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Objective:To evaluate the life quality of patients with Kashin-Beck disease (KBD), and to analyze its influencing factors.Methods:From September 2017 to May 2019, adult KBD patients aged 18 years old and over were selected as the study subjects in the historical serious disease areas (Yongshou County and Linyou County) of KBD in Shaanxi Province. KBD patients were investigated by using the basic information questionnaire and the Chinese version of the European Five-dimensional Five-level Health Scale (EQ-5D-5L), the distribution of health status in the five dimensions of mobility, self-care ability, daily activity, pain/discomfort, and anxiety/depression were described, and each dimension included five levels of no problem, mild problem, moderate problem, severe problem, and extreme problem. EQ index (- 0.391 - 1.000) was used to evaluate the quality of life of patients based on group perspective, the higher EQ index was, the better life quality of the group would be; visual analogue system (VAS) score (0 - 100 points) was used to evaluate the life quality of patients based on individual perspective, the higher VAS score was, the better life quality of the individual would be. At the same time, multiple linear regression analysis was used to analyze the life quality of KBD patients.Results:A total of 245 KBD patients were included, aged (60.37 ± 7.10) years old. The mild problems of self-care ability and anxiety/depression of KBD patients, accounted for the largest proportion, which were 31.8% (78/245) and 27.3% (67/245), respectively; in terms of daily activity, the moderate problem accounted for the largest proportion, which was 32.7% (80/245); in terms of mobility and pain/discomfort, the severe problem accounted for the largest proportion, which were 46.9% (115/245) and 45.7% (112/245), respectively. EQ index [median (quartile range)] was 0.311 (0.059, 0.563), and VAS score was 42.5 (30.0, 60.0) points. After multiple linear regression analysis, the effects of education level, pain level, body deformity inferiority complex, and social participation barrier on EQ index were statistically significant ( P < 0.01); the effects of economic level, pain level, body deformity inferiority complex, and social participation barrier on VAS score were statistically significant ( P < 0.05). Conclusion:The life quality of KBD patients is poor, it is affected by physical, psychological and social aspects, so relevant medical workers should pay attention to the overall health of KBD patients.
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Objective:To investigate the current situation of economic income and quality of life of patients with Kashin-Beck disease (KBD) , and to analyze the impact of different economic levels on quality of life of patients with KBD, and to provide evidence for selection of target and key populations setting of poverty alleviation in KBD area.Methods:The anrual family income and quality of life of adults with KBD in Yongshou County and Linyou County, Shaanxi Province were investigated from May 2017 to May 2019. Patient's quality of life were evaluated using Chinese version of European five-dimensional five-level health scale (EQ-5D-5L) and its utility value conversion system was used to calculate the EQ-index. The ratio of income difference to quality of life difference in different income KBD patients was calculated.Results:A total of 290 patients with KBD participated in the survey. The average annual income of families with KBD was 11 462.41 Yuan of which the average annual income of low (< 5 000 Yuan), medium (5 000 ~ 10 000 Yuan) and high-income (> 10 000 Yuan) groups was 2 663.48, 9 262.75 and 28 397.26 Yuan, respectively. The ratios of income difference to quality of life difference between low-income and medium-income groups (109.99 × 10 4, 94.28 × 10 4, 94.28 × 10 4) were bigger than the ratios of income difference to quality of life difference (55.94 × 10 4, 91.91 × 10 4,-3.20 × 10 3) between low-income and high-income groups in terms of mobility, usual activity, and EQ-index. The ratios of income difference to quality of life difference were negative in terms of self care, anxiety/depression and VAS score (- 131.99 × 10 4,-65.99 × 10 4,-65.99 × 10 3). Conclusions:Patients with KBD have low income level and large income gap. The KBD patients whose annual income less than 10 000 Yuan could be the key population of poverty alleviation, and family income level of more than 10 000 Yuan could be the target of poverty alleviation.
