Objective To observe the effect of tongue-drawing at lateral position in nasogastric intubation for senile patients with conscious disorders. Methods One hundred senile patients with conscious disorders were randomly divided into observation group and control group with 50 cases in each group. The patients in the control group were given routine nasogastric intubation while those in the observation group were given nasogastric intubation by tongue drawing at the lateral position. The two groups were compared in terms of success rate of intubation, the rate of adverse reactions and intubation effects. Result Compared with the control group, the observation group showed significantly higher in one-time intubation success rate , comfort rate and lower rate of adverse reaction (all P<0.01). Conclusions The nasogastric intubation by tongue-drawing at lateral position is superior to the routine intubation. It can improve the success rate of one-time intubation, decrease the rate of adverse reactions and relieve the pains of patients.

Objective To explore the effect of Jiangzhipailuan decoction in regulating PPARα( belong to the nuclear receptor family of ligand-activated transcription factors ), PGC- 1α ( peroxime proliferator activated releptour)and SREBP-1c( belong to the baichelix-loop-helix-leucine zipper class of transcription factors), SCAP( SREBP cleavage activating protein) related to lipid metabolism in the treatment of polycystic ovarian syndrome. Methods 84 patients suffered polycystic ovary syndrome were randomly divided into 4 groups: one received traditional Chinese medicine treatment, one western medicine treatment, one combination therapy and one as the control group. Traditional Chinese medicine group was treated with Jiangzhipailuan decoction treatment for 3 months, western medicine group was treated with up to Diane-35 ( ethinyl cyproterone tablets) for three cycles, while the combination therapy group was treated with traditional Chinese medicine ,western medicine as well as combined treatment for 3 courses. Results In the combination therapy group the PPARα, PGC-1α and decreased SREBP-1c, SCAP copy number was significantly improved ,and body mass index was significantly lowered. The total improvement rate of menstrual in three groups were 71.42% ,75.00% ,92.86% respectively. Conclusion Jiangzhipailuan decoction played a prominent role in regulating PPARα,PGC-1α and SREBP-1c,SCAP related to lipid metabolism in the treatment of polycystic ovarian syndrome.

Objective:To investigate the serum hepcidin level and risk factors associated with peripheral arterial disease (PAD) and foot ulcer in type 2 diabetic patients.Methods:From January 2019 to June 2019, 70 patients with type 2 diabetes in Department of Endocrinology of Xiangya Third Hospital were selected, including 21 newly diagnosed patients with type 2 diabetes (DM group), 23 patients with lower extremity vascular disease (PAD group) and 26 patients with foot ulcer (DF group). Serum hepcidin was determined by enzyme linked immunosorbent assay (ELISA). The serum levels of hepcidin in different groups were compared, and the correlation between diabetic lower extremity vascular disease and foot ulcer was analyzed.Results:⑴ The hemoglobin, albumin, triglycerides and total cholesterol were significantly lower in DF group compared with PAD and DM groups ( P<0.05), while the DF group patients were with higher white blood cell (WBC) count and high sensitivity C reactive protein (hs-CRP) than patients in PAD and DM groups ( P<0.05). DF group also showed significantly higher WBC, hs-CRP and neutrophil ratio level (NEUT%) than DM group ( P<0.05). The inflammatory indicators of WBC, hs-CRP and NEUT% showed no significant difference between DM group and PAD group ( P>0.05). ⑵ The levels of hepcidin in DF and PAD groups were higher than those in DM group, while that in DF group were higher than those in PAD group ( P<0.05); Hepcidin was positively correlated with systolic blood pressure, WBC count, NEUT% and ferritin ( P<0.05), and negatively correlated with hemoglobin, glycosylated hemoglobin, albumin and 25-hydroxyvitamin D ( P<0.05). ⑶ Binary multivariate logistic regression analysis showed that elevated hepcidin level was an independent risk factor for diabetic foot ulcer [ OR=1.755, 95% CI: 1.063-2.897, P=0.028]. Conclusions:The fluctuation of serum hepcidin level in diabetic patients is related to the stimulation of inflammation, the degree of anemia and the nutritional status, which means it might be an early indicator of inflammation in diabetic patients with peripheral arterial disease. Moreover, the increase of hepcidin is an independent risk factor for diabetic foot ulcers in our study.

