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2017 Vol. 40, No. 3
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2017, 40(3): 245-250.
doi: 10.3969/j.issn.1674-4500.2017.03.01
Abstract:
Objective Cabrol procedure was introduced by Professor Cabrol C in 1981, but little information existed regarding the results of Cabrol technique in aortic dissection(AD). This study explored a 7-year period results of aortic root replacements in type A aortic dissection employing this procedure. Methods From January 2009 to December 2016, 47 patients with type A aortic dissection received Cabrol procedure in our hospital. All patients received echocardiography and CT scan of whole aorta before operation. Cabrol procedure was performed to repair the aortic root. The replacement of right hemi aortic arch or total aortic arch and a stented frozen elephant trunk implantation might be performed based on the extent of the dissection in the aortic arch. A retrospective analysis was performed to evaluate the effectiveness of this procedure in type A aortic dissection. Results Forty-seven cases were admitted, including 6 cases of simple Cabrol procedure, 13 cases with concomitant replacement of right hemi aortic arch and 28 cases with concomitant total aortic arch replacement and frozen elephant trunk technique.The 30-day mortality was 10.6%(5/47). 25.5%(12/47) of patients developed acute renal failure, and 12.8%(6/47) needed continuous renal replacement therapy (CRRT) during hospital time. The median hospital time were 25.5 d, ranging from 15 to 128 d.It followed-up from 6 to 36 months. Conclusion The Cabrol procedure is feasible and safe for patients with type A aortic dissection. The artificial blood vessels are unobstructed.
2017, 40(3): 251-256.
doi: 10.3969/j.issn.1674-4500.2017.03.02
Abstract:
Objective To explore the effect of extensive resection induced by MRI T2Flair sequence on the prognosis of glioblastoma. Methods Forty-one cases of anesthesia in patients with intracranial glioblastoma between September 2010 and January 2016 in our Hospital were retrospectively analyzed. Seventeen cases were performed with MRI T2Flair sequence under extended resection of brain glioblastoma patients, 24 cases of control group with T1 enhancement were performed with the remaining resection of brain glioblastoma patients. All cases were applied with intraoperative neural navigation application in the process of surgery combined with electrical stimulation DTI, cortex, intraoperative ultrasound, intraoperative tumor fluorescence imaging. Postoperative pathology were diagnosed with glioblastoma (GBM). The preoperative and postoperative MRI T1 enhanced lesions and T2Flair scope were outlined by German making radiotherapy plan system. Image fusion was conducted. The preoperative and postoperative volume were compared. T1 enhance tumor resection range and T2Flair excision scope were definited. The patients were followed up to January 2017. The patient underwent postoperative radiotherapy and chemotherapy. Results T1 enhanced lesions of 24 cases in Control group were excised. No patient had neurological dysfunction after operation. Another 17 cases of T2Flair patients as extended resection, 7 cases T2Flair had a excision of 0%~10%, 4 cases of T2Flair had a resection of 10%~25%, 6 T2Flair removed more than 25%. All patients were followed up to January 2017, 17 patients with GBM T2Flair excision had a median survival time of 30.45 months. In the control group of 24 cases with GBM patients, median survival time was 15.37 months. Difference between two groups was significantly (P=0.013). T2Flair resection were divided into group of 0%~10%, 10%~25% and more than 25%. The median survival time of each group was 20.16, 45, 33 months, respectively, with no significant differences . Conclusion Application of awaken anesthesia combined with intraoperative neural navigation, electrical stimulation DTI, cortex, intraoperative ultrasound, intraoperative tumor fluorescence imaging can effectively guarantee the operation safety of the intracranial GBM patients. It improves the T1 enhanced the rate of total resection of lesions like, promotes the maximum safe range to complete the T2Flair extended resection. T2Flair total excision of the expansion can obviously prolong the survival time of GBM patients, but not T2Flair like to remove the more the better. The difference between the survival degree of resection is not significant.
2017, 40(3): 257-261.
doi: 10.3969/j.issn.1674-4500.2017.03.03
Abstract:
Objective To investigate the CT features and evolution of lung abnormalities in patients suffered from acute pulmonary embolism. Methods The CT and clinical data of 34 patients suffered from acute pulmonay embolism were analyzed retrospectively. The direct sign, that is, thefilling defect within the pulmonary arteries, and the abnormal CT signs in the lungs, including pulmonaryinfarction, mosaic sign, ground-glass opacity, Westermark'ssign, and pulmonary atelectasis were assessed, and their location and radiologic features of lesions were described too. On the follow-up CT examinations, the evolution of lesions were carried out by comparing to their appearance shown on previous CT images. Results On initial CT exminations, pulmonaryinfarction involved 18 patients, resulting to 28 lesions, while mosaic sign involving 6 patients, resulting to 10 lesions, ground glass opacity involving 12 patients, resulting to 28 lesions, Westermark'ssign involving 5 patients, resulting to 6 lesions, and pulmonary atelectasis involving 13 patients, resulting to 19 lesions. Thirteen patients peformed at least one time follow-up CT exminations in various period. As the filling defectdecreased while followed up, almost of the lung abnormalities shrinked or disappeared on CT, but the pulmonaryinfarction turned to be focal fibrosis lesions. Conclusion Pulmonaryinfarction, mosaic sign, ground-glass opacity, Westermark'ssign, and pulmonary atelectasis were common signs on CT in patients suffered from acute pulmonary embolism, and acknowledging the signs and their evolution would contribute to the diagnosis and therapeutic effects evaluation of pulmonary embolism.
