Journal of Hebei Medical College for Continuing Education

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Medical Reserch and Education 2020, 37 (1): 1-6. DOI: 10.3969/j.issn.1674-490X.2020.01.001

Abstract （549）

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Diabetic nephropathy(DN)is a severe microvascular complication of diabetes and is a chronic progressive kidney disease. Diabetic nephropathy is also a major cause of end-stage renal disease(ESRD). In order to better protect and prevent the progression of DN, this review summarizes the relevant pathological mechanisms of DN and targeted treatment measures to reduce the incidence and mortality of cardiovascular disease, and is essential for early intervention and treatment.

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Medical Reserch and Education 2020, 37 (1): 7-13. DOI: 10.3969/j.issn.1674-490X.2020.01.002

Abstract （454）

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Objective To optimize the preparation process of telmisartan sodium salt in telmisartan tablets. Methods The effect of different production processes on the dissolution profile of telmisartan sodium salt prepared by different drying processes was studied. Results The dissolution profiles of telmisartan sodium salt prepared by vacuum drying and spray drying were different. Different telmisartan sodium salt drying processes had an effect on the dissolution rate of the formulation. Conclusion The telmisartan tablets prepared by spray-dried telmisartan sodium salt are similar to the reference preparations. The capsule has a feasible process, good repeatability and stable and reliable quality.

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Medical Reserch and Education 2020, 37 (1): 14-20. DOI: 10.3969/j.issn.1674-490X.2020.01.003

Abstract （607）

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Objective To study the expression of Nupr1(including mRNA and protein)in breast cancers and explore the relationship between Nupr1 expression and the clinical/pathological characteristics in breast cancer. Methods The expression of Nupr1 protein was detected with immunohistochemistry in 228 cases of breast cancer and 60 cases of benign breast lesions as control group. The expression of Nupr1 mRNA was detected with real-time fluorescence quantitative PCR. The relationships between Nupr1 expression and clinical pathological characteristics of breast cancer were analyzed. Results The level of Nupr1 protein and mRNA in breast cancer showed high expression, which tended to be consistent. The high expression rate of Nupr1 in breast cancer was significantly higher than that in the control group(P<0.05). The high expression rate of Nupr1 was significantly correlated with breast cancer stage and molecular type(P<0.05), but not with menstrual state, histological type, histological grade and tumor size(P>0.05). Conclusion The expressionof Nupr1 mRNA in benign breast lesions-precancerous breast lesions-breast cancer is increasing gradually. It is speculated that Nupr1 may play an important role in the occurrence and progression of breast cancer. The consistent expression of Nupr1 at mRNA level and protein level suggested that Nupr1 plays an important role in the occurrence and development of breast cancer. The high expression of Nupr1 is related to poor prognosis. The detection of Nupr1 expression can be used as breast cancer detection The useful indexes of cancer prognosis can provide new ideas for tumor targeted therapy.

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Medical Reserch and Education 2020, 37 (1): 20-25. DOI: 10.3969/j.issn.1674-490X.2020.01.004

Abstract （1175）

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Objective To observe therapeutic effect and metabolism of blood lipid with Ginkgo leaves tablet and olanzapine on schizophrenia.Methods 80 schizophrenics were randomly divided into two groups:single grouptreated with olanzapine alone(15±5)mg/d, combination group on the basis of olanzapine(15±5)mg/d, and with ginkgo leaves tablet 1.2g/d. The treatment lasted for 8 weeks. Before treatment and at the end of the 2nd, 4th and 8th week, the concentrations of triglyceride(TG), the total cholesterol(TC), low density lipoprotein(LDL)and high density lipoprotein(HDL)of the two groups were monitored. Results In the single group, TG, TC and LDL at 4 weeks and 8 weeks were significance higher than those before treatment(P<0.05), the HDL were significance lower than those before treatment(P<0.05). In the combined group, the LDL and HDL had no significant change compared with those before treatment(P>0.05), the TG and TC were significance higher than those before treatment(P<0.05). Interesting, the TG and TC of the combined group were significance lower than the single group at the 8th weeks(P<0.05). Conclusion The patients with schizophrenia who take olanzapine often have the change of blood lipid level in different degrees, and Ginkgo leaves tablet can antagonize the increase of blood lipid, which is better than that of olanzapine alone.

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Medical Reserch and Education 2020, 37 (1): 26-29. DOI: 10.3969/j.issn.1674-490X.2020.01.005

Abstract （912）

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Neonatal jaundice is a common disease in neonatal period. If the treatment is not timely, some severe infants may suffer permanent damage to the nervous system due to bilirubin encephalopathy, and serious infants may die. At present, the research on the clinical manifestations and diagnosis of neonatal jaundice has been relatively clear in China, but its treatment needs to be further explored. By studying the progress of the treatment of neonatal jaundice, we can provide reference for the treatment of neonatal jaundice.