Objective To investigate the change and clinical application value of plasma D‐dimer in acute cerebral hemorrhage . Methods The plasma D‐dimer level was detected in 78 individuals of healthy physical examination(healthy control group) and 82 patients with acute cerebral hemorrhage .Results The plasma D‐dimer levels at admission(0 h) had no statistical difference among various groups(P> 0 .05) ;the D‐dimer level at 24 ,48 ,72 h in the small cerebral hemorrhage group was significantly higher than that in the healthy control group(P< 0 .05) ;the D‐dimer level in the massive cerebral hemorrhage group was significantly higher than that in the small cerebral hemorrhage group(P< 0 .05) ;the D‐dimer level in the small cerebral hemorrhage group reached the peak at 24 h ,while which in the massive cerebral hemorrhage group reached the peak at 48 h and was positively correlated with the intracranial hemorrhage volume(r= 0 .914 ,P= 0 .000 < 0 .05) .Conclusion The plasma D‐dimer level in the patients with acute cer‐ebral hemorrhage is obviously increased and shows the increasing trend with the intracranial hemorrhage volume increase ;the more the intracranial hemorrhage volume ,the longer the persistence time of high D‐dimer level .Therefore detecting plasma D‐dimer level has an important significance for monitoring the condition in the patients with acute cerebral hemorrhage .

Objective To compare the clinical effect of preserving the ascending uterine artery in laparoscopic hysterectomy with traditional laparoscopic hysterectomy.Methods 112 patients with various kinds of uterine benign lesions performed by hysterectomy were randomly divided into the preserving the ascending uterine artery in laparoscopic hysterectomy group(observation group,n =60) and traditional laparoscopic hysterectomy group (control group,n =52),The operation time,the intra operative blood loss,the postoperative complications rate and the perimenopausal symptoms in two groups were compared as well as the levels of blood calcium and the levels of hormone before operation,the first month,the sixth month,the first year,and the third year after operation.Results The opreration time [(95.5 ± 22.8) win] and intraoperative blood soss [(81.3 ± 11.6) ml] of the observation group was more than those of the control group [(68.8 ± 7.2) ml] (t =3.772,4.418,all P ＜ 0.05).The postoperative abnormal uniation and defection (1.7％) and fever incidence (1.7％) of the observation group was lower than those of the control group (11.5 ％,13.5 ％) (x2 =4.623,5.843,all P ＜ 0.05).The estradiol level of the observation group began to fall in 6 months postoperative,and had significant differences compare with those of the control group 6 months,1 year,3 years after operation [(328.4 ± 13.4) pmol/L vs (304.8 ± 15.2) pmol/L,(311.3 ± 12.9) pmol/L vs (248.5 ±13.6)pmol/L,(258.3 ± 11.4)pmol/L vs (138.7 ± 12.7)pmol/L] (t =8.758,25.121,52.688,all P ＜0.05).There was significant difference in the level of follicle stimulating hormone (FSH) and luteinizing hormone (LH) between the two groups 1,3 years after operation(t =-90.540,-123.229,-14.757,-19.845,all P ＜ 0.01).There was significant difference in the level of calcium between the two groups 1,3 years after operation(t =3.261,3.050,all P ＜0.05).The perimenopausal symptoms of the observation group was less than those of the control group(x2 =6.142,3.471,4.976,6.646,4.633,all P ＜ 0.05).Conclusion Laparoscopic hysterectomy of preserving the ascending uterine artery is safe and reliable;the recently ovarian function of the patients with hysterectomy is to maximize the preservation in the treatment,the women's quality of life will be to improved.

Objective:To investigate the relationship between social support and depression of only-child-lost (OCL) people,and the mediation role of self-efficacy in this relationship.Methods:By stratified cluster sampling,214 OCL people were enrolled,with 80 males and 134 females,ages from 49 to 83 years old.They were assessed by General Self-Efficacy Scale,Social Support Rating Scale,and Self-rating Depression Scale.Results:Univariate analysis showed that there were significant differences in age groups (t=2.85,P＜0.05),with or without spouse (t=5.62,P＜0.05),family location (t=3.95,P＜0.05),per capita monthly income (F=3.48,P＜0.05) among the social support scores.There was significant difference between the per capita monthly income and self-efficacy scores in QCL people (F=5.46,P＜0.05).Correlation analysis showed self-efficacy and social support were positively correlated (r=0.26,P＜0.01).Self-efficacy (r=-0.59,P＜0.01) and social support (r=-0.59,P＜0.01) negatively correlated with depression in OCL people.Self-efficacy partially mediated the relationship between social support and depression.Conclusion:The person who is ＜60 years old,with spouse and the high per capita monthly income,and lives the rural area,would have high social support levels among QCL people.The person who has high per capita monthly income would have high self-efficacy.Self-efficacy is one of the direct prediction for depression,and plays an indirect role between social support and depression.Intervention of depression among OCL people could be applied to change their cognition,and to enhance their self-efficacy.

