Journal of Clinical and Experimental Medicine

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2 Journal of Clinical and Experimental Medicine Volume 1 Issue 3 DEC 2017 Editor-in-chief R.F Deng Deputy-Editors-in-Chief W.H. Chen X.R. XU Y.J. ZHANG X.R. WANG Y.G. HUANG L.X.SU Editor staff Y.Y. JIANG Publisher Cao Qi Editorial Advisory Board Hong Yang The Third Afliated Hospital of Southern Medical University ChiFang Lu Shanghai Clinical Hearing Medical Center QingGang Li Chinese PLA General Hospital Fang Liu Chinese PLA General Hospital Hong Qu Pan Yu Central Hospital Journal of Clinical and Experimental Medicine: An international journal is published quarterly a year in print and electronic editions. Editorial Office, Subscriptions, Advertising, and Ingquiries: GREYSH LIMITED FLAT C7, 6/F., LEAPONT INDUSTRIAL BUILDING, 18, WO LIU HANG ROAD, FO TAN NT, HONG KONG, CHINA Tel: (+852) ; Fax: (+852) ; support@jocem.org; Copyright@2017 GREYSH LIMITED. All rights reserved. No part of this publication may be reproduced, stored, transmitted, or disseminated, in any form or by any means, without prior written permission form Greysh, to whom all requests to reproduce copyright material should be directed, in writing.

3 Journal of Clinical and Experimental Medicine Volume 1 Issue 3 DEC 2017 INDEXING JOCEM has been indexed by several world class databases. For more information, please access the following links: Research Bible Worldcat JournalTOCs Google Google Scholar Research Center for Chinese Science Evaluation(RCCSE) Baidu Xueshu

4 Journal of Clinical and Experimental Medicine Volume 1 Issue 3 DEC 2017 CONTENTS 1 Clinical study of 9 patients with acquired thrombotic thrombocytopenic purpura Hong Qu 6 Application of Friction and Spiral Disinfection in PICC Maintenance Yuwei Wang, Xiao Hu 10 Investigation on depressive state of hospitalized senile patients Xiaorong Wang 14 Clinical Study of the Treatment of Coronary Heart Disease by Coronary Artery Bypass Grafting Hong Qu 17 A Study on the Curative Effect of Omeprazole in the Treatment of Ulcerative colitis GuoDong Zheng

5 Journal of Clinical and Experimental Medicine VOL.1,ISS.3,DEC 2017,1-5 ONLINE ISSN: PRINT ISSN: DOI: /jocem Clinical study of 9 patients with acquired thrombotic thrombocytopenic purpura Hong Qu Pan Yu Central Hospital, GuangDong, China Abstract: Objective: To analyze the clinical features, treatment strategies and outcomes of patients with acquired thrombocytopenic purpura (TTP). Methods: The clinical data of 9 patients with acquired TTP were retrospectively analyzed. Using SPSS 13.0 software for data analysis. Results: There were 4 males and 5 females in 9 patients, with a median age of 43 (24-72) years. Five patients (55.56%) showed typical pentadia syndrome. Thrombocytopenia (100%), microangiopathy Anemia (100%), fever (88.89%) is more common, while the nervous system symptoms (77.78%) and kidney damage (55.56%) is relatively rare. Two patients were tested for plasma von Willebrand factor (ADAMTS13) activity, with activities of 2.4% and 4.4%, respectively. Four patients (44.44%) were treated effectively, and the effective rate of plasma exchange and plasma infusion was 55.56%. Five patients died without recurrence. The average age of onset of death was higher than that of the effective patients (52.2 ± VS ± 11.44), but the difference was not statistically significant (P = 0.081). Conclusion: Concurrent clinical fever, hemolysis and bleeding tendency need to consider the possibility of TTP. Detection of plasma ADAMTS13 activity contributes to the clinical diagnosis of TTP. Early diagnosis and timely application of plasma therapy can help control the disease. The prognosis of elderly patients is relatively poor. keywords: Purpura, thrombotic thrombocytopenia; von Willebrand factor lyase; clinical features; treatment Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy (TMA) characterized primarily by microvascular hemolytic anemia (MAHA), reduced platelet aggregation depletion, and organ damage caused by thrombosis (eg, the kidney, central nervous system, etc.). TTP has low incidence, high mortality and the presence of multiple system symptoms and misdiagnosis, missed diagnosis, leading to miss the best timing of treatment. Clinically, according to the genetic background it is divided into hereditary TTP and acquired TTP. The latter is divided into idiopathic and secondary according to whether there are obvious incentives. Most cases are idiopathic, no special cause can be found, the disease is easy to recurrent; secondary has a specific reason, having an increasing incidence in recent years,. We retrospectively analyzed the clinical features, treatment strategies and outcomes of 9 patients with acquired TTP, and the report is as follows. Cases and methods 1.General Information: 9 patients with acquired TTP were admitted to Panyu Central Hospital of Guangzhou from April 2010 to May TTP diagnosis of all patients was in line with the standard [1]. There were 4 males and 5 females, with a median age of 43 (24-72) years (Table 1). 2.Research Methods: All cases are in line with TTP diagnostic criteria. TTP diagnosis is based on five clinical features: reduced thrombocytopenia, microangiopathic hemolytic anemia (blood smears see broken red blood cells), nervous system abnormalities, renal damage and fever; diagnosis of TTP must have at least two criteria: microangiopathy hemolytic anemia and reduced thrombocytopenia, excluding other diseases that cause reduced thrombocytopenia and microangiopathic hemolytic anemia, such as antiphospholipid antibody syndrome and diffuse intravascular coagulation. changzhi212@163.com

