中华全科医学

Comparative study on the effectiveness of two machine learning algorithms in constructing risk assessment models of coronary heart disease in the elderly

WANG Xiao-li, SHI Tian-xing, PENC De-rong, WANG ZIhao-xin, WANC Hui, SHI Jian-wei, YU Wen-ya

2021, 19(4): 523-527. doi: 10.16766/j.cnki.issn.1674-4152.001852

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Objective The aim of this study is to established the ta risk assessment models for coronary heart disease in elderly based on machine learning algorithms and provide a more efficient health management methods for the prevention of coronary heart disease in the elderly. and compared the effectiveness of Logical regression and XGBoost for the risk prediction of coronary heart disease in elderly. Methods Data records of 47 community health service centers in Pudong area from January to December in 2019 were extracted from the regional health information platform of Shanghai Pudong health development research institute. Using Python Panda, 80 000 physical examination data of the elderly were included to build the model. Twenty-seven variables were selected by feature engineering to build the model, and logistic and xgboost were used to construct the model respectively. Results The optimal parameter of XGBoost model: learning_rate=0.1, Tree depth=8, Minimum node weight=5, Number of cycles=50. The optimal parameters of logistic model: C=1, class_weight=None, max_iter=100, solver=newton-cg. The accuracies of XGBoost and logistic were 0.82 and 0.71, and the area under the receiver operating characteristic curve was 0.85 and 0.80. The importance of XGBoost model is concentrated in a few features, and the importance of the first nine features accounts for 94.2% of the relative importance, while the importance of logistic model is relatively balanced among the features, and the importance of the first nine features accounts for 59.5% of the relative importance. Conclusion The coronary heart disease risk assessment model based on the physical examination data of the elderly in the community has good stability, and the efficiency of the model constructed by XGBoost is better than that of the logistic regression, which can provide a method for coronary heart disease risk assessment of the elderly in the community.

2021, 19(4): 528-529.

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SF-12 and EQ-5D scale in evaluating the quality of life of elderly hypertensive patients in rural areas of Lianyungang City

YING Xiao-wen, TANG Gen-fu, SHU Ji, HU Chuan-qi, ZHANG Xu, XU Ya-ping

2021, 19(4): 599-602. doi: 10.16766/j.cnki.issn.1674-4152.001871

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Objective This study aimed to compare the results of the SF-12 and EQ-5D scale in evaluating the quality of life of elderly hypertensive patients in rural areas of Lianyungang City. Methods The SF-12 scale and EQ-5D scale were used to evaluate the quality of life of 1 262 elderly hypertensive patients in rural areas of Lianyungang City. T-test, one-way analysis of variance and other statistical methods were used to compare the results, and the physiology of SF-12 was analysed. Pearson correlations amongst the physical component score (PCS), mental component score (MCS), EQ-5D index score and EQ-VAS score were tested. Results The 1 262 elderly hypertensive patients surveyed had a total SF-12, PCS, MCS, EQ-5D index and EQ-VAS scores of 70.35±20.57, 66.11±25.21, 74.59±22.55, 0.77±0.10 and 69.22±18.91, respectively. The EQ-5D index score and EQ-VAS score corresponding to different SF-12 score ranges are different (all P < 0.001). PCS and MCS corresponding to different levels in different dimensions were significantly different (all P < 0.001). PCS was strongly correlated with the EQ-5D index score (r=0.632, P < 0.001) and moderately correlated with EQ-VAS score (r=0.442, P < 0.001). Moreover, MCS was moderately correlated with the EQ-5D index score (r=0.467, P < 0.001) and weakly correlated with the EQ-VAS score (r=0.332, P < 0.001). Conclusion The SF-12 scale and EQ-5D scale can accurately indicate the quality of life of elderly hypertensive patients, and the results also have a certain correlation. However, EQ-5D has an evident ceiling effect, and SF-12 is more sensitive.

Correlation between 23S rRNA mutation of Mycoplasma pneumoniae and clinical characteristics and drug resistance in children

WU Chao-xiong, WANG Ai-min, CAI Zhen-dang

2021, 19(4): 603-606. doi: 10.16766/j.cnki.issn.1674-4152.001872

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Objective This study aimed to observe the mutation characteristics of 23S rRNA gene in children with Mycoplasma pneumoniae (MP) and explore the correlation amongst the mutation, clinical characteristics and drug resistance in children. Methods A total of 214 cases of infantile MP with 23S rRNA gene mutation treated with the combination of traditional Chinese and Western medicine in a hospital in Wenzhou from January 2016 to January 2019 were collected and divided into the non-mutated group (36 cases) and mutated group (178 cases). Patient's general information, clinical data and drug susceptibility test results were collected on the basis of medical records to analyse the correlation between 23S rRNA gene mutation with the clinical characteristic and drug resistance of the patients. Results A total of 178 cases (83.18%) of 23S rRNA gene mutations were detected. Compared with the non-mutated group, the proportion of severe pneumonia in the mutated group was higher (83.18%); the mean fever time was longer (7.22±2.13) d; the hospital stay was longer (8.30±3.25) d, and the time to normal body temperature was longer (6.45±2.33) d. The differences were statistically significant (all P < 0.05). The drug susceptibility test results showed that the drug resistance rates of azithromycin and roxithromycin in the mutated group (38.20% vs. 25.84%) were significantly higher than those in non-mutated group (13.89% vs. 8.33%), all P < 0.05. Multivariate logistic regression analysis showed that the severity of pneumonia, the time to return to normal body temperature and 23S rRNA gene mutation were independent related factors of MP resistance (OR=1.693, 1.285, 3.338, all P < 0.05). Conclusion The mutation of A2603G gene in 23S rRNA is the main type of MP mutation, which has evident resistance to macrolide antibiotics, which can increase the proportion of children with severe pneumonia and significantly prolong the clinical treatment time of children.

Application of low molecular weight heparin combined with fresh frozen plasma in the treatment of coagulation abnormalities in critically ill neonates

CHEN Ru-ru, LUO Hou-jiang, YANG Jun, JIA Wen-ting, WANG Lei, GUO Hong-hui

2021, 19(4): 607-610. doi: 10.16766/j.cnki.issn.1674-4152.001873

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Objective To investigate the clinical effects of low molecular weight heparin combined with fresh frozen plasma in the treatment of abnormal coagulation functions in critically ill neonates. Methods Seventy-two critically ill children with coagulopathy admitted to the neonatal ward of The Second Affiliated Hospital of Bengbu Medical College from February 2019 to August 2020 were selected and divided into an observation group (n=35) and a control group (n=37). Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-Dimer (D-D) and platelet (PLT) levels were monitored. The control group received conventional treatment, whereas the observation group was administered with low molecular weight heparin and fresh frozen plasma on the basis of conventional treatment. The aforementioned indicators were retested after 72 h of treatment. The clinical efficacy, coagulation function indexes and complication incidence of the two groups were compared. Results The effective rate of the observation group was significantly higher than that of the control group after treatment (P < 0.05). No significant difference was observed in the levels of PT, APTT, FIB, TT, D-D and PLT between the two groups before treatment (all P>0.05). After treatment, the PT, APTT, TT and D-D levels of the observation group were significantly lower than those of the control group (all P < 0.05). By contrast, the FIB level of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, the PLT level of the observation group was lower than that of the control group, but the difference was not statistically significant (P>0.05). After treatment, the levels of PT, APTT, TT and D-D in both groups were significantly lower than those before the treatment (all P < 0.05). Furthermore, the level of FIB was significantly higher than that before the treatment (P < 0.05). The levels of PLT in both groups after the treatment were significantly higher than those before thetreatment (P < 0.05). After the treatment, the incidence of intracranial haemorrhage, gastrointestinal hemorrhage and pulmonary hemorrhage in the observation group was lower than that in the control group, but the difference was not statistically significant (all P>0.05). Conclusion Early intervention with low molecular weight heparin combined with fresh frozen plasma in the treatment of abnormal coagulation functions in critically ill newborns can improve clinical symptoms and restore coagulation functions. This intervention has good clinical effects.

Expression of P53 and lncRNA TINCR in placental trophoblast cells and apoptosis of placental trophoblast cells in preeclampsia

LYU Ying, YE Li-yan, FAN Xu-fei, ZHENG Xiu-juan

2021, 19(4): 611-613. doi: 10.16766/j.cnki.issn.1674-4152.001874

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Objective This study aimed to investigate the expression of P53 and lncRNA TINCR and apoptosis of placental trophoblast cells in preeclampsia. Methods A total of 98 cases of preeclampsia who were hospitalised in Jinhua Central Hospital from June 2018 to June 2020 were included in the study; 50 normal pregnant women were selected as the control group. Semi-quantitative reverse transcription polymerase chain reaction was used to detect the expression of P53 and lncRNA TINCR, and the expression of Bax and Bcl-2 was detected by chemiluminescence. The expression of P53, lncRNA TINCR, Bax and Bcl-2 protein was compared. Results The relative expression of p53 (5.09±1.26) and lncRNA TINCR (3.79±0.83) in the preeclampsia group was higher than that in the control group (1.32±0.36 and 1.09±0.31, t=20.699, 22.195, all P < 0.05). The expression of Bax in the preeclampsia group (0.65±0.14) was lower than that in control group (1.28±0.36), whereas the expression of Bcl-2 (1.26±0.16) was higher than the control group (0.67±0.23, t=15.248, 18.208, all P < 0.05). Conclusion The expression of P53 and lncRNA TINCR in placental trophoblast cells of preeclampsia is abnormally increased, and the apoptotic level of placental trophoblast cells is increased.

Application value of heparin binding protein in the early diagnosis of sepsis in children

CHEN Shuang, DONG Huai-fu, CHEN Xin, QU Se-hua

2021, 19(4): 614-616, 620. doi: 10.16766/j.cnki.issn.1674-4152.001875

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Objective To examine the clinical value of heparin-binding protein (HBP) in the early diagnosis and evaluation of childhood sepsis. Methods Total 61 children with sepsis who were hospitalized in the First Affiliated Hospital of Bengbu Medical College from January 2019 to February 2020 were selected and divided into sepsis group (35 cases), severe sepsis group (16 cases) and septic shock group (10 cases) according to the severity of the disease. Meanwhile, 30 children who were hospitalized due to local infection were set as local infection group. The levels of HBP, procalcitonin (PCT), and C-reactive protein (CRP) were compared per group, and the efficacy of each indicator in diagnosing sepsis was compared and analysed. Results The overall differences amongst the four groups were statistically significant (F=162.024, 78.944, 10.982, all P < 0.05). The levels of HBP were (19.74±15.2) μg/L, (34.79±14.08) μg/L, (57.42±14.63) μg/L, (191.20±53.28) μg/L; the levels of PCT were (1.33±1.07) ng/mL, (3.38±2.63) ng/mL, (9.93±6.65) ng/mL, (18.13±1.45) ng/mL, respectively, and increased with the aggravation of the disease (all P < 0.05). No statistically significant difference in CRP level existed between the septic shock group [(79.47±18.94) mg/L] and the severe sepsis group [(73.60±26.22) mg/L, P>0.05], and pausal differences between the other groups were statistically significant (all P < 0.05). ROC curve analysis showed that the maximum area under the curve (AUC) was 0.922, sensitivity was 72.13%, and specificity was 96.67% when the three indicators were combined to diagnose sepsis. Conclusion Serum HBP has good value in diagnosing childhood sepsis, and the combined detection of the three indices is better than single detection.

