Clinical Focus

Application and skill of balloontipped floating catheter in temporary cardiac pacing

Hao Jie， Liu Fan

2017, 32(6): 462-465. doi:10.3969/j.issn.1004-583X.2017.06.002

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Serious bradyarrhythmia， three degree atrioventricular for example， is common in clinic， while temporary cardiac pacing is a kind of primary measure to rescue severe patients in emergency. It is very important to implant temporary pacemakers safely and rapidly. In the condition of emergency without X ray， balloontipped floating catheter is helpful in the process of implantation of bedside temporary pacemaker. Operator can put balloontipped floating electrode catheter to right ventricular via femoral vein， subclavian vein or internal jugular vein. And balloontipped floating catheter is inserted guiding by the length of catheter in body and the QRS morphology of pacing electrocardiogram.

Parameters modulation of temporary cardiac pacing

Du Hong， Lu Jingchao

2017, 32(6): 466-468. doi:10.3969/j.issn.1004-583X.2017.06.003

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Temporary cardiac pacing (TCP) is significantly an emergency procedure to stabilize patients suffering from hemodynamically unstable bradyarrhythmia. It involves placing a catheterbased electrode into the right side of the heart and modulating parameters of pacemaker in order to pace the endocardium in a VVI mode. This article will focus on the indications for TCP placement and describe the modulation of parameters which will help reflect the pacing functions.

Common problems and solutions of temporary cardiac pacemaker implantation

Yang Xiuchun， Li Yue， Xiao Bing

2017, 32(6): 469-471. doi:10.3969/j.issn.1004-583X.2017.06.004

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Temporary cardiac pacing is an effective emergency measure for the treatment of severe bradycardia. In clinical practice， unexpected problems sometimes lead to failure of cardiac pacemaker implantation. This article focuses on the implantation methods of temporary cardiac pacemaker and common problems and solutions，which helps beginners master implantation techniques and improve the ability to solve the problems.

A new education method on metabolic parameter in newly diagnosed type 2 diabetic patients

Luo Pingyan， Wu Zhongming

2017, 32(6): 472-474,478. doi:10.3969/j.issn.1004-583X.2017.06.005

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Objective To analyze the effect of metabolic indexes in newly diagnosed type 2 diabetic patients under an innovative and intensified education method. Methods Eighty patients with newly diagnosed type 2 diabetes mellitus in our hospital were randomly divided into experimental group and control group (n=40，each group).The control group was treated with basic diabetes education， while the experimental group was treated with the method of strengthening innovation education. The metabolic indexes were measured at the time of admission， 3 months and 6 months of treatment， respectively. Results At baseline， the experimental group showed higher blood glucose parameters， after treatment for 6 months， they fell to a better control level， while the control group got higher blood glucose still after treatment for 6 months(P<0.05). Conclusion The innovative education method can significantly improve the effectiveness of the education of newly diagnosed patients with diabetes， which can help obtain a better level of metabolic parameters and achieve good control of diabetes.

Joint ultrasonography in diagnosis of acute gout arthritis

Chen Zhihan， Yan Qing， Gao Fei， Lin He

2017, 32(6): 475-478. doi:10.3969/j.issn.1004-583X.2017.06.006

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Objective To discuss the application of joint ultrasonography in the diagnosis of acute gout arthritis. Methods The ultrasound imaging findings and the specific manifestations were compared in different joint zones of the patients with acute gout and other arthritis， evaluating the diagnostic value of different ultrasound manifestations. Results In the period of acute gout arthritis， the “double contour sign” was statistically significant and the positive rate was high， the sign was found mostly in the knees and toe joints.Conclusion “Double contour sign”could be the main ultrasound imaging feature in acute gout different from other arthritis， the knees and toe joints are the most frequently involved sites.