6 2 VOL.1,ISS.3,DEC 2017,1-5 3.treatment programs 3.1 plasma treatment plasma infusion (PI) and (or) plasma exchange (PE). Plasma exchange volume 40-60ml / kg / d, when the patient improved symptoms it gradually adjusted to 1 time / qod, 2 times / W to 1 time / W. Plasma infusion ml / d, for 3-5 days, when the patient improved symptoms it gradually disabled. The median time to onset of plasma therapy was 2 (1-20) days, of which the median PE was 5 (1-10). 3.2 glucocorticoid treatment glucocorticoid choose methylprednisolone or prednisolone 1mg / (kg.d), or dexamethasone 10-20mg / d intravenous infusion, once every 5-14d, after stable condition the reduction and with a splash Nisong oral maintenance, specific reduction and maintenance of treatment programs is same with the diagnosis and treatment of immune thrombocytopenia [18]. 3.3 Immunosuppressant treatment 1 patient with systemic lupus erythematosus (SLE), combined with cyclophosphamide (CTX) 1.2g / w, a total of 1, due to the patients economic reasons to give up treatment, not to continue to use. 4. Efficacy: the efficacy standard reference [2-3] : 1 effective: normal platelet count, no clinical symptoms and signs; 2 some effective: PLT 50 * 10 ^ 9 / L or 1 times the basal value, no clinical symptoms and signs; 3 invalid: PLT <20 * 10 ^ 9 / L or less than 1 times, the increase in clinical symptoms; 4 recurrence: TTP clinical manifestations again after complete remission 30d. 5. Statistical analysis: The SPSS 13.0 software was used to analyze the data, and the independent sample t-test was used to compare the effective group with the death group. The difference was statistically significant at p <0.05. Other data use median representation. Results I.the clinical features 1. Causes: Nine patients with acquired TTP were acute onset, of which 3 cases co-exist autoimmune diseases, namely systemic lupus erythematosus, hyperthyroidism and immune thrombocytopenic purpura, 1 case of pulmonary infection, the rest 5 cases having no obvious incentive. 2, clinical manifestations: 9 cases of acquired TTP in patients with first symptoms include fever, thrombocytopenia, fatigue, hemolytic anemia, neuropsychiatric symptoms, the above single or joint manifestations, in the effective treatment of progressive exacerbations or successive occurrence. Five cases showed "five joint" sign. Nine patients had thrombocytopenia and MAHA, one with hemorrhage concurrently, seven with neurological symptoms, eight with fever, and five with renal insufficiency (Table 2). II.laboratory tests 1. Hematology analysis: Nine cases of TTP patients have complete blood cell analysis data. HGB median 76 (43-93) g / L, 8 cases of moderate and severe anemia; PLT median 8 (2-17) * 10 ^ 9 / L; all 9 patients with peripheral blood smear, All detected broken red blood cells, the median was 4.4% (0.5% -13.0%), of which 3 patients with broken red blood cell count 3%. 2. Biochemical tests: The countable total bilirubin values of 8 patients, the median was 76.3 ( ) μmol / L, the normal reference value ( ) μmol / L; 6 patients with median LDH 1474 ( ) U / L, the normal reference value ( ) U / L, of which 4 cases (66.67%) patients with LDH> 1000U / L. The median creatinine was 157 ( ) μmol / L in 5 patients with renal dysfunction, the normal reference value was μmol / L, the median urea nitrogen was 11.6 ( ) μmol / L, the reference value is ( ) μmol / L. 3. Plasma ADAMTS13 activity and inhibitor test: ADAMTS13 was detected in 2 of 9 patients with TTP, with 1 activity of 4.4% and 1 activity of 2.4%, meanwhile, the test result of plasma ADAMTS13 inhibitor was weakly positive. III.treatment All 9 patients received glucocorticoid therapy, of which only 1 patient was treated with glucocorticoid alone and the remaining 8 patients were treated with PE or (and) PI or (and) immunosuppressant (cyclophosphamide). One patient was accompanied by systemic lupus erythematosus. CTX 1.2g / w was used for 1 time, and then the treatment was abandoned due to economic reasons. IV. the treatment results Five patients (55.56%) died, including 3 deaths in the

7 VOL.1,ISS.3,DEC 2017,1-5 3 hospital (1 failed due to plasma therapy) and 2 patients who abandoned treatment and died outside the hospital. One patient with glucocorticoid alone died; four of the eight patients receiving plasma therapy survived and four died (Table 3). There was no significant difference in age of onset, the total bilirubin level before treatment, body temperature, white blood cell count, hemoglobin, platelet count, serum creatinine and LDH (Table 4). Discussion TTP is a rare thrombotic microvascular disease characterized by multiple systemic lesions with a prevalence of about 3.7 / 1 million [4], with a prevalence of years and a male to female ratio of about 1: 2 [5]. Recent studies of FV Leiden anomaly [14] and tissue plasminogen activator activity (t-pa) reduction [15] have been linked to the development of TTP. However, the lack of vasopressin lyase (ADAMTS13) is a major pathological mechanism of TTP [6-9], but not all TTP patients detect abnormalities of ADAMTS13, especially TTP patients secondary to other diseases can seldom detect ADAMTS13 abnormalities [10]. In this study, only 2 patients were tested for ADAMTS13 activity due to the lack of detection means or reagents, and their activity was reduced. Therefore, ADAMTS13 activity measurement is an important auxiliary indicator in the diagnosis of TTP, rather than the only standard [11], but dynamic detection of ADAMTS13 activity can provide some reference for the disease. The diversity of TTP clinical manifestations. Among the patients with acquired TTP, thrombocytopenia (100%), microangiopathy hemolytic anemia (100%) and fever (88.89%) were more common, while neurological symptoms (77.78%) and renal damage (55.56% )were relatively rare. Five cases (55.56%) had a typical "five joint sign" performance. Therefore, TTP should be considered when patients have unexplained thrombocytopenia, hemolytic anemia and fever. In addition, patients with atypical clinical manifestations, broken red blood cells and elevated LDH can also assist in the early diagnosis of TTP. Since the introduction of PE therapy in clinical practice in the 1970s, the mortality rate of TTP has been gradually reduced from 90% to 10% -20% [17]. PE is still an important method for the treatment of this disease. It can effectively remove ADAMTS13 autoantibodies and excessive vwf multimers and supplement the normal ADAMTS13 for therapeutic purposes [12]. Plasma therapy was given in 8 patients (88.89%) in this group. The median time from onset to the PE treatment was 2 (1-20) days. The clinical symptoms were significantly improved in 4 patients. The median effective time was 3 (2-4) days. The mortality rate of patients receiving plasma therapy was 50%, much higher than the lowest reported international mortality rate (4%) [13]. Possible reasons include: 1 Among the 8 patients undergoing plasma therapy, 3 gave up follow-up treatment and 1 case of poor treatment; 2 due to delayed diagnosis, not timely PE treatment or insufficient replacement. In this study, plasma therapy combined with glucocorticoid therapy in patients without recurrence and death, the plasma and hormone dose, treatment time and the drug adjustment standard is based on the actual situation of the grass-roots hospitals and patients economic conditions, the effect seems encouraging. In summary, TTP is a rare clinical critically ill, clinical complex and diverse. When patients have unexplained manifestations of thrombocytopenia and hemolytic anemia, they are indications for the initiation of TTP treatment [16]. ADAMTS13 activity detection and related biochemical indicators of dynamic changes play a guiding role for the clinical evaluation of the disease development. The advent of PE has significantly increased the survival rate of patients with TTP, especially for the elderly, winning time for the patient's life, and new therapeutic approaches for TTP are also being actively explored, mainly focusing on inhibiting the collagen-vwf-platelet response axis and VWF antibody is expected for the treatment of TTP. However, for grass-roots medical units, primary medical staff's comprehensive understanding of the disease and its familiarity with clinical features are of crucial importance for the early diagnosis of TTP. Looking for TTP treatment guidelines and emergency procedures more suitable for primary health care workers remains to be confirmed by a large number of clinical studies.

