中华全科医学

The reform and research in general practice education based on big data technology

HAN Yiping, ZHANG Congxin, LIU Yanmin, ZHAO Jiayi, SHEN Lu, KE Jun, YUAN Pengqun, CHEN Xihui

2017, 15(7): 1093-1096. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.001

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Big data is the scientific power to promote the innovation and development of education.Big data in general practice education is a branch of big data in education.It is a new concept, mainly referring to the data collection from the entire general practice education process.According to the training requirements, the data collection could be applied to the development of the general practice education and create enormous potential value.Besides such features as the volume, velocity, variety and value, the big data in general practice education also has its unique characteristics, for example, complexity, comprehensiveness, causality, completeness and creativity.Its structure can be divided into five levels such as individuals, courses, institutions, regions and industries.The value of big data in general practice education is reflected in the deep integration and the promotion of general practice education reform.Personalization in teaching idea:the individual learning based on big data will be more and more customized.Diversification in teaching model:data mining and learning analysis technology will make general medicine education break the time and space constraints to be the multi-dimensional and full-time teaching model.Scientization in teaching management:via the big data technology, more scientific, accurate and efficient general education management will be achieved.Quantification in teaching evaluation:the behavioral information of teaching and learning will be recorded accurately and the evaluation results will become authentic.It is reasonable to believe that the big data general practice education could improve the reform of general practice education.

2017, 15(7): 1097-1098.

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Clinical study of percutaneous transforaminal endoscopic discectomy for far lateral lumbar disc herniation

WANG Yandong, MA Rui, QIAN Jixian, ZHOU Yong, ZHANG Wei, YANG Zhiquan, HAN Kang, DANG Peiye

2017, 15(7): 1099-1101,1108. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.002

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Objective Lumbar disc herniation is the common spinal disease.The far lateral lumbar disc herniation is a special type, which of the diagnosis and treatment are different from that of the conventional lumbar disc herniation.The aim of this paper is to observe the clinical effect and safety of percutaneous endoscopic lumbar discectomy (PELD) in patients with far lateral lumbar disc herniation. Methods The clinical and follow-up data of 43 patients who were admitted in our hospital from September, 2013 to September, 2015 and diagnosed as far lateral lumbar disc herniation undergoing surgery therapy were retrospectively analyzed.The patients were divided into experimental group (PELD:n=25) and control group (tradition open-operation:n=18) and followed up at least 6 months after the treatment.The clinical outcomes were evaluated by visual analogue scale (VAS) and Lehmann Lumbar function score, operation time, the time in bed, blood loss, cost and complications and so on. Results There were significant difference in the VAS and lumbar function in two groups comparing that before the operation (P < 0.05), while there was no difference between two groups in the VAS score and lumbar function after the operation (P > 0.05).The operation time, the time in bed, blood loss, cost and complications who had PELD was significantly better compared with those in control group (P < 0.05), which shows that the patients in PELD group has less blood loss, shorter operation and hospital time and more safe complication. Conclusion PELD for far lateral lumbar disc herniation has more particular advantages than normal treatments, which should be further application and promotion in clinic.

Porphyromonas gingivalis Infection and expression of NLRP3,IL-1β,IL-18 in Human Periodontal Ligament Cells with chronic periodontitis

YIN Min, FENG Wei, JIN Qiaoxia, ZHENG Yuanna

2017, 15(7): 1102-1104. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.003

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Objective To discuss porphyromonas gingivalis (Pg) infection and expression of NLRP3, IL-1β, IL-18 in human periodontal ligament cells with chronic periodontitis. Methods Fifty cases of patients with chronic periodontitis and50 cases of periodontal healthy people were selected.Real-time fluorescence PCR technique was used to detect gingival plaque Pg, Chronic periodontitis patients after tooth extraction in periodontal membrane of the periodontal ligament cell culture, Some cells were used for Pg standard strains infection, some don't do processing of infection.The protein level of NLRP3 was determined by Western blot, the protein levels of IL-1β and IL-18 were measured by ELISA. Results Positive rate were 84.00% of pg in chronic periodontitis, positive rate were 22.00% of pg in periodontal healthy people.Probing depth of 5, 6, 7 mm, Pg concentration were 4.38 ±0.81, 4.79 ±0.76, 5.47 ±0.63 in chronic periodontitis, Pg concentration were 0.38 ±0.12, 0.46 ±0.15, 0.72 ±0.20 in periodontal healthy people.The difference was statistically significant (P < 0.05).NLRP3, IL-1β and IL-18 concentration were 1.25 ±0.12, (1 820.42 ±425.57) pg/ml and (311.55 ±45.70) pg/ml in human periodontal ligament cells with Pg infection, 0.74 ±0.08, (1 138.65 ±350.76) pg/ml and (124.70 ±42.54) pg/ml in human periodontal ligament cells with Pg non-infection, The difference was statistically significant (P < 0.05). Conclusion Pg microbial infection rate and infection were higher in chronic periodontitis, Pg infection can cause NLRP3, IL-1 beta, IL-18 expression increases in human periodontal ligament cells.This may be one of the reasons for Pg cause chronic periodontitis.

Clinical study of uremic clearance granule combined losartan in treatment of hypertension with hyperuricemia

GONG Ming, KUANG Yongdong, PAN Jiaxi, HAN Zhao

2017, 15(7): 1105-1108. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.004

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Objective To investigate the clinical efficacy of uremic clearance granule combined with losartan in the treatment of hypertension with hyperuricemia. Methods Total 168 cases of hyperuricemia with hyperuricemia in our hospital between January, 2015 and March, 2016 were selected and divided into observation group and control group (n=84) by random number method.The patients in the control group were given losartan, while the patients in the observation group were added uremic clearance granule based on losartan.Before and after the treatment, blood and uric acid indicators[systolic blood pressure (SBP), diastolic blood pressure (DBP), and uric acid (UA)], endothelial cell function[nitric oxide (NO), Von Willebrand factor (vWF)], RAS activity indicators[plasma supine renin, Angiotensin Ⅱ (Ang Ⅱ)], blood lipids indicators[triglycerides (TG), cholesterol (TCG) and high density lipoprotein (HDL-1)]of two groups were tested, and the adverse reactions and clinical efficacy of the two groups were accounted. Results After the treatment, the levels of SBP, DBP, uric acid, vWF, adrenaline, Ang Ⅱ, TG and TCG HDL-C in both groups were significantly reduced (P <0.05), and each indexes of the observation group were significantly lower than those of the control group (P < 0.05).The NO levels of the two groups were significantly increased (P < 0.05), NO level of the observation group was significantly higher than that of control group (P < 0.05).The total effective rate of the observation group was 91.7%, which was significantly higher than that of control group (79.8%), P < 0.05. Conclusion Uremic clearance granule combined losartan could inhibit the over-activation of RAS system, improve the function of endothelial cells, effectively reduce the blood pressure and blood uric acid content, with satisfactory treatment.

Amino terminal B-type natriuretic peptide precursor relevance to modified Ross score and evaluation the value of left to right shunt congenital heart disease cardiac function

ZHANG Hui, JIANG Rong, ZHAO Sheng, ZHENG Liyun

2017, 15(7): 1109-1112. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.005

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Objective To study the left to right shunt congenital heart disease (congenital heart diseases, CHD) in children with heart failure when plasma amino-terminal B-type Natriuretic Peptide Precursor (Amino Terminal B-type Natriuretic Peptide, NT-pro BNP) changes and its value in the evaluation of cardiac function, analyze the correlation with modified Ross score, search for pediatric heart failure rapid detection methods. Methods The object of study is 55 cases left to right shunt CHD patients.According to the modified Ross score, the patients were divided into four groups, and the before and after treatment were compared.An alternate 12 cases in the same period in the hospital without CHD and heart failure in children as control group.With the United States (Roche) rapid heart failure diagnosis instrument determination of all children with plasma NT-pro BNP level, analyze its significance. Results The NT-pro BNP and modified Ross score into positive correlation (r=0.859), the children with CHD NT-pro BNP level obviously higher than that of control group, with statistical significance (P < 0.05), there were significant difference among heart failure group (P < 0.05).Children with heart failure after treatment, plasma NT-pro BNP levels significantly decreased, with statistical significance (P <0.001), the NT-pro BNP in the diagnosis of cardiac insufficiency of cutoff value was 286.5 pg/ml. Conclusion Different degree of heart failure in children with NT-pro BNP have a significant difference, the plasma NT-pro BNP can be used as the infant left to right shunt CHD with heart failure an objective indicator of cardiac function evaluation.

Effect of levamlodipine on serum levels of platelet-derived growth factor-BB in patients with essential hypertension and its influence on carotid artery intima-media thickness

HENG Xuhua, BAO Xiaohong, ZOU Jianjie, LI Zhanglong, YANG Yanlin, TANG Jie, LIU Mingchun, NI Huanjuan

2017, 15(7): 1113-1116,1132. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.006

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Objective To study the effect of levamlodipine on the serum levels of platelet-derived growth factor-BB (PDGF-BB) in patients with essential hypertension and its influence on carotid artery intima-media thickness (IMT). Methods Ninety patients with essential hypertension who were visited in the cardiovascular clinic of the affiliated hospital of Panzhihua university from April 2014 to January 2016 were randomized into control group (n=30), levamlodipine group (n=30) and diuretics group (n=30).All groups received the therapeutic lifestyle interventions, in addition, the levamlodipine group was administered with oral levamlodipine, diuretics group with oral diuretics.The serum levels of PDGF-BB and carotid artery IMT were determined.The serum levels of PDGF-BB and carotid artery IMT were analyzed by linear correlation before treatment.The changes in serum levels of PDGF-BB and carotid artery IMT were compared after 6and 12 months of treatment. Results The serum level of PDGF-BB was moderately positively correlated with carotid artery IMT before the treatment.There were obviously decreased in the serum levels of PDGF-BB of the levamlodipine group after 6 months of treatment as compared with those before the treatment.There were no significant difference in the serum levels of PDGF-BB of the control group and diuretics group after 6 months of treatment as compared with those before the treatment.After 12 months of treatment, there was no significant difference in the serum levels of PDGF-BB of the control group as compared with those before the treatment and after 6 months of treatment.The serum levels of PDGF-BB of both levamlodipine group and diuretics group were evidently decreased as compared with those after 6 months.And the serum levels of PDGF-BB of the levamlodipine group were lower than the diuretics group.After 12 months of treatment, the carotid artery IMT of the control group was increased as compared with that before the treatment.The value in the diuretics group was unchanged;the carotid artery IMT of the levamlodipine group was decreased as compared with that before the treatment and after 6 months of treatment. Conclusion In patients with essential hypertension, Levamlodipine may reduce the serum levels of PDGF-BB and carotid artery IMT, and the serum level of PDGF-BB is moderately positively correlated with carotid artery IMT.Levamlodipine may decline the carotid artery IMT through reducing the serum levels of PDGF-BB of essential hypertension.

