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Objective@#To explore the effect of exercise intervention based on the self-efficacy theory on quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis.@*Methods@#The convenience sampling method was used to select 64 rheumatoid arthritis patients who visited the department of rheumatology of Tianjin Medical University General Hospital from December 2017 to August 2018. Thirty-two rheumatoid arthritis patients were divided into the intervention group and other 32 rheumatoid arthritis patients were divided into the control group according to the visiting time. Patients in the control group received the conventional nursing care, and patients in the intervention group received the conventional nursing care and exercise intervention based on the self-efficacy theory. The 36-Item Short Form Health Survey (SF-36), Health Assessment Questionnaire (HAQ), Fatigue Severity Scale (FSS), Visual Analog Scale (VAS) were assessed three months after the intervention.@*Results@#After the intervention, the scores of the SF-36 in the intervention group and the control group were (68.04±12.27) and (54.32±21.66) points, respectively. The difference between the two groups was statistically significant (t=-3.119, P<0.05). After the intervention, the scores of the HAQ, FSS and VAS were (0.60±0.57), (3.68±1.75) and (4.08±2.17) points, respectively in the intervention group and (1.00±0.78), (4.65±2.07) and (5.44±2.75) points in the control group. The difference between the two groups was statistically significant (t=2.329, Z=-2.024, Z=-2.058, P<0.05).@*Conclusions@#The exercise intervention based on the self- efficacy theory can improve the quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis, which is worthy of further promotion in clinical practice.
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Objective To explore the effect of exercise intervention based on the self-efficacy theory on quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis. Methods The convenience sampling method was used to select 64 rheumatoid arthritis patients who visited the department of rheumatology of Tianjin Medical University General Hospital from December 2017 to August 2018. Thirty-two rheumatoid arthritis patients were divided into the intervention group and other 32 rheumatoid arthritis patients were divided into the control group according to the visiting time. Patients in the control group received the conventional nursing care, and patients in the intervention group received the conventional nursing care and exercise intervention based on the self-efficacy theory. The 36-Item Short Form Health Survey (SF-36), Health Assessment Questionnaire (HAQ), Fatigue Severity Scale (FSS), Visual Analog Scale (VAS) were assessed three months after the intervention. ResuLts After the intervention, the scores of the SF-36 in the intervention group and the control group were (68.04±12.27) and (54.32±21.66) points, respectively. The difference between the two groups was statistically significant (t=-3.119, P<0.05). After the intervention, the scores of the HAQ, FSS and VAS were (0.60±0.57), (3.68± 1.75) and (4.08 ± 2.17) points, respectively in the intervention group and (1.00 ± 0.78), (4.65 ± 2.07) and (5.44±2.75) points in the control group. The difference between the two groups was statistically significant (t=2.329, Z=-2.024, Z=-2.058, P<0.05). ConcLusions The exercise intervention based on the self- efficacy theory can improve the quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis, which is worthy of further promotion in clinical practice.
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Objective To analyze the influence of modern clinical teaching on nursing students' interpersonal relationship and social adaptability,and discuss the problems of intership,for providing reference for clinical teaching improvement.Methods A total of 200 nursing students in Tianjin Medical University were tested with the general information,interpersonal relationship and social adaptability questionnaires by purposive sampling method before and 3 months after the intership respectively.The data of 189 nursing students were collected and then analyzed by SPSS 17.0.Specifically the t test or Mann-Whitney U rank test and Chi-squared test were used to compare the differences of the questionnaire.Results At the midterm internship,students' interpersonal relationship score (4.19 ± 3.52) was significantly lower than that at the beginning stage (6.55 ± 5.22),while the social adaptation ability score (18.93 ± 9.52) was significantly higher than that at the beginning stage (10.28 ± 13.12) (P＜0.05).Conclusion Modern clinical teaching is beneficial for nursing students' interpersonal relationship and social adaptation ability,but not systematic.The more attention should be paid to cultivating nursing students' interpersonal relationship and social adaptation ability during the whole process from classoom teaching to clinical teaching.
