2021 Vol. 19, No. 2

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Expert Forum
Exploration of general practitioner training model based on artificial intelligence technology
CHEN Guo-xiang, LI Jun, WEI Hua, YANG Jing, LI Guang-zhi, HUANG Bin, SU Shi-xiang, CAO Cong
2021, 19(2): 167-170. doi: 10.16766/j.cnki.issn.1674-4152.001758
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General practitioners (GPs) aim at maintaining the health of residents. They can supply the health service needs of residents in their communities and provide them with treatment, health knowledge popularization, disease prevention and other health services. China's general practice is in a rapid development stage. In recent years, our country has also been increasing the investment in the social medical field and general practice teaching in colleges and universities. However, the number of GPs is seriously insufficient and the medical level is limited, which restricts the improvement of basic medical and health services. Moreover, during the training of GPs, it faces various challenges such as insufficient teachers, a single training model, insufficient frontiers of teaching content, insufficient breadth of knowledge involved, difficulties in continuing education, and low professional appeal. Therefore, the model and training system need to be further improved and enriched. With the continuous development of science and technology, artificial intelligence (AI) has made great achievements in education, medicine and other fields, which also brings new opportunities for the reform of the training mode of general practitioners in China. AI has many advantages such as mass integration, information mining, and personalization. Taking the AI express train to comprehensively empower GP training will greatly enrich the training mode of GPs and effectively enhance the professional appeal of GPs. It is very important to promote the cultivation of qualified, reliable and high-level GPs in batches and the construction of excellent GPs at the grassroots level. The purpose of this article is to present the problems faced in the training of traditional GPs, to discover the opportunity of combining AI and GP training, to explore new solutions of GP training based on AI technology, so as to provide reference for AI to assist the training of GPs in China, and to carry out the development prospects and development directions of this model looking forward.
2021, 19(2): 171-173. doi: 10.16766/j.cnki.issn.1674-4152.001759
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2021, 19(2): 174-175.
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Prognosis of recurrent hepatocellular carcinoma patients after TACE combined with microwave ablation and analysis of prognosis-related predictive factors
ZHU Xian-zhong, ZHANG Xian-nan, WANG Qin, ZHOU Ling
2021, 19(2): 227-231. doi: 10.16766/j.cnki.issn.1674-4152.001774
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  Objective  To explore the prognosis of recurrent hepatocellular carcinoma patients after transcatheter arterial chemoembolisation (TACE) combined with microwave ablation (MWA) and its related factors, constructing a prognostic nomogram concerning overall survival.  Methods  Retrospective analysis was performed on clinical data from recurrent hepatocellular carcinoma patients (82 cases) treated by TACE-MWA in our hospital from January 2015 to January 2017. The patients were divided into progress, non-progress, survival, and death groups depending on disease progression and survival. The progression and survival situation during 2 years of follow-up were recorded, and the related factors for both were analysed. A prognostic nomogram was then constructed.  Results  The overall survival of patients in the two years after TACE-MWA was 68.29%, and the progression-free survival rate was 36.59%. The preoperative AFP level, tumour number, and largest tumour diameter in the progress group were higher than those in the non-progress group (all P < 0.05). The largest tumour diameter, cases with tumour close to hepatic hilum < 2 cm, and preoperative AFP level in the death group were higher than those in the survival group (all P < 0.05). Statistical differences were observed between the two groups in terms of Child-Pugh classification and BCLC classification (all P < 0.05). The preoperative AFP level, tumour number, and largest tumour diameter (HR=1.026, 51.487, 2.463; P=0.024, 0.047, 0.016, respectively) were the risk factors of recurrent hepatocellular carcinoma patients' progression-free survival. Preoperative AFP level, largest tumour diameter, and tumour proximity to hepatic hilum < 2 cm (HR=1.012, 1.189, 8.479; P=0.002, 0.011, 0.021, respectively) were the risk factors of recurrent hepatocellular carcinoma patients' overall survival. The consistency index for predicting patients' overall survival in two years was 0.919 (95% CI: 0.885-0.946).  Conclusion  Emphasising on factors such as tumour number, size, and location has certain meaning for predicting the progression-free survival and overall survival of hepatocellular carcinoma patients after TACE-MWA.
Clinical diagnosis, treatment, and imaging analysis of diffuse osteomyelitis of the maxilla
WANG Yan, WANG Jing-xiao, GUO Qian-qian, CHEN Bin, LUO Jia, LYU Yi-min, ZHOU Chang-long
2021, 19(2): 232-235. doi: 10.16766/j.cnki.issn.1674-4152.001775
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  Objective  To investigate the clinical manifestations, imaging features, and treatment of diffuse osteomyelitis of the maxilla.  Methods  From January 2011 to March 2020, the clinical data and imaging features of three patients with diffuse osteomyelitis of the maxilla admitted to the Department of stomatology, Lihuili Hospital, Ningbo Medical Center were analysed retrospectively. Ten patients (6 males and 4 females, aged 7-79 years, average of 52.5 years) duration of 2.5 months-1 year, with an average of 4.8 months, including 1 with two phosphonic acid salts medication history, 4 with a history of diabetes, 1 with fungal infection history, 10 with the same pain with facial swelling and discharging mouth, 3 with fever, 7 with no obvious fever. All patients underwent CT examination to determine the condition of soft and hard tissues on the affected side. They were given cephalosporin anti-infection treatment before surgery, followed by maxillary osteomyelitis dead-bone curetomy (including maxillary sinus radical resection), and further followed by cephalosporin anti-infection treatment and hyperbolic oxygen treatment.  Results  The main clinical manifestations of the 10 patients were as follows: conscious side pain and discomfort, obvious facial swelling, excessive pus in the mouth, bone exposure, and obvious tenderness. The imaging findings were as follows: extensive patchy, uneven low-density shadow of the maxillary bone, bone destruction, local bone cortex discontinuity, gas density shadow in some areas, corresponding osteolysis destruction of the upper alveolar bone, swelling and accumulation of surrounding soft tissues. After treatment, the symptoms such as swelling and pain, pus discharge significantly improved without recurrence.  Conclusion  Imaging examination, especially CT, plays an important role in diagnosing diffuse osteomyelitis of the maxilla by guiding the treatment plan. Combined with medication, hyperbaric medicine, and surgery, this technique can achieve good results.
Changes and clinical significance of serum STREM-1 and sCD163 levels in patients with acute exacerbation of chronic obstructive pulmonary disease
WANG Wei, WU Wei, GAO Feng, WANG Bin
2021, 19(2): 236-240. doi: 10.16766/j.cnki.issn.1674-4152.001776
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  Objective  To investigate the changes of serum soluble myeloid cell trigger receptor 1 (sTREM-1) and soluble hemoglobin scavenger receptor (sCD163) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and analyze their diagnostic value for the prognosis of patients with AECOPD.  Methods  Total 124 AECOPD patients admitted to our hospital from May 2017 to August 2019 were selected and divided into deterioration group (32 cases) and good conversion group (92 cases) according to the clinical outcome after 28 d of hospitalization. Another 50 healthy people were selected as the control group. Serum sTREM-1 and sCD163 levels were detected by enzyme linked immunosorbent assay. Clinical data of the patients were collected, and factors affecting the prognosis of AECOPD patients were analyzed by Logistic stepwise regression. The prognostic value of STREM-1 and sCD163 in AECOPD patients was analyzed by receiver operator characteristics curve (ROC).  Results  Serum STREM-1 and sCD163 levels in the deterioration group were higher than that in the good conversion group and control group (all P < 0.05), and the good conversion group was higher than control group (all P < 0.05). Logistic stepwise regression analysis results showed that the acute physiology and chronic health conditions (APACHE Ⅱ) score, number of acute hospital nearly 1 years, combined shock, sTREM-1, sCD163 were risk factors for poor prognosis of AECOPD patients (all P < 0.01). ROC analysis results showed that the area under curve (AUC) of sTREM-1, sCD163 and combined sTREM-1+sCD163 in the diagnosis of AECOPD patients were 0.727, 0.730, 0.910, the sensitivity were 68.75%, 62.50%, 84.38%, the specificity were 78.26%, 82.61%, 92.39%.  Conclusion  Elevated sTREM-1 and sCD163 levels may be risk factors for poor prognosis in AECOPD patients, and combined detection of sTREM-1 and sCD163 may help improve the accuracy of prognosis prediction.
Analysis on clinical characteristics and laboratory examination of Epstein-Barr virus infection in hospitalized children at different age stages
CHEN Qiong, DING Zhou-zhi, LIU Na-na, PENG Wan-sheng
2021, 19(2): 241-244. doi: 10.16766/j.cnki.issn.1674-4152.001777
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  Objective  To explore the clinical features and in laboratory examination of children with EBV infection at different age stages.  Methods  The clinical data of 153 case hospitalized children with EBV infection from January 2012 to January 2020 in the First Affiliated Hospital of Bengbu Medical Collage were collected. All Patients were divided three groups, the infant and toddler period group (1 month to 3 years old, 52 cases), the preschool period group (3-7 years old, 57 cases), and the school-age period group (7-14 years old, 44 cases). The general data, clinical manifestations and laboratory examination results of children in each group were analyzed, and the characteristics were found and summarized.  Results  The onset season was dominated by spring and summer, and high in summer and low in winter, respectively, 66 cases (43.1%) in summer, 32 cases (20.9%) in autumn, 43 cases (28.1%) in spring, and 12 cases (7.8%) in winter. In the spectrum of disease, the infectious mononucleosis predominates had 62 case (40.5%). Diseases were more diverse in the infant and toddler period group, and they had high incidence of respiratory diseases such as bronchopneumonia and bronchitis, some rare cases of parotid gland enlargement. In clinical manifestation, there were 25 cases of cough (48.1%) and 14 cases of rash (26.9%) in the infant and toddler period group, higher than those in the preschool period group and school-age group (all P < 0.05). The lymphadenectasis in preschool period group had 36 case (63.2%) and in the school-age group has 26 case (59.1%), higher than those in the infant and toddler period group (all P < 0.05). The proportion of apyrexia in the infant and toddler period group had 18 cases (72.0%), higher than that in the other two groups, and hyperpyrexia had 7 cases (16.7%), lower than that in the other two groups (all P < 0.05). In the laboratory examination, there were 93 case patients increased in ALT, the ALT level of the infant and toddler period group was lower than that of the preschool period group. The difference was statistically significant (all P < 0.05).  Conclusion  Children who infect EBV at different ages are not totally identical in disease spectrum distribution, clinical manifestation and laboratory examination. So, mastering the characteristics of diseases at different age stages is conducive to early detection, early diagnosis and early treatment of diseases.