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Medical Reserch and Education 2020, 37 (1): 30-35. DOI: 10.3969/j.issn.1674-490X.2020.01.006

Abstract （354）

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Objective To investigate the clinical efficacy and safety of laparoscopic nephron sparing surgery(LNSS)with the two different methods, main renal artery clamping(MRAC)and selective segmental renal artery clamping(SSRAC). Methods 84 patients, who had the localized renal tumor in stage T1, admitted from October 2017 to October 2018 were conducted a retrospective analysis,42 of the patients were operated with the method of SSRAC(Group S), and the other 42 patients were operated with the method of MRAC(Group M). The operative time, intraoperative blood loss, intraoperative warm ischemia time, postoperative hospital stay, positive margins, the values of serum creatinine rate(SCr)and blood urea nitrogen(BUN)before and after surgery, intraoperative and postoperative complications rate and so on were compared between the two surgical methods. Results All the operations were successfully completed, and there was no positive margins. There was no intraoperative transfer to MRAC in group S. There was no significant difference in the operation time and intraoperative blood loss between the Group S and the Group M(P<0.05). There was no significant difference in the duration of warm ischemia, postoperative drainage, and postoperative hospital stay(P>0.05). There was no significant difference in preoperative SCr and BUN levels between the two groups(P>0.05). The levels of SCr and BUN in the 1st day of postoperative period were significantly higher than those before surgery. There was significant difference in SCr and BUN between the 1st day after operations in the Group S(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion SSRAC is a new renal artery occlusion technique. It is effective and safe in patients with LNSS, and its effect on renal function is small. This study still needs to be supported with large amounts of sample cases.

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Medical Reserch and Education 2020, 37 (1): 36-40. DOI: 10.3969/j.issn.1674-490X.2020.01.007

Abstract （382）

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Objective To explore the methylation and transcription level of SLC5A8 gene in breast cancer. Methods The tumor samples and adjacent normal tissue samples of 32 cases of breast cancer patients treated with basic surgery in Affiliated Hospital of Hebei University from May 2017 to December 2019 were divided into two groups, namely the experimental group and the control group. Methylation of SLC5A8 gene in 32 cases of breast cancer and surrounding normal tissues was detected with methylation-specific PCR, and transcriptional expression of SLC5A8 gene in 32 cases of breast cancer was detected with RT-PCR. Results There were 20(62.50%)positive cases of SLC5A8 methylation in 32 breast cancer tissues in the experimental group and 7(21.87%)positive cases of SLC5A8 methylation in 32 adjacent tissues in the control group. The methylation positive rate in the experimental group was significantly higher than that in the control group(P<0.05). mRNA transcription was detected in 6 of the 20 breast cancer patients(30.00%). mRNA transcription was detected in 7(58.33%)of the 12 cancer tissues with negative methylation in the experimental group. In the experimental group, the transcription expression rate of methylated positive oncotissue was significantly lower than that of methylated negative oncotissue(P<0.05). Conclusion SLC5A8 gene methylation is a common phenomenon in breast cancer, which may be involved in the occurrence and development of breast cancer, and The methylation of SLC5A8 gene in breast cancer tissues is not completely consistent with the transcriptional expression of the gene, and there is a certain inverse consistency between the two.

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Medical Reserch and Education 2020, 37 (1): 41-46. DOI: 10.3969/j.issn.1674-490X.2020.01.008

Abstract （350）

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Objective To study the correlation between the level of thyroid stimulating hormone(TSH)and the severity of coronary artery disease in patients with subclinical hypothyroidism(SCH).Methods 246 patients with coronary heart disease diagnosed by coronary angiography, according to the level of serum TSH, were selected and divided into subclinical hypothyroidism group(126 patients)and normal nail function group(120 patients), and the SYNTAX score of coronary artery disease in subclinical hypothyroidism group was calculated. Spearman was used to analyze the correlation between TSH level and severity of coronary artery disease. Results There was no significant difference in age, sex, smoking history, prevalence of hypertension, systolic blood pressure and diastolic blood pressure between subclinical hypothyroidism group and normal group(P>0.05).The TSH,TC, TG, LDL-C, AIP in subclinical hypothyroidism group were higher than those in normal group, the difference was statistically significant(P<0.05). The TSH, TC, TG, LDL-C, AIP were higher than middle group and low group、middle group were higher than low group in subclinical hypothyroidism group, the difference was statistically significant(P<0.05). Spearman correlation analysis showed that TSH was positively correlated with SYNTAX score(r=0.768, P<0.001). Conclusion The increase of TSH at subclinical level is one of the risk factors of coronary heart disease, and has a positive correlation with the severity of coronary artery disease.

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Medical Reserch and Education 2020, 37 (1): 47-53. DOI: 10.3969/j.issn.1674-490X.2020.01.009

Abstract （360）

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This paper introduces Hou Tingxiu's experience in the diagnosing and treating female diseases.Hou Tingxiu was a Chinese medicine doctor in Hebei Province in the 1950s.Four generations of doctors specialized in treating female diseases.He's got a lot of clinical experience.The drug dose is small and the drug is flexible.The clinical curative effect is remarkable.Some clinical cases are selected for clinical reference.

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Medical Reserch and Education 2020, 37 (1): 54-59. DOI: 10.3969/j.issn.1674-490X.2020.01.010

Abstract （299）

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Objective To understand the current situation of health service provided by pension institutions in Wanquan district of Zhangjiakou City, Hebei Province, and hence contribute to formulating the informational foundation for improving pension institutions’ performance. Methods Carried out field investigation on all pension institutions registered in Wanquan district based on the information provided by the Department of Civil Affairs in 2018. Results There were a total of 13 pension institutions for elderly people in Wanquan district. Most of the institutions were located in towns that were in better economic position. No pension institutions were found in five out nine towns in the county. These five towns are located near the Taihang Mountain and far from the urban area. Although 7 out of 13 pension institutions have health care rooms, all of the pension institutions are lacking in medical facilities and in professional medical personnel. No pension institution has rehabilitation room, psychological counseling room, or hospice room. The overall education level of the staffs in these pension institutions is low, with about 75.44% of staffs having only junior high school degree or below. In all the 13 institutions, only three professional medical staffs are found. Further, the average occupancy rate in the pension institutions of Wanquan is only 41.37%. Conclusion Unreasonable geographical distribution, deficiency in medical infrastructure, and low occupancy rate are the main problems found in the pension institutions in Wanquan district. In particular, the health services need to be further improved.

