Evolution in the indications for anti-viral therapy in chronic hepatitis B / 临床肝胆病杂志

In order to reduce the disease burden of chronic hepatitis B (CHB) and improve the treatment rate of CHB, the indications for anti-viral therapy have been gradually expanded and simplified in guidelines for the prevention and treatment of CHB released by Chinese Medical Association from 2005 to 2022. This article elaborates on the evolution in the indications for anti-viral therapy in CHB from the five aspects of converging indications of HBeAg-positive and HBeAg-negative CHB, reduction in the treatment threshold of HBV DNA, reduction in the treatment threshold of serum alanine aminotransferase, emphasis on the risk factors for disease progression, and gradual loosening of the requirements for virological indicators in patients with liver cirrhosis.

Changes in coronal spino-pelvis alignment in patients with developmental hip dysplasia / 中华骨科杂志

Objective:To investigate the changes in coronal spino-pelvis alignment in patients with developmental dysplasia of the hip (DDH) and effects of total hip arthroplasty on it.Methods:This study included 48 patients (6 males and 42 females) with DDH who underwent total hip arthroplasty from January 2009 to December 2019 at the Department of Orthopaedics, the PLA General Hospital. The average age of patients was 42.81±10.42 years (range, 22 to 61 years), whose follow-up time was 10.31±2.62 months (range, 3 to 18 months). Eleven cases underwent bilateral hip replacements and 37 cases underwent unilateral hip replacements, which included 13 hips in Crowe I, 7 hips in II, 4 hips in III, 35 hips in IV. The coronal spino-pelvic parameters were measured with all patients, including Cobb angle, coronal balance distance (CBD), sacral obliquity (SO), iliac obliquity (IO), hip obliquity (HO), L 5 obliquity (L 5O) and leg length. Results:The interobserver reliability of IO, SO, HO and L 5O in patients with DDH was 0.965, 0.875, 0.912 and 0.934. The interobserver reliability of IO, SO, HO and L 5O was 0.887, 0.889, 0.892 and 0.907. Thirty-three patients diagnosed with DDH had leg length discrepancy, which the incidence was 69% (33/48). The incidence of scoliosis of patients was 58% (28/48). The incidence of pelvic obliquity was 96% (46/48). The preoperative IO was 6.71°±4.62° and the postoperative IO was 3.52°±3.14°, the difference was statistically significant ( t=4.81, P<0.001). The preoperative SO was 6.38°±5.48° and the postoperative SO was 3.72°±3.38°, the difference was statistically significant ( t=3.91, P<0.001). The preoperative HO was 5.32°±5.83° and the postoperative HO was 3.71°±3.62°, the difference had not statistically significant ( t=1.85, P=0.071). The preoperative L 5O was 6.12°±5.46° and the postoperative L 5O was 4.33°±4.71°, the difference had statistically significant ( t=2.15, P=0.037). The preoperative Cobb angle was 11.05°±10.76° and the postoperative Cobb angle was 6.82°±7.76°, which had a statistically difference ( t=4.07, P=0.001). There is no significant difference of preoperative CBD and postoperative CBD, which was 14.22±10.64 mm vs. 13.73±12.58 mm ( t=0.24, P=0.821). Cobb angle was positively correlated with SO and IO ( r=0.61, P<0.001; r=0.57, P<0.001). Conclusion:Causes coronal pelvic obliquity in patients with DDH included leg length discrepancy and hip dislocation. Coronal pelvic obliquity can lead to compensatory scoliosis, which alters the overall coronal spino-pelvic alignment of patients with DDH. However, they can still maintain coronal balance. Total hip arthroplasty could improve the degree of coronal pelvic obliquity significantly and compensatory scoliosis in patients with DDH.