Effect of early pregnancy medical nutrition therapy on blood glucose, weight control, maternal and infant outcomes and medical compliance in gestational diabetes mellitus

DU Zhi-mei, NI Yan, JIANG Ruo-an, CHEN Dan-qing

2021, 19(4): 617-620. doi: 10.16766/j.cnki.issn.1674-4152.001876

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Objective This study aimed to investigate the effect of medical nutrition therapy (MNT) on blood glucose, body weight and pregnancy outcome of pregnant women with gestational diabetes mellitus (GDM). Methods A total of 100 cases of pregnant women with GDM in the first trimester of pregnancy (3 months of pregnancy), who were admitted in our hospital obstetrics department from January to December 2018 for clinical observation, were included in this study. On the basis of the random number table method, the patients were divided into two groups, 50 cases in each group. The control group received routine pregnancy examination, diet guidance and blood glucose control during pregnancy, whereas the observation group received individualised MNT regimen on the basis of routine pregnancy examination. Weight gain during pregnancy (total weight gain, the proportion of abnormal weight gain), blood glucose control results (fasting blood glucose, 2 h blood glucose after breakfast, lunch and dinner, glycosylated haemoglobin), compliance rate (strict diet control, regular blood glucose monitoring, reasonable aerobic exercise and weight control) and the incidence of pregnancy complications related to glucose metabolism (gestational hypertension, dyslipidaemia during pregnancy and delivery of giant newborns) were compared between the two groups. Results After 3 months of intervention, the results of blood glucose control in the observation group were better than those in the control group, with significant difference between the two groups (all P>0.05). The total weight gain and abnormal weight gain ratio in the observation group were lower than those in the control group (all P < 0.05). The improvement of compliance rate with strict control of diet and regular monitoring of blood sugar in the control group (70.0%, 76.0%) was better than that in the observation group (86.0%, 90.0%; all P>0.05). The improvement of compliance rate with reasonable aerobic exercise and weight control in the observation group (88.0%, 84.0%) was better than that in the control group (70.0%, 66.0%; all P < 0.05). The incidence of abnormal blood lipid in the delivery group was lower than that in the control group (P < 0.05). Conclusion Individualised MNT in early pregnancy can change the compliance rate of women with GDM, control weight gain during pregnancy and reduce the incidence of adverse pregnancy outcomes. Therefore, MNT in early pregnancy has potential clinical application.

The mediating effect of diabetes self-efficacy between perceived role demands and diabetes self-management among community patients with type 2 diabetes

WU Shi-shi, LIU Yu, LIN Ke-ke, LI Ming-zi, GUO Hong

2021, 19(4): 621-624, 666. doi: 10.16766/j.cnki.issn.1674-4152.001877

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Objective To investigate the status of perceived role demands, explore the mediating effect of self-efficacy between perceived role demands and self-management among people with type 2 diabetes (T2DM) in China. Methods A cross-sectional study was conducted in this study. A total of 210 patients with type 2 diabetes from Jimenli Community Health Service Center in Beijing from May 2016 to June 2016 were surveyed by using perceived role demands scale, self-efficacy scale and siabetes self-management scale for patients with T2DM. Results The score of perceived role demands scale ranged from 0 to 9, with median as 0; 66.19% percent of the patients were responsible for household chores, followed by work and child care. There were statistically differences in the perceived role demands of work, household chores and child care between different genders (all P < 0.05). Seventy-eight point five seven percent of patients' self-efficacy scores were in a relatively middle and high level; 65.24% patients' self-efficacy scores were in a middle to low level.Among them, perceived role demands were negatively associated with self-efficacy, and self-efficacy was positively associated with self-management. Perceived role demands were significantly correlated with self-efficacy and self-management (P < 0.05). Self-efficacy had a mediating effect between perceived role demands and self-management, the coefficient was -0.101 (P < 0.001). In addition, self-efficacy mediated the effect of perceived role demands on self-management for females but not males. Conclusion There is gender difference in perceived role demands of patients with T2DM. Self-efficacy significantly mediates the relationship between perceived role demands and self-management, especially for females. This finding suggests that for those who are with strong perceived role demands, especially for females with diabetes, Clinicians should consider improving self-efficacy to enhance diabetes self-management behaviors in future interventions.

Analysis on the frailty of the elderly in community and its influencing factors

WANG Chen-chen, XIE Hui, CAI Wei-wei

2021, 19(4): 625-627, 683. doi: 10.16766/j.cnki.issn.1674-4152.001878

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Objective This study aimed to understand the current status of frailty and physical activity of the elderly in Bengbu community, analyse the influencing factors of frailty and provide a basis for further development of frailty prevention and intervention measures to delay the occurrence of frailty. Methods A total of 405 cases of elderly people, who were residing in the community of Bengbu City, Anhui Province, from July to December 2019, were conveniently selected as the survey subjects. The general information questionnaire, Tilburg frailty index (TFI) and physical activity scale for the elderly (PASE) were used in this study. The research subjects were asked to fill out the questionnaires for data collection. SPSS 25.0 statistical software was used to perform descriptive statistics, correlation analysis, chi-square test and linear regression analysis on the data. Results Amongst the 400 elderly cases, 59 (14.8%) were frail: physical frailty (0.76±1.15) points, mental frailty (1.26±1.03) points and social frailty (1.14±0.85) points. Statistically significant differences in age, gender, marital status, level of education, lifestyle, chronic disease and per capita monthly income (all P < 0.05) were found between the frail group and the non-frail group. The total score range of PASE scale was (91.95±53.12) points. The frailty of the elderly in the community was negatively correlated with physical activity (r=-0.434, P < 0.01). Multiple linear stepwise regression analysis showed that gender, marital status, lifestyle, chronic diseases and physical activity were the influencing factors of frailty (all P < 0.05). Conclusion Community medical staff must pay attention to the screening and evaluation of debilitating high-risk groups, particularly women, living alone, widowed or divorced, chronic diseases and elderly people with low physical activity, and timely take corresponding measures to deal with the occurrence of frailty and its adverse outcomes. Patients and their families must be instructed to face frailty, understand disease-related knowledge, reduce the occurrence of adverse health outcomes and improve the quality of life of the elderly.

Investigation on the oral health literacy and the influencing factors among residents in Bozhou city

WANG Xiao-li, ZHANG Wei, DING Wei, YIN Nan, ZHANG Yan-yong, ZHOU Hao-yun, LIAO Sheng-kai

2021, 19(4): 628-631. doi: 10.16766/j.cnki.issn.1674-4152.001879

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Objective To understand the current situation of oral health literacy of bozhou residents and analyze its influencing factors, so as to provide scientific basis for making targeted oral health education plan. Methods From September to December 2019, a questionnaire was made by ourselves and 985 residents of Bozhou city were sampled by multi-stage stratified random sampling with equal capacity. Mann-whitney U test or Kruskal-Wallis H test and logistic stepwise regression analysis were used for data analysis. Results The median scores of oral health knowledge, attitude, knowledge-beliefs-behaviors were: 9.00 (7.00, 11.00), 7.00 (6.00, 8.00), 6.00 (4.00, 9.00), 22.00 (19.00, 26.00). The passing rate was 38.38%, 49.95%, 35.63% and 41.73%, respectively. Logistic regression analysis showed that education level, one-child or not, oral health education and access to oral health care were the influencing factors of oral knowledge-beliefs-behaviors score.The scores of oral health knowledge, behavior and knowledge-beliefs-behaviors were 1.674, 2.159 and 2.915 times higher than those of the residents who had not received oral health education. Residents who have received oral health guidance have scores of 3.020, 2.982, 4.241, and 5.072 times on oral health knowledge, attitudes, behaviors, and knowledge-beliefs-behaviors than those who had not. Conclusion The oral health education and instruction is one of the important ways to improve the oral health literacy of residents in Bozhou city.

Application of PRECEDE-PROCEED mode health education in the family of children with febrile seizures

CHEN Qiu-zhu, DU Jin, JIA Xiao-rong, PENG Yi, KOU Qiong

2021, 19(4): 632-635. doi: 10.16766/j.cnki.issn.1674-4152.001880

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Objective To explore the influence of precede-proceed model (pretreatment model) health education on the health cognition, negative emotion and nursing satisfaction of the family members of patients with febric convulsion. Methods Eighty-six children with febrile seizures from January 2016 to July 2018 were enrolled from The First People's Hospital of Guangyuan City.The patients were divided into observation group and control group according to the admission time, with 43 cases in each group. The family members of the control group were given regular health education, and the family members of the observation group were given the PRECEDE-PROCEED model health education and regular health education. The health knowledge, negative emotions before and after the intervention [anxiety (self-rating anxiety scale, SAS), depression (self-rating depression scale, SDS)], coordination, patients outcome and nursing satisfaction of the two groups were compared. Results After intervention, the scores of disease cognition, treatment cognition, nursing cognition, health attitude and behavior of the family members of the observation group were higher than those of the control group, the SAS and SDS scores in both groups were lower than those before intervention, and SAS and SDS scores in the observation group were lower than those in the control group, the coordination degree of the observation group was higher than that in the control group and the difference were statistically significant (all P < 0.05). There was no statistically significant difference in the time of antipyretic and anticonvulsant between the two groups (all P>0.05). But the recurrence times in the observation group was less than that in the control group, and the nursing satisfaction of the observation group was higher than that of the control group, with statistically significant difference (all P < 0.05). Conclusion The PRECEDE-PROCEED model health education for the family members of patients with febric convulsion could effectively improve their recognition of related health knowledge, relieve negative emotions, ensure the family members to carry out clinical related work smoothly, have high nursing satisfaction, and reduce the recurrence rate of convulsion.

Expression and significance of IL-17 and IL-22 in tuberculosis heat-resistant antigen and phospho-antigen stimulated cell amplified polarization

SHENG Ling-ling, JIN hui, YANG Zai-xing, LI Bai-qing

2021, 19(4): 636-638,697. doi: 10.16766/j.cnki.issn.1674-4152.001881

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Objective To clarified the expression of IL-17 and IL-22 in tuberculosis heat-resistant antigen (Mtb-Hag) and phosphorylated antigen (HDMAPP) under the polarization state of IL-1β, TGF-β and IL-23 Happening. Methods Peripheral blood mononuclear cells (PBMC) were obtained by density gradient centrifugation and cultured in RPMI1640 medium. The experimental group was divided into three groups: Mtb-HAg, HDMAPP, and whole bacterial antigens. Each group was cultured with (IL-1β, TGF-β) for 3 days, rIL-2 for further culture, and IL-23 for 12 days on the 9th day. The control group was divided into three groups: Mtb-HAg, HDMAPP, and whole cell antigen. After 3 days of culture, rIL-2 was added to continue to culture until 12 days. The experimental group and the control group finally expanded into a cell population rich in effector γδ T cells, then the cells were collected and stimulated with PMA/Ionomycin and Monensin for 6 hours, and Tγδ 17 and Tγδ 22 were detected and analyzed. The proportion of cell subpopulations was compared and analyzed. Results In all groups, γδ T cells could produce IL-17 and IL-22. The percentage of IL-17 cells produced by γδ T cells in the Mtb-Hag+ck group was significantly higher than that in the Mtb-HAg group, and the HDMAPP+ck group was higher than the HDMAPP group (all P < 0.05). IL-17 was mainly produced by Vδ2 subpopulations, but there was no significant difference in the proportion of IL-22 cells produced by γ δ T cells in different polarization groups. Conclusion Under the polarization of IL-1 β, TGF-β and IL-23, the cultured PBMC stimulated by Mtb-Hag and HDMAPP can induce more IL-17 production by γδ T cells, but not IL-22.