Risk factors for death patients with sepsis in EICU

Jin Ruifang， He Xinbiao

2017, 32(6): 479-482. doi:10.3969/j.issn.1004-583X.2017.06.007

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Objective To explore the risk factors of death with sepsis patients in EICU. Methods Retrospectively analysis was performed on 268 cases who admitted in EICU within more than 48 h. Epidemiological data， the worst laboratory indexes， the main intervention treatment and prognostic outcomes were recorded. The risk factors of death of septic patients in EICU were analyzed by logical regression. Results A total of 163 cases were discharged from hospital with improved condition， 105 cases were death. The death rate was 39.2%. Multivariable logistic analysis indicated that alanine transaminase (ALT)， aspartate transaminase (AST)， lactic acid (Lac)， shock were the independent risk factors of septic patients in EICU， urine volume (UV) and mechanical ventilation (MV) were protective factors.Conclusion ALT， AST， Lac， shock， UV and MV are of great significance in prognosis evaluation of sepsis patients in EICU.

Hypertension on prevalence and influencing factors in a hospital’s checkup population of Beijing

Yan Wei1， Li Rui2， Zhang Hongbo1， Wang Jieping1， Xu Ying1， Wu Wei1， Yang Xinghua3

2017, 32(6): 483-486. doi:10.3969/j.issn.1004-583X.2017.06.008

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Objective To investigate the prevalence of hypertension in 1 101 tertiary care hospital’s checkup people of Beijing，and explore its relationship with socioeconomic status and behavior factors. MethodsC heckup subjects from April to May in 2013 were surveyed by questionnaire. The questionnaire included socioeconomic status，behavior，medical history and medication history，etc. At the same time，the outcomes of physical examination and biochemical indicators were collected. The prevalence of hypertension was estimated and influencing factors of hypertension were analyzed. Results From survey in 1 034 subjects by questionnaire and physical examination， valid questionnaires 1 001 were gained， the effective rate was 96.8%. 1 001 pieces subjects were enrolled in the investigation，male 460 and female 541，the subjects’ average age was (34.42±8.93) years old. The prevalence of hypertension was 17.4%（174/1 001），and male’s was 24.3%（112/460），female’s was 11.5%（62/541），and significant difference was in the prevalence of hypertension（P<0.05). The prevalence of hypertension increased gradually with the increasing of age. Eliminating the confounding factors，gender，age，body mass index(BMI)，monthly income，working hours，eating habits were the risk factors of hypertension（P<0.05）. Conclusion Hypertension was characterized by gender and age，and was related to socioeconomic status and behavior factors. The comprehensive management should be carried out in patients with hypertension.

Relation between platelet parameters and clinical classification and severity of acute coronary syndrome

Teng Xin1， Qin Qin2， Lu Yaru2， Yang Ning2

2017, 32(6): 487-490. doi:10.3969/j.issn.1004-583X.2017.06.009

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Objective To investigate the association between platelet parameters and the clinical classification and the severity of coronary artery disease in patients with acute coronary syndrome(ACS). Methods A total of 262 patients with ACS were divided into STEMI group (n=167)， NSTEMI group (n=30) and UAP group (n=65). The severity of coronary stenosis was quantitated by Gensini score system. The clinical data of three groups were compared， the correlation between Gensini score and clinical indexes were analyzed. Results There were significantly higher levels of age， hsCRP， mean platelet volume and platelet distribution width in STEMI group and NSTEMI group than in UAP group（P<0.05）， MPV and PDW in STEMI group were significantly higher than those of NSTEMI group（P<0.05）. Correlation and regression analysis showed there were significant positive correlations between MPV， PDW and hsCRP levels and coronary lesions and Gensini score in all patients with ACS. Conclusion MPV and PDW levels were significantly different in patients with different ACS types， and the levels of MPV and PDW were positively correlated with the severity of coronary artery lesions in patients with ACS， which could be used as predictors of the severity of coronary artery lesions in patients with ACS.