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Medical Reserch and Education 2020, 37 (1): 60-64. DOI: 10.3969/j.issn.1674-490X.2020.01.011

Abstract （371）

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Objective To analyze the cancer incidence and mortality of Tangxian in 2018. Methods In accordance with the methods and criteria of data quality control made by National Central Cancer Registry(NCCR), the crude rate, standard rate and proportion of leading cancers were calculated. Results In 2018, there were 1 292 new cases of malignant tumors and 621 deaths in Tangxian.The crude incidence of malignant tumors was 236.43/10⁵, and age-standardized incidence rate by Chinese standard population(ASR China)was 184.60/10⁵. The crude mortality of malignant tumors was 113.64/10⁵, and ASR China was 74.91/10⁵. The top 5 malignant tumors were lung cancer, breast cancer, stomach cancer, esophageal cancer, colorectal anal cancer. The top 5 deaths were lung cancer, stomach cancer, liver cancer, esophageal cancer and Brain and Central Nervous System. Conclusion Lung cancer and female breast cancer are the most common malignant tumors. Prevention and control work should be carried out in a targeted way.

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Medical Reserch and Education 2020, 37 (1): 65-70. DOI: 10.3969/j.issn.1674-490X.2020.01.012

Abstract （401）

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Perinatal death is the death of a fetus during pregnancy or one month after birth, which is a sudden loss. Perinatal bereavement care is a relatively special and newly research field, which has serious physical and mental impact on the perinatal loss families and caregivers. There is more research and practical experience in this field in foreign countries, and there lack of research about this in ours country. In this article,it summed up the ethical principles of perinatal bereavement care, the objectives of clinical practice and the development status of the education and training of caregiversto provide the relevant inspiration for our country.

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Medical Reserch and Education 2020, 37 (1): 71-75. DOI: 10.3969/j.issn.1674-490X.2020.01.013

Abstract （890）

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In recent years, palliative care under the leadership of the government is gradually rising in mainland China, the convening of academic conferences and the launch of pilot units have all promoted the development of palliative care. Palliative care focus on humanism, psychosocial and spiritual concerns of patients. The curriculum construction and professional education related to palliative care in medical colleges should also reflect the core idea of palliative care. Therefore, it is necessary to set up the related courses of palliative care in medical colleges and as an important part of the professional quality education. Only when medical students learn the knowledge related to palliative care, can they better apply the knowledge to clinical practice. This paper reviews the current status, development and curriculum construction of palliative care in China, and provides reference for the medical education and training of professionals in China.

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Medical Reserch and Education 2020, 37 (1): 76-80. DOI: 10.3969/j.issn.1674-490X.2020.01.014

Abstract （387）

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Objective To investigate the training demands and the influencing factors of stroke among nursing assistant, and put forward some suggestions. Methods 249 elderly nursing assistants who extracted 4 old-age institutions in proportion to the 4 main urban areas of Shijiazhuang were investigated with a self-designed questionnaire. Results The elderly nurses assistants had a high demand for rehabilitation nursing knowledge of stroke. On site guidance is the most acceptable training method for nursing assistants. The main factors that influence the training needs of the nurses assistants were nature of their institution and working years(P<0.05). Conclusion There is an urgent need for the elderly care staff to train their knowledge of stroke rehabilitation nursing. The government and the elderly care institutions should take the knowledge of stroke rehabilitation nursing as general education and carry out specialized nursing knowledge training.

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Medical Reserch and Education 2020, 37 (2): 1-12. DOI: 10.3969/j.issn.1674-490X.2020.02.001

Abstract （566）

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Since the outbreak of COVID-19 in December 2019, the formulation of “Diagnostic Guidelines for Imaging of COVID-19” have been further enhanced the understanding of the value of CT imaging for novel coronavirus pneumonia among healthcare providers, and performed objective diagnoses by mastering the complementary relationship between clinical indicators, laboratory indicators and CT imaging manifestation. These guidelines were developed by the Chinese Infectious Disease Radiology Committee led by its directorswho also served as a leading role to organize the Chinese Research Hospital Society of Infection and Inflammation Radiology Special Committee, the Chinese Radiology Association of Infectious Disease Radiology Committee, the Chinese Radiographers Association of Infection Imaging Committee, Beijing Imaging Technology Innovation Alliance and other expert teams to jointly formulate these guidelines.This article will give an interpretation on the new guidelines.

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Medical Reserch and Education 2020, 37 (2): 13-17. DOI: 10.3969/j.issn.1674-490X.2020.02.002

Abstract （320）

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Objective To evaluate the effectiveness of the implementation of the intensified-evaluation model for community hospital staff. Methods Through a third-party data collection platform, the epidemic prevention and control knowledge questionnaire were evaluated within a specified time and under a real-name system. Taking the passing score of each post as the standard, making sure medical workers whether or not to take up the position, strengthen the knowledge of prevention and control, dynamically update the test bank, and maintain a high level of cognitive combat. Results For the first test, the average knowledge of new hospital pneumonia prevention and control among all the hospital staffs was 78.37. 100% of them knew the disposal of used disposable hats and masks, only 23.27% knew the frequency of disinfection of the pre-check points or triage tables of medical institutions. One week after the implementation of the enhanced assessment model, the average score of knowledge about COVID-19 prevention and control among all staffs in the hospital rose to 93.84. The employment situation of hospital staff has changed. The number of employees on the third day of training increased from 48 to 78, and on the 10th day of training was 149. The employment rate also increased from 30.19% to 49.05% on the third day, and 93.71% on the tenth day of training. Conclusion Forcing community hospital staff to learn the new coronavirus new coronavirus pneumonia prevention and control knowledge was effective. The overall level of personnel has increased rapidly in the short term and has maintained a high level of awareness. The evaluation model has a significant impact on community hospitals in the front line of prevention and control.

