2021 Vol. 19, No. 10

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Expert Forum
Deepen the reform of the medical and health system: The advantages of TCM general practice in primary medical services and suggestions on the construction of talent team
SHAO Yi-ying, MO Ying-ning, JIAO Ao-nan, XUE Si-yang
2021, 19(10): 1615-1618. doi: 10.16766/j.cnki.issn.1674-4152.002125
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The team of general practitioners is the core and cornerstone of China's primary medical service system and the backbone of basic medical and public health services. Strengthening the construction of the general practitioner team is the key to improving the level of primary medical services and promoting the implementation of the hierarchical diagnosis and treatment policy. Traditional Chinese medicine (TCM) is a gem of Chinese traditional culture, and its diagnosis and treatment philosophy has many similarities with general medicine. The development of TCM general medicine and the strengthening the construction of the TCM general medicine talent team are of great significance to the enrichment of the service forms of general practitioners and family doctors, reduction of medical expenses, improvement of the efficiency of primary medical services and promotion of the hierarchical medical system's implementation. This paper outlines the necessity and feasibility of strengthening the construction of the TCM general practitioner team. The advantages of TCM general practice in primary medical services and the problems in the construction of the TCM general practitioner team are analysed. Suggestions from the internal and external perspectives of the TCM general practice talent training system are put forward. Inside the system, improving the TCM general practice talent training system by strengthening the discipline construction and faculty construction of TCM general practitioners and improving the standardized training system for general practitioners of traditional Chinese medicine and continuing education system are recommended. Outside the system, improving supporting policies, strengthening informatization construction, building incentive mechanisms and strengthening publicity and education can provide a good environment for the construction of TCM general practitioners, as well as enhance the attractiveness of TCM general practitioners and promote the construction of a team of general practitioners with Chinese characteristics that integrate Chinese and Western medicine. Suggestions are provided for improving primary medical service capabilities, alleviating the contradiction between doctor and patient supply and demand, and constructing an efficient medical service system.
Basic principles for treatment of acute poisoning and treatment of common acute poisoning
WU Guang-fu, WU Xiao-fei
2021, 19(10): 1619-1620.
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Correlation between hypoglycaemia and cognitive dysfunction in elderly diabetic patients
ZHANG Jie, WANG Qiong, CAO Hong-wei
2021, 19(10): 1677-1679. doi: 10.16766/j.cnki.issn.1674-4152.002140
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  Objective  To explore the cognitive dysfunction in elderly diabetic patients with hypoglycaemia and to analyse the correlation between hypoglycaemia and cognitive dysfunction.  Methods  A total of 610 elderly diabetic patients admitted at our hospital from June 2019 to June 2020 were selected as the research subjects. The patients were divided into the severe hypoglycaemia group (n=24), mild hypoglycaemia group (n=277) and non-hypoglycaemia group (n=309). According to the frequency of hypoglycaemia, the patients were divided into the low-frequency group (≤3 times, 351 cases), medium-frequency group (3-7 times, 172 cases) and high-frequency group (≥8 times, 87 cases). Multiple stepwise regression was used to analyse the correlation between hypoglycaemia and cognitive function.  Results  (1) The cognitive function score of the non-hypoglycaemia group [(26.13±1.28) points] was significantly better than that of the mild [(24.92±1.12) points] and severe hypoglycaemia groups [(24.73±1.25) points, F=78.601, P < 0.01]. (2) Statistically significant differences were observed in the incidence of cognitive dysfunction amongst groups with different frequency of hypoglycaemia (P < 0.05). The incidence of cognitive dysfunction was the highest in the high-frequency group (68.97%) and the lowest in the low-frequency group (38.75%). Significant differences were observed in the incidence of cognitive dysfunction amongst groups with different degrees of hypoglycaemia (P < 0.05). The incidence of cognitive dysfunction was the highest in the severe hypoglycaemia group (75.00%) and lowest in the non-hypoglycaemia group (31.07%). (3) The occurrence, frequency and degree of hypoglycaemia were important factors affecting patients' cognitive dysfunction.  Conclusion  Hypoglycaemia is a risk factor for cognitive impairment in diabetic patients. The frequency and degree of hypoglycaemia can affect the cognitive level of elderly diabetic patients.
Efficacy evaluation of simplified 'six-word formula' combined with extracorporeal phrenic pace-making in pulmonary rehabilitation of patients with COPD stable period
FANG Ying, FANG Qun, WANG Shi-qiang, XU Yi-kai, LI Qin, CHEN Mei
2021, 19(10): 1680-1684. doi: 10.16766/j.cnki.issn.1674-4152.002141
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  Objective  To explore the effect of simplified 'six-word formula' combined with extracorporeal phrenic pace-making in pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD) stable period.  Methods  A total of 120 patients with COPD stable period in our hospital were selected from July 2017 to June 2019, and they were randomly divided into four groups, with 30 cases in each group. Group A was given basic treatment, group B was given the simplified 'six-word formula' training on the basis of group A, group C was given extracorporeal phrenic pace-making on the basis of group A, and group D was given simplified 'six-word formula' training combined with extracorporeal phrenic pace-making on the basis of group A. The intervention period of each group was 3 months. The TCM syndrome score, BODE index, quality of life and times of acute exacerbation in half a year of the four groups were compared.  Results  After intervention, the scores of TCM syndromes (6.82±1.57, 5.26±1.34, 5.63±1.28, 4.52±1.15), the score of quality of life in each dimension and total scores (44.21±9.07, 37.91±8.65, 39.92±7.83, 32.42±8.26), and the number of acute exacerbations (4.25±1.26, 3.32±0.87, 3.86±1.03, 2.62±0.79) in half a year in the four groups of patients were decreased compared with those before the intervention. Group D had the lowest scores, and the difference was statistically significant (all P < 0.05). After the intervention, the BODE index of the four groups decreased. The BODE index of group D (4.21±1.04) was lower than that of group A, B and C (5.32±1.67, 4.84±1.40, 5.23±1.35, respectively), and the difference was statistically significant (all P < 0.05).  Conclusion  The simplified 'six-word formula' combined with extracorporeal phrenic pace-making in pulmonary rehabilitation can effectively alleviate the clinical symptoms of COPD stable period patients, enhance the pulmonary function, reduce the number of acute attacks, reduce the BODE index and improve the quality of life of COPD patients.
Analysis of influencing factors of exclusive breastfeeding within 6 months in 445 preterm infants
WANG Dan-ni, WEI Ting, LUO Xiao-ting, HAN Zi-min, ZHU Min-li, CHEN Ying-ying
2021, 19(10): 1685-1688. doi: 10.16766/j.cnki.issn.1674-4152.002142
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  Objective  To investigate the situation of breastfeeding within 6 months and its influencing factors in preterm infants, and provide reference for breastfeeding intervention of premature infants.  Methods  A total of 493 participants were recruited as follow-up subjects from four tertiary hospitals in Wenzhou, Zhejiang Province by convenience sampling between April and December 2018. Twenty-one cases were lost during the 3-month return visit, 27 cases were lost during the 6-month return visit, and 445 cases were finally included. The basic data questionnaire and Edinburgh Postpartum Depression Questionnaire were used to collect data. Single-factor analysis of the influencing factors of exclusive breastfeeding rate in preterm infants within 6 months was carried out using χ2 test, and the meaningful variables of single-factor analysis were entered into multivariate logistic regression analysis.  Results  The breastfeeding rate was 27.2% (134/493) at discharge of preterm infants with exclusive breastfeeding rate of 9.3% (46/493). The breastfeeding rate at 3 months of corrected age was 39.2% (185/472), of which the exclusive breastfeeding rate was 18.4% (87/472). The breastfeeding rate at 6 months of corrected age was 28.1% (125/445), of which the exclusive breastfeeding rate was 11.7% (52/445). The regression results showed that breastfeeding history, postpartum depression, postpartum lactation time and family monthly income could affect the exclusive breastfeeding of premature infants within 6 months.  Conclusion  Medical workers should improve the breastfeeding knowledge and problem-solving skills of mothers of premature infants, especially those with no breastfeeding history and higher family income, ensure their normal lactation, carry out early psychological intervention to relieve their negative emotions, and increase the exclusive breastfeeding rate of premature infants within 6 months.
Clinical observation of different doses of pulmonary surfactant combined with INSURE technology in the treatment of neonatal respiratory distress syndrome
FENG Min, LUO Bing
2021, 19(10): 1689-1692. doi: 10.16766/j.cnki.issn.1674-4152.002143
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  Objective  To investigate the clinical effect of different doses of pulmonary surfactant (PS) combined with INSURE technology in the treatment of neonatal respiratory distress syndrome.  Methods  A total of 80 neonatal respiratory distress syndrome cases in the NICU of Anhui No.2 Provincial People's Hospital from January 2017 to September 2020 were selected as the research objects. According to the random number method, the children were divided into two groups with 40 cases in each group. Both groups were treated with INSURE technology and injected with PS. The control group was given 70 mg/kg PS, and the experimental group was given 100 mg/kg PS. The clinical efficacy, blood gas analysis index, oxygenation index, oxygen duration, length of hospital stay and incidence of complications of the two groups were compared before and after treatment.  Results  The total effective rate of the experimental group (100.0%) was higher than that of the control group (85.0%), and the difference was statistically significant (P < 0.05). The duration of oxygen use in the experimental group was significantly shorter than that of the control group (P < 0.05). No difference was observed in the length of stay between the two groups (P>0.05). No significant difference was observed in blood gas analysis and oxygenation indices between both groups before treatment (P>0.05). The blood gas analysis and oxygenation index after treatment were significantly improved compared with those before treatment; that is, PaO2 increased, PaCO2 decreased, and pH improved (all P < 0.05). The PaO2 [(77.55±5.79) mm Hg] of the experimental group was significantly higher than that of the control group [(72.45±4.37) mm Hg], whilst the PaCO2 [(39.45±2.45) mm Hg] was lower than that of the control group [(40.88±2.32) mm Hg]. The pH of the experimental group (7.36±0.02) was significantly better than that of the control group (7.35±0.02), with statistically significant differences (P < 0.05). The complication rate of the experimental group (12.5%) was lower than that of the control group (35.0%), and the difference was statistically significant (P < 0.05).  Conclusion  The treatment of neonatal respiratory distress syndrome with 100 mg/kg PS combined with INSURE technology can significantly improve the clinical symptoms, improve oxygenation and reduce the duration of oxygen use and clinical complications.