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Objective The study aimed to evaluate the effects of web-problem-based learning (WPBL) in the application of Fundamental Nursing.Methods The sample was purposively selected.172 students in School of Nursing in Tianjin were recruited as the control group (n=83) and the intervention group (n=89).Traditional teaching method and WPBL was implemented in the control group and the intervention group,respectively.The teaching effectiveness of the two groups was measured by the examination and learning initiative evaluation scale and the teaching effect evaluation questionnaire,and the teaching satisfaction questionnaire was implemented among the intervention group.SPSS 18.0 was used and t test was performed to analyze the comparison between groups.Results In the theoretical examination,the scores of comprehensive analysis of the nursing students in the intervention group were better than those in the control group,and the difference was statistically significant (P＜0.05).In the evaluation of active learning after school,the scores of control learning in the intervention group were higher than those in the control group,and the difference was statistically significant ([14.78 ± 2.16),vs.(13.58 ± 2.16),t=-3.58,P=0.000].83 effective questionnaires of intervention group nursing students' teaching satisfaction were recovered.73 of them (88％) thought that WPBL could improve the students' ability of independent learning,71 students (85.5％) found that WPBL could enhance the ability of information processing,73 students (88％) thought they could communicate well with their classmates in WPBL and cooperate well to complete the task.Conclusion WPBL which is on the basis of PBL and make full use of the network,could promote the ability of autonomous learning,information processing and communication with classmates and good cooperation,but in the application process,it needs teachers to organize reasonably,perfect the supervision mechanism,and reduce taking up students' spare time.
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Objective To investigate the effects of inhibiting NgR on retinal ganglion cells density and synaptophysin expression of diabetic rat.Methods Thirty-two SD male rats were randomly divided into normal control group,diabetic group,siNgR group and scNgR group,8 rats in each group.Normal control group was given no any treatment.Diabetes model was induced by intraperitoneal injection of 50 mg · kg-1 streptozotocin in diabetic group,siNgR group and scNgR group,and the blood giucose more than 16.7 mmol · L-1 at 72 hours was set as the successfully model.The rats of siNgR group were intravitreally administrated with anti-NgR nucleotide and the rats of scNgR group intravitreally administrated with negative nucleotide.Eight weeks later,HE staining was conducted to detect density of retinal ganglion cell (RGC),immunofluorescence was used to evaluate the expression and distribution of synaptophysin (a marker of synaptic number).Relative expression of NgR and synaptophysin in retina were analyzed by Western blot.Results RGC density in normal control group,diabetes group,siNgR group and scNgR group were (624.33 ± 3.51) mm-2,(420.00 ± 2.65) mm-2,(621.67 ± 1.53) mm-2,(416.67 ± 2.52) mm-2,respectively.There was significant difference among four groups (F =5985.37,P ＜ 0.01).Compared with normal control group,RGC density in diabetes group and scNgR group were obviously decreased (all P ＜0.01),but siNgR group had no obviously change (P ＞ 0.05).The synaptophysin mainly expressed in the inner and outer network layer.Compared with normal control group,the positive expression of synaptophysin in diabetes group and scNgR group were decreased,but siNgR group had no obviously change.The relative expression of NgR in normal control group,diabetes group,siNgR group and scNgR group were (11.26 ±0.02) ％,(19.38 ± 0.10) ％,(11.17 ± 0.02) ％,(19.47 ± 0.31) ％,respectively.There was significant difference among four groups (F =2466.09,P ＜ 0.01).Compared with normal control group,the relative expression of NgR in diabetes group and scNgR group were obviously decreased (all P ＜ 0.01),but siNgR group had no obviously change (P ＞0.05).The relative expression of synaptophysin in normal control group,diabetes group,siNgR group and scNgR group were (35.76 ± 0.15) ％,(25.47 ± 0.36) ％,(35.28 ± 0.12) ％,(25.03 ± 0.75) ％,respectively.There was significant difference among four groups (F =583.70,P ＜ 0.01).Compared with the normal control group,the expression of synaptophysin in diabetic group and scNgR group were decreased increased (all P ＜ 0.01),while there was no significant difference in siNgR group (P ＞ 0.05).Conclusion Inhibiting the expression of NgR in the retina of diabetic rats can help to restore the number of synapses and protect the damaged RGC.
