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BACKGROUND:In the treatment of skin trauma with active repair,tissue engineering techniques are needed to generate new tissue to replace necrotic tissue.Skin scaffolds have a good application prospect in the field of wound repair.Skin scaffolds need to present three-dimensional porous structures with certain mechanical strength to meet the needs of cell proliferation and division.However,the mechanical strength of the currently used gelatin-based biomaterials is weak and cannot meet the requirements of the use of skin scaffolds. OBJECTIVE:To study the 3D printing process used in the preparation of tissue engineering skin scaffolds by gelatin/oxidized nanocellulose composites,and focus on the relationship between the porosity and mechanical strength of the scaffolds prepared under different process parameters. METHODS:Oxidized nanocellulose whiskers at 10%concentration were extracted from Humulus scandens and then compounded with 5%gelatin to obtain gelatin/oxidized nanocellulose composites.The elastic modulus of gelatin and gelatin/oxidized nanocellulose composite was determined.Skin scaffolds were prepared by 3D printing extrusion molding using gelatin/oxidized nanocellulose composite as the base material.Mechanical and rheological properties of the composite were tested to determine extrusion molding parameters(filling gap 1.5-2.5 mm,uniform distribution of 0.1 mm;air pressure of 160-200 kPa),and the skin scaffold with a three-dimensional porous structure was prepared.The compressive performance of the skin scaffold was tested and compared with the finite element analysis results.The relationship between the filling gap and the porosity and mechanical strength of the scaffold was demonstrated. RESULTS AND CONCLUSION:(1)The elastic modulus of 5%gelatin was increased by 8.84 times by adding 10%oxidized nanocellulose whisker.A gel filament with a diameter of 1 mm was obtained by extrusion at the air pressure of 160 kPa.When the filling gap increased from 1.5 mm to 2.5 mm,the theoretical porosity of the scaffold increased from 33%to 60%,but the compressive strength decreased from 230 000 Pa to 95 000 Pa.(2)These findings showed that the skin scaffold with theoretical porosity of 50%and elastic modulus of 160 000 Pa was prepared by using 2 mm filling gap.The scaffold had a clear three-dimensional porous structure.
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Gastric cancer is one of the common tumors in the world and a major cause of cancer death.Although the 5-year survival rate of gastric cancer patients has increased greatly with the improvement levels of diagnosis and treatment,the high malnutri-tion rate of gastric cancer patients still has a significant impact on their overall survival and quality of life.Malnutrition is considered an independent prognostic factor for cancer patients,early detection of malnutrition in gastric cancer patients and more reasonable peri-operative nutritional support play an important role in the survival and prognosis of gastric cancer patients.This article combines exist-ing research at domestic and abroad to review the nutritional risk screening and assessment of gastric cancer patients during periopera-tive period,as well as the research progress of perioperative nutritional support and immunonutrition,in order to provide more compre-hensive nutritional management strategies for patients with gastric cancer during the perioperative period.
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As the research of traditional Chinese medicine (TCM) on knee osteoarthritis (KOA) is progressing, researchers have discovered that a variety of Chinese medicines can delay the progress of KOA by regulating signaling pathways at the molecular level. The Chinese medicines and their active ingredients mentioned in this article are associated with the signaling pathways in KOA. They can regulate the levels of targeted molecules via different signaling pathways to inhibit cartilage inflammatory cytokine, apoptosis, and cartilage matrix degradation and promote chondrocyte autophagy, so as to reduce the synovial inflammatory edema and delay cartilage degeneration. This paper systematically reviews the studies about the TCM intervention of KOA. Baicalein can reduce the inflammatory cytokines and apoptosis and promote the autophagy of chondrocytes by blocking the phosphatidylinositol-3 kinase/protein kinase (PI3K/Akt) signaling pathway. Cornuside I can decrease the phosphorylation activity of Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) pathway to reduce synovial inflammation and delay cartilage matrix degeneration. Salvianolic acid A can reduce inflammation and cartilage matrix degradation by inhibiting the phosphorylation of the nuclear factor-κB (NF-κB) pathway. Emodin can reduce the activity of Wnt/β-catenin pathway to inhibit the decomposition of collagen and proteoglycan. Myristicoside can inhibit apoptosis by blocking the p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway. Akebia saponin D can enhance the activity of nuclear factor E2-related factor 2/heme oxygenase 1(Nrf2/HO-1) pathway to inhibit oxidative stress in chondrocytes. The saponins in Achyranthis Bidentatae Radix reduce cartilage matrix degradation by enhancing the transforming growth factor-β (TGF-β)/Smad signaling pathway. Crocin inhibits the cartilage inflammation and apoptosis factor increase by stimulating the activity of hippo-Yes-associated protein (Hippo-YAP). Ligustrazine blocks the Notch pathway to improve the morphology and abnormality of chondrocytes. Oleanolic acid reduces the destruction and degeneration of cartilage matrix via the estrogen signaling pathway. The above summary aims to provide references for future clinical and experimental research on KOA.
