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Objective:To investigate the effect of the application of "internet +" disease management based on the AISAS model on the young and middle-aged patients after PCI therapy.Method:A total of 90 young and middle-aged patients hospitalized in cardiological department of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) were enrolled between June 2018 to October 2019, and they were randomly divided into observation group and control group with 45 cases in each group. Patients in the control group received telephone follow-up while "internet +" disease management based on the AISAS model was applied in the observation group. The drug therapy compliance, acquisition of the disease knowledge, quality of life, anxiety and depression levels, return to workand incidence of cardiovascular events.Results:One year after the intervention, the drug therapy compliance score, disease-related knowledge score, quality of life score, SAS and SDS scores of the observation group were 7.55±1.21, 7.29±1.27, 701.17±74.86, 32.55± 4.31, 34.74±4.16, the scores of patients in the control group were 6.48±1.56, 6.12±1.94, 670.58±65.29, 41.72±4.33, 40.79±4.17. The difference was statistically significant ( t value was 2.066-11.203, P<0.05). The comparison between the return of the patients and the incidence of cardiovascular events in the two groups was statistically significant ( χ2 value was 5.031, 11.275, P<0.05). Conclusion:This management model can increase the knowledge of disease PCI postoperative patients, improve their quality of life, make patients return to society earlier, and promote the improvement of the quality of continuous nursing service.
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【Objective】 To explore the application value of narrative nursing in blood collection nursing. 【Methods】 The quantitative questionnaire covering three periods, i. e. prior to narrative nursing intervention, January to June 2019 and July to December 2019, was designed. The pre-, 6-month-post-, and 12-month-post-intervention differences of 10 medical and nursing staff were scored by 100 donors, concerning active listening, reflective writing skill, empathy skill, communication skill and professionalism. 980 valid questionnaires out of 1 000 were returned and analyzed statistically, with P0.05). After 12 months of narrative nursing, active listening, reflective writing, empathy skill, communication skills and professionalism increased to 97.46%, 96.44%, 97.97%, 98.73% and 99.24%, respectively, and all items increased significantly (P<0.01). 【Conclusion】 The empathy between medical staff and blood donors as well as the lack of humanistic care during the blood collection nursing could be promoted by the application of narrative nursing, which is helpful for providing high-quality nursing service for blood donors.
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Objective:To investigate the incidence, clinical characteristics and risk factors for hip fractures in patients within two years after stroke onset.Methods:A total of 332 persons with first-onset stroke from the neurology department of our hospital between 1 June 2013 and 31 December 2014 were recruited and were divided into the hip fracture group and the non-hip fracture group.Clinical characteristics were recorded.Vision was tested as normal or impaired.Patients were accessed by the National Institutes of Health Stroke Scale(NIHSS), Behavioral Inattention Test, Baking Tray Task, Mini-Mental State Examination(MMSE), Birgitta Lindmark(BL)motor assessment scale, Berg Balance Scale(BBS), Timed Up & Go(TUG)Scale, and Stops Walking When Talking(SWWT)Scale.The clinic characteristics and risk factors for hip fractures were compared between the two groups after a 2-year follow-up.The accuracy of risk factors for fracture prediction was assessed by the sensitivity, specificity, and positive and negative predictive values.Results:Of 332 patients with stroke, 16 cases fractured their hips within two years after stroke onset, which corresponded to an incidence of 33‰/year(95% CI: 15‰/year-50‰/year). The 2-year mortality rate was 44%(95% CI: 25%-60%)and 48%(95% CI: 42%-54%)in patients with and without hip fractures respectively( χ2=0.036, P=0.724). The mean survival time for patients with and without hip fracture was 2.72 years(95% CI: 1.45-2.79)and 2.21 years(95% CI: 1.48-2.34)respectively.The proportions of patients with previous fractures history( χ2=16.780, P=0.041)and impaired vision( χ2=11.210, P=0.027), MMSE scale score( U=14.220, P=0.031), TUG ≥ 15 s( χ2=18.560, P=0.000)were higher, and SWWT( χ2=20.340, P=0.000)was lower in the hip fracture group than in the non-hip fracture group.The negative predictive values of previous fractures history, impaired vision, TUG and SWWT were higher than their positive predictive value.The specificities of previous fractures history, impaired vision, and SWWT were higher than their sensitivities.And the sensitivity of TUG was higher than its specificity. Conclusions:Hip fractures after stroke are common in elderly patients.Fractures often occur during daytime at home in daily activities.The previous fractures history, visual and cognitive dysfunction and impaired functional mobility are risk factors for hip fractures.We should take measures to prevent falls according to the relevant factors.Among the test scales, the timed up & go(TUG)scale could much more accurately identify patients at high risk for hip fractures.