Expression of S100A6 in AML and Its Influence no Curative Effect

BAO Hongyu, WANG Jianning, MENG Qingqi, SONG Min

2017, 15(7): 1117-1119,1126. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.007

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Objective To investigate the expression of S100A6 in AML and its influence no curative effect. Methods Collecting 42 AML patients and 12 normal persons, the expression of S100A6 mRNA in these AML patients was determined by real time quantitative PCR (RQ-PCR).The expressions in AML patients and normal persons, different types AML patients, the patients before and after the therapy were compared.The expression differences before and after the therapy between the effective treatment group and the ineffective treatment group of AML-M3, M4, M5 patients were compared.The expression differences before the therapy between the recurrence group within two years and the no recurrence group within two years of AML-M3, M4, M5 patients were compared.The expression differences of CR1, CR2 between the high expression group and the low expression group of AML-M3, M4, M5 patients were compared.The expression differences of OS in two years between the high expression group and the low expression group of AML-M3, M4, M5 patients were compared.The expression differences of relapse between the high expression group and the low expression group of AML-M3, M4, M5 patients were compared.All the results were analyzed by statistic. Results Compared with normal persons, the expression lever of S100A6 in the AML-M3, M4, M5 patients was higher (P < 0.05), the expression lever in the AML-M1, M2, M6, M7 patients was not different (P > 0.05).The expression of S100A6 in the AML-M3, M4, M5 patients who have effective treatment has difference between before and after therapy (P < 0.05), the expression of S100A6 in these patients who have no effective treatment has no difference between before and after therapy (P > 0.05).The expression of S100A6 in the AML-M3, M4, M5 patients who relapsed in two years was higher than that in the patients who have not relapsed in two years (P < 0.05).The rate of CR1 and CR2 in the S100A6 high expression group is no statistical difference with the rate of the low expression group of AML-M3, M4, M5 patients (P > 0.05).The rate of OS in two years in the S100A6 high expression group is no statistical difference with the low expression group of AML-M3, M4, M5 patients (P > 0.05).The rate of relapse in the S100A6 high expression group is higher than that of low expression group of AML-M3, M4, M5 patients (P < 0.05). Conclusion The expression of S100A6 in AML patients is related to the patients' styles, curative effect and prognosis.It might be the diagnosis molecular markers of AML.

Analgesic effect of oxycodone during post-anesthesia recovery in patients undergoing functional endoscopic sinus surgery

HE Xihuan, WENG Hao, LIU Haijian

2017, 15(7): 1120-1122,1149. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.008

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Objective To evaluate the analgesic effect of different dose of oxycodone during post-anesthesia recovery in the patients undergoing functional endoscopic sinus surgery (FESS). Methods Total 90 patients planned to receive FESS, aged 18-60 years, weighing 55-85 kg, ASA status I or Ⅱ, were randomized and assigned into group A, group B and group C (n=30).The patients in group A, B and C received oxycodone of 0.1, 0.15, 0.2 mg/kg, respectively.Oxycodone was given at 30 min before the termination of FESS.HR, SBP, DBP and SPO₂ were recorded at the surgery closure (T₁), extubation (T₂), 10 min after extubation (T₃) and departure from PACU (T₄);Time to spontaneous breathing and extubation, SAS during extubation, Ramsay and VAS 20 min after extubation termination, satisfaction score of extubation, and the cases of nausea and vomiting were also recorded. Results The cases of nausea (12 cases) and vomiting (12 cases) in group C were the most among the three groups (P < 0.05);HR, SBP and DBP were significantly different among the three groups at T₂ (P < 0.05);HR, SBP and DBP at T₃ in group A, and HR, SBP and DBP at T₄ were the highest in the three groups;SPO₂ at T₃ in group C was the lowest (P < 0.05);The SAS was significant differences among the three groups (P < 0.05);In group A, extubation satisfaction score and VAS were the highest, while the Ramsay was the lowest among the three groups (P < 0.05). Conclusion The 0.15 mg/kg of Oxycodone is the ideal dose for post-anesthesia recovery of patients undergoing functional endoscopic sinus surgery.

Clinical study of D-dimer level in patients with progressive hemorrhagic injury after traumatic brain injury

LIN Ning, YAO Guoquan, LI Jun, SHI Beitian, XU Lilin, ZHOU Xiaozhou, XIAO Bo

2017, 15(7): 1123-1126. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.009

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Objective To investigate the dynamic changes of plasma D-dimer (D-D) level in patients iwht intracranial progressive hemorrhagic injury (PHI) after traumatic brain injury, and evaluate its auxiliary value in process of diagnosis and treatment of acute traumatic brain injury, and the influence on the prognosis. Methods Eighty-eight patients with acute craniocerebral injury in our hospital from July, 2012 to August, 2016 were enrolled.On 24 h, d1, d7 and d15, the peripheral venous blood was prepared for the test of D-D levels, and CT was performed in all patients, and according to the CT findings, the patients were divided into control group and PHI group (the intracranial hematoma increased significantly, ≥ 25%).The influence of D-D level on the degree of brain injury and prognosis was analyzed combined with the clinical data. Results Of the 88 patients, 42 were with PHI (47.73%).The levels of DD in peripheral venous blood were significantly higher than those in the control group[24 hours, (7.47 ±6.35):(2.01 ±2.46)],[3 days, (4.06 ±3.43):(1.41 ±2.37)],[7 days, (2.73 ±3.03):(0.91 ±1.38)],[15 days, (1.77 ±3.15):(0.41 ±1.07)], P < 0.05.GCS ≤ 8 points in patients with D-D level was significantly higher, GCS ≥ 9 points in patients with low D-D level, the two groups were significantly different;The plasma D-D level was significantly higher in the death group than in the non-death group (P < 0.05).The results showed that the higher the D-D level, PHI incidence was also higher;the prognosis of patients with different D-D level was significantly different. Conclusion The abnormal increase of D-D level in patients with acute brain injury can be used as a predictive factor of PHI, and is an important index to judge the injury and prognosis of patients.

Expression of miR-187 in the tissues of gastric cancer and its clinical significance

SHI Li, XUE Xiangyang, XIANG Hua, FAN Bo, WEI Wei

2017, 15(7): 1127-1129. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.010

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Objective To investigate the expression of microRNA (miR) -187 and its association with clinicopathologic features in the gastric cancer and YNM staging. Methods The miR-187 expression in the 32 cases of gastric cancer and the matched non-tumor adjacent tissue specimens were examined by using stem-loop Real-Time PCR (RT-PCR).The relationship between the expression of miR-187 and its clinicopathologic features of gastric cancer was analyzed by RT-PCR. Results miR-187 was detected in both the tumor tissues and the non-tumor adjacent tissues.The expression level of miR-187 in the tumor tissues was significantly lower than that in the adjacent tissues (P < 0.05).Down-regulated miR-187 expression was associated with the cell differentiation (P < 0.05) and lymph node metastasis TNM staging (P < 0.05) in gastric cancer patients. Conclusions There is a significant difference in the expression level of miR-187 between the tumor tissues and the adjacent tissues (P < 0.05).The miR-187 expression was associated with the cell differentiation and lymph node metastasis TNM staging.The expression of miR-187 might play a key role in the carcinogenesis and progress of gastric cancer.

Risk factors of intrahepatic cholestasis of pregnancy and its influence on pregnancy outcome

SUN Caiping, ZHANG Ke, WANG Qian, ZHANG Qing, ZHU Baoju

2017, 15(7): 1130-1132. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.011

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Objective To investigate the risk factors of intrahepatic cholestasis of pregnancy (ICP) and its influence on pregnancy outcome. Methods The clinical data of 40 patients with ICP in the second affiliated hospital of Zhengzhou university from September, 2013 to September, 2016 were analyzed, and 70 healthy pregnant women in the same hospital were selected as the control group, then the risk factors of ICP were analyzed.In addition, the perinatal gestational age and birth weight of both groups were recorded, and perinatal distress, amniotic fluid meconium contamination, premature delivery, aspiration pneumonia, asphyxia, pregnancy adverse events and perinatal complications of both groups were recorded and compared. Results The ratio of combined with hepatitis B or other hepatobiliary disease, ICP history, concomitant twins, and pregnancy complication of the ICP group were significantly higher than those of the control group, the differences were statistically significant (P < 0.05).The incidence rate of perinatal distress, amniotic fluid pollution, asphyxia, premature delivery and low birth weight infants of the ICP group were significantly higher than those of the control group, the differences were statistically significant (P < 0.05).The ratio of hypertensive disease of pregnancy, premature rupture of membranes, postpartum hemorrhage of ICP group were significantly higher than those of control group, the differences were statistically significant (P < 0.05). Conclusion Hepatitis B or other hepatobiliary diseases, ICP history, twins, pregnancy complications were the risk factors of cholestasis syndrome during pregnancy.ICP could increase perinatal distress, amniotic fluid meconium contamination, premature delivery, inhalation pneumonia, asphyxia and perinatal complications, effect the perinatal growth, and result in a poor outcome.

Expression of cytoplasmic polyadenylation-binding protein-4 in glioma and its effect on glioma cell growth

HE Guodong, XUE Zhaoliang, NIU Huanjiang, PAN Jinlong, ZHENG Rong, FENG Bo, XU Wei

2017, 15(7): 1133-1136,1258. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.012

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Objective To observe the expression of cytoplasmic polyadenylation element binding protein 4 (CPEB4) in glioma and the effect of CPEB4 on the growth of glioma U87 cells. Methods The expression of CPEB4 protein in glioma tissues and normal brain tissues were detected.The expression of CPEB4 protein in cells, the cell proliferation, apoptosis, cell cycle and the expression of CPEB4, PIK3 CA, IGF2, SMAD3, IDH1 and AKT1 mRNA were measured. Results The positive rate of CPEB4 protein in low-grade glioma gliomas tissues and high-grade gliomas tissues were higher than that in the normal brain tissues (P < 0.05).The positive rate of CPEB4 protein in the high grade glioma tissues was higher than that in the low grade glioma tissues (P < 0.05).The level of CPEB4 protein in the Low-grade glioma tissues and highgrade glioma tissues were significantly higher than those in the normal brain tissues.The level of CPEB4 protein in the high grade glioma was higher than that in the low grade glioma (P < 0.05).At 24 h after transfection, the level of CPEB4 protein in the CPEB4-shRNA group was lower than that in the negative control group and blank control group (P < 0.05).On the third and seventh day of culture, the A490 value of CPEB4-shRNA group were lower than those in the negative control group and the blank control group (P < 0.05).The early apoptotic rate in the CPEB4-shRNA group was significantly higher than that in the negative control group and the control group (P < 0.05).The G1 phase cells of CPEB4-shRNA group was significantly higher than that the negative control group and the control group (P < 0.05), the S phase cells was significantly lower than those in the negative control group and the blank control group (P < 0.05).The relative expression of CPEB4 mRNA, PIK3 CA mRNA, IGF2 mRNA and SMAD3 mRNA in CPEB4-shRNA group were lower than those in negative control group and blank control group (P < 0.05). Conclusion The CPEB4 is highly expressed in gliomatissues, CPEB4 involves the growth of glioma cells.The effect of CPEB4 on glioma cells may be related to the levels of CPEB4, PIK3 CA, IGF2 and SMAD3.