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Medical Reserch and Education 2020, 37 (2): 18-23. DOI: 10.3969/j.issn.1674-490X.2020.02.003

Abstract （430）

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Objective To understand basic information and anxiety status of the callers seeking for help under the new coronavirus pneumonia(COVID-19)epidemic situation, and provide advices for effective psychological services in the future. Methods The callers who asked for help because of the epidemic during 25th, January to 10th, March, 2020 were selected as the research objects. Their general demographic information was collected, and the callers were evaluated by generalized anxiety scale. The data were analyzed statistically. Results Four hundred fiftyfive valid callers' information was collected during the epidemic. There were 381 callers suffering from anxiety and 74 callers had normal emotions. According to the Chi-square test, the results showed that there were significant differences in terms of gender, education, occupation, marriage, purpose of the call for the caller's emotional state(P<0.05). The female callers were more likely to have anxiety emotion than male. The level 2 people had more anxiety emotion than others in level 3 or 4. The people who sought for “epidemic-related knowledge” were more anxious than others who wanted “releasing emotions or complaining” and “information related to COVID-19 epidemic prevention and control”, and the people who wanted “releasing emotions or complaining” were more anxious than the ones who sought for “information related to COVID-19 epidemic prevention and control”. Conclusion Counseling and assistance through the psychological assistance hot line can alleviate caller anxiety. This requires us to improve the psychological assistance hot line service system further and establish a multi-department linkage mechanism to protect the public's mental health during major public health emergencies.

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Medical Reserch and Education 2020, 37 (2): 24-30. DOI: 10.3969/j.issn.1674-490X.2020.02.004

Abstract （489）

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Liver fibrosis is a dynamic process of complex fibrosis and inflammatory reactions caused by chronic liver injury caused by multiple causes. It can further progress to cirrhosis and liver cancer, and is a major factor affecting the life and health of patients with chronic liver injury problem. This article reviews the molecular mechanisms related to the occurrence and development of liver fibrosis and the research progress of current treatment targets in order to provide a basis for the clinical treatment of liver fibrosis.

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Medical Reserch and Education 2020, 37 (2): 31-36. DOI: 10.3969/j.issn.1674-490X.2020.02.005

Abstract （440）

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Objective To explore the effect of early inhalation of budesonide on lung function, osteopontin and α-SMA in asthmatic animals. Methods Sixty male SD rats were randomly divided into control group, model group and treatment group. The model group and the treatment group were prepared by intraperitoneal injection of ovalbumin and repeated aerosol inhalation of ovalbumin, and the control animals were treated with physiological saline. Changes in lung function, osteopontin, and α-SMA were measured in three groups of animals. Results Compared with the control group, the basic airway resistance and airway responsiveness increased in the model group and the treatment group. The basic airway resistance and airway responsiveness in the treatment group were better than those in the model group. The expression of osteopontin and airway α-SMA in the model group and the treatment group was significantly higher than that in the control group. The expression of the above indicators in the treatment group was lower than that in the model group. The expression of osteopontin was positively correlated with airway resistance, and it was also positively correlated with the expression of α-SMA. Conclusion Early inhalation of budesonide is beneficial to improve lung function and reduce airway remodeling in asthma, and its mechanism may be related to the regulation of osteopontin.

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Medical Reserch and Education 2020, 37 (2): 37-43. DOI: 10.3969/j.issn.1674-490X.2020.02.006

Abstract （359）

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Objective To explore the diagnostic value of the parameters of neurite orientation dispersion and density imaging(NODDI)in glioma classification. Methods A total of 30 cases of brain glioma, 16 cases of male and 14 cases of female, with an average age of(46.23±7.58)years were investigated with a retrospective study, of which 18 cases suffered from high-grade glioma and 12 cases from low-level glioma. Patients were examined with routine MR scan, enhancement, diffusion weighted imaging(DWI)and NODDI before operation,the results were determined with software to get figures of the oritention dispersion index(ODI), the intracellular volume fraction(VIC), the entracellular volume fraction(xVEC,yVEC,zVEC), the concentration distribution of Watson parameters(kappa)and the isotropic volume fraction(VISO), through the picture analysis software measurement with a tumor parenchyma, peritumoral area and contralateral normal white matter value of the average(mean). Results The mean values of VISO, yVEC, kappa, VIC and ODI of low-grade glioma could distinguish the solid area from the normal area, with statistically significant difference(P<0.05). The mean values of VISO, xVEC and VIC could distinguish the edema area from the normal area, with statistically significant difference(P<0.05). The mean values of VISO, yVEC, kappa, VIC and ODI of high-grade glioma could distinguish the solid area from the normal area, with statistically significant difference(P<0.05). The mean values of VISO, xVEC, yVEC, kappa, VIC and ODI could distinguish the edema area from the normal area, with statistically significant difference(P<0.05). In the solid area, the mean values of VISO, yVEC, kappa, VIC and ODI could distinguish the high grade glioma from the low grade glioma, with statistically significant difference(P<0.05). In edema area, the mean values of VISO, xVEC, zVEC and kappa could distinguish high-grade glioma from low-grade glioma, with statistically significant difference(P<0.05). Conclusion In the statistical results of the data in this study, NODDI's VISO, VEC, kappa, VIC and ODI parameters could identify high and low grade gliomas.