Expression and clinical significance of HIF-1α, VEGF and AMH in patients with polycystic ovary syndrome
QIN Wei, HUANG Xiao-hong, HUANG Hui-lian
2021, 19(10): 1693-1696. doi: 10.16766/j.cnki.issn.1674-4152.002144
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  Objective   To study the expression of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and anti-Mullerian hormone (AMH) in polycystic ovary syndrome (PCOS) and to explore their clinical significance.   Methods   A total of 130 cases of PCOS patients in our hospital from June 2018 to June 2020 were selected as the observation group, and 100 healthy women were recruited as the control group. The levels of follicle stimulating hormone (FSH), luteinising hormone (LH), prolactin (PRL), testosterone (T), progesterone (P) and estradiol (E2) were measured by immunochemiluminescence. The serum HIF-1α, VEGF and AMH levels were detected by enzyme-linked immunosorbent assay. The correlation between HIF-1α, VEGF and AMH and the predictive value of PCOS clinical significance were analysed.   Results   The levels of FSH [(5.81±0.92) mU/mL], LH [(10.54±0.72) mU/mL], PRL [(398.55±80.47) ng/mL], T [(7.76±2.27) nmol/L], P [(5.29±0.92) nmol/L] and E2 [(118.63±42.78) pmol/L] in the observation group were significantly higher than those in the control group (t=3.179, 12.150, 4.284, 11.223, 43.724 and 3.955, all P < 0.05). The levels of HIF-1α [(163.12±25.17) pg/L], VEGF [(257.03±30.45) pg/L] and AMH [(7.29±1.02) pg/L] in the observation group were significantly higher than those in the control group (t=42.592, 31.612 and 47.194, all P < 0.05). HIF-1α was positively correlated with VEGF and AMH levels (r=0.811, 0.848 and 0.762, all P < 0.05). The areas under the curve of serum HIF-1α, VEGF and AMH were 0.764, 0.731 and 0.742, and 95% confidence intervals were 0.681-0.852, 0.634-0.819 and 0.649-0.827, respectively.   Conclusion   The levels of HIF-1α, VEGF and AMH in patients with PCOS are significantly increased, which have high predictive value for PCOS and can be used as clinical diagnostic indicators.
Analysis of the clinical application value of balloon-induced labour in term pregnancy delivery
WANG Wen-xia, ZHANG Ying, SUN Mei-guo, RUAN Jing
2021, 19(10): 1697-1699. doi: 10.16766/j.cnki.issn.1674-4152.002145
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  Objective  To analyse the difference of clinical efficacy between balloon induced labor and oxytocin induced labor.  Methods  A total of 145 term pregnant women who received treatment at the Department of Obstetrics and Gynecology of Feidong County People's Hospital from April 2020 to December 2020 were selected. The study group included 89 cases of balloon-induced labour, whilst the control group included 56 cases of oxytocin-induced labour. The labour time, difference of birth rate time and differences between pregnancy outcome situation in both groups were compared using 2 test analysis.  Results  A total of 145 parturients met the inclusion and exclusion criteria of the study and were included in this study. The average gestational age was 39 weeks. The minimum gestational age was 37+1 weeks, and the maximum was 41+6 weeks. All pregnant women had indications related to labour induction. In this study, 89 cases of balloon-induced labour and 56 cases of oxytocin-induced labour were included. In terms of delivery mode, 117 cases underwent normal delivery, accounting for 80.70%. In 94 (64.80%) and 125 (86.20%) women, the first stage and second stage of labour lasted < 12 and < 2 h, respectively. About 76 cases (52.40%) were delivered within 12 h after manual intervention. The Apgar score of newborns was mostly 9 (51.70%). Compared with oxytocin-induced labour, balloon-induced labour significantly decreased the first and second delivery time (all P < 0.05). After using balloon, most of the women delivered within 12 h, whilst all women induced by oxytocin did not deliver until 24 h. After artificial intervention of balloon-induced labour, the delivery rate within 12 h was significantly increased (P < 0.05). In addition, compared with oxytocin induction, the natural birth rate and the Apgar score of balloon induction were significantly increased.  Conclusion  Balloon induction of labour can improve the natural birth rate and neonatal Apgar score. At the same time, it can decrease the first and second delivery time and the time from human intervention to delivery. Balloon induction of labour is worthy of clinical application.
Analysis of the core elements of the successful construction of "cardiac rehabilitation in the community" clinical path of community general practice care under hierarchical medical system
CHEN Bi-hua, LI Qing, JIANG Dan-ma, WANG Jun
2021, 19(10): 1700-1705. doi: 10.16766/j.cnki.issn.1674-4152.002146
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  Objective  Under the background of hierarchical diagnosis and treatment, with the application of advanced and appropriate technologies in specialized specialty communities as the source of technology, and the principle of technology introduction and re-innovation as the principle of acceptance and absorption, successfully constructing a community general medical diagnosis and treatment path for key specialized diseases, this study intends to clarify the challenges and major difficulties, and the core elements and basic principles of the countermeasures.  Methods  In March 2020, the Longhua "cardiac rehabilitation in the community" project was used as the research object. The preliminary decision-making, construction process and construction results of the project in the two-year construction period were sorted out by key insiders reviewing and historical data of the department sorting, and then summarized and condensed the practical experience by literature search and expert judgment.  Results  Four core elements were drawn: do a good job in basic guarantees, make the members of the organization realize the importance and inevitability of introducing technology for business development; choose technology carefully to ensure that technology can actually help the development of the community and the whole department; value technology interface, and integrate the advantages of specialization into translation and conversion into the general practice and community environment; through technology penetration, let technology not only solve the problem of cardiovascular disease but also the management of all chronic diseases of the same kind.  Conclusion  The "cardiac rehabilitation in the community" is a very complex and comprehensive project, which meets the characteristics of general practice. It faces the current situation of multiple roles, complex technology, and insufficient community resource allocation. Only by identifying all needs and available resources, and obtaining these resources through scientific, professional, and careful cooperation, integration and coordination, and then organic integration and export to community residents, attach importance to internal mobilization, external coordination, process management. It is technically inferior to other factors to make it possible to work.
Analysis on the characteristics of allergic diseases in health examination population of Beijing Medical Center
CHEN Si-yu, MA Li
2021, 19(10): 1706-1709. doi: 10.16766/j.cnki.issn.1674-4152.002147
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  Objective  To understand the current situation of allergic diseases in the health examination population of Beijing and provide the basis for formulating effective prevention measures and strengthening the prevention and control of allergic diseases.  Methods  Using a cross-sectional study, the patients who were selected for physical examination at the Beijing Physical Examination Center from June to September 2018 were divided into the allergic disease group and non-allergic disease group according to the history of allergic diseases. Characteristics such as basic condition, lifestyle, allergen condition and protective behaviour were analysed.  Results  A total of 8 938 people were included in the health examination, including 5 135 males (57.45%) and 3 803 females (42.55%). A total of 934 people were included in the allergic disease group, accounting for 10.45% of the selected physical examination population. More women had allergies than men (11.62% vs 9.58%, P < 0.05). Moreover, 671 cases had a single allergen (671/934, 71.84%), amongst which the most single drug allergy (330/671, 49.18%). A total of 1278 allergens were obtained; 39.91% (510/1 278) were drug allergens, of which 59.02% (301/510) were penicillin allergies and 401 were inhaled allergens (401/1 278, 31.38%). The proportion of people with low exercise frequency (less than five times per week, 80.95%) and short exercise time (less than 1 h each time, 84.21%) was high in the allergic disease group. High proportion of mild manual workers (77.09%), a high percentage (87.31%) of non-masked persons, haze outdoor activities within 2 h (65.81%) high proportion, less than half of those using air purifiers (41.35%).  Conclusion  The proportion of allergic diseases in the health examination population of Beijing is high, and individuals with allergic diseases do not pay attention to personal protective measures. According to the characteristics of allergic diseases in different populations, targeted protective measures should be taken for different types of allergens.
Effect of psychotherapy on digestive function and psychological state of elderly patients with functional dyspepsia
DAI Yi-qing, WANG Jin-jin, ZHANG Lei, DAI Jin-feng, ZHANG Wen-ting
2021, 19(10): 1710-1712, 1716. doi: 10.16766/j.cnki.issn.1674-4152.002148
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  Objective  To explore and analyse the effect of psychotherapy on the digestive function and mental state of elderly patients with functional dyspepsia.  Methods  From May 2018 to May 2020, 85 elderly patients with functional dyspepsia admitted at the First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang Province were selected and randomly divided into observation group and control group with 43 and 42 cases, respectively. The control group was given trimebutine maleate, whilst the observation group was given targeted psychotherapy on the basis of the control group. The therapeutic effects of the two groups were observed and recorded.  Results  Three months after treatment, the symptom scores of the two groups were significantly lower than those before treatment, and the symptom scores of the observation group were significantly lower than those of the control group (2.23±0.62 vs. 3.65±0.65, P=0.021). The SCL-90 scores of the two groups were significantly lower than those before treatment, and the SCL-90 score of the observation group was significantly lower than that of the control group (10.43±0.58 vs. 12.25±0.53, P=0.012). The quality of life scores of the two groups were significantly increased 3 months after treatment. The quality of life of the observation group was significantly improved 3 months after treatment and was significantly higher than that of the control group (85.36±5.81 vs. 73.53±5.86, P=0.008).  Conclusion  Trimebutine maleate combined with psychotherapy can effectively improve the digestive function and quality of life of elderly patients with functional dyspepsia and reduce the SCL-90 score.
Qualitative study of daytime rehabilitation experience in patients with high-compliance schizophrenia
LIU Ya-fang, XI Xiao-ling, XU Zhao-jun, LI Xian-wen
2021, 19(10): 1713-1716. doi: 10.16766/j.cnki.issn.1674-4152.002149
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  Objective  To explore the inner feelings and experiences of patients with high-compliance schizophrenia participating in daytime rehabilitation, and to provide reference for the development of effective interventions tailored to the needs of patients.  Methods  The purposive sampling method was used to select semi-structured interviews of 14 patients with high-compliance schizophrenia from November 2018 to January 2019 in Nanjing Youan Homeland Day Rehabilitation Center. The phenomenological research method in qualitative research was used to sort out and analyze the data.  Results  All 14 respondents were able to perceive the positive impact of daytime rehabilitation on their own diseases and life. On the basis of their rehabilitation experience, four themes were extracted from the analysis: the perception of rehabilitation effect showed that daytime rehabilitation improved negative emotions, and the frequency of relapse and rehospitalization decreased. Rehabilitation promoted cognitive reconstruction by affirming self-worth and reconstructing life pleasure. The establishment of rehabilitation promotion behaviour included improving life ability, establishing drug self-management mode, actively coping with the recurrence aura and actively using medical resources and social support. The conflict between management mode and practical problems was that it pays attention to treatment and management and neglects the feelings of patients and protective environment, which could not simulate the real society.  Conclusion  Patients with high-compliance schizophrenia are fully aware of the effect of daytime rehabilitation and the necessity of continuous rehabilitation. High-compliance rehabilitation exercise can effectively promote the stability of the disease, change the patient's cognition of the disease, improve social function and improve the quality of life. The daytime rehabilitation centre provides community rehabilitation services with multidisciplinary support for patients. It can meet the needs of patients and improve rehabilitation compliance by setting up diversified rehabilitation activities, which is a powerful guarantee for patients to return to society. The management of daytime rehabilitation mode is still in the exploratory stage, and the whole society should pay more attention to and participate in expanding the utilisation of mental health resources.
