2021 Vol. 19, No. 3

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Expert Forum
SWOT analysis of guiding primary health service by general practice department of general hospital
LI Han-xiang, BAI Yong-kai, WANG Liu-yi
2021, 19(3): 341-344. doi: 10.16766/j.cnki.issn.1674-4152.001805
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As an important part of China's medical and health system, the primary health service institutions represented by community health service centers and township health centers are the main body of providing basic medical and health services. The construction of their service capacity has great strategic significance in building an efficient and orderly hierarchical diagnosis and treatment system. With the continuous advancement of China's medical and health system reform, the importance of basic medical and health services has become increasingly prominent. However, the development of primary medical and health services in China is still in its infancy, and the shortage of primary health service personnel and low quality of the primary health services are still the main problems that limit the level of primary health care. Exploring effective ways to comprehensively improve the ability of primary health services has become the key to promoting the development of primary health. In recent years, with the support of national policies, the general practice department of general hospitals has been constantly improving its discipline construction and base construction. Moreover, as a bridge connecting grassroots and general hospitals, the general practice department of general hospitals relying on its advantages of medical treatment, education and scientific research has the ability and responsibility to guide and help the development of grassroots medical and health services, and promote cooperation and exchange between higher and lower medical institutions. Based on SWOT analysis, combined with the ideas of experts from general hospitals, community health institutions and health administrative departments, this paper systematically analyze the strengths, weaknesses, opportunities and threats of a general hospitals participating in the guidance of primary medical and health services, and comprehensively analyzes the necessity and feasibility of general practice department in general hospitals guiding community health services. At the same time, it puts forward corresponding development strategies from the perspectives of exerting advantages, overcoming disadvantages, seizing opportunities and avoiding threats, so as to provide reference for further improving the ability of primary health services and promoting the construction of hierarchical diagnosis and treatment system.
2021, 19(3): 345-346.
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Effects of glycolipid metabolism and blood uric acid level on serum alpha-fetoprotein concentration in patients with metabolic syndrome
LI Ruo-qing, MAO Mei, CUI Yuan-ting, JIANG Yi, XIE Qin-li, YANG Qiao, ZHOU Min, TANG Yu-ping
2021, 19(3): 413-415,470. doi: 10.16766/j.cnki.issn.1674-4152.001824
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  Objective  To study the relationship between metabolic parameters and serum alpha-fetoprotein (AFP) of patients with metabolic syndrome (MS) and to clarify the influence of metabolic parameters on AFP, in order to provide reference for MS patients in cancer prevention and treatment.  Methods  General information of 415 MS patients and 227 non-MS people who participated in physical examination at Central Hospital of Chongqing University from June 2017 to June 2020 were collected. Abdominal circumference, systolic blood pressure, diastolic blood pressure, AFP, fasting blood glucose (FBS), glycated hemoglobin (HbA1c), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), urea nitrogen (BUN), serum creatinine (Cr), blood uric acid (UA), β2-microglobulin and cystatin-C were measured. Differences in the above parameters between patients with MS and non-MS were compared. The parameters of different AFP concentrations in MS patients were compared and the relationship between AFP and parameters in patients with MS were analyzed.  Results  The serum AFP concentration in the MS group was significantly higher than that in the non-MS group (P < 0.001). When the FBS, HbA1c, TC, LDL, and UA of MS patients were high, the serum AFP concentration matched corresponds to the high concentration level (P < 0.001), showing a significant positive correlation (P < 0.001). FBS (β'=0.460, P < 0.001), HbA1c (β'=0.212, P < 0.001), UA (β'=0.348, P < 0.001) were independently correlated with serum AFP concentrations.  Conclusion  Glycolipid metabolism and blood uric acid levels in MS patients may affect serum AFP concentration, and this influence was more significant when glucose metabolism and blood uric acid were abnormal.
Multidisciplinary health literacy management practices in elderly patients with chronic heart failure
JIANG Wei-lian, LI Fang, YANG Ping, WANG Hai-rong, LI Quan-zhong, LI Su-fen, WANG Xin-tao, LIAO Zeng-zhen, HE Jie
2021, 19(3): 416-420. doi: 10.16766/j.cnki.issn.1674-4152.001825
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  Objective  To explore the nursing strategy of multidisciplinary health literacy management for elderly patients with chronic heart failure and evaluate its clinical application effect.  Methods  From January 2019 to December 2019, A total of 130 elderly patients with chronic heart failure who were hospitalised in a tertiary Grade A hospital in Guilin, Guangxi Zhuang Autonomous Region were selected via the convenience sampling method. Sixty-five patients who were hospitalised each month from January 2019 to June 2019 were set as the control group. Moreover, 65 patients who were hospitalised from July 2019 to December 2019 were set as the observation group. The control group received routine nursing guidance and was followed up via telephone, and the observation group was given multidisciplinary team guidance for self-management on the basis of the control group. The discipline team guided the patients to self-manage. The health literacy and quality of life of the two groups of patients were compared after 3 months of intervention.  Results  No significant difference was observed in terms of health literacy and the Minnesota living with heart failure questionnaire (MLHFQ) scores between the two groups before intervention (all P>0.05). After 3 months of intervention, the health literacy score of the observation group (36.63±4.16) was significantly higher than that of the control group (27.89±3.64), P < 0.05. The quality of life scale score of the observation group (36.56±5.07) was significantly lower than that of the control group (49.78±6.32), P < 0.05.  Conclusion  Implementing multidisciplinary health literacy management can effectively improve the health literacy and quality of life of elderly patients with chronic heart failure.
Correlation between serum 25-(OH)D level and incidence and severity of community acquired pneumonia in infants
WANG Xian-xian, SHAN Zi-hong, MA Li-juan, YANG Jun, ZHOU Rui
2021, 19(3): 421-424. doi: 10.16766/j.cnki.issn.1674-4152.001826
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  Objective  To investigate the association between serum 25 hydroxyvitamin D[25-(OH) D] level and incidence and severity of community acquired pneumonia (CAP) in infants.  Methods  The enrolled participants were all from the First Affiliated Hospital of Bengbu Medical College admitted from January 2018 to May 2019, including 172 infants with CAP as the CAP group and 50 normal infants as the control group. According to different concentrations of 25-(OH) D, the CAP group was divided into adequacy (88 cases), insufficiency (54 cases), and deficiency (30 cases) groups. The differences in serum 25-(OH)D, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), extra-pulmonary complications, and severity of disease amongst the three groups were recorded and compared. The correlation between the 25-(OH) D levels of CAP patients with WBC, CRP, PCT, and ESR levels were statistically analysed.  Results  Comparison of the CAP group with the control group revealed that the 25-(OH) D deficiency rates were 48.84% and 24.00%, respectively, and the difference was statistically significant (P < 0.05). No significant difference in CRP levels was observed between the adequate, insufficient, and deficient groups (P>0.05), whereas statistically significant differences were observed amongst the 25-(OH) D, WBC, PCT, ESR, extra-pulmonary complications, and degree of disease in the adequate, insufficient, and deficient groups (all P < 0.05). In particular, the levels of WBC, PCT, ESR, incidence of extra-pulmonary complications, and severe disease rate in the deficiency group were higher than those in the other two groups, and the difference was statistically significant (all P < 0.05). Spearman rank correlation analysis showed that the serum 25-(OH) D level was negatively correlated with WBC and ESR in the CAP group (r=-0.444, -0.326, P < 0.05). No correlation was observed with CRP and PCT level (r=0.033, -0.170, P>0.05).  Conclusion  The deficiency rate of serum 25-(OH) D in infants with CAP is higher than that of normal infants, which is correlated with the occurrence and severity of the disease. Therefore, monitoring serum 25-(OH) D can aid the assessment of CAP severity in infants.
Study on the outcome of glucose metabolism and related factors in gestational diabetes mellituss at 6-12 weeks postpartum
CHEN Qing-hong, YANG Lin-lin
2021, 19(3): 425-427, 431. doi: 10.16766/j.cnki.issn.1674-4152.001827
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  Objective  To discuss the effects of glucose metabolism and related factors in gestational diabetes mellitus (GDM) patients at 6-12 weeks postpartum on GDM and to provide theoretical reference for preventing abnormal glucose metabolism in GDM patients.  Methods  GDM inpatients who met the requirements in our hospital from January 2019 to January 2020 were selected for the study and divided into the abnormal glucose metabolism group (80 cases) and normal glucose metabolism group (120 cases) on the basis of the results of 6-12 weeks postpartum glucose metabolism. Pre-pregnancy, mid-pregnancy and neonatal-related indicators were compared and analysed between the two groups.  Results  Univariate analysis showed that GDM patients had significant differences in age, family history of diabetes, pre-pregnancy BMI, oral glucose tolerance test (OGTT) FPG and OGTT 2hPG; all the differences were statistically significant (P < 0.05). Multivariate analysis showed that age (OR=2.177, P=0.002), pre-pregnancy BMI (ORfat=3.062, P=0.001; ORoverweight=0.038, P=0.036) and family history of diabetes (OR=6.968, P=0.030)were independent risk factors for glucose metabolism abnormalities in GDM patients at 6-12 weeks postpartum.  Conclusion  Abnormal postpartum glucose metabolism in GDM patients may be related to patient's age, family history of diabetes and BMI before pregnancy. Clinicians should be alert to the relevant risk factors during diagnosis and treatment, and follow-up and preventive and control measures should be taken to reduce the incidence of postpartum glucose metabolism abnormalities in GDM patients.
The expression and significance of CD24 and Siglec-10 in epithelial ovarian cancer
CHEN Shu, ZHENG Jing, LI Yan-hua
2021, 19(3): 428-431. doi: 10.16766/j.cnki.issn.1674-4152.001828
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  Objective  To analyze the expression of CD24 and Siglec-10 in different ovarian tissues, and to explore their expression and significance in epithelial ovarian cancer.  Methods  The expression of CD24 and Siglec-10 were detected by immunohistochemistry (SP), their expression and characteristics in different ovarian tissues were analyzed. The relationship between CD24, Siglec-10 and different pathological parameters of epithelial ovarian cancer and the relationship between the two parameters were investigated, and the relationship between CD24, Siglec-10 and the occurrence, development, invasion, metastasis and recurrence of epithelial ovarian cancer were explored.  Results  CD24 and Siglec-10 were not expressed in normal ovarian tissues, and their expression levels increased with the benign, borderline, and malignant changes of ovarian tumors, the difference between the groups was statistically significant (P < 0.05). The expression level of CD24 and Siglec-10 was closely related to FIGO staging, lymph node metastasis, omental metastasis, pelvic and abdominal implantation, and recurrence, the difference was statistically significant (P < 0.05). The highly expression level of CD24 and Siglec-10 had a significant correlation in epithelial ovarian cancer (r=0.500, P < 0.001).  Conclusion  CD24 and Siglec-10 have a synergistic effect, which can jointly promote the occurrence and development, invasion, metastasis and recurrence of tumors. CD24-Siglec-10 is expected to become a new immune detection point, providing more possibilities for the immunotherapy of epithelial ovarian cancer.