2017, 40(3): 262-265.
doi: 10.3969/j.issn.1674-4500.2017.03.04
Abstract:
Objective To analyse the clinical history combined with routine lip jaws on the three aspects, alveolar sudden transverse section, other special plane and three-dimensional ultrasound fetal position,and improve the efficiency of prenatal ultrasound diagnosis of fetal cleft lip and palate. Methods The facial ultrasound screening were performed to 7000 fetus in the second trimester in our hospital from September 2014 to December 2016. Medical history were asked before ultrasound examination. We standardized the conventional three section, alveolar cross section as a screening section. A two-dimensional image were collected at the same time of opening and closing of the fetal anomaly. 3D acquisition the image were collected at last. The induction of labor or delivery in children after facial results were compared.The effects of prenatal ultrasound of different methods in diagnosis of cleft lip and palate efficiency were compared. Results In 7000 cases of fetal ultrasonography, 27 cases were detected of cleft lip and palate, 29 cases were confirmed of cleft lip and palate by labor and childbirth.Twenty cases were detected of cleft lip and cleft palate in the conventional three section group. Nine cases were missed diagnosis of prenatal ultrasound. Coincidence rate of ultrasound diagnosis was 69%. 27 cases were fetal cleft lip and palate malformation by conventional three aspects, alveolar sudden transverse section, other special section on three-dimensional ultrasound group. Two cases were missed diagnosis of prenatal ultrasound. Coincidence rate of prenatal ultrasound diagnosis was 93%. Effects of two methods in the merger of cleft lip cleft palate cases were significantly different (P<0.05). Conclusion Ultrasound doctors should do conventional acquisition history before examination.The identification of normal structure and sonographic features of cleft lip and palate nose, the conventional three section on the alveolar transverse section, a careful observation of the fetal lip nasal structure and closed mouth movement, the application of three-dimensional ultrasound surface imaging mode will improve ultrasound diagnostic rate of cleft lip and palate deformity.It can provide reliable informations for clinicians and pregnant women.
2017, 40(3): 266-269.
doi: 10.3969/j.issn.1674-4500.2017.03.05
Abstract:
Objective To evaluate the diagnostic value of spiral CT multiplanar reconstruction in traumatic carpaldislocation or fracture-dislocation. Methods The clinical and imaging data of 48 cases confirmed of carpal dislocation or fracture-dislocation were retrospective analyzed.The diagnostic accuracy of plain film radiography, CT (axial, MPR and VR reconstructionincluded) in the diagnosis of wrist dislocation were compared. Results In 48 patients diagnosed by clinical data, accuracy of spiral CT was 100% and accuracy of plain film radiography was 70.83%. There was significant difference of carpaldis location detection between CT and X-ray (χ2=4.5, P<0.05). Ten cases were unable to detect the small fractures of scaphoid and triquetrum in the X-ray missed cases. Four cases were misdiagnosed in plain film which pisiform was the most common. Conclusion Small carpal fractures may be missed even in a high detection rate of carpal dislocation in X-ray. MPR and VR reconstruction of spiral CT can clearly show carpal dislocation and fracture, provide imaging supports for clinical treatment. In addition, misdiagnosis of dislocation of some carpal in the plain film are caused by the passive position of patients.
Clinical value of multiplanar reconstruction with multi-slice spiral CT in diagnosis of appendicitis
2017, 40(3): 270-272.
doi: 10.3969/j.issn.1674-4500.2017.03.06
Abstract:
Objective To explore the diagnostic value of multiplanar reconstruction (MPR) with multi-slice spiral CT on appendicitis. Methods Fifty-five patients with clinical suspected acute appendicitis were enrolled. 16-slice spiral CT was used to scan and manage multi planar volume recombination images. The CT images were retrospectively analyzed. The rates of signs in the diagnosis of acute appendicitis were expored by comparing the reconstructed image with the reconstructed image. Results The diagnosis of acute appendicitis was performed in 50 patients with pathologically confirmed appendicitis. Right ovarian cyst, calculi within distal segment of right ureter, cholecystitis, colon tumor, pelvic inflammatory disease were performed in 1 patient for each. The discrimination rate of appendix, detection rate of appendix wall thickening and ileocecum wall thickening in reconstruction image were higher than that in unreconstruction image (P<0.05). Conclusion Multi-slice CT in combination with MPR can improve the diagnosis accuracy for acute appendicitis. It is fast and accurate in the diagnosis of appendicitis and other diseases, which is worthy of clinical application.
2017, 40(3): 273-276.
doi: 10.3969/j.issn.1674-4500.2017.03.07
Abstract:
Objective To explore the effect of nasal dilation on the subjective and objective symptoms of sleep in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and provide clinical basis for the application of nasal cavity expansion in patients with OSAHS. Methods Fifty-six cases adult patients with OSAHS were chosen as objects. The nasal resistance, the results of multiple sleep monitoring (PSG), the snore outcome survey (SOS), the visual analogue scale (VAS) and the epworth sleepy survey (ESS) were compared before and after nasal surgery expansion. Results After nasal dilation, the nasal resistance and apnea hypopnea index (AHI) of OSAHS patients were decreased significantly (P<0.05).The average oxygen saturation and the lowest oxygen saturation were increased significantly (P<0.05). Scores of SOS scale, VAS scale and ESS scale which reflecting the sleep subjective symptoms were decreased significantly (P<0.05). Conclusion Nasal dilation has a curative effect on reducing nasal resistance and alleviating the severity of obstructive sleep apnea in OSAHS patients.It improves sleep subjective symptoms such as sleep snoring nasal blockage and daytime sleepiness. It is significant in the treatment of patients with OSAHS.
2017, 40(3): 277-280.
doi: 10.3969/j.issn.1674-4500.2017.03.08
Abstract:
Objective To evaluate the effect of tea polyphenols on sinus healing in post-operative radioactive osteomyelitis of jaws (ORN) by cone beam CT and contrast fistulography. Methods Thirty ORN cases with post-operative oral mucosa sinus were divided into 2 groups randomly. In experimental group, sinus was rinsed and gargled with tea polyphenols solution in daily. In control group, sinus was treated with normal saline. Sinus radiography was taken by cone beam CT every 3 weeks with calculation of sinus volume in 2 groups. Effect of tea polyphenols on proliferation of human immortalized oral mucosal epithelial cell line was detected by MTT. Results The sinus volume in experimental group was smaller than that in control group after 12 weeks of treatment (P<0.05). With treatment of 120 mg/L tea polyphenols, growth rate of NOK in experimental group was higher than that of control group (P<0.05). Conclusion Tea polyphenols can accelerate the healing of post-operative sinus in ORN through stimulating the proliferation of epithelium cell.