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Objective To assess the prognostic significance of prognostic nutritional index (PNI),neutrophil lymphocyte ratio (NLR) and platelet-lymphocyte ratio in gastric cancer patients.Methods Clinico-pathological data of 257 patients with gastric cancer in the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 was analyzed retrospectively.The ROC curve and Youden index were used to determine the cut-off value,survival curves were described by KaplanMeier method and compared by Log-rank test.The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.Results PNI was positively correlated with ages,tumor size,depth of tumor invasion,TNM stages,albumin,pre-albumin and hemoglobin (all P ＜ 0.05).NLR was associated with the tumor size,the depth of invasion,lymph node metastasis,TNM stages,albumin,pre-albumin and hemoglobin (all P ＜ 0.05).PLR was associated with the tumor size,prealbumin and hemoglobin (all P ＜ 0.05).The Kaplan-Meier curves showed that gastric cancer patients had longer overall time in the low NLR group,low PLR group and high PNI group than in the high NLR group,high PLR group and low PNI group respectively (all P ＜ 0.05).The multivariate analyses showed that PNI and NLR were independent factors for predicting overall survival of gastric cancer patients.Conclusions PNI and NLR have more predictive value of overall survival than the PLR,PNI and NLR are independent prognostic factors of OS (overall survival) in gastric cancer.
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Objective To examine the incidence ,clinical characteristics ,and risk factors for falls within two years after stroke in elderly patients. Methods A total of 365 elderly stroke patients from the Department of Neurology at the 8th Nanning People's Hospital were recruited from June 1 , 2013 to December 31 ,2014. They were divided into a fall group and a non-fall group and were followed up for two years. The incidence and clinic characteristics of falls were analyzed. The risk factors for falls were analyzed by multiple Logistic regression analysis. Results Of the 365 stroke patients included in this study ,falls were observed in 146(40.2％ )patients. The interval between the stroke and the first fall :72(49.3％ )patients had the first fall within 3 months;22(15.1％ )occurred between 4 and 6 months;20 (13.7％ )between 7 and 12 months ;17 (11.6％ )between 13 and 18 months ;and 15 (10.3％ )between 19 and 24 months.A hundred and five(71.9％ )patients fell during daytime and 41 (28.1％ )patients during night.Eighteen(12.3％ )patients had one fall ;65(44.5％ )patients fell 2 to 4 times ;60(41.1％ )patients fell 5 to 10 times ;and 3(2.1％ )patients fell over 10 times.A total of 709 falls were observed.Places of falls :102(69.9％ )falls happened indoors and 44(30.1％ )falls occurred outdoors.Circumstances of falls :27 (18.5％ )patients fell when turning over ;23 (15.8％ )fell when rising from a seating position ;4(2.7％ )patients fell when showering ;15(10.3％ )patients fell while standing ;9(6.8％ )fell when turning around ;56(38.3％ )fell while walking ;and 12(8.2％ )fell while climbing the stairs or running.The severity of falls :52(35.6％ )patients had no injury ;78(53.2％ ) suffered soft tissue injury ;16 (11.0％ )had fractures ;and 78 (53.2％ )had fear of falling.Multiple Logistic regression analysis showed that age(OR=2.41 ;95％ CI :1.69-3.05) ,history of falls(OR =2.85 ;95％ CI :1.46-3.81) ,history of stroke(OR=1.87 ;95％ CI :1.12-2.79) ,right hemiplegia(OR=2.37 ;95％ CI :1.62-4.59) ,left hemiplegia(OR= 2.47 ;95％ CI :1.46-4.78) ,paraplegia(OR= 2.55 ;95％ CI :1.57-4.98) ,visual impairment(OR=2.35 ;95％ CI :1.35-6.62) ,apraxia(OR=2.53 ;95％ CI :1.42-5.63) ,unilateral spatial neglect (OR=3.34 ;95％ CI :2.82-6.34) ,use of psychotropic medications (OR= 1.76 ;95％ CI :1.11-1.98) ,impaired physical mobility (OR = 1.58 ;95％ CI :1.82-2.91) ,low MMSE scale(OR = 3.42 ;95％ CI :1.38-7.41) ,low Barthel Index score(OR = 2.83 ;95％ CI :0.97-4.68) ,BBS scale<45(OR=2.48 ;95％ CI :1.27-4.18) ,TUG>15seconds(OR=3.56 ;95％ CI :1.91-5.23) ,and lack of rehabilitation therapy (OR=3.42 ;95％ CI :1.38-7.41)were independent predictors for falls(all P<0.05). Conclusions Falls are common among elderly patients within two years after stroke.Most falls happen indoors ,during daytime and while moving.Age ,history of falls ,history of stroke ,hemiplegia ,visual impairment ,apraxia ,unilateral spatial neglect ,use of psychotropic medications ,walk with a walker ,low MMSE scale ,low Barthel Index score ,BBS scale<45 ,TUG>15 seconds ,and lack of rehabilitation therapy are independent risk factors for falls after stroke.