Association of related markers in blood routine examination with diagnosis and severity of acute cerebral infarction
TAO Tao, HE Ling-ling, ZHANG Ye-min
2021, 19(10): 1717-1720, 1783. doi: 10.16766/j.cnki.issn.1674-4152.002150
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  Objective  To investigate the relationship between diagnosis and severity of acute cerebral infarction (ACI) and neutrophil/lymphocyte ratio (NLR) and mean platelet volume/lymphocyte ratio (MPVLR).  Methods  From October August 2018 to June 2020, 125 ACI patients from Chaohu Hospital Affiliated to Anhui Medical University who were admitted within 24 h after onset were enrolled. They were divided into the mild ACI group (NIHSS < 5 points, n=70) and moderate and severe ACI group (NIHSS ≥ 5 points, n=55) according to the National Institutes of Health Stroke Scale (NIHSS) score. Another 75 healthy volunteers examined in our physical examination centre were selected as the control group. The values of NLR and MPVLR in predicting ACI were determined by constructing receiver operating characteristic curves. Pearson correlation analysis was used to evaluate the correlation between NE, NLR, MPVLR, PNR, and LYM and NIHSS score. The independent risk factors of ACI severity were analysed by multivariate logistic regression analysis.  Results  Serum MPV, NLR and MPVLR levels in the ACI group were significantly higher, whilst the levels of LYM and PNR were significantly lower than those of the control group (P < 0.05). The levels of NLR and MPVLR in the moderate and severe ACI group were significantly higher, whilst the levels of PNR and LYM were obviously lower than those in the mild ACI group (P < 0.05). The areas under the curve of NLR and MPVLR to predict ACI were 0.739 (0.672-0.806) and 0.704 (0.632-0.776), respectively. The NE, NLR and MPVLR levels in ACI were positively correlated with the NIHSS score (r=0.475, 0.582, 0.220, P < 0.05). The PNR and LYM levels were negatively correlated with the NIHSS score (r=-0.359, -0.223, P < 0.05). NLR was an independent risk factor for the severity of ACI (P < 0.05).  Conclusion  NLR and MPVLR have certain clinical significance for ACI diagnosis and evaluating the severity of ACI. NLR may be an independent risk factor for the severity of ACI. Monitoring these two indicators has a certain guiding value for the early evaluation and treatment of ACI.
Relationship between ultrasound features and expression of ER, PR, CerbB-2 and Ki-67 in breast cancer
CHEN Jia-jia, MENG Li-wei, LI Xing-yun
2021, 19(10): 1721-1724. doi: 10.16766/j.cnki.issn.1674-4152.002151
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  Objective  To analyse the ultrasonographic features of breast cancer patients and their relationship with estrogen receptor (ER), progesterone receptor (PR), CerbB-2 and Ki-67 positive expression so as to provide reference for clinical treatment plan.  Methods  Eighty cases of breast cancer patients in our hospital from January to December 2020 were selected as the research objects. All patients underwent breast ultrasound examination. ER, PR, CerbB-2 and Ki-67 were detected. Pearson correlation analysis was used to explore the relationship between ultrasound imaging characteristics and ER, PR, CerbB-2 and Ki-67 positive expression.  Results  A total of 29 cases had a tumor diameter ≤ 2 cm, 23 cases had regular shape, 35 cases had smooth edges, 36 cases had clear boundaries, 65 cases had hypoechoic or mixed echo, 50 cases had posterior attenuation, 51 cases had rich blood supply, and 24 cases had an aspect ratio ≤ 1. A total of 41 cases had microcalcification, and 41 cases had lymph node metastasis. The positive rates of ER, PR, CerbB-2 and Ki-67 in breast cancer patients were 60.00%, 56.25%, 48.75% and 77.50%, respectively. The edge, border, posterior attenuation and lymph node metastasis were positively correlated with ER (r=0.251, 0.303, 0.213, 0.308, all P < 0.05). The edge of lesion and lymph node metastasis were positively correlated with PR (r=0.065, 0.387, all P < 0.05). Blood supply and lymph node metastasis were positively correlated with CerbB-2 (r=0.184, 0.376, all P < 0.05). Microcalcification was negatively correlated with CerbB-2 (r=-0.023, P < 0.05). The diameter of lesion was positively correlated with Ki-67 (r=0.258, P < 0.05).  Conclusion  A certain correlation exists between the ultrasound characteristics of breast cancer and the positive expression of ER, PR, CerbB-2 and Ki-67.
Predictive value of reticulocyte parameters and relative value of immature granulocytes in adverse pregnancy outcome
WU Xiu-ji, WANG Yong-qing, QIU Mei-hua
2021, 19(10): 1725-1728. doi: 10.16766/j.cnki.issn.1674-4152.002152
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  Objective  To investigate the predictive value of reticulocyte parameters and immature granulocytes in pregnant women with adverse pregnancy outcomes.  Methods  A total of 100 non-pregnant women, 300 normal pregnant women and 201 unhealthy pregnant women were divided into three groups. The reticulocyte percentage (Ret%), immature reticulocyte index (IRF), reticulocyte haemoglobin (Ret-He), and relative value (%IG) of immature granulocytes and haemoglobin (Hb) were detected by XN-9000 automatic haematology analyser (Sysmex, Japan). The ROC curve was used to explore the predictive value of reticulocyte parameters and relative value of immature granulocytes for adverse pregnancy outcomes of pregnant women.  Results  Compared with the non-pregnancy group, the unhealthy pregnant women group had significantly reduced Hb and Ret-He and increased IRF (P < 0.05), whilst the normal pregnancy group had significantly reduced Hb and significantly increased Ret%, IRF and %IG (P < 0.05). Compared with the normal pregnancy group, the unhealthy pregnant women group had significantly reduced Hb, Ret%, IRF, Ret-He and %IG (P < 0.05). The areas under the ROC curve of Ret%, IRF, Ret-He and %IG were 0.611, 0.619, 0.727 and 0.821, respectively. The best predicted cut-off values were 1.695, 14.100, 32.450 and 1.350. The sensitivity values were 0.814, 0.833, 0.502 and 0.671, whereas the specificity values were 0.375, 0.667, 0.875 and 0.896.  Conclusion  The Ret%, IRF, Ret-He and %IG are related to the occurrence of adverse pregnancy outcomes. The %IG predicts the occurrence of adverse pregnancy outcomes with the greatest specificity, whilst IRF has the highest sensitivity. Reticulocyte parameters combined with the detection of the relative value of immature granulocytes have certain value in predicting the adverse pregnancy outcomes of pregnant women.
Current status and challenges of health management for osteoporosis
GUAN Jing-jing, CHEN Yu, TANG Hua-dong, ZHOU Ping-hui
2021, 19(10): 1729-1732. doi: 10.16766/j.cnki.issn.1674-4152.002153
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Osteoporosis is the main cause of osteoporosis fracture in the elderly, which seriously affects the quality of life of patients and increases economic burden. The main causes of osteoporosis include the decrease of bone density, the destruction of bone microstructure and the decrease of bone strength. At present, the main treatment for decreased bone mineral density is to use anti-bone absorption drugs (such as bisphosphonates, calcitonin), bone formation-promoting drugs (parathyroid hormone) and some traditional Chinese medicine. However, the effect of drug treatment is not ideal. Despite surgical intervention, many complications exist. In recent years, with the establishment of the idea of three-level prevention, the health management of osteoporosis from the perspective of one-level prevention has become the mainstream method to prevent osteoporosis and related fractures. In this study, the source of osteoporosis health management and the relationship between patients and medical staff are introduced briefly, including some measures of osteoporosis health management and the challenges in the current development. In addition, the osteoporosis of postmenopausal women is mainly caused by the decrease of bone density caused by the loss of oestrogen. Thus, its preventive measures are different from those of senile osteoporosis, which should be described separately. The current situation of the three-level diagnosis and treatment system in China needs to be solved, a more scientific evaluation standard of osteoporosis should be developed, and patients' compliance with diet and living habits in the health management plan need to be strengthened. In addition, we should improve and develop the application of oestrogen in the health management of perimenopausal women's osteoporosis from the type, dose, duration and individual situation of estrogen, and finally play the primary preventive role of health management in osteoporosis and related fractures.
Research progress on the mechanism of hypoxic liver injury and the changes of coagulation factor levels
WANG Zhen, ZHANG Pei-li, YANG Fa-man
2021, 19(10): 1733-1736. doi: 10.16766/j.cnki.issn.1674-4152.002154
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The liver is the main organ that synthesises blood coagulation factors. Damage to liver function in a normoxic environment will affect the synthesis of blood coagulation factors and cause bleeding and other diseases. Hypoxic environment (high altitude) and the presence and aggravation of underlying diseases (cardiogenic, pulmonary and blood system diseases) can cause hypoxia in liver tissue. Hypoxic liver disease is defined as the lack of blood supply to the liver (preload failure) or severe congestion (afterload failure), which causes ischemia, hypoxia and even necrosis of hepatocytes in the central area of the liver. In terms of liver-derived diseases, non-alcoholic fatty liver disease, alcoholic liver injury, liver fibrosis, cirrhosis, ischemia-reperfusion liver injury and other liver diseases all have liver tissue hypoxia. The common feature of these diseases is first manifested in the liver itself, and liver tissue hypoxia is caused by the imbalance of metabolic supply and demand. The body will experience changes in the level of coagulation factors under chronic hypoxia. For example, if residents in high-altitude areas live in a low-oxygen environment for a long time, the body will have compensatory changes in blood cell counts, such as increased levels of red blood cells and hemoglobin, resulting in thick and sticky blood; stagnation, thrombosis or microthrombus formation in a hypercoagulable state; prolongation of prothrombin time and partially activated prothrombin time; and abnormal expression of secondary partial coagulation factors. Thus, the blood coagulation function of patients with liver disease and whether liver-derived diseases will affect the expression of coagulation factors need to be determined. This article describes the mechanism of hypoxic liver injury in various liver-derived diseases and the changes in blood coagulation factors after hypoxic liver injury.