Clinical analysis of 427 cases of acute poisoning in children in Bengbu area
HU Qing-yan, DING Zhou-zhi, ZHAO Bing, FU Lian-guo, XU Hui
2021, 19(3): 432-435. doi: 10.16766/j.cnki.issn.1674-4152.001829
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  Objective  To explore the clinical characteristics of acute poisoning in children and to provide reference for the prevention and treatment of acute poisoning in children in this area.  Methods  Using the method of retrospective investigation, the data of hospitalized children with acute poisoning were collected and divided into groups according to the developmental stages of children of different ages. The statistical software summarized and sorted out the information of sex, age of onset, type of poisoning, location of poisoning, cause and route of poisoning, living environment, season of onset, time from poisoning to admission, pre-hospital first aid, treatment outcome and so on. The general data distribution was described by constituent ratio statistics, and the chi-square test was used to analyze the clinical characteristics of children with acute poisoning.  Results  Among the 427 cases of acute poisoning, 234 (54.8%) were boys and 193 (45.2%) were girls, 6 (1.4%) were acute poisoning in infancy, 369 (86.4%) were in infancy and preschool, and 52 (12.2%) were above school age. There were 286 cases (67.0%) in rural areas, the top three types of poisoning were 112 cases of pesticides (39.2%), 80 cases of drugs (28.0%), 63 cases of rodenticide poisoning (22.0%), and 141 cases of urban cases (33.0%). The top three types of poisoning were 76 cases of drugs (53.9%), 20 cases of household chemicals (14.2%) and 16 cases of pesticides (11.3%). The site of poisoning was 411 cases (96.3%) at home. In the onset season, 249 cases (58.3%) occurred in spring and summer, 98.1% of the children with acute poisoning recovered well after active treatment.  Conclusion  Acute poisoning of children in this area is most common in early childhood and preschool children, and misadministration of drugs, pesticides and rodenticide through digestive tract is the most prominent in this area. Rural grass-roots poison management and safety education of guardians should be strengthened in spring and summer to reduce the occurrence of acute poisoning in children.
Study on the influencing factors of "1+1+1" type of contracted family doctor services
JI Hui
2021, 19(3): 436-440. doi: 10.16766/j.cnki.issn.1674-4152.001830
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  Objective  To explore the influencing factors of "1+1+1" type of contracted family doctor services, to understand the obstacles in the process of policy promotion, and to put forward the targeted suggestions and measures for improvement.  Methods  The random number table method was used to sample residents in the outpatient clinics of Huaihai Middle Road Health Service Center in Huangpu District, Shanghai in 2018 according to signed and unsigned contracts. A total of 1 204 valid samples were obtained, which include 602 residents contracting family doctor and 602 residents without contracting family doctor. Their demographic sociology information, health status, medical treatment status, family doctor contract awareness status were collected through questionnaire survey. Data analysis was performed in SPSS 24.0.  Results  The results of single factor analysis showed that residents with different situation showed statistically significant differences in family doctors' contracting status (all P < 0.05), such as occupation, whether to retire, education level, marital status, hyperlipidemia, stroke, heart disease, kidney disease, osteoporosis, other diseases, the need for long-term medication, dispensing needs, rehabilitation care needs, other care needs and knowledge of family doctor contract. There was a statistically significant difference in the age and years of education between contracted and unsigned residents (all P < 0.05). Multi-factor analysis results showed that occupation, retirement or not, education, marital status, hyperlipidemia, osteoporosis, needs for long-term medication, knowledge of family doctor contract were the independent factors affecting signing rate with family doctors (all P < 0.05). "No demand" was the main reason why residents did not consider signing contracts.  Conclusion  To promote the implementation of "1+1+1" medical institution combination contracting policy and establish a long-term and stable contracting relationship are necessary to further strengthen the propaganda of the policy, and provide health services based on the needs of community resident.
Effects of repetitive transcranial magnetic stimulation combined with sertraline on depressive symptoms and related miR-expression in peripheral blood of patients with postpartum depression
LIU Wen-juan, SONG Ming-fen, WANG Wei, LIU Xue-jun
2021, 19(3): 441-445. doi: 10.16766/j.cnki.issn.1674-4152.001831
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  Objective  To investigate the effects of repeated transcranial magnetic stimulation combined with sertraline on the depressive symptoms and expression of peripheral blood miR-195 and miR-124 in patients with postpartum depression (PPD).  Methods  A total of 96 patients with PPD were selected from June 2017 to October 2019 in Hangzhou Seventh People's Hospital. They were divided into a combined group, control group A and control group B via a simple randomization method, 32 cases in each group. Control group A was given sertraline (50 mg/d at 1 week, which was increased to 100 mg/d after 1 week), whereas control group B was given transcranial magnetic stimulation (1 time/d, 5 times/week).The combined group was treated with repeated transcranial magnetic stimulation and sertraline. All patients were treated for 8 weeks. The efficacy and depression score (EPDS), quality of life (GQOLI-74) score, plasma miR-195 and miR-124 expressions and levels of serum neurotransmitters before and after treatment among the three groups were compared.  Results  The total effective rate of the combined group (93.75%) was significantly higher than that of control group A (71.88%) and control group B (68.75%, all P < 0.05). After 8 weeks of treatment, the plasma miR-195 expression[(0.15±0.07) ng/L] and serum NE[(23.05±4.11) ng/L], 5-HT[(239.57±12.24) ng/L], and E2[(176.98±14.13) ng/L] levels of the combined group were higher than those of control group A[0.11±0.05, (17.18±3.09)ng/L, (214.06±15.37)ng/L and (149.13±11.50) ng/L, respectively] and control group B[0.09±0.06, (16.34±3.28)ng/L, (207.81±13.62)ng/L and (145.09±12.72) ng/L, respectively]. Moreover, plasma miR-124 expressions[(0.11±0.05) ng/L] and serum P levels[(21.87±3.16) ng/L] of the combined group were lower than those of control group A[0.17±0.06 and (30.65±4.24) ng/L, respectively] and control group B[0.20±0.09 and (31.98±4.09) ng/L, all P < 0.05]. After 8 weeks of treatment, the GQOLI-74 score of the combined group was higher than that of control groups A and B, and the EPDS score was lower than that of control groups A and B (all P < 0.05).  Conclusion  Repeated transcranial magnetic stimulation combined with sertraline for the treatment of patients with PPD can regulate the levels of serum neurotransmitters, sex hormones and the expression levels of miR-195 and miR-124 in plasma, reduce the EPDS score and improve the quality of life of patients.
Effect of experience-based education on complications in patients with type 2 diabetes mellitus with low educational background
SHI Fei-fei, ZHUANG Lan-gen, SHI Guan-hua, ZHANG Yan-li
2021, 19(3): 446-448, 522. doi: 10.16766/j.cnki.issn.1674-4152.001832
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  Objective  To introduce a new diabetes education model and explored the impact of the traditional education model combined with experiential complication education on the cognitive level and blood glucose regulation of type 2 diabetes patients with low educational background.  Methods  A total of 88 cases of type 2 diabetes patients with low educational background who visited our department from June to October in 2019 were randomly divided into the experimental and control groups, with 44 cases in each group. They were rand only divided into the control group (traditional diabetes health education) and experimental group (traditional health education combined with complication experience). Age, gender, duration, waist circumference and body mass index were collected as basic data. Blood sugar and glycosylated haemoglobin were tested. Vest, sand bags, special plastic model of kidney, special glass gloves, knitted gloves, elastic and cushions were used as teaching aid for complication experience of diabetes. Self-management behaviour scale and biochemical indicators were used to evaluate the effects of cognition and blood glucose control. SPSS software 24.0 was used for statistical analysis.  Results  No difference in baseline data was found between the two groups (all P < 0.05). The cognition, coping ability, healthy behaviour adoption and blood glucose control effect of the experimental group were significantly better than that of the control group (all P < 0.05).  Conclusion  The traditional health education combined with complication experience education can improve the self-management ability of diabetic patients, which has positive effects on blood glucose regulation.
The value in differentiation of renal angiomyolipoma with minimal fat and clear cell renal cell carcinoma by using CT heterogeneous degree
WANG Xu, SONG Ge, WANG Zong-ping
2021, 19(3): 449-453. doi: 10.16766/j.cnki.issn.1674-4152.001833
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  Objective  To investigate the value of heterogeneous degree in differential diagnosis of renal angiomyolipoma with minimal fat (mfAML) and clear cell renal cell carcinoma (ccRCC).  Methods  CT scan images of mfAML (n=25) and ccRCC (n=45) confirmed by pathology in Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) were retrospectively collected and analyzed from January 2016 to October 2019. The heterogeneous degree of tumor and psoas (HDT/HDP) were measured and standardized heterogeneous rate of tumor (SHRT) was obtained. The CT value of tumor and renal cortex in each enhanced phase were measured and enhancement rate of tumor (ERT) was obtained. The difference of parameters between the two tumors were statistically analyzed. The receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of each parameter.  Results  HDT and SHRT of cortical phase, HDT of nephrographic phase, and HDT and SHRT of excretory phase in mfAML were all lower than that in ccRCC, the difference was statistically significant (all P < 0.05). There was no statistically significant difference in HDT and SHRT of pre-contrast phase and SHRT of nephrographic phase between the two groups (all P>0.05). The CT value of pre-contrast phase in mfAML was higher than ccRCC, while the ERT of cortical phase in mfAML was lower than ccRCC, the difference was statistically significant (all P < 0.05). There was no statistically significant difference in CT value of cortical phase, CT value and ERT of nephrographic phase and CT value and ERT of excretory phase between the two tumors (all P>0.05).The ROC curve showed that the area under curve (AUC) of HDT & SHRT in cortical phase was larger, with AUC values of 0.85 and 0.82 respectively.When HDT of cortical phase took 31.31 Hu as the cutoff value, the sensitivity to distinguish these two tumors was 84.4%, and its specificity was 72.0%.  Conclusion  The heterogeneous degree can be used as a simple quantitative index to reflect the difference in enhanced homogeneity to distinguish mfAML from ccRCC, among which the diagnosis value of heterogeneous degree in cortical phase is higher.
Clinical characteristics of primary biliary cholangitis and RPR value in diagnosing cirrhosis
LIU Xin-xin, GAO Chun-ming, LIU Chuan-miao
2021, 19(3): 454-458. doi: 10.16766/j.cnki.issn.1674-4152.001834
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  Objective  To investigate the clinical features of primary biliary cholangitis (PBC) and the value of red blood cell distribution width-to-platelet ratio (RPR) in diagnosing PBC progression to cirrhosis, as well as to improve the level of diagnosis and treatment of the disease by clinicians.  Methods  From January 2014 to December 2019, 61 patients were diagnosed as PBC in the Outpatient and Inpatient Department of the First Affiliated Hospital of Bengbu Medical College. The clinical data of the patients were retrospectively analysed. According to the diagnostic criteria of cirrhosis, it was divided into cirrhosis and non-cirrhosis groups. Blood routine, biochemical indices, RPR values, immunoglobulin, and complement levels were compared between the two groups. The diagnostic value of RPR for PBC cirrhosis was judged by the area under the working characteristic curve (AUC).  Results  Amongst the 61 patients with PBC, 47 were female (77.05%). The main clinical manifestations were jaundice (44.26%) and abdominal distension (24.59%). Sjogren's syndrome was the most common extrahepatic autoimmune disease. A total of 56 cases (91.80%) had abnormal liver function, primarily GGT increase. The positive rate of anti-mitochondrial antibody (AMA) and/or AMA-M2 was 93.44%. Significant differences were observed in RDW, PLT, RPR, and complement C3 and C4 between cirrhotic and non-cirrhotic groups. The AUC value of RPR in diagnosing liver cirrhosis was 0.705 (95% CI: 0.567-0.843; P=0.008). The best value was 0.471, and the sensitivity and specificity were 52.20% and 81.60%, respectively.  Conclusion  PBC usually occurs in middle-aged women, and jaundice is the most common clinical manifestation. The increase in ALP and GGT and the positive AMA are the main characteristics of the disease. Sjogren's syndrome is the most commonly associated extrahepatic autoimmune disease. RPR has a high specificity in diagnosing PBC progression to cirrhosis and can be combined with other non-invasive serological indicators to help evaluate the disease progress.
