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Objective:To analyze the application effect of "Internet+" early grading follow-up management mode after enterostomy for colorectal neoplasms.Methods:The 186 patients who underwent enterostomy for colorectal neoplasms in Lishui Central Hospital were selected as the research objects. The patients enrolled from January 2019 to February 2020 served as the control group, and the patients enrolled from March 2020 to April 2021 served as the observation group, with 93 patients in each group. Routine follow-up measures were taken in the control group, while "Internet+" was used in the observation group for early grading follow-up management of patients with enterostomy for colorectal neoplasms. The timely follow-up feedback, score of skin condition around stoma, incidence of stoma complications and nursing satisfaction during follow-up were compared between the two groups.Results:The two-day non feedback rate in the control group was 20.43% (19/93) and that in the observation group was 7.53% (7/93), the difference was statistically significant ( χ2 = 6.44, P<0.05) .The score of skin condition around stoma in the observation group was (2.53 ± 0.78) points 3 months after discharge, which was significantly better than that in the control group 4.02 ± 1.13, the difference was statistically significant ( t = 10.47, P<0.05). The incidence of stoma complications in the observation group was 9.68% (9/93) , which was lower than that in the control group 21.51% (20/93) , the difference was statistically significant ( χ2 = 4.94, P<0.05). The nursing satisfaction in the observation group was 98.92% (92/93) , which was significantly higher than that in the control group 91.40% (85/93) , the difference was statistically significant ( χ2 = 4.20, P<0.05). Conclusions:"Internet+" early grading follow-up management model can significantly improve the follow-up effect after enterostomy for colorectal neoplasms, improve the skin condition around stoma, reduce stoma complications and improve nursing satisfaction.
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Objective To investigate radiation-induced carotid and cerebral vascular injury and its relationship with radiation-induced temporal lobe necrosis in nasopharyngeal carcinoma (NPC) patients.Methods Fifty-eight NPC patients with radiation-induced temporal lobe necrosis (TLN) were recruited in the study.Duplex ultrasonography was used to scan bilateral carotid arterials to evaluate the intima-media thickness (IMT) and occurrence of plaque formation.Flow velocities of bilateral middle cerebral arteries (MCAs),internal carotid arteries (ICAs) and basal artery (BA) were estimated through Transcranial Color Doppler (TCD).The result were compared with data from 33 patients who were free from radiation-induced temporal lobe necrosis after radiotherapy and 29 healthy individuals,to study the relationship between IMT,occurrence of plaque and ventricular diastolic dysfunction.Results Significant differences in IMT,occurrence of plaques of ICAs and flow velocities of both MCAs and ICAs were found between patients after and healthy individuals (t =18.624,8.221,P ＜0.05;x2 =17.886,P ＜0.05;t =14.367,10.112,P ＜0.05).IMT had positive correlation with post radiation interval (r =0.368,P =0.049).IMT or incidence of plaques may be related to dose of radiotherapy,course of treatment and T stage (x2 =-17.635,12.006,-3.125,P ＜ 0.05).Compared with result from patients without radiation-induced TLN,the mean IMT was significantly thicker in patients with TLN (t =10.208,P ＜ 0.05).Plaques were more common in patients with TLN than patients without TLN (x2 =13.118,P ＜0.05).In addition,flow velocities of MCAs and ICAs in patients with TLN were much faster (t =5.011,5.035,P ＜ 0.05).Among patients with unilateral TLN,flow velocity of MCAs was significantly different between ipsilateral and contralateral sides to the lesion (t =18.362,P ＜ 0.05).Conclusions Thickening of IMT,occurrence of plaque formation and hemodynamic abnormality are more common in patients after radiotherapy,especially in those with TLN,compared with healthy individuals.