2017, 40(3): 281-283.
doi: 10.3969/j.issn.1674-4500.2017.03.09
Abstract:
Objective To compare the clinical application of extraction of mandibular impacted wisdom teeth under turbine combined minimally invasive extraction instrument method and traditional method of tooth extraction. The advantages and disadvantages were compared. Methods Eighty-two cases with low mandibular impacted wisdom teeth were selected. They were randomly divided into experimental and control group, with 41 cases in each group. Experimental group was performed with minimally invasive tooth extraction knife tooth extraction in combining with the high speed turbine dental drill tooth extraction. Control group was performed with traditional tooth extraction equipment. Increased rate, rate of incomplete tooth extraction sockets, dental fear of disease incidence rate, operation time and postoperative mouth by the limit of differences were compared. Results The experimental group was healed in primary, whereas the control group had 4 cases with delayed healing caused by infection. The rate of root fracture in experimental group was 7.3%, while the control group was 22%. None of experimental group had incompleted of tooth extraction socket, while the control group had 18 cases with incomplete tooth extraction socket. Two cases in experimental group had dental fear of disease, while 5 cases in the control group. Compared with control group, operation time decreased significantly and postoperative mouth was lighter in experimental group (P<0.05). Conclusion Compared to traditional method of tooth extraction, the minimally invasive tooth extraction technology in the mandibular impacted wisdom teeth low urethral surgery are painless, safe and minimally invasive. It has a good clinical application prospects.
2017, 40(3): 284-287.
doi: 10.3969/j.issn.1674-4500.2017.03.10
Abstract:
Objective To explore the correlation of carotid ultrasound parameters, dynamic arterial stiffness index (AASI) and coronary heart disease (CHD). Methods AASI, carotid ultrasound and coronary angiography were detected in 110 patients with CHD. According to the result of coronary angiography, patients were divided into single lesion group (n=40), two lesion group (n=37) and 3 or more lesion group (n=33). Based on carotid ultrasound examination, patients were divided into carotid mild stenosis group (n=42), moderate stenosis group (n=46) and severe stenosis group (n=22). Fifty cases with healthy physical examination were selected as the normal control group. Blood pressure, AASI, carotid intima-media thickness (IMT), carotid atherosclerosis plaque integral and coronary artery score were compared in 4 groups with correlation analysis. Results There were no significant differences in systolic blood pressure and diastolic blood pressure between patients with different coronary lesions and different degrees of carotid stenosis (P>0.05). The differences of AASI between 3 lesions group, two single lesion group and the control group were significant (P<0.05). The differences of AASI between severe carotid stenosis group, moderate stenosis group, mild stenosis group and the control group were significant (P<0.05). IMT of patients with CHD were significant higher than that of control group (P<0.05). But IMT between coronary heart disease group were not significant different (P>0.05). Coronary plaque integral score between 3 lesion group, two lesions in group 1 lesion group and control group were significant different (P<0.05). Coronary plaque integral score between severe stenosis, moderate stenosis group, mild stenosis group and control group were significant different (P<0.05). AASI and coronary lesions, stenosis were correlated positively (r=0.72, 0.65, P<0.05). Plaque scores and scores of coronary artery were positively related to the coronary lesions and carotid artery stenosis (r=0.88, 0.19, 0.88, 0.19, P<0.05). Conclusion The parameters of carotid artery ultrasound and AASI can objectively reflect the degree of atherosclerosis and atherosclerotic plaques. It can early predict, evaluate the risk of coronary heart disease and provide reliable basis for early clinical intervention.
2017, 40(3): 288-290.
doi: 10.3969/j.issn.1674-4500.2017.03.11
Abstract:
Objective To investigate the feasibility, safety, practicality and ease operation of micro laparoscopic surgical TAPP umbilical single parts in clinical application. Methods Seventy-one cases were performed with umbilical TAPP micro laparoscopic operation in our hospital since 2015. A total of 100 cases without tension hernia repair were randomly chosed. The operation time, intraoperative blood loss, postoperative incision pain, satisfaction of incision, scrotal hematoma, incision infection,antibiotic usage and postoperative hospital stay were compared between 2 groups. TAPP micro laparoscopic surgery by umbilical single parts were repaired by bud in 3 d Max patch.Traditional cases without tension hernia repair patch had different specifications. Results Two groups of patients achieved surgical success. Operation time, intraoperative blood loss, postoperative incision pain, aesthetic satisfaction, antibiotic usage of incision, postoperative hospital stay in the umbilical single parts micro laparoscopic TAPP group is superior than that of the traditional group, with same incision infection rate and scrotal hematoma. During followed-up years(2 ± 0.5), there were no recurrence of hernia and other complications. Conclusion The umbilical single site TAPP micro laparoscopic surgery have a clear anatomy, simple operation, clinical operation feasibility. It is worth of clinical promotion with safety, practicality and simplicity.
2017, 40(3): 291-293.
doi: 10.3969/j.issn.1674-4500.2017.03.12
Abstract:
Objective To evaluate the value of MR Image identification in patients with chronic ankle instability. Methods Forty-five cases with ankle instability in our hospital were randomly selected as research group. The other 45 cases with others foot disease (excluding ankle injury) patients were selected as control group. MRI was performed to patients. The position of the talus and fibular patients were observed by measuring the AMI patients, IMI, MTI talus and fibula. Results MRI results showed osteochondral injury of the talus in 16 cases, 8 cases of fracture of cartilage surrounding tissue edema, 11 cases of the peroneal tendons,7 cases of ligaments injury and 3 cases of achilles tendon rupture . AMI, MTI were significantly higher in research group than the control group (P<0.05 or P<0.01). IMI in 2 groups was not significantly different (P>0.05). Conclusion MRI has a high sensitivity in joint soft tissue injuries, especially the ligaments, muscles, tendons and cartilage. Spin phenomenain the talus exist in patients with functional instability of ankle injury.
2017, 40(3): 294-298.
doi: 10.3969/j.issn.1674-4500.2017.03.13
Abstract:
Objective To explore the relationship between structure and function of SR and DAO in schizophrenia. Methods SR and DAO gene were cloned from blood of patients with schizophrenia with bioinformatics analysis. Results The SR and DAO genes encoded 340 and 347 amino acids, respectively. It had more than 96% homology with healthy humans, apes and monkeys. The relative molecular mass of SR and DAO proteins were predicted to be 36.57 KDa and 39.47 KDa, respectively. The isoelectric point were 6.11 and 6.36. SR distribution was involved in chondriosome. DAO distribution was involved in chondriosome and peroxysome. It indicated that SR and DAO played a mayor role in synthesis and metabolism of cells.Three-dimensional measurement revealed that SR protein was composed of a structural domains and DAO protein was composed of two structural domains and one link region. Conclution SR and DAO can promote protein synthesis and metabolism in eukaryotic cells.
