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Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.
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Objective To investigate the relationship between Toxoplasma gondii (T.gondii) infection and metabolic syndrome (MS).Methods A total of 20 577 patients who received serum test of anti-T.gondii IgG antibody in the National Health and Nutrition Examination Survey ( NHANES) of the United States from 2009 to 2014 were collected to analyze the clinical features of anti-T.gondii IgG antibody positive patients , and to compare metabolic related indicators in the antibody IgG positive and negative groups .The independent sample t-test, chi-square test, and logistic regression analysis were used to explore the risk factors of MS . Results A total of 2 746 participants were positive for the T.gondii antibody (13.34%), with a higher prevalence of male (14.44%vs 12.27%, χ2 ＝15.99, P＜0.01).Meanwhile, the prevalence of T.gondii increased with age and body mass index (BMI) (χ2 ＝979.98 and 50.85,respectively, both P＜0.01).Among the 2 191 patients with MS, 449 (20.49%) patients were positive for T.gondii.While 2 297 (12.49%) patients were anti-T.gondii positive in 18 386 non-MS patients.The difference was statistically significant (χ2 ＝78.504, P＜0.01).Age (t＝-37.37), BMI (t＝-4.28), glycosylated hemoglobin (t＝-11.81), fasting blood glucose (t＝-9.38), triacylglycerol (t＝-6.32), cholesterol (t＝-7.16), serum uric acid (t＝-5.25) and serum creatinine (t＝-7.69) in the seropositive group were all higher than those in the seronegative group (all P＜0.01).After adjusting for age and gender , the prevalence of T.gondii was an independent risk factor for MS (odds ratio [OR]＝1.147,P＝0.023).Conclusions BMI, blood lipids, blood uric acid and blood glucose are significantly increased in patients with T.gondii infection.T.gondii infection is an independent risk factor for MS.
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Objective To explore the effect of monitoring gastric residual status during enteral nutrition in patients with craniocerebral injury. Methods Totally 114 cases were selected from January 2014 to January 2017 in our hospital for enteral nutrition in patients with craniocerebral injury, the patients were divided intocontrol group and observation group according to the random number table, every group had 57 cases,the control received routine nursing care in addition to residual gastric volume status of the patients during enteral nutrition, the observation group adopted nursing measures by monitoring residual gastric volume related to the timing of monitoring gastric residual patients,adjusting nutrient supply rate.The two groups of patients with nursing before and 14 d weight,hemoglobin,plasma albumin,blood glucose were counted and compared; statistics and compared two groups of patients with reflux or aspiration,diarrhea,abdominal distension and the incidence of nutritional compliance rate of two groups of patients in hospital; the incidence of aspiration pneumonia were statistically analyzed and compared. Results Nursing care of two groups before the index contrast, there was no significant difference (P>0.05), the patients in the observation group after nursing 14 d weight, plasma albumin, hemoglobin,blood glucose and other indicators were(57.8±6.7)kg,(38.3±5.9)g/L,(107.2±2.4)g/L,(8.2±2.5)mmol/L,were higher than the control group(55.5±1.3)kg,(37.1±1.3)g/L,(98.7±1.9)g/L,(7.4±3.9)mmol/L, the difference was significant (t=2.015-2.325, P<0.05); the observation group of patients with nutritional compliance rate of 91.23% (52/57) was higher than the control group 63.16% (36/57), the difference was statistically significant(χ2=4.872,P=0.032);the incidence of aspiration pneumonia in the observation group was 7.02% (4/57) which was significantly lower than 12.28% (7/57) in the control group, the difference was statistically significant (χ2=2.124, P=0.045); patients of observation group with reflux and aspiration the incidence of abdominal distension,diarrhea,were 17.54%(10/57),19.30%(11/57),15.79%(9/57),lower than 26.32% (15/57), 29.82% (17/57), 28.07% (16/57) of the control group, the differences were statistically significant (χ2=3.916-5.379, P<0.05). Conclusion It is helpful to improve the nutritional compliance rate and reduce the incidence of complications such as aspiration pneumonia in patients with craniocerebral injury.
