Comparisons of characteristics of adult and juvenile callers at high risk for suicide from psychological assistance hotline and the influencing factors of intervention effect / 四川精神卫生

ObjectiveTo compare the characteristics of adult and juvenile callers at high risk of suicide from psychological assistance hotline， to screen factors influencing the crisis intervention effect， so as to develop specific intervention programs for different age groups on psychological assistance hotline. MethodsFrom January 2021 to June 2021， a total of 2 229 callers at high risk for suicide were recruited from Beijing psychological assistance hotline. The selected individuals were divided into adult group （n=1 344） and juvenile group （n=885）. Callers were interviewed by the hotline operators. Their general information， suicidal ideation， socio-psychological characteristics and chief complaints were recorded and compared between two groups. Before and after hotline crisis interventions， psychological distress， suicidal ideation intensity and hope level of the callers were assessed， and the improvements in the three assessed dimensions were compared between two groups. Then Logistic regression was adopted to compare the crisis intervention effects on three dimensions and their associated factors. ResultsCompared with adult group， juvenile group reported higher rates of family relationship problems， learning problems， history of suicide attempts and fear of assault， with statistically significant differences （χ2=55.604， 24.706， 41.944， 106.527， P<0.01）. After hotline crisis intervention， the proportion of callers with increased level of hope was larger in juvenile group than that in adult group （42.74% vs. 30.97%， χ2=26.042， P<0.01）. Multivariate Logistic regression analysis showed that the chances of improvement in psychological distress for major depressive disorder （OR=0.650， 95% CI： 0.510~0.827）， the chances of improvement in the level of hope for those with substance dependents （OR=0.550， 95% CI： 0.327~0.926）， and the chances of improvement in the intensity of suicidal ideation for those with stressful life events （OR=0.565， 95% CI： 0.328~0.973） were all higher in juvenile group than those in adult group after crisis intervention. ConclusionAmong the callers at high risk for suicide from psychological assistance hotline， adult callers are more concerned about extra-familial relationships， work and economic problems， while juvenile callers are more concerned about family relationship and learning problems. Furthermore， the effect of crisis intervention in juvenile callers is less affected by major depressive disorder， substance use problems and stressful life events.

Prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index in septic patients / 中华危重病急救医学

Objective:To evaluate the prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index (EVLWI) in septic patients.Methods:A prospective cohort study was conducted. Sixty septic patients admitted to department of intensive care unit (ICU) of Sichuan Provincial People's Hospital from November 2016 to October 2019 were enrolled. The EVLWI and pulmonary vascular permeability index (PVPI) were determined by pulse-indicated continuous cardiac output (PiCCO) system at 0, 24, 48 and 72 hours. At the same time, the numbers of comet tail signs in both lungs (parasternal, midclavicular, axillary to midaxillary) were collected by chest ultrasound. Moreover, arterial blood gas analysis, such as pH value, central venous-to-arterial carbon dioxide difference (Pcv-aCO 2), central venous oxygen saturation (ScvO 2), blood lactic acid (Lac), PaO 2/FiO 2 were measured. Pearson correlation analysis was performed between the number of comet-tail sign and EVLWI. Multivariate Logistic regression model was used to analyze the relationship between the number of comet-tail sign, EVLWI and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to predict the prognosis. Results:There were 43 males and 17 females in 60 septic patients. The average age was (64.3±15.5) years old (range: 31-83 years old). There were 35 cases with pulmonary infection, 10 cases with abdominal infection, 6 cases with urinary tract infection, 3 cases with skin and soft tissue infection, 3 cases with intestinal infection, 1 case with meningitis, 1 case with cellulitis and 1 case with multiple injury. Acute respiratory distress syndrome (ARDS) occurred with 8 patients; 40 patients (66.7%) survived and 20 patients (33.3%) died on day 28. Pearson correlation analysis showed that the number of comet-tail sign was positively correlated with EVLWI ( r = 0.944, P < 0.001). There was significant difference in the number of comet-tail signs among sepsis patients with different primary infection sites ( H = 17.714, P < 0.001). The number of comet-tail signs in sepsis patients with pulmonary infection [19 (13, 27)] was significantly higher than that with other infections. The number of comet-tail sign in patients with ARDS was significantly higher than that in patients without ARDS [27 (19, 30) vs. 15 (9, 24), H = 25.387, P < 0.001]. Multivariate Logistic regression analysis showed that EVLWI, the number of comet-tail signs and PVPI were independent risk factors for death in septic patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 10.772 (1.161-99.851), 2.360 (1.070-5.202), 2.042 (1.152-3.622), all P < 0.05]. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value of Logistic regression model based on comet-tail sign and EVLWI were 90.0%, 90.0%, 90.0%, 81.8%, 94.7%, respectively, and area under curve (AUC) were 0.926±0.018, 95% CI was 0.912-0.975, P < 0.001. Conclusions:The transthoracic lung ultrasound comet-tail in septic patients is significantly correlated with EVLWI monitored by PiCCO. The transthoracic lung ultrasound comet-tail combined with EVLWI can better improve the sensitivity, specificity and accuracy of 28-day prognosis in septic patients.

