中华全科医学

Analysis of breakthrough point of community population health management from the perspective of physical medicine integration

SHI Jian-wei, WANG Zhao-xin, JIN Hua, LI Zi-yun, ZHOU Hui-ning, CHEN Cheng, CHEN Ning, YANG Yan, YU Zhao-hu

2021, 19(1): 1-3,9. doi: 10.16766/j.cnki.issn.1674-4152.001714

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Abstract:
As the first health strategic plan put forward by the national level since the founding of the People's Republic of China, the "Healthy China 2030 Strategic Plan" clearly puts forward that the physical medicine integration should be regarded as an important means to realize the population health. With the continuous strengthening of the health management function of community health service institutions, the physical medicine integration has gradually become the best combination of constructing community residents' health. This study systematically combed the current situation and bottleneck of the application of physical medicine integration in the health management of all kinds of people in our community, and further analyzed the development status and characteristics of the physical medicine integration abroad, and finally put forward the breakthrough point. The results showed that the existing community-level physical medicine integration application was still in its infancy. The key problems included: the existing residents' physique monitoring results were isolated islands, the physical monitoring data were not connected with the medical system, the exercise prescription intervention was not scientific and accurate, and the construction of the professional personnel team was insufficient. Compared with the international experience, some developed countries have carried out the physical medicine integration earlier, especially in the coverage group and disease category, the fineness of exercise prescription, the precise intervention of complex diseases, and the combination with the medical system. Based on this, it is suggested that the breakthrough point of promoting health management is that community health service institutions should be more involved in health management, the integration and utilization of all kinds of health data, the continuous improvement of precision exercise intervention, and the continuous follow-up of compound community medical personnel training, and finally the physical medicine integration achieve a breakthrough in the application of community health management through multiple channels.

2021, 19(1): 4-5.

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Analysis of the value of serum irisin in the diagnosis of obstructive sleep apnea syndrome

QIU Feng, SONG Chun-yan, QIN Fu-chuang, TIAN Si-qi, HUANG Rong, MA Xi-lie, ZENG Jian-ping

2021, 19(1): 62-64,68. doi: 10.16766/j.cnki.issn.1674-4152.001731

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Objective To investigate the correlation between the degree of obstructive sleep apnea syndrome (OSAS) and the level of irisin in serum. Methods Ninety-six OSAS patients diagnosed in Shulan (Hangzhou) Hospital from May 2017 to December 2018 were selected in the OSAS group, and according to the apnea hypopnea index, they were divided into mild (30 cases), moderate (30 cases) and severe (36 cases), another 30 healthy people were selected as the control group. The indexes of apnea hypopnea, the lowest oxygen saturation and the longest time of apnea were measured by polysomnography. The level of serum irisin was measured by enzyme-linked immunosorbent assay. Results The serum irisin level [(1.43±0.28) ng/mL], the lowest oxygen saturation [(70.47±3.81)%] in the OSAS group were significantly lower than those in the control group [(2.82±0.54) ng/mL and (94.58±3.21)%], the apnea hypopnea index [(27.64±3.29) times/h], the longest apnea time [(37.45±4.23) s] were significantly higher than those in the control group [(2.37±1.08) times/h and (1.73±0.65) s], the difference was statistically significant (all P < 0.05). With the increase of the severity of the disease, the level of serum irisin, the lowest oxygen saturation and the longest apnea time decreased. In the OSAS group, the index of apnea hypopnea and the longest time of apnea were negatively correlated with the level of serum irisin (r=-0.717, -0.765; all P < 0.05), and the lowest oxygen saturation was positively correlated with the level of serum irisin (r=0.747, P < 0.05). According to the gold standard of polysomnography, the sensitivity and specificity of irisin in the diagnosis of OSAS were 68.8% and 93.3%, respectively. Conclusion The serum irisin level of OSAS patients is related to the severity of OSAS. The more severe OSAS, the lower the serum irisin level.

Retrospective study of non-invasive prenatal screening using high-throughput sequencing technology in a single centre

HU Yue, LIU Wen, PENG Ya-qin, XU Jing-jing, SONG Ya-xian, HE Guo-ping, WU Li-min, WANG Jing

2021, 19(1): 65-68. doi: 10.16766/j.cnki.issn.1674-4152.001732

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Abstract:
Objective To explore the clinical application value and effectiveness of non-invasive prenatal testing (NIPT) for the identification of foetal chromosomal aneuploidies. Methods A total of 8 246 singleton pregnant women who were voluntarily undergoing NIPT testing at the First Affiliated Hospital of the University of Science and Technology of China from 2017 to 2018 were selected. Blood samples were collected from the subjects, and free foetal DNA was extracted. High-throughput sequencing was used to analyse the cell-free foetal DNA from the plasma of pregnant women. Those at high risk for chromosomal abnormalities underwent invasive prenatal diagnosis. The clinical data, test results and pregnancy outcomes were recorded during the period, and special cases were further analysed. All cases were analysed collectively to explore the actual clinical testing efficacy of NIPT. Results This study detected 68 cases at high risk using NIPT, including 25 cases of Trisomy 21, 8 cases of Trisomy 18, 5 cases of Trisomy 13, 18 cases of sexual chromosome aneuploid, 5 cases of other chromosomal abnormalities and 7 cases of microdeletion/microduplication. After genetic counselling, 58 patients underwent invasive prenatal diagnosis, and 38 positive cases were confirmed by chromosomal karyotyping analysis. The positive predictive values of the aforementioned detected cases were 87.50%, 85.70%, 25.00%, 50.00%, 25.00% and 40.00%, respectively. Conclusion NIPT is an effective screening method. Apart from being effective for the detection of trisomy 21 and 18, NIPT is effective in detecting sex chromosome aneuploidy, microdeletion/microduplication and chromosomal mosaicism.

Changes in plasma odendmcyte-myelin glycoprotein levels for the diagnosis of brain injury in premature infants

ZHANG Jun, LIU Juan, HU Jin-hui, WU Rong

2021, 19(1): 69-72. doi: 10.16766/j.cnki.issn.1674-4152.001733

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Objective To investigate the relationship between brain injury and plasma odendmcyte-myelin glycoprotein (Omgp) levels and neuron-specific enolase (NSE) in premature infants, and analyze its clinical significance in premature infants with brain injury. Methods Total 80 cases of premature infants who were hospitalized in the Neonatal Medical Centre of Huai'an Maternal and Child Health Hospital from January 2019 to December 2019 were included in the study. According to the results of craniocerebral imaging, all infants were divided into brain injury group and non-brain injury group. Blood samples were obtained at 6, 72 and 168 h after birth. Levels of NSE and Omgp were detected via ELISA. The predictive value of plasma NSE and Omgp for brain injury in premature infants (BIPI) was analysed. Results (1) The NSE and Omgp levels in the brain injury group were significantly higher than that in the non-brain injury group at 6, 72 and 168 h after birth. (2)The area under ROC curve of OMgp level at 6 h after birth was the largest, which was 0.952, Yoden index was 0.813, sensitivity was 87.50%, specificity was 93.75%. The corresponding optimal threshold was 57.971, positive predictive value was 97.22%, and negative predictive value was 75.03%, which was higher than NSE. (3)The levels of Omgp at 6, 72 and 168 h were significantly negatively correlated with the NBNA score at 40 weeks of corrected gestational age (r=-0.728, -0.732 and -0.752, respectively; all P < 0.01). Levels of NSE had no significant correlation with prognosis at 6, 72 and 168 h after birth (all P>0.05) but could predict the prognosis. Conclusion Levels of NSE and Omgp at 6 h after birth are all correlated with BIPI and can be used as potential diagnostic markers. The diagnostic accuracy of Omgp level is higher. The Omgp levels at 6, 72 and 168 h after birth may be a good biomarker for predicting BIPI prognosis.

Expression of miR-30b and miR-96 in endometrial carcinoma and their relationship with prognosis

LIN Yi-he, ZHUANG Xiao-ping, JIN Wei-wei

2021, 19(1): 73-76,107. doi: 10.16766/j.cnki.issn.1674-4152.001734

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Objective The levels of miR-30b and miR-96 in peripheral blood mononuclear cells (PBMC) in patients with endometrial carcinoma (EC) were detected to explore their relationship with clinicopathology and prognosis. Methods A total of 76 EC patients and healthy outpatients(control group)admitted to Wenzhou hospital of integrated traditional Chinese and western medicine were selected. The expression levels of miR-30b and miR-96 in PBMC were detected by fluorescence quantitative PCR, the correlation was analyzed by Pearson method, the relationships between miR-30b and miR-96 expression levels in PBMC and 5-year survival rate of EC patients were analyzed by Kaplan-Meier method, and the risk factors affecting the prognosis of EC patients were analyzed by Cox regression. Results The expression levels of miR-30b and miR-96 in PBMC of EC patients were higher than those of control group (t=21.913, 24.188, all P < 0.05). They were positively correlated (r=0.553, P < 0.05), and correlated with pathological grade, FIGO stage, depth of muscle invasion and lymph node metastasis (P < 0.05). The 5-year overall survival rate of patients with high expression of miR-30b (16.13%) was lower than that of patients with low expression (66.67%, χ²=16.890, P < 0.05). The 5-year overall survival rate of patients with high expression of miR-96 (18.18%) was lower than that of patients with low expression (67.44%, χ²=16.307, P < 0.05). Levels of miR-30b and miR-96, FIGO stage and lymph node metastasis in PMBC were independent risk factors affecting the prognosis of EC patients (HR=2.861, 95% CI: 1.427-5.736; HR=1.973, 95% CI: 1.462-2.663; HR=2.235, 95% CI: 1.491-3.350; HR=2.439, 95% CI: 1.365-4.358; all P < 0.05). Conclusion The miR-30b and miR-96 are highly expressed in PMBC, which are related to pathological grade, FIGO stage, muscle invasion, lymph node metastasis and 5-year survival rate of EC patients, and are independent risk factors for adverse prognosis of EC patients.