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Objective@#To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways.@*Methods@#PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research(CERQual)was used to grade the confidence of each study.@*Results@#A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources(15 articles, 34.9%), increasing workload(14 articles, 32.6%), unrecognizing pathways(12 articles, 27.9%). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1%), supporting from managers and colleagues(21 articles, 48.8%)and establishing a clinical pathway facilitation committee(17 articles, 39.5%).@*Conclusions@#The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.
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Objective To evaluate the reliability and validity of the Chinese version of European Five-dimensional Five-level Health Scale (EQ-5D-5L) for patients with Kaschin-Beck disease.Methods From May 2017 to September 2018,a total of 245 patients with Kaschin-Beck disease in Yongshou and Linyou counties,Shaanxi Province were interviewed face-to-face with the EQ-5D-5L.The health-related value score was used to calculate the overall health-related quality of life of patients with Kaschin-Beck disease.The higher the score,the better the overall health of the population,and vice versa (-0.391-1.000).The visual analogue system (VAS)score was used to calculate the individual health status,higher scores indicated that the health status of self-evaluation were better,and vice versa (0 to 100 points).Sixty-three patients were retested two weeks later.Evaluation was performed using internal consistency,test-retest reliability,structural validity and criterion validity.Results A total of 245 patients with Kaschin-Beck disease were investigated,including 127 males (51.8％) and 118 females (48.2％),aged (60.37 ± 7.10) years old.The medians and quartile ranges of EQ index and VAS of patients were 0.311 (0.504) and 42.5 (30.0) points,respectively.And the Cronbach coefficient of the five-dimensional score of the health description system was 0.828.The intra-class correlation coefficient (ICC) of each dimension of the health description system was 0.571-0.719.EQ index and VAS score showed that the two had a relatively stable correlation (rs =0.522,P ＜ 0.05),and the ICCs of EQ index and VAS score were 0.754 and 0.570,respectively;the EQ-5D-5L validity calculated by "Therapeutic Efficacy on Kaschin-Beck Disease" (WS/T 79-2011) was between 0.375-0.647 (P ＜ 0.05).Conclusions The overall health status of the Kaschin-Beck disease patient population and the health status of the individual self-evaluation measured by EQ-5D-5L are poor.The reliability test and validity test prove that the EQ-5D-5L is applied to the health status of patients with Kaschin-Beck disease.The EQ-5D-5L has good reliability and validity.
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Objective To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways.Methods PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research ( CERQual) was used to grade the confidence of each study. Results A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources (15 articles, 34.9% ), increasing workload (14 articles, 32.6% ), unrecognizing pathways(12 articles, 27.9% ). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1% ), supporting from managers and colleagues ( 21 articles, 48.8% ) and establishing a clinical pathway facilitation committee(17 articles, 39.5% ).Conclusions The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.
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Objective To systematically evaluate the effect of different administration methods of hydrocortisone on blood glucose in patients with septic shock. Methods The Cochrane Library, PubMed, Web of Science, Embase, CNKI, CBM, Wanfang, and VIP databases were searched from foundation to December 31st, 2017 for the randomized controlled trials (RCTs) about hydrocortisone on blood glucose of different drug-deliver ways in patients with septic shock. In addition, the citation retrievals were performed by the literature references. Then the quality evaluation and data extraction was conducted by two researchers independently according to the Cochrane systematic review methods. RevMan 5.3 software was utilized to perform meta-analysis on the influences of the two different administration methods of the continuously pumping hydrocortisone group (experimental group) vs. the intermittently dripping hydrocortisone group (control group) on the mean blood glucose (MBG), largest amplitude of glycemic excursion (LAGE), glucose variability (GV), hyperglycemia time window in patients with septic shock. Results 1 203 relevant articles were preliminarily searched. Then the duplications were removed, reviews, and non-RCTs and articles evidently not accordant with the inclusion criteria were excluded by titles and abstracts. Eventually a total of 5 well-designed RCTs (404 cases) were incorporated, including 201 cases in the experimental group and 203 cases in the control group. The results of meta-analysis showed that compared with the control group, MBG was significantly decreased in the experimental group [mean difference (MD) = -0.99, 95% confidence interval (95%CI) = -1.53 to -0.45, P < 0.05], LAGE was decreased (MD = -5.66, 95%CI =-6.92 to -4.41, P < 0.05), GV was reduced (MD = -0.67, 95%CI = -0.82 to -0.53, P < 0.05), and hyperglycemia time window was shortened (MD = -7.68, 95%CI = -9.03 to -6.33, P < 0.05). The funnel chart revealed that there was publication bias in the MBG, hyperglycemia time window of the articles, and the publication bias was lower in the LAGE and GV. Conclusion Compared with intermittent administration method, the continuous pumping hydrocortisone method can stabilize the blood glucose of septic shock patients, shorten the duration of hyperglycemia and reduce the peak value of blood glucose.