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Objective To investigate the prognostic factors and influencing factors of lymph node ratio (LNR) in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective case-control study was conducted.The clinicopathological data of 444 patients with Siewert Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 were collected.All the 444 patients underwent radical D2 lymph node dissection,extent of lymph node dissection was inferior mediastinum,around the esophageal hiatus and celiac lymph node.Follow-up usingtelephone interview and outpatient examination was performed to detect patients' prognosis once every 3 months within 2 years postoperatively,once every 6 months from 2 vears to 5 years postoperatively and once every 12 months after 5 years up to October 2016.Observation indicators:(1) follow-up and survival situations;(2) univariate and multivariate factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ[AEG;(3) univariate and multivariate factors analysis affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and the COX regression model.Results (1) Follow-up and survival situations:all the 444 patients were followed up for 1-81 months,with a median time of 52 months.The 1-,3-,5-year overall survival rates of 444 patients were respectively 93.2％,60.3％ and 45.7％.(2) Factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation,invasion depth of tumor,pN staging and staging of LNR were related factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2 =12.332,5.898,36.045,38.847,46.464,P＜0.05).Results of multivariate analysis showed that invasion depth of tumor and staging of LNR were independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG [RR =1.393,1.411,95％ confidence interval (CI):1.137-1.708,1.106-1.801,P＜0.05].(3) Factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were related factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2=20.077,12.618,36.586,P＜0.05).Results of multivariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG (OR=0.684,0.688,0.788,95％ CI:0.485-0.965,0.505-0.936,0.687-0.903,P＜0.05).Conclusions The invasion depth of tunor and staging of LNR are independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG.Tumor diameter,tumor differentiation and invasion depth of tumor are independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.
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Objective To explore the value of preoperative D-dimer in patients with gastric cancer in judging gastric cancer metastasis and assessing prognosis.Methods Clinicopathological data of 132 patients with gastric cancer in the First Affiliated Hospital of Anhui Medical University between Jan.2010 and Jan.2011 was analyzed retrospectively in this study.All patients were divided into two groups according to the cutoff value (1.465 mg/L)of D-dimer and the relationships between D-dimer and clinicopathological data were determined by chi-square test.Moreover,the association of preoperative D-dimer and the prognosis was analyzed by Kaplan-Meier analysis and Log-rank test.Univariate and multivaritate Cox model were used to analyze the factors which might affect the survival of the patients and significant independent factors.Results A total of 132 patients were enrolled in this study in accordance with the inclusion criteria.D-dimer was positively correlated with the depth of invasion (x2 =4.996,P ＜ 0.05),age (x2 =4.311,P ＜ 0.05) and distant metastasis of gastric cancer (x2 =16.641,P ＜0.01),but not with thc gcndcr,lymph node metastasis,tumor size,the degree of differentiation and TNM stage (P ＞ 0.05).The mean D-dimer level was (1.39 ± 0.7) mg/L in distant metastasis patients and (0.97 ±0.83) mg/L in non distant metastasis patients (P =0.023),the mean plasma D-dimer level in patients alive at the 5 years after the surgery was (0.78 ± 0.58) mg/L,which was significantly lower than the amounts determined for the deceased patients (0.75 ± 0.58) mg/L (P ＜ 0.01).The Kaplan-Meier curves showed that the patients with gastric cancer had a longer time in the low D-dimer group than in the high D-dimer group,showing a significant difference between the two groups (P ＜ 0.01).Univariate analysis showed that the overall survival rate was significantly correlated with the gender,D-dimer,tumor size,the depth of invasion,lymph node metastasis and TNM stage (P all ＜ 0.05).The D-dimer was proved to be independent risk factor for the prognosis of gastric cancer by multivariate analysis(P ＜ 0.05).Conclusion According to the analysis,D-dimer may be valuable biomarker for metastasis patients,besides,D-dimer was an independent prognostic factor for patients with gastric cancer.
