment cost(all P<0.05), but it had no significant effect on the inspection cost(P=0.685). Multivariate regression analysis found that the drug cost had the greatest influence on the total hospitalization expenses. Analyzing both general and zero price difference factors showed that the longer the patients stay at hospital, the higher cost of hospitalization is(P<0.05). In terms of total hospitalization expenses and drug costs, the price difference of 5% and price difference of 10% were remarkably higher than zero price difference(all P<0.05). There was no significant difference between the price difference of 15% and zero price difference(P>0.05). Furthermore, the price difference of 5% was less than the price difference of 10%. In terms of treatment fees, the fees of males were higher than females'(P<0.05), and the price difference policy had no significant impact on the treatment costs. Conclusion The majority of medical expenses among psoriasis vulgaris inpatients show a downward trend after the implementation of the policy, which reduces the economic burden of patients to some extent.

The impact of home care based on information management platform on the quality of life of the elderly with dementia

BAI Meng, CHEN Ling-yan, JIA Kang-lu, JIE Yan-hong

2020, 18(8): 1392-1394,1420. doi: 10.16766/j.cnki.issn.1674-4152.001515

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Objective The pace of aging in our country is gradually accelerating, and the elderly with dementia has become an important burden to the society and family. The development of modern science and technology provides convenient conditions for the management of the mentally retarded elderly. This study aims to reduce the hidden danger of the safety of the mentally retarded elderly at home and improve their quality of life by establishing an information management platform for the mentally retarded elderly. Methods Forty cases of the elderly with dementia who met the criteria of case selection in Zhejiang Hospital from July to December 2018 were selected as the observation group, they were established a professional team and an information management platform to implement remote health management, 35 cases of the elderly with dementia who met the criteria of case selection in our hospital from January to June 2018 were selected as the control group, and they were given routine intervention, mainly through telephone follow-up or door-to-door service. After 6 months of intervention, QOL-AD was used to investigate the quality of life of the two groups of patients, and potential safety hazards in the two groups was counted. Results There was no significant difference in QOL-AD total score and mean score between the two groups(P>0.05).The total score and mean score of QOL-AD in the observation group were respectively 28.56±4.21 and 2.16±0.42, which were higher than 25.29±4.82 and 1.92±0.47 in the control group(t=3.136, 2.335, P=0.002, 0.022). The incidence of falls, falling to bed, loss and scald in the observation group was 40.0% lower than 68.6% in the control group, the difference was statistically significant(χ²=6.122, P=0.013). Conclusion Information management using modern technology platform can improve the medical experience of the elderly with dementia, improve the quality of life in home care for the elderly with dementia, reduce the occurrence of security risks, and has high application value.

Epidemiological investigation of Helicobacter pylori in central and southern area of Anhui province

ZHANG Ming-wei, WANG Jian-chao, WANG Qi-zhi, KE Xi-quan, ZHENG Hai-lun, CUI Yan-yan

2020, 18(8): 1395-1398. doi: 10.16766/j.cnki.issn.1674-4152.001516

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Objective To investigate the Helicobacter pylori infection among residents in central and southern area of Anhui province, to explore the risk factors associated with Helicobacter pylori infection, and to guide the early prevention and intervention of Helicobacter pylori infection in local population. Methods After signing the informed consent, all the subjects will conduct the investigation with a unified questionnaire. After the end of the questionnaire, the ¹⁴C urea breath test was used to evaluate the infection status, analyze the test results, and analyze some related factors by using the questionnaire survey. The SPSS 18.0 statistical software was used to explore the risk factors associated with H. pylori infection in the region. Results A total of 1 536 people were surveyed. The results showed that the Helicobacter pylori infection rate was 63.2%(970/1 536) in central and southern area of Anhui province, Helicobacter pylori infection and age(χ²=70.886, P<0.001),education(χ²=29.754, P<0.001), sleep quality(χ²=136.339, P<0.001), eating beans and products(χ²=89.114, P<0.001), and eating Fruit and Vegetables(χ²=91.919, P<0.001),Alcohol consumption(χ²=266.436, P<0.001), drinking strong tea(χ²=86.956, P<0.001), and pickled food consumption(χ²=215.677, P<0.001) were related. Conclusion The infection rate of Helicobacter pylori in the central and southern area of Anhui is higher than the national average. The infection of Helicobacter pylori is related to demographic characteristics, personal living habits and personal eating habits. Among them, higher cultural education, better quality of sleep, eating beans and their products, eating fruits and vegetables, drinking strong tea, etc. are protective factors for Helicobacter pylori infection, and the cultural level is low, poor sleep, drinking and eating preserved foods is a risk factor for Helicobacter Pylori infection.