Clinical features, prognosis, and influencing factors of respiratory tract infection in children
WANG Jing, ZHANG Ying
2021, 19(2): 245-247. doi: 10.16766/j.cnki.issn.1674-4152.001778
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  Objective  To explore the clinical characteristics and main pathogenic bacteria of respiratory tract infection in children, to analyse the prognosis and related factors of children with poor prognosis, and to provide clinical basis for good prognosis of children with respiratory tract infection.  Methods  From January 2018 to December 2019, 1 246 children with respiratory tract infection were selected as the subjects of study. The types of respiratory tract infection pathogens were retrospectively analysed, and the prognosis of children with respiratory tract infection was counted. Multivariate logistic regression analysis was used to determine the prognostic factors of children with respiratory tract infection.  Results  Amongst the 1 246 children with respiratory infections, 387 were positive for respiratory viruses, the incidence was 31.1%. Respiratory syncytial virus (RSV) was the highest number of positive cases, with a composition ratio of 62.8% (243/387), followed by Influenza A virus (Flu A), with a composition ratio of 22.5% (87/387). After treatment, 95.2% (1 186/1 246) of the children improved, the prognosis of 4.8% (60/1 246) children was poor. Univariate analysis showed statistically significant differences in the prognosis of children with allergic history, second-hand smoke, no outdoor activities, respiratory tract infections in spring, winter, and under one year of age (P < 0.001). Multivariate logistic analysis results showed that no outdoor activities, spring, winter, and age under 1 years were risk factors for poor prognosis (all P < 0.05).  Conclusion  RSV is the main pathogen of respiratory tract infection in children, and the proportion of children with poor prognosis is high, and mainly in winter and spring. Children under 1 year old are the susceptible population, and they should increase outdoor activities in daily life, ensure a balanced diet, and improve their immune function.
A comparative study of paracetamol and ibuprofen on patent ductus arteriosus in preterm infants at different stages of gestational age
GUO Li-min, MA Jin, CHEN Ming-wu
2021, 19(2): 248-251. doi: 10.16766/j.cnki.issn.1674-4152.001779
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  Objective  To observe the efficacy and safety of paracetamol and ibuprofen in the treatment of patent ductus arteriosus (PDA) in preterm infants of different gestational ages.  Methods  Total 110 preterm infants with gestational age ≤37 weeks, birthweight ≤2 500 g confirmed PDA were enrolled, including group Ⅰ (ibuprofen group, from January 2016 to January 2018, a total of 56 preterm infants received oral ibuprofen) and group Ⅱ (paracetamol group, from January 2018 to January 2020, a total of 54 preterm infants received oral paracetamol). According to gestational age, all the infants were divided into three groups: 28-30+6 weeks group, 31-33+6 weeks group, 34-36+6 weeks group. The efficacy and safety of the two drugs and the difference of PDA closure rate among the three groups were observed and compared.  Results  There was no significant difference in PDA closure rate between group Ⅰ (78.57%) and Ⅱ (79.63%), P>0.05. The closure rate of PDA were 62.5%, 84.2% and 87.5%, respectively, in 28-30+6 weeks group, 31-33+6 weeks group and 34-36+6 weeks. In addition, oral paracetamol was as safe as oral ibuprofen in terms of gastrointestinal bleeding, retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular hemorrhage, hyperbilirubinemia, uri nary output (all P>0.05).  Conclusion  The efficacy and safety of paracetamol and ibuprofen on PDA are similar. There was no significant difference in the incidence of adverse reactions between the two drugs. The closure rate of patent ductus arteriosus is not equal in different gestational age and is inversely proportional to gestational age.
Changes and clinical significance of serum IFN-γ and H2S levels in children with benign infantile convulsion associated with mild gastroenteritis
ZHANG Ling, TU You-quan, FANG Chun-yan, HUANG Ming-hai
2021, 19(2): 252-255. doi: 10.16766/j.cnki.issn.1674-4152.001780
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  Objective  To explore the changes and clinical significance of serum interferon-γ (IFN-γ) and hydrogen sulfide (H2S) levels in children with benign infantile convulsion associated with mild gastroenteritis (BICE), as well as to explore their roles in the occurrence and development of BICE.  Methods  A total of 83 BICE children who were treated in Women and Children's Hospital in Ningbo from March 2017 to July 2019 were enrolled as observation group, whereas another 65 healthy controls during the same period were enrolled as control group. The levels of serum IFN-γ and H2S were detected by ELISA and spectrophotometry. The correlation between serum IFN-γ and H2S levels and the correlation between the two indices and severity of BICE were analysed by Pearson and Spearman tests. The diagnostic value of serum IFN-γ and H2S levels for BICE was analysed by ROC curves.  Results  The levels of serum H2S and IFN-γ in the observation group were significant different from those in the control group [(30.15±6.09) μmol/L, (5.68±1.13) μg/L vs. (43.28±8.34) μmol/L, (4.25±0.92) μg/L, t=11.066, 8.277, all P < 0.001].They were also correlated with the severity of BICE (all P < 0.05). The AUC values of serum IFN-γ and H2S levels for diagnosis of BICE were 0.785 and 0.895, respectively.  Conclusion  The levels of serum IFN-γ and H2S are relevant in BICE children and associated with disease severity. The serum IFN-γ and H2S levels are of diagnostic value for BICE.
Application of hospital-growth album for very low birth weight infants to improve their parents' anxiety
WANG Na, LI Shuai, JIAO Yong-feng, CHEN Xin
2021, 19(2): 256-259. doi: 10.16766/j.cnki.issn.1674-4152.001781
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  Objective  To explore the effect of establishing hospital-growth album for very low birth weight infants on their parents' anxiety and the satisfaction of medical staff.  Methods  A total of 65 cases of very low birth weight infants (VLBWI) in the Neonatal Intensive Care Unit (NICU) of Fuyang Women and Children's Hospital of Anhui Province were selected for treatment from November 2017 to January 2020. They were divided into 32 cases for the observation group and 33 cases for the control group according to the random-number table method. Parents of the control group used time-limited video visitation, and parents of the observation group were provided with a VLBWI hospital-growth album on the basis of video visitation in the control group. A self-assessment of anxiety scale score (SAS) and satisfaction survey on their parents at VLBWI admission, two weeks of admission, and discharge was conducted.  Results  The parents of the observation and control groups had anxiety when their infants were admitted to the hospital. The scores were (66.78±6.21) and (67.30±5.07), the differences were not statistically significant (t=-0.370, P>0.05). Compared with the control group, the anxiety of the parents in the observation group was significantly reduced during 2 weeks of admission and discharge (52.50±5.44 vs. 60.00±4.29, 39.62±6.50 vs. 48.48±3.62), respectively. The differences were statistically significant (all P < 0.05). The satisfaction of parents in the observation group significantly improved (100.00% vs. 81.82%, χ2=4.424, P < 0.05) compared with that of parents in the control group.  Conclusion  Establishing a VLBWI growth album can obviously improve the anxiety of parents without accompanying infants, improve their parents' satisfaction with medical care work, and provide a new model for the management of visiting infants without accompanying infants.
Influencing factors of diverticular regeneration after cicatricial diverticulum of caesarean section uterine incision
YE Ren, YING Hong-jun, LI Jie
2021, 19(2): 260-262, 327. doi: 10.16766/j.cnki.issn.1674-4152.001782
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  Objective  To explore the influencing factors of diverticulum formation after caesarean scar diverticulum operation to provide evidence for effective prevention and control measures.  Methods  The clinical data of 186 patients with scar diverticulum of caesarean section incision who underwent transvaginal surgery in Ningbo Women's and Children's Hospital from January 2016 to January 2018 were collected via retrospective investigation. They were divided into non-diverticulum group (96 cases) and diverticulum formation group (90 cases) according to the healing condition after operation. Logistic regression analysis was performed to explore the influencing factors of diverticulum formation after operation.  Results  Among the 186 patients, 90 had diverticular remodelling, and the incidence of diverticulum remodelling after caesarean section uterine incision scar chamber was 48.39%. The time of postoperative vaginal abnormal bleeding in the diverticulum remodelling group was significantly longer than that of the non-sacral group, and the postoperative vaginal abnormal bleeding time was significantly shorter in the diverticulum re-formation group than that in the non-sacral group (all P < 0.05). Univariate analysis revealed that the dilatation of the diverticulum after caesarean section in the uterine incision was significantly associated with preoperative vaginal bleeding time, surgical distance from the last caesarean section, postoperative haemoglobin value and other factors (all P < 0.05). Multivariate logistic regression analysis showed that the operation time less than 5 years before the caesarean section, and haemoglobin levels of < 110 g/L were the influence factors for diverticulum remodelling after caesarean section uterine incision scar (all P < 0.05).  Conclusion  The occurrence may be related to factors, such as caesarean section time>5 years before operation and haemoglobin levels < 110 g/L after operation. In the course of clinical treatment, targeted interventions should be adopted to reduce the occurrence of diverticulum recurrence after caesarean scar diverticulum operation.
Application of comprehensive remote diagnosis and treatment mode in community health service in mountainous area of northern Beijing
WANG Hai-li, CHEN Jing-jing, PENG Ying-chun
2021, 19(2): 263-265, 315. doi: 10.16766/j.cnki.issn.1674-4152.001783
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  Objective  To understand the effect of comprehensive remote diagnosis and treatment mode on alleviating the waste of medical resources, inadequate implementation of family doctor contract services, the role of poor equity in medical services and the problems existing in the existing practice in the mountainous area of northern Beijing, and to analyze the existing problems and put forward suggestions for improvement.  Methods  Relying on the information system, remote diagnosis and treatment, charging and data transmission are completed. The completion of work quantity, expenditure, work quality and residents' satisfaction of Bamudi village community health service center in LIULIMIAO Town, Huairou District, Beijing from 2014 to 2019 were collected. The differences before and after the comprehensive diagnosis and treatment mode were comparative analyzed.  Results  After the application of comprehensive remote diagnosis and treatment mode, the number of health records, the number of family doctors signing contracts, the number of elderly people, hypertension and diabetes patients health management increased by 100.28%, 180.09%, 229.88%, 150.00% and 190.00%, personnel expenditure and office expenditure decreased by 71.40% and 72.14%, respectively. Compared with 2014, the growth rates in 2019 of the medical ethics, diagnosis and treatment ability, drug allocation, family doctor contract satisfaction score increased by 5.23%, 17.52%, 9.64% and 10.25% respectively. Health records integrity, hypertension, diabetes standardized management rate and other quality indicators had improved to varying degrees.  Conclusion  Application of comprehensive remote diagnosis and treatment mode under the premise of ensuring the quality of service can effectively strengthen the relationship between family doctors and contract residents, improve the performance of family doctors' contracted services, reduce the human cost of primary medical and health service institutions, and improve the service efficiency of primary health service institutions in mountainous areas. It provides a new idea to promote the balanced development of urban and rural basic medical and health services.