8 4 VOL.1,ISS.3,DEC 2017,1-5 Table 1 Summary of clinical data in 9 cases of acquired thrombocytopenic purpura patients no. item gender male female female female male male female male female age Body tempreture( ) WBC(*10^9/L) Hb (g/l) Plt(*10^9/L) LDH(U/L) Creatinine (umol/l) Urea nitrogen (umol/l) TB(umol/L) DB(umol/L) IB(umol/L) Ferr Re% Broken red blood cells (%) ADAMTS13 ADAMTS13 Not checked Not checked Not checked Not checked Not checked activity 2.4% Not checked Not checked 4.4% Table 2 the clinical manifestations of 9 cases of acquired thrombocytopenic purpura patients Clinical manifestations cases(%) Bleeding 6(66.67%) Cerebral hemorrhage 2(22.22%) Skin ecchymosis 3(33.33%) Menstrual volume increased 1(11.11%) Microvascular hemolytic anemia 9(100%) Neuropsychiatric symptoms 7(77.78%) Consciousness indifferent, unconscious 2(22.22%) Looking, convulsions 4(44.44%) Headache, vomiting 1(11.11%) fever 8(88.89%) Renal insufficiency 5(55.56%) Table 3 the treatment and outcome of 9 cases of thrombotic thrombocytopenic purpura patients [cases (%)] treatment method cases effective died Glucocorticoids 1 0(0) 1(100.00%) Glucocorticoids + plasma exchange + plasma infusion Glucocorticoids + plasma exchange + plasma infusion + immunosuppressants Plasma exchange + plasma infusion 3 1(33.33%) 2(66.67%) 1 0(0) 1(100%) 4 3(75.00%) 1(25.00%) Table 4 the comparison of clinical features when onset of patients with thrombotic thrombocytopenic purpura with different treatment results (± s) Clinical indicators effective group (4 cases) death group (5 cases) P value age(year) 32.25± ± body temperature( ) 39.1± ± WBC(*10^9/L) 39.8± ± HGB(g/L) 75± ± PLT(*10^9/L) 10.25± ± Total bilirubin (μmol/l) Creatinine (μmol/l) Urea nitrogen (μmol/l) 78.78± ± ± ± ± ± LDH(U/L) ± ± References: [1] Chinese Society of Hematology, Department of Thrombosis and Hemostasis. Chinese expert consensus on diagnosis and treatment of Thrombotic thrombocytopenic purpura (2012 Edition) [J] Journal of Hematology, 2012,33 (11): [2] Zhan X, Streiff MB, King KE,et al. Thrombotic thrombocytopenic purpura at the Johns Hopkins Hospital from 1992 to 2008: clinical outcomes and risk factors for relapse[j]. Transfusion,2010,50(4): [3] Gurkan E, Baslamisli F, Guvenc B, et al. Thrombotic thrombocytopenic prupura in southern Turkey: a single-center experience of 29 cases[j]. Clin Lab Haematol,2003,120(4): [4] Allford SL,Hunt BJ,Rose P,et al.guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias[j].br J Haematol,2003,120(4):

9 VOL.1,ISS.3,DEC 2017,1-5 5 [5] George JN,Terrell DR,Swisher KK,et al.lessons learned from the Oklahoma syndrome registry[j].j Clin Apher,2008,23(4): [6] Zheng X,Chung D,Takayama TK,et al.structure of von Willebrand factor- cleaving protease (ADAMTS13),a metalloprotease involed in thrombotic thrombocytopenic purpura[j].j Bio Chem,2001,276(44): [7] Fujikawa K,Suzuki H,MeMullen B,et al.purification of human von Willebrand factor-cleaving protease and its identification as a new member of the metalloproteinase family [J].Blood, 2001,98(6): [8] Soejima K,Mimura N,Hirashima M,et al.a novel human metalloprotease synthesized in the liver and secreted into the blood:possibly,the von Willebrand factor cleaving protease?[j].j Biochem,2001,130(4): [9] SADLER J E.Von Willebrand factor,adamts13,and thrombotic thrombocytopenic purpura [J].Blood,112(1): [10] KREMER HOVINGA J A,LAMMLE B.Role of ADAMTS13 in the pathogenesis,diagnosis,and treatment of thrombotic thrombocytopenic purpura [J].Hematology Am Soc Hematol Educ Program,2012,2012: [11] George JN.How I treat patients with thrombotic thrombocytopenic purpura:2010[j].blood,2010,116(20): [12] MATSUMOTO M.Anti-ADAMTS13 autoantibodies in patientis with thrombotic thrombocytopenic purpura[j].nihon Rinsho Meneki Gakkai Kaishi,2013,36(2): [13] Zhan H,Streiff MB,King KE,et al.thrombotic thrombocytopenic purpura at the Johns Hopkins Hospital from 1992 to 2008: clinical outcomes and risk factors for relapse[j]. Transfusion,2010,50(4): [14] RAIFE TJ,LENTZ SR,ATKINSON BS,et al.faclor V Leiden;a genetic risk factor for thrombotic Microangiopathy in patients with normal von Willebrand factor-clearing protease activity[j]. Blood,2002,99(2); [15] HOIRISCH-CLAPAUCH S,NARDI AE.A role for tissue plasminogen activator in thrombotic thrombocytopenic purpura[j].med Hypotheses,2014,83(6): [16] YANG Yan,DONG Chun-xia,YANG Lin-hua.Thrombotic thrombocytopenic purpura research[j].chinese Jurnal of Thrombosis and Hemostasis,2016,22(1): [17] Bandarenko N,Brecher ME,United States Thrombotic THrombocytopenic Purpura Apheresis Study Group (US TTP ASG);multicenter survey and retrospective analysis of current efficacy of therapeutic plasma exchange[j].j Clin Apher,1998,13(3): [18] Chinese Society of Hematology, Department of Thrombosis and Hemostasis. Chinese expert consensus on diagnosis and treatment of adult primary immune thrombocytopenia [J] Journal of Hematology, 2011,32 (3):

10 Journal of Clinical and Experimental Medicine ONLINE ISSN: PRINT ISSN: VOL.1,ISS.3,DEC 2017,6-9 DOI: /jocem Application of Friction and Spiral Disinfection in PICC Maintenance Yuwei Wang,Xiao Hu Department of General Surgery, 309th Hospital of PLA, Beijing Abstract: Objective: To compare the application of friction disinfection and spiral disinfection in PICC catheter maintenance. Methods: Ninety patients with PICC catheter were enrolled in this study. They were randomly divided into experimental group (43 cases) and control group (47 cases). In the experimental group, the skin around the puncture site was disinfected by frictional disinfection method, and spiral methods for the control groups. Sampling inspection was done before and after the disinfection. The number of bacterial culture colonies, catheter maintenance time, patients and nurses evaluation of operation before and after disinfection were compared between the two groups. Results: There was statistically significant difference between the two groups for bacterial colony count before the disinfection(p<0.05), but no statistically significant difference after the disinfection. There was not statistically significant difference between the two groups for the Maintenance time (P>0.05). The nurses and patients satisfaction for the procedure were higher in the experimental group compared with that in the control groups(p<0.05). Conclusions: during the PICC Maintenance, Friction methods can reach the technical standards of disinfection (Bacterial colony count 5 CFU / cm 2 ) and the antibacterial effect was also better during the 7 days after maintenance. The Satisfaction and acceptance from nurses and patients were higher than spiral methods. keywords: Disinfection methods: PICC Skin disinfection is an indispensable operation in clinical work. Reasonable skin disinfection can eliminate the transient bacteria and resident bacteria on the skin to achieve an almost sterilized state. Catheter-related infections are a common complication of catheterization in PICC patients and one of the major contributors to catheter-related infections is skin contamination in the host [1-2]. Medical care practices require: for the local disinfection of the skin, subcutaneous, intravenous injection and other parts, the spiral disinfection was used with the injection point as the center [3]. PICC maintain the catheter, puncture point and skin disinfection area, different from the flat surface of intravenous injection, and the disinfection area of 10 * 10cm above, in practice both nurses and patients think conventional spiral disinfection the power can not effectively emit. It is very difficult to remove glue marks caused by covering viscous dressings and fiber stains around clothes [4]. Therefore, this study adopts a friction-type disinfection method to explore disinfection operations more suitable for PICC maintenance. The report is as follows. 1.data and methods 1.1.General Information: 90 cases of patients in our hospital to do PICC clinical maintenance catheter from February 2015 to April 2015are chosen as the research object. Exclusion of the merger of other parts infection and alcohol, chlorhexidine, foil and other allergic cases, they were maintained at an interval of 7 days, randomly divided into experimental group 43 cases and the control group 47 cases. The experimental group use friction disinfection, the control group use conventional spiral disinfection. There was no significant difference in gender, age, puncture site and other aspects between the two groups (P> 0.05), which is comparable.