Building a reasonable and efficient hospital infection management mechanism relying on informatization

MAO Qiu-yun, ZHANG Ling, SONG Yan-ping, ZHANG Wei, JIA Chao, YAN Ling, LAN Sheng-mei, ZHU Hong-qin

2020, 18(8): 1399-1403. doi: 10.16766/j.cnki.issn.1674-4152.001517

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Objective To explore a scientific, objective, and efficient hospital infection management mechanism. Methods Based on the blue dragonfly nosocomial infection management system, LIS, HIS, PACS, EMR, PDA, and OA system, a reasonable and efficient hospital infection management system of monitoring, quality control, evaluation and feedback was developed. The false negative rates, implementation rate of multi resistant bacteria prevention and control measures, hospital infection knowledge training participations rates, incidence of equipment related hospital infection, supervision of hospital infection, supervision of infectious diseases, effectiveness of monitoring results of disinfection and sterilization effect were compared through the application of the information management system. Results After using information hospital infection management system,the false negative rates, implementation rate of multi resistant bacteria prevention and control measures, hospital infection knowledge training participations rates were reduced to 0.0%, 96.3%, and 97.1% from 19.0%, 78.2%, and 79.2%. The infection rates of VAP, CLABSI, and CAUTI were reduced to 4.51‰, 1.96‰ and 2.79‰ from 14.52‰, 3.91‰ and 6.90‰. But the incidence of CLABSI was relatively high as compared with the class 35 hospital ICU of china, thus it should put emphasis on the constitution of the CLABSI interventions. The supervision of hospital infection, supervision of infectious diseases, effectiveness of monitoring results of disinfection and sterilization effect increased significantly. Conclusion The application of hospital infection management mechanism relying on the informatization can effectively improve the whole quality of hospital infection management and management efficiency.

Distribution and drug resistance analysis of tigecycline-resistant Klebsiella pneumoniae

RUAN Yong-chun, ZHOU Yi-qing, ZHANG Hai-wang, YU Li-xia, WANG Dan, CENG Min, ZHOU Jie, LI Ming-hui

2020, 18(8): 1404-1408. doi: 10.16766/j.cnki.issn.1674-4152.001518

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Objective To investigate the clinical distribution and drug resistance of tigecycline-resistant Klebsiella pneumoniae(TRKP), and to provide evidence for clinical prevention and treatment. Methods Total 261 strains of TRKP isolated from various samples of inpatients from Shaoxing People's Hospital from January 2015 to December 2018 were collected. VITEK-2 compac automatic microbial analyzer was used for bacterial identification and drug susceptibility test. The sensitivity of other clinical commonly used antimicrobial agents was measured by K-B method. Clinical distribution characteristics of TRKP and its resistance to antimicrobial agents were studied and analyzed. Results The 261 strains of TRKP were isolated mainly from sputum(n=123, 47.13%), urine(n=55, 21.07%) and bile(n=37, 14.18%), and the stains were mainly originated from ICU(including Emergency ICU), department of hepatobiliary surgery and department of neurosurgery(including Neurosurgery ICU), accounting for 22.61%, 17.62% and 15.71%, respectively. Among the 22 antimicrobial agents, TRKP was more than 80% resistant to 5 and 50% resistant to 14. The resistant rate of TRKP strains which were also resistant to carbapenem was over 90% to 16 species antimicrobial agents and over 80% to 20 species. A total of 249 strains of TRKP, accounting for 95.40%, were multidrug-resistant strains. Furthermore, 93 TRKP strains which were also resistant to carbapenem, accounting for 100%, were multidrug-resistant strains. The overall resistance rate of TRKP to amikacin was relatively low at 16.09%, and the resistance rate to various antibiotics in the department of hepatobiliary surgery was not higher than that in the ICU and the department of neurosurgery. Conclusion There is a wide range of clinical distribution of TRKP, of which the drug resistance is serious. Antimicrobial agents can be available is limited for treatment of TRKP, and amikacin is one of the few optional drugs.