The therapeutic effect of community elderly patients with chronic pain and insomnia by applying the theory of“physiological and psychological therapy”of Chinese medicine

CHEN Wenyu, ZHANG Xiaoping, XU Longsheng, YAO Ming, ZHANG Zhengyu, ZHANG Zhaohe, ZHENG Jiuling

2017, 15(7): 1137-1140. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.013

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Objective To investigate the therapeutic effect of community elderly patients with chronic pain and insomnia by applying the theory of"physiological and psychological therapy"of Chinese medicine. Methods It selected 120 community elderly patients with chronic pain and insomnia in Zhijing Street of Lishui City, River and Lake Street of Hangzhou City and Xinjia Street of Jiaxing City as the research subjects.The patients were randomly divided into observation group and control group with 60 people in each group.The control group was given western medicine analgesia and drug hypnosis therapy in a routine way while the observation group was treated with the theory of"physiological and psychological therapy"of Chinese medicine on the basis of western medicine treatment.The curative effects of the two group were evaluated after 30 d of treatment. Results (1) After 3 courses of treatment, the effect of observation group was better than control group.The difference was statistically significant (P < 0.05). (2) After the treatment, grades of sleep quality improvement (SRSS), degree of pain (NRS), anxiety (SAS) and depression (SDS) in both groups were lower than those before treatment, and the difference was statistically significant (P < 0.05).After treatment, SRSS, NRS, SAS, SDS scores of the observation group were significantly lower than those of the control group, with statistical significance (P < 0.05). (3) After treatment, eight dimension scores in the SF-36 health survey table of the observation group, including physiological function (PF), physiological functions (RP), body pain (BP), general health (GH), vitality (VT), social function (SF), role emotional (RE) and mental health (MH) were better than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion Applying the theory of "physiological and psychological therapy"of Chinese medicine to the community management of the community elderly patients with chronic pain and insomnia can effectively relieve the pain of patients and alleviate insomnia symptoms so as to improve the quality of life of the patients.

Expression and significance of miR-21 and its target protein RASA1 in the skin of patients with psoriasis vulgaris

WANG Huiqin, TANG Chengbo, TANG Hong, WU Weidong

2017, 15(7): 1141-1143,1180. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.014

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Objective To investigate the expression of miR-21 and its target protein RASA1 in skin of patients with psoriasis vulgaris and its significance in the development of psoriasis vulgaris. Methods The expressions of miR-21 were studied with real-time fluorescent quantitative PCR in the 12 psoriatic vulgaris lesions and beside-lesional tissue and 15 normal skin, differential multiple representation with 2^-ΔΔCt.The expressions of RASA1 were studied with immunohistochemical in the 45 psoriatic and 20 normal skin.The positive mainly as brown or tan particles in cytoplasm. Results With real-time fluorescent quantitative PCR, the expression level of miR-21 was higher in lesions of psoriasis vulgaris than that in the beside-lesional tissue and normal skin tissue, and differences was statistical significance (P < 0.01).The positive expression of RASA1 in skin lesions of patients with psoriasis population was 10.00%, it's lower than 60.00% the rate of positive expression in the normal group.The data were statistically significant (χ²=14.009, P < 0.001). Conclusion The expression of miR-21 is higher in lesions of psoriasis vulgaris than that in the normal skin tissue, but the positive expression of its target protein RASA1 is lower in lesions of psoriasis vulgaris.Differential expression of miR-21 may be regulation of RASA1 gene, which can inhibit the expression of RASA1 protein.These may lead to psoriasis vulgaris.

Influence of biofeedback and electronic stimulation of pelvic floor on quality of life of elderly women with stress urinary incontinence

WANG Taoran, ZHOU Xin, LI Xiaoyan, JIANG Lijun

2017, 15(7): 1144-1146. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.015

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Objective To investigate the influence of biofeedback and electronic stimulation of pelvic floor combining pelvic floor muscle training on quality of life of elderly women with light or moderate stress urinary incontinence. Methods Sixty elderly female patients suffering from light or moderate stress urinary incontinence were randomly divided into two groups (n=30) and received twelve-week therapy.The test group received biofeedback and electrical stimulation combining pelvic floor muscle training, while the control group received pelvic floor muscle training.They were followed up for three months after the therapy.All the patients received one-hour pad test and the Urinary Incontinence Quality of Life Scale (I-QOL) before and after the therapy and after the follow-up.All the data were statistically analyzed by square-test and T-test.The curative and I-QOL score were compared between the two groups. Results The cure rate of the test group after the therapy and after the follow-up were individually 90.00% (27/30) and 76.67% (23/30);the cure rate of the control group after the therapy and after the follow-up were individually 40.00% (12/30) and 30.00% (9/30).The cure rate of the test group after the therapy and after the follow-up were statistically higher than those of the control group (P <0.05).The mean I-QOL score of the test group before the therapy, after the therapy and after the follow-up were 63.5, 89.6 and 86.4, respectively;the mean I-QOL score of the control group before the therapy, after the therapy and after the follow-up were 64.1, 71.2 and 70.3, respectively.The mean I-QOL score of the test group after therapy and after the follow-up were significantly higher than that before therapy and those of the control group (P < 0.05). Conclusion The biofeedback and electronic stimulation therapy of pelvic floor can evidently alleviate the symptoms of urinary incontinence in elderly women, improve their QOL, and promote their physical and mental health.

The clinical value of the procalcitonin in prediction of severity of acute pancreatitis

HU Liping, CHEN Wenhu, ZHU Xiangyu, LUO Xuhang, SHEN Xiangdi

2017, 15(7): 1147-1149. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.016

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Objective Procalcitonin (PCT) is a biomarker of early bacterial infection, and it can reflect severity of infection, and regarded as a prognostic factor.In this study, PCT was used to evaluate the clinical value of serum procalcitonin (PCT) in early diagnosis of acute pancreatitis (AP) and predictive of severity. Methods The enrolled included 41 cases of the severe AP (SAP), 68 cases of mild AP (MAP), and 50 cases of normal controls.The levels of PCT and CRP in each group were dynamically detected respectively at 1st, 3th, 5th and 7th day after admission, and the correlations between these indexes and the severity and progress of AP were analyzed and data were processed by statistical software SPSS17.0. Results The levels of serum PCT and CRP in SAP and MAP patients were significantly higher than those of control group (all P < 0.05).In addition to 1st of serum CRP, the rest of S PCT and CRP levels in patients with SAP group were higher than those in the same period of MAP group (all P < 0.05).The threshold of PCT and CRP in SAP were 2.0μg/L and 120 mg/L, respectively.The sensitivity of the serum PCT and CRP were 82.9% and 70.7%, respectively;the specificity of the serum PCT and CRP were all above 90%.The serum PCT + CRP combined detection of sensitivity enhanced to 92.7% and specificity still above 90%. Conclusion Serum levels of PCT can reflect the severity of acute pancreatitis at the early stage and has an important clinical value.When the levels of PCT and CRP reach the cut-off values of2.0 μg/L and 120 mg/L, serum PCT value is a sensitive and specific serological a diagnostic method for diagnosis of SAP.

Clinical effect and safety of laparoscopic and open surgery in the treatment of acute appendicitis

SU Zhou, YAO Hanhui, XIA Meng, DONG Lei

2017, 15(7): 1150-1152,1165. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.017

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Objective To compare the clinical effect and safety of laparoscopic and open surgery in the treatment of acute appendicitis. Methods The clinical data of 63 cases of acute appendicitis patients treated with laparoscopic surgery (LA) 33 cases and open operation (OA) 30 cases in our hospital between July, 2013 and May, 2016 were analyzed retrospectively.The operation time, intraoperative blood loss, gastrointestinal function recovery time, hospital stay, hospital expenses, analgesic drug utilization rate, complications (incision infection, abdominal abscess, abdominal bleeding, intestinal obstruction, etc.) and the change of peripheral blood leukocyte and neutrophil count after the operation were compared between the two groups. Results The gastrointestinal function recovery time, hospitalization time, intraoperative blood loss, analgesic drug utilization rate and incidence of complication in LA group were lower than those in the OA group, with statistically significant difference (P < 0.05).No complication was found in LA group, with a lower incidence of complications as compared with that in LA group (6 cases), the difference was statistically significant (P < 0.05);There was no statistical difference in the operation time between two groups (P < 0.05), while the hospitalization cost in LA group was higher than OA group (P < 0.05).One day after the operation, the white blood cells and neutrophils count in OA group were higher than that of LA group (P < 0.05);on D3, review of white blood cells and neutrophils count were declined, but the white blood cells count in OA group was still higher than that in the LA group (P < 0.05), The difference was statistically significant (P < 0.05). Conclusion The laparoscopic treatment for acute appendicitis can promote the recovery of patients, shorten hospital stay, reduce the incidence of complications, and significantly improve the level of systemic inflammation, with good clinical efficacy and safety, it is worth of popularizing in clinical application.

Analysis of characteristics and risk factors of postoperative infectious complications of laparoscopic colorectal cancer surgery

DAN Jianfeng, YU Yaojun

2017, 15(7): 1153-1155. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.018

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Objective To evaluate the characteristics and risk factors of postoperative infectious complications of laparoscopic colorectal cancer surgery in order to take targeted measures to reduce infection rates. Methods A retrospective analysis of 205 patients undertaking laparoscopic colorectal surgery from February, 2011 to February, 2016 was made to summarize the postoperative infectious complications characteristics as well as the risk factors such as the age, diabetes, lung disease, surgery time, surgical intervention, TNM stage, body mass index, blood loss, infection. Results There are 24 cases of postoperative infection following laparoscopic colorectal cancer surgery, and the infectious rate was 11.76%, among which abdominal abscess ranks the highest with a infectious rate 41.76% followed by wound infection, nosocomial pneumonia, urinary tract infections, catheter-related infections with infectious rates of 29.17%, 12.50%, 8.33%, 8.33%respectively.Compared with other kinds of infections, abdominal abscess has statistical difference (P < 0.05).The risk factors include lung disease, long operative time (> 180 min), and diabetes (P < 0.05), irrelevant to age, surgical intervention, body mass index, blood loss, TNM stage-independent (P > 0.05).The operation time, diabetes, lung disease infection after laparoscopic colorectal cancer surgery are independent risk factors (Wald values were 9.679, 10.121, 13.893;P values were 0.011, 0.014, 0.025). Conclusion Abdominal abscess is the most common infection following laparoscopic colorectal cancer surgery, while the operation time, diabetes, lung disease infection are independent risk factors which need further observation in clinical practice.