2017, 40(3): 299-303.
doi: 10.3969/j.issn.1674-4500.2017.03.14
Abstract:
Objective To explore if amniocentesis in pregnant with HBV infection carriers will increase the risk of mother-to-child transmission(MTCT). Methods All relevant published papers and abstracts of English and Chinese were searched by the key words such as hepatitis B virus/HBV, amniocentesis, vertical/mother-to-child transmission in Pubmed (MEDLINE), Embase, Google scholar and Wanfang database between January 1 1990 and March 15 2016. Four papers with 3997 pregnant women including 167 amniocentesis cases and 3830 control cases were entered to this analysis. The analysis was performed by statistical software Review Manager Version 5.0. Results The meta-analysis showed that there was no significant difference of infant’s HBsAg-positive rate between two groups of mothers who underwent amniocentesis or no amniocentesis (R2=1.37, 95% CI: 0.70~2.69, P=0.36). It increased the risk of MCTC of HBV if amniocentesis was performed in pregnant women with serum HBV-DNA≥107 copies/mL (R2=9.54, 95% CI: 3.52~25.85, P<0.0004) and/or HBeAg-positivity (R2=3.41, 95% CI: 1.05~11.13, P=0.04). Conclusion Amniocentesis in pregnant women with serum HBV-DNA ≥107 copies/mL and/or HBeAg-positivity would increase the risk of MTCT in HBV infection.
2017, 40(3): 304-307.
doi: 10.3969/j.issn.1674-4500.2017.03.15
Abstract:
Objective To evaluate the value of lipopolysaccharide (LPS) in invasive brain injury (TBI) inflammatory response (Inflammation). Methods Eighty-six patients with TBI in Third People's Hospital of Nanhai Foshan were enrolled.They were divided into 3 groups according to the Glasgow coma scale (GCS) score, with mild group of 33 cases, moderate group of 24 cases and severe group of 29 cases. Twenty-eight cases with health examination in the same period were selected as a control group.The levels of nitric oxide (NO) in serum were detected by GREISS. The levels of TNF-α, IL-6, IL-1β and were measured by ELISA. Results The levels of serum TNF-α were increased in the mild, moderate and severe groups, and the third day was the highest. The levels of serum TNF-α on the 5th and 7th day were gradually decreased and still higher than the control group. The levels of serum IL-6 in the mild, moderate and severe groups were higher than those in the control group (P<0.05). The level of IL-6 in the mild and moderate group was significantly higher than that in the control group (r=0.925, P<0.05). The levels of serum IL-1β in the mild group, moderate group and severe group were higher than those in the control group, and the increasement was significant on the third , fifth day (P<0.05). The severity of TBI was correlated with serum IL-1β concentration (r=1.267, P<0.05). The levels of serum NO in the mild, moderate and severe groups were significantly higher than those in the control group (P<0.05), and serum NO levels on the third day was higher than that in the control group. NO concentration was correlated with the severity of TBI (r=0.847, P<0.05). Conclusion The changes of TNF-α, IL-6, IL-1β and NO in serum are closely related to the degree of TBI. High NO concentration means a serious brain tissue injury and poor prognosis.
2017, 40(3): 308-310.
doi: 10.3969/j.issn.1674-4500.2017.03.16
Abstract:
Objective To investigate the clinical and laboratory characteristics of severe pneumonia during pregnancy. Methods Eighteen cases of pneumonia with pregnant in our department from March 2013 to October 2016 were retrospectively analyzed. Nine cases recieved tracheal intubation and the other 9 cases were not.Clinical manifestations, biochemical and infection indicators during admission, hospital days, pregnant women and fetal outcomes were analyzed. Results There were no significant differences of pregnancy times between two groups.But the delivery times of two group were significantly different(1.7±1.1 vs 0.7±0.7, P=0.038); Difference of gestational weeks in two groups was not significant(P>0.05).The concentration of hemoglobin and serum albumin was low in patient with pneumonia, but there was no significant difference between two group(P>0.05); ICU stay in intubated group and non intubated group were significantly different(P<0.05).No pregnant women died in non intubatd group, 2 casesin intubated group died(2/9). Conclusion The more the failure of pregnancy, the higher the rate of intubation after pneumonia.Pneumonia may be more severe in the second trimester.Patients with low hemoglobin and albumin are predisposed to intubation.Patients of pregnancy complicated with pneumonia in intubation have a longer ICU stay and a high mortality.
2017, 40(3): 311-314.
doi: 10.3969/j.issn.1674-4500.2017.03.17
Abstract:
Objective To investigate the effect of modified Hyper-CVAD therapy on elderly patients with pH negative acute lymphoblastic leukemia (ALL) secondary hyperglycemia and explore the relation between prognosis and hyperglycemia. Methods Seventy-two elderly patients (≥55) with pH -negative ALL were enrolled in the study. The patients were randomly divided into 2 groups with 36 patients in each group. Patients in group A were performed with improved Hyper-CVAD therapy. Group B were performed with routine Hyper-CVAD therapy. The clinical features, secondary hyperglycemia and the survival status after chemotherapy were compared between the two groups before and after chemotherapy. The patients were followed up for 3 years. Results The random blood sugar of control group on the third weekend was higher than that of the observation group, and higher than that of the first weekend in control group (P<0.05). Fasting blood glucose and blood glucose were higher on the fourth weekend in the two groups than that in the first weekend (P<0.05). The random blood sugar in control group was significantly higher than that in observation group (P<0.05). There was no significant difference of fasting blood glucose between the two groups (P<0.05). The proportion of secondary hyperglycemia in control group was 22.22%, which is significantly higher than that of observation group(5.56%). There was no significant difference of recurrence rate and survival rate between the two groups. Fasting and random blood glucose on the fourth week of the two groups were correlated with infection, remission rate, relapse rate and overall survival rate.There were 11 and 14 cases recurred respectively in the two groups, with no significant difference (30.56% vs 38.89%, P=0.458). Nine cases and 12 patients died respectively in the two groups, with no significant difference(75.00% vs 67.67%, P=0.437). Conclusion The improved Hyper-CVAD therapy can effectively reduce the risk of secondary hyperglycemia induced by chemotherapy on elderly patients with Ph-negative acute lymphoblastic leukemia.