The application effect of Swanson care theory in insulin injection education for diabetic patients

KONG Li-ping, REN Xiao-ping, GE Hua-ying, LI Xiu-ying, YU Zhe, LIU Su-zhen, WU Xiao, LI Yi-min

2020, 18(8): 1409-1413. doi: 10.16766/j.cnki.issn.1674-4152.001519

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Objective To apply the Swanson care theory in insulin injection education of diabetic patients and explore its application effect. Methods Total 120 patients with type 2 diabetes admitted to the Department of Endocrinology, Hangzhou First People's Hospital Affiliated to Zhejiang University Medical College from March to December 2018 using convenient sampling method were selected as the study objects. According to the admission time, 56 patients from March to July were set as control group, and 64 patients from August to December 2018 were set as observation group. The control group used the conventional mode to inject insulin to the diabetic patients. On the basis of the control group, the observation group used Swanson care theory for education. The ability of insulin injection management and self-care behavior were assessed by self-made questionnaire and self-care behavior ability scale. The ability of insulin injection management, self-care behavior and blood glucose control were compared between the two groups at the time of admission and three months after discharge. Results Three months after discharge, the total score of insulin injection management ability in the observation group(54.06±2.70) was significantly higher than that in the control group(42.64±4.84), and the difference was significant(t=16.231, P=0.001). Three months after discharge, the score of self-care behavior ability in the observation group(111.69±9.14) was significantly higher than that in the control group(94.77±12.41), and the difference was statistically significant(t=8.569, P=0.002). Three months after discharge, the fasting blood glucose, 2-hour postprandial blood glucose and HbA1 c water in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion Swanson care theory can help patients improve insulin injection skills and self-care ability of diabetic patients, thus achieving the goal of controlling blood glucose and promoting health.

Effect of cluster intervention in hospital transport of critical patients in emergency surgery

LI Hui, DENG Xi-ming, ZHANG Fei-peng, MENG Dan

2020, 18(8): 1414-1416,1424. doi: 10.16766/j.cnki.issn.1674-4152.001520

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Objective To explore the effect of cluster intervention on in-hospital transport of critical patients in emergency department. Methods A total of 100 patients who were admitted to the emergency department from June 2017 to May 2018 were selected as the control group, and the routine nursing measures were adopted. As an observation group, 100 critically ill patients transported to the hospital from June 2018 to May 2019 were treated with cluster intervention. Statistical analysis of the incidence of adverse events, average transfer time, patient/family, the satisfaction of medical staff in receiving department, the change of patients,condition and the success rate were performed during the two groups of patients. Results The incidence of adverse events in the control group was 18.0%, higher than the observation group's 7.0%, and the difference was statistically significant(P<0.05). The average transit time in the control group was(14.57±2.16) min higher than(10.12±1.88) min in the observation group. The difference was statistically significant(P<0.05). The Satisfaction score of doctors, patients/families in the control group were 6.23±1.48, 6.03±1.45, which were lower than the observation group's 7.08±1.35, 7.35±1.36, the difference was statistically significant(all P<0.05). The incidence of change in condition in the control group was 23.0% higher than that in the observation group's 6.0%; the transfer success rate in the control group was 79.0% lower than the observation group's 93.0%, and the difference was statistically significant(all P<0.05). Conclusion Clustering interventions can reduce the incidence of adverse transport events in hospitals for critically ill patients from department of emergency surgery, shorten the transport time, reduce the incidence of disease changes in patients during the transport process, and improve the satisfaction level of doctors and patients and the success rate of transport.

Effect of UV printing pictures and simulation model to improve self-care ability of dermatitis around stoma of patients with enterostomy

PAN Xuan-xuan, HONG Jing, MA Jing, HU Wan-le

2020, 18(8): 1417-1420. doi: 10.16766/j.cnki.issn.1674-4152.001521

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Objective To improve the self-care ability of dermatitis around stoma of patients with enterostomy by using UV printing pictures and simulation model before operation in order to find a more effective health education model. Methods Total 80 patients with enterostomy in our hospital from January 2019 to August 2019 were randomly divided into control group and observation group, 40 cases in each group. The control group was given general nursing. On the basis of the control group, UV printing pictures and simulation model were used for health education one week before the operation in the observation group. The nursing knowledge score, standard rate, self-care ability score and the skin damage around the stoma were observed. Results One hour before discharge, the nursing knowledge score of the observation group was higher than that of the control group[(85.6±9.5) vs.(77.6±10.2), t=3.630, P<0.001], the rate of reaching the standard in the observation group was higher than that in the control group(85.0% vs. 65.0%, χ²=4.267, P=0.039). At 1 and 3 months, the scores of self will, self-care knowledge and self-care skills in the observation group were significantly higher than those in the control group(P<0.05). The scores of DET in the observation group were significantly lower than those in the control group[before discharge:(4.1±0.6) vs.(7.8±1.5); 1 month:(2.6±0.5) vs.(5.3±1.2); 3 months:(1.4±0.3) vs.(3.1±0.8), all P<0.05]. Conclusion Using UV printing pictures and simulation model before operation can significantly improve the self-care ability of dermatitis around stoma of patients with enterostomy compared with routine health education, and can enhance the level of nursing knowledge and reduce the skin injury around the stoma, which is worth popularizing.