Application of a self-made epidural catheter needle in laparoscopic high ligation of hernial sac in children

HU Zongju, NING Zhangqing, SUN Xuefeng, YU Jiangtao

2017, 15(7): 1156-1158,1270. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.019

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Objective To explore the feasibility, effectiveness and safety of laparoscopic high ligation of hernial sac with a self-made suture needle (remade from epidural catheter needle) by comparing with minithoracotomy high ligation of hernial sac for children's hernia. Methods The clinical data of 56 children with inguinal hernia in our hospital between April, 2014 and April, 2016 were analyzed retrospectively.The patients were divided into two groups according to the operation methods.Twenty-eight cases of the laparoscopy group were treated with laparoscopic high ligation of hernial sac with a self-made epidural catheter needle, while other 28 cases of the open surgery group were treated with minithoracotomy high ligation of hernial sac.The intraoperative and postoperative conditions of patients in the two groups were recorded.The operation time, surgical incision, postoperative complication, postoperative recurrence rate and hospitalization time between the two groups were compared.The data was analyzed by SPSS 19.0 statistical software, setting P < 0.05 for statistically significant. Results Compared with minithoracotomy high ligation method, laparoscopic high ligation of hernial sac was with advantage in the operation time (t=5.441, 5.403, all P < 0.001) and postoperative complications (χ²=4.082, P=0.043), the difference was statistically significant (P < 0.05).The difference in recurrence rate and hospitalization time was not significant. Conclusion The laparoscopic high ligation of hernial sac with a self-made suture needle is a simple, effective and minimally invasive procedure with a shorter operative time, smaller incision, less postoperative complications, clearer intraoperative vision.The contralateral occult hernia can be found.At the same time, the abdominal cavity detection can be performed, which can provide with a new method for children's inguinal hernia treatment and get the approbation of the parents.Therefore it was worthy of clinical promotion.

Influence of ultrasound guided transversus abdominis plane block on postoperative analgesic effect and immune function in elderly patients undergoing laparoscopic radical resection of rectal cancer

PANG Xiyou

2017, 15(7): 1159-1162. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.020

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Abstract:
Objective To observe the influence of ultrasound guided transversus abdominis plane block on postoperative analgesic effect and immune function in elderly patients undergoing laparoscopic radical resection of rectal cancer. Methods Sixty elderly patients undergoing laparoscopic radical resection of rectal cancer were randomly divided into observation group and control group.Ultrasound guided transversus abdominis plane block after general anesthesia induction was performed in the observation group (intravenous injection of 0.25% ropivacaine hydrochloride of 30 ml), while the control group received intravenous injection of equal volume saline.The visual analogue score (VAS score) and related parameters of hemodynamics were observed before anesthesia (T0), 1 h after operation (T1), 12 h after operation (T2), 24 h after operation (T3) and 48 h after operation (T4).Twenty-four hours analgesia pressing times and total postoperative sufentanil were recorded.CD4₊%, CD8₊% and IFN_-γ levels and adverse reactions were compared between the two groups. Results Compared with the control group, MAP in the observation group decreased at T1 and T2, and HR decreased at T2 and T3 (P < 0.05).Compared with the control group, the VAS scores in the observation group were lower at T1, T2, T3 and T4;the postoperative 24 h pressing times and amount of sufentanil were decreased (P < 0.05).Compared with the control group, CD4⁺% levels in the observation group increased at T1, T2, T3 and T4, IFN_-γ levels at T2 and T3 were higher (P < 0.05).Compared with the control group, the incidence of adverse reactions in the observation group was lower (P < 0.05). Conclusion Ultrasound guided transversus abdominis plane block used in laparoscopic radical resection of rectal cancer in elderly patients has better postoperative analgesic effect, stable hemodynamics and less postoperative pain, and it has protective effect on immune function and lower the incidence of adverse reactions.

Value of prenatal ultrasonography in diagnosis of placenta accreta in patients with placenta pracvia

DAN Huaying, FEI Jingying, CHA Yibao, LIU Mingsong

2017, 15(7): 1163-1165. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.021

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Objective To evaluate the value of prenatal ultrasonography in diagnosis of placenta accreta in patients with placenta pracvia. Methods A total of 87 pregnant women with placenta previa undergoing cesarean section I our Department from March, 2009 to June, 2016 were enrolled into this study.The two-dimensional ultrasound and color Doppler ultrasonography were performed in all patients.The patients were divided into placenta accrete group and non-accrete group according to the postoperative pathological results.The ultrasonographic features of the two groups were compared.The sensitivity, specificity, missed diagnosis rate, misdiagnosis rate and Kappa value of prenatal ultrasound for the placenta accrete were evaluated. Results Among 87 cases of placenta previa, the incidence of thickened placenta, disappearance of part or all of the posterior placental space, myometrial thickness that placenta attached to, placenta internal uneven echo, well vascularized uterine serous layer-bladder interface that placenta attached to, focal or generalized placental parenchyma lacunae blood flow in the placenta accrete group was significantly higher than that of non-accrete group (P < 0.05).There was no significant difference in the type of placenta previa between placenta accreta group and non-accrete group (P >0.05).Taking pathological results as the gold standard, the sensitivity of preimplantation ultrasound was 80.00%, specificity was 91.23%, missed rate was 20.00%, misdiagnosis rate was 8.77%, and Kappa was 0.718. Conclusion Prenatal ultrasound examination for placenta accreta in patients with placenta previa has a high sensitivity and specificity, which can provide guidance for safe delivery.

Effect of chemotherapy combined with Qingfei mixture on immune function in patients with non small cell lung cancer

WANG Lili, SHI Lei, QIAN Xiang, LI Zhaodong

2017, 15(7): 1166-1168. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.022

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Objective To investigate the effect of chemotherapy combined with Qingfei mixture on immune function of patients with non-small cell lung cancer (NSCLC) and provide reference for clinical treatment. Methods Total 100 cases of advanced NSCLC in our department between August, 2015 and January, 2016 were enrolled and divided into control group (50 cases) and observation group (50 cases) according to the admission sequence alternation.The control group was treated with Methylene Changchun and cisplatin, while the observation group were treated with Qingfei mixture.Changes of T lymphocyte subsets on the base of the chemotherapy treatment of the control group, improvement of quality of life and adverse reactions after treatment of these two groups were compared. Results The value of CD3⁺, CD3⁺+ CD4⁺, CD3⁺+CD8⁺, the ratio of CD3⁺+ CD8⁺ and the percentage of NK cells before the treatment had no significant difference between these two groups, the difference had no statistically significant (P > 0.05).After the treatment, the value of CD3⁺, CD3⁺+ CD4⁺ and the percentage of NK cells of NSCLC patients in the observation group were significant higher than those in the control group, the difference was statistically significant (P < 0.05).The improvement of quality of life in the observation group after the treatment was significantly better than that in the control group (96.00% vs.60.00%), P <0.05.The incidence of adverse reactions including thrombocytopenia, thrombocytopenia, anemia, gastrointestinal symptoms and liver injury were significantly lower than those of the control group (P < 0.05). Conclusion The Qingfei mixture can regulate the immune function of NSCLC patients, reduce immunosuppressant, enhance the body's immune defense mechanism, improve the prognosis of the patients, the immune function can be confirmed with the detection of T lymphocyte subsets by FCM.The combination application can be widely promoted.

Clinical effects of less invasive stabilization systems assisted with arthroscopy for tibial plateau fracture

HE Xiaoyong

2017, 15(7): 1169-1171. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.023

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Abstract:
Objective To investigate the clinical effects of less invasive stabilization systems (LISS) assisted with arthroscopy for tibial plateau fracture. Methods A retrospective analysis of 50 patients with tibial plateau fracture who were followed up for 6 months or more in our hospital from July, 2013 to January, 2015 was conducted.The exploration and repair of arthroscopic meniscus, ligaments and other soft tissue injury were attempted to implement with arthroscopy, and all the cases underwent joint reduction and were treated with LISS assisted with arthroscopy.The postoperative functional exercises were done step-by-step.The complications, joint range of motion, fracture healing time and Rasmussen knee functional score were evaluated. Results Six months after the operation, 3 cases were with fracture malunion, 2 cases with incision necrosis or infection.The mean knee joint ROM was (93.4 ±7.8) at extension and (3.9 ±1.8) at flexion.The fracture healing time were 2.5-7.0 months, with an average of (3.8 ±1.1) months.Rasmussen knee functional score showed that the rate of excellent and good was 88%. Conclusion Less invasive stabilization systems assisted with arthroscopy for tibial plateau fracture can proceed fracture reduction with the advantage of better visual field, fewer complications and less damage and satisfactory restoration, which deserves clinical expansion.

Effects of sufentanil combined remifentanil on anesthesia and stress of patients with radical gastrectomy

CONG Hao

2017, 15(7): 1172-1174. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.024

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Objective To investigate the effects of sufentanil combined remifentanil on anesthesia and stress of patients with radical gastrectomy. Methods Eighty-four patients with radical gastrectomy of Shaoxing people 's hospital from June, 2010 to May, 2014 were randomly divided into two groups, each group 42 cases.The control group was given remifentanil anesthesia, and the observation group was given sufentanil combined remifentanil anesthesia.The hemodynamics at before anesthesia (T1), before intubation (T2), 1 min after intubation (T3), 1 min after extubation (T4), 5 min after extubation (T5), Observer's assessment of alertness/sedation (OAA/S) scale and restless score (RS) at 10 min after extubation, VAS score at postoperative 6 h (T6), postoperative 12 h (T7) and postoperative 24 h (T8), norepinephrine (NE), adrenaline (E) levels at T1, T3, T4, T6, T7, T8 of two groups were compared. Results Compared with T1, the HR levels at T2 of two groups were significantly decreased (P < 0.05), HR levels at T3-T4 of two groups were significantly increased (P < 0.05), and HR levels at T3-T5 of observation group were significantly lower than those of control group (P < 0.05).Compared with T1, the MAP levels at T2 of two groups were significantly decreased (P < 0.05), MAP levels at T3-T5 of control group were significantly increased (P < 0.05), and MAP levels at T3-T5 of observation group were significantly lower than that of control group (P < 0.05).The OAA/S, RS, VAS scores of observation group were significantly lower than those of control group (P < 0.05).Compared with T1, the NE, E levels at T3-T4 of two groups were significantly increased (P < 0.05), NE, E levels at T7-T8 of two groups were significantly reduced (P < 0.05), and NE, E levels at T3, T4, T6, T7, T8 of observation group were significantly lower than those of control group (P < 0.05). Conclusion Compared to remifentanil alone, sufentanil combined remifentanil could effectively maintain hemodynamics, reduce pain and stress of patients with radical gastrectomy.