Study on the relationship between serum vitamin D level and gestational diabetes mellitus in pregnant women

YE Ying-ying, WANG Jin-hui, WANG Li-jun, GONG Ai-min

2021, 19(1): 77-79, 119. doi: 10.16766/j.cnki.issn.1674-4152.001735

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Objective To investigate the relationship between serum 25-hydroxyvitamin D [25-(OH)D] level and gestational diabetes mellitus (GDM) in pregnant women, and to analyze the influencing factors of serum 25-hydroxyvitamin D level in pregnant women. Methods A random number table was used to select 300 pregnant women who were examined in Yuhuan People's Hospital from September 2017 to December 2018. The levels of 25-(OH)D were detected in the early, middle and late stages of pregnancy. According to the serum levels of 25-(OH)D, the pregnant women were divided into two groups: lack group and no lack group, and the incidence of gestational diabetes was compared between the two groups. According to the serum 25-(OH)D level in the third trimester, the influencing factors of serum 25-(OH)D level in pregnant women were analyzed. Results The incidence of gestational diabetes was 26.32% in the lack group and 12.50% in the no lack group, with no statistically significant difference (P>0.05). The incidence of gestational diabetes in the second trimester deficiency group and the no deficiency group were 28.65% and 9.80%, respectively, with statistically significant differences (P < 0.05). The incidence of gestational diabetes was 27.47% and 10.00% in the lack group and no lack group, respectively, with statistically significant differences (P < 0.05). On the basis of univariate analysis, multivariate logistic regression analysis showed that the independent risk factors of serum 25-(OH)D deficiency in pregnant women were less time spent in outdoor activities, winter and spring, no regular vitamin D supplementation, and no timely vitamin D supplementation (all P < 0.05). Conclusion Decreased serum 25-(OH)D level in pregnant women may increase the risk of gestational diabetes. Reasonable vitamin D supplementation in early pregnancy can effectively prevent vitamin D deficiency in pregnant women and help reduce the risk of gestational diabetes.

Status of family doctor contract signing in Guangzhou and its influencing factors

FAN Yang-dong, JIANG Lei, LIU Wei, WU Ding-juan

2021, 19(1): 80-82, 166. doi: 10.16766/j.cnki.issn.1674-4152.001736

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Objective To investigate the knowledge and signing status of family doctor signing service in Guangzhou and to explore its influencing factors, so as to provide basis for the improvement of the awareness and signing rates. Methods A simple random sampling method was used to select 16 subjects from 142 community health service centres in Guangzhou. Paper questionnaires were distributed to randomly intercept residents near to community health service centres from November to December 2019, and 600 valid questionnaires were collected. Results Amongst the 600 respondents, 224 males (37.3%) and 376 females (62.7%) were identified. Sixty-nine (11.5%) of the respondents were aged between 18 and 30; 147 (24.5%) were aged between 31 and 40; 119 (19.8%) were aged between 41 and 50; 104 (17.3%) were aged between 51 and 60; 161 (26.9%) were aged over 60. 223 (37.2%) with chronic diseases and 377 (62.8%) without chronic diseases; 508 (84.7%) were aware of the contracted services of family doctors, and 92 (15.3%) were unaware of the contracted services of family doctors. A total of 354 cases (59.0%) signed the family doctor service agreement, and 246 cases (41.0%) did not. The signing rate of residents who were aware of the family contract doctor service was 69.7%. Chi-square test showed that residents of different genders, educational background and occupation had statistically significant differences in the awareness rate of family doctor signing (all P < 0.05), and residents of different educational background and occupation had statistically significant differences in family doctor signing (all P < 0.05). Logistic regression analysis showed that family doctors with higher education, chronic diseases, professional technicians and administrative staff were more likely to sign up. Objective Conclusion Resident awareness through ascension could increase the rate of family doctors signing by 10.7%, for men with lower education, general workers, enterprise employees and unemployed on cognitive education. Furthermore, we should focus on the signing of low education levels and unemployed to promote the family doctor signing.

Efficacy and safety of aripiprazole combined with buspirone in the treatment of schizophrenia

LUO Xiao-dong, LYU Yue-zhong, JIA Xue-zhen, ZHANG Chen

2021, 19(1): 83-85, 123. doi: 10.16766/j.cnki.issn.1674-4152.001737

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Objective To analyse the efficacy and safety of aripiprazole and buspirone in the treatment of schizophrenia and to explore the effective treatment to improve clinical efficacy. Methods A total of 102 schizophrenic patients from April 2019 to April 2020 in the Department of Psychiatry of Jinhua Second Hospital were selected and randomly divided into group A (n=51) and group B (n=51). Groups A and B were treated with aripiprazole and aripiprazole combined with buspirone, respectively. The symptom score (PANSS), cognitive function score (MCCB) and quality of life (SF-36) of the two groups were compared to evaluate clinical efficacy and adverse reactions. Results The total score of PANSS in group B (48.81±7.66) was lower than that in group A (64.13±9.55), and the difference was statistically significant (t=8.937, P < 0.001); the MCCB score in group B (48.43±5.09) was higher than that in group A (40.72±5.27), and the difference was statistically significant (t=7.515, P < 0.001); the SF-36 score in group B (77.90±4.13) was higher than that in group A (65.84±4.77), and the difference was statistically significant (t=13.650, P < 0.001); the total effective rate in group B (94.12%) was higher than that in group A (80.39%), and the difference was statistically significant (χ²=4.320, P=0.038); the incidence of adverse reactions in group B (11.76%) was similar to that of group A (9.80%), thereby showing no significant difference (χ²=0.102, P=0.750). Conclusion Aripiprazole combined with buspirone is effective in the treatment of schizophrenia. It can reduce the clinical symptoms and improve the cognitive function and quality of life. The total clinical effective rate is high, and it has a certain degree of safety.

Influence of individualised nursing intervention based on quantitative evaluation on the self-management ability of adolescents with schizophrenia

QIN Zhi-hang, CHEN Lin-xia

2021, 19(1): 86-88. doi: 10.16766/j.cnki.issn.1674-4152.001738

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Objective To explore the application effect of individualised nursing intervention based on quantitative evaluation on self-management of adolescents with schizophrenia. Methods A total of 200 adolescent patients with schizophrenia hospitalised in the Psychiatry Department of Shaoxing No.7 People's Hospital from February 2019 to February 2020 were selected as subjects. The patients were divided into two groups using the random number table method: 100 cases in the intervention group and 100 cases in the control group. Patients in the control group were given routine psychiatric nursing, whereas patients in the intervention group were given individualised nursing intervention under quantitative evaluation. Schizophrenia symptom score [positive and negative syndrome scale (PANSS)], quality of life (comprehensive quality of life rating scale, GQILI-74), [self-management ability schizophrenia self-management instrument scale (SSMIS)] and social function [social function defect scale (SDSS)] were compared between the two groups. Results Before intervention, no significant difference in PANSS, GQOLI-74, SSMIS and SDSS scores was found between the two groups. After intervention, the PANSS score of the intervention group (41.97±3.81) was significantly lower than that of the control group (60.03±4.01, P < 0.05). In addition, the GQOLI-74 score of the intervention group was significantly higher than that of the control group (P < 0.05). The SSMIS score of the intervention group (70.71±13.25) was significantly higher than that of the control group (59.46±6.53, P < 0.05). Furthermore, the SDSS score of the intervention group (6.01±1.25) was significantly lower than that of the control group (7.76±1.53, P < 0.05). Conclusion Personalised nursing intervention based on quantitative evaluation can improve the self-management ability of adolescents with schizophrenia.

Effects of anxiety and depression disorder on hyperthyroidism

WANG Dai-yan, ZHANG Wei, ZHENG Tian-sheng, SONG Le-ou, ZHU Lu-jun, ZHOU Na-dan

2021, 19(1): 89-92. doi: 10.16766/j.cnki.issn.1674-4152.001739

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Objective To investigated the clinical effects of anxiety and depression in patients with hyperthyroidism. Methods Total 60 patients with or without anxiety and depression and hyperthyroidism were selected from the outpatient department of the Psychology Department of Yueqing People's Hospital and Wenzhou Kangning Hospital from September 2018 to February 2019. The patients were randomly assigned to an observation group and a control group. General information and clinical data were collected from the two groups of patients, and differences between the groups were analysed. Results The goitre, heart rate, eye sign, TGA positive and TMA positive indicators of the observation group were statistically significant from those of the control group (χ²=19.394, 25.679, 14.803, 7.350 and 25.145, respectively; all P < 0.05). The TT3, TT4, FT3, FT4, TG-Ab and TPOAb in the observation group were significantly different from those in the control group (t=12.941, 11.757, 7.756, 20.746, 8.543 and 2.637, respectively; all P < 0.05). Scores of objective support, subjective support, support utilization and total social support of the observation group were higher than those of the control group (t=3.589, 4.194, 3.880 and 4.306, respectively; all P < 0.05). The somatization, depression, anxiety and terror scores the of the observation group were higher than those of the control group (t=4.309, 7.582, 7.324 and 11.078, respectively; all P < 0.05). Conclusion Anxiety and depression disorders have a certain relationship with thyroid functions. Compared with people without anxiety and depression disorders, patients with both hyperthyroidism and anxiety and depression disorders have more obvious symptoms and signs, worse social support and greater emotional instability.

Comparison of two deafness gene detection methods in genetic hearing loss gene screening

DONG Xue-yan, YU Dao-jun, WANG Xian-jun, TONG Wen-juan, CHEN Yue-ming

2021, 19(1): 93-98. doi: 10.16766/j.cnki.issn.1674-4152.001740

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Abstract:
Objective To explore the clinical application value of PCR + flow-through hybridisation method and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry in genetic deafness screening. Methods A total of 236 patients with hearing impairment were selected from the Department of Otolaryngology in Hangzhou First People's Hospital from July 2016 to July 2017. PCR + flow-guided hybridisation and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry were used to detect 20 mutations in four common deafness-related genes: GJB2, GJB3, SLC26A4 and mitochondrial 12SrRNA. All samples were verified by Sanger sequencing. Results PCR + diversion hybridisation method detected 48 cases of deafness mutations, of which the GJB2 gene mutation rate was 11.44%, 17 heterozygous mutations and 10 homozygous mutations; the GJB3 gene mutation rate was 0.42%, 1 heterozygous mutation; the SLC26A4 mutation rate was 5.08%, 10 heterozygous mutations and 2 homozygous mutations; the 12 s RNA mutation rate was 0.85%, 2 heterogeneous mutations and 6 double heterozygous mutations. Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry detected 53 cases of deafness gene mutations, of which the GJB2 gene mutation rate was 11.86%, 18 heterozygous mutations and 10 homozygous mutations; the GJB3 gene mutation rate was 0.85%, 2 heterozygous mutations; the SLC26A4 gene mutation rate was 5.51%, 10 heterozygous mutations and 3 homozygous mutations; the 12 s RNA gene mutation rate was 0.85%, 2 heterogeneous mutations and 8 double heterozygous mutations. The detection rates of deafness genes of the two methods were 20.3% and 22.5%, respectively, and no statistically significant difference was found in the detection results (P>0.05). Conclusion The use of reasonable detection methods for deafness gene screening is important to prevent and reduce the occurrence of hereditary deafness.