Effect of kinesio taping on the core muscle groups of children with cerebral palsy and the prevention of abnormal gait
XU Yan, WU Feng-feng, HE Feng-xiang
2021, 19(10): 1737-1741. doi: 10.16766/j.cnki.issn.1674-4152.002155
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  Objective  To investigate the effect of kinesio taping on the core muscle groups of children with cerebral palsy and its preventive effect of abnormal gait so as to provide a reference for the clinical prevention of abnormal gait in children with cerebral palsy.  Methods  Fifty children with cerebral palsy admitted at Huzhou Central Hospital from January 2017 to May 2019 were selected. They were divided into two groups according to simple randomisation, with 25 cases in each group. The control group was given routine rehabilitation training, whereas the observation group was given kinesio taping. The two groups were intervened for 2 months, and a balance training detector was used to evaluate the trunk stability control indicators of the two groups when the eyes were opened. The core muscle strength changes, Berg Balance Scale (BBS) score, Tinetti Gait Analysis (TGA) and gait test data, comprehensive spasticity scale (CSS), modified Barthel index (MBI) and gross motor function evaluation form (GMFM-88) before and after intervention were compared between the two groups.  Results  After intervention, the standard deviations of the displacement in the observation group before and after COP and the left and right directions, the average movement speed of the front and rear and the left and right directions were lower than those in the control group. The rectus abdominis, erector spinae, gluteus maximus and iliopsoas muscle scores of the observation group were higher than those of the control group (all P < 0.05). The BBS and TGA scores of the observation group after intervention were (35.51±3.67) and (10.23±1.13) points, which were higher than those of the control group (30.49±2.98) and (7.49±1.08) points, respectively (all P < 0.05). After intervention, the left-side step length, right-side step length, left-side step speed and GMFM-88 scale A-E scores of the observation group were higher than those of the control group, and the step width of the observation group was lower than that of the control group (all P < 0.05). After intervention, the CSS score and MBI score of the observation group (7.48±1.27 and 80.67±7.08) were lower and higher than those of the control group (9.11±1.18 and 72.39±7.19), respectively (all P < 0.05).  Conclusion  Kinesio taping can improve the trunk stability control ability of children with cerebral palsy, increase the muscle strength of the core muscle group, improve the body's balance ability, prevent and correct gait abnormalities and improve children's daily life ability and gross motor function.
Observation on the clinical effect of meridian flow theory combined with five elements music therapy in treating insomnia with deficiency of heart and spleen
JIN Jie, CHEN Zi-jun, LIN Li-hua, ZHOU Dan-yu, ZHENG Jian-gong
2021, 19(10): 1742-1744, 1796. doi: 10.16766/j.cnki.issn.1674-4152.002156
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  Objective  To observe the clinical effect of meridian flow theory combined with five elements music therapy on insomnia caused by deficiency of heart and spleen.  Methods  Seventy-two cases of insomnia with deficiency of both heart and spleen in Zhejiang Tongde hospital from June 2019 to June 2020 were selected and randomly divided into observation group and control group according to random number table method, each group of 36 cases. The control group only used the five elements of music intervention, the observation group was given the meridional flow combined with the five elements of music intervention method. The scores of the Pittsburgh Sleep Quality Index (PSQI) scale before and after treatment and the scores of TCM syndromes related to insomnia with deficiency of heart and spleen were compared between the two groups, and the clinical efficacy of the two groups was compared.  Results  Before treatment, there were no statistically significant differences in subjective sleep quality, sleeping time, sleeping time, sleep efficiency, sleep disorder, daytime function, sleeping drugs and PSQI total score (all P>0.05). After treatment, the above indicators were improved in both groups, and the sleep quality scores and total PSQI scores in the observation group were significantly lower than those in the control group (all P < 0.01). Before treatment, there was no difference in TCM syndrome score between the two groups (t=0.191, P>0.05). After treatment, TCM syndrome scores in both groups were improved, and those in the observation group were significantly lower than those in the control group (t=26.886, P < 0.01). The total effective rate of clinical treatment in the observation group was significantly higher than that in the control group (χ2=8.692, P < 0.01).  Conclusion  The combination of meridian flow theory and five-element music therapy can obviously improve the clinical symptoms of insomnia patients with deficiency of heart and spleen and improve the clinical treatment effect, which is worthy of clinical promotion and use.
Investigation and analysis on the current situation and demand of continuing medical education for paediatricians in community health service institutions
YIN De-lu, WANG Xi, YIN Tao
2021, 19(10): 1745-1747, 1751. doi: 10.16766/j.cnki.issn.1674-4152.002157
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  Objective  To evaluate the current situation and demand of continuing medical education (CME) and training for paediatricians in community health service institutions and to provide reference for improving the serviceability of existing community paediatricians.  Methods  A total of 378 cases were successfully investigated by using a self-designed questionnaire, which was filled in by paediatricians (including general practitioners who can see paediatric diseases) voluntarily and anonymously online. Excel was used for data processing, and SAS 9.1 statistical software was used for data processing.  Results  From the current situation, 19.05% of the respondents said that they had received the needs of CME, and 55.82% said that the applicability of training content was ' very good or good'. The satisfaction of training teachers was 66.67%, which was higher than that of training content (61.38%) and training form (59.26%). The proportion of ' common drug use ' in CME was the largest (82.01%), and that of ' online learning' in CME was the highest (80.16%). From the perspective of demand, ' diagnosis and treatment of diseases', ' common use of drugs' and 'emergency treatment' had the highest demand for training community paediatricians, accounting for 85.45%, 87.83% and 85.19%, respectively. 'Training course', 'academic lecture meeting' and ' E-Learning' were the three most desirable forms of training for grassroots paediatricians, accounting for 66.14%, 60.85% and 61.90%, respectively.  Conclusion  At present, the evaluation of the training needs of community paediatricians was insufficient. Thus, the training content, training form and training effect need to be further improved. The training content and form needs of community paediatricians had their uniqueness and differences, so we should pay attention to their personalised training needs.
Practical exploration of workshop teaching mode in general practitioners' transfer training
WEI Na-na, LIANG Bing, LI Yi-wen, WU Wan, SUN Na, LEI Si-si
2021, 19(10): 1748-1751. doi: 10.16766/j.cnki.issn.1674-4152.002158
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  Objective  To evaluate the training effect of the workshop teaching mode in general practitioners' transfer training.  Methods  All students who participated in the transfer training of general practitioners of Anhui City Hospital from December 23, 2019 to January 10, 2020 were selected as the research objects. The workshop teaching model was used to carry out three teaching activities for all students, including general outpatient teaching, teaching case discussion and general teaching. The effects of teaching activities were assessed through on-site questionnaire survey. Moreover, the feelings and experience to the workshop teaching mode of general practice transfer physicians who participated in the training were investigated. The data were sorted and analysed by SPSS 22.0 software.  Results  A total of 243 trainees were investigated, and 231 valid questionnaires were recovered on site (95.1%). In general, the majority of students (84.9%) believed that the teaching model was excellent, and 14.7% and 1.3% of students thought it was good and general, respectively. In terms of training sessions, the recognition of case discussion teaching was the highest, with an excellent rate of 81.8%, whilst the excellent rate of general outpatient teaching demonstration was relatively low (72.7%). From the perspective of training effects, most students greatly improved their abilities in various dimensions: general practice theory (83.1%), general practice outpatient consultation ability (81.4%), basic clinical skills (82.3%), medical record writing (84.4%), doctor-patient communication skills (81.4%), human-centred clinical thinking (74.5%), general practice thinking (82.7%) and self-learning (78.8%). The main suggestions and opinions put forward by the trainees included strengthening the knowledge transfer of disease and health management (57.1%), insufficient personalised training (54.1%), unstandardised training program system (36.8%), insufficient teaching material construction (25.6%), improvement of assessment plan (22.5%) and strengthening of bilingual teaching (15.2%).  Conclusion  The workshop teaching model has an excellent effect on improving the comprehensive ability of general practitioners.
Influence of PBL combined with interclass probation teaching on paediatric teaching effect
WANG Lei, XU Jia-xin, CHEN Xin, ZHU Hong-wei, ZHOU Rui, DING Zhou-zhi
2021, 19(10): 1752-1754. doi: 10.16766/j.cnki.issn.1674-4152.002159
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  Objective  To analyse the influence of problem-based learning (PBL) combined with interclass probation teaching on scientific theory test scores, students' learning ability and students' satisfaction with teaching effect.  Methods  A total of 80 undergraduates majoring in clinical medicine in Bengbu Medical College in 2015 were selected as the study subjects. The subjects were divided into observation group and control group by random number table method, with 40 students in each group. The control group adopted the traditional pure theory teaching mode, whilst the observation group adopted the PBL teaching mode combined with interclass probation. After the end of teaching, the theoretical test scores of both groups were compared. In addition, the differences of learning ability in five aspects, including self-study ability, literature review ability, problem analysis ability, communication ability and summary ability, and the satisfaction degree of both groups to the teaching effect were compared.  Results  The theoretical test scores of students in the observation group were (87.41±5.59) points, and those in the control group were (73.32±7.98) points. The difference was statistically significant (t=9.146, P < 0.001). The t-values of both groups for self-learning ability, literature review ability, problem analysis ability, communication ability and summary ability were 16.102, 12.215, 15.813, 11.934 and 12.624, respectively. The differences were statistically significant (all P < 0.001). The satisfaction degree of teaching effect in the observation group was also higher than that in the control group, and the difference was statistically significant (Z=6.391, P < 0.001).  Conclusion  PBL combined with interclass probation teaching can improve students' learning initiative, improve teaching effect and enhance clinical thinking ability. It is a high-quality teaching mode in line with the law of education and the training of qualified medical personnel.
Association between frailty and sleep quality in kidney transplant recipients
PENG Fu-cong, WANG Han, HU Shu-jing, LI Xin, GUO Xue-jie, LIU Hong-xia
2021, 19(10): 1755-1759. doi: 10.16766/j.cnki.issn.1674-4152.002160
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  Objective  To explore the association between frailty and sleep quality in order to provide evidence for the prevention and treatment of frailty in kidney transplant recipients.  Methods  A questionnaire survey was conducted among 200 renal transplant recipients. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and frailty was measured using the Tilburg frailty indicator. Non-parametric tests were used for comparing the differences of sleep quality between frail and non-frail recipients. Spearman correlations were used to analyse the relationship between sleep quality and frailty in kidney transplant recipients.  Results  The rate of frailty was 41%, with medianscores of 3 (2, 6). The highest score was recorded in the area of physical frailty. Twenty percent of recipients had poor sleep quality, with common sleep problems such as daytime dysfunction (39.50%), sleep latency (35.50%) and subjective sleep quality (22.50%). The results of non-parametric tests suggested that the sleep quality was significantly better in non-frail renal transplant recipients than in frail recipients (Z=-5.745, P < 0.001). The PSQI score of kidney transplant recipients was positively correlated with the TFI score, with a correlation coefficient of r=0.452 (P < 0.001). Physical and psychological frailty were related to several sleep problems. Amongst the components of the PSQI, daytime dysfunction and frailty had the strongest correlation (r=0.491, P < 0.001).  Conclusion  The incidence of frailty in kidney transplant recipients is high, and some of them face multiple sleep problems. Poor night-time sleep quality rather than inadequate sleep duration may be related to frailty. Recipients with poor sleep quality may experience frailty, suggesting that nurses should pay more attention to identifying sleep disorders, especially sleep irregularity, frequent nocturnal awakenings and sleep breathing disorders, so as to provide effective interventions and improve sleep quality in kidney transplant recipients.