Observation on the clinical effect of modified oral endotracheal intubation method on ICU patients with instrumental pressure injury

ZHANG Qin, SONG Zhang-chun, ZOU Qi, WAN Juan, ZHU Xiao-jie, YANG Bin

2020, 18(8): 1421-1424. doi: 10.16766/j.cnki.issn.1674-4152.001522

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Objective To investigate the effect of modified oral endotracheal intubation fixation on instrumental pressure injury of oral, facial and neck in patients with clinical ICU. Methods A single-center, prospective, randomized controlled research method was used to select 80 patients who were admitted to the ICU ward of the Third People's Hospital of Bengbu City from June 2019 to March 2020, and were fixed by the method of oral tracheal intubation. Random number table method was used to randomly divide them into an observation group and a control group, with 40 patients in each group. The observation group adopts the modified tracheal intubation fixation method, and the control group adopts the conventional tracheal intubation fixation method. Compare the location and severity of device-related pressure injury in the mouth, face, and neck of the two groups of patients. Results The two groups of patients showed no significant difference in age, endotracheal intubation time, Braden scale score, muscle strength and other indicators(all P>0.05). A total of 3 cases(7.5%) of oral, facial and neck pressure injuries occurred in the observation group; 15 cases(37.5%) of pressure, oral, facial and neck pressure injuries occurred in the control group. The number and proportion of injuries in the observation group were significantly less than those in the control group. After statistical analysis, the difference was statistically significant(all P<0.05). Conclusion Compared with the control group, the observation group using the modified oral endotracheal intubation fixation method can significantly reduce the incidence and severity of patients with oral, facial and neck instrumental pressure injury. This has a great help in effectively reducing the iatrogenic complications that persist in the mouth, face, and neck of ICU patients, such as redness, pain, ulceration, infection, and necrosis. It greatly enhances the confidence of patients to restore health, and has great practical guiding significance for clinicians and nursing managers.

Application of enteral nutrition support based on the concept of rapid rehabilitation in patients with esophageal cancer after operation

QIAN Duo-yun, LI Duo-jie, YUAN Pei-pei, SUN Huan

2020, 18(8): 1425-1427,1430. doi: 10.16766/j.cnki.issn.1674-4152.001523

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Objective To observe the application of enteral nutrition support based on the concept of rapid rehabilitation in patients with esophageal cancer after operation. Methods A total of 60 patients with esophageal cancer were enrolled in our hospital(from January 2017 to September 2019). They were randomly divided into control group(30 cases) and experimental group(30 cases). Among them, patients in the control group received enteral nutrition support intervention under the concept of conventional nursing, while those in the experimental group received enteral nutrition support intervention based on the concept of rapid rehabilitation. Before and after the intervention, the nutritional index, immune function index, postoperative recovery, the incidence of complications and the satisfaction rate of patients with nursing intervention were compared between the two groups. Results The nutritional indexes of the two groups were significantly improved after intervention, and the level of nutritional indexes in the experimental group was significantly higher than that in the control group(all P<0.001). After the intervention, the level of immune response index in the two groups increased, and the level of immune response index in the experimental group was significantly higher than that in the control group(all P<0.001). The patients in the experimental group were less than those in the control group(all P<0.01). The incidence of complications in the experimental group was 6.67%, which was significantly lower than that in the control group(26.67%), χ²=4.320, P=0.038. The total satisfaction rate of the patients in the experimental group was 100.00%, significantly higher than that in the control group(76.67%), χ²=5.822, P=0.016. Conclusion Nutritional support nursing intervention based on the concept of rapid rehabilitation can significantly improve the nutritional index and immune function of patients, shorten the recovery time of patients, reduce the incidence of complications during hospitalization, and improve the satisfaction of patients with nursing.

XU Li-dan, LI Xiao-bing, WANG Kai-xuan, JI Xiu-mei, SHI Qian-wen, TANG Hong-juan

2020, 18(8): 1428-1430. doi: 10.16766/j.cnki.issn.1674-4152.001524

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TONG Jing-wei, XU Pei-quan

2020, 18(8): 1431-1432. doi: 10.16766/j.cnki.issn.1674-4152.001525

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About Journal

2020 Vol. 18, No. 8

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