Objective To evaluate the effects of modulated, medium frequency electrotherapy on hemodynamics after thoracic surgery to provide non-pharmacological measures for preventing deep vein thrombosis (DVT).Methods Seventy thoracic surgery patients were divided into an experimental group and a control group. Both groups received conventional treatment and nursing. The experimental group (35 patients) was treated with modulated, medium frequency electrotherapy additionally while the control group (35 patients) was not. The vein systolic maximum velocity (Vmax), vein diastolic minimum velocity (Vmin) and time-averaged mean velocity (TAVM) in the femoral vein, the superficial femoral vein, the deep femoral vein, the popliteal vein and the anterior tibial vein were observed before the operation, 4h after the operation, just after 20 minutes of electrotherapy, 15 min after the electrotherapy and 30 min after the electrotherapy. Results There were significant differences among the time points in the experimental group. There was no significant difference among the time points in the control group.There were significant differences in lower extremity hemodynamics between the experimental group and the control group at end of the electrotherapy session, but no significant differences at the later time points. Conclusions Modulated, medium frequency electrotherapy has a significant effect on lower extremity hemodynamics. It is an effective method for DVT prophylaxis in perioperative thoracic surgical patients.

Objective To explore the clinical effect of laparoscopic uterine artery occlusion combined with uterine myomectomy for uterine myomas.Methods 120 patients with uterine fibroids were selected and randomly divided into research group and control group according to the digital table,60 cases in each group.Patients of the control group directly received conventional laparoscopic myomectomy,and patients of the research group received uterine artery occlusion before laparoscopic myomectomy.The intraoperative blood loss,operative time,postoperative anal exhaust time,hospitalization time of the two groups were observed and recorded.The patients were followed up with menstrual with improvement and luteinizing hormone,estradiol,follicle stimulating hormone.Results The intraoperative blood loss,operative time,postoperative anal exhaust time,menstrual improvement,fibroids relapse and other indicators of the research group were better than those of the control group,the differences were statistically significant [(82.85 ± 19.32) mL vs.(153.26 ± 21.18) mL,(60.56 ± 12.21) min vs.(153.38 ± 21.34) min,(15.62 ± 1.66) h vs.(25.03 ± 1.98) h,96.7 ％ vs.78.3 ％,3.3 ％ vs.16.7 ％,t =28.06,27.67,28.21,x2 =9.21,5.92,all P ＜ 0.05].Two months after operation,the E2 and FSH levels of the research group were significantly different with those before operation (t =3.90,3.51,all P ＜ 0.05),but after 12 months,there were no statistically significant differences in E2,FSH and LH compared with before operation (t =0.42,0.50,P =0.68,0.62).There were no statistically significant differences in E2,FSH and LH compared with before operation at two or twelve months after operation(t =0.19,0.39,0.69,P =0.85,0.70,0.49;t =0.58,0.20,0.37,P =0.56,0.83,0.71).Conclusion Uterine artery occlusion before laparoscopic myomectomy can significantly reduce blood loss,shorten the operation time,speed up the recovery and reduce the recurrence rate,and its influence on ovarian function is temporary and reversible,it is worthy of clinical popularization and application.

Dyspnea is an important issue for the patients with chronic heart failure. Breathing training, especially the inspiratory muscle training can help to improve the patients′ cardiopulmonary function, endurance and quality of life. In this paper, the foreign research about the method, effect evaluation and appropriate case of inspiratory muscle training in patients with chronic heart failure were reviewed so as to explore a specific strategy of inspiratory muscle training for China′s patients with chronic heart failure.

Objective To discuss the method of stomach tube instead of normal nasointestinal tube for severe craniocerebral injury patients.Methods Placing the stomach tube into the jejunum blindly according to the patient's gastrointestinal peristalsis for 99 severe craniocerebral injury patients and observing the success rate and plugging rate.Results Ninety-two tubes were successfully placed,the success rate was 92.9％(92/99).The placement time was (45.9±26.7) min.The time of successful insertion tube enteral nutrition was (46.0±34.2) d.No clogging occurred during this period.Conclusions The method of stomach tube instead of normal nasointestinal tube is safe and effective.