Comparative analysis of C-TIRADS and ACR-TIRADS in the diagnostic efficiency of thyroid nodules / 中华健康管理学杂志

Objective:To investigate the diagnostic efficiency of the 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) and the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) in the diagnosis of benign and malignant thyroid nodules.Methods:A retrospective analysis of the two-dimensional ultrasound image results of 324 thyroid nodules in 289 patients with thyroid nodules and thyroid nodules were performed in the physical examination of the Health Management Department of the Guangdong Second Provincial General Hospital from January 2018 to January 2019. A superficial professional doctor with a senior professional title simultaneously uses the C-TIRADS and ACR-TIRADS methods to evaluate the above nodules. The results are all pathologically referenced for the χ2 test and the receiver operating characteristic curve is drawn. Results:The sensitivity of C-TIRADS in diagnosing benign and malignant thyroid nodules was 81.90%, specificity was 97.72%, accuracy was 92.59%, negative predictive value was 91.85%, positive predictive value was 84.51%; ACR-TIRADS diagnosis The sensitivity of benign and malignant thyroid nodules was 59.05%, specificity was 99.54%, accuracy was 86.42%, negative predictive value was 83.52%, and positive predictive value was 98.41%. The area under the ROC curve was 0.958 and 0.935( Z=2.31 P=0.021). Conclusion:C-TIRADS classification based on counting method is better than ACR-TIRADS classification based on sub-method in the diagnosis of thyroid nodules. It has better efficacy and is more suitable for the current status of diagnosis and treatment of thyroid nodules in China.

Application of three-dimensional shear wave elastography in the differential diagnosis of benign and malignant breast masses / 中华超声影像学杂志

Objective:To evaluate the application value of three-dimensional shear wave elastography(3D-SWE) with quantitative parameters and qualitative analysis of stiff rim sign in differentiating benign and malignant breast masses.Methods:One hundred and seventeen female patients (121 breast masses) admitted to the First Affiliated Hospital of Soochow University from January 2020 to February 2021 were examined by conventional ultrasound, two-dimensional shear wave elastography (2D-SWE) and 3D-SWE. Surgical or puncture pathology were used as the gold standard, the ROC curves of 2D-SWE and 3D-SWE were drawn to obtain the optimal qualitative and quantitative indicators. Afterwards, BI-RADS category was adjusted according to the optimal indicators, which could be used to evaluate the diagnostic value in differentiating benign and malignant breast masses.Results:The area under ROC curve (AUC) of BI-RADS category was 0.846, the sensitivity and specificity were 89.6% and 79.6%, respectively. The AUC value of mass-to-fat elasticity ratio(Eratio) of coronal plane was 0.869, which was the highest among all quantitative parameters and was significantly higher than that of 2D-SWE ( P<0.05). In addition, the AUC value of stiff rim sign of coronal plane was significantly higher than those of 2D-SWE, sagittal plane and transverse plane (All P<0.05). The AUC of combination of stiff rim sign of coronal plane and conventional US was 0.901, which was significantly higher than that using conventional ultrasound alone( P<0.05). Conclusions:Compared with 2D-SWE, Eratio and stiff rim sign of coronal plane of 3D-SWE yield better diagnostic efficiency.Adjusting stiff rim sign coronal plane to BI-RADS category can effectively improve the diagnostic efficiency.

Crescent sign for predicting the invasiveness of lung adenocarcinoma with pure ground-glass opacity / 中华放射学杂志

Objective:To evaluate the value of the crescent sign for predicting the invasiveness of lung adenocarcinoma presenting as pure ground-glass nodule (pGGN).Methods:The clinical, pathological and imaging data of 316 patients (320 pGGNs) confirmed lung adenocarcinoma by surgery and pathology from July 2013 to June 2018 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. All pGGNs were divided into preinvasive group (148 pGGNs) and invasive group (172 pGGNs) according to histopathology. Logistic regression analysis was used to determine the risk factors for invasiveness of pGGN, and the ROC curve analysis was performed on each risk factor.Results:Crescent sign was found in 24 cases (16.2%) in the preinvasive group and 49 (28.5%) in the invasive group, and the difference between the two groups was statistically significant (χ2=6.804 ,P=0.009).There were statistically significant differences in patient′s age, lesion size, shape, lobulation sign, and vascular stretch sign between the two groups ( P<0.05). The ROC curve showed that with the lesion size 10.5 mm as the optimal cut off value, the sensitivity for differential diagnosis of preinvasive and invasive lesions was 65.7%, the specificity was 61.5%, and the area under the curve was 0.666. Logistic regression analysis showed that maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch were independent risk factors of invasiveness of pGGN, and the OR value (95%CI) were 3.192 (1.981-5.144), 3.672 (1.545-8.725), 1.972 (1.104-3.521), and 2.026 (1.087-3.777), respectively. A logistic model was established based on the above four independent risk factors, and the area under curve was 0.711 (95%CI 0.655-0.768). Conclusion:Crescent sign can effectively reflect the invasiveness of pGGN. Maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch sign are independent risk factors of invasiveness of pGGN.