Value of ratio of triglyceride/high-density lipoprotein and γ-glutamyl transferase in prognosis of non-alcoholic fatty liver disease

LIN Fang, REN Yuezhong, CHU Jianping, ZHOU Qiong

2017, 15(7): 1175-1177,1191. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.025

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Objective To analyze the risk factors of the non-alcoholic fatty liver diseases (NAFLD) and explore the value of triglyceride/high-density lipoprotein (TG/HDL-C) ratio and γ-glutamyl transferase level in the diagnosis of NAFLD. Methods Total 335 individuals receiving physical examination were enrolled into this study and were followed up for 3years.Their alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, lipid profile, fasting glucose were examined in baseline and during following up.The triglyceride (TG)/high-density lipoprotein (HDL-C) ratio was calculated by TG/HDL-C. Results (1) The level of basic body index, triglyceride, TG/HDL-C, γ-glutamyl transferase were higher and the body mass index (BMI), blood pressure, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein, uric acid, alanine aminotransferase, alkaline phosphatase had no difference in NAFLD group as compared with the normal group at 3 years after the physical examination (P < 0.01). (2) TG/HDL-C and γ-glutamyl transferase enzyme had higher sensitivity and specificity than triglyceride, blood pressure, total cholesterol, high density lipoprotein, low density lipoproteinalanine aminotransferase, aspartate aminotransferase, fasting plasma glucose in the diagnosis of NAFLD.Area under curve of TG/HDL-C was 0.723 and 95% confidence limits was 0.632-0.813.Area under curve of GGT was 0.753 and 95% confidence limits was 0.661-0.846.There were significance in the diagnosis of NAFLD when TG/HDL-C were 1.396 or γ-glutamyl transferase were 28 U/L. Conclusion TG/HDL-C and γ-glutamyl transferase has comparably higher sensitivity and specificity in the diagnosis of NAFLD.

Effects of early intensive antihypertensive therapy on mass,inflammation and neurological function of patients with hypertensive intracerebral hemorrhage

ZHONG Guofu, ZHANG Zhe, CHEN Lin

2017, 15(7): 1178-1180. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.026

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Objective To investigate the effects of early intensive antihypertensive therapy on mass, inflammation and neurological function of patients with hypertensive intracerebral hemorrhage. Methods One hundred and sixty-eight patients with cerebral hemorrhage admitted from January, 2014 to June, 2016 were randomly divided into two groups, with 84 cases in each group.Patients in control group were only given conventional treatment, by intravenous titration of Nitroglycerin to maintain systolic blood pressure from 160 to 180 mm Hg.Patients in observation group were given early enhanced treatment, by pumped Nitroglycerin to maintain systolic blood pressure from 130 to 140 mm Hg.The hematoma of two groups were measured by CT results, the inflammation levels (TNF-α, IL-1β, IL-6) of two groups were detected by Elisa methods, and neurological function of two groups were measured by National Institutes of Health Stroke Scale (NIHSS).The data were statistical analyzed to investigate the effects of early intensive antihypertensive therapy on mass, inflammation and neurological function of patients with hypertensive intracerebral hemorrhage. Results After 1 d treatment, the hematoma volume of observation group was significantly lower than that of control group (P < 0.05).The hematoma enlargement ratio of observation group was 8.3%, which was significantly lower than that of control group (20.8%) (P <0.05).After 14 d treatment, the TNF-α, IL-1β and IL-6 levels of two groups were significantly reduced (P < 0.05), and the TNF-α, IL-1β and IL-6 levels of observation group were significantly lower than those of control group (P < 0.05).After 14 d treatment, the NIHSS level of two groups were significantly reduced (P < 0.05), and the NIHSS level of observation group were significantly lower than those of control group (P < 0.05). Conclusion Early intensive antihypertensive therapy could improve the hematoma, inflammation and neurological function of patients with cerebral hemorrhage, with satisfactory effects.

A study of differences in classification of COPD patients with CAT or mMRC

YANG Jianmin, ZHENG Xiwen, CHEN Xue, YAO Shufang, WU Shengling, TAO Xiulin, HUANG Muchao

2017, 15(7): 1181-1184. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.027

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Objective Chronic obstructive pulmonary disease (COPD) is one of the most important diseases in the world.In the 2011 new version of the GOLD Guide, a new system was used to classify COPD patients.The aim of study was to investigate the agreement between COPD risk group classifications using COPD assessment (CAT) or modified Medical Research Council (m MRC) and severity grades or past-year exacerbations.Physical activity across was examined and analyzed. Methods One hundred and sixty patients with stable COPD were classified into risk group A-D.CAT and m MRC were completed.Severity grades Ⅰ-Ⅳ were determined using spirometry and the number of past-year exacerbations was recorded.To test the interrater agreement, Cohen's Kappa was calculated.Daily physical activity was measured by Mini arm band. Results Using CAT, 105 patients were in high-symptom groups (B and D).With m MRC, 61 patients (41.25%) were in groups B and D.Using severity gradesⅠ-Ⅳ, 70 (43.75%) of patients were in high-exacerbation risk groups C and D.With past-year exacerbations, 76 (47.5%) patients were in C and D.Interrater agreement between CAT and m MRC was fair (r=0.45, P < 0.001), severity grades and past year-year exacerbation was also fair.Daily steps were reduced in risk groups B and C + D compared to A (P < 0.1), using either classification. Conclusion When classifying COPD patients into risk groups A-D, the use of CAT or m MRC and severity grades or past-year exacerbations can't provide equal results.Daily steps decreased with increasing COPD risk groups.

Analysis of the mechanism and risk factors of early vascular disease in obese children

WANG Shanlin, XU Jun, SHAO Qimin, ZHU Jin, WU Yidong

2017, 15(7): 1185-1187. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.028

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Objective To investigate the possible mechanism and risk factors of early cardiovascular disease in obese children. Methods From June, 2016 to December, 2016, a total of 100 obese children in our hospital were selected as the research object, and they were divided into mild group and moderate and severe obesity group according to BMI (body mass index).Sixty healthy children in our hospital during the same period were selected as control group.To study the human morphology parameters indexes including blood pressure, height, BMI, waist circumference, lipid metabolism index (blood glucose, blood lipid), vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF-BB) and its receptor (PDGFR-2) expression levels, arterial intima-media thickness (IMT).Logistic regression was used to analyze the risk factors of cardiovascular disease in obese children. Results The age and IMT value in children with moderate and severe obesity group was higher than that of mild obesity group (P < 0.05).The F variance analysis showed that the observation group and control group in blood pressure, waist circumference, BMI, FPG, TC, TG, VEGF, PDGF-BB, PDGFR-2 expression level were statistically significant differences (P < 0.05).Logistic regression analysis showed that blood pressure, BMI, waist circumference, FPG, TG, VEGF, PDGF-BB and PDGFR-2 were correlated with the IMT of obese children (P < 0.05), which were the risk factors of early vascular disease. Conclusion Obese children are more prone to hypertension, abnormal expression of lipid metabolism and glucose, VEGF, and PDGF-BB and PDGFR-2 abnormal expression.All the above indexes was correlation with IMT in obese children, it is the risk factors for the occurrence of early vascular disease.

Effects of Huayu Sanjie therapy on the expression of E2,P,ER and PR in patients with endometrial polyp

JIANG Ying, QIAN Xuwu, ZHANG Yiqun

2017, 15(7): 1188-1191. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.029

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Objective Endometrial polyp is a common gynecological disease.Transcervical resection of polyps (TCRP) is an effective treatment for endometrial polyp;however, the recurrence rate was higher.Therefore, how to prevent the recurrence of endometrial polyp was the purpose of this research.The aim of this paper is to investigate the changes of E2 and P levels in blood, and ER and PR in endometrium before and after the Huayu Sanjie therapy in in patients with endometrial polyp after TCRP. Methods Total 147 cases of endometrial polyp (blood stasis type by TCM, confirmed by hysteroscopy and histopathologic examination) undergoing TCRP in our hospital between June, 2015 and June, 2016 were randomly divided into traditional Chinese medicine group, western medicine group and control group with 49 cases in each group.The traditional Chinese medicine group received Huayu Sanjie therapy and the western medicine group received Marvelon therapy for 3 months.The changes of E2 and P levels in blood, and ER and PR levels in endometrium before and after treatment were compared. Results There was no obvious change in the levels of E2, P and ER in all three groups after the treatment.The expression of PR was up-regulated both in the Chinese medicine group and the western medicine group, and especially obvious in the Chinese medicine treatment group (P < 0.05). Conclusion Huayu Sanjie therapy may improve the endometrial blood flow, and regulate the distribution of PR in endometrium, and up-regulate the expression of PR in patients with endometrial polyp, promote the uterine lining to shed completely and periodically, then to inhibit the recurrence of endometrial polyp.

Detection and clinical significance of related biochemical indexes in patients with intrahepatic cholestasis of pregnancy

XU Hui, HUANG Xiabing, WU Tao

2017, 15(7): 1192-1193,1197. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.030

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Objective To investigate the clinical significance of biochemical indicators in patients with intrahepatic cholestasis of pregnancy. Methods One hundred and thirty-six cases of intrahepatic cholestasis of pregnancy from September, 2014 to September, 2016 in our hospital were selected into observation group, and 86 cases of healthy pregnant women at the same period in our hospital were selected as control group.The lipids[Triacylglycerol (TG), total cholesterol (CHOL), high-density lipoprotein (HDL), low-density lipoprotein (LDL)], liver function[total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum total bile acid (TBA)], estrogen (estradiol, estriol) of two groups were detected, and the neonatal outcome of two groups were observed.All date of two groups were statistical analyzed using statistical soft to analyze the application value of blood lipid, liver function and estrogen in intrahepatic cholestasis of pregnancy. Results The TG, CHOL, LDL levels of observation group were significantly higher than those of control group (P < 0.05), and the HDL level of observation group was significantly lower than those of control group (P <0.05).The TBIL, ALT, AST, TBA levels of observation group were significantly higher than those of control group (P <0.05).The estradiol, estriol levels of observation group were significantly higher than those of control group (P < 0.05).The premature infants, neonatal asphyxia, intrauterine distress ratio of observation group were significantly higher than those of control group (P < 0.05). Conclusion The blood lipids, liver function, estrogen of pregnancy intrahepatic cholestasis were abnormalities, timely examination and prevention would be helpful to reduce the neonatal adverse outcomes.

Research on the application of mobile medical D2C model in the management of hypertension in primary community hospital

WANG Wenxiang, LI Dazhong, SHI Weidong, ZHANG Jinhui, SUI Jian

2017, 15(7): 1194-1197. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.031

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Objective This study is aimed to explore the role of mobile health D2 C model on the prevention and management of hypertension in primary community hospital, and to study the far-reaching significance of D2 C model in the management of hypertension and chronic disease in grass-roots community. Methods Patients diagnosed with hypertension and treated at community health service center in Health Road, Jingkou District, Zhenjiang City from January to June 2014 were randomly selected.Altogether 103 cases were randomly divided into two equal groups, and group A is mobile health chronic disease management model group (59 cases) and group B is traditional management model of chronic disease control group (44 cases).Comparison of two groups of patients before and after 12 months of management and control of hypertension was made between the two groups.The awareness of disease, the incidence of complications, the degree of satisfaction and the self-management outside the hospital of patients in group A and group B were also compared. Results The systolic blood pressure, diastolic blood pressure, body mass index, fasting blood glucose and triglyceride in group A are all lower than the group B, and the differences were significant (P < 0.05).By comparing hypertension patients' awareness of hypertensive disease, the incidence of complications, the degree of satisfaction and the level of self-management outside the hospital in two groups, the chi-square values were 9.397, 11.928, 7.555, 9.936 respectively (P <0.05), the difference was statistically significant.Showing that the hypertension patients of group A had better awareness of hypertensive disease, satisfaction, self-management ability outside the hospital, and had fewer complications.The disease control effect of group A was better than the group B.The patients applied with mobile health D2 C model had better awareness of disease, satisfaction, self-management ability outside the hospital, and had fewer complications. Conclusion The application of mobile health D2 C model in the management of chronic diseases in gross-roots community strengthened the control of chronic diseases, reinforced the ability of mastering knowledge and self-management of chronic disease patients, reduced the complications, obtained satisfactory recognition of patients with mobile health, and eventually developed scientific concept of life and improved quality of life of chronic diseases patients in the community.

