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Objective:To investigate the knowledge, attitude and practice of general practitioners (GPs) in Shenzhen towards managing patients with common mental health problems.Methods:It was a cross-sectional study, from September 19 to October 31, 2020, 500 GPs from 100 community health centers (CHC) in 10 districts of Shenzhen municipality were randomly selected as the research subjects by stratified random sampling; the survey was conducted by self-filled questionnaire, which included general conditions, knowledge tests of common psychological problems (generalized anxiety disorder, depressive disorder, panic attacks, sleep disorders), GPs′ attitudes to take care of common psychological problems, and GPs′ practice of caring for common psychological problems.Results:A total of 500 questionnaires were distributed and 329 valid ones were collected. In terms of knowledge, GPs had the highest accuracy of answering the characteristics of depressive disorder (97.3%, 320/329), and the lowest accuracy of case analysis of panic attacks (50.2%, 165/329). In terms of attitude, 71.1%(234/329)of GPs agreed that "common psychological problems should be taken care of",there was a statistically significant difference in attitude scores among GPs with different years of working in CHC ( Z=14.60, P=0.006). In terms of practice, the most encountered mental health problem was insomnia (91.2%, 300/329), 46.5% (153/329) of GPs would use psychological assessment scales, 52.9% (174/329) of GPs would choose direct referral, and there were statistically significant differences in attitude scores among GPs with different years of working ( Z=10.70, P=0.030) and years of working in CHC ( Z=22.14, P<0.001). Conclusions:GPs have a positive attitude in taking care of common psychological problems, but lack of knowledge and confidence. As working in CHC for more years, GPs are more inclined to care for patients with common psychological problems in practice.
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Bilioenterostomy is the one of the main therapy options for extrahepatic and perihilar biliary diseases(benign and malignant tumors, congenital biliary dilatation, inflammatory stricture of bile duct reconstructive drainage of bile duct after lesion and iatrogenic injury of bile duct) resection and is a common procedure for hepatobiliary surgery. It’s necessary to take a further consideration in the choice of operation type, anastomosis method, suture and the placement of biliary stent in the bilioenterostomy for the hepatobiliary surgeon, since the incidence of postoperative complications such as anastomotic stenosis and reflux cholangitis will increase on account of the difference and inappropriateness of these choices. Currently, the development of techniques relating bilioenterostomy has become more proficient and some viewpoints have been unified. However, there are still some controversies in clinical application. It is necessary for surgeon to make the appropriate and reasonable choice on the basis of the specific circumstances in patients.
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Objective To study the protective effect of trimetazidine pretreatment on myocardial I/R in a rat I/R model and its mechanism.Methods One hundred and twenty SD rats were divided into control group,I/R group,HSP70 inhibitor group,trimetazidine treatment group and combined treatment group (24 in each group).The rats in each group were further divided into 30 min reperfusion group,4 h reperfusion group and 8 h reperfusion group (8 in each group).Their HSP70-positive myocardial cells were calculated,their serum CK,CK-MB,MDA,SOD levels and their myocardial infarction size were measured.Results The serum CK and CK-MB levels were significantly higher in I/R group,HSP70 inhibitor group,trimetazidine treatment group and combined treatment group than in control group and were significantly lower in trimetazidine treatment group than in combined treatment group and I/R group after reperfusion for 4 and 8 h (P＜0.01).The serum levels of HSP70 and SOD were significantly higher,the MDA levels were significantly lower in trimetazidine treatment group than in combined treatment group and I/R group after reperfusion for 30 min,4 and 8 h (P＜0.01).The infraction size was significantly smaller in trimetazidine treatment group than in combined treatment group and I/R group after reperfusion for 4 and 8 h (P＜0.05).Conclusion Trimetazidine can increase the serum HSP70 level in myocardial cells,reduce the infarction size,and protect the myocardium against I/R in rats.