Prenatal ultrasound diagnostic clues of congenital dislocation of the knee / 中华超声影像学杂志

Objective:To explore prenatal ultrasound diagnostic clues of congenital dislocation of the knee(CDK).Methods:The prenatal ultrasonographic features of 13 CDK fetuses diagnosed from January 2013 to December 2018 in the Third Affiliated Hospital of Zhengzhou University were retrospectively analyzed, combined with the results of gene detections and pathological findings.Results:Thirteen fetuses were diagnosed by prenatal ultrasound during the second trimester. Two-dimensional and three-dimensional ultrasound showed dislocation of the knee(unilateral in 3 cases and bilateral in 10 cases). All cases were accompanied with multiple abnormalities, including talipes(5 cases), overlapping fingers(2 cases), short nasal bone(1 case), thicken nuchal fold(1 case), narrow thorax(1 case), abnormal vertebral development(1 case), etc. Ultrasound diagnosis included Larsen syndrome in 2 cases, arthrogryosis multiplex congenital in 3 cases, asphyxiating thoracic dysplasia in 1 case, and congenital dislocation of the knee in 7 cases. CDK was confirmed in all fetuses after termination of pregnancy. Three of them were known to undergo chromosome examinations with normal chromosomal microarray analysis (CMA). One case was confirmed to be Larsen syndrome by further second-generation sequencing combined with first-generation sequencing screening, suggesting there was FLNB gene mutation.Conclusions:CDK can exist isolated, and it can also be a common manifestation of various diseases. Therefore, attention should be paid to other associated abnormalities in the prenatal detection of knee flexion, and further detection of related genes can provide valuable information for genetic counseling.

Comparison of carbon nanoparticles and methylene blue for sentinel lymph node mapping in laparoscopic staging of early endometrial carcinoma / 中华全科医师杂志

To compare carbon nanoparticles with methylene blue for sentinel lymph nodes mapping in laparoscopic staging of early endometrial carcinoma.Forty five patients with stage I or stage Ⅱ endometrial carcinoma undergoing laparoscopic operation from January 2016 to January 2018 were randomly divided into two groups:methylene blue was applied in 20 cases and carbon nanoparticies were applied in 25 cases for sentinel lymph node (SLN) mapping in laparoscopic staging;and the images of two tracers were compared.The development time of nano-carbon group was shorter[(16.4±3.4) min vs.(21.0±5.9)min,t=3.26,P=0.02] and duration was longer [(73.1 ± 14.3) min vs.(54.6 ± 14.9)min,t=5.41,P=0.04] than those of methylene blue group.In lymphatic mapping,the detection rate of SLN in nano-carbon group was significantly higher than that of methylene blue group [95％ (21/22)vs.5/18].For detection of metastatic SLN,the sensitivity of methylene blue group was 1/2 and that of nano-carbon group was 4/4 (x2=66.70,P＜0.01).The results indicate that both methylene blue and Nano-carbon tracer can be used for SLN mapping in laparoscopic staging of early endometrial carcinoma,and nano-carbon tracer is recommended as the first choice to predict pelvic lymph node metastasis in endometrial carcinoma surgery.

