Objective:To explore the effect of the discharge preparation plan based on community linkage in the out-of-hospital continuous nursing of chronic obstructive pulmonary disease (COPD) patients.Methods:From March 2019 to March 2020, convenience sampling was used to select 206 COPD patients hospitalized in the Respiratory Department of Henan Provincial People's Hospital. The patients were randomly divided into the observation group and the control group, with 103 cases in each group. The control group received routine management of COPD, and the observation group implemented a community-linked discharge preparation plan on the basis of the control group, and carried out a six-month intervention. The COPD Assessment Test (CAT) score, Patient Assessment of Chronic Illness Care (PACIC) score, body mass index, degree of airflow obstruction, dyspnea and exercise capacity (BODE) index, and the patient readmission rate during the intervention period were compared between the two groups before and after the intervention.Results:After the intervention, the item scores and total scores of the CAT of the observation group were lower than those of the control group. Except for cough and sputum, the differences in the other items and total scores were statistically significant ( P<0.05) . The item scores and total scores of the CAT of the observation group after intervention were lower than those before intervention, and the differences were statistically significant ( P<0.05) . The dimension scores and total score of the PACIC of the observation group after the intervention were higher than those before the intervention, and were higher than those of the control group after the intervention, and the difference was statistically significant ( P<0.05) . The BODE index score of the observation group after intervention was lower than that of the control group, and the difference between the two groups was statistically significant ( P<0.05) . The readmission rate in the observation group within six months was 13.59% (14/103) , which was lower than 31.07% (32/103) in the control group, and the difference between the two groups was statistically significant (χ 2=9.068, P=0.003) . Conclusions:The discharge preparation plan based on community linkage can improve the quality of life and lung function of COPD patients, increase the patient's recognition of chronic disease management, reduce the rate of hospital readmission, and achieve the overall quality improvement in continuous nursing of patients.

Objective:To investigate the clinical value of magnifying endoscopy and high frequency endoscopic ultrasonography (HFUS) in the diagnosis and recurrence monitoring of gastric mucosa-associated lymphoid tissue lymphoma (GML).Methods:A total of 15 patients with newly diagnosed GML in the Jiangsu Province Hospital of Chinese Medicine from October 2016 to October 2019 were collected. The general data, clinical manifestations, Lugano staging, gastroscope performance, magnifying endoscopic performance, HFUS performance and helicobacter pylori infection were retrospectively analyzed. The efficacy and follow-up were also analyzed.Results:The most common symptom of 15 patients with GML was upper abdominal discomfort, followed by weight loss and anemia. The frequent site of GML was the middle 1/3 of the stomach (10 cases) and the most common type was diffuse (8 cases). The positive helicobacter pylori were detected in 9 cases. The positive tree-like appearance (TLA) was found in 13 cases under magnifying endoscopy; after the treatment, 2 cases had positive TLA. The unclear 1-3 layer structure of gastric wall in lesions was observed by using HFUS, accompanied with hypoechoic alteration. After the treatment, HFUS reexamination showed that the 1-5 layer structure of gastric wall disappeared in one patient, the pathological results confirmed that GML transformed into diffuse large B-cell lymphoma.Conclusion:Magnifying endoscopy combined with HFUS has an important application value in therapeutic efficacy evaluation and recurrence monitoring of GML; HFUS may has a certain clinical value in the progress assessment of GML.

Objective:To compare the efficacy and safety of triamcinolone acetonide (TA) alone and in combination with 5-fluorouracil (5-FU) for treating keloids using meta-analysis.Methods:Databases including PubMed, Embase, and Cochrane Library were retrieved with the search terms of " triamcinolone acetonide, 5-fluorouracil, glucocorticoid, fluorouracil, keloid, scar, TAC, 5-FU, hypertrophic scar " and databases including Chinese Journal Full- Text Database, Chinese Biomedical Database, and Wanfang Data were retrieved with the search terms of "曲安奈德,瘢痕疙瘩, 5-氟尿嘧啶,糖皮质激素,增生性瘢痕" in Chinese to obtain the publicly published randomized controlled trials about the effects of TA alone and in combination with 5-fluorouracil for treating keloids from the establishment of each database to august 2019. The outcome indexes included effective proportion of treatment, incidence proportion of adverse reactions, and recurrence proportion of keloids. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results:A total of 1 326 patients with keloids were included in 14 studies, including 668 patients in TA+ 5-fluorouracil group whose keloids were injected with TA and 5-fluorouracil and 658 patients in TA alone group whose keloids were injected with TA alone. A total of 7 articles achieved 1 to 3 points in modified Jadad score, while 7 articles achieved 4 to 7 points in modified Jadad score. Patients in TA+ 5-fluorouracil group had a higher effective proportion of treatment than that of TA alone group (relative risk=1.28, 95% confidence interval=1.16-1.41, P<0.01). Subgroup analysis showed that the quality of the included literature and ethnic factors might be the source of heterogeneity in effective proportion of treatment. Patients in TA+ 5-fluorouracil group had a lower incidence proportion of adverse reactions than that of TA alone group (relative risk=0.44, 95% confidence interval=0.25-0.75, P<0.01). Patients in TA+ 5-fluorouracil group had a lower recurrence proportion of keloids than that of TA alone group (relative risk=0.25, 95% confidence interval=0.14-0.44, P<0.01). There was no publication bias in incidence proportion of adverse reactions ( P>0.05), while the effective proportion of treatment and recurrence proportion of keloids had publication bias ( P<0.05). Conclusions:TA combined with 5-fluorouracil is more effective than TA alone for treating keloids, with less incidence of adverse reactions and recurrence.