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Medical Reserch and Education 2020, 37 (2): 44-48. DOI: 10.3969/j.issn.1674-490X.2020.02.007

Abstract （367）

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Objective To explore the therapeutic effect of the post-outer incision incision reset with Chinese medicine in the treatment effect of the spin IV-ankle fracture. Methods 80 cases of post-spin IV ankle fracture patients admitted to our hospital from January 2016 to June 2018 were selected into the study, and 40 cases were randomly divided into observation group and control group. Both groups were given post-outer incision reset fixed treatment fractures, after surgery the patients of the control group were given routine treatment, the patients of the observation group given Chinese medicine soup in-service treatment, the recoveries of two sets of surgical indicators were observed after follow-up 52 weeks, AOFAS ankle and posterior foot scoring function were observed after treatment for 26 weeks. Results The pain relief time, deflating time, fracture healing time and joint function recovery time were(5.71±0.96)d,(6.14±1.03)d,(50.83±8.17)d,(65.24±6.28)d. The control group was(6.62±1.77)d,(7.24±1.69),(71.02±10.26)d,(77.13±11.48)d. Compared with the surgical recovery index of two groups, the observation group was significantly better than that of the control group, and the difference was statistically significant(P<0.05). After 26 weeksof follow-up study, observation group indicated that AOFAS scores in 22 cases were excellent, 15 cases good, 3 cases not bad, the excellent and good treating effect rate was up to 92.50%. The treating effects of patients of the control group showed that AOFAS scores in 16 cases were excellent, 14 cases good, 10 cases not bad, the excellent and good treating effects were 75.00%. The two groups had a high rate of AOFAS score, but the observation group was significantly higher than the control group, and the difference was statistically significant(P<0.05). In the observation group, 4 patients had complications, the incidence rate was 10.0%, 4 patients had drug resistance, and the treatment compliance was 90.00%. There were 11 cases of complications in the control group, with an incidence rate of 27.50%. During the treatment, 12 cases took medicine against the doctor's advice, and the treatment compliance was 70.00%. Conclusion For treating supination extorsion Ⅳ°ankle fractures, open reduction and internal fixation with Chinese medicine treatment has obvious advantages,the complications are low. Compared with regular treatment, it is not only welcomed in patients,which can significantly shorten the recovery time after the surgery, but also can significantly improve the ankle functions.

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Medical Reserch and Education 2020, 37 (2): 49-54. DOI: 10.3969/j.issn.1674-490X.2020.02.008

Abstract （545）

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This paper introduces CHANG Zhizhong's experience in the diagnosing and treating measles. CHANG Zhizhong was a famous Chinese medicine doctor in Hebei Province in the 1950s. He's got a lot of clinical experience. He specializes in the treatment of internal medicine diseases.By sorting out CHANG Zhizhong's academic thought of traditional Chinese medicine, summarizing the experience in diagnosis and treatment of measles and apply it to the clinic, good results have been achieved. Some clinical cases are selected for clinical reference.

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Medical Reserch and Education 2020, 37 (2): 55-62. DOI: 10.3969/j.issn.1674-490X.2020.02.009

Abstract （516）

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With the deepening of China's population aging and the increase in demand for aged care, the traditional aged care model has been unable to adapt to the development of contemporary aging society. Therefore, it is imperative to explore and promote a new model that integrate medical care and aged care. This article analyzes a large amount of literature, analyzes the current situation of China's population aging, the successful experience of foreign aged care operating system, China's traditional pension model, and the development status of the model that integrates medical care and aged care, and discusses the main issues restrict the combined development of the model that integrates medical care and aged care institutions, and provide a basis for better promotion of the elderly care industry in China.

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Medical Reserch and Education 2020, 37 (2): 63-69. DOI: 10.3969/j.issn.1674-490X.2020.02.010

Abstract （339）

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Objective To explore the status of health information literacy of medical students in a university in Hebei province, and analyze the influencing factors to provide a basis for the development of health education in universities and the formulation of intervention measures to improve health information literacy of medical students. Methods A self-designed questionnaire was used to investigate the medical students in a university in Hebei province. Results The mean score of health information literacy was 114.21±10.58. The total score of their health information literacy was significantly different in different places of family residence, parental education and family economic status(P<0.05). Medical students whose families live in cities had higher cognitive ability, acquisition ability and evaluation ability of health information(P<0.05). Gender, major and grade had an impact on medical students' ability to obtain health information(P<0.05). Conclusion The health information literacy level of medical students is affected by family residence, gender, grade, major, parents' education level and family economic status, so comprehensive measures should be taken to improve the health information literacy level of medical students.

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Medical Reserch and Education 2020, 37 (2): 70-75. DOI: 10.3969/j.issn.1674-490X.2020.02.011

Abstract （578）

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Based on the domestic and foreign experience in community hospice palliative care services, we explored the development of community hospice palliative services in China,some suggestions were put forward: Establish and improve relevant policies and legal systems for community hospice palliative care. Enhance the integrated capacity of community palliative care services. Increase the promotion and publicity of hospice palliative care in the community to promote and accelerate the development of community hospice palliative services in China.