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Objective To investigate the distribution and drug resistance to pathogenic bacterial pathogen in children with community acquired pneumonia (CAP),so as to provide recommendations for clinical rational use of anti-biotics. Methods A retrospective analysis was made on the distribution and drug resistance to bacteria in CAP chil-dren admitted to Department of Respiration,Shanghai Children′s Medical Center from January 2014 to December 2015. Results There were 463 patients with positive sputum culture,and a total of 496 strains of pathogens were found. There were 273 Galanz negative bacteria,195 Galanz positive bacteria and 28 other rare bacteria,accounted for 55. 04％,39. 31％ and 5. 65％ of the total bacteria,respectively. The main pathogens were Streptococcus pneumoniae, Staphylococcus aureus,Haemophilus influenzae,Klebsiella pneumoniae and Escherichia coli. The highest detection rate of bacteria in 1-12 months children with CAP was Staphylococcus aureus,Klebsiella pneumoniae and Escherichia coli;in > 12 months children with CAP,the highest detection rate of bacteria was Streptococcus pneumoniae,Haemophilus influenzae and Staphylococcus aureus. Both of Streptococcus pneumoniae and Staphylococcus aureus had a high resis-tance to Erythromycin,Clindamycin and Oxacillin. There were 11. 00％ Streptococcus pneumoniae and 94. 74％ taphy-lococcus aureus resistant to Penicillin,while they were not resistant to Vancomycin. Escherichia coli and Klebsiella pneumoniae both showed a high resistance to ampicillin,the second and third generation cephalosporins. Haemophilus influenzae were highly resistant to Compound sulfamethoxazole and Ampicillin. Galanz negative bacteria had the lowest resistance to Piperacillin/ Tazobactam and Amikacin. Conclusions The main pathogens of CAP in children were G -bacteria. There were some differences among the isolates at different ages of CAP. Their resistance to very common anti-biotics was very high in children.
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Objective To investigate the status quo of nurses' comfort about physical touch and to analyze the influencing factors.Methods Totally 398 nurses were selected during March to May 2017 from three tertiary hospitals in Tianjin with convenience sampling.General information questionnaire,Maslach Burnout Inventory General Survey (MBI-GS),and Nurses' Comfort with Touch Scale (NCTS) were used to collect data and analyze influencing factors.Results The score of nurses' comfort with touch was (44.18±6.27).The average score of nurses' comfort was (5.84±1.43) in task-oriented contact dimension,higher than scores of the other three dimensions.Multiple linear regression analysis indicated that age and emotional exhaustion were main influencing factors.Conclusion The nurses' comfort with touch was at a moderate level.Nurses aged between 25 and 46 years,with emotional exhaustion scored less than 27,had higher comfort with touch.
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Objective To study and analyze the prognostic value of psychological dredging nursing combined with edaravone and naloxone in the treatment of craniocerebral injury. Methods 100 patients with craniocerebral injury treated in our hospital from February 2012 to October 2016 were selected and randomly divided into the control group and the experimental group,50 patients in each group. The control group was treated with edaravone combined with naloxone,experimental group were treated with edaravone combined with naloxone in treatment, and psychological counseling,pay attention to the psychological status of patients,strengthen communication and exchanges,increase confidence and compliance of patients. Compared and analyzed the blood coagulation indexes of the two groups. Results After corresponding treatment, the prothrombin time of the experimental group was (16.8±2.5)s, and the prothrombin time of the control group was (20.7±2.3)s. There was significantly statistical difference (P<0.05).In addition, the platelet count,activated partial thromboplastin time and thrombin time index in the experimental group were significantly better than those in the control group(P<0.05).Conclusion Edaravone combined with naloxone and psychological counseling in the treatment of craniocerebral injury can improve the abnormal coagulation function of patients significantly, and recover consciousness, and has clinical significance.
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Objective To examine the status quo and relationships between medication adherence and beliefs regarding endocrine therapy in breast cancer patients.Methods A total of 273 patients were recruited from one tertiary hospital in Shenyang by convenience sampling method.They were investigated by using the Morisky medication adherence scale and brief medication questionnaire (BMQ) for medication adherence and behefs about medicines.Results The mean 8-item medication adherence scale score was 6.39 ± 1.68,with 65％ medication compliance,which was lower than the domestic and foreign literature levels.The mean BMQ score was-0.02 ± 4.394 points,given that the conviction was low.Medication beliefs in medication compliance impact strength was statistically significant (r =0.457,P ＜ 0.05),with positive correlation.Conclusion The current status of medication adherence and beliefs regarding endocrine therapy in breast cancer patients was not satisfactory.Based on the urgent need to improve the compliance of endocrine therapy in patients with breast cancer in China,breast specialist nurses need to focus on the establishment of a nursing follow-up program for endocrine therapy to improve patient compliance.
