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Objective@#To evaluate the reliability and validity of Chinese version of the Hypertensive Intracerebral Hemorrhage Empowerment Scale-Short Form (C-HICHES-SF).@*Methods@#A total of 207 hypertensive intracerebral hemorrhage patients treated in the Department of Neurology inpatients of a three-grade hospital in Tianjin from August 2017 to January 2018 were selected by convenient sampling method. Chinese Diabetes Empowerment Scale-Short Form (C-DES-SF) was adapted into C-HICHES-SF by expert enquiry and the patients were surveyed. SPSS 24.0 and AMOS 24.0 were used for data processing.@*Results@#C-HICHES-SF contains 8 items. Its Cronbach α was 0.833, Sperman's half-reliability was 0.797, Guttman's half-reliability was 0.742, test-retest reliability was 0.787, content validity was 0.943. one common factor was extracted by exploratory factor analysis, and could explain 52.36% of the variance contribution.the confirmatory factor analysis revealed a good fit of the model to the date based on various fit indices (χ2/df ratio=1.172, GFI=0.997, AGFI= 0.949, NFI= 0.980, CFI=0.980, TLI=0.994, RMSEA=0.029).@*Conclusion@#C-HICHES-SF has fewer articles and easy to use. It has good reliability and validity in patients with hypertensive intracerebral hemorrhage, It can be used as an effective tool to measure empowerment ability.
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Objective To evaluate the reliability and validity of Chinese version of the Hypertensive Intracerebral Hemorrhage Empowerment Scale-Short Form (C-HICHES-SF). Methods A total of 207 hypertensive intracerebral hemorrhage patients treated in the Department of Neurology inpatients of a three-grade hospital in Tianjin from August 2017 to January 2018 were selected by convenient sampling method. Chinese Diabetes Empowerment Scale-Short Form(C-DES-SF)was adapted into C-HICHES-SF by expert enquiry and the patients were surveyed. SPSS 24.0 and AMOS 24.0 were used for data processing. Results C-HICHES-SF contains 8 items. Its Cronbach α was 0.833, Sperman's half-reliability was 0.797, Guttman's half-reliability was 0.742, test-retest reliability was 0.787, content validity was 0.943. one common factor was extracted by exploratory factor analysis, and could explain 52.36% of the variance contribution.the confirmatory factor analysis revealed a good fit of the model to the date based on various fit indices ( χ2/df ratio=1.172, GFI=0.997, AGFI=0.949, NFI=0.980, CFI=0.980, TLI=0.994, RMSEA=0.029). Conclusion C-HICHES-SF has fewer articles and easy to use. It has good reliability and validity in patients with hypertensive intracerebral hemorrhage, It can be used as an effective tool to measure empowerment ability.
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Objective To evaluate the efficacy and safety of heated gel mattress(HGM) for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods Systematic searches on PubMed, EMBASE, Cochrane Library, Web of Science CBM,CNKI,Wanfang and VIP were performed for randomized controlled trials or quasi-randomized control trials which explored the effects of HGM on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria,extracting data and assessing quality. Then, Meta-analysis and trial sequential analysis were performed by using RevMan 5.3 and TSA v0.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results This systematic review included 10 studies which comprised 7 randomized controlled trials and 3 quasi-randomized control trials, encompassing 773 patients. The results of Meta-analysis showed that in HGM group admission temperature on neonatal intensive care unit (standardized mean difference was 0.63, 95% confidence interval was 0.40-0.87, P=0.00), incidence of hypothermia (relative risk was 0.73, 95% confidence interval was 0.57-0.93, P=0.01) and hyperthermia (relative risk was 1.82, 95% confidence interval was 1.31-2.54, P=0.00) compared with the control group had significantly statistical difference;however, there was no significant difference in admission temperature on EM or TWM group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage III/IV between two groups. TSA confirmed that the pooled results of admission temperature on NICU and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusions HGM is an effective rewarming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia but not decrease the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever and complications. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, high-quality research.