Application value of indocyanine green fluorescence combined with carbon nanotracer in sentinel lymph node localization of papillary thyroid cancer
CHEN Gu, ZHANG Xing, CONG Ling-hua, LI Jia-gen
2021, 19(3): 459-462. doi: 10.16766/j.cnki.issn.1674-4152.001835
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  Objective  To explore the application value of indocyanine green fluorescence combined with carbon nanotracer in sentinel lymph node (SLN) localization of papillary thyroid cancer (PTC).  Methods  Ninety patients with PTC who underwent surgery in our hospital from July 2017 to July 2018 were enrolled. Sixty patients with indocyanine green fluorescence combined with carbon nanotracer as observation group, and 30 patients with carbon nanotracer as control group. The location and number of SLNs in both groups were recorded, followed by cervical lymph node dissection. Surgically resected sentinel lymph nodes and other dissected lymph nodes were frozen for pathological examination, relevant indicators were compared between the two groups.  Results  There was no significant difference in sex, tumor size, multifocal and TNM staging, age, operation time, intraoperative bleeding volume and sentinel lymph node resection time between the two groups (all P>0.05). The detection rate, accuracy and sensitivity of SLN in the observation group were significantly higher than those in the control group, and the false negative rate was significantly lower than that in the control group (all P < .05). There was no significant difference in the average number of SLN detected between the two groups (t=0.569, P>0.05). The influence of clinicopathological parameters on sentinel lymph node detection was analyzed, it was found that the patient's gender, age, tumor size, multifocal, TNM staging and other pathological parameters had no significant effect on SLN detection rate and accuracy (all P>0.05).  Conclusion  Indocyanine green fluorescence combined with carbon nanotracer has good visibility as a lymph node tracer. The detection rate, accuracy and sensitivity of SLN is significantly higher than that of single-use nano-carbon. It has high application value in SLN biopsy of thyroid papillary carcinoma.
Observe on the clinical value of combined multi-channel ultrasound in the diagnosis of cesarean scar pregnancy
YAN Jing, LOU Ye-lin, CHEN Jing-wan, XU Chen
2021, 19(3): 463-465,475. doi: 10.16766/j.cnki.issn.1674-4152.001836
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  Objective  To observe the clinical effect of transabdominal combined with transvaginal color Doppler ultrasound in the early differential diagnosis of cesarean scar pregnancy (CSP).  Methods  Total 110 CSP patients and 110 non CSP patients confirmed during pregnancy clearance were selected as the research objects. All patients were examined by transabdominal ultrasound, transvaginal ultrasound and transabdominal combined transvaginal ultrasound in early pregnancy. The difference of the diagnostic efficacy of the three ultrasound methods for CSP was compared, and the diagnostic coincidence rate of the three ultrasound methods for different clinical types of CSP was counted. The difference of trophoblast blood flow display rate of CSP patients was observed by three ultrasonic examination methods.  Results  The sensitivity, specificity and accuracy of transabdominal combined with transvaginal ultrasound in the differential diagnosis of CSP (98.18%, 96.36% and 97.27%) were significantly higher than those of transabdominal ultrasound (79.09%, 74.54% and 76.82%) and transvaginal ultrasound (90.91%, 88.18% and 89.54%) alone (all P < .05). The diagnostic coincidence rate of type Ⅱ CSP and overall CSP by transabdominal combined with transvaginal ultrasound (95.74% and 94.54%) were significantly higher than that of transabdominal ultrasound (59.57% and 61.82%) and transvaginal ultrasound (82.98% and 81.82%, P < .05). The display rate of trophoblast blood flow in CSP patients by transabdominal combined with transvaginal ultrasound (97.27%) was significantly higher than that by transabdominal ultrasound (76.36%) and transvaginal ultrasound (89.09%) alone (all P < .05).  Conclusion  The combination of transabdominal and transvaginal ultrasound can effectively improve the early differential diagnosis efficiency and classification diagnosis rate of CSP, which is worthy of clinical application.
Effects of family social support on treatment compliance of patients with hypertension
HUANG Chuan-ying, YANG Rong, LIAO Xiao-yang
2021, 19(3): 466-470. doi: 10.16766/j.cnki.issn.1674-4152.001837
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Hypertension is an important public health problem in the world, and poor treatment compliance is the main factor of substandard blood pressure and poor prognosis. It is also an important factor affecting hospitalisation rate and medical cost. In recent years, improving the treatment compliance of patients with hypertension has been the bottleneck in the standardised management of hypertension and has been a research hotspot. Family social support has been researched in many fields such as cardiovascular disease, cancer, AIDS, asthma, mood and sleep, particularly its unique role in the management of chronic diseases. Study shows that family social support is an important factor that affects treatment compliance of patients with hypertension and improves self-care ability and quality of life, and it has been widely used in the management of hypertension, such as health education, peer communication and family supervision. Most of the current research is cross-sectional investigations, and it is primarily nursing research, which focuses on the relationship between social support and the life stress and health outcomes of patients with chronic diseases. However, few studies on family social support interventions are conducted to improve the treatment compliance of patients with hypertension. Insufficient sample size, uneven test design methods and short intervention time are the shortcomings of the current research. In addition, the mediators of family social support affecting compliance of patients with hypertension are not clear. This article synthesizes domestic and international research on family social support and treatment compliance of patients with hypertension and reviews the connotation, clinical application and intermediary factors of the relationship between family social support and treatment compliance to provide a theoretical basis for further research.
Recent developments of gene polymorphisms of sepsis
CAI Min-jie, JIN Yin-yin, LIN Rong-hai, XU Ying-he, CHEN Qi, JIANG Yong-po
2021, 19(3): 471-475. doi: 10.16766/j.cnki.issn.1674-4152.001838
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Sepsis is a life-threatening organ dysfunction caused by the dysregulation of host response due to infection. This condition is one of the main causes of death in clinically critical patients. Recent research shows that the incidence of sepsis continues to increase at a rate of 1.5%-9.0% annually, and the mortality rate is also high. As research on sepsis has continuously progressed, our understanding of sepsis, especially at the genetic level, has improved. Research on the gene polymorphisms of sepsis is constantly updated by investigations on the correlation between genes and sepsis-related cell expression, protein expression, and inflammatory factors. Moreover, ongoing research focus on the susceptibility of these factors during the development of sepsis. Thus, the important role that these factors play must be determined to achieve early diagnosis of sepsis. Furthermore, these factors are crucial to the treatment and prognosis of sepsis at the genetic level. For example, the traditional method of identifying the source of infection is complicated, time-consuming, is influenced by numerous factors. Research on the genetic level of sepsis allows rapid diagnosis of sepsis and identification of new types of microorganisms, such as myeloid differentiation protein 2, BTLA gene polymorphism, endothelial cell protein C receptor gene and 16S rRNA gene. Early diagnosis of sepsis allows prompt treatment. Thus far, big data that can inform the clinical implementation of true gene-level treatment are lacking. Another research avenue is the study of the pathogenesis of sepsis, which can inform direction of treatment at the genetic level. The premise of continuous treatment is the good prognosis, which is crucial point to the patients' families. Therefore, the prediction accuracy during treatment of sepsis must be improved. Presently, this topic is the hotspot of research on sepsis to reduce mortality due to sepsis. The progress of research on the gene polymorphisms of sepsis is reviewed herein.
Observation on the clinical effect of traditional Chinese medicine in the treatment of joint swelling and pain after arthroscopy in knee osteoarthritis
SHEN Jian-zeng, LING Yi-long, SHEN Qin-rong, CHEN Jian-mo, LIU Yun-hai, LIU Lei, ZHANG Hua-liang
2021, 19(3): 476-478. doi: 10.16766/j.cnki.issn.1674-4152.001839
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  Objective  In this study, traditional Chinese medicine prescriptions were used to treat patients with joint swelling and pain after knee arthroscopy in knee osteoarthritis(KOA) patients, and the clinical effect was evaluated by observing the improvement of joint swelling and pain after medication, so as to provide a certain basis for the treatment of joint swelling and pain after knee arthroscopy in patients with knee arthroscopy with traditional Chinese medicine.  Methods  A total of 72 patients with joint swelling and pain after KOA arthroscopy admitted to Shaoxing Hospital of Traditional Chinese Medicine from February 2018 to February 2020 were randomly divided into observation group and control group with 36 cases in each group according to random number table method. The control group was given routine treatment after surgery, and the observation group was given oral treatment of self-designed traditional Chinese medicine prescription Xiaozhong Zhitong on the basis of routine treatment in the control group. The therapeutic effect of 2 groups was compared.  Results  On day 3, 7 and 14 after surgery, the VAS scores of the observation group were (4.91±0.73) points, (3.17±0.81) points and (1.75±0.76) points, respectively, while those of the control group were (5.68±0.72) points, (4.51±0.79) points and (3.11±0.77) points, respectively. The VAS scores of the observation group were significantly lower than those of the control group (all P < 0.05). The swelling values of knee joint in the control group on the 3, 7 and 14 days after operation were (43.12±2.16) mm, (32.23±1.37) mm and (19.73±0.85) mm respectively, while those in the observation group were (36.52±2.13) mm, (19.73±1.53) mm and (8.42±0.93) mm respectively. The swelling value of the affected knee joint in the observation group on the 3, 7 and 14 days after operation was significantly lower than that in the control group (all P < 0.01).  Conclusion  Traditional Chinese medicine has a good clinical effect on joint swelling and pain after knee arthroscopy in patients with KOA, and can significantly improve the joint swelling and pain after knee arthroscopy. It is worthy of clinical application.
Clinical comparative study of Chinese and western medicine treatment for acute early lactation mastitis
KANG Wen, MA Xiao-mei, REN Xiao-hua, WANG Ji-chen, LANG Lin, ZHANG Xiao-jun
2021, 19(3): 479-482. doi: 10.16766/j.cnki.issn.1674-4152.001840
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  Objective  To observe and compare the effect of comprehensive treatment of traditional Chinese medicine and routine treatment of western medicine on acute early lactation mastitis.  Methods  A total of 60 patients with acute early lactation mastitis admitted to the General Surgery Department of Nanyuan Hospital, Fengtai District, Beijing from January 2018 to October 2019 were selected and randomly divided into the traditional Chinese medicine treatment group and the western medicine treatment group according to the random number table method, with 30 patients in each group. Traditional Chinese medicine treatment group were taken orally and applied externally, combined with the manipulation of lactation. Western medicine treatment group were intravenously infused of cefuroxime sodium, external application of 50% magnesium sulfate, combined with manual lactation and breast suction. The changes of overall efficacy, breast mass size, body temperature, white blood cell count, and CRP were evaluated in both groups after 3 days of treatment.  Results  The total effective rate of the traditional Chinese medicine treatment group and the Western medicine treatment group was 90% and 93%, respectively, with no statistical difference in the overall efficacy (Z=-0.301, P=0.764). Comparison between the two groups before and after treatment: body temperature, breast mass size, total number of white blood cells and CRP were statistically different (P < 0.05). The total number of white blood cells in the Western medicine treatment group was significantly lower than that in the traditional Chinese medicine treatment group, and the difference was statistically significant (t=5.425, P < 0.001).  Conclusion  For patients with acute early lactation mastitis, manual lactation therapy is indispensable. Traditional Chinese medicine treatment and Western medicine treatment of the same effect, but antibiotics anti-inflammatory effect is more obvious. Clinical treatment can be based on the patient's own situation and the requirements of breastfeeding to choose the appropriate treatment. For patients with heavy inflammation and large breast mass at the first visit, early appropriate use of antibiotics is beneficial for treatment, but further observation and statistical confirmation are needed.