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Objective To investigate the effect of extremely high temperature and high humidity exposure on the survival and blood biochemical indexes of SD rats and the to the major organs .Methods Twenty-six SD rats were divided into the normal tem-perature and humidity group and the extremely high-temperature and high-humidity group .The mortality of SD rats in extremely high-temperature and high humidity environment was observed ,and at the median lethal time ,the living rats were undergoing the tests of serum biochemical indicators and the pathological examination of the heart ,lung ,kidney ,brain ,muscles and intestinal tis-sues .Results The exposure to the extremely high-temperature and high-humidity environment could lead to the death of SD rats , the median lethal time was 48 h .The serum creatinine(Scr) increased significantly(P<0 .05) ,and the serum alkaline phosphatase (ALP) and ischemia modified albumin (IMA) decreased significantly (P<0 .05) when compared with the normal temperature and humidity group ,and there was no significant difference in other biochemical indicators .The inflammatory cell infiltration was ob-served in heart ,lung ,kidney and intestines ,and there were no obvious pathological changes in brain and muscle .Conclusion The exposure to the extremely high-temperature and high-humidity environment has obvious lesion on SD rats ,it can lead to the abnor-mality of some biochemical indicators ,the inflammatory changes in heart ,lung ,kidney and intestines ,and even death .
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Objective To explore the relationship between anxiety ,resilience and hope levels among gastric cancer patients ,so as to provide evi?dence for psychological intervention. Methods Cluster sampling design was used to select 324 gastric cancer patients. The anxiety self?assess?ment scale,resilience scale and hope scale are used to measure the related indicators. Results The comparative analysis showed that patients with different genders,education levels and marital status had different scores in anxiety level and resilience level(P<0.05),and those with differ?ent genders and marital status got different hope levels(P<0.05). Correlation analysis showed that anxiety was negatively correlated with resil?ience and hope levels(P<0.05),the coefficient of correlations ranged from-0.556 to-0.124. Multiple linear regression analysis showed that edu?cation level,marital status,income level,resilience,hope levels explained portion of the variance of anxiety. Conclusion Clinical nursing staff should reduce the gastric cancer patients′anxiety by improving their resilience and hope levels.
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Objective To analyze the reasons of cesarean section in primiparae without operation indications ,in order to provide foundation for reducing the rate of cesarean section .Methods 640 cases of primipara were randomly divided into cesarean section with no operation indications(observation group) and spontaneous labor group(control group) ,320 cases in each each .The general data was investigated and analyzed ,the scale of cesarean section causes ,scale of cesarean section and pregnancy knowledge were compared between the two groups .Results The average age of the observation group was significant higher than that of the control group ,the percentage of monthly income of over 2 000 yuan and the proportion of level of education for college or above was signifi-cant higher than that of the observation group(P<0 .05) .In terms of pain tolerance ,no confidence in the natural delivery ,timing production ,family members will ,elderly parturient women ,the observation group were significant higher than the control group (P<0 .05) .The pregnancy knowledge level of observation group was significant lower than the control group (P<0 .05) .Multi-fac-tor analysis showed that ,high education level ,no tolerence of pain ,no confidence in the natural delivery ,timing production ,elderly parturient women ,and low degree of knowledge during pregnancy were major cause of of cesarean section rate .Conclusion The ap-propriate analgesia and encourage should be adopted for pregnant women who can′t stand the pain ,without confidence in the natural delivery .Education should be strengthen for pregnant women who timing production ,elderly parturient women ,low degree of knowledge .
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Objective To study the clinical application value of the low forceps in vaginal delivery. Methods To retrospectively analyze the clinical data of 280 cases of the low forceps in vaginal delivery,and randomly selected 140 cases pregnant women who cesarean section, as the control group. To compare the influence of maternal and neonatal morbidity in the two groups. Results There were no statistically significant differences between the two groups for the incidence of the postdelivery hemorrage,birth trauma infectious, asphyxia neonatorum associated with delivery from low forceps when compared with cesarean section. The incidenc of the postdelivery sick rate was significantly lower in the low forceps group( 3.2% ) than that in the control group ( 10.0% ) ( x2 = 8.30, P ＜ 0.05 ). Conclusion Low forceps may be a valuable instrument and safety or efficacy in vaginal delivery and that it should be more widely used in appropriate clinical situations.