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OBJECTIVE:To systematically review the efficacy and safety of cinacalcet in the treatment of hemodialysis pa-tients with secondary hyperparathyroidism,and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from Medline,Cochrane Library,EMBase and CBM,randomized controlled trials(RCT)about cinacalcet in the treatment of he-modialysis patients with secondary hyperparathyroidism (SHPT) were collected. Meta-analysis was performed by using Rev Man 5.3.5 software after data extract and quality evaluation by Cochrane systematic Rev Man 5.3.5. RESULTS:Totally 7 RCTs were en-rolled,involving 1 987 patients. Results of Meta-analysis showed cinacalcet can significantly reduce the rate of surgical parathyroid-ectomy[RR=0.23,95%CI(0.06,0.89),P=0.03],incidence of fracture[RR=0.26,95%CI(0.12,0.60),P=0.002] and increase the incidences of hypocalcemia[RR=9.81,95%CI(3.92,4.59),P<0.001],nausea[RR=1.97,95%CI(1.58,2.46),P<0.001] and vomit-ing[RR=1.91,95%CI(1.50,2.42),P<0.001],while it showed no significant effect on the the incidence of all-cause mortality and cardiovascular death. CONCLUSIONS:The clinical efficacy of cinacalcet in the treatment of hemodialysis patients with secondary hyperparathyroidism is good,but there are common adverse reactions such as nausea and vomiting,hypocalcemia.
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Objective To investigate the recurrence rate and recurrence risk factors of benign positional vertigo after manual reduction. Methods A total of 186 cases diagnosed with BPPV were selected as our subjects. Vertigo recurrence rate was calculated at 30 d,60 d,90 d after manual reduction. Risk factors for recurrence were analyzed using binary Logistic Regression. Results 172 cases diagnosed in BPPV patients completed 90 days follow-up. Vertigo recurrence rate was 8. 79%(16/182)in 30 days,17. 05%(30/176)in 60 days,and 22. 09%(38/172)in 90 days. The average age in recurrence patients was(59. 1 ± 10. 2)years old,significantly higher than the non-recurrent group( 47. 6 ± 7. 3 ). The recurrence rates in patients with complicated with hypertension,diabetes,hyperlipidemia,coronary heart disease were 57. 89%(22/38),60. 53%(23/38),73. 68%(28/38),39. 47%(15/38)respectively. Rise and turning neck are prone to recurrence,and recurrence rate were 16. 42%( 22/134 ),8. 21%( 11/134 ),9. 70%( 13/134 ) and 16. 42%(22/134). Recurrence rate of patients with manipulative reduction times ﹥10 times( reset multiple times before being cured)was 90. 90%( 10/11 ). Logistic regression analysis showed that the duration before manual reduction BPPV(OR=2. 631,95%CI 1. 082 -7. 572,P =0. 022)and the number of manual reduction ﹥10( OR=3. 107,95%CI 1. 205-7. 842,P=0. 018)after BPPV is manipulative reduction independent risk factor for recurrence. Conclusion Patients with BPPV in middle-aged and high seizure frequency have a high recurrence rate. Patients with BPPV complicated by hypertension,diabetes,hyperlipidemia,coronary atherosclerotic heart disease have the same higher recurrence rate. The rise and turn the neck often cause BPPV recurrence. The reduction and the number of manual reduction﹥10 are independent risk factors of recurrence of the BPPV.
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ObjectiveTo determine the expression of matrix metalloproteinase-2 (MMP-2),cysteine rich protein 61 (Cyr61) and CD25 in esophageal carcinoma and investigate their clinical significance.MethodThe expression of MMP-2, Cyr61 and CD25 in 68 cases of esophageal tumor tissues (esophageal carcinoma group ) and part-cancer( para-cancer group ) and 68 cases of reflux esophagitis (control group ) was detected by immunohistochemical method and the results were statistically analysed. ResultsThe positive expression rates of MMP-2,Cyr61 and CD25 were 82.35％(56/68), 73.53％(50/68) and 89.71％(61/68)respectively in esophageal carcinoma group,there were significant differences compared with those in paracancer group and control group(P ＜ 0.05) ; while there was no significantdifference between para-cancer group and control group (P ＞ 0.05 ). The positive expression rates of MMP-2, Cyr61 and CD25 in esophageal carcinoma group in different T stage, N stage and M stage all had statisticall differences (P ＜ 0.05),while there was no significant difference in different degree of differentiation (P ＞ 0.05 ). ConclusionMMP-2,Cyr61 and CD25 is highly expressed in esophageal carcinoma,there is some significance for understanding the occurrence, development and prognosis of esophageal carcinoma.