Correlation of type 2 diabetes and impaired glucose regulation with chronic kidney disease in middle-aged and elderly individuals / 南方医科大学学报

OBJECTIVE@#To explore the correlation of different glucose metabolism statues with chronic kidney disease (CKD) in middle-aged and elderly individuals in Lanzhou.@*METHODS@#Based on the baseline data of REACTION Study in Lanzhou area, we randomly sampled 10 038 residents aged 40-75 years in 3 communities in Lanzhou, who were classified into normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes groups. The estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used to assess the renal function and albuminuria, respectively. Binary logistic regression was performed to analyze the contribution of the risk factors to CKD. Polynominal regression was used to determine the trends of eGFR with the increment of ACR.@*RESULTS@#Among all the participants, the prevalences of albuminuria, CKD and renal insufficiency (RI) were 26.2%, 27.4% and 2.5%, respectively. The prevalence of albuminuria, CKD and RI were significantly higher in the diabetes group than in IGR and NGT groups (@*CONCLUSIONS@#Diabetes mellitus is a significant risk factor for albuminuria and RI, while IGR is not. Screening for albuminuria and eGFR is highly recommended for individuals with diabetes, hypertension, and obesity, especially in women and the elderly population.

Study on the correlation between HER-2 expression status and multimode ultrasonic characteristics in ER-negative breast cancer / 中华超声影像学杂志

Objective@#To explore the correlation between the expression status of human epidermal growth factor receptor 2 (HER-2) and the characteristics of conventional ultrasound, shear wave elastography(SWE) and contrast enhanced ultrasound(CEUS) images in breast cancer patients with negative expression of estrogen receptor (ER).@*Methods@#In this study, 117 patients with 117 lesions were selected from the Second Hospital of Harbin Medical University Hospital, who had definite pathology and ER negative expression, including 62 patients with positive HER-2 (group Ⅰ) and 55 patients with negative HER-2(group Ⅱ). Conventional ultrasound images and SWE were collected preoperatively, and CEUS images were collected in 62 patients to analyze the correlation between the expression of HER-2 and the ultrasonic characteristics of the three ultrasonic modes.@*Results@#①Conventional ultrasound: the groupⅠwas characterized by irregular shape, unclear boundary, mainly with spicule edges, microcalcification, axillary lymph node metastasis and higher histological grading. The groupⅡhad no such characteristics (all P<0.05). ②SWE: the Emax, Emean and Eratio of group Ⅰ were higher than group Ⅱ(all P<0.05). ③CEUS: the peak time of group Ⅰ was earlier than group Ⅱ, the slope of ascending branch and the area under the curve were larger, and the characteristics of perforating vessels were easier to be observed, while perfusion defects were more likely to occur in groupⅡ(all P<0.05).@*Conclusions@#In the case of ER negative expression, there are obvious differences in multimodal sonograms of different breast cancer HER-2 expression conditions. The analysis of the above sonograms will play an important guiding role in the selection of clinical treatment plans.