Influencing factors of fatigue in in maintenance hemodialysis patients and their correlation with psychological resilience and hope
HOU Rui, SONG Ming-fen, KANG Jun-jun, GUO Yan-xiang
2021, 19(2): 266-269. doi: 10.16766/j.cnki.issn.1674-4152.001784
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  Objective  To understand the psychological resilience, hope and fatigue of maintenance hemodialysis (MHD) patients, and to analyze the role of psychological resilience in patients' hope and fatigue.  Methods  Using convenient sampling technique, 120 maintenance hemodialysis patients who met the inclusion exclusion criteria in department of nephrology of Hospital of Traditional Chinese Medicine of Hangzhou City were selected for the questionnaire survey from September to October 2019. The questionnaire included patients' general information questionnaire, Revised Piper Fatigue Scale (RPFS), Herth Hope Index (HHI), Connor-Davidson Resilience Scale (CD-RISC). The investigators conducted one-to-one survey with unified guidance, and finally obtained 114 valid questionnaires were returned, Statistical software was used to analyze the survey result.  Results  Fatigue scores of the MHD patients was (5.74±0.84), which is at medium level. The hope score is (33.97±3.45), which is on the high side of the medium level. The psychological resilience score was (51.48±7.71), which was at a low level. The fatigue scores of patients with different ages and hemoglobin level were statistically significant (all P < 0.01). Among them, patients aged >65 years old had the highest the highest fatigue score, and patients with hemoglobin level < 100 g/L had the highest fatigue score. Hope score was negatively correlated with fatigue score (r=-0.374, P < 0.01). Resilience score was positively correlated with hope score (r=0.342, P < 0.01) and negatively correlated with fatigue score (r=-0.624, P < 0.01). psychological resilience played a mediating role between hope and fatigue (P < 0.01), and the ratio of mediating effect to total effect was 13.4%.  Conclusion  The fatigue status of MHD patients needs to be improved urgently. The hope is an important factor affecting fatigue, and the mental resilience plays a mediating role.
Application of cognitive behavioural therapy and group games combined with relaxation training in psychological intervention for adolescent cleft lip and palate patients
YUAN Feng, LI Guang-zao, LIU Shan-shan, ZHANG Rui-rui, CAO Ming-ming, XU Zhi-hui
2021, 19(2): 270-273. doi: 10.16766/j.cnki.issn.1674-4152.001785
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  Objective  To explore the effect of cognitive behavioural therapy and group games combined with relaxation training in psychological intervention for adolescents with cleft lip and palate.  Methods  Twenty-nine adolescent cleft lip and palate patients treated in our department from March 2019 to March 2020 were selected as the research objects. The patients were divided into control and observation groups through the random-number table method. Conventional psychological counseling, cognitive behavioural therapy, and group games combined with relaxation training were conducted. The psychological state, self-acceptance level, and coping style of the patients in both groups were compared before and after intervention.  Results  After intervention, the SCORE of SCL-90 in the observation group (192.88±24.03) was significantly lower than that before intervention (233.29±43.88), and the difference was statistically significant (P < 0.05). The score of SCL-90 was lower than that of the control group (214.00±30.88, t=-2.072, P=0.048). In terms of self-acceptance, the total score and factor scores of the observation group were higher than those of the control group, and the total score (47.18±4.64) of the observation group was significantly higher than that of the control group (36.08±3.18, t=7.164, P < 0.001). In terms of coping style, the positive factor score (13.52±1.19) in the observation group was higher than that in the control group (10.86±1.19, t=5.901, P < 0.001), and the negative factor score (3.36±0.84) was lower than that in the control group (5.62±0.96, t=-6.702, P < 0.001).  Conclusion  Cognitive behaviour therapy and group games combined with relaxation training can improve the psychological state of adolescents with cleft lip and palate. It can help patients cope with difficulties in a positive way and promote self-acceptance, so it can be extensively used in clinical work.
Predictive effect of subjective experience of antipsychotic side effects on medication compliance in schizophrenia
CHEN Chun-mian, LIN Chong-guang, JIANG De-guo
2021, 19(2): 274-276, 279. doi: 10.16766/j.cnki.issn.1674-4152.001786
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  Objective  To examine the predictive value of subjective experience of antipsychotic side effects on medication compliance in patients with schizophrenia.  Methods  One hundred and twenty-three patients with schizophrenia completed the Glasgow Antipsychotics Side-effect Scale (GASS) at discharge, and medication compliance follow-up was completed 4-5 weeks after discharge. In the receiver operating curve, the total GASS score was used as the independent variable. The area under the curve was calculated, and the sensitivity and specificity were predicted.  Results  Fifty-two patients (42.3%) were defined as medication non-compliance. The total score of GASS (OR=1.105, 95% CI=1.041-1.173) and the score of extrapyramidal side effect of GASS (OR=7.965, 95% CI=2.371-26.754) were significantly associated with medication non-compliance (all P < 0.01). Receiver operating characteristic curve analysis indicated that the suitable cut-off points on total score of GASS for identifying medication non-compliance was ≥20 (sensitivity and specificity were 92.3% and 66.2%, respectively).  Conclusion  The subjective experience of antipsychotic side effects can be used to predict medication non-compliance in patients with schizophrenia.
Comparative study of the clinical efficacy of acetylglutamine and paroxetine in treating generalised anxiety disorder
XU Ya-xuan, XU Li, WEI Dao-xiang
2021, 19(2): 277-279. doi: 10.16766/j.cnki.issn.1674-4152.001787
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  Objective  To compare and analyse the clinical efficacy of aceglutamide and paroxetine in treating generalised anxiety disorder.  Methods  A total of 30 patients with anxiety disorders admitted to the First Affiliated Hospital of Bengbu Medical College from March 2019 to November 2019 were collected and divided into study group and control group by random number table method, with 15 patients per group. No statistically significant difference existed between the two groups in general information such as age, gender, course of disease, and other basic information which could be compared and analysed. Patients in the study group were treated with aceglutamide, whereas those in the control group were treated with paroxetine. Changes in the condition of patients in the two groups after 7 and 14 days of treatment were compared using Hamilton Anxiety scale scores.  Results  The anxiety scores of the control group before treatment, 7 days after treatment and 14 days after treatment were 21.33±3.42, 17.40±3.38 and 15.20±2.51 respectively, while those of the study group were 22.47±4.03, 16.53±3.52 and 11.80±2.47 respectively. The anxiety scores of the study group were significantly reduced compared with those of the control group (P < 0.05). The total effective rate of the control group was significantly lower than that of the study group (P=0.039).  Conclusion  Aceglutamide and paroxetine have obvious therapeutic effects in treating generalised anxiety disorder, but the former has better anti-anxiety effect, with faster onset, safety and reliability, which is more worthy of clinical application.
Application of single nucleotide polymorphism microarray in genetic diagnosis of nuchal fold thickened fetuses
LIANG Zhi-kun, LI Ming-yi, DENG Rui, HUANG Min, XIE Bo-bo, OUYANG Lu-ping
2021, 19(2): 280-282, 323. doi: 10.16766/j.cnki.issn.1674-4152.001788
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  Objective  To discuss the prenatal diagnosis and genetic counseling of nuchal fold (NF) thickened fetuses.  Methods  A retrospective analysis was performed on 152 pregnant women with NF ≥ 5.0 mm at 16-18 gestational weeks and NF ≥ 6.0 mm at 19-22 gestational weeks From January 2018 to July 2019 in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Amniotic fluid samples were obtained by amniocentesis, and chromosome karyotype analysis and single nucleotide polymorphism array (SNP-array) were performed at the same time. Clinical diagnostic data of these pregnant women were collected, and fetal chromosome karyotype analysis and chromosome microarray detection results were analyzed.  Results  Among the 152 cases of nuchal fold thickened fetuses, 19 cases (19/152, 12.5%) of chromosomal karyotype abnormalities were detected. Among the 19 abnormal karyotypes, there were 12 cases of trisomy 21, 2 cases of trisomy 18, 2 cases of 45, X, 1 cases of 47, XXX, 1 cases of 45, -6[28]/46, r(6)(p25q26)[12], and 1 case of 46, XN, del (5) (p14). There were 33 abnormal cases detected by SNP-array, with a detection rate of 21.71% (33/152). The SNP-array detection rate was significantly higher than that of chromosome karyotype. In addition to the aneuploid or large fragment structural abnormalities detected by karyotype detection, the SNP-array also detected 14 cases of microdeletions not detected by karyotype analysis, including 4 cases of pathogenic copy number variation, 2 cases of suspected pathogenic copy number variation, and 8 cases of unknown clinical significance copy number variation.  Conclusion  For the nuchal fold thickened fetuses screened by ultrasound, SNP array technique can significantly improve the chromosome ultrastructure aberrations which cannot be detected by karyotype analysis.
Significance of ultrasound examination in the evaluation and treatment of uterine scar pregnancy
SHI Cai-hong, LIU Xue-ge, MENG Hui-yan, WEI Yue-liu
2021, 19(2): 283-286. doi: 10.16766/j.cnki.issn.1674-4152.001789
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  Objective  To explore the ultrasonographic characteristics, surgical methods and postoperative recovery of different types of cesarean scar pregnancy (CSP) patients.  Methods  Ninety-two cases of CSP diagnosed and treated in our hospital from January 2015 to December 2018 were analysed. The general clinical data, ultrasonographic features, operation and postoperative recovery were compared. The data were analysed by SPSS 23.0 statistical software.  Results  A total of 92 CSP patients were divided into 28 cases of type Ⅰ, 45 cases of type Ⅱ and 19 cases of type Ⅲ. No significant difference in age, menopause time, distance from the last caesarean section and serum β-HCG content was found before treatment (all P>0.05), but a significant difference in the number of induced abortion and caesarean section was observed (all P < 0.05). Significant differences in the thickness of the anterior inferior segment of the uterus, the percentage of villus invading the myometrium, the percentage of small amount of blood flow and rich blood flow in Alder classification were found (all P < 0.05). Moreover, statistical differences in the ratio of type A operation to type B operation and hospitalisation time were observed (all P < 0.05). However, no significant difference in the time when β-HCG dropped to normal was observed (P>0.05).  Conclusion  There are some differences in the general clinical, ultrasonic features, surgical methods and postoperative recovery of CSP patients with different ultrasonic classification. Ultrasound examination has certain guiding value for the classification of CSP and the selection of surgical methods.