Experts consensus on the management of delirium in critically ill patients / 中华内科杂志

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Effects of isoflurane versus sevoflurane on postoperative cognitive function in old patients / 临床麻醉学杂志

Objective To compare the effects of isoflurane compare sevoflurane on postoperative cognitive function and the level of serum β-amyloid in elder patients at 12 months after surgery.Methods Seventy-seven patients undergoing abdominal surgery,43 males and 34 females,aged 65-75 years,ASA physical status Ⅰ-Ⅲ,were divided into two proups:isoflurane group (group Ⅰ,n =32) and sevoflurane group (group S,n =45).The patients' cognitive function were assessed using mini-mental state examination (MMSE) 1 d before operation,3 d and 12 months after opertion.Blood samples were taken before operation,3 d and 12 monthes after operation for determination of serum Aβ42 and Aβ40 concentrations.Results The MMSE scores of the two groups 3 d after operation were significantly lower than those before operation (P＜0.05).The MMSE score 3 d after operation in group Ⅰ was significantly lower than that in group S (P＜0.05).The incidence of cognitive dysfunction 12 months after operation had no significant difference between two groups [13 (40.6％) cases vs 15 (33.3％) cases].There was no significant difference in the serum Aβ42 and Aβ40 concentration between groups.Conclusion Sevoflurane has less effect on postoperative cognitive function in short time than isoflurane,but its long-term effect seemed to be similar.The levels of Aβ42 and Aβ40 showed no difference between two groups.

Advantages of ultrasound-guided caudal epidural block over TIVA for transrectal ultrasound guided transrectal prostate biopsy / 中国医师杂志

Objective To compare the safety and efficacy of the caudal block and Total Intravenous Anesthesia (TIVA) for transrectal ultrasound (TRUS) guided prostate biopsy.Methods 60 elderly patients with transrectal ultrasound guided transperineal prostate biopsy were randomized into Group A and Group B.Patients in Group A received ultrasound guided caudal block (0.33％ ropivacaine 15 ml) and patients in Group B received TIVA.In operation room (T1),immediately before operation (T2) and at the end of operation (T3),mean artery pressure (MAP),heart rate (HR),breathing rate (BR) and pulse oxygen saturation (SpO2) were recorded.The patients in two groups were rated the level of mini-mental state examination (MMES) at 2 h,8 h and 24 h after operation.Complications during the whole study period were also evaluated.Results The values of MAP,HR and BR of T1 in group B were significantly lower than those at T2 (P＜0.05),and were lower than those in the group A (P ＜0.05).The MMSE value in group A [2 h (25.66 ± 1.71) and 8 h (26.13 ± 1.52)] was significantly higher than that in group B [2 h (27.96 ± 1.71) and 8 h (29.01 ± 0.77)] at after operation (P ＜ 0.05).The rate of usage of ephedrine (13％) and assisted ventilation (20％) in group B was higher.No significant differences were detected in side effects between the two groups.Conclusions Caudal block provides better anesthesia than TIVA for TRUS guided prostate biopsy without an increase of side effects,and it may be safely used during ambulatory surgery.

Clinical effect of Ejiao Huangqi oral liquid combined with norethisterone in treatment of dysfunctional uterine bleeding and its effect on improving anemia / 中国基层医药