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Pttrpose Contrast-enhanced ultrasound (CEUS) is a noninvasive technique that can monitor the blood perfusion of organs.The study aims to discuss the value of CEUS in quantitative analysis of renal microcirculation during resuscitation after hemorrhagic shock (HS).Materials and Methods Forty healthy New Zealand white rabbits were randomly divided into five groups in this prospective study.One group was selected as normal control group (T1),the other four groups were established HS model by using the modified Wiggers's method;one of the four HS groups was taken as shock group (T2),and the other three HS groups were named as 2 h group (T3),6 h group (T4),and 24 h group (T5) according to resuscitation time.CEUS was used to observe the rabbits' renal perfusion and the perfusion parameters were recorded including amplitude of peak intensity (A),time to peak (TTP),area under curve (AUC) and curve rising slope rate (Grad);the correlation of these parameters with histological examination was analyzed.Results Compared with T1 group,The TTP ofT2 group prolonged and the A,AUC and Grad decreased (P＜0.05);the HS model was established successfully.Compared with T2 group,the A,AUC and Grad of T3,T4 groups increased (P＜0.05),but the TTP of T3,T4 groups was not shortened (P＞0.05).The above parameters were all significantly different between T5 group and T2 group (P＜0.05),but the differences did not exist between T5 and T1 groups (P＞0.05),which indicated that the perfusion parameters gradually returned to normal level after resuscitation.The histological staining demonstrated that the renal tubular epithelial cell swelling and vascular congestion gradually restored after resuscitation.Conclusion CEUS can quantitatively assess renal perfusion changes during resuscitation as a noninvasive monitor.
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Objective To evaluate the effect of a new type of fixation tape for tracheal catheter in intensive care patients.Methods A purposive sampling study was conducted. Ninety patients experienced oral tracheal intubation for mechanical ventilation, and admitted to respiratory intensive care unit (ICU) of the Second Affiliated Hospital of Nantong University from November 2015 to February 2017 were enrolled. All the patients were randomly (random number) divided into the control group and the observation group with 45 patients in each group. The patients in control group was treated with the traditional medical adhesive tape and fixation belt to fix endotracheal tube, while the patients in observation group was treated with a new type of tracheal catheter fixation tape. The fixation effect, skin complication rate, patient's comfort level, nursing workload and satisfaction were evaluated in both groups.Results There were 6 patients with mild displacement, 2 patients with moderate displacement and 1 patient with severe displacement in the control group, while there was no catheter displacement or detachment occurred in the observation group, and the difference between the two groups was statistically significant (χ2 = 2.944,P = 0.003). In the control group, there were 39 patients with facial skin redness,6 patients with facial skin damage, 36 patients with neck skin redness, and 2 patients with neck skin damage. In the observation group, there were no facial skin complications and only 2 patients with neck skin redness, and the skin complication rate was significantly higher than that of the control group (facial skin:Z = 9.173,P = 0.000; neck skin:Z = 7.549,P = 0.000). Compared with the control group, the patients' comfort levels were significantly elevated in the observation group (the intolerance patients: 9 vs. 24, the extreme discomfort patients: 4 vs. 8,Z = 3.695,P = 0.000). The total changing times of the fixation belt and operating time for each change in the observation group were significantly decreased as compared with those of control group [changing times of the fixation belt (times): 1.89±0.77 vs. 3.86±1.18, operating time for each change (minutes): 10.31±1.47 vs. 15.78±1.89, bothP < 0.01]. Nursing satisfaction in the observation group was significantly higher than that of the control group (100% vs. 33.3%,P < 0.01).Conclusions The new fixation tape for tracheal catheter could significantly reduce the catheter displacement and detachment rate, and decreasethe incidence of facial skin injury. It is easy to learn and worth to generalize clinically.