Value of pelvic magnetic resonance imaging and intraoperative frozen section in diagnosing myometrial invasion in patients with endometrial cancer
LI Qiong-fang, TAO Qun, YIN Zong-zhi
2021, 19(2): 287-289. doi: 10.16766/j.cnki.issn.1674-4152.001790
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  Objective  To analyse the results of preoperative pelvic magnetic resonance imaging (MRI), intraoperative rapid frozen section (FS), and postoperative paraffin pathology in diagnosing myometrial invasion in patients with endometrial cancer, as well as to compare the diagnostic value of pelvic MRI and FS in the myometrial invasion of endometrial cancer.  Methods  Through retrospective analysis, 89 patients with stage I endometrial cancer diagnosed by paraffin after operation were selected from Chaohu Hospital of Anhui Medical University from January 2009 to January 2017, and their sociodemographic and clinical data were collected. Results of preoperative pelvic MRI and intraoperative FS on myometrial invasion and deep myometrial invasion were compared with those of postoperative paraffin pathology, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to compare the diagnostic value of preoperative pelvic MRI and intraoperative FS in myometrial invasion.  Results  The sensitivity (86.76% vs. 63.24%), accuracy (84.27% vs. 62.92%), and NPV (64.00% vs. 34.21%) of intraoperative FS for myometrial invasion were higher than those of preoperative MRI (P < 0.05). Similarly, the specificity (100.00% vs. 90.41%), accuracy (95.51% vs. 86.52%), and PPV (100.00% vs. 61.11%) of intraoperative FS for deep myometrial invasion were higher than those of preoperative MRI (all P < 0.05).  Conclusion  For patients with endometrial cancer whose myometrial invasion is tested negative by preoperative MRI, intraoperative rapid FS examination should be performed to further evaluate myometrial invasion with increased accuracy.
Advances in the research of thrombopoietin
CHEN Lu-xin, GU Dong-mei, LUO Wei
2021, 19(2): 290-292,297. doi: 10.16766/j.cnki.issn.1674-4152.001791
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Thrombopoietin (TPO) is a key regulator in platelet production, and also known as a megakaryocyte growth-derived factor. TPO can bind to c-Mpl, a surface receptor on megakaryocytes, activate megakaryocytes through a variety of signaling pathways to promote the proliferation and differentiation of megakaryocytes to produce platelets, and then achieve the purpose of increasing platelet levels in circulation. Now, TPO has been isolated and cloned at home and abroad, a lot of research has been done on its protein structure, expression regulation, biological activity and its therapeutic effect in clinical diseases. These studies revealed new sources of TPO and their similarities and differences with erythropoietin (EPO) structure, the maintenance mechanism of TPO concentration in vivo, and the advantages and disadvantages of TPO drugs of different generations. At the same time, TPO was reported not only in common platelets reducing diseases have a good therapeutic effect, and also have positive protective effects on the other organs or cells except the blood system, such as aplastic anemia, myelodysplastic syndrome, liver cirrhosis and so on. This series of research developments has an important guiding significance for the clinical application of TPO. This article reviews the latest developments mentioned above.
Research progress of the effect of SARS-CoV-2 on the circulatory system
WANG Xi, AN Song-tao, LI Wen-bo, CHEN Dong-chang, MENG Hua
2021, 19(2): 293-297. doi: 10.16766/j.cnki.issn.1674-4152.001792
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Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (SARS-CoV-2). It is a disease that can spread widely amongst the population with fever, cough, and dyspnea as the main clinical symptoms. To date, SARS-CoV-2 is causing a pandemic. With the effective development of domestic epidemic prevention and control and the understanding and research of the new type of coronavirus pneumonia, many patients with new coronary pneumonia have been discovered to have clinical symptoms that are first or secondary to symptoms of circulatory system damage. SARS-CoV-2 can directly damage cardiomyocytes through angiotensin converting enzyme 2 receptors. It can also activate the immune system abnormally and release a large number of cytokines to cause acute and chronic myocardial damage. When the heart function is severely impaired, kidney function may be affected through the RAS system, which may lead to clinical manifestations of heart and kidney damage at the same time. For COVID-19 patients, risks of arterial and venous thromboembolism also exist. This article combines the data of the new coronary pneumonia cases announced in recent days and the latest findings of research teams to provide a brief overview of the study progress of the new coronavirus on the circulatory system. We aim to better elucidate the damage to the circulatory system caused by the new coronavirus infection.
Effect of Duhuo Jisheng Decoction combined with large area moxibustion on analgesic effect and quality of life of cold-damp type lumbar disc herniation
ZHOU Xiao-fang, FANG Qun, GU Min-Jie, LUO Han-bing, ZHANG Xu-ping, GUO Fang-fang, CUI Juan
2021, 19(2): 298-301. doi: 10.16766/j.cnki.issn.1674-4152.001793
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  Objective  To research the effect of Duhuo Jisheng Decoction combined with large area moxibustion on the analgesic effect and quality of life of cold and damp type lumbar disc herniation, and provide the evidence for clinical application.  Methods  A total of 90 patients with cold-damp type lumbar disc herniation admitted to the Third Affiliated Hospital of Zhejiang University of Chinese Medicine from January 2018 to October 2019 were randomly divided into control group and treatment group by using the random number table method, with 45 patients in each group. The control group was treated with Duhuo Jisheng Decoction oral treatment, and the treatment group was treated with large area moxibustion (fire dragon moxibustion) on the basis of the control group. The clinical efficacy, visual analogue (VAS) score, modified Japanese Orthopedic Association lower back pain (M-JOA) score, quality of life score, and adverse reactions were evaluated before and after treatment in both groups.  Results  After 14 days of treatment, the clinical effective rate of the treatment group was 95.56% and the control group was 77.78%, the difference was statistically significant (P < 0.05). The VAS scores were (2.56±0.69) and (3.82±0.83) respectively, which were lower than those before treatment (all P < 0.001), and the treatment group was significantly lower than the control group (P < 0.001). The M-JOA score was (23.11±3.55) and (20.36±3.39) respectively, which was significantly higher than that before treatment (P < 0.001), and the treatment group was better than the control group (P < 0.001). The scores of physical function, health status, emotional function and social function in the treatment group were 85.49±1.82, 84.42±1.75, 82.84±5.68 and 81.49±11.46, respectively, which were better than those of the control group (63.44±3.24, 62.47±2.90, 62.76±2.31 and 62.96±1.83, respectively, all P < 0.001).  Conclusion  Duhuo Jisheng Decoction combined with large scale moxibustion treatment of cold-damp type lumbar disc herniation can significantly improve clinical symptoms, effectively improve the quality of life, and have good safety.
Clinical curative effect of Shugan Xiehuo Decoction in treating Qiyu Huahuo type post-stroke depression
WU Xu-jie, ZHAO Na, WANG Yi-ru, ZHU Zheng-yu
2021, 19(2): 302-304. doi: 10.16766/j.cnki.issn.1674-4152.001794
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  Objective  To explore the clinical efficacy of Shugan Xiehuo Decoction in treating Type of stagnated qi turning to fire post-stroke depression (PSD).  Methods  A total of 120 patients with Type of stagnated qi turning to fire PSD treated in Wenzhou Hospital of Traditional Chinese Medicine of Zhejiang University from August 2017 to December 2019 were included in this study. According to the random-number table method, the observation and control groups had 60 patients each. Patients in the control group were treated with sertraline hydrochloride tablets, whereas patients in the observation group were treated with Shugan Xiehuo Decoction for 6 weeks. Patients in the two groups were followed-up, and their HAMD score, NIHSS score, Barthel Index score, and TCM syndrome score were observed. The occurrence of adverse reactions during treatment was compared and analysed.  Results  (1) No statistically significant difference in HAMD score, NIHSS score, Barthel index score, and TCM syndrome score was observed between the two groups before treatment (all P>0.05). Improvement was observed after treatment, and this improvement was significantly higher in the observation group than in the control group (tHAMD score=-2.467, P=0.015; tNIHSS score=-5.707, P < 0.001; tBarthel index score=36.258, P < 0.001; tTCM syndrome score=-7.267, P < 0.001). (2) The incidence of adverse reactions was 8.33% in the observation group and 10.00% in the control group, with no significant difference between both groups (χ2=0.100, P=0.752).  Conclusion  Shugan Xiehuo Decoction has a definite effect on the treatment of Type of stagnated qi turning to fire PSD. On the basis of improving patients' depressive symptoms, it has a certain effect on their neurological rehabilitation and further improves patients' quality of life. No serious adverse drug reactions or drug addiction is observed during treatment.
Application of three-dimensional printing technology and PBL in teaching about aortic dilated diseases
TANG Dian-jun, LI Fan-dong, GUO Ya-nan, WU Peng, YANG Yan-fei, SUN Qiang, MIAO Xiang-ling, ZHOU Tao, WU Meng-tao
2021, 19(2): 305-307. doi: 10.16766/j.cnki.issn.1674-4152.001795
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  Objective  To study the effect of 3D printing technology combined with problem-based learning (PBL) teaching mode in the teaching of aortic dilation disease for clinical undergraduates and residents.  Methods  A total of 64 undergraduates and 42 residents who studied in our center from January 2019 to February 2020 were randomly divided into control groups and experimental groups according to odd or even number by drawing lots. The traditional teaching model was used in the control group (32 undergraduates and 21 residents), and 3D-printed models and PBL were added to the traditional teaching model in the experimental group (32 undergraduates and 21 residents). After teaching, the effectiveness of the two methods was evaluated using tests and practical examination.  Results  Regarding the teaching of undergraduates, the performance of the experimental group was better than that of the control group in terms of aortic anatomy and basic theory, typing and characteristics of abdominal aortic aneurysms, and practical examination (localisation and puncture of the femoral vascular, all P < 0.05). Regarding the teaching of residents, no statistical difference existed between the aortic anatomy and the basic theoretical in two groups (all P>0.05). The teaching performance of the experimental group was better in terms of type and endovascular treatment measurement, operation points, and characteristics of complicated abdominal aortic aneurysms (all P < 0.05) during the teaching of common cases and complicated cases.  Conclusion  The application of 3D-printing technology and PBL enables undergraduate students to better master the basic theories of aortic dilatation diseases and the key points of vascular puncture operation. Residents can improve the identification and treatment of aortic dilated diseases and enhance the teaching effect of aortic dilatation diseases.