Relationship between the quantitative parameters of diffusion kurtosis imaging and the Ki-67 expression level in rectal adenocarcinoma

ZHANG Dao-chun, HUANG Jin-biao, LIU Zi-shan, ZHOU Kai, ZHANG Min-ge, PAN Shan-jun, YU Hai-yan, CHEN Wei-cui

2021, 19(1): 99-102. doi: 10.16766/j.cnki.issn.1674-4152.001741

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Objective To explore the relationship between quantitative parameters of diffusion kurtosis imaging (DKI) and the molecular markers Ki-67 in patients with rectal adenocarcinoma. Methods A total of 43 patients with rectal adenocarcinoma who underwent surgery and did not receive chemoradiotherapy were selected in this retrospective study. The image data included high-resolution MRI, conventional diffusion-weighted imaging and DKI, Mean kurtosis (MK), mean diffusivity (MD) and apparent diffusion coefficient (ADC) were calculated. The patients were divided into the low-Ki-67 group (Ki-67 ≤ 25%) and high-Ki-67 group (Ki-67>25%) on the basis of the Ki-67 level. The difference of each parameter between the two groups was compared. Spearman correlation analysis was applied to confirm the correlation between each parameter value and Ki-67 expression level. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of each parameter. Results In the high-Ki-67 group, MK and MD were significantly different compared with those in the low-Ki-67 group [0.88(0.81, 0.94) vs. 1.22(1.06, 1.34), P < 0.01; 1.20(1.12, 1.30)×10^-3 mm²/s vs. 1.10(0.94, 1.15)×10^-3 mm²/s, P < 0.01]. However, MD showed no difference between the two groups [1.20(1.12, 1.30)×10^-3 mm²/s vs. 1.20(1.10, 1.30)×10^-3 mm²/s, P>0.05]. MK showed a positive association with the Ki-67 expression level (r=0.523, P < 0.001), whereas ADC showed a negative association with the Ki-67 expression level (r=-0.467, P < 0.01). Compared with MD and ADC, MK showed relatively higher area under the ROC curve of 0.906, sensitivity of 0.97 and specificity of 0.75. Conclusion MK and ADC are related to Ki-67 expression, which can indirectly evaluate the proliferation of rectal adenocarcinoma cells. However, MK is superior to ADC in diagnosis efficiency, and can better reflect the invasion and molecular biological characteristics of rectal adenocarcinoma.

Clinical decision-making on the prognosis prediction of traumatic brain injury

ZHENG Rui-zhe, ZHAO Zhi-jie, YANG Xi-tao, DAI Rong-xiao, HOU Lei

2021, 19(1): 103-107. doi: 10.16766/j.cnki.issn.1674-4152.001742

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Prognosis and prediction of traumatic brain injury (TBI) play an important role in clinical decision-making which focuses on the influence of specific disease-related characteristics on prognosis. Given the limitation of previous predictors in patients with TBI, new biomarkers and models must be explored and developed. The predictive factors of TBI prognosis starts from different population characteristics, patient differences and study endpoints related to TBI, finds or establishing univariate relationships, as well as analysing and adjusting relationship of variables related to outcome, and explores the relationship between specific disease characteristics and prognosis. A TBI prediction model of prognosis is built on the basis of multidimensional predictive factors. The performance of this model is explained, estimated, evaluated and verified. Determining proper prognostic markers of TBI not only is useful in building a more accurate TBI prediction model, but also is essential for risk stratification and clinical decision-making after TBI diagnosis. In addition, the building of a TBI prediction model can achieve more accurate and practical comparison among different models, as well as contribute to risk stratification among different patients with TBI. The limitations of research on TBI prognosis prediction are mainly related to the lack of prognostic information, the exploration of nonlinear effects and the evaluation of heterogeneity among studies. This paper reviews the current methods and principles of prognosis prediction of patients with TBI to provide a reference for future investigations on TBI prognosis prediction. We emphasize the importance of patient selection, factor screening and research design in studying predictive factors. In establishing a prediction model, we highlight the necessity of model development and the principle of internal and external validation.

The use of antihypertensive drugs with different sustained and controlled release dosage forms in nasal feeding

SUN Yu-jing, LI Yan-hua, LI Jun-wei

2021, 19(1): 108-112. doi: 10.16766/j.cnki.issn.1674-4152.001743

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The oral solid preparation of antihypertensive drugs has many unreasonable uses in patients with nasal feeding. Most solid preparations cannot be broken and ground after nasal feeding due to their special pharmaceutical technology. In this paper, referring to relevant literature, we summarized the types and structural characteristics of several types of antihypertensive drugs slow and controlled release preparation. To explore the characteristics of different controlled release types of drugs in the use of nasal feeding, and to provide a reference for general practitioners to use the drugs rationally in clinical work. The main types of sustained-release formulations are skeletal sustained-release formulations, membrane controlled-release formulations, osmotic pump sustained-release formulations, enteric-release controlled-release formulations and pellet controlled-release formulations. The commonly used nifedipine controlled release preparations mainly include Bayer company's imported original research drug osmotic pump nifedipine controlled release agent (Adalet), domestic nifedipine sustained release agent for hydrophilic gel matrix type sustained release agent, controlled release tablets for osmotic pump type-controlled release agent. Commonly used metoprolol for imported drugs which Swiss astrazeneca company tartrate metoprolol and succinic acid metoprolol (Betaloc) are ordinary tablets and skeleton type micro pill respectively controlled release agent. And the domestic tartrate metoprolol is mainly based on osmotic pressure release principle with hydroxypropyl methyl cellulose (HPMC)/ethyl cellulose ethoce (EC) as the skeleton of sustained release preparation or capsule preparation. Delayed and controlled release preparation is prohibited to be used for grinding nasal feeding, especially osmotic pump controlled release tablets, because the delayed and controlled release structure is damaged to varying degrees after grinding, the drug enters the blood quickly, and the single dose is several times that of ordinary tablets, which brings great side effects. The frame type sustained-release tablets with scratches can be snapped off and do not grind.

The effect of surface electromyography and lumbar function of leverage replacement manipulation for patients with lumbar disc herniation

HU Guo-bao, WU Bo-hai, SHU Wen-xiu, LYU Li-jiang

2021, 19(1): 113-115, 145. doi: 10.16766/j.cnki.issn.1674-4152.001744

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Objective To study effect of surface electromyography and lumbar function of leverage replacement manipulation for patients with lumbar disc herniation. Methods A total of 118 patients with lumbar disc herniation, from July 2018 to June 2019, were divided into treatment group (61 cases) and control group (57 cases). The control group was given lumbar traction therapy combined with plane forceful massage technique, and the treatment group was given lumbar traction therapy combined with leverage replacement manipulation. 1 course after therapy, clinical efficacy, surface electromyography, and lumbar function were compared between two groups. Results The effective rate (90.16%) of treatment group was higher than that control group (75.44%), χ²=4.359, P < 0.05. Affected side erector spinae muscles IEMG, RMS, MF in the treatment group were higher than control group [(27.45±4.23) V·s vs. (18.32±3.25) V·s, (32.45±5.12) μV vs. (21.34±4.20) μV, (82.25±10.21) Hz vs. 68.12±9.23) Hz], t=13.110, 12.836, 7.867, all P < 0.05). Multifidus muscle IEMG, RMG, MF in the treatment group were higher than control group [(42.36±6.20) V·s vs. (25.45±4.62)V.s, (45.24±7.72) μV vs. (34.32±6.12) μV, (90.45±12.14) Hz vs. (75.32±9.24) Hz], t=16.707, 8.476, 7.578, all P < 0.05). Lumbago and leg pain, self-care ability, weight extraction, sitting and standing status, standing status, and sleep quality score in the treatment group were lower than control group (all P < 0.05). Conclusion Leverage replacement manipulation help to improve the core muscle recruitment ability and fatigue resistance, promote the recovery of lumbar function, then improve the clinical efficacy.

Effect of Chaihu Guizhi Decoction on somatoform pain disorder and its effect on 5-HT and PGE₂

SUN Mu-yan, LOU Min-fang, ZHENG Yun-hua, ZHOU Jiang-wen, MAO Zhi-yuan, ZHOU Xiao-hua

2021, 19(1): 116-119. doi: 10.16766/j.cnki.issn.1674-4152.001745

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Abstract:
Objective To explore the clinical effect of Chaihu Guizhi Decoction on patients with somatoform pain disorder and the effect of 5-HT and PGE₂ in blood. Methods A total of 64 patients with somatoform pain disorder admitted to Quzhou Hospital of Traditional Chinese Medicine and Quhua hospital from January 2017 to February 2019 were selected and randomly divided into study group given Chaihu Guizhi Decoction orally and control group given duloxetine with 32 cases each by numerical table method. Both groups were treated with psychotherapy, the cured duration was 8 weeks. Depressive symptom severity scale (PHQ-9), Generalized anxiety inventory (GAD-7), McGill pain scale (SF-MPQ), comprehensive assessment of quality of life (GQOLI-74) and effective rate were used to evaluate depression, anxiety, pain levels, and quality of life improvement of the 2 groups before and after treatment. The blood levels of 5-HT and PGE₂ were monitored before and 8 weeks after treatment. All patients were followed up for 6 months. Results The scores of PRI, VAS, PPI, PHQ-9, GAD-7 and GQOLI-74 of 2 groups were not statistically significant (all P>0.05) before treatment and 8 weekends after treatment. The scores of PRI, VAS, PPI, GQOLI-74 total score of 2 groups were statistically significant (all P < 0.05), study group was superior to control group. At the end of 8 weeks, there was no significant difference in efficiency between the two groups (χ²=0.172, P=0.679), no significant adverse reactions occurred in the study group. The serum PGE₂ level in the study group was statistically different from that in the control group, while 5-HT level was not statistically different from that before treatment. Conclusion Chaihu Guizhi Decoction has the same short-term effect as duloxetine in the treatment of SPD, and the long-term effect is significant.