Objective To evaluate the effect of breathing exercise program (shrinking lips abdominal breathing combined with vertical breathing gymnastics) on dyspnea, pulmonary function, exercise tolerance and quality of life in patients with moderate to severe chronic obstructive pulmonary disease(COPD). Methods A total of 90 hospitalized patients with moderate to severe COPD were randomly divided into the experimental group and the control group with 45 cases in each group. The experimental group lost one case and the control group lost three cases, 86 patients finished the experiment. During hospitalization, on the base of conventional treatment and care, the experimental group
received training of shrinking lips abdominal breathing combined with vertical breathing gymnastics after medical staff′s care, with folk music as the background. Exercise frequency:morning, afternoon, 2 times per day, 15 min per time and continue to exercise with researchers′ guidance after discharge. In the control group:take exercises by self, take routine follow-up after discharge. The intervention continued for three months. The indicators such as dyspnea, pulmonary function, exercise tolerance and life quality of both groups were assessed respectively before and after the intervention. Results There were no significant differences in dyspnea symptoms, lung function, exercise endurance, quality of life between two groups before intervention (P>0.05). The dyspnea scored 1.43±0.87 after intervention in the experimental group, and 1.93 ±0.97 in the control group, there was significant difference (Z=-2.293, P=0.022). The 6 min walking test distance was (371.34 ± 67.74) m after intervention in the experimental group, and (301.57 ± 61.67) m in the control group, there was significant difference(t = 4.988, P =0.000). The St. George′s Respiratory Questionnaire (respiratory symptoms, limited activity, influence disease) score and total score were 54.73 ± 11.96, 52.55 ± 14.48, 55.45 ± 10.01, 54.56 ± 10.79 after intervention in experimental group respectively, and 61.19 ± 10.72, 61.35 ± 14.66, 60.48 ± 9.39, 60.93 ± 10.16 in the control group, there were significant differences(t=-2.815--2.397, P<0.05). There was no significant difference in lung function after intervention between two groups (P>0.05). Conclusions The program of shrinking lips abdominal breathing combined with vertical breathing gymnastics can relieve dyspnea in patients with moderate to severe COPD, improve exercise tolerance and quality of life, which is a safe and effective rehabilitation for patients with COPD.

Objective To evaluate the harmful effects of olanzapine and quetiapine therapeusis on swallowing ability in patients with Alzheimer'disease (AD).Methods AD inpatients with behavioral and psychological symptoms were randomly divided into two groups,treated with olanzapine (n=42) or quetiapine (n=38) for 6 weeks.The patients were assessed with Kubota's water swallowing test and arterial oxygen saturation(SaO2) monitoring pre and pro treatment.Results After treatment,a significant higher score of water swallowing test (t =2.682,2.040;both P＜ 0.05)in either of two groups,and a significant raised degrade of SaO2 only in olanzapine group(t=4.313,P＜0.01)but not in quetiapine group (P＞0.05)were observed.There was a significant higher degrade of SaO2 in olanzapine group than that in quetiapine group (t=2.155,P＜0.05)at 6 weekend of the study.Before pharmacon,about 29％ (23/80) AD subjects were diagnosed as dysphagia.After pharmacon,more emerging dysphagia patients were surveyed in olanzapine group compared with that in quetiapine group(9/31 vs 2/26,x2=4.135,P＜0.05).No significant change (both P＞0.05) in scores of mini-mental state examination(MMSE) and a significant reduced score(t=3.019,2.867;both P＜0.01)of behavioral pathology in Alzheimer'disease rating scale (BEHAVE-AD) were found in both two groups at the end of study.There was no difference among the two groups with regard to score of MMSE or BEHAVE-AD after treatment(both P＞0.05).Conclusion Either olanzapine or quetiapine therapeutics might do some harmful effects on swallowing function in patients with AD,especially the former.