Analysis of high-risk factors of contrast agent reflux in 4D-hysterosalpingo contrast sonography

CHEN Xian-qiu, JIN Wei-wei

2021, 19(4): 639-642. doi: 10.16766/j.cnki.issn.1674-4152.001882

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Objective This study aimed to analyse the main risk factors of contrast agent reflux in four-dimensional ultrasonography of vagina (4D HyCoSy) to provide reference basis for the prevention of contrast agent reflux. Methods Women who underwent 4D HyCoSy in our hospital from January 2018 to December 2019 were selected as the study objects. The differences of clinical data and tubal patency between the reflux group (n=248) and non-reflux group (n=410) were compared, and the risk factors of contrast agent reflux were analysed. Results Secondary infertility (77.82% vs. 69.51%), history of uterine cavity operation (59.68% vs. 37.07%), adenomyosis (14.52% vs. 9.27%), examination time < 5 days after menstruation (47.18% vs. 38.54%) and endometrial polyp (22.18% vs. 14.88%) were significantly different between the reflux group and non-reflux group (all P < 0.05). Statistically significant differences in the proportion of bilateral fallopian tube obstruction (6.05% vs. 2.44%) and bilateral fallopian tube patency (4.44% vs. 14.63%) were found between the reflux group and non-reflux group (all P < 0.001). The proportion of endometrial polyps (27.92% vs. 12.77%) was significantly different between the myometrium main reflux group and the parathyroid main reflux group (P < 0.05). History of uterine cavity operation, adenomyosis, endometrial polyps and bilateral fallopian tube obstruction were independent risk factors for contrast medium counter current (all P < 0.05). Conclusion The incidence of contrast agent reflux was high in 4D HyCoSy, which was related to endometrial injury and bilateral oviduct obstruction.

Advances in biological therapies for hidradenitis suppurativa

CHENG Ping, JIA Wei-xue, LI Cheng-rang

2021, 19(4): 643-647. doi: 10.16766/j.cnki.issn.1674-4152.001883

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Hidradenitis suppurativa is a chronic recurrent inflammatory skin disease, which occurs in the skin folds of axillary, inguinal, gluteal and perianal areas. The disease is often seen in young females, which is characterised by inflammatory nodules, abscesses, fistulae and scars. Patients with hidradenitis suppurativa have a long disease history and a reduced quality of life. Although its pathogenesis is still unclear, hidradenitis suppurativa is considered as a result of interactions between genetic factors and other environmental factors. At present, the therapeutic options are limited to antibiotics and other symptom-relieving measures. Aberrant immune responses, including increased cytokines, such as TNF-α, IL-17, IL-12 and IL-23, may play an important role. Considering that the pathogenetic mechanisms are understood, and observations are made when patients with concurrent hidradenitis suppurativa are treated with biological agents, biological treatment has gained considerable attention. Adalimumab, an anti-TNF-α monoclonal antibody, is currently the only biological agent approved by the US FDA based on the results of several clinical trials, which can treat hidradenitis suppurativa, but other biological agents targeting these inflammatory cytokines have also shown good efficacy and safety in the treatment of moderate-to-severe hidradenitis suppurativa. Based on a brief introduction to hidradenitis suppurativa, this review summarises advances in the biological therapy targeting immune factors involved in hidradenitis suppurativa.

Advances in the diagnosis and treatment of rheumatoid arthritis in elderly patients

SONG Meng-ting, WANG Zhen-jie, GUO Pei-xia, LI Jun-ru, CHENG Hai-hua

2021, 19(4): 648-652. doi: 10.16766/j.cnki.issn.1674-4152.001884

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Rheumatoid arthritis (RA) is a systemic autoimmune disease that mainly manifests as symmetrically, continuously and erosive polyarthriti multiple arthritis mainly involving small joints such as the proximal interphalangeal joints, metacarpophalangeal joints, and wrist joints of both hands. Elderly patients with RA refers to patients with this disease with an age ed over 60 years. Elderly patients with RA are classified into two clinical subsets, namely, elderly-onset RA (EORA) and younger-onset elderly RA (YORA). The population of elderly with RA is expanding because of the aging of populations and increased life expectancy. EORA seems to have an epidemiological character and a clinical pattern different from that of YORA. A prompt diagnosis of true RA is important to implement early treatment. The diagnosis of EORA from other rheumatological disorders, such as polymyalgia, gouty arthritis and osteoarthritis, which are prevalent in this stratum of the population, are different. The method for diagnosing EORA lacks specificity. In addition, this disease exhibits symptoms similar to EORA, which makes diagnosis more difficult at the early stage. The treatment of EORA aims to achieve the same objectives as in the treatment of YORA, that is, to control clinical manifestations, prevent structural damage, preserve functions and decrease excess mortality. Owing to pharmacokinetics changes, high renal insufficiency, age-related immunosenescence and other risk factors, the management of patients with EORA is challenging. Currently, the drugs used to treat RA include Nonsteroidal anti-inflammatory drug (NSAIDs), glucocorticoid, traditional disease-modifying anti-rheumatic drugs (csDMARD), biological DMARDs (BDMARDs) and targeted synthetic DMARDs (TsDMARDs). Patients with EORA should be carefully monitored because of high risk of adverse events associated with treatment. A tailored approach that aims to achieve clinical remission should be adopted on the basis of disease severity and risk profiles of patients with EORA.

Effect of joint mobilisation combined with massage on knee osteoarthritis and functional recovery

LI Yue, LYU Cun-xian, YANG Sheng-wu

2021, 19(4): 653-655. doi: 10.16766/j.cnki.issn.1674-4152.001885

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Objective This study aimed to observe the effect and functional recovery of joint mobilisation combined with massage in the treatment of knee osteoarthritis and explore effective treatment to improve curative effect and prognosis. Methods A total of 94 patients who were diagnosed with knee osteoarthritis from October 2019 to October 2020 in the Department of Orthopedics of our hospital were selected and divided into group A (47 cases) and group B (47 cases) on the basis of different treatment schemes; group A was treated with joint mobilisation, and group B was treated with joint mobilisation combined with massage. The knee joint pain degree (VAS score), knee joint function (KSS score) and knee joint range of motion of the two groups were compared (active ROM and passive ROM) with the levels of inflammatory factors in synovial fluid (IL-6, TNF-α and C-reactive protein) and overall efficacy. Results The VAS score of group B (1.21±0.72) points was lower than that of group A (2.19±1.04) points, and the KSS score of group B (80.02±5.66) points was higher than that of group A (73.17±6.20) points. Active ROM and passive ROM of group B (121.68°±10.16° and 128.49°±12.35°, respectively) were higher than those of group A (102.34°±7.24° and 110.34°±7.83°, respectively). In addition, the levels of interleukin-6, tumour necrosis factor-α and C-reactive protein in group B [(17.93±3.01) ng/L, (11.02±1.76) ng/L and (20.25±5.31) mg/L, respectively] were lower than those in group A [(22.61±3.27) ng/L, (13.21±2.05) ng/L and (27.69±7.14) mg/L, respectively]. The total effective rate of group B (95.74%) was higher than that of group A (80.85%), all P < 0.05. Conclusion The effect of joint mobilisation combined with massage in the treatment of knee osteoarthritis is exact, which can significantly reduce the pain of knee joint, improve the function of knee joint, increase the range of motion of knee joint and reduce the inflammatory reaction of joint fluid.

Clinical observation on 72 cases of type 2 diabetes mellitus complicated with gouty arthritis treated by integrated traditional Chinese and Western medicine

GU Jian, LIN Li-ying, HU Yan

2021, 19(4): 656-659. doi: 10.16766/j.cnki.issn.1674-4152.001886

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Abstract:
Objective This study aimed to compare the clinical effect of conventional Western medicine or combination of Chinese and Western medicine in the treatment of type II diabetes mellitus complicated with gouty arthritis. Methods A total of 72 diabetic patients who were diagnosed with gouty arthritis from January 2018 to December 2019 were selected and randomly divided into the observation group and control group, with 36 cases in each group. The control group was given conventional Western medicine (oral indomethacin enteric coated tablets), and the observation group was given conventional Western medicine combined with Qingli Xiaotong Chinese medicine. The indexes of glucose and lipid metabolism [fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPG), glycosylated haemoglobin (HbA1c%), serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)] and inflammatory indexes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), joint pain score and uric acid (UA) level were observed before and after treatment. Results After treatment, FBG, 2hPG, HbA1c, TC, TG, HDL-C, LDL-C and the inflammatory indexes, such as ESR, CRP, joint swelling, pain score and UA, were significantly improved in the observation group than in the control group (all P < 0.05). Conclusion The combination of traditional Chinese and Western medicine has better curative effect on diabetic patients with gouty arthritis. It can relieve pain symptoms, reduce inflammatory indexes and uric acid levels and help to control blood glucose and blood lipid levels.

Study on the effect of extracorporeal shock wave on pain and inflammatory factor levels in patients with shoulder periarthritis

JIANG Jun, JIN Xiao-feng, YANG Yan-ping, FANG Bin

2021, 19(4): 660-662. doi: 10.16766/j.cnki.issn.1674-4152.001887

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Abstract:
Objective To analyze the efficacy of extracorporeal shock wave (ESW) in the treatment of scapulohumeral periarthritis and the improvement of pain and inflammatory factors. Methods A total of 120 patients with shoulder periarthritis in the Department of Orthopedics of our hospital from January 2019 to January 2020 were selected. According to different treatment plans, they were divided into group A and group B with 60 cases each. Group A was treated with sodium hyaluronate injection in the shoulder joint cavity, and group B were used sodium hyaluronate injection in the shoulder joint cavity combined with electromagnetic extracorporeal shock wave therapy. The clinical efficacy, pain degree, shoulder joint function, shoulder joint range of motion and inflammatory factor levels were compared between the two groups. Results After treatment, the total effective rate of group B (93.33%) was higher than that of group A (78.33%), the VAS score of group B [(2.21±0.72) points] was lower than that of group A [(4.19±1.04) points], and the Constant-Murley score[(70.76±5.89) points] was higher than that of group A [(64.22±6.15) points]. After treatment, the range of movement of shoulder joint abduction, flexion and extension (133.12°±7.25°, 137.81°±8.27°, 40.06°±3.15°) of group B was greater than that of group A (108.43°±6.87°, 102.54°±7.82°, 33.82°±2.90°). After treatment, the levels of interleukin-6 and tumor necrosis factor-α in group B [(47.93±4.01) ng/L, (11.02±1.76) ng/L] were lower than those in group A [(56.61±3.27) ng/L, (18.21±2.05)ng/L], all P < 0.05. Conclusion ESW treatment of shoulder periarthritis has a definite effect, which can significantly reduce the pain of patients, improve shoulder joint function, increase shoulder joint mobility, reduce inflammation, and have a high clinical total effective rate, which can help patients recover as soon as possible.

