Objective To study the effects of anxious condition on asthma symptom burden and asthma control in elderly asthma patients in primary care settings. Methods Totally 128 elderly asthma patients were recruited in this study. The patients were required to fill in the questionnaire，then the score of asthma control test （ACT） and Hamilton anxious meter（HAMA） were calculated. Risk factors of anxious condition were analyzed by logistic analysis. Results The ACT scores in the anxious patients were significantly lower than those of the non-anxious patients [17.45±3.14 vs. 21.45±2.37，Plt;0.05）. The patients with lower incoming and more complications had more severe anxious condition，lower asthma control level，and more asthmatic medications. Meanwhile the latter conditions also increased the incidence of anxiety in the elderly asthma patients significantly （Plt;0.05）. Conclusions The elderly asthma patients in primary care settings are also complicated with anxiety，and the anxious condition can significantly increase asthma symptom burden and decrease asthma control level.
Objective
To explore the safety, feasibility and learning curve of video-assisted thoracoscopic surgery(VATS) in treatment of thoracic diseases.
Method
We retrospectively analyzed the clinical data of 591 patients of thoracic surgery in our hospital between September 2009 and September 2016. There were 378 males and 213 females at age of 14–82 years.
Result
All patients were successfully completed surgery. Twelve patients converted to open chest with conversion rate of 2.0%. Postoperative complications occurred in 24 patients (4.1%). Four patients died during the perioperative period, and mortality rate was 0.7%. The learning curve of VATS for lung cancer was about 25 patients. And the learning curve of video-assisted laparoscopy for resection of esophageal cancer was about 15 patients.
Conclusion
VATS is safety and feasible for the chest disease patients in municipal hospital, and is worthy to popularize.
【摘要】 目的 研究降鈣素基因相關肽（calcitonin gene related peptide， CRGP）在肝硬化門靜脈高壓癥患者食管下段胃底靜脈曲張中的作用。 方法 以2005年1月－2010年8月46例肝硬化門靜脈高壓癥不同程度食管下段胃底靜脈曲張患者作為研究對象，并按食管下段胃底靜脈曲張嚴重程度分為輕度曲張組、中度曲張組、重度曲張組，以30例行胃腸疾病手術無肝病患者作為對照。術中水柱法測定門靜脈壓力；酶聯免疫吸附法測定門靜脈血中CGRP含量。 結果 對照組及輕、中、重度曲張組門靜脈壓力分別為（14.8±2.1）、（30.5±2.5）、（44.3±3.2）、（47.6±3.8） cm H2O（1 cm H2O=0.098 kPa）。門靜脈血中CGRP的含量分別為（45.4±5.4）、（69.2±7.2）、（93.6±8.7）、（98.2±9.4） pg/mL。對照組門靜脈壓力及CGRP含量明顯低于其他3組（Plt;0.05），在輕度曲張組明顯低于中度和重度曲張組（Plt;0.05），中度和重度曲張組之間差異無統計學意義（Pgt;0.05）。 結論 CRGP在肝硬化門靜脈高壓癥食管下段胃底靜脈曲張的發生和發展中起重要作用，CGRP可作為反映食管靜脈曲張程度的一種有用指標。【Abstract】 Objective To investigate the role of calcitonin gene related peptide (CRGP) in pathogenesis of esophageal varices in portal hypertension with cirrhosis. Methods from January 2005 to August 2010, 46 patients with portal hypertension and cirrhosis at different degrees of esophageal varices were divided into mild varicose group, moderate varicose group and severe varicose group according to the severity of esophageal varices. The patients who underwent gastrointestinal surgery without liver disease were as the control. Portal vein pressure was detected by mercury during the surgery. The expression of CGRP was assayed by enzyme-linked immunosorbent assay. Results The portal pressure was (14.8±2.1), (30.5±2.5), (44.3±3.2), and (47.6±3.8) cm H2O (1 cm H2O=0.098 kPa) in the control group and the mild, moderate and severe varicose group, respectively. Those CGRP content in the portal vein was (45.4±5.4), (69.2±7.2), (93.6±8.7), and (98.2±9.4) pg/mL, respectively. CGRP content and portal vein pressure were the lowest in control group, which were significantly lower than those in the other three groups (Plt;0.05); which were also significantly lower in mild varicose group than those in the moderate and severe esophageal varices group (Plt;0.05), while no statistic difference between moderate and severe esophageal varices group was found (Plt;0.05). Conclusion CGRP plays an important role in the occurrence and development of portal hypertension with cirrhosis concurrent esophageal varices, and it may serve as a useful indicator reflecting the degree of esophageal varices.