Objective To observe the clinical effect of Ejiao Huangqi oral liquid combined with norethis-terone in treating dysfunctional uterine bleeding and its effect on improving anemia .Methods 100 patients with dysfunctional uterine bleeding were randomly divided into study group ( 50 cases ) and control group ( 50 cases ) according to the order of admission .The control group was given oral norethindrone treatment ,the study group was given Ejiao Huangqi oral liquid on the basis of the control group ,10mL per time,2 times a day.Both two groups were treated for 3 menstrual cycles.The fasting blood samples were taken to test the red blood cells (RBC) and hemoglobin(Hb). All patients were followed up for 3 months to evaluate clinical efficacy .Results The levels of RBC and Hb in the study group and control group were (3.05 ±0.58) ×1012/L and (3.67 ±0.65) ×1012/L,(86.75 ±6.30) g/L and (97.95 ±6.53) g/L,respectively,which were significantly higher than those before treatment (all P<0.05).The levels of RBC and Hb in the study group were significantly higher than those in the control group (P<0.05).The total effective rate of the study group was 92％(46/50),which was significantly higher than that of the control group [84％(42/50)],the difference was statistically significant (Z=-3.334,P<0.01).Conclusion Ejiao Huangqi oral liquid combined with norethisterone has exact effect in treating dysfunctional uterine bleeding , can quickly stop bleeding,improve the symptoms of anemia ,improve the clinical treatment effect ,which is worthy of clinical use .

Investigation and analysis on 20 elderly care institutions in urban Shanghai / 中华医院管理杂志

Objective To understand current reality of institutional elderly care services in 11 districts in Shanghai and discuss solutions to the planning and enhancement of such institutions. Methods Surveys were conducted in 20 elderly care institutions in Shanghai from August to October 2017 and questionnaires were distributed to the staff and residents in these facilities. Data were analyzed using Stata 12. 0. Results All the 20 institutions offer medical and nursing care, 19 of which providing insurance settlement and 10 were in deficit. Public facilities boost larger scale than private ones. A survey of 186 staff indicated that only 59. 67% of them felt satisfied with their academic title and professional career promotion opportunities; of 450 of the residents surveyed, 61. 47% of them expressed high acceptance of institutional elderly care, and the coverage of such insurances as critical illness and long-term care insurance was below 7%. Conclusions Half of the sample institutions experienced financial difficulties, roadblocks for staff professional promotion mechanism, unaffordable economic burden for residents, and insufficient supplementary insurance coverage. Policies should be implemented to ensure infrastructure and talent cultivation at elderly care facilities. Combination of elderly care with medical services should be promoted. Supplementary insurance is recommended for citizens to relieve disease and elderly care burden.

Prenatal ultrasonic manifestations and prognostic analysis of 17q12 microdeletion syndrome / 中华超声影像学杂志

Objective To summarize and analyze the prenatal ultrasonic manifestations of 17q12 microdeletion syndrome ,so as to provide help for prenatal diagnosis . Methods It carried out a retrospective analysis of 21 cases of 17q12 microdeletion syndrome prenatally confirmed by chromosomal microarray analysis(CMA) in the third affiliated hospital of Zhengzhou University from 2015 .01 to 2018 .05 . Prenatal ultrasound findings were collected . A close follow-up was given for the cases . Results Of the 21 fetus ,20 cases were presented with bilateral hyperechogenic kidneys ,and 1 case showed duodenal obstruction . There were 4 cases accompanied with polyhydramnios ,8 cases with mild polyhydramnio ,and 9 cases with normal amniotic fluid index . Parents of 6 fetus underwent chromosomal examination ,of which 2 cases were inherited from the mother and 4 cases had new chromosomal mutations;Seven cases had a family history of diabetes and 3 cases had a family history of kidney disease;Twelve cases performed induced labor ,2 cases lost follow-up and 1 case was unborn . Six cases were born ,of the 6 cases ,1 case associated with mild dysmorphic facial features , and 1 case associated with bilateral renal cysts . Conclusions 17q12 microdeletion syndrome has specific prenatal ultrasound characteristics ,while echogenic kidneys are of great value in the diagnosis of 17q12 microdeletion syndrome prenatally .