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Medical Reserch and Education 2020, 37 (2): 76-80. DOI: 10.3969/j.issn.1674-490X.2020.02.012

Abstract （323）

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Objective To investigate the degree of satisfaction of the first-year clinical students in medical physics teaching and provide the basis and suggestions for the further reform of medical physics curriculum. Methods Questionnaire star was used to carry out the survey anonymously. The questionnaire was divided into 12 indicators from four dimensions: teaching content, teaching method, ability cultivation and growth assistance. At the same time “the reason of dislike the medical physics class” was to make a single choice in order to understand students' learning attitude and needs. Results(1)Students were satisfied with the teaching content and teaching method of this course. Five grades were assigned, with an average score of 4.201 and 3.984, respectively.(2)Students were highly satisfied with cultivating their independent learning ability, critical thinking ability, problem-solving ability, pioneering thinking and innovation ability. Satisfaction rate was the highest 84.12%, the lowest 75.79%. There was no significant difference in satisfaction among the four indicators(P>0.05). There were significant differences between the satisfaction degree of ability cultivation and the satisfaction degree of learning growth(χ²=19.886,P=0.001).(3)47.22% of students who answered “the reason of dislike medical physics class” chose “poor physics foundation in high school”. Conclusion Teachers should have more communications with students, pay more attention to physical knowledge in clinical and life applications. Flipped classroom and other methods should be used in teaching to improve the teaching effects.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 1-9. DOI: 10.3969/j.issn.1674-490X.2020.03.001

Abstract （416）

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Worldwide morbidity and mortality of acute myocardial infarction(AMI)and related heart failure are still high. While effective early reperfusion of the criminal coronary artery after a confirmed AMI is the typical and effective treatment at present, collateral myocardial ischemia reperfusion injury(MIRI)and pertinent cardioprotection are still challenging to address and have inadequately understood mechanisms. Therefore, unveiling the related novel molecular targets and networks participating in triggering and resisting the pathobiology of MIRI is a promising and valuable frontier. The present study specifically focuses on the recent MIRI advances that are supported by sophisticated molecular pharmacology in order to bring the poorly understood interrelationship among MIRI participant molecules up to date, as well as to identify findings that may facilitate the new drug of novel targets.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 10-17. DOI: 10.3969/j.issn.1674-490X.2020.03.002

Abstract （330）

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The purpose of the study aims to construct a complete theory that clarifies the causes and rich connotations of blood laminar flow spectrum in transcranial doppler ultrasound. According to the theory of hemodynamics and hemorheology, the innovation hypothesis is that the blood of the straight blood vessels in time interval Δt follows the Poiseuille Flow, and the key innovation concepts such as the thickness and division of the flow layers, the division of the spectrum are applied. The red blood cell density, the volume of the stratum and the distribution of the number of red blood cells contained in the stratum in time and space are scientifically demonstrated. Finally, three innovation conclusions are obtained. This study builds the theory of expectations.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 18-27. DOI: 10.3969/j.issn.1674-490X.2020.03.003

Abstract （327）

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Objective To evaluate the prognostic and clinicopathological significance of AXL expression in breast cancer tissues by meta-analysis. Methods Such databases as CNKI, Wanfang Data, Cochrane Library, Embase, PubMed and Medline were searched for the studies on the prognostic value of AXL expression in breast cancer from inception to October 2019. Two researchers independently screened eligible literature, extracted data and evaluate the risk of bias of included studies to analyze the data. Results Seven studies involving 933 patients were included. It was shown that,the higher AXL expression group had a shorter overall survival than that of the lower AXL expression group(HR=2.36, 95%CI 1.60-3.46, P<0.000 1). However,there was no significant difference between two group in relapse free survival and disease free survival. It was shown that the expression of AXL was not associated with age, clinical stages, histologic grade, lymph node metastasis or receptor expression. Conclusion The meta-analysis suggests that AXL positive expression is associated with worse survival in patients. It will be a protential molecular marker for individualized treatment of breast cancer.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 28-31. DOI: 10.3969/j.issn.1674-490X.2020.03.004

Abstract （332）

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Objective To investigate the efficacy of Qiyang capsule combined with low dose 5-phosphodiesterase inhibitors in the treatment of diabetic erectile dysfunction. Methods 90 patients with diabetic erectile dysfunction were randomly selected. The patients were divided into 45 cases in the study group and 45 cases in the control group according to the single and double number grouping. The control group patients were given a small oral dose of 5-phosphodiesterase inhibitors. The study group were given Qiyang capsule combined treatment on the basis of the control group, and compared the clinical efficacy of the two groups, the changes in the score of the IIEF-5 scale before and after treatment, and the incidence of adverse reactions. Results The total effective rate of the study group was 95.56%, and the total effective rate of the control group was 75.56%. The total effective rate of the study group was significantly higher than that of the reference group(P<0.05). Before the treatment, there was no statistical significance in the score of the IIEF-5 scale between the groups(P>0.05), and there was a significant improvement after treatment(P<0.05).The treatment effect of the study group was significantly higher than that of the control group(P<0.05). The total incidence of adverse reactions in the study group was 6.67%, and the total incidence of adverse reactions in the reference group was 11.11%. There was no statistical significance between the two groups(P>0.05). Conclusion Qiyang capsule combined with small dose of 5-phosphodiesterase inhibitors for treating diabetic erectile dysfunction has obvious clinical effect and high safety.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 32-38. DOI: 10.3969/j.issn.1674-490X.2020.03.005

Abstract （457）

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Trastuzumab is a specific antagonist of human epidermal growth factor receptor-2(HER-2). It is the first molecular-targeted drug for the treatment of breast cancer. Since its market debut in 1998, trastuzumab has been in clinical application for more than 20 years. However, with the extension of clinical application, more and more adverse reactions are reported. By consulting the literature, the types, monitoring and prevention of trastuzumab related adverse reactions were reviewed in this paper so as to provide reference for clinical rational drug use.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 39-43. DOI: 10.3969/j.issn.1674-490X.2020.03.006