The application of Mini-CEX simulation teaching combined with DOPS evaluation exercise in the standardized training of critical medical residents

ZOU Qi, WENG Wen-juan, LIU Cheng, WU Qiang, ZHAO Shi-bing

2021, 19(4): 663-666. doi: 10.16766/j.cnki.issn.1674-4152.001888

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Abstract:
Objective To explore the role of mini clinical evaluation exercise(Mini-CEX)simulation teaching combined with direct observation of operating skills (DOPS) evaluation exercise in the standardized training of critical medical residents. Methods From June 2019 to December 2019, the students undergoing standardized training in the Intensive Care Unit of the First Affiliated Hospital of Bengbu Medical College were divided into the traditional teaching group and the Mini-CEX combined DOPS teaching group (MD teaching group). First of all, the theoretical scores, skill operation scores and medical record writing quality of each group were compare those on admission. Then, the differences of students' scores between the two groups were compared on graduation. Finally, the satisfaction of the student on teaching was evaluated. Results After the traditional teaching and training, the theoretical scores and medical record writing of the students were improved to a certain extent (all P < 0.05), but the skills of operation were not significantly improved (P=0.166); After Mini-CEX combined with DOPS teaching, the theoretical scores, skill operation of the students were all improved when compared with those at the beginning of the training (all P < 0.05). There were statistically significant differences in theoretical scores and skill operation scores between the traditional teaching group and the MD teaching group after training (all P < 0.05). There was significant difference between the two groups in the satisfaction of teaching (P < 0.05). Conclusion Mini-CEX simulation teaching combined with DOPS evaluation exercise in the standardized training of residents in intensive care unit can significantly improve the clinical theory and operation skills of the students, and increase the satisfaction of the students on the teaching.

The design and application of cloud platform based on cloud technology for general practice of case-centered, problem-based, community-oriented teaching mode

ZHANG Peng, LI Zhao, LIU Jin-cheng

2021, 19(4): 667-670. doi: 10.16766/j.cnki.issn.1674-4152.001889

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Abstract:
Objective To design a teaching cloud platform based on cloud technology for general practice (GP) tutors and general practitioners using in case-centered, problem-based, community-oriented (CPC) teaching mode, and to investigate the effects of the cloud platform in CPC teaching mode. Methods Through consulting the relevant literature, the problems and needs of CPC teaching mode for GP were analyzed. According to the problems and teaching needs, we designed the teaching cloud platform based on cloud technology which could be used in CPC teaching mode.The general practice students were randomly divided into two groups by random number table method.The teachers guided students to use CPC teaching cloud platform for learning and examination in the research group, while students only uses CPC teaching platform for examination in the control group. The test scores of the two groups were compared. Results Based on cloud technology, the CPC teaching cloud platform had been built. A total of 167 students had used the cloud platform in the research group, as well as 150 students in the control group.The score of the study group was better than that of the control group, and the difference was statistically significant. Conclusion The cloud platform finally provided the convenient, visualized teaching and learning system in the CPC teaching mode for GP teaching professionals as well as GP, which is helpful in enhancing the theory and the clinical practice ability.

Analysis of risk factors related to pneumonia after multidrug-resistant bacterial infection and exploration of control methodology

CHI Shui-jing, FENG Yi, LI Hui, YANG Yue, ZHAO Kai-feng, FAN Bo, ZHANG Le, TANG Guan-jie

2021, 19(4): 671-673, 701. doi: 10.16766/j.cnki.issn.1674-4152.001890

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Abstract:
Objective This study aimed to monitor the incidence of nosocomial pneumonia caused by multidrug-resistant bacteria after thoracic surgery; analyse the risk factors of postoperative pneumonia caused by multidrug-resistant bacteria; develop corresponding prevention, control and intervention measures and reduce the incidence of postoperative pneumonia and multidrug-resistant bacterial infection, thereby accelerating the postoperative recovery of patients. Methods A total of 610 patients were admitted to the Department of Thoracic Surgery from 2016 to 2018 and monitored for nosocomial infection, and the incidence of postoperative pneumonia caused by multidrug-resistant bacterial infection and the risk factors associated with infection were analysed. SPSS 20.0 software was used for statistical analysis of data. Results A total of 22 strains of Pseudomonas aeruginosa were detected, accounting for 50.00% (22/44), and 8 strains of carbapenem-resistant Acinetobacter baumannii were detected, accounting for 53.33% (8/15). The rate of postoperative pneumonia caused by multidrug-resistant bacterial infection decreased from 3.38% in 2016 to 1.37% in 2018, and single-factor analysis showed the following risk factors: antibiotic use for 14 days, urethral catheter or mechanical ventilation. The length of stay in intensive care unit, ASA score acuity Ⅱ and use of antimicrobial agents are the main risk factors (all P < 0.05). Logistic multifactor analysis showed that only antibiotic use was the related independent risk factor of postoperative pneumonia caused by multidrug-resistant bacterial infection. Conclusion The main risk factors of postoperative pneumonia caused by multidrug-resistant bacterial infection can be found through effective nosocomial infection monitoring and risk factor analysis, thereby reducing the incidence of postoperative pneumonia caused by multidrug-resistant bacterial infection.

Multivariate analysis of prognosis and nomogram construction of cystadenocarcinoma based on SEER database

TAO Run, GUAN Han, LIU Yan-shen, ZHOU Wen-sheng

2021, 19(4): 674-678. doi: 10.16766/j.cnki.issn.1674-4152.001891

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Abstract:
Objective This study aimed to establish a nomogram model that can individually predict the prognosis of patients with bladder adenocarcinoma (ACB) by studying the independent prognostic risk factors. Methods Clinical data of patients diagnosed with ACB from 2004 to 2015 in the SEER database were collected for screening. A total of 659 patients with adenocarcinoma who met the study conditions were included for retrospective analysis. COX univariate regression analysis was performed on all variables using Empower stat software, and P < 0.05 was analysed. Variables of 0.05 were included in COX multivariate regression analysis. Independent prognostic risk factors determined in COX multivariate regression analysis were constructed into a survival nomogram model using R language. The bootstrap method was used to perform 1 000 times of equal number of repeated sampling to verify the model. Results Age > 70 years, tumour size>3 cm, T3, T4, N1, N2 and M1 were independent risk factors affecting the survival time of patients. The established alignment curve of the nomogram has a high consistency with the ideal curve and high applicability and accuracy after internal verification. Conclusion In this study, the seer database was used to determine the independent risk factors for the prognosis of ACB patients, and the first nomogram model was established to individually predict the survival prognosis of ACB patients and guide clinicians in selecting reasonable treatment options and conducting accurate individualised assessment of the prognosis of different patients.

Study on the usage status and the factors influencing the utilisation of mobile health services for diabetes treatment among patients with this disease

BIAN Mao-mao, XIE Hong

2021, 19(4): 679-683. doi: 10.16766/j.cnki.issn.1674-4152.001892

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Abstract:
Objective To investigate the awareness and usage status of mobile medical services for diabetes treatment among patients with this disease and analyse the factors influencing the utilisation of such services to provide a reference for their development and promotion. Methods A total of 410 patients with diabetes from the endocrinology department of three comprehensive tertiary hospitals between July and September 2019 were selected in a cluster. Questionnaires were used to assess their awareness and their usage of mobile medical services for diabetes treatment. The patients' level of awareness and the factors influencing their utilisation of such services were evaluated via logistic regression. Results The patients' awareness rate and utilisation rate of such services were 64.1% and 49.6%, respectively. Regression analysis revealed that the The awareness rate of diabetes mellitus in the 18-44 age group wais 2.914 times that of the age group 60 and above (P < 0.05). Moreover, The awareness rate of diabetes mobile medical services in the junior high school education group and the high school education group and above was 2.156 times and 4.265 times that of the elementary school education group and below (all P < 0.05). Furthermore, the awareness rate of such services for urban patients was 1.922 times that of rural patients (P < 0.05). The utilisation rate of such services in the junior high school education group and the senior high school education group was 2.957 times and 6.856 times that in the primary school education group (all P < 0.01). Conclusion The level of awareness and the utilisation rate of mobile medical services for diabetes treatment among patients with this disease are at an intermediate level. Designers and managers of such mobile applications should take effective measures to improve the level of awareness and utilisation rate of these potentially life-saving services among patients with diabetes.

Evaluation of the effect of online classroom based on cognitive behavioral therapy on preventing postpartum depression

WANG Yong-xin, CHEN Xiu-feng, JIANG Jian-lan, WU Min, GAN Quan, LI Ming-wei

2021, 19(4): 684-688. doi: 10.16766/j.cnki.issn.1674-4152.001893

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Abstract:
Objective To explore the effect of online classroom based on cognitive behavioral therapy on preventing postpartum depression. Methods Eighty pregnant women undergoing obstetric outpatient check-ups from June 2019 to January 2020 were collected. According to the random number table, they were divided into observation group and control group with 40 cases each. The control group adopted routine prenatal check-ups, routine obstetric care and post-natal follow-up. An online classroom based on cognitive behavioral therapy were performed on the cognitive behavior of pregnant women. Before the intervention and 42 days postpartum, the general status questionnaire, Edinburgh postpartum depression scale, anxiety self-rating scale, and stress perception scale were used for questionnaire surveys, and the Parenting Competency Scale was used for questionnaire surveys on 42 days postpartum. Results Before the intervention, there was no significant difference in depression, anxiety, and stress scores between the two groups (all P>0.05); at 42 days postpartum, the depression score of the observation group (6.85±3.83) was significantly lower than that of the control group (9.13±4.91), the difference was statistically significant (P < 0.05); in the anxiety state, the score of the observation group (28.88±9.63) was significantly lower than that of the control group (36.12±9.18), and the difference was statistically significant (P < 0.05). On the stress score, the stress score of the observation group (20.20±7.43) was significantly lower than that of the control group (25.12±10.54), the difference was statistically significant (P < 0.05); the parenting competency score of the observation group was 81.20±9.35, and it was significantly higher than the control group (75.33±10.65), and the difference was statistically significant (t=-2.622, P=0.011). Conclusion Online classes based on cognitive behavioral therapy can effectively improve maternal parenting competence, reduce parenting pressure, relieve anxiety, and prevent the postpartum depression.