Observation on the effect of pressing needle embedding acupuncture point combined with swallowing rehabilitation training on dysphagia after stroke
JIANG Fang-hui, YING Zhong-ming, SHI Ling-ling
2021, 19(3): 483-485. doi: 10.16766/j.cnki.issn.1674-4152.001841
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  Objective  To explore the intervention effect of pressing needle embedding needle therapy combined with rehabilitation training on stroke patients with dysphagia.  Methods  Total 120 patients with dysphagia after stroke were enrolled in our hospital from January to December 2019 for clinical observation. They were randomly divided into observation group and control group. Both groups were given basic treatment, the control group received conventional rehabilitation training for dysphagia, and the treatment group received conventional rehabilitation training for dysphagia combined with pressing needle embedding needle for acupoint. The clinical therapeutic effect, dysphagia symptom score and adverse events were compared between the two groups.  Results  After treatment, the clinical symptoms of dysphagia in the two groups were improved to varying degrees, in the observation group: 19 cases were cured, 32 cases were improved and 9 cases were ineffective. While in the control group: 11 cases were cured, 24 cases were improved and 25 cases were ineffective, the difference between the two groups was statistically significant (U=9.070, P < 0.05). The effective rate was 85.0% in the observation group and 58.33% in the control group, there was no significant difference in the effective rate between the two groups (χ2=10.510, P < 0.05). The dysphagia symptom scores of the two groups were improved, the score of observation group was (6.13±2.58), and that of control group was (4.52±2.39), and the difference between the two groups was statistically significant (t=7.280, P < 0.05).  Conclusion  On the basis of conventional rehabilitation, training of dysphagia combined with pressing needle embedding needle for acupoint can better improve the symptoms of stroke patients with dysphagia, and has good safety, which has the feasibility of clinical application.
A preliminary study on curriculum reform and evaluation system
YU Lei, BI Ya-xin, CHEN Wei-dong, LI Dian-ming, HUANG Yu-li, WANG Qi-zhi
2021, 19(3): 483-485. doi: 10.16766/j.cnki.issn.1674-4152.001842
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With the development of society, the progress of science and technology, and the rise of global communication, in order to cultivate medical personnel with post competence, realize the training goal of "Excellent Physician Program" and realize the great strategy of healthy China, medical education reform is urgently needed. Internal medicine is a clinical medicine discipline that has an important impact on the development of medical science, it is a discipline with wide range and strong integrity, and is the basic discipline of clinical medicine, the content of internal medicine is of great significance in the theory and practice of clinical medicine and is an important basis for learning and mastering other clinical disciplines, so the reform of internal medicine teaching is very important. According to the advanced experience of medical education reform at home and abroad, the Department of Internal Medicine of our school has completed the teaching reform of internal medicine credit stage course system and evaluation system with our own actual situation. A systematic and scientific curriculum planning and evaluation scheme has been developed according to the teaching purpose of different stages, based on dividing teaching of internal medicine into two stages: theoretical teaching and practical teaching. In terms of curriculum construction, the teaching objectives of each stage have been established to optimize classroom teaching and promote online teaching, carry out problem-based learning, case-based learning, medical simulation teaching, standardized patient teaching, mind mapping and other diversified teaching methods. Teacher evaluation and student evaluation program have been improved, the assessment of teachers has realized the comprehensive assessment system of teaching and research office, department, college and student. Student evaluation has realized many kinds of assessment methods, such as theory assessment, process assessment and objective structured clinical examination, the students' learning process and learning effect have been comprehensively examined. Through teaching reform, teachers' professional quality and teaching level have been improved, students' interest in learning has been improved, and students' clinical thinking ability and medical humanistic quality have been cultivated.
Exploration of internal medicine education system with community characteristics
LIN Yi, CHEN Ying, GU Ming-yu, HU Ying, TANG Xian, WU Jian, PENG Yong-de, XU Huan-bai
2021, 19(3): 490-493. doi: 10.16766/j.cnki.issn.1674-4152.001843
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  Objective  Medical education with community characteristics is established by taking diabetes mellitus as the carrier of common chronic diseases, so as to strengthen and improve the community's diagnosis and treatment of chronic diseases.  Methods  From February 2018 to January 2019, according to the actual needs of community general practitioners of 8 community health service centers, endocrinologists of two Class A tertiary hospitals in Hongkou District of Shanghai carried out theoretical lecturing for the general practitioners. Tutors gave the key general practitioners clinical teaching. Annual training assessment, patient satisfaction survey, education system establishment and effect analysis were carried out. The "public health and maternal and child health section" of the District Health and Family Planning Commission cooperated with the community departments in charge to carry out inter hospital coordination and work supervision, so as to ensure the development of the work.  Results  During one year, 12 endocrinologists gave 96 lectures and trained more than 3 000 medical staff of community. The community diabetes clinic of 8 community health service centers went from "none" to "yes", 9 tutors and key general practitioners for diabetes prevention and treatment visited together and were praised by the patients; patients' suggestions focus on increasing the frequency from once per month to once or twice per week, improving the efficiency of referral to Class A tertiary hospital. All community general practitioners passed the assessment (85.01±3.86), among which 16 key general practitioners for diabetes prevention and treatment had excellent performance (87.25±3.72), there was difference between groups (P=0.028).  Conclusion  The establishment of community characteristic internal medicine education in the community, especially the tutorial system for the cultivation of key general practitioners for diabetes prevention and treatment, obviously improve the standard diagnosis and treatment level of diabetes (including complications and complications) in the community, which has a high community value-in-use. Further improving the connotation and quality of teaching and improve the attendance and assessment mechanism, then twice as much can be accomplished with half the effort.
The construction and reliability and validity analysis of the questionnaire on knowledge-belief-behavior of eCASH concept for ICU nurses
XU Jian-qiu, CHEN Xiao-lei, ZHAN Lei, CAI Xiao-dan, CHEN Jie
2021, 19(3): 494-497. doi: 10.16766/j.cnki.issn.1674-4152.001844
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  Objective  To construct the questionnaire of knowledge-belief-behavior of ICU nurses' eCASH concept by means of Delphi expert letter consultation method, and to test its reliability and validity, so as to provide a basis for the construction of localized eCASH concept training system and the promotion of ICU nurses' nursing level of sedation and analgesia.  Methods  Based on the theory of knowledge-belief-behavior, the questionnaire framework was established by literature analysis and semi-structured interview. Total 17 ICU nursing experts from 3 Class A tertiary hospitals in Zhejiang Province were selected for 2 rounds of expert consultation to form the first draft of the questionnaire. Finally, the final draft of the questionnaire was formed by evaluating the reliability and validity of the questionnaire among 187 ICU nurses in 3 Class A tertiary hospitals in Zhejiang Province.  Results  Results of the two rounds of expert consultation: the recovery rates were 82.35% and 100%, the expert coordination coefficient was 0.32 and 0.45, and the authority coefficient was 0.845 and 0.913, respectively. The average score of the importance of the four dimensions was 3.56-3.77, with the full score ranging from 44.12% to 65.24%. The average score of the importance of 22 items was 3.43-3.77, and the full score was 43.52%-65.72%. Finally, a questionnaire on knowledge-belief-behavior of eCASH concept was formed, which included four dimensions of eCASH basic knowledge, eCASH skills, eCASH beliefs and eCASH behaviors, and 22 items. Results of reliability and validity evaluation: the contribution rate of the four dimensions was 21.91%, 17.81%, 13.32% and 15.45%, respectively, and the cumulative contribution rate was 68.49% (> 40%). The content validity S-CVI of the total questionnaire was 0.982, Cronbach's coefficient was 0.931, and the retest reliability ranged from 0.814 to 0.923.  Conclusion  The questionnaire on knowledge-belief-behavior of ICU nurses' eCASH concept has good reliability and validity, which can accurately reflect the knowledge level, executive intention and clinical implementation status of ICU nurses' eCASH concept, and can be used as an applicable tool to evaluate the level of ICU nurses' eCASH concept epistemic practice.
Study on correlation between research ability and research self-efficacy of medical academic masters
WANG Ning, WANG Xi
2021, 19(3): 498-501. doi: 10.16766/j.cnki.issn.1674-4152.001845
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  Objective  To understand the current situation of research ability and research self-efficacy of medical academic masters, and to discuss the relationship between them and the influencing factors of research ability.  Methods  Cluster sampling method was adopted to select academic masters of Bengbu Medical College from 2017 to 2019 for investigation, and the questionnaire of academic masters' research ability and research self-efficacy were applied for data collection.  Results  The scores of research ability and research self-efficacy of academic masters in Bengbu Medical College were (3.00±0.60) and (3.25±0.61) respectively. The scores of research ability and self-efficacy were statistically significant for the masters of different grades, disciplines, marital status, place of birth, research interest, frequency of attending on-campus lectures, number of academic meetings (including exchanges), research experience and supervisor's project participation (P < 0.05). The scores of research ability were significantly positively correlated with the total score and all dimensions scores of research self-efficacy (P < 0.01). Grade, participation in supervisor's project, research interest, problem formation and result presentation had a significant impact on research ability (P < 0.05).  Conclusion  The research ability and the research self-efficacy level of medical academic masters are general. The research self-efficacy has a significant influence on the research ability. Therefore, college educators should take effective measures to improve the research self-efficacy of medical academic masters to promote their research ability.
Characteristics of multidrug-resistant organism infections in a hospital for three consecutive years
DAI Li-lan, SHI Ming-mei, ZHANG Ai-ping, HU Zhong, WANG Hua-xue
2021, 19(3): 502-504. doi: 10.16766/j.cnki.issn.1674-4152.001846
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  Objective  To explore the detection and distribution of multi-drug resistant organism (MDRO) in the Hospital of China Seventeenth Metallurgical Group Co., Ltd.  Methods  The monitoring data for MDROs isolated from clinical thesamples submitted by the hospital of China Seventeenth Metallurgical Group Co., Ltd. from 2016 to 2018 were analyzed retrospectively.  Results  From 2016 to 2018, 314 strains, 420 strains and 359 strains of MDROs were detected. The isolation rate of MDROs were 28.31%, 35.35% and 30.95%, with statistically significant difference (P < 0.05). MDROs accounted for more than 30.00% of the isolated pathogens in both 2017 and 2018. The positive rates of klebsiella pneumoniae producing ESBLs were 33.90%, 67.54% and 40.98% in 2016, 2017 and 2018, respectively (P < 0.05). The detection rates of Methicillin-resistant Staphylococcus aureus (MRSA) were 20.51%, 19.09% and 38.53% in 2016, 2017 and 2018 respectively (P < 0.05). The detection rates of Acinetobacter baumannii with multiple-drug resistance were 68.42%, 46.15% and 45.24% in 2016, 2017 and 2018, respectively (P < 0.05), showed a decreasing trend year by year. The detection rates of carbapenems-resistant Klebsiella pneumoniae were 0.00%, 5.26% and 9.84% in 2016, 2017 and 2018, respectively (P < 0.05), showing an increasing trend year by year. The department with the highest proportion of MDROs detection was internal medicine, followed by ICU. The composition ratio of MDROs in urology were 9.24%, 9.76% and 6.41%, respectively (P < 0.05). The composition ratio in brain surgery were 1.59%, 1.46% and 5.57%, respectively (P < 0.05). The most common types of specimens with high detection rates of MDROs were sputum, urine, and others.  Conclusion  The detection rate of MDROs showed an overall increase, especially the isolation rate of carbapenems-resistant Klebsiella pneumoniae was increasing year by year. The prevention, control and management of MDROs infection should be strengthened to promote the rational use of antibiotics in clinical practice.