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Objective:To evaluate the dose-response relationship of remimazolam for loss of consciousness during anesthesia induction in the patients undergoing coronary artery bypass grafting (CABG).Methods:American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳpatients, aged 55-64 yr, with body mass index of 21-26 kg/m 2, scheduled for elective CABG under general anesthesia, were included in this study.The trial was conducted using the modified Dixon′s up-and-down method. The initial dose of remimazolam was 0.225 mg/kg, each time the concentration increased/decreased by 0.025 mg/kg in the next patient depending on whether or not the patients lost consciousness. Criteria for loss of consciousness was considered as the modified vigilance sedation score≤1 within 3 min after remimazolam administration. The 50% effective dose (ED 50), 95% effective dose (ED 95) and their 95% confidence interval ( CI) was analyzed by probit probability analysis method. Results:The ED 50 of remimazolam for loss of consciousness during anesthesia induction was 0.175 mg/kg, 95% CI was 0.163-0.185 mg/kg, ED 95 was 0.211 mg/kg, and 95% CI was 0.197-0.255 mg/kg. Conclusions:The ED 50 and ED 95 of remimazolam were 0.175 and 0.211 mg/kg respectively when used for loss of consciousness during anesthesia induction in the patients undergoing CABG.
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Objective To evaluate the value of PLT and its parameters combined with AFP, CA199, CA125 and CEA on the preoperative differential diagnosis of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Methods We analyzed retrospectively 274 patients with liver cancer who underwent surgery in the Second Hospital of Lanzhou University. They were divided into 229 cases in HCC group and 45 cases in ICC group according to postoperative pathological results. The differences of PLT, its parameters and tumor markers between the two groups were compared. ROC curve was used to evaluate the differential diagnosis effect on HCC and ICC by significantly different indicators in single and combined forms. The best scheme was verified in the patients with determined and undetermined preoperative diagnosis. Results Compared with HCC group, the levels of PLT, PCT, CA199 and CA125 in ICC group were higher (P < 0.05) and the level of AFP was lower (P < 0.05). The diagnostic analysis results of ROC curve showed that in single test, the AUC of AFP for HCC diagnosis was the largest (0.827). The AUC of the combined groups was higher than the single groups of tumor markers; the AUC of the PCT+AFP+CA199+CA125 group was the highest in all combination groups, and AUC was 0.891. The verification of the best combination group showed that the AUC was 0.924 in the preoperative determined diagnosis group and 0.854 in the undetermined diagnosis group. Conclusion Tumor markers in combination with PLT and PCT can increase the preoperative differential diagnosis efficacy of HCC and ICC. The combination of PCT, AFP, CA199 and CA125 before operation is helpful to further determine the diagnosis and plan the operation scheme.