Effects of different hypoglycemic methods on high tibial osteotomy in patients with diabetes mellitus / 中国综合临床

Objective To investigate the effect of different hypoglycemic methods on tibial osteotomy (HTO)in patients with diabetes mellitus,and to seek a more scientific and reasonable clinical intervention model.Methods From February 2016 to January 2017,sixty patients with knee osteoarthritis and diabetes mellitus were randomly divided into the control group and the observation group,with 30 cases in each group.Patients in the control group were treated with Acarbose and Aspartic Insulin 30 injection method for blood glucose intervention.Patients in the observation group were treated with vildagliptin and Aspartic Insulin 30 injection.The changes of fasting blood glucose(FPG),postprandial 2 h blood glucose(2 hPG),glycosylated hemoglobin(HbAlc),body mass index(BMI)and other indicators of the two groups were measured before treatment,before surgery and 6 months after surgery,and the adverse reactions of the two groups of patients were compared.Results Repeated measures analysis of variance showed that there were statistically significant differences in FPG and 2 hPG of the two groups collected before treatment,before surgery and 6 months after surgery(F=85.40,617.06; P<0.05).Independent sample t test showed that HbAlc in the control and the observation group((7.9±0.9)%,(7.5±0.8)%)were significantly lower than those before treatment((9.8 ±1.5)%,(9.5±1.2)%)(t=5.95,7.60,P<0.05),at 6 months after surgery,BMI((25.83±1.78)kg/m2) in the observation group was significantly lower than that in the control group((27.35 ± 2.41)kg/m2)(t=2.78,P<0.05).The number of adverse reactions in the observation group was 2 cases(6.67%),significantly lower than that of the control group of 13 cases(43.33%),the difference between the two groups was statistically significant(χ2=10.756,P<0.05).Conclusion Vildagliptin combined with Aspartic Insulin 30 injection can not only effectively control the perioperative blood glucose levels in patients with HTO,but also can help the patients to control the body weight and reduce the incidence of adverse reactions.This method has a positive effect on the recovery of HTO.

Da Vinci robot surgical system versus traditional open surgery for old patients with upper abdominal surgical diseases: a case control study / 中华普通外科杂志

Objective To compare the clinical application of Da Vinci robot surgical system (RSS) with traditional open surgery (TOS).Methods From Feb 2015 to Jul 2016,48 cases of upper abdominal surgical disease patients were divided into RSS group (23 cases) and TOS group (25 patients) randomly.Results The anesthesia time [(194 ±16)min vs.(181 ±11)min,t=3.262,P=0.002] and operation time [(167 ± 14) min vs.(158 ± 14) min,t =2.292,P =0.027] were much longer in the RSS,while the blood loss during operation significantly less than the TOS [(128 ± 62) ml vs.(190 ± 86) ml,t =-2.886,P =0.006].The RSS has obvious advantages in 24 h-drainage [(69 ± 27) ml vs.(114 ± 54) ml.t =-3.680,P =0.001],time to out-of-bed activity [(27.7 ± 8.0) h vs.(35.7 ± 9.9) h,t =-3.067,P =0.004],BPS,postoperative exhausting time[(27.2 ±5.9)h vs.(32.8 ±8.3)h,t =-2.690,P =0.01] and length of hospital stay [(10.4 ± 1.8) d vs.(11.8 ± 1.9) d,t =-2.600,P =0.013].But the total hospital cost was higher in RSS [(117 000 ± 10 000) yuan vs.(77 000 ± 8 000) yuan,t =15.087,P =0.000)].Conclusions The RSS is a much minimally invasive surgery,reducing blood loss and postoperative pain,promoting rapid recovery,shortening hospital stay.

Direct renin inhibitor aliskiren increases AQP2 expression in renal collecting ducts and improves urinary concentration defect in NDI / 中国病理生理杂志