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Objective:To investigate the expression of hypoxia-inducible factor-2α (HIF-2α)in non-small cell lung cancer (NSCLC)tissue,and to analyze its relationships with angiogenesis,cell proliferation and chemotherapy resistance. Methods: Total 112 cases of NSCLC and 20 cases of normal lung tissues were selected, immunohistochemical method was used to detect the expressions of HIF-2α,CD31,Ki67 and GST-π in 112 cases of cancer tissue and 20 cases of normal lung tissue,and the correlations of HIF-2α expression with microvessel density (MVD),Ki67, and GST-π were analyzed.Results:The positive expression rate of HIF-2α in NSCLC tissue was significantly higher than that in normal lung tissue (P < 0.05 ), the expression rate of HIF-2α in 112 cases of NSCLC was 47.3% (53/112).The MVD in HIF-2α protein high expression NSCLC group (31.1 ± 14.7)was higher than that in HIF-2αprotein low expression NSCLC group (24.3±15.8)(P <0.05).The cases of high expression of Ki67 in HIF-2αhigh expression group occupied 54.7% (29/53),and it was higher than that in HIF-2αlow expression group (16/59,27.1%);there was significant difference (r = 0.281,P = 0.003).The high expression of HIF-2α had no obvious correlation with the expression of GST-π (r = 0.122,P = 0.202). Conclusion:HIF-2αmay play an important role in the carcinogenesis and development of NSCLC by promoting the angiogenesis and enhancing the cell proliferation of NSCLC,but it may have no correlation with chemotherapy resistance.
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The aim of the present research was to investigate and analyze the hunting intentions of medical students for rural grassroots in Gansu and to provide a reference for decision-making on rural health human resource . A questionnaire is the research tool which was used to investigate the views of the senior students from six medical schools , and we studied their employment willingness to rural healthcare institutions .Chi-square test and non-condi-tional logistic regression analyses were used for data analysis .A sample of 600 medical graduates was involved in this investigation.The results of this study show that more than a half (55.6%) of the students would like to work in ru-ral, but only 13.8%of which were “very willing” to work at the rural healthcare institutions .According to the out-comes of this investigation , the number of junior college students who would like to work at the grassroots was 2.3 times the number of the undergraduate students .Medical students whose monthly salary expectations were not high ,with the household registration in rural areas , and having a better understanding of the policy of rural grass-roots em-ployment were more likely to work at the rural healthcare institutions .Based on the findings of this investigation , it can be concluded that the grassroots medical career intention of medical students is not only influenced by its own fac -tors, such as education and household registration , but also the policy of the government , school employment guid-ance and social atmosphere play an important role .The above-mentioned factors should be considered by decision-making and management departments of public healthcare .The departments should introduce a reasonable recruit-ment policy and strengthen the construction of grass-roots medical technology , equipment , and infrastructure , im-prove the grass-roots of employment environment and career development opportunities and strengthen the medical students'employment guidance work to make medical students more willing to work at rural healthcare institutions .