2017, 40(3): 315-318.
doi: 10.3969/j.issn.1674-4500.2017.03.18
Abstract:
Objective To explore the effect of dexmedetomidine in patients with invasive mechanical ventilation. Methods A total of 124 patients receiving invasive mechanical ventilation more than 72 hours in our hospital from July 2013 to June 2016 were enrolled. The patients were randomly divided into 2 groups for sedative treatment. The patients in both groups received continuous intravenous infusion of fentanyl with 0.7~1.5 mg·kg–1·h–1 for analgesia. Drug dose was adjusted according to RASS every 1 h to maintain the appropriate sedation depth.Satisfactory sedation target was Richmond agitation-sedation scale (RASS) score 0~−1 during the day, and −1~−3 at night.In dexmedetomidine group, the patients received dexmedetomidine(4 μg/mL) whose loading dose was intravenous pump infusion of 0.5~1.0 μg/kg in first 20 min, followed by continuous pump IV infusion of 0.2~0.7 ug·kg–1·h–1 to achieve a goal of satisfactory sedation.In midazolam group, the patients received midazolam (1mg/mL) 2~3 mg intravenously first, then 0.05 mg·kg–1·h–1 for maintenance to achieve a goal of satisfactory sedation.Heart rate before and after treatment, mean arterial pressure, the incidence of delirium, duration of mechanical ventilation and ICU stay were recorded. Results Both dexmedetomidine and midazolam gave rise to sedation with same score of analgesia in similar effect. Compared with midazolam, dexmedetomidine dereased duration of invasive mechanical ventilation (119.37±47.76 h vs 142.66±43.77 h, t=−2.829, P=0.005), ICU stay (145.08±57.92 h vs 172.00±53.69 h, t=−2.682, P=0.008) and incidence of delirium significantly (9.52% vs 32.79%, χ2=10.12, P=0.0015). Dexmedetomidine increased incidence of bradycardia (22.22%1 vs 4.92%, χ2=7.844, P=0.0051) and hypotension (22.22% vs. 8.20%, χ2=4.699, P=0.0302). Conclusion Sedative effects of dexmedetomidine in the ICU patients treated with invasive mechanical ventilation are satisfactory.It can decrease duration of invasive mechanical ventilation, extubation time, ICU stay and incidence of delirium. Vital signs should be monitored to prevent bradycardia, hypotension and other adverse events. It can improve the prognosis of severe patients .
2017, 40(3): 319-322.
doi: 10.3969/j.issn.1674-4500.2017.03.19
Abstract:
Objective To access the effect of advanced glycation end products（AGEs） on oocyte quality and granulosa cell function for patients with tubal factor infertility. Methods From February 2015 to June 2015, 19 IVF patients with tubal factor were enrolled. All patients were <35 years old.They were controlled ovarian hyperstimulation (COH) with long-acting long protocol and retrieved ≥8 oocytes. Their follicular fluid and granulosa cells were collected during ovum pick-up (OPU) and cryopreserved at –80 ℃. The patients were devided into 2 groups: Group A of 10 patients with high quality embryo rate >35% and group B of 9 patients with high quality embryo rate <35%. Follicular fluid AGEs and ROS levels on OPU day were detected by sandwiched ELISA, and the RAGE mRNA expression of granulosa cells were detected by Real-time PCR. Results There were no significant differences of general informations between two groups (P>0.05). There were significant differences in average numbers of high quality embryos (5.2±2.34 vs 1.50±1.08, P=0.001) and the high quality embryo rate (60.27±12.48 vs 21.48±14.02, P=0.000). Follicular fluid ROS levels in 2 groups were significantly different (0.82±0.28 vs 1.11±0.27 ng/mL, P=0.000). The follicular fluid AGES level in 2 groups were not significantly different (0.33±0.13 vs 0.35±0.13 μg/mL, P=0.462). Conclusion The oxidative status may be the reason of oocytes dysplasia in the young patients with tubal factor infertility. But AGES-RAGE probably was not the mechanism.
2017, 40(3): 323-326.
doi: 10.3969/j.issn.1674-4500.2017.03.20
Abstract:
Objective To explore the relationship between the blood uric acid levels and aortic compliance of H hypertensive patients (HHT). Methods A total of 102 patients with HHT were selected as observation group and 106 patients without HHT hypertension patients as control group. Medical history, blood lipid, renal function, liver function index differences were compared. The brachial artery blood pressure were detected. The aortic compliance were measured by echocardiography and left ventricular function. The correlation of the indicators was analyzed. Results Cases of high-frequency eating seafood (>1000 g/d), family history with hypertension ,uric acid and HCY levels in observation group were significantly higher than that of control group (P<0.05). Late left ventricular systolic and diastolic diameter and ejection fraction in observation group were significantly less than that of control group (P<0.05). The systolic blood pressure and the aortic stiffness index in observation group were significantly higher than that of control group(P<0.05).The diastolic blood pressure and the aorta tension and inflation index was significantly lower than that of control group (P<0.05).Correlation analysis showed that seafood intake , uric acid and aorta tension and swelling index were in a significant negative correlation. They were positively correlated with stiffness index. Conclusion Huric acid levels are higher in hypertension patients than non hypertensive patients with type H. The uric acid and seafood intake are associated with decreased aortic compliance.