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The competence of scientific research ethnical review in domestic hospital was inadequate,which was associated with the development of medical ethnics,values of Chinese traditional society,unsound domestic laws and regulations,weak administrative management,unqualified committee of medical ethnics,the drive of scientific deriving interests and restriction of project funds.Aiming at the above problems,countermeasures were carried out to strengthen the construction of laws and regulations,strengthen the constraint of administrative management,standardize the self-construction of ethnic committee,implement the standard operative procedure,thus to provide a reference for the standardized construction of scientific research ethnical review.
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Objective To observe the changes of abdominal oxygen saturation in very low birth weight infants (VLBWI)with feeding intolerance (FI)within 1 4 days after birth monitored by near infrared spectroscopy (NIRS).Methods VLBWI fitting entry criteria were enrolled into this study.NIRS monitoring was carried out to detect cerebral oxygen saturation (ScO2 )and abdominal oxygen saturation (SsO2 ).Data were analyzed between FI infants and feeding tolerance (FT)infants.FI was defined as follows:gastric residual of more than 50% of the previous feeding volume;emesis or abdominal distention or both;decrease,delay or discontinuation of enteral feedings. Results 93 VLBWI were enrolled.52 cases(55.91 %)presented with FI,including 29 cases(31 .1 9%)of gastric residual increasing and 23 cases(24.73%)of emesis with or without abdominal distention within 1 4 days after birth. The levels of SsO2 and SsO2 /ScO2 showed no differences in infants with FT and with FI within 24h after birth (P >0.05).The change rates of the median of SsO2 and SsO2 /ScO2 in FT infants were similar during 1 4 days (P >0.05).While both the change rates of SsO2 and SsO2 /ScO2 were markedly decreased 1 day before and the day of FI (P <0.01 ).The decreasing degree of SsO2 was similar between infants with gastric residual increasing and infants with emesis with or without abdominal distention[(1 6.2 ±5.1 )vs (1 7.4 ±3.6)%,t =0.733,P =0.476]. Conclusion Abdominal oxygen saturation measured by NIRS may be a useful method for infants adjusting the feeding plan.
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Objective@#To explore the impact of weight management and related medication intervention based on body weight changes on cardiac function among patients with chronic congestive heart failure (CHF).@*Methods@#Using prospective, randomized, controlled study methods, consecutive CHF patients, who hospitalized in our department from June 2014 to June 2016 (n=350), were randomly divided into intervention group (n=175) and control group (n=175). Patients in the intervention group received weight management guidance and the post discharge diuretic drugs regimen was adjusted based on body weight changes. The control group received routine medical care post discharge. Left ventricular ejection fraction (LVEF), B type natriuretic peptide precursor (NT-proBNP), 6 minutes walk distance and NYHA classification at one day before discharge and after 6 months were compared between the two groups respectively.@*Results@#Follow-up visit data were not available from 6 patients in the control and intervention group respectively. NYHA classification, LVEF, NT-proBNP and 6 minutes walk distance were similar between the two groups at one day before discharge (all P>0.05). After 6 months, the LVEF and 6 minutes walk distance were significantly higher while NT-proBNP level was significantly lower in the intervention group compared to the control group (all P<0.01). Meanwhile, the LVEF and 6 minutes walk distance were significantly increased, while NT-proBNP was significantly reduced at 6 months post discharge compared to one day before discharge in the intervention group (all P<0.01). The LVEF was also significantly improved (P=0.035), but the NT-proBNP and 6 minutes walk distance were similar (P were 0.328 and 0.807 respectively) at 6 months after discharge compared to one day before discharge in the control group. The NYHA classification was significantly lower in intervention group and in control group at 6 months after discharge compared to one day before discharge (Z=5.154, P<0.01 and Z=10.497, P<0.01), and the NYHA classification improved more in the intervention group than in control group at 6 months after discharge (Z=9.235, P<0.01). The re-hospitalization rate of CHF patients in intervention group was 11.83% (20/169), which was significantly lower than the control group (33.14% (56/169), χ2=21.99, P<0.01). At 6 months follow up, body weight remained unchanged in the intervention group, while body weight tended to be higher in the control group compared to one day before discharge.@*Conclusion@#The weight management and diuretic drug regimen adjudgment intervention based on body weight changes can improve cardiac function and reduced re-hospitalization rate in CHF patients.