Objective:To understand the status of frailty in postoperative gastric cancer patients and to explore its influence on symptom groups during the initial oral chemotherapy. Provide theoretical guidance for symptom management of cancer patients.Methods:A total of 133 postoperative gastric cancer patients who received initial oral chemotherapy were selected as subjects by cross section survey from Octomber 2021 to Octomber 2022 in Department of Oncology, First People′s Hospital of Changzhou by couvenient sampling method. Baseline data of patients before chemotherapy were investigated by general data questionnaire and Frailty Phenotype. Symptoms on the 2nd and 14th day of chemotherapy were investigated by M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module.Results:The incidence of frailty in postoperative gastric cancer patients was 48.9% (65/133). On the 2nd day of chemotherapy, there were four symptom clusters, namely emotional symptom cluster, gastrointestinal symptom cluster, disease related symptom cluster and neurological symptom cluster, and the cumulative variance contribution rate was 61.20%. On the 14th day of chemotherapy, there were five symptom clusters after gastric cancer specific symptom cluster appeared. and the cumulative variance contribution rate was 63.90%. On the 2nd day of chemotherapy, frailty had statistical significance on emotional symptom cluster, gastrointestinal symptom cluster andneurological symptom cluster ( t = 3.52, 2.66, 5.48, all P<0.05), which explained 7.2%, 4.1% and 15.1% of symptom group severity, respectively. On the 14th day of chemotherapy, frailty still had statistical significance on emotional symptom cluster, gastrointestinal symptom cluster and neurological symptom cluster ( t = 3.41, 5.47, 4.06, all P<0.05), which explained 7.1%, 13.2% and 9.6% of symptom group severity, respectively. Conclusions:The incidence of frailty in patients with postoperative gastric cancer was at a relatively high level. The emotional symptom cluster, gastrointestinal symptom cluster, and neurological system related symptom cluster in patients with frailty were more serious at different time points.

Objective To investigate the expressions of octamer-binding transcription factor 4 (Oct4) and phosphorylated-protein kinase B (p-Akt) proteins in colorectal cancer and their clinical significances, in order to explore the roles of Oct4 and p-Akt in the staging and grading of colorectal cancer. Methods Immunohistochemical technique was used to examine the expression of Oct4 and p-Akt proteins in 78 cases of colorectal cancer in Wuxi Second Hospital of Traditional Chinese Medicine and Wuxi First People's Hospital from January 2011 to December 2016. Relationship between expressions of Oct4 and p-Akt proteins and clinicopathological parameters were analyzed. Results The positive rate of Oct4 in tumors was 74.36 % (58/78), which was obviously higher than that in normal tissues [35.90 % (20/78), χ2= 23.32, P < 0.01]; and the positive rate of p-Akt in tumors was 67.95 % (53/78), which was obviously higher than that in normal tissues[28.21 %(25/78),χ2=24.68,P <0.01].The double positive and negative expression rate of these two proteins accounted for 80.8 %(63/78), with a linear positive correlation (r= 0.455, P < 0.000 1). In 78 cases of colorectal cancer, the expression of Oct4 protein was correlated with histological grade, lymph node metastasis, and Duke staging (all P < 0.05), and the expression of p-Akt protein was correlated with histological grade and lymph node metastasis (both P < 0.05). The multivariate logistic regression analysis showed that the expression of Oct4 protein was related to histological grade and Duke staging(both P<0.05),and the expression of p-Akt protein was only related to lymph node metastasis (P<0.05). Conclusion The combined detection of Oct4 protein and p-Akt protein has reliable and important clinical significance for judging the histological grade,lymph node metastasis and Duke staging of colorectal cancer.

OBJECTIVETo assess the association of CYP2C19 gene polymorphisms with the incidence of ischemic stroke among patients receiving clopidogrel therapy following coronary stenting for coronary artery disease.

METHODSClinical data of patients receiving clopidogrel therapy after coronary stenting were retrospectively studied. For a case-control study, 137 patients with acute cerebral infarction and 122 non-stroke patients were selected. Based on the variants of the CYP2C19 gene detected by a DNA microarray assay, the patients were further divided into the wild-type group(CYP2C19*1/*1) and mutant group(defined by the presence of at least one loss-of-function allele, including CYP2C19*1/*2, CYP2C19*1/*3, CYP2C19*2/*2, CYP2C19*2/*3 and CYP2C19*3/*3). The incidences of ischemic stroke in the two groups were compared through a chi-square analysis. The influence of CYP2C19 gene polymorphisms and clopidogrel therapy on the incidence of ischemic stroke was analyzed through multivariable logistic regression.