11 VOL.1,ISS.3,DEC 2017, Material: The dressing kit is the PICC special maintenance package made by 3M Company. There are six cotton swabs with disinfectant in a fixed package. The sterilizing solution is 75% alcohol and 2% glucose gluconate. The cotton swab head size is 2 * 1cm. Sampling use cotton swabs, agar medium and so on. 1.3.Methods: Catheter maintenance and sampling are completed by two full-time training nurses, the maintenance place is at a fixed maintenance room, doing air disinfection with high-intensity UV air disinfection daily during treatment. (1) colony sampling method before and after disinfection: sampling before and after each disinfection, strictly follow the aseptic operation. With a single sterile eluent cotton swab without a neutralizer, in the specification board roundtrip back and forth evenly rub five times, and then rotate the cotton swab, cut off the hands contact area, the cotton Swabs were placed in tubes containing 10 ml of sterile neutralizer eluate and immediately inspected. (2) friction disinfection method: first 75% alcohol swab avoid the puncture point and catheter, lift the spiral coil around the first lap, the second lap began to take up and down friction, disinfected from the inside out: The next friction 5cm, from the inside out every lap disinfection about 0.5cm, disinfection area 12 * 12cm above (larger than the film area). The same method after three alcohol 2% gluconic acid has been disinfected three times. Swabs were sterilized from the puncture point, the catheter flat on the skin, the first spiral disinfection, after the second ring the up and down friction and disinfection, disinfecting the catheter using the same method of alcohol disinfection, the catheter need to be reversed in the interval of the two disinfection and move its location, to achieve seamless disinfection the catheter and skin. The control group use 75% alcohol cotton balls, cotton balls have been set 2% gluconic acid chloride from inside to outside the reverse spiral disinfection the skin area around puncture points 3 times each, to be naturally dry. (3) Satisfaction Questionnaire: 90 patients Satisfaction Questionnaire were given the evaluation of comfort and cleanliness after the dressing change. 30 PICC outpatient rotation training nurses, working years 2-5 years, the number of maintenance cases times / month, to give evaluation of satisfaction from the ease of operation and the effectiveness of cleaning. 1.4.Evaluation Index: (1) Bacteria culture bacterial count before and after disinfection by two methods: Bacterial culture colonies>5 CFU / cm 2 on the skin surface were regarded as infection according to the standard of disinfection technical standard [5], and no pathogen growth was qualified. (2) operating time. (3) Patients experience evaluation. (4) nurses experience evaluation. 1.5 Statistical Methods: all data are processes by SPSS 11.0 statistical software, chi-square test is used to compare count data, measurement data is shown by mean ± standard deviation, using t test or u test, the P <0.05 difference was statistically significant. 2.results 2.1.Comparison of the number of colonies before and after disinfection in two groups There were significant differences in the number of colonies cultured before disinfection between the two groups. There was no significant difference in bacterial colonies after disinfection. The number of colonies after disinfection was <1 CFU/cm 2, no pathogen growth, the qualified rate of % in Table 1. Table 1 cultured colonies before and after disinfection using two methods(cfu/cm 2 X ±s) Method before disinfection after disinfection Experimental group 0.90± ±0.32 Control group 1.94± ±0.47 P value P<0.05 P> Comparison of the operation time in two groups All patients catheter maintenance operation time remained at 20 ~ 30 min, the difference was not statistically significant. 2.3.Patients' perceptions of the two operations There was significant difference in the comfort and cleanliness between the two types of patients (P <0.05). Patients believe that friction-type disinfection can effectively eliminate the skin stains, skin itching flu soothed after the friction, see Table 2.

12 8 VOL.1,ISS.3,DEC 2017,6-9 Table 2 patients experience evaluation of the two kinds of operation Method Cleanliness Satisfaction Comfort satisfaction yes no yes no Experimental group Control group P value P<0.05 P< nurses experience evaluation of the two kinds of operation Nurses evaluate friction disinfection method can quickly and effectively remove skin stains, gel marks, and have consistent action during operation, disinfecting the skin have a certain degree of friction, satisfaction P <0.05, the difference is statistical significance. See Table 3 Table 3 nurses experience evaluation on the two operations Method Operation convenience Cleaning Effectiveness yes no yes no Experimental group Control group P value P<0.05 P< Discussion PICC catheter infection was mostly caused by intubation at the skin of bacteria subcutaneously migrate to the outside tunnel of the catheter [6]. Microscopically, in infected tubes, the microorganisms adhere mainly to the outer diameter of the catheter. Staphylococcus aureus, a resident bacteria on the surface of the skin, is a microorganism that causes 2/3 of the vein-related infections. The skin resident bacteria is characterized by more resistant strains, not easy to remove and kill. Clinical PICC catheter maintenance follow the technical specifications of the spiral disinfection of skin, PICC catheter is in the disinfection center, in operation, spiral disinfection can not be as continuous intravenous injection of the ring when the catheter is often taken out by disinfected cotton swab, the skin disinfection is weakened. According to mechanics, the upper and lower friction force is greater than the spiral force, the spiral force needs to be under full effect in a complete ring. Li Chunhui, Shi Wei found that in the actual clinical disinfection, health care workers have the habit of parallel disinfection up and down from around the way to improve wiping efforts, but also remind the round friction is easy to increase the risk of contamination [7]. In this study, by standardizing the friction disinfection method, follow the basic principles of routine disinfection from the inside to the outside, to avoid re-contamination in the disinfection, there is no difference in samples after disinfection and the control group. Frictional disinfection can make the disinfectant full contact with the skin, especially the potential gap in the pore area, play a full role in eliminating the skin resident bacteria and transparent paste viscose and skin oils, clothing wool mixed stains. Seven days after the friction disinfection (before disinfection) there is difference in sampling and spiral disinfection group, which may be related to the friction disinfection effective removal of the resident bacteria in the deep skin, the results from the sample friction disinfection in PICC catheter maintenance can achieve a good disinfection effect. The skin of patients with PICC catheter is covered by the film for a long time, more or less have itchy skin, sticky unpleasant feeling, after comparing the two disinfection methods, the patient feels friction disinfection can effectively relieve itching, the skin is partially refreshing, the overall comfort feeling is better than the spiral disinfection. Nurses operate from the inside to the outside as the disinfection principle, having a higher acceptance of friction disinfection practices, a high degree of coherence, obvious decontamination effect. Friction disinfection and spiral disinfection use the same disinfection package, without increasing the cost of patients, the improved disinfection operation can achieve better effects of skin disinfection operation, to reduce the iatrogenic infection as much as possible, and accepted by patients and operators unanimously and thus it can be clinically promoted. References: [1] O'Gradg NP, Alexander M, Bellinger EP, et al. Guideline for the prevention of intravascular catheter-related infections Center for Disease Control and Prevention [J]. MMWR, 2002,51 (RR-10): [2] Wang Xuyi, Huang Yurong, Shi Jian. Nursing management of 160 cases of elderly patients with central venous catheter