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Objective To assess the empathy level of general practitioners (GPs) in the outpatient clinics of a general hospital,and to investigate the related factors.Methods Patients attending the Family Medicine Clinic of HKU-Shenzhen Hospital in September 2014 and met the inclusion criteria were asked to complete the questionnaire which included general characteristics,overall satisfaction and the Measure-Consultation and Relational Empathy Measure (CARE) Scale after the consultation.Results Of the 1 818 questionnaires retrieved,1 690 CARE scales were completed (intact rate was 92.96%).The overall satisfaction rate was 95.92% (1 621/1 690).And 97.28% (1 644/1 690) of the patients would recommend family medicine service to their friends or relatives.The total score of CARE scale was (45.47±6.26),and the scores of 4 CARE components were (4.63 ± 0.59),(4.43 ± 0.81),(4.54 ± 0.69) and (4.55 ± 0.66),which showed significant difference (P<0.01).The multivariate linear regression analysis showed that the mean CARE scores were not influenced by gender and education levels of the patients,gender of the consulting doctors,initial/follow up consultation,and the location of the consultation.The mean CARE scores were influenced by age of patients and the reasons for consulting (P<0.05).There was a moderate correlation of the CARE scores with the overall satisfaction of patients (r=0.613,P<0.001) and patient's recommendation of the clinic (r=0.466,P<0.001).Conclusion Doctors who were evaluated in this study have a higher empathy level than results from other countries.There is positive correlation between doctor's empathy level and patient's overall satisfaction.The result of doctor's empathy level may be influenced by patient's age and the reasons for consulting.
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Objective To assess the patient enablement level in a general hospital and its related factors,to investigate the relationship of patient enablement with patient's overall satisfaction and doctor's empathy levels.Methods Patients attending the Family Medicine Clinic of HKU-Shenzhen Hospital in September 2014 and met the inclusion criteria were asked to complete a questionnaire survey which included general characteristics,overall satisfaction;the Patient Enablement Instrument (PEI) and the Consultation and Relational Empathy Measure Scale (CARE) after the consultation.Results Total 2 326 questionnaires were issued and 1 818 were retrieved,of which 1 478 were qualified questionnaires.The qualified rate of PEI was 81.3％ and the qualified rate of patient overall satisfaction was 96.28％.The positive rate of patient enablement was 97.70％ (1 444/1 478),and the mean score of PEI was 8.21 ±3.33.Multivariate linear regression analysis showed that the PEI scores were not influenced by gender and education level of the patients,gender of the consulting doctors and initial/follow up consultation.The PEI scores were influenced by the age of the patients,the types of clinic (general practice/chronic practice clinic) and the reasons for consulting (P ＜ 0.05).There were correlations between PEI score and overall satisfaction of patients (r =0.383,P ＜ 0.001),patient's recommendation of the clinic (r =0.595,P ＜ 0.001) and CARE scores (r =0.546,P ＜ 0.001).Conclusion The results show that the PEI scores of patients visiting family medicine clinic of this hospital are higher than those reported in other studies.The PEI score may be influenced by the age of the patients,the types of clinic and the reasons for consulting.Positive correlations between patient enablement and the overall satisfaction,patient's recommendation and doctor empathy were observed.
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Objective To investigate the effect of different additional filtration thickness of DSA on image quality and radiation dose with cerebral angiography. Methods Prospective collected 90 patients with DSA examination of the whole cerebral artery, patients were divided into A, B and C group according to the time of the examination, each group included 30 cases. Patients underwent conventional DSA, the additional filtration of group A, B and C were (1.0 mmAl+0.1 mmCu), (1.0 mmAl+0.4 mmCu) and (1.0 mmAl+0.9 mmCu), respectively. Dose area product (DAP), air kerma (AK), tube current and tube voltage of anteroposterior and lateral radiography of the whole brain were recorded, and scored the image quality. Eye lens organ dose values were obtained by using simulation phantom and LiF dosemeter under A, B and C groups with three different additional filtrations for cerebral angiography. The image quality scores and the radiation dosewere analyzed by one-way ANOVA tests or Kruskal-Wallis tests. Results The image quality comprehensive score of three groups showed significant difference (F=40.07,P<0. 01), which were (3.8±0.4), (3.6 ± 0.5) and (3.0 ± 0.6), respectively. The DAP and AK value of anteroposterior and lateral radiography of three groups also showed significant difference (P<0.05), B and C group were lower than the A group. Left and right eye lens organ dose were decreased along with the increase of the additional filtration thickness, and the difference between the 3 groups also had significant difference (P<0.01). Conclusion Both the image quality and radiation dose can acquire when conducted the whole brain DSA with 1.0 mmAl+0.4 mmCu additional filtration.