Comparative analysis of general practice research based on Citespace
FENG Gong, LIU Jun-lin, ZHANG Xiao-chun, YAN Qin-qin, MI Man
2021, 19(2): 308-311. doi: 10.16766/j.cnki.issn.1674-4152.001796
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  Objective  To explore the current situation, differences and boundaries of general medical research at home and abroad, and to compare their similarities and differences.  Methods  In this study, we searched and screened the relevant literatures in recent 10 years (2009-2019) in CNKI and Web of Science database, and then analyzed and sorted out the retrieval results using the bibliometric software Citespace.  Results  Within the retrieval time span, 11 703 articles were published in China, with Professor YANG Hui, Professor YU Xiaosong and Professor WANG Shuang as the most prominent ones. Capital medical university, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of China Medical University and other institutions ranked the top in terms of the number of papers issued. The Chinese general medicine, general practitioners, community health services, education and family medicine had become the top five research hotspots. The number of foreign papers was 77 202, LITTLE P was the most prolific author with 116 papers. University of Toronto ranked first in research institutions with 1 200 papers. Family, randomized controlled trial (RCT), primary-care, general-practice and risk had become the top five research hotspots.  Conclusion  The number of articles published in the field of general practice is increasing rapidly in China, but there is a lack of strong cooperation network between high-yield authors. There are different focuses on general practice research at home and abroad, which provides a new idea for the development direction of general practice in China.
Effects of physical activity on self-perceived burden among patients with colorectal cancer under chemotherapy
XU Xiao-wei, ZHAI Yin-ping, ZHANG Fang, GU Qiu-di, CHEN Yu
2021, 19(2): 312-315. doi: 10.16766/j.cnki.issn.1674-4152.001797
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  Objective  To investigate the physical activity and self-perceived burden of patients with colorectal cancer under chemotherapy, and analyze the correlation between them.  Methods  A total of 232 patients with colorectal cancer under chemotherapy in the First Affiliated Hospital of Wenzhou Medical University from July to December in 2019 were selected using the method of convenient sampling. General information questionnaire, EPIC Physical Activity Questionnaire and Self-perceived Burden Scale were investigated.  Results  Physical activity energy expenditure was 430.00 (393.50, 527.50) MET-min/week in colorectal cancer patients under chemotherapy. There were 10 active cases, accounting for 4.31%. Moderate 41 cases, accounting for 17.67%. Less than 181 cases, accounting for 78.02%. The score of self-perceived burden was (31.89±8.08), and the average score of items was (3.19±0.81). Twenty-five cases had no obvious burden, accounting for 10.78%. Sixty-one patients (26.29%) had mild burden. There were 102 patients with moderate burden, accounting for 43.97%. There were 44 cases with severe burden, accounting for 18.97%. Pearson correlation analysis showed that physical activity was negatively correlated with self-perceived burden among patients with rectal cancer chemotherapy (P < 0.01). Multiple linear regression analysis showed that physical activity, self-care status, per capita family income and residence of colorectal cancer chemotherapy patients were the main influencing factors of self-perceived burden (all P < 0.05).  Conclusion  Patients with colorectal cancer under chemotherapy have a high proportion of insufficient physical activity and a high level of self-perceived burden. In clinical nursing work, health education for patients should be strengthened to guide patients to increase physical activity appropriately, reduce patients' self-perceived burden and improve patients' rehabilitation level.
A study on the relationship between clinical and CT features and length of stay of general type novel coronavirus pneumonia patients in mobile cabin hospital
MA Gang, FENG Ke, MA Han-ning, MA Xiao-bin, YANG Xiao, MEI Bin
2021, 19(2): 316-319. doi: 10.16766/j.cnki.issn.1674-4152.001798
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  Objective  To retrospectively analyze the clinical and CT features of novel coronavirus pneumonia patients with general type and its' influence on the length of hospital stay, so as to provide reference for understanding the imaging features of novel coronavirus pneumonia and determining the outcome of patient.  Methods  The clinical and CT features of 84 patients with general type novel coronavirus pneumonia admitted to Wuhan Dongxihu mobile cabin hospital from February 7, 2020 to March 3, 2020 were summarized. Regression analysis was used to determine the impact of clinical and imaging characteristics on hospital stay.  Results  Among the 84 patients, 41 were males and 43 were females, aged from 17 to 73 years old, and 15 cases were positive for nucleic acid reexamination (17.86%). The most common manifestations of chest CT imaging were ground glass (98.81%) and enlarged vascular lumens (89.29%%). Most of the patients had signs of enlarged vascular lumens perpendicular to pleura (51.19%), some patients had Kerley B line (47.62%), strip shadow (38.10%) and consolidation shadow (16.67%), and a few patients had nodules (8.33%) and paving stone sign (4.76%). The majority of cases had bilateral distribution of lesions (82.14%), the proportion of lesions involving both the central and peripheral regions was 11.90%, and only the peripheral areas was 88.10%. The length of hospital stay was 8-25 days, and the average length of hospital stay was (16.02±4.32) days. The hospital stay of patients with positive nucleic acid reexamination was extended by 4.179 days compared with those with negative nucleic acid retest. The hospital stay of patients with lesions involving both central area and peripheral area, enlarged vascular lumens perpendicular to pleura was extended by 2.692 days and 3.123 days respectively compared with those without the above image features.  Conclusion  The length of hospital stay was longer in patients with positive nucleic acid reexamination, involvement of central area, thickening of blood vessels and signs perpendicular to pleura. It should be communicate with patients in time, and do a good job in psychological counseling.
Risk factors of cross-infection in orthodontic patients and predictive nursing intervention
ZHANG Li-ping, LOU Zhi-ping
2021, 19(2): 320-323. doi: 10.16766/j.cnki.issn.1674-4152.001799
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  Objective  To analyse the risk factors of cross-infection in orthodontic patients and to develop relevant predictive nursing intervention measures.  Methods  A total of 68 patients with cross-infection who received orthodontic treatment in our hospital from March 2017 to December 2019 were selected as the infection group, and 70 patients without cross-infection in our hospital during the same period were selected as the control group. The etiological distribution of infection group was analysed, and the related factors that may lead to cross-infection in patients with general information, disease data, and treatment related data were counted.  Results  A total of 134 strains of gram-negative bacteria (79.3%) were detected in the infection group. Most of them were Actinobacillus actinomycetemcomitans, Fossett's bacteria, and Porphyromonas gingivalis. A total of 35 strains (20.7%) were gram-positive bacteria. Most of them were oral Streptococcus, Staphylococcus aureus, and Staphylococcus epidermidis. Univariate analysis showed significant differences in age, diabetes mellitus, non-use of disposable instruments, unqualified disinfection of instruments, nonstandard operation of doctors, low level of protection awareness of medical staff, and substandard disinfection of air and environment between the two groups (all P < 0.05). Results of multivariate logistic analysis showed that significant differences were observed between the two groups in terms of age, diabetes mellitus, and non-use of disposable instruments and devices. The risk factors of cross-infection in orthodontic patients were as follows: unqualified mechanical disinfection, nonstandard operation of doctors and nurses, low level of protection awareness of medical staff, and substandard air and environment disinfection (all P < 0.05).  Conclusion  The main pathogen of cross-infection in orthodontic patients is gram-negative bacteria. Many risk factors lead to infection in patients. Predictive nursing intervention should be performed to improve prevention awareness.
Study on Nursing Care of Patients with Severe Pneumonia with Multi-frequency Vibrating Sputum Extractor
XU Fang-fang, WU Xia-yun, WANG Ya-ping, LU Jun-mei, PANG Lu, WANG Dan-qiong
2021, 19(2): 324-327. doi: 10.16766/j.cnki.issn.1674-4152.001800
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  Objective  To explore the nursing effect of multi-frequency concussion sputum extractor in ICU patients with severe pneumonia.  Methods  According to the random number method, 122 patients with severe pneumonia in ICU admitted by Quzhou City People's hospital, from January 2018 to December 2019, were divided into two groups, with 61 patients in each group. Both groups were given conventional treatment. On this basis, the control group was treated with traditional manual back button sputum drainage, and the observation group was treated with multi-frequency shock sputum drainage machine. After treatment, the average daily sputum volume, temperature (T), calcitonin (PCT) and c-reactive protein (CRP) and white blood cell count (WBC), arterial blood oxygen partial pressure, arterial blood (PaO2), CO2 partial pressure (PaCO2) and clinical pulmonary infection score (CPIS), vascular active drug use time, mechanical ventilation, ICU length of hospital stay, the total length of hospital stay, acute physiology and chronic health evaluation (APACHE Ⅱ) and 28 d case fatality rate of change were compared between two groups.  Results  The total effective rate of the observation group (95.08%) was significantly higher than that of the control group (77.05%, χ2=8.296, P=0.016). After treatment, the levels of PCT, CRP, WBC, PaCO2, T and CPIS in both groups were significantly reduced (all P < 0.05), and the observation group was lower than the control group (all P < 0.05). PaO2 level increased in the two groups (all P < 0.05), and was higher in the observation group than in the control group (P < 0.05). The average daily sputum output of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, the use time, mechanical ventilation time, length of stay in ICU and total length of stay in the observation group were significantly shorter than those in the control group (all P < 0.05). APACHE Ⅱ scores of the two groups were significantly reduced (all P < 0.05), and the observation group was lower than the control group (P < 0.05).The case fatality rate of the observation group on day 28 (1.64%) was lower than that of the control group (8.20%), but the difference was not statistically significant (χ2=1.578, P=0.209).  Conclusion  The application of multi-frequency oscillatory sputum ejector in the treatment of severe pneumonia in ICU can significantly shorten the use time of vasoactive drugs, mechanical ventilation time and ICU hospitalization time, promote the sputum ejector, reduce the inflammatory response of patients, improve the blood gas level of patients, and the treatment effect is better.
Effect of TCM characteristic nursing based on evidence-based theory on the quality of life and therapeutic effect of patients with femoral head necrosis
WANG Shui-fang, XIA Bing-jiang
2021, 19(2): 328-331. doi: 10.16766/j.cnki.issn.1674-4152.001801
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  Objective  To explore the application effect of TCM characteristic nursing based on evidence-based theory in treating patients with femoral head necrosis.  Methods  A total of 120 patients with femoral head necrosis who were hospitalised in The Fourth Ward of Shaoxing Hospital of Traditional Chinese Medicine from January to December 2019 were selected as the study subjects. Amongst them, 60 patients admitted from January to June 2019 served as the control group, and 60 admitted from July to December 2019 served as the intervention group. Patients in the control group were given routine nursing, and those in the intervention group was given TCM nursing intervention based on evidence-based theory on the basis of the control group. The depressive anxiety symptom scores (SAS and SDS), hip-joint-function scores (Harris Hip Joint Rating Scale), quality-of-life scores (SF-36), and complication rates of both groups were analysed and compared.  Results  Before intervention, no significant difference in SAS, SDS scores, Harris, and SF-36 scores was observed between the two groups (all P>0.05). After intervention, the SAS and SDS scores of the intervention group were significantly lower than those of the control group (all P < 0.05). After intervention, the Harris and SF-36 score in the intervention group was significantly higher than that in the control group (all P < 0.05). The complication rate in the intervention group was 1.66%, significantly lower than that in the control group (13.33%, P < 0.05).  Conclusion  TCM characteristic nursing based on evidence theory can effectively improve the quality of life of patients with femoral head necrosis and has therapeutic value.