AIM:The direct renin inhibitor aliskiren displays antihypertensive and antialbuminuric effects in humans and in animal models . Emerging evidence has shown that aliskiren localizes and persists in medullary collecting ducts even after treatment was discontinued . The purpose of the present study was to investigate whether aliskiren regulates renal aquaporin expression and improves urinary concen -trating defect induced by lithium .METHODS:The mice were either fed with normal chow or LiCl diet (40 mmol/kg dry food per day for first 4 days and 20 mmol/kg dry food per day for last 3 days ) for seven days .Some mice were intraperitoneally injected aliskiren ( 50 mg/kg BW per day in saline ) .RESULTS:Mice injected aliskiren developed decreased urine output and increased urine osmolal -ity when compared with controls .Aliskiren significantly increased protein abundance of AQP 2 and phosphorylated-S256 AQP2 in the kidney inner medulla .Immunohistochemistry and immunofluoresence showed increased apical and intracellular labeling of AQP 2 and pS256-AQP2 in collecting duct principal cells of kidneys in mice treated with aliskiren .Aliskiren treatment prevented urinary concen-trating defect in lithium-treated mice , and improved the downregulation of AQP 2 and pS256-AQP2 protein abundance in inner medulla of the kidney .In primary cultured rat inner medulla collecting duct cells , aliskiren dramatically increased AQP 2 protein abundance which was significantly inhibited either by PKA inhibitor H 89 or by adenylyl cyclase inhibitor MDL 12330, indicating an involvement of the cAMP signalling pathway in mediating aliskiren-induced increased AQP 2 expression .CONCLUSION: The direct renin inhibitor aliskiren upregulates AQP 2 protein expression in inner medullary collecting duct principal cells and prevents lithium -induced nephro-genic diabetes insipidus ( NDI) likely via PKA-cAMP pathways .

A study on the correlation between humanistic care ability of nursing students and their family en-vironment in western Guangxi / 中国实用护理杂志

Objective To explore the correlation between humanistic care ability of nursing students and their family environmental factors. Methods A sample of 198 nursing students was recruited with cluster sampling method. Demographic data, humanistic caring capacity, and family environmental factors were collected using a self-designed questionnaire, Caring Ability- Inventory (CAI) and Family Environment Scale (FES- CV) and then an analysis was conducted. Results Han nationality students accounted for 32.83%(65/198), minority students accounted for 67.17%(133/198) . The total average score of humanistic care ability was 190.79±18.84, the average score of items was 5.16±0.99. There were significant differences between our participants and those regarded as international norms on the three dimensions of humanistic care ability (t=-16.27--8.12, P < 0.01). The total average score of family environment was 42.57±8.88. Significant differences were also presented between our participants and those of domestic norms on the ten factors of the family environment (t=-10.94-30.04, P < 0.01). The significant correlation was not documented between the total scores of humanistic care ability and family environment. However, the correlations were documented between the six domains of family environment (intimacy, emotional expression, knowledge, entertainment, contradiction, sense of organization) and the total score and each dimension of humanistic caring capacity (P < 0.05 or 0.01). Conclusions The humanistic care ability of nursing students in minority area is relatively low. The humanistic care ability and family environment are correlated on the multi- dimen-sional facets. School educational strategies should be combined with family environment factors of nursing students to jointly promote the humanistic care ability of nursing students.

Impact of Collaborative Care Model on Self-care Ability of Patients with Cerebral Apoplexy / 沈阳医学院学报

Objective:To investigate the application of collaborative care model on self-care ability of patients with cerebral apoplexy. Methods:A total of 96 patients with cerebral apoplexy from Jan 1, 2015 to Aug 30, 2015 were randomly divided into experimental group and control group (48 patients in each) . Control group received the conventional treatment and care. On the basis of the control group, the experimental group received collaborative nursing mode. ESCA was used before and after the intervention in 2 groups to evaluate self-care ability. Results:There was no significance in self-care ability before intervention (P>0.05) .Self-care skills, personal responsibility, self concept and health knowledge levels in the experimental group after intervention were significantly higher than that in the control group (P<0.01). Conclusion:Collaborative care model as a kind of comprehensive nursing care intervention model used in patients with cerebral apoplexy,can promote the patient and family to jointly participate in nursing,to solve all kinds of health problems,improve patients’self-care ability,improve health outcomes.