Objective
To compare the subaxillary small incision thoracotomy (SSIT) with video-assisted thoracic surgery (VATS) for patients with lung cancer.
Methods
Retrospective analysis of 142 patients with lung cancer in Department of Thoracic Surgery, The First People's Hospital of Neijiang from January 2014 to April 2016 was conducted. There were 86 males and 56 females, aged 40-77 years. Patients were divided into a VATS group (n=72) and a SSIT group (n=70). The following postoperative data were evaluated: operation time, number of dissected lymph nodes, intraoperative bleeding, postoperative chest drainage volume, drainage duration, postoperative ambulation time, average hospital stay, postoperative complications, hospitalization cost, early postoperative incision pain (visual analogue scale, VAS) and other indicators.
Results
There were no statistically significant differences between the two groups in the operation time (120.8±20.4 minvs. 126.2±21.6 min,P=0.124), the dissected lymph node (11.1±2.0vs. 11.4±1.9,P=0.333) and the postoperative complications rate (13.9% vs. 15.7%, P=0.759). Laparoscopic intraoperative bleeding and postoperative drainage volume were significantly less in the VATS group than those in the SSIT group (123.2±26.9 mlvs. 156.4±24.0 ml,P<0.001; 227.0±75.5 mlvs. 334.3±89.1 ml,P<0.001). Postoperative drainage duration, postoperative ambulation time and hospital stay were shorter in the VATS group than those in the SSIT group (2.5±0.5 dvs. 3.1±0.6 d, 1.5±0.5 dvs. 2.2±0.6 d, 6.5±0.5 dvs. 7.4±0.6 d, allP<0.001). The average hospitalization cost of the VATS group was significantly higher than that of the SSIT group (42 338.9±8 855.7 yuanvs. 32 043.7±7 178.1 yuan,P<0.001). There was no significant difference in the operation cost and anesthesia cost between the two groups (P>0.05). The early postoperative pain of laparoscopic group was less, but the difference was not statistically significant (P>0.05).
Conclusion
The hospitalization cost of the SSIT is lower than that of thoracic surgery, which may be beneficial to the appilication in primary hospitals.
Objective
To observe the clinical effect of intravenous thrombolytic therapy for central retinal artery occlusion (CRAO) with poor effect after the treatment of arterial thrombolytic therapy.
Methods
Twenty-four CRAO patients (24 eyes) with poor effect after the treatment of arterial thrombolytic therapy were enrolled in this study. There were 11 males and 13 females. The age was ranged from 35 to 80 years, with the mean age of (56.7±15.6) years. There were 11 right eyes and 13 left eyes. The visual acuity was tested by standard visual acuity chart. The arm-retinal circulation time (A-Rct) and the filling time of retinal artery and its branches (FT) were detected by fluorescein fundus angiography (FFA). The visual acuity was ranged from light sensation to 0.5, with the average of 0.04±0.012. The A-Rct was ranged from 18.0 s to 35.0 s, with the mean of (29.7±5.8) s. The FT was ranged from 4.0 s to 16.0 s, with the mean of (12.9±2.3) s. All patients were treated with urokinase intravenous thrombolytic therapy. The dosage of urokinase was 3000 U/kg, 2 times/d, adding 250 ml of 0.9% sodium chloride intravenous drip, 2 times between 8 - 10 h, and continuous treatment of FFA after 5 days. Comparative analysis was performed on the visual acuity of the patients before and after treatment, and the changes of A-Rct and FT.