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Objective To investigate the lens and pituitary dose impacted by additional filtration and collection field in head and neck DSA examinations. Methods All images were acquired by a Philips ALLura Xper FD 20 DSA machine. The combination of the different collection fields (48 cm, 42 cm, 31 cm, 22 cm) and additional filtrations (0.9 mmCu+1.0 mmAl, 0.4 mmCu+1.0 mmAl, 0.1 mmCu+1.0 mmAl) were adjusted when the anthropomorphic phantom filled with dosimeter was scanned in anterioposterior and lateral positions with 2D?DSA and 3D?DSA. The dose area product (DAP), air kerma (AK) and the radiation dose values of bilateral lens and pituitary were measured and recorded. The 2D and 3D?DSA regional absorption dose on lens and pituitary were analyzed using t' test, the correlations between DAP and AK parameters and different regional absorption doses were evaluated by Pearson rank correlation coefficient. Results Absorption doses of left lens, right lens and pituitary with 2D?DSA (n=12) were as following:(2.77 ± 0.68), (6.23 ± 3.54), (8.65 ± 2.62) mGy, while the parameters with 3D?DSA (n=12) were (1.78 ± 0.82), (2.18±1.15), (3.32±0.64) mGy, respectively;the results revealed a significant difference (t'=3.20, 3.76 and 6.85, P<0.01). DAP [(8 739±5 731) mGy·cm2] had a relationship with absorption dose of pituitary, left lens and right lens [(5.988 ± 3.299),( 2.258 ± 0.872),( 4.207 ± 3.303) mGy, r values were 0.766, 0.684, 0.727; P<0.01]. AK values was (31 ± 23) mGy and it had a relationship with pituitary absorption dose (r value was 0.894, P<0.01). The lens dose was reduced when the additional filtration was increased and the collection field was decreased, the radiation dose of the pituitary was reduced when both the additional filtration and the collection field were increased. Conclusions In the head and neck DSA examinations, the radiation dose of the lens and the pituitary had different changes with the different additional filters and collecting fields. The organ dose with 3D?DSA was significantly less than that with 2D?DSA.
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Objective To compare the clinical effect of laparoscopic and open appendectomy in the treat-ment of perforated appendicitis.Methods 107 patients with perforated appendicitis were selected as the research object and were divided into two groups.The observation group(54cases)received laparoscopic appendectomy while the control group (53cases)received traditional open appendectomy.The size of incision,the amount of bleeding during operation,time of operation and hospitalization and other perioperative indexes and the incidence rate of complications were compared between the two groups.Results The operation time between the two groups had no statistical significance(t =1.286,P >0.05 ).The incision size [(2.5 ±0.3)cm],the amount of intraoperative bleeding[(10.3 ±3.4)mL]and hospitalization time[(5.4 ±0.9)d]of the observation group were better than those of (4.2 ±0.4)cm,(19.4 ±4.2)mL and (6.5 ±1.1 )d in the control group,the differences were statistically significant(t =24.901,12.329,5.666,all P <0.05).The occurrence rate of complications of the observation group was 3.4%,which was lower than 15.1% of the control group,the difference was statistically significant(χ2 =3.940, P <0.05 ).Conclusion Laparoscopic appendectomy has the advantages of less trauma,faster recovery,less complications,shorter hospitalization time,etc.And its effect is better than open appendectomy and worthy of populari-zation and application.
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PurposeThe monitor of organ microcirculation is significant in the diagnosis and treatment of hemorrhagic shock (HS). We established an HS experimental model and evaluated it by contrast-enhanced ultrasound (CEUS), which aimed to evaluate the value of CEUS and time-intensity curve (TIC) in quantitative analysis of renal cortical microcirculation.Materials and Methods The experimental models of HS were established in 30 healthy New Zealand white rabbits by controlled exsanguinations and were divided into four groups according to the shock grade: normal (100% MAP), mild (70% MAP), moderate (50% MAP) and severe (40% MAP). The right kidneys of the experimental model were examined by CEUS. The corresponding parameters of the TIC such as arrival time (AT), time to peak (TTP), peak intensity (PI) and area under the curve (AUC) were measured with the TIC analysis software package when the region of interest was set in superficial of renal cortex.Results The model of HS were successfully established with 30 healthy New Zealand rabbits. Twenty-seven healthy New Zealand rabbits were alive at the end of the experiment, and three died of severe shock. The TIC rose steeply and reached the peak quickly, and then declined slowly to the baseline, which reflected the transition of microbubble in the region of interest. As the hemorrhagic shock model progressed from normal to mild, PI and AUC gradually decreased and the differences were significant (P0.05). AT and TTP gradually prolonged compared with normal and mild shock groups, and the differences were significant (P<0.05).Conclusion CEUS and TIC can quickly and accurately assess the renal perfusion changes of acute hemorrhagic shock model of animals in a quantitative way. It can be used as a new noninvasive monitoring tool in quantitative analysis of renal cortical microcirculation.