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Objective To analyze the accuracy of staging among the combination of endoscopic biopsy sites,operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) with five different biopsy sites.Methods From January 2014 to September 2015,patients with functional dyspepsia and undergoing gastroendoscopy examination were enrolled.According to update Sydney system,a total of five biopsy pieces were obtained from lesser curvature of gastric body,larger curvature of gastric body,gastric angle,larger curvature of antrum and lesser curvature of antrum.The degrees of atrophy and intestinal metaplasia were determined and staged according to OLGA and OLGIM.Kappa test and chi-square test were performed for the statistical analysis.Results A total of 268 patients were enrolled.The incidences of atrophy and intestinal metaplasia in different sites were as follow:30.4％ (113/372) and 31.0％ (111/358) in lesser curvature of antrum;26.1％(97/372) and 25.1％(90/358) in gastric angle;20.2％(75/372) and 15.4％(56/358) in larger curvature of antrum;14.8％(55/372) and 15.4％(55/358) in lesser curvature of gastric body;8.6％(32/372) and 8.1％(29/358) in larger curvature of gastric body.The incidences of atrophy and intestinal metaplasia of lesser curvature of antrum were significantly higher than those of larger curvature of gastric body,lesser curvature of gastric body and larger curvature of antrum (x2 =45.248,48.029,20.024,18.892,7.681 and 7.848;all P＜＜0.05).The incidences of atrophy and intestinal metaplasia of gastric angle were significantly higher than those of lesser curvature and larger curvature of gastric body(x2 =32.752,31.269,11.605 and 8.448;all P＜0.05).The incidences of atrophy and intestinal metaplasia of the lesser curvature of gastric body and larger curvature of antrum were higher than those of larger curvature of gastric body,and the differences were statistically significant (x2 =6.080,8.048,17.280,18.980,all P＜0.05).The incidences of mild atrophy and intestinal metaplasia of the lesser curvature of antrum were 20.2 ％ (75/ 372) and 21.2％ (76/358),respectively,which were higher than those of larger curvature of antrum (12.9％,48/372 and 12.8％,46/358),and the differences were statistically significant (x2 =5.927 and 7.377,both P＜0.05).The incidence of severe atrophy of lesser curvature of antrum was 2.4％ (9/372),respectively,which was higher than that of larger curvature of antrum (0.8％,3/372),and the difference was statistically significant (x2 =3.000,P =0.015).The incidences of mild atrophy and intestinal metaplasia of the lesser curvature of gastric body were 10.5％ (39/372) and 11.2％ (40/358),respectively,which were higher than those of larger curvature of gastric body (5.4 ％,20/372 and 5.9 ％,21/358),and the differences were statistically significant (x2 =6.119 and 5.918,both P＜0.05).The consistency of staging by three biopsy sites (lesser curvature of gastric body,gastric angle and lesser curvature of antrum) and five biopsy sites with OLGA and OLGIM was 94.0 ％ (95 ％ confidence interval (CI) =91.2％ to 96.9％,Kappa value=0.912,P＜0.01) and 92.9％ (95％CI:89.8％ to 96.0％,Kappa value=0.893,P＜0.01).Conclusion Three biopsy sites (lesser curvature of gastric body,gastric angle and lesser curvature of antrum) could accurately reflect gastric mucosa lesions with less biopsy tissues and it is worthy of clinical popularization and application.
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Background:Oryz-Aspergillus Enzyme and Pancreatin Tablet is a double-deck digestive enzyme pellet containing Oryz-Aspergillus enzyme and pancreatin that has been widely used for treatment of functional dyspepsia (FD)in clinical practice. However,there is no randomized controlled trial focusing on the efficacy of this agent versus other drugs used for treatment of FD such as prokinetics and proton pump inhibitors (PPI). Aims:To compare the efficacy and safety among Oryz-Aspergillus Enzyme and Pancreatin Tablet,Domperidone Tablet and Esomeprazole Magnesium Enteric-coated Tablet, three drugs with different mechanisms of action on FD,in Chinese population. Methods:A total of 82 Helicobacter pylori-negative outpatients fulfilling the diagnostic criteria of FD in Rome Ⅲ were recruited from Nov. 2015 to Jun. 2016 at the First Affiliated Hospital of Zhejiang Chinese Medical University. These patients were randomly allocated into 3 groups,and received Oryz-Aspergillus Enzyme and Pancreatin Tablet (group A),Domperidone Tablet (group B)and Esomeprazole Magnesium Enteric-coated Tablet (group C)orally for 4 weeks,respectively. The improvement of dyspeptic symptoms and adverse events were observed and recorded. Results:After 4 weeks treatment,the overall efficacies for global symptoms in group A,group B and group C were 93. 1%,88. 9% and 69. 2%,respectively,statistically significant difference was existed among the three groups (P < 0. 05). Domperidone Tablet was effective for postprandial fullness and early satiety;Esomeprazole Magnesium Enteric-coated Tablet was sensitive for epigastric pain,epigastric burning,and belching and regurgitation;the efficacies of Oryz-Aspergillus Enzyme and Pancreatin Tablet for all five dyspeptic symptoms were in between. No adverse events were observed during treatment course. Conclusions:Digestive enzymes,prokinetics and PPI have different sensitive symptoms and optimal indications for treatment of FD. The overall efficacy of Oryz-Aspergillus Enzyme and Pancreatin Tablet is superior to that of prokinetics and PPI.