RESULTSA total of 259 patients were enrolled. The case and control groups showed no difference in terms of gender and age. There were 123 cases (47.5%) in the CYP2C19 wild-type group and 136 cases (52.5%) in the mutant group. The incidence of ischemic stroke of mutant group was significantly higher than that of wild-type group (59.9% vs. 44.3%, X2=6.398, P=0.042). Multivariate analysis revealed that loss-of-function polymorphisms of the CYP2C19 gene carried a 1.13 times greater risk for ischemic stroke compared to wild-type genotype (OR=2.13, 95%CI: 1.23-3.71).

CONCLUSIONThe efficacy of clopidogrel for the prevention of ischemic stroke in post-coronary stent patients may be reduced by the insufficiency of the CYP2C19 gene. The dosage of clopidogrel therapy should be adjusted based on its polymorphisms.

Brain Ischemia ; prevention & control ; Cytochrome P-450 CYP2C19 ; genetics ; Genotype ; Humans ; Percutaneous Coronary Intervention ; adverse effects ; Platelet Aggregation Inhibitors ; therapeutic use ; Polymorphism, Genetic ; Stents ; adverse effects ; Stroke ; prevention & control ; Ticlopidine ; analogs & derivatives ; therapeutic use

Objective:To compare the dynamic changes of transcutaneous partial pressure of carbon dioxide (PtCO 2) and treatment effect of non-invasive intermittent nebulization and non-invasive simultaneous nebulization in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods:This was a randomized parallel controlled trial study. A total of 70 patients with acute exacerbation of COPD in Changzhou First People′s Hospital from October 2021 to September 2022 were selected by convenience sampling method, and divided into control group and experimental group by randomized digits table method with 35 cases in each group. The control group was given non-invasive intermittent oxygen-driven nebulization, and the experimental group was given non-invasive simultaneous oxygen-driven nebulization. The PtCO 2 values at 0, 5, 10, 15 min (the end point of atomization) of the 2 groups were observed, the daily arterial blood gas analysis indexes (mainly including PaCO 2, PaO 2 and pH) were recorded, and the clinical pulmonary infection score and the self-assessment score of COPD patients were recorded before treatment, on the 4th and 7th day of treatment. Results:Finally, 33 patients were included in both the control group and the experimental group. There were 25 males and 8 females in the control group, aged (75.33 ± 8.24) years old. There were 25 males and 8 females in the experimental group, aged (72.39 ± 8.56) years old. The PtCO 2 values at 0, 5, 10, 15 min in the control group were (63.83 ± 12.47), (64.40 ± 12.57), (65.42 ± 13.77), (66.62 ± 14.59) mmHg (1 mmHg=0.133 kPa). There were statistically significant differences in PtCO 2 at all time points ( F=8.05, P<0.01). Further pairwise comparison by Sidak method showed that there were statistically significant differences in PtCO 2 at 15 min compared with 0, 5, 10 min (all P<0.05). The PtCO 2 values at 0, 5, 10, 15 min in the experimental group were (67.62 ± 11.89), (67.15 ± 12.12), (67.82 ± 12.22), (68.15 ± 12.09) mmHg. There was no statistically significant difference in PtCO 2 at all time points ( F=2.00, P>0.05). The PaCO 2 and pH value of the two groups were improved with the treatment time, the control group had a statistically significant difference on the 4th day of treatment compared with before treatment ( P<0.05), while the experimental group on the second day of treatment compared with before treatment ( P<0.05). Conclusions:Both kinds of nebulization have achieved good therapeutic effects, but non-invasive simultaneous nebulization can better maintain the stability of PtCO 2 in the process of nebulization with higher safety, and can improve the arterial blood gas index PaCO 2 and pH value of patients earlier, which is a more suitable nebulization method for the combination of non-invasive ventilation and nebulization, especially for patients with hypercapnia.