A comparative analysis of CT features and pathological types of small lung invasive adenocarcinoma with air-containing space / 中华放射学杂志

Objective@#To evaluate the CT features of small lung invasive adenocarcinoma with air-containing space and its relationship with pathological types, and to explore the pathological basis of air-containing space.@*Methods@#CT and pathological data of fifty patients with surgically proven lung invasive adenocarcinoma with air-containing space in our hospital from January 2012 to December 2017 were retrospectively reviewed. CT image analysis included image features of tumor and air-containing space. Pathological analysis included pathological subtype, differentiation degree. CT features of tumor and air-containing space were compared with regard to pathological types using chi-square test or Fisher exact text. Analysis of variance was used to compare quantitative data satisfying normal distribution, while those data not satisfying normal distribution were compared with Kruskal-Wallis test. In addition, Spearman correlation was used to analyze the correlation between nodule density and pathological types.@*Results@#(1) CT features of tumors: Tumors were predominantly located in peripheral lungs (46/50). Most of the tumors were subsolid nodules (37/50). Tumor-lung interface was generally clear (46/50). Tumors are often accompanied by malignant signs such as lobulation (37/50), spicule sign (27/50), air bronchogram sign (43/50), and pleural indentation (36/50). The mean diameter of nodules ranged from 7.50 mm to 18.12 mm, with an average of (12.91±2.85)mm. The nodule density ranged from-657.00 to 73.00 HU with an average of (-213.88±206.16) HU. (2) CT features of air-containing space: Air-containing spaces were commonly solitary (37/50) and were found to be mainly in an eccentric distribution (29/37). The maximum diameter of air-containing space ranged from 1.00 to 16.00mm, and the average diameter was (4.23±3.14)mm. Air-containing spaces less than 5mm were found in 35 cases (70%), and air-containing spaces more than 5mm were found in 15 cases. (3) Comparison of CT features and corresponding pathological types: Nodule density, number of air-containing space, and type of nodule density in different pathological types were statistically different (P<0.05). There was a correlation between nodule density and pathological subtypes (r=0.371, P=0.008). Differences of nodule density, short-dimension of nodule, type of nodule density, spicule sign, pleural indentation among different tumor differentiation degrees were significant (P<0.05). The degree of tumor differentiation was negatively correlated with nodule density (r=-0.451, P=0.001).@*Conclusion@#The detection rate of air-containing space in lung invasive adenocarcinomas is 12.7%. Most small lung invasive adenocarcinomas with air-containing space are presented as peripheral subsolid nodule, and there is a certain correlation between their CT features and pathological types. The pathological basis of air-containing space was supposed to be dilated distal bronchiole induced by check-valve mechanism and destruction of alveolar structure by tumor.

A comparative analysis of CT features and pathological types of small lung invasive adenocarcinoma with air?containing space / 中华放射学杂志

Objective To evaluate the CT features of small lung invasive adenocarcinoma with air?containing space and its relationship with pathological types, and to explore the pathological basis of air?containing space. Methods CT and pathological data of fifty patients with surgically proven lung invasive adenocarcinoma with air?containing space in our hospital from January 2012 to December 2017 were retrospectively reviewed. CT image analysis included image features of tumor and air?containing space. Pathological analysis included pathological subtype, differentiation degree. CT features of tumor and air?containing space were compared with regard to pathological types using chi?square test or Fisher exact text. Analysis of variance was used to compare quantitative data satisfying normal distribution, while those data not satisfying normal distribution were compared with Kruskal?Wallis test. In addition, Spearman correlation was used to analyze the correlation between nodule density and pathological types. Results (1) CT features of tumors: Tumors were predominantly located in peripheral lungs (46/50). Most of the tumors were subsolid nodules (37/50). Tumor?lung interface was generally clear (46/50). Tumors are often accompanied by malignant signs such as lobulation (37/50), spicule sign (27/50), air bronchogram sign (43/50), and pleural indentation (36/50). The mean diameter of nodules ranged from 7.50 mm to 18.12 mm, with an average of (12.91±2.85)mm. The nodule density ranged from-657.00 to 73.00 HU with an average of (-213.88±206.16) HU. (2) CT features of air?containing space:Air?containing spaces were commonly solitary (37/50) and were found to be mainly in an eccentric distribution (29/37). The maximum diameter of air?containing space ranged from 1.00 to 16.00mm, and the average diameter was (4.23±3.14)mm. Air?containing spaces less than 5mm were found in 35 cases (70%), and air?containing spaces more than 5mm were found in 15 cases. (3) Comparison of CT features and corresponding pathological types: Nodule density, number of air?containing space, and type of nodule density in different pathological types were statistically different (P<0.05). There was a correlation between nodule density and pathological subtypes (r=0.371, P=0.008). Differences of nodule density, short?dimension of nodule, type of nodule density, spicule sign, pleural indentation among different tumor differentiation degrees were significant (P<0.05). The degree of tumor differentiation was negatively correlated with nodule density (r=-0.451, P=0.001). Conclusion The detection rate of air?containing space in lung invasive adenocarcinomas is 12.7%. Most small lung invasive adenocarcinomas with air?containing space are presented as peripheral subsolid nodule, and there is a certain correlation between their CT features and pathological types. The pathological basis of air?containing space was supposed to be dilated distal bronchiole induced by check?valve mechanism and destruction of alveolar structure by tumor.