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Objective To understand the status of the disease in local population and the fluoride content in drinking water in the endemic areas of endemic fluorosis in Etuoke Banner of Inner Mongolia,and to provide a scientific basis for making strategies in prevention and control of the disease.Methods Totally 100 endemic fluorosis villages were selected as survey sites,to study the progress and effect of water-improving and defluoridation projects in Etuoke Banner in 2015.In monitoring villages with improved water,1 water sample from the tap water was collected to determine the fluoride level,and in water unimproved villages,1 water sample from each direction of the east,south,west,north and middle of the villages was collected,respectively,to determine fluoride level.Dental fluorosis of children aged 8 to 12 was examined in each village.Water fluoride was tested according to the Standard Testing Methods for Drinking Water (GB/T 5750.5-2006).Diagnosis of dental fluorosis was based on the Diagnostic Criteria for Dental Fluorosis (WS/T 208-2011).Results A total of 100 diseased villages were investigate,the water-improving rate was 39.00％ (39/100).Among the 39 water-improving projects,normal operating rate was 66.67％ (26/39),intermittent operating rate was 15.38％ (6/39) and scrapped projects accounted for 17.95％ (7/39);the qualified rate of water fluoride projects was 53.85％ (21/39).A total of 268 tap water samples were collected,the mean of water fluoride was 1.39 mg/L,and the range was 0.22-5.57 mg/L.In the 61 waterunimproved villages,the water fluoride level ＞ 1.2 mg/L in the drinking water accounted for 49.18％ (30/61),covering a population of 5 231 people.The water fluoride level ＞ 2.0-4.0 mg/L in the drinking water accounted for 18.03％ (11/61),covering a population of 2 326 people;the number of village with water fluoride level ＞ 4.0 mg/L was 1,accounted for 1.64％ (1/61),covering a population of 162 people.A total of 1 040 children aged 8 to 12 in the survey villages were examined,the total rate of dental fluorosis was 9.71％ (101/1 040),the index of dental fluorosis was 0.18,and the prevalence was negative.Conclusion The water-improving and defluoridation projects in Etuoke Banner,Inner Mongolia has a certain effect on children's dental fluorosis,but water fluoride content has exceeded the standard significantly,the water improvement measures should be further strengthened.
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Objective To investigate the effects of nerve growth factor (NGF) on retinal synaptic plasticity of diabetic mellitus rat and its underlying mechanisms.Methods A total of 24 clean SD male rats were randomly divided into three groups (n =8),and they were control group,diabetic group and treatment group.In the latter two groups,a model of diabetic rats was induced by streptozotocin,and then the rats of treatment group were injected intraperitoneally 800 U · kg-1 NGF once a day after the model was induced successfully.Both control group and diabetic group were given the same amount of normal saline.Twelve weeks later,MDA content and SOD activity were detected;meanwhile,the expression of retinal synaptophysin was detected by immunofluorescence,and the expressions of retina synaptophysin and Caspase-3 were detected by Western blot.Results The difference of MDA content in the three groups was statistically significant (F =85.46,P ＜ 0.01);and the content of MDA in the diabetic group was significantly higher than that in the control group (P ＜0.01),while its content in the treatment group was significantly lower than that in the diabetic group (P ＜0.01).The difference of SOD activity in the three groups was statistically significant (F =17.76,P ＜0.01);and the SOD activity in the diabetic group was significantly lower than that in the control group (P ＜0.01),while its activity in the treatment group was significantly higher than that in the diabetic group (P ＜0.01).The difference of immunofluorescence intensity of synaptophysin in the three groups was statistically significant (F =395.42,P ＜ 0.01);immunofluorescence intensity of synaptophysin in the diabetic group was attenuated compared with the control group (P ＜0.01),while the intensity in the treatment group was enhanced compared with the diabetic group(P ＜0.01).The difference of the relative expression of synaptophysin in the three groups was statistically significant (F =17.27,P ＜ 0.01);and the expression of synaptophysin in the diabetic group was significantly downregulated compared with the control group (P ＜ 0.01),while its expression in the treatment group was upregulated compared with the diabetic group (P ＜ 0.01).The difference of relative expression of Caspase 3 protein in the three groups was statistically significant (F=217.13,P ＜0.01);and the expression level of Caspase 3 in the diabetic group was significantly higher than that in the control group (P ＜0.01),while its level in the treatment group was significantly lower than that in the diabetic group (P ＜ 0.01).Conclusion NGF can help to inhibit the apoptosis of retinal cell,restore the number of retina synapse by reducing the oxidative stress in diabetic retina,which suggests that NGF may be involved in the changes of synaptic plasticity in diabetic retina via oxidative stress pathway.