Consideration and analysis of public information disclosure and personal information protection in epidemic response
PENG Ying-chun
2021, 19(10): 1760-1763, 1788. doi: 10.16766/j.cnki.issn.1674-4152.002161
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The disclosure of public information in epidemic prevention and control is the key to the credibility of the government. The timely and accurate disclosure of epidemic monitoring information highlights the responsibility of the government. The release of information on the activities of confirmed cases is beneficial to the precise prevention of the epidemic situation. In dealing with the epidemic situation, the protection of personal privacy information is a basic right and interest of individuals, which should adhere to the ethical principle of 'people-oriented', not only to ensure the safety of the individual's life, but also to safeguard the individual's dignity. The disclosure of public information should be based on the protection of individual privacy. Government departments should strengthen the effective supervision of information security whilst making public health monitoring information in a timely manner. Information concerning the privacy of individuals must be properly protected. In view of the emergency needs of epidemic prevention and control, professional and technical institutions such as the Centers for Disease Control and Prevention and medical institutions have the legitimacy of access to personal information and the protection of personal privacy mandatory at special times. From the viewpoint of interest distribution, conflict and coordination between the public's right to know and the individual's right to privacy in epidemic prevention and control are in essence the restriction and balance between public interest and individual interest. In the special period of the epidemic response, the government and relevant departments need to properly coordinate the tension between individual interests and public interests. They should not maximise public interests at the expense of individual interests, and they should safeguard individual interest and public interest. In response to an epidemic, when it is necessary to restrict or interfere with certain individual rights for reasons of public interest, the infringement of citizens' rights should be kept to a minimum. The appropriate restriction of individual rights and interests should be in accordance with the reasonable requirement of the collective protection of public interests and should be a temporary measure that must be taken in view of the situation at that time.
Investigation and analysis on the attitude and behaviour intention of medical staff in cancer hospital to advance care planning
SHAO Qiu-yue, WANG You-qing, YU Xin-yan, XIE Shu-ping, HAN Na
2021, 19(10): 1764-1767, 1771. doi: 10.16766/j.cnki.issn.1674-4152.002162
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  Objective  To investigate the attitudes and behavioural intentions of medical staff in a specialised cancer hospital in Zhejiang Province towards advance care planning (ACP) in order to provide reference for the relevant work in the field of palliative care.  Methods  A random sampling method was used to investigate 520 medical staff in a specialised cancer hospital in Zhejiang Province from August to November 2019. The general data questionnaire and the pre-established medical care plan attitude and behavioural intention questionnaire were used to conduct the investigation and study.  Results  Approximately 99.8% of the medical staff believed that it is very important to understand the patient's life intention; 98.5% believed that medical decisions should be made after discussion amongst the patient, family members and doctors; and 96.3% agreed that family members should be involved. The participation rate of ACP behaviour of medical staff in the cancer hospital was 26.6%. In terms of assisting patients to set up living will in advance, 78.4% were willing, 6.0% were not clear, and 15.6% were unwilling. Univariate analysis showed significant differences in working years, marriage, education level, bereavement experience and cognition of pre-set medical care plan on ACP attitude and behaviour amongst medical staff in the cancer hospital (P < 0.05). Multivariate analysis found that married, high education, bereavement experience and cognition of pre-set medical care plan were factors influencing the attitude and behaviour intention of medical staff in the cancer hospital to implement ACP.  Conclusion  In general, medical staff showed positive acceptance of ACP attitudes and behavioural intentions towards patients with advanced cancer, and ACP attitudes amongst medical staff were affected by education and marital status. Some differences were observed in the treatment of patients amongst the medical staff who were more inclined to the implementation of ACP and more willing to help patients sign a living will.
Analysis of human resource allocation and input-output efficiency in a third-grade A specialised hospital in Nanjing
ZHOU Yang, WANG Fan-ke, YANG Duo-er, WANG Lei, JI Yue-hua
2021, 19(10): 1768-1771. doi: 10.16766/j.cnki.issn.1674-4152.002163
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  Objective  To analyse the human resource allocation status and input-output efficiency of public hospitals so as to provide decision support for optimising human resource allocation and increasing efficiency in public hospitals.  Methods  Taking a third-grade A specialised hospital as a research sample, the basic situation of human resources from 2012 to 2020 and the current distribution of staff's age, education and professional titles in the sample hospital were described, and the human resource input-output efficiency from 2012 to 2019 was analysed with data envelopment analysis (DEA).  Results  At present, the proportions of health technicians (84.66%), nurses with junior college degree or above (99.42%) and pharmacists with full-time bachelor's degree or above majoring in pharmacy (40.00%) reached the standards of the Detailed Rules for Implementation of Accreditation standards for Third-grade Stomatological Hospitals (2011 Edition) in the sample hospital. However, the percentage of nurses in health technicians (43.73%) and the ratio of medical staff and nurses (1 ∶ 0.89) did not meet the above standards. Meanwhile, the number of nursing staff was low, and nurses had low education level, low professional titles and low average age. According to the DEA results, the input-output efficiency of human resources in 2015 and 2019 was relatively effective in the sample hospital. In 2013, 2014, 2016, 2017 and 2018, the input-output efficiency of human resources needed to be optimised. In 2017 and 2018, the staff redundancy was over 15.  Conclusion  Under the background of normalisation of the prevention and control of COVID-19, the sample hospital should formulate talent introduction plan, improve the details of the medical service process, promote the enthusiasm of nurses and attach importance to the training of young talents.
Studies on the influencing factors of self-management of discharged patients with urinary catheters after cervical cancer surgery
WANG Yao, WANG Chun-lan, YU Hui-yan, FU Li-ying, ZHANG Wan-ping
2021, 19(10): 1772-1774. doi: 10.16766/j.cnki.issn.1674-4152.002164
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  Objective  To investigate and analyse the influencing factors of self-management of discharged patients with indwelling urinary catheters after cervical cancer surgery, and provide certain references for improving self-management behaviours.  Methods  Using convenience sampling method, cervical cancer patients who underwent radical hysterectomies from February 2020 to May 2020 and inserted with urinary catheters after discharge were randomly selected as research objects. The general information questionnaire and self-management ability scale were also used to obtain data.  Results  The total score of self-management ability was (136.51±19.75), 53.33% of which were above-average level (72/135). Univariate analyses showed that age, education level, annual family income, medical insurance type, residential environment and main family caregiver were influencing factors of self-management abilities of discharged patients with urinary catheters after surgery (F=6.388, 7.130, 4.926, 8.571, 10.968, 4.261, all P < 0.05). Multiple linear regression analyses showed that annual family income and residential environment were related influencing factors of self-management ability (F=-3.239, -2.041, all P < 0.05).  Conclusion  Age, occupation, annual family income and residential environment are the influencing factors of self-management abilities of discharged patients with urinary catheters after cervical cancer surgeries. The management intervention of relevant factors can provide scientific guidance for clinical nursing and improve the quality of life of patients.
Construction of a responsibility index system of case managers for inflammatory bowel disease
TANG A-mao, NING Li, LOU Li-lan, YE Liu-ya, XU Jia-ying, LYU Wen
2021, 19(10): 1775-1779. doi: 10.16766/j.cnki.issn.1674-4152.002165
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  Objective  To constructe an index system of job responsibilities of case managers for inflammatory bowel disease (IBD), and direct the appointment and job responsibilities of case managers for IBD.  Methods  Through consulting domestic and foreign literature and semi-structured interviews, the first draft of the job responsibility index system of IBD case managers was constructed. Using Delphi expert consultation method, 16 experts in the fields of IBD and digestive medical care in medical colleges or third-class hospitalA hospitals were selected for two rounds of expert consultation. After the first round of expert consultation, two secondary indicators and four tertiary indicators were revised, three tertiary indicators were added, and the three tertiary indicators were combined in combination with the opinions of experts and research group. In the second round of expert consultation, the three tertiary indicators were modified, and the expert positive coefficient, variation coefficient, authority of expert opinions and Kendall harmony coefficient were calculated.  Results  Finally, a job responsibility system for IBD case managers was formed, including 5 primary indicators (evaluation, planning, implementation, evaluation and research), 19 secondary indicators and 75 tertiary indicators. The mean value of the first round of importance assignment was 3.94-5.00, and the coefficient of variation was 0.000-0.235. The mean value of each index in the second round of importance assignment was 4.06-5.00, and the coefficient of variation was 0.000-0.229. In the two rounds of expert consultation, the expert enthusiasm coefficient was 100.00%, the authority coefficient was 0.863, of which the judgment coefficient was 0.850 and the familiarity coefficient was 0.863.  Conclusion  The job responsibility index system of IBD case managers includes five aspects: evaluation, planning, implementation, evaluation and research. The expert opinions are concentrated, the results are scientific and practical, which reflect the disease management characteristics of patients with IBD, and can provide a reference basis for the appointment, evaluation and assessment of IBD case managers.
Analysis of dietary energy intake in overweight and obese patients with type 2 diabetes mellitus
YU Bi-jun, SONG Ying-xiang, QIN Hua-zhen, CHEN Ying-ting, CHEN Ping, WANG Jin-wei, PANG Cai-zhen
2021, 19(10): 1780-1783. doi: 10.16766/j.cnki.issn.1674-4152.002166
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  Objective  To investigate and analyse the dietary energy intake of overweight and obese patients with type 2 diabetes (T2DM).  Methods  A total of 128 T2DM patients admitted at our hospital from February 2018 to February 2020 were selected as the research object. They were divided into the normal weight group (45 cases), overweight group (35 cases) and obesity group (48 cases). A total of 45 healthy non-diabetic patients (healthy physical examination group) who visited our outpatient department during the same period were selected as controls. The daily total energy intake and dietary fibre intake of the three groups were compared and analysed, and the intake, energy supply and energy ratio of the three nutrients in each group were compared.  Results  The average daily total energy intake of the obesity group was significantly higher than that of the normal weight group and the hyperrecombination group (all P < 0.01). The carbohydrate intake in the obesity group was significantly higher than that in the normal weight group and the hyperrecombination group (all P < 0.01). The carbohydrate energy supply in the obesity group was significantly higher than that in the normal weight group and the hyperrecombination group (all P < 0.01). No statistical significance was observed in the comparison of fat and protein energy supply amongst the three groups (all P>0.05). The carbohydrate, fat and protein energy ratio results of the three groups were not statistically significant (all P>0.05) and were all higher than the recommended amount in the guidelines. No statistically significant difference was observed in dietary fibre intake amongst the three groups (P>0.05), which was lower than the recommended amount in the guidelines.  Conclusion  The dietary energy intake and daily total energy intake of obese T2DM patients are high, and the food source of excess energy is mainly carbohydrate. Clinical treatment for obese T2DM patients should involve limiting the intake of total energy and carbohydrate, reducing the fat energy supply ratio and appropriately increasing the intake of dietary fibre.