The observation of the educational effect of diabetes food quick hand measurement in community

FANG Yuewei, PAN Songtao, ZHI Yifen, DUAN Jiangwen

2017, 15(7): 1198-1200. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.032

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Objective To compare the effectiveness of two dietary health education methods in the management of type 2diabetes mellitus in community, and to evaluate the role of"food fast estimation hand measurement"in community diabetes management. Methods Using purposive sampling method, we chose 2 health service stations operated on the same basis, and randomly divided into experimental group and control group.In the experimental group, we use food quick hand measurement to conduct the dietary education, and in the control group we use the conventional method to conduct the dietary education.We effectively investigated 96 cases of diabetes.he observation indexes were obtained by questionnaire, physical examination and biochemical examination. Results In the experimental group and the control group, the difference was statistically significant (P < 0.05), and the experimental group was significantly higher than the control group, and the difference was statistically significant (P < 0.01).The satisfaction rate of the "self executing diabetes diet treatment satisfaction"after the intervention were lower than that before the intervention, but only the experimental group had statistical significance.Before the intervention, the observed differences between the two groups were not statistically significant.In each monitoring index, the BP and HDL-C compliance rate of the experimental group was increased, and the difference was statistically significant (P < 0.05).Control group LDL-C compliance rate has increased, and the difference was statistically significant (P < 0.01).The average value of each monitoring index, the LDL-C and HDL-C indexes of the experimental group were improved, and the difference was statistically significant (P < 0.01).The waist circumference, Hb A1 c, LDL-C, HDL-C indexes of the control group were improved, and the difference was statistically significant (P <0.01).But there was no significant difference between the two groups after the intervention (P > 0.05). Conclusion Compared to the traditional education method to improve dietary knowledge, the effect of diabetes food quick hand measurement is more apparent, but there is no better educational effect if it is only conducted in a conventional form of dietary education.Therefore, we need to further explore the dietary education form for diabetes patients.

Effectiveness evaluation of community-based rehabilitation management model on functional recovery of homebound stroke patients

ZHOU Xiaolin, ZHU Lan, CAO Guangwen

2017, 15(7): 1201-1203. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.033

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Objective To explore the application effect of the hierarchical rehabilitation management mode of the community health service organization of the specialized hospital ward and a community health service institution in the community standardized management of the stroke patients. Methods A total of 100 acute apoplexy patients, diagnosed by CT or MRI from March, 2014 to February, 2015 in specialist hospital, was divided randomly into the rehabilitation group (n=50) and control group (n=50).The patients in the rehabilitation group were given the three-level management:(1) Firstlevel rehabilitation included acute stage treatment in the specialist hospital. (2) Second-level rehabilitation included three month rehabilitation training in community health service station for 40 minutes, 2 times a week at least;and the patients were given brochure on rehabilitation training. (3) Third-level rehabilitation included nine month home rehabilitation training for 40 minutes, once in two week;and during non-treating times, the patients were asked to do rehabilitation once or twice a day under the help by family members or nursing staff who had learnt the correct method from the doctor, the control group continued to carry out the general management. Results Fugl-Meyer motor function evaluation, FIM evaluation and modified Barthel index were used to evaluate the therapeutic effect of the 6 months and 12 months after the selection.Before the intervention, the two groups of Fugl-Meye, modified FIM Barthel index score, the difference was not statistically significant (P > 0.05).Intervention for 6 months and 12 months, the intervention group Fugl-Meye, improved Barthel and FIM scores, significantly higher than those in the control group (P < 0.01). Conclusion In the community of grading rehabilitation management mode of stroke community norms of management, the function of stroke patients recovery plays a good promoting role in improving the quality of life, with better social and economic effects.

Clinical study of sertraline combined with psychotherapy in the treatment of coronary heart disease complicated with depression

FANG Fei

2017, 15(7): 1204-1206,1262. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.034

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Objective To investigate the clinical effect of sertraline combined with psychotherapy in the treatment of coronary heart disease (CHD) complicated with depression, evaluate the degree of depression and provide scientific basis for clinical treatment. Methods Ninety-one patients admitted to our hospital from July, 2014 to April, 2016 were randomly divided into observation group (n=46) and control group (n=45).The control group received CHD conventional therapy and psychological intervention, while the observation group received additional sertraline treatment on the basis of the control group.The clinical efficacy, SDS, HAMD and SCL-90 score were compared between the two groups.SPSS 17 was used for statistical analysis. Results The total effective rate of the observation group was 97.83% (45/46), which was significantly higher than that of 86.67% (39/45) in the control group (Z=2.496, P=0.013).After 2 and 12 weeks of treatment, the HAMD and SDS scores of the two groups were significantly decreased (P < 0.05), and the observation group was significantly lower than that of the control group (P < 0.05).By SCL-90, the somatization, depression, anxiety, hostility, terror and paranoid scores were all significantly decreased after 2 weeks of treatment (P < 0.05), and 8 indicators continued to decline after 12 weeks of treatment (P < 0.05).There were statistical differences in somatization, depression, anxiety and phobia scores after 12 weeks of treatment in the control group (P < 0.05).The scores of somatization, depression, anxiety and terror in the observation group were significantly lower than those in the control group (P < 0.05). Conclusion It has a significant clinical efficacy of sertraline combined with psychotherapy in the treatment of coronary heart disease complicated with depression.It can effectively reduce the HAMD, SDS and SCL-90 score, and improve the depressive symptoms.It is worthy of popularization and application.

Status Survey of Central Obesity Complicating Type 2 Diabetes in Community

FAN Aiqing, SU Qi, PENG Xin, HOU Jin

2017, 15(7): 1207-1209. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.035

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Objective To understand the correlation between Type 2 diabetes mellitus (T2DM) and concomitant central obesity as well as condition of reaching standard of blood glucose monitored by general family medical management in middle area of Pudong community. Methods There were 1 055 cases of T2 DM patients recorded in chronic disease information system of Pudong center for disease control and prevention in Shanghai Pudong Lingqiao Community.Altogether 901 (85.40%) valid questionnaires were included to investigate their gender, age, course, blood pressure, blood lipid (TG, TC, LDL-C and HDL-C), DPG, Hb A1 c, Body Mass Index (BMI), waistline, hipline, and WHR, all of which were conducted the baseline survey and correlation analysis. Results Of the 901 patients with T2DM, there were 403 cases accompanying central obesity (44.73%), and 498 cases of non central obesity (55.27%).There were significant differences in course distribution between the patients with central obesity and non central obesity group (χ²=7.399, P=0.025).The rate of FPG, HbA1c and blood lipids in the non central obesity group was higher than those in the central obesity group (P < 0.05). Conclusion It was found that more than half of T2 DM patients who had received the General Practitioner intervention had acceptable FPG and HbA1c level, and accompanying central obesity had lower FPG and lipid level rate.To strengthen the community obesity intervention, especially central obesity intervention is one of the important preventions and treatments of diabetes patients.

A novel method for detection the deafness-associated mitochondrial A1555G or C1494T mutation

DING Yu, ZHUO Guangchao, ZHENG Hui, HUANG Shuixian, LENG Jianhang

2017, 15(7): 1210-1212,1222. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.036

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Objective Mutations in mitochondrial 12 S rRNA gene are the molecular basis of hearing loss, of these, the A1555 G and C1494 T mutations have been found to be associated with nonsyndromic hearing loss in many families worldwide.This study aimed to establish a novel method for detection the deafness-associated mitochondrial 12 S rRNA A1555 G or C1494 T mutation. Methods We used 3 standard templates (wild type, A1555 G, C1494T mutation) of human mitochondrial 12 S rRNA to design four primers for PCR amplification by employing the Primer 5.0 software, then this method was applied to clinical screening of 200 non-syndromic hearing loss subjects and confirmed by Sanger sequencing. Results We found that samples with the A1555 G mutation can be detected by two specific bands (226 bp and 736 bp), samples with the C1494 T mutation can be detected by the 488 bp and 736 bp, while the samples without these mutations can be detected by only one band (736 bp).Using this method, we detected the 8 cases carrying these mutations (4%, 8/200), including 4 cases with A1555 G mutation, 4 cases with C1494 T mutation, which was well consistent with the results of DNA sequencing (Kappa=1.000, P < 0.01). Conclusion This is a convenience, cost-effective, accurate and useful method for detection the deafness-associated mitochondrial A1555 G or C1494 T mutation, which could identify the subjects at risk and effectively prevent the aminoglycoside induced hearing loss.

Color Doppler ultrasound and ultrasonic elastography in differential diagnosis of breast benign and malignant diseases

MA Caiye, LI Xingyun, TAN Yan, CHEN Jiajia

2017, 15(7): 1213-1216. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.037

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Objective To evaluate the clinical value of color Doppler ultrasound and ultrasonic elastography in the differential diagnosis of benign and malignant breast diseases. Methods The clinical data of 131 cases of breast lesion were analyzed retrospectively.Accuracy, specificity and sensitivity of were calculated for color Doppler ultrasound and ultrasonic elastography, considering the pathological diagnosis as the gold standard.Kappa consistency test was performed to measure the inter-rater reliability.Kappa over 0.75 as excellent, 0.40 to 0.75 as fair to good and below 0.40 as poor. Results Pathological results showed that there were 150 niduses with the diameter of 7.1-43.2 mm among 131 patients.There were 85 cases of benign lesion with 97 niduses, including 61 niduses in breast fibroadenoma, 15 niduses in mammary gland inflammatory lesion, 13 niduses in mammary gland hyperplasia, 3 niduses in intraductal papilloma, 2 niduses in fibrolipoma, 2 niduses in duct ectasia, 1 nidus in atypical hyperplasia.There were 46 cases of malignant lesion with 53 niduses, including 39 niduses in invasive ductal carcinoma, 5 niduses in intraductal carcinoma, 3 niduses in lobular carcinoma in situ, 3 niduses in invasive lobular carcinoma, 2 niduses in medullary carcinoma, and 1 nidus in mucinous adenocarcinoma.The accuracy, sensitivity and specificity for color Doppler ultrasound was 79.4%, 78.3% and 80.0%, respectively, Kappa=0.563;while the accuracy, sensitivity and specificity for ultrasonic elastography was 88.5%, 87.0% and89.4%, respectively, Kappa=0.752. Conclusion The ultrasonic elastography have advantages over color Doppler ultrasound in the differential diagnosis of benign and malignant breast diseases.