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Objective To evaluate the clinical effect of therapy of the trisacryl gelatin microspheres combinee the gelatin sponge particle on embolize the bronchial artery in acute massive hemoptic patients. Methods One huneree cases with massive hemoptysis were selectee as our subjects ane eivieee into control ane research group(n = 50 for each group). Patients in control group were given only gelatin sponge particle,ane in research group were given the trisacryl gelatin microspheres combinee the gelatin sponge particle to embolize the bronchial artery. All cases were followee up for more than 12 months. Ane the effect of therapy was recoreee. Results In research group,42 cases(84. 0% ,42 / 50)were got the bleeeing stop immeeiately after embolization,7 cases in 72 h(14. 0% ,7 / 50),ane the effective rate of hemostasis was 98. 0%(49 / 50). In the control group,41 case(82. 0% ,41 / 50)were got the stop bleeeing immeeiately,8 cases in 72 h(16. 0% , 8 / 50),ane the effective rate of hemostasis was 98. 0%(49 / 50). There was no statistic eifference between two groups(P > 0. 05). After more than one year follow-up,3 cases(6. 12% )were reoccurree in the therapy group ane 15 cases(30. 61% )was in the control group. The eifference was significant between two groups after surgery for one year( χ2 = 9. 801,P < 0. 01 ). There was no serious complication in patients of two groups. Conclusion The operation of BAE is effective therapy for the massive hemoptoe,ane it is provee to be a safe,effective ane lower rate of recurrence approach of the trisacryl gelatin microspheres combinee the gelatin sponge particle for eouble embolzation the bronchial artery.
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Objective To explore the effect of atorvastatin application on serum ferritin(SF)levels in elderly male patients with acute coronary syndrome(ACS)and its clinical significance. Methods 120 elderly male patients treated in Department of Cardiology in Cangzhou People's Hospital were randomly divided into treatment group and control group(60 cases in each group). All the patients in the two groups took the standard treatment of coronary heart disease,and the patients in treatment group were additionally given atorvastatin 20 mg orally,once-daily for 1 month. After 1 month of treatment,the changes in SF and lipid levels before and after treatment were determined. Results The total cholesterol(TC),low density lipoprotein(LDL)and SF levels of the two groups after treatment were significantly decreased compared with those before treatment. After treatment,triacylglycerol (TG)was decreased,and high-density lipoprotein(HDL)was increased significantly in treatment group,while in the control group,after treatment TG was increased and HDL was decreased. Compared between treatment and control groups after treatment,the differences in SF,TC,TG,HDL and LDL levels were statistically significant〔SF(μg/L):174.33±99.87 vs. 255.66±100.34,TC(mmol/L):4.23±0.60 vs. 5.15±0.56,TG(mmol/L):1.98±0.64 vs. 2.00±1.03,HDL(mmol/L):1.13±0.14 vs. 1.09±0.22,LDL(mmol/L):2.45±0.33 vs. 3.35±0.50,P<0.05 or P<0.01〕. Conclusion In elderly male hospitalized patients with ACS,the level of SF is significantly higher than normal,after atorvastatin specification treatment,the blood fat and SF levels are significantly lower,thus the SF inducing myocardial damage may be reduced and the risk of recurrence of acute coronary events can be decreased.
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Purpose To explore the role of expression of MMP-9 and MMP-13 in non-small cell lung cancer ( NSCLC) , and to investi-gate their association with the clinicopathologic feactures and prognosis of NSCLC. Methods The expression of MMP-9 and MMP-13 was detected in 88 NSCLC tissues and 18 adjacent normal tissues by immunohistochemistry SP method. Results The expression of MMP-9 and MMP-13 was higher in NSCLC than that in adjacent normal tissues (P<0. 05), which was positively correlated with dif-ferentiation and lymph node metastasis (P<0. 05). The expression of MMP-9 was positively correlated with age (P<0. 05), which was positively correlated with the expression of MMP-13 in NSCLC ( P <0. 05 ) . The survival rates in positive expression group of MMP-9 and MMP-13 were significantly lower than that of the negative expression group by log-rank method comparing survival curves (P<0. 05). Cox model analysis showed that the tumor size, lymph node metastasis and MMP-13 positive expression were closely relat-ed with the prognosis of NSCLC (P<0. 05). Conclusion MMP-9 and MMP-13 both are associated with the metastasis, invasion and prognosis of NSCLC, and MMP-13 may mainly activate MMP-9 to participate the invasion and metastasis of NSCLC.