Evaluation of the effect of the high-quality nursing in the treatment of limb trauma under VSD
WANG Fang, XI Qing-hong, TAO Hai-rong, QIU Shuang-ling
2021, 19(10): 1784-1788. doi: 10.16766/j.cnki.issn.1674-4152.002167
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  Objective  To explore the effect of high-quality nursing on rehabilitation, satisfaction and quality of life of patients with extremity trauma treated by vacuum sealing drainage (VSD).  Methods  A total of 98 patients with limb trauma admitted to the Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University from March 2018 to October 2019 were randomly divided into observation group and control group, 49 cases in each group. All patients were treated with VSD. The times of dressing change, wound healing time, wound healing treatment cost, clinical nursing satisfaction, pain (VAS) score, swelling circumference and quality of life score before and one month after nursing were observed.  Results  After the high-quality nursing intervention, there was statistical significance in the dressing change times of the control group and the observation group [(4.19±0.71) times vs. (2.43±0.42), wound healing time [(26.62±6.31) d vs. (20.57±5.12) d], wound healing treatment cost [(3 245.86±254.39) yuan vs. (1 628.09±103.54) yuan (all P < 0.05). The satisfaction of patients and their families to clinical nursing increased from 81.64% to 97.96%, the difference was statistically significant (P < 0.05). Before nursing, there was no difference in VAS score, swelling circumference and quality of life between the two groups. After one month of nursing, the VAS score of the observation group was significantly lower than that of the control group [(1.93±0.46) points vs. (6.98±1.41) points], the swelling circumference was significantly shortened [(1.21±0.15)mm vs. (12.91±0.19) mm], and the score of quality of life was significantly improved [(90.24±5.09) points vs. (65.28±2.61) points], and better than the control group [(4.02±0.86) points, (4.12±0.18)mm, (78.59±4.52) points], the differences were statistically significant (all P < 0.05).  Conclusion  High-quality nursing care in the treatment of limb trauma patients with VSD surgery has a positive impact on the rehabilitation effect and satisfaction, which can not only reduce the VAS score, swelling, number of dressing changes and wound healing time, but also improve the quality of life score and clinical nursing satisfaction and shorten wound healing time.
Clinical analysis and nursing measures of cutaneous GVHD after allogeneic haematopoietic stem cell transplantation in 152 patients
ZHANG Ting, HAN Ai-zhi, LONG Zhang-biao, GE Jian, YANG Ming-zhen
2021, 19(10): 1789-1792. doi: 10.16766/j.cnki.issn.1674-4152.002168
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  Objective  To explore the clinical characteristics and risk factors associated with cutaneous graft-versus-host disease (GVHD) after allogeneic haematopoietic stem cell transplantation (allo-HSCT) and put forward prevention and treatment nursing countermeasures for cutaneous GVHD.  Methods  The clinical data of 152 patients who received successful allo-HSCT from June 2008 to December 2019 and were followed up for more than six months were retrospectively analysed. Data regarding patient transplantation, including the occurrence of cutaneous GVHD, patients' conditions and disease-related information, were recorded. Follow-up to June 22, 2020, using inpatient records, outpatient, telephone and WeChat platform follow-up. Patients with cutaneous GVHD were given individualised comprehensive nursing interventions according to their grade or severity.  Results  A total of 94 cases of cutaneous GVHD were diagnosed in 152 allo-HSCT patients, with an occurrence rate of 61.84%. Amongst them, 36 cases (23.68%) were acute, and 69 cases (45.39%) were chronic. Multi-factor analysis showed that high-risk patients, blood type mismatch, human leucocyte antigen mismatch and the occurrence of systemic chronic GVHD were important risk factors for cutaneous GVHD. After the treatment and care of 94 cases of cutaneous GVHD, 70 cases of cutaneous injury improved, and 24 cases died. The fatality rate was 25.53%.  Conclusion  Cutaneous GVHD seriously affects patients' daily life and prognostics. Thus, donors with compatible blood type and HLA type should be preferred, and effective nursing intervention programs should be performed to reduce the degree of cutaneous injury of patients.
2021, 19(10): 1793-1796. doi: 10.16766/j.cnki.issn.1674-4152.002169
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General Practice Research
Nuclear receptor corepressor 1 significantly attenuates myocardial infarction injury in mice
QIN Zi-han, CHEN Ying-min, PU Jun
2021, 19(10): 1621-1625,1653. doi: 10.16766/j.cnki.issn.1674-4152.002126
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  Objective   To explore the effect of nuclear receptor corepressor 1 (NCoR1) derived from cardiomyocytes on myocardial infarction injury in mice.   Methods   Cardiomyocyte-specific NCoR1 knockout mice were constructed and divided into the sham operation wild-type group, sham operation gene knockout group, myocardial infarction wild-type group and myocardial infarction gene knockout group, with 50 mice in each group. The survival rate and cardiac function level of mice in each group at 28 days of myocardial infarction were statistically analysed. Pathological staining was used to determine the infarct area and fibrosis degree. The levels of serum myocardial enzymes (creatine kinase MB, lactate dehydrogenase) and inflammation indicators (tumor necrosis factor-α, interleukin-6) were determined.   Results   Compared with wild-type mice, the knockout group mice had lower survival rate, significantly decreased left ventricular ejection fraction [(30.39±5.13)% vs. (9.46±2.10)%] and left ventricular shortening fraction [(14.62±2.69)% vs. (4.26±0.96)%], and significantly increased left ventricular volume [(101.50±14.07)μL vs. (197.50±22.41)μL, all P < 0.05]. Small animal PET/CT indicated that wild-type mice had higher intake of 18F-FDG after myocardial infarction [(2.74±0.06)MBq vs. (1.60±0.03)MBq] and degree of infarction [(36.22±0.86)% vs. (47.17±1.27)%] and degree of fibrosis [(32.70±0.85)% vs. (46.38±1.31)%, all P < 0.05]. Serological indicators showed that the myocardial damage of knockout mice was more severe, and the level of inflammation was higher (all P < 0.05).   Conclusion   NCoR1 in cardiomyocytes plays an important protective role in myocardial infarction in mice.
Relationship between lipoprotein-associated phospholipase A2 with degree of carotid atherosclerosis
LAI Jia-cheng, HAN Yong-sheng
2021, 19(10): 1626-1628,1705. doi: 10.16766/j.cnki.issn.1674-4152.002127
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  Objective  To investigate the correlation and clinical significance of lipoprotein phospholipase A2 (Lp-PLA2) with the extent of atherosclerosis in carotid arteries.  Methods  A total of 227 patients admitted at Anhui Provincial Hospital from October 2019 to April 2020 were included in this study. Patients were divided into three groups according to the degree of carotid artery atherosclerosis, namely, control group (no significant carotid stenosis, n=58), carotid atherosclerosis group (carotid artery stenosis < 50%, n=119) and carotid stenosis group (carotid stenosis≥50%, n=50). According to whether there are new cardiovascular events, they were divided into no new event group (154 cases) and new event group (73 cases). The levels of Lp-PLA2 and other conventional indicators were detected in all subjects, and the relationship between their levels and degree of carotid atherosclerosis was analysed, and analyzing the factors associated with carotid atherosclerotic lesions using multiple linear regression models.  Results  Compared with the control group [(89.29±41.15) ng/mL], Lp-PLA2 was significantly increased in the carotid atherosclerosis group [(103.92±37.90) ng/mL] and carotid stenosis group [(121.96±41.27) ng/mL, all P < 0.05]. Lp-PLA2 in the new event group [(114.93±36.50) ng/mL] was significantly higher than that in the no new event group [(98.76±42.47) ng/mL, P < 0.05]. Linear regression analysis showed that Lp-PLA2 was an independent risk factor for carotid atherosclerosis.  Conclusion  Lp-PLA2 was correlated with the degree of carotid atherosclerosis. The serum Lp-PLA2 concentration increased with the gradual deepening of carotid atherosclerosis.
Comparative study of fractional CO2 laser and behavioural training in the treatment of overactive bladder in women
MA Han-bo, WU Si-yu, TONG Xiao-wen, LI Huai-fang
2021, 19(10): 1629-1632. doi: 10.16766/j.cnki.issn.1674-4152.002128
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  Objective  To investigate the therapeutic effect and safety of fractional CO2 laser on overactive bladder (OAB) in women compared with behavioural training.  Methods  A total of 60 female OAB patients who visited the Department of Gynecology, Tongji Hospital from August 1, 2018 to January 30, 2020 were selected. They were randomly divided into the fractional CO2 laser group and behavioural training group, with 30 cases in each group, using a random number table. Follow-up was performed at 1 and 3 months after treatment. The overactive bladder symptom score (OABSS), urgency score, 24 h voiding frequency, pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12) and urodynamics were used to evaluate the therapeutic effect.  Results  Three months after treatment, the therapeutic effect of the fractional CO2 laser group was significantly better than that of the behavioural training group. The OABSS, urination symptom score and 24 h voiding frequency between the fractional CO2 laser group and behavioural training group were (1.87±0.81) points and (5.61±1.62) points, (1.04±0.27) points and (1.64±1.17) points, and (6.41±1.28) times and (10.07±3.21) times (all P < 0.05). The scores of the PISQ-12 questionnaire, including emotional factor and physiological factor, of the two groups were (47.75±5.16) points and (35.97±5.65) points, (21.68±2.43) points and (14.96±3.76) points, and (21.05±2.52) points and (15.45±4.43) points, and the difference was statistically significant (all P < 0.001). No significant difference was observed in partner factor (P>0.05). However, the PISQ-12 scores in the behavioural training group did not significantly differ before and after treatment. No adverse reactions such as aggravation of urinary tract symptoms occurred in both groups after treatment.  Conclusion  Compared with behavioural training, fractional CO2 laser has better efficacy and safety in the treatment of female OAB and can significantly improve the quality of sexual life of patients, which is worth promoting in clinical applications.