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Objective:To investigate the effects of lengths of intramedullary nails on the treatment efficacy of osteoporotic unstable intertrochanteric fracture.Methods:Retrospectively analyzed were the data of patients with osteoporotic unstable intertrochanteric fracture who had been admitted to Department of Orthopedics, China-Japan Friendship Hospital from January 2017 to December 2019. According to the lengths of intramedullary nails, the patients were divided into 2 groups. In the short nail group of 135 cases, there were 38 males and 97 females with an age of (82.2 ± 7.7) years and an intramedullary nail with a length of 170 mm was used. In the long nail group of 32 cases, there were 8 males and 24 females with an age of (81.5±7.1) years and an intramedullary nail longer than 300 mm was used. The amount of intraoperative hemoglobin drop value, operation time, Harris hip score at 6 months after surgery, incidence of complications and mortality were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability between groups ( P>0.05). There were no significant differences between the 2 groups in intraoperative hemoglobin drop value [(19.8±2.2) g/L versus (20.0±2.1) g/L], Harris hip score (72.0±3.0 versus 71.2±3.6), incidence of complications [3.0% (4/135) versus 6.2 (2/32)] or mortality [14.3% (19/135) versus 15.6% (5/32)] ( P>0.05). The long nail group needed significantly longer operation time than the short nail group [(84.6±5.6) min versus (92.0±7.2) min] ( P<0.05). Conclusions:In the treatment of osteoporotic unstable intertrochanteric fracture, short and long intramedullary nails show no significant difference in hemoglobin drop value, functional score, complications or mortality, indicating they can both lead to safe and reliable curative efficacy. However, long nails need longer operation time.
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Severe acute pancreatitis (SAP) is closely related to intestinal mucosal barrier dysfunction, in which intestinal epithelial mechanical barrier injury is the structural basis of SAP-related intestinal mucosal dysfunction. Among the molecular mechanisms of injury factors, inflammatory mediators and cytokines, produced by SAP waterfall inflammation, are the main factors of intestinal mucosal barrier injury. This article briefly describes the effects of SAP on intestinal mechanical barrier injury and its molecular mechanism in order to provide ideas for the treatment of SAP.
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AIM: To reveal that the targeted regulation of TGF-β1 by miR-21-5P is the key mechanism that mediates the activation of myocardial fibroblasts, and to clarify the intervention ofRadix Angelica Sinensis and Radix Hedysari ultrafiltration on the mechanism of miR-21-5P targeting to regulate TGF-β1 effect. METHODS: (1) The cells were randomly divided into normal group and irradiation group. The irradiation group received 6Gry single irradiation, and then RT-PCR was used to detect miR-21-5P, and Western Blot was used to detect the expression of α-SMA and TGF-β1. (2) The cells were randomly divided into normal group, irradiation group, miR-21-5P
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Objective To determine the distribution of common bacteria in hospital infections and to provide a basis for the prevention and control of bacterial infection and for rational use of antibiotics in clinical departments. Methods A retrospective analysis was conducted on common bacterial strains isolated from inpatients of a Grade III class A hospital from 2015 to 2019, including sample source and drug sensitivity changes. Results A total of 4,924 strains of Escherichia coli, 2 762 strains of Klebsiella pneumoniae, 1 297 strains of Staphylococcus aureus, 967 strains of Pseudomonas aeruginosa, and 1 585 strains of Acinetobacter baumannii were detected during the past 5 years. The bacteria were detected mainly from sputum. The resistance rate of Escherichia coli to ampicillin was as high as 88%, and the resistance rate to ceftriaxone was 58.22%. The resistance rate of Klebsiella pneumoniae to ampicillin was higher than 97%. The resistance rate of Staphylococcus aureus to penicillin G reached 93%, and the resistance rates to erythromycin and clindamycin were 60% and 70%, respectively. Pseudomonas aeruginosa had a high resistance rate to ampicillin, but a low resistance rate to other types of antibiotics. Acinetobacter baumannii had a high resistance to common antibacterial drugs. Conclusion Escherichia coli and Klebsiella pneumoniae had a high incidence of nosocomial infections. Pseudomonas aeruginosa and Acinetobacter baumannii both showed serious multi-drug resistance. Clinical departments should strengthen the monitoring of drug sensitivity changes of pathogenic bacteria, and manage and use antibiotics purposefully.