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Noninfectious diarrhea is a kind of digestive disease caused by many factors and the main clinical features are increased frequency of defecation and change of character of stool,most of the patients have intestinal microecological imbalance. Improving the intestinal microecological balance is very important in the treatment of noninfectious diarrhea. Microbial ecological agent(MEA)has definite efficacy for the treatment of noninfectious diarrhea,and gradually becomes the commonly used drug for noninfectious diarrhea in clinical practice. This article reviewed the use of MEA in the treatment of noninfectious diarrhea.
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Objective To compare the levels of the serum pepsinogen (PG) in the gastric diseases, and explore the diagnostic value in gastric diseases. Methods Two hundred and fourteen patients who had undergone endoscopy were selected, and the patients were divided into 3 groups according to the results of endoscope pathological diagnosis:chronic superficial gastritis (CSG) group ( 70 cases), chronic atrophic gastritis (CAG) group (86 cases) and gastric cancer (GC) group (58 cases). The quantitative chemiluminescence method was used to test serum PGⅠand PGⅡ, and the PGⅠ/PGⅡratio (PGR) was calculated. Results The PGⅠin GC group was significantly higher than that in CAG group: (78.41 ± 55.42) μg/L vs. (53.10 ± 30.08) μg/L, and there was statistical difference (P0.05). The PGⅡin GC group was significantly higher than that in CAG group and CSG group: (23.26 ± 17.80) μg/L vs. (13.12 ± 10.23) and (13.78 ± 9.26) μg/L, the PGR was significantly lower than that in CAG group and CSG group:3.67±2.03 vs. 4.88 ± 1.82 and 5.24 ± 1.88, and there were statistical differences (P0.05. The PGⅡin Hp positive group was significantly higher than that in Hp negative group: (19.58 ± 1.57) μg/L vs. (14.09 ± 13.21) μg/L, the PGR was significantly lower than that in Hp negative group: 3.82 ± 0.18 vs. 4.99 ± 0.18, and there were statistical differences (P<0.05). Conclusions Compared with that in the CSG and CAG patients, the PG Ⅱ in GC patients increases significantly, while PGR descends significantly, but PG Ⅰ has no correlation with the risk of GC. The PG Ⅱ combined with PGR can predict people with high risk of GC, and help with the judgment of Hp infection.
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Objective To investigate the effects of transcutaneous electro acupuncture stimulation (TEA) on esophageal motility of patients with refractory gastroesophageal reflux disease (RGERD) by high resolution manometry (HRM),and to provide a new treatment option for RGERD.Methods From February 2014 to June 2015,a total of 45 patients with RGERD were enrolled.TEA instrument was used for electro acupuncture stimulation at the points of Zusanli and Neiguan.HRM was carried out before and after treatment.The changes of HRM parameters such as lower esophageal sphincter pressure (LESP),distal contractile integral (DCI),and amplitude of 3 cm,7 cm above lower esophageal sphincter (LES),esophageal body velocity and contractile front velocity (CFV) were also compared.The paired-samples t test was performed for statistical analysis.Results According to LESP value,45 patients were divided into low LESP group (10 patients) and normal LESP group (35 patients).According to parameter of esophageal motility function,patients were divided into esophageal dysmotility group (25 patients) and normal esophageal motility group (20 patients).After TEA treatment,the LESP of lower LESP group was (14.83± 4.17) mmHg (1 mmHg =0.133 kPa),which was higher than that before treatment ((9.54 ±2.42) mmHg),and the difference was statistically significant (t=4.92,P=0.001).LESP of esophageal dysmotility group was (19.04±5.91) mmHg,which was higher than that before treatment ((16.20±6.09) mmHg),and the difference was statistically significant (t=4.92,P=0.001).There was no statistically significant difference in LESP of normal LESP group and normal esophageal motility group before and after treatment (both P＞0.05).After treatment,DCI of esophageal dysmotility group was (530.76±215.53) mmHg· cm· s,which was higher than that before treatment ((363.92 ± 279.17) mmHg · cm · s),and the difference was statistically significant (t=2.86,P＜0.05).There was no statistically significant difference in esophageal body velocity,amplitude of 3 cm,7 cm above LES andCFV before and after treatment (all P＞0.05).There was no statistically significant difference in all of the esophageal motility parameters in normal esophageal motility group before and after treatment (all P＞0.05).Conclusion TEA can increase LESP and DCI in RGERD patients with esophageal motility dysfunction,improve contraction of entire esophagus and raise esophageal clearance capacity.