2017, 40(3): 327-330.
doi: 10.3969/j.issn.1674-4500.2017.03.21
Abstract:
Objective To explore the relationship between thyroid stimulating hormone (TSH) level and the prognosis of patients with thyrotropin-secreting pituitary adenoma. Methods The clinical data of 53 patients with thyrotropin-secreting pituitary adenoma were retrospectively analyzed. Patients were performed with routine treatment after examination. One week before treatment, serum TSH level was detected.According to TSH level, the patients were divided into group I (n=20, TSH level <2.5 mU/L) and group II (n=33, TSH level ≥ 2.5 mU/L). The two groups were followed up for at least 5 years (or till death). The tumor-free survival and total survival were recorded. Results There were no significant differences of gender, age and tumor size between the two groups (P>0.05). Rate of lymph node metastasis was significantly higher in group II than group I (36.36% vs 10.00%, P<0.05). Among all TNM stages, the proportion of stage III~IVwas significantly higher in group II than group I (57.58% vs 25.00%, P<0.05). Before treatment, levels of triiodothyronine (T3) and thyroxine (T4) were significantly higher in group II than group I (P<0.05). Till February 2017, the 5-year disease-free survival rate and overall survival rate of group II were significantly lower than those of group I (48.48% and 63.64% vs 80.00% and 90.00%, P<0.05). Cox regression risk model showed that lymph node metastasis, TNM stage, levels of T3, T4 and TSH were independent factors influencing the 5-year survival rate of patients with thyrotropin-secreting pituitary adenoma (P<0.05). Conclusion High TSH levels are associated with poor prognosis of patients with thyrotropin-secreting pituitary adenoma. Clinical measures should be taken to control the TSH level of patients.
2017, 40(3): 331-334.
doi: 10.3969/j.issn.1674-4500.2017.03.22
Abstract:
Objective To investigate the effect of secreted Hsp90α (eHSP90α) on the development and progression of coronary heart disease (CHD). Methods A total of 101 patients with CHD and 31 cases as healthy control group were enrolled in this study from June 2013 to June 2016. The eHSP90 αlevels in peripheral blood of all cases were collected. The correlation of eHSP90α levels in peripheral blood with condition of patients with CHD was analyzed. Results The eHSP90α levels in peripheral blood of patients with CHD was significantly higher than that of healthy control group (P<0.01). In patients with CHD, eHSP90α levels in peripheral blood in unstable CHD group was significantly higher than that in stable CHD group (P<0.01). The eHSP90α levels in peripheral blood in CHD combined with heart failure was significantly higher than that in patients group without heart failure (P<0.05). The eHSP90α levels in peripheral blood of CHD patients with grade Ⅳ heart failure had no significant difference with grade III heart failure patients (P=0.158). Conclusion The eHSP90α levels in peripheral blood are closely related to the condition of CHD in Guangdong. It may be a serological marker of coronary heart disease by further study.
2017, 40(3): 335-337.
doi: 10.3969/j.issn.1674-4500.2017.03.23
Abstract:
Objective To investigate the clinical efficacy of benzbromarone combined with sodium bicarbonate in the treatment of hyperuricemia complicated with primary hypertension. Methods A total of 126 patients with hyperuricemia and primary hypertension were enrolled .The patients were divided into group A, B and C with 42 cases in each group according to random number table method. Patients in group A were treated with benzbromarone, group B were treated with sodium bicarbonate and group C were treated with benzbromarone and sodium bicarbonate. The changes of serum creatinine, serum uric acid (UA), 24 h urine UA, urea nitrogen, triglyceride, 24 h mean diastolic and systolic blood pressure were compared between the before and after treatment of patients in three groups. Results After a 5-week-treatment, serum UA, 24 h mean systolic and diastolic blood pressure of patients in 3 groups were lower than that before treatment (P<0.05).Urine UA was higher than that before treatment (P<0.05). Blood UA, 24 h mean systolic and diastolic blood pressure in patients of group C were lower than those of group A and group B (P<0.05) and urine UA was higher than that of group A and group B (P<0.05). Conclusion Benzbromarone combined with sodium bicarbonate can reduce blood UA, 24 h mean systolic and diastolic blood pressure and increased urine UA excretion in the treatment of patients undergoing hyperuricemia complicated with primary hypertension. The combination therapy have significant clinical effects.It is worthy of popularization in clinical application.
2017, 40(3): 338-340.
doi: 10.3969/j.issn.1674-4500.2017.03.24
Abstract:
Objective To analyze the effect of psychological intervention during operation on the results of uterine tubal radiography, and improve the diagnosis reliability. Methods A total of 100 cases of infertility patients who were performed uterine tubal radiography and manometry in our hospital from January to October 2014 were enrolled. The patients were randomly divided into control group and observation group, each of 50 cases. The control group were received routine hysterosalpingography nursing. The observation group were uderwent of psychological intervention on the basis of routine hysterosalpingography nursing. Tubal patency and pressure changes were compared before and after intervention. The pain of patients in 2 groups were examined. Results After the intervention, the tubal pressure in observation group (17.24±5.24 Kpa) was significantly lower than that in control group (25.36±4.24 Kpa, P<0.05). In the observation group, the patients with obstructed fallopian tubes (18%), and the patients with undeveloped fallopian tubes/poorly developed (6%) were less than that of the control group (36%, 22%, P<0.05). The pain score of the observation group (3.14±1.02) were significantly lower than that of control group (4.56±1.28, P<0.05). Conclusion Psychological intervention can reduce the patient’s tension, pain and interference factors. It helps to complete tubal radiography, improves the reliability of diagnosis and is worthy of promotion in clinical practice.
2017, 40(3): 341-343.
doi: 10.3969/j.issn.1674-4500.2017.03.25
Abstract:
Objective To explore correlation of cervical low-alcohol intraepithelial neoplasia (CIN I) with positive index Ki-67. Methods A total of 100 patients with cervical hypothelial neoplasm were diagnosed of cervical biopsy in our hospital. The immunohistochemical ki-67 was detected with no treatment. The histopathological biopsy and immunohistochemical detection ki-67 were examined in 6 months. The pathologic biopsy and immunohistochemical ki-67 results were compared. Results In the first cervical biopsy, 100 patients were diagnosed of CIN Ⅰ. The ki-67 positive index was detected. According to the positivity rate, 100 cases of CIN Ⅰ were divided into 3 Ki-67 ranges:88 cases were less than 3%, 10 cases in 3%~10% and 2 cases were more than 10% (P<0.05). Patients with a positive rate less than 3% in the second biopsy showed no progress of disease. Eight cases in 3%~10% were developed for CIN Ⅱ. 2 cases in group of more than 10% were developed for CIN Ⅲ. Conclusion Ki-67 positive index can decide the cervical low-alcohol intraepithelial neoplasia outcome of patients. The high positive index make it develop for CIN II or CIN III.