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Objective:To analyze the influence of comprehensive rehabilitation on postoperative functions in the elderly patients with femoral intertrochanteric fracture.Methods:From June 2015 to June 2019, 144 elderly patients were treated at Department of Orthopedics, China-Japan Friendship Hospital for femoral intertrochanteric fractures by internal fixation with proximal femoral nail anti-rotation (PFNA). Of them, 65 received comprehensive rehabilitation, including intervention measures for details, prevention and management of comorbidities and complications and active exercise of the injured limb, while 79 conventional rehabilitation. In the comprehensive rehabilitation group, there were 22 males and 43 females with an age of (76.6±6.7) years, and 18 cases of type 31-A1, 35 cases of type 31-A2 and 12 cases of type 31-A3 by the AO type. In the control group, there were 23 males and 56 females with an age of (75.2±7.0) years, and 25 cases of type 31-A1, 39 cases of type 31-A2 and 15 cases of type 31-A3 by the AO type. The 2 groups were compared in terms of visual analog scale (VAS), Harris hip score, Barthel index, postoperative ambulation time and complications at 6 months after operation.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative or intraoperative general data ( P>0.05). The comprehensive rehabilitation group had a significantly lower VAS score (1.5±1.0), a significantly higher Harris hip score(83.9±5.4), a significantly higher Barthel index (81.6±5.4), significantly shorter postoperative ambulation time [(2.6±1.0) d], and a significantly lower incidence of complications [4.6% (3/65)] than the control group did [1.9±1.2, 80.2±7.9, 78.2±7.9, (3.2±1.4) d, 16.5%(13/79), respectively] (all P< 0.05). Conclusion:For elderly patients with femoral intertrochanteric fracture, comprehensive rehabilitation can significantly reduce complications, promote functional recovery of the hip, and speed up recovery of capabilities of daily living compared with conventional rehabilitation.
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Objective:To compare the effect of the 2% chlorhexidinegluconate disinfectant and 0.5% iodophor disinfectant on the maintenance of central venous catheter (CVC) in patients with immunodeficiency.Methods:The patients were randomly divided into two groups. 2% chlorhexidinegluconate disinfectant was used in the experimental group, and 0.5% iodophor disinfectant was used in the control group. The CVC was sterilized once a week and continuously maintained for 3 weeks. According to the condition of catheter, the dressing was changed in time in case of any problem,and the reason and time for the catheter nursing care were recorded. The duration of changing the catheter dressing in different disinfectant, incidence rate of dressings looseness and incidence of catheter-related infections in two groups were analyzed.Results:The duration of skin drying and duration of caring in the experimental group were (0.62±0.10)min, (11.67±0.33) min, significantly shorter than the control group [(1.97±0.18) min, (14.48±0.33) min]( t values were 63.044, 57.296, P<0.01).In term of the adverse effects on CVC,there were no statistical differences between two groups ( P> 0.05). Conclusions:Both 2% chlorhexidinegluconate and 0.5% iodophor disinfectant have similar disinfection effect on CVC caring, but 2% chlorhexidinegluconate disinfection is more efficient and worthy of application in clinical settings.
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Objective:To explore the incidence and morphology of the posterolateral fracture fragment affecting the fibular notch in posterior pilon fracture.Methods:A retrospective analysis was conducted of the CT and clinical data of the 31 patients with posterior pilon fracture who had been treated at Department of Orthopaedic, China-Japan Friendship Hospital from May 2013 to May 2018. They were 17 men and 14 women, aged from 20 to 68 years (average, 42 years). The injury affected the left side in 13 cases and the right side in 18 ones. The incidence of the posterolateral fracture fragments affecting the fibular notch was counted. The morphologic indexes of the fragments were measured like axial angle of their fracture line, fragment area, fragment height, and sagittal angle of their fracture line.Results:A posterolateral fracture fragment affecting the fibular notch was found in all the 31 posterior pilon fractures, giving an incidence of 100% in the posterior pilon fracture. The fracture line of the fragments tended to be in the coronal plane. The axial angle of the fracture line was 20.25°±9.48°; the ratio of the fragment area to the distal tibial articular area was 15.78%±6.75%; the fragment height was 36.59 mm ± 10.70 mm; the sagittal angle of the fracture line was 18.37°±5.45°.Conclusions:A posterolateral fracture fragment affecting the fibular notch can be found in all the posterior pilon fractures. It does not affect a large articular area and its fracture line is usually located in the coronal plane. These data may help choose appropriate surgical approach and internal fixation.