Therapeutic effect analysis of mechanical thrombectomy for acute middle cerebral artery M2 segment occlusion
ZHU Yu-you, WANG Li, LIU Tian-long, ZHANG Chao, SONG Jian-long, WANG Peng, SUN Wen, HU Wei, WANG Guo-ping
2021, 19(10): 1633-1636,1649. doi: 10.16766/j.cnki.issn.1674-4152.002129
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  Objective  To explore the efficacy and safety of mechanical thrombectomy for acute occlusion of the M2 segment of the middle cerebral artery.  Methods  Twenty patients with acute cerebral infarction who were subjected to mechanical thrombectomy for M2 segment middle cerebral artery occlusion in the First Affiliated Hospital of the University of Science and Technology of China from September 2019 to October 2020 were retrospectively collected. Amongst them, 8 were males, and 12 were females. Their ages ranged from 32 to 84 (62.5±14.4) years. The National Institutes of Health Stroke Scale score was (14±3) on admission. The preoperative ASPECTS score was 8.0 (7.0, 9.0) points. The aetiology classification adopted was TOAST classification, including 2 cases of aortic atherosclerosis, 10 cases of cardiogenic embolism, 5 cases of other causes, 3 cases of unknown cause. Before mechanical thrombectomy, intravenous thrombolysis was performed in 6 cases, of which 5 cases were treated with recombinant tissue plasminogen activator and 1 case with urokinase. There were 14 patients with dominant M2. The operation mode, recanalization and intracranial hemorrhage were analyzed, and the prognosis 90 days after operation was analyzed. An mTICI grade 2b-3 indicated successful recanalisation of blood vessels, and an mRS score of 0-2 meant good clinical prognosis.  Results  The average time from onset to femoral artery puncture in 20 patients was 200-582 min, the median time was 370 (277, 483) min, and the time from onset to recanalisation was (481.3±121.4) min. Stents were only used in 6 patients to remove the thrombus, direct aspiration was only used in 8 patients to remove the embolus, and stent combined with aspiration technology was used in 6 patients to remove the embolus. The number of emboli removed was 2 (1, 2). The successful recanalisation rate was 95%. Four patients had intracranial haemorrhage, and two of them had symptomatic intracranial haemorrhage. At 90-day follow-up, 1 patient died, the good prognosis rate was 65%. Univariate analysis showed that combined intravenous thrombolysis, without sICH were associated with good 90-day prognosis.  Conclusion  Mechanical thrombectomy for acute ischemic stroke patients with middle cerebral artery M2 occlusion is safe and effective. Combined intravenous thrombolysis, without sICH are associated with good prognosis at 90 days.
Value of fibrinogen-to-albumin ratio in predicting the formation and prognosis of collateral circulation in patients with chronic complete coronary artery occlusion
WANG Tong, WANG Feng-yun, ZHANG Qian-qian, WANG Pei-yan, TANG Jian-min
2021, 19(10): 1637-1641. doi: 10.16766/j.cnki.issn.1674-4152.002130
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  Objective  To explore the value of fibrinogen-to-albumin ratio (FAR) in predicting the formation and prognosis of collateral circulation in patients with chronic total occlusion (CTO).  Methods  From October 2017 to April 2019, 126 coronary heart disease patients with CTO in an at least one major coronary artery were selected for percutaneous coronary intervention (PCI) in the Second Affiliated Hospital of Zhengzhou University. According to the Cohen-Rentrop method, patients with CTO were divided into two groups: poor collateral circulation group (n=72) and good collateral circulation group (n=54). Multivariate logistic regression screening was used to evaluate the influencing factors of collateral circulation formation in patients with CTO. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting collateral circulation formation in CTO patients. The incidence of major adverse cardiovascular events (MACEs) within one year of follow-up was used to evaluate the prognosis of patients.  Results  The levels of FAR and high-sensitivity C-reactive protein in patients with good collateral circulation were lower than those in patients with poor collateral circulation (P < 0.001). Multivariate logistic regression analysis showed an independent negative correlation between FAR, high-sensitivity C-reactive protein and good collateral circulation in patients with CTO. The ROC curve showed that the area under the curve of admission FAR level to predict the formation of collateral circulation in CTO patients was 0.832 (95% CI: 0.755-0.893, P < 0.001), the diagnostic threshold was 9.62, the sensitivity was 85.19%, and the specificity was 77.78%.  Conclusion  The level of FAR on admission has a certain predictive value for the formation of collateral circulation in patients with CTO. Patients with lower FAR have better collateral circulation formation, lower incidence of MACEs and better prognosis.
Surgical experience and clinical effect observation of the resection of right atrial myxomas
LIU Yan-yi, LI Xin, GE Sheng-lin
2021, 19(10): 1642-1645,1665. doi: 10.16766/j.cnki.issn.1674-4152.002131
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  Objective  To investigate the clinical features and prognosis of right atrial myxomas and summarise the experience of surgical treatment.  Methods  From January 2008 to December 2018, 12 cases (6 males and 6 females) of right atrial myxomas underwent surgical resection under mild hypothermic cardiopulmonary bypass (CPB). The mean age was 18.00-75.00 (54.17±16.75) years. Amongst them, surgical resection was performed on arrested heart through median sternotomy in 11 cases, and robot-assisted surgery was performed on a beating heart in 1 case. Through retrospective analysis of the clinical data, the clinical characteristics, incidence, intraoperative technique, attachment site and short-term and middle-term surgical outcomes of right atrial myxomas were summarised.  Results  Right atrial myxomas comprised only 10.53% of all sporadic myxomas. The most common attachment site of right atrial myxomas was the atrial septum. All operations were successfully performed with no operative death or fatal postoperative complications such as low cardiac output syndrome, acute respiratory insufficiency, acute renal failure, stroke, malignant arrhythmia and pulmonary embolism. The operative time was 130-255 (180.25±40.53) min. The CPB time was 30-72 (49.17±14.33) min. The median aortic cross-clamping time was 20.00(18.00-42.00)min(range, 15-49 min). Nine patients (75.00%) were followed up for 12-109 (44.56±30.59) months. No deaths or recurrence occurred. The cardiac functions of all patients in the follow-up were class Ⅰ- Ⅱ (NYHA).  Conclusion  Right atrial myxoma is clinically rare. Once diagnosed, operation should be the first choice of treatment. The key to the success of the operation is the establishment of CPB and careful explorations to the cardiac chambers. The short-term and middle-term outcomes of surgical resection were satisfactory. However, long-term outcomes also need to be further observed.
Effect of dexmedetomidine combined with different anaesthesia depth on postoperative delirium in elderly patients undergoing total hip replacement
XU Meng-ting, LING Yun-zhi, ZHANG Jing-jun, XU Hui
2021, 19(10): 1646-1649. doi: 10.16766/j.cnki.issn.1674-4152.002132
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  Objective  To investigate the effect of dexmedetomidine combined with different anaesthesia depth on postoperative delirium in elderly patients with total hip replacement.  Methods  A total of 96 elderly patients undergoing total hip arthroplasty in our hospital from December 2018 to May 2020 were selected and divided into three groups according to their bispectral index (BIS). The BIS values of groups A, B and C were 40-49 (n=32), 50-59 (n=35) and 60-69 (n=29), respectively. The degree of consciousness disturbance, serum neuron-specific enolase (NSE), serum S100β protein concentration and delirium were observed and compared amongst the three groups.  Results  The Mini-Mental State Examination (MMSE) scores of the three groups were significantly different (P < 0.05). The MMSE score of group B was higher than that of groups A and C (all P < 0.05), but no significant difference was observed between group A and group C (P>0.05). Compared with NSE and serum S100β protein concentration before operation, NSE and serum S100β protein concentration at 72 h after operation were significantly different amongst the three groups (all P < 0.05). NSE and serum S100β protein concentrations in group B were lower than those in groups A and C (all P < 0.05), but no difference was observed between group A and group C in terms of NSE and serum S100 β protein concentration (all P>0.05). Eight cases (25.00%), 1 case (2.86%) and 7 cases (24.14%) of delirium were observed in groups A, B and C within 72 h after operation, respectively. A significant difference was observed between the three groups (P < 0.05). The incidence of postoperative delirium in group B was lower than that in groups A and C (all P < 0.017), but no difference was observed between group A and group C (P>0.017).  Conclusion  Dexmedetomidine combined with anaesthesia depth range of 50-59 can not only effectively improve the NSE and serum S100β protein concentration, but also reduce the degree of postoperative consciousness disturbance and delirium in elderly patients undergoing total hip replacement.
Application analysis of myocardial protection technique for off-pump coronary artery bypass grafting in the operation of valve disease combined with coronary heart disease
DONG Gui-fu, WANG Yu-hang, GE Jian-jun
2021, 19(10): 1650-1653. doi: 10.16766/j.cnki.issn.1674-4152.002133
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  Objective   To introduce the application of myocardial protection technique for off-pump coronary artery bypass grafting (OPCABG) in the operation of valve disease complicated with coronary heart disease.   Methods   The effect and related complications of valve replacement combined with coronary artery bypass grafting using myocardial protection technique for OPCABG in patients with valvular disease complicated with coronary heart disease treated in the Department of Cardiac Surgery of the First Affiliated Hospital of China University of science and technology from January 2017 to July 2020. For bypass surgery+aortic valve replacement surgery, the direct perfusion through the left and right coronary artery orifices and transvenous graft perfusion were firstly performed, and then heart valve replacement surgery was taken and the anastomosis of aortic incision and vascular graft was sutured. For bypass surgery+mitral valve replacement surgery, the vascular graft was anastomosed with the pathological target vessel under the circulatory beating heart, and the vascular graft was anastomosed with the aorta. After the aorta was cooled and blocked, the aortic root perfusion and the mitral valve replacement were performed.   Results   Among the 149 patients, 49 patients taken aortic valve replacement+bypass surgery, 83 taken mitral valve replacement+bypass surgery, 17 taken double valves replacement+bypass surgery, 54 had a single pathological branch of coronary artery which required bypass surgery, 55 had two pathological branches of coronary artery which required bypass surgery, and 40 had three pathological branches of coronary artery requiring bypass surgery. Ten patients died during postoperative hospitalization, 4 suffered permanent stroke after surgery, 28 suffered acute renal insufficiency and required dialysis treatment, and 18 taken mechanical ventilation for more than 24 hours.   Conclusion   For patients with coronary heart disease combined with valvular diseases, the myocardial protection technique for OPCABG in coronary artery bypass surgery combined with valve surgery is easy to operate, causing less postoperative complications and bringing satisfactory surgical results and clinical effects.