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Objective To evaluate the safety and efficacy of interventional procedure for treating the renal artery aneurysm (RAA).Methods From Jan 2009 to Apr 2014,17 patients,who were diagnosed as RAA and accepted the interventional therapy,were reviewed in our hospital.The mean age in those patients,including 7 males and 10 females,was (46.4±10.3) years old (range from 20 to 67 years old).The related symptoms included backache in 4 cases,abdominal pain in 4 cases,intermittent hematuria in 2 cases,chyluria in one case,oligouria in one case.9 cases were diagnosed as multiple RAA and 8 cases were confirmed as signle cases.In 17 cases,31 aneurysms were found,including 26 true aneurysms,5 pseudoaneurysums,17 sacculated aneurysms,4 spindle-like aneurysms,4 irregular shape aneurysms,4 parenchyma aneurysm and 2 dissecting aneurysm.8 aneurysms located in the main renal artery,19 aneurysms located in the branch of renal artery,4 aneurysums located in the renal parenchyma.Intracavitary coil embolization was used in 4 patients.We carried out parent artery embolization in 3 patients.A combination of the former techniques was performed in 6 cases.Covered stent placement was operated in one case.Combination of the intracavitary coil embolization and nude stent placement were performed in 2 patients.We used two techniques in one patient with multiple artery aneurysms in both sides.Results The interventional treatment of RAAs succeed at the first operation in 16 of 17 patients.17 cases were followed-up from 3 to 53 months (mean 23 months).No severe complications or death cases occurred in this study.Urine occult blood in 3 patients turned to negative after one week.Primary symptoms such as gross hematuria,abdominal pain,lumbodorsalgia,fever vanished or obviously eased after a month.Laboratory tests showed that normal level in SCr,BUN,routine urinalysis 3 months,6 months and 1 year later.No tendency of stent and coil stent shifting was found in 16 patients and the parent arteries were patent in 8 cases,with reexamination bv ultrasonic or computed tomography angiography (CTA).Conclusions Interventional techniques are minimally-invasive,safe and effective methods for treating the RAAs.
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Objective To study the feasibility of using gooseneck snare combined with 0.035 inch loach guidewire for subintimal angioplasty in iliac artery occlusion , and to discuss its clinical indications. Methods During the period from October 2011 to May 2013, 3 cases with unilateral complete iliac artery occlusion were admitted to authors’ hospital. As the guidewire inserted from the healthy side could not returned into the true lumen once it entered into the subintimal space of the iliac artery , the puncture at the diseased side was carried out and the guidewire was pushed into the artery , but the catheter and the guidewire could not converge or anastomose in the subintimal site , gooseneck snare had to be used to grab the guidewire in subintimal site as to establish a path and completed the angioplasty. Results Successful and safe balloon dilatation and stent implantation were accomplished in all the 3 patients , and the patients complained of no special discomfort. Conclusion In performing the subintimal angioplasty for patients with iliac artery occlusion, the use of gooseneck snare combined with retrograde insertion of guidewire should be considered when it occurs that the guidewire can not return into the true lumen after it enters into the subintimal space. Nevertheless, gentle manipulation is first important in order to avoid the possible rupture of vessels.
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Form 2008 to 2009, four patients with complex thoracic aortic disease, including aortic aneurysms and dissections, were successfully treated in our department with a new treatment approach: hybrid procedure. Combined open surgery and endovascular repair were performed in these patients without deep hypothermia or circulatory arrest. Compared to those who underwent traditional open surgery in the same period, time of mechanical ventilation and ICU stay was decreased in these four patients. All of them were discharged soon after operation without postoperative complications or death. The result suggests that this new approach could be an option for thoracic aortic disease, but long-term and large-population studies are still required to demonstrate the safety and validity.