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Objective To investigate the predictive value of metastatic lymph node ratio (MLNR) combined with preoperative serum carcinoembryonic antigen (CEA) in the detection of distant metastasis of stage Ⅱ-Ⅲ colon cancer after radical resection.Methods A retrospective study was performed on the clinical data of 325 patients with stage Ⅱ-Ⅲ colon cancer undergoing radical resection in the Second Hospital of Lanzhou University from Jan 2010 to Jan 2015.Results MLNR was correlated with the maximum diameter of tumors,the degree of differentiation of tumors,clinical TNM stage and distant metastasis (P < 0.05),serum CEA was correlated with the maximum diameter of tumors,clinical TNM stage,nerve or vascular invasion and distant metastasis (P < 0.05).Logistic regression analysis showed that low differentiation of tumor tissue,TNM Ⅲ stage,high MLNR and high serum CEA were independent risk factors for distant metastasis of colon cancer after radical operation.Conclusions The combined detection of MLNR and serum CEA has a good predictive value for distant metastasis with stage Ⅱ-Ⅲ colon cancer.
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Dubin-Johnson syndrome (DJS) is an inherited disease as an autosomal recessive trait which the clinical presentation is jaundice,and is easy to be misdiagnosed.We reported one case of DJS for providing basis of clinical diagnosis.
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Objective To study the effects of altitude exposure and altitude exposure on mental health of Tibetan cadres. Methods 105 cadres in Tibet were selected as the research objects. Among them, 74 cadres in Shannan and Lhasa of Tibet (average altitude 3 680 m), 31 in Shigaze and Ali (above 3 800 m) and 14 in Ali (above 4 300 m) were selected. Using Symptom Checklist 90 (SCL-90), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Ascension Insomnia Scale (AIS), 105 Tibetan aid cadres were tested by SAS, SDS, AIS and SCL-90 one week after entering Tibet and one week before leaving the plateau. The scores were collected and the mental health and sleep status of Tibetan aid workers were measured. Results The number of positive items of SCL-90 of 105 Tibetan cadres increased from (13.21±9.05) one week after entering Tibet to (38.35±18.84) one week before leaving Tibet. SAS, SDS and AIS also increased from (25.49 ± 5.19), (26.41 ± 5.15), (5.16 ± 3.54) points one week after entering Tibet to (36.78 ± 7.53), (41.42 ± 9.15), (8.71 ± 4.64) points one week before leaving Tibet. The difference was significant in the last week (Z = 8.420, 8.689, 6.277, P<0.01). The correlation analysis between SCL-90 and SAS, SDS and AIS showed that SCL-90 was positively correlated with SAS, SDS and AIS scores (r=0.651, 0.616, 0.356, P<0.01). Different altitudes have an effect on the mental health of Tibetan aid cadres. The paranoid item scores of Tibetan aid cadres with altitude>4 300 m in SCL-90 were (1.68 ±0.50) points, which were higher than those of Tibetan aid cadres with altitude<4 300 m (1.24 ± 0.28) points and (1.40± 0.38) points. The difference was statistically significant (F=5.255, P=0.007); The SDS scores of Tibetan aid cadres with altitude>4 300 m were (46.64 ± 7.24) points, which were higher than those of Tibetan aid cadres with altitude<4 300 m (40.76± 8.99) points and (40.58± 8.28) points. The difference was statistically significant (F=3.223, P=0.044). Conclusion Exposure to high altitude affects the mental health of cadres assisting Tibet to varying degrees. The mental health of cadres assisting Tibet deserves attention.
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Objective To compare the outcomes of Dresden technique versus open surgery for acute Achilles tendon ruptures.Methods From January 2013 to June 2017,67 patients were operatively treated for acute Achilles tendon rupture at Department of Orthopaedics,China Japan Friendship Hospital.Of them,Dresden technique was used in 32(minimally invasive group) and open surgery in 35(open surgery group).The 2 groups were compared in terms of baseline characteristics,operation time,operative incision length,hospital stay,postoperative complications like incision infection and tendon re-rupture and the Achilles Tendon Total Rupture Score(ATRS).Results The 2 groups were compatible due to insignificant differences in the baseline characteristics(P>0.05).They were followed up for 18 months.The minimally invasive group had significant shorter operation time(40.0min),incision length(3.0cm) and hospital stay(5 d) than the open surgery group(42.5 min,10.0 cm and 6 d)(P<0.05).No sural nerve lesion was observed in either group.The rate of wound complications was 0% for the minimally invasive group and 8.6% for the open surgery group;the rate of re-rupture was 3.1% for the former and 2.9% for the latter;the ATRS at the final follow-up was 98.0 for the former and 98.5 for the latter.There were no significant differences between the 2 groups in the above comparisons(P>0.05).Conclusions Percutaneous suture of the Achilles tendon with the Dresden instruments is a safe,fast and standardized surgical procedure for acute Achilles tendon ruptures,leading to shorter operation time,incision length and hospital stay,better functional recovery and a tendency of decreased wound complications than the open surgery.