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Objective To observe the changes of esophageal motility in patients with achalasia (AC) before and after peroral endoscopic myotomy (POEM ) and to evaluate the effects of POEM on esophageal motility in AC .Methods A total of 35 patients with AC received POEM .The esophageal motility in response to different food swallows (5 mL liquid and 2 cm × 2 cm × 2 cm solid food) was evaluated by high-resolution manometry (HRM) system before operation and one month after operation .The changes of parameters of esophageal body and lower esophageal sphincter (LES) were analyzed and compared before and after operation .The t-test ,non-parametric test or single factor analysis of variance was performed for statistical analysis .Results Before POEM operation ,lower esophageal sphincter pressure (LESP) of 35 patients in response to liquid swallows and solid swallows was (28 .94 ± 18 .70) mmHg (1 mmHg=0 .133 kPa) and (26 .41 ± 11 .57) mmHg ,respectively ;after operation it was (16 .02 ± 5 .46) mmHg and (15 .82 ± 5 .04) mmHg ,respectively ;and the differences were statistically significant (t= 4 .338 and 4 .726 ,both P0 .05) .There was no difference in the distal contractile integral (DCI) and distal esophageal peristaltic amplitude in subtype Ⅰ and Ⅲ patients before and after operation (all P>0 .05 ) .All those parameters decreased in subtype Ⅱ patients (Z= -2 .704 and -2 .489 ,P 0 .05 ) . Proximal esophageal peristalsis was observed in two patients after operation , however there was no integrated esophageal body peristalsis .Clinical symptoms quickly relieved in all patients after POEM operation and clinical score significantly decreased compared to that before operation (0 .86 ± 1 .19 vs 8 .16 ± 1 .84 ,t=20 .605 , P<0 .05) .Conclusions POEM can effectively relieve LES relaxation disorder in AC patients and improve esophageal body peristalsis to a certain degree .The efficacy is regardless of AC types ,and further studies are need to shed light on the long-term efficacy .The long-term efficacy still need further follow-up study .
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Inflammatory bowel disease( IBD)includes ulcerative colitis( UC)and Crohn’s disease( CD),its incidence is increasing yearly in our country. With the progress of molecular biology,genetics,the understanding of IBD is deepen,however,the exact pathogenesis of IBD is still not fully clear,and it may be related to gene,environment, immunity,microorganism. Studies have shown that smoking,vitamin D,sex hormones,emotions,diet may be related with the occurrence of IBD. This article reviewed the role of environmental factors in IBD.
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Non-steroidal anti-inflammatory drugs( NSAIDs)are widely used in clinical practice,and their gastrointestinal adverse effects have attracted more and more attentions. Although many investigations were focused on gastroduodenal mucosal injury induced by NSAIDs over times,small intestinal injury has become the new hot-spot because of its high morbidity rate in recent years. The mechanisms of NSAIDs-induced small intestinal injury have not been fully elucidated and no specific prevention and treatment modalities have been developed. In this article,the mechanisms of NSAIDs-induced small intestinal injury and the preventive and therapeutic effect of muscovite were reviewed.
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Crohn’s disease( CD)is a gastrointestinal progressive granulomatous disease with unknown etiology. It is characterized as active stage alternating with remission stage,long-term course with many complications,sometimes needing surgery and having the tendency of relapse in patient ’s whole life. Therefore,it is important to define an effective therapeutic endpoint to ameliorate the natural course of CD. This article reviewed the progress in defining treatment endpoint of CD.
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Objective To develop a clinical practice satisfaction scale for the nursing interns,and to test its reliability and validity.Methods Original scale was formed on the basis of literature review and existing clinical practice satisfaction measurement tools of nursing interns.Totally 270 nursing interns of six tertiary first-class hospitals were investigated with the clinical practice satisfacfion scale of nursing intern by convenience sampling.SPSS13.0 and AMOS 17.0 were used to test the reliability and validity.Then the original scale was modified and the eventual scale was formed.Results The Cronbach's Alpha between each entries and the total scale were 0.548～0.752.The Cranbach's Alpha of total scale was 0.965and the split-half reliability of Guttman was 0.885.Five factors were extracted by exploratory factor analysis and they could explain 65.307％ of the total variance.The confirmatory factor analysis revealed a good model fit of the first and second order,and the fit indices x2/df,GFI,AGFI,RMR,RMSEA,NFI,CFI,TLI were 1.176/1.095,0.893/0.900,0.856/0.864,0.034/0.033,0.026/0.019,0.918/0.924,0.987/0.993,0.983/0.991.Conclusions The clinical practice satisfaction scale of nursing intern is reliable and valid,and can be used to assess the clinical practice satisfaction of nursing intern.