Study on the application effect of intravenous safe medication nursing based on information construction in infusion room management
WU Xiao-hui, SHEN Guo-di
2021, 19(3): 505-507,519. doi: 10.16766/j.cnki.issn.1674-4152.001847
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  Objective  According to the characteristics of nursing needs of infusion room management, this paper puts forward reliable countermeasures which can be used for clinical nursing work, and analyzes the application effect of intravenous safe drug nursing based on information construction on nursing quality of patients in infusion room.  Methods  Since May 2019, the intravenous medication safety management mode based on information construction (hereinafter referred to as information management) had been fully implemented in the Infusion Room of Huzhou Central Hospital. Total 276 patients admitted to the Infusion Room from May 2018 to February 2019 were selected as the control group (conventional management mode) by random number table method, other 298 patients in Infusion Room from May 2019 to February 2020 were selected as the observation group (information management mode). The nursing time, incidence of complications related to intravenous infusion and nursing satisfaction were compared between the two groups.  Results  Average interval of dressing change and pre-configuration time of drugs in observation group were shorter than those in control group, and the number of visits during infusion was less than that in control group (P < 0.05). The incidence of complications related to intravenous infusion in the observation group was 5.4% (16/298), lower than that in the control group was 10.1% (28/276), P < 0.05. Nursing satisfaction in the observation group was 94.0% (280/298), higher than 87.3% (241/276) in the control group (P < 0.05).  Conclusion  Intravenous safe medication nursing based on information construction can shorten the nursing time of infusion room management, improve nursing quality and nursing satisfaction, reduce the occurrence of complications related to intravenous infusion, and is worthy of clinical application.
Nursing management plan and effect evaluation of stroke patients with dysphagia from the evidence-based perspective
WANG Lan-zhen, XU Li-ping, XU Shu-fen, HU Jun, XU Hui-xia, CHEN Mei-qin
2021, 19(3): 508-510,514. doi: 10.16766/j.cnki.issn.1674-4152.001848
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  Objective  To analyze the specific measures to construct the nursing management scheme of stroke patients with dysphagia from the perspective of evidence-based, and analyze the effect evaluation of applying evidence-based nursing to stroke patients with dysphagia.  Methods  Total 821 cases of stroke patients in our hospital from January 2018 to December 2018 were selected as the control group, and 829 cases of stroke patients in our hospital from January 2019 to December 2019 were selected as the observation group. Patients in the control group were treated with routine nursing program, while patients in the observation group were treated with nursing management scheme constructed from the evidence-based perspective. The rate of indwelling gastric tube, indwelling time of gastric tube and incidence of pneumonia after stroke were compared between the two groups.  Results  The retention rate was 25.2% in the control group. The length of indwelling gastric tube in the observation group was (6.28±1.54) d, shorter than that in the control group (7.02±2.31). The incidence of pneumonia after stroke in the control group was 5.0%, significantly higher than 2.9% of the patients in the observation group (P < 0.05). Before the intervention, there was no significant difference in standard swallowing function score (SSA) between the two groups (P>0.05). After nursing intervention, the scores of swallowing functions in the observation group were better than those in the control group, differences were statistically significant (P < 0.05).  Conclusion  The implementation of evidence-based nursing management program is more conducive to reduce the incidence of indwelling gastric tube and post-stroke pneumonia in patients with dysphagia after stroke, and significantly improve the swallowing function of patients, which is worthy of clinical application.
The effect of continuous nursing with health coaching technique on the recovery of elderly patients with type 2 diabetes mellitus
XING Xiao-han, CHEN Yin-yu, TAO Hai-ying
2021, 19(3): 511-514. doi: 10.16766/j.cnki.issn.1674-4152.001849
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  Objective  To explore the application effect of continuous nursing with health coaching technology as the core in the recovery of elderly patients with type 2 diabetes.  Methods  From January 2019 to January 2020, 120 elderly patients with type 2 diabetes who were hospitalized in Taizhou First People's Hospital were selected for the study. The subjects were divided into intervention group and control group by random number table method, with 60 patients in each group. The 2 groups of patients were given routine nursing during their stay in the hospital. The control group received routine continuing nursing after discharge according to the department regulations, while the intervention group received continuous nursing based on the health coach technology. The changes of blood glucose index (fasting blood glucose, 2 hours postpranational blood glucose), knowledge of diabetes, self-management ability of disease, and satisfaction with continuing nursing with health coaching technology as the core were compared between the two groups.  Results  After 6 months of nursing intervention, the changes in blood glucose indicators of the intervention group were significantly better than those of the control group (P < 0.05); after the intervention, the knowledge of diabetes in the intervention group was also significantly better than the control group (P < 0.05); after the intervention, The disease self-management ability score of patients in the intervention group was (21.71±6.75) points, and the score of patients in the control group was (14.46±6.51) points. The intervention group was significantly higher than the control group (P < 0.05); The satisfaction rate of core continuous care was 96.67%, which was significantly higher than 75.00% of the control group (P < 0.05).  Conclusion  Continuous nursing with health coaching technology as the core can effectively improve the recovery of elderly patients with type 2 diabetes.
Effect of rehabilitation therapy and nursing intervention on postoperative recovery of patients with hypertensive intracerebral hemorrhage
LIU Xue-ying
2021, 19(3): 515-519. doi: 10.16766/j.cnki.issn.1674-4152.001850
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  Objective  To investigate rehabilitation therapy combined with nursing intervention in postoperative recovery of patients with hypertensive intracerebral hemorrhage (HICH).  Methods  Retrospective analysis was carried out in 78 patients with severe HICH hematoma evacuation after treatment in the Tenth Affiliated Hospital of Guangxi Medical University from March 2017 to November 2019. The 28 patients who received routine treatment and nursing care were regarded as the control group, the 27 patients who underwent rehabilitation training based with routine treatment and nursing care were the rehabilitation training group. Moreover, the 23 patients who underwent rehabilitation training and nursing intervention based on routine treatment were regarded as the nursing intervention group. Systolic blood pressure, diastolic blood pressure, and Fugl-Meyer scores were compared immediately after surgery (T1), 4 weeks after treatment (T2) and 12 weeks after treatment (T3). During the period of T3, the total effective rate and adverse reactions were compared among the three groups of patients.  Results  The systolic blood pressure and diastolic blood pressure at T3 among the three groups were significantly lower than both T2 and T1, and the systolic and diastolic blood pressure of T2 was lower than T1 (all P < 0.05). Among the three groups of patients, the Fugl-Meyer score at T3 was significantly higher than both the T2 and T1, and the Fugl-Meyer score at T2 was higher than T1 (all P < 0.05). The total effective rate in the rehabilitation training group and the nursing intervention group were significantly higher than the control group, and the difference was statistically significant (all P < 0.05). There was no significant difference in total effective rate between the rehabilitation training group and the nursing intervention group (P>0.05). In the control group, the number of patients with shoulder-hand syndrome, hemorrhoids, and depression was significantly higher than both the rehabilitation training group and the nursing intervention group (all P < 0.05). The number of people with depression in the rehabilitation training group was significantly higher than the nursing intervention group (P < 0.05).  Conclusion  Rehabilitation therapy and nursing intervention are better than routine treatment and nursing for postoperative recovery of HICH patients, and has a lower adverse reaction rates after surgery, it is worthy of promotion clinically.
2021, 19(3): 520-522. doi: 10.16766/j.cnki.issn.1674-4152.001851
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General Practice Research
Clinical efficacy of animal bone peptides in promoting fracture healing after PFNA operation
ZHAO Xiao-ming, SU Chen-chen, LOU Xiao-xiao, ZHANG Yin-gang
2021, 19(3): 347-350. doi: 10.16766/j.cnki.issn.1674-4152.001806
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  Objective  To explore the effect of animal bone polypeptide injection on the postoperative fracture healing of senile osteoporosis intertrochanteric fracture after proximal femoral nail antirotation (PFNA).   Methods   A total of 104 senile osteoporotic femoral intertrochanteric fractures admitted to the Department of Orthopedics, the First Affiliated Hospital of Xi'an Jiaotong University from December 2018 to June 2019 were selected. According to the method of random number table, all the patients were divided into the control group (52 cases) and the observation group (52 cases). PFNA surgery was performed in both groups. Patients in the observation group used animal bone polypeptide after surgery, while patients in the control group were treated with conventional basic drug after surgery for comparison. Postoperative pain relief (VAS score), hip fracture healing, postoperative joint function recovery (Harris score), excellent and good fracture healing rate and bone mineral density deposition improvement were compared between the two groups. Adverse complications during follow-up treatment were recorded and the rate was calculated.   Results   All 104 cases were followed up. Compared with the control group, the clinical healing time of postoperative fracture in the observation group was obviously shorter [(11.37±1.35) weeks vs. (12.85±1.76) weeks], the degree of relief of postoperative pain symptoms [(0.21±0.11) vs. (0.83±0.13)] and the degree of functional recovery of hip joint [(86.35±10.51) vs. (75.61±11.32)] in the observation group were also better than those in the control group. Meanwhile, the bone mineral density of different parts in the observation group was higher than that in the control group, and the incidence of postoperative complications was also significantly lower (3.8% vs. 7.7%), all P < 0.05).   Conclusion  Animal bone polypeptide drugs can effectively promote fracture healing, reduce swelling and pain, facilitate the postoperative rehabilitation of hip function, and effectively decrease adverse complications during follow-up treatment such as re-fracture and intramedullary nail loosening. It can be used as a good postoperative supplement for PFNA fixation of intertrochanteric fractures and has extensive clinical value.