Study on the correlation between HER-2 expression status and multimode ultrasonic characteristics in ER-negative breast cancer / 中华超声影像学杂志

Objective To explore the correlation between the expression status of human epidermal growth factor receptor 2 (HER-2) and the characteristics of conventional ultrasound,shear wave elastography(SWE) and contrast enhanced ultrasound (CEUS) images in breast cancer patients with negative expression of estrogen receptor (ER).Methods In this study,117 patients with 117 lesions were selected from the Second Hospital of Harbin Medical University Hospital,who had definite pathology and ER negative expression,including 62 patients with positive HER-2 (group Ⅰ) and 55 patients with negative HER-2(group Ⅱ).Conventional ultrasound images and SWE were collected preoperatively,and CEUS images were collected in 62 patients to analyze the correlation between the expression of HER-2 and the ultrasonic characteristics of the three ultrasonic modes.Results ① Conventional ultrasound:the group Ⅰ was characterized by irregular shape,unclear boundary,mainly with spicule edges,microcalcification,axillary lymph node metastasis and higher histological grading.The group Ⅱ had no such characteristics (all P ＜0.05).②SWE:the Emax,Emean and Eratio of group Ⅰ were higher than group Ⅱ (all P ＜0.05.③CEUS:the peak time of group Ⅰ was earlier than group Ⅱ,the slope of ascending branch and the area under the curve were larger,and the characteristics of perforating vessels were easier to be observed,while perfusion defects were more likely to occur in group Ⅱ (all P ＜0.05).Conclusions In the case of ER negative expression,there are obvious differences in multimodal sonograms of different breast cancer HER-2 expression conditions.The analysis of the above sonograms will play an important guiding role in the selection of clinical treatment plans.

Applied value of routine ultrasound and shear wave elastography in the diagnosis of triple negative breast cancer / 中华超声影像学杂志

Objective To investigate the applied value of routine ultrasound and shear wave elastography (SWE) in the comparison between triple negative breast cancer ( TNBC) and non-triple negative breast cancer (non-TNBC) . Methods A total of 120 lesions in 120 patients with pathologically confirmed breast cancer were retrospectively reviewed ,which were examined by routine ultrasound and SWE before surgery . According to immunohistochemical analysis ,those were divided into TNBC group and non-TNBC group . The features of routine ultrasound ( including shape ,orientation ,margin ,boundary ,echo pattern ,microcalcification ,posterior features of each lesion and blood flow characteristics) and the SWE index[including the average value of the lesion stiffness(Emean) ,the maximum value (Emax) ,the minimum value (Emin) ,the standard deviation (SD) ,and the ratio of the normal breast gland tissue (Eratio)] in the two groups were analyzed and compared . Results ① Two-dimensional ultrasound :TNBC lesions mostly showed the margin of microlobulated ,abrupt boundaries and no internal microcalcification ,but non-TNBC lesions were more likely to have an angular or spiculated margin ,an echogenic halo of boundary and a few microcalcification in the interior ,which were statistically different( P ＜0 .05) . The grade of blood flow and resistance index between TNBC and non-TNBC group showed no statistical difference( P ＞0 .05) . ② The values of Emax ,Emean and Eratio were statistically different( P ＜0 .05) ,with AUCs of 0 .811 ,0 .781 ,and 0 .770 , respectively . Conclusions Routine ultrasound and SWE can comprehensively analyze the morphology ,blood flow and stiffness features of breast lesions ,which provides more valid information to identify T NBC and non-T NBC .