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Objective To explore the influence of type A character on early renal impairment in elderly patients with essential hypertension and the protective effect of benazepril. Methods According to the type A behavior measuring scale, 80 cases with type A character and 80 cases without type A character were screened out from the elderly patients with essential hypertension. The patients received benazepril intervention with incipient dose of 10 mg daily, which increased gradually to the largest does of 20 mg daily within 1 month, The treatment lasted 6 months in order to make the patients achieve the normal blood pressure (BP). The general data, plasma angiotensin Ⅱ (AngⅡ )> urinary albumin excretion rate (UAER) and urinary β2-microglobulin (β2-MG) were measured at pretherapy and post-treatment respectively. Results There were no statistically significant differences at pretherapy between the two groups in age, gender, body mass index (BMI), blood urea nitrogen (BUN), creatinine (Cr), systolic pressure and diastolic pressure (all P>0.05). Ang Ⅱ [(60.3±11.6)mg/Lvs (55.8±10.2)mg/L], UAER[(83.3±23.3)μg/min vs. (75.7±16.3)μg/min] and β2-MG [(75.6±24.5)mmol/L vs. (66.0±19.4)mmol/L] were significantly higher in type A character group than in non-type A character group (t=2.598, 2.603, 2.742; P= 0.016,0.012, 0.008). TypeA character value of the two groups showed a positive correlation with Ang Ⅱ (r= 0.361, P=0.002), UAER (r=0.198, P=0.015) and β2-MG (r=0.202, P = 0.021). Only Ang Ⅱ (β=0.291, t=2.793, P= 0.008) was correlated to type A character value independently by multiple stepwise regression analysis. Before treatment in both of the type A character group and the non-type-A character group, there was a positive correlation between Ang II and UAER, (β2-MG, and obvious correlation in type-A character group. The systolic pressure, diastolic pressure, Ang Ⅱ , UREA and β2-MG were all decreased obviously in two groups post treatment. And the variable value of AngⅡ was also positively correlated with UAER (r=0.373, P=0.005; r=0.282, P=0.032), fr-MG (r= 0.385, P=0.003; r= 0.279, P=0.039) before and after treatment. Conclusions Type A character can aggravate injury of early renal function by certain stress systems in the elderly patients with essential hypertension and benazepril has better protective effect for it.
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Objective:To determine the risk factor for early stage atherosclerosis in elderly patients with impaired glucose tolerance(IGT).Methods:One hundred patients were divided into 2 groups,experimental group(IGT,n=50)and control group(NGT,n=50).Patients in both groups underwent high-frequency Doppler echocardiography to evaluate intima-media thickness(IMT)of carotid artery and flow-mediated diastolic function(FMD)of brachial artery,which was indicated by diastolic inner diameter changing rate(D %).The values were measured in both groups of including body height,body weight,waist line,hip line,blood pressure,fasting plasma glucose(FPG),two hours plasma glucose(2hPG),fasting insulin(FINS),triglyceride(TG),total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cbolesterel(HDL-C),high sensitive C-reactive protein(hs-CRP),nitrogen monoxidum(NO),body mass index(BMl),waist-to-hip ratios(WHR),and insulin resistance index with homeostasis model(HOMA-IR).The association between all of the parameters and IMT,and the risk factors for the carotid artery were analysed in IGT group.Results:The values of BMI,WHR,2hPG,TG,LDL-C,hs-CRP,FINS and IMT of carotid artery were significantly increased in IGT group compared with those of the NGT group.Conversely,NO,HOMA-IR and D% were significantly decreased in IGT group than those of NGT group(P ＜ 0.05 or P ＜ 0.01).There was positive correlation between carotid-IMT and the age,BMI,WHR,2hPG,TC,LDL-C,hs-CRP and HOMA-IR in IGT group(P ＜0.05 or P ＜ 0.01).Inversely,there was negative correlation between carotid-IMT with D% in IGT group(P ＜ 0.01).The risk factors for carotid-IMT were age,WHR,HOMA-IR and D%.Conclusion:Elderly patients with IGT have already had risk factors for early stage atherosclerosis,including age,concentric obesity,insulin resistance,and impaired endothelial function.
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Objective To investigate the mechanism of the effects of heavy alcohol consumption in a short term and the protection of angiotensin Ⅱ receptor blocker (valsartan) on cardiac function in rats. Methods The 42 male Wistar rats aged 20 weeks were randomly divided into 4 groups:control group (group C, n= 10), alcohol group (group A, n=10), low-dose valsartan group (LD group, n= 11) and high-dose valsartan group (HD group, n= 11). They were supplied with same animal feeds, but all of them were administered different dose of alcohol and medicine via intragastric tube: group C was administered water, group A was administered alcohol (6. 4 g/kg), LD group was administered alcohol (6.4 g/kg) and valsartan (15 mg/kg), HD group was administered alcohol (6.4 g/kg) and valsartan (30 mg/kg). And 9 weeks later, the change of cardiac function was observed by echocardiography, the body and heart weight were measured, the hydroxyproline content of rat myocardium was determined by sample alkaline solution. Results After 9 weeks, there were no significant differences among four groups in left ventricular ejection fraction (LVEF), stroke volume (SV) and fraction shortening (FS). But the E peak, Ea/Aa, Ea peak and Aa peak were obviously lower in group A than in groups of C, LD and HD (all P＜0.05), and there were significant differences among C group, LD group and HD group in E peak, Ea/Aa (all P＜0. 05). The HW/BW and hydroxproline (Hyp) contents of myocardium were higher in group A than in groups of C, LD and HD (all P＜0. 01), but there were no statistical significances among group C, LD group and HD group (all P＞0. 05). Conclusions The short term heavy alcohol consumption results in impaired ultrastructure and diastolic function of myocardium in rats, the angiotensin Ⅱ receptor blocker (valsartan) may protect it.