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Objective To explore the relationship among structural empowerment,psychological empowerment and nurses' job burnout,and to provide new approach for relieving nurses' job burnout.Methods Conditions for Work Effectiveness Questionnaire-Ⅱ (CWEQ-Ⅱ),Psychological Empowerment Scale (PES),and Maslach Burnout Inventory (MBI) were used to investigate 233 nurses working at three general tertiary-level hospitals in Tianjin.Results The total scores of structural empowerment,psychological empowerment,and burnout were (43.498 ±9.977),(38.871 ±7.052) and (45.489 ± 11.331),respectively.Relevant Analysis results showed that structural empowerment,psychological empowerment and nurses' job burnout had significant correlation,and the absolute value of coefficient of correlation between 0.358-0.560.The structural equation modeling results showed that fit indexes for fully mediating effect model were excellent(x2 =57.703,x2/df =1.202,GFI =0.965,AGFI =0.933,NFI =0.948,RFI =0.916,IFI =0.991,TLI =0.985,CFI =0.991,RMSEA =0.030,CN =263).Structural empowerment had a positive significant influence on psychological empowerment; structural empowerment and psychological empowerment had a negative significant influence on nurses' job burnout; psychological empowerment played a fully mediating role between structural empowerment and nurses' job burnout.Conclusion Nurse psychological empowerment has direct effect on job burnout.Nurse structrual empowerment affects job burnout via the full effects of psychological empowerment.
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BACKGROUND:As lumbar spine biomechanics research is unceasingly thorough and the constant development of related fusion and dynamic fixation device, the spine fusion technique which is represented by artificial disc replacement is a new choice to the spine surgeons. Therefore, it is particularly important to design reasonable artificial intervertebral disc. OBJECTIVE:To establish the finite element model of the new artificial disc replacement of the lumbar motion segment for further biomechanical study. METHODS:The L3-4 thin-section CT images of a healthy male volunteer was selected, combined with human anatomy data and applied the reverse engineering technology to rebuild the lumbar spine model with medical image software Mimics and tool software Geomagic Studio. The three-dimensional model of the silicone artificial disc was converted into a finite element model through software ANSYS12.0. RESULTS AND CONCLUSION:Through CT scanning, digital image processing and computer-aided design, the three-dimensional model of the lumbar motion segment and the finite element model of artificial disc replacement were successful y established. The finite element model contained 691 085 units and 1 008 913 nodes which could be applied constraint and load and could be used for spinal biomechanics and the further research of the new artificial intervertebral disc.
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Objective To evaluate the efficacy and safety of itopride in the treatment of functional dyspepsia (FD) according to the data of published clinical studies.Methods The papers about randomized controlled trials (RCT) of itopride in treatment of FD were searched from Cochrane library,EMBASE,PubMed,Elsevier,web of science (ISI),China national knonledge internet (CNKI),VIP Chinese Scientific and Technologic Periodical Database and Wanfang data,and the feature information in the studies were extracted.The relative risk (RR) value was used for count data and the weighted mean difference (WMD) was used for measurement data.The proper effect model was selected according to the results of heterogeneity test and the publication bias was investigated through visual inspection of funnel plots.Results A total of nine RCT met the inclusion standard.Of 2620 FD cases,1372 received itopride treatment and 1248 cases received placebo or other medicine as control treatment.The RR value of total effective rates,postprandial fullness and early satiety effective rates in itopride treated FD patients was 1.11 (95％CI:1.01,1.21; P=0.02),1.18 (95％CI:1.04,1.33; P=0.009),1.24 (95％CI:1.01,1.53; P=0.04),which showed the curative effects of itropride group were all better than those of control group.However there was no statistical significance in epigastric discomfort.The WMD of effective rates evaluated with the leeds dyspepsia questionnaire (LDQ) score was-1.38 (95％CI:-1.75,-1.01; P＜0.01),which showed the curative effect of itropride group was better than that of control group.For safety,the adverse effects rates of itopride groups were similar with control groups.The funnel plots of each inspection index presented wide bottom,narrow up and symmetrical graphics,which indicated that there was no publication bias.Conclusion Itopride has better efficacy in general symptoms,postprandial fullness,early satiety and LDQ score in FD patients,and few effects are detected.