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Objective To compare the curative effect of conservative treatment and surgical treatment for bronchiectasis. Methods 60 patients with bronchiectasis were randomly divided into observation group and control group,30 cases in each group,they were treated with surgery and medical therapy respectively,the clinical efficacy,length of stay, costs, remission time of symptoms and signs, changes of blood gas index and ESR, CRP,TNF-α, WBC,NEUT of the two groups after treatment were compared. Results The curative rate of observation group was significandy higher than control group, while the length of stay, remission time of symptoms and signs and hospitalization costs were significantly lower than control group, the difference was statistically significant (all P ＜0.05) ;After treatmenit,the blood gas index of both groups improved significantly than before treatment(all P ＜ 0.05), and the blood gas index of observation group improved significantly than the control group (all P ＜ 0. 05); After treatment, ESR, CRP,TNF-α,WBC and NEUT of both groups were significantly decreased compared with those before treatment(all P ＜0. 05); Between the two groups, the index value of the observation group decreased significantly (all P ＜ 0.05).Conclusion Surgical treatment for bronchiectasis was superior to conservative treatment with better curative effect,lower cost, shorter hospital stay and faster relief of symptoms and signs, it had good prospects to be applied.
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[Objective]To investigate the clinical application of treating soft tissue defects of the feet、ankle and lower one third of the legs with reverse saphenous neurocutaneous concomitant vessel pedicled island flap.[Method]From March 1999 to June 2003,six cases of soft tissue defects of the feet,ankle and lower one third of the legs were treated with reverse saphenous neurocutaneous concomitant vessel pedicled island flap.The size of flaps were from 12 cm?7 cm to 5 cm?3 cm,aver aging 8 cm?5 cm.[Result]Flaps of 6 cases survived all showing good quality.After 10 months to 3 years follow-up,all of the six cases were thinked very good.[Conclusion]The reversed saphenous neurocutaneous concomitant vessel pedicled island flap treating soft tissue defects of the feet,the ankle and the lower one third of legs is easy to be performed.The flap has liable blood supply and does not sacrifice the major arteries.
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Objective To evaluate the effect of nebulized budesonide and oral prednisolone in treatment of idiopathic pulmonary fibrosis(IPF).Methods Forty-two patients with IPF were randomized to divide into two groups,nebulised budesonide groups and oral prednisolone groups.Symptoms,signs,pulmonary function,arterial blood gases analysis and the adverse effects were measured.ResultsThere were significant improvement of VC and PaO2 of nebulized budesonide and oral prednisolone groups,but there were no significant differences between of nebulized budesonide groups and oral prednisolone groups.The adverse effects in nebulised budesonide group were obviously less than those in oral prednisolone groups.Conclusion Nebulized budesonide was an effective method in treatment of idiopathic pulmonary fibrosis.
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BACKGROUND:It is crucial for us to find an objective and sensitive means for the assessment ofthe severitv and development of dementia,so as to make instant diagnosis and examination of therapeutic effect on patientswith vascular dementias(VD).Event related potential endogenetic eomponent P300 is proved closely correlated with the cognitive management of examinees but not with stimulus property,thereby considered as one of the most valuable and objective index for brain superior psychological activity.OBJECTIVE:To study the role and significance of events related potential P300,providing objective basis for clinical diagnosis and therapeutic assessment for patients with VD.DESIGN:Non-randomized simultaneous controlled explorative study based on patients. SETTING:Neurological department and electromyography department in aprovincial hospital and neurological department in a medical college hospital.PARTICIPANTS:Between February 2000 and June 2001,64 patients were of VD at neurological clinic and ward ofthe Second Affiliated Hospital of Chongqing Medical College,including 38 males and 26 females with theaverage age of(66.0±4.6)years(VD group).Culturallevel:19 cases re-ceiyed over senior school education,31 cases of junior school education and14 cases of illiteracy.Meanwhile 60 inpatients without VD were enrolled(non-VD group)including 35 males and 25 females withthe average age of(68.0±3.7)years.Culturallevel:senior school or above,15 cases,junior school, 29 cases and illiteracy,16 cases.METHODS:Mental sate of both VD and non-VD groups were assessed with mini-mental state examination(MMSE),and tested with P300 potential observing the variability of latency and amplitude of P300 in patients.Both methods were compared between VD group and non-VD group, moreover relationship between P300 latency and MMSE scores was also explored.MAIN OUTCOME MEASURES:Variability of P300 latency and amplitude Relationship between P300 latency and MMSE scores.RESULTS:P300 latency was found prolonged in 74% and 7% of VD group and non-VD group respectively,with obvious significance between them,meanwhile prolonged P300 latency was proved closely correlated with the MMSE scores(r=0.609 6,P＜0.05).CONCLUSION:P300 latency can be considered as an obiective predictor for the earlier diagnosis and the assessment of therapeutic effects in patients with VD.