Application of single utility port thoracoscopic combined with on-pump beating heart technique in open-heart surgery
Ling WANG, LIU Xue-gang, LI Hai-hui, DIAO Wen-jie
2021, 19(3): 362-364,445. doi: 10.16766/j.cnki.issn.1674-4152.001810
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  Objective   To investigate the application of single utility port thoracoscopic combined with on-pump beating heart minimally invasive technique in open-heart surgery.   Methods   From September 2015 to December 2018, 41 cases of various cardiac surgeries were performed by using single utility port thoracoscopic combined with on-pump beating heart minimally invasive technique. Among them, there were 10 males and 31 females; The average age was 40.95±15.95 years old. Surgical diseases and methods included: the repair of atrial septal defect in 24 cases, the correction of partial atrioventricular canal defect in 1 case, the repair of membranous ventricular septal defect in 2 cases, the resection of the left atrial tumour in 8 cases, the resection of right atrial myxoma in 1 case, the modified Carpentier annuloplasty for Ebstein anomaly in 3 cases, the leaflet and prosthetic ring annuloplasty for tricuspid regurgitation in right heart failure in 1 case, and the tricuspid bioprosthetic valve replacement for tricuspid regurgitation in right heart failure after the mitral valve replacement in 1 case.   Results   The operation in the whole group was successfully completed, the perioperative indicators showed: the time of cardiopulmonary bypass was (81.18±39.07) min, the time of vena cava blocking was (51.60±30.94) min, the operation time was (177.15±45.05) min, the time of respirator assistance was (10.68±18.99)h, the drainage volume within 24 hours after the operation was (241.86±64.38) ml, and the hospital stay was (13.33±12.43) d. The main postoperative complications included: the secondary invasion hemostasis for right atrial incision bleeding in 1 case, the pulmonary infection in 2 cases, the tracheotomy for respiratory failure in 1 case, and the hemoglobinuria in 1 case. There was no post-operative death, and the patient recovered well and was discharged. There was no residual patent ductus arteriosus or significant valve regurgitation, and no cases of late death or reoperation in the post-operative follow-up for 2-5 years.   Conclusion  It was safe, simple and effective for the single utility port thoracoscopic combined with on-pump beating heart minimally invasive technique to be applied to various open-heart surgeries.
The clinical value of Eustachian tube exploration in tympanoplasty under otoendoscopy
CHENG Jian-an, XI Qing-ming, TONG Bu-sheng
2021, 19(3): 365-367,378. doi: 10.16766/j.cnki.issn.1674-4152.001811
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  Objective  To investigate the clinical value of eustachian tube exploration in the tympanoplasty of chronic suppurative otitis media with eustachian tube dysfunction.   Methods   A total of 58 patients diagnosed with chronic suppurative otitis media with eustachian tube dysfunction and underwent tympanoplasty in the Department of Otorhinolaryngology, Chuzhou Clinical College, Anhui Medical University from February 2017 to December 2019 were enrolled in this study. They were randomly divided into observation (29 cases) and control (29 cases) groups by using a random-number table. Eustachian tube exploration was performed in the observation group, whereas only tympanum exploration was conducted in the control group. The graft survival rate, eustachian tube function, and hearing improvement before and after 3 and 6 months were evaluated.   Results   At 3 and 6 months after operation, the observation group (both 100%) was superior to the control group (both 96.6%) in graft survival rate, but no statistical difference (P>0.05) was observed. The eustachian tube dysfunction scale lowered in the observation group [the scores of eustachian tube dysfunction questionnaire (ETDQ-7) for and 3 and 6 months after operation were 8.78±5.35, and 9.64±5.76, respectively) than in the control group (the scores of ETDQ-7 for and 3 and 6 months after operation were 9.81±4.50, and 10.30±5.16, respectively), P < 0.001]. No significant difference was observed between the two time points and the two groups (P>0.05). 3 months, 6 months after operation, the hearing condition of the observation group [the pure tone average (PTA) were (19.9±10.5) dB HL and (20.5±8.8) dB HL respectively] and the control group [the PTA were (25.6±9.2) dB HL and (26.6±10.3) dB HL respectively] were improved(P < 0.001). But the hearing was stable after 3 months, and there was no significant difference in PTA difference compared with 6 months (P>0.05). Both 3 months and 6 months after operation, the pure tone threshold of observation group was better than that of the control group(P < 0.05).   Conclusion   Eustachian tube plays an important role in the pathogenesis of otitis media. Whether tympanoplasty can restore the sound transmission of the middle ear cavity depends on whether the eustachian tube functions are normal. The exploration of eustachian tube can improve the operative effect in the tympanoplasty of chronic suppurative otitis media with eustachian tube dysfunction. Whether the Eustachian tube can be penetrated may be used as the basis of prognosis and indication of postoperative treatment.
The clinical significance of heparin-binding protein combined with CRP in the early evaluation of severe acute pancreatitis
ZHANG Fu-long, QIU Zhao-lei, WANG Zhen-jie, JI Zhong, ZHAO Heng, CHENG Feng, ZHAO De-jun
2021, 19(3): 368-370, 374. doi: 10.16766/j.cnki.issn.1674-4152.001812
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  Objective   To investigate the correlation study and clinical significance of heparin-binding protein (HBP) combined with C-reactive protein (CRP) in evaluating the severity of the disease in patients with severe acute pancreatitis(SAP).   Methods   A total of 71 patients with acute pancreatitis admitted to the Emergency Department of the First Affiliated Hospital of Bengbu Medical College from October 2018 to February 2020 were collected. According to the severity of the disease, 37 patients with SAP and 34 patients with non-SAP patients were classified according to the diagnostic criteria of severe acute pancreatitis. The general clinical data of the two groups of patients were recorded, HBP and CRP levels at admission were detected, and APACHEⅡ scores were performed. Pearson correlation analysis and operating characteristic curve (ROC) were used to evaluate HBP, CRP and the combination of the two in evaluating the clinical value and significance of the disease in patients with severe acute pancreatitis.   Results   The general clinical data of the two groups of patients were not statistically significant. The levels of HBP and CRP were related to ApacheⅡ score (r=0.759, 0.365, all P < 0.05). According to ROC curve, the area under curve of HBP, CRP and HBP+CRP were 0.841, 0.792 and 0.869, respectively.   Conclusion   HBP and CRP are positively correlated with the severity of early acute pancreatitis, and the correlation between HBP is higher than that of CRP. Both HBP and CRP can predict SAP well, and the sensitivity and specificity of the combined prediction are high. Based on the prediction of a single index, this study shows that HBP combined with CRP detection has a high clinical guiding significance in the early evaluation of severe acute pancreatitis.
linical analysis of 16 cases of large benign adnexal mass treated by transumbilical laparoendosopic single-site surgery
JIA Xiao-ping, ZHOU Jing, WANG Hui
2021, 19(3): 371-374. doi: 10.16766/j.cnki.issn.1674-4152.001813
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  Objective  To explore the clinical effect of transumbilical laparoendosopic single-site surgery with self-made approach in the treatment of large adnexal begin mass.   Methods   Total 16 cases of large adnexal begin mass operation with transumbilical laparoendosopic single-site were successfully carried out by Gynecological Department of Central Hospital in Karamay City from February 2017 to September 2019. All cases were performed with homemade approach and conventional laparoscopic instruments. The maximum diameter of the mass ranged from 12 to 35 cm, including 6 mature teratomas, 4 benign ovarian serous tumors, 2 benign ovarian mucinous tumor, 2 simple ovarian cysts, 1 mesosalpinx cyst and 1 hydrosalpinx. The mean age of the patients was (41.9±19.1) years, and the mean body mass index (BMI) was (22.0±3.2). There were 4 cases of pelvic and abdominal cavity operation history and 6 cases of pelvic and abdominal cavity adhesion, but no dense intestinal adhesion was found in all patients.   Results   The average diameter of the mass was (18.0±6.1) cm, the average operation time was (47.6±13.0) min, the intraoperative blood loss was (17.4±11.1) mL, the first postoperative exhaust time was (7.4±2.2) h, the first postoperative ambulation time was (6.2±0.7) h, the pain visual analogue scale (VAS) was (0.9±0.4) min, and the postoperative hospital stay was (2.2±0.4) d. There were no complications in 16 cases and after surgery. Follow-up of 3 to 6 months, the umbilical incision healed well and the patient's satisfaction was high.   Conclusion   The transumbilical laparoendosopic single-site surgery with self-made approach is suitable for the operation of large adnexal begin mass. It can fully reflect the advantages of transumbilical laparoendosopic single-site surgery, which is worth popularizing in clinical practice.
Application value of white blood cell, C-reactive protein and hematocrit in adult acute infectious diarrhea
YANG Di, HUANG Yu-hong, ZHANG Bin
2021, 9(3): 375-378. doi: 10.16766/j.cnki.issn.1674-4152.001814
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  Objective  To explore the application value of white blood cell (WBC), C-reactive protein (CRP) and hematocrit (HCT) in adult's acute infectious diarrhea.  Methods  A total of 90 patients with acute infectious diarrhea admitted to our hospital from April 2014 to October 2018 were collected. According to the dehydration symptoms caused by the disease, they were divided into three groups of mild, medium and severe group (30 cases each). All patients were treated with antibiotics. WBC, CRP, HCT, abdominal pain, nausea and vomiting, fever and fatigue were examined before and after treatment. Pearson's method was used to analyze the relationship among the three indexes, dehydration degree and antidiarrheal time.  Results  The differences of WBC, CRP and HCT in the three groups before treatment were statistically significant (F=23.092, 3.998, 8.905, all P < 0.05). Among them, the WBC, CRP and HCT levels were the lowest in the mild group and the highest in the severe group (P < 0.05). The differences of WBC, CRP and HCT in the three group after treatment were statistically significant (F=13.966, 4.031, 5.435, all P < 0.05). Among them, the WBC, CRP and HCT levels were the lowest in the mild group, and the highest in the severe group (P < 0.05). The antidiarrheal time [(10.57±4.36) d] and antibiotic treatment time [(10.71±3.92) d] were the longest in the severe group, and the incidence of abdominal pain, nausea and vomiting, fever and fatigue were the highest in the severe group (P < 0.05). WBC was positively correlated with dehydration degree and antidiarrheal time (r=0.767, 0.813, all P < 0.05), CRP was positively correlated with dehydration degree and antidiarrheal time (r=0.829, 0.802, all P < 0.05), HCT was positively correlated with dehydration degree and antidiarrheal time (r=0.886, 0.823, all P < 0.05).  Conclusion  WBC, CRP and HCT can predict the dehydration degree and prognosis of patients with negative bacterial culture, and provide reference for guiding treatment and avoiding excessive use of antibiotics.
Observation of curative effect and analysis of prognostic factors of S-1 adjuvant chemotherapy after radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma in the elderly
WANG Gui-feng, CUI Zhen, WAN Qiang-kun, JIANG Hao
2021, 19(3): 379-382,453. doi: 10.16766/j.cnki.issn.1674-4152.001815
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  Objective  To analyze the clinical efficacy and prognostic factors of the elderly patients with esophageal squamous cell carcinoma who underwent radical concurrent chemoradiotherapy (CCRT) followed by S-1 adjuvant chemotherapy.  Methods  A total of 102 elderly patients with esophageal squamous cell carcinoma (≥ 70 years old) were enrolled in this study from June 1, 2016 to June 30, 2019. All the patients had received radical concurrent chemoradiotherapy in the Radiotherapy Department of the First Affiliated Hospital of Bengbu Medical College. The patients were divided into chemotherapy group (42 cases) and control group (60 cases) according to whether or not they received S-1 adjuvant chemotherapy. Kaplan-Meier statistical analysis was conducted for T staging, adjuvant chemotherapy and length of primary tumor (GTV length).  Results  The 2-year and 3-year overall survival rates (OS) in the chemotherapy group and the control group were 54.1%, 42.6% and 38.4%, 28.5% (P=0.081), the 2-year and 3-year progression free survival rates (PFS) were 55.4%, 44.3% and 32.9%, 21.8% (P=0.024), and the 2-year and 3-year local recurrence free survival rates (LRFFS) were 68.2%, 61.4% and 39.2%, 25.9% (P=0.004), respectively. Cox model multivariate analysis showed that adjuvant chemotherapy had better PFS and LRFFS (all P < 0.05). Clinical stage Ⅱ-Ⅲ had better OS, PFS and LRFFS than stage Ⅳ. lymph node status (N status) was closely related to OS and PFS. Age was an independent predictor of OS.  Conclusion  For elderly patients with esophageal squamous cell carcinoma, after concurrent chemoradiotherapy, S-1 adjuvant chemotherapy can improve PFS and LRFFS, and the incidence of related adverse reactions is low and can be tolerated.