13 VOL.1,ISS.3,DEC 2017,6-9 9 infection [J]. Chinese Journal of Infectious Diseases, 2006,16 (6): [3] People's Republic of China Ministry of Health. Sanitation and disinfection technical specifications [S]. Beijing: People's Republic of China Ministry of Health, 2004: [4] Guo Li. New Methods of Replacement of PICC transparent stickers [J]. Journal of Nursing, 2010,25 (6): 29 [5] People's Republic of China Ministry of Health. Disinfection technical specifications [S]. Third Edition, Beijing: Ministry of Health, People's Republic of China 2000: 1-63 [6] Li Xiaojuan, Sun Lihui, Fang Fang, et al. Comparison and clinical nursing of infection caused by 64 different PICC dressing in patients with acute leukemia [J]. Qilu Nursing, 2008,14 (11): [7] Li Chun-hui, Shi Wei. Disinfection Effects of two skin disinfection methods [J]. Chinese Journal of Disinfection, 2008: 25 (5):

14 Journal of Clinical and Experimental Medicine ONLINE ISSN: PRINT ISSN: VOL.1,ISS.3,DEC 2017, DOI: /jocem Investigation on depressive state of hospitalized senile patients Abstract: XiaoRong Wang Department of Preventive Medicine, YongDingMenWai Community Health Service Center, Beijing, China Objective: In order to discuss the degree of depression of hospitalized senile patients and to know the proegumenal cause, 100 hospitalized senile patients were taken out randomly and investigated with depression by adopting the Geriatric Depression Scale ( GDS) and the Symptom Self-evaluation Scale (SCL-90). The results showed that 50 percent senile patients showed different depression condition. The occurrence of depression in the patients with bad self-rating health or with low self-care ability was significantly higer than that in those with better self-rating health or with higher self-care ability. Depressive state was mainly from the patients underestimate their health condition. keywords: senile patients; in hospital; depressive state; investigation and research With the development of science and technology and the improvement of medical conditions, the life of human beings is generally prolonged and the aging of the population has become a social problem. During aging, the old, especially the old with affective disorder, have high incidence rates because of the effects of physiological, psychological, and social factors. Some epidemiology data showed that depressive affective disorder was particularly prominent in the old and badly affected elderly's life quality. To know the the degree of depression of hospitalized senile patients and the proegumenal cause, a questionnaire study has been done for 100 hospitalized senile patients by adopting the GDS and nursing countermeasures was raised accordingly. 1.Data and Method Study objects were inpatients from Shanxi Medical University Hospital and Second Hospital of Shanxi Medical University. The patients were selected based on the following criterias: 1 age 60 years old; 2 three-level caregiver; 3 without Severe hearing, vision, and language disorders. 100 hospitalized senile patients were taken out randomly and investigated with questionnaire investigation. 100 questionnaires were given out and gathered at the same time (afternoon). The Geriatric Depression Scale ( GDS), approved by psychiatrist, was adopted as research tool. 13 depression genes in the Symptom Self-evaluation Scale (SCL-90) attach to it to assist and check. If GDS is greater than or equal to 11, he or she will be considered to have mild depression. In 8 psychosocial factors of Reference material, self evaluation was conducted from 1 point to 4 points, respectively indicate four levels from good to bad. χ2 test and correlation analysis was adopted to analyze the data. 2.Results and Analysis 2.1.GDS scores of varied items (table 1) It showed that the major clinical manifestations of this group are: 1 negative self-image. Most old people felt memory lose, difficult to concentrate and slow thinking; 2 reducing fun activities, enjoying staying at home and keeping away from social events; 3 feeling melancholy, empty, tired and afraid something bad happen. It can be seen that the melancholy mostly comes from underestimating their health @qq.com

15 VOL.1,ISS.3,DEC 2017, Items Number Memory is worse than before 49 It s difficult to concentrate 46 The mind is not as clear as ever 35 A lot of activities and interests have been abandoned 48 Prefer to stay at home, rather than go out and do new things 43 Hope to avoid party 35 Be afraid that something bad is going to happen 41 Always be worried about future 36 Be worried because some ideas can t get rid off 33 Always be melancholy and sad The prevalence of depression of hospitalized senile patients in all age groups (Table 2). In this group, the oldest is 83 years old; the youngest is 60 years old; the average 66 years old. The group was divided into three subgroups by age, the higher depression incidence rate were observed in the group whose age was older than 70. And the average of GDS and SCL-90 are higher. By statistical tests, there is no statistically significance in the difference among three age groups. (χ 2 =3.05, P>0.05) age Table 1 score of 100 hospitalized senile patients Table 2 Comparison of GDS and SC L-90 scores in all age groups number Score of GDS Health condition Selfcare ability Depression The incidence of depression The relationship between depression and sex, educational level, occupation (Table 3). In this group, there are 56 men and 44 women; below secondary school education is 58, above secondary school education is 42; 58 cadres and 42 workers. The difference was not statistically significant by the χ 2 test Table 3 The relationship between depression and sex, occupation, education level factors Number Depression incidence rate% χ 2 P sex Male >0.05 Female >0.05 Education below secondary level school education occupation cadre >0.05 worker The incidence of depression in the elderly patients with different diseases and course of disease (Table 4). In this group, the medical patients accounted for 82%. According to comparing with classification of inpatient diseases, the incidence of depression in patients with tumor and endocrine patients is higher. Considering some other factors, the causes of depression is that endocrinology patients have a long course of disease and resistance to treatment, the causes of depression. The main cause of depression is that the patients with tumor are mostly caused by acute onset and short course of disease (average 2.98 a), especially those of malignant tumor. In addition, it was also found that the health of the patients with cardiovascular disease was poor (2.70), but the incidence of depression was lower (40%). It is believed that the attack of cardiovascular disease is sudden and critical. After receiving treatment and nursing in the hospital, it is relatively relieved. This may be the main cause of the lower incidence of depression. What s more, the scores of GDS in patients with depression were significantly higher in the Department of Dermatology, the Department of the five department and other departments. Through conversations, the reason is that some skin diseases have a long resistance to treatment, have a bad smell and unbearable itching. ENT often affects the appearance. The feelings of these patients are generally very sensitive. They are very vulnerable to psychological injury and become depressed. They are eager to get others' understanding and recognition, especially for medical staff. From the course of the disease, those whose course of the disease was higher than 5A (59.5%), the incidence of depression was higher. There is no statistical significance between different diseases and course of disease by the χ 2 tests. 2.5.The effect of psychosocial factors on the depression of elderly patients Epidemiological data confirm that the main psychosocial factors of elderly depressive patients are following items: alienation of mutual affection, children's dispute, elderly person of no family, poor neighborhood relations, chronic physical diseases, Economic difficulties, Children's promotion and employment. Among them, poor neighborhood and chronic physical disease had a significant