Effect of comprehensive lung rehabilitation training on lung function and syndrome in patients with lung cancer undergoing radiotherapy

HE Ting-ting, BEI Yan-ping, XU Guo-dong

2021, 19(1): 120-123. doi: 10.16766/j.cnki.issn.1674-4152.001746

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Abstract:
Objective To explore the effect of comprehensive lung rehabilitation training on lung function, cancer-related fatigue, symptoms and quality of life in patients with lung cancer undergoing radiotherapy. Methods Eighty-seven lung cancer patients who received radiotherapy in Li Huili Hospital of Ningbo Medical Center from June 2018 to June 2019 were included in this study. They were divided into the observation group (44 cases) and control group (43 cases). The control group used conventional radiotherapy management and out-of-hospital management. The observation group used combined comprehensive lung rehabilitation training on the basis of the control group for 24 weeks. Lung function, cancer-related fatigue (PFS-R), MSAS and EORTCQLQ-C30 were compared before and after the intervention. Results After intervention, the predictive values of preFEV1%, preFVC% and preMVV% were (90.37±2.18)%, (93.65±2.20)% and (87.67±2.59)%, respectively, whereas those of the control group were (87.33±2.38)%, (88.36±2.27)% and (83.47±2.19)%, respectively, and the difference was statistically significant (P < 0.05). The PFS-R score of the observation group (4.58±0.60) was lower than that of the control group (5.17±0.65, t=4.401, P < 0.05). The score of cough syndrome in the observation group was 1.02±0.18, which was lower than that in the control group (1.78±0.23, t=17.186, P < 0.05). No significant difference in the score of appetite decline was found between the two groups (t=0.491, P>0.05). After intervention, the scores of physical dimension, emotional dimension and social dimension in the observation group were higher than those in the control group (all P < 0.05), and no significant difference in role dimension and cognitive dimension was found between the two groups (all P>0.05). Conclusion Comprehensive lung rehabilitation training can improve lung ventilation function and quality of life relieve cancer-related fatigue and cough symptoms, and improve quality of life.

Investigation and analysis of the standardized training situation for residency of general practitioners in community bases of Liaoning province

LI Zeng-hui, HUANG Ying, JI Xin-zhu, SHEN Shi-li, YU Xiao-song

2021, 19(1): 124-127, 149. doi: 10.16766/j.cnki.issn.1674-4152.001747

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Abstract:
Objective To investigate the training situation of standardized training bases for general practice residents in Liaoning Province. Methods A total of 426 students from 2016 to 2018 in 30 standardized training bases for general practitioners in Liaoning Province were selected as the research objects. A self-made questionnaire was used to evaluate the training situation of the trainees at the community base. Data were entered using Excel software, and statistical analysis was performed using SPSS 23.0 software. Results Among the 290 trainees who completed the 1-5 months of training at the community base, 136 (46.9%) received all the relevant theoretical training required by the General Practice Rules of standardized Training Content and Standards for Resident Doctors (Detailed Rules), whereas 42 (14.5%) completed all the relevant skills and practices required by the Detailed Rules. A total of 135 (46.6%) trainees showed a good grasp of the relevant content of the community base in the Detailed Rules. Among the 136 trainees who completed the 6 month training at the community base, 83 (61.0%) received all the relevant theoretical training required by the Detailed Rules, and 57 (41.9%) completed all the relevant skills and practices required by the Detailed Rules. Furthermore, 85 (62.5%) exhibited a good grasp of the relevant content of the community base in the Detailed Rules. The theoretical training, skill practice and mastery of the students who completed all the basic training (6 months) were substantially better than those who completed the 1-5 months of training. Conclusion The standardized training bases for general practice residents in Liaoning Province generally complete the training tasks well.

Application value of PBL combined with CBL in clinical teaching of emergency medicine

TAO Yan-yan, GUO Jin, ZHANG Hong, WANG Fang-li, XIAO Heng, LU Guo-yu

2021, 19(1): 128-130，140. doi: 10.16766/j.cnki.issn.1674-4152.001748

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Abstract:
Objective To explore the effect of the problem-based teaching (PBL) combined with case-based teaching (CBL) model in clinical teaching of emergency medicine. Methods Total 84 clinical medical interns of grade 2015 in the First Affiliated Hospital of Bengbu Medical College from July 2018 to May 2019 were selected as the research subjects. The random digital table method was used to divide the subjects into two groups: 42 in the control group (PBL combined with the traditional mode of teaching) and 42 in the observation group (PBL combined CBL teaching). Theoretical test results, case analysis results and teaching satisfaction questionnaire of two groups were used to evaluate the value of the two teaching methods in emergency medical clinical teaching. Results There was no significant difference between the two groups in gender, age and academic entrance examination scores (all P>0.05) There was no significant difference in theoretical knowledge score between the observation group and the control group (34.18±3.13) and (33.45±3.21, P>0.05). However, the case analysis score (35.51±4.07) and clinical skill score (34.78±3.04) in the observation group were significantly higher than those in the control group (32.57±4.11 and 30.44±3.22, respectively), the difference was statistically significant (all P < 0.01). Furthermore, the students in the observation group had a high evaluation of teaching satisfaction (P < 0.01). Conclusion PBL combined with CBL teaching ensure the level of theoretical knowledge in emergency medical clinical teaching, whilst significantly improving students' ability to solve practical clinical problems, which has been recognised by students.

Meta-analysis of the relationship between HMGB1 level and systemic vasculitis

ZHU Qing, ZHU Bin, WU Ting, HONG Jing, LI Nan-fang

2021, 19(1): 131-136. doi: 10.16766/j.cnki.issn.1674-4152.001749

174 6

Abstract:
Objective To systematically evaluated the correlation between high mobility group protein B1 (HMGB1) and systemic vasculitis (SV), and provide basis for evaluating the clinical value of HMGB1 in the diagnosis of SV and disease assessment. Methods The studies focused on the association between the HMGB1 level and SV were searched in databases containing PubMed, Medline, Web of Science, Corchrane library, CNKI, Wanfang and VIP from the time of databases establishment to December 2018. Two independent evaluators screened literature according to according to inclusion and exclusion criteria, extracted relevant data, and then used Stata 12.0 software for meta-analysis. Results A total of 16 studies were finally included in the meta-analysis. Pooled data suggested HMGB1 levels were significant increased in SV patients compared with inactive patients and healthy controls (HC). The subgroup analysis indicated that HMGB1 levels in small vessel vasculitis and variable vessel vasculitis patients were significantly higher than that in the HC. With the subgroup analyses by region showed that HMGB1 levels were higher in Asia and Europe patients. Conclusion The meta-analysis indicates that HMGB1 levels are significant higher in patients with SV than in HC, and can reflect the disease activity. However, further enlargement of the sample size is needed to confirm the results.

Applying PDCA cycle to study tracking and feedback in information processing under a complex background

YU Lin-na, JIN Xia, YUAN Shi-ping, TAO Li-li, XU Bin-bin, MEI Zi-yang, CHENG Qi

2021, 19(1): 137-140. doi: 10.16766/j.cnki.issn.1674-4152.001750

129 1

Abstract:
With the continuous development of hospital network office, the means of hospital information transmission gradually increase, and the background of information transmission becomes more and more complicated. This paper analyzes the complex information sources and processing channels of the office, and dissects the root causes of the inefficiency and low quality of office information processing. Taking the hospital office of a tertiary hospital as an example, this paper analyzes the complex information sources and processing channels of the office, analyzes the root causes of the low efficiency and quality of office information processing, and puts forward solutions. Through the fishbone diagram analysis method, from the hospital, Department, individual and other four dimensions, summed up 14 factors affecting office efficiency; through the use of PDCA cycle management model, from the four stages of P (plan), D (implementation), C (inspection), a (processing), formulate improvement plan, establish a normal long-term mechanism, the omission rate in the first quarter of 2020 is 3% lower than that of the same period last year, 3 days The completion rate of internal affairs increased from 69.38% to 95.00%, and the administrative office efficiency was significantly improved. Using PDCA cycle to tracking and feedback of information processing process to improve and upgrade, to ensure the office needs to handle affairs to have response, both have to implement, and improves the efficiency of information transmission and processing speed, in complex information environment to improve the efficiency of hospital management.

Procedure and monitoring management of extracranial radiofrequency thermocoagulation for trigeminal neuralgia

CHEN Dong-liang, ZHONG Jun-feng, HUANG Bing, ZHANG Li, REN Xiao-mei, YAO Ming, DENG Jia-jia

2021, 19(1): 141-145. doi: 10.16766/j.cnki.issn.1674-4152.001751

225 1

Abstract:
Objective By comparing the effects of local anesthesia and total intravenous anesthesia in the treatment of trigeminal neuralgia by extracranial non-Gasserian ganglia radiofrequency thermocoagulation, the optimal comfortable medical process and monitoring management measures were selected. Methods A total of 150 patients with trigeminal neuralgia scheduled for radiofrequency thermocoagulation of extracranial non-Gasserian ganglia were randomly divided into three groups with random number table method: group A received no anesthetic intervention except local anesthesia at puncture point; The others received intravenous injection of dexmedetomidine (0.3 μg/kg), after electrophysiological tests were correct, group B received injection of 2% lidocaine 0.5 mL through radiofrequency needle; In group C, propofol was injected intravenously 1.0-1.5 mg/kg. Then radiofrequency therapy was performed after patients fell asleep. The corresponding vasoactive drugs such as urapidil, ephedrine and atropine were given to maintain circulation stability according to the changes of blood pressure, heart rate and oxygen saturation during operation. The blood pressure, heart rate, oxygen saturation, intraoperative dosage of drugs, intraoperative complications, short-term efficacy and patient satisfaction were recorded. Results Blood pressure and heart rate in group A were significantly higher than the baseline values during treatment, and at T1 (Puncture operation) and T2 (radiofrequency thermocoagulation 60 s), blood pressure and heart rate in group A were significantly higher than those in group B and C (all P < 0.05), respectively. 68% of patients in group A needed vasoactive drugs to control blood pressure during treatment, and comfort satisfaction in group C was significantly higher than those in group A and B (all P < 0.05). Conclusion When patients with trigeminal neuralgia are treated with extracranial radiofrequency thermocoagulation, dexmedetomidine injection before puncture and propofol injection before radiofrequency can greatly improve the comfort and satisfaction of radiofrequency therapy, without affecting the short-term efficacy judgement, but they need oxygen inhalation and monitoring, and use vasoactive drugs to maintain circulation stability when necessary to ensure safety.