Effect of zoledronic acid combined with percutaneous vertebroplasty on osteoporotic compression fractures in the elderly patients
RAO Min-jie, LI Yi-nan, ZHANG Gong-heng, YUAN Xiao-jun, GAN Xin-rong, XU Wen-hua, CAO Sheng-sheng
2021, 19(3): 383-386. doi: 10.16766/j.cnki.issn.1674-4152.001816
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  Objective  To explore the effect of zoledronic acid on bone mineral density and bone metabolism in elderly patients with osteoporotic vertebral compression fracture after vertebroplasty providing basis for clinical treatment.  Methods  From January 2019 to December 2019, a total of 92 elderly patients with osteoporotic vertebral compression fractures in the People's Hospital of Yichun City were selected, and divided into treatment group (44 cases) and control group (48 cases) according to the random number table method. All the patients in the two groups received percutaneous vertebroplasty treatment. The patients in the control group were treated with calcitriol and vitamin D after the percutaneous vertebroplasty, and the patients in the treatment group were additionally given zoledronic acid. The visual analogue scale (VAS) and Oswestry disability index score (ODI) were recorded. Bone mineral density and serum bone Gla-protein (BGP) were assessed before and after the treatment.  Results  All patients successfully completed the percutaneous vertebroplasty operation. The VAS, ODI, lumbar vertebral bone density and serum osteocalcin were not significantly different between the two groups before the treatment (all P>0.05). The VAS and ODI scores of patients in the two groups after the treatment were all improved (all P < 0.05), the difference between the two groups was statistically significant (all P < 0.05). At the last follow-up, lumbar vertebral bone density and serum osteocalcin were significantly increased in both groups (all P < 0.05), and the treatment group was significantly better than the control group (all P < 0.05).  Conclusion  The application of zoledronic acid combined with percutaneous vertebroplasty has favorable curative effect on osteoporotic vertebral compression fractures in elderly patients, and could improve the symptoms of osteoporosis, the bone density and bone metabolism indexes of patients.
Expression of GFAP and inflammatory factors in spinal cord of neuropathic pain rats treated with glucocorticoid receptor agonists
YANG Hui-fang, ZHAO Li, LU Ling-song, WU Yan-hui
2021, 19(3): 387-390. doi: 10.16766/j.cnki.issn.1674-4152.001817
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  Objective  To investigate the effect of glucocorticoid receptor agonists on glial fibrillary acidic protein (GFAP) and inflammatory factors expression in spinal cord of neuropathic pain rats.  Methods  Twenty SD rats were randomly divided into control group, sham operation group, model group and treatment group. The model group and treatment group were used to establish neuropathic pain model. In the sham operated group, only the sciatic nerve was exposed, but not ligated. Dexamethasone was injected intrathecally in the treatment group, normal saline was injected intrathecally in other three groups for 7 days. The mechanical pain threshold was measured by Von Frey filament one day before operation, three days after operation and seven days after operation. The rats were killed 7 days after operation. The expression of GFAP protein was detected by western blot and the expression of inflammatory factor was detected by RT-PCR.  Results  The mechanical pain threshold and thermal pain threshold in the treatment group were significantly lower than those in the control group and the sham operation group (P < 0.05), but significantly higher than those in the model group (P < 0.05). The expression level of GFAP protein in the model group and the treatment group was significantly higher than that in the control group and the sham operation group (P < 0.05), but the expression level of GFAP protein in the treatment group was significantly lower than that in the model group (P < 0.05). The expression of TNF-α and IL-1β mRNA in the spinal cord of the model group and the treatment group was significantly higher than that of the control group and the sham operation group (P < 0.05), but the expression of TNF-α and IL-1β mRNA in the spinal cord of the treatment group was significantly lower than that of the model group (P < 0.05).  Conclusion  Glucocorticoid receptor agonists can significantly reduce the pain sensitivity of neuropathic pain rats, and its mechanism may be related to the down-regulation of GFAP and the expression of downstream inflammatory factors.
General Practice Rsearch
Application of residual laryngeal mucosa flap in surgical repair of hypopharyngeal carcinoma
LIU Shen-cheng, CUI Yi-xuan, ZHAO Bao, ZHOU Lan-zhu, WU Jun, WANG Wen-zhong
2021, 19(3): 351-353,386. doi: 10.16766/j.cnki.issn.1674-4152.001807
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  Objective   To explore the application of residual laryngeal mucosa flap in surgical repair of hypopharyngeal carcinoma.   Methods   Total 48 patients with hypopharyngeal cancer who underwent hypopharyngeal defect repair with residual laryngeal mucosal flap in the Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical College from September 2015 to September 2017were collected. The TNM stages of 48 patients were T2N0M0 8 cases, T2N1M0 7 cases, T2N2M0 7 cases, T3N0M0 10 cases, T3N1M0 9 cases, T3N2M0 6 cases and T4N2M0 1 cases. According to the primary location of the tumor, the surgical approaches were selected: epiglottis valley, lateral wall or tip of pyriform fossa entering the pharyngeal cavity. The resection range was 1.5-2.0 cm from the tumor. The cutting edge was quickly frozen and the residual laryngeal mucosal flap was used to repair the hypopharyngeal defect. Evaluate the changes of patients' condition and physical condition, and receive radiotherapy or chemotherapy one month after operation.   Results   All 48 patients recovered normal swallowing function in a short time. Local infection and pharyngeal fistula were found in 3 patients 6 days after operation. The pharyngeal fistula was less than 2 cm, accounting for 6.25% (3/48), and healed within 2 weeks after local dressing change. Anastomotic stenosis occurred in 2 patients (6.25%, 2/32) after operation, and improved after corresponding expansion. Among them, 16 patients underwent total laryngectomy and breathed smoothly after operation. Tracheal cannula was removed in 28 patients within 3 months after operation, and extubation rate was 94% (30/32) in 2 patients 6 months after operation. The laryngeal cavity of 2 patients was narrow after operation, which made it impossible to extubate. Local recurrence + cervical metastasis + distant metastasis (lung metastasis) occurred in 2 cases within 3 years. Local recurrence + esophageal metastasis occurred in 1 case within 3 years. One patient was depressed (self-catheter removal), and 5 patients lost follow-up. The 3-year survival rate was 81.3% (39/48).   Conclusion   Repairing hypopharyngeal defect after partial hypopharyngeal cancer resection with residual laryngeal mucosa flap has the advantages of taking materials nearby, not increasing incision, less trauma, strong anti-infection ability, easy survival and relatively few complications.
Analysis of related clinical risk factors of lung infection in patients with lung cancer
SONG Yang, XIA Bing, WU Yue-guang
2021, 19(3): 354-357,462. doi: 10.16766/j.cnki.issn.1674-4152.001808
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  Objective   To explore the relevant risk factors for lung infection.   Methods   We conducted a retrospective study of 156 lung cancer patients admitted to Hangzhou Cancer Hospital from January 2014 to December 2016. Pulmonary infection was defined as a chest radiograph showing the presence of new or ongoing infiltrating lesions combined with any of the following: new purulent sputum, changes chronic sputum, or fever. Multivariate cox regression analysis was used to explore the risk factors that were significantly related to lung infection.   Results   A total of 60 cases (38.5%) of all study subjects developed pulmonary infections. Until the end of follow-up, the average overall survival rate of patients in the pneumonia group was significantly shorter than that of patients in the non-pneumonia group (48.5% vs. 74.2%, P < 0.05). The overall survival rate of smoking patients was significantly lower than that of never-smokers (32.8% vs. 19.6% vs. 75.4%, P < 0.001). Multivariate analysis showed that age (P=0.001), clinical stage Ⅳ (P=0.045), neutropenia (P < 0.001), and smoking (P=0.020) were independent risk factors for lung infection in patients with lung cancer. A subgroup analysis of patients receiving chemotherapy showed that age (P=0.006), neutral granulocytopenia (P < 0.001), smoking (P=0.030), and second-line therapy (P=0.004) were independent risk factors for the development of pneumonia.   Conclusion   For lung cancer patients, old age, smoking, and neutropenia are significant risk factors affecting their lung infections.
Analysis of the correlation between serum indexes and the degree of frailty in elderly inpatients
ZHANG Miao-yu, LUO Ke-xue, GAO Yan-fei, LI Hong-chun, ZHONG Ling-ling
2021, 19(3): 358-361. doi: 10.16766/j.cnki.issn.1674-4152.001809
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  Objective   To analyze the correlation between serum 25-hydroxyvitamin D [25(OH)D], interleukin-10 (IL-10), D-dimer (D-D) levels and the degree of frailty in elderly hospitalized frail patients.   Methods   A total of 420 elderly inpatients in our hospital were selected as the research objects, including 47 in the frailty group and 373 in the non-frailty group. The serum 25(OH)D, IL-10 and D-D levels of patients with different degrees of debilitating and re-admitted and non-re-admitted patients were compared between the two groups. The influencing factors of the occurrence of frailty in elderly inpatients were analyzed, and the correlation between serum indexes and the degree of frailty and the predictive value of re-admission to elderly frail patients were discussed.   Results   Age, length of hospital stays, 25(OH)D, IL-10, and D-D were all important risk factors for frailty in elderly hospitalized patients (OR=4.847, 5.887, 0.580, 4.820, 5.120, all P < 0.05). Serum 25(OH)D level (r=-0.415) was negatively correlated with the degree of frailty in elderly hospitalized patients with frailty. IL-10 (r=0.379) and D-D (r=0.392) levels were positively correlated with the degree of frailty (P < 0.05). The area under the curve predicted by the combination of serum 25(OH)D, IL-10, and D-D for re-admission of elderly hospitalized patients with frailty was 0.844, the sensitivity was 80.96%, and the specificity was 80.77%.   Conclusion   The abnormal expression of serum 25(OH)D, IL-10 and D-D levels is related to the degree of frailty. The combination of the three can provide evidence-based guidance for predicting the re-admission of elderly hospitalized patients with frailty.