16 12 VOL.1,ISS.3,DEC 2017,10-13 Table 4 Comparison of the incidence of depression in elderly patients with different diseases and course of disease Disease Course of disease factors Cardiovascular disease Digestive system disease Endocrine disease number GDS Average depression the incidence average course of depression tumor others a >5 a impact on the incidence of depression. The effect of health status, self-care ability, economic status and family relationship on elderly patients with depression in this group is detailed in Table 5. As can be seen from table 5, 98% family relations are good, 96% patients have better economic conditions, and the elderly patients with poor family relations and poor economic conditions all have depression psychology. In addition, the self-assessment score suggested that 25% of the patients could take care of themselves or could not take care of themselves. 44% of the patients thought their health condition was poor or worse, which may be related to the respondents are all three level nursing patients. Among these people, the incidence of depression was significantly higher than that of the average (70.5% and 76%, more than 50%). There is statistical significance by the χ 2 tests. 3.Discussions 3.1.Depression reduces the quality of life of elderly hospitalized patients. In this group, 50% the elderly patients have different degrees of depression, most of which are mild depression and rarely develop to severity. The main clinical symptoms were depression, pessimism, loss of interest in all kinds of activities, lack of enthusiasm and energy, and a small number of patients with suicide tendency. The depression is very volatile and changes with time, place, and interest. Depression can lead to the body's endocrine disorders and Table 5 The relationship between psychosocial factors and depression in elderly patients factors Health condition Self-care ability Economic situation Family relations GDS scores number Depression The incidence of depression < < Note : 2 is good, 3 is bad. decline immune ability, the body's resistance and increase susceptibility. In addition, the elderly patient's tolerance to mental stimulation is very low. Once the depression is appearing, the risk of various diseases is very high. In turn, somatic diseases can also aggravate mental disorders through psychological effects, thus forming a vicious circle. And the old have senile obstinacy. Depressive mood not only aggravates physical disease, but also seriously disrupts the daily life of elderly patients, thus greatly reducing their quality of life. 3.2.Depression is mainly because the patient's self underestimate their health There are many factors that lead to depression in elderly patients. Heredity, medical environment, psychological factors, social factors, and the severity of disease can all be the causes of depression. The survey found that the fundamental cause of depression in hospitalized elderly patients is the underestimation of the patient's own health. A healthy body is an important basis for the realization of self worth, which is particularly important for the elderly. TOM's self consciousness theory holds that when the health condition is damaged, the body instinctively self regulates, on the one hand, objectively appraise the reality of oneself, on the other hand, it envisages the ideal health condition. If it is hard to narrow the gap between reality and expectation, it will fall into a long-term self anxiety mode that wants to get the lost health. Extreme self anxiety exaggerates negative χ 2 P

17 VOL.1,ISS.3,DEC 2017, emotions and creates a negative self image of the individual. In addition, the mental activities and thinking patterns of the elderly are relatively fixed, aging and sensitive, which are difficult to accept new explanations and explanations, but are rather concerned about some specific people or events, and are very susceptible to them. Therefore, when the body is abnormal and hospitalized, it is easy to exaggerate some negative reactions, underestimate its health and self-care ability, resulting in the occurrence of depression 3.3.Nursing countermeasures Based on the above analysis and discussion, the following points should be paid special attention to the nursing of elderly inpatient depressive patients: 1 When implementing nursing activities, we should encourage them to take an active part in, making the patients feel "I am OK" or "I can". At the same time, we should pay attention to timely affirming and strengthening this benign feeling; 2 Avoid too much protection, and do not mention a lot of demands so as not to hurt their enthusiasm. 3 Promote communication between patients and society, encourage family and friends to visit more, actively participate in the recreational activities of the ward organization, in order to divert and distract their attention; 4 To help patients correctly understand their disease, their abilities and values, and make cognitive reconstruction, enable them to correctly evaluate their health and establish confidence in conquering diseases; 5 More attention should be paid to the serious depressivepatients, in order to prevent the occurrence of suicide. infarction--mri findings and its distribution][j]. Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 1992, 94(9):851. [6]Xue B Y, Huang Y. Perioperative Anxiety and Depressive State of Senile Cataract Patients and the Related Nursing Intervention[J]. Nursing Journal of Chinese Peoples Liberation Army, Reference [1]Xiangdong Wang, Rating Scales of Mental Health [ J].Chinese Mental Health Journal,1993 (Suppl.): [2]Qianjin Jiang MedicalPsychology [ M].Beijing: People's Medical Publishing House, [3]Yinling Zhang, He Lei, Ruying Zhang. Applying of the Cognitive-Behavior Therapy in the Course of Psychological nursing care[ J]. researching study,2001, 15(3):125. [4]Zhao M, Song W, Diao L. A survey and health education on depressive state of senile hospitalized patients[j]. Chinese Nursing Research, [5]Fujikawa T, Yamawaki S, Fujita Y, et al. [Clinical study of correlation pre-senile, senile depressive state with silent cerebral

18 Journal of Clinical and Experimental Medicine ONLINE ISSN: PRINT ISSN: VOL.1,ISS.3,DEC 2017, DOI: /jocem Clinical Study of the Treatment of Coronary Heart Disease by Coronary Artery Bypass Grafting Hong Qu Pan Yu Central Hospital, GuangDong, China Abstract: Objective: To study and analyze the clinical effects on the treatment of coronary heart disease (CHD) by using coronary artery bypass grafting (CABG). Methods:to randomly select 68 patients of coronary heart disease as objects of the study and then to perform the CABG by using non-cardiopulmonary bypass (NCPB) and finally to summarize and analyze its clinical treatment effects. Results:all patients were operated under NCPB. The inspection result after operation showed that there was a significant improvement in myocardium blood supply that compared with before operation. 38 of these patients did not suffer hypoxia or myocardial hemorrhage. Conclusion:CABG is safe and effective for the treatment of coronary heart disease by using NCBP. If indications can be strictly controlled, in general, it is worthy for clinical application. keywords: Coronary heart disease; Coronary artery bypass grafting (CABG); Non-cardiopulmonary bypass (NCPB); Clinical study. In recent years, the incidence of coronary heart disease has increased year by year. It is becoming more and more important that explore the effective method for the treatment of coronary heart disease. The main clinical manifestations of the coronary heart disease were arrhythmia, angina, myocardial loss, even myocardial infarction or sudden death in severe cases [1]. The accepted and the most effective way to treat coronary heart disease is coronary artery bypass grafting (CABG). Performing CABG by using NCPB has shorter time of operation, fewer complications, and fewer traumas [2]. In this paper, the clinical effects of 68 patients undergoing CABGs were summarized and analyzed, and the report is as follows. 1.Data and Methods. 1.1.Clinical Data 68 patients with coronary heart disease were selected as the research subjects, including 42 males and 26 females with the ages of 48 ~ 76 years old, with an average age of ( ) years old. Among them, there were 2 cases of hypertension, 19 cases of multiple organ dysfunction, 35 cases of concurrent velar disease, and 12 cases of diabetes mellitus. There were 26 cases of stable angina pectoris, 24 cases of unstable angina pectoris and 18 cases of myocardial infarction. There were 46 cases with more than 3 coronary arteries that occurring lesion, 15 cases with 2 coronary arteries that occurring lesion, 23 cases of the lesion of the left main coronary artery. 1.2.Operation Method All patients were treated by using NCBP. Each patient under general anesthesia had the assisted respiration by putting intubation in their tracheas. First cut an incision in the median position of the sternum, next before cutting the left internal mammary artery (LIMA) give the intravenous injection; inject about 1 mg/kg heparin at most no more than 1.5 mg/kg, controlling the activation and coagulation time of changzhi212@163.com