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Objective To evaluate the diagnostic value of acetic acid spray combined with narrow-band imaging ( NBI) for early gastric cancer and precancerous lesion. Methods A total of 136 gastric cancers and precancerous lesions from 132 patients detected by screening endoscopy from November 2015 to November 2017 in Guangming Chinese Medicine Hospital of Pudong New Area, Shanghai were enrolled in this study, and were divided into NBI group, acetic acid spray group, and acetic acid spray combined with NBI group ( combination group) . The image clarity, microsurface pattern, microvascular pattern, demarcation line, and mucosal whitening time were observed, and value of the 3 methods in diagnosis of early gastric cancer and precancerous lesions was analyzed. Results Image clarity of micro glandular in combination group was significantly better than that in NBI group and acetic acid spray group (χ2=8. 766, P=0. 003;χ2=5. 273, P=0. 022) , and image clarity of microvascular in combination group was significantly better than that in NBI group (χ2=7. 457, P=0. 006) . The overall diagnostic coincidence rate with pathology of combination group, NBI group, and acetic acid spray group was 91. 9%(125/136), 85. 3%(116/136), and 89. 7%(122/136), respectively. The diagnostic sensitivity of irregular or missing microsurface, irregular or missing microvascular, obvious demarcation line, mucosal whitening time <30 s for carcinoma ( including high grade intraepithelial neoplasia, early carcinoma and infiltrating carcinoma ) were 92. 3%, 91. 3%, 92. 3% and 90. 4%, respectively, in the combination group, and the diagnostic specificity of above indicators were 93. 8%, 93. 8%, 96. 9% and 90. 6%, respectively, accuracy were 92. 6%, 91. 9%, 93. 4% and 90. 4%, respectively. For observation of microsurface, the combination group was superior to the NBI group (χ2 =7. 378, P=0. 007) , but there was no significant difference compared with the acetic acid spray group (χ2=0. 427, P=0. 513);the acetic acid spray group was superior to the NBI group (χ2=4. 405, P=0. 036) . For observation of microvascular, the combination group was not significantly better than the NBI group (χ2=2. 398, P=0. 122). For observation of demarcation line, the combination group was not significantly better than the NBI group (χ2=2. 722,P=0. 099) and the acetic acid spray group (χ2=0. 216, P=0. 642). There was no difference between the acetic acid spray group and the NBI group (χ2=1. 433, P=0. 231) in observation of demarcation line. Conclusion Acetic acid spray combined with NBI has a good consistency with pathological results with high diagnostic sensitivity and specificity, and can clearly show microsurface of early gastric cancers and precancerous lesions compared to single NBI.
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Objective@#To study the effects of altitude exposure and altitude exposure on mental health of Tibetan cadres.@*Methods@#105 cadres in Tibet were selected as the research objects. Among them, 74 cadres in Shannan and Lhasa of Tibet (average altitude 3 680 m), 31 in Shigaze and Ali (above 3 800 m) and 14 in Ali (above 4 300 m) were selected. Using Symptom Checklist 90 (SCL-90), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Ascension Insomnia Scale (AIS), 105 Tibetan aid cadres were tested by SAS, SDS, AIS and SCL-90 one week after entering Tibet and one week before leaving the plateau. The scores were collected and the mental health and sleep status of Tibetan aid workers were measured.@*Results@#The number of positive items of SCL-90 of 105 Tibetan cadres increased from (13.21±9.05) one week after entering Tibet to (38.35±18.84) one week before leaving Tibet. SAS, SDS and AIS also increased from (25.49±5.19), (26.41±5.15), (5.16±3.54) points one week after entering Tibet to (36.78±7.53), (41.42±9.15), (8.71±4.64) points one week before leaving Tibet. The difference was significant in the last week (Z = 8.420, 8.689, 6.277, P<0.01). The correlation analysis between SCL-90 and SAS, SDS and AIS showed that SCL-90 was positively correlated with SAS, SDS and AIS scores (r = 0.651, 0.616, 0.356, P<0.01). Different altitudes have an effect on the mental health of Tibetan aid cadres. The paranoid item scores of Tibetan aid cadres with altitude>4 300 m in SCL-90 were (1.68 ± 0.50) points, which were higher than those of Tibetan aid cadres with altitude<4 300 m (1.24±0.28) points and (1.40± 0.38) points. The difference was statistically significant (F=5.255, P=0.007); The SDS scores of Tibetan aid cadres with altitude>4 300 m were (46.64 ± 7.24) points, which were higher than those of Tibetan aid cadres with altitude<4 300 m (40.76 ± 8.99) points and (40.58 ± 8.28) points. The difference was statistically significant (F=3.223, P=0.044).@*Conclusion@#Exposure to high altitude affects the mental health of cadres assisting Tibet to varying degrees. The mental health of cadres assisting Tibet deserves attention.