Objective To evaluate the impact of Montessori-based intervention on eating ability of the elderly with dementia.Methods Sixty-four patients with dementia were randomly divided into intervention group(n=32) and control group(n=32).Patients in intervention group were given Montessori-based intervention,and patients in control group received regular care.The effect of Montessori-based intervention on eating ability,eating difficulty and self-eating time were assessed by the simplified Chinese version of EBS (C-EBS),simplified Chinese version of Edinburgh feeding evaluation in dementia scale (C-EdFED) and stopwatch respectively at pre-intervention,post-intervention,1-month and 3-month follow-up.Results Compared with the control group (EBS:(12.42± 3.59);EdFED:(10.48± 3.83);self-eating time:(15.28±6.04) min)),the average scores of EBS(14.31±2.63) increased and the self-eating time ((21.44±7.17)min) increased after 8 weeks intervention in intervention group,while the average scores of EdFED (7.86±4.16) increased.The C-EBS scores and self-eating time in intervention group were significantly higher than that of control group while the C-EdFED scores were lower than that of control at all time points(P＜0.01).The difference in time effect between the two groups was statistically significant (P ＜ 0.05)Conclusion The Montessori-based intervention can improve the eating ability of elderly people with dementia,reduce eating difficulty and increase self-eating time.

Objective To develop the Dementia Caregivers' Nursing Ability Scale and test its reliability and validity. Methods Based on the model of Caregiver Skill Building/Effectiveness, the item pool was formulated through literature review and semi-structured interview, the items were selected by experts consultation and the pilot survey of 30 dementia caregivers. Totally 293 dementia caregivers in the hospital and the elderly homes were selected for investigation to test the reliability and validity. Results The Dementia Caregivers' Nursing Ability Scale consisted 5 subscales and 36 items, the exploratory factor analysis identified five principal factors which explained 79.44% of the total variance. The item content validity index ranged from 0.857 to 1, the scale content validity index was 0.985. The Cronbach's α coefficient of the scale was 0.936, the split reliabilit was 0.970, and the test-retest reliability was 0.980. Conclusion Dementia Caregivers' Nursing Ability Scale has good reliability and validity, which can be used as a tool to measure the dementia caregivers' nursing ability.

Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection(ESD)for massive colorectal laterally spreading tumor(LST). Methods A retrospective study was conducted on the data of patients with colorectal large area LST(the shortest diameter>4 cm) undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4.0 to 7.0 cm with mean size of 5.18 ± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57±12.95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess,3 patients with low grade intraepithelial neoplasia,6 patients with high grade intraepithelial neophasia,1 patient with carcinoma in situ, 1 patient with carcinoma in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST,which is worth popularizing in clinics.

Objective To translate the Eating Behavior Scale (EBS) into Chinese and test its reliability and validity. Methods The Chinese Version of the scale (C-EBS) was developed through translation, back-translation, cross-cultural adaption and pre-test. A convenient sample of 100 old people with dementia was investigated with C-EBS to test its reliability and validity. Results The Cronbach′s α, Guttman Spilt and test-retest reliability of C-EBS were 0.842, 0.865 and 0.840, respectively. The I-CVIand S-CVI of C-EBS were 1.00, and the score of C-EBS was negatively correlated to the total score of The Chinese Edinburgh Feeding Evaluation in Dementia scale(C-EdFED) (r = 0.727,P < 0.01). Conclusion The C-EBS is reliable and valid and can be used as a valid tool to measure the eating ability among the old people with dementia in China.