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The purpose of this study was to clarify the strains of E .granulosus from sheep of Xiwuqi and people of Xil-inhot in Inner Mongolia region and its genotypes .CO1 and ND1 of mitochondria gene were cloned and sequenced ,and then they were analyzed by MegAlign of DNAStar5 .0 .Results showed that the length of CO1 and ND1 gene of E .granulosus ,which were from sheep of Xiwuqi or people of Xilinhot ,were 936 bp and 895 bp ,respectively .The homology of CO1 gene sequences of E .granulosus strains from Xiwuqi and Xinjiang was 99 .3% ,while the homology of the corresponding gene sequences of E .granulosus from man of Xilinhot City and Xinjiang were 98 .6% .ND1 gene of E .granulosus of sheep from Xiwuqi and hu-man from Xilinhot were identical to ND1 gene of G1 type .All these indicated that the homology of E .granulosus from the two regions were high and the genotype were G1 type ,which provided an important basis for the determination of strains ,and it al-so had a great significance to prevent and control the disease .
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Objective To discuss the influence of motor imagery therapy on the recovery of the stroke patients with aphasia.Methods Sixty cases of stroke patients with aphasia were divided into the treatment group and the control group according to the odd and even of last number.The single number was set into the control group.The double number was given to the treatment group.There were thirty patients in each group.Both groups received the conventional drug treatment and routine care of the Department of Neurology.On this basis,from the second day in hospital,the treatment group received the speech rehabili tation training with motor imagery therapy.Aphasia assessment was done for the two groups on the first day in hospital with CRRCAE.On the first day and after receiving ten-day treatment with motor imagery therapy,the grade of the severity for aphasia of Boston Diagnostic Aphasia Examination (BDAE) was done to assess the severity of aphasia in two groups.The scores of the two groups were compared.Results Before the treatment,there was no significant difference between the two groups.After receiving ten times treatment,both the two groups were improved.Compared with the control group,the treatment group became better.There was statistically significant difference between the two groups.Conclusions For the stroke patients with aphasia,motor imagery therapy has significant effect on their recovery.
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Objective To investigate the relationships between level of serum ferritin(SF)/blood lipid and the degree of coronary artery stenosis in elderly patients with acute coronary syndrome(ACS),and evaluate the value of SF in the diagnosis of coronary heart disease. Methods ①One hundred and twenty-five elderly patients with ACS(65 males,60 females)underwent coronary angiography examination,and the total cholesterol(TC), triglycerides(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C)and SF were determined;according to the results of coronary angiography,the degree of coronary artery stenosis was obtained by using the Gensini score and the degrees of severity of stenosis were divided into three groups:light(42 cases),medium (45 cases)and severe(38 cases). The differences in levels of SF and blood lipids among the three groups were observed,and the relationships between the level of SF/blood lipids and various degrees of coronary artery stenoses were analyzed.②The elderly patients with ACS were divided into two groups,male and female,to compare the SF numerical value and Gensini score between the two groups. ③The SF numerical value and Gensini score of 65 senile male cases with ACS were compared to those of 60 middle aged male cases with the same disease. Results ①Variance analysis showed that SF,TC,LDL-C distribution had significant differences among light,medium and severe groups〔SF(μg/L):147.287±73.838,162.313±94.882,290.421±194.501;TC(mmol/L):4.423±0.900,4.998±0.740, 5.032±1.009;LDL-C(mmol/L):3.150±0.799,3.439±0.839,3.902±1.053,all P0.05);in elderly patients with ACS,SF was positively correlated with Gensini score(r=0.355,P=0.000),while there was no correlation between Gensini score and any one of the following lipids:TC,TG,LDL-C,HDL-C(r=0.090,-0.170,0.256,-0.060,P=0.532,0.092,0.089,0.537).②The comparisons of SF value and Gensini score between senile male and senile female patients with ACS showed no significant differences(all P>0.05).③The comparisons of SF value and Gensini score between senile and middle aged male patients with ACS also showed no significant differences(all P>0.05). Conclusion The occurrence of ACS has certain correlation with SF and lipids,the degree of severity in coronary artery lesion is associated with SF,and there are no differences in age and sex in relation to the value of SF in the diagnosis of ACS.