Application of hospital-family continuous nursing-intervention model in patients with enterostomy after Miles operation
WANG Jie, WANG Chun-liang
2021, 19(2): 332-335. doi: 10.16766/j.cnki.issn.1674-4152.001802
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  Objective  To explore the influence of hospital-family continuous nursing-intervention model on the physiological and psychological status, stoma self-care efficacy and quality of life of patients with enterostomy after Miles.  Methods  Fifty-three patients with rectal cancer who underwent Miles surgery in our hospital from January 2017 to September 2018 were selected as the control group, and another 54 patients with rectal cancer who underwent Miles surgery in our hospital from October 2018 to December 2019 were selected as the observation group. The control group received routine nursing intervention, whereas the observation group received routine nursing intervention and hospital-family continuous nursing intervention. The anxiety self-rating scale (SAS), depression self-rating scale (SDS), Pittsburgh sleep quality index (PSQI), quality of life, postoperative intestinal function recovery, complication rate, and postoperative stoma adjustment were observed and compared before and after intervention.  Results  After the intervention, the SAS, SDS, and PSQI scores of the observation group were significantly lower than those of the control group (P < 0.05). The recovery time of bowel sounds [(13.45±4.82) h] and the first anal exhaust time [(25.63±5.21) h] in the observation group were significantly lower than those in the control group [(19.85±5.24) h, (33.84±6.87) h, P < 0.05]. The incidence of complications in the observation group (5.56%) was significantly lower than that in the control group (18.87%, P < 0.05). The physiological function, mental state, social interaction, and total score of the observation group after intervention (171.83±25.64) were significantly higher than those of the control group (129.53±22.43, P < 0.05). The quality-of-life score of the observation group was significantly higher than that of the control group (P < 0.05).  Conclusion  Hospital-family continuous nursing intervention can significantly improve the anxiety and depression of patients after Miles by improving the quality of sleep, enhancing the ability to cope with the stoma, promoting the postoperative recovery of intestinal function, reducing the incidence of complications, and improving the quality of life.
2021, 19(2): 336-338. doi: 10.16766/j.cnki.issn.1674-4152.001803
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2021, 19(2): 339-340. doi: 10.16766/j.cnki.issn.1674-4152.001804
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General Practice Research
The predictive value of nutritional risk index in elderly patients with postoperative complications after pancreatoduodenectomy
WEI Xiao-yan, ZHANG Jia-qiang, SHA Sha
2021, 19(2): 176-178,231. doi: 10.16766/j.cnki.issn.1674-4152.001760
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  Objective  To analyze the predictive value of nutritional risk index for postoperative complications in elderly patients with pancreatoduodenectomy (PD), so as to provide reference for perioperative treatment of elderly patients with PD.  Methods  Total 120 elderly patients admitted to the General Surgery Department of our hospital for elective pancreatoduodenectomy (PD) from December 2018 to December 2019 were included in the study. Clinical and follow-up data of the included patients were collected comprehensively.  Results  (1) According to the occurrence of postoperative complications, 120 elderly PD patients were divided into complication group (49 cases) and non-complication group (71 cases). (2) Univariate analysis showed that GNRI, diabetes mellitus, albumin, BMI and operation time were the possible risk factors for postoperative complications in elderly PD patients. (3) Logistic multivariate regression analysis showed that low GNRI, history of diabetes and long operation time were independent risk factors for postoperative complications in elderly PD patients. (4) Value of GNRI in predicting postoperative overall complications in elderly PD patients: sensitivity 83.26%, specificity 75.25%, positive predictive value 58.96%, negative predictive value 92.86%, area under the curve 0.801 (P=0.003), critical value 88.7.  Conclusion  GNRI is an independent risk factor for postoperative complications in clinical elderly PD patients. Timely, comprehensive, accurate and effective preoperative nutrition screening has a good predictive value for postoperative complications in elderly PD patients and can be applied in clinical practice.
Clinical study of liver cancer resection combined with splenectomy in the treatment of liver cancer complicated with hypersplenism
WU An-qi, WANG Lin, YANG Yan-ru
2021, 19(2): 179-181, 331. doi: 10.16766/j.cnki.issn.1674-4152.001761
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  Objective  To investigate the clinical effect of liver cancer resection combined with splenectomy in patients with liver cancer complicated with hypersplenism.  Methods  Total 118 patients with primary liver cancer with spleen hypersplenism were Selected from February 2015 to February 2017 in our hospital, according to the operation method, who were divided into joint resection of liver and spleen group (observation group, 66 cases) and simple hepatic resection group (control group, 52 cases). Intraoperative blood loss and transfusion volume, red blood cell (RBC), white blood cell (WBC), platelet (PLT), CD4+, CD8+, CD4+/CD8+ and other T cell subtypes before and after surgery were compared between the two groups. Postoperative complications were compared between the two groups, and survival of the two groups was compared after 3 years of follow-up.  Results  There was no significant difference in intraoperative blood loss and blood transfusion between the two groups (all P>0.05). There were no statistically significant differences in RBC, WBC, PLT, CD4+, CD8+, CD4+/CD8+ and other indicators between the two groups 1 week before surgery (all P>0.05). The WBC and PLT indicators in the observation group were significantly higher than those in the control group 2 weeks after surgery (all P < 0.01), and the CD4+ and CD4+/CD8+ indicators in the observation group were significantly higher than those in the control group 2 months after surgery (all P < 0.01). The incidence of pulmonary infection, pleural effusion, biliary leakage, gastrointestinal bleeding and other complications in the observation group was 15.15%(10/66), while that in the control group was 11.54%(6/52). The incidence of postoperative complications in the two groups was not statistically significant (χ2=0.324, P=0.569). After 3 years of postoperative follow-up, the tumor-free survival rate of the observation group was 40.91%(27/66) and that of the control group was 21.15%(11/52), and the tumor-free survival rate of the observation group was significantly higher than that of the control group (χ2=5.199, P=0.023).  Conclusion  Combined splenectomy for hepatocellular carcinoma with hypersplenism can effectively promote the rise of WBC and PLT, enhance the immune function of the body, improve the long-term treatment effect, and is relatively safe, which is worthy of clinical promotion and use.
The role of PI3K/ Akt signaling pathway in upregulation of ISG15 induced by interferon 2α in hepatocellular carcinoma cells
WANG Qiang-hua, PANG Qing, WANG Xue-gu, WU Hua, CHEN Hui-juan, ZHAO Wen-jun, LI Xiang
2021, 19(2): 182-185, 269. doi: 10.16766/j.cnki.issn.1674-4152.001762
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  Objective  To investigate the mechanism of protein expression of interferon-stimulated gene 15 (ISG15) induced by interferon 2α (IFN-2α) via phosphatidy linositol 3-kinase (PI3K)/protein kinase B (Akt) in hepatocellular carcinoma cells.  Methods  HepG2 cells were cultured in the media containing IFN-2α and/or PI3K inhibitor LY294002, and four groups were created: control, IFN-2α, LY294002, IFN-2α+LY294002. The protein expressions of Akt, p-Akt and ISG15 were determined using western blot. Immunofluorescence was used to determine the co-expression of p-Akt and ISG15. Data were analyzed with one-way ANOVA followed by Bonferroni post hoc tests.  Results  Western blot analysis showed that the protein expression of ISG 15 was significantly increased in the IFN-2α group compared with control and IFN-2α+LY294002 group. Immunostaining analysis showed that the fluorescence intensity of ISG15 in the IFN-2α group was significantly higher than that in control and IFN-2α+LY294002 group. Western blot analysis showed that, in the IFN-2α group, the level of p-Akt (Thr308) was significantly increased, while the p-Akt (Ser473) was significantly decreased, compared with control group. Immunofluorescence results showed that the fluorescence intensity of p-Akt (Thr308) in the IFN-2α group was significantly higher than that in the control group and the IFN-2α+LY294002 group.  Conclusion  In HepG2 cells, IFN-2α induces the protein expression of ISG 15 via increasing p-Akt (Thr308) in the PI3K/Akt pathway.
Clinical application of ultrasound-guided low sacral plexus nerve block combined with general anesthesia in hip replacement for elderly patients
AN Xiao-feng, FANG Liang-qin, WU Dan
2021, 19(2): 186-188, 311. doi: 10.16766/j.cnki.issn.1674-4152.001763
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  Objective  To observe the effect of ultrasound-guided sacral plexus block combined with general anesthesia on the postoperative clinical effect of hip replacement in elderly patients.  Methods  Total 80 elderly patients undergoing elective total hip replacement from January 2018 to January 2020 in our department were selected. They were randomly divided into experimental and control groups with 40 cases per group. The operation methods of the two groups were the same. The observation group was anesthetized by ultrasound-guided lumbosacral plexus block combined with general anesthesia, while the control group was anesthetized by general anesthesia. Laryngeal mask ventilation was used during anesthesia, and the bispectral index (BIS) of EEG was maintained at 45-55. The heart rate (HR) and mean arterial pressure (map) were recorded before entering the room (T0), 10 min after anesthesia (T1), 30 min after operation (T2) and 2 h after operation (T3), and 6, 12, 24, 36, 48 and 72 h after operation VAS scores were recorded, including intraoperative infusion volume, sufentanil dosage, operation time, intraoperative blood loss, postoperative extubation time and exhaust time. The data of two groups were compared and analysed.  Results  The intraoperative infusion volume, sufentanil dosage, operation time, intraoperative blood loss, postoperative extubation time, and exhaust time in the observation group were significantly lower than those in the control group (all P < 0.05). The HR and MAP of the observation group at T1 and T2 were lower than those of the control group (all P < 0.05). Vas scores at 6, 12, 24, and 36 h in the observation group were lower than those in the control group (all P < 0.05).  Conclusion  Compared with general anesthesia, ultrasound-guided lumbosacral plexus block combined with general anesthesia can reduce the dosage of opioid analgesics during the operation, and has better analgesic effect. It can reduce the amount of intraoperative infusion and blood loss, shorten the operation time, postoperative extubation time and exhaust time, and has high anesthesia satisfaction.