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To examine the effect of transcatheter arterial embolization (TAE) of liver tumors on hypoxia-inducible factor-1alpha (HIF-1alpha) expression in the residual viable tumor, a total of 30 New Zealand White rabbits implanted with VX2 liver tumor were divided into 2 groups. TAE-treated group animals (n=15) were subjected to TAE with 150-250 mum polyvinyl alcohol particles. Control group animals (n=15) underwent sham embolization with distilled water. Six hours, 3 days or 7 days after TAE, the animals were sacrificed, and samples of tumor and adjacent normal liver tissue were harvested. Expression of HIF-1alpha protein was examined immunohistochemically. Real-time PCR was performed to examine the HIF-1alpha mRNA levels. Our results showed that HIF-1alpha protein was expressed in the VX2 tumors but not in the adjacent normal liver tissue. The HIF-1alpha-positive tumor cells were located predominantly at the periphery of necrotic tumor regions. The mean levels of HIF-1alpha protein were significantly higher in TAE-treated tumors than those in control tumors (P=0.002). Among the three sacrificing time points, the difference in increase in HIF-1alpha protein was significant between the two groups at the sacrificing time point of 6 h and 3 days after TAE (P=0.020, P=0.031, respectively), whereas no significant increase was noted 7 days after TAE (P=0.502). In contrast, although HIF-1alpha mRNA was expressed in TAE-treated and control VX2 tumors, there existed no significant difference in the HIF-1alpha mRNA level between the two groups (P=0.372). It is concluded that TAE of liver tumors increases the expression of HIF-1alpha at protein level in the residual viable tumor, which could be attributed to hypoxia generated by the procedure.
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This study investigated the changes of CD4(+) CD25(+) regulatory T cells (Tregs) in peripheral blood of patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolization (TACE). The proportion of CD4(+) CD25(+) Tregs among CD4(+) T lymphocytes in peripheral blood of 33 patients with hepatocellular carcinoma was determined by flow cytometry before, 1 week and 1 month after TACE. And 25 healthy volunteers served as control. One month after TACE, the patients were divided into two groups: 22 in group A, who were in stable condition or getting better; and 10 in group B, who were deteriorating. One patient died and was excluded. The results showed that the percentage of CD4(+)CD25(+) Tregs among CD4(+) T lymphocytes did not significantly change in the 33 patients 1 week after TACE as compared with that before TACE, however, the difference was significant (P<0.01) between the patients with hepatocellular carcinoma and the healthy subjects. The percentage of CD4(+) CD25(+) Tregs among CD4(+) T lymphocytes in group A 1 month after TACE was decreased significantly in comparison with that before and 1 week after TACE (P<0.01), whereas, that in group B was increased significantly 1 month after TACE (P<0.01). It was concluded that patients with hepatocellular carcinoma had a higher proportion of CD4(+)CD25(+) Tregs in peripheral blood. TACE did not significantly affect the level of CD4(+) CD25(+) Tregs within short time (such as 1 week). The proportion of CD4(+)CD25(+) Tregs in peripheral blood 1 month after TACE was related to the prognosis of hepatocellular carcinoma.
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Antineoplastic Agents/administration & dosage , Carcinoma, Hepatocellular/immunology , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/methods , Liver Neoplasms/immunology , Liver Neoplasms/therapy , T-Lymphocytes, Regulatory/immunologyABSTRACT
<p><b>OBJECTIVE</b>To assess a new intervention for reestablishing the second hepatic hilum by means of puncturing and stenting the liver tissue between the intrahepatic vena cava and a hepatic vein for the treatment of Budd-Chiari syndrome (BCS).</p><p><b>METHODS</b>Two patients with BCS, in which no second hepatic hilum structure was found in transhepatic venography, underwent an interventional procedure of canalizing and stenting the parenchyma tract between the intrahepatic vena cava and a hepatic vein. The procedures were performed in the percutaneous transhepatic and right jugular vein, respectively. A metallic stent with a 10 mm diameter was implanted to maintain tract patency.</p><p><b>RESULTS</b>The free hepatic vein pressure (FHVP) of both patients decreased from 37 mm Hg to 5 mm Hg and from 28 mm Hg to 4 mm Hg, respectively, after the procedure. The complication of hemorrhage due to puncture was observed in one patient. Both patients maintained hepatic improvements in 3-year follow-up. Both clinical conditions and laboratory values were significantly improved after the procedure. Furthermore, the stented canals (the reestablished second hepatic hilum) maintained patent with normal FHVP, which was confirmed by control venography.</p><p><b>CONCLUSION</b>The new technique provides a simple, safe, effective, and relatively inexpensive treatment of Budd-Chiari syndrome. Long-lasting effectiveness is expected.</p>
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Adult , Humans , Male , Middle Aged , Budd-Chiari Syndrome , Therapeutics , Hepatic Veins , Stents , Vena Cava, InferiorABSTRACT
The clinical thought is the core and the foundation of clinical ability.The logical teaching strengthens the students'clinical thought most directly and effectively.Through the thought training,the inference thought training and the basic thought rule training the medical students' clinical thought ability can be effectively strengthened.