Effects of interested games on acute pain and early ambulation of postoperative in preschool children

GENG He-hong, ZHU Ying-ying, YAN Lin, YAN Li-li, ZHANG Xian-wei, SHI Cai-xiao

2021, 19(1): 146-149. doi: 10.16766/j.cnki.issn.1674-4152.001752

166 3

Abstract:
Objective To explored the application effect of interested games on acute pain and early ambulation of postoperative in preschool children. Methods Total 114 children with gastrointestinal surgery were selected from May 2018 to May 2019 in our Department. In order to avoid the cross-influence of interventions, 57 children who were admitted to the hospital were used as the control group, and 57 children who were admitted to the hospital as the intervention group. The control group performed routine postoperative nursing of enhanced recovery after surgery, and the intervention group was based on the control group and implemented interested games intervention on the children. The postoperative acute pain scores, the time of first postoperative activities, the number of first postoperative activities, the amount of getting out of the first three days after surgery, the incidence of postoperative complications, and the satisfaction of the parents of the children were compared between the two groups. Results There was significant difference in postoperative pain score between the two groups (P < 0.01). Compared with the control group, the pain score in the intervention group was significantly lower than that in the control group; the time of first ambulation and the incidence of postoperative complications (nausea / vomiting, upper respiratory tract infection, incision infection and adhesive intestinal obstruction) in the intervention group were lower than those in the control group (all P < 0.05). The activities of the first time out of bed, the first day, the second day and the third day were significantly higher than those in the control group (all P < 0.01). In addition, the parental satisfaction score (96.5%) of the intervention group was higher than that of the control group (87.7%). Conclusion Interested games can effectively alleviate postoperative acute pain in preschool children, promote early ambulation, reduce the incidence of postoperative complications, and improve the satisfaction of parents.

Effect of Qibai Tazi Decoction Combined with Comprehensive Nursing Based on 5E Concept on the Clinical Efficacy and Inflammatory Factors of Jellyfish Acute Dermatitis

ZHANG Ling, LI Huai-an, ZHOU Jin

2021, 19(1): 150-153. doi: 10.16766/j.cnki.issn.1674-4152.001753

179 3

Abstract:
Objective To explore the effect of external application of Qibai Tazi Decoction combined with comprehensive nursing based on 5E concept on the curative effect and serum inflammatory factors of jellyfish acute dermatitis. Methods A total of 157 patients with acute dermatitis were divided into standard group (79 cases) and 5E group (78 cases). Both groups were given external application of Qibai Tazi Decoction, standard group was given standardized nursing management, and 5E group was given 5E comprehensive nursing intervention. Three days later, the efficacy, pain time, skin lesions, swelling time, histamine, pain causing substances, IL-6, IL-8, IL-10, water content and oil content in epidermis of the two groups were compared, and then the effect of the two groups was evaluated. Results The onset time of 5E group was faster than that of the standard group (P < 0.05). After treatment, histamine and pain causing substance in the two groups decreased compared with that before treatment (P < 0.01). The effect of 5E group was significantly better than that of the standard group (all P < 0.05). The expressions of IL-6, IL-8 and IL-10 in the two groups increased before and after treatment. The expressions of IL-6 and IL-8 in the two groups decreased and the expression of IL-10 increased (all P < 0.05). The 5E effect of the two groups was better than that of the standard group (P < 0.05). There was interaction effect between the two groups at the time point (all P < 0.05). The water content and oil content of epidermis in the two groups decreased before treatment, and the above indexes increased in the two groups after treatment (all P < 0.01), and the improvement of 5E was better than that in the standard group (P < 0.05). Conclusion The external application of Qibai Tazi Decoction combined with 5E comprehensive nursing can improve the clinical effect, the allergic state and inflammatory response of skin, and the local skin state.

Effect of rescue case sharing combined with emergency preview on the quality of emergency pre-examination and triage and the working ability of nurses

HE Jia-tao, SHEN Xiao-ling

2021, 19(1): 154-156, 160. doi: 10.16766/j.cnki.issn.1674-4152.001754

153 2

Abstract:
Objective To explore the effect of rescue case sharing combined with emergency rehearsal on the quality of emergency pre-examination and triage, nurses' work ability and nursing satisfaction. Methods We selected 58 nurses from the emergency department of Hangzhou First People's Hospital from January 2017 to January 2019 as the research object, and January 2017 to December 2017 as the routine emergency department period. The personnel were arranged for routine emergency rescue and other work arrangements. From January 2018 to January 2019, it was the new management emergency department. During this period, the nursing staff joined the rescue case sharing + emergency preview new management content under the relevant management arrangements of the regular emergency department. The quality of emergency pre-examination and triage, the working ability of nurses and the satisfaction of nursing in different stages were observed and compared. Results The accuracy rate of emergency triage in the newly managed emergency department was 99.11%, and the rescue rate was 97.90%, which was significantly higher than 95.61% and 94.01% in the conventional emergency department, respectively. The missing rate (0.80%) in the rescue unit of the newly managed emergency department was significantly lower than that in the conventional emergency department (8.13%). The differences were statistically significant (all P < 0.01). The help role ability, education-guidance ability, evaluation and judgment ability, coping ability, nursing intervention ability, quality evaluation ability and job role ability score of the new management emergency period were significantly higher than those in the conventional emergency period, and there were statistical differences between the comparisons (all P < 0.05). The total satisfaction rate of nursing in the newly-managed emergency department was 90.91%, and the total satisfaction rate in the conventional emergency department was 76.36%. The newly-managed emergency department was significantly better than the conventional emergency department. The comparison was significant and statistically significant (χ²=4.251, P < 0.05). Conclusion The sharing of rescue cases + emergency management measures for emergency rehearsal can improve treatment effect and service quality, reduce doctor-patient disputes, and improve medical service satisfaction.

Study on the effect of nursing intervention based on target management theory on stroke patients with long-term bedridden pulmonary infection

HONG Jing, SU Shao-wei, YE Sheng

2021, 19(1): 157-160. doi: 10.16766/j.cnki.issn.1674-4152.001755

183 2

Abstract:
Objective To analyse the effect of nursing intervention based on target management theory on stroke patients with long-term bedridden pulmonary infection. Methods A total of 94 stroke patients with long-term lung infection, who were hospitalised in our hospital from February 2019 to February 2020, were selected as the research object. The patients were divided into two groups using the random number table method: 47 cases in the control group (receiving basic nursing) and 47 cases in the observation group (based on respiratory rehabilitation nursing). Treatment adherence and quality-of-life scores were compared between the two groups. Results Nursing compliance of the observation group (97.87%) was higher than that of the control group (85.11%), which was statistically significant (χ²=4.918, P < 0.05); knowledge mastery (75.16±1.52), belief attitude after intervention (76.95±1.74) and action (79.25±1.68) scores of the observation group were higher than those of the control group (71.54±1.47, 69.56±2.42 and 73.16±2.74, respectively; all P < 0.05). The Degree of knowledge mastery (23.68±2.45), nursing skills (25.19±1.47), nutritional status (24.10±0.98) and consciousness (22.42±1.41) scores of the observation group were higher than those of the control group (18.16±1.84, 14.58±2.34, 16.82±1.76 and 18.62±2.05; all P < 0.05). The difference in respiratory function between the two groups before nursing was small (P>0.05). After intervention, the respiratory function indexes of the observation group were significantly better than those of the control group (P < 0.05). The quality of life score of the observation group was higher than that of the control group (P < 0.05). Conclusion Target management theory for stroke patients with long-term bedridden pulmonary infection can effectively improve the nursing compliance of patients, but also can improve the quality of life score of patients, which has clinical application value.

Effect of rapid rehabilitation nursing on patients in operating room

SHEN Hai-ping, CHEN Xiao-mei, JIANG Yun-yun, HAN Cui-lan, TENG Bei-na, ZHANG Wei-chen

2021, 19(1): 161-163. doi: 10.16766/j.cnki.issn.1674-4152.001756

280 6

Abstract:
Objective To explore the effect of rapid rehabilitation nursing on the psychological state, postoperative recovery and nursing satisfaction of patients undergoing surgery. Methods A total of 120 patients who underwent elective surgery in The Cardiovascular Hospital of Greentown, Zhejiang, from January 2018 to December 2019 were randomly selected and divided into control and intervention groups by the random number table method, 60 patients in each group. Patients in the control group were given usual routine nursing care. Based on the rapid rehabilitation nursing, the patients in the intervention group were modelled. Depression anxiety symptoms (anxiety depression self-rating scale[SAS and SDS]), complications, postoperative patients recovery (waking hours after surgery, postoperative exhaust time and total duration) in hospital for the first time and nursing satisfaction were compared between the two groups. Results No significant difference in the scores of depression and anxiety was found before intervention (P>0.05). After the intervention, the negative mood scores of the intervention and control groups were 22.11±1.21, 19.47±4.01 and 37.12±4.01, 35.25±3.35, respectively. The score of intervention group was significantly lower than that of control group (P < 0.05). After the intervention, the complication rate was 5.00% in the intervention group, which was significantly lower than that in the control group (20.00%, P < 0.05). The postoperative recovery of patients in the intervention group was significantly better than that in the control group (P < 0.05). Moreover, the nursing satisfaction of patients in the intervention group was 96.66%, which was significantly higher than that in the control group (58.33%, P < 0.05). Conclusion Rapid rehabilitation can improve the psychological state, postoperative recovery and nursing satisfaction of patients and reduce the incidence of surgical complications.

2021, 19(1): 164-166. doi: 10.16766/j.cnki.issn.1674-4152.001757

114 4

Abstract:

Effects of endothelial progenitor cell transplantation on the expression of inflammatory factors in a rat model of acute lung injury caused by paraquat poisoning

JIN Yan, LIU Zhi, SUN Ning, YANG Hong-da, CAI Quan

2021, 19(1): 6-9. doi: 10.16766/j.cnki.issn.1674-4152.001715

173 4

Abstract:
Objective To analyse the effect of endothelial progenitor cell transplantation on the expression of inflammatory factors in a rat model of acute lung injury caused by paraquat poisoning and to provide references for the clinical application of endothelial progenitor cell transplantation. Methods Sixty male SD rats were selected as experimental animals, and the rats were divided into the control group, paraquat group (model group) and endothelial progenitor cell transplantation group (observation group) by a random number table method. The tissue damage and expression level of serum inflammatory factors and other indicators were also compared. Results The lung tissue damage score and wet-dry weight ratio of the three groups of rats were significantly different (F=12.336, 10.571, all P < 0.05). The lung tissue damage score and wet-dry weight ratio of the model group were higher than those of the observation and control groups (all P < 0.05), but no significant difference was found between the observation and control groups (all P>0.05). The lung serum inflammatory factor expression levels of the three groups of rats were significantly different (F=23.305, 26.271, 18.814, 20.056, all P < 0.05), and the expression levels of the serum inflammatory factors in the observation and model groups were higher than those in the control group (all P < 0.05), but the expression level of the serum inflammatory factors in the observation group was lower than that in the model group (all P < 0.05). The oxidative stress indicators of the three groups of rats were significantly different (F=8.326, 14.505, all P < 0.05). The MDA of the model group was significantly higher than that of the observation and control groups (all P < 0.05), and SOD of the model group was significantly lower than that of the observation and control groups (all P < 0.05), but the observation and control groups had no significant difference in oxidative stress indicators (all P>0.05). Conclusion Endothelial progenitor cell transplantation can reduce the expression of inflammatory factors in a rat model of acute lung injury caused by paraquat poisoning, which has a definite effect.