Relationship between carotid plaque score and inflammatory factors in patients with cerebral infarction

Zhao Mengting1， Wang Hongchun1， Shi Yanqing1， Li Yongjie1， Li Rouxuan1， Tian Hui2

2017, 32(6): 491-494. doi:10.3969/j.issn.1004-583X.2017.06.010

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Objective To investigate the correlation between the modified Crouse score， serum C reactive protein (CRP) levels and neurological impairment (NIHSS score) in acute cerebral infarction patients.Methods 153 participants who were diagnosed by CT or MRI as the first acute ACI elderly patients were enrolled from Jul. 2015 to Nov. 2016 in our hospital and the elderly physical examination patients were enrolled as the control group in the same period . The carotid ultrasound and serum CRP were detected in two groups. Results In ACI group， the plaque detection rate was 91.5%(140/153) and the total number of patch was 954. In control group， the detection rate of 70.0% (98/140) and the total number of patch was 378. The plaque detection rate of ACI group was significantly higher than that of control group（χ2=22.170，P＜0.05). The irregular echo plaques of ACI group were increased compared with those of control group (χ2=32.270，P<0.05). The plaque morphology in ACI group was composed with hybrid echo and hypoechoic plaques. However， the plaque morphology in control group was mainly composed with homogeneous echo and hyperechoic plaque， ulcer plaque of ACI group also increased compared with that of control group (χ2=343.180，P<0.05). The serum CRP and the modified Crouse score in ACI group were significantly higher than those in control group (χ2=79.520，P<0.05). NIHSS ≤ 7 and NIHSS >7 group in CRP level and carotid artery plaque group serum Crouse score differences between groups were statistically significant (χ2=19.450，P<0.05). Conclusion The number of irregular plaques， hypoechoic plaques and mixed echo patches increased in ACI patients. Moreover， the incidence of plaque， plaque score and serum CRP protein in ACI patients were higher. With the increase of NIHSS score， plaque score and CRP in patients with ACI also increased.

Diagnostic value of dual source CT coronary angiography for congenital coronary artery variation

Wang Huia， Shi Xiangmingb， Xu Yafangb， Qian Dewenb， Wang Chengjianb

2017, 32(6): 495-497,502. doi:10.3969/j.issn.1004-583X.2017.06.011

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Objective To discuss the value of dual source CT （DSCT） angiography in the diagnosis of congenital coronary artery anomalies. Methods The DSCT coronary artery angiography data of 3 216 cases in our hospital were used with multiplanar reconstruction(MPR)， volume rendering(VR)， maximum intensity projection(MIP) and curved planar reformation(CPR) to analyze a variety of congenital coronary artery anomalies. Results 361 cases of congenital coronary artery anomalies were found in 3 216 cases of MSCT coronary artery angiography， including 297 cases of the courses of congenital coronary artery anomalies， 32 cases of the origin of congenital coronary artery anomalies， 4 cases of the number of congenital coronary artery anomalies， 16 cases of the structure of congenital coronary artery anomalies，12 cases of the end of congenital coronary artery anomalies. Conclusion DSCT can accurately and safely find congenital coronary artery anomalies， can be used as the preferred examination of congenital coronary artery anomalies.

Clinical efficacy of Chinese medicine decoction combined with point injection of three oxygen therapy in patients with postherpetic neuralgia

Jing Zhaode1a， Wang Dongyan1b， Song Weidong1a， Chen Jingde1c，

2017, 32(6): 498-502. doi:10.3969/j.issn.1004-583X.2017.06.012

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Objective To observe the clinical effect of Chinese medicine decoction combined with acupoint injection ozone (three oxygen) on the patients with postherpetic neuralgia (PHN). Methods A total of 105 cases of PHN patients were selected as the study subjects， and divided into three groups according to the random number table method， group A was given traditional Chinese medicine; group B adriamycin by acupoint injection; group C traditional Chinese medicine decoction combined with acupoint injection of three oxygen treatment. Giving a total of two weeks of treatment， the visual analogue scale (VAS) was observed before and after treatment， the levels of IL2， IL6， IL8 and PGE2 in venous serum were detected and the duration of neuralgia was recorded to evaluate the clinical efficacy.Results There were no significant difference in the VAS scores， the levels of IL2， IL6， IL8， PGE2 among three groups (P>0.05); After treatment， the indicators in three groups were significantly lower than those before treatment (P<0.05); The indexes of group C showed more decrease than those of group A and B， the duration of neuralgia and the total effective rate in group C were significantly higher than those of group B. The levels of IL2， IL6， IL8， PGE2 and VAS in group A were significantly decreased (P<0.05); Compared with group A and B， the duration of neuralgia in group C was significantly decreased and the total effective rate was significantly improved (P<0.05). Conclusion The threelevel treatment of Chinese medicine decoction combined with acupoint injection of three oxygen showed the effect of promoting blood circulation， inhibited inflammatory factors to reduce pain， and improved immune status of patients， local blood circulation and clinical outcomes.