One-stage surgical treatment for Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis: Single-centre experience of 63 cases
ZHU Yan, ZHU Jie, ZHOU Guang-xin, QIAN Hong-bo, HE Zhi-wei
2021, 19(10): 1654-1657,1684. doi: 10.16766/j.cnki.issn.1674-4152.002134
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  Objective  Chronic calcaneal osteomyelitis has many pathogenic factors and complex classification, and it is challenging to treat. This study retrospectively analysed the clinical characteristics of Cierny-Mader type Ⅱ and Ⅲ chronic calcaneal osteomyelitis and explored the clinical efficacy of one-stage surgery and related factors of limb function.  Methods  A retrospective case series study was conducted to analyse the clinical data of 63 patients with Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis admitted at the Eastern Theater General Hospital from January 2005 to December 2018. A total of 55 patients were males, and 8 were females. The ages ranged from 6 to 68 years, with the median age of 39 (23, 57) years. According to the Cierny-Mader classification, 32 cases had type Ⅱ disease, and 31 had type Ⅲ disease. Thirty-two patients with type Ⅱ disease were treated with debridement, and 18 patients with type Ⅲ disease were treated with autologous bone implantation after debridement. The remaining 13 patients with type Ⅲ disease were treated with antibiotic bone cement after debridement. The American Orthopaedic Foot and Ankle Society's hind foot (AOFAS-AH) score was used to assess the postoperative limb function.  Results  All patients were followed up for 12-68 months. A total of 8 cases recurred, of which 5 with type Ⅱ disease recurred. Two of the 18 patients with type Ⅲ disease recurred, and 1 case in 13 patients with type Ⅲ disease who were treated with antibiotic bone cement after debridement recurred. The AOFAS-AH score improved from preoperative (63.4±7.6) points to postoperative (84.8±7.4) points. After statistical analysis, the preoperative limb function was found to be related to the Cierny-Mader classification (P < 0.001) and the aetiology of calcaneal osteomyelitis (P=0.005), and the postoperative AOFAS score was related to the patient's age (P=0.018) and aetiology (P=0.035).  Conclusion  One-stage surgery is an effective method for Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis with short treatment cycle and good curative effect.
Effect of long chain noncoding RNA BCYRN1 on malignant biological behavior of SKOV3 cells
LI Xi-mei, LIN Li, MAO Yu-lei, CHEN Xin-xiao, FENG Ze-jiao, LIAO Hai-hong
2021, 19(10): 1658-1661,1728. doi: 10.16766/j.cnki.issn.1674-4152.002135
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  Objective  To investigate the expression of long chain non-coding RNA brain cytoplasmic RNA-1 (BCYRN1) in ovarian cancer and its effect on the malignant biological behaviour of SKOV3 cells.  Methods  A total of 32 ovarian cancer tissues and their corresponding adjacent tissues treated in Wenzhou Central Hospital from March 2017 to March 2019 were selected. Normal ovarian epithelial cell lines (IOSE) and ovarian cancer cell lines (SKOV3, HO8910, A2780) were purchased from ATCC. The level of BCYRN1 was detected by real-time PCR. SKOV3 cells were transfected with BCYRN1 high-expression plasmid and low-expression plasmid and their corresponding control substances, and cell lines with high and low expression of BCYRN1 were constructed. BrdU assay was used to detect cell proliferation, scratch healing test was used to detect cell migration, and Transwell assay was used to detect cell invasion.  Results  The expression of BCYRN1 in ovarian cancer tissues (5.64±1.02) was higher than that in adjacent tissues (2.12±0.65), and the levels of BCYRN1 in SKOV3, HO8910 and A27809 cells were (2.25±0.78), (2.85±0.78) and (3.12±1.01), respectively, which were significantly higher than those of IOSE (1.01±0.12). The high expression of BCYRN1 promoted the proliferation, migration and invasion of SKOV3 cells.  Conclusion  The expression of BCYRN1 is up-regulated in ovarian cancer, and it can be used as an oncogene to promote the progression of ovarian cancer.
Individualised treatment of pectus carinatum combined with Haversian sulcus depression
ZHU Bao-feng, DUAN Xian-lun, ZHONG Wen-wen, SUN Di-wen, LI Xu
2021, 19(10): 1662-1665. doi: 10.16766/j.cnki.issn.1674-4152.002136
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  Objective  To explore the feasibility of minimally invasive sternal sedimentation combined with Nuss procedure in the treatment of pectus carinatum with Haversian sulcus depression.  Methods  We collected the clinical data of children treated with minimally invasive sternal sedimentation combined with Nuss procedure for pectus carinatum with Haversian sulcus depression during June 2015 to August 2020. Then, we described and analysed their information such as Haller index, operative time, intraoperative blood loss, postoperative hospitalisation time, postoperative complications and family satisfaction.  Results  A total of 45 cases with pectus carinatum with Haversian sulcus depression were collected. Amongst them, 43 were boys, and 2 were girls. Their age ranged from 8 to 18 years [average age (12.98±1.80) years]. Their weight ranged from 23.00 to 28.50 kg [(44.58±8.60) kg]. Their Haller index ranged from 1.69 to 2.27 (2.12±0.15). The surgery was successfully performed in all patients. The surgery time ranged from 107 to 208 min [(181.89±32.61) min]. Intraoperative bleeding was between 5 mL and 20 mL [(10.58±2.58) mL]. The satisfaction rate was >95%. No severe surgical complications were noted. Infection at the incision site in one patient was treated with regular changing of wound dressing. We followed up the patients for 1, 4, 12 and 24 months after surgery. There are 22 patients removed their internal support at present. During the follow-up period, no recurrence was observed.  Conclusion  Individualised minimally invasive sternal sedimentation combined with Nuss procedure is suitable for the treatment of pectus carinatum with Haversian sulcus depression. It not only improves the chest wall appearance, but also increases the volume of the chest. Thus, it is worth popularising and applying.
General Clinical Research
Predictive value of the new predictive model AULTS score for ischemic stroke
WANG Ya, ZHOU Hou-yuan, LUO Zhi-qiang, MENG Ding-qiang, ZHENG Ying-ying
2021, 19(10): 1666-1668,1696. doi: 10.16766/j.cnki.issn.1674-4152.002137
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  Objective  To establish a new predictive model to provide a new method for the assessment of the risk of stroke.  Methods  Data were collected from hospitalised patients who were clinically diagnosed with stroke in the Department of Neurology, Chongqing Tongliang District Hospital of Traditional Chinese Medicine from 2012 to 2017. The controls were selected from subjects of outpatient physical examination during the same period. SPSS 22.0 software and R software were used for data analysis and model construction. We selected variables according to the area under the ROC curve. These variables were used to construct the model. The model construction was carried out in R software and presented with a nomogram.  Results  Univariate analysis showed significant differences in drinking, uric acid, blood lipids and systolic blood pressure between the ischemic stroke group and the control group (all P < 0.05). The variables that entered the final model included age (AUC=0.737), uric acid (AUC=0.567), triglycerides (AUC=0.537), low-density lipoprotein cholesterol (AUC=0.541) and systolic blood pressure (AUC=0.615). The area under the ROC curve of the predictive value of the predictive model for stroke was 0.789 (95% CI: 0.765-0.814, P < 0.001). We constructed a new nomogram based on the model prediction score. According to the model prediction probability score quartile, the probabilities of stroke in Q1, Q2, Q3 and Q4 were 18.3%, 40.3%, 60.0% and 82.7%, respectively.  Conclusion  This study shows that the new risk prediction model has good predictive value for stroke and is worthy of popularisation and application.
Effect of group cognitive behavioural therapy on depressive symptoms, coping styles and family functions in adolescents with bipolar depression
YANG Yan
2021, 19(10): 1669-1672,1692. doi: 10.16766/j.cnki.issn.1674-4152.002138
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  Objective  To explore the effects of group cognitive behavioural therapy (G-CBT) on the population's clinical characteristics, coping styles and family functions in adolescents with bipolar depression.  Methods  Eighty adolescents with bipolar depression who were hospitalised in Hangzhou Seventh People's Hospital from January 2019 to January 2021 were selected as the research subjects. They were randomly divided into the study group (drug therapy combined with G-CBT) and control group (drug therapy) for a total of 8 weeks of treatment. Thirty-four patients in the study group and 35 patients in the control group completed the treatment. Hamilton's depression scale, simplified coping style questionnaire and family assessment device scale were used to assess the depressive symptoms, coping styles and family functions of the two groups of patients before and after treatment.  Results  The Hamilton's depression scale scores of the two groups were lower after treatment (study group 10.941±3.302, control group 14.742±4.293) than before treatment (25.676±2.371 and 26.057±2.900), and the difference was statistically significant (P < 0.05). In terms of coping style, the active coping dimensions (1.904±0.248 and 1.793±0.345) of the two groups were higher than those before treatment (1.541±0.300 and 1.588±0.330, P < 0.05), the dimensions of negative coping (1.398±0.366 and 1.589±0.411) were all lower than those before treatment (1.783±0.398 and 1.789±0.062, P < 0.05). After treatment, the negative coping dimension score of the study group was lower than that of the control group, and the difference was statistically significant (P < 0.05). In terms of family function, the study group's communication, role, behaviour control and total functional dimensions were lower after treatment than before treatment (P < 0.05). After treatment, the study group had better communication and role dimensions than the control group, and the difference was statistically significant (P < 0.05).  Conclusion  G-CBT can enhance the efficacy of drug therapy on depressive symptoms in adolescents with bipolar depression and can significantly improve patients' coping style and family function in communication, role, behaviour control and overall function.
Analysis of physical activity status and influencing factors in patients with enterostomy
ZHOU Xue-dan, ZHOU Hai-yang
2021, 19(10): 1673-1676. doi: 10.16766/j.cnki.issn.1674-4152.002139
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  Objective  To analyse the status of physical activity in colorectal cancer patients with enterostomy and explore the influencing factors of physical activity in these patients.  Methods  A total of 185 patients who underwent rectal cancer stoma at the First People's Hospital of Liangshan Yi Autonomous Prefecture from February 2018 to February 2019 were selected as the research objects. The International Physical Activity Questionnaire was used to analyse the physical activity level of patients, and univariate analysis and multivariate logistic regression analysis were used to analyse related factors affecting patients' physical activity.  Results  The total physical activity of patients with colorectal cancer ostomy reached a low physical activity level in 122 cases (65.95%), medium physical activity level in 38 cases (20.54%) and high physical activity level in 25 cases (13.51%). The results of univariate analysis showed statistically significant differences amongst the low physical activity group, middle physical activity group and high physical activity group in terms of gender, in-service, educational level, type of stoma, operation time, total score of stoma adaptation, total score of cancer fatigue and regular exercise (all P < 0.05). The results of multivariate logistic regression analysis showed that males, higher educational level, ileostomy, irregular exercise, operation time < 1 year, reduced ostomy adaptation score and increased cancer fatigue score were independent risk factors affecting low physical activity in colorectal cancer patients with ostomy.  Conclusion  The physical activity level of patients with colorectal cancer ostomy is mainly low. Male patients, high education level, operation time < 1 year, irregular exercise, ileum ostomy, increased fatigue score and decreased stoma adaptation score are independent risk factors for low physical activity.

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