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Objective To study the effects of sodium nitropnisside on early left ventricular remodeling after acute myocardial infarction (AMI). Methods 50 patients with ST segment elevating AMI who hadn' t been PCI or thrombolysis because of the delayed visiting time or poverty were randomly devided into two groups. Treatment group (n = 26) was treated with Sodium Nitropnisside on the basis of routine therapy and control group treated with Nitroglycerol and ACEI/ARB. In 4th week after AMI,left ventricular systolic volume index( LESVI) ,left ventricular diastolic volume index ( LEDAI), left ventricular ejection fraction ( LVEF) and left bventricular diastolic early and advanced stage engorging velocity ratio(E/A) were detected by ultrasonography. Results LESVI and LEDAI were significantly decreased and LVEF and E/A were significant increased after treated with Sodium Nitropnisside. There was significantly difference between two groups. Conclusion Sodium Nitropnisside could effectively prevent and treat patients with early left ventricular remodeling after AMI.
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Objective This study was designed to determine the expression ofgeneproducts of phosphatase and tensin homoligy deleted onehromoseten(PTEN)and DNA content in non small cell lung cancer(NSCLC)tissue and investigate their association with the invasion and metastasis of NSCLC.Methods The expression of PTEN were detected in 78 cases of lung cancer tissues by immunohistochemistry SP methods,DNA content in 30 cases of lung cancer tissues was examined by flow cytometry.Results The rate of total expression depletion of PTEN was 42.3%.The rates of PTEN expression depletion in lymph node metastasis group and no lymph node metastasis group were 52.1%and 26.7%respectively,with significantant difference(P＜0.05).The patients who had high expression of PTEN had a longer survival time.The range of the DNA index(DI)distribution ranged from 1.04 to 1.93,the DNA index and aneuploid tumor had a positive correlation with the lymph node metastasis,with the increased of TNM stage,the DI and the rate of DNA aneuploid increased(P＜0.05).Conclusions Expression of PTEN is associated strongly with lymph node metastasis of lung cancer,correlations exist between DNA content and TNM stage,lymph node metastasis.They are indications of metastasis potential and prognosis of lung cancer.
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Objective To study the influence of probiotic bacteria on rats blood lipids and immune function.Methods Rats fed with high fat diet,as a positive control of lovastatin in different kinds of experimental rats fed with probiotic bacteria.Before the experiment and 30 days after the experiment,the serum TC,TG and immune indicators were examined,compared with the control group.Results Probiotic bacteria feeding rats compared with control group rats,TC and TG in probiotic bacteria feeding rats blood are obviously lower than the eontroled group,(P＜0.01),the immune index is obviously higher than the control group (P＜0.05).Conclusion Probiotic bacteria obviously reduces TG and TG in Probiotic feeding rats blood,and improves the immunological function of probiotic bacteria feeding rats.
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Objective To investigate the role of FHIT in NSCLC and the relativity between FHIT and cigarette.Methods 81 cases of NSCLC and 7 cases of the nomal lung tisses were examined for FHIT by immunochemical(S-P).Results The postive expression rates of FHIT were significantly lower than those in nomal lung tisses(P