Nursing cooperation of endoscopic and laparoscopic treatment of middle and high congenital anal atresia

LIU Xiao-tian, WANG Yu, PAN Shou-dong, WU Xin-yan, HAN Ding, DIAO Mei, LI Qi, ZHANG Zhen, WANG Nan, LI Long

2021, 19(4): 689-692. doi: 10.16766/j.cnki.issn.1674-4152.001894

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Abstract:
Objective This study aimed to summarise the nursing cooperation methods of endoscopic and laparoscopic anorectoplasty in the treatment of high anorectal malformation (ARM) and to provide a standardised operation of nursing cooperation. Methods A retrospective analysis was performed in 16 cases of high ARM who underwent endoscopic and laparoscopic anorectoplasty in Capital Institute of Pediatrics from November 2019 to June 2020. All patients had rectal urethral fistula; rectum mucosa around fistula was dissected by endoscopy, and the rectum was mobilised by laparoscopy. The operation cooperation process and nursing key points were summarised. Results The procedure was successfully performed in all patients. The median endoscopic time was 45.0(29.5, 60.0) min. The median total operative time was 188.5(167.5, 211.3) min, and the intraoperative blood loss was approximately 5-10 mL. Postoperative recovery was uneventful; the median postoperative hospitalisation time was 5.5 days, and postoperative re-examination of VCU showed no occurrence of complications such as urethral diverticulum, urethral leakage and urethral stricture. Conclusion Endoscopic and laparoscopic anorectoplasty is safe and feasible in the treatment of middle and high ARM, which has the advantages of less trauma, accurate positioning and few complications. Regular training of surgical nurses' professional skills, full preparation before operation, thermal retardation during operation, monitoring of vital signs, strict aseptic operation, effective management of instruments and equipment, standardised placement of surgical positions, skilled coordination techniques and adequate doctor-patient communication are the key to the success of surgery.

Influencing factors of needlestick injuries in clinical nurses

YANG Cong-yan, HU Man-man, ZHOU Ying, ZHAO Mei-jun, ZHANG Pei-pei, ZHU Jing-rui

2021, 19(4): 693-697. doi: 10.16766/j.cnki.issn.1674-4152.001895

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Abstract:
Objective This study aimed to understand the current situation of needlestick injuries in clinical nurses of third-class-A hospitals in Anhui Province, explore the influencing factors and provide a practical basis for the prevention and control measures of needlestick injuries. Methods A total of 1 537 nurses who were engaged in clinical work in nine third-class-A hospitals in Anhui Province were investigated by general information questionnaire, risk perception questionnaire, needlestick injury questionnaire, needlestick injury-related attitude, behaviour questionnaire and temperament type test questionnaire. Results In the past year, the number of clinical nurses with needlestick injuries was 1 364, accounting for 88.74%. The median score of attitude and behaviour related to needlestick injuries was 4.20 and 4.06, respectively. Working years, departments, risk perception, temperament types and needlestick injury-related behaviour were the main influencing factors (all P < 0.05). Conclusion The incidence of needlestick injuries of clinical nurses in third-class-A hospitals in Anhui Province is still at a high level, and the attitude and behaviour related to needlestick injuries are remarkable. The influencing factors of needlestick injuries in clinical nurses include nurses' temperament characteristics, working years, departments, risk perception level and the implementation of needle stick injury prevention measures. Nursing managers should reasonably allocate work tasks according to the characteristics of nurses to reduce the occurrence of needlestick injuries. In the training of needlestick injuries, not only the training of junior clinical nurses, but also the training and education of senior clinical nurses should be paid attention to. In addition to emphasising the risk and harm of needlestick injuries, clinical nurses should also be stressed to correctly understand the risk. After the training, hospital nursing managers should supervise the implementation of needlestick injury preventive measures. Each department should reasonably allocate personnel according to the characteristics of the department.

Application effect of WeChat group nursing intervention on patients undergoing painless gastrointestinal endoscopy procedure

WANG Xue-fei, XU Yan, ZHU Xu-Qing, HE Cai-di, ZHANG Xi-jiang

2021, 19(4): 698-701. doi: 10.16766/j.cnki.issn.1674-4152.001896

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Abstract:
Objective This study aimed to investigate the clinical application effect of WeChat group nursing intervention on painless gastrointestinal endoscopy procedure. Methods A total of 126 patients, who were undergoing painless gastrointestinal endoscopy in Taizhou Municipal Hospital from January 2018 to June 2020, were selected as research subjects. The patients were divided into the control group and observation group according to random number table, with 63 cases in each group. The control group was given routine nursing, and face-to-face and paper materials were used for nursing education. The observation group was given WeChat group nursing intervention on the basis of routine nursing, and regular push text, pictures, short videos and other forms of knowledge were given to educate and guide patients. The WeChat group pushed many messages about the right time to take cathartics that can preferably improve intestinal tract cleanliness on the day of examination and the night before. The anxiety status (SAS score), gastrointestinal preparation compliance (diet compliance and laxative medication compliance), intestinal cleanliness (Boston bowel preparation scale, BBPS score) and patient satisfaction were compared between the two groups. Results After nursing intervention, SAS scores of the two groups decreased to varying degrees (all P < 0.05), and the observation group was significantly lower than the control group (all P < 0.05). The diet compliance and laxative medication compliance of the observation group were significantly higher than those of the control group (all P < 0.05). The BBPS score and patient satisfaction score of the observation group were (8.62±0.31) points and (97.16±2.04) points, respectively, which were significantly higher than those of the control group [(8.13±0.26) points and (92.08±1.37) points, respectively], and the difference was statistically significant (all P < 0.05). Conclusion The clinical application effect of WeChat group nursing intervention on painless gastrointestinal endoscopy is remarkable, which can improve the quality of intestinal cleansing.

2021, 19(4): 702-704. doi: 10.16766/j.cnki.issn.1674-4152.001897

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Abstract:

Risk assessment of carotid intimal thickening in elderly patients with type 2 diabetes by coronary risk index: Inverted U curve

LI Shi-wei, YU Wei-hua, CHEN De-yu, YAN Ting, ZHENG Jun-jun, FENG Huan

2021, 19(4): 530-533. doi: 10.16766/j.cnki.issn.1674-4152.001853

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Abstract:
Objective To explore the predictive value of coronary risk index (CRI) for carotid atherosclerosis (CAD) in elderly patients with type 2 diabetes mellitus (T2DM) and provide references for clinical screening of risk for CAD. Methods A total of 156 elderly patients with T2DM who were treated in two third-class hospitals in Hefei from September 2019 to December 2019 were selected. On the basis of carotid artery intimal thickening and plaque formation, the patients were divided into non-carotid arteriosclerosis groups: Control group (55 cases), carotid artery intimal thickening group (52 cases) and carotid artery plaque formation group (49 cases). The clinical data of each group were recorded. Data were analysed using SPSS 25.0. Results Spearman correlation analysis revealed that the coronary heart disease risk index was positively correlated with carotid artery intima thickness in the elderly patients with T2DM (r=0.158, P=0.049). With the quartile of CRI as the critical value, the coronary heart disease risk index was divided into four intervals (Q1-Q4), and carotid artery intima thickness was analysed via logistic regression analysis. In the Q1-Q3 interval, as the risk of carotid artery intimal thickening increased as CRI increased (OR values for Q1, Q2 and Q3 were 1.000, 1.677 and 5.333, respectively). In the Q4 interval, increased CRI the risk of carotid artery intimal thickening slightly decreased as CRI increased (OR=2.970). The increase in ratio displayed an inverted U-shaped relationship with the risk of carotid artery intimal thickening in the elderly patients with T2DM. Conclusion When CRI ranges from 3.59 to 4.14, medical staff should carefully observe if patients are showing clinical signs of microvascular diseases; if the CRI is at an excessively high level for a long time (CRI ≥4.15), the staff should be alerted to the occurrence of occult microvascular diseases. Clinically, the Total Cholesterol/High-Density Lipoprotein Cholesterol (TC/HDL-C) ratio can be included in screening for CAD among elderly patients with T2DM to comprehensively evaluate the risk of CAD in these patients.

Relationship between circadian rhythm of blood pressure and carotid atherosclerosis in the elderly with hypertension

Ll Jing, ZHE Jian-qing, LUO Juan-juan, ZHANG Su-yun, LIU Mei-li

2021, 19(4): 534-537. doi: 10.16766/j.cnki.issn.1674-4152.001854

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Abstract:
Objective This study aimed to investigate the relationship between circadian rhythm of blood pressure and carotid atherosclerosis in elderly patients with hypertension. Methods A total of 128 patients with senile hypertension, who were undergoing treatment in the First Affiliated Hospital of Xi'an Jiaotong University from February 2019 to February 2020, were selected as the research object. On the basis of the 24 h ambulatory blood pressure monitoring results, the patients were divided into the dipper hypertension group (32 cases) and abnormal circadian rhythm (96 cases), and abnormal circadian rhythm was then divided into the non-dipper hypertension group (68 cases) and the reverse dipper hypertension group (28 cases). The intima-media thickness (IMT) and plaque occurrence in the left and right common carotid artery in each group were measured, and the 24-h systolic blood pressure, 24-h diastolic blood pressure, daytime systolic blood pressure, daytime diastolic blood pressure, nocturnal diastolic blood pressure systolic blood pressure of each group were measured, and the general clinical data and relevant biochemical indicators were collected. The clinical indicators of patients in each group were compared. Results Nocturnal systolic blood pressure and nocturnal diastolic blood pressure in patients with abnormal circadian rhythm were significantly higher than those in the dipper hypertension group (all P < 0.01). The incidence of plaque in patients with abnormal circadian rhythm was significantly higher than that of the dipper hypertension group (P < 0.01). The IMT values of the left and right sides of patients with abnormal circadian rhythm were significantly higher than those of the dipper hypertension group (all P < 0.01). The nocturnal systolic blood pressure and nocturnal diastolic blood pressure were significantly higher in the anti-arytenoid group than in the non-arytenoid group (all P < 0.01). The detection rate of left common carotid artery plaque and left IMT in the non-dipper hypertension and reverse dipper hypertension groups was significantly higher than those in the right side of the same group (all P < 0.05). Conclusion The circadian rhythm of blood pressure in elderly patients with hypertension is significantly different between nocturnal systolic blood pressure and diastolic blood pressure. The circadian rhythm of blood pressure is related to carotid atherosclerosis, and abnormal circadian rhythm of blood pressure causes more damage to target organs. Moreover, abnormal circadian rhythm of blood pressure of non -dipper hypertension and reverse dipper hypertension patients causes more damage to left carotid intima than right.