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Objective To investigate the clinical value of home-made self-expandable metallic stent therapy for benign or malignant segmental obstruction of inferior vena cava (IVC). Methods 48 patients, including 30 cases of benignancy and 18 of malignancy, were underwent the home-made self-expandable metallic stent endovascular implantation of IVC. Results Of 48 patients, the average obstructive length of IVC were 5.3?2.8 cm. The IVC pressure below the obstruction varied from 21.4?5.1 mmHg of preoperation to 8.4?3.3 mmHg of postoperation(P
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Objective To investigate the change on the extent of coagulated lesion under various interrupting methods of hepatic blood flow in vivo animal livers, and the clinical effect of combining tran scathcter arterial chernoembolization(TACE) with percutaneous microwave coagulation therapy (PMCT) for primary and metastatic hepatic tumors. Methods Using FORSEA MTC-3-500s microwave coagulator, we performed microwave tissue coagulation in vivo liver of 6 pigs at 60 W, 2 min and of 20 rabbits al 40 W, 2 min with or without the interruption of hepatic blood flow. 27 patients with primary hepatic carcinoma(30 nodules) and 8 patients with metastatic carcinoma( 12 nodules) underwent the combination therapy of 1 - 4 sessions of TACK followed by within 3-10 days by 1 - 3 sessions of PMCT guided by ultrasonography and/or CT. The 42 lesions measured from 2. 3 cm to 15.6 cm were taken place. Results In vivo liver, the greatest dimension of the lesions coagulated by microwave with the interruption of hepatic arterial and portal flow were 22.510.6 mm at 40 W, 2 min and 28. 6?1. 2 mm at 60 W, 2 min, which were markedly larger than those without the interruption (13.3?0.3; and 15.6?0.7 mm, P
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Modern medical staff are facing the challenge to survive in competitions and develop through cooperation.Thus it is of great importance for the future medical staff,that is,medical students to cultivate and enhance their teamwork for future demand.Cultivating approaches mainly include creating a collaborative environment,carrying out cooperative scientific research,creating teamwork in the curriculum,and launching community service activities.
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the education the education of appreciate the beauty is a kind of character education,.And the character of a kind of spirit level of structure the education.It can educate what medical science living to appreciate beauty the ability,and affect the medical science the concept of value that living,and increase the medical science the human life state that living,and educate the medical science the creation thought that living.this article basic of medical science history teaching to discuss how foster the students to appreciate the beauty of the education.
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New type medical talents are in great need in the fierce international competition in medical field.Logic quality is acquired by accumulation,not born to be.Modern medicine sets higher requirement for medical talents in the aspects of logic quality including receiving and processing information,ability of expression and collaboration,forecasting and innovation.Therefore,only through diligent learning,training and repeated practice can enhance the logic quality of medical talents,and develop into winners in the increasingly fiercer international competition in medical field.
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The obese children are increasing at a surprisingly high annual rate of 9.1 percent in China.Meanwhile children are lack of health consciousness and self-protection,thus obese children are more vulnerable towards obesity.Since parents are responsible for their children's daily lives and behaviors,the health education of obesity should be started with those parents with obese children.This paper calls to carry out health education aimed at parents of obese children through multiple means such as community health services,taking advantage of public media and establishing specific clubs,in order to effectively control the increase of obese children.