Study on the correlation of C -reactive protein level and cerebral hemorrhage prognosis / 中国基层医药

Objective To analyze the correlation of C -reactive protein level and acute cerebral hemorrhage prognosis,provide the evidence for determining the condition and prognosis.Methods 163 patients with acute spon-taneous intracerebral hemorrhage met selection criteria in Yantai Economic and Technology Development Area Hospi-tal were selected as the study objects,the CRP were detected by immunoturbidimetry in the 1 day,3 days,7 days, 14 days after admission,the NIHSS were calculated,48 cases of healthy people were selected as the control group,the CRP between hemorrhage group and the healthy control group,patients with different brain hemorrhage,patients with different neurological deficit were compared.Results (1 )The C -reactive protein of cerebral hemorrhage group when admission were (8.92 ±1.0)mg/L,the control group were (4.25 ±0.23)mg/L,the C -reactive protein of cer-ebral hemorrhage group were significantly higher than that of the control group,the difference was statistically signifi-cant,t =-3.683,P <0.01.(2)The mean serum CRP after admission admission 1,3,7,14d were (9.34 ±1.65) mg/L,(9.56 ±1.58)mg/L,(6.58 ±1.17)mg/L,(4.98 ±1.26)mg/L,the CRP was a large rise in the course of the disease 1d,3d peak,F =7.487,P <0.05,the CRP had difference between large amount of brain hemorrhage,moder-ate amount of brain hemorrhage,and small amount of brain hemorrhage,a large amount of patients with cerebral hem-orrhage CRP levels were higher than a moderate amount of patients with cerebral hemorrhage and a small amount of patients with cerebral hemorrhage 1,3 and 7d,during which the difference was statistically significant(F =3.31, 4.62,4.21,P <0.01 or P <0.05).(3)The CRP peak levels of different degrees of neurological deficits in patients with acute cerebral hemorrhage decreased in 3d,7d,14d,the CRP of 3d were higher than that in 1d,the CRP of 7,14d were lower than that in 1d,CRP levels between different neurological deficits degree of acute cerebral hemorrhage were also significantly different (F =4.29,5.32,3.62,3.21,P <0.05 or P <0.01),the CRP levels of Severe neurological deficit in 1d,3d,7d,14d were significantly higher in mild and moderate neurological deficit (t =6.567,4.241, 4.010,3.511 and 4.965,3.031,3.104,3.009,P <0.05 or P <0.01 ).Conclusion The serum CRP levels of patients with acute cerebral hemorrhage significantly increased,the serum CRP level shows dynamic changes in the first three days of the onset of peak,the CRP levels significantly correlated with the prognosis of cerebral hemorrhage, the more severe neurological deficit,the greater the amount of cerebral hemorrhage,higher serum CRP levels.

The research of the application of motor imagery therapy on the recovery of the stroke patients with aphasia / 中国实用护理杂志

Objective To discuss the influence of motor imagery therapy on the recovery of the stroke patients with aphasia.Methods Sixty cases of stroke patients with aphasia were divided into the treatment group and the control group according to the odd and even of last number.The single number was set into the control group.The double number was given to the treatment group.There were thirty patients in each group.Both groups received the conventional drug treatment and routine care of the Department of Neurology.On this basis,from the second day in hospital,the treatment group received the speech rehabili tation training with motor imagery therapy.Aphasia assessment was done for the two groups on the first day in hospital with CRRCAE.On the first day and after receiving ten-day treatment with motor imagery therapy,the grade of the severity for aphasia of Boston Diagnostic Aphasia Examination (BDAE) was done to assess the severity of aphasia in two groups.The scores of the two groups were compared.Results Before the treatment,there was no significant difference between the two groups.After receiving ten times treatment,both the two groups were improved.Compared with the control group,the treatment group became better.There was statistically significant difference between the two groups.Conclusions For the stroke patients with aphasia,motor imagery therapy has significant effect on their recovery.

Effects of isoflurane or sevoflurane combined with remifentanil anesthesia on blood amyloid beta protein in elderly patients undergoing abdominal surgery / 中华麻醉学杂志