2017, 40(3): 344-349.
doi: 10.3969/j.issn.1674-4500.2017.03.26
Abstract:
The assessment of tumor invasive depth, metastasis and if surgical margin had residual cancer were in urgent need of an in situ, real-time diagnosis technology to determine surgical treatment of gastrointestinal tract malignant tumor and the extent of resection surgery. Multiphoton microscopy can provide gastrointestinal tissue structure and cell morphology of real-time information. Multiphoton imaging technology had no exogenous marker of tissue, was extremely sensitive to collagen, had light of the tissue damage and deep penetration depth. Such characters enable the technology to be applied in gastrointestinal tumor as a new optical biopsy. The review aimed to overview the feasibility of multiphoton imaging for evaluation of gastrointestinal tumor optical biopsy and had a discussion on the development prospect of multiphoton imaging technology considerable.
The assessment of tumor invasive depth, metastasis and if surgical margin had residual cancer were in urgent need of an in situ, real-time diagnosis technology to determine surgical treatment of gastrointestinal tract malignant tumor and the extent of resection surgery. Multiphoton microscopy can provide gastrointestinal tissue structure and cell morphology of real-time information. Multiphoton imaging technology had no exogenous marker of tissue, was extremely sensitive to collagen, had light of the tissue damage and deep penetration depth. Such characters enable the technology to be applied in gastrointestinal tumor as a new optical biopsy. The review aimed to overview the feasibility of multiphoton imaging for evaluation of gastrointestinal tumor optical biopsy and had a discussion on the development prospect of multiphoton imaging technology considerable.
2017, 40(3): 350-353.
doi: 10.3969/j.issn.1674-4500.2017.03.27
Abstract:
Pyruvate kinase is a critical rate limiting enzyme in glucose metabolism. It has mainly 4 isozyme forms: L type, R type, M1 type and M2 type. Pyruvate kinase M2 (PKM2) mainly expressed in tumor cells. The metabolism of glucose by tumor cells is mainly accomplished by aerobic glycolysis. During the process, PKM2 plays a key role in the rate limiting enzyme. It regulates the signal transduction in the process of tumor cell proliferation. Pyruvate kinase M2 provides energy and material basis for the proliferation of tumor cells. It can be used as a biomarker for early detection of tumor. The exploration of mechanism of PKM2 in tumor can provide a new way to tumor targeted treatment.
Pyruvate kinase is a critical rate limiting enzyme in glucose metabolism. It has mainly 4 isozyme forms: L type, R type, M1 type and M2 type. Pyruvate kinase M2 (PKM2) mainly expressed in tumor cells. The metabolism of glucose by tumor cells is mainly accomplished by aerobic glycolysis. During the process, PKM2 plays a key role in the rate limiting enzyme. It regulates the signal transduction in the process of tumor cell proliferation. Pyruvate kinase M2 provides energy and material basis for the proliferation of tumor cells. It can be used as a biomarker for early detection of tumor. The exploration of mechanism of PKM2 in tumor can provide a new way to tumor targeted treatment.
2017, 40(3): 354-358.
doi: 10.3969/j.issn.1674-4500.2017.03.28
Abstract:
Objective To normalize the pathological sampling and provide precise information for clinical doctors. Methods We normalized Seven-part sampling method as the standard method of pathological sampling.Seven samples from seven different directions of Glioblastoma (GBM) tumor (central, anterior, posterior, medial, lateral, superior, inferior) were obtained by neurosurgeon during surgery. Forty glioblastoma patients which had pathological samples through Seven-part Sampling Method were included. Primary tumor cells cultivation were conducted. The expressions of MGMT、IDH1 proteins were detected through IHC in these seven tumor samples. Results Tumor cells were cultivated in 100% from tumor tissue which in center of GBM tumor successfully.The primary tumor cells were spindle-shape with a strong ability of migration and high rate of proliferation. Primary tumor cells were cultivated in other sites of GBM tumor with a successful rate of 60%. The cells were obtuse-shape with a slower ability of migration and rate of proliferation. The two kinds of primary cells were different of cell morphology and biology. The expressions of IDH1 protein IHC in 10 cases were significantly different (P=0.001). The expressions of MGMT protein in 12 cases were significantly different (P=0.004). Conclusion Seven sites in GBM tumor have tumor cells. The expressions of IDH1 and MGMT proteins are different. The tumor tissue obtained from central site of GBM tumor can reflect the pathological grade of tumor more accurately.The other 6 sites in peritumoral area can reflect the molecular pathology information of these residual tumor cells which cannot be removed by surgery. Seven-part sampling method is very important for pathological diagnosis of glioblastoma.
2017, 40(3): 359-361.
doi: 10.3969/j.issn.1674-4500.2017.03.29
Abstract:
Objective To provide data support for disease prevention, discipline construction and hospital development. Methods The medical record information of hospitalized patients between 2002 and 2015 were extracted and analyzed by IBM SPSS 19 software. Results Top two diseases were factors influencing health services for examination and investigation and neoplasms,which were in an increasing tendency .Diseases of the digestive system and circulatory system ranked third and fourth. The first 10 diseases accounted for a declining trend.It decreased from 88% in 2002 to 83.8% in 2015. Conclusion Cancer disease mainly endanger people's health. Government sector needs to strengthen the monitoring and management of food safety, living environment. Individuals should strengthen exercise and make a reasonable diet. So as to improve the health consciousness.
2017, 40(3): 362-365.
doi: 10.3969/j.issn.1674-4500.2017.03.30
Abstract:
Objective To explore the effect of 6 sigma management model on nursing in patients with gastric cancer after gastratrophia with physiological index, nursing quality and cost management. Methods A total of 200 patients who underwent subtotal resection of gastric cancer in our hospital were selected.In which 100 patients were used as control group with routine management method and the other were treated as observation group with 6-sigma management model. Pain, anxiety and physiological indexes of the patients in different time periods were compared. Nursing quality, satisfaction, hospitalization time and hospitalization costs were observed. Results After performing 6-sigma, pain and anxiety scores of the observation group were lower than that of control group at the fifth day after operation and 1 d before discharge. In observation group, patients’ satisfaction (93%), nurses’ satisfaction (95%) was significantly higher than that in control group.Hospital stays (13.5±3.1) in observation group was shorter than that in control group. Total hospital expenses (24588.3±4282.2), daily hospital expenses (1832.2±323.6) were significantly lower in observation group than control group. Conclusion Six-sigma management is beneficial for relieving anxiety of patients with gastric cancer resection. It can reduce pain, improve nursing quality, cut down hospital stay and hospitalization expenses and enhance patients and nurses’ satisfaction.