Clinical effect and prognosis of sacubitril-valsartan in treating heart failure patients with different ejection fraction

LI Ran, XIE Li-juan, JIAO Chang-qing, LU Hong-hong, ZHOU Bi-rong

2021, 19(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.001716

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Abstract:
Objective To observe the clinical effect, prognosis and safety of sacubitril-valsartan in treating chronic heart failure (CHF) patients with different ejection fraction. Methods Seventy-eight patients were obtained from the Department of Cardiology of The First Affiliated Hospital of Anhui Medical University from January 2019 to December 2019. The patients were divided into the HFrEF group and HFpEF group on the basis of ejection fraction: 40 patients in the HFrEF group and 38 patients in the HFpEF group. All patients were treated with sacubitril-valsartan on the basis of routine heart failure treatment. Brain natriuretic peptide (BNP), renal function, serum potassium, left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD) and New York heart function classification (NYHA) of both groups were compared after 6 months of treatment. Treatment safety was also assessed. The end point event was cardiovascular death or hospitalisation for worsening heart failure. The accumulated end-point event-free survival rate in 6 months between the two groups was compared by the Kaplan-Meier survival curve method. Results After 6 months of treatment, the HFrEF group showed significantly decreased BNP, LAD and LVEDD; significantly increased LVEF and significantly improved NYHA classification (all P < 0.05) compared with that before treatment. After 6 months of treatment, the HFpEF group also showed significantly decreased BNP, LAD and LVEDD; significantly increased LVEF and significantly improved NYHA classification (all P < 0.05) compared with that before treatment. However, the degree of decrease in the BNP levels and improvement in NYHA class were better in the HFrEF group than that in the HFpEF group. No difference in cumulative event-free survival was found between the HFrEF and HFpEF groups (81.9% vs. 85.0%, P=0.694). Safety was good in both groups. Conclusion Sacubitril-valsartan has a certain effect on heart failure with preserved ejection fraction, which shows potential clinical application, but it is slightly less effective on heart failure with reduced ejection fraction. There is no significant difference in prognosis and safety between the two groups.

Effect of systemic interventions on compliance of patients with neuromyelitis optica spectrum disorder treated with low-dose rituximab

WANG Xian-ni, REN Ting-ting, SUN Tang-na, GUO Jun, ZHU Xiao-yu, FAN Shan-hong

2021, 19(1): 14-16,92. doi: 10.16766/j.cnki.issn.1674-4152.001717

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Abstract:
Objective To investigate the effect of systematic intervention on treatment compliance of patients with neuromyelitis optica spectrum disorder (NMOSD) treated with low-dose rituximab, and to provide evidence to reduce the recurrence rate and improve the treatment effect. Methods Eighty-nine NMOSD patients treated in Tangdu Hospital of Air Force Military Medical University from September 2014 to September 2019 were selected and randomly divided into observation group (46 cases) and control group (43 cases). Routine treatment and nursing were given to the control group, and systematic intervention measures were implemented to the observation group. Treatment compliance, annual recurrence rate (ARR) and number of recurrent patients in the 2 groups were compared. The improved neurological function of the patients was evaluated by the Clinical Extended Disability Scale (EDSS) and the Daily Living Ability Scale (ADL). Results The treatment compliance of patients in the observation group was 100.00%, significantly higher than that of the control group (81.40%), and the difference was statistically significant (P=0.002). The annual recurrence rate in the observation group was 0.23±0.16, lower than that in the control group (0.56±0.15, P=0.002). The EDSS score of the observation group at 1 year after the induction period was (1.71±0.69) points, which was significantly lower than that of the control group [(2.36±1.25) points, P=0.017]. At 1 year after the induction period, the ADL score of patients in the observation group was (78.25±10.83) points, which was significantly higher than that of the control group [(71.12±10.12) points, P=0.046]. Conclusion Systematic intervention can effectively improve the disease awareness and treatment compliance of NMOSD patients, and has positive clinical significance for reducing disease recurrence, improving neurological function and improving quality of life.

Correlation between multiple epilepsy related gene polymorphisms and serum concentrations of lamotrigine in the treatment of epilepsy in children

LOU Jiang, LIN Neng-ming, CHEN Ling, LIU Zhan-li, WANG Wei, WANG Fei, LI Qing-Yu, YAN Wei

2021, 19(1): 17-19,45. doi: 10.16766/j.cnki.issn.1674-4152.001718

374 2

Abstract:
Objective To evaluated that association between UGT1A4, OCT1, ABCB1 and SCN1A polymorphisms and blood concentration of lamotrigine in pediatric epilepsy patients. Methods A total of 49 pediatric epilepsy patients treated with lamotrigine alone in Hangzhou First People's Hospital were enrolled from January 2018 to June 2019. Steady-state plasma concentrations of lamotrigine were collected for a stable dose of consecutive 7 days and above. High performance liquid chromatography was used to measure blood concentrations of lamotrigine. Collect whole blood and analyzed the metabolic enzymes UGT1A4 (rs2011425), transporter OCT1 (rs628031), ABCB1 (rs1045642 and rs1128503) and receptor SCN1A (rs3812718) gene polymorphisms by direct sequencing. The correlation between different genotypes and the dose-normalized blood concentration of lamotrigine [the blood concentration of lamotrigine divided by the daily dose and the patient's body weight per kilogram, Concentration-to-dose-ratio by body weight, CDR, (μg/mL)/(mg/kg)] were investigated by using Kruskal-Wallis H test or Mann-Whitney U test. P < 0.05 was considered statistically significant. Results There was significant associations between OCT1 rs628031 polymorphism and lamotrigine CDR, compared with AA and AG genotypes, GG genotype of OCT1 rs628031 was associated with lower LTG CDR [AA + AG vs. GG: 1.27(1.03, 2.20) and 0.69(0.57, 1.02), P=0.002]. No associations were detected between other genotypes and lamotrigine CDR. Conclusion OCT1 rs628031 polymorphisms maybe an important factor for the inter-individual in blood concentration and clinical efficacy of lamotrigine.

Analysis of risk factors of children with severe hand-foot-mouth disease

WANG Jin, PENG Wan-sheng, ZHOU Rui, WANG Ya-ming, XYU Jia-li

2021, 19(1): 20-23. doi: 10.16766/j.cnki.issn.1674-4152.001719

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Abstract:
Objective To observe the primary laboratory examination results of children with severe hand-foot-mouth disease (HFMD), determine their risk factors and establish a prediction model to provide early diagnosis and timely HFMD treatment. Methods Children with HFMD (including clinical diagnosis cases and confirmed cases) were included in the study. They were admitted to the First Affiliated Hospital of Bengbu Medical College from January 2019 to December 2019. The clinical symptoms, signs and major laboratory indicators were analysed, and statistically significant terms were further processed via multifactor logistic regression to build a regression model. ROC curves were drawn to evaluate the predictive effect of the model. Data were analysed using SPSS 26.0 software. Results The clinical data of 109 HFMD cases (including 41 mild cases and 68 severe cases), showed that body temperature of ≥ 38.9 ℃ (OR=2.943, 95% CI: 1.099-7.884), poor spirit (OR=5.899, 95% CI: 2.130-16.339), increased peripheral blood white blood cells (OR=4.386, 95% CI: 1.420-13.541) and abnormal electroencephalogram (OR=4.502, 95% CI: 1.714-11.821) were independent risk factors for severe HFMD. The regression equation of the prediction model was Logit (P)=-2.893+1.079X₁+1.775X₂+1.478X₃+1.504X₄. The sensitivity of the model was 61.0%, and its specificity was 83.8%. The area under the curve corresponding to the ROC curve was 0.843 (95% CI: 0.768-0.917). Conclusion Body temperature of ≥ 38.9 ℃, poor spirit, increased peripheral blood white blood cells and abnormal electroencephalogram are independent risk factors for severe HFMD. These risk factors can be used to establish a predictive logistic regression model for severe HFMD.

Correlation analysis of sleep quality and life quality in patients with atrial fibrillation

HU Guang-ling, QIAO Xin-yue, ZHANG Lin-hong, YU man, HUANG Li-li, CUI Fang-fang, YANG Qiao-fang

2021, 19(1): 24-26,41. doi: 10.16766/j.cnki.issn.1674-4152.001720

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Abstract:
Objective To evaluate the sleep quality and life quality of patients with atrial fibrillation (AF) using the score scale, and analyse the correlation between sleep quality and life quality of patients with AF. Methods A total of 96 cases of AF admitted in the Heart Medicine Department from March 2019 to March 2020 were collected as the research subjects. The Pittsburgh sleep quality index scale (PSQI) was used to evaluate patients' sleep quality, and the specific quality of life scale (AFEQT) was performed in patients with AF to evaluate quality of life. The patients were divided into the sleep disorder and non-sleep disorder groups on the basis of their PSQI scores. Sleep quality and quality of life were compared between the two groups, and their correlation was analysed. Results Amongst the 96 patients, 62 (64.58%) were in the sleep disorder group, and 34 (35.42%) were in the non-sleep disorder group. Subjective sleep quality, sleep time, sleep efficiency, sleep disturbance, sleep medication use, daytime dysfunction score and total PSQI score of patients in the sleep disorder group were significantly higher than those in the non-sleep disorder group (all P < 0.01). The severity of symptoms, treatment anxiety, daily activities and total AFEQT scores of patients in the sleep disorder group were significantly lower than those in the non-sleep disorder group (all P < 0.05). Moreover, no statistical significance in the scores of treatment satisfaction was found between the two groups (P>0.05). Pearson linear analysis showed that the total PSQI score was negatively correlated with the symptom severity, daily activities, treatment anxiety and total AFEQT score in the AFEQT scale (all P < 0.05). Conclusion AF is mostly associated with sleep disorders. The quality of life of AF patients with sleep disorders is significantly lower than that of patients without sleep disorders. The sleep quality of patients with AF is closely related to the quality of life. Clinical treatment should consider the sleep quality status of AF patients, and measures should be taken to improve the sleep quality and quality of life of patients with AF.