A systematic review on the instrument for evaluating evidence-based practice competency

FEI Jiaojiao, LI Yanhua, LI Junwei

2017, 15(7): 1217-1222. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.038

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Objective To describe, appraise and summarize currently available evaluating evidence-based practice (EBP) competency evaluation instruments for appraising evidence-based medicine (EBM) teaching and training outcomes. Methods We searched the Pubmed, CBMdisc, CNKI and Web of science to select the literatures published between April, 2011 and April, 2016 regarding the instrument for evaluating evidence-based practice competency.Two professors of General Practice assessed independently all titles, abstracts, full texts and abstracted data.The studies involving EBP competency evaluation instruments and analysis on its validity and reliability were included. Results Total 15 articles were selected, including 9 studies describing the development of tools, and 6 tested and verified the tools through EBM interventions.These 6 studies reported that knowledge scores had been increased significantly after the intervention. Conclusions Construct validity and internal reliability are the most common assessment items when making scale.Instruments with reasonable validity are available for evaluating some domains of EBP (5 steps of EBP) and may be targeted to different evaluation needs.The Fresno test has been proved the best documentation of validity and reliability and psychometric properties, it evaluates the first four steps, and is the best candidate for evaluating Chinese general practitioners EBM competency.

The application of visual evoked potential in the infection of central nervous system

ZHOU Xiaoyun, WANG Jimei

2017, 15(7): 1223-1226. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.039

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The infection of the central nervous systems (CSF) is a kind of disease of nervous systems, the diagnose of which is mainly confirmed by cerebrospinal fluid's culture through lumbar puncture.Because of different pathogens, the pathogenesis, pathophysiology, severity of acute phase and prognosis are different, but each can lead to many complications, such as visual impairment, hearing impairment, secondary epilepsy, brain abscess and so on.Because early symptoms are not typical, the diagnosis is not timely, resulting in delaying treatment, so morbidity and mortality of central nervous's infection are high.Early assessment of prognosis is helpful to improving the life quality of patients, reducing the burden of the family.The current assessments of CNS infection mainly depends on health care including the development of intelligence and movement, or relies on imaging, such as magnetic resonance and CT, or the application of electrophysiological methods.Visual impairment is a kind of complications after central nervous infection.Because the incidence of visual impairment is not easy to find, it is too late to find until blindness.Visual evoked potential (visual evoked potential, VEP) is a kind of method extracting from electroencephalogram (EEG), which is easier to learn and to analyze than EEG.It is different from MRI or CT, which is dominant to find the lesion of the nervous system.The visual evoked potential is gradually applied to the infection of central nervous system, and to infer the development and integrity of nervous system.This paper mainly relies on reading literature and sums up the application in nervous system infection, and explores the value of its prognosis.

Effects of moxibustion at Guanyuan and Qihai points on quality of life in patients with advanced liver cancer

YAN Yuetai, SHEN Dan, RUAN Yingdan, LIU Donghong

2017, 15(7): 1227-1229. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.040

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Objective To investigate the effect of moxibustion at on Guanyuan and Qihai points on quality of life of patients with advanced liver cancer. Methods Total 60 patients with advanced liver cancer in our hospital between September 2013 and August 2015 were enrolled and divided into two groups.The control group received the symptomatic treatment, while the treatment group received additional moxibustion at Guanyuan and Qihai based on the therapy in the control group.The improvement of clinical symptoms in the two groups was compared.Before and after the treatment, the changes of T lymphocyte subsets (CD3⁺, CD4⁺, CD4⁺/CD8⁺) and NK cells in the two groups were compared.Quality of life (QOL-LC) was used to assess the quality of life of patients before and after the treatment, including physical function, psychological function, symptoms and side effects, social function and overall health score. Results The scores of TCM symptoms of the two groups were significantly decreased after the treatment (P < 0.05), TCM symptom scores of the treatment group were significantly lower than those of the control group, the difference was statistically significant (P < 0.05).CD3⁺, CD4⁺, CD4⁺/CD8⁺ and NK cells in the treatment group were significantly increased (P < 0.05), and were significantly higher than those in the control group, the difference was statistically significant (P < 0.05).In the control group, there were no significant difference in CD3⁺, CD4⁺, CD4⁺/CD8⁺ and NK cells before and after the treatment (P >0.05);After the treatment, the physical function, psychological function, social function and overall health score of the treatment group were significantly increased (P < 0.05), and were significantly higher than those of the control group, the difference was statistically significant (P < 0.05).The psychological function and overall health score of the control group were significantly increased (P < 0.05). Conclusion Moxibustion at Guanyuan and Qihai point can improve immune function and QOL of patients with advanced hepatocellular carcinomato.

YU Fangyu, XU Yinghe, SHEN Qunhe, HUANG Danhong

2017, 15(7): 1230-1232. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.041

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Application of CBL and PBL combined with simulated training method in the teaching of clinical resident physician in cardiothoracic surgery department

ZHANG Lei, TANG Zhen, LIANG Bing, LI Xiaojun, GONG Huiyuan, WANG Biao

2017, 15(7): 1233-1235. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.042

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Objective To explore application effects of CBL (case based learning) and PBL (problem based learning) combined with simulated training in regular clinical training and teaching of cardiothoracic surgery learners. Methods A total of 32 physicians (male cases) receiving standard resident doctor training in cardiothoracic surgery department of the First Affiliated Hospital of Bengbu Medical College from September, 2013 to October, 2015 were selected as the research object, aged from 23 to 33 years old with 20 undergraduates and 12 postgraduates.Randomly, 16 cases were chosen as the research group receiving CBL and PBL combined with simulated training, and 16 as the control group receiving the traditional LBL (Lecture-Based Learning).The mean age of the study group was 27.94 ±2.93, and the mean age of the control group was 28.00 ±3.67.After learners of the two groups finished their training, their theoretical test results, practical operations, clinical case analysis performance and satisfaction degree of teaching were compared. Results There was no significant difference between the two groups in age, education background, and the theoretical test scores before admission.The score of theoretical test results, operational abilities and case analysis results in the research group were 88.69 ±2.41, 89.50 ±2.37 and 85.06 ±2.38, and those in control group were 77.25 ±2.65, 79.31 ±2.21 and 77.19 ±1.52.The teaching satisfaction rate in the research group was 93.8%, while that in the control group was 56.25%.Learners' theoretical test results, technical operations, case analysis performance and satisfaction degree of teaching in the research group were significantly higher than those in the control group (P < 0.05). Conclusion CBL and PBL combined with simulated training could significantly improve learners' theoretical test results and operational abilities of cardiothoracic surgery learners, so it is worth further promotion.

Application of the teaching method combining PBL with CBL in resident standardization training in the department of endocrinology

HU Xiaolei, CHEN Weidong, SUN Weihua, YU Lei, SHI Zhaoming, JIN Guoxi

2017, 15(7): 1236-1238. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.043

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Objective To explore the application of the teaching method combining problem-based learning (PBL) with case-based learning (CBL) in resident standardization training in the department of endocrinology. Methods A total of40 students for resident standardization training were divided into experimental group and control group with 20 students in each group.PBL combined with CBL was applied to the experimental group, while the control group received the traditional approach.We carried out the theoretical and clinical practice skills exams at the end of the teaching and questionnaire survey to understand the residents for teaching evaluation. Results The results of case analysis (24.35 ±1.35 vs.21.25 ±2.79, P < 0.05), practical skill assessment (23.55 ±1.67 vs.20.60 ±3.10, P < 0.05) and total score (83.40 ±2.52 vs.76.20 ±5.43, P < 0.05) in experimental group were higher than those of control group.There was no significant difference between the two groups in theoretical examination (35.50 ±1.85 vs.34.35 ±2.16, P > 0.05).The self-learning ability (4.25 ±0.64 vs.3.85 ±0.37, P < 0.05), problem-solving ability (4.30 ±0.47 vs.3.95 ±0.61, P < 0.05), teamwork ability (4.20 ±0.52 vs.3.75 ±0.44, P < 0.05) and communication ability between doctors and patients (4.15 ±0.67 vs.3.40 ±0.50, P < 0.05) in the experimental group were all higher than those in the control group. Conclusion The PBL combined with CBL teaching method can increase the clinical practice skills of residents, improve students' satisfaction of teaching and enhance the comprehensive ability of students, which is worthy of further popularization and application.

Changes of glycogen antigens 125 and procalcitonin in serum and ascites of patients with hepatitis B cirrhosis complicated with spontaneous bacterial peritonitis

MENG Ying, LUO Xin, ZHAO Guogen, GU Huihua, FU Xiaoqing

2017, 15(7): 1239-1241. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.044

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Objective To investigate the changes of glycogen antigens 125 (CA125) and procalcitonin (PCT) in serum and ascites of patients with hepatitis B cirrhosis complicated with spontaneous bacterial peritonitis. Methods Sixty cases of patients with Hepatitis B cirrhosis of ascites combined with spontaneous bacterial peritonitis were selected as the observation group and 60 cases of patients with Hepatitis B cirrhosis of ascites without spontaneous bacterial peritonitis were selected as the control group.The levels of CA125 and PCT in serum and ascites were measured. Results Serum levels of CA125 and PCT in the observation group[(425.76 ±157.43) U/L, (1.326 ±0.434) ng/ml] were significantly higher than those in the control group[(314.27 ±132.95) U/L, (0.587 ±0.276) ng/ml], P < 0.05.The ascites CA125 and PCT levels in the observation group[(567.34 ±213.75) U/L, (0.983 ±0.316) ng/ml] were higher than those in the control group[(378.52 ±167.53) U/L, (0.214 ±0.105) ng/ml], P < 0.05.In the 47 patients with antibiotic therapy, the serum and ascites CA125 and PCT level after treatment[(411.53 ±152.13) U/L, (1.279 ±0.424) ng/ml; (558.76 ±202.14) U/L, (0.946 ±0.307) ng/ml] were lower than those before treatment[(331.86 ±143.25) U/L, (0.635 ±0.265) ng/ml, (385.42 ±197.47) U/L, (0.546 ±0.324) ng/ml], P < 0.05.The serum CA125 and ascites CA125 were positively correlated (r=0.882, P=0.000).There was positive correlation between serum PCT and ascites PCT (r=0.856, P=0.000).There was no significant correlation between serum CA125 level and serum PCT level (P >0.05). Conclusion The serum and ascites CA125, PCT levels in patients with Hepatitis B cirrhosis with spontaneous bacterial peritonitis increases.The levels of CA125 and PCT in serum and ascites are decreased in validated patients by antibiotic treatment.