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Objective To investigate the effect of Diane-35 and metformin on blood-adipose and sex hor-mone in patients with polycystic ovary syndrome ( PCOS ) .Methods 52 cases with PCOS admitted from Jan . 2010 to Jan.2013 were selected as research objects .They were randomly divided into the control group and the observation group .The control group were treated with metformin , while the observation group with metformin and Diane-35.Follicle-stimulating hormone ( FSH), luteinizing hormone ( LH), testosterone ( T), total cholesterol (TC), triglyceride(TG), high density lipoprotein(HDL), low-density lipoprotein(LDL)in the 2 groups of pa-tients were tested before and after treatment .Results The levels of blood-adipose and sex hormone between the 2 groups had no statistical difference (P>0.05).The level of T reduced in the control group after treatment , and there was statistical difference compared with that before treatment ( P <0.05 ) .FSH and LH levels did not change obviously in the observation group .Levels of LH and T in the observation group reduced , and had statisti-cal difference with that before treatment (P<0.05).FSH levels did not change significantly after treatment .Lev-els of LH and T had statistical difference between the 2 groups(P<0.05).Levels of TC, TG, and LDL reduced after treatment and had statistical difference compared with those before treatment ( P<0.05 ) while HDL signifi-cantly increased after treatment(P<0.05).Levels of TC, TG, HDL, and LDL between the 2 groups were signif-icantly different(P<0.05).Conclusion Metformin combined with Diane-35 are effective in improving the lev-els of blood-adipose and sex hormone in patients with PCOS .
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<p><b>OBJECTIVE</b>To investigate the feasibility of establishing an integrated regional network for ST-segment elevation myocardial infarction (STEMI) care in China and evaluate the implementation effect of this network.</p><p><b>METHODS</b>Based on real-time electrocardiogram transmission technology, we established an integrated regional network for STEMI care (IRN-STEMI) with Xiamen Heart Center as the core center, 120 Emergency Systems, PCI-capable hospitals and other community health units as core elements of this network. Reperfusion treatment data of Xiamen Heart Center including the number of patients receiving primary percutaneous coronary intervention (PCI), the mean first medical contact to balloon (FMC-to-B) time, the mean door to balloon (D-to-B) time, the mean length of hospital stay, the mean medical cost and in-hospital mortality were compared before (n = 165) and at 1 year after the built-up of IRN-STEMI (n = 343).</p><p><b>RESULTS</b>Compared to pre-IRN-STEMI era, primary PCI ratio (84.5% (290/343) vs. 75.5% (185/245)) were significantly increased post establishment of IRN-STEMI within the network (P = 0.06). STEMI patients admitted in Xiamen Heart Center was significantly increased from 165 to 256, the annual mean FMC-to-B time ((110.3 ± 34.0)min vs. (137.9 ± 58.5) min, P < 0.01) and D-to-B ( (76.5 ± 33.0) min vs. (107.3 ± 38.0) min, P < 0.01) , as well as the mean medical cost were significantly decreased ( (51 398 ± 22 100) RMB vs. (56 970 ± 24 593) RMB, P < 0.05), while the mean length of hospital stay ((9.0 ± 4.3)d vs. (9.7 ± 4.8)d, P > 0.05) and in-hospital mortality (3.1% (8/256) vs. 3.0% (5/165) , P > 0.05) remained unchanged before and after the setting of IRN-STEMI in Xiamen Heart Center.</p><p><b>CONCLUSION</b>Establishment of an integrated regional network system for STEMI patients in China is feasible. With collaboration of qualified heart center, EMS and PCI-capable and non-PCI capable local hospitals, establishment of IRN-STEMI effectively increased the ratio of primary PCI for STEMI patients, it also significantly shortened the FMC-to-B and D-to-B time, decreased mean medical cost, thus, the regional IRN-STEMI network might be an effective working system for improving the medical care for STEMI patients.</p>
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Humans , China , Epidemiology , Community Networks , Cost Control , Electrocardiography , Hospital Mortality , Hospitalization , Length of Stay , Myocardial Infarction , Mortality , Therapeutics , Percutaneous Coronary Intervention , Time FactorsABSTRACT