Comparative analysis of four scoring systems in predicting the short-term prognosis of patients with traumatic brain injury

SU Guan, CHEN Yan-ru, YANG Tao, LIANG Cheng-ying, ZHANG Ruo

2021, 19(1): 27-30. doi: 10.16766/j.cnki.issn.1674-4152.001721

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Abstract:
Objective To investigate the efficacy of four scoring methods in evaluating the prognosis of patients with traumatic brain injury (TBI). Methods A total of 149 patients with TBI who were admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to June 2018 were selected. According to the prognosis at 28 days after admission, all patients were divided into two types: good prognosis and poor prognosis. The general data of the two groups of patients at admission was analyzed and the patients' admission status was scored based on the Glasgow Coma Index (GCS), Acute Physiology and Chronic Health Status Score (APACHEⅡ), Modified Early Warning Score (MEWS), and Triage Early Warning Score (TEWS). Then logistic regression analysis was used to determine the factors affecting the prognosis of the patients, and the ROC curve was used to evaluate the predictive power of the four scores on the prognosis of the patients. Results The number of patients with poor prognosis at the time of discharge was 42, and the poor prognosis rate was 28.18%. The intracranial hemorrhage rate, GCS, APACHEⅡ, MEWS, and TEWS of patients with good prognosis were significantly lower than those with poor prognosis, and the injuries were significantly better than those with poor prognosis (all P < 0.05). The APACHEⅡ, MEWS and TEWS were the independent risk factors that affect the prognosis of patients (all P < 0.05). The results of ROC analysis showed that the prognosis of APACHEⅡ and TEWS for TBI patients were significantly greater than that of MEWS (both P < 0.05), and the prognosis of APACHEⅡ and TEWS for TBI patients were not significantly different (P>0.05). Conclusion Both TWES and APACHEⅡ have better predictive power for the prognosis of TBI patients, but the positive predictive reliability of TWES is good, and they can be used in TBI patients' admission evaluation.

Analysis of preoperative risk factors of severe neonatal meconium aspiration syndrome

XU Qian-qian, LIU Bin-bin, CHEN Xue-xiang, SHEN Huai-yun

2021, 19(1): 31-34. doi: 10.16766/j.cnki.issn.1674-4152.001722

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Abstract:
Objective To explore the risk factors affecting the prognosis of children with severe meconium inhalation syndrome (MAS), analyse the predictive value of these factors, and improve the clinical treatment level of MAS. Methods The clinical data of 77 patients with severe MAS treated by mechanical ventilation from January 2014 to December 2019 were retrospectively analysed. According to the treatment results, the patients were divided into successful ventilation group and failure ventilation group. The general data, arterial blood gas analysis and their complications were compared between the two groups. Receiver characteristic (ROC) curve and stepwise logistic regression were used to analyse the statistically significant observation indexes. Results (1) The incidence of intrauterine distress, persistent pulmonary hypertension (PPHN) and multiple organ dysfunction (MODS) in the failure ventilation group was 66.7%, 41.7% and 66.7%, respectively, which were higher than those in the successful ventilation group (41.5%, 5.7% and 22.6%). The Apgar score, pH value, arterial partial pressure of oxygen (PaO₂) and buffer excess (BE) in the failure ventilation group were significantly lower than those in the successful ventilation group. The difference was statistically significant (all P < 0.05). (2) Multivariate logistic regression analysis showed that PaO₂, BE value, PPHN and MODS were independent risk factors of mechanical ventilation in the treatment of MAS. (3) ROC curve analysis showed that the BE value of -8.5 was the suitable boundary point to predict MAS prognosis, and the sensitivity and specificity were 94.3% and 58.3%, respectively; its PaO₂ was 40.5 mm Hg, which was the best boundary point to predict prognosis, and the sensitivity and specificity were 79.2% and 58.3%, respectively. Conclusion PaO₂ BE values and combined PPHN and MODS are the independent risk factors affecting the prognosis of MAS after mechanical ventilation. BE values and PaO₂ can predict the prognosis of children with MAS, and early and timely prevention and treatment of these risk factors can reduce the mortality of severe MAS.

Clinical effect and value of laparoscopic guided secondary spleen pedicle transection in patients with traumatic spleen injury

YANG Yan-ru, WANG Lin, WU An-qi

2021, 19(1): 35-37, 58. doi: 10.16766/j.cnki.issn.1674-4152.001723

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Abstract:
Objective To explore the clinical effect and value of laparoscopic guided secondary spleen pedicle transection in patients with traumatic spleen injury and to provide reference for clinical treatment of this kind of disease. Methods A total of 54 cases of traumatic splenic rupture in our hospital from May 2016 to May 2019 were selected as subjects and divided into the observation group and control group on the basis of the operation mode (27 cases in each group). The control group was treated with conventional laparotomy, whereas the observation group was treated with laparoscopy-guided secondary spleen pedicle transection. The average operation time, drainage tube indwelling time, intraoperative blood loss, postoperative exhaust time, average hospital stay, the incidence of complications in the short-term and one-year follow-up were recorded and analysed. Before discharge, treatment satisfaction was analysed by the current patient satisfaction questionnaire in the undergraduate department. Results The average operation time in the observation group of perioperative indicators was longer than that in the control group. The difference was statistically significant (P < 0.05). The average intraoperative blood loss, drainage tube indwelling time and postoperative exhaust time in the observation group were significantly shorter than those in the control group, which had statistically significant differences (all P < 0.05). The incidence of complications in the short-term postoperative and 1 year postoperative follow-up was significantly lower in the observation group than that in the control group, which had statistically significant differences (all P < 0.05). The total clinical treatment satisfaction of the observation group was higher than that of the control group, and the difference was significant (P < 0.05). Conclusion Compared with conventional open surgery, traumatic splenic injury in patients with laparoscopic guided secondary spleen pedicle transection has a better clinical effect. It significantly reduces intraoperative blood loss, drainage time, postoperative exhaust time, length of hospital stay, perioperative indicators, and postoperative complications and improves patient satisfaction, which is worth popularizing in clinical application.

Expression and clinical significance of serum S-100β protein in patients with white matter ischaemic lesions

LIU Shi-hua, ZHANG Chao, TIAN Zhi-gang, HOU Wen-zhe, ZHONG Ping

2021, 19(1): 38-41. doi: 10.16766/j.cnki.issn.1674-4152.001724

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Abstract:
Objective To explore the expression level of serum S-100β protein in patients with white matter ischaemic lesions (WMIL) and its relationship with WMIL. Methods Patients with WMIL, as confirmed by craniocerebral magnetic resonance, from June 2017 to September 2019 were selected as the research subjects, and the degree of white matter lesions was evaluated on the basis of the Fazekas rating scale. Those with normal craniocerebral magnetic resonance matched with age and sex during the same period were selected as the control group. Serum S-100β protein concentrations were detected with enzyme-linked immunosorbent assays. The general clinical data and S-100β protein levels were compared between the two groups. Spearman rank correlation was used to analyse the relationship between the serum S-100β protein level and degree of white matter lesions, and multivariate Logistic regression was used to analyse the influencing factors of WMIL. Results Compared with the control group, the proportion of patients with hypertension (79.1% vs. 42.0%, P < 0.001), the proportion of patients with diabetes (34.8% vs. 15.9%, P=0.006) and the level of S-100β protein [(1.414±0.260) pg/mL vs. (0.961±0.316) pg/mL, P < 0.001] in the WMIL group were significantly higher, and the differences were statistically significant. The serum S-100β protein level of patients in WMIL group was significantly and positively correlated with the Fazekas score (r=0.736, P < 0.001). Multivariate logistic regression analysis showed that hypertension, diabetes and elevated S-100β protein levels were independent risk factors for WMIL (all P < 0.01). Conclusion The expression level of serum S-100β protein is increased in WMIL patients and positively correlated with the severity of WMIL. The elevated serum S-100β protein level might be an independent risk factor for WMIL, which might be an effective biological marker of chronic white matter damage.

Clinical study of robot-assisted placement of thoracolumbar pedicle screws

HE Liu, FANG Xuan-cheng, SHEN Cai-liang, LI Hao, LI Yu

2021, 19(1): 42-45. doi: 10.16766/j.cnki.issn.1674-4152.001725

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Abstract:
Objective To explore the clinical effect of thoracic and lumbar pedicle screw placement with the assistance of a robotic system for orthopaedic surgery. Methods Total 40 patients underwent thoracolumbar pedicle screw internal fixation at the Department of Spine Surgery, Anqing First People's Hospital From August 2018 to May 2020 were divided into two groups: robot assisted operation group and "C" arm fluoroscopy group with 20 cases in each group according to the operation methods. The placement time of each pedicle screw and the number of intraoperative fluoroscopy were recorded, and the position (accuracy) of the two groups of screws was evaluated on the basis of postoperative X-ray and three-dimensional CT. Moreover, the accuracy and safety of screw placement were evaluated. Results In the robot-assisted surgery group, the average screw insertion time was (13.85±1.41) min, and in the "C" arm X-ray fluoroscopy, the screw insertion time was (14.03±1.84) min, and the difference between the two groups of data was not statistically significant (P>0.05). A total of 94 screws were placed in the robot-assisted surgery group (90 in Class Ⅰ screws, 4 in Class Ⅱ screws and 0 in Class Ⅲ screws), with an accuracy rate of 95.74% (90/94). Using the "C" arm X-ray fluoroscopy, a total of 96 screws (83 Grade Ⅰ screws, 10 Grade Ⅱ screws and 3 Grade Ⅲ screws) were placed in the nail placement group, with an accuracy rate of 86.46%(83/96). The difference between the two groups was significant (P < 0.05). The number of fluoroscopy in the robot-assisted surgery group was (8.15±1.53) times, and the number of fluoroscopy in the "C" arm X-ray fluoroscopy was (13.35±2.58) times. The difference between the two groups was statistically significant (P < 0.05). Conclusion The robot-assisted Tianji orthopaedic surgery can improve the accuracy and safety of pedicle screw placement and reduce intraoperative radiation, but it does not significantly increase the time of nail placement. Furthermore, it has a great application potential in spinal surgery.