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Objective: To investigate the effect of type-A character on endothelial function in the elderly. Methods:According to type-A character scale of Zhang Baiyuan, type-A character group and non-type-A character group were screened from the normal elderly, 60 eases for each respectively. Flow-mediated diastolic function of brachial artery was examined by high-frequency eehocardiography, which was reflected by diastolic inner diameter changing rate (D %). Other parameters included height, weight, body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FPG), triglyceride (TG), total cholesterol(TC), low-density lipoprotein-cholesterol (LDL-C), nitric oxide (NO), endothelin (ET)and angiotensin Ⅱ (AngⅡ). All of the parameters and the scores of type-A character were compared and analyzed between the two groups. ResultS:(1) The levels of SBP and DBP were significantly higher in type A character group than those of non-type A character group (P＜0.05). There were no significant differences in values of FPG, TC, TG and LDL-C between two groups (P＞0.05). (2) The values of D% and NO were significantly lower in type A character group than those of non-type-A character group (P＜0.05 ). The values of Ang Ⅱand ET were significantly higher in type-A character group than those of non-type-A group (P＜0.05 ). (3)Pearson correlation analysis indicated that the scores of type-A character were positively correlated with Ang Ⅱ, ET, SBP and DBP (P＜0.05, P＜0.01), but negatively correlated with D% and NO (P＜0.05). Multiple linear stepwise regression analysis showed that only Ang Ⅱwas an independent risk factor for type-A character. Conclusion:h was showed that the increased Ang Ⅱinduced by abnormal activation of reunin-angiotensin-aldosteerone system (RAAS)may be the main mechanism of endothelial dysfunction in the eldedy with type-A character.
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ObjectiveTo investigate the effects of type-A behavior pattern on intervention of benasepril in patients with essential hypertension.MethodsAccording to the type-A behavior score patients with essential hypertension were divided into two groups:type-A group(n=80)and non-type-A group(n=80).Benazepfil was given to all patients for 3 months with gradual increase of dosage till the blood pressure (Bp)was controlled under 140/90 nlln Hg(1 mm Hg=0.133 kPa).The plasma levels of angiotensin II (Ang Ⅱ)was measured by radioimmunoassay and left yentrieular mass index(LVMI)was examined by ultrasonic echoeardiography(UCG)before and after treatmenL ResultsBefore benazepril treatment.plasma AngⅡ levels and LVMI in type-A group were higher than those in non-type-A group(P＜0.05),but there was no difference in Bp between two groups.Type-A behavior value were positively correlated with Ang Ⅱ and LVMI in two groups,but only Ang Ⅱ level was independent risk factor.Ang II levels were positively correlated with LVMI in two groups and that was more significantly in type-A group(P＜0.05-0.01).After treatment,Bp,plasma Ang Ⅱ and LVMI were all decreased significantly in two groups(P＜0.05-0.01)and Ang Ⅱ and LVMI were decreased more markedly in type-A group(P＜0.05).The variations of Ang Ⅱ and LVMI before and after treatment were positively correlated in two groups.but more markedly in type.A group (P＜0.05-0.01).CondusionCharacters may affect left ventricular hypertrophy in patients with essential hypertension through some stress factors and benazepril has better intervening effect on it.
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Objective:To understand the nasopharyngeal submucous carcinoma with the first show of cervicallymph node swell. Method:To collect the clinical data of 4 patients with such disease. Result:The 4 cases ofnasopharyngeal submucous carcinoma were not diagnosed until 3～6 months after cervical lymphnode metastasis.All patients received radiotherapy,three died within 1 year and another survived. Conclusion: If some patientshave cervical lymph node swell,pay attention to the meastasis of nasopharyngeal submucous carcinoma firstly.Even the examinations such as cytologic test,VCA-IgA,CT,MRI were negative,or even tuberculomas had beendiagnosed,nasopharyngeal submucous carcinoma still can not be excluded.