Objective To compare the effects of isoflurane or sevoflurane in combination with remifentanil anesthesia on blood amyloid beta protein (Aβ) in the elderly patients undergoing abdominal surgery.Methods Two hundred patients of both sexes,aged 65-75 yr,weighing 51-76 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective abdominal surgery under general anesthesia,were randomly divided into 2 groups (n =100 each) using a random number table:isoflurane combined with remifentanil anesthesia group (IR group) and sevoflurane combined with remifentanil anesthesia group (SR group).Fifty healthy elderly subjects served as control group (group C).After anesthesia was induced with iv penehyclidine,sufentanil,propofol and vecuronium,the patients were endotracheally intubated and mechanically ventilated.In group IR,anesthesia was maintained with inhalation of isoflurane (end-tidal concentration 1.68 ％,in IR group) or sevoflurane (end-tidal concentration 1.71％,in SR group),and target-controlled infusion of remifentanil (target plasma concentration 2-6 ng/ml).At l day before surgery and 3 days after surgery,the patients' cognitive function was assessed using Mini-Mental State Examination (MMSE),the development of postoperative cognitive dysfunction (POCD) was recorded,and blood samples were taken for determination of serum Aβ40 and Aβ42 concentrations.Results The incidence of POCD was 5％ (in C group),56％ (in IR group) or 22％ (in SR group),and there was no significant difference among the three groups.There were no significant differences in the serum Aβ42 and Aβ40 concentrations after surgery among the three groups.Conclusion The mechanism by which sevoflurane or isoflurane in combination with remifentanil anesthesia results in POCD is not related to the levels of blood Aβ40 or Aβ42 in the elderly patients undergoing abdominal surgery.

Value of ultrasonography in early diagnosis of metatarsal fatigue fractures / 中华超声影像学杂志

Objective To observe the ultrasonic manifestation of metatarsal fatigue fractures and probe into the clinical values of ultrasonic diagnosis and follow-up to the disease.Methods The clinical data and sonographic features of 30 cases with metatarsal fatigue fracture confirmed by X-ray and CT were analyzed retrospectively.Results All the subjects in this study were metatarsals insufficiency fractures located in the second or third diaphysis.2D-ultrasound found microfracture in the cortex and the periosteal elevation by increased vascularity in the early stage.During the 3-month follow-up,thickened cortex and callus shown as the shape of mushroom or cauliflower and a great amount of neovascularisation were visualised with color Doppler flow imaging.Then,the cortex surface became gradually changing from rough to smooth and obvious posterior shadows were observed with the illness progression.Conclusions Ultrasonography could be used to detect the cortical continuity,callus characteristics and blood flow perfusion of fatigue fracture in the different damage stages.

Expression and significance of HIF-1α, PDGF and VEGF/VEGFR-2 in breast cancer / 国际肿瘤学杂志

Objective To discuss the relationship among hypoxia-inducible factor-1α (HIF-1ct),platelet derived growth factor (PDGF) and vascular endothelial growth factor (VEGF)/VEGFR signaling pathway in breast cancer occurring and metastasis in the early stage.Methods The clinical and pathological features and the expression of HIF-1 α,PDGF-A,VEGF-A and VEGFR-2 were assayed by histomorphology and immunohistochemical staining on tissue specimens from 61 patients of breast cancer and healthy breast tissues healthy breast tissue from 17 patients of benign breast disease.Results VEGF expression was observed in 39 out of 61 malignant breast tissues,more than distribution of positive staining 20 patients (51.3％) of which.VEGFR expression was found in 42 out of 61 lesions,.more than 10％ distribution of positive staining 22 patients (52.4％) of which.Simultaneous expression of VEGF and VEGFR-2 was found in 12 cases.HIF-1α was expressed in 50 and PDGF in 39 out of 61 breast cancer patients,and in 36(72.0％) HIF-1α positive specimens and 23 (59.0％) PDGF positive specimens the staining area was more than 10％.The expression of VEGFR was correlated with patient's age (x2 =11.080,P =0.001) and lymph node metastasis (x2 =4.699,P =0.046).VEGF,HIF-1α and PDGF were not correlated with patient's age (x2 =0.880,P =0.415; x2 =1.620,P =0.303 ; x2 =0.150,P =0.786) and lymph node metastasis (x2 =0.677,P =0.437 ; x2 =1.394,P=0.323;x2 =1.841,P=0.192).Conclusion HIF-1α,PDGF,VEGF and VEGFR-2 express in breast tumor tissues at a high level,and VEGFR-2 is correlated with patient's age and lymph node metastasis.Abovementioned proteins can be used as markers for diagnosis,prognosis and targeted therapy.