OBJECTIVE: To investigate the clinical value of negative pressure tympanograms for diagnosis of middle ear effusion in adults. METHOD: GSI-Tympstar II Middle Ear Analyzer of America was used to test tympanogram peak pressure (TPP); tympanogram width (TW); middle ear resonant frequency and stapedius muscle reflex for sceptical secretory otitis media (SOM) adult patients. Patients (207 ears) with C type tympanograms accepted tympanocentesis after tests. According to middle ear effusion quantity, 207 ears have been divided to three groups: non-effusion group (123 ears), small-effusion group (45 ears) and mickle-effusion group (39 ears). Acoustic immittance and ipsilateral stapedius muscle reflex were statistically analysed. RESULT: About TPP and resonant frequency, non-effusion group and small-effusion group have statistical difference (P < 0.05); non-effusion group and mickle-effusion group have significant statistics different (P < 0.01). About TW, non-effusion group have significant difference from mickle-effusion group (P < 0.01). There was statistical difference on ipsilateral stapedius muscle reflex (P < 0.01) among three groups. CONCLUSION Negative pressure tympanograms has diagnostic value for middle ear effusion combined to TPP, TW, middle ear resonant frequency and ipsilateral stapedius muscle reflex.
Acoustic Impedance Tests ; methods ; Adolescent ; Adult ; Aged ; Ear, Middle ; pathology ; Female ; Humans ; Male ; Middle Aged ; Otitis Media with Effusion ; diagnosis ; Young Adult

Objective To understand patient pathway and clinical characteristics of chronic diseases in urban areas of Shanghai. Methods A total of 10 002 residents were enrolled and assigned to the chronic disease group (including hypertension, diabetes, coronary heart disease, myocardial infarction, and ischemic stroke) and the non-chronic disease group. Body mass index,fasting blood glucose, triglyceride,total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were tested.Difference of patient pathway and clinical characteristics of those chronic diseases was compared. Results Above chronic diseases were observed in 37.7% participants. About 2/3 diseases were confirmed and 80% patients were followed up in healthcare units not far away from home. Patients with coronary heart disease and myocardial infarction showed more outpatient visit to tertiary hospitals (P＜0. 05 ). However, patients with ischemic stroke had health check, rehabilitation and pharmacy done mainly in local healthcare centers (P＜0. 05 ). Diastolic blood pressure of patients visiting local doctors was significantly decreased (P＜0. 05). Conclusion Some differences in patient pathway were found in this study. Communication and cooperation between medical institutions should be intensified for effective chronic disease control.

Objective To increase the awareness of ectopic ACTH syndrome in patients with thymus carcinoid. Methods Clinical manifestations, especially atypical presentation of ectopic ACTH syndrome, laboratory findings and imaging data (chest X-ray and CT, etc.) in 6 patients were analysed. Results In all 6 patients, the thymus tumors removed were pathologically proved to be thymus carcinoid. Conclusion Patients having typical manifestations of Cushing′s syndrome with hypokalemia, edema, proteinuria and equivocal result of dexamethasone inhibition test, should be considered as ACTH syndrome. And thymus carcinoid seems to be the cause of the disease.

Abdominoscrotal hydrocele is rare in clinic. In the past, routine examination and diagnosis were difficult, easy to be misdiagnosed. The daily operations were mostly completed through the groin area or abdominal incision, the wound is large. The application of laparoscopy can clearly diagnose the abdominoscrotal hydrocele through "springing back ball" sign, and can cure the disease by laparoscopic resection of interperitoneal mass and closure of the internal ring. It is worthy of clinical application. In this article, we summarized and analyzed the clinical experience of 15 cases of children with abdominoscrotal hydrocele diagnosed and treated by laparoscopy, to explore the value of the laparoscopic technology in the diagnosis and treatment of the abdominoscrotal hydrocele.