The predictive value of serum prostate-specific antigen on prostate volume in patients with benign prostatic hyperplasia

ZHOU Hao, SUN Chao, LI Bo, GUAN Han, CHEN Zhi-jun

2021, 19(1): 46-48. doi: 10.16766/j.cnki.issn.1674-4152.001726

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Abstract:
Objective To evaluate the value of predicting prostate volume by analyzing the relationship between serum total prostate specific antigen (tPSA), free prostate specific antigen (fPSA), age and prostate volume (PV). Methods The clinical data of 111 patients with benign prostatic hyperplasia admitted to the Department of Urology, Bengbu Third People's Hospital from January 2018 to December 2019 were compiled. All patients underwent prostatectomy and pathologically confirmed benign glandular hyperplasia. Variance analysis and LSD multiple comparison method were used to analyze the differences in prostate volume, tPSA, fPSA of different age groups, and the differences in serum tPSA and fPSA of different prostate volumes. Pearson correlation analysis was further used to describe the difference between patient age, tPSA, fPSA and PV, and evaluate the value of age, tPSA, and fPSA in predicting PV. Results The differences in prostate volume, tPSA, and fPSA among the three age groups were statistically significant (F=5.137, P=0.007; F=7.551, P=0.001; F=5.186, P=0.007). After pairwise comparison, it was found that prostate volume, tPSA, and fPSA were not completely statistically significant, but there were statistical differences in serum tPSA and fPSA values of prostate volumes of different sizes (F= 8.187, P < 0.001; F=7.318, P=0.001), the serum tPSA and fPSA values increased with the increase of the anterior gland volume (all P < 0.05). The patient's age, serum tPSA and blood fPSA were positively correlated with PV (r=0.259, P=0.006; r=0.375, P < 0.001; r=0.339, P < 0.001). Conclusion The detection of serum tPSA and fPSA levels can be used to predict PV, which is helpful for judging the degree of disease development of patients with benign prostatic hyperplasia (BPH), assessing surgical risk and prognostic follow-up.

Correlation between gingival crevicular fluid adiponectin level, inflammation and periodontal index in patients with periodontitis and type 2 diabetes

TONG Xi, DING Cheng, PU Li-li, LYU Chen-yi, ZHANG Lei, LI Xiao-fang, MA Qiu-jun

2021, 19(1): 49-51,136. doi: 10.16766/j.cnki.issn.1674-4152.001727

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Abstract:
Objective To investigate the correlation of the adiponectin (APN) level in gingival crevicular fluid, inflammation response and periodontal index in patients with periodontitis and type 2 diabetes (T₂DM). Methods Fifty healthy patients from January 2018 to December 2019 were selected as group A. At the same period, 50 patients with simple periodontitis admitted to the Department of Stomatology, Jinhua Central Hospital, and Department of Stomatology, Hangzhou Second People's Hospital, were selected as group B, and 50 patients with periodontitis and T₂DM were selected as group C. The blood glucose, APN, periodontal index and inflammatory factor level of the three groups were compared, and the correlation between the inflammatory factor level and periodontal index of the gingival crevicular fluid APN level in patients with periodontitis and T₂DM was analysed by the Pearson method. Results The blood glucose level of gingival crevicular fluid in group C was significantly higher than that in groups A and B (all P < 0.05); the APN level of gingival crevicular fluid in groups B and C was significantly lower than that in group A (all P < 0.05), and the APN level in group C was significantly lower than that in group B (P < 0.05); the levels of monocyte chemotactic protein-1 (MCP-1), tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in groups B and C were significantly higher than those in group A (all P < 0.05), and group C was significantly higher than group B (all P < 0.05); plaque index (PLI), bleeding index (SBI), loss of attachment (AL) and depth of exploration (PD) in groups B and C were significantly higher than those in group A (all P < 0.05), and group C was significantly higher than group B (all P < 0.05); the level of gingival crevicular fluid APN in patients with periodontitis and T₂DM was negatively correlated with MCP-1, TNF-α, IL-6, PLI, SBI, AL and PD (r=-0.464, -0.471, -0.571, -0.319, -0.518, -0.515, -0.430, all P < 0.05). Conclusion The level of APN increases in patients with periodontitis, and its level further increases in patients with periodontitis and T₂DM, and the APN level is closely related to inflammation and periodontal symptoms in patients with periodontitis and T₂DM.

Diagnosis and treatment of 71 cases of chronic myeloid leukaemia with secondary myelofibrosis

SU Li-fang, WU Fen-zhi, KONG Hong-wei, LYU Hong-jiao, WU Wen-ping, WANG Jia-heng

2021, 19(1): 52-54,112. doi: 10.16766/j.cnki.issn.1674-4152.001728

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Abstract:
Objective To analyse the clinical treatment effect and follow-up results of patients with chronic myeloid leukaemia (CML) complicated with myelofibrosis (MF) and to provide relevant data for clinical treatment and prognosis. Methods The clinical data of 71 patients with CML complicated with MF admitted in the Department of Hematology of Quzhou People's Hospital from January 2014 to June 2019 were analysed retrospectively. The course of CML was 3-9 years, and all of the patients received systematic treatment in the hospital. In the treatment maintenance or remission period, progressive anaemia, generalised bone pain and megaspleen appeared, which was consistent with the diagnosis of MF (I degree). CML: Glivec (400-600 mg/time, 1 time/day; or 800 mg/time, 2 times/day, 800 mg/time) was used in the treatment for 4 weeks/course×4 courses; CML secondary bone fibrosis: when the baseline PLT was 100-200×10⁹/L, the initial dose of lucotinib was 2 times/day, 15 mg/time; when the baseline PLT was>200×10⁹/L, the initial dose was 2 times/day, 20 mg/time. The treatment effect, follow-up results and survival rate were observed. Results Clinical treatment results: after 1 week of treatment, the symptoms of pain and anaemia were improved, and the spleen was less than 8 cm under the rib; after 5 months of treatment, the haematopoietic function of the bone marrow was partially restored, and the morphology of classified cells was generally normal; haemoglobin level was≥100 g/L; white blood cell count was 9-10×10⁹/L, and the spleen was < 7 cm under the rib. The incidence of complications was 15.49% (11/71). The average follow-up time was 12-63 months. Follow-up results: 9 cases were lost (12.68%); 19 cases survived without recurrence (26.76%); 38 cases (53.52%) survived but relapsed and turned into cataclysm. The median time of transformation was 35.8 months. Five cases (7.04%) died of severe infection (two cases of central nervous system infection and three cases of respiratory tract infection). Conclusion Targeted drug therapy can achieve a certain short-term effect in the treatment of patients with MF secondary to CML. The long-term effects such as the change of the condition to cataclysm and survival are related to the severity of myelofibrosis. The aggravation of bone marrow fibrosis can promote the change or death of the disease.

Clinical effect of the treatment of acute lung injury with rhubarb by nasal feeding based on the theory of 'lung and large intestine inside and outside'

JIANG Huan-huan, LI Zhi-jun

2021, 19(1): 55-58. doi: 10.16766/j.cnki.issn.1674-4152.001729

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Abstract:
Objective To observe the effect of nasal feeding rhubarb on the improvement of clinical symptoms and prognosis of patients with acute lung injury (ALI). Methods A total of 128 patients with ALI were selected as the research subjects. All subjects were divided into the control group (n=64) and the research group (n=64) using the random number table method. The patients in the control group were given routine treatment, whereas the patients in the research group were given adjuvant treatment of rhubarb by nasal feeding on the basis of routine treatment. The hs-CRP, TNF-α, IL-6 and IL-8 levels were measured before and after treatment. The time of mechanical ventilation and hospitalisation were recorded. The changes of respiratory frequency, arterial oxygen partial pressure and oxygenation index were counted before and after treatment, and the incidence of ARDS and death was observed during the treatment. Results After treatment, the hs-CRP, TNF-α, IL-6 and IL-8 levels in the research group were significantly lower than those in the control group (all P < 0.05). The respiratory rate in the research group [(24.81±2.64) times/min] was significantly lower than that in the control group [(27.64±2.79) times/min], whereas PaO₂ and oxygenation index in the research group [(78.35±6.63) mm Hg and (314.20±42.17) mm Hg, respectively] were significantly higher than those in the control group [(70.26±6.21) mm Hg and (263.07±39.60) mm Hg, respectively; all P < 0.05]. The duration of mechanical ventilation in the study group [(4.27±1.39) days] was significantly shorter than that in the control group [(6.95±1.81) days, t=-4.971; P < 0.001]. The incidence and mortality of ARDS in the study group (18.75% and 3.12%) were significantly lower than those in the control group (39.06% and 14.06%, χ²=6.425, 4.873; all P < 0.05). Conclusion Rhubarb by nasal feeding can inhibit the inflammatory response of patients with ALI, promote the recovery of respiratory function and blood gas index and prevent the deterioration of the disease.

Clinical factors of the collateral formation of unilateral atherosclerotic middle cerebral artery occlusion

LIAO Zhao-liang, DONG Hai-yan, LU Zhen-chan

2021, 19(1): 59-61. doi: 10.16766/j.cnki.issn.1674-4152.001730

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Objective To explore the effect of clinical factors and biochemical indexes on the formation of unilateral large-artery atherosclerotic middle cerebral artery occlusion (MCAO) collaterals and to provide basis for its treatment. Methods A total of 198 unilateral aortic atherosclerotic patients with MCAO who were hospitalised in the Department of Neurology at Cangnan People's hospital from February 2016 to September 2019 were selected as the research subjects. They were divided into the good collateral (GC) and poor collateral (PC) groups on the basis of the formation of collaterals. The baseline data, medication data and biochemical tests of the two groups were compared. Multivariate logistic regression analysis was used to analyse the independent factors that affected the formation of unilateral aortic MCAO collaterals. Results Forty-eight cases were included in the GC group, and 150 cases were included in the PC group. The high-density lipoprotein (HDL) level in the GC group was (1.21±0.14) mmol/L, which was higher than that in the PC group [(0.94±0.11) mmol/L, t=13.810, P < 0.05]; the low-density lipoprotein (LDL), homocysteine (Hcy) and fasting blood glucose levels in the GC group were (2.41±0.85) mmol/L, (11.52±4.20) mmol/L and (5.45±1.84) mmol/L, respectively, whereas those in the PC group were (2.93±0.89) mmol/L, (13.71±4.06) mmol/L and (6.02±1.39) mmol/L, respectively, and the difference was statistically significant (t=3.560, 3.226, 2.276, respectively, P < 0.05). The National Institutes of Health Stoke Scale (NIHSS) in the GC group was lower than that in the PC group (t=3.201, P < 0.05), and the proportion of statins was higher than that in the PC group (χ²=6.406, P < 0.05). Hypertension, HDL, Hcy, NIHSS and statins affected the formation of collateral circulation of unilateral large-artery atherosclerotic MCAO independently. Conclusion Statins and high HDL levels can promote the formation of unilateral aortic MCAO collateral circulation, but high Hcy level and high NIHSS are not conducive to good collateral establishment.

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2021 Vol. 19, No. 1

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