19 VOL.1,ISS.3,DEC 2017, the whole blood of the patients within 240s~400s. Check one time every half hour. Then expose left anterior descending branch; fix the target vessel by the cardiac fixer; temporarily block the proximal and distal vessels of the stoma. As occasion requires, it is necessary to use the coronary shunt thrombus to make the great saphenous vein and the aorta ascendens anastomose. After the anastomosis was completed, use protamine to neutralize heparin and finally conduct sternal closure to complete the treatment. 2.Results All patients were operated by using NCPB. The inspection result after operation showed that there was a significant improvement in myocardium blood supply that compared with before operation. 38 of these patients did not have hypoxia or myocardial hemorrhage. 65 cases were successfully treated (effective rate was 96.5%), 30 cases had myocardial ischemia and hypoxia (44.1%), 2 cases had loss of heart rate (3%) and 1 cases had multiple organ failure (1.5%). 3.Discussion Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease. It means that the coronary artery wall of the heart has atherosclerotic plaques due to various reasons, leading to stenosis of vascular lumen and insufficiency of myocardial cell oxygen supply, resulting in myocardial failure or generator lesion. With the change of people's life style and the improvement of living standard, the incidence of this disease is increasing year by year. It has become one of the most common heart diseases in China in recent years [2]. With the continuous improvement of medical technology, new methods for treating coronary heart disease are constantly emerging. Coronary artery bypass grafting (CABG) is the main method for the treatment of coronary heart disease. Compared with westerns, Asians coronary arteries have smaller pipe diameter and are in poorer conditions, so it need higher requirement on the technique of anastomose. Therefore, the indications should be strictly controlled in order to reduce the risk of surgery during performing the CABG. Compared with the great saphenous vein, the left internal mammary artery has a better long-term patency rate than the great saphenous vein, but its requirement for technology is higher. Therefore, we must have comprehensive consideration and control the indications strictly when start a CABG. The CABG by using NCBP is performed on the surface of the contractile myocardium. It is quiet difficult and has many aspects that should be noticed. First, the heart rate and blood pressure of the patients must be control and ensure that the myocardial oxygen supply is sufficient. The heart rate is maintained at 80~90 times/min, and the blood pressure is 80~90 mm Hg. Secondly, the coronary artery bypass grafting by using NCBP and cardiopulmonary bypass(cpb) are similar [3]. Good preoperative preparation and CBP machines must be prepared. When some exceptional cases happen, make adjustment to CBP treatment without any delay. Thirdly, the blood vessels must be anastomosed orderly. The vessels in front of the heart are anastomosed first, then are the inferior and side heart wall; the compensatory vessels are anastomosed first, followed by the blood vessels without compensatory function. Too short blood vessels will cause spasms, too long and easy to bend, which will impede the circulation of coronary artery. Therefore, the length of blood vessels must be suitable. After completing the vascular anastomosis, exhaust first. Finally, during the operation, the blood flow must maintain stable. Because blood vessels on one side of the heart and inferior wall will be exposed during the operation, and moving, reversing and shuffling the heart will cause a certain degree of influence on the blood flow of the heart, the target vessel must be fixed by the cardiac fixer [4]. CABG by using NCBP is a new type of operation. It can avoid the damage caused by immune system injury and perfusion, myocardial ischemia, systemic inflammation and other symptoms, maximize the protection of the patient's heart function, and reduce arrhythmia, lesions on respiratory and nervous system. Myocardial infarction is the main cause of death after CABG, so we should try to avoid the occurrence of myocardial infarction, mainly through good anaesthesia, advanced myocardial protection technology and proper cardiopulmonary bypass management, so as to maintain good revascularization [5].

20 16 VOL.1,ISS.3,DEC 2017,14-16 In conclusion, the coronary artery bypass grafting under the model of non-cardiopulmonary bypass can effectively eliminate the clinical symptoms, improve cardiac function, and has the characteristics of small trauma, safety and reliability, short operative time, short hospitalization time, and effectively avoiding CBP related complications. As a result, it is worth further research and application of medical staff in the future treatment to fundamentally improve the patient's condition and make patients satisfied, so that this treatment method can play a wider and better role. References [1] Shi Aiqun, Zhao Yuansheng, Jiang Yongquan, etc. 25 Cases of Elderly Patients with Off-pump Coronary Artery Bypass Grafting Surgery [J]. Chinese Journal of Cardiovascular Review, 2014, 12 (5): [2] Zhao Haiyang, Bai Mingwei, Zhang Jihui, etc. 25 Cases of Off-pump Coronary Artery Bypass Grafting Surgery [J]. Chinese Journal of Coal Industry Medicine, 2008, 11 (2): [3] Zhu Jialong, Wei Yutao, Yang Shijiang, etc. 132 Cases analysis of Off-pump Coronary Artery Bypass Grafting Surgery [J]. Shaanxi Medical Journal, 2008, 37 (8): [4] Cai Weiwei, Chen Xingpeng, Wang Yahong, etc. Experience of Beating Coronary Artery Bypass Grafting Assisted with Extracorporeal Circulation in 48 High-risk Coronary Patients [J]. Chinese Journal of Cardiovascular Review, 2013, 11 (9): [5] Jing Quanmin, Han Yaling, Wang Shouli, etc. Transradial Approach Matched Transfemoral Approach for Coronary Intervention in the Aged [J]. Chinese Journal of Practical Internal Medicine, 2011, 25 (1):

21 Journal of Clinical and Experimental Medicine VOL.1,ISS.3,DEC 2017,17-19 ONLINE ISSN: PRINT ISSN: DOI: /jocem A Study on the Curative Effect of Omeprazole in the Treatment of Ulcerative colitis GuoDong Zheng The Third Affiliated Hospital of Southern Medical University, Guangdong, China Abstract: Objective:to study the clinical efficacy of Omeprazole in the treatment of ulcerative colitis. Methods: 40 cases of ulcerative colitis were randomly divided into two groups, each with 20 cases. The control group was treated with Mesalazine granules, and the treatment group was treated with above-mentioned medicine and oral Omeprazole enteric-coated capsules at the same time. Results: the treatment effect of ulcerative colitis in the treatment group was significantly superior to that in the control group; the time of colitis symptom disappeared was significantly shorter than that in the control group, and the recurrence number after treatment was significantly less than that in the control group. Conclusion: Omeprazole has very obvious treatment effect in the treatment of ulcerative colitis. keywords: Omeprazole; ulcerative colitis; study on the curative effects; treatment. Ulcerative colitis (UC) is a chronic non-specific inflammation of large intestine mucosa in an unknown etiology. The main symptoms of it are diarrhea, hematochezia and abdominal pain. It is generally considered that maybe related to genetic, environmental and immunological factors [1]. The main medical treatment methods are to control the symptoms, prevent recurrence, and avoid complications. The medicines are mainly hormone, Mesalamine, immunosuppressant and so on [2]. In recent years, the successful treatments of UC with proton pump inhibitors have reported in foreign countries, but there are not too many domestic studies in this field. In this paper, Omeprazole combined with Mesalazine granules were used in the treatment of minor and moderate UC patients to make observations about the recent curative effect and recurrence rate, and then compare the result with that by using traditional mesalazine granules medicine, so that to explore a new approach to the treatment of UC. 1.Data and Methods. 1.1.Clinical Data 40 patients with UC from 2011 to 2015 that had received and cured in our hospital were selected. The diagnoses and classifications of the illness of them conform to the common view in the 7th National Congress of Digestive System Diseases that hosting by Chinese Medical Association. Among them, there were 18 males and 22 females on the ages of 19~63 years old, with an average of (32±7) years. The medical histories of them ranged from 2 months to 20 years, with an average of (5.8±1.3) years. According to fibercolonscopy, lesions were restricted to 21 cases of rectum, 17 cases of proctosigmoid lesions, 2 cases of total colonic lesion, 26 cases of minor UC patients, 14 cases of moderate UC patients 26 patients, 21 cases of patients that were first occurred, 10 cases of chronic recurrence, and 9 cases of chronic persistent. 40 cases were in active stage. The main clinical manifestations were abdominal pain, pus zgddoct@163.com