Clinical characteristics of 110 children with severe Mycoplasma pneumoniae pneumonia

Chen Qin， Wang Chengyi， Liu Guanghua， Wang Shibiao

2017, 32(6): 503-506. doi:10.3969/j.issn.1004-583X.2017.06.013

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Objective To study the clinical characteristics of severe Mycoplasma pneumoniae pneumonia (MPP) in children， and to provide a basis for diagnosis and treatment. Methods Retrospective analysis was performed on the epidemiological and clinical data of the children who were hospitalized due to severe MPP from January 2014 to December 2015 in the hospital. Results Among the 110 children who were hospitalized due to severe MPP， 43 cases were between 0 and 1 years old， 39 cases >13 years old， 18 cases >35 years old and 10 cases >5 years old. The incidence of MPP varied with the seasons and was significantly highest in summer. With the growing of ages， the proportion of children with cough， with rale all decreased，the proportion of pulmonary complications（including lung abscess， hydrothorax，emphysema and pneumothorax） and pathological change of right lung both increased（P＜0.05）.White blood cell count (WBC) differed significantly among four groups （P＜0.05）. Creactive protein(CRP) and lactate dehydrogenase increased， but there were no statistical significance among different groups. A total of 110 patients were tested for other respiratory etiology， and coinfection was diagnosed in a total of 52 cases(47.3%). EB virus was the most common(23 cases，20.9%)， followed by cytomegalovirus (18 cases，16.4%). The coinfection features of severe MPP were different among children of different ages. The therapeutic effects of antibacterial agents， glucocorticoid and intravenous immunoglobulin in treating 110 severe MPP were positive. Conclusion Severe MPP is sporadic throughout the whole year， with a higher incidence in summer. The clinical features of severe MPP are different among children of different ages， and there are mixed infections of MPP and respiratory viruses. CRP and lactate dehydrogenase were significantly higher in children of severe MPP. Early recognition and combined treatment can reduce the occurrence of sequelae.

Diagnostic value of TSPOT.TB interferonγ release assay for tuberculosis

Tian Ruixue1， Ma Liping2， Wu Hongli1， Hou Hongyan1， Zhang Liping1

2017, 32(6): 507-510,514. doi:10.3969/j.issn.1004-583X.2017.06.014

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Objective To evaluate the value of interferongamma release assay(IGRA) in diagnosis of tuberculosis. Methods The study recruited 130 cases of active tuberculosis clinically proved from Beijing Chest Hospital， and 89 cases of old healed tuberculosis and 137 cases of nonTB patients from Beijing Haidian Hospital. TSPOT.TB test and fluorescence staining before antituberculosis therapy were performed in all patients．According to the result of the fluorescence staining， the patients with tuberculosis were divided into positive group and negative group. According to the age， the patients were divided into younger group and elderly group. The diagnostic performance of TSPOT.TB was compared.Results The sensitivity of the tuberculosis from TSPOT.TB diagnosis was 82.307％， the specificity was 75.182％. The positive rates of TSPOT.TB among pulmonary tuberculosis， old healed tuberculosis and nonTB patients were significantly different (χ2=7.580，P=0.032). The positive rate of TSPOT.TB in old healed tuberculosis was significantly higher than that of nonTB patients. The sensitivity of pulmonary tuberculosis was 86.60％， the specificity of TSPOT.TB was 75.0%， the sensitivity of the fluorescence staining was 65.17％， the specificity of the fluorescence staining was 98.33%. The comparison between the two results had remarkable statistical significance（P<0.001）. The sensitivity of the younger group was obviously higher than that of the elder group (χ2=4.782，P=0.029). Conclusion TSPOT.TB is more quick and convenient. It also has a higher sensitivity and negative predicted value. TSPOT.TB is a more valuable auxiliary diagnosis to younger patients. It can be used in the diagnosis of smear negative pulmonary tuberculosis patients and is not recommended in identifying old healed tuberculosis and active tuberculosis.