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Purpose To study the effects of different doses of ultrasound contrast agent SonoVue upon contrast-enhanced ultrasound (CEUS) in the kidney of healthy rabbits, and to seek the optimal dose of SonoVue. Materials and Methods CEUS was performed in 10 healthy rabbits with GE LOGIQ-E9 by using 8 different doses of SonoVue (ranging from 0.02 ml/kg to 0.16 ml/kg). The quantitative parameters of the time-intensity curve (TIC) were measured and statistically compared. Results The TICs showed that the peak intensity (PI) and the area under curve (AUC) increased with dose when the doses ranged from 0.02 ml/kg to 0.10 ml/kg (r=0.962 and 0.965, P<0.05); when the dose further increased, AUC had little change but PI decreased reversely. The arrival time (AT) shortened along with the increase of the SonoVue dose (r= - 0.917, P<0.05). The dose had a positive correlation with time to peak (r=0.49, P<0.05). Conclusion The parameters of TIC are influenced intensely by different doses of SonoVue. It is important to realize the relationship between SonoVue doses and its effects upon contrast-enhancement ultrasound in microcirculatory quantification. The dose of 0.10 ml/kg appears to be the optimal dose for CEUS in examining kidney of healthy rabbit.
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Objective To detect the expression of heat shock protein 47(HSP47) in renal proximal epithelial cell lines (HK-2) and to investigate the role of HSP47 in the progress of transforming growth factor β1 (TGF-β1) induced epithelial-mesenchymal transdifferentiation (EMT) in HK-2 cells.Methods HK-2 cells were exposed to TGF-β1 (0,2.5,5,10 μg/L) for different time (0,12,24,48 h).The expression of HSP47 was examined by Western blotting.Then HK-2 cells were exposed to 10 μg/L TGF-β1,the expressions of vimentin,zona occludens-1 (ZO-1) were examined by Western blotting and real-time PCR.Furthermore,the expressions of p-Smad3 and Smad3 were examined by Western blotting.HK-2 cells were transfected with HSP47 siRNA and siRNA negative control before exposing to TGF-β1.Then the expressions of vimentin,ZO-1 were detected by Western blotting and real-time PCR,meanwhile Western blotting for HSP47,p-Smad3 and Smad3.Results Stimulating HK-2 with TGF-β1 resulted in a significant increased expression of HSP47 in time-and concentration-dependent manner (P ＜ 0.05).Meanwhile,TGF-β1 up-regulated the protein and mRNA expression of vimentin (P ＜ 0.05),and down-regulated the protein and mRNA expression of ZO-1 (P ＜ 0.05),all in time-dependent manner.Stimulating HK-2 with TGF-β1 resulted in phosphorylation of Smad3,which was peaked at 30 min,slightly decreased at 1 h,and then increased again between 24 and 48 h (P ＜ 0.05).Compared to the TGF-β1 group,inhibition of HSP4.7 expression in HK-2up-regulated the protein and mRNA expression of ZO-1,down-regulated the protein and mRNA expression of vimentin (P ＜ 0.05) and down-regulated the ratio of p-Smad3/Smad3.HSP47 siRNA negative control had no significant effect on the expressions of ZO-1,vimentin and p-Smad3/Smad3 (P ＞ 0.05).Conclusion HSP47 can promote the EMT of renal tubular epithelial cell which is possibly via the TGF-β1-Smad3 pathway.