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<p><b>OBJECTIVE</b>To summarize the diagnosis and treatment of iatrogenic colonoscopic perforation (ICP).</p><p><b>METHODS</b>Clinical data, treatment course and outcome of 17 patients who developed ICP following colonoscopic examination or operation at Department of Colorectal Surgery, Changhai Hospital from January 2000 to December 2013 were retrospectively analyzed.</p><p><b>RESULTS</b>During above 13 years, a total of 127 106 patients underwent colonoscopic examination or operation, of whom 17 cases (0.013%) had ICP. There were 8 males and 9 females with an average age of 65.2 (32-85) years. The interval between the onset of ICP and clinically diagnosed ICP was 0 to 6 days after performance. ICP occurred in 8 patients following colonoscopy operations, including simple colonic polyp excision, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), while in 9 patients following simple colonoscopy examination. Except for one patient who was immediately diagnosed with ICP through the finding of "yellow adipose tissue visible in the vision field" during operation,7 early cases (41.2%) were diagnosed by abdominal X-ray examination, and 9 later cases were confirmed by abdominal CT examination. The perforation sites included sigmoid colon in 5 cases, caecum in 3 cases, descending colon in 3 cases, descending and sigmoid junction in 2 cases, ileum in 1 case, splenic flexure in 1 case, sigmoid and rectum junction in 1 case, retum in 1 case. One case with ICP following ESD after resection of polyp in caecum was cured successfully with conservative treatment, including fasting, gastrointestinal decompression, fluid infusion, anti-infection and nutritional support. One case with ICP, which was found during colonoscopic operation and the perforation was immediately closed with titanium clip, received conservative treatment, including anti-infection and then was cured. Fifteen patients underwent surgery, including 8 patients with primary intention intestinal perforation repair, 4 patients with primary intention resection of associated intestine and anastomosis, 2 patients with primary intention resection of associated intestine and ostomy, 1 patient with primary intention intestinal perforation repair and ostomy. Postoperative abdominal incision infection occurred in 4 cases, pulmonary infection in 1 case, incision infection with cardiovascular event or urinary tract infection in 1 case each. All the patients were cured and discharged. Average hospital stay was 18.6(3-45) days.</p><p><b>CONCLUSIONS</b>ICP should be diagnosed by physical examination and imaging examination as soon as possible. For perforation during colonoscopic performance, colonoscopic titanium clip can be used for closure. Perforation repair is still the main procedure for ICP. If necessary, partial intestinal resection and anastomosis or ostomy can be selected.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos do Colo , Colonoscopia , Doença Iatrogênica , Perfuração Intestinal , Diagnóstico , Terapêutica , Estudos Retrospectivos , Resultado do TratamentoRESUMO
By expounding the connotation of doctor-patient relationship, this paper looked upon the public or audience in the sense of journalism and communication as potential patients, and emphasized the influence of mass media, that is to say, widely analyzed more macroscopical"doctor-patient -media relationships" from analyzing the doctor-patient relationship. And from the perspective of social psychology, this paper analyzed the influence of media coverage on the public from three aspects of cognition, emotion and memory, to explore its mechanism in doctor-patient relationship.