Study on the correlation between cerebral oxygen saturation and PEEP level of thoracoscopic elderly patients with lung cancer
YU Ru, LIANG Qi-sheng, LIU Lei, FU Wei, JIANG Yu-yu, WANG Kang-wu
2021, 19(2): 189-192, 259. doi: 10.16766/j.cnki.issn.1674-4152.001764
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  Objective  To investigate the correlation between positive end-expiratory pressure (PEEP) and cerebral oxygen saturation (rSO2) in elderly patients with thoracoscopic lung cancer.  Methods  A total of 60 elderly patients with thoracoscopic lobectomy from October 2019 to February 2020 were selected from the First Affiliated Hospital of Bengbu Medical College. They were divided into group A, group B and group C according to the order of admission, with 20 patients in each group. In the case of one-lung ventilation, tidal volume (VT) was set at 5 mL/kg in the 3 groups, and PEEP was set at 0, 5, and 10 cm H2O in the A, B, and C groups, respectively. Pulse oxygen saturation (SpO2), airway peak pressure (Ppeak), pulmonary dynamic compliance (Cdyn), oxygen partial pressure (PaO2) and cerebral oxygen saturation values (rSO2) were observed and recorded at five time points after anesthesia induction: 15 min (T0), 10 min (T1), 30 min (T2), 60 min (T3), and 20 min (T4) after recovery of bilateral ventilation.  Results  The minimum and average values of rSO2 in group B was significantly higher than that in group A and C (all P < 0.05), and the maximum percentage of rSO2 in group B was significantly lower than that in group A and C (all P < 0.05). At the time point T2-T4, rSO2 in group B was higher than that in group A and C, with group C higher than that in group A (all P < 0.05). At time point T1-T4, Ppeak in group B was lower than that in group A and C (all P < 0.05). Cydn of group B at time T1-T4 was higher than that of group A, and that of group B at time T1 was higher than that of group A and C (all P < 0.05). PaO2 in group B and C was significantly higher than that in group A at T2-T4 (all P < 0.05), and SpO2 showed no statistically significant difference between the three groups at T0-T4 (all P>0.05).  Conclusion  There was a correlation between brain oxygen saturation value and PEEP level during single lung ventilation in elderly patients undergoing thoracoscopic lung resection for lung cancer, and PEEP level at 5 cm H2O had a better rSO2 level.
The Mechanism study of the promotion of photodynamic therapy combined with NS-398 on the apoptosis of bile duct cancer cells QBC939 through inhibiting Bcl-2
JIANG Hai-tao, HUANG Zuo-an, HUANG Dan-dan, XIANG Jian-jian, WANG Wu-ke, CHEN Yun-jie
2021, 19(2): 193-197. doi: 10.16766/j.cnki.issn.1674-4152.001765
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  Objective  To study the effect of photodynamic therapy (PDT) combined with NS-398 on apoptosis of cholangiocarcinoma QBC939 cells and mechanism.  Methods  QBC939 cells were cultured and divided into four groups, namely, the photodynamic group, NS-398 group, joint experimental group and blank control group, which were exposed to 0, 2, 4, 6, 8 and 10 μg/mL of hematoporphyrin derivatives (HPD) with 0, 5, 10 and 15 J/cm2 light radiation and 0, 25, 50, 100 and 200 μmol/L NS-398, respectively. The growth inhibition ratio of the QBC939 cells (R) was measured and calculated by cell proliferation experiment (CCK8). Flow cytometry was used to measure cell apoptosis. The mRNA and protein expression levels of Bcl-2 were measured by real-time PCR, immunocytochemistry and ELISA.  Results  Both PDT and NS-398 could inhibit the growth of QBC939 cells in vitro. When HPD concentration was 8 μ g/ml, light intensity was 5 J/cm2, and NS-398 was 50 μmol/L, the R value was about 95%. There were significant differences between the combined experimental group and other groups (P < 0.05). If light radiation and NS-398 were increased, then the result would show no statistical differences. PDT combined with NS-398 could promote QBC939 cell apoptosis at the early stage through flow cytometry (F=3 224.753, P < 0.001). Real-time PCR demonstrated it could suppress the expression of Bcl-2 gene (F=6 262.227, P < 0.001). SP immunocytochemistry showed it could inhibit the expression of Bcl-2 (F=1 355.577, P < 0.001). ELISA showed it could inhibit the secretion of Bcl-2 (F=5 123.387, P < 0.001).  Conclusion  PDT combined with NS-398 could suppress the growth and promote early apoptosis of QBC939 cells. The inhibitory effect may be achieved by inhibiting the expression of Bcl-2 gene and protein, thus promoting the early apoptosis.
The shunt value of HPV E6/E7mRNA examination in cervical cytology ASCUS
NI Chang-xue, WANG Yan, YE Guo-liu, WANG Cai-zhi
2021, 19(2): 198-201, 255. doi: 10.16766/j.cnki.issn.1674-4152.001766
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  Objective  To explore the shunt value of human papillomavirus (HPV) E6/E7 mRNA examination in patients with atypical squamous epithelial cells (ASCUS) whose cervical cytology results are ambiguous.  Methods  Patients treated in the Department of Gynecology, the First Affiliated Hospital of Bengbu Medical College from August 2019 to August 2020, with liquid-based thin-layer cytology (TCT) as ASCUS, underwent (HPV) DNA examination and (HPV) E6/E7 mRNA examination were collected. The positive patients underwent colposcopy, the test results and cervical biopsy results were analyzed statistically, and the shunt value of HPV E6/E7 mRNA test in patients with ASCUS TCT results was discussed.  Results  The 231 ASCUS patients were divided into 117 cases of chronic cervical inflammation (50.65%), 65 cases of low-grade cervical intraepithelial lesions (28.14%), 47 cases of high-grade cervical intraepithelial lesions (20.35%), and 2 cases of cervical cancer (0.87%). 91 cases (39.39%) were HPV E6/E7 mRNA positive, 127 cases (54.98%) were HPV DNA positive, there was no significant difference in the detection rate of CINⅡ+between the two methods. (HPV) E6/E7 mRNA examination CINⅡ+(HISL+SCC) specificity was 69.2%, sensitivity was 71.4%, negative predictive value was 90.0%, positive predictive value was 38.5%. The specificity of HPV DNA examination CINⅡ+(HISL+SCC) was 53.3%, the sensitivity was 85.7%, the negative predictive value was 93.3%, and the positive predictive value was 33.1%. The specificity of (HPV) E6/E7 mRNA examination was significantly higher than that of (HPV) DNA, and the difference was statistically significant (χ2=26.273, P < 0.001). The copy value of patients with different cervical lesions was counted and analyzed. As the lesion level progresses, the copy value of (HPV) E6/E7mRNA also increased, the difference was statistically significant (ρ=0.562, P < 0.001). The AUC of E6/E7 mRNA examination is 0.69, which was greater than the value of (HPV) DNA AUC (0.60), which was more efficient than (HPV) DNA examination.  Conclusion  (HPV) E6/E7 mRNA examination is a good shunt for patients with atypical squamous epithelial cells (ASCUS) whose TCT results are ambiguous. It can reduce the colposcopy referral rate, reducing the burden of patients and the work of clinicians, avoiding missed diagnosis and over-treatment, becoming a new method for triage of ASCUS patients.
Clinical observation of iRoot SP single tip method for sinus periapical periodontitis
LI Xiu-juan, HAN Xue-song, ZHONG Liang-jun, CHEN Xing, DING Cheng
2021, 19(2): 202-204, 216. doi: 10.16766/j.cnki.issn.1674-4152.001767
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  Objective  To evaluate the clinical efficacy of iRoot SP single-tip filling and iRoot SP warm vertical technique in patients with chronic apical periodontitis with sinus in posterior teeth.  Methods  A total of 100 posterior teeth diagnosed as chronic apical periodontitis with sinus were selected as research object from March 2018 to February 2019. According to the random number table, each group has 50 cases. The control group were treated with iRoot SP warm vertical technique and the study group were with iRoot SP single-tip filling. Pain rate 1week after operation, sinus status 2 weeks after operation, apical shadow 3, 6 months after operation and 6 months follow-up of clinical effect were compared.  Results  Compared with the pain score at 1 week after operation, the response rates of the study group and the control group were 24.0% and 20.0%, respectively, with no significant difference (χ2=0.233, P=0.629); the sinus healing rates at 2 weeks after operation were 96.0% and 94.0%, respectively, with no significant difference (χ2=0.001, P>0.999); the effective rates of the study group and the control group at 3 months after operation were 100.0% and 76.0%, respectively, the difference was statistically significant (χ2=13.636, P=0.001). Six months after operation, the effective rates of the study group and the control group were 100.0% and 96.0%, respectively, with no statistically significant difference (χ2=0.501, P=0.475). Six months after operation, the comprehensive efficacy evaluation showed that the effective rates of the study group and the control group were 98.0% and 96.0%, respectively, with no statistically significant difference (χ2 < 0.001, P>0.999).  Conclusion  iRoot SP single-tip method for chronic apical periodontitis patients is with high filling efficiency, ease of clinical operation, low incidence of postoperative pain and high treatment success rate, it is worthy of clinical promotion.
Platelet-rich plasma combined with vacuum-sealing drainage in treating chronic refractory wounds
ZHU Si-wen, ZHANG Li, JIANG Bang-hong, LU Yao, ZHANG Yi-wen
2021, 19(2): 205-208, 301. doi: 10.16766/j.cnki.issn.1674-4152.001768
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  Objective  To investigate the clinical effect of platelet-rich plasma (PRP) combined with vacuum-sealing drainage (VSD) in treating chronic refractory wounds.  Methods  From March 2019 to June 2020, 40 patients with chronic refractory wounds admitted in the Department of Plastic and Burn, the First Affiliated Hospital of Bengbu Medical College, were selected and randomly divided into two groups, namely, control (only using VSD to cover the wound) and observation groups using PRP to inject the base and margin of wounds and using VSD to cover the wounds, 20 cases in each group. The length of hospital stay, effective rate of treatment, postoperative wound pain score (using visual analogue scale), and histomorphological characteristics of wound under HE staining were compared between the two groups.  Results  In the control group, 2 cases were ineffective, 10 cases were effective, and 8 cases were markedly effective; in the observation group, 0 cases were ineffective, 0 cases were effective, and 20 cases were markedly effective. Compared with the control group, the average length of stay in the observation group was significantly shorter [(27.10±8.63) d vs. (20.10±3.60) d, P < 0.01], and the effective rate was significantly increased (40.00% vs. 100.00%, P < 0.01). Results of HE staining showed that the inflammatory reaction of the control group was obvious, and the number of new granulation tissue and blood vessels was less in the control group, whereas the inflammatory reaction in the observation group was lighter, the number of new granulation tissue and blood vessels was higher, and the re-epithelialisation rate was higher in the observation group.  Conclusion  For patients with chronic refractory wounds, compared with the traditional PRP gel technology, PRP injection combined with VSD treatment can stimulate angiogenesis, improve the local blood circulation, accelerate the recovery of patients, relieve postoperative pain, shorten the length of stay, reduce the cost of treatment, and achieve good therapeutic effect.