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ObjectiveTostudytheroleof hotshockprotein (HSP)47in tubulointerstitial fibrosis induced by transforming growth factor β1(TGF-β1),and to explore its possible mechanism.Methods Human proximal tubular epithelial cells(HK-2) were divided into threegroups:control,TGF-β1andHSP47siRNA. Theexpressionsof HSP47, collagenⅣ,fibronectin(FN),plasminogen activator inhibitor 1(PAI-1) mRNA and HSP47,collagen Ⅳ,FN protein were detected by RT-PCR and Western blotting respectively.PAl-1 protein was detected by ELISA. ResultsHK-2expressedHSP47innormalmedium. ThemRNAandprotein expressions of HSP47 up-regulated in concentration- and time-dependent manner in HK-2 cells induced with increasing concentrations of TGF-β1(0,2.5,5,10 μg/L) and with prolong times (12,24,48 h),and peaked at 10 μg/L TGF-β1 for 48 h.Similar phenomena was observed in the mRNA andproteinexpressionsof collagenⅣ, FN, PAI-1inHK-2 cellsinducedbyincreasing concentrations of TGF-β1 (0,2.5,5,10 μg/L) at different time points (12,24,48 h),and peaked at 10 μg/L TGF-β1 for 48 h.HSP47 siRNA could significantly reduce the up-regulation of mRNA and protein expressions of HSP47,collagen Ⅳ,FN,PAI-1 in HK-2 cells induced by TGF-β1.Conclusion HSP47 can promote renal tubulointerstitial fibrosis maybe through the regulation of the expressions of collagen Ⅳ,FN,PAI-1.
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Objective To evaluate the value of MSCT perfusion imaging in assessment of single renal function of hydronephrotic kidney.Methods 64-slice spiral CT perfusion was performed in 36 obstructive nephrohydrosis patients whose split renal glomerular filtration rate(GFR) was measured by SPECT renal dynamic imaging. ①The perfusion parameters of the renal cortex and renal medulla of the hydronephrotic kidney were compared with the normal kidney studied by contrast group. ②The 72 kidneys were divided into normal renal function, mild and severe renal impairment groups according to renal function. Differences between the groups respect to all the mean perfusion parameters of the renal cortex and renal medulla were assesses by ANOVA. ③Using Pearsons correlation test, the correlations between all the mean perfusion parameters of the renal cortex and renal medulla and renal GFR were examined.Results ① The time-density curves of bilateral normal renal cortex and medulla were not symmetric. The mean BF, BV, PS, PBV of renal cortex were (203. 2±44.9)ml·100 ml~(-1)·min~(-1), (27.6±3.9)ml/100 ml, (30.7±6.5)ml·100 ml~(-1)· min~(-1), (46.5±10. 9)ml/100 ml; and the mean BF, BV, PS, PBV of renal medulla were (99.9±24.1)ml·100 ml~(-1)·min~(-1) ,(18. 3±4.3)ml/100 ml, (51.8±12.1)ml · 100 ml~(-1)· min~(-1) , (21.3±3.0)ml/100 ml. The mean perfusion parameters of the cortex and medulla of obstructed kidney were lower compared to that of normal kidney. ②There were significant differences of all the perfusion parameters of the renal cortex and me-dulla between 3 groups (P<0. 05). ③The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR. The best correlation was the blood flow of the cortex of kidney. The correlation coefficient r=0.852.Conclusions64-slice spiral CT perfusion imaging can quantita-tively evaluate the haemodynamic condition and functional lesion of the kidney, classify the impaired kidney function. The perfusion parameters of the renal cortex and medulla had positive linear correlation with GFR.
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valuating the unilateral renal function of hydronephresis.
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A model of s bacute senility state was established in mice by successive retrobulbar injectiou of 80 mg/kg D-galactose for 50 days. Concomitant oral administration of 4 g/kg and 8 g/kg gastrodia can effectively recovcr the decreased ability of the passive avoid ance reaction in the model animals.The activity of RBC SOD and the contents of hydroxyproline in the animals skin were markedly increased as well as the lipofuscin of myocardium. However, gastrodia was less effective to lower lipofuscin in liver and brain.