Endoscopic incision combined bouginage for refractory benign esophogeal stricture

2017, 32(6): 511-514. doi:10.3969/j.issn.1004-583X.2017.06.015

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Objective To explore the curative effect of endoscopic incision combined bouginage for refractory benign esophogeal stricture. Methods Seventeen patients of anastomotic stricture who failed repeated dilatation were treated with endoscopic incision combined bouginage. The symptoms improvement， anastomotic diameter， restenosis time interval were observed. Results All patients had successful treatment with endoscopic incision combined bouginage. Compared with the simple bouginage， the patients with dysphagia symptoms improved significantly， anastomosis diameter enlarged（P<0.05）， mean relief time expanded （P<0.05）. Conclusion Endoscopic incision combined bouginage for refractory benign esophogeal stricture was safe and effective.

Efficacy and safety of sitagliptin combined with metformin in treatment of type 2 diabetes mellitus: a meta analysis

Cheng Rui， Li Xi

2017, 32(6): 515-522. doi:10.3969/j.issn.1004-583X.2017.06.016

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Objective To assess the effects and safety of sitagliptin combined with metformin in treating type 2 diabetes mellitus (T2DM). Methods CNKI， Wanfang， VIP， PubMed， Cochrane Library， MEDLINE and other foreign language database were serached. The randomized controlled studies both at home and abroad about the efficacy and safety of sitagliptin combined with metformin and metformin alone in treating T2DM were enrolled into this study. The methodological value of the included studies were judged， the data conformed to the standard were extracted and RevMan 5.3 software was performed. Results A total of 20 studies were included (n=3 359). Compared with MET alone， SITA+MET obviously reduced the fasting blood glucose (FBG)， postprandial 2 hours blood glucose (2 hPG)， glycosylated hemoglobin (HbA1c)， body mass index (BMI) and insulin resistance index (HOMAIR)， but no significant difference was found in fasting plasma insulin(FINS); SITA+MET had no obvious increase in the incidence of hypoglycemia， gastrointestinal reaction rate was significantly reduced. Conclusion SITA+MET can obviously reduce FBG， 2 hPG， HbA1c， BMI and HOMAIR of T2DM patients，the incidence of hypoglycemia is low， so it has higher safety and low incidence of gastrointestinal reaction， the patients have better tolerability.

Diagnostic value of adenosine deaminase of pleural effusion for tuberculous pleurisy: a metaanalysis

Ma Qingguang， Li Huimin， Li Hongying

2017, 32(6): 523-527. doi:10.3969/j.issn.1004-583X.2017.06.017

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Objective To systematically review the diagnostic value of adenosine deaminase(ADA) of pleural effusion for tuberculous pleurisy. Methods We searched Pubmed， Embase， Medline， Cochrane Library， CNKI，CBMdise and Wanfang Database， comprehensive collection studies about the diagnostic value of ADA for tuberculous pleurisy from Jan.2005 to Jun. 2016.Two reviewers screened literature according to the inclusion and exclusion criteria， extracted data， and assessed the quality of included studies. MetaDisc 1.4 was used to conduct the metaanalysis. Results A total of 23 studies(3 312 cases) were finally included. The results of metaanalysis showed that the value of pooled sensitivity，specificity， LR+，LR-， diagnostic odds ratio(DOR) were SEN=0.876，95%CI=0.8590.892；SPE=0.899，95%CI=0.8850.912；LR+=8.139， 95%CI=6.64410.327；LR-=0.172，95%CI=0.1330.222；DOR=72.29， 95%CI=44.771116.75；AUC=0.9535.Conclusion ADA determination is a sensitive and specific test for the diagnosis of tuberculous pleurisy. Pleural effusion ADA can be used as an auxiliary indicator in diagnosis of tuberculous pleural effusion.

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