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Objective To evaluate the efficacy and safety of preoperative colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction based on literature. Methods The randomized clinical trials (RCT) on the subject were retrieved from PubMed,OVID,EMBASE,Cochrane library,CNKI,Wanfang data and VIP Chinese Scientific and Technologic Periodical Database.Statistical heterogeneity between trials was evaluated by Revman 5.0 and was considered to exist when P ＜ 0.1.Heterogeneity of the included articles was tested,which was used to select proper effect model.Publication bias was investigated through visual inspection of funnel plots.Results Five RCT including 283 cases were analyzed,in which 145 patients received preoperative colonic stenting and 138 received emergency surgery.Compared with those of emergency surgery groups,the total OR of permanent stoma,one-stage operation,and infection of preoperative colonic stenting group were 0.28 (95％ CI:0.12 - 0.62,P =0.002),2.13 (95 ％ CI:1.28 - 3.55,P =0.004) and 0.25 (95％ CI:0.08 - 0.80,P =0.02),respectively.There were no significant differences between 2 groups in anastomotic leakage,mortality,intra-abdominal infection,or overall morbidity.OR were 0.70 (95％ CI:0.29 - 1.71,P =0.44),1.17 (95％ CI:0.49 -2.79,P=0.72),0.27 (95％CI:0.03-2.65,P=0.26) and 0.32 (95％CI:0.07-1.42,P=0.13),respectively.Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias.Conclusion Preoperative colonic stenting significantly improves one-stage operation and decrease the rates of permanent stoma and wound infection.However,large-scale and high-quality RCTs are further needed.
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Cultivation of medical students' clinical practice is an important part of higher medical education.At present,the imbalance of teachers structure and the old and single teaching mode and method etc,have had a great impact on the clinical practice of medical students.Only by strengthening the construction of clinical teachers,establishing access and assessment system of clinical teachers,carring out diverse clinical education reform,such as Problem-Based Learning ( PBL )and Case-Based Learning ( CBL ),etc,and fully mobilizing the initiative of students and enthusiasm for learning to reach teaching and learning complement in virtuous circle.can we truly improve the quality of clinical practice.
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@#The family functioning of stroke patients is lower and related to many factors. This paper reviews the recent study in family functioning and measurement tools; the impact factors in terms of family structure, family economic status, social support and family development stage and life events.
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<p><b>OBJECTIVE</b>To investigate the distribution and expression of corticotropin releasing factor (CRF) in spinal cord, hypothalamus and third ventricle of cerebrum, of the hypersensitive viscera rats, and to research on the mechanism of CRF in the hypersensitive vicera signal conduction pathway in IBS (irritable bowel syndrome) and to investigate possible active mechanisms of tongxie prescription on IBS.</p><p><b>METHOD</b>Forty SD rats were divided randomly into three groups. The rats of model No. 1 were sensitized by injecting egg albumin into abdominal cavity. The rats of model No. 2 were sensitised by conditional stimulus and unconditional stimulus. The two model groups were both divided randomly into two groups. The five groups were given intragastric administration with Tongxie prescription or normal saline for four weeks. Then quantitative analysis of CRF in the lumbosacral spinal cord and brain of rats were achieved by immunohistochemical method and computerized image system.</p><p><b>RESULT</b>The sensitivity of the groups being treated with tongxie prescription were much lower than the model groups (P < 0.01). The immunohistochemical method showed that CRF was expressed in the lumbar intumescentia of spinal cord, hypothalamus and the diaphragmatic surface of third ventricle of cerebrum. The CRF positive index of the model groups was higher than that of the blank group (P < 0.01). The CRF positive index of the healing groups was lower than that of the model groups (P < 0.01). The CRF positive index of the healing groups was higher than that of the blank group (P < 0.01).</p><p><b>CONCLUSION</b>The two model rats evoked by two different stimulation both appeared visceral hypersensitivity state. CRF is related to stress. The increase of CRF expression in the lumbar intumescentia of spinal cord, hypothalamus and the diaphragmatic surface of third ventricle of cerebrum showed that CRF is critical to the introduce of stimulus signal of vicera. Tongxie prescription can significantly decrease CRF expression. This is one mechanism to decrease sensitivity of hypersensitive viscera rats.</p>