Application of different types of sedation methods in painless induced abortion and their influence on cognition of puerpera

CHEN Xi-xi, CHEN Gui-hai, WANG Huan, JIANG Hui, HUANG Jin, LIU Xue-sheng, LIU Xun-qin

2021, 19(4): 538-541, 546. doi: 10.16766/j.cnki.issn.1674-4152.001855

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Abstract:
Objective The aim of this study is to compare the effect of propofol and etomidate alone or combination in painless artificial abortion and their influence on cognition of puerperal. Methods One hundred and eighty pregnant women scheduled for painless induced abortion in the First Affiliated Hospital of Anhui Medical University from January to April 2019 were randomized assigned into P (propofol), E (etomidate) and EP (etomidate combined with propofol) groups. Before leaving the operating room, the cognitive level was assessed by Montreal cognitive assessment (MoCA). The figures of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), SpO₂ were recorded before anesthesia, and after anesthesia induction, during operation and at the end of operation. The injection pain, myoclonus, hypotension, bradycardia, hypoxemia, nausea and vomiting, and other adverse reactions were recorded. The total dose, operation time, recovery time and departure time were recorded. Results There were no significant differences in the total score and cognitive domain index scores of MoCA among the three groups (all P>0.05). The P and PE groups obtained relatively satisfactory anesthesia, but the anesthetic effect of 4 cases in the E group was not good. There was no significant difference in SBP, DBP, MAP and HR among groups (all P>0.05), however, there was significant difference in SpO₂ among different time points (all P < 0.05). There were interaction effects among groups and time points had interventions on SBP, DBP and MAP. Different interventions and different time points had significant effects on SpO₂, and there was interaction (all P < 0.05). The P group had more injection pain than the E and EP and groups (all P < 0.017), the P and EP groups had more frequent hypoxemia as compared with the E group (all P < 0.017), and myoclonus and nausea and vomiting were more frequent in the E group when compared with the P and EP groups. Conclusion The propofol and etomidate alone or combination had similar short-term effect on cognition, the combination of propofol and etomidate had the best anesthetic effective in painless abortion, however, etomidate alone had the best safety.

PM-induced IL-17A expression enhances airway inflammation in cigarette-exposed mice

ZHONG Yu, SU Guo-mei, XIONG Zhi-lin, HUANG Tong, LUO Chao-le, LAI Tian-wen

2021, 19(4): 542-546. doi: 10.16766/j.cnki.issn.1674-4152.001856

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Abstract:
Objective This study aimed to investigate the mechanisms of atmospheric fine particulate matter (PM), which enhanced the inflammatory response in cigarette-exposed mice. Methods Wild-type and IL-17A knockout (IL-17A^-/-) mice were randomly divided into the control group, smoked group, PM group and smoked+PM group according to the random number table method (6-8 mice/group). Mice were exposed to smoke using cigarette smoke exposure device. PM was inhaled by airway instillation, and airway inflammation was observed. After continuous intervention for 3 months, mice were sacrificed to measure airway inflammation. HE was used to detect inflammatory infiltration in lung tissue, and ELISA and RT-PCR were used to detect inflammatory cytokines in lung tissue. Smooth muscle expression was detected by immunohistochemistry, and collagen deposition was observed by Masson staining. In addition, IL-17A-secreting lymphocytes were detected by cell flow cytometry. In in vitro experiments, different concentrations of cigarette smoke extract (CSE) and/or PM were used to stimulate human airway epithelial (HBE) cells, and IL-17A siRNA was used to knock down IL-17A gene in HBE cells. RT-PCR detects the expression of inflammatory factors. Results Compared with the control, smoked and PM groups, lung tissue inflammatory factors (CXCL1, TFG-β1, IL-6 and IL-17A), collagen deposition and smooth muscle expression were significantly increased in the smoked+PM group. By contrast, IL-17A^-/- mice can alleviate the above-mentioned indicators. Flow cytometry found that PM promoted IL-17A expression by regulating CD4 cells and worsened the inflammatory response induced by smoking. In vitro, CSE or PM intervention in HBE cells can induce the secretion of IL-6 and IL-8, whereas CSE combined with PM can further increase the expression of IL-6 and IL-8. Knockout of IL-17A gene in HBE cells can alleviate the expression of IL-6 and IL-8. Conclusion PM can induce the expression of IL-17A and exacerbate the inflammation, collagen deposition and smooth muscle hyperplasia in the lung tissue of cigarette-exposed mice, suggesting that targeted therapy for the IL-17A signalling pathway may be effective in relieving acute exacerbation of COPD caused by PM.

Correlation analysis of mir-15a and postoperative recurrence amongst patients with bladder carcinoma

CAO Zhen-xue, CUO Yuan-yuan, LIU Bei-bei, SUN Wei, GAO Wu-yue, LIANG Yu-jie, LIU Jian-min

2021, 19(4): 547-549, 647. doi: 10.16766/j.cnki.issn.1674-4152.001857

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Abstract:
Objective This study aimed to investigate the correlation between the miR-15a expression level and progression of bladder cancer and postoperative recurrence in patients with bladder cancer. Methods Thirty-two patients diagnosed with bladder cancer who underwent transurethral plasma resection of bladder tumour transurethral resection of bladder tumour (TURBT) in the Department of Urology of the First Affiliated Hospital of Bengbu Medical College from June 2014 to December 2019 were enrolled in this study. Bladder cancer tissue was obtained from the tumour site, whereas paracancerous tissue was obtained from the adjacent normal area. Real-time quantitative polymerase chain reaction was used to detect the expression of miR-15a in bladder cancer tissue samples or paracancerous tissue samples. The Kaplan-Meier method was used to describe the postoperative prognosis curve, and log-rank test was used for comparison amongst groups. The χ²-test test was used to compare the differences in the expression level and general clinical characteristics of miR-15a in bladder cancer tissues and matched paracancerous tissues. Multivariate logistic regression analysis was used to describe the clinicopathological features such as muscular invasion, distant metastasis and tumour grade. Results The expression level of miR-15a in bladder cancer tissues was significantly lower than that in adjacent tissues (1.126±0.254 vs 1.450±0.139), and the difference was statistically significant (P < 0.001). In addition, the miR-15a expression level was significantly correlated with muscular invasion (P=0.001), distant metastasis (P=0.005) and tumour grade (P=0.027). Log-rank test showed that patients with down-regulated miR-15a expression had a higher overall recurrence rate, and the difference was statistically significant (P=0.023). Multivariate logistic regression analysis showed that positive distant metastasis, muscular invasion (T2-T4) and tumour grade G3 were independent risk factors for the down-regulation of miR-15a expression. Conclusion The expression level of miR-15a may be closely related to the occurrence and development of bladder cancer, and its expression level is significantly correlated with muscular invasion, distant metastasis and tumour grade. The down-regulated expression level of miR-15a may be a biomarker for bladder tumour recurrence.

Analysis of factors related to pulmonary infection after radical resection of lung cancer

LIU Dong-dong, SHEN Jian, HUANG Si-yuan, WANG Hai-lao

2021, 19(4): 550-553. doi: 10.16766/j.cnki.issn.1674-4152.001858

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Abstract:
Objective To investigate the factors influencing pulmonary infection after radical resection of lung cancer. Methods Eighty-two patients who underwent radical resection of lung cancer in Department of Cardio-thoracic Surgery in Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College were selected from February 2018 to February 2020. Eighty-two cases of lung cancer, according to whether the lung infection can be divided into pulmonary infection (23 cases) and non-pulmonary infection group (59 cases). The general clinical data of the patients were collected. The factors related to lung cancer that affect postoperative pulmonary infection after radical cure were analysed. Results The incidence of postoperative pulmonary infection was 28.05%. Univariate analysis revealed no significant correlation among gender, hypertension, preoperative pulmonary function, lobectomy site, pathological type, pathological stage and postoperative pulmonary infection (all P>0.05). Age (≥60 years old), VAS score of incision (4-10 points), long-term smoking history, combined chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), operation duratiion (≥3 h), operation method (i.e., traditional thoracotomy), mechanical ventilation time (≥6 h) and indwelling time of thoracic drainage tube (≥4 days) were closely correlated with pulmonary infection (all P < 0.05). Logistic multivariate analysis showed that age (≥60 years old), long operation duration (≥3 h), combined COPD, DM, operation method (traditional thoracotomy), long-term smoking history, VAS score of incision (4-10 points) and long duration of pleural indwelling drainage (≥4 days) were independent influencing factors for postoperative pulmonary infection in patients undergoing radical resection of lung cancer (all P < 0.05). Conclusion The incidence of postoperative pulmonary infection is high in lung cancer patients after radical resection pulmonary infection. The risk factors of postoperative pulmonary infection in patients with lung cancer after radical resection are age (≥60 years old), long operation duration (≥3 h), with COPD, with DM (traditional surgery), surgical way, long-term smoking history, VAS score of incision (4-10 points) and long chest drainage timeline (≥4 days). These risk factors should be paid more attentions so as to reduce the incidence of postoperative pulmonary infection.

The prognostic value of SII, NLR, PLR and LMR in the stage of ⅠA-ⅡA2 cervical cancer

Ll Ying, YANG Bo, ZHANG Jing

2021, 19(4): 554-557,576. doi: 10.16766/j.cnki.issn.1674-4152.001859

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Abstract:
Objective To investigate the prognostic value of systemic immune inflammatory index (SⅡ), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) in patients with cervical cancer of stage ⅠA-ⅡA2 before treatment. Methods 196 patients with cervical cancer of stage ⅠA2-ⅡA2 who were initially diagnosed in the First Affiliated Hospital of Bengbu Medical College from May 2012 to December 2014 were included. The Cut off values of NLR, PLR, LMR and SⅡ were calculated and divided into high and low value groups.The relationship between the four indexes and clinicopathological parameters in the high and low value groups were observed. The difference in overall survival between high and low value groups were compared. Univariate and multivariate analyses were performed to assess the predictive validity of independent risk factors, and establish a nomogram. Results NLR was correlated with histological type and lymphatic vascular stromal infiltration, PLR was correlated with histological type and tumor size, and SⅡ was correlated with histological type, with statistically significant difference respectively (all P < 0.05). The high value group of NLR, PLR and SⅡ and the low value group of LMR had shorter OS, and the difference was statistically significant (all P < 0.05). PLR, SⅡ, histological type and lymph node metastasis were independent risk factors for OS (all P < 0.05). Predictive validity: PLR>SⅡ>lymph node metastasis>the histological type (AUC: 73.2%>71.9%>65.1%>37.0%). The accuracy of the nomogram was high (OS3/OS5 AUC: 90.7%/79.1%). Conclusion The value of PLR and SⅡ before treatment can be reliable indicators to predict the prognosis of patients with stage ⅠA2~ⅡA2 cervical cancer.

Mangiferin relieves Staphylococcus aureus-induced pneumonia by inhibiting the NF-κB signalling pathway

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

2021, 19(4): 558-560. doi: 10.16766/j.cnki.issn.1674-4152.001860

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Abstract:
Objective This study aimed to investigate the effect of mangiferin on Staphylococcus aureus-induced pneumonia and on the NF-κB signalling pathway. Methods Fifty Balb/c male mice were randomly divided into five groups by the random number method, with 10 mice in each group: control group, S. aureus group and mangiferin (15, 30 and 60 mg/kg) group. After 1 h of S. aureus-induced modelling, the mangiferin group was given intraperitoneal injection of mangiferin. After 12 h, the alveolar lavage fluid and lung tissues of each group were collected. The TNF-α and IL-1β levels of alveolar lavage fluid, wet-to-dry ratio (W/D), activity of pulmonary myeloperoxidase (MPO) and the p65 level of lung tissue were measured. Results Compared with the model group, low, middle and high dose of mangiferin could effectively reduce TNF-α, IL-1β, W/D and MPO in a quantitative manner (all P < 0.05). The TNF-α, IL-1β, W/D and MPO of the high-dose mangiferin group were (3.25±0.52) ng/mL, (3.53±0.65) ng/mL, 7.16±0.34 and (3.15±0.61) U/g, respectively, which were significantly lower than those of the model group[(5.28±0.93) ng/mL, (6.63±0.85) ng/mL, 10.55±0.92, (6.74±0.85) U/g, t=6.025, P < 0.001; t=9.161, P < 0.001; t=10.930, P < 0.001; t=10.850, P < 0.001]. Mechanism research showed that mangiferin could effectively down-regulate p-p65 induced by S. aureus. Conclusion Mangiferin could improve S. aureus-induced pneumonia in mice by inhibiting the NF-κB signalling pathway.