2017, 40(3): 366-369.
doi: 10.3969/j.issn.1674-4500.2017.03.31
Abstract:
Objective To explore the application of psychological steering joint of zheng in rehabilitation exercise of AECOPD patients. Methods Sixty-five AECOPD patients were randomly divided into control group and observation group. CAT, mMRC score were assessed on admission. The mental health status were evaluated by SAS and SDS . The rehabilitation exercise and walking distance of 6 min were evaluated.The blood gas analysis and pulmonary function were evaluated.On the day of admission, patients in 2 groups were treated with daily Zheng rehabilitation guidance. The control group left the bed after guidance with no longer intervention. The observation group patients were urged to complete the whole rehabilitation process after guidance. The index were evaluated again after 7 d with statistical analysis of the results. Results Rehabilitation exercise and 6 minutes walking distance were greater in observation group than that of control group. Mental health improvement and the CAT assessment were slightly better in observation group than that of control group (P<0.05). Conclusion Daily Zheng rehabilitation exercise for AECOPD can promote the mental health status of patients.It can improve the exercise endurance, respiratory symptoms and patient compliance of rehabilitation.
2017, 40(3): 370-372.
doi: 10.3969/j.issn.1674-4500.2017.03.32
Abstract:
Objective To explore the intelligent management of personnel, articles and equipment in operation room through radio frequency identification technology. Methods A toltal of 200 patients in our hospital were selected, which 100 patients were used as observation group with radio frequency identification.The other 100 patients were treated as control group with routine manual management method, such as manual check of medical staff and patient’s identification, preoperative equipment and articles preparation. Preparation before surgery, goods in and out of warehouse and infection after surgery were observed.The equipment delivery rate, operation frequency and cost, the satisfaction of medical staff and patients, the working quality of operation room were compared. Results The preparation time before surgery, the error rate and the rate of infection after surgery in observation group were lower than those in control group (P<0.05). The effective utilization rate of the observation group was 99%.The average daily operation quantity was 5.38±1.23, the average cost was 5482.38±1231.23 yuan, and the results were better than that of the control group (P<0.05). Patients satisfaction of observation group was 96%, the doctor satisfaction was 94%, nursing satisfaction was 97%.Work quality assessment score of operation room were significantly higher than that of the control group(P<0.05). Conclusion Radio frequency identification technology can realize the comprehensive management of goods, equipment and personnel of the operation room. It improves work efficiency, reduces the incidence of medical accidents and cost.
2017, 40(3): 373-376.
doi: 10.3969/j.issn.1674-4500.2017.03.33
Abstract:
Objective To investigate the influence and effect analysis of multiple nursing intervention on hemorheology in children with mycoplasma pneumoniae infection. Methods 128 children with mycoplasma pneumoniae infection were treated in our hospital from January 2016 to December 2016. According to the random grouping method, 128 children were divided into the observation group (n=64) and the control group (n=64). The control group was treated with routine nursing, and the observation group was treated with multiple nursing intervention. The clinical efficacy, clinical parameters, blood rheology, adverse reaction rate and nursing satisfaction were compared between the two groups. Results The total effective rate (90.6%) of the observation group was significantly higher than that (75%) of the control group (P<0.05). The time of fever, the time of rales disappearance and the length of stay in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the whole blood low shear viscosity, plasma viscosity and aggregation index of the observation group were significantly lower than that of the control group (P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). The nursing satisfaction of the observation group (93.8%) was significantly higher than that of the control group(79.7%)(P<0.05). Conclusion The multiple nursing intervention can effectively improve the clinical treatment effect, improve the blood rheology index, reduce the adverse reaction, and improve the satisfaction of nursing.
2017, 40(3): 377-378.
doi: 10.3969/j.issn.1674-4500.2017.03.34
Abstract:
Objective To investigate the nursing measures of phlebitis caused by MRI contrast agent leakage. Methods Fifty cases of phlebitis caused by MRI contrast agent leakage were selected to receive a retrospective analysis.Twenty-five phlebitis patients with routine nursing were divided into the control group and other 25 phlebitis patients with effective nursing were divided into experimental group . Nursing satisfaction and efficacy of the two groups were compared. Results Nursing satisfaction rate of the experimental group was significantly higher than that of the control group (P<0.05).Total effective nursing rate of the experimental group was significantly higher than that of the control group (P<0.05). Conclusion The effective nursing measures can improve patient’s condition, treatment efficacy and nursing satisfaction.
Effect of innovative practice ability in training of comprehensive ability of medical undergraduates
2017, 40(3): 379-382.
doi: 10.3969/j.issn.1674-4500.2017.03.35
Abstract:
The medical talents with innovative practice ability are needed increasingly in society at present.Most educators have realized the significance of the ability to cultivate the comprehensive ability of medical students,but due to the long-term influence of the traditional examination oriented education concept, and teachers and students do not pay enough attention to practice, the result is not satisfactory. This paper briefly describes the role of innovative practice ability in the comprehensive ability training as well as the current problems in cultivating innovative practice ability, we put forward some methods of cultivating innovative practice ability, in order to improve the comprehensive ability of medical students, and lay the foundation for training high-quality medical talents.
The medical talents with innovative practice ability are needed increasingly in society at present.Most educators have realized the significance of the ability to cultivate the comprehensive ability of medical students,but due to the long-term influence of the traditional examination oriented education concept, and teachers and students do not pay enough attention to practice, the result is not satisfactory. This paper briefly describes the role of innovative practice ability in the comprehensive ability training as well as the current problems in cultivating innovative practice ability, we put forward some methods of cultivating innovative practice ability, in order to improve the comprehensive ability of medical students, and lay the foundation for training high-quality medical talents.