RPS15a Silencing Suppresses Cell Proliferation and Migration of Gastric Cancer

PURPOSE: Information on the possible role of the ribosomal protein S15a (RPS15a) in gastric cancer is scarce. The aim of this study was to evaluate the impact of RPS15a gene expression on the growth and cell cycle of gastric cancer cells in vitro and in vivo. MATERIALS AND METHODS: RPS15a mRNA expression was examined in cancer tissues and their corresponding adjacent normal tissues of 40 gastric adenocarcinoma patients. Next, RPS15a was knocked down using a lentivirus-mediated RNA interference (short hairpin RNA) system in the gastric cancer cell line BGC823. The effect of RPS15a knockdown was examined using CCK-8 assay, cell scratch test, colony formation assay, and flow cytometry. Finally, in nude mice, a tumorigenicity test was performed, and the tumor volume and weight were measured. RESULTS: RPS15a expression in tumor tissue was significantly greater than that in the adjacent normal tissue of gastric cancer patients. After RPS15a silencing, the BGC823 cell proliferation rate decreased significantly; most cells were arrested in the G0/G1 phase, cell growth was inhibited, and the migration rate was decreased. Colony formation assay showed that the number and size of clones in the RPS15a-silenced cells were fewer and smaller, compared to control cells. The nude mouse tumorigenicity test showed that RPS15a silencing had an inhibitory effect on tumor volume and mice weight. CONCLUSION: The present study found RPS15a expression to be higher in gastric tumors and its silencing in gastric cancer cells to inhibit the proliferation, growth, and migration thereof. Accordingly, RPS15a may be considered as a potential therapeutic target in gastric cancer.

Effect of emotional freedom technique on perceived stress, anxiety and depression in cancer patients: a preliminary experiment / 现代临床护理

Objective To evaluate the effect of emotional freedom technique (EFT) on the levels of perceived stress, anxiety and depression in cancer patients. Methods Fifteen cancer patients received the intervention of EFT once per day for one week. The effect was evaluated with the Chinese version of perceived stress scale (CPSS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) before and after the intervention. Result The total scores of SAS, CPSS and SDS after the intervention were significantly lower than those before the intervention (P<0.01). Conclusion EFT can effectively reduce the levels of perceived stress, anxiety and depression in cancer patients.

Short-term and medium-term outcomes after off-pump coronary artery bypass grafting in patients with renal functional damage / 解放军医学杂志

Objective To investigate the short- and mid-term outcomes of after off-pump coronary artery bypass grafting (OPCABG) in patients with severe elevation of preoperative serum creatinine levels (SEPSC). Methods The perioperative data of SEPSC patients undergoing OPCABG were investigated based on the perioperative CABG database from Feb. 2012 to Jul. 2016. The patients were also followed up for the perioperative complication, short and medium-term survival were estimated. Results The mean age of the patients was 65.4(45-85) years. The in-hospital mortality was 4.4% and the CRRT rate was 19.6%(9 case). Survival analyses revealed a survival ratio of 100% at one year, 97.6% at two years. Short-Form Mini Nutritional Assessment was used to show that 13(28.3%) patients had malnutrition. Conclusions SEPSC patients can be candidates for OPCABG procedure. The mortality in hospital and 2-year survival rate of SEPSC patients after OPCABG procedure are both considered within an acceptable range. OPCABG may be performed in these patients with a satisfactory survival rate with the development of surgical instruments and medical treatment.