Abstract （634）

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Objective To investigate the clinical efficacy and safety of escitalopram combined with topiramate on male alcohol dependence with anxiety and depression,and the effect on the rate of relapse. Methods A randomized, controlled clinical trial design was used to randomly divide patients into escitalopram combined with topiramate treatment group(co-administration group)and escitalopram treatment group(single-treatment group). The comcourse of treatment was 12 weeks.Before and after treatment, the Hamilton Depression Scale(HAMD), Hamilton Anxiety Scale(HAMA), Symptom Scale(TESS), Visual Analogue Scale(VAS), etc. were used to evaluate the clinical efficacy of patients and safety. Results The HAMA and HAMD scores of the two groups were significantly different at the 4th and 8th weekends after treatment compared with before treatment(P<0.05). With the extension of treatment, the VAS scores of the two groups gradually decreased, and the degree of craving for alcohol in co-administration group was more obvious.Compared with the single-treatment group, the difference was statistically significant(P<0.05). The re-drinking rate of the co-administration group was lower than that of the single-treatment group at 6 months of follow-up, and the difference was statistically significant(χ²=11.009, P=0.001<0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant(P>0.05). Conclusion For the alcohol-dependent patients with anxiety and depression, the effect between esitalopram combined with topiramate and esitalopram alone treating anxiety and depression have no statistical difference, but the effect decreasing thirst for alcohol of esitalopram combined with topiramate is better than esitalopram alone, and the patients of esitalopram combined with topiramate have a lower rate of recidivism. The adverse effects of the two treatments are comparable.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 44-49. DOI: 10.3969/j.issn.1674-490X.2020.03.007

Abstract （386）

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Objective To investigate the correlation between cervical squamous intraepithelial lesions(SIL)and vaginal microecological changes in postmenopausal women with human papilloma virus(HPV)infection, and to regulate vaginal microecological balance and block postmenopausal women with HPV infection provide evidence for the development of SIL. Methods We collected postmenopausal women who attended the gynecological clinic of Baoding First Central Hospital from April 2018 to April 2019. HPV positive with or without thinprep cytologic test(TCT)was abnormal. Further colposcopy of cervical biopsy was performed, and 122 patients with SIL were diagnosed as the disease group, and 129 patients without SIL were regarded as the normal group. The results of vaginal microecology examination were compared between the two groups. Results The detection rates of bacterial vaginosis(BV)in the disease group and normal group were 32.79% and 12.40%, respectively(P<0.001). Vulvovaginal candidiasis(VVC)were 14.75% and 10.85%, respectively(P>0.050). Vaginal cleanliness III-IV degrees were 68.03% and 46.51%, respectively(P<0.050). A small amounts of lactobacillus were 13.93% and 20.16%, respectively(P>0.050). WBC>10/HPF were 62.30% and 40.31%, respectively(P<0.001). H₂O₂ deficiency were 15.57% and 22.48%, respectively(P>0.050). Leukocyte esterase positive were 36.07% and 17.83%, respectively(P<0.050). Sialidase positive were 19.67% and 6.20%, respectively(P<0.050). Conclusion BV, poor vaginal cleanliness, more white blood cells, leukocyte esterase and sialidase positive may be closely related to the occurrence and development of SIL in postmenopausal women with HPV infection.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 50-54. DOI: 10.3969/j.issn.1674-490X.2020.03.008

Abstract （227）

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This paper introduces Tang Pinqing's experience in diagnosing and treating female diseases. Tang Pinqing was a Chinese medicine doctor in Hebei Province in the 1950s.As thirteen generations of doctors specialized in treating female diseases. He's got a lot of clinical experience. The drug dose is small and the drug is flexible. The clinical curative effect is remarkable.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 55-59. DOI: 10.3969/j.issn.1674-490X.2020.03.009

Abstract （251）

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Objective To analyze the health monitoring data and personal dose monitoring data of 843 radiational workers in order to provide a reference for further work on radiological protection. Methods A total of 843 radiological staffs in Baoding from 2016 to 2017 were selected as our subjects. Their occupational health examination data and personal dose monitoring data were collected, meanwhile, four sensitive indicators including blood routine, eye lens condition, thyroid function and chromosome aberration were detected too. Data were analyzed with software SPSS 17.0. Results The abnormal rate of routine blood test indexes of female workers was higher than that in male workers(P=0.014). As the increase work history, the abnormal rate of occupational health(P=0.002)and the five abnormal rates of thyroid function were also increased(P=0.024). The difference was statistically significant. The rate of lens turbidity of worker with the group 1-5 mSv was higher than that in worker with group MDL-<1 mSv, and there was statistically significant difference between these. The chromosomal aberration rates of workers engaged in nuclear medicine(P=0.040)and interventional radiology(P=0.012)were all higher than that of workers engaged in radiation diagnosis, and there was statistically significant difference between these workers. Conclusion Long-term and low dose radiation exposure has certainly affected the health of radiation workers. The radiation workers who are female, long exposure history and engaged in interventional radiology or nuclear medicine can be impacted easily.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 60-66. DOI: 10.3969/j.issn.1674-490X.2020.03.010