22 18 VOL.1,ISS.3,DEC 2017,17-19 and blood stool and tenesmus. Some patients had weight loss or fever, but all patients had no liver, kidney, gallbladder and systemic disease upon examination. The patients were randomly divided into 2 groups, 20 cases in the treatment group and 20 cases in the control group. There was no statistically significant difference in gender, age and course of disease between the 2 groups, after statistics processing (P>0.05), so it was comparable. The pharmacies of the treatment group and the control group were be informed and accepted. 1.2.Treatment Methods The control group: 20 cases of minor and moderate UC patients were given oral mesalazine granules (French Ethypharm Pharmaceutical Co. Ltd.) 1g, 4 times/d. Other anti infective drugs and hormones were discontinued during the treatment period for 4 weeks. The treatment group was treated with above-mentioned medicine and oral Omeprazole Enteric-coated Capsules (AstraZeneca pharmaceutical co. ltd.) at the same time, 20mg, 2 times/d. Other anti infective drugs and hormones were discontinued during the treatment period for 4 weeks [3]. 1.3.Therapeutic Evaluation Cure: the clinical symptoms disappeared completely; the shape, color, frequency and routine examination results of stool returned to normal condition; the results of colonoscopy were completely normal. Effective: the clinical symptoms basically disappeared or improved markedly; the shape, color and frequency of stool basically returned to normal condition. The stool routine examination demonstrated the existence of a small number of white blood cells. The results of colonoscopy showed that the mucous membrane has a mild inflammatory reaction. Ineffective: there was no improvement in clinical symptoms; the shape, color, frequency, routine examination and endoscopic examination of stool had no improvement, or the patient's condition was further aggravated, so change to other methods for treatment. 1.4.Statistical treatment: Using SPSS17.0 statistical software, x±s indicates measurement data. The curative effect and symptom disappearance time of 2 groups were compared with two samples t test. The ratio of the rate was tested by χ 2. if P<0,The difference was statistical significance 2.Conclusions 2.1.Comparison of curative effect between 2 groups: The total effective rate of the treatment group was 85% (16 / 19), and the total effective rate of the control group was 55% (11 / 20). The difference was statistically significant by the χ 2 test. It showed that the curative effect of the treatment group was better than that of the control group.(table 1) Table 1 Comparison of total effective rate between 2 groups Group Treatment group Control group Total Cure improvement invalid effective Number % Number % Number % (%) 13 l Extinction time of Colitis symptoms: the extinction time of colitis in the treatment group ( ) d was significantly less than that of the control group ( ) d. There were statistically significant differences between groups. 2.3.Comparison of relapse in 2 groups: the recurrence rate of the treatment group was 10% (2 / 20), which is significantly less than that of the control group (40% (8 / 20)). There were statistically significant differences between groups.(χ 2 =4.800,p<0.05) 3.Discussions UC is one of the major types of inflammatory bowel disease. The cases reported in China have gradually increased in recent years. It was estimated that the case rate was 11.6 / 100 thousand [4]. Its etiology and pathogenesis are still unclear. It is considered to be related to the interaction of many factors such as immunity, environment, infection and heredity. The immune factors play an important role in the pathogenesis of UC. Currently, Mesalazine is acknowledged as an effective drug for the treatment of UC, but there are many adverse reactions. Patients present headache, nausea and vomiting, loss of appetite, upper abdominal discomfort and allergy, which limits the use of Mesalazine. The main mechanism of ranitidine in the treatment of UC is the effective inhibitory effect of ranitidine on the histamine released from the colon mast cells. In addition, it s reported

23 VOL.1,ISS.3,DEC 2017, recently that Omeprazole has a good effect on the treatment of UC [6, 7] at home and abroad. Accordingly, this study used combined mesalazine granules in the treatment of mild and moderate UC, the total effective rate was 85%, the curative effect was satisfactory, and the untoward effects were significantly less than those in the control group. Omeprazole is a new proton pump inhibitor, which has many advantages, such as significant efficacy, low recurrence rate, few adverse reactions and easy to eat. It is widely used in clinic. Omeprazole is an fat-soluble alkalescent drug, which is easily enriched in acidic environment, also known as H + - K + - ATP enzyme inhibitor or gastric proton pump inhibitors. After oral administration, Omeprazole can specifically distributed in the tubular secretion of gastric parietal cells. In this high acid environment, it is converted to the active form of sulfonthalamide. Omeprazole Irreversibly combined with thiol of H + K + - ATP enzyme in Parietal cell secretory membrane through disulfide bond. This can inhibit the activity of the enzyme to block the secretion of gastric acid and increase the ph of gastric acid significantly. In addition, it can also improve gastric mucosal potential, maintain gastric cell stability, protect gastric mucosal barrier, and facilitate the repair and hemostasis of gastric and duodenal lesions (8, 9). The mechanism of omeprazole in the treatment of inflammatory bowel disease is unknown, and it is presumed that it may be related to the chemical structure of omeprazole, which is similar to metronidazole. In recent years, omeprazole has also achieved good results in the treatment of pancreatitis [10]. Its important function is to bind to neutrophils directly and inhibit the release of oxygen free radicals. The mechanism of omeprazole in the treatment of UC is probably related to anti secretory, antiinfection, promoting healing, accelerating mucosal repair and antibacterial. The mechanism of treatment for this disease still needs further study, which can further observe its curative effect in clinic. [2] Qin Ouyang.Progress and prospect of inflammatory bowel disease in China[J].Chinese Journal of Digestion,2011, 13(16): [3] Junle Yang,Jiping Dong,Zhide Ning.HRCT Diagnosis of cholesteatoma [J].Chinese Journal of Medical Imaging,2010, 10(5):330. [4] Qin Ouyang.Diagnostic Criteria and Thinking of Ulcerative Colitis[J].Medicine and Philosophy.,2008,29(5):7. [5] Baokun Chen,Yanfang Liu,Aiping Zheng.Ulcerative Colitis Treatment with Traditional Chinese Drug Combined with Chemical Drug Enema :Analysis of 65 Cases[J].Chinese Journal of Coloproctology,2009,21(17): [6] Wenbo Lin.The clinical observation of Omeprazole in the treatment with ulcerative colitis[j].medical Information, 2006,19(5):1098. [7] Qingrong Hao,Bowei Guo.The analysis of 13 cases of ulcerative colitis with omeprazole[j].public Medical Forum Magazine,2008,12(11): [8] Shuping Qiu.Pharmacological Research and Latest Application Progress of Omeprazole[J].Pharmacological Research,2007, 10(6):128. [9] Dezhi Zhang.Clinical Treatment and Analysis of Ulcerative Colitis[J]..Modern Chinese Doctor,2007,45(8): 37, 89. [10] Zefei Pei.Observation of Citicoline Combined Omeprazole in Treating Acute Pancreatitis[J].Youjiang Medical Journal, 2006,34(2): Reference: [1] Hanauer S B. Update on the etiology, pathogenesis and diagnosis of ulcerative colitis.[j]. Nat Clin Pract Gastroenterol Hepatol, 2004, 1(1):26-31.

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