Risk factors of continuous renal replacement therapy in patients with preoperative severe renal injury undergoing off-pump coronary artery bypass grafting / 临床麻醉学杂志

Objective To analyze risk factors of continuous renal replacement therapy (CRRT) in patients with severe serum creatinine levels elevation undergoing off-pump coronary artery bypass grafting (OPCABG).Methods The perioperative data of 45 patients with severe elevation of preoperative serum creatinine levels undergoing OPCABG were investigated based on the perioperative CABG database from Feb, 2012 to Jul, 2016.The postoperative treatment rates of CRRT were recorded and the risk factors were identified by multivariate logistic regressions.Results There were 9 patients (20%) who suffered from CRRT after OPCABG in all 45 recruitment patients.Compared with non-CRRT patients, there were higher levels of serum creatinine (Cr) and blood urea nitrogen (BUN) before surgery, a lower volume of urine during surgery, a higher level of serum creatinine at postoperative 12 hour and 24 hour, longer ICU staying time and higher in-hospital mortality after surgery in patients with CRRT (P＜0.05 or P＜0.01).Multivariate logistic regression analysis demonstrated that preoperative level of serum creatinine (OR=1.05, 95% CI 1.05-1.10, P=0.046) was the independent risk factor of postoperative CRRT in patients with severe serum creatinine levels elevation undergoing OPCABG.At the value of postoperative 12 hour serum creatinine up to 166 μmol/L, the incidence of postoperative CRRT in patients increased 5% by postoperative 12 hour serum creatinine increasing 1 μmol/L(OR=1.05, 95% CI 1.01-1.08, P=0.013).However at the value of postoperative 12 hour serum creatinine above 350 μmol/L, ceiling effect was apparent.Conclusion This study shows that 20% patients with preoperative severe serum creatinine level elevation are suffered from CRRT after OPCABG procedure and preoperative level of serum creatinine is predominant factor of postoperative CRRT.

The Application and Effectiveness Evaluation of Continuing Care Based on Humanistic Care for Out Patients with Facial Plastic Surgery / 中国医学伦理学

Objective:To evaluate the effect of continuing care in facial plastic operation .Method:Select 120 patients who had aesthetic plastic surgery in our hospital during the period from January to July in 2014 and ran-domize them into the observation group (60 cases)and the control group (60 cases).The control group merely re-ceive conventional treatment .The observation group is employed continuing care based on conventional treatment . Results:The satisfaction of two groups has no significant difference a week after operation (P>0.05).Six months after operation , the satisfaction of the observation group is obviously higher than that of the control group .The difference is statistically different ( P<0 .0001 ) .The anxiety level of the observation group is obvious lower than that of the control group and the difference is Statisticallydifferent ( P<0 .0001 ) .Conclusion: Based on the hu-manistic care, carry on the continuing care could considerately improve the satisfaction of patients in clinic facial plastic surgery and is one of the most important solution of preventing medical disputes ;mean while , it is also one of the most effective stress reduction measures which makes the patients feel humanized nursing .

Efficacy and safety of different kinds of anticoagulation methods in hemodialysis patients with high risk of hemorrhage / 中国实用护理杂志

Objective To observe the efficacy, safety and feasibility of the four kinds of anticoagulation method in hemodialysis patients with high risk of hemorrhage. Methods 128 patients with high risk of hemorrhage who had undergone hemodialysis were randomly divided into four groups. In group A, 68patients were resorted with 30% regional sodium citrate anticoagulation(RCA). In group B, 60 patients were treated with local heparin anticoagulation. In group C, 64 patients were treated with low molecular weight heparin (LMWH). In group D, 66 patients received no heparinization hemodialysis. The changes of bleeding, clotting function, adverse effect and nursing strategies were studied. Results All patients of group A completed regular hemodialysis with satisfactory indices, 6 cases with bleeding and primary bleeding aggravated in group B, 8 cases with bleeding and primary bleeding aggravated in group C, 8 cases occurred grade three coagulation and finished dialysis in group D. 3 cases in group A and 2 cases in group B occurred adverse reaction, but no adverse reaction was seen in group C and D. Conclusions RCA is safe,effective and can be easily handled in regular hemodialysis. It is an ideal dialysate for hemodialysis in patients with high risk of hemorrhage.