Objective To measure the sizes of patent ductus arteriosus (PDA) by echocardiography,compare the results with those by X-ray angiography(XA),to analysis the correlation of measurements between echocardiography and XA,to explore the value of echocardiography on screening the size of PDA suitable for transcatheter occlusion.Methods One hundred and forty-one participants was included.The parameters of PDA including the length of PDA(PDAL),the aortic side diameter (PDADao) and the pulmonary side diameter of PDA(PDADpa) were measured from the parasternal great artery short-axis view (PSSA) and the suprasternal descending aorta long-axis view(SSLA) of echocardiography and left lateral projection of XA,and the other parameters such as the left ventriclular end-diastolic diameter index (LVEDDI),the main pulmonary artery diameter index(MPADI),the pressure drop of PDA shunt (△P) and the pulmonary artery systolic pressure index(PASPI) were measured by echocardiography.The sizes of PDA from PSSA,SSLA and XA were compared,and the correlations of the sizes of PDA between echocardiography and XA,the correlations between the other parameters by echocardiography and the PDADpa index(PDADIpa) by XA(PDADIpa-XA) and PSSA(PDADIpa-PSSA) were analyzed.Results ①The difference of the sizes of PDA:Between PSSA and SSLA had difference on mersurement of PDA(all P ＜ 0.05),except SSLA had no difference on measurement of PDADao with XA (P ＞0.05),others echocardiography parameters all had difference on measurement of PDA with XA (all P ＜ 0.05).②Correlation:Both PSSA and SSLA had positive correlations with XA (all P ＜0.01).And among these parameters,PDAL by SSLA,PDADao by SSLA and PDADpa by PSSA had better correlations with XA (r =0.92,0.87 and 0.91,respectively,all P ＜0.01).LVEDDI,MPADI and PASPI had positive correlations with PDADIpa (all P ＜0.01),the LVEDDI and MPADI had better correlations with PDADIpa-PSSA(r =0.76,0.72,all P ＜0.01),but the PASPI had a better correlation with PDADIpa-XA(r =0.70,P ＜0.01).PASP had a negative correlation with △P (r =-0.79,P ＜0.01).Conclusions There was difference between the sizes of PDA at different echocardiographic views,PDADpa by PSSA and the PDAL and the PDADao by the SSLA were more close to those parameters by XA.Multiplane views of echocardiography can evaluate all the more accurately the size of PDA and play an important role in guiding transcatheter occlusion of PDA.

Objective To compare the changes in myocardial fibrosis degree and left ventricular function before versus after percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease (CHD).Methods 121 elderly patients diagnosed as CHD with a single vessel by coronary angiography were enrolled.All patients were treated with PCI guided by thrombolysis in myocardial ischemia (TIMI) grade,symptoms and fractional flow reserve (FFR) comprehensively,and reviewed by coronary angiography after 12 months.The changes in serum concentration of procollagen type Ⅰ (PC I),procollagen type Ⅲ (PC Ⅲ),laminin (LN),hyaluronic acid (HA) and aldosterone (ALD) before versus 3,12 months after PCI were detected by enzyme-linked immunosorbent assay (ELISA).Left ventricular ejection fraction (LVEF),left ventricular enddiastolic diameter (LVEDD),plasma N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) level and 6-minute walk test (6MWD) were assessed before and 3,12 months after PCI.The correlations were analyzed between FFR and serum procollagen type Ⅲ level,between serum PC Ⅲ level and plasma NT-proBNP level,and between serum ALD level and serum levels of PC Ⅰ,PC Ⅲ,LN,HA.Results All patients were treated with PCI successfully.At 12 months after PCI,stenosis with different degree were found in implanted stents or some large vessels in 6 cases by coronary angiography FFR=0.56-0.82).The serum levels of PC Ⅰ,PC Ⅲ,LN,HA,ALD,LVEDD and the plasma levels of NT-pro BNP were lower at 3 months after PCI than at preoperative follow-up (all P＜0.05),but LVEF was higher at 3 months after PCI than at preoperative fellow-up (P＜0.05),and the change trends in above observations were more significantly at 12 months after PCI.Linear correlation analysis showed that there was negative correlation between FFR and PC Ⅲ (r=-0.67,P＜0.01).There were positive correlations between PC Ⅲ and NT-proBNP,between ALD and PCⅠ,PC Ⅲ,LN,HA respectively (r=0.67,0.52,0.55,0.46,0.51,all P＜0.01).Conclusions PCI comprehensively guided by TIMI grade,symptoms and FFR can reduce myocardial fibrosis,improve cardiac function and quality of life in elderly patients with single coronary heart disease.

Objective To observe the influences of Yiqi-Humo recipe,A traditional Chinese prescription,on mucosa repair after endoscopic mucosal resction (EMR) and (or) endoscopic submucoal dissection (ESD).Methods 32 patients,who received EMR or ESD,were randomly recurited into a control group with 14 patients (omeprazole) and a experiment group with 18 patients (Yiqi-Humo recipe + omeprazole).Patients of both groups received treatment for a period of 4 weeks.Follow-up endoscopy was performed at 1 and 4 weeks after EMR or ESD,the index of symptom and mucosa signs were evaluated before and after the operation.Results At the 4 weeks after the procedure,the index of pain,pantothenic acid,anorexia,burning sensation in the experiment group [(0± 0.00)、(0± 0.00)、(2 ± 0.11)、(1 ± 0.06)] were lower than those in the control group [(12±0.86)、(6±0.43)、(15 ± 1.07)、(14± 1.00),P＜0.01].The index of hyperemia and edema of the experiment group [(3 ± 0.17)、(3 ± 0.17)] were less than those of the control group [(16± 1.14)、(15 ± 1.07),P＜ 0.01].Conclusion The prescription of Yiqi-Humo recipe promoted mucosa repair significantly after EMR or ESD.