Application of serum albumin, globulin and creatinine in predicting the severity of Guillain-Barré syndrome

JIANG Bo, SHI Peng, LIU Dong-liang, SANG Qing-qing, SONG Chuan-wang, SANG Dao-qian

2021, 19(4): 561-563, 692. doi: 10.16766/j.cnki.issn.1674-4152.001861

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Abstract:
Objective To explore the application of serum albumin, globulin and creatinine to predict the severity of Guillain-Barré syndrome (GBS). Methods A total of 106 patients with GBS treated in the Department of Neurology, the first affiliated Hospital of Bengbu Medical College from June 2016 to May 2020 were selected. Hughes functional score was used to compare the differences of albumin, globulin and creatinine between the two groups. Spearman correlation analysis was used to analyze the correlation between the levels of albumin, globulin, creatinine and the severity of disease in patients with GBS. The globulin and creatinine related to the severity of the disease were selected and analyzed by ROC curve. Results The levels of serum albumin (40.12±4.43) g/L and creatinine (63.47±11.64) μmol/L in GBS patients were lower than those in healthy controls [(47.42±4.14) g/L, (83.96±31.00) μmol/L, all P < 0.05], while the levels of globulin (29.94±5.68) g/L were higher than those in healthy controls (24.58±6.17) g/L, P < 0.05. The levels of globulin and creatinine in patients with GBS were correlated with the severity of the disease (r=0.353, P < 0.001; r=0.323, P < 0.001). The ROC curve showed that the area under the curve of globulin predicting GBS severe group was 0.699 (95% CI: 0.602-0.784). The area under the curve predicted by creatinine in GBS severe group was 0.671 (95% CI: 0.573-0.760). Conclusion The level of globulin in patients with GBS is positively correlated with the severity of the disease, while the level of creatinine is negatively correlated with the severity of the disease. Globulin and creatinine have certain value in evaluating the severity of GBS.

Analysis of different gender-related factors and observation of the safety of enhanced external counterpulsation in elderly patients with heart failure and preserved ejection fraction

HUANG Xin, KONG Hong-jiao, ZHU Ming-na, HUANG Lin-kai, YANG Yu, REN Xiao-ying, ZHANG Hui

2021, 19(4): 564-567. doi: 10.16766/j.cnki.issn.1674-4152.001862

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Abstract:
Objective This study aimed to explore the gender-related factors and clinical characteristics of elderly patients with heart failure and preserved ejection fraction (HFpEF) and compare the safety of enhanced external counterpulsation (EECP) in the treatment of elderly patients with HFpEF of different genders. Methods A total of 200 elderly patients (≥65 years old) who received EECP treatment at the Second Affiliated Hospital of Zhengzhou University from January 2019 to January 2020 and were diagnosed with HFpEF were divided into the male group (n=88) and female group (n=112) according to gender. General clinical data (age, BMI, smoking history and past history), inspection data [NYHA cardiac function grade, renal function, left ventricular ejection fraction (LVEF) and Brain Natriuretic Peptide], BNP were recorded, and the adverse reactions of the elderly HFpEF patients of different gender were compared after EECP treatment. Results The number of elderly women with HFpEF was significantly higher than that of men (56% and 44%, P < 0.05), and the age of disease, BMI and LVEF were greater than that of men (all P < 0.05). There are more patients in the NYHA heart function class Ⅲ and Ⅳ in the female group than in the male group; the number of elderly male HFpEF patients with smoking history was greater than that of females (P < 0.05), and there are more patients in the NYHA cardiac function classification of grade Ⅰ and Ⅱ in the male group than in the female group. Analysis of related factors showed that obesity, atrial fibrillation, hypertension and LVEF have a strong correlation with the female group (all P < 0.05); smoking history and hyperlipidaemia have a strong correlation with the male group (P < 0.05). The incidence of adverse reactions in different gender groups of EECP treatment for HFpEF was not statistically significant (7.95% vs. 9.82%, P > 0.05). Conclusion Gender differences in the relevant factors of elderly HFpEF patients are found, and the clinical characteristics of elderly female HFpEF patients are unique, but EECP has the same safety for elderly HFpEF patients of different gender.

Expression of B cell activating factor and interleukin-21 in the plasma of patients with Hashimoto's thyroiditis

HE Cheng-cheng, JIN Guo-xi, BI Ya-xin

2021, 19(4): 568-571. doi: 10.16766/j.cnki.issn.1674-4152.001863

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Abstract:
Objective To investigate the expression of human B cell activating factor (BAFF) and interleukin-21 (IL-21) in the plasma of patients with Hashimoto's thyroiditis (HT) and explore their roles in the pathogenesis of HT. Methods Patients with HT in the Endocrinology Clinic of The First Affiliated Hospital of Bengbu Medical College from December 2019 to June 2020 were selected as the observation group (HT group, n= 82). According to thyroid functions, the HT group was further divided into an NHT group (normal thyroid function, n= 39) and an SHT group (hypothyroidism or subclinical hypothyroidism, n=43). A total of 51 patients (NC group) who visited the hospital for consultation during the same period were designated as the control group. Peripheral venous blood plasma was collected. BAFF and IL-21 were tested via enzyme-linked immunosorbent assay(ELISA). Thyroid function, thyroid microsomal antibody (TMAB) and thyroglobulin antibody (TGAB) were detected via chemiluminescence immunoassay. Data were analysed using SPSS 24.0. Results The levels of BAFF and IL-21 in the plasma of the HT group were significantly higher than those of the NC group (all P < 0.05). The levels of BAFF in the SHT group was significantly higher than that in the NHT group (P < 0.05). The plasma levels of BAFF in the patients with HT were positively correlated with TGAB and TMAB (r=0.444 and 0.401, respectively; all P < 0.05). Similarly, IL-21 was positively correlated with TGAB and TMAB (r=0.451 and 0.451, respectively; all P < 0.05). A positive correlation was observed between BAFF and IL-21 (r=0.324, P < 0.05). By contrast, a negative correlation was found between BAFF and total T4(TT4, r=-0.214, P < 0.05). The combined diagnosis of HT with BAFF and IL-21 (AUC=0.896) was more valuable than that of BAFF (AUC=0.862) and IL-21 (AUC=0.809) alone. Conclusion BAFF combined with IL-21 has a certain value in the diagnosis of HT. BAFF and IL-21 play an important role in the occurrence and development of HT. Moreover, they participate in the maturation, proliferation and differentiation of B cells. Finally, they participate jointly in the production of TGAB and TMAR.

Immunophenotype and clinical characteristics of acute myeloid leukaemia with positive FLT3-ITD

FENG Hui-xin, YANG Yan-li, GENG Ying-hua

2021, 19(4): 572-576. doi: 10.16766/j.cnki.issn.1674-4152.001864

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Abstract:
Objective To explore the immunophenotype and clinical characteristics of patients with acute myeloid leukaemia (AML) with fms-like tyrosine kinase 3-internal tandem replication (FLT3-ITD) mutation. Methods A total of 103 patients with AML (excluding the M3 type), including 24 patients with FLT3-ITD⁺ (positive group) and 79 patients with FLT3-ITD^- (negative group), who were initially diagnosed in the haematology department of the First Affiliated Hospital of Bengbu Medical College from December 2016 to December 2018 were enrolled in this study. The clinical haematological characteristics and immunophenotypes of the two groups were retrospectively studied. The patients in both groups were followed up, and the overall reaction rate (OR), progress-free survival (PFS) and overall survival (OS) were calculated. Results The expression rates of CD33, CD7, CD56 and CD38 in the FLT3-ITD⁺group were significantly higher than those in the FLT3-ITD^- group (all P < 0.05). By contrast, the expression rates of CD13 and CD34 were low (all P < 0.05). White blood cell count, haemoglobin count, bone marrow leukaemia cells and mutation rate of combined NPM1 in the FLT3-ITD⁺ group were higher than those in the FLT3-ITD^- group (all P < 0.05). after the treatment the Objective response rate in the FLT3-ITD^- group (78.5%) was significantly higher than that in the FLT3-ITD⁺ group (33.3%), and the difference was statistically significant (P < 0.001). The median OS and PFS in the FLT3-ITD⁺ group were 9.5 and 9 months, respectively, and those in the FLT3-ITD^- group were 17 and 16 months, respectively. The OS and PFS of the FLT3-ITD^- group were longer than those of the FLT3-ITD⁺ group (P < 0.05). Conclusion Patients with AML with FLT3-ITD⁺ have abnormal expression of leukaemia cell antigen, high peripheral blood leukocytes, abundant haemoglobin and bone marrow primordial cells, are prone to NPM1 mutation, have shortened PFS, OS and reduced the response rate. Hence, the treatment effect and prognosis of these patients are poor.

Application of fluid infusion under Flotrac/Vigileo monitoring in laparoscopic radical cystectomy for bladder cancer in elderly patients

SONG Zhen-dong, WEN Shao-yun, LI Xin

2021, 19(4): 577-580, 606. doi: 10.16766/j.cnki.issn.1674-4152.001865

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Abstract:
Objective This study aimed to investigate the effects of infusion under Flotrac/Vigileo monitoring on postoperative recovery and inflammatory response in patients undergoing laparoscopic radical cystectomy for bladder cancer. Methods A total of 160 patients undergoing laparoscopic radical cystectomy for bladder cancer in Taizhou Central Hospital from January 2019 to December 2019 were selected and divided into group A and group B by the random number method, with 80 patients in each group. Group A was given liquid infusion based on "4/2/1" rule for Ⅳ, and group B was given liquid infusion according to Flotrac/Vigileo monitoring results. Peripheral venous blood was collected before surgery, 1 day after surgery, 3 days after surgery and 7 days after surgery. Serum samples were separated. Serum levels of tumour necrosis factor-α (TNF-α), interleukin-2 (IL-2) and IL-6 were determined by double-antibody ELISA. Results No significant differences in anaesthesia time, operation duration, postoperative recovering time, total fluid volume, blood loss and urine volume, haemodynamics, complications, length of hospital stay, bladder volume, maximum urine flow rate and bladder pressure were found between the two groups (all P > 0.05). The amount of colloid Ⅳ solution in group B [(1 291.45±224.83) mL] was higher than that in group A (P < 0.05), and the amount of crystalloid Ⅳ solutions in group B [(992.13±234.15) mL] was lower than that in group A (P < 0.05). The anal exhaust time of group B [(61.35±14.16) h], time to post-operative ambulation [(6.34±1.42) h] and time of resuming feeding [(3.51±1.07) h] were all shorter than those of group A (all P < 0.05). Compared with preoperation, the serum levels of TNF-α and IL-6 increased and IL-2 decreased in the two groups at 1 and 3 days after operation (P < 0.05). The serum levels of TNF-α and IL-6 in group B were higher than those in group A, while the serum level of IL-2 was lower than that in group A (P < 0.05). Conclusion Infusion under Flotrac/Vigileo monitoring can promote postoperative recovery and inhibit perioperative inflammatory response in patients undergoing radical laparoscopic radical bladder cancer surgery.