Effect of nutritional risk screening and prophylactic enteral nutrition support in patients with colorectal cancer

CHEN Shanshan, SUN Lin

2017, 15(7): 1242-1244. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.045

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Objective To evaluate the effects of preoperative prophylaxis nutrition support on the recover index in patients with colorectal cancer. Methods Sixty cases of colorectal cancer (NRS-2002 ≥ 3) in our department from April to September in 2016 were randomly assigned into control group (n=30) and experiment group (n=30).All the patients in both groups took the routine diet, while the patients in the experiment group consumed 1 500 ml of protein-type enteral nutrition Risai produced by Huarui Pharmaceutical Co Ltd at 3 days before the operation.PA, ALB and HB before the operation and 3 days after the operation, body weight on the third day after operation, tiem for first flatus passing, self-care ability 3 days after operation (Barthel, HBB), and postoperative complications (pulmonary infection, incision healing, anastomotic fistula) were compared between the two groups. Results The level of PA[(175.02 ±6.39) mg/L], ALB[(34.73 ±3.53) g/L]and HE[(108.45 ±9.45) g/L]3 days after the operation in the experimental group were significantly higher than those of the control group (P < 0.05).The first flatus passing[(56.84 ±12.35) h] and first oral feeding[(66.77 ±13.59) h] in the experimental were significantly earlier than those in the control group (P < 0.05).The Barthel score at 3 days after the operation in the experimental group (62.80 ±4.88) was significantly higher than that (52.16 ±9.62) in the control group (P < 0.01).There was not obvious difference in body weight at 3 days after the operation and postoperative complications between the two groups. Conclusion For the colorectal cancer patients with risks of low nutrition, the preoperative nutritional support can effectively improve the postoperative nutritional status, minimize the surgical stress response and improve the patient's physical and mental health in order to promote the rehabilitation of patients.

Practice of home visiting based on empowerment theory in community-dwelling elderly diabetic patients

LIU Dongmei, ZHANG Jiaqi, LI Shengling, LIU Guolian

2017, 15(7): 1245-1248,1252. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.046

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Objective To evaluate the effects of home visiting based on empowerment theory on empowerment, self-management behaviors and the glycemic control in community-dwelling elderly diabetic patients, in order to provide a new theoretical and implementation method for home visiting in community-dwelling elderly diabetic patients. Methods The elderly patients with diabetes that meet the criteria for inclusion were randomly recruited from two community health service stations in Yinchuan city and were divided into control group (n=67) and intervention group (n=67) according to their geographic setting.The control group got routine home visiting, while the patients in the intervention group received a sixmonth home visiting based on empowerment theory.The patients were investigated with China Mainland-Diabetes Empowerment Scale (CM-DES) and Diabetes Self-care Scale (DSCS) and the fasting plasma glucose were measured before intervention and six months after intervention. Results There were no significant difference in the scores of empowerment and self-management behaviors between the two groups before intervention (P > 0.05).While after intervention, the scores of empowerment, self-management behaviors as well as their dimensions in the intervention group were all significantly higher than those in the control group (P < 0.05).From the five months of the intervention to the end of intervention, the glycemic control in the intervention group were significantly better than that in the control group (P < 0.05). Conclusion Home visiting based on empowerment theory as an effective management and follow-up method for diabetes in community can not only enhance the empowerment, but also improve self-management behaviors and glycemic control of the elderly diabetic patients.

Effect of personalized nursing on constipation caused by clozapine

HE Liping, XIA Yong

2017, 15(7): 1249-1252. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.047

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Objective To explore the application of individualized nursing on clozapine lead to amelioration of constipation. Methods In our hospital in July 2014-2016 year in May in accordance with the inclusion criteria for clozapine caused 86 cases of constipation patients were randomly divided into study group and control group were 43 cases, the control group was given routine nursing the study group;two groups of individual nursing intervention for 3 months for a course of treatment during the assessment of Longo outlet obstruction constipation severity score, Wexner score, gastrointestinal quality of life score and self rating Anxiety Scale (SAS), self rating Depression Scale (SDS), concise Health Questionnaire (SF-36).At the same time comparison between the two groups of nursing effect and satisfaction condition. Results Compared with before treatment, scores of the two groups after treatment Longo outlet obstruction, Wexner constipation severity score decreased, quality of life score increased after treatment of gastrointestinal SAS, SDS score decreased, SF-36 scores were significantly increased (P < 0.05);compared with the control group, the Longo scores of the study group after treatment of outlet obstruction, Wexner constipation severity score lower gastrointestinal quality of life score higher, after treatment SAS, SDS score lower, higher SF-36 score (P < 0.05);the effective rate of control group72.09% and the effective rate was 90.70% of the research data comparison, study group than in control group (P <0.05);the control group satisfaction rate was 65.12% and the satisfaction rate of study group 88.37% data comparison, study group than in control group (P < 0.05);all patients were followed up, no cases of falling, during the treatment of liver/kidney.Blood/urine ion detection were in the normal range, no adverse reactions occurred in two patients. Conclusion The curative effect of individualized nursing on constipation induced by clozapine is effective, can improve constipation symptoms, improve the quality of life, worthy of promotion.

Effect of nursing intervention by quality control circle activities on tracheostomy after severe traumatic brain injury

SHEN Li, ZHAN Yan, ZHAO Li, LI Daochang

2017, 15(7): 1253-1255. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.048

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Objective Pulmonary infection is a common complication in patients with severe traumatic brain injury, which seriously affects the prognosis of patients.Not only do we need to improve the patient's condition, but also to take scientific measures to reduce the incidence of pulmonary infection.The paper supplies control circle (QCC) activities to explore the value of nursing care after tracheostomy in patients with severe craniocerebral injury. Methods Quality control circle activity was set up and the activity theme was established in 36 patients with tracheostomy after the injury and 40 subjects serving as control group.Pneumonia rate was compared between QCC activities group and control group.Time of antibiotic use and duration of fever in patients with pneumonia were also compared after the injury between two groups. Results In the control group, including 34 cases of patients with pulmonary infection, infection rate was 85%.There were 19 cases of pulmonary infection in QCC group, accounting for 52.78%, which was statistically significant compared with the control group (χ²=9.321, P=0.002, P < 0.05).For patients with pneumonia, the QCC activities significantly shortened the time of antibiotic use and duration of fever (P < 0.05). Conclusion The results indicated that QCC activity not only reduced the incidence of pneumonia after tracheostomy and pulmonary infection which was effectively controlled, but also may be helpful for improving the skills as a quality management tool, thus worthy of promotion and use in clinical practice.

Effect of level of care programmes based need theory in hemodialysis patients

ZHOU Yilin, ZHOU Canxin

2017, 15(7): 1256-1258. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.049

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Objective To implement level of care programmes based need theory in hemodialysis patients to improve the mental status and prognosis of patients. Methods A total of 118 hemodialysis patients in our hospital between February, 2015 and January, 2016 were recruited and divided into observation groups (level of care based need theory) and control group (routine care) according to the random number table.The health status, mental state and other physiological indicators were compared before and after the treatment. Results SF-36 scores before the nursing care was performed had no significant difference between the two groups (P > 0.05);after the treatment, SF-36 scores were 66.24 ±9.17 in the observation group and 59.38 ±8.26 in the control group, the difference was statistically significant (P < 0.05).There were no significant difference in SAS and SDS score before the treatment (P > 0.05);after the treatment, SAS and SDS score were 36.15 ±6.28 and 37.28 ±5.06 in the observation group, which were higher than 48.66 ±6.43 and 49.15 ±5.46 in the control group, the difference was statistically significant (P < 0.05).The treatment effectively improved the levels ofβ2-MG, BUN and Cr in hemodialysis patients (P < 0.05). Conclusion The level of care based need theory can significantly improve the health status and negative emotions of hemodialysis patients, thus improve the clinical outcomes.

The feasibility study of early mobilization for ICU patients in critical conditions

FANG Xiuhua, WU Lixin, SU Yan, MEI Bengang, LIU Yan, YANG Yang, JIN Lifang, CHA Junjing

2017, 15(7): 1259-1262. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.050

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Objective To investigate the feasibility and efficacy of providing early physical activities for ICU patients and to serve as a reference for practicing early activities in ICU. Methods We sampled 32 patients who hospitalized in ICU for over 24 hours from August, 2014 to February, 2015.All patients met the standards for engaging in early physical activities, and they participated in a total of 81 early activities following standard protocols.Physical activity levels (a total of 4classes from sitting up in bed with nurses' assistance to autonomous walking) were gradually increased per patients' level of resilience and changes in vital signs.Pre and post vital functions including HR, RR, SpO₂, and BP were measured and compared.Patients' subjective feelings including dizziness, fatigue, and pain were recorded.Adverse events such as tumbling, slipping, and sudden worsening of symptoms were also observed. Results Among the 81 early activities (64 first class, 6 second class, 10 third class, 1 fourth class), patients reported positive feelings in 51 cases, moderate but tolerable discomfort in 26 cases, and intolerable experience in 4 cases.There was one case of thrombophlebitis, but no tumbling or slipping was observed.No statistical significant difference was found between pre-and post-activity HR, RR, SpO₂, or DBP measures (P > 0.05).There was a statistically significant increase in post-activity SBP (P < 0.01). Conclusion Following a standardized protocol, it is safe and feasible to provide early physical activities for ICU patients.Although the class of activity is mostly constrained to sitting up in bed, the protocol is tolerable for patients and free from adverse events.Further investigations on methods to improve class of activity are needed in future clinical practices on early activities.

Effect of collaborative nursing model on radial artery occlusion after trans-radial percutaneous coronary intervention

WANG Chengxiang, MA Saike, WANG Xinghong, GE Cuihong

2017, 15(7): 1263-1265. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.051

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Objective To explore the effect of collaborative nursing model on radial artery occlusion after trans-radial percutaneous coronary intervention and patient and their family satisfaction. Methods The clinical data of 84 consecutive patients undergoing trans-radial percutaneous coronary intervention in our hospital between September, 2015 and December, 2016 were retrospectively analyzed.Forty-two cases in the observation group received the cooperative nursing model, while 42 cases in the control group received the routine nursing model.The incidence of radial artery occlusion after surgery was recorded.The patient and their family satisfaction questionnaire surveys were carried out.The occurrence of radial artery occlusion and nursing satisfaction were compared between the two groups by χ²test. Results The incidence of radial artery occlusion after trans-radial coronary intervention in the observation group was 2.4% (1 case) and the nursing satisfaction was 100% (42 cases);while those in the control group was 19.1% (8 cases) and 85.7% (36 cases).There was significant difference in the incidence of radial artery occlusion and nursing satisfaction between the two groups (P <0.05). Conclusion Collaborative nursing model can significantly reduce the incidence of radial artery occlusion after trans-radial coronary intervention, and effectively increased patient compliance with treatment and care satisfaction, significantly improve the ability of communication between doctors and patients.

2017, 15(7): 1266-1268. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.052

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2017, 15(7): 1268-1270. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.053

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2017, 15(7): 1271-1272. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.054

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2017, 15(7): 1273-1274. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.055

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2017 Vol. 15, No. 7

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