General Clinical Research
Clinical value of SOFA combined with procalcitonin test in assessing the condition and prognosis of patients with sepsis
LIU Bin-gwei, XU Yan-ping, XI Shao-song, HU Wei, LIN Hua-peng, ZHU Ying, CAI Xue-ying, ZENG Xiao-kang, JIN Guang-yong
2021, 19(3): 391-393. doi: 10.16766/j.cnki.issn.1674-4152.001818
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  Objective  To observe the dynamic changes in sequential organ failure assessment (SOFA) scores and serum procalcitonin (PCT) in patients with sepsis and analyse the condition and prognosis of the patients through the combined assessment of the two tests.  Methods  Forty patients with sepsis who were admitted in the intensive care unit of Hangzhou City First People's Hospital affiliated to Zhejiang University School of Medicine from December 2016 to December 2019 were included in this study. The patients were divided into sepsis and septic shock groups according to the severity of their illness and following the 2018 China sepsis/septic shock emergency treatment guidelines (2018). The patients were further divided into survival and death groups; the patients in the survival group were those that remained alive within 28 days of admission. SOFA scores and changes in PCT were compared by analysing area under the receiver-operating characteristic (ROC) curve. The predictive value of these scores and changes was used to assess the condition and prognosis of the patients.  Results  On the first and fifth days, differences in SOFA scores between the sepsis group and the septic shock group were statistically significant (all P < 0.01). After the sepsis group was treated, the SOFA scores substantially improved, whereas PCT considerably decreased. On the fifth day, the SOFA score of the survival group (8.36±1.87) was lower than that of the death group (13.22±2.84), and the difference was statistically significant (P < 0.01). Moreover, the PCT of the survival group was significantly different from that of the death group (P < 0.01). ROC curve analysis revealed that the AUC of SOFA scores and PCT was 0.607 and 0.814, respectively. The combined AUC of SOFA scores and PCT was 0.875.  Conclusion  The combined test of SOFA and PCT can predict the condition and prognosis of sepsis patients.
Relationship between Livin expression and epithelial-mesenchymal transformation in oral squamous cell carcinoma and its clinical significance
HAN Ying-ying, DING Dan-dan, DING Xiang, CHENG Ru-yu, HAN rui, WANG Qian-qian, ZENG Ling-gong, ZHOU Mei-yun, XU Jin-cheng
2021, 19(3): 394-397. doi: 10.16766/j.cnki.issn.1674-4152.001819
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  Objective  To investigate the expression of Livin protein and epithelial-mesenchymal transformation (EMT)-related proteins Vimentin and E-cadherin in oral squamous cell carcinoma (OSCC) tissues, and to explore the correlation and clinical significance of the three protein expressions.  Methods  EliVision method of immunohistochemical was used to examine the expression of Livin, Vimentin and E-cadherin in 56 cases of OSCC and 56 cases of paracancerous tissues. The correlation between the expression of Livin, Vimentin and E-cadherin and the clinicopathological features of OSCC patients was analyzed. Furthermore, western blot was used to examine the expression of Livin, Vimentin and E-cadherin in 10 fresh OSCC tissues.  Results  The positive rate of Livin in OSCC tissues was 67.9%, which was significantly higher than that in paracancerous tissues (16.1%), and the expression of Livin was related to lymph node metastasis and TNM stage of OSCC. The positive rates of E-cadherin and Vimentin in OSCC tissues were 44.6% and 50%, respectively. Livin was negatively correlated with the expression of E-cadherin and positively correlated with the expression of Vimentin. The results of western blot showed that in the OSCC tissues with high expression of Livin, the expression of E-cadherin was low and Vimentin was high.  Conclusion  The expression of Livin can promote the invasion and metastasis of OSCC, which may be achieved by activating the occurrence of EMT by expressing Livin.
The efficacy and safety of transdermal buprenorphine patch for postoperative analgesia after arthroscopic rotator cuff repair
SHENG Jing, YAN Ying-zhao, SUN Yu, QU Hang-bo, HUANG Xiao-qin
2021, 19(3): 398-401. doi: 10.16766/j.cnki.issn.1674-4152.001820
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  Objective  To explore the effect of transdermal buprenorphine patch (TBP) for postoperative analgesia after arthroscopic rotator cuff repair (ARCR) and to count the incidence of adverse drug reactions (ADR).  Methods  The clinical data of patients (30 cases in each group) who did not receive and received buprenorphine transdermal patch after ARCR under arthroscope in Zhejiang hospital from October 2017 to October 2019 were retrospectively analyzed. Group A were only treated with flurbiprofen axetil (FA) 100 mg twice a day for 5 days postoperatively. Group B were treated with FA as in A group postoperatively and 5mg TBP for 14 days (from 1 day before operation). The visual analogue score (VAS) of each group was tracked 1 day before operation and 1, 2, 3, 5 and 14 day after operation, and the incidence of ADR was counted. The simple shoulder test score (SST), range of shoulder forward elevation (FE) and external rotation (ER) were recorded, and compared between the same patients preoperatively and postoperatively and compared also between two groups.The statistical data was analyzed with t-test, analysis of variance and chi-squared test.  Results  On 3, 5 and 14 day after operation, the VAS of group B was lower than that of group A (P < 0.05).At 12 weeks follow-up, compared with preoperative values, the VAS, SST, FE and ER of two groups were significantly improved (P < 0.05). At 12 weeks, group B showed a larger FE range compared with group A (P < 0.05), while the difference of VAS, SST and ER between two groups had no statistical significance. The ADR of group A and group B was 2/30 (6.67%) and 5/30 (16.67%). No significant difference was found between two groups.  Conclusion  TBP has good effect for postoperative analgesia after ARCR and does not delay the recovery of shoulder joint function.
Expression of SOX6 in oral mucoepidermoid carcinoma and its clinical significance
ZHENG Qing-rui, ZHOU Mei-yun, HAN Ying-ying, WANG Qian-qian, XU Jin-cheng
2021, 19(3): 402-404,440. doi: 10.16766/j.cnki.issn.1674-4152.001821
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  Objective  To detect the expression of transcription factor sex-determining region Y-box 6 (SOX6) in mucoepidermoid carcinoma (MEC) of salivary gland and adjacent normal tissues, as well as to explore the relationship between the expression difference and clinicopathological features and prognosis of patients.  Methods  The immunohistochemical EnVision method was used to detect the expression of SOX6 protein in 55 cases of salivary gland mucoepidermoid carcinoma and the corresponding normal tissues adjacent to the cancer. The relationship between the expression of SOX6 and the clinicopathological characteristics (gender, age, pathological grade, TNM staging, and lymph-node metastasis) and prognosis of salivary gland mucoepidermoid carcinoma was analysed by statistical methods.  Results  The positive expression rate of SOX6 in mucoepidermoid carcinoma was 62.3% (37/55), and the positive expression rate of SOX6 in the corresponding normal tissues adjacent to the cancer was 36.4% (20/55). The positive expression rate of SOX6 in mucoepidermoid carcinoma was significantly higher than that of the corresponding normal tissues (P < 0.05). The difference of SOX6 expression in mucoepidermoid carcinoma was related to pathological grade and clinical stage (all P < 0.05). With decreased pathological grade of MEC patients and increased TNM stage, the expression of SOX6 increased. But there was no statistical significance between gender, age and SOX6 positive expression rate (all P>0.05). The results of statistical analysis showed that the five-year survival time of the SOX6 negative group was longer than that of the positive group, and the difference was statistically significant. The high expression of SOX6 was significantly correlated with the poor prognosis of patients (P < 0.05). SOX6 may be an independent prognostic factor in patients with mucoepidermoid carcinoma of salivary gland.  Conclusion  SOX6 is highly expressed in MEC tissues and may play an important role in the occurrence of MEC, which has certain reference value for the treatment and diagnosis of MEC.
Zhuhuang compound preparation promotes the healing of soft and bone wounds in cellular level
LI Li-feng, YANG Hua-jun, ZHANG Qiao-li, LAI Yue-li, ZHAO Tong
2021, 19(3): 405-409. doi: 10.16766/j.cnki.issn.1674-4152.001822
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  Objective  To demonstrate the effectiveness of the traditional compound preparation of Zhuhuang powder in promoting wound healing of soft and bone as well as to explore the quantitative effect relationship of 5 kinds of traditional Chinese medicines in compound in the prescription, and provide scientific basis for the new clinical application of ancient Chinese medicines and screen new prescriptions.  Methods  Zhuhuang powder was used as the basic prescription, and Panax notoginseng, elderberry and intermittent medicinal materials were added. Five formulations were obtained by using uniform design method to proportionate the dosage of medicinal materials. The water extract and ethanol extract dry powder were prepared from five groups of prescriptions. RAW 309 Cr.1 cells stimulated with LPS were treated with these water extracts or ethanol extracts to detect inflammatory factors (NO) levels. The proliferation of human umbilical vein endothelial cells (HUVEC-12) and osteoblasts (UMR-106) were detected by methyl thiazolyl tetrazolium (MTT).  Results  The extract 2, 3 and 5 of 5 groups showed 44.3%-56.7% inhibition of NO expression at 1-5 μg/mL. The extract 1 and 4 showed 46.7%-73.4% inhibition of NO expression at 1-5 μg/mL. The extract 4 showed 110%-128% induction of the proliferation of HUVEC-12 cells at 3-4 μg/mL. The extract 1 showed 110%-120% proliferation at 4 μg/mL. Compared with control, all 5 groups showed 18% induction on the proliferation of UMR-106 cells, the proliferation effect was obvious at 4 μg/mL.  Conclusion  The five formulations showed single or multiple effects on cell proliferation in vitro. Formula No.4 (pearl 8 g, taurine 8 g, notoginseng 6 g, intermittent 15 g, elderberry 9 g) shows inhibition of inflammatory factors release and strong proliferation activity of human umbilical vein endothelial cells and osteoblasts (P < 0.05). The traditional prescription of Zhuhuang powder can promote the healing of soft tissue and bone tissue wounds. Formula 4 inhibits the release of inflammatory factors and has a significant effect on the proliferation of human umbilical vein endothelial cells and osteoblasts.
Clinicopathological analysis of 9 patients with metaplastic breast carcinoma
TONG Jing-wei, LIU Xian-fu, ZHU Jing-wei, XU Pei-quan
2021, 19(3): 410-412. doi: 10.16766/j.cnki.issn.1674-4152.001823
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Abstract:
  Objective  Metaplastic breast cancinoma (MBC) is a very rare form of breast cancer. This study aimed to analyze the clinicopathologyic features and prognosis of MBC.  Methods  The clinicopathological data of 9 patients with MBC admitted to the First Affiliated Hospital of Bengbu Medical College from January 2011 to October 2019 were retrospectively reviewed, and the pathological characteristics, treatment and prognosis were summarized.  Results  All nine cases were women aged 46-60 years with median age of 49 years. The size of tumor was 1.0 to 4.5 cm, there was no obvious specificity in all imaging examination. Lymph node metastasis was found in 4 cases. Clinical stages: 3 cases of stage Ⅰ, 5 cases of stage Ⅱ and 1 cases of stage Ⅲ. All 9 cases were with negative hormone receptor, and 1 case was with positive for CerbB-2 receptor. The modified radical mastectomy was performed in 8 patients, and the simple breast resection plus sentinel lymph node biopsy was performed in 1 patient. Eight patients received postoperative adjuvant chemotherapy. Among them, there were 4 patients with chemotherapy regimen, 1 patient with AT chemotherapy regimen, 1 patient with PA chemotherapy regimen, 1 patient with TP chemotherapy regiment, 1 patient with E C chemotherapy regime plus capecitabine due to docetaxel allergy. Two patients received postoperative radiotherpy. One patient did not receive postoperative chemoradiotherapy due to age and physical reasons. Three cases had a recurrence, 1 case died from cancer.  Conclusion  The MBC is a rare malignant tumor of breast cancer that dose not has special imaging features, complex and diverse tissue components, negative hormone receptors and CerbB-2, and poor biological behavior and prognosis. Currently, there is no standard treatment plan. Therefore, further research on metastatic breast cancer may lead to the discovery of new and potentially effective treatment regimens, and ultimately improve the prognosis of these patients.

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