Objective To investigate the efficacy of jet endotracheal tube (JET) designed by Wei (WEI JET) for tracheal intubation.Methods One hundred and two ASA Ⅰ-Ⅲ and Cormack & Lehane grade Ⅰ-Ⅳ patients of both sexes,aged 15-50 yr,weighing 40-99 kg,requiring tracheal intubation under general anesthesia,were randomly allocated into 2 groups (n =51 each):conventional tracheal tube group (group C) and WEI JET group (group WJ).Groups C and WJ were further divided into 2 subgroups according to Cormack & Lehane grade:difficult airway subgroup (n =16) and non-difficult airway subgroup (n =35).The patients were tracheal intubated with the common Kendall endotracheal tube in group C.Jet ventilation (driving pressure 100 kPa,frequency of ventilation 15 bpm,I∶ E =1∶2) was performed and the patients were simultaneously tracheal intubated with WEI JET of the same internal diameter in group WJ.PETCO2 was recorded immediately after mechanical ventilation.The success rate of tracheal intubation at first attempt and time spent were recorded.The complications were also recorded within 24 h after extubation.Results Compared with group C,the intubation time was significantly prolonged,and the success rate of tracheal intubation at first attempt was increased in patients with a difficult airway than that in the patients without difficult airways in group WJ (P ＜ 0.01).There was no significant difference in PETCO2 recorded immediately after mechanical ventilation,intubation time and the success rate of tracheal intubation at first attempt between the patients with a difficult airway and the ones without difficult airways in group WJ (P ＞ 0.05).PET CO2 recorded immediately after mechanical ventilation was significantly higher and the success rate of tracheal intubation at first attempt was lower in the patients with a difficult airway than in the patients without difficult airways in group C (P ＜ 0.01).No severe barotrauma such as pneumothorax,mediastinal emphysema and subcutaneous emphysema occurred in group WJ.There was no significant difference in the incidences of laryngospasm,sore throat,and flatulence between the two groups (P ＞ 0.05).Conclusion WEI JET can not only provide adequate ventilation safely and effectively in patients requiring tracheal intubation under general anesthesia,but also increase the probability of successful tracheal intubation in patients with a difficult airway.
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To compare the effect of insulin glargine combined with nateglinide and continuous subcutaneous insulin infusion(CSII) during intraoperative period in type 2 diabetic patients with fracture. Both of the managements made blood glucose under control [fasting blood glucose(6.89±1.96)vs(6.75±2.33)mmol/L] in similar period [(3.6±1.6)vs(2.9±1.2) d,both P>0.05]. The mean blood glucose was lower in patients treated by CSII than that of the other group.
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Objective To investigate the therapeutic and adverse effects of short-term continuous subcutaneous insulin infusion (CSII) in patients with newly-diagnosed type 2 diabetes mellitus. Methods By way of follow-up and retrospective study, 256 patients with newly-diagnosed type 2 diabetes mellitus receiving two weeks of CSII therapy were analyzed in our diabetes center. The parameters, such as blood glucose level after two-week CSII therapy, time needed to control hyperglycemia, insulin dosage and the rate of hypoglycemic episodes were observed and recorded. Results The optimal glycemic control rates after 3 days, 7 days, 2 weeks were 46.7%, 78.4%, 92.2% respectively. The remission rates of patients who maintained optimal glycemic control at the third, sixth, twelfth, twenty-fourth and thirty-sixth months and more than 48 months after withdrawal of insulin were 75%, 64.8%, 53.5%, 30.9%, 10.2% and 0%, respectively. In patients with a period of remission over 3 months,the daily total insulin requirement on the day of withdrawal of CSII was less than that in patients with remission less than 3 months (P＜0.01). The duration of remission was negatively correlated to daily insulin requirement on the day of CSII withdrawal(r=-0.63, P＜0.01). Conclusion Patients with newly-diagnosed type 2 diabetes mellitus can quickly achieve optimal glycemic control by CSII. CSII may decrease glucotoxicity to pancreatic β cells and delay the deterioration of β-cell function .