The predictive value of variation index of inferior vena cava measured by ultrasonography and central venous pressure in volume responsiveness in patients with septic shock

GAO Shan, ZHANG Yong

2021, 19(4): 581-585. doi: 10.16766/j.cnki.issn.1674-4152.001866

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Abstract:
Objective To compare the predictive value of inferior vena cava ultrasound indicators and central venous pressure (CVP) as predictors of fluid of responsiveness in patients who experienced septic shock. Methods Twenty-seven patients who experienced septic shock were enrolled in the study. The diameter of inferior vena cava (d-IVC) and its variation with respiration (v-IVC), CVP measured by bedside ultrasound, arterial blood lactate level and cardiac index (CI) were collected at hospitalisation and after resuscitation. The fluid resuscitation was performed as follows: All patients were administered with 7 mL/kg lactated Ringer's solution (ideal body weight) within 20 min. Fluid responsiveness was defined as ΔCI≥15% after resuscitation (responding group or R group, n=19; the rest was classified as nonresponding group or NR group, n=8). The accuracy of predicting volume responsiveness was evaluated by plotting the receiver operating characteristic (ROC) curve on the basis of the measured indicators before resuscitation. Results Compared with the NR group, the R group had a low d-IVC_min, d-IVC_max and a significantly high v-IVC before resuscitation (P < 0.05). However, no significant difference was observed in lactate level of arterial blood, CVP before resuscitation (P > 0.05). The optimal cut-off value of v-IVC was 17.65%. The sensitivity and specificity of the predictive value of volume responsiveness in patient who experienced septic shock were 100.0% and 87.5%, respectively. The area under the ROC curve of v-IVC for predicting volume responsiveness was 0.924 (95% CI: 0.781-1.000). Conclusion The predictive value of v-IVC in the volume responsiveness of patients who experienced septic shock is high, and the predictive value is higher when v-IVC >17.65%.

Expression of serum SUR1 in middle-aged and elderly patients with aneurysmal subarachnoid hemorrhage and its relationship with prognosis

GU Tian-yi, YANG Qi-guo, JIN Bo

2021, 19(4): 586-588, 688. doi: 10.16766/j.cnki.issn.1674-4152.001867

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Abstract:
Objective To investigate the expression and correlation of serum sulfonylurea receptor 1 (SUR1) in middle-aged and elderly patients with aneurysmal subarachnoid haemorrhage (aSAH). Methods Ninety-one patients suffering from aSAH admitted to Ningbo Sixth Hospital from July 2015 to May 2019 were selected as the observation objects. The expression of SUR1 in serum before operation was detected via fluorescence real-time quantitative polymerase chain reaction. According to the median expression of Sulfonylurea receptor 1(SUR1) in serum before operation, the patients were divided into low SUR1 expression group (n=46) and high SUR1 expression group (n=45). Before operation, the degree of nerve defect in the patients with aSAH was evaluated using the national institutes of health stroke scale (NIHSS) score. At 6 months after operation, prognosis was assessed using the Glasgow Outcome Scale, and the patients were divided into good prognosis group (n=77) and poor prognosis group (n=14). The expression of SUR1 before operation was compared between the two groups. The correlation between SUR1 expression and NIHSS score was evaluated via Spearman correlation analysis. The prognostic factors of the patients with aSAH were analysed via Cox model. Results The proportion of patients with hypertension history, with diabetes history, preoperative NIHSS score and operative timing in the good prognosis group were lower than those in the poor prognosis group (all P < 0.05). The expression of serum SUR1 in patients with aSAH in the poor prognosis group was higher than that in the good prognosis group (P < 0.05). Spearman correlation analysis revealed a positive correlation between serum SUR1 expression and NIHSS score in the patients with aSAH (P < 0.05). The Results of Cox regression model showed that age of >60 years, history of hypertension, history of diabetes, NIHSS score ≥15, 3-7 d of operation timing and SUR1 overexpression were all independent risk factors for the prognosis of patients with aSAH (all P < 0.05). Conclusion SUR1 may be involved in the development and progression of aSAH in the middle-aged and the elderly, and may become a serological index for the assessment of aSAH and treatment target.

Diagnostic value of different types of capsule endoscopy in digestive tract diseases

LIU Man, KE Xi-quan, WANG Qi-zhi, ZHU Yu, CUI Yan-yan, LIU Xiao-yang, DENG Xiao-jing

2021, 19(4): 589-592. doi: 10.16766/j.cnki.issn.1674-4152.001868

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Abstract:
Objective To compare the clinical value of small bowel capsule endoscopy (SBCE) and magnetically controlled capsule endoscopy (MCE) in the diagnosis of digestive tract diseases. Methods A total of 154 patients who underwent capsule endoscopy in the Department of Gastroenterology of our hospital were selected, and the clinical data were analyzed retrospectively. The feasibility and detection of diseases of capsule endoscopy were analyzed, and the differences of small intestinal diseases among SBCE patients with different gender, age and main clinical symptoms were analyzed. Results All the patients who underwent capsule endoscopy successfully completed the examination of the main parts of digestive tract and collected images, which were finally discharged smoothly within 2 weeks. Only one elderly patient developed adverse reactions during the magnetic capsule endoscopy and then self-relieved. The overall detection rate of digestive tract diseases in the MCE group was 96.6% (85/88) higher than that in the SBCE group 78.8% (52/66), and the difference was statistically significant (P < 0.05). The detection rate of small intestinal diseases in SBCE group was 71.2% (47/66) higher than that in MCE group 21.6% (19/88), and the difference was statistically significant (P < 0.05). The detection rate of intestinal lesions in SBCE group with gastrointestinal bleeding was 95.7% (22/23) higher than that in other symptom groups, and the difference was statistically significant (P < 0.05). In MCE group, the detection rate of gastric lesions was 90.9% (80/88), while that of small intestine lesions was 21.6% (19/88). And erosive lesions were 42.1% (8/19) and ulcerative lesions were 31.6% (6/19) in small intestine lesions. Conclusion SBCE and MCE are both important ways to screen digestive tract diseases.SBCE has high diagnostic value for small intestinal diseases, especially for small intestinal bleeding. MCE not only has a high detection rate for stomach diseases, but also has certain significance in diagnosis of small intestine diseases.

Study on the reducing toxicity and enhancing efficacy of Jiedu Quyu Zishen Recipe in treating systemic lupus erythematosus with hormone

HUANG Dan-yun, CHEN Yue, SHI Hai-lan, SHEN Xiao-fen

2021, 19(4): 593-595, 652. doi: 10.16766/j.cnki.issn.1674-4152.001869

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Abstract:
Objective To observe the clinical efficacy and side effect of Jiedu Quyu Zishen Recipe prescription on hormone therapy for systemic lupus erythematosus (SLE). Methods A total of 110 patients with moderate systemic lupus erythematosus were divided into control group (n=55) and study group (n=55) by random number table. Patients in the control group were treated with prednisone acetate, and patients in the study group were given Jiedu Quyu Zishen Recipe supplemented with prednisone acetate. The serum levels of antinuclear antibody (ANA), anti-double stranded DNA (anti-dsDNA), IgA and IgG of the two groups were compared before and after treatment. The SLE disease activity index (SLEDAI) score was conducted to detect the urine protein level, evaluate the clinical efficacy of systemic lupus erythematosus after treatment, and observe the adverse drug reactions during treatment. Results After treatment, the levels of ANA, anti-dsDNA, IgA and IgG in the study group [(1.74±0.18) mg/mL, (0.99±0.10) mg/mL, (1.45±0.12) mg/mL and (8.57±0.74) mg/mL] were significantly lower than those in the control group [(2.15±0.21) mg/mL, (1.32±0.16) mg/mL, (1.78±0.14) mg/mL and (11.57±1.02) mg/mL], P < 0.05. After treatment, SLEDAI score and urine protein content at 24 h [(4.57±0.36) points and (0.67±0.06) g] in the study group were significantly lower than those in the control group [(5.18±0.49) points and (0.93±0.08) g], P < 0.05. The overall response rate of systemic lupus erythematosus in the study group (96.67%) was significantly higher than that in the control group (83.33%), P=0.015. The overall incidence of adverse drug reactions in the study group (11.63%) was significantly lower than that in the control group (33.33%), P=0.004. Conclusion Jiedu Quyu Zishen Recipe can assist prednisone acetate in the treatment of systemic lupus erythematosus. On the basis of reducing the maintenance dose of prednisone acetate, it can effectively relieve clinical symptoms, improve curative effect, and reduce adverse reactions of hormone drugs. It has the effect of enhancing and reducing toxicity, and is worthy of clinical promotion.

Clinical research of 30 premature infants with lowhypotriiodothyronine syndrome

WANG Yue, CHEN Xin

2021, 19(4): 596-598. doi: 10.16766/j.cnki.issn.1674-4152.001870

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Abstract:
Objective To observe the adverse effects of low hypotriiodothyronine (T3) syndrome on premature infants. Methods Thirty premature infants hospitalised in the neonatal ward of The First Affiliated Hospital of Bengbu Medical College from January to 2019 to December 2019 were selected. About 4 to 7 days and 4 weeks after birth, 2 mL of fasting venous blood was collected from the infants. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and triiodothyronine (T3) were determined via electrochemiluminescence. According to the diagnostic criteria, premature infants diagnosed with low T3 were taken as the observation group (n=30), whereas premature infants with normal thyroid functions at the same gestational age were taken as the control group (n=30). No statistical difference was observed in the general conditions of the two groups (P > 0.05), both group were given with the same basic supportive treatment. Differences in the duration of jaundice, feeding intolerance, hospitalisation days, days of birth weight recovery and neonatal behavior neurological assessment (NBNA)test scores at 40 weeks of gestational age were observed between the two groups. Results Between the two groups, T3 levels at 4 to 7 days after birth (t=-19.042, P < 0.001) and FT3 levels at 4 weeks after birth (t=-22.041, P < 0.001) were statistically significant. At 4 weeks after birth, T3 levels (t=-1.933, P=0.059) and FT3 levels (t=-1.622, P=0.110) were not statistically significant. The differences in jaundice duration (t=2.759, P=0.008), feeding intolerance (χ²=8.531, P=0.003), hospitalisation days (t=6.471, P < 0.001) and birth weight recovery days (t=6.584, P < 0.001) were statistically significant between the two groups. However, no statistically significant difference (t=-1.842, P=0.071) was observed in NBNA scores between the two groups at the correct gestational age of 40 weeks. Conclusion Children with a low T3 syndrome have longer jaundice durations, hospitalisation days and weight recovery times, as well as a higher incidence of feeding intolerance, than children with normal thyroid functions. Nevertheless, their short-term neurodevelopment was not significantly influenced.

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2021 Vol. 19, No. 4

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