Results
After intravenous thrombolytic therapy, the A-Rct was ranged from 16.0 s to 34.0 s, with the mean of (22.4±5.5) s. Among 24 eyes, the A-Rct was 27.0 - 34.0 s in 4 eyes (16.67%), 18.0 - 26.0 s in 11 eyes (45.83%); 16.0 - 17.0 s in 9 eyes (37.50%). The FT was ranged from 2.4 s to 16.0 s, with the mean of (7.4±2.6) s. Compared with before intravenous thrombolytic therapy, the A-Rct was shortened by 7.3 s and the FT was shortened by 5.5 s with the significant differences (χ2=24.6, 24.9; P＜0.01). After intravenous thrombolytic therapy, the visual acuity was ranged from light sensation to 0.6, with the average of 0.08±0.011. There were 1 eye with vision of light perception (4.17%), 8 eyes with hand movement/20 cm (33.33%), 11 eyes with 0.02 - 0.05 (45.83%), 2 eyes with 0.1 - 0.2 (8.33%), 1 eye with 0.5 (4.17%) and 1 eye with 0.6 (4.17%). The visual acuity was improved in 19 eyes (79.17%). The difference of visual acuity before and after intravenous thrombolytic therapy was significant (χ2=7.99, P＜0.05). There was no local and systemic adverse effects during and after treatment.
Conclusion
Intravenous thrombolytic therapy for CRAO with poor effect after the treatment of arterial thrombolytic therapy can further improve the circulation of retinal artery and visual acuity.
ObjectiveTo observe the clinical effect of super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion (CRAO).
MethodsTwelve CRAO patients (12 eyes) were enrolled in this study. The patients included 7 males and 5 females. The age was ranged from 19 to 68 years old, with an average of (50.0±3.5) years. The disease duration was from 8 to 72 hours, with a mean of 18 hours. All the patients were received the treatment of super-selective ophthalmic artery or selective carotid artery thrombolysis with urokinase (total 0.20-0.4 million U) and injection of papaverine 30 mg. Five patients received the treatment of super-selective ophthalmic artery thrombolytic therapy, 7 patients received the treatment of selective carotid artery thrombolytic therapy (4 patients because of the financial issues, 3 patients because of thin ophthalmic artery). According to the visual acuity of post-treatment and pre-treatment, the therapeutic effects on vision were defined as effective markedly (improving three lines or more), effective (improving two lines) and no effect (no change or a decline). According to the arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT) on fluorescence fundus angiography (FFA), the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct 15 s, FT 2 s), effective (A-Rct was improved but in the range of 16-20 s, FT was in 3-8 s) and no effect (A-Rct was improved but 21 s, FT 9 s).
ResultsThe vision changes showed effective markedly in 5 eyes (41.7%), effective in 5 eyes (41.7%), no effect in 2 eyes (16.6%). The total therapeutic efficiency on vision was 83.4%. The retinal circulation was improved in all eyes after treatment, including effective markedly in 8 eyes (67.0%), effective in 4 eyes (33.0%). The total therapeutic efficiency on retinal circulation was 100.0%. No complications occurred in these 12 patients during the treatment or follow-up, such as puncture site hematoma, intracranial hemorrhage, cerebral embolism, eye movement abnormalities, retinal and vitreous hemorrhage.
ConclusionSuper-selective ophthalmic artery and selective carotid artery thrombolytic therapy were effective in the treatment of CRAO.
E-health is regarded as a strategic tool to achieve a human-oriented integrated service model. This study introduced the e-health framework of the World Health Organization, and conducted a comparative study of the different e-health development characteristics in the United Kingdom, United States, Australia, Canada and other countries. Based on the results, we analyzed the practical problems in e-health development in China, and suggested possible policy approaches for strategies of e-health development to support the policy of e-health development in China.