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BACKGROUND: Looking for effective measures to ensure the survival of the implanted stem cells against ischemia-induced hypoxia becomes the major concern in the research of cell transplantation therapy for cerebral infarction.OBJECTIVE: To study the effects of human Persephin gene transfer on hypoxia-induced apoptosis of neural stem cells.DESTGN: A randomized controlled basic study on cells.SETTTNG: Department of Neurology, the Second Affiliated Hospital of Sun Yat-sen University.MATERTALS: This study was completed in the Lin Baixing Laboratory Center of the Second Affiliated Hospital of Sun Yat-sen University from July to December in 2006. Recombinant adenovirus pAdCMV persephin was constructed in our lab. C17.2 neural stem cells were kindly provided by Prof. Snyder, Harvard Medical University, USA. Trypsin and DMEM/F12 were purchased from Gibco Company (USA), fetal bovine serum (FBS) from Sijiqing Biological Engineering Materials Co. Ltd (Hangzhou, China); Poly-lysine from Sigma Company (USA), TUNEL assay kit and FuGENE kit from Roche Molecular Biochemicals Company (Swiss), and S-P immunohistochemical detection kit and DAB reaction kit from Mycine Biological Engineering Company (Fujian). Rat anti-human monoclonal Nestin antibody and rabbit anti-human polyclonal persephin antibody were manufactured by Santa Cruz Company (USA), and persephin anti-senseoligodeoxynucleotide (ODN) was synthesized by Shanghai Biological Engineering Company.METHODS: ① Interventions: C17.2 neural stem cells cultured in vitro were infected by recombinant adenovirus containing persephin gene, and they were divided into four groups: blank control group (Group A, in which the C17.2 neural stem cells were not treated with hypoxia), hypoxic group [Group B, in which the cells were cultured at 37 ℃ in anaerobic incubation containing N2 (0.95 in volume fraction) and CO2 (0.05 in volume fraction)], hypoxia + pAdCMV persephin infection group [Group C, where the cells were cultured under the conditions as in group B after pAdCMV persephin infection for 48 hours], and hypoxia + pAdCMV persephin infection + anti-sense persephin ODN group (Group D, where the cells were infected by pAdCMV persephin and anti-sense persephin ODN. ② Evaluation: The expression of Persephin protein was analyzed using Western blotting; Apoptotic index was detected with terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) assay; The changes of apoptotic rate was determined with flow cytometry.MAIN OUTCOME MEASURES: Expression of Persephin protein; Apoptotic index; Apoptotic rate.RESULTS: ① Expression of Persephin protein: A specific band (relative molecular mass of 24 000) was detected by Western blotting in pAdCMV persephin infected cells, suggesting the successful expression of persephin gene.Interestingly, the cells infected with both pAdCMV persephin and anti-sense persephin ODN also showed the specific band of about 24 000, but with much less density, indicating that anti-sense persephin ODN could effectively inhibit the expression of pAdCMV persephin. However, this band was not presented in the blank control groups. ② Apoptotic index:The apoptotic index in group C was significantly lower than those in groups B and D (P＜0.01), but still higher than that of group A (P＜0.01), suggesting that persephin gene transfer could attenuate apoptosis to some extent. ③ Apoptotic rate: The apoptotic rate in groups B and D were obviously higher than that in group A (P ＜ 0.01), and it was lower in group C than in groups B and D (P＜0.01).CONCLUSION:Recombinant adenovirus can efficiently mediate Persephin gene transfer into C17.2 neural stem cells,resulting in high expression of the exogenous Persephin in vitro, which effectively reduces C17.2 neural stem cell apoptosis induced by hypoxia.