Abstract （324）

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Objective To summarize the end-stage tranquility nursing care of 28 patients with abdominal and pelvic cancer, and guide the clinical practice of tranquility nursing.Methods From May 2017 to December 2018, 28 patients with end-stage pelvic cancer admitted to the Department of Oncology, Affiliated Hospital of Southwest Medical University were selected, and patients and their families were treated with nurse-led medical treatment and multidisciplinary cooperation. Nursing care team care, implement symptom management, comfort care, psychological care, death education, sorrow counseling, etc were conducted.Results Summarizing the impact of tranquil care behavior on its outcome indicators, 28 patients all developed pre-established medical care plans. Through symptom management, 25 patients(89.28%)had significantly relieved bloating symptoms, 28 patients had effective pain control, NRS score was maintained at 0 to 3 points, edema symptoms were effectively relieved, and 5 patients with lower limb edema developed tension blisters. No cases of skin rupture and infection occurred after treatment. Twenty-five patients(89.28%)made arrangements for end-of-life treatment and care, choice of place of death, whether to be rescued, and disposal of corpses under the witness of family members and medical care. End-of-life treatment choices: only 3 patients(10.71%)selected cardiopulmonary resuscitation; 1 patient(3.57%)selected endotracheal intubation; no patients selected electroshock defibrillation and admission to the ICU ward; 1 of them was completed with the assistance of the annu treatment nursing team corneal donation.Conclusion By constructing a nurse-led medical and nursing integration, multi-disciplinary cooperation and peaceful care team model, it can improve the comfort of patients with end-stage pelvic cancer, relieve symptoms, and help patients and their families fight against death correctly.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 67-71. DOI: 10.3969/j.issn.1674-490X.2020.03.011

Abstract （248）

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Objective To explore the teaching effects of introducing “theory of mind” knowledge on chapter “Doctor-Patient communication” in “Medical Psychology” curriculum. Methods Two parallel classes of grade 2017 clinical medicine undergraduate course students were selected as teaching subjects. 81 students of class A were chosen as study group, 76 students of class B were selected as control group. “Theory of mind” knowledge were introduced into students of class A during chapter “Doctor-Patient communication” teaching process, while the same chapter was taught based on the textbook contents in class B. A1 choice questions, A2 choice questions, case analysis, teaching satisfaction survey were used to evaluate the teaching effects when the chapter teaching accomplished. Results There was no significant difference between the two groups on scores of A1 choice questions. The scores of class A was higher than that of class B on A2 choice questions, the difference was statistically significant. In case analysis, there was no significant difference between two groups on scores of communication design, medical content and the total scores. The scores of class A was higher than that of class B on humanistic content, the difference was statistically significant. There was no significant difference between the two groups on scores of teaching satisfaction survey. Conclusion Introducing “theory of mind” knowledge can improve the humanistic accomplishment, these knowledge can improve the teaching effects in chapter “Doctor-Patient communication” in “Medical Psychology” curriculum.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (3): 72-80. DOI: 10.3969/j.issn.1674-490X.2020.03.012

Abstract （339）

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Objective To explore current status of laboratory safety cognition among students in a medical university and analyze the relevant influencing factors. Methods In undergraduate and graduate students with more experimental courses, a unified questionnaire was used and the answers were statistically analyzed. Results The accuracy range in the laboratory situation was 72.46%-93.68%, and the awareness rate was 85.58%.The accuracy range was 22.32%-96.52% in personal laboratory experience, 42.19% in awareness rate, and 65.27% in overall awareness rate. The differences of gender, age, grade and major were significant(χ²=16.07,χ²=51.84,χ²=92.79,χ²=13.84,P<0.05). Logistic analysis showed that gender(OR=0.718, 95% CI=0.606-0.851), age(OR=1.335, 95% CI =1.204-1.480)and major(OR=1.243, 95% CI=1.039-1.486)were the main influencing factors for the status of laboratory safety cognition. Conclusion Students in this university have a high degree of cognition about the laboratory situation, but the level of laboratory knowledge still needs to be improved. Therefore, supervision should be strengthened to eliminate potential safety hazards.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (4): 1-7. DOI: 10.3969/j.issn.1674-490X.2020.04.001

Abstract （489）

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The SIRT family is an evolutionarily conserved family of NAD⁺-dependent lysine deacetylases and ADP ribose transferases that regulate cell physiological activity. NAD⁺ levels are dynamically changed in the physiological activities of cells, whose abnormal changes can cause various diseases. SIRT has cell-specific and organelle-specific expressions in the brain and is involved in the pathology of many diseases, including ischemic stroke. Therefore, the development and use of SIRT-specific modulators might exhibit neuroprotection effects and is expected to develop a new target for the treatment of ischemic stroke.

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Journal of Hebei Medical College for Continuing Education 2020, 37 (4): 8-12. DOI: 10.3969/j.issn.1674-490X.2020.04.002

Abstract （237）

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Objective To explore the effects of low tidal volume mechanical ventilation combined with lung recruitment maneuver in patients with acute severe organophosphorus pesticide poisoning.Methods Analysis of 48 cases with acute severe dichlorphos poisoning, all patients were treated with mechanical ventilation because of respiratory failure.These patient were randomly assigned to the standard ventilation group and the protective ventilation group with 24 cases in each group. The patients of the standard ventilation group were received a tidal volume of 10 mL/kg ideal body weight and 3 cmH₂O positive end-expiratory pressure. The patients of the protective ventilation group were received a tidal volume of 6 mL/kg ideal body weight and 6 cmH₂O positive end-expiratory pressure,and implementing twice lung recruitment maneuver per day.Blood gas analysis parameters. Indicators of pulmonary infection(clinicalpulmonary infection scoreCPIS, C-reactive protein CRP, procalcitonin PCT)and atelectasis were recorded after 24 h and 72 h mechanical ventilation. Results After mechanical ventilation 24 h and 72 h, indicators of pulmonary infection in protective ventilation group were significantly lower than that of thestandard ventilation group, the difference was statistically significant(P<0.05). Oxygen partial pressure(PO₂)and oxygenation index in protective ventilation group were significantly higher than that of thestandard ventilation group(P<0.05). There was no significant difference in the incidence of atelectasis between the two groups(P>0.05).Conclusion Protective ventilation strategy can reduce the risk of pulmonary infection and improve oxygenation,but can not reduce the occurrence of atelectasis in patients with acute severe organophosphorus pesticide poisoning.

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