The effectiveness evaluation of polyethylene glycol electrolyte solution in bowel preparation in divided doses of two days for elderly constipation patients
CHEN Li-peng, DU Li-yun, ZHENG Pei-fen
2021, 19(2): 209-211, 251. doi: 10.16766/j.cnki.issn.1674-4152.001769
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  Objective  To compare and analyze the bowel preparation effect and patient tolerance to different regimens of elderly constipation patients taking compound polyethylene glycol electrolyte powder in several doses 1 day before colonoscopy and on the same day as taking the same dose once 6 hours before colonoscopy.  Methods  According to the diagnostic criteria of Roman Ⅳ constipation, 150 mild to moderate constipation patients aged 60~85 years who were to undergo painless colonoscopy were selected and randomly divided into A, B and C groups, with 50 people in each group. Group A took 1 L of compound PEGYlated electrolyte powder at 15:00 1 day before the examination, and 2 L 6 hours before the examination. Group B received 3 L of compound PEGYlated electrolyte powder 6 hours before the examination. In group C, 1 L of compound PEGYlated electrolyte powder was taken at 20:00 1 day before the examination, and 2 L was taken 6 hours before the examination. The colonoscopy time point and diet of patients in the 3 groups were the same. Bowel cleanliness was assessed using the Boston Bowel Preparation Scale (BBPS), and scope-forward time was recorded. Both were recorded singly and blindly by the same endoscope physician. Patients' tolerance to different bowel preparation plans and adverse reactions were obtained through questionnaire survey.  Results  All patients completed bowel preparation and colonoscopy well. The average scope-forward time of the 3 groups were (4.34±1.29) min, (4.59±1.32) min, (4.45±1.50) min, and the good and good rates of bowel preparation quality after BBPS score were 95.7%, 93.9%, and 95.9%, respectively, with no statistically significant difference (all P>0.05). The bowel preparation tolerance rate in group A and Group C were 85.11% and 79.59%, both of which were better than 62.22% in group B. The incidence of adverse reactions in group A was the lowest (31.91%, 57.14% and 93.88%), and the results were statistically significant (all P < 0.05).  Conclusion  There is no difference in the effect of bowel preparation between the next day by several times of oral complex polyethylene glycol electrolyte powder and conventional colonoscopy one-time 6 hours before taking the same dose drugs, but the next day taking has better tolerance in patients with senile constipation, less adverse reaction, especially in the afternoon to take 1 day in advance and influence to sleep less, worth clinical promotion.
Analysis of clinical efficacy of tympanic membrane repair surgery under otoscope under wet ear stage
DING Zhao-ran, JIANG Cheng-yi, WANG Wei, QIANG Hua-long, CHENG Zhong-qiang, ZHAN Xiao-dong
2021, 19(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.001770
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  Objective  To investigate the clinical effect of tympanoplasty in patients with chronic suppurative otitis media in wet ear stage.  Methods  A retrospective study was conducted on 31 patients with otitis media in wet ear stage who were treated in the Department of Otolaryngology, head and neck surgery, the First Affiliated Hospital of Bengbu Medical College from September 2018 to December 2019. The degree of tympanic membrane perforation and hearing loss before operation were compared, and the hearing recovery, tympanic membrane healing and patients' satisfaction three months after operation were analyzed. Whether the patients with chronic suppurative otitis media in wet ear stage can be operated with tympanic membrane repair under otoscope in clinical work, and whether the operation can obtain satisfactory curative effect were discussed.  Results  All the patients (30/31 ears) had good tympanic membrane healing at 3 months after operation, except that 1 patient showed perforation of tympanic membrane. The postoperative hearing of all patients was significantly improved compared with that before surgery, and the mean air-to-air hearing threshold recovered from (38.45±1.65) dB HL before surgery to (25.94±2.62)dB HL 3 months after surgery. The mean gas-bone conduction threshold difference recovered from (23.68±1.17) dB HL before surgery to (7.77±1.78) dB HL 3 months after surgery, with statistically significant difference (all P < 0.05). The overall satisfaction of patients reached 30(96.77%).  Conclusion  Under the condition of proper cleaning of purulent secretions in the external auditory canal and the drum chamber before and during the operation, and rational use of antibiotics according to drug sensitivity results before and after the operation, Otoscopic tympanoplasty can be performed in patients with chronic suppurative otitis media in the wet ear stage, with satisfactory clinical efficacy.
General Clinical Research
Clinical effect of Xinshen Jieyu Decoction in the imbalance of Th17/Treg and Barthel index in the moderate or severe post-stroke depression patients
HAN Zhen-xiang, QI Li-li, HOU Zhen-zhen, ZHOU Yi-xin, LIU Ai-hua
2021, 19(2): 217-220. doi: 10.16766/j.cnki.issn.1674-4152.001771
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  Objective  To investigate the clinical effect of Xinshen Jieyu Decoction in the moderate or severe post-stroke depression patients.  Methods  Ninety post-stroke depression patients were included in Seventh People's Hospital of Shanghai University of TCM, which was conducted from January 2014 to January 2018. The patients were randomized to receive Xinshen Jieyu Decoction combined with sertraline vs control sertraline group over 8 weeks. The HAMD was the primary outcome measure. As secondary aims, several biomarkers, such as BDNF, Treg and Th17 were investigated.  Results  The 2 group did not differ with the baseline severity of depression. Hamilton Depression scale (HAMD) score and Barthel Index in both groups were significantly improved (all P < 0.05). Meanwhile, HAMD score and Bathel Index were significantly more improved in the treatment group than in the control group after 4 weeks (all P < 0.05). The biomarkers, such as BDNF, Treg, Th17 and Treg/Th17 were significant difference before and after treatment (all P < 0.05) and these biomarkers were significantly better than those of the control group (all P < 0.05). BDNF level (27.31±5.20) and Treg level (6.52±0.93) in treatment group after treatment were higher than those in control group (23.03±5.62, 4.52±1.51). Th17 level (0.30±0.16) and Th17/Treg level (0.10±0.06) in treatment group after treatment were higher than those in control group (0.41±0.27, 0.16±0.07).  Conclusion  Imbalance of Th17/Treg may be a potent pathogenesis of PSD. Xinshen Jieyu Decoction combined with sertraline hydrochloride is more effective and safer than sertraline hydrochloride alone in the PSD treatment.
Effects of Shujin Songjian topical liniment on the prevention and treatment of advanced knee osteoarthritis and its influence on serum bFGF level and knee joint function recovery
ZHANG Li-yuan, CHEN Xiang-yi, WU Hui-ming
2021, 19(2): 221-223, 273. doi: 10.16766/j.cnki.issn.1674-4152.001772
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  Objective  To investigate the effects of Shujin Songjian topical liniment on the treatment of advanced knee osteoarthritis (KOA).  Methods  Seventy-four patients with advanced KOA who were diagnosed and treated between January 2017 and June 2019 were divided into a treatment group (n=37) and a control group (n=37) via the random number table method. The control group was treated with total knee arthroplasty (TKA) and given routine treatment after surgery. On the 7th day after surgery, the treatment group was externally applied with Shujin Songjian topical liniment. The curative effect of this agent was evaluated after 28 days of medication. Scores of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Rasmussen grading were calculated and statistically analysed before and after treatment. Levels of serum bone gla protein (BGP), vascular endothelial cell growth factor (VEGF) and basic fibroblast growth factor (bFGF) were determined via enzyme-linked immunosorbent assay.  Results  The total effective rate in the treatment group (97.30%) was significantly higher than that in the control group (78.38%, P < 0.05). The WOMAC scores, serum VEGF and bFGF levels in the two groups significantly decreased after treatment (all P < 0.05), whereas serum BGP levels and Rasmussen grading scores significantly increased (all P < 0.05). After treatment, WOMAC scores, serum VEGF and bFGF levels of the treatment group were significantly lower, whereas serum BGP levels and Rasmussen grading scores were significantly higher than those of the control group (all P < 0.05).  Conclusion  External application of Shujin Songjian topical liniment can effectively improve the effects of TKA on patients with advanced KOA, reduce the symptoms of osteoarthritis and the level of bFGF and improve knee joint functions.
Research of the characteristic of pathogenic bacteria and risk factors in intracranial infection after hypertensive cerebral hemorrhage
YAO Xiao-qian, XU Tong-mei, XU Jing, YU Er-li, SHI Bei-tian, LIN Ning
2021, 19(2): 224-226. doi: 10.16766/j.cnki.issn.1674-4152.001773
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  Objective  To analyze the characteristics of pathogenic bacteria and related risk factors of intracranial infection after hypertensive cerebral hemorrhage, and provide a basis for the prevention and treatment of clinical intracranial infection.  Methods  A total of 102 patients with hypertensive cerebral hemorrhage who were surgically treated in the Neurosurgery Department of the First People's Hospital of Quzhou from January 2017 to December 2019 were selected as the research subjects. The clinical data were retrospectively collected and analyzed. The distribution of pathogenic bacteria in patients with intracranial infection was observed, and the risk factors related to intracranial infection were analyzed.  Results  There were 23 cases of intracranial infection in the 102 patients with hypertensive cerebral hemorrhage. Staphylococcus epidermidis was the main gram-positive pathogen, accounting for 25.00%. Acinetobacter baumannii was the main gram-negative pathogen, accounting for 32.14%. The resistance rates of Staphylococcus epidermidis to penicillin, ciprofloxacin, erythromycin, clindamycin, linezolid, vancomycin, and tigecycline were 100.00%, 85.71%, 100.00%, 85.71%, 0.00%, 0.00% and 0.00%, respectively. The resistance rates of Acinetobacter baumannii to piperacillin, ceftazidime, ceftriaxone, imipenem, levofloxacin, compound sinomine and tigecycline were 100.00%, 88.89%, 100.00%, 44.44%, 55.56%, 66.67% and 0.00%, respectively. There were no significant differences in gender, age, BMI, operative time, ASA score, and whether with diabetes between the infected and non-infected patients (all P>0.05), but there were statistical differences in preoperative Glasgow Coma Scale (GCS) scores and whether indwelling ventricle drainage tubes and drainage tube time (all P < 0.05). Multivariate analysis showed that preoperative GCS scores and whether indwelling ventricle drainage tubes were independent risk factors for intracranial infection (all P < 0.05).  Conclusion  The main pathogens of intracranial infection after hypertensive intracerebral hemorrhage are mainly Staphylococcus epidermidis and Acinetobacter baumannii, with characteristics of multiple drug resistance. The preoperative GCS score and whether indwelling ventricular drainage tube are independent risk factors for intracranial